final technical implementation report of the project...

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Final technical implementation report of the project "Europe for Health and Wealth"

By the beneficiaries: Ministry of Social Affairs and Health (MSAH) - Finland National Public Health Institute (NPHI) National Research and Development Centre for Welfare and Health (STAKES) Finnish Institute of Occupational Health and, in collaboration with the European Commission the European Observatory on Health Systems and Policies (OBS).

Done at Helsinki, 23.3.2007

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TABLE OF CONTENTS 1. Introduction 3 2. Detailed description of the activities 3 3. Manpower for the execution of the activities 7 4. Partners involved 13 5. Countries involved 16 6. Achievement of the activities 23 7. Financial report 29 Annexes 30

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1. Introduction The Europe for Health and Wealth - project is the framework in which the Finnish presidency launched its main health sector theme “Health in All Policies” (HiAP). The project constituted a tool to raise the issue among the Member States and their Ministers, policy makers, civil servants as well as raise awareness among other stakeholders. This was done through the main activities as explained below and constituted two conferences of which one was the main health sector conference of the Finnish presidency, a publication where the main relevant information was compiled and policy discussions in which policy makers could exchange good practice on how HiAP is or could be implemented. The Minister adopted Conclusions on the issue at its meeting in November 2006. The theme has gained broad support both in the EU and beyond, and will be taken forward by coming presidencies. It has also been mentioned in the Commissions consultation paper on a future health strategy for the European Union. 2. Detailed description of the activities 1.1. European Conference on Chronic Disease Prevention (EURONCD)

The conference was organised by the National Public Health Institute (NPHI) and held as planned in Helsinki, Finland on 8–10 December 2005. By reviewing the progress and experience of chronic disease prevention in the WHO European region over the past, the conference was linked particularly to the specific Objective 2 ”gather the best available knowledge on good practices, pros and cons of in-depth health impact assessment, and how to improve the use of other policies to enhance health and reduce disparities, especially with a view to children’s and young people’s health”. The conference also contributed to the strategic objectives of the project by raising awareness of the existing experiences, by identifying and addressing existing barriers and by disseminating and transforming the best practices into European-wide implementation and public policies. The conference discussed the theory and practice of chronic disease prevention in the population, proposed effective strategies and actions for chronic disease prevention on different levels, contributed to the development of the new WHO European NCD strategy in 2006, and as such, provided background information for the Finnish EU presidency work on health. Prior to the conference ancillary meetings (European NCD Strategy Counterparts meeting and WHO CINDI Directors’ meeting), funded by the WHO, Regional Office for Europe and NPHI, were organised. Description of work The structure of the conference programme was organised according to main themes and specific topics, which formed together the core elements for developing the new NCD prevention strategy in Europe. The main themes were partnership, capacity building and advocacy, integration, using evidence for public health policy, resource mobilization and economics, and health inequalities. The specific topics highlighted were tobacco, obesity, diet and physical activity, alcohol, role of networks, role of national public health institutes and the new European NCD strategy. The programme was composed of opening and closing remarks, plenary sessions (6), parallel sessions (8) and poster sessions (3). The keynote lectures given in plenary sessions by invited speakers combined one or more of the main themes and were concluded with panel discussions. The invited speakers were Professor Vilius Grabauskas (Kaunas University of Medicine,

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Lithuania), Professor Jussi Huttunen (Duodecim, Finland), Professor W. Philip T. James (IOTF, UK), Luk Joossens (Association of European Cancer Leagues, Belgium), Dr. Darwin Labarthe (National Center for Chronic Disease Prevention and Health Promotion, USA), Dr. Kimmo Leppo (Ministry of Social Affairs and Health, Finland), Susanne Løgstrup (European Heart Network, Belgium), Dr. Johan Mackenbach (Erasmus University, The Netherlands), Dr. Gudjon Magnusson (WHO, Regional Office for Europe, Denmark), Professor (emeritus) Kaare R. Norum (University of Oslo, Norway), Professor Rafael G. Oganov (National Research Centre for Preventive Medicine, Russia), Professor Pekka Puska (National Public Health Institute, Finland), Dr. Matti Rajala (European Commission, Switzerland) and Dr. Sylvie Stachenko (Public Health Agency, Canada). Dr. Liisa Hyssälä (Minister for Social Affairs and Health, Finland) and Dr. Pekka Puska (Director General, National Public Health Institute, Finland) were the president and the vice-president of the conference respectively. The parallel sessions were based both on submitted abstracts and on invited workshops. By the deadline for abstract submission 123 abstracts were received. After the review process, a total of 116 abstracts were accepted for the conference. Of these, 34 were given as oral presentations and 82 were presented as posters. The invited workshops contained 11 presentations. (See the Final Programme and Abstracts of the European Conference on Chronic Disease Prevention, Annex 1 or alternatively http://www.ktl.fi/attachments/suomi/julkaisut/julkaisusarja_b/2005/2005b21.pdf). Deliveries

• First Conference Call -leaflet • European Conference on Chronic Disease Prevention (8–10 December 2005) • Final Programme and Abstracts of the European Conference on Chronic Disease

Prevention • Conference website • Presentations of invited speakers (available on the conference website)

2.2. Policy dialogue workshops The policy dialogue workshops were linked to the objective one ‘identify the needs of the Member States related to in-depth Health Impact Assessment (HIA) and develop the project accordingly’. It contributed to the achievement of the objective through the organization of workshops facilitating a high-level policy dialogue for senior administrators and decision-makers. The policy dialogue workshops contributed to the strategic objectives of the project, especially the understanding of the importance and relevance of Health in All Policies (HiAP) approach that was selected as a leading principle for the whole project. The workshops reviewed the key issues and identified the needs of the Member States addressing concrete political and practical realities in HiAP/HIA. The participants were given access to experts who helped them bridge the gap between evidence and practice. As a working method, the policy dialogues created opportunities for policy-makers to exchange ideas and strengthen networks. The workshops also stimulated Member States to make use of the HiAP approach and develop national HIAs. The preliminary themes of the planned council conclusions were first time discussed in the plenary workshop in June. Description of the work Five workshops were conducted in total. First, four workshops were held to enable participants from the EU Member States, EEA, accession and applicant countries to meet in small groups for

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effective dialogue. These four workshops were held between February 2006 and March 2006 (see Annex 2). Eight countries were assigned to participate in each policy dialogue. Twenty-six of the 32 invited countries participated in the events. Some countries had two or three participants, thus all together there was 33 participants from the Member States and 12 experts. Participants were mainly from the ministries, their position varying from advisors to the minister to desk-level officials. A few participants represented research institutes. In five cases, there was no representative from the capital, but the health attaché represented their countries. No representation came from Italy, Greece, Poland, Liechtenstein, Bulgaria, or Iceland. The fifth workshop held on 12 June 2006 in Brussels was the summit of the workshops, consequently bringing together the various discussion strands from the workshops. In total, there were 34 participants from 23 countries (Member States, applicant countries, EFTA-EEA countries) and 13 experts in the plenary workshop. Ten Member States had only health attaché representation. France, Greece, the Netherlands, Poland, Slovak Republic, Spain, Bulgaria, Liechtenstein, or Iceland had no representatives present. The workshops were organized jointly by the National Research and Development Centre for Welfare and Health (STAKES) and the European Observatory on Health Systems and Policies (OBS). The logistics of the workshops was taken care of by the Ministry of Social Affairs and Health (MSAH).

Deliveries

• 5 workshops • Report of the Policy dialogues – the Finnish EU Presidency project on ”Europe for Health

and Wealth” 2006. 3.3. Health in All Policies - Prospects and potentials -publication The publication contributed especially to the objectives two and three of the project. The purpose was to gather the best available knowledge on good practices, pros and cons of in-depth health impact assessment and explore ways to improve the use of other policies to enhance health and reduce health disparities, especially with a view to children’s and young people’s health. Increased knowledge on broad societal health determinants was going to be achieved by investigating what population health gains are available and how the monitoring of these determinants can produce arguments for the political process. Description of the work The first meeting between MSAH, STAKES and OBS was held on 6 May 2005. Dr. Wismar had prepared a proposal for the Presidency publication on Health in All Policies. According to the proposal the participants of the meeting started to recruit authors for the publication. The timetable was extremely tight because the book was printed before the Presidency conference that was held in September 2006. After the meeting the editors’ team was decided and set as: Eeva Ollila and Timo Ståhl from STAKES, Matthias Wismar from OBS and Eero Lahtinen and Kimmo Leppo from MSAH. The editors’ team drafted and finalised the background paper that clarified the objectives, scope, outline, chapter focus, target group and style. Additionally, an author’s guideline was prepared. The editorial board was appointed in November 2005. The members of the editorial board were:

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• Dr. Jarkko Eskola (former Director-General at the Ministry of Social Affairs and Health, Finland)

• Dr. Josep Figueras (Director, European Observatory on Health Systems and Policies, Brussels)

• Dr. Maarike Harro (Director General, National Institute for Health Development, Estonia) • Dr. Anna Hedin (Desk Officer, Ministry of Health and Social Affairs, Stockholm, Sweden) • Dr. Meri Koivusalo (Senior Researcher, STAKES, Finland) • Dr. Tapani Melkas (Director, Ministry of Social Affairs and Health, Finland) • Dr. Horst Noack (Professor, Medizinische Universität Graz, Austria) • Dr. Don Nutbeam (Pro-Vice-Chancellor, University of Sydney, Australia) • Dr. José Pereira Miguel (High Commissioner for Health, Portugal) • Dr. Pekka Puska (Director General, National Public Health Institute, Finland) • Dr. Rolf Rosenbrock (Professor, Social Science Research Center Berlin, Germany) • Ms. Imogen Sharp (Head, Health Inequalities - UK Presidency of EU, Department of

Health, UK). The editorial board had a meeting in Brussels on 23 January 2006 when the first drafts of the chapters were reviewed. Thereafter several members of the editorial board commented the elaborated drafts of the chapters via e-mail. All chapters (excluding introduction and summary) were reviewed by an external expert (two experts split the work). Thus, the chapters were commented twice by external experts (the editorial board and a reviewer) and many times by editors. In addition the Commission commented on all the chapters before they were finalised. The WHO Observatory took care of the copy-editing and STAKES of the printing of the publication. STAKES was responsible for the project management of the publication. The book was published by MSAH, under the auspices of OBS. It was a joint work by all beneficiaries and OBS. Distribution of the publication is described in Chapter 4.3. Deliveries

• Health in All Policies - Prospects and potentials -publication (4000 + 2700 copies), see Annex 3

• Policy brief on Health in All Policies in the European Union and its member states (executive summary), see Annex 4

2.4. High Level Presidency Conference The conference was organised 20–21 September in Kuopio, Finland. In total, there were 225 participants in the conference (see Annex 5). Although it was an expert conference it had the Commissioner’s, three ministers’ and a State Secretary’s representation. Other participants were mainly from the ministries but also health organisations and industry were represented. The programme consisted of four opening session speeches, six plenary presentations, a ministerial panel, five working groups, plenary feedback from the working groups and two closing session speeches (see Annex 6). Themes of the working groups were: 1) Health Inequalities as a Multisectoral Challenge; 2) Diet, Nutrition and Physical Activity: policies for counteracting the epidemic of chronic diseases; 3) Alcohol Policies: balancing macroeconomic impacts and public

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health harms of alcohol; 4) Transport – Environment – Health: shared policy goals?; and 5) Mental Health and Public Policies. The coordinators of the working groups prepared together with other experts a background document that served a basis for discussions in the working groups. The background document was distributed to the participants in advance. Exhibition was limited to the following organisations that were also present at the conference: City of Kuopio, European Commission, MSAH and its institutions (Finnish Institute of Occupational Health, NPHI, STAKES) complemented with the National Health Confederation and WHO Regional Office for Europe. Two press conferences were held during the conference: Wednesday 20 September at 13–14

• Minister Liisa Hyssälä, Ministry of Social Affairs and Health, • Regional Director Marc Danzon, WHO Regional Office for Europe, • Director Bernard Merkel, Health Directorate General, European Commission • Director-General Kimmo Leppo, Ministry of Social Affairs and Health • Professor Martin McKee, London School of Hygiene and Tropical Medicine and • Professor Ilona Kickbusch

Thursday 21 September at 12.30 • Commissioner Markos Kyprianou, European Commission • Minister Liisa Hyssälä, Ministry of Social Affairs and Health

The organisation of the conference was run by 46 persons from MSAH, STAKES and the Secretariat for Finland’s EU Presidency. The Secretariat also funded the conference including the rent of the location and the costs for the interpretation. Simultaneous interpretation was available in English, Finnish, French and German. Thus, nine interpreters were recruited from SCIC. Deliveries

• Background documents of the workshops (Annex 7) • Presentations and speeches (available at the MSAH’s web page)

2.5. Council Conclusions on Health in All Policies All five policy dialogues served as a basis for the Council Conclusions on Health in All Policies that were accepted on 30 November 2006 by the Employment, Social Policy, Health and Consumer Affairs Council of the European Union (Annex 8). Preliminary themes for the Conclusions were for the first time presented at the closing session of the plenary policy dialogues in Brussels in June. After the Kuopio high-level conference in September the first draft of the conclusions was written and presented in the Council working party on Public Health. The text was elaborated by the group and sent for adoption by the Health Council, which took place on 30 November 2007.

3. Manpower for the execution of the activities 3.1. Manpower of the coordination of the project WP 1 MSAH Days of

work Total cost

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Kimmo Leppo Director-General Health Department 4 1906,40 Tapani Melkas Director Health Department, Health

Promotion and Disease Prevention

6 2084,22

Anna Ehrnrooth Counsellor for public health

Permanent Representation of Finland to the European Union

15 2785,05

ero Lahtinen Ministerial Adviser Health Department, Health Promotion and Disease Prevention

30 9 144,00

Satu Koskenkorva Senior Officer Health Department, Health Promotion and Disease Prevention

70 12 020,40

Eerik Tarnaala Planning officer Health Department, Health Promotion and Disease Prevention

15 2 100,30

Martta Forsell Project coordinator Health Department 35 5 048,05 Eeva Larjomaa Director of

information and Communication

Information and Communication Unit

1 325,52

Heini Utunen Information Officer Information and Communication Unit

5 882,70

Tarja Tamminen Head of Information


7 1 787,38

Tuomas Leppo Project coordinator International Affairs Unit 20 2 839,60 Outi Kuivasniemi Project Manager International Affairs Unit 5 1 054,80 Merja Huovinen Senior Officer International Affairs Unit 2 357,74 STAKES Niina Sipiläinen Financial Officer Administration 10 1 649,28 Hannele Honkanen Financial Secretary Administration 100 15 716,90 TOTAL 325 59702,34 3.2. Manpower of the dissemination of the results WP 2 MSAH Days of

work Total cost

Eero Lahtinen Ministerial Adviser Health Department, Health Promotion and Disease Prevention

5 1 524,00


5 858,60


5 882,70

Satu Renko Communication Secretary


2 257,90

Sanna Leinonen Information Officer Information and Communication Unit

2 335,98

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Tarja Tamminen Head of Information


5 1 276,70

Hannele Tanhua Senior Officer International Affairs Unit 6 1 018,44 TOTAL 30 6 154,32 3.3. Manpower of the evaluation of the project WP 3 Name Professional level Unit

Days of work

Total cost

MSAH Kimmo Leppo Director-General Health Department 2 953,20 Tapani Melkas Director Health Department, Health


2 694,74


5 1 524,00

STAKES Timo Ståhl1 Senior Researcher STAKES, Municipal

Welfare Strategies Unit 20 5 920,00

TOTAL 29 9091,94 3.4. Manpower of the execution of the policy dialogues WP 4 Name Professional level Unit

Days of work

Total cost

STAKES Hannele Honkanen1 Financial Secretary Administration 2 314,34 Timo Ståhl1 Senior Researcher Municipal Welfare

Strategies Unit 5 1 480,00



1 347,37


20 6 096,00


3 515,16

TOTAL 33 9706,07 1Costs not pertaining to national officials 3.5. Manpower of the execution of the EURONCD conference WP 5

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Name Professional level Unit

Days of work

Total cost

NPHI Hanne Heikkinen1 Coordinator Department of Health

Promotion and Chronic Disease Prevention, Chronic Disease Prevention Unit

43,5 6 558,00

Marketta Taimi1 Secretary Department of Health Promotion and Chronic Disease Prevention, Chronic Disease Epidemiology Unit

44,5 5 755,57

Erkki Vartiainen 23 8 644,46 Pekka Jousilahti Research Professor Department of Health

Promotion and Chronic Disease Prevention, Chronic Disease Epidemiology Unit

20 6 000,00

Kimmo Leppo Director-General Health Department 1 476,60 Tapani Melkas Director Health Department, Health


1 347,37


2 609,60


2 343,44

TOTAL 137 28 735,04 1Costs not pertaining to national officials 3.6. Manpower of the execution of the Health in All Policies - Prospects and potentials –

publication WP 6 Name Professional level Unit

Days of work

Total cost

NPHI Pekka Jousilahti Research Professor Department of Health


20 6 000,00

STAKES Tapani Kauppinen1 Project Manager Municipal Welfare


Timo Ståhl1 Senior Researcher Municipal Welfare Strategies Unit

80 23 679,98

Kerttu Perttilä Development Municipal Welfare 5 1 450,68

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Manager Strategies Unit MSAH Kimmo Leppo Director-General Health Department 4 1 906,40 Tapani Melkas Director Health Department, Health


7 2 431,59


17 5 181,60


5 858,60

Finnish Institue of Occupational Health (FIOH) Kari Lindström Director Centre of Expertise for

Work Organisations 20 9 000,00

TOTAL 178 54 310,28 1Costs not pertaining to national officials 3.7. Manpower of the execution of the Presidency Conference WP 7 Name Professional

level/category Unit

Days of work

Total cost

NPHI Pekka Jousilahti Research Professor Department of Health


20 6 000,00

Erkki Vartiainen Department of Health Promotion and Chronic Disease Prevention, Chronic Disease Epidemiology Unit

3 1 127,54

Tiina Laatikainen Reseracher

Department of Health Promotion and Chronic Disease Prevention, Chronic Disease Epidemiology Unit 26 6 325,69

Ritva Prättälä, Researcher

Department of Health Promotion and Chronic Disease Prevention, Chronic Disease Epidemiology Unit 16 4 304,00

Hanne Heikkinen1 Coordinator Department of Health Promotion and Chronic Disease Prevention, Chronic Disease Prevention Unit

22 3 278,53

Marketta Taimi1 Secretary Department of Health Promotion and Chronic

33 4 315,41

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Disease Prevention, Chronic Disease Epidemiology Unit

STAKES Aimo Silvenius Chief of Caretaker

Service Administration 7,5

1 114,82

Niina Sipiläinen1 Financial Officer Administration 59 9 731,54 Hannele Honkanen1 Financial Secretary Administration 38 5 972,42 Merja Paimensaari1 Project Coordinator Welfare Research 140 28 721,06 Timo Ståhl1 Senior Researcher Municipal Welfare


Floor staff Various positions Various departments 60 8 966,32 Kerttu Perttilä Development

Manager Municipal Welfare Strategies Unit

15 4 352,03



3 1 042,11

Eerik Tarnaala Planning officer Health Department, Health Promotion and Disease Prevention

70 9 801,40


5 1 524,00

Eeva Larjomaa Director of Information and Communication


4 1 302,08


5 882,70

Satu Renko Communication Secretary


3 386,85

Sanna Leinonen Information Officer Information and Communication Unit

3 503,97

Outi Kuivasniemi Project Manager International Affairs Unit 5 1 054,80 Tuomas Leppo Project Coordinator International Affairs Unit 5 709,90 Merja Huovinen Senior Officer International Affairs Unit 3 536,61 Hannele Tanhua Senior Officer International Affairs Unit 3 509,22 Satu Koskenkorva Senior Officer Health Department, Health


5 858,60

Martta Forsell Project Coordinator Health Department 5 721,15 Niina Bodekole1 Secretary Insurance Department,

MSAH 5

Henna Eronen1 Translator International Affairs Unit, MSAH

4

Anne Maunu1 Secretary Insurance Department, MSAH

4

Kia Paasivirta1 Project Secretary Health Department, MSAH 4

2 834,71

13

Maria Forslund1 Project Planning Officer

International Affairs Unit, MSAH

4

Ilari Wickström Transportation Chief

Administrative Department 4

Jarmo Hämäläinen Security Officer Administrative Department 4 Pekka Nurmi Security Control

Technician Administrative Department 4

Lauri Ristimäki Head Attendant, In-House Services


Keijo Venäläinen Senior Attendant, In-House Services


2 526,72

FIOH Kari Lindström Director Centre of Expertise for

Work Organisations 40 18 000,00

TOTAL 775,5 168 021,34 1Costs not pertaining to national officials 4. Partners involved EURONCD conference NPHI had the main responsibility for organising the conference. MSAH, the European Commission and the WHO Regional Office for Europe were closely involved in the preparations and realization of the conference. In addition to the associated partners, a group of collaborators was closely involved in the preparations and realisation of the conference especially through the Scientific Committee. The main collaborators included the European Cancer League, European Heart Network, Finnish Cancer Society, Finnish Centre for Health Promotion, Finnish Diabetes Association, Finnish Heart Association, Health Promotion Agency (Northern Ireland, UK), North Karelia Project Research Foundation, Public Health Agency (Canada), Centers for Disease Control and Prevention (CDC) and WHO CINDI Programme Network. Two preparatory committees were involved in the preparations: the Scientific and the Programme Committee, which had the responsibility of laying out the scientific guidelines and the structure for the programme. The members of the Scientific Committee were

• Vilius Grabauskas, chair (Kaunas University of Medicine, Lithuania) • Jill Farrington (WHO, Regional Office for Europe, Denmark) • Igor Glasunov (State Research Centre for Preventive Medicine, Russia) • Gudjon Magnusson (WHO, Regional Office for Europe, Denmark) • Aulikki Nissinen (National Public Health Institute, Finland) • Rafael Oganov (National Research Centre for Preventive Medicine, Russia) • Pekka Puska (National Public Health Institute, Finland) • Matti Rajala (European Commission, Switzerland) • Aushra Shatchkute (WHO, Regional Office for Europe, Denmark) • Sylvie Stachenko (Public Health Agency, Canada) • Erkki Vartiainen (National Public Health Institute, Finland) • Tor Jungman (Finnish Heart Association, Finland) • Mika Pyykkö (Finnish Centre for Health Promotion, Finland)

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• Harri Vertio (Finnish Cancer Society, Finland) • Leena Etu-Seppälä (Finnish Diabetes Association, Finland) • Susanne Løgstrup (European Heart Network, Belgium) • Bruno Meili (Association of European Cancer Leagues, Belgium)

The members of the Programme Committee were

• Vilius Grabauskas, chair (Kaunas University of Medicine, Lithuania) • Jill Farrington (WHO, Regional Office for Europe, Denmark) • Brian Gaffney (Health Promotion Agency, Northern Ireland, UK) • Ritva Prättälä (National Public Health Institute, Finland) • Pekka Puska (National Public Health Institute, Finland) • Aushra Shatchkute (WHO, Regional Office for Europe, Denmark) • Sylvie Stachkenko (Public Health Agency, Canada) • Erkki Vartiainen (National Public Health Institute, Finland)

The practical preparations of the work were carried out by NPHI. The following persons were involved: Erkki Vartiainen, Tiina Laatikainen, Ritva Prättälä, Pekka Jousilahti, Hanne Heikkinen and Marketta Taimi. Policy dialogues STAKES, MSAH and OBS were responsible for the planning and execution of the policy dialogues. As an important task, the Ministry took care of the invitations of the policy dialogues. The contacts of the Ministry and associated partners were used to guarantee the widest possible participation. OBS planned the content and outline of the dialogues according to their earlier experiences. Together with MSAH it invited the moderators to the policy dialogues. STAKES took care of the practical arrangements and produced the report of the dialogues together with OBS and MSAH. Policy dialogues contributed especially to the objectives one ”identify the needs of the Member States related to in-depth Health Impact Assessment (HIA) and develop the project accordingly” and four ”support the Member States in using all policies to improve health and developing national in-depth HIAs; and support the Commission in emphasising health effects of relevant other policies trough impact assessment procedures by promoting good governance and legislation in the Council”. Health in All Policies - Prospects and potentials -publication STAKES was responsible for the publication. The first and third editors came from STAKES, the second editor came from OBS, the fourth and fifth from MSAH. Eleven persons from STAKES, four from MSAH, one from NPHI, two from FIOH and two from OBS contributed the publication as authors. The Editorial Board contributed the scientific quality and political relevance of the publication and its appropriateness regarding the aims of the Finnish Presidency, i.e. to promote the ‘Health in All Policies’ approach in the EU and Member States decision-making. The following partners/persons were involved in the work of the editorial board: • Dr. Josep Figueras (Director, European Observatory on Health Systems and Policies, Brussels) • Dr. Maarike Harro (Director General, National Institute for Health Development, Estonia) • Dr. Anna Hedin (Desk Officer, Ministry of Health and Social Affairs, Stockholm, Sweden)

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• Dr. Meri Koivusalo (Senior Researcher, STAKES, Finland) • Dr. Tapani Melkas (Director, Ministry of Social Affairs and Health, Finland) • Dr. José Pereira Miguel (High Commissioner for Health, Portugal) • Dr. Pekka Puska (Director General, National Public Health Institute, Finland) • Ms. Imogen Sharp (Head, Health Inequalities - UK Presidency of EU, Department of Health,

UK). The publication contributed especially to the objectives two ”gather the best available knowledge on good practices, pros and cons of in-depth health impact assessment, and how to improve the use of other policies to enhance health and reduce health disparities, especially with a view to children’s and young people’s health” and three ”increase knowledge on broad societal health determinants; what population health gains are available and how the monitoring of these determinants can produce arguments for the political process” of the project. Presidency Conference The Ministry of Social Affairs and Health had the main responsible for the organization of the High Level Presidency conference. The associated partners STAKES, NPHI and FIOH were closely involved in the preparations especially through the steering group, which had the overall strategic and political responsibility of the conference. OBS was also closely involved in the planning of the programme. The composition of the national steering group was the following: Members • Kimmo Leppo, chair, Director-General, Ministry of Social Affairs and Health • Tapani Melkas, vice-chair, Director, Ministry of Social Affairs and Health • Vappu Taipale, Director-General, STAKES • Pekka Puska, Director-General, National Public Health Institute • Harri Vainio, Director-General, Finnish Institute of Occupational Health • Kari Lindström, Director, Finnish Institute of Occupational Health • Aino-Inkeri Hansson, Director-General, Ministry of Social Affairs and Health • Eero Lahtinen, Ministerial Adviser, Ministry of Social Affairs and Health • Merja Huovinen, Senior Officer, Ministry of Social Affairs and Health • Outi Kuivasniemi, Project Manager, Ministry of Social Affairs and Health • Eeva Aittoniemi, Counsellor, Government Secretariat for EU Affairs • Jouni Flink, Meeting Coordinator, Secretariat for Finland's EU Presidency • Arto Koho, Counsellor, Permanent Representation of Finland to the European Union Secretary • Tuomas Leppo, secretary, Project Coordinator, Ministry of Social Affairs and Health • Satu Koskenkorva, secretary, Senior Officer, Ministry of Social Affairs and Health Experts • Merja Paimensaari, Project Coordinator, STAKES • Timo Ståhl, Senior Researcher, STAKES • Tarja Tamminen, Head of Information, Ministry of Social Affairs and Health • Eerik Tarnaala, Project Coordinator, Ministry of Social Affairs and Health Practical preparations of the work was carried out by the task force. The composition of the task force was following: • Eero Lahtinen, Ministerial Adviser, Ministry of Social Affairs and Health • Satu Koskenkorva, Senior Officer, Ministry of Social Affairs and Health

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• Eerik Tarnaala, Project Coordinator, Ministry of Social Affairs and Health • Tarja Tamminen, Head of Information, Ministry of Social Affairs and Health • Martta Forsell, Project Coordinator, Ministry of Social Affairs and Health • Tuomas Leppo, Project Coordinator, Ministry of Social Affairs and Health • Anna Parkkinen, Trainee, Ministry of Social Affairs and Health • Timo Ståhl, Senior Researcher, STAKES • Merja Paimensaari, Project Coordinator, STAKES • Jouni Flink, Meeting Coordinator, Secretariat for Finland's EU Presidency The conference contributed especially to the achievement of the Objective 2 (gathering best available knowledge on good practices…). The conference offered a forum for sharing experiences and for learning from one another while at the same time building networks of experts, to whom policy-makers can turn to when implementing HiAP/HIA in their respective countries. The conference also contributed to the achievement of the Objective 3 (increase knowledge on broad social determinants…), as the conference provided sound, scientific knowledge of the role of social health determinants in the determination of population health. The conference was a natural continuation of the policy dialogues and together they served as the basis for the Objective 5 (stimulate the practical tools...) and acceptance of the Council Conclusions on HiAP. 5. Countries involved 5.1. EURONCD The Helsinki conference hosted 193 participants from 45 countries, including 21 EU countries and 5 applicant countries (Table 1). First and foremost the audience consisted of the Member States’ public health experts, which were drawn up and invited by NHPI, but also of a wide range of researchers and decision makers from the Member States and countries both in Europe and in the rest of the world.

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Table 1. Participants by the country of origin in the European Conference on Chronic Disease Prevention in December 2005

Member states Number of participants (speakers included)

Austria 2 Belgium 2 Czech Republic 2 Denmark 5 Estonia 9 Finland 57 Germany 2 Hungary 3 Ireland 2 Italy 4 Latvia 4 Lithuania 5 Luxembourg 2 Netherlands 9 Poland 2 Portugal 1 Slovakia 2 Slovenia 5 Spain 2 Sweden 1 United Kingdom 9

Applicant countries Bulgaria 2 Croatia 2 Macedonia 2 Romania 1 Turkey 3

Other European countries Albania 1 Armenia 1 Azerbaijan 1 Belarus 1 Bosnia and Herzegovina 2 Georgia 3 Kazakhstan 1 Kyrgyzstan 1 Moldova 1 Norway 1 Russia 15 Switzerland 2 Ukraine 2 Yugoslavia 3

Other countries Canada 9 Nigeria 3 Pakistan 2 Qatar 1 United States 3

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All the participants received the conference publication. The keynote presentations were also available on the conference website after the event for further use to ensure a wider access to and dissemination of the overall conference output. The output from the conference was also exploited in a workshop that was outlining the European Report on Chronic Disease Prevention. The workshop, held in Copenhagen on the 17 March 2006, brought together various experts, including WHO and NPHI officials. 5.2. Policy dialogues Five workshops were conducted in total. First, four workshops were held to enable participants from the EU Member States, EFTA-EEA and applicant countries to meet in small groups for effective dialogue (Table 2). Twenty-six of the 32 invited countries participated in the events. Some countries had two or three participants, thus all together there was 33 participants from the invited countries and 12 experts. Participants were mainly from the ministries, their position varying from the advisor to the minister to desk-level officials. A few participants represented research institutes. In five cases, there was not representation from the capital, but the health attaché represented their countries. No representation came from Italy, Greece, Poland, Liechtenstein, Bulgaria, or Iceland. Table 2. Participants of the policy dialogues in February and March 2006 Name Country Organisation Title Haas Aziza Austria PR of Austria to the EU Health Attaché Meulenbergs Leen Belgium Federal Pubic Service, Health, Food Safety and

Environment, Services of the President - International Relations

Evi Missouri Cyprus Ministry of Health Klaudie Faltysová Czech Rep. PR of Czech Republic to the EU Health Attaché Razova Jarmila Czech Rep. Department of Strategy and Management of

Public Health, Ministry of Health of the Czech Republic

Andersen Janus Denmark Ministry of the Interior and Health of Denmark Senior Adviser Link Edda-Helen Estonia PR of Estonia to the EU Health Attaché Reinap Marge Estonia Public Health Department, Ministry of Social

Affairs of Estonia Brodin Marc France Ministry of Health, Santé Publique/ Faculté de

Médecine Paris VII Professor

Brand Helmut Germany Institute of Public Health Northrhine-Westfalia Director Hoepner-Stamos Friederike

Germany Federal Ministry of Health Counsellor

Laube-Friese Dagmar Germany PR of Germany to the EU Kovács Éva Hungary National Institute of Health Promotion O´Toole John Ireland PR of Ireland to the EU Health Attaché Kitija Abola-Abolina Latvia Department of Strategic Planning, Ministry of

Health of Republic of Latvia Starkiene Liudvika Lithuania Ministry of Health of the Republic of Lithuania Adviser to the

Minister Calteux Anne Luxembourg PR of Luxembourg to the EU Health Attaché Muscat Natasha Malta EU and International Affairs, Department of

Health, Malta Director of EU and International Affairs

van Elk, Birte Netherlands PR of the Netherlands to the EU

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Fosse Arne Marius Norway Health Impact Assessment Unit, Directorate for Health and Social Affairs

Project Coordinator

Sundrehagen Hilde C Norway Mission of Norway to the EU Counsellor for Health and Food Safety

Portugal Rui Portugal Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa

Professor

Anglehuta Carmen Romania Department of European Integration and Foreign Relations, Ministry of Health

Deputy General Director

Letanovsky Peter Slovak Rep. Ministry of Health of the Slovak Republic Skublova Zuzana Slovak Rep. Ministry of Health of the Slovak Republic Head of Project Unit

of Foreign Aid Zvezdana Veber Hartman

Slovenia EU Affairs and International Cooperation Service, Ministry of Health, Slovenia

Head of EU and International Affairs

Sarria-Santamera Antonio

Spain Spanish Agency for Health Technology Assessment

Ampelas Anna-Eva Sweden PR of Sweden to the EU Health Attaché Ulrich-Vögtlin Ursula Switzerland Swiss Federal Office of Public Health Head of Division of

Multisectoral Health Policy

Yardim Nazan Turkey School of Public Health, Ministry of Health Deputy Director Brookes Chris UK Department of Health International Project

Manager Korkodilos Marilena UK Department of Health Specialist, Registrar

on Public Health Experts and organisers

Francis Jacobs EP Committee on the Environment, Public Health and Food Safety

Mann Daniel COM Health Information Unit C2, SANCO - Health and Consumer Protection

Project and Policy Officer

Siddall Clare COM Health Strategy Unit C5, SANCO Flynn Peter UK Former Deputy Regional Director of Public

Health for North West England

Broucken van den Stefan

Leuven Research Group for Stress, Health and Wellbeing Associate professor

Martuzzi Marco WHO WHO, Rome Scientific Officer Figueras Josep WHO European Observatory on Health Systems and

Policies, WHO European Centre for Health Policy

Head of the Observatory Secretariat and a Researcher Director

Wissmar Matthias WHO European Observatory on Health Systems and Policies, WHO European Centre for Health Policy

Health Policy Analyst

Anna Ehrnrooth Finland PR of Finland to the EU Counsellor Lahtinen Eero Finland Ministry of Social Affairs and Health Senior Medical

Officer, Project Leader

Ståhl Timo Finland National Research and Development Centre for Welfare and Health (STAKES)

Senior Researcher

Tuominen Ismo Finland Ministry of Social Affairs and Health Ministerial Adviser The fifth workshop held on 12 June 2006 in Brussels was the summit of the workshops, consequently bringing together the various discussion strands from the workshops. In total, there were 34 participants from 23 countries and 13 experts in the plenary workshop (Table 3). Ten Member States had only health attaché representation. There was no representation from France, Greece, the Netherlands, Poland, Slovak Republic, Spain, Bulgaria, Liechtenstein, or Iceland.

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Table 3. Participants of the plenary policy dialogue in June 2006 Name

Country Organisation Title

Michael Kunze Austria Institut für Sozialmedizin Professor Aziza Haas Austria PR of Austria to the EU Health attaché Anne Deltour Belgium PR of Belgium to the EU Health attaché Inga Depolo-Bucan Croatia Ministry of Health and Social Affairs Head of

International Department

Evi Missouri Cyprus Ministry of Health Frenaritou Charitini Cyprus PR of Cyprus to the EU Health attaché Eva Gottvaldova Czech Rep. Department of Strategy and Management of

Public Health, Ministry of Health

Klaudie Faltysová Czech Rep. PR of Czech Rep. to the EU Health Attaché Hanne Findsen Denmark PR of Denmark to the EU Health Counsellor Edda-Helen Link Estonia PR of Estonia to the EU Health Attaché Kimmo Leppo Finland Ministry of Social Affairs and Health, Finland,

Health Department Director General

Anna Ehrnrooth Finland PR of Finland to the EU Health Attaché Friederike Hoepner-Stamos

Germany Federal Ministry of Health

Helmut Brand Germany Institute of Public Health Northrhine-Westfalia Director

Éva Kovács Hungary National Institute of Health Promotion John O´Toole Ireland PR of Ireland to the EU Health Attaché Marco Castellina Italy PR of Italia to the EU Kitija Abola-Abolina Latvia Department of Strategical Planning, Ministry of

Health

Silvija Juscenno Latvia PR of Latvia to the EU Health attaché Radvile Jakaitiené Lithuania Ministry of Health, Foreign Affairs Division Chief Specialist

Anne Calteux Luxembourg PR of Luxemburg to the EU Health Attaché Natasha Azzopardi Muscat

Malta Ministry of Health, the Elderly and Community Care

Director

Stephen Mifsud Malta PR of Malta to the EU Health Attaché Arne Marius Fosse Norway Health Impact Assessment Unit, Directorate for

Health and Social Affairs Project Coordinator

Dalila Maulide Portugal Ministry of Health High Commissioner of Health

Agata Zupančič Slovenia Ministry of Health Anna Hedin Sweden Ministry of Health and Social Affairs Desk Officer Anna Eva Ampelas Sweden PR of Sweden to the EU Ursula Ulrich-Vögtlin Switzerland Swiss Federal Office of Public Health, Head of Division of

Multisectoral Health Policy

Huseyin Ozbay Turkey School of Public Health Maggie Rae United

Kingdom Department of Health Head of Health

Inequalities Unit

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Marilena Korkodilos United Kingdom

Department of Health Specialist, Registrar on Public Health

Helena Bowden UK Health attaché

Experts Marshall Marinker United

Kingdom King's Colliege, London Professor

John F. Ryan COM European Commission, DG SANCO, Health Information Unit

Head of Unit

Johan.. Fontarini COM Clare Siddall COM Matthias Wismar WHO/OBS European Observatory on Health Systems and

Policies, WHO European Centre for Health Policy

Health Policy Analyst

Marco Martuzzi WHO/EURO WHO/EURO, Centre for Environment and Health, Rome Office

Scientific Officer

Nata Menabde WHO/EURO WHO Regional Office for Europe Deputy Regional Director

Albeuor Arnaudova WHO/EURO Josep Figueras WHO/OBS Eero Lahtinen Finland Ministry of Social Affairs and Health, Finland,

Health Department Senior Medical Officer, Project Leader

Timo Ståhl Finland National Research and Development Centre for Welfare and Health STAKES

Senior Researcher

Eeva Ollila Finland National Research and Development Centre for Welfare and Health STAKES

Senior Researcher

Merja Paimensaari Finland National Research and Development Centre for Welfare and Health STAKES

Project Coordinator

Clive Needle Belgium EuroHealthNet Liasion Office Director

A report based on the four dialogues held in February and March was sent to all the invited countries for their internal distribution. All the presentations held in February, March and June were sent to the invited countries. The countries were encouraged to use the presentations to inform colleagues about the HiAP process. 5.3. Health in All Policies - Prospects and potentials -publication The publication was distributed widely across Europe and also worldwide. Distribution lists were provided by OBS. Table 4 shows the main distribution channels. Until the end of November 2006 the Finnish partners had distributed 3000 copies of the book. OBS had distributed an additional 1000 copies. Table 4. Main distribution groups of the publication

Object of the distribution Nr of copies

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Authors, co-authors and editorial board 90 Participants of the conference 200 Distribution in HiAP Kuopio conference 60 ENVI committee 63 Commission, DG SANCO Member States and other European countries (five copies per country) 170 Distribution list provided by OBS

ASPEHR 70 EUPHA 48 UN Offices 22 Depository libraries for WHO publications 54 Medical Associations 161 Public Health Schools 47 WHO documentation centres 47 Universities 80 MHI-OSI (eastern Europe, Asia) 94 Open Society institutes/foundations (East Europe) 24

WHO Regional Committee meeting 70 National distribution 420 WHO Healthy Cities Conference, Turku 350 5.4. Presidency Conference Totally there were 225 participants in the Kuopio conference. There was a representation of each Member States, applicant countries and other European countries (Table 5). The full list of participants is in Annex 5. Table 5. Countries participated in the Presidency Conference

Country

Nr of participants (includes speakers)

Member states Austria 5 Belgium 4 Cyprus 3 Czech Republic 4 Denmark 2 Estonia 3 Finland 68 France 1 Germany 9 Greece 2 Hungary 2 Ireland 2 Italy 2 Latvia 2 Lithuania 3 Luxembourg 2 Malta 2

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Netherlands 7 Poland 5 Portugal 6 Slovak Republic 4 Slovenia 5 Spain 2 Sweden 9 United Kingdom 16

Applicant countries Turkey 2 Romania 1 Bulgaria 1

Other European countries Croatia 1 Norway 4 Switzerland 1

6. Achievement of the activities The evaluation is related to all specific objectives referred to Annex I of the Grant agreement. Objective 1 is assessed by keeping record of the participating countries in the policy dialogues and concluding seminar (number of participants and their affiliation). Evaluation of the Objectives 2 and 3 is based on the outputs of the publication (number, quality and comprehensiveness of the papers), the Conference on Chronic Disease Prevention (number of relevant presentations) and the Presidency Conference (number, quality and comprehensiveness of the presentations). The quality, comprehensiveness and relevance of the papers and presentations are assessed by the National Steering Group. The knowledge increase (Objective 3) is assessed by collecting information of the number of people directly in contact with the process and considering the number of papers that address broad societal health determinants in the publication. Objective 4 is assessed by considering the geographical coverage of the network and whether the Council Conclusions are adopted during the Finnish Presidency. For the Objective 5 the number of concrete suggestions for the development of the HIA in the Council Conclusions is considered and assessed. Following the evaluation is presented according to the specific objectives using the indicators referred to above. Summary of the evaluation The project can be assessed as successful in its implementation and in reaching the objectives of the project. All activities were conducted as planned and in time. The participation in the various events of the project has been extensive and the feedback very positive. The ’end products’ of the project, the publication and Presidency conference have received unusually wide attention. Indications of the successfulness of the project are the inclusion of Health in All Policies as one of the three mains strands of the proposed Health Strategy of the Commission. Also, Germany is going to have Nutrition and physical activity as the main public health theme of its Presidency and will consider the theme from the HiAP perspective. Slovenia will run the Presidency after Germany and has decided to concentrate on cancer. It has also adopted a wide standpoint and is going to consider cancer not only as screening and treatment, but also from all sectors’ perspective. OBJECTIVE 1 Identify the needs of the participating countries: number of participating countries

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Twenty-six of the 32 invited countries participated in the four policy dialogues that were held during February and March 2006 (see Table 2). Some countries had two or three participants, thus all together there was 33 participants and 12 experts. Participants were mainly from the ministries, their position varying from the advisors to the minister to desk-level officials. A few participants represented research institutes. In five cases, there was not representation from the capital, but the health attaché represented their countries. No representation came from Italy, Greece, Poland, Liechtenstein, Bulgaria, or Iceland. Twenty-three of the 32 invited countries participated in the plenary policy dialogue that was held in June 2006. In total, there were 34 participants from the invited countries and 13 experts (see Table 3). Ten Member States had only health attachés representation. There was no representation from France, Greece, the Netherlands, Poland, Slovak Republic, Spain, Bulgaria, Liechtenstein, or Iceland. The participation in the plenary policy dialogue can be assessed as very good since there was only one date available. Only two Member States did not participate in the policy dialogues held in the spring, which can be considered a good result. OBJECTIVE 2. Gather the best available knowledge on good practices, pros and cons of in-depth health impact assessment, and how to improve the use of other policies to enhance health and reduce health disparities, especially with a view to children’s and young people’s health The objective was achieved well. The chapters of the publication and presentations held in the conferences were relevant and of high quality. Conference on Chronic Disease Prevention (number of relevant presentations) Providing background information for the Finnish EU presidency work on health was one of the aims of the conference and HIA was discussed within the main themes of the conference, e.g. “Capacity building and advocacy” and “Integration”. Altogether four plenary presentations and two panel discussions were devoted to these themes. Eleven of the fourteen plenary presentations considered the role of other sectors from different perspectives. One plenary presentation (Professor Mackenbach) and panel discussion discussed health inequalities and especially the contribution of health behaviours and chronic diseases to inequalities in morbidity and mortality. Health inequalities were dealt with in several poster presentations, as well. The theme was mentioned briefly in other presentations, too.

Health of children and adolescents was discussed in workshops and poster sessions. Altogether seven workshops were held focussing on modelling, interventions, public health policies and action plans, integrated NCD preventions - CINDI experiences, capacity building, partnership and networking and the role of institutions (45 presentations). The role of other sectors was considered in many presentations but the emphasis was on health sector activities. What other sectors could/should do for health or how they are doing at the moment from health perspective was not considered that often. Bearing in mind that eleven of the fourteen plenary presentations had a strong emphasis on the role of other sectors and one emphasised specifically inequality issues the national steering group

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appraises that the objective concerning the role of other sectors was achieved well. The speakers were dedicated international experts, which guaranteed the high quality of the presentations. However, there could have been more concrete presentations about how to get other sectors to take health into account in their decision-making. The Publication: “Health in All Policies - Prospects and potentials” (number, quality and comprehensiveness of the papers) Four chapters (Chapters. 10, 11, 12 and 13) were dedicated to health impact assessment. The external reviewer considered Chapter 10 as one of the best papers on health impact assessment that he had ever seen: ”This is an excellent, well researched and well written paper. It offers an objective, insightful and intelligent critique of the strengths and weaknesses of health impact assessment as a policy tool, and provides a clear explanation of the potential use of HIA in supporting the achievement of HIAP. It is certainly the best examination of HIA that I have read.” He was a bit more critical on Chapters 11 and 12 stating that the chapters ”provide a selection of results from a Europe-wide survey of the application of HIA in different countries, at different levels within countries. It provides a reasonable descriptive overview of results and provides some useful case studies of apparently successfully executed HIAs”" The reviewer pointed out several shortcomings in reporting the methodology of the study and interpreting the results. These were taken into account in later elaborations that were guided by one of the editors. The reviewer considered Chapter 13 as “an excellent contribution to the book providing a concise, analytical examination of a case study in implementation in a Finnish city”. Health inequality was chosen as a crosscutting theme. It was specifically emphasised in introduction and Chapters 1, 2, 3, 5, 8, 10, 11, 12, 13 and 14. Other sectors’ role in determining the health of the population was discussed in every chapter. The second reviewer commented the chapters as follows: ”All the chapters I read are relevant, valuable, and interesting to read but in most cases they are still in a draft stage and there is much more work to do. Needless to say, the potential of this volume arises from bringing together a wide range of sectoral policies (with evidence on their impact) under the common policy strategy of ‘health in all policies’.” The national steering group fully agrees with the views of the external reviewer referred to above and regards the choice of having inequality as a crosscutting theme as appropriate. The quality of the chapters was assessed as high. Presidency Conference (number, quality and comprehensiveness of the presentations) The first conference day started with four opening session speeches followed by three plenary presentations. Health impact assessment was visible especially in DG SANCO’s presentation (Bernard Merkel). Health inequality was emphasised especially in the presentations of Professors Mckee and Kickbush as well as children’s and young people’s health. The ministerial panel started the afternoon programme. The panel discussed a variety of issues based on the countries’/institutions’ own experiences. After the panel the programme was divided into five workshops: 1) Health Inequalities as a Multisectoral Challenge; 2) Diet, Nutrition and Physical Activity: policies for counteracting the epidemic of chronic diseases; 3) Alcohol Policies: balancing macroeconomic impacts and public health harms of alcohol; 4) Transport – Environment – Health: shared policy goals?; and 5) Mental Health and Public Policies. Health impact assessment was mentioned in several presentations. The Workshops 4 (six presentations) and 5 (five presentations) put specific emphasis on impact assessments. Although there was a working

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group focusing specifically on health inequalities (nine presentations), the issue was discussed extensively also in other working groups. On Thursday the programme started with feedback from the working groups followed by three plenary presentations. Director Figueras’ presentation focused on the implementation of HiAP and there HIA played a visible role. Sir Marmot’s presentation concentrated on inequality issues.

Children’s and young peoples health was a crosscutting theme in the workshops and was emphasised especially in those workshops related to health behaviours i.e. Alcohol policies and Diet, nutrition and physical activity. The workshop on health inequalities considered children and young people, as well. Bearing in mind that two of the six plenary presentations had a strong emphasis on HIA, three of the six emphasised the inequality issues and all presentations considered the role of other sectors in determining the health of the population, the national steering group appraises that the objective was achieved well both in terms of comprehensiveness and in terms of quality of the actions.

OBJECTIVE 3. Increase knowledge on broad societal health determinants; what population health gains are available and how the monitoring of these determinants can produce arguments for the political process; The conference and publication provided good overview of the importance of broad societal health determinants by showing concrete examples of their role in determining the population health. Arguments for the political process was presented both in the conference (especially the relationship between health and wealth) and in the publication (concrete example of the importance of the structural determinants). Presidency Conference (nr of presentations focusing on broad societal health determinants) The role of broad societal health determinants in Health in All Policies was clarified and emphasised in the key note speakers’ introductory presentations in the first plenary session the as well as in Director-General Kimmo Leppo's presentations in the plenary and in Workshop I. Thereafter the role of broad determinants of health was present in all presentations. The speakers emphasised that tackling with broader determinants has a potential to affect on large groups of population. However, it was also mentioned that reducing health inequalities may require substantially different approaches than influencing particular health problems. Policies aimed at amending health determinants are not necessarily neutral in terms of their effectiveness in the various subgroups of the population. In general, disadvantaged groups benefit later from improvement in health determinants. They are also the most vulnerable when unexpected societal changes occur. Many of the presentations argued that in addition to health gains, also wealth gains can be achieved via improved population health. The present evidence on the relationship between health and wealth provides good arguments for the political process. The Publication: “Health in All Policies - Prospects and potentials” (nr of chapters focusing broad societal health determinants) Introduction of the publication set the scene for broad societal health determinants. Each chapter dealt with the broader health determinants from a perspective relevant to a certain chapter. For

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example, the chapter six on alcohol policies considered the problem from institutions perspective, chapters 10, 11 and 12 from methodology and current practice point of view etc. The knowledge increase was assessed by collecting information of the number of people directly in contact with the process. Considering that there were 193 participants in the EURONCD conference, 79 participants in the policy dialogues, 225 participants in the high-level conference and over 4000 copies of the HiAP publication were distributed the objective can be assessed to be reached well. OBJECTIVE 4 Support the Member States in using all policies to improve health and developing national in-depth HIAs; and support the Commission in emphasising health effects of relevant other policies through impact assessment procedures by promoting good governance and legislation in the Council; geographical coverage of the network; support the Commission in emphasising health effects: adoption of Council Conclusions during the Finnish EU Presidency The objective can be assessed to have been successfully achieved since the Council Conclusions on Health in All Policies were accepted in 30 November 2006 by the Employment, Social Policy, Health and Consumer Affairs Council of the European Union. Geographical coverage of the countries participating in the various activities of the project was in balance. OBJECTIVE 5 Stimulate the development of practical tools and examples for the area, in particular in terms of indicators and surveillance of non-health-sector determinants of health; number of concrete suggestions included in the Council Conclusions The Council Conclusions include several concrete suggestions on how to further develop Health in All Policies and its implementation. In the following there are some of the main suggestions that contribute the Objective 5: URGES the Commission, the Member States and the European Parliament − to ensure the visibility and value of health in the development of EU legislation and policies by, inter alia, health impact assessments; INVITES the Commission − to set out a plan for work in Health in All Policies with a specific emphasis on equity in health and consider including such activities in its new Health Strategy; − to investigate and where necessary develop further coordination mechanisms to ensure that health considerations are taken into account in decision-making across sectors, including international treaties, in a systematic and structured manner; − to further develop the knowledge base and methodology necessary for better understanding of health determinants and the ways in which they are affected by public policies at all levels, including evaluation of the relevance of current impact assessment practices for public health by for example ex-post evaluation, working closely with the WHO Commission for the Social Determinants of Health; − to provide information on trends in health determinants and links between public health and social and economic development in the European Union, at national and regional level; − exploit synergies between policy sectors with interrelated objectives for example through programme cooperation, in particular concerning health at work;

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− to encourage and support exchange of good practices and information on intersectoral policies between Community sectors, Member States and other stakeholders, with special emphasis on health inequalities; and to support capacity building in intersectoral health policy; − to ensure reporting on current Commission practices in health impact assessment and, initially by 2009 and thereafter at appropriate intervals, on the most essential actions to ensure a high level of health protection in all Community policies and actions; INVITES the Member States − to develop the knowledge base on health and its determinants, trends in them, and in health inequalities; − to undertake, where appropriate, health impact assessment of major policy initiatives with a potential bearing on health; − to focus on capacity building in policy analysis and development for improved intersectoral policies; INVITES the European Parliament − to apply Parliamentary mechanisms to ensure effective cross-sectoral cooperation for high level of health protection in all policy sectors; − to take into account and carry out health impact assessments of legislative and nonlegislative proposals; − to consider health impacts, with particular emphasis on equity in health, of decision-making across all policy sectors."

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7. Financial report

Please find the detailed description of the costs from annex 9

Expenditures

Direct eligible costsE1. Staff 335 721 € a. Costs not pertaining to national officials 166 640 € b. Costs pertaining to national officials 169 082 € E2. Travel costs and subsistence allowances 156 434 € E3. Equipment - € E4. Consumables and supplies directly linked to the project - € E5. Subcontracting costs 14 245 € E6. Other costs 36 315 € Total direct eligible costs 542 714 € Indirect eligible costsE7. Overheads 37 990 € Total - Expenditure 580 704 €

Incomes

I1. Commission funding 290 062 € I2. Contribution pertaining to national officials 170 972 € I3. Applicant's financial contribution 103 763 € I4. Income generated by the project 8 759 € I5. Other external resources 7 149 € I6. Other current funding applications - € Total - Incomes 580 704 €

I1. Commission funding 49,95 %

A. GLOBAL COSTS

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Annexes

1. Final Programme and Abstracts of the European Conference on Chronic Disease Prevention 2. Report of the Policy dialogues – the Finnish EU Presidency project on ”Europe for Health

and Wealth” 2006 3. Health in All Policies - Prospects and potentials 4. Policy brief on Health in All Policies in the European Union and its Member States 5. Participants of the High-Level Conference 6. Programme of the High-Level Conference 7. Background documents for the working groups of the high-level conference:

1) Health Inequalities as a Multisectoral Challenge, 2) Diet, Nutrition and Physical Activity: policies for counteracting the epidemic of

chronic diseases, 3) Alcohol Policies: balancing macroeconomic impacts and public health harms of

alcohol, 4) Transport – Environment – Health: shared policy goals? 5) Mental Health and Public Policies.

8. Council Conclusions on Health in All Policies 9. Detailed description of the costs

This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of thecontractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarilyrepresent the view of the Commission or the Directorate General for Health and Consumer Protection. The EuropeanCommission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use madethereof.

final technical implementation report of the project...

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