Developing a Social

Determinants Approach to

Policy

Kevin Buckett

Director Public Health

SA Health

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SA Health

Outline

> Key Challenges

> SDH Approach to Policy

> Innovation

> Future Directions

> Using experience in South Australia as a

basis for discussion

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SA Health

Key Challenges

• Ageing of the population

• Expanding medical technology

• Community expectations of treatment and care

• Financial and budget restrictions

• Workforce

labour shortfalls

escalating prevalence of chronic conditions

• Disparities in distribution of health and well-being

• Requires innovative approaches

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Budget implications of increased health

expenditure

Million

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SA Health

New public health challenges

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SA Health

New public health challenges

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SA Health 7

SA Health

New public health challenges

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SA Health

New public health challenges

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SA Health

Why develop a social determinants of

health policy?

Lifestyle heavily

influenced by

place…commercial

decisions and

regulation

Environment heavily

influenced by

place…commercial

decisions and

regulation

70% of these determinants can be affected

by healthy public policy

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SA Health

• Environment and lifestyle factors (SDH) are multi-determinate

• Action by a number of government agencies, working together, is required

• Such inter-sectoral action (joined-up-government) is difficult

• Why?

Inter-sectoral action: Why is this

so difficult?

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SA Health

1: Whose business is it?

• Factor 1

• The agencies who are able to take action on the determinants of health don‘t (always) know how to and don‘t (always) see it as their business

• In the Health sector we know we need to

work intersectorally, but we are not

always that good at it . . .

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SA Health

2: Government departmental structures

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SA Health

Decision making

Cabinet

Media

Community

Elections

Budget

cuts

AFL

The Policy Cycle

SA Health

4: The Health sector‘s traditional approach

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SA Health

So, where are we now?

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SA Health

• We don‘t try to pull other agencies onto

health‘s agenda or priorities.

• We don‘t try to turn other sectors of

government into health agencies.

• We work with them on their issues and their

priorities and help them achieve their policy

goals in ways that protect and promote health.

A different way: Health in All Policies

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SA Health

> Thinker in Residence, Ilona

Kickbusch

> South Australia‘s Strategic

Plan

> A receptive and proactive

Cabinet Office

> A supportive Chief Executive

> Officers willing and ready to

have a go!

Health in All Policies The Foundations

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SA Health

Why Health in All Policies?

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HiAP – South Australian Model

Source: Health in All Policies: The South Australian Approach, Government of South Australia (2011)

The Health Lens Analysis process The Health Lens processThe Health Lens process

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SA Health

• Language—that speaks to other sectors as well as Health

• Clearly linking determinants to other sectors policy agenda

• Tackling health policy issues using HiAP framework

• Medium and long term impacts for health and other policy

goals

• Capacity Building- adapting the approach to enable others

to apply a health lens

Issues and Challenges

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SA Health

Health Lens Analysis Projects

• Water Sustainability

• Regional Migrant Settlement

• Digital Technology

• Transit-oriented Developments (TODs)

• Marion City Council Re-Development–Rapid

Assessment

• Improving Parental Engagement in Children‘s

Literacy

• Aboriginal Road Safety

• Healthy Weight (desktop analysis)

• Active Transport

• Healthy Sustainable Regional Development: Mining

• Overseas Students Health and Welfare

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.

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SA Health

> In our experience the following elements have been

critical to success in adopting a HiAP approach:

• Leadership from the centre

• High level mandate

• Dedicated strategic HiAP team within Health

• The HiAP process itself

• Evaluation

What have we learned?

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SA Health

So, what happened next. . . ?

> Government policy change

> Reviews of Local Health Network services

and expenditure

> Re-prioritisation of out-of-hospital funding

> Re-allocation of funds

> Consequential structural re-alignment

> The Policy challenge - Sustainability

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SA Health

> When all else fails - Public Health Law

Our new shopfront offices

. . . and our response

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SA Health

―Traditional‖ Public Health Challenges

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SA Health

―New‖ Public Health Challenges

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SA Health 30

SA Health

Can ―new‖ Public Health challenges be tackled by ―traditional‖

Public Health approaches – i.e. Law?

A knotty problem

South Australian Public Health Act

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SA Health

South Australian Public Health Act 32

SA Health

> Key Elements

• Objects; Principles

• Role of the Minister

• Role of Local Councils

• The General Duty

• Public Health Planning – State

• Public Health Planning – Local Councils

•Concept of Public Health Partner Authorities

• Reporting

• Regulations, Policies, Guidelines

South Australian Public Health Act 2011 An Act to promote and provide for the protection of the health of the public of South

Australia and to reduce the incidence of preventable illness, injury and

disability

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SA Health

Key Objects

• To promote health and well being

• To protect from risks to health

• Early detection, management and amelioration of risks to health

• Provide information to individuals and communities on risks to

public health

• Encourage… plan, create and maintain a healthy environment

• Prevention, early detection management and control

• Monitoring conditions of public health significance

• Scheme for state and local government action for public health

South Australian Public Health Act

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SA Health

Principles

• Precautionary principle

• Principle of proportionate regulation

• Sustainability principle

• Prevention

• Population focus

• Participation

• Partnership

• Equity

• Special principles concerning communicable disease and

emergency powers

South Australian Public Health Act

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SA Health

Role of the Minister

• Primary source of advice to government on health

protection and promotion

• Develop procedures for government to ensure the

promotion or implementation of policies or measures

that are designed to enhance the health of individuals

and communities

• Ensure the Minister is consulted or involved in the

development of policies or measures that may have a

significant impact on the public health

South Australian Public Health Act (section 17)

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SA Health

South Australian Public Health Act

> Section 17 provides the opportunity for

incorporating Health in All Policies ideas under a

legislative mandate

> Procedures and protocols

> Inter-agency agreements – Public Health Partner

Authorities

> Aim to facilitate cross-sector policy development

that meets the aims of partner agencies and

advances health and well-being

Other components of the Act deal with compliance

and enforcement

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SA Health

Conclusions

> Key Challenges

• Continuing and emerging ‗conditions‘

• COST

> SDH approach to policy

• Health cannot do it alone

• Inter-sectoral action required

> Innovation

• Stop telling, start understanding

• Health in All Policies

> Future Directions

• Public Health Law as the mandate

• Be useful, be sustainable

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SA Health

“It is a mistake to think you can solve any major problems just with potatoes”

Douglas Adams

http:www.sahealth.sa.gov.au/publichealthact

http://www.sahealth.sa.gov.au/healthinallpolicies

Acknowledgements

Danny Broderick

Julie Patterson

Miriam Hunter

Carmel Williams

Deb Wildgoose

Isobel Ludford

Claudia Galicki