A Thriving Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council

Department of Health and Human Services

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Date: February 2014 Version:

Images courtesy of the Tasmanian Government Image Library. © Copyright State of Tasmania, 2014.

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Contents

Foreword ...... 4 Introduction ...... 6 Background...... 6 The Advisory Council’s Final Report ...... 7 Our Approach to Tackling Inequities ...... 9 The Facts...... 9 Tasmanian Government Policy Framework ...... 10 A Healthy Tasmania ...... 11 A Focus on Place...... 12 The Advisory Council’s Recommendations ...... 13 Place-Based Action ...... 13 Statewide Action ...... 17 Evidence-Based Action ...... 23 Thrive Tasmania Model ...... 27 Where to From Here? ...... 28 Appendices ...... 30 Appendix 1. Thrive Tasmania Community-Driven Model of Health and Wellbeing ...... 30 Appendix 2. Ministerial Health and Wellbeing Advisory Council Recommendations ...... 31

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 4

Foreword A focus on health inequities requires new and different responses to complexity and systems The Tasmanian Government welcomes the and must acknowledge the fact that all sectors Advisory Council’s final report of the Health have an impact on health and its determinants. and Wellbeing Advisory Council as an This challenge is being considered more broadly important opportunity to further the amongst policy makers working in government prevention agenda in Tasmania and the focus on agencies nationally and internationally. While the social determinants of health. The final approaches are still emerging in Tasmania, there report will help to increase knowledge and is a current commitment and interest across understanding across government about the sectors to improving the productivity and health causes and consequences of health including of people and communities. outcomes and inequities, as well as how to practically address them. Some of the Advisory Council’s recommendations can be achieved in the short The issues and ideas presented by the Advisory to medium term, such as the establishment of a Council deliberately build on existing strengths State Public Health Plan, community indicators and draw on contemporary solutions and the and health equity impact assessment; others will best available evidence. The Advisory Council’s require a more long-term, sustained effort and findings and recommendations confirm what the investment of additional resources. In many working in the public sector, both inside particular, investment in the Thrive Tasmania and outside of government, believe needs to be Community-Driven Model of Health and done for more Tasmanians to have healthy, Wellbeing provides the foundation for a long- productive and fulfilling lives. Greater investment term vision for prevention in Tasmania that in prevention, stronger leadership, a focus on place needs to be built up over a number of years. and more effective collaboration across sectors is needed. The Tasmanian Government has begun This response highlights examples of work to pursue these opportunities, and has some underway across government and what more demonstrable successes that have been can be done both now and in the future to assessed1 but there is always more that can be improve the health and wellbeing of done. Tasmanians. By working in partnership with schools, workplaces, councils, community-based The Advisory Council’s final report presents the organisations and others the Tasmanian Tasmanian Government with an opportunity as Government is already promoting good health well as a complex challenge. Addressing the and wellbeing to thousands of Tasmanians and social determinants of health and health helping to foster the right conditions for them inequities is no easy task. While public health to achieve good health in the first place. By researchers and practitioners have clearly investing further in these collaborative, “on the demonstrated the need to address these issues, ground” approaches, government can help implementation strategies are still communities themselves to identify and address developmental and substantive evidence of their own needs. success is contested.

1 Department of Health and Human Services, 2012, A Healthy Tasmania Mapping Report, Tasmanian Government, .

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In considering the Advisory Council’s findings, it is important not to overlook some of the more fundamental government roles in providing for community health and wellbeing. Protective activities, such as maintaining environmental health standards in terms of food, water and air quality as well as managing risks to public health such as immunisation are part of the core public investment to maintain population health services. There is a need to continue to support these activities in the face of an increased need and focus on the prevention of chronic conditions, such as diabetes and obesity, as is the focus of the Advisory Council’s report.

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Introduction Closing the Gap in a Generation – a ground breaking publication by the World Health Background Organization’s Commission on the Social The Tasmanian Government has significantly Determinants of Health that has influenced raised awareness of the need to improve health government approaches to population health and focus on the social determinants of health around the world. in recent years. In successive State of Public The Fair and Healthy Tasmania Strategic Review Health Reports released since 2003, the embraced the findings of Closing the Gap in a Director of Public Health has raised community Generation and called for a combination of awareness of the relationship between the leadership across sectors and place-based health outcomes of Tasmanians and the social approaches to improve health outcomes and and economic conditions they face. It is now reduce health inequities amongst Tasmanians. broadly understood that inequities in access, capability and opportunity in life are likely to In response to the Fair and Healthy Tasmania result in poorer health and greater difficulty in Strategic Review the Tasmanian Government living with chronic released A Healthy Tasmania: Setting New diseases or Directions for Health conditions. and Wellbeing and established a With greater Ministerial Health understanding and Wellbeing comes greater Advisory Council. A opportunity. There Healthy Tasmania has been a real and represents the observable shift in Tasmanian Tasmanian Government’s long- Government term commitment commitment to to building good prevent and protect health and wellbeing the population in collaboration with against the consequences of avoidable health communities. It identifies six strategic directions inequities. For example, the Tasmania Health and associated actions for guiding preventive Plan 2007 recognised the need to integrate healthcare in Tasmania. The Ministerial Health healthy lifestyles programs into community- and Wellbeing Advisory Council (the Advisory based health services in order to better meet Council) was established at the same time to the changing needs of the Tasmanian provide further advice from outside the population. More recently, Child and Family healthcare sector on the best ways to move a Centres have sought to intervene early to social determinants of health agenda forward. improve health and education outcomes for children, families and communities. The Advisory Council are a group of independent leaders drawn from different In 2010 the Minister for Health, the Hon. sectors of the Tasmanian community. Members Michelle O’Byrne MP initiated the Fair and developed and delivered their advice to the Healthy Tasmania Strategic Review to directly Tasmanian Government over a two year period explore the social determinants of health in from 2012 to 2013. An interim report with Tasmania. The review followed the release of preliminary recommendations was delivered in

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2012, followed by a final report and The Advisory Council has identified a number recommendations in 2013. During their sitting of areas where further work is needed and calls term, the Advisory Council completed a for urgent action to improve health outcomes substantial analysis of existing health and and reduce health inequity in Tasmania: wellbeing activities in Tasmania, considered an “The Advisory Council extensive evidence-base on the social recognises the factors determinants of health, and consulted broadly supporting healthy people and with public health experts and the Tasmanian communities are the social community. The final report represents the determinants of health – the culmination of these efforts and is gratefully conditions of daily living in received by the Tasmanian Government. which people are born, grow, live, work and age. Tackling the social determinants demands Benefits of Reducing Health action across all sectors that Inequities influence these conditions. Saves lives Success will be achieved by a coordinated, sustained and Boosts economic productivity and systematic commitment to build employment the conditions for all Reduces healthcare costs Tasmanians to be healthy and well.” Lifts educational attainment (Health and Wellbeing Advisory Enhances health and wellbeing Council, 2013, p. 33) Improves material circumstances A significant area of opportunity Reduces illness and disability. identified by the Advisory Council is the need for greater leadership and coordination for prevention and intersectoral action on the social The Advisory Council’s determinants of health. Despite the Final Report good work underway, the Advisory Council found the absence of an The Advisory Council delivered A Thriving overarching plan for prevention and Tasmania: Final Report of the Ministerial Health coordinated action on the social and Wellbeing Advisory Council to the Tasmanian determinants of health to be a barrier Government in November 2013. The Advisory to progress. Other important areas of Council’s final report rightfully acknowledges opportunity include health intelligence that a lot of good work is already underway in and health equity impact assessment to Tasmania to protect and promote the health improve capacity for understanding, and wellbeing of the population. It also identifies planning and evaluating prevention the characteristics of the most effective policies activities in Tasmania. for reducing health inequities and their social and economic benefits.

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The Advisory Council’s final report recommends a prevention system for Tasmania that builds leadership at a local, state and national level to help influence the political, economic and social factors that shape health and equity. The Advisory Council also identified three main components for this prevention system - place-based action, statewide action and evidence- based action – and priorities for action within each. Copies of the Advisory Council’s final report are available for download from the Department of Health and Human Services’ website: www.dhhs.tas.gov.au. At the heart of this prevention system is Thrive Tasmania, a community-driven model of health and wellbeing to help communities and their governments identify, prioritise, action and evaluate their own needs (see Appendix 1). Thrive Tasmania is the Advisory Council’s vision for prevention at the local level.

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Our Approach to wages have risen by 59 per cent Tackling Inequities ($65,000 to $103,000). 5 • Housing stress among low income The Facts earners is increasing in and 36.8 per cent of males and 33.8 per The evidence is clear. Inequity is one of the cent of females in low income biggest social, economic and political challenges households are living in housing stress of our time.2 Inequity harms the economy, (defined as living in accommodation social conditions and people’s health and where over 30 per cent of income is wellbeing. There is much to be gained by spent on rent).6 reducing inequity and protecting populations • There has been growth in job insecurity from its consequences:3 and precarious employment • Economic costs: Inequity weakens arrangements (such as temporary work, economies and impedes economic growth. part-time work, informal work and Reliance a small part of the population piece work), leading to increasingly less builds vulnerability into economic systems. job control among those in work.7 • Social costs: Inequity diminishes daily living • Unemployment benefits in Australia conditions, human capital and social have declined steadily compared to cohesion, each of which is required for a other benefits and to community flourishing and secure society. standards regarding costs of living.8 • Health costs: Inequity damages people’s • Generally, people at the bottom of the sense of self and prevents access to the income distribution have worse health resources and opportunities necessary for outcomes than those in the middle that health and wellbeing. in turn have worse health outcomes Inequities in income and wealth have widened in than those at the top. This ‘social many countries, including Australia. These gradient in health’ is seen for a number growing financial and social inequities are of health outcomes including accompanied by widening inequities in health depression, heart disease and cancer.9 and wellbeing. Health inequities are differences While it is clear that poor health can lead to in health that are unnecessary, avoidable and lower income, there is solid evidence that poor unfair.4 For example: health occurs as a consequence of the social • Since 1975, the wages of a full-time, gradient. Poor health is both a cause and non-managerial worker in Australia in the bottom ten per cent of income earners has risen by 15 per cent (from

$32,000 to $37,000). Whereas for a

worker in the 90th percentile their 5 Leigh, A, 2013, Battlers and Billionaires: the Story of Inequality in Australia, Redback, Collingwood, VIC. 6 Australian Bureau of Statistics, 2013, Gender Indicators, Australia, Cat no 4125.0, Australian Bureau 2 Friel, S, & Denniss, R, 2014, Unfair economic of Statistics, Canberra. arrangements make us sick, Australia 21, Weston, 7 Friel, S, & Denniss, R, 2014, Unfair economic ACT. arrangements make us sick, Australia 21, Weston, 3 Stiglitz, J, 2013, The price of inequality, Penguin, ACT. London. 8 Ibid. 4 Whitehead, M, 1992, Inequalities in health – The 9 Friel, S, & Denniss, R, 2014, Unfair economic black report: The health divide, Penguin Books, arrangements make us sick, Australia 21, Weston, London. ACT. Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 10

programs and initiatives can be guided. It The Collaboration Approach strongly reflects the Advisory Council’s focus on health inequity and a social determinants of The Tasmanian Government Approach to health agenda. The Policy Framework identifies Collaboration provides a best practice three priorities: framework to assist agencies to work better together on complex policy and • Modernising the economy – it’s all service delivery issues in order to about jobs deliver better outcomes for all • Reducing inequality – caring for people Tasmanians. • Investing in the next generation – generating new opportunities for our kids

Each of these priority areas will help to improve a consequence of social and economic the health and wellbeing of Tasmanians. disadvantage.10 Examples of actions that are currently being By examining health inequity in terms of the taken right now across these areas include: the social gradient it becomes clear that not only First Home Builders Boost to help Tasmanians does poverty and disadvantage affect health and build new homes; participating in the National wellbeing, but so do the basic social and Disability Insurance Scheme launch to provide economic conditions that affect everyone. This greater choice and control for Tasmanians with is a major issue for all Tasmanians. a disability; and backing the Gonski education reforms to deliver needs based funding to Tasmanian schools. Tasmanian Government The Tasmanian Government Policy Framework Policy Framework demonstrates the Tasmanian Government’s The Tasmanian Government acknowledges the firm commitment to reducing inequality in value of working together to meet the Tasmania. It is complemented by two further challenges faced by many. Complex social and whole-of-government projects designed to economic problems, such as literacy, climate support collaborative, evidence-based decision change and homelessness require not only a making: The Collaboration Approach and Stats whole-of-government, but a whole-of- Matter. Together, these three initiatives are community response. The Tasmanian working to improve the basic conditions that Government aims to increase intersectoral underpin health and wellbeing for all collaboration in line with the Advisory Council’s Tasmanians. recommendations and has taken a number of steps to achieve this. Stats Matter The Tasmanian Government’s 2013-2014 Policy Stats Matters is a long term strategy to Framework of Jobs, People and Opportunities is strengthen the Tasmanian about giving all Tasmanians the opportunity to Government’s statistical assets and get a job and build a better life. This Policy capability to enhance decision making – Framework sets the Tasmanian Government’s It is about the government and higher order priorities against which policies, community making effective decisions based on sound statistical advice.

10 Wilkinson, R, & Marmot, M, 2003, The Solid Facts 2nd Ed, World Health Organization, Geneva.

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A Healthy Tasmania

A Healthy Tasmania: Setting New Directions for Health and Wellbeing is a long-term approach for Directions for A Healthy Tasmania building good health and wellbeing in collaboration with communities. It identifies the Bring together and strengthen our Tasmanian Government’s directions for health intelligence by: preventive health. - Fostering social action research A Healthy Tasmania is a commitment by the - Establishing health and wellbeing Tasmanian Government to realise the vision of indicators a fair and healthy Tasmania by: - Investigating health outcomes commissioning. • Establishing a coordinated and comprehensive approach to health and Support the health and wellbeing of wellbeing across government and Tasmanians who are vulnerable by: community, by building collaborative - Adopting a life-course approach partnerships with communities, and the - Targeting social determinants of government, non-government and health. private sectors; • Addressing health inequity by targeting Build supportive environments and efforts to support the most vulnerable policies that will: Tasmanians and addressing the social - Promote and protect factors that determine health and - Build healthy people and places wellbeing outcomes; and - Explore health equity impact • Empowering people and communities to assessment. improve their wellbeing, by bringing together all that is known and assessing Address locational disadvantage by: the impact of the activities of all sectors - Encouraging place-based on health and social outcomes. approaches The social determinants of health are - Using people centred planning. recognised and prioritised in A Healthy Spread the message of A Healthy Tasmania. It is the conditions in which people Tasmania so that we: live, learn, work and play that determine their health and wellbeing - much more than what - Empower people and communities individuals do or how healthcare services - Connect to support respond. It is estimated that medical care - Enable access. accounts for only 10% of overall health, with Build leadership by: social, environmental and behavioural factors accounting for the rest.11 At the heart of A - Working together Healthy Tasmania is the notion that getting - Taking intersectoral action for people to maintain their own wellbeing is part – health and wellbeing not all – of the solution. - Addressing inequity and health.

11 Ash, D & Volpp, K, 2012, ‘What business are we in? The emergence of health as the business of health care’, New England Journal of Medicine, vol. 367, pp. 888-889. Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 12

A Focus on Place A further $580,000 has been invested over two years to 2016 in the Thriving Communities – International evidence shows there is a strong Healthy Families Project in Community Houses. link between people’s health and the conditions The project will work locally to involve families in which they live. People with poorer health and community members in maintaining their outcomes tend to be concentrated in own health and in establishing service responses disadvantaged areas and are lower down the to the specific needs they identify. social gradient, with health inequities closely following this gradient. Three regional community development family support workers will facilitate community- This suggests that locality, community or place- driven activity aimed at engaging families with specific approaches that promote capability will young children in building capability and be best. Place-based approaches accept that resilience for health and wellbeing over time. local knowledge of the social, cultural and institutional context of communities is central The Tasmanian Government is also a supporting to improving the health and wellbeing of its partner in the Tasmania Medicare Local’s Social residents. Determinants of Health and Risk Factors Project. The Project is focusing on improving A focus on place can also help to drive the the health of Tasmanians through addressing the collaboration across government that is needed social determinants of health. A range of to solve complex social and economic strategies will be promoted in selected problems.12 In places where multiple and communities across the Tasmania from early complex issues exist, multiple agencies and 2014 until June 2016. community members can combine in a collaborative process, to work towards making a difference. Place-Base Approaches: The Tasmanian Government has already begun Are designed to meet the unique needs to invest in place-based approaches to health of locations or communities and wellbeing and will continue to build on this in 2014. Place-based approaches are happening Engage stakeholders across all sectors in in communities throughout Tasmania in collaborative decision-making partnership with Child and Family Centres, arts Seize opportunities, particularly local and cultural groups, schools, clubs, local skills and resources councils, Community Health Centres and other community-based organisations. Evolve and adapt to new learning and stakeholder interests Tasmania’s 34 Community and Neighbourhood Houses are delivering support programs at a Encourage collaborative action by local level to build the strength and resilience of crossing organisational borders and individuals, families and communities. In 2013 interests the Tasmanian Government allocated funding of Pull together assets and knowledge $4.0 million over two years to expand the through shared ownership current capital and maintenance program statewide for Community Houses. Attempt to change behaviour and norms in a location. 12 Department of Health and Human Services, 2012, Place-Based Approaches to Health and Wellbeing – Issues Paper, Tasmanian Government, Hobart.

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The Advisory Council’s Place-Based Action Recommendations The Advisory Council rightly identifies place- based action as an area of opportunity for The Advisory Council’s final report preventive health in Tasmania. Tasmania is recommends three key components for relatively similar to other regional parts of preventive health in Tasmania – place-based Australia and many people living are affected by action, statewide action and evidence-based action. social exclusion, unemployment, low education It also recommends that these components be outcomes and poor physical environments with brought together and consolidated under the a consequential greater risk of poor health and Thrive Tasmania model, the Advisory Council’s wellbeing than others.13 Social and economic vision for community health and wellbeing. factors can also have a negative impact on the What follows is the Tasmanian Government’s wellbeing of individuals and families in any response to this model for directing and shaping community, even if they are affluent. This makes health and wellbeing in Tasmania. For an a focus on place an appropriate response to indicative list of strategies and timeframes for health and wellbeing in all locations in Tasmania. the Tasmanian Government’s response to the recommendations in the final report, see Appendix 2. Challenges and Opportunities A place-based approach is a method of working that is used to target actions and resources within a particular community or location, in order to better meet the particular needs or issues of that location. The method is often applied to a ‘wicked’ problem, that is, a public policy issue that has multiple causes and solutions, that involves multiple stakeholders, but has no clear point of leadership or accountability. For this reason, health and wellbeing is often a common focus of placed-based approaches. Other examples of wicked problems that place-based approaches attempt to address include poverty, employment and climate change. A major advantage of place-based approaches is that they can bring together the many stakeholders that are needed to make a real difference within a community. This might include members of government, business and non-government sectors, as well as community members themselves. A community development approach is often taken to draw

13 Department of Health and Human Services, 2012, Place-Based Approaches to Health and Wellbeing – Issues Paper, Tasmanian Government, Hobart. Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 14

upon and build the resources that already exist within communities. Residing in neighbourhoods of concentrated social disadvantage One of the challenges of place-based can have an impact on the health approaches is that they are often very difficult to evaluate due to the long-term nature of of people in a number of direct and outcomes, difficulties in accessing data and indirect ways, including: difficulties in attributing health and wellbeing • Lack of access to social outcomes to the interventions because of the networks and job opportunities number of factors at play within communities. • Lack of exposure to the health Experience also shows that place-based promoting values and approaches are highly dependent on sufficient behaviours of broader society time and resources for implementation. To be • Prejudice and stigma successful, place-based approaches require: associated with residing in strong relationships between stakeholders, community participation, local ownership and areas that are perceived as leadership, local skills and capacity building, negative and undesirable adequate time for outcomes and impact to places occur, strong government support, • Decreased access to a range of responsiveness to local needs, and strategies for health, education and monitoring and evaluation. community services. Like any intervention targeting the social (Larsen, K, 2007) determinants of health, there is a risk of “lifestyle drift” in place-based approaches. That is, the tendency for the focus to shift from the Tasmanian Government Activity social determinants to a focus on individual behavior rather than structural change. The Tasmanian Government already provides a range of services and programs with a focus on Place-based approaches must also be place. For example: considered within the context of a broader • preventive health system that helps shape the Child and Family Centres are places for conditions of daily living that determine health families with children from birth to five and wellbeing at a local, state and national level. years to access a range of services. Their Other preventive health approaches that purpose is to improve the health and complement a place-based approach include: wellbeing, education and care of Tasmania’s legislation and regulation; taxation and pricing; very young children by supporting parents advocacy; social marketing; settings-based and enhancing accessibility of services in the approaches (schools, workplaces, clubs); local community. By the end of 2013, nine enhancing built environments; workforce state funded and two commonwealth development and training; and surveillance, funded centres have been established in monitoring and evaluation. communities around Tasmania. Work has also commenced towards a twelfth centre at George Town. • Community and neighbourhood houses provide grass roots, place-based services to communities. These facilities support

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education, childcare, community gatherings to: Positive Behaviour Support, Kids Matter, and healthcare in some of Tasmania’s most Mind Matters, Restorative Practice and disadvantaged and isolated communities. Program Achieve. Chaplains and/or Student • LINC Tasmania' is a statewide network that Welfare Workers, School Support gives Tasmanians access to library services, Teachers, Student Needs Support Teams, research and information, adult literacy Multi- Disciplinary Learning Services support, community learning, online access, Support Teams and Statewide Support and archive and heritage services. LINC Teams help deliver these programs. Tasmania services are available online and in • The Healthy Workers Initiative supports 69 locations around Tasmania, including workplace-based health programs aimed at LINCS, Branch Libraries and Online Access reducing overweight and obesity, increasing Centres. levels of physical activity and the intake of • In schools, breakfast fruit and vegetables, programs and supporting smoking community or kitchen cessation and reducing gardens have been harmful levels of alcohol established to consumption. support children to • The Residential prepare and eat Development Strategy is healthy meals. about delivering better Programs such as the housing and more liveable Young Parents communities in Tasmania. Activity Group and It applies liveability Dads at School principles and best- Program at practice in urban design Clarendon Vale are to enhance community encouraging parents cohesiveness, provide to connect with these green public spaces, and other school- improve safety and build based activities. resilience and energy • The highly successful efficiency into housing Move Well Eat Well design. All tenders for Program is working to new builds or promote healthy refurbishment of Housing eating and physical activity as a normal and Tasmania assets must demonstrate positive part of every child’s day. Over the adherence to the principles. past four years, 155 schools have joined the • Better Housing Futures is a major new step program and one in five has achieved a in the Tasmanian Government’s reform of Move Well Eat Well Award. In 2012, the the social housing sector to establish more program was extended from Primary accessible and responsive services for Schools to also include Early Childhood tenants. Up to 4,000 public housing Education and Care Services. tenancies (or about 35% of public housing • Schools are responsive to meeting need stock) is being transferred to the within the school community by providing community housing sector. Community programs that support student welfare. housing organisations will be based in the These programs include but are not limited community, making access easier for Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 16

tenants. The focus of Better Housing Futures the criminal justice system. The IAST Plus is to deliver a sustainable and place-based Project is currently considering how a multi- approach in broad acre estates to improve agency approach can best achieve positive property upgrades and access to housing outcomes for families. help. Community engagement is central to • Police and Community Youth Clubs (PCYC) the success of the project and achievement are located in communities throughout of project outcomes. The first stage started Tasmania. They provide a broad range of in early 2012 with the release of about 500 sporting, recreation, social and cultural homes at Clarendon Vale and Rokeby. Stage programs in a safe environment primarily 2 will see a further 1,100 homes handed for ‘at risk’ youth. over in suburbs across Tasmania in 2014. • The Tasmanian Parks and Wildlife Service is • Recent reforms to the Tasmanian disability encouraging more visits to parks and sectors have included the outsourcing of all gardens through the Healthy Parks Healthy disability services to the community sector People program. This integrated, multi- and the establishment of Gateway services, disciplinary and collaborative approach locally-based information, referral, intake acknowledges the link between nature and and assessment agencies. The new service health. A range of events and activities are model aims to improve choices for people promoted to exalt the benefits of natural with disability and provide services that are resources. more closely aligned to the communities in which they are situated. Next Steps The Tasmanian Government has already begun Successful Place-Base Approaches: to invest in place-based approaches, however, Take time much more needs to be done if Tasmanians are to fully reap the benefits of this way of working. Require adequate resourcing While there are lots of activities happening at a Develop relationships between local or community in Tasmania, better stakeholders coordination and a shared understanding and agreement is needed to bring all of this Enable community participation, together. ownership and leadership A first step will be to consolidate the Build community capacity knowledge and experience that already exists Are strongly supported by government within government and non-government sectors on place-based approaches. Child and Family Are tailored to different communities Centres and many community sector Measure success and evaluate. organisations, for example, have been working in this way for several years. There is a need to better evaluate these existing programs to learn • Inter-Agency Support Teams (IASTs) what is making a difference in Tasmanian operate in locations across the state to communities. In the next year, both Tasmania support children and young people with Medicare Local and the Tasmanian Association complex needs and their families. IAST of Community Houses are embarking on place- participants are generally at risk of entering based approaches to health and wellbeing that will provide invaluable learning for Tasmania.

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The University of Tasmania is a partner in the Statewide Action evaluation of these approaches together with The need to bring statewide coordination and Population Health Services as these consistency to prevention activity in Tasmania orgsnisations establish a proof of concept. emerged as a clear theme in a number of the Another important step will be to pursue a Advisory Council’s publications, including the commitment across government agencies to final report. This is unsurprising, given that adopt place as an focus for economic and social evidence has consistently shown that preventive improvement and to establish the principles and health effort requires a “broad, multifaceted and goals for working. A genuine commitment and coordinated strategy over a sustained period buy-in from all government agencies will be with partnerships between health and other essential to furthering productivity and healthy portfolios and industry sectors, and between fulfilling lives for Tasmanians. This will require government, business and community groups to the development of practical resources and a succeed.”14 shared language to guide both government and The history of preventive health action to non-government stakeholders in adopting the reduce tobacco smoking in Australia provides approach. the perfect example of the strength of A major opportunity in the next year will be the coordinated, systemic new Tasmanian action. In tobacco Government Framework control, a multifaceted, for Community comprehensive set of Engagement, which aims actions have been taken to support better including public community engagement education, taxation, practices, coordination legislation, quit smoking and information sharing, support services, and improved regulation, monitoring, community participation research and evaluation. in decision-making to This has led to a achieve better outcomes for communities and marked drop in the nation’s smoking rates over government. Under the framework a number of the last 30 years. Taking this type of systematic initiatives are being implemented in 2014, such approach to preventive health more broadly will as networking and learning opportunities for help to foster the conditions that will support government staff on best practice engagement, a people to healthy and well in the first place. register of public consultations to support better coordination of Tasmanian Government- led engagement activities, and development of a Challenges and Opportunities website to promote these activities and High level policy support, coordination and encourage community participation. These leadership are key elements of a systematic practical resources will help guide the approach to preventive health. These elements implementation of place-based approaches at a help to support the design and delivery of more local or community level. effective interventions.

14 Australian National Preventive Health Agency, 2013, State of Preventive Health, Australian National Prevention Agency, Canberra, p. 26. Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 18

Another essential part of delivering high quality preventive health outcomes are partnerships with non-government organisations, community and industry.15 Partnerships can help to target interventions at the needs of particular groups or to deliver prevention activities in common settings such as schools and workplaces. Connections between preventive health and the broader health sector are also required. Changes in populations take time and a major barrier to systemic public health action is overcoming government structures and budget cycles. Government departments, by their very - Financial Literacy Exchange structure, are separated with different Program; responsibilities and accountabilities, making it - Housewarming Program – including more difficult to establish effective joint goals the Stay Warm Save Money and across organisations. Government budget cycles Housewarming Boxes and Curtains are relatively short-term and there is often an programs; expectation that return on investment will be - Wheels for Work and Training demonstrated quickly. Program; - Emergency Relief; - Emergency Food Relief. Tasmanian Government Activity • Food for All Tasmanians: A Food Security The Tasmanian Government provides statewide Strategy identifies key strategies for strategies and approaches across a number of increasing access to affordable and nutrition areas that have an impact on population health food for all Tasmanians, particularly those and wellbeing. For example: most at risk. Under the strategy the • A Social Inclusion Strategy for Tasmania Tasmanian Government has invested $1 recognises that social exclusion contributes million in 2012-2013 food security related to disadvantage and sets out 10 strategies activities, including grants to coalition of for action. The strategy is about getting the organisations to support community basics right, early intervention and gardens and integrated food skills, access prevention and structural change. and affordability programs. • A Cost of Living Strategy for Tasmania is • The Premier’s Physical Activity Council, guiding activities to relieve pressures together with the Tasmanian Plan for Physical associated with the rising costs of living. Activity 2011-2012, provides coordination The Tasmanian Government has invested and statewide leadership for initiatives and $5 million into cost of living initiatives, many programs designed to promote and provide of which directly support the social opportunities for physical activity. Key determinants of health: priority areas are to influence the built environment to support healthy and active lifestyles in Tasmania by addressing

community design, policy and transport 15 Australian National Preventive Health Agency, 2013, State of Preventive Health, Australian National planning. Prevention Agency, Canberra.

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• Sport and Recreation Tasmania works in • The Tasmanian Jobs Package is working to partnership with a range of organisations provide all Tasmanians with the opportunity statewide, including local government, to get a job and build a better life. Under national, state and local sporting the package: organisations and other providers to - Tasmanians will be able to achieve support all Tasmanians to participate in their dream of building their first sport, recreation and physical activity. A new home with a $15,000 First strong focus is placed on ensuring there are Home Builders Grant well-planned facilities, places and - Businesses will receive a Full Payroll environments for people to participate. The Tax Rebate for all new jobs created recent $4 million Trails and Bikeways in Tasmania Program has resulted in over $10.4 million - Small businesses can access grants in trail and bikeway infrastructure around of up to $250,000 to help them the state. expand and create jobs in Tasmania • provides a number of - Communities will benefit from an diversion options across Tasmania that investment of $6 million for enable offenders who commit a range of community and recreation offences to be dealt infrastructure with aside from the - Touris criminal justice m operators will benefit system. These from an additional $1 programs provide a million to promote restorative justice Tasmania approach and seek - Farmers to promote better will get support to tap outcomes for the into the dairy boom individuals involved. through a $400,000 For example the dairy conversion Illicit Drug program. Diversion Initiative and the Tasmanian Early • The Tasmanian Adult Literacy Action Plan Intervention Pilot Program are referring 2010-2015 invests in people and programs minor drug and alcohol offenders to health- to raise awareness and understanding of based initiatives. adult literacy. It provides support and • The Economic Development Plan provides a programs for people to improve adult basis for the next ten years to deliver literacy in their workplace and their increased economic growth, jobs and a community. better, more equitable and sustainable • The 26TEN Grants Program aims to future for Tasmanians. The plan centers on increase the core skills levels of people in making the most of Tasmania’s assets to the workplace and communities, to build a secure prosperity and jobs. culture of life-long learning and to make it easier for employees and community groups to access literacy support.

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 20

• The Tasmanian Skills Strategy 2008-2015 - Guidelines for Inclusive Language seeks to guide investment to match ensures employees and students are Tasmania’s skills needs. Investment is aware of their responsibility to use targeted at the 400,000 Tasmanians over inclusive language, to acknowledge the age of 15 years that make up the state’s and treat all people equitably with working age population. The strategy has sensitivity and respect; four themes: - The Relationship and Sexuality - Increasing opportunity; Education in Tasmanian Government - A better system for clients; Schools Strategy supports schools to - Workforce development; deliver development-appropriate - Skills for the future. relationships and sexual education. • The Inclusive Ageing: Tasmania 2012-2014 • The Tasmanian Urban Passenger Transport Strategy represents a commitment by the Framework sets the future direction for Tasmanian Government to support a passenger transport across Tasmania’s socially inclusive society in the context of an urban areas. The Framework identifies six ageing population. The strategy is being action areas: implemented through six inter-related - Moving Minds – increasing public projects based on themes which emerged awareness, acceptance and usage of from statewide consultation: public transport, walking and cycling - Building evidence: a demographic options; profile (of older Tasmanians); - Moving Places – consolidation of - Finding out: accessing the right population around transit corridors, information at the right time: proving the critical population - Supporting resourcefulness: living density to support future mass affordability; transit systems; - Engaging in different ways: voluntary - Moving People – high frequency contributions; public transport delivered with high - Improving access: age-friendly quality infrastructure that enhances communities; attractiveness, efficiency and utility - Contributing economically: of public transport; workforce participation. - Moving Policies – encouraging use of • A statewide approach to relationships and alternatives to private vehicles; sexuality education in all government schools from kindergarten to Grade 12 ensure all young people are provided with inclusive and appropriate education and support: - Guidelines for Sexual and Gender Diversity in Schools and Colleges are a commitment to ensure the education experience for lesbian, gay, bisexual, transgender and intersex students is free from discrimination, harassment and

bullying;

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 21

- Moving Legs – Encouraging walking Tasmania’s objectives are to: and cycling through infrastructure, - Foster an intolerance of violence in land use planning and behavioural Tasmania through a range of change. strategies; - Moving Forward – Adopting a long- - Use evidence-based best practice term approach to integrated use of programs to build people’s capacity transport and planning. to develop respectful relationships; • Similarly, the Tasmanian Walking and Cycling - Participate in national approaches; for Active Transport Strategy aims to make - Strengthen collaboration between communities healthier, and more government and non-government sustainable, liveable and accessible by services to ensure services meet supporting people to walk and cycle as part the needs of clients. of their every-day journeys. Principal Urban • Arts Tasmania is a part of the National Arts Cycling networks have been identified in and Health Working Group which has each major urban centre and are being supported the development of the National supported by cycling infrastructure on key Arts and Health Framework. The framework active transport routes. has been developed to enhance the profile • Tasmania is a signatory of the National Plan of arts and health in Australia and to to Reduce Violence Against Women and their promote greater integration of arts and Children 2010-2022. A key action of the health practice and approaches into health Tasmanian Implementation Plan has been promotion, services, settings and facilities. the development of a primary prevention • The Better Access to Government Services for strategy entitled Taking Action: Tasmania’s Humanitarian Refugee Entrants Report is a Primary Prevention Strategy to Reduce Violence whole-of-government approach to Against Women and Children 2012-2022. improving access to Tasmanian Government services for former humanitarian entrants. The report recognises there are often significant challenges that need to be addressed to enable equitable access to government services and outcomes for former humanitarian entrants. New initiatives and adjustments to existing programs are being overseen by and Interagency Working Group to meet the needs of former humanitarian entrants. • Sharing Responsibility for Our Children, Young People and Families: Government Embracing Change aims to improve policies and service delivery arrangements for children, young people and their families. The agenda sets out key directions for the next 10 years and assists in determining the sort of environment Tasmanians wish their children to grow up in. • A Committee of Cabinet on Children, Young People and Their Families has been Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 22

established. Chaired by the Premier, - Building an integrated service membership comprises of the Attorney system General and Ministers for Children, Health, - Focusing on whole of population Human Services, Police and Emergency approaches. Management, and Education and Skills. It is • In accordance with the Land Use Planning supported by an Interdepartmental and Approvals Act 1993, the Tasmanian Committee made up of Heads of Agencies. Planning System works “to secure a • Building the Foundations for Mental Health and pleasant, efficient and safe working, living Wellbeing: A Strategic Framework and Action and recreation environment for all Plan for Implementing Promotion, Prevention Tasmanians.” As awareness of the and Early Intervention Approaches reflects the relationship between the built environment Tasmanian Government’s ongoing and health and wellbeing grows, land use commitment to the delivery of quality planning is becoming an important strategy mental health services. Its implementation is for achieving positive community health and being driven with the oversight of the wellbeing outcomes. Tasmanian Inter-Agency Working Group • The Tasmanian Early Years Foundation is a for Mental Health. non-profit organisation to support and • Tasmania’s Suicide Prevention Strategy 2010- promote the wellbeing, development and 2014 provides a clear direction for suicide learning of Tasmanian children up to the age prevention activity in Tasmania. The of six years. The foundation is to play a Tasmanian Suicide Prevention Committee central role in bringing sectors together to focuses on implementing the strategy’s five help foster a society in which all Tasmanian priority areas: children are valued and given the best - Governance and leadership possible start to life. - Primary prevention; - Secondary prevention and early intervention; - Tertiary prevention - Evaluation and quality improvement of services. • The Tasmanian Alcohol Tobacco and Other Drugs Promotion, Prevention and Early Intervention Strategic Framework: Everybody’s Business has been developed by the Tasmanian Inter-Agency Working Group on Drugs. Everybody’s Business seeks to address the underlying cuases of substance use, moving beyond traditional health, justice and education approaches. It focuses on the following priority areas: - Nurturing the early years and strengthening families - Fostering resilient individuals - Building an inclusive community

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 23

Information, be it anecdotal reports Next Steps of how the conditions of daily living There is clearly a need for greater consistency, effect health or formal academic integration and collaboration in government research, is the most powerful activity at a statewide level in Tasmania. While catalyst for bringing sectors the Tasmanian Government is responsible for together to work on improving numerous statewide services, programs and health and equity. planning activities, there is no single overarching plan or body to bring them together. The public have an expectation of easy access to public services that work coherently Evidence-Based Action together. More needs to be done to define integrated service delivery in Tasmania and how Effective preventive health action is dependent government agencies might support and develop on an enabling infrastructure that includes such an approach statewide. Transparency of research, monitoring and evaluation, public services must be at the forefront of any information, a strong workforce and commitment to improve statewide consistency leadership.16 Without these essential elements, and collaboration. public health practitioners cannot know when, A next step will be to identify and agree the where and how to act. shared interests at a statewide level that can For this reason, the World Health bring government departments and activities Organization’s Commission on the Social together across portfolios. Agendas such as Determinants of Health17 identified ‘knowledge, mental health and suicide, children and young monitoring and skills’ as the ‘backbone of people, climate change and employment are action’ to reduce health inequity. shared by all parts of government and can help Building Tasmania’s ‘health intelligence’ foster commitment and practical collaboration capability is perhaps the greatest area of strategies across diverse parts of government. opportunity identified in the Advisory Council’s Another important step will be to raise greater final report. Increasing the state’s health understanding and awareness of the intelligence, including access to community interconnectedness of government portfolio health and wellbeing profiles and health equity areas. As flagged by the Advisory Council, this impact assessment, will help to bring sectors could be achieved through whole-of- and communities together to work on government forums or formal policy assessment improving health and equity. processes, such as Health Equity Impact

Assessment (see evidence-based action).

The Tasmanian Government Approach to Collaboration remains a major opportunity to drive a preventive health agenda forward, including the Health and Wellbeing Advisory Council’s recommendations. Work on 16 Australian National Preventive Health Agency, implementation of the approach is ongoing 2013, State of Preventive Health, Australian National across government. Prevention Agency, Canberra. 17 Commission on Social Determinants of Health, 2008, Closing the Gap in a Generation, World Health Organisation, Geneva. Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 24

Challenges and Opportunities Like the rest of Australia, Tasmania has relatively good access to information on the health status of its citizens.18 Less is known, however, about the causes or determinants of preventable chronic disease in the population. There are also gaps in knowledge about both health outcomes and their causes at a local government or regional level in Tasmania. Evaluating the impact of prevention initiatives remains a challenge. There is not enough good evidence of what works in reducing health inequities and influencing underlying causes.19 Barriers to evaluation Tasmanian Government Activity include the long-term nature of interventions, The Tasmanian Government is working across lack of dedicated funding for evaluation agencies to improve collaboration and access to activities, difficulties attributing causation and information. For example: sometimes a lack of clear or measurable goals. • For these reasons evaluations often tend to Stats Matter is a long-term strategy to build focus on descriptions of the problem and on Tasmanian Government statistical assets inputs, throughputs and satisfaction levels, and capability. Its vision is for better rather than health outcomes. government decisions informed by quality data and sound statistical practice for the Despite these challenges many opportunities benefit of all Tasmanians. The major actions currently exist in Tasmania. Policy makers are outlined in the strategy are: beginning to integrate data from across sectors, - To identify and manage statistical such as education and health, which will assist assets to strengthen government to better understand the factors that influence accountability; health and wellbeing. Improvements are also - To establish a toolkit of resources being made in the way that data is shared and to build data quality and support accessed across government and the capability; community. - To build mechanisms to make sharing and publication of statistical information easier; - To strengthen collaboration across

government to make the best use of statistical information; - To develop and implement a plan to improve Tasmanian Government 18 Australian National Preventive Health Agency, 2013, State of Preventive Health, Australian National statistical capability. Prevention Agency, Canberra. 19 Ministerial Taskforce on Health Inequalities, 2008, Equally Well – Report of the Ministerial Taskforce on Health Inequalities, Scottish Government, Edinburgh.

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 25

• The Tasmanian Data Linkage Unit provides Understanding underpinned by a Cross- the potential to bring together and cross Agency Partnering Agreement. The reference a range of health and social data Agreement outlines roles, responsibilities from disparate information sources. The and processes that support the work is delivered through a partnership collaborative effort required to improve the between the Menzies Research Institute of educational achievements for students Tasmania and the Department of Health under guardianship and custody orders and Human Services. enrolled in government schools. • Sense-T is a partnership between the • The State of Public Health Reports and CSIRO and the Department of Economic Health Indicators Tasmania provide detailed Development, Tourism and the Arts which statistical information about the health facilitates the analysis of geospatial data in status and determinants of health in our real time to aid in decision making. population. These reports are submitted • Kids Come First is a whole-of-government through the Minister for Health to both initiative that has established a database of Houses of Parliament, as required by the key indicators of the health, wellbeing, Public Health Act 1997 every five years. safety, development and learning outcomes of Tasmanian children from birth to age 17. In some instances, the database allows Next Steps analysis of data down to a locality or suburb While the Tasmanian Government has made level. good progress in strengthening the evidence- • Every three years since 2009, Tasmanian based for preventive health, there is still more children enrolled in the Preparatory year of to be done. A number of initiatives will help to schooling have participated in the Australian progress this important area in the next year Early Development Index (AEDI) data and beyond. collection. The AEDI is a national

population measure of young children’s health and development as they transition Community Health and Wellbeing into full-time schooling. Both the Profiles: Department of Health and Human Services and the Department of Education use the Help local governments to govern data to support young children, their better through greater knowledge families and the community they live in. Inform local people and organisations • The Department of Education is currently about local issues and encourage their engaged in a collaborative data linkage engagement project with the South Australian Department of Education and Child Ensure policy, budget and other Development. This project is using data decision making is informed by evidence linkage methodologies to provide a proof of Illustrate how different issues in concept researchable dataset of de- communities are connected identified population-level data that will Focus service planners on results incorporate available health and education data sets at a unit-record level. Encourage strong government • The Department of Education and the reporting, accountability and Department of Health and Human Services transparency. have a data sharing Memorandum of Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 26

For example, Web-Epi is a web-based government departments to consider their epidemiological reporting system that provides impact on population health and wellbeing. a user-friendly way to analyse the latest data about hospitalisations, cancer incidence, infectious diseases and mortality to identify health trends and outcomes in Tasmania. The Department of Health and Human Services is developing Web-Epi into a publically accessible resource of holistic information on the health and wellbeing of Tasmanians. The Department of Health and Human Services will also develop community health and wellbeing profiles and indicators to make information about that status and determinants of population health more readily accessible, applicable and useful for communities. This will help to guide preventative health measures at a local or community level, including place-based approaches. The Department of Health and Human Services is also scoping the development of a health equity impact assessment process for Tasmania. Health equity impact assessment is a type of information tool used to raise awareness of the influence that the activities of all sectors have over the conditions of daily living that affect health. The tool will be trialled internally within Population Health Services in the first instance. A major opportunity for boosting the leadership and evidence base for preventive health in Tasmania will be the development of a State Public Health Plan for Tasmania in response to the five-yearly State of Public Health Report tabled in the . The legislative basis for the structure to oversee such an approach already exists within the Public Health Act 1997, with the establishment of a Public Health Advisory Committee being an option for the Minister for Health under Section 37 of the Act. The establishment of such a committee for the purposes of developing a broadly-based State Public Health Plan would be a major undertaking for the Tasmanian Government and would require all

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 27

Thrive Tasmania Model

The Thrive Tasmania Community Model of Health and Wellbeing presents a fantastic opportunity to the Tasmanian Government. The model has great potential to bring a diverse range of people together within communities around a shared agenda. It offers all parts of government the opportunity to pursue their goals for Tasmanian its earliest stages. Skillful community communities in collaboration with others. engagement will be an essential component of a The model already enjoys a high level of “thriving community”. support amongst key stakeholders as a result of Community support and participation can the Health and Wellbeing Advisory Council’s strongly advantage place-based approaches like broad community linkages. This paves the way the model for Thrive Tasmania. Community for the necessary partnerships and collaboration support helps to mobilise the many resources across the Tasmanian community. Advisory that community members can bring to policy Council members have also generously offered and decision-making processes and ultimately to to play an ongoing role in bringing together the service delivery. necessary players to make a difference. Community capacity building must therefore be Developing an approach like Thrive Tasmania is embedded into all planning and implementation no small undertaking. In the first instance, activities towards the Thrive Tasmania model in further work is needed to develop the practical order to create functional and effective systems implementation strategies that will bring the within communities that will enable community Advisory Council’s vision to life. This will members and groups to fulfil their role in involve development of the Joint Statement of contributing to health outcomes. Participatory Commitment to Prevention, principles and and deliberative processes that include both methods for working in Thrive Tasmania local and external stakeholders in communities communities, and tools and resources for will be essential. working with communities.

The Thrive Tasmania brand also needs to be tested with the broader Tasmanian community. Thrive Tasmania will only be successful if individuals, families, schools, clubs and other community groups can each develop a sense of shared ownership and commitment to the approach. Communities must therefore have input into the development of the model from

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 28

Where to From Here? consistency, integration and collaboration across government activity, particularly through Tasmania faces the significant challenge of the opportunities that arise under the managing rising healthcare costs at a time of implementation of Collaboration – A Tasmanian tight fiscal circumstances. Modelling indicates Government Approach. that if no action is taken to address rising healthcare costs, healthcare will consume the Improvements to the Tasmanian Government’s entire State Budget within the next few statistical capability will continue to be made as decades. a part of the Stats Matters initiative across government. The Department of Health and Prevention is a strong priority of the Tasmanian Human Services is also strengthening its health Government, and is strongly supported by intelligence capacity through such advancement 20 clinicians in the healthcare sectors . Prevention as the Web-Epi reporting system, community improves quality of life for individuals and their health and wellbeing profiles and indicators and families. It also offers the potential to reign in health equity impact assessment. predicted growth in healthcare expenditure, and generates substantial social and economic benefits for the broader community. As this response illustrates, the Tasmanian Government has invested heavily in preventive health in Tasmania, including the social determinants of health agenda. In line with this commitment, the Tasmanian Government accepts the Health and Wellbeing Advisory Council’s recommendations. In the coming year, the Tasmanian Government will continue to support place-based approaches, principally through Child and Family Centres, neighbourhood and community houses, LINCS, schools and workplaces. The Thriving Communities – Healthy Families Project and the Tasmanian Government Framework for Community Engagement will pave the way for further development of place-based approaches in Tasmanian communities. At a statewide level, the Tasmanian Government will continue to pursue greater

20 http://www.dhhs.tas.gov.au/about_the_department /our_plans_and_strategies/thp/tasmanias_health_pl anning_framework/thp_framework_summary

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 29

The development of a State Public Health Plan in response to the five-yearly State of Public

Health Reports is a major undertaking that the Tasmanian Government will pursue in 2014. A State of Public Health Plan would bring whole- of-government attention to the important health and wellbeing issues raised by the Director of Public Health in these reports, and encourage a social determinants of health approach in response. If resources allow, the State Public Health Plan will be overseen by a Public Health Advisory Committee appointed by the Minister for Health under the legislative structure within the Public Health Act 1997. The Public Health Advisory Committee could include senior State Service officers as well as independent public health experts to guide the implementation of a State Public Health Plan. Their role would include regular progress reporting and advice to government.

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 30

Appendices Appendix 1. Thrive Tasmania Community-Driven Model of Health and Wellbeing

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 31

Appendix 2. Ministerial Health and Wellbeing Advisory Council Recommendations 1. Place-Based Action

Priorities Brief Description Strategies Timeframe • Develop a Joint Statement of Commitment to Prevention to which local 1.1 Develop an agreed Establishing a shared 12 Months vision, principles and whole- commitment meets need government, community sector organisations, and other partners can commit. of-government commitment for greater coordination • Build partnership and collaboration for local action. 1-3 Years to Thrive Tasmania. for prevention, and a • Establish the Thrive Tasmania criteria under which all preventive health programs, common purpose. 1-3 Years activities and organisations can contribute to a shared vision. • Establish model for Thrive Tasmania communities, where priorities are identified by 1.2 Establish the evidence- A means for a community- 12 Months base and proof of concept driven model for health members of the community. for the model in selected and wellbeing, identifying • Commence the Thrive Tasmania community model of health and wellbeing with a communities across resources and small number of test sites, with a view to building the number of Thrive Tasmania 1-3 Years Tasmania. implementation plans. communities over time. • Develop responsibilities, planning and evaluation strategies for the Thrive Tasmania 1-3 Years model. 1.3 Support community- Evidence informed • Use local or community partnership agreements to bring all stakeholders together. If resources allow driven health and wellbeing strategies are needed to • Establish support mechanisms for local government and partner organisations to strategies with information, drive demand in local coordinate effort at a local level. If resources allow knowledge, tools and communities for wellbeing, resources, including sense of place and health • Work with local government to develop and implement community development If resources allow personnel. promotion. strategies to maintain and improve health and wellbeing. • Ensure all services and parts of the Department of Health and Human Services 1-3 Years contribute to Thrive Tasmania communities. 1.4 Foster and resource Effective engagement for • Invest in strategies for participatory engagement such as local summits, citizen With DPAC if effective engagement community decision- juries, group creative processes and structured discussion. resources allow strategies to inform local making requires adequate • Use community cultural development strategies to support communities to If resources allow priority setting and build resourcing, which could be develop sound, evidence-based and creative responses to their situation. capacity for action. targeted. • Work with and influence Tasmania Medicare Local to support local government Until June 2016 and communities through the Tasmania Healthcare Assistance Package funding.

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 32

2. Statewide Action

Priorities Brief Description Strategies Timeframe • Actively engage health and human services including Tasmanian Health 2.1 Redirect state There is a need to drive the priority 3-5 Years government programs, for reducing avoidable inequities. Organisations and Tasmania Medicare Local. policy and processes to • Implementation of health promotion, self-management and health There is potential for greater 3 Years drive local Thrive Tasmania integration of existing, successful literacy plans. partnerships and initiatives programs, such as self-management, • Establish an annual public health forum across whole-of-government to (e.g. streamlined grants). across the Tasmanian Health educate decision makers about the social determinants of health. If resources allow Organisations, Tasmania Medicare Local and other service providers • Use local or community partnership agreements to bring all 2.2 Support identified Builds on place-based approaches 1-3 Years priorities, such as the early across Government. stakeholders together. • years and mental health, The early years are a focus through Produce a Thrive Tasmania toolkit, based on principles of place-based through local or community Child and Family Centres and approaches, and using existing resources to support local health 3-5 Years partnership agreements and Community Houses. promotion activities. local government health • Strong emphasis under Thrive Tasmania on the early years and mental Parental mental health issues and promotion plans. health as a fundamental basis for good health and wellbeing. Tasmania deprivation during the early years communities. 1-3 Years significantly impact child health outcomes • Enable staff to better understand and respond to vulnerable and at risk 2.3 Provide health literacy There is a need for greater awareness 1-3 Years and health equity training to and understanding of issues people. support frontline health and surrounding the social determinants of • Written and oral communication takes account of low levels of literacy human services staff health. 1-3 Years working with vulnerable or • Provide health literacy and health equity training to health and human Until June 2016 at risk groups. services staff, particularly frontline workers and decision-makers.

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council 33

3. Evidence-Based Action

Priorities Brief Description Strategies Timeframe • Establish an ongoing, three-yearly population health survey for 3.1 Conduct three-yearly Provides access to and explanation of If resources allow population health surveys, regular information to inform planning Tasmania. establish community and decision-making for health and • Use population health survey data to produce and explain community indicators and evaluate the wellbeing. profiles and indicators in support of municipal health and wellbeing 3-5 Years effect of interventions. Responds to calls from local strategies. government and other stakeholders • Make these community profiles and indicators publicly accessible, well for community level health and promoted and easily understandable for communities. If resources allow wellbeing data. 3.2 Establish a State Public Establishes high-level leadership and • Develop and implement a State of Public Health Plan for Tasmania in Health Plan led by a Public commitment across government. response to the five-yearly State of Public Health Reports tabled in 1-5 Years Parliament. Health Advisory Committee The Public Health Act 1997 provides a with an ongoing action plan legislative basis for the governance • Establish a Public Health Advisory Committee made up of public health and budget to address structure with which to drive these experts and heads of agencies to provide advice to government and If resources allow identified health issues. reforms. drive action across portfolios • Develop criteria and methodology for health equity impact assessment 3.3 Assess the impact of Health equity impact assessment 1 Year major policy decisions and commissioned by the Public Health across government. projects on health and Advisory Committee will help raise • Commence health equity impact assessment on selected Government equity. public awareness of the influence of all programs, policy and processes of social and/or economic significance. sectors on health and wellbeing. If resources allow Health equity impact assessment has been identified as a priority in the new Tasmanian Primary Health Framework.

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council

Department of Health and Human Services GPO Box 125 Hobart TAS 7001 P (03) 6222 7729 F (03) 6222 7409 www.dhhs.tas.gov.au

Tasmanian Government Response to the Final Report of the Ministerial Health and Wellbeing Advisory Council