Healthy Families NZ Grant Pollard Ministry of Health New Zealand November 2014

Outline The journey to date Overview of Healthy Families NZ model Update on where we are at in establishing Healthy Families NZ

Overweight and obesity 31% of NZers are obese and a further 34% are overweight 11% children (12-14 years) are obese Total of 1.2 million obese New Zealanders 2/3 Pacific adults and almost half Maori adults are obese 29% of European /Other adults are obese Adult obesity rate has tripled since 1970s (from 10% in 1977 to 30% in 2011-13) Obesity strongly positively associated with deprivation –even after adjusting for age, sex and ethnicity Dietary risk factors have now overtaken tobacco as the leading cause of heath loss in NZ (11.4% vs 9.1%) Globally obesity high on the agenda. Global Action plan for NCDs and more recently Sir Peter Gluckman has accepted the role as co-chair of the WHO Commission on ending Childhood Obesity. Two of the commissioners are also from New Zealand – Dr Colin Tukuitonga and Helen Clark. At a population level BMI is a reasonable measure of body fatness. BMI is correlated with total body fat, this relationship varies according to age, gender, ethnicity and other factors such as body build. This variation occurs primarily because BMI does not differentiate between lean and fat mass nor does it provide information about the distribution of the body fat.

Timeline November 2013 – Cabinet paper commissioned & approved March 2014 – Registration of Interest to identify lead providers released – Healthy Together Victoria managers delivered workshops on systems approach July 2014 – Short-listed organisations invited to develop detailed response to request for proposal September 2014 – First contract with lead providers signed November 2014 – Last contract with lead providers signed

Aims to improve people’s health where they live, learn, work and play by taking a dynamic systems approach to prevention About encouraging families to live healthy lives – by making good food choices, being physically active, sustaining a healthy weight, being smoke-free and moderating alcohol consumption

The Healthy Families NZ Model

Key elements of each Healthy Families Community Lead provider as ‘backbone organisation’ Dedicated health promotion workforce (x 4 FTE min) that works across the community to create sustainable change Establishment of local Prevention Partnership - bringing together a partnership of key stakeholders Establishment of local governance arrangements Explicit focus on engaging settings to become health promoting environments – including schools, ECEs, workplaces, and other community settings

Whole of system working Traditional health promotion Whole of systems approach Projects Planning Expert leads Technical leadership Knowledge transfer and translation Meetings Training System networks and activation Implementation and improvement Communities lead Adaptive leadership Knowledge co-creation ‘Everyone in the room’ sessions Networks of practice

STATEWIDE REGIONAL LOCAL Prevention planning and delivery sub system SCHOOLS WORKPLACES COMMUNITIES Settings (focus of interventions) sub systems Causative/contributing sub systems Food System Planning System Alcohol System Tobacco System Transport System Networks of communication & influence within and between settings Local government: part of delivery system, a setting for change and a system in own right Media System COMPLEX INTERORGANISATIONAL RELATIONS National

10 Healthy Families NZ communities East Cape Whanganui District Lower Hutt City Spreydon-Heathcote Ward Invercargill City Far North District Waitakere Ward Manukau Ward Manurewa-Papakura Ward Rotorua District

Procurement process to select providers that are: Embedded in their community with an excellent understanding of local needs, strengths, networks and infrastructure Well placed to lead a systems approach to prevention in the community selected Perceived by the community as credible and supported as lead provider by key stakeholders Strong relationships with key stakeholders who could have a role in making Healthy Families NZ successful Demonstrated an ability to work strategically, collaboratively, and to work across sectors and settings Linked into key initiatives underway in the community (for example, Social Sector Trials, Whānau Ora, Children’s Action Plan, and other initiatives related to Better Public Services)

10 Healthy Families lead providers Far North District – Te Runanga o Te Rarawa Waitakere Ward – Sport Waitakere Manukau Ward – (Auckland Council in partnership with Alliance Health Plus and Ngā Manawhenua o Tāmaki Makaurau) Manurewa-Papakura Ward – (Auckland Council in partnership with Alliance Health Plus and Ngā Manawhenua o Tāmaki Makaurau) Rotorua District – Te Arawa Whānau Ora & Kowhai Health Associates East Cape – Horouta Whanaunga (Hauiti Hauora) Whanganui District – Te Oranganui Lower Hutt City – Hutt City Council Spreydon-Heathcote Ward – Pacific Trust Canterbury Invercargill City – Sport Southland 4 Maori Providers 2 Sports Trusts 2 Councils (Auckland Council 1 Pacific Provider

Healthy Families NZ Principles 1. Implementation at Scale Strategies are delivered at a scale that impacts the health and wellbeing of large number of the population in the places where they spend their time – in schools, workplaces and communities

Healthy Families NZ Principles 2. Collaboration for Collective Impact Long term commitment is required by multiple partners, from different sectors, at multiple levels, to generate greater collective impact on the health of all New Zealanders Knowledge is co-created and interventions co-produced, supported by a shared measurement system, mutually reinforcing activities, ongoing communication and a “backbone” support organisation

Healthy Families NZ Principles 3. Adaptation Strengthening the prevention system requires constant reflection, learning and adaption to ensure strategies are timely, relevant and sustainable

Healthy Families NZ Principles 4. Experimentation Small scale experiments provide insight into the most effective interventions to address chronic disease These experiments are underpinned by evidence and experience, monitored and designed to be amplified across the system if they prove effective

Healthy Families NZ Principles 5. Leadership Leadership is supported at all levels of the prevention effort including senior managers, elected officials, and health champions in our schools, businesses, workplaces, sporting clubs and other settings in the community

Healthy Families NZ Principles 6. Equity Health equity is the attainment of the highest level of health for all people. Healthy Families NZ will have an explicit focus on improving Māori health and reducing inequalities for groups at increased risk of chronic diseases Māori participation at all levels of the planning and implementation of Healthy Families NZ community is critical

Where we are at Supporting communities in establishment phase Participation in recruitment process Guidance and support around governance arrangements Developing evaluation and monitoring framework Establishing the Ministry’s Healthy Families NZ team (4 FTE) Establishment of national networks

Where we are at Development of national level support structures Working through licencing arrangements with Victorian Department of Health Finalising agreement with Health Promotion Agency to lead adaptation of Healthy Together Victoria’s Achievement Program for NZ context Orientation process and ongoing workforce development approach to support systems thinking, leadership for prevention, evaluation capacity building

Challenges and opportunities Competitive procurement process and implications for building collaboration Speed of Cabinet paper development, procurement process, and getting contracts in place Challenges around getting baseline measures New Minister – high interest in childhood obesity, also Minister for Sport and Recreation Sir Peter Gluckman as co-chair of the WHO Commission on ending Childhood Obesity – provisional report due December

Questions?