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Irene Verins 9 th November Johannesburg Experiences and lessons in health promotion

Experience and lessons - Irene Verins

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Experience and lessons from VicHealth

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Page 1: Experience and lessons - Irene Verins

Irene Verins 9th November Johannesburg

Experiences and lessons in health promotion

Page 2: Experience and lessons - Irene Verins

Presentation overview

• Brief introduction to Victorian Health Promotion Foundation (VicHealth)

• Consider some of the learnings and challenges in establishing a health promotion foundation

• Provide case studies

Page 3: Experience and lessons - Irene Verins

VICTORIA

Context

• Population of Australia: 23 million

• Population of Victoria: 5.5 million

• Victorian health budget: AUD 13 billion

• VicHealth budget: AUD 36 million

Healthway HPF

VicHealth HPF

Page 5: Experience and lessons - Irene Verins

Origins of VicHealth

• Established 1987 (Tobacco Act 1987)

• Funded by 5% tobacco levy

• Independent statutory authority

• Tri-partisan political support

• Buy-out of tobacco advertising and support to hp research

Page 7: Experience and lessons - Irene Verins

• Loss of hypothecated tax in 1997 = appropriation directly from treasury

• Move out of sponsorship funding in 1999/2000

• Greater emphasis on changing the social determinants that impact on health

• Improved alignment of research investment with priority areas

VicHealth

Page 8: Experience and lessons - Irene Verins

What we do now- setting up the business

Funding of $36.4 million per annum for:

• Social and economic participation for

mental health and wellbeing

• Active communities and healthy eating

• Tobacco and alcohol control

• Program design and evaluation, capacity

building and research are core functions

Page 9: Experience and lessons - Irene Verins

VicHealth’s Mission 2009-2013

To build the capabilities of organisations, communities and individuals in ways that:

• change social, economic and physical environments

so they improve health for all Victorians

• strengthen the understanding and the skills of individuals in ways that support their efforts to achieve and maintain health

Page 10: Experience and lessons - Irene Verins

[Source] www.who.int/social_determinants

“This ends the debate decisively. Health care is an important determinant of health.

Lifestyles are important determinants of health.

But it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place.”

Page 11: Experience and lessons - Irene Verins

VicHealth’s strategic priorities 2009-2013 Priorities for focus

Reduce smoking

Improve nutrition

Reducing harm from alcohol

Increasing physical activity

Increasing social and economic participation

Reducing harm from UV

Key result areas

KRA 1 Health inequalities

1.1 Improve the physical and mental health of those experiencing social, economic or geographic disadvantage.

1.2 Contribute to closing the health gap between Indigenous and non-Indigenous Victorians.

KRA 2 Participation

2.1 Increase participation in physical activity.

2.2 Increase opportunities for social connection.

2.3 Reduce race-based discrimination and promote diversity.

2.4 Prevent violence against women by increasing participation in respectful relationships.

2.5 Build access to economic resources.

KRA 3 Nutrition, tobacco, alcohol and UV

3.1 Create environments that improve health.

3.2 Increase optimal nutrition.

3.3 Reduce tobacco use.

3.4 Reduce harm from alcohol.

3.5 Reduce harmful UV exposure.

Page 12: Experience and lessons - Irene Verins

VicHealth’s strategic priorities 2009-2013

Health promotion actions

• Create and use knowledge acquired through research and evaluation.

• Create environments that foster good health.

• Encourage the development of systems that support and sustain health.

• Communicate about priority health issues.

• Develop communities which are inclusive, accessible, equitable and safe.

• Support organisations to plan, implement and evaluate health promotion activity.

• Facilitate participation and skill development.

• Contribute to and advocate for healthy public policy and regulation.

Settings for action

Workplace, education, justice

Community, local government, corporate

Culture, sports, arts, media, technology

Page 14: Experience and lessons - Irene Verins

• A dedicated tax on a harmful product is used to promote health

• It required an ACT of Parliament = important

• Is more difficult for governments to make changes to a dedicated tax

• Secures a long term investment

1. Tax hypothecation

Page 15: Experience and lessons - Irene Verins

• A balanced government relationship

• Work with government but not as government

• Do not duplicate

• Find and articulate the boundaries: more able to carry risk, more innovative, more responsive

2. Independence... Be the value add to government

Page 16: Experience and lessons - Irene Verins

Foundation must be able to weather change and plan long term strategies by:

• Being less bureaucratic, smaller & cheaper than government

• Align activity & resources across government silos in areas that could deliver health benefits: education, workplaces, sport

• “Yeast in the system”

3. Adaptable, nimble: a lean machine…

Page 17: Experience and lessons - Irene Verins

• Identify emerging trends in public health

• Test new ideas and strategies: Research & evaluation, knowledge dissemination

• Carry the risk

4. Innovative

Page 18: Experience and lessons - Irene Verins

1987: @ 20 people • $25 million

• Disbursed through large funding rounds (breadth)

• Community Health Program had 3 people disbursing through 16 week funding round cycles

• Advocacy through partners and key stakeholders

• CEO partnered with health people predominantly

5. VicHealth’s evolution: from breadth to depth

Page 19: Experience and lessons - Irene Verins

2011:@ 50 people • $36 million

• Disbursed through both development, design and evaluation of interventions (depth) and large funding rounds in physical activity, the arts and research (innovation)

• A knowledge builder and disseminator

• CEO partners with those inside and outside of health, NGO and corporate sectors

• Advocacy through stakeholder/policy coalitions, social media

5. VicHealth’s evolution: from breadth to depth continue…

Page 20: Experience and lessons - Irene Verins

Reducing discrimination & supporting diversity for health

Page 21: Experience and lessons - Irene Verins

What we know

• In Australia, 47% of people from non-English speaking backgrounds and 75% of Indigenous people report having experienced discrimination.

• The majority of Victorians value cultural diversity; however 10% believe that some races are inferior to others and that people from different racial backgrounds should not marry one another.

• Discrimination contributes to health inequality and disadvantage experienced by Indigenous Victorians and some migrant and refugee communities.

Reducing race-based discrimination

Page 22: Experience and lessons - Irene Verins

• Research, building the evidence in what works

• Design approaches to decrease discrimination through settings (local government, education, workplaces, sport, arts)

• Building partnerships

• Communications and social marketing strategies

• Workforce development

• Advocacy to state and national governments

Current action to reduce race-based discrimination

Page 23: Experience and lessons - Irene Verins

Workplace Health program

Arts About Us Discrimination Program

Everyone Wins Sports Program

Social Marketing Campaign See Beyond Race

Advisory Committee of key stakeholders &

content experts

Policy Coalition for Advocacy

Federal Government Department of

Immigration Multicultural Affairs

State Government Health

Philanthropy/ NGO

VicHealth Program staff : 2EFT

VicHealth Board

University led research & evaluation

partnerships

Interventions site LEAD: Local government

program urban

Intervention site LEAD: Local government program rural

Page 24: Experience and lessons - Irene Verins

In recent years we have an improved track record overall:

• 90% of Victorians support society being made up of people from diverse cultures

• Progressive elimination of obvious institutional discrimination

International variation indicates that diversity can and has been effectively managed in Australia

• 1 in 3 people in Europe hold blatantly racist views. However less than 1 in 10 Victorians do

Our work is measured against state and national data sources such as the Victorian Population Health Survey, VicHealth’s own Community Indicators and VicHealth’s Community Attitudes surveys.

Measuring success

Page 29: Experience and lessons - Irene Verins

• The economic evidence for health promotion is under-developed

• Reviews estimate that about 10 per cent of economic studies assess prevention

• Relatively few health promotion interventions have been assessed

• Population approaches are the most difficult to assess

6. Is there support for promotion and prevention?

Page 30: Experience and lessons - Irene Verins

e • Alcohol = estimated $13 billion cost to society each year.

1/3 Victorians still drink at high risk levels at least once a year.

• Obesity = Australia one of ‘fattest’ nations - will overtake

smoking as biggest preventable health threat in next 15 years.

• Violence against women = costs Australian society

$13.6 billion a year. Leading contributor to death and disability in Vic women 15-44.

• Smoking = despite many wins, still represents 10% of the

health burden for Victorian males and 6% for females.

• Mental illness and stress = annual cost due to 6 million

days of lost productivity due to depression is $14.9 billion

Costs of chronic disease

Page 31: Experience and lessons - Irene Verins

If annual per capita alcohol consumption were reduced by one-third (already achieved in Norway) = 98,000 fewer new cases annually of alcohol-caused disease and 21,000 fewer years lost to illness and death.

Cutting physical inactivity by 5 per cent = 1,000 lives nationally, and result in 3,000 fewer cases of illness every year = $129 million in savings, including $48 million in the health sector and $81 million in production and leisure.

Economics of prevention The health and economic benefits of reducing disease risk factors (2009)

Download the full report from www.vichealth.vic.gov.au

Page 32: Experience and lessons - Irene Verins

If tobacco smoking in Australia were reduced to 15 per cent (achieved in California), there could be 5000 lives saved a year and 158,000 fewer new cases annually of tobacco-caused illness.

(note: the Victorian Government has set a target to reduce smoking in adults from 17.3% to 13.8% by 2013)

Economics of prevention continued… The health and economic benefits of reducing disease risk factors (2009)

Download the full report from www.vichealth.vic.gov.au

Page 33: Experience and lessons - Irene Verins

1. Political:

• Tri-partisanship, reps from each Party on Board to achieve broad parliamentary consensus for public health

2. Strategic and Representational:

• Sectoral support from sport, arts, health, education, medical research sectors and the media

• Champions

3. Organisational:

• Chairperson-high profile, CEO-high profile

7. Leadership

Page 34: Experience and lessons - Irene Verins

• Sport x 2

• Health and medical research x 3

• Arts x 1

• Local government x 1

• Media and communications x 2

• Legal x 1

• Politicians x 3

The VicHealth Board

Page 35: Experience and lessons - Irene Verins

• Embraced tobacco buyout early

• Provided great support in expanding the resource base for influencing health behaviours and attitudes

• Provided the community networks throughout which advocacy can be channeled

8. Support from sponsored sectors: Sports & Arts

Page 36: Experience and lessons - Irene Verins

The drivers of health lie outside of the health sector then we must partner with agencies outside of the health sector

9. Ability to harness diverse players, build coalitions

Page 37: Experience and lessons - Irene Verins

• Replacement of tobacco sponsorships

• Centres for Research and Practice

• Development of public health research infrastructure

• Contributed to lower tobacco and alcohol consumption, greater sun protection

• Training thousands of non health sector workers in hp

• Contribution to public health policy and partnerships across sectors

• Mental health promotion strategy and evidence

• Influence on state and federal government policy

VicHealth’s Achievements

Page 38: Experience and lessons - Irene Verins

1. Tax levy is separate money from health budget: a hpf is not a burden

2. Be the value add and the enabler to government : hpf can extend the work of government

3. Build the business case for hpf in South Africa (befriend the health economists)

4. Be the Innovation incubator and carry the risk which government can’t

5. Strong & strategic leadership: champions

6. Cross sectoral partnerships: invest in them now as your advocacy coalition

7.Health promotion/prevention takes a long time

In closing a few thoughts about establishment of a hpf