Fran Baum is blogging from the 8th World Health Organization Global Health meeting. Read her other blogs here.
It was good to hear Pekka Puska present Finland’s health promotion success which has resulted in an 80% reduction in cardiovascular disease over 30 years. He stressed that this has been a long term complex process. The Finns realised early on that victim blaming doesn’t work and that changing the environment is vital. So they regulated food supply so it was lower in fat and salt and worked with the food industry to encourage them to make food healthier. Subsidies for dairy products were reduced and dairy farmers were encouraged to change to berry farming. Finland’s experience raises the question of how governments globally can get “Big Food” to change its addiction to sugar and fat?
Ravi Narayan presented a civil society perspective and noted the rapidly increasing inequities occurring everywhere. He spoke of the importance of listening to people at the grassroots and hearing their concerns. He stressed the importance of solidarity to social movements and the crucial importance of involving civil society in all policy making. He documented the mechanism society uses including “watches” such as the People’s Health Movement Global Health Watch, health tribunals, health assemblies, and campaigns. He spoke of the importance of social vaccines that build active civil society movements to protect health. Ravi also stressed the importance of seeing people not just as patients and customers, but also as citizens who can help plan and shape the style of health and other services. He also spoke of his work training “activist health professionals.”
The next plenary was on capacity bullding. Viroj Tangcharoensathien described the sophisticated Thai approach to Health in All Policies (HiAP) which uses constitutional mandates, regulation, citizen engagement through the Thai National Health Assembly, and organisational capacity development. Thailand offers many lessons for progressive health policy. Ilona Kickbusch (described by the chair as “the mother of health promotion”) talked about health as an overall societal goal which needs whole of government commitment. She stressed speed and agility as crucial skills to navigate health promotion systems. She also noted that complexity science and political science are essential to understanding HiAP processes because policy processes are chaotic and political. She says HiAP is an ever moving target and its work is never done. Stakeholder and network analysis and management are also crucial skills for HiAP. Learning systems are required where people can experiment and make mistakes and so keep their courage for challenging the status quo. She also spoke of the need for both hard (law) and soft (incentives) governance. This session would have benefited from a sharper analysis of how power interacts within and outside organisations to restrict capacity for action.
Work is progressing on the Helsinki Declaration and participants are invited to comment on drafts in plenary sessions and by email. It will be hard to come up with as robust a document as the Ottawa Charter. The conference is flagged as a green conference, but I wonder about the excessive use of bottled water when Finnish tap water perfectly is fine to drink!
Fran Baum is a professor of public health. She is the director of the Southgate Institute of Health Society and Equity, Flinders University, Adelaide, Australia, and is a member of the Global Steering Committee, People’s Health Movement. She is an Australian Research Council Federation fellow.