Kevin buckett - SA Health - Social Determinants of Health Conference


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Kevin buckett - SA Health - Social Determinants of Health Conference

  1. 1. Developing a Social Determinants Approach to Policy Kevin Buckett Director Public Health SA Health 1
  2. 2. Outline > > > > Key Challenges SDH Approach to Policy Innovation Future Directions > Using experience in South Australia as a basis for discussion 2 SA Health
  3. 3. Key Challenges • • • • • Ageing of the population Expanding medical technology Community expectations of treatment and care Financial and budget restrictions Workforce  labour shortfalls  escalating prevalence of chronic conditions • Disparities in distribution of health and well-being • Requires innovative approaches 3 SA Health
  4. 4. Budget implications of increased health expenditure Million 4
  5. 5. New public health challenges 5 SA Health
  6. 6. New public health challenges 6 SA Health
  7. 7. 7 SA Health
  8. 8. New public health challenges 8 SA Health
  9. 9. New public health challenges 9 SA Health
  10. 10. Why develop a social determinants of health policy? Environment heavily influenced by place…commercial decisions and regulation Lifestyle heavily influenced by place…commercial decisions and regulation 70% of these determinants can be affected by healthy public policy 10 SA Health
  11. 11. Inter-sectoral action: Why is this so difficult? • Environment and lifestyle factors (SDH) are multi-determinate • Action by a number of government agencies, working together, is required • Such inter-sectoral action (joined-upgovernment) is difficult • Why? 11 SA Health
  12. 12. 1: Whose business is it? • Factor 1 • The agencies who are able to take action on the determinants of health don‘t (always) know how to and don‘t (always) see it as their business • In the Health sector we know we need to work intersectorally, but we are not always that good at it . . . 12 SA Health
  13. 13. 2: Government departmental structures 13 SA Health
  14. 14. Media AFL Budget cuts The Policy Cycle Elections Cabinet Decision making Community SA Health
  15. 15. 4: The Health sector‘s traditional approach 15 SA Health
  16. 16. So, where are we now? 16 SA Health
  17. 17. A different way: Health in All Policies • We don‘t try to pull other agencies onto health‘s agenda or priorities. • We don‘t try to turn other sectors of government into health agencies. • We work with them on their issues and their priorities and help them achieve their policy goals in ways that protect and promote health. 17 SA Health
  18. 18. Health in All Policies The Foundations > Thinker in Residence, Ilona Kickbusch > South Australia‘s Strategic Plan > A receptive and proactive Cabinet Office > A supportive Chief Executive > Officers willing and ready to have a go! 18 SA Health
  19. 19. Why Health in All Policies? 19 SA Health
  20. 20. HiAP – South Australian Model Source: Health in All Policies: The South Australian Approach, Government of South Australia (2011)
  21. 21. The Health Lens process The Health Lens Analysis process 21
  22. 22. Issues and Challenges • Language—that speaks to other sectors as well as Health • Clearly linking determinants to other sectors policy agenda • Tackling health policy issues using HiAP framework • Medium and long term impacts for health and other policy goals • Capacity Building- adapting the approach to enable others to apply a health lens 22 SA Health
  23. 23. Health Lens Analysis Projects • • • • • • • • • • • 23 Water Sustainability Regional Migrant Settlement Digital Technology Transit-oriented Developments (TODs) Marion City Council Re-Development–Rapid Assessment Improving Parental Engagement in Children‘s Literacy Aboriginal Road Safety Healthy Weight (desktop analysis) Active Transport Healthy Sustainable Regional Development: Mining Overseas Students Health and Welfare SA Health
  24. 24. . 24
  25. 25. What have we learned? > In our experience the following elements have been critical to success in adopting a HiAP approach: • • • • • 25 Leadership from the centre High level mandate Dedicated strategic HiAP team within Health The HiAP process itself Evaluation SA Health
  26. 26. So, what happened next. . . ? > Government policy change > Reviews of Local Health Network services and expenditure > Re-prioritisation of out-of-hospital funding > Re-allocation of funds > Consequential structural re-alignment > The Policy challenge - Sustainability 26 SA Health
  27. 27. . . . and our response > When all else fails - Public Health Law Our new shopfront offices 27 SA Health
  28. 28. ―Traditional‖ Public Health Challenges 28 SA Health
  29. 29. ―New‖ Public Health Challenges 29 SA Health
  30. 30. 30 SA Health
  31. 31. South Australian Public Health Act Can ―new‖ Public Health challenges be tackled by ―traditional‖ Public Health approaches – i.e. Law? A knotty problem 31 SA Health
  32. 32. 32 South Australian Public Health Act SA Health
  33. 33. South Australian Public Health Act 2011 An Act to promote and provide for the protection of the health of the public of South Australia and to reduce the incidence of preventable illness, injury and disability > Key Elements • Objects; Principles • Role of the Minister • Role of Local Councils • The General Duty • Public Health Planning – State • Public Health Planning – Local Councils •Concept of Public Health Partner Authorities • Reporting • Regulations, Policies, Guidelines 33 SA Health
  34. 34. South Australian Public Health Act Key Objects • To promote health and well being • To protect from risks to health • Early detection, management and amelioration of risks to health • Provide information to individuals and communities on risks to public health • Encourage… plan, create and maintain a healthy environment • Prevention, early detection management and control • Monitoring conditions of public health significance • Scheme for state and local government action for public health 34 SA Health
  35. 35. South Australian Public Health Act Principles • Precautionary principle • Principle of proportionate regulation • Sustainability principle • Prevention • Population focus • Participation • Partnership • Equity • Special principles concerning communicable disease and emergency powers 35 SA Health
  36. 36. South Australian Public Health Act (section 17) Role of the Minister • Primary source of advice to government on health protection and promotion • Develop procedures for government to ensure the promotion or implementation of policies or measures that are designed to enhance the health of individuals and communities • Ensure the Minister is consulted or involved in the development of policies or measures that may have a significant impact on the public health 36 SA Health
  37. 37. South Australian Public Health Act > Section 17 provides the opportunity for incorporating Health in All Policies ideas under a legislative mandate > Procedures and protocols > Inter-agency agreements – Public Health Partner Authorities > Aim to facilitate cross-sector policy development that meets the aims of partner agencies and advances health and well-being Other components of the Act deal with compliance and enforcement 37 SA Health
  38. 38. Conclusions > Key Challenges • Continuing and emerging ‗conditions‘ • COST > SDH approach to policy • Health cannot do it alone • Inter-sectoral action required > Innovation • Stop telling, start understanding • Health in All Policies > Future Directions • Public Health Law as the mandate • Be useful, be sustainable 38 SA Health
  39. 39. “It is a mistake to think you can solve any major problems just with potatoes” Douglas Adams Acknowledgements Danny Broderick Julie Patterson Miriam Hunter Carmel Williams Deb Wildgoose Isobel Ludford Claudia Galicki SA Health