HiAP in action

Canterbury DHB
Health in all Policies
Newsletter

July 2015
Health in All Policies is an approach to public policies across sectors 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. (Helsinki Statement 2013)
Kia ora Claire

Health in All Policies has many different incarnations. This newsletter provides a glimpse of the broad sweep of projects and relationships that the Canterbury DHB Health in All Policies (HiAP) team have.  In all our work we strive to:  
  • work upstream; keeping people healthy
  • intervene for good in causal pathways between social determinants and health outcomes
  • enable people to choose options that prevent illness and promote health
  • embed health and wellbeing as foundations in the Canterbury earthquake rebuild
  • work towards equitable health and wellbeing outcomes for all population groups
  • honour our responsibilities as Treaty partners
  • redirect scarce health sector resources toward more and better services for less money.  
The health sector can only do so much – our partners in local and regional government, the non- government organisational sector and volunteer agencies can have more impact on health and wellbeing outcomes. We welcome you to join us in this interesting and exciting way of understanding and experiencing the world, and taking up the call to action.
 
Please contact us if you have any questions or comments. 
 
Kind regards,
 
Evon Currie
General Manager, Community and Public Health

In this issue:

CHIAPP - A particularly valued partnership

The Canterbury Health in All Policies partner (CHIAPP) organisations are committed to championing approaches that will ensure that health and wellbeing are embedded into policy development, planning cycles and project development.

Four Healthy Christchurch partner organisations make up CHIAPP: CHIAPP is consistent with and is able to give effect to the Healthy Christchurch Charter. More information about CHIAPP can be found here. The latest CHIAPP annual report showcases some good examples of recent work undertaken.  
 

Coming together for Health in all Policies 

The Canterbury Health in All Policies Partnership (CHiAPP) recently hosted two ground breaking events to ‘take the pulse’ of HiAP activity in New Zealand: a reflective practice day for Cantabrian HiAP practitioners who have been working in this space for over a decade, and an inaugural NZ-wide conference.

The events were coordinated by the Community and Public Health HiAP team. Both days were well attended by a wide range of people, and feedback has been very positive about the venue, number of participants, networking opportunities, calibre and diversity of the speakers and the friendly atmosphere. 
 

Reflective Practice Day 

A highlight of the Reflective Practice day was the awards ceremony for the best HiAP project nominated by a CHiAPP partner. This was judged by three international HiAP practitioners and was won by the Christchurch City Council (lead agency) and Community and Public Health  for their Smokefree Social Housing Policy. The two runners up were the Alcohol Harm Minimisation Project and the Air Quality Health Impact Assessment carried out with Environment Canterbury by Community and Public Health. You can view the presentations here.


Environment Canterbury chief executive Bill Bayfield (left) and judge Dr Patrick Harris (right) from the University of Sydney present Christchurch City Council Housing Unit Manager Carolyn Gallagher with the  Excellence Award
  

New Zealand HiAP Conference

The Inaugural New Zealand HiAP Conference was well attended by people working in NGOs, Councils, DHBs, universities, public health units and other organisations.
 
The presentations by Sir Peter Gluckman (Prime Ministers Chief Scientific Advisor) and Henare O'Keefe (Flaxmere local government councillor and community worker) were particularly informative and challenging. Rob Quigley, HIA and HIAP practitioner, strategist, trainer and author raised issues with the ‘Helsinki definition’, suggesting an even more aspirational version:
 
Health in All Policies is a structured approach to working across sectors and with communities on public policies. It promotes trusting relationships and engages stakeholders to systematically take into account the health implications of decisions. Health in All Policies seeks synergies and avoids harmful health impacts, in order to improve societal goals, population health and health equity.
(WHO, 8th Global Conference Definition, 2013; Amended by RQ, 1st December 2014)
 
What do you think? We hope that conversations among practitioners will continue unabated. Future issues of this newsletter will highlight others issues raised in the Reflective Practice Day and Conference.  In the meantime, check out the conference presentations.


Dr Anna Stevenson from Community and Public Health with Sir Peter Gluckman
 

Some people like lists...

The following checklist will help you determine whether your work would come under the HiAP banner, or would benefit from a HiAP approach.

A HiAP approach: 
 
  1. Aims to ensure health, wellbeing, sustainability and equity issues are explicitly addressed in policy or decision making process
  2. Aims to improve the health outcomes associated with policies
  3. Aims to mitigate health disparities
  4. Uses a model or framework that acknowledges the social determinants of health
  5. Addresses a health goal, even if the health sector is not involved
  6. Gives priority to joined up working together to address the social determinants of health
  7. Works with partner agencies to achieve their goals and in so doing advance health and wellbeing
  8. Assesses comparative health consequences of options within the policy development process
  9. Works with partner agencies to achieve their goals and in so doing advance health and wellbeing
  10. Creates regular platforms for dialogue and problem solving with other sectors
  11. Evaluates the effectiveness of inter-sector work and integrated policy-making
  12. Builds capacity (in social determinants work) through better mechanisms, resources, agency support and skilled and dedicated staff

    In addition, consider whether the work includes:
     
  13. Cross-sector action teams or interagency committees or partnership platforms
  14. Community consultations and engagement?
  15. Integrated or cross sectoral visions, objectives and programmes?
  16. Integrated or cross sectoral budgets and accounting?
  17. Joint development of strategies, plans, policies and workforce development?
  18. Integrated or cross sectoral data collection, analysis and sharing of information?
  19. Health lens analysis / Health Impact Assessment methodologies?

Other people like pictures... 

Some messages are easier than others to communicate.  HiAP, despite having the benefit of an acronym that can actually be pronounced, is a challenge to explain succinctly in plain language. 

Words are clearly important tools, but we also recognise that a visual representation might help to catch people’s attention and convey the key concepts of HiAP. 

So we have adopted graphics that can be used as logos.  This will be particularly helpful to identify HiAP projects that are done collaboratively with our formal partners. It gives an alternative, or an addition, to using the organisational logos.

The designs are stylised speech bubbles, reflecting the importance of communication. The first is related to the graphics based on Te Pae Mahutonga, the health promotion model which underpin Canterbury’s HiAP work.

The highlighting and centrality of the heart conveys the importance of speaking together with a heart at the core. 



The second graphic hopefully makes it clear that HiAP is about the mutual benefits of working and collaborating together. 


We invite organisations to consider using these logos for projects that use HiAP concepts and tools.  To check whether your project would be suitable, see the HiAP checklist above.  Further information is included in Information Sheet 1 or by emailing Jane Murray.

See an example of our logos in action in the 2014 CHIAPP annual report.

HiAP in action – Te Pae Mahutonga as a teaching tool

We are always on the lookout for opportunities to teach about HiAP.  The Maori health promotion model, Te Pae Mahutonga (TPM), developed by Dr Mason Durie, helps us to identify the questions raised by new policies.



TPM is used to represent the factors that influence our health and wellbeing, known as the determinants of health. TPM uses the imagery of the Southern Cross star constellation. 

As Dr Mason Durie explains, the hope is that the six stars which make up Te Pae Mahutonga will serve not only as a navigational aid to the south, or as an icon of New Zealand, but as a reminder about the potential for a healthy people and a healthy nation.  Recently he challenged us to bring together Te Pae Mahutonga and public health in the June Public Health Association Kawerongo publication.


Lee Tuki and Christchurch Polytechnic Institute of Technology health promotion students used the TPM lens to learn about the new Smokefree Policy in Prisons. To implement the policy successfully, it is useful to consider the following questions:
  1. Who needs to participate
  2. How to make the healthy choice the easy choice
  3. How much better a smokefree environment is for everyone
  4. How to align cultural perspectives with a smokefree identify
  5. Who are the leaders and role models
  6. How a smokefree future beyond prison can be encouraged.

Te Matatini

 
Te Matatini, the national Kapa Haka competition, was held in March in Otautahi/Christchurch.

Community and Public Health joined with a number of other organisations in a Maori health village, Te Kaika Waiora.  Using the Te Pae Mahutonga holistic Maori model of health,  the village provided a focal point for a Health in All Policies approach. For example, Rawhiti primary school to showcased their understanding of the connection between the protection of food, the soil, and the environment, a topic of keen interest to Canterbury Regional Council. 

Dr Ruth Richards reflects on HiAP

We invited one of New Zealand’s most experienced HiAP practitioners to comment on her career working outside the health sector. Ruth’s employment in the social development sector was not a typical career pathway at the time she made the move. Increasingly, other sectors, such as local government and social sectors, are recognising the value of employing staff with public health qualifications.

"My role in the social sector is as a public health physician working in preventive health. Some years ago now, I moved from a policy role in the Ministry of Health to what I thought would be a similar role in strategic social policy in the Ministry of Social Development. In this role I worked across a broad range of social sectors with the aim of improving the wellbeing of the population.

Health in All Policies makes the tacit assumption that all sectors have as an aim better health for the population. But there are many hoops, hurdles and barriers to get through just to have this aim acknowledged. Here I am sharing some of the learnings from my time in the Ministry of Social Development.

Lesson # 1: A committee does not constitute collaboration
Initially, representatives from sectors will come with their own (usually unspoken) world views and agendas. For a committee to function cohesively, these world views and agendas need to be explored and a collective view of the common purpose of the group established.

Lesson # 2: English is not a common language between sectors
Sectors have their own languages and use the same words to mean different things. Check out what others mean by their words – and be prepared to explain what you mean by the words you use.

Lesson # 3: Words are just labels for ideas
Check out the deeper meaning behind the words. As well as differences across sectors, researchers, policy makers and practitioners all have their own ways of expressing their ideas, clearly understood by their colleagues but a mystery to others.

Lesson # 4: Acronyms are barriers to communication
Acronyms used in one sector are usually completely incomprehensible to others. They may be used as an instrument for exclusion, or may just ‘accidentally’ do that. Listen to discussions within your sector and see how many acronyms and how much ‘jargon’ is used. What do PATHS, PISA, and PIRLS mean to you?

Lesson # 5: Drivers are different across agencies
What pushes your buttons? Drivers are different for different sectors. Look at the Statements of Intent for different social agencies to find out what drives each sector.

Lesson # 6: Check out values and assumptions and go for synergy
So, if the aim is collaboration, it is important to explore the drivers for agencies and find points of synergy as a launching pad for working together.

Lesson # 7: Get fit and go mountaineering
Imagine you are on top of the ‘mountain’ of your sector, looking down on the world. Each sector will see a different part of the world. Some will see China, some South America, some Europe. But they would all say they are looking at the world. Unless we climb someone else’s mountain we will never know what the view is from the top, what the world looks like from their perspective.

Lesson # 8: Take mountaineering lessons
Before setting out on a mountaineering trip it is usual to learn about how to do it. So explore the frameworks and paradigms that will help understand the terrain you will traverse and the techniques for doing this. This can be a collective, collaborative practice. You may be the teacher, you may be the learner. It will be important to understand each other using the lessons learnt so far if this is to be meaningful.

Lesson # 9: Practice mountaineering roped to a buddy
Even with the best understanding and the best preparation, there will be perils along the way on the ‘mountaineering trip’ to reach a common view. Get with an expert and gain an in depth understanding of how to work together to get to see the view from the top.

Lesson # 10: Mountaineers respond to the climate
You may be getting along well as a roped up pair of mountaineers, but then the weather may turn. Someone moves the goal posts. Keep a ‘weather eye’ out for what is happening more widely (for example there is an election coming up). When there is a new external driver to respond to, apply the in depth knowledge, learning and experience gained together to turn it into an opportunity.
 

Conclusion

In summary, the lessons I learned in my time at the Social Development Ministry are:      
  • Language matters – the meaning of words, the use of words, acronyms – can all be barriers to communication
  • Understand the drivers and world views of other parties – the drivers within other departments / agencies and the drivers for collaboration from every perspective
  • Collaboration is just an input to the real goal of making the change we want to see in society
  • We cannot succeed alone but need a common vision to move forward.
There is an old Kenyan saying “Sticks in a bundle cannot be broken”. Gather the sticks together to get Health in All Policies".

Interesting web resources 

In our web travels we find material that inspires, delights or dismays. Here's a sample for your consideration:

Jason Corburn, author of “Toward the Healthy City: People, Places, and the Politics of Urban Planning” discusses urban planning, the environment, and equity: http://www.commissiononhealth.org/Post.aspx?Blog=79764
 
Lots of links to interesting sites concerning healthy cities and related topics:
http://healthyurbanplanning.blogspot.co.nz/
 
Article about what really happened when Ebola arrived in Dallas:
http://www.vanityfair.com/news/2015/02/ebola-us-dallas-epidemic
 
Interesting TED resources concerning clinical medicine and public health, based on The Upstream Doctors: Medical Innovators Track Sickness to Its Source by Rishi Manchanda
http://blog.ted.com/2013/06/05/investigating-the-root-causes-of-the-global-health-crisis-paul-farmer-on-the-upstream-doctors/
http://blog.ted.com/2013/06/06/tackling-sickness-at-its-source-an-interview-with-ted-book-author-rishi-manchanda/
 
We have collected a number of excellent resources as part of our work advising on the Christchurch rebuild.  Urban design affects everyone, and these resources provide a starting point for information on universal design, building guidelines, health promoting environments, and more. Go to
http://www.healthychristchurch.org.nz/priority-areas/urban-design

See the interesting report Nga Hua a Tane Rore – The Benfits of Kapa Haka  www.mch.govt.nz/benefits-kapa-haka-report
 
Another site worth surfing is theconversation.com.  For example, read "More than a health issue: addressing the social determinants of obesity”

Next issue

  • More from the Health in All Policies Conference 
     
  • HIAP overseas
     
  • Isn’t it obvious?  Why rebuilding Christchurch as inclusive and accessible for people of all ages and abilities is harder than you’d think.

Until next time...

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