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Emerging solutions to chronic conditions – Practical experiences of intersectoral action for health

Source: TropIKA.net editorial team

Title of presentation: Emerging solutions to chronic conditions – Practical experiences of intersectoral action for health

Date: 17 Nov 2008

Location: Moussa Keïta

Chair: David Butler-Jones, Chief health officer, public health Agency of Canada, Canada

Presenters:

• Lucy Gilson, University of Cape Town; London School of Hygiene & Tropical Medicine – Presentation
• Raúl Mejía, CEDES University of Buenos Aires, Argentina – Presentation
• Robert Geneau, PhD Gayle Fraser, MA Barbara Legowski, B.Sc.Phm., Pharm.D Sylvie Stachenko, MD, M.sc. – Presentation

TropIKA Rapporteurs: Fatou Berthé

Major topics:

• Leveraging inter-sectoral action to address the social determinants of health: view from the health system
• TOBACCO & NCD
• Mobilizing intersectoral action to promote health: the case of ActNow in British Columbia, Canada

Scope: Public health

Overview

The session was about the challenges and opportunities raised by the epidemiological transition to chronic conditions. Discussions focused on the action and research approaches needed to tackle these challenges. Interesting experiences of intersectoral action for health on the different topics have been shared during the session.

Context and issue

Key factors

• Ideological & political context
• Economic environment
• Government structures & decision-making processes
• Electoral cycle

Issues raised, obstacles, difficulties

Issues raised

• Rethinking health systems from a social determinants perspective
• Link between tobacco control and cardiorespiratory disease prevention and management
• Protect babies form preventable brain damage with iodine nutrition

Obstacles/ Difficulties

• Social divisions; State fragility; Low political priority.
• Poor economic growth; Budget cuts
• Short-term political horizons
• Government silos & funding structures National/local disconnect
• Staff turnover Weak skills

New ideas, progress, successes

A continuum of strategies (Sectors working separately but sharing information or coordinating activities <--> Actors contributing meaningful resources towards shared outcomes, with joint planning)

Policies and programmes

Policy instrument/s in place; experience/s derived

WHO FCTC (First global public health treaty Signed by 168 countries, Ratified by 157 countries, Went into force in February 2005)

Operational programmes and projects

• ActNow in British Columbia, Canada

Initiatives on the ground; experience/s derived

• The approach is strategic by delivering an impact on more than one disease.

Lessons learned

In terms of intersectoral action for health, strategies may focus on

• a specific population or health issue;
• working within a defined, local area;
• working incrementally over long time scales
• broad policy frameworks

Findings and conclusions

From formal presentations

Successful intersectoral action requires the sharing of power

Key factors identified above (context, etc) need to be taken into account

From open discussions/debates

• Improvement in how research results are transmitted to policymakers
• Necessity to put emphasis on accountability at all levels.

Identified conclusions

Main points of agreement

Necessity to take into account the context anytime there is need to formulate a policy

Policy aspects/Recommendations

• An integrated approach on the largest scale means simultaneously targeting (multiple) risk factors, underlying determinants of health and opportunities for disease prevention common to major CDs.
• Alliances with committed legislators
• Developing permanent structures rather than project based initiatives
• Central guidance & support for local staff (training, guidance, sharing e-experience), but local level flexibility
• Performance incentives
• Mandatory requirements e.g. for health impact assessments

Focus and priorities for the Bamako Action Plan

Operational aspects/Recommendations

• Dedicated funding programme
• Civil society engagement
• Citizens forums to maintain pressure

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