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Ilona Kickbusch, Governance for health, wellbeing  and sustainability
 

Ilona Kickbusch, Governance for health, wellbeing and sustainability

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    Ilona Kickbusch, Governance for health, wellbeing  and sustainability Ilona Kickbusch, Governance for health, wellbeing and sustainability Presentation Transcript

    • Taru Koivisto Co-chair Mihály Kökény Co-chair Bosse Pettersson Ilona Kickbush Eeva Ollila Outi Kuivasniemi Vesna-Kerstin Petric Maris Jesse Svetlana Axelrod Michael Huebel European Commission Charles Price European Commission David Pattison IUHPE/Europe Clive Needle EuroHealthNet Gauden Galea WHO/Europe Secretariat Agis Tsouros WHO/Europe Secretariat Erio Ziglio WHO/Europe Secretariat Vivian Barnekow WHO/Europe Secretariat Europe Day Committee
    • Kickbusch Helsinki 2013 Professor Ilona Kickbusch Governance for health, wellbeing and sustainability 1986 – 2013 - Post 2015- pre 2030
    • 1986 Ottawa Pledge Kickbusch Helsinki 2013 to move into the arena of healthy public policy, and to advocate a clear political commitment to health and equity in all sectors; to counteract the pressures towards harmful products, resource depletion, unhealthy living conditions and environments, and bad nutrition; to respond to the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of these societies;
    • 1986 Ottawa Pledge Kickbusch Helsinki 2013 to acknowledge people as the main health resource, to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and wellbeing; to reorient health services and their resources towards the promotion of health; and to share power with other sectors, other disciplines and most importantly with people themselves; .
    • Ottawa Pledge Kickbusch Helsinki 2013 to recognize health and its maintenance as a major social investment and challenge; and to address the overall ecological issue of our ways of living The Conference is firmly convinced that if people in all walks of life, nongovernmental and voluntary organizations, governments, the WHO and all other bodies concerned join forces in introducing strategies for health promotion, in line with the moral and social values that form the basis of this CHARTER, health for all by the year 2000 will become a reality.
    • 25 years on ……context25 years on ……context Kickbusch Helsinki 2013 Radically changing societies: Globalization Urbanization Individualization Virtual connectedness Commercialization Demography Radically changing societies: Globalization Urbanization Individualization Virtual connectedness Commercialization Demography
    • ……………………25 years on ….……………………25 years on …. Kickbusch Helsinki 2013 Ottawa Action Areas The nation Healthy public policy Supportive Environments Community action Personal skills Reorient health systems Ottawa Action Areas The nation Healthy public policy Supportive Environments Community action Personal skills Reorient health systems Determinants: the globae Political Social (Macro) Economic Commercial Environmental Behavioral (genetic) Determinants: the globae Political Social (Macro) Economic Commercial Environmental Behavioral (genetic)
    • ……………………..25 years on…….……………………..25 years on……. Kickbusch Helsinki 2013 Ottawa Action Areas Healthy public policy Supportive Environments Community action Personal skills Reorient health systems Ottawa Action Areas Healthy public policy Supportive Environments Community action Personal skills Reorient health systems 21st century action areas Whole of government Global governance Sustainable production and consumption Whole of society Governance for health and wellbeing Health in All Policies Health literacy Resilience …………………… 21st century action areas Whole of government Global governance Sustainable production and consumption Whole of society Governance for health and wellbeing Health in All Policies Health literacy Resilience ……………………
    • Two major strands of public health George Rosen (1910-1977) Two major strands of public health George Rosen (1910-1977) Kickbusch Helsinki 2013 As inequalities increase the health debate changes: the medical and technical development dimension of public health is increasingly overlaid by a debate on the social, political and economic/commercial factors that determine health. In the 19th and early 20th century the focus of public health was mainly national, social and political. in the course of the 20th century it moved to being national, medical and technical, As inequalities increase the health debate changes: the medical and technical development dimension of public health is increasingly overlaid by a debate on the social, political and economic/commercial factors that determine health. In the 19th and early 20th century the focus of public health was mainly national, social and political. in the course of the 20th century it moved to being national, medical and technical,
    • Global - social - political Kickbusch Helsinki 2013 in the late 20th and very early 21st century it moved to being global, economic and technical (“the science of delivery”) Today the focus must be increasingly global, social and political – powered by developments in information technology which were not at our disposal even 10 years ago. /
    • Political determinants of healthPolitical determinants of health Kickbusch Helsinki 2013 Health has moved up in the political agenda in countries, in development policies and in global agreements precisely because of its relevance both to the economy, political ideology and legitimacy and to the expectations of citizens. It is of a highly political and symbolic nature: it concerns definitions of the common good, the role of the state, markets and individuals, as well as the interests of many stake holders. Is health and wellbeing something that „we collectively strive to pursue” (Sandel 2009) in a world of globalization, individualization and commercialization? Health has moved up in the political agenda in countries, in development policies and in global agreements precisely because of its relevance both to the economy, political ideology and legitimacy and to the expectations of citizens. It is of a highly political and symbolic nature: it concerns definitions of the common good, the role of the state, markets and individuals, as well as the interests of many stake holders. Is health and wellbeing something that „we collectively strive to pursue” (Sandel 2009) in a world of globalization, individualization and commercialization?
    • Justice can mean……….. Kickbusch Helsinki 2013 1. ….maximizing utility or welfare – the greatest happiness for the greatest number 2. ….respecting freedom of choice 3. ….reasoning together about the meaning of the good life – developing a politics of the common good – the solidarity of democratic citizenship Michael Sandel What Money Can't Buy: The Moral Limits of Markets 2010
    • Committment to health and wellbeing as a public good Committment to health and wellbeing as a public good Kickbusch Helsinki 2013 The success of societies must be measured differently: “The time is ripe for our measurement system to shift emphasis from measuring economic production to measuring people’s well-being. And measures of well-being should be put in a context of sustainability.”  Recommendation of the Commission on the Measurement of Economic Performance and Social Progress (chaired by Joseph Stiglitz) 2010. This takes us back to the concept of health as wellbeing in the WHO Constitution. The success of societies must be measured differently: “The time is ripe for our measurement system to shift emphasis from measuring economic production to measuring people’s well-being. And measures of well-being should be put in a context of sustainability.”  Recommendation of the Commission on the Measurement of Economic Performance and Social Progress (chaired by Joseph Stiglitz) 2010. This takes us back to the concept of health as wellbeing in the WHO Constitution.
    • High Level Panel report 2013 Kickbusch Helsinki 2013 Global impact by 2030 – 5 transformative shifts: Leave no one behind Put sustainable development at the core Transform economies for Jobs and inclusive growth Build peace and effective, open and accountable public institutions Forge a new global partnership
    • SDSN Report priority challenges Kickbusch Helsinki 2013  End extreme poverty and hunger  Achieve development and prosperity for all without ruining the environment  Ensure learning for all children and youth  Achieve gender equality and reduce inequalities  Achieve health and wellbeing at all ages  Increase agricultural production in an environmentally sustainable manner, to achieve food security and rural prosperity  Make cities productive and environmentally sustainable  Curb human-induced climate change with sustainable energy  Protect ecosystems and ensure sound management of natural resources  Improve governance and align business behavior with all the goals Sustainable Development Solutions Network 2013
    • Proposals for Future Goals Peoples choices Kickbusch Helsinki 2013 Source: ODI (2013) Future Goals Tracker Global People’s Survey Source: www.myworld2015.org
    • Message from thematic consutations Kickbusch Helsinki 2013 Human rights Governance equity
    • Some thoughts………… Kickbusch Helsinki 2013 Politicians and electorates need to accept that in a global world we now have both national and global interests - and governments must be held accountable for both There is a convergence of a set of key principles that form a global health ethics. It is not sufficient to string a set of priority health challenges together -- we must have the courage to think beyond health and embrace a broad notion of sustainable development. Our debate must start not end with governance. We must learn how to govern a global system in the making more fairly. No longer can "the West" write the roadmap of global governance and development.
    • Systems thinking Kickbusch Helsinki 2013
    • Bridge BuildingBridge Building Kickbusch Helsinki 2013 In many cases, the best choices for health are also the best choices for the planet; and the most ethical and environmental choices are also good for health. In many cases addressing poverty also addresses the survival of the planet. In many cases, the best choices for health are also the best choices for the planet; and the most ethical and environmental choices are also good for health. In many cases addressing poverty also addresses the survival of the planet.
    • New consumer dynamics of health Unsustainable systems - Unsustainable lifestyles New consumer dynamics of health Unsustainable systems - Unsustainable lifestyles Kickbusch Helsinki 2013 The obesity epidemic - and the global system of food production, distribution, consumption and waste - is one of the most obvious symptoms of “unsustainable lifestyles” and unsustainable production and consumption patterns. It reflects paradigmatically the global flow of ways of life, ideas and products and the global dimension of health promotion The obesity epidemic - and the global system of food production, distribution, consumption and waste - is one of the most obvious symptoms of “unsustainable lifestyles” and unsustainable production and consumption patterns. It reflects paradigmatically the global flow of ways of life, ideas and products and the global dimension of health promotion
    • CO BENEFITS Kickbusch Helsinki 2013 Scientific American 2009 Industrial animal production consumes especially large amounts of energy, requiring 35 calories of fossil fuel to produce 1 calorie of food energy— not counting the energy required for processing, packaging, cold storage, and transportation of meat
    • Commercial determinants of healthCommercial determinants of health Kickbusch Helsinki 2013 “Lifestyles” - The power of markets and business, in particular transnational companies/corporations and their marketing has led to “industrial” and “communicated” epidemics based on encouraging unhealthy consumption. There is increasing proof that brands can shift consumer habits. “Lifestyles” - The power of markets and business, in particular transnational companies/corporations and their marketing has led to “industrial” and “communicated” epidemics based on encouraging unhealthy consumption. There is increasing proof that brands can shift consumer habits.
    • Ubiquity – 24/7 Kickbusch Helsinki 2013 Sanitary Revolution HIAP/GFH Revolution
    • Regulation: tax - limit sizeRegulation: tax - limit size Kickbusch Helsinki 2013
    • URBAN ACTION:ZONING Kickbusch Helsinki 2013
    • Global Consumerism – constant choiceGlobal Consumerism – constant choice Kickbusch Helsinki 2013 It has become common practice to turn health issues into a fundamental debate about individual freedom and choice.
    • New economic dynamics of healthNew economic dynamics of health Kickbusch Helsinki 2013  In many developed countries health/medical care now constitutes 10-15% of GNP and 10 – 15% of the work force – many emerging economies are making major investments in health and medical care  Health/medical care is a major business sector, a major employer, part the economic competition between countries, the import and export of goods and services and of foreign policy - Health damaging products are a major business sector – economic crisis is affecting both  A new dynamics how a range of governmental sectors and processes contribute to health and how health contributes to societal and economic development require a new positioning of health within government and society.  In many developed countries health/medical care now constitutes 10-15% of GNP and 10 – 15% of the work force – many emerging economies are making major investments in health and medical care  Health/medical care is a major business sector, a major employer, part the economic competition between countries, the import and export of goods and services and of foreign policy - Health damaging products are a major business sector – economic crisis is affecting both  A new dynamics how a range of governmental sectors and processes contribute to health and how health contributes to societal and economic development require a new positioning of health within government and society.
    • Political determinants: Overcome Equation of market behaviour with democracy Political determinants: Overcome Equation of market behaviour with democracy Kickbusch Helsinki 2013 consumerconsumer Citizen We must ensure that our democratic institutions value health. We must invest in the health literacy of parliamentarians and of the citizens who elect them. Citizen We must ensure that our democratic institutions value health. We must invest in the health literacy of parliamentarians and of the citizens who elect them.
    • Some more thoughts………….. Kickbusch Helsinki 2013 The priority focus needs to be on the global public goods we ALL require in relation to health, climate, population food, water, energy, conflict -- they are the building blocks for our future. In consequence such a global system requires reliable institutions related to three big pillars: A vigorous and fair global economy Environmental sustainability, sustainable production and consumption Global health and wellbeing We will require an agreement how to jointly finance the global public goods we prioritize as a global community, not just through governments but with the contribution of other global actors – i.e. taxing the 6.5.trill. global health industry.
    • Smart sovereignty Diplomacy today + Health policy today Kickbusch Helsinki 2013 „Today‘s diplomat has a dual responsibility: to promote his or her country‘s interest and to advance the interests of the global community“  Muldoon et al 2005 Today‘s minister of health has a dual responsibility: to promote his or her country‘s health and to advance the health interests of the global community. The key governance challenge is setting the rules for the new interfaces – ENSURE GLOBAL PUBLIC GOODS - Key role of WHO