1. ‘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

2. 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)

3. 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 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. .
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 ??

11. 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

12. 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

13. 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

14. 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

15. 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)

16. SA Health in All Policies Model 2017

17. 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

18. 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