Public health planning for the Sydney 2000 Olympic and Paralympic Games in metropolitan area health services

In addition to an increase in visitors to Sydney and movement to and from Olympic venues, many activities and attractions are planned throughout the Sydney metropolitan area for the period of the Sydney 2000 Olympic and Paralympic Games. Public health planning and strategy development has been conducted at the NSW Department of Health, area health service, public health unit, and local government levels to ensure that all possible steps have been taken to mitigate public health risk.

Can we skill and activate children through primary school physical education lessons? "Move it Groove it" - a collaborative health promotion intervention

Background: Physical education (PE) lessons are an ideal setting to improve child fundamental movement skills (FMSs) and increase physical activity (PA) for optimal health. Despite this, few studies have assessed the potential to do both simultaneously. The “Move It Groove It” primary school intervention in New South Wales, Australia, had this opportunity.

Methods: A whole school approach to implementation included establishment of school project teams, a teacher “buddy” system, project Web site, teacher training workshops, and small grants for equipment. The quasi-experimental evaluation involved 1,045 year 3 and 4 children (aged 7 to 10 years) in nine intervention and nine control rural primary schools (53% boys/47% girls). It utilised pre- and postobservational surveys of (1) mastery or near mastery levels for each of eight FMSs, (2) proportion of PE lesson time spent in moderate to vigorous PA (MVPA) and vigorous PA (VPA), and (3) teacher- and lesson-related contextual covariates. Data were analysed by hierarchical logistic multiple regression.

Results: For FMSs, overall mastery or near mastery level at baseline was 47% ranging from 22.7% for the overarm throw among girls to 75.4% for the static balance among boys. The intervention delivered substantial improvements in every FMS for both genders ranging from 7.2% to 25.7% (13 of 16 comparisons were significant). For PA level, mean MVPA at baseline was 34.7%. Baseline MVPA for boys was 38.7% and for girls was 33.2%. The intervention was associated with a nonsignificant 4.5% increase in MVPA and a significant 3.0% increase in VPA. This translates to a gain of <1 minute of MVPA per average 21-minute lesson.

Conclusions: This is the first study to show that by modifying existing PE lessons, significant improvements in FMS mastery can be gained without adversely affecting children’s MVPA and VPA. To increase PA levels, we recommend increasing the number of PE lessons per week.

Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.

Are metropolitan planning frameworks healthy? The case of Melbourne 2030

This paper presents preliminary findings of a project investigating the integration and application of ecological public health principles in Melboume 2030, the Victorian Government's urban planning blueprint for Melboume for the next 30 years. The study examines the political, organisational, social, and inter-personal factors that impact on the integration and application of broad health considerations into urban planning policy in Victoria. We are testing the premise that achieving integrated planning requires a systematic integration of government activity across sectors. Using discourse analysis and key informant interviews, we examined relevant government policy and legislation and its implementation against world's best practice. Preliminary findings show that the degree of leadership in relation to deploying the mission, and implementation processes sustain or impede integrated planning at a whole-of-government and intersectoral level.

These findings may inform a much-needed national agenda on promoting health through integrated planning. Findings will identify future research directions and action to bridge the gap between urban planning and health planning systems

Evaluation of the environments for health framework

Environments for Health, Five Years On…
Since its release in 2001, Victoria’s Environments for Health Municipal Public Heath Planning Framework, has represented a leading edge approach to supporting quality public health planning at the local government level.

In 2006 the Department of Human Services appointed an external evaluation team from Deakin and Melbourne Universities to assess the introduction of the Environments for Health framework to municipal public health planning and to make recommendations for its future direction.

The evaluation aimed to determine the extent to which Environments for Health and related implementation activities had:

* been incorporated by local governments in their policies and practices
* created greater opportunities for health gain, and
* been supported effectively by the Department of Human Services and other stakeholders

The evaluation project involved participation from a broad range of key stakeholders, including all local Councils within Victoria. Data collection covered four distinct stages - document analysis, key informant interviews, state-wide survey of practitioners, and council and stakeholder forums, all with opportunities for input to the evaluation.

Imperatives for policy health impact assessment : perspectives, positions, power relation

The thesis disturbs the seeming secure foundations of the dominant realist tales about the imperatives for the development of Health Impact Assessment, a relatively new policy device used within governments to consider the effects of policies on health. Foucauldian genealogical approaches are used to provide alternative, non-linear and non-definitive accounts.

NSW health and equity statement - In all fairness - increasing equity in health across NSW

In All Fairness is a point of reference for the NSW Health system to gauge current strategic directions, policies and programs in terms of reducing health inequalities.

First report on National Health Priority Areas 1996

Focuses on the health of Australians by documenting progress towards goals and targets for the five priority areas of cardiovascular health, cancer control, injury prevention and control, mental health, and diabetes mellitus.

'Ecological embeddedness' and its public health implications: findings from an exploratory study

Western culture over the last two centuries has become significantly ecologically 'dis-embedded', with nature increasingly reduced to resources for human use. The consequence is global environmental degradation, including accelerating climate change. Much recent research supports associations between nature contact and human health and well-being, and between feelings of nature-connectedness and pro-environmental attitudes and behaviours. The oft-cited Ottawa Charter for Health Promotion (WHO, Ottawa Charter for Health Promotion, 1986) emphasises human-environment inextricability; however public health discourse and response has not fully engaged with this recognition. This qualitative study explored the attitudes, motivations, and experiences-including formative influences-of six individuals whose behaviour was congruent with recognition of human-nature interconnectedness; such individuals may be understood as ecologically embedded. Key aspects of participants' experience, identified through grounded theory thematic analysis, were (i) connecting with nature (especially in childhood); (ii) seeing the threat and taking it personally; (iii) the nature of reality; (iv) dedicated beyond the ego-oriented self; and (v) sustaining the eco-centric self. The findings highlight the necessity for cross-sectoral advocacy at all levels of government policy development focused on recognition of human-environment connectedness, especially bridging health, planning and education policies affecting children. Only thus will both population health and ecological health on which population health depends be possible.

Chronic condition management and self-management in Aboriginal communities in South Australia : outcomes of a longitudinal study

OBJECTIVES: This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. METHODS: The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. RESULTS: Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. CONCLUSIONS: The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs.

Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: a review

Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required.

Not just a fisherman's wife : women's contribution to health and wellbeing in commercial fishing

OBJECTIVE: To explore the role of women in fishing industry organisations and communities in promoting best-practice health behaviours among fishers in Australia. DESIGN: This paper reports aspects of research that examined how the fishing industry can best support physical health and mental well-being of fishers. The study employed a mixed-methods, multisite case study approach. Data were gathered from face-to-face and phone interactions. SETTING: Two sites in Victoria and one in Western Australia. PARTICIPANTS: Thirty-one male fishers, including commercial licence owners, skippers, deckhands, three female family members, three fishing association representatives, one local government representative, two health care providers, and three regional health planning and funding bodies. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Often unrecognised, women associated with the fishing industry are integral to the promotion of good health for fishers. They are key to identifying health issues (particularly mental health issues) and proposing community-based health and well-being strategies. They often do so by incorporating health information and activities into 'soft entry points' - informal, non-health service mechanisms by which fishers can access health information and health services. CONCLUSIONS: While not working at the industry coalface, women have a stake, and are key players, in the commercial fishing industry. Their knowledge of, and credibility within, fishing enterprises makes them valuable sources of information about health issues facing the industry and effective strategies to address them. This expertise should be applied in conjunction with industry associations and health providers to achieve better health outcomes for fishers and their families.

The problem of failing to provide culturally and linguistically appropriate healthcare

Analysing health policy explores Australian health policy using a novel, problem-orientated approach. It shows the problem-solving techniques that are used when developing policy and demonstrates the skills of analysis and decision making.Introductory chapters explain the problem-orientated approach to health policy development and introduce the policy making process. Case studies then explore developments in health policy in both priority and topical areas. Chapters illustrate how policy-makers respond to perennial and emerging policy problems and demonstrate problem-solving approaches to the conception, development and implementation of health policy.

Problem and solution trees : a practical approach for identifying potential interventions to improve population nutrition

Population nutrition problems have a diversity of contributory factors and, ideally, multi-sectoral solutions should be developed by the relevant stakeholders, based on a common understanding of these factors. The problem and solution tree approach is a participatory process of working through the layers of determinants and then developing potential interventions for a specific issue, using the available data and expertise. We tailored this approach for non-communicable disease-related nutrition problems in Pacific Islands and applied it in several countries. The process led to the identification of a considerable range of determinants of unhealthy diets and potential interventions to improve the situation. This practical approach also offered the additional benefit of developing stakeholder awareness in the issues. Problem trees are a relatively simple tool to implement, easy to adapt to differing needs, can generate a wealth of information and can be more widely used.