ilona kickbusch, governance for health, wellbeing and sustainability

Taru Koivisto Co-chairMihály Kökény Co-chairBosse PetterssonIlona KickbushEeva OllilaOuti KuivasniemiVesna-Kerstin PetricMaris JesseSvetlana AxelrodMichael Huebel European CommissionCharles Price European CommissionDavid Pattison IUHPE/EuropeClive Needle EuroHealthNetGauden Galea WHO/Europe SecretariatAgis Tsouros WHO/Europe SecretariatErio Ziglio WHO/Europe SecretariatVivian Barnekow WHO/Europe Secretariat

Europe Day Committee

Kickbusch Helsinki 2013

Professor Ilona Kickbusch

Governance for health, wellbeing and sustainability

1986 – 2013 - Post 2015- pre 2030

1986 Ottawa Pledge


to move into the arena of healthy public policy, and to advocate a clear political commitment to health and equity in all sectors;

to counteract the pressures towards harmful products, resource depletion, unhealthy living conditions and environments, and bad nutrition;

to respond to the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of these societies;

1986 Ottawa Pledge


to acknowledge people as the main health resource, to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and wellbeing;

to reorient health services and their resources towards the promotion of health; and to share power with other sectors, other disciplines and most importantly with people themselves;

.

Ottawa Pledge


to recognize health and its maintenance as a major social investment and challenge; and to address the overall ecological issue of our ways of living

The Conference is firmly convinced that if people in all walks of life, nongovernmental and voluntary organizations, governments, the WHO and all other bodies concerned join forces in introducing strategies for health promotion, in line with the moral and social values that form the basis of this CHARTER, health for all by the year 2000 will become a reality.

25 years on ……context25 years on ……context


Radically changing societies:

GlobalizationUrbanization IndividualizationVirtual connectednessCommercializationDemography

Radically changing societies:

GlobalizationUrbanization IndividualizationVirtual connectednessCommercializationDemography

……………………25 years on …. ……………………25 years on ….


Ottawa Action AreasThe nation

Healthy public policy

Supportive Environments

Community actionPersonal skillsReorient health

systems

Ottawa Action AreasThe nation

Healthy public policy

Supportive Environments

Community actionPersonal skillsReorient health

systems

Determinants: the globae

PoliticalSocial(Macro) EconomicCommercialEnvironmentalBehavioral

(genetic)

Determinants: the globae

PoliticalSocial(Macro) EconomicCommercialEnvironmentalBehavioral

(genetic)

……………………..25 years on…….……………………..25 years on…….


Ottawa Action Areas

Healthy public policySupportive

EnvironmentsCommunity actionPersonal skillsReorient health

systems

Ottawa Action Areas

Healthy public policySupportive

EnvironmentsCommunity actionPersonal skillsReorient health

systems

21st century action areas

Whole of governmentGlobal governanceSustainable production

and consumptionWhole of societyGovernance for health

and wellbeingHealth in All PoliciesHealth literacyResilience……………………

21st century action areas

Whole of governmentGlobal governanceSustainable production

and consumptionWhole of societyGovernance for health

and wellbeingHealth in All PoliciesHealth literacyResilience……………………

Two major strands of public health George Rosen (1910-1977)

Two major strands of public health George Rosen (1910-1977)


As inequalities increase the health debate changes:

the medical and technical development dimension of public health is increasingly overlaid by a debate on the social, political and economic/commercial factors that determine health.

In the 19th and early 20th century the focus of public health was mainly national, social and political.

in the course of the 20th century it moved to being national, medical and technical,

As inequalities increase the health debate changes:

the medical and technical development dimension of public health is increasingly overlaid by a debate on the social, political and economic/commercial factors that determine health.

In the 19th and early 20th century the focus of public health was mainly national, social and political.

in the course of the 20th century it moved to being national, medical and technical,

Global - social - political


in the late 20th and very early 21st century it moved to being global, economic and technical (“the science of delivery”)

Today the focus must be increasingly global, social and political – powered by developments in information technology which were not at our disposal even 10 years ago.

/

Political determinants of healthPolitical determinants of health


Health has moved up in the political agenda in countries, in development policies and in global agreements precisely because of its relevance both to the economy, political ideology and legitimacy and to the expectations of citizens.

It is of a highly political and symbolic nature: it concerns definitions of the common good, the role of the state, markets and individuals, as well as the interests of many stake holders. Is health and wellbeing something that „we collectively strive to pursue” (Sandel 2009) in a world of globalization, individualization and commercialization?

Health has moved up in the political agenda in countries, in development policies and in global agreements precisely because of its relevance both to the economy, political ideology and legitimacy and to the expectations of citizens.

It is of a highly political and symbolic nature: it concerns definitions of the common good, the role of the state, markets and individuals, as well as the interests of many stake holders. Is health and wellbeing something that „we collectively strive to pursue” (Sandel 2009) in a world of globalization, individualization and commercialization?

Justice can mean………..


1. ….maximizing utility or welfare – the greatest happiness for the greatest number

2. ….respecting freedom of choice

3. ….reasoning together about the meaning of the good life – developing a politics of the common good – the solidarity of democratic citizenship

Michael Sandel What Money Can't Buy: The Moral Limits of Markets 2010

Committment to health and wellbeing as a public goodCommittment to health and wellbeing as a public good


The success of societies must be measured differently:

“The time is ripe for our measurement system to shift emphasis from measuring economic production to measuring people’s well-being. And measures of well-being should be put in a context of sustainability.”

Recommendation of the Commission on the Measurement of Economic Performance and Social Progress (chaired by Joseph Stiglitz) 2010.

This takes us back to the concept of health as wellbeing in the WHO Constitution.

The success of societies must be measured differently:

“The time is ripe for our measurement system to shift emphasis from measuring economic production to measuring people’s well-being. And measures of well-being should be put in a context of sustainability.”

Recommendation of the Commission on the Measurement of Economic Performance and Social Progress (chaired by Joseph Stiglitz) 2010.

This takes us back to the concept of health as wellbeing in the WHO Constitution.

High Level Panel report 2013


Global impact by 2030 – 5 transformative shifts:

Leave no one behindPut sustainable development at the coreTransform economies for Jobs and inclusive

growthBuild peace and effective, open and

accountable public institutionsForge a new global partnership

SDSN Report priority challenges


End extreme poverty and hunger Achieve development and prosperity for all without

ruining the environment Ensure learning for all children and youth Achieve gender equality and reduce inequalities Achieve health and wellbeing at all ages Increase agricultural production in an environmentally

sustainable manner, to achieve food security and rural prosperity

Make cities productive and environmentally sustainable Curb human-induced climate change with sustainable

energy Protect ecosystems and ensure sound management of

natural resources Improve governance and align business behavior with all

the goalsSustainable Development Solutions Network 2013

Proposals for Future Goals

Peoples choices


Source: ODI (2013) Future Goals Tracker

Global People’s Survey

Source: www.myworld2015.org

Message from thematic consutations


Human rightsGovernanceequity

Some thoughts…………


Politicians and electorates need to accept that in a global world we now have both national and global interests - and governments must be held accountable for both

There is a convergence of a set of key principles that form a global health ethics.

It is not sufficient to string a set of priority health challenges together -- we must have the courage to think beyond health and embrace a broad notion of sustainable development.

Our debate must start not end with governance. We must learn how to govern a global system in the making more fairly. No longer can "the West" write the roadmap of global governance and development.

Systems thinking


Bridge BuildingBridge Building


In many cases, the best choices for health are also the best choices for the planet; and the most ethical and environmental choices are also good for health.

In many cases addressing poverty also addresses the survival of the planet.

In many cases, the best choices for health are also the best choices for the planet; and the most ethical and environmental choices are also good for health.

In many cases addressing poverty also addresses the survival of the planet.

New consumer dynamics of health Unsustainable systems - Unsustainable lifestyles

New consumer dynamics of health Unsustainable systems - Unsustainable lifestyles


The obesity epidemic - and the global system of food production, distribution, consumption and waste - is one of the most obvious symptoms of “unsustainable lifestyles” and unsustainable production and consumption patterns. It reflects paradigmatically the global flow of ways of life, ideas and products and the global dimension of health promotion

The obesity epidemic - and the global system of food production, distribution, consumption and waste - is one of the most obvious symptoms of “unsustainable lifestyles” and unsustainable production and consumption patterns. It reflects paradigmatically the global flow of ways of life, ideas and products and the global dimension of health promotion

CO BENEFITS

Kickbusch Helsinki 2013Scientific American 2009

Industrial animal production consumes especially large amounts of energy, requiring 35 calories of fossil fuel to produce 1 calorie of food energy—not counting the energy required for processing, packaging, cold storage, and transportation of meat

Commercial determinants of healthCommercial determinants of health


“Lifestyles” - The power of markets and business, in particular transnational companies/corporations and their marketing has led to “industrial” and “communicated” epidemics based on encouraging unhealthy consumption. There is increasing proof that brands can shift consumer habits.

“Lifestyles” - The power of markets and business, in particular transnational companies/corporations and their marketing has led to “industrial” and “communicated” epidemics based on encouraging unhealthy consumption. There is increasing proof that brands can shift consumer habits.

Ubiquity – 24/7


SanitaryRevolution HIAP/

GFHRevolution

Regulation: tax - limit sizeRegulation: tax - limit size


URBAN ACTION:ZONING


Global Consumerism – constant choiceGlobal Consumerism – constant choice


It has become common practice to turn health issues into a fundamental debate about individual freedom and choice.

New economic dynamics of healthNew economic dynamics of health


In many developed countries health/medical care now constitutes 10-15% of GNP and 10 – 15% of the work force – many emerging economies are making major investments in health and medical care

Health/medical care is a major business sector, a major employer, part the economic competition between countries, the import and export of goods and services and of foreign policy - Health damaging products are a major business sector – economic crisis is affecting both

A new dynamics how a range of governmental sectors and processes contribute to health and how health contributes to societal and economic development require a new positioning of health within government and society.

In many developed countries health/medical care now constitutes 10-15% of GNP and 10 – 15% of the work force – many emerging economies are making major investments in health and medical care

Health/medical care is a major business sector, a major employer, part the economic competition between countries, the import and export of goods and services and of foreign policy - Health damaging products are a major business sector – economic crisis is affecting both

A new dynamics how a range of governmental sectors and processes contribute to health and how health contributes to societal and economic development require a new positioning of health within government and society.

Political determinants: Overcome Equation of market behaviour with democracy

Political determinants: Overcome Equation of market behaviour with democracy


consumerconsumer Citizen

We must ensure that our democratic institutions value health. We must invest in the health literacy of parliamentarians and of the citizens who elect them.

Citizen

We must ensure that our democratic institutions value health. We must invest in the health literacy of parliamentarians and of the citizens who elect them.

Some more thoughts…………..


The priority focus needs to be on the global public goods we ALL require in relation to health, climate, population food, water, energy, conflict -- they are the building blocks for our future. In consequence such a global system requires reliable institutions related to three big pillars:A vigorous and fair global economyEnvironmental sustainability, sustainable production and

consumptionGlobal health and wellbeing

We will require an agreement how to jointly finance the global public goods we prioritize as a global community, not just through governments but with the contribution of other global actors – i.e. taxing the 6.5.trill. global health industry.

Smart sovereigntyDiplomacy today + Health policy today


„Today‘s diplomat has a dual responsibility: to promote his or her country‘s interest and to advance the interests of the global community“

Muldoon et al 2005

Today‘s minister of health has a dual responsibility: to promote his or her country‘s health and to advance the health interests of the global community.

The key governance challenge is setting the rules for the new interfaces – ENSURE GLOBAL PUBLIC GOODS - Key role of WHO

ilona kickbusch, governance for health, wellbeing and sustainability

Health & Medicine