Presentation on theme: "International Network of Health Promotion Foundations"— Presentation transcript:
1 International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP
2 Infrastructure for health promotion investment: models for financing HP government based approach within ministrypublic bodies closely linked to governmenthealth promotion foundationsprivate foundationThaiHealthHealth Scotland Austrian HPFDoHA ChagnonAustralia FoundationColin Sindall: Department of Health & Ageing, AustraliaGraham Robertson: Health Scotland (former CEO)Krissada Raungarreerat: ThaiHealthRainer Christ: Austrian Health Promotion FoundationDiane Le May: Quebec en Forme
3 What do Health Promotion Foundations do? Build capacity for promoting health;Mobilize civil society and support community actions for health by providing resources, training and technical assistanceFund health promotion initiatives to promote health and prevent diseaseBuild a health promotion evidence baseWork collaboratively across sectorsAdvocate for health promoting policiesAddress equity issuesTrial innovative programs in sensitive areas (drugs, STIs, etc.) that may expose governments to political criticism
4 Characteristics of HP Foundations Budget Stability: funding is enshrined in legislation, can plan and implement long term programmesIndependent Operation: operate WITH, but not AS government: supporting government priorities and direction.No Bureaucratic Constraints: quickly react toemerging needsMulti-Sectoral: across a range of government departments, nongovernmental and community-based organizations- Why? The Establishment and Use of Dedicates taxes for Health. WHO WPRO 2004 INHPF (http://www.hpfoundations.net) Access Shaping the future of health promotion: priorities for action,IUHPE CCHPC 2007 Infrastructures to promote health: the art of the possible, Moodie et al
5 How are Health Promotion Foundations funded? Through a variety of methods:Earmarked taxesTobacco and / or Alcohol tax ThaiHealth (2% each)Fiscal adjustmentsAustria (value added tax)Appropriation from Treasury budgetsVicHealth, Healthway (Australian HPFs) Malaysian Health Promotion BoardLevy on health / sickness insuranceSwitzerland : x Euro/insured person/year
6 Health promotion financing and organisation in Australia Capacity Building – sustainable financing and infrastructures for Health PromotionHealth promotion financing and organisation in AustraliaColin SindallSenior AdviserPopulation Health DivisionDepartment of Health and Ageing
7 ContextFederal system of government with health responsibilities shared between Australian (Commonwealth) government + 6 states + 2 territories.National responsibility for health promotion and disease prevention sits with the Australian Government Department of Health and Ageing, but states undertake significant proportion of program delivery; however, the mix is changing.Australian Government provides largest share of total public health funding (64%), but states incur nearly three quarters (73.9%) of total public health expenditure.Funding for public health (includes health promotion, health protection and preventive health services such as screening ) appropriated from consolidated revenue as part of the overall health portfolio budget.Between 1999–00 and 2007–08 public health expenditure increased by around 78% in real terms, averaging 7.4% pa. Total = $2.2 billion; about $100 per head.Reform commitments of current government and recent agreements by COAG (Council of Australian Governments, the peak intergovernmental forum of First Ministers, chaired by PM) have seen significant injections of new funding.Major structural reform of health system underway: PHC reforms important for HP.Two states have HP foundations: currently no national equivalent, but legislation has been introduced to create National Prevention Agency.
8 EXTRACT - MINISTER’S MEDIA RELEASE, 12 May 2009 Investing in preventionThe Budget delivers on the Rudd Government’s commitment at COAG to fund the single largest investment ever made in health promotion in Australia – focused on tackling the health problems caused by tobacco, obesity and excessive consumption of alcohol.In partnership with the states and territories, the Australian Government will invest $872.1 million over six years in preventing lifestyle risks that cause chronic disease.
9 COAG National Reform Agenda: a basis for sustainable HP? Demographic ageingChronic disease (& MH)Health system pressuresSocial inclusion3. HUMAN CAPITALHealthier, better skilled and more motivated workforce1. COMPETITION2. REGULATIONHEALTH REFORMLife CycleMaintain good health65+HealthHealthy LivingEarly childhood developmentDevelop good habits(eg diet, exercise)Maintain good habitsManage healthEducation& TrainingLifelong LearningLiteracy & numeracy skillsTransition into working lifeEarly work experienceMaintain & refresh skill setsWork IncentivesEncouraging & Supporting WorkEncourage & support workChildcareOut of school careSupport ongoing participationBalance work & leisureBalance work & studySupporting re-entryBalance work & familySource: Adapted from Victorian Department of Premier and Cabinet
10 Sustainable financing : opportunities, challenges, threats Case for investment in “prevention” generally well supported in Australia, but funding from consolidated revenue always subject to decisions of government of the day and state of the economy.Hypothecation of funding (eg from “sin taxes) historically not supported by central economic agencies at national level.However, government’s recent increase in tax on alcopops (pre-mixed alcoholic drinks) enabled a portion of the revenue derived from the excise to support the funding of the COAG Partnership Agreement on Preventive Health; and announcement of a $50 million package of additional measures under the National Binge Drinking Strategy.The government has stated that all of the revenue derived from the recent 25 per cent increase in tobacco excise will be dedicated to the new National Health and Hospitals Network Fund.Legislation for proposed Australian National Preventive Health Agency (“National Prevention Agency”) enables the Agency to establish and operate a “Special Account” which would allow it to receive funding from different sources, including state governments.Current funding allocated for Agency is $132m over four years.Agency legislation may not passed.
11 Capacity building and sustainable financing Graham Robertson
12 Public bodies closely linked to government NHS Health ScotlandStatus: a national special health board, part of the National Health Service in ScotlandPrimary focus: to work with local NHS Boards and health improvement partners to develop and implement public health improvement and health inequalities programmes
13 NHS Health Scotland Funding Direct from government as an allocation within NHS budget overallMixture of core (recurring) and non-core (project) funding2010/11: £27m
14 Implications Strengths Part of whole system (Relatively) secure fundingEfficiency and value addedIntegrated deliveryWeaknessesTopic-based fundingMismatch between national and local prioritiesPerception of NHS dominationBureaucracyThreatsPublic sector funding cutsVisibility of contributionTime-lag for impactOpportunitiesAccess to local capacity/resourcesAccess to government and opportunity to influence policy
15 Overview: ThaiHealth Set up by the Health Promotion Act 2001 Funded by an earmarked tax, 2% of tobacco and alcohol excise taxGoverning Board consists of experts and officials, chaired by the Prime MinisterLet me give all of you an overview of ThaiHealth so you can understand better about our financing and operating model.ThaiHealth is set up according to the Health Promotion Act in 2001 (so we will have our 10-year anniversary next year!)We are funded by 2% of the tobacco and alcohol excise tax, which comes out to about $120 million US dollars in 2010.ThaiHealth policy is supervised by the Governing Board. The Prime Minister is the chairman of the board. Other members are experts as well as officials.We have independent Evaluation Board.We function as a lubricant or catalyst in supporting over 4000 partners.We work on multiple approaches: issue-based, setting-based, area-based, target-group based, and system-based.Our strategy follow the traiangular power of Knowledge, Social Movement and Policy Mobilization.15
16 ThaiHealth Budget (2008) ThaiHealth Budget 80 million $ GDP Thailad Billion $Total Gov. Budget Billion $Gov. Health Budget Billion $ThaiHealth Budget 80 million $(Less than 2% Gov. Health Budget)
17 Why the ThaiHealth Model Win-Win financing model by using the surcharge sin tax from harmful products to promote healthy peopleThe secured funding for the long-term and innovative health promotion initiativesTo mobilize a range of sectors to work collaboratively and flexibly17
18 Obstacles & Challenges Independence from political interferenceThreats from opposition industries (e.g. tobacco, alcohol)Challenges:Use health promotion influence the national direction towards sustainable developmentBuilding capacity and competencies of our various partners18
20 Austrian Health Promotion Foundation Health Promotion Act, 1998 Project funding National competence center for HP Information and awareness raising
21 Financing model Population: 8.336.549 (2008) Funds: Euro annuallyUSD (1,09 USD per capita)Budget money (value added tax)
22 Relationship to Government and NGOs Government: Board 15 Members representing various sectors and level of administration, health care and insurance sector, presided by the MOH Agreement on priorities (workplans) NGOs: carry out the work in the field, get grants, are trained, consulted...
25 Organigram Fund in promotion of healthy lifestyles 75 % 25 % Fondation Lucie et André ChagnonGovernement of QuébecFund in promotion of healthy lifestyles480 millions $ over 10 yearsPublic Health Agency of Canada1,3M$ ( )75 %Group of local partnersMobilization projectsPromotion projectsNational partnersGroup of regional partners25 %
26 How it became a reality The good idea at the right moment… Pilot scheme of partnership between la Fondation Lucie et André Chagnon and 3 ministries of the Government of Québec aiming to give access to physical activity and sportive programs to the youth between 4 and 12 years of age in underprivileged environments.Governmental Action Plan on promotion of healthy lifestyles and prevention of weight problemsAct creating the Fund for promotion of healthy lifestyles (June 2007)Politique-cadre for healthy eating habits and an active lifestyle (2007)Public Health Act (revised August 2007)
27 What we doMissionTo contribute to the adoption and upholding of an active lifestyle and healthy eating habits by Québec Youth, from birth to age 17 inclusively.
28 VisionWhat we want to achieveTo see all concerned actors of Quebec society to create environments favouring the adoption and the upholding of an active lifestyle and healthy eating habits.Meaning :Be a catalyst rather than an operator; increase efficiency of ressources and ensure the sustainability of actions.
29 Infrastructure for health promotion investment: models for financing HP government based approach within ministrypublic bodies closely linked to governmenthealth promotion foundationsprivate foundationThaiHealthHealth Scotland Austrian HPFDoHA ChagnonAustralia FoundationColin Sindall: Department of Health & Ageing, AustraliaGraham Robertson: Health Scotland (former CEO)Krissada Raungarreerat: ThaiHealthRainer Christ: Austrian Health Promotion FoundationDiane Le May: Quebec en Forme
30 Advantages and disadvantages of different organisational models The Australian model for health promotion has generally worked well, although with room for improvement. Location of health promotion responsibilities within the national health ministry has enabled a strong connection with the wider health and public policy agenda, and to the legislative, regulatory and fiscal levers of government.The federal system has allowed for a considerable degree of flexibility and innovation at the state level and opportunities for learning. However, this has come at the cost of some fragmentation of effort and inconsistency in program delivery.The proposed Prevention Agency would add value to the current health promotion environment by eg (a) consolidating social marketing functions; (b) providing a central authoritative source of evidence- based advice and recommendations for the Commonwealth Minister, for the Health Ministers Conference, for non-health ministries and for local government; (c) providing a national mechanism for collation and analysis of various sources of information, including evaluations of interventions; (d) supporting and building partnerships with other agencies (including state health promotion agencies, research groups, NGOs ) and sectors; (e) developing and promoting national standards, codes of practice and guidelines, and (f) supporting primary health organisations to deliver regional and community based health promotion programs.With a strong relationship between the health department and the Agency, the advantages of both models - combining the flexibility and technical capacity provided by an Agency with the policy capacity and administrative expertise of government - might be realised.
31 Enjeux- Perception of a Private foundation’s intervention in the interventions usually taken by the state.Reactions of organisms and networks who would have prefered that the state would directly deposit them the money.- Silo and top-down thinking of different networks.Over-consultation and the pressure put on local actorsMobilization strategy of local actors vs the impacts on an active lifestyle and healthy eating habits.
32 International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP