1. Mobilizing communities to promote active and healthy lifestyles
Glenn Laverack

2. Can public parks make you healthier?
A new report from the USA shows that active living communities investing in bike paths, parks and outdoor exercise facilities have healthier residents.
Significantly lower rates of smoking, obesity, diabetes, high blood pressure, high cholesterol and depression.
Significantly higher rates of exercise and healthy eating (Gallup- Healthways, 2015)

4. Top-down health profiles
Obesity (Exercise & Diet)
Cancers (Skin)
Violence & Injury (Domestic violence and abuse)
Dangerous Consumptions (Gambling, Alcohol, Drugs, smoking)
National Security
(Wanless, 2003)

5. Bottom-up health profiles
Low pay;
Poor housing, empty and derelict properties;
Increasing alcohol abuse by children;
Dirty and unsafe environment including high crime levels and drug related incidents;
Poor access to health and social services.
(Kashefi and Mort, 2004)

6. The Saskatoon ‘In Motion’ Programme.
A 3-5 year plan to increase physical activity in Saskatchewan, Canada.
Used public awareness and motivational strategies for individual behaviour change.
57% people surveyed said that they had seen, heard or read about the ‘in motion’ programme.
18% surveyed said that the ‘in motion’ messages had led to them to think about physical activity.
30% said they had become more active but 49% had no change in physical activity (SRHA, 2005).
No or very low influence on low socio- economic, adolescents, indigenous people and ethnic minority groups

7. Top down or bottom up? It can be both Key new feature of the Bill
It contains a set of objectives and principles which will guide public health workers using this Act. It will help shape the way they administer the Act and make decisions about public health. It makes it very clear to the public what this Act is for and how it is meant to be used
It actually defines public health and the range of activities which public health undertakes in order to protect and advance health in South Australia
It continues the long standing partnership between State and Local Government which is a feature of the current and all previous public Health Acts in South Australia and many other jurisdictions around the world. State and local government are both partners in public health and the new Bill clarifies the roles and relationships of these two levels of government.
A new Statutory position of CPHO is created with significant powers.
The new Bill introduces the concept of public health planning. The current Act only requires local councils to report on activities but says nothing about the need to plan for better public health. Many local councils are already undertaking public health planning and this will be strengthened by the provisions in this Bill.
Bill introduces a general duty for public health. This is similar to other modern legislation in the areas of environmental law and occupational health for example. That is it recognises public health as a major social responsibility shared by everyone in the community and makes it clear that we all have a responsibility for public health.
The Bill has a much clearer system of identifying and assessing risks to public health which will aid in the capacity of authorised officers to determine offences when the need arises.
The Bill has a new section on non-communicable diseases which give the Minister the power to issue guidelines and statements designed to prevent the circumstances which can give rise to the spread of chronic health conditions.
The Bill continues a focus on infectious disease as in the current Act but strengthens the powers to more effectively manage these conditions and to get in and respond earlier to halt their spread.
The Bill contains all the Emergency Provisions which were recently put into the current PEH Act as a result of concerns of pandemic influenza.
The Bill also requires notification of specified micro-organisms so that the department can track human pathogens in the environment or food.
It can be both

8. The Safer Parks Scheme New Zealand
Started by the City Council following complaints about crime, drug use, litter and graffiti in public parks.
A dirty park environment led to low public patronage.
The City Council employed park wardens and honorary rangers to patrol the park areas.

9. The Safer Parks Scheme New Zealand
In collaboration with the Department of Conservation the City Council encouraged public participation through its ‘adopt a park’ initiative.
Volunteers helped to raise money and to report any problems that they encountered to the park rangers.
Cleaned the parks, installed lighting and exercise equipment.
As a result park patronage and exercise levels greatly increased-leading to a healthy community.

10. Accommodating the bottom-up
Parallel-tracking is a ‘best practice’ planning tool.
Easy to use and provides a visual approach.
Allows community-centred needs to be integrated within projects.
Equally emphases government and community profiles.

11. Project planning Programme design (appraisal & approval).
Objective setting.
Strategic approach (services, resources and information).
Management.
Evaluation.

12. Parallel-Tracking This is not an either or situation.
Bottom-up profile
Top-down Profile
1. Programme design phase: Identification of issues, appraisal and approval stage.
Chronic Disease Prevention Track
Obesity (Exercise - Diet)
Capacity Building Track
Engaging and Enabling people to take control of their lives and health
This is not an either or situation.
Top-down programming will continue to be the most dominant style of programming in HP. HPs need to think creatively about how they can accommodate build bottom-up approaches within top-down programming.
What works?
The ‘like minds, like mine’ national project to counter stigma and discrimination associated with mental illness in NZ. Uses a combination of top-down mass media and community education, building community leadership and participation, developing infrastructure and culturally specific approaches. 3 year project. (MoH, 2003)

13. Parallel-Tracking This is not an either or situation.
Bottom-up
Profile
Top-down Profile
1. Programme design phase: Identification of issues, appraisal and approval stage.
Chronic Disease Prevention Track
Obesity (Exercise - Diet)
Capacity Building Track
Engaging and Enabling people to take control of their lives and health
2. Programme Objectives.
Improvements in the morbidity and mortality of the population.
Capacity Building Objectives.
Increasing skills, knowledge and competencies for greater control over decision-making/ access to resources.
This is not an either or situation.
Top-down programming will continue to be the most dominant style of programming in HP. HPs need to think creatively about how they can accommodate build bottom-up approaches within top-down programming.
What works?
The ‘like minds, like mine’ national project to counter stigma and discrimination associated with mental illness in NZ. Uses a combination of top-down mass media and community education, building community leadership and participation, developing infrastructure and culturally specific approaches. 3 year project. (MoH, 2003)

14. Parallel-Tracking This is not an either or situation.
Bottom-up
Profile
Top-down Profile
1. Programme design phase: Identification of issues, appraisal and approval stage.
Chronic Disease Prevention Track
Obesity (Exercise - Diet)
Capacity Building Track
Engaging and Enabling people to take control of their lives and health
2. Programme Objectives.
Improvements in the morbidity and mortality of the population.
Capacity Building Objectives.
Increasing skills, knowledge and competencies for greater control over decision-making/access to resources.
This is not an either or situation.
Top-down programming will continue to be the most dominant style of programming in HP. HPs need to think creatively about how they can accommodate build bottom-up approaches within top-down programming.
What works?
The ‘like minds, like mine’ national project to counter stigma and discrimination associated with mental illness in NZ. Uses a combination of top-down mass media and community education, building community leadership and participation, developing infrastructure and culturally specific approaches. 3 year project. (MoH, 2003)
3. Strategic Approach.
Top-down approaches employing social marketing, health education, motivational and behaviour change interventions.
Strategic Approach.
Addressing local issues and capacity building techniques (skills training, mentoring, local champions).

15. Community Health Champions
15,000 local champions recruited to support the project
Roles vary in intensity from talking to people as part of their daily lives through to organising community activities.
Helped to recruit other volunteers (Altogether better, 2011).

16. Parallel-Tracking This is not an either or situation.
Bottom-up
Profile
Top-down Profile
Programme design phase: Identification of issues, appraisal and approval stage.
Chronic Disease Prevention Track
Obesity (Exercise - Diet)
Capacity Building Track
Engaging and Enabling people to take control of their lives and health
2. Programme Objectives.
Improvements in the morbidity and mortality of the population.
Capacity Building Objectives.
Increasing skills, knowledge and competencies for greater control over decision-making/access to resources.
This is not an either or situation.
Top-down programming will continue to be the most dominant style of programming in HP. HPs need to think creatively about how they can accommodate build bottom-up approaches within top-down programming.
What works?
The ‘like minds, like mine’ national project to counter stigma and discrimination associated with mental illness in NZ. Uses a combination of top-down mass media and community education, building community leadership and participation, developing infrastructure and culturally specific approaches. 3 year project. (MoH, 2003)
3. Strategic Approach.
Top-down approaches employing social marketing, health education , motivational and behaviour change interventions.
Strategic Approach.
Addressing local issues and capacity building techniques (skills training, mentoring, local champions).
Management
Community is involved in the management of the programme in a systematic way that also builds capacity.
4. Management.
Pre-packaged , implemented and controlled by an outside agent.

17. Parallel-Tracking This is not an either or situation.
Bottom-up
Profile
Top-down Profile
Programme design phase: Identification of issues, appraisal and approval stage.
Chronic Disease Prevention Track
Obesity (Exercise - Diet)
Capacity Building Track
Engaging and Enabling people to take control of their lives and health
2. Programme Objectives.
Improvements in the morbidity and mortality of the population.
Capacity Building Objectives.
Increasing skills, knowledge and competencies for greater control over decision-making/access to resources.
This is not an either or situation.
Top-down programming will continue to be the most dominant style of programming in HP. HPs need to think creatively about how they can accommodate build bottom-up approaches within top-down programming.
What works?
The ‘like minds, like mine’ national project to counter stigma and discrimination associated with mental illness in NZ. Uses a combination of top-down mass media and community education, building community leadership and participation, developing infrastructure and culturally specific approaches. 3 year project. (MoH, 2003)
3. Strategic Approach.
Top-down approaches employing social marketing, health education and motivational and behaviour change interventions.
Strategic Approach.
Addressing local issues and capacity building techniques (skills training, mentoring, local champions).
Management
Community is involved in the management of the programme in a systematic way that also builds capacity.
4. Management.
Pre-packaged , implemented and controlled by an outside agent.
5. Evaluation
Epidemiological and quantitative data to measure the success of the objectives.
Evaluation
Evaluation uses participatory, qualitative techniques that are also empowering.

18. Key lessons learnt: Mobilizing communities for active and healthy lifestyles
Engage with communities to share priorities.
Create a common point of entry.
Build on successful local initiatives.
Have flexible funding criteria.
Identify local health champions.
Build community capacity.
Measure the process as well as the outcomes.
What works- Recent research in the UK:
Exceptional people (local leaders) with a shared commitment to public involvement were necessary to motivate others and develop partnerships.
Bridging state and civil society
2. Local people were drawn into the process and with increased confidence (and capacity) became powerful advocates for their community.
Creative methods are necessary to involve people and a proper balance between professional inputs and lay people is necessary.
Important because conflict is common often over lack of clarity of who has decision making influence (control). (see- Anderson, E. et al (2006).

19. Grazie mille