Congress report - European Health Forum Gastein

Forum I: Health in other Policies and Sectors
Session 3: Measuring progress and impact
This concerned a description of the WHO supported Verona initiative (4), both in the
eponymous region of Italy and adapted in the context of Slovenia, that attempts to take
account of the economic, social and human environment. Verona is a province of 250,000
people in the North east of Italy. Luigi Bertinato indicated that here had not previously been
a tradition of inter-action between the health sector and others. An objective of the project
was to create an arena of debate between various sectors and to compare and discuss
experience of various health issues. It was intended to create a true European multidisciplinary
learning and working environment. For instance three themed meetings between
1998-2000 on macro trends and their relative impact and the positioning of health promotion
for the 21st century were debates, rather than conferences, with an ongoing chat line system.
The concept of investment for health was not new to the Verona initiative but had been
developed over 5-6 years at WHO Copenhagen. It was concerned with planning the political
process for achieving the necessary changes in population health. This included identifying
relevant policy attributes, considering factors that might enhance or inhibit policy change and
identifying what sectors to involve. By contrast with the epidemiological model of study, the
initiative was concerned with the means of implementing their findings. This meant dialogue
on how to choose local partners, how to explain it to these and how to win their
involvement and support. After 3 years of debate the Verona benchmark guidelines were
produced. These included identification of means of monitoring success, adopting a
sustained approach, accountability, and putting an emphasis on high priority for health,
social capital for health and a process of public engagement. This entailed seven system
characteristics that were hallmarks of good practice. Finally he highlighted and discussed
concrete initiatives. The process of discussion meant a completely new health promotion
structure and a new observatory system for the elderly population. The use of an existing
surveillance system, in this case the international HBSC survey (5), highlighted social
variations in health behaviours, directly responsible for persuading politicians to fund a
drugs prevention programme. Challenges include shifting theory to practice, and the need to
introduce a new vision of public health among health professionals themselves.
Moyca Grunter Cinc is under secretary for health in Slovenia. This small country of 1.9
million people has undergone major social, cultural and economic change since its
independence 10 years ago. Not alone do these changes affect health care sector provision,
but also the population health. There have been major changes in health status in Middle
and Eastern Europe in the last decade (6). In 1996 a WHO Euro appraisal was undertaken
and between 1998-2000 they were participants in an adaptation of the Verona initiative.
Slovenia joined pilot in Benchmark 2 at local level. Main aims were to assess the readiness
of administrative areas to implement an investment for health approach and testing an
appropriate needs identification tool. Main lessons learned included the fact that health is
perceived as the responsibility of the traditional health sector, with limited existing
collaboration, a lack of appropriately qualified public health specialists and a lack of formal
organisational structures. This was balanced by willingness for involvement. Since then
developments have included a broadening of the minister for health’s title to include health
care, the establishment of a number of inter-sectoral agencies and the active involvements of
ministry of health in inter-sect oral action. These two examples therefore illustrated that the
shared principles of cross-sectoral collaboration and re-oriented health professional practice
could be applied in two markedly contrasting social and political contexts.
Presentation slides are available for download at the EHFG web-site
http://www.ehfg.org/website01/abstracts.htm
International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein
Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org
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