Conclusion

This chapter distills the contents of the book into six central messages: (1) reducing inequities is the central, vital mechanism for building population health; (2) human health is intimately connected to planetary health and needs to be viewed as part of the broader ecosystem; (3) how we govern is vitally important to how healthy, sustainable and equitable we are: good governance is centrally concerned with the involvement of all sectors to promote health and reduce inequities; (4) regulation is a powerful and essential tool for public health; (5) new ways of measuring progress are important; (6) ubiquitous leadership is required for health, equity, and well-being. The chapter elaborates on each of these and then ends with a consideration of the importance of maintaining hope and acting with courage.

Urban Planning

This chapter discusses the symbiotic relationship between urban planning and public health, examines the features of healthy and sustainable urban environments, provides positive examples of healthy urban planning and the blocks to conducting such planning. Consideration is given to how urban planning can contain sprawl and can create cites that rely more on public transportation, cycling, and walking. Examples of good practice from New York, Zurich, and Bursa (Turkey) are provided. Issues of governance, including public participation in planning and the importance of visionary leadership, are discussed. A perspective of cities as contested ground in which developers seek to maximize profits, often at the expense of urban residents, is developed. Conflicts of interest that arise in development processes are examined.

Fiscal Policy

Fiscal policy is central to governing for health. It determines what resources are available, largely via taxation, to invest in health and well-being, and how equitably and effectively national resources are allocated. The decisions made by treasurers, finance ministers, and chancellors of the exchequers are vital to health, yet this is rarely recognized, and the economic sphere is treated as if it were somehow separate from the rest of society. This chapter argues that in order to govern for health, this view has to change, with economic decisions made to serve the health and well-being of society. In making this argument, the chapter starts with a consideration of the health-damaging effects of neoliberalism and then asserts and examines five action points that would lead to fiscal policies that support health and well-being.

The Power of Policy to Promote Health and Well-Being

Governing for health involves designing, crafting, drafting, and implementing policies that will result in healthy, equitable, and sustainable societies in which well-being is enhanced. These policies need to be present in every sector. They need to both direct government actions toward well-being and provide a regulatory framework for the private sector. This chapter examines the role of values and ideologies in policy, including the extent to which agency or structure determines health, describes policy processes, and finally outlines the important meta-policy messages required for good governance for health and well-being. It presents the Mandela of health and discusses the Raworth doughnut model of economics as a useful tool to understand the values that should underline healthy public policy.

Creating an Ecologically Sustainable World to Support Environmental and Human Health

This chapter explains the impact of environmental threats on human health, considers the urgency for action in a context of disputed politics, argues the need for an ecosystems perspective, and assesses policy action in the areas of global warming (climate change), renewable energy, sustainable food and water, and the need for humans to reconnect to nature and land. It argues that the earth’s ecosystem is greatly threatened by human activity and that industrialization has ravaged the natural environment to the point that soon it may no longer support human life. Consequently, the case is made for radical change toward an ecosystems view to maintain a safe operating space for humanity. The importance of renewable energy, sustainable food and water supplies, restoring nature, and protecting biodiversity are seen as vital to human health.

Education

Education is a vital determinant of health. If you work in the education sector, you are likely to make a greater contributions to promoting population health than many other professionals, including doctors. This is because you have the opportunity to establish the building blocks for good health by encouraging children to maximize their social, emotional, and educational skills, each of which is vital to good health. You can both prevent problems before they occur and create the conditions for good health. This chapter demonstrates why education is so important to health and provides examples of public policies that enable education to maximize its health-promoting potential.

Health Sectors as Actors and Advocates for Health and Health Equity

Many assume that the health sector is the central government agency for health. Yet very often, health sectors are actually “illness care” sectors that give little concern to the production or maintenance of health. This chapter argues that this state of affairs needs to change so that health sectors do become stewards of the health of the population they are established to serve. Achieving such a health sector will require strong and determined leadership that is able to ensure that curative functions are effective, while also ensuring that disease prevention and health promotion flourish. This is vital to governing for health. This chapter examines the importance of primary health care, disease prevention, and health promotion. The chapter plays particular attention to community strategies, including community ownership of health services, and public health functions, including health impact assessments and Health in All Policies.

Civil Society

Civil society has been vital to many measures that have improved governance for health. Advocates outside government have inspired many policy and law changes that have resulted in improved health and well-being. Examples include the abolition of slavery, women’s voting rights, and marriage equality. Civil society is also vital to maintain good governance through mechanisms including representative boards of management, watchdog functions, and formal processes of participation. This chapter reviews each of these to demonstrate that civil society is vital to good governance for health. The chapter argues that governance for health is much stronger and more likely to come about when there is top-down action from government, combined with bottom-up pressure for change that can force the hand of governments to act in favor of health, equity, and sustainability. Many examples of civil society action are provided.

Local Government and Health Governance

This chapter examines how local governance can be most effective in promoting health and then reviews developments in first urban and then rural and regional governance in terms of contributions to health equity, well-being, and sustainability. The chapter notes that while local government can be a positive part of the governance for health, it is not always benign. It can be captured by vested interests whose aim is to profit from development in a city, rather than acting in the interests of the public good. The argument is made that local government requires safeguards so that those who have only a profit motive in mind are not able to capture local authorities or exercise undue influence over them. The characteristics of good local governance are described. Examples are provided of urban and rural local governments acting in the interests of health and equity.

Political Dimensions of Governing for Health

Politicians are central to governing for health, and this chapter is directed at persuading them to do so. It includes a well-being manifesto and provides evidence to support the value of adopting this manifesto in terms of individual, population, and planetary well-being. Further evidence is provided in terms of how more equitable societies are also more successful, and how pursuing equity can create political capital. The power of the various lobby groups the politicians will encounter and the need to privilege public interests above private profit when assessing the messages from this lobbying are considered. Concomitant to this is the importance of listening to public interest advocates. Civil society advocacy is vital to winning a constituency for the well-being manifesto. The chapter argues the need for global political governance in the face of waning power for nation-states and increasing power for transnational corporations.