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

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

3. 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 )
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.

4. 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

5. 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

6. The Healthy Families NZ Model

7. 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

8. 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

9. 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. 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

11. 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)

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Questions?