‘Health in All Policies’ Sustaining South Australia’s approach to address determinants of health.… NHP endorsement meeting February 2018 Sudan Carmel Williams Manager Health Determinants and Policy Unit Prevention and Population Health Department for Health & Ageing

South Australia – where are we? Adelaide: 1,826.9 km2 South Australia: 983,482 km² With a total land area of 983,482 square kilometres (379,725 sq mi), it is the fourth largest of Australia's states and territories. In terms of size, South Australia is almost the same size as Egypt, and five times the size of the UK. Adelaide is the capital city, and there are a number of regional centres, as shown in this map, the largest of which is Mount Gambier in the south east. Adelaide covers an area of 1,826.9 km2 (705.4 sq mi) (Sources: ABS, December 2013; UNData 2013)

South Australia – who are we? Total population: 1.68 million Majority live in the Greater Adelaide area, about 1.2 million Population density 659/km2 30,400 Aboriginal people (Australia’s First Peoples) 353,000 born overseas Median age = 39.2 years Putting that in context… Population of Beijing is 21.15 million (almost 18 times that of Adelaide, and about the same as all of Australia!) Population density 1,300/km2 Median age = 36.7 years Australia's population, like that of most developed countries, is ageing as a result of sustained low fertility and increasing life expectancy. This is resulting in proportionally fewer children (under 15 years of age) in the population. South Australia has a median age of 39.2 years, which makes it the second oldest state in Australia, after Tasmania. More than a quarter (27.5%) of Adelaide's population is aged 55 years or older (Sources: ABS, December 2013; UNData 2011)

South Australia’s approach HEALTH POLICIES When it comes down to the bare bones of it all …. HiAP is basically an approach to working collaboratively on policy issues. It’s a method of addressing complex public policy issues .. And Especially the “wicked”, ones. By seeking to highlight the connections and interactions between positive health outcomes and policies within other sectors, and in so doing, identify the gains for both policy agendas. What we would like to do today is talk about South Australia’s health in policies experience and present a case study around international students health and wellbeing. Health in All Policies (HiAP) is about promoting healthy public policy. It is a way of working across government to encourage all sectors to consider the health impacts of their policies and practices. HiAP is based on understanding that population health is largely influenced by social, economic, environmental, political and cultural determinants. At the same time, HiAP examines the contribution that a healthier population can make to other sectors’ goals. Good population health has positive impacts on productivity, sustainability and the economy—it benefits all sectors and society as a whole. It is about working together to achieve the goals and policies of other sectors in ways that protect or promote health 4

Key Strategies Central government directive and mandate Social determinants of health – as entry point Public policy focus – not health priority Leveraging existing government decision making structures Collaboration and partnership Co design process Evidence 5

Evolution of South Australia’s Health in All Policies approach Five phases Proof of concept Establish and apply Consolidate and growth Adapt and renew Strengthen and systematise Five elements Authorising environment Policy opportunities Supportive structures Champions Adaptive response

Phase 1. Proof of Concept Thinker in Residence Initiative of new Premier Social progressive history Supportive social policy culture Catalyst – Ilona Kickbusch Identify opportunities Access to decision makers Engage with Policy makers Workshops Emerging Policy Champions Space to try

Phase 2. Establish and Apply Executive Cabinet Committee Memorandum of Understanding South Australia’s Strategic Plan Public policy focus Health Lens Analysis model Co-design collaborative approach Health in All Policies Unit Small but dedicated Community of Practice Public policy makers Health professionals

Phase 3. Consolidate and Growth Central Government Champions Strengthening relationships South Australia’s Strategic Plan Public policy focus Health Lens Analysis model Extend approach Share Emerging Practice International meeting Adelaide Statement Research and evidence Five year NHMRC grant

. Government objectives are best achieved when all sectors include health and wellbeing as a key component of policy development Requires new form of governance. Different role for the health sector, one of facilitator and enabler ??

South Australian HiAP Model This is how we actually do HiAP in SA – currently in process of updating for new context – systematising The SA HiAP model aims to deliver systematic change through evidenced-based policy recommendations. Firstly, the governance structures are very important aspect of the HiAP model in South Australia It is at a Cabinet Taskforce level that decides the policy focus and approves proposals as well as endorses final recommendations Horizontal and vertical accountability / governance structures in place at the crunch decision making level And very clear expected outcomes of PUBLIC Policy outcomes AND (of equal importance) outcomes of “joined up government approaches and sustainable partnerships” Note that improved economic, environmental, social or educational public policy outcomes equates improving health outcomes … work on one … get the other seven (and health) for free! A health lens analysis as a methodology and a tool - This model, in action, is not two dimensional or linear … and each stage is continuous, dynamic and may take time … Engage to establish strong collaborative relationships

Phase 4. Adapt and Renew Cabinet Taskforce New Premier Seven Strategic Cabinet Priorities Health Lens across Cabinet priorities New Public Health Act 2011 Strengthen legislative focus on Promotion and prevention Reduced funding prevention Changing role for HiAP Unit Reduced capacity Uncertain future

Phase 5. Strengthen and Systematise Central Directive and Mandate Renewed Memorandum of Understanding Premier’s Priorities Expanding policy agenda Joined-Up Policy Public Health Act 2011 Interagency Agreements:- Public Health Partner Authorities Section 17 Strategic Partnerships Unit Diversify Health Lens Methodology Joined-Up Policy: 90 Day Project

Health in All Policies in a changing context Authorising environment Premiers directive Memorandum of Understanding Policy opportunities State Strategic Plan Cabinet Priorities South Australian Public Health Act Premier’s Priorities Supportive structure Executive Committee of Cabinet Seven Strategic Cabinet Taskforce Champions Many and building

Systemising Health in All Policies Limited and unstable cross cutting government structures Expanding public policy agenda requiring collaborative policy approaches To realise potential of HiAP MOU PHA health needed to strengthen WOG structures. New methods: HiAP 90 Day Projects; Public Health Partner Authorities (PHPAs)

SA Health in All Policies Model 2017

Critical success factors – why HiAP works? Political and strategic relevance – adaptive and responsive to change South Australia’s Strategic Plan Seven Strategic Priorities 10 Economic Priorities South Australian Public Health Act 2011 Central government mandate MOU between DPC and DHA Co design process - co-benefits / mutual gains Flexible tools; working with limited but dedicated resources Focus on People and Relationships Maintaining relevance despite changes in central government policy focus Importance of having a flexible, adaptable and reactive approach

Conclusions Key Challenges Continuing and emerging complex policy issues Constricted economic climate SDH approach to policy Health cannot do it alone Joined-up action required Co-benefits for all agencies Innovation Stop telling, start understanding Systematising HiAP principles, practices and processes Persistence and tenacity