RHN study visit to Seville. Why Andalusia?
Opportunity; entry point; people: these are the 3 keywords related to a study visit to Seville, Andalusia (Spain), on 12–14 November 2018, organized by the Regions for Health Network (RHN). The aim of the visit, in which 42 representatives of 13 regions took part, was to become familiar with the innovative 4th health plan, "IV Andalusian Health Plan" (IV AHP), which is based on the Health-in-All Policies principle.
The visit provided the participants with:
- a unique opportunity to hear about Andalusia’s programmes and projects and visit places where they were in progress;
- entry points to implementation of the United Nations 2030 Agenda for Sustainable Development (complex health strategies, such as the 4th Andalusian Health Plan, offer multiple possibilities);
- an insight into the important role played by the people in such experimentations – it is only through their commitment that real levers of change are possible.
A combination of meetin gs with the regional authorities, discussions with experts, and visits to primary health care facilities and the historical and cultural heritages of the Region, enabled the participants to become fully immersed in the Andalusian path towards reducing inequalities and promoting the right to health.
In her welcome, the Regional Minister of Health, Dr Marina Álvarez, celebrated the 25 years of life of RHN, underlining the role of the Network in promoting the right to health and the strategic function of the subnational level: “The role of the Regions for Health Network has been fundamental in promoting mutual learning among us through an exchange of knowledge and concrete experiences in different field of health. In this sense, the great commitment of WHO in strengthening partnerships among regions has been the key lever in moving forward towards the formulation of public health policies and strategies with the common objective of Health for All.”
The 4th Andalusian Health Plan 2013–2020
In 2013, the Autonomous Region of Andalusia launched its visionary 4th health plan, walking the talk of the 2030 Agenda.
The IV AHP is the result of a participative process, involving citizens, civil-society organizations, health professionals and academics from the local to the regional levels; it has 24 goals, 92 objectives and 290 actions.
Fully aligned with RHN’s core principles, the IV AHP aims to protect and improve the health status of the Andalusian population by addressing the social determinants of health, involving all policies in the process. It focuses on 6 commitments agreed by all departments of the Regional Government of Andalusia:
- to increase citizens’ healthy life expectancy;
- to protect and promote population health from the effects of climate change, globalization and emerging risks affecting environmental factors and food safety;
- to generate and develop health assets and make them available to Andalusian society;
- to reduce social inequalities in health;
- to provide citizens with a people-centred public health system led by health professionals; and
- to apply sustainability criteria in knowledge management and in introducing technology to improve population health.
The guiding principles of the plan are as follows.
Health-in-All Policies approach and intersectoral integration
Health is considered a right and a resource. The IV AHP changes the level of region’s approach to applying health policy from sectoral to intersectoral, placing its main purposes at the core of the Regional Government commitment. It is being applied through various local action plans and initiatives, based on integrated action to address the social determinants at all levels of governance, involving all policies in the process. These relate, for example, to: comprehensive health care for patients with chronic diseases; mental health; diabetes; obesity; and physical activity and healthy diet.
The local action plans and initiatives for implementation of the IV AHP involve a huge participatory process in which the public is included.
Local action in health
Local governments are considered essential stakeholders. Approaches to addressing the social determinants of health in Andalusia are based on strong political commitment and municipal leadership, equity, community engagement and intersectorality.
Health impact assessment
According to Article 2 of the Public Health Law of Andalusia, health impact assessment is a combination of procedures, methods and tools for judging the potential effects of a policy, programme or project on the health of the population, as well as the distribution of these effects. Multidisciplinary groups (1 regional and 8 provincial) have been set up to promote innovative health impact assessment in Andalusia. With a strong focus on equity, these groups will give special consideration to vulnerable populations and citizen participation, and to improving scientific evidence.
The IV AHP was framed using a gender perspective in allocating resources and decision-making roles, rectifying imbalances and assuring fairness in the treatment of people, regardless of gender.