Tackling-health-inequities-from-concepts-to-practice-The-experience-of-Vastra-Gotaland

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Section 5. DiscussionWhen engaging in smart governance processes that extend over different publicsectors as well as the political sphere and civic society, a lot of time and energywill have to focus on finding tools for cooperation and mutual understanding. Asa summary, some of the possibilities and difficulties encountered are discussed.The concept of health inequalities proved to be a difficult concept to form anetwork of different stakeholders around. Instead social sustainability becamethe common denominator among stakeholders. A number of the workgroupmembers thought it might be difficult to establish their contribution to thenetwork if health inequalities should be the core concept, since the statutesof their organizations did not explicitly deal with health. However, no onefound a similar difficulty with social sustainability. Given that growinghealth inequalities are incompatible with socially sustainable development,the Commission agreed that the core concept of the process should becollaboration for social sustainability. This is an example of the importanceof a common terminology. Finding and agreeing to this language are criticalmeans through which the participants communicate their expectations onthe upcoming process and the preconditions for them to legitimize theirparticipation. This proved to be useful also to link actions against healthinequalities to regional development policies, which often use the rhetoricaround sustainable development as a foundation, thereby enabling acommunicative channel to other actors not yet involved in the process.One main conclusion from reviews and strategies to tackle health inequalitiesis that politicians need to be involved and to be advocates of actions; if healthinequalities are not on the political agenda, no political decisions will bemade to reduce them and, consequently, no action will be taken. But soonenough this endeavour will be challenged. The counterarguments are rarelyabout the intention to reduce unfair health disparities but rather about themeans to get there. This is illustrated in the process when the Action Planwas to be approved within the Regional Executive Board and passed to theRegional Council. Even if the political disagreement was unexpected – theSteering Group had representatives of both the majority and the opposition –and caused a delay, the final decision in the Regional Council would probablynot have been possible without the commitment of the Steering Group.30 Tackling health inequities: from concepts to practice.
© Johan WingborgThe process in Västra Götaland proved in a way to be a compromise: on the onehand, it was judged as necessary to gather participants from politics, practice andtheory (research) around the same table to develop an action plan; on the otherhand, it proved not to be possible to enrol the research community fully intothe process. According to the evaluation, this was the result from the pressure tokeep to the time schedule; it was simply too complex an endeavour to integratethe three perspectives within the given timeframe. Meeting the schedulewas prioritized above including researchers in order to meet expectations atpolitical level and from the workgroup. Instead, the establishment of a platformwhere researchers, politicians and practitioners could meet was identified asa strategic objective to be prioritized and achieved as part of the Action Plan,according to the Regional Council decision.A stronger link to the research community would probably have allowedscientists to present evidenced-based research and practices in Västra Götalandand might have shortened the six-month delay in approving the Action Plan.Instead, information from other reviews, for example the Commission fora Socially Sustainable Malmö (6) and the WHO Commission on SocialDeterminants of Health (3), was collected and translated into a regionalcontext for Västra Götaland and presented to the politicians by the secretariatsand workgroup, who did not have the same authority as the scientists.Section 5. Discussion31
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Tackling-health-inequities-from-concepts-to-practice-The-experience-of-Vastra-Gotaland

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