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Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Involvement
Learning from Australia
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Snap shot of Australia
Pop: 22.1 million
(plus 1 every1 min 11 secs)
44% born overseas or with
a parent born overseas
About 3 people per square
kilometre
90% live within an hour of
coast (60% in 5 biggest cities)
We’re talking about:
- population growth
- maintaining living
standard
- water
- carbon tax
- closing the gap
Long working hours vs
under employment
12 million cars
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Australian health
Life expectancy is 79 for
men & 84 for women
16.6% smokers &
22% obese
10 million covered by private
health to some extent
Duel health care
provider system
but 10-12 years less for
Indigenous Australians
9 health departments
Health expenditure:
8.7% of GDP
About ⅔ of hospital beds
are public
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Involvement snapshot
80s HIV/AIDS strategy
90s mental health consumer led reform
No. of deliberative processes, but dominated by
WA & planning
Indigenous engagement in research projects
All health departments have a statement/
strategy about consumer involvement
eg Victoria’s Doing it with us not for us
EQUiP standards – ‘governing body is
committed to consumer participation’
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Involvement overview
National - Consumer Health Forum
State groups - eg Health Consumers Qld
District – health councils, eg Health Community
Councils
Population & condition specific
Population & region, eg Health Actions Teams
Great variation in capacity & activity
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Involvement overview
Consumer engagement in Australian health policy
is poorly understood, inconsistently practiced, and
under theorised
Dr Judy Gregory, Australian Institute of Health Policy,
Consumer engagement in health policy: Final report of the
AIPHPS research report (November 2008)
Has it gone off the boil?
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Lessons from Australia
Isolated & sparse populations call for new ways
of working
Working with different cultures raise questions
about how we work with similar cultures
‘Involvement’ can go in & out of fashion (& back
in again)
Communication skills (or lack of) can weaken
the experience
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Sparse & geographically
isolated populations
Online opportunities, eg Your health
You’ll never never know if you never never go
Existing social infrastructure & networks, eg
Country Women’s Association
Peta Ashworth, CSIRO, Energymark
small, community based networks
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Your health site here
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Your health stats here
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Lessons in culture
Who are you?
Time to build relationships
Methods of participation developed by the
dominant culture will very likely not be
appropriate for other cultural groups,
particularly those that are quite different from
Australian culture Queensland Health Action Plan for Consumer and Carer Participation in Queensland Mental Health
Services, 2003, p. 2.
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Surviving ‘off the boil’
Keeping it relevant
Maintaining relationships
Monitoring over the border
Role descriptions as an opening position
Supporting allies & sharing knowledge
Maintaining the values
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
The way we talk & listen
The facilitator
Assumptions
Judgements
Defensiveness
Respect for each others knowledge
Do we need to focus more on communication in
training for all parties?
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
An example – Marshall B Rosenberg’s
Non-violent communication
Observations
Feelings
Needs
Requests
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Judgement leading to
defensiveness
Doctors just have their own pet treatments and
they don’t listen to what we want
or
Patients can’t handle that sort of information. They
just can’t be expected to understand that sort of
technical detail.
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Observation leading to
expressed need
When I talk about treatment options with my
doctor she says some of the options I suggest
are not suitable. I need to feel that my ideas are
being considered so I would like her to explain
why she has ruled them out so I can
understand
or
I have tried to communicate that information to
some patients. I felt concerned that it confused
them. I need to be sure the information I give
patients is not adding to their worries.
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
So ...
At the heart of involvement are relationships
Participation is a two way process – we must go
out to communities and do things their way not
just expect them to come to us and do things
our way
Starting from the bottom up (with commitment
from the top) may support broader & more
sustainable involvement
Don’t assume the communication skills
Finally, involvement changes the tone of policy
& a genuine desire to involve changes the tone
of involvement
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
Useful websites
Health Issues Centre
www.healthissuescentre.org.au/participate
Consumer Health Forum of Australia
www.chf.org.au
Doing it with us not to us
www.health.vic.gov.au/consumer/
Health consumers Queensland resource kit
www.health.qld.gov.au/hcq/network_reps/
consumer_kit.asp
Participation and Health: 2020 Vision, 16 & 17 February 2010 – Involvement: Learning from Australia (Ann Single) © Ann Single 2010
More useful website
Energymark
www.csiro.au/science/Energymark-Trial.html
Queensland Transcultural Mental Health Centre
www.health.qld.gov.au/qtmhc/comsumer.asp