21st century Health Leadership Regions for Health Ilona Kickbusch - - PowerPoint PPT Presentation

21st century Health Leadership Regions for Health

Ilona Kickbusch The Graduate Institute, Geneva Cardiff 11.10.2013

Why regions?

• (Most?) Powerful actors for health, well

being and sustainability - hard factors – soft factors

• The capacity for innovation and learning
• Champions of health citizenship

Kickbusch Cardiff 2013

Regions – critical interface of multilevel governance

Kickbusch Cardiff 2013

global EU national State provincial local

Kickbusch Cardiff 2013

Health is about political choices

• The political choices we make about how

we want to live

• Contested visions of a good society and a

good life – WHAT constitutes the common good – HOW TO resolve collective action problems

Kickbusch Cardiff 2013

Governance

• ‘Governance concerns the state’s ability to serve the
• citizens. It refers to the rules, processes and

behavior by which interests are articulated, resources are managed, and power is exercised in society.

• Governance is a basic measure of the stability and

performance of a society. The way public functions are

carried out, public resources are managed and public regulatory powers are exercised …’. EC 2003

Kickbusch Cardiff 2013

What is governance about?

Rules Interests Resources Power Issues

Kickbusch Cardiff 2013

• Technical leadership in public health: we

know what to do………….leadership in health promotion „healthy regions“

Kickbusch Cardiff 2013

History: Heartbeat Wales

• was a community based program in Wales to improve cardiovascular
• health. The program used a range of health promotion methods to change

individual health behaviors and to promote environmental,

• rganizational, and policy changes that support healthy choices.
• The program included local television series such as "Don't Break Your

Heart," "Fit for Life," and the "BBC Diet Programme." To encourage smoking cessation, the program developed the Quit and Win project. Heartbeat Wales worked with grocery retailers to encourage food labeling and nutrition education, and developed the Heartbeat Awards for restaurants that increased the availability of healthy food choices and smoke free areas. The program also developed a worksite health promotion program called Make Health Your Business.

Kickbusch Cardiff 2013

1986 Ottawa Charter Pledge

Kickbusch Cardiff 2013

to move into the arena of healthy public policy, and to advocate a clear political commitment to health and equity in all sectors; to counteract the pressures towards harmful products, resource depletion, unhealthy living conditions and environments, and bad nutrition; to respond to the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of these societies;

1986 Ottawa Charter Pledge

Kickbusch Cardiff 2013

to acknowledge people as the main health resource, to support and enable them to keep themselves, their families and friends healthy through financial and

• ther means, and to accept the community as the

essential voice in matters of its health, living conditions and wellbeing; to reorient health services and their resources towards the promotion of health; and to share power with

• ther sectors, other disciplines and most importantly

with people themselves; .

1986 Ottawa Charter Pledge

Kickbusch Cardiff 2013

 to recognize health and its maintenance as a major social investment and challenge; and to address the

• verall ecological issue of our ways of living

 The Conference is firmly convinced that if people in all walks of life, nongovernmental and voluntary

• rganizations, governments, the WHO and all other

bodies concerned join forces in introducing strategies for health promotion, in line with the moral and social values that form the basis of this CHARTER, health for all by the year 2000 will become a reality.

25 years on ……context

Kickbusch Cardiff 2013

Radically changing societies: Globalization Urbanization Individualization Virtual connectedness Commercialization Demography

Constant change

• Governments … will need to adapt and continuously

evolve to create value.

• They need to stay relevant by being responsive to

rapidly changing conditions and citizens’ expectations, and build capacity to operate effectively in complex, interdependent networks of organizations and systems across the public, private and non-profit sectors to co-produce public value.

• ..what is needed today is flatter, agile, streamlined

and tech-enabled (FAST) government. WEF

Kickbusch Cardiff 2013

Innovation

• Regions can re-shape the political narrative
• f public value and public health

Kickbusch Cardiff 2013

Unsustainable systems - Unsustainable lifestyles

Kickbusch Cardiff 2013

 The obesity epidemic is one of the most obvious symptoms of “unsustainable lifestyles” and unsustainable production and consumption patterns. It reflects paradigmatically the global flow of ways

• f life, ideas and products and the global dimension
• f health promotion.

 a global system of food production, distribution, consumption and waste……………………manifestation at regional level

The narrative: sustainability, health, wellbeing The values

Public goods Social good Equity Market values

The drivers (power and ressources)

Political determinants Commercial and economic determinants

The social determinants

The living environment The people

Kickbusch Cardiff 2013

The WHAT of Health

• Health and wellbeing: something that „we collectively

strive to pursue” (Sandel 2009)in a world of globalization, individualization and commercialization.

• Address social cohesion
• Ensure next generation
• Address unsustainable production and consumption:

food, tobacco, alcohol, fossil fuels and its equity dimensions in new ways

• Address climate change

Kickbusch Cardiff 2013

21st century health leadership

Allign sectors Empower people Mission Health and wellbeing Values Equity Access

Kickbusch Cardiff 2013

Co benefits: Social cohesion and sustainability

Kickbusch Cardiff 2013

• Invest in community

structure, assets, social capital, public participation, public spaces and resilience

Public spaces: ZONING

Kickbusch Cardiff 2013

Co benefits: next generation

• strengthen children early – critical support to early

child development

• make children’s formal learning environments – in

particular the school and health care – more conducive to their wellbeing

• create a supportive social environment (consumer

world, ICT, media, virtual worlds)

• create opportunities to play creatively

Kickbusch Cardiff 2013

Co benefits – sustainability and diet

• A recent study (SDC, 2009) highlighted the changes most likely to have the

most significant and immediate impact on making diets more sustainable, in which health, environmental, economic and social impacts were more likely to complement each other. These were:

• reducing consumption of meat and dairy products, reducing consumption of

food and drink of low nutritional value (i.e. fatty and sugary foods) and reducing food waste.

• All imply significant societal, environmental and economic challenges and

significant conflicts, particularly with producers – but have great potential for network governance

Kickbusch Cardiff 2013

Co Benefits: climate change and health

Kickbusch Cardiff 2013

• The how

Kickbusch Cardiff 2013

Kickbusch NEK CNE Bern 2009

Governance shortcomings

• We tend to focus on governance shortcomings

as a lack of technical capacity (do it better – the cook book)

• Rather than as related to the structures of

power and the constraints imposed by vested political interests and established ways of doing things (do it smarter – be strategic)

Kickbusch Cardiff 2013

What is governance about?

participation inclusion transparency accountability Principles

Kickbusch Cardiff 2013

ALLIGN and EMPOWER

Coalitions are one of

the key political mechanisms for

• vercoming the

pervasive collective action problems that define most development challenges and are also at the heart of politics and the concerns of political science (Ostrom, 1997).

Kickbusch Cardiff 2013

The age of the network

• The network is a defining

feature of the 21st century society and governance

• When the power to govern

is shared collaboration becomes the new imperative

• Transparency and flow of

information are critical

Kickbusch Cardiff 2013

Champions of Network governance

• Become strategic
• Focus on collective action

solutions

• Invest in network

governance

• Build complementary

relationships

• Explore „efficiency“

through network governance – co-benefits

• Embrace diversity
• Create hubs of partipation

Kickbusch Cardiff 2013

Create the web of interaction

Kickbusch Cardiff 2013

Chordoma Research

Create the 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 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)

Kickbusch Cardiff 2013

Experiment with new institutions

• 21st century governance for health requires

structures and mechanism which enable collaboration, ensure accountability, increase transparency and work for health and equity.

• Institutional consequence:
• A department of health and sustainability

impacts

Kickbusch Cardiff 2013

Measures of success

• socially equitable
• economically viable
• politically participatory
• ecologically sustainable
• culturally transferable
• Multiplier effects

Kickbusch Cardiff 2013

Policy making

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”.

Kickbusch Cardiff 2013

The key political determinant

• Methodological sophistication cannot solve

fundamental political problems. (Tenbesel 2002)

• We must ensure that our democratic

institutions value health and address equity. We must invest in the health literacy of parliamentarians and of the citizens who elect them

Kickbusch Cardiff 2013