Open Health Forum Workshop Report: Health in All Policies – What Role for Stakeholders?

As well as discussing the involvement of non-health stakeholders in health policy decision making, participants discussed health stakeholders’ involvement in policies which affect health but over which they do not have direct involvement or ownership. The aim of the workshop was to discuss the opportunities and challenges in implementing joined-up health policies through the ’Health in all Policies’ approach. Experience has shown that a joined-up approach to policy making results in better policy – the same approach should be taken to delivery of those policies.

As well as EPHA’s Secretary General Monika Kosińska speakers included Olivier Raynaud, Senior Director, Global Health and Healthcare Sector at the World Economic Forum; Michelle Ceccini, Health economist at the OECD ; Graham Minton, Director of Corporate Relations from the World Heart Federation ; Zsuzsanna Benko, Corporate Affairs Manager at Tesco Hungary; and René Maertens of Echnaton School in the Netherlands. The meeting was chaired by Professor John Ashton, Chair of the UK Public Health Association Council and Director of Public Health in the Cumbria Primary Care Trust in the UK.

Health is a complex outcome with complex drivers. The ’Health in all Policies’ approach requires ownership and awareness from other governmental policies such as Education and Agriculture, however the implementation of the approach includes the stakeholders who own the drivers - whether schools, farmers or other local actors. The workshop examined the opportunities and challenges arising from the health sector engaging in partnerships and dialogue with other actors. Given the financial pressures currently faced by publicly funded European health systems, together with the absence of health and well-being from the current EU 2020, the debate was both up-to-the-minute and challenging. Traditionally, government departments of health have been seen as cost centres and ‘drains on resources’ rather than areas to be invested in. Investment in health must be recognized as worthwhile for economic operators as employers and investors in people. The World Heart Federation frequently works with businesses to promote heart health. Graham Minton said that the key to this is finding areas where objectives overlap – it is not a question of philanthropy on the part of the businesses.

Participants from the audience drew attention to the need to be sceptical of the added value which economic operators could bring to the issue. A partnership between industry and NGOs would have to be preceded by an admission on the part of the economic operators of the role that they play in driving the causes of ill health.

Olivier Raynaud pointed to the example of GAVI as a successful partnership between economic operators, governments and civil society. He outlined how at the end of the 1990s, the pharmaceutical industry had begun to stop manufacturing vaccinations, what reversed that trend and recommenced production was not children suffering or calling vaccinations a fundamental right, but building GAVI, and creating a market and funding mechanisms – the alliance has to date vaccinated 250-300 million children. He suggested that perhaps this model be exported to other sectors.

Participants questioned whether economic operators ever have a role in delivering health interventions, despite the warning issued by Michelle Ceccini of the OECD that antagonism is the key to failure. OECD research has shown that a combined, multi-stakeholder approach is always the most effective. He gave the example of the failure to establish the proposed tax on soft drinks in the US. He blamed this on hostility between civil society, legislators and the food and drink industry which led to it being impossible for discussions to proceed politically.

The question arose on the limitations of corporate social responsibility (CSR) and indeed when CSR legitimised core business behaviours that are detrimental for health - such as behaviours seen in the baby milk industry. Olivier Raynaud warned that businesses need to understand why it is in their interests to change behaviours or engage in ’responsible’ and health promoting activities.

EPHA President Archie Turnbull pointed to this seeming contradiction in activities of the food industry. He pointed out that Unilever, with whom Graham Minton said the World Heart Federation has a productive partnership, actively lobbied against the health community on the proposal for Regulation on Food Information to Consumers. Archie Turnbull questioned whether the health community’s approach was mistaken, and if the public interest would be better served if the public health community were to enter into partnerships. Graham Minton pointed out in reply that the two are not mutually exclusive. Despite having a strong partnership with Unilever, the World Heart Federation advocated for stronger food labelling than them, in the case of the proposed Food Information to Consumers Regulation.

Whether such partnerships constitute, or can lead to, a conflict of interest was also a topic of intense discussion. While some attendees felt receiving money from economic operators was in its nature a conflict of interest, others said that it was necessary, particularly when the administrative burden of receiving European Union funding is so great.

Silva Rukavina, President of the International Federation of Medical Students Associations pointed out that while vital issues were being discussed by the panel the youth element was not adequately addressed in the session. Monika Kosińska agreed that upcoming challenges to health including an ageing population and young workforce mean that it is vital to incorporate youth into such discussions.

A clear outcome from the meeting was that this is an important discussion that is only really beginning to start. The workshop was not able to conclude all the important issues that arose, and these will be taken up by EPHA with its members and partners in other settings.

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 Open Health Forum workshop discusses stakeholder involvement in ’Health in All Policies’