Could you please provide us with a definition of a life-course approach, and an example of a policy that represents a good practice in this field? In addition, what would be an example of a policy that does not apply the life-course approach?
The life-course approach requires a focus on acting early, on having a healthy start, acting on time and acting together. One example on how not to apply the life-course approach is the ‘silo design’: policies that do not look at the complexity and interconnectedness between different areas are going in the wrong direction.
There are many good examples of how to apply the life-course approach in Europe, and these include national policies addressing different cohorts and different needs. They also look at different moments in life and how these moments accumulate in terms of health over time. Tailored and differentiated policies on employment, for example, are becoming more and more common in our countries. These are signs of the transition from a silo to a more comprehensive approach.
Moving on to intersectoral action for health, could you give us an example of a policy in Europe that integrates and facilitates cross-sectoral cooperation and helps bringing down the ‘silos’?
In relation to the life-course approach, the idea is that if your objective is to reduce inequalities, you need to start with children. We have to start early and we need a policy mix. One policy is not enough. The mix of policies is important. I will give you an example. We want to improve antenatal and child health, meaning lower mortality figures, but also better physical and cognitive development. What is the mix of policies and interventions that we need to achieve this? Parental skills, education, literacy skills, vaccination services, mental health services… just to name a few. Not all of them are health domains, but they are all fundamentally important to reach good health outcomes. This is an example of intersectoral action for health, of bringing stakeholders together for a system-approach to health.
WHO Europe is organising an upcoming meeting on intersectoral action for health, looking specifically at the health, education and social sectors, which will take place in Paris, France, on 7-8 December. What are the expected outcomes of this meeting?
I think it is important to understand that we are talking about a process. This process started with the European health policy framework – Health 2020, and it has been influenced by the adoption of the Sustainable Development Goals (SDG) Agenda in New York. For the first time in Paris, we are trying to reach out to two “sister” sectors – the education and social sectors – to agree on common objectives, which cannot be achieved unless we work together. The focus of the Paris meeting is to agree on a transformative agenda. In some aspects, what we are doing now is not working and we want to be better. We have to be transformative and we have to lead by example. We are big enough to make a difference and we can really be a good example if we move towards a system-approach also within our organisation.
There are three expected outcomes from the Paris meeting, which we would like Member States to commit to:
- The identification of common areas for policy action between the health, education and social sectors.
- The identification of joint approaches and concrete actions to promote health and social literacy.
- The identification of approaches to strengthening intersectoral work between the health, education and social sectors, at different levels of government.
When tackling health inequalities in the EU, are our policies sound enough? Do we evaluate them properly? What can we do more or better?
Nowadays it is very clear to all stakeholders that a reduction in health inequalities will not be achieved unless it has been planned properly in advance. In other words, we now know very well that if we do not address inequalities explicitly throughout the policy making process, we will not reduce them. If policies have equity as an outcome, they need to have equity as an input into the process too. Many countries are specifically targeting the health of migrants and other groups at risks of marginalisation, as well as gender gaps. These practices are going in the right direction. The European health policy framework, Health2020, explicitly calls for a focus on two components: the reduction of health inequalities and the strengthening of governance for health. Around two-thirds of the countries in the European Region – composed of 53 Member States – have adopted national policies which are aligned with the objectives of Health2020 and address explicitly the issue of health inequalities.
What is the relationship between policy making and governance?
You cannot have one without the other. When designing policies you need to have governance mechanisms in mind. Frankly speaking, governance will almost always be context-dependent and will differ from country to country.
One last word dedicated to Young Gasteiners?
You are the ones that in 15-20 years will make the decisions for us. Have faith and ambition towards a bright future that looks interdisciplinary, complex, and nothing like what we can foresee now!
This interview was conducted at the EHFG Conference 2016 by the Young Gasteiners Alessandra Lafranconi, Damir Ivankovic and Sara Barragán Montes