The Story of Vichealth: a World First in Health Promotion

The Story of VicHealth A world ﬁrst in health promotion

VicHealth and health promotion milestones 1988 1987–2005 VicHealth moves to buy out tobacco company sponsorship of sport and the arts; Quit, Heart Health and other health promotion programs replace the tobacco sponsorships. 1987 The Anti-Cancer Council of Victoria (now the Cancer Council Victoria) Victorian Tobacco Act 1987 passed receives funding from VicHealth to in Parliament. run its SunSmart and Quit programs. The Victorian Health Promotion Foundation SA (the South Australian Foundation (VicHealth) established health promotion foundation, later with funding from government- renamed Living Health) established. collected tobacco taxes and mandated to promote health in VicHealth funds ﬁrst Victorian breast the State of Victoria. cancer screening program.

Healthway (the Western Australian Federal Government bans tobacco Health Promotion Foundation) sponsorships and most remaining established under the Tobacco forms of advertising from 1995. Control Act 1990. Centre for the Study of Sexually Centre for the Study of Mothers’ and Transmitted Diseases established; Children’s Health (later renamed later changed to Australian Research Mother and Child Health Research) Centre in Sex, Health and Society established. (ARCSHS). Centre for the Study of Adolescent Publication of A Considerable Health (later renamed Centre for Success – an evaluation of VicHealth’s Adolescent Health) established. first five years from an economic perspective, by Dr Neville Norman Prevalence of smoking in Victoria from of the University of Melbourne. 1986 to 1991 declines at the rate of 1% 1 per year, from 31.5% to 25.6%. 1992 1991 1989 Tobacco billboard advertising replaced. Food and Nutrition Program established. 1990 A ban is placed on all tobacco Healthy Localities project brings local advertising in Victorian print media. government, community agencies and residents together to identify priority Victorian Arts Centre becomes health issues and implement local completely smoke-free. health promotion strategies. First community-based cervical VicHealth funds significant research screening program established. into Alzheimer’s disease at the Mental VicHealth establishes a Public Health Health Research Institute. Fellowships Scheme (which runs until ACT Health Promotion Fund (changed 1992), funding Victorian researchers to Healthpact in 1995) established. for 3 years.

Launch of the State Government’s World Health Organisation calls New Strategic Plan (Healthy Victoria Cancer and Heart Offensive, aimed at for other countries to adopt the to the Year 2000) launched; the cutting the numbers of people dying VicHealth model. emphasis is on knowledge transfer. prematurely from Victoria’s two VicHealth holds its ﬁrst national VicHealth launches Healthy Families biggest killers. conference to examine the pioneering of the Future, a program to improve Of Australia’s top private companies developments of working with sport mental health and wellbeing within based in Victoria, 75% now totally and art organisations to promote families. smoke-free (an increase of 25% in health. Completion of tobacco sponsorship one year). VicHealth funds research arm of replacement program. Launch of Partnerships with Healthy the Early Psychosis Prevention and Industry – health promotion in the Intervention Centre, a program which workplace. will increase capacity to intervene 1995 and prevent youth suicide. 1993 1994

1 Centre for Behavioural Research in Cancer 1986, 1988, 1989, 1990, 1991, 1992, 1995, 1996. 1996 The work of VicHealth in promoting 1998 health is recognised when the 1997 VicHealth Senior Research World Health Organisation Medal Australian High Court invalidates state Fellowships Scheme begins, bringing for Excellence is presented to the tobacco fees, which ends tobacco-fee successful Australian researchers Premier of Victoria, Jeff Kennett. funding for VicHealth; funding from working overseas back to Victoria. state budget commences. Active for Life launched in schools to In the ﬁrst year, two senior teach children about making exercise Federal Government and Quit fellows are funded for 5 years. a healthy lifetime habit to prevent agencies in the states and territories Removal of sponsorship from Carlton heart disease. develop the National Tobacco Football Club after continuing Campaign. The campaign includes VicHealth-sponsored sporting breaches of sponsorship agreement graphic TV ads depicting the health organisations are encouraged to by their chairman, John Elliott. effects of smoking. A national Quitline promote smoke-free environments is introduced. Launch of VicHealth’s Indigenous with healthy food options and sun research centre: the Koori Health shade. Foundation SA disbanded. Research and Community Health Promotion Switzerland Austrian Health Promotion Development Unit (renamed Onemda established. Foundation established. VicHealth Koori Health Unit in 2005).

Sport program redevelopment Walking School Bus Program VicHealth launches Leading the announced: shift from sponsorship commences in four local councils; Way: Councils Creating Healthier model to increasing participation 14 primary schools and 224 children Communities, a resource to better in physical activity through the participate. equip councils to identify and respond Promoting Health through Sport to the built, social, economic and VicHealth joins forces with education, and Active Recreation Program. environmental issues that affect adolescent and welfare organisations health and wellbeing in communities. Introduction of smoke-free dining to highlight bullying behaviour as a in Victoria. significant mental health issue. VicHealth now fully funds or supports 55 fellows and scholars. Launch of Together We Do Better Launch of Out of School Hours Sports campaign promoting mental health Program to increase physical activity and wellbeing. of primary school aged children. 2003 Food Security Program begins, aimed at giving people in disadvantaged communities better 2002 access to fresh foods. Thai Health Promotion Foundation (ThaiHealth) established. 2001 Late in the evening of 17 November 1987, the Tobacco Act 1987 was passed by State Parliament in Victoria, Australia. The Victorian Health Promotion Foundation (VicHealth) was born – the first health promotion body in the world to be funded by a tax on tobacco. It was the result of an unparalleled public health advocacy effort. 2000 The VicHealth Centre for Tobacco Control opens, focusing on legal, 1999 economic and social research to strengthen tobacco control initiatives. VicHealth’s Strategic Directions 1999–2002 focuses on physical VicHealth begins funding the Cochrane activity, healthy eating, substance Health Promotion and Public Health Field misuse, tobacco control and mental to establish it in Australia and support the health and wellbeing. field’s local and international activities. VicHealth launches the Mental Health Public Health PhD Research Scholarships Promotion Plan for Victoria, focusing Scheme introduced, providing 3 years of on social connectedness, freedom funding for young Victorian researchers. from discrimination and violence, New Arts for Health Program funding and economic participation as major begins, with a focus on participation factors impacting on mental health. and access. Victorian Public Health Research Government of Victoria amends its and Education Council (VPHREC) Tobacco Act to introduce smoke-free launched. dining, bans on point-of-sale advertising, International Network of Health and increased penalties for retailers Promotion Foundations established. who sell to minors.

Health 2004: The World Conference Smoking rates drop below 17% of on Health Promotion and Health Victoria’s adult population (from 31.5% Education takes place in Melbourne. in 1986). It attracts over 2000 delegates in Quit celebrates its 20th anniversary four days. as an anti-smoking campaign. The Health Costs of Violence shows More than 3000 Victorian primary the extent of intimate partner violence school children from 200 schools walk and its enormous impact on women’s to and from school as part of VicHealth’s mental health and wellbeing. Walking School Bus Program. Food Security Demonstration Projects from City of Yarra and City of Maribyrnong win Victorian Public 2005 Health Awards for Excellence and Innovation. 2004 Victorian Health Promotion Foundation P.O. Box 154 Carlton South 3053 Victoria Australia Tel: +61 3 9667 1333 Fax: +61 3 9667 1375 Email: [email protected] www.vichealth.vic.gov.au The Story of VicHealth A world ﬁrst in health promotion The Story of VicHealth A world ﬁrst in health promotion First published in November 2005 by the Victorian Health Promotion Foundation 15–31 Pelham Street Carlton VIC 3053, Australia www.vichealth.vic.gov.au

Additional copies of this book can be obtained from VicHealth.

National Library of Australia Cataloguing-in-Publication data:

Victorian Health Promotion Foundation. The Story of VicHealth: a world ﬁrst in health promotion.

Bibliography. ISBN 0 9757335 1 6.

1. Victorian Health Promotion Foundation – History. 2. Health promotion – Victoria – History. I. Title.

353.627409945

Cover image: Robyn Lea Design and layout: Paoli Smith Contents

Foreword v Chapter Four 35 Preface vi Adapting to a changing environment: 1997 onwards Acknowledgements vii – A new message for a new era 38

Chapter One 1 The start of Something Big: how Chapter Five 43 the Tobacco Act came into being The Big Issues – Tobacco Control 45

Chapter Two 13 – Sport and Physical Activity 52 Putting the Act into action: – Mental Health and Wellbeing 57 the creation of VicHealth – The Arts 62 – The importance of a 15 – Public Health Research 65 tripartisan Board – Sun Protection 70 – Appointing a worthy leader 17 – Creating a sustainable 18 funding model Chapter Six 73 Reaching beyond state borders – A change of government puts 19 hypothecation under threat – The view from overseas 75 – Out of everyone’s hands 21 – The story within Australia 77

Chapter Three 23 Epilogue 80 A new era in Health Promotion: Health Promotion is everyone’s 1987–1997 business – A strong leader 26 – Health messages the main game 26 Appendix 83 – Selling the tobacco buyout 28 VicHealth Board Members – Governance 30 – A shift in thinking 31 Bibliography 84

Foreword

I am pleased to provide the foreword In line with the need to adapt its to this wonderful book. The creation activities to the pressing health of the Victorian Health Promotion issues of society, VicHealth has Foundation (VicHealth) was a been at the forefront of research signiﬁcant policy change by the and innovation in promoting mental Victorian Government, and signalled health and wellbeing, and increasing a new vision and commitment to participation in physical activity. health promotion. The innovative Issues including mental health, proposal to apply a dedicated physical activity, poor nutrition and tax on tobacco to fund such a health inequalities require diverse foundation was groundbreaking and innovative ways of partnering I commend this book to all who are for its time, and opened the door and networking, coupled with interested or involved in health for a program of wide-ranging highly skilled advocacy techniques promotion and to those who have reform in health promotion. Several to lobby for the promotion of good watched the development of VicHealth. foundations from around the world health. The ingenuity, persistence have adopted the VicHealth model and commitment of leaders such I continue to wish VicHealth every and now collaborate as members as Nigel Gray, Gus Nossal, Rhonda success in the future. of the International Network of Galbally, David White, Mark Birrell, Health Promotion Foundations. John Funder, Jane Fenton, Rob Moodie and a team of hard working Overwhelming political support professionals have made this possible. from all parties set the foundation for VicHealth to work with government The Story of VicHealth – a world The Hon. Bronwyn Pike MP and industry to address the big ﬁrst in health promotion is a Minister for Health issues in health with a long-term fascinating overview of VicHealth view. Initially the tobacco industry from inception to present day. This was tackled head-on by replacing publication will provide readers tobacco sponsorships with health with an insight into the breadth promotion messages. VicHealth of work undertaken by VicHealth showed how the media could be and the complexity of applying used to advocate for change in health promotion concepts and policy. This adaptability displayed programs to the multifaceted early on has continued, and allowed policy environment of health. VicHealth to address the challenges that have presented over the years in imaginative and practical ways.

v Preface

Out with the Marlboro Man It is both a privilege and honour to and in with Quit – the idea was follow in their footsteps, and to work smart – just like David White, alongside Rob Moodie, whose inspired Mark Birrell and Nigel Gray, the appointment has raised Victoria’s architects and champions behind profile as a leader in health promotion, the model. They understood the both nationally and internationally. benefits of investing in long-term He has developed VicHealth’s role so initiatives and laid the foundations that it now not only supports other for the creation of VicHealth. organisations to improve health, but identifies trends and emerging health The success of the organisation is issues, drives innovative programs, the result of the vision, persistence creates and contributes to debate, and commitment of many individuals gathers and interprets evidence whose contributions are honoured in and keeps responding to a dynamic this book. external environment. Few have been more influential in The challenges involved in promoting shaping VicHealth’s character than health will only increase as time its inaugural Chief Executive Rhonda goes on – as will the necessity for an Galbally, whose foresight, determination innovative, effective and committed and exceptional work was critical to the VicHealth. early success of the organisation. The irrepressible Sir Gustav Nossal brought the Board together and inspired those involved to work for the greater good. Professor John Funder demonstrated outstanding leadership and made significant and sustainable advances Ms Jane Fenton AM during his long chairmanship. Chair, VicHealth

vi Acknowledgements

VicHealth gratefully acknowledges Many others have assisted with the contribution, enthusiasm and development and production. Thanks support of the many individuals to Chris Borthwick for transcripts involved in this project. of interviews completed in his initial work on this book; Vicki Heywood for Special thanks to the Hon. Ron Best, editorial expertise; Heather Kelly and the Hon. Mark Birrell, Prof. Glenn Greg Alford for prooﬁng; the Paoli Bowes, Mr Paul Briggs, Mr John Cain, Smith design team for their creative Prof. John Catford, Mr Edmund Ewe, talent; and Jonathan Liberman for Ms Jane Farrance, Ms Jane Fenton, the legal advice. Hon. Bill Forwood, Prof. John Funder, Dr Rhonda Galbally, Mr Lindsay Gaze, VicHealth also thanks Peter Ryan for Ms Frances Gianinotti, Prof. Nigel his work in bringing together this rich Gray, Prof. David Hill, Ms Anne-Marie and groundbreaking history. Holley, Mr Rob Jolly, Mr Rob Knowles, Finally, thank you to all the individuals Dr Judith Lumley, Ms Victoria Marles, and organisations that have been Mr Bill McGrath, Ms Sue Nattrass, connected with VicHealth in some Ms Cathy Nixon, Sir Gus Nossal, way or another since 1987 and have Mr David Parkin, the Hon. Bronwyn worked with people and communities Pike, Prof. Doreen Rosenthal, to make Victoria healthier. Prof. Graeme Ryan, Ms Michelle Scollo, Mr Craig Sinclair, Mr Nigel Taylor, Ms Di Trotter, the Hon. Graeme Weideman, Mr David White, Ms Fay White and Mr Peter Worland. Thanks are also offered to Rhonda Galbally for permission to use material from Just Passions: The personal is political (Pluto Press Australia, 2004) and to the Cancer Council of Victoria for historical data.

vii viii

Tina Haynes / Fairfaxphotos 1.

The start of Something Big How the Tobacco Act came into being Late in the evening of 17 November 1987, the Tobacco Act 1987 was passed by State Parliament in Victoria, Australia. The Victorian Health Promotion Foundation (VicHealth) was born – the ﬁrst health promotion body in the world to be funded by a tax on tobacco. It was the result of an unparalleled public health advocacy effort.

2 | Chapter One The quietly spoken Nigel Gray Gray recalls: “David said his father is persistent. Two years after had died of emphysema, this was arriving as Director of the Anti- not an election year, and he’d be Cancer Council of Victoria (now interested in doing something Cancer Council Victoria), he about tobacco.” With the softest of came to a conclusion: reducing taps, opportunity had knocked. smoking was one obvious way to Gray acted quickly. Within two days cut cancer rates. That was 1970. his proposal was on the Minister’s By February 1987, David White was desk. “We’d been talking about it Victoria’s Health Minister in the State like a broken gramophone record for Labor Government. He was the eighth years and years”, he said. Throughout consecutive Victorian Health Minister his 19 years at the forefront of David White, former Victorian to whom Gray had articulated his public health in Victoria, Gray had Health Minister (Labor) – his words would alter the landscape potent message. The message was advocated, but not antagonised. of tobacco control and health simple and accurate: using tobacco He’d stuck to the science and never promotion in Victoria forever. causes cancer. Cancer rates could let emotion overcome reason. “You be reduced if fewer people smoked. have to walk a fine line”, admits No Health Minister, however, had Gray. As each issue progressed, he found a way to implement Gray’s consulted his colleague, Dr David big idea – to increase taxes on Hill (now Director of the Cancer cigarettes to keep them out of reach Council Victoria), to ensure their of young people and to ban tobacco words would reflect the data. Then advertising and sponsorship. a public position would be taken. As a matter of course, he made himself Tom Roper, Health Minister from available to the press: “We did make 1982 to 1985, had told Gray the only it clear that we were the people to way to stop tobacco sponsorship come to, to ask questions”, said Gray. of sport and the arts would be to ‘buy out’ 2 the tobacco companies. White’s advisor, Peter Worland, “If we did not have Nigel in the thought the notion of a tax to reduce Cancer Council, we could not smoking sounded too negative. have entered the fray.” Creatively Worland combined the David White, former Victorian ideas, suggesting that a tobacco Health Minister (Labor) fee be used to buy out tobacco sponsorship and that a body be set up to promote positive health messages. Gray’s credibility on all sides of politics was beyond question. His In White’s office, Gray and White commitment was unmatched. These met to discuss an Anti-Cancer strengths were to be critical. “I think Council proposal for mammographic that the tobacco industry lost because screening. Towards the end of the the health professionals won, not the meeting White changed tack. His politicians. Someone like Nigel Gray words would alter the landscape is rather hard to discredit”, said Mark of tobacco control and health Birrell, Shadow Health Minister at promotion in Victoria forever. the time.

2 ‘Buy out’ in this context means ‘replacement’. The term is used colloquially. In fact, VicHealth could only offer ‘replacement’ sponsorships when the sport and arts organisations were free from existing tobacco contract obligations. Otherwise, there was the risk that the tobacco companies could sue VicHealth for inducing a breach of contract.

The start of Something Big | 3 Based on Gray’s proposal, White (‘hypothecated’) tax, also had to be quickly committed himself to a convinced of the idea. Gray admits campaign to get a Bill through the now he didn’t think chances of Victorian Parliament. The Bill would success were high. put a levy on tobacco, creating a fund White and Gray mapped out a strategy to buy out tobacco sponsorship, to do and a timetable. The Bill was to be research, to provide funds to sports introduced before the House rose and activities that hadn’t previously for Christmas, so they had to move received funding. Gray agreed, in his fast. Gray contacted an old friend, words, to be the go-between, building Bob Fordham, who was Leader of the bridges, disarming defences, utilising House and had the Bill placed on the allies, mobilising support in the wider agenda. Step one had been taken. community. “I was to be the architect of the public campaign, but it was All realised the media’s attitude David White who told me what to do would be crucial. In Western Australia about the politicians”, said Gray. “He similar legislation had been proposed advised me to talk to Mark Birrell, in 1983 and had been torpedoed who was already on side, and get – by just one vote. A concerted him to run our strategy in the Liberal campaign by the tobacco industry, Party. Without any discussion directly with support from sporting groups between those two, it was decided and advertising bodies, had been that our focus would be a Bill, and backed by the state’s media outlets. that Mark would run the Liberal side Their objection to the proposed Bill: and David would run the Labor side.” banning tobacco advertising would decimate groups that relied on it for Passing such a Bill would not be a survival. In 1987, Victoria heeded the simple task. Labor was the State implications of that campaign. Funds Government but the opposition raised in Victoria with the dedicated Liberal Party held the numbers in tax would be used to buy out tobacco the Upper House, the Legislative sponsorship of sport and the arts, Council. Under Victoria’s bi-cameral thus guaranteeing their survival. parliamentary system any Bill had to pass through both Houses to Gray knew Creighton Burns, editor of become legislation. Therefore both The Age newspaper. Burns listened parties had to be convinced of its to Gray’s oft-repeated spiel about merits before it was passed. tobacco and promised to assign two young reporters, Fiona Harari and Enormous pressure was expected Graeme O’Neill, to a series of stories from the tobacco industry, particularly about the issue. Gray asked if he could towards the Liberal Party, who would inﬂuence the timing. Burns agreed. generally be philosophically opposed The series would run in the week to taxation or any other restraint on Cabinet deliberated on the proposal. business. The National Party held seats in tobacco-growing areas and Labor had to be convinced next. was expected to oppose the Bill. White wanted the proposal through Public opinion was thought to favour the party room in June or July before such an idea, but was an unknown at the Budget. The Treasurer needed the start of the campaign. Treasury, convincing. “Our discussion with the traditional opponents of any dedicated Treasurer, Rob Jolly, rested on the

4 | Chapter One The submission to Cabinet for a tax Getting News Corp on side increase on cigarettes and restrictions on tobacco advertising coincided News Corporation, publisher of The editor of The Herald was with a week-long series of articles by Melbourne’s two other daily papers, unenthusiastic about Gray’s The Age newspaper, agreed to earlier The Sun and The Herald, was also views, but allowed the issue to by Burns, that ran under the tagline approached. Nigel Gray discovered be fully covered. Its reporting ‘Victoria’s Dying Habit’. It opened informally that Rupert Murdoch, the was initially non-committal and with an article headed ‘Move to Ban proprietor, would not object to “a later supportive. As The Herald Tobacco Advertising’ carrying the local decision being made on local was traditionally a foe of tobacco proposed legislation and its effect. grounds” not to oppose a ban on advertising restrictions, its support Other articles on the history of cigarette advertising. White met with (which continues today) was smoking, arguments for and against the editor of The Sun. The paper’s something of a coup for the health smoking, perspectives from cancer position on the proposal was neutral. lobby, and was certainly noted by victims, addicted smokers, children This was all that was required. the politicians. born to smokers, tobacco growers, doctors, non-smoking advocates and the tobacco lobby ran during the evidence that 17 people died each a year in contributions to sport week and feedback from readers was day in Victoria from smoking-related and culture. In the end, Treasury invited. “The articles really ventilated diseases, two people died every day allocated A$24 million to VicHealth the issue”, said Gray. from alcohol-related diseases, and one but the buyout cost only A$6 million. The proposal went through Cabinet. person died every two days from hard The tobacco industry had, in fact, Critically, White and Gray decided drugs. Therefore, if we were talking exaggerated its contribution. that pushing the proposal through the about drug abuse, the major issue was Public opinion needed to support the Budget process would not be the best tobacco. Reducing tobacco use wasn’t proposal. Premier John Cain’s advisors way to achieve a sustainable result. what state and federal government also needed to be convinced the plan A Tobacco Bill that incorporated the money was directed at. Rob [Jolly] was politically palatable. Gray had tax and the restrictions on advertising was persuaded by that argument”, become aware of a poll completed at and introduced the Victorian Health said White. the University of Melbourne, where Promotion Foundation to manage the Jolly was against hypothecation results showed, surprisingly, that a funds and the buyout was decided as but saw the merits of this proposal tax on tobacco was popular. “This the appropriate course of action. This and had a sympathetic Head of was unique information. In those turned out to be absolutely crucial. Treasury. “We were quite a different days nobody had any idea that any The tobacco industry, relieved to government compared with many tax could be popular”, said Gray. see that no tax increases had been other governments. We worked “They hadn’t even thought of asking introduced through the Budget, was together as a team and were willing the question.” caught napping when the Bill became to sacrifice conventional policies if The Anti-Cancer Council commissioned public. Forced to mount a campaign it was in the best interests of the a survey asking a range of questions opposing the Bill at short notice, their community – myself, David and framed by the Council’s David Hill. response was reactive and misjudged the Premier [John Cain] were all The survey of 1136 Victorians showed the mood, according to Shadow pretty strong anti-smoking people that 84% would support an increase in Health Minister Mark Birrell. “The big and that certainly helped in terms tobacco tax of 50 cents a packet if the picture was that everyone in Victoria, of the campaign”, said Jolly. revenue went to such programs as down to the brown dog in the street, In his proposal, Gray estimated A$12 health education, medical research and knew that cigarettes did cause harm. million would be needed to buy sports and arts funding. The results The tobacco companies were saying out tobacco sponsorship. Unofficial were broken down by party affiliation. ‘No, they don’t’ or ‘We don’t need to estimates at the time had the tobacco This underpinned confidence in the discuss the medical aspects – it’s a industry spending about A$15 million idea and the advance continued. rights issue.’ In Australia, that’s not a

The start of Something Big | 5 Results of the public survey In June 1987, the Centre for • when asked if they would Behavioural Research in Cancer approve of a 50 cent per pack commissioned the Roy Morgan tax increase if the revenue Research Centre to survey public raised were put into programs attitudes to: the current anti-smoking such as health education, campaign, to increases in tobacco medical research and funding taxation, to restrictions in tobacco sport and the arts, total approval advertising and promotion, and to the for the tax soared to 84%. idea of putting tobacco tax revenue • 63% approved of a ban on all into a fund to pay for sporting, health forms of tobacco advertising. and medical activities. Opinions The most common reason given were measured by voter intention, for not approving of such a making the results particularly ban was the belief that issues salient to the political parties. such as freedom, rights and A representative sample of 1136 democracy would suffer (54%). adults aged over 16 years was • 37% would unconditionally interviewed. The poll pointed to approve of a ban on sponsorship strong community support for of sport by tobacco companies. the new initiatives: • 57% would approve of a ban on • 79% of Victorians believed the sponsorship of sport by tobacco smoking reduction campaign companies if such funding were currently in progress should replaced by money raised from be the same or tougher. tobacco taxes, and 35% • 47% approved of an increased continued to disapprove. tobacco tax of 50 cents per Source: Hill D. Public opinion on tobacco packet; just over 20% of smokers advertising, sports sponsorships and taxation prior to the Victorian Tobacco Act, 1987. approved of this increase. Community Health Studies 1988; XII: 282-288.

6 | Chapter One The Anti-Cancer Council’s TV commercial The Coroner was very provocative, very political, and deliberately so.

sustainable public position. They lost, The campaign that the Anti-Cancer Organisations and individuals began a or abandoned, the main debate and Council implemented was sharp and letter-writing campaign at the council’s then tried to run an argument on the effective. The TV commercial The urging. The mailout of the newsletter right to communicate. There’s a valid Coroner was very provocative, very reached 140,000 members and the argument there, but not for a product political, and deliberately so. In it a letter-writing campaign was regarded that visibly causes death in so many packet of cigarettes is pulled from a by many members of parliament as the of its users. There’s no other legal corpse during an autopsy and cited biggest, most sustained in memory. product in this category, and we had as the cause of death. The Big Kill The contribution of the Peter to run specific legislation to deal – information sheets containing a MacCallum Cancer Institute, read with it”, he said. breakdown of deaths by municipality out during the parliamentary – highlighted the contribution of By contrast, the Anti-Cancer debate, summed up the need for tobacco to these figures. Sent to Council had a plan, could mobilise the legislation: “Up until July of every suburban newspaper and every big numbers and, along with some this year, 1976 new patients with parliamentarian at their electorate powerful allies, was ready to fight lung cancer were referred to the office, the information impressed hard. Gray summed it up simply in institute, and smoking histories were many of the need to act immediately. a quote to The Age on 28 July 1987: available for 1958 of these patients: “We attack tobacco because it is the An article was included in a special only 71 (3.6%) were non-smokers. biggest. Not worse or better, but it is edition of Cancer News, the Anti- There is little we can do to prevent the biggest [killer].” The advocate’s Cancer Council publication, asking lung cancer. You can do a lot more. eyes would not be taken off the ball. donors to contact their local members. Please vote for the Tobacco Bill.”

The start of Something Big | 7 Sport and Recreation Victoria formally of the need to reduce smoking. He government of the day had indicated informed the sporting bodies of the thought the idea a good one but, along willingness for the foundation to proposal and most got behind the idea. with other supportive colleagues such be bipartisan if the opposition was as Tom Reynolds, Geoff Connard and prepared to support it. There had Sir Gustav Nossal, Australia’s leading Graeme Weideman, would have to fight been a concern that the money would scientist and one of the world’s hard to sway sceptical colleagues. The be used by the government of the day leading immunologists, agreed arguments against the proposal were as a slush fund, so it was important to be the inaugural chair of the old, but had some resonance: Would there was give and take on both sides proposed Victorian Health Promotion banning advertising in fact lead to to create an independent body.” Foundation, known as VicHealth. a decline in smoking prevalence? If Nossal was approached in a late-night smoking is legal, why should smokers’ phone call to Tokyo by Gray. Nossal rights be infringed? What about “It’s fair to say that most MPs today was surprised to be asked but keen tobacco growers? Most of all, tobacco would not be aware of the heroic to be involved. “I could see that this industry support was under threat. achievement of getting this body was the best chance to strike a real up, nor be completely on top of blow against the tobacco industry and Some heroes emerged. “It was a its breadth of activity now, but the I was happy to be involved”, he said. cathartic and tumultuous debate goodwill lives on and there’s been A breakfast launched the foundation [about whether to pass the Tobacco no mistrust created.” and announced his appointment, Bill] that extended over a very Mark Birrell, former Shadow Health before the Bill was even carried – a considerable period”, said Birrell. Minister and Leader of the Upper strategic move, but one that upset “But we were able to put together House (Liberal) some members of parliament. a team of people who wanted to seize the agenda that Nigel Gray had Nossal’s appointment was a real created – he deserves the credit as While conceding that philosophically coup. “Having a key medical leader at the inspiration, and he didn’t leave it he had been opposed to the Bill, the the forefront gave credibility to the to the last moment to do his lobbying. then Leader of the Opposition, later organisation. It was important that He’d influenced my views, and those Premier, Jeff Kennett, backed the all key sections of the community of a number of us in the party, for Bill in Parliament. “Just as we have and all important interests were lined years and years. He’d created a taken action as a Parliament regarding up before we even began to fight”, great opportunity – but it was just deaths on our roads and drinking of said White. “It sent a message to the right moment; we were able to alcohol and the relationship between the whole medical profession that come with it. The party room debate alcohol and accidents on the road, this was not some fantasy land but was very intense, and there were a we should not be prepared to back was something credible.” Birrell lot of opponents, but I tried to work away from what is obviously a serious agreed: “The strength of the effort with our Shadow Sports Minister at problem, and that is the dependency to create the foundation was its the time, Tom Reynolds, and with of young people on cigarettes”, said scientific credibility. That, more than a number of backbenchers, to get Kennett during the parliamentary anything, was the bridge across some together enough people who said debate on the Bill. of the sea of doubt or opposition we should really give this a try.” that comes with grand projects “A lot of the debate was on the like this. It had scientific rigor, Rob Knowles, who was later to importance of keeping it [the funds scientific credibility and scientific become Health Minister, recalled raised and the foundation managing spokesmen. Without people like Nigel that a general view existed within those funds] out of the hands of Gray and Gus Nossal it probably the Liberal Party that anything done government during election campaigns”, would have been remembered as to reduce smoking was a good thing. agreed Birrell. “There was an appeal nothing more than a bright idea.” That was due to persistent, long-term that such a policy initiative would only and credible lobbying by tobacco be sustainable if it was at arm’s length The Liberal Party party room was the control advocates. It was more the from day-to-day government, and also next obstacle to negotiate. Birrell, who detail that created discussion. “The wasn’t just subsumed into the was also the Liberals’ Leader of the idea had appeal, particularly as the monolithic Health Department – not Upper House, was already convinced

8 | Chapter One Kennett debates the issue “In recent times I cannot remember I do not for a moment deny them their receiving so much correspondence right to smoke, but I do think in this from so many eminent Victorians community we, the legislators, must as well as so many Victorians who be prepared to address the problems are what I would call rank and that confront society when so many ﬁle members of our community. of our young are turning, in many The whole thrust of the Bill has cases through boredom and, on other been to try to restrict access to occasions, through example of their cigarettes by young people in our parents and grandparents, to become community. I do not think anyone dependent on cigarettes. would have any argument with that. Again, I do not deny them the right As a politician and campaigner, in to do so, but...we should not be campaigns of recent times, such prepared to back away from what is as the Central Highlands Province obviously a serious problem, and that by-election and the Nunawading is the dependency of young people on Province re-election, I have spent cigarettes.” 3 considerable time on railway stations Jeff Kennett, former Leader of the early in the morning. I must admit Opposition and later Premier of that it is of great concern to me to Victoria (Liberal) see the number of schoolchildren and young people who walk towards the railway station at 6.30am clutching a cigarette, and, in particular, the number of young women.

3 Victoria Parliamentary Debates, Tobacco Bill Legislative Assembly, vol. 388-389, 28 October 1987, pp. 1848-1849.

The start of Something Big | 9 so much a sense that there would be obvious political enemies, but a sense “Mark Birrell laid out our strategy. that it would be defeated by so-called We had to capture 12 out of 22 higher demands within the Health votes in Shadow Cabinet on the Department or defeated by the natural Monday, which would mean that we and perpetual opposition from the then had a basic 22 votes out of 64 State Treasury. So to have a separate in the party room on the Tuesday. body with hypothecated revenue I visited as many of the Shadow meant that it wasn’t going to be Cabinet Members as I could. The politicised and it wasn’t going to be industry had been getting at several defeated by the bureaucracy.” members, especially Jim Ramsay, on the basis of freedom of speech, and White’s tactic was to allow the Liberal I had to deal with that argument. At The persistent Nigel Gray, who Party to make some amendments had a big idea to increase taxes his suggestion, I contacted our two on cigarettes to keep them out and gain some political mileage out Archbishops. David Penman said, of reach of young people. of them. In return they would support “I’d be very pleased to help, I’ll make the Bill’s major features. “We had a couple of phone calls.” Frank Little to introduce legislation saying we was out of town, but his assistant would make a compulsory buyout said that he was sure the Archbishop of all tobacco sponsorship”, said was sympathetic (and I got a really White. “Along the way, they were lovely letter from Little afterwards going to amend it and make it a saying that he’d taken action on the voluntary buyout and call me a matter, though I never found out Maoist and a Stalinist. I was happy what the action was. Letters? for that to happen if it got the Phone calls? Thunderbolts?).” legislation through.” Nigel Gray, former Director of the On 7 October, the Bill was introduced Anti-Cancer Council of Victoria to Parliament. The Melbourne Herald Shadow Health Minister at ran an opinion piece by Gus Nossal on the time, Mark Birrell says the the same date. The debate resumed on After much discussion, the Bill passed tobacco industry lost because the health professionals won, 28 October with urgency to complete through the Legislative Council with not the politicians. it during that session of Parliament. one major amendment: sports and arts While the ALP and the Liberal Party bodies would be free to choose their discussed the form of the legislation, sponsors. Tobacco sponsorship of the National Party argued for referral sports and arts would not be banned. of the Bill to a committee. Some In the public arena it became a estimated such a move would delay sticking point. Labor threatened not to the legislation by up to three years. pass the Bill with those amendments in place. The Liberal Party argued publicly that VicHealth had the money to buy out the sponsorships and groups would be persuaded by the merits of being associated with health messages rather than tobacco – particularly with more money on offer. Free choice, though, must remain. Gray got back on the hustings. On 5 November in The Age he wrote, “in summary, the differences between

10 | Chapter One the parties [were] very small and the them. I think everybody knew that grounds for agreement very large. area was important and would grow. As one who has advocated this cause Beyond that a number of people, for many years, I now feel that we myself included, hoped that it would are on the verge of taking a historic also be a body that could be a pace- step forward. It would be a great setter in other public health initiatives. tragedy if the baby was thrown out It could be a respected leader and with the bathwater and the certainty an advocate – quite an unusual one, of the Bill was destroyed because because, at the end of the day, it the Government and the Opposition enjoyed multipartisan support.” cannot negotiate this ﬁnal issue.”

On 14 November the amended “Nigel Gray and Gus Nossal gave it Bill was ratified by the Legislative stature because of their credibility Assembly. The drama continued and the arguments they could as arguments came late about the mount. Then there was the political legislation being the thin edge of the patronage without which it wouldn’t wedge. Birrell, with a party room have got up, but you needed the decision in his bag, just made it known scientific basis first. And then the he was not leaving until it passed. “We political coalition: MPs who were had a decision to stand behind. I didn’t drawn to the idea of creating a know what might happen if the issue unique health promotion body. So, was recommitted”, Knowles said. the campaign was a great mix of Late on 17 November, Gray watched figures from science, people from the Bill passed into legislation. “It is politics, and – the third key criterion one of the achievements I am most – allies. These were people who had proud of.” White was more relieved helped throw up the agenda for this than anything else: “You’re just trying great new body, and were able to to get there, and then hope, in the make clear that it had a long-term execution of it, it will survive and visionary agenda, or allies who could prosper. The elation is in the fight help achieve its implementation such – you’re drained by the end.” as people from sport who said that they would alter their sponsorship Birrell summed up the hopes well: practices. All these were big steps, “Everybody involved would have their all would need to be harnessed … own perception of what it was to be; I don’t think you could have done there were immediate imperatives, it without all three.” and then the broader vision. The Mark Birrell, former Shadow Health immediate imperatives were to buy Minister and Leader of the Upper out the leverage points that cigarette House (Liberal) companies had inserted over sporting and other community groups. So, there was a mission to be fulfilled – get them out of the game, stop the patronage that they had misused. Then there was a wish to better fund what were at that stage relatively embryonic Quit-style campaigns and to ensure substantial funding for

The start of Something Big | 11

Putting the Act into action The creation of VicHealth The ﬁrst Board of VicHealth

1 2 3 4 5

6 7 8 9 10

1. Sir Gustav Nossal 10. Ms Pam Ryan 2. Dr Nigel Gray 11. The Hon. Graeme 3. Ms Terri Jackson Weideman (Liberal Party) 4. Mr Ron Casey 12. The Hon.William McGrath (National Party) 5. Mr Russell Hopper 13. The Hon. Michael Arnold 6. Ms Sue Nattrass (Australian Labor Party) 7. Mr David Parkin 8. Sir Donald Trescowthick 9. Mr John Clemenger

11 12 13

14 | Chapter Two Once the Tobacco Act had been with expertise in research, medical passed into legislation, and the science, sport, the arts and business/ foundations laid for the creation of marketing have been critical to the VicHealth, fast action was needed. organisation’s credibility, profile A torrent of money was coming down and success in reaching deep into the sluice, and it was necessary to many parts of the community. create an organisation that could The Board’s first National Party spend it. Sir Gustav Nossal had representative, Bill McGrath, agrees. already been appointed VicHealth’s “The political support from the first Chair. A skeleton team was then different parties sent out a clear appointed on short-term contracts message – it emphasised the under the leadership of Andrew importance of what VicHealth Herington (an advisor to David White was doing.” and the head of the Tobacco Project Group within the Health Department). Mark Birrell says the structure was Temporary quarters were arranged at important for many reasons. “I was the offices of the Anti-Cancer Council looking for a structure that met the until new quarters in Carlton were goal of ensuring VicHealth outlived ready, and a committee was formed the inevitable challenges and threats (and an executive search organisation that reforming agencies face. We hired) to choose VicHealth’s needed VicHealth to have a governance first Chief Executive Officer. structure that was balanced and representative. We found a precedent VicHealth needed a structure to in the councils that oversaw universities, manage the workload and the politics, which enshrined representations from personnel committed to the cause all shades of politics. It was the of improving people’s health, the perfect model. I should add that by capacity to adapt as society changed amending the original Tobacco Bill and the needs of the community this way, I was also able to convince progressed, and a reliance on doubting members of my party that partnerships and networks to make the initiative deserved their vote.” things happen. Not only that, the team at VicHealth had to complete It wasn’t, however, just the structure the pragmatic, yet substantial, tasks that made it work. The quality of of devising grant schemes, informing the people on the initial Board, and the community about them, processing the attitudes of parliamentarians applications and quickly getting responsible for monitoring VicHealth’s funding to organisations. activity were vital. Mark Birrell credits David White with creating the initial THE IMPORTANCE OF environment for good governance: A TRIPARTISAN BOARD “David White helped ensure a broad tripartisanship and that was The tripartisan nature of VicHealth’s particularly important in making it Board has been, and continues to work after it was created. He did be, one of its greatest strengths. An not seek to politicise VicHealth, elected representative from each which despite everything you could of the parliamentary parties – the write into the legislation in terms Australian Labor Party, the Liberal of safeguards, could still have been Party and the National Party – and done. It was of enduring importance high-profile hard-working members that he ran it true to its spirit.”

Putting the Act into action | 15 Political support for a generation Any success in managing VicHealth’s myriad objectives started at the top. Former Chair Professor John Funder says: “VicHealth has been fortunate to have had good Ministers.” Politicians such as David White, Mark Birrell, the late Marie Tehan, Rob Knowles, John Thwaites and Bronwyn Pike have been Health Ministers who have supported VicHealth and the ideals forged through the creation of the Tobacco Act. Political support is vital, as VicHealth’s existence is inherently vulnerable. Often public health and health promotion results take a long time to emerge. In politics, that isn’t always attractive. Therefore the organisation Former Health Minister Rob Knowles (Liberal), one of many strong supporters of VicHealth, celebrates needs champions; supporters who 10 years of health promotion achievement in Victoria with VicHealth CEO Rhonda Galbally (centre) and Chair Professor John Funder (right). understand the benefits of investing at least part of the health budget in the Cancer Council, and from the to use the money available with the long-term initiatives. Former Health medical research available Parliament greatest amount of respect and get Minister Rob Knowles (Liberal) understood the detrimental effects value for our money. I believe we did.” says it’s why it is worth fighting for. to smokers. It was important to get Not only that, but a collection of “As a Health Minister, one thing I the anti-smoking messages out to people with skill, ideals and integrity was very clear about is that public young people.” McGrath says that gathered together to sit on the first health initiatives per se are slow in there was no better way to do this Board (see page 83 for full listing) delivering results, but the results they at the time than through the football and began a tradition of excellent and deliver are much more sustainable leagues across Victoria, like the cooperative governance that continues and have a much greater impact Oven’s & Murray league, which is today. The Board, as David White on the wellbeing of the community still strong. “Local members were says, was “stacked with credibility”. generally than the quick fixes.” invited to the games, which were All he, as Minister, purported to do much more high profile then.” Bill McGrath, the Board’s first National was provide emotional support, and party representative, was definite As long-serving Liberal politician let those on the Board shape its about the value of VicHealth: “The and VicHealth Board member character. tobacco growers in the main accepted Graeme Weideman says: “We had the change. At the time there were the opportunity to do things that a lot of messages coming out from had never been done before. We had

16 | Chapter Two White is adamant that the intention Bruce Mildenhall visited North those involved to work for the greater to create something above politics America and Europe to investigate good. He played no small part in was essential for such an organisation harm minimisation approaches providing some armour plating for to survive and prosper. “The question taken in relation to illicit drug use. the organisation when it came under is why develop something that threat or attack. “Tripartisan support is very special”, is going to be abolished? It’s just says Professor John Catford, Dean Rhonda Galbally, who was selected rubbish”, says White. “It needed of Health and Behavioural Sciences as VicHealth’s first Chief Executive to be tripartisan because no one at Deakin University. “It has meant Officer (see Chapter Three), had no stays in government forever.” some of the more difficult things doubt about his contribution: “As [to deal with] have been taken the most eminent research scientist “The ebullient Graeme Weideman, away from any political bunfights, in Australia, and CEO of Australia’s representing the Liberal Party, was which is, of course, very good.” most prestigious research institute, the Walter and Eliza Hall Institute, so enthusiastic a Board member that Those behind the model, such as Gus was naturally devoted to medical we had to assign a staff member Birrell, say that it was critical that research. The world of health to respond to his multitude of the structure be kept at arm’s length promotion was new to him. He was suggestions and ideas. Ron Best from day-to-day government. “I hoped faced with a Board full of sectional was the longest serving National it would be a body that was a pace interests. Some wanted funding for Party representative; he used his setter in public health initiatives their own organisations; others felt Board position to search for every and that it could be a respected they had to deliver funds to their possibility to fight for every drop leader and advocate because it sector. Others had political interests, of money for the rural sector. Labor was broadly based. My aim was to where geographic constituents party member Eddie Micallef often get it above day-to-day politics.” joined up with Ron Best (always certainly influenced their decision supported by Graeme Weideman) making. It could have been the Board APPOINTING A to promote any group from the from hell. Yet somehow Gus managed WORTHY LEADER wrong side of the tracks. Eddie to pull these disparate individuals would also join with Sir James The appointment of Sir Gustav together into a team. He achieved Gobbo to keep ethnic interests Nossal to lead the first Board was this through the passion of his strongly on the agenda.” seen as critical to the credibility presentation, usually about an aspect Rhonda Galbally, former Chief of the organisation. Nossal, AC, of the research program. Calling Gus Executive Officer of VicHealth Kt CBE, Emeritus Professor, charismatic is an understatement. It University of Melbourne, is a world was his integrity that literally rallied leader in fundamental immunology a potentially disparate group into a Having such a high-profile Board, research. Knighted in 1977, he was tight pack.” being an independent statutory made a Companion of the Order of The essence of this description was authority and being answerable to Australia in 1989, was Australian of repeated in various forms over and Parliament has enabled VicHealth the Year in 2000 and is regarded as over again by members of the Board. to keep discussion of health one of Australia’s National Living “Gus was a great person to have in promotion and public health issues Treasures. Born in Austria in 1931, the driving seat”, says Bill McGrath, focused towards outcomes for the he emigrated with his family to who represented the National Party. public good. It has allowed the Australia before the outbreak of David Parkin, former AFL coach and organisation to advance agendas World War II and is renowned both long-term member of the Board, was that may be considered too hot for as an extraordinary researcher effusive in his praise: “We were led government departments to handle and as a communicator of complex by the most magnificent leader. I and to trial leading-edge models scientific topics. Both revered and have not found in all my walks of life for change. For example, in 2000 respected, he was an inspired choice. another person who was so intelligent Rob Moodie, Robert Doyle (Leader His charisma and intellect brought but so people oriented. He just made of the Opposition) and the ALP’s the Board together and inspired everyone around that [Board] table

Putting the Act into action | 17 feel good about themselves – he never mechanism was revolutionary; a failed to reward people for their time world first that created in Victoria and their effort. And, he made some a sustainable base and structure tough decisions too.” for health promotion. Rob Knowles, Liberal Health Minister CREATING A SUSTAINABLE from 1996 to 1999, is just one of FUNDING MODEL many people who argue the dedicated Establishing a sustainable funding funding stream was critical to base for health promotion activity is VicHealth’s success. notoriously difficult. It’s why the use The dedicated tax was an efficient of hypothecation – a tongue-stretching and unique way for the Government name for the tax Victoria put on to raise sufficient funds to enable cigarettes that was to be dedicated to VicHealth to buy out the tobacco underpinning VicHealth – became a Revered and respected, Sir Gustav Nossal (second industry’s sponsorship of sport and from left) was an inspired choice to lead VicHealth’s funding model scrutinised throughout the arts. As Randall Kent, Finance & first Board. He is pictured here celebrating the health promotion world. VicHealth’s first anniversary in 1988 with Shadow Administration Director at VicHealth, Health Minister Mark Birrell (left), CEO Rhonda Peter Worland, former advisor to who recalls picking up by hand the Galbally and Health Minister David White (right). Health Minister David White, is cheque from the State Revenue Office credited with the idea. White said each month, says: “The concept that Treasury, renowned for disliking itself was interesting – tax a harmful earmarked taxes, first heard of the product, tobacco, to fund schemes idea in 1985. Rob Jolly, then Treasurer and programs that benefit the and a man who liked the idea but was community.” not sold on the need for dedicated The Tobacco Act 1987 put a levy tax, told White to be patient. In on top of existing state tobacco 1987 White’s patience paid off. “We fees, which saw 5% of tobacco persisted and we got it”, said White. sales hypothecated to the Health From Jolly’s perspective it was the Promotion Fund. In its first full strength of the community support year, 1988–1989, VicHealth’s that was important. “It became a budget was A$25.215 million. really strong community issue; to such an extent I was able to persuade The tax was also an effective tobacco Peter Worland, former advisor to Health Minister David White. the Department to actually introduce control strategy in its own right. An hypothecation. There was a greater increase in price caused by the tax prospect of getting money for that would mean fewer sales in particular area of activity than some other that segments of the market and therefore was regarded as a lower priority. The less smoking. Studies around price priority given to it by government elasticity had shown that the price reflected the community’s concern on increase caused by the Tobacco Act the extent of smoking. Hypothecation would reduce the smoking rates of served the dual purposes of allowing those under 18. Politically such an people to know where money was impact was popular. Free market/free coming from and also elevating the choice arguments carried some weight in relation to the adult community, importance of it in the community’s The Premier, Mr John Cain, with Nunawading Quit eyes, because it was a rare event but all thought that stopping young Spectre’s captain Michelle Timms at the launch in 1989 of the VicHealth billboards in which she features. for such a thing to happen.” people from taking up smoking was a reasonable and, it must be Its effect is not to be underestimated said, vote-catching objective. in the story of VicHealth. Such a

18 | Chapter Two A CHANGE OF GOVERNMENT Graeme Weideman, a constant and PUTS HYPOTHECATION vociferous supporter of VicHealth UNDER THREAT and the Tobacco Act, and a founding Board member of the The benefits of such a scheme to organisation, was also crucial in health promotion were obvious and convincing the party of the merits the gain hard won. However, its of retaining the original model. popularity with Treasury was only ever lukewarm. Treasury officials Many believe the survival of generally do not like dedicated taxes. hypothecation was critical to the VicHealth in danger with the change to a Liberal They argue they distort priorities. survival of VicHealth. Knowles, who government in 1992 headed by Jeff Kennett. The system would come under was then assistant to the Treasurer, threat again in 1992, after a change was part of the fight to retain the of government. Everything related dedicated funding stream. “Those in to government finances was coming the health area knew full well that under heavy scrutiny. VicHealth was the end of hypothecation would be no exception. New State Treasurer the death knell of VicHealth. Health Alan Stockdale believed that the funding is influenced by waiting lists Health Department could determine and ambulances so it was crucial health promotion’s importance and for us to win the argument. We did allocate an appropriate budget to concede that VicHealth would make reflect that. He could see no reason its contribution to recovery, as every for a dedicated tax. other program would, however we’d made that concession to win the Mark Birrell remembers it as a argument on hypothecation.” dangerous time for the tax. However, sufficient contemporary knowledge In Restoring Victoria’s Finances: of how the legislation had been A Beginning, Alan Stockdale, the passed meant a degree of ownership new Treasurer, spelt out what this over VicHealth existed within the meant for VicHealth: Liberal Party. Birrell said it diverted The Victorian Health Promotion the debate away from removal Fund currently receives of hypothecation on principle to 5 percentage points or one-tenth of ensuring VicHealth survived with tobacco franchise fee receipts. For appropriate funding: “I wouldn’t 1992–93, the VicHealth share shall suggest that there was no tension. be re-expressed as a fixed amount of We’d capped the hypothecation, but A$25 million, and the Government Treasury wanted all the money back. will review its funding base before Its view was – and probably still is the 1993–94 Budget. This measure today – that if what VicHealth did was [the rate rise, the harmonisation of a legitimate function of government Australian rates, and the capping then it should be funded out of the of VicHealth funds] is estimated Health Budget. The funding in fact to raise additional revenues of is a huge achievement, but it’s still A$39 million in 1992–93 and a drop in the ocean, and it would be A$120.6 million in 1993–94.4 obscene to take that drop away.”

4 A. Stockdale, Restoring Victoria’s Finances: A Beginning, 28 October 1992.

Putting the Act into action | 19 The Labor Party opposed this Promotion Foundation is now change to its legacy in Parliament. getting on with the job, as are other The debate that followed was in organisations in the State, of coping some ways a fuller consideration of with tight fiscal circumstances.5 the hypothecation issue than had Hypothecation became nominal only, occurred in the first instance. It as the funding to VicHealth was was now universally conceded that capped without indexation from 1992 VicHealth was a good thing, only the to 1996, initially at A$25 million before funding method was in question. moving to A$22 million (see table next Bill Forwood, now a VicHealth The Hon. Bill Forwood (Liberal), who debated page). The annual amount allocated the hypothecation issue in Parliament. Board member, speaking for the to VicHealth from tobacco franchise Government, said in Parliament: fees was determined by the Treasurer. There is no doubt that the Victorian In three years, VicHealth’s budget Health Promotion Foundation has dropped by 29%. Kent remembers been an outstanding success. It was the time well: “Symbolically the a brilliant idea, it was received well rationale was we can’t afford to and its gestation period has proven exempt VicHealth from all the cuts. to be effective. I will continue to Everything is getting cut, so you argue strongly and consistently have to take your medicine too.” that the Victorian Health Promotion Gus Nossal and Rhonda Galbally kept Foundation has a significant role quiet publicly, but behind the scenes to play in the health of Victorians. worked feverishly to maintain the That is obviously a matter that the organisation close to its original state. Government is highly aware of Some in the Labor Party believed and will encourage. it should have fought harder and However, Forwood said also: more loudly to retain funding at original levels. Compromises were Hypothecation is a difficult issue. made and VicHealth did change its I know that both the Treasurer and focus, but its work continued. the Shadow Treasurer are on the record as opposing it … it is one Rob Knowles says it was actually a of those issues that does not enjoy good battle for VicHealth to face, as unanimity of support on either it contained lessons for the future. side of the House. “In terms of finances VicHealth doesn’t necessarily rank highly, White, architect of the Tobacco unless there are really difficult Act, interjected: circumstances like in 1992. Having You should have seen the trouble had to go through that challenge I went to to get it in the first place. once, if we’re in dire straits we could Forwood: do what we did in 1992 again.” I am firmly committed to arguing in VicHealth had survived a challenge in every forum that we should move the toughest of circumstances because back to full hypothecation as quickly the merits of its programs were as possible. The current situation, obvious to everyone in Parliament. however, is that the Victorian Health

5 State Taxation (Further Amendment Bill), Second Reading, 17 November 1993, p. 1078.

20 | Chapter Two OUT OF EVERYONE’S HANDS tobacco were abolished. VicHealth was funded from consolidated Hypothecation as a source of revenue to remove the immediate revenue for VicHealth would not threat and then funding came out survive beyond 1997. That year the of standard budget expenditures High Court of Australia (following – a situation that continues today. legal challenges by retailers and Since 1 July 1998, annual funding for wholesalers upon whom licence fees VicHealth has been determined by were imposed) invalidated state the Treasurer, appropriated as part and territory business franchise and of Victoria’s annual budget within the licence fees, including tobacco fees, by Department’s appropriation. deciding the tax was unconstitutional. (State franchise fees on tobacco, Rhonda Galbally thinks it is a great alcohol and petroleum were in effect pity that the dedicated tobacco excise duties. Under the Constitution, tax was capped, then abolished. “It excise is the sole prerogative of became the model that we were still the Federal Government.) pushing internationally, because it was the only model many countries could It was a worrying time for VicHealth, afford, however it wasn’t the model we admits Kent, but was resolved quickly. were using.” State business franchise fees on

How VicHealth has been funded

1988 1989 1990 1993 1995 1997+

Total Victorian tobacco licence fees 30% 35% 50% 75% 100% Nil (as a percentage of value of wholesale sales)

� �� Proportion hypothecated to health promotion fund � �� (max)�� (max) Nil

Percentage of wholesale sales for health promotion 5% 5% 5% 5% (max) 6.66% (max) Nil

NOTES • 1987–88 to 1991–92: Full hypothecation • 1996–97: Indexation of 3% introduced. calculated as percentage of Victorian ad valorem • 1997–: On 5 August 1997 the High Court of Australia tobacco franchise fees (the tobacco levy). invalidated state and territory business franchise • 1992–93 to 1995–96: Nominal hypothecation, and licence fees, including tobacco fees. Since but capped. VicHealth funded from tobacco fees then VicHealth has been funded from consolidated but actual amount capped and less than the revenue as part of Victoria’s annual budget and paid speciﬁed maximum. via the Department of Human Services.

Putting the Act into action | 21

A new era in Health Promotion 1987–1997 The structure and funding model for VicHealth had been established and the organisation was poised for a period of frenetic activity. There was an air of expectation as the Board met for the ﬁrst time on 3 December 1987.

24 | Chapter Three VicHealth is a very different alcohol, helped set up centres of organisation now compared with research to discover more about its early days. But the first 10 years sexual health, mothers’ and children’s played a crucial part in creating the health, adolescent health, Indigenous dynamic and innovative organisation health, funded ways to prevent sports it continues to be known as, despite injury, and used its social marketing significant changes in the external muscle to inform the community about environment. The original focus of risk factors for health issues such as VicHealth was clear: to substantially diabetes, asthma and heart disease reduce the impact of smoking. (see Chapter Five for more detail). VicHealth had a guaranteed funding More recently, VicHealth has led the stream with the tax on tobacco. It also charge to promote mental health and had a tobacco buyout to complete wellbeing, and increase participation Inaugural CEO Rhonda Galbally. – an achievement that took little over in physical activity. The organisation a year to be put into place, apart has also delved deep into the social from the sports with national reach factors that influence a person’s such as cricket, snooker, Rugby health – poverty, poor housing, League and some Australian Football unemployment and poor education, League clubs, such as St Kilda. among others. Methods of working The buyout still ranks as one of the have changed – so too have the organisation’s greatest achievements. types of partnerships and networks, and the ways in which VicHealth As a consistent, reliable funder of advocates change to support health. Quit – a successful and professional campaign dedicated to reducing Start-up Chief Executive Officer smoking prevalence – VicHealth was Rhonda Galbally grins now when able to share the impact, credibility asked where she wanted to take and results that the Quit smoking the organisation when she began. program delivered. This allowed “In the beginning I wanted to get VicHealth the scope to tackle other a viable foundation going. That areas, a position it exploited fully. was hard enough in itself. It’s hard to get something new going in a VicHealth supported SunSmart, landscape where you’ve got a lot of which carries a well-earned reputation enemies, ranging from the tobacco as a world leader in the area of sun industry to bureaucracy – those protection. Right from the beginning, envious of what was perceived to VicHealth also promoted physical be a lot of money”, said Galbally. activity, became a significant voice in debates around illicit drugs and

A new era in Health Promotion | 25 A STRONG LEADER Organisations, many of them health the sporting, arts, health and research agencies, built the community’s communities were established quickly, Few were more influential in awareness of a range of risk factors as well as links with government shaping VicHealth’s character then that might cause ill-health and helped at all levels, the community sector Galbally. A dynamic individual with show ways to positively address across a range of areas and, it a giant intellect and the capacity those issues. Nigel Gray concedes must be said, the general public. to make something out of the that most people in public health smallest opportunity, Galbally’s National party member Ron Best, were sent on a steep learning curve. leadership was critical to the status who served on the Board for 12 “Advertising as used by commerce is that the organisation now enjoys. years, says that Galbally’s strategy different to advertising as used by a to create third party advocates for Galbally excelled at many things, health campaign. Coca-Cola tells you VicHealth and promote the brand but a few of her characteristics ‘Buy Coca-Cola’, but they don’t tell meant that the organisation was were critical to the early success of you to drink it, because they don’t quickly embraced. “Rhonda created the organisation. She was a master need to. But if we are advertising important partnerships and networks networker, whom Nossal affectionately SunSmart, we are not just saying ‘Be that broke the discontent. Some describes as someone who “could SunSmart’, we are telling you how to groups quite rightly had trepidation knock heads together”. She was a be SunSmart. Buy a 15+ sunscreen, about moving to funding from stickler for systems: records would be put on a hat, wear a shirt, sit under VicHealth. Rhonda guided and kept that would provide a wall around a tree between 11 and 3. These are reassured them – their concerns were the organisation, which allowed actually precise instructions, and that replaced with support and praise.” VicHealth to show it was acting with is something that we do in health integrity in fulfilling the intentions advertising that is not necessary in The depth of talent on the Board of the Tobacco Act – staring down some other forms of advertising.” helped. Nigel Gray says that Ron the inevitable attacks on its credibility Casey, legendary sports broadcaster VicHealth would secure sponsorship launched by the tobacco industry. and administrator, was the ‘jewel in with either the peak association or, the crown’, bringing to the challenge Galbally also knew how to spend in some cases, an elite club, and not only incredible links with money. As Rob Moodie, her successor allocate the health message developed sport, but enormous respect, tough in the CEO’s seat, says, VicHealth in consultation with the relevant negotiating skills and a commitment was highly pragamtic. It never let the health agency. The messages were to fulfilling the objective of using sport “perfect get in the way of the good”. In simple but memorable: “Booze Less as a conduit for health messages. other words, the organisation moved Be Your Best” or “Move it or Lose It”. quickly to establish sub-committees Health agencies such as the Cancer The research committee led by the to authorise spending and systems Council’s Quit and SunSmart, irrepressible Sir Gustav Nossal was to show where the money was going. Diabetes Australia, the National swamped with applications, most of Galbally’s philanthropic background Heart Foundation and the Australian them biomedical, but it would start meant she could recognise ways to Drug Foundation would then manage a new age in public health research get credible projects up and running. the sponsorship on its behalf. that just 20 years later is still yielding dividends for the community. All in all it led to a huge array of HEALTH MESSAGES organisations and people with one VicHealth and health agencies such THE MAIN GAME degree of separation: VicHealth. as the Cancer Council, the Arthritis Back then, health messages were Moodie agrees that this initial Foundation, the Australian Drug promoted through sponsorship in an work often gives the organisation Foundation, the Heart Foundation attempt to change behaviour. This greater influence than the budget and Diabetes Australia suddenly had was the main game – to break the might suggest. “The notion of connections and access to elite sports nexus between tobacco and sport being an honest broker and and arts organisations, a high level and the arts. It was an ambitious facilitator is a good place to be.” of advertising in the community, and and, in some ways, audacious plan health promotion programs on a scale Long-lasting connections with and – to buy out tobacco sponsorships. that only a few years earlier would between the movers and shakers in have seemed like a dream.

26 | Chapter Three Campaign examples

2 3

4 5 6

The messages were simple but memorable, and included: 1. Booze Less, Be Your Best (alcohol misuse) 2. Active at Any Age (increasing physical activity) 3. Quit (smoking) 4. SunSmart (sun protection) 5 & 6. Active for Life (increasing physical activity)

A new era in Health Promotion | 27 Left Celebrating greyhound sponsorship – Bill Collins, Professor Paul Zimmet and Rhonda Galbally. Right Signage at Moonee Valley – a strong partnership was forged between VicHealth and the racing industry to promote health to the racing public. Far right Through VicHealth’s sponsorship of the Herald Sun Tour, one of Australia’s premier cycling events, Victorians are encouraged to be physically active.

SELLING THE TOBACCO BUYOUT reach that they became a feature “My main job in the early days was to of VicHealth – its effectiveness Of course, this wasn’t the total story. go around to sports bodies and ask and ability to move across sectors Many battles were fought and won them to give up tobacco sponsorship being very hard to replicate. Rob over a short period. and replace it with promotion of a Knowles, Liberal Health Minister One major concession had been made health message – the Quit campaign, from 1996 to 1999, said this feature to ensure the passing of the Tobacco for preference, although [VicHealth] of the organisation was amazing. Act: no organisation or group would offered other campaigns to sports “It really was an endeavour to build be forced to give up their tobacco that found Quit hard to stomach. a community initiative so that it sponsorship. Any buyout would be Country Football, for example, was wasn’t just government that had purely voluntary. However, the many a reluctant bride, and its leaders ownership over it, but the community people who’d worked so long and hard didn’t want to be too offensive generally. The message was to see the Bill pass into legislation to their former spouse, Winfield. permeating into activities and strata were hopeful. With funds from the VicHealth thus asked them to support of society that traditional government dedicated tax, VicHealth would be a campaign, “Move It Or Lose It”, programs had never reached.” in a strong position to argue its case. mounted by the Arthritis Foundation The first sport to be tackled was horse And so it transpired. to promote gentle exercise (though racing. “There was some debate at that slogan for some reason always The first objective of the buyout was the Board as to whether horse racing elicited titters of anxiety from middle- to replace tobacco sponsorships with was actually a sport – one point of aged men, particularly politicians).” sponsorships from health agencies view frequently expressed was that Rhonda Galbally, former Chief that promoted health messages. The all that [VicHealth] was doing with Executive Officer of VicHealth rest of the revenue would be used to events such as the Manikato Cup invest in promotion of good health, was promoting the health of Victoria’s safety or the prevention and early Sport was guaranteed 30% of the horses, which by and large didn’t detection of disease, research and funds by the Tobacco Act. However, really need it,” recalled Galbally. sports and arts programs.6 as the buyout was not compulsory, But legendary sports broadcaster Ron VicHealth began to establish influential Casey brought the Board around to networks throughout the community. the view that the racetrack was where These extended well beyond health. you would find a captive audience of In fact, so extensive was their 6 Victorian Tobacco Act 1987. the unhealthiest people in Australia

28 | Chapter Three congregated in one spot. The deal name – they feared that if they had was a voluntary buyout, VicHealth was done. Greyhound racing was ‘Quit’ written all over their gear it made it easy for the sporting and next, followed by harness racing. would sap their players’ energy and arts community to seek sponsorship leach away their winning streaks – but funds to replace tobacco. It involved David Parkin, an Australian Football we stuck to our guns, as Quit was not other health promotion agencies icon who was also on the Board, only a well-established name, but one – connecting them with organisations says the then Department of Sport that was short enough to capture on and health messages and, where and Recreation played a huge role in the TV cameras”, said Galbally. necessary, coaching them how to advising VicHealth as to how to best make maximum use of the investment. use the money. “They gave us real State rivalries presented their own insight into how the sporting bodies difficulties. When the tobacco industry The arts community jumped worked and who would be effective pressed for the Motorcycle Grand on board quickly and, for them, in getting things done”, says Parkin. Prix to be taken away from the Phillip the tobacco buyout was a done Island Circuit to punish Victoria, every deal – everyone happy and the On a national level, however, it other state leapt at the opportunity. smoke-free/Quit messages in arts was not all plain sailing. The largest It ended up with New South Wales. foyers all around the state. tobacco sponsorship packages in Australia were those of national “VicHealth became famous for Ron Best attributes success in sports, which naturally enough losing Victoria the seedy, grossly the rural areas to the fact that were televised in Victoria as well. overvalued Formula One Grand “VicHealth understood the fabric of Cricket was the toughest: the Benson Prix motorbike race. We offered country Victoria”. The organisation & Hedges (Wills) deal with the to replace the sponsorship for the was sensitive to their needs Australian Cricket Board said to be first motorbike grand prix, but the and became involved in a lot of worth A$15 million over five years. price went up and up and eventually signature community events. we drew a line in the sand. In the Soccer was the first national sport Such was the enthusiasm with which end it went to Sydney, and much to come on board, with VicHealth most of Victoria’s sporting and arts to my joy, it was always a complete negotiating a name change from communities greeted VicHealth’s financial disaster”, said Galbally. the Winfield Socceroos to the Quit alternative sponsorship, the bulk of Socceroos. “Sporting teams always VicHealth used its Board members to the buyout, which had been expected had some level of discomfort with the launch and talk up the organisation to take five years, was completed in use of the word ‘Quit’ in their team at every opportunity. Because it just over one. Even the Confederation

A new era in Health Promotion | 29 of Australian Sport itself, a citadel of electorate should get value for the support base. As far as the Board tobacco money, had seen the writing A$30 million”, said Weideman. went, grant-making decisions were the on the wall (or the Quit posters on hottest part of our business. Because Ron Best, a National Party politician the boundary) and signed up for of the lively system of inclusion of and member of the VicHealth Board, A$116,000 of VicHealth money. community members through the was also mindful of engaging and committee system, by the time a Sport by sport, art venue by art updating local members so that there recommendation was made to the venue, the tobacco industry was would be no confusion about what Board, the project had been well given its marching orders, even VicHealth was doing. He says Galbally and truly vetted, debated and often including events like Victoria’s made sure that potential spot fires did redesigned. Our recommendations to Stawell Gift, one of the world’s not flare up. “There was a lot of petty Board were usually endorsed, with most famous and prestigious jealousy because VicHealth had more some unexceptional exceptions. The footraces. By the end of 1991 the money to spend than the government political members occasionally raised buyout was considered complete. departments that had been looking an issue about partisan allegiance, and after them – sport and recreation, The process was intense and lively, Ron Casey sometimes had political for example, had A$7 million but it was also energy sapping. The concerns about the tobacco industry dollars, while VicHealth had A$28 tobacco companies were ready for gaining a potential advantage from a million. Rhonda made sure that the any slip-up, elite sports weren’t naïve decision.” important people were involved and sure whether community sport understood [what was happening] and It was a pressure-charged situation, should get much money, the arts those issues were resolved without which Galbally acknowledges caused community ran the same argument, too many bones being broken.” much stress within the organisation, and allocation of research funding but also claims was absolutely continued to be scrutinised. VicHealth necessary. “In small ways, more could and the health agencies managing GOVERNANCE be drawn from my experience with the sponsorships were competing The governance system set up to the Myer trusts, where I had inherited for recognition and exposure. oversee grants was critical to the meticulous, well-oiled systems for success of VicHealth’s survival VicHealth’s early high profile had also processing the grants and keeping during its early years. Galbally, with put some noses out of joint, and the track of every step in the process. the Board’s support, established organisation’s reach continued to VicHealth was another matter. After a a robust and accountable system: expand as the money was pushed out. couple of near misses where files were “We established a second level of Powerful allies had been created, but mislaid, I became anally obsessive. governance to handle decisions about after some years the organisation’s And it worked. Work styles, and work grants – a series of committees expert resources were spread very thinly ethics, gradually changed. By the time in health promotion with sports, arts and some relationships would feel the the Estimates Committee enquired and research. The membership of strain. Galbally’s comments reveal the into our operation, we were highly these committees was drawn from a intensity of those early battles: “You organised with outstandingly accurate, mixture of community representatives have to get people on side when you’re safe systems. But it was at a cost and others who brought specialist mobilising, so that when the attacks – the whole VicHealth organisation skills. The addition of this layer come you’ve got friends behind you.” was tense from flogging ourselves to between the Board and the staff achieve higher and higher standards VicHealth established processes to assessment of the projects proved and to take on more developmental ensure politicians were informed very beneficial over the years.” when and where money was spent in work – all with the enemy, the tobacco their electorate. “When I was there,” “Many of the most exciting industry, in the back of our minds. says Weideman, “I made sure that developments came from the The enemy was real. The industry every person got to know VicHealth committees. They added in a level would have cheered if we had fallen and every member was aware of what of accountability and community down over administrative or financial was happening in their electorate. involvement in VicHealth that added mishaps”, says Galbally. We were also conscious that every significantly to the building of our

30 | Chapter Three A SHIFT IN THINKING have a positive impact on such other risks as depression, alcohol and drug Both Galbally and Nossal had abuse. However, there seemed to be a recognised early the need to look reluctant admiration for the enemy’s beyond the sponsorship model marketing strategies. If it was good to make a real difference to the enough for the marketing of smokes, community’s health. This model the idea seemed to be, it was good remained relatively effective at enough for the marketing of anti- reaching the general population, but smoking messages. The assumption often failed to reach the particularly was that people consume behaviours at-risk groups. The benefits of such as not smoking in the same way reaching the general population were as they consume a product such as not to be discounted, though. They cigarettes, and that the consumption brought awareness among decision- of behaviour can therefore be created makers of the issues, reliance by by the same approach used to market some sports on the funding and a any consumer good or service.” network outside of health that would be impossible for a government “Advertisements on television and The real change in health would happen department to establish and maintain. radio, pamphlets, kits and billboards with a connection at the community level, when people identified with the message and However, the real change in health can all be used interchangeably by subsequently made changes to the way they would happen with a connection at the tobacco industry to promote the worked, played and socialised. the community level, when people joys of cigarettes or by the anti- identified with the message and smoking movement’s Quit messages. subsequently made changes to Behaviour around choices for health the way they worked, played and doesn’t move through a set of ‘steps’ socialised. Nossal said in the 1990 towards the light at the end of the Annual Report, “It is clear to me that tunnel. Human beings get tripped health promotion is in part about up by poverty, disability, alienation acceptance, at the local level, that and despair. The more people are the promotion of health is of value.” disenfranchised, isolated, lonely and depressed, the less likely they are to Galbally was on the same path: be able to act on any message except “All the evidence coming in showed the one that is going to make their life people weren’t at the risk of one more bearable right now.” behaviour, but several.” VicHealth’s focus began, ever so slightly, to shift “We needed new ideas, new from using sponsorship to promote explorations, discussions and debates. health messages to changing the VicHealth’s main job, as I saw it, was way in which VicHealth-funded to ensure that the latest thinking and institutions operated. practice was encouraged, even if it was experimental and unpopular. As Galbally articulates the shift in a result, while the tobacco industry thinking well: “The best anti- was calling me a social engineering smoking strategies seemed to be nanny who was trying to stop people those that encouraged people to get from enjoying all the pleasures of out, join groups from bowls clubs life – smoking, drinking, sex, meat to neighbourhood houses and be pies – the anti-smoking people were in charge of their own lives. This castigating me for being diverted approach would not only be effective from the narrow tried-and-true path for tobacco control, it could also that if you just tell people something

A new era in Health Promotion | 31 Treasurer Alan Stockdale and Health Minister (the late) Marie Tehan join VicHealth Chair Sir Gus Nossal in December 1992 to celebrate the Foundation’s 5th birthday and launch Partnerships with Healthy Industry. often enough with bigger and more legitimate voice in health and that its of a priority-driven health promotion expensive advertising campaigns, they ambitions to work with the bodies it research program still years off being will eventually take notice. We needed funded were worthwhile. Programs possible. Between 1987 and 1991, new approaches to prevention, not addressing community needs began biomedical investments accounted for just more of the same”, she says. to run alongside the more overt social 33% of the funding (A$8,441,991), marketing programs. clinical 6% (A$1,646,048) and Throughout much of Galbally’s era, public health 61% (A$15,769, 546).8 the organisation would grapple Programs such as the Healthy with the notion of how to combine Localities project provided the Successful programs were making the social marketing model that opportunity for local government to a significant impact on the their initial success and profile had work with community agencies and understanding of health promotion been built upon, and the growing residents to identify priority health issues. The Royal Children’s Hospital sophistication and complexity of issues and implement local health was funded to implement and evaluate promotions that relied on policy, promotion strategies;7 the Fairlea the effectiveness of a new hearing skill development, strengthening Women’s Prison project (Somebody’s screening program, based on the community action and creating Daughter Theatre Company) by theory that it would result in a supportive environments. Arts Access; support of the Flying lowering of the mean age of diagnosis Fruit Fly Circus; and sports injury of deafness. A grant was given to The organisation’s ability to position prevention programs that addressed establish a pilot mammographic itself as a proactive advocate for one of the barriers to people’s screening service to determine the organisational and structural change participation in sport showed that acceptability of such a service among to support health should not be VicHealth could be involved at a much Victorian women, the costs and underestimated. Galbally continued more complex level than sticking standards to be applied. As well, a pilot to advocate that people at the signs on walls. The answers weren’t of Pap smear recruitment – personal community level, on the ground – obvious, but the need to connect letters of invitation to women in rural the teachers, the football coaches, the with the community essential. Victoria for Pap smear screening – choir leaders – who were in control of and comparison with other their own environment were the keys The research program was continuing recruitment strategies began. to influencing and changing behaviour. to shift the terrain towards public Organisations saw VicHealth as a health research with its eventual goals

7 VicHealth Annual Report 1990, p. 22. 8 VicHealth Annual Report 1991, p. 10.

32 | Chapter Three Programs addressing community needs began to run alongside the more overt social marketing programs. VicHealth became an ‘invisible’ hand in many health promotion initiatives.

Whether sponsorship was the best and major arts organisations and So a much-needed transition began. way to sustain behavioural change you needed to maintain that for It would affect the way VicHealth was increasingly being questioned by about a decade. I had a willingness worked with sport, the arts and the academics and internally. However, to support politically a review of community as well as government. VicHealth itself could not change some of that funding. I wanted the During the early years, VicHealth overnight. The political realities in funding basis to change from one had developed a unique approach 1992, when the Kennett Government that is replacing tobacco sponsorship and had many wins. That approach came into power, the subsequent to one showing the sponsorship as was now to change. It would see changes to the way it did business, good value for what can be achieved VicHealth becoming an ‘invisible hand’ and the often paranoid approach in health by promoting a positive in many health promotion initiatives. ingrained in the organisation – not health message. Funding became without some justification – meant more of a business decision. It wasn’t that investments often continued compensation [to replace tobacco], it on the same lines as during the early was a business decision about where years. Stakeholders and politicians we can get the best bang for our were kept happy, the programs were buck in terms of using these funds.” easy to understand and VicHealth’s VicHealth’s new Chief Executive visibility was kept high. However, after Officer, Rob Moodie, had no problem 10 years, with many conversations with that situation. It was essential to about the change needed and the keep the energy levels high and the departure of Galbally, the time was action results oriented. His opening ripe for a new era to begin. address in the 1998 Annual Report Minister Rob Knowles supported brimmed with confidence: “I look to a review. Key members of the the future with great optimism and state ALP also wanted change and anticipation. As we develop a new indicated as much to VicHealth. VicHealth, I am confident that the “The review of some of the early achievements of the next 10 years sponsorship deals was important. will be equal to or, if not, greater VicHealth had to replace big-ticket than what we have achieved to date.” sponsorship – VFL, racing, cricket,

A new era in Health Promotion | 33

Adapting to a changing environment 1997 onwards VicHealth Chief Executive Ofﬁcer Dr Rob Moodie knows that health promotion works and is comfortable with VicHealth being put under the microscope: “I think VicHealth should only exist if it proves its worth. We should not be here unless we are doing something good, both in terms of what we do and how we do it.”

36 | Chapter Four It’s an attitude that has driven the The external environment had shifted organisation through a transition too. Pressure to show the outcomes it period that began with his arrival as delivered, always present, continued CEO in 1998. The changes wrought to build. Luckily, the organisation had have created not only a body that a running start. The previous regime supports other organisations to had developed several strengths improve health, but one with a much – all vital to the change program upon bigger brief – to identify trends and which VicHealth was about to embark. emerging health issues, drive Its brand was strong, both in the innovative programs, create and community and politically. Its leaders, contribute to debate, gather and Galbally and Nossal, had established interpret evidence and keep networks that were deep and wide. responding to a dynamic external These long-term links established with a Rob Moodie, CEO of VicHealth environment. range of sectors outside of health such since 1998. as the arts, sport and local government In 1998, VicHealth was an organisation gave the organisation both credibility ripe for change. The tobacco buyout, and space to change – as well as a group critical to breaking the connection of involved stakeholders with which to between sport, the arts and tobacco, work. These connections, combined had been completed at the start of with the rock-solid tripartisan support the decade. The scope of the on the Board, gave VicHealth a great organisation, although an advantage platform from which to reinvent itself. in its development, had become too wide to deliver effective outcomes in In 1999, VicHealth began to take the all areas. Relationships with some key steps necessary to move from its status partners needed to be reinvigorated as a funding agency that managed (former Chair Professor John Funder contracts to become a partnering was instrumental in changing the organisation. governance structure with Quit, for Rob Moodie was well suited to lead the example), and existing strong organisation through this shift. Highly relationships realigned, to ensure respected for his public health work their sustainability. The discipline of in Australia and overseas, his natural health promotion had become more management instinct is to find common sophisticated throughout the 1990s ground and then work with people and VicHealth needed to reflect latest and organisations to achieve realistic practices with sustainable programs. goals. His ability to create effective The discussion, begun during the partnerships is, says Nossal, one of his Galbally years, was advanced but best assets. Moodie believes it’s the best action had to follow. Finding ways way to get results: “People will do, in a to address the social factors that sense, what you tell them if you’ve got influence health became a legitimate the money for a certain period of time, concern for VicHealth and, although but if the relationship is not mutual, the previous era had delved partly into respectful, it will disappear. Therefore this area, there had not been a we’ve placed a great deal of emphasis coordinated leap by the organisation on how do you do partnership, what to take up this complex and multi- does it really mean, what sort of layered challenge. relationship should you have and how can people treat each other well?”

Adapting to a changing environment | 37 A NEW MESSAGE need to deliver. It’s stopped being ‘Just FOR A NEW ERA take your money, put your signs up and see you later’”, said Rob Moodie. A nine-month consultation began. VicHealth took its message out to Professor John Funder, who followed a range of stakeholders: VicHealth Sir Gus as Chair, was also conﬁdent of would be more effective working with breaking new ground and encouraging organisations, rather than providing social change: “Just as VicHealth sponsorships with health messages. managed the transition from tobacco

VicHealth’s investments would be replacement, from such things as Professor John Funder, VicHealth Chair 1997–2004, directed to those areas where it could burning VicHealth’s name into the awards the Northeast Support and Action for Youth: SmartArts Music Program for their contribution to yield the best health dividends. It grass at the racecourse, to a wider promoting the health of Victorians, 2002. would review its priority areas to mission, we can move forward and ensure it was investing in areas where take the community with us.” it could make a difference. It assessed Dean of Deakin University’s Faculty the political environment to support of Health and Behavioural Sciences, government priorities. And it took Professor John Catford, says the new stock of the reality of a community partnership approach was a brave but more desperate for health promotion necessary step for VicHealth. “The action than ever – with declining rates great challenge for VicHealth was of physical activity, increased anxiety whether it could evolve. To its credit and depression, and static smoking it has. It has changed the concept of rates all areas of concern among health promotion and reframed the sections of the population. Ms Jane Fenton (right), VicHealth’s current Chair, questions and that is really good and presents Ms Sally Beck from the Geelong Performing This review set a new course for really smart. If it was doing the same Arts Centre with an award for excellence in health the organisation. VicHealth would thing it was doing 10 years ago there promotion, 2004. focus on people with the greatest would be signiﬁcant concern.” health needs, but not lose sight of Rob Knowles, who supported the the needs of the general community. review as Minister, said change was Tobacco control, mental health and inevitable. “I wanted the funding wellbeing, participation in physical basis to change from one that was activity, healthy eating and substance replacing tobacco sponsorship to one misuse were re-established as priority that assessed the investments as good areas to focus its investment, while value for what can be achieved.” investments in traditional areas such as sun protection and injury prevention VicHealth realised it would need to were simultaneously maintained. work more closely with the Cancer Council in the future. VicHealth would VicHealth would work with sectors also reinvent its relationship with such as sport, the arts and local sport and the arts, becoming more government to effect structural involved in brokering strategies that change that promoted health. It improved participation. To address aimed high – to be a leader and the decline in physical activity, it innovator in health promotion and to would begin to work beyond sport make a demonstrable contribution to with active recreation providers, population health. “We were working and advocate for change to the built out how we would align what the environment to support physical organisation wants in terms of health activity. It would make a more outcomes with what sport and arts strategic and long-term investment

38 | Chapter Four Active young Africans

“In 2002–2003, Banyule City Council received $25,000 in VicHealth funding for the Active Young Africans Project for young people from the Horn of Africa countries, particularly Somalia. The project was in partnership with Darebin City Council and the Victorian Co-operative on Children’s Services for Ethnic Groups (VICSEG). Activities over the 12- month life of the project included basketball and soccer tournaments, young women’s swimming and gym programs, excursions and school holiday camps. There were more than 1500 registrations for the series of 10 positive role modelling and peer “From a health and wellbeing major programs for young women, support through its leadership perspective, the positive outcomes and nearly 900 registrations for the program. It also raised awareness of for disadvantaged groups like this eight major programs for young men.” the cultural, social and recreational cannot be understated. The project needs of African young people within has enhanced young participants’ “The project was highly successful the broader Banyule and Darebin self-esteem, personal development, on a number of fronts. It provided communities, leading to changes leadership skills and connection to signiﬁcantly increased opportunities such as the Olympic Leisure Centre’s their peers.” for young people to participate in development of a women-only physical activities, and cultivated Frances Gianinotti, Coordinator of swimming session.” Youth Services at Banyule City Council

in research. It would endeavour to the place must continually sharpen there was a 2.5% increase in connect the research and program its edges. “As far as being a learning Victorians participating in sufﬁcient areas more closely and build a organisation and being innovative, physical activity to achieve health public health research workforce we have to keep learning and keep gains9 …to be honest, we’re still yet to that would make Victoria a leader out in front. I’m keener and keener on prove more of the outcomes in in the area. It would take a lead talking about outcomes. For instance physical activity and mental health and role in developing a mental health we should focus on the intermediate wellbeing. They are huge challenges. promotion plan. It would attempt outcomes in our mental health No one has really got the answers yet. to address health inequalities by plan. Are we starting to increase I’m very hopeful that we will.” improving access to healthy food the levels of social connection, “We must continue to listen and for sections of the community. and reduce freedom from violence build relationships. If you’ve and discrimination as we claim?” To Rob Moodie such moves need to got a good relationship you can be ongoing if the organisation is, as “In terms of physical activity, we are negotiate with organisations and he said at the beginning, to prove its starting to make some headway, with communities,” said Rob Moodie. worth continually. Internally, he says, one survey showing that last year

9 Department of Human Services 2002 & 2003, Victorian Population Health Surveys 2002 & 2003 selected ﬁndings, Melbourne, Victoria.

Adapting to a changing environment | 39 In 2002 VicHealth began to realign its Rob Knowles says VicHealth’s structure to reflect the shift in strategy. very success may create danger. This would help it respond quickly to “Governments may try to push external circumstances and maintain more responsibility on to VicHealth its visibility as it moved away from without a consequential increase the sponsorship model of promoting in resources. In the past there health. As the strategic directions have been ideas on occasions that for 2003–2006 were developed, VicHealth should become an even VicHealth established core units greater player in health and become to focus on issues such as physical responsible for promoting good activity, healthy eating, mental health health per se, and become the and wellbeing, health inequalities, greatest vehicle for doing that.” research workforce, tobacco control, By contrast, Mark Birrell believes sun protection, alcohol, drugs, and VicHealth’s impact across a range sexual and reproductive health. of areas remains its most important Most of the instigators of the Tobacco safeguard. He thinks it has proved its Act believe VicHealth remains on the worth many times over and barring right track. David White says that disaster will continue to do so. “I think through VicHealth, initiatives have its strength has been proven by the happened that would never have been fact it’s endured frequent changes possible otherwise. “It’s taken on a life of government and of minister of its own. It’s moved successfully and – it’s endured the inevitable wish of continually into areas such as mental Treasury that it didn’t exist, and it’s health, as well as tobacco. It is able to endured some tortuous attacks by send messages to people successfully the tobacco industry. So now it’s a in subtle ways that impact across a permanent and significant institution. whole spectrum of society, without I can’t imagine an obstacle in its any negative connotations that might path that would stop it – other than be associated with a government inactivity. The work that’s being done of the day informing people. It’s now is different, but equally active not a prohibition organisation; – and I think the only thing that could it’s saying if you want to behave harm it would be if it became a slow in a certain way, be aware of the or unrepresentative body. It’s still consequences of your behaviour.” seen as multipartisan. It’s welcome.” Ron Best did not agree with the change in direction. He says that VicHealth has lost opportunities to push the brand, which means it’s now struggling to been seen as separate from government. “VicHealth was established as an independent body and should fiercely fight to keep that independence.” He’d like to see it as an Institute for Excellence – a place people automatically come to for information on public health.

40 | Chapter Four Health through football

The shift from sponsorship and branding to participation and healthy environments is particularly evident in Australian Football. In the early days, branding was the name of the game – SmokeFree messages were everywhere, adorning everything from the jumpers of the North Melbourne Kangaroos to the drink stands at amateur games, and Booze Less was particularly prevalent at country games. When VicHealth decided to become more involved in brokering strategies South East Youth Girls Footy Park Cup Grand Final 2004. Photo: courtesy Football Victoria that improved participation, which included moving away from “For this reason we established a and understanding of the game the elites to grass roots clubs, it strategic alliance aimed at increasing for children and parents from restructured its investments with participation in healthy and welcoming diverse cultural backgrounds. environments in both new and various football bodies to work Football Victoria recently launched traditional football markets.” with the newly established Football their Quality Club Program, Victoria which provided access to all Some of the initiatives underway designed to help community football levels of football across the state. include the ‘You Kick Like a Girl... clubs enhance their operations Through the partnership with Good for You!’ promotion, the and provide club environments VicHealth, the sport has become more establishment of a junior girls that will attract new participants, inclusive, welcoming and responsive competition, and pathways for girls officials and members and retain to community needs. The alliance has from Auskick to open age and into those they already have. coaching and umpiring. Recreational already benefited many participants With policies and processes in football, a tamer version of the game (officials, volunteers, umpires and place for the responsible serving which has broader appeal, is being coaches, as well as players), clubs, of alcohol, bouncing racism out trialled. There are also campaigns leagues and the sport in general. of sport, accommodating people aimed at building the participation “Football Victoria and VicHealth with disabilities, addressing and capacity of volunteers, and recognise the physical and mental training of volunteers, establishing coaching and umpiring programs. health gains from participation community partnerships, and in footy and the need for clubs to Opportunities for Koori communities more, many club environments are attract and retain participants”, to participate on and off the field on their way to becoming much says Mick Daniher, Football Victoria are increasing, and there is much more healthy and welcoming. Manager Development and Planning. work being done to increase interest

Adapting to a changing environment | 41

The Big Issues VicHealth fosters change in the social, economic and physical environments that inﬂuence the health of all Victorians. Underpinning the work is the belief that health is a fundamental human right, that everyone shares in the responsibility for promoting health, and everyone should beneﬁt from improved health outcomes.

44 | Chapter Five VicHealth works across many sectors responsive, imaginative and evidence- knowledge base and disseminating and with many partners in the informed approach to working with its evaluation data and new evidence to community to build opportunities for partners from across different sectors practitioners and policy-makers. people to be informed, learn new skills in the community. While tobacco control continues to be and have greater access to activities, VicHealth is continually scanning a key focus for VicHealth, other key as well as create environments that the environment for, and investing areas of involvement now span sport enable people to enjoy healthier living. in, new knowledge and approaches and physical activity, mental health Sitting within a state and federal to help lead the discipline of health and wellbeing, the arts, research, and system of health promotion and promotion. The organisation also sun protection. VicHealth’s approach disease prevention, VicHealth’s seeks to contribute value to the larger to each of these issues is detailed in particular focus is on a ﬂexible, public health system by adding to the the following sections.

Tobacco Control VicHealth’s biggest question has always been: Is smoking prevalence decreasing? The answer: Slowly, but surely. Rates are half what they were in 1987 when VicHealth began – down from 34% to 17% of Victorian adults regularly smoking. In fact, tobacco control has been one of the best, if not the best buy in health over the last 30 years. And with the federal and state governments facing massive increases in their health budgets over the next 30 years, it remains the best, if still largely under appreciated, ‘blue chip’ investment in health. That’s due to the partnership between VicHealth and the Cancer Council Victoria’s Quit campaign landscape, is only just beginning. Success has been real. Now, less than – a relationship that has been Quit, which received a significant one in five Victorian and Australian maintained since 1987 – and injection of funding from VicHealth adults smoke. As a result, over 17,000 support of successive ministers and after the Tobacco Act was passed premature deaths are being averted governments for legislative change. (its budget was tripled in 1988), has each year in Australia. A lower rate of The Quit partnership has required been at the front line of anti-smoking tobacco use has been a major reason energy, consultation, intellect, campaigning for 20 years. VicHealth for the decline in heart disease, let courage, evidence and has, like any has been a significant other, often in alone in chronic respiratory diseases. relationship, experienced its highs the background, sometimes right up We know that people who don’t smoke, and lows. But it has endured and front, in the battle to reduce tobacco or those who quit, not only live a lot now prospers, as all parties recognise use in the community. longer, but they get sick for a much that the fight, although part of the shorter time than smokers do.10

10 VicHealth Centre for Tobacco Control 2003, Tobacco Control: A Blue Chip Investment in Public Health.

The Big Issues | 45 Blitz on cigarette advertising

It would have been difficult for Melburnians to miss the anti-smoking message emblazoned on 200 prime- site billboards around the city in early January 1989. The signs: This poster has just given up smoking (and it feels terrific), were the first shot in a long-term anti-smoking campaign launched by VicHealth. The poster campaign drew attention to the decision by the Victorian Parliament to gradually phase out billboard advertising by cigarette companies. Half of cigarette company billboards had to be removed in 1989, and a further 25% the year after, with the final 25% removed in 1991.

46 | Chapter Five Tobacco control is a great investment There is compelling evidence that as well. In 1998 alone, the estimated the partnership between VicHealth In 1990 Quit sponsored: total benefit in Australia was and the Cancer Council is working. A$12.3 billion11, made up of lower The mutual respect between the • Fitzroy Football Club health care costs of A$500 million, two agencies is now evident. Rob • Eastside Spectres National improved health status gains of A$2.2 Moodie says VicHealth was very lucky Basketball Team billion and longevity gains of A$9.6 to be able to fund a campaign such • Victorian Football League billion. And this was calculated using as Quit because it was such a good • Nunawading Spectres Women’s a very conservative assumption that investment. “It’s the first thing I show National Basketball Team public health programs contributed to those who want to know what • Victorian Netball Association only 10% to the decline in tobacco VicHealth funds and that VicHealth consumption. The savings, due works”, he said. • Victorian Tennis Association to lower health care costs, can be The Cancer Council’s Director, David • Australian Surfriders Association put back into the health system Hill, says that VicHealth is a very good • AFL Victorian Football for people who don’t smoke. and understanding funding body. “If Development Foundation Most tobacco advertising has been that was the only thing I said about banned. No more tobacco ads on VicHealth that would be significant television during peak viewing periods in itself; however, I do have more at the rate of one every 12 minutes, positive things to say. They have been as happened in Australia during the consistently concerned with health 1970s. Sponsorship in sport has almost outcomes and that is very important.” completely disappeared. No more The Tobacco Act marked a significant Benson & Hedges cricket competitions, development in tobacco control for nor Winfield Cups. The dreadful irony many reasons. Hill says its effect of tobacco companies sponsoring should not be underestimated. “The health agencies to take advantage of the opera is a remnant of the past. Tobacco Act, as well as having an the VicHealth model when it began We know more about the lying immediate practical impact in some of in 1987. Quit’s campaign geared and misrepresentations of tobacco the forms of regulation and providing up after 1987 and continued to companies. Millions of previously secret a steady stream of money for tobacco cause smoking rates to decline. Its internal documents have been released control, had enormous symbolic advocacy, research, campaigns and through litigation in the United States, importance. The fact that this was strategies to support quitters would telling a 40 year tale of denial about the an issue that needed its own Act of see it entrenched as a world leader in health effects and addictiveness of Parliament was very important. You tobacco control early in its history – tobacco. Plus, who can forget the can’t quantify that aspect.” It was a a reputation it has continued to build bosses of Big Tobacco testifying in the very important line in the sand. on, to this day. US Congress, putting their hands on When VicHealth began, Quit was VicHealth has played a big part in this their hearts and saying they believe already well advanced as a campaign. process. Of its funding, 10% (more that nicotine is not addictive? We know A media campaign, No Butts, had recently 12%) has gone to the Quit of their efforts in Australia and across run in 1984 and the Quit campaign campaign – a significant amount, but the globe to directly and indirectly began in 1985. It moved quickly into still infinitesimally small when the influence government policies, through sponsorship, sponsoring high-profile budgets of its opponents in the tobacco financial contributions to political sporting clubs and personalities to industry are considered. However, parties and individual candidates, communicate its message. This meant VicHealth’s reliability as a source of and through sophisticated public Quit was the best placed of all the funding and its independence from relations campaigns.

11 Applied Economics (2003), Returns on Investment in Public Health: An Epidemiologic and Economic Analysis, Department of Health and Ageing, Canberra.

The Big Issues | 47 The decline in smoking rates (% of Victoria’s Adult Population) 12

electors think we should be doing. They might be the same thing or they John Elliott loses might not be”, said Hill. Carlton Football Club The structure of the relationship its sponsorship has meant more than one voice has One of the most significant continually and effectively advocated developments in the early stages for changes – legislative and of Rob Moodie’s period as Chief environmental – to reduce smoking. Executive Officer was when Hill says the fact that Gus Nossal was Professor David Hill, current Director of The VicHealth decided to terminate consistently ready to speak out for Cancer Council Victoria. its smoke-free contract with the tobacco control policies in his role as Carlton Football Club after Club government has enabled Quit, thinks Chair of VicHealth added substantially President John Elliott chose to Hill, to do a much more professional to the credibility of Quit. Rob Moodie smoke during a nationally televised job in tobacco control than it might has continued to regard tobacco North Melbourne Grand Final have been able to do otherwise. “I’m control as VicHealth’s raison d’être, Breakfast. The decision created very enamoured with the VicHealth even though the organisation he leads a furore and much associated model for public institutions. It’s arm’s carries a broad health promotion publicity for the smoke-free cause. length. It depoliticises issues and you brief. This has been useful for both VicHealth’s contract clearly stated have long-term support. For instance, organisations’ credibility. “The thing club officials could not promote Quit is able to create television about tobacco control,” says Hill, “is tobacco or tobacco products.13 campaigns based principally on need that once you understand the issues and evidence. We do not need to be you become an advocate.” concerned about what we believe the 12 Quit 2004, . 13 VicHealth Annual Report 1998–1999, p. 15.

48 | Chapter Five Arts Centre goes smoke free The current Victorian Arts Centre venue so there was pressure from the website says it simply enough: In stage up to implement some sort of the interests of public health, the structural change.” Victorian Arts Centre is a smoke- Each time the issue went to the Arts free area. This didn’t happen by Centre Board it would take another step osmosis. VicHealth and Quit were forward. Initially zones were set up for the impetus for such change. Sue smokers. Those zones began to shrink. Nattrass, former General Manager In the end the smokers disappeared out of the Victorian Arts Centre and the door. In 1990, the Victorian Arts former VicHealth Board member, Centre became completely smoke free. was part of the push. “Getting places “We were early adopters. There is no [arts venues] to be smoke free was doubt about that”, said Nattrass. “The not that difﬁcult in actual fact”, said money was important for forcing the Nattrass. “Certainly the Victorian change, but it was not the only State Opera [VSO] was the ﬁrst to motivation. You need conviction to carry take it on board and help convince these things out properly and the VSO the Arts Centre it should be smoke were very responsible as to how they free. The singers wanted a smoke- went about forcing the change.” free atmosphere right through the

The VicHealth Research Centre for This support helped Quit to play an Quit has also been instrumental in Tobacco Control was also established important role in supporting reforms Australia’s national tobacco control in 1999. Work has focussed on the that have dragged down smoking efforts. Together with the VicHealth legal, economic and social aspects rates: legislation banning smoking Centre for Tobacco Control (VCTC), of tobacco control. It is, says Nigel in many public places, including Quit developed Tobacco Control: Gray, one of the best things to workplaces; smoke-free environments A Blue Chip Investment in Public happen through VicHealth funding. in sporting clubs and stadia, including Health, a valuable document for non- Back when the Act was passed, he the famous Melbourne Cricket government organisations lobbying says such a research centre was Ground; legislation abolishing point- the Government for appropriate only a faint glimmer on the horizon. of-sale advertising and regulating resourcing of tobacco control nationally. It further strengthened an already the display of tobacco products in Quit and VCTC also actively lobbied existing culture at Quit that evidence retail outlets; media campaigns that the Federal Government to ensure must underpin activity and public were both confronting and effective that Australia became a signatory statements – Quit’s evaluation (including an award-winning television to the WHO Framework Convention studies are famous for their rigour. campaign that featured a father in on Tobacco Control, a treaty that This philosophy has been crucial for hospital being visited by his family); gives countries more tools to control maintaining credibility and respect increases in the price of cigarettes tobacco use and save lives. within the community. VicHealth and warnings on cigarette packets to has also evaluated the program discourage smoking and advertise the Both Quit and VCTC are consortium independently, providing an important dangers and health consequences; and members of the National Centre for sounding board for the campaign. programs to support those quitting. Excellence in Indigenous Tobacco Control, created in 2002 to build

The Big Issues | 49 Rob Moodie continues to regard tobacco control as VicHealth’s raison d’être, even though the organisation carries a broad health promotion brief. Photo courtesy Quit Victoria. national capacity for effective so of Quit being funded by VicHealth, Indigenous tobacco control programs. we’ve only halved the prevalence Indigenous smoking rates, at 57.1%, of smoking during that time. So, it are still the highest among any needs sustained funding and the population group in Australia. ability to plan in the long term, which is what Quit Victoria has been able But still much is to be done. Tobacco is to do. The challenge is to keep it the largest cause of preventable deaths fresh. As long as it’s on the public in Victoria and Australia. Despite and political agenda, I’m sure we can the increased controls, the tobacco keep going forward. But we can’t companies are still very active globally. afford to drop the ball”, says Hill. The US Federal Trade Commission has estimated that in 2002 they spent US$12.47 billion in the US alone on promotion, an increase of 11% over the previous year and an increase of 30% over the sum spent in 2000. No wonder former Victorian Health Minister Rob Knowles says VicHealth still has a long way to go before it loses its original focus: to substantially reduce the impact of smoking. Hill has no doubt that the battle, although yielding many victories, is nowhere near over. “Although we’re proud of pushing the fact that smoking rates have gone down so much, it is a multi-generational undertaking. Even after 20 years or

50 | Chapter Five Tobacco reforms in 1999 Prior to the tobacco reforms, Victorian “The Labor Party’s smoking policy children were spending about developed in Opposition, and later $25 million per year on cigarettes, implemented in Government, led to a and research showed that about 40% wave of change, culminating in other of Victorian retailers were selling states following Victoria’s lead, and tobacco to children on a regular basis. introducing similar smoking bans”, says Minister Thwaites. A number of other Australian states had already, or were in the process of, Expectations were high. Government introducing smoke-free dining laws. wanted to reduce exposure to second- hand smoke, reduce the sale of Tobacco reforms were part of the cigarettes to minors by retailers, and Bracks’ Government election platform. reduce the numbers of young people A number of reforms were introduced smoking. The Hon. Bronwyn Pike MP, Minister for Health. to address under-age smoking rates including: “The Government introduced the and strengthening laws to enforce the tobacco reforms with a view to getting • A ban on point of sale advertising ban on cigarette sales to young people people to quit. But it is fair to say from 1 March 2006. • Restrictions on the display of that getting smoking rates down to tobacco products in retail outlets as low as 16.3% is better than we Minister Pike says the phasing of • Increased penalties for cigarette anticipated,” says current Minister tobacco reforms has been “incredibly sales to minors for Health, Bronwyn Pike. valuable”, allowing evaluation and monitoring of each phase to inform Another highlight was the high • A negative licensing system for future strategies and reforms. community support for further tobacco retailers Increased support for the reforms has tobacco reforms. The Parliamentary come from enhanced consultation • Compulsory display of health Secretary for Health, Mr Daniel opportunities with stakeholders and warning signs in tobacco retail Andrews MP, led the Government’s the public. outlets community consultation, striving to The Government also wanted to work with all key groups, from health Minister Pike acknowledges there address passive smoking via an advocates and the community to is still more work to be done, but incremental raft of tobacco reforms unions and industry. is confident of results. “There are specific groups where we would that initially included smoke-free In 2000, support for smoking bans in hope to further reduce smoking rates dining and smoke-free shopping licensed premises was around 55%, – groups within which there have not centres. The intention was to phase in 2004 this increased to around 80%. been significant declines following in further smoking bans and to Minister Pike says that there have smoking reforms, such as young maintain enforcement of cigarette been no negative economic impacts on woman, Koori Victorians, and ethnic sales to minors laws. restaurants, cafes and shopping centres communities. New tobacco reforms In Opposition, John Thwaites, the as a result of the smoking bans. give us another opportunity to further then Shadow Minister for Health, On 5 May 2005 the State Government drive down the numbers of people worked closely with Quit and announced further reforms to the smoking in Victoria.” VicHealth to garner support for Tobacco Act, which include smoking smoking bans in public areas, such bans in enclosed workplaces from 1 as in restaurants. March 2006, smoking bans in enclosed licensed premises from 1 July 2007,

The Big Issues | 51 Sport and Physical Activity

The relationship between VicHealth Victorian sport’s rapid transition from lifesavers. Diabetes Australia covered and sport always loomed large over semi-professional to professional the racing codes with messages the organisation. The Act requires in the late 1980s and early 1990s. about healthy diets. The Arthritis that at least 30% of VicHealth funds Foundation encouraged older However, as a way of advocating have to be paid to sporting bodies. people to be physically active. participation – an issue VicHealth During the initial debate, the tobacco took a lead on in the late 1990s – the Where a synergy existed between the companies had pushed hard the line sponsorship model was not going to message and the sport, the method that VicHealth would abandon sport be as effective. By the late 1990s, it worked well. Some sports managed once the initial flurry of activity was was time to change the structure of the relationship brilliantly. Others over. The late Ron Casey, a man vital the link between sport and VicHealth. floundered. Some health agencies to the early success of VicHealth, maximised their sponsorship. Others knew that if a guaranteed funding rate The game kicks off took time to learn how to spend the were legislated he would be able to money. Nigel Gray admits he was allay the sporting communities’ fears. When the siren first sounded in 1987, the tobacco buyout was surprised, after his experience with The relationship between sport and the main game. The strategy was the Anti-Cancer Council, that parts of VicHealth, although evolving, still simple enough: health agencies the sporting sector were not geared stands strong today. In many cases such as the Anti-Cancer Council, up to use the money well. However, the sponsorship of sport to promote the National Heart Foundation and whatever the nature of the message health messages – VicHealth’s original Diabetes Australia would use the and its effectiveness, one impact was brief – worked wonders. As a way of sponsorship to promote their key certain: less tobacco advertising was advocating the Quit and SunSmart messages into the public arena. reaching sports followers. messages, for example, the connection The SunSmart program, which linked and outcomes were brilliant. Lindsay For example, Quit was encouraging surf lifesaving with sun protection, is Gaze, basketball legend and VicHealth the community to stop smoking by one case study that exemplifies the Board member, says that, in some sponsoring Victorian football club, powerful connection between sport ways, the organisation changed Fitzroy. SunSmart encouraged and health. The message went beyond the face of sport in Victoria. David people to employ sun protection signs and sponsors’ logos and slogans. Parkin says it was a key part of methods by sponsoring iconic surf It created news. It challenged

52 | Chapter Five Tobacco out and VicHealth in to make Victoria the sporting state of Australia

Submission to Martin Inquiry into to tobacco sponsorship. Prior to Sports Funding and Administration, the existence of tobacco legislation Tuesday, 25 July 1989 and the Victorian Health Promotion Foundation, sport had no choice Mr Ron Casey, Board member of but to take tobacco sponsorship. the Victorian Health Promotion Sport was well aware of the Foundation and Chairman of the contradiction in promoting a product Tobacco Replacement Committee, that created bad health for sports told the inquiry that he was delighted people, while also contributing to at the speed with which sport has the exploitation of young Victorians endorsed the foundation and enabled in the habit of smoking, which it to replace tobacco. leads to death and illness.” “Sport has expressed great pleasure Source: VicHealth Letter, September 1989, that they now have an alternative Issue no. 4, p. 6.

stereotypes. It slipped into the the market. The organisation could get of resistance to change. I think the community’s dialogue and better ‘bang for its buck’ elsewhere. consultations that we went through understanding of what is normal – implementing the change and the Where relationships existed between protecting yourself from the sun. It explanations were well received.” sports and a health agency, the sports was based on research and evidence. found they were sometimes serving CEO Nigel Taylor of Surf Life It demonstrated the skill of the Anti- two masters. For example, sometimes Saving Victoria (now Life Saving Cancer Council in developing the elite level of the sport and its Victoria, following a merger with integrated communications campaigns. governing body were receiving grants the Victorian branch of the Royal And it played a part in reversing a that simultaneously carried different Life Saving Society Australia) has trend in skin cancer rates to see them messages. It was, says Lindsay Gaze, also been a supporter of the shift decline for the ﬁrst time in 50 years. long-time supporter of the connection in orientation. “In some ways the (See also page 70.) between sport and VicHealth, shift to focus on participation is becoming confusing and unworkable. not dissimilar to social marketing. The transition It’s only early days, but it’s getting At the same time, sports participation As time went on, the use of a lot of people who might not be and development at the community sponsorship to promote health became obviously aligned to the organisation level were becoming real issues unsustainable. Complementing to potentially join. Transport is a for both sport and health bodies, other strategies, sponsorship had a big issue for a lot of communities, who shared the mutual objective of place. On its own it could not last. As but lifesaving is basically free and wanting more people to be active. sponsorships became more outcome there is a broad range of activities driven, and at the same time more Gaze watched the subsequent move you can get involved in. We’ve expensive, the relationship between from advertising and sponsorship addressed that by not pushing hard the extent of the investment and the to a partnership-based approach for members, but by trying to get value of the end result was put under happen: “The transition has been people to connect to the beach closer scrutiny. In basic terms, as remarkably efﬁcient and effective initially and then, from there, take sport became an even more attractive and for some of us maybe a little bit a board and go and ride a wave. vehicle for commercial sponsors, surprising. There was concern there We hope that over time different VicHealth began to be priced out of may have been a backlash and a bit communities can feel more aligned.”

The Big Issues | 53 Wimmera Region Sports Assembly

In 1988, the Wimmera Region “Over time sponsorships from sports participation now embrace Sports Assembly first gained a VicHealth required something more applications from not only traditional grant from VicHealth to train 10 than these ‘naming rights’ and clubs sport organisations but those with a ‘Gentle Exercise to Music’ leaders, developed partnerships with health commitment to sport and physical some of whom are still involved in agencies or altered their approach to activity such as local government and this today. The WRSA also gained include promoting health messages. YMCAs. Each one of these agencies funding from VicHealth between This led to clubs developing and has a role to play in promoting and 1990 and 2001 to support the adopting policies to cover non-smoking, supporting an increase in physical development of Regional Games. responsible serving of alcohol, healthy activity for a variety of population eating and SunSmart behaviour.” groups. In essence, this widens the “VicHealth’s early years were very impact that VicHealth is able to have much about gaining a profile. Initially “VicHealth’s funding guidelines reflect and highlights its important role in the it bought out tobacco sponsorships their most recent change of policy health of Victoria.” and supported a wide variety of profile direction and now we see regular, and grass roots sporting events. cyclical funding programs set up to Di Trotter, Executive Officer, Communities, particularly sporting directly support VicHealth’s aims. Wimmera Region Sports Assembly clubs, saw VicHealth as another readily For example, funded programs available funding source.” aimed at physical activity rather than

Rob Moodie says that VicHealth receive the full health benefits intends to keep pushing and of engaging in sport, and creates expanding the frontiers of the science opportunities for social connection. of participation and supporting sport Making people feel welcome and every step of the way. “We want sport included is just one component of to be thinking with our assistance a healthy environment. All sporting about the best way to attract people associations are expected, as a and keep them involved. There are condition of their involvement in more than 9500 sporting clubs in the scheme, to have their affiliated Gymnastics Victoria – a firm supporter of the Victoria, and they are more than just Partnerships for Health scheme. clubs support 100% indoor smoke- clubs – they’re community resources.” free environments. State Sporting Maher says that the clubs that are Associations also work with their Creating healthy environments most successful, whether that’s on clubs and associations to promote or off the field, tend to have a range VicHealth is partnering State practices that prevent sport-related of healthy practices in place. In Sporting Associations to develop injury, encourage responsible alcohol many cases increased membership healthy environments throughout management, provide healthy eating has allayed initial fears at club level their clubs and associations as part choices, and promote sun protection. about possible revenue losses caused of the Partnerships for Health VicHealth Project Officer Shelley by introducing responsible alcohol scheme. It’s a long-term process Maher says healthy environments management or smoke-free policies. that is advancing one step, and in make sporting clubs attractive and some cases one club, at a time. But Gymnastics Victoria is one inclusive. “If you’ve got a place where creating healthy environments is not organisation that is well advanced people feel welcome and valued, they merely an end in itself. It underpins in developing healthy environments. will be more likely to join a club, and strategies to increase physical Its Club 10 program, developed then to come back the next week, activity, ensures that participants nationally in response to declining and the week after that.”

54 | Chapter Five membership numbers, is an excellent formative stage, at least 3200 primary model for sports grappling with the school children and 700 volunteers Sports injury prevention notion of how to work with clubs to regularly walk to and from one of improve environments. Embedded more than 200 schools where the within this scheme in Victoria is bus operates across Victoria. the condition that clubs deliver on The program was developed in smoke-free environments and, over response to the fact that less than time, depending on their capacity, 30% of Victorian children walk to provide healthy eating choices at school. VicHealth recognised that their venues. if children were to be encouraged Jane Farrance, Executive Director to become more active, it would be of Gymnastics Victoria, is a firm necessary to come up with relevant The Sports Injury Prevention supporter of the Partnerships for and innovative models, to deal with Program began in 1989 when Health scheme. “It’s important to parental concerns about ‘stranger the Sports Safety Equipment build a solid club infrastructure. Clubs danger’ and road safety, and to engage Program was launched. It’s that are bursting at the seams and the community and sustain real VicHealth’s longest-running small can’t have any more members are the cultural change that once again makes grants program. ones that are well run.” it easy and common for children to walk independently to school. The It is also one of its most far Recently Gymnastics Victoria has also Walking School Bus was the first reaching. Since 1990, when the committed to developing measures step to addressing these issues. first grants were allocated, 5962 to support responsible alcohol- clubs through metropolitan and management and injury-prevention The idea is simple. Children walk regional Victoria have received practices. It has five accreditation to school along a predetermined, A$6,286,287 in funding to buy categories that enable clubs safety-audited route, led by a equipment to protect participants – regardless of their size, location or volunteer adult ‘driver’ and with a from injuries received while scope of operations – the opportunity volunteer adult ‘conductor’ at the playing sport. Grants go directly and direction to improve continuously. rear. Local government authorities to the club. Currently 103 clubs are accredited. have acted as facilitators to establish most Walking School Bus networks The average grant approved has Walking School Bus Program and routes in the local area. been about A$1000. The types In 2001, VicHealth was invited of equipment approved under by the State Government’s Lead the scheme include goal-post Agency Committee on Physical padding; cricket batting pads, Activity to take a leading role in gloves and helmets; goalie gear for hockey; portable steps and initiating and developing a Walking non-slip mats for lawn bowls; and School Bus Program in Victoria. The development of the model was catchers’ gear for baseball and assisted by a statewide network of softball. Successful applicants government and non-government have also been required to agencies that had already generated attend Smartplay Workshops, or planned complementary initiatives which are designed to provide and policies across Victoria. basic education on how clubs can reduce and prevent sports VicHealth piloted the program injuries. in 2002 with four councils. Over the past three years, the program has grown to include 55 councils. VicHealth piloted the Walking School Bus Program – an innovative model to deal with Despite the program still being in a ‘stranger danger’ and road safety – in 2002.

The Big Issues | 55 Food for all

In recent years VicHealth has people experiencing food insecurity worked with local councils on a are more likely to be overweight number of food security projects or obese, particularly women. to improve people’s access to and “Most of the strategies to improve consumption of a variety of foods, access to healthy eating for vulnerable particularly fruit and vegetables. groups have focused on short term These projects are now providing emergency food relief or individual lasting solutions in local communities. counselling and health education. Food access is a complex issue potentially Food insecurity is basically an access to affordable, nutritious involving many different players inability for people to eat regularly meals by making healthy food – from planners to housing ofﬁcers from sources other than emergency available where people live. and small business owners to health relief. It’s much more common than professionals – and we believe local The Braystone Project has had many we think or would like and it has councils are best placed to develop positive outcomes. Not only have much broader consequences than relevant, integrated and long lasting people got a better understanding just diet – it impacts on people’s strategies to tackle this problem”, of how improving their diet impacts physical, mental and social wellbeing. says Lee Choon Siauw, VicHealth’s on their lives; the market stall Those most at risk of not eating healthy project ofﬁcer for healthy eating. provides a focus for social activity and nutritious food include people with and interaction, and promotes wider One example is the Braystone low or no income, and those who live in acceptance of people with disabilities. Project, which provides a shop, poor quality or insecure housing. Often It’s all about communities connecting mobile market stall and delivery the groups who are most affected are and supporting each other. service for fresh fruit and vegetables Aboriginal and Torres Strait Islanders, in the western suburbs of Melbourne. Activities to improve access to healthy refugees, single parents, people Operated by WestNet, an organisation food choices for vulnerable groups with chronic illnesses or disabilities, that provides a range of pre- complement VicHealth’s investments in people living in remote or isolated vocational training opportunities for research, community development and areas and young unemployed people. people with intellectual disabilities, health education for healthy eating. There is growing evidence that the project has provided improved

By walking to school, children get increases a sense of community in Police, Primary Care Partnerships, some regular exercise, they make the neighbourhood, and that safety Community Health Centres, Regional new friends and they’re more alert around schools has improved. It’s also Sports Assemblies and Neighbourhood in the classroom. Additional beneﬁts been suggested that the bus offers a Renewal programs. include fewer cars on the road, less practical solution to bullying, which pollution and a repopulation of the can occur as students walk to and neighbourhood, which results in a from school. safer environment for children. Development of the Walking School VicHealth’s Kellie-Ann Jolly is the Bus at the local level has also seen the director responsible for the overall growth of collaborative partnerships implementation of the program. between schools and local councils She says there is no doubt that the and, in a number of instances, Walking School Bus Program other agencies such as VicRoads,

56 | Chapter Five Mental Health and Wellbeing

VicHealth’s collaborative work VicHealth’s move into mental • promotion of mental health in in promoting mental health and health promotion as one of its great families, schools and workplaces wellbeing, particularly since 1999, has achievements over its lifetime. Both (workplace model adapted from the lifted its reputation throughout the also admit the issue was not in Tavistock Institute). state. The organisation has taken a their vision when they vociferously In December 1998, VicHealth leadership position, consulting widely supported the Tobacco Act way back launched Exercise Your Mental and with experts, and using all the in 1987. “We have seen things happen Health, a campaign that coincided strategies necessary for effective that would never have been possible with the arrival of the new chief mental health promotion – research, otherwise. VicHealth has taken a life executive, Rob Moodie. VicHealth communication, policy analysis, of its own, governments have not concedes now it was a campaign evaluation, program and workforce intervened and it’s moved successfully conceived without a strategy to development and community and continually into areas such as underpin and anchor it; however, it strengthening. The achievements, mental health promotion”, says White. acted as a catalyst for the organisation widely recognised not only throughout How the promotion of mental health to find a way to effectively promote the Victorian community but and wellbeing began, and what it has mental health and wellbeing. “We had nationally and internationally as become, are two different things. to bring organisations and people well, demonstrate the dividends a VicHealth’s investment in mental together and work out a coordinated long-term commitment to a health health before 1998 was focused on approach”, says Moodie. promotion organisation can yield. two very specific outcomes: By 1999, significant change had The work also demonstrates the vision • research (Alzheimer’s Disease by occurred, including the development and leadership that former chair Professor Colin Masters at the of a Mental Health Promotion Plan. Professor John Funder (now Chair of Mental Health Research Institute, SANE Australia) brought to VicHealth Project worker Lyn Walker, now the Professor Pat McGorry’s Early – his willingness to push forward and Director of VicHealth’s Mental Health Identification of Psychosis, and create the evidence. and Wellbeing Unit, was the person Professor Helen Herrman’s work to assigned the task of developing the Former Ministers for Health Rob establish baselines on the health broad strategy for the plan. Walker Knowles and David White cite status of primary caregivers); and knew that a good plan needed

The Big Issues | 57 policy analysis, evidence review structural change and they came from and stakeholder input and support. a range of sectors and disciplines. We VicHealth could do the analysis got a cross-fertilisation of ideas and and review, but stakeholder input discussion”, says Walker. would be the key to success. Walker Above The Hon. Jeff Kennett (top), Premier of There was a buzz at VicHealth. Victoria, and the Hon. John Thwaites (above, left), proposed that VicHealth invite experts Shadow Minister for Health, launch the Mental “People were being brought into a from a range of fields to sit on task Health Promotion Plan with VicHealth’s Chair, discussion recognising the importance Professor John Funder, October 1999. groups arranged around the discrete of social determinants to health, Left The Exercise Your Mental Health campaign population groups – young people, was a catalyst for VicHealth to find ways to and being asked to be part of joint old people, Indigenous people, new effectively promote mental health and wellbeing. planning for future investment. It was arrivals and regional/rural people – very exciting. It also heralded a new in order to develop the plan. VicHealth then began to grapple way for VicHealth to do business, with these conclusions to develop Rob Moodie, who was very keen to opening doors to people that had a conceptual framework. “We knew establish a consultative organisation never worked with VicHealth before”, what the issues were. The question that acted as a broker of good ideas, says Walker. This process marked a was: How do we indicate the evidence, supported the process. “It wasn’t us new era and revealed to all that the reflect health promotion practice and defining the issue. It was a whole lot organisation was about to change. create a flow to the plan in relation to of people defining it. We developed Supported by an evidence and outcomes, so that we can reputably a strategy which brought 100 literature review, as well as their own proceed?” says Walker. organisations together”, he says. expertise, the task groups, without Walker revisited the evidence. The Each task group consisted of 15 to exception, were able to establish and task group Chairs were invited back 25 people with expertise in mental settle on three determinants of mental to draw out the conceptual lines. health, mental illness or experience health that the plan should focus on: The plan began to emerge and was and expertise in supporting the social connectedness, freedom from approved by the community and population group. A wide range discrimination and violence, and health committee and the Board. It of backgrounds and expertise was economic participation. Improved would be a defining document for brought to the table – from the arts, access to these resources has many VicHealth and the way it worked. education, housing, local government health benefits, including an increased and sport. The notion that one in four sense of belonging, improved physical In October 1999, the Mental Health people would suffer mental health health, less stress anxiety and Promotion Plan was launched. The problems in a 12-month period would depression, less substance misuse, framework was clear and logical. quickly get their attention. “They all and enhanced skill levels. Factors influencing mental health had a commitment to individual and and wellbeing would be addressed

58 | Chapter Five Bringing cultural communities together

“VicHealth has contributed funding Greece and Malta – and thousands towards a number of CERES (Centre more from the local community came for Education and Research in along to watch the demonstrations, Environmental Strategies) events try the food and celebrate.” over the years, including Music Under “Through these events, people the Stars, The Kingﬁsher Festival experiencing social isolation are and, most recently, The Harvest included and a sense of community Festival. Initially the funding we cohesion is created. This can only received was linked with a speciﬁc enhance our mental health and Celebrating cultural diversity at the CERES health organisation, such as Diabetes wellbeing.” Harvest Festival. Australia, but nowadays funding is aligned to a project such as the “Our relationship with VicHealth form partnerships with established Communities Together mental is very important. Not only in groups and get the message out that health and wellbeing initiative.” terms of the funding we receive, way. It’s a much more fundamental but also because they are a great approach and it gives people a “At the most recent Harvest Festival, partnership organisation. We’re very real sense of ownership.” for instance, hundreds of local cultural on the same wavelength when it groups were involved in cooking up a Cathy Nixon, Events and Festivals comes to community involvement. huge spread. There were groups from Coordinator, CERES Community Instead of just telling people what everywhere – Ethiopia, Indonesia, Environment Park they should or shouldn’t do, they Vietnam, Iraq, Sri Lanka, India, Italy,

through a range of health promotion to undertake successful mental actions: research, workforce education health promotion activity. and skill development, direct service Irene Verins, one of the people who pilots, community strengthening, managed the implementation of the organisational development, advocacy plan through VicHealth, says the for legislative and policy reform, and ﬁrst step was to look at a new kind communication and social marketing. of language which would engage Over 700 organisations from people from various sectors in a many sectors have since received common understanding of mental Health Minister Bronwyn Pike launches the second funding and been involved in the health: “Understanding began to phase of Together We Do Better in 2003, which explores ways in which individuals and organisations implementation of the plan, 32 local change when we began to talk can remove potential barriers to participation and governments have been engaged in about mental health and wellbeing. help everyone improve their social networks. development and implementation Mental health and wellbeing has activity, over 1500 people have now become part of the mainstream The inclusion of those outside health attended launches, seminars and language.” A community awareness was relevant because it meant access forums and two key stakeholder campaign was relaunched in June to external resources. “It’s very useful symposiums have attracted 600 2001 as Together We Do Better. to emphasise that the drivers of attendees. More than 500 people the mental health and wellbeing lie By April–June 2003, this campaign have attended VicHealth’s pilot outside the health sector. It means had an estimated Reach of 96% of short course, which is aimed at you are able to draw on a larger Victorians aged over 18 years developing the skills and capacity resource base, instead of diluting (source: Optimedia). of people in different sectors funding allocated to the mental illness/

The Big Issues | 59 A positive spin on mental health

Report from the Western Pacific to reduce isolation and improve physical health promotion. He says Region of the World Health mental health as well as reduce the one of the group’s main tasks is to Organisation, released on Mental risk of developing mental illness. develop evidence that mental health Health Day, 2001 promotion has lasting results. One example is a project that aims to An Australian agency is putting include residents of depressed rural Dr Helen Herrman, Acting Regional a positive spin on mental health. areas in community revitalisation… Adviser for Mental Health in the VicHealth, a Government-funded, other VicHealth-supported initiatives Western Pacific Regional Office of privately run foundation, is engaging include a mentoring program for WPRO who also served on VicHealth’s community groups to help shift public young juvenile offenders with sports advisory board, says this approach perceptions of mental health from role models, leadership training to mental health promotion can be illness to empowerment. for Aboriginal Australians, and applied in other countries, developing an initiative to help newly arrived as well as developed. VicHealth’s mantra is to ensure immigrants from areas of armed people feel ‘connected’ to their “People in Government, non- conflict to deal with the stress of communities: school children playing governmental organisations and the their old and new environments. In sports and games; immigrants community must begin to see that addition, VicHealth’s programs also learning about their new homes; they can have a positive impact on focus on the needs of senior citizens. or depressed rural communities mental health. This has benefits for According to Dr Moodie, mental launching new initiatives to inspire everyone,” said Dr Herrman. health promotion is 30 years behind community productivity. This helps

treatment end of the health spectrum. without necessarily having all the It’s one of the most creative things evidence that it works. In a sense that has happened”, said Verins. “It we’re creating the evidence”, he says. encourages ownership and engenders Research reports such as The Health responsibility for mental health in Costs of Violence, showing the those not from Health.” extent of intimate partner violence VicHealth also recognised that a and its enormous impact on women’s skilled workforce was needed to mental health and wellbeing (see underpin its strategy. It therefore pages 66-67 for more information), invested signiﬁcant resources in have made signiﬁcant international equipping hundreds of people from a inroads into understanding the link variety of professional and community between violence and poor mental backgrounds to deal with the many health, while social inclusion has been complex issues surrounding mental the factor most naturally leading to health promotion. logical program and policy responses. Verins says it is also the factor that Verins says the last six years have has been understood by people One of the posters from Together We Do Better, been about learning, building evidence the community awareness campaign that helped and incorporated into social policy and substantiating the initial claims engage people from various sectors in a common – evidenced by the Department of understanding of mental health. that came out in the plan. Moodie Victorian Communities Community makes no apology for this. It was too Strengthening program. critical an issue to sit on. “There are issues you need to push forward. You While this is the case, Walker also need to go with what the ideas are, warns that with government now

60 | Chapter Five committed to improving our social environments and relationships, we Engaging the Rumbalara community cannot expect this activity to address the very significant mental health Paul Briggs is a community leader and impacts brought about by poverty, president of the Rumbalara Football/ discrimination and alienation. Social Netball club. Most members of the relationships are but one part of the Rumbalara community are Yorta Yorta jigsaw; however, structural poverty people, the traditional owners of the and alienation remain huge mental Goulburn Valley area, which is home health pressures that VicHealth will to the largest Indigenous population continue to respond to in current outside of Melbourne. and future work. Rumbalara might now be considered In some areas, finding the evidence one of the State’s more important and connections has been difficult. football/netball clubs. Its members Projects such as Changing Lanes are predominantly Aboriginal. in Bairnsdale – a project set up in The club provides a space for the 2004 to retain disengaged and at-risk community to come together and young people in learning – have been, provides potential for those within on their own, hugely successful. to flourish. Its activities go well Health Minister at the time, Rob However, showing the critical link beyond sport. The club promotes Knowles, remembers that the between economic participation leadership and mentoring and has existing government structures and mental health is not an easy a strong focus on youth suicide weren’t able to address the task. “It’s difficult to clearly define prevention. It promotes pride in issues and VicHealth provided relationships of causality between the culture and the community a structure that could work. one’s economic status and one’s – critical for health and wellbeing. “VicHealth was prepared to use state of mental health and wellbeing, It also is a club that is successful its status and independence to even though we know that being in both netball and football. This fund a community initiative when unemployed makes you feel worse.” promotes health by itself, but also the broader community had provides a link to the mainstream completely lost confidence in that It’s where the focus has now turned community. These activities come community sector.” – measuring the intermediate under the Healthy Lifestyles and outcomes in VicHealth’s mental health Briggs claims that without the Leadership Program. It’s a beacon plan. Moodie says the organisation partnership with VicHealth the club in a community that is doing it tough. has to ask: “Are we starting to change would not have got off the ground. the levels of connection, freedom Briggs, who led the club’s However, without Briggs’s tireless work from violence and discrimination development, says that before he on behalf of his community, it’s doubtful as we claim? We need to get people took the proposal to VicHealth, much would have been achieved. The to focus on that – how well are we members of the community project has shown the mainstream doing quantitatively?” John McLeod, were invisible to the mainstream community what is possible. an evaluator who has worked with community, merging through VicHealth through implementation of negative stereotypes – lost to school, the first plan, sums the approach up out of the workforce, in crisis. well: “The most successful strategy has been to target organisations within communities. You realise that the first step in social change or community change is not with the individual participants, it’s with the organisation, changing them and developing a policy and guidelines for doing things better.” The Big Issues | 61 The Arts

VicHealth promotes participation in wide and appropriate audience. message to the public; however, that the arts and access to arts events to Projects that broaden community was not the only objective. Right from promote mental health and wellbeing. access to, and involvement in, the beginning VicHealth aimed to use It works in partnership with arts the arts are preferred. Up to 7% the sponsorship as leverage to create organisations – both large and small of Victorian Health Promotion structural change within the arts and – to develop strategies that encourage Foundation funds will be available generate healthy practices during those who would not traditionally for arts and culture projects. events – for participants, workers participate in the arts or attend arts and spectators. The tobacco buyout for the arts was events to do so. Access to the arts much smaller than that for sport, but Sue Nattrass, who was on the Arts helps people to connect socially and significant nonetheless. However, Committee from 1987 to 1998, says participate in their community’s it happened quickly and, according even this simple structure influenced cultural life. Getting out, getting to Victoria Marles, a member of the thinking of those in the arts together, having fun. That’s healthy VicHealth’s first Arts and Culture community. “It might have been in – mentally healthy. Committee and long-time conduit subtle ways, but these messages made It’s a significant progression in the between VicHealth and the arts, the people think differently how the arts relationship between the arts and initial committee didn’t have much to related to health. The arts focus a lot VicHealth that began in 1988 with, do with any buyout because “there more on community involvement now by today’s standards, quite simple wasn’t much to buy out”. Tobacco had than they did in the past.” funding criteria: sponsored the elite end of the arts, A shift began to happen in 1995, but these organisations were happy The arts and culture program will when VicHealth determined that the to switch sponsorship to convey a sponsor arts projects that encourage sponsorship relationship would be message with which they were much excellence and are innovative. with the organisation itself, rather more comfortable. These projects must assist the than the event. Organisations were foundation to communicate health The funding criteria concentrated expected to provide healthy food messages to Victorians. Funding mainly on signage that promoted choices, establish smoking control priority will be given to those arts health messages at events. The arts measures and implement responsible and culture activities that reach a were to be a vehicle for conveying a alcohol-servicing practices. Marles

62 | Chapter Five says that a shift began to happen as pushes for local governments Bringing professional the arts organisations demonstrated and local communities to employ theatre to regional Victoria that they had fulfilled all the arts practices which bring public requirements VicHealth had attached spaces in communities alive For most people living in regional to the relationship. Simultaneously – and, if done well, to bring people Victoria, the chance to see high-quality a research base began to grow together during the consultation professional theatre is a very rare treat. underneath the arts and VicHealth and development process. But those living in the north-east of the began to review the arts program and Importantly, the success of these state are luckier than most. They have examine its effectiveness. Hothouse Theatre, Australia’s biggest programs is being measured. Marles and most successful regional theatre, In 1999, after much internal discussion says the recognition of the importance on their doorstep. and consultation with the arts sector, of evaluation was a key driver of VicHealth launched its Arts for Health the changes that occurred around As well as putting on a number of Program. This recognised not just 1999. “There is scrutiny of the productions at their home base in the importance of the arts as a means questions: What effect do the arts Albury-Wodonga, Hothouse take to the of communicating health messages, have on people? What makes a good road once or twice a year, playing in but also the arts themselves as health community arts project that provides halls, community centres and other promoting activities. In recognising people with a positive experience? venues in 10 to 15 small towns across this, VicHealth also acknowledged How do we include more people?” the region. that such pursuits, however beneficial, Nattrass has little doubt that being were not available to everyone. The Charles Parkinson is Hothouse involved in the arts is enough to Arts for Health Program promoted Theatre’s artistic manager and says change a person’s mental, and participation and access to those most that having a professional theatre therefore physical, health. “It creates in need, to overcome social isolation. company in the region makes it a richer a sense of wellbeing, a sense of It therefore put community-based arts place for people to live. “Hothouse has sharing and a sense of belonging to at the top of the agenda. become a very important part of the some sort of family and community. community, and a leader in lobbying Marles says that growing evidence for the cultural rights of people living about the potential benefit of the in regional areas.” arts for health drove the shift. “The Hothouse also holds an annual youth research says that involvement in theatre festival, Biting Dog, and offers these activities [the arts] is good for a two-year traineeship in technical you. So there was a move away from theatre. Funding for the past four years supporting institutionalised art. These has come from VicHealth’s Major Arts organisations are in good shape and Partnership Scheme, and now the have a subscriber base that keeps Audience Access Scheme, which returning, so you can’t keep saying the encourages community involvement same thing to them.” in the arts as a way of strengthening VicHealth decided to fund social networks and delivering positive community arts organisations to mental health outcomes. increase participation in the arts. HotHouse is working in partnership It maintains a relationship with 10 with the Upper Hume Community major arts organisations to encourage Health Service developing a production them to develop programs that in response to the disastrous 2003 increase access to the arts so that bushfires. Embers will be produced all members of the community in 2006 and tour through the bushfire- might have a better chance of ravaged areas of Victoria. seeing the elite performances. The VicHealth has funded 16 councils through its Arts and Arts and Environment Scheme Environment Scheme to work with the local community on creative projects dealing with public space.

The Big Issues | 63 It’s important in every sense because it shores up values, and if the values Community singing across Victoria are right in a community it means people will look after each other. They will nurture and encourage good health and communality. It sounds amorphous, but I think it’s a terribly powerful thing. The arts can do so much in a community. It’s how you measure what comes out the other end that is so difficult.” The community, led by VicHealth, now understands better the role the arts can play in improving community mental health and wellbeing. The tobacco legislation and subsequent buyout took the organisation into the sector, the sponsorships created the right conditions for structural change and then, to everyone’s credit, when these changes had Victoria Sings is one of the real In the three and a half years since been implemented the arts had the success stories of VicHealth’s the program started, the network courage to change gear. The arts Community Arts Participation of singing leaders has grown to sector now promotes health by scheme. In town halls and community 350. There are now more than 560 involving, developing new skills and halls across the state, people are singing groups operating in Victoria, including – surely an ethos the arts getting together – regardless of their from the ‘Acafellas’ in Castlemaine were renowned for, years before it vocal abilities, age, background or to ‘Vocal Nosh’ in Emerald. This became a health promotion mantra. gender – and singing. means that close to 7000 people regularly get together to sing. Fay White, a doyenne of community music, and community developer VicHealth Project Officer Susan Anne-Marie Holley, train people to Ball says the emphasis on rural and run community singing sessions. regional Victoria was deliberate Participants in their training courses in order to support communities learn how to select and teach songs that do not have opportunities aurally, and how to unleash the for musical training. Individuals creativity of participants in singing come together, give themselves a groups. They develop leadership name, sing, and share a meal. It’s skills and look at ways to establish about loosening up, laughing, being and sustain their groups. The involved and making a bit of a racket leadership training makes the in the process. These sessions are program organic and self-fulfilling. great for bringing people together, creating social connections, breaking down a sense of isolation and strengthening communities.

64 | Chapter Five Public Health Research

Sir Gustav Nossal, the first Chair of Change would not happen overnight, As part of its research investment VicHealth’s research committee, once nor would it occur on its own. The strategy, VicHealth contributed to said that researchers should always research committee, led by Professor building a critical mass of researchers. look at what they achieved over five Graeme Ryan (and including It began to work towards investing in years, not one. It’s an approach, he Professor John Funder, who joined the research activity that was more closely claims, that paints a much more committee in 1994, three years before aligned to its priority areas of interest positive and realistic picture of your becoming Chair of VicHealth in 1997), – tobacco control, mental health and work. VicHealth can rightfully take knew that a transition would occur wellbeing, and participation in physical a similarly long-term view when and eventually more public health and activity. Applications for research assessing its research investment. Not health promotion programs would in identified priority areas were only has it funded its own successful emerge. VicHealth began to play a advertised. Research and practice research projects, it has also played a nurturing role. “As time went by and and advocacy became more closely significant role in encouraging more we saw more and more applications entwined. It also forced the centres to good public health/health promotion/ coming in, we were able to say we find their own funding once they had preventive medicine research to come now have the capacity to be more had time to get up and running. out of Victoria. In some ways the hard strategic in our approach”, he says. Funder and Ryan were an integral yards have been done: Victorians will In 1997, the time came to embed part of this shift, but some things benefit even more in the future than the change. The research committee were difficult. Scepticism about their they have in the past from the results received 178 applications and funded intentions had to be overcome. “We of this work. nine projects. Ryan says it was like needed to show that we had our VicHealth’s research program started being “drowned in applications”. heart in the right place in trying to with a grand vision. It wanted to Many of the short-listed applications promote the disciplines that exist create a base for public health and received National Health and in the public health arena rather health promotion research, but it Medical Research Council (NHMRC) than those in the more traditional was battered in its attempts by the funding. A review occurred and medical research arena”, says Ryan. reality of a research environment a new path was chosen. “The “Having established [our good faith] focused more strongly on biomedical move created a seachange.” there, we also wanted to make sure issues than health promotion. that the research we funded was

The Big Issues | 65 underpinned by a proper evidence- the way it supported the groups based approach and wasn’t going over the years that needed support. to be too … herbal. There needed It’s actually moved beyond Victoria to be an appropriately rigorous now. We need to continue to nurture assessment of applications.” Potential and be on the lookout to bring candidates also had to be identified more people back from overseas – many overseas and interstate with that sort of capacity.” – and enticed back with realistic Increasingly, efforts are being directed career opportunities and greater at ensuring the translation of research availability of funds. In the end, the findings into policy and practice. shift took over five years to embed. A critical piece of research undertaken in 2004 was VicHealth’s If I look back on my time at study of the health impact of intimate The intimate partner violence report not only gives an insight into the effects of violence on VicHealth, the change of research partner violence. The study has women’s lives – it prompts the hard questions strategy is one of the achievements been internationally recognised and about how we inform, educate and change the behaviour that leads to partner violence. I’m happiest about. The provision of has played a critical role in raising senior research fellowships, the PhD awareness of the complexity of the “The project was marked by an scholarships – that clear capacity issue and providing some key levers to environment open to challenging building in the health promotion area. addressing longer-term prevention. frameworks and understanding, Professor John Funder, former alongside a willingness to share VicHealth Chair VicHealth and the Department of Human Services worked with a knowledge and expertise. This range of researchers, policy-makers contributed to the shared ownership The 1998 Annual Report stated: and practitioners to assess the of the project outcomes, a key “With public health and clinical health health impact of intimate partner factor in addressing such an issue research workers chronically under- violence for Victorian women, as intimate partner violence, as funded in Australia, VicHealth aims focusing on its prevalence, the prevention requires multilevel to make a significant contribution to a health problems it causes, and its strategies across all sectors.” well-trained public health and clinical contribution to the total disease research workforce in Australia.”14 burden in Victorian women. “The burden of disease associated Although it’s early days, Ryan says the The results sent shock waves across with this violence must be understood effect is already being felt. “In Victoria the community, showing that intimate as a significant public health issue. the situation has been transformed. partner violence is responsible for The results of this study show the The more active people are – like more ill-health and premature death whole community needs to be Melbourne University’s Professor in Victorian women under the age of involved in the effort to prevent Terry Nolan, Monash’s Professor 45 than any other of the well-known domestic violence.” John McNeil, Deakin’s Professor John preventable risk factors, including high The Hon. Bronwyn Pike, Catford and La Trobe’s Professor blood pressure, obesity and smoking. Minister for Health Stephen Duckett – the more other “A key part of the study’s success people are attracted. Action generates and strength of evidence base has There is consensus internationally its own momentum.” been the strong and collaborative that intimate partner violence is best partnerships developed between Funder agrees: “There is no question addressed in the context of a human government, community sectors, now that Victoria is internationally rights, legal and health framework and researchers and experts”, said competitive. It is providing national through the development of multi- Rachael Green, Senior Policy Officer leadership and quite a bit of that level strategies across sectors. In in the Office of Women’s Policy in the is due to VicHealth’s foresight and Victoria, this approach is coordinated Department of Victorian Communities. through the whole-of-government 14 VicHealth Annual Report 1998, p. 48.

66 | Chapter Five Women’s Safety Strategy, with building provided by the foundations many of us had worked in this way intimate partner violence also being in assisting researchers to obtain and we learned about a variety of identified as a priority in the Women’s national funding. methodologies. We were also working Health and Wellbeing Strategy. in an area that was relatively new. In 2000 VicHealth increased the Sexuality and sexual health was really The findings of the VicHealth study alignment of the research investment of no concern until HIV/AIDS came pointed clearly to the need to increase to VicHealth’s Strategic Directions and along, so not only was it a blank slate efforts in policy implementation in its program areas. It articulated a need but it became very rapidly a public these areas, with particular emphasis to link research with policy and the health issue. We were right there at on the primary prevention of violence health promotion programs VicHealth the coalface.” against women. identified as priority areas for funding (tobacco control, mental health and Professor Judith Lumley, who The Health Costs of Violence was wellbeing, physical activity, healthy remains Director of Mother and one of two studies acknowledged eating and health inequalities). Child Health Research, a centre in the World Health Organisation’s established in 1991 under the name Milestones of a Global Campaign Current research funding comprises Centre for the Study of Mothers’ and for Violence Prevention 2005: fellowships, scholarships, centres for Children’s Health, also auspiced by Changing the Face of Violence research and specific grants. La Trobe University, can claim a fair Prevention, launched in October degree of responsibility for changing 2005: “WHO-WPRO views these THE RESEARCH CENTRES the birth experience for families studies as tremendously important The development of the research throughout Victoria. “One of the examples from which other countries centres was part opportunistic, part things different about this centre is can learn how to design and conduct inspiration. They remain among that it wasn’t set up as a centre to research that is of practical value the organisation’s best investments begin with. I put in a program grant for changing the face of violence – humming along, as one researcher application to set up a group of people prevention by showing the true puts it. The centres were very researching in the area of mothers’ scale of the problem, the inadequacy effective models for VicHealth. By and children’s health with a public of current policy and programme building a mass of activity around an health rather than a clinical focus.” responses, and what must be done to area of research, different disciplines, Lumley, a lecturer in both paediatrics improve the situation.” methodologies, personalities and and obstetrics, saw both disciplines cultures could focus on gathering as powerful oligarchies with very poor RESEARCH AT A GLANCE evidence and effecting real change in communication between them. “It VicHealth supports a mix of one specific area. In the end, though, was very clear to me that we wanted investigator-led research, strategic their success was a result of excellent to look at the maternal health aspects research and evaluation research to directors, appointed by VicHealth, seriously in their own right as well as build evidence for health promotion who made things happen. their impact on children. That focus interventions. Over the past 15 years, was, and still is, very unusual.” Professor Doreen Rosenthal, first VicHealth has invested more than director of the Centre for the Study Lumley saw Melbourne as the A$60 million in 400 individual research of Sexually Transmitted Diseases at perfect location for such a centre projects to help improve the health La Trobe University (now Australian – a large population of migrants of all Victorians. In 2004 the level of Research Centre in Sex, Health and refugees, a good population research funding was around A$6 and Society), says the development data gathering system (including a million. In that year, Victoria received of the centre in 1990 was the highlight review of maternal, infant and child the highest per capita NHMRC of her academic career. It had a life deaths dating back to the 1950s), a funding for public health research. and energy that was enormously strong perinatal data system and a Victoria and Western Australia (the exciting. “It gave us the opportunity good system for monitoring prenatal two states that have health promotion to put together a group of people diagnosis. Lumley, the individual, foundations) both perform very well in with an interest in the same area but was perfectly placed to bring all public health research funding. This is coming at it from different disciplinary the pieces of the puzzle together. an indication of the value of capacity perspectives. It was the first time

The Big Issues | 67 Despite different personalities, both at promoting emotional wellbeing Koori students and undergraduate Lumley and Rosenthal led centres that and preventing behaviour problems teaching in Aboriginal issues, became very influential. Rosenthal by working to strengthen a sense of especially in the Faculty of Medicine, adopted a policy that presented the positive connection to the school. Dentistry and Health Sciences. centre as the experts in the field. Professor Bowes says the project has In line with VicHealth’s commitment Getting the message across was a key informed health promotion research to tobacco reform, it was clear that part of the strategy, with a community by describing a rigorously evaluated increasing resources needed to liaison model leading the way in intervention that has the potential to be directed to developing a strong communicating research in a palatable substantially reduce the morbidity research base. Consistent with this, manner. “One of the best things I did associated with the use of tobacco, the VicHealth Centre for Tobacco was employ someone whose role it alcohol and illicit drugs by young Control was established in 1999. was to actually bridge the research people. It provided an understanding Originally auspiced by a consortium and policy-makers, research and of the influence of social environments of the Anti-Cancer Council of Victoria, practitioners, research and the on emotional wellbeing and other the University of Melbourne’s Centre community. We did a lot of media, a lot important health risk factors of for Public Policy and the Institute of of writing letters to the paper.” Quality adolescents. Public Health and Health Services research was translated for practical Research at Monash University, it is use – a critical need in the area of Funding from VicHealth in 2001 now auspiced by the Cancer Council sexual health, where community enabled the Centre for Adolescent of Victoria. The centre covers the education and quick response is vital. Health to develop a comprehensive economic, legal and social issues program to disseminate both research Another centre that also became involved in reducing smoking and findings and the intervention strategy very influential was the Centre undertakes research on the broader more broadly. for Adolescent Health, led by socio-political and policy factors Professor Glenn Bowes, inaugural One of VicHealth’s goals is to narrow the associated with tobacco control work. Professor of Adolescent Health at the inequalities in health that exist between Having taken a leadership role in University of Melbourne. It was the sections of the community. To this end, mental health promotion, VicHealth first multidisciplinary centre to focus the VicHealth Koori Health Research recognised that it needed research on adolescent health in Australia and Community Development Unit to underpin its strategy and in 2004 and is recognised for advancing was established in 1998 to improve the established the VicHealth Centre for knowledge that has influenced health outcomes for Koori communities the Promotion of Mental Health adolescent health practice and policy in Victoria. The unit (renamed the and Social Wellbeing. Auspiced internationally. Established in 1991 Onemda VicHealth Koori Health by the University of Melbourne, with support from VicHealth and Unit in 2005) is building the evidence VicHealth’s newest centre will enhance the William Buckland Trust, it was base by taking a partnership approach the capacity of different sectors to auspiced by the Royal Children’s to research and academic teaching by promote mental health and wellbeing. Hospital working in partnership actively encouraging and supporting with the University of Melbourne, Koori participation. OTHER RESEARCH the Royal Women’s Hospital and Auspiced by the University of INVESTMENTS the Royal Melbourne Hospital. Melbourne, the unit now also A major, groundbreaking piece of work receives funding from the Office for Victorian Public Health Research to come out of the centre was the Aboriginal and Torres Strait Islander and Education Council (VPHREC) Gatehouse Project, which looked at Health (OATSIH). It focuses on The Victorian Public Health the impact of the school environment historical and cultural determinants Research and Education Council on the health and wellbeing of young and how they relate to health and (VPHREC) was established in May people, and the scope of schools to health services, and facilitates and 1999 to develop opportunities for provide a setting that meets their brokers research action between public health research, education emotional needs. The innovative five- researchers and Koori communities and training service providers to year research project involved over and disseminates research findings. build new partnerships and create 60 secondary schools and was aimed It also has a major role in supporting

68 | Chapter Five Researching children’s physical activity

One of VicHealth’s major objectives is boys”. It’s clear that older children to increase participation in physical spend more time in sedentary pursuits activity. Physical inactivity is ranked than younger children. The study also second only to smoking as the found that nearly one-third of older most important issue affecting our boys would prefer to watch TV than health15. VicHealth is funding leading be physically active. Most children researchers to find ways to address thought they were highly active, barriers to physical activity and but the study found that they were explore effective interventions. engaged in only low levels of activity. public spaces. Dr Salmon agrees that One of the first studies in the world to Specific barriers to physical activity we must protect the public spaces we objectively measure children’s activity were highlighted by parents, including currently have. She is now conducting involved more than 1200 families. The perceived ‘stranger danger’ and road follow-up research with the children Children’s Leisure Activities Study safety. “Every second parent of younger and their parents to measure the 16 (CLASS) , launched in December children saw a need to supervise their relationship between green space and 2003, was conducted by researchers child whilst playing outside.” physical activity. at Deakin University’s Centre for Children who reported not having Physical Activity and Nutrition Dr Salmon exemplifies the approach a park near to their home were less Research, including VicHealth VicHealth seeks when investing in likely to walk or cycle in their local Research Fellow Dr Jo Salmon. researchers. She is determined to make neighbourhood and children living in a real impact, which means spending It examined changes in physical houses or flats on small blocks of land time out in the community, listening, activity and obesity and provided a were less active than other children. and engaging stakeholders. The results detailed picture of the influence of Clearly, neighbourhoods need to be show that this consultative approach is the family environment. “The results made more accessible and welcoming. more likely to lead to behaviour change were very telling”, said Dr Salmon. It can be as simple as having traffic – not only amongst the community “We found that the older children lights nearby so children can cross using leisure spaces, but those who were only half as active as the younger safely and having good lighting in design and regulate them. children and girls were less active than

a stronger public health advocacy aim is to prepare and maintain Evaluation program in Victoria. VPHREC was systematic reviews of the effects of VicHealth has a demonstrated originally funded by its members, health interventions, and to make commitment to the evaluation of the Department of Human Services this information available to all funding and outputs of research and VicHealth. VicHealth is now the practitioners, policy-makers and and has developed a comprehensive principal funder of the program. consumers. VicHealth funds the performance management and Cochrane Health Promotion and evaluation framework that Cochrane Collaboration Public Health Field, an entity of the incorporates research grants. The Cochrane Collaboration was Cochrane Collaboration that seeks to formed in the UK in 1993 in response support and promote the development, to the drive by Archie Cochrane for dissemination and use of systematic best evidence to inﬂuence health reviews of health promotion and public care practice. The collaboration’s health interventions.

15 Mathers C & Stevenson C, November 1999, Burden of disease and injury in Australia, Australian Institute of Health and Welfare Catalogue PHE 17, Canberra. 16 Salmon J, Telford A & Crawford D, July 2004, Children’s Leisure Activities Study (CLASS) (Summary Report), Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne.

The Big Issues | 69 Sun Protection

VicHealth started providing a Importantly, it was also critical in show the younger people that there continual, reliable funding stream raising public awareness about the was a long-term outcome [from sun to SunSmart in 1988. In fact, importance of sun protection. exposure] that wasn’t so great. SunSmart was the first beneficiary The strategy was effective because “Uniforms were introduced that of VicHealth funding. This was used it tipped a stereotype on its head. covered skin. It turned out that only to provide a A$100,000 sponsorship The notion of the bronzed Aussie had about 10–20% of the organisation of Surf Life Saving Victoria for the deep cultural roots and surf lifesaving were comfortable standing around Cancer Council’s Slip, Slop, Slap exemplified that image. SunSmart in just their bathers and cap campaign to “educate people about knew that to make an impact on skin anyway. Every time we had a major the dangers of skin cancer from cancer, people’s understanding of conference we offered screenings. excessive exposure to the sun”.17 what was ideal would have to change. These initiatives started to turn SunSmart was soon the world’s Cultural perceptions would need to the culture around.” SunSmart leading sun protection program. be confronted and shifted. advertising on beaches and CEO Nigel Taylor of Surf Life uniforms, and the extensive media Sport, through Surf Life Saving Saving Victoria (now Life Saving coverage the campaign attracted, Victoria, could lead that charge. Victoria, following a merger with provided further support. “It was always going to be quite a the Victorian branch of the Royal challenge”, said Taylor. “The Cancer Taylor says it was successful because Life Saving Society Australia) was Council understood that this [culture] there was a synergy between the there at the start. His organisation was going to take significant time to health message and the sport signed the first sponsorship contract change. It needed to be done with a involved. “It might have seemed a with VicHealth in 1988, to promote carrot rather than a stick. What we had hard sell, but in reality it was easy, sun protection through SunSmart. to do was educate our own people as to because it made sense trying to effect The relationship between the the damage being done by the sun. We change. However, you do need to find two organisations changed surf started to use older lifesavers that had subtle ways to get the message out lifesaving’s look and had an had cancers cut out as role models to without putting members offside.” enormous influence on its culture.

17 VicHealth 1987, First grants by health promotion foundation, media release, 8 December.

70 | Chapter Five Craig Sinclair, who started leading the SunSmart program in 1988, says the continuity of funding has been critical. “To change behaviour is only part of the picture. Ultimately what we’re trying to do is reduce skin cancer incidence and deaths. To do that requires a long-term commitment of funding”, he says. “One of the most signiﬁcant reasons why SunSmart has been able to prove such a successful model – a model that is now duplicated in other states around Australia and is a WHO Collaborating Centre for the Promotion of Sun Protection – is that we have grown out of a very strong home base of sustained funding.” Everything under the sun

SunSmart continues to demonstrate Signiﬁcant behavioural and • Half as many people are being its value to VicHealth and Victorians attitudinal changes have taken sunburnt than were in 1988. with an international review panel place in the Victorian population • Skin cancer incidence is evaluating the program every three thanks to the SunSmart program, beginning to plateau after years. “We see VicHealth very much as including: many years of increase. a partner”, says Sinclair. “Without them we would not have been able to achieve anywhere near the degree of outcomes we’ve been able to demonstrate.”

The Big Issues | 71

Reaching beyond state borders VicHealth continues to extend its reach internationally, supporting other countries attempting to start up health promotion foundations and participating in a network of existing foundations.

74 | Chapter Six THE VIEW FROM OVERSEAS those countries adopted at least some Among its many measures, the aspects of the model. treaty requires countries to impose An international focus has been part restrictions on tobacco advertising, of VicHealth’s work almost since its VicHealth’s Director of Health sponsorship and promotion; establish inception. Sharing information about Promotion Innovations, Barbara Mouy, new packaging and labelling of the VicHealth model, internationally is quick to emphasise that it’s not tobacco products; establish clean advocating for the use of dedicated generally a matter of just exporting indoor air controls; and strengthen taxes to gather funds for tobacco the model. legislation to clamp down on tobacco control, and sharing information on Each foundation needs to be smuggling.18 how to undertake health promotion established and run differently, are just some of the roles VicHealth Countries such as Thailand and Korea according to specific cultural, political has played. Over the years VicHealth have expanded on the original model and economic circumstances. has hosted delegations from a range by including a tax on alcohol. In a For instance, health promotion of countries, attended workshops held recent World Health Organisation foundations are reliant on existing by those countries, including China Report, World Report on Knowledge infrastructure to spend money and Korea, run summer schools, and for Better Health, Strengthening allocated to programs to reduce presented at conferences. Health Systems, the importance of smoking or increase physical activity. the VicHealth model for sustaining In many developing countries this finance for health promotion research “There are never enough human infrastructure may not be well was underlined. and financial resources for health developed. In some countries, internal promotion, but there are always new decision-making may be influenced approaches and methods to increase by external forces such as aid donors VicHealth joins Global our options. The global health or international bodies like the World Consortium for Mental Bank. In addition, tobacco control and promotion foundation network, which Health Promotion has its origins in the Victorian Health other non-communicable diseases Promotion Foundation of Australia, may not be seen as priorities and In April 2004 VicHealth’s work in is a good example, which has now finance ministries may be antagonistic the promotion of mental health and spread to many other countries.” towards earmarked taxes. wellbeing was acknowledged when it was invited to become a member Dr Lee Jong-wook, Director-General Thailand’s ThaiHealth is modelled of the Global Consortium for the WHO, 6th Global Conference on on VicHealth, while Hungary, Korea, Advancement of Promotion and Health Promotion, Bangkok, South Africa, the Philippines, Prevention in Mental Health. 7 August 2005 Mongolia and Malaysia are all in different phases of adopting the VicHealth is one of 11 organisations model. Of particular interest to to join, including the Centre for From 1990, there was a more countries trying to form such an Disease Control in the USA, The directed effort to publicise the model organisation is the use of a dedicated Clifford Beers Foundation in the UK, overseas, with CEO Rhonda Galbally tax to gather funds for tobacco the International Union for Health hosting visits by public servants from control. This interest has been Promotion & Education and the Canada, Ireland, Singapore, New reinforced by the adoption of the World Federation for Mental Health. Zealand, Switzerland, China, Thailand, world’s first public health treaty, the They will work collaboratively to Indonesia, Korea and West Germany. World Health Organisation Framework develop, implement and disseminate In 1990–91 alone, VicHealth received Convention on Tobacco Control, effective interventions and policies delegations from Austria, Germany, which came into force on 27 February that address factors impacting on New Zealand, the United States, Israel 2005 and is providing impetus for mental health, across population and the United Kingdom. Some of many countries to examine the model. groups, worldwide.

18 WHO Framework Convention for Tobacco Control and related material is available at:

Reaching beyond state borders | 75 Inspired by the Australian approach, the Thai Government created the The Malaysian experience Thai Health Promotion Foundation (ThaiHealth) in 2001, which is funded Malaysia is well on its way to almost every organisation in from 2% of tobacco and alcohol establishing a health promotion Victoria is working for health.” foundation. It has an interest taxes. ThaiHealth’s priorities include “We in Malaysia would like to see this in implementing public health tobacco control, alcohol control and happen in our own country. We want strategies to support tobacco traffic accident prevention, where the to do away with the false notion that and alcohol control measures production and transfer of knowledge promoting and safeguarding health and has looked to the VicHealth are both key components. Other is only the duty of the Ministry of experience for guidance, inspiration examples include Finland, which Health. We want to emulate VicHealth and, where required, advice. earmarks 0.45% of the estimated in building partnerships with different annual revenues from the tobacco tax Edmund Ewe, Director of the sectors and engaging them in creating for tobacco control, health education Health Education Division of the health for the nation wherever our and research; and Portugal, which Ministry of Health, Malaysia, is an people live, work, play and study.” earmarks 1% for cancer research, admirer of the model developed in “Most of VicHealth’s health prevention, diagnosis and treatment. Victoria: “VicHealth is synonymous promotion programs in the areas of with comprehensive and successful International Network of Health promoting good physical, mental and health promotion programs that Promotion Foundations social health are very well known are supported by many partners internationally. One of its great In 1999 VicHealth was a founding outside the traditional health achievements is to build capacity member of the International Network arena. It has succeeded in making for all aspects of health promotion, of Health Promotion Foundations, health promotion into everybody’s including research and training.” established in Melbourne. The business, so much so that it seems network aims to enhance the performance of existing health promotion foundations and mentor VicHealth has been working with Fiji and support the establishment of new and Tonga as part of this program, health promotion foundations.19 work which complements previous The network currently has 12 work undertaken in the region with members, including six established Kiribati, Fiji and Tonga. health promotion foundations: Rob Moodie doesn’t see VicHealth VicHealth, Health Promotion necessarily as the leader in all this, Switzerland, Austrian Health although he concedes that other Promotion Foundation, Thai Health countries might view VicHealth in Promotion Foundation, Healthpact that way. “Networks exist to create (Australian Capital Territory), and learning and advocacy. As long as we Healthway (Western Australia). contribute our goodwill in a mutually The network works particularly respectful way, we will continue closely with representatives of to benefit from the international countries in the Asia-Pacific region relationships as much as anyone.” via a partnership with the WHO’s ProLead program, which is supporting 12 countries to look at establishing health promotion foundations.

19 International Network of Health Promotion Foundations mission statement available at .

76 | Chapter Six THE STORY WITHIN AUSTRALIA healthy behaviour, effective health allow the introduction of a health communications, injury prevention, promotion foundation akin to the The model developed in Victoria has cancer prevention, cardiovascular Victorian example. VicHealth’s had an influence within Australia, as disease prevention, mental health South Australian equivalent, well as internationally. The idea was promotion, physical activity Foundation SA, was established rapidly taken up by the anti-tobacco promotion, good nutrition education, in July 1988, later became Living movement in other Australian states; musculoskeletal disorders, tobacco Health and was disbanded in 1997. however, only Western Australia’s smoking control, alcohol abuse, Healthway remains in its original form. Foundation SA began without cross- HIV infection prevention, sexually party parliamentary support and failed The development of Healthway in transmitted disease prevention, sex to bring all stakeholders on board. At Western Australia paralleled that of and fertility education, and education least 70% of its funding was allocated VicHealth. In 1991, it was established in human relationships. to sports sponsorships, and direct as a statutory body, operating as an As with VicHealth, Healthway found health promotion activity became independent organisation governed that after a few years it was moving secondary. Rather than involving by an 11-member Board representing towards a more proactive approach health agencies to manage these arts, sports, health, youth and rural to its funding in an effort to reach sponsorships with sporting and arts interests, with the broad objectives of: identified target groups, such as bodies, Foundation SA managed • funding activities that promote youth, those with health inequalities, them itself. health, particularly that of young country organisations, and those In late 1992, Foundation SA adjusted people, and providing grants to who have more limited participation its mission statement to allow it to organisations engaged in health opportunities because of gender, support health promotion activities promotion programs and disability, language barriers or income. that were not directly associated with research; and Healthway is a recognised leader in foundation sponsorships, but the • offering sports, the arts and racing: the evaluation of health promotion, goodwill was difficult to recover. A – a replacement source of funding funding the Health Promotion stakeholder survey conducted for the for activities sponsored by the Development and Evaluation foundation in 1993 reported criticisms tobacco industry; Program (HPDEP) as an independent that Foundation SA had been seen to: organisation based at the University 1. indulge too heavily in the – sponsorship support for sports of Western Australia. HPDEP also trappings of corporate sponsorship and arts activities to encourage offered training to health agencies – there were allegations that it had a healthy lifestyle and to provide to develop skills and expertise in demanded complimentary tickets opportunities to promote health marketing, sponsorship, program and insisted on celebrity treatment messages. planning and evaluation, as well as an for its own representatives; evaluation and consultancy service for As with VicHealth, but unlike adjectives such as ‘grandiose’ and recipients of grants. Foundation SA, Healthway did not ‘self-aggrandising’ were appended to conduct health promotion programs Healthway’s current goals are: the conduct to a disturbing degree; itself, but provided funds to enable a range of government and non- • the creation of healthier 2. favour elitist activities to the government agencies to do so. environments, particularly through exclusion of recreational and Non-government health agencies, the sponsorship program; and cultural needs in comparatively underprivileged areas; while initially lacking experience in • the careful entrusting of the the sponsorship area, were eventually allocation of funds on behalf of the 3. reject joint sponsorship proposals ready and willing to develop people of Western Australia. – in the words of one corporate sponsorships in the sports, arts and executive, Foundation SA was In South Australia the Tobacco racing areas. ‘vanilla-flavoured’, preferring always Products Control Act 1986 to go it alone; In its early years, Healthway’s was amended in response to the priorities included determinants of successful floating of VicHealth, to

Reaching beyond state borders | 77 4. ignore those groups in the • encourage healthy lifestyles and sportspeople did much to convince community who were unfamiliar the support of activities involving federal parliamentarians that tobacco with, or ill-equipped to handle, a participation in healthy pursuits; control and advertising bans could complex application procedure; and be sold to the Australian public: • promote community capacity “Over a 12-month period around 5. promote its own name, logo and to support its own good health, the early nineties, at least 10 top image to the detriment of its core through self-supporting activities; sportsmen trekked around the message.20 • promote good health through Federal Parliament with me, knocking In 1995, in the nation’s capital, the intersectoral collaboration; and on doors and putting the case. For ACT Health Promotion Board (known • fund research and development drama nothing could top the time in the community as Healthpact) was activities in support of the above Ross Oakley, who was then the top established as a statutory authority functions. honcho of the Australian Football under the Health Promotion Act 1995. League, presented the argument to Queensland toyed with the idea in The ACT Health Promotion Board has Graeme Richardson, then Minister for the late 1980s, yet Labor decided, a Chairperson and seven members Sport. Richardson screamed at Ross, after a protracted debate, to not with specific expertise appointed by ‘First tobacco, then alcohol, then food, proceed with its 1989 promise the Minister for Health and a public then sex. What are you guys – a pack to establish a Health Promotion service member. Unlike other similar of wowsers?’ Neither I nor Ross were Foundation in the state. bodies in other Australian states, wowsers, and Graeme, who struck me the Board does not employ staff and Towards the end of 1989, the as a bully, got more than he bargained has a service agreement with ACT Commonwealth House of for that day”, said Galbally. Health who provides Healthpact’s Representatives conducted an inquiry In general, however, the VicHealth staff, human resource support, into sports funding and administration. network did not extend to the facilities management and financial VicHealth made a submission that Commonwealth level, and public support services. The relationship proposed the establishment of a health and health promotion between ACT Health and Healthpact Commonwealth Foundation. initiatives at the national level did is collaborative and founded on the The Committee...considered that not take any great account of the Board’s independent identity as a advertising directed at promoting VicHealth model. statutory authority with control of its socially desired attitudinal change There are important lessons for all own budget and accountability for its was preferable to banning the health promotion foundations in the own actions. advertising of products perceived experiences of Australia, and the The Health Promotion Act 1995 by some to be undesirable. They challenges involved in promoting defines the Board’s functions as: did not support the establishment health will only increase as time goes of a Commonwealth Health • fund activities related to the on. As pressure for immediate care Foundation.21 promotion of good health, safety and treatment grows stronger by the and the prevention or early In the years that followed, VicHealth day, Governments of all persuasions detection of disease; lobbied vigorously for further are finding it increasingly difficult restrictions on tobacco advertising at to invest in health promotion and • promote good health in the a national level, if only to remove its prevention. However, the economic community through the sponsorship difficulties with tobacco sponsorship arguments tell us that prevention is of sports, recreation and arts of national peak bodies in such indeed better than cure, and they activities, and cultural activities sports as cricket and motor sport. underline the necessity for innovative, generally; Rhonda Galbally believes that the effective and committed health support of prominent Victorian promotion foundations.

20 McGregor Marketing 1998, Living Health; Key stakeholder study. 21 Martin, S.P. 1990, Can sport be bought?: the second report of an inquiry into sports funding and administration, House of Representatives Standing Committee on Finance and Public Administration, Canberra.

78 | Chapter Six Reaching beyond state borders | 79 Epilogue

HEALTH PROMOTION IS Prevention and health crushed under the ever increasing EVERYONE’S BUSINESS promotion are for life burden of medical and hospital treatment and care. Maud Clark is the founder of This Story of VicHealth describes Somebody’s Daughter Theatre some of the fascinating work that These challenges require a long- Company – a theatre company of we have had the privilege of being term commitment. It is not a women in detention, whose work is involved in over the last two decades. matter, for example, of bringing the now expanding to a number of other Much of the work has resulted from smoking rates down then taking the sites in Victoria. She is an inspirational one of the reasons for having a health ‘foot off the pedal”. Despite great leader who shows how we can use promotion foundation – to innovate success, tobacco related disease, the the arts as a means of promoting and take calculated risks. But we catalyst and rallying point for the health and human rights. Todd also need to remember that not all establishment of VicHealth, remains Harper is the Director of the Cancer risks and investments pay off. We the largest preventable cause of death Council of Victoria’s Quit program have had real problems in developing and disability of Victorians. As the and leads the VicHealth Centre for evaluation expertise, in establishing a overall prevalence rates drop we may Tobacco Control. A superb strategist centre for mental health promotion, ﬁnd it harder to continue to reduce and communicator, he is the go-to in getting effective outcomes for levels of smoking. We also face the person for tobacco control in Victoria our investments in healthy eating, paradox that people with the least and is seen as one of Australia’s in capturing the public’s imagination economic resources have the highest leading brains in the tobacco control about promoting mental health, rates of smoking and thus the highest movement. Mick Daniher, of the and in being able to reduce health direct costs. It gives us more of a famous southern Riverina footballing inequalities. We have much to do in reason to ensure that declines can be family, runs Football Victoria’s developing optimal ways of working shared across all parts of our society. development program. He is part of with the primary, secondary and the backbone of the highly successful tertiary levels of the health care The new frontiers of health Vickick and Auskick programs. He system; and we need to improve the promotion understands social capital theory, and way we communicate with Victorians Obesity and its complications such as knows the physical and mental health about what we do. diabetes as a result of poor nutrition promoting potential of good sport. The challenges we face over the next and inactivity is undoubtedly the issue Maud, Todd and Mick symbolise the 10 years and beyond are daunting but that has captured the public’s interest fact that health promotion is, indeed, not insurmountable. They include in the last three years. The solutions everyone’s business. They lead health issues such as tobacco related are perhaps far more complex than three of the many organisations that illness, physical inactivity and poor we might have ﬁrst thought. I am VicHealth has partnered since 1987, nutrition, depression and anxiety, convinced that obesity, for example, and are part of the great spectrum of and the greater burden of illness and is a ‘market success’. Products that groups whose work underpins health death faced by the least advantaged in effectively reduce physical activity, promotion in Victoria. our community. We face the challenge provide ‘exercise free’ alternatives, or of improving the evidence that directs increase energy consumption (such as investments in promoting health, just cars, computer games and junk food) as we face these investments being sell far better than those that increase

80 | Epilogue or even encourage physical activity of obesity, how do we cope with major or moderate energy consumption societal changes such as increasing (bicycles, sport and active recreation individualism, described by social club memberships, public transport, researcher Hugh Mackay as cocooning fruit and vegetables). or caving, where life is pursued indoors, travel is only by car and social It seems inevitable that our public interactions, let alone understandings policy will have to provide incentives of difference, start to dwindle? to increase the marketing of health promoting products and restrict These are the new frontiers of higher rates of morbidity and mortality those that are health damaging. health promotion where we have to and lower life and health expectancy. We will have to restrict junk food deal with powerful forces of global They are also more likely than their advertising at prime time for children, trade, advertising, consumerism, more advantaged counterparts to change school canteen practices, and individualism and new forms of perceive their health as poor. prioritise pedestrians, bicycles and information technology. All of these public transport over the car. Future have undoubted upsides, yet all So our challenge is to work public social engineering versus may have unintended and poorly alongside business and industry, contemporary and highly prevalent understood negative repercussions on employment, education, sports and commercial social engineering! our health. arts, urban renewal, justice and local governments to ensure that those Our individual and collective mental Addressing health inequalities with less (health) don’t continue to health will become of even greater get less (resources). concern if the World Health There is a law in health known as the Inverse Care Law – those with less Organisation’s predictions that A call for better evidence depression will be the second largest get less, those with more get more. contributor to the global burden of Many of the resources understood There has been a call for better disease by the year 2020 are correct. to inﬂuence health are unequally evidence to underpin all of our Much has been gained by the distributed in Australian society and actions, interventions and investments heightened community awareness of this in turn is reﬂected in marked in medicine and in public health. This depression and anxiety and the need inequalities in health. has resulted in the growing stature of organisations such as the Cochrane for early intervention and treatment Inequalities exist across a range of Collaboration. In particular there through the work of organisations such social and cultural measures including is a need for cost effectiveness of as beyondblue and Orygen. But education level, occupation, income, interventions which in turn requires enormous challenges remain in the employment status, rurality, ethnicity, the development of public health prevention of these highly prevalent Aboriginality and gender as well as economists. VicHealth’s challenge is mental health problems. How do we in area-based measures of social and to better align the research it funds prevent the violence, bullying, economic disadvantage. discrimination and marginalisation with its overall strategic directions. which are increasingly being We know that, in general, those understood as determinants of experiencing higher levels of depression and anxiety? Like the issue disadvantage on these measures have

Epilogue | 81 An ounce of prevention is Promoting the future health Austria and Thailand, and are under worth a pound of cure of Victorians development, with the support of the Western Pacific Office of One of the major challenges for The fact that our health is determined the World Health Organisation, in VicHealth will be to ensure that by much more than our health system Malaysia, Tonga, the Philippines, health promotion and public health throws up challenges to Vichealth of Mongolia, Shanghai and Fiji. It is increase their role as integral parts how to engage other sectors in our in our enlightened self interest to of our overall health services, rather society, so that we have real whole- support the developments of these than disappear as a result of rapidly of-society approaches to improving foundations as it assists us with increasing and costly community our health and wellbeing. This improving our own practice, and demands for hospital and medical engagement has to be predicated on establishing world’s best practice. treatment and care. There is no finding common ground and common waiting list for prevention, and it is purpose with the private sector, with VicHealth has no inalienable right often difficult for governments to education and training, with sports to exist. It must constantly prove its commit to long-term investments that and recreation, justice, transport, worth as an innovator that can act are required to improve the health of infrastructure and urban planning. rapidly, that can inspire and support populations. However, it may be the health promotion in other sectors Public health and health promotion longer-term economic arguments, and in the community sector, and is changing so our expertise must rather than shorter-term financial and can work in a complementary and quickly adapt as well. The traditional political demands that will prove to be supportive way with the different arms disciplines of epidemiology, statistics, most useful. of government. And it must support sociology and anthropology must and encourage the development and Already this is the case in the UK be expanded to a broader set of work of leaders and health promotion where Sir Derek Wanless, an economist disciplines including public health entrepreneurs like Maud Clark, Todd and businessman, and the author of economics, political science, Harper and Mick Daniher. the seminal report for the UK Treasury commerce and marketing, geography entitled Securing Good Health for and urban planning. the Whole Population,22 states that VicHealth, as the longest standing the National Health Service “must health promotion foundation, has an move from being the national sickness obligation to the global movement Rob Moodie service, which treats disease, to a of health promotion foundations. As CEO, VicHealth national health service which focuses mentioned in the previous chapter, on preventing it”. His view was foundations now exist in Western very much driven by the economic Australia, the Australian Capital arguments based on people becoming Territory (ACT), Switzerland, “fully engaged with their own health”.23

22 Wanless D. 2004. Securing Good Health for the Whole Population, UK Treasury. 23 Ibid.

82 | Epilogue Appendix

VICHEALTH BOARD MEMBERS

VicHealth’s First Board Past Board Members Current Board Members (November 2005) Sir Gustav Nossal AC, CBE (Chair) Sir James Gobbo AC Dr Nigel Gray AO Prof. Kerin O’Dea AO Ms Jane Fenton AM (Chair) Ms Terri Jackson Mr Will Bailey AO Prof. Richard Smallwood AO Mr Ron Casey AM Mr Mal Sandon Dr Judith Slocombe Mr Russell Hopper (Australian Labor Party) Ms Maxine Morand Ms Sue Nattrass AO Mr Eddie Micallef (Australian Labor Party) Mr David Parkin (Australian Labor Party) Ms Jerril Rechter Sir Donald Trescowthick AC, KBE Ms Helen Armitage Prof. Glenn Bowes Mr John Clemenger OAM The Hon. Ron Best Ms Elaine Canty (National Party) Ms Pam Ryan MBE Mr Hugh Delahunty (National Party) Mr Lachlan Tighe The Hon. Graeme Weideman The Hon. Bill Forwood (Liberal Party) (Liberal Party) Mr Marc Besen AO Mr Lindsay Gaze OAM The Hon. William McGrath Prof. Judith Lumley Prof. David Hill AM (National Party) The Hon. Bruce Mildenhall Mr John Howie The Hon. Michael Arnold (Australian Labor Party) Ms Belinda Jakiel (Australian Labor Party) Ms Anne Marie Harrison Ms Sue Cormack Ms Carol Schwartz Mr Peter Thomas The Hon. Gerald Ashman (Liberal Party) Ms Jan Wilson (Australian Labor Party) Ms Maxine Crouch Mr Gerard Healy Prof. Graeme Ryan AC Prof. Robert Burton Mr Tim Jacobs Ms Susan Holmes Ms Jenny Lindell (Australian Labor Party) Professor Helen Herrman Ms Leeanne Grantham Prof. John Funder AO (former Chair)

Appendix | 83 Bibliography

Applied Economics 2003, Returns Norman, Neville 1993, A considerable VicHealth Annual Report 1998-1999 on Investment in Public Health: success: an economic evaluation VicHealth Annual Report 1999-2000 An Epidemiologic and Economic of the Victorian Health Promotion VicHealth Annual Report 2000-2001 Analysis, Department of Health and Foundation. VicHealth Annual Report 2001-2002 Ageing, Canberra. Quit 2004 VicHealth Annual Report 2002-2003 VicHealth Annual Report 2003-2004 Department of Human Services 2002 Salmon J, Telford A & Crawford & 2003, Victorian Population Health D, July 2004, Children’s Leisure VicHealth Letter issues 1-23, 1989-2005 Surveys 2002 & 2003 selected Activities Study (CLASS) (Summary VicHealth Centre for Tobacco Control ﬁndings, Melbourne, Victoria. Report), Centre for Physical Activity 2003, Tobacco Control: A Blue Chip Galbally, Rhonda 2004, Just Passions: and Nutrition Research, Deakin Investment in Public Health. The Personal is Political, Pluto University, Melbourne. Victoria Parliamentary Debates, Press, Australia. State Taxation (Further Amendment Tobacco Bill Legislative Assembly, Harari, Fiona 1987, ‘Why pick on the Bill), Second Reading, 17 November vol no. 388-389, 28 October 1987, smoker? Arguments for and against’, 1993, p. 1078. pp. 1848-1849. The Age, 28 July, p. 4. Stockdale, Alan 1992, Restoring Victorian Tobacco Act 1987. Hill D. Public opinion on tobacco Victoria’s Finances: A Beginning. Wanless D. 2004, Securing Good advertising, sports sponsorships VicHealth 1994, Achieving Health Health for the Whole Population, and taxation prior to the Victorian with Sports and the Arts, Issues UK Treasury. Tobacco Act, 1987. Community Health Series. WHO Framework Convention for Studies 1988; XII: 282-288. VicHealth 1987, First grants by Tobacco Control and related material International Network of Health health promotion foundation, media Promotion Foundations mission release, Melbourne, 8 December. statement VicHealth 1999, Mental Health Martin, S.P. 1990, Can sport be Promotion Plan. bought?: the second report of an inquiry VicHealth Annual Report 1987 into sports funding and administration, VicHealth Annual Report 1988 House of Representatives Standing VicHealth Annual Report 1989 Committee on Finance and Public VicHealth Annual Report 1990 Administration, Canberra. VicHealth Annual Report 1991 Mathers C & Stevenson C, November VicHealth Annual Report 1992 1999, Burden of disease and injury VicHealth Annual Report 1993 in Australia, Australian Institute of VicHealth Annual Report 1994 Health and Welfare Catalogue PHE 17, VicHealth Annual Report 1995 Canberra. VicHealth Annual Report 1996 McGregor Marketing 1998, Living VicHealth Annual Report 1997 Health; key stakeholder study.

84 | Bibliography