A global perspective

The health sector can support other arms of government by assisting in developing policy and attaining goals.

Health 2020 could pool reports of best and failed innovative practices in working with others for shared goals within the European Region and beyond. Regular meetings with health minis-ters, heads of public health agencies and representatives of other sectors could drive these inno-vations forward. The WHO Regional Office for Europe could use models of long-term cooperation with other sectors, such as the European environment and health process in its work on food and health, as well as network approaches such as the south-eastern Europe Health network and health-promoting schools.

In the context of Health 2020, member states and the WHO Regional Office for Europe should:

• assess and monitor progress in governance for health in the European Region, by designing a measure of innovation in governance for health focused on society and whole-of-government approaches as a follow-up to this study and submitting a biannual report on in-novation in governance for health to the WHO Regional committee for Europe; and

• consider establishing a multidisciplinary European institute of governance for health, which, like the recent initiative taken by the union of south American nations in establishing the In-The new governance for health must integrate all levels of governance, from the local to the global.

Health challenges often require states to work together to provide public goods. The globaliza-tion of public goods through the integraglobaliza-tion of economies and the aboliglobaliza-tion of political borders has led to the notion of regional and global public goods based on national building blocks. For example, pandemic disease surveillance is based on effective monitoring and reporting by many different actors at local and national levels, who answer to regional bodies such as the European centre for Disease Prevention and control and to global actors such as WHO. coherence is essen-tial for effective collective action, and this requires seamless coordination and policy implementa-tion, from local to global level, with continual feedback and review.

Health 2020 can initiate a process in which policy-makers at various levels are brought together to respond to interdependent challenges by making use of the cooperation among the various levels of WHO. This will require support for new types of health diplomacy that promote coher-ence between sectors, such as foreign policy, trade, agriculture, development and health.

ciety strategy, open-data initiatives and tracking systems that allow better public accountability, including digital and mobile government approaches, and a comprehensive strategy to strength-en health literacy.

new governance for health and well-being

stituto suramericano de Gobierno en salud (south American Institute for Health Governance), would operate as a resource for member states of the WHO European Region to reorient their governments towards smart governance for health by leadership development, political de-bate, training and research, in cooperation with national institutes in many disciplines.

Glossary

Glossary

Accountability: being called to account to some authority for one’s actions. It is external, in that the account is given to another person or body outside the person or body being held account-able; it involves social interaction and exchange, in that one side, that calling for the account, seeks answers and rectification, and the other side, that being held accountable, responds and accepts sanctions; it implies rights of authority, in that the person or body calling for an account is asserting the right of superior authority over the person or body that is accountable, including the right to demand answers and to impose sanctions.

Complex adaptive system: made up of many individual, self-organizing elements capable of re-sponding to others and to their environment. The entire system can be seen as a network of relations and interactions, in which the whole is much more than the sum of the parts. A change in any part of the system, even in a single element, results in reactions and changes in associated elements and the environment. Therefore, the effects of any one intervention in the system can-not be predicted with complete accuracy, because the system is always responding and adapting to changes and to the actions of individuals.

Foresight: the capacity to anticipate alternatives, on the basis of sensitivity to weak signals, and the ability to visualize multiple possible outcomes (fuerth, 2009).

Governance: how governments and other social organizations interact, how they relate to citi-zens and how they take decisions (Graham et al., 2003).

Governance for health: attempts of governments and others to steer communities, whole coun-tries or groups of councoun-tries in the pursuit of health and well-being as a collective goal (adapted from bell & Hindmoor, 2009).

Health governance: actions and means a society adopts to organize itself for promoting and pro-tecting the health of its population (Dodgson et al., 2002).

Health in all policies: a strategy to strengthen the link between health and other policies, address-ing the effects on health of all policies, such as those for agriculture, education, the environment, finance, housing and transport. It seeks to improve health and at the same time contribute to the well-being and the wealth of countries through structures, mechanisms and actions planned and managed mainly by sectors other than health (Wismar et al., 2007).

Healthy public policy: an explicit concern for health and equity in all areas of policy and account-ability for health impact. The main aim is to create a supportive environment to enable people to lead healthy lives, making healthy choices possible or easier for citizens (WHO, 1988).

Glossary

Health promotion: Health promotion is the process of enabling people to increase control over, and to improve, their health (WHO Regional Office for Europe, 1986).

Health system: all activities with the primary purpose of promoting, restoring and maintaining health (WHO, 2000).

Health equity: the absence of systematic disparities in health (or in the major social determi-nants of health) between groups with different underlying social advantage or disadvantage, such as wealth, power or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female or members of a disenfranchised racial, ethnic or religious group) at further disadvantage with respect to their health (braveman & Gruskin, 2003).

Interdependence: situations characterized by reciprocal effects among countries or actors in countries. Interdependence exists when transactions have reciprocal – not necessarily sym-metrical, costly effects; when interactions do not have significant costly effects, there is simply interconnectedness. Interdependence does not mean mutual benefit. Interdependent relations always involve costs, as interdependence restricts autonomy; specifying a priori whether the benefits of a relationship will exceed the costs is impossible. This depends on the values of the actors and the nature of the relationship (Keohane & nye, 1989).

Intersectoral action: working with more than one sector of society to take action on an area of shared interest. Sectors may include government departments such as health, education, en-vironment and justice; ordinary citizens; not-for-profit societies or organizations; and business (Health canada, 2000).

Legitimacy: a generalized perception or assumption that the actions of an entity are desirable, proper or appropriate within some socially constructed system of norms, values, beliefs and defi-nitions (suchman, 1995). legitimacy depends on the level of acceptance by various direct and external stakeholders. Representation, inclusiveness and transparency are critical to building the necessary trust for legitimacy. In addition, legitimacy depends on the ability to engage stakehold-ers in a meaningful dialogue in which they feel ownstakehold-ership and the possibility of deriving benefits, which requires full transparency, openness and respect. nascent multistakeholder processes can be seriously jeopardized if the partners do not regularly monitor the transparency of perceptions and expectations with regard to participation (burger & mayer, 2003; vallejo & Hauselmann, 2004).

Multistakeholder deliberation: a collective and collaborative public effort to examine an issue from different viewpoints before taking a decision; deliberative processes strengthen policy de-sign by building recognition of common values, shared commitment and emerging issues and by providing a comprehensive understanding of causal relationships (swanson et al., 2009).

Glossary