State and local government officials are responsible for the health and well-being of their people as health is a fundamental human right. They have a critical leadership and stewardship role in the organized effort by society to promote health and well-being. Given this responsibility and the complexity of many contemporary health challenges, governments have a crucial role to play in identifying the barriers to and determinants of good health in their communities, and to jointly work – to invest in programs and policies that create healthier environments for living and working. They need to support communities to identify important health determinants, championing public goods and social justice in health and well-being.
LINKS TO SDGs:
All government sectors are critical to achieving the SDGs and addressing the determinants of health and health equity. All the Goals (17 SDGs) require the provision of public goods or the implementation of a public-sector policy and, therefore, depend on public service to coordinate, mediate or directly provide. The cross-cutting nature of the SDGs means that partnerships across government sectors must be emphasized. The successful implementation of the SDGs requires a whole-of-government approach to link different goals together and overcome trade-offs. Effective partnerships lead to a greater understanding of unintended consequences of policies and interventions across sectors, leading to the formulation of potentially wiser solutions, strengthened policy coherence, and better considerations of health and well-being.
Studies of societal savings from improved policy coherence estimate that integrated policies to meet targets for energy use, climate change, air quality and health could result in 40% of total costs savings, amounting to US$ 80 billion annually (source: Johansson TB, Patwardhan A, Nakincenovic N, Gomez-Echeverri L, eds. Global Energy Assessment: Toward a sustainable future. England: Cambridge University Press, 2012 (http://www.iiasa.ac.at/web/home/research/Flagship-Projects/Global-Energy-Assessment/Global_Energy_Assessment_FullReport.pdf, accessed 1 December 2016; As quoted in the WHO EB140/32, Dec 2016, Progress in the implementation of the 2030 Agenda for Sustainable Development).
HOW DO WE ENGAGE WITH OTHER SECTORS:
Addressing the social determinants of health through intersectoral action refers to the coordinated efforts of two or more sectors within government to improve health outcomes. This can include working across different levels of government such as district, provincial and national jurisdictions. Intesectoral action through Health in All Policies approach has been implemented differently in different contexts reflecting local social and political cultures as well as government structures. It is important to share experiences and lessons learned to understand how the approach can be most effective at each level. The term intergovernment is sometimes used to refer to these horizontal and vertical linkages between levels of government within a country. The most common structures and mechanisms for intersectoral action include: cabinet committees and secretariats; parliamentary committees; interdepartmental committees and units; mega-ministries and merges; joint budgeting; and intersectoral policy-making procedures.
The conditions that most favour effective intersectoral collaboration that will address social inequities in health include:
- building and sustaining a strong case for health equity which connects to broader sectoral, governmental and societal goals (which requires capacities and intelligence, including evidence and analysis, in order to stimulate debates in parliament, in cabinet committees and in the media);
- government support and encouragement of intersectoral action i.e. support for a common understanding of problems and of possible solutions to address social inequities and health improvement.;
- sectors having shared interests or both benefit from cooperation;
- addressed issues have high political importance and require urgent action; proposed policy has public support; existence of strong, effective leaders in the bureaucracy (policy champions/entrepreneurs);
- intersectoral action is well-planned with clear objectives, roles and responsibilities;
- laws exist or are planned to support the proposed policy; available sufficient resources; and monitoring and sustaining outcomes defined.
Possible obstacles to successful intersectoral collaboration within government are:
- distracted or unstable leadership;
- lack of institutional support;
- fragmented government functions;
- sub-national geographical and government jurisdiction divisions;
- limited or misused resources (staff, funding, etc.);
- poorly planned or unclear objectives and responsibilities;
- impediments of hostile stakeholders;
- shifting political priorities; weak enforcement;
- unrealistic time frames;
- and restricted policy space.
KEY TOOLS AND EXAMPLES TO SUPPORT THIS ACTION:
- WHO (2015) Health in All Policies Training Manual. Geneva, WHO
- Lin V et al. (2013) Synthesizing the Evidence: How Governance Structures can Trigger Governance Actions to Support Health in All Policies in McQueen DV et al. (2012) Intersectoral Governance for Health in All Policies. WHO (30 pages)
- Leppo K et al. (2013) Lessons for Policy-Makers in Leppo K et al. (2013) Health in All Policies: Seizing Opportunities, Implementing Policies. Ministry of Social Affairs and Health, Finland (12 pages)
- WHO Social Determinants of Health Sectoral Briefings:
- WHO (2011) Housing: Shared Interests in Health and Development – Social Determinants of Health Sectoral Briefing Series One. Geneva, WHO
- WHO (2011) Education: Shared Interests in Well-Being and Development – Social Determinants of Health Sectoral Briefing Series Two. Geneva, WHO
- WHO (2011) Transport (Road Transport): Shared Interests in Sustainable Outcomes – Social Determinants of Health Sectoral Briefing Series Three. Geneva, WHO
- WHO (2012) Social Protection: Shared Interests in Vulnerability Reduction and Development –Social Determinants of Health Sectoral Briefing Series Four. Geneva, WHO
- WHO (2013) Energy: Shared Interests in Sustainable Development and Energy Services – Social Determinants of Health Sectoral Briefing Series Four. Geneva, WHO
- Koivusalo M et al. (2013) Globalization and National Policy Space for Health and a HiAP approach in Leppo K et al. (2013)Health in All Policies: Seizing Opportunities, Implementing Policies. Ministry of Social Affairs and Health, Finland (16 pages)
- WHO (2013) Health in All Policies: Report on Perspectives and Intersectoral Actions in the African Region. Brazzaville, WHO
- WHO (2013) Health in All Policies: Report on Perspectives and Intersectoral Actions in the South-East Asia Region. New Delhi, WHO
- WHO (2013) Health in All Policies: Report on Perspectives and Intersectoral Actions in the Western Pacific Region. Manila, WHO
- British Academy (2014) If You Could Do One Thing: Nine Local Action to Reduce Health Inequalities, London. The British Academy (Executive Summary) (4 pages)