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Katherine Drasic Health Team, Advisory Services Management Consulting KPMG CPHA Conference May 28, 2014 The framing of "Health in All Policies” initiatives.

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Presentation on theme: "Katherine Drasic Health Team, Advisory Services Management Consulting KPMG CPHA Conference May 28, 2014 The framing of "Health in All Policies” initiatives."— Presentation transcript:

1 Katherine Drasic Health Team, Advisory Services Management Consulting KPMG CPHA Conference May 28, 2014 The framing of "Health in All Policies” initiatives in eleven countries and its impact on the intensity of intersectoral commitments

2 Overview  Background  Research Questions  Methods  Limitations  Results & Discussion  Concepts in HiAPs  Framing on ISC  Confounding Political Factors  Conclusion  Acknowledgements  Works Cited

3 Background - HiAP  Health in All Policies (HiAP):  Most in the last decade (Shankardass et al., 2011)  Extension of ‘healthy public policy’ (St- Pierre, 2011)  Unique because (Shankardass et al., 2011):  Formal structures and mechanisms of governments  Supra-governmental policies (not ad hoc)

4 Background - Framing  “Health” - understood through biomedical or social paradigms (Bacchi, 2009)  “Wellbeing” – often more holistic (Bacchi, 2009)  Framing complex health issues broadly:  “define their roles and engage in working towards solutions” (WHO & PHAC, 2008, p. III)  “unifying diverse sectors and interests around the goal of improving health” (de Chavez, 2005, p. 72)

5 Research Questions  How national HiAPs frame use health and/or broader concepts, like wellbeing, to get HiAP on the policy agenda for intersectoral collaboration?  Does framing impact the level of intersectoral commitments when HiAPs are initiated?

6 Methods 1. Literature Review : HiAP, policy framing, concepts of health and wellbeing 2. Qualitative analysis : Health concepts in HiAPs  HiAPs identified in Shankardass et al., 2011  English translations only (11 countries) 3. Mixed method analysis : Association between concepts in HiAPs and the intensity of intersectoral commitments (ISC)  Primary Analysis: Health concept vs. ISC  count, average, outliers, trends  Secondary Analysis: Confounding political factors  years of prior ISA, position in world economy, labour market egalitarianism

7 Limitations  Lack of translation  bias in countries  Excluding non-English, non-OECD, low and middle income countries  Diversity within categories of scales  Ex. broader included “wellbeing” and “drivers of crime”  Some lack of ISA rationale in Shankardass et al., 2011  Many other political factors  Ex. governance structures, political processes, welfare state  ISC could reflect existing intersectoral relationships, not new ones from HiAP  No measures for implementation or effectiveness

8 Results – Concepts in HiAP Type of Concept#List of Countries Health2 Brazil † Thailand † Health Concept2 England Finland † Health + Broader Concept 4 Northern Ireland Norway † Quebec † Scotland Broader Concept3 New Zealand South Australia Wales † English is not an official language of this country/state, or the majority of its citizens don’t speak English (Central Intelligence Agency, 2012; Office of the Commissioner of Official Languages, 2011; South Australian Tourism Commission, n.d. )  Relatively equal use of health, broader, and both health + broader concepts

9 Results – Concepts in HiAP Health Concepts Health + Broader Broader Multiple Countries “health inequalities” (3) “population health”/ “health of the population” (2) “health and wellbeing”(2) “wellbeing” (3) One Country “health promotion” † “public health” “social inequalities in health” † “drivers of crime” “quality of life at every stage of life” “public service” “poverty and income inequality”  The framing of HiAPs is diverse † English is not an official language of this country/state, or the majority of its citizens don’t speak English (Central Intelligence Agency, 2012; Office of the Commissioner of Official Languages, 2011; South Australian Tourism Commission, n.d. )

10 Results – Concepts in HiAP  Some evidence of language/culture impact framing  Only English-speaking countries used broader concepts  Non-English-speaking countries:  2 used “health” (Brazil, Thailand)  3 used health concepts:  “health promotion” (Finland); “social inequalities in health” (Norway); “population health”/ “public health”/ “health and wellbeing” (Quebec)  Only non-OECD countries use “health”  Priorities? Culture/Language? (Brazil, Thailand)

11 Results – Framing on ISC

12  Type of intersectoral commitments are diverse but most HiAPs use “coordination”  Use of “health and broader” framing may slightly increase the average level of intersectoral action  Limited ability to generalize these trends  Small differences between the averages in concept categories  Large spread  Limited number of HiAPs  Bias of English/English translations only

13 Results – Confounding Political Factors 1. Years of prior intersectoral action on health equity  6 countries have 5-15 years; 3 countries had years  Only 2 HiAP with < 5 years (NI, SA)  Used health + broader concepts  Mid-high levels of ISC  Suggests:  ISA progresses into the development of HiAPs OR  Integrated intersectoral connections required for a HiAP approach may take time to develop

14 Results – Confounding Political Factors 2. Place in world economy  2 HiAPs came from middle income countries (Brazil and Thailand)  Only HiAPs using “health”  Different ISC: cooperation/coordination & integration  Suggests:  May influence the concept used  Don’t know if position in world economy (i.e. priorities) or culture/language  Does not impact the type of intersectoral commitments in a HiAP

15 Results – Confounding Political Factors 3. Labour market egalitarianism  Less labour market egalitarian countries:  Tend to use broader concepts (alone, + health)  Higher ISC in HiAPs with health + broader  More labour market egalitarian countries:  Higher ISC

16 Results – Confounding Political Factors

17 Conclusion  Importance of political context  Stronger associations between ISC and political context than ISC and framing  Less LM egalitarian countries: broader concepts and higher ISC  Without long history of ISA, broader concepts may help get HiAP on the policy agenda  Diversity of concepts in framing

18 Does talking about “health” help or hinder getting your work on the policy agenda and collaborating with others?

19 Acknowledgements  Dr. John Calvert  Dr. Ketan Shankardass  Lydia Drasic  Jenna LaFrance  Aya Tomioka  Melay Drasic and Aaron Kirkpatrick

20 Works Cited  Bacchi, C.L. (2009). Analysing policy: What's the problem represented to be?. Frenchs Forest, N.S.W.: Pearson Education.  Drasic, K.E. (2012). Broad health concepts in Health in All Policies and their influence on the intensity of intersectoral action in the policy agenda. [unpublished thesis].  de Chavez, A. C., Backett-Milburn, K., Parry, O., & Platt, S. (2005). Understanding and researching wellbeing: Its usage in different disciplines and potential for health research and health promotion. Health Education Journal, 64(1), doi: /  St-Pierre, L. (2011, June 21). Health in all policies (HiAP): An overview. [Power Point]. In L. St-Pierre (Moderator), Health in All Policies. Presentation conducted at the Canadian Public Health Association Conference, Montreal, Quebec.  Shankardass, K., Solar, O., Murphy, K., Freiler, A., Bobbili, S., Bayoumi, A., & O’Campo, P. (2011b February). Health in All Policies: A Snapshot for Ontario: Results of a realist-informed scoping review of the literature. In Getting started with “Health in All Policies”: A resource pack (chap.1). Retrieved from =18218&page=1 =18218&page=1  World Health Organization & Public Health Association of Canada. (2008). Health equity through intersectoral action: An analysis of 18 country case studies. Geneva: World Health Organization.

21 Results – Concepts in HiAPs Type of Concept #CountriesConcept Used Health2 Brazil † Thailand † Health Health Concept 2 England Health inequalities Health (Life expectancy, Infant mortality) Health of the population Finland † Health promotion † English is not an official language of this country/state, or the majority of its citizens don’t speak English (Central Intelligence Agency, 2012; Office of the Commissioner of Official Languages, 2011; South Australian Tourism Commission, n.d. ) Concepts in HiAPs

22 Type of Concept #CountriesConcept Used Broader Concept 3 New Zealand Drivers of crime South Australia Wellbeing Quality of life at every stage of life WalesPublic service Health + Broader Concept 4 Northern Ireland Health and Wellbeing Health Inequalities Norway † Social inequalities in health Quebec † Population health Health and wellbeing Public health Scotland Health inequalities Poverty and income inequality Health † English is not an official language of this country/state, or the majority of its citizens don’t speak English (Central Intelligence Agency, 2012; Office of the Commissioner of Official Languages, 2011; South Australian Tourism Commission, n.d. ) Concepts in HiAPs (II)


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