Adelaide Thinker in Residence

Professor Ilona Kickbusch

The Shift to the Health Society: Addressing the challenges of 21st century health Public lecture

13. November 2007

The Turning point

We are at a turning point in health policy: the nature of 21st century health – the health society - calls for a radical change of mindset and a reorganization of how we govern health in the 21st century.

The goal

To make South Australia a global

leader in 21st century health

Many of the elements are already in place

Second International Conference on Health Promotion, Adelaide, South Australia, 5-9 April 1988

Adelaide Recommendations on Healthy Public Policy

The requirement

• Interconnected forms of government

• New partnerships for health

Citizens participation

Department of the Premier and CabinetDepartment of HealthFlinders UniversityMotor Accident CommissionUniversity of AdelaideCentral Northern Adelaide Health ServicesChildren, Youth and Women’s Health ServicesDepartment of Education and Children's ServicesUniversity of South AustraliaWorkCoverTRACsa – Trauma and Injury RecoveryCity of MarionCity of OnkaparingaSouthern Adelaide Health Service – Healthy Cities Noarlunga

Program Partners: thinking together

The starting point: South Australia’s Strategic Plan Objectives

1. Growing

Prosperity

2. Improving Wellbeing

3.Attaining Sustainability

4.Fostering

Creativity & Innovation

5.Building

Communities

6. Expanding Opportunity

Secure a good quality of life for

South Australians of all ages and backgrounds

Think! health and wellbeing

• Apply a health lens to the South Australian Strategic Plan

• Introduce new outcome measures to measure wellbeing

Think! policy learning

Target Case StudiesAcross government 1 2 3 4 5 6 7 +7

SASP

Thinking together

HiAP Conference 2007

Kickbusch 2007

Think! “State Well-Being Account,"

• AIM: to provide a broad

measure of the well-being of people of all ages and backgrounds in SA, akin to the economic measure of the Gross Domestic Product.

NIH USA

New York Times

World Happiness Survey

• 1 - Denmark (273)

• 2. - Switzerland

3 - Austria

4 - Iceland

5 - The Bahamas

6 - Finland

7 - Sweden

8 - Bhutan

9 - Brunei

10 - Canada

11 - Ireland

12 - Luxembourg

13 - Costa Rica

• 26 Australia(243)

• The three predictor variables of health, wealth and education were also very closely associated with each other, illustrating the interdependence of these factors.

When people are asked if they are happy with their lives, people in countries with good healthcare, a higher GDP per captia, and access to education were much more likely to report being happy.“

Source: University of Leicester 2006

Think! determinants of health

Health is created in the context of everyday life where we live, love, work and play ….and where we shop, google, travel

Wellbeing Project 2006

Think! equity: the health and wellbeing of aboriginal peoples

• Aboriginal and Torres Strait Islander Australians born during 1996 to 2001 had life expectancies of 59 years for males and 65 years for females. These were around 17 years lower than the average life expectancies for all male and female Australians born during 1998 to 2000 (ABS/AIHW 2005).

Aboriginal Health

Impact Statements

Think! Health and wealth in the 21st century

Wealth of countries driven by human capital

Interdependence between healthy people and healthy economy – demographic shift

Health itself as an economic and social driving force

Think! sustainability

• Ensuring the health of the next generation is as big an issue as climate change

Evolution - RevolutionRevolution

The pace of the technological revolution is outstripping human evolution

Foresight Project Report 2006 Tackling Obesities

– A mismatch between our genes and our environment

“Development that meets the needs of the present without compromising the ability of future generations to meet their own needs".

Our Common Future, World Commission on Environment and Development 1987

HEALTH

Think! Future generations

Think! Generation H!SA

Faced with an epidemic of chronic diseases we also need to address the twenty-first century determinants

The generation of children born at the turn of the 21st century could be the first to have a lower health and life expectancy than their parents.

(Olshansky, J. et al., 2005)

Life expectancy Australia: sixth highest in the world

average life span 80.0 years,

72.6 years free from ill-health or disability. (WHO 2004).

OECD DATA:Obesity world wide

Think! “obesogenic environments” OE

• Change in type of work and activities within each job;

• Change in home production and leisure; • Change in transportation A rapid shift toward reduced energy

expenditures• The Nutrition Transition Program The University of North

Carolina at Chapel Hill

OE „Infection“and

„Pollution“

Baker et al 2006

OE: Supermarkets and shopping malls: the 21st century health settings

                                                                                         

                           

OE: Mediascapes and images

Overall body dissatisfaction in young people has increased dramatically in the last few decades, with a heightened prevalence of dieting, eating disorders, obsessive exercise and steroid abuse BMI 16

Generation H!SA

• Health must become a critical goal of all of government:

• Children’s health act

The International Convention on the Rights of the Child

Examples of actions

• breastfeeding; • reducing the amount of

fat, sugar and salt; • promoting cycling and

walking; • opportunities for daily

physical activity and for good nutrition schools.

• WHO: European Charter on Obesity

• "Specific regulatory measures should include: the adoption of regulations to substantially reduce the extent and impact of commercial promotion of energy-dense food and beverages, particularly to children”

Examples of policies and sectors

Think! health in all policies

Healthy Public Policy is characterized by an explicit concern for health and equity in all areas of policy and by an accountability for health impact.

Adelaide recommendations 1988

Think! new policy mechanisms

across government • Core principle• The main aim of

Healthy Public Policy is to create a supportive environment to enable people to lead healthy lives.

• Premiers Directive on Health and Wellbeing

• H+WB impact statements/health lens

• High level HIAP unit SASP and committee

• Minister for health and wellbeing

• Joined up budgets

Think! partnerships for health throughout SA society

Health of children must become a critical goal beyond government – within society as a whole

• Platform Generation H!SA

• Coalition eating disorders/body image

• Local Alliance Generation H!SA

• Generation H!SA youth forum

Think! Wellbeing at school

• Healthy schools

• DECS wellbeing framework

• CYWHS: gender health

• Health in the new SA education act

Think! partnerships for health throughout SA society

•

• Mobility, equity and health

Increase focus on: • Determinants of

Health in compensation settings

• Equity in accidents• Aboriginal mobility

Think! more health in the health sector

• Strengthen the focus on:

• Health in all Policies• Prevention and health

promotion• Empowerment in

disease management• Integration of services• Equity• Partnerships

• High level commitment for generation H!SA

• A minister for health and wellbeing

Think! integrative action

Think! critical role of local government

• Health lens and HiAP at the local level: Southern Centre for collaborative action on health

• Health literacy initiatives• Local strategic alliance

for Generation H!SA• Community participation

Critical role of local government •

aztlan2K

Think! the role of the citizens in health

• Two key elements:

• Community participation

• Health literacy and equity

Think! health literacy Policies must aim to increase people’s

control over their health and its determinants – involvement and empowerment

SA Health Literacy Alliance

• Health literacy is the capacity to make sound health decisions in the context of everyday life – address double inequity

• Assess levels of health literacy

• Make HL a key benchmark of GP+ and SA hospitals

• Create HL circles and patient university

• Prioritize navigation support for aboriginal peoples

In and outpatient care

Pharmacies

Health resorts / Rehab

Medical and gerontotechnology

Biotechnology

Pharmaceutical industry

Sports and leisure

Nutrition

Health tourism

The emerging health market – exports for South Australia

educationresearch

Social and policy innovation

Think! research

• Strengthen interdisciplinary research capacity on health

• Generation H!SA cohort study

• Health literacy survey• Health lens research

ThinkHealth!

Think! global leadership

Think together!•

Think together!

www.adamsunity.org