Department of Human Services, policy and practice forum: tackling health inequalities Evidence, policy and practice forum: tackling health inequalities Shelley Bowen Principal Policy Manager, Chronic Disease Prevention, Public Health Branch 14 April 2008

This presentation will aim to: Overview of the DHS Directions and reflections on evidence, policy and practice to tackle inequalities Share some ideas we are developing and trying at the CDPU, DHS

Our context (CDPU) for health inequalities evidence, policy and practice

CDPU organisational chart

Our mission and vision Mission: Is to promote health and reduce the burden of chronic disease in the Victorian population through developing and supporting government policy and related processes Vision: Improved health through a reduction in the incidence of preventable chronic diseases in the Victorian population and a narrowing of the gap between disadvantaged and advantaged groups.

Factors that influence policy NOCRAP plus –Necessity –Opportunity –Capacity –Relationships –Actors –Processes (Adapted from Commonwealth, Harris et al 1996)

Evidence and inequalities

What we need research evidence for: What is the evidence of the problem? (Descriptive) What is the evidence of what works? (Intervention) What is the evidence of how it would work? (Implementation) What is the evidence of what it will cost? (Economic)

Is there research evidence? “Most interventions to protect and promote health have not been evaluated for their differential impact on different socioeconomic groups, only for average impact across the population as a whole”. (Whitehead JECH 2007)

Type of information = evidence Societal and political Policy reports Economic data Science – research Opinion and knowledge e.g. “expert” (Bowen and Zwi 2007)

In the absence of research evidence: The logic in formulation of interventions, make best use of: 1) The literature on causes of specific inequalities in health 2) Knowledge about different contexts in which different socioeconomic groups live 3) Intervention program theories (Whitehead JECH 2007)

Keeping up the momentum when there are no “easy wins” Revisit high level principles - typology of action Tackling the implementation and application gap Research agenda Methods development Revisit some good old tools and theories e.g.diffusion New opportunities for leverage – e.g. CDP, Climate

Some of our ideas and directions

Mapping our approach LIFE COURSE PH/HP Priorities Life course 0-3ChildhoodAdolescenceAdulthoodOlder age Smoking Nutrition Physical activity Alcohol Injury Stress Settings for best population reach & effective interventions Schools ? GPs Workplace GPs Hospital Community Family home Childcare Health services Childcare Pre-school Schools Social determinants (Adapted from NPHP, 2003)

Our equity filter for programs  Intervention targeted for potential health improvement at population level, with an increasing rate of improvement with each step down the socio- economic gradient  Some health improvement at population level, with greater rate of improvement for the most disadvantaged groups  Likely health improvement for all groups  Likely health improvement for the most disadvantaged groups only  Greater rate of health improvement likely for advantaged groups, increasing the gap  Unknown impact on health inequalities

Actions: systems for policy to programs Chronic disease prevention plan Match all program investments to baseline indicators Rapid research reviews One-stop evidence portal Policy and practice relevant reporting formats Annual research priority setting process Planning & eval. Tools – equity and evidence

Shelley Bowen Principal Policy Manager Chronic Disease Prevention DHS Ph: