equity in health and well-being a political...
TRANSCRIPT
Equity in health and well-being – a political choice!
Dina von Heimburg, public health coordinator Innherred joint municipality and vice-chairman Healthy cities Norway
Do something! Do more! Do better!
3 keys for political commitment
• Strengthen system capacity!
• Strengthen human capacity!
• Be patient, brush up on your soft skills, and keep pushing forward!
WHO Healty Cities
» Euro Healthy Cities network
» National network in Norway
» «Laboratory»: Develop and
share «best practice» of
public health work at the
local and regional level.
Verdal and Levanger municipalities
• Levanger: ca. 20.000 inhabitants
• Verdal: ca. 15.000 inhabitants
• Cooperations through Innherred samkommune (joint municipality) since2004
WHO Health 2020
Health 2020 recognizes that successful governments can achieve real improvements in health if they work across government to fulfil two linked strategic objectives:
• improving health for all and reducing health inequalities
• improving leadership and participatory governance for health.
07.04.2017 5
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Overview of public health
and health determinants
Strategic societal planning:
overall goals and strategies
policy
and
action
plans
Implementation
of measures
Evaluation
Verdal and Levanger try our best to fulfill the systematic public health circle as requested by national legislation
Dialogue and enthusiasm!
7All politicians are public health politicians!
8“Action Spectrum on inequalities in health” (Whitehead 1998)
2008: Not even on thespectrum…?
2010: members of
WHO Norwegian HC
2012: Partnership
withUCL/Marmot
team
2012-2014Making the case, telling the story,
intensive planning
2017Moving further
down the action spectrum
(but still a longway to go…!)
Central principles «back home»:
The municipal couincil decides thedirection for societal development
The Mayor is our captain
The Chief Executives facilitatesdevelopment through leadership, holistic governance, co-creationand co-design.
Our work is «glued» to thebackbone of the municipalorganization.
Political commitment!
Public health and equity in health and
well-being – a political choice!
(Trondheim declaration, 2014)However, we politicians
need an INFORMED debate in order to make
health promotingdecitions
Well well, then, I guess you need
my help!!!!
Holistic governance systemEnsuring accountability across sectors and
mobilize local community
Whole of governmentWhole of society
«window of opportunity»
Problems
Policies
Politics
Based on Kingdon, 2011; Leppo et al. 2013
GU
IDEL
INES
VA
LUES
KN
OW
LED
GE
Revision of public health strategy Developement of services and local community
Planning strategy 2013-2016
Municipal plan – public health strategyProcess 2014
Holistic solutions – Municipal plans
Health Childhood Culture Buisiness City Centre
Existing municipal plans
Defining perspectives
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(Trondheims-deklarasjonen, 2014)
Men in Levanger: Life expectancy by education level
17http://khs.fhi.no/webview/
Percieved loneliness among youth
18
3065106
What is Health?
"Good health is what a person has when he has the ability and the capacity to cope with and adapt to life's inevitable difficulties and day-to-day requirements."
(Peter F. Hjort).
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Basert på Dahlgren og Whitehead, 1991 og Bloch et al., 2014
H ealth and well-being is created where people areborn, play , learn, work, enjoy leisure, shop and
live24 /7365
Sustainable development
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Focus on ASSETS
45
From disease prevention to community mobilization!
GU
IDEL
INES
VA
LUES
KN
OW
LED
GE
Revision of public health strategyDevelopement of services and local community
Planning strategy 2013-2016
Municipal plan – public health strategyProcess 2014
Holistic solutions – Municipal plans
Health Childhood Culture Buisiness City Centre
Existing municipal plans
Defining perspectives
Municipal Masterplan 2015-2030
Municipality of Levanger Municipality of Verdal
Vision: Quality of life and growthsustainable societies - a good start and coping throughout the lifespan - generous and robust life environments
GOALSWe are working to achieve the following objectives:
• Our municipalities are good communities to live in for a whole lifetime, and everyone feel as a valued part of the community
• All children must be given the best possible start in life
• All the inhabitants feel secure, they have control of their everyday life and they have added several active years of life with good health and well-being
• Our municipalities are a force for development in a sustainable and robust part of Central Norway
Masterplan = 1 page!
Direct links between strategies, measures and (joint) budgeting
INDIKATORER OG RESULTATVURDERING
Målindikatorene som er vist under, legges til grunn for resultatvurderingen i årsrapporten. Resultatvurderingen skjer i lys av samfunnsmålene og skal gi pekepinn på om utviklingen går i retning av disse. Der det er mulig skal resultatvurderingen skje ut fra en fordeling på geografi, alder, kjønn og sosial status. Det legges til grunn en ambisjon om at situasjonen skal forbedres for alle og at ulikhet skal reduseres.
• Levealder (Folkehelseinstituttet)• Selvrapportert helse og livskvalitet (HUNT4 og UngData)• Leveår med god helse (HUNT4)• Andel med fortrolig venn/nettverk som kan hjelpe ved problemer (HUNT4 og UngData)• Gjennomføring videregående skole (Fylkesdata)• Langtids arbeidsledighet (Nav)• Uførhet (Nav)• Husholdninger med vedvarende fattigdom/langtids sosialhjelpsmottakere (SSB/Nav)• Kulturdeltakelse/deltakelse frivillighet (HUNT4 og UngData)• Fysisk aktivitet (Sykkeltelling og selvrapportert fysisk aktivitet HUNT4/UngData)• Infrastruktur til gående og syklende (Antall nye meter)• Trafikk (Passasjertall kollektivtrafikk, biltrafikkmåling)• Borgerindeks (Borgerundersøkelsen) • Demokratiindeks (Borgerundersøkelsen)• Kommunebarometeret (Kommunal rapport)• Kildesortering (Innherred Renovasjon)• Næringsindeks (Næringslivets Hovedorganisasjon)• Bedriftsetableringer (Innovasjon Norge)• Netto og brutto driftsresultat i % av driftsinntekter (Kommuneregnskapet)• Disposisjonsfond i % av driftsinntekter (Kommuneregnskapet)
The performance review is supposedto indicate whether the development
is moving toward societal goals
The ambition is to improve thesituation for everybody, and to reduce
inequity.
Evidence-based…?
30
With a little help from our friends...
31
National legislation&
compliant municipalities…???
Soft skillsthe «new skills on the
block»
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Soft skills – change agents
• Creative bureacracy – facilitate innovation
• Strategic staff unit – bridge spanners who tears down walls between sectors
• Accumulated group (crowd-sourcing) of change agents –strengthen the equity message together. Start with those who are positive and wants to commit.
Soft skills – change agents
• Adjust language and «chapters of the main story» to fit into relevant contexts. Create win-win situations.
• Tacit leadership
• Make sure to have somequick wins and successes, and let others take credit
«Narratives on housing»
Story-telling and narratives to accumulate knowledge, empwer citizents, and set the political agenda. Basedon Clandinin og Connelly (2000) «Three-dimensionalnarrative space».
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Supersetting = Coordinated and equal efforts which enhances the effect of each other
Work-place
Market-place
Health instituti
onPark and
green space
BUA
Kindergarten
Neigbourhood
School
Principles
MediaKnowledge
Context
Empower-ment
Participation
Integration
Actors
Citizents
Politicians
Public sector
Private sector
Academia
Bus
Librery
Volunteers
Bloch, Bruun Jensen & al. 2014
Supersettings are created by supermen- and superwomen
Chief of administration Ola Stene,Levanger
Chief of administration Jostein Grimstad
Verdal
Promote publichealth and well-
being
&
Reduce inequity
!!
Bloch et al. International Journal of Behavioral Nutrition and Physical Activity 2014, 11:118 http://www.ijbnpa.org/content/11/1/118
Follow up on political decisions - creating the new welfare municipality
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Holistic planning: 1+1+1 = 5, 6, 7 ….
«Mayors talk» on political leadership for sustainable development, health and well-being for all. Dialogue seminar between politicians, administrative leaders and union representatives, march 2017
3 keys for political commitment
• Be patient, brush up on your soft skills, and keep pushing forwards!
• Strengthen system capacity!
• Strengthen human capacity!
Levanger kommuneenhet Kommunalteknikk
48
Levanger
ungdomsskoleSchools as a place to
meet, learn, play, love,
and enjoy leisure
24/7 - 365
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Siden BUA Levanger åpnet i april 2015 har tilbudet fått
nær 800 registrerte kunder, og per januar 2017 er det
registrert hele 5519 unike utlån.
Levanger kommuneenhet Kommunalteknikk
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Stadionparken 27.08.15
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Levanger kommune, Røde kors og Levangers unge
sanitetsforening inviterte til beachparty 10.07.2016
«Dugnad» to make an inclusive place to meet and eat
Kafe Verden in Levanger works to include immigrants and other citizents in a supportive community. As volunteers, many people strengthen their socialnetworks, work experience and they get access to references and relationships they can bring with themto enhance their success in working life and society
Levanger Arena Arbeid
http://www.levanger.kommune.no/PageFiles/1738/Prosjektplan%20FARVE%202016.pdf
http://www.levanger.kommune.no/PageFiles/1738/Verkt%C3%B8ybok_Levanger.pdf
Systematisk utvikling av system- og humankapasitet
Og underveis har vi hatt det gøy sammen med mange kunnskapsrike og kreative mennesker!