Municipal Public Health Planning Framework - Part A

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3. Overview

Page content: 3.1 Local government and public health | 3.2 Municipal public health plans | 3.3 Related planning processes | 3.4 Linking MPHPs and municipal planning

3.1 Local government and public health

Local government in Victoria has had a long-standing association with public health. It began during the gold rushes of the 1850s, with the rapid increase in population and concerns about insanitary conditions. The focus was on preventing the spread of epidemic diseases, primarily through action on sanitation and housing standards. This continued into the 20th century, with public health practitioners focused on threats to health in the immediate environment by dealing with sewage, the provision of clean water, sale of adulterated foods, and housing conditions. There is still an important role for local government to play in controlling these threats.

The leading causes of ill health are no longer infectious diseases, but chronic diseases such as cardiovascular disease, cancer, mental disorders, neurological and sensory disorders, chronic respiratory conditions, and injuries. The approach to addressing these diseases has included focusing on prevention, utilising health education messages targeting individual behaviour change. This approach alone will not assist in addressing the health inequalities between the places that people live. It is recognised that social inequalities influence health and that social class and material circumstances both generate and maintain inequalities in health.

The Victorian Burden of Disease Study shows that although the overall health status of Victorians has improved over the past 20 years, it varies according to where people live. Local governments have a traditional geographical concern with people and place, which includes the local context of health, disease and social process. A focus on individuals and their access to health services, education, income and employment is vitally important, but not the whole answer. Recognition that place influences health may help to balance this individual focus, by redirecting attention to interventions at the environmental level, such as providing green spaces for healthy recreation, a pleasant and safe urban environment, improved public transport, and better housing stock.

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3.1.1 Determinants of health: Applying a social model

As discussed above, many of the factors influencing health lie in the complex social, economic and physical environments in which people live, and therefore require a more social view of health.

A social model of health is a conceptual framework for thinking about health. Within this framework, improvements in health and wellbeing are achieved by addressing the many social, cultural, environmental, biological, political and economic determinants of health.

Many determinants affecting people's health have been influenced or controlled through public health interventions. Research into causes of injury and illness has identified a range of social, environmental, and behavioural factors that affect health. These factors include poor diet, physical inactivity, smoking, consumption of alcohol, exposure to ultraviolet radiation, workplace safety, discrimination and road safety.

Most public health issues are notable for their complexity. For example, the National Public Health Partnership (NPHP) states that the propensity of an individual to smoke, and therefore the prevalence of smoking-related disease in the community, is determined by a range of contributory factors including, age, gender, social class, price, advertising, peer pressure, outlet density and smoking opportunities. These factors combine with even broader influences, such as demographically targeted advertising, the political influence of multinational cigarette companies on government legislation, and the historical reliance of governments on tobacco sales tax for general revenue.

Identifying individual determinants of a health problem is useful for public health planning, but is not sufficient explanation. To avoid simplistic models of causation that lead to simplistic solutions, the interaction of determinants and how they operate in context must also be considered. In Social Determinants of Health: The Solid Facts, WHO discusses ten different but interrelated aspects of the social determinants of health and identifies the research underpinning each area.

A social model of health implies that we must intervene to change those aspects of the environment that are promoting ill health. We cannot continue to simply deal with illness after it appears, or keep exhorting individuals to change their attitudes and lifestyles, when the environment in which they live and work gives them little or no choice or support.

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3.2 Municipal public health plans

The development of MPHPs is the most recent example of local governments applying a contemporary approach to public health. A broad systems approach means a focus on the public health issues and needs of the whole municipality, not just a series of Council plans. The 'new public health' paradigm has adopted the community development approach promoted by WHO in the Ottawa Charter and the subsequent Health for All policy development, Local Agenda 21, and Healthy Cities programs. The Ottawa Charter states that health promotion action means:

• Building healthy public policy
• Creating supportive environments
• Strengthening community actions
• Developing personal skills
• Reorienting health services.

Ten years of development of MPHPs across Victoria has provided the basis for a strategic and integrated approach to public health planning at a municipal level. In 1990 eleven councils participated in a pilot program to put into practice the new section of the Health Act relating to MPHPs. By 1994, 76 per cent of the then 210 councils had an MPHP and others were in the process of developing plans.

A Department of Human Services survey in 2000 found that over 52 per cent of the 78 new councils were implementing a plan, 18 per cent were developing a new plan, and 15 per cent were under review. Positive features reported included: providing a strategic planning focus, promoting useful partnerships and networks throughout the municipality, highlighting local health issues and providing a vehicle by which to address them, involving all divisions of council, promoting community involvement and ownership enabling councils to integrate a social model of health into public health planning and linking regional, state and national priorities. A wide range of positive processes was reported in the areas of strategic planning, partnership development, community involvement, management and working relationships to implement plans, and a whole-of-council commitment to public health.

Suggestions for improving MPHP implementation were also received:

• More effective planning through a whole-of-council approach, improved data, better evaluation, making plans more practical and a better grounding in theory.
• Improved access to resources to aid both development and implementation.
• Enhanced collaborative partnerships between Councils and other stakeholders across sectors.
• Meaningful community involvement at all stages of development.
• Internal council changes, such as raising the profile of the importance of MPHPs to Councils' corporate planning process.
• More coordination between sub-regional local government areas.
• Enhanced reporting and communication of outcomes.
• Better monitoring and evaluation systems.

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3.3 Related planning processes

3.3.1 National level | 3.3.2 State level | 3.3.3 Municipal level

The MPHP links with planning processes at a national, state and local level.

3.3.1 National level

3.3.1.1 National strategy for ecologically sustainable development

Australia's three tiers of Government adopted the National Strategy for Ecologically Sustainable Development (ESD) in December 1992. There are five key principles:

• Integrating economic and environmental goals in policies and activities.
• Ensuring that environmental assets are properly valued.
• Providing for equity within and between generations.
• Dealing cautiously with risk and irreversibility.
• Recognising the global dimension.

Objective 24.1 of the National ESD strategy concerns public health. The challenge is to establish an effective, cooperative and holistic approach, based on a sound knowledge of environmental and health problems, their causes and the best means by which they can be resolved. It should focus on health and human and natural environments, and on the interrelationships and interactions which sustain or threaten them.

Apart from the implementation of the agreed strategies, current National ESD priorities include the development of intergovernmental cooperation and coordinated policies for the sustainable management of Australia's extensive coastal zone, the establishment of a comprehensive system of State of the Environment reporting, and greater use of economic measures and instruments in environmental policy.

The National Strategy for ESD and Agenda 21 are closely linked. Each seeks to provide a framework for the development of environmentally sound and ecologically sustainable decision making at all levels. While Agenda 21 takes a global perspective, it is also very much focused on the actions that individual governments need to take in order to ensure that development is sustainable.

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3.3.1.2 National environmental health strategy

The National Environmental Health Strategy, launched in October 1999, seeks to enhance environmental health management nationally by providing a framework to bring the diverse range of environmental health stakeholders together across the range of issues that encompass environmental health. To commence implementation, the enHealth Council has developed the National Environmental Health Strategy Implementation Plan to address priority issues in the domains of environmental health justice, environmental health systems and the human-environment interface. The Implementation Plan recognises that within the domains of environmental health justice and environmental health systems, action is required at the national level and provides action plans that will be led by the enHealth Council. Due to the diversity of roles and responsibilities within the domain of the human-environment interface, environmental health jurisdictions are encouraged to develop individual action plans.

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3.3.2 State level

A number of initiatives are underway across the Department of Human Services and in other state government departments to focus planning on local areas and to engage local communities in the planning process (for example, local crime prevention programs operated by the Department of Justice). MPHPs developed by local governments in collaboration with local communities will be a major planning resource for the development of a wide range of program planning at a local level, and in achieving integrated planning. The MPHP framework promotes a consistent approach to community participation, making use of relevant data and involving a range of stakeholders in the planning process, including primary care agencies.

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3.3.2.1 Community health plans and primary care partnerships

MPHPs are a primary resource for Community Health Plans (CHPs). Planning processes for MPHPs and CHPs are clearly complementary and it is important to avoid duplication of consultation and data collection at a local level (see Common Planning Protocol). This is discussed in further detail in Municipal Scanning, Section 6.2.

The development of the MPHP framework has proceeded in close consultation with the development of guidelines for integrated service planning, a key component of CHPs. It is envisaged that over time, the identification of community needs through MPHPs will be directly utilised in CHPs.

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3.3.2.2 Relationship between MPHP and infrastructure planning

A number of urban planning schemes are driven by the Department of Infrastructure (DoI). They have the potential to impact on public health outcomes by virtue of their involvement of local government and their impact on the built environment, land use, housing and service provision. They range in focus from state to local level:

• The State Planning Policy Framework (SPPF) comprises general principles for land use and development in Victoria and specific policies dealing with settlement, environment, housing, economic development, infrastructure and particular uses and development.

• The Metropolitan Strategy, currently under development, will focus on physical infrastructure, land use planning and transport planning, but it will also be supportive of the Government's objectives in economic, environmental and social development. The main focus of the Metropolitan Strategy is the current metropolitan urban and non-urban areas and growth areas over the next 20 to 30 years. The issues to be addressed by the Strategy will mainly affect the 31 metropolitan local governments.

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3.3.3 Municipal level

3.3.3.1 Municipal strategic statements

The development of the Metropolitan Strategy has the potential to influence the direction of Municipal Strategic Statements (MSS). All local Councils are required to develop a MSS, which details key strategic planning, land use, transport and development objectives and strategies for the municipality, and is clearly linked to the Corporate Plan. It furthers the objectives of planning in Victoria to the extent that the SPPF is applicable to the municipality and local issues.

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3.3.3.2 Best value

Best Value is a quality management process that is part of current government policy. It is focused on meeting the needs of the local community. This corporate management tool aims to ensure that council services are the best on offer to meet those needs. Best Value is based on six principles:

• Quality and cost standards for all services
• Responsiveness to community needs
• Accessible and appropriately targeted services
• Continuous improvement
• Regular community consultation
• Frequent reporting to the community.

The MPHP, with its emphasis on community participation and identification of community needs, may also assist councils in meeting their Best Value requirements. For example, the planning and processes adopted as part of the MPHP could be documented in the annual Best Value Principles Report.

3.4 Linking MPHPs and municipal planning

Local governments are the closest level of government to the community and are best able to respond to local and diverse community needs and concerns. The role of local governments is one of leadership and involves a range of functions such as creation of vision and goals, promoting integrated planning, community development and participation, promoting partnerships and advocacy of local needs, establishing structures for corporate cooperation and facilitating change.

Corporate Plans, MPHPs and the MSS are all required by statute, and are key statements for articulating strategies about community wellbeing and health within the governance responsibilities of local governments. Planning for health and wellbeing must be afforded the same level of prominence as the MSS, by clearly expressing its links to the Corporate Plan, and by ensuring that concern for community health and wellbeing is integrated into the MSS. Figure 1 shows these inter-relationships between MPHPs and other Municipal Plans.

The MPHP can be an integrating mechanism for many municipal planning requirements. There are also opportunities for neighbouring councils to prepare joint MPHPs. In rural regions with smaller populations and fewer resources, a cooperative approach can be an effective way of addressing the wide range of public health issues that are shared across sub-regions.

Figure 1 Statutory Planning Responsibilities of Local Government (City of Banyule, 2001)

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