28 April 2016

Here are some items that may interest readers

The WHO Commission on Ending Childhood Obesity (ECHO) 


Public Forum - A fair go for all: Addressing social and health inequities in Australia and internationally - 12 May 2016. The Forum will focus on what works and why in policy areas including: Indigenous affairs, urban environments, social protection/paid parental leave and health systems. The forum will start with a panel discussion entitled "How equitable is the Federal 2016 budget?” hosted by Paul Barclay, host of Big Ideas on ABC Radio National. This discussion will be broadcast on the Big Ideas radio program. For more information: http://www.anu.edu.au/events/a-fair-go-for-all-addressing-social-and-health-inequities-in-australia-and-internationally-0


UNICEF report - 'Fairness for Children' - released 14 April 2016. This Report Card presents an overview of inequalities in child well-being in 41 countries of the European Union (EU) and the Organisation for Economic Co-operation and Development (OECD). It focuses on ‘bottom-end inequality’ – the gap between children at the bottom and those in the middle – and addresses the question ‘how far behind are children being allowed to fall?’ in income, education, health and life satisfaction. Visit: https://www.unicef-irc.org/publications/830/?utm_source=m2news-newsletter&utm_medium=email&utm_content=html&utm_ca.


How can we increase children’s understanding of the social determinants of health? Why charitable drives in schools reinforce individualism, responsibilisation and inequity. http://www.tandfonline.com/doi/abs/10.1080/09581596.2014.935703 (if you want this article and can’t access it – please email.)

Abstract: This paper examines the ways in which neoliberal responses to social health issues shape the educational discourses and practices of schools. As schools are increasingly identified as ideal spaces for health promotion, the question of how and why educators and public health practitioners can and should work together continues to be debated. Using Bourdieu’s theory of reproduction, we use this indicative example of emergency food to examine how ‘charity alone’ models reproduce and perpetuate inequitable health outcomes in neoliberal societies. This individualistic view of health continues to work against public health and social justice education initiatives increasingly found in schools, curricula and wider society; creating a dissonance between rhetoric and reality. Revolutionary critical pedagogies are explored to examine the implications of these practices in schools, and how the framework of service learning may offer an approach for involving primary students in empathy, caring and social justice. We seek to extend the existing literature by exploring ways of shifting, rather than reproducing, the current practices of educators and public health practitioners in how children experience health inequality and the social determinants of health.


World Development Indicators 2016: Featuring the Sustainable Development Goals: http://data.worldbank.org/products/wdi


Neoliberalism – the ideology at the root of all our problems - http://www.theguardian.com/books/2016/apr/15/neoliberalism-ideology-problem-george-monbiot?CMP=fb_gu 


11 March 2016

Network message sent to members today

Many thanks to all those who joined the conversation, prepared submissions and contributed to the Network’s submission (final posted below (19 Feb) on the Healthy Tasmania Community Consultation Draft. Some of us also attended the public forums that were held and it was fantastic to hear a strong voice on the need for action on the social determinants of health. It’s important that we continue to advocate at all levels in relation to this matter.

In relation to tobacco, Kathy Barnsley from SmokeFree Tasmania has provided some useful information that compares the two tobacco smoking proposals: MINIMUM LEGAL SMOKING AGE (MLSA) VERSUS TOBACCO-FREE GENERATION AMENDMENT (TFG). View the comparison table here: http://www.smokefreetasmania.com/wp-content/uploads/2014/11/Comparison-table-MLSA-and-TFG_16125-1.pdf.

To help us plan our next moves as a Network please join us for our next meeting on 29th of April (10 – 11 am) - all welcome. Attend and video conference at these sites: Hobart, Launceston & Burnie. Please RSVP and obtain further details by contacting: socialdeterminantsofhealthtas@gmail.com.

Information and resources:

Climate Change and Health Promotion
This virtual issue of Health Promotion Journal of Australia devoted to climate change is timely and important. The recent Paris Agreement in which the world’s nations committed to try to limit global warming to 1.5°C above pre-industrial temperatures will mean our efforts to transform into low carbon societies and economies over next few decades will be both dramatic and disruptive. The nature and scale of disruption will depend on the extent to which industries, sectors, businesses and professions prepare for and are involved in this 21st century low carbon ‘revolution’. Read more: http://www.publish.csiro.au/nid/293/aid/20759.htm


Obesity in Canada: A Whole-of-Society Approach for a Healthier Canada



Youtube Video on Social Determinants of Health – Good Health is a Product of Good Choice – or is it?


In his recently published The Health Gap, Michael Marmot reports on two lists of ‘top ten tips’ for health: http://www.grahamscambler.com/realistic-public-health-interventions/






19 February 2016

Here's what we told the Tasmanian Government in relation to their Healthy Tasmania Community Consultation Draft

19 February 2016


A Healthy Tasmania
Department of Health and Human Services
GPO Box 125
Hobart TAS 7001


Submission on the Healthy Tasmania Community Consultation Draft

The Tasmanian Social Determinants of Health Advocacy Network (SDoHAN) appreciates this opportunity to comment on the Community Consultation Draft of the Healthy Tasmania Five Year Strategic Plan (December 2015). We commend the Tasmanian Government for taking this important step towards a healthier Tasmania.

As a Network, we support the goal of improving the health of the Tasmanian population through systems change and investment in preventive measures underpinned by evidence-informed action on the social determinants of health. We endorse the World Health Organisation’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Therefore, it focuses not only on reducing mortality and morbidity, but on the impact of health determinants, the economic, environmental and social conditions, on health and well-being at various stages in life.”[i]
  
To improve the effectiveness of the planned strategy we strongly suggest that the following elements are incorporated.

A core focus on the social determinants of health. The Consultation Draft makes minimal reference to social and environmental factors such as education, income, housing, food security, equity, climate change and social connections, and the influence these have on health outcomes.  Tasmania continues to have among the lowest health status in Australia yet is spending as much if not more on health services than are other states and territories. Clearly, continual investment in services is having little effect on the overall health of the population and there are many other reasons that lie much deeper than our health care system for our low achievements in health. The proposed health impact assessment process has the potential to recognise social factors and their effect on population health, but this process is complex, and must be well-resourced to do so. The planned commissioning model should also be strongly based within a social determinants framework.

There is a strong international evidence base which clearly demonstrates the relationship between action on social determinants and improved health outcomes (e.g. Closing the gap in a generation: Health equity through action on the social determinants of health (WHO, 2008); Evidence review: Early childhood development and the social determinants of health inequities (Moore et al 2015); Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities (Garrett et al 2015); Social Determinants of Mental Health (WHO, 2014); Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco (Friel, 2009).

In our submission to the Joint Select Committee Preventative Health Care Inquiry, we provided numerous examples of evidence of some of the social determinants on health in the Tasmanian context. On this note, we urge the Government, in preparing the Healthy Tasmania Five Year Strategic Plan to consider the submissions that were presented by stakeholders to this Inquiry and to engage in dialogue with the Committee as it prepares its report. The two pieces of work should be in synergy and the evidence that was presented to the Inquiry taken into consideration as part of the development process for the Government’s Strategic Plan.

 The action areas of the Ottawa Charter for Health Promotion (WHO, 1986) that include:
o   building healthy public policy
o   creating supportive environments
o   strengthening community action
o   developing personal skills
o   reorienting health services.

Focusing simply on education strategies and placing the responsibility for improving one’s health on the individual, without appreciation for the wider determinants of health and a comprehensive plan of actions, is out of step with modern thinking and evidence-based best practice.



 The concept of Proportional Universalism. We encourage the Government to become familiar with the concept of proportionate universalism and to embrace a population health approach. Proportionate universalism is the resourcing and delivering of universal services and programs at a scale and intensity proportionate to the degree of need.[ii] We would argue that the terms preventive, public, and population health should not be used interchangeably. Public health (the ‘new’ definition) and population health are about more than prevention. A comprehensive review of the literature would be useful in clarifying any misconception and provide the Government with a useful framework.


A life course approach. Government’s Strategic Plan should emphasis a life course approach to good health and wellbeing. Key stages in people’s lives have particular relevance for their health. The life course approach is about recognising the importance of these stages. The Strategic Plan should respond to key milestones in the life course including the early years, adolescence, work/social life, and ageing. Each of these phases presents important opportunities for a healthy life.


Building on relevant literature. The Consultation Draft needs to draw strong parallels with existing well-researched publications, frameworks and plans, such as Chronic diseases in Australia: Blueprint for preventive action, The Cost of Inaction on the Social Determinants of Health, Rethink Mental Health (obesity and smoking should not be considered in isolation of mental health and wellbeing, and other social determinants such as employment and income) and The World Report on Ageing and Health. We note that there is virtually no reference to Tasmania’s five-yearly State of Public Health Report (a requirement of the Public Health Act 1997) or to relevant preventative health data that demonstrates social gradients of health in Tasmania. We suggest that further research be undertaken to inform the Strategic Plan and that it be prepared in consultation with those who can identify the existing evidence-base on which it should be based.


We encourage the Government to recognise frameworks and principles such as those put forward in Chronic diseases in Australia: Blueprint for preventive action, and to base the Plan on a similar set of principles:
1. Systemic approach: focus on common risk factors and determinants, not individual diseases.
2. Evidence-based action: act now using best available evidence and continue to build evidence.
3. Tackling health inequity: work to improve and redress inequities in outcomes.
4. National agenda with local action: build commitment and innovation with local action.
5. A life course approach: intervene early and exploit prevention opportunities at all ages and across generations.
6. Shared responsibility: encourage complementary actions by all groups.
7. Responsible partnerships: avoid ceding policy influence to vested interests.[iii]

Addressing legal barriers. Legal barriers that undermine health and wellbeing outcomes for Tasmanian’s must be addressed if there is to be successful implementation of harm reduction and health promotion programs in the community. Punitive laws, policies and practices that promote stigma and discrimination against particular groups in the community (such as sex workers, people living with or affected by HIV, people who inject drugs) persist within many healthcare facilities, deterring people from seeking services, eroding trust in health systems and jeopardising implementation of and access to services. An investment approach that strengthens linkages to the Office of the Attorney General should be adopted as part of a Health in All Policies approach.


Achieving good health requires significant investment. We question what new money will be directed towards improving the health of the population. We note that current investment in preventive health is just 1.9% of the Department’s budget and dispute the statement that the “Tasmanian Government already significantly invests in prevention...” While we support ideas raised in the Consultation Draft such as health impact assessment, embedding a focus on health across government, improving health literacy and anticipatory care, these are all processes that require significant planning and investment. We thus endorse the proposal by the Heart Foundation, TasCOSS and others that the prevention budget be raised to at least 5% of the health budget (irrespective of where this money comes from).


Ongoing community consultation. We encourage the Government to include the community when preparing its Healthy Tasmania Five Year Strategic Plan – recognising communities as educators of policy-makers. [iv] We query what process the Government employed in determining the priorities identified in the discussion paper. We agree that obesity, smoking and health literacy are issues of concern but such symptoms are usually the result of more complex social problems – and this is not reflected in your Consultation Draft.

When consulting with the community, there needs to be acknowledgement that health is complicated and that language matters. As stated by World Health Organisation: “Health is not a stand-alone phenomenon with clear boundaries. Diseases and health conditions have multiple causes, including social. They are interrelated with nature and nurture, and evolve over time.”[v] This complexity is well recognised in the community. In 2015, we undertook a study where we asked members of the Tasmanian public for their thoughts about health, and specifically the way in which policy makers and researchers talk about it. In contrast to the Healthy Tasmania publication, we found that Tasmanians place a lot of emphasis on the underlying factors that contribute to good health – such as education, housing, and social connections.

We also found that the community are concerned when they are labelled as being ‘vulnerable’, ‘disadvantaged’ and being ‘targeted’. Study participants described these words as being impersonal and vilifying, contributing to stigma and blame. Participants suggested that words which reflect prejudice, that oversimplify complex relationships or that minimise history, can heighten bias and exclusion. Study participants suggested that those who use such terminology are disconnected and out of touch. 

If we want to be a healthy population, we need to bring everyone along for the ride. Defining people by their weaknesses and over-simplifying the complexities of their existence will not lead us to the end goal.

Ongoing community partnerships. We strongly urge the Government to work in partnership with stakeholders – such as community organisations, peak bodies and volunteer networks – to determine the health priorities that can make Tasmanians a healthier population. There is vast untapped knowledge and important social capital that could support the Government’s work in this area. Tapping into this knowledge, and integrating it with quality data will help give the Government a strong evidence-based Strategic Plan. 

Achieving good health requires a long term approach. We wish to raise the point that if the Government is serious about improving the health of the population, a five year timeframe is too short. This is a plan that requires long term strategic vision, with bi-partisan support. It also requires a Health in All Policies approach. As it stands, the Consultation Draft proffers much uncertainty in terms of:

·         The governance arrangements for the implementation of the Strategic Plan; how will the Government ensure accountability, transparency and inclusiveness in governance?
·        The resources that will be invested in the implementation and evaluation of the Strategic Plan.


We look forward to further engagement as the Government undertakes the process of developing the Healthy Tasmania Five Year Strategic Plan.

[i] WHO, Health at key stages of life – the life-course approach to public health, WHO, Denmark.
[ii] NHS Scotland, Proportion universalism and health inequalities, http://www.healthscotland.com/uploads/documents/24296-ProportionateUniversalismBriefing.pdf.
[iii] Willcox, S, 2015, Chronic diseases in Australia: Blueprint for preventive action, Australian Health Policy Collaboration Policy paper No. 2015-01. Melbourne: Australian Health Policy Collaboration.
[iv] Mackenzie, M et al, 2016, ‘Working-class discourses of politics, policy and health: ‘I don’t smoke; I don’t drink. The only thing wrong with me is my health’, Policy and Politics, Early Online Publication.
[v] Pourbohloul, B & Kieny M, 2011, ‘Complex systems analysis: towards holistic approaches to health systems planning and policy’, Bulletin of the WHO, 2011;89:242-242.

22 January 2016

Let’s Discuss: Healthy Tasmania Community Consultation Draft

TasCOSS and the Social Determinants of Health Advocacy Network invite you to a roundtable discussion about the Government’s recently released Healthy Tasmania, Five Year Strategic Plan – Community Consultation Draft

There has been much discussion in our networks about this publication so we thought it would be helpful to meet so we can talk as a group about the issues that we feel are important to raise.

This meeting is for anyone who is considering preparing a submission on this Draft document.

When: Monday 1 February 2016, 12:00-2:00pm

Where: Primary Health Tasmania VC sites:

Hobart
Level 4, 15 Victoria Street
Hobart  TAS  7000

Ulverstone
Level 1, 11 Alexandra Road
Ulverstone  TAS  7315

Launceston
Level 5, 11 High Street
Launceston  TAS  7250

RSVP: Please advise if you will be attending: socialdeterminantsofhealthtas@gmail.com



Items of interest:

1. Government releases Draft Climate Change Plan – calls for submissions: http://www.dpac.tas.gov.au/__data/assets/pdf_file/0006/275343/Embracing_the_Climate_Challenge-Action_Plan.pdf


2. Have you signed up or are you interested in being part of a Health Literacy Network?
Come along to one of the regional meetings to talk about what the Network will do:
Ulverstone     21  January       10 - 11:30
Launceston     21 January          2 -   3:30
Hobart           22 January       10 - 11:30

Lisa O’Toole | Health Promoting Systems Program Support Officer
Public Health Services | Department of Health and Human Services
Level 1 Henty House, Civic Square, Launceston
Phone (03) 6777 1986


3. FGM/C and Violence Against Women: Red Cross' BCHP presents...

Dear People,

Red Cross Tasmania’s Bi-cultural Community Health Program assists women, girls and others affected by Female Genital Mutilation and Cutting (FGM/C).

FGM/C is a practice that does not take place in a vacuum.  It occurs in a much broader context of violence against women and is also influenced by social determinants of health.

Our Team invite the health sector and broader public community to engage with our events, which commemorate the International Day of Zero Tolerance to FGM/C, which is February 6th each year.

Attendees will begin to appreciate how very complex dealing with this form of gender based violence is; and why it is so important to begin to own a deeper understanding of the issues supporting its continuation: in the hope that one day, it will be a practice that is understood universally to have no place in the lives of women, children and their significant others.

Please join our Team, as we present this discussion and associated dilemmas; and which includes anonymous testimony of a woman who now takes a firm stance to protect her own daughters, despite significant personal risk.

Attached is a flier for free public events in Launceston (Monday 8th February) and Hobart (Tuesday 9th February): 3 weeks’ time.  Please share far and wide.  All are Welcome. (Note: Flier not attached and can be forwarded as requested)

Warm regards,

Xavier and BCHP Team

Xavier Lane-Mullins
Bi-Cultural Community Health Program (BCHP) Community Development Worker
Migration Support Programs - Tasmania

4. Common Ground Men's Group
Hi all
I would like to let you know about a new initiative that is commencing in 2016 for men in Tasmania - the Common Ground Men's Group program. Common Ground Men's Groups are an 8 week facilitated program that challenge and enable men to strengthen their relationships and explore the issues common to most men, in a safe and respectful space. This program has been running successfully in Queensland for over 10 years and has received very favourable feedback from men who have attended, as well as their partners.  You can read some of the feedback on the Men’s Wellbeing webpage here.
For those in Hobart I would like to invite you to a service providers brief information session and discussion at room 1 on the ground floor in the Mcdougal Building, 90 Davey Street, Hobart, at 1pm on Thursday 4th February.  If you would like to come along, please drop me an email.  Feel free to bring your lunch.

At this session you will be able to find out the program, and how it may be useful for men that you may know or work with, and ask questions about some of the content etc.  Feel free to bring friends or colleagues.

For those in Launceston:
I will also be in Launceston I can put you in touch with the folks running the program up there, or possibly come and speak with your group myself when I visit Launnie in early Feb.

A free intro night
There will be free introductory nights for men and or their partners or other interested people in the community before every Common Ground program. Dates for the next free evenings in Hobart and Launceston are below.  Please get in touch if you are interested in attending.
·         Hobart - 7.30 pm,   Wed. 10th Feb. 2016. McDougal Building, Battery Point - contact Bill McDonald
·         Launceston -  7.30 pm – Venue to be advised  Thursday 11th Feb. 2016  - contact: 
At the following link is information flyer you can hand out to men, or women who have partners that might be interested: http://tasmen.org.au/images/Common-Ground-TasMen-A5-Poster.pd 
More information about the program can be found at the Common Ground page of the Tasmen website
Please feel free to send this message onto other lists and networks.
Cheerio
JB

Jonathan Bedloe
0429 581 095


6. Trends Shaping Education
Does education have a role to play in stemming the obesity epidemic? Are new technologies really changing the way our children think and learn?  Trends Shaping Education 2016 tells the story of how economic, social, demographic and technological trends can potentially impact education.  It aims to inform strategic thinking and stimulate reflection on the future of education, in schools, universities, or in programmes for older adults.


7. Discover the impact of the free trade agreements on public health. https://vimeo.com/148089528


8. Can the sociology of social problems help us to understand and manage ‘lifestyle drift’? 
Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocella’s residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it.



9. Does public health advocacy seek to redress health inequities? A scoping review - http://onlinelibrary.wiley.com/doi/10.1111/hsc.12320/full

30 October 2015

Just Words Workshop - All welcome

Many thanks to those who supported the launch of Just Words before I went on leave. We will be conducting a workshop about our research on Thursday 19 November 2015 at the Video Conference Room, Level 4, 34 Davey Street Hobart from 10am – 12pm as part of the Health Promotion Community of Practice gatherings. 

We will discuss the findings of our qualitative study exploring how ‘everyday’ people interpret and understand the language of social determinants of health in the context of their own lives and broader society. The study identified deep concerns among community members about health inequity and words without action. The findings have implications for the ways in which health promotion policy, practice and advocacy are framed. We will discuss as a group how we can use the findings of this study in everyday practice.

So if you didn’t attend the launch or you would like the opportunity to discuss it further please come along. Everyone is welcome to attend. We will link to other sites around the state but this will need to be organised beforehand. For further information please contact Rebecca: rebecca.essex@dhhs.tas.gov.au. 

Here's some great resources you might like to check out

1. How’s life? 2015 Measuring health and wellbeing
How’s Life? describes the essential ingredients that shape people’s well-being in OECD and partner countries. It includes a wide variety of statistics, capturing both material well-being. This third edition includes a special focus on child wellbeing. http://www.keepeek.com/Digital-Asset-Management/oecd/economics/how-s-life-2015_how_life-2015-en#page1

2. An interesting resource on injury prevention: Canadian Injury Prevention Resource – includes a deeper dive into the determinants of injury

3. Sick with worry – Stories from the front-line of inequality 2015

4. Addressing social determinants of health inequities through settings: a rapid review

5. Towards health equity: a framework for the application of proportionate universalism

6. Update from Heart Foundation. Please find attached an update on the Heart Foundation’s position regarding suggested legislative amendments to increase the visibility of health and wellbeing as an objective of the Tasmanian Planning Scheme. For further information please contact Graeme Lynch - Graeme.Lynch@heartfoundation.org.au

7. Ageing and Health. The World Health Organisation released the World Report on Ageing and Health on the 1st of October.  The report states that health inequities is a key global challenge for the future.  View the full report, fact sheets and media statements at www.who.int/mediacentre/factsheets/fs404/en/

8. VicHealth suite of 18 new health equity resources
Evidence tells us that promoting equity in health is best done by understanding and addressing the social conditions that influence health, and how these conditions are distributed unequally in society.  These are called the social determinants of health inequities.  Click here for the full suite.

9. Fantasy paradigms of health inequalities: Utopian thinking ?
Alex Scott-Samuel and Katherine Elizabeth Smith
Social Theory & Health 13, 418-436 (August /November 2015) | doi:10.1057/sth.2015.12

Abstract
This article argues that, while it can be politically expedient for governments to engage with health inequalities, they cannot, within the confines of neo-liberalism, realistically propose actions that evidence suggests will effectively reduce them – such as tackling power inequalities, social status and connections or class inequality. Indeed, a dominant ‘policy paradigm’ prioritising economic growth restricts the ability of policy actors to imagine alternative, more equitable scenarios. In this context, some policy actors and researchers have devised a parallel fantasy world in which proximal, downstream, easily tackled exposures are posited as potential solutions to health inequalities. The consequence of this is a widespread public sector culture in which well-meaning policymakers, practitioners, researchers and members of the public collude in sustaining a ‘cargo cult’ of health behaviourism. In examining this situation, we draw on accounts and critiques of utopian thinking to help explain: (i) the remarkable persistence of policy proposals to tackle health inequalities via downstream interventions, in spite of the strength of evidence challenging such approaches; and (ii) the limited extent to which more upstream proposals inform policy debates. We argue Ruth Levitas’ notion of ‘utopia as method’ offers an imaginative and potentially useful avenue for future health inequalities research.
http://www.palgrave-journals.com/sth/journal/v13/n3-4/full/sth201512a.html Please email me if you can’t access the full article and would like to read it.

10. A Practitioner’s Guide for Advancing Health Equity-Community strategies for preventing chronic disease

11. Systems change for the social determinants of health


22 August 2015

Just Words

On 21 August 2015, we published the findings of our study, Just Words - what we talk about when we talk about health.

To obtain a copy of the report please send an email to: michael.bentley@utas.edu.au.



Pictured: Robin Banks, Michael Bentley, Ruth Forrest, Miriam Vandenberg, Richard Ecclestone, Cheynee Pullen