HiAP in action
Canterbury DHB
Health in all Policies

June 2014
Kia ora Claire, and welcome to the inaugural issue of the Canterbury Health in All Policies (HiAP) newsletter. This publication will invite readers to view HiAP in action: in Canterbury, across New Zealand, and overseas.

The most recent definition of HiAP, from the 2013 Helsinki meeting, 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." 

HiAP is being actively pursued in Canterbury. The 2010/2011 earthquakes made clear the need to work across sectors and organisations to support a ‘determinants of health’ approach to this unprecedented emergency and its consequences.

Our newsletter will provide information, updates, resources, links, and education opportunities. We will identify the challenges of working collaboratively, and show how these challenges are being addressed.

This issue has been sent to a wide range of people who may have an interest in HiAP. We encourage you to read it, pass it on to others, provide feedback, and consider making a contribution.  Please direct your comments to Allison Nichols-Dunsmuir or Anna Stevenson

Evon Currie
General Manager,
Community & Public Health,
Canterbury District Health Board

A healthy population brings economic and social benefits

The social, economic, cultural and physical environments in which people live their lives have a significant effect on their health and wellbeing. Although genetics and personal behaviour play a strong part in determining an individual’s health, good health starts where we live, where we work, and where we play. (Some add that health also starts ‘where we shop, learn and pray’).

Improving community health requires taking a broader view of the conditions that create health and wellbeing, from how we plan and develop our urban spaces and places, to the opportunities for employment, recreation, and social connection available to all who live in them.

The Christchurch City Health and Wellbeing Profile is a snapshot capturing information about Christchurch's population and the factors that influence their health and wellbeing. The Profile is a summary of the thoughts and feelings of the almost 700 people and organisations questioned. This information identified a range of issues that were important to creating healthy people and communities.

The Profile was created through the Healthy Christchurch interagency network led by staff from Community and Public Health (CDHB) and the Christchurch City Council.

Check out over 40 papers that have been written on key topics 

Helsinki Conference June 2013

The recent World Health Organization (WHO) sponsored conference in Helsinki Finland was focused entirely on Health in All Policies. The outcome of the meeting was the Helsinki Statement which will shortly be ratified by WHO member states.

The statement builds on the WHO constitution which emphasises government accountability for the health of people. In the context of HiAP, this is understood as ensuring that governments understand the impact of their policy decisions on people’s health and undertake to promote good health through their policy.

The statement calls on governments to fulfil their obligations to their peoples’ health and well-being by taking the following actions:
  • Commit to health and health equity as a political priority by adopting the principles of Health in All Policies and taking action on the social determinants of health.
  • Ensure effective structures, processes and resources that enable implementation of the Health in All Policies approach across governments at all levels and between governments.
  • Strengthen the capacity of Ministries of Health to engage other sectors of government through leadership, partnership, advocacy and mediation to achieve improved health outcomes.
  • Build institutional capacity and skills that enable the implementation of Health in All Policies and provide evidence on the determinants of health and inequity and on effective responses.
  • Adopt transparent audit and accountability mechanisms for health and equity impacts that build trust across government and between governments and their people.
  • Establish conflict of interest measures that include effective safeguards to protect policies from distortion by commercial and vested interests and influence.
  • Include communities, social movements and civil society in the development, implementation and monitoring of Health in All Policies, building health literacy in the population.
To have any chance of achieving these ambitious goals there will need to be ongoing capacity building in all sectors. The presentation on building professional capacity for using a Health in All Policies approach by Ilona Kickbusch is very worth your time. 

The Kiwi connection to Helsinki

New Zealander Dr Doone Winnard attended the Helsinki conference. A highlight of the conference for Dr Winnard was meeting and learning from Carmel Williams and continuing that journey when she came to (the University of Otago Wellington) Summer School in February 2014.

"Carmel's very grounded approach really challenges health people to get over themselves and actually really work ‘with’ other sectors, not ‘on’ them, to achieve their goals as well as health goals is a call to action for all of us I think.”

Carmel Williams leads the HiAP work being done in South Australia Health, in partnership with colleagues from across government and other relevant agencies. More on the South Australia approach can be found here.

Te Pae Mahutonga

An indigenous framework for health promotion

Te Pae Mahutonga offers an integrated thinking approach and useful way of framing questions that can support many areas of work. It was developed in the late 1990’s by Sir Mason Durie. The original article was published in the Health Promotion Forum of New Zealand Newsletter. 
Te Pae Mahutonga (TPM) supports the vision of a thriving, prosperous community through the image of the Southern Cross which represents the health promotion goals of environmental protection, healthy lifestyles, active participation in civil society and secure cultural identity. The two southern pointers represent leadership and self-reliance – communities taking responsibility for themselves.
The Canterbury Health in All Policies team has been actively committed to using Te Pae Mahutonga. Examples include:  Sir Mason Durie recently presented at a seminar in Christchurch (Maori in the 21st Century, Platforms for Social Transformation), and we were able to show him some of these resources and how we have used them.  He was generous enough to autograph a team copy!
For more information about how to use Te Pae Mahutonga in your daily work refer to the Christchurch City Health Profile on the Healthy Christchurch website  (page 56) and/or make a time to meet and or contact a member of the Health in All Policies team.

People not car parks!

20th Canterbury Regional Active Transport Forum - 1 March 2014

The Canterbury Active Transport (CAT) Forum was set up to encourage information sharing and cross-sector action in Canterbury between agencies with an interest in active transport, including representatives from such sectors as education, environment, health and disability, recreation, sport, tourism, transport and local and national government.

The Forum is one example of a HiAP mechanism. The relationship between active transport and public health is well documented: physical activity is one of the most recognised determinants of health. 

Active transport is also an example of the complexity of working across sectors, for instance: understanding the decision-making processes of different organisations; community engagement processes; district and local government planning; economic development; and demographics.

Recently, Dr Anna Stevenson, public health physician with Community & Public Health, chaired a CAT Forum attended by over 100 people. Presentations from the forum can be found here.

Joint Work Plans and HiAP 

A joint work plan identifies key milestones and current priority activities that affect public health that we can (or already are) working on together. In many instances the activities will also involve other organisations that each of our organisations work alongside, often in tandem.  

A joint work plan between organisations encourages strong relationships at different levels and helps to develop a better understanding of each others business, drivers, roles, responsibilities and constraints.  The approach also helps to realise opportunities to enhance ways of working together and improve work effectiveness.  Understanding the influence of social, economic, environmental, and cultural factors upon health and wellbeing are also deepened.  

The ultimate health outcome of the joint work plans are that wider health determinants of the Canterbury public are considered in strategic policy planning, project development and decision-making processes.

Health Impact Assessment 

The Air Plan Review

Health Impact Assessment (HIA) is a tool that translates the Health in All Policies (HiAP) principles into action.

HIA is a formal process that identifies and systematically assesses the impacts of decisions made in other sectors on population health and wellbeing.  The process is most effective when conducted collaboratively, with government agencies, organisations, and stakeholders working together take a health determinants-based look at a proposed policy or project and identify ways to minimise or mitigate any negative health impacts.

Members of the HiAP team at Community & Public Health are currently working with Environment Canterbury (ECan) on an HIA of ECan’s Air Plan.  The Air Plan, which sets out the regulatory approach for managing air quality in Canterbury, is undergoing a review this year to investigate progress towards meeting the National Environmental Standards for Air Quality.  Approximately 80% of emissions in Christchurch are from wood burning appliances used for home heating.  The HIA is specifically considering the potential health impacts of any additional requirements for households to upgrade wood burning appliances or move away from burning wood to other forms of heating.  

In April 2014, the HIA has already completed:
  • a household survey to identify the population using wood burners in Christchurch and the level of insulation in homes
  • a heating options report summarising the capital costs for installing heating types and ongoing operational costs to heat the home to achieve a healthy temperature
  • a literature review of the health impacts associated with cold and otherwise unhealthy homes, and how these impacts affect vulnerable populations, such as the elderly, families with young children, low income and unemployed, people with chronic illness, and Maori and Pacific households
  • an analysis of household survey data to estimate the current level of fuel poverty in Christchurch, as well as the impact of a wood burner ban on fuel poverty levels within the general population, and for the key populations groups.

We will post a link to the final Air Review HIA report when it is issued. Other example HIAs that have been completed throughout New Zealand can be seen here.

The relevance of the Local Government Act to HiAP?

Local government is one of the most important and powerful influences on the health and wellbeing of communities and populations. 

A recent ‘think piece’ developed through the Public Health Association canvassed the linkages between public health and local government.

Over the past decade the Local Government Act (LGA) 2002 has  had a number of amendments. The most relevant change in the 2012 review was the removal in the ‘purpose’ of the need for local government to take actions on broad social, economic, environmental and cultural objectives. The updated purpose focused on meeting current and future needs of communities in regard to quality local infrastructure, local public services and regulatory functions.

To protect the work of HiAP so that legislative changes such has this have limited impact relies on strong and enduring relationships. Local government will always at some level concern itself with broader wellbeing issues we in HiAP need to understand how to engage with changing language and focus, we also need to find ways to make a positive contribution. 

The HiAP team in Community & Public Health worked over time to ensure that local and regional government sees health as a very important outcome and therefore looks for opportunities to engage around health and wellbeing. Some examples of this are working to develop joint work plans, undertaking joint health impact assessments, developing a formal HiAP partnership, seeking early input into draft annual district plans and sharing workforce development opportunities.

River of Flowers - Te Waitohi Maumahara

The River of Flowers is an event that commemorates the February 22nd earthquake. It provides an opportunity for people to connect or reconnect with their communities, to share their experiences and hopes for the future, and to look positively towards the future.

The River of Flowers concept was born on 22 February 2012, led by Healthy Christchurch and the Avon-Otakaro Network (AvON).

Local sites are hosted by local community organisations, supported and provided with resources and promotion. 
This year, there were 15 River of Flower sites along the Avon, Heathcote and Liffey rivers, and one at the estuary. Over 5000 people took part in the hosted period across all sites. The civic ceremony was held in conjunction with the River of Flowers for the first time at the Botanic Gardens, and Canterbury University was also a new participant.

Three years after the 2011 quake, the sites continue to be needed and hosted by local community groups and schools who make the event their own to reflect their community. 

We asked the site hosts how long we should be supporting this event, the overwhelming response was ‘for as long as it is needed’.

“Throwing my flower into the river… is for me, letting go for a few moments of the sadness, trauma, loss, and worries about the future. It feels healthy to me, and I like that.” - Participant 2014.

Introducing the CDHB Health in All Policies Team

Further Reading


Christchurch City Health Profile – a way to know your communities and make the connections to health and wellbeing Christchurch city health and wellbeing profile: 2012. 2012. Christchurch: Canterbury District Health Board.

Health in All Policies at Canterbury District Health Board  
A series of Information Sheets on HiAP, developed at the time when the CDHB HiAP team was being established

A humorous look at how health and planning can work together to create healthier and sustainable neighbourhoods.
Health Girl and friends: From here to equality. National Health Service of Scotland, Glasgow Centre for Population Health. 2010.
The link between healthy lives and physical activity; international examples with excellent graphics
Active by Design: Designing places for healthy lives: A short guide. 2014. The Design Council. UK

Next issue

Health in All Policies is really about health and wellbeing in all policies. Wellbeing is predicated on people participating in their communities.  Where there are barriers to participation in the built environment, a HiAP approach is the way to go to make improvements. 

Watch for our August issue to find out more about what is being done to ensure that the rebuilt Christchurch is a great place for all people, regardless of age or ability.
Also, coming in August: Christchurch as one of 100 worldwide Resilient Cities: The challenges of resiliency, health promotion, whanau ora and sustainability. 
Copyright © 2014 Community and Public Health, All rights reserved.

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