24 August 2017

Some news items shared among network members

1. Sustainable Development Goals: The 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs) were adopted in 2015 by all Member States of the United Nations. Health and well-being for all at all ages is a goal in itself (Goal 3), but it also affects and contributes to other SDGs. In addition, progress towards other SDGs can directly and indirectly benefit health and well-being. Health 2020, the policy framework for the WHO European Region, incorporates approaches and priorities common to the 2030 Agenda and provides a stepping stone towards achieving the SDGs in the Region.

2. Pokies cause harm: Get poker machines out of pubs and clubs – sign the letter: http://sarc.good.do/getthepokiesoutoftasmaniaspubsandclubs/letter/

4. Infographic – what makes us healthy? http://www.health.org.uk/blog/infographic-what-makes-us-healthy

8. “Personal Responsibility” Is A Meaningless Term: https://medium.com/@gidmk/personal-responsibility-is-a-meaningless-term-8c1f7732993b

10. Teenagers from remote NT Aboriginal community make hip hop clip about mental illness: http://www.abc.net.au/radio/programs/am/indigenous-teens-make-hip-hop-clip-about-mental-illness/8833206

To see more posts visit: https://www.facebook.com/sdohantas

06 September 2016

A big week with Prof Michael Marmot in town last week

Here are few links that you may like to check out:

Other items of interest:

23 August 2016

Here are some of the items we've shared as a Network recently

1. Are you under 18 and living in Tassie? Commissioner for Children and Young People Tasmania
I need your help to fill out this short survey, so that I can advocate to make Tasmania a better place for you! The results of the survey as well as two meetings already held with the Commissioner for Children and Young Peoples Advisory Council will be published in a Report to be released later this year. https://www.surveymonkey.com/r/M9CMCP6

2. Just announced! The New Parliament: Challenges Australia Can’t Ignore
We are delighted to announce a special panel event in October featuring Michelle Grattan AO (Chief Political Correspondent at The Conversation), Dr Cassandra Goldie (CEO, Australian Council of Social Service) and Professor Ian Harper (Deloitte Access Economics and Reserve Bank Board Member). Mark your diaries now for 6.00pm on Tuesday 25 October in the Stanley Burbury Theatre, Sandy Bay Campus. We will be serving refreshments from 5.30pm. Early registrations can be emailed to Louise.Grimmer@utas.edu.au. This is a free event and open to members of the public as well as University staff and students. http://www.utas.edu.au/social-change/home

3. Watch Q&A on ABC next Monday night - 29 August - as Sir Michael Marmot will be on the panel. http://www.abc.net.au/tv/qanda/coming_up.htm
Professor Sir Michael Marmot, President of the World Medical Association, has been a leading researcher on health inequality issues for more than four decades. He has played a central role in research projects studying health equity and bringing research evidence to bear on policy and practice. His many achievements include chairing the Commission on Social Determinants of Health for the World Health Organization in 2005 which produced the influential Closing the Gap in a Generation report in 2008. Its central conclusion was social injustice is killing on a grand scale.

4. What will it take for Tasmania to have Australia’s healthiest population by 2025?
A Research Week public forum inspired by the Tasmanian Governments Healthy Tasmania Plan, 31st  Aug 2016, 3:00-5:00pm, Rory Spence VOS Construction Lecture Theatre, Architecture & Design, Inveresk campus, RSVP / Contact Information: E: UTAS.Events@utas.edu.au, T: 6324 3290

5. Opinions on the State’s new Healthy Tasmania Strategic Plan:
·         Letter to the editor regarding tobacco component of Healthy Tasmania Strategy - http://www.examiner.com.au/story/4080885/letters-to-the-editor/?cs=100
·         Kym Goodes (TasCOSS) opinion piece – The Examiner - http://www.examiner.com.au/story/4083987/finding-balance-the-key-to-good-health/?cs=97

7. What's your share of the pie?
When you think about your household’s income, do you feel rich, poor, or just average? Most of us have no idea – or the wrong idea – of how we compare with the rest of the population. But here, in 10 clicks, you can find out how many households are better or worse off than yours, and see how your ideal world compares. http://www.compareyourincome.org/index.php

8. Australian Youth Development Index
The Australian Youth Development Index analyses youth development across domains of education, health, employment, political and civic participation. http://www.youthaction.org.au/australian_ydi
Tasmania's youth suicide rate highest in the country, prompting calls for better targeted services: http://www.abc.net.au/…/tasmanian-youth-suicide-rat…/7732576

9. Many wealthy countries face a mental health crisis – here’s what governments can do

10. Shift toward social determinants transforming public health work: Targeting causes of health disparities

15 July 2016

Items of interest shared with Network members

1. Transgender health: an opportunity for global health equity
The Lancet is publishing its first Series on transgender health. Transgender people live in all countries, but their acceptance by communities and freedom to live with their chosen gender identity or expression varies according to culture and society. Read more: http://www.thelancet.com/series/transgender-health.

2. Global Nutrition Report 2016: Rates of obesity and overweight are rising in every region of the world and in nearly every country according to the 2016 Global Nutrition Report. The independent report reveals insufficient progress in the fight against all forms of malnutrition; for example, almost all countries are off course on efforts to reduce anemia in women and to prevent further increase in diabetes. Read more: http://globalnutritionreport.org/

3. The Social Determinants of NCDs - Youtube Video
Walk the streets of Copenhagen, Denmark, as Dr Alessandro Demaio explains the Social Determinants of NCDs and Global Health. Click here to watch the video.

4. You can Create Change: In October 2015, the Sudbury & District Health Unit (SDHU) launched a campaign called You Can Create Change. It is part of the SDHU’s health equity communications and social marketing activities, which aim to shift the conversation about health equity in our communities, and, more importantly, to encourage community members to take action to address health inequities. As part of this campaign we have developed a video. This video highlights the notion that everyone can create change in their community.
The video, along with information about the campaign, can be found online by visiting www.sdhu.com/change

5. The challenge of false beliefs Understanding and countering misperceptions in politics and health care:
Misperceptions about politics and health can undermine public debate and distort people’s choices and behaviour. Why do people hold these false or unsupported beliefs and why is it so difficult to change their minds? An emerging literature examines the difficulty of correcting false or unsupported beliefs and the reasons for this resistance, but relatively little is known about the sources of misperceptions, the psychology of misperception belief, or how to most effectively counter these false claims. In addition, most studies focus on the mass public’s beliefs in well-known misperceptions; the mechanisms by which false beliefs become politicized, disseminated, and integrated into individual belief systems and the role of elites and the media in that process are less well understood. Read more: https://www.isr.umich.edu/cps/events/Nyhan_20160613.pdf.  

6. How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? A study in sixteen municipalities in the Netherlands. The causes of health inequalities are complex. For the reduction of health inequalities, intersectoral collaboration between the public health sector and both social policy sectors (e.g. youth affairs, education) and physical policy sectors (e.g. housing, spatial planning) is essential, but in local practice difficult to realize. The aim of this study was to examine the collaboration between the sectors in question more closely and to identify opportunities for improvement. The study found that the policy workers of social sectors were more involved in the public health network and more frequently supported the objectives in the field of health inequality reduction. Both social policy sectors and physical policy sectors used policies and activities to reduce health inequalities. More is done to influence the determinants of health inequality through policies aimed at lifestyle and social setting than through policies aimed at socioeconomic factors and the physical environment. Where the physical policy sectors are involved in the public health network, the collaboration follows a very similar pattern as with the social policy sectors. All sectors recognise the importance of good relationships, positive experiences, a common interest in working together and coordinated mechanisms. This study shows that there is scope for improving collaboration in the field of health inequality reduction between the public health sector and both social policy sectors and physical policy sectors. Ways in which improvement could be realised include involving physical policy sectors in the network, pursuing widely supported policy goals, making balanced efforts to influence determinants of health inequalities, and increasing the emphasis on a programmatic approach. Read more: click here.

7. Beyond Individualised Approaches to Diabetes Type 2
Explanations for type 2 diabetes are broadened beyond the individual body and ‘bad lifestyles’ to include major institutions, the social and material contexts of food and eating, and employment. Precarious employment, a social determinant of health, encourages changes to food practices, lowers working conditions, worsens health, can bring poverty and increases shift work, a causal risk factor for diabetes. Scientists have played a part in revolutionising foods and technologies which minimise labour and movement. There are excess additives in processed food. Genetic explanations for the higher rates of diabetes in First Nations peoples give way to social explanations: colonial history, British/Euro-American cuisine, food insecurity, trauma and social conditions resulting in chronic stress. Self-management education takes a ‘nutritionist’ approach towards food and eating and tends to minimise the social context and skills of those with the condition particularly women workers in poorer social groups who have higher rates of diabetes (T2DM). Read more: http://onlinelibrary.wiley.com/doi/10.1111/soc4.12369/full

8. Health in All Policies: A Guide for State and Local Governments: https://www.apha.org/~/media/files/pdf/factsheets/health_inall_policies_guide_169pages.ashx

9. 'Afternow' - what's next for the health of society?
Professor Phil Hanlon from the University of Glasgow discusses such seemingly intractable problems as; obesity, overwhelming involvement in various 'addictions', loss of wellbeing and inequalities as emergent products of our late modern culture and social structures. He argues that these problems will not improve until there is a radical transformation of our whole society and the culture that has created it. Watch here:

10. Many Australians pay too much for health care – here’s what the government needs to do: https://croakey.org/many-australians-pay-too-much-for-health-care-heres-what-the-government-needs-to-do/?mc_cid=0373aa9239&mc_eid=04b9c370f0

11. What would Brexit mean for the NHS, social care and disabled people? https://www.theguardian.com/society/2016/jun/14/brexit-nhs-health-social-care-disabled-people-eu-referendum

28 April 2016

Here are some items that may interest readers

The WHO Commission on Ending Childhood Obesity (ECHO) 

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

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

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

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

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

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

11 March 2016

Network message sent to members today

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

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

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

Information and resources:

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

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

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

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

19 February 2016

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

19 February 2016

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

Submission on the Healthy Tasmania Community Consultation Draft

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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