6TH GLOBAL CONFERANCE ON HEALTH PROMOTIONS FROM 7-11 AUGUST 2005 IN BANGKOK THAILAND
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- 6TH GLOBAL CONFERANCE ON HEALTH PROMOTIONS FROM 7-11 AUGUST 2005 IN BANGKOK THAILAND
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’’BACK TO THE FUTURE” - A PERSPECTIVE ON
ENVIRONMENTAL CHANGE, ENVIRONMENTAL HEALTH AND
CREATING SUPPORTIVE ENVIRONMENTS FOR HEALTH
Stephen A. Tamplin
The 6lh Global Conference on Health Promotion
Bangkok, Thailand, 7-11 August 2005
"BACK TO THE FUTURE" - A PERSPECTIVE ON ENVIRONMENTAL CHANGE,
ENVIRONMENTAL HEALTH AND CREATING SUPPORTIVE ENVIRONMENTS FOR HEALTH
1.0
Introduction
The Earth’s physical environment has undergone considerable change in recent decades.
Some of these changes have seemingly occurred outside the control of humankind, while others
are directly attributable to human activity. Many of these changes negatively impact health and
well-being. They range from changes in global climate that affect the nature and extent of the
incidence of vector borne diseases to increased urbanization and associated slums that nurture
the spread of emerging and re-emerging diseases; from, what is at least perceived to be, an
increase in the incidence of natural disasters to unplanned growth and development that are
depleting natural resources at an alarming rate.' While the causes of these changes are widely
debated, finding sustainable solutions to the related public health problems is proving elusive and
challenging.
Narrow attempts to “quick fix" these problems abound, with the focus often being on providing
short-term relief that gives the appearance of solution but fails the long-term test of sustainability.
Environmental health-related intellectual frameworks that support broader-based approaches
directed at the forces that drive these changes have been developed, widely discussed and
endorsed by stakeholders (e.g., the WHO Driving Forces-Pressures-State-Exposure-EffectsAction {DPSEEA} model). The successful application of such frameworks in real-life, real-time
settings to solve priority problems, however, has been, itself, problematic. While this can be
attributed to many factors, two of the most important, particularly in low-income countries, are:
1) the failure of decision makers to implement, in practice, the “integrated" and “inter-sector"
approaches suggested by the frameworks, despite much talk about them; and, 2) the reluctance
of key stakeholders to take on the inherent issues of governance that are critical to bringing about
meaningful and sustainable change.
Health promotion interventions are essential components of efforts to overcome these
failures, especially in relation to advocacy and the development of health leaders. Also,
partnerships between environmental health, health promotion, and their relevant constituencies
are critical to effectively meeting the complex public health challenges posed by environmental
change These partnerships need to be exercised within frameworks that integrate the range of
ecological, social, economic and human determinants that shape the health of people 1
23
2.0
The challenges posed by environmental change
Some of the changes to the Earth’s environment seemingly occur outside the control of
humankind, while many others are directly attributable to human activity. Dramatic environmental
events in 2004 provide a vivid illustration. Heavy monsoons in Bangladesh, India and Nepal
caused massive flooding; China suffered its worst drought in 50 years; a record 10 typhoons hit
Japan; and, most dramatically, an earthquake-generated tsunami off the coast of Indonesia killed
more than 200,000 people and caused billions of dollars in damage across Indonesia, Malaysia,
Sri Lanka, Thailand and other Asian countries. Poorly planned development exacerbated the
death and destruction associated with many of these events; vulnerable populations (e.g., the
aged, the very young and the poor) were the most heavily impacted; and, in the case of the
1 Reid WV. et al. Millennium Ecosystem Assessment Synthesis Report. Pre-publication Final Draft Approved by MA
Board on Marell 23, 2005. www.millcnnhtmassessnicnt.ore . downloaded 2 May 2005.
’ Ilancock T. People, pannersliips and human progress: building community capital. Health Promotion International.
September 2001, 16. 3.
’ Galea S. Freudenberg N. Vlahov D. Cities and population health. Social Science & Medicine. 2005, 60: 1017-1033.
tsunami, available technological innovation that could have provided early warning was not
operating where it was needed/
October 04, 2004
“Ramping Up CNG
for Transportation in
India
..Air quality in Delhi has improved
significantly since a Supreme
Court order mandating its bus
fleets to convert to run on cleaner
burning compressed natural gas
(CNG) came into effect in 2002.
More cities are expected to follow
Delhi in adopting natural gas as a
vehicle fuel."
|http;//www.qreencarconqress.com
/2004/10/cummins westpor html,
accessed 18 June 2005]
“Bhopal gas tragedy lives on, 20
years later
Evidence of contaminated water in Indian city
mounts.
By Scott Baldauf | Staff writer of The Christian
Science Monitor
BHOPAL, INDIA - Nearly 20 years after an accident
at a Union Carbide chemical plant killed thousands
here, there are signs that a second tragedy is in the
making. Nev/ environmental studies indicate that tons
of toxic material dumped at the old plant have now
seeped into the groundwater, affecting a new
generation of Bhopal citizens." [Christian Science
Monitor, May 4, 2004]
Sometimes we seem to make progress; sometimes our past catches up with us.
The recent Millennium Ecosystem Assessment Synthesis Report*5 clearly documents that
over the past 50 years “humans have changed...[the Earth's ecosystems],..more rapidly and
extensively than in any comparable period of time in human history." It indicates that poor
ecosystem management is already causing significant harm to some people, and highlights three
major problems:
Approximately 60% of the ecosystem services examined during the Assessment are
being used unsustainably;
2. Changes being made in ecosystems are increasing the likelihood of nonlinear
changes;and,
3. “The harmful effect of the degradation of ecosystem services6... are being borne
disproportionately by the poor"
1
It is further noted that there are no simple fixes to these problems; that they pose significant
barriers to the achievement of the Millennium Development Goals; and, that effective responses
require ‘changes in institutions and governance, economic policies and incentives, social and
behavior factors, technology and knowledge."
The public health challenge associated with environmental change and the degradation of
ecosystems is complex; resources are scarce; and people are often overwhelmed. There
continues to be a critical need to address the dynamics of these changes with integrated
‘ WHO Centre for Health Development Annual Report 2004. Kobe, Japan, WHO Centre for Health
Development. 2005.
5 Reid WV. et al. Millennium Ecosystem Assessment Synthesis Report Pre-publication Final Draft
Approved by MA Board on March 23. 2005. www.millenniumassessment orq , downloaded 2 May 2005.
6 The Report characterizes “ecosystem services" as “the benefits people obtain from ecosystems,"
noting that “changes in these services affect human well-being through impacts on security, the
basic material for a good life, health, and social and cultural relations."
4
approaches that encompass the related components of socio-economic development, the
environment, demographic change and health This is particularly true in relation to climate
change and increasing urbanization.
Climate change
"...today the world population is encountering unfamiliar human-induced changes in
the lower and middle atmospheres and world-wide depletion of various natural
systems (e.g., soil fertility, aquifers, ocean fisheries, and biodiversity in general).
Beyond the early recognition that such changes would affect economic activities,
infrastructure and managed ecosystems, there is now recognition that global climate
change poses risks to human population health.” [Climate Change and Human
Health - Risks and Responses - SUMMARY. WHO.WMO and UNEP. World Health
Organization, 2003] 4
The health-effects issues associated with climate change and variability are summarized in
Table 1. The relative importance of these issues to human health and well-being, particularly in
low- and medium-income countries has been the subject of intense discussion and debate for
some time now.
A series of 1993 articles published in The Lancet highlighted the increasing awareness that
climate change is a significant public health issue. Among other things, these articles discussed
climate change and health from the perspectives of the changing character of emerging and reemerging diseases in a wanner world; decreasing biodiversity; stratospheric ozone depletion;
marine ecosystems; and food supply. Particular attention was also given to impacts on cities and
critical regions of the worid. In looking to the future, one of the articles (Haines A, Epstein P, and
McMichael J) concluded:
■
“A global health monitoring network is essential not only to determine the impact of
climate change but also to shape strategies to prevent climate change as far as
possible and mitigate those effects which do occur."7
The 1995 report on the State of the Environment in Asia and the Pacific also visited the
subject of climate change and pointed to adverse impact of human-related activities such as rapid
industrial expansion, increasing energy consumption and deforestation on the atmosphere. In the
chapter on Human Health, the report concludes that while a number of countries have developed
environmental health policies:
•
“...primary emphasis has always been on curative, rather than preventive measures.
This is usually because the majority of sectoral ministries, which could implement
these preventive measures, are not effectively involved in policy and programe
development. Furthermore, health system research is geared more to epidemiology
rather than to procedural initiatives within communities and multi-sectoral research."8
7 Health and Climate Change - a Lancet series reprint. The Lancet Ltd, Devonshire Press, 1994.
8 1995 State of the Environment in Asia and the Pacific. Economic and Social Commission for Asia and the
Pacific, and the Asian Development Bank. New York, the United Nations. 1996.
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Table 1: Global Health Effects from Climate Change and Variability9
Health and well-being issues
Temperature-related morbidity and
mortality
Health effects of extreme weather events
Air pollution-related health effects
Water- and food-borne contamination
Vector-borne infectious diseases
Population vulnerabilities in cities and
communities
Health and socio-economic effects
Health effects of stratospheric ozone
depletion
Examples of health issues
Cold and heat-related illnesses, mental health,
respiratory and cardiovascular stress, and
occupational health stress
Mental health, preparedness and population
displacement; damaged public health infrastructure,
and occupational health hazards.
Respiratory diseases, cardiovascular diseases;
cancer, asthma and allergens; changed exposure to
indoor air pollutants.
Enteric diseases and contaminants; food safety and
security
Changed patterns for vectors, pathogens and
transmission rates.
Rural and urban health; seniors, children, homeless
and low income, traditional cultures, disabled, and
immigrant populations
Changed determinants of environmental health and
well-being, global burden of disease, health and social
co-benefits, health risks of greenhouse gases
mitigation technology and policy.
Cancer; cataracts, immune suppression.
In a 2002 meeting on “Climate Change and Health," the World Health Organization (WHO)
noted its growing concern regarding climate change and human health issues because of, among
other things:
■ "...their potentially serious health consequences, their disproportionate expected impact
on poor countries and their disproportionate impact on the poor and vulnerable groups in
general Climate change may, therefore, contribute to an increase in health inequalities
within and between countries.”9
1011
In charting a course for developing responses to climate change, WHO, the World Meteorological
Organization and the United Nations Environment Programme have particularly noted the
importance of “policy-focused assessment" and “communicating assessment results" to raise
public awareness.11
Urbanization
“A radical process of change is underway in large urban conglomerations. This process
is unregulated and places extreme strains on health, natural resources and social
equilibrium. It is a process that requires a new way of thinking about the health and
welfare system, and how to respond more effectively to the growing pressures of a
rapidly expanding urban population.” [Report of the Driving Force Sub-Group on
Urbanization and Health. Kobe, Japan, WHO Centre for Health Development, 2004.]
9 Meeting Report - Planning Meeting for Ministries of Health to Address Climate Change and Health
Geneva. Switzerland, World Health Organization. 2002.
10 Meeting Report - Planning Meeting for Ministnes of Health to Address Climate Change and Health.
Geneva. Switzerland. World Health Organization. 2002
11 Climate Change and Human Health - Risks and Responses - SUMMARY WHO.WMO and UNEP.
World Health Organization. 2003
6
The participants in the Driving Force Sub-Group on Urbanization and Health referred to in the
box above coined the term "new urban setting" to describe the complex processes, the
relationships and the geography that encompass the radical process of change that is underway
in large urban conglomerations. The Sub-Group also introduced the notion of “glocalization” to
reflect the merging of traditional global and local perspectives on urbanization and health, and to
recognize the central role that urban municipalities play as key drivers of modernization and
social change. In this context, cities were seen as "fundamental local platforms for finding
equitable and efficient solutions to a range of global problems, including those related to health."12
From the perspectives of environmental health and health promotion, the critical impacts of
urbanization on health have been recognized for some time
One of WHO's mam inputs to HABITAT II was the background document, Creating Healthy
Cities in the 21s Century. 13 This document presented the Organization's 1996 perspective on
urbanization and health in the coming century in the context of five themes, highlighting, among
other things, the following
Building healthy cities - Highlighting the fact that people's health can be as much the
result of conditions where they work, go to school, live and play as the quality of health
care available to them.
❖
Emerging and re-emerging diseases - Understanding that these diseases are "one
component of a complex and changing global ecology which is shaped ... by economic,
social, environmental, demographic and technological changes....”
❖
Environmental health - Emphasizing that inadequate provision for water and sanitation
is "arguably the single most serious environmental problem in cities in terms of its health
impact."
Child health - Noting that the potential for implementing relatively low-cost measures to
make cities safe for children is high.
❖ Women’s health - Recognizing the disadvantages for health faced by women in most
urban centers - the hazards of bearing and giving birth to children in the absence of "a
healthy, secure home and good quality health services;" discrimination in education, labor
markets and resource allocations; and, violence.
More recent assessments of the urban condition continue to reinforce the critical nature of
these issues, depicting a rapidly deteriorating situation, especially for the urban poor.14 New
perspectives are needed on dealing with these issues in the context of “new urban settings."
With respect to environmental issues, Hardoy, Mitlin and Satterthwaite15*note that: “most
environmental problems have underlying economic and political causes," and reflect a failure of
government to plan effectively, control pollution and promote environmental health. In looking to
the future, they suggest: "It is remedying these failures of government within cities and city
districts and addressing the reasons that underlie them that should be central to any new urban
environmental agenda."
12 Health in Development - Healthier People in Healthier Environments. A Proposed Research Framework
for the WHO Centre for Health Development. Kobe, Japan, WHO Centre for Health Development, 2004.
13 Creating Healthy Cities in the 21s' Century. Geneva, World Health Organization. 1996
14 A Home in the City. The UN Millennium Development Project Task Force on Improving the Lives of Slum
Dwellers. London. Earthscan. 2005,
Hardoy J. Mitlin D, Satterthwaite D. Environmental Problems in an Urbanizing World. Finding Solutions
for Cities in Africa. Asia and Latin America London, Earthscan Publications Ltd., 2001.
7
Thus, one of the major tasks for the future is to undertake truly holistic, integrated
approaches to complex problem-solving that address critical issues of governance. This is a task
that has always been easier to 'say' than 'be ' 16
3.0
The environmental health - health promotion alliance
Environmental health-related frameworks that support broad-based approaches directed at
the forces that drive environmental changes have been developed, widely discussed and
endorsed by stakeholders. For example, the WHO Driving Forces-Pressures-State-ExposureEffects-Action {DPSEEA} model is one such framework It provides a unifying framework for
describing the potential causal pathways and preventive or remedial actions for improving health.
As designed in the 1990s, the model depicts how driving forces impose different kinds of
pressure on the environment. These pressures can lead to changes in the state of the
environment, potentially leading to exposures among humans that can result in a variety of health
effects. Actions are possible at any point in the chain to prevent or treat adverse health effects.
Although the DPSEEA model was designed for use in the analysis of environmental health
indicators, its general structure makes it possible to apply it to a variety of health problems and
the socio-economic or behavioral determinants that lie behind them Within this broader
construct, driving forces create pressures in society that alter the state of health in development
and lead to changes in exposures and health outcomes. The basic DPSEEA framework can also
be used as a guide in developing and classifying public health interventions (Figure 1). It
provides common conceptual ground for public health action among programmes such as
environmental health and health promotion.
Effectively applying such frameworks in practice, however, has been problematic. Two of the
most important factors in this regard are 1) the failure to actually implement approaches that are
truly ■integrated" and “inter-sector," despite much talk to the contrary; and, 2) the reluctance of
stakeholders to tackle the issues of governance that are critical to bringing about meaningful
change and success. For example, environmental health practitioners, as stakeholders, often
retreat to the comfort of “we only provide technical solutions” in the face of these challenges when
a strategic alliance with health promotion stakeholders could offer a more hopeful response.
Health promotion practitioners need only look at the Ottawa Charter to find clear links to the
task of dealing with these factors in the context of "environmental change," including recognition
of the importance of: 1) building healthy public policy; 2) creating supportive environments for
health; 3) strengthening community action; and, 4) developing personal skills 17 These are
natural bridges between health promotion, environmental health and the many other public and
private sector stakeholders who need to contribute to resolving environment-related public health
issues, as well as broader development-based issues such as the Millennium Development
Goals. If used effectively, they can support partnerships that develop creative and holistic
approaches to solving complex public health problems that could benefit from environmental
health and health promotion interventions. A good example of this is found in the experience of
WHO and its partners with “healthy settings" approaches*21
16 Takano T. Ed. Healthy Cities & Urban Policy Research London and New York. Spon Press. 2003.
” Ottawa Charter for Health Promotion. First International Conference on Health Promotion. Ottawa, CAN,
21 November 1986. WHO/HPR/HEP/95.1.
Figure 1:
A modified DPSEEA framework for public health action'8
"Healthy Cities" emerged in WHO in the 1980s as a response to deteriorating health
conditions in urban settings. Based on the principles of Health-for-Alt adopted at Alma Ata’9 and
embodied in the Ottawa Charter,18
*20 it was characterized as a new public health movement.21
Healthy Cities' projects are intended to reflect holistic approaches to problem solving; emphasize
the importance of inter-sector collaboration; engage political leaders and decision-makers;
encourage and facilitate community participation, and, create supportive environments for
health.22
“Healthy Cities’ has flourished in Europe, met with significant success throughout Asia, as
well as in the Pacific (where it was re-invented as "Healthy Islands" in the 1990's), and has been
applied with region-specific success in the Americas and elsewhere. It is an integrating
mechanism that has significant potential for effectively addressing health governance-related
issues. On a smaller and more focused scale, the approach and attendant health-promoting
principles have been successfully applied in other "settings" such as villages, schools.
workplaces, marketplaces, and hospitals.
18 Health in Development - Healthier People in Healthier Environments A Proposed Research Framework
tor the WHO Centre for Health Development Kobe. Japan. WHO Centre for Health Development. 2004.
15 World Health Organization. Managerial Process for National Health Development - Guiding Principles
Geneva. World Health Organization. 1981.
20 Ottawa Charter for Health Promotion. First International Conference on Health Promotion. Ottawa. CAN.
21 November 1986. WHO/HPR/HEP/95.1
21 Kickbusch I. Healthy Cities: a working project and a growing movement. Health Promotion, 4: 77-82
22 World Health Organization. Building a Healthy City A Practitioners' Guide. [WHO/EOS/95 10). and WHO
Healthy Cities A Programme Framework [WHO/EOS/95.11] Geneva. World Health Organization, 1995
9
“Health for All” Principles
*
■
■
■
•
■
4.0
Reduced inequalities in health
Emphasis on prevention of
disease
Inter sector cooperation
Community participation
Emphasis on primary health care
International cooperation
Key Healthy City & Healthy Settings Principles
■
■
Inter-sector collaboration for health
o
Health impact analysis
o
Policy development
o Advocacy
o
Political support
Partnership approaches
o
Supportive environments
o
Physical, social & economic
Effective partnership approaches
What is a partnership anyway?
Since partnerships are considered important in public health problem solving, we would do
well to better understand the nature of partnerships. In recent years, there has been a significant
increase in the numbers and diversity of public-private partnerships (PPPs) in public health.23
This is reflected in actions such as the World Bank encouraging partnerships as part of its
comprehensive development framework;24 the World Health Organization (WHO) promoting
partnerships;25 and, non-governmental organizations (NGOs) establishing relationships with forprofit organizations. Included among the reasons for this are the increasing influence of NGOs
on public health concerns; and, the inability of public or private organizations to resolve complex
public health problems on their own.26
There is a general lack of consistency and consensus in terminology used to describe PPPs.
A variety of terms are used to describe the spectrum of such partnerships involving both not-forprofit and for-profit stakeholders. Terms such as partnerships, collaborations, collectives,
alliances, and joint ventures are all used and interchanged.27 The United Nations Development
Programme (UNDP) has described PPPs very broadly as “a spectrum of possible relationships
between public and private actors for the cooperative provision of infrastructure services."28
What are the ingredients that make a partnership effective?
Collaboration is a critical element in PPPs. The degree to which it is effectively achieved
determines to a great extent whether the partnership works or fails. In examining the challenges
of collaboration between non-profit organizations and businesses, J. Austin29 enumerates “seven
23 Roussos ST, Fawcett SB. A Review of Collaborative Partnerships as a Strategy for Improving Community
Health. Annual Review of Public Health. 2000. 21:369-402, ProQuest Medical Ubrary.
24 World Bank, Afnca Regional Office. Project Appraisal Document on a Proposed Development Credit . to
the Republic of Ghana for a Health Sector Program Support Project II. Report No.: 24842-GH. January
2003.
25 Lucas AO. Public-Private Partnerships: Illustrative Examples. Massachusetts, Harvard University,
Workshop on Public-Private Partnerships in Public Health, April, 2000.
26 Nishtar S. Public-private partnerships in health - a global call to action. PubMed Central, published
online July 2004 (http://vAvw.pubmedcentral.nih.gov).
27 Linder S. Coming to terms with the public-private partnership: a grammar of multiple meanings. In.
Rosenau PV, ed. Public-Private Policy Partnerships. Cambridge, Massachusetts, MIT Press. 2000: 19-35.
28 http://undp.orq/pppueAmaqes/qraphics-what1.qif
29 Austin J. The Collaboration Challenge. How Nonprofits and Businesses Succeed Through Strategic
Alliances. Jossey-Bass. 2000; and. an associated Workbook - Tools of Collaboration. 2002.
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C's" of effective collaboration that also mirror the characteristics of successful Public-Private
Partnerships (PPPs)
1.
2.
3.
4
5.
6.
7.
Connection with Purpose and People
Clarity of Purpose
Congruency of Mission. Strategy and Values
Creation of Value
Communication Between Partners
Continual Learning
Commitment to Partnership
In discussing some of the factors that determine the rate at which collaborative partnerships
affect community and system change. S.T. Roussos and S B. Fawcett30 note the importance of
similar characteristics:
□
□
□
□
□
□
□
Having a clear vision and mission;
Action planning for community and systems change;
Developing and supporting leadership;
Documentation and ongoing feedback on progress;
Technical assistance and support,
Securing financial resources for the work; and,
Making outcomes matter.
Such characteristics are also reflected in the views of PPP practitioners regarding the key factors
that cause PPPs to succeed or fail. A recent report to the WHO Centre for Health Development,
Kobe, Japan, highlights the importance of the following:31
•
■
■
•
■
■
Building relationships
Agreeing on goals and objectives
Being sensitive to the local context and environment
Identifying “Champions"
Promoting good governance and transparency
Supporting the strengthening of national and local systems and pnorities
How can effective partnerships be developed?
The key question in establishing a partnership is: "Why are we doing it?" The answer to this
question is essential for establishing an effective relationship, and a participatory approach that
involves all key stakeholders is essential in coming up with the answer. While there are many
ways to go about this, Z. O'Leary has developed a stepwise approach32 that is reflected in a
recently suggested “10-Step Protocol Framework" for developing PPP evaluation protocols.33
The “10-Steps" noted in the Framework" (see Box 1 below) can also be adapted to the process of
building partnerships. The Framework and the associated Steps recognize that a “one-size-fitsall" approach will not work and offers a progressive, consultative, participatory process for
developing settings- and problem-specific relationships that engages key stakeholders and
decision makers and responds to their needs and interests.
30 Roussos ST, Fawcett SB. A Review of Collaborative Partnerships as a Strategy for Improving Community
Health. Annual Review of Public Health. 2000. 21:369-402, ProQuest Medical Library.
31 Tamplin S. O'Leary Z. Report on Refining and Testing a Research Protocol for Evaluating the
Effectiveness of Private-Public Partnerships in Enhancing Health and Welfare Systems Development.
Kobe. Japan. WHO Centre for Health Development. 2005.
32 O'Leary Z. Researching Real-World Problems: A Guide to Methods of Inquiry. London. Sage. 2005.
33 Tamplin S. O'Leary Z. Report on Refining and Testing a Research Protocol for Evaluating the
Effectiveness of Private-Public Partnerships in Enhancing Health and Welfare Systems Development.
Kobe. Japan. WHO Centre for Health Development. 2005.
II
In taking the "10 Steps" and exercising the resulting partnership, Tamplin and O'Leary note
that a number of guiding principles are important:34
■
■
■
■
■
■
Building relationships and trust are most important - this takes time.
A co-learning approach with an "in partnership with” mentality is preferable.
The process needs to be participatory and inclusive
A concerted effort needs to be made to embed capacity building in the process
Integrity and transparency are critical to success.
Clarity of purpose is crucial - everyone needs to be on the same page
Box 1: Ten steps to building effective partnerships
I.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Gain support for the partnership from key stakeholders
Come to an agreement on purpose
Negotiate an appropriate operational team
Agree on evaluation priorities
Negotiate and operationalize indicators of success
Design methods
Collect and analyze data
Draw conclusions
Produce ‘deliverables'
Disseminate and facilitate result utilization
How might we best use partnership approaches to solve real-life, real-time problems?
There is a wide range of examples of proven partnership approaches that attest to the
soundness of the characteristics, principles and steps noted above. Among many others, these
include initiatives related to:
National policy and programme development, such as -
In Fiji, the adoption of a National Environmental Health Action Plan (NEHAP) in Fiji 1998
[see Box 2] might, on the surface, seem like a rather straightforward event. In reality, it was far
from that, representing the culmination of 15 years of partnership effort involving the Government
of Fiji, the Fiji School of Medicine, the World Health Organization, several external support
organizations and, most importantly, local communities. Along the way, Fiji’s environmental
health service was professionalized and a sustainable relationship was developed between
health promotion and environmental health practitioners. In the final analysis, the development of
the NEHAP was effectively driven from the bottom up with the full participation of all relevant
stakeholders.
nnau:
11
11
11
■u Tamplin S. O’Lear,’ Z. Report on Refining and Testing a Research Protocol for Evaluating the
Effectiveness of Private-Public Partnerships in Enhancing Health and Welfare Systems Development.
Kobe. Japan. WHO Centre for Health Development. 2005.
12
Box 2: Shaping Fiji’s Healthy Islands
"In... 1998, Fiji produced it first National Environmental Health Action Plan
(NEHAP). This document began by setting out frameworks for Environmental Health
and Healthy Islands. It did four things:
•
•
•
■
Aligned Fiji’s Environmental Health programme with Agenda 21;
Gave shape to the Healthy Islands vision of the Yanuca Island Declaration;
Acknowledged the Jakarta Declaration on Health Promotion; and
Reinforced the Raratonga Agreement on Healthy Islands.
The document provided a blueprint for reshaping the old reactive Health Inspectorate,
as a much more pro-active and collaborative Environmental Health Service. It also
paved the way for a productive partnership with the emerging National Centre for
Health Promotion." [Shaping Fiji's Healthy Islands - Strategies for transforming
national policy into local practice. Fiji, Ministry of Health, 2001.]
In the United States, the struggle for smoke-free passenger airplanes began in the United
States in the 1970s. It was only in 1990 that a ban on smoking on all passenger airplanes took
effect. The success of this long campaign is attributed to the partnership of organized labor (the
flight attendants and their unions) with health advocacy groups and key members of the United
States Congress around a single-focus issue. The dynamics of the partnership went well beyond
the obvious concern over the health impacts of secondhand tobacco smoke.
Population-specific issues, such as -
In Asia and the Pacific, hospitals are traditionally viewed as the cornerstone of the system
that provides health care services to the community. However, in practice, services are focused
more on providing technical solutions to the curative aspects of ill health. Less effort and time are
spent on preventive interventions, health promotion and health protection. At San Lazaro
Hospital in Manila (the Philippines' major infectious disease hospital) the establishment of an
Extended Child Care Centre, in 2001, is an innovative programme that responds to this need.
Children (together with parents and caregivers) receive on-going support, nurture, protection and
or stimulation while they are in the hospital environment.
This initiative is making a significant contribution to the development of a national extended
childcare policy in the Philippines, and providing new knowledge about the development of public
private partnerships to combat poverty and support children's health and wellbeing. This initiative
is partnership venture among San Lazaro Hospital, the Philippine Department of Health, the
World Health Organization and a not-for-profit non-governmental organization, Precious Jewels
Ministry (PJM). The lessons learned in this on-going initiative will be relevant to enhancing child
health and related policies and programmes in other settings and countries. A significant factor in
making this initiative successful has been the 15-year relationship building work undertaken by
PJM in the communities served by San Lazaro Hospital, as well as in the hospital itself.35
35 Ireland J. Tamplin S. Case Study Report on the First Year of Operation of the San Lazaro Hospital
Extended Child Care Centre. University of Western Sydney, Hawkesbury, The Centre of Environmental
Health Development, a WHO Collaborating Centre for Environmental Health. 2003.
Settinqs-based approaches.” such as □
□
□
□
5.0
The WHO "Healthy Cities" movement [including “Healthy Islands" in the Western Pacific
Region, "Healthy Municipalities and Communities in the Region of the Americas, etc ),
and the related “Healthy Settings” approaches,
The Local Agenda 21 initiative of the United Nations Division for Sustainable
Development and its partners,
The Sustainable Cities Programme of UN-HABITAT; and,
Cities Alliance launched by the World Bank and the United Nations Centre for Human
Settlements.
“Back to the Future”
In looking to the future, how might "health promotion" and “environmental health" build on
these types of successful partnership experiences to effectively address emerging issues of
environmental change? Or, from Asian perspective, how might we honor the past while meeting
the challenges of the future9
A challenging opportunity provides a context
In March 2005, in Santiago, Chile, the World Health Organization launched its Commission
on Social Determinants of Health (CSDH). This Commission will “work to recommend the best
ways to address health's social determinants and safeguard the health of poor and marginalized
populations, and to break the ‘poverty equals ill-health’ cycle."36
37 Among the ways in which the
work of Commission will be supported is through the use of several "knowledge networks"38 of
leading scientists and practitioners to assemble evidence to underpin actions on social
determinants of health. In the words of Dr. J.W. Lee, Director-General, WHO
"The goal is not an academic exercise, but to marshal scientific evidence as a lever
for policy change - aiming toward practical uptake among policymakers and stakeholders in
countries.'39
One of the Knowledge Networks is being organized around the theme of “urban settings."
The “Hub" that has been selected to manage the work of this Network is the WHO Centre for
Health Development, located in Kobe, Japan. The Scope of Work for the Urban Settings
Knowledge Network suggests an interesting conceptual framework for considering health and
well being, identifying "health governance" as the critical causal pathway. This identification of
governance as a critical factor in determining health outcomes and the need to focus on it in
achieving sustainable improvements in health and well being is well-documented [for example, S
Burris (2OO4);40 E Sclar, et al (2005);41 S Galea, et al (2005);421 Kickbusch (2002);43 and the
36 Referring to areas such as cities, islands, communities, villages, neighborhoods, schools,
hospitals, workplaces, markets, etc.
37 News Release WHO/13,18 March 2005.
38 These Knowledge Networks will be organized around the themes of social exclusion, urban
settings, employment conditions, early child development, priority public health conditions, health
systems, globalization and measurement
World Health Organization. Commission on Social Determinants of Health Concept Paper- 29 April
2004. Geneva. WHO. 2004
40 Burris S. Governance, Micro-governance and Health. Conference on SARS and the Global Governance
of Public Health, Temple University Beasley School of Law, Philadelphia. PA. USA, March 2004.
41 Sclar E. Garau P. Carolini G The 21s1 century health challenge of slums and cities. The Lancet, Mar 5Mar 11. 2005; 365. 9462; Health Module.
42 Galea S. Freudenberg N, Vlahov D Cities and population health. Social Science & Medicine. 60 (2005)
1017-1033.
14
Millennium Project Task Force on Improving the Lives of Slum Dwellers (2005)-’4] However, this
Knowledge Network effort to focus on analyzing what's working on the ground in relation to health
governance and to look for creative ways of "scaling up” as a major public health initiative is
unique.
A historical concept suggests a methodological focus
In a paper based on his participation at the Second Annual Belfast Healthy City Lecture
(1999), Trevor Hancock introduces the notion of "community capital."43
4546
44
He characterizes health
as "a form of wealth, a resource, an asset; in short, a form of capital." In developing the idea of
community capital, Hancock speaks of total wealth as consisting of four forms of capital:
□
□
□
□
Human capital - consisting of "healthy, well educated, skilled, innovative and creative
people who are engaged in their communities and participate in governance;"
Natural capital - comprised of "high environmental quality, healthy ecosystems,
sustainable resources and the conservation of habitat, wildlife and biodiversity;"
Social capital - constituting “the 'glue' that holds our communities
together...[consisting of]...an informal aspect related to social networks and a more
formal aspect related to our social development programs," and,
Economic capital - constituting “the means by which we can attain many of our
human and social goals."
Hancock offers the challenge: "What communities require is a new form of capitalism: one that
will simultaneously increase all four forms of capital. This can be considered to be the creation of
community capital." This idea of needing to simultaneously increase all four forms of capital
resonates well with the findings of the Millennium Ecosystem Assessment Synthesis Report,* as
well as with the experience of others involved in “Healthy Cities" and other similar approaches.4748
Experience provides a mechanism for honoring the past in meeting the challenges of the
future
A framework for responding to the challenges of environmental change would do well to
incorporate the collaborative strengths of health promotion and environmental health For the
most part, this grows out of their experience in relation to “healthy settings," where the litany of
integrated, inter-sector, participatory approaches to public health problem solving abounds. This
experience is particularly relevant to the work envisioned for the CSDH Knowledge Network on
Urban Settings. In this regard, the Scope of Work for the Network notes the following:
“...at present, a significant number of economic, social and political factors find their
expression in two major trends of global restructuring: globalization and urbanization. These two
major forces are intertwined which has led some analysts to speak of a 'global' phenomenon
Therefore, as urbanization and its impacts on health are analyzed, the related global dimension
and its impact cannot be neglected.
43 Kickbusch I. Influence and opportunity: Reflections on the US role in global public health. Health Affairs.
Chevy Chase: Nov/Dec 2002. Vol. 21, Is. 6
44 A Home in the City. The UN Millennium Development Project Task Force on Improving the Lives of Slum
Dwellers. London, Earthscan, 2005.
45 Hancock T. People, partnerships and human progress: building community capital. Health Promotion
International. September 2001, 16. 3.
46 Reid VW. et al. Millennium Ecosystem Assessment Synthesis Report. Pre-publication Final Draft
Approved by MA Board on March 23. 2005. www.millenniumassessment.org . downloaded 2 May 2005.
47 Price C. Tsouros A. Eds. Our Cities. Our Future Policies and Action Plans for Health and Sustainable
Development Copenhagen. WHO Healthy Cities Project Office. 1996.
48 Scope of Work for the Knowledge Network on Urban Settings. Kobe, Japan, World Health Organization
Centre for Health Development, June 2005
15
Similarly, national-level policy and governance dimensions cannot be neglected either. As
characterization of the "globalization" phenomenon suggests, consideration of the social
determinants of health in the context of urbanization and urban settings needs to take traditional
cities and health approaches to a new level. The idea of "new urban settings" encompasses
much more than a city’s generally recognized geographic and political boundaries. "New urban
settings" have local, national and global impacts In this context, national governments face
significant health, environment and development challenges in relation to urbanization,
globalization and environmental change. They need to be intimately involved in policy
development that creates immediate and sustainable responses to these challenges in urban
settings. Also, at both the national and local levels, external support organizations (in both the
public and private sectors) need to be engaged as partners.
The key word in all of this is "partnerships" - partnerships that are built on a well-considered,
step-wise approach and reflect the “seven C's" of effective collaboration
Articulating a Grand Challenge
"Healthy urban settings partnerships" (encompassing the related initiatives of external
support agencies - e g.. Cities Alliance, Healthy Cities, Local Agenda 21, Sustainable Cities, etc.)
are potentially powerful mechanisms for influencing health governance.
The grand challenge for the Knowledge Network on Urban Settings and the future
collaborative work of health promotion and environmental health and their partners is to influence
health governance in ways that create and sustain community capital and reduce health inequity.
In taking on this Grand Challenge, partners should be mindful of the need to simultaneously
enhance human, natural, social and economic capital, and Hancock’s admonition that:
“There are no quick-fix solutions to the creation of healthier cities and communities, instead a
long-term commitment to multiple small steps must be taken In essence, a healthy community
and a healthy city is created one household at a time, one street at a time, one block at a time,
one neighborhood at a time and one day at a time "
[Hancock T. People, partnerships and human progress: building community capital. Health
Promotion International. September 2001, 16,3.]
16
6.0
Conclusions
■
Finding sustainable solutions to environmental change-related public health problems is
elusive and challenging.
■
The public health problems associated with environmental change are complex;
resources to deal with them are scarce; and people are overwhelmed.
•
Environmental health-related frameworks that support broad-based approaches directed
at the forces that dnve environmental changes are available, but effectively using them is
sometimes problematic
■
Holistic approaches to environmental health problem solving often require health
promotion interventions; and, holistic approaches to health promotion problem solving
often benefit from environmental health interventions
•
Effective partnership approaches can help overcome complexity and contribute to
achievement of the Millennium Development Goals. The experience of health promotion
and environmental health practitioners in the “healthy settings" approach bears this out.
■
“Health governance" is a critical pathway to affecting health and well being.
•
Creating and sustaining “community capital” is critical to enhancing health and well being
in urban settings.
■
"Healthy urban settings partnerships" are potentially powerful mechanisms for enhancing
health governance in ways that create and sustain community capital.
Grand challenges are to be embraced, not feared.
vv - siA 'a-2
GENDER AND HEALTH PROMOTION:
A MULTISECTORAL POLICY APPROACH
Piroska Ostlin*, Elizabeth Eckermann, Udaya Shankar Mishra,
Mwansa Nkowane, Eva Wallstam
6th Global Conference on Health Promotion
August 2005, Bangkok, Thailand.
Abstract
Women and men are different as regards their biology, their roles and responsibilities that society
assigns to them, and their position in the family and community. These factors have a great
influence on causes, consequences and management of diseases and ill-health. This is
confirmed by evidence on male-female differences in cause-specific mortality and morbidity and
exposure to risk factors. Health promoting interventions and policies aimed at ensuring safe and
supportive environments, healthy living conditions and lifestyles, community involvement and
participation, access to essential facilities and to social and health services, need to address
these differences between women and men, boys and girls in an equitable manner in order to be
effective. The aim of this paper is to (a) demonstrate that health promotion policies that take
women’s and men's differential biological and social vulnerability to health risks into account are
more likely to be successful and effective compared to policies that are not concerned with such
differences, and (b) discuss what is required to build a multisectoral policy response to gender
inequities in health through health promotion and disease prevention. The requirements
discussed in the paper include 1) the establishment of joint commitment for policy within society
through setting objectives related to gender equality and equity in health as well as health
promotion, 2) an assessment and analysis of gender inequalities affecting health and
determinants of health, 3) the actions needed to tackle the main determinants of those
inequalities, and 4) documentation and dissemination of effective and gender sensitive policy
interventions to promote health. In the discussion of these key policy elements we use illustrative
examples of good practices from different countries around the world.
'Corresponding author. Karolinska Institute!, Department of Public Health Sciences, Division of
International Health, SE-171 77 Stockholm, Sweden. E-mail: piroska.ostlin@phs.ki.se
2
Introduction
In most countries, resources allocated by government to health promoting activities are very
limited compared to investments in medical care'. This imbalance is evident also in the richest
countries of the world. For example, in the US approximately 95 percent of the health expenditure
goes to direct medical care services, while only 5 percent is allocated to prevention activities.2 In
Canada, the medical care systems absorbs the majority of health sector resources, with less than
3 percent of health spending allocated towards health promotion.3 Therefore, it is of utmost
importance to invest these limited resources in preventive activities with high potential for success
and cost-effectiveness.
In the first section of this paper we argue that health promotion policies that take women's and
men's differential biological and social vulnerability to health risks into account are more likely to
be successful and cost-effective compared to policies that are not concerned with such
differences.
Examples of common gender biases in health promotion programmes are discussed in the
second section and, in the third section, we discuss what is needed to counteract gender biases
in health promotion interventions and what is required to build a strong multisectoral policy
response to gender inequalities in health through health promotion and disease prevention. We
emphasize that health promotion actions need to take place within the broader social and
economic arena (e.g. finance, labour market, education) where the unequal distributions of power,
wealth and risks to health between men and women are generated, beyond the reach of the
health care sector.
1. Why should health promotion and disease prevention policies and interventions pay
attention to gender?
There is increasing evidence from all fields of health research that women and men are different
as regards their biology, their access to and control over resources and their decision-making
power in the family and community, as well as the roles and responsibilities that society assigns
to them. These factors have a great influence on causes, consequences, management and
outcomes of diseases and ill-health.
Biological differences (sex differences) between men and women, such as muscular strength,
proportion of fat tissue, body size, hormonal makeup, and reproductive functions result in
differential susceptibility to diseases. For example, women are biologically more vulnerable to
morbidity from malaria during pregnancy 4 Women are at risk of acquiring HIV through hetero
sexual contact due to the larger surface area of the mucous membrane exposed during sexual
intercourse and the fragility of the mucosal membrane among girls under the age of 18? Even for
non-communicable diseases, studies show that there are biological differences in the impact on
health.6 Because of biological factors, women (or men) may experience worse health effects,
even when exposed to the same degree to certain risk factors. For example, women are at
greater risk of harm from fat-soluble chemicals because of their greater proportion of fat tissue,
thinner skin and slower metabolism.7 As regards sex-specific morbidity, studies show that men
who smoke have decreased fertility and sexual potency8, while smoking women are at higher risk
for cardiovascular disease, infertility, cervical cancer, premature labour, early menopause and
increased risk for fractures9. Women also appear to be more vulnerable than men to many
adverse consequences of alcohol use. Women absorb and metabolize alcohol differently than
men and they achieve higher blood alcohol concentrations after drinking equivalent amounts of
alcohol.10
Differences between men and women due to social and cultural factors (gender differences),
such as power relations, social position, accepted roles and behaviours, division of labour as well
as living and working conditions result in differential exposure to risk factors. These social
3
arrangements differentially affect men's and women's chances to remain healthy. For example,
because of the strongly gender segregated labour market women and men are often found in
different type of jobs - with different social benefits and in different work environments - and,
consequently, they are exposed to different kinds of health-promoting and health damaging
factors.1' Gender constructed roles and norms around masculinity that include risk taking and
aggressive behaviour, risky alcohol consumption and other psychoactive substance use puts men
at greater risk of road traffic accidents.’2 The construction of femininity may also provoke health
damaging behaviours. For example, body weight perceptions and the use of weight control
behaviours are significantly associated with predictors of smoking among adolescent females.13
Neither biological nor social factors act alone to determine health inequalities between women
and men. Biology and social factors interact in complex ways: For example, evidence suggests
that women's lower social status and autonomy exacerbate their susceptibility to HIV and other
diseases.14 Little attention has been paid in health promotion research, as well as in policy, to the
interaction between gender and other social factors (e.g. class and ethnicity).15 For example,
gender and poverty often combine to create multiple barriers to the well being of women: apart
from being biologically more vulnerable when pregnant, poor women are also more vulnerable to
morbidity from malaria (than both rich women and poor men) due to poorer access to quality
health services, adequate nutrition and education.16
Health promotion as well as disease prevention needs to address these differences between
women and men, boys and girls in an equitable manner in order to be effective. There is
emerging evidence that integrating gender considerations into interventions has a positive effect
on health outcomes across various domains.17
2.
Gender bias in health promotion policies and interventions
During the last few decades there has been an emerging recognition among health professionals
— researchers and policymakers alike, of the widespread and profound implications of gender
based inequities in health. There is growing body of scientific evidence that women and men face
distinct health risks and have different health needs due to biological differences as well as
socially constructed inequalities or gender differences. Even though knowledge of gender
differences in health is increasingly available, it does not always translate easily into realities of
health planning and programme implementation. The field of health promotion is no exception:
gender bias in far too many health promotion interventions leads to misallocated resources and
weakened potential for success.
2.1
Gender blindness
When planning and implementing health promotion and disease prevention strategies, gender is
an issue that is often neglected. 19,20 Generally, there seems to be an assumption that
interventions will be just as effective for men as for women. Many health promotion programmes
are gender blind and based on research where the sex of the study participants is not made
explicit. Gender-neutral expressions, such as ‘health care providers', ‘children’, ‘adolescents' or
‘employees' are often used in programme descriptions and reports.21 As a result, collection,
analysis and presentation of data are often not sex-disaggregated.
2.2
Gender’ as a proxy for 'women'
While talking about health promotion, It needs to be recognised that health promotion involves the
agent of promotion and the beneficiary of it. In this context the social construction of gender roles
come into play as many of the promotional measures are put into action by women being the care
guarantor of every individual in the household. Consequently, health promotion messages often
target women in their assigned role as caregivers in the family.22 Since women’s ability to make
decisions about implementing health promotional measures is often limited in many countries due
4
to their lower status in the household, the positive health effects of the promotional measures
may be less than expected. When health promotion campaigns are addressed to the family as a
whole, health programmes can be considerably improved. In Ghana, for example, information
about the importance of child immunization was directed to both fathers and mothers. As a result,
men have taken greater responsibility for their children's health, leading to increased vaccination
rates and earlier immunization.23
2.3
Focus on behavioural change
Many health promotion strategies aim at reducing risk behaviours, such as smoking, while
ignoring the social and psychological conditions within which the targeted behaviours are
embedded. Critics have argued that gender roles and health-related behaviours linked to those
roles in many health promotion programmes have led to a focus on behavioural change at the
individual level, rather than on policy change at the societal level.24'25 For example, prevention
strategies to reduce harmful stress among working women often include measures where the
onus is put on women to develop their own personal stress coping strategies to balance
competing gender roles. Targeted women feel often accused of not being able to cope with
multiple pressures arising from lheir responsibilities as mothers, wives, housekeepers and
workers. To avoid this, complementary measures to ease women’s burden through e.g. provision
of day-care centres for children and introduction of more flexible working hours should also be
introduced.
Similarly, many men may experience extraordinary pressures from unemployment and material
hardship, which constrain them to fulfil their assigned gender role as "breadwinners".26 Those
who try to cope with stresses through behaviours, such as smoking, drinking or drug abuse, are
accused of risking their health by their own personal choice. Strategies that aim at changing the
life-styles of these men would probably be more effective if combined with measures to change
the social environment in which the health damaging life-styles are embedded.
According to a study from Thailand, while the nationwide “100% condom programme" to prevent
HIV infection has led to a decrease of the infection among men, young women who were
engaged in commercial sex have not been protected from the infection to the same degree as
men. The authors of the study call for additional measures to protect young women. Obviously,
there is a need for policies that recognise and address the gender differences of status and
power that structure sexual relationships and counteract women's lack of assertiveness to insist
on condom use.
2.4
Lack of multisectoral approach
Traditionally, the health field has been predominantly the domain of medical professionals and
the health care sector, where the main focus is on individual health and individual risk factors.
Therefore, health promotion and disease prevention strategies within the health care sector are
often limited to individual health advice, e.g. on smoking cessation. One limitation of this is that
certain groups of people, such as the poor who cannol afford user fees, or women who cannot
without permission from their husbands visit health clinics, will be excluded from health advice
and information. Another limitation is that the promotional measures within the health care sector
are unable to tackle the root causes of health disparities. Many of the health determinants need to
be tackled by policies outside the health sector, e.g. the labour market, social services, education
system, housing, environmental protection, water and sanitation, transport, road safety and
security. These policies have direct and indirect health impacts, which may differ between men
and women.24 Thus, health promoting policies and interventions should be a concern for several
societal sectors. Any such initiative should take into account the involvement of key stakeholders
in communities and needs to be acceptable at individual, household as well as societal level.
5
2.5
Top-down approach
The traditional public health approach is top-down rather than bottom-up, i.e. experts identify
problems and formulate interventions while the problems and solutions as perceived by those at
particular risk rarely constitute the base for action.29 The power of change is then defined
primarily in political and professional terms without the possibility of the targeted people to
influence and control various determinants of health. Because of power imbalances, and because
of the low representation of women in decision-making bodies, women can seldom make their
voices heard. As a result, health promotion programmes designed in top-down manner will not
necessarily correspond to women's health needs. Health promotion policies and activities are
most meaningful when target communities and groups are involved in all aspects of policy and
programme development, implementation and evaluation. For example, "The Blue Nile Health
Project" in Sudan with the objective to control water associated diseases was perceived as very
successful, thanks to the particular emphasis in the programme on gender-related aspects that
defined women’s role and participation.30 The study urges health planners to persuade the
subordinated communities of women in many African countries, like Sudan, to play a more active
role in the health programmes.
3. The way forward: multisectoral policy response to gender inequities in health through
health promotion and disease prevention
Building on past experience from successful and less successful health promotion strategies from
a gender equity perspective, we discuss in the following some minimum requirements for gender
sensitive health promotion and disease prevention policies and programmes. These include 1)
the establishment of joint commitment for policy within society through setting objectives related
to gender equality and health as well as health promotion, 2) an assessment and analysis of
gender inequalities affecting health and determinants of health, 3) the actions needed to tackle
the main determinants of those inequalities, and 4) documentation and dissemination of effective
and gender sensitive policy interventions to promote health.
3.1
Joint commitment
Through international agreements, such as the Ottawa Charter of Health Promotion and the WHO
Health For All Strategy3’, many countries have already committed themselves to health promotion.
Likewise, most countries in the world have committed themselves to promote gender equity.
These agreements state that all women and men have the right to live without discrimination in all
spheres of life, including access to health care, education, and equal remuneration for equal
work.3233
Most recently, the internationally agreed Millennium Development Goals identified "Gender
equality and empowerment of women” as the third of eight goals and a condition for achieving the
other seven. Although, these and similar commitments33 have been ratified by most United
Nations Member States, action by governments to bring national laws, policies and practices in
line with the provisions of the ratified conventions has lagged behind. Moreover, these
commitments have not been pursued in the health sector.
The Beijing Declaration and Platform for Action in 1995 as well as the UN Economic and Social
Council (ECOSOC) in 1997 have clearly established "gender mainstreaming" as the global
strategy for promoting, among other things, women's health. In the field of public health, this
strategy means the integration of both women's and men's concerns into the formulation,
monitoring and analysis of policies, programmes and projects. In relation to health promotion, it
entails taking into account gender issues that have implications for individual and community
health.
6
Setting international, national and local objectives for gender equity in health is the first step in
establishing a joint commitment. These objectives need to be measurable and translated into
policies and actions.
A good example of translating international objectives to promote gender equity and health into
national objectives comes from Lao PDR. The Lao Ministries of Health and Education have
signed, in response to the need to meet the targets of the MDGs, a memorandum of
understanding to collaborate in developing health promotion programmes in Lao primary schools
which address all 8 targets including MDG 3 to promote gender equity. In combination with the
Lao Women’s Union, village health committees, NGOs and international organizations, the Lao
government ministries have also developed a multi-sectoral national development plan to
mainstream gender into all areas of health and wellbeing.
3.2
Assessment and analysis of gender inequities in health
In order to maximize efficient use of resources, health promoting strategies and actions, in
general, need to be based on an assessment of the size, nature and root causes of gender
inequalities in health. More specifically, health promotion relating to certain issues e.g. HIV/AIDS,
malaria, nutrition or smoking, needs to be designed with an understanding of how women and
men differ in relation to the issue's causes, manifestations and consequences. Indicators of
health, wellbeing and quality of life need to be sex and gender sensitive. Collection, analysis and
reporting of data disaggregated by sex, age, socioeconomic status, education, ethnicity, and
geographic location, where relevant and possible, should be performed systematically by
individual research projects or through larger data systems at regional, national and international
levels. Attention needs to be paid to the possibility that data may reflect systematic gender biases
(e.g. in exposure levels to health risks) due to inadequate methodologies that fail to capture
women’s and men's different realities.15 The promotion of gender sensitive-research to inform the
development, implementation, monitoring and evaluation of health promotion policies and
programs is also desirable. Although many data bases which are available within international
and national health institutions have the potential for being analysed by sex with a gender
perspective, such analysis is seldom done. This is clearly a lost opportunity for identifying and
understanding gender and sex related differences which may benefit from specific actions.
One good example of recording sex disaggregated, gender sensitive and gender specific health
data comes from Malaysia. In 2000, the Asian-Pacific Resource & Research Centre for Women
(ARROW) published 'A Framework of Indicators for Action on Women's Health Needs & Rights
after Beijing'.35 This publication was developed as a tool for all government, non-govemment and
international organisations to use in monitoring implementation of the Beijing Platform for Action.
The framework presents selected Beijing recommendations on women's health and rights, sexual
and reproductive health, violence against women and gender-sensitive health programmes,
which are then operationalised into quantitative and qualitative indicators. These can be
measured to assess progress particularly in women’s health status; health service provision, use
and quality; and national laws, policies and plans.
Another good practice in analysing data by gender to inform implementation of a health
promotional intervention has taken place in Sao Paulo in Brazil. The Agita Sao Paulo Programme
to promote physical activity is a multi-level, community-wide intervention. Gender analysis of sexdisaggregated data revealed important differences between adolescent boys and girls concerning
patterns of physical activity.36 Firstly, girls were more involved in vigorous physical activity than
boys, which was a surprise because literature from well-developed countries suggested the
opposite. Further analysis showed that the main reason behind this was girls’ involvement in
strenuous housekeeping (42% of girls versus 6% of boys). On the other hand, boys utilised more
active transportation to and from school (100% of boys versus 57% of girls). This was a very
important source of information for the programme managers for the design and kind of
intervention to increase physical activity among girls and boys.
7
3.3 Actions needed to tackle the main social and environmental determinants of gender
inequities in health
The prime determinants of gender inequities in health are social and economic disadvantages
related to factors such as decision-making power, income, employment, working environment,
education, housing, nutrition and individual behaviours. As mentioned previously, women and
men are exposed to various risk factors to different degrees due to differences in gender roles
and living and working conditions. These differences are crucial to recognize, estimate and
monitor when designing interventions, programmes and population-wide risk reduction strategies.
Many determinants of gender inequities in health can be influenced by health promoting
measures and risk reduction strategies ranging from micro to macro public policy levels.37
(a)
Actions to strengthen individuals
Many health promoting interventions with a gender perspective have focused mainly on
strengthening women's and girl’ capacity to better respond to, and control determinants of, health
in the physical and social environment. The most effective interventions are those with an
empowerment focus.38 They aim to help women to gain their rights, improve their access to
essential services, address perceived deficiencies in their knowledge, acquire personal skills, and
thereby improve their health. Empowerment initiatives aim to encourage both sexes to challenge
gender stereotypes. Such actions can include, for example, training boys and men to reduce
gender biases by promoting gender-sensitive behaviour and reducing violence. Another example
of such initiatives is raising awareness among young girls and their families about unfair
discrimination against girls and thereby promoting the status and a value of the girl child. The Girl
Child Project in Pakistan has for example made girls aware that unequal food allocation in the
family is wrong.39
(b)
Actions to strengthen communities
Strengthening communities can cover a wide spectrum of strategies aimed at strengthening the
way deprived communities function collectively for mutual support and benefit. These range from
helping to create meeting places and facilities for social interaction to supporting communities’
defence against health hazards, such as substance abuse, crime and violence or environmental
pollution. For example, several innovative and gender-sensitive community level initiatives have
emerged in Africa over the past decade in response to the devastating effects of the AIDS
epidemic in the region.40 One of these initiatives is the Community Life Project in Lagos, Nigeria
which is a unique example of how synergistic partnerships between activists, community and
religious organizations, local institutions, involving men, women, and children simultaneously, can
help to effectively break the silence on sexuality issues.41 The project is working with 23
community groups to increase and sustain HIV/AIDS awareness in the community; addressing
HIV/AIDS within the broader framework of sexual and reproductive health through sexuality
education sessions; and increasing community ownership and participation by training
representatives of the groups as volunteers and family life educators. Thus, the initiative places
sexuality education on the community’s agenda, thereby creating a supportive environment for
advancing women’s reproductive and sexual health.
(c)
Actions to promote gender equity in access to essential facilities and services
In both industrialized and developing countries improvements in living and working conditions and
access to services have been shown to bring substantial health improvements to populations.
Public health initiatives influencing living and working conditions include measures to improve
access to clean water, adequate nutrition and housing, sanitation, safer workplaces and health
and other welfare services. Policies within these areas are normally the responsibility of separate
sectors and there is a need for them to co-operate in order to improve the health of the population.
Health promotion policies and interventions aiming at improving living and working conditions and
access to services need to be particularly gender sensitive due to the fact that women and men
8
face distinct health risks in their living and working environment and have different health needs.
For example, many developing countries suffer from weak health services, infrastructures and
unaffordable services, a situation that disproportionately affects women as they require more
preventive reproductive health services. The inadequacy and lack of affordability of health
services is compounded by physical and cultural barriers to care. At the national level some
attempts have been made to tackle cost and affordability barriers in health services to women.
For example, South Africa and Sri Lanka provide free maternal and infant health services. In
some cultures, women are reluctant to consult male doctors. The lack of female medical
personnel is an important barrier to utilization of health services for many women.'12 To overcome
this barrier, the Women's Health Project in Pakistan works with the Ministry of Health to improve
the health of women, girls and infants in 20 predominantly rural districts in four provinces through
measures, such as the expansion of community-based health care and family planning services
through the recruitment and training of thousands of village women as Lady Health Workers, a
'safe delivery' campaign, and the promotion of women's health and nutritional needs and family
planning.43 The project assumes that a female health care provider could better understand the
problem of another woman.
(d)
Actions to encourage social and economic policy change
Policies at the structural level include economic and social policies spanning sectors such as
labour market, trade environment, and more general efforts to improve women's status. These
policies have a great potential to reduce or exacerbate gender inequality, including inequities in
health. Influencing factors affecting social stratification is therefore a key for the improvement of
women’s social position relative to men. This requires policies that influence opportunities women
have to improve their capabilities. Policies aimed at improving women’s education, increasing
their possibilities to earn an income within the labour market and family welfare policies are all
measures for improving women’s social status in the family and in the society. Improved social
status for women relative to men may improve women's control over household resources and
their own lives. For example, development policies in Matlab (Bangladesh) included strategies,
such as micro-credit schemes linked to employment and provision of more places in school for
daughters of poor families, which successfully increased the status of the poorest women. Equityoriented policies in a social context in which women had traditional matrilineal rights to property
and girls were valued as much as boys have resulted in considerable health gains in Kerala, India.
Women could benefit from improvements in health care provision and to achieve high levels of
literacy. Kerala is the only state in India where the population sex ratio has been favourable to
women throughout the twentieth century and it is not plagued by the problem of "missing
women”.44 Increasing the participation of women in political and other decision-making processes
- at household, community and national levels and ensuring that laws and their implementation do
not discriminate against women are measures that have a great potential to improve gender
equality and health equity.
3.4 Documenting and disseminating effective and gender sensitive policy interventions to
promote health
There is a paucity of information on cost-effective and gender sensitive health promoting
strategies and interventions that have successfully addressed social determinants of health, and
little concrete guidance is available to policymakers. Developing an international reporting system
to collect such information in order to increase the accessibility for policy-makers to relevant
information needs to be encouraged. Monitoring and evaluation of strategies and interventions
are also important for informing future processes and track progress towards gender equality.
Indicators and methods should be developed urgently for systematic integration of gender
dimensions in health impact assessments that assess not only a policy's impact at an aggregate
level, but on different population groups, including the marginalized and vulnerable; such an
9
assessment should be applicable not only to health systems policy, but also to policy in other
sectors.45,46
Conclusion
Recognizing gender inequalities is crucial when designing health promotion strategies. Without
such a perspective their effectiveness may be jeopardized and inequities in health between men
and women might even increase. Although, the dynamics of gender inequalities are of profound
importance, gender biases in health research, policy and programming, and institutions continue
to create a vicious circle that downgrades and neglects gender perspectives in health.
The country case study examples presented in this paper suggest that it is feasible and beneficial
to integrate gender in health promotion policies. However, greater efforts are needed to sensitize
stakeholders including health professionals - policymakers and researchers alike - to its
importance. Many lessons have been learnt which can be used as building blocks for adaptation
to ensure that health promotion policies are contextual in nature taking into account gender
specific factors that can impinge on the promotion of health among a given community. Effective
health promotion policies and programmes are those based on joint commitment and a
multisectoral approach and are based on evidence gathered with gender dimensions in mind.
Acknowledgement
We would like to thank the staff of the Gender, Women and Health Department and the
Department of Chronic Diseases and Health Promotion at WHO in Geneva, for valuable
comments.
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13
C.On-n. \-v — s
Health Promotion in an Urbanizing World
Dinesh Mehta, Gora, Mboup, Sandro Gaela, Nicholas You
6lh Global Conference on Health Promotion
Bangkok, 7-11 August 2005
> D-y
1
The Urbanization Challenge
United Nations projections suggest that over the next thirty years virtually all of the
world's population growth will occur in the urban areas of low- and middle-income
countries. In 1950, only 30% of the world was urbanized; and by 2001, it was estimated
that 47.5% of the world's population live in urban areas. This level of urbanization will
rise to 56.7% by 2020, with all of the urban growth occurring in developing countries. At
the beginning of the 20th century, just 16 cities in the world contained at least a million
people, the vast majority of which were in industrially advanced economies. Today, at the
beginning of the 21st century, there are around 400 cities around the world that contain
over a million residents, and about three-quarters of these are in low- and middle-income
countries. This dramatic transition of world population growth is unprecedented in human
history, as more people will live in urban areas of the world. Another distinctive feature
is that most of the urban growth will be a result of natural population increase and the
structural transformation of formerly rural areas on the periphery of urban areas, and not
due to rural-to-urban migration as is commonly understood.
Urban and rural populations in developing countries
(millions)
4000
£ 3500
| 3000
2500
7 2000
□ Urban
o
■ Rural
1500
a 1000
a-
500
0
1965
1975
1985
1995
2005
2015
2025
Year
Fig. 1 The urban population in developing countries will soon surpass the rural population.
Significant regional differences continue to define worldwide urbanization trends. Latin
America continues to be the most urbanized region, with almost 76% of its population
already urbanized, and an anticipated 81% by 2020. In Latin America there is now a
deconcentration process seen by more rapid growth of small and medium sized cities. In
Asia, there are large population concentrations and almost half of the total world urban
population is in this region. It is anticipated that by 2020. 54% of Asia will be urbanized.
Sub-Sahuian Africa will also experience a dramatic reversal of demographic trends.
Africa will cut through the rural-urban divide by 2015 and be 53% urbanized by 2020.'
However. Africa is also been the one region that has been characterized by dramatic
urbanization and very low economic growth.
Historically, urbanisation process was stimulated by economic development. The reason
was that economic development involved the transformation of an agricultural based
economy to an industrial-service based economy. Production of manufacturing and
services is much more efficient when concentrated in dense business-industrial locations
in cities. Close spatial proximity, or high density, promoted information spillovers
amongst producers, more efficiently functioning labour markets, and savings in the
transport costs. This was the experience of Europe in the nineteenth century and Latin
America in second half of twentieth century. Today in many parts of the world.
urbanization is being accelerated by (and is accelerating) a new global economy that is
literally changing the face of the planet. Increasingly, urban growth is being influenced
by continued global economic integration and the struggle for countries—and indeed
individual cities—to be competitive in the global marketplace. Managing urban growth
has increased in both scope and complexity and has become one of the most important
challenges of the 21st century.1
In a W'orld of liberalized trade and finance, cities are focal points for investment.
communication, commerce, production and consumption. Along with the prosperity that
such investments bring to cities, in developing countries there are associated problems of
poor infrastructure, lack of basic services, increasing pollution, and increasing number of
poor people. For developing countries, meeting the challenge of health in new urban
setting is difficult for many reasons. Currently, information is limited on the extent to
which changes in migration, size and density of cities and characteristics of the urban
physical and social environments affects individual and population health. Intra-urban
differentials in health outcomes is unavailable for most urban areas, but information from
a few cities suggest that situation in urban poor neighbourhoods is often worse than rural
areas. This paper discusses some of the available evidences that demonstrate health
conditions for the urban poor in developing countries and suggests possible ways to
promote health in urban setting.
' Barney Cohen (2004), "Urban Growth in Developing Countries: A Review of Current Trends and a
Caution Regarding Existing Forecasts", World Development Vol. 32, No. 1, pp. 23-51, 2004
-3-
2.
Urbanisation of Poverty and Skints
Just as the world is becoming increasingly urban, there is also an increase in the number
ot poor people in the world. UNDP's 1999 Human Development Report demonstrates
that despite the significant advances in human development in previous decades, extreme
poverty persists. In developing countries there are still 60 percent more illiterate women
than men. An estimated 1.3 billion people live on incomes of less than $1 per day.' In
his "Millennium Report." United Nations Secretary-General Kofi Annan declared that
"extreme poverty is an affront to our common humanity.” and called on the international
community, "to adopt the target of halving the proportion of people living in extreme
poverty... by 2015.”’
The World Development Report 2001. estimated that while both the share of population
and the number of people living on less than a dollar a day declined in the mid-nineties,
this decline was exclusively due to a reduction in the number of poor people in East Asia.
most notably China. In South Asia, the absolute number of poor has been rising steadily
since 1987. Africa is now the region with the largest share of people living below $l/day.
In Latin America, the share of peer people remained the same and the absolute number
has increased. And in the countries of the former Soviet bloc, poverty rose markedly,
both in terms of share and absolute number.
Do more poor people are now in urban areas than ever before? Using the best available
survey data from WHO and the World Bank. Haddad. Ruel. Garret (1999) find that for a
majority of countries not only has the absolute number of the urban poor and
undernourished increased in the last 15-20 years but they have done so at a rate that
outpaces corresponding changes in rural areas: in other words, the share of the poor and
undernourished that come from urban areas is increasing.*
1 While the estimates of exact
number of urban poor is not available, given the problems of definitions and
measurement of poverty, on a dollar per capita basis, it is estimated that nearly 400
million poor live in urban areas. If the multi-dimensional aspect of poverty is considered,
related to access to basic services such as water, sewage, health and education, then the
extent of urban poverty incidences are considerably higher.
Slums as manifestation of urban poverty:
The Millennium Declaration, adopted in September 2000 by member states, commits to
“achieve a significant improvement in the lives of at least 100 million slum dwellers by
2020", is linked to the primary goal of urban poverty reduction. The focus on slums in the
Millennium Declaration has revived the interest in urban poverty reduction policies and
programmes, as the slums are the most visible manifestation of urban poverty.
: 1987 purchasing-power-parity; See UNDP 1999 Human Development Report 1999, pages 25 and 28.
3 "We the Peoples: The Role of the United Nations in the 21M Century," paragraphs 70 and 73.
1 Haddad. L.. Ruel, M. T., Garrett, J. L. (1999). “Are urban poverty and under nutrition growing? Some
newly assembled evidence." World Development 27( 11), 1891-1904.
-4-
UN-HAB1TAT estimates that 946 million people live in slums in urban areas of
developing countries
Table 1: Slum Population in Developing Countries’
1990
Developing Regions:
North Africa
Sub-Saharan Africa
Latin America & Caribbean
Eastern Asia
Eastern Asia excluding China
South Asia
South Eastern Asia
Western Asia
Oceania
Total
21719
100973
110837
150761
12831
198663
48986
2864!
350
660,929
2001
21355
166208
127566
193824
15568
253122
56781
40726
499
860,081
| 2005
21224
199231
134257
212368
16702
276432
59913
46288
568
946,529
UNHABITAT has developed a household level definition of a slum household in order to
be able to use existing household level surveys and censuses to identify slum dwellers
among the urban population. A slum household is a household that lacks any one of the
following five elements:
•
•
•
•
•
Access to improved water ( access to sufficient amount of waterforfamily use.
at an affordable price, available to household members without being subject to
extreme effort):
Access to improved sanitation ( access to an excreta disposal system, either in
the form of a private toilet or a public toilet shared with a reasonable number of
people):
Security of tenure ( evidence of documentation to prove secure tenure status or
de facto or perceived protection from evictions )
Durability of housing (permanent and adequate structure in non-hazardous
location)
Sufficient living area ( not more than two people sharing the same room).
! UN-HABITAT (2003). The Challenge of Slums: Global Report on Human Settlements 2003. London:
Earthscan Publications.
-5 -
The Millennium Development Goals have been accepted internationally as a common
global development framework. At its core, the Millennium Development Goals are
about bringing the vast majority of the world’s population out of a poverty trap that robs
them of their health, dignity and aspirations for fulfilling their human potential. Although.
the slums target is the only target of the MDGs that specifically addresses the issue of
urban poverty, it is important to recognise that by improving the lives of slum dwellers.
governments are also combating HIV, improving environmental sustainability.
addressing gender inequality (and all the MDGs) in the most efficient manner. In other
words, as the world becomes more urban, the integration and synergies emerging from
the potential of comprehensively addressing the MDGs in a specific, dense location are
best achieved in the very settlements where slum dwellers live.’
3.
Health in Urban Settings
In general, urban residents in developing countries do have better health outcomes. This
is attributed to availability of better health care facilities, both from public and privates
sector. If this is indeed the case, why should one focus on health promotion in urban
areas? While it is true that, on an average, heath outcome in urban areas is better than
national average, the intra-urban differentials suggest a worsening of health outcome for
the urban poor. We examine below some available statistics, both at aggregate level, and
the intra-urban differentials for a few urban locations.
Aggregate urban health outcomes:
Wang (2003)’ using DHS data from over 60 low-income countries between 1990 and
1999 showed that there is a significant gap in child mortality between urban and rural
areas, with rural population having a much slower reduction in mortality compared with
their urban counterpart.
Table 2: Urban/Rural Gaps in Mortality Rate:
Global
All DHS
Countries
Year
Early 1990s
End 1990s
Decline rate
(%
per
annum)
Rural
87
77
1.7
1MR
Urban
67
58
2.1
Rural
143
126
2.1
U5 MR
Urban
105
89
2.6
Source: Limin Wang (2003)
’ A Home in the City, Report of Task Force on improving lives of Slum Dwellers. UN Millennium Project
2005
' Limin Wang (2003), "Health Outcomes in Low-Income Countries and Policy Implications: Empirical
Findings from Demographic and Health Surveys". Research working paper series: no. WPS 2S31. World
Bank
A recent study by International Food Policy Research Institute (1FPRI) also corroborates
such findings. Smith et.al (2004) demonstrate that the extent of malnourishment in urban
areas of developing countries is lower than in rural areas.
Figure 1—Stunting prevalences across urban and rural areas, by region
□ Rural
■ Urban
Source: Smith. Ruel, and Ndiaye ( 2004)'
4.
Intra-Urban Differentials in Health Outcomes:
While aggregate health statistics suggest that the urban dwellers have better health status
compared to those living in rural areas, there is a large and growing gap between the
health status of the upper/middle class urban residents and those living at the margins of
poverty. The 940 million urban residents, live in slum that are characterized by high
density, overcrowded unsanitary conditions often lacking access to basic health, water
and sanitation services. This has serious implications on their health status. (See Figure 2
for data on access to sanitation and Figure 3 for links between lack of improved
sanitation and infant mortality).
‘ Lisa C. Smith, Marie T. Ruel, and Aida Ndiaye ( 2004), Why Is Child Malnutrition Lower in Urban Than
Rural Areas? Evidence from 36 Developing Countries, FCND Discussion Paper No. 176, International
Food Policy Research Institute, Washington
-7-
Figure 2: Percentage of urban households that lack access to improved sanitation,
urban areas
Though the slum dwellers constitute over one-third of the global urban population, there
is very little data on the health status of this population. Compiling data on health in
urban slums poses serious problem. Existing data are rarely disaggregated according to
intra-urban location or socioeconomic criteria. Data sets such as DHS and MICS are
disaggregate by “urban” and “rural.” but go no further. Nonetheless. UN-HABITAT has
been making concerted efforts to reanalyze large data sets where the geographic origins
of the data can clearly be identified as “slum” and “non-slum.”
’ Gora Mboup (2003), Improving health conditions of slum communities: Health Interventions versus
slum upgrading, presentation at Urban Poverty and Health in Sub-Saharan Africa, Nairobi. April 14-15.
2003
-8-
Source: Gora Mboup (2003)
4.1
Malnourishinent in urban shuns:
Urban residents, while better nourished on average, are extremely vulnerable to
macroeconomic shocks that undermine their earning capacity and lead to substitution
towards less nutritious, cheaper foods. The urban poor are particularly vulnerable. The
nutritional vulnerability of the urban poor is evidenced by the fact that, where data is
available, the number of children that show evidence of malnutrition amongst the urban
poor is higher or equal to the rural poor. Respiratory infections from both indoor and
outdoor air pollution and diarrhoeal diseases, two of the world's greatest challenges to
child survival, are also daunting challenges in urban areas.
Percentage of children 0-59 months underweight
source: G.Mboup, 2004. Impact of slum upgrading on health
a Rural
□ Slum
Non-slum
4.2
Infant and Child Mortality in urban slums:
While urban residents in developing countries have better health outcomes on average
than their rural counterparts, these averages often hide large intra-urban inequities in
disease and injury burdens and premature death. In some cities the urban poor may fare
worse than residents of rural areas. (Montgomery et al 2OO3)10. High barriers to accessing
good-quality water, sanitation, health services, and emergency services, especially for
slum dwellers, often make it difficult for poor urban residents to prevent and treat
debilitating health problems. In Dhaka infant mortality rates are higher in urban slums
than in rural areas (Harpham and Tanner 1995. see Figure )" In Sao Paulo 1992 infant
mortality rates in municipalities ranged from IS to 60 per 1.000 live births, with slums
and poorer communities experiencing the worst outcomes (Stephens and others 1994)i:.
Montgomery, Mark R, Richard Stren, Barney Cohen, and Holly Reed. eds. 2003. Cities Transformed:
Demographic Change and Its Implications in the Developing World. Washington. D.C.: National Academv
Press.
11 Harpham, Trudy, and Marcel Tanner, eds. 1995. Urban Health in Developing Countries: Progress and
Prospects. London: Earthscan Publications.
Stephens, C., I. Timaeus, M. Ackerman, S. Alve. P.B. Maia, P. Campanario. B. Doe. L. Lush, D. Tetteh.
and T. Harpham. 1994. “Environment and Health in Developing Countries: An Analysis of Intra-Urban
Differentials Using Existing Data.’’ London School of Hygiene and Tropical Medicine.
- 10-
Figure 4: Under Five Mortality by human settlement types in the Sub-Saharan
Africa
------------------------------------------------------------------------------------------- I
SLUM Under Five 3 NON SLUM Under Five
RURAL Under- Five
11 Harpham, Trudy, and Marcel Tanner, eds. 1995. Urban Health in Developing Countries: Progress and
Prospects. London: Earthscan Publications.
- 11 -
Studies from Slums in Nairobi show that Infant and Child mortality in urban slums are
highest in Kenya. A comprehensive 1998 survey of Nairobi slums found that residents
who lacked basic services, adequate housing, and health services and who lived among
similarly disadvantaged people had worse health outcomes in almost every dimension
than other Nairobi residents, rural Kenyans, and Kenyans overall (APHRC 2002). This
survey also showed that under-five mortality rates in Nairobi’s slums were 151 per 1.000
live births—much higher than the average for Nairobi (62) or the average for rural areas
(113). The very poor living conditions in slums, including the lack of provision for water
and sanitation and high levels of overcrowding, contribute much to the health status of
the poor. Adequate health services to prevent and treat illnesses remain inaccessible to
these communities, because of price, quality of care, and treatment-seeking behaviour.
Infant and Child (under 5 yrs) Mortality Rates
in the Urban Slums of Nairobi
(compared with o±ei area so: Kexya).
Infant Mortality
(per 1 000 births)
Under-five Mortality
(per 1000 births)
KCSSVV
Nairobi Slums
91.3
150.6
National*
Rural *
Other Urban"
Nairobi"
73.7
75.9
56 6
38.7
111.5
113.0
83.9
61.5
* Based on 1 998 KDHS data - Kenya Demographic and Health Surveys
** NCSS - National Cross Sectional Slums Survey, 2000
4.3
Diarrhoea in urban Slums
Prevalence of diarrhoea among urban slum children is also more pronounced. Firkee
(2004)'1 cites information from Egypt to show that diarrhoea prevalence among urban
slum children is higher than in rural areas. (See Fig 6) Though the difference in Egypt is
not very significant, the information for Nairobi, as presented by Gora Mboup (2003)”
shows the effect of income on diarrhoea incidence in Nairobi slums. Studies from other
African countries also show higher diarrhoea prevalence in urban slum areas (see Figure
5).
" Fariyal Firkee (2004), A Global Perspective: Cross National Pressures on Urban Health, presentation
Fikree3rd International Conference on Urban Health Boston. October 21, 2004
15 Gora Mboup (2003). Improving health conditions of .slum communities: Health Interventions versus
slum upgrading, presentation at Urban Poverty and Health in Sub-Saharan Africa Nairobi. April 14-15,
2003
- 12-
□ Nairobi Slum ■ Rural Kenya
Figure 4: Diarrhea in the Last Two Weeks by Wealth Index Quintiles and Residence
Source: NCSS. 2000 & KD11S 1998
- 13 -
I IAB1TAT 2(1(14)"'. I.ike all other health indicators, we sec highei prevalence of I IIV among
the urban slum residents. (Sec lag 7 tor South Africa).
///I prevalence aiiaaty; persens eyed 75-/9 years by Incalrly type, Soafli AJriea
5.
Health Promotion Programmes in Urban Settings
Healthcare facilities are overwhelmingly concentrated in urban areas. Urban health
services are typically provided by a patchwork of entities, including public hospitals and
clinics, private physicians, laboratories, pharmacies, and NGOs. As a result, urban
populations - on average - have greater access to formal healthcare services. These
services are, however, not accessible to the urban poor for a variety of reasons. High cost
of these services is one of the reasons, but even where free public health services are
available in urban areas; these are not specifically oriented to serve the urban poor. Often.
the urban poor are unaware of availability of free health care services. Even when they
are aware, it is difficult for them to use these services as they have to spend a great deal
of time to avail these services.
Specific programmes for promoting health in urban slums did exist in the past. The
WHO’s Healthy Cities Programme, and UNICEF’s Urban Basic Services Programme
(UBSP) was quite active in 80’s and 90’s and contributed significantly to promote health
and provide primary health care services in slums. The Healthy Cities Programme (HCP)
was first implemented in developed regions, but was extended to lower income countries
in the late 1990s. The main activities of the projects were awareness raising and
environmental improvements, particularly solid waste disposal and home and
neighbourhood hygiene. An evaluation of the project, undertaken in 1998-9 showed that
City leaders had little political commitment to Healthy Cities Projects. As a result, HCPs
have limited influence on municipal health policies. WHO support for HCP enabled
project co-ordinators to network at national and international levels, but did not
necessarily build capacity of their institutions. The evaluation report also warned that end
11 UN-HABITAT (2004), Challenging the Challenge: Shelter Dimensions of HIV/AIDS and Orphans in
Urban Slums of Sub-Saharan Africa, Draft December 2004
- 15 -
of WHO funding and the absence of alternative sources of finance have threatened the
sustainability of HCPs. '
Without global funding, both Healthy Cities Programme of WHO. and the Urban Basic
Services Programme (UBSP) of UNICEF have curtailed its activities in developing
countries. A few countries have, however, continued with similar programme for health
promotion among the urban poor, but clearly greater effort at global level is required.
6.
Need fbr a New Programme on Health Promotion for Urban Poor:
The MDG Goal 7 on environmental sustainability and the target 11, “of improving lives
of at least 100 million slum dwellers by 2020”, has been instrumental in focusing
attention on issues related to urban poverty. UN-HAB1TAT along with many other UN
agencies and partner organisations have agreed that ‘improving the lives of slum
dwellers' means not only improvement in shelter conditions of the urban poor, but must
also include improvements in health status of the urban poor.
• Intra-urban inequities need to be documented by disaggregating information by slum and non
slum population
• Appropriate technologies need to be provided for sustainable shelter design that provides for
adequate ventilation, safe disposal of wastes, easy access to clean and safe drinking water and
sanitation, improved drainage, increased safety and appropriate fuel options.
• Improving lives of slum dwellers requires that high quality health interventions are brought to
slum neighbourhoods. Urban slums have to be targeted with well-focused education
campaigns designed to spread important information about the prevention, diagnosis and
treatment of disease.
• Promotion of health in urban setting requires a multi-sectoral approach involving a range of
stakeholders. Health promotion campaigns for urban poor must include strengthening of
capacity of local governments and other stakeholders.
• Lessons from Healthy Cities Programme and UBSP programme have highlighted the need for
commitments of local government leaders and for active engagement of community based
organisations in urban slums in health promotion programmes.
• Strengthen local institutions (private and public) and find ways to link them to resources and
facilities that can help them gain the attention and collaboration of policy makers who can
affect their long-term status in the community.
More recently, the report by the “Commission on Africa”, popularly known as the Blair
commission on Africa, cites rapid urbanisation and poverty in urban areas of Africa as an
important issue. The WHO’s Commission on Social Determinants of Health has decided
that one of its foci is on urban settings as a social determinant of health and inequities in
health. The WHO Center for Health Development in Kobe Japan has been selected to
lead the learning in this area towards synthesizing what is known on how to address
various aspects of urban settings as a social determinant of health and developing
17 'Health city projects in developing countries: the first evaluation' by T. Harpham, S. Burton and I. Blue.
Health Promotion International 16 (2001)
- 16-
recommendations that include what and how to address these issues and scale up existing
successful programs/policies.
h is expected that through this renewed focus on urban poor, national and local
governments will reorient the health services and public health infrastructure, with the
explicit intention of reaching the slum dwellers UN-HAB1TAT with in partnership with
other UN agencies has begun a programme to collect intra-ii.’.an data on morbidity and
mortality, for selected cities. Such data are important for better directing health resources
to the neediest groups. But greater research effort is needed to learn more about
treatment-seeking behaviour of the urban poor, the quality of various urban health
services, and perceptions of such care by users.
- 17 -
As of 10 August 2005
6th Global Conference on Health Promotion, "Policy and Partnership
For Action: Addressing the Determinants of Health"
7-11 August 2005
UNCC, Bangkok
Updated Provisional List of Addresses
Janet
@
TABLE OF CONTENTS
AFRICAN REGION........................................................................................................... ............ ...................... 1
Benin.................................................................... ...................... ................ ..................... ........................ 1
Cameroon............................................................................................. ....................................................... 1
Ethiopia........ ...................... ............. .............................................................................. .............................1
Kenya........................................................................................................................................................... 2
Lesotho......................................................................................................................................................... 2
j
Mauritius............................................................................................................................... .......................3
Mozambique.................................................................................................................................................3
*
Namibia........................................................................................................................................................ 3
Nigeria .........................................................................................................................................................3
Republic of Congo........................................................................................................................................4
Republic of Guinea....... ................ ........... ...................................................................................................4
Senegal......................................................................................... .. ................... ........................................4
Seychelles.................................................................................................................................................... 4
South Africa... .
...............
................4
Tanzania............. ............................................................... ..................... ................................................... 6
Uganda............................................................... .................
7
Zambia .................................................................................................................................................. ..... 7
Zimbabwe.. . .................................................................................................................... ............................8
AMERICAN REGION............................................................................................................................................ 8
Argentina .................................................................................................................................................... 8
Brazil..................................... ..
.
.............. 8
Canada..................................................................... ..................................................... ...............................9
Chile........................................................................................................................................................... 12
Colombia.......................................................................... ................................... .... ........ ........................12
Cuba...................................................... .......... .................... .
................13
*
Guatemala........................................................................................................ ..........................................13
Honduras................................................................................................................... .............................. . 13
Mexico......................................................................... ............................................................................. 14
USA..................................................................... ...................................................................................... 14
Venezuela................................................................................................................................................... 17
EASTERN MEDITERRANEAN REGION............................................................................................................17
Bahrain......................................................................................................................................................... 17
Egypt............................................................................................................................................................ 17
Iran............................................................................................................................................................... 18
Iraq............................................................................................................................................................... 18
Jordan........................................................................................................................................................... 19
Lebanon........................................................................................................................................................ 19
Oman............................................................................................................................................................20
Pakistan........................................................................................................................................................ 21
Qatar............................................................................................................................................................. 22
Saudi Arabia................................................................................................................................................ 22
Sultanate of Oman....................................................................................................................................... 23
United Arab Emirates.................................................................................................................................. 23
EUROPEAN REGION............................................................................................................................................ 23
Albania......................................................................................................................................................... 23
Austria.......................................................................................................................................................... 23
Belgium........................................................................................................................................................ 24
Croatia.......................................................................................................................................................... 25
Czech Republic............................................................................................................................................ 25
Denmark................ ...................................................................................................................................... 25
Finland......................................................................................................................................................... 26
France........................................................................................................................................................... 27
Georgia......................................................................................................................................................... 27
Germany....................................................................................................................................................... 27
Hungary........................................................................................................................................................ 28
Ireland.......................................................................................................................................................... 28
Kazakhstan................................................................................................................................................... 28
Kyrgyzstan................................................................................................................................................... 29
Latvia........................................................................................................................................................... 29
Netherlands..................................................................................................................................................29
Norway........................................................................................................................................................ 30
Poland......................................................................................................................................................... 30
Portugal....................................................................................................................................................... 31
Russian Federation...................................................................................................................................... 31
ii
Spain..................................................................................................................................................... ......31
Sweden........................................................................................................................................................ 32
Switzerland................................................................................................................................................. 33
The Netherlands.......................................................................................................................................... 36
United Kingdom.........................................................................................................................................36
SOUTH-EAST ASIA REGION............................................................................................................................. 38
Bangladesh.................................................................................................................................................. 38
Bhutan......................................................................................................................................................... 41
India............................................................................................................................................................ 41
Indonesia..................................................................................................................................................... 44
Maldives...................................................................................................................................................... 48
Myanmar.....................................................................................................................................................48
Nepal.............................................................. ............................................................................................ 49
Republic of Korea....................................................................................................................................... 50
Sri Lanka......................... .................. ..................... ..... ............................................................................. 50
Thailand...................................................................................................................................................... 51
WESTERN PACIFIC REGION............................................................................................................................. 76
Australia..................................................................................................................................................... 76
Brunei Darussalam..................................................................................................................................... 80
Cambodia.................................................................................................................................................... 80
Fiji............................................................................................................................................................... 82
Japan.......................................................................................................................................................... 82
Kiribati.......................................................................................... .............................................................83
Lao People's Democratic Republic............................................................................................................ 84
Malaysia......................................................................................................................................................84
Mongolia.....................................................................................................................................................85
New Zealand...............................................................................................................................................86
Papua New Guinea.....................................................................................................................................88
People's Republic of China.........................................................................................................................88
Philippines..................................................................................................................................................91
Republic of Korea...................................................................................................................................... 92
Samoa......................................................................................................................................................... 93
Singapore....................................................................................................................................................93
Tonga......................................................................................................................................................... 95
iii
Viet Nam......................................................................................................................................................95
CONFERENCE ORGANIZING COMMITTEE (COC) & PROGRAMME COMMITTEE (PC)............................ 98
AFRICAN REGION................................................................................................................................................ 98
South Africa................................................................................................................................................. 98
AMERICAN REGION............................................................................................................................................ 98
Canada.......................................................................................................................................................... 98
Puerto Rico.................................................................................................................................................. 98
USA.............................................................................................................................................................. 98
EASTERN MEDITERRANEAN REGION............................................................................................................99
Egypt............................................................................................................................................................ 99
EUROPEAN REGION............................................................................................................................................ 99
Norway......................................................................................................................................................... 99
Sweden......................................................................................................................................................... 99
Switzerland.................................................................................................................................................. 99
SOUTH-EAST ASIA REGION............................................................................................................................ 100
India........................................................................................................................................................... 100
Thailand..................................................................................................................................................... 100
WESTERN PACIFIC REGION............................................................................................................................102
Australia..................................................................................................................................................... 102
China.......................................................................................................................................................... 102
Philippines................................................................................................................................................. 102
SPEAKERS & CHAIRS.............................................................................................................................................. 103
AFRICAN REGION.............................................................................................................................................. 103
South Africa............................................................................................................................................... 103
AMERICAN REGION.......................................................................................................................................... 103
Brazil.......................................................................................................................................................... 103
EUROPEAN REGION.......................................................................................................................................... 103
Sweden....................................................................................................................................................... 103
United Kingdom........................................................................................................................................104
SOUTH-EAST ASIA REGION........................................................................................................................... 104
India...........................................................................................................................................................104
Thailand.....................................................................................................................................................104
WESTERN PACIFIC REGION........................................................................................................................... 105
People's Democratic Republic of China................................................................................................... 105
iv
TECHNICAL DISCUSSION RAPPORTEURS........................................................................................................ 105
AFRICAN REGION............................................................................................................................................. 105
Benin......................................................................................................................................................... 105
Cameroon.................................................................................................................................................. 105
Kenya........................................................................................................................................................ 105
AMERICAN REGION......................................................................................................................................... 106
Brazil......................................................................................................................................................... 106
Canada....................................................................................................................................................... 106
Chile.......................................................................................................................................................... 106
USA........................................................................................................................................................... 107
EASTERN MEDITERRANEAN REGION..........................................................................................................107
Lebanon......................................................................................................................................................107
EUROPEAN REGION..........................................................................................................................................107
Estonia........................................................................................................................................................ 107
France......................................................................................................................................................... 107
Hungary...................................................................................................................................................... 108
Norway....................................................................................................................................................... 108
Sweden....................................................................................................................................................... 108
SOUTH EAST ASIA REGION............................................................................................................................. 108
Maldives..................................................................................................................................................... 108
Thailand..................................................................................................................................................... 108
WESTERN PACIFIC REGION............................................................................................................................ 109
Republic of Korea...................................................................................................................................... 109
Singapore................................................................................................................................................... 109
VOLUNTEERS............................................................................................................................................................ 109
AMERICAN REGION.......................................................................................................................................... 109
USA............................................................................................................................................................ 109
EUROPEAN REGION.......................................................................................................................................... 109
Sweden....................................................................................................................................................... 109
Switzerland................................................................................................................................................ 110
WESTERN PACIFIC REGION............................................................................................................................ 110
Australia..................................................................................................................................................... 110
New Zealand.............................................................................................................................................. 110
WORLD HEALTH ORGANIZATION..................................................................................................................... 110
AFRICAN REGION.............................................................................................................................................. HO
AMERICAN REGION.......................................................................................................................................... 112
EASTERN MEDITERRANEAN REGION......................................................................................................... 113
EUROPEAN REGION.......................................................................................................................................... 114
SOUTH-EAST ASIA REGION............................................................................................................................ 114
WESTERN PACIFIC REGION........................................................................................................................... 119
WHO HEADQUARTERS.....................................................................................................................................120
6th Global Conference on Health Promotion, "Policy and Partnership
For Action: Addressing the Determinants of Health"
Bangkok, Thailand, 7-11 August 2005
Updated Provisional List of Addresses as of 10 August 2005
AFRICAN REGION
Dr Bernard Gnahoui-David
Senior National Advisor
Public Health
Plan Benin
P.O. Box 05 BP 2266
Cotonou
Benin
Email: gnahouidb@yahoo.fr
bgnahouid@voila.fr
bemard.gnahoui-david@plan-intemational.org
Dr Catherine Mbena
Director
School Health
Ministry of National Education
MINEDUC
Yaounde
Cameroon
Email: ebebakate@yahoo.fr
Mr Daniel Sibetcheu
Director
Department of Health Promotion
Ministry of Public Health
P.O. Box 11 058
Yaounde
Cameroon
Email: dsibetcheu@camnet.cm
Dr Gashaw Mengistu
AIDS Resource Centre, Ethiopia
P.O. Box 26171
Addis Ababa
Ethiopia
Email:'
gashawn.etharc@ethionet.et
1
Dr Dinesh Mehta
Coordinator
Urban Management Programme (UMP)
UN-Habitat
P.O. Box 30030
Nairobi
Kenya
Email: dinesh.mehta@unhabitat.org
Dr Nicholas Muraguri
Director
Promotive & Preventive Health
Ministry of Health
P.O. Box 30562
c/o WCO Kenya
Nairobi 00100
Kenya
Email: dhp@wananchi.com
dnmurags@yahoo.co.uk
Dr Peter Ngatia
Director
Learning Systems/Health Promotion
African Medical and Research Foundation (AMREF)
P.O. Box 27691 00506
Nairobi
Kenya
Email: petem@amrefhq.org
Mr William N. Okedi
PhD Student
Public Health and Health Policy
The London School of Hygiene and Tropical Medicine
P.O. Box 85 Uhuru Gardens
Nairobi
Kenya
Email: w.okedi@fordfound.org
Mr Khabiso Ntoampe
Chief of Section
Health Promotion
Ministry of Health
c/o WR/WCO Lesotho
Lesotho
Email: healthhed@ilesotho.com
ntoampekhabiso@yahoo.co.uk
2
Mr Deowan Mohee
Principal Health Information & Communication Officer
Ministry of Health and Quality of Life
Deowan Mohee
Ministry of Health
Atchia Building, 2nd Floor
Suffren Street
Port Louis
Mauritius
Email: vdmohee@yahoo.com
Ms Mercia Isabel Muchine Abilio
Antrophologist
Non Communicable Disease
Ministry of Health
Maputo 264
Mozambique
Email: mbuchile@dnsdee.misau.gov.mz
Ms Rufina Masterane Macie
Head
School Health
Ministry of Education and Culture
Bairro de Bagamoio
Maputo 3585
Mozambique
Email: RUFINA@MEC.GOV.MZ
Ms Gladys Kamboo
National Health Promotion/Social Mobilization Programme Officer
Information, Education and Communication (IEC)
Ministry of Health and Social Services
P/Bag 13198
Windhoek 9000
Namibia
Email: xoagubf@na.affo.who.int
Prof Michael Balogun
Provost/Professor of Medicine
Internal Medicine
Obafemi Awolowo University
Provost, College of Health Sciences
Ile-Ife
Nigeria
Email: bodebalogun@yahoo.co.uk
3
Ms Comfort Hassan
Programme Officer
Nigerian Environmental Study/Action Team (NEST)
UI. P.O. Box 22503, Ibadan, Oyo-State
Ibadan
Nigeria
Email: fortlara@yahoo.com
Mrs Shuwiso Chatora
c/o WHO/AFRO Brazaville
Brazzaville
Republic of Congo
Email: chatorar@affo.who.int
Dr Morissanda Kouyate
Director of Operations
Inter-African Committee
Dr Morissanda Kouyate BP 585
Conakry 01
Republic of Guinea
Email: morissanda@yahoo.fr
Mr Henri Naw Mbengue
Educateur pour la Same
Service National de 1'Education et de 1'Information pour la Sante
Ministere de la Sante et de la Prevention Medicale
Dakar 45268
Senegal
Email: mboyelamane@yahoo.fr
Ms Nichole Dina
Head, Health Promotion Unit
Department of Health
Ministry of Health and Social Services
Department of Health
P.O. Box 52
Victoria
Seychelles
Email: dhp@moh.gov.sc
Dr Gail Verah Andrews
Research Manager/Director
Social Aspects of HIV/AIDS, Research Alliance (Sahara)
Human Sciences Research Council
Private Bag X41, Pretoria 0001
11th Floor, HSRC Building
134 Pretorius Street
Pretoria 0002
South Africa
Email: gandrews@hsrc.ac.za
4
Ms Samantha Bloem
Department of Health
Private Bag X830
Private Bag X828
Pretoria 0001
South Africa
Email: Maagal@health.gov.za
bloems@health.gov.za
Dr Nolwazi Mbananga
Executive Manager
Informatics & Knowledge Management Directorate
Medical Research Council of South Africa
P/B X385
Pretoria 0001
South Africa
Email: nolwazi.mbananga@mrc.ac.za
Mrs Tshimi Lynn Moeng
Director Nutrition
Department of Health
Private Bag X828
Pretoria 0001
South Africa
Email: moengl@health.gov.za
Ms Zanele Mthembu
Director, Health Promotion
Department of Health
Private Bag X828
Pretoria 0001
South Africa
Email: mthemz@health.gov.za
MthemZ@health.gov.za
Mr Elias Mugari
Manager Health Promotion
Health and Social Development
Limpopo Provincial Government
Private Bag X9302
Polokwane 0700
South Africa
Email: malemamr@dhw.norprov.gov.za
5
Dr Craig Nossel
Head of Clinical Vitality
Vitality
Discovery Health
P.O. Box786722
Sandton
Johannesburg 2146
South Africa
Email: craign@discovery.co.za
Prof Hans Onya
Department Head
Health Promotion
University of Limpopo, sub-regional, Southern Africa
Private Bag XI106
Private Bag XI106
Sovenga 0727
South Africa
Email: onya@pixie.co.za
Mrs Shona Sturgeon
Senior Lecturer
Department of Social Development
University of Cape Town
Private Bag 2001
P/B Rondebosch 7701
South Africa
Email: sturgeon@humanities.uct.ac.za
Dr Theodora Nosisa Tshangana
Department of Health
Eastern Cape Province
Health Promotion
Private Bag X0038
Bisho 5605
South Africa
Email:
Dr Romani Momburi
Tutor
Training
Ministry of Health
Primary Health Care Institute
P.O. Box 235
Iringa
Tanzania
Email: rbmomburi@yahoo.com
rbmomburi@phci.ac.tz
6
Ms Dorothy Hyuha
Chair
Socia Sector Committee of Parliament
Parliament of Uganda
c/o WR/WCO Uganda
Uganda
Email: dhyuha@parliamentgo.ug
Mrs Liliane Christine Luwaga
Ag. Principle Health Educationist
Health Promotion and Education Division
Ministry of Health
P.O. Box 104
Entebbe
Uganda
Email: lilianeluwaga@yahoo.com
Dr Everd Maniple Bikaitwoha
Dean
Faculty of Health Sciences
Uganda Martyrs University
P.O.Box 5498
Kampala
Uganda
Email: everdmaniple@umu.ac.ug
health@umu.ac.ug
Mr Chrispine K. Melele
Program Officer/Capacity Building
Zambia National Response to HIV/AIDS, Ministry of Finance
Community Response to HIV/AIDS (CRAIDS)
Craids
Didani Kimathi Road
Kambendekela House
Lusaka 31559
Zambia
Email: crispin@zamsif.org.zm
Ms Miriam Shakafuswa
Project Manager
Education Development Center
Plot 4102 Mtenguleni Road
Sunningdale
Kabulonga
Lusaka 0101
Zambia
Email: mirshaka@yahoo.com
7
Mr George Sikazwe
Head
Health Promotion
Ministry of Health
P.O. Box 30205
c/o WR/WCO Zambia
Lusaka
Zambia
Email: gsikazwe@cboh.org.zm
Prof Julita Maradzika
Professor Health Promotion
Community Medicine
University of Zimbabwe
College of Health Sciences
Box A178 Avondale
Harare
Zimbabwe
Email: chideme53@yahoo.com
jmaradzika@medsch.az.ac.zw
AMERICAN REGION
Dr Carlos Alberto Vizzotti
Subsecretario de Relaciones Sanitarias e Investigacion en Salud
Ministerio de Salud y Ambiente de la Nacion
Av. 9 de Julio 1925, 2do piso
C1073ABA-Ciudad Autonoma de Buenos Aires
Buenos Aires
Argentina
Email: cvizzotti@msal.gov.ar
kchier@msal.gov.ar
Prof Marco Akerman
Full Professor/Coordinator
Collective Health/Permanent Education
ABC Region Medical School/Cepedoc
Rua Dona Brigida 232 casa 32
Sao Paulo 04111-080
Brazil
Email: akermanm.ops@terra.com.br
Dr Dulce Chiaverini
Sao Paulo
Brazil
Email:
8
Dr Marcelo M.P. Demarzo
Lecturer of Public Health
Education
Brazilian Society of Family Medicine
Avenida Do Cafe 1139
Apto. 40IF
Ribeirao Preto-SP 14050-230
Brazil
Email: marcelokele@yahoo.com.br
Ms Tatiana Pluciennik Dowbor
Associaijao de Saude da Familia
Rua Jose de Freitas Guimaraes, 468
Sao Paulo-SP 01237-010
Brazil
Email: tdowbor@saudedafamilia.org
Dr Marcia Faria Westphal
Professor
Health Promotion
Faculdad de Salud Publica
Sao Paulo School of Public Health
Av. Dr Arnaldo 715
Sao Paulo 01246.904
Brazil
Email: marciafw@USP.BR
Dr Roch Bernier
Directeur general Prevention
Foundation Lucie et Andre Chagnon
2001, avenue McGill College
Bureau 1000
Montreal (Quebec) H3A 1G1
Canada
Email: bemierr@fondationchagnon.org
Ms Heather Fraser
Manager
Strategic Policy Directorate, Development & Partnerships Division
Public Health Agency of Canada
540-757 West Hastings Street (Federal Building)
Vancouver V6C 3E6
Canada
Email: Heather_Fraser@phac-aspc.gc.ca
9
Ms Elizabeth Gyorfi-Dyke
Director
Canadian Population Health Initiative
377 Dalhousie Street
Suite 200
Ottawa, Ontario KIN 9N8
Canada
Email: egyorfi-dyke@cihi.ca
Dr Marcia Hills
Professor, School of Nursing; Director, Center for Community Health;
Health Promotion Research
Canadian Consortium for Health Promotion Research,
University of Victoria
3800 Finnerty Road,
P.O. Box 3060 STN CSC
Victoria BC V8W 3R4
Canada
Email: mhills@uvic.ca
Dr Suzanne F. Jackson
Director
Centre for Health Promotion
University of Toronto
100 College Street, Suite 207
Toronto, ON M5G 1L5
Canada
Email: suzanne.jackson@utoronto.ca
Ms Erika Khandor
Research and Evaluation Coordinator
The Centre for Health Promotion
The Banning Institute
University of Toronto
100 College Street, Suite 207
Toronto, ON M5G 1L5
Canada
Email: erika.khandor@utoronto.ca
Dr Jean Lariviere
Consultant
International Health
1047 Plante Drive
Ottawa, ON KI V9E5
Canada
Email: jeanlariviere@rogers.com
10
Dr Richard Masse
President-Directeur General
Institut national de sante publique du Quebec
945 avenue Wolfe, 3e etage
Sainte-Foy
Quebec G1V 5B3
Canada
Email: Richard.masse@inspq.qc.ca
Dr Lise Mathieu
Senior Advisor to the Deputy Chief Public Health Officer
Public Health Agency of Canada
Canada
Email: Lise_Mathieu@phac-aspc.gc.ca
Dr Douglas McCall
Executive Director
Canadian Association for School Health
16629-62 A Avenue, Surrey
British Columbia V3S OLS
Canada
Email: dmccall@schoolfile.com
Mrs Suzanne Lorrain Michaud
Nursing Policy Consultant
International Policy and Development
Canadian Nurses Association
50 Driveway
Ottawa ON K2P 1E2
Canada
Email: smichaud@cna-aiic.ca
Ms Frances Perkins
Coordinator, International Health Unit
Centre for Health Promotion
University of Toronto
100 College Street, Suite 207
Toronto M5G 1L5
Canada
Email: fran.perkins@sympatico.ca
Dr Alain Poirier
Directeur National de Sante publique
Direction Generale de la Sante publique
Ministere de la Sante et des Services Sociaux
1075 Chemin Ste-Foy
Quebec G1S 2M1
Canada
Email: Alain.poirier@msss.gouv.qc.ca
11
Dr Claude Rocan
Director General
Centre for Healthy Human Development
Public Health Agency of Canada
3rd Floor
Address locator 1909A2
Jeanne Mance Building
Tunney's Pasture
Ottawa, Ontario
Canada
Email: Claude_Rocan@phac-aspc.gc.ca
Dr Sora Park Tanjasiri
Associate Professor
CSUF Division of Kinesiology & Health Science
P.O. Box 6870
Fullerton 92834-6870
Canada
Email: stanjasiri@fullerton.edu
Dr Elinor Wilson
Chief Executive Officer
Canadian Public Health Association
Suite 400
1565 Carling Avenue
Ottawa, Ontario K1Z 8R1
Canada
Email: ewilson@cpha.ca
Prof Judith Salinas
Director
Health Publics Policies
Ministry of Health
Mac Iver 541 Office 521
Santiago
Chile
Email: jsalinas@minsal.cl
jsalina@vtr.net
Dr Ligia De Salazar Malagon
Director
Escuela de Salud Publica
Facultad de Salud
Universidad del Valle
Carrera 25D Oeste No.8, Apartamento 402
Edificio Scala-Barrio Los Cristales
Cali
Colombia
Email: lsalazar@emcali.net.co
12
Dr Blanca Patricia Mantilla Uribe
Director
Institute of Interdisciplinary Programs for PHC - PROINAPSA-UIS
University Industrial of Santander
Carrera 32 No. 29-31 Piso 3ro.
Facultad de Salud
Bucaramanga
Colombia
Email: bpmantil@uis.edu.co
Dr Pedro Mariano Bornet Gorbea
Instituto Nacional de Fligiene, Edidemiologia
La Habana 10400
Cuba
Email: mbonet@inhem.sld.cu
Dr Josefa Isabel Castanedo Rojas
Director
Centro Nacional de Promocion y Educacion Para La Salud
Ministerio de Salud Publica
Calle I No.507 E/23 Y 25. Vedado
La Habana 10400
Cuba
Email: Isarojas@cnpes.sld.cu
isarojas@infomed.sld.cu
Mr Carlos Enrique Batzin Chojoj
Vice Presidente
Consejo Directive
Consejo Indigena Cetro America (CICA)
2a. Avenida 3-47 zona 2
Chimaltenango
Guatemala
Email: Carlosbatzin@intelnett.com
Ms Karla Suyapa Lezama Verde
Assistant to Viceministra de Salud
Ministerio de Salud
Attn: OPS/OMS en Honduras
Tegucigalpa
Honduras
Email:
Dr Fanny Mejia Flores
Viceministra de Salud
Ministerio de Salud
Attn: OPS/OMS en Honduras
Tegucigalpa
Honduras
Email: fanny@cybertelh.hn
13
Dr Carlos Santos-Burgoa
Ministry of Health
Mexico City
Mexico
Email: csantos@salud.gob.mx
Dr Maria Marcela Aguilar Gonzalez
Senior Program Officer
John Hopkins University Center for Communication Programs
111 Market Place - Suite 310
Baltimore, MD 21202
USA
Email: maguilar@jhuccp.org
Ms Carmen Aldinger
Health and Human Development Programs
55 Chapel Street
Newton, MA 2458-1060
USA
Email: caldinger@edc.org
Dr Stella Aguinaga Bialous
President
Tobacco Policy International
676 Funston Avenue
San Franciso, CA 94118
USA
Email: stella@bialous.com
Dr David P. Fidler
Professor of Law and Harry T. Ice Faculty Fellow
Indiana University School of Law
211 South Indiana Avenue
Bloomington
IN 47405
Bloomington
USA
Email: dfidler@indiana.edu
Mr Kenneth Gustavsen
Manager
Global Product Donations
Merck & Co. Inc.
Office of Contributions
One Merck Drive, WSIA
17, Whitehouse Station
NJ 08889
USA
Email: ken_gustavsen@merck.com
14
Dr Philip Hedger
Executive Managing Director
International Affairs
Pfizer Inc.
235 East 42nd St
New York NY 10017
USA
Email: philip.hedger@pfizer.com
Luz.S.Gonzalez@pfizer.com
Prof Lloyd Kolbe
Professor
Department of Applied Health Science
Indiana University
1025 E., 7th Street
HPER 116
Bloomington
Indiana 47405
USA
Email: lkolbe@indiana.edu
Ms Donna Langiil
Principal
Thrusight Consulting
6516 Auburn Avenue
Riverdale. MD 20737
USA
Email: thrusight@gmail.com
dlangill@gmail.com
Mr Robert L. Mallett
Senior Vice President
Corporate Affairs
Pfizer Inc.
235 East 42 Street
New York, NY 10017
USA
Email: robert.mallett@pfizer.com
Dr Michael O'Donnell
Director, Wellness and Health Promotion
Cleveland Clinic Health System
9500 Euclind Ave
Cleveland, Ohio 44195
USA
Email: Michael.odonnell@HealthPromotionJoumal.com
odonnem 1 @ccf.org
15
Dr Lisa R. Pawloski
Associate Professor
College of Nursing and Health Science
George Mason University
4400 University Drive MSN 3C4
Fairfax
VA 22030
USA
Email: Ipawlosk@gmu.edu
Dr Jumana Qamruddin
Human Development Network (HDNHE)
The World Bank
1819 H Street, NW
Room G7-022, MS G7-702
Washington, D.C. 20434
USA
Email: lbrenzel@worldbank.org
Dr Angel Roca
Public Health Analyst
Centers for Disease Control and Prevention (CDC)
4770 Buford Highway, N.E.
Atlanta, GA 30341-3717
USA
Email: angel.roca@cdc.hhs.gov
axr4@cdc.gov
Dr Anthony So
Director
Program on Global Health and Technology Access
Duke University Terry Sanford Institute of Public Policy
Box 90245
Durham
NC 27708-0245
North Carolina
USA
Email: anthony.so@duke.edu
Mr Stephen A. Tamplin
Principal Associate and Coordinator
Global Service Associates
32 Wagon Train Trail
Hedgesville 25427
West Virginia
USA
Email: TamplinsWV@aol.com
16
Ms Cheryl Vince-Whitman
Director
Health & Human Development Programs (HHD)
Education Development Center (EDC)
55 Chapel Street
Newton
MA 02458-1060
USA
Email: cvincewhitman@edc.org
Dr Arismend Cesar
Coordinator
Committee of Health
Viceministeno de Salud
Caracas
Venezuela
Email: arismendicesar@hotmail.com
EASTERN MEDITERRANEAN REGION
Dr Hala Al-Mehza
Chief of International Relation Section
Public and International Relation Directorate
Ministry of Health
P.O. Box 12
Manama
Bahrain
Email: hmehza@health.gov.bh
Dr Fawzi Amin
Medical Staff for Primary Health Care, Ministry of Health
POBox22118
Manama
Bahrain
Email:
Prof Mamdouh Gabr
Secretary General
Egyptian Red Crescent
Abdel Razak El Sanhorui Street
Nasr City
Egypt
Email: erc@brainyl.ie.eg.com
erc@intemetegypt.com
17
Mrs Nahid Akbari
Khoshro Shahid Street
Bahreloloom Allay
No. 40 Shademan St.
Azadi St.
Tehran
Iran
Email: akbari_n2000@yahoo.com
Dr Nouradin Pirmoazen
Rapporteur
Health Commission
Parliament of Iran
Modares General Hospital
Saadat Abad
Tehran 19987
Iran
Email: npirmoazen@hotmail.com
Dr Muayad Naji AI-Yasiri Majeed
Dean, Thi-Qar College of Medicine
Thi-Qar College of Medicine
Thi-Qar University, Higher Education and Scientific Research
Thiqar
Iraq
Email: university_of_thi_qar@yahoo.com
Dr Waseem G. Shakir
Manager of Studies & Structures Section
Policy & Health Planning Department
Planning and Human Resource Directorate
Ministry of Health
Baghdad
Iraq
Email: waseemhealth@yahoo.com
Dr Mohammed Taher
Consultant
Technical Deputy Minister
Ministry of Environment
Salhyia Resident Complex
Building 15, Floor 3, Apt. 4
Baghdad
Iraq
Email: mjouri38@yahoo.com
18
Dr Soliman Farah
Chief of Party
Jordan Health Communication Partnership (JHCP)
John Hopkins University
Health Communication Partnership
P.O. Box 942143
Amman 11194
Jordan
Email: solimanf@jhcp.com.jo
Ms Asma Fashho
Jordan Health Communication Partnership (JHCP)
Communication Partnership for Family Health (CPFH)
Center for Communication Programs (JHU/CCP)
Jordan Office
P.O.Box 942143
Amman 11194
Jordan
Email: asmaf@jhcp.com.jo
Dr Soliman Guirgis
Amman
Jordan
Email:
Dr M. Bassam Hijawi Qasem
Director
Health Promotion
Ministry of Health
P.O. Box 961750
Amman 11196
Jordan
Email: hphijawi@go.com.jo
Dr Rima Afifi-Soweid
Associate Professor and Chairperson
Faculty of Health Sciences
Health Behavior and Education Department
c/o American University of Beirut
P.O. Box 11-0236
Riad El Solh 11072020
Beirut
Lebanon
Email: ral5@aub.edu.lb
19
Mrs Nada Aghar Naja
Coordinator of RH
United Nations Population Fund (UNFPA)
P.O.Box 11-3216
Beirut
Lebanon
Email: nada.aghar@undp.org.lb
Ms Peggy Hanna
Director
Health Education
Ministry of Public Health
Museum Square-Mansour Building, 8th Floor
Beirut
Lebanon
Email: minister@public-health.gov.lb
peggy@terra.net.lb
Ms Mayada Kanj
Faculty of Health Sciences
American University of Beirut
Riad El Sohl 1107 2020
P.O. Box 11-0236
Beirut
Lebanon
Email: mkanj@aub.edu.lb
Dr Nader Nassif
Lecturer
American University of Beirut
P.O.Box 11-0236Riad Solh
Beirut 1107 2020
Lebanon
Email: nn23@aub.edu.lb
Ms Sabah Al Bahlani
Director of Health Education
Ministry of Health
P.O. Box 393
Muscat
Oman
Email:
20
Mr Saleh Al Hadabi
Director General
Health Services, Nizwa Dakhiliya Region
Ministry of Health
P.O: Box 393
Muscat
Oman
Email:
Dr Jawad Al-Lawat
Head, Non-Communicable Disease Section
Ministry of Health
P.O.Box 393
113
Muscat
Oman
Email: jallawat@gto.net.om
Dr Salim Said Al-Wahaibi
Director
Department of Environmental Health and Malaria Eradication
Ministry of Health
P.O. Box 393 PCI 13
Muscat
Oman
Email: enmal898@omantel.net.om
epienv@yahoo.com
Dr Ashfaq Ahmed
Deputy Director General
International Health
Ministry of Health
Pakistan
Email: ashfaq@doctor.com
Dr Moazzam Khalil
Chief of Health Programs
National Commission for Human Development (NCHD)
Primer Minister's Secretariat
Lvel 2, Block D
Islamabad
Pakistan
Email: moazzam.khalil@nchd.org.pk
21
Dr Rozina F. Mistry
Director Community Health and Health Promotion
Aga Khan Health Services Pakistan
Health Promotion Resource Center
G-9/7, Block 7, Kehkashan
Clifton
Karachi 75600
Pakistan
Email: rozinafm@akunet.org
rozinafin@gmail.com
rozinamistry@aya.yale.edu
Dr Sania Nishtar
President (CEO)
Heartfile
Heartfile
1 Park Road
Chak Shahzad
Islamabad 44000
Pakistan
Email: sania@heartfile.org
Dr Mohammed Ilyas Khan
Trainer
Maternal & Child Health
MCH Section, PHC Department
3050-Hamad Medical Corporation
Doha
Qatar
Email: mohd_ilyas3@hotmail.com
Dr Rashul Abaaikheil
Riyadh
Saudi Arabia
Email:
Dr Sabah Abdulla Bin-Afif
Family and Community Health Consultant
King Fahad Armed Forces Hospital
P.Box - 9862
Jeddah-21159
Saudi Arabia
Email: sabah@medu.net.sa
22
Dr Salah Bin Said Nasser
Ministry of Health
Directorate General of Health Services
Director General
Nizwa
Sultanate of Oman
Email: dghsdr@omantel.net.om
Mr Abd Al Lateef Al Hadidi Al Shams!
Manager, Prevention & Health Promotion Department
Division of Health Affairs
General Authority for Health Services
Abu Dhabi
United Arab Emirates
Email:
EUROPEAN REGION
Mr Rasim Gjoka
Executive Director
Albanian Foundation for Conflict Resolution & Reconciliation of Disputes
Rruga "Him Kolli"
P.F. Trade
Kat.I, Ap 2-C
Tirana
Albania
Email: gioka@albaniaonline.net
afcr@icc-al.org
Prof Richard Horst Noack
Professor and Director
Social Medicine and Epidemiology
Medical University Graz
Institute of Social Medicine
Medical University
Universitatsstrabe 6/1
A-8010 Graz
Austria
Email: horst.noack@meduni-graz.at
23
Dr Jurgen M. Pelikan
Ludwig Boltzmann
Institut fur Medizin-und Gesundheitssoziologie
WHO-Kooperationszentrum fur Krankenhaus und Gesundheitsforderung
beim Institut fur Soziologie
Universitat Wien
A-1090 Wien
Austria
Email: juergen.pelikan@univie.ac.at
Dr Hartmut Pelinka
Aerztlicher Direktor
Adalbert-Stifter-Strasse 65
A-1201 Vienna
Austria
Email: Hartmut.Pelinka@auva.at
Ms Petra Plunger
Health Promotion Officer
Austrian Health Promotion Foundation
Mariahilferstrasse 176
A-l 150 Vienna
Austria
Email: petra.plunger@fgoe.org
Ms Caroline Costongs
Programme Manager
Rue Philippe Le Bon, 6
Brussels 1000
Belgium
Email: c.costongs@eurohealthnet.org
Prof Danielle Piette
Professor, Head of the Health Promotion and Education Unit
School of Public Health
Route de Lennik 808
CP 596
Brussels 1070
Belgium
Email: dpiette@ulb.ac.be
Dr Stephan Van den Broucke
Head
Department of Research and Documentation
Gustave Schildknechtstraat 9
B-1020 Brussels
Belgium
Email: stephan.vandenbroucke@vig.be
24
Dr Vlasta Hrabak-Zerjavic
Head of Service
Chronic Diseases Epidemiology Service
Croatian National Institute of Public Health
Rockefellerova 7
HR-10000 Zagreb
Croatia
Email: vlasta.zeqavic@hzjz.hr
Dr Ivana Pavic Simetin
Resident working in School Health Service
School Health Sendees
Croatian National Institute of Public Health
Zagreb 10 000
Croatia
Email: ivana.pavic@hzjz.hr
Mr Petr Hava
Director
Institute of Health Policy and Economics
Kutnohorska 1102
Kosletec nad Cemymi lesy 281 63
Czech Republic
Email: petr.hava@seznam.cz
Mrs Jana Havelkova
Head of the department
Health and Health Policy
Institute of Health Policy and Economics
Kutnohorska 1102
Kosletec nad Cemymi lesy 281 63
Czech Republic
Email: jana.havelkova@izpe.cz
Dr Jarmila Razova
Head, Division of Health Promotion
Department of Public Health Policy and Management
Ministry of Health of the Czech Republic
Prague 2 12801
Czech Republic
Email: jarmila.razova@mzcr.cz
Dr Jens Kristian Gatrik
Chief Medical Officer, Director General
National Board of Health
Islands Brygge 67
DK-2300 Copenhagen 5
Denmark
Email: sst@sst.dk
25
Mr Mikael Forss
Director
Research Department
KELA
PL 450
Helsinki 00101
Finland
Email: mikael.forss@kela.fi
Prof Jorma Jarvisalo
Deputy Director, Research Professor
Health Policy and International Development
Social Insurance Institution of Finland
Peltolantie 4
Turku 20720
Finland
Email: jorma.jarvisalo@kela.fi
Dr Taru Koivisto
Senior Officer
Ministry of Social Affairs and Health
P.O. Box 33
00023 Government
Finland
Email: taru.koivisto@stm.fi
Dr Eero Lahtinen
Senior Health Policy Advisor
Health Department
Ministry of Social Affairs and Health
Helsinki
Finland
Email: eero.lahtinen@stm.fi
Dr Miko Pyykko
Executive Director
Finnish Institute for Health Promotion
karjalankatu 2C 63
Helsinki
Finland
Email: mika.pyykko@health.fi
Dr Antti Uutela
Chief of Laboratory
Department of Epidemiology and Health Promotion
National Public Health Institute (KTL)
Mannerheimintie 166
FIN-00300 Helsinki
Finland
Email: antti.uutela@ktl.fi
26
Dr Pierre Arwidson
Director of DAS
Sendee Direction des Affaires Scientifiques
Institut National de Prevention et d' Education de la Sante
Inmieuble Pleyel
42 Boulevard de la Liberation
Saint-Denis 93203
France
Email: pierre.arwidson@inpes.sante.fr
Ms Marie-Claude Lamarre
Executive Director
IUHPE/UEPES
International Union for Health Promotion & Education (IUHPE)
42 Boulevard de la Liberation
Saint Denis Cedex 93203
France
Email: mclamarre@iuhpe.org
Dr George Bakhturidze
Chairman
Georgian Health Promotion and Education Foundation
17, Lermontov St.
Tbilisi 0105
Georgia
Email: iayd@yahoo.com
Dr Steffen Grammling
Senior Health Adviser
InWent - Internationale Weiterbildung und Entwicklung GmbH Capacity Building International
Abteilung 3.03, Gesundheit
Division 3.03, Health
Tulpenfeld 5
53113 Bonn
Germany
Email: steffen.grammling@inwent.org
Dr Wolf Kirsten
President
International Health Consulting
Holtzdorffstrasse 3
14057 Berlin
Germany
Email: wk@wolfkirsten.com
27
Dr Mihaly Kbkeny
Government Commissioner for Public Health Coordination, Member of Parliament
Office of the Commissioner for Public Health Coordination
Gyali Ut 2-6
Budapest 1097
Hungary
Email: kokeny@oth.antsz.hu
Prof Margaret Barry
Professor and Head of Department
Department of Health Promotion
National University of Ireland
Clinical Science Institute
National University of Ireland
Galway
Ireland
Email: margaret.barry@nuigalway.ie
Dr Eugene Donoghue
Chief Executive Officer
Nursing Board
31/32 Fitzwilliam Square
Dublin 2
Ireland
Email: ed@nursingboard.ie
edowoghue@nursingboard.ie
Dr Biddy O'Neill
National Health Promotion Advisor
Health Promotion Unit
Department of Health and Children
Hawkins House
Poolbeg Street
Dublin 2
Ireland
Email: Biddy_OrNeill@health.irlgov.ie
Dr Altyn Aringazina
Head
Health Promotion and Social Sciences
Kazakhstan School of Public Health
19A Utepov Str.
050060 Almaty
Kazakhstan
Email: altyn@ksph.kz
altyn_a@hotmail.com
28
Mrs Venera Baisugurova
Head of Department
Preventive Programmers
National Centre for Problems of Healthy Lifestyle Development
86 Kunaev Street
480100 Almaty
Kazakhstan
Email: baisugurova@ncphld.kz
Dr Gulmira Aitmurzaeva
Head of Republic Cente for Health Promotion
Bishkek
Kyrgyzstan
Email: rchp@elcat.kg
gulmira_2004@mail .ru
Dr Iveta Pudule
Head of Department
Strategy Development Department
Health Promotion State Agency
Skolas Street 3
Riga LV1010
Latvia
Email: iveta.pudule@vwa.gov.lv
Mr Hans Krosse
Exeuctive Director
Netherlands Institute for Health Promotion and Disease Prevention
P.O. Box 500
3440 AM Woerden
Netherlands
Email: jkrosse@nigz.nl
Mr Erik Ruland
Assistant Director
Netherlands Institute for Health Promotion and Disease Prevention
P.O. Box 500
3440 AM Woerden
Netherlands
Email: eruland@nigz.nl
Mr Hans Saan
Senior Consultant
Centre of Knowledge and quality management
NIGZ
P.O. Box 500
Woerden 3440 AM
Netherlands
Email: hsaan@nigz.nl
29
Dr Caret Tenhaeff
Representative, International Council on Social Welfare (ICSW)
International Council on Social Welfare
The Netherlands Institute for Care and Welfare (NIZW)
Catharijnesingel 47
3511 GC Utrecht
Netherlands
Email: c.tenhaeff@nizw.nl
Dr Theo van Iwaarden
Deputy Director
Department of Nutrition, Health Protection and Prevention
Ministry of Health
P.O. Box 20350
The Hague 2500 EJ
Netherlands
Email: mj.v.iwaarden@minvws.nl
Dr Anita Aadland
Director
Department of Physical activity
Directorate for Health and Social Affairs
P.O. Box 7000
St Olavs plass
Oslo 0031
Nonvay
Email: ani@shdir.no
Dr Kristian Hagestad
Chief Medical Officer for the Vest Adger Region
Norway
Email: tjk@mfa.no
Dr Jacek Czapla
Director
Clinical Department
Hospital of lomeh
Institute of Occupational Medicine and Environmental Health
13 Koscielna Street
Sosnowiec 41-200
Poland
Email: j.czapla@imp.sosnowiec.pl
30
Dr Joanna Pruchnicka
Institute of Occupational Medicine and Environmental Health
Sosnowiec
Poland
Email: i-pruchnicka@imp.sosnowiec.pl
Dr Berta Nunes
Family Doctor and member of the European Association of Rural Practitioners (EURIPA)
EURIPA-Portugal
Centro de Saiide de Alfandega da Fe
Alfandega da Fe 5350-009
Portugal
Email: bertanunes@mail.telepac.pt
Dr Pedro Ribeiro da Silva
Ministerio da Saude
Alameda D. Alfonso Henriques 45
1056 Lisboa Codex
Portugal
Email: pedros@dgsaude.min-saude.pt
Prof Igor Glasunov
Head
Department for Policy and Strategy Development
National Centre of Preventive Medicine
10 Petroverigskij Street
101990 Moscow
Russian Federation
Email: glasunov@comtv.ru
Dr Rimma Potemkina
Senior Researcher
Policy Development of Disease Prevention and Health Promotion
State Research Centre for Preventive Medicine of Ministry of Health and Social Development of
Russian Federation
Petroverigskij Pereulok 10
Moscow 101990
Russian Federation
Email: rpotem@online.ru
Dr Begoha Merino
Consejeras Tecnica
Ministerio de Sanidad y Consume
Subdireccion General de Promocion de la Salud y Epidemiologfa
Paseo del Prado 18-20
Madrid 28071
Spain
Email: bmerino@msc.es
31
Mr Andreas Hilmerson
Desk Officer
Division of International Affairs
Ministry of Health and Social Affairs
SE-10352 Stockholm
Sweden
Email: andreas.hilmerson@social.ministry.se
Prof Christer Hogstedt
Head
Research Department
Swedish National Institute of Public Health
Olof Palmes Gata 17
SE-10352 Stockholm
Sweden
Email: christer.hogstedt@fhi.se
Ms Irene Nilsson-Karlsson
Director
Division of Public Health
Ministry of Health and Social Affairs
SE-10352 Stockholm
Sweden
Email: irene.nilsson-carlsson@social.ministry.se
Dr Piroska Oestlin
Senior Lecturer
Department of Public Health Sciences
Karolinska Institute
Friggavagen 3
Djursholm 18263
Sweden
Email: piroska.ostlin@fhi.se
piroska.ostlin@phs.ki.se
Ms Ella Sohlberg
Public Health Coordinator
Toemrosavaegen 4M
SE-85740-Sundsvall
Sundsvall
Sweden
Email: ella.sohlberg@swipnet.se
32
Assoc. Prof Per Tillgren
Associate Professor
Malardalen University
Department of Carring and Public Health Sciences
Post Box 883
SE-721 23 Vasteras
Sweden
Email: per.tillgren@mdh.se
Dr Gerd Albracht
Senior Specialist in Occupational Safety and Health
Safe Work Coodinator, Development of Inspection Systems
International Labour Office
CH-12 11
CH-Geneva 22
Switzerland
Email: albracht@ilo.org
Dr Ursel Broeskamp-Stone
Head of International Affairs and Evidence
International Affairs and Evidence
Health Promotion Switzerland
Dufourstrasse 30
CH-3000 Bern 6
Switzerland
Email: ursel.broesskamp@promotionsante.ch
Ms Mary Anne Burke
Health Analyst/Statistician
Global Forum for Health Research (GFHR)
1-5 route des Morillons
P.O. Box 1211
Geneva
Switzerland
Email: maryanne.burke@globalforumhealth.org
Dr Tesfamicael Ghebyehiwet
Consultant
Nursing and Health Policy
International Council of Nurses
3, place Jean Marteau
CH-1201 Geneva
Switzerland
Email: tesfa@icn.ch
33
Dr Dalmer Hoskins
Secretary General
International Social Security Association (ISSA)
4, route des Morillons, CP.l
CH-1211 Geneva 22
Switzerland
Email: hoskins@ilo.org
Dr Bernard Amahaya Kadasia
International Aids Society
Ch. De 1'Avanchet 33
1216 Cointrin
Geneva
Switzerland
Email: info@iasociety.org
Dr Claudia Kessler Bodiang
Backstopper/Technical Advisor
Swiss Agency for Development and Cooperation (SDC)
c/o Swiss Tropical Institute
Socinstrasse 57
Basel 4051
Switzerland
Email: claudia.kessler@unibas.ch
Dr Joanna Koch
NGO Representative at the UN
Associated County Women of the World
Alte Landstr. 89
Kilchberg 8802
Switzerland
Email: joannakoch@gmx.net
Dr Grace Lo
Senior Health Officer
Asia Pacific region & first aid Health and Care Department
International Federation of Red Cross and Red Crescent Societies
P.O. Box 373
Geneva
Switzerland
Email: Grace.Lo@ifrc.org
Ms Marianne Monclair
Senior Health Officer
Health and Care Department
International Federation of Red Cross and Red Crescent Societies
Geneva
Switzerland
Email: Marianne.Monclair@ifrc.org
34
Dr Eric Noehrenberg
Director
International Trade and Market Policy
International Federation of Pharmaceutical Manufacturers Associations (IFPMA)
Chemin Louis-Dunant 15
P.O. Box 195
CH-1211 Geneva 20
Switzerland
Email: e.noehrenberg@ifpma.org
Mr Choonsik Park
Seconded Staff Member
Unt of Research in Social Security
International Social Security Association (ISSA)
1-76 BIT
4, route des Morillons, CP.l
CH-1211 Geneva 22
Switzerland
Email: cspark7@yahoo.com
parkc@ilo.org
Mrs Berhane Ras-Work
Executive Director
Inter-African Committee on Traditional Practices Affecting the Health of Women and Children
145, rue de Lausanne
CH-1202 Geneva
Switzerland
Email: cominter@iprolink.ch
Mr Jens Schremmer
Programme Manager - Health Policy
Office of the Secretary General
International Social Security Association
4, route des Morillons
Case postale 1
CH-1211 Geneva 22
Switzerland
Email: schremmer@ilo.org
Dr Bertino Somaini
Director
Swiss Health Promotion Foundation (Promotion Sante Suisse)
Dufourstrasse 30
CH-3005 Bern
Switzerland
Email: bertino.somaini@promotionsante.ch
35
Mr Mike Shaw
Head of Department
English Language Service
Radio Netherlands
P.O. Box 222
Hi 1 versum 1200 JG
The Netherlands
Email: mike.shaw@mw.nl
Mr Ian Cumming
Chief Executive
Trust Headquarters
Morecambe Bay Hospitals NHS Trust
Westmorlano General Hospital
Burton Road
Kendal LA9 7RG
Cumbria
United Kingdom
Email: ian.cumming@mbht.nhs.uk
Ms Maggie Davies
Associate Director of Development
National Institute for Health and Clinical Excellence (NICE)
MidCity Place
71 High Holbom
London WC1V 6NA
United Kingdom
Email: Maggie.Davies@nice.org.uk
Dr John Kenneth Davies
Vice President
European Region
International Union for Health Promotion and Education (IUHPE)
c/o International Health Development Research Centre
Faculty of Health
University of Brighton
Brighton BN1 9PH
United Kingdom
Email: j.k.davies@brighton.ac.uk
Ms Jenny Douglas
Senior Lecturer in Health Promotion
Faculty of Health and Social Care
The Open University
Walton Hall
Milton Keynes, MK7 6AA
United Kingdom
Email: J.Douglas@open.ac.uk
36
Dr Marianne Haslegrave
Independent Consultant working with NGOs, UN Agencies and others
28 Ashmount Road
London, N19 3BJ
United Kingdom
Email: mh@commat.org
Dr Kelley Lee
Reader
Centre on Global Change and Health
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E7HT
United Kingdom
Email: kelley.lee@lshtm.ac.uk
Dr Paul Lincoln
Chief Executive
National Heart Forum
Tavistock House South
Tavistock Square
London WC1H 9LG
United Kingdom
Email: paul.lincoln@heartforum.org.uk
Ms Doreen McIntyre
Director
International Non Governmental Coalition Against Tobacco
P.O. Box 42134
London SW8 4WS
United Kingdom
Email: doreen.mcintyre@ingcat.org
Prof Mala Rao
Joint Head
Head, Public Health Development
Public Health Development
Skipton House
80 London Road
London SEI 6LH
United Kingdom
Email: mala.rao@dh.gsi.gov.uk
judy.beswick@dh.gsi.gov.uk
37
Dr Geof Rayner
Visiting Research Fellow
Health Management and Food Policy
City University
9 Dalebury Road
London SW17 7HQ
United Kingdom
Email: mail@rayner.uk.com
Mr David Seal
Acting Chief Executive
Wales Centre for Health
Canolfan lechyd Cymru
14 Cathedral Road
Cardiff, CF11 9LJ, Wales
United Kingdom
Email: David.Seal@wch.wales.nhs.uk
SOUTH-EAST ASIA REGION
Mr Faruque Ahmed
Director, Health and Nutrition Program
Bangladesh Rural Advancement Committee (BRAC)
BRAC Centre
75, Mohakhali
Dhaka-1212
Bangladesh
Email: faruque.a@brac.net
Dr Zubaida Shahan Ara
Medical Officer (Incharge)
School Health Clinic (Girls Section)
Azimpur
Dhaka
Bangladesh
Email: elutfullah@pathfind.org
elutfullah@nsdp.org
Dr Laila Parvenn Banu
Assistant Professor
Institute of Health Sciences
Gonoshasthaya Kendra
House No. 14E, Road No. 6
Dhanmondi
Dhaka-1205
Bangladesh
Email: gk@citechco.net
38
Prof Sushil Howlader
Professor
Institute of Health Economics
Dhaka University
Dhaka 1000
Bangladesh
Email: ihedu@citechco.net
Mr Md Anowarul Islam Khan
Line Director Health Education and Promotion and Chief, Health Education Bureau
Directorate-General of Health Services
Mohakhali
Dhaka
Bangladesh
Email:
Ms Manuara Manuara Begum
Divisional Health Education Officer
Directorate General of Health Services
Ministry of Health and Family Welfare
Bureau of Health Education
Mohakhali
Dhaka 1212
Bangladesh
Email: mdaikhan53@yahoo.com
Dr Mohammed Milon Munshe Milon
Dhaka
Bangladesh
Email:
Ms Advocate Nazmun Nahar
Chairperson
United Social and Human Advancement (USHA)
Siraj Villa
Moushair (Chalaban)
Uttarkhan
Uttara
Dhaka-1230
Bangladesh
Email: ushabangladesh@yahoo.com
Dr Nazim Nazim Uddin
Deputy Manager (Health)
Grameen Kalyan
8th Floor, Grameen Bank Complex
Mirpur-02
Dhaka-1216
Bangladesh
Email: g_kalyan@grameen.net
39
Dr Maswoodur Prince Rahman
Editor, Stethoscope
The Daily Independent
32, Kazi Nazru Islam Avenue
Kawran Bazar, Dhaka-1215
Dhaka
Bangladesh
Email: cdrb@dhaka.agni.com
Mr Md. Abul Quashem
Executive Director (Joint Secretary)
Ministry of Health and Family Welfare
National Nutrition Programme (NNP)
H#46, R#5
Dhanmondi
Dhaka-1205
Bangladesh
Email: n.npquashem@yahoo.com
Prof Mahmudur Rahman
Director
Institute of Epidemiology, Disease Control & Research (IEDCR)
Mohakhali
Dhaka 1212
Bangladesh
Email: mrahman@citechco.net
Dr Matiur Rahman
Deputy Secretary (PER)
Ministry of Health and Family Welfare
Room No.322, Building No.3
Ministry of Health and Family Welfare
Bangladesh Secretariat
Dhaka 1000
Bangladesh
Email: mmatiurrahman_ds@yahoo.com
Dr Hossain Shahadat
Family Planning Officer
IEM Unit
Directorate of Family Planning
Azimpur
Dhaka
Bangladesh
Email:
40
Mr Sonam Phuntsho
Information and Communication Specialist
Information and Communication Bureau
Ministry of Health, Royal Government of Bhutan, Thimphu
Thimphu
Bhutan
Email: sonpo@druknet.bt
Dr Mahesh Chandra Agarwal
Specialist in Laser Surgery
Eye Department
Deen Dayal Upadhyaya Hospital
Hari Nagar
New Delhi 64
India
Email: amaheshdoc@rediffmail.com
Dr Harikiran Arkalgud Govindaraju
Assistant Professor
R V Dental College
Ca37, 24th main
J P Nagar 1st Phase Bangalore
Karnataka
India
Email:
Dr Daya Ram Haldwani
Professor of Physiology
Maulana Azad Medical College
180-B, Pocket-J & K
Dilshad Garden
Shahdara
New Delhi 95
India
Email:
Dr Saroj S. Jha
Co/WR India
Maharashtra
India
Email: sarojsjha@hotmail.com
41
Dr Udaya Shankar Mishra
Associate Fellow
Centre for Development Studies
Prasanth Nagar Road
Ulloor
Trivandrum 695 011
Trivandrum
India
Email: mishra@cds.ac.in
udayamishra@yahoo.co.uk
mishra@cds.ac.in
Ms Bhavna Banati Mukhopadhyay
Director
Development Communication Division
Voluntary Health Association of India
40 Institutional Area, behind Qutub Hotel
New Delhi 16
India
Email:
DrNamrita Nair
Independent Health Planner
46 Jalvayu Vihar
Kammanahalli Main Road
Bangalore 560043
India
Email: namritanair@hotmail.com
namritanair@yahoo.com
z3127188@student.unsw.edu.au
Dr Thelma Narayan
Coordinator
Community Health Cell
359, (Old No. 367)
Srinivasa Nilaya
Jakkasandra, 1st Block, 1st Main
Koramangala
Bangalore 560 034
India
Email: chc@sochara.org
Mr Ramesh Papanna Rudra Murthy
Councillor
Former Mayor of Bangalore
144, Lalbagh Fort Road
Patvathipura
Bangalore 560004
India
Email: rameshwpuram@rediffmail.com
42
Ms Ramuben Parmar
Senior Health Promoter
Health
Self -Employed Women's Association (SEWA)
Sewa. Chanda Niwas
Opposite Kamavati Hospital
Ellisbridge
Ahmedabad - 380006
India
Email: social@sewass.org
Ms Roshanben Pathan
Senior Health Supervisor
Health
Self-Employed Women's Association (SEWA)
Sewa
Chanda Niwas
Opposite Kamavati Hospital
Ellisbridge
Ahmedabad 380 006
India
Email: social@sewass.org
Mr Venkatachalam Pillai Regunathan
Founder
Youth Smoking Prevention
Volunteers Against Smoking and Tobacco
No. 132 - Tiruvenkata Nagar
Tiruverumbur Post
Tiruchirapalli-620013
India
Email: vregu@bheltry.co.in
Dr Bela Shah
Senior Deputy Director General
Division of Noncommunicable Diseases
Indian Council for Medical Rsearch (ICM)
New Delhi -110029
India
Email: belashah@yahoo.com
Dr Yashpal Sharma
Medical Superintendent
Govt. Medical College
S.M.G.S Hospital
Jammu-18001
India
Email: yashpalsharma@yahoo.co.in
yash 1000@hotmail .com
43
Mr Praveen Kumar Tripathi
Director
Information and Broadcasting
Government of India
Indian Institute of Mass Communication
Aruna Asaf Ali Marg, JNU, N8W Campus
New Delhi-110067
India
Email: jsp.inb@sb.nic.in
Dr Srinivasan Velu
#790, 1st Cross 2nd Main
Koratnangala 8th Block
Bangalore
Karnataka 560095
India
Email:
Dr Iskandar Adisapoetra
Jakarta
Indonesia
Email:
Dr Dachroni
Jakarta
Indonesia
Email:
Ms Judhiastuty Februhartanty
Lecturer
Regional Centre for Community Nutrition
University of Indonesia
Jakarta 10560
Indonesia
Email:
Dr Bambang Hartono
Chief
Center of Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email: bambangh@depkes.go.id
44
Dr Rahmat Kurniadi
Health Promotion Professional
Division of CHP Internal Affairs
Center of Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email:
Dr Zulazmy Mamdy
Chair of Indonesian Health Promoter and Health Educator Association
Indonesian Society for Heath Promotion and Education
Faculty of Public Health
University of Indonesia
Depok
Indonesia
Email: zulmamdy@yahoo.com
Dr Anis Abdul Muis
Health Promotion Professional
Division of Community Participation and Partnership for Health Promotion
Center of Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email: aa_muiz@yahoo.com
Dr Dyah Erti Mustikawati
Chief
Subdivision of Methodology and Technology for Health Promotion
Division of Technology and Media Development for Health Promotion, Center of Health
Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email: dmustika@indosat.net.id
45
Mr Purjanto
Division of Technology and Media Development for Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email:
Dra Ruflina Rauf
Chief
Subdivision of Community Participation in Health Promotion
Division of Technology and Media Development for Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-10
Block C 6th Floor
South Jakarta 12950
Indonesia
Email:
Dra Hafiii Rochmah
Chief, Subdivision of Partnership in Health Promotion
Division of Community Participation and Partnership for Health Promotion
Centre of Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email: hafhi_rochmah@yahoo.com
Mr James Sianipar
Jakarta
Indonesia
Email:
Ms Srinivas Siswati
Chief of Health Promotion Division
West Sumatera Provincial Government
West Sumatera Provincial Health Service
Komp-Parupuk Raya Block C No.30
Taing-Padong
Padong
Indonesia
Email:
46
Dr Soesilawati Soebekti
Women Community Empowerment Organization
Ditjend PMD Depdagri
JI. Raya Pasar Minggu Km. 19
South Jakarta
Indonesia
Email:
Dr Soeharsono Soemantri
Senior Researcher
Ministry of Health
JI. Percetakan Negara No.23A
Jakarta 10560
Indonesia
Email: harsono@litbang.depkes.go.id
some s @yahoo.com
Ms Herawaty Tanty
Senior Professional Staff
Center for Health Promotion
Ministry of Health
R.I., Jakarta
JI. H.R. Rasuna Said Kav. 4-9, Block C
6th Floor
Jakarta 12950
Indonesia
Email: promokes@depkes.go.id
Dr Hernani
Directorate General CDC&EH
Ministry of Public Health
Head of Subdirectorate Leprosy Control
JI. Percetakan Negara No.29
Jakarta Pusat
Indonesia
Email: hemanitb2001@yahoo.com
Dra Zuraidah
Chief, Subdivision of Media for Health Promotion
Subdivision of Media for HP
Division of Technology and Media Development for Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-10
Block C 6th Floor
South Jakarta 12950
Indonesia
Email: idamarku@hotmail.com
47
Dr Ismoyowati
Chief, Division of Community Participation and Partnership for Health Promotion
Center of Health Promotion
Ministry of Health
JI. HR. Rasuna Said Kav 4-9
Block C 6th Floor
South Jakarta 12950
Indonesia
Email: ismoyowati@plasa.com
Dr Heidi Brown
Health Promotion Officer
Health Education Unit
Department of Public Health, Republic of Maldives
VSO Programme Office
P.O. Box 2008
Male
Maldives
Email: heids_on_tour@yahoo.com
Ms Fathimath Khalid
Assistant Public Health Officer
Department of Public Health
Ministry of Health
Male
Maldives
Email:
Mr Hussain Rasheed
Senior Coordinator
School Health Programme
Ministry of Education
Male
Maldives
Email:
Dr Phyu Phyu Aye
Medical Officer
Public Health
Department of Health
36 Theinbyu Road
Yangon
Myanmar
Email:
48
Dr Nyo Nyo Kyaing
Deputy Director (Primary Health Care)
Department of Health
Ministry of Health
36 Theinbyu Road
Yangon 951
Myanmar
Email: nyonyok@myanmar.com.mm
Dr Khin Maung Lwin
Deputy Director
Department of Health Planning
Central Health Education Bureau
Ministry of Health
44 Theinbyu Road
Yangon
Myanmar
Email: Lkmlwin@mptmail.net.mm
Dr San Shway Wynn
Director (Public Health)
Public Health Division
Department of Health
36 Theinbyu Road
Yangon
Myanmar
Email: d4-004@moh.gov.mm
Mr Lava Kumar Devacota
Secretary
Ministry of Health & Population
Ramshahpath
Kathmandu
Nepal
Email:
Mr Rishi Ram Nepal
Senior Health Education Administrator
National Health Education, Information & Communication Centre
Ministry of Health and Population
Teku
Katmandu
Nepal
Email:
49
Dr Bishnu Prasad Pandit
Director General
Department of Health Services
Ministry of Health and Population
Teku
Katmandu
Nepal
Email:
Dr Keshak Bhakta Shrestha
Director
Department of Health Services
National Tuberculosis Control Center
Bhaktapur 00-977-1
Nepal
Email: keshab@hotmail.com
ntpdirector@mail.com.np
Mr Prem Kumar Shrestha
Under Secretary
Ministry of Health & Population
Ramshahpath
Kathmandu
Nepal
Email:
Mr Ok Ryun Moon
Professor of Health Policy
Department of Health Policy and Management
School of Public Health
Seoul National University
Seoul
Republic of Korea
Email: uchorm@snu.ac.kr
Dr Kanthi Ariyaratne
Director, Health Education Bureau
Ministry of Health, Colombo
No 2, Kinsey Road, Colombo 8, Sri Lanka
Sri Lanka
Email: kanthi_ariyarathne@yahoo.com
Dr Manoj Fernando
Secretary of the Committee on Tobacco and Alcohol
Sri Lanka Medical Association
Executive Director, Sumithrayo
Mel Medura 60 Horton Place
Colombo 7
Sri Lanka
Email: melmedur@sri.lanka.net
50
Ms Angelique Alberti
Bangkok
Thailand
Email:
Dr Jutamas Arunanondcha
Senior Researcher
International Economy
Fiscal Policy Research Institute Foundation
32nd Floor, Tipco Tower
Rama 6 Road
Bangkok 10400
Thailand
Email: jutamas@fispri.org
Dr Narongsakdi Aungkasuvapala
Thailand
Email:
Mr Berhard Barth
Associate Social Affairs Officer
Health and Development Section, Emerging Social Issues Division
UN Economic and Social Commission for Asia and the Pacific (UNESCAP)
United Nations Building
Rajadamnem Nok Avenue
Bangkok, 10200
Thailand
Email: barth@un.org
Dr Tipvadee Bempenboon
Thailand
Email:
Dr Yothin Benjawung
Associate Dean & Professor
Preventive Medicine
Srinakharinwirot University
Faculty of Medicine
Srinakharinwirot University Wattana
Sukhumvit 23
Bangkok 10110
Thailand
Email: yothin@swu.ac.th
51
Dr Katherine C. Bond
Associate Director of Development
Health Equity
The Rockefeller Foundation
Regional Office for Southeast Asia
21/F, UBC II Building
Sukhumvit Road, Soi 34
Bangkok
Thailand
Email:
Prof DrTassana Boontong
President
Thailand Nursing Council
Nagarindrasri Building
Ministry of Public Health
Tiwanond Rd
Ampur Muang
Nonthaburi 11000
Thailand
Email: btassana@ji-net.com
Dr Theechat Boonyakarnkul
Director
Sanitation and Health Impact
Assessment Division
Department of Health
Nonthaburi 11000
Thailand
Email: tchat@health.moph.g.th
Dr Umapom Boonyasopun
Associated Dean
Faculty of Nursing Prince
Songkla University
Faculty of Nursing
Prince of Songkla University
POB 9 Kor-Hong
HatYai Songkla
Thailand
Email: umapom.B@psu.ac.th
Dr Prat Boonyawongvirot
Bangkok
Thailand
Email:
52
Dr Grete Budsted
Regional Health Delegate for South-East Asia
Asoke Towers 219/8-10, 4th Floor
Sukhumvit21 Wattana
Bangkok 10110
Thailand
Email: ifrcth02@ifrc.org
Dr Cai Cai
Social Affairs Officer
Emerging Social Issues Division
United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP)
United Nations Building
Rajadamnem Nok Avenue
Bangkok 10200
Thailand
Email: caic@un.org
Dr Witaya Chadbunchachai
Thailand
Email:
Prof Weerasak Chaipah
Assistant Professor
Faculty of Public Health
Khon Kaen University
Dean's Office
Faculty of Public Health
Khon Kaen University
Khon Kaen 40002
Thailand
Email: deanph@kku.ac.th
Dr Somchai Chakpabhand
Bangkok
Thailand
Email:
Dr Kanyika Chamniprasas
Head of The Department
Faculty of Medicine
Prince of Songkla University
Prince of Songkla University
Hat-Yai
Songkla 90110
Thailand
Email: kanyika.c@psu.ac.th
53
Dr Puangpen Chanprasert
Bureau of Health Promotion
Department of Health
Ministry of Public Health
Tivanond Rd
Nonthaburi 11000
Thailand
Email: puangpen@yahoo.com
ppen@health.moph.go.th
Dr Somyos Charoensak
Director
Department of Health
Ministry of Public Health
Muang
Nonthaburi 11000
Thailand
Email: somyos@.health3.go.th
Ms Angela Chen
Health and Human Development Programs
Education Development Center (EDC)
209/1 CMIC Tower B Unit 2, 11th Floor
SUKHUMVIT 21 Road (ASOKE), Klongton-Nua, Wattana
Bangkok 10110
Thailand
Email: achen@edc.org
Dr Hatai Chitanond
Thailand
Email:
Dr Anupong Chitvarakorn
Thailand
Email:
Dr Suthon Choeikhamhaeng
Bangkok
Thailand
Email:
Dr Vichai Chokevivat
Bangkok
Thailand
Email:
54
Dr Komatra Chuengsatiansup
Director
Society and Health Institute
Bureau of Health Policy and Strategy
4th Floor, Bld No.4
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: komatra@health.moph.go.th
Dr Anchalee Chuthaputti
Senior Phamacist
Department for Development of Thai Treditional & Alternative Medicine
Institute of Thai Traditional Medicine
Ministry of Public Health
Muang
Tiwanond Rd.
Nonthaburi 11000
Thailand
Email: anchalee@dtam.moph.go.th
Dr Pranom Cometieng
Thailand
Email:
Dr Panida Damapong
Thailand
Email:
Dr Somchai Durongdej
Bangkok
Thailand
Email:
Dr Nikom Dusitsin
Thailand
Email:
Dr Wijitr Fungladda
Associate Professor and Head
Department of Social & Environmental Medicine
SEAMEO TROPMED Regional Centre for Tropical Medicine
Faculty of Tropical Medicine
Mahidol University
Bangkok
Thailand
Email:
55
Dr Jirapom Getpreechawas
Senior Expert in Preventive Medicine
Department of Medical Service
Ministry of Public Health
Ministry of Public Health
Muang
Tiwanond Rd.
Nonthaburi 11000
Thailand
Email: getpree@yahoo.com
Dr Stephen L. Hamann
International Affairs Consultant
International Affairs
Thai Health Promotion Foundation
979 34th Floor, S.M. Tower
Phaholyothm Rd, Phayathai, Samsennai
Phayathai
Bangkok 10400
Thailand
Email: stephen@thaihealth.or.th
Prof Yanyong Inmoung
Faculty of Pharmacy and Health Sciences
Mahasarakham University
Kantarawichai Mahasarakham 44150
Thailand
Email: yanyong.i@msu.ac.th
Dr Amphon Jindawatthana
Director
Nation Health System Reform Office (HSRO)
Ministry of Public Health
Muang
Tiwanond Rd.
Nonthaburi 11000
Thailand
Email: amphon@hsro.or.th
amphon@health.moph.go. th
Dr Praphasri Jongsuksuntigul
Senior Expert in Public Health
Department of Disease Control
Ministry of Public Health
Ministry of Public Health
Muang
Tiwanond Rd.
Nonthaburi 11000
Thailand
Email: praphasri@gmail.com
56
Dr Pongpisut Jongudomsuk
Director
Bureau of Policy and Planning
National Health Security Office
28th Floor Jasmine International Tower
Pakkret
Chaengwattana Rd.
Nonthaburi 11000
Thailand
Email: pongpisut.j@nhso.go.th
Dr Thavachai Kamoltham
Thailand
Email:
Dr Kanchana Kanchanasinith
Deputy of Medical Sciences
Department of Medical Sciences
Ministry’ of Public Health
Faculty' of Nursing
Chulalongkorn University
Payathai Rd.
Patumwan 10331
Thailand
Email: kanchana@dmsc.moph.go.th
Dr Visal Kantaratandkul
Thailand
Email:
Ms Thelma Kay
Chief, Emerging Social Issues Division
United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP)
6th Floor, Block B, United Nations Building
Rajdamnem Avenue
Bangkok 10200
Thailand
Email: kay.unescap@un.org
Dr Noppadol Keawsupat
The Thailand Association of Tambon Administration Offices
OmKred Tambon Administration Office
OmKred Sub-district
Pakkred District
Nonthaburi 11120
Thailand
Email: pocky_pock@hotmail.com
57
Ms Suwanee Khaminan
Director
Quality of Life and Social Department Office
Office of National Economic and Social Departmant Board (NESDB)
962 NESDB Krungkasem Rd.
Pomprab
Bangkok 10100
Thailand
Email: skhamman@hotmail.com
suwamee@nesdb.go.th
Mr Shiv Khare
Executive Director
Asian Forum of Parliamentarians on Population and Development (AFPPD)
Phathay Plaza, suite 9-C
Ratchathewi
Bangkok 10400
Thailand
Email: afppd@afppd.org
Dr Decha Khuwuthyakorn
Director
Public Health & Environmental Bureau
Chiang Mai Municipality
Chiang Mai Municipality Office
Wangsingcome Rd.
Muang Chiang Mai 50300
Thailand
Email: anurat_ma@yahoo.com
Dr Nittaya Kotchabha
Director
National Institute for Child & Family Dcvelopement ( NICFD)
Mahidol University
NICFD Mahidol University
999 Buddhamonthol 4 Rd.
Salaya Nakhon
Thailand
Email: ranjk@mahidol.ac.th
Dr Orasa Kovindha
Policy and Planning Analyst
Bureau of Policy and Strategy
Ministry of Public Health
Nonthaburi, 11000
Thailand
Email: kovindha@yahoo.com
58
Dr Chai Kritiyapichatkul
Health Promotion Partnership Development
Health Education Division
Department of Health Service Support
Permanent Secretary, Ministry of Public Health
4th Building, 5th Floor
Tiwanond Road
Bangkok
Thailand
Email: drchai@hotmail.com
Prof Pinit Kullavanijaya
Secretary - General
The Medicine Council of Thailand
Ministry of Public Health
7th Floor, Office of The Permanent Secretary
The Ministry of Public Health
Tiwanond Rd.
Muang
Thailand
Email: Pinitkul@hotmail.com
Dr Supachai Kuraratanapruk
Thailand
Email:
Dr Somchai Leetongin
Director
Department of Health
Ministry of Public Health
Tiwanon Rd.
Muang
Nonthaburi 11000
Thailand
Email: sopah@health3.moph.go.th
Leetong 16@hotmai l.com
Dr Jirapom Limpananont
Thailand
Email:
Dr Chadapom Naiyachit
Bangkok
Thailand
Email:
Dr Mahabhol Nitaya
Thailand
Email:
59
Dr Sanguan Nitayarumphong
Secretary General
National Health Security Office
200 Moo 4 Jasmine International Tower
28 FL Chaengwatana Rd
Pakkert
Nonthaburi
Thailand
Email: sanguan.n@nhso.go.th
Dr Amom Nondasuta
Thailand
Email:
Dr Sepi Pangphit
Thailand
Email:
Prof Vicham Panich
Director
23rd Floor SM Tower
The Knowledge Management Institute
979 Phayathai Road, Samsen-nai
Phayathai, Bangkok 10400
Bangkok 10400
Thailand
Email: xncham@krni.or.th
vicham@trf.or.th
Mrs Panida Panyangarm
Executive Director
Pharmaceutical Research and Manufacturers Association - PReMA
Room No. 408/51, 12th Floor
Phaholyothin Place Bldg.
Phaholyothin Rd.
Bangkok 10400
Thailand
Email: panida@prema.or.th
Ms Roongpetch Parinayok
Senior Professional Relations Manager
Regulatory and Corporate Affairs
GlaxoSmithKline (Thailand) Ltd.
12th Fl., Wave Place
55 Wireless Rd.
Lumpini, Patumwan
Bangkok 10330
Thailand
Email: roongpetch.parinayok@gsk.com
60
Prof Paichit Pawabutr
Dean
Faculty of Public Health
Naresuan University
Phisanulok 65001
Thailand
Email: nok_patoomrat@hotmail.com
Dr Arkavadet Pensini
Rhonkaen Province
Thailand
Email:
Dr Suthep Petchmark
Director, Department of Health
Regional Health Promotion Center 5
177 Mu 6 Tambol Kokgruad
Muang Nakhon
Ratchasrima 30280
Thailand
Email: suthep@anamai.moph.go.th
Dr Prapoj Petrakard
Medical Officer, Senior
Department for Development of Thai Traditional and Alternative Medicine
Ministry of Public Health
Ministry of Public Health
Muang
Nonthaburi 11000
Thailand
Email: prapoj@dtam.moph.go.th
Ms Kobkul Phancharoenwarakul
Dean to Faculty of Nursing
Faculty of Nursing
Mahidol University
No.2 Pranok Rd.
Faculty of Nursing (Cat Siriraj)
Mahidol University
Bangkok 10700
Thailand
Email: dearms@mcc.mahidol.ac.th
Mr Wiput Phoolcharoen
Freelance
205/7 Soi Chaikiat 1 Ngamwongwan Rd.
Laksi
Bangkok 10210
Thailand
Email: Pwiput@yahoo.com
61
Ms Warapom Piyasirananda
Thailand
Email:
Dr Adisak Plitponkarnpim
Thailand
Email:
Dr Tipicha Posayanonda
Thailand
Email:
Dr Pakdee Pothisiri
Secretary - General
Food and Drug Administration
Ministry of Public Health
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: ppakdee@health.moph.go.th
Ms Areekul Puangsuwan
Program and International Affairs Officer
Research, Policy and Capacity Development Programme
Thai Health Promotion Foundation
S.M. Tower, Paholyotin Rd., Phayathai
979/22 Floor 15
Bangkok 10400
Thailand
Email: areekul@thaihealth.or.th
Dr Twisuk Punpeng
Senior Public Health Officer
Department of Health
Ministry of Public Health
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: twisuk@health.moph.go.th
Dr Sawat Ramaboot
WHO Retiree
54/111 Tiwanon Road
Nonthaburi 11000
Thailand
Email: ramaboot@yahoo.com
62
Dr Krissada Raungarreerat
Deputy Manager
Thai Health Promotion Foundation (ThaiHealth)
979 S.M. Tower Floor 15
Paholyotin Road
Samsen Nai, Payathai
Bangkok 10400
Thailand
Email: kris@thailhealth.or.th
Ms Duangduen Sahavechaphan
Administrative Manager
Pharmaceutical Research and Manufacturers Association - PReMA
Room No. 408/51, 12th Floor
Phaholyothin Rd.
Phyathai
Bangkok 10400
Thailand
Email: duangduen@prema.or.th
Ms Yuenwah San
Chief, Health and Development Section, Emerging Social Issues Division
UN Economic and Social Commission for Asia and the Pacific (UNESCAP)
United Nations Building
Rajadamnem Nok Avenue
Bangkok 10200
Thailand
Email: san.unescap@un.org
Dr Boosaba Sanguanprasit
Assistant Dean
Faculty of Public Health
Mahidol University
420/1 Rajavithee Rd.
Rajathevee Payathai
Bangkok 10400
Thailand
Email: boosaba@health.moph.go.th
phbsp@mahidol.ac.th
Ms Chamaipam Santikarn
Senior Expert in Preventive Medicine
Noncommunicable Disease Department of Disease Control
Ministry of Public Health
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: chamaipa@health.moph.go.th
63
Dr Wanchai Sattayawuthipong
Bangkok
Thailand
Email:
Dr Rosalia Sciortino
Director
The Rockefeller Foundation
Regional Office for Southeast Asia
21/F, UBC II Building
Sukhumvit Road, Soi 33
Bangkok 10110
Thailand
Email:
Dr Sean Christian Sellars
External Affairs
MSD Thailand
Bangkok
Thailand
Email: Christian_Sellars@Merck.com
Dr Suvaj Siasiriwattana
Bangkok
Thailand
Email:
Mrs Anutra Sinchaipanich
Director
Business and Corporate Affairs Department
Pfizer (Thailand) Ltd.
38th Floor
United Center Building
323 Silom Road
Silom
Bangrak
Bangkok 10500
Thailand
Email: Anutra.sinchaipanich@pfizer.com
Prof Dr Palarp Sinhaseni
Head, Chemical Safety Research Division
Institute of Health Research (IHR)
Chulalongkorn University
Chulalongkorn Soi 62
Phyathai Road
Pathum Wan
Bangkok 10330
Thailand
Email: spalarp@chula.ac.th
64
Prof Chitr Sitthi-Amorn
Dean
The College of Public Health
Chulalongkorn University
Institute Building 3, 10th floor
Soi Chula 62 Patumwan
Bangkok 10330
Thailand
Email: schitr@chula.ac.th
Dr Sasitom Sittichai
Bangkok
Thailand
Email:
Dr Sompob Snidvongs Na Ayudhya
Director
Health Department
Bangkok Metropolitan Administation
BMA Hall 2 Mitrmaitri Rd.
Dindaeng
Bangkok 10400
Thailand
Email: yayu092000@yahoo.com
Dr Boonchai Somboonsook
Deputy Director-General
Department of Health Service Support
Ministry of Public Health
Department of Health Service Support
Ministry of Public Health
Nonthaburi 11000
Thailand
Email: boonchai@hss.moph.go.th
Dr Bundit Sornpaisarn
Thailand
Email:
Prof Jiruth Sriratanaban
Associate Professor
Department of Preventive and Social Medicine
Chualongkom University
1873 Rama 4 Road, Pathumwan
Bangkok 10330
Thailand
Email: sjiruth@chula.ac.th
65
Dr Suphan Srithamma
Senior Advisor on Public Health Service System Developmemu
Office of Permanent Secretary
Ministry' of Public Health
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: supans@health2.moph.go.th
Dr Kittima Sriwatanakul
Scientific Affairs Manager
Scientific Affairs Department
Servier (Thailand) Ltd.
2 Pleonchit Center
15th Floor, Sukhumit Road
Klongtoey
Bangkok 10110
Thailand
Email: Kittima.Sriwatanakul@th.netgrs.com
Mr Decharut Sukkumnoed
Coordinator
Health Public Policy and Health Impact Assessment Program (HIA)
Health Systems Research Institute; Ministry of Public Health
70/7 Al Nont Building, 5th Floor
Tiwanond Road
Muang
Nonthaburi 11000
Thailand
Email: tonkiagroup@yahoo.com
Dr Metaee Sukontarug
Bangkok
Thailand
Email:
Dr Thawat Suntpajarn
Bangkok
Thailand
Email:
66
Dr Choochai Supawongse
Consultant
Office of The National Human Rights Commission
88/7 Department of Medical Sciences
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: choochai@nhrc.or.th
Dr Paiboon Suriyawongpaisal
Thailand
Email:
Dr Viroj Tangcharoensathien
Director
Bureau of Policy and Strategy
International Health Policy Program (IHPP)
Ministry’ of Public Health
Tivanond Road, Muang
Nonthaburi 11000
Thailand
Email: viroj@ihpp.thaigov.net
Dr Napong Tangtrongpaisan
Thailand
Email:
Mr Kitti Tanhan
Chief, Water Resources Section
Bureau of Environmental Impact Evaluation
Office of Natural Resources and Environmental Policy and Planning
Ministry of Natural Resources and Environment
60/1 Soi Phibunwattana 7
Rama VI Rd
Phayathai Bangkok 10400
Thailand
Email: k_tanhan@yahoo.com
Dr Prawate Tantipiwatanaskul
Advisor
Department of Mental Health
Ministry of Public Health
Muang
Nonthaburi 11000
Thailand
Email: tprawate@dmhthai.com
tprewate@yahoo.com
67
Dr Nit Tassniyom
Associate Professor
Faculty of Nursing
Khon Kaen University
Faculty of Nursing
Khon Kaen University
Khon Kaen 4002
Thailand
Email: nittas@kku.ac.th
Dr Sandra B. Tempongko
Deputy Coordinator
SEAMED TROPMED Network
Bangkok
Thailand
Email: tmseanet@diamond.mahidol.ac.th
fnvpn@diamond.mahidol.ac.th
Mrs Caranee Thianthai
Marketing Training
Marketing - Grocery
Nestle (Thai) Ltd.
999/9 Rama 1 Road
Pathumwan
Bangkok 10330
Thailand
Email: Caranee.Thianthai@th.nestle.com
Dr Siriwat Tiptaradoi
Director
Health Systems Research Institute ( HSR1)
Ministry of Public Health
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: siriwat@hsri.or.th
Ms Yongkolnee Vithayarungruangsri
Thailand
Email:
68
Dr Luecha Wanaratna
Head of The Health Technical Office
Office of thePermanent Secretary
Ministry of Public Health
Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: luecha@health.go.th
Dr Sanchai Wattana
Thailand
Email:
Dr Paiboon Wattanasiritham
Thailand
Email:
Dr Suwannachai Wattanaying Charoenchai
Bangkok
Thailand
Email:
Mr Piset Wechakama
Thailand
Email:
Ms Daranee Wenuchan
WAGGGS Liaison Person for the UNESCAP
Asia Pacific Region
The World Association of Girl Guides and Girl Scouts
The Girls Guides Association of Thailand
5/1-2 phayathai road
Rajathewee
Bangkok 10400
Thailand
Email: ggat@cscoms.com
waggs@waggsworld.org
Dr Pradit Winichakoon
Thailand
Email:
69
Dr Suriya Wongkongkathep
Senior Health Supervisor
Office of Inspection
Ministry of Public Health
Fl. 4 BLG 2 Ministry of Public Health
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: suriya@health.moph.go.th
Ms Benchamas Wongsam
c/o Embassy of the Argentine Republic in Bangkok
Bangkok
Thailand
Email:
Dr Lamduan Wongsawasdi
Associate Professor
Faculty of Medicine
Chiang Mai University
110 Intravaroros
Muang
Chiang Mai 50200
Thailand
Email: lwongsaw@mail.med.cmu.ac.th
Dr Pipat Yingseree
Bangkok
Thailand
Email:
Ms Jintana Yunibhand
Dean, Faculty of Nursing
Chulalongkorn University
88/7 Department of Medical Sciences
Tiwanond Rd.
Muang
Nonthaburi 11000
Thailand
Email: deannurs@chula.ac.th
Mr Praween Payapvipapong
Vice President
Population and community Development Association (PDA)
6 Sukhumvit 12
Klongtoey
Bangkok
Thailand 10110
Email: urb@pda.or.th
70
Mr Chairoj Khunimongkol
Director
Department of Health
Regional Health Promotion Center 1
Bang Khane District
Bangkok
Thailand 10130
Email: Chai_94@hotmail.com
Assit. Prof Dr Lakkhana Termsirikulchai
Assistant Professor
Faculty of Public Health
Mahidol University
Rajavetee Rajatevee
Bangkok
Thailand 10400
Email: phlts@yahoo.com
Prof Dr Prakit Vathesatogkit
Professor of Medicine
Thai Health Promotion Foundation
Ramathobodi Hospital 270 Rama VI Rd.
Bangkok
Thailand 10400
Email: rapws@mahidol.ac.th
Dr Wanee Pinprateep
Programme Manager
Nation Health Foundation
1168 Phaholyothin 22 Chatuchak
Bangkok
Thailand 10900
Email: wanee@thainhf.org
pwanee@hotmail.com
Dr Suwat Kusolchariya
Director
Department of Health
Regional Health Promotion Center 2
1 Mu 11 Tumbo
Ban-Mo Amphur Ban
Mo Saraburi
Thailand 18130
Email: suwat@anamai.moph.go.th
71
Dr Buares Sripratak
Provincial Chief Medical Officer
Nakomsawan Public Health Office
Ministry of Public Health
782 Paholyothin Rd.
Muang
Nakomsawan
Thailand 60000
Email: nswpho@hotmail.com
Mr Panus Prueksunand
Director
Department of Health
Regional Health Promotion Center 4
429 Sri-Suriyawong Rd'
Muang
Ratchaburi
Thailand 70000
Email: panus_P@rtcog.or.th
Dr Uthai Dulyakasem
Dean
Walailak University
Nakhonsithammarat
Thailand 80160
Email: duthai@wu.ac.th
Mr Shane Wipatbawonwong
Inspector General (Central Region)
Office of the Permanent Secretary for Interior
Ministry of Interior
Asadang Rd.
Bangkok
Thailand 10200
Email: wichen89@yahoo.com
Dr Poranee Laoitthi
Instructor
Faculty of Medicine
Chulalongkorn University
1873 Rama IV Rd.
Lumphini Phyathai
Bangkok
Thailand 10330
Email: fmedpli@md.chula.ac.th
yui_pauline@hotmail.com
72
Dr Supreda Adulyanon
Director
Population Health and Risk Reduction Programme
Thai Health Promotion Foundation
973 34th Fir. S.M.Tower Paholyothin Rd.
Phayathai
Bangkok
Thailand 10400
Email: supreda@thaihealth.or.th
Dr Ugrid Milintangkul
General Secretary
Folk Doctor Foundation
Thai Health Promotion Foundation
36/6 Soi 10 Pradipat Rd'
Samsen Nai Phayathai
Bangkok
Thailand 10400
Email: fdf@doctor.or.th
Dr Wilaisinee Phiphitkul
Director (Advocacy and Social Marketing Section)
Thai Health Promotion Foundation
973 34th Fir. S.M.Tower
Paholyothin Rd.
Phayathai
Bangkok
Thailand 10400
Email: wilasinee@thaihealth.or.th
Dr Prapaitrakul Kanokpun
Deputy Dean
Phramongkutkao Army Medical College
315 Rachavithi Rd.
Bangkok
Thailand 10700
Email: P_kanokpun@yahoo.com
Dr Somsak Chunharas
Senior Public Health Advisor
Department of Health
Ministry of Public Health
88/22 Tivanon Rd.
Muang
Nonthaburi
Thailand 11000
Email: somsak@health.moph.go.th
73
Lt. Gen. Dr Phisal Thepsithar
Thai Dental Council
Thai Dental Council
6th Floor Institute of Dentistry
Tiwanon Rd.
Nonthaburi
Thailand 11000
Email:
Prof Vanich Vanapruks
Assistant Director
The Institute of Hospital Quality Improvement Accreditation
2nd Floor DMS 6 Bldg
Ngamvonvan Rd.
Muang
Nonthaburi
Thailand 11000
Email: vanapruks@hotmail.com
Prof.Dr Surasak Buranatrevedh
Head, Occupational Health
Faculty of Medicine
Thammasat University
Klongluang District
Prathomthani Province
Thailand 12121
Email: sburana@tu.ac.th
Prof.Dr. Nuntavam Vichit-Vadakan
Faculty Member
Faculty of Science & Technology
Thammasat University
Rangsit Campus Paholyotin Rd.
Klongluang
Pathumthani
Thailand 12121
Email: nuntavam@yahoo.com
Mrs Wanapom Jamjumrus
Division Director
Division of Public Health and Environment
The City of Pattaya
Pattaya City Hall
Banglamung Chonburi
Thailand 20150
Email: admihnet@se-ed.net
74
Dr Danai Theewanda
Director
Department of Health
Regional Health Promotion Center 7
45 Mu 4 Satholamark Rd.
T.that Warinchamrab District
Ubonrachathani
Thailand 34190
Email: danai@anamai.moph.go.th
Dr Wanida Sinchai
Director
Department of Health
Regional Health Promotion Center 6
195 Srichan Rd.
Muang
Khon Kaen
Thailand 40000
Email: hpc6kk@health2.go.th
Dr Sompong Sakulzsariyaporn
Director
Department of Health
Regional Health Promotion Center 10
51 prachasumpan Rd.
Muang Chiangmai
Thailand 51000
Email: sakulsompong@hotmail.com
Mr Chamchai Pinmuang-Ngam
Director
Department of Health
Regional Health Promotion Center 8
157 Pahalyothin Rd.
Muang
Nakhonsawan
Thailand 60000
Email: champin@hotmail.com
Dr Poovanon Eamchan
Director
Department of Health
Regional Health Promotion Center 9
21 Moo 4 Phisanulok
Watbot Rd.
Makhamsoong Muang
Phiaanulok
Thailand 65000
Email: poovanon@dr.com
75
Dr Veerachai Peetawan
Provincial Chief Medical Officer
Nakhonpathom Public Health Office
Ministry of Public Health
202 M.3 Ladyai
Muang Samut
Songkhram
Thailand 75000
Email: Pho750@health2.moph.go.th
Dr Noppom Cheanklin
Provincial Chief Medical Officer
Nakhonsithammarat Public Health Office
Ministry of Public Health
Muang
Nakhonsithammarat
Thailand 80000
Email: dmopp@hotmail.com
Dr Chaipom Promsingh
Director, Department of Health
Regional Health Promotion Center 3
By Pass Road
Muang
Chonburi
Thailand 80000
Email: siripom_P3@hotmail.com
WESTERN PACIFIC REGION
Ms Anne Bunde-Birouste
Senior Lecturer, Coordinator Health and Peace Program
School of Public Health and Community Medicine
University of New South Wales
Sydney 2052
Australia
Email: ab.birouste@unsw.edu.au
Dr Colin Butler
Research Fellow
National Centre for Epidemiology and Population Health
Australian National University
NCEPH, Building 62
cnr Eggleston Rd and Mills Rd
Canberra 7210
Australia
Email: colin.butler@anu.edu.au
csbutler@iprimus.com.au
76
Prof Cordia Chu
Director
Centre for Environment and Population Health, Griffith University
Nathan, Queensland 4111
Australia
Email: c.chu@griffith.edu.au
Dr Johanna Clarkson
Director, Health Promotion
Western Australian Health Promotion Foundation (Elealthway)
P.O.Box 1284
West Perth 6872
Australia
Email: jclarkson@healthway.wa.gov.au
Dr Evelyne De Leeuw
Head
School of Health and Social Development
Deakin University
221 Burwood Highway
Victoria 3125
Australia
Email: evelyne.deleeuw@deakin.edu.au
Dr Mary Ditton
Lecturer in Health Management
School of Health
University of New England
Armindale 2351
Australia
Email: mary.ditton@une.edu.au
Dr Elizabeth Eckerman
Associate Dean
Research, Arts Faculty
Deakin University
Geelong Victoria 3217
Geelong
Australia
Email: lizeck@deakin.edu.au
Dr Rosmarie Erben
Adjunct Associate Professor
School of Public Health
Griffith University
15 Saville Street
Eight Mile Plains
Brisbane 4113
Australia
Email: rosmarie.erben@gmail.com
77
Mr Shane Hearn
Senior Lecturer
School of Public Health
University of Sydney
Edward Fod Building A27
University of Sydney
NSW 2006
Sydney 2006
Australia
Email: shane@health.usyd.edu.au
Ms Leigh Lehane
Australia
Email:
Dr Vivian Lin
Professor Public Health and Head of School
School of Public Health
Faculty of Health Sciences, La Trobe University
Bandoora, VIC3086
Australia
Email: v.lin@latrobe.edu.au
Dr Robert Moodie
Chief Executive Officer
Victorian Health Promotion Foundation
Suite 2 First Floor, 333 Drummond Street
P.O.Box 154
Carlton South 3053
Australia
Email: rmoodie@vichealth.vic.gov.au
Ms Sharon Anne Moskwa
Director, Healthpact
Population Health Division
ACT Health Promotion Foundation (Healthpact)
P.O. Box 825
Canberra 2601
Australia
Email: Sam.Moskwa@act.gov.au
Assoc. Prof Chris Rissel
Director, Health Promotion Unit (Eastern Zone)
Sydney South West Area Health Service
Level 9
King George V
Missenden Road
Camperdown 2050
Australia
Email: criss@email.cs.nsw.gov.au
78
Prof Jan Ritchie
Regional Director
South West Pacific Region
International Union for Health Promotion and Education
School of Public Health and Community Medicine
University of New South Wales
Sydney 2052
Australia
Email: J.Ritchie@unsw.edu.au
Ms Caroline Sheehan
Acting Director
Health Promotion Innovation Unit
Victorian Health Promotion Foundation (VicHealth)
P.O. Box 154
Carlton South 3053
Australia
Email: csheehan@vichealth.vic.gov.au
Mr Colin Sindall
Senior Policy Adviser
Population Health Division
Australian Government Department of Health and Ageing
37 Finniss Crescent
Narrabundah 2604
Australia
Email: Colin.Sindall@health.gov.au
Prof Ben Smith
Senior Research Fellow
School of Public Health
University of Sydney
Lev 2. Medical Foundation Bldg K25
Sydney 2006
Australia
Email: bens@health.usyd.edu.au
Assoc. Prof Michael Sparks
Vice President
South West Pacific Region
International Union of Health Promotion and Education
23 Farrer Street
Braddon, ACT 2612
Australia
Email: michael.sparks@act.gov.au
79
Ms Marilyn Wise
Executive Director
Australian Center for Health Promotion
The University of Sydney
Health Promotion and Education (IUHPE)
Sydney, NSW 2006
Australia
Email: marilynw@health.usyd.edu.au
Ms Lauren Cor dwell
Health Promotion Consultant
Health Promotion
North Central Metro Primary Care Partnership
P.O. Box 1681 Preston South
Victoria 3072
Australia
Email: laurencordwell@hotmail.com
Dr Salleh Hjh Intan Datin
Director-General of Health Services
Department of Health Services
Ministry of Health
Bandar Seri Begawan
Brunei Darussalam
Email:
Mrs Siti Norhayati Mohammad
Education Officer, Human Resource Management
Ministry of Education
Permanent Secretary Office
Bandar Seri Begawan BB 3510
Begawan
Brunei Darussalam
Email: siti.smk@gmail.com
Dr Kassim Norhayati
Ministry of Heath
Brunei Darussalam
Email:
Ms Samphors Dor
Government's Staff
International Relations
Phnom Penh Municipality
#69, Monivong Blvd.
Khan Daun Penh
Phnom Penh
Cambodia
Email: samphorsdor@hotmail .com
my_bellie@yahoo.com
80
Dr Thai Pheang Lim
Director
National Center for Health Promotion
Ministry of Health
No. 162, Preah Sihanouk Blvd
Boeung Keng Kang I
Chamkar Mom
Phnom Penh
Cambodia
Email: nchp@camnet.com.kh
Dr Thai Thieng Lim
Ministry of Health
Phnom Penh
Cambodia
Email:
Dr Heng Lim Try
Chief of Health Education/Health Promotion
National Center for Health Promotion
Ministry' of Health
No. 162, Preah Sihanouk Blvd
Boeung Keng Kang I
Chamkar Mom
Phnom Penh
Cambodia
Email: limtryheng@yahoo.com
Mr Sarin Map
Vice Governor of Phnom Penh Municipality
Phnom Penh Municipality
#69, Monivong Blvd.
Khan Daun Penh
Phnom Penh
Cambodia
Email: samphorsdor@hotmail .com
my_bellie@yahoo.com
Ms Teng You Ky
Deputy Director
Rural Health Care
Ministry of Rural Development of Cambodia
Comer Street 169 and Russian Blvd.
Phnom Penh
Cambodia
Email: cheasamnang@online.com.kh
pro.coordinator@online.com.kh
81
Ms Siliveni Hazelman
Senior Health Sister
Savusavu Health Centre
P.O.Box 230
Savusavu
Fiji
Email: shazelman3@hotmail.com
Mr Manasa Rayasidamu
Health Human Resources Officer
National Centre for Health Promotion
Ministry of Health & Social Welfare
P.O. Box 2223
Government Buildings
Suva
Fiji
Email: mmateiwail@yahoo.com
Ms Pansy Shereen Singh
Senior Education Officer (Health)
Curriculum Development Unit
Ministry of Education
Marela House
Suva
Fiji
Email: mclarena@sp.wpro.who.int
Prof Dr Toshihito Katsumura
Professor
Department of Preventive Medicine & Public Health
Tokyo Medical University
6-1-1 Shinjuku, Shinjuku-ku
Tokyo 160-8402
Japan
Email: kats@tokyo-med.ac.jp
Dr Norio Murase
Assistant Professor
Department of Preventive Medicine & Public Health
Tokyo Medical University
6-1-1 Shinjuku, Shinjuku-ku
Tokyo 160-8403
Japan
Email: murase@tokyo-med.ac.jp
82
Dr Keiko Nakamura
Head
Tokyo Medical and Dntal University
Graduate School of Tokyo Medical and Dental University
Yushima 1-5-45, Bunkyo-ku
Tokyo 113-8519
Japan
Email: nakamura.ith@tmd.ac.jp
Ms Fumiko Saikai
Officer
General Affairs Department
Hyogo Emergency Medical Centre
Kobe
Hyogo Prefecture
Japan
Email: s-persian@hemc.jp
Prof Norio Shimanouclii
Director
Department of Health Sociology
Juntendo University School of Health and Sports Sciences
1-1, Hiragagakuendai
Inbamura, Inbagun
Chiba 270-1695
Japan
Email: norio.shimanouchi@sakura.juntendo.ac.jp
Mr Minako Takamura
The Coordinator of WHO Collaborating Centre for Health Behaviour Research and Health
Promotion
Juntendo University
School of Health and Sports Science
1-1, Hiraga-gakuendai
Inbamura, Inbagun
Chiba 270-1695
Japan
Email: sunsmile375@hotmail.com
Mrs Mweritonga Rubeiariki
Health Promotion Officer
Health Promotion Services
Ministry of Health and Medical Services
P.O. Box 268
Nawerewere
Tarawa
Kiribati
Email: IoaneT@kir.wpro.who.int
83
Mr Soutsakhone Chanthaphone
Deputy Director
Department of Hygiene and Preventive Medicine
National Center for Environmental Health and Water Suply
P.O. Box 26171
Vientiane
Lao People's Democratic Republic
Email: souteh@laotel.com
Mr Phouvong Luangxayasana
Director
EIA Division
Environment Department
Science, Technology and Environment Agency
Vientiane
Lao People's Democratic Republic
Email:
Dr Lokman Hakim bin Sulaiman
Head
Environmental Health Research Centre
Institute for Medical Research
Kuala Lumpur
Malaysia
Email:
Dato Ursula Thomk Dumpangol
World President
The Associated Country Women of the World
P.O. Box 2049
98008 Miri
Sarawak
Malaysia
Email: ursulagoh@hotmail.com
Mr Edmund Ewe Thean Teik
Acting Director
Health Education Division, Department of Public Health
Ministry of Health, Federal Government Administrative Centre
Block E10, Level 4
62591 Putrajaya
Malaysia
Email: eetteik@hotmail.com
eetteik57@yahoo.com
84
Dr Rozlan Ishak
Head, Environmental Health Unit
Department of Public Health
Ministry of Health
6th Floor. Block E 10, Parcel E
Federal Government Office Complexes
Putrajaya 62590
Malaysia
Email: rozlan@dph.gov.my
Dr Andrew Kiyu
Deputy Director of Health
Sarawak Health Department
Tun Abang Haji Openg Road, 93590 Kuching
Sarawak
Malaysia
Email: kiyu.andrew@gmail.com
Dr Susan Loo
Programme Director
Persatuan Wamta Berilmu Malaysia
Suite 103, Block C, Damansara Intan
No. 1 Jalan SS20/27 Petaling Jaya
47401 Selangor
Malaysia
Email: susanloo2002@yahoo.com
Mr Azman Mohammed
Principal Assistant Director
Health Education Division, department of Public Health
Ministry of Health, Federal Government Administrative Centre
Block E10, Level 3
62590 Putrajaya
Malaysia
Email: azmupk@pc.jaring.my
Dr Mrs Tsetsegdary Gombodorj
Senior Officer, NCD Prevention and Control
Focal Point for TFI and MNH
Policy and Coordination Department
Ministry of Health
Olympic Street 2
Government Building 8
Ulaanbaatar 11
Mongolia
Email: tsetsegdary@yahoo.co.uk
85
Mr Bekhbat Sodnom
President
Rotary Club of Ulaanbaatar
P.O. Box 516
Ulaanbaatar-210646
Mongolia
Email: bekhbat@rotarymongolia.org
sbehbat@hotmail.com
Dr Rob Beaglehole
Representative of the World Dental Foundation
179 Cockayne Rd, Ngaio
Private Bag 31-907
Welington
New Zealand
Email: roby@robbeaglehole.com
Dr Alison Jean Blaiklock
Executive Director
Health Promotion Forum of New Zealand
P.O. Box 99064
Newmarket
Auckland
New Zealand
Email: alisonb@hpforum.org.nz
Prof Sally Casswell
Director
Centre for Outcomes Research and Evaluation (SHORE)
Massey University
Level 7, Massey University House
90 Symonds St.
P.O. Box 6137
Wellesley Street
Auckland
New Zealand
Email: s.casswell@massey.ac.nz
Ms Kathrine May Clarke
Chief Executive Officer
Hapai Te Hauora Tapui Ltd
212 Manukau Road
P.O. Box 26.593
EPSOM
Auckland
New Zealand
Email: kclarke@hapai.co.nz
86
Dr Gabrielle Mary Keating
Director
Public Health Association of New Zealand
P.O. Box 11-243
Wellington
New Zealand
Email: pha.gay@actrix.co.nz
Dr Don Matheson
Deputy Director-General
Public Health Directorate
Ministry of Health
Level 1, Old Bank Chambers
P.O. Box 5013
Wellington
New Zealand
Email: Don_Matheson@moh.govt.nz
Dr Maggie McGregor
Strategic Advisor
Public Health Sector Policy & Development
Public Health Directorate
Ministry of Health
DDL 09 580 9114
New Zealand
Email: Maggie_McGregor@moh.govt.nz
Prof John Raeburn
Associate Professor, Director of Mental Health Programmes, Director of Community
Development
School of Population
University of Auckland
PB 92019
Auckland
New Zealand
Email: jm.raebum@auckland.ac.nz
Dr Mihi Ratima
Director, Maori Health
Public Health
Auckland University of Technology
Division of Public Health, Faculty of Health
Auckland University of Technology
Private Bag 92006
Auckland 1020
New Zealand
Email: mihi.ratima@aut.ac.nz
87
Ms Roselyne Daniels
Focal Person for Health Promoting Schools
Department of Health
P.O. Box 807
Waigani
Port Moresby
Papua New Guinea
Email: roselyn_daniels@health.gov.pg
Mr Bernard Gunn
Program Coordinator
Community Base Health Care
Nazarene Health Ministries
P.O. Box 456
Mt Hagen, WHP
Papua New Guinea
Email:
Mr Lindsay Piliwas
Director, Health Promotion Branch
Department of Health
P.O. Box 807
Waigani
National Capital District
Port Moresby
Papua New Guinea
Email: piliwas_lindsay@health.gov.pg
PradhanangaY@png.wpro. who.int
Mr Brian Tieba
Principal Curriculum Adviser, (HPS Chairperson)
Department of Education
Government
P.O.Box 446
Waigani
Port Moresby
Papua New Guinea
Email: Brian_Tieba@education.gov.pg
Mr Wei-qing Chen
Associate Dean
School of Public Health
Sun Yat Sen University
Guangzhou
People's Republic of China
Email:
88
Dr Cheuk Tuen Regina Ching
Head/Assistant Director of Health
Programme Management and Professional Development Branch, and Assistant Director of Health
Centre for Health Protection
147C Argyle Street, Kowloon
Hong Kong SAR
People's Republic of China
Email: regina_ching@dh.gov.hk
Prof Hua Fu
Deputy Dean
School of Public Health
Fudan University
P.O. Box 248
138 Yixueyuan Road
Shanghai 200032
People's Republic of China
Email: hfu@shmu.edu.cn
Dr Ping Yan Lam
Director of Health
Department of Health
21st Floor, Wu Chung House
213 Queen's Road
Wanchai
Hong Kong SAR
People's Republic of China
Email: pylam@dh.gov.hk
Prof Shiu Hung Lee
Honorary Adviser
School of Public Health
The Chinese University of Hong Kong
4th Floor, Lek Yuen Health Centre
9 Lek Yuen Street
Shatin, N.T.
Hong Kong SAR 852
People's Republic of China
Email: shlee@cuhk.edu.hk
MrKa Wai Leong
Technician in Health Promotion
Center for Disease Control and Prevention
Health Bureau
P.O. Box 3002, CDC, Health Bureau
Macao SAR
People's Republic of China
Email: ken.leong@ssm.gov.mo
89
Dr Mao-Xuan Tao
Director
National Institute for Health Education
Chinese Center for Disease Control and Prevention
Building 12, Block 1
Andingmenwai Anhuaxili
Beijing 100011
People's Republic of China
Email: mxtao@tom.com
Dr Ka Lo Tong
Head
Center for Disease Control and Prevention
Health Bureau
P.O. Box 3002, CDC, Health Bureau
Macao SAR
People's Republic of China
Email: cdc@ssm.gov.mo
Ms Veng Ian U
Technician (Health Promotion)
Centre for Disease Control and Prevention
Health Bureau
Macao SAR
People's Republic of China
Email: esther_u@ssm.gov.mo
Dr Sen-Hai Yu
Senior Researcher
National Institute of Parasitic Diseases
Chinese Center for Disease Control and Prevention
207, Rui Jin Er Road
Shanghai 200025
People's Republic of China
Email: Yusenhai@yahoo.com
yusenhai@sh 163 .net
Mr Liqiang Zhang
Director
WHO Collaborating Center for Health Education and Promotion
Building B, Lane 358
Jiaozhou road
Shanghai 200040
People's Republic of China
Email:
90
Dr Maria Ofelia Alcantara
Office of the Secretary
Department of Health
San Lazaro Compound
Rizal Avenue
Sta. Cruz.
Manila 1003
Philippines
Email: ooa62@yahoo.com
Dr Francisco T. Duque III
Secretary of Health
Office of the Secretary
Department of Health
San Lazaro Compound
Rizal Avenue
Sta. Cruz.
Manila 1003
Philippines
Email: oscc@central.doh.gov.ph
Senator Juan M. Flavier
Senate of the Philippines
GSIS Building
Pasay City
Philippines
Email:
Dr Alberto Herrera
City Health Officer
Marikina City Health Department
City Government of Marikina
Shoe Avenue, Sto. Nino
Marikina City 1800
Philippines
Email: doc_aph@yahoo.com
Mr Ramon Jr. Navarra
Supervising Legislative Staff Officer
Office of Sen. Juan M. Flavier
Philippines Senate
Room 62
Financial Center
Roxas Blvd.
Pasay 1300
Philippines
Email: rjnir@pacific.net.ph
mavarrajr@yahoo.com
91
Prof Buenalyn Theresita Ramos
Associate Professor, Chairperson
Department of Health Promotion and Education
SEAMOA TROPMED Regional Centre for Public Health
College of Public Health
University of the Philippines
Manila
Philippines
Email:
Ms Angelina Sebial
Director III
National Center for Health Promotion
Department of Health
San Lazaro Compound
Rizal Avenue
Sta. Cruz.
Manila 1003
Philippines
Email: aksebial@co.doh.gov.ph
Mr Horacio G. Severino
Reporter/News Producer
News/Public Affairs Department
GMA Net work Inc.
EDSA Comer Timong Avenue
Quezon city
Philippines
Email: howieseverino@yahoo.com
Dr Tong-ryoung Jung
Team Leader, Health Promotion Support Team
Korean Health Promotion Fund
6th floor, Da-young Building
40-6 Jung-Ang Dong, Gwacheon
Kyoung-gi Do
Republic of Korea
Email:
Ms Hwa-Suk Kim
Health Promotion Team
Division of Health Promotion
Bureau of Welfare and Health Policy
Seoul Metropolitan Government
31 Taepyeongno lga Jung-Gu
Seoul 100-744
Republic of Korea
Email: grandsook@seoul.go.kr
92
Prof Myoung-Soon Lee
Associate Professor
Department of Social Medicine
School of Medicine, Sungkyunkwan University
300 Chunchun-Dong
Changan-Gu
Suwon 440-746
Republic of Korea
Email: msnlee@med.skku.ac.kr
Mrs Hyo Sook Park
Deputy Director, Division of Health Promotion
Seoul Metropolitan Government
7-306 Sam Sung Raemian Apartment
720-18 Banghak 1 Dong
Dobong Gu
Seoul 132-774
Republic of Korea
Email: margareta55@hanmail.net
Mr Soon Tae Song
Director, Health Promotion Project Support group
Ministry of Health and Welfare
Seoul
Republic of Korea
Email: sooltae@yahoo.co.kr
Ms Palanitina Mala Toelupe
Chief Executive Officer
Ministry of Health
Private Bag, Apia
Samoa
Email: dg@health.gov.ws
Dr Ling Chew
National Health Education Department
Ministry of Health
3 Second Hospital Avenue
Singapore 168937
Singapore
Email:
Dr Yang Huang Koh
Manager
Workplace Health Promotion Programme and Communicable Disease Education
Health Promotion Board
3 Second Hospital Avenue
Singapore 168937
Singapore
Email: koh_yang_huang@hpb.gov.sg
93
Mr Pin Woon Lam
Chief Executive Officer
Health Promotion Board
3 Second Hospital Avenue
Singapore 168937
Singapore
Email: lam_pin_woon@hpb.gov.sg
ong_beng_hwee@hpb.gov.sg
Dr Peng Lim Ooi
Deputy Director
Disease Control
Ministry of Health
College of Medicine Building
16 College Road
Singapore 169854
Singapore
Email: ooi_peng_lim@moh.gov.sg
Prof. Kai Hong Phua
Vice-Chairman
Singapore Red Cross Society
International Federation of Red Cross and Red Crescent Societies
Red Cross House
11, Penang Lane
Singapore 238486
Singapore
Email: spppkh@nus.edu.sg
Dr Shyamala Thilagaratnam
Head, National Myopia Prevention Programme
School Health Service Division
Health Promotion Board
#02-04, 255 Tagore Avenue, Block 1
Green Meadows
Singapore 787796
Singapore
Email: Shyamala_Thilagaratnam@hpb.gov.sg
Mr Ruei-Shiang Shiu
Director
Division of Adult and Elderly Health
Bureau of Health Promotion
Department of Health
5 Fl., No. 503, Sect.2
Liming Road
Taichung 408
Email: ray@bhp.doh.gov.tw
sung@bhp.doh.gov.tw
94
Mr Po-Tswen Yu
Director
Department of Health
Health Education Center
Bureau of Health Promotion
2, Chang-ching St.
Shin-juang City
Taipei
Email: vbt@bhp.doh.gov.tw
Rev Semisi Fonua
Chairman, Healthy Eating Sub Committee
National Non-Communicable Disease Committee
Ministry of Health
P.O. Box 296
Nukualofa
Tonga
Email: sfonua@kalianet.to
Dr Viliami Kulikefu Puloka
Director of Health Promotion and NCD
Ministry of Health
P.O. Box 59 Viola Hospital
Nukualofa
Tonga
Email: vpuloka@health.gov.to
mohtonga@kalianet.to
Ms Kilisitina Tiane Tuaimei'api
AZPrincipal Economist
Ministry of Finance
B 87, Vuna Road
Nukualofa
Tonga
Email: ktuaimeiapi@finance.gov.to
ktuaimeiapi@yahoo.com
Mr Huy Lieu Duong
Director of Planning and Finance
Ministry of Health
138A Giang Vo Street
Hanoi
Viet Nam
Email: DaoN@vtn.wpro.who.int
95
Prof Vu Anh Le
Dean, School of Public Health
Hanoi Medical University
Hanoi
Viet Nam
Email: lva@hsph.edu.vn
Dr Ti Hong Tu Nguyen
Deputy Director
Preventive Medicine and HIV/AIDS Control Department
Ministry of Health
138A Giang Vo Street
Hanoi
Viet Nam
Email:
Dr Khac Kinh Nguyen
Director, Environmental Impact Assessment and Appraisal Department
Ministry of National Resources and Environment
83 Nguyen Chi Thanh
Dong Da
Hanoi
Viet Nam
Email:
Dr Doan Thi Ngoc Van
Hue City Committee on Population, Family and Children Issues
Hue City
Viet Nam
Email: info@doingoai.org
Mr Bui Tran
Director of Hue City Centre for Health Care
Hue City Center for Health Care
Hue City
Viet Nam
Email: info@doingoai.org
Dr Man Tran
Lecturer of Hue Medical College
Hue City
Viet Nam
Email: info@doingoai.org
96
Ms Thi Giang Huong Tran
Deputy Director General
International Cooperation Department
Ministry of Health
13SA Giang Vo Street
Hanoi
Viet Nam
Email: gianghuong_tran2002@yahoo.com
Dr Tien Truong Quang
Lecturer, Vice Head of Department of Health
Health Education and Health Promotion
Hanoi School of Public Health
138 Giang Vo Street
Hanoi
Viet Nam
Email: tqt@hsph.edu.vn
tienmph@yahoo.com
97
CONFERENCE ORGANIZING COMMITTEE (COC) &
PROGRAMME COMMITTEE (PC)
AFRICAN REGION
Mrs Blanche Pitt
Country Director, The African Medical & Research Foundation South Africa (AMREF SA)
P.O. Box 11489
The Tramshed
Pretoria 0126
South Africa
Email: pittb@iafrica.com
AMERICAN REGION
Dr Sylvie Stachenko
Dep. Chief Public Health Officer
Office of the Chief Public Health Officer
Public Health Agency of Canada
130 Colonnade Rd, Rm 164B, PL:6501C
Ottawa, Ontario KIA 0K9
Ottawa
Canada
Email: sylvie_stachenko@hc-sc.gc.ca
Prof Hiram Arroyo
Professor and Department Chair
Social Sciences-Health Education
School of Public Health
University of Puerto Rico
Medical Sciences Campus
University of Porto Rico
PO Box 365067
San Juan 00936-5067
Puerto Rico
Email: harroyo@rcm.upr.edu
Dr Jacques Baudouy
Director, Health, Nutrition and Population
The World Bank
1818 H Street, NW
Washington, DC 20433
Washington
USA
Email: jbaudouy@worldbank.org
98
Ms Thi Giang Huong Tran
Deputy Director General
International Cooperation Department
Ministry of Health
138A Giang Vo Street
Hanoi
Viet Nam
Email: gianghuong_tran2002@yahoo.com
Dr Tien Truong Quang
Lecturer, Vice Head of Department of Health
Health Education and Health Promotion
Hanoi School of Public Health
138 Giang Vo Street
Hanoi
Viet Nam
Email: tqt@hsph.edu.vn
tienmph@yahoo.com
97
EASTERN MEDITERRANEAN REGION
Ambassador Moushira Khattab
Secretary General
National Council for Childhood and Motherhood
P.O.Box 11 Misr Al Kadima
Komish El Nil - Al Maadi
Cairo
Egypt
Email: NCCMl@Intouch.com
EUROPEAN REGION
Prof Maurice Mittelmark
President
International Union for Health Promotion and Education (IUHPE)
University of Bergen, Research Center for Health Promotion
Christie Gate 13
N-5015 Bergen
Bergen
Norway
Email: maurice.mittelmark@phyhp.uib.no
Mr Bosse Pettersson
Deputy Director-General
D-G's Office
Swedish National Institute of Public Health (NIPH)
Olof Palmes Gata 17
SE-10352 Stockholm
Sweden
Email: bosse.pettersson@fhi.se
Dr Dona Kickbusch
Senior Adviser on Health Policy
Kickbusch Health Consult
Tiefental, Chalet Fahrimaa, PF 434
CH-3855 Brienz BE
Switzerland
Email: Dona.Kickbusch@bag.admin.ch
99
SOUTH-EAST ASIA REGION
Mr Alok Mukhopadhyay
Chief Executive
Voluntary Health Association of India (VHAI)
Tong Swasthya Bhawan, 40 Institutional Area
South of ITT, Near Qutab Hotel
New Delhi 110 016
India
Email: vhai@vsnl.com
Dr Supakom Buasai
Chief Executive Officer
Thai Health Promotion Foundation
979/22 floor 15
S.M. Tower, Paholyotin Rd
Bangkok 10400
Bangkok
Thailand
Email: supakom@thaihealth.or.th
Dr Somyos Charoensak
Director General
Department of Flealth
Ministry of Public Health
Tivanond Road, Muang
Nonthaburi 11000
Nonthaburi
Thailand
Email: somyos@health3.moph.go.th
Assoc. Prof Sirikul Isaranurug
Deputy Director
Asean Institute for Health Development
Mahidol University
Phuttamonton 4
Nakhon Pathom 73170
Nakhon Pathom
Thailand
Email: phsir@mahidol.ac.th
Prof Pirom Kamolratanakul
Dean
Faculty of Medicine
Chulalongkorn University
Bangkok
Thailand
Email: fmedpkr@md2.md.chula.ac.th
100
Dr Chumrurtai Kanchanachitra
Director
Thai Health Global Link Initiative Project
Mahidol University
25/254 Moo 3, Phuttamonthon 4 Road
Salaya, Phuttamonthon District
Nakohn Pathom 73170
Thailand
Email: prckc@mucc.mahidol.ac.th
Dr Siripon Kanshana
Inspector General
Office of the Permanent Secretary for Public Health
Ministry of Public Health
Tivanond Road, Muang
Nonthaburi 11000
Nonthaburi
Thailand
Email: siripon@health.moph.go.th
Dr Borwom Ngamsiriudom
Deputy Director-General
Department of Health
Ministry of Public Health
Tivanond Road, Muang
Nonthaburi 11000
Nonthaburi
Thailand
Email: borwomhp@hotmail.com
Dr Vichai Tienthavorn
Permanent Secretary
Ministry of Public Health
Tivanond Road, Muang
Nonthaburi 11000
Nonthaburi
Thailand
Email: vichait@health.moph.go.th
Dr Suwit Wibulpolprasert
International Affairs Adviser
Office of the Permanent Secretary
Ministry of Public Health
Tiwanond Road, Muang District
Nonthaburi 11000
Nonthaburi
Thailand
Email: suwit@health.moph.go.th
101
WESTERN PACIFIC REGION
Prof John Catford
Dean
Faculty of Health and Behavioural Sciences
Deakin University
Melbourne Campus
221 Burwood Highway
Burwood VIC 3125
Burwood
Australia
Email: jcatford@deakin.edu.au
Prof Don Nutbeam
Pro-Vice-Chancellor/Head
College of Health Sciences
University of Sydney
Edward Ford Building (A27)
Sydney, New South Wales 2006
Sydney
Australia
Email: don@chs.usyd.edu.au
Prof Yan Guo
Vice Dean
School of Public Health
Peking University Health Sciences Centre
38 Xue Yuan Road
Beijing, 100083
Beijing
China
Email: guoyan@bjmu.edu.cn
Ms Maria Lourdes Fernando
Mayor
City of Marikina (Healthy City)
Marikina City Hall
Metro Manila 1800
Manila
Philippines
Email: saavedrajoyce@yahoo.com
102
SPEAKERS & CHAIRS
AFRICAN REGION
Dr Olive Shisana
Executive Director
Social Aspects of HIV/AIDS and Health
Human Sciences Research Council (HSRC)
Private Bag X9182
14th Floor, 69-83 Plein Park Building
Cape Town 8001
South Africa
oshisana@hsrc .ac .za
sandy@hsrc.ac.za
olive.shisana@hixnet.co.za
AMERICAN REGION
Dr Paulo Buss
President
Fundacao Oswaldo Cruz (FIOCRUZ)
Av. Brasil No. 4365, Manguinhos
21045-900 Rio de Janeiro RJ
Buss
Brazil
Email: presidencia@fiocruz.br
EUROPEAN REGION
Ms Ewa Persson-Goeransson
Secretary of State
Ministry of Health and Social Affairs
SE 103 52 Stockholm
Sweden
Email: ewa.persson-goransson@social.ministry.se
andreas.hilmerson@social.ministry.se
irene.nilsson-carlsson@social.ministry.se
103
Prof Michael Marmot
Head
Department of Edpidemiology and Public Health
University College London
1-19 Torringtron Place
London WC1E6BT
United Kingdom
Email: m.marmot@ucl.ac.uk
SOUTH-EAST ASIA REGION
Ms Mirai Chatterjee
Coordinator
Social Security
Self Employed Women's Association (SEWA)
Sewa, Chand Niwas
Opposite Kamavati Hospital
Ellisbridge
Ahmedabad 380006
India
Email: social@sewass.org
Dr Hak-Su Kim
Under Secretary-General of the United Nations and Executive Secretary
UN Economic and Social commission for Asia and the Pacific (UNESCAP)
United Nations Building
Rajadamnem Nok Avenue
Bangkok, 10200
Thailand
Email: Kskim.unescap@un.org
Dr Udomsil Srisangnatn
Second-Vice Chairman of Governing Board
Thai Health Promotion Foundation
979, 34th Floor S.M. Tower
Phaholyothin Road
Phayathai
Samsennai
Bangkok 10400
Thailand
Email: udomsil@thaihealth.or.th
bonus@thaihealth.or.th
secretary
104
WESTERN PACIFIC REGION
Dr Baige Zhao
Vice Minister
National Population and Family Planning Commission of China
No. 14, Zhichun Lu, Haidian District
Beijing 100088
People's Democratic Republic of China
Email: zaobaige@public3.bta.net.cn
TECHNICAL DISCUSSION RAPPORTEURS
AFRICAN REGION
Dr David Houeto
Directeur
Promotion de la Sante
Centre de Recherche pour la Promotion de la Sante et la Nutrition Appliquee (CREPSNA)
O7BP1411 SainteRita
Cotonou
Benin
Email: dhoueto@yahoo.fr
Mr Raymond Mbouzeko
Health Information & Promotion Officer
Health Promotion
World Health Organization
c/o World Health Organization
Yaounde 155
Cameroon
Email: mbouzekor@cm.afro.who.int
mbouzeko@yahoo.com
Dr Mary Amuyunzu-Nyamongo
Executive Director
African Institute for Health & Development (AIHD)
P.O. Box 5043
Nairobi-00100
Kenya
Email: mnyamongo@aihd.org
mnyamongo@yahoo.com
105
Mr Francis Naniisi
PhD Student
Research Centre for Health Promotion
Faculty of Psychology
Uhuru Gardens
P.O. Box 003
Nairobi
Kenya
Email: Francis.Namisi@psyhp.uib.no
AMERICAN REGION
Dr Juliana de Paula
Health Promotion
Conselho Nacional de Secretarias Municipals de Saude
Av. Esplanada dos Ministerios
Mmisterio de Saude, Anexo B, Sala 130
Brasilia
Brazil
Email: iuliana.paula@saude.gov.br
Dr Anne Andermann
Family and Community Medicine
McGill University
5821 Cote Saint Luc Road, Apt. 25
Montreal, Quebec H3X 2G2
Canada
Email: anne.andermann@mail.mcgill.ca
anne.andermann@gmail.com
Mr Simon Carroll
Research and Development Coordinator
Centre for Community Health Promotion Research
University of Victoria
P.O. Box 3060, STN CSC
Victoria, B.C. V8W 3R4
Canada
Email: scarroll@uvic.ca
Dr Jaime Sapag
Professor Auxiliar
Family Medicine Department
Pontificia Universidad Catolica de Chile
Victor Rae No.6060
Las Condes
Santiago 10
Chile
Email: jsapag@med.puc.cl
jsapag@uc.cl
106
Dr Gaelle Picherit-Duthler
Professor
Communication
University of North Carolina at Charlotte
2700 Riddings Court
Postal Code 28269
Charlotte NC
USA
Email: gduthler@carolina.rr.com
EASTERN MEDITERRANEAN REGION
Ms Rima Nakkash
Dr PH Candidate
Public Health and Policy
London School of Hygiene and Tropical Medicine
P.O. Box 145303
Beirut
Lebanon
Email: rima.nakkash@aub.edu.lb
Rima.Nakkash@lshtm.ac.uk
EUROPEAN REGION
Ms Ulla-Karin Nurm
Tervise Arengu Instituut
National Institute for Health Development
Hiiu42, 11619 Tallinn Estonia
11620 Tallinn
Estonia
Email: ullanurm@hot.ee
ulla.nurm@tai.ee
Ms Catherine Jones
International Projects Manager IUHPE/UIPES
42 Boulevard de la Liberation
93203 Saint-Denis Cedex
France
Email: cjones@iuhpe.org
107
Ms Lilia Veto
Project Manager
Department of EU Integration and International Relations
National Institute for Health Development
Andrassy U.82
Budapest H-1062
Hungary
Email: vetolilla@oeli.hu
Ms Hope Corbin
Research Associate
International Union for Health Promotion and Education (IUHPE)
Research Centre for Health Promotion
University of Bergen
Bergen 5007
Norway
Email: hope.corbin@student.uib.no
Assoc. Prof Sarah Wamala
Head of Unit
Public Health Sciences
Swedish National Institute of Public Health
Olof Palmes gata 17
SE-10352 Stockholm
Sweden
Email: sarah.wamala@flii.se
SOUTH EAST ASIA REGION
Dr Ahmed Afaal
Assistant Director
Planning, Information and Research
Ministry of Health
Ameenee Magu
Male 20-03
Maldives
Email: afaal@health.gov.mv
Dr Nithat Sirichotiratana
Lecturer
Health Education and Behavioural Sciences
Faculty of Public Health
420/1 Rajvithi Road
Raj the vi District
Bangkok 10401
Thailand
Email: nithats@hotmail.com
108
WESTERN PACIFIC REGION
Dr Katrin Engelhardt
Advisor
Healthy Cities Project
Division of Health Promotion, Seoul Metropolitan Government
7-306 Dongik Villa
40-Gugi Dong, Chongro Gu
Seoul 110-803
Republic of Korea
Email: engelhardt-katrin@web.de
kreiselk@web.de
Dr Mabel Deurenberg-Yap
Director
Research & Information Management Division
Health Promotion Board
3 Second Hospital Avenue
Singapore 168937
Singapore
Email: mabel_yap@hpb.gov.sg
VOLUNTEERS
AMERICAN REGION
Dr Kirk Duthler
Charlotte NC
USA
Email: gduthler@carolina.rr.com
EUROPEAN REGION
Ms Asa Pettersson
Research Assistant
Nordregio-The Nordic Centre for Spatial Development
Nordregio
Box 1658
Stockholm 111 86
Sweden
Email: asa.pettersson@nordregio.se
109
Mr Julian Kickbusch
Tiefental, Chalet Fahrimaa, PF 434
CH-3S55 Brienz BE
Switzerland
Email: raggal23@aol.com
WESTERN PACIFIC REGION
Ms Dale Marie Bampton
Lecturer
School of Public Health
University of Sydney
Edward Ford Building, A27
School of Public Health
University of Sydney
Sydney NSW 2006 '
Australia
Email: daleb@health.usyd.edu.au
Mr Braden Leonard
Community and Public Health
P.O. Box 1475
Christchurch
New Zealand
Email: LeonBl@cph.co.nz
WORLD HEALTH ORGANIZATION
AFRICAN REGION
WHO Regional Office for Africa (AFRO):
Dr Rufaro Richard Chatora
Director of Prevention and Control of Noncommunicable Diseases
Cite du Djoue
B.P. 6
Brazzaville
Republic of Congo
Email: chatorar@afro.who.int
110
Dr David Nyamwaya
Regional Adviser, Health Promotion
Cite du Djoue
B.P. 6
Brazzaville
Republic of Congo
Email: nyamwayad@afro.who.int
Ms Hawa Senkoro
Regional Adviser
Healthy settings and Children Environmental Health
Division of Healthy Environment and Sustainable Development
Cite du Djoue
B.P. 6
Brazzaville
Republic of Congo
Email: senkoroh@who.who.int
WHO Country Office, Ghana
Ms Sophia Twum-Barima
Health Information & Promotion Officer
Country Office-Ghana
World Health Organization
P.O. Box MB. 142
Accra
Ghana
Email: twum-barimas@gh.who.afro.who.int
WHO Country Office, Kenya
Mrs Eulalia Namai
Health Information & Promotion Officer
P.O. Box 45335
Ack Garden House
Nairobi 00100
Kenya
Email: namaielke@afro.who.int
Dr Eileen Josephine Petit-Mshana
Health Systems Advisor
MSG Centre, HDP/MDG
P.O.Box 45335
Ack Garden House
Nairobi 00100
Kenya
Email: who05tz@yahoo.co.uk
e.petit-mshana@cgiar.org
111
WHO Country Office, Lesotho
Mr Peter Phori
Health Information & Promotion Officer
Maseru 100
Lesotho
Email: phorip@ls.afro.who.int
WHO Country Office, Senegal
Mr Khalifa Mbengue
Charge de 1'Information et de la Promotion de la Sante
Communication
Almadies Extension Zone 10
LaotNo. 10
BP 4039
Dakar
Senegal
Email: mbengueh@oms.sn
omsdakar@oms.sn
AMERICAN REGION
WHO Regional Office for the Americas (PAHO/AMRO):
Dr Carissa F. Etienne
Assistant Director
525, 23rd Street, N.W.
Washington D.C. 20037
USA
Email: etiennec@paho.org
AssistantDirector@paho.org
Dr Monica Brana
Assistant Director
Assistant Director's Office
525, 23rd Street, N.W.
Washington D.C. 20037
USA
Email: branamon@paho.org
112
Dr Luiz Augusto Galvao
Area Manager
Sustainable Development and Environmental Health
525 23rd Street, NW
Room 526
Washington, DC 20037
USA
Email: galvaolu@paho.org
Dr Maria Teresa Cerqueira
Unit Chief, Healthy Settings
Area of Sustainable Development and Environmental Health - Healthy Settings Unit
525, 23rd Street, N.W.
Washington D.C. 20037
USA
Email: cerqueim@paho.org
EASTERN MEDITERRANEAN REGION
WHO Regional Office for the Eastern Mediterranean (EMRO)
Dr Ahmad Mohit
Director Health Protection and Promotion
Abdul Razzak Al Sanhouri Street (opposite Children's Library)
Naser City
Cairo 11371
Egypt
Email: mohita@emro.who.int
Dr Syed Jaffar Hussain
Medical Officer, Healthy Lifestyle Promotion (HLP)
Abdul Razzak Al Sanhouri Street (opposite Children's Library)
Naser City
Cairo 11371
Egypt
Email: hussains@emro.who.int
Dr Abdul-Halim Joukhadar
Regional Adviser, Health Education
Abdul Razzak Al Sanhouri Street (opposite Children's Library)
Naser City
Cairo 11371
Egypt
Email: joukhadara@emro.who.int
113
EUROPEAN REGION
WHO Regional Office for Europe (EURO):
Dr Haik Nikogosian
Deputy Director
Technical Support
8, Scherfigsvej
Copenhagen
Denmark
Email: han@who.dk
Dr Chris Brown
Program Manager
Investment for Health & Health Promotion
WHO/ European Office for Investment for Health & Development
WHO Centre Venice, DTH/HDT
Venice
Italy
Email: chb@ihd.euro.who.int
SOUTH-EAST ASIA REGION
WHO Regional Office for the South-East Asia (SEARO)
Dr Samlee Plianbangchang
Regional Director
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email:
Dr Than Sein
Director, Noncommunicable Diseases and Mental Health
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: thansein@whosea.org
114
Dr A. Sattar Yoosuf
Director, SDE
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: Yoosufa@whosea.org
Dr Davison Munodawafa
Regional Adviser, Health Promotion and Education
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: munodawafad@whosea.org
Mr Anil Chitkara
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: Chitkaraa@whosea.org
Mr Albert Edward McLaren
Project Coordinator
Building Health Communities and populations
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: mclarena@whosea.org
Mr Stephen Rozario
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: rozarios@whosea.org
Mr Napatr Thanesnant
Intern
World Health House
Indraprastha Estate, Mahatma Gandhi Road
New Delhi-11002
India
Email: thanesnantn@whosea.org
115
WHO Country Office, Bangladesh
Dr George John Koniba-Kono
Medical Officer
House 12, Road 7
Dhanmondi R/A
GPO Box No. 250
Bangladesh
Email: kombakongog@whoban.org
Dr Mostafa Zaman
National Professional Officer
Non-Communicable Diseases
House 12, Road 7
Dhanmondi R/A
GPO Box No. 250
Dhaka 1205
Bangladesh
Email: zamanm@whoban.org
WHO Country Office, India
Dr Cherian Varghese Vengal
Coordinator, Noncommunicable Diseases and Mental Health
Room 537, A Wing
Nirman Bhavan
New Delhi 110011
India
Email: varghesec@searo.who.int
WHO Country Office, Indonesia
Ms Guangyuan Liu
Technical Officer, Health Leadership Service
9th Floor, Bina Mulia 1 Building
JI. H.R. Rasuna Said Kav. 10
P.O. Box 1302
Jakarta 12950
Indonesia
Email: liu_guangyuan_moh@yahoo.com.cn
liug@who.or.id
116
WHO Country Office, Maldives
Dr Ohn Kyaw
Medical Officer (Management)
MTCC Tower 5F
Bodhuthakurufaanu Magu
Male 20-04
Maldives
Email: ohnkyaw@who.org.rnv
WHO Country Office, Myanmar
Dr Maung Maung Lin
National Professional Officer (NPO)
7th Floor, Yangon International Hotel
330, Ahlone Road, Dagon Township
Yangon
Myanmar
Email: mmlin.whomm@undp.org
WHO Country Office, Sri Lanka
Dr Abhaya Tissera
National Professional Officer
226, Bauddhaloka Mawatha
Colombo 7
Sri Lanka
Email: abhaya@whosrilanka.org
WHO Country Office, Thailand
Dr William L. Aldis
The WHO Representative
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: aldis@whothai.org
Ms Michele Vanderlanh Smith
Technical Officer (Management)
Permanent Secretary Building 3,4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: vanderlanhsmith@whothai.org
117
Dr Narintr Tima
Monitoring and Evaluation Officer
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: narintr@whothai.org
Ms Nutwaree Chotchinda
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: nutwaree@whothai.org
Ms Rachadapom Praneenararat
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: rachadapom@whothai.org
Ms Sasithom Tangjareonsuk
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: sasithom@whothai.org
Ms Kanpirom Wiboonpanich
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: kanpirom@whothai.org
Ms Accharawan Wongsatithkul
Permanent Secretary Building 3, 4th Floor
Soi Bamrasnaradoon, Tiwanond Road
Nonthaburi 11000
Thailand
Email: accharawan@whothai.org
118
WESTERN PACIFIC REGION
WHO Regional Office for the Western Pacific Region (WPRO):
Dr Linda Milan
Director
Building Healthy Communities & Populations (DHP)
P.O. Box 2932
Manila 1099
Philippines
Email: milanl@wpro.who.int
Dr Hisashi Ogawa
Regional Adviser in Healthy Settings and Environment
Building Healthy Communities and Populations (DHP)
P.O. Box 2932
Manila 1099
Philippines
Email: ogawah@wpro.who.int
Dr Doraisingam Ponnudurai
Acting Regional Adviser on Health Promotion
Building Healthy Communities and Populations
P.O. Box 2932
Manila 1099
Philippines
Email: ponnuduraid@wpro.who.int
WHO Country Office, People’s Republic of China
Mr Anand Sivasankara Kurup
Health Leadership Officer
401, Dongwai Diplomatic Office Building
23, Dongzhimenwai Dajie
Chaoyang District
Beijing 100600
People's Republic of China
Email: kurupa@chn.wpro.who.int
Mr Satya Paul Sardana
23, Dongzhimenwai Dajie
Chaoyang District
Beijing 100600
People's Republic of China
Email: sardanap@chn.wpro.who.int
119
WHO Country Office. Papua New Guinea
Dr Yogendra Pradhananga
Health Education Specialist
Health Promotion
World Health Organization
Office of Papua New Guinea, 4th Floor
Aopi Centre
P.O. Box 5896
Boroko, NCD
Port Moresby
Papua New Guinea
Email: PradhanangaY@png.wpro.who.int
WHO HEADQUARTERS
Dr Jong-Wook Lee
Director-General
Avenue Appia 20
1211 Geneva 27
Switzerland
Email: leej@who.int
Dr Catherine Le Gales-Camus
Assistant Director-General
Noncommunicable Diseases and Mental Health (NMH)
Avenue Appia 20
1211 Geneva 27
Geneva
Switzerland
Email: legalescamusc@who.int
Dr Robert Beaglehole
Director
Department of Chronic Diseases and Health Promotion (NMH/CHP)
Avenue Appia 20
Geneva
Switzerland
Email: beagleholer@who.int
120
Dr Wilfried Kreisel
Director
WHO Kobe Centre (WKC)
H.D. Building, 9th Floor
I.
5-1, 1-chome, Wakinohama-Kaigandori
Chuo-ku
Kobe 651-0073
Japan
Email: kreiselw@who.or.jp
Dr Desmond O'Byrne
Conference Coordinator (6GCHP)
Department of Chronic Diseases and Health Promotion (NMH/CHP)
Health Promotion Unit
Avenue Appia 20
Geneva
Switzerland
Email: obymed@who.int
Dr Kwok-Cho Tang
Senior Professional Officer
Department of Chronic Diseases and Health Promotion (NMH/CHP)
Health Promotion Unit
Avenue Appia 20
1211 Geneva 27
Geneva
Switzerland
Email: tangkc@who.int
Dr Nick Drager
Senior Adviser
Department of Ethics, Trade, Human Rights/Health Law (SDE/ETH)
Avenue Appia 20
1211 Geneva 27
Geneva
Switzerland
Email: dragem@who.int
renardf@who.int
Dr Susan Mercado
Programme Coordinator
Cities and Health Programme
WHO Kobe Centre (WKC)
H.D. Building, 9th Floor
I.
5-1,1-chome, Wakinohama-Kaigandori
Chuo-ku
Kobe 651-0073
Japan
Email: mercados@who.or.jp
121
Mr Robert Bos
Scientist, Protection of the Human Environment
Water, Sanitation and Health
20 Avenue Appia
1211 Geneve 27
Switzerland
Email: bosr@who.int
Mr Jack Jones
Team Leader, School Health and Youth Health Promotion
Department of Chronic Diseases and Health Promotion (NMH/CHP)
Health Promotion Unit
Avenue Appia 20
1211 Geneva 27
Geneva
Switzerland
Email: jonesj@who.int
!■
1
Dr Faten Ben Abdelaziz
Technical Officer
WHO Kobe Centre (WKC)
H.D. Building, 9th Floor
I.
5-1, 1-chome, Wakinohama-Kaigandori
Chuo-ku
Kobe 651-0073
Japan
Email: abdelazizf@who.or.jp
Ms Virginia Arnold
Assistant
Office of the Director General
Avenue Appia 20
1211 Geneva 27
Geneva
Switzerland
Email: amoldv@who.int
Ms Karina Wolbang
Conference Secretary
Department of Chronic Diseases and Health Promotion (NMH/CHP)
Health Promotion Unit
Avenue Appia 20
1211 Geneva 27
Geneva
Switzerland
Email: wolbangk@who.int
*
*
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122
Cor^ \ k - -S 1-^30
Contribution of Health Promotion to the Achievement of
Millennium Development Goals.
Dr. Eileen J. Petit-Mshana , Dr. Andrew K. Cassels, Mr. Fabian J. Magoma
6lh Global Conference on Health Promotion
Bangkok, 7-11 August 2005
1
Abstract
The Millennium Development Goals (MDG) adopted by the United Nations in year
2000 provide an opportunity towards improved global health, through harmonised
efforts of the developing and developed world. The MDG process involves critical
review of the current innovative practices, prioritised policy reforms, identification of
frameworks for implementation and monitoring, as well as evaluation of financial
options. Goal number 1-7 are outcomes related, whereas MDG 8 is concerned with
process. Out of the eight set MDGs four arc directly health related, while the other
four have important indirect relationship with health.
This paper shows linkages between health promotion and MDGs. There is a brief
description of the eight MDGs as adapted in year 2000, highlighting how each goal
relates to health. Main issues and challenges are explained under each goal. More
attention is given to the health goals and related targets. Health promotion
contribution towards MDG achievements and as an important tool for advocating
effective global, national and community partnership is demonstrated. There is an
emphasis on ways of tackling future health challenges. Some examples of innovative
and good practice across regions and countries arc given. In addition, relevant equity
and cultural issues have been addressed.
In conclusion, the paper shows that health promotion could potentially contribute in
accelerating the progress, especially towards achievement of the health related MDGs.
Recommendations for the way forward are provided. Specific strategies that could be
adapted as part of health promotion initiative are also given, including strategies for
disease prevention and management; epidemic prevention and control; information.
education and communication; as well as monitoring and Evaluation strategies.
Health Overview of MDG Goals and Targets
Goal
Target
1: Eradicate extreme
poverty and hunger
Halve the proportion of people whose income is less than one
dollar a day and the proportion of people who suffer from hunger
by year 2015
Ensure that by 2015, children everywhere, boys and girls alike,
will be able to complete a full course of primary schooling.
Eliminate gender disparity in primary and secondary education,
preferably by 2005, and to all levels of education no later than
2015
Reduce by two-thirds between 1990 and 2015, the under-fivemortality rate
Reduce by three quarters, between 1990 and 2015, the maternal
mortality ratio.
i) Have halted by 2015 and begun to reverse the spread of
HIV/AIDS
ii) The target of halting and reversing malaria incidence by 2015.
iii) Halting and reversing Tuberculosis
By integrating the principles of sustainable development into
country policies and programmes and reversing the loss of
environmental resources; by halving by 2015 the proportion of
people without sustainable access to safe drinking-water and
basic sanitation ; and by having achieved, by 2020, a significant
2: Achieve universal
primary education
3: Promote Gender
equality and empower
women
4: Reduce child mortality
5: Improve Maternal
Health
6: Combat HIV/AIDS.
malaria and other
diseases
7: Ensure Environmental
sustainability
2
8: Global Partnership for
Development
improvement in the lives of at least 100 million slum dwellers.
Develop further an open, rule-based, predictable, nodiseriminatory trading and financial system; address the special
needs of the least developed countries: address the special needs
of landlocked countries and small island developing States; deal
comprehensively with the debt problems of developing countries
through national and international measures in order to make
debt-relief sustainable in long term.
Present Status with Relation to Health Related MDGs:
Main and Cross Cutting Issues.
It has been acknowledged that progress towards meeting several goals is too slow
especially with relation to health indicators in sub-Saharan Africa (UN, WHO, WB,
UN/MP).
A main cross-cutting issue is whether and how countries adapt MDGs more closely to
their level of development since feasibility of goals especially for the very poor
countries is constrained by inadequate human, financial and other resources
Debt relief and Highly Indebted Poorest Countries funds (HIPC) in support of poverty
reduction plans increase potential for meeting the goals; however donors are not fully
living up to their commitments, while trade and aid policies remain unfair.
Financial and Human Resource for Health (HRH) constraints (shortage in numbers
and skills), as well as poor infrastructure and inadequate supply systems explain why
health systems fail to respond. The massive exodus of professionals from poor to
richer countries and HIV/AIDS continue to drain the already scarce human resources.
The interconnectedness of the problems should be recognised, for example the
linkage of childhood mortality with rapid population growth and lack of family
planning. HIV/AIDS. poor water and sanitation status. Poverty breeds ill health while
ill health breeds poverty. In sub-Saharan Africa HIV/AIDS compounds the situation.
increasing the workload while weakening the system at the same time. Fast population
growth, urbanization, migration and global climate change are further crucial in
relation to water, sanitation and hygiene in health and development. There is further a
direct relationship between poverty. Tuberculosis (TB). gender and women health
while linkage of health with water and fuel inaccessibility is also evident. The lack of
harmonisation strategies is therefore worrying for instance with relation to noncommunicable diseases that are missing from most poverty reduction strategies and
MDG needs assessment reports. Greater emphasis need to be placed on cross
government thinking, establishment of synergies across sectors/goals. integrated
planning and inter-sectoral action.
A selection of issues specific to individual goals is presented in the table below.
There are issues that contribute to the progress of each specific goal. However, as
noted in the previous section, it is more important to consider the Interconnectedness
of issues, as well as key health determinants across the eight goals. For example, ill
health as related to poverty, gender, poor education and illiteracy. HIV/AIDS. fast
growing population, environmental issues, migration, urbanization and other related
factors.
3
Goal
1 Eradicate
extreme
poverty
and
hunger
2:Achieve
universal
primary'
education
3: Promote
Gender
equality
and
empower
women
4:Reduce
Child
Mortality
5:Improve
Maternal
Health
6: Combat
HIV/AIDS.
malaria and
Issues
• Rapidly growing populations
• Impact of increasing urbanisation and unemployment
• Climate changes affecting agriculture
• Farmers in poor countries affected by Hl V/AIDS and malaria
• Unfair competition from subsidised farmers in richer countries
• National and international disaster un-preparedness
• Socio-economic barriers hindering access especially for girls.
• Poor teacher motivation and retention
• In-availability of free school meals, safe water and sanitation
• Curricula relevance, for self reliance or for global markets?
• Risk of substance abuse, teenage pregnancies and HfV/AIDS.
• Lack of investment in new distance learning technologies and
the problem of ‘education’ miles for rural communities
» Poverty has a greater impact on women
• Gender equality and empowerment of women still far of target
• Socio-cultural, legal, religious, political and employment barriers
• Vulnerability of women during conflicts
« HIV/AIDS. maternal and non maternal conditions.
• Poor data on the progress of women empowerment
® 4 million babies die yearly before the age of one month.
• Nearly 99% of child deaths occur in developing countries.
® WHO estimates that two-thirds of child deaths could be
prevented by interventions which are already available, which
are also feasible to implement in low-income countries.
• Nutrition interventions, including appropriate breast feeding,
complementary feeding, zinc. Vitamin A, could save 2-4 million
children or 25% of the total child deaths, while
• Management of infections like diarrhoea, malaria and neonatal
sepsis could save 3.2 million or 33% of total child deaths.
• low-quality of care and in -accessibility of essentia] drugs and
vaccinations
• The lifetime risk of dying from maternal causes in sub-Saharan
Africa is 1 in 16. 1 in 160 in Latin America and 1 in 4.000 in
Western Europe.
• 830 maternal deaths per 100.000 live births in Africa.
• Each year, nearly 1 m children die due to death of their mother.
• More than 70% of all maternal deaths are caused by
haemorrhage, infection or sepsis, unsafe abortion, eclampsia and
obstructed labour (WHO 2003. 2004). Worsened by increased
fertility rates, lack of family planning, harmful traditions (such as
Female Genital Mutilation -FGM) and high illiteracy rate among
women.
• human resources constraints a controversial issue
• It is estimated that globally only 62% of births are attended by a
skilled attendant. In developing countries the average is 53%. in
some countries as low as 347r.
HIV/AIDS
. WHO and UNAIDS (2004) reports that HIV/AIDS has killed
more than 20 million people and is now the leading cause of death and
4
other diseases
•
•
•
•
lost years of productive life for adults aged 15-59 years worldwide.
At the end of 2003 estimated 40 million people were living with
H1V/A1DS. Without treatment, all of them will die a premature.
In 2003, three million people died and live million became infected.
Almost 6 million people in developing countries need
antiretroviral treatment, but only 440.000 were receiving it by
end of 2003.
HRH insufficient and inadequate for scaled-up response
Malaria in Africa
« Accounts for 20% of all deaths in children under 5.
• Severe malaria causing maternal deaths directly and from
malaria-related severe anaemia.
• In malaria endemic areas of Africa infection during pregnancy is
estimated to cause an estimated 75 000 to 200 000 infant deaths
each year (WHO 2004).
• Recently (2004/05) conducted MDG needs assessment in 4
African countries (Kenya. Ethiopia. Ghana and Senegal) show
slow progress towards reaching Abuja coverage targets of 60%.
For example. ITNs less than 10% coverage for the target groups:
o Malaria control is hampered by poverty, drug resistance,
HIV/AIDS. climate and environmental change, lack of resources
and breakdown of control programmes.
Tuberculosis
• TB kills 2 million people yearly.
• South-East Asia Region; 33% of incident TB cases globally.
However, per capita TB incidence in sub-Saharan Africa is
nearly twice that of the South-East Asia, at 350 cases per 100
000 population (WHO 2004)
• There is direct relationship between poverty, TB. gender and
women health.
• TB and HIV co-infection posing a great challenge.
• Inadequate funding for TB calls for greater partnership.
• TB control needs stronger general health systems
Important non-communicable diseases (NCD)
• Tobacco and smoking related illness, stroke, cancer, diabetes and
chronic respiratory diseases, mental illness, substance abuse.
7: Ensure
Environmental
sustainability
•
NCD not sufficiently addressed in MDG needs assessment and poverty
reduction strategies in countries
•
•
Environmental sustainability is directly linked with health.
Many lack access to clean water and sanitation, causing 5.5% of
the global burden of disease.
1.6 million people die every year from diarrhoeal diseases
(including cholera) attributable to lack of access to safe drinking
water and basic sanitation and 90% of these are children under 5.
mostly in developing countries (WHO/WSH 2005)
Health depends on combined access to water and fuel.
Solid fuel use is responsible for approximately 2.7% of the
global burden of disease.
Fast population growth, urbanization, migration and global
•
•
•
•
5
climate change relate to water, sanitation and hygiene in health
and development.
8: Global
Partnership for
Development
•
•
•
•
»
The Commission on Macroeconomics and Health has estimated
requirements for investments, primarily in the health sector, to a
total annual figure of USS 27 billion, at least a four-fold increase
in current donor spending on health.
Only a few donor countries have made significant progress
towards the 0.7% GNP target.
However, spending on health and combating AIDS has
increased. For example through The United States Millennium
Challenge Account and the Global Fund to Fight AIDS.
Tuberculosis and Malaria (GFATM).
There are also issues of Trade- Related Aspects of Intellectual
Property Rights (TRIPS) agreement and public health; trade in
health services.
There is also a need to address other areas of inter-sectoral co
operation.
Promotion for MDGs
Health should be promoted at individual, family, community, institutional as well as
national and international policy levels. Partnership is a key requirement because of
the interconnectedness of the benefits, problems and the solutions. Research and
monitoring of indicators through functional health information systems, integrated
with a health promotion strategy is further essential to ensure that health promotion
interventions are rational, evidence based and cost-effective.
Reduction of Poverty and Hunger
Advocating for fair trade of agriculture products from poor countries at global level,
sustainable agriculture production, targeted welfare benefits and promotion of greater
partnership with communities, civil society across sectors and with development
agencies will have impact not only on reduction of poverty and hunger but also on
child and maternal health, better sanitation and reduction of communicable and noncommunicable diseases.
Universal Primary Education
The link between health and the goal of universal primary education is evident.
Supportive health promotion programmes for the children and adolescents in and out
of school are crucial for the promotion of life-skills for adulthood and the principles
of health promoting schools, personal and environmental hygiene, sexual and
reproductive health. HIV/A1DS prevention, anti-tobacco campaigns, prevention of
substance abuse, and promotion of sports as an important aspect of health.
Gender Equality
The socio-cultural and religious barriers that contribute to gender inequality need to
be addressed through strengthened advocacy and accelerated implementation of
gender equity strategies, as well as reinforcement of relevant legislations to protect
women from domestic and other types of violence.
6
Advocacy is required to get gender related interventions with matching budgets
included in the national poverty reduction and health strategic plans. Gender related
campaigns should be conducted to discourage harmful traditions such as FGM and to
enact laws.
Reduction of Child Mortality
Health promotion should show the link between child mortality and poverty, while
emphasising that most under five children deaths are caused by preventable
interventions that can be implemented in low-income countries. For example.
Integrated Management of Childhood Illness Package which should be promoted and
expanded for wider coverage of under five populations.
Community based health promotion strategy can prevent childhood diseases through
child immunization campaigns, advocacy on the use of long lasting insecticide treated
nets (LLITNS). access to safe drinking water and childhood nutrition, control on
marketing of breast milk substitutes, greatly reducing child mortality.
Such
interventions could further be backed up through promotion of children’s rights
policies and laws and promotion of inter-sectoral collaboration and partnership for
child health at various levels.
Tanzania Essential Health Intervention Project (TEHIP) has reported significant
reduction in the mortality of children under the age of 5 years through evidence based
approach to health planning and interventions. Community - level information
systems provided the basis for bringing about more rational allocation of existing
district level funds, and personnel to better focus on resources on highest diseases
burden with dramatic reduction in for example the mortality of under-five children
(557c decline between 1998 and 2003)
Maternal Health
Most interventions for reduction of maternal mortality are feasible at community
levels, and may be facilitated through appropriate health promotion interventions (see
box below)
| Health promotion interventions for reduction of maternal mortality
•
•
•
•
•
•
Community IEC on family planning, ante-natal care, improved nutrition
during pregnancy, malaria prevention through use of LLITNs and other
measures;
Prevention of mother to child transmission of HIV/AIDS and
importance of attended child birth by skilled health workers;
Preparedness and timely response to obstetric emergencies and establishment
of functional referral system through strong inter-sectoral partnership;
Addressing socio-political and cultural barriers that contribute to maternal
mortality
Developing and reinforcing implementation of policies and laws to protect
girls and women from early marriages, ensuring the rights to family planning.
and protection from Female Genital Mutilation (FGM). war and domestic
violence
Combating HIV/AIDS
Health promotion approaches, are crucial in ongoing global, and national efforts to
combat HIV/AIDS. tackling major barriers to HIV/AIDS control. Prevention and care
programmes for HIV/AIDS need to take into consideration underlying determinants
7
of the epidemic, including poverty, gender, inequality, and social dislocation and
vulnerability.
The following HIV/AIDS interventions could benefit from health promotion:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1EC on social stigma and discrimination.
Education and behaviour change campaigns
Promoting gender equity in H1V/AIDS and related programmes.
Campaigning for global, national and community level support to the orphans.
Harm reduction, behaviour change and condom promotion programmes, focused on
vulnerable population
IEC on Voluntary testing and counselling, control of sexually transmitted diseases (STIs)
Advocating for prenatal testing and increased coverage of Anti-Retroviral treatment
(ARVs) to prevent mother-to-child transmission (PMTCT)
Promoting health systems precautions and blood safety
Advocating for the rights to have access to treatment and care and social support for
people living with HIV/AIDS.
Support the harmonisation of prevention and treatment messages, in the communities and
other levels.
Advocate for greater partnership and commitments towards strengthened health systems,
in response to HIV/AIDS
Mobilisation of greater partnership in support of poor nations with high diseases burden
due to HIV/AIDS and related conditions with one agreed HIV/AIDS action framework,
one national AIDS coordinating authority and one agreed country-level monitoring and
evaluation system
Campaigning for accelerated action, which will enhance accessing and using the pledged
vital resources for combating HIV/AIDS, including the GFTAM, US President's
Emergency Plan for HIV/AIDS Relief (PEPFAR) and the World Bank.
Promoting multi-sectoral response to HIV/AIDS.
Campaigning for supportive policies and legal environment
Promoting HIV research towards effective diagnostics and possible vaccine and
traditional medicines through global and regional partnerships._______________________
Uganda (in East Africa ) has demonstrated a good example, whereby through strong
partnership with national and international communities. PLWA. Government Civil
Society Organisations, development partners.
across sectors (multisectoral
response). HIV/AIDS prevalence has been drastically reduced from over 30% in the
90s to 6.5% in 2005. (Uganda National HIV seroprevalence survey 2005).
The Government of Botswana began providing ART services in January 2002 and 29 months
later a of24. 087 patients were covered. The trend shows that more than 40.000 patients will
be covered by end of 2005. which is nearly half of the 110,000 total patients needing ART
country wide. Strong collaboration with international and local partners, between health
facilities, support for PLWAs, improved health infrastructure, adequate HRH, decentralized
ART services are among main enhancing factors (WHO/AFRO 2004)._________
Combating Malaria
Health Promotion in the implementation of the proposed integrated package for
malaria control should address disease prevention through promotion of: (LLITNs).
indoor residual spraying (IRS), anti-larval measures and malaria prevention in
Pregnancy.
8
Malaria disease management should be backed up by 1EC on the need for prompt and
accurate malaria diagnosis, advocacy for increased access to effective and affordable
antimalarials (e.g. Artemisinin Combination Therapy - ACT) and increased access to
basic health care services, including home -based malaria management in
underserved areas.
Successful scaled -up malaria control programmes have been reported from
Ethiopia. Eritrea. Madagascar. Vietnam. South Africa and Tanzania. Experience from
these countries shows that sustained reduction in the malaria burden can be achieved
through well- coordinated efforts and strong partnership with communities and all
stakeholders.
In Vietnam: 144 malaria outbreaks in 1991 triggered Government increased
investment in malaria control including free distribution and treatment of bed nets in
annual and biannual campaigns: application of IRS: deploying of new antimalarial
medicines, including artemisinin derivatives: training and supervision of voluntary
health workers to improve health seeking behaviours at community level. As result
• number of people protected by vector control methods (ITNS, IRS) increased
from 4 million in 1991 to 12million in 1998.
• number ofpeople using ITNs rose from 300.000 to more than 10 million
• morbidity and mortality rates were reduced by 977c and 607c respectively
• local malaria outbreaks were eliminated (WHO 2000).
Combating Tuberculosis
Health promotion initiatives may contribute significantly to the Global Plan to stop
TB including advocating for actions to reduce stigma, promoting increased access to
Directly Observed TB Treatment (DOTS) and care, promoting integrated TB,
HEV/AIDS interventions and advocating for Global partnership and national
commitments towards increased percentage of resource allocation for combating TB.
Special attention to be given to the 22 high-burden countries which account for 80%
of all TB cases, as well as Sub-Saharan Africa because of poverty and HIV-related
TB.
Combating Non-Communicable Diseases
Advocacy should aim at more attention for non-communicable and chronic diseases
and their consequences, promoting an integrated strategy for chronic disease
prevention and control, mobilisation of global, regional and national partnership and
additional funding. Research should remain as key function of Health Promotion, to
generate more evidence on NCD and their impact on health and development. However,
emphasis needs to be given to research on implementation, not just epidemiology.
Although there are gaps in the evidence, enough is known to enhance necessary action
now.
WHO supported World Health Days (WHD) have been useful as an entry point in
campaigning for the control of NCD. especially, control of tobacco use. mental health, and
other related conditions. It has proved quite effective in mobilising target groups al national
and lower levels and could be considered as a good practice. However, there is a need to
strengthen and support local ownership of this initiative towards sustainability.___________
9
Summary of Health Promotion Approaches for Combating Diseases
a) Disease prevention through promotion of relevant preventive measures for example,
increased access to ITNs to prevent malaria and condoms to prevent HIV/A1DS.
b) Back up of disease management strategies including
• IEC on the need for prompt and accurate diagnosis
• Advocating for increased access to effective and affordable drugs (e.g. ACT for
malaria, ARV for H1V/A1DS and DOTS for TB)
• Advocate for increased access to basic health care services, including home -based
care in underserved areas
c) Backing epidemic prevention and control strategies including:
• Studies towards early detection of outbreaks
• Early warning and effective surveillance systems
• Addressing social and environmental factors, such as war, migration, change in local
vector ecology etc.
d) Promoting Information, education and communication Strategies through
• IEC that is sensitive to local socio-cultural and environmental factors
• IEC on integrated disease control approaches (e.g. integrated malaria/HIV/AIDS/ TB.
IMCI and safe motherhood), to foster effective and horizontal communications
• IEC that encompass broad exchange and adapt implementation measures to the needs
of community
e) Supporting Monitoring and Evaluation (M&E) through:
• Monitoring trends in morbidity and mortality, resistance to medicines, coverage rates
of prevention and management interventions etc
• Developing indicators to be used in monitoring, chosen according to local
transmission conditions
• Ensuring availability of high-quality data for the chosen indicators.
• Developing capacities in health information systems as priority to enhance effective
M&E of disease control programme
10
Environmental Sustainability
Health promotion is also important for alleviating the problems of water scarcity.
pollution and related issues of environmental risks to child health, the fast population
growth, urbanization, migration and global climate change. There is a need for strong
health promotion to protect the poor, including advocating for legislation to protect
human rights to safe and sustainable environment. Continuous generation of relevant
data to monitor progress towards the waler and sanitation targets and country support
in the assessment of impact of water management activities are important health
promotion interventions. Selective interventions should benefit “un-served"
populations, such as slum areas. Also there is a need to empower and support local
communities, especially the low-income and vulnerable groups, through strong
advocacy and greater partnership.
Good practices have been reported from a number of countries through Healthy Cities
Projects (Thailand, Dar es Salaam in Tanzania. Cairo etc.). Healthy cities project includes
among other interventions, promotion of healthy living styles integrated with poverty
alleviation programmes in various settings. For example, through healthy market places,
promoting food safety among street food vendors, healthy school, 'healthy communities'
focusing on the poor and vulnerable groups, such as adolescents, People Living With AIDS
(PLWA), women and orphans.
Promoting Partnership
Health Promotion approaches are crucial for sstrengthening partnership and joint
commitments, at local (community), national, regional and global levels in support of
MDG achievement, including partnership with and among donors, international
agencies, trade organizations, civil society, the private sector and local community.
Health Promotion could support the dissemination of good practices including
experiences and learned lessons from countries that have adapted effective partnership
approaches in MDG-PRS processes and Sector Wide Approaches (SWAp), which
encourages joint donor/govemment/private sector/community planning, pooling of
resources, joint implementation, monitoring and evaluation. Other forms of
partnership that could be supported through health promotion include partnership
across sectors (multi-sectoral approach), partnership with various groups in the
society, including youth and women groups, partnership among professionals from
various disciplines, also among various health programmes and partnership between
Government and the private sector (public/private partnership).
The Piloting of MDG-PRS processes under the UN Millennium Project in selected
countries (Kenya, Ghana, Senegal, Ethiopia, Tanzania, Tajikistan, Yemen, Cambodia and The
Dominican Republic), has demonstrated good examples of strengthened partnership in the
context of MDGs. The process involves partnership actions among Government, UN country
teams, bilateral and multilateral agencies, the civil society, private sector, the community,
training and research institutes. It includes close linkages between goals and sectors to ensure
necessary synergies, to avoid unnecessary overlaps and reduce costs. The conducted MDG
needs assessment has covered each of eight MDGs. The process involves five major steps:
developing generic list of interventions; specifying targets for each set of interventions;
estimating synergies across interventions/sectors; developing investment model, estimating
resource needs and developing financing strategy.
It focuses on alignment with the national development policies and strategies, especially the
PRS and supports capacity building for local ownership, greater partnership and
sustainability. The end result is MDG-based national plans/PRS and responding Medium term
Expenditure Frameworks (MTEF) and national budgets, all geared at MDG attainment.______
11
Conclusion:
There is general slow progress towards MDGs achievements. Health promotion could
potentially contribute in accelerating the progress, especially for the Health related
MDGs.
Recommended way forward through Health Promotion
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Continue strong advocacy at national, regional and global level, taking the
2015 time-horizon seriously.
Promote Information, education and communication strategies, sensitive to
local socio-cultural and environmental factors, integrated with other health
programmes to foster effective and horizontal communications, encompassing
broad exchange and adapting implementation measures to the needs of
communities
Emphasis should be placed on underlying determinants of health including
poverty, education and illiteracy, gender, environmental sustainability.
urbanization, migration and other relevant factors, which calls for strengthened
partnership and multi-sectoral action.
Strengthen partnership, mutual trust and joint commitments, at local
(community), national, regional and global level including development
partners, international agencies, trade organizations, civil society and the
private sector
Promote social mobilization and community participation
Promote social and economic development through MDG-based poverty
reduction strategies
Organise donor assistance around achievement of MDG’s
Advocate for increased financing, while streamlining and harmonizing
financial and administrative procedures
Promote proven cost-effective health interventions including "Quick Wins"
actions to save and improve millions and to promote economic growth.
Strengthen health systems to match the required up-scaling of activities to
achieve the health MDG's
Advocate for strong attention to human resources for health issues including
motivation, migration, innovative training and flexibility in deployment
Provide information and clear guidelines to countries on MDG-bascd poverty
reduction (MDG-PRS) strategies aiming at achieving healthy populations
Support MDG-PRS networking across regions and countries, and
dissemination of lessons and best practices from the piloting countries.
Improve required knowledge and information by promoting relevant research
and strengthening MDG I Health information management systems
Give special attention to sub-Saharan Africa because of its disproportional
heavy burden of disease
12
References
CMH (Commission on Macroeconomic and Health). 2001 Final Report of
the Commission on Macroeconomic and health WHO, Geneva.
2. De Savigny, D et al. Fixing Health Systems. IDRC Ottawa 2004
3. De Savigny. D and F. Binka Monitoring Future Impact on Malaria Burden in
Sub-Saharan Africa: American Journal of Tropical Medicine and Hygiene
2004
4. Graves, P.M. Eritrea: Malaria Surveillance, Epidemic Preparedness and
Control. Washington (Environmental Health Project) 2004
5. Hanson K, et al: The Economics of Malaria Control Interventions (Global
Forum for Health Research 2004)
6. High-Level Forum on the Health Development Goals, overview of progress
toward meeting the health MDG’s issues for discussion, WHO. The World
Bank. Dec. 2003
7. Http://www.who.int International AIDS Conference: Access for all. Bangkok
July 2004
8. MDG needs assessment country case studies. MP Secretariat NY January
2004
9. MDG Needs Assessment Reports 2004/2005 (Ethiopia, Kenya, Ghana and
Senegal).
10 United Republic of Tanzania: The National Strategy for Growth and
Reduction of Poverty (NSGPR 2005-2010), VPO Dar es Salaam Tz
11. MDG Needs Assessment Methodology, MP Secretariat, NY 2004.
12. Millennium Development Goals, Status 2004, UN Department of PublicInformation, DP1/2363-A
13. Millennium Health Goals: paths to the future (accessed via www.who.int
24th August 2004
14. Regional Framework for Health Promotion: making healthy choices easy,
early and exciting...everywhere (WHO Regional Office for Western Pacific)
Accessed through http://www.who.int June 2005
15. The African Malaria Report (WHO and UNICEF 2003)
16. Uganda National HIV seroprevalence survey 2005
17. UN Millennium Project: Task force Reports on Child Health, Maternal
Health, HIV/AIDS, Malaria and Tuberculosis: UN/MP, New York January
2005
18. UN Millennium Project: Investing in Development: A practical Plan to
achieve The Millennium Development Goal MP/NY 2005
19. United Nations Statistics Division: Millennium Indicators Database- goals,
targets and indicators, UN, May 2004.
20. WHO/AFRO: Communicable Diseases Bulletin for the Africa Region (Sept
2004)
21. Move for Health Initiative: Supportive Environments (WHO -Dept for
Chronic Diseases and Health Promotion, Feb 2005
22. WHO: Roll Back Malaria: A global Partnership. Geneva 1998
23. WHO: The Community-Based Malaria Programme in Tigray, Northern
Ethiopia Geneva 1999
24. WHO: A story To Be Shared: The successful fight against malaria in
Vietnam, WHO/Geneva 2000
25. WHO: World Health Report 2003 Shaping the Future. Geneva 2003
26. WHO (2005 ) Chronic diseases and health promotion (www.who.int)
27. WHO/WSH (2005) Health through Safe Drinking Water and Basic Sanitation
(www.who.inl)
1.
13
1
EMERGING HEALTH ISSUES:
THE WIDENING CHALLENGE FOR POPULATION HEALTH
PROMOTION
A.J. McMichael
C.D. Butler
The 6th Global Conference on Health Promotion
Bangkok, Thailand, 7-11 August 2005
2
Abstract
There is a widening spectrum of tasks for health promotion in today’s world. Since the Ottawa Charter
(1986), substantial political, social, economic and environmental changes have occurred. While many
broadly-averaged measures of population health are improving, various other indices of health and its
determinants are faltering. There are emerging risks to health from demographic shifts, large-scale
environmental changes, the cultural and behavioural changes accompanying national development,
and an economic system that emphasises the material over other elements of well-being.
Reinforcement of inter-sectoral health promotion is needed (including engaging with the development,
human rights and environmental movements). Not only must health promotion often transcend the
health sector, but, increasingly, it must engage beyond national boundaries. The Ottawa Charter
argued for "healthy public policy” - yet that was in a world that largely predated HIV/AIDS and a surge
of other infections, unyielding widespread poverty and under-nutrition, worldwide declines in
freshwater and soil fertility, recognition of climate change as a health threat, and escalating chronic
disease burdens in developing countries. The need for that policy-level approach has heightened.
Examples of emerging health risks and trends include:
•
Infectious diseases: Many diseases have emerged since the late 1970s, while others have
unexpectedly increased. Reasons include persistent poverty, urban crowding, environmental
changes (mobilising new microbes), altered sexual relations, intensified food production,
increased mobility and trade, and tardy vaccine development.
•
Regional life expectancy declines: Life expectancy has unexpectedly declined in various
countries. Factors linking these declines suggest that others could follow. Relatedly, the
demographic and epidemiological transitions have faltered. In some regions, declining fertility has
overshot that needed for optimal age structure, while elsewhere mortality increases have reduced
population growth rates despite continuing high fertility.
•
Millennium Development Goals, health and sustainability: Several health-related MDGs appear
unlikely to be achieved. Most policy-makers do not understand the link between environmental
sustainability (MDG #7) and health. Sustainability entails maintenance of Earth's ecological and
geophysical systems, and social cohesion, as the basis for health.
These large-scale risks to health present great challenges. Beyond engaging with other sectors, and
across levels of society, health promotion must also address population health influences that
transcend national boundaries and generations. The big task is to promote sustainable environmental
and social conditions that bring enduring and equitable health gains.
3
Introduction
The 1986 declaration of the Ottawa Charter reflected a growing awareness that, in many parts of the
world, declines in the social, economic, political and environmental conditions that underpin population
health were jeopardising the goal of Health for All by 2000, signed 8 years earlier in Alma Ata.1,2 This
awareness stimulated fresh strategies to induce healthier behaviours for both communities and
individuals, reflected in phrases such as “healthy choices should be easy choices” and calls for
“healthy public policy". The Charter also emphasised the important, but often latent, health-promoting
role of informed and empowered communities.
The forces driving the upward trajectory in global health evident in the decades before 1978, including
the development and dissemination of improved health technologies, health services, decolonization
and foreign aid, gave Health for All credence. But many of the underlying social forces that stimulated
to the Ottawa Charter have intensified, despite the efforts of those concerned with health
advancement and protection, and despite large increases in formal evidence and understanding of the
fundamental determinants of health. Indeed, the foundations necessary to maintain current health
levels are now at risk, while in some regions hard-won health gains have already been reversed.
Periodic attempts to reverse this trend, such as the Millennium Development Goals (MDGs), have
slowed but not reversed this slide. Indeed, the rate of deterioration in the fundamentals needed for
good global health appears to be quickening.
Two fundamental causes for these "emerging health risks” are: (i) economic policies that emphasise
markets and intensified throughput over other elements of social, environmental and personal well
being, and, relatedly, (ii) Earth’s ever-diminishing spare “bio-capacity"3 available for exploitation. While
an economic system that disproportionately benefits the powerful is hardly new, this co-exists with a
human population with an expanding capacity and aspiration to appropriate and critically transform
nature on a global scale.
The scale of these synergistic problems is unprecedented. If it seems overstated to call this
combination “dangerous", bear in mind that the WHO constitution argues that “Unequal development
in different countries in the promotion of health and the control of disease ... is a common danger" for
humankind as a whole.’’4 To this long-recognised danger of grossly unequal health development must
now be added the danger of unprecedented environmental change.
This paper discusses six selected contemporary emerging health issues, all relevant to and reflective
of increased global health inequalities. The first four are the challenge of infectious diseases,
urbanisation, declines in regional life expectancy, and the relationship between health and global
environmental change, including to the climate. The UN’s (2000) Millennium Development Goals are
then viewed in the context of sustainability and health. Finally, we discuss the faltering of the global
epidemiological and demographic transitions. We explore the linkages between these six issues, and
conclude that health promoters must give heightened emphasis to population-level influences, and
must expand alliances with other government sectors and other social reformers in order to improve
population and community health.
Other emerging health issues which cannot be discussed in detail here include: (I) population ageing
(including long periods of dementia-based dependency); (ii) the changing nature of work, including
employment casualisation and the gulf of economic power separating consumers from workers; (iii)
the increasing burden of road traffic accidents in low-income countries; (iv) the increasing likelihood of
destructive acts of terrorism and bioterrorism, and (v) the increasing burden of mental health
problems.
This paper does not consider in any detail the Health Promotion strategies needed to address these
emerging health issues. Rather, the paper reviews the changing health-risks which highlight how
today’s world differs from that of the Ottawa Charter in 1986. However, we identify a systems-based
understanding and a capacity to think on a larger scale and longer term as an underlying principle
needed.
4
1.
Emerging and re-emerging infectious diseases
In the early 1970s, it was widely assumed that infectious diseases would continue to recede:
sanitation, vaccines and antibiotics were at hand. The subsequent generalised upturn in infectious
diseases was unexpected. Worldwide, at least 30 "new” infectious diseases have been recognised
since 1975.5 HIV/AIDS has become a serious pandemic. Several "old” infectious diseases, including
tuberculosis, malaria, cholera and dengue fever have proven unexpectedly problematic, including
because of increased antimicrobial resistance,6,7 new ecological niches, weak public health services
and activation of infectious agents (e.g., tuberculosis) in people whose immune system is weakened
by AIDS.
Diarrhoeal disease, acute respiratory infections and other infections continue to kill more than seven
million infants and children every year.8 In parts of sub-Saharan Africa mortality rates among children
are now increasing.9 While persistent poverty has preceded and shadowed most of these conditions
the spread of some, such as SARS and West Nile Fever, have been promoted by trade, affluence and
air travel.
This recent upturn in range and burden of infectious diseases reflects a general increase in
opportunities for entry into the human species, transmission and long-distance spread. The underlying
influences include increases in population size and density, greater mobility (including for air
travellers, migrants and refugees), population age-distributions unfavourable to development10 and
conducive to violence,11 persistent poverty - especially in overcrowded and unhygienic slums,
encroachment on undisturbed ecosystems and human-induced large-scale environmental changes
(such as ongoing changes to the world’s climate system. These causes are further complicated by
conflict and warfare, gender-based violence, political ignorance, denial (as has occurred with
HIV/AIDS in parts of sub-Saharan Africa), iatrogenesis (as with HIV in China) and vaccine obstacles.
While specific new infectious diseases cannot be predicted, there is now improved understanding of
the conditions favouring disease emergence and spread: (i) new human-microbe contacts, as in
animal domestication and forest clearance;12,13 (ii) disturbance of natural ecosystems and their various
internal biotic controls;14 and (iii) poverty, crowding, social disorder and under-nutrition - and, at the
other end of the nutritional spectrum, people with impaired immunity due to poorly controlled diabetes
(an obesity-associated disease on the increase globally).
The apparent failure of WHO's Roll Back Malaria program15 shows the risk of stand-alone (vertical)
approaches to disease and the difficulties in operating outside older institutions. Yet the program
raised new funds, increased high-level awareness, and led to political pledges of support. This
encapsulates a dilemma for health promotion. Enthusiasm, while necessary, is insufficient. Technical
advice, attention to detail and genuine collaboration are essential.
Finally, this is a microbially-dominated world, and we must understand and approach our relations
with microbes primarily in ecological (not military) terms. We cannot banish the world’s infectious
agents; but we can eliminate some, control many, and we have knowledge of how to reduce human
population vulnerability and avert conditions conducive to infectious disease occurrence - both of
which should be foci of health promotions strategies. We would thus achieve a more sustainable
approach to human-microbe co-existence.
2.
Urbanisation: gains and losses for population health
Most of the recent global population increase has been absorbed by towns and cities in developing
countries. The urban environment is rapidly becoming the dominant ‘human habitat’. Few cities have
been able to adequately plan and provide social and material infrastructure, essential for health,
resulting often in un- and under-employment,16 slums and other high-risk environments. Rapid
urbanisation transforms many values and behaviours, alters social relations, and leads to various
health gains and losses. In recent decades, rural-to-urban migration yielded a net health gain in many
developing countries (as in European countries in the nineteenth century). This is no longer assured.
Losses include breakdown in family and community relations; amplified violence and drug-abuse;
readier spread of many infections' road trauma; air pollution; a distorted daily energy-balance in an
’obesogenic’ urban environment, and, for many, a search for meaning and spiritual connection
unfulfilled by consumerism.18
5
Empirical evidence and understanding of how some health risks are embedded in urban design,
infrastructure (especially transport systems), housing, marketing strategies and retail choices have
recently increased - as has the understanding of how these ‘urban’ health risks are modulated by
socioeconomic and other disparities. This growing awareness of the urban environmental and social
contextual influences on health risks, in contrast to a focus on personal behaviours and consumer
choices, underscores the important ecological dimension that health promotion strategies must
embrace if enduring health gains are to be achieved.
3.
Declines in regional life expectancy: Reflecting what?
The upward trajectory in life expectancy forecast in the 1980s19 has been challenged by recent major
reversals in several regions, especially in Russia 20 and sub-Saharan Africa.21 Although these could
either be temporary aberrations or be unconnected to one another, identifiable factors appear to link
these declines - declines that may presage other falls in life expectancy.
The dramatic decline in life expectancy in Russia since 1990 has been unprecedented for a
technologically developed country. Many proximal causes have been well- documented, including
increases in alcoholism (especially binge drinking), suicide, violence, accidents and cardiovascular
disease.22 These factors suggest a society facing a collective crisis of social disintegration and
crisis.23. As recognised with malaria and HIV in sub-Saharan Africa, these adverse health
consequences are of sufficient consequence to further depress population health.
In sub-Saharan Africa, HIV/AIDS has combined with poverty, malaria, tuberculosis, depleted soils and
undernutrition,24 deteriorating infrastructure, gender inequality, sexual exploitation and political taboos
to foster a runaway epidemic that has reduced life expectancy, in some cases drastically. In turn,
adverse health and human capital losses, caused both by disease and the out-migration of skilled
adults has helped to "lock-in” poverty. In parts of sub-Saharan Africa childhood mortality has
increased, not only directly from AIDS but also because of a loss of parents and other carers.23 More
broadly, indebtedness and punitive development policies, including charges for schooling and health
services, often introduced as a consequence of structural adjustment programmes, have also hurt
population health in Africa, following decades of earlier improvement.1 The intersectoral implications
for health promotion are clear.
Conflict - most notoriously in Rwanda26 - has also been on a sufficient scale to temporarily reduce life
expectancy for some populations. Age pyramids skewed to young adults have almost certainly played
a role in this violence,11 together with resource scarcity, pre-existing ethnic tensions, poor governance
and international inactivity when crises develop.
4.
Globa! environmental changes (including climate change)
Sustainable population health depends fundamentally on the viability of the planet’s life-support
systems - the integrity of the natural environment. For humans, achieving and maintaining good
population health and wellbeing is the true goal of sustainability. Human societies have devised social
structures, economic systems, technologies and environmental management practices primarily to
enhance human security, wellbeing and health.
In today's world, global environmental changes pose new risks to human health, on an unprecedented
spatial-temporal scale. Over recent years, evidence has accrued of complex human-induced
environmental changes at global/worldwide scales - climate change, stratospheric ozone depletion,
biodiversity loss, regional downturns in the productivity of land and oceans, freshwater depletion, and
disruption of major elemental cycles (especially sulphur, phosphorus and nitrogen - resulting in
environmental nitrification). Over the coming decades, these long-term change processes could exact
a great health toll via physical hazards, infectious diseases, food and water shortages, conflict and an
inter-linked decline in societal capacity.
Material living standards and life expectancy have increased greatly in most countries during the past
half century. However, trends in measures of ’’inclusive" wealth which account for the true economic
costs of the drawdown of natural and social capital (the support systems needed for biological
production and social harmony) are less favourable. These data reveal that the true increase in net
6
income is less than supposed, and in some populous countries is actually declining.
More
fundamentally, the juxtaposition of regions with declining inclusive wealth may generate harmful
synergies, including conflict and health declines.
We currently extract "goods and services"28 from the natural environment about 25 per cent faster
than they can be replenished.3 Correspondingly, there is now little unused "biocapacity" to draw down.
In combination, we are therefore transmitting an increasingly depleted natural world to future
generations, and this will have inevitably have adverse health consequences. While the distribution of
these adverse effects is likely to be unequal, and - for many - lagged, it is not inconceivable that this
decline could eventually harm the entire human population.
Global climate change is attracting increasing attention. Fossil fuel combustion for industrial
processes, agriculture and transport has caused unprecedented levels of atmospheric carbon dioxide
and other heat-trapping gases. The majority expert view is that climate change, which is likely to also
involve significant hydrological and agricultural changes29 is now underway. WHO has estimated that,
globally, over one hundred thousand deaths annually result from recent change in the world’s climate
relative to the baseline average of 1961-1990.30
The most direct risks to future health from climate change are posed by heatwaves (exemplified by
the estimated 25,000 extra deaths in Europe in August 20 0331), cyclones and floods. Climate-sensitive
biotic systems will also be affected. This includes: (i) the vector-pathogen-host complex involved in
transmission of various infections (both vector-borne infections and those due to various bacteria such
as salmonella), (ii) the production of aeroallergens, and (iii) the agro-ecosystems that generate food.
Recent changes in infectious disease occurrence in some locations - tickborne encephalitis in
Sweden,32 cholera outbreaks in Bangladesh,33 and, debatably, malaria in the east African highlands34
- may partly reflect regional climatic changes.)
Altered climate and ecosystems, biodiversity losses, and other large-scale environmental stresses
will, in combination, affect the productivity of local agro-ecosystems, freshwater quality and supplies,
and the habitability, safety and productivity of coastal zones. Such impacts will cause economic
dislocation and population displacement. Conflicts and migrant flows would increase, and, variably, a
mix of violence, injury, infectious diseases, malnutrition, mental disorders and other health problems
would result.
7
Figure 1. Major pathways by which global and other large-scale environmental
changes affect population health.
Forest clearance, altered
land use/cover
Changes in global
elemental cycles (esp.
nitrogen, phosphorus)
_ Increased
UVR flux
Climate change
Land/soil degradation
Increased UVR flux
Rainfall
changes
Thermal stress,
weather disasters,
changes in
infectious diseases
i
Reduced
Food yields
Flooding
Human Health
Conflict potential
Declines in phenotypic,
genetic materials and
diverse “goods and services”
Biodiversity loss and
)<>
ecosystem dysfunction^/'“
—>
Fisheries depletion
A
Freshwater stocks,
and quality
z' Marine and coastal
■^xecosystem damage
These and other categories of global environmental changes, often acting in combination, pose
serious health risks to current and future human societies (see Figure 1). The important message from
this diagram is that, increasingly, human health is influenced by social-economic and environmental
changes originating well beyond national or local boundaries. The major, perhaps irreversible,
changes to the biosphere’s life-support system, including its climate system, increase the likelihood of
adverse inter-generational health impacts.
5.
Emerging health issues and the Millennium Development Goals
In 2000, UN member states agreed on eight Millennium Development Goals (MDGs), with targets to
be achieved by 2015. Four MDGs refer explicitly to health outcomes: eradicating extreme poverty and
hunger; reducing child mortality; improving maternal health; and combating HIV/AIDS, malaria and
other infectious diseases. Figure 2 indicates the relationships of the MDG topic areas to the emerging
health issues discussed in this paper.
8
Figure 2. Relationships between: (i) social and environmental conditions and their
underlying economic and demographic influences, and (ii) the Millennium Development
Goal topics. (Three of this paper's main issues - urbanisation, environmental changes,
infectious diseases - are explicitly represented as boxes.)
Many of the MDG targets are already in jeopardy. While all MDGs are inter-linked, the 'environmental
sustainability’ MDG has fundamental long-term importance.35 Without it, the other concomitants of
sustainability - economic productivity, social stability and, most importantly, population health - are
unachievable.
Striving for sustainability should not, however, overshadow tackling the existing, immediate, social and
environmental problems that directly affect the health-related MDGs.35 But, by similar token, we
cannot ignore the connections of population size and economic growth with health status, poverty and
environmental sustainability. The burgeoning environmental impact of humanity's collective ‘ecological
footprint’ reflects the ongoing increases in both the levels of per capita consumption and population
size.3 Therefore, an additional reason to advance the MDGs is because that will help slow population
growth rates, and that will reduce our collective ecological footprint.
6.
The faltering demographic and epidemiological transitions
Both the demographic and epidemiological transitions have become less orderly than previously
predicted. In some regions (including parts of Europe, Russia, Japan, and possibly China) declining
9
fertility rates have overshot the rate needed for an economically and socially optimal age structure,36
while in other countries population growth has declined substantially because of the reduced life
expectancy discussed above.21 Further, the health dividend from a reduction in poverty may still be
only partial because of the emergence of "diseases of affluence", including those due to obesity,
tobacco use and air pollution.
During the Green Revolution (which coincided with the period before the drafting of the Ottawa
Charter) a prevalent view was that unconstrained population growth has little impact upon
environmental amenitv and other conditions needed for human well-being. This view has recently
been re-evaluated,37,35 signifying a return to an earlier, more cautious approach to the benefits and
costs of rapid population growth. There is increasing recognition of the likely adverse effects, including
high unemployment when population increase outstrips growth of opportunity. Hence, unsustainable
regional population growth is characterised by age pyramids excessively skewed to young age, high
levels of under- and un-employment, and intense competition for limited resources. These
circumstances predispose to a social milieu inimical to public health Indeed, if there is also significant
inequality and/or ethnic tension, catastrophic violence can result.26,39
Although they have vastly different demographic characteristics, there are links between the life
expectancy declines in Russia and parts of sub-Saharan Africa, particularly the erosion of public
goods. Viewed on an even larger scale, these set-backs accord with certain elements of a global class
system,46642 in which privileged groups in both developed and developing countries act (often in
concert) to protect their own position at the expense and health of others.
While inequality is intrinsic to all human societies, its current scale and accelerating growth, in the
context of a declining stock of spare ’bio-capacity” (the capacity of the Earth’s biological and other
natural processes to provide, replenish and absorb - see above)3 jeopardises the already faltering
demographic and epidemiological transitions. Hence, future population growth may slow not only
because of a decreased fertility linked to increased life expectancy (in some regions), but because of
persistently high death rates elsewhere.
On the other hand, the resurgent awareness of these related issues, the publicity surrounding the
MDGs, the ongoing campaigns against poverty and Third World debt, calls for public health to
address political violence, and the renewed vigour of social movements for health (e.g., the People’s
Health Movement)43 afford new potential resources and collaborations to the global health promotion
effort.
Globalisation, trade, economic policy, and public health: Towards a unifying explanation for
faltering health
There is intense debate about the health benefits of the complex social, cultural, trade and economic
phenomena that comprise "globalisation”.44'46 Well-informed advocates have differing viewpoints47 perhaps inevitably, given the complex mix of factors that allow alternative explanations of heath
consequences that might otherwise be attributed to globalisation. The debate itself, however,
indicates that the net gain or loss for population health from globalisation is unclear.
As described above, the rate of gain in average global life expectancy has recently slowed, as has the
‘classical’ epidemiological transition associate with 'development'. These changes to a blunt but
powerful indicator of population health question the proposition that globalisation confers widespread
health benefit. Further, many of the health (and other) dividends that might be attributed to
globalisation have alternative explanations - for example, health gains in many developing countries
may actually be the time-lagged result of development policies and technologies introduced before the
era of structural adjustment and partial economic liberalisation. The accelerated demographic
transition in China has also played an under-recognised role in that country’s rapidly growing wealth,10
as did China’s earlier investments in health and education.
In theory, free trade, via the mutual benefits of comparative advantage, can benefit all populations. In
reality, wealthy populations are likely to continue tilting the economic and political playing field so that
the theoretical shared gains of free trade (as, indeed, was predicted by some 191h-century trade
theorists)48 Indeed, a powerful real-politic impediment to the complete removal of trade-distorting
national subsidies is that this would probably entail a greater relative economic loss for wealthy
10
countries than for the poor. The economic disadvantages incurred to date through partial market
deregulation have largely been confined to relatively poor, politically weak, populations. Any
suggestion of broadening these economic stringencies to more powerful populations, especially to
their subsidised agricultural sectors, provokes great opposition.
The current dominance of economic theory and criteria, in government, presents a major challenge to
health promotion in tackling fundamental impediments to wide and enduring gains in health. The
narrow focus of the World Trade Organization, in largely discounting the adverse social,
environmental and public health impacts of its championing of ‘free-trade’ policies, underscores the
problem. Today’s dominant economic theory' evolved when environmental limits were considered
remote.49 Besides, these theories assume that increased per capita income will offset the non-costed
losses (“negative externalities’’), whether those affect social welfare, environmental resources, or
public health. Critiques of these theories27,49 consistently note that the harshest costs of modern
economic practices fall upon ecosystems and populations with little current economic power or value
- including generations not yet born.
Many indices of inequality, including in health, income, and the risks from climate change, have risen
in recent decades.29,50 To date, much of the critical commentary on this51 has been largely conceptual,
emphasising the adverse experiences of the disadvantaged and unborn. Meanwhile, the practical
feedback actually received by the main beneficiaries of modern economic policy is mostly positive and hence misleading. Hence, a major challenge for the promoters of health (and other forms of
justice) is to adduce stronger evidence to convince policy-makers to promote these public goods,
even though this may diminish the relative privilege of those policy-makers and their constituencies.
This is a tall order - but an essential task for health promotion. The diverse challenges of modern
globalisation cannot be ignored. Mobility of capital brings development, but its fickleness risks
capricious flight, with consequent economic and public health hardship. Deregulated labour conditions
facilitate cheap goods, but concentrate occupational health hazards among powerless workers.52
Increased labour mobility and steep economic gradients weaken family and community structures,
contribute to “brain drain” (including of many health workers)53 and promote inter-ethnic tensions. All
these endanger or erode the health of vulnerable populations.
In summary, global and regional inequality, narrow and outdated economic theories and their
misleading price signals, and an ever-nearing set of global environmental limits are endangering
population health. On the positive side of the ledger, there have been gains in literacy, information
sharing, and food production (environmental costs notwithstanding) and access to food in some
regions, and new medical and public health technologies continue to confer large health benefits.
Overall, though, reliance on economic processes to achieve social goals and to set priorities, and on
technological fixes for environmental problems, are poorly attuned to the long-term improvement of
global human well-being and health. For that, a transformation of social institutions and norms, and,
hence, of public policy priorities is needed.5,1 The criterion of population health should be a powerful
lever in that process of change. That is part of the modern task of health promotion.
Emerging Health issues: The chalienges for health promotion
This paper has explored the widening spectrum of tasks for health promotion in today’s world. Since
the Ottawa Charter (1986), substantial political, social, economic and environmental changes have
occurred. While many broadly-averaged measures of population health are improving, various other
indices of health and its determinants are faltering.
The sources of many contemporary risks to population health are of large spatial and temporal scale;
they affect whole systems and social-cultural processes (in contrast to the many continuing health
risks from personal/family behaviours and localised environmental exposures). These newly
recognised risks to health derive from demographic shifts, large-scale environmental changes, the
cultural and behavioural changes accompanying national development, and an economic system that
emphasises the material over other elements of well-being.
These emerging risks to health present a huge challenge. The wider community, including most
governments, are not yet well attuned to understanding or responding to these larger-scale influences
on health. They fall outside the popular focus on health risks in relation to personal behaviours.
1]
specific environmental pollutants, doctors and hospitals. In countries where the prevailing ethos
promotes individual choice and responsibility, there are few economic incentives to promote the
population’s health or other public goods.
Health promotion must, of course, continue to deal with the many local and immediate health
problems faced by individuals, families and communities. But to do so without also seeking, to guide
social-economic development and the forms and policies of regional and international governance is
to risk being “penny wise but pound foolish". Tackling these more systemic health issues requires
multi-sectoral policy coordination55 at community, national and international levels, via an expanded
repertoire of bottom-up, top-down and “middle-out" approaches.56 The essential task is that of
population health promotion.
Reinforcements for the work of population health promotion must come from:
1.
Research: Better understanding of large-scale sources of health risks, and intervention strategies,
requires a capacity for systems-level interdisciplinary analyses, informed by an ethical framework.
The UN's Intergovernmental Panel on Climate Change provides a good model of interdisciplinary
research that incorporates assessment of health risks.57 The research gaps exploited by
proponents of unhealthy products and practices to oppose health-promoting reform should be
filled, though some scientific uncertainty is inevitable and should not be used to excuse inaction.55
There is also need for better monitoring of indicators of wellbeing, social development and equity.
2.
Education: The rising generations must understand better the ecological envelope within which
the human species lives. We are a part of, not apart from, nature - and are ultimately accountable
in nature's currency. Hence, the essence of “sustainability” is that we must learn to live on the
natural world’s terms, not on our own presumptuously detached (and ultimately destructive) terms.
That requires changes in educational curricula and social norms.
3.
Politics and governance: Our nineteenth-century political legacy of narrowly self-interested nation
states can be described (with some poetic licence) as a modern analogue of ancestral warring
tribes. This self-centred short-termism appears to have been 'programmed' into the human
species by the primordial evolutionary struggle for survival. Its downside, in an increasingly
interconnected and inter-dependent world, is that it now threatens humanity with the adverse
consequences of self-interested, non-sustainable, social, economic and environmental
behaviours. We must deploy our (largely latent) ability to anticipate and shape the distant future,
in order to override these counter-productive drives.
4.
Business: This sector remains a key (potential) partner for population health. This sector can play
a key role, for example, in countering emerging infectious diseases and human-induced global
environmental problems. There is (at last) a growing acceptance by the pharmaceutical industry of
the need to provide cheaper drugs in high-need low-income countries. There is great health
promotion potential in relation to health-endangering production processes (e.g. local air pollution
and greenhouse gas emissions), and in the distribution and sale of products and services harmful
to health such as tobacco and energy-dense food. Business is beginning to respond to the wider
health implications of its commercial actions. The sector must be encouraged to recognise that for both ethical and self-interest reasons - there is an urgent need for corporate social
responsibility to protect the health of people, workers, environment and social relations.
Health Promotion should engage effectively with the private sector in three relevant domains:
corporate social responsibility, consumer and environmental advocacy, and government
stewardship. Meanwhile, it must be alert to how some companies, such as major tobacco
transnationals, have sought to corrupt the concept of corporate social responsibility by their
actions.
Conclusion
The contemporary challenge for health promotion extends that foreseen in 1986. However, the
essential principles of the Ottawa Charter are still valid. Tackling today's systemic population health
issues requires working at community, national and international levels. There is need for proactive
12
engagement with international agencies and programs that bear on the social-economic fundamentals
in disadvantaged regions/countries. Many low- and middle-income countries require financial aid from
donor countries to achieve the health-related Millennium Development Goals, to deal with emerging
and re-emerging infectious diseases, and to counter the emerging health risks from human-induced
global environmental problems. Linkages should be strengthened between the health sector, and civil
society, including those struggling to promote development, human rights, human security and
environmental protection.
We urgently need an increased understanding that “sustainability" is ultimately about optimizing
human social and biological experiences - especially wellbeing, health and survival. That requires
changes in social and political organization, and in how we design and manage our communities
(especially modern urban environments). We must live within the limits of the natural world.
Beyond engaging with other sectors, and across levels of society, health promotion must also now
address population health influences that transcend national boundaries and generations. The big
task is to promote sustainable environmental and social conditions that bring enduring and equitable
gains in population health.
13
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C o rA y\ - S z_
Health of the Marginalized Groups
Alok Mukhopadhyay
Mihi Ratima
Carel Tenhaeff
Maria Ofelia O. Alcantara
Assisted by:
Madhavi Misra
The 6th Global Conference on Health Promotion
Bangkok, Thailand, 7-11 August 2005
o
Health of the Marginalized
Poverty and ill-health are intertwined, as poor countries tend to have worse health outcomes than
better off countries. Within countries itself, the poor and the marginalized have worse health
outcomes than the better off For example, those living in absolute poverty are five times more
likely to die before reaching the age of five, and two and a half times more likely to die between
the age of 15 and 59, than those in higher income groups. This association between poverty and
ill health reflects causality as ill-health may have a substantial impact on household income and
may even make the difference between being above and being below poverty line.
Poor countries and the marginalized within these countries suffer from a multiplicity of
deprivations that translate into high levels of ill health. The marginalized people are caught in a
vicious circle as poverty breeds ill-health and ill-health maintains poverty. Among the
marginalized itself, there are those who are doubly burdened such as, the economically
depressed indigenous people, refugees and women. Although there has been significant
improvement in the health status of the people of the world overall, these groups have remained
further marginalized.
The failure of health services to reach the poor and the marginalized in developing countries,
despite their disease burden is not just a matter of the better off using their higher income to
purchase care from private sector. The marginalized receive less of government subsidies to the
health sector, this bias in favour of the rich is especially pronounced in the hospital sector, which
benefits from the largest part of the government spending.
Emerging context and its implications on health promotion
The earlier ups and downs
The interest of the international community in health inequality has varied greatly in recent years.
The ‘Health for AH' movement, which was greatly accelerated by the 1978 International
conference on Primary Health Care, held at Alma Ata was later displaced by greater concern for
health system efficiency and sustainability. As the pendulum began to swings towards what
became known as "health sector reform" the attention shifted from the disease burden of the poor
to that of the worlds as a whole More recently the interest in equality, equity and the health of the
poor has begun to rise again.
The incipient renewal of concern
As the third millennium began, there was an incipient renewal of concern for poverty and equity in
health. Further impetus was provided in statements by WHO's Director-General, Dr. Brundtland in
'World Health Report' stating,"... there is a need to reduce greatly the burden of excess mortality
and morbidity suffered by the poor".
As health is now higher on the international agenda than ever before, and concern for the health
for the poor people is becoming a central issue in development, three of the Millennium
Development Goals (MDGs) call for health improvements by 2015: reducing child deaths,
maternal mortality and the spread of HIV/AIDS, Malaria and Tuberculosis. The first MDG to
reduce by half the proportion of the population in extreme poverty by 2015 cannot conceivably be
accomplished if the health goals are not achieved. The nations of the world have agreed that
enjoying the highest attainable standard of health is one of the fundamental rights of every human
being, without distinction of race, religion, political belief, and economic or social condition which
is also central to overall human development and to the reduction of poverty.
Need for a Paradigm Shift
Health Promotion and Development efforts need a paradigm shift to substantially address the
challenges of Health & Development of the marginalized. Let us examine them
Poverty and Social Justice
The heatlh of all communities specially marginalized is inextricably linked with issues of food,
shelter, education and social dignity. While various efforts have been made to tackle these
issues, their overall impact has been insignificant. In the coming years, therefore, the
governments will have to devise more imaginative and people-centred efforts to deal with these
vexing issues. Land reform and minimum wages, in particular, will need to be tackled on a war
footing. Economic and social development of the underprivileged must go hand in hand.
Gender Inequity
Gender inequity is another major stumbling block. It must be addressed through state legislation
and involvement of women in formal decision making. This must be supported by people
awareness, education and income generation if the transition is to be meaningful.
Since health is integral to the overall development of women, a multi-sectoral approach will be
needed through development of partnerships with other related sectors. Any group, programme
or body aiming to enhance the status of women is a potential partner for health.
Population Stabilization
Factors contributing to population growth include new sources of income, the desire for security in
the absence of banking and pension schemes, innovative technologies, improved crops,
education and health care. Factors which contribute to a decline in growth rate are high child
mortality, the preference for sons, greater awareness of family planning, delayed marriages and
the consequent reduction in the number of child bearing years. There are important lessons to be
learned from the overall success of Sri Lanka and some pockets of Bangladesh and India with
respect to population stabilization.
Compared to the scale of government efforts to tackle this problem in the region, the overall
results have been disappointing. Most countries are seized of the need for a fresh approach, and
are making the necessary shifts.
Health and Environment
A very high percentage of morbidity of the marginalized population can be traced to the absence
of safe drinking water and improper sanitation. Water and sanitation schemes can no longer be
viewed simply as engineering projects: the human element has to be recognized and due
importance given to involvement and co-operation of intended beneficiaries, particularly women.
At the same time, these interventions must be sensitive to local customs governing the position of
women in the home and community, as well as their relative seclusion.
Pesticide use and dumping of chemicals are adding a new dimension to health problems. Barring
some isolated pockets, these problems have not received adequate attention. Common
resources like waterbody, forest on which marginalized are dependant getting polluted, privatized,
often making it difficult for them to access causing considerable hardship.
Control of Communicable & Non-communicable Diseases
Most countries are passing through a prolonged phase of epidemiological transition: a phase in
which the health problems of the affluent and not-so-affluent co-exist. In other world, these
countries must bear a dual burden: of communicable diseases associated with poverty,
malnutrition & unhygienic living conditions and non-communicable ones such as ischemic heart
disease, hypertension, cancer and diabetes associated with affluence, stress, changes in
lifestyles and dietary habits.
It must be stressed that globally, non-communicable diseases are emerging as the leading cause
of death. At present, the risk of death from these during adulthood (15-60 years) is considerably
higher in the developing world than in established market economies.
Given longer life spans, the health needs of the elderly must be kept in mind as societies evolve.
The number of people in the over 65 bracket is growing faster in poor and developing countries
than in advanced ones. Although the elderly in many countries now enjoy better health, an ageing
population is often associated with a growth in non-communicable diseases and mental and
emotional health problems.
Urban Health Strategies
The major health problems identified in the poor urban areas can be summarized as follows:
diarrhoeal diseases, respiratory diseases, infectious diseases (preventable by immunization),
malnutrition, tuberculosis, malaria, gynecological disorders and infections, sexually transmitted
diseases and socio-psychological problems like drug addition, alcoholism, domestic violence and
child abuse.
A comprehensive urban health care strategy, if it is to succeed, requires fundamental changes of
attitude and approach in city health systems and government agencies. Urban health cannot
simple by ‘added on’ to existing services. Priorities should be set on the basis of the most
important causes of mortality and morbidity, prevailing epidemiological and socio-economic
conditions. However, the following interventions are almost universally required:
Provision of primary health care services like immunization, control of diarrhoeal
diseases, acute respiratory infections, malaria, tuberculosis and provision of
antenatal and postnatal care. While these are important in the short run, interventions
that focus on the underlying causes of ill health are much more significant in the long
run.
Decentralized area-bound planning and the management of primary health care and
development programmes, with the active, democratic participation of the community,
is essential. Broadening the outlook of municipal departments and capacity-building
of community workers are necessary supportive steps.
And above all comprehensive housing policy for the marginalized.
Cooperation and Partnership for Health
Health is a social goal. Hence, responsibility for it has to be shared among all concerned sectors.
This was reflected in the principle of primary health care enunciated at Alma Ata in 1978, where
WHO Member States endorsed the strategy for intersectoral action to achieve the goal of Health
for All.
Outside the boundaries of the health sector exist an array of opportunities, sectors and systems
institutions and individuals, as well as organizations engaged in the cause of human development
or crucial to it. These are out potential partners for health.
Health is also an attractive entry point for most development programme or change initiatives.
This is already evident in the numerous partnerships which have been established. Three such
examples are environmental sanitation, immunization and safe motherhood, which have attracted
willing partners - NGOs, both national and international, and bilateral development assistance
agencies. School health is another area where the ministries of health and education collaborate.
Major multisectoral opportunities are also offered by HIV/AIDS prevention and care and by
environmental issues. Strengthening of district health systems is an area which has gained the
support of UN agencies.
There is a need to develop greater awareness of the responsibility of governments towards
ensuring health security for the marginalized people, and to strengthen health systems with
allocation of adequate resources for health development, particularly for primary health care
benefiting the marginalized and underprivileged population. This needs strong political will and
commitment to HFA on the part of decision makers. Efficient and effective utilization of available
resources call for sound managerial skills and motivation. Improving the managerial performance
of the civil service, including decentralization, is one of the key areas of health sector reform,
discussed below:
Government Health Infrastructure
As discussed earlier in this paper, the performance of the health infrastructure is clearly below
par. Health sector reform, therefore, is imperative. Such reform calls for fundamental, not
cosmetic, changes in health policy and institutional arrangements. The main areas where reform
is indicated are:
Reorientation and restructuring of ministries of health, including publicity financed
and organized services.
Broadening health financing options.
Improving the performance of the civil service, including decentralization.
Expanding partnerships.
Specially focusing to the needs of the marginalized.
In other world, it is imperative that we develop a long term perspective and an altogether new
framework for public health action so as to strengthen national capabilities, infrastructure and
technologies.
Meanwhile, change will inevitably come about in the way health services are planned, financed
and managed. New approaches to health care will be tried out in different countries. Mechanisms
to disseminate and share these experiments will need to be worked out.
-I
Private Sector in Health Care
The growing disillusionment with the government's delivery system has fuelled the phenomenal
growth of the private sector in health care. The private sector is unusual in its variety and scope,
allowing room for various systems of system to co-exist. The emergence of the cadre of
registered medical practitioners (RMPs) is an interesting feature and points to the ability of the
private sector to respond to felt needs and purchasing power of different segments of society.
Unfortunately, many private doctors resort to unethical and irresponsible practices, not least
among them irrational prescription of drugs.
Recent studies show that the private sector is a significant provider of primary health care as well,
providing services like immunization across regions and income groups, though their overall
quality is debatable. However, given that the sector will continue to be a major player in the health
scene, a conscious effort and strategy must be evolved to involve it in overall health care. At the
same time, regulatory policies may be needed to improve the quality of private health care
services without affecting their accessibility and affordability. A rational drug policy will go a long
way in diluting the nexus between the drug industry and medical practitioners making curative
resources cheaper.
The time has come to evolve subsidized health insurance scheme for the marginalized. Many
studies show this is one of the major cause of indebtedness of the poor.
Voluntary Agencies and Health Care
Voluntary agencies have played a significant role in developing alternative models, as well as
providing low-cost and effective health services. They have succeeded in developing village
based health cadres, appropriate educational materials and technologies. These voluntary
agencies also play a critical role in filling gaps in the government health services, specially in the
area where the marginalized live.
Given their track record, it would be wise to upscale the activities of voluntary agencies.
Unfortunately, their work is often hampered for want of a supportive climate and finances.
Enabling policies and appropriate government inputs will go a long way in helping NGOs reach
out to the innumerable pockets where the health situation continues to be grim.
Likewise, voluntary agencies can play an extremely important role in pioneering research work on
issues of public ccncern, helping communities evolve self-sustaining health care mechanisms, as
well as lobbying for policy change.
If they are to realize their true potential, voluntary agencies must widen their scope and concerns
by:
Proactively addressing the health need of the marginalized
Joining hands with other progressive forces in the broader struggle for social justice
Tackling issues of socio-economic justice in their areas of operation
Working towards a viable alternative health strategy
Generating public awareness on rational and holistic health so as to create a
conducive atmosphere for a shift in policy
Pressing for greater public accountability of the government health machinery
Building up a consumer movement to ensure affordable, quality health care from the
private sector
> In their new role, voluntary agencies will often find themselves at loggerheads with the state.
medical establishment and drug industry. But then genuine change without conflict is impossible.
Traditional Systems of Medicine
In many countries, traditional systems co-exist alongside modern, mainstream medicine.
However, gigantic and multi-tiered efforts are still required to bring these systems to the forefront
through research, documentation and policy support. They can be cheaper but viable alternative
for the marginalized.
Community Participation and Empowerment
Genuine development is not possible where communities passively receive health care judged
appropriate by others, and have no say in assessing their health needs, planning for, providing
and evaluating services. For, in their hands are the critical determinants of health: in
understanding the nature of problems and in finding solutions to them. In bypassing communities,
not only do we undermine their dignity, but we also lose the essential resource for health and
development - the people themselves
Community participation takes many forms, be it village development committees, mothers' clubs,
village drug co-operatives, community health based insurance and health care schemes or village
funds for nutrition. Community-based approaches are also being attempted while addressing the
emerging problems of the elderly and home care for persons with chronic or degenerative
diseases.
The mandating of rural development committees in India, with men and women elected by the
rural community (Panchayati Raj) through a constitutional amendment, is expected to lead to
enhanced community participation in development, including health.
Health Education
Health Education has traditionally been a one-way process, working on the assumption that local
communities need to learn from “health educators”. In developing countries, their messages often
have little to do with local practices which have evolved through centuries of trial and error.
Imposed education of this nature usually ends in frustration: it also leads to a gradual erosion of
some sound local health practices.
Health education must start with an understanding of local health traditions, habitat and dietary
habits. This will ensure that messages conveyed are easily understood and accepted, and also
that goals and milestones are set realistically. True health education, therefore, is a two way
process: of learning from communities as well as imparting new information to them.
Current mainstream health education relies largely on the written tradition, even though the vast
majority of the marginalized in developing countries are illiterate. In a region where the oral
tradition has predominated, health educators need to understand how information is traditionally
acquired, processed and recorded. Overemphasis on written information and records such as
growth charts, family health cards and so on in unlikely to yield the desired results. After all,
farmers plan their crop, estimate seed and fertilizer requirements and balance the family budget
without a single noting.
Furthermore, these communities have vibrant, entertaining and ever-evolving methods of
communication that are visible at local fairs and festivals: puppeteers, folk musicians, street
theatre groups, to name a few. These forms are far more interactive, and easier for communities
to relate to. These forms must be integrated into the health education strategy.
This is not to deny the importance of the print media, or the immense outreach of radio and
television. Health messages have been successfully propagated through the medium of feature
films and songs, particularly in India. Radio and television are particularly effective in creating a
favourable climate for launching community-based educational efforts.
6
All to often, health education initiatives prove non-starters, because they are out of sync with the
true needs of the community. Take for instance an Eye-Care campaign in an area where people
are suffering from Malaria. Health education campaigns must be rooted in the needs of the
community.
Similarly, concepts of time, dates and venues vary across societies. In agrarian communities, life
is dictated by the agricultural cycle - sowing and harvesting, seasonal changes and festivals.
Modern notions of time, like fixing meetings at nine O'clock every Sunday morning, are
incongruous. Decisions regarding time are best left to the community. Given the highly stratified
nature of societies and caste and other dynamics, venues must be selected with care. Similarly,
meetings must be moderated to ensure participation of women and the oppressed.
In short, the entire approach to health education must be thoroughly overhauled if it is to reach
out to those for whom it is intended.
Impact of Economic Liberalization
Economic liberalization and privatization are sweeping across the world. Most countries view
privatization as an instrument to improve living standards, and thereby promote human welfare.
But development is not a guaranteed outcome of economic liberalization. Unintended fallout such
as environmental degradation and widening disparities need careful monitoring. Economic
liberalization may be necessary, but in the process, governments must not shirk their
responsibility of providing safety nets to the vulnerable and protecting their interest.
7
Effective Health Promotion Interventions to assist the Marginalized - Some Selected Case
Studies
A'c’H' Zealand
Maori are the indigenous people of New Zealand and comprise 14% of the total population.
Al the time of contact with the British, there was already a well-developed concept of public
health in New Zealand. But the colonization process progressively undermined these
foundations largely due to the impact of infectious diseases, land alienation and political
oppression.
In 1937, Nurse Robina Cameron founded the Women’s Health League in Rotorua, a central
North Island town, this was in response to the concerns about the health of Maori women and
children. In terms of health status, Maori women are over-represented in major disease
categories like cervical cancer, lung cancer and mental illness. In response to the concerns for
the well being of marginalized Maori mothers and their babies, the women’s health league
established the Tipu Ora Charitable Trust in 1990. This initiative was undertaken with the
help of Department of Health for an initial period of one year but seeing the positive health
outcomes in routine evaluations, funding was secured from the government to carry on the
Tipu Ora programme.
The philosophy of 'Tipu Ora' is for "Maori to be healthy as Maori” and is extremely Maori
centered. Principles such as interconnectedness, self-determination, Maori identity, quality,
whanau (extended family) relationships, caring, community credibility and empowerment
have been guiding the Tipu Ora programme. It uses cultural affirmations as a mechanism to
improve health and thereby seeks to strengthen the Maori identity. Individuals are not viewed
in isolation from their whanau, but their participation in the programme is encouraged.
Currently there are 1980 Kaitiaki (caregivers) registered with Tipu Ora, almost all of who are
Maori Women. Activities such as family support and advocacy; individual and group health
education; informal well-child checks; building relationships with health professionals and
other support givers; referrals and follow-up care form a part of the Tipu Ora programme.
Routine monitoring of the programme provides evidence that it has led to significant health
gains and has improved Maori health outcomes. Evaluation has shown that high mortality rate
in children due to SIDS earlier, has reduced much more than expected as there were only
three deaths due to SIDS. Positive lifestyle changes have been incorporated by the extended
families as well.
8
Ketherlaiuls
'The Work & Caring Project1, was developed in collaboration between the Social Assistance
Department of Amsterdam and the Netherlands Institute of Care and Welfare (N1ZW). As a
model and experimental project, it lasted from 1996 to 2002, and was promoted as one of the
best practice by the Dutch Ministry of Public Health, Social Welfare and Sports on National
Television.
This model was evolved and implemented because of various studies done by Dutch Social and
Cultural Planning Bureau (SCP) and Dutch Central Bureau of Statistics (CBS) which showed
clear-cut links between social and economic status (SES) and health hazards of a predominantly
physical nature which were being replaced by welfare diseases and mental health. Research
conducted revealed that poorest 20% o f the population rate their own health as “not good”, more
than twice as often as the richest 20% of the population. These marginalized 20 % consist of
persons living on an allowance, a state pension, or a marginal income from work or profit.
Three-quarters of all families living on public assistance are below' the Dutch Poverty line.
Between 1993-95, every one on the disability-from-work allowance was re-examined medically
and a substantial number of persons lost their disability allowance. Medically their problems
could not be assessed seriously and this implied that a high percentage of this group was having
'vague complaints1. In 1999, 60% of the long -term unemployed on public assistance were
facing health problems such as backache/hernia, migraine, depression, addiction and
psychosocial problems.
Low-income senior citizens scored high on loneliness and feeling redundant and depressed. The
work & caring created mutual beneficial relationship between this group, which required simple
care services rendered by peers or health providers and in return offered friendship and life
experiences and by the end of the project 120 of them were receiving supplementary care
regularly.
Many unemployed women had complex problems such as 14 of them were single, % were black
or immigrants and % were traumatized by war or violence. With work & caring, many women
wanted to render services such as work experience within a training course empowering them to
get their life organized and preparing them for future jobs or further education, 54% out of them
gained jobs, 14% continued education or voluntary work
The work & caring project carries out an intense six month training with focuses on enhancing
skills such as self-esteem and self-confidence, communicative skills, coping styles etc. health
education, health improvements and self care were woven into the programme as well.
At present the Work & Caring Project is being implemented at Tilbury, in Netherlands since
2001.
India
Voluntary health Association of India (VHAI) is the worlds largest association of voluntary
organizations formed by the federation of state level voluntary health associations linking over
4000 health and development organizations in India.
An experiment was launched by VHAI known as ‘KHOJ’, a Hindi word meaning ‘search’ at a
lime when the overall situation of the country was at it lowest ebb. Socio-political and
economic degeneration had reached a level where hunger and malnutrition were universal, half
the children died before the age of 5, primary health care was non-existent and nine-tenths of
the population was illiterate.
The philosophy behind KHOJ is to search for innovative methods and strategies to combat
community health related problems in remote areas. The approach being that community health
is a crucial component in the development of a broad base of human capital that can reinforce
economic growth. VHAI, aspired to highlight the “areas of light” by incorporating the salient
features of path breaking community health programmes in an integrated community health
and development package, thus it aspired to make a concerted and conscious effort to do away
with the "areas of darkness”.
The KHOJ projects were initiated in the state of Rajasthan and also subsequently in various
parts of rural and underdeveloped India. Currently KHOJ projects are being implemented in as
much as 30 pockets in India. VHAI understood that women could play the most vital role in
keeping the families as well as the societies going. Thus a dialogue was initiated with the
community who identified potential women for this crucial role. Subsequently training was
imparted to them as most of them were illiterate or semi literate. They were then properly
equipped to deal with the day to day health situation of their fellow villagers. The process was
further strengthened with the monthly meetings of the community health workers and their
supervisors.
These women are playing the most important role of health educators and the impact of KHOJ
is more than visible. Gradual and sure decline of maternal and infant mortality, lesser number
of complex cases of morbidity and almost negation of malaria and vector borne diseases are a
sure sign of the contributions of these community health workers.
There has been significant improvement in the general socio-economic development of the
beneficiaries of KHOJ. With the formation of women, youth as well as farmers groups.
decision-making power has remained with the people and with the help of capacity building
programmes, income generation has increased.
io
r~------------ --------------------Philippines
1 he health of Filipinos has slightly improved in the past decade, however, the progress slowed
down during recent years. Infant mortality and maternal mortality are still higher than in
comparable countries. Infectious diseases continue to prevail, while lifestyle related chronic
and degenerative diseases are becoming more prevalent. The spending of Fihpinos is still
heavy on family out-of-pocket and greatly affects the marginalized sector.
The three major factors that gravely affect the health sector are the inappropriateness of the
health delivery system, the inadequate regulatory mechanisms the poor health care financing.
in 1999. the Department of Health initiated a bold move by launching the Health Sector
Reforms (HSRA) which covers the area of health financing. This concept revolves around
universal coverage and is aimed at the fact that there will be increased access to health services
especially for the poor, which would reduce financial burden on the individual families.
Under the National Health Insurance Act of 1995 the National Health Insurance Program or
NH1P was enacted. The ‘Philippines Health Insurance Cooperation’ was established with a
vision that ensures sustainable, affordable, and progressive social health insurance, which
endeavors to deliver accessible quality health care for all Filipinos. One important component
of NH1P being the Outpatient Diagnostic Package, which is also referred to as “The Primary
Care Package” where, LGUs who enrolled their indigents would be receiving a capitation of
P300 (US $6) as advance payment for medical care per family per year.
Health financing, by simultaneously involving the formal as well as the non formal sectors of
society has shown that equity in health care can be realized and most importantly has given the
local government executives the “battle-cry” and the impetus to seek improvements in health
service delivery. Philhealth is now the biggest social security agency in the country in terms of
membership base covering the big sector of the poor and the marginalized.
The health-seeking behavior of the poor has improved. Health promotion is a major
intervention in reaching the marginalized sector. Philhealth has successfully aimed at
mobilizing partners to become health promoters and payers for premium for the marginalized.
Universal access to essential health care is assured by mobilizing resources for health,
improving efficiency in the production and allocation of health goods and services, and
providing safety nets and addressing inequities specifically among the vulnerable and
marginalized groups.
II
Conclusion
Judging by the innumerable innovative and successful experiments, solutions to the many and
varied health and development problems of the marginalized do exist.
Many of these solutions lie in wider areas of socio-political action. This is something that health
professionals and activists must take cognizance of. At the same time, we must grapple with a
host of emerging health problems which are linked to new modes of human behaviour, social
transition and materialism. Solutions to these may be harder to find.
It is a matter of grave concern that the vast government health machineries are operating well
below par, and appears ill-equipped to cope with current problems, let alone future challenges.
Restructuring and revitalizing this gigantic apparatus is urgently needed.
The involvement of larger civil society, including traditional healers, NGOs and the private sector
can make a significant difference to all aspects of health promotion - effort in this direction has so
far been lacking
Health Education too, needs a facelift, and must be rooted in the needs of the community.
Forums and modes of communication have to be culturally relevant and suitable if they are to be
effective. Similarly, without community participation, health promotion and development efforts
are bound to flounder.
There is a dire need for partnerships between nations for health promotion. These must be built
with great care and skill, with common interests and goals clearly defined in a spirit of mutual
trust. These partnerships must break out of the narrow mould of mere financial or sponsorship
arrangements. They could be product based (bed-nets for malaria), service-based (guidance in
disease prevention), system-and-settings-based (healthy cities, safe work places, schools), or
issue-based (polio eradication).
We must carefully study the traditional health cultures and guard against the pitfalls of Western
medicine and health care models while evolving a health strategy. Health care in recent years
has become a commodity that can be bought and sold. It is no longer an organic part of
community life as it once was. The germ theory needs to be substituted by one where the
individual is regarded as central, and helped to regenerate a sense of well-being. Interestingly,
most traditional systems approach health from this holistic angle. We obviously need a new
paradigm of health care: one that is far removed from the current bio-medical model, and closer
to a socio-political and spiritual one.
The health of any nation is the sum total of the health of its citizens, communities and their
settlements. A healthy nation, therefore, presupposes the participation of all its citizens in
achieving the goal of HFA. Unfortunately, over the last five decades, most parts of the world have
followed a pattern of governance in which the State is alienated from the people and their needs.
Sadly, development efforts have failed to build on traditional institutions and forms of governance
that have evolved over centuries, and are culturally relevant, participatory and self-sustaining. We
must tap into our native wisdom before it is too late.
12
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13
Com y\ • 5 x_/Cy. Xi
Regulation of products harmful to health in an era of
globalization
Nyo Nyo Kyaing and Sally Casswell
6th Global Conference on Health Promotion
Bangkok, 7-11 August 2005
Abstract
This session examines the way globalization has impacted on threats to public health
by facilitating the use of tobacco and alcohol products. It also examines the way
globalization enables a public health response to these threats; the use of global
strategies is illustrated with lessons learned from the WHO Framework Convention on
Tobacco Control and its application in the context of Myanmar. These lessons will
inform the development of a Global Alcohol Strategy in the coming years.
Globalisation and health
Impacts on health
In the era of globalization, marketing and promotion of harmful products such as
tobacco and alcohol have been identified as major transnational determinants of illhealth. The enormous resource of the powerful multinational corporations which are
producing and distributing alcohol and tobacco facilitates the use of innovative and
sophisticated marketing, sometimes globally themed, sometimes with national
emphasis. As Jemigan (Jemigan, 2001) states in relation to alcohol: "What is
emerging worldwide is the dominance of a small number of companies, several of
which are based in Europe, whose marketed images, created to appeal to young
people in the developed countries, increasingly define alcohol and the culture of
alcohol use for the world." In a globalised, media-saturated world the
commodification of youth culture provides a fertile environment in which the
marketing can grow demand for these products, particularly among the young (Hong,
2000. Klein, 2000).
Globalization via trade and economic agreements also have had and have potential to
have further impacts on alcohol and tobacco as determinants of ill-health.
Globalization restricts the capacity of countries to regulate these products through
domestic legislation alone. While aiming to achieve free trade across borders the
rules in trade agreements limit governments’ regulatory authority over trade and
enhance the authority of international financial organizations and trade organizations
(Kickbusch cited in Shaffer et al., 2005). The mechanisms which have affected this
include GATT (general agreement of Trade and Tariffs), regional free trade
agreements and the WTO negotiations on the GATS (General Agreement on Trade
and Services). These have meant that national governments have had less ability to
control in key policy areas. Internationa! trade treaties have already forced changes in
many government measures affecting availability and control (Grieshaber-Otto et al.,
2000).
The World Health Organisation’s Comparative Risk Assessment has determined the
contribution made to the global burden of disease of a range of risk factors including
alcohol and tobacco. Globally tobacco contributed 4.1% of disability adjusted life
years lost in 2000 and alcohol contributed 4% making them respectively fourth and
fifth leading cause of the loss of healthy life years (Ezzati et al.. 2002). In both
developing and developed regions alcohol and tobacco were major causes of disease
2
burden. However the relative contribution of these products varied in different regions
of the world depending on their levels of use and the importance of other risks to
health. In developed regions tobacco (12.2%) and alcohol (9.2%) were consistently
among the leading causes of loss of healthy life. In high mortality, developing
countries tobacco contributed 2% and alcohol 1.6%> to loss of healthy life. The role of
both alcohol and tobacco is particularly striking in developing countries with low
mortality, such as parts of America and Asia Pacific: Alcohol contributed 6.2% to loss
of healthy life in these countries, making it the leading cause, and tobacco contributed
4.0% (Ezzati et al., 2002). It is these countries, some with expanding economies and
many with yet unsaturated tobacco and alcohol markets, where many of the impacts
of globalisation on the production and marketing of these products are yet to be fully
experienced.
A global public health response
In response to the globalization of the tobacco epidemic, the 191 Member States of
World Health Organization unanimously adopted the WHO Framework Convention
on Tobacco Control at the 56'1' World Health Assembly in May 2003. as a global
complement to national actions. THE WHOFCTC is a major global development for
addressing the globalization of the tobacco epidemic and an example of emerging
global health governance (Dodgson et al., 2002).
In response to similar concerns with regard to the globalisation of alcohol the member
states unanimously passed the resolution "Public health problems caused by harmful
use of alcohol" at the 58"' World Health Assembly in May 2005. The WHO
Secretariat has been asked to report back to the World Health Assembly in May 2007
and work on regional strategies is already underway. This signals the beginning of the
development of an urgently needed Global Strategy on Alcohol.
This paper describes the involvement of a low income country, Myanmar, in the
development of the WHOFCTC and the implications of this at the national level. It
then describes some of the health impacts of alcohol and draws on lessons from the
Myanmar case study to delineate the key elements of a global public health strategy
aiming to reduce harm at the national level and the impact of globalisation on these
key determinants of health
Globalization and tobacco in Myanmar - a case study
Tobacco use has long been culturally and socially accepted in most countries of the
WHO South-East Asia Region. The Region is also unique in having a diversity of
tobacco products being used. Home to one-quarter of the world's population and
undergoing significant demographic and socio-economic changes, the Region has
become a lucrative market for the tobacco industry. The multinational tobacco
companies had intensified their marketing practices in the Region during the last two
or three decades through a variety of complex factors with cross-border effects such
as advertising, promotion and sponsorship, trade liberalization and foreign direct
investment.
3
Myanmar, like other Member Countries of the Region is a fertile ground for the
tobacco habit and a probable scene of tobacco-related morbidity and mortality
explosions by the tum of the century. With the opening of the market economy.
multinational tobacco companies and a few Indonesian tobacco companies came to
invest in the country in the 1990s. New cigarette brands were introduced through vast
investments on advertisement; hundreds of cigarette advertising billboards were
erected in major cities and gradually expanded to rural areas. The cigarettes were sold
at relatively cheaper prices than imported cigarettes and the “foreign" brands with
colorful pictures attracted many customers. With the lack of tobacco control
legislation, youth had easy access to tobacco products which were sold in loose forms
without age limitation. Cigarette consumption increased rapidly among all ages.
especially among adolescent males and young adults. The Ministry of Health became
seriously concerned about the increasing trends in tobacco use and increased its health
education activities on dangers of tobacco.
Myanmar and the global movement for tobacco control
In July 1998. WHO reorganized its tobacco control efforts within a new structure, the
Tobacco Free Initiative (TH) and this movement greatly enhanced the momentum of
the anti-tobacco activities in Myanmar. The National Health Committee which is the
highest inter-ministerial advisory group of all concerned ministries at the national
level issued guidelines for prevention and control of smoking related diseases at its
26th meeting held in September 1998.
The National Programme on Tobacco Control was officially launched in January 2000
with the drafting and approval of the National Policy on Tobacco Control and Plan of
action. The National Tobacco Control Committee was formed in March 2002, headed
by the Minister for Health and included heads of related departments and chairpersons
of several national NGOs as members. The Committee set guidelines for the tobacco
control measures to be implemented in the country.
The Ministry of Information prohibited advertisement of tobacco on television and
radio and from all electronic media in the year 2000. Tobacco advertising billboards
were banned from the vicinity of schools, hospitals, health facilities, sports stadiums
and maternity homes in May 2002 and from other places in April 2003. Tobacco
advertisement were also been banned from the newspapers, journals and magazines in
early 2003. Smoking was prohibited at all hospitals and health departments, at all
basic education schools, all sports stadiums and sports fields and at some workplaces.
In May 1999. the World Health Assembly-the governing body of the World Health
Organization, adopted a resolution (WHA 52.18) (World Health Assembly, 1999)
which paved the way for starting multi-lateral negotiations on the WHO FCTC and
possible related protocols. Myanmar along with fellow Member States actively
participated in the negotiating process of the WHOFCTC and strongly supported the
convention.
Myanmar delegates expressed their strong commitment towards
comprehensive tobacco control measures and voiced the need for a comprehensive
ban on all forms of tobacco advertisement including cross-border advertising.
Myanmar proudly hosted the 4lh Inter-country Consultation Meeting on Framework
Convention on Tobacco Control in August 2002. where the countries of South-East
Asia Region issued the “Yangon Declaration" (The Yangon Declaration. 2002).
4
Myanmar delegates who participated at these negotiations, reported back to the
national authorities with strong recommendations to sign and ratify the convention.
The theme and provisions of WHOFCTC were put up by the Minister for Health to
the 34,h meeting of the National Health Committee in April. 2002; the meeting
principally agreed the provisions of WHOFCTC and gave the green light for
becoming Party to the Convention. Myanmar became a proud signatory to the FCTC
on the 23rd of October 2003 and became a Party to the Convention on the 20lh of
April, 2004; it was the 1 l'h country to become Party to the Convention.
National legislation on tobacco control
Drafting of Tobacco Control Law started in 2002, when Myanmar was actively
participating in the negotiating processes of WHOFCTC. The ratification of
WHOFCTC increased the momentum of the drafting process and also widened the
scope of contents of the legislation as the drafting committee tried to cover the
provisions of FCTC as much as possible. An example was prohibition of sale of
individual or small packets of cigarettes; this was previously not included in the
legislation as it was considered impractical in Myanmar but was later included in the
law as one of the FCTC provisions. The legislation has been approved and is in the
process of being enacted by the Government of the Union of Myanmar.
Opportunities and challenges
Dedicated personnel at the Ministry of Health and multisectoral collaboration
mechanisms among sectors contributed to the achievements in the tobacco control
activities of Myanmar. The negotiating processes of WHOFCTC had been
successfully used as an advocating tool for tobacco control; becoming a Party to the
FCTC further strengthened the dedication and commitment of anti-tobacco advocates.
Reluctance of the decision makers to increase tax and price on tobacco products for
fear of increasing the burden on the poor was a major challenge in the drafting process
of the legislation. The legislative draft has failed to include any measures on price and
tax. More research studies need to be conducted to provide the policy makers with
evidence-based information.
The whole process of implementing the tobacco control programme, involvement of
multi-sectoral bodies in the national committee, active participation in the FCTC
negotiations, signing and ratifying the FCTC. drafting the legislation and having it
approved had achieved significant impact on public health measures regarding
tobacco in Myanmar.
5
Framework convention on tobacco
The initiation and adoption of WHOFCTC had an enormous impact on the world
wide anti-tobacco movements. Getting involved in the negotiating process itself
moved the tobacco control measures of countries forward; in countries like Myanmar.
delegates who had participated in the Intergovernmental Negotiating Bodies reported
back to the policy makers with strong recommendations to enhance the momentum of
anti-tobacco activities and public awareness campaigns. The whole process of
adopting, signing and ratifying the WHO FCTC was a challenging and exciting
experience and having the national tobacco control legislation approved was a huge
success in the history of public health in Myanmar. In many countries the WHOFCTC
has been used as a strong advocating tool to fight against the powerful lobbying of
tobacco industries.
Global strategy on alcohol
Lessons can be learned from the Myanmar case study which illustrate the value in the
development of a global strategy on alcohol.
The resolution on alcohol harm passed in 2005 was the first WHO resolution solely
addressing alcohol since 1982. Unlike both narcotics and tobacco the United Nations
system has not identified alcohol as in need of a global response. However, recent
data has illustrated clearly the importance of alcohol as a risk factor for ill health.
Alcohol is causally related to more than 60 medical conditions (Room et al., 2005).
The WHO study on the global burden of disease has illustrated the importance of
alcohol in developed and developing regions of the world with the contribution made
to loss of healthy life in developing countries with low mortality, where it was the
leading cause, of particular concern (Ezzati et al.. 2002).
The size of the burden caused by alcohol is likely to be even greater than indicated in
these WHO analyses since they take into account primarily health problems related to
drinking. The limited evidence available, however, suggests that social problems
related to drinking impose as much of a burden (Room et al., 2003). Furthermore, not
only the drinker experiences the health and social consequences of alcohol but so do
others; the externalities from alcohol use may well exceed those of tobacco.
The impacts of alcohol are also importantly related to development opportunities and
poverty. While consumption of commercially produced alcohol may remain the
prerogative of the elite in low and medium income countries the transfer of money
from the local community to global corporation via a product which does not
generally aid development efforts make it a relevant issue for health inequalities.
Expansion of alcohol harm
Developing countries, especially those with expanding economies, have been
identified as areas for market expansion. Thailand provides a good example of such a
country. Thailand has seen a rise in GDP accompanied by a substantial rise in per
capita consumption of commercially produced alcohol over the last four decades.
6
Commercial alcohol consumption doubled in the eight years from 1992 to 2000
(Thamarangsi. 2005).
Harm from alcohol has also become a topic of concern and measurement in Thailand.
Calculations of the costs associated with alcohol related traffic crashes have been
estimated at between 2 - 3.5% of GDP (Thamarangsi, 2005). Families with a drinking
member have been found to have 3.84 times higher rate of household violence
(Thamarangsi, 2005).
While there have been expansions in consumption and harm the implementation of
effective public health policies has not kept pace (Thamarangsi, 2005). Taxation
policies are in place but do not have an explicit health goal; there is little effective
restriction on the availability of alcohol and the minimum purchase age of 18 is not
enforced. There is legislation to regulate conduct in licensed premises in Thailand, for
example, against selling to intoxication, being drunk in public place and being
underage in tavem but this is not enforced. With regard to drinking and driving there
is a per se law at 0.05% but once again there is little enforcement of this. Finally
controls over alcohol promotion are limited and have been subjected to sabotage by
the industry.
This lack of enforcement and. in many cases, lack of legislation and regulation for the
most effective policies, is common in high income countries (Babor et al.. 2003) and
also in countries with low and medium incomes.
Need for the development of an international framework for alcohol control
The situation with regard to alcohol is such that a similar process to that engaged in
for the development of the WHOFCTC would be likely to assist the development and
implementation of more effective policies at the national level and also to assist
urgently required regional and international co-operation. Both the process and the
elements of the WHOFCTC are relevant to the needs of a Global Alcohol Strategy.
The involvement of member states in regional and global strategy development, as
illustrated by Myanmar’s involvement in the WHOFTC, will have a positive impact
on national development.
Elements of a public health framework/global strategy
Surveillance, research and policy analysis
The Myanmar case study illustrated the impact that monitoring of trends in tobacco
consumption and noting increases in young and in males had in motivating action by
the Ministry of Health.
There is a similar need for surveillance and analysis of alcohol. WHO is currently
undertaking the collation of data at a global level on consumption (World Health
Organization. 2005) and the policies jurisdiction have in place (World Health
Organization. 2004). With regard to data on consumption, countries have often relied
on statistics collected for taxation purposes to make estimates of per capita
consumption. In countries with developing alcohol markets it is necessary to estimate
7
among what proportion of the population the alcohol is shared. Taxed alcohol also
excludes illicit supply of commercial alcohol and informal, often traditional.
beverages. The need to obtain accurate estimates is likely to increase reliance on
population surveys to measure and monitor trends in use and makes the issue ot
appropriate measurement methods very important. Population surveys also allow tor
monitoring of specific demographic groups, which is important in the context of
increased youth drinking, and for the monitoring of patterns of drinking such as
episodic, heavier consumption, which are important for harm and policy development.
To a greater extent than is now the case for tobacco, there is a need to measure harms
causally related to alcohol use. Alcohol interacts with the cultural setting in ways
which influence much of the harm associated with its use. Measurement of alcohol
harm needs to cover the full range of social consequences. Current estimates of
economic costs lack adequate data in many areas. In countries in which the
globalization process is accelerating socioeconomic transition alcohol plays a
important, but largely undocumented, role in changing traditional family and
community structures and can also have impacts on spiritual values.
The Myanmar case study also described the importance to the policy development
process of the analysis of market developments - it was noted that new brands were
introduced at cheaper prices, and were being heavily marketed. Analysis of alcohol
issues requires economic literacy given the globalized and privatized context.
Finally, there is a need to evaluate in low and medium income countries the
implementation of policies. This includes policies which have been shown to be
effective in high income countries and new approaches relevant to the country setting.
In a country like Myanmar, with high levels of poverty, the adoption of taxation
policies m relation to both alcohol and tobacco in order to achieve a public health goal
requires clear evidence of effectiveness.
Advocacy
The Myanmar case study illustrated the way in which the drafting of the national
tobacco control legislation took place in parallel with the participation by Ministry of
Health personnel in the development of the WHOFCTC and showed that there was
synergy between these two parallel developments.
While alcohol has come to greater prominence in a number of jurisdictions and
regional and international organizations in recent years (GAPA. Eurocare, European
Commission. Secretariat of the Pacific Community, 2004), it is apparent that progress
on a Global Alcohol Strategy will enhance developments at the national, regional and
international level and there will be similar synergies to those which occurred in
relation to the WHOFCTC.
The Myanmar case study illustrated the complementary role of the NGO sector.
Globally 200 NGOs were engaged in the successful achievement of the WHOFCTC.
They came together in a Framework Convention Alliance which included a range of
NGOs working at the national, regional and international levels. The work of the
NGO network was crucial. The NGO network in alcohol is less well developed
globally than is currently the case for tobacco but there are some clear indications that
8
this is growing (GAPA). The technological developments which have allowed
globalization of the markets for alcohol and tobacco also facilitate the global
development of public health networks.
Much of the societal level response to alcohol occurs at the community level in the
informal sector (eg. women's organizations, religious organizations) and the
involvement of these organizations in advocacy on alcohol issues is important.
An important difference in alcohol advocacy compared with tobacco is the salience of
the role of the alcohol industry and its associated organizations. Some sectors of the
global alcohol industry are actively engaged in lobbying at national, regional and
international levels (eg. distilled spirits re economic agreements). They also fund a
large number of ‘social aspects organizations’ which advocate for industry-friendly
policies (McCreanor. 2000. Anderson. 2002). One important issue which will be
increasingly clarified during the development of a Global Strategy on Alcohol is the
appropriate role of industry sectors in policy development and implementation. While
local retailers may have an important role in responsible supply of alcohol the
interests of alcohol producers conflict with those of public health and their
involvement in a policy development process will tend to frustrate public health
objectives in favour of more industry friendly approaches (Babor 2000 cited in
Anderson, 2002).
Resourcing
In Myanmar resources were provided for the tobacco control work. First there was the
establishment of national level committee and then the funding of a national
programme in 2000. Myanmar also hosted the WHO meeting resulting in the Yangon
Declaration, a significant step towards the WHOFCTC. Such resourcing will also be
required to support the development of a Global Alcohol Strategy.
Important here is the resource required for civil society to develop and sustain
networks able to be involved in the process of global health governance. At the
national level there is a need to ensure resources for policy implementation; in
addition to the needs of the health sector there is resource required for cost effective
policies such as the enforcement of effective drink-driving legislation, the minimum
purchase age. and hours and places of sale. Much of this requires funded community
mobilization as well as adequate funding for the relevant sectors.
Implementation of effective policies
The adoption of effective tobacco control policies at the national level was facilitated
by the WHOFCTC. Myanmar established controls on marketing tobacco and some
smoke free environments in 2000 - 2003. However, the inclusion of the prohibition of
sale of single cigarettes was included in national legislation only after Myanmar
became a signatory to the WHOFTC which requires it. Taxation remains an area
which is a crucial part of the WHOFCTC but is not included in Myanmar’s
legislation.
There are effective alcohol policies which have been shown in evaluations in higher
income countries to reduce harm (Babor et al.. 2003. Chisholm et al.. 2004). These are
9
often less popular than the more individually focused approaches and the support of a
Global Strategy, by promoting the evidence base on effective implementation, would
assist their uptake. The implementation of effective policies requires a legislative
framework, enforcement, and media and the resourcing and development of
community capacity to sustain their implementation.
Regional and international collaboration
The involvement of Myanmar’s Ministry of Health personnel in the development of
the WHOFCTC helped in their role as national level advocates. Similarly the
involvement of these advocates assisted the momentum of the WHOFCTC. The
development of a Global Alcohol Strategy will also require strong input from a range
of supportive member states.
Many of the effective policies relating to both tobacco and alcohol increasingly
require regional and international response. Effective public health policy for both
alcohol and tobacco requires restriction on availability, marketing and pricing.
Alcohol policies have generally until now been the concern of national and local
governments. In the globalised world there is a need for regional and international
support for national efforts to control the alcohol market.
Public health professionals and organizations have rarely participated in trade
negotiations or in resolution of trade disputes. The linkages among global trade.
international trade agreements, and public health deserve more attention than they
have received to date (Shaffer et al., 2005). There is an urgent need for alcohol and
tobacco to be excluded from the general trade and services agreement of the WTO
and of regional trade agreements (Room et al.. 2003).
Some form of global health governance (Dodgson et al.. 2002) will also be required if
the myriad of new technological possibilities for brand marketing, including the
internet, are to be appropriately controlled.
Conclusion
Globalisation has affected the use of alcohol and tobacco and the consequent
experience of harm. This has resulted from the growth in global corporations leading
to increased marketing and accessibility of commercially produced, branded alcohol
products. The globalization of media and youth culture has also facilitated their
spread in many countries of the world. The economic agreements which have reduced
the barriers to the distribution of these products have facilitated their penetration into
new markets. Future agreements in regard to trade and services as well as new
regional economic agreements have the capacity to allow greater access and
marketing of these products and threaten the capacity of national governments to
control access to these products. This requires a strong public health response with
much greater analysis of the public health implications of all economic agreements
The WHOFCTC illustrates a strong public health response to the threats of
globalization to the health and welfare of the world’s citizens. It requires ongoing
support, including resourcing of national and community capacity in lower income
10
countries to ensure that more countries become signatories and to ensure that the
WHOFCTC's clauses are implemented at national levels. A similar global response to
the threats to health posed by the spread of alcohol is urgently required and many of
the key issues to do with the marketing and promotion of the products are very similar
to those of tobacco.
Global health governance requires a combination of regulatory frameworks and
informal, normative developments (Dodgson et al.. 2002). There is a need for an
ongoing response to alcohol and tobacco which incorporates the strength of the
regulatory framework agreed to by national governments and the informal monitoring
and influence which is an essential part of the role of civil society in governance in
this area.
11
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sh
13
Cor-A Vk - S
Health as Foreign Policy:
Harnessing Globalization for Health
David P. Fidler
The 6th Global Conference on Health Promotion
Bangkok, Thailand, 7-11 August 2005
1
Abstract
This technical paper explores the importance for health promotion of the rise of public health as a foreign
policy issue. Although health promotion encompassed foreign policy as part of "healthy public policy,"
mainstream foreign policy neglected public health and health promotion's role in it. Globalization forces
health promotion, however, to address directly the relationship between public health and foreign policy.
The need for “health as foreign policy" is apparent from the prominence public health now has in all the
basic governance functions served by foreign policy. The UN Secretary-General’s UN reform proposals
demonstrate the importance of foreign policy to health promotion as a core component of public health
because the proposals embed public health in each element of the Secretary-General's vision for the UN
in the 21st century. The emergence of health as foreign policy presents opportunities and risks for health
promotion that can be managed by emphasizing that public health constitutes an integrated public good
that benefits all governance tasks served by foreign policy. Any effort to harness globalization for public
health will have to make health as foreign policy a centerpiece of its ambitions, and this task is now health
promotion's burden and opportunity.
2
Introduction
1 • The 6th Global Conference on Health Promotion seeks to reaffirm the values, principles, and
purposes of the health promotion movement that stretches back nearly two decades. Reaffirmation of the
tenets of health promotion as a core component of public health today unfolds, however, in an
environment radically different from the situation prevailing when the Ottawa Charter was adopted in
1986. This technical paper focuses on one transformation that affects health promotion—public health’s
rise as a foreign policy issue in international relations
2. Increasing the visibility of health promotion has previously linked health promotion and foreign
policy. These linkages tended, however, to be subsumed in advocacy for the larger goal of “healthy public
policy."1 The last decade witnessed relationships between public health and foreign policy intensify,
expand, and become more explicit. These developments reveal that a new context and a new reality for
health promotion and foreign policy have emerged.
3. Intersections between foreign policy and public health have become critical in analyzing the
management of globalization in ways sensitive to health promotion. Thinking about “health as foreign
policy” requires understanding the opportunities and challenges this task creates. In addition, health as
foreign policy necessitates initiatives that can make foreign policy a more robust channel for health
promotion.
The Health Promotion Movement and Foreign Policy
4. The transformation of the relationship between public health and foreign policy should not obscure
the long-standing intersections between health promotion and foreign policy. Past conferences framed
health promotion in global terms, stressed the need for health promotion to be advanced by all
governmental sectors, and called for healthy public policy at all levels. The health promotion vision
encompassed foreign policy as an important governance activity.
5. Foreign policy’s relevance for health promotion remained, however, implicit and mostly assumed.
None of the documents issued by previous health promotion conferences specifically mention foreign
policy. Earlier conferences conflated policy categories to emphasize that health promotion “puts health on
the agenda of policy makers in all sectors and at all levels[.]”*3
6. This message did not, however, penetrate mainstream foreign policy. Experts have noted how the
study and practice of foreign policy and international relations historically neglected public health,3
treating it as a non-political matter best left to technical specialists.4 A gap existed between foreign policy
communities, which relegated public health to the “low politics” of foreign policy, and health promotion
advocates, for whom public health was among the most important challenges facing countries in an
interdependent world.
Health Promotion and Foreign Policy: The New Context
7. The decision to focus on foreign policy at the Bangkok Conference represents recognition that the
relationship between health promotion and foreign policy has been transformed. This recognition echoes
the realization by foreign policy makers that public health has risen on their agendas in ways that
challenge the traditional neglect of this area. Developments over the past decade precipitated a collision
of the worlds of public health and foreign policy that is historically unprecedented.
Professor of Law and Harry T. Ice Faculty Fellow, Indiana University School of Law, Bloomington, USA.
Ottawa Charter for Health Promotion, 21 Nov. 1986, WHO/HPR/HEP/95.1.
Id.
3 See, e.g., I. Kickbusch, “Global Health Governance: Some Theoretical Considerations on the New
Political Space," in Health Impacts of Globalization (K. Lee, ed.) (Palgrave, 2003): 192-203, p. 192.
4 E. B. Haas, Beyond the Nation-State: Functionalism and International Organization (Stanford University
Press, 1964), pp. 14-17.
3
8. A key factor producing this collision is globalization. Earlier health promotion conferences identified
international interdependencies as one reason why healthy public policy should be a global objective.
Assertions about interdependence did not produce robust foreign policy engagement with public health,
especially among the great powers. Globalization has, however, expanded, intensified, and transformed
interdependence to the point that public health problems cascade across foreign policy agendas and
capture the attention of strong and weak countries. See Box 1.
Box 1.___________________________________________________________________________
Examples of Public Health Issues and Developments of Foreign Policy Significance
• Emerging and re-emerging communicable diseases
-» HIV/AIDS pandemic and associated infections (e.g., tuberculosis)
-> Outbreak of Severe Acute Respiratory Syndrome (SARS)
-> Outbreaks of avian influenza (H5N1)
-> Problems with the fight against malaria
• Proliferation of biological weapons by states and the threat of bioterrorism
-> Breakdown in the negotiations for a compliance protocol to the Biological and Toxin
Weapons Convention
-» Anthrax attacks in the United States in 2001
-» Development of policies to improve biosecurity
Fears of rapidly advancing science making perpetration of bioterrorism easier
• Global increase in non-communicable diseases
-> Concerns related to tobacco consumption leading to the WHO-sponsored negotiation and
adoption of the Framework Convention on Tobacco Control
-> Growing problem of obesity worldwide leading to WHO work on a global strategy on diet
and physical activity
• Linkages between international trade and public health
Controversies over the protection of patent rights for makers of pharmaceutical products
and access to essential medicines in developing countries
-> Concerns about further liberalization of trade in health-related services adversely affecting
the quality, affordability, and accessibility of health services
• Reassessment of the role public health plays in economic development (e.g., Commission on
Macroeconomics and Health)
•Public health and human rights issues
-> Reinvigoration in international interest in the right to health
-> Renewed concern about respect for civil and political rights in connection with responses
to dangerous outbreaks of communicable diseases (e.g., SARS)
• Major diplomatic initiatives on global public health problems
-> UN's Millennium Development Goals
-> Global Fund to Fight AIDS, Tuberculosis, and Malaria
-> Roll Back Malaria Campaign
-> Stop TB Partnership
-> WHO’s “3 by 5” Initiative
U.S. President’s Emergency Plan for AIDS Relief
-> Doha Declaration on the TRIPS Agreement and Public Health and related initiatives (e.g.,
Paragraph 6 Agreement and the WHO Commission on Intellectual Property, Innovation, and
Public Health)
-> Global Health Security Initiative
•» Negotiation and adoption of the WHO’s new International Health Regulations____________
9. Globalization exposed vulnerabilities of countries to public health threats that were previously non
existent, latent, or ignored. Governments faced mounting public health threats with the realization that
globalization constrained policy control over many determinants of health, limiting options to the detriment
of population and individual health. Globalization also affected the traditional dichotomy between*
5 See, e.g., Recommendations from the 2nd International Conference on Health Promotion, Adelaide,
Australia, April 1988 (“The achievement of global health rests on recognizing and accepting
interdependence both within and between countries.”).
4
domestic and foreign affairs, blurring the utility of borders to demarcate where and how policy should be
made. Interconnectedness between the local and the global produced centralization of policy making at
the national level because only at that level could states address the international and transnational
contexts of globalized health issues.
Health as Foreign Policy: The New Reality
10. Globalization’s impact on public health appears to underscore the need for healthy public policy at
all governance levels given the ways in which globalization challenges every level of policymaking within
countries. The reality of public health’s emergence in foreign policy has been, however, to make foreign
policy more important to public health. Globalization has not altered the political structure of international
relations—humanity remains organized into nearly 200 territorial states that interact in a condition of
anarchy, defined as the absence of any common, superior authority. The dynamics, and many of the
foundational norms, of this anarchical structure privilege sovereignty as a governance principle.
Intercourse between sovereign states is the essence of foreign policy—policy that organizes the state's
relations with other sovereigns.
11. Historically, public health has predominantly been a domestic policy concern;6 but developments
over the last decade have forced public health experts and diplomats to think of health as foreign policy,
namely public health as important to states' pursuit of their interests and values in international relations.
This transformation is complicated and cannot simply be equated with “healthy public policy.” This new
reality presents opportunities and risks for health promotion.
Foreign Policy Functions and Public Health
12. One way to understand the new reality of health as foreign policy is to see how public health
connects with the basic functions of foreign policy. Although foreign policy is complex, states engage in it
to fulfill four basic governance functions. First, through foreign policy, states seek to ensure their security
from external threats. Achieving national and international security is, thus, a foreign policy function.
Second, a country uses foreign policy to contribute to its economic power and prosperity. States promote
their interests in international trade and investment through foreign policy.
13. Third, states use foreign policy to support the development of political and economic order and
stability in other countries. Such development supplements a state’s interest in its security and economic
well-being. As a result, political and economic development forms part of foreign policy. Fourth, states
make efforts to promote and protect human dignity through foreign policy, as evidenced by support for
human rights and the provision of humanitarian assistance.
14. Identifying foreign policy’s governance functions does not imply that any given state integrates
these functions well or even considers them equally important. Students of international relations have
frequently noted a hierarchy in the foreign policy functions,7 with security and economic power ranking
higher than development or human dignity. Public health’s traditional place in the “low politics” of foreign
policy can be attributed to this hierarchy because public health was generally categorized as a
development or human dignity issue. See Figure 1.
6 R. Cheek, "Public Health as a Global Security Issue,” Foreign Service Journal (Dec. 2004): 22-29, p. 23.
7 See, e.g., Steven Weber, "Institutions and Change,” in New Thinking in International Relations Theory
(M. W. Doyle and G. J. Ikenberry, eds.) (Westview Press, 1997): 229-265, p. 230.
5
Figure 1.
Traditional Hierarchy of Foreign
Policy Governance Functions
Foreign
policy
functions
High politics
Low politics
15. The health promotion strategy reinforced public health's subordination in mainstream foreign policy.
Global conferences on health promotion stressed the health of individuals over the security of states, the
right to health over economic interests, and the primacy of global equity and justice over the aggregation
of national power.
16. Public health’s subordination was entrenched during the 20th century because many states faced
military threats to their existence and diplomacy rife with political and ideological hostility about how to
organize economic systems, how political and economic development should proceed in developing
countries, and what constituted human rights. These problems were acute during the Cold War.
Advocacy for healthy public policy based on human rights, equity, and social justice emerged into a
foreign policy context inhospitable to health promotion's universalistic ambitions.
17. The emergence of health as foreign policy in the post-Cold War period signals a sea change in
public health’s relationship with foreign policy’s functions. Public health today features prominently in all
foreign policy’s basic functions. Those concerned with national and international security have realized
public health’s importance concerning threats from biological weapons proliferation and bioterrorism.
Debates concerning the impact of international trade and investment on public health demonstrate public
health’s importance to the state’s pursuit of its economic interests. The traditional trope of "wealth leads
to health” that guided economic development’s relationship to public health for most of the post-World
War II period has been challenged by the “health produces wealth" argument.8 In addition, rising health
care costs in many countries are becoming major macroeconomic factors that can affect a country’s
global competitiveness and fiscal policy options. Finally, public health’s importance to civil and political
rights and economic, social, and cultural rights has been a feature of human rights and public health
discourse over the last decade. See Table 1.
18. For the first time since health promotion advocacy began, health promotion advances in a context in
which the role of public health features prominently in all foreign policy’s functions. In terms of foreign
policy, public health has a higher profile than ever before.
8 See, e.g., Commission on Macroeconomics and Health, Macroeconomics and Health: Investing in
Health for Economic Development (WHO, 2001).
6
Table 1.
Foreign Policy
Governance
__
Function
Security
Economic
well-being
Development
Human dignity
Examples of Importance of Public Health to Each Function
• Fears about the state proliferation of biological weapons
• Concerns about the use of biological weapons by terrorists
• Acknowledgment that emerging communicable diseases, such as SARS
and avian influenza, can pose direct threats to the security of states,
peoples, and individuals
• Recognition that the political, economic, and social devastation caused by
HIV/AIDS can threaten the security of states, peoples, and individuals
• Development by WHO of the concept of “global health security” with
respect to communicable disease threats
• Understanding of the economic damage communicable disease epidemics
and pandemics can cause to national economies integrated through
globalization
• Tensions between states that export products harmful to human health
(e.g., tobacco products) and states that import such products and try to
mitigate the health effects of the products
• Health care costs as increasingly important factors for national economic
performance and the dynamics of global economic competition
• Controversies over the effect of trade liberalization strategies on national
health regulatory powers and capabilities
• Advocacy to put public health at the center of economic development
strategies
• Centrality of health to the achievement of the UN Millennium Development
Goals
• Research and analysis that highlights the contributions health makes to
macroeconomic and microeconomic development
• Linking debt-forgiveness and future international assistance to increased
attention on, and investments in, health
• Focus on a human-rights based approach to HIV/AIDS
• Human-rights centered arguments in favor of increasing access to essential
medicines subject to patent rights under TRIPS
• Appointment by the UN of a Special Rapporteur on the Right to Health
• Challenge of balancing enjoyment of civil and political rights and
addressing dangerous communicable disease outbreaks effectively
United Nations Reform, Foreign Policy, and Health Promotion
19. One can appreciate this transformation by examining the UN Secretary-General's proposals for
United Nations reform. UN reform is not new for the foreign policy of UN members; but never before has
public health appeared in UN reform proposals as significantly as it did in Kofi Annan’s March 2005 report
In Larger Freedom.910
20. Each of the Secretary-General's objectives for UN reform—freedom from fear, freedom from want,
and freedom to live in dignity—depends on public health improvements. To achieve freedom from want,
the Secretary-General emphasizes fulfillment of the eight UN Millennium Development Goals (MDGs),1
three of which target specific health problems (child mortality; maternal health; and combat HIV/AIDS,
malaria, and other diseases) and four of which seek improvement in key health determinants (poverty
9 In Larger Freedom: Towards Development, Security and Human Rights for All, A/59/2005, 21 Mar.
2005.
10 Id., 1HI28-32.
7
and hunger; universal primary education; gender equality; and environmental sustainability). The eighth
MDG (develop a global partnership for development) targets cooperation with pharmaceutical companies
to provide access to affordable, essential medicines in developing countries.11
12
21. The Secretary-General also asserts that ensuring access to sexual and reproductive health
services, providing safe drinking water and sanitation, controlling pollution and waste disposal, assuring
universal access to essential health services, and building national capacities in science, technology, and
innovation are national priorities for achieving freedom from want.13 Strengthening global infectious
disease surveillance and increasing research on the special health needs of the poor are global priorities
in realizing freedom from want.14
22. In terms of freedom from fear, the Secretary-General’s new vision of collective security includes
addressing threats presented by naturally occurring infectious diseases and biological weapons. These
tasks require strengthening national and global public health and potentially involving the UN Security
Council in "any overwhelming outbreak of infectious disease that threatens international peace and
security."15
23. The Secretary-General's conception of freedom to live in dignity also connects to public health. The
Secretary-General declared that “[t]he right to choose how they are ruled, and who rules them, must be
the birthright of all people, and its universal achievement must be a central objective of an Organization
devoted to the cause of larger freedom.”16 Public health feeds this right and attribute of human dignity
because “[e]ven if he can vote to choose his rulers, a young man with AIDS who cannot read or write and
lives on the brink of starvation is not truly free.”17
24. The Secretary-General's UN reform proposals constitute a vision in which UN members must
elevate public health as a foreign policy priority in order to support security, development, and human
dignity. The Secretary-General’s UN reform strategy clarifies the importance of states thinking in terms of
health as foreign policy. Indeed, this strategy fuses the success of UN reform to the effectiveness of
global health promotion.
Opportunities and Risks with Respect to Health as Foreign Policy
25. The prominence the Secretary-General gives public health reveals that health promotion, as a core
component of public health, is a strategic necessity for the international community, the fulfillment of
which depends on how states organize and implement their foreign policies. Health’s rise on foreign
policy agendas, and the centrality of public health to UN reform, demonstrates that strengthening foreign
policy approaches to public health offers significant contributions to all the governance functions served
by foreign policy. These contributions can develop at national, regional, and global levels. Engraining
health promotion into foreign policy helps ensure that linkages between health and foreign policy assist
states in addressing governance challenges the world faces as globalization accelerates.
26. The number and significance of the links between public health and foreign policy suggest that
effective public health has become an independent marker of “good governance” for 21 st century
humanity and its globalized interactions. Health promotion has long emphasized the need for healthy
public policy, and the emergence of public health as an independent marker of good governance opens
new opportunities for health promotion as a normative value and a material interest.
11 UN Millennium Development Goals, http://www.un.org/millenniumgoals/.
12 Id. .
13 In Larger Freedom, ffl[40-41, 43-44, 46.
14 Id., 1J1J63-64, 67.
15 Id., 11105.
16 Id., 1J148.
17 Id., 1J15.
8
27. Opportunities do not come without risks, and health as foreign policy is no exception (see Box 2).
One danger is that states will use public health for ulterior foreign policy motives or purposes that have
little to do with health protection and promotion. In other words, health policy becomes another pawn in a
power-political game of competition that values public health as a short-term instrument not as a
sustainable foundation for good governance nationally and globally. Health policy can, thus, become yet
another arena in which states engage in traditional foreign policy conflicts over power, security, and
influence.
28. A second danger concerns the possibility that foreign policy interest in specific public health
problems, such as the control of infectious diseases and the threat of bioterrorism, subordinates health
promotion’s emphasis on determinants of health in policymaking. Such subordination would mean that
only parts of public health connected to national security and economic power emerge into the “high
politics” of foreign policy while health promotion remains neglected.
29. A third danger involves the disequilibrium of power that exists in international relations. This
imbalance can create conditions in which more powerful countries pursue foreign policy agendas with
respect to public health that do not address the needs of weaker states. Health as foreign policy contains
the potential for the mixture of power and epidemiology to create controversies.
30. A fourth danger is gridlock because foreign policy interests of different states concerning public
health can produce divergence rather than convergence on appropriate actions. Public health's rise as a
foreign policy issue has been accompanied by controversies that have undermined trust and goodwill
among states. Even in the realm of public health, producing a harmony of interests among states in their
foreign policy pursuits is not easy.
Box 2.____________________________________________________________________________
Opportunities and Risks: The New International Health Regulations
The new International Health Regulations (IHR), adopted in May 2005 by the World Health
Assembly,18 provide a case study for the opportunities and risks health as foreign policy presents
to health promotion. The new IHR constitute a radically different set of rules from the old IHR and
are designed to achieve global health security in the context of the globalization of disease
threats. The WHO, its member states, and the UN Secretary-General have embraced the new
IHR as a critical instrument in protecting and promoting public health in the 21st century.
The new IHR's negotiation raised, however, risks that health as foreign policy can create.
Tensions arose about the new IHR's application to suspected incidents involving biological
weapons and the politically sensitive relationship between China and Taiwan. Further, the new
IHR concentrate on detecting and responding to public health emergencies of international
concern and do not directly address determinants of health that create the conditions conducive
for disease emergence and spread. Such determinants are targets of health promotion efforts.
Concerns exist, thus, that the attention the new IHR bring to global health security between states
might drain resources and interest away from improving determinants of health within countries.
Health Promotion and Foreign Policy
31. Health promotion now faces a context transformed by globalization and public health's emergence
as an issue for all the governance functions served by foreign policy. In this environment, health
promotion needs to sharpen its focus on foreign policy as an aspect of the larger objective of healthy
public policy, which means paying more attention to substantive and institutional aspects of public health
as a foreign policy issue.
32. Substantively, health promotion’s message should be that public health constitutes an integrated
public good that benefits the state’s pursuit of security, economic well-being, development efforts, and
18 World Health Assembly, Revision of the International Health Regulations, WHA58.3, 23 May 2005.
9
respect for human dignity. The multiple interests and governance purposes public health supports make it
a “best buy” for foreign policy. As such, health as foreign policy allows public health to escape its
traditional relegation to the “low politics” of foreign policy. See Figure 2.
Figure 2.
Health as Foreign Policy:
Public Health as an Integrated Public Good
33. Foreign policy pursuit of the integrated public good of public health will necessitate changes to the
structure and dynamics of health and foreign policy bureaucracies. Health promotion should focus
attention on how governments can better facilitate public health as a foreign policy objective. Pursuing
public health as an integrated public good requires health and foreign policy bureaucracies to develop
new skills in order to understand the new context in which they operate, promote more effective
interagency collaboration, produce policy coherence, and assess progress. Health and foreign ministries
could exchange staff more frequently to increase the health competence of foreign ministries and the
diplomatic competence of health ministries.
34. Health as foreign policy offers health promotion opportunities to engage non-governmental actors.
For example, non-governmental organizations (NGOs), such as universities and schools of public health,
could contribute to the pursuit of public health as an integrated public good by deepening understanding
of the health-foreign policy dynamic and training prospective public health practitioners to operate in the
new environment created by the health as foreign policy transformation. Foreign policy collaboration with
NGOs through public-private partnerships may also be a fruitful strategy for health as foreign policy.
NGOs may also be valuable in assessing how well countries engage in health as foreign policy.
Conclusion
35. Public health's rise as a foreign policy issue has transformed how health promotion unfolds in the
future. This transformation forces health promotion advocates to pay more attention to health as a foreign
policy issue rather than subsuming foreign policy in the concept of healthy public policy.
36. Health promotion's challenge is to advance the concept of health as foreign policy defined as the
pursuit of public health as an integrated public good across all governance functions served by foreign
policy. Advancing this concept of health as foreign policy serves not only each country but also
perspectives on how global politics should progressively develop in the 21st century.
10
37. Although the increased intersections between public health and foreign policy generate risks for
health promotion, these risks do not negate the challenge facing health promotion at the Bangkok
Conference and beyond. Any effective effort to harness globalization for public health will have to make
health as foreign policy a centerpiece of its ambitions. This responsibility is now the health promotion
strategy's burden and opportunity.
11
Of WORLD HEALTH ORGANIZATION
FIFTY-FOURTH WORLD HEALTH ASSEMBLY
Provisional agenda item 13.2
A54/8
30 March 2001
Health promotion
Report by the Secretariat
1.
Resolution WHA51.12 requests the Director-General to support the development of evidence
based health promotion activities, give health promotion top priority within WHO, and report back to
the Executive Board and the Health Assembly. The Executive Board at its 105th session acknowledged
the importance of health promotion programmes, particularly the need to implement programmes that
are based on evidence, to monitor their effectiveness, and to give priority to the need for health
promotion programmes in developing countries. Time did not permit the subject to be fully discussed
at the Fifty-third World Health Assembly in May 2000; it was therefore decided that the item should
be placed on the agenda of the Fifty-fourth World Health Assembly.1
2.
Health promotion has a rich history at WHO, and it remains a cornerstone of WHO policies and
actions. WHO has designated many collaborating centres, sponsored five international conferences,
benefited from significant regional and national conferences, and conducted important programmes
and activities on health promotion.
3.
The Ottawa Charter for Health Promotion continues to guide the global practice of health
promotion and sets out a strategy with five essential actions: building healthy public policy, creating
supportive environments, strengthening community action, developing personal skills, and reorienting
health services. These remain valid. The most recent meeting - the Fifth Global Conference on Health
Promotion (Mexico City, 5 to 9 June 2000) - adopted a Ministerial Statement which affirmed the
contribution of health promotion strategies to the sustainability of local, national and international
actions in health, and pledged to draw up country-wide plans of action to monitor progress made in
incorporating strategies which promote health into national and local policy and planning.
4.
Over the past few years, much of the progress in WHO’s health promotion programme has been
achieved by application of health promotion principles to specific risk factors and diseases in
particular populations and settings, and generation of an evidence base of effective practice. After 25
years of effort, community-based health promotion activities in North Karelia, Finland, have reduced
age-adjusted mortality due to heart disease among men by 73% and cut all cause mortality for men by
44%. Over a 10-year period in California, United States of America, a comprehensive tobacco control
programme has prevented 33 000 heart disease deaths and reduced the incidence of lung cancer by
14%, compared to a reduction of 3% in the rest of the United States. In Belgium, educational efforts
on the importance of designated drivers and stringent enforcement of drink driving laws have
decreased motor vehicle deaths and injuries by 10% in the year following the launch of the
programme. In Thailand,; a national HTV/AIDS prevention programme increased condom use and
1 Document WHA53/2000/REC/3, summary record of the eighth meeting of Committee A, section 3.
A 54/8
decreased sexually transmitted disease and HIV infection rates across the whole population. Many
other examples of successful health promotion programmes have been published.
5.
Health promotion strategies are not limited to a specific health problem, nor to a specific set of
behaviours. WHO as a whole applies the principles of, and strategies for, health promotion to a variety
of population groups, risk factors, diseases, and in various settings. Health promotion, and the
associated efforts put into education, community development, policy, legislation and regulation, are
equally valid for prevention of communicable diseases, injury and violence, and mental problems, as
they are for prevention of noncommunicable diseases.
6.
Despite the progress made, health promotion needs to be applied more energetically at local,
country and regional levels in order to change the factors that influence health and improve health
outcomes.
7.
In order to strengthen its health promotion programme throughout the Organization, WHO will
streamline its efforts, focusing on a specific set of priorities, but with a broad spectrum of
involvement. The priorities proposed are young people, health communications, and health systems.
8.
Health promotion directed at young people, especially those in early adolescence, has a great
potential for advancing the health of the population. Establishing supportive communities, networks
and institutions, and encouraging healthful behaviour are the most effective ways to enable young
people and their families to increase control over, and improve, their health. It is essential that health
promotion activities should be available to all young people, both in and out of school. Of particular
importance is the potential role of sports and recreation in providing healthful alternatives to risky
youth behaviour and the often counteractive influence of the media and the entertainment industry.
9.
Improved health literacy is necessary for people to increase control over their health, and for
better management of disease and risk. Communications strategies that increase access to information
and build the capacity to use it can improve health literacy, decision-making, risk perception and
assessment, and lead to informed action of individuals, communities and organizations.
Communications, particularly media advocacy, can be directed at moving public opinion and action
toward reforms in policies and regulations of the various social, economic and environmental factors
that influence health.
10.
In addition, health systems that are integrated and accessible have great potential to promote
health, as well as to prevent disease. Health systems have an essential responsibility for primary and
secondary prevention, and assist in improving adherence to therapies and treatment regimens. Health
systems can be instrumental in involving other sectors as partners in health promotion.
11.
In a broader policy context, it is recognized that health promotion is integral to, and can help
advance, WHO’s corporate strategy. Health promotion helps to reduce excess mortality, address the
leading risk factors and underlying determinants of health, helps to strengthen sustainable health
systems, and places health at the centre of the broader development agenda.
12.
Based on sound evidence, WHO’s health promotion efforts will target specific populations at
risk, taking account of the interface between health status and the broader determinants of health.
Priority will be given to implementation of programmes among disadvantaged populations in specific
settings. Too often, it is not proven strategies that are lacking, but vigorous and culturally sensitive
application of measures that are known to work.
2
A 54/8
13.
In WHO health promotion is being brought into the mainstream of technical programmes and
initiatives. For example, the cluster on Sustainable development and healthy environments deals with
the cross-sectoral dimensions of health and coordinates work related to poverty, trade and human
rights, all of which affect the underlying determinants of health. Work on healthy cities, islands, or
municipalities, which shows how multisectoral approaches to health development lead to improved
health, is being undertaken in several regions. The Commission on Macroeconomics and Health will
continue to deal with poverty and other determinants of ill health.
14.
WHO will cooperate with Member States in strengthening their capacity for health promotion
and incorporating it into national plans, with particular emphasis on programme implementation and
evaluation. To this end, use is encouraged of WHO’s Health promotion glossary, which provides
clear definitions and descriptions of health promotion terms. This glossary will be reviewed and
revised to include additional relevant terms, as part of the process of obtaining standardized
terminology and of the provision of technical assistance to Member States.
15.
In order to improve the evidence base for health promotion, WHO will build up a vigorous
research and development component, focusing on better dissemination and application of its
principles and approaches, especially in developing countries. This will be achieved through existing
research partnerships with academic institutions, professional organizations, and WHO collaborating
centres. Thus health promotion research will be integrated into the content of WHO programmes in
order to achieve coherence and greater relevance, and to ensure applicability of research findings.
16.
A mechanism for coordination and planning will be set up, that will serve as a driving force for
the continuous development of health promotion throughout WHO. One of its first activities will be to
take stock of what has been done worldwide, in order to develop approaches that will speed up
implementation of activities in the three areas of priority outlined above, and to advance the practice of
health promotion in general.
17.
WHO will establish a forum for health promotion dialogue with other organizations of the
United Nations system, academic institutions, professional associations, and other nongovernmental
organizations, such as the International Union for Health Promotion and Education. Its purpose will be
to stimulate joint action, coordinate activities, expand partnerships, especially with nongovernmental
organizations and the private sector, and work together on a common agenda. Emphasis will be laid on
advancing understanding of the development, delivery and assessment of health promotion
programmes, particularly for disadvantaged populations. The activities of each participant in the forum
should complement, not duplicate, those of the others.
ACTION BY THE HEALTH ASSEMBLY
18.
The Health Assembly is invited to note the report.
1 Health promotion glossary, WHO, Geneva, 1998 (document WHO/HPR/HEP/98.1).
3
Review/2005/3
Page 1 of 2
Charters, Declarations, World Conferences: Practical
Significance for Health Promotion Practitioners 'on the
ground’
Maurice B. Mittelmark, Professor, University of Bergen and President, IUHPE
Mittelmark, Maurice B., Charters, Declarations, World Conferences: Practical Significance for Health
Promotion Practitioners 'on the ground’, Reviews of Health Promotion and Education Online, 2005.
URL:http://www.rhpeo.org/reviews/2005/3/index.htm.
We are on the cusp of the twentieth anniversary of the Ottawa Charter for Health
Promotion. In 2005 in Bangkok^the World Health Organization will lead a reexaminationof the Ottawa Charter, and the Bangkok Charter on health promotion
will have be launched. At the International Union for Health Promotion and
Education’s_globalconference in Vancouver in 2007, the Ottawa Charter will again be
ifi the spotlight, as will, for that matter, the new Bangkok Charter.
One might wonder about the need for a new Charter, and what impact such
documents have on the practical work of health promotion practitioners, if any. The
need for a new Charter is the subject of lively debate at the time of this writing, a
sign that the Ottawa Charter continues to have significance, even though the world
has changed remarkably in the twenty years since its adoption. Perhaps the best test
of the Bangkok Charter’s impact will be the degree of attention it receives in 2025,
when the young readers of this book have aged into the vanguard of health
promotion leadership.
That still leaves the question of if, and how, the high level political machinations
which culminate in health promotion Charters and Declarations have significance for
the day-to-day work of health promotion practitioners. For a start, it is clear that
health promotion provides common ground for many health professionals, which
enhances the quality and effectiveness of cross-discipline team work. Education in
health promotion stimulates and enables cross-discipline dialogue, respect, and
eagerness for collaboration. Regardless of a health professFonal’sTfiscipline-specific
training, education in health promotion creates bonds with other disciplines. It
ensures a high regard for the principles of empowerment and participation. It instils
appreciation for the expertise of non-health professionals. It creates commitment to
http://www.rhpeo.Org/reviews/2005/3/index.htm
7/5/2005
Review/2005/3
Page 2 of2
community-based solutions, and to action in community settings. Health promotion’s
conferences, continuing education offerings, journals, and newsletters, help
maintain the bonds forged in early training.
So, health promotion does have practical significance for health professionals. A vital
point is that for health promotion to 'deliver’ in the ways mentioned, it must have
mechanisms of action, it must have infrastructure, and it must have visibility in
education, in practice, and in policy arenas. The existence of these essential
elements should not be taken for granted. There exists an attractive logic that, since
health promotion has relevance to all public health work, it should be diffused in
health care systems. To the contrary, health promotion’s distinctiveness requires
diligent preservation, in no small part because of its almost unique bridge-building
capability.
That claim brings me back full circle, to the question of what relevance health
promotion’s high level political processes, and Charters and Declarations, have for
allied health professionals. The answer is that if health promotion is to remain vital,
and to serve the practical functions described above, it requires periodic
illumination, with critical debate. At the very least, global conferences and the
Charters and declarations they spawn do illuminate health promotion. They do spark
much needed debate. Two outcomes of discussion and debate swirling around the
Bangkok conference and the Bangkok Charter can be safely anticipated: affirmation
of health promotion’s foundational values, and agreement on the need for ever more
innovative health promotion strategies and more effective coliaboratiorHn~6uT~
rapidiychangihgTimes? ~
Note: This text has been adapted slightly, with authorisation from the Publisher and
the Editor, from the Preface to: Scriven, 4. (ed) (2005) Health Promoting Practice:
The Contribution of Nurses and Allied Health Professions. Palgrave, London. It will
also be published in French and Spanish, as well as its original language, in
Promotion & Education, Volume XII, Number 1, 2005 (in press).
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On image, ownership and open space
Hans Saan, NIGZ (Netherlands Institute for Health Education), the Netherlands,
Saan, Hans, On image, ownership and open space, Reviews of Health Promotion and Education Online,
2005. URL:http://www.rhpeo.org/reviews/2005/24/index.htm.
It is most interesting to see how we negotiate about the Bangkok Charter. The vigour
shows how much many of us are fully engaged in health promotion and are ready to
debate their principles and values. That in itself is a good sign of how health
promotion is alive and kicking. I would like to add to the debate three arguments,
that relate not so much to the content, but to the positioning and style of that
declaration.
5--- --- --------- —.
My first observation has to do with the logo of the conference. The Ottawa logo is a
great trade mark and the variations in each of the following conferences added to
the impact of that image without destroying it. I liked the curves of the shapes, the
escape from the circular form, the beauty of its simplicity. It sends a message on
concepts, by putting them in a dynamic pattern. The Ottawa logo had a one to one
fit with the charter, so it worked as a didactic tool too. Now the Bangkok conference
chooses a logo that overlaps the Ottawa image with a human figure in a green
circle. It remains to be seen how that image relates with the content of the
statement. It has not yet won a prize in my beauty contest.
The second argument has to do with language. The drafts of the text circulated so
far had many boring sentences of a rather abstract language. It seeks to inspire, but
it misses the feeling of innovativeness and border crossing that made the Ottawa
Charter then such a challengingjext. Taken into account the context of the
statement being produced, buropolicy language seems unavoidable, but I wonder
what would happen if the now final sentence: "We the participants....” like the
famous "We the people....” were put first. It might have a refreshing impact on the
text if We promise something to Us, to You and to All.
My final argument will embrace the two mentioned. So far the text and the
conference have four tracks. Now four is a closed number: it evokes seasons,
directions, so rather stable situations. Health promotion deserves a more dynamic
approach, so I propose (in line with a book about the Rule of Four) to apply a Rule of
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Five. Put in the text and the conference a fifth track labelled Open Space. That area
invites innovative approaches that people find not yet covered in the other four
tracks. It will help to lower the pressure on the four tracks to be all-inclusive and by
putting at the conference a room apart for this fifth track, in which we are ready for
the surprise. Health promotion always is on_the lookout for the possible, for
unexpected knots in a pattern, for opportunities for innovative empowerment. In
that open space some workshops may provoke creative approaches to the issues at
hand. Agenda setting could be done on the spot, people_vote_withJ:heirfeet, the
output should be at most five sentences or items, to fit with the format of the other
tracks?
My suggestions for workshops: a competition for a Bangkok Logo and a workshop with
experienced text writers and journalists on a We the People version of the Charter.
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The Bangkok Charter: will it be as significant as the
Ottawa one ?
Michel O’Neill, Professor, Universite Laval, Quebec and Vice-President for
Communications, IUHPE
O'Neill, Michel, The Bangkok Charter: will it be as significant as the Ottawa one ?, Reviews of Health
Promotion and Education Online, 2005. URL:http://www.rhpeo.org/reviews/2005/23/index.htm.
On the 11th of August 2005, the Bangkok Charter will be proclaimed in Thailand
during the 6th international conference for health promotion sponsored by the World
Health Organization (WHO). Whatever the final version looks like, and in my opinion
it will not be too different from the preliminary versions that have been circulating
for a while, this Charter (or whatever it will end up being called) will necessarily be
of the same type than what such conferences generate : values and broad principles
as well as noble and generous suggestions that are increasingly difficult to apply by
Member States, crippled by less and less freedom of action in our era of
globalization -Given the very nature of the WHO, it could hardly be otherwise.
Why did the Ottawa Charter have such an impact then, while the final documents
proclaimed at the four other WHO international conferences were much less
influential? Because it’s content was particularly convincing? Because it was a
Charter and not like in Adelaide a set of Recommendations, or in Sundsvall, Djakarta
or Mexico, a Declaration (« ministerial » in the case of Mexico)? Is the fact that it will
most likely be a Charter in Bangkok a guaranteed recipe for success?
I suggest here to explain the success of the Ottawa Charter and the relatively small
impact of the final documents of following WHO international health promotion
conferences not by their contents nor by the fact that they are labeled a Charter or
not. I think the key element is the historical and political circumstances in which
each of them has been proclaimed. If this analysis is correct, it can already provide
us with some interesting indications relating to the possibilities of the new Bangkok
Charter. So why were the historical and political circumstances of the Ottawa
Charter so special?
First and foremost, there was a novelty factor involved: this Charter was the first of
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it’s kind, proclaimed at the first of WHO international conferences in health
promotion. I would argue that this "first kid on the block” syndrome played a similar
role with the famous Lalonde report (1974): it was followed very closely by similar
reports from the USA and most of the industrialized countries but with much less
international impact. Being the first matters thus.
A second phenomenon of importance : the Ottawa conference was the outcome of
almost ten years of work, reflections and exchanges. It was in the wake of the Health
forTdl declaratTorTdHhe World Health Assembly in 1977 and the Primary Healthcare
conference of Alma Ata in 1978, where lots of people were trying to operationalize
all over the world the first major reorientation proposed by the WHO since it’s
creation in 1948.
Thirdly, we must also recall that in 1986 the WHO, like all the other organizations of
the UN system, still had strong credibility and leadership; 20 years of economic
conservatism and « new world order » have seriously weakened these two important
characteristics. Is today’s WHO moral authority, whatever the content of the new
charter produceain Bangkok, as strong as yesterdayjs?
Finally, the leadership in the production of the Ottawa Charter came from northern
countries : the WHO European office in Copenhagen in interaction with the Canadian
federal government. This charter also benefited from the tenacious efforts of a group
of people like Ilona Kickbusch, Ron Draper and several other intellectual visionaries
who were very well networked and occupied relatively powerful positions. Even if
the international macro-economical leadership in the last 20 years, has somewhat
shifted from Europe and North America to South-East Asia, will the proclamation of
the Bangkok Charter next August benefit from the same positioning in the global
political economy than the Ottawa one in 1986?
Only time will allow to answer the questions above. I nevertheless thought important
to point out that it is not necessarily the exact wording nor the name of the Bangkok
Charter that will explain the impact (or lack of) of this document on the
international health promotion scene but the broader context in which they occur.
Note : a first version of this paper was published in French in the Bangkok Charter
electronic discussion group of the Institut national de prevention et d’education pour
la sante (INPES) in Paris in February 2005; it was reprinted in the same month in
RHPEO. Thanks to Sebastien Courchesne-O’Neill for a first draft of translation in
English.
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Bangkok Charter: criticizing but backing WHO
Maurice B. Mittelmark, Professor, University of Bergen and President, 1UHPE
Mittlemark, Maurice B., Bangkok Charter: criticizing but backing WHO, Reviews of Health Promotion
and Education Online, 2005. URL:http://www.rhpeo.org/reviews/2005/22/index.htm.
The focus on the wording of the Bangkok Charter, while important, has tended to
obscure what I feel are other important issues. As I stated in my previous
contribution to this discussion, the test of the Bangkok Charter will be a test of time.
Will it excite debate in 20 years? I hope so. Will that in any way diminish the
significance of the Ottawa Charter? I think not. However, that there will be a
Bangkok Charter at all IS significant. Immediately after the Mexico City conference in
the series started in Ottawa, it seemed sure that Mexico City would the last in the
series. WHO leadership in Geneva at that time told me there were no plans for
continuing, and that upset me. Without question, the WHO health promotion
conference series has pumped air into the healtb_pr-omo.tion-balloon_atxegular and
needed"intervals?
IUHPE conferences do so, too, but in a different way. At the professionals'
conferences, there are many points of activity that energise virtually all who attend - and the numbers are in the thousands and growing. WHO conferences, with
attendance by invitation and with relatively few participants, serve a different
function. These WHO 'happenings', including their Charters, Declarations and other
pronouncements, provide advocacy opportunities that are priceless. For example,
after Mexico, the NorwegiaiTgwerhment launched an importantTn^country review
of, and discussion about, thestateofjts h ealth_promotion efforts. That would hardly
have happened without Mexico City.
Today, the WHO Director General and senior staff are emphasising health promotion
again by holding the Bangkok conference. In this, they need and deserve our support
and encouragement. Many of us are helping them with the Bangkok conference, even
as we exercise our right to criticise aspects we are uncomfortable with (that
Bangkok intends to adopt a 'Charter' seems the main point of contention; issues of
wording are mostly being worked out, I think).
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I have been ambling along toward my central point, and it is this: WHO in Geneva has
far too few resources to accomplish all that its stakeholders, constituentTahcTcritics
demand. As politics is the sweet science of deciding how too-scarce resources should
be distributed, decisions about how much emphasis health promotion will receive in
Geneva are political decisions -- influenced by other factors, but political decisions
at the core. We in health promotion need to do all we can to influence those
decisions. Grumbling about various inadequacies to one another and adopting
a confrontive style with WHO will get us nowhere. Only advocacy -- by us -- at the
State level has a chance of helping. In our countries, we need to advocate for health
promotion with a simple message:
Health promotion is the cutting-edge action arm of public health. It works at low
cost, and works well, when done with seriousness of purpose and in a sustained way.
A strong core of professional expertise in health promotion at WHO in all its regions
and in Geneva can help States do health promotion effectively. Therefore, Member
States are committed to investment in a critical mass of health promotion expertise
in WHO, that is at present sorely lacking. The very good, but very few, health
promotion experts at WHO need~more help!
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What would the Nutbeam Charter look like if it were
written with my editing?
By Lawrence W. Green, Visiting Professor, University of California at Berkeley School
of Public Health, USA
Green, Lawrence W., What would the Nutbeam Charter look like if it were written with my editing?,
Reviews of Health Promotion and Education Online, 2005.
URL:http://www.rhpeo.org/reviews/2005/21/index , htm.
Don Nutbeam’s very nicely crafted and cogent commentary (2005) on the Ottawa
Charter leads with the stage-setting observation that the Charter process was highly
consultative, but within a relatively small group. One could add that most of those
present from developing or developed countries were not necessarily representing
their governments or the leading professional associations or other stakeholders in
their countries. They were the people who could attend, among those who were
invited. If my invitation was typical, it is easy to appreciate the issue Prof Nutbeam
raises concerning the representativeness of consultative process. The other part of
Nutbeam’s implicit concern here is with the representation of the developing world
at the Ottawa conference. In response to this frequent criticism, Ilona Kickbusch
pointed out in her commentary in February (2005) that this was the very "challenge
thrown out by Dr. Halfdan Mahler, the then Director General of the WHO, ...to make
the principles of the Alma Ata Declaration applicable to the developed world...” If
Ottawa was the tilting of the balance back toward developed countries, Bangkok may
be expected to be the pendulum swing back toward the emphasis of the Alma Ata
Declaration on developing countries, but with a greater emphasis on the health
promotion issues raised in Ottawa. Or, as Kickbusch suggests, it could be the end of
this "false dichotomy.”
Nutbeam’s section on "Healthy Public Policy" accurately reflects the origins of the
concept, its limitations for certain developing countries, and the needs for updating
it to give greater weight to decentralized policy-making, the needs of developing
countries, and globalization. I would embellish his decentralization to emphasize
organizational and institutional policies within communities, because community has
such varied geographic meaning across the globe, as witnessed by the need to
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rename the "Healthy Cities" initiative of Western Europe "Healthy Communities" in
North America, "Healthy Shires" in Australia, and "Healthy Villages," "Healthy Towns,”
or "Healthy Counties,” in some places. What also concerned me with the naming of
these things as "healthy" is that the real intent was to make them healthful so that
people living in them could be healthy. Living things can be healthy. Inanimate or
nonliving objects can, at best, be healthful. This is not just a grammatical point, but
also a concern that the redirection of focus from the health of people to the "health"
of policies, cities, and communities could have the effect of diluting the concern
with health outcomes for people. It might have had the effect of reinventing
policies, cities, communities, etc in the possibly romanticized or utopian image of
what some people (e.g., those attending the Ottawa conference) would hold for an
ideal community life or political orientation of policy, but which would not be
guaranteed to improve the health of people. What it did contribute toward was the
growing interest in reviving ecological approaches to health promotion.
Some of the foregoing issues are addressed in the Nutbeam’s following section on
"Healthy Environments." Here Nutbeam seems to shift the spotlight onto the physical
environment and "settings," which became the "more subtle" way of expressing health
promotion's particular interests in social environments. Some reference might be in
order here to the shift in emphasis from physical environment in public health history
to social environments in the Ottawa Charter's health promotion, to the current
emphasis on "social determinants of health" which places less emphasis on settings
and more on social inequalities and early childhood or lifetime exposures to
socioeconomic conditions harmful to health. Whether health promotion needs to take
this additional step toward social inequalities or away from "settings” as a focal
concern for the Bangkok Charter needs to be debated. Such a shift, however, must
not abrogate the traditional (and now growing) responsibility of public health for the
protection of people from exposures to toxins and other threats of the physical
environment? which is deteriorating Tn many places.
Nutbeam's point about the over-reaction of the Charter to simplistic behavioral and
individualistic approaches is very important and worthy of a prominent place in this
debate leading up to the Bangkok meeting. It was expressed by some during the
Ottawa Charter era as disdain for the historical roots in health education and
disparagement of those continuing to develop the theoretical and empirical
grounding of educational and behavioral components of more ecologically layered,
more comprehensive programs. The subsequent maturing of both levels-individual
and social--expressed in part in the Ottawa Charter, might give the Charter a
different tone, emphasizing the reciprocal determinism of behavior and
environment, a central tenet of ecology, if written today. Nutbeam’s casting this
section of his commentary in the context of health literacy puts a particular spin on
one aspect of the issue that for those with a narrow understanding of health literacy
could miss the larger ecological context in which the individual-community,
behavioral-environmental interplay and dialectic have played out. This would be,
ironically, the same fate of those who held a narrow understanding of health
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education at the time of the Ottawa Charter.
Nutbeam's observation in the next paragraph that governments have tended to invest
in the IEC components of the more comprehensive efforts needed to get at the social
determinants and other ecological forces recovers the important point that the
combination of both is needed to achieve the goals of health promotion. One could
add, perhaps more cynically, that governmental focus on IEC components gives them
publicity and visibility whentheyaredoing little tci_address the determinants over
which individualscan exert minimal control, so that IEC sometimes becomes public
relations rather than pubric~healtTf education.
In his section on community development, I would add a plea for more participatory
research with professionals and other indigenous practitioners, community policy
makers, and grass roots residents. This is a concrete example of the point Professor
Nutbeam makes here about the richness of experience and literature from developing
countries that is only beginning to be reflected in mainstream health promotion
literature. Participatory research was not a concept developed in the Ottawa
Charter, but one whose time has come.
In short, if Don Nutbeam and I were co-authoring a draft of the next charter, it would
likely have (1) a built-in consultative process to assure wider representation of key
stakeholders; (2) a more systematic tracing of causal links from population health
outcomes to the policies, regulations, and organizational structures that could
achieve them7 rather than "healthy polices” and "healthy cities” as apparent ends in
themselves; (3) a blending of physical and social environmental issues; (4) a
rehabilitation of health education (perhaps in the new clothes of health literacy)
with its recognition of individual agency and reciprocal determinism between
behavior and the environment; (5) recommendations to strike a better balance in the
distribution of expenditures of governments on information, education and
communications; such that government officials’could not misdirect such' funds
toward their own public relations purposes; and (6) an underpinning of the health
promotion enterprise with the development of a science that grows as much out of
participatory research on existing needs and local practices as from highly
controlled, hypothesis-driven trials in artificially contrived experiments.
These features, of course, would depend on Professor Nutbeam’s acceptance or
further rewriting of my edits on his virtual, hypothetical, updated redrafting of the
Ottawa Charter. It was his prospectus for such an update that inspired me to sign on.
We both "retain a strong attachment to the basic concepts and principles of the
Ottawa Charter,” and we both seem to come back to it with the benefit of our
respective revolving-door careers in and out of academia and government service.
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SPOTLIGHT
WHO > WHO sites > Health promotion > Global Conferences on Health Promotion
The 6th Global Conference on Health
Promotion
"Policy and Partnership for Action: Addressing the Determinants
of Health", Bangkok, Thailand, 7-11 August 2005
The 6th Global Conference on Health Promotion, organized by the World
Health Organization and the Ministry of Public Health, Thailand, will be
held at the United Nations Conference Centre in Bangkok, on 7-11
August 2005.
This conference is the latest in the series which began in Ottawa in 1986
and produced the Ottawa Charter on Health Promotion. This benchmark
conference was followed by Adelaide (1988), Sundsvall (1991), Jakarta
(1997) and Mexico-City (2000).
Almost 20 years later, many things have changed in the world, including
the impact of globalization, the internet, greater moves towards private
sector involvement in public health, emphasis on a sound evidence-based
approach and cost-effectiveness. The 6th Global Conference has been
convened to meet these challenges and to better exploit the
opportunities presented for health promotion in the 21st Century.
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PREVIOUS CONFERENCES
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Sundsvall (1991), Jakarta (1997)
and Mexico-City (2000).
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IS THE HEALTH PROMOTION COMMUNITY
ADDRESSING THE CONFILCTS OF INTERESTS
THAT UNDERPIN THE SITUATION?
LI SX3
NGO COALITE
BUILDING FOR
HEALTH PROMOTION
Social health activism to increase community
control over health determinants.
bleeds vision, skill), care, time and resources.
Selecting partners with shared goaDs.
Reaching agreements and evolving strategies.
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office.
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constituency
reality and engage with
wider processes.
Enadequate cooperation and sense off
responsibility
The PespSes Charter for health addneSSmg health <nW<mrrmiirffl;H>tr>ifr<s
Economic
trade, debt, IPR,
speculative finance
/
Environment
>
pollution, climate,
ozone layer, toxics,
Pesticides, nuclear
wastes, biodiversity, soil
\erosion, deforestation/
Rfan violle nee, confiict
and natural disasters
People's IKieaUth Movement
Largest consensus document on
health, 50 translations.
Framework for action - globally.
Second Peoples Health Assembly Cuenca, Ecuador, July 18th to 23rd.
(30g&fi
KioaOCto
hS© cento^aDozed funding
Loose networking = gDohaD and di a ft Bon aS
structures
Strong inputs from the South
Strong community wake and agency
A giobaiization ©f soHdaritv from below
addressing heaith determinants
Final Draft
The Bangkok Charter for Health Promotion
in a globalized world
Introduction
The Bangkok Charter identifies the strategies and commitments that are required to
address the determinants of health in a globalized world through health promotion. It
affirms that policies and partnerships to empower communities, improve health and
reduce health inequalities should be at the centre of global and national development.
The Bangkok Charter supports and builds upon the values, principles and action
strategies of health promotion established by the Ottawa Charter for Health Promotion
and the recommendations of the subsequent global health promotion conferences. These
are shared by activists and practitioners around the world and have been confirmed by
member states through the World Health Assembly.
The Bangkok Charter reaches out to people, groups and organizations that are critical to
the achievement of health. This includes governments at all levels, civil society, the
private sector and international organisations.
Health promotion
The United Nations recognize that the enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human being without discrimination.
Health promotion is based on this critical human right. It offers a positive and inclusive
concept of health as a determinant of the quality of life, and of mental and spiritual well
being. Health promotion is the process of enabling people to increase control over their
health and its determinants, and thereby improve their health. Health promotion is a core
function of public health and contributes to tackling communicable and chronic non
communicable diseases and emerging threats to health. It is an effective investment in
improving health and human development. It contributes to reducing both health and
gender inequities.
Addressing the determinants of health
The context for health promotion has changed markedly since the development of the
Ottawa Charter. Increasing inequities within and between countries, new patterns of
consumption and communication, commercialisation, environmental degradation, and
urbanization are some of the critical factors that influence health. Rapid and often adverse
social change affects working conditions, family patterns and the culture and social fabric
of communities. Health and demographic transitions have also contributed to this change.
Women and men are affected differently by these developments; the vulnerability of
children and exclusion of marginalised and indigenous groups have increased.
10.08.2005:23:50
1
Globalization can also open up new opportunities for cooperation to improve health, for
example through improved mechanisms for global governance and enhanced information
technology and communication, and sharing of solutions. Health promotion strategies can
address avoidable transnational health risks by enabling policies and partnerships which
ensure that benefits for health from globalization are maximised and equitable, and the
negative effects are minimised and mitigated.
To manage this challenge, policy must be coherent across all levels of governments,
United Nations bodies and other organizations, including the private sector. This will
strengthen compliance, transparency and accountability with international agreements
and treaties that affect health. The global commitment to reduce poverty by addressing all
of the Millennium Development Goals is a critical entry point for health promotion
action. The active participation of civil society is crucial in this process.
Strategies for health promotion in a globalized world
Progress towards a healthier world requires strong political action, broad participation
and sustained advocacy. Health promotion has an established repertoire of proven
effective strategies which need to be fully utilised. To make further advances all sectors
and settings must act to:
Advocate for a rights based approach to health promotion;
Invest in sustainable policies, actions and infrastructure to address the determinants of
health;
Build capacity for policy development, leadership, health promotion practice, knowledge
and research, and health literacy;
Partner and build alliances with public, private and nongovernmental organizations to
create sustainable actions;
Regulate and legislate to ensure a high level of protection from harm, and enable equal
opportunity for health and well being for all people.
Commitments to health for all
Make the promotion of health central to the global development agenda
Government and international bodies must act to close the gap in health between rich and
poor. Strong intergovernmental agreements that increase health and collective health
security need to be in place. Effective mechanisms for global governance for health are
needed to address the harmful effects of trade, products, services and marketing
strategies. Health promotion must become an integral part of domestic and foreign policy
and international relations, including in situations of war and conflict. This requires
actions to promote dialogue and cooperation among nation states, civil society, and the
private sector that build on the example of existing treaties such as the World Health
Organization Framework Convention for Tobacco Control.
10.08.2005:23:50
2
Make the promotion of health a core responsibility for all of government
Health determines socio-economic and political development. Therefore governments at
all levels must tackle poor health and inequalities as a matter of urgency. The health
sector has a key role to provide leadership in building policies and partnerships for health
promotion. Responsibility to address the determinants of health rests with the whole of
government, and depends upon actions by many sectors as well as the health sector. An
integrated policy approach within government, and a commitment to working with civil
society and the private sector is essential to make progress in addressing these
determinants. Local, regional and national governments must give priority to investments
in health, within and outside the health sector, and provide sustainable financing for
health promotion. To ensure this, all levels of government should make the health
consequences of policies and legislation explicit, using tools such as health impact
assessment and national or local health plans.
Make the promotion of health a key focus of communities and civil society
Communities and civil society often lead in initiating, shaping and undertaking health
promotion. They need to have rights, resources and opportunities so that that their
contributions are amplified and sustained, and support for capacity building is important
less developed communities. Well organized and empowered communities are not only
highly effective in determining their own health, and as partners with others, but are also
capable of making governments and the private sector accountable for the health
consequences of their policies and practices. Civil society needs to exercise
its power in the marketplace by giving preference to the goods, services and shares of
companies that exemplify corporate social responsibility. Successful grass roots
community projects, civil society activities, and women’s organizations have
demonstrated their effectiveness in health promotion, and provide models of practice for
others to follow.
Make the promotion of health a requirement for good corporate practices
The private sector has a direct impact on the health of people and on the determinants of
health through their influence on local and national cultures, environments and wealth
distribution. The private sector has a responsibility to ensure the health and safety, and
promote the health and well being of their employees, their families and communities.
They also contribute to wider global health impacts, such as those associated with global
environmental change. The private sector must ensure that its actions comply with local,
national and international regulations and agreements that promote and protect health.
Ethical and responsible business practices, and fair trade have been spearheaded by some
companies exemplify the type of business practice that should be supported by
consumers, and through government incentives and regulations.
10.08.2005:23:50
3
A global pledge to make it happen
Meeting these commitments requires better application of existing, proven strategies, as
well as the use of new entry points and innovative responses. Partnerships, alliances,
networks and collaborations provide exciting and rewarding ways of bringing people and
organizations together around common goals and joint actions to improve the health of
populations. Each sector, government, civil society and the private sector, has a unique
role and responsibility. However, progress in addressing the underlying determinants of
health in many cases will only occur by working together so that resources can be used
more effectively and efficiently to achieve lasting results.
Since the adoption of the Ottawa Charter, a significant number of resolutions at national
and global level have been signed in support of health promotion. The participants of this
Bangkok Conference forcefully call on Member States and the World Health
Organization to proceed to close this implementation gap and move to policies and
partnerships for action.
Conference participants expect the World Health Organization, in collaboration with
others, to work with Member States to allocate resources, initiate a plan of action,
monitor performance through appropriate indicators and targets, and report on progress at
regular intervals.
This Bangkok Charter urges everyone to join in a worldwide health promotion
partnership to promote health, with both global and local engagement and action. We, the
participants of the 6th Global Conference on Health Promotion in Bangkok, Thailand,
pledge to advance these commitments to improve health, and to advocate for the required
resources, policies and practices.
11 August 2005
10.08.2005: 23:50
4
Draft 7
The Bangkok Charter for Health Promotion in a globalized world
Overview
Policies and partnerships} to improve health, empower communities and reduce health
inequalities must be at the centre of global and national development. The Bangkok
Charter identifies major challenges,jactions tiiid^ommilmen'ts)needed to address the
determinants of health in a globalized world.
The Bangkok Charter builds upon tine principles and values of health promotion
established in tine Ottawa Charter for Health Promotion and the recommendations of the
subsequent globafhealth promotion conferences.
The Bangkok Charter reaches out to the many actors and stakeholders that are critical to
the achievement of health. This includes international organisations, governments, civil
society and the private sector.
Context, challenges and actions
Health promotion
One of the fundamental rights of every human being is the enjoyment of the highest
attainable standard of health. Health promotion is based on a positive and inclusive
concept of health that emphasizes the quality of life, and mental and spiritual well being.
Health promotion is the process of enabling people to increase control over their health
and its determinants, and thereby improve their health. It is an effective investment in
improving health and reducing health and gender inequalities.
Global context
Addressing the determinants of health requires continuous adaptation of policies and
actions to improve health. The context for health promotion action has changed markedly
since the development of the Ottawa Charter. Continued environmental degradation,
urbanization and changes to working conditions, as well as political, epidemiological and
demographic transitions have all contributed to this changed context.
While globalization can open up new opportunities for cooperation to improve health it
can also weaken governmental control over health determinants, increase inequalities in
health (particularly for women, for marginalized and indigenous peoples), and subject
individuals and communities to rapid and often adverse social change.
A goal of health promotion is to create policies and partnerships to ensure that the
positive benefits for health of globalization are maximised, and the negative effects are
minimised and mitigated.
To achieve this goal, policy coherence is required between all levels of governments,
United Nations bodies and other organizations, to ensure compliance, transparency and
10.08.2005: 3:15am
J
accountability with international agreements and treaties that affect health. Of particular
importance is die global agreement to poverty reduction and the other Millennium
Development Goals; the active participation of civil society is critical in this process.
National Challenges
While primary responsibility for health promotion lies in the healdi sector, responsibility
to address the determinants of health often rests with other pails of government. Policies
and practices that improve health are required from both the public and private sectors. A
whole of government approach to improving health and a commitment to partnership is
essential to make progress in addressing die determinants of health.
Priority’ Actions
Progress towards a healthier world requires strong political action and active participation
by the many stakeholders. Health promotion has an established repertoire of effective
strategies which need to be frilly utilised in order to ensure tliis action and participation.
To ensure continuing and sustainable progress, four priorities for action across sectors are
to:
Invest in sustainable policies, actions and infrastructure to tackle the determinants of
health;
Build capacity to promote health, particularly in policy development and practice, health
impact assessment, health literacy, community actions, leadership, workforce, monitoring
and research
£ Partner and build alliances with public, private and nongovernmental organizations to
create sustainable actions to address the determinants of health
Regulate to ensure a high level of protection from harm, and ensure equal opportunity
---- for health and well being for all people.
New commitments
To meet the wide range of existing, emerging and potential future opportunities and
challenges, commitment is required by all stakeholders to:
Make the promotion of health central to the global development agenda
This requires actions to promote dialogue and cooperation among civil society, the
private sector, government and intergovernmental bodies to coordinate health promotion
actions. Public health considerations need to become an integral part of foreign and
domestic policy and international relations, including during times of conflict. National
government action and intergovernmental alliances that increase positive health benefits
and protect people from the potentially harmful effects of trade, products, services and
marketing strategies are essential.
Make the promotion of health a core responsibility of all of government
To ensure that health promotion is an integral part of socio-economic and political
development, governments at all levels must tackle the underlying causes of poverty,
poor health and inequalities as a matter of priority. Governments need to make the health
10.08.2005: 3:15am
2
impact and consequences of all policies and legislation explicit, and ensure that
investments outside the health sector contribute to the achievement of positive health
outcomes.
Make the promotion of health a requirement for good corporate practices
Private sector activity has a direct impact on the health of people, and on the determinants
of healtli. The private sector has a responsibility to ensure the health and safety, and
promote the health and well being of their employees, their families and communities.
The sector must also ensure that production processes, products and marketing strategies
comply with local, national and international regulations and agreements that promote
and protect health. This includes environmental and trade practices that do not
compromise living conditions and healtli.
Make the promotion of health a key focus of communities and civil society
Non governmental organisations have a crucial role in demanding and creating health.
Communities and civil society often lead in initiating, shaping and undertaking health
promotion - but they need to be supported so that their contributions are amplified and
sustained. Policies and environments need to be strengthened so that individuals and
communities are empowered to take action with others and on their own.
Partnerships for health
While each sector - government, private sector and civil society - has a unique role and
responsibility, partnerships provide new opportunities and unlock new resources and
energy to tackle the major health promotion challenges and meet the key commitments.
Formal and informal alliances and networks operate at all levels and can bring people and
organisations together around a common goal and joint action to improve the health of
populations. Strong partnerships enable stronger and more sustainable approaches to
tackle the underlying determinants of health and use resources more effectively and
efficiently.
A global pledge
This Bangkok Charter urges all stakeholders to work together in a worldwide health
promotion partnership, with global and local engagement and action, to undertake the
actions and commitments outlined above for the health and well being of all.
To measure progress on implementation of the Bangkok Charter, Conference participants
call upon tire World Health Organization, in collaboration with other partners, to work
with Member States to develop appropriate indicators, processes and mechanisms.
We, the participants of the 6th Global Conference on Health Promotion in Bangkok,
Thailand, pledge to advance the actions and commitments outlined in this Charter.
10.08.2005: 3:15am
3
DRAFT
Version 6 29/7/05
The Bangkok Charter for Health Promotion
Overview
The Bangkok Charter for Health Promotion in a globalized world highlights the new
challenges, the commitments to be made and the actions to be undertaken by all
stakeholders to address the determinants of health. This Charter aims to engage and
provide guidance to all health promotion stakeholders. The goal is to position health
improvement and the reduction of health inequalities at the centre of global and
national development agendas.
Health is a
human right
One of the fundamental rights of every human being is the enjoyment of the highest
attainable standard of health. Health is a "state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity".
Values
Health promotion is based on the following values:
•
»
o
Social justice and gender and health equity within and between countries
Respect for diversity and human dignity
Peace and security
Public health
and health
promotion
Public health action underpins the achievement of Health For All. Health promotion, a core
function of public health, is the process of enabling people to increase control over their
health and its determinants, and thereby improve their health. It embraces community
actions by people and supportive actions by decision-makers to improve the underlying
conditions that affect physical, mental, social and cultural aspects of health.
Ottawa Charter
and global
health
promotion
conferences
The Bangkok Charter endorses the principles and purposes of health promotion as laid out
in the Ottawa Charter and the recommendations of the subsequent global conferences held
in Adelaide, Sundsvall, Jakarta and Mexico City. The Bangkok Charter builds on the
Ottawa Charter’s five Action Areas:
•
»
•
o
•
Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient health services
'■
Context, challenges and opportunities
National
challenges
While special responsibility for health promotion lies in the health sector, it alone cannot
achieve health for all. Health supportive policies from both the public and private sector
are required. Therefore the adoption of the whole of government approach and partnership
among all stakeholders for health are essential to address the determinants of health. It is
crucial to build the capacity for health promotion in all sectors at the local and national
levels.
DRAFT
1
DRAFT
Version 6 29/7/05
Global changes
Environmental degradation, urbanization and political, epidemiological and demographic
transitions, advances in science and information technology, the role of the state and
particularly globalization, have markedly changed the context for health since the Ottawa
Charter.
Health
promotion in a
globalizing
world
Globalization opens up new opportunities for cooperation and health improvement. It can
also:
»
»
•
Weaken governmental control over a growing number of health determinants
Subject individuals and communities to rapid and often adverse social change
Reduce social and economic development prospects particularly for marginalized
and indigenous peoples
Policy cohesion is required between all levels of governments, United Nations bodies and
other organizations for more equitable globalization. Globalization also demonstrates the
central importance of poverty reduction for health improvement and the economic and
social development of nations, as emphasized by the importance given to health in the
Millennium Development Goals and other international agreements.
Active
participation
required
Progress towards a healthier world requires strong political action and active participation
by many stakeholders including:
o
o
o
o
o
o
The health sector
Governments
International organizations
The private sector
Nongovernmental organizations and civil society
The wider community
New commitments
Four
commitments
To meet the wide range of existing, emerging and potential future opportunities and
challenges, commitment is required by all stakeholders to ensure that:
•
•
•
•
Make the
promotion of
health central
to the global
development
agenda
Globalization becomes a positive force for improving the health of populations
The promotion of health is a core responsibility of all governments
The promotion of health is a key criterion for good corporate practices
Environments empower individuals and communities to improve their health
The task of ensuring that the promotion of health becomes central to the global
development agendas requires actions by all concerned stakeholders to:
•
•
•
•
•
Promote dialogue and cooperation among civil society, the private sector,
government and intergovernmental bodies to coordinate public health actions
Balance the benefits of globalization with the benefits of local action so that the
assets of culture are preserved and cultural diversity is enhanced
Make public health considerations an integral part of foreign and domestic policy
and international relations including during times of conflict
Support national government actions and intergovernmental alliances that increase
positive health benefits and protect people from the potentially harmful effects of
products, services and marketing strategies
Address the brain drain of health expertise from developing countries
DRAFT
2
DRAFT
Version 6 29/7/05
To ensure that health promotion is an integral part of socioeconomic and political
Make the
development, governments should use the whole of government approach to:
promotion of
health a core
responsibility of
• Tackle the underlying causes of poverty, poor health and inequalities
governments
® Ensure that the health implications of all government policies and legislation are
taken into consideration
o Ensure that investments outside the health sector contribute to the achievement of
positive health outcomes
o Develop appropriate legal and regulatory frameworks to promote public-private
and intersectoral collaboration
o Invest in health promotion capacity, research and its application to practice
Make the
promotion of
health a
criterion for
good corporate
practices
The private sector is an important stakeholder in the achievement of population health.
This sector needs to:
o
o
o
o
Promote
environments
that empower
individuals and
communities
Invest in health and safety and promote well-being of employees, their families
and communities
Ensure that production processes, products and marketing strategies do not
undermine health
Foster public-private collaboration and multinational alliances to enhance health
through greater corporate social responsibilities
Undertake collaborate efforts with public sector health care providers to enhance
access to basic, good quality and affordable health services
This commitment will include actions that:
o
®
o
o
•
Provide policy environments which enable communities to engage in selfdetermined health promotion action
Establish networks and partnerships, particularly with nongovernmental
organizations, that strengthen community actions for tackling local, national and
global health issues
Support evidence-based traditional and complementary approaches to health
Make health-promoting information available to every individual and engage in
efforts to ensure high levels of health literacy
Assist communities to engage in activities that promote mental health especially
when they are undergoing rapid transition
Making it happen
Implementation
Support for the Bangkok Charter is an important step in strengthening action-oriented
health promotion. This will require:
•
•
•
•
Adopting integrated strategies in multiple settings across all age groups.
Acknowledging the importance of partnerships for health
Recognizing the urgent need to strengthen health promotion capacity
Affirming the adoption of the evidence-based approaches to policy development
and practice
DRAFT
3
DRAFT
Implementation
guide
Version 6 29/7/05
To ensure continuing progress on health promotion, the following implementation guide is
proposed:
#
Requirements
Actions
1
Invest
2
Advocate
3
Build capacity
4
Enable and
mobilize
5
Collaborate
Achieve adequate and sustainable financing for investment in
actions that tackle the determinants of health and in health
systems that are appropriate, affordable and accessible
Advocate for evidence-based policy development and practices
that support and protect health by engaging the political system at
all levels, and by working with nongovernmental and community
organizations
Build capacity to promote health, particularly in the areas of
policy development and practice, health literacy, community
actions, leadership, workforce and research
Enable and mobilize individuals and communities to overcome
structural barriers to health, to enhance social support, and to
reinforce social norms conducive to health, in particular through
information and communication technology
Collaborate and build alliances with public, private and
nongovernmental organizations to create sustainable actions
across sectors to address the determinants of health
Health
promotion is
result oriented
The health of the population is a key criterion of the success in managing the natural and
social environments. To measure progress on implementation of the Bangkok Charter, the
World Health Organization, in collaboration with other partners, will encourage, and work
with, Member States to develop appropriate indicators, processes and mechanisms.
Benchmarks
for measuring
progress
The following benchmarks, against which progress can be measured, will enable countries
and communities to report on progress in 2009 and at regular intervals:
•
»
°
•
•
»
A global pledge
Capacity for health promotion
Investment in health promotion
Health concerns in international trade agreements
Policies focusing on health determinants in all sectors
Stakeholder participation in health promotion policy formulation, planning and
implementation
Trends in health of the population and in health inequalities
This Bangkok Charter urges all stakeholders to work together in a worldwide health
promotion partnership, with global and local engagement and action, to undertake the
commitments and strategies outlined above for the health and well-being of all.
We, the participants of the 6th Global Conference on Health Promotion in Bangkok,
Thailand, strongly support the values, commitments and actions outlined in this Charter.
DRAFT
4
DRAFT
Version 6 29/7/05
The Bangkok Charter for Health Promotion
Overview
The Bangkok Charter for Health Promotion in a globalized world highlights the new
challenges, the commitments to be made and the actions to be undertaken by all
stakeholders to address the determinants of health. This Charter aims to engage and
provide guidance to all health promotion stakeholders. The goal is to position health
improvement and the reduction of health inequalities at the centre of global and
national development agendas.
Health is a
human right
One of the fundamental rights of every human being is the enjoyment of the highest
attainable standard of health. Health is a "state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity".
Values
Health promotion is based on the following values:
•
•
•
Social justice and gender and health equity within and between countries
Respect for diversity and human dignity
Peace and security
Public health
and health
promotion
Public health action underpins the achievement of Health For All. Health promotion, a core
function of public health, is the process of enabling people to increase control over their
health and its determinants, and thereby improve their health. It embraces community
actions by people and supportive actions by decision-makers to improve the underlying
conditions that affect physical, mental, social and cultural aspects of health.
Ottawa Charter
and global
health
promotion
conferences
The Bangkok Charter endorses the principles and purposes of health promotion as laid out
in the Ottawa Charter and the recommendations of the subsequent global conferences held
in Adelaide, Sundsvall, Jakarta and Mexico City. The Bangkok Charter builds on the
Ottawa Charter’s five Action Areas:
•
•
•
•
•
Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient health services
Context, challenges and opportunities
National
challenges
While special responsibility for health promotion lies in the health sector, it alone cannot
achieve health for all. Health supportive policies from both the public and private sector
are required. Therefore the adoption of the whole of government approach and partnership
among all stakeholders for health are essential to address the determinants of health, it is
crucial to build the capacity for health promotion in all sectors at the local and national
levels.
DRAFT
1
D R A
Global changes
F T
Version 6 29/7/05
Environmental degradation, urbanization and political, epidemiological and demographic
transitions, advances in science and information technology, the role of the state and
particularly globalization, have markedly changed the context for health since the Ottawa
Charter.
Health
promotion in a
globalizing
world
Globalization opens up new opportunities for cooperation and health improvement. It can
also:
•
•
•
Weaken governmental control over a growing number of health determinants
Subject individuals and communities to rapid and often adverse social change
Reduce social and economic development prospects particularly for marginalized
and indigenous peoples
Policy cohesion is required between all levels of governments, United Nations bodies and
other organizations for more equitable globalization. Globalization also demonstrates the
central importance of poverty reduction for health improvement and the economic and
social development of nations, as emphasized by the importance given to health in the
Millennium Development Goals and other international agreements.
Active
participation
required
Progress towards a healthier world requires strong political action and active participation
by many stakeholders including:
•
•
•
•
•
•
The health sector
Governments
International organizations
The private sector
Nongovernmental organizations and civil society
The wider community .
New commitments
Four
commitments
To meet the wide range of existing, emerging and potential future opportunities and
challenges, commitment is required by all stakeholders to ensure that:
•
•
•
•
Make the
promotion of
health central
to the global
development
agenda
Globalization becomes a positive force for improving the health of populations
The promotion of health is a core responsibility of all governments
The promotion of health is a key criterion for good corporate practices
Environments empower individuals and communities to improve their health
The task of ensuring that the promotion of health becomes central to the global
development agendas requires actions by all concerned stakeholders to:
•
•
•
r
'•
•
Promote dialogue and cooperation among civil society, the private sector,
government and intergovernmental bodies to coordinate public health actions
Balance the benefits of globalization with the benefits of local action so that the
assets of culture are preserved and cultural diversity is enhanced
Make public health considerations an integral part of foreign and domestic policy
and international relations including during times of conflict
: Support national government actions and intergovernmental alliances that increase
positive health benefits and protect people from the potentially harmful effects of
products, services and marketing strategies
Address the brain drain of health expertise from developing countries
DRAFT
2
D R A
Make the
promotion of
health a core
responsibility of
governments
•
•
•
•
Tackle the underlying causes of poverty, poor health and inequalities
Ensure that the health implications of ail government policies and legislation are
taken into consideration
Ensure that investments outside the health sector contribute to the achievement of
positive health outcomes
Develop appropriate legal and regulatory frameworks to promote public-private
and intersectoral collaboration
Invest in health prom^tjon capacity, research and its application to practice
The private sector is an important stakeholder in the achievement of population health.
This sector needs to:
•
•
•
»
Promote
environments
that empower
individuals and
communities
Version 6 29/7/05
To ensure that health promotion is an integral part of socioeconomic and political
development, governments should use the whole of government approach to:
•
Make the
promotion of
health a
criterion for
good corporate
practices
F T
Invest in health and safety and promote well-being of employees, their families
and communities
Ensure that production processes, products and marketing strategies do not
undermine health
Foster public-private collaboration and multinational alliances.to enhance health
through greater corporate social responsibilities
Undertake collaborate efforts with public sector health care providers to enhance
access to basic, good quality and affordable health services
This commitment will include actions that:
•
•
•
•
•
Provide policy environments which enable communities to engage in selfdetermined health promotion action
Establish networks and partnerships, particularly with nongovernmental
organizations, that strengthen community actions for tackling local, national and
global health issues
Support evidence-based traditional and complementary approaches to health
Make health-promoting information available to every individual and engage in
efforts to ensure high levels of health literacy
Assist communities to engage in activities that promote mental health especially
when they are undergoing rapid transition
Making it happen
Implementation
Support for the Bangkok Charter is an important step in strengthening action-oriented
health promotion. This will require:
•
•
•
•
Adopting integrated strategies in multiple settings across all age groups.
Acknowledging the importance of partnerships for health
Recognizing the urgent need to strengthen health promotion capacity
Affirming the adoption of the evidence-based approaches to policy development
and practice
D
R A
F T
D R A
Ini piementation
guide
I-' T
Version 6 29/7/05
To ensure continuing progress on health promotion, the following implementation guide is
proposed:
Req uirements
Actions
1
Invest
Advocate
J
Build capacity
4
Enable and
mobilize
5
Collaborate
Achieve adequate and sustainable financing for investment in
actions that tackle the determinants of health and in health
sv stems that arc appropriate, affordable and accessible
Advocate for evidence-based policy development and practices
that support and protect health by engaging the political system at
all levels, and by working with nongovernmental and community
organizations
Build capacity to promote health, particularly in the areas of
policy dev elopment and practice, health literacy, community
actions, leadership, workforce and research
Enable and mobilize indiv iduals and communities to overcome
structural barriers to health, to enhance social support, and to
reinforce social norms conducive to health, in particular through
information and communication technology
Collaborate and build alliances with public, private and
nongovernmental organizations to create sustainable actions
across sectors to address the determinants of health
Health
promotion is
result oriented
The health of the population is a key criterion of the success in managing the natural and
social environments. To measure progress on implementation of the Bangkok Charter, the
World Health Organization, in collaboration with other partners, will encourage, and work
with. Member States to develop appropriate indicators, processes and mechanisms.
Benchmarks
for measuring
progress
The following benchmarks, against which progress can be measured, will enable countries
and communities to report on progress in 2009 and at regular intervals:
Capacity for health promotion
Investment in health promotion—-—
* LLa—CK
.
Health concemsjjn international trade agreements
Policies focusing on health determinants in all sectors
Stakeholder participation in health promotion policy formulation, planning and
implementation
Trends in health of the population and in health inequalities
A global pledge
This Bangkok Charter urges all stakeholders to work together in a worldwide health
promotion partnership, with global and local engagement and action, to undertake the
commitments and strategies outlined above for the health and well-being of all.
We. the participants of the 6th Global Conference on Health Promotion in Bangkok.
Thailand, strongly support the values, commitments and actions outlined in this Charter.
D
R A
F T
Cuenca, Ecuador
21 July 2005
Submission from the People’s Health
Movement on The Fifth Draft, 24 June 2005,
of the Bangkok Charter for Health Promotion
Thank you for the opportunity to comment on the draft Bangkok Charter. This submission comes
from the People's Health Movement (PHM) and is based on email discussions between PHM
members and supporters worldwide and discussions held at the People's Health Assembly 2 in
Cuenca, Ecuador. The People's Health Movement is a worldwide coalition of people's
organisations, civil society organisations, NGOs, social activists, health professionals, academics
and researchers that endorse the People's Charter for Health
(httD://www.phmovement.orq/charter/pch-index.html).
The PHM is strongly focused on the interests of the poor and the marginalized and their struggle
for health. The People's Charter for Health summarises our basic ethos about the struggle to
achieve "health for all" as envisioned by the Declaration at Alma Ata. Our comments overall
reflect the discrepancies in focus and intent between the draft Bangkok Charter and the People's
Charter for Health
We appreciate the work and expertise that has gone into developing the draft Charter. We are
supportive of the intent to address global issues that have arisen since the Ottawa Charter was
drafted in 1986. However, we have concerns about many aspects of the draft and hope that our
comments will be taken constructively to inform the final draft to represent the interests of those
currently marginalised by the global obstacles to "health for all". We would thus like to make the
following points:
1.
We agree that health is a human right but would like to see this firmly grounded by
reference to Article 12 of the International Covenant on Economic, Social and Cultural
Rights, and more clearly articulated throughout the document.
2.
We see the reduction of inequalities between and within countries as a fundamental aspect
of health promotion and would like to see this re-instated explicitly as a principle in the draft
(in addition to referring to social justice and health equity).
3.
We believe that the increase in poverty and health inequalities since the Ottawa Charter
was drafted should be clearly identified.
4.
We believe that the Ottawa Charter has been very important in the development of health
promotion and that it remains relevant today. We would like to see a stronger endorsement
of the Ottawa Charter and more explicit identification that the Bangkok Charter will operate
alongside it, as opposed to replacing the Ottawa Charter.
5.
We believe that the draft should explicitly identify the serious negative forms and impacts of
the processes that may be collectively termed "globalisation". Key elements of current
globalisation such as transnational property and land tenure concentration; large-scale
1
social exclusion, privatisation of public resources; and the loss of human rights resulting
from commodification should be identified due to the challenges they pose to health.
6.
We believe the draft should also identify that the current processes of globalisation have
reduced social and economic development prospects, particularly for marginalised and
impoverished peoples, and that they have exacerbated health inequalities. Whilst some
members of developing countries have benefited from globalisation, it is important that the
overall negative effect of current modes of globalisation on health is noted.
7.
We argue that any potential positive health effects of a "globalising world" lie in adherence
by all nations to internationalised rights and obligations. The draft should therefore clearly
endorse and align with existing international human rights and environmental treaties, and
agreements such as the Framework Convention on Tobacco Control and the Millennium
Development Goals (MDGs). These treaties offer health promotion potentially powerful
frameworks which have the backing of international law.
8.
We are concerned that the draft charter is weaker than aforementioned existing
international human rights and environmental treaties, the MDGs and other international
agreements that promote health. If the draft is not clearly aligned as above, there is the risk
that it could be cynically used by corporations, states and international finance institutions
to claim that their actions were “health promoting in accordance with the Bangkok Charter’’
and thus avoid complying with stronger health promoting standards set by the international
treaties, agreements and MDGs. If this happened, the Charter would facilitate the
equivalent of “greenwash” and have a negative effect.
9.
We argue that the potential negative impacts on health of international trade agreements
should be identified and that rights which improve health should be asserted as
superordinate to the provisions of any such agreements and incorporated as such within all
bilateral, regional and multilateral trade agreements.
10.
We would like to see the endorsement of equity-focused health impact assessment of trade
agreements during their negotiation and the endorsement of assistance from global bodies
for poorer countries to undertake this.
11.
We reject that the importance of health is for poverty reduction. Rather, the relationship is
in the opposite direction whereby the importance of poverty reduction is for health.
12.
We suggest several other strategies to make globalisation less negative for health:
•
Trade agreements should be reformed to discriminate positively in favour of
economic development of low- and middle-income countries.
•
Debt owed by developing countries should be cancelled due to the negative impact
this transfer of wealth has on the health of the poor.
•
Economic conditionalities should be removed from debt cancellation, development
assistance or loans/grants from the international financial institutions and other
development banks.
•
Financial markets and international taxation systems should be reorganised to
ensure equitable cost-sharing of public programs and infrastructures amongst all
citizens and corporations.
•
All nations should immediately ratify, and agree on enforcement measures for, the
United Nations Convention on Corruption to reduce the negative health effects of
bribery and other forms of illegal or unethical practices involving multinational
corporations and governments.
13.
We strongly advocate the re-instatement of the need to support governments to work for
peace in areas of conflict and minimise the health impacts of war on peoples, given the
enormous effect that war continues to have on health.
2
14.
We reject the encouragement given to public-private partnerships throughout the draft.
Such partnerships do not improve health, particularly for the poor and marginalised peoples
that are our focus. Instead they contribute to the commodification of health. We do not
believe that advocacy of such partnerships is therefore consistent with health promotion. All
references to facilitation of such partnerships should be removed.
15.
We would add that a core responsibility of all governments is to develop appropriate legal
and regulatory frameworks to protect health from commercial activity and promote
appropriate, sustainable and health promoting intersectoral collaborations
16.
We strongly advocate the consideration of the health of indigenous peoples in the draft.
Currently, this is a serious omission. The Bangkok Charter should aim to be of particular
benefit to indigenous peoples given the specific and grave health problems they face.
17.
We believe that the draft could achieve this by aligning itself with the 1999 World Health
Organisation Declaration on the Health and Survival of Indigenous Peoples, which called
for action on the following:
•
Respect for all the rights of indigenous peoples as described in international
instruments and other treaties and agreements between governments and
indigenous peoples.
•
Recognition for indigenous peoples' concept of health and survival and expressions
of culture and knowledge.
•
Policies and programmes in capacity building, research, education, rectifying the
inequities and imbalances in globalisation; increased resources; co-ordination
between United Nations bodies; the participation of indigenous peoples at all stages
of policy development and implementation; and constitutional, legislative and
monitoring mechanisms.
•
Action on the broad determinants of the health and wellbeing of indigenous peoples
which include the effects of the loss of identity due to removal from family and
community, displacement and dispossession of lands, resources and waters, and the
destruction of languages and cultures; the impact of environmental degradation; the
need for sustainable development; the need for participatory community
development; and the effects of war and conflict.
18.
We believe that there should be consideration of labour rights in the draft, and support for
the need for governments and corporations to respect such rights globally and nationally,
including the ratification of International Labour Organisation conventions.
Once more, thank you for the opportunity to make this submission and contribute to the drafting
process for the Bangkok Charter. We look forward to the discussions at the 6lh Global Conference
on Health Promotion and the final document.
The People's Health Movement
People's Health Movement Secretariat (Global)
C/o Community Health Cell
# 367, "Srinivasa Nilaya", Jakkasandra I Main
I Block, Koramangala,
Bangalore- 560 034
India
Email: secretariat @ phmovement.org
Telephone: +91-80-51280009 (Direct) or + 91-80 - 25531518 (CHC)
Fax:
+91-80-25525372
3
STH GLOBAL CONFERENCE ON HEALTH PROMOTION
7TH - 11TH AUGUST 2005 ~ BANGKOK
"Policy and Partnership for Action:
Addressing the Determinants of Health"
NGO COALITIONS FOR GLOBAL HEALTH PROMOTION
TheEma hlarayan, Community Health CeBO,
PeopEes Health Movement
Marilyn Wise,
International LOnoon for Health
Promotion and) Education
TesfesmacaeE <Shebr®hiwetf Internatioriial Council
of Nuirses
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
Technical Session
Emerging health issues: the widening cha'^ige
for population HP
"Back to the future" - a perspective on
environmental change, environmental health and
creating supportive environments for health
Health in new urban settings
Health of the marginalized groups
Track
1 (11:00-12:30)
Julita Maradzika
1 (11:00-12:30)
Rob Moodie
Gender and health promotion: a multisectoral
policy approach
Promoting mental health as a neglected issue
Health promotion capacity mapping - a global
overview
Trade agreements and public health
Regulation of products harmful to health in an era
of globalization
Health as foreign policy: harnessing globalization
for health
Globalization, workplace and health
PH emergencies of international concern
How to strengthen corporate responsibility and
MNC commitment to HP
Trade liberalization and the diet and nutrition
transition: a public health response
Global health promotion
NGO coalition for global health promotion
The role of private sector foundation in health
promotion
The role of independent health providers/practitioners
in HP
Contribution of HP to the achievement of MDGs
Integrated HP strategies
Setting-based HP: a contribution to tackling current and
future health challenges
Information and communication for HP - towards a
health competent society
The whole of government approach to promote health
Knowledge management and HP
Building the capacity of MOH to promote health
Building community capacity to promote health
Sustainable financing for HP: issues and challenges
Integrated HP into health systems
Health impact assessments and the globalization
challenges
1 (11:00-12:30)
1 (11:00-12:30)
Chair
j ftl/F
F
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AFR
Rapporteur
Francis Namisi
WPR
Katrin Engelhardt
Region
M/F
M
Region
AFR
F
WPR
F
AFR
EUR
F
EMR
Gail Andrews
F
AFR
F
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David Houeto
Hope Corbin
1 (11:00-12:30)
Claudia Kessler
Bodiang
Rima Afifi-Soweid
F
EMR
Rima Nakkash
1 (11:00-12:30)
Thai Health
F
SEAR
1 (11:00-12:30)
F
EUR
2 (16:00 -1730)
2 (16:00 -1730)
Maurice
Mittelmark
Nick Drager
Mikael Forss
F
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2 (16:00 -1730)
Sirikul Isaranurug
2 (16:00 -1730)
2 (16:00 -1730)
Christer Hogstedt
Sylvie Stachenko
2 (16:00 -1730)
2 (16:00 -1730)
Marica Faria
Westphal
Jacques Baudouy
2 (16:00 -1730)
3 (11:00-12:30)
3 (11:00-12:30)
Thelma Narayan
Michael O'Donnell
Rob Moodie
3 (11:00-12:30)
Julita Maradzika
3 (11:00-12:30)
3 (11:00-12:30)
3 (11:00-12:30)
Nicholas Muraguri
Colin Sindall
Maurice
Mittelmark
3 (11:00-12:30)
Claudia Kessler
Bodiang
4(16:00 -1730)
Marica Faria
Westphal
4(16:00 -1730)
4 (16:00 - 1730)
4(16:00 -1730)
4 (16:00 -1730)
4 (16:00 - 1730)
4(16:00 - 1730)
Rima Afifi-Soweid
Ahmed Mohit
Gail Andrews
Mikael Forss
Linda Milan
Christer Hogstedt
M
IUHPE
Nithat
Sirichotiratana
Catherine Jones
M
M
WHO
EC
Anne Andermann
Caroline Costings
F
SEAR
Simon Carroll
F
EUR
AMR
F
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Sarah Wamala
Gaelle PicheritDuthler
Jaime Sapag
M
WB
M
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M
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PHM
EMR
WPR
Mary AmuyunzuNyamongo
Ahmed Afaal
M
SEAR
AMR
F
F
M
M
Katrin Enelhardt
Francis Namisi
M
M
M
AFR
WPR
M
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Raymond Mbouzeko
Filomena Wilson
Catherine Jones
F
EUR
Ulla-Karin Nurm
F
AMR
Jaime Sapag
F
EMR
EMR
AFR
EUR
Rima Nakkash
M
F
M
F
M
WPR
EUR
Lilia Veto
David Houeto
Caroline costings
Mabel Yap
Sarah Wamala
AFR
SEAR
F
F
AFR
F
AMR
F
Juliana de Paula
EUR
AMR
AMR
WPR
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—4
•A
How to strength corporate social responsibility and MNC
commitment to Health Promotion
Robert Mallett, Ken Gustavsen, Stella Bialous
The 6th Global Conference on Health Promotion
Bangkok, Thailand, 7-11 August 2005
Abstract
This session will concentrate on the growing role of multi-national corporations (MNCs) in
addressing major public health issues by creating effective public-private partnerships. The
session begins with an overview of the role of MNCs in addressing health issues to set the stage
for a more specific case study. The case study will focus on the Mectizan Donation Program,
which is considered a best practice. Spearheaded by MERCK, the successes and challenges of
implementing the program and the effectiveness of MNCs in addressing health issues will be
discussed. This session will also provide examples from the tobacco industry to illustrate when
public/private partnerships are not in the public's interest.
There will be three short presentations by respectively R Mallett, Ken Gustavsen, Stella Bialous
For the manuscript of Stella Bialous, please refer to 6a Manuscripts
Position: 2815 (3 views)