New WHO publication on participation for better health with case studies from 4 European regions
Participation is a key element of an interconnected society, a necessary factor to achieve both community and individual goals. Including participatory concepts within the core of health plans and legislations makes it possible to improve health and well-being at different levels and in all groups of society. The recent WHO/Europe publication "Taking a participatory approach to development and better health" proves this with case studies from 4 members of the Regions for Health Network (RHN).
The publication documents 4 examples of successful experiences of Health 2020 implementation at all levels of governance. It has a specific focus on the participatory processes through which Region Skåne (Sweden) created its regional development strategy "The open Skåne 2030".
Regional development strategy in Skåne (Sweden)
Skåne, a county in the southernmost region of Sweden, has been growing economically for many years and saw a very visible increase in the exchange of goods, capital and people across its border. Such a dynamic trend brought opportunities, as well as challenges: the population is young and diverse and many residents are living longer and becoming healthier. However, differences in social determinants of health are increasing too. Moreover, even if demand for employees is great, the region has the highest unemployment rates of the country.
Work on Skåne's regional development strategy started with the commissioning of an Organisation for Economic Co-operation and Development (OECD) territorial review of the region, published in 2012. A background assessment by an independent body is one of the key lessons that emerged from the Swedish experience. The OECD's analysis and recommendations laid the foundations for an extensive dialogue with citizens, civil society, business and public sectors, aimed at achieving an open Skåne by 2030.
The open Skåne 2030 vision is based on 5 main priorities:
- the opportunity to offer optimism and quality of life;
- the necessity to be a strong, sustainable growth engine;
- the capability to take advantage from its polycentric urban structure, which is unique in Sweden;
- the development of the welfare services of tomorrow; and
- a global attractiveness element.
8 priority areas were defined to include different aspects of public health and social sustainability, each with its own goal indicators, most of which measure health and its social determinants. Joint actions have been performed by gathering actors on cross-sectoral platforms, in order to foster a broad approach based on cooperating and highlighting each other's strengths. To do this, it was necessary to emphasize the potential of the common good by finding a common purpose for stakeholders through a process that required trust at all levels and that involved and empowered sectors other than health. A follow-up tool, "How has it gone in Skåne?", is compiled annually to report further developments with regards to certain chosen indicators.
Together with the Skåne experience, the publication reports on 3 other case studies.
Regional health plan in the Autonomous Province of Trento (Italy)
The Autonomous Province of Trento is located in the Northern part of Italy and has about 500 000 inhabitants. Its main aim was to draft a strategic plan within the framework of Health 2020, ensuring the adoption of a participatory approach and drawing attention to the determinants of health. A radical change in the structure of the health report was carried out in 2012, followed by the organization – together with WHO/Europe and RHN – of a training course for decision-makers on public health planning in 2013. In 2014, a working group was set up to involve both the health and social sectors in the development of the first draft of the strategic health plan 2015–2025, which is expected to be approved by autumn 2015. The Trento case is, thus, a relevant example of the shifting focus from health services to health promotion and from a merely technical to a more participatory approach in the development of a health plan.
The Fourth Andalusian Health Plan (IV AHP) in the Autonomous Community of Andalusia (Spain)
The Autonomous Community of Andalusia (with a population larger than 8 million people) is Spain's biggest autonomous region. Participation was one of the pillars of the IV AHP since the evaluation of the previous health plan, in line with the approach suggested by Health 2020. Working groups were established with the participation of experts in charge of policies with impact on the social determinants of health. Subsequently, their technical proposal was considered by citizens and patient associations, professional unions, and other social and administrative actors. The final step was an official public hearing process, open to all citizens, before the approval of the IV APH. Also, a participatory process is ongoing to assess and rank provincial and local health needs through a combination of participation and discussion forums, and citizens' and experts' panels.
The Well-being of Future Generations Act 2015 in Wales (United Kingdom)
Wales is 1 of 4 nations within the United Kingdom with devolved powers in several areas, including health. It implemented several participatory approaches that led to the introduction of the Well-being of Future Generations Act 2015. One of these initiatives is The Wales we want, a national conversation aimed directly at the people of Wales about the most important issues for them to better their lives and those of their families, communities and businesses. It involved over 7000 people across the country through both public and individual communication. The Act calls on public bodies to improve citizens' well-being and considers future generations' needs. To this end, 7 statutory goals were set up, and public institutions will work jointly through public services boards to achieve them. National indicators will be published to measure collective progress.
About Health 2020
Among the objectives of WHO/Europe's framework Health 2020 is a strong impulse towards a new approach to health governance mechanisms. The policy framework has 2 goals:
- improving health for all and reducing health inequalities
- enhancing leadership and participatory governance for health.