Experience and lessons from VicHealth

1. Experiences and lessons in
health promotion
Irene Verins
9th November Johannesburg

2. Presentation overview
• Brief introduction to Victorian Health Promotion
Foundation (VicHealth)
• Consider some of the learnings and challenges in
establishing a health promotion foundation
• Provide case studies

3. • Population of Australia:
Context 23 million
• Population of Victoria:
5.5 million
• Victorian health budget:
AUD 13 billion
• VicHealth budget: AUD
36 million
Healthway
HPF
VicHealth
VICTORIA
HPF

5. Origins of VicHealth
• Established 1987 (Tobacco Act
1987)
• Funded by 5% tobacco levy
• Independent statutory authority
• Tri-partisan political support
• Buy-out of tobacco advertising
and support to hp research

7. VicHealth
• Loss of hypothecated tax in 1997 =
appropriation directly from treasury
• Move out of sponsorship funding in 1999/2000
• Greater emphasis on changing the social
determinants that impact on health
• Improved alignment of research investment
with priority areas

8. What we do now- setting up the business
Funding of $36.4 million per annum for:
• Social and economic participation for
mental health and wellbeing
• Active communities and healthy eating
• Tobacco and alcohol control
• Program design and evaluation, capacity
building and research are core functions

9. VicHealth’s Mission 2009-2013
To build the capabilities of organisations, communities
and individuals in ways that:
• change social, economic and physical environments
so they improve health for all Victorians
• strengthen the understanding and the skills of
individuals in ways that support their efforts to
achieve and maintain health

10. “This ends the debate decisively.
Health care is an important
determinant of health.
Lifestyles are important
determinants of health.
But it is factors in the social
environment that determine
access to health services and
influence lifestyle choices in
the first place.”
[Source] www.who.int/social_determinants

11. VicHealth’s strategic priorities
2009-2013
Priorities for focus
Reduce Improve Reducing Increasing Increasing social and Reducing
smoking nutrition harm from physical economic harm from
alcohol activity participation UV
Key result areas
KRA 1 Health KRA 2 Participation KRA 3 Nutrition, tobacco, alcohol
inequalities and UV
2.1 Increase participation in physical
1.1 Improve the physical
and mental health of activity. 3.1 Create environments that
those experiencing 2.2 Increase opportunities for social improve health.
social, economic or
geographic
connection. 3.2 Increase optimal nutrition.
disadvantage. 2.3 Reduce race-based 3.3 Reduce tobacco use.
1.2 Contribute to closing discrimination and promote 3.4 Reduce harm from alcohol.
the health gap between diversity.
Indigenous and 3.5 Reduce harmful UV exposure.
non-Indigenous 2.4 Prevent violence against women
Victorians. by increasing participation in
respectful relationships.
2.5 Build access to economic resources.

12. VicHealth’s strategic priorities
2009-2013
Health promotion actions
• Create and use knowledge acquired through • Develop communities which are inclusive,
research and evaluation. accessible, equitable and safe.
• Create environments that foster good health. • Support organisations to plan, implement and
• Encourage the development of systems that evaluate health promotion activity.
support and sustain health. • Facilitate participation and skill development.
• Communicate about priority health issues. • Contribute to and advocate for healthy public
policy and regulation.
Settings for action
Workplace, education, Community, local Culture, sports, arts,
justice government, corporate media, technology

13. Experiences & Lessons

14. 1. Tax hypothecation
• A dedicated tax on a harmful product is used to
promote health
• It required an ACT of Parliament = important
• Is more difficult for governments to make changes
to a dedicated tax
• Secures a long term investment

15. 2. Independence... Be the value
add to government
• A balanced government relationship
• Work with government but not as government
• Do not duplicate
• Find and articulate the boundaries: more able to
carry risk, more innovative, more responsive

16. 3. Adaptable, nimble: a lean
machine…
Foundation must be able to weather change and plan
long term strategies by:
• Being less bureaucratic, smaller & cheaper than government
• Align activity & resources across government silos in areas
that could deliver health benefits: education, workplaces,
sport
• “Yeast in the system”

17. 4. Innovative
• Identify emerging trends in public health
• Test new ideas and strategies: Research &
evaluation, knowledge dissemination
• Carry the risk

18. 5. VicHealth’s evolution: from
breadth to depth
1987: @ 20 people
• $25 million
• Disbursed through large funding rounds (breadth)
• Community Health Program had 3 people disbursing
through 16 week funding round cycles
• Advocacy through partners and key stakeholders
• CEO partnered with health people predominantly

19. 5. VicHealth’s evolution: from
breadth to depth continue…
2011:@ 50 people
• $36 million
• Disbursed through both development, design and evaluation
of interventions (depth) and large funding rounds in physical
activity, the arts and research (innovation)
• A knowledge builder and disseminator
• CEO partners with those inside and outside of health, NGO
and corporate sectors
• Advocacy through stakeholder/policy coalitions,
social media

20. Reducing discrimination &
supporting diversity for health

21. Reducing race-based discrimination
What we know
• In Australia, 47% of people from non-English speaking
backgrounds and 75% of Indigenous people report having
experienced discrimination.
• The majority of Victorians value cultural diversity; however 10%
believe that some races are inferior to others and that people
from different racial backgrounds should not marry one another.
• Discrimination contributes to health inequality and disadvantage
experienced by Indigenous Victorians and some migrant and
refugee communities.

22. Current action to reduce race-based
discrimination
• Research, building the evidence in
what works
• Design approaches to decrease
discrimination through settings
(local government, education,
workplaces, sport, arts)
• Building partnerships
• Communications and social marketing
strategies
• Workforce development
• Advocacy to state and national
governments

23. Federal Government
Department of State Government
Philanthropy/ NGO
Immigration Health
Multicultural Affairs
Advisory Committee of
key stakeholders &
VicHealth Board VicHealth Program content experts
staff : 2EFT
Policy Coalition for
Advocacy
University led Intervention site LEAD: Local Interventions site LEAD:
research & evaluation government program rural Local government
partnerships program urban
Arts About Us Discrimination Program
Workplace Health program
Everyone Wins Sports Program
Social Marketing Campaign See Beyond Race

24. Measuring success
In recent years we have an improved track record overall:
• 90% of Victorians support society being made up of people from
diverse cultures
• Progressive elimination of obvious institutional discrimination
International variation indicates that diversity can and has been
effectively managed in Australia
• 1 in 3 people in Europe hold blatantly racist views. However less
than 1 in 10 Victorians do
Our work is measured against state and national data sources such as
the Victorian Population Health Survey, VicHealth’s own Community
Indicators and VicHealth’s Community Attitudes surveys.

29. 6. Is there support for promotion and
prevention?
• The economic evidence for health promotion is
under-developed
• Reviews estimate that about 10 per cent of economic
studies assess prevention
• Relatively few health promotion interventions have
been assessed
• Population approaches are the most difficult to assess

30. Costs of chronic disease
e
• Alcohol = estimated $13 billion cost to society each year.
1/3 Victorians still drink at high risk levels at least once a year.
• Obesity = Australia one of ‘fattest’ nations - will overtake
smoking as biggest preventable health threat in next 15 years.
• Violence against women = costs Australian society
$13.6 billion a year. Leading contributor to death and
disability in Vic women 15-44.
• Smoking = despite many wins, still represents 10% of the
health burden for Victorian males and 6% for females.
• Mental illness and stress = annual cost due to 6 million
days of lost productivity due to depression is $14.9 billion

31. Economics of prevention
The health and economic benefits of reducing disease risk factors (2009)
If annual per capita alcohol consumption
were reduced by one-third (already
achieved in Norway) = 98,000 fewer new
cases annually of alcohol-caused disease
and 21,000 fewer years lost to illness and
death.
Cutting physical inactivity by 5 per cent
= 1,000 lives nationally, and result in
3,000 fewer cases of illness every year
= $129 million in savings, including $48
million in the health sector and $81
million in production and leisure.
Download the full report from www.vichealth.vic.gov.au

32. Economics of prevention continued…
The health and economic benefits of reducing disease risk factors (2009)
If tobacco smoking in Australia were
reduced to 15 per cent (achieved in
California), there could be 5000 lives
saved a year and 158,000 fewer
new cases annually of tobacco-
caused illness.
(note: the Victorian Government has set a
target to reduce smoking in adults from
17.3% to 13.8% by 2013)
Download the full report from www.vichealth.vic.gov.au

33. 7. Leadership
1. Political:
• Tri-partisanship, reps from each Party on Board to achieve
broad parliamentary consensus for public health
2. Strategic and Representational:
• Sectoral support from sport, arts, health, education, medical
research sectors and the media
• Champions
3. Organisational:
• Chairperson-high profile, CEO-high profile

34. The VicHealth Board
• Sport x 2
• Health and medical research x 3
• Arts x 1
• Local government x 1
• Media and communications x 2
• Legal x 1
• Politicians x 3

35. 8. Support from sponsored sectors:
Sports & Arts
• Embraced tobacco buyout early
• Provided great support in expanding the
resource base for influencing health
behaviours and attitudes
• Provided the community networks
throughout which advocacy can be channeled

36. 9. Ability to harness diverse players,
build coalitions
The drivers of health lie outside of the health sector then we
must partner with agencies outside of the health sector

37. VicHealth’s Achievements
• Replacement of tobacco sponsorships
• Centres for Research and Practice
• Development of public health research infrastructure
• Contributed to lower tobacco and alcohol consumption, greater
sun protection
• Training thousands of non health sector workers in hp
• Contribution to public health policy and partnerships across
sectors
• Mental health promotion strategy and evidence
• Influence on state and federal government policy

38. In closing a few thoughts about establishment of a hpf
1. Tax levy is separate money from health budget: a hpf is not a
burden
2. Be the value add and the enabler to government : hpf can
extend the work of government
3. Build the business case for hpf in South Africa (befriend the
health economists)
4. Be the Innovation incubator and carry the risk which
government can’t
5. Strong & strategic leadership: champions
6. Cross sectoral partnerships: invest in them now as your
advocacy coalition
7.Health promotion/prevention takes a long time