HIA in Switzerland: strategies for achieving Health in All Policies

(1)

Article

Reference

HIA in Switzerland: strategies for achieving Health in All Policies

MATTIG, Thomas, et al.

Abstract

The purpose of this article is to review the status of Health Impact Assessment (HIA) in Switzerland and assess whether HIA can be used to implement Health in All Policies (HiAP) in this highly decentralized country. The methods include expert opinion and an extensive literature review, as well as targeted interviews with key informers in the cantons of Geneva, Jura and Ticino. HIA has been implemented successfully since the early 2000s in Switzerland.

However, integration has been heterogeneous with only a few cantons taking the lead.

Integration of HIA at the federal level was attempted in 2012 but failed due to resistance from a pro-business lobby. HIA in Switzerland has the potential to contribute to HiAP, but success depends on a wider dissemination of HIA and on some form of integration at the national level. In this respect, a‘bottom-up' approach based on inter-cantonal collaborations appearsmore promising than the‘top-down'federal level approach.

MATTIG, Thomas, et al . HIA in Switzerland: strategies for achieving Health in All Policies.

Health Promotion International , 2015, p. 1-8

DOI : 10.1093/heapro/dav087

Available at:

http://archive-ouverte.unige.ch/unige:90000

Disclaimer: layout of this document may differ from the published version.

1 / 1

(2)

HIA in Switzerland: strategies for achieving Health in All Policies

Thomas Mattig

¹

, Nicola Cantoreggi

^2,

*, Jean Simos

²

, Catherine Favre Kruit

¹

, and Derek P.T.H. Christie

²

1

Health Promotion Switzerland, Lausanne, Switzerland, and

²

Institute for Environmental Sciences and Faculty of Medicine, University of Geneva, Geneva, Switzerland

*Corresponding author. E-mail: nicola.cantoreggi@unige.ch

Summary

The purpose of this article is to review the status of Health Impact Assessment (HIA) in Switzerland and assess whether HIA can be used to implement Health in All Policies (HiAP) in this highly decentralized country. The methods include expert opinion and an extensive literature review, as well as targeted interviews with key informers in the cantons of Geneva, Jura and Ticino. HIA has been implemented successfully since the early 2000s in Switzerland. However, integration has been heterogeneous with only a few cantons taking the lead. Integration of HIA at the federal level was attempted in 2012 but failed due to resistance from a pro-business lobby. HIA in Switzerland has the potential to contribute to HiAP, but success depends on a wider dissemination of HIA and on some form of integration at the national level. In this respect, a‘bottom-up’approach based on inter-cantonal collaborations appears more promising than the‘top-down’federal level approach.

Key words:determinants of health, Health Impact Assessment, healthy public policy, Switzerland

INTRODUCTION

Nowadays, health systems throughout Europe are being challenged by social, economic, environmental and demo- graphic upheavals. In many countries, the health share of government budgets are larger than ever, and healthcare costs have grown much faster than their GDP. Nevertheless, governments spend only a small fraction of their health budgets on promoting health and preventing disease—

about 3% in the OECD countries. Switzerland naturally is no exception: health promotion accounts for around 2.4% of the health budget (OECD, 2012; Jakubowski and Saltman, 2013).

Favouring healthcare over prevention or health promotion is ingrained in public policy in Switzerland, although

a cost–benefit approach shows that it would be justifiable to undergo a potential shift in policy. Such a shift might be accomplished by enabling policy in other sectors to evolve in a more favourable direction towards public health. At the federal level, the idea of introducing health perspectives into all public policy areas has started well, with the formulation of guidelines for a multi-sectorial health policy established in 2005. The Health Impact Assessment (HIA) was identified as the tool which would enable such a shift to take place. At the local (cantonal) level, this process has been met with some success, thanks to the high level of decentralization in Switzerland which has allowed thefine- tuning of HIA belonging both to the political and administrative situation in each canton.

Health Promotion International, 2015, 1–8 doi: 10.1093/heapro/dav087

at Institut universitaire de hautes etudesinternationales - Bibliotheque on December 7, 2016http://heapro.oxfordjournals.org/Downloaded from

(3)

This article investigates the parallel cantonal (bottom- up) and federal (top-down) processes of HIA institutionalization, showing clearly how a major opportunity for anchoring the HIA as the main implementing tool for es- tablishing Health in All Policies (HiAP) at the federal level was missed due to pressure from conservative lobbies during negotiations around a new law on public health.

Nevertheless, HIA has continued to be used in a decentralized manner in Switzerland, despiteﬁnancial constraints.

The article goes on to discuss how the cantonal level has become the core arena for the implementation of HiAP through the use of HIA and discusses how inter-cantonal collaborations may ultimately open up possibilities at the national level.

THE OTTAWA CHARTER AND THE IMPORTANCE OF BUILDING HEALTHY PUBLIC POLICY

In 1986, the World Health Organization (WHO) heralded a paradigm shift in public health with the dominant focus on disease prevention being extended to include health promotion. This commitment was formulated in the Ottawa Charter, which since then has formed the basis of the health promotion policy, which implies empower- ment of individuals and communities and requires healthcare services to reassess their priorities. Underpinning the Ottawa Charter is the realization that health depends to a great degree on environmental factors which are beyond the inﬂuence of individuals (Dever, 1976;SAMS, 2012).

To be effective, health promotion must inﬂuence the environment in which people live. This can only succeed if the needs of health promotion can be factored into political and administrative decisions beyond the boundaries of healthcare, in areas such as urban planning, transport and the building sector. At the global level though, positive developments have been identiﬁed in the healthcare sector itself, resulting in the creation of new structures for health promotion. However, in most countries the health promotion project has not fully succeeded in in- corporating other policy areas into its work (McQueen et al., 2012) because the responsible bodies, unfortunate- ly, do not feel accountable for health matters and resist interference in their areas of competence.

Furthermore, there is still a deep mistrust of inter- vention among business circles, which fear red tape and the infringement of commercial freedom. Its supporters have not yet succeeded in demonstrating the effectiveness and economic beneﬁts of health promotion and, also, in persuading the political world of its necessity. More broadly, there is a lack of know-how and of practical mechanisms which would enable health promotion to become

successfully integrated into decision-making processes across all sectors (Goldsmithet al., 2004;Wieseret al., 2010).

A TOOL TO MAKE PUBLIC POLICY HEALTHIER: HEALTH IMPACT ASSESSMENT

Improving and protecting population health requires attending to natural, cultural, social and environmental health determinants (Marmot and Wilkinson, 1999;WHO, 2003). These determinants are structured and shaped by public policy and investments as well as by private sector economic and social development activities, which are pri- marily implemented outside the health sector. Therefore, immediate action is needed at the societal level to improve resources for health including income and education, housing, access to food, exposure to chemical hazards and the quality of social networks and relationships with relatives, friends and neighbours (WHO, 1986).

It is important to mention that HIA enables health practitioners to inform societal decision-making. HIA wasﬁrst discussed in the context of development projects in the early 1990s (Birley, 2011). Guidelines for the Health Impact Assessment of Development Projects were published by the Asian Development Bank Ofﬁce of the Environment in 1992 (Birley and Peralta, 1992). During the 1990s, HIA was popularized in England (Scott- Samuel, 1996). Since then, the number of HIAs undertaken has grown and interest in HIA has spread. Centres of health impact assessment expertise have developed in many countries and the community of people interested in HIA has steadily increased (Kemm, 2013). HIA is now implemented or is on the verge of being implemented in almost all highly developed countries, including a rapid expansion in the USA over the last few years (www.

healthimpactproject.org). Some developing or emerging countries such as Thailand and Ghana are also progres- sing with HIA implementation.

The development of HIA has led to various deﬁnitions.

The most common is the Gothenburg Consensus, which defines HIA as‘a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population’ (WHO, 1999). HIA identifies how and through which pathways a wide range of health determinants may be affected by a policy, programme or project decision. These pathways can be direct (e.g. increases in respiratory illnesses when air pollution increases) or in- direct (e.g. motorized vehicle traffic reducing human- powered mobility) (Dahlgren, 1995). HIA aims to identify

2 T. Mattiget al.

(4)

the potential health impacts of a decision and improve its quality through recommendations that maximize positive impacts and minimize negative impacts (WHO, 1999).

The International Association for Impact Assessment extended the Gothenburg deﬁnition by adding that‘HIA identiﬁes appropriate action’ in order to manage the effects on health (Quigleyet al., 2006).

Indeed, recommendations for action are inherent to HIA, a decision support tool that contributes to public health by allowing those who make decisions on behalf of the public to anticipate how these decisions will affect people’s health. The decision makers are then able to take health into consideration along with the other objectives that they are aiming to achieve for the public good. HIA is predictive, informative and can be used for advocacy;

because it seeks to deﬁne the distribution of effects within populations, it also raises the issue of equity (Kemm, 2013).

Despite methodological similarities with environmental impact assessment (EIA), the approach used in HIA has more in common with the policy appraisal process (Scott-Samuelet al., 2001). Those who make decisions on behalf of the public have always tried to review the op- tions open to them, assess the consequences of choosing each option and then select the best option for the communities served. HIA builds on this process by allowing a thorough and systematic review of the health consequences (Milio, 1986;Kemm, 2013).

HEALTH IN ALL POLICIES

HiAP emerged as a main theme during the Finnish Presidency of the Council of the European Union in 2006. It builds on the health promotion experiences that underpin thefirst of thefive action areas named in the Ottawa Charter—‘building healthy public policy’. The WHO Global Conference on Health Promotion, held in Helsinki in 2013, defined HiAP as‘an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity’ (Ollilaet al., 2013). This approach advocates moving health up the policy agenda, strengthening policy dialogue on health and its determinants, and building accountability for health outcomes (Ståhl et al., 2006).

HiAP is more concerned with the‘big issues’and less with individual programmes or projects. Depending on the institutional context of a country, these policies may be found at the national, regional or local levels or can be dispersed throughout multilevel governance systems.

HiAP is a policy practice adopted by leaders and policy

makers to integrate the consideration of health, well- being and equity during the development, implementation and evaluation of public policies (see Figure 1).

This policy practice‘requires a new form of governance where there is joined-up leadership within governments, across all sectors and between levels of government’ (WHO, 2010).

Theﬁrst years of HiAP implementation yielded a few limited successes at EU level. Despite the inclusion of HiAP in the European legislation on public health, its impact on policy has been less successful than expected (Baumet al, 2013). Nevertheless, a recent literature review (Shankardasset al., 2011) shows that 16 countries or regions (10 in industrialized countries, 6 in developing or emerging countries) have implemented whole- of-government HiAP with a health equity orientation, although there is considerable heterogeneity between countries (Baumet al., 2013). TheHealthiﬁcationproject, soon to be implemented in Northern Europe among countries bordering on the Baltic Sea, may also be considered an institutionalization of HiAP (Baltic Region Healthy Cities Association, 2014).

The HiAP approach, like other public health initiatives in the past, is a political process with a non-linear development (De Leeuw and Clavier, 2011). Strong support by politicians and civil society are critical for the success of such initiatives (Baumet al., 2013). HiAP implementation is facilitated by the existence of pre-existing procedures and tools such as HIA, which is in a position to become a main driver for achieving HiAP according to several authors (Collins and Koplan, 2009;Kemmet al., 2011).

A recent review of intersectoral action for health equity (Shankardass et al, 2012) showed that in half of all cases, HIA is the appropriate tool for impact assessment.

Thisﬁts with the main tenet of the HiAP approach, which is that health and well-being are largely inﬂuenced by mea- sures managed by sectors other than health.

Fig. 1:HIA and HiAP governance (adapted fromKickbusch, 2008).

(5)

HIA IN SWITZERLAND

HIA began to be implemented in Switzerland in the early 2000s in the cantons of Geneva, Jura and Ticino. Due to the federal organization of the Swiss health system, each canton is granted independence for formulating health policies and organizing its health sector. This has led to a heterogeneous way of integrating HIA into the political and institutional context (Simos, 2006).

The Italian-speaking canton of Ticino played a pioneering role by introducing the health determinants approach and using HIA as a tool in cantonal public policies.

HIA was introduced in the Ticino Governmental Policy Guidelines 2000–2003, with an explicit link to sustainable development. The cantonal government then took two key decisions: an HIA pilot procedure for the appraisal of cantonal public policies was introduced in the 2003–2007 le- gislature programme, and an Interdepartmental HIA Committee was set up in January 2006. This Committee ﬁrst focussed its activities on the development of criteria for the selection of policies to be assessed and then on the design of tools for different stages of the assessment.

Ticino has conducted several rapid HIAs on subjects such as the development of public transport or the school dental service. During this initial experimentation period (2005–2007), awareness for the potential of HIA grew among stakeholders. Now, political support needs to be consolidated, as several people involved in the pioneer period are no longer in ofﬁce and their successors need to be convinced to pursue the process.

In the French-speaking canton of Geneva, HIA was introduced in the context of the WHO European Healthy Cities Network, which placed HIA among its priorities.

The canton adopted both an experimental and legislative approach (Simos and Cantoreggi, 2008). Pilot HIAs were carried out and HIA was integrated into a Health Act adopted in 2006. This allows the Cantonal Government to request an HIA for any legislative project that may affect public health. Several HIAs have been conducted so far on various development projects in suburban areas, and on a smoking ban in cafés and restaurants. For a more systematic use of HIA, it is envisaged to establish a speciﬁc regulation.

The also French-speaking Canton Jura adopted an approach similar to the procedural and experimental one developed by the Canton of Ticino. Health promotion was selected as a guiding principle of the canton’s Agenda 21, and in 2002 the government decided to adopt a tool to facilitate decision-making processes. The strategy was to draw up a procedure that would be accepted by both the political level (heads of departments) and the oper- ational level (heads of services). A monitoring group was

created, integrating civil servants of non-health departments, and several pilot HIAs were undertaken. These experiences have strengthened the position of HIA in Canton Jura and in 2006 the Government institutionalized the mandate of the monitoring group. Almost every year since 2004, an HIA has been conducted on a major policy or project in Canton Jura.

In its long-term strategy 2007–2018, Health Promotion Switzerland, a public, semi-autonomous foundation established by the Federal Health Insurance Act of 1994, identi- ﬁed HIA as a tool with the potential to integrate the challenges of health in all policy sectors. For this reason, it supported the creation of a Swiss HIA Platform by the three pioneer cantons (Ticino, Geneva and Jura) together withequiterre, a Swiss NGO involved in sustainable development and health promotion.

Based on various pilot experiences, the Swiss HIA Platform aims to spread the knowledge and use of HIA at the national level (Cantoreggiet al., 2007) through a horizontal, inter-cantonal process which brings together the learnings acquired at the cantonal level. The anchoring of HIA at the federal level would contribute to reinforcing the movement which is underway at the cantonal level.

Another hurdle to be overcome in the Swiss context is language: expertise on HIA is mainly located in the French- speaking and Italian-speaking parts of the country, which represent around 25 and 10% of the population, respectively. The challenge is to develop the capacity to conduct studies in the Swiss-German cantons, which represent around 65% of the population.

In June 2011, the Swiss HIA Platform became an association and other cantons which had conducted pilot HIAs became members: Vaud, Aargau and Fribourg (which are, respectively, French-speaking, German-speaking and bi- lingual French and German). Theﬁrst HIA at the national level was done in 2012, on the impact of agricultural land- scapes on health and the consequences in terms of agricultural policy.

MULTI-SECTORIAL HEALTH POLICY IN SWITZERLAND: AN UNFINISHED HIAP APPROACH WITH ROOM FOR HIA

In 2005, the Swiss federal authorities published guidelines for a multi-sectorial health policy (OFSP, 2005), based on the international mind-shift which occurred during the 1980s, leading to a focus on the structural factors responsible for ill health. The document speciﬁcally aimed at de- ﬁning policy areas, objectives and methods whereby public policy (at national level) could become more focussed on the health and well-being of the population.

4 T. Mattiget al.

(6)

The diversity of topic areas which were chosen, of which five out of seven were outside the healthcare sector, is an indication that the move was HiAP-inspired, although the term is not mentioned explicitly. These guidelines had no specific mechanism to help transform them into policy, because the Federal office of public health had decided to an- chor them in laws under discussion at the time, in particular a law on prevention and health promotion.

Such a context opened up interesting prospects for HIA.

One of the main points of discussion was whether HIA should be introduced as a stand-alone tool or be integrated with other, pre-existing tools. This debate had been taking place at the international level for years, in a context where increasing budgetary constraints were pushing towards integration (Morrison-Saunderset al., 2014;St-Pierre and Marchand, 2014). In Switzerland, the integration under discussion was between HIA and sustainability assessment, whereby the health component of the existing sustainability evaluation would have been reinforced. This idea was pinpointed as the best possible solution for mainstreaming HIA in Switzerland, in a series of reports that the Federal office of public health asked private contrac- tors to produce. The intermediate steps of this process were never published, which can be interpreted as a desire on the part of the Federal office of public health to keep control of the use of HIA, in a context of competition between federal offices to see which of the impact evaluation tools would be integrated into legislation at the national level (Wachter, 2010; Forbat, 2014). As a result, HIA was inserted into the federal law on prevention and health promotion, the idea being to give it formal recognition without rendering it compulsory.

MULTI-SCALAR IMPLEMENTATION OF HIA:

A MISSED WINDOW OF OPPORTUNITY

In autumn 2012, an attempt to pass the federal law on prevention at the Swiss federal parliament failed. Resistance to the bill came from speciﬁc pro-business circles which have strong political inﬂuence in Switzerland. A major ob- jection was the provision relating to HIA. In the political debate, business organizations (led by those representing small and medium-sized companies) unanimously op- posed this tool despite the fact that a very restrained formulation had been chosen. Under the bill, the national executive level (Swiss Federal Council) was to identify which legislative proposals were to be examined more closely with regard to their consequences for public health. Opponents feared that these mechanisms would hinder future reforms and that an unnecessary regulatory burden would be added to administrative processes.

Opponents referred negatively to the EIA, which has

been in force in Switzerland since 1988 and which has been a thorn in the side of industry ever since, as has also been suggested in other countries (Bhatia and Wernham, 2008). The business community and its representatives in the federal parliament therefore rejected HIA (Mattig, 2013).

Important differences give EIA and HIA different roles in the decision-making process, speciﬁcally in Switzerland:

• EIA only concerns infrastructural projects such as roads and shopping malls and not programmes and policies which are amenable to HIA.

• EIA occurs towards the end of the project process; it provides an opportunity for potential critics of a project to initiate a legal challenge against the entire project, without necessarily making suggestions for adapting it; this is widely interpreted as a negative attitude.

• The purpose of EIA is to examine the compatibility of a project with the current environmental legislation. EIA therefore helps obtain or reject the authorization of the project, while the purpose of HIA is to make the project (however good or bad it may be) better for the health of the population.

Nevertheless, only few voices were raised by private companies against the bill itself, which aimed at furthering prevention in Switzerland (Mattig, 2013). From this, it may be concluded that broad sections of industry are convinced of the importance of health promotion and prevention.

This assumption is supported by extensive investments by companies themselves in occupational health, i.e. in the health of their employees. The commercial benefits of prevention and health promotion have been scientific- ally proven, including by studies in Switzerland (Jenny et al., 2011). Return on investment is a key criterion when it comes to investment decisions. This is also the case for investment in occupational health, as illustrated by the fact that several leading Swiss companies regularly attend Health Promotion Switzerland’s conference on workplace health promotion, which has been taking place annually since 2004. The cost-effectiveness criterion is also of paramount importance in thefield of political decision-making.

POTENTIAL AND CONSTRAINTS OF BOTTOM-UP HIA IMPLEMENTATION

The introduction of HIA at the federal level would have reinforced the development of healthy public policies and health promotion throughout the country. Such a position can now only be defended in individual cantons but also, importantly, at an intermediate, inter-cantonal level.

(7)

Since the HIA Platform was launched in 2007, capacity building has continued in the Italian and French lan- guages, but the lack of supply and demand for HIA courses in German has hampered success. This is an area where federal support would have been strategic. At pre- sent, there is little HIA ability in German within the country, and HIA is rarely called upon by the public sector in the German-speaking cantons and areas.

These difﬁculties have been pinpointed at the level of inter-cantonal collaboration, which is institutionalized by direct coordination between cantonal governments, and through the so-called conferences of cantonal directors, which proceed by sector (conference of cantonal directors of education, conference of cantonal directors of health, etc.). These conferences have become steadily more important since the 1970s, and especially since the 1990s. Health was one of the last sectors to undergo such a process, but progressed rapidly compared with other sectors: health was responsible for 4% of all inter- cantonal treaties before 1970, and for 11% of them after 1970 (Sciarini and Bochsler, 2006). Most of these agreements do not include all of the 26 cantons or half- cantons but a subset based on geographical or language criteria, e.g. Central Switzerland, Eastern Switzerland,

‘Latin’ (i.e. French or Italian-speaking) cantons, etc. It

can be seen that the problems encountered while promoting HIA in Switzerland are a consequence of the political and administrative complexity of the country.

It has been shown in the international literature that the local level is often appropriate for developing novel policy approaches (De Leeuw and Clavier, 2011). Among the advantages are a pragmatic approach to partnerships and everyday policy orientations (Popayet al., 2010), an integrated vision of local development, and greaterﬂexi- bility for engaging with public, private and community stakeholders (Rhodes, 1997;Le Galès, 2002). Such conditions exist in many locations in Switzerland, as evidenced by Canton Jura which has played a pioneering role for HIA. With a population of only 70 000 and a weaker economic footing than the rest of the country, this canton has a small administrative system which is able to engage in collaborations within ministries, between ministries and with outside partners. Today, Canton Jura continues to carry out HIAs in various sectors despite budgetary constraints, and despite the fact that several people in key positions within the administration have changed over the years.

Finally, the municipal level has remained relatively in- active regarding HIA in Switzerland, probably because health is a mainly cantonal prerogative. An exception is the town of La Chaux-de-Fonds (in canton Neuchâtel), which has remained committed to HIA through a municipal

Healthy Cities programme. Synergies could therefore be developed between such regions where HIA enjoys con- tinuing support and other cantons or geographical con- texts which remain reticent or under-informed.

CONCLUSION: PERSPECTIVES FOR SWITZERLAND AND BEYOND

The local anchoring of HIA has now a reality in Switzerland, at least in certain areas of the country.

Attempts to institutionalize HIA at the federal level have been unsuccessful up to now. A bottom-up diffusion strategy, from cantons horizontally to other cantons and up towards the federal level, therefore appears to be the most logical course of action to achieve HIA institutionalization in Switzerland. With support from the Swiss HIA platform which brings together practitioners, academics and cantonal government representatives, HIA could help public policy proceed in the direction of HiAP.

To achieve a breakthrough in Switzerland, HIA must emancipate itself from the negative and inaccurate percep- tion of being the ‘clone’ of EIA in the health sector.

Politicians and business leaders need to be informed of the scope and effectiveness of HIA, and misunderstand- ings should be confronted and clariﬁed. This analysis of HIA integration in Switzerland may prove useful for ob- servers and actors in other countries which have a decentralized political structure, and which may also experience difﬁculties in mainstreaming HIA. The language and cultural barriers encountered in Switzerland may be of interest for researchers investigating the diffusion of HIA across Europe, where language and cultural barriers also exist, but on another scale.

REFERENCES

Baltic Region Healthy Cities Association. (2014) Healthiﬁcation.

Health in All Policies for Healthier Communities. Project Report. Baltic Region Healthy Cities Association, Turku.

Baum A., Ollila E., Peña S. (2013) History of HiAP. In Leppo K., Ollila E., Peña S., Wismar M., Cook S. (eds),Health in All Policies. Seizing Opportunities, Implementing Policies.

Ministry of Social Affairs and Health, Finland, pp. 25–42.

Bhatia R., Wernham A. (2008) Integrating human health into Environmental Impact Assessment: an unrealized opportunity for environmental health and justice.Environmental Health Perspectives,116, 991–1000.

Birley M. (2011) Health Impact Assessment. Principles and Practice. Earthscan, London.

Birley M., Peralta G. (1992) Guidelines for the Health Impact Assessment of Development Projects. Asian Development Bank Environment Paper, Manila.

6 T. Mattiget al.

(8)

Cantoreggi N., Frei K., Simos J., Casabianca A., Litzistorf Spina N., Diallo T. (2007) HIA in Switzerland: considerations concerning the experience of the Cantons of Geneva, Jura and Ticino.Italian Journal of Public Health,4, 169–175.

Collins J., Koplan J. P. (2009) Health impact assessment: a step toward Health in All Policies. Journal of the American Medical Association,302, 315–317.

Dahlgren G. (1995) European Health Policy Conference:

Opportunities for the Future. Vol. 11, Intersectoral Action for Health. WHO Regional Ofﬁce for Europe, Copenhagen.

De Leeuw E., Clavier C. (2011) Healthy public in all policies.

Health Promotion International,26, 237–244.

Dever G. (1976) An epidemiological model for health policy analysis.Social Indicators Research,2, 453–466.

Forbat J. (2014)Les politiques publiques de santé environnemen- tale en Europe: un parent pauvre du développement durable?

PhD thesis, University of Geneva.

Goldsmith L. J., Hutchison B., Hurley J. (2004)L’évaluation économique Appliquée aux Quatre Volets de la Prevention:

une Perspective Canadienne. Center for Health Economics and Policy Analysis, McMaster University, Hamilton.

Jakubowski E., Saltman R. (eds) (2013)The Changing National Role in Health System Governance: A Case-Based Study of 11 European Countries and Australia. WHO Regional Ofﬁce for Europe, Copenhagen.

Jenny G., Inauen A., Brauchli R., Füllemann D., Müller F., Bauer G., et al. (2011) SWiNG Project. Final Report of the Evaluation.

Institute of Social and Preventive Medicine, University of Zurich/Center for Organizational and Occupational Sciences, ETH Zurich and Winterthur Institute of Health Economics, Zurich University of Applied Sciences.

Kemm J. (ed) (2013) Health Impact Assessment. Past Achievement, Current Understanding and Future Progress.

Oxford University Press, Oxford.

Kemm J., den Broeder L., Wismar M., Fehr R., Douglas M., Gulis G. (2011) How Can HIA Support Health in All Policies: Draft Policy Brief Circulated at 11th International HIA Conference in Granada. European Observatory on Health Systems and Policies, Brussels.

Kickbusch I. (2008) Healthy Societies: Addressing 21st Century Health Challenges. State of South Australia, Adelaide.

Le Galès P. (2002) European Cities: Social Conﬂicts and Governance. Oxford University Press, Oxford.

Marmot M., Wilkinson R. (1999)Social Determinants of Health.

Oxford University Press, Oxford.

Mattig T. (2013) Das Gescheiterte Präventionsgesetz: ein Lehrstück (Gesundheitsförderung Schweiz Arbeitspapier 9).

Gesundheitsförderung Schweiz, Bern.

McQueen D., Wismar M., Lin V., Jones C. M., Davies M. (2012) Intersectoral Governance for Health in All Policies. Structures, Actions and Experiences. World Health Organization, on behalf of the European Observatory on Health Systems and Policies, Brussels.

Milio N. (1986) Promoting Health Through Public Policy.

Canadian Public Health Association, Ottawa.

Morrison-Saunders A., Pope J., Gunn J., Bond A., Retief F. (2014) Strengthening impact assessment: a call for integration and focus.Impact Assessment and Project Appraisal,32, 2–8.

OECD. (2012) OECD Health Data 2012. Organization for Economic Cooperation and Development, Paris.

OFSP. (2005)Lignes Directrices Pour une Politique Multisectorielle de la Santé. Ofﬁce Fédéral de la Santé Publique, Bern.

Ollila E., Baum A., Peña S. (2013) Introduction to Health in All Policies and the analytical framework of the book. In Leppo K., Ollila E., Peña S., Wismar M., Cook S. (eds), Health in All Policies. Seizing Opportunities, Implementing Policies. Ministry of Social Affairs and Health, Finland, pp. 3–24.

Popay J., Whitehead M., Hunter D. (2010) Injustice is killing people on a large scale—but what is to be done about it?Journal of Public Health,32, 148–149.

Quigley R., den Broeder L., Furu P., Bond A., Cave B., Bos R. (2006) Health Impact Assessment International Best Practice Principles.

International Association for Impact Assessment, Fargo.

Rhodes R. A. W. (1997)Understanding Governance: Policy Networks, Governance, Reﬂexivity and Accountability.

Open University Press, Buckingham.

Sciarini P., Bochsler D. (2006) Réforme du fédéralisme Suisse:

contribution, promesses et limites de la collaboration inter- cantonale. In Chappelet J.-P. (ed),Contributions à L’action Publique. Presses Polytechniques Universitaires Romandes, Lausanne, pp. 267–286.

Scott-Samuel A. (1996) Health Impact Assessment: an idea whose time has come.British Medical Journal,313, 183.

Scott-Samuel A., Birley M., Ardern K. (2001)The Merseyside Guidelines for Health Impact Assessment. International Health Impact Assessment Consortium, Liverpool.

Shankardass K., Solar O., Murphy K., Freiler A., Bobbili S., Bayoumi S., et al. (2012) A scoping review of intersectoral action for health equity involving governments.International Journal of Public Health,57, 25–33.

Shankardass K., Solar O., Murphy K., Greaves L., O’Campo P.

(2011) Getting Started with Health in All Policies: A Resource Pack. Centre for Research of Inner City Health, St. Michael’s Hospital, Ontario.

Simos J. (2006) Introducing Health Impact Assessment (HIA) in Switzerland.Social and Preventive Medicine,51, 130–132.

Simos J., Cantoreggi N. (2008) Mise enœuvre des EIS à Genève (Suisse) et utilisation de leurs résultats dans le processus législatif.

Téléscope, Revue D’analyse Comparée de L’Observatoire de L’administration Publique, Ecole Nationale D’administration Publique,14, 51–61.

Ståhl T., Wismar M., Ollia E., Lahtinen E., Leppo K. (eds) (2006) Health in All Policies: Prospects and Potentials. Ministry of Social Affairs and Health, Helsinki.

St-Pierre L., Marchand J.-S. (2014)Series on Integrated Impact Assessment: 1—Overall Situation and Clariﬁcation of Concepts. National Collaborating Centre for Healthy Public Policy, Montreal, Québec.

Swiss Academy of Medical Sciences (SAMS). (2012)Sustainable Medicine. Position Paper issued by the Swiss Academy

(9)

of Medical Sciences (SAMS), 5. http://www.samw.ch/en/

Publications/Statements.html(last accessed 19 June 2013).

Wachter D. (2010) Evaluation d’impact sur la santé: ( pas) une solution de rechange à l’évaluation de la durabilité.Spectra— Prevention and Health Promotion,83, 2.

WHO. (1986)The Ottawa Charter for Health Promotion. World Health Organization, Geneva.

WHO. (1999)Health Impact Assessment: Main Concepts and Suggested Approach. The Gothenburg Consensus Paper.

WHO Regional Ofﬁce for Europe, Copenhagen.

WHO. (2003)Social Determinants of Health: The Solid Facts.

WHO Regional Ofﬁce for Europe, Copenhagen.

WHO and Government of South Australia. (2010) Adelaide Statement on Health in All Policies.http://www.who.int/social_

determinants/publications/en/(last accessed 5 March 2013).

Wieser S., Kauer L., Schmidhauser S., Pletscher M., Brügger U., Jeanrenaud C., et al. (2010) Evaluation économique des Mesures de Prevention en Suisse. Winterthur Institute of Health Economics (WIG) and Institut de recherches économiques, Université de Neuchâtel (IRENE), Winterthur.

8 T. Mattiget al.