3 Lessons

1. Plenary Session 1 - Developing HiAP/HIA to reduce Health Inequalities in the context of current systemic crisis Granada 14 April 2011 The Need to Strengthen Health Governance to address the SDH and related Health Inequities: Lessons from Europe Erio Ziglio & Sarah Simpson European Office for Investment for Health and Development World Health Organization, Regional Office for Europe Venice

2. Concept 3 Lessons Context

3. Public Health in a fast changing world… Granada 2011

4. Climate change Source: Climate Change 2007: The Physical Science Basis http://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-chapter10.pdf

5. A world of urbanized people Urbana Rurale Source: World Urbanisation Prospects | 2005 Revision http://www.un.org/esa/population/publications/WUP2005/2005wup.htm

6. By next time we are going to meet…There will be more people over 65 than under 5 Source: World Population Prospects: The 1996 Revision, Annex 2 (Low-Variant Projection) UN Population Division 1

7. A fast changing context for health

8. Concept 3 Lessons Context Issues

9. WHO Study on Governance by Professor Kickbusch “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” Source: Institute on Governance, Ottawa Policy Brief 15, 2003.

10. Adelaide Statement on Health in All Policies moving towards a shared governance for health and well-being

11. In HIA and in making HiAP working there is a need to better understand: “Governance principles, institutional arrangements and delivery instruments, including how progress is monitored and how accountability is defined and managed” Improved and more specific knowledge about these arrangements.

12. Concept 3 Lessons Context Issues

13. Key questions/issues from our work • What are the challenges of governance in different country contexts? • What are the core elements that construct good governance? • What promising practices are emerging in Europe? • What tools can be used to appraise and strengthen governance capacity in countries?

14. In-depth analysis of implementation

15. Sub-national level experiences Italy Czech Republic Slovenia United Kingdom Veneto MURA Project Pomurje Liberec North West Region of England South Moravia Tuscany South Bohemia Friuli Venezia Giulia

16. The need for good governance The issue of health inequities needs to be a whole-of-government priority to be addressed through a coherent set of policies and interventions on a scale appropriate to the trends and magnitude of the problem in the country Source: http://www.scotland.gov.uk

17. 1. Analyse the context • What trends can we identify in relation to governance for SDH/HI? • What factors determine whether or not SDH/HI are on the agenda? • What factors are associated with governance principles such as ‘whole of government approach or “policy consistency” among different levels of policy-making?

18. A tool to assess and strengthen governance capacity • Sustained policy commitment • Robust and equity oriented Health System • Active intersectoral working • Sustained funding mechanism • A high priority for health • Social capital and cohesion for health • Public engagement and community participation • Accountability for health inequities • Health intelligence • Monitoring of system performance • Communication and advocacy • Other according to country context

19. 3. Know the different levels of governance Joint new policy Integrated Policies Adjusted + more efficient sectoral policies Coordination More efficient sectoral policies Cooperation Source: Adapted from Meijers E, Stead D. Policy integration: what does it mean and how can it be achieved? A multi-disciplinary review. Delft University of Technology OTB Research Institute fir housing, Urban and Mobility Studies.

20. Give him charity, girl, as there is nothing worse in life than being blind in Granada.Francisco Alarcón de Icaza, Venezuelian writter. THANK YOU