The global perspective on good governance for health promoting health services
Large system transformation to facilitate people-centered health care systems
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In-Source Research Group, Vancouver CAN
Alex has global experience leading change in the health care industry, government, higher education, social services and community development. As a senior executive, Alex worked extensively in teaching hospitals. As a consultant, he leads system-level planning, policy and governance reviews, evaluation studies and strategic initiatives. As a volunteer, Alex visits Bangladesh regularly to assist in development of health service and nurse education programs and is an editorial advisory board member for the International Journal of Health Governance.
Large-scale change is hard to manage in the complex adaptive systems so typical of the health care environment. In order to deliver people-centred and health promoting services, leaders at all levels need to transform organizational culture, as well as traditional structures and processes. However, this transformation is not easy because many organizations lack capacity for systems thinking or have no experience in collaborative learning and using change methods. This presentation introduces "systems-thinking" tools to illustrate the challenges and opportunities in transforming complex adaptive systems. The systems-thinking case studies include national strategies for tobacco control in USA; coalition-building for Non-Communicable Disease and Primary Health Care in Canada; introduction of clinical guidelines across the entire hospital system of a Canadian province, and evolution of a global network for Human Resources for Health. The tools briefly introduced include systems dynamics modelling, network analysis, causal loop diagrams and others. These tools open the possibility of “strategic conversations” about people-centered care within health services. The case studies illustrate the importance of a learning approach and the significant role of leaders in large-system transformation. The lessons learned emphasize "simple rules" for promoting and sustaining on-going change in a Complex Adaptive System. For example, creating structures and processes with the right mix of "tight" and "loose" management; and sustaining change through effective network development.People-centred care is coming whether or not health services are ready. Fortunately, leaders exist at all levels in our health care systems. We need to provide them with the right tools and support for large system transformation.
Effective policies and strategies to implement health promotion
President, Istituto Superiore di Sanità, Rome, ITA
Professor of Hygiene and Public Health at the Catholic University of the Sacred Heart in Rome, in August 2015 Walter Ricciardi was appointed President of the Italian National Institute of Health (Istituto Superiore di Sanità) where he was Commissioner from July 2014 to July 2015.In 2010 he was elected President of the European Public Health Association (EUPHA) and in 2011 he was re-elected for a second term up to 2014. Since 2014 he is Past President of EUPHA.In 2011 he was appointed Member of the European Advisory Committee on Health Research to the WHO European Regional Director and from 2011 to 2014 he was Member of the Executive Board of the National Board of Medical Examiners of the United States of America.He manages several undergraduate and postgraduate teaching activities including a Master of Science programme and International Courses in Epidemiology.In Italy he was member of the Higher Health Council of the Ministry of Health in the years 2003-2006 and the Italian Minister of Health appointed him Chair of the Public Health Section of the Council itself from 2010 to 2014.In May 2013 he was appointed Member of the Expert Panel on effective ways of investing in Health (European Commission, DG – SANTE) and in December 2016 he has been awarded a three-year second mandate.He was appointed Member of the Steering Committee of the Center for Global Health Research and Studies of the Medical School, Catholic University of the Sacred Heart, Rome for the years 2015/2016 -2018/2019.In December 2015, he was appointed Director of the WHO Collaborating Centre for Health Policy, Governance and Leadership at the Institute of Public Health, Medical School, Catholic University of the Sacred Heart – Rome.In 2016 he was appointed Principal Investigator of the EC Grant N° 733274 “TO REACH” for the period of December 2016 – November 2019.In June 2017 he was appointed “Commendatore” of the Italian Republic by Decree of the President of the Republic.In November 2017 he was appointed Italian Representative in the Executive Board of WHO.He is Editor of the European Journal of Public Health, of the Oxford Handbook of Public Health Practice and Founding Editor of the Italian Journal of Public Health and of Epidemiology, Biostatistics and Public Health.In May 2018 he has been elected President of the World Federation of Public Health Associations (WFPHA) by the General Assembly of the WFPHA.
Since the Ottawa Charter for Health Promotion (World Health Organization, 1986), health promotion has been based on the principle that health is the most intimate personal value, strictly related to people and on how they live and create health in the context of their everyday lives and on the culture of their community. Furthermore, given that the global financial crisis has plotted against the sustainability of western welfare states, a stronger health promotion paradigm (also known as ‘salutogenic model’) is prevailing rather than barely providing healthcare services. Governance for health and well-being has been defined by WHO as "the attempts of governments and other actors to steer communities, whole countries or even groups of countries in the pursuit of health as integral to well-being through both whole-of-government and whole-of-society approaches". "Health 2020: the European policy for health and well-being" is the mainstream of this new understanding, placing promotion of health and well-being as the key feature of what constitutes a successful society, a safe and healthy economy and a higher value placed on equity and participation. The principle of "Health in all policies" stands for the necessity to adopt cross-sectoral and multicomponent strategies through alliances among different stakeholders and active citizens’ participation. As indicated by WHO in the 8th and 9th Global Conferences on Health Promotion (respectively, Helsinki 2013 and Shanghai 2016), and specifically on non-communicable diseases in the Global Action Plan 2013-2020, the intersectoral approach and empowerment at individual and community levels let people succeed in the process that enables them to increase control over, and to improve, their own health. Adaptation of governance for health and well-being is driven by the changing nature of societies and the challenges they face, just as the deep essence of every society is conserved and protected by its culture and its core values. This is why health and well-being are recognised as primary values to be preserved and priorities to be addressed only if culture is strongly oriented and people are fully aware.Governance for health is the driver for change in healthcare, but leadership is the core energy that makes change happen: in the context of health building according to a multidisciplinary and integrated perspective, healthcare professionals need to play a crucial role in the so-called advocacy by catalysing opportunities for interventions of prevention and health promotion in several community settings (even others than healthcare). This requires that societies invest in future leadership and governments strengthen and modernize education for healthcare professionals, building on formal education and moving towards a trans-cultural education. A focus on leadership in healthcare is essential to animate governance for health and to shape a new culture within society, stressing leadership behaviour directed to strengthen the healthcare system and ensure that health is repositioned as primary objective, a view clearly shared by the European Union’s Member States as well as the WHO European Region.An important challenge at national level is the system governance overall that involves all stakeholders and country-specific population needs, based on international commitments. The Italian policy documents on health promotion, the National Prevention Plan (the version currently in use is 2014-2018) and related Regional Prevention Plans, refer to a global involvement strategy informed by shared programs and objectives which foster a complex and inclusive ‘public health for all’, during the whole life course. Recognizing competences and fine planning are found to be the strategic keys that lead to effective health promotion policies and interventions, as best, good or promising practices producing scientific evidence. The Istituto Superiore di Sanità (ISS), as the main research institute in public health and the technical-scientific body of the National Health Service in Italy, recognises the importance of health promotion and plays a stewardship role with the Ministry of Health. The ISS includes a dedicated Centre (National Centre for Disease Prevention and Health Promotion) that works on achieving health promotion outcomes through the implementation of effective methods and integrated multidisciplinary approaches. Based on both international and national public health priorities, the ISS Centre coordinates surveillance systems, surveys and studies on health determinants and behavioural risk factors (e.g., levels of physical activity or hesitant attitudes towards vaccinations). Building on results and findings, health promotion initiatives are developed in collaboration with the Italian Regions and the Ministry of Health, including the evaluation of effectiveness.
Is HPH contributing to improving governance for health promoting hospitals and health services?
Coordinator, HPH Network of Australia, La Trobe University, Melbourne, AUS
Sally Fawkes is a senior academic at La Trobe University, Australia, coordinating two doctoral programs (public health, medicine) and post graduate health promotion studies. She holds a BSc, MBA (Monash) and PhD on foresight and health policy (La Trobe). Sally is a regular technical advisor to WHO in her core fields of research, teaching and consulting: health leadership development; health promoting health systems; using foresight and systems thinking for innovation in health; urban health and Healthy Cities; and health literacy. Sally was one of the first leaders in Australia of hospital-based health promotion portfolios. She has been associated with the International HPH Network since 1993 and has served three terms on the HPH Governance Board. Sally is also a board member for Victorian Health Promotion Foundation, the first health promotion body in the world to be funded by tobacco tax, and an executive committee member of the Council of Public Health Institutions Australasia.
The HPH Newsletter Number 25 published in 2005 and edited by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care in Vienna, included an item by WHO Regional Office for Europe on a new governance structure for the International HPH Network (HPH). This signaled the shift to the network’s independence from WHO, with the formation of a structure that "strengthens participation of coordinators and will better reflect the concerns and issues faced at the level of national/regional networks and hospitals". A secretariat function was established to "enable better support of countries in their hospital reform processes and adoption of quality improvement models". A steering group (now the HPH Governance Board) was set up to “aim at a better development of the network, a closer collaboration of the working group/ task force leaders, national/regional coordinators and external partners”.Now, more than a decade after these structures were put in place, what can we say about governance for health promoting hospitals and health services? Drawing on case examples, this presentation will consider two dimensions of governance: governance of the International HPH Network and governance in HPH member organisations that enables the comprehensive concept of reorientation of health services to be adapted and thrive. It will briefly explore contemporary concepts of ‘good governance’ and ‘networked governance’ and links between HPH and the dual policy agendas of Universal Health Coverage and Sustainable Development Goals. Finally, this presentation will propose the idea of collectively developing a set of ‘Vital Signs’ of good governance for use in diverse contexts by the International HPH Network.
Ministry of Social Affairs, Health, Care and Consumer Protection, Austria
Christina Dietscher is a trained medical sociologist. As a researcher, she worked at the WHO Collaborating Centre for Health Promotion in Hospitals and Health Care for more than 20 years. Her research focused on health promotion in settings and on health literacy, especially health literate organizations. In 2015, she started to work for the Austrian Ministry of Health where she is currently leading the department of non-communicable diseases, mental health and geriatric medicine. Christina is currently policy co-chair of the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) and chair of the Austrian Health Literacy Alliance. She has widely published and is a frequent speaker at national and international conferences.
Former National Co-ordinator of the Italian Regional HPH Networks, ITA
Physician, specialist in Public Health.Secretary and Member of the Board of the Centre for Leadership in Medicine, Catholic University of the Sacred Heart, Rome.Visiting Professor of Evaluation in Public Health, School of Hygiene and Public Health, University of Padua.President of the European Public Health Association Section on HTA.Honorary President of the Italian Society of Health Technology Assessment and Co-ordinator of the Working Group on HTA of the Italian Society of Public Health.Former National Co-ordinator of the Italian Regional Networks of Health Promoting Hospitals.Former CEO of the Healthcare Trust No. 19 of the Veneto Region, the Healthcare Trust of the Autonomous Province of Trento and the University Hospital Trust Santa Maria della Misericordia of Udine. Former Medical Director of the University Hospital of Padova.