Challenging health inequalities : from Acheson to choosing health

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It's the first project which, by including the Common Agricultural Policy CAP , has pretended to calculate the specific impacts on health at a national level Lock et al. Precisely, CAP is the European Union's most important policy in budgetary terms as it entails almost half of the total budget. It comprises a joint complex of political instruments and laws which regulate the production, the market and the process corresponding to the agricultural products, as well as the rural development. In the report from the Swedish National Institute of Public Health Shafer, , the CAP is criticized for using subsidies inefficiently, damaging agriculture in developing countries and having negative public health effects within the EU.

The report analyses four sectors for which it makes practical recommendations: fruit and vegetables, dairy products, wine and tobacco. It suggests how a reformed CAP could support health policies and help prevent major public health problems in Europe Shafer, ; Dahlgren; Nordgren; Whitehead, However, HIA cannot be considered formally in this study. The HIA undertaken in Slovenia has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation Lock; Gabrijelcic, This HIA approach involved national and regional stakeholders.

A total of 66 people participated, including local farmers' representatives, food processors, consumer organisations, public health, non-governmental organisations, national and regional development agencies and officials from Ministries of Agriculture, Economic Development, Tourism, Education and a representative of the president of Slovenia. The participants not only had to identify the possible impacts upon health taking the main health determinants into consideration, but they also had to identify which population groups were going to be the most affected ones.

Once again, the Slovene experience shows the benefits of HIA when it comes to raise more general public health issues within the political agendas.

It comes forth as a valuable strategy to formulate more integrated theories at an intersectoral level. Its methods flexibility, its holistic approach and the incorporation of the stakeholders into the process are the HIA features which contribute the most to the success of the intersectoral work.

The Farm Security and Rural Investment Act of , also known as the Farm Bill, includes ten titles addressing a great variety of issues related to agriculture, ecology, energy, trade, and nutrition. The Farm Bill provides financial assistance to farmers through subsidy programmes. This HIA underlines the aspects corresponding to the new Farm Bill which can have the greatest impacts on the health status: dietary consumption, food safety, rural income and quality of life, air pollution and environmental degradation.

Of these, the study is focused on evaluating whether the dietary consumption is affected by the farm subsidy policy and whether air pollution is affected by the ethanol production. In general terms, this HIA is trying to prove, on the one hand, the links between the changes in the agricultural policy and the results regarding health. On the other hand, it's seeking to show that HIA can be a valid tool for a quick assessment of the impacts on health caused by a far-reaching national policy Sumner, ; Dannenberg et al.

In spite of more than a decade of experience in the planning and implementation of the sustainable development at a local level, there are still significant barriers that hamper the union of the political agendas and the development of integrated approaches.


Two of the greatest weaknesses regarding the Local Agenda 21 and the sustainable development agenda refer to the fact that they haven't adopted a wide approach with respect to health and its determinants and they haven't considered health as a key resource for the economic and social development in the decision making process. An experience which seeks to be transferred to the rural associations, institutions and areas. HIA comes forth as the best-suited tool to increase the acknowledgement of the health social model among the local associations, organisations and governments and to develop the responsibility sense regarding health during the planning of local policies.

In rural areas, at a more local level, HIA has been used to a larger extent and in a bigger number of sectors: rural transportation planning, aboriginal health, health service delivery, natural heritage, housing, accessing healthy food, social services, health care disparities, etc. A graphic example of how this tool can help is the HIA carried out so as to consider the possible impacts of a re-arrangement in the rendering of health services on a small Australian rural community Neumayer; Chapman; Haberecht, The foreseen changes are applied in order to deal with the problems concerning the small rural communities, such as sustainability, access to healthcare services, healthcare staff retention and a decreasing and aging population's needs.

Within the framework of this methodology, the idea of taking into account 2 scenarios was considered necessary: 1 the one where no changes had taken place in the current service and 2 the rearranged service. After revealing the impacts identified for each scenario, the re-arrangement of the current model was unanimously chosen. A process which is successful not only for determining the important impacts but also for giving recommendations adapted to the population's needs in every stage of the restoration of health services. Humboldt County California is currently considering three development plans to accommodate future population growth, and the described HIA process successfully identified and analysed potential health impacts associated with each Harris et al.

Likewise, as a result of this process, "Rural Healthy Development Measurement Tool" has been developed so as to take the matter of health into account when making decisions regarding rural development, thus helping to plan more equal, fairer and healthier communities. This tool includes 73 health indicators suitable to a rural context and it can be used for incorporating health analysis into built environment projects in other rural locations in the future. The implementation of HIA in rural areas enjoys the same benefits obtained in urban areas. HIA provides a framework for determining how positive and negative health impacts are distributed across different segments of the population.

Decisions that benefit the general population could have negative impacts in the short or medium run upon certain rural areas or upon specific social groups.

Acheson Report - Wikipedia

HIA helps to identify groups at risk and to reduce health inequalities. HIA provides a systematic approach for integrating the principle of equity into decision making. HIA also provides a better understanding of local needs for public services and the way they are used, enabling sectors to better target resources. The HIA implementation process allows and demands to sensitize the communities and the people who make decisions concerning the social determinants of health. In this sense, politicians are also sensitized with respect to the influence of their actions and policies on the population's health, making them co-responsible to a large extent.

This tool, when taking into account the opinions on the part of those to whom this policy is addressed, favours the democratisation of the decision making process and raises awareness of the way in which the health determinants are interrelated and affect the people in real social contexts. It's a tool which gives place to an integrated, intersectoral, participatory and long-term approach to the policies design and development for the sake of helping and enhancing the decision making process which involves an improvement in the local population's health.

In connection with the difficulties identified for the HIA implementation, it can be seen that these are worse in rural areas. At an individual level, the lack of knowledge, skills and experience regarding this methodology constitute barriers identified repeatedly. The identified barriers are diverse at an organisational and external level.

The lack of evidence increases when taking rural-specific issues into account, such as the aforementioned case regarding the agricultural policies. The geographical access, the longest travel distances and its additional time and money costs also hinder its implementation on these areas. Likewise, the lack of information suitable for the study and assessment of the rural areas constitutes one of the main barriers.

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Most of the existing data are regional and make the possible features corresponding to the rural areas invisible in a significant way. We need information about these small rural areas.

Challenging health inequalities

This information must be sensible to "rurality" and, at the same time, it must ensure confidentiality. Besides, public, private and voluntary organisations in rural areas tend to be smaller than their urban counterparts and have very limited resources, in terms of staff and budgets. This will impact on their ability and capacity to work up partnerships, submit bids for funding, etc.

Finally, it's worth mentioning that resistance to change and innovation can also represent a significant barrier among the elected members and the municipal staff Welsh Assembly Government, The incipient and growing experience in the HIA implementation in rural areas shows us its powerful potential. Its use on these areas, taking care of their diversity, singularity, contradictions and difficulties, is precisely what makes it an effective tool useful for reducing the social inequalities in health.

go to site The implementation of this tool makes it possible to include the rural dimension into the development of national, regional and local policies, maximize health profits and reduce or avoid the negative impacts. An efficacy mainly known due to its huge versatility: in strategic planning, small scale projects or in promoting partnership working. HIA raises awareness and understanding of the effects upon the population's health caused by policies regarding food and agriculture, development, employment, housing, transport, social services, healthcare services, etc.

In this sense, it determines a health definition shared among a wide range of stakeholders and it creates a sense of responsibility between the different sectors' representatives. HIA provides evidence to contribute with political decision making and it constitutes a tool which makes the intersectoral collaboration easier.

In order to move on with the HIA implementation in rural areas, it would be necessary to provide additional assistance to achieve a proper development. In view of the aforementioned difficulties, economic and technical assistance is recommended support on the part of specialized staff, implementation of proper statistics, etc.

All in all, people in good health are more productive and can participate more effectively in the labour market and education. Improving population health then becomes a shared goal across all sectors. Independent inquiry into inequalities in health report. London: The Stationary Office, La desigualdad perjudica seriamente la salud. Gaceta Sanitaria, Barcelona, v.

A conceptual framework for action on the social determinants of health. Geneva: WHO, Closing the gap in a generation: health equity through action on the social determinants of health: final report of the Commission on Social Determinants of Health. Stockholm: National Institute of Public Health, Policies and strategies to promote social equity in health.

Levelling up part 2 : a discussion paper on European strategies for tackling social inequities in health. Growing the field of health impact assessment in the United States: an agenda for research and practice. Use of health impact assessment in the U. The social basis of disparities in health. Challenging inequities in health: from ethics to action. New York: Oxford University Press, Developing public sociology through health impact assessment.

What Is Health Equity, and Why Does It Matter?

Health inequalities: concepts, frameworks and policy. London, Health Development Agency, Humboldt county general plan update health impact assessment: a case study. Environmental Justice, New York, v. The Canadian handbook on health impact assessment. Ottawa, Health for all? ISON, E. Health Promotion International, Oxford, v. KEMM, J. Health impact assessment and health in all policies.

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Health in all policies: prospects and potentials. A new perspective on the health of Canadians: a working document. Ottawa: Government of Canada, The book is organised into seven parts, each one of them consisting of an introduction and three contributions. It pays attention to the continuing hegemony of youthful attitudes among the baby-boom generation, and convincingly challenges the weakness of the intergenerational contract, arguing that a viable social contract between generations will remain a characteristic of society in the future of age-group interactions.