Fiscal considerationsIrene VerinsAddressing the social and economic determinants ofmental and physical healthwww.vichealth.vic.gov.au
Addressing the social and economic determinants ofmental and physical health
1. Scoping policy, research & stakeholders for emerging health issues of concern. 2. Establish the case 9. Sustainability of change research , evidence & (for uptake & integration) attitudes to inform future directions 8. Communication of 3. Develop conceptual, learnings through evidence basedpublications, resources & framework to guide tools activity 7. Identify skills gaps & 4. Partnerships with strengthen capacity through practice, research & workforce development strategic partnerships 5. Intervention design & 6. Evaluation of cross sector activity implementation of cross sector activity
Elements of accountability• $36 million – $27,255,000 was disbursed to 798 grants in 2010-2011 • Sport 36% • Arts 5% • Research 16% • Community 27% • Media 1% • Education 1% • Workplace 7% • Local government 7%Brokerage of external funds: 10-15% overheads versus 30% of universities.
Population groups –55% whole of population approaches –10% low socioeconomic status –10% to Aboriginal projects –8% to Children –7% new arrival groups –5% people with a disability –5% geographic disadvantage
What we won’t fund –Individuals –unincorporated bodies –Capital works and major equipment –Recurrent funding –In receipt of tobaco or alcohol funding or sponsorship –Recalcitrant projects
GovernanceBoard• board structure was found which resembled those of University boards which enshrine representatives from all shades.• Board is level one• Advisory committees for each health area are level 2 dealing with grants
Transparency• All grants are publically advertised (conflict of interest governs board and staff)• All applications for grants are assessed by: – Internal review & assessment – External stakeholder assessments• Board members must register all conflicts of interest at each bi monthly meeting
Other aspects of accountability• Being evidence based and rigorous in a poorly evaluated discipline in which evidence is still evolving• Exposing ourselves to open debate, cynicism and skeptics.• Acting independently from government and other stakeholders but with the interests of stakeholders at the fore…being representative and reflective of our stakeholders.
Building the argument for a hpf• Context specific• People from science, politics and then the allies…(some from sport who said that they would change their sponsorship practices)• Bi partisan approach very important• Moving across well established networks became an important and enduring aspect of VH..• A campaign of well briefed media (supported and expanded the audience for the issues)• Community attitudes surveys and polls (identified % people favored a tax)
Participation for health:a framework for action 2009-2013Key social and economic determinants of mental and physical healthPhysical activity Social connection Freedom from Freedom from Access to economic violence discrimination resourcesActive communities Supportive relationships Social, emotional, physical Valuing diversity Work and economic securityInvolvement in Involvement in community Physical security and Educationcommunity sport and group activities Equitable and respectful respect Housingand active recreation relationships Civic engagement Equality of opportunity MoneyPopulation groups and action areasPopulation groups Action areasChildren Indigenous communities Research, monitoring and evaluation Communications and social marketingYoung people Culturally diverse Organisational development (including AdvocacyWomen and men communities workforce development) Legislative and policy reform Rural communities Strengthening communities andOlder people Direct participation programs community environmentsSettings for actionHousing Community Education Workplace Sport and recreation Health AcademicTransport Corporate Public Arts Local government Justice Technology
Participation for health:a framework for action 2009-2013Intermediate outcomesIndividual Organisational Community SocietalProjects and programs that facilitate: Organisations that: Environments that: A society with:• involvement in community and group • are inclusive, responsive, safe • are inclusive, responsive, safe • integrated, sustained andactivities and supportive and supportive supportive policies and programs• self efficacy • work in partnerships across • value civic engagement • strong legislative platforms for• self determination and control sectors • are cohesive mental health and wellbeing• political and civic efficacy • implement evidence-informed • promote community • appropriate resource allocation approaches to their work responsibility • responsive and inclusive• taking responsibility for others • sustain change • reflect awareness of mental governance structures• respectful, supportive and equalrelationships health and wellbeing issues• acceptance of diversity • sustain change• access to education and employment• mental health literacyLong-term benefitsIndividual Organisational Community Societal• Increased sense of belonging • Resources and activities • Community valuing of diversity • Reduced social and health• Improved physical health integrated across organisations, and actively disowning inequalities sectors and settings discrimination • Improved quality of life and life• Less stress, anxiety and depression • Less violence and crime expectancy• Less substance misuse • Improved productivity• Enhanced skill levels
What influences/determines health? Society Distribution of power and resources Policy (e.g. social, education, Social and cultural beliefs Economic wealthemployment, infrastructure, health, Social structures and institutions environmental sustainability) Social cohesion Community Neighbourhood facilities and Social networks and support infrastructure Group and peer norms Local services and amenities Participation opportunities Living and working conditions Community cohesion and stress Family/Household Employment, Family structure income and wealth and relationships Housing and living Health related conditions behaviours and Individual exposures Behaviour Age Sex Genes www.vichealth.vic.gov.au
Why invest in a HPF?• Effective health promotion has the capacity to• improve health,• reduce the costs of treating chronic disease,• enhance economic productivity,• bridge the health divide between population groups, and• add healthy years to life expectancy.