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Integrated planning for health and wellbeingHow a Health in All Policies approach can assist
Miriam HunterHealth in All Policies UnitPublic HealthSA Health
NWMR Integrated Planning Conference30-31 October 2012Melbourne, Victoria
Health in All Policies- What’s it about?
Why?
•
In 2012-13, $4.927 billion will be spent on health services and functions in South Australia
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A 5.6% increase compared with 2011-12
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A 129% increase ($2.8 billion more) than 2001-02
Department of Treasury and Finance SA - 2012
Why?State Budget vs Health spending
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State Budget vs Health spending
0100002000030000400005000060000700008000090000
100000
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2018
2020
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on D
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State Budget vs Health spending
0100002000030000400005000060000700008000090000
100000
2006
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2010
2012
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Billi
on D
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Health SA$ million
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SA Health spending has grown by an average of 8.3% per year over the period 2004-05 – 2010-11
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If SA Health spending continues on its current growth path then by 2035 the entire state budget will be consumed by health
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As early as 2015 all new revenue would need to be spent on health
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From 2016 all non-health areas will have to cut their budgets to feed the growth in health
The causes of the causes Foresight - Tackling Obesities:Future ChoicesDepartment of Innovation Universities and Skills, UK 2007
Why?…
Health’s traditional approach…Why? …
But we work together all the time!Intersectorial action – the traditional approach…
Health in all Policies ‘drops the rope’
HiAP - a different approach
When health needs a tree...
HiAP sees the tree from a partner’s perspective and then works together to create their tree for their benefit
The HiAP FoundationsThinker in Residence, Professor Ilona Kickbusch
South Australia’s Strategic Plan
A receptive and proactive Cabinet Office
A willing and supportive Chief Executive
•
HiAP is applied to South Australia’s Strategic Plan (SASP) and 7 Cabinet Strategic Priorities (CSP)
•
HiAP provides the framework to:–
explore some of the interconnections between the SASP targets/CSP
–
to identify joint areas of work to achieve a ‘win-win’
solution–
progress agencies’
SASP targets/CSP and support the health and wellbeing of the population
Government Priorities
South Australian HiAP model
Decision making
Impl
emen
tatio
n
Agenda Setting
Policy Formation
Monitoring &
Evaluation
Cabinet
Media
Community
Elections
Budget cuts
AFL
HiAP in the Public Policy Cycle
The science and the political art of HiAP
Is it working?
Health Lens Analysis ‘Projects’•Water Sustainability •Regional Migrant Settlement •Healthy Weight (desktop analysis) •Access to and use of Digital Technology•Transit-oriented Developments (TODs) •Marion City Council Castle Plaza Redevelopment•Overseas Students Health and Welfare•Active Transport : Economic contribution of cycling•Improving Parental Engagement in Children’s Literacy •Aboriginal Road Safety •Sustainable Regional Development: Mining •Earning and Learning•Active Ageing through workforce participation•Cycling Strategy for SA •Eat Well Be Active Implementation
Healthy Weight Desktop Analysis and Eat Well Be Active Strategy
Key drivers•Healthy weight SASP target identified as a priority for HiAP•Revision of the Eat Well Be Active Strategy 2006-2010Challenges•First time HiAP applied to a “Health led target”•All government agencies were potential partners
Developing the processThere are no proven national precedents for action to reverse obesity Foresight Report 2007
But why should other sectors be even interested?
•
Support their CORE business?•
Help meet their KPIs / state plan / targets?
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Meet their national agreements / funding guidelines?
•
Contribute directly or indirectly to their other goals?
How does incorporating healthy weight principles …
1. Mapping the pathways
Source: Newman, 2010
2. Identifying policy opportunities
Act Now BC framework -
modified it to the SA context and a focus on policy
Source: Newman et al (forthcoming). Using the South Australian Health in All Policies approach to achieve high level cross government policy commitment to act on the social determinants of obesity.
Housing SA example…Housing SA
policy driversHW policy potential Audience Housing SA
benefitsLong term
HW benefits•
Sustainable housing
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Social inclusion
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Landscaping design (e.g. gardens beds, water tanks)
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Gardening programs
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Public rental tenants
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Visitors•
Family and Friends
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Housing designers
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Wider community
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↑
social cohesion leading to ↓vandalism
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Healthier, more active tenants
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Leader in housing design
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↑opportunitie
s to consume healthy food
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↑physical activity
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↑psych. and physical wellbeing
Source: Newman et al (forthcoming). Using the South Australian Health in All Policies approach to achieve high level cross government policy commitment to act on the social determinants of obesity.
3. Negotiate policy commitments•Mapped policy opportunities for 44 departments/divisions, 12 of which were prioritised for negotiation•Desktop analysis document used as a “discussion starter”•Feedback from departments/divisions used to refine recommendations•Recommendations negotiated with senior executive from 10 departments and divisions & endorsed by Chief Executives
Project outcomes & evaluation•Policy commitments incorporated into the Eat Well Be Active Strategy 2011-2016
•
Disability, Ageing and Carers•
Housing SA•
Community Connect (community program funding)•
Planning, Transport and Infrastructure•
Primary Industries and Regions•
Environment and Natural Resources•
Further Education, Employment, Science & Technology•
Correctional Services
HiAP’s role EWBA implementation
Support project partners by facilitating the integration of EWBA commitments into existing and new state- wide programs and initiatives
Provide support to project partners to realise the strategic opportunities and interdependencies
Challenges for HiAP 5 years onEvaluationFacilitate mechanisms in the HiAP approach to evaluate the collective impact of policy change and recommendations at a whole of government level Building capacityBuilding the capacity of the approach outside of (and perhaps more crucially) within healthTranslatingTranslating and adapting the principles of HiAP into different policy and planning environments – (integrity of approach)Tall Poppy SyndromeMaintaining the passion, interest and a “quiet rage” at the International, National and local level
Translating the HiAP approachRegional health and wellbeing integrated planning
Elements for success in SA•Central governance•Investment •Commitment •Accountability •Application to public policy in the internal government process with a Health Lens Analysis methodology•A dedicated (*small) strategic HiAP team (*within SA Health)•Systemic engagement
“It is a mistake to think you can solve any major problems just with potatoes”
Douglas Adams
http://www.sahealth.sa.gov.au/healthinallpolicies
AcknowledgementsDr Kevin BuckettDanny BroderickLareen
Newman FUSAJulie Patterson
The HiAP TeamCarmel WilliamsDeb WildgooseMiriam HunterIsobel LudfordClaudia GalickiDr Zoe Gill
