Health in All Policies

1. Health in All Policies Anne-Marie Doherty PhD Candidate

2. Overview of Presentation • Set the scene • My research - gaining access to elites • Some findings…

3. Setting the scene….. • Historical perspective - Rudolf Virchow - Alma-Ata Declaration (1978) - WHO Ottawa Charter (1986) - Black Report/Acheson Inquiry re Health Inequalities - WHO Global Commission on the Social Determinants of Health (2008) - International developments - http://vimeo.com/whosdh/review/32456456/285f6e786d (passcode WHO123)

4. Health in All Policies • Finland - Presidency of the EU (2006) • A new strategic approach to health for the EU (2008-2013) 3rd principle • Government of South Australia – ‘Thinker in Residence’ Professor Ilona Kickbusch

5. South Australia’s Strategic Plan (SASP) • Long term vision for whole of South Australia • 98 high level targets and 6 interrelated objectives • Recognises: Interdependence and interconnections of the targets and need for concerted action across multiple sectors…..“Individual targets do not stand alone” • The implementation of HiAP is based on SASP = provides the opportunity to use SASP mandate and governance structures to drive HiAP.

6. HiAP Model – South Australia’s Strategic Plan

7. Investing for Health (2002) • First term of devolution • Challenging time • ‘Health in All Policies….?’ • Shankandras (2011) Personal communication • Review of Investing for Health published 2011

8. My research….and gaining access to elites • HSC Doctoral Fellowship Award, Public Health Agency • Commenced October 2009 • Anticipate completion September 2012 • Health in All Policies in NI • Qualitative research • Interviews with ‘elites’

9. Elites……? • “Elite interviews are with persons who are leaders or experts in a community, who are usually in powerful positions” (Kvale & Brinkmann, 2009) • “The elite sector is another minority community…people used to exercising power and influence. Obtaining access can be difficult” (Arksey & Knight, 1999) • “Obtaining access to the interviewees is a key problem when studying elites” (Hertz & Imber, 1995) • MLA’s/Departmental Officials/Special Advisors

10. Access….. • Elections in 2011 – started with politicians • ‘Launch’ of report – approached MLA’s directly • Annual Party Conference • Phone constituency office “What would be the best way …” • Appointments (secretary\self) • Follow up e mail • Twitter • Weather - vehicles • Pre-existing contacts • The Great Hall….

11. ‘Goldilocks in The Great Hall’

12. Interviews • 34 interviews • Politicians/Advisors/Officials • Parliament Buildings/Constituency Office/Ministerial Office/Departmental Office • Duration of interview: 35 minutes – 1.5 hours • Wait time from asking: 5 minutes – 16 months • Waited and waited and persisted …….

13. Some findings….. • Government Departments are working in silos.

14. Some findings cont’d • Recognition that Departments should be working together to tackle the social determinants of health but this is often challenging.

15. Some findings cont’d • Terminology can be confusing - Health in All Policies, Health Impact Assessment, Investing for Health.

16. Some findings cont’d • Investing for Health was easily understood - but not progressed.

17. Some findings cont’d • The ‘voice of the people’ is important in influencing policy – media and lobbyists are also considerations along with evidence presented by various Departments/officials.

18. Some findings cont’d • Assembly research is used to provide evidence that shapes a course of action but also used to authenticate evidence provided by departments.

19. Some findings cont’d • Health in All Policies should be included within Programme for Government.

20. Some findings cont’d • Health in All Policies should ‘logically’ be taken forward by OFMDFM but recognition that currently there are limitations to this.

21. Conclusion • Optimism • Could be European Leader…… • Political will • Communication/good working relationships • Budget administration • Embedding HiAP within Programme for Government • How can Public Health Agency support OFMDFM?

22. Finally…. • “It is true that money is tight …. Health officials, development partners and WHO are looking at money closely. Money is important, but many other factors drive progress in public health…. Dr Margaret Chan, Director General of the World Heath Organisation. Speaking at 65th World Health Assembly 21 May 2012 in Geneva • The Health Assembly endorsed the Rio Political Declaration (2011) and its recommendations. “7. Health in All Policies, together with intersectoral cooperation and action, is one promising approach to enhance accountability in other sectors for health, as well as the promotion of health equity and more inclusive and productive societies”. http://www.who.int/sdhconference/declaration/Rio_political_declaration.pdf

23. Thank you Arksey, H. & Knight, P. (1999) Interviewing for Social Scientists Sage, London. Hertz, R. & Imber, J.B. (Eds). (1995) Studying elites using qualitative methods. Sage, California. Kvale, S. & Brinkmann, S. (2009) Interviews Learning the craft of Qualitative Research Interviewing. Sage, London. email: adoherty44@qub.ac.uk