HEALTHY TASMANIA FIVE YEAR STRATEGIC PLAN FEBRUARY 2016

COTA TAS INC

COTA TASMANIA

About COTA Tasmania

COTA Tasmania (Council on the Ageing [Tas] Inc) is a not-for-profit organisation, operating as a peak body for a wide range of organisations and individuals who are committed to encouraging our community to think positively about ageing. This involves promoting and encouraging social inclusion and championing the rights and interests of older Tasmanians.

The vision of COTA Tas is for an inclusive societywhich values, supports and respects older people.

For further information or advice regarding the content of this document please contact:

SUE LEITCH

Chief Executive Officer

COTA Tasmania

‘Westella’

181 Elizabeth Street

HOBART TAS 7000

Phone: (03) 6231 3265

Mobile: 0448 281 897

Email: suel@cotatas.org.au

Su

stainable

Inf u

entia

l

COTA

Voice of older Tasmanians

Relevant

Representative

Networked

COTA Tasmania appreciates the opportunity to respond to the Healthy Tasmania Five Year

Strategic Plan – Community Consultation Draft.

Older Tasmanians are significant users of the health system and a large and growing section

of the community in Tasmania. The needs of this section of the community should be given

careful consideration in the design of the health system, its operation and evaluation.

Introduction

Traditional views of our ageing world that see ageing as a considerable economic burden for

governments around the world are being challenged on many fronts; locally, nationally and

internationally. The World Economic Forum states that older people are a “highly significant

and underutilised resource to their community” and the key to this is through health. This is

not only through their voluntary contributions to society and caring roles, but also through

longer working lives in paid employment. Investment in health for older people can have

productivity gains for communities. 1

2

It is true that older people use more healthcare than younger people and that the number

and proportion of older people in the population is increasing. However, it is possible that

aggregate health costs are determined by factors that are independent of the age structure

of the population, and that the age structure merely defines the distribution of

predetermined expenditures.3

1 S. J. Olshansky, J. Beard and A. Borsch-Supan, (2012) “The Longevity Dividend: Health as an Investment” Chapter 11, pages 57-60 in Global

Population Ageing: Peril or Promise? World Economic Forum 2 P 17 P 99-100, World Health Organisation, (2015) World Report on Ageing and Health

3 Medical Journal of Australia 7 June 2004, Ageing and healthcare costs in Australia: a case of policy-based

evidence.

In light of this, COTA Tasmania endorses investment in programs that benefit the whole

Tasmanian community and seeks acknowledgement by the Tasmanian Government that

specific investment in healthy ageing will be of benefit to the whole of Tasmanian society.

A commitment to healthy longevity and long term outcomes is a challenge but critical if the

worthy aspirations outlined in the strategy are to be achieved. Implementation will require

multiple solutions, flexibility, innovation and a commitment to real engagement with the

Tasmanian community to identify solutions and adapting to local conditions. Higher levels

of health literacy and access to programs that support individual actions to improve health

outcomes will be equally significant.

The body of our submission that follows aims to provide constructive input to aid the

effective implementation of the Healthy Tasmania Strategy. Our comments draw on

international and national literature, input from our Board and Tasmanian Policy Council

members and feedback from older Tasmanians.

1. Data Improvements

Improving our decision making with fine-grained data

COTA Tasmania notes that the Healthy Tasmania Strategy draws together useful data on the

state of Tasmania’s health at the macro level. This data provides a valuable starting point.

Naturally, segmented data is required to develop plans to address these macro patterns at

the community level. COTA Tasmania strongly recommends that data in relation to older

Tasmanians is collected and reported in a disaggregated manner. All too frequently we see

data for the 60 or 65 plus age groups shown together as one group. Combining data for

people in their 60’s, 70’s, 80’s and even 90’s can conceal patterns that exist within sub-sets

of these age groups. For example, the Health Indicators Tasmania 2013 document reports

the health profile of the Tasmanian population 60 Years and over notwithstanding the fact

that the document states the following:

The size of the seniors’ group, which in Tasmania is calculated from 60 years of age, covers a

period of potentially 30+ years – the largest size of all age related cohorts. It effectively

covers a generation – the same period as the childhood, adolescence and young adulthood

periods combined. As such the seniors’ cohort is heterogeneous in age; interests; abilities;

(physical, mental, cognitive, emotional, and functional); health and wellbeing; and health

service needs – for disease prevention, illness management and to end of life requirements.4

Few would suggest combining data for people in their 20’s, 30’s, 40’s and 50’s and will

readily accept that there will be significant variations in health across these age groups.

Health status also varies for people in their 60’s, 70’s, 80’s and 90’s.

4 DHHS, Health Indicators Tasmania 2013, P 164,

COTA Tasmania’s Facing the Future report breaks down demographic data into the young

old (60- 74 years), mid old (75-84 years) and older old (85+ years) groups.5 We recommend

that future collection of data, analysis and reporting of data reflects this breakdown to

improve decision making and monitoring of performance around preventative health

decisions. Such a measure would also help to tailor age appropriate messages and

communication mechanisms regarding preventative health and necessary behaviour

changes.

Geographic and local area data

Similarly, the ability to capture data to support local/regional decision making is equally

critical to the long term success of Healthy Tasmania strategy. Aggregate data, even at the

regional level, averages measures without providing any insight into which particular groups

are most at risk or in greatest need of resources and intervention. If we are to tackle health

issues effectively and efficiently we need to address the apparent lack of detail in the

available data and engage local communities in this process.

Data Partnerships

As the strategy document points out success must include the identification and targeting of

risk factors and a commitment to delivering evidence based services and programs. Sound

evaluation of existing and new programs and sharing of lessons learned from region to

region will dramatically enhance our chances of refining and improving programs over the

medium to long term.

COTA Tasmania is encouraged by the expansion of HealthStats into the preventative health

space and recommends that the model adopted in the United Kingdom that delivers the

Older People’s Health and Wellbeing Atlas is worthy of review as an example of a system

that provides rich comparative data to assist planning and evaluation.

http://www.wmpho.org.uk/olderpeopleatlas/

Co-ordination of data partnerships across Tasmania that facilitate the collection and sharing

of data between regions and agencies would also be invaluable.

COTA Tasmania strongly recommends

Appropriate resourcing that will facilitate the collation and analysis of detailed health

data.

Data collection and analysis that separately identifies the young old (60- 74 years),

mid old (75-84 years) and older old (85+ years) groups, and

5 COTA Tasmania, Facing the Future, A Baseline Profile on Older Tasmanians, 2013

Engagement of local communities in the collection of more detailed data at the local

and regional level.

2. Commissioning Models

The objective of bringing different groups and sectors together to support communities and

individuals to have greater control of their health and wellbeing will be of benefit to

communities and the system as a whole in Tasmania. To ensure that such partnerships are

effective COTA recommends that the commissioning model addresses the following points:

Preventative health must be resourced appropriately and over the long term.

Making the best use of available resources is important, but without a long term

commitment to appropriate levels of resourcing for preventative health (5% of

budget) the system will not be able to deliver the outcomes desired.

Evaluation measures and processes must be carefully designed to reflect long term

objectives not just short term outcomes.

Shared identification of strategic health targets for each community between the

government and the community are also fundamental to success. Health targets

should reflect both health and wellbeing as identified in the strategy document, not

just an absence of disease.

Real partnerships with and between community organisations, government at all

levels, local businesses and community members will be essential and the

commissioning model should reflect the value placed on such partnerships.

The engagement of the community through the adoption of a co-design approach

will underpin confidence and community buy-in to the plan and its implementation.

Flexibility in the implementation of actions to deliver on the community’s health and

wellbeing targets and a capacity for risk and failure that underpin innovative

approaches will also be key drivers of long term success.

The commissioning model must be responsive and timely and ensure there is

adequate flexibility in the system. Equally the model must accommodate the long

term nature of the behavioural change that is required to deliver the health

outcomes sought. There is a potential tension between the notion of ‘best-buys’ and

the long term commitment required to raise community awareness of health issues;

facilitate learning; identify and address barriers to change and ensure that behaviour

changes are sustainable. The system that supports the strategy needs to reflect the

long term nature of the objectives and Government must make a commitment to

supporting the priorities identified in local communities.

3. Short term versus the long term: what does the best health outcome mean?

There is some ambiguity in the strategy around how the best health outcomes for the

community are to be defined. There also appears to be a long term remit with a short term

funding structure.

The strategy discusses the notion of a ‘best buys’ approach where future programs will

target those at most risk and a cost benefit analysis tool to help identify at risk groups. Care

needs to be taken to ensure that this approach does not lead to a system that addresses

short term needs at the expense of longer term benefits. The parameters used in the cost

benefit analysis must extend beyond the typical 5-8 year period for return. Preventative

health initiatives can require longer time frames to deliver real results for what are often

deeply embedded social and economic problems. Tasmania’s health system must have the

capacity to focus some programs on the long term horizon.

As our community continues to age the focus of preventative care must include quality of

life and a capacity to maintain independence. Increased wellbeing during our longer lives

has both a social and economic benefit. Tasmania’s ageing community is not unique and

there is much to be learned from others both nationally and internationally.

The WHO World report on Healthy Ageing suggests that “....focusing primarily on older

people’s intrinsic capacity is more effective than prioritising the management of specific

chronic diseases. This is not to reject the worth of disease management but rather to

underscore that it is an older person’s physical and mental capacities that should be the

targets of ... health interventions. Approaching older people through the lens of intrinsic

capacity and the environments in which they live helps ensure that health services are

oriented towards the outcomes that are most relevant to their daily lives. It can also help to

avoid unnecessary treatments, polypharmacy and their side effects.”6

COTA Tasmania recommends a focus on people’s intrinsic capacity in health program

design.

6, World Health Organisation, World Report on Ageing and Health, 2015, P 99-100

7

4. Health in all Policies Approach

COTA Tasmania supports a health in all policies approach. It is well established that health

is determined not only by our personal characteristics but also by the environment and the

social setting into which we are born and live.

“Age-friendly environments foster health and well-being and the participation of people as

they age. They are accessible, equitable, inclusive, safe and secure, and supportive. They

promote health and prevent or delay the onset of disease and functional decline. They

provide people-centred services and support to enable recovery, or to compensate for the

loss of function so that people can continue to do the things that are important to them.”8

If we accept this premise, then it is clear that a holistic and integrated approach to policy

that impacts on the health of our community is required.

Healthy communities encourage incidental exercise, foster social connections, provide

adequate and accessible public transport, address social isolation and provide health

literacy support.

7 World Health Organisation, World Report on Ageing and Health, 2015, p 100

8 World Health Organisation, Age Friendly Communities

“Social networks, family support; and economic, social and cultural participation promote

wellbeing, recovery and effective self-management.”9

Integrated policies within government and linked up thinking fostered by a health in all

policies approach will add value to the implementation process. However, successful

implementation of a health in all policies approach will require leadership and appropriate

information outlining the rationale and benefits together with support tools to aid the

process across agencies where health impact assessments will be a new process.

There are many areas for action that are recognised in the social determinants of health

discussions. However, COTA Tasmania believes strongly that safe, secure and affordable

housing is critical for the health and wellbeing of the Tasmanian community. National and

international research confirms that multiple interactions between health and housing.10

Homelessness and poor physical environments at home exacerbate health issues within the

community and this is a key area for action that will directly underpin achievement of the

objectives of the Healthy Tasmania Strategy.

COTA Tasmania supports the recommendations of Shelter Tasmania in respect of

housing and health.

COTA Tasmania supports a health in all policies approach and recommends the

appropriate resourcing to support the implementation across government agencies.

It is important to remember that vertical collaboration between governments is equally

critical. Local Government has a significant role to play in creating healthy environments

and should be recognised as a key player in creating a healthy Tasmania.

5. Health Literacy

Comprehensive and co-ordinated person centred care is central to good health outcomes

for people of all age groups. Focusing on the needs and preferences of the individual and

including them as active participants in care planning and managing their health has been

shown to reap benefits in terms of minimising overall costs in the health system.

There is considerable room to improve health literacy in the Tasmanian community across

the board. Targeted messages for at risk groups should include our older community

members. There is potential to both improve the wellbeing and health of older

Tasmanians and the costs to the health system by targeting older Tasmanians with health

9 Consumer’s Health Forum of Australia, Jan 2013, Real People and Real Data Project, Literature and Practice

Review, Capturing, analysing and using consumers’ health experience narratives to drive better health outcomes. 10

For example, AHURI The health impacts of housing: toward a policy-relevant research agenda, 2011; Baker, E., Mason,K.,Bentley,R., and Mallett,S Exploring the Bi-directional Relationship between Health and Housing in Australia, Urban Policy and Research 32:1 2013 pp 71-84

literacy messages in areas such as nutrition and food security, falls prevention and mental

health and wellbeing.

In addition, support is required to assist older Tasmanians to navigate the often complex

health system. This will require a thorough understanding of how older Tasmanians

currently access information and the barriers that exist to obtaining the information they

need. COTA Tasmania has compiled a report called Finding Out: the Information Needs of

Older Tasmanians (funded by the Tasmanian Government as part of the Inclusive Ageing

Strategy: Tasmania 2011-2014).

The research project has identified that access to information in Tasmania today is not

equal. Our research shows that older people are feeling disenfranchised and are

encountering multiple barriers to finding information. There are difficulties with

communication, both written and verbal. There are problems with physical access to, and

use of, services and activities. There are many lessons contained in the report for improving

access to information for older people.

FALLS PREVENTION

COTA believes there is a strong role for community organisations beyond the traditional

health sector in communicating preventative health messages.

Our organisation has considerable experience with communication models that engage

older people in sharing information, promoting discussion and empowering action. Peer

education successfully delivered over many years now includes topics such as the use of

medicines, identifying and managing depression and elder abuse prevention.

One specific example of how peer education could assist in reducing hospital admissions

among older people is fall related injuries. Such injuries are common among older people

and are a major cause of pain, disability, loss of independence and premature death. Falls

also result in relatively high levels of preventable hospitalisation, often for extended

periods, that come at a high cost.

One in every 10 days spent in hospital by a person aged 65 years and older in 2010-11

was directly attributable to an injurious fall. These episodes of care accounted for 1.4

million patient days over the year and the average total length of stay per fall injury

case was estimated to be 14.7 days.1

Recent data presented at the Australian Association for Gerontology Conference in 2014

also highlighted the fact that there are a significant number of emergency ambulance calls

that are made by people who need assistance to get up from a fall but do not require

further medical assistance.1 The financial costs associated with the treatment of fall

related injuries are substantial as are the social implications for the individual involved. It

is clear that intervention to limit the number of falls being experienced by older people in

our community has the potential to significantly reduce costs within the health system.

...cont

6. Co-Design

As regular users of a range of health services, older Tasmanians are in a good position to

provide valuable input to the design and monitoring of health services. The adoption of the

principles of co-design has been proven to yield positive health outcomes for older people in

the United Kingdom, New Zealand and many other jurisdictions.

COTA believes strongly that patient experience and consumer evidence should also be

integral to decision making and performance assessment.

“Consumer narratives are uniquely well-placed to provide information about health system

performance. In contrast to more widely reported performance measures, consumers’ own

accounts can provide information about health experiences and outcomes over the course

of any given health condition; about experiences that cross different parts of the health

system; and about care in the home and community as well as in medical and clinical

settings......In short, consumer stories constitute an important evidence base for identifying

where and how health interventions and expenditure could be better targeted toward

measuring and improving health outcomes. Where quantitative health data can describe

what is happening – for example in terms of health service use and health outcomes -

qualitative and narrative data can explain why these things are so. This is essential

information to inform evidence-based policy decision-making.”11

COTA Tasmania recommends the adoption of co-design principles in the design and

monitoring of health services.

11

Consumer Health Forum of Australia, Real People Real Data Project Funded by the Australian Government Department of Health Literature and Practice Review Capturing, analysing and using consumers’ health experience narratives to drive better health outcomes. January 2013

FALLS PREVENTION cont....

In recognition of the substantial financial and personal costs caused by falls in older

Tasmanians, the Department of Health and Human Services has made a substantial investment

in falls prevention through the development of the Stay on Your Feet resources. The package

of resources is comprehensive and provides excellent advice for older people in the

community. Other jurisdictions have also produced similar resources that are also well

supported by successful research.

Notwithstanding this fact, indications are that community awareness and knowledge of

preventative measures is still relatively low and participation in interventions recommended

by health professionals is often not sustained.1

The addition of a peer education component to this program would assist in further

disseminating this information to the target audience and increase awareness of the

recommendations contained within the resources. COTA Tasmania has delivered peer

education modules in related areas in the past and currently has a team of volunteer

experienced Peer Educators who could engage in such a project.

7. Quality of Life as a key indicator of health

Everyone should have the opportunity to achieve a high level of health and wellbeing

regardless of their age, sex, gender, cultural background and wealth.

Older Tasmanians are significant users of the health system. Most have a strong desire to

retain their health and independence as long as possible. In fact, in 2012 older Tasmanians

identified health and wellbeing as the most important issue as they age.12 To achieve this

end older Tasmanians need access, convenience and affordability from our health system.

Healthy ageing is not just about being free of disease.

“Healthy Ageing is the process of developing and maintaining the functional ability that

enables wellbeing in older age.”13

Many people lead a good and active lifestyle contributing to the community while dealing

with multiple chronic diseases. Quality of life is not to be underestimated and evaluation of

health programs should incorporate an indicator of quality of life.

“Older people in particular often suffer from more than one condition at a time. The broad

strategies to foster health in older age therefore need to be centred on a new horizontal

model that seeks to prevent the root causes of disease and disability rather than a vertical

approach that is targeted to individual disorders.”14

Quality of life indicators that have been identified as being valued by older people include:

A role or identity

Relationships

The possibility of enjoyment

Autonomy

Security

The potential for personal growth15

Concluding remarks

COTA Tasmania strongly recommends the WHO’s World Report on Ageing as a valuable

resource for informing the implementation of strategies identified in the Healthy Tasmania

document.

Four priority areas for action to achieve the goal of healthy ageing are identified by the

WHO in the report:

12

Jamieson, L, 2013 Key Issues for Older Tasmanians, COTA Tasmania 13

13

World Health Organisation, World Report on Ageing and Health, 2015, p 28 14

S. J. Olshansky, J. Beard and A. Borsch-Supan, (2012) “The Longevity Dividend: Health as an Investment”

Chapter 11, pages 57-60 in Global Population Ageing: Peril or Promise? World Economic Forum 15

World Health Organisation, World Report on Ageing and Health, 2015, P29

Aligning health systems with the needs of the older population

Developing systems for providing long term care

Creating age-friendly environments

Improving measurement, monitoring and understanding.

The following diagram provides a useful summary and may be valuable in the Tasmanian

context.

References:

AHURI, The health impacts of housing: toward a policy-relevant research agenda, 2011

Baker, E., Mason,K., Bentley,R., and Mallett,S Exploring the Bi-directional Relationship

between Health and Housing in Australia, Urban Policy and Research 32:1 2013

Consumer Health Forum of Australia, Real People Real Data Project Funded by the

Australian Government Department of Health Literature and Practice Review Capturing,

analysing and using consumers’ health experience narratives to drive better health

outcomes, January 2013

COTA Tasmania, Facing the Future, A Baseline Profile on Older Tasmanians, 2013

COTA Tasmania, Finding Out: Supporting older people to access the right information at the

right time, 2015

Department of Health & Human Services, Health Indicators Tasmania, 2013

Jamieson, L, 2013 Key Issues for Older Tasmanians, COTA Tasmania S. J. Olshansky, J. Beard and A. Borsch-Supan, (2012) “The Longevity Dividend: Health as an Investment” in Global Population Ageing: Peril or Promise? World Economic Forum

World Health Organisation, Global age-friendly Cities: a guide, 2007

World Health Organisation, World Report on Ageing and Health, 2015

COTA TAS Inc“Westella”181 Elizabeth St, Hobart TAS 7000Phone: (03) 6231 3265Email: admin@cotatas.org.auwww.cotatas.org.au