1. Day 2 Good morning Capacity Building Course on Human Rights and Health Equity Mainstreaming in Public Health

2. Session 5: Health in all policies and inter-sectoral action for health

3. 3 Power walk

4. 4 Was empowerment an obstacle for your character? Empowerment …a process that helps people gain and/or strengthen control of their lives …about putting power in the hands of women and men of all groups

5. 5 WPRO Global Learning Program Did gender matter?

6. 6 Gender matters because… Biological differences are not enough to explain different disease patterns. Due to gender norms, roles and relations, there are differences between different groups of men and women in: –exposure to risk factors –household-level investment in nutrition, care and education –access to and use of services –their experiences in care settings –social impact of ill-health Many differences in health can be mitigated or prevented altogether.

7. 7 How did your access to or control over resources affect your ability to move forward? UHC and health equity cannot be achieved without action on social determinants of health and coherent recognition of health across other sectors.

8. 8 Social determinants of health

9. 9 Poverty as a social determinant The vicious circle : Ill health leads to poverty Poverty leads to ill health The virtuous circle : Good health is linked to higher income and welfare Higher income is linked to good health

10. Why do people not access services?

11. Geographical barriers Economic barriers Low knowledge/awareness Sociocultural factors (gender, ethnicity) Stigma, fear of social isolation Lack of health system responsiveness Access barriers

12. 12 Activity What is health and well-being? What kind of places do you think of when we talk about health? What kind of people do you imagine? What keeps us healthy and well? What place does health have in society?

13. 13 Integrating equity, gender and human rights Answer 4 critical questions:  Who has been left behind?  Why? o Which rights are at stake? o How have gender norms, roles and relations affected risk/exposure, household investments in care, nutrition and education, access to and use of health services or the social impact of ill-health?  Who has to do something about it?  What do they need, to take action? Process and outcome are equally important

14. 14 Good practice Encourage country ownership and responsibility Facilitate partnerships and team building Encourage stakeholder participation Reinforce in-country capacities

15. 15 What is health & well-being? WHO (1946): “…Health is a state of complete physical, mental and social well- being, and not merely the absence of disease or infirmity… The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition… Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures…”

16. 16 What is health & well-being? UN Universal Declaration of Human Rights (1948) “…Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control…” – Article 25

17. 17 What is health & well-being? International Covenant on Economic, Social and Cultural Rights (1966): “…The States Parties… recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. …Steps to be taken by States Parties to achieve full realization of this right shall include: a) provision for reduction of stillbirth, infant mortality, and healthy development of the child; b) improvement of all aspects of environmental and industrial hygiene; c) prevention, treatment, and control of epidemic, endemic, occupational and other diseases; d) creation of conditions which would assure to all medical service and medical attention in the event of sickness…”

18. 18 Group activity What factors determine health? Individual behaviour Clinical care Socioeconomic factors Physical environment

19. 19

20. 20 The determinants of health

21. 21 Group activity How does inequality impact health? Why do health inequalities matter?

22. 22 The health gradient

23. 23 Global challenges & health dynamics Globalization: trade, migration, industrialization Urbanization Economic growth, poverty and governance Socioecnomic inequality Environmental degradation Demographic transition

24. 24 Group activity How is health linked to other sectors? Food Water Energy Education Economy Infrastructure and transport Governance Environment

25. 25 What is public health? All organized efforts to prevent disease, promote health and prolong life among the population as a whole. Three main public health functions: Assessment and monitoring of health of communities and populations Formulation of public policies on health priorities Assuring that al populations have access to appropriate care, including prevention and promotion

26. 26 What is health in all policies? An approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies and avoids harmful impacts to improve population health and health equity. It improves accountability of policy-makers for health impacts of policy-making.

27. 27 When to use a HiAP approach?

28. Obesity: a “wicked problem” problems

29. Group activity Characteristics of complex social problems? Antimicrobial resistance Poverty Climate change

30. Complex social problems Ill-defined, ambiguous and associated with big moral, political and professional issues. They are subjective and strongly stakeholder-dependent: there is often little consensus on what the problem is and how to resolve it. These problems won’t keep still: they are set of complex, interacting social issues evolving in a dynamic social context.

31. Role of government in HiAP Health is an individual right and a public good. Governments have a responsibility for the health of their people. Evidence building Engaging stakeholders within and beyond government Formulating and implementing intersectoral policies Evaluating their impact.

32. Group activity What promotes intersectoral action? What hinders intersectoral action?

33. Degrees of collaboration

34. Role playing: Inter-sectoral action Preparation: 10 minutes Read the scenario Read the information relating to your role only. Do not read your partner’s details. Consider how you will approach the meeting you are about to have with your partner. –What do you want to get out of the meeting? –What do you think they will want from you? –What can you offer or ask for? –How will you introduce yourself? –Who else could be invited to future meetings?

35. Role Play Each pair has five minutes to ‘role play’ their meeting while the others watch

36. Thank you