Health in All Policies as Radical Approach toward Sustainable Development.

بسم الله الرحمن الرحیم

Prof. Mohammad. H. Taghdisi Health Promotion PhD

Email: [email protected]

Health in All Policies as Radical Approach toward Sustainable Development

Health is, therefore, seen as a

resource for everyday life, not the

objective of living.

Therefore, Health promotion is

not just the responsibility of

Health sector, but goes beyond

healthy lifestyles to well – being.

WHO approach

The WHO approach places emphasis

on community members and

settings, in other words moves the

emphasis from diseases, to the

people who have them. Thus, a

"settings-based" approach starts

with a target population and plans

intervention for a population in

different settings relevant to that

population.

WHO approach

It treats each of these settings as a

system which is characterised by

certain tructures, norms,

participants, communication

It recognizes that each of these is

part of a wider system and is

interdependent on other parts of

the system in terms of providing

services or mounting intervention

International Conferences on Health Promotion

HISTORICAL PRESENT WATERSHEDS SITUATION

ALMA ATA HEALTH- BASIC HUM RIGHT 1978 INEQUITIES – HEALTH FOR ALL HEALTH PROMOTION – HEALTH EDUCATION

OTTAWA PROBLEMS – SETTINGS1986 ENABLING – MEDIATING - ADVOCATING ORGANIZATIONAL MODEL ACCOUNTABILITY

ADELAIDE HEALTHY PUBLIC POLICY1988

SUNDSWAL NEW PUBLIC HEALTH1991 ENVIRONMENT ECOLOGY

JAKARTA SOCIAL RESPONSIBILITY1997 INVESTMENT IN HEALTH DEVELOPMENT PARTNERSHIP IN HEALTH COMMUNITY CAPACITY INDIVIDUAL EMPOWERMENT HP INFRASTRUCTURE

Shift from problems to settings

PROBLEMS SETTING

CHD HP COMMUNITIES HP HC SYSTEM

AIDS

CA FAMILY HA

FLU CITY GP HBP SCHOOL HOSPITAL

Making HiAP Happen

BackgroundOttawa; Adelaide (‘Healthy Public Policy’)

Calls for ‘whole-of-government’ work

Social Determinants

NCD ‘crisis’

Finnish presidency EU

8GCHP

8GCHP Helsinki ….. Helsinki Statement

Framework for Country Action

‘Checklist’

Evidence on NCD ‘best buys’

Framework for Country Action

HiAP publication proliferation … (?)

But it is not a cycle:(re-)define the problem

gather information

matrix power, interest and priority

involvestakeholders

evaluate existing policy

consider political strategy

trade off costs and benefits

establish policy logic based on SDH

describe and plan implementation

develop alternatives with stakeholders

Health Health Others

?

?

And --- what is/are HiAP?

OthersHealth Others

?

?


OthersHealthOthers

?

?


And --- what is/are HiAP?PRES Finance

Others Others

?

HealthFinance

?

And --- what is/are HiAP?PRES

Health

?

FinanceHealth

Health

(re-)define the problem

gather information

matrix power, interest and priority

involvestakeholders

evaluate existing policy

consider political strategy

trade off costs and benefits

establish policy logic based on SDH

describe and plan implementation

develop alternatives with stakeholders

Steps or elements in the cycle?

Define the problem

Gather information

Establish the policy theory

Evaluate existing policy

Develop alternatives

Select ‘best fit’

Trade-off costs - benefits

Matrix it

Describe implementation

Consider political strategy

AHow has the problem been

framed by whom?

BWhat information is there

about the problem, its proponents and

magnitude?

CWhat is the policy theory (causal, final, normative

assumptions)?

DWhat is currently done?

With what effect?

EWhat evidence, experience and opportunity exists to

develop alternative approaches? Which?

FWhat is the ‘best fit’

between feasibility and effectiveness? Who ‘owns’

that option?

GWhat social, economic and institutional ‘win-wins’ can

be established? Against which cost?

HCan a matrix with support

vs opposition against power x priority be developed?

With what result?

IHave barriers and facili-

tators of implementation (support; capacity;

resources; partnerships) been gauged?

JWhat politics are involved (opportunity; leadership; will; institution; vision)?

HiAP

Method

Approach

HiAP Framework

Tool

Process

Health in All Policies

Why?

What?

Who?

How?

Governance for HiAP (2013-14)

Towards Dynamic Governance

Governance for Health in the 21ST

Governance for Health Equity

A Tool for H Governance in the 21ST

(Re-)define the problemHow has the problem been framed and by whom?

Has the problem been framed in specific and clear

terms?

Is there shared ownership of the problem?

Are there opportunities to re-frame the problem?

Evaluate existing policyWithin the problem definition and

tentative policy logic, which policies are already in force and are there any that are being processed? Are there any measures

of success?

In your or other sectors: are there existing policies that would

possibly support solving the problem identified?

Do policies exist that present institutional, fiscal or regulatory

barriers to a policy that would address the problem identified?

Is there evidence of effectiveness of these policies (e.g.,

through policy analyses, audits or parliamentary deliberation)?

Gather informationWhat information is there about the problem, its magnitude and consequences, and relevant stakeholder positions, now and in the future?Is there unequivocal scholarly evidence on the nature of the

problem?

Has the available evidence been compiled systematically and

accessibly?

Has this evidence identified populations and communities

impacted?

Which public sectors and social groups are affected and can

influence the nature of the problem and its solutions?

Establish the policy logicbased on social determinantsWhat facts, ideas and assumptions constitute the policy logic in relation to the problem?

Can an overview be made of ideas in your country about the causes of the problem?

Can an overview be made of ideas in your country about the best interventions to solve

the problem?

Are there any cultural or statutory conditions (e.g., human rights, equity, constitutional)

that prioritise some problems and solutions over others?

Develop alternativeswith stakeholders

What evidence, experience and opportunity exist to develop winning alternative approaches?

What is the evidence about the most cost-effective policy option?

What other alternatives have been proposed? By whom?

Have alternatives been field-tested with whom, and if so, to what effect?

For different policy alternatives with different stakeholders, what is the contextual

feasibility?

For different policy alternatives with different stakeholders, what is the contextual

effectiveness?

Trade off costs and benefitsWhat social, economic and institutional ‘win-wins’ can be established? What gains can be identified?

What social gain comes out of the HiAP?

What economic gain comes out of the HiAP?

What institutional gain comes out of the HiAP?

What investment is required to attain those gains?

Matrix power, interest and priorityWhat are the power, priority and support positions of all stakeholders in particular policy proposal?

Has a systematic inventory of all possible stakeholders and their positions for the policy

proposal been developed?

Can stakeholders be characterised as supportive, powerful, and giving the proposal

priority?

Can strategies be developed to move actor positions toward higher support and priority

for critical stakeholders?

Matrix power, interest and prioritysupportive

oppose

neutral

power x priority

Professional group A

Ministry X

Industry X

Ministry B

Ministry A

Professional group B

Community A

Community B

Community C

Industry Z

Consider political strategyWhat politics are involved in the initiation and final stages of policy development and adoption?

Can politicians or political groupings be identified that are in support of HiAP?

Is there political leadership for HiAP?

Is there institutional and rhetorical opportunity for HiAP?

Describe and plan implementationHave policy implementation barriers and facilitators been considered and integrated in policy formulation?

Can implementation issues like (a) policy complexity, (b) support, (c) capacity, (d)

resources, (e) partnerships, and (f) timeframes be identified in the policy proposal?

Can these issues be characterised as sufficient supporters of policy?

Are procedures in place to monitor and continue implementation support?

Iran’s Health Promotion Strategy

It is in this context that integration

can explain how all these different

programs, systems and standards

can be brought together and

subsequently create and coordinate

a logical coherent connection

between them all.

The Formulation Process

The main objective was to prepare

and theoretically test the basic

topics for formulation of the NSBHP.

This way grounds were prepared for

the creation and modification of the

NSBHP by senior policy makers and

decision makers in the country. To

achieve this goal the study was

conducted in the following nine

phases:

Iran’s Health Promotion Strategy phase1

Phase1:Establishment of a steering

committee comprising experienced

experts to approve the

recommended theoretical

framework, to steer and guide the

study procedure and finalize the

draft of the

NSBHP


Phase 2: Literature review and

formulation of a theoretical

framework (conceptual) for the

steering bill


Phase 3: Adaptive studies on the methods

of formulation of HP strategic plans

(HPSP) in developing and developed

countries, and of countries in the region.

Based on the available documents the

political and health similarities between

those countries and Iran..


Phase 4: Review and analysis of

scientific and legal literature of the

following, for formulation of the

primary bill on objectives, values,

principles, orientations, strategies,

and selective indices:


theoretical concepts of HP plans, trend

analysis of Iran’s health system’s

selected indices, research conducted on

MOHME and other organizations (such as

situation analysis of community-based

interventions for HP in Iran, equity

assessment in Tehran etc.),


the national scientific health map, policy

documentations prepared by the deputy for co-

ordinations of MOHME under the Fourth

Development Plan, the report on risk factors of

non-communicable diseases (2006-2009), and

management of non-communicable diseases by

MOHME (2009), legal upstream documentations

(the constitution, Iran’s Outlook 2025, general

policies of the fourth and fifth development

plans)


Phase 5: Overall identification of stakeholder

organizations and examining the analyses of

strategic documentations (such as the

documentations on: Fundamental Changes in

Education and Training, Empowerment and

Organization of Un-Official Residences- ratified

by the Cabinet Ministers, the Welfare

Organization’s Strategic Plan, Tehran

Municipality’s Strategic Plan etc.)

Iran’s Health Promotion Strategy phases6-7

Phase 6: Situation analysis and

analysis of SWOT results

Phase7:Stakeholder nalysis

and its prioritization

Iran’s Health Promotion Strategy phase 8

Phase 8: Establishment of workgroups

comprising prioritized intersectoral

stakeholders (representatives of relevant

organizations and ministries) and senior

experts involved in developing strategic bills in

headquarter domains relevant to MOHME; and

holding meetings for critical appraisal of the

primary bill developed


Phase 9: Preparation of the final

report, based on previous

phases’ results, and presentation

to the Supreme Health Council

for ratification measures


Phase 9: Preparation of the

final report, based on previous

phases’ results, and

presentation to the Supreme

Health Council for ratification

measures


Analysis of Upstream Documents Iran’s Outlook 2025 Iran’s Fifth Development Plan’s Health

Map (2000 – 2014) Iran’s General health policies, ratified by

the Scientific, Cultural and Social Commission

The constitution; principles related to HP


Vision A healthy and capable Iran, a role model in

the region by 2025 Mission In keeping with the goal of ‘national sustained

development’, supportive healthy environments &communities should be created. This should be done with the participation of the public, policy makers and professionals through intersectoral collaboration, empowerment and capacity building (CB).


Values Justice Responsiveness and clarity Sustainability Responsibility Participation Satisfaction Being holistic and universal Coherence and moderation Continuous learning Self-reliance and self-management


Priorities Among the indices evaluated, the

following priorities were specified upon consensus:

A life free of tobacco products A life free of drug abuse,

particularly synthetic drugs Healthy nutrition A life associated with physical

activity A safe life, free of hazards, harms,

accidents and violence


Priorities Psycho-spiritual health Establishing equity in health A life free of AIDS and high-risk

behaviors Preparedness against natural

disasters and crisis Integrated management in HP

across the country

Iran’s Health Promotion Strategy Goals and Strategies

Establishment of healthy public policies towards equity in health

Development and strengthening of health-related policies to create healthy environments and the MDG target groups (women and youth)

Existence of healthy public policies to improve lifestyle

Healthy supportive environments Development of safe and healthy environments

(healthy schools, healthy workplaces, healthy hospitals….)


Community participation

Promoting CP in policies and stages of HP

planning (design, execution, evaluation)

Strengthening social capital among the

masses


Community mobilization Raising awareness and understanding

about health risk factors among the

people, communities and social

institutions

Mobilization and advocacy of influencers

and cooperating networks in preventive

activities and HP


Empowerment and capacity

building

HP Training and CB of the public

HP Training and CB of social

institutions and organizations


Monitoring & EvaluationPromotion and development of a

culture of evaluation in all programs and policies related to prevention and HP, in all sectors of the society, and for all HP-related programs and policies


Knowledge management and transfer system Knowledge management and development of

health knowledge transfer and utilization models among policy makers, people and other stakeholders

Providing equal, fair and safe opportunities to all citizens for using health IT

Provision of security to the community, family and individuals in using health electronic services

Spreading the Islamic-Iranian culture in E-health


Knowledge management and transfer system

Knowledge management and development of health knowledge transfer and utilization models among policy makers, people and other stakeholders

Providing equal, fair and safe opportunities to all citizens for using health IT

Provision of security to the community, family and individuals in using health electronic services

Spreading the Islamic-Iranian culture in E-health


This bill has sent to the SCHFS for ratification with the following regulation:

1- The NSBHP which includes definition, concepts, workflow and requirements is determined according to the attachment, and approved with the cabinet ministers’ official stamp.


2- MOHME must send the report of this ratification’s implementation to the cabinet ministers once every 3 months.

The ‘National HP Strategic Plan Studies’ Assessment Workgroup’ which is based in MOHME will be responsible for implementing the bill.


At the level of Organizations & Ministries

1- Formation of a workgroup for monitoring operational plans affecting health

2- This workgroup must have the following list of duties:

o Continuous assessment of the implementation process of HP programs approved by the SCHFS


At the level of the SCHFS Secretariat1- Reception of recommendations and

reports from the workgroup and professional HP committees

2- Establishment of a decision making committee for organizations & ministries’ HP programs

3- Presentation of reports and decisions made in the committee meetings to the Supreme Council (the President or Vice President)

4- Giving feedback on assessment of implemented HP programs to other organizations & ministries

5- Delivery of guidelines, plans and new decisions by the SCHFS to HP Units in organizations & ministries

High Council of Health and Food Security: A Management Structure to implement Health in All Policies

Outline Introduction Objectives of the High Council Composition of the High Council The Responsibilities of the High Council Decision-making Process at the High Council Meetings of the High Council Structure of the High Council Achievements A few thoughts on how to overcome difficulties and barriers A challenge facing the international community for

implementing HiAP

High Council of Health and Food Security(HChFS(

Introduction Health in All Policies requires a well established

coordination mechanism for improving inter-sectoral collaboration.

Accordingly, In 2005, the High Council of Health and Food Security was established by the Parliament of Islamic Republic of Iran

The Ministry of Health and Medical Education was assigned to develop the rules of procedures for the High Council.

Objectives of the High Council

To maintain and promote level of health and quality of life within and among different social strata;

To develop and adopt suitable policies, programs and decisions;

To set up appropriate policy management mechanisms, to enhance inter-sectoral cooperation and collaboration

Decisions of the High Council are binding on all relevant sectors in the country.

81

Composition of the High Council

The membership of the High Council includes, inter alia:

The President of the Islamic Republic of Iran is the Chair of the High Council (The Vice-President in the absence of the President);

Deputy President of the Islamic Republic of Iran on Strategic, Planning and Human Resources;

Minister of Health and Medical Education (as the Secretariat); Minister of Education; Minister of Agriculture ; Minister of Industry, Mine and Trade; Minister of Cooperatives , labor and Social welfare; Minister of Interior; Minister of Justice; Minister of Energy; Minister of Youth and Sport; Other relevant ministers, when deemed necessary; Head of the Islamic Republic of Iran Broadcasting; Head of the Environmental protection Organization; Head of the Iranian Medical Council; Other experts and professionals, as appropriate, without right to vote.

The Responsibilities of the High Council

Making policy decisions in all areas related to public health and food security;

Examining proposals and plans presented by the Ministry of Health as well as other relevant organizations in the areas of public health and food security;

The responsibilities of the High Council continue ...

Keeping under constant review to evaluate Effectiveness of the policy decisions related to

boosting inter-sectoral collaboration; Relevancy of the policies and programs related to

promotion of quality of life; Performance of policy and appropriateness of the adopted

decisions;

Decision-making Process at the High Council

All proposals, before being examined by the High Council should be submitted to the Ministry of Health as the Secretariat.

Different expert groups from relevant ministries and organizations consider and prepare drafts and submit it to the Secretariat.

Working groups at the national and provincial levels review particular situations or problems and provide their suggestions.

Applied research centers, private sectors, as well as NGOs can submit their suggestions to the Secretariat.

Decisions adopted by the High Council are issued to all relevant organizations in the country;

All policies, regulations and decisions adopted by the High Council, are followed-up and assessed regularly by the Secretariat.

The First Stage: RECIVIENG THE SUGESSTION

High Council Secretariat in Ministry of Health

NGOs, Research

Center

Health Sector

Other sectors

The Second Stage: Submitting to working groups

• In the National levels

• In the Provincial levels

submitting to working

groups

The Third stage:

Discussion by working groups to

consider, to get agreement from other

sectors to suggest decisions, policies,

and regulation to the Health Council

The Forth stage: Declaring and announcing the ratified policies and regulations

The last stage: follow up and assessment

Suggestions

Regulations Decisions Policies

The High Council Meetings

The High Council meets quarterly; When required, extraordinary meetings will be

held The High Council meets officially with the

presence of the President and majority of its members, present and voting;

The Ministry of Health might establish various working groups to support the High Council.

The secretariat Members Levels Structure of the High Council

The Secretariat is placed at the Ministry of Health and Medical Education.

•9 ministries

•3 organizations

•President of the Islamic Republic of Iran, as its Head.

National

The Secretariat is placed in Medical Science Universities

In 31 provinces, Working Groups of Health and Food Security comprise of representatives of relevant ministers, organizations

the Governor Generals as their head.

Provincial

The Secretariat is placed in the District Health and Cure Network.

In 420 districsts, Working Groups of Health and Food Security comprise of representatives of relevant organizations at the district level

the local governors as their head.

District

Achievements

87 Approved Policies, Programs, Decisions

% of Approved areas by High Council for Health & Food Security (2004-2009(

0

5

10

15

20

25

30

35

40

Nutrition Diseases Control EnviromentalHealth

Otehrs

Thank you for your kind attention

Health in All Policies as Radical Approach toward Sustainable Development.

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