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
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
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
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 disseminateHIA feasible ?
•
What opportunities should one take andGroupe 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:
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
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
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)
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
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
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
Healthy Cities Phase V WHO Collaborating Institute
