Transcript Folie 1

Ottawa – challenges we face
Ilona Kickbusch
Open University London 2006
Kickbusch London 2006
20 Years Ottawa Charter
Towards a new public health……………………..
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Towards a new public health…
We are challenged to develop a public
health approach that responds to the
globalized world and its political, social
and economic ramifications. The challenge
is as large as when public health was first
developed.
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Better population health depends on:
• Making health everybody's business
• Ensuring equity.
• Making the healthy choice the easier
choice
• Ensuring sustainability.
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Expansion processes of the health
society
• the expansion of the do-ability of health:
something can be done, there is always more
health
• the expansion of the territory of health into an
increasing array of personal, social and political
spaces: health is everywhere
• the expansion of risk and reflexivity: every
choice is potentially also a choice for or
against health
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Navigating the health society
In almost every aspect of our
lives we are faced with
questions and decisions about
health.
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But……
UK: One in five people has problems
with the basic skills needed to
understand simple information
that could lead to better health,
15% of adult population have
low health literacy
Canada: 22% of Canadians are
unable to read a medicine label
and calculate amounts of medicine
US Institute of Medicine: 90 MILLION AMERICANS (NEARLY 1 IN 2
ADULTS) DO NOT
UNDERSTAND BASIC HEALTH INFORMATION
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How to create health
Health is created
in the context of
everyday life:
where people
live, love,
work and play.
Ottawa Charter 1986
• Google?shop?travel?
gg
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The new public health:
Health is created
in the context of
everyday life:
where people
live, love,
work and play.
Key components
of change:
Ottawa Charter
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1. Health and longevity drive
society
We need to adapt
health and welfare
Policies to achieve
the „longevity
dividend“
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2. Consumer society: Health as a
global market force
• Commercialization
and Privatization:
health as a product
• Health as a key global
market
• Countries compete on
health
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Increasing number of consumer
products and choices
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Increasing sources of health
information
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Increasing choices in products and
treatments
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Increasing provider choices
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Empowerment in the consumer
society
Citizens have a right to
• health competencies,
• patient competencies,
• consumer competencies,
• citizen competencies
in the context of supportive environments
• Health Literacy is a critical empowerment strategy to increase
people‘s control over their health, their ability to seekout information
and their ability to take responsibility.
• Kickbusch/Maag 2005
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3. The globalizaton of everyday
life drives health
• The global
• The local
• Risks in the 21st
century are
transnational and all
attempts to control
them lead into the
international arena
• Global risk production
is localized through
the “globalization” of
everyday life
• COGNITIVE
• SPATIAL
• TEMPORAL
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Address the trans boundary
scapes of health in a global world
Ideoscapes
Images with political
ideological meanings
Technoscapes
Export of technologies
Ethnoscapes
Flow of people
Mediascapes
Mass media IT marketing
Finanscapes
Global capital transfers
A. Appadurai, New School University, New
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Healthscapes: Food - Drink
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Healthscape: virtual realities
• "The Internet is unlike
anything we've seen
before," says David
Greenfield, PhD, founder
of the
Center for Internet
Studies (www.virtualaddiction.com). "It's a
socially connecting
device that's socially
isolating at the same
time."
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Healthscape Fashion industry
• New Regulations in Madrid:
• A model of 1,76 m. must not
weigh less than 56 Kilogramm.
That is a Body-Mass-Index of
18.0 and is already below the
value assigned to a healthy
body weight.
Naomi Campbell 1,77 m. and
weighs 51 Kilo. That means a
BMI of 16.
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Healthscapes: women’s mobility
Migration and
increased mobility of women
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•
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New slave markets
Forced prostitution
Domestic workers
Health workers
Low paid service work
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4. The policy arenas and actors
shift
• From the ministries of
health to:
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Foreign policy
Security policy
Economic policy
Trade policy
Geopolitics
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Consider the new health actors
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Consider the new health actors
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Consider the new health actors
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Consider the new health actors:
Patient organizations
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Health policy becomes an „open
system“
Health policy in the 21st • Health policy in the
century is
21st century is part of
transnational and
all sectors and
attempts to control
attempts to create
risks by linking the
health through new
local, national and
types of policy
the global policy
networks
arenas
Healthy public policy
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Open systems of
governance
Finnish European Union
Presidency
• Ideally: health agenda owned by
other sectors
• Empowering ministries of health
– Political will
– Governance mechanisms
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Open systems of governance
• National global health
strategies: “to counter
from a national
standpoint, the
threats to global
health”
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Problems which directly or
indirectly threaten populations
Contribution to global problems
Contributions to global solutions
National consensus on principles,
values, intent and directions
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Foreign policy
Security policy
Economic policy
Trade policy
Demographic
Geopolitics
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…..a new global POLITICAL ECOSYSTEM
MSF
CLINTON
BONO
PHA
WEF
World Bank
150 PPPH
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5. The Sustainability Challenge
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„
„Ecological footprint“
of the health system
• What amount of
ressources does it
take to create
health?
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„Ecological footprint“
Costa Rica Schweiz
USA
8 949
34 087
39 901
Life
75
expectancy
78
75
Health
65
expectancy
71
67
(2004 WHO)
GNP p.c.
Health
616
3776
expenditure (7,3%)
(11,5%)
p.c.
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5711
(15,2%)
The new dynamics of health
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Health is a determinant
Health is an investment
Health is a resource
Health is a human right
• We must begin not
end with the
political
and social
determinants of
health
• Health is a driving
force in modern
societies
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Political determinants…..
The deliberation of
What kind of Ministers of
major health issues
Health??????????
and major health
determinants in fora
to which the public
health community has
little or no access –
and is not prepared
for.
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Political advocacy: Have you
voted for health today?
• Public health actors must work
systematically with political decision
makers and parliamentarians at all levels
of governance – national, European and
global.
• Create new types of public health forums
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Health Promotion in a
globalized world
• Healthy public policy
• Supportive
environments
• Community action
• Personal skills
• Reorient health
services
• health as
• a global public good
• a key component of
collective human security
• a key factor of good
global governance
• responsible business
practice and social
responsibility
• global citizenship and
human rights.
Ottawa Charter
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European nations
• should ensure through cooperation a common
high level of health protection and health rights
for all citizens wherever they live, love work and
play (and travel, buy or google)
• from those risks and threats to their health,
safety and well being which are beyond the
control of individuals and communities AND
NATION STATES
• And cannot be effectively tackled by nation
states alone but need to be multiactor and
multilevel (e.g. health threats, unsafe products, unfair
commercial practices).
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The global is here not there.....
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Interdependence
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Global Governance becomes more important
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M
O
H
Regulatory power 1
•
The renewed mandate given to
Member States and WHO under
the IHR(2005) has also increased
their respective roles and
responsibilities. In particular,
States Parties* to the IHR(2005)
are required to develop,
strengthen and maintain core
surveillance and response
capacities to detect, assess, notify
and report public health events to
WHO and respond to public health
risks and public health
emergencies. WHO, in turn, is to
collaborate with States Parties to
evaluate their public health
capacities, facilitate technical
cooperation, logistical support and
the mobilization of financial
resources for building capacity in
surveillance and response.
•
The broadened purpose and
scope of the IHR(2005) are to
"prevent, protect against, control
and provide a public health
response to the international
spread of disease and which avoid
unnecessary interference with
international traffic and trade."
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Regulatory Power 2: Framework Convention
Tobacco Control 27.05.2005
• "The WHO FCTC negotiations
have already unleashed a
process that has resulted in
visible differences at country
level. The success of the WHO
FCTC as a tool for public
health will depend on the
energy and political
commitment that we devote to
implementing it in countries in
the coming years. A successful
result will be global public
health gains for all."
• Dr LEE Jong-wook. DirectorGeneral, World Health
Organization 2006
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Framework Convention Tobacco
Control
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Global developments: Projected prevalence
of obesity in adults by 2025
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Local IMPACT
Cost of the SARS
epidemic to Toronto:
12 000 lost jobs
Cost to the local economy:
over $ 1 billion in 2003
• Asia:
• Cost per person US$ 6 million (60 billion in
costs)
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Accountability to “own”
constituency and global community
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Taxation
• the tax on flights from France is expected to generate
200 million euros a year for an International Drug
Purchase Facility, also known as Unitaid.The fund will be
used to bulk-buy medicines for countries -- mainly in
Africa –
• 19 pays se sont engagés à instaurer une contribution volontaire. 4
pays ont déjà rejoint la France en instaurant une contribution
volontaire : le Chili, la Côte d’Ivoire, le Gabon, Maurice. 12 autres
pays ont engagé des procédures interministérielles ou
parlementaires pour l’adopter.
• Passengers flying out of French airports will pay one
euro in economy class, and 10 euros in business, if their
destination is in the EU. For flights outside Europe, the
surcharges are between four and 40 euros, depending
on the class
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Active citizenship
• Active health citizenship is a critical
empowerment strategy in modern society –
a significant dimension of citizen, consumer
and patient’s rights and dignity –multi level
dimensions
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„Une démarche citoyenne
mondiale“
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