Canterbury Health in All Policies Newsletter
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Canterbury
Health in All Policies
Newsletter
August 2016

We are pleased to present a mid-year Canterbury Health in All Policies Newsletter. We’ve been really busy responding to opportunities to put theory into practice.
 
The definition that we are using in Canterbury is:
 
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.
 
Health in All Policies is a way of thinking and a program of action. In this edition of the HiAP newsletter we are showcasing pieces of work ranging from capacity building to impact assessments to ongoing development of the institutional support required to enable HiAP practice. Canterbury is rightly being recognised on the global stage as a centre of excellence for HiAP practice.
 

You will note that this edition includes the names and email addresses of the people responsible for the work being described. Please consider this an invitation to contact any of our team to learn more about work that interests you.
 
Kind regards,
 
Evon Currie
General Manager, Community and Public Health

Getting the message across

In May this year our colleague Rob Quigley was asked to give a keynote presentation at the 22nd IUHPE World Conference on Health Promotion in Brazil.

His presentation focused on the HiAP work in South Australia and in Canterbury.  Rob outlined the importance of leadership and governance in enabling HiAP practice.

And he summarised in a slide some of the key pieces of work in Canterbury over the last decade that demonstrate the way we have operationalised HiAP.

To learn more about HiAP and the work being done in Canterbury, go to http://www.cph.co.nz/your-health/health-in-all-policies/
 
Or contact anna.stevenson@cdhb.health.nz

Tools that support HiAP practice

Joint Work Plan Portal: A tool to assist the Christchurch City Council, Environment Canterbury and Canterbury District Health Board to collaborate integrate, co-operate, find synergies, liaise. These are well-used words in the public sector for the past decade. But what do they really mean in a practical sense?  Click on the image below to view a larger image of the Joint Work Plan Portal.
 
Click for larger image
The Canterbury Health in All Policies Partnership (CHIAPP) which consists of the Canterbury District Health Board (CDHB), Environment Canterbury (ECan) and the Christchurch City Council (CCC) wanted to find a way for staff to easily connect with staff at other agencies working on similar topics. All three agencies have an interest in environmental health whether it be air, water, transport and housing for example.

Originally, the CDHB developed two-way Joint Work Plans, capturing the work shared between CDHB and ECan, and the CDHB and CCC. The Joint Work Plans showed a wide range of projects and what the milestones are for each of those projects, all agreed to by the Chief Executives of each agency.The two-way Joint Work Plans were simply A3 Word documents with only limited information. There was overlap between the contents of the two plans with some work streams appearing in both documents.The CHIAPP members decided that there was value in moving from two-way to three-way planning, so each organisation could see at a glance all the projects, liaise and make updates accordingly. This would mean that three agencies required shared access.


The CHIAPP partners agreed to use available technology to create a joint portal that all partners could access. Chris Ambrose, web developer at Community and Public Health, designed an electronic system, readily accessible to authorised users from each agency. The Joint Work plan portal lists all the work streams in a series of categories, with associated milestones and actions. Staff from all three agencies liaise to provide up to date progress notes. Staff can also attach key documents, such as meeting minutes, plans, etc., to relevant milestones.  Each user can print custom reports.
An internet page serves as the portal, which is fully transparent to all users, giving people a sense of ownership for projects and clearly articulating
the expectations for each agency. Relationships among the agencies have been enhanced through the specification, planning, trialling, training and implementation stages of the project.  To date, the new Joint Work Plan Portal is proving a unique way of working that gives each agency a clear picture of shared expectations, work and achievements.
 
For more information contact, Jane Murray, Health in All Policies Advisor jane.murray@cdhb.health.nz

HiAP Practice Tools

Integrated Assessment of the Waimakariri Residential Red Zone Recovery Plan

Between October 2015 and February 2016, three members of the Canterbury DHB HiAP team were involved in a project with Canterbury Earthquake Recovery Authority (CERA), Waimakariri District Council (WDC) and Ngai Tahu to carry out an integrated assessment of the Waimakariri Residential Red Zone Recovery Plan (the Plan).  We were happy to support the WDC to conduct an impact assessment to meet the directive from the Minister for Canterbury Earthquake Recovery.  Our existing relationships with CERA, WDC and Ngai Tahu were helpful and were strengthened throughout this process.
 

What is an Integrated Assessment?

The purpose of an integrated assessment is to assess the potential social, economic, cultural and environmental impacts of a plan and make adjustments during the drafting phase in order to positively influence the final version and ensure the best possible health and wellbeing outcomes for the community.

We met with the WDC planners to develop an approach centered around a series of workshops. Together, we created 37 criteria to rank and assess various drafts of the plan. We also assisted with facilitation of the workshops.

WDC invited a wide range of stakeholders to the workshops: community members, business association members and business owners, residential red zone residents, ecologists, architects, council staff and health protection officers.  

 

Summary of the Integrated Assessment Process

The first workshop assessed an Early Preliminary Draft Plan.  Attendees worked in four groups, each assessed the plan against either social, economic, cultural or environmental criteria.  A plan writer sat with each group to listen to the discussion and hear first-hand how attendees thought the Plan might be improved.  Written recommendations helped the plan writers to revise the next draft version.
 
The second workshop assessed the Preliminary Draft Plan before it was publically notified.  The purpose of this workshop was to assess how the plan writers had incorporated the recommendations from the first workshop into the Plan and if any further improvements were needed.  Again, plan writers sat with each of the four groups to hear this feedback.  
 

The third workshop assessed whether the recommendations made in the second workshop had been incorporated into the publically notified Preliminary Draft Plan.
 
As part of the public consultation, hearings were held by WDC in April 2016.  The hearing is currently adjourned and the Council anticipate handing the Draft Plan to the Minister on 1 August.  A further desktop Integrated Assessment will be undertaken on that version of the document, using the same criteria.
 

Benefits and outcomes of the Integrated Assessment

The overall feedback from the groups at the end of the workshops was overwhelmingly positive.  Participants were appreciative of the opportunity to directly give feedback to the plan writers.  The rating process was seen as a good way to stimulate discussion, build consensus, and provide substantive feedback to the writers.
 
WDC staff said that they found the Integrated Assessment process and outcome reassuring.
“The workshops were well run.  Attendees knew what was expected of them and they all had opportunities to contribute, thanks to the HiAP facilitators.  It was reassuring to see the results of the assessment come through and to see the scoring improve at each step.  We knew that we were going into our consultation phase with a robust policy document.”
– Rachel McClung, WDC Senior Policy Analyst
 
We found that the process of carrying out an integrated assessment and using a Health in All Policies approach yields many benefits.  As a linguistic exercise, the efforts put into clarifying the criteria resulted in the plan being explicit about that it can and cannot deliver.  We also learned a few lessons along the way which will enable us to refine the processes used in future integrated assessments.
 
You can read more about the Waimakariri Residential Red Zone Recovery Plan here; http://www.redzoneplan.nz/
 
For more information, contact Jane Murray, Health in All Policies Advisor at jane.murray@cdhb.health.nz, or Geraldine McGettigan, Health in All Policies Advisor at geraldine.megettigan@cdhb.health.nz

HiAP Partnerships

Tackling alcohol related harm works better if we work together

We know that the harms of alcohol extend beyond intoxication and alcoholism and include a range of negative health, social and economic outcomes that can’t be tackled effectively by any one agency.  That is why the Health in All Policy (HiAP) approach has been so important to the progress made in this area.

I’ve been working to reduce alcohol related harm in New Zealand for four years, the last three as the Canterbury DHBs Alcohol Harm Minimisation Co-ordinator in the Health in All Policies team.  This shows the DHB’s commitment to lead on the reduction of alcohol-related harm.  My role includes:-
  • working with the Medical Officers of Health on their input in to the development of territorial authorities Local Alcohol Policies (LAPs) across Canterbury
  • collaborating with Christchurch City Council, Canterbury Police and a range of alcohol stakeholders in the identification of local alcohol priorities and harm reduction opportunities and culminating in the development of an alcohol harm reduction plan for Christchurch
  • working within the local health system to engage patients around their alcohol use and prevent and reduce alcohol-related condition.
Across the alcohol harm reduction agenda the HiAP approach is also embodied in the relationships developed through the Alcohol Harm Minimisation Advisory Group (AHMAG).  AHMAG is a multi-agency advisory group facilitated by the HiAP team that links key alcohol stakeholders from a range of organisations, including the Christchurch City Council, Police, the Health Promotion Agency, ACC and commissioners and clinicians from across the health system.  In coming together we have a better chance of organisational alignment, and improved mutual understanding and respect across the various agencies’ alcohol harm reduction goals.
 
There has been a lot of positive momentum and support for policies and interventions that reduce alcohol-related harm in recent years, like the Sale and Supply of Alcohol Act and the new drink drive limit but we still have some way to go before the health and social impacts of alcohol lessen significantly. My hope would be that this positive momentum is maintained in to the future through increased national leadership on the issue, and partnership working and community involvement at a local level.
 
For more information contact Stuart Dodd, CDHB Alcohol Harm Minimisation Coordinator
Note Stuart is newly appointed as the Southern Regional Manager at the Health Promotion Agency, and can be contacted at s.dodd@hpa.org.nz

HiAP capacity building

2016 Pegasus Pacific Health Scholarships

As Chair of the Pacific Reference Group, I was privileged to award the 2016 Pegasus Pacific Health Scholarships to Pacific students currently undertaking a course of study in a health related field. Developing a Pacific health workforce is essential to improving the health status of our Pacific population and the health scholarships are a tangible way of supporting our students while they undertake their studies. The scholarships were established in 2005 and since that time, over 50 exceptional and aspiring Pacific health students have been presented with scholarships.
 
I believe a Health in All Policies approach must always be forward looking. How can we invest now, to reap the benefits later? How can we nurture the leaders we need, who have a deep understanding of the determinants of health?
 
This year Pacific scholarships were presented to seven students. One student is studying towards a Bachelor of Medicine and Surgery, two are studying towards a Bachelor of Health Sciences, two are training to be nurses, one is studying Human Services and one student is enrolled in the Master of Health Sciences / Bachelor of Nursing programme.
 
Two students who were presented with scholarships are Suli Robert Tuitaupe and Damaris Dekker.
 
Suli is the first Pasifika student to be enrolled in the Master of Health Sciences programme at the University of Canterbury, articulated with a Bachelor of Nursing from the Ara Institute of Canterbury. Suli is of Samoan descent and outside of his studies, is a fitness trainer at Les Mills. Suli extends an open invitation to members from his church and community to attend his Group Fitness classes. His career aspirations include helping our Pasifika community to lead happy, healthy and fulfilling lives.
 
Damaris is in her 4th year of study towards a Bachelor of Medicine and Surgery. Damaris is a member of the Pacific Health Professionals Student Association Committee and has acted as a mentor to help other Pacific students undertaking their first year of Health Sciences study at Otago University. Damaris’s summer studentship research looked at the rates of preventable hospitalisations for Pacific children under the age of 5 in comparison to non-Maori and non-Pacific populations in New Zealand.
 
To hear the students share their individual journeys was incredibly humbling and moving. Although they each faced different challenges along the way, the one constant for all the students was the support and love of their whanau.
 
I left the evening knowing I would hear more about these young Pacific leaders in the years ahead. The future health and well-being of our Pasifika population is in safe competent hands.
 
Samoan proverb:
O le ala i le pule, o le tautua (The pathway to leadership is through service).
 
For more information contact Tanya McCall – Manager HiAP team, at tanya.mccall@cdhb.health.nz

Pacific Scholarship Recipients 2016

From L-R back row: Amosa Tualamalii (health sciences); Damaris Dekker (medicine/surgery); Alice Mareko (nursing); Suli Robert Tuitaupe (health sciences/nursing).
From L-R front row: Mārie Hutana (nursing); Anshni Kumar (health sciences); Keriata Kurene (human services).

2016 HiAP participants in the Wellington School of Medicine Summer School

Early this year the University of Otago’s Wellington School of Medicine Summer School offered a course on Health in All Policies, attended by 32 people interested in learning about HiAP. This included 15 people funded by the World Health Organisation, from the Western Pacific Region member countries to attend.  The funding recognised the WHOs desire that all countries work toward making HiAP part of business as usual.
 
It was great to have such engaged participants from countries as diverse as Mongolia, Tonga, Australia and New Zealand. Over the three day course we worked in small groups to think about how to apply HiAP approaches in a range of settings.  Our group carried out a case study on ways to improve water quality in rural villages. In some Pacific countries the water treatment plants are community owned - this means the villagers are responsible for funding and maintaining this infrastructure. Often this system fails for a variety of reasons and there is not enough funding to ensure the task gets done.
 
We talked about how to incentivise villagers to do this work. It took several conversations to come up with a link to tourism- these days many tourists are willing to pay good money to have a ‘real life’ experience in a village setting, living with locals. Their desire for real life experiences does not extend to contracting water borne diseases though! If a village was able to offer certified clean water this would give them a clear business advantage in the tourism market.  And the income generated from tourism would be hugely beneficial to the villagers who are often living on the edge of poverty.

There are many other skills required to successfully offer such a tourist attraction. We discovered that the local chamber of commerce has funding to run financial management courses and small business skills training – but often can’t spend that money for lack of suitable projects.
 
Suddenly we realised that this was opportunity to work together in a classic HiAP ‘win-win’- villagers can access funding and training from the local chamber of commerce to develop a viable source of income from tourism. In so doing they gain the skills required to run the water treatment plant and a very strong incentive to do so. What started as a problem of improving water quality has been reframed as a community development programme where villagers are creating sustainable businesses that showcase the best of the Pacific to the wider world.
 
After the course, Dr Akauola has initiated discussions with the Tongan Ministry of Health and with Oxfam NZ – these agencies see real potential in this proposal and are seeking a development partner to make it happen.
 
Dr Anna Stevenson, Public Health Specialist HiAP team (anna.stevenson@cdhb.health.nz)
and Dr Siale ‘Akauola, Ministry of Health Tonga

“Health is made at home, hospitals are for repairs”

The call for a Health in All Policies approach is being heard in diverse and interesting spaces. Recently Nigel Crisp, an independent member of the House of Lords in London spoke to his peers saying: “The World Health Organization in Europe has said that modern societies actively market unhealthy lifestyles. 1

What if they actively marketed healthy lifestyles instead? How could we begin to build a health creating society, with all sectors working towards a healthy and resilient population? 1 2

You can read his speech where he outlines a long term vision for the future of a healthy society at BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6654 (Published 16 December 2015) Cite this as: BMJ 2015;351:h6654

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