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Broadly Speaking - Canterbury's Health in All Policies Newsletter
July 2020
Health in All Policies in Action

Our last communication was mere days before we went into the level 4 response to COVID-19. It’s difficult to accurately remember those days before the pandemic triggered a worldwide crisis and consumed global politics. These unprecedented times have prompted conversation on public health, equity and racism like never before.

We would call these issues wicked problems — social or cultural problems that are so highly interconnected that are difficult to define and are always evolving. There are no definitive solutions to wicked problems –approaches rather than clearly right wrong. Solutions involve a wide range of sectors and need action at a range of levels from individual to intercontinental. The COVID-19 pandemic can be understood as a wicked problem in itself and as a contributor to existing already identified wicked problems.

In recent months we, as a society, have become acutely aware that life is not the same for everyone. The pandemic has highlighted and magnified existing inequities. To be isolated with a job, a full pantry, local access to nutritious food, a warm home that is large enough to accommodate its occupants all day every day, money to pay for devices and broadband to keep connected with schooling and loved ones, and a neighbourhood conducive to walking is far different from being in lockdown or self-isolation when you are hungry, cold, lonely or trapped in overcrowded or inadequate accommodation or an unsafe situation, as many New Zealanders. Similarly, people with disabilities or existing health conditions who rely on others for care and day-to-day support faced unmet needs and increased vulnerability. Racism, discrimination, and social inequality have contributed to increased case numbers and risk of death from COVID-19 among ethnic minority groups, especially black people in the UK and USA. The longer-term impacts of the lockdown on jobs and incomes will disproportionately affect already disadvantaged populations, especially children.
Graph showing that Black, Asian and Minority Ethnic (BAME) groups have higher risk of death for COVID-19 in the UK

Health is All Policies (HiAP) is an approach to tackling such wicked problems. As members of the HiAP team at Community and Public Health we know that health and wellbeing outcomes at a population level are largely dependent on policies created by those outside the health sector. The pandemic has highlighted how well different sectors and levels of government can work together and be agile, adaptable, and perform well quickly when their is a will. We have long been working alongside partner organisations in Canterbury support health and wellbeing, sustainability and equity being into consideration in policy and planning processes.

During recent months our team and colleagues at Community and Public Health, Canterbury DHB’s Public Health Unit, have been working on the ground actively manage, investigate, and support those with COVID-19. Our partners in central and local government have been responding to the emergency in myriad ways and preparing for the economic and social response to the consequences of the pandemic. At the same time colleagues in non-government and iwi agencies have been supporting vulnerable people, as they do every day of the year, and planning for the future needs of their populations.
The syndemic of COVID-19, non-communicable diseases (NCDs) and the social determinants of health (BMJ http://dx.doi.org/10.1136/jech-2020-214401)

In the midst of this, we have been inspired by New Zealand’s incredible collective action in the name of public health, and we want to support a greater vision – one of a healthy and thriving New Zealand society, supported by central and local government agencies, where environmental sustainability is prioritised and with zero tolerance for inequity, and for conditions that result in preventable illness, both physical and mental.

Like many others, we see this pandemic as an opportunity to do things differently. Instead of setting the bar at stamping out COVID-19 and returning to as close to “normal” as possible, we recognise that normal was never good enough for a large section of our population. The need to involve all sectors in this has been clear for many years. The challenge was explicitly laid out in the 2019 Waitangi Tribunal Hauora report which stated that the achievement of equitable health outcomes for Māori is the responsibility of all sectors.

If Aotearoa is to achieve the vision of a healthy and thriving New Zealand, it is now clearer than ever that all households and whānau need a reliable and sufficient source of income, social connectivity and support, equitable access to appropriate transport, health and social services, nutritious food, high quality warm housing, and education. There is an opportunity now to reimagine our policy platforms in a way that prioritises health and equity outcomes for everyone - to reorient cities, to meaningfully address racial justice, and to rethink our economy. The false dichotomy of healthy people or a healthy economy needs to be confronted – an economy that does not support a flourishing community is not performing as it should. This is also the perfect opportunity to finally get serious about combating the climate crisis.

Our national response to COVID-19 has shown that there is political will to prioritise health, to use evidence-based policy making and to work across agencies to provide solutions – this is HiAP in action and this work is now as important as ever. As a country and a region we need to ensure that the decisions being made not only keep us on the path to recovering from this pandemic, but also address existing inequities, protect the planet and lead to improved population health in the long-term. We encourage our partners, as well as organisations across New Zealand and further afield, to consider these issues in their planning at this time. HiAP approaches and tools can and should support this work and we look forward to working with you on this journey.

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Also in this issue....

New resource: Key questions for pandemic recovery planning

The response to COVID-19 reinforces how policies and actions outside of the health sector can protect wellbeing and foster resilience. While planning the recovery from this pandemic three key priorities should be taken into account: health and equity; addressing climate sustainability; and incorporating wider social goals.

The Pandemic Supplement to the Integrated Planning Guide for a healthy, sustainable and resilient future (IPG) provides strategic questions and considerations across key dimensions of health specific to recovery from this pandemic and to help prepare for future health challenges.

Previous tools developed in conjunction with local partners such as the Integrated Recovery Planning Guide and original Integrated Planning Guide for a healthy, sustainable and resilient future (IPG) were well used locally in reviewing policies and plans that responded to the Canterbury earthquake sequence. As a result of  of the pandemic, we have worked with key partners such as Christchurch City Council and Environment Canterbury to develop this special supplement to the IPG to support policy and decision making in the current environment.

This new five-page pandemic-specific supplement is intended for use alongside the IPG. Use the additional prompts when developing plans or projects for both pandemic recovery and to build ongoing resilience to public health emergencies.

Contact the Health in All Policies team to explore training options for the IPG or for assist using one of our tools with your project.

Prime Minister Jacinda Ardern holds a copy of the Integrated Planning Guide
During a recent visit to Christchurch, the Prime Minister, the Rt Hon Jacinda Ardern, looked through a copy of the IPG and new supplement with interest. (Photo courtesy of Sandy Brinsdon)

Working together on psychosocial recovery

The need to address psychosocial wellbeing was identified early in the pandemic response. Initially fear and concern in communities rose in people directly and indirectly affected by the illness. Secondary stressors of COVID-19 have been pre-existing challenges exacerbated by events, most notably racism, poverty, food insecurity, poor housing, unemployment, digital inequity, and stigma. So not only could COVID-19 have a devastating effect on already vulnerable sectors of society, ongoing rises in unemployment could create newly at-risk people. A prolonged period of chronic stress means New Zealand’s recovery period will also be long-term.

To look at these issues, Canterbury DHB convened a psychosocial committee as part of a TransAlpine response, with representatives of Te Rūnanga o Ngāi Tahu, Te Puni Kōkiri, Ministry of Pacific Peoples, Ministry of Education, Oranga Tamariki, Civil Defence (Canterbury and West Coast) and NZ Police. The Canterbury Committee also includes leaders of key networks such as SEWN, the Earthquake Disability Leadership Group, the Interchurch Forum, MHAPS, MHERC, plus Salvation Army, Red Cross and Victim Support. The role of the committee is to stand in the wellbeing space, supporting and advising on existing initiatives, and finding ways to ensure communities and individuals can articulate what they need to be well.

Since the first meeting in April, the committee has reflected on the importance of equity and Te Tiriti, the components of psychosocial wellbeing, and the values which underpin equitable community wellbeing. They will be looking to measure progress against the Pae Ora framework - a holistic concept that includes three interconnected elements: mauri ora – healthy individuals; whānau ora – healthy families; and wai ora – healthy environments.

Members of the group reported into the development of the The Kia Kaha, Kia Māia, Kia Ora Aotearoa: COVID-19 Psychosocial and Mental Wellbeing Recovery Plan, which provides a national approach to supporting the mental and social wellbeing of New Zealanders in the COVID-19 recovery period. CDHB and Christchurch City Council staff also collaborated on a joint submission during the consultation period.
Of note, the Government priority outlined in the plan reflects a HiAP worldview - taking a determinants of health approach to achieve improved wellbeing for every person in New Zealand. The inverted triangle used to structure the focus areas represents an advance on previous recovery planning, putting collectively building social and economic foundations for psychosocial and mental wellbeing at the top rather than specialist services.
MOH COVID-19 Psychosocial and Recovery Framework

Rethinking the health system

Cover of Health and Disability System Review Final Report Purongo WhakamutungaThe Health and Disability System Review Report was released a few weeks ago. While the focus is on the healthcare institutions themselves, like the Ministry of Health and district health boards, the review notes that these health services contribute to only about 20 percent of our health outcomes.

The other 80 percent of our health is shaped by systems outside of healthcare – the food, transport, education, taxation, employment, housing, urban development, trade, justice and welfare systems. The review recognises this and suggests that responses are required across sectors, to promote health and wellbeing and create environments that support health and wellbeing. It specifically notes that population health functions are delivered by local government, other government agencies and community organisations.

The report notes that improving population health, with an explicit focus on equity, must become the driver of all planning within the system. Without successful population health strategies, individual treatment services will not be able to achieve equity or significant improvements in the overall health and wellbeing of New Zealanders.

The report notes the health and disability system has a responsibility to work collaboratively and form partnerships to ensure health concerns are firmly considered alongside economic, social and environmental considerations in key policy and planning decisions. The report recognises the HiAP approach and the excellent examples of successful cross-sectoral approaches throughout New Zealand, such as the active promotion of HiAP in Canterbury, and notes that there is a need to scale up and expand these approaches.
Despite this, there are no specific recommendations for working across sectors, implementing HiAP or bolstering capacity for health impact assessments in the report.

Although the recommendations, if implemented, should improve how the health system functions, as pointed out by Professor Boyd Swinburn, if we’re serious about improving health, we also need to focus on the 80 percent of health determined by societal systems.

Building Health for All® in the face of COVID-19

In the face of COVID-19, decision makers are urgently requesting guidance on how to adapt their projects and portfolios to respond to the unique challenges presented by the pandemic. As we move through our collective response to COVID-19 and begin to recover, a new normal will emerge to create a more resilient society—and the buildings and public places we inhabit will play a critical role in this shift. The US-based Center for Active Design, operator of Fitwel, is preparing content to respond to this demand, using the best available evidence to date. Resources include webinars, fact sheets and a ‘Research to Action’ series. Resources are being released on a rolling basis and will be updated periodically to reflect emerging scientific evidence around COVID-19.
Research to Action chapters now available:
  • Chapter 1: Leveraging Buildings to Mitigate Viral Transmission
  • Chapter 2: Building Trust in the Workplace
  • Chapter 3: Addressing Mental Health Within Residential Settings
  • Chapter 4: Optimizing Density for People
  • Chapter 5: Addressing Health Disparities in the Built Environment
Visit fitwel.org/covid-19  for more details.

NZTA - Investment Decision-Making Framework

Waka Kotahi NZ Transport Agency has released their Investment Decision-Making Framework (IDMF) Final Report which summarises the outcomes of the IDMF review and details the changes that come into effect on 1 July 2020.
 
Waka Kotahi believes improvements have been made at each stage to create a more coherent end-to-end framework that is easy to understand and simpler to use. The report is the result of collaborative efforts of agencies: Waka Kotahi, the Ministry of Transport and throughout the transport sector, as well as the ongoing support of Local Government New Zealand.
 
Recognising that land transport investment decisions affect the lives and wellbeing of all New Zealanders, improvements have also been made to the way proposals are assessed, allowing for clarified investment principles and policies, and consideration of both monetised and non-monetised impacts – for dimensions such as health and safety, resilience, environmental sustainability, inclusive access, and impact on Te Ao Māori.

Connecting

Stories from here and around the globe related to the social determinants of health, sustainability and health equity.

Events:

  • SOLGM Online Forum - Towards a Wellbeing-Led Recovery: 22 July 2020, 11 am. This online forum will explore how the wellbeing of communities can be factored into the scope of recovery measures. Expert panellists will consider the challenges and opportunities of a wellbeing-focused recovery in the wake of the pandemic crisis and the role local governments can play in developing a sustainable, inclusive and resilient plan.
  • NACCHO Health in All Policies Monthly Webinar Series; 29 July 2020 (NZ time): The US National Association of County and City Health Officials (NACCHO)'s monthly HiAP Webinar for July will be used to introduce a new tool for local health departments interested in developing evaluation metrics for their HiAP initiatives.

Resources:

HI-C Health Impact Checklist Toolkit
  • Health impact checklist – a tool for policymaking: The Kansas Health Institute has developed the Health Impact Checklist or HI-C, a new tool to inform decisions at many levels (e.g. organizational, city, county and state). It asks a series of questions and uses a combination of check boxes and written responses to connect potential changes in social, economic and environmental conditions with potential health impacts. Further, the tool guides users as they create practical recommendations. The HI-C also includes a template for a one-page summary that provides a high-level snapshot of findings.
  • Emerging Transport Practices for Cities: Cities and transit agencies are taking action now to address the most critical impacts of the coronavirus and ensure that essential services operate in their communities. To help city and agency staff plan responses to the pandemic, US-based National Association of City Transportation Officials (NACTO) is regularly updating a summary of rapidly-deployed responses. 

Other related items:

  • How prioritizing health could rebuild economies:  As organizations around the world look for tools to speed up economic recovery, rethinking health as an investment, not just a cost, could accelerate growth for decades to come. The McKinsey Global Institute outline four lessons from the pandemic show how to build a healthier and more prosperous future.
  • Why Car-Free Streets May Be Here to Stay [Video]: While increasing automobile traffic has been a growing problem in major US cities, the threat of COVID-19 has revealed what life could look like without car-clogged streets. This dramatic change triggered by pandemic shutdowns may lead to significant and permanent modifications to how we live, work and get around.
Cover of Protecting and Promoting Mental Wellbeing report
  • Protecting and Promoting Mental Wellbeing: Beyond Covid-19: - From Koi Tū: The Centre for Informed Futures, this paper focuses on the effects on individuals and their mental wellbeing. It was informed by extensive and iterative conversations with a diverse group of experts and practitioners who have contributed to the final report.
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Health in All Policies (HiAP) is a structured approach that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity.
Canterbury's Health in All Policies Team is based at Community and Public Health,
part of the Canterbury District Health Board.
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