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HEALTH21 – the World Health Organization’s agenda for health
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| In September 1998 the Member States of WHO endorsed a new policy framework known as Health21 – health for all in the 21st Century. Health21 emphasizes the importance of social and economic factors as determinants of health. Central to this framework is the idea of promoting health through social and economic development.
Health21 is not just about "vision". It is about supporting European Member States to take practical actions to improve the health of their populations. These actions need to be based on a thorough understanding of social and economic factors and how they influence the health of a population. This understanding must reach beyond academic discussion and into the design and implementation of robust programmes and policies.
A sound and credible strategy for health promotion requires concerted efforts of a variety of players. It includes all levels of government. The concept and .principles of health promotion must influence sectors such as health care, social services, education and environmental protection as well as the media, nongovernmental organizations and all public and private bodies that contribute in some way to social cohesion, justice and human rights. With so many interests a strategy for health promotion must be intersectoral. It has to involve multi-levels of policy-making in social and economic development (local, regional, national and, in several instances, supra-national). It must employ a range of different measures (e.g. educational, legislative, fiscal etc.).
Above all it must recognize that the prime purpose of many of those who can influence the health of the population is not health promotion. What is now needed is to find ways in which the different interests involved in economic and social development can achieve their prime objectives in a way that improves people’s health. "Investment for Health" is the term that we have used to describe this approach to health development. |
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The rationale of Investment for Health
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| Health is a crucial social and personal resource that requires nurturing. We know that if we apply resources in ways that secure positive health and wellbeing, then this in turn also brings social and economic benefits for the whole of society. But we also know that not all social and economic investment promotes health. The key is to identify those investments that do. The Investment for Health approach is a deliberate attempt to tackle the roots of the main causes of ill health in a credible, effective, ethical and equitable manner.
The word "investment" is used deliberately. But we do not just mean the use of money. The investments that can be deployed to improve health cover the full range of resources available within society – people, communities, land, buildings, and the environment, to mention but a few. Investment implies choices and decisions. This is what Investment for Health is all about – making those choices, those investments that will improve people’s health.
Making investment decisions that promote the health of a population sounds very easy in principle. However, throughout Europe the evidence suggests that it is not. This may be partly due to the complexity of investment decisions. Health is determined by the interplay of wide-ranging factors. For example, given the links between unemployment, poverty and illness how far should we go to invest in the creation of new jobs? At what stage does environmental pollution from those new enterprises outweigh the health benefits of economic prosperity? Underpinning the choices that we make are trade-offs. Even if a perfect technical answer can be found about the net health gains from different investment options, there is no guarantee that this will be the politically acceptable one. Investing for Health is about balancing the complex array of positive and negative benefits with the political realities of what is and is not acceptable. |
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THE VERONA INITIATIVE
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| The Verona Initiative is a multi-partner venture bringing together political, business, academic and nongovernmental leaders to explore, develop and extend our understanding of Investment for Health and how it can be used to support countries, regions and local communities.
The initiative is a response to major changes taking place across the European Region – in national and international politics, in social and economic performance, in institutions and in technology. At the same time we are seeing widening gaps in health status – both in countries that are in economic crisis and in those which are prospering. Good health is fundamental to people’s wellbeing and central to sustainable economic development. Although we instinctively know this to be true, health is all too often ignored or excluded in matters of economic and social policy.
The Verona Initiative is structured around three Arena Meetings, which take.place over three years from October 1998 to July 2000. Arena meetings are a forum for debate providing the opportunity for participants to meet, discuss and exchange views in a search for consensus. The meetings are designed to provide a learning and working environment that is quite different to the conventional conference agenda. But the Verona Initiative has proved to be more than meetings. Throughout its three-year duration and beyond it has generated an on-going process of debate, information exchange, experimentation, testing of methodologies, networking and cooperation rarely seen in Europe before. This involves a much wider network of participants than those invited to the Arena meetings.
Throughout the three years, the whole design of the Verona Initiative is about gaining the active participation and insight of each participant. But we also want to involve many more people than those who are able to be present in Verona. A much larger number of countries and regions, groups and stakeholders have joined in through the creation of a live, interactive learning network through live satellite TV, the WWW and Internet exchanges before, during and after the Arena meetings.
The main outcomes of the three-year programme are as follows:
Arena Meeting I (14 - 17 October 1998)
The Verona Benchmark: establishing the characteristics of systems that support Investment for Health. This focused on helping countries, regions and communities understand what needs to be in place before Investment for Health can happen.
Arena Meeting II (29 September - 2 October 1999)
The Verona Guidelines: establishing the characteristics of the decision and policy-making process that will promote the health of a population. This will focus on understanding how the different interests involved in health, social and economic development can work together for mutual benefit.
Arena Meeting III (5 - 9 July 2000)
The Verona Investment for Health Resolution:This will focus on ensuring that the learning about Investment for Health produced by the Verona Initiative can be used to influence policy makers everywhere. The resolution will be instrumental in both positioning health promotion for the 21st century and fostering political commitment for action. |
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Why Verona?
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| Verona has been chosen as the centre for this debate as it is at the crossroads of Europe. Its reputation for innovation and tradition of sensitivity to cultural and economic diversity makes it a natural site for a series of meetings of this magnitude and philosophical direction.
The Arena, the landmark of the city and the inspiration for the specially developed logo for the Verona Initiative, was once an amphitheatre for gladiatorial contest and challenge. It is an appropriate symbol for the new approach to vigorous debate on the promotion of population health. The meetings will further enhance the city’s and region’s reputation as a centre for dialogue between East and West. |
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The Work So Far: From Arena Meeting I to Arena Meeting III
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The Arena Meeting I (1998) raised the profile of the concept of Investment for Health. One of the outputs of that first event was the design of a benchmarking tool that could be used by a country, region or community to assess its capacity to invest for health.
Since that initial work, the benchmark has been refined and tested and the results of this process will be discussed at the third Arena meeting. Crucial to an area’s capacity to Invest for Health is the ability of organisations and agencies from across different sectors to work together in partnership. The benchmark being piloted at regional and local levels, has come to focus on how multisectoral partnerships can improve the quality of partnership working and thus bring more coherence to efforts to Invest for Health.
Testing of the benchmark has been conducted at national, local and regional level. The use of the benchmark tool has been part of the national investment for health appraisal carried out in Romania and Malta. At subnational level, utilization of the benchmark has taken place in regions in England, Wales, and Scotland. Ongoing efforts are now taking place in the Veneto Region, Italy, Sweden, Slovenia, Germany, and other European countries. At local level pilot sites ranging from cities to municipalities and counties are involved in a programme of piloting and developing the benchmark. The learning from this study will be feed back to participants at the Arena III meeting. The benchmark provides a good general overview of the system characteristics that provide the fertile ground for Investment for Health. However, it gives little indication of what types of investment are required, how these priorities are to be selected and how those investments should be made. These were the issues Arena Meeting II focused on. Thus Arena II and its follow-up explored more fully the linkages between economic and social development and health and the different forms that investments, negotiations, bargaining and partnership can take.
The Arena Meeting II looked deeply into the Investment for Health process. This was done by exploring three different but potentially complementary perspectives on investment – which the Arena Meeting II participants referred to as the investment triangle.
Within the framework of the triangle, participants from Arena Meeting II recognized that decisions about how resources are invested at national, regional and community level can be approached from three very different perspectives. Economic development is perhaps most frequently stated as the main goal of development projects but there are also those where the primary focus is the development or regeneration of social or community infrastructure. Others, such as WHO, have as their main goal the improvement of population health. Using each of these perspectives may produce different policies and a different pattern of investment decisions.
One of the main learning outcomes of Arena Meeting II is that in order to invest To be viable, the investment for health process has to provide added value to economic and social development. This is, of course, in addition to the population health results one should expect from Investment for Health. Following Arena meeting II, we are collecting practical experiences showing that investments can be made in a way that improves the health of the population and contributes to improved economic performance and social development, in a sustainable and equitable way. It is understanding the 'trade-offs' within the triangle and about how interests might be 'realigned' to achieve this mutual and commonality of interest across the investment triangle that was at the heart of the Arena Meeting II. Some of the significant experiences in this area will be object of discussion at Arena Meeting III.
The objectives of Arena Meeting III
The objectives and outcomes of Arena Meeting II are:
- To present practical follow-up experience related to the outcome of the two first Arena Meetings.
- To provide opportunities for further learning related to the overall Arena meetings and the various aspects related to the Investment for health process.
- To translate the learning into a powerful and inspiring resolution. the aim of the resolution is to encapsulate the key learning of the 3 year Verona Initiative process, and to call for specific action and European cooperation at all levels to influence policy-making.
The Verona Resolution will be one of the main outcomes and will summarize the learning from the 3 year Verona Initiative process. It will distil from this learning a number of key areas for commitment and action to advocate and implement Investment for Health strategies. Furthermore, the Resolution aims at providing a platform through which the momentum generated by the Verona Initiative can continue through intensified cooperation among countries, institutions and professionals. The way in which WHO and other international agencies can facilitate this will also be addressed by the Resolution.
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Participants
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| Around 170 participants will attend this Arena Meeting. We have deliberately selected participants who come from a wide range of backgrounds, contributing varied areas of expertise to explore different perspectives on the Investment for Health process. Participants in Arena Meeting II will include people with a health promotion background, experts in economic development, regeneration and commerce and those whose areas of work is in social and community affairs and education. The participants will include people working at national, regional and local and international level. They include politicians, journalists and media presenters, public and private sector managers, economists, people working in the financial sector and nongovernmental organizations. The total number of participants at Arena Meeting III will be greater than at the two first Arena Meetings as members of the European Committee for Health Promotion Development (ECHPD) will participate. The ECHPD is a top level committee of health promotion expertise, to provide authoritative advice on national policies, structures and effective practices for Investment for Health. |
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The Arena approach
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| The meetings of the Verona Initiative are different. They will excite and engage, surprise and inspire, provoke and challenge, but above all they will link the best of European thinking about creating health and welfare to the pragmatic business of making Investment for Health happen. The Arena Meeting does not follow the format of a conventional conference with presentations, questions and the occasional group session. The whole process is designed to be highly interactive. Presentational input will be minimal. Instead, there will be TV documentary style discussion sessions between participants and internationally recognized experts and 'live' case studies reporting on the work and experience of a number of European countries. |
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