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Transcript of HiAP_Andreeva
Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient health services
1st Global Conference on Health Promotion: Ottawa 1986
The science and art of promoting health, preventing disease and prolonging life through organized efforts of society
Health in All Policies
in less developed countries:
current state and perspectives for further implementation
Tatiana I Andreeva, MD, PhD, Ukraine
Three Public Health Revolutions
The first public health revolution
addressed sanitary conditions and fought infectious diseases
The second public health revolution
focused on the contribution of individual behaviors to non-communicable diseases and premature death
The third public health revolution
recognizes health as a key dimension of quality of life
The key question of the current state of public health and health promotion:
"What makes people healthy?"
Awofeso, N. (2004). What's new about the "new public health"? Am J Public Health, 94(5), 705-709.
Six Eras in the Evolution of Public Health
2. Miasma Control (1840s–1870s)
1. Health Protection (antiquity–1830s)
3. Contagion Control (1880s–1930s)
4. Preventive Medicine (1940s–1960s)
5. Primary Health Care (1970s–1980s)
6. Health Promotion (1990s–present)
Health in All Policies somewhere here - a 7-th stage we need to achieve?
Sundsvall Statement on Supportive Environments for Health
3rd Global Conference on Health Promotion: Sundsvall 1991
Adelaide Recommendations on Healthy Public Policy
2nd Global Conference on Health Promotion: Adelaide 1988
Mexico Ministerial Statement for the Promotion of Health: From Ideas to Action
5th Global Conference on Health Promotion: Mexico 2000
Health promoting schools
4th Global Conference on Health Promotion: Jakarta 1997
Promoting health and development: closing the implementation gap
7th Global Conference on Health Promotion: Nairobi 2009
Health Promotion in a globalized world
6th Global Conference on Health Promotion: Bangkok 2005
Health in All Policies Framework for Country Action
8th Global Conference on Health Promotion, Helsinki, 2013
How HiAP usually looks in these pioneering countries?
But what is going on or is feasible in less developed countries?
Examples from pioneering countries
Active citizens / civil society / NGOs
National and local authorities
Grounded theory approach:
Central phenomena considered in the interviews were:
- examples of health issues that require intersectoral collaboration to be solved,
- causes of these issues,
- required solutions,
- players who take part in the problem or its resolution,
- obstacles that interfere with successful resolution.
In-depth interview questions
Six interviews were conducted in April 2015 with professionals who have experience of participation in activities that require intersectoral collaboration with regard to health issues.
Three interviewees live in Kiev and had some experience of work with national or international level institutions, and three were representatives of local authorities, NGOs or other institutions of regional level.
Four interviews were conducted in Russian and two - in Ukrainian language.
One interview was conducted face-to-face and five using skype.
was performed immediately after conducting and transcribing each interview. No predefined theory was used while code identifying.
was used repeatedly when the coding of new transcripts revealed codes that were similar and yet different from the earlier codes. Similar codes were grouped into 'branches' of the code system.
was performed using MAXDictio subsystem with word frequencies tables used to identify keywords that might be related to certain codes, especially those added to the code system later than the transcripts bearing the corresponding keywords was coded.
Cases - most typical health issues
What do we about the real picture?
All interviews were recorded and then transcribed using either MAXQDA (11 demo version) or F4 software.
All coding and analysis was conducted in MAXQDA2007.
1. Please describe one health issue which could be much improved in case of intersectoral collaboration which has not yet been done.
4. Please explain the place of this issue on the policy agenda. If it is high, why? If it is low, why?
5. Who needs to be involved in this case?
6. With regard to every listed participant:
a. How do they consider this issue?
b. What is their role?
c. How can they contribute?
d. What is their motivation to act? If they want to contribute, why?
e. What are their interests: to change the situation or to keep it as it is?
f. How do you think the issue of ‘health’ is present or not present in their decision-making, attitudes or activities?
g. If they do not want to help with this problem, what could be their reasons?
h. Are there any other players who could be able to change their attitudes and behaviors?
i. Are there any other players interaction with whom could be crucial? What defines the possibility of this interaction?
j. What is your assessment of how this player interacts with others, what are the advantages and facilitators? What are the disadvantages and the barriers?
7. How do you assess the effectiveness of the intersectoral collaboration in general? What are its strengths? What are the drawbacks?
8. What are the most common and important barriers towards effective intersectoral collaboration?
9. If you were in a position to change anything you want, what you would start with to facilitate the process of intersectoral collaboration to deal with health-related problems in Ukraine?
10. Are there any additional thoughts which came up to you during our conversation which you would like to share?
11. From your point of view, who are the people worth involving in this study?
Typology of health issues for HiAP approach
Roots of the problems:
their groups, characteristics,
Health issues which require intersectoral collaboration to be solved
health or health behaviors of children - 5/6
cardiovascular diseases - 4/6
sodium consumption - 3/6
environmental pollution - 2/6
HIV-related problems - 2/6
viral hepatitis - 2/6
Alcohol-related issues - 2/6
Several chronic diseases including diabetes, obesity, kidney problems, cancer, and several transport-related issues including public transport, traffic accidents, bicycle use, were discussed by separate respondents.
The source of the problem is on the one side, the civil society is on the other, and the authorities are in between them.
Potentially collaborative cases
Managerial cases where an initiator (a person or a team) elaborates a new mode of solution, takes into account all the interests of the potential players and communicates with all of them. 'Win-win' situations are deemed to be possible.
Groups of major players
Authorities of national and local levels
Potential types of interaction
Groups of players
special services like police.
Obstacles deriving from authorities
Two groups of obstacles
- pertinent to any type of governmental authorities;
- pertinent to particular authories
One and most dangerous obstacle pertinent to all the governmental officials in Ukraine
Officials are there not to undertake any changes and reforms but to keep to their positions
Obstacles typical for the ministry of health and health sector