Social determinants of health and Health in All Policies

1. Social determinants of healthandHealth in All Policies

2. Key message Universal health coverage (UHC) and health equity cannot be achieved without action on social determinants of health and coherent recognition of health across other sectors

3. Social Determinants of Healthin Mongolia • Geographical disparity: remote households, people living in mountains • Employment, informal sector employment • Socialexclusion: on the basis of social identity, homelessness, migrants, garbage collectors, etc. • Poor food variety, lack of fruits and vegetables, increase of low quality imported food • Poor environment: Water and sanitation, air pollution • Weak primary health care • Poor social protection in illness for and disabled people, orphanages, very poor • High out of pocket treatment expenses • Population coverage • Service coverage • Financial protection

4. Social determinants of health

5. Poverty as a social determinant The vicious circle : • Ill health leads to poverty • Poverty leads to ill health The virtuous circle : • Good health is linked to higher income and welfare • Higher income is linked to good health

6. Infant and Under-5 Mortality by Mother’s Education Level, Mongolia 2005

7. Health in All Policies An approach to public policies across sectors that: • systematically takes into account the health implications of decisions • seeks synergies across sectors • avoids harmful health impacts to improve population health and health equity

8. HiAP

9. HiAP reflects the principles of: • population rights and government obligations conferred by national and international law • participation of society in policy process • accountability of governments to their people • transparency of policy-making and access to information • sustainability in use of resources for current and future generations • collaboration across sectors to promote health, equity, and sustainability

10. Patterns of interaction between health and other sectors Malaysia N Ireland Quebec Scotland Sth Australia Sweden England Sri Lanka Wales Cuba Finland Thailand Brazil N Zealand Iran Norway Cooperation Informative Coordination Coherence Integration

11. Broad or issue-specific intersectoral action? • broad strategies; integrating a systematic consideration of health into other sectors’ policy processes. • issue-centred strategies; integrating a specific health concern into other sectors’ policies, e.g. • Both can be used

12. HiAP into action: • Establish the need and priorities for HiAP • Assess and engage other sectors • Foster common understanding between sectors • Identify supportive structures and processes • Enhance community participation • Ensure monitoring, evaluation, reporting and accountability

13. Examples of intersectoral action • WHO Framework Convention on Tobacco Control • Mongolia: Alcohol control • Viet Nam: National mandatory helmet law • South Africa: Mental health • Liverpool: Active City 2005-2010 • Australia: Governance on Health in All Policies • Ghana: Extractive industries – oil and gas sector

14. Healthy soum & aimag towns & cities Local government that can help to: • promote physical activity • increase safety • promote good nutrition and reduce obesity: • encourage farming in urban areas • encourage fruit and vegetable stores in residential areas • reduce fast food restaurants • restrict fast food restaurants near schools

15. Healthy Transport Compact • Inter-agency initiative on transport to: • balance the needs of all transport users • expand mobility • improve public health • support a cleaner environment • create stronger communities • Involves: • Department of Transport • Energy and Environmental Affairs • Public Health

16. NCD prevention can benefit everyone

17. Key Lessons • Use already identified priority public health issues • A supportive governance structure helps to promote integration of strategies and sustain efforts • Establish a common information system with sector-specific data • Community participation and empowerment is critical. • MDG’s can promote intersectoral action • Health Impact Assessment can help identify when intersectoral action is needed

18. Benefits from Intersectoral Action • Health benefits: synergy between different strands of the health and well-being agendas; • Environmental benefits: boosting use of city parks • Educational benefits: enhanced facilities in schools • Transport benefits: enhanced transport and mobility plans • Economic benefits: healthier workforces

19. Thank you