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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> When all else fails - Public Health Law
Our new shopfront offices
. . . and our response
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―Traditional‖ Public Health Challenges
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―New‖ Public Health Challenges
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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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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