Canterbury Health in All Policies Newsletter
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Canterbury Health in All Policies Newsletter
December 2016

Sharing information – learning from each other

 
This issue of the Canterbury Health in All Policies Newsletter is brought to you by the letters D,E,E & T, which stand for Determinants, Evidence, Equity and the Treaty of Waitangi. All of these are crucial to achieving healthy public policy.
 
This newsletter showcases some of the ways we provide information to support increased understanding of DEET. As part of highlighting DEET in this newsletter we’ve been a bit over generous in our use of capital letters – apologies in advance!
 
We hope you enjoy our newsletter, pass it on to others who may be interested, and feel free to provide us with feedback.
 
I hope you have a restful break,
 
Evon Currie
General Manager, Community and Public Health

Broadly Speaking Workshops

Since 2013, Community and Public Health has delivered a training workshop called Broadly Speaking, designed to build capacity within the health sector and across other sectors about the social Determinants of health, the first and essential component of DEET.

The course introduces the idea that many factors affect an individual’s health and wellbeing: genetic, behavioural, social, economic, cultural and environmental. Some are easier to change than others, and many are dependent on causes outside an individual’s control. Most of the factors sit outside of the health sector itself. 

The course was conceived and developed within the CDHB, and was initially rolled out to all staff at the Public Health division. Now the course has attendees from right across the CDHB, the wider health sector, and local and regional government. This broad mix of attendees brings a richness to the conversations and knowledge building that occurs over the two mornings the course is held.

The last session of the course enables people to work on a particular project they will use to implement what they have learned. Feedback from participants helps us to know that learning is happening and we are providing them value for their time and input.

We’ve received some great feedback from participants, such as:
  • ‘Excellent course. Refocused my awareness of the social Determinants of health. Great to add the big picture to the day to day interface with people’.  Health Service Manager
     
  • ‘Attending this course gave me an overview and understanding about health Determinants in relation to my work.’ CCC, Strategy and Planning.
We are continuing to offer Broadly Speaking at least three times per year, and welcome anyone who wishes to attend – from throughout New Zealand. There is currently no course fee for those in the CDHB region; others may attend by negotiation.

For further information and course dates please email Megan Bryce.

Issue Papers

 
CPH also helps to provide an ‘Evidence base’ to make it easy to find succinct information on key public health issues, the first ‘E’ in DEET.  The topics for our City Health Profile Issue Papers were prepared to support the findings of the Christchurch City Health and Wellbeing Profile. The Profile’s community consultation process highlighted the need for information on the topics that were important for creating healthy people and communities. These issues were analysed and over 40 individual papers were developed and published in 2012.
 
The purpose of Issue Papers is to provide background information on each issue, along with recent data and Evidence-based solutions with a particular focus on Equity, the second ‘E’ in DEET. The papers are intended as a starting point for people, enabling them to learn something about these issues. Links to more detailed information are provided for those who require more in-depth material. They are easily accessed and easily understood by the community so they can be used for action, for submissions, for planning guidance, etc. Papers are grouped according to topic, in line with the Te Pae Mahutonga Māori model of health promotion, respecting the Treaty basis of our work.
 


The HiAP Team has been busy updating the issue papers, which can be found on the Healthy Christchurch website:
  Work is ongoing to update the remaining papers so check the website often. We’ll also post on the Healthy Christchurch Facebook Page when we upload more.

Sharing our story with Public Health Physicians


The annual scientific meeting of the New Zealand College of Public Health Physicians was held in Christchurch in October 2016, which included a session on healthy and sustainable cities.

Canterbury Health in All Policies partnership (CHIAPP) leaders Christchurch Mayor Lianne Dalziel; CDHB chief executive David Meates; Environment Canterbury chief executive Bill Bayfield; and Ngai Tahu CEO Arihia Bennett presented how we are working together to focus on sustainable development for our community.

All four spoke clearly and passionately about their commitment to health Equity, bringing an indigenous peoples lens to the cities rebuild, and putting the community, the people, at the centre of the city’s activities. They spoke of how working in partnership was not always easy or conflict-free, but resulted in outcomes for their organisations and the populations they served that were qualitatively and quantitatively better – the grazed knees were worth it!

Feedback from the audience was overwhelmingly positive. Several people commented on the apparent strength of the working relationship between these leaders and afterwards there were many questions about how this was achieved.
David Meates, Lianne Dalziell, Arihia Bennet, Phillip Howden-Chapman, and Bill Bayfield
‘Good things take time’ - the Health in All Policies approach in Canterbury has been in action for over a decade now and it is at events like this that we can see how much progress we have made. It always feels like there is so much more that can be done - so much more that needs to be done. It is good, however, to take the time to acknowledge how well we are doing and celebrating that!

You can find out more about the CHIAPP on our webpage. 
 

Urban characteristics & non-communicable diseases

A Rapid Evidence Review

Our colleagues in the Community and Public Health Information Team support the HiAP team by providing literature reviews, data and evaluation services. The latest publication considers the association between urban characteristics and non-communicable diseases. Have a look as it may help you to draw on up to date information – Evidence - when supporting the aim of healthier public policy.

According to this rapid Evidence review:

"In Aotearoa New Zealand, non-communicable diseases (NCDs) are the leading cause of health loss and contribute to significant inequities. As many of the risk factors for NCDs are modifiable to some extent, there is substantial opportunity for NCD prevention through effective population health interventions. The physical (natural and built) and social environment are Determinants of health with the potential to impact health and Equity through influencing behaviour and safety. As the majority of the New Zealand population lives in urban areas, creating urban environments that support health will impact a large number of people." 

Canterbury Wellbeing Index - a plethora of info!

The Canterbury Wellbeing Index was developed by the Canterbury Earthquake Recovery Authority (CERA) with the support of multiple agencies to track the progress of social recovery in greater Christchurch following the 2010 and 2011 earthquakes. Indicators are used to identify emerging social trends and issues to enable agencies to respond in a timely way.

The Canterbury Wellbeing Index is also prepared to provide the greater Christchurch community with accurate and comprehensive information about social recovery. With the disestablishment of CERA in April 2016, social recovery monitoring was inherited by the Ministry of Health and delegated to the Canterbury District Health Board (CDHB), which is now responsible for producing the Canterbury Wellbeing Index and Canterbury Wellbeing Survey (formerly CERA Wellbeing Survey). We'll have more on the Survey in the next HiAP Newsletter).

The Canterbury Wellbeing Index has been published annually since 2013 and includes the following topic sections:
  • participation in education
  • educational achievement
  • employment outcomes
  • household income
  • housing
  • keeping well
  • mental wellbeing
  • risk factors
  • offending patterns
  • child abuse and neglect
  • arts
  • sports
  • emergency preparedness
  • social connectedness
  • civil participation
  • population.
Current and past results can be accessed on the Community and Public Health website. 

The Index differs from the Issue Papers in that the content is framed around earthquake recovery in greater Christchurch and it is updated annually as a complete volume.

The 2016 Canterbury Wellbeing Index shows that there are many signs of progress in the community’s recovery as the region moves beyond the fifth anniversaries of the 2010 and 2011 earthquakes. As the earthquake recovery continues, ongoing efforts need to be made to identify emerging social trends and to monitor Equity to inform the actions of local and national agencies.

HiAP Elevator Pitch

By Dr Julianna Lees
As a new recruit to the Health in All Policies (HiAP) team, one of the challenges of the job was succinctly describing to friends and colleagues exactly what a “HiAP” approach entails. Thankfully, over the last few months my ability to give “an elevator pitch” describing our work and the reasons for a HiAP approach has improved. As many of my team mates often say, our work involves “meddling in other people’s policies” to ensure health outcomes are considered and risks to health and wellbeing are addressed. Nowadays a short elevator ride is not a problem!

I have come to appreciate in a new way that no single agency, community group or profession is responsible for health outcomes. Strong relationships and networks, particularly across agencies are crucial. And of course, for these relationships to function well and enable collaboration, we must aim to understand and acknowledge the differing responsibilities, roles and tensions placed on other agencies.

A HiAP approach has also reinforced for me that health starts in our homes, schools, workplaces and with our whanau and communities. Healthcare services, while crucial, do not address the wider social and environmental factors that impact our health. Consequently, the way in which many of us conceptualise “health policy” must change. Health policy needs to be seen more broadly than just that which impacts on health services.

To quote Professor David Williams of the Harvard School of Public Health:

“… housing policy is health policy. Educational policy is health policy. Anti-violence policy is health policy. Neighbourhood improvement policies are health policies. Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.”

Working at the interface of public health & disability

 

In 2013, Community and Public Health identified an opportunity to actively influence the social Determinants of health for our disabled population. We have worked to:
  • understand the particular barriers and obstacles to positive health and social outcomes created by disability
  • gather relevant resources and Evidence, and make them available
  • form relationships with the disability sector
  • provide advice and make submissions using a ‘disability lens’
  • encourage opportunities for people with disabilities to have their voices heard
  • advocate for a Canterbury rebuild that incorporates a ‘universal design’ approach.
This work has been boosted by the 2014 Enabling Health report by VicHealth  (which includes the graphic above). The graphic resonates with public health practitioners who recognise the adaptation from Barton and Grant’s Health Map.

It also is very useful in explaining to people why we are working across sectors and settings. For CPH, it gives a mandate, a rationale, and a call to action. Finally, it helps to show health colleagues that while health services themselves are important, health outcomes are also influenced by much broader factors.  

We have collected interesting and informative reports, articles and videos about disability, which live in the ‘Building for All Portal’ on the Healthy Christchurch website.

Effective Submissions 

Fundamental to HiAP work is ensuring that health and wellbeing is a key focus for proposed policy and projects. The HiAP team devotes a significant proportion of its time influencing public policy and this includes submitting on local and national government consultations.

During 2016, Community and Public Health reviewed its own submissions and submission processes to identify critical areas for development. The HiAP team recommend the following be taken into consideration when writing effective submissions.
  • All submission points must be clear, concise and Evidence based.
  • Decide the level of support for the proposal. Is the purpose to support or oppose something in its entirety or to recommend specific changes?
  • Submission points should be within the scope of the consultation itself otherwise it may difficult to affect change, especially if the submission points are better suited to another proposal, another organisation, or another stage of development.
  • Recommendations must be clear and specific about what areas of a proposal could be improved and include the reasons why. Offer solutions rather than just highlight problems.
  • Long lists of recommendations should be set out in priority order for the consulting organisation to understand what needs to change immediately and what could be changed at a later date.
  • Your comments, suggestions and recommendations should be linked to the goals of the consulting organisation. This requires you to have a good understanding of the organisation’s objectives. You may express the view that the proposal will not support their own objectives, why, and what you recommend instead.
  • Make sure you fully understand, and refer to, the role of the consulting organisation, their statutory obligations, and ‘how things work’. For example, there is little point in making recommendations to a local authority on matters that are legislated nationally.
  • Use the consultation period to network with other like-minded agencies. How can agencies best support each other’s submissions?
  • Identify whether there will be opportunity to engage with the consulting organisation on early drafts of subsequent consultations.
  • Understand your own sphere of influence. What is the best way to make a difference?
 
At the end of the submission process, it can sometimes be difficult to identify the effectiveness of the submissions. It is often unclear whether changes made to a proposal are due to the influence of any one submission, or whether the consulting agency has been influenced by other groups. Conversely, failures to influence change will likely be due to multiple factors.
 
Despite these challenges, it is important to keep a record of the outcome of any consultation you are involved in. This will help you to see what results you are getting on various topics and approaches. It is also useful to scan the published submissions made by other submitters, to identify the positions of other organisations. You may be surprised to find new allies, new perspectives, and new ways to positively influence the social Determinants of health

New Smokefree Social Housing Toolkit

A smokefree social housing policy can result in wins for tenants, housing providers, and the wider community.

While the successful introduction of smokefree social housing policies requires commitment, research and experience shows it's achievable.

Community and Public Health (as a member of Smokefree Canterbury) has developed a Toolkit to assist social housing providers to implement smokefree policies in social housing settings.

The Toolkit draws on recent findings from the Christchurch City Council’s smokefree social housing initiative and from other studies conducted overseas.

You can find the toolkit on the Smokefree Canterbury website.

We're always stumbling across things we'd like to share...

Taking active transport & the built environment to the next level

For their new headquarters, global bicycle component manufacturer SRAM Corporation selected a 72,000 square foot space spread across a single floor in Chicago’s burgeoning Fulton Market District. The new office design caters to the staff’s already robust bike commuting habits, through elements such as a bike storage facility, bike wash station, locker rooms with showers and laundry, and bike mounts at individual workstations. The Perkins+Will design team turned the large floorplate into a 1/8-mile bicycle test track that winds through the entire office, connecting co-workers and facilitating product testing. Height-adjustable desks for all employees as well as strategically located communal spaces further encourage movement throughout the floor. An open-air terrace functions as an all-day working and social space, providing staff with a place of respite and natural light. The new headquarters design supports a fun, active, high-performance environment, which connects employees and reinforces SRAM’s unique office culture.

For more information and to peruse a great website, go to https://centerforactivedesign.org

A(nother) great TED talk

Jeff Speck on walkable cities – he builds an excellent argument and is very entertaining.
Jeff Speck: The walkable city
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