Non-health Sectors Research Articles

Federal Data for Conducting Patient-centered Outcomes Research on Economic Outcomes.

Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these costs. Although there have been various federal investments into patient-centered outcomes research (PCOR), an assessment of the coverage and gaps in federally funded data for PCOR economic evaluations has not been produced to date. To classify relevant categories of PCOR economic costs, to assess current federally funded data for coverage of these categories, and to identify gaps for future research and collection. A targeted internet search was conducted to identify a list of relevant outcomes and data sources. The study team assessed data sources for coverage of economic outcomes. A technical panel and key informant interviews were used for evaluation and feedback. Four types of formal health care sector costs, 3 types of informal health care sector costs, and 10 types of non-health care sector costs were identified as relevant for PCOR economic evaluations. Twenty-nine federally funded data sources were identified. Most contained elements on formal costs. Data on informal costs (eg, transportation) were less common, and non-health care sector costs (eg, productivity) were the least common. Most data sources were annual, cross-sectional, nationally representative individual-level surveys. The existing federal data infrastructure captures many areas of the economic burden of health and health care, but gaps remain. Research from multiple data sources and potential future integrations may offset gaps in individual data sources. Linkages are promising strategies for future research on patient-centered economic outcomes.

Perceived Barriers of Accessing Healthcare among Migrant Workers in Thailand during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Qualitative Study.

The outbreak of Coronavirus Disease 2019 (COVID-19) has threatened health and well-being in all populations. This impact is also deepening structural inequalities for migrant workers in Thailand. Due to their vulnerability and limited opportunity to access health services, they have greater risks in many health aspects compared to other populations. This qualitative study sought to examine the key health concerns and barriers during the COVID-19 pandemic on healthcare access among migrant workers in Thailand through the lens of policymakers, healthcare professionals, experts on migrant health, and migrant workers. We conducted 17 semi-structured in-depth interviews of stakeholders from health and non-health sectors in Thailand from July to October 2021. The interviews were transcribed and analyzed using both deductive and inductive thematic approaches. Thematic coding was applied. The results showed that financial constraints were a major barrier for healthcare access among migrant workers. These included affordability of healthcare and difficulty accessing funds (migrant health insurance). Structural barriers included some health facilities opening for emergency cases only. Insufficient healthcare resources were profound during the peak of positive cases. Cognitive barriers included negative attitudes and diverse understanding of healthcare rights. Language and communication barriers, and a lack of information also played an important role. Conclusion, our study highlights healthcare access barriers to migrant workers in Thailand during the COVID-19 pandemic. Recommendations for future resolution of these barriers were also proposed.

Healthcare-acquired Sars-Cov-2 infection: A viable legal category?

In the context of the Sars-Cov-2 pandemic, according to the various periods of emergency and the rate of infections, hospitalized subjects also contracted the infection within the ward, sometimes with the development of disease (COVID-19) and sometimes with permanent damage. The authors wondered if Sars-Cov-2 infection should be considered on a par with other infections acquired in the healthcare setting. The non-diversified diffusion between the health and non-health sectors, the ubiquity of the virus and the high contagiousness, together with the factual inability to prevent it by the health structures, despite the adoption of entry control, practices of isolation of positive subjects, and staff surveillance, lead to consider COVID-19 in a different way, in order to otherwise burden health structures in the face of unmanageable risks, clearly also dependent on exogenous and uncontrollable factors. The guarantee of care safety must, in the pandemic, be able to compare with the real capacity for intervention according to the asset of the current health service, requesting State intervention with alternative instruments, such as una tantum compensation, for COVID-19 damage reparation occurred in the health sector.

Guidance for management competency identification and development in the health context: a systematic scoping review

BackgroundUsing management competency-based frameworks to guide developing and delivering training and formal education to managers has been increasingly recognized as a key strategy in building management capacity. Hence, interest in identifying and confirming the competency requirements in various contexts have been witnessed. Therefore, learnings from how competency studies were designed and conducted, how competencies were identified, and strategies in ensuring success in competency identification are of great value to researchers planning and conducting competency studies in their own country.MethodsA scoping review was conducted guided by the Arksey and O’Malley framework and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). All papers that published empirical studies aiming at identifying and assessing manager’s competencies at the peer-reviewed journals were identified from Web of sciences, PubMed, Scopus and Emerald Management between 2000 and 2021. In order to maximize learning, studies focusing on health and non-health sectors are all included.ResultsIn total, 186 studies were included in the review including slightly more than half of the studies conducted in health sector (54.5%). 60% of the studies focused on mid to senior level managers. Surveys and Interviews were the two most commonly used methods either solely or as part of the mix-method in the studies. Half of the studies used mixed methods approach (51.1%). Large proportion of the papers failed to include all information that is necessary to contribute to learning and improvement in future study design. Based on the results of the scoping review a four steps framework was developed that can guide designing and implementing management competency studies in specific country vs. sector context and to ensure benefits of the studies are maximised.ConclusionThe review confirmed the increasing trend in investing in management competency studies and that the management competency identification and development process varied substantially, in the choice of methods and processes. The identification of missing information in majority of the published studies calls for the development of more rigorous guidelines for the peer-review process of journal publications. The proposed framework of improving the quality and impact of the future management competency study provides clear guidance to management competency identification and development that promotes the functional alignment of methods and strategies with intended uses and contexts.

Development of the Matrix for Regional Collaboration on Disaster Health Management in the ASEAN Region

Introduction:The ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) was adopted at the 31st Summit in Manila in 2017. The Plan of Action (POA) to implement the ALD on DHM was adopted by the ASEAN Health Ministers Meeting in 2019, with Regional Collaboration Committee on Disaster Health Management (RCCDHM) established as a primary implementing mechanism under the purview of ASEAN Health Cluster two and Senior Officials Meeting on Health Development (SOMHD) to operationalize the implementation of the POA with its priority areas and targets to be realized by 2025. The first RCCDHM Meeting was organized in-person in Bangkok in 2020. The RCCDHM is composed of two representatives from each ASEAN member state (AMS), one representative from the ASEAN Secretariat and one representative from AHA Centre, and the secretariat role for the RCCDHM is carried out by the Ministry of Public Health, Thailand. The RCCDHM Meeting decided to develop the Matrix of Detailed Activities (MDA) addressing the five priority areas of the POA-ALD on DHM.Method:The RCCDHM Meeting organized a core group consisting of the Philippines and Thailand to develop the MDA which identifies information on activities, expected outputs, indicators, lead country, source of support, and the timeline for achieving objectives of the POA. During the COVID-19 pandemic, online communication was applied to discuss and coordinate among the AMS.Results:The core group developed the draft MDA in consultation with the ASEAN Secretariat/Health Division. After a series of discussions, the RCCDHM endorsed the MDA which confirms necessary activities and commitment of AMS.Conclusion:The review and endorsement process for the MDA will be elevated to the higher level meetings in the ASEAN Health sector for final approval. The RCCDHM also confirmed to strengthen collaboration with other ASEAN initiatives, non-health ASEAN sectors, UN, or other international partners, and the ARCH Project.

Policy actors’ perceptions of public participation to tackle health inequalities in Scotland: a paradox?

BackgroundHealth inequalities are persistent and widening with transformative policy change needed. Radically shifting policy to tackle upstream causes of inequalities is likely to require public participation to provide a mandate, evidence and to address questions of co-design, implementation and acceptability. The aim of this paper is to explore perceptions among policy actors on why and how the public should be involved in policymaking for health inequalities.MethodsIn 2019–2020, we conducted exploratory, in-depth, semi-structured interviews with 21 Scottish policy actors from a range of public sector bodies and agencies and third sector organisations that work in, or across, health and non-health sectors. Data were analysed thematically and used to examine implications for the development of participatory policymaking.ResultsPolicy actors viewed public participation in policymaking as intrinsically valuable for democratic reasons, but the main, and more challenging, concern was with how it could affect positive policy change. Participation was seen as instrumental in two overlapping ways: as evidence to improve policies to tackle health inequalities and to achieve public acceptance for implementing more transformative policies. However, our analysis suggests a paradox: whilst policy actors place importance on the instrumental value of public participation, they simultaneously believe the public hold views about health inequalities that would prevent transformative change. Finally, despite broad agreement on the need to improve public participation in policy development, policy actors were uncertain about how to make the necessary changes due to conceptual, methodological and practical challenges.ConclusionsPolicy actors believe in the importance of public participation in policy to address health inequalities for intrinsic and instrumental reasons. Yet, there is an evident tension between seeing public participation as a route to upstream policies and a belief that public views might be misinformed, individualistic, short-term or self-interested and doubts about how to make public participation meaningful. We lack good insight into what the public think about policy solutions to health inequalities. We propose that research needs to shift from describing the problem to focusing more on potential solutions and outline a potential way forward to undertake effective public participation to tackle health inequalities.

Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018.

Performance based financing was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level. The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. Data was collected through document review (n=19) and in-depth interviews (n=8). Framework analysis was used to analyse data and generate findings. In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management structures. It was further influenced by interpretations of the idea of 'pay-for-performance', its framing as 'additional funding', as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped. Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions.

The portrayal of electronic cigarettes in Indonesia: a content analysis of news media

BackgroundThe news media play an essential role in shaping public opinion. Analyzing a specific issue reported in the news media provides insight and considerations for a government to form a policy. This study aimed to assess the portrayal of electronic cigarettes (e-cigarettes) in Indonesian news media, including the variety of arguments being presented and the actors behind them.MethodsWe used a paid service database from eBdesk to collect Indonesian news articles from 2020 to 2021 using the keywords ‘rokok elektronik’ (electronic cigarette), ‘rokok elektrik’ (electric cigarette), ‘e-rokok’ (e-cigarette), ‘vape’, and ‘vaping’. Content analysis of 551 full-text news articles was conducted to identify the concepts, topics, and frames of quoted arguments and to examine whether any frames were presented by different types of organizations and the origin of actors.ResultsNews articles related to e-cigarettes were mostly published in the national newspaper and in the non-health section of the newspaper desk. A total of 891 arguments from 393 persons representing 212 institutions were identified. Twenty-eight concepts were further categorized into 12 topics. Health impact was the most frequently reported topic, followed by regulation, tax/price, and e-cigarettes as smoking cessation tools. Overall, the articles and arguments with positive tones toward e-cigarettes outnumbered negative articles and arguments. The industry, university, and research-based institutions were the most involved types of organizations in the news articles. There were more neutral frames toward e-cigarettes among government, even though the frame within the non-health government sector was reported to be more positive toward e-cigarettes.ConclusionsAlthough health impact is the most reported topic, the actors involved in delivering arguments were mainly from the non-health sector, including when the news articles were published by the newspaper desk. The e-cigarette issue in Indonesia was mainly played by the non-health sector, which is more inclined toward economic interest than health.

The effect of nursing home closure on local employment in the United States.

To estimate the effect of nursing home closure on local employment, overall, and by rurality. We obtained 2008-2018 county-level data from the Quarterly Workforce Indicators, Medicare Provider of Services, Area Health Resource, and Urban Influence Codes files. From 2008 to 2018, 878 counties experienced at least one nursing home closure, and 2055 counties did not experience a closure. Using a difference-in-difference study design, we compare the changes of total employment, health sector employment and non-health sector employment over time between counties with and without a nursing home closure. We utilize the variation in the year and quarter of nursing home closures to estimate subsequent employment changes as well as employment trends before closure. We also account for contemporaneous events including nursing home entries and hospital entries and closures, and evaluate heterogeneity by rurality. We include data on nursing home closure from the Medicare Provider of Service file. Quarterly county-level employee counts were obtained from the Quarterly Workforce Indicators provided by the Census Bureau. County-level demographic data were obtained from the Area Health Resource Files. We use Urban Influence Codes from the Economic Research Service, Department of Agriculture, to classify metropolitan, micropolitan, and rural (noncore) counties. Health sector employment decreased by about 3.2%-4.1% (p < 0.01) in counties with a nursing home closure. The reduction was largest in rural counties (approximately 7.2%-9.4%, p < 0.01). The reduction in health sector employment persisted over time, particularly in rural counties. Overall, there was no discernable effect on non-health sector employment. Nursing home closure is associated with a persistent decline in health sector employment, particularly in rural counties, suggesting a reduction in the health care workforce and in the ability to sustain health care services supply, particularly in rural areas.

Exploring the wider societal impacts of sexual health issues and interventions to build a framework for research and policy: a qualitative study based on in-depth semi-structured interviews with experts in OECD member countries

ObjectivesSexual health is a complex public health challenge and can generate wide-ranging health, social and economic impacts both within and beyond the health sector (ie, intersectoral costs and benefits). Methods...

Malaria Control Before and During the COVID-19’s Pandemic in Lawang Kidul, South Sumatera

Global cases of malaria have increased with the COVID-19 pandemic which has affected the morbidity and mortality of malaria in the world. Malaria cases in Indonesia decreased during the COVID-19 pandemic as well as malaria cases in the regions. Lawang Kidul District is a malaria-endemic area and is the focus of a malaria elimination area in Muara Enim Regency, South Sumatra Province. All malaria control activities have been disrupted due to the COVID-19 pandemic. The purpose of this study was to find out how to control malaria in the period before the COVID-19 pandemic and during the COVID-19 pandemic. The research was conducted using a qualitative method with in-depth interview techniques from 11 health and non-health sector informants. Data processing analysis was carried out using the NVivo 12 Pro application with visualization of the results in the form of a project map. The results showed that malaria control efforts during the 2020-2021 COVID-19 pandemic were reduced along with the reduced cross-sectoral involvement, this was due to the increasing development of COVID-19 cases. However, the new form of control during the COVID-19 pandemic is the formation of larva cadres in one elementary school, the formation of village regulations, and increased efforts to clean and healthy living behavior.

Optimalisasi Pemantauan Kesehatan Balita Stunting melalui Buku Monitoring Gizi Anak di Kabupaten Rote Ndao, NTT

Rote Ndao Regency, which is located on one of the outer islands in NTT Province, has a total stunting prevalence of 23.48%. The improvement of stunting with interventions in the health and non-health sectors has a considerable contribution. This activity aims to carry out a stunting control improvement program by utilizing child nutrition monitoring books as a medium in monitoring the health of stunting toddlers in Rote Ndao Regency. The target in this activity is families who have toddlers aged 13-48 months as many as 88 children. The method of this activity is that all targets are given a monitoring book and supplementary feeding and Zinc supplementation is carried out for 12 weeks. The results showed that the provision of additional feeding assistance and supplementation improved nutritional status with increased weight and even this activity increased the motivation of the family to improve the child's lifestyle and health status.

The whole-of-society approach of mass COVID-19 vaccination in China: a qualitative study

BackgroundMany countries have an inefficient vaccination system, which hinders global exit from the COVID-19 pandemic. It is vital to summarize COVID-19 vaccination practices in countries with high vaccination coverage and provide implications for other countries. This study aimed to investigate China’s COVID-19 vaccination system and to summarize its implementation experience from a health system perspective.MethodsWe conducted key informant interviews in five representative cities of China in late 2021. Guided by the health systems framework proposed by WHO, we developed our interview guidelines which included seven building blocks—leadership and governance, health workforce, vaccination service delivery, vaccination mobilization and communication, financing, access to vaccines, and information systems. Semi-structured interviews and COVID-19 vaccination policy documents were collected and coded using a thematic analysis approach.ResultsA total of 61 participants (nine vaccination programme directors of the local Center for Disease Control and Prevention, four government staff and 48 vaccination service workers) were interviewed. We found that China adopted a whole-of-society approach with adequate government engagement and linked health and non-health sectors to promote COVID-19 vaccination. Key measures included the collaboration of multiple systems and departments from a governance perspective, allocating sufficient health workers and resources, large-scale vaccination mobilization and communication, expansion of vaccine financing channels, localized production and digital information systems. With the vaccination system strengthening, the two-doses vaccination coverage reached 89.5% for the total population but relatively lower coverage for older adults as of July 2022.ConclusionsOur study highlights the importance of a government-led whole-of-society approach to promote mass vaccination. The low vaccination coverage among older adults should be paid the greatest attention to. The experiences and lessons from China may serve as a reference for other countries.

Structure, functions, performance and gaps of event-based surveillance (EBS) in Sudan, 2021: a cross-sectional review

BackgroundEvent-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward. MethodsThe review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. SPSS software was used to perform descriptive statistical analysis for quantitative data, while qualitative data was analysed manually using thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate.ResultsSudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high academic qualification (Diploma or MSc) were noticed as inhibiting factors.ConclusionThe review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted.

Preferences and willingness of accepting COVID-19 vaccine booster: Results from a middle-income country

The recent wave of COVID-19 cases has led to the potential need for booster doses. We surveyed 6,294 people and found that 87.6% reported willingness to take a booster dose, with vaccine efficacy rate being the most common reason cited to accept booster dose. Differences in acceptance rates were noted among those working in non-health related sectors, different ethnic groups as well as those who had taken viral vector vaccines.

Identifying opportunities for multisectoral action for drowning prevention: a scoping review

BackgroundDrowning is a complex health issue, where global agendas call for greater emphasis on multisectoral action, and engagement with sectors not yet involved in prevention efforts. Here, we explored the...

2.L. Workshop: Public Health Institution and Academia’s role in building capacity for Health Impact Assessment

Abstract Health impact assessment (HIA) is a process, which systematically judges the potential, and sometimes unintended effects of any new proposal (policy, project, program or strategy) on the population health, and the distribution of those effects within the population. It was conceived in 1999 as the supporting tool for the implementation of Health in All Policies (HiAP), but its practical use remains quite partial worldwide, with exceptional regions and countries (e.g. Wales (UK), Australia). Several surveys conducted nationally, but also across Europe by the World Health Organization-Regional Office for Europe identified several barriers that hinder a broader and more extensive practical application of HIA. One of these limitations lies in the lack of understanding and knowledge of professionals from non-health sectors about the benefits that addressing health considerations in the planning process of their projects, strategies or programs may have. In this sense, the HIA is frequently seen as an additional bureaucratic burden. Other common constraints reported refer to inadequate resources (guidelines, tools, evidence) and lack of qualified staff experienced in conducting HIA. Respondents from those surveys also deplored a history of unsatisfactory experiences involving intersectoral collaboration with health professionals, decision makers and other public sector stakeholders. Health agencies, such as national and regional Public Health Institutes (PHIs) can play a critical role in overcoming these limitations. They can act by providing independent advice and support based on the best available evidence to governments and proposal developers (projects, programs, strategies). However, they need to have knowledge, resources and capacity to do so. On the other hand, these basic concepts and procedures related to HiAP or HIA are rarely addressed in depth in the university curricular training of health sectors or other sectors such as environmental science or urbanism. Present workshop intends to analyse different experiences in Europe regarding the role of PHIs and also the academia in overcoming those reported exiting barriers, and reach a more sustainable and healthy societies. The fundamentals of what could be a training program on HIA principles across Europe will be also discussed. Key messages • PHIs can demonstrate leadership for HIA and HiAP by providing support to decision makers in better understand the wider health impacts and how they will manifest themselves across the population. • HIA practice requires of the design of proper training programs and of certain validation process, which avoids conflicts regarding consultants’ impartiality and independence in conducting a HIA.

Health impact Assessment practice in Wales: factors conditioning its success

Abstract Historically, Public Health Institutes (PHIs) were formed to address emergency public health and environmental health related challenges for example, infectious disease outbreaks and sanitary conditions which will affect health. The COVID-19 pandemic has demonstrated the importance and value of PHIs and the specific knowledge and expertise sat within them in the 21st century in relation to critical health issues. However, PHIs have also the potential expertise to look at the wider determinants of health and how they might affect population health and inequalities. In doing so, they play a critical role to advocate for Health in All Policies (HiAP) and Health Impact Assessment (HIA) by engaging with decision makers from health and non-health sectors and providing evidence and health intelligence. Public Health Wales (PHW) has conducted very complex studies as the HIA of the impact of Brexit on the population of Wales, which was praised as very useful by the Welsh Government and local decision makers at a time when, otherwise, little robust evidence-based information was available. Other positive HIA experiences are the recently published HIA about impacts of climate change or COVID-19 pandemic. Those achievements were possible thanks to the establishment of a specific unit dedicated to HIA within PHW, and to the political support and resources. This has built awareness raising and trust in HIA as a tool to support decision making from all sectors in Wales, enabled also by much training and stakeholder participation.

9.G. Workshop: Health in all Policies: key driver for better health still awaiting of greater governing stewardship

Abstract Healthy public policies are those that take accountability of all possible health impacts, acknowledging the causal pathways resulting from the modification of upstream health determinants (e.g. transport strategies, etc.), and related risk factors downstream (e.g. air pollutants). The strategy of Health in All Policies (HiAP), promoted by the World Health Organization (WHO) and adopted by the European Union (EU) in 2006, reinforced the need to reduce inequalities and improve health and wellbeing as essential pillars for a sustainable economic development. Central to HiAP is the notion that health is not only the responsibility of the health sector, but also a shared responsibility with many other sectors. In this context, Health impact Assessment (HIA) was proposed as the combination of methods to support HiAP implementation by providing scientific evidence on the positive and negative effects that any new proposal may have on health and health equity. The COVID-19 pandemic, and the climate change threat, are two of the main challenges that emphasise the need of integrated responses across many sectors to mitigate not only effects on health and inequalities, but also in the economy. However, HiAP and HIA implementation remains almost at a conceptual level, with a few remarkable exceptions in Europe. One of the most relevant reported barriers contributing to this uneven HiAP implementation is the lack of political stewardship and commitment. The difficulties in applying the guiding principles of HiAP (and consequently of HIA) at local, regional, or national governance level are in many cases linked to a conflict between the right to work and mobilization of the economy, with the right to health and reduction of inequities. This is where the role and drive of public health actors comes across, as HiAP requires public health professionals to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity, external to the health sector. A good proxy example to HiAP implementation, facilitating local and regional initiatives with communities, is the WHO initiative of Healthy Cities. The present panel discussion intends to analyse, from different perspectives, why HiAP has not gained a meaningful place within governing contexts, the current and future status of the intersectoral approach, and the advocacy role of public health in this context. The session is scheduled with a first overview presentation followed by a debate framed around the following aspects: – Different perceptions regarding the concrete implementation of HiAP at all political levels. – Perceived barriers or trade-offs for a broader implementation of HiAP. – Role of public health actors in the implementation of HiAP at a strategic, policy level, and how it could gain a more prominent role. – Level of understanding and awareness of the utility of HIA for HiAP implementation by public health actors. Key messages • HiAP, a recognised approach requiring all sectors to address decisions’ health and equity implications for reaching better global health, has not yet been implemented with an overarching vision. • Public Health actors can disentangle political and technical aspects, seeking for synergisms, and clarifying to non-health sectors the complexity and interrelatedness of social health determinants.

Health in All policies: what do we mean and where are we now?

Abstract This presentation sets what HiAP is and is not, and its evolution since it was conceived. It also addresses how HiAP can be mobilised in practice via the use of tools such as HIA and the key role that enabling structures and contexts - both politically strategic and locally operational- to ensure that health, wellbeing and equity is promoted in the European region. It discusses the enabling context of Wales, with the Future Generations (Wales) Act 2015, which provides political leverage for the implementation of HiAP in practical terms, enabling addressing health considerations intersectorially by non-health policies and projects. This Act along with supporting documents, guidance and legislation implicitly incorporates the principles of HiAP so the rest of non-health sector understand (and also have the statutory obligation) to address the health considerations of policies and plans. It does this by requiring all public bodies in Wales to strive to maximise 7 Well-being Goals - which include ‘A healthier Wales’, ‘A more equal Wales’ - and requires that they do so by working with other agencies in order to prevent negative impacts and promote participation, long-term thinking and integration to ensure that inequalities are minimised. These are key public health principles from which to have conversations. Wales also provides a good example with its advocacy and policy in respect to Economies of Wellbeing - a critical challenge for HIAP is that HiAP is, by its nature, political, and may challenge some policy proposals. Although the focus is on identifying ‘win:wins’ and co-benefits, sometimes there is a conflict between health and other outcomes. There may be a need to balance health gains against economic growth or other policy aims. The following debate intends to discuss the challenges and enablers to achieve that aim, and how public health can make its voice heard.