| The World Health Organization defines Health Promotion as: the process of enabling people to increase control over; and to improve their health It is clear that the Health for All targets and Health Promotion targets in particular, are profoundly affected by broad social and economic circumstances, as shown by many epidemiological studies. These health determinants are, in turn, responded to through a variety of public policies including among other policy areas; education, income maintenance, housing, transport, communication, medical care, agriculture, and tourism.
Promoting health must take on a more assertive role across the many policy reforms affecting social and economic development in the European Region. Where are those health investments with greatest promise of benefits? Who will identify them? What kinds of data will be required? What new analytical skills will be required to evaluate the trade-offs and implications for health investments? How will public policies be monitored and publicized to achieve public review and critique? And of course, which kind of health promotion infrastructure would be needed to effectively deal with a fast changing Europe? These are the questions being explored in the demonstration projects in "Investment in Health" by the Health Promotion and Investment Unit (HPI) of WHO/EURO.. Criteria include concerns for equity, empowerment, accountability, sustainability.
These are key criteria for Health for All and the basis for a health promotion strategy. Locating relevant "Investment in Health" potentials must follow a disciplined process of mapping and recording.. The WHO Health Promotion and Investment Unit now has initiated a number of field demonstrations under way to strengthen local capacity for building healthy public policies. The demonstrations are testing approaches to organizing and managing investment strategies for the promotion of health in a given geographical area. These demonstrations aim at learning how to efficiently break down problems into their interrelated aspects; how to link problems with policy area(s) most central to the problem's solution; how to stimulate innovative action (investment) options; and how to balance the investment selection in the context of multiple criteria where compromise may be necessary. The first of these demonstrations was organized on behalf of the Autonomous Provinces of Trento and Bolzano.
A legislated commitment by the two provinces made possible an officially authorized invitation to WHO/EURO and its collaborators, the Office for Public Management and the Yale School of Public Health, to work closely with local authorities on this innovative project. It should be emphasized that this demonstration was a mutual learning experience, at the same time, to create a sound strategic approach to inter-policy collaboration and to test a series of new methodologies. Building local capacity to sustain the investment approach was the underlying goal. This Report highlights the process undertaken and the methodological "tools" that were developed. In light of the project findings, the report puts forward a number of key strategic recommendations and guidelines for implementing and sustaining an investment strategy for the promotion of health.
The Report reveals how complex this process is, what major challenges were encountered, how potential barriers were overcome, and the many opportunities for the future. Several important lessons were learned; chief among these was the essential requirement that trust be built among the authorities representing the several policy sectors involved. Trust does not come easily. It begins through early involvement of all sectors and establishing an equilibrium among them - a sense of common cause and mutual respect for how various policy sector contributions fit together. A second key lesson was how to ensure that outside "experts" function to facilitate and support local authorities rather than take a leadership role. The demonstration team learned how crucial it is to listen carefully and to honour qualitative data, community opinions and judgements, as these inform quantitative data.
There are no "right answers''; there are only answers which are most appropriate in the context of competing options and social, cultural, and economic realities.. Subsequent WHO/EURO demonstrations will certainly benefit by new knowledge of process and the creation of new technical tools of fact finding, data management, organisational approaches, criteria settings, community involvement, decision-making, evaluation, and action planning. The European Office of the World Health Organisation is grateful to all those in the Trentino-Alto Adige Region who gave their time, talent, and effort so unstintingly and enthusiastically I trust the benefits of the demonstration will be evidenced in health gains through the policy investments they have chosen so wisely.
Our appreciation also must be expressed to the Fondazione Incontri di Madruzzo for its steady and sensitive facilitation of this demonstration from the beginning to its successful conclusion.
Dr. Erio Ziglio, Reg. Adviser for Health Promotion and Investment WHO Regional Office for Europe |
