Walkways from Paris

16 December 2016
“Promoting intersectoral and interagency action for health and wellbeing”

EuroHealthNet policy director Clive Needle and PHASE co-ordinator Cristina Chiotan took part in the event organised by WHO Europe, held at UNESCO HQ in Paris 7-8 December, on Promoting intersectoral and interagency action for health and wellbeing. Here Clive offers his personal perspectives on what emerged and what can be done:

  1. The conference was proactively hosted by France, which demonstrated an important collaboration between the Ministry of Social Affairs & Health and the Ministry of Education. There is much being developed on health literacy and citizenship through childhood into adolescence, including a new convention on public health partnership, signed on 29 November, which focuses on the most vulnerable young people from age 3 and equips professionals with tools to assist them. EuroHealthNet will meet with Santé Publique France, its national member, in early 2017 to discuss how we can work together to support such major initiatives. You can find all information about the conference on the dedicated site
  2. Other countries, regions and parts of the ‘UN family” of agencies made concrete contributions on initiatives they are taking, not least EuroHealthNet partners in Ireland, Scotland, Slovenia, and Wales. Interesting learning about the importance of scale was demonstrated, including from the extensive compendium of actions compiled as part of the extensive guidance and support documentation for the event, to which EuroHealthNet contributed. Finland also presented on progress strengthening employment and health sectors, which will be featured during the EuroHealthNet annual conference in Helsinki in June 2017.
  3. On the wider issue of what constitutes an effective ‘health workforce”, I was reminded of learning from the all-Ireland conference in Belfast recently. When public health seeks liaison with lifelong learning or creative sectors, for example, it was suggested that it can benefit from engaging people from wider backgrounds than public health medicine or sciences, such as humanities, arts, media or community experiences. That is crucial in developing mutual trust and understanding. I would like to see that developed further in follow up processes.
  4. The education and literacy aspects of intersectoral working were well explored: clearly well-established mechanisms exist (such as the health behaviour in schools studies and health promoting schools networks). Less clear were concrete mechanisms for tackling issues of social inequities, although building social protection “floors” are undoubtedly a priority. The International Labour Organisation (ILO) made important points about decent jobs within and beyond health systems; but high profile political issues such as low pay, social exclusion and wealth inequalities were marginal. One interesting aspect is that some countries have joint health and social ministries: it would be intriguing to learn if that is a desirable model for all.
  5. In several panels evidence was shown how legislation plays a key role in effective, sustainable policy making. The potential EU Pillar of Social Rights, which could underpin such processes, was barely mentioned (except by me and the European Commission DG EMPL adviser who spoke). Of course WHO is a much wider region than the EU, so good examples also came from beyond its borders. But one key factor was not stressed: to work intersectorally, health actors need to systematically monitor and understand the needs and objectives of other sectors, not only their own. It is not just about jargon and language. We need to walk the walk, not just talk the talk. Sometimes, health actors just need to support gains in other sectors for indirect solidarity.
  6. I have long heard pleas from groups active in communities for much better, earlier involvement of stakeholders; that case was well made again by Eurochild and others in Paris. We know that, unless people who are most directly affected by decisions are involved in design as well as implementation, outcomes are likely to be less effective and sustainable. However, that involvement really does need to be inclusive and equitable, which is difficult but achievable. Evidence also shows the most excluded, the most vulnerable people are less likely to conform, and to be less confident in articulating realities. Yet they are not hard to reach by definition, only practice and prejudice. Health promoters get that: I am not convinced some policy makers do.
  7. Politics matters. A plethora of brilliant Professors produced compelling evidence of the role of ideologies in shaping policy and practice, globally as well as from the diverse elements which comprise the UN European regions. Data helps but may not be decisive. Yet few people contributed about their experience of open accountability, of contesting competitive public elections, or having to deliver in power when “No” is the most difficult word. The changing political climate was often mentioned, but some difficult debates were avoided until the informal “networking” breaks. I fear that is how barriers persist or grow. We were urged to stand up for our values by Professor Martin McKee; like him and others we should do so.
  8. When I help train people from organisations about advocacy, I advise to address the core of decisions where “power, wealth, and resources lie”, not linger at the margins. That links with the still relevant recommendations of the Commission on Social Determinants of Health, which Professor Sir Michael Marmot powerfully updated in Paris. It connects with the compelling evidence presented by OECD, especially Mark Pearson, also in the session which I helped to moderate. I commend their slides which are now available for download.
  9. Money matters too. I wish there had been more time for the case introduced by David McDaid of the London School of Economics in the session about intersectoral governance. Finance ministries were of course noticeable by their absence, although WHO and others do much work elsewhere with them. Unfortunately that often focusses around fiscal sustainability and cost effectiveness of more narrowly defined health and care systems, leaving questions of responsibility for change agendas towards health improvement and equity insufficiently owned and resourced. There are ideas and options to address that: I would like to explore those further. Without better resources, wellbeing promoters cannot deliver better outcomes.
  10. We must not be complacent about fundamental public health matters such as water (or air or energy) supply. A paltry handful of people forsook their lunch for a terrific side event by WHO on water, sanitation and hygiene (WASH) needs in schools. Yet, in an EU state, 4 out of 10 pupils say they can never use school toilets. It raised crucial issues about cultural, behavioural, social, environmental and economic determinants of wellbeing. Much is being done, but much more is needed. More information is available on WASH in schools on the WHO website.