Day 2: new European platform for partnerships across sectors, United Nations agencies and civil society
The second day of the high-level conference Working together for better health and well-being focused on how to implement intersectoral and cross-governmental policies. A common observation among delegates was the need to identify and communicate co-benefits for sectors other than health in order to generate effective, sustainable partnerships. They agreed to establish a new platform to improve and implement collaboration.
Session 4: a systems approach – investing in the workforce, enabling change
Mr Heikki Räisänen, Research Director of Finland’s Ministry of Economic Affairs and Employment, introduced the session with a presentation on the importance of ensuring that the conditions are right for building a labour market capable of delivering the complex, cross-sectoral services needed to improve the health and well-being of children and young people. He underlined that even countries with good infrastructure for educating and training an effective workforce must place an additional focus on developing foundational skills in literacy and numeracy.
Mr Räisänen described the implementation of the Youth Guarantee in Finland, a cross-sectoral programme that works to provide young people with access to education and employment. It includes “one-stop-shop” guidance centres that enable people under 30 to resolve their problems by coordinating with different services. He emphasized the importance of addressing the individual’s most pressing problem first – for example, attending to the health issues preventing a young person from working before providing employment services, or developing a debt-repayment plan to give someone incentive to accept an offer of employment. Mr Räisänen explained that the Finnish example illustrates how working across different sectors is not an end in itself, but a means to solving common problems.
Participants representing health, education and social sectors within government and civil society raised many key issues during the session’s panel discussion. These included: the importance of reviewing higher education for teachers, doctors and social workers so they have the skills to implement intersectoral policies; the need for assessment criteria to measure education standards; the additional employment that health professionals generate (every nurse or doctor creates 2.3 additional jobs); the need to ensure decent working conditions and standards, including universal social protection, for those working in the health and care sectors that traditionally consist of low-paying jobs or unpaid work predominantly done by women; the increasing role of civil society and the private sector in providing health and social services; the need to remove barriers preventing potential health workers from entering the field; the heavier burden of coordination challenges that larger countries face; and the challenge of enabling data-sharing across sectors.
Many delegates agreed with the idea of moving away from the concept of “health care” and towards that of “people-centred care”. People-centred care brings together an integrated team of health, social and education personnel around the individual, working with them as a person rather than simply as a patient.
Session 5: a systems approach – good governance for the health and well-being of all children and adolescents
Mr Oleg Crăciun, Deputy Minister of Health for the Republic of Moldova, began the session’s panel discussion by describing how his country’s health reform has underlined the need to work across sectors. Using the example of providing nutritious food in schools, he noted that in order for an apple to reach the plate of a child in school, the health, finance, agriculture, transport and education ministries all have to work together.
A delegate of Austria called for the development of a joint language for working across sectors to more effectively communicate co-benefits for each partner. This point was echoed by a delegate of Slovenia, who called for the identification of win-win activities for each sector. She also underlined the need to ensure that such activities are implementable at the local level, and described how an initiative to improve nutrition in Slovenian schools by cooking lunches using locally sourced ingredients was only successful when children themselves were involved in developing and making the dishes.
A delegate of Ireland emphasized the importance of communicating with the public to build understanding and commitment to policies and initiatives, pointing out that a shared language – including terms such as quality of life and well-being – means that more people are engaged. Offering a municipal perspective from France, a representative of the European Healthy Cities Network underlined that national policies must be implementable at the local level, and that a legal and financial basis to partnerships must be established.
A representative of the European Public Health Alliance offered compelling arguments for including civil society in developing and implementing intersectoral policies. She described nongovernmental organizations as models for intersectoral action, explaining that they could act as an early warning system for systemic failures such as in-work poverty for health workers and carers; fill a watchdog role; and facilitate the listening process for people on the other side of the health gap.
The final panellist, Mr David McDaid of the London School of Economics and Political Science in the United Kingdom, brought a financial perspective to the discussions. He explained that one of the most effective ways to overcome barriers to working intersectorally is to establish an earmarked fund from the finance ministry or prime minister’s office to be used exclusively for cross-government and intersectoral work.
Session 6: bridging the gap – information and evidence for action
Minister of Health of Andorra Carles Álvarez Marfany began the session by describing a 30 km-long path across the country that was historically used by refugees. The path was recently revitalized as a health and human rights walkway, where a different article of the Universal Declaration of Human Rights is shown on a poster every kilometre. The walkway provided an example of using innovation to reinterpret an existing resource, and introduced the focus of the session: moving beyond data and finding new methods to understand evidence through multilayered and nuanced cultural interpretations.
There was broad consensus among participants that quantitative research alone does not provide the understanding needed by the health, education and social sectors for effective policy-making. They agreed that qualitative research and storytelling is also needed to assess and understand subjective experiences such as happiness and well-being. With a balanced approach, the application of data and evidence can be transformative.
The Centre for Medical History at the University of Exeter in the United Kingdom, now designated as the WHO Collaborating Centre on Culture and Health, aims to support the creation of locally effective, socially sensible policies. Professor Mark Jackson described a specific example that the Centre investigated: the very high rates of cervical cancer found in Romania, despite the availability of the human papillomavirus vaccine and screening. The Centre’s ethnographic and anthropological research revealed that uptake of screening and vaccination has been low among Romanian women because of widespread mistrust of health promotion initiatives stemming from reactions against aggressive policies dating back to the 1970s, combined with the stigmatizing perception of women with cervical cancer as promiscuous. Professor Jackson argued that this layer of understanding allows for more effective evaluation of health policies.
A rich plenary discussion provided further examples of the need to look behind the data in order to understand the cultural contexts of policies. A delegate of Iceland explained that, counter-intuitively, adolescents in the country reported higher levels of well-being after the financial crisis in 2008. Underlying this trend was the fact that parents were working less, had more time and could provide more emotional support to their children.
Other participants pointed out the need to consider research and evidence in the global context; noted that benchmarking across countries was sometimes unhelpful; and discussed the ongoing challenge of capturing data about the people most in need but also most difficult to reach. In order to tackle health inequalities, delegates emphasized, health information inequalities must first be addressed.
Session 7: a transformative partnership between the health, education and social sectors to fulfil the 2030 Agenda for Sustainable Development
Dr Zsuzsanna Jakab, WHO Regional Director for Europe, explained that achieving the goals of the 2030 Agenda for Sustainable Development and implementing the European health policy framework Health 2020 calls for transformative partnerships to address the social determinants of health across agencies, sectors and civil society, involving all in policy-making and implementation. Dr Jakab proposed that a regional platform for regularly bringing all partners together, as well as a mechanism to work effectively through the United Nations family and harness United Nations coalitions, would be a positive step towards stronger intersectoral and interagency action. It would also help to ensure that national development plans have health and well-being at their heart, she argued.
Representatives of United Nations organizations expressed their support for such a platform and their willingness to participate. Ms Rie Vejs-Kjeldgaard, Deputy Regional Director of the International Labour Organization’s Regional Office for Europe and Central Asia, underlined her organization’s commitment to promoting the social protection floor and advocating for the fiscal space and capacity to deliver these social protection measures. Mr Basil Rodriques, Regional Adviser for the United Nations Children’s Fund, suggested the development of an inventory of relevant initiatives across agencies to facilitate collective work and pool resources more effectively. Ms Rosemary Kumwenda, Regional Adviser at the United Nations Development Programme, emphasized the importance of strengthening partnerships and collective action at the country level. Ms Tamar Khomasuridze, Sexual and Reproductive Health Adviser for the United Nations Population Fund’s Eastern Europe and Central Asia Regional Office, expressed her belief that the new platform will make it possible to bridge experiences, and that it will benefit from the participation of civil society – particularly youth networks. Finally, Mr Christophe Cornu, Senior Programme Specialist at the United Nations Educational, Scientific and Cultural Organization, explained that the conference itself was a collaborative process, which “gives a strong signal to the world”.
Ms Monika Kosinska, Programme Manager of Governance for Health at WHO/Europe and Conference Coordinator, outlined the key elements of the conference declaration “Partnerships for the health and well-being of our young and future generations”. These include ensuring the full participation of all target groups, focusing on risk prevention, seeking collaborative opportunities, strengthening mental health and reinforcing the need for culturally appropriate action. The declaration will be proposed for adoption at the 67th session of the WHO Regional Committee for Europe in September 2017, following a full consultative process.
Closing of the conference
In her closing comments, Dr Zsuzsanna Jakab described the conference as a dream come true – the practical realization of discussions about placing health in all policies and engaging civil society in policy-making and implementation. “To go far, we need to go together. To ensure that no child is left behind, we need to work together and share responsibility,” she concluded.
Side event: health literacy
This event examined how the health community can best frame the case for investing in health literacy, particularly when reaching out to the education sector. In his presentation, Mr David McDaid explained that up to 47% of the European population has poor or inadequate levels of health literacy. He then laid out examples and evidence of how health literacy can improve outcomes in multiple sectors. He emphasized that health literacy can also yield short-term gains, which can spur early action and investment in this area. Comments from the audience, including participants from the education sector, reiterated the importance of using vocabulary that resonates with other sectors when making the case for health literacy.
Side event: WHO survey of institutions for adults with mental disabilities in the European Region
Presenters shared compelling data on the results of a WHO survey of 35 countries on the governance, number and demographics of institutions for those living with chronic mental health disorders. Delegates from the Republic of Moldova and the United Kingdom shared examples of successful collaboration across sectors and actors to ensure that people living with chronic mental health disorders can continue to reside in their communities. Participants pointed out the key challenge of a culture of stigmatizing attitudes, which requires hands-on community support and intensive workforce training to transform.