Health in All Policies Prospects and potentials ppt

Edited by Timo Ståhl, Matthias Wismar, Eeva Ollila, Eero Lahtinen & Kimmo Leppo Health in All Policies Prospects and potentials on Health Systems and Policies European Health in All Policies Prospects and potentials This volume was produced as a part of a project entitled “Europe for Health and Wealth”, which was supported by funding from the European Union Public Health Programme. It was published by the Finnish Ministry of Social Affairs and Health, under the auspices of the European Observatory on Health Systems and Policies. The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. The advice and help of the members of the advisory editorial board have been indispensable. They have not only given general directions for the book, but many of them also made comments on individual chapters. Two anonymous external reviewers reviewed the chapters. The editors want to thank the external reviewers for their significant contribution to the publication. Their advice and constructive criticism was instrumental in achieving the final form and content of this book. Editorial board: Dr Jarkko Eskola (former Director-General at the Ministry of Social Affairs and Health, Finland) Dr Josep Figueras (Director, European Observatory on Health Systems and Policies, and Head of the WHO European Centre on Health Policy, Brussels, Belgium) Dr Maarike Harro (Director-General, National Institute for Health Development, Estonia) Dr Anna Hedin (Desk Officer, Ministry of Health and Social Affairs, Stockholm, Sweden) Dr Meri Koivusalo (Senior Researcher, STAKES, Finland) Dr Tapani Melkas (Director, Ministry of Social Affairs and Health, Finland) Dr José Pereira Miguel (High Commissioner for Health, Portugal) Dr Horst Noack (Professor, Medizinische Universität Graz, Austria) Dr Don Nutbeam (Pro-Vice-Chancellor, University of Sydney, Australia) Dr Pekka Puska (Director-General, National Public Health Institute, Finland ) Dr Rolf Rosenbrock (Professor, Social Science Research Center Berlin, Germany) Ms Imogen Sharp (Head, Health Inequalities – UK Presidency of EU, Department of Health, England) We would also like to thank Mike Meakin for the copy-editing and his involvement in the project management of this book. Health in All Policies Prospects and potentials Edited by Timo Ståhl PhD Senior Researcher, STAKES, Helsinki, Finland Matthias Wismar PhD Health Policy Analyst, European Observatory on Health Systems and Policies Eeva Ollila MD, DMedSci Senior Researcher, STAKES, Helsinki, Finland Eero Lahtinen MD, PhD Ministerial Adviser, Ministry of Social Affairs and Health, Helsinki, Finland Kimmo Leppo MD, PhD Director-General, Ministry of Social Affairs and Health, Helsinki, Finland © Ministry of Social Affairs and Health, 2006 All rights reserved. Please address requests for permission to reproduce or translate this publication to: Ministry of Social Affairs and Health Health Department Finland kirjaamo.stm@stm.fi The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the Finnish Ministry of Social Affairs and Health, the European Commission, or the European Observatory on Health Systems and Policies or any of its partners. ISBN 952-00-1964-2 Printed and bound in Finland Further copies of this publication are available from: asiakaspalvelu@stakes.fi Contents List of figures vii List of tables viii List of contributors ix Foreword xiii Robert Madelin Preface xv Liisa Hyssälä Introduction xvii Part 1 Health in All Policies: the wider context 1 Principles and challenges of Health in All Policies 3 Marita Sihto, Eeva Ollila, Meri Koivusalo 2 Moving health higher up the European agenda 21 Meri Koivusalo Part 2 Sectoral experiences 3 The promotion of heart health: a vital investment for Europe 41 Pekka Jousilahti 4 Health in the world of work 65 Riitta-Maija Hämäläinen, Kari Lindström 5 Public health, food and agriculture policy in the European Union 93 Liselotte Schäfer Elinder, Karen Lock, Mojca Gabrijelcic Blenkus ˆˆˆ 6 Health in alcohol policies: the European Union and its Nordic 111 Member States Christoffer Tigerstedt, Thomas Karlsson, Pia Mäkelä, Esa Österberg, Ismo Tuominen 7 Environment and health: perspectives from the intersectoral experience 129 in Europe Marco Martuzzi Part 3 Governance 8 Opportunities and challenges for including health components in 145 the policy-making process Anna Ritsatakis, Jorma Järvisalo 9 Towards closer intersectoral cooperation: the preparation of the 169 Finnish national health report Timo Ståhl, Eero Lahtinen Part 4 Health impact assessment 10 Health impact assessment and Health in All Policies 189 John Kemm 11 The use of health impact assessment across Europe 209 Julia Blau, Kelly Ernst, Matthias Wismar, Franz Baro, Mojca Gabrijelcic Blenkus, Konrade von Bremen, Rainer Fehr, Gabriel Gulis, Tapani Kauppinen, Odile Mekel, Kirsi Nelimarkka, Kerttu Perttilä, Nina Scagnetti, Martin Sprenger, Ingrid Stegeman, Rudolf Welteke 12 Implementing and institutionalizing health impact assessment in Europe 231 Matthias Wismar, Julia Blau, Kelly Ernst, Eva Elliott, Alison Golby, Loes van Herten, Teresa Lavin, Marius Stricka, Gareth Williams 13 A case study of the role of health impact assessment in 253 implementing welfare strategy at local level Tapani Kauppinen, Kirsi Nelimarkka, Kerttu Perttilä Part 5 Conclusions and the way forward 14 Towards a healthier future 269 Eeva Ollila, Eero Lahtinen, Tapani Melkas, Matthias Wismar, Timo Ståhl, Kimmo Leppo Contentsvi ˆˆ ˆ ˆ List of figures Figure I.1 Europe’s growing wealth xix Figure I.2 Europe’s increased health xx Figure I.3 Europe’s declining fertility rate xxii Figure I.4 Europe’s ageing population xxii Figure I.5 Europe’s population is shrinking xxiii Figure I.6 The determinants of health xxvii Figure 3.1 The role of smoking, high-serum total cholesterol, high 46 blood pressure, obesity and physical inactivity on the development of coronary heart disease Figure 3.2 IMPACT model showing the decline in coronary heart 47 disease mortality in Finland between 1982 and 1997 Figure 3.3 Age-adjusted coronary heart disease mortality in Finland 49 and 24 other countries, per 100 000, from 1965 to 1969 Figure 3.4 Coronary heart disease mortality changes in the North 52 Karelia province and the whole of Finland from 1970 to 2002 in men aged 35–64 years Figure 3.5 Fruit and vegetables withdrawn in the EU from 1997 to 2001 54 Figure 3.6 The price of cigarettes (Marlboro) in Europe in January 2005 57 Figure 4.1 The interrelationship between work, health and employability 77 Figure 6.1 Total consumption of alcohol in litres per inhabitant over 120 15 years of age, and alcohol-related mortality (alcohol- related diseases and poisonings), 1969–2004 Figure 6.2 Recorded, unrecorded and total alcohol consumption in 120 litres per capita in Finland, 1994–2005 Figure 9.1 Coordination of EU affairs within the Finnish Government 180 Figure 10.1 The sequence of processes in health impact assessment 189 Figure 10.2 Causal links in alcohol policy 192 Figure 11.1 The focus of health impact assessment presentation 213 Figure 11.2 Community and stakeholder participation in health 221 impact assessment as reported in the fact sheets Figure 11.3 Types of health impact assessment by level as reported 227 in the fact sheets Figure 13.1 The health impact assessment in the city of Kajaani 256 was organized according to a “hand model” Figure 13.2 Who is right? Health impact assessment helps to collect 257 and structure participants’ knowledge and information on health issues List of tables Table 2.1 The 2005 plan for priority areas in work for Community 27 action in the field of public health (2003–2008) Table 3.1 Mortality rate per 100 000 in the EU in 2002 42 Table 3.2 Costs of cardiovascular diseases (€ million) in 43 different EU countries Table 3.3 Coronary heart disease mortality rate per 100 000 in 45 different EU countries in 2002 by gender Table 3.4 Overall mortality due to smoking as a proportion of all 56 deaths in the EU (year 2000 data) Table 4.1 A matrix of the framework of actions on workers’ health 68 (some illustrative examples) Table 4.2 Some adverse health effects of changes in workplaces 75 Table 6.1 Changes in the operational environment in alcohol policy in 124 the EU, from the point of view of the Finnish Member State Table 7.1 Burden of disease for selected environmental factors 134 and injuries in the European Region Table 9.1 Priority-setting of policies and activities from (2002 to 2005) 178 as defined by the respective ministries for the promotion of health and welfare of the population Table 11.1 Health impact assessments as reported in the fact sheets 215 Table 11.2 The objectives of health impact assessment as reported 218 in the analysed sample of documents Table 11.3 Factors to stratify health impact assessment in order to 219 take health inequalities into account Table 11.4 Sectors of health impact assessment 223 Table 11.5 Stages of health impact assessment as reported in the 226 fact sheets Table 12.1 Policy, regulation or other means of endorsement to 236 provide a framework and basis for action for health impact assessment Table 12.2 Selected aspects of health intelligence for health impact 238 assessment Table 12.3 Budgets for health impact assessment at national level 238 Table 12.4 Costs of a health impact assessment 241 Table 12.5 Resource generation and capacity building: 242 organizations and institutions involved Table 12.6 Ministries whose policies were the subject of health 247 impact assessments in the Netherlands and Finland Table 12.7 Reporting to the decision-makers (based on a sample 249 of 158 health impact assessments) Table 13.1 Which model is the best possible? In the city of Kajaani, 260 the effects of the implementation of the welfare strategy were analysed by health impact assessment. A working group formed three models for organizing health promotion and services in the municipality Contributors For those contributors based at STAKES (The National Research and Development Centre for Welfare and Health), the address is P.O. Box 220, Helsinki, FIN-00531, Finland. Franz Baro Professor of Psychiatry, Collaborating Centre on Health and Psychosocial and Psychobiological Factors, Rue de l’Autonomie 4, 1070 Brussels, Belgium Julia Blau MSc, Research Officer, European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Rue de l’Autonomie 4, 1070 Brussels, Belgium Mojca Gabrijelcic Blenkus MD, Specialist in Public Health, Head of the Department for Health Promotion, Institute of Public Health of the Republic of Slovenia, Trubarjeva 2, 1000 Ljubljana, Slovenia Konrade von Bremen MD, MHEM, Senior Researcher, Institute of Health Economics and Management, University of Lausanne, César Roux 19, 1005 Lausanne, Switzerland Liselotte Schäfer Elinder PhD, Director, Associate Professor, Department of Health Behaviour, Swedish National Institute of Public Health, S-103 52 Stockholm, Sweden Eva Elliott, Senior Research Fellow, The Cardiff Institute of Society, Health and Ethics, 53 Park Place, Cardiff CF23 3AT, UK Kelly Ernst MPH, Research Officer, European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Rue de l’Autonomie 4, 1070 Brussels, Belgium Rainer Fehr MPH, PhD, LÖGD (Landesinstitut für den Öffentlichen Gesundheitsdienst NRW), Institute of Public Health, North Rhine- Westphalia, Westerfeldstrasse 35–37, D-33613 Bielefeld, Germany Alison Golby PhD, Research Associate, The Cardiff Institute of Society, Health and Ethics, 53 Park Place, Cardiff CF23 3AT, UK Gabriel Gulis PhD, Associate Professor, Unit of Health, University of Southern Denmark, Niels Bohrsvej 9–10, 6700 Esbjerg, Denmark Riitta-Maija Hämäläinen PhD, Researcher, Finnish Institute of Occupational Health, Topeliuksenkatu 41a A, FIN-00250 Helsinki, Finland ˆˆˆ [...]... workers is increasing, putting even more emphasis on appropriate and effective strategies to integrate older workers into the labour market Declining populations and dwindling labour market participation could result in shrinking economies unless there are gains in productivity and income Again, this could put pressure on the European social model in terms of financial sustainability, undermining social... policy options can be formulated in terms of a virtuous and vicious cycle Investing in health and maintaining and raising the health status of European populations will contribute not only to increased well-being but also to economic stability and growth This, in turn, may strengthen the financial sustainability of health care systems In effect, a productive investment in health is the chance to embark... constructed in other sectors beyond the health sector It concludes that changes in policy-making forums have made it increasingly challenging for those aiming at improved population health to integrate health aspects into policy-making Other policies have other aims and priorities, and integrating health considerations in other policies requires a solid information base, personnel with appropriate public health. .. HiAP, and the need to reconcile the aims and values of the various policies We then discuss the challenges in the implementation of HiAP Finally we deal with the aim of decreasing health inequalities and the fact that while addressing inequalities in health is an intrinsic part of HiAP, it needs special emphases and attention, as addressing health determinants does not automatically also address determinants... values and principles similar to those in the WHO’s call for multisectoral action for health, 26 and the concept of building healthy public policies, 27 or the whole government approach.28 Policies, determinants and the population’s health are conceptualized as a chain of causation Health in All Policies starts at the source of this chain and it may help to make policies more consistent overall and therefore... further integration of health aspects into European policy-making at all levels HiAP is a strategy with a solid background in science which aims at influencing health determinants so as to improve, maintain and protect health An HiAP approach has its analytical and scientific roots in public health sciences, hygiene and epidemiology It is especially rooted in the broader policy-level interventions on health. .. Netherlands Jorma Järvisalo DMedSci, Research Professor, Health Policy and International Development, Social Insurance Institution, Peltolantie 3, FIN-20720 Turku, Finland Pekka Jousilahti MD, PhD, Research Professor, National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300, Helsinki, Finland, and School of Public Health, Tampere, Finland Thomas... health training and a good knowledge of the policy-making system and structures, as well as negotiating skills Implementation remains a challenge for HiAP and five aspects of key relevance in the context of implementation are 4 Health in All Policies: Prospects and potentials discussed The means and mechanisms for implementing HiAP are discussed in more detail in Chapter 8 This chapter starts by looking... Sweden and Finland.22, 23 However, contradictory results have also been obtained.24 Health in All Policies: strengthening the link between health and other policies Policies shape the conditions in which we live and work and these conditions may have positive or negative consequences for the health of a given population and individuals Factors that are found to have the most significant influence on health. .. legislatures and regulatory agencies Supranational institutions’ policies may overrule government policies. 9 The scientific background and principles of Health in All Policies The HiAP approach is solidly rooted in the public health sciences and the interaction among and knowledge of health, governance and public policies Knowledge about factors outside of health care which contribute to health and ill health . Lahtinen & Kimmo Leppo Health in All Policies Prospects and potentials on Health Systems and Policies European Health in All Policies Prospects and potentials. Madelin Preface xv Liisa Hyssälä Introduction xvii Part 1 Health in All Policies: the wider context 1 Principles and challenges of Health in All Policies