“We members of the Global Network for Health in All Policies commit to sharing the experience of institutionalizing the Health in All Policies (HiAP) approach and to facilitating and accelerating HiAP implementation for progressing the Sustainable Development Goals and Universal Health Coverage”.
This bold mission statement of the newly launched global network to strengthen country action on HiAP captures the essence of the network spearheaded by five countries and regions – Sudan, Canada (Quebec), Finland, Thailand and South Australia. HiAP is “an approach to public policies across sectors which systematically take into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity”. The HiAP network was launched on 24th May 2017, at a side-event during the 70th World Health Assembly hosted by the Graduate Institute, Geneva. Chairing the panel was Sudan’s Federal Minister of Health H.E. Bahar Idris. This blog reflects on some of the proceedings of the launch. Of particular interest to me is HiAP within the context of African countries as my PhD focuses on this.
The session addressed many aspects of HiAP and also some of the challenges. Political commitment for HiAP is a major challenge, as many participants emphasized. South Australia is known for its Health in All Policies Model; political commitment is one aspect which its Chief Medical Officer, Paddy Phillips attributed to his country standing out as a leading example for HiAP globally. He stated that HiAP was a mandate from the South Australian government, and leaders took it upon themselves to push the HiAP agenda. This is critical – because for HiAP to work across a whole government, coordination and commitment need to be supported by a high-level government mandate as in this case. Philips also stated that HiAP is well embedded in their 30-year plan for a greater Adelaide (2017 update). In the case of Sudan, Dr. Abdalla Sid Ahmed Osman, the Director National Public Health Institute, Federal Ministry of Health Sudan, pondered some ministries are more aware of their impact on health than the Ministry of Health itself. Dr. Vivian Lin and Professor Illona Kickbusch who are compiling a book of case studies on HiAP (to be published in October 2017), highlighted both advanced and emerging HiAP strategies in the SDG context. They cited the example of South Australia as a “mature” example where HiAP has been practiced for a decade now. Emerging practices listed by them were from Africa – Namibia and Zambia, countries which have developed a national strategy for HiAP. However, implementation of HiAP continues to present a challenge.
One of the ways suggested during the discussion to tackle the issue of political commitment, and boost cooperation between ministries towards improved implementation is to aim for a “win-win strategy”. Horacio Arruda, Chief Public Health Office and Assistant Deputy Minister of Health and Social Services, Quebec Canada indicated that a win-win strategy could increase the practicality of including health objectives in the planning processes of ministries. He showed how power is shared between levels of government with ample opportunities to address issues in different sectors while integrating health, thus emphasising win-win’s. The need to establish a flexible and adaptive approach to HiAP which could withstand the constant change of actors – State and Non-State – in HiAP was also raised. A specific body for coordination within the government was suggested as a better way to foster HiAP initiatives. Some possible roles for the non-state actors were also suggested.
Nicole Valentine, senior technical officer, department of Public Health, Environment and Social Determinant of Health, WHO hopes that by 2030 the Network will have made a significant contribution towards the SDGs goals. HiAP as a concept of promoting health through intersectoral collaboration epitomizes presently what has been advocated for since the Alma Ata declaration. Given the uneven progress registered with the MDGs, HiAP as a comprehensive approach, encompassing multiple aspects of governance, is more relevant than ever for sustainable development – one which should be the norm rather than a “cutting edge” solution. Nicole said that models of HiAP should find ways to be more focused in addressing SDGs and reflect on the Adelaide II statement. They should give attention to health promotion especially in raising public debates on social equity and the SDG’s “leaving no one behind”. HiAP education is extremely important in embodying the spirit of the Shanghai declaration, reinforcing basic principles on Health Literacy and promoting constant dialogue. HiAP initiatives should also be bold to promote financial support not just on Universal Health Coverage, but also health promotion and public health functions. The Director of the Ministry of Social Affairs and Health, Finland, Mr. Taru Koivisto indicated that HiAP was particularly relevant within the context of the SDGs – all of which influence health. However, there is a need to address its implementation at local level entities to address the SDGs. In Finland, for example, Taru said that the legislation for implementation was present but cooperation within the ministries remained a challenge.
This first network steering committee meeting representing at least 11 committed partners from both country representatives and non-state actors was held on 26th May 2017. Current member countries include Sudan, Finland, Thailand, South Australia, Tunisia, Saudi Arabia, Chad, Botswana and Somalia. Non-state members include the WHO Department of Public Health, Environment and Social Determinants of Health, and The Global Health Centre, at the Graduate Institute of Geneva. The concept note for the network was shared once again. The chair H.E. Bahar Idris committed to financing the network and said he’ll call upon other ministers to join. The network will aim to mainstream HiAP to be the “modus operandi” globally. It will increase access to country experiences in a more supportive way so that members can learn from each other’s successes and failures. Budget constraints for HiAP will also be addressed, and the use of e-tools as suggested by Nicole from the WHO will be taken up as one of the ways for the WHO to contribute to the network.
The pioneering champions of this network are convinced that this is the way forward. Horacio Arruda emphasised the power of a network and the shared commitment to bring about change, parting with a somewhat familiar slogan, “I will have a dream – yes we can!” and the chair echoed, “together- yes we can!”