Whole of society approach for health and

wellbeing

Monika KosińskaProgramme Manager Governance for Health

WHO Regional Office for Europe

Slovenia, 9 June 2015

Introduction

• Moving towards a new strategy and policy framework for Health in the European Region: the road to Health 2020

• Implementing Health 2020: Governance for Health

• Whole-of-society approach to health and well-being

Part I

• Moving towards a new strategy and policy framework for Health in the European Region: the road to Health 2020

• Implementing Health 2020: Governance for Health

• What next: strengthening intersectoral action in the European Region.

Life expectancy at birth

Average gross national income per capita

Life expectancy, by average national income

per capita

Review of social determinants and the health divide in the WHO European Region

• Avoidable health inequities exist within and between countries

• These health inequities have social, economic and environmental causes

• The wealth of a country is not the only factor in determining level of health

• Government choices can make positive difference, at any level of GDP

Key recommendations to improve equity in health• Ensure the best start in life for every child – including early child

education• Improve employment levels and working conditions• Promote equity through adequate social protection, taxes and transfers• Work with local communities to make local environments healthier

(homes, schools, streets, neighbourhoods)• Address the structural and mediating factors of social exclusion• Improve governance mechanisms to act on the social determinants of

health

• “Do Something, Do More, Do Better”

* The study was carried out by a consortium of over 80 policy researchers and institutions across Europe (2012), and led by Sir Michael Marmot.

Health 2020 evidence base

Working to improve health for all and reducing

the health divide

Improving leadership, and participatory governance

for health

Investing in health through a life-course

approach and empowering

people

Tackling Europe’s major

health challenges: NCDs and

communicable diseases

Strengthening people-centred health systems,

public health capacities and

emergency preparedness,

surveillance and response

Creating resilient

communities and supportive environments

Health 2020: four common policy priorities for health

Health 2020: a strategy for Europe

New approach for new challenges

• Complexity, uncertainty, high stakes, and conflicting value

• Systems thinking used to analyse problems and devise solutions

• Policies to be implemented as large-scale experiments

• A commitment to learning from practice

• Monitoring and evaluation systems• Policies adapted based on

experience

Part II

• Moving towards a new strategy and policy framework for Health in the European Region: the road to Health 2020

• Implementing Health 2020: Governance for Health

• Whole-of-society approach to health and well-being

Governance• Governance is about how governments and other

social organizations interact, how they relate to citizens, and how decisions are taken in a complex and globalized world.

(Institute on Governance, Ottawa Policy Brief 15, 2003)

– New types of leadership– New types of engagement– New types of democratization– Steering - diffusion

Governance for Health ‘The attempts of governments or other actors to steer

communities, whole countries, or even groups of countries in the pursuit of health and wellbeing as a collective goal.’

(based on Bell/Hindmoor 2009)

– health is a human right– health is essential to well being– health is a global public good– Health is social justice

Political determinants: indicators of commitment of government and in many sectors of society

Improving governance for health and increasing participation

Source: Kickbusch, 2011

Governing through:

collaboration

citizen engagement

a mix of regulation and persuasion

independent agencies and expert bodies

adaptive policies, resilient structures and foresight

New collaborative approaches

• Governance for health and wellbeing requires both a whole of government (WoG) and a whole of society (WoS) approach.

• Requires new processes and structures, both formal and informal, strengthening collaboration with existing partners and identifying new ones.

• It challenges health system boundaries• It positions human health and well being as an over

arching societal goal grounded in values such as human rights and equity

• It integrates good population health as a key feature of what constitutes a successful society in the 21st century.

• It requires a new role for ministers and ministries of health and health agencies at all levels

Whole of government• Public services agencies working across portfolio

boundaries to achieve a shared goal • An integrated government response to particular issues.• Approaches can be formal or informal. They can focus on

policy development, program management, and service delivery.

(Australian Management Advisory Committee, 2004)

• Includes multilevel activities: aiming for coherence between subnational, national and global levels

• Political commitment and support essential • Builds on HiAP to beyond a health-centric approach

Whole of society• Wicked problems need solutions that go beyond

government and the public sector• Involves stakeholders, particularly citizens, in an inclusive

and participatory way on issues impacting on their health and their communities

• Requires expanded and new forms of communication and new participatory models of governance

• A form of collaborative governance that requires trust building

(Kickbusch 2011)

Implementing Governance for Health

The health sector should be considered “one of a number of intersectoral players in a ‘web’ that makes use of new kinds

of leadership, skills, information and intelligence”

(WHO, 1997).

Part III

• Moving towards a new strategy and policy framework for Health in the European Region: the road to Health 2020

• Implementing Health 2020: Governance for Health

• Whole-of-society approach to health and well-being

Origins of WOS: changing political context

• Substantial shift in geopolitics marked the beginning of the trend towards new models and relationships in health.

• Traditional models of diplomacy, policy and politics – and in particular the power and responsibilities of the state – were challenged and revised

• Transfer of resources to private enterprise as well as a spirit of great collaboration between state and non-state actors

• The emergence of nonstate actors in the geopolitical arena and their influence on the need to move beyond traditional centralized or devolved governmental models in tackling health challenges.

Whole-of-society approach

• Extension of the whole-of-government approach to include the roles of the private sector and civil society

• Beyond institutions: - Influences and mobilizes local and global culture and

media, rural and urban communities - Engages relevant policy sectors, such as the education

system, the transport sector, the environment, urban design.

Participatory governance for health

Thailand’s National Health Assembly Mechanism for opening up the debate on public health policy-making to citizens.

– Attended by over 1500 people, – Discusses health and related issues (eg agriculture,

food prices, economic crises, youth). – Participating groups have equal speaking rights. – Resolutions considered by the National Health

Commission

Collaborative governance: involving citizens

State Health Conferences in Germany• Public health law 1997: health conferences should be held to

debate and discuss solutions to health problems with local stakeholders and community

• Attended by local government, state health institutions, professionals, unions, NGOs, public

• Topic set in advance (eg healthy ageing, patient self-determination, healthy growing-up etc)

• Resolutions passed and must be followed up by government

The role of the private sector• Corporate social responsibility and “inclusive

capitalism”.• Public private partnerships• Self-regulation vs co-regulation vs regulation

• All private actors equal?

Key questions and challenges• Purpose including ownership, priority setting,

duration• Governance including participation, representation,

transparency and accountability• Capacity including public sector as well as partners,

for both implementation as well as governance• Communication including new technologies, ethics

and messages• Trust amongst and between all actors involved

Summary• Response to complex policy challenge• Recognition of power/resources lying outside the

realm of the traditional state• Process is part of the outcome• Justification for inaction in regulation?• Replacement for lack of political will?• Manifestation of public health governance where

government cannot drive change for political/financial reasons?

Concluding comments• Systematically strengthening partnerships is a

key goal of the Health 2020• A partnership-based vision engaging

governments, nongovernmental organizations, civil society, the private sector, science and academe, health professionals, communities – and every individual

• The importance of shared governance for health at all levels supporting whole-of-government and whole-of-society approaches

Thank you for listening!