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International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP www.hpfoundations.net.

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Presentation on theme: "International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP www.hpfoundations.net."— Presentation transcript:

1 International Network of Health Promotion Foundations Capacity Building – sustainable financing and infrastructures for HP

2 International Network of Health Promotion Foundations Infrastructure for health promotion investment: models for financing HP government based approach within ministry public bodies closely linked to government health promotion foundations private foundation ThaiHealth Health Scotland Austrian HPF DoHA Chagnon Australia Foundation Colin Sindall: Department of Health & Ageing, Australia Graham Robertson: Health Scotland (former CEO) Krissada Raungarreerat: ThaiHealth Rainer Christ: Austrian Health Promotion Foundation Diane Le May: Quebec en Forme

3 International Network of Health Promotion Foundations 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 assistance – Fund health promotion initiatives to promote health and prevent disease – Build a health promotion evidence base – Work collaboratively across sectors – Advocate for health promoting policies – Address equity issues – Trial innovative programs in sensitive areas (drugs, STIs, etc.) that may expose governments to political criticism

4 International Network of Health Promotion Foundations Characteristics of HP Foundations Characteristics of HP Foundations Budget Stability: funding is enshrined in legislation, can plan and implement long term programmes Budget Stability: funding is enshrined in legislation, can plan and implement long term programmes Independent Operation: operate WITH, but not AS government: supporting government priorities and direction. Independent Operation: operate WITH, but not AS government: supporting government priorities and direction. No Bureaucratic Constraints: quickly react to No Bureaucratic Constraints: quickly react to emerging needs emerging needs Multi-Sectoral: across a range of government departments, nongovernmental and community-based organizations Multi-Sectoral: across a range of government departments, nongovernmental and community-based organizations [1] The Establishment and Use of Dedicates taxes for Health. WHO WPRO 2004 [2] INHPF (http://www.hpfoundations.net) Access http://www.hpfoundations.net [3] Shaping the future of health promotion: priorities for action, IUHPE CCHPC 2007 [4] Infrastructures to promote health: the art of the possible, Moodie et al

5 International Network of Health Promotion Foundations How are Health Promotion Foundations funded? Through a variety of methods: – Earmarked taxes Tobacco and / or Alcohol tax ThaiHealth (2% each) – Fiscal adjustments Austria (value added tax) – Appropriation from Treasury budgets VicHealth, Healthway (Australian HPFs) Malaysian Health Promotion Board – Levy on health / sickness insurance Switzerland : x Euro/insured person/year

6 Health promotion financing and organisation in Australia Colin Sindall Senior Adviser Population Health Division Department of Health and Ageing Capacity Building – sustainable financing and infrastructures for Health Promotion

7 Federal 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. Context

8 Investing in prevention The Budget delivers on the Rudd Governments 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. EXTRACT - MINISTERS MEDIA RELEASE, 12 May 2009

9 COAG National Reform Agenda: a basis for sustainable HP? 1. COMPETITION 3. HUMAN CAPITAL Healthier, better skilled and more motivated workforce 2. REGULATION Health Education & Training Work Incentives 65+0 Develop good habits (eg diet, exercise) Childcare Out of school care Literacy & numeracy skills Maintain good habits Transition into working life Encourage & support work Early work experience Balance work & study Supporting re-entry Balance work & family Maintain good health Support ongoing participation Balance work & leisure Manage health Maintain & refresh skill sets Healthy Living Lifelong Learning Encouraging & Supporting Work Early childhood development Life Cycle Demographic ageing Chronic disease (& MH) Health system pressures Social inclusion Source: Adapted from Victorian Department of Premier and Cabinet HEALTH REFORM

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, governments 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 Scotland Status: a national special health board, part of the National Health Service in Scotland Primary 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 overall Mixture of core (recurring) and non-core (project) funding 2010/11: £27m

14 Implications Strengths Part of whole system (Relatively) secure funding Efficiency and value added Integrated delivery Weaknesses Topic-based funding Mismatch between national and local priorities Perception of NHS domination Bureaucracy Opportunities Access to local capacity/resources Access to government and opportunity to influence policy Threats Public sector funding cuts Visibility of contribution Time-lag for impact

15 Set up by the Health Promotion Act 2001 Funded by an earmarked tax, 2% of tobacco and alcohol excise tax Governing Board consists of experts and officials, chaired by the Prime Minister Overview: ThaiHealth

16 ThaiHealth Budget (2008) 16 GDP Thailad 240 Billion $ Total Gov. Budget 52.8 Billion $ Gov. Health Budget 4.3 Billion $ ThaiHealth Budget 80 million $ ThaiHealth Budget 80 million $ (Less than 2% Gov. Health Budget) (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 people The secured funding for the long-term and innovative health promotion initiatives To mobilize a range of sectors to work collaboratively and flexibly

18 Obstacles & Challenges Obstacles: Independence from political interference Threats from opposition industries (e.g. tobacco, alcohol) Challenges: Use health promotion influence the national direction towards sustainable development Building capacity and competencies of our various partners

19 Austrian Health Promotion Foundation

20 Health Promotion Act, 1998 Project funding National competence center for HP Information and awareness raising

21 Financing model Population: (2008) Funds: Euro annually USD (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...

23 International Network of Health Promotion Foundations

24 Québec en Forme Join the movement

25 National partners Group of regional partners Group of local partners Organigram Fondation Lucie et André Chagnon Governement of Québec Fund in promotion of healthy lifestyles 480 millions $ over 10 years Mobilization projectsPromotion projects 25 % 75 % Public Health Agency of Canada 1,3M$ ( )

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 problems Act 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 Mission To contribute to the adoption and upholding of an active lifestyle and healthy eating habits by Québec Youth, from birth to age 17 inclusively. What we do

28 What we want to achieve To see all concerned actors of Quebec society to create environments favouring the adoption and the upholding of an active lifestyle and healthy eating habits. Vision Meaning : Be a catalyst rather than an operator; increase efficiency of ressources and ensure the sustainability of actions.

29 International Network of Health Promotion Foundations Infrastructure for health promotion investment: models for financing HP government based approach within ministry public bodies closely linked to government health promotion foundations private foundation ThaiHealth Health Scotland Austrian HPF DoHA Chagnon Australia Foundation Colin Sindall: Department of Health & Ageing, Australia Graham Robertson: Health Scotland (former CEO) Krissada Raungarreerat: ThaiHealth Rainer Christ: Austrian Health Promotion Foundation Diane 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 foundations 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 actors - Mobilization 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


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