Ilona Kickbusch, Governance for health, wellbeing and sustainability

Taru Koivisto Co-chair
Mihály Kökény Co-chair
Bosse Pettersson
Ilona Kickbush
Eeva Ollila
Outi Kuivasniemi
Vesna-Kerstin Petric
Maris Jesse
Svetlana Axelrod
Michael Huebel European Commission
Charles Price European Commission
David Pattison IUHPE/Europe
Clive Needle EuroHealthNet
Gauden Galea WHO/Europe Secretariat
Agis Tsouros WHO/Europe Secretariat
Erio Ziglio WHO/Europe Secretariat
Vivian 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:
Globalization
Urbanization
Individualization
Virtual connectedness
Commercialization
Demography
Radically changing societies:
Globalization
Urbanization
Individualization
Virtual connectedness
Commercialization
Demography

……………………25 years on ….……………………25 years on ….
Ottawa Action Areas
The nation
Healthy public policy
Supportive Environments
Community action
Personal skills
Reorient health systems
The nation
Community action
Personal skills
Determinants: the globae
Political
Social
(Macro) Economic
Commercial
Environmental
Behavioral
(genetic)
Determinants: the globae
Political
Social
(Macro) Economic
Commercial
Environmental
Behavioral
(genetic)

……………………..25 years on…….……………………..25 years on…….
Community action
Personal skills
Community action
Personal skills
21st century action areas
Whole of government
Global governance
Sustainable production and
consumption
Whole of society
Governance for health and
wellbeing
Health in All Policies
Health literacy
Resilience
……………………
21st century action areas
Whole of government
Global governance
Sustainable production and
consumption
Whole of society
Governance for health and
wellbeing
Health in All Policies
Health literacy
Resilience
……………………

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 good
Committment 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 behind
Put sustainable development at the core
Transform economies for Jobs and inclusive growth
Build peace and effective, open and accountable public
institutions
Forge 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 goals
Sustainable 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 rights
Governance
equity

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
Scientific 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
Sanitary
Revolution
HIAP/GFH
Revolution

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
consumerconsumer 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 economy
Environmental sustainability, sustainable production and
consumption
Global 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 sovereignty
Diplomacy 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

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

Similaire à Ilona Kickbusch, Governance for health, wellbeing and sustainability

Similaire à Ilona Kickbusch, Governance for health, wellbeing and sustainability (20)

Plus de Sosiaali- ja terveysministeriö / yleiset

Plus de Sosiaali- ja terveysministeriö / yleiset (20)

Dernier

Dernier (20)

Ilona Kickbusch, Governance for health, wellbeing and sustainability