User manual | Page 1 of 14 First Global Ministerial Conference on Healthy

First Global Ministerial Conference on Healthy Lifestyles and
Noncommunicable Disease Control
(Moscow, 28-29 April 2011)
DISCUSSION PAPER
INTERSECTORAL ACTION ON HEALTH:
A PATH FOR POLICY-MAKERS TO IMPLEMENT EFFECTIVE AND
SUSTAINABALE INTERSECTORAL ACTION ON HEALTH
What is this document about?
The need to involve many other sectors of society in addition to health in the struggle for a
healthier society has been a long-held concern of WHO. WHO’s recommendations to address
specific issues usually emphasize the role of a wide range of players beyond the health sector.
Recognizing the complex network of determinants of health demands such an approach. After a
series of consultations, including a review of experiences worldwide, this document summarizes a
set of recommendations, lessons and approaches to intersectoral action on health as an overall
strategy for public policy. The document presents a series of steps which policy-makers can take
to promote multi-sector health initiatives, illustrated by six examples.
This is by no means a “one size fits all” approach, but a sharing of lessons and an encouragement
to policy-makers and advocates at all levels of government to move towards intersectoral action
to positively impact on population health and health equity.
Background
Health and quality of life of individuals and populations are determined by a complex net of
interrelated factors. These factors cover the broader determinants of health including social,
environmental, and economic determinants. Such complexity means that measures to promote
and protect health and well-being cannot be confined to the health sector alone. Designing and
implementing public policies that improve quality of life require the active involvement and
engagement of other sectors of society in all steps of the process. In most countries of the world
new health challenges are constantly arising. Combined with the added complexity of rapidly
growing urban settings, the need for the engagement of other sectors is ever-growing. This
generates a need for relevant tools and practical examples of how the health sector can
successfully engage with other sectors.
Working together across sectors to improve health and influence its determinants is often
referred to as Intersectoral Action on Health. The objective is to achieve greater awareness of the
health and health equity consequences of policy decisions and organizational practice in different
sectors and thereby move in the direction of healthy public policy and practice across sectors.
Although the health sector can be the central player, this is not always necessary. For instance,
the police and transport sectors might combine to take action to reduce road transport injuries, a
public health objective, without direct involvement from the health sector.
Page 1 of 14
Despite a wealth of literature on intersectoral action, from the well-known Alma Ata Declaration
(1978) to the Adelaide Declaration (2010), successful and sustainable initiatives in this area
remain a challenge for cities and countries. Based on analysis of international experiences and a
series of expert consultations hosted by WHO (Kobe, June 2009; Helsinki, September 2010; and
Global Forum on Urbanization and Health in Kobe, November 2010) with academics and
policy-makers, this document aims to present in plain language some simple steps which policymakers can take to more systematically work across sectors to improve the health and health
equity of their citizens.
Approaches to intersectoral action in health
Many approaches to implementing intersectoral action on health exist and deciding on the scale
of intersectoral action and the most appropriate method depends on the context. However, two
overall strategies for intersectoral action can be described.
- One general strategy is to aim to integrate a systematic consideration of health concerns into
all other sectors’ routine policy processes, and identify approaches and opportunities to
promote better quality of life. This approach has been disseminated by the Finnish
government as “Health in All Policies” based on its well-documented experience.
- An alternative approach to the ambitious goal of formally including health in all national
policies is a more issue-centred and narrower strategy. Here the goal is to integrate a specific
health concern into other relevant sectors’ policies, programmes and activities. Widespread
adoption of the WHO Framework Convention of Tobacco Control has made tobacco
control an excellent example of this strategy (see Box #2).
Regardless of the approach, all strategies to implement intersectoral action should consider three
cross-cutting issues fundamental to any public policy.
- First, intersectoral action depends highly on the context – political, economic, and cultural –
and it is also affected by the characteristics of the targeted issue.
- Second, political will and commitment from all levels of government and all sectors is
required to allow a shared policy framework for concrete actions and policies to be
established and applied.
- Third, the establishment and reinforcement of accountability mechanisms which can be used
to evaluate the overall health-related performance of the sector policy.
Moreover, the political context, including moments of political and economic opportunity,
transition and crisis can provide opportunities for promoting ISA as an effective way to address
problems. This includes the role of the media as an effective tool for gaining the attention of
political leaders as well as the public, as well as taking advantage of internationally-adopted social
and developmental goals that can promote cross-sector action at the national level. For instance,
the Millennium Development Goals (MDGs) are an outstanding opportunity in that sense.
Steps to implement intersectoral action on health
There are a series of steps that can be taken to initiate and succeed with intersectoral action on
health. The ten steps described below are relevant to both an issue-centred approach to
implementing intersectoral action on health and to a general strategy of achieving health in all
Page 2 of 14
policies. The steps should not be seen as linear, but form part of a continuous cycle of learning
for improvement, and need to be adapted to every different context.
The roadmap proposed is primarily directed towards national level but may also be applied at
regional and municipal level. The uniqueness of each level of government must however be taken
into consideration and the steps adapted to the specific opportunities and barriers of the setting.
The role of the mayor, for example, may be a key opportunity for intersectoral action which
should be taken into account. In all circumstances it is essential to consider the role of each level
of government with regards to jurisdiction and the establishment of responsibilities, based on the
capacity of each level.
1.
Self-assessment
Assess the health sector’s capabilities, readiness, existing relationships with relevant
sectors and participation in relevant intergovernmental bodies.
Strengthen the institution by improving staff capacity to interact with other sectors (e.g.
public health expertise, overall understanding of public policies, politics, economics,
human rights expertise), to effectively address and communicate potential co-benefits and
to contribute to the debate with other sectors on health issues associated with policies not
specifically targeting health.
2.
Assessment and engagement of other sectors
Achieve a better understanding of other sectors, their policies, goals, language, values, and
priorities, and establish links and means of communication with them and assess their
relevance to the established health priorities.
Use Health Impact Assessment (HIA) as a tool to identify:
- potential (positive and negative) health impacts of other sectors’ policies;
- actions that can enhance positive impacts and reduce risks; and
- the roles and responsibilities of other sectors in achieving healthy policies.
Conduct a stakeholder and sector analysis. Identify opportunities and potential
governance structures to engage other sectors, and acknowledge the complexity of the
policy environment and health determinants. Explain to other sectors the health sector’s
interest in their involvement and vice versa.
Identify existing intersectoral bodies, laws, mandates for intersectoral action and public
health, executive orders, constitutional mandates, and human rights instruments that can
support intersectoral actions.
Set a regular/periodic mechanism to maintain and strengthen the intersectoral
engagement.
Page 3 of 14
Participate in activities led by other sectors or at least take advantage of them. Be
responsive to other sector-led opportunities, since they could provide potential windows
of opportunities for cross-sectoral activity.
Be alert to moments of political and economic change, transition, and crisis that can
provide opportunities for promoting intersectoral actions as an effective way to address
problems.
Establishing a common information system with sector-specific data accessible to
multiple sectors can be a tool to shed light on opportunities for intersectoral action and
increase accountability by enabling analysis of policies and monitoring of outcomes.
Existing data and information systems should be used and built on if available.
3.
Analyse the area of concern
Define the area of concern and the intervention needed in terms of determinants of
health and a cross-sectoral approach, and analyse the context with regards to available
mechanisms, opportunities, interests, and politics.
Present sector-specific disaggregated data focusing on the impact on other sectors and
analyse the feasibility of the intervention.
Build your case using disaggregated data to describe how policies in the sector of interest
affect health, making clear the mechanisms that lead to health impacts (e.g. occupational
risks, pollution, employment, health care costs, and transportation time) including health
equity. Establish a systematic way to review the implications of specific policies and
actions, and propose ways these can be changed to promote health co-benefits. Use data
to highlight potential co-benefits.
4.
Select an engagement approach
Gauge the intensity of engagement with other sectors in terms of health impact, health
priorities, overall public policy priorities, common interests, and the strategic relevance of
the relationship with the sector. There are three general approaches:
- Issue approach: identify sector policies that have a major impact on public health
priorities (e.g. policies that can reduce cardiovascular diseases).
- Sector approach: Identify the sectors with policies that are most likely to impact
health (and contribute to public health gain).
- Opportunistic approach: Select issues, policies or sectoral alliances based on the
objective of early impact on health and early success for all involved parties.
5.
Develop an engagement strategy and policy
After defining and analysing the problem and selecting an engagement approach, develop
a strategy to involve the relevant sectors. The strategy should consider adequate longterm commitment, time allocation, supporting champions with tools and guidance,
Page 4 of 14
establishing common points of interest and concern with the other sector, and identify
strategies that are agreeable to all parties.
6.
Use a framework to foster common understanding between sectors
A key factor for successful intersectoral action is the ability to identify a common
understanding of the key issues and required actions to address them. This can be aided
through the use of a common framework to facilitate the same understanding of the
causal pathways and key intervention points (e.g. the Commission on Social
Determinants of Health conceptual framework emphasizing the production of health
inequities, or the Dahlgren and Whitehead framework which is widely used in Health
Impact Assessments). An essential aspect of such a framework is that it takes a broad
view of health and the various health determinants and includes specific reference to
health inequities. A framework helps facilitate discussions with other sectors, inform the
selection of interventions and ensure a common plan of action that has measurable ways
of assessing the intervention’s design, implementation and evaluation.
7.
Strengthen governance structures, political will and accountability mechanisms
Based on an analysis of the political context, and expected support and opposition from
different stakeholders, assess the political route required to adopt the policy. The
strategies and actions depend on the context for the specific issue that is being promoted;
therefore the political alternatives are very diverse (e.g. partisan agreement, grassroots
involvement, media campaign, involvement of expert bodies, etc.).
Existing or new governance structures are tools to ensure successful intersectoral action.
Examples from different places illustrate the wide scope of such structures: a) national
constitutions (Brazil, Ecuador); b) presidential mandate (Philippines); c) adoption of new
laws (see Finnish law for advisory board on public health); d) planning mechanisms
(Finland, Denmark); e) compulsory reporting (Finnish law); f) human rights
accountability (Brazil, right to food); g) shared budgets; and international agreements
(such as the FCTC).
Develop accountability mechanisms using mechanisms such as access to information,
public participation, disclosure, grievance and ombudsperson functions, such as those
used in existing accountability frameworks, including those developed for corruption and
environmental justice.
Take advantage of the human rights treaties and reporting mechanisms mandated by
international agreements to integrate health determinants across sectors, e.g. intersectoral
reporting by relevant committees (usually led by foreign ministries). It can also provide
insight into the selection of priorities. Examples of relevant treaties are: the right to
adequate food, Art. 11 ICESCR; freedom of information, Art. 19 ICCPR; and children’s
rights, in particular Art. 17 and 36 of CRC.
Page 5 of 14
8.
Enhance community participation
Enhance community participation throughout the policy development and
implementation process through:
- Public consultation/hearings processes, citizen juries
- Disseminating information using mass media
- Web-based tools
- Facilitating the involvement of NGOs from different sectors in the policy-making
process.
Effective public engagement requires more than a one-off effort during the policy design
phase. Adequate and continuous disclosure of information and the creation of feedback
channels to convey concerns and potential grievances once the policy has been
implemented are essential in sustaining community participation and ensuring
accountability for actions taken.
9.
Choose other good practices to foster intersectoral action
Join other sectors in establishing common policies/programmes/initiatives with joint
reporting on implementation (e.g. compliance with human rights standards), explicit
principles to be followed such as transparency, stakeholder participation, and with
common targets.
Be an agent in other sectors’ policies/programmes/initiatives, and invite other sectors to
be an agent in yours, preferably with involvement at the earliest stages of the policy
development process.
Provide expertise required by other sectors (e.g. policies on indigenous people, migration,
health care, health economics, health determinants or social inequalities).
Provide tools and techniques to include health in the policies of other sectors and to
address health inequalities/inequities (e.g. Health Impact Assessment, Urban HEART,
economic analysis, data disaggregated by gender, class, ethnicity, participatory research,
and qualitative analysis).
Allocate available resources to contribute to other sectors’ policy implementation and
share lessons in terms of successful implementation of policies in similar contexts.
Use each sector’s regulatory capabilities to have an impact on health or to accomplish
other common or public objectives.
10.
Monitor and evaluate
Follow closely the implementation of intersectoral action through monitoring and
evaluation processes to determine the progress in achieving planned outcomes. This is a
process that requires continuous learning for reinforcement of good practices and
Page 6 of 14
learning from failures. Report regularly on the development of policies that protect and
promote health, and on the health impacts of policies in key sectors.
Example 1 of intersectoral action: Viet Nam's national mandatory helmet law
Motorcycle helmets are a well-documented public health and road safety intervention. With its
multisectoral approach, Viet Nam provides an excellent example of how intersectoral action can
help save lives and improve health.
Road traffic injury in Viet Nam is a leading cause of death and disability. Statistics from 2008
show that an estimated 60% of all road traffic fatalities were associated with motorcycle riders
and passengers. A motorcycle helmet law has been in place since 1995, but low penalties and
limited enforcement coverage made it largely ineffective.
Advocacy for a universal mandatory helmet law has been a long-term objective for many
international agencies and NGOs in Viet Nam. In 1997, a multidisciplinary council named the
National Traffic Safety Committee (NTSC) with representatives from 15 ministries and agencies
including transport, police, health and education was established. The NTSC has led the
development and implementation of the national helmet law. Each of Viet Nam's 64 provinces
has replicated the national model in the form of a provincial traffic safety committee (TSC). As a
whole, the NTSC was responsible for obtaining the clearance of the Government on the details
of the helmet law and associated implementation action plan, collaborating and consulting with
the provincial TSC network to ensure nationwide implementation and for reporting on
implementation progress and any barriers to the Prime Minister. The terms of reference of the
NTSC include promotion of international cooperation for road safety, to which end the NTSC
has established several effective partnerships with international bilateral and multilateral agencies,
NGOs and private companies to streamline international assistance into achieving national road
safety objectives.
In June 2007, a strategy to dramatically strengthen the helmet wearing provisions was passed into
law, requiring from December 2007 all riders and passengers to wear helmets on all roads at all
times. In December 2008, the NTSC reported that more than 1557 lives had been saved and
2495 serious injuries prevented compared to the same time the previous year.
The successful implementation is tribute to the intersectoral collaboration of the NTSC and
serves as an important example of multisectoral collaboration to other countries with a high
burden of road traffic injury and death and with motorcycles as a major form of personal
transport.
Source: WHO country office in Hanoi, Viet Nam, 2010
Example 2 of intersectoral action: WHO Framework Convention on Tobacco Control
Tobacco control requires intersectoral action as it affects several sectors including agriculture, the
tobacco industry, civil society and the health sector. The WHO experience in promoting the
Framework Convention on Tobacco Control shows the importance of intersectoral action in
many different arenas. Below are three examples.
Page 7 of 14
WHO took part in a process that brought together several UN organizations toward a common
objective through the United Nations Ad Hoc Inter‐Agency Task Force on Tobacco Control.
The Task Force was chaired by WHO and joined by 20 UN and non ‐ UN agencies. It
accomplished increased research and knowledge in tobacco economics‐related issues through
studies commissioned by the FAO on tobacco agricultural issues, by the ILO on tobacco
employment, and by the World Bank on issues related to tobacco industry privatization and illicit
trade. The Task Force also led to the adoption of a Resolution by the UN Economic and Social
Council recognizing the contribution of tobacco control to poverty alleviation.
The link between tobacco control and agriculture is another source of successful experience for
an intersectoral approach. Several conflicts arise between agriculture, the tobacco industry and
the health sector when efforts are launched to reduce tobacco consumption. The main concern
for tobacco‐growing countries is job security for tobacco farmers. To deal with this conflict, the
initiative generated communications among several stakeholders, including relevant ministries,
the tobacco industry and the health sector. Civil society played a significant role in supporting the
health ministry efforts to develop a policy. One of the key mechanisms for dealing with this
conflict was to find common ground. Negative impacts from reducing tobacco consumption
should be minimized in order to make the policy acceptable. Alternative employment for tobacco
workers should be developed for the time when the demand for tobacco goes down as a result of
tobacco control.
Third, illicit trade in tobacco products is a problem requiring a domestic and global multisectoral
response and also illustrates the success of the approach. In this case it was a conjunction of
sectoral interests that converged. The Finance Ministry was concerned about decreased revenue
for government programmes (including health); the higher costs of combating organized crime
and corruption also required national budget allocations. And, of course, illicit trade led to higher
direct health costs from higher consumption (especially among the poor and the young),
increasing the health burden. A similar process led to further cooperation with the Ministry of
Finance on taxation for tobacco issues.
Source: WHO, Department of Tobacco Free Initiative, 2010
Example 3 of intersectoral action: Mental health in South Africa
Mental health constitutes an important public health and development issue in South Africa.
Neuropsychiatric conditions rank third in their contribution to the burden of disease in South
Africa and 16.5% of South Africans report having suffered from mental disorders in the last year.
To address the issue, the Mental Health and Poverty Project (MHaPP) led by the University of
Cape Town was established. The aim of the project was to examine mental health policy and
systems in South Africa, with a view to identify key barriers to mental health policy development
and implementation, and steps that can be taken to strengthen the mental health system.
A key finding of the MHaPP was that in order to address mental health issues and to implement
mental health policy and legislation, sectors other than health need to be involved, with clearly
identified roles and responsibilities. The sectors include the South African Police Service, Labour,
Page 8 of 14
Social Development, Housing, Local Government, Sport and Recreation, Transport, Agriculture,
Justice and Constitutional and Education.
Based on a situation analysis, one of the key recommendations from the MHaPP for intersectoral
collaboration was the need to create a Mental Health Directorate within the national Department
of Health to take the lead in collaborating with other sectors regarding the following:
- Establishment of a national intersectoral forum on mental health in South Africa.
- Identification of relevant mental health issues that need to be addressed in the policies and
programmes of various sectors.
- Research to provide evidence on the nature and scope of relevant issues.
- Delineation of departmental responsibilities for different aspects of a service to people with
mental and intellectual disability.
- Technical expertise to improve the inclusion of relevant mental health issues in other sectors’
policies.
- Support in the development of guidelines and protocols for the implementation of mental
health legislation and policy.
In addition to these general recommendations, respondents identified a number of sector-specific
suggestions for intersectoral collaboration.
Source: Mental Health and Poverty Project, WHO, 2008
Example 4 of intersectoral action: Boosting levels of physical activity in Liverpool
Nationally, most people in the United Kingdom are not active enough to benefit their health. In
Liverpool, fewer people are active than the national average. Within disadvantaged parts of the
city, activity levels and broader health indicators are particularly poor. In this context, the
Liverpool Active City strategy was developed in 2005 to increase levels of physical activity within
the city and improve the health and well-being of its population.
The strategy developed by the Liverpool Local Strategic Partnership – a formal intersectoral
partnership of public, private, voluntary and community-sector organizations – aimed to make
more people, more active, more often.
Four key strands have underpinned the Active City agenda. Together these have shaped a series
of integrated actions and involved a wide range of public, private, voluntary and other civil
society partners. The strategy and actions have focused on:
- Increasing the profile of active living in Liverpool.
- Improving the coordination of existing services.
- Ensuring access to appropriate activities for all.
- Ensuring structural support for physical activity and integrating with wider urban agendas.
Survey data from the Sport England Active People Survey have shown that the physical activity
level in Liverpool has increased since the onset of the Liverpool Active City programme. Data
suggests that activity levels in Liverpool have outpaced improvements at national level. Equally,
Page 9 of 14
targeting resources to areas of need has led to the greatest improvements within the areas with
the worst health indicators.
Source: John Dawson Associates, 2010
Example 5 of intersectoral action: the oil and gas sector in Ghana
The Ghana Health Service (GHS), with technical support from WHO, is leading the
development of a sector-based health management plan for the oil and gas industry that is rapidly
developing in Ghana. As a first step, the GHS, in partnership with the Environmental Protection
Agency/Ministry of Environment and the Petroleum Directorate of the Ministry of Energy, is
conducting a strategic level health impact assessment (HIA) of their national oil and gas
development plans. The aims of this strategic HIA are to 1) identify the full range of potential
environment and health impacts that could result from the rapid growth of Ghana's oil and gas
industry; 2) establish a comprehensive health baseline against which to monitor and report
changes in population health status and for use in measuring future development outcomes
associated with investments in this sector; 3) define core health systems capacities (and related
resources) needed to anticipate and respond to health issues (e.g. chemical incident and
emergency preparedness and response, occupational health and safety, outbreak response) should
they arise; and 4) establish a master public health action plan for the oil and gas sector which
clearly defines different roles, inputs and responsibilities of relevant sector and industry
stakeholders, and 5) establish a process for continuous engagement and communication with
potentially affected communities.
The health sector on its own cannot address all of the potential drivers of health impacts
associated with the oil and gas extraction plans for Ghana. It has neither the remit nor the
resources to do so. What it can do, however, is to take a lead in identifying both health threats
and opportunities. It can articulate a clear vision and plan, define what each player, be they
government agencies or private sector actors, can do to address the health issues, and provide the
tools and capacity needed to support that process.
As a result of the above process and efforts, the Government of Ghana is revising its
environmental assessment requirements for the oil and gas and mining sectors to include a more
explicit requirement for health impact assessment. This will result in the more systematic
consideration of health as part of all investments in those two sectors.
Source: Dora, C. and M. Pfeiffer (2011) WHO Interventions for Healthy Environments Unit –
on their ongoing technical support to the Ghana Health Service and Environmental Protection
Agency.
Example 6 of intersectoral action: South Australian model on Health-in-all-Policies
Following a series of relationship-building steps and catalytic events that made the case for
greater integration of health considerations for development and well-being, the South Australia
Government endorsed the application of an Health-in-All-Policies (HiAP) approach to the South
Australian Strategic Plan (a development plan). The Department of Health and the Department
of the Premier (head of government) then worked together to develop an approach to support
Page 10 of 14
the implementation of HiAP. It provides an example of a type of central governance structure
that supports intersectoral action.
It is widely acknowledged that an important feature of successful intersectoral work is to establish
clear governance arrangements and accountability structures that cut across all sectors of
government and create joint responsibility. In South Australia four critical elements have helped
HiAP’s early success, of which two relate to governance initiatives.
Firstly, the Strategic Plan provided an important cross-government mandate. Development
frameworks are important for all South Australia Government departments, as they are required
to achieve and report on the targets relating to their portfolio and department. Chief Executives
are responsible to the Premier for achievement of the targets. By linking HiAP to the plan, HiAP
benefits from the cross-government commitment already established to deliver on its targets and
provide the legitimacy or mandate for HiAP.
A second critical governance area is leadership. The Strategic Plan is overseen by the Executive
Committee of Cabinet (ExComm), which is chaired by the Premier and includes the Treasurer,
three other Ministers and the chairs of the government’s two most powerful advisory bodies –
the Economic Development Board and the Social Inclusion Board. ExComm serves as a
strategic policy committee of Cabinet and, among other things, undertakes annual appraisals of
Chief Executives’ performance against the plan and other whole-of-government objectives.
ExComm charged the Executive Committee of Cabinet’s Chief Executive Group (ExComm
CEG) with overseeing the development, implementation and evaluation of HiAP across
government. This group also oversees the implementation of the plan on behalf of ExComm. A
small but dedicated strategic HiAP Unit within the Department of Health supported the actual
operational work. Together with the governance structures, health outlined a clear priority-setting
process to identify which areas of the Strategic Plan would undertake Health in All Policies work.
In this way, an incremental process that was reasonable within resource envelopes was achieved.
For more information on the implementation process and the overall model, please refer to the
detailed case study at the reference provided below.
Source: Extracted from: The South Australian approach to Health in All Policies: background
and practical guide, Government of South Australia, 2010.
Key lessons learned on intersectoral action on health
1.
Use already identified and prioritized public health issues, generated through analysis of
determinants of health and policy trends, to create political opportunities for promoting ISA.
2.
A supportive governance structure with the concurrence of multiple levels of government
and a shared policy framework will help to sustain efforts and ensure integration of strategies and
actions towards a common end.
3.
A capable and accountable health sector is vital to promote and support intersectoral
action. The health sector should facilitate the process as appropriate, ensure the early
involvement of other policy sectors in the policy-making process and be flexible to adapt its role
at various stages in the implementation of ISA.
Page 11 of 14
4.
Establishing a common information system with sector-specific data can shed light on
opportunities for intersectoral action and increase accountability by enabling analysis of policies
and monitoring of outcomes. Existing data and information systems should be used and built on
if available.
5.
Policies selected for implementation through intersectoral mechanisms need to be robust,
feasible, based on the evidence, oriented towards outcomes, applied systematically, sustainable,
and appropriately resourced.
6.
Community participation and empowerment in the process of policy-making, from the
initial stage of assessment to evaluation of the intervention and monitoring of outcomes, are
critical to focus attention on the needs of the people.
7.
MDGs as a mechanism to promote intersectoral action with a special focus on the impact
of determinants of health and health equity can be useful tool in increasing the accountability of
other sectors for health outcomes.
8.
Context-appropriate application of Health Impact Assessment can help to promote
intersectoral action for health. The potential of integrated impact assessments should be
considered.
9.
A human rights-based approach can help address the underlying social and environmental
determinants of health and the need for multi-sector involvement.
10.
Assessment, monitoring, evaluation, and reporting are required throughout the whole
process. Proper assessment of the problem, its determinants and social, political and cultural
context are crucial to frame the issue and benefits to various sectors. Regular monitoring and
evaluation of health impacts is required to maintain focus on outcomes and identify the strengths
and weakness of interventions.
References and further reading
WHO Health Impact Assessment website - www.who.int/hia/en
WHO. Managing the public health impacts of natural resource extraction activities – a framework
for national and local health authorities. World Health Organization (forthcoming in spring 2011)
WHO. Community health and development finance - Six key entry points to identify and address
community health and safety issues within bank environmental and social safeguard systems.
World Health Organization (forthcoming in spring 2011)
Co-Benefits Hub Asia. Synthesis of co-benefits discussions at the Better Air Quality Conference.
2006.
Page 12 of 14
WHO Commission on Social Determinants of Health. Closing the gap in a generation: Health
equity through action on the social determinants of health. Geneva: World Health Organization,
2008.
European Observatory on Health Systems and Policies. Health in All Policies. Prospects and
potentials. Finland Ministry of Social Affairs and Welfare, 2006
Public Health Agency of Canada (PHAC) & WHO. Health equity through intersectoral action: an
analysis of 18 country case studies. Ottawa: PHAC & WHO, 2008.
WHO. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata,
USSR, 6-12 September 1978.
WHO. Intersectoral Action for Health: A Conference for Health-for-All in the Twenty-First
Century. Halifax, Nova Scotia, Canada, 22-23 April 1997.
WHO. Health Equity in All Urban Policies: A report on the Expert Consultation on Intersectoral
Action (ISA) in the Prevention of noncommunicable Conditions, 22–24 June 2009, Kobe, Japan.
WHO. The World Health Report 2008. Primary health care: Now more than ever. World Health
Organization, 2009.
WHO. Intersectoral Action on Health: Impact on noncommunicable diseases through diet and
physical activity Report of an Expert Consultation, 6–7 September 2010 Helsinki, Finland.
WHO. Adelaide Statement on Health in All Policies: moving towards a shared governance for
health and well-being. World Health Organization, 2010
WHO & UN-Habitat. Hidden cities. Unmasking and overcoming health inequities in urban
settings. World Health Organization, 2010.
Acknowledgements
This discussion paper does not represent an official position of the World Health Organization.
It is a tool to explore the views of interested parties on the subject matter. References to
international partners are suggestions only and do not constitute or imply any endorsement
whatsoever of this discussion paper.
The World Health Organization does not warrant that the information contained in this
discussion paper is complete and correct and shall not be liable for any damages incurred as a
result of its use.
The designations employed and the presentation of the material in this discussion paper do not
imply the expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area of its authorities, or concerning
the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate
border lines for which there may not yet be full agreement.
Page 13 of 14
The mention of specific companies or of certain manufacturers' products does not imply that
they are endorsed or recommended by the World Health Organization in preference to others of
a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary
products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the
information contained in this discussion paper. However, this discussion paper is being
distributed without warranty of any kind, either expressed or implied. The responsibility for the
interpretation and use of the presentation lies with the reader. In no event shall the World
Health Organization be liable for damages arising from its use.
Unless specified otherwise, the data contained in this discussion paper is based on the 2004
update on the 'Global burden of disease'. Additional information is available at
www.who.int/research.
© World Health Organization, 2011. All rights reserved.
The following copy right notice applies: www.who.int/about/copyright
Page 14 of 14

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project