Professor Margaret BarryWorld Health Organization Collaborating Centre for Health

Promotion Research National University of Ireland Galway

Ollscoil na hÉireann, Gaillimh

Innovation in Health Promotion – has it reached its potential?

Health Matters: Innovation in Health Promotion Conference

Budapest, 29 September, 2015

Innovation in Health Promotion• Innovation in health systems - new ways of addressing

health priorities- process by which new ideas are generated using information,

imagination and initiative, and converted into useful products and services

• Incremental innovation – gradual, continuous or dynamic change

• Radical innovation – unexpected but does not disrupt existing systems

• Disruptive innovation (Christensen et al., 2008)“enable a larger population of less-skilled, less-wealthy people to do things in a more convenient, lower-cost setting, which historically could only be done by specialists in less convenient settings”.

e.g., mainframe computer -> personal computers, smart phones

Innovation in Health PromotionEC Expert Panel on Effective Ways of Investing in Health (2015)

Opinion on Disruptive Innovation: Considerations for health and health care in Europe • Defines “disruptive innovation” in healthcare as a type of innovation that

creates new networks and new organisational cultures based on a new set of values, involving new players, and helping to produce relevant and equitable value increase. This innovation displaces older systems and ways of doing things.”– novel organisational models – new models of service provision and technologies – with the aim of improving access, quality, equity and/or resilience of the

systems Paradigm-shift; transformational change; improved outcomes; more

accessible and more affordable services/products

Health Promotion as a Disruptive Innovation

• Health Promotion – dynamic multidisciplinary field within public health in the 1980’s

• Paradigm change in thinking about health (WHO, 1986)• Reframed the challenge of improving population health

– a focus on health rather than illness– how can the greatest health gain be achieved for the greatest

number of people?– shift from a deficit model of illness to the health potential of

everyday settings for living

(Kickbusch, 1996; McQueen & Jones, 2007)

Shifted the centre of gravity to a focus on population health and wellbeing

Health Promotion as a Disruptive Innovation• Social model of health replaced a biomedical model

– embraced a socio-ecological model of health– addressing the broader determinants of health and wellbeing - the

‘causes of the causes’• Transdisciplinary perspectives from political, environmental and

social sciences brought a fresh perspective on addressing health challenges

• New players and actors from the non-health sector• Places empowered citizens at the centre of their own health• Comprehensive multilevel interventions

Shift from more costly biomedical interventions to systems-based approaches that can be implemented at a population wide level

Health Promotion action areas

Build healthy public policy

Create supportive environments

Reorient health services

Strengthen community action

Develop personal skill

combined into Health Promotion strategies

Systems

Policies

environment

organisation

community

person

Systems scale

Health Promotion Principles (participation, empowerment, equity, social justice)

Assessment

Pla

nn

ing

Implementation

Eva

luat

ion

micro - macro

Health Promotion Socio-ecological Model (Ottawa Charter, WHO, 1986)

The process of enabling people to increase control over their health and the determinants of health

Development of a Suite of New Strategies for Health Promotion

• 1970’s - tackling preventable diseases and risk behaviours - information and education

• 1980’s - integrated intervention approaches - Ottawa Charter actions

• 1990’s the settings approach - reaching people through the settings where they live, work, play and love - homes, schools, communities, workplaces

• 2000’s - addressing the social determinants of health and health inequities (WHO ‘Closing the Gap in a Generation’ 2008 report)

• 2010 -> all of government approach ‘Health in all Policies (HiAP)’(WHO, 2013)

Policy Frameworks

• The Helsinki Statement on Health in All Policies (HiAP) (WHO, 2013) & Framework for Country Action (WHO, 2014)“HiAP is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity”

accountability of policymakers for health impacts at all levels of policy-making

• WHO European Strategy Health 2020 – Leadership for Health and Wellbeing in 21st Century Europe

a whole of government and a whole of society approach

Policy Frameworks

A whole-of-government approach

• Positioning of health and wellbeing in the political, economic and social sphere

• Governance for health and wellbeing – priority for more than the health sector - education, welfare, transport, agriculture, environment, housing, employment, finance

• Policy coherence - cross-sectoral responsibility for health equity and wellbeing

• Addressing the social determinants of health and tackling health inequities

intersectoral action, participatory policy processes, leadership

Policy Frameworks

Whole-of-society approach

• Citizen empowerment - enabling control and agency

• Engaging a wider set of actors and partnerships for intersectoral action on promoting population health - education, welfare, arts and culture, sports, environment, urban design, local authorities, media, economic and social policy

• Wider public engagement - focus on wellbeing - flourishing society -> promotion of social inclusion and cohesion,

reducing poverty and inequity

participation of all of government and the wider community in creating the conditions for population health and wellbeing

Unlocking the potential in other sectors

Media Media

Child and family support services Child and family support services

Housing & Planning

Housing & Planning

Urban design and

regeneration

Urban design and

regeneration

WelfareWelfare

Community sector

Community sector

Primary Care Services

Primary Care Services

Financial sector

Financial sector

Local AuthoritiesLocal Authorities

Social InclusionSocial Inclusion

Media Media

JusticeJustice

Employment sector

Employment sector

HealthcareHealthcarePre-school educationPre-school education

EnvironmentEnvironment

Education sector

Education sector

Arts & CultureArts & Culture

SportsSports

Example: Use of Policy Mechanisms for Health Promotion

• WHO Framework Convention on Tobacco Control (WHO FCTC) 2003 – into force in 2005– first international legal instrument for public health– asserts the right of governments to protect public health– global regulatory framework for implementing public health measures

• Range of innovative strategies for addresing tobacco control – supply, demand and harm reduction strategies– Treaty has been followed by legislative mechanisms at local, national

and regional levels (EU revised Tobacco Products Directives, 2014)– tobacco labelling and packaging, ingredients and emissions, security

features and cross-border sales -> tobacco free societies

Example: Use of Policy Mechanisms for Health Promotion

• WHO FCTC – new phase in global health policy • recognition that many of the determinants of health and health

inequities lie outside the health sector• need for policies across sectors for population health gain and the

reduction of health inequities

• Action on health inequity and the social determinants of health• WHO CSDH, 2008; Rio Political Declaration on Social Determinants of

Health, 2011• Political Declaration on the Prevention and Control of NCDs (UN, 2011)

and the WHO Global NCD Action Plan 2013-2020

• An integrated policy approach – integral to effective action for health promotion

• Health in all Policies approach • new entry points and innovative strategies for health promotion• potential application across a broad range of areas

•

WHO Global Mental Health Policy Framework

Mental Health Action Plan 2013-2020 (WHO, 2013)“The essential role of mental health in achieving health for all”

• comprehensive strategies for promotion, prevention, treatment and recovery in a whole-of-government approach

• to protect and promote the mental well-being of all citizens

• responsibility extends across all sectors and all government departments

mainstreaming mental health into health, poverty reduction, development and social policies, strategies and interventions

WHO & Calouste Gulbenkian Foundation (2014) Social Determinants of Mental Health

“Mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live”

• calls for actions to improve the conditions of daily life

• whole of society approach – comprehensive and universal actions across the life course, multiple sectors and levels

policy making at all levels of governance and across sectors can make a positive difference to mental health outcomes

Example: Mental Health Promotion

• Adopting a health promotion approach - broadens our concept and understanding of mental health and how it can be promoted

• Focus on positive mental health (flourishing) and enhancing the strengths and competencies of individuals, communities and society

• Mental health promotion as integral to population health and wellbeing and the social and economic prosperity of society (WHO, 2005; UK Foresight Project 2008)

• Mental health is created in the settings where people live their lives – homes, schools, workplaces, communities

Implementing Mental Health Promotion

• Working across sectors to implement mental health promotion actions

• Strengthening individuals, families, communities and removing structural barriers to good mental health -> creating a mentally healthy society

• Ensure access to resources and life opportunitieso supportive relationships, education, employment, income,

housing, social inclusiono addressing social inequity, injustice, poverty, stigma and

discrimination that deny access to life opportunities

a shared responsibility across whole of government and whole of society

Implementing Mental Health Promotion

• WHO Evidence Brief on Implementation of Global Mental Health Action Plan in the Eastern Mediterranean RegionPromotion of Mental Health and Primary Prevention of Mental Disorders: Priorities for Implementation (Barry & Petersen, 2014)

• Barry, Clarke, Jenkins & Patel, V. (2013) A systematic review of the effectiveness of mental health promotion interventions

for young people in low and middle income countries. BMC Public Health, 13:835

• Barry, M. M. and Jenkins, R. (2007) Implementing Mental Health Promotion. Elsevier, Oxford

Health Promotion Structures

Structures to support multisectoral policy development and implementation

• political mandate for cross-sectoral action• common governance structure – accountability • operational structures - effective delivery mechanisms• infrastructure, resources, leadership, expertise, workforce

development

• Resourcing the delivery of integrated multilevel strategies addressing the determinants of health• dedicated budgets and capacity development• focus efforts where they can reap the largest health and social

gains

Health Promotion Implementation Systems & Frameworks

• Implementation infrastructure and support systemsfor multisectoral action

• Mainstreaming sustainable health promotion policies and practices into standard support and service delivery

• Delivery mechanisms - based on collaboration and partnerships

• Invest in the organizational capacity and human resources to achieve priority actions and outcomes

strengthening frameworks and capacity for effective

implementation within changing policy and political environments

Research & Evidence Base for Action

• Solid case for investing in health promotion

• Knowledge base on effective programmes and policies• robust evidence base to guide best practice• growing research and practice base of effective implementation

• Multisectoral Action• shift in focus from discrete programmes to multisectoral actions and

interventions effecting systems change at a population level

• Translational research – bridging the research, policy and practice divide

Health Promotion Capacity Development

• Aligning capacity to deliver on health in all policies– organizational and workforce capacity

• Policy and decision-makers – engage in multisectoral policy analysis, development and implementation

• Organizational capacity – intersectoral action and systems level change

• Workforce capacity - base of multidisciplinary knowledge, research, skills and values - working in partnership with other sectors to effect systems change- mobilising public engagement

Health Promotion Capacity Development

• Need for a coherent European approach - aligning resources and capacity to the delivery of health goals in Europe

• Capacity for effective implementation - skills of partnership working, cross-sectoral collaboration, leadership, advocacy, communication, implementation and research

• Multi-skilled workforce to adress complex health challenges

• The necessary knowledge, skills and abilites in translating policy, theory and research into effective action

intersectoral working and partnership skills

• Barry, M M; Battel-Kirk, B; Davison, H; Dempsey, C; Parish, R; Schipperen, M; Speller, V; Zanden, van der, G; Zilnyk, A. (2012) The CompHP Project Handbooks. International Union for Health Promotion and Education (IUHPE), Paris

• Barry, M.M., Battel-Kirk, B. and Dempsey, C. (2012) The CompHP Core Competencies Framework for Health Promotion in Europe. Health Education & Behavior, 39(6): 648-662.

• Battle-Kirk, B., Barry, M.M., van der Zanden, Contu, P., Gallardo, C., Martinez., Speller, V., Debenedetti, S. (2014) Operationalising and piloting the IUHPE European accreditation system for health promotion (2014) Global Health Promotion, doi: 10.1177/1757975914545386

• Further details available at: http://www.iuhpe.org/index.php/en/the-accreditation-system

Innovation in Health Promotion

• Addressing complex health and social challenges– innovative approaches to achieve dynamic change in complex

systems

• Implementation and systems change– systems transformation for enduring change

• Complexity of social interventions - dynamic change in multilevel systems

– skilled practice operating across multiple levels– research approaches that can capture systems change– process of change is not linear

• Support for transdisciplinary research

Innovation in Health Promotion

Innovative policy systems, implementation structures and new research and practice paradigms

• Population level actions• Cross-sectoral planning, delivery and evaluation

• Create and explore new perspectives, methodologies and strategies for innovative Health Promotion that addresses current and future health challenges

Innovative & Sustainable Actionensuring that the conditions that create and promote population health and

wellbeing are accessible to all

structures

systems

research

practice