Municipal Public Health Planning Framework

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Special notes page

Health Act 1958

See Section 29A, Functions of councils, and

Section 29B, Municipal public health plans:

1. Every council must, in consultation with the Secretary, prepare at three-year intervals a municipal public health plan.
2. A municipal public health plan must-

1. (a) identify and assess actual and potential public health dangers affecting the municipal district; and

   (b) outline programs and strategies which the council intends to pursue to

   (i) prevent or minimise those dangers;

   (ii) enable people living in the municipal district to achieve maximum wellbeing;

   (c) provide for periodic evaluation of programs and strategies.

3. Every council must review its municipal public health plan annually and, if appropriate, amend the plan.

Local Government Act 1989

Refer to Sections 6 (1) (b) & (d); and 7 (c), (d) & (f).

This legislation can be found via the Australasian Legal Information Institute Web site.

Ottawa Charter for health promotion:

Available from the World Health Organisation website

Victorian burden of disease study

Available from the Health Status of Victorians website.

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Participation

"A process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change."

WHO (1999). Community participation in local health and sustainable development: a working document on approaches and techniques. Copenhagen, Denmark: WHO. Available on-line:

WHO book 4 (274kb, pdf)

Objectives of Participation:

• To inform the community and relevant agencies about the planning process.
• To invite individuals, groups, agencies and central governments to participate in consultation and planning processes.
• To identify opportunities, issues and specific needs.
• To build cooperation and trust between planners, providers and consumers.
• To identify skills and resources in the community which can be applied to planning and provision.
• To build capacity in the Council and the community for planning.
• To identify a shared vision for community planning and program development.

(MAV, 1996). Planning Partnerships: An Integrated Local Planning Framework for Human Services.

Peak bodies representing victorian local governments:

• Municipal Association of Victoria
• Victorian Local Governance Association

"Health is the state of complete physical, mental and social wellbeing and not the merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief or economic and social condition." (WHO Constitution.)

The WHO Healthy Cities project is a long-term development project that seeks to place health on the agenda of cities around the world, and to build a constituency of support for public health at the local level. The concept is evolving to encompass healthy villages and municipalities, and as such has a close relationship to MPHPs.

Determinants of health

Indicators for Determinants of Health, from the Public Health Agency of Canada website.

The National Public Health Partnerships' Planning Framework for Public Health Practice includes a discussion on health determinants. Available from the National Public Health Partnerships website.

Social determinants of health

1. The need for policies to prevent people from falling into long-term disadvantage;
2. How the social and psychological environment affects health;
3. The importance of ensuring a good environment in early childhood;
4. The impact of work on health;
5. The problems of unemployment and job insecurity;
6. The role of friendship and social cohesion;
7. The dangers of social exclusion;
8. The effects of alcohol and other drugs;
9. The need to ensure access to supplies of healthy food for everyone; and
10. The need for healthier transport systems

WHO Ottawa Charter:

Available from the World Health Organisation website

WHO healthy cities:

Available from the World Health Organisation website.

Statement on health and local agenda 21:

Available from the World Health Organisation website.

For an Australian historical perspective on the international literature, see:

• Better Health Outcomes for Australia. Commonwealth of Australia, 1994.
• Macklin, J. (1993). Pathways to Better Health

Agenda 21

Agenda 21 was adopted during the United Nations Conference on Environment and Development (the 'Earth Summit') - in Rio de Janeiro in June 1992. The Conference also saw the signing of two new global Conventions, on Climate Change and Conservation of Biological Diversity and the adoption of a Declaration on the principles of sustainable development ('The Rio Declaration'). Agenda 21 sets out actions that nations, communities and international organisations can all take to contribute to the goal of global sustainability in the twentyfirst century.

For more information see the UN Department of Economic and Social Affairs website.

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National environmental health strategy

The National Environmental health strategy is available from the Federal Department of Health and Ageing website.

National environmental health strategy implementation plan:

The National environmental health strategy implementation plan is available from the Federal Department of Health and Ageing website. (external link)

Department of Human Services divisions:

Office of Housing

Disability Services

Public Health

Aged Care

Mental Health Services

Primary Care Partnerships are developed through ACMH

Primary and Community Health Information

For details of all the Department's Divisions visit the DHS website.

Department of Justice

The Department of Justice website can be viewed at: www.justice.vic.gov.au.

For topics related to Safer Cities and Shires, and Local Crime Prevention, we recommend that you perform a search of these phrases at the DoJ homepage.

For topics related to Community Safety and Crime Prevention we recommend that you perform a search of these phrases at the DoJ homepage.

Department of Infrastructure

The Department of Infrastructure (DOI) is the lead provider of essential infrastructure in Victoria, with responsibility for transport, major development, energy, and information and communication technology (ICT).

The DSE manages the regulatory framework for land-use planning, environment assessment and land subdivision. It provides advice on planning policy and urban design, strategic planning, and information on land development and forecasting.

For more information see the Department of Infrastructure website, or the DOI Planning Division.

Department of Sustainability and Environment (DSE)

See the Department of Sustainability and Environment website..

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Relevant legislation

• Local Government Act 1989
• Planning and Environment Act 1987
• Health Act 1958

These can be found via the Australasian Legal Information Institute Web site:
www.austlii.edu.au/.

Best value:

Refer to Section 208 of the Local Government Act. See also the Department of Infrastructure's Local Government Web site.

Systems approach

The systems approach outlined in this framework reflects the growing evidence that local environments in which we live have profound effects on health. See:

Harris, E., & Wills, J. (1997). Developing healthy local communities at local government level: Lessons from the past decade. Australian and New Zealand Journal of Public Health, 21, 403-412.

Health outcomes: A definition

"A change in the health status of an individual, group or population which is attributable to a planned intervention or series of interventions, regardless of whether such an intervention was intended to change health status." (WHO Health Promotion Glossary).

Useful resources

Saving lives: Our Healthier Nation (OHN) White Paper is a comprehensive Government wide public health strategy for England.

A New Perspective on the Health of Canadians is one of the founding documents in health promotion. The document is available from the Health Canada website.

Future Directions in Public Health in New South Wales: A Consultation Paper. Available from the Health NSW website.

Defining capacity building

"Developing sustainable skills, organisational structures, resources and commitment to health improvement in health and other sectors... [to] prolong and multiply health gains many times over. Capacity building not only can occur within programs, but also more broadly occurs within systems and leads to greater capacity of people, organisations and communities to promote health. This means that capacity building activity may be developed with individuals, groups, teams, organisations, inter-organisational coalitions, or communities."

Hawe, P., King, L., Noort. M., Jordens, C., & Lloyd, B. (2000).

Indicators to Help with Capacity Building In Health Promotion. Sydney: NSW Dept. Health. Available from the Health NSW website.

Definition of community wellbeing:

"Wellbeing refers to the condition or state of being well, contented and satisfied with life. Wellbeing has several components, including physical, mental, social and spiritual. Wellbeing can be used in a collective sense to describe how well a society satisfies people's wants and needs." (Measuring Progress, 1998).

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Key WHO documents linking health and urban planning

Healthy cities and the city planning process: - A background document on links between health and urban planning. (Duhl & Sanchez, 1999) - explores and analyses the relationship between urban planning and public health in terms of history and current issues in cities. Available from the World Health Organisation website.

Community participation in local health and sustainable development:

A working document on approaches and techniques (WHO, 1999).

This document describes community participation and why it is important. The document provides specific guidance to people wishing to engage in their own community participation activities.

Case studies, contacts and reference material are included:

WHO book 4 (274kb, pdf)

City planning for health and sustainable development

City health plans form an important model for local Agenda 21 plans, using local health profiles and promoting community participation to achieve change at the municipal level:

www.who.dk/document/wa38097ci.pdf (450kb, pdf)

Towards a new planning process. A guide to reorienting urban planning towards Local Agenda 21 (WHO, 1999)

Urban planning plays a critical role in reducing the levels of pollution and increasing the quality of life in cities:

WHO book 3 (572kb, pdf)

Health Canada (1997). Health and environment: Partners for life.

For section on the built environment

Eleven elements as key parameters for healthy cities, communities and towns

1. A clean, safe, high-quality environment (including housing).
2. An ecosystem that is stable now and sustainable in the long term.
3. A strong, mutually supportive and non-exploitative community.
4. A high degree of public participation in and control over the decisions affecting life, health and wellbeing.
5. The meeting of basic needs (food, water, shelter, income, safety, work) for all people.
6. Access to a wide variety of experiences and resources, with the possibility of multiple contacts, interaction and communication.
7. A diverse, vital and innovative economy.
8. Encouragement of connections with the past, with the varied cultural and biological heritage and with other groups and individuals.
9. A city form (design) that is compatible with and enhances the preceding parameters and forms of behaviour.
10. An optimum level of appropriate public health and sick care services accessible to all.
11. High health status (both high positive health status and low disease status).

Useful link: Supportive Environments for Physical Activity (SEPA)

SEPA is a project of the National Heart Foundation that aims to increase environmental support and opportunities for people to be physically active in their daily life. For more information see the Heart Foundation website.

Tools needed for healthy and sustainable urban planning

Policy tools

General and specific guidelines and indicators such as biophysical, health, economic, social and cultural indicators

Planning tools

Techniques and information for day-to-day planning in transport, residential housing, natural landscaping and programs to reduce, reuse and recycle.

Information tools

Baseline and periodic data within reports on the state of the environment, or health reports such as city health profiles, impact monitoring and exchange of information through networks.

Fiscal tools

These draw attention to equity: for example, incentives such as tax relief for those who live close to where they work; disincentives such as tax subsidies for commuting by car; subsidies for public transit; life cycle costing; and appropriate government procurement policies.

Decision making tools

Urban planning, environmental impact assessment, strategic environmental assessment or strategic sustainability assessment, mediation skills, stakeholder and interdisciplinary teams and mechanisms to ensure greater public involvement.

Educational tools

These target urban planners and health practitioners and can include conferences, workshops, task forces, case studies, training and small-group sessions.

Participation tools

Innovative techniques such as participatory mapping of a settlement, modelling of new housing designs, collective planning, seasonal calendars and forums for ideas.

From (WHO, 1999) Towards a new planning process. A guide to reorienting urban planning towards Local Agenda 21, p. 31

WHO book 3 (572kb, pdf)

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Useful planning documents

Towards a New Planning Process: A Guide to Reorienting Urban Planning Towards Local Agenda 21 (WHO, 1999):
WHO book 3 (572kb, pdf)

Three Dimensions of Capacity Building

1. Health Infrastructure or service development: Capacity to deliver particular program responses to particular health problems. Usually refers to the establishment of minimum requirements in structures, organisations, skills and resources in the health sector.
2. Program maintenance and sustainability: Capacity to continue to deliver a particular program through a network of agencies, in addition to, or instead of, the agency that initiated the program.
3. Problem solving capability of organisations and communities: The capacity of a more generic kind to identify health issues and develop appropriate mechanisms to address them, either building on the experience with a particular program or as an activity in its own right (Hawe et al., 2000).

In 1999 North East Health Promotion Centre published this research report. It aimed to strengthen integration of Municipal Public Health Plans within corporate strategic planning among the four local governments within Melbourne's Northeast region. The project identified good practice models and case studies in municipal public health planning through:

• A literature search on good practice in building an integrated approach to health planning.
• A survey of metropolitan and large provincial councils to gain an understanding of the current status of health planning and implementation within each council.
• Qualitative interviews with managers or coordinators in local councils who had identified good practice in their Councils.

Three dimensions of capacity building

1. Health Infrastructure or service development:Capacity to deliver particular program responses to particular health problems. Usually refers to the establishment of minimum requirements in structures, organisations, skills and resources in the health sector.
2. Program maintenance and sustainability: Capacity to continue to deliver a particular program through a network of agencies, in addition to, or instead of, the agency that initiated the program.
3. Problem solving capability of organisations and communities:
   The capacity of a more generic kind to identify health issues and develop appropriate mechanisms to address them, either building on the experience with a particular program or as an activity in its own right (Hawe et al., 2000).

Hawe, P., King, L., Noort. M., Jordens, C., & Lloyd, B. (2000).

NSW Dept. Health (2001). A Framework for Building Capacity to Improve Health

Strategic vs. operational planning

Strategic level planning is about acknowledgement that there are choices in the directions that can be taken in the future. The development of a vision, mission and values is used to assist in selecting priorities for future decision making. Strategic plans tend to pay particular attention to the analysis of the broad or macro environment, the identification and response to issues, and longerterm goals and objectives.

Typical features associated with strategic planning processes include:

• Broad scale information gathering
• An exploration of alternatives
• An emphasis on future implications of present decisions
• Fostering orderly decision making and successful implementation.

In contrast to strategic planning, operational level planning ('service', 'program' or 'business' planning) is more detailed and is focused on the implementation of strategic-level plans. Typically operational planning activities look to the short term, such as the current fiscal year or life of a project or program.

Questions often associated with operational planning include:

• Who wants the service or product (customer, client, consumer)?
• What specific program or service do they want?
• Where do they want the service delivered?
• When do they want the service delivered?
• How do they want the service delivered?
• Why do they want the service? (What purposes are served, functions fulfilled?)

MPHPs may involve a combination of strategic and operational planning

Organisational development issues in pre-planning

Organisational development processes ensure that the structures, systems, policies, procedures and practices of an organisation reflect its purpose, role, values and objectives and ensure that change is managed effectively (NSW Dept Health, 2000, p. 21). Organisational development strategies can include a focus on:

• Policies and strategic plans
• Organisational management structures
• Management support and commitment
• Recognition and reward systems
• Information systems - monitoring and evaluation
• Quality Improvement systems
• Informal organisational culture

Community participation and data collection

Refer to WHO (1999) Community participation in local health and sustainable development: a working document on approaches and techniques. Available:
WHO book 4 (274kb, pdf)

This important document reminds us that meaningful community participation in municipal public health planning can generate important, 'grounded' information that will inform the development of useful, locally relevant plans, and also provide a direct link to community capacity development. However, the extent to which this will occur will depend on whether residents are informed, consulted, give advice, share in the planning process, have delegated responsibility, or assume control. A range of skills and resources will be required to encourage participation along this continuum (see Checklist 2).

Refer to 'Health Planning Concepts', Section 2.2 pp. 6-7.

Also see 'Partnership Development', Section 6.3 below.

Action planning and action research

Labonte R. (1997).Power, participation and partnerships for health promotion. Melbourne: Victorian Health Promotion Foundation.

Walker, R. (2000). Collaboration and alliances: A review for VicHealth.

This document is a review of the research literature on collaboration, and related issues, that is pertinent to the VicHealth Strategic Directions and the Primary Care Partnership Strategy in Victoria.

For a detailed discussion on action planning, refer to Section 3 of Community Participation In Local Health And Sustainable Development: A Working Document On Approaches And Techniques (WHO, 1999):
WHO book 4 (274kb, pdf)

Melbourne Action Research Issues Centre

See section on 'Getting started: building partnerships' (p. 33) of WHO (1999). Towards a new planning process: A guide to reorienting urban planning towards Local Agenda 21:
WHO book 3 (572kb, pdf)

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Participation and collaboration

WHO, 1999, pp. 9-10:

WHO book 4 (274kb, pdf)

Refer to Checklists 3, 4 and 5 for a detailed system for identifying and engaging stakeholders, including community members

Useful planning documents

The following are useful guides for implementation: See "Stage 4. Getting organized: action planning" (pp. 36, 39) of WHO (1999). Towards a new planning process: A guide to reorienting urban planning towards Local Agenda 21:
WHO book 3 (572kb, pdf)

See pp. 34 - 40 of Community participation in local health and sustainable development: A working document on approaches and techniques for a comprehensive guide to 'generating ideas and plans for action':
WHO book 4 (274kb, pdf)

Relevance of quality management

Quality Improvement in Municipal Public Health Practice

This Project was coordinated by Public Health Division, Department of Human Services, the Centre for Development and Innovation in Health (at La Trobe University), and the School of Health Sciences, Deakin University The project aimed to support the capacity of local government to provide effective, good quality public health programs and services, and to strengthen the infrastructure for public health practice at a municipal level. The methodology included surveys of local government officers, interviews with key informants, a focus group, and an issues workshop with practitioners.

The study found that there was considerable variety among councils in the level of application and types of quality improvement processes utilised. However, the principle of actively considering program quality in public health programs and services has developed a culture of continuous quality improvement.

Useful monitoring resources

WHO (1999). Community participation in local health and sustainable development: a working document on approaches and techniques. Copenhagen: WHO. See pages 51-57 of this document for a description of a number of monitoring techniques, including community indicators:
WHO book 4 (274kb, pdf)

Health Canada. (1996). Guide to Project Evaluation: A Participatory Approach.

See Appendix 5 for Success Indicators of Increased Public Participation and Strengthened Community Groups. Examples are given of indicators of success for two health promotion program/project impacts: increased public participation and strengthened community groups. For each impact, sample indicators of success are given. Below the indicators are the types of questions project staff can ask themselves in order to determine these indicators of success.

Indicators of Community Wellbeing (Jenny Wills). See the Local Government Community Services Association of Australia Web site.

Useful evaluation resources

The following evaluation guides are particularly useful:

Hawe, P., Degeling, D., & Hall, J. (1990). Evaluating health promotion: A health worker's guide. Sydney: MacLennan & Petty.

Health Canada. (1996). Guide to Project Evaluation: A Participatory Approach.

Swerissen, H., et. Al. (2001). Health promotion and evaluation: A programmatic approach. Health Promotion Journal of Australia, 11 (1, April). Supplement.

Wadsworth, Y. (1991). Everyday Evaluation on the Run. Melbourne, Australia: Action Research Issues Association Inc.

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Other resources

WHO (1999). Community participation in local health and sustainable development: a working document on approaches and techniques.

Copenhagen: WHO.
WHO book 4 (274kb, pdf) (See pages 51-57).

Patton, M. Q. (1982). Practical evaluation. London: Sage Patton, M. Q. 1997. Utilization-Focused Evaluation (3rd Ed). Sage Publications

Five key evaluation questions

Each evaluation will be different, but five fundamental questions remain the same for all MPHPs:

1. What? Did we do what we said we would do?
2. Why? What did we learn about what worked and what didn't work?
3. So what? What difference did it make that we did this work?
4. Now what? What could we do differently?
5. Then what? How do we plan to use evaluation findings for continuous learning?

Five evaluation process steps

Seeking answers to the five key evaluation questions will guide the way you evaluate your MPHP. The insights gained from answering the questions can then be used to shape current and future work. Five useful, practical steps for evaluating your MPHP are:

1. Define the project work.
2. Develop success indicators and their measures.
3. Collect the evaluation data.
4. Analyse and interpret the data.
5. Use the evaluation results.

Common evaluation terms and what they mean

Evaluation A way of measuring if a project is doing what it says it will do.

Goals General statements of what an organisation is trying to do.

Objectives Specific, measurable statements of what an organisation wants to accomplish by a given point in time.

Objective approach One that values the perspective, views and opinions of those outside of or distanced from the situation, event, organisation, project, etc., as the primary basis for making an assessment or judgement.

Informant In research and evaluation terminology, the person you interview or question is called the "informant".

Impact or outcome evaluation Gathers information related to the anticipated results, or changes in participants, to determine if these did indeed occur. It may also be used to test the effectiveness of a new program relative to the results of an existing form of service. An impact evaluation will tell you about the effects of a project.

Process or formative evaluation An ongoing dynamic process, where information is added continuously (typically using a qualitative approach), organised systematically and analysed periodically during the evaluation period. A process evaluation will tell you how the project is operating.

Quantitative approach An approach that tries to determine cause and effect relationships in a program. A quantitative approach will use measurements, numbers and statistics to compare program results. The information is considered "hard" data.

Qualitative approach An approach that examines the qualities of a program using a number of methods. This approach uses nonnumerical information - words, thoughts and phrases from program participants, staff and people in the community - to try and understand the meaning of a program and its outcome. The information is considered "soft" data.

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