HIA Implementation and Challenges for Switzerland

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(1)

Groupe de recherche environnement et santé Institut des sciences de l’environnement (ISE)

ET Faculté de médecine

Healthy Cities Phase V WHO Collaborating Institute

HIA 11 “In times of crisis, healthier ways” Granada 14 -15 April 2011

Dr. Jean Simos Nicola Cantoreggi

Research Group on Environment and Health University of Geneva

Implementation and Institutionalisation of HIA

in a Federalist Country:

Opportunities and Challenges for Switzerland

Implementation and Institutionalisation of HIA

Implementation and Institutionalisation of HIA

in a Federalist Country:

in a Federalist Country:

Opportunities and Challenges for Switzerland

(2)

Healthy Cities Phase V WHO Collaborating Institute

Swiss Health System

Swiss Health System

7,7 millions people, 4

National languages, 22%

foreigners

diversity

Federal (political system)

= 26 cantonal+1 national

Health Systems

Organisation, structures,

facilities management:

canton level

(3)

Groupe de recherche environnement et santé Institut des sciences de l’environnement (ISE)

ET Faculté de médecine

Healthy Cities Phase V WHO Collaborating Institute

Swiss Health

Swiss Health

System (2)

System (2)

Health and accidents Insurance, specific issues (e.g.

epidemiology and infectious diseases, substance abuse and drug prevention, stem cell research and bioterrorism, noise and

radiation protection): federal level

Health Promotion at the federal level:

No other legal basis than that for a national foundation (Health

Promotion Switzerland)

Federal law on the way (but strong opposition…)

Health Promotion at the canton level:

Included in canton’s Public Health Act

Specific actions in fields where are loopholes in

federal level, e.g. prevention of non communicable & mental diseases

(4)

Healthy Cities Phase V WHO Collaborating Institute

In

In

this context, what strategy to

this context, what strategy to

promote HIA?

promote HIA?

How a bottom-up approach and a top-down

approach could be combined to strengthen

HIA implementation and institutionalization, at

different territorial levels?

Is there room for HIA at “local” (cantonal) level ?

Is a bottom-up approach to promote and disseminate

HIA feasible ?

What opportunities should one take and

(5)

Groupe de recherche environnement et santé Institut des sciences de l’environnement (ISE)

ET Faculté de médecine

Healthy Cities Phase V WHO Collaborating Institute

Opportunities

Opportunities

• Cantons are legitimate to introduce and

experiment HIA at local level

i.e. Geneva, Jura and Ticino

• Organisational design of HIA is locally

agreed, i.e. it is coherent with available

resources and political-administrative

options

(legislate first VS experiment first)

i.e. Geneva: legislative approach, Jura/Ticino:

(6)

Healthy Cities Phase V WHO Collaborating Institute

• Experiences and best practices could be

shared and disseminated at little costs

through supra-cantonal fora

e.g. Swiss Platform on HIA, National Health

Promotion Conferences

• Other cantons, not yet involved, could select

organisational and institutional options which

fit at best to their own specificities

VS mandatory, not specific and costly institutional

(7)

Groupe de recherche environnement et santé Institut des sciences de l’environnement (ISE)

ET Faculté de médecine

Healthy Cities Phase V WHO Collaborating Institute

Challenges

Challenges

• The minority groups legitimacy is under

scrutiny

i.e. communities clichés in Switzerland

• Governance fragmentation multiplies the

level of cross-examination of a proposal

…the day the Federal Health Minister upheld HIA

into the new federal Law proposal on Health promotion and prevention

Potential serious hinder when a given authority

disagree with it…

…but more entry points for advocacy and

(8)

Healthy Cities Phase V WHO Collaborating Institute

How do we operate ?

How do we operate ?

• Promotion and dissemination of HIA during

national events and through bilateral

contacts with cantons (activity funded by

Health Promotion Switzerland since 2009)

concerning:

Swiss HIA Platform activities and deliverables

Activities engaged in other Francophone

countries (France, Belgium, African countries)

Activities engaged at international involving

Swiss HIA actors level (GWGHIA, HIA conferences)

(9)

Groupe de recherche environnement et santé Institut des sciences de l’environnement (ISE)

ET Faculté de médecine

Healthy Cities Phase V WHO Collaborating Institute

How do we operate ?

How do we operate ?

• Bottom-up intensive advocacy and lobbying

for HIA at federal level:

through convinced Health promotion public

servants in cantonal health administration

…from them, through cantonal Health Ministers,

gathered into the Association of Cantonal Health Ministers

through activities within Swiss Parliament:

Elected representatives (from all parties), members of the Health Commission

(10)

Healthy Cities Phase V WHO Collaborating Institute

Swiss HIA

Swiss HIA Platform

activities and

activities and

deliverables

deliverables

Information about HIA to the other

cantons

Implementation by pilot study-cases

Communication: website,

newsletters, Guide

Training courses (e.g. Summer

School)

Advocacy for administrative and

political decision makers

(11)

Groupe de recherche environnement et santé Institut des sciences de l’environnement (ISE)

ET Faculté de médecine

Healthy Cities Phase V WHO Collaborating Institute

Current situation

Current situation

• New Health Promotion Law, which included

HIA (with non-mandatory clause) is currently

discussed at Swiss Parliament

• HIA implementation at Federal level is facing

internal opposition because of a perceived

concurrence with others assessment tools (i.e.

sustainability)

• HIA at Cantonal level is gaining legitimacy but

its implementation suffers from

budgets reductions

(12)

Healthy Cities Phase V WHO Collaborating Institute

Open questions

Open questions

• Will a multi-level implementation of HIA boost

its dissemination as a priority tool to

materialize a “health in all policies” approach?

• Is a strongest regulatory involvement (cf. EIA,

top-down approach) of the Federal level

conceivable and feasible?

• Within current public finances “crisis”, is it

possible to tackle the pervasive mantra:

“there are too many assessment tools

on the market: let’s integrate all

of them!”?

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