3.4 Health promotion model: Autonomous agency

VicHealth, established by the Victorian Parliament as part of the Tobacco Act 1987, was the first health promotion foundation in the world. It is based in Victoria in the Commonwealth of Australia. VicHealth is a statutory body with an independent chair and board of governance that reports to the Victorian Minister for Health and to the State Parliament. The Board is constituent-based, drawing from the sports, health, law, business, arts, and communication/media sectors. The Board also has three serving Members of Parliament, that reflect the composition of the Victoria Parliament. Currently there is one Member representing each of the State Government, the Opposition and the cross-bench. 

VicHealth was the first health promotion foundation in the world.

The multi-party representation on the VicHealth Board has been and continues to be one of its key strengths. The elected representatives drawn from multiple parliamentary parties, together with high profile members with diverse expertise and backgrounds, have been vital to the organization’s credibility, profile and success in reaching all segments of the Victorian community. 

For its first 10 years (until 1997), VicHealth was funded by a dedicated (or ‘hypothecated’) tax. The Victorian State Government applied a levy of 5% on top of existing state tobacco fees. The fund was dedicated to the Victorian Health Promotion Fund, and the Fund was administered by VicHealth. 

In 1997, the High Court of Australia ruled tobacco hypothecation unconstitutional at the state level. Since this time, VicHealth’s annual funding has been determined by the Victorian government and is allocated out of general consolidated revenue through the Victorian State Government’s annual budget process. It receives an annual fund of approximately AUD 41.3 million. Additionally, VicHealth periodically receives special funding from various Government agencies to deliver specific programmes and campaigns.

VicHealth focuses on promoting good health and preventing chronic disease. Its work includes creating and funding world-class interventions; conducting vital research to advance Victoria’s population health; producing and supporting public campaigns to promote a healthier Victoria; and providing transformational expertise and insights to government. Above all it seeks to make health gains among Victorians by pre-empting and targeting improvements in health across our population, fostered within the day-to-day spaces where people spend their time, and with benefits to be enjoyed by all.

VicHealth's Action Agenda for Health Promotion (2013-2023) focuses on five strategic imperatives with associated goals and three-year priorities. Those strategic imperatives are:

• promoting healthy eating
• encouraging regular physical activity
• preventing tobacco use
• preventing harm from alcohol
• improving mental wellbeing.

Across all of its imperatives, VicHealth aims to improve health and wellbeing by reducing health inequities and addressing the social determinants of health.

VicHealth works with all levels of government, across political parties and communities, and a range of sectors across health, sport and active recreation, research, education, the arts, planning and built environment, workplaces, industry, community food, local communities and media. It was designated as a World Health Organization Collaborating Centre for Leadership in Health Promotion in 2014, with a focus on building the capacity of existing and new health promotion organisations in the Western Pacific Region.  

A Chief Executive Officer leads the organisation with support from five executive managers, each in charge of a functional area: systems change for children and young people’s health and wellbeing, social marketing and communications, policy and research, human resources (people and culture), and corporate support. There is an additional small team that also directly supports the Chief Executive Officer. 

In accordance with the Tobacco Act, thirty percent (30%) of VicHealth’s budget must be spent on sporting bodies. VicHealth’s activities include small grants funding for community-based initiatives as well as long-term multi-million-dollar funding for programmes such as Quit Victoria (tobacco control and smoking cessation programme), investments in public health research and capacity building activity.

VicHealth has played a very active role in sharing information about its model of health promotion, internationally advocating for the use of dedicated taxes to fund health promotion and tobacco control along with sharing its experiences on working across settings, sectors and population groups to achieve positive health and wellbeing outcomes for all.

References

Tobacco Act 1987 (Vic) (Austl.). 

Victorian Health Promotion Foundation (VicHealth). 'What we do'. Available at: https://www.vichealth.vic.gov.au/about/what-we-do

Victorian Health Promotion Foundation (VicHealth). ‘Our history’. Available at: https://www.vichealth.vic.gov.au/about/our-history  

Victorian Health Promotion Foundation (VicHealth). ‘Who we are’. Available at: https://www.vichealth.vic.gov.au/about/who-we-are 

Victorian Health Promotion Foundation (VicHealth). Annual Report 2019–20. Melbourne Australia, 2020.

Victorian Health Promotion Foundation (VicHealth). The Story of VicHealth: A World First In Health Promotion. Melbourne Australia, 2005.

Victorian Health Promotion Foundation (VicHealth). VicHealth Action Agenda for Health Promotion 2019–23. Melbourne Australia, 2019.

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth). 

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

Healthway (the Western Australian Health Promotion Foundation) was established in 1991 under the Tobacco Control Act 1990 and later the Tobacco Products Control Act 2006 as a statutory body to operate as an independent organization. Now operating under the Western Australian Health Promotion Foundation Act 2016, Healthway is funded through the state government’s general consolidated revenue. 

Healthway is the only dedicated health promotion agency in Western Australia. Reporting to the Minister of Health, Healthway aims to promote and facilitate good health and activities that encourage healthy lifestyles. This is achieved through funding activities that promote health, particularly that of young people, and providing grants to organizations engaged in health promotion programmes and research.  It also offers sports, arts and racing sectors a source of funding for health promoting activities. Healthway partners with government, health and non-health organizations, communities and other stakeholders in varied settings including sport and reareation, education, culture and the arts, racing, local government, transport and workplaces.

Healthway is governed by a Board. As the accountable authority of Healthway, the Board sets strategic goals and direction and decides on the allocation of funding grants. A Health Promotion Advisory Committee provides advice to the Board to ensure its work aligns with contemporary health promotion policies and practice. A Research Assessment Committee also supports Healthway’s research programme, ensuring applications are assessed for their scientific rigor and ability to contribute to new evidence in health promotion policy and practice.

The organizational structure is made up of a Chief Executive Officer, Chief Financial Officer and Director Health Promotion that oversee two main grants programmes: health promotion and research, and partnerships. The health promotion and research area provide the Healthy Communities Programme and Healthy Research Programmes. The partnership area is responsible for Healthy Spaces and Healthy Partnerships Programmes. Healthway’s shared services are provided by Lotterywest including finance, organizational development, information management and technology, and risk management.

Between 2019 and 2022, Healthway received an estimation total annual budget of USD 14.83 million and USD 15.2 million. The fund supports various health promotion activities and research include communicating healthy messages, providing health promotion education, facilitating healthy environments and promoting participation in healthy activities. It also invests in capacity building within the health promotion sector through scholarships, fellowships and partnering with health organisations. Healthway also has extensive associations with ‘grass-roots’ organizations (more than 700 partners).

The key priorities for Healthway are outlined in its strategic plan, Active Healthy People 2018-2023 and include increasing healthy eating and physical activity, improving mental health, preventing harms from alcohol and creating a smoke-free Western Australia. 

References

Tobacco Control Act 1990.

Western Australian Health Promotion Foundation Act 2016.

Healthway. Healthway website: https://www.healthway.wa.gov.au/

Healthway. Strategic Plan, Active Healthy People: 2018 – 2023: Available at: https://www.healthway.wa.gov.au/our-priorities/active-healthy-people-2018-2023/.

Healthway. Annual report 2020/21. Available at:  https://www.healthway.wa.gov.au/wp-content/uploads/Healthway-Annual-Report-2020-21.pdf

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth). 

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

In 1986, the WHO’s Ottawa Charter for Health Promotion defined health as a person’s overall sense of physical, emotional, and social well-being. Two years later, in 1988, committed health policymakers in Austria responded to this idea by establishing the Forum Gesundes Österreich (Forum for a Healthy Austria), which was later renamed the Fonds Gesundes Österreich (FGÖ), or the Austrian Health Promotion Fund. This organization was set up specifically to support health initiatives, and its initial tasks, limited in scope due to its modest budget, included the coordination and documentation of information on promoting health and self-help. In 1995, Austria’s accession to the European Union (EU) provided fresh impetus to the FGÖ’s work. Since 1996, member states of the EU have set up several transnational networks to foster cooperation and exchange experiences on various health promotion initiatives, and these networks have helped advance the field. The FGÖ has regularly participated in these activities.

While the health promotion movement gained traction at EU level, there was also renewed commitment at national level. A team of legislators and experts responded to this shift by drawing up a health promotion bill, which led to the current Health Promotion Act, passed by parliament in 1998. This Act adopted a holistic approach to health and expanded the FGÖ’s responsibilities and budget. 

The FGÖ is an autonomous body that is accountable to its board, which is chaired by the Minister of Health. The governing board is composed of representatives of the ministries of health, education, and finance, the Chamber of Pharmacists, and the Austrian Medical Chamber; health officials and governors representing the federal states; and members of the associations of communities and cities, the Main Association of Austrian Social Security Institutions, the Association of Private Insurance Companies, and the Association of Senior Citizens. 

The FGÖ has been assigned the responsibility to “maintain, promote, and improve  health in a holistic sense and at all stages of life” as well as to “provide education and information on avoidable diseases and on the emotional, mental, and social factors influencing health”. Effective from August 2006, the FGÖ is a subsidiary of Gesundheit Österreich GmbH (The Austrian National Public Health Institute), with its financing and governance rules unchanged. 

The Health Promotion Act defines the goals and strategies for using earmarked funds made available from VAT revenue and budgeted by the Federal Ministry of Health. Annual funds of €7.25 million allow coherent, long-term planning and implementation in the field of health promotion, education, and information.

The fundamental principles of health promotion are also at the heart of the ten Health Targets for Austria. The Austrian Health Targets are based on the health in all policies approach. Their declared goal is the improvement of the health of all people living in Austria regardless of their educational background, income, or the circumstances of their lives (health determinants), and particularly a sustainable increase in the number of their healthy years of life.

In accordance with the Health Promotion Act (1998), the FGÖ defines its role in the Austrian health promotion landscape as a national funding agency, competence center, and information hub. In its capacity as the national funding agency for health promotion projects in Austria and in cooperation with stakeholders and actors in health promotion, the FGÖ develops and disseminates knowledge, developing skills and quality in the field of health promotion. The FGÖ encourages knowledge transfer between practice, science, and politics in the domain of health promotion.

To ensure that they are used for their intended purpose, grants awarded for larger projects (more than €72,000) are reviewed by a scientific board and approved by the governing board, which includes stakeholders from various national, regional, and local authorities, social security institutions, and organizations for healthcare professionals. The FGÖ must conduct its long-term and annual planning to implement these measures and initiatives in a manner that takes the measures and initiatives undertaken by regional and local authorities into account. The FGÖ must produce and publish an annual business report which is made available to the public to ensure the necessary transparency and accountability of the FGÖ’s activities. 

The Act defines the goals and strategies for using earmarked funds made available from VAT revenue and budgeted by the Federal Ministry of Health.

The main areas of activity are defined along five programme lines: 1. Growing up healthy – the psychosocial health of children and adolescents; 2. Workplace Health Promotion – equal health opportunities in the workplace, digital transformation, workplace 4.0; 3. Communities – social support, participation, and cohesion in healthy neighborhoods – municipal health promotion; 4. Quality of life and equal health opportunities for older people; 5. Healthy lifestyle through intersectoral cooperation.

The following three guiding themes are dealt with and further developed as overarching issues in all five programme lines:

* psychosocial health – living together in settings to promote health

* health equity – developing knowledge and disseminating good practice. One of the main objectives of the FGÖ is to promote a reduction in health inequities.

* gender-appropriate health promotion and diversity

The FGÖ’s functional divisions are: project funding; advanced training and networking; capacity building and knowledge development; education, information, and distribution; ÖKUSS – the Austrian competence and service center for self-help (coordination and services); ÖPGK – the Austrian health literacy alliance (coordination and services).

Strategies used to achieve the FGÖ’s objectives include creating structures for health promotion and disease prevention; developing and commissioning relevant programmes and services for municipalities, cities, schools, businesses, and the public health care system; developing programmes for specific target groups to inform and advise them about healthy lifestyles, disease prevention, and strategies for coping with chronic diseases and crises; conducting scientific programmes to foster health promotion and disease prevention as well as epidemiology, evaluation, and quality assurance in this field; supporting the continuing education of people working in health promotion and disease prevention; and coordinating the measures and initiatives outlined in this Federal Act with existing activities in health promotion.

References

Fonds Gesundes Österreich. Available at: https://fgoe.org

Federal Ministry of Labour, Social Affairs, Health and Consumer Protection. (2019). The Austrian Health Care System / Key Facts. Available at: 

https://www.sozialministerium.at/dam/jcr:6102a229-7b92-44fd-af1f-3aa691900296/BMASGK_The-Austrian_Health-Care-System__KeyFacts__WEB.PDF

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth). 

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

When the Thailand Parliament enacted the Health Promotion Foundation Act (B.E. 2544) in 2001, it marked the birth of the Thailand Health Promotion Foundation (ThaiHealth) as an independent organization. It is formed as an autonomous state agency outside the formal structures of government. ThaiHealth is not part of Ministry of Public Health and its bureaucratic system but it is under the supervision of the Prime Minister. ThaiHealth consists of two boards: the multi-sectoral Board of Governance; and an Evaluation Board.

The multi-sectoral Board of Governance comprises 21 members, chaired by Prime Minister with Minister of Public Health as the first Vice-Chairman and the second Vice-Chairman of the board is an independent expert appointed by the cabinet. Other board members are representatives from nine different ministries and eight independent experts from various disciplines who have no political affiliations. They set policies, regulations, strategies and overall budget arrangement besides overseeing the management structure and other guidelines for ThaiHealth. 

The Evaluation Board has seven members from health promotion, finance and evaluation experts. They are responsible for evaluating the overall performance of ThaiHealth to ensure accountability, transparency and efficiency of the organization. ThaiHealth is required to report annually to the Cabinet and to both houses of Parliament in accordance to the Act. It is also supported by a group of expert advisory committees.

ThaiHealth as an autonomous health promotion agency is the first to be established in the ASEAN region. It utilizes an innovative health promotion financing system through a two percent (2%) surcharge levied on excise tax from alcohol and tobacco. The surcharge requires tobacco and alcohol producers to pay an additional tax on top of the excise tax. This type of funding mechanism is the most effective means for securing sustainable and long-term funding for a health promotion fund. 

Funding certainty allows ThaiHealth to continue supporting and implementing a range of short, medium-and long-term health promotion programmes and innovative projects throughout the country. There are 15 master plans on issue-based areas (tobacco control, alcohol and substance abuse control, road safety and disaster management, health risk control, physical activity, healthy diet, media system and spiritual health), setting-based actions (vulnerable populations, healthy community strengthening, children, youth and family health, health promotion in organization, health service system); and supportive systems and mechanisms. 

A surcharge tax, requiring tobacco and alcohol producers to pay an additional tax on top of the excise tax, the most effective funding mechanism for securing sustainable and long-term funding for a health promotion fund.

ThaiHealth encourages interested organizations to apply for open grants and innovative projects and also supports programmes that aim to change public values, lifestyles and the social environment in ways that promote health and wellbeing. It acts as a catalyst and complements the existing bodies that are working in the area of health promotion.

Over the years, ThaiHealth has demonstrated that taxing alcohol and tobacco products provides a reliable, effective, and predictable source of revenue for health promotion fund and also contributes to health promotion gains, notably with a reduction of the use of tobacco and alcohol as well as other harmful substances. Between1991 and 2017, cigarette excise taxes increased about 11 times, resulting in a significant gain in revenues from THB15,898 million (USD 482 million) in 1991 to THB 68,603 million (USD 2,079 million) in 2017. 

At the same time, smoking prevalence among adults (more than 15 years old) showed a declining trend from 25.47% in 2001 to 17.4% in 2021. A similar reduction rate was reported in alcohol consumption from 31.5% in 2001 to 28.0% in 2021 as well as death rate from vehicle accidents from 16.82 per 100,000 in 2010 to 10.98 in 2020. 

ThaiHealth, through its strategic partnerships with various sectors including government, private, non-governmental organizations and communities, helps to mobilize and empower individuals and organizations across sectors in planning and carrying out health promotion activities for positive health enhancement. It has established a network with more than 200 partners across the country and continues to foster cross-sector partnerships with different sectors to promote and improve well-being of the community. 

A flexible organizational structure and management system along with financial security and effective strategies are ThaiHealth key strengths that help to improve the health of all Thai people.

References

Thai Health Promotion Foundation. Health Promotion Foundation Act, B.E. 2544 (2001). Bangkok, 2001.

Siwaraksa P. The Birth of Thaihealth Fund. Bangkok: Thai Health Promotion Foundation, 2002.

Adulyanon S. Funding Health Promotion and Disease Prevention Programmes: An Innovative Financing Experience from Thailand. WHO South-East Asia Journal of Public Health 2012;1(2):201-207.

Vathesatogkit P. Strengthening Intersectoral Collaboration in Addressing NCDs through Health Promotion. Presented at the Workshop on Strengthening Intersectoral Collaboration in Addressing Non-communicable Diseases through Health Promotion, 3 May 2013, Philippine. 

Thai Health Promotion Foundation. Thaihealth plan (Online). Available at: https://en.thaihealth.or.th/NEWS.html

National Statistic Office. (2021). The 2021 health behavior of population survey. Ministry of Digital Economy and Society, Thailand. Available at: http://www.nso.go.th/sites/2014en/Pages/survey/Social/Health/The-2020-Health-behavior-population-survey.aspx

Ministry of Finance. (2017). Annual report. Excise tax department, Ministry of Finance, Thailand. Available at: https://www.excise.go.th/cs/groups/public/documents/document/dwnt/mzex/~edisp/uatucm311825.pdf  

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth). 

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

Tonga Health Promotion Foundation (TongaHealth) was established by the Health Promotion Foundation Act 2007. It is an autonomous body that is accountable to the Government of Tonga through the Minister of Health. An appointment committee in which the Minister of Health chair appoint the members of the governance board and one to be chairman of the governance board. The governing body consists of five representatives, one from each sector comprising community churches, the legislative assembly, business and management, and the health. They are responsible for setting the agenda, policies and fund management of the foundation as well as appointment of the Chief Executive Officer who oversees the overall management of the foundation. TongaHealth commenced operations in May 2009.

Strengthening the understanding of health promotion through developing effective strategic partnerships, advocating for healthy lifestyle policies and legislation in all settings, managing grant and sponsorship programmes as well as strengthening existing Non-Communicable Diseases (NCDs) research to prevent and reduce harm from NCDs for a healthy Tonga where everyone is responsible for promoting health and everyone shares in the benefits of a healthy population is the main objective for TongaHealth.

As part of the capacity development and technical support for both staff and board members, they received mentoring support from VicHealth’s representative to empower them to plan, develop and implement health promotion programmes. The four priority areas in the National NCD strategies were to reduce harm from tobacco and alcohol consumption, promote healthy eating and physical activity. The principal strategy involved supporting and facilitating partner organizations to undertake health promotion activities. Being the first health promotion foundation to be established in the Pacific Islands, TongaHealth plays a crucial role in promoting health to all levels of society to reduce the health risks of NCDs in line with Tonga’s national NCD prevention strategy. TongaHealth has recently finalised its 5th National NCD Strategies awaiting cabinet approval namely ‘Tuiaki I he Amanaki ki ha Tonga Mo’uilelei (persevering together through the crisis to a healthier Tonga) - Tonga National Strategy for the Prevention and Control of Non-Communicable Diseases 2021-2025”. This strategy acknowledges gaps, thereby presenting opportunities for improvement through empowerment of the collective and adopting a shared purpose. In contrast to previous strategies, the Tuiaki strategy takes a systems-approach to address NCDs, it considers the underlying social, economic, cultural, political and environmental factors, their interactions, consequences and how they impact health outcomes in a systematic way.

TongaHealth initially obtained its funding from three different sources including government, the Secretariat Pacific Community (SPC) and private donors. In 2016 a total of AUD 2 million was contributed by Department of Foreign Affairs (DFAT) over 5 years to TongaHealth for implementation of the Tonga National NCD Strategy 2015-2020, with additional funding from the government budget of TOP 500,000 now increased to TOP 600,000.  To date TongaHealth continued to obtain its funding from the Government of Australia through DFAT with a total of AUD 2 million over 5 years which was concluded in 2021 with a new transitional grant of AUD 300 million until June 2020 awaiting new arrangement through Tonga Health System Support Phase 3 (THSSP3). In 2020 TongaHealth also received a grant from European Union of TOP 125,000 for implementation of Zumba for 5 secondary schools in Tonga.

The TongaHealth fund aims to build knowledge and skills in public health, research, social marketing and health promotion programmes that focus on preventive health and reducing the impact of NCDs. Specifically, TongaHealth promotes and advocates for healthy environments and access to healthy activity and food supply. Increasing awareness and encouraging healthy behavior through a healthy lifestyle includes staying physically active, eating healthy food, reduce consumption of alcohol and not smoking. A variety of programmes are implemented through a grant programme.

The limited and unstable funding source provides a great challenge for TongaHealth to plan for sustainable and long-term health promotion programmes. TongaHealth has fostered strong partnerships with various sectors including Ministry of Health, World Health Organization, AusAID, European Union, SPC, other governmental departments, NGOs, churches and villages communities to secure a more sustainable funding source. 

References

Health Promotion Foundation Act 2007.

Tonga Health Promotion Foundation (TongaHealth). Annual Report 2017-2018.

Ministry of Health. Tonga National Non-Communicable Disease (NCD) Strategy 2021-2025 (Draft).

Tonga Health Promotion Foundation (TongaHealth). Our Story – TongaHealth.Presented at Presented at International Seminar on Health Promotion Foundations and 12th Annual Meeting of the INHPF, 25- 27 June 2012, Seoul, South Korea.

Tonga Health Promotion Foundation (TongaHealth). TongaHealth Annual Update June 2011 – May 2012.Presented at Presented at International Seminar on Health Promotion Foundations and 12th Annual Meeting of the INHPF, 25- 27 June 2012, Seoul, South Korea.

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth). 

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.