A perspective on the SIP and AHA.SI approach in Slovenia
By Clive Needle
Watching the Active and Healthy Ageing (AHA.SI) initiatives in Slovenia develop from ideas to implementation has been an inspiring process. EuroHealthNet has long advocated for whole of government and whole of society approaches to resolving problems, as established within the WHO Europe Health 2020 strategy for wellbeing.[i] It has also engaged stakeholders in the processes relevant for health and social equity within the EU Semester process[ii], which provides practical and policy frameworks for implementation of the EU2020 strategic goals.
Merging wellbeing, equity and sustainability goals with the realities of economic governance is not easy, especially in difficult circumstances. The launch of the EU Social Investment Package for Growth and Cohesion (SIP) has provided a policy impetus to do that.[iii] Importantly it identifies the priority challenges on a European scale as:
Economic crisis – unemployment and poverty and social exclusion levels have reached record highs. They are a huge drain on Europe's human resources at a time when public budgets are under pressure.
Demographic changes - the working-age population in Europe is shrinking, while the proportion of older people is growing. Solutions must be found to ensure sustainable and adequate social protection systems.
If the SIP approach is to be judged to have worked by the original criteria, it will have stimulated:
- Greater focus on policies that strengthen people's capacities and skills and remove barriers to finding work.
- More effective and efficient use of resources, helping to ensure adequate and sustainable social protection.
- Better results – ensuring greater productivity, employability, health, helping people to get out of poverty and social exclusion and having appropriate living standards.
The AHA-SI is exciting because it has addressed exactly those challenges, and can justifiably demonstrate that it has reached a strategic implementation phase that offers real prospects of achieving the success criteria.
The commitment of the government to outcomes is noticeably high, evidenced by the participation of senior ministers and state secretaries at events and conferences, in addition to their involvement in strategic decisions. Clearly much is at stake and progress is anticipated. I noted how a good example has been brought forward of pre-retirement planning from military and defence sectors, likely to be rolled out to wider public and private contexts. That offers a fascinating opportunity for Europe wide learning, linking sectors that are not usually partners.
From a health perspective, the contribution to not only reviews of health and care system developments and the forthcoming national active ageing strategy, but also to wider economic and social planning, is important. That includes follow up work with people from identified particularly vulnerable groups and regional communities. The development of work towards falls prevention strategies and mental wellbeing are strong elements. One participant noted that the “background was local but this is now national and local”. The continued engagement of multiple levels is clearly essential for effective implementation.
The determined, imaginative use of innovative methods to build consensus, break down multi-sectoral and cross sectoral barriers, and to stimulate involvement and ownership from initially disparate partners, has been bold and exemplary. I recall early meetings and formative processes displaying some hesitancy, even suspicion of motives at times. This was expressed by a key participant from a ministry as moving from the negative perspective of “knowing what we do not want to the vision needed for a progressive society.” Now criticism is constructive, embraced and recognised. The inclusion of initially unforeseen elements, such as the vital examination of digital society implications for literacy and access, is evidence of this greater confidence and of genuine intent to involve and include.
Potential flaws and complex scenarios are transparently set out and considered from multiple perspectives. Methodologies from other countries, other systems and other EU co-funded studies are brought into play, including from the EuroHealthNet work on equitable methodologies Crossing Bridges[iv] and the AFE Innovet introduction of a Covenant for Demographic Change including age-friendly environments.[v]
There are, of course, persistent and new challenges. Difficult decisions on resource allocation within social protection system and the extent of personal responsibilities will be faced. Intergenerational solidarity and engagement of civil society is not guaranteed, let alone the elusive empowerment of older people. Increasing migration patterns, social mobility and the roles of new and established media have yet to be fully integrated. A study in preparation on the impacts of economic change on inequalities will be important. The glue which would hold together and support implementation and further phases is not yet set.
But as another participant said “We are moving mountains”. Fittingly, to the south east of the Alps, a model for many aspects of European 21st century social investment has been begun, to the great credit of the institutes, ministries, organisations and people responsible.