Kickbusch building professional capacity for HiAP

Professor Ilona Kickbusch
Graduate Institute, Geneva
Capacity building to implement
health in all policies
Kickbusch Helsinki 2013

The challenge
 The challenge for health promotion at the
beginning of the 21st century is to develop
capacity at various levels of governance to be
able to address the key determinants of health:
political, social, economic, commercial,
environmental and behavioral – and to
contribute to sustainable growth and
development.
 This requires new knowledge, strategic insights,
skills, approaches and instruments – within
“health” and beyond

Modules HIAP training manual
 Context: 21st century dynamics of health
 Measuring progress in health and wellbeing
 Understanding the policy process - Preparing a policy
brief
 Political determinants of health: whole of government
 Managing complexity
 Targeting inequities in health
 Multi stakeholder governance - Negotiating for health
 Intergovernmental integration
 Commercial determinants of health
 HIA Health lens, health co benefits
 Local action for health
 Whole of society - Influencing policies: citizens and
advocates
 New role of the health sectorKickbusch Helsinki 2013

Health promotion is not a
discipline
 The move towards a
new public health
 Advocate
 Mediate
 Enable

Health is not a silo
 Population health and
wellbeing is not a
sectoral but an overall
societal goal with
many benefits. It needs
to be embedded within
the general policy
imperative as a whole of
government
commitment.
 WHO Constitution:
Health is the
responsibility of
governments

Capacity is not just „technical
capacity“
 Beyond boundaries
 Systems thinking
 Speed and agility
 Interconnectedness
teamwork
 Innovation is valued
 Continuous
improvement
 Community focus

The system must welcome change
–
reorienting institutions to promote health and to
adopt new ways of working across government
and with many stakeholders at the institutional
level (whole of government approach) is highly
complex and difficult

….and become a learning
organization
 Capacity building is a long-term continual
process of development that involves all
stakeholders; including ministries, local
authorities, non-governmental
organizations, professionals, community
members, academics and more. (UNDP)
Collaboration is imperative!
 This links well to the understanding of health
promotion as a process. Capacity building aims
to primarily build on existing resources – it applies
principles such as the learning organization or
community development.
 It includes enhancing knowledge, developing

Macro-economics, law, policy science, political
science, political economy, complexity
science…………

Capacity to understand the policy
process
 Deal with uncertainty

Capacity to understand politics

Capacity to understand commercial
drivers
 Over the past decade sales of packaged
foods around the world have jumped by 92%,
to $2.2 trillion this year. In Brazil, China and
Russia sales are three to four times their level
in 2002.
 Sales of soft drinks across the world have
more than doubled in the past decade, to
$532 billion; in India, Brazil and China sales of
fizzy drinks have more than quadrupled. This
is troubling, given that sugary drinks
accounted for at least 20% of America’s
weight gain between 1977 and 2007. The Economist
Dec 15/2012

Capacity to understand health care as
a driver

Capacity to understand the
community

New mindset

Capacity for managing wicked
problems

Capacity for whole of society
response
WHO
Pandemic preparedness

Capacity to address systemic risks –
systemic failures – systemic solutions
Environment and health SA health lens IHR

Capacity for inward and outward
framing
Health impact –
societal impact
Investments in
population health
wellbeing can be
considered integral
to economic
development and to
promoting the wealth
of nations. Improving
the health of nations
is a powerful
instrument to this end.

Capacity for framing public health
challenges
Indiviual
behaviour Public health
 Cause:
 Poor lifestyle choices
of individuals
 Response: education
 Cause:
 obesogenic environments
 Response: HIAP,
regulation, wider
determinants, nudge

Stakeholder analysis and
management

Capacity for policy coherence
 Policy Coherence is the systematic promotion
of mutually reinforcing policy actions
across government departments and
agencies creating synergies towards
achieving the agreed objectives. (OECD)
 Platforms, networks, public private
partnerships, alliances and hybrid
organizations abound in the health arena.
 This requires cross cutting skills

SA Eat well – be active

Capacity for managing
conflicts
Article 5.3 of the FCTC:
“In setting and
implementing their
public health policies
Parties shall act to
protect these policies
from commercial and
other vested interests of
the tobacco industry ”
The WHO FCTC is the
only international
convention to explicitly
address the dangers of
an industry subverting
the object and purpose
of a convention.

Capacity for partnerships

Capacity to act at different
levels
Kickbusch NEK CNE Bern 2009

Communication and negotiation
skills
 Negotiation has become a critical public health
skill at all levels – from city parliament to global
health diplomacy.

Political skills………………..
 The globalization of
lifestyles is by no
means just a
technical issue for
public health. It is a
political issue. It is a
trade issue. And it is
an issue for foreign
affairs.
 Dr. Margaret Chan
2013

Enabling systems: political will is
required to
 Provide incentives
for collaborative
approaches to
governance and
policy making in order
to achieve synergies
and co benefits
 address conflicts
between
political, societal and
sectoral interests -

Enabling systems

New problems - New roles – new
arenas
 “Wicked problems” such as NCDs require
systems approaches. Ministries of health and
public health agencies are required to reach
out and to perform new roles in order to gain
leverage.
 They become champions within government for
tackling complexity through a mix of hard and soft
governance mechanisms ranging from law to
persuasion and incentives in order to engage
other sectors for health.
 New arenas: trade, foreign affairs,
finance…”top of the table”Kickbusch Helsinki 2013

Policy space
 The FORMAL recognition of a “HIAP” strategy or
approach provides the recognized policy space to
engage in collaborative cross--‐government work.
 It implies agreements/rules for the decision-
making processes between different sectors and
between different levels of government (horizontal
and vertical) as well as agreements on feedback
loops to central government (this takes different forms
depending on political systems and levels of
government) – this means ensuring commitment to
and mechanisms for accountability.
 In some countries – depending on the political system
- this includes not only the executive branch of
government but also the legislature.

Policy space
 It is essential to develop formal and sustained
mechanisms for intergovernmental integration and
joint learning and capacity building for this new form
of policy making and horizontal governance for health
– this can be a HIAP unit in the MOH with a
counterpart in central government.
 This goes beyond committees set up to deal with
specifically defined problems.
 There must be continuity and legitimacy of
leadership (possibly through the features of the
public health legislation)

SA health lens model

Joined up learning
opportunities
 Capacity building also
includes intersectoral
training opportunities
in cooperation with
schools of public health,
business schools,
schools of diplomacy
and foreign policy and
schools for public policy
to create a new skills
mix based on systems
thinking and dealing
with complexity.

http://www.healthinfonet.ecu.edu.au/health-
risks/nutrition/
nutrition-workforce/nutrition-workforce-development

Community capacity
 Community capacity building concerns the
ability of community members to take action to
address their health through social and political
support that is required for successful
implementation of policies and programs that
have an impact on health. Empowerment for
health is a critical factor at the individual and
community level.
 Empowerment through health literacy.Kickbusch Helsinki 2013

Policy making
 21st century governance for health requires
structures and mechanism which enable
collaboration, ensure accountability, increase
transparency and work for health and equity.
 The core skill of strategic public health will be
the management of the interfaces between varied
groups with very different interests, legitimacy
and power. The Health in All Policies
strategist, then, must “evolve from a master
who gives the orders to a facilitator who
makes the process work”.

Capacity for smart sovereignty
 With the impact of globalization and the increase
of actors in global health action at the global
level is gaining increasing importance;
 Understanding the global-local interface is
essential

Kickbusch building professional capacity for HiAP

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Kickbusch building professional capacity for HiAP