Kickbusch London 2006

Ottawa – challenges we face

Ilona Kickbusch

Open University London 2006

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20 Years Ottawa Charter

Towards a new public health……………………..

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Towards a new public health…

We are challenged to develop a public health approach that responds to the globalized world and its political, social and economic ramifications. The challenge is as large as when public health was first developed.

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Better population health depends on:

• Making health everybody's business• Ensuring equity.• Making the healthy choice the easier

choice• Ensuring sustainability.

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Expansion processes of the health society

• the expansion of the do-ability of health: something can be done, there is always more health

• the expansion of the territory of health into an increasing array of personal, social and political spaces: health is everywhere

• the expansion of risk and reflexivity: every choice is potentially also a choice for or against health

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In almost every aspect of our lives we are faced with questions and decisions about health.

Navigating the health society

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But……UK: One in five people has problems with the basic skills needed to understand simple information that could lead to better health, 15% of adult population have low health literacy

Canada: 22% of Canadians are unable to read a medicine label and calculate amounts of medicine

US Institute of Medicine: 90 MILLION AMERICANS (NEARLY 1 IN 2 ADULTS) DO NOT UNDERSTAND BASIC HEALTH INFORMATION

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How to create health

Health is createdin the context of everyday life: where people live, love,work and play.Ottawa Charter 1986

• Google?shop?travel?google

go

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The new public health:

Health is created

in the context of

everyday life:

where people

live, love,

work and play.Ottawa Charter

Key components of change:

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1. Health and longevity drive society

We need to adapthealth and welfarePolicies to achieve the „longevity dividend“

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2. Consumer society: Health as a global market force

• Commercialization and Privatization: health as a product

• Health as a key global market

• Countries compete on health

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Increasing number of consumer products and choices

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TheConsumer

TV/Radio

NewsMedia

PopularMedia

Self-help

books

Health-care

Provider

Internet

Friends&

Family

Peer-review

Lit.

HealthAssoc’s

Gov’tHealthOrg’s

HealthIns.

Org’s

Filter

Increasing sources of health information

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Increasing choices in products and treatments

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Increasing provider choices

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Empowerment in the consumer society

Citizens have a right to • health competencies, • patient competencies, • consumer competencies, • citizen competencies in the context of supportive environments

• Health Literacy is a critical empowerment strategy to increase people‘s control over their health, their ability to seekout information and their ability to take responsibility.

• Kickbusch/Maag 2005

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3. The globalizaton of everyday life drives health

• The global

• Risks in the 21st century are transnational and all attempts to control them lead into the international arena

• The local

• Global risk production is localized through the “globalization” of everyday life

• COGNITIVE• SPATIAL• TEMPORAL

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Address the trans boundary scapes of health in a global worldIdeoscapes Images with political

ideological meanings

Technoscapes Export of technologies

Ethnoscapes Flow of people

Mediascapes Mass media IT marketing

Finanscapes Global capital transfers

A. Appadurai, New School University, New York

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Healthscapes: Food - Drink

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Healthscape: virtual realities

• "The Internet is unlike anything we've seen before," says David Greenfield, PhD, founder of the Center for Internet Studies (www.virtual-addiction.com). "It's a socially connecting device that's socially isolating at the same time."

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Healthscape Fashion industry

• New Regulations in Madrid:

• A model of 1,76 m. must not weigh less than 56 Kilogramm. That is a Body-Mass-Index of 18.0 and is already below the value assigned to a healthy body weight.

Naomi Campbell 1,77 m. and weighs 51 Kilo. That means a BMI of 16.

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Healthscapes: women’s mobility

Migration and increased mobility of women

• New slave markets• Forced prostitution• Domestic workers• Health workers• Low paid service work

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4. The policy arenas and actors shift

• Foreign policy• Security policy• Economic policy• Trade policy• Geopolitics

• From the ministries of health to:

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Consider the new health actors

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Consider the new health actors

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Consider the new health actors

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Consider the new health actors: Patient organizations

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Health policy becomes an „open system“

Health policy in the 21st century is transnational and attempts to control risks by linking the local, national and the global policy arenas

• Health policy in the 21st century is part of all sectors and attempts to create health through new types of policy networks

Healthy public policy

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Open systems of governance

Finnish European Union Presidency

• Ideally: health agenda owned by other sectors

• Empowering ministries of health – Political will – Governance mechanisms

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Open systems of governance

• National global health strategies: “to counter from a national standpoint, the threats to global health”

• Problems which directly or indirectly threaten populations

• Contribution to global problems• Contributions to global solutions• National consensus on principles,

values, intent and directions

• Foreign policy• Security policy• Economic policy• Trade policy• Demographic

Geopolitics

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…..a new global POLITICAL ECOSYSTEM

BONO

CLINTON

MSF

150 PPPHWEF PHA

World Bank

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5. The Sustainability Challenge

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„ „Ecological footprint“ of the health system

• What amount of ressources does it take to create health?

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„Ecological footprint“

(2004 WHO)

Costa Rica Schweiz USA

GNP p.c. 8 949 34 087 39 901

Life

expectancy

75 78 75

Health

expectancy

65 71 67

Health expenditure p.c.

616

(7,3%)

3776

(11,5%)

5711

(15,2%)

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The new dynamics of health

• We must begin not end with the political and social determinants of health

• Health is a determinant• Health is an investment• Health is a resource• Health is a human right

• Health is a driving force in modern societies

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Political determinants…..

The deliberation of major health issues and major health determinants in fora to which the public health community has little or no access – and is not prepared for.

What kind of Ministers of Health??????????

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Political advocacy: Have you

voted for health today?

• Public health actors must work systematically with political decision makers and parliamentarians at all levels of governance – national, European and global.

• Create new types of public health forums

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Health Promotion in a globalized world

• Healthy public policy• Supportive

environments• Community action• Personal skills• Reorient health

services

Ottawa Charter

• health as• a global public good • a key component of

collective human security• a key factor of good

global governance• responsible business

practice and social responsibility

• global citizenship and human rights.

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European nations

• should ensure through cooperation a common high level of health protection and health rights for all citizens wherever they live, love work and play (and travel, buy or google)

• from those risks and threats to their health, safety and well being which are beyond the control of individuals and communities AND NATION STATES

• And cannot be effectively tackled by nation states alone but need to be multiactor and multilevel (e.g. health threats, unsafe products, unfair commercial practices).

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The global is here not there.....

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Interdependence

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Global Governance becomes more important

MOH

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Regulatory power 1• The renewed mandate given to

Member States and WHO under the IHR(2005) has also increased their respective roles and responsibilities. In particular, States Parties* to the IHR(2005) are required to develop, strengthen and maintain core surveillance and response capacities to detect, assess, notify and report public health events to WHO and respond to public health risks and public health emergencies. WHO, in turn, is to collaborate with States Parties to evaluate their public health capacities, facilitate technical cooperation, logistical support and the mobilization of financial resources for building capacity in surveillance and response.

• The broadened purpose and scope of the IHR(2005) are to "prevent, protect against, control and provide a public health response to the international spread of disease and which avoid unnecessary interference with international traffic and trade."

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Regulatory Power 2: Framework Convention Tobacco Control 27.05.2005

• "The WHO FCTC negotiations have already unleashed a process that has resulted in visible differences at country level. The success of the WHO FCTC as a tool for public health will depend on the energy and political commitment that we devote to implementing it in countries in the coming years. A successful result will be global public health gains for all."

• Dr LEE Jong-wook. Director-General, World Health Organization 2006

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Framework Convention Tobacco Control

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Global developments: Projected prevalence

of obesity in adults by 2025

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Local IMPACT

Cost of the SARSepidemic to Toronto:12 000 lost jobsCost to the local economy: over $ 1 billion in 2003

• Asia:• Cost per person US$ 6 million (60 billion in

costs)

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Accountability to “own” constituency and global community

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• the tax on flights from France is expected to generate 200 million euros a year for an International Drug Purchase Facility, also known as Unitaid.The fund will be used to bulk-buy medicines for countries -- mainly in Africa –

• 19 pays se sont engagés à instaurer une contribution volontaire. 4 pays ont déjà rejoint la France en instaurant une contribution volontaire : le Chili, la Côte d’Ivoire, le Gabon, Maurice. 12 autres pays ont engagé des procédures interministérielles ou parlementaires pour l’adopter.

• Passengers flying out of French airports will pay one euro in economy class, and 10 euros in business, if their destination is in the EU. For flights outside Europe, the surcharges are between four and 40 euros, depending on the class 

Taxation

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• Active health citizenship is a critical empowerment strategy in modern society – a significant dimension of citizen, consumer and patient’s rights and dignity –multi level dimensions

Active citizenship

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„Une démarche citoyenne mondiale“