Kickbusch building professional capacity for HiAP

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8GCHP Helsinki, Finland 2013

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Kickbusch building professional capacity for HiAP

  1. 1. Professor Ilona KickbuschGraduate Institute, GenevaCapacity building to implementhealth in all policiesKickbusch Helsinki 2013
  2. 2. The challenge The challenge for health promotion at thebeginning of the 21st century is to developcapacity at various levels of governance to beable to address the key determinants of health:political, social, economic, commercial,environmental and behavioral – and tocontribute to sustainable growth anddevelopment. This requires new knowledge, strategic insights,skills, approaches and instruments – within“health” and beyondKickbusch Helsinki 2013
  3. 3. Modules HIAP training manual Context: 21st century dynamics of health Measuring progress in health and wellbeing Understanding the policy process - Preparing a policybrief Political determinants of health: whole of government Managing complexity Targeting inequities in health Multi stakeholder governance - Negotiating for health Intergovernmental integration Commercial determinants of health HIA Health lens, health co benefits Local action for health Whole of society - Influencing policies: citizens andadvocates New role of the health sectorKickbusch Helsinki 2013
  4. 4. Health promotion is not adiscipline The move towards anew public health Advocate Mediate EnableKickbusch Helsinki 2013
  5. 5. Health is not a silo Population health andwellbeing is not asectoral but an overallsocietal goal withmany benefits. It needsto be embedded withinthe general policyimperative as a whole ofgovernmentcommitment. WHO Constitution:Health is theresponsibility ofgovernmentsKickbusch Helsinki 2013
  6. 6. Capacity is not just „technicalcapacity“ Beyond boundaries Systems thinking Speed and agility Interconnectednessteamwork Innovation is valued Continuousimprovement Community focusKickbusch Helsinki 2013
  7. 7. The system must welcome change–reorienting institutions to promote health and toadopt new ways of working across governmentand with many stakeholders at the institutionallevel (whole of government approach) is highlycomplex and difficultKickbusch Helsinki 2013
  8. 8. ….and become a learningorganization Capacity building is a long-term continualprocess of development that involves allstakeholders; including ministries, localauthorities, non-governmentalorganizations, professionals, communitymembers, academics and more. (UNDP)Collaboration is imperative! This links well to the understanding of healthpromotion as a process. Capacity building aimsto primarily build on existing resources – it appliesprinciples such as the learning organization orcommunity development. It includes enhancing knowledge, developingKickbusch Helsinki 2013
  9. 9. Kickbusch Helsinki 2013Macro-economics, law, policy science, politicalscience, political economy, complexityscience…………
  10. 10. Capacity to understand the policyprocess Deal with uncertaintyKickbusch Helsinki 2013
  11. 11. Capacity to understand politicsKickbusch Helsinki 2013
  12. 12. Capacity to understand commercialdrivers Over the past decade sales of packagedfoods around the world have jumped by 92%,to $2.2 trillion this year. In Brazil, China andRussia sales are three to four times their levelin 2002. Sales of soft drinks across the world havemore than doubled in the past decade, to$532 billion; in India, Brazil and China sales offizzy drinks have more than quadrupled. Thisis troubling, given that sugary drinksaccounted for at least 20% of America’sweight gain between 1977 and 2007. The EconomistDec 15/2012Kickbusch Helsinki 2013
  13. 13. Capacity to understand health care asa driverKickbusch Helsinki 2013
  14. 14. Capacity to understand thecommunityKickbusch Helsinki 2013
  15. 15. Kickbusch Helsinki 2013New mindset
  16. 16. Capacity for managing wickedproblemsKickbusch Helsinki 2013
  17. 17. Capacity for whole of societyresponseKickbusch Helsinki 2013WHOPandemic preparedness
  18. 18. Capacity to address systemic risks –systemic failures – systemic solutionsEnvironment and health SA health lens IHRKickbusch Helsinki 2013
  19. 19. Capacity for inward and outwardframingHealth impact –societal impactInvestments inpopulation healthwellbeing can beconsidered integralto economicdevelopment and topromoting the wealthof nations. Improvingthe health of nationsis a powerfulinstrument to this end.Kickbusch Helsinki 2013
  20. 20. Capacity for framing public healthchallengesIndiviualbehaviour Public healthKickbusch Helsinki 2013 Cause: Poor lifestyle choicesof individuals Response: education Cause: obesogenic environments Response: HIAP,regulation, widerdeterminants, nudge
  21. 21. Stakeholder analysis andmanagementKickbusch Helsinki 2013
  22. 22. Capacity for policy coherence Policy Coherence is the systematic promotionof mutually reinforcing policy actionsacross government departments andagencies creating synergies towardsachieving the agreed objectives. (OECD) Platforms, networks, public privatepartnerships, alliances and hybridorganizations abound in the health arena. This requires cross cutting skillsKickbusch Helsinki 2013
  23. 23. SA Eat well – be activeKickbusch Helsinki 2013
  24. 24. Capacity for managingconflictsArticle 5.3 of the FCTC:“In setting andimplementing theirpublic health policiesParties shall act toprotect these policiesfrom commercial andother vested interests ofthe tobacco industry ”The WHO FCTC is theonly internationalconvention to explicitlyaddress the dangers ofan industry subvertingthe object and purposeof a convention.Kickbusch Helsinki 2013
  25. 25. Capacity for partnershipsKickbusch Helsinki 2013
  26. 26. Capacity to act at differentlevelsKickbusch Helsinki 2013Kickbusch NEK CNE Bern 2009
  27. 27. Communication and negotiationskills Negotiation has become a critical public healthskill at all levels – from city parliament to globalhealth diplomacy.Kickbusch Helsinki 2013
  28. 28. Political skills………………..Kickbusch Helsinki 2013 The globalization oflifestyles is by nomeans just atechnical issue forpublic health. It is apolitical issue. It is atrade issue. And it isan issue for foreignaffairs. Dr. Margaret Chan2013
  29. 29. Enabling systems: political will isrequired to Provide incentivesfor collaborativeapproaches togovernance andpolicy making in orderto achieve synergiesand co benefits address conflictsbetweenpolitical, societal andsectoral interests -Kickbusch Helsinki 2013
  30. 30. Enabling systemsKickbusch Helsinki 2013
  31. 31. New problems - New roles – newarenas “Wicked problems” such as NCDs requiresystems approaches. Ministries of health andpublic health agencies are required to reachout and to perform new roles in order to gainleverage. They become champions within government fortackling complexity through a mix of hard and softgovernance mechanisms ranging from law topersuasion and incentives in order to engageother sectors for health. New arenas: trade, foreign affairs,finance…”top of the table”Kickbusch Helsinki 2013
  32. 32. Policy space The FORMAL recognition of a “HIAP” strategy orapproach provides the recognized policy space toengage in collaborative cross--‐government work. It implies agreements/rules for the decision-making processes between different sectors andbetween different levels of government (horizontaland vertical) as well as agreements on feedbackloops to central government (this takes different formsdepending on political systems and levels ofgovernment) – this means ensuring commitment toand mechanisms for accountability. In some countries – depending on the political system- this includes not only the executive branch ofgovernment but also the legislature.Kickbusch Helsinki 2013
  33. 33. Policy space It is essential to develop formal and sustainedmechanisms for intergovernmental integration andjoint learning and capacity building for this new formof policy making and horizontal governance for health– this can be a HIAP unit in the MOH with acounterpart in central government. This goes beyond committees set up to deal withspecifically defined problems. There must be continuity and legitimacy ofleadership (possibly through the features of thepublic health legislation)Kickbusch Helsinki 2013
  34. 34. SA health lens modelKickbusch Helsinki 2013
  35. 35. Joined up learningopportunitiesKickbusch Helsinki 2013 Capacity building alsoincludes intersectoraltraining opportunitiesin cooperation withschools of public health,business schools,schools of diplomacyand foreign policy andschools for public policyto create a new skillsmix based on systemsthinking and dealingwith complexity.
  36. 36. Kickbusch Helsinki 2013http://www.healthinfonet.ecu.edu.au/health-risks/nutrition/nutrition-workforce/nutrition-workforce-development
  37. 37. Community capacity Community capacity building concerns theability of community members to take action toaddress their health through social and politicalsupport that is required for successfulimplementation of policies and programs thathave an impact on health. Empowerment forhealth is a critical factor at the individual andcommunity level. Empowerment through health literacy.Kickbusch Helsinki 2013
  38. 38. Policy making 21st century governance for health requiresstructures and mechanism which enablecollaboration, ensure accountability, increasetransparency and work for health and equity. The core skill of strategic public health will bethe management of the interfaces between variedgroups with very different interests, legitimacyand power. The Health in All Policiesstrategist, then, must “evolve from a masterwho gives the orders to a facilitator whomakes the process work”.Kickbusch Helsinki 2013
  39. 39. Capacity for smart sovereignty With the impact of globalization and the increaseof actors in global health action at the globallevel is gaining increasing importance; Understanding the global-local interface isessentialKickbusch Helsinki 2013

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