Tobacco-tax based health promotion foundations

1. Tobacco-tax based health promotion foundations Burke Fishburn Technical Adviser International Union Against Tuberculosis & Lung Disease

2. 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

3. Health promotion is not…. Health Promotion ≠ Health Education (alone)

4. Health promotion is… • Education • Social Mobilization • Advocacy

5. 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

6. 5 priority HP actions • Build healthy public policy; • Create supportive environments for health; • Strengthen community action for health; • Develop personal skills; and • Re-orient health services.

7. 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.

8. 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

9. 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

10. 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

11. HPF structures: 4 models • Invisible • Embedded • Attached • Independent

12. 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

13. Embedded • Location: HPF located within/under Government agency/Ministry of Health • Funded: • General revenues provided to agency • Can receive funding from other sources • Partners: are external but partnerships can be directly through HPF

14. Attached • Location: HPF “attached” to government agency/Ministry of Health • Funded: • General revenues provided to agency • Can receive funding from other sources • Funds can go directly to HPF • Partners: can be internalized with HPFs

15. 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

16. 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

17. 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

18. 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

19. ThaiHealth • ThaiHealth Promotion Foundationhttp://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

20. 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

21. Others • Malaysian Health Promotion Boardhttp://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