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Health Equity in All Urban Policies
A report on the Expert Consultation on Intersectoral Action (ISA)
in the Prevention of Noncommunicable Conditions
22–24 June 2009, Kobe, Japan
Table of Contents
Executive Summary
1. Background .................................................................................................................1
2. Objective and programme...........................................................................................2
3. Discussion points ........................................................................................................2
4. Conclusions.................................................................................................................7
5. Way forward ...............................................................................................................9
Box 1: Main recommendations for national policy-makers ..............................................10
Box 2: Intersectoral action mechanisms in tobacco control: The experience of the WHO
FCTC.......................................................................................................................11
Box 3: Viet Nam's national mandatory helmet law ...........................................................12
Box 4: Intersectoral action for the prevention of chronic noncommunicable diseases in
China .......................................................................................................................13
References...........................................................................................................................14
Annex 1: Programme .........................................................................................................15
Annex 2: List of participants..............................................................................................21
Executive Summary
In some ways, the debate about intersectoral action on health is as old as public health
as a discipline. Several studies of infectious diseases in the 19th century pointed out the need
to implement sanitation policies and to promote proper housing in order to prevent or combat
diseases. The call for the involvement of sectors in addition to health in the formulation of
health policies is a longstanding one within WHO. Our Constitution calls for cooperation
with other specialized agencies and identifies several key areas including nutrition, housing,
sanitation, recreation, and working conditions. The Alma Ata Conference is recognized as the
formal acknowledgement of intersectoral action on health.
The WHO Commission on Social Determinants of Health 2005–2008 deepened our
understanding of the impact of multi-sector action on health equity. The inequitable
distribution of power, money, and resources cannot be addressed if the health sector is alone
in designing and implementing public policies to mitigate social determinants of health. In
2009, the World Health Assembly called for intersectoral action on health and adopted a
resolution, “Reducing health inequities through action on the social determinants of health”.
Despite this background, we can hardly say there is enough intersectoral action taking
place today. In fact, there is need for more. It is common to find policy-makers from the
health sector, and also from other areas such as education, calling for intersectoral action.
Unfortunately, we also find frustrated public health practitioners and policy-makers who
despite their conviction of its need have not been successful in initiating it. Why is this so?
One of the reasons is that there are only a few easily replicable models of successful
intersectoral action.
In order to identify mechanisms that will help policy-makers to trigger effective
intersectoral action, an interesting mix of public health practitioners, policy-makers,
academics and fellow WHO colleagues from different disciplines gathered in Kobe, Japan at
the WHO Centre for Health Development in June 2009. Experiences from 20 countries were
analysed. The topics included tobacco control, nutrition, urban planning, health impact
assessment and human rights. Although several of the analyses drew on noncommunicable
disease and urban experiences, the conclusions arrived at were broad and applicable to public
health as a whole.
This report contains a set of practical recommendations for policy-makers on how to
trigger intersectoral action. The need for high-level “political commitment” and adaptation of
the policies to the local political, economical, cultural and social contexts was recognized as
crucial to success. Based on lessons learned, these recommendations are a useful contribution
in implementing Objective 1 of the Action Plan of the Global Strategy for the Prevention and
Control of Noncommunicable Diseases. Further work will be needed to attain this Objective
and to provide technical guidance to Member States on effective mechanisms to
achieve "Health in All Policies".
1. Background
Since the beginning of public health as a discipline, the complex net of interrelated
factors that influence health has been an important consideration. Beginning with the Alma
Ata Declaration in 1978, WHO has explicitly promoted approaches that account for these
factors. Today, the need to include many sectors of society in addition to the traditional
“health sector” in the process of designing and implementing public policies to improve
quality of life, known as intersectoral action for health (ISA), is widely recognized, and is a
WHO priority (WHA Resolution 62.12, 62.14). The role of the social determinants of health
and WHO’s renewed commitment to primary health care also reinforce the need to identify
mechanisms to promote ISA.
Many WHO reports and documents call for a broader involvement in policies far
beyond the traditional health sector. Moreover, the recent work of the WHO Commission on
Social Determinants of Health (CSDH) and the 2008 World Health Report on Primary Health
Care have clearly captured the importance of collaboration among sectors if we are to have a
real impact on health (1, 2).
In the time when a number of new health challenges are adding up, there is an urgent
need for more intersectoral action today. Many reports, scientific papers, policy commitments
and advocacy initiatives, as well as the weight of everyday public health practice, have
helped to convince policy-makers, especially in the health arena, of the need for intersectoral
action. Today, it is common to find policy-makers from the health sector and elsewhere
calling for a united approach. However, we also find frustrated health ministers who, despite
their conviction of the need for ISA, have not been successful in initiating it. One of the
reasons is that few easily replicable successful models of intersectoral action exist, and the
features of policy-making that should be encouraged in order to facilitate intersectoral action
are not well mapped. There is also a felt need to define suitable mechanism explaining how to
practically implement ISA for urban health policies.
Intersectoral action for health was defined at a conference entitled Intersectoral action
for health: a cornerstone for health for all in the 21st century held in Canada in 1997 as “a
recognized relationship between part or parts of another sector which has been formed to take
action on an issue to achieve health outcomes (or intermediate health outcomes) in a way that
is more effective, efficient or sustainable than could be achieved by the health sector acting
alone” (3). This definition has been elaborated in the collaborative work between the Public
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Health Agency of Canada (PHAC) and WHO, An analysis of 18 country case studies: health
equity through intersectoral action. The report refers to ISA as “actions undertaken by
sectors outside the health sector; possibly, but not necessarily, in collaboration with the health
sector, on health or health equity outcomes or on the determinants of health or health equity”
(4). This enhanced definition attempts to incorporate the spectrum of intersectoral policy-
making and implementation models ranging from cooperation and collaboration to
integration (and whole-of-government approaches that achieve “Health in All Policies –
HiAP”). The term “multisectoral” is used to refer to the engagement or activities of many
sectors, whether they be economic or social sectors. Cross-sectoral is also used as a synonym.
2. Objective and programme
A consultation was held at WHO Centre for Health Development in Kobe, Japan to
identify the challenges and find solutions to promote intersectoral action for health. The main
objective was to exchange experiences on effective mechanisms to implement and sustain
intersectoral action that impacts on reducing health inequities in urban settings with a special
focus on noncommunicable conditions (NCCs).
The consultation was conducted in four interactive sessions over two-and-a-half days.
Each session began with presentations and continued with group discussions to identify
practical recommendations and mechanisms for policy actions. Session 1 looked at the ISA
policy framework and strategies from urban and NCC perspectives. Session 2 was devoted to
reviewing experiences from countries. Session 3 focused on lessons from specific successful
policies and their prospects for replication. The last session delved into the relationship
between health impact assessment (HIA) and ISA. The final plenary discussion concluded
with recommendations on ISA for policy-makers.
3. Discussion points
The extensive exchange among the meeting participants covered a varied range of
issues around ISA. The discussion points are grouped in four different areas to facilitate
understanding: pre-conditions, mechanisms, specific issues for ISA, and challenges.
a. Preconditions
This section identified elements considered to be primary conditions for triggering
ISA.
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Participants emphasised that the role of social determinants in health outcomes should be
shared among policy-makers.
Evidence of the effectiveness of ISA helps policy-makers to allocate scarce resources and
respond to advocacy for ISA. It was emphasized by participants that evidence should be
placed in context since different contexts yield different decision-making.
Awareness of the limits of mono-sectoral work was frequently raised during the meeting
as a significant trigger for ISA. All sectors need to recognize the limitations of mono-
sectoral work to deal with NCC prevention. Unfortunately, some health sector
practitioners may still believe that they should deal with NCC prevention only with their
limited purview as they have traditionally done. This inhibits seeking assistance beyond
the health sector.
It was noted that NCC problems and their causes need to be identified and clearly
articulated. However, general problem statements may not attract non-health sectors. The
causes of problems should be specifically stated, such as “insufficient public
transportation” or “decreasing numbers of small retailers, reducing food accessibility” as
the basis to initiate ISA.
Policies made by non-health sectors can impact health, and health impact assessment
(HIA) has great potential to enhance other sectors’ understandings of the impact of their
policies on health. Participants recommended that governments use existing reviews and
appraisals to implement HIA as a strategy to enhance others sectors’ understandings of
their health impacts.
Health issues should be creatively presented and articulated to allow non-health sectors to
appreciate how they can contribute solutions to complex problems. One important
strategy is to interpret or describe health issues from the perspective of other sectors.
The concept of “co-benefits” was repeatedly stressed as significant to promote ISA. The
focus on co-benefits enables policy-makers from different sectors to develop integrated
strategies that address multiple issues simultaneously, and achieves shared benefits. Co-
benefits refer to the multiple and varying benefits in different fields resulting from a
single integrated strategy, policy, and action plan (5).
Non-health sectors’ engagement in valuing health and well-being, and sharing
accountability for health outcomes, also facilitates ISA. Non-health sectors have their
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own priorities and health is not necessarily high on their agendas. At the same time,
national and local governments have accountability for public services that are consistent
with the improvement of citizens’ health status, taking into consideration human rights
perspectives. Reframing policies for non-health sectors from the perspective of human
rights ensures accountability for health issues and increases the potential for ISA.
The health sector should review its role in stimulating, facilitating and implementing ISA.
It should share power and decision-making with other sectors to attract all the potential
players and involve them collaboratively. Also, there may be instances where other
sectors, such as education or environment, may have already implemented successful
intersectoral initiatives. The health sector can learn from their experience and should not
assume that ISA strategies relate only to health issues.
The involvement of international organizations can also be useful. They can make a
significant contribution in identifying and defining issues. Countries’ experiences from
WHO’s initiatives, such as tobacco control and road safety, clearly show the significant
role of international leadership.
b. Mechanisms
Seven elements were highlighted from the discussion on the mechanisms for ISA.
It was noted that high-level political commitment was essential for the success of ISA. It
aids the development and implementation of policy, and supports funding, legislative and
conflict resolution processes.
Common policy frameworks can potentially increase the chances of developing a shared
policy and a common plan of action across sectors. Such frameworks should incorporate
the concepts of social determinants of health, health inequity, and human rights.
Political change usually takes place when large parts of the population support it. Thus,
community involvement and community empowerment are keys to creating political will
for initiating ISA. Community involvement increases the chances of successful ISA
because it helps policy-makers understand the linkages between policies and
programmes. By involving those most affected and vulnerable groups, officials can
develop realistic solutions and policies that are likely to achieve health equity.
Governance structure and organizational developments are key to successful ISA
implementation. Ad hoc committees should be established as temporary bodies for
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discussions and negotiations among different government sectors, community agencies
and private sectors to launch ISA. Proper legislation can also facilitate collaboration
among different government sectors and strengthen their interaction.
The roles and responsibilities of each sector in an ISA should be delineated. Intersectoral
collaboration requires each actor to undertake distinct aspects of the integrated action.
Each sector needs to identify their unique contribution to, and responsibility for,
achieving the goal.
Monitoring and evaluation are significant tools for sustaining ISA. Through monitoring,
information is routinely gathered for tracking the progress of ISA action plans. Evaluation
determines the degree to which ISA projects are successful in achieving their planned
outcomes.
c. Specific issues for ISA
Three experiences are presented here as promising examples for ISA: tobacco control,
transportation laws, and the need for HIA.
Effective tobacco control requires collaboration with other economic and social sectors
including agriculture, the tobacco industry and civil society. The WHO Tobacco Free
Initiative describes the process to bring these sectors together, and provides suggestions
for resolving conflicts in initiating ISA (Box 2).
Expansion of transportation activities increases emissions of greenhouse gases and the
harm to health caused by factors related to traffic, such as air pollutants, noise, accidents
and reduces opportunities for physical exercise (e.g. walking and cycling). The health
sector must highlight these issues to advocate for and trigger intersectoral action as
described in the experiences of Viet Nam’s helmet law (Box 3).
Experiences from several countries suggest that health impact assessment has tremendous
potential to contribute to successful ISA. The assessment of the health impact of
proposed, or already implemented policies as in the case of noncommunicable diseases in
China (Box 4), often helps to highlight the need for coordinated efforts among several
sectors.
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d. Challenges
Several obstacles to ISA were discussed. In general, ISA is presented as an overly
complex process. It is important to focus on developing and initiating implementation of
ISA, addressing obstacles as they arise.
There is a lack of evidence of what works and what does not work in implementing ISA
plans. For example, cost-benefit arguments provide good incentives to negotiate with
other sectors. However, it is uncertain what economic changes ISA brings about.
It was noted that sectors are often reluctant to share information with each other. They
may fear a loss of control if their knowledge is made available to others, especially if
other sectors do not reciprocate. Therefore, sectors have a natural tendency to concentrate
their duties rather than promoting an ISA. In consequence, knowledge collected and
created by each sector is seldom used to develop integrated strategies for NCC
prevention.
Commercial interests often intrude on ISAs. Lack of interaction between health and other
government sectors often jeopardizes effective regulation of commercial activities that
impact on health. There are many cases where commercial interests have opposed strong
health-motivated tobacco and food regulations, for example, on the basis of allegedly
negative economic impact.
Intersectoral action is resource-intensive. Staff workloads may increase to negotiate with
other sectors whose interests may be divergent and perhaps in opposition. It also requires
sufficient financial resources to initiate and sustain multisectoral dialogue.
Political conditions may hinder implementation of ISA for NCC prevention. In some
countries, less attention is paid to NCC prevention as they are burdened with even more
pressing problems such as acute infectious diseases.
Governmental sectors often try to protect their vested interests and to stake their claim to
limited resources in the political process. This encourages competition between sectors,
rather than cooperation. There is limited effort to recognize, understand and appreciate
the contributions of other sectors.
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4. Conclusions
The main goal of the meeting was to provide practical guidance to policy-makers on
mechanisms to reduce health inequalities. The discussions and experiences on successful ISA
led to the following conclusions
I. A common policy framework stressing the social determinants of health, guiding the
identification of the problem and the objective of the interventions, as well as its design,
implementation and evaluation, can lead to a shared policy and facilitate a common
plan of action across sectors. Adopting such a policy framework facilitates the
necessary stakeholder analysis as well as the proper “recruitment” of a broader range of
sectors to work together with clear roles, responsibilities, and targets. In addition, a
common policy framework can lead to a collective response and enable the effective
harnessing of political momentum. The framework should be broad enough to address
the interests of a range of sectors and stakeholders. The common goal should transcend
health and focus on broader societal or human development issues with health
consequences.
II. The strongest possible political support is needed to develop and apply a shared policy
framework. Several policy tools have proven effective in building political support,
such as participatory budgeting, public consultation on policies, systems for
government accountability, public reporting, and mass media attention. Community
awareness of public health issues that require action beyond the health sector, through
the engagement of NGOs, can provide the public understanding needed to trigger ISA.
Moments of political and economic opportunity, transition, and crisis can provide
opportunities for promoting ISA as an effective way to address problems. Moreover, the
media can be an effective tool for gaining the attention of political leaders as well as the
public.
III. Governments can use legislation and other means to create governance structures that
facilitate cross-sector participation through sharing of accountabilities, and clearly
defining roles and responsibilities. However, the use of existing structures is preferable
when possible. Intersectoral institutions such as ministerial committees, consultative
bodies and cross-government planning entities with shared budgets, common legislative
frames, monitoring tools, and shared accountability are mechanisms that support ISA.
They can also facilitate the links between communities and political power.
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IV. The health sector should be prepared to facilitate the process, which includes being
flexible about the role it plays at various stages in the implementation of the policy. If
the heath sector takes the lead, it can risk framing public health issues narrowly and
becoming a barrier to intersectoral action.
V. A proper assessment of the public health problem at hand should be based on reliable
data and framed in a way that places the responsibility on the whole of government as
well as on the diversity of players involved. The assessment should engage and benefit
all relevant sectors. The co-benefits of the action should be stressed. The sectors with
responsibility for covering the costs of the assessment should be identified, as well as
those most likely to benefit, and those potentially negatively affected. Monitoring of
outcomes helps to keep the focus on results, and facilitates timely changes.
Documenting the operational aspects, challenges and successes (i.e. evaluating
activities and interventions) is also crucial for sustainability. Finally, mandatory public
health reporting contributes to identifying the impact of the interventions of multiple
sectors, while boosting the political capital of the health sector as the initiator or
facilitator of intersectoral action.
VI. The concurrence of multiple levels of governments, though a challenge to achieve,
provides an opportunity for effective intersectoral actions. ISA is more readily achieved
by local governments, especially in urban settings, due to closer proximity to the
community. The role of municipal governments in implementing successful
interventions can inspire or complement national government actions. When local
governments do not have all of the policy levers needed to create change, the
involvement of the national level becomes essential.
VII. Community involvement across sectors during the process of policy-making, from
diagnosis and formulation to implementation and evaluation, is a key element in
successful intersectoral action. It also helps to build political support.
VIII. International organizations such as those in the UN system, international covenants and
inter-regional agreements, including the FCTC, and internationally-adopted social and
developmental goals (MDGs and others) can promote cross-sector action at the national
level.
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5. Way forward
This consultation identified conditions, mechanisms, and challenges for policy-
makers who initiate, facilitate, and sustain ISA. The next steps include promotion of ISA on
health, and a deeper analysis to develop guidance to policy-makers.
In terms of ensuring the sustainability of ISA, collaboration among various sectors
requires energy, time and commitment and projects may too easily lapse if they have not
developed proper support mechanisms. Future work should focus on identification of the
conditions and mechanisms to scale-up and sustain ISA.
ISA has enormous potential for reducing health inequities in urban settings. However,
research has yet to establish its impact, particularly with regard to reducing health inequities.
Furthermore, the impact of urban planning on health equity needs to be explained. Lack of
evidence on the causal relationships and benefits of interventions are major obstacles to
creating political support. Case studies and successful experiences must be documented to
build knowledge on the potential value of ISA. Evaluative research that demonstrates health
gains arising directly from ISA is needed.
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Box 1: Main recommendations for national policy-makers
RECOMMENDATIONS FOR NATIONAL POLICY‐MAKERS ON
INTERSECTORAL ACTION ON HEALTH
1. A shared policy framework between all participating sectors will facilitate the integration of
strategies and actions towards a common end. The framework should consider prevailing
political, cultural and socioeconomic circumstances, and be supported by strong political
commitment.
2. A supportive governance structure for implementing intersectoral action should be
established to sustain efforts, utilizing existing organizations where possible. Legislation,
institutions, and mandatory reporting are among the tools to strengthen governance for
intersectoral action.
3. A capable and accountable health sector is vital to promote and support intersectoral
action. The health sector should facilitate the process as appropriate, and be flexible to
adapt its role at various stages in the implementation of ISA.
4. Community participation and empowerment in the process of policy‐making, from the
initial stage of assessment to evaluation of the intervention and monitoring of outcomes, are
critical to focus attention on the needs of the people.
5. The concurrence of multiple levels of government on a prioritized and focused set of
intersectoral actions is important to success and will help to obtain sufficient funding and
human resources.
6. Effective intersectoral action can lead to better public policies. The policies selected for
implementation through intersectoral mechanisms have to be robust, feasible, based on the
evidence, oriented towards outcomes, applied systematically, sustainable, and appropriately
resourced.
7. Assessment, monitoring, evaluation, and reporting are required through the whole
process. Proper assessment of the problem, its determinants and social, political and
cultural context are crucial to frame the issue and benefits to several sectors. Evaluation of
the activities should identify the strengths and weakness of interventions. Regular
monitoring of the health impacts is required to maintain focus on outcomes.
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Box 2: Intersectoral action mechanisms in tobacco control: the experience of
the WHO FCTC
Tobacco control requires intersectoral action as it affects several sectors including agriculture, the
tobacco industry, civil society and the health sector. The WHO experience in promoting the
Framework Convention on Tobacco Control shows the key importance of intersectoral action in
many different arenas. The following three are examples of those.
First, in the international scenario, WHO took part in a process that articulated several UN
organizations into a common objective through the United Nations Ad Hoc Inter‐Agency Task Force
on Tobacco Control. This team was chaired by WHO and joined by 20 UN and non‐UN agencies
including: Food and Agriculture Organization, International Civil Aviation Organization, International
Labour Organization, International Monetary Fund (IMF), UNICEF, United Nations Conference on
Trade and Development, UNDP, UNESCO, UNEP, World Bank, and WTO. The Task Force
accomplished increased research and knowledge in tobacco economics‐related issues, through
studies commissioned by the FAO on tobacco agricultural issues, by the ILO on tobacco employment,
and by the World Bank on issues related to tobacco industry privatization and illicit trade. The Task
Force also led to the adoption of a Resolution by the UN Economic and Social Council recognizing the
contribution of tobacco control to poverty alleviation.
Second, the area of tobacco control and agriculture was another source of successful experience for
an ISA approach. There are several conflicts that arise between agriculture, the tobacco industry and
the health sector when efforts are launched to reduce tobacco consumption. The main concern for
tobacco‐growing countries is job security for tobacco farmers. To deal with this conflict, the initiative
generated communications among several stakeholders, including relevant ministries, the tobacco
industry and the health sector. Civil society played a significant role in supporting the health ministry
efforts to develop a policy. One of the key mechanisms for dealing with this conflict was to find
common ground. Negative impacts from reducing tobacco consumption should be minimized in
order to make the policy acceptable. Alternative employment for tobacco workers should be
developed for the time when the demand for tobacco goes down in the future as a result of tobacco
control.
Third, illicit trade in tobacco products is a problem requiring a domestic and global multisectoral
response and also illustrates the success in this area. In this case it was a conjunction of sectoral
interests that converged. The Finance Ministry was concerned about decreased revenue for
government programmes (including health); the higher costs of combating organized crime and
corruption also required national budget allocations. And , of course, illicit trade led to higher direct
health costs from increased consumption (especially the poor and the young), increasing the health
burden. A similar process led to further cooperation with the Ministry of Finance on taxation for
tobacco issues.
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Box 3: Viet Nam's national mandatory helmet law
The implementation of Viet Nam's national mandatory helmet law:
Success of a multisectoral approach
Road traffic injury in Viet Nam is a leading cause of death and disability. In 2008, official statistics
reported 11 243 deaths, representing a mortality rate of 13 per 100 000 population or more than 30
deaths per day. Associated with this high motorization, an estimated 60% of all road traffic fatalities
are motorcycle riders and passengers.
Motorcycle helmets are a well documented public health and road safety intervention. Although
Viet Nam has had some form of motorcycle helmet law since 1995, low penalties and limited
enforcement coverage made this law largely ineffective.
Advocacy for a universal mandatory helmet law has been a long term objective for many
international agencies and NGOs in Viet Nam. These collaborative efforts came to fruition when on
29 June 2007, the Prime Minister of Viet Nam, Mr Nguyen Tan Dung culminated a decade‐long
process and passed into law a strategy that represented a dramatic strengthening of helmet wearing
requirements. From 15 December 2007, Viet Nam's new helmet law required all riders and
passengers to wear helmets on all roads at all times.
In 1997, Viet Nam established a multidisciplinary council comprising representatives from 15
ministries and agencies including transport, police, health and education. This National Traffic Safety
Committee (NTSC) is hosted and Chaired by the Minister of Transport. Each of Viet Nam's 64
provinces has replicated the national model in the form of a provincial traffic safety committee.
The NTSC led the development and implementation of the national helmet law on behalf of the
Vietnamese government. The successful implementation is tribute to the intersectoral collaboration
of the NTSC. As a whole, the NTSC was responsible for obtaining the clearance of the Government on
the details of the helmet law and associated implementation action plan, collaborating and
consulting with the provincial TSC network to ensure nationwide implementation and for reporting
on implementation progress and any barriers to the Prime Minister.
Intersectoral collaboration in the NTSC extends beyond national agencies. The terms of reference of
the NTSC include promotion of international cooperation for road safety, to which end the NTSC has
established several effective partnerships with international bilateral and multilateral agencies,
NGOs and private companies to streamline international assistance into achieving national road
safety objectives.
regard to injury prevention, as of December 2008, the NTSC reported that more than 1557 lives
have been saved and 2495 serious injuries prevented compared to the same time the previous year.
The experiences and lessons learnt by Viet Nam through this process should serve as an important
example of multisectoral collaboration to other regional countries with a high burden of road traffic
injury and death and with motorcycles as a major form of personal transport.
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Box 4: Intersectoral action for the prevention of chronic noncommunicable
diseases in China
Like many other developing nations, China has entered a new era of high burden of chronic
noncommunicable diseases. Currently, about 80% of the 8.6 million total deaths annually are caused
by noncommunicable diseases. Stroke, cancer, chronic respiratory disease and heart disease rank as
the four leading causes of death. In 2005, the financial burden of these diseases in China amounted
to RMB 2.4 trillion (equivalent to 12.9% of GDP), representing a 6.4‐fold increase from 1993, and
faster than the GDP growth of 420% over the same period. The weight of chronic disease burden of
all kinds of diseases climbed to 65% from 54% in 1993.
The Chinese government has recognized the challenge of chronic disease and implemented the
following examples of intersectoral action on health:
1) Incorporating chronic disease prevention into the National Health‐Care Reform Plan. In April 2009,
the Chinese government approved guidelines for the reform of the health care system and published
an action plan of targets in 2009‐11.
2) Nationwide Fitness Initiative. The State Sport General Administration has provided athletic
facilities in urban communities and rural areas, to promote and encourage the populace to engage in
more physical activities.
3) Food and Nutrition Betterment. The jointly formulated “Strategic Outline for the Development of
Food and Nutrition in China” by the Ministries of Agriculture, Health, Industry and Education has put
emphasis on chronic disease prevention, and adjusted food cultivation, breeding and food product
manufacturing plans and patterns in accordance with the Outline.
4) Healthy Lifestyle Action. In 2007, the state launched the action of healthy lifestyle for the whole
population with the theme of “Harmoniously I live, healthy Chinese I am”. It prompted ordinary
citizens to pursue a balance between diet and activities by learning about good health, practicing
good health and gaining good health. Municipalities in Beijing, Shanghai and Zhejiang have built
“healthy paths” to encourage citizens to walk for physical fitness benefits.
5) High level involvement. In October 2008 WHO, World Bank and China MOH jointly sponsored the
Forum on Health and Social Development‐Chronic Noncommunicable Disease Prevention and
Control, focusing on intersectoral cooperation, with the participation of relevant sectors and
international agencies.
6) CPPCC Engagement. The Special Committee of Education, Science, Culture and Health of the
National Committee of the Chinese People's Political Consultative Conference (CPPCC) have
conducted a series of special investigations on chronic disease aimed at promoting prevention and
control of chronic disease.
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References
1. Commission on Social Determinants of Health. Closing the gap in a generation:
Health equity through action on the social determinants of health. Geneva: World
Health Organization, 2008.
2. WHO. The World Health Report 2008 Primary health care: Now more than ever./
WHO, 2009.
3. WHO. Intersectoral Action for Health: A Conference for Health-for-All in the
Twenty-First Century. Halifax, Nova Scotia, Canada22-23 April 1997, 1997.
4. Public Health Agency of Canada (PHAC) & WHO. Health equity through
intersectoral action: An analysis of 18 country case studies. Ottawa: PHAC & WHO,
2008.
5. Co-Benefits Hub Asia. Synthesis of co-benefits discussions at the Better Air Quality
Conference 2006.
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Annex 1: Programme
“Health Equity in All Urban Policies” UHE-HGR/09/MTG
An Expert Consultation on Intersectoral Action (ISA)
in the Prevention of Noncommunicable Conditions (NCCs) Language: English
22–24 June 2009
Kobe, Japan
Monday, 22 June 2009
08:45–09:00 Registration
09:00–09:10 Welcome Remarks Dr Jacob Kumaresan
Director
WHO Kobe Centre (WKC)
09:10–10:00 Introduction
09:10–09:30 Opening Address: Dr Ala Alwan
Worldwide increasing magnitude of Assistant Director-General
NCCs and the strategic importance Noncommunicable Diseases and Mental
of ISA/HIAP for WHO Health (NMH), WHO/HQ
09:30–09:45 Methodology, organization, and Dr Francisco Armada
agenda of the meeting Technical Officer
Health Governance Research (HGR), WKC
09:45–10:00 Designation of Chairperson and
Rapporteur
Self introductions
Expected outputs Common understanding of:
- the practical objectives of the meaning, the definition of ISA for the purposes
of this meeting
- the target audience of recommendations (national and local policy-makers)
- methodology of the meeting (focus on the mechanisms and preparing
recommendations)
10:00–10:15 Coffee/tea break
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10:15–12:30 Session 1: Policy Framework – Strategies – General Approach
10:15–10:30 The PHC strategy and the renewed Ms Nicole Valentine
challenges for ISA on health Technical Officer
Ethics, Equity, Trade and Human Rights
(ETH), Information, Evidence and
Research (IER), WHO/HQ
on behalf of
Dr Abdelhay Mechbal
Director
Office of the Assistant Director-General
for Information, Evidence and
Research (IER), WHO/HQ
10:30–10:45 Approaching ISA on health from a Dr Fiona Adshead
social determinants framework – Director
from a NCD perspective Chronic Diseases and Health Promotion
(CHP), NMH, WHO/HQ
10:45–11:00 NCDs, the developmental agenda, and Dr Gauden Galea
ISA on health Coordinator
Health Promotion (HPR), NMH/CHP,
WHO/HQ
11:00–11:15 Lessons from Healthy Cities for Professor Keiko Nakamura
ISA on health Tokyo Medical and Dental University;
WHO Collaborating Centre for Healthy
Cities and Urban Policy Research; and
Secretary of the Alliance for Healthy
Cities
Tokyo, Japan
11:15–11:45 Health equity through ISA: an Ms Nicole Valentine
analysis of 18 country case Technical Officer
studies IER/ETH, WHO/HQ
and
Ms Heather Fraser
Manager
Health Determinants & Global Initiatives,
Strategic Initiatives and Innovations
Directorate, Public Health Agency of
Canada (PHAC)
Canada
11:45–12:30 Q&A
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Expected outputs - WHO political framework for approaching ISA
- Learning from NCDs to apply to all health issues in the case of ISA
- Use of social determinants framework for ISA
- Uses and limitations of the Healthy Cities approach for ISA
- Successful mechanisms from the Healthy Cities experiences to trigger ISA
12:30–14:00 Lunch
14:00–15:30 Group Discussion 1
A guide for discussion will be provided
15:30–15:45 Coffee/tea break
15:45–18:00 Session 2:
Experiences from countries – challenges faced in the implementation of ISA
15:45–16:05 Health in All Policies: prospects Dr Timo Ståhl
and potential Development Manager
Benchmarking of Local Health Promotion
Capacity, National Institute for Health
and Welfare (THL)
Helsinki, Finland
16:05–16:20 Challenges and lessons of the Dr Lingzhi Kong
Chinese experience in Deputy Director-General
implementing ISA in NCD Disease Control Bureau, Ministry of Health
and
Dr Junmin Liu
Researcher
National Research Institute of the Fiscal
Science, Ministry of Finance
People’s Republic of China
16:20–16:35 Japanese experience in Dr Hidemi Takimoto
implementing ISA in NCD Chief, Division of Maternal and Child
Health, Department of Health Promotion,
National Institute of Public Health
(NIPH)
Tokyo, Japan
16:35–16:50 Lessons from the Andean countries Dr Oscar Feo Isturiz
in implementing ISA in NCD Executive Secretary
Andean Health Organization
Lima, Peru
16:50–17:10 Experience of Viet Nam: Adoption Mr Jonathon Passmore
of crash helmets to reduce deaths Road Safety and Injury Prevention
from road traffic injuries Office of the WHO Representative in
Viet Nam
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17:10–17:25 Challenges in implementing ISA in Professor Ali Haeri
Iran to address NCD Dean, Faculty of Medicine
Shahid Beheshti University of Medical
Sciences and Health Services
Tehran, Islamic Republic of Iran
17:25–18:00 Q&A
Expected outputs - Elements from HIAP that should be taken into consideration for ISA policies
- Successful mechanisms from those experiences that helped to trigger
satisfactory ISA policies
- Mechanisms/issues that should be avoided in order to facilitate ISA
- Social, political, and organizational conditions supportive/challenging to the
implementation of ISA
- Key recommendations for policy-makers to promote ISA that impact on health
inequalities
Tuesday, 23 June 2009
09:00–11:00 Group Discussion 2
A guide for discussion will be provided
11:00–11:15 Coffee/tea break
11:15–12:35 Session 3: Lessons and prospects from specific policies
11:15–11:30 Transportation policies and health Dr Carlos Dora
Coordinator a.i.
Interventions for Healthy Environments
(IHE), Public Health and Environment
(PHE), Health Security and Environment
(HSE), WHO/HQ
11:30–11:45 Experience in ISA on nutritional Mr Robert Hughes
policy Visiting Research Fellow, Nutrition Unit,
School of Population Health, University
of Queensland
Queensland, Australia
11:45–12:00 Intersectoral action mechanisms in Dr Douglas Bettcher
tobacco control: The experience of Director
the FCTC and Smoke Free Tobacco Free Initiative (TFI), NMH,
Games/Sports/Olympics HO/HQ
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12:00–12:15 Addressing health challenges in the Mr Patricio V. Marquez
Russian Federation: from theory Lead Health Specialist
to action Europe and Central Asia
The World Bank
12:15–12:30 EMR experience on ISA for health Dr Muhammad Afzal
as one of the principle of Programme Manager, Urbanization and
Community-based Initiatives Health Equity (UHE), WKC
(CBI) on behalf of Dr Mohammad Assai,
Regional Adviser Community-based
Initiatives, WHO/EMRO
Expected outputs - Priority issues (e.g. physical activity, tobacco, nutrition, etc) susceptible to
intersectoral actions that impact on health inequalities identified, as well as
issues not likely to benefit from ISA
- Successful mechanisms that have helped to trigger satisfactory ISA policies
- Mechanisms/issues that should be avoided in order to facilitate ISA
- Potential contributions from international financial institutions to promote ISA
- Social, political, and organizational conditions that support/hinder the
implementation of those intersectoral actions
12:30–14:00 Lunch
14:00–14:30 Q&A
14:30–16:30 Group Discussion 3
A guide for discussion will be provided
16:30–16:45 Coffee/tea break
16:45–18:00 Group Discussion 3 (continued)
Wednesday, 24 June 2009
09:00–10:00 Session 4: Health impact assessment, urban planning and ISA
09:00–09:15 Application of health impact Mrs Erica Ison
assessment for ISA Specialist Practitioner in Health Impact
Assessment, Knowledge into Action
Oxford, United Kingdom
09:15–09:30 Trans-sectoral accountability for Dr Urban Jonsson
impact on health equity from a Executive Director
human rights perspective The Owls
Nairobi, Kenya
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09:30–09:45 Urban HEART: a tool to link Mr Amit Prasad
assessment and response in urban Technical Officer, Urbanization and Health
settings Equity Impact Assessment (HEIA);
Urban HEART Project Leader, UHE,
WKC
09:45–10:00 Spatial planning and health; Mr Neil Blackshaw
implementing intersectoral action Head of Unit
NHS London Healthy Urban Development
Unit (HUDU)
London, United Kingdom
Expected outputs - Ways in which HIA can contribute to or obstruct ISA
- Potential contribution of the human rights approach to ISA, and HIAP
- Main aspects of HIA to become an ISA process itself
- Features of the HIA process that can trigger ISA on health equity
10:00–11:00 Group Discussion 4
A guide for discussion will be provided
11:00–11:15 Coffee/tea break
11:15–12:15 Final Discussion and Conclusions
A guide for discussion will be provided
Expected outputs - Mechanism for intersectoral action on health
- Key recommendations for policy-makers to promote intersectoral
actions that impact on health inequalities
- Agenda for WHO to establish concrete recommendations for policy-
makers promoting intersectoral actions that impact on health
inequalities
12:15–12:30 Closing remarks Dr Jacob Kumaresan
Director, WKC
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Annex 2: List of participants
“Health Equity in All Urban Policies” UHE-HGR/09/MTG
An Expert Consultation on Intersectoral Action (ISA)
in the Prevention of Noncommunicable Conditions (NCCs) Language: English
22–24 June 2009
Kobe, Japan
Participants
Mr Neil Blackshaw, Head of Unit, NHS London Healthy Urban Development Unit (HUDU),
London, United Kingdom
Dr Oscar Feo Isturiz, Executive Secretary, Andean Health Organization, Lima, Peru
Ms Heather Fraser, Manager, Health Determinants & Global Initiatives, Strategic Initiatives
and Innovations Directorate, Public Health Agency of Canada (PHAC), Canada
Professor Ali Haeri, Dean, Faculty of Medicine, Shahid Beheshti University of Medical
Sciences and Health Services, Tehran, Islamic Republic of Iran
Mr Robert Hughes, Visiting Research Fellow, Nutrition Unit, School of Population Health,
University of Queensland, Queensland, Australia
Mrs Erica Ison, Specialist Practitioner in Health Impact Assessment, Knowledge into Action,
Oxford, United Kingdom
Dr Urban Jonsson, Executive Director, The Owls, Nairobi, Kenya
Dr Makie Kawabata, Consultant, Kobe, Japan
Ms Norie Kawahara, Project Researcher, Research Center for Advanced Science and
Technology
Dr Lingzhi Kong, Deputy Director-General, Disease Control Bureau, Ministry of Health,
People’s Republic of China
Dr Junmin Liu, Researcher, National Research Institute of the Fiscal Science, Ministry of
Finance, People’s Republic of China
Mr Patricio V. Marquez, Lead Health Specialist, Europe and Central Asia, The World Bank
Professor Keiko Nakamura, Tokyo Medical and Dental University; WHO Collaborating
Centre for Healthy Cities and Urban Policy Research; and Secretary of the Alliance for
Healthy Cities, Tokyo, Japan
Dr Timo Ståhl, Development Manager, Benchmarking of Local Health Promotion Capacity,
National Institute for Health and Welfare (THL), Helsinki, Finland
Dr Hidemi Takimoto, Chief, Division of Maternal and Child Health, Department of Health
Promotion, National Institute of Public Health (NIPH), Tokyo, Japan
Mr Akito Yokomaku, Assistant Director-General, International Policy Planning, Ministry of
Health, Labour and Welfare, Tokyo, Japan
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WHO/HQ
Dr Ala Alwan, Assistant Director-General, Noncommunicable Diseases and Mental Health
(NMH)
Dr Fiona Adshead, Director, Chronic Diseases and Health Promotion (CHP), NMH
Dr Douglas Bettcher, Director, Tobacco Free Initiative (TFI), NMH
Dr Carlos Dora, Coordinator a.i., Interventions for Healthy Environments (IHE), Public Health
and Environment (PHE), Health Security and Environment (HSE)
Dr Gauden Galea, Coordinator, Health Promotion (HPR), NMH/CHP
Dr Abdelhay Mechbal*, Director, Office of the Assistant Director-General for Information,
Evidence and Research (IER)
Ms Nicole Valentine, Technical Officer, Ethics, Equity, Trade and Human Rights (ETH),
Information, Evidence and Research (IER)
WHO Regional/Country Office
Mr Jonathon Passmore, Road Safety and Injury Prevention, Office of the WHO Representative
in Viet Nam
WHO Centre for Health Development (WHO Kobe Centre – WKC)
Dr Jacob Kumaresan, Director, WHO Kobe Centre (WKC)
Dr Muhammad Afzal, Programme Manager, Urbanization and Health Equity (UHE)
Dr Francisco Armada, Technical Officer, Health Governance Research (HGR)
Mr Loïc Garçon, Technical Officer, UHE
Dr Megumi Kano, Technical Officer, Urbanization and Health Equity Impact Assessment (HEIA)
Dr Jostacio Lapitan, Technical Officer, Urbanization and Emergency Preparedness (UEP)
Mr Amit Prasad, Technical Officer, HEIA; Urban HEART Project Leader
*Unable to attend.
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