Health Promotion capacity for action on the Social Determinants of Health.

Since the Ottawa Charter, health promotion in Europe has developed considerably. On the one hand, the growing recognition of healthy lifestyles and of the social and physical environment as important determinants of health have spurred policy makers and academic institutions across Europe to invest in health promotion and to strengthen capacities allowing for more effective actions to promote health. On the other hand, social and political difficulties have hampered a structured approach to health promotion, and large differences in capacity remain between countries. This is particularly the case for capacities to address the social determinants of health, despite the general awareness that tackling the social gradient in health is one of the main challenges for current health systems. Bearing in mind that any attempt to strengthen health promotion capacities should start from an analysis of which capacities already exist, how well they are developed, and how well they link together as a system, the presentation will provide a review of existing capacities of public health and health promotion organizations and professionals in Europe to address the social determinants of health. The review will be based on a model of public health and health promotion capacity, distinguishing between leadership and governance, organizational structure, financial resources, workforce, partnership and knowledge development. Drawing on this model, it will be shown that although the majority of EU countries have formal policy frameworks for public health with clearly established responsibilities and accountabilities, the responsibilities for broader public health issues including action on social determinants of health and health inequalities are less clearly defined. Moreover, financial and human resources allocated to health promotion are often insufficient, and may even further decrease in times of decreased public spending. While several countries have established centers or agencies for health promotion, most have a limited remit and focus on ad hoc, issue-based lifestyle-related interventions, rather than on integrated approaches taking account of the wider social determinants of health. Legal and organizational mechanisms to support partnerships between sectors are often underdeveloped, as is the facilitation of research capacity in support of policy development and programmes. The review will conclude with a series of recommendations to focus health promotion actions on socio-economic and environmental determinants of health and to strengthening the competences for health promotion at various levels of government. An exchange of information on best practices, experienced barriers and limitations may be a key element to strengthen the capacity to address the social determinants of health across Europe