Public Health Planning Addressing the challenges

Transcription

1 Public Health Planning Addressing the challenges Melissa Stoneham & Myra Robinson

2 Outline of workshop Why do we need a PHP? What is it? Legislative considerations What do we need to upskill in? Barriers & Opportunities EHP roles Success factors Lessons from Victoria

3 Why do we need to plan for public health?

4 Why do we need a PHP?

5 Why do we need a PHP?

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14 Focus on people. Focus on how the environment they live in affects their health. Equity.

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17 Context for public health planning

18 Public Health Bill Overall Direction Autonomy to local government Risk based Broadened scope of the definition of PH Sets broad principles and objectives Should reduce the number of plans in LG Reduce reporting and auditing of Local Government by DoH Address local risks Establish relationships with PHUs and others

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20 Department of Local Government Integrated Planning and Reporting Framework Conceptual framework to ensure that Plans for the Future integrate the needs of the community Process for allowing LGs to determine which issues they can address given resource limitations A356D684D2B6E6D6D4D6E D3 D&ContentID= A673D (guidelines) PH Bill and Integrated Planning and Reporting Framework share similar concepts.

21 Legislative Synergy! Public Health Bill Requires a PH&W Plan Advocates for an integrated approach Integrated Planning Framework Strategic community plan should include community aspirations relating to social, economic, environment & health With opportunity for LGs to determine priorities

22 STRATEGIC COMMUNITY PLAN CORPORATE BUSINESS PLAN INFORMING STRATEGIES Finance Workforce Public health ANNUAL BUDGET Measurement and reporting

23 Public Health Bill and LG planning MUST be part of the overall strategic and corporate planning and reporting framework May be prepared in conjunction with a Plan for the Future of the local government district prepared under the Local Government Act 1995 Integrated planning process Consistent with the State Public Health Plan

24 Need to think broadly EHPs are used to dealing with environmental determinants of health any external agent (biological, chemical, physical, social, or cultural) that can be causally linked to a change in health status Need to integrate other determinants of health to give a holistic view Environmental and social factors that affect health and wellbeing

25 Need to be convinced? In the 2006 Australia Fair report it was found that an estimated 2,210,000 people, or 11.1% of Australians including 412,000 children, lived below the most widely used poverty line measurement Within many disadvantaged communities, retail outlets selling affordable and fresh nutritious food are often underrepresented yet processed food (fast food) outlets are often clustered within these areas Only 54% of Australians aged 15 to 74 years have the literacy skills needed to meet the complex demands of everyday life and work (ABS)

26 Is this a role for local government? LG has an influence, sometimes big, sometimes small, in everyday lives LG can positively impact on biodiversity, access to safe food, the liveability of the community, opportunities for physical activity and recreation, provision of areas for people to connect, and so on LG provide local surveillance data and community aspirations

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28 An example Ballarat City Council PHP focuses on: Urban design, land use, management of natural resources, employment, social connectedness, transport, community participation & access to services Vulnerable groups

29 But to be able to take this broad view you need to: Think broadly about what health means to your community and Council Work with other LG departments Collaboration not just information sharing Balance legislative requirements with community needs Identify local risks Communicate well

30 What is health? You have been asked to attend a community meeting to explain what a PHP is. One of their key questions is what is the Council s definition of health. You have 2 minutes to articulate what health means to your Council. What would you say? List key points but have a clear definition of what health is. Make it relevant to your audience. Language is important!

31 Key challenges to PHP Language Working with others Time Skills Lead agent When do we start? Determining priorities Evaluating performance Funding the development, implementation and review

32 Grab 2 people. And spend 10 minutes discussing the skills you think you need to develop or strengthen to take the lead in developing your Council s PHP How do you get these skills? What do your outsource? What others ways can you enhance your skills?

33 EHP Roles EHPs should work with and alongside other public health professionals, and be key partners in local efforts to protect and improve the health and quality of life of individuals and communities and to reduce health inequalities. Internal and external to the LG EHPs have skills to identify and tackle the wider determinants of the population s health by identifying, controlling and preventing current and future risks. Key member of the team and should aim to lead the development of a PHP

34 Local Government Survey Partnered with EH Directorate ed PEHOs asking them to complete the survey online n=142 Response rate 52% (n=75) Targeted PEHOs due to the complex management of PH issues within individual LGs 18 public health questions what do you currently do and do these broader issues get any attention?

35 Most urgent PH issue Most important PH issue Most resource intensive PH issue Issue % Issue % Issue % Food safety 21 Food safety 29 Food safety 24 Sewerage/ waste water 16 Sewerage/ waste water 13 Waste 15 Vectors 14 Vectors 11 Building control Waste 11 Waste 9 Vectors 13 Lifestyle diseases 10 Disease control 14 7 Complaints 10 Pollution 8 Pollution 7 Noise 6 Public buildings 7 Sewerage 5

36 Partners Local government collaboration with NGOs Number of responses No Yes Heart Foundation Cancer Council Diabetes WA Asthma Foundation AMA* ACOSH

37 What LG told us 92% spent less than 30% of their time conducting health promotion activities 35% spent no time on health promotion 92% spent less than 30% of their time in Indigenous health 61% spent no time on Indigenous health Almost three-quarters advised they spent less than 30% of their time planning 57% of the respondents did not have an annual business

38 Ok, so we have some work to do. Somehow we need to balance the important yet time consuming traditional roles with the new determinants of health approach (where traditional EH is integrated) What are the answers? One answer is risk management Another answer is to stop doing things just because that is what we have always done You could collaborate with others to share the load Diversify the team to include specialists and technical assistants

39 Linking the Bill with Practice The scope of public If you do health not have planning a should include a balance you of environmental will either end health and broader determinants up with: of health. Environmental An health environmental makes health a fundamental contribution to the maintenance plan or and A public health plan that is improvement of public health and improving championed by another quality of life and wellbeing but you need to Unit with little to no input think beyond traditional from EHapproaches to EH and include chronic disease prevention and consider risk factors (e.g. alcohol, fast food, etc).

40 Public Health Plans and the Bill There is no WA model yet PHAIWA and WALGA have developed an options paper with recommendations. PHP Planning Resource The Public Health Plan is a tool to enhance health and wellbeing you have to use it! Remember that you c an have a ha mm er in a shed but the verandah boards will remain broken until you grab that hammer and use it.

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42 Align with state and national priorities

43 When to start? No WA State PHP yet 2 year transition period after the Bill is enacted What are the risks of waiting? What are the benefits of acting sooner rather than later?

44 Your thoughts Grab a partner & take 10 minutes to consider: When would your organisation consider developing a PHP? Do you wait for State Plan or go ahead when the Bill is passed? Why? Pros and cons? Any barriers to overcome with starting the process of developing a PHP? Which internal partners do you involve?

45 Barriers to overcome New skills needed - strategic planning, partnership management, community consultation & community development identified as important in future arrangements for effective practice Necessity for LGs to focus on the statutory enforcement duties, and on complying with performance management and best value regimes Insufficient evaluation of EH programs Insufficient research for EH (where do you go?) Uncertainty around how to identify risks Lack of external funding agencies

46 What is a Public Health Plan? From the horses mouth. Identifies and assesses the actual and potential public health dangers and issues affecting a community. A plan to prevent or minimise PH risks in order to enable people living, working or studying in the LG to achieve maximum health and wellbeing. Prevents disease, prolongs life and promotes public health and wellbeing. Creates a vision for the people and other stakeholders to work together to enhance community wellbeing and quality of life.

47 Others The Plan aims to set the framework for: Enhancing integrated and collaborative planning for improved health Implementingeffectiveplanningmechanisms, which identifies and responds to local public health needs Identifyinghowservicescanbebetteraccessed by the community for their health needs Engaging the community in decision-making on health needs and services

48 Frameworks used by others Plan alignment This document identifies a number of strategic actions that XX LG is committed to throughout the duration of the Plan. It is understood that activities to improve community health and wellbeing are more effective if they are aligned with other plans and policies. For this reason the Municipal Public Health Plan is linked very closely to the Council Plan and other key documents.

49 PHPs should aim to get the following outcomes Health protection services such as food safety, immunisation, infectious disease notification, water quality and environmental health. Health development issues that can be advanced by local government (within state-wide frameworks) such as prevention of injuries, cancer, cardiovascular diseases, drug and alcohol use, tobacco control and nutrition. Population health strategies that address the preventive needs of population groups considered being at risk. This includes strategies to address child and family health, aged care, youth health, and the health of vulnerable groups. Public health emergency requirements. Community capacity building and community wellbeing issues should be grounded, individualised, reflect local needs and partners and align with State Plan.

50 Stand Alone Plan with a focus on facilitation This stand alone PHP: Advocates to effect policy at other levels of government; Develops strategic partnerships to address high priority issues; and Focuses the City s activities on the areas which will have the greatest impact. This approach addresses underlying issues rather than their symptoms. The Plan does not commit any additional resources on the part of the City, but positions the City well to argue for, and pursue, additional funding from State and Federal Government and other relevant funding bodies.

51 Integrated Plan Our public health and wellbeing strategies and activities are documented in the Council Plan for the first time, demonstrating Council's commitment to addressing health and wellbeing issues. This Plan replaces the previous Municipal Public Health Plan. Fits well with the WA Integrated Planning framework and PH Bill

52 What is a Public Health Plan A WA response On the ground results Public Health Plans need to include the basics including housing standards, rubbish disposal, water, power, effluent disposal, animal control, disease vector control, dog health programs and I would like to see basic public health education included. A good start but we need to extend the focus

53 Key principles to success Clear and unambiguous commitment and leadership from highest level Clear understanding of what health is Collaboration within the LG Emphasis on outcomes + process Community engagement in decision making Alignment with local and state policies Indicators (pre and post) evaluation Skills and resources

54 Let s look at what has worked Key lessons from Victoria 10 years of experience and have made many mistakes along the way! Great for WA but we have to make sure we take advantage of their reflective learning and use their key lessons to guide our processes, taking into account our local and state issues and communities.

55 A Quick History 1988 Health Act required LGs to develop a MPHP Vic Govt funded 6 pilots Ambitious & insufficiently funded Legislative mandate forced adoption Prescriptive model with little personality or innovation Did not reflect community needs No capacity to develop plans fostered Onerous task by resource poor Officers Isolated or silo plans

56 MPHPs in Victoria 2000: LGPT established to develop a statewide framework and support LGs Developed Environments for He alth Ran workshops Funded 40/79 LGs

57 Key components of Environments for He alth Social model of health Health-promoting systems Focusing on health outcomes Participation and partnership Strategic local area planning

58 Why focus on the East? WA is in a unique situation We have contemporary legislation that will enable us to integrate the PHP into the Corporate Plan We have many lessons learned from over East (which have had MPHP legislation for over 10 years) about what not to do!

59 Recent Amendments.another change to practice In 2009, PH & Wellbeing Act 4 year MPHP, develop within 12 months of Council elections, integrate with Corporate Plan Must include: Data on health status & health determinants Goals and strategies based on evidence Involve people in development, implementation & evaluation Specify how the LG will work in partnership with Vic Govt and other agencies How meet State PH Plan objectives Vic developed community indicators - evaluation

60 Two examples from Victoria Stand alone PHP: City of Ballarat Determinants of health Urban design, land use, management of natural resources, employment, social connectedness, transport, community participation & access to services What do you think of these issues? Where would you fit in this Plan?

61 Ballarat - Methods Identified community aspirations and needs Interviews, meetings, workshops Community and key stakeholders Presented local evidence in 5 domains Developed fact sheets for public 1. Healthy, safe & inclusive communities 2. Sustainable built & natural environments 3. Dynamic, resilient and local economies 4. Culturally rich & vibrant communities 5. Democratic & engaged communities

62 Methods & Barriers Demographic profile, evidence on local health & wellbeing issues Community identified priorities based on evidence presented Barriers: LG busy, complex, competing priorities Convince LG Officers that health was fundamental Narrow def n of health and needed to sell determinants Language of public health was not appropriate Elected Members have own agendas

63 Why not integrated? Thought some principles would be watered down Planning cycles did not align Corporate Plan has a focus on short term projects & infrastructure rather than strategic public health outcomes

64 Costs 1 FTE to develop plan + resources Health and Wellbeing Co-ordinator supporting staff member estimated at 30% over 12 months Other Council Officer time Since 2007 estimated to have cost $

65 City of Melbourne - Integrated City of Melbourne s Municipal Public Health and Wellbeing Plan is fully integrated within the four-year Council Plan. 38 public health and wellbeing objectives within the Council Plan. The Plan reflects national, state and regional health priorities. The health objectives are underpinned by the principles of public health planning, including the Ottawa Charter and the Environments for Health Planning framework. This integrated Plan replaces the previous Municipal Public Health Plan City Health

66 Why Integrated? Increased profile for H&WB Increased internal awareness of H&WB Secured placement of issues on Council agenda Increased accountability and integration across Council Clear alignment with the Future Melbourne Plan

67 Consultation Comprehensive planning process that included: Extensive analysis of senior executive Council functions; Involvement of a small team of Altitude participants (a CoM leadership development program) in setting up the Council Plan framework; Councillor planning workshops to set objectives and priorities; A detailed organisation wide assessment of what needs to be done over the next four years, and A website and online discussion boards to enable staff participation.

68 Integration When integrating public health and wellbeing objectives into the Council Plan, the following was used as a guide: Examined data about health status and health determinants in the municipality; Developed evidence based goals and strategies to create a local community in which people can achieve maximum health; Involved people in the local community in the development, implementation and evaluation of the public health strategies, and Partnered with the Department of Human Services and other agencies undertaking public health initiatives, projects and programs to achieve the goals identified in the plan.

69 Monitoring Online monitoring system for the Council Plan. Allows each Branch to view achievements under each objective, enabling gaps and successes to be clearly articulated. Outputs are recorded quarterly + the system uses one language avoiding public health or management jargon. It is the only reporting system within the Council, reducing the reporting burden considerably. This online monitoring system is directly aligned with manager s annual performance reviews.

70 Additional requirements Able to articulate what health is and how it is a basic and fundamental right Many Council activities impact on health Additional training for Planners Champion on Snr Exec Commitment from all in Health to not only deal with EH but wider determinants of health Whole of council reporting process for health

71 Challenges No State Plan little guidance or direction for Council to ensure it was meeting State priorities Health Act did not specify what a review should involve no evaluation framework LG Act has no guidance on what should be in a Corporate Plan, nor any requirement to review Run with traditional and hierarchical planning processes Rapidly acquire knowledge of how Corporate Plans are developed

72 In WA Head of power is an issue Local Government Act: has some flexibility to address H&WB Expansion of general competence powers to enable LG to respond to local needs Public Health Bill Proactive planning process States a local PHP may be prepared in conjunction with a plan for the future of the LG District under the Local Government Act 1995 Section 5.56

73 In conclusion Many different ways and methods to develop a PHP Legislative mandate coming soon Prescriptive processes shown not to work Many actions occurring: WALGA and WA Health recommending some PHP frameworks WALGA, PHAIWA and DoH skills mapping WALGA, PHAIWA & Stoneham funding submission to build capacity Integrated approach is favoured but we may need to trial some stand alone plans before LGs are ready to attempt to successfully combine

74 Suggested Action Need to advocate for supportive structures when the Bill is passed: Resources Skills and training Advice and input from others Support from Executive and Elected Members Framework/Guidance document (nonprescriptive) State PH Plan developed in timely manner Evaluation processes

75 Your role EHPs are critical to the success of PHP Traditional first contact point in LG Take advantage of that but ensure the Plan is more than an EH Plan Broad skills base with the ability to access and communicate with the community & stakeholders Important to learn more (determinants of health, etc) Know your constraints & the legislative environment Be innovative

76 For more information contact Stoneham and Associates PHAIWA