ARCHIVED - Preface

The level of health enjoyed by a population depends on many factors outside the reach of the health sector itself. For instance, the inequitable distribution of health across population groups is a function of social determinants such as educational access and attainment, income, and employment. [1] Risk factors such as unhealthy diets, smoking, physical inactivity, and the harmful use of alcohol, are themselves largely determined by factors such as price, marketing, availability of goods, and urban design, among other influences. The ability to cope with ill-health and the consequences of disease are affected by access to health care, insurance cover, and other social protection mechanisms.

Mandated by a range of high-level policy documents, intersectoral action has come to be seen by public health advocates as a key strategy for health improvement and health equity. The Ottawa Charter for Health Promotion [2] made “building healthy public policy” its first action area. The Bangkok Charter for Health Promotion in a Globalized World [3] committed to make “the promotion of health a core responsibility for all of government.” The World Health Report [4] of 2008 renewed the concept of primary health care and made healthy public policies across sectors one of its four proposed reforms. In the face of the overwhelming health burden of this century, the burden of non communicable diseases, the World Health Assembly has adopted an action plan [5] whose first objective is “to integrate prevention and control of such diseases into policies across all government departments.” Intersectoral action for health is an essential strategy for public health and a number of notable international efforts have been made to describe the concept and to extract the practical lessons for wider adoption. [6] [7]

Despite the clear case for intersectoral action, there is a sense among practitioners that the principle is not always translated into action. In the real world, it is held back by the competing interests of government ministries, by incentives for unisectoral action, and by a results-based management imperative that requires visible, attributable outcomes from specific investments and not from collective action (easier to attain in focused projects within direct control).

 

In this context, this study is particularly welcome and timely. ActNowBC is an interesting experiment, an example of a province asking itself: if we are investing millions in the organization of a mass event such the Winter Olympics, should there not be a discernible, positive, and lasting impact on our well-being? Given our understanding that health is determined by actions outside the health sector, can we set up an effective mechanism to foster collaboration for health across Ministries and with other stakeholders in the community? As noted by this study, the solution adopted, ActNowBC, is a “promising best practice”. It is an innovation in the field of mass events and could be held up as an example for other global and regional events such as a World Expo or World Cup Tournaments. The lessons of ActNowBC would also hold promise for many developing countries who themselves organize similar mass events with regularity (note, for example, the FIFA World Cup in South Africa and the Commonwealth Games in India being held in the same year as the Winter Olympics in Vancouver).

This effort to evaluate the performance of ActNowBC as an institutionalized form of intersectoral action is an invaluable contribution to the literature. The study frankly discusses many of the difficulties. Were the targets too behaviourally oriented? Were they so ambitious as to undermine the long-term viability of the initiative? Will ActNowBC survive over time, across political transitions, or beyond the 2010 Winter Olympics, the mass event that gave it birth?

This study does not shirk from addressing these questions, and the ultimate answers will only be available with later studies. But this case study is a clear illustration that intersectoral action is possible, and can be sustained over a number of years. It illustrates how different sectors can define a commonality of interest in health, how an accountable agenda for joint action is arrived at, and how a specific set of resources is invested in the collaboration. While the principle of intersectoral action for health is widely accepted, it is in such innovative, pragmatic approaches as ActNowBC that the ideal will become more real and, hopefully, more common.

Dr Fiona Adshead
Director, Department of Chronic Diseases and Health Promotion
World Health Organization, Geneva
May 26, 2009

 

References

1. WHO Commission on Social Determinants of Health. Closing The Gap In A Generation: Health Equity through action on the social determinants of health. 2008. Available at: http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf
   [Accessed March 22, 2009].
2. The Ottawa Charter for Health Promotion. 1986. Available at: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index.html
   [Accessed May 25, 2009].
3. The Bangkok Charter for Health Promotion in a Globalized World. 2005. Available at: http://www.who.int/healthpromotion/conferences/6gchp/hpr_050829_%20BCHP.pdf [Accessed May 25, 2009].
4. WHO. Primary Health Care – Now More Than Ever: The World Health Report 2008. Available at: http://www.who.int/whr/2008/en/index.html
   [Accessed March 22, 2009].
5. World Health Organization. Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases: 2008-2013. Available at: http://www.who.int/nmh/Actionplan-PC-NCD-2008.pdf [Accessed April 2, 2009].
6. Government of Canada PHAOC. Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies. Available at: http://www.phac-aspc.gc.ca/publicat/2008/hetia18-esgai18/hetia18-esgai18-1-eng.php
   [Accessed April 6, 2009].
7. Stahl T, Wismar M, Ollila E, Lahtinen E, Leppo K. Health in all policies: prospects and potentials. Ministry of Social Affairs and Health; 2006.