+

Tobacco-tax based health promotion foundations

Burke FishburnTechnical AdviserInternational Union Against Tuberculosis & Lung Disease

+Rationale

PUBLIC HEALTH EFFICIENCY Funds spent on keeping the population healthy, versus

treating the sick, could improve efficiency within the same level of resources;

SOCIAL COHESION “Wellness of all” can be a rallying point for political and

health sector reforms.

COMMUNITIES & FAMILIES CAN CHANGE THE NORM Behavior change is a collective endeavor

INVESTMENT IN HEALTH PROMOTION PAYS OFF Health promotion can yield big [short-term] returns

+Health promotion is not….

Health Promotion

≠

Health Education (alone)

+Health promotion is…

Education

Social Mobilization

Advocacy

+Health promotion is…

“…the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. …Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.” Ottawa Charter, developed from the 1st International

Conference on Health Promotion in Ottawa, Canada in 1986

+5 priority HP actions

1. Build healthy public policy;

2. Create supportive environments for health;

3. Strengthen community action for health;

4. Develop personal skills; and

5. Re-orient health services.

+ HP approaches: Social determinants of health Socio-enviironmental

Improve access to food, housing, income, employment, social isolation, early life, transport, addiction and education

Create healthy environments

Preventive Prevent initial occurrence of an illness (primary prevention); e.g. childhood

immunisation programs; Stop or slow existing illness (secondary prevention); e.g. cervical screening; Reduce the re-occurrence and establishment of chronic illness (tertiary

prevention), e.g. effective rehabilitation.

Lifestyle/behavioral Improving behavioural risk factors, such as smoking, poor nutrition, physical

inactivity and substance abuse. Focus at the individual or population level and commonly uses health

education, social marketing, self-help, self-care and public policies to support healthy lifestyles.

+HPF Characteristics Primarily fund health promotion activities

Established under legislation

Have long term and recurrent funding

Governed by an independent Board

Make decisions autonomously

Allocate funds transparently and equitably

Are politically non aligned

Work with and across all sectors

+What HPFs can do Provide grants

Plan and implement health promotion programs

Use sport and arts activities to promote health messages

Support health promotion research by offering grants

Carry out health promotion research

Fund community development

Offer an alternative source of funds to prevent sponsorship from “unhealthy products” (tobacco, alcohol, fast-food)

Conduct social marketing

Advocate for policy

Build leadership and capacity in communities

+HPF funding models

Austria

Vic Health & Healthway

Malaysia

Mongolia

Switzerland

Thailand

VAT distributed by MOF

Direct grant from Treasury (formerly tobacco tax)

Triennial allocation from Govt based on application from Board

Govt budget plus non refundable aid and contributions from other countries and orgs. 2% tobacco and alcohol tax

Health insurance levy of around $ 2.25 per insured person annually

2% of alcohol and tobacco excise tax

+HPF structures: 4 models

Invisible

Embedded

Attached

Independent

+Invisible

Location: HPF located within/under Government agency/Ministry of Health

Funded: “only” by general revenues provided to agency

Partners: are external to HPF and agency; partnerships are through agency

+Embedded

Location: HPF located within/under Government agency/Ministry of Health

Funded: General revenues provided to agencyCan receive funding from other sources

Partners: are external but partnerships can be directly through HPF

+Attached

Location: HPF “attached” to government agency/Ministry of Health

Funded: General revenues provided to agencyCan receive funding from other sourcesFunds can go directly to HPF

Partners: can be internalized with HPFs

+Independent

Location: HPF independent from government agency/Ministry of Health

Funded: Tobacco tax+ revenue directly to HPF General revenues can be provided directly to

HPF HPF can receive funding from other sources

Partners: can be initiated and internalized within HPF

+HPF governing structures

Governing Board with representation from a wide range of stakeholders usually a mix of government and non-government organizations Representation from government Ministries or people with

expertise in health, sport and physical activity, arts and culture, young people, local government

Board members nominated for their expertise in marketing, finance, community development or research. May be political

Committees or advisory panels with expertise in priority areas

Staff to manage activities

+Resources

International Network of Health Promotion Foundations http://www.hpfoundations.net Economic rationale

http://www.hpfoundations.net/why-health-promotion/economic-rationale-health-promotion

 Key features of HPFs http://www.hpfoundations.net/about-hp-foundations/key-features-of-hpf

 General roles http://www.hpfoundations.net/about-hp-foundations/what-can-health-promotion-foundations-do 

Summaries of information on VicHealth, Healthway, Austrian Health Promotion Foundation, (FGÖ), Health Promotion Switzerland, ThaiHealth and Malaysian Health Promotion Board Legislation

http://www.hpfoundations.net/about-hp-foundations/legislation-for-hpf

Funding http://www.hpfoundations.net/about-hp-foundations/sources-of-funding

+VicHealth

VicHealth http://www.vichealth.vic.gov.au/ The story of VicHealth

http://www.vichealth.vic.gov.au/en/About-VicHealth/Story-of-VicHealth.aspx

VicHealth Funding model http://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/General/Fact Sheet_VicHealth Funding Model.ashx

+ThaiHealth

ThaiHealth Promotion Foundation http://en.thaihealth.or.th/ Origin of ThaiHealth

http://en.thaihealth.or.th/resource-center/reports/origin Master Plan 2010-2012

http://en.thaihealth.or.th/resource-center/reports/masterplan

+Healthway

Healthway (Australia) http://www.healthway.wa.gov.au/ Strategic Plan 2008-2011

http://www.healthway.wa.gov.au/default.aspx?MenuID=485 Corporate Governance

http://www.healthway.wa.gov.au/default.aspx?MenuID=675 Best Practices in Tobacco Control: Earmarked Tobacco Taxes

and the Role of the Western Australian Health Promotion Foundation (Healthway) http://www.who.int/tobacco/training/success_stories/en/best_practices_western_australia.pdf

+Others

Malaysian Health Promotion Board http://www.healthpromo.gov.my/

Austrian Health Promotion Foundation (Fonds Gesundes Österreic) http://www.fgoe.org/welcome-to-fond-gesundes-oesterreich?set_language=en&cl=en