To: Healthy Auckland Together

From: Aimee Hadrup – Ministry of Health; Michael Hale - Auckland Regional Public Health Service

Date: 12March 2015

Topic: Healthy Families NZ

Purpose

  1. This paper provides an overview of Healthy Families NZ, to assist Healthy Auckland Together inidentifyingopportunities to support and collaborate with Healthy Families NZ in the Waitakere, Manukau, and Manurewa-Papakura Wards.

Executive summary.

  1. Encouraging New Zealand families to live healthy, active lives – by making good food choices, being physically active, sustaining a healthy weight, being smoke free and drinking alcohol only in moderation – is part of the Government’s approach to promoting good health and reducing the incidence and impact of chronic disease.
  1. Healthy Families NZ aims to improve the health of children and families where they live, learn, work and play, and involves an intensive health promotion effort in 10 locations across New Zealand. Once fully implemented, Healthy Families NZ will have a potential reach of approximately 900,000 people.
  2. Healthy Families NZ is informed by and modelled on the Healthy Victoria Together (HTV) initiative, which is achieving large-scale reach across the Victorian population, initiating action on the systems that influence the health and wellbeing of individuals, families and communities.
  1. Like HTV, Healthy Families NZ is taking an innovative systems buildingapproach to prevention. This includes:
  • National level support and strategies to encourage a whole of system approach
  • Professional networking
  • Targeted community-level investment into the building blocks of a prevention system, which is stewarded by local leaders through Healthy Families Communities
  1. There are three Healthy Families Communities in the Auckland region; Waitakere Ward, Manukau Ward, and Manurewa-Papakura Ward.
  2. Locally-based Lead Providers for each of the 10Healthy FamiliesCommunities were selected through a rigorous two-stage competitive tender process, which was run from March – September 2014.
  3. Sport Waitakere is the Lead Provider for Healthy Families Waitakere. The Tāmaki Healthy Families Alliance (Auckland Council in partnership with Alliance Health Plus and Ngā Mana Whenua o Tāmaki Makaurau) is the Lead Provider for the Manukau and Manurewa-Papakura Wards.
  4. Healthy Families NZ and Healthy Auckland Together share some goals: increasing physical activity, improving nutrition and reducing obesity. The implementation of Healthy Families NZ in these locations is in the early establishment phase, so the discussion on how Healthy Auckland Together and Healthy Families NZ may collaborate and support each other’s work is very timely.

Background

  1. In Budget 2014, the Government allocated $40 million over four years to support the implementation of Healthy Families NZ, a new approach to the prevention of chronic disease.
  1. The overarching goals of Healthy Families NZ are toimprove nutrition, increase physical activity, and reduce obesity, tobacco consumption and harmful alcohol use.
  1. Healthy Families NZ is focused on providing a concentrated, well-resourced health promotion effort in selected locations to build a ‘prevention system’ at the local level.It is being implemented in the following locations across New Zealand:
  • Far North District
  • Waitakere Ward
  • Manukau Ward
  • Manurewa-Papakura Ward
  • Rotorua District
  • East Cape[1]
  • Whanganui District
  • Lower Hutt City
  • Spreydon-Heathcote Ward
  • Invercargill City
  1. The 10 locations selected for Healthy Families NZ investment come from a short-list of areas with higher-than-average rates of preventable chronic diseases (such as diabetes), higher-than-average rates of risk factors for these diseases (such as smoking), and/or high levels of deprivation. The 10 locations selected represent a geographic spread of locations, and are a mixture of urban and rural areas.
  1. Based on figures from the 2012 Census, Healthy Families Communities will have a potential reach of approximately 900,000 New Zealanders across these locations. Over half of the population included in the Healthy Families NZ sites are within the three Healthy Families Communities in the Auckland region; 166,220 in the Manukau Ward, 136,360 in Manurewa-Papakura, and 171,090 Waitakere Ward (473,670 in total). It is expected that Healthy Families NZ will reach significantly larger numbers due to region-wide action that may occur and the ‘spillover’[2] effect of interventions.

Healthy Families NZ

  1. The design for Healthy Families NZ draws on a growing body of evidence which suggests that concentrated, community-led health promotion, tailored to specific community needs and with action where people live, learn, work and play, can be successful in reducing risk factors for chronic disease.
  1. In particular, the Healthy Families NZ approach is strongly informed by HTV in its aim to drive the necessary changes to support good health and wellbeing by moving away from disconnected, small-scale, and short-term approaches, to a model that addresses the systemic drivers of chronic disease in a concerted and coordinated manner.
  1. It is important to note that while the programme design for Healthy Families NZ draws on that of Healthy Together Victoria, Healthy Families NZ is being adapted to reflect the unique context of New Zealand communities, and the special relationship with Māori and obligations under Te Tiriti o Waitangi.
  1. In each location, a locally-based lead provider is responsible for bringing together a partnership of key stakeholders in the community. Partnership members will be those organisations or individuals best placed to influence sustainable healthy change within the community.
  1. Through investment in local partnerships and a skilled health promotion workforce, Healthy Families Communities are tasked with developing local solutions to local needs, supporting healthy living. There is a strong focus on enabling leadership across organisations, sectors, and communities to make sustainable healthy changes.

Figure 1 provides an overview of the Healthy Families Community model:

  1. Locally-based Lead Providers for the 10 locations were selected through a two-stage competitive tender process. The Lead Providers for Healthy Families NZ are:
  • Far North District: Te Runanga o Te Rarawa
  • Waitakere Ward: Sport Waitakere
  • Manukau Ward: Tāmaki Healthy Families Alliance (Auckland Council in partnership with Alliance Health Plus and Ngā Mana Whenua o Tāmaki Makaurau)
  • Manurewa-Papakura Ward: Tāmaki Healthy Families Alliance (Auckland Council in partnership with Alliance Health Plus and Ngā Mana Whenua o Tāmaki Makaurau)
  • Rotorua District: Te Arawa Whānau Ora (in joint partnership with Kowhai Health Associates)
  • East Cape: Te Aitanga a Hauiti Hauora – Horouta Whanaunga
  • Whanganui District: Te Oranganui
  • Lower Hutt City: Hutt City Council
  • Spreydon-Heathcote Ward: Pacific Trust Canterbury
  • Invercargill City: Sport Southland
  1. Contracts with Healthy Families NZ Lead Providers began from September 2014, for an initial term of 4 financial years (to June 2018).
  1. Healthy Families NZ Lead Providers are currently in the process of establishing their health promotion workforce, local governance arrangements, and prevention partnership groups. Further information on the size of the Healthy Families NZ workforce to be established in the Auckland sites is provided on page 7.

Healthy Together Victoria - applying a systems approach to prevention

  1. Much of Healthy Families NZ’s approach is drawn from the HTV model that applies a complex systems approach to prevention. Understanding the complex task of tackling chronic diseases and their risk factors, such as obesity, requires us to explore the range of factors that are beyond an individual’s control. Understanding these connections and influences suggests what types of interventions can be tried.
  1. Taking a systems approach means a departure from a narrow health promotion projects approach, whichmayreach a few people, for a short time. It means considering how the systems that influence health work and where best to intervene for optimal health and wellbeing outcomes. Drawing from different types of theories of complexity, socioecology and systems, HTV explores and adopts sustainable and cost effective strategies to prevent obesity related chronic disease across the whole population[3].

The critical ‘building blocks’ of a prevention system effort

  1. To enable sustained action across the Victorian prevention system, the Department of Health and Human Services has focused their investment on the building blocks of a strong prevention system. HTV is:
  • resourcing and supporting a dedicated, reflective and skilled workforce at a local level to engage,activate and influence at multiple levels of the system
  • building relationships with prevention partners across the system, and across sectors and industries, to strengthen positive health outcomes on multiple fronts
  • capturing and feeding back knowledge and data on progress, impact and effectiveness and calling for new types of research, policy and practice collaborations
  • allocating resources based on best possible investment to effect change and population need, seeding long term change by resourcing local organisations to lead action towards public health
  • building leadership for sustained prevention across the system to drive effective and long lasting change.

Informed by the experience of HTV, Healthy Families NZ is also orienting its investment around the prevention system building blocks in this way. These building blocks also form the basis for the Implementation Roadmap to be developed in each location.

The important principles of system-wide change for good health

  1. HTV and Healthy Families NZ are underpinned by a number of key principles that support system-wide change for good health:

Implementation at scale

Prevention is delivered at a scale that impacts the health and wellbeing of large number of the population in the places where they spend their time – in schools, workplaces and communities.

Collaboration for collective impact

Long-term commitment is required by multiple partners, from different sectors, and at multiple levels, to generate greater collective impact on the health of the population. Knowledge is co-created and interventions co-produced supported by a shared measurement system, mutually reinforcing activities, ongoing communication and a ‘backbone’ support organisation.

Transformation

Leading transformative change is a way for working as a system. It recognises that when it comes to prevention we are often ‘stuck’. Transformation requires us to operate differently, engage all of the stakeholders in the system in the change, and seek their perspectives in the system.

Experimentation

Experiments provide insight into the most effective interventions to address chronic disease. These experiments are underpinned by evidence and experience, monitored and designed to be amplified across the system if they prove effective.

Adaptation

Strengthening the prevention system requires a culture of constant reflection, learning and adaption to ensure strategies are timely, relevant and sustainable.

Equity

Health equity is the attainment of the highest level of health for all people. Healthy Families NZ has an explicit focus on improving Māori health and reducing inequalities for groups at increased risk of chronic diseases. Māori participation and leadership at all levels of the planning and implementation of Healthy Families NZ is critical.

Leadership

System-level change requires a new model of leadership that builds on, but is distinct from, traditional ideas of leadership. Leadership for systems change is about disrupting the system to create change. It is about acting collectively, and it acknowledges that leadership can emerge from anywhere across the system. Leadership for systems changes is also an ongoing process which learns from success and failure.

Line-of-sight

The line of sight provides a transparent view on how investment in policy is translated into measured impacts in communities, ensuring best value from every dollar spent on prevention.

Joint Commitment to Prevention between the Ministry of Health and the Department of Health and Human Services, Victoria

  1. A Joint Commitment to Prevention document has been developed to recognise and formalise the collaboration between the Department of Health and Human Services, Victoria and the Ministry of Health.
  1. To maximise the health of our communities, both parties to the agreement acknowledge the similarities in population health needs, workforce challenges, the benefits of economies of scale and the desire to achieve sustainable prevention.
  1. This agreement aims to enhance and strengthen the exchange and sharing of ideas between jurisdictions through:
  • undertaking joint leadership and professional development opportunities through networks, exchanges, conferences and more to support ongoing learning and development
  • connecting research and evaluation approaches and findings to support the ongoing development of an evidence base to support whole of systems initiatives
  • sharing resources, publications, advice and support across jurisdictions to enhance communication, collaboration and engagement in our communities
  • supporting the creation of healthier early childhood education services, schools and workplaces across multiple sites in Victoria and New Zealand.
  1. On 4 March 2015, the Ministry hosted officials from the Department of Health and Human Services, Victoria for the official signing of Joint Commitment to Prevention. The signatories to the agreement are Chai Chuah, Acting Director-General of Health, New Zealand and Dr Pradeep Philip, Secretary of the Department of Health and Human Services, Victoria.

Key aspects of Healthy Families Communities

Workforce
  1. The core Healthy Families NZ investment is in building a dedicated health promotion workforce in the 10 Healthy Families Communities. Eighty percent of the funding for Healthy Families NZ in the workforce, with the remaining 20 percent allocated to an Action Budget to support sustainable healthy change.
  1. The Lead Provider in each location is responsible for establishing this dedicated workforce. The Healthy Families NZ workforce in each location comprises of the following roles:
  • A Manager/Team Leader, responsible for leadership and coordination of implementation, and management of the Healthy Families NZ team
  • A Settings Coordinator, focussed on supporting systems change across early childhoodcentres, schools, workplaces, sports clubs, marae, churches and other community settings across the community
  • A Partnerships and Engagement Coordinator, focussed on local level communication,media, social marketing and community engagement
  • A Health Promoter, responsible for assisting early childhood services, schoolsand workplaces in the implementation of health promotion frameworks. Larger communities have additional Health Promoters - approximately one per 30,000 population with slight adjustment for factors such as thepopulation size, demographic profile, health status and geographic size of each Healthy Families Community.
  • All roles will contribute to the strengthening of local health promotion networks, support partnerships to undertake health promotion interventions, engage and empower community to inform and participate in creating a healthy community, and provide leadership support on preventive health issues.

The workforce to be established in the three Healthy Families Communities within the Auckland region will be as follows:

Healthy Families Community / Number of Full-Time Equivalent staff (FTE)
Waitakere Ward / 10.5 FTE
Manukau Ward / 15.5 FTE
Manukau-Papakura Ward / 12 FTE
Total: / 38 FTE

Governance

  1. Shared governance at a local level is an important aspect of each Healthy Families Community. Although the Local Lead Provider holds the Healthy Families NZ contract with government, governance is shared with a local partnership, with participation from the Ministry of Health. Lead Providers are responsible for establishing appropriate governance arrangements, involving those who are best placed to influence change at a local level.

Establishment of local ‘Prevention Partnerships’

  1. Healthy Families NZ Lead Providers are responsible for bringing together a ‘Prevention Partnership’ of key stakeholders in the community to:
  • Develop a ‘prevention system’ at a local level that will help coordinate activities withineach community
  • Support community engagement, leadership and participation in determining localsolutions
  • Work together to achieve collective impact by workingstrategically with existing health promotion services and workforces
  • Support evidence-based health promotion action in early childhood services, schools, workplaces and othercommunity settings
  • Tailor health messages to the circumstances and needs of local communities
  • Contribute to building the evidence base for locally-driven health promotion.

A focus on the settings where people live, learn, work and play

  1. Healthy Families NZ will focus on investing in efforts to embed positive health behaviours in early childhood settings, schools, workplaces, sports clubs and other community settings.
  1. One of the key programme elements to support evidence-based action in these settings is the establishment of an overarching settings-based health promotion quality improvement framework for the Healthy Families NZ workforce to use in their engagement with settings.
  1. In order to support common data collection and collaborative working with existing health promotion services and workforces, the framework will need to act as an umbrella to bring together existing settings-based health promotion programmes[4] already underway in New Zealand under one banner.
  1. It will also be a key source of data on the reach and impact of settings-based health promotion initiatives in each Healthy Families Community, and nationally.
  1. The need for an overarching quality improvement framework for health promotion action in settings is informed by the experience of HTV. A key aspect of HTV, is the ‘Achievement Program’. The Achievement Program supports early childhood education services, schools and workplaces (and workforces) to create healthy environments for learning, working and living. Participants receive guidelines, resources and ongoing support to help meet benchmarks for evidence-based health promotion. For further information on the Achievement Program, see:
  1. The Healthy Families NZ framework will:
  • act as an umbrella to link existing settings-based health promotion programmes in New Zealand
  • be informed by and integrate aspects of the HTV ‘Achievement Program’, where appropriate
  • integrate key New Zealand-based tools, information and resources;
  • be a key source of data on the reach and impact of settings-based health promotion initiatives both nationally and in each of the 10 Healthy Families Communities.
  1. The Health Promotion Agency is leading the development of the framework. The approach will involve:
  2. reviewing existing health promotion programmes for workplaces and education settings in New Zealand
  3. reviewing and adapting the HTV Achievement Program for the NZ context, where appropriate
  4. establishing a reference group and engaging key stakeholders (such as organisations who deliver settings-based health promotion programmes) in the framework’s development and design
  5. facilitating training opportunities for Healthy Families NZ staff in using the framework
  1. The development of the framework is currently in its early stages. An anticipated launch date of 1 August 2015 has been conveyed to the Minister’s office for the Minister of Health to officially launch the Healthy Families NZ settings-based health promotion framework. The name of the framework will be considered as part of the development process.

Healthy Families NZ at a national level