Social determinants of health and Health in All Policies

2 Policy and planning Key message Universal health coverage (UHC) and health equity cannot be achieved without action on social determinants of health and coherent recognition of health across other sectors

Social Determinants of Health in Mongolia Geographical disparity: remote households, people living in mountains Employment, informal sector employment Social exclusion: on the basis of social identity, homelessness, migrants, garbage collectors, etc. Poor food variety, lack of fruits and vegetables, increase of low quality imported food Poor environment: Water and sanitation, air pollution Weak primary health care Poor social protection in illness for and disabled people, orphanages, very poor High out of pocket treatment expenses Financial protection Service coverage Population coverage

Social determinants of health

5 Policy and planning 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

Infant and Under-5 Mortality by Mother’s Education Level, Mongolia 2005

7 Policy and planning Health in All Policies An approach to public policies across sectors that: seeks synergies across sectors systematically takes into account the health implications of decisions avoids harmful health impacts to improve population health and health equity

HiAP

9 Policy and planning HiAP reflects the principles of: population rights and government obligations conferred by national and international law participation of society in policy process accountability of governments to their people transparency of policy-making and access to information sustainability in use of resources for current and future generations collaboration across sectors to promote health, equity, and sustainability

Patterns of interaction between health and other sectors InformativeCooperation Coordination CoherenceIntegration Brazil N Zealand England Sri Lanka Wales Malaysia N Ireland Quebec Scotland Sth Australia Sweden Cuba Finland Thailand Iran Norway

11 Policy and planning Broad or issue-specific intersectoral action? broad strategies; integrating a systematic consideration of health into other sectors’ policy processes. issue-centred strategies; integrating a specific health concern into other sectors’ policies, e.g. Both can be used

12 Policy and planning HiAP into action: 1.Establish the need and priorities for HiAP 2.Assess and engage other sectors 3.Foster common understanding between sectors 4.Identify supportive structures and processes 5.Enhance community participation 6.Ensure monitoring, evaluation, reporting and accountability

13 Policy and planning Examples of intersectoral action WHO Framework Convention on Tobacco Control Mongolia: Alcohol control Viet Nam: National mandatory helmet law South Africa: Mental health Liverpool: Active City Australia: Governance on Health in All Policies Ghana: Extractive industries – oil and gas sector

14 Policy and planning Healthy soum & aimag towns & cities Local government that can help to: promote physical activity increase safety promote good nutrition and reduce obesity: ●encourage farming in urban areas ●encourage fruit and vegetable stores in residential areas ●reduce fast food restaurants ●restrict fast food restaurants near schools

15 Policy and planning Healthy Transport Compact Inter-agency initiative on transport to: balance the needs of all transport users expand mobility improve public health support a cleaner environment create stronger communities Involves: Department of Transport Energy and Environmental Affairs Public Health

16 Policy and planning NCD prevention can benefit everyone Education Improved scholastic outcome Healthy children and development Agriculture Improved production of fruits and vegetables Healthy people and internal trade Industries Improved productivity Lower cost of staff illness Healthy people and economy Urban planning More physical activity and cleaner air Healthy cities, more tourists, healthy economy

17 Policy and planning Key Lessons 1.Use already identified priority public health issues 2.A supportive governance structure helps to promote integration of strategies and sustain efforts 3.Establish a common information system with sector- specific data 4.Community participation and empowerment is critical. 5.MDG’s can promote intersectoral action 6.Health Impact Assessment can help identify when intersectoral action is needed

18 Policy and planning Benefits from Intersectoral Action Health benefits: synergy between different strands of the health and well-being agendas; Environmental benefits: boosting use of city parks Educational benefits: enhanced facilities in schools Transport benefits: enhanced transport and mobility plans Economic benefits: healthier workforces

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