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Is Victoria the pace-setter in health promotion?

It’s just over three years since COAG announced The National Partnership Agreement on Preventive Health (NPAPH), which is providing $872.1 million over six years from 2009-10, and is billed as the “largest investment ever made by an Australian Government in health promotion for healthy eating and physical activity”.

These recent job advertisements, for health promotion staff to be based on local government in Victoria, show that the money is starting to flow on the ground.

Boyd Swinburn, Alfred Deakin Professor and Director of the WHO Collaborating Centre for Obesity Prevention at Deakin University, has been involved in some of the Victorian planning under the agreement, and believes that Victoria is looking like the pace-setter.

More details of the agreement are at the bottom of this post or can be downloaded here. They show that the impact of the initiatives funded under agreement is scheduled to be assessed in June 2013 and December 2014.

I wonder if it will be possible to determine which approaches and which jurisdictions gave the most bang for buck?

***

Victoria: the place to watch?

Boyd Swinburn writes:

After a few years of behind-the-scenes planning, the National Partnership Agreement on Preventive Health is about to start making some waves.

The agreement marks a significant landmark in national health promotion efforts for a number of reasons, including that it will be measured for outcomes (which are detailed at the bottom of this post).

The agreement is also proving to be a useful catalyst for change – although some jurisdictions are being more progressive than others.

Victoria is probably at the forefront, using it as an opportunity to broaden our focus beyond the health sector. Funding has just been announced for over 90 new positions to be based in local government.

This is an important development because it recognises the potential of local government to help create health-promoting environments.

By contrast, some of the other jurisdictions, notably NSW, seem to remain focused on spending the money within health system.

This may prove not to be the wisest use of the funds, given most of the determinants of health sit outside the health system.

The other notable aspect of Victoria’s approach is that it is using the funds to invest in building a health promotion workforce and platform, rather than simply scattering the money between an assortment of small projects that are unlikely to create the systemic changes needed (as has happened in the past).

Victoria is trying to create what I call the “back of house” capacity that doesn’t normally attract political kudos because it doesn’t lend itself to political “announceables” and photo opportunities. I’m referring to things like workforce and leadership development, and monitoring and intelligence systems.

The varied approaches being taken by jurisdictions under the agreement are creating a fascinating natural experiment. We may end up with 8 different models under the agreement, and we will learn a lot from that heterogeneity.

No doubt we will eventually find that some of the money will have been wasted and invested in areas of low effectiveness.

Even at this relatively early stage, it seems that other jurisdictions could learn from the Victorian approach.

I spend a lot of my time looking at what is happening around the world, and it seems that few other places in the world are as well positioned as Victoria when it comes to health promotion.

We’ve got a great evidence platform from multiple community demonstration projects, we’ve got a state bureaucracy that ‘gets it’ and is driving it, and a minister that is clearly supporting it.

We seem to have one of those rare situations where the stars are all aligned for advancing community’s health in Victoria. (And did I mention that we’re recruiting….)

That said, we still lack strong national leadership for driving the broader policy framework, for example around food marketing and labelling.

Another huge challenge is how the Australian National Preventive Health Agency will integrate with the other activities and agencies working under the National Partnership Agreement on Preventive Health.

The social marketing for obesity prevention that we’ve seen around health out of Canberra has been largely safe, non-confrontational – and unlikely to be an effective use of public money unless it is much better connected with on-the-ground action and pushes the boundaries like the Quit campaigns did for smoking.

****

More details on The National Partnership Agreement on Preventive Health

It seeks to address the rising prevalence of lifestyle related chronic disease by laying the foundations for healthy behaviours in the daily lives of Australians through settings such as communities, early childhood education and care environments, schools and workplaces, supported by national social marketing campaigns (MeasureUp and an anti-smoking campaign).

The Prevention NP consists of 11 initiatives. More details about each initiative are available below.
1. Healthy Communities
2. Healthy Children
3. Healthy Workers
4. Industry Partnership
5. Australian Health Survey
6. Social Marketing – MeasureUp
7. Social Marketing – Tobacco
8. Enhanced State/Territory Surveillance
9. Workforce Audit and Strategy
10. Australian National Preventive Health Agency and Research Fund
11. Eating Disorders Collaboration

Through this Agreement, the Parties commit to:

(a)         support all Australians in reducing their risk of chronic disease by embedding healthy behaviours in the settings of their pre-schools, schools, workplaces and communities, by instituting programs across smoking, nutrition, alcohol, and physical activity (SNAP) risk factors which mobilise the resources of the private, public and non-government sectors;

(b)         work with the food supply and the food service sectors towards offering healthy choices and minimising choices high in fat, sugar or salt, and with the sport, recreation and commercial fitness sectors in efforts towards increasing physical activity in the community;

(c)         support behavioural change with public education by placing on a sustained and adequately resourced footing the national MeasureUP or other agreed social marketing campaigns that will be initiated until 2010 under the Australian Better Health Initiative, and administering this from a dedicated national preventive health agency, in order to alert, inform and educate Australians in the need for healthy lifestyles and in the resources and choices available to them for these purposes;

(d)         similarly supporting behavioural change with a national anti-smoking campaign achieving the evidence threshold of market saturation to effect further lowering of the national daily smoking rate, and also to be managed by the proposed national preventive health agency; and

(e)         invest in the evidence base necessary for effective prevention by instituting national programs in chronic disease risk factor surveillance, translational research, evaluation, a national collaboration in eating disorders, and a workforce audit, and establishing a national preventive health agency to inform best practice in policy design for preventive health as well as administering national social marketing.

The measures funded through this Agreement include provisions for the particular needs of socio-economically disadvantaged Australians, and those, especially young women, who are vulnerable to eating disorders.

The Agreement, consistent with the National Healthcare Agreement performance targets, will contribute to the following medium to long-term outcomes:

(a)         increase the proportion of children and adults at healthy body weight by 3 percentage points within ten years;

(b)         increase the proportion of children and adults meeting national guidelines for healthy eating and physical activity by 15 per cent within six years;

(c)         reduce the proportion of Australian adults smoking daily to 10 per cent within ten years;

(d)         reduce the harmful and hazardous consumption of alcohol; and

(e)         help assure Australian children of a healthy start to life, including through promoting positive parenting and supportive communities, and with an emphasis on the new-born.

The translation of these outcomes to the six year window of the Agreement is articulated in Part 4 – Performance Benchmarks and Reporting.

Outputs

The objectives and outcomes of this Agreement will be achieved by the delivery of the following programs/initiatives:

Healthy children

Initiative: States and Territories funded to deliver a range of programs:

(a)         building on existing efforts currently in place, while adapting them to suit demographic and other factors in play at various sites;

(b)         covering physical activity, healthy eating, and primary and secondary prevention;

(c)         in settings such as child care centres, pre-schools, schools, multi-disciplinary service sites, and children and family centres; and

(d)         including family based interventions, settings based initiatives, environmental strategies in and around schools, and breastfeeding support interventions.

Healthy workers

Initiative: States and Territories funded to facilitate delivery of healthy living programs in workplaces:

(a)         focusing on healthy living and covering topics such as physical activity, healthy eating, the harmful/hazardous consumption of alcohol and smoking cessation;

(b)         meeting nationally agreed guidelines for these topics, and including support for risk assessment and the provision of education and information;

(c)         which could include the provision of incentives either directly or indirectly to employers;

(d)         including small and medium enterprises, who may require support from roving teams of program providers; and

(e)         with support, where possible, from peak employer groups such as chambers of commerce and industry.

Initiative: Commonwealth to develop a national healthy workplace charter with peak employer groups, to conduct voluntary competitive benchmarking, supporting the development of nationally agreed standards of workplace based prevention programs, and national awards for healthy workplace achievements. Commonwealth, in consultation with the States and Territories, may consider taking responsibility for national employers in the future.

Healthy communities

Initiative: Funds will be provided to support the national roll-out of successful and effective community-based physical activity and healthy eating programs:

(a)         including the major initiatives of the national health non-government organisations, such as Heart Moves, Lift for Life and the Heart Foundation’s Walking Initiative;

(b)         focusing on disadvantaged populations and those not in the workforce;

(c)         through local government organisations, with states/territories participating in the identification of priority, high needs areas;

(d)         utilising resources currently available through the commercial fitness and weight loss sectors to facilitate the expansion of programs; and

(e)         with support from national level ‘soft infrastructure’ such as accreditation of programs and service providers, web-based directories, and recruitment strategies through primary health care and other pathways.

Industry partnership

Initiative: Commonwealth, in consultation with the States and Territories, to develop partnerships with relevant industry and non-government sectors to encourage changes in policies and practices.

Social marketing

Initiative: Commonwealth to fund a social marketing campaign to extend and complement the Australian Better Health Initiative campaign, and a national preventive health agency to oversee the campaign.

Initiative: Commonwealth to fund states and territories to complement the national social marketing campaign by providing reinforcing local activities.

Initiative: Commonwealth to fund tobacco social marketing through national level campaigns supported by state/territory funded complementary activities.

Enabling infrastructure

Initiative: Effective implementation and evaluation of the Partnership requires the establishment of ‘soft infrastructure’ including:

(a)         expansion of the National Nutrition and Physical Activity Survey to include individuals of all ages, Indigenous Australians and bio-medical measures;

(b)         a research fund with the aims of building an evidence base for future preventive health activities and the capacity for future research, and a focus on translational research;

(c)         a workforce audit and strategy to identify any gaps and options to resolve them;

(d)         an Eating Disorders Collaboration, to provide a national focal point for prevention, early intervention and best practice treatment strategies for disordered eating; and

(e)         a national preventive health agency: staffed with population health experts; with responsibility for providing evidence-based policy advice to health and other ministers interested in preventive health; tasked with administering social marketing programs and other national preventive health programs which it may be tasked with by Health Ministers; overseeing surveillance and research activities of a national nature; and with responsibility for stakeholder consultation.

Initiative: States and territories to implement a complementary system of more frequent health, nutrition and physical activity monitoring surveys, with leadership from the national preventive health agency.  This data will be provided for national aggregation and analysis in accordance with Minimum Data Sets and reporting protocols.

The Commonwealth, the States and Territories agree to meet the following performance benchmarks:

(a)         increase in proportion of children at unhealthy weight held at less than five per cent  from baseline for each state by 2013; proportion of children at healthy weight returned to baseline level by 2015.

(b)         increase in mean number of daily serves of fruits and vegetables consumed by children by at least 0.2 for fruits and 0.5 for vegetables from baseline for each State by 2013; 0.6 for fruits and 1.5 for vegetables by 2015.

(c)         increase in proportion of children participating in at least 60 minutes of moderate physical activity every day from baseline for each State by five per cent by 2013; by 15 per cent by 2015.

(d)         increase in proportion of adults at unhealthy weight held at less than five per cent from baseline for each state by 2013; proportion of adults at healthy weight returned to baseline level by 2015.

(e)         increase in mean number of daily serves of fruits and vegetables consumed by adults by at least 0.2 for fruits and 0.5 for vegetables from baseline for each state by 2013; 0.6 for fruits and 1.5 for vegetables from baseline by 2015.

(f)         increase in proportion of adults participating in at least 30 minutes of moderate physical activity on five or more days of the week of 5% from baseline for each state by 2013; 15 per cent from baseline by 2015.

(g)         reduction in state baseline for proportion of adults smoking daily commensurate with a two percentage point reduction in smoking from 2007 national baseline by 2011; 3.5 percentage point reduction from 2007 national baseline by 2013.

(h)         performance against benchmarks will be assessed at two time points: June 2013 and December 2014.

The baseline for these benchmarks will be the last available data at June 2009.

 ***

Update, 21 Dec: related items

A Victorian Health Department release on the local government initiative

Herald Sun on “gut busting teams to blitz Victorian towns

 

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