Victorian Prevention Policy Context

NWMR Integrated Planning ConferenceWednesday 7 December 2011

Vikki SinnottPrevention & Population HealthDepartment of Health

Overview of presentation

1. National initiatives

2. Victorian legislative context

3. Victorian Plans & related work

4. Victorian Public Health and Wellbeing Plan

• key directions• role of local government• policy case study – implementation of the NPAPH

5. Next steps & future challenges

National initiatives

• COAG National Partnership Agreement on Preventive Health (2008/2009 - 2014/2015)

• Preventive Health Taskforce - produced the National Preventative Health Strategy (2009) Taking Preventive Action (2010) – Commonwealth government’s response to the Strategy

• Australian Preventive Health Agency –established 1 January 2011

NATIONAL PARTNERSHIPAGREEMENT ON PREVENTIVE HEALTH 

   

Council of Australian 

Governments 

 

   

An agreement between 

  the Commonwealth of Australia and 

the States and Territories, being:  

the State of New South Wales; 

the State of Victoria; 

the State of Queensland; 

the State of Western Australia; 

the State of South Australia; 

the State of Tasmania; 

the Australian Capital Territory; and 

the Northern Territory of Australia.  

The agreement reforms Australia’s efforts in preventing the lifestyle risks that cause chronic disease. 

 

Legislative context – I

• Public Health and Wellbeing Act (2008) requires the Minister for Health to ensure a State Public Health and Wellbeing Plan is prepared by 1 September 2011 & every four years thereafter

• The Act requires the Plan to establish objectives and policy priorities for:

the promotion and protection of public health and wellbeing in the State

the development and delivery of public health interventions in the state

Legislative context - II

• The Act outlines a number of principles:

principle of evidence based decision-making

precautionary principle

principle of primacy of prevention

principle of accountability

principle of proportionality

principle of collaboration • The Act also requires local councils to have

regard to the State Public Health and Wellbeing Plan when preparing a Municipal public health and wellbeing plan

• Climate Change Act 2010

• Tobacco Act 1987

State plans - I

• Victorian Families Statement

• Victorian Health Priorities Framework

Articulates the long-term planning and development priorities for Victoria’s health services throughout the next decade

Metropolitan Health PlanRural & Regional Health PlanHealth Capital & Resources Plan

Recognises the importance of prevention

State plans - II

• Victorian Public Health and Wellbeing Plan

summarises the health status of Victorians

identifies challenges that affect population health

outlines commitment to strengthening the prevention system

emphasises partnerships

identifies priority settings

describes a new approach (NPAPH)

summarises opportunities in established health issues

outlines monitoring & review approaches

State Plans - III

Victorian government has committed to developing:

• Victorian Alcohol & Drug Strategy

• Healthy Ageing Plan

• Skin Cancer Prevention Framework

• Violence Against Women & their Children Action Plan

• Suicide Prevention Strategy

• Eating Disorders Strategy

• Primary Care Plan

Related state inquiries

• Victorian Government inquiries into a number of whole-of- government issues relevant to supporting and promoting healthy individuals, families and communities, including:

the contribution of environmental design to prevention and public health

liveability options in outer suburban Melbourne.

successful ageing to maximise the social and economic contribution of the increasing number of older Victorians.

Victorian Public Health and Wellbeing Plan 2011– 2015

The case for change in prevention

• Health outcomes are determined by social, cultural, economic, environmental factors – these are mostly outside the traditional responsibility of ‘health’

• Preventable diseases are on the rise

• Our lifestyles, populations & the world are changing – & we need to respond

• Within ‘health’ – our prevention efforts are often spread too thinly to achieve an effect, and we have not been able to scale up and sustain programs that have demonstrated effectiveness

• We face ‘wicked’ problems – complex problems/issues with a range of interrelated causal factors where there are no quick fixes – we need to “do” prevention differently to make a difference

Proportion of Victorians who are overweight or obese

41424344454647484950515253

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Year

Per c

ent

No action

An example – projections of unhealthy weight in Victoria

Source: Victorian Population Health Survey (VPHS)

If we are to change the trend we must deliver prevention differently from how it has been done in the past.

Requirements for a successful prevention effort

• Research and local and international experience tells us that:

complex problems need a comprehensive response health disparities need a whole-of-government response community-level implementation needs sustained support.

• Successful public health efforts, such as tobacco control or road safety, have required:

implementation of a variety of different, mutually reinforcing interventions (multilevel, cross government)

a long term commitment to achieve results.

Strategic directions 2011–2015

• Build prevention infrastructure to support evidence-based policy and practice

• Develop leadership and strengthen partnerships to maximise prevention efforts across sectors

• Review financing and priority setting mechanisms to ensure available resources are based on population need and potential for impact

• Develop effective modes of engagement and delivery of evidence-based interventions in key settings

• Strengthen local government capacity to develop and implement public health and wellbeing plans

Strategic directions 2011–2015 cont.

• Improve health service capacity to promote health and wellbeing

• Integrate statewide policy and planning to strengthen public health and wellbeing interventions

• Increase the health literacy of all Victorians and support people to better manage their own health

• Tailor interventions for priority populations to reduce disparities in health outcomes

Summary

• Strengthening the system

leadership & governance arrangements information – data, evidence syntheses, policy-practice-

research relationships integrated prevention funding partnerships (including community engagement) the workforce

‘The building blocks alone do not constitute a system, any more than a pile of bricks constitutes a functioning building. It is the multiple relationships and interactions among the blocks – how one affects and influences the others, and is in turn affected by them – that convert these blocks into a system’ (WHO 2009)

Key directions – I

Key directions – II

• Partnerships in prevention

state & local government health sector private sector communities research

• Focus on priority settings

local communities & environmentsworkplaces early childhood & educational settings health services

Key directions – III

• Priority interventions

continue to protect the health of Victorians keep people well strengthen preventive healthcare

Lead role of local government at the community level – I

The function of a Council under the PH&W Act is to seek to protect, improve and promote public health and wellbeing within the municipal district by:

(a) creating an environment which supports the health of members of the local community and strengthens the capacity of the community and individuals to achieve better health

(b) initiating, supporting and managing public health planning processes at the local government level

(c) developing and implementing public health policies and programs within the municipal district

Lead role of local government at the community level - II

Victorian Health Priorities Framework 2012–2022All local governments will have Municipal “Healthy Communities” Public Health and Wellbeing Plans that are well known to their local communities and that promote healthy living.

Policy case study

• Implementing the COAG National Partnership Agreement on Preventive Health in Victoria

• Opportunity to do things differently – based on local, national & international experience

• Invest adequately in a responsive infrastructure that is able to deliver coordinated, comprehensive interventions that would make a measurable difference

• NPAPH funded as part of the 2008 reform package, it provides $872 million over six years to:

“address the rising prevalence of lifestyle related chronic disease by laying the foundations for healthy behaviours in the daily lives of Australians through settings such as communities, early childhood education and care environments, schools and workplaces, supported by national social marketing campaigns (MeasureUp and an anti-smoking campaign)”

• Major focus is on poor nutrition, physical inactivity, smoking and excessive alcohol consumption

COAG National Partnership Agreement on Preventive Health (NPAPH)

NPAPH initiatives

• Healthy Children *

• Healthy Workers *

• Healthy Communities (Commonwealth measure, through local government)

• Measure Up * & tobacco social marketing

• Workforce audit

• Industry partnership

• Enabling infrastructure

Australian National Preventive Health Agency Surveillance *

* States funded to deliver in whole or in part

Funding allocation to Victoria – I

Funding for Victoria 2009-10 to 2014-15 = $81.79M

Measure Up Campaign $4.5M

Healthy Children 2011 $39M

• health promoting early childhood & schools• healthy children & families through communities

Healthy Workers 2011 $36M

• health promoting workplaces program • workplaces through communities

NPAPH performance benchmarks & indicators

• Increase in proportion of children & adults at unhealthy weight held at less than 5% from baseline by 2013 & returned to baseline by 2015

• Increase in mean number of daily serves of fruit and vegetables for children and adults by

0.2 for fruit & by 0.5 for vegetables by 2013 and

0.6 for fruit & by 1.5 for vegetables by 2015

• Increase in proportion of children doing 60 minutes & adults doing 30 minutes of moderate physical activity daily by 5% by 2013 & by 15% by 2015

• Reduce adult daily smoking by 2% from 2007 national baseline by 2011 & by 3.5% by 2013

NB: Alcohol is an objective but not a performance measure

Lifestyle health risk factors, 2003-2008

2003 2004 2005 2006 2007 2008 Measure Trend

Fruit intake 49.3 48 50 52.6 53.7 51 Not met guidelines Unchanged

Vegetable intake 88.1 92.3 90 88.8 90.4 90.6 Not met guidelines Unchanged

Smoking 22.1 22 20.5 20.4 19.9 19.1 Current smokers Improving

Physical activity - - 34.3 33.2 33.9 33.2 Not met guidelines Unchanged

Obesity / overweight 45.2 46.4 47.8 47.4 48.2 48.6 Body mass index ≥ 25 Worsening

Per cent

Victorian trends

Source: Victorian Population Health Survey

Proportion of Victorians who are overweight or obese

41

4243

44

45

4647

48

4950

51

52

53

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Year

Per c

ent

No action

NPAPH reward targets – how much difference do we need to make?

Source: Victorian Population Health Survey (VPHS)

NPAPH Reward Targets

Victorian approach

• Implement whole-of-community intervention model designed to influence behaviour change

• Invest in an adequate workforce • Deliver evidence based interventions• Ensure research assesses the impact• Support local initiatives with statewide policy and resources

• Distribute funding to enable this:

Statewide inputs – research & evaluation, social marketing, learning & development, healthy living programs (25%)

Prevention workforce – LGA & community level personnel (40%)

Local interventions – engagement & settings-based action (35%)

Concentrated scenario has potential todemonstrate evidence of policy outcome impact

(NPAPH outcomes are agreed to be measured by the Victorian Population Health Survey)

Getting evidence of policy outcome impact

Two resource deployment scenarios:

• Focus is on sustained, consistent and coordinated action across community, family, councils, schools, early childhood settings, health services and workplaces

• Concentrated community-level interventions in preventive health are increasingly being utilised across Australia and internationally (Australia - Colac Childhood Obesity Prevention & Opal; France – Epode*; United States - Communities Putting Prevention to Work)

• Strong evidence that in obesity prevention this approach delivers results• International studies point to key role of local government engagement

and leadership – cannot be achieved by health care system alone

Whole of community approach

* EPODE: Ensemble, prévenons l'obésité des enfants [Together, let's prevent obesity in children]

Targeted Funding: 14* selected LGAs

Resource allocation takes account of:• Population size

• Number of communities with high need and potential to meet targets

• Number of settings (schools, early childhood and workplaces)

• Mix of rural, metropolitan and provincial LGAs

• Combined with existing resources, enough to produce a detectable effect by 2014

(Of the 14 LGA’s, 3 are very small and are combined into one area, making 12 areas)

Preventive health effort – local prevention teams

Towns (Healthy)15-20

State-wide SystemEffort

12 Prevention Areas(14 LGAs)

Communities/Towns

Prevention Partnerships and Team Coordination

Health Promoting Children

Health Promoting Workplaces

Communications

Research and Evaluation

Health Promotion Officers

1 per community/town

Department of Health (central & regional office teams)

Department of Education & Early Childhood Development

DH funded research centre - CEIPS

VicHealth

NGOs (eg Cancer Council, QUIT, CBRC, Diabetes Victoria, Heart Foundation)

WorkHealth

MAV“New Prevention Delivery Teams”

Menu of possible evidence-based healthy living programs for communities to choose from (examples)

Children

Birth – 4 years

5-11 years

12-17 years Adults

Parents:Males

Females

Links with workplaces and communitiesLinks with early childhood and school setting

Community gardens, cooking classes

Walking groups

Walkable communities

Peer education

Healthy Dads, Healthy Kids

Life!

Healthy food choices / accessibility

HeLp-her

InFANT

Healthy living programs

The aims of healthy living programs are to:

• increase healthy eating, physical activity and/or healthy weight; and

• decrease smoking and/or harmful/hazardous consumption of alcohol (for adults)

This is to be achieved by targeting groups or communities and providing:

• information or education

• practical skills development

• participation opportunities, contributing to increased healthy eating, physical activity and/or healthy weight

• programs to strengthen community action / create supportive environments

Statewide initiatives - I

Victorian Healthy Eating Advisory Service

• To provide health eating and nutrition advice to early childhood services, primary and secondary schools, hospitals and workplaces

• Menu assessments, training, support and advice (phone and web based)

• $3M over 4 years

Statewide initiatives - II

Healthy Children

Parliamentary Inquiry into the Potential for Developing Opportunities for Schools to Become a Focus for Promoting Healthy Community Living (Sept 2010)

Nine recommendations, the first:

That Department Education and Early Childhood Development, in consultation with Department Health, review the development and implementation of the health promoting schools approach in Victoria

Government response tabled in March 2011, ‘agreed’ or ‘agreed in principle’ to the nine recommendations

An interdepartmental steering group, co-chaired by DEECD and DH, established.

Statewide initiatives - III

Healthy Children - recent announcements

• Statewide policy to guide health promotion for children and young people

• Victorian Prevention and Health Promotion Achievement Program for schools and early childhood services

Kids – ‘Go for your life’ schools and services will be transitioned into Achievement Program

Achievement Program will build capacity of schools/ECS to address healthy eating, physical activity & broader health issues

Statewide initiatives - IV

Better Health Channel customisable for individuals

Healthy workers

Centre of Excellence in Intervention and Prevention Sciences (CEIPS)

Role of CEIPS

• Brokerage role (strategic projects, reviews, relationships)

• Independent research (for example, health economics)

• Oversight of the evaluation of the NPAPH

• Integrated knowledge exchange

Evaluation

• 12 prospective case studies in implementation/quality improvement

• Matched (randomised) comparison of intensive ‘dose’

• National comparison of state and territory performance

• Research & Evaluation Officer documenting local efforts & impacts

• Augmented VPHS measures outcomes / targets

• Multi-level evaluation – local, state & national

Next steps & future challenges – I

• Improve planning and investment for improved health outcomes – across government and the broad prevention sector

• Support prevention champions with effective governance arrangements (for example, the Prevention & Population Health Advisory Board)

• Implement & evaluate Prevention Community Model

• Statewide Prevention and Health Promotion Achievement Program for

early childhood settings & schools

workplaces

communities

Next steps & future challenges – II

• Share lessons from PCMs through established leadership & governance fora

• Maximise effective use of digital & social media

• Develop resources to support all local councils to strengthen their focus on health and wellbeing

• Continue to work closely with our partners across the prevention sector

Thank you

How might your agency contribute to the new directions for prevention... & how can we assist you to partner

with us?

http://www.health.vic.gov.au/prevention

Vikki Sinnottvikki.sinnott@health.vic.gov.au

9096 5143