Experience and lessons - Irene Verins

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Experience and lessons from VicHealth

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Experience and lessons - Irene Verins

  1. 1. Experiences and lessons inhealth promotionIrene Verins 9th November Johannesburg
  2. 2. Presentation overview• Brief introduction to Victorian Health Promotion Foundation (VicHealth)• Consider some of the learnings and challenges in establishing a health promotion foundation• Provide case studies
  3. 3. • Population of Australia:Context 23 million • Population of Victoria: 5.5 million • Victorian health budget: AUD 13 billion • VicHealth budget: AUD 36 millionHealthwayHPF VicHealth VICTORIA HPF
  4. 4. Origins of VicHealth• Established 1987 (Tobacco Act 1987)• Funded by 5% tobacco levy• Independent statutory authority• Tri-partisan political support• Buy-out of tobacco advertising and support to hp research
  5. 5. VicHealth• Loss of hypothecated tax in 1997 = appropriation directly from treasury• Move out of sponsorship funding in 1999/2000• Greater emphasis on changing the social determinants that impact on health• Improved alignment of research investment with priority areas
  6. 6. What we do now- setting up the businessFunding of $36.4 million per annum for:• Social and economic participation for mental health and wellbeing• Active communities and healthy eating• Tobacco and alcohol control• Program design and evaluation, capacity building and research are core functions
  7. 7. VicHealth’s Mission 2009-2013To build the capabilities of organisations, communitiesand individuals in ways that:• change social, economic and physical environments so they improve health for all Victorians• strengthen the understanding and the skills of individuals in ways that support their efforts to achieve and maintain health
  8. 8. “This ends the debate decisively. Health care is an important determinant of health. Lifestyles are important determinants of health. But it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place.”[Source] www.who.int/social_determinants
  9. 9. VicHealth’s strategic priorities2009-2013Priorities for focusReduce Improve Reducing Increasing Increasing social and Reducingsmoking nutrition harm from physical economic harm from alcohol activity participation UVKey result areasKRA 1 Health KRA 2 Participation KRA 3 Nutrition, tobacco, alcoholinequalities and UV 2.1 Increase participation in physical1.1 Improve the physicaland mental health of activity. 3.1 Create environments thatthose experiencing 2.2 Increase opportunities for social improve health.social, economic orgeographic connection. 3.2 Increase optimal nutrition.disadvantage. 2.3 Reduce race-based 3.3 Reduce tobacco use.1.2 Contribute to closing discrimination and promote 3.4 Reduce harm from alcohol.the health gap between diversity.Indigenous and 3.5 Reduce harmful UV exposure.non-Indigenous 2.4 Prevent violence against womenVictorians. by increasing participation in respectful relationships. 2.5 Build access to economic resources.
  10. 10. VicHealth’s strategic priorities2009-2013Health promotion actions• Create and use knowledge acquired through • Develop communities which are inclusive,research and evaluation. accessible, equitable and safe.• Create environments that foster good health. • Support organisations to plan, implement and• Encourage the development of systems that evaluate health promotion activity.support and sustain health. • Facilitate participation and skill development.• Communicate about priority health issues. • Contribute to and advocate for healthy public policy and regulation.Settings for actionWorkplace, education, Community, local Culture, sports, arts,justice government, corporate media, technology
  11. 11. Experiences & Lessons
  12. 12. 1. Tax hypothecation• A dedicated tax on a harmful product is used to promote health• It required an ACT of Parliament = important• Is more difficult for governments to make changes to a dedicated tax• Secures a long term investment
  13. 13. 2. Independence... Be the valueadd to government• A balanced government relationship• Work with government but not as government• Do not duplicate• Find and articulate the boundaries: more able to carry risk, more innovative, more responsive
  14. 14. 3. Adaptable, nimble: a leanmachine…Foundation must be able to weather change and planlong term strategies by: • Being less bureaucratic, smaller & cheaper than government • Align activity & resources across government silos in areas that could deliver health benefits: education, workplaces, sport • “Yeast in the system”
  15. 15. 4. Innovative• Identify emerging trends in public health• Test new ideas and strategies: Research & evaluation, knowledge dissemination• Carry the risk
  16. 16. 5. VicHealth’s evolution: frombreadth to depth1987: @ 20 people• $25 million• Disbursed through large funding rounds (breadth)• Community Health Program had 3 people disbursing through 16 week funding round cycles• Advocacy through partners and key stakeholders• CEO partnered with health people predominantly
  17. 17. 5. VicHealth’s evolution: frombreadth to depth continue… 2011:@ 50 people• $36 million• Disbursed through both development, design and evaluation of interventions (depth) and large funding rounds in physical activity, the arts and research (innovation)• A knowledge builder and disseminator• CEO partners with those inside and outside of health, NGO and corporate sectors• Advocacy through stakeholder/policy coalitions, social media
  18. 18. Reducing discrimination &supporting diversity for health
  19. 19. Reducing race-based discriminationWhat we know• In Australia, 47% of people from non-English speaking backgrounds and 75% of Indigenous people report having experienced discrimination.• The majority of Victorians value cultural diversity; however 10% believe that some races are inferior to others and that people from different racial backgrounds should not marry one another.• Discrimination contributes to health inequality and disadvantage experienced by Indigenous Victorians and some migrant and refugee communities.
  20. 20. Current action to reduce race-baseddiscrimination• Research, building the evidence in what works• Design approaches to decrease discrimination through settings (local government, education, workplaces, sport, arts)• Building partnerships• Communications and social marketing strategies• Workforce development• Advocacy to state and national governments
  21. 21. Federal Government Department of State Government Philanthropy/ NGO Immigration HealthMulticultural Affairs Advisory Committee of key stakeholders & VicHealth Board VicHealth Program content experts staff : 2EFT Policy Coalition for Advocacy University led Intervention site LEAD: Local Interventions site LEAD:research & evaluation government program rural Local government partnerships program urban Arts About Us Discrimination Program Workplace Health program Everyone Wins Sports Program Social Marketing Campaign See Beyond Race
  22. 22. Measuring successIn recent years we have an improved track record overall:• 90% of Victorians support society being made up of people from diverse cultures• Progressive elimination of obvious institutional discriminationInternational variation indicates that diversity can and has beeneffectively managed in Australia• 1 in 3 people in Europe hold blatantly racist views. However less than 1 in 10 Victorians doOur work is measured against state and national data sources such asthe Victorian Population Health Survey, VicHealth’s own CommunityIndicators and VicHealth’s Community Attitudes surveys.
  23. 23. 6. Is there support for promotion andprevention?• The economic evidence for health promotion is under-developed• Reviews estimate that about 10 per cent of economic studies assess prevention• Relatively few health promotion interventions have been assessed• Population approaches are the most difficult to assess
  24. 24. Costs of chronic disease e• Alcohol = estimated $13 billion cost to society each year. 1/3 Victorians still drink at high risk levels at least once a year.• Obesity = Australia one of ‘fattest’ nations - will overtake smoking as biggest preventable health threat in next 15 years.• Violence against women = costs Australian society $13.6 billion a year. Leading contributor to death and disability in Vic women 15-44.• Smoking = despite many wins, still represents 10% of the health burden for Victorian males and 6% for females.• Mental illness and stress = annual cost due to 6 million days of lost productivity due to depression is $14.9 billion
  25. 25. Economics of preventionThe health and economic benefits of reducing disease risk factors (2009)If annual per capita alcohol consumptionwere reduced by one-third (alreadyachieved in Norway) = 98,000 fewer newcases annually of alcohol-caused diseaseand 21,000 fewer years lost to illness anddeath.Cutting physical inactivity by 5 per cent= 1,000 lives nationally, and result in3,000 fewer cases of illness every year= $129 million in savings, including $48million in the health sector and $81million in production and leisure.Download the full report from www.vichealth.vic.gov.au
  26. 26. Economics of prevention continued…The health and economic benefits of reducing disease risk factors (2009)If tobacco smoking in Australia werereduced to 15 per cent (achieved inCalifornia), there could be 5000 livessaved a year and 158,000 fewernew cases annually of tobacco-caused illness.(note: the Victorian Government has set atarget to reduce smoking in adults from17.3% to 13.8% by 2013)Download the full report from www.vichealth.vic.gov.au
  27. 27. 7. Leadership1. Political: • Tri-partisanship, reps from each Party on Board to achieve broad parliamentary consensus for public health2. Strategic and Representational: • Sectoral support from sport, arts, health, education, medical research sectors and the media • Champions3. Organisational: • Chairperson-high profile, CEO-high profile
  28. 28. The VicHealth Board• Sport x 2• Health and medical research x 3• Arts x 1• Local government x 1• Media and communications x 2• Legal x 1• Politicians x 3
  29. 29. 8. Support from sponsored sectors:Sports & Arts• Embraced tobacco buyout early• Provided great support in expanding the resource base for influencing health behaviours and attitudes• Provided the community networks throughout which advocacy can be channeled
  30. 30. 9. Ability to harness diverse players,build coalitionsThe drivers of health lie outside of the health sector then wemust partner with agencies outside of the health sector
  31. 31. VicHealth’s Achievements• Replacement of tobacco sponsorships• Centres for Research and Practice• Development of public health research infrastructure• Contributed to lower tobacco and alcohol consumption, greater sun protection• Training thousands of non health sector workers in hp• Contribution to public health policy and partnerships across sectors• Mental health promotion strategy and evidence• Influence on state and federal government policy
  32. 32. In closing a few thoughts about establishment of a hpf1. Tax levy is separate money from health budget: a hpf is not a burden2. Be the value add and the enabler to government : hpf can extend the work of government3. Build the business case for hpf in South Africa (befriend the health economists)4. Be the Innovation incubator and carry the risk which government can’t5. Strong & strategic leadership: champions6. Cross sectoral partnerships: invest in them now as your advocacy coalition7.Health promotion/prevention takes a long time

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