International Health Policy Program -Thailand Tipicha Posayanonda, PhD. National Health Commission Office Suladda Pongutta International Health Policy.

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Tipicha Posayanonda, PhD.National Health Commission Office

Suladda PonguttaInternational Health Policy Program - Thailand

Journal ClubAugust 14, 2009

A Healthy, Productive Canada:A Determinant of Health Approach

Final Report of Senate Subcommittee on Population Health

June 2009

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I. Background 1Final Report of

The Commission on Social Determinants of Health (CSDH) 2008“Closing the Gap in a Generation:

Health Equity through Action on the SDH”• Improve daily living conditions

(equity from the start; healthy places healthy people; fair employment and decent work; social protection across the lifecourse; universal health care)

• Tackle the inequitable distribution of power, money, and resources(health equity in all policies, systems and programs; fair financing; market responsibility; gender equity; political empowerment – inclusion and voice; good global governance)• Measure and understand the problem and access the impact of action

(monitoring, research and training)

SEA Regional Consultation on SDHColombo 2009

WHA 62, Geneva 2009(SDH movement at international and national level/to report in WHA 2012)

WHO EB, Geneva 2009

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Canada: The Greatest countries in the world

in which to live• Some Canadians;

excellent health + one of the highest life expectancies in the world

While• Other Canadians;

poor health + life expectancy similar to some third world countries

Cannot correct this with health care system itself

I. Background 2

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Mandate from the 1st session of the 39th Parliament

“examine and report on the impact of multiple factors and conditions that contribute to the health of Canada’s population-referred to collectively as the determinants of health”

II. Population Health and Health Disparities 1

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Methodologies

• 30 subcommittee meetings• 117 witness interviews • Hundreds of written submissions• 6 Canadian community visits

2.1 From Health Care to Determinants of Health

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Social Determinants of Health

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2.2 Population Health Policy

Fundamentally, all roads lead to population health. Whether it is economic issues, income security issues or environmental issues, they all come back to population health

Mel Cappe, President, Institute for research on Public Policy, 26 February 2009

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2.3 The case for action, the cost of inaction1

“Canada’s health and wealth depend on the health of all Canadians”

SocialEconomicCulturalEnvironmental

Health status

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Cost• Direct cost

- health care cost

• Indirect cost- social costs; welfare & crime - lost productivity- reduced quality of life

2.3 The case for action, the cost of inaction2

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Adoption and implementation

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1.A whole-of-government approach; targets health disparities in all policies

2.All sections in society work together

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Major challenge One problem is that we see the cost of acting but we do not see the cost of not acting. Conditioning must be done to explain to the public that not addressing this problem, whether in social housing, income security or

any of these elements, will make things worse down the road.

The public says: Do I want my tax dollars going to that problem now? The answer is: Yes, otherwise, we will pay

a bigger price.

Mel Cappe, President, Institute for research on Public Policy, 26 February 2009.

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III. Health Pays Off – Act Now

• Whole-of-Government Approach

• Database Infrastructure

• Engaging Communities

• Aboriginal Population Health

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3.1 Whole-of-Government Approach 1

• Governance

– All political parties are committed to reducing health disparities in Canada, and this must be top priority on the government agenda.

– The Prime Minister must show leadership and engage/support other levels of government in advancing the population health agenda across Canada.

– Interdepartmental and intergovernmental collaboration

• Successful models should be learnt.• Creation of policy and knowledge node –

expert knowledge and connectivity for the implementation of population health and health disparities reduction policies and initiatives

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3.1 Whole-of-Government Approach 2

• Vision and Goals – “To allow every Canadian to develop, live

and contribute to society to her/his fullest potential”

• Tangible and measurable health goals, objectives and targets are essential (Agreed upon in 2005)

• Health disparities indicators should be matched with the Health Goals.

– “We aspire to a Canada in which every person is as healthy as they can be, physically, mentally, emotionally and spiritually, is the medicine wheel” The Hon. Carolyn Bennett, M.P. June 2008

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A set of health goals was developed in 2005 through a broad consultation and validation process involving provinces, territories, public health experts, stakeholders and citizens who shared their knowledge and vision for a healthy Canada.

Areas Health Goals for Canada

1. Basic needs (social and physical environment)

Our children reach their full potential, growing up happy, healthy, confident and secure. The air we breathe, the water we drink, the food we eat, and the places we live, work and play are safe and healthy – now and for generations to come.

2. Belonging and engagement

Each and every person has dignity, a sense of belongings, and contributes to supportive families, friendships and diverse communities. We keep learning throughout our lives through formal and informal education, relationships with others, and the land. We participate in and influence the decisions that affect our personal and collective health and well-being. We work to make the world a healthy place for allpeople, through leadership, collaboration and knowledge.

3. Healthy living Every person receives the support and information they need to make healthy choices.

4. A system for health

We work to prevent and are prepared to respond to threats to our health and safety through coordinated efforts across the country and around the world. A strong system for health and social well-being responds to disparities in health status and offers timely, appropriate care.

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• Interdepartmental Spending Review – To identify programs that influence health;– To reallocate funding to programs that

focus on health disparities

• Health Lens in all Policies – Federal Cabinet endorsed in 1997 that

Health Impact Assessment (HIA) be applied to all federal policies and programs.

• Canadian Handbook on HIA• It was a mandatory in British Columbia that

HIA was integrated in the process of policy analysis.

– The use of HIA should be encouraged in all provinces and territories.

3.1 Whole-of-Government Approach 3

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3.2 Database Infrastructure 1 • Community Accounts (CA) and

Electronic Health Records (EHR) – CA is an internet-based retrieval and

exchange system providing unrestricted/free access to view and analyze social, economic and environmental data from various sources at the local, regional and provincial levels.

– EHR contains patient health information (e.g. clinical reports, immunization data, prescribed medicines, etc.)

– Linkages of CA and EHR should be facilitated by Canadian Institute for Health Information

• A need to find a good balance between protecting the information of individuals and allowing the use of information on a population group to inform public policies and strategies.

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3.2 Database Infrastructure 2

• Population Health Intervention Research – To continuously monitor and evaluate

policies and programs in order to understand about what policies and programs are effective in improving population health and reducing health disparities.

• Research on housing, early childhood development and mitigating the effects of poverty among Aboriginal peoples and other vulnerable populations be considered priorities.

– Capacity and strengths of existing networks and research centers should be built on, collaborative partnerships among municipal, provincial and federal research agencies as well as academic partners need to be developed for a focused research agenda.

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3.3 Engaging Communities 1

“The leadership has to come not only from the federal government – and I believe the federal government has a key role – but it has to come from the bottom as well.” Debra Lynkowski, Chief Executive Officer, Canadian Public Health Association April 2008

• Reporting Requirements – Harmonization of reporting and audit requirements

– For a more holistic, responsive and coordinated approach to community investments

• Long-Term Funding – It often takes many years before results are seen

in terms of improved health status or reduced health disparities – Multi-year funding agreements are encouraged.

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3.3 Engaging Communities 2

• Community Data and Research

– Actions to improve health and reduce health disparities almost certainly have to be tailored to the different realities of each neighbourhood.

– Easy access to neighbourhood-level data is essential.

– Local analysis and evaluation capacity in the design of programs aimed at improving population health and reducing health disparities should be supported by the Government.

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3.3 Engaging Communities 3

• Community Models that Work

– Citizen’s Voice Network in St. John’s – To meet regularly to share information, to learn, and collectively to impact policy-making and decision-making of the city.

– A local action committee in Montreal neighbourhood – To improve social and economic conditions of the neighbourhood by a comprehensive community plan developed by 400 community members and stakeholders (i.e. residents, community groups, businesses and institutions)

– Healthy Communities movement – Ontario, Quebec and BC

– Polyclinic model in Cuba – A strong multidisciplinary approach: prevention mandate, medical training and education, working closely with teachers

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3.4 Aboriginal Population Health

“There are striking disparities between Aboriginal and non-Aboriginal Canadians in most health determinants and the gaps are widening.”

– Better coordinated and integrated programs and services with the view of addressing health determinants among the Aboriginal population are needed.

– Priorities include clean water, food security, parenting and early childhood learning, education, housing, economic development, health care and violence against Aboriginal women, children and elders.

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Recommendations

• A new style of governance: - leadership from the top to develop and

implement population health policies- implement at the in all levels with clear

goals/targetsand a health perspective to all policies and programs

• The foundation: create a sound population health data infrastructure

• Building healthy communities• A priority focus on aboriginal

population: development and implementation of health policies and reduction of health disparities

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Conclusion “Canada has led the world in understanding

population health and health disparities: Ottawa Charter for Health Promotion in 1986, but the lack of action has led the country to a widening of health disparities.”

“If all governments, with the leadership of the PM of Canada, act strategically and in a coordinated way on the determinants of health, mobilizing communities, the business sector and all Canadians, people of Canada can together achieve better health and wealth within a generation.”

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SDH Thailand 1• The National Health Act: 4 Dimensions of

health, Statute on the National Health System, health assemblies, health impact assessment (HIA), participatory healthy public policy development

• Current Movements:• SDH Network/meetings among MoPH and partners –

sharing ideas/experiences• Linkage between health assemblies/ National Health

Assembly/ stakeholders/ policy implementation• Linkage between WHA and SDH (SDH Thailand to be

launched in NHA 2009)• Health inequity report by IHPP• Clearly established roles of HIA Co-Unit• SDH Training and Knowledge Network (Mahidol U)

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SDH Thailand 2

• National Health Assembly 2009 (NHA2009)

• Technical Briefing Session/ Thailand inequity report

• CSDH Report in Thai Language

“SDH”

“Health Determinants of Social Equity (HDSE)”

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Case Study – Obesity and Nutrition

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Future Movements and Challenges

• Strengthening of the SDH Network in Thailand, ensuring political commitment and participatory involvement of stakeholders

• Development of vision, health goals and health disparities indicators using evidence-based information and participatory process, then the national plan of actions

• Development of the national database system linking information and research at all levels for policy development and implementation

• Monitoring and Evaluation for further policy interventions

• Raise awareness of people on “public participation and HIA in all policies”

• Development of international SDH network

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Thank you for your kind attention