Aim: To strengthen and invigorate HIV and related health promotion practice statewide Objectives: 1.To examine some contemporary health promotion theories, principles and perspectives 2.To critically reflect on health promotion activity in the sector 3.To foster opportunities for professional networking and collaboration.
Policy Update Darryl O’Donnell Acting Associate Director AIDS/Infectious Diseases Branch, NSW Health
Darryl O’Donnell A/Associate Director, AIDS/Infectious Diseases Branch NSW Department of Health 26 July 2010 From Here to There: Plotting a course and getting results during uncertainty
Overview Thank you for the invitation. Commitment to this Forum National Health & Hospitals Network Reform: Change, worries, process Aspirations for the coming 12 months: A checklist for next time Evaluation of the Strategies: An imperative to inform and influence –… express needs and aspirations –… contribute analyses and directions –… act collectively and distinctively. But first, introducing… 9
National Health and Hospital Network Reform National Health and Hospitals Network Agreement (COAG Agreement) – authoritative source; non-negotiables –Financial sustainability, role delineation, local decision-making –Key elements –Public hospitals and Local Hospital Networks (LHNs) –Primary Health Care Organisations (PHCOs) –Financing, performance accountability, national governance and implementation –Transfer, further consideration, not for transfer It matters. Guidance: COAG Agreement; DG’s listening tour and blog; NSW Health Reform microsite; local and AIDB documents. 10
NHHN Reform – Population Health Not for transfer: “Specialist STI services and general sexual health services” COAG Meeting – 10 December 2010 –Decision to transfer or reform certain other programs Population Health-level processes –NHHR Primary Health Care Transition Group –Population Health Executive –AIDB-level and HARPM Population health infrastructure / suprastructure 11
NHHN Reform – Known Worries Responding to known worries –1. Job security –2. Loss of the ‘local’ –3. Corporate raiders Change will come. Extended transitional states. Some shared practical tasks: –Know the fundamentals –Think about the unique and essential elements of the program –Take opportunities to be informed, participate and influence. 12
Aspirations - Overview A partnership-building vision for the coming twelve months: –Underpinning relationships –Listening and understanding –Shared vision –Supporting action –A multi-strategic approach AIDB’s performance benchmarks 13
1 – Underpinning relationships A diversification and strengthening of relationships between the Department and our workforce: –More diverse, frequent and deeper relationships, across more AIDB officers, with a greater breadth of the health promotion workforce –Recognising, differentiating and respecting roles – valuing functional specialisation –Right conversations in the right place, with the right people at the right time –Relationships are routine, purposeful and appropriate. 14
2 – Listening and understanding A better understanding of the workforce, it’s issues and priorities: –Who and where the workforce is –Concerns, aspirations, insights, intelligence –Current and future strategic priorities of the workforce –Range and nature of projects being undertaken, including examples of good practice –Policy, operational, workforce and infrastructural barriers to better practice 15
3 – Shared vision A shared vision for health promotion directions and priorities: –Action to facilitate a shared vision for health promotion –Recognition and valuing of program foundations and principles –An orientation to purpose, priority populations, and population-level outcomes –Clear roles and responsibilities, and agreed accountabilities in all parts of the program –Agreed milestones and targets, appropriate measurement of our progress and consequent adjustment of our settings 16
4 – Supporting action Action to enable and strengthen the achievement of goals, including supporting infrastructure: –Understanding and meeting workforce development needs –Multi-level mechanisms for planning, coordination and support are operating effectively –A sufficiency and efficiency of resources is available –Resources are organised to achieve population-level goals –Diverse research needs are identified and actioned –A multi-level evaluation strategy is planned and actioned 17
5 – A multi-strategic approach A visible multi-strategic approach to achieve program outcomes –AIDB offers leadership, is a partner to and participates in the implementation of these strategies, with its workforce –Local, regional, state in balance –Health promoting – comprehensively and unapologetically Ottawa Charter –Systems-oriented – Reforming health and other services –Results-oriented; outputs- and outcomes-focused, including health literacy and ‘intermediate outcomes’ –Population health – population-focused, and concerned with improving health equity 18
Aspirations - Getting there Your ideas? Your agenda? Meeting locally Existing mechanisms –HARPM Network –SHEO/M Network –CAS Health Promotion Sub-Committee Additional mechanisms? Your guidance. Evaluation of the NSW Strategies…. 19
Evaluation of the NSW Strategies NSW HIV, STI and Hepatitis C Strategies 2006-2010 and supporting Implementation Plan for Aboriginal People Independent. Tender being finalised. Objectives: –Assess process, impact and outcomes –Recommendations to strengthen response Strategic goals, objectives and targets Principles, priority populations, workforce, resources, partnership Implementation and emerging issues. 20
Evaluation – Influencing future action Full consultation – formal and informal. More soon. Tomorrow – an interactive workshop: –Strengths, weaknesses, opportunities, threats –Success factors –Problem-solving –Informing the Evaluation –Influencing future directions Questions? 21
One genius of the system we live under is that the strategies it requires to survive it from day to day are exactly the opposite of what is required to change it.
gobbledegook Sexual health promotion should be interactive. The most effective sexual health promotion programs are those that are developed in partnership with target populations or a range of key informants, through a process of community development and personal empowerment. Such a process is grounded in the sexual health needs, wants and motivations of target populations and communities, as well as recognising cultural norms, unique characteristics, specific attributes, existing knowledge, skills, abilities and aspirations.
Health Promotion Health Behaviour and Health behaviour change focussed on the individual Change in communities and community action for health Use of communication strategies for change to promote health Changes in organisations and the creation of health supportive organisational practices
Prevention Science Identifies what prevents poor health Narrower Wider Risk Factors Protective factors Social Ecology Social Injustice Structural Inequality
Social determinants Non-discriminatory social & cultural attitudes Social inequalities Provision of universal sexuality education Access to safe accessible services
Talking Better Health - Commonwealth of Australia (1994) The groups of people who control the language, control the ways the rest of us view and see the world Education is always political, it is never neutral The people who define the problem control the range of solutions Sharing individual experiences is the starting point for identifying issues and concerns People’s actions are a valuable resource
Sexual rights Negative –Freedom from STI/HIV –Freedom from sexual violence Positive –the right to sexual pleasure and satisfaction
A new set of goals A model to reduce sexual risk behaviour and increase the quality of sexual experience (to help young people have the kinds of sexual experience they would like to have and to avoid those they don’t want to have)
Skill development Identify more clearly what they want to do and not do sexually with different people and in different situations Improve their skills to communicate to their partner what they want to do and not do sexually Improve their skills to please their partner
Community action scale Acting ON a community Acting ON BEHALF OF a community Acting WITH a community Acting AS a community Acting FOR THE GOOD OF a community Brown 1995
Techniques Story telling Critical thinking Appreciative inquiry Social action Community mobilisation Purpose = transformative from passive recipient to active participant
Outcomes of effective engagement Health literacy –access information –recognise cues to action –access care and support –navigate institutions –advocate on their own behalf Non-service linked action (and activism) Complaints processes Problem solving capacity
Tracing a syphilis outbreak through cyberspace (JAMA, Klausner et al 2000) But is the correlation between increasing internet use and STI rates causative?
Around half of gay men in Australian cities use the internet to look for sex partners (Murphy et al 2004) Serosorting easier online? Perhaps, but many still don’t know own status, others status, and even when they do unprotected sex happens. (Holt et al, 2008)
Opportunities Concept of ‘new gay communities’ online supporting the safe sex culture Opportunity to contact and support gay men and non gay identified MSM across NSW eg rural, remote, isolated, young gay men, newly and not ‘out’ men
Opportunities already started Banner ads online Internet-based education and information eg website Contact tracing
3.Youth Nadine Finlay Digital Content Producer Inspire Foundation What opportunities does the use of information technology and the new media give you in working with your priority population?
Technology, new media and young people Nadine Finlay, Inspire Foundation Our mission is to help millions of young people lead happier lives 65
Inspire reaches young people in need “It was 1.30am; I was desperate and had nowhere to turn. I somewhat sarcastically went to Google and typed in ‘help’. The Reach Out site was the first result.” Lucas 8/25/2014 Our mission is to help millions of young people lead happier lives 66
8/25/2014 Our mission is to help millions of young people lead happier lives 67 What does Inspire do? Inspire uses technology and new media tools to reach young people when they need support the most. We go where they are… We communicate how they communicate… We use the technology and networks they use… *
WHY and HOW we use NEW MEDIA 8/25/2014 Our mission is to help millions of young people lead happier lives 68 CONNECT with young people…COLLABORATE with young people…CREATE for and with young people… Interactive forms of communication: Internet Mobile phones Serious games Virtual Worlds Social Networks Text Messages Blogs Forums Pod and Vod Casts RSS Feeds
The FLAGSHIP program: ReachOut.com Information Support Resources Community 8/25/2014 Our mission is to help millions of young people lead happier lives 69 Provides information, support and resources to improve young people’s understanding of mental health issues, develop resilience and coping skills, and facilitate help-seeking behaviour
8/25/2014 Our mission is to help millions of young people lead happier lives 70 Reach Out on facebook
Reach Out on Twitter 8/25/2014 Our mission is to help millions of young people lead happier lives 71
Reach Out on YouTube 8/25/2014 Our mission is to help millions of young people lead happier lives 72
Reach Out Central: Serious Game 8/25/2014 Our mission is to help millions of young people lead happier lives 73
WHY is New MEDIA so fantastic? 8/25/2014 Our mission is to help millions of young people lead happier lives 74 Almost every young person has access to at least one medium, and accesses the Internet somewhere, sometime. We can find whatever knowledge we need about young people We can reach young people by simply ENGAGING in the right conversations through the right media We need to COMMUNICATE with young people. Social media is the fasting growing communication tool New media saves TIME and MONEY for us We want our programs and services to be easily found. Young people use the Internet to find their health information first.
Nadine Finlay Digital Content Producer Inspire Foundation email@example.com Please feel free to contact me for any additional information 8/25/2014 Our mission is to help millions of young people lead happier lives 75
4. Sex Workers Lance Schema General Manager Sex Workers Outreach Program, ACON What opportunities does the use of information technology and the new media give you in working with your priority population?
Current use: Email and resource distribution SWOP website – launching this year Online lodgment on Ugly Mug reports SMS notification trail of Ugly Mug reports Workers use of web to advertise and communicate
Endless opportunities: Provides detailed information and support to a wide range of sex industry workers in NSW and beyond Reaches those isolated by stigma and geography or who prefer anonymity Enables workers to be connected/ part of a sex worker community/industry Educates and supports sex industry venue management, especially around issues such as OH&S
More endless opportunities: Educates the wider Australian community to help reduce stigma and discrimination Educates the media to encourage more balanced reporting of sex work issues Can assist is matters relating to workers safety and wellbeing
5. People from Culturally and Linguistically Diverse Backgrounds Barbara Luisi Deputy Manager Multicultural HIV & Hepatitis C Service What opportunities does the use of information technology and the new media give you in working with your priority population?
MHAHS website First developed in 2001 to carry HIV information in 7 languages Currently HIV and hepatitis C information in more than 20 languages Receives >7000 unique visitors every month Visitors stay >20 minutes each visit Key Feature – website navigation in English and LOTE
Opportunities Potential broad reach Cost effective and rapid updating of information Flexibility Tool for primary prevention Facilitates secondary prevention
Limitations Availability of language support Labour intensive Access and equity issues – physical – literacy – technological savvy
In conclusion Not a stand alone strategy, but one of many in the health promotion ‘tool-kit’ Needs to be planned, supported and evaluated/monitored Needs input from target group as well as technical experts
6. Aboriginal & Torres Strait Islander People Sallie Cairnduff Public Health Program Manager Aboriginal Medical Health & Research Council NSW What opportunities does the use of information technology and the new media give you in working with your priority population?
Acknowledgements Limited evidence, but general assumption is that Aboriginal people do not access new technologies AHMRC & others experience - not necessarily the case Aboriginal people have been adapting to changing environment for centuries
Trial of Apple I-Pad in NT for health education Use of Bebo, Facebook, you-tube very common PDSAs – AHMRC research experience Use of internet for further education – TAFE, college, university Use of ‘health kiosks’ in ACCHSs and other settings IBERA – developed by AMSANT
Some issues to address Access to internet, computers etc Choosing appropriate websites etc that reach target audience Ensure resources is appropriately focused tested for language, content and context
7. HIV Positive People Rob Lake CEO Positive Life NSW What opportunities does the use of information technology and the new media give you in working with your priority population?
Panel Discussion What opportunities does the use of information technology and the new media give you in working with your priority population?
What are the challenges for engaging your priority population in meaningful prevention strategies? How do you approach, adapt and work with these challenges in order to define solutions and find successes? Round 1: 12.05 (25 mins) Round 2: 12.35 (25 mins) Round 3: 1.50 (25 mins) Round 4: 2.20 (25 mins) Lunch: 1.05 (45 mins)
A Gay men / MSM Central Room B People who inject drugs Town Hall Room C Youth Town Hall Room D Sex Workers Wynyard Room E People from Culturally and Linguistically Diverse Backgrounds Wynyard Room F Aboriginal and Torres Strait Islander People St James Room G HIV Positive People St James Room
In reducing the personal and public health impacts of HIV and related diseases, biomedical interventions can achieve more than conventional health promotion activities. microbicides condoms & barriers rapid testing PrEP and PEP vaccines… T HE C ASE F OR : Basil Donovan Head, Sexual Health Program, NCHECR Phillip Keen HIV Educator, AFAO T HE C ASE A GAINST : Bridget Haire Snr Policy Analyst, Family Planning NSW Jeanne Ellard Research Fellow, NCHSR
Closing Remarks Julia Purchas Chair HARP Health Promotion Managers and Seniors Network
Thank You! Please return your completed F EEDBACK S HEET before you leave.
HIV & R ELATED P ROGRAMS H EALTH P ROMOTION F ORUM 2010 Mercure Hotel, Sydney Monday 27 July