New directions in public health in Victoria: joining the dots Colin Sindall, Director, Prevention and Population Health, Department of Health

Overview of presentation Introduction International perspective National developments Policy context in Victoria Municipal Public Health and Wellbeing Planning Opportunities and challenges

Beginnings of modern public health Sir Edwin Chadwick, social reformer and central actor in the sanitary movement in the 1840s. Secretary to the Poor Law commissioners. During the 1854 Cholera outbreak in London, Dr John Snow plotted the cholera cases on a map of Soho and showed that a high concentration of cholera cases around a water pump on Broad Street.

Tuesday 30 November 2010 White paper hands responsibility for public health to local authorities Health secretary Andrew Lansley … called the white paper a radical plan to tackle the causes of premature death and ill health. Public health was also about the environment, poverty, education and housing, which were key concerns of local authorities. "People's health and wellbeing will be at the heart of everything local councils do. It's nonsense to think that health can be tackled on its own," he said. "Directors of public health will be able to champion local co-operation so that health issues are considered alongside housing, transport, and education”. “Great expectations - public health is coming home”

“Building on local government’s long and proud history of public health leadership, our vision is for local authorities to use their new responsibilities and resources to put health and wellbeing at the heart of everything they do, thereby helping people to lead healthier lives, both mentally and physically… Local authorities are democratically accountable stewards of their local populations’ wellbeing. They understand the crucial importance of “place” in promoting wellbeing. In other words, the environment within which people live, work and play, the housing they live in, the green spaces around them, and their opportunities for work and leisure, are all crucial to their health and wellbeing… Local authorities can fulfil their duties in a wide range of ways, including the way they operate the planning system, policies on leisure, key partnerships with other agencies for example on children’s and young people’s service ...promoting community renewal and engagement, development of social networks… Local political leadership will be critical in ensuring that public health receives the focus it needs”.

National context Health Reform National Partnership Agreement on Preventive Health Australian National Preventive Health Agency Medicare Locals National Health Performance Authority: Healthy Communities reports Healthy Communities Reports will…provide contextual information about each local area, allowing comparisons with Australian averages, and preventive health risk factors and other measures of community health and wellbeing Major Cities Unit reports eg Creating Places For People: an urban design protocol for Australian Cities

POLICY CONTEXT FOR PREVENTION IN VICTORIA

Victorian Public Health and Wellbeing Plan 2011-2015 Goal: To improve the health and wellbeing of all Victorians by engaging communities in prevention and by strengthening systems for health protection, health promotion and preventive healthcare across all sectors and levels of government. The Victorian Public Health and Wellbeing Plan 2011-2015 was released on September 1, 2011. Victoria’s first public health and wellbeing plan – it is both a response to the legislative requirement under the Victorian Public Health & Wellbeing Act 2008 that a plan to identify public health priorities for the state be developed every four years, and an important companion document to the overarching Victorian Health Priorities Framework which articulates the long-term planning and development priorities for Victoria’s health system. The plan aims to build on the current strengths of public health in Victoria, while at the same time providing a solid foundation to meet future challenges The Plan represents a cross-government, cross-sector approach to prevention, and sets the agenda for improving health and wellbeing across the state over the next four years.

UK Faculty of Public Health Three key domains of public health practice The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society. Health Improvement Health Protection Improving services

Policy Priorities The plan identifies opportunities for actions in five policy priorities: strengthen the prevention system – through governance and leadership, information systems, financing and resource allocation, partnerships, and workforce development support priority settings for action an engagement – with a focus on local communities, workplaces, early childhood and education settings, and health services continue to protect the health of Victorians – including communicable disease control, immunisation, environmental health, food safety, and incident and emergency response keep people well – focussing on healthy eating, physical activity, tobacco control, oral health promotion, reducing misuse of alcohol and drugs, sexual health promotion, mental health promotion, injury prevention, and skin cancer prevention strengthen preventive healthcare – including cancer screening, newborn screening, and early detection and intervention services

Strategic directions 2011-2015 Build prevention infrastructure to support evidence-based policy and practice Develop leadership and strengthen partnerships to maximise prevention efforts across sectors Review financing and priority setting mechanisms to ensure available resources are based on population need and potential for impact Develop effective modes of engagement and delivery of evidence-based interventions in key settings Strengthen local government capacity to develop and implement public health and wellbeing plans Improve health service capacity to promote health and wellbeing Integrate statewide policy and planning to strengthen public health and wellbeing interventions Increase the health literacy of all Victorians and support people to better manage their own health Tailor interventions for priority populations to reduce disparities in health outcomes There are nine strategic directions which consolidate all of the opportunities for progress identified within the plan

Monitoring & Review Governance – Prevention and Population Health Advisory Board (includes other portfolios, VicHealth, CCV, Heart Foundation, MAV) Monitoring and reporting on public health and wellbeing & the determinants of health and wellbeing: eg Victorian Population Health Survey; Chief Health Officer’s report; State of Victoria’s Children report; CIV. Evidence translation and brokerage – The Centre for Excellence in Intervention and Prevention Science (CEIPS): links to research and evaluation expertise in Victoria (VicHealth, universities etc), nationally (eg NH&MRC, ANPHA, AIHW), and internationally

Other related initiatives include NPAPH: State initiatives (incl PCM) and Healthy Communities (Commonwealth) Metropolitan Planning Strategy Positive Ageing in Local Communities/Age friendly communities Pedestrian Advisory Council (DoT) Sports Injury Prevention Taskforce Parliamentary Inquiry into Environmental Design and Public Health WorkHealth Various initiatives: VicHealth, Heart Foundation etc

Prevention Community Model: Linking state policy & local community action on health Universal – Whole of State Health Promoting Early Childhood Settings & Schools Policy + Accreditation Model Hospital food & drink guidelines Healthy Eating Advisory Service Environments for HP Workplaces Department of Health as a HP org Prevention Workforce Innovation Strategy (Networks of Practice) Healthy Living Web 2.0 Life! Chronic disease prevention Victorian Prevention Achievement Program Health checks & health coaching Community Digital community engagement Healthy Living Programs Targeted social marketing in local settings Leadership for Health Health Promoting Early Childhood Health Promoting workers & workplaces Health Promoting Schools Health Promoting Local Government Enabling Infrastructure Prevention Partnership Networks of practice Prevention Area Workforce Prevention Funding CEIPS

Lead role of local government at the community level Public Health and Wellbeing Act 2008 The function of a Council under this Act is to seek to protect, improve and promote public health and wellbeing within the municipal district by: (a) creating an environment which supports the health of members of the local community and strengthens the capacity of the community and individuals to achieve better health (b) initiating, supporting and managing public health planning processes at the local government level (c) developing and implementing public health policies and programs within the municipal district… In preparing a municipal public health and wellbeing plan, a Council must have regard to the State Public Health and Wellbeing Plan. Victorian Health Priorities Framework 2012-2022 All local governments will have Municipal 'Healthy Communities‘ Public Health and Wellbeing Plans that are well known to their local communities and that promote healthy living.

VPH&WP: Priority settings for action and engagement: local communities and environments For all communities, the primary strategic planning mechanism for public health and wellbeing efforts is the MPHWP Build on the Environments for Health framework to support next wave of municipal health and wellbeing planning Build on the experience of Positive Ageing in Local Communities Project, and the Improving Liveability for Older People initiative Link to opportunities to improve health and wellbeing in development of a Metropolitan Planning Strategy.

New Planning Guide Meeting the requirement under section 26(3) of the Public Health and Wellbeing Act 2008 that councils developing MPHWPs ‘have regard to the Victorian Public Health and Wellbeing Plan’ Meeting requirements under section 14 of the Climate Change Act (2010) (section 14) which requires decision makers to have regard to climate change Understanding the legislated provisions for the requirements, timing and annual review of MPHWPs, and The essential elements of good practice in planning for healthy communities Importance of an integrated approach

Additional Resources Resource for including public health and wellbeing matters into Council Plans A tool to guide annual reviews of MPHWP was developed by the Southern Metropolitan Region Ongoing resources Access to data Regional office support