VH Fiscal Concerns - Irene Verins
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Addressing the social and economic determinants of mental and physical health
Fiscal considerations
Irene Verins
www.vichealth.vic.gov.au
Addressing the social and economic determinants of mental and physical health
1. Scoping policy, research & stakeholders for
emerging health issues of concern.
2. Establish the case research , evidence &
attitudes to inform future directions
3. Develop conceptual, evidence based
framework to guide activity
7. Identify skills gaps & strengthen capacity through
workforce development
5. Intervention design & implementation of cross
sector activity
4. Partnerships with practice, research &
strategic partnerships
9. Sustainability of change (for uptake & integration)
8. Communication of learnings through
publications, resources & tools
6. Evaluation of cross sector activity
Elements of accountability
• $36 million – $27,255,000 was disbursed to 798 grants in 2010-2011
• Sport 36%
• Arts 5%
• Research 16%
• Community 27%
• Media 1%
• Education 1%
• Workplace 7%
• Local government 7%
Brokerage of external funds: 10-15% overheads versus 30% of universities.
Population groups
–55% whole of population approaches
–10% low socioeconomic status
–10% to Aboriginal projects
–8% to Children
–7% new arrival groups
–5% people with a disability
–5% geographic disadvantage
What we won’t fund
–Individuals
–unincorporated bodies
–Capital works and major equipment
–Recurrent funding
–In receipt of tobaco or alcohol funding or sponsorship
–Recalcitrant projects
Governance
Board
• board structure was found which resembled those of University boards which enshrine representatives from all shades.
• Board is level one
• Advisory committees for each health area are level 2 dealing with grants
Transparency
• All grants are publically advertised (conflict of interest governs board and staff)
• All applications for grants are assessed by:
– Internal review & assessment
– External stakeholder assessments
• Board members must register all conflicts of interest at each bi monthly meeting
Other aspects of accountability
• Being evidence based and rigorous in a poorly evaluated discipline in which evidence is still evolving
• Exposing ourselves to open debate, cynicism
and skeptics.
• Acting independently from government and other stakeholders but with the interests of stakeholders at the fore…being representative and reflective of our stakeholders.
Building the argument for a hpf
• Context specific
• People from science, politics and then the allies…(some from sport who said that they would change their sponsorship practices)
• Bi partisan approach very important
• Moving across well established networks became an important and enduring aspect of VH..
• A campaign of well briefed media (supported and expanded the audience for the issues)
• Community attitudes surveys and polls (identified % people favored a tax)
Participation for health: a framework for action 2009-2013
Key social and economic determinants of mental and physical health
Physical activity Social connection Freedom from violence
Freedom from discrimination
Access to economic resources
Active communities
Involvement in community sport and active recreation
Supportive relationships
Involvement in community and group activities
Civic engagement
Social, emotional, physical and economic security
Equitable and respectful relationships
Valuing diversity
Physical security and respect
Equality of opportunity
Work
Education
Housing
Money
Population groups and action areas
Population groups Action areas
Children
Young people
Women and men
Older people
Indigenous communities
Culturally diverse communities
Rural communities
Research, monitoring and evaluation
Organisational development (including workforce development)
Strengthening communities and community environments
Communications and social marketing
Advocacy
Legislative and policy reform
Direct participation programs
Settings for action
Housing Community Education Workplace Sport and recreation Health Academic
Transport Corporate Public Arts Local government Justice Technology
Participation for health: a framework for action 2009-2013
Intermediate outcomes
Individual Organisational Community Societal
Projects and programs that facilitate:
• involvement in community and group activities
• self efficacy
• self determination and control
• political and civic efficacy
• taking responsibility for others
• respectful, supportive and equal relationships
• acceptance of diversity
• access to education and employment
• mental health literacy
Organisations that:
• are inclusive, responsive, safe and supportive
• work in partnerships across sectors
• implement evidence-informed approaches to their work
• sustain change
Environments that:
• are inclusive, responsive, safe and supportive
• value civic engagement
• are cohesive
• promote community responsibility
• reflect awareness of mental health and wellbeing issues
• sustain change
A society with:
• integrated, sustained and supportive policies and programs
• strong legislative platforms for mental health and wellbeing
• appropriate resource allocation
• responsive and inclusive governance structures
Long-term benefits
Individual Organisational Community Societal
• Increased sense of belonging
• Improved physical health
• Less stress, anxiety and depression
• Less substance misuse
• Enhanced skill levels
• Resources and activities integrated across organisations, sectors and settings
• Community valuing of diversity and actively disowning discrimination
• Less violence and crime
• Improved productivity
• Reduced social and health inequalities
• Improved quality of life and life expectancy
www.vichealth.vic.gov.au
What influences/determines health?
Society
Policy (e.g. social, education,
employment, infrastructure, health,
environmental sustainability)
Social and cultural beliefs
Social structures and institutions
Social cohesion
Distribution of power
and resources
Economic wealth
Community
Family/Household
Family structure
and relationships
Health related
behaviours and
exposures
Employment,
income and wealth
Housing and living
conditions
Behaviour
Age Sex
Genes
Individual
Neighbourhood facilities and
infrastructure
Local services and amenities
Living and working conditions
Social networks and support
Group and peer norms
Participation opportunities
Community cohesion and stress
Why invest in a HPF?
• Effective health promotion has the capacity to
• improve health,
• reduce the costs of treating chronic disease,
• enhance economic productivity,
• bridge the health divide between population groups, and
• add healthy years to life expectancy.