Ottawa – challenges we face

1. Ottawa – challenges we face Ilona Kickbusch Open University London 2006 Kickbusch London 2006

2. 20 Years Ottawa Charter Towards a new public health…………………….. Kickbusch London 2006

3. Towards a new public health… We are challenged to develop a public health approach that responds to the globalized world and its political, social and economic ramifications. The challenge is as large as when public health was first developed. Kickbusch London 2006

4. Better population health depends on: • Making health everybody's business • Ensuring equity. • Making the healthy choice the easier choice • Ensuring sustainability. Kickbusch London 2006

5. Expansion processes of the health society • the expansion of the do-ability of health: something can be done, there is always more health • the expansion of the territory of health into an increasing array of personal, social and political spaces: health is everywhere • the expansion of risk and reflexivity: every choice is potentially also a choice for or against health Kickbusch London 2006

6. Navigating the health society In almost every aspect of our lives we are faced with questions and decisions about health. Kickbusch London 2006

7. But…… UK: One in five people has problems with the basic skills needed to understand simple information that could lead to better health, 15% of adult population have low health literacy Canada: 22% of Canadians are unable to read a medicine label and calculate amounts of medicine US Institute of Medicine: 90 MILLION AMERICANS (NEARLY 1 IN 2 ADULTS) DO NOT UNDERSTAND BASIC HEALTH INFORMATION Kickbusch London 2006

8. Health is created in the context of everyday life: where people live, love, work and play. Ottawa Charter 1986 Google?shop?travel? How to create health go google Kickbusch London 2006

9. Health is created in the context of everyday life: where people live, love, work and play. Ottawa Charter Key components of change: The new public health: Kickbusch London 2006

10. 1. Health and longevity drive society We need to adapt health and welfare Policies to achieve the „longevity dividend“ Kickbusch London 2006

11. Commercialization and Privatization: health as a product Health as a key global market Countries compete on health 2. Consumer society: Health as a global market force Kickbusch London 2006

12. Increasing number of consumer products and choices Kickbusch London 2006

13. Increasing sources of health information Kickbusch London 2006

14. Increasing choices in products and treatments Kickbusch London 2006

15. Increasing provider choices Kickbusch London 2006

16. Empowerment in the consumer society Citizens have a right to • health competencies, • patient competencies, • consumer competencies, • citizen competencies in the context of supportive environments • Health Literacy is a critical empowerment strategy to increase people‘s control over their health, their ability to seekout information and their ability to take responsibility. • Kickbusch/Maag 2005 Kickbusch London 2006

17. The global Risks in the 21st century are transnational and all attempts to control them lead into the international arena The local Global risk production is localized through the “globalization” of everyday life COGNITIVE SPATIAL TEMPORAL 3. The globalizaton of everyday life drives health Kickbusch London 2006

18. Address the trans boundary scapes of health in a global world Kickbusch London 2006

19. Healthscapes: Food - Drink Kickbusch London 2006

20. "The Internet is unlike anything we've seen before," says David Greenfield, PhD, founder of the Center for Internet Studies (www.virtual-addiction.com). "It's a socially connecting device that's socially isolating at the same time." Healthscape: virtual realities Kickbusch London 2006

21. New Regulations in Madrid: A model of 1,76 m. must not weigh less than 56 Kilogramm. That is a Body-Mass-Index of 18.0 and is already below the value assigned to a healthy body weight.Naomi Campbell 1,77 m. and weighs 51 Kilo. That means a BMI of 16. Healthscape Fashion industry Kickbusch London 2006

22. Healthscapes: women’s mobility Migration and increased mobility of women • New slave markets • Forced prostitution • Domestic workers • Health workers • Low paid service work Kickbusch London 2006

23. Foreign policy Security policy Economic policy Trade policy Geopolitics From the ministries of health to: 4. The policy arenas and actors shift Kickbusch London 2006

24. Consider the new health actors Kickbusch London 2006

25. Consider the new health actors Kickbusch London 2006

26. Consider the new health actors Kickbusch London 2006

27. Consider the new health actors: Patient organizations Kickbusch London 2006

28. Health policy in the 21st century is transnational and attempts to control risks by linking the local, national and the global policy arenas Health policy in the 21st century is part of all sectors and attempts to create health through new types of policy networks Health policy becomes an „open system“ Healthy public policy Kickbusch London 2006

29. Open systems of governance • Finnish European Union Presidency • Ideally: health agenda owned by other sectors • Empowering ministries of health • Political will • Governance mechanisms Kickbusch London 2006

30. Open systems of governance • National global health strategies: “to counter from a national standpoint, the threats to global health” • Problems which directly or indirectly threaten populations • Contribution to global problems • Contributions to global solutions • National consensus on principles, values, intent and directions • Foreign policy • Security policy • Economic policy • Trade policy • Demographic Geopolitics Kickbusch London 2006

31. …..a new global POLITICAL ECOSYSTEM MSF CLINTON BONO PHA WEF World Bank 150 PPPH Kickbusch London 2006

32. 5. The Sustainability Challenge Kickbusch London 2006

33. What amount of ressources does it take to create health? „ „Ecological footprint“ of the health system Kickbusch London 2006

34. „Ecological footprint“ Kickbusch London 2006

35. We must begin not end with the political and social determinants of health Health is a determinant Health is an investment Health is a resource Health is a human right Health is a driving force in modern societies The new dynamics of health Kickbusch London 2006

36. The deliberation of major health issues and major health determinants in fora to which the public health community has little or no access – and is not prepared for. Political determinants….. What kind of Ministers of Health?????????? Kickbusch London 2006

37. Political advocacy: Have you voted for health today? • Public health actors must work systematically with political decision makers and parliamentarians at all levels of governance – national, European and global. • Create new types of public health forums Kickbusch London 2006

38. Healthy public policy Supportive environments Community action Personal skills Reorient health services Ottawa Charter health as a global public good a key component of collective human security a key factor of good global governance responsible business practice and social responsibility global citizenship and human rights. Health Promotion in a globalized world Kickbusch London 2006

39. European nations • should ensure through cooperation a common high level of health protection and health rights for all citizens wherever they live, love work and play (and travel, buy or google) • from those risks and threats to their health, safety and well being which are beyond the control of individuals and communities AND NATION STATES • And cannot be effectively tackled by nation states alone but need to be multiactor and multilevel (e.g. health threats, unsafe products, unfair commercial practices). Kickbusch London 2006

40. The global is here not there..... Kickbusch London 2006

41. Interdependence Kickbusch London 2006

42. Global Governance becomes more important MOH Kickbusch London 2006

43. The renewed mandate given to Member States and WHO under the IHR(2005) has also increased their respective roles and responsibilities. In particular, States Parties* to the IHR(2005) are required to develop, strengthen and maintain core surveillance and response capacities to detect, assess, notify and report public health events to WHO and respond to public health risks and public health emergencies. WHO, in turn, is to collaborate with States Parties to evaluate their public health capacities, facilitate technical cooperation, logistical support and the mobilization of financial resources for building capacity in surveillance and response. The broadened purpose and scope of the IHR(2005) are to "prevent, protect against, control and provide a public health response to the international spread of disease and which avoid unnecessary interference with international traffic and trade." Regulatory power 1 Kickbusch London 2006

44. "The WHO FCTC negotiations have already unleashed a process that has resulted in visible differences at country level. The success of the WHO FCTC as a tool for public health will depend on the energy and political commitment that we devote to implementing it in countries in the coming years. A successful result will be global public health gains for all." Dr LEE Jong-wook. Director-General, World Health Organization 2006 Regulatory Power 2: Framework Convention Tobacco Control 27.05.2005 Kickbusch London 2006

45. Framework Convention Tobacco Control Kickbusch London 2006

46. Global developments: Projected prevalence of obesity in adults by 2025 Kickbusch London 2006

47. Local IMPACT Cost of the SARS epidemic to Toronto: 12 000 lost jobs Cost to the local economy: over $ 1 billion in 2003 • Asia: • Cost per person US$ 6 million (60 billion in costs) Kickbusch London 2006

48. Accountability to “own” constituency and global community Kickbusch London 2006

49. Taxation • the tax on flights from France is expected to generate 200 million euros a year for an International Drug Purchase Facility, also known as Unitaid.The fund will be used to bulk-buy medicines for countries -- mainly in Africa – • 19 pays se sont engagés à instaurer une contribution volontaire. 4 pays ont déjà rejoint la France en instaurant une contribution volontaire : le Chili, la Côte d’Ivoire, le Gabon, Maurice. 12 autres pays ont engagé des procédures interministérielles ou parlementaires pour l’adopter. • Passengers flying out of French airports will pay one euro in economy class, and 10 euros in business, if their destination is in the EU. For flights outside Europe, the surcharges are between four and 40 euros, depending on the class  Kickbusch London 2006

50. Active citizenship • Active health citizenship is a critical empowerment strategy in modern society – a significant dimension of citizen, consumer and patient’s rights and dignity –multi level dimensions Kickbusch London 2006