Congress report - European Health Forum Gastein

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European Health Forum Gastein 2001
judgment and insight as well as research data and other ‘scientific’ sources and practical,
hands-on experience.
The ideas behind these principles are not new. We intuitively know them to be right. But
very few (if any) countries or regions in Europe systematically apply these principles to
decisions about improving the health of their people.
In order to implement these principles, a strategy is required involving the concerted efforts
of a variety of players at all levels of government and society. As mentioned earlier, the
successful strategy must influence sectors such as health care, social services, education,
environment, and economic and social development. Public and private initiatives, the
media, non-governmental organizations, and all other institutional arrangements crucial to
social cohesion, social justice, and human rights must be involved. (59; 60; 64, 66; 69). With
so many interests visibly involved, the strategy for promoting health has to be intersectoral,
it must involve multiple levels of policy-making in economic and social development (local,
regional, national, and in several instances supranational), and it needs to use a wide range
of levers for change (educational, legislative, fiscal, etc.). To achieve such broad and
encompassing influence over so many sectors of society, those with an interest in the
promotion of health must offer something in return to other interest groups or policy sectors.
The IFH approach attempts to do precisely this. An analysis (IFH appraisal) conducted in
several European countries at the request of their Parliament (including Romania, Slovenia,
Hungary and Malta) indicates clearly that economic regeneration will not be sustainable
unless there are parallel improvements in the health of the population. The initial findings of
the WHO Commission on Health and Macro-Economics (chaired by professor Jeremy Sachs)
substantiate the need to position the promotion of population health at the heart of the
development agenda of countries.
4. Methodologies and practical experiences
We noted earlier that one of the key challenges in applying the concept of IFH in practice
was moving from theory and belief to making decisions and implementing them. This section
summarizes a selection of the tools that have been developed, applied and refined in various
IFH demonstration projects and national IFH appraisals carried out by the WHO Regional
Office for Europe. 9 Through these on the ground experiences it has become clear that to
make IFH a reality requires methodologies, tools and policy-making processes capable of:
• assessing the structures, systems and processes with a country/region or local
area’s current and future opportunities, within and outside the health sector, that
promote or hinder the health of its population and identifying ways in which this
infrastructure can be improved;
• identifying the key elements for a strategy that enhances the population’s health
through selective investment (both within and outside the health sector) while
supporting key economic and social priorities;
• negotiating for investment for better health with policy makers and key decision
takers in other leading social and economic sectors.
It is clear that there is much to be learned regarding the efficacy of health investment
processes. Evaluation of these is made harder by the fact that economic and social
circumstances vary, making transfer and replication difficult (24,25). It is only by testing
things in practice that we can begin to identify and order those variables that contribute to
9 In this process WHO was assisted by a wide range of cooperation with countries and institutions.
Among these it is important to acknowledge the support of the Office for Public Management.
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