21st century Health Leadership Regions for Health Ilona Kickbusch The Graduate Institute, Geneva Cardiff 11.10.2013
Why regions? • (Most?) Powerful actors for health, well being and sustainability - hard factors – soft factors • The capacity for innovation and learning • Champions of health citizenship Kickbusch Cardiff 2013
Regions – critical interface of multilevel governance global EU national State provincial local Kickbusch Cardiff 2013
Kickbusch Cardiff 2013
Health is about political choices • The political choices we make about how we want to live • Contested visions of a good society and a good life – WHAT constitutes the common good – HOW TO resolve collective action problems Kickbusch Cardiff 2013
Governance • ‘ Governance concerns the state’s ability to serve the citizens. It refers to the rules, processes and behavior by which interests are articulated, resources are managed, and power is exercised in society. • Governance is a basic measure of the stability and performance of a society . The way public functions are carried out, public resources are managed and public regulatory powers are exercised … ’. EC 2003 Kickbusch Cardiff 2013
What is governance about? Rules Interests Issues Resources Power Kickbusch Cardiff 2013
• Technical leadership in public health: we know what to do…………. leadership in health promotion „ healthy regions “ Kickbusch Cardiff 2013
History: Heartbeat Wales • was a community based program in Wales to improve cardiovascular health. The program used a range of health promotion methods to change individual health behaviors and to promote environmental, organizational, and policy changes that support healthy choices . • The program included local television series such as "Don't Break Your Heart," "Fit for Life," and the "BBC Diet Programme." To encourage smoking cessation, the program developed the Quit and Win project. Heartbeat Wales worked with grocery retailers to encourage food labeling and nutrition education, and developed the Heartbeat Awards for restaurants that increased the availability of healthy food choices and smoke free areas. The program also developed a worksite health promotion program called Make Health Your Business. Kickbusch Cardiff 2013
1986 Ottawa Charter 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; Kickbusch Cardiff 2013
1986 Ottawa Charter 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; . Kickbusch Cardiff 2013
1986 Ottawa Charter 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. Kickbusch Cardiff 2013
25 years on …… context Radically changing societies: Globalization Urbanization Individualization Virtual connectedness Commercialization Demography Kickbusch Cardiff 2013
Constant change • Governments … will need to adapt and continuously evolve to create value. • They need to stay relevant by being responsive to rapidly changing conditions and citizens’ expectations, and build capacity to operate effectively in complex, interdependent networks of organizations and systems across the public, private and non-profit sectors to co-produce public value. • ..what is needed today is flatter, agile, streamlined and tech-enabled (FAST) government. WEF Kickbusch Cardiff 2013
Innovation • Regions can re-shape the political narrative of public value and public health Kickbusch Cardiff 2013
Unsustainable systems - Unsustainable lifestyles The obesity epidemic 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. a global system of food production, distribution, consumption and waste……………………manifestation at regional level Kickbusch Cardiff 2013
The narrative: sustainability, health, wellbeing The values The drivers (power and ressources) Public goods Social good Equity The social determinants Political determinants Commercial Market The living environment The people values and economic determinants Kickbusch Cardiff 2013
The WHAT of Health • Health and wellbeing: something that „ we collectively strive to pursue” (Sandel 2009) in a world of globalization, individualization and commercialization. • Address social cohesion • Ensure next generation • Address unsustainable production and consumption: food, tobacco, alcohol, fossil fuels and its equity dimensions in new ways • Address climate change Kickbusch Cardiff 2013
21st century health leadership Allign Empower sectors people Values Mission Equity Health and wellbeing Access Kickbusch Cardiff 2013
Co benefits: Social cohesion and sustainability • Invest in community structure, assets, social capital, public participation, public spaces and resilience Kickbusch Cardiff 2013
Public spaces: ZONING Kickbusch Cardiff 2013
Co benefits: next generation • strengthen children early – critical support to early child development • make children’s formal learning environments – in particular the school and health care – more conducive to their wellbeing • create a supportive social environment (consumer world, ICT, media, virtual worlds) • create opportunities to play creatively Kickbusch Cardiff 2013
Co benefits – sustainability and diet • A recent study (SDC, 2009) highlighted the changes most likely to have the most significant and immediate impact on making diets more sustainable, in which health, environmental, economic and social impacts were more likely to complement each other. These were: • reducing consumption of meat and dairy products, reducing consumption of food and drink of low nutritional value (i.e. fatty and sugary foods) and reducing food waste. • All imply significant societal, environmental and economic challenges and significant conflicts, particularly with producers – but have great potential for network governance Kickbusch Cardiff 2013
Co Benefits: climate change and health Kickbusch Cardiff 2013
• The how Kickbusch NEK CNE Bern 2009 Kickbusch Cardiff 2013
Governance shortcomings • We tend to focus on governance shortcomings as a lack of technical capacity (do it better – the cook book) • Rather than as related to the structures of power and the constraints imposed by vested political interests and established ways of doing things (do it smarter – be strategic) Kickbusch Cardiff 2013
What is governance about? participation inclusion Principles transparency accountability Kickbusch Cardiff 2013
ALLIGN and EMPOWER Coalitions are one of the key political mechanisms for overcoming the pervasive collective action problems that define most development challenges and are also at the heart of politics and the concerns of political science (Ostrom, 1997). Kickbusch Cardiff 2013
The age of the network • The network is a defining feature of the 21 st century society and governance • When the power to govern is shared collaboration becomes the new imperative • Transparency and flow of information are critical Kickbusch Cardiff 2013
Champions of Network governance • Become strategic • Focus on collective action solutions • Invest in network governance • Build complementary relationships • Explore „ efficiency “ through network governance – co-benefits • Embrace diversity • Create hubs of partipation Kickbusch Cardiff 2013
Create the web of interaction Chordoma Research Kickbusch Cardiff 2013
Create the policy space It is essential to develop formal and sustained mechanisms for intergovernmental integration and joint learning and capacity building for this new form of policy making and horizontal governance for health . This goes beyond committees set up to deal with specifically defined problems. There must be continuity and legitimacy of leadership (possibly through the features of the public health legislation) Kickbusch Cardiff 2013
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