HEALTH IN ALL POLICIES IN MULTIETHNIC REGIONS: A COMPARATIVE ANALYSIS OF SIX INTERNATIONAL MODELS AND THE CASE FOR A CONSTITUTIONAL INSTITUTIONAL HUB IN THE REPUBLIC OF KAZAKHSTAN

Abstract

This article proposes and substantiates a regional model of the Health in All Policies (HiAP) approach for the Zhetysu region of Kazakhstan that integrates the Centre for Public Accord (CPA) under the Assembly of the People of Kazakhstan as a non-medical institution of health protection for the multiethnic population. A comparative analysis of six international cases-Aboriginal Health Access Centers in Canada, Whānau Ora in New Zealand, Aboriginal Community Controlled Health Services in Australia, the Well-being of Future Generations (Wales) Act 2015, Health in All Policies in Finland, and Community Health Workers / Promotora model in the United States-demonstrates that no developed country has yet implemented at the national level an institutional model that simultaneously combines (a) a community-controlled centre of an ethnocultural community, (b) a legislatively or programmatically anchored HiAP framework, (c) the operational model of ethnocultural gatekeepers, and (d) a constitutionally entrenched institutional “roof” in the form of an institution of interethnic accord. The proposed Kazakhstani institutional configuration integrates all four components. A three-scenario financial model of the regional road-map for 2026-2028 is presented (KZT 130-281 million); the baseline scenario provides an additional reach of 14,400 representatives of ethnocultural groups at a direct return-on-investment ratio of 1.92:1 and a long-term ratio of 6.3:1, calibrated against the WHO Investment Case for NCDs in Kazakhstan. The national scaling concept covering 17 subjects of the Republic of Kazakhstan implies an aggregate three-year budget of KZT 3.5 billion (0.06 per cent of national annual health expenditure), an expected annual saving of KZT 11.5 billion through reduced economic losses from non-communicable diseases, and a national return-on-investment ratio of 3.3:1. The article concludes that the Kazakhstani model represents an internationally novel institutional configuration suitable for dissemination across multiethnic states of Central Asia and the Commonwealth of Independent States