Addressing health inequalities:Lessons from an advocacy

agenda

Grace Blau

Mark Boyd

Presentation Outline

• ‘Determinants of health’ approach

• Health inequalities in Victoria

• Building a collaborative network

• Victorian Health Inequalities Network

• Lessons

• Policy transfer: making it happen

‘Determinants of health’ approach

• ‘Health’ is a social phenomenon

• Health inequalities are determined by social and political mechanisms that create and maintain social hierarchies– Structural factors– Intermediate factors

• Therefore health inequalities are unfair & avoidable

Health Inequalities in Victoria

• Highest mortality rates amongst lowest income earners

• Life expectancy 17 years lower in Indigenous population

• Age of death in rural areas 6 years younger than in metropolitan areas

• Lower socio-economic groups – Much less diagnostic testing for breast cancer– 3 times less likely to use sun protection– 21% (M) to 63% (F) more likely to be obese – 2-3 times more likely to smoke

Building a Collaborative Network - Opportunities -

• Passionate champions in various sectors• Good will between champions• Mounting evidence about prevalence and

effective interventions• Current Victorian Government policy context is

focused on reducing inequalities• Some funds available to address this issue• WHO Commission on the Social Determinants of

Health has developed a framework for action• National strategies being developed by other

countries

Building a Collaborative Network - Challenges -

• Data collection uncoordinated and fragmented• Relatively small, short term funding• Long term effectiveness of interventions unknown• Victorian Government policies are already addressing

‘inequalities’- possible reluctance to do more• Possible change of state government• Champions may get ‘burnt out’ because of lack of action• Policies associated with ‘determinants of health’ are

developed in many different Government ‘silos’• Lack of common language and understanding across

sectors

Victorian Health Inequalities Network

• Purpose

• Strategies– Core partners– Close liaison with champions in State

Government – Events

• Four Roundtables• State Forum

– Website

Lessons

• Value in Roundtables– Background reading very useful to introduce

the issue• Begin to think differently

– Opportunity for discussion across sectors – Acknowledge complexity of the issue– Share diverse perspectives– Develop common understanding– Form valuable new networks

Lessons

• Value in Network– Provide leadership– Advocate for policy changes– Facilitate new collaborations – Liaise between sectors– Think tank– Clearinghouse for information– Set direction for meaningful community

participation

Lessons

• Policy-makers’ frustrations – Expectations

• Agreed assumptions• Less discussion of known facts• A way forward and solutions

– BUT some also acknowledged the value in creating and sharing a new, expanded language

• Unanticipated outcomes– Offer of collaboration to organise a community forum

about ‘health inequalities’

How do we get policy change?

“Evidence and knowledge not enough for practical uptake”

Health promotion and public health initiatives fall into a zone of complexity that leads to uncertainty about what works and so to a lack of agreement among policy makers and practitioners

- Fran Baum, AHPA Conference 2007

Characteristics of successful policy

• Consensus with community• Building confidence with senior decision-makers

(Parliamentary members, local government councillors, etc) that change is possible

• Improve on current actions• Create and drive a learning culture• Pragmatic: building blocks that will make a difference in

5 years• Balance between government action, personal

responsibility and market mechanisms

- Ben Rimmer, VHIN presentation 2007

Consensus with community

Examples:

• Joseph Rowntree Foundation: Public attitudes to economic inequality

• CIV data; DVC data

• Community Attitudes Surveys: Violence against women and culturally-based discrimination

Building confidence

Examples from Darebin alcohol strategy:

• From ‘no’ to ‘we might win this’ to successful test case

• Council briefings with Police invited

• Document that across Council already involved

• Councillor chairs Alcohol and Drug Committee

Improve on current actions

Missed opportunity (IMHO): Childcare policy in Victoria

Avoiding paralysis:Amenable mortality

Strengthen interpersonal connections

Create and drive a learning culture

Framework for knowledge management (Armstrong, Waters, Crockett & Keleher)

Knowledge brokers (Lomas)

www.vichealth.vic.gov.au/inequalities

www.vhin.org.au

Pragmatic: 5 year building blocksVehicular ideas, eg. REPP’s OSHLSP

Curriculum changes:“We only ever learn about Aboriginal people in relation to how white people took their land from them, never about their culture as independent of white people. We should learn about it as a subject. The fact that Australia’s first people were black is important.” (young woman of Sudanese background)

Culture of urgency from HIV/AIDS not useful in current policy context

Govt – Individual - Market

Human capital policy arguments

Costs of not acting

Sharing stories of personal responsibility already?

VHIN: membership fee? Charging for policy briefs? (Not possible)

Questions/Comments

Thank you