The views of an expat
Celebrating the Ottawa Charter
Glocal Health Consultants are networkers par excellence:
- We are part of a global network of experts, both within and outside government, academia and industry, that we can call upon for quick scoping assistance and occasional consultancy assistance;
- Do not hesitate to contact us for services in Oceania, the Western Pacific and Australasia. Further afield we collaborate with partners in Europe (e.g., Marcus Grant) and the Americas (e.g., Marti Rice);
- In our research we have seen the power (and potential detrimental effect) of networks on health policy development. It is one of our key values to connect communities into policy networks, and reconnect those on the periphery to more central actors;
- Through software and graphing development we assist networks in becoming aware of the complex connections in health promotion and policy development, and assist in interpreting positions and nodes in networks
Thinking With You
From Lipp, A., T. Winters & E. de Leeuw (2012) Evaluation of Partnership Working in Cities in Phase IV of the WHO Healthy Cities Network. Journal of Urban Health, doi: 10.1007/s11524-011-9647-5
The WHO Commission on Social Determinants of Health demonstrated the pivotal connection between wealth and health. However, Healthy Cities seem less engaged with the economic sector and joint initiatives with the private sector are poorly developed. This is consistent with other studies, for example in Victoria (Australia) where state government requires local governments to plan for health in four so-called environments, including the economic environment. Virtually every local government there reports conceptual challenges in operationally connecting health and wealth.
From de Leeuw, E. & C. Clavier (2011) Healthy public in all policies. The Ottawa Charter for Health Promotion 25 Years On. The move towards a new public health continues. Health Promotion International, 26 Supplement 2, December 2011, ii237-ii244. doi: 10.1093/heapro/dar071
In our work with local governments, we have seen many indications that the post-modern social discourse fits local conditions exquisitely well. We would in fact postulate that the policymaking processes at the local level have always, better than the national level, allowed for creating the conditions for healthy public in all policy engagement.
From de Leeuw, E. (2009) Mixing Urban Health Research Methods for Best Fit. Journal of Urban Health. 87(1) 1-4 doi 10.1007/s11524-009-9411-2
In many domains, diversity is attractive; whether we look at urban planning and aesthetics, political or culinary smorgasbords, access to health service and entertainment facilities, or opportunities for connectedness, a greater variety tends to relate to more choice for well-being and fulfilment. A landmark study that eventually led to the emerging discipline of social neuroscience found a dose– response relationship between the diversity of social ties people engage in and their susceptibility to infectious disease. Similarly, it is postulated that such a relationship might exist between urban aesthetics, physical activity, and health. Clearly, the diversity of city life is an important determinant of health—if city dwellers choose to embrace that diversity.
From de Leeuw, E. , A. McNess, B. Crisp & K. Stagnitti (2008) Theoretical reflections on the nexus between research, policy and practice. Critical Public Health 18 (1) 5-20
‘Knowledge’, it is clear, is not a stable or value-free entity, but is manipulated, massaged and moulded to serve strategic, tactical and opportunistic purposes. (…)What is clear is that it is insufficient for researchers and research organisations to assume that production of research evidence alone is sufficient to ensure uptake by those in the policy and practice spheres. If research evidence is to have the best chance of being utilised, a strong and ongoing nexus between the research, policy and practice communities is essential.
From de Leeuw, E. (2012) Do Healthy Cities Work? A logic of method for assessing impact and outcome of Healthy Cities. Journal of Urban Health. 89(2) 217-231
Again, the hyperspecialization and fragmentation of the professions has not done much good to the capacity of humankind to deal with complex (urban health) problems. In the “standard normal” model of public health and epidemiology this complexity tends to be dissected into proximal (downstream) and distal (upstream) factors, the former being amenable to individual action (medical intervention, lifestyle change), and the latter subject to institutional consideration (laws, rules, and design parameters). Krieger shows that this oversimplification even applies to modifications of this notion that account for the complexity and multi-level nature of most population health problems. With the introduction of a hierarchy of levels between the “most proximal” (gene-protein responses to intracellular and intercellular environments) and “most distal” (the health of our planet—and possibly beyond) the “causal potency” (and our potential to substantively improve human health) has not been changed. The proximal–distal divide therefore does not seem extremely helpful, even when a hierarchy of levels of influence and action is introduced. The reason for this is that persistently, the rhetoric has ignored issues of power and co-existent multi-level interactivity between different functions of determinants of health. Only by recognizing this multi-dimensional co-existence in space and time in a universe that is determined by political econology can the true re-integration of urban planning and public health occur.
From de Leeuw, E. & T. Skovgaard (2005) Utility-driven evidence for healthy cities: Problems with evidence generation and application. Social Science & Medicine (61) 1331-1341
Our research indicates that cogent political commitment, relevant for ensuring the health status and stated health targets of a given urban population and environment, is something that most cities have before entering the HCP, not something they get along the way. Elsewhere, in a discussion on policy ontologies in Healthy Cities (Milewa & de Leeuw, 1995), we have found that such ontologies (sets of causal and final relations upon which policy decisions are based) may not change due to the participation of a city in the project. It is not without reason to interpret these findings as indications that political considerations lead to participation in the Healthy Cities Project, whereas participation in the Project does not lead to shifts in political considerations and subsequent policy-making.