Abstract Empowering women has been presented as a key strategy to improve child health. Yet, the literature on the subject is mixed, with strong variations in measures or according to context. Additionally, most of the research focuses on social or economic empowerment at the individual level rather than on structural factors or political empowerment. In this study, we explore whether women political empowerment is associated with improved health for children under 5 years old, in comparison to socio-economic empowerment or structural factors from the sustainable development agenda. We use the V-Dem project’s Women’s Political Empowerment Index and its components, combined with selected indicators of child health from the World Bank’s World Development Indicators for 166 countries, between 1990 and 2016. We estimate random- and fixed-effects regressions for the index as a whole and its individual components against child mortality, stunting and immunization coverage, controlling for structural and socio-economic indicators. The association between women political empowerment and child health outcomes tends to weaken once country heterogeneity is accounted for. Looking at individual components of women empowerment, factors or markers of socio-economic empowerment tend to have a stronger positive effect on child health compared to more political ones, for which we found either no correlations or even detrimental links to child health outcomes. Our results demonstrate the complexity of the relations linking women empowerment and child health. Presenting women political empowerment as a whole as the solution to improved child health appears misguided. However, selected individual freedoms and markers of women socio-economic empowerment are associated with positive effects on specific child health outcomes. This calls for a more context-specific yet multi-dimensional approach to women empowerment and child health in order to provide cohesive evidence to achieve the related SDGs. Key messages The relations between different dimensions of women empowerment and child health are complex. Women socio-economic empowerment may offer better leverages than political empowerment to improve child health.

L Ellis, E Besnier, M Ward, M Dyakova, L Green Public Health Wales, Policy, Research and International Development Directorate/International Health Coordination Centre, Cardiff, UK Contact: Liz.Green@wales.nhs.uk Welsh Government is committed to their global responsibility, highlighted most recently through the adoption of the ‘Wellbeing of Future Generations (Wales) Act 2015, the first legal commitment to the Sustainable Development Goals (SDGs). NHS Wales also recognizes the importance of developing Welsh health workers as Global Citizens as demonstrated by their commitment to the Charter for International Health Partnerships in 2014. Whilst global citizenship resources exist for school-aged pupils, there are no resources for health professionals. The development of health-focused global citizenship training would be a unique resource with the potential to increase awareness of international engagement and global social responsibility in the NHS. To explore perceptions and interest in global citizenship, the International Health Coordination Centre (IHCC) circulated a scoping questionnaire to the 10 Welsh NHS Health Boards and Trusts. To ensure participants had an accurate and similar understanding of the concept of global citizenship, a fact sheet was provided to inform the questionnaire. 81 responses were collected from a wide range of NHS professions and groups in all 10 Boards and Trusts. Results showed strong interest in the health of those living overseas with a high level of empathy and a responsibility to the health issues faced in other nations and how this potentially impacts the NHS (>95% of positive responses). 90% of participants indicated they would like to develop professionally in the field of Global Citizenship through continued professional development combining both online and workshop sessions. The scoping demonstrated a strong appetite for global citizenship training across the NHS in Wales. This resource will enhance learning, empathy and increase understanding of the importance of global and environmental responsibility, in addition to the sustainable development agenda and connections to population health and wellbeing in Wales and abroad.

Governments across the WHO European Region need to take urgent action to address the growing public health, inequality, economic and environmental challenges in order to achieve sustainable development (meeting current needs without compromising the ability of future generations to meet their own needs) and to ensure health and well-being for present and future generations. Based on a scoping review, this report concludes that current investment policies and practices (doing business as usual) are unsustainable, with high costs to individuals, families, communities, societies, the economy and the planet. Investment in public health policies that are based on values and evidence provides effective and efficient, inclusive and innovative solutions that can drive social, economic and environmental sustainability. Investing for health and well-being is a driver and an enabler of sustainable development, and vice versa, and it empowers people to achieve the highest attainable standard of health for all.