Integrated Health Promotion at Ballarat Community Health Prevention Strategy

Integrated Health Promotion at Ballarat Community Health Prevention Strategy 2017 2021

Our Values and Beliefs From its very beginnings Ballarat Community Health (BCH) has been committed to enhancing the health and wellbeing of the local community i. A primary emphasis in all service delivery is health promotion and illness prevention. This is evident in: Our Vision That the people and the communities we support achieve the best possible health and wellbeing. Our Mission To work in partnership with the community to create opportunities and supportive environments which empower people to develop and maintain optimal health and wellbeing. Contents Ballarat Community Health s Values are: Respect Integrity Responsibility Optimism Courage Resilience Our Reach Ballarat Community Health recognises that there are certain prerequisites for health as outlined in the Ottawa and Bangkok Charters and that health and wellbeing inequalities are often a result of inequities in the wider social determinants of health. These include but are not limited to: our gender; access to education, employment, nutritious food, affordable and stable housing; adequate income; a healthy environment; and social connections and supports. Health outcomes are also influenced by our level of remoteness - with Australians living outside of major cities having higher rates of disease and injury than people in major cities 1. As a consequence all BCH work is framed by an awareness of the critical importance of the wider determinants of health in working towards our vision. This understanding informs our delivery of services and programs, our health promotion and educational activities, and our role as an advocate for our community. As a forward-looking community health service, we understand and promote the importance of an empowered community and clients, and our role in developing the opportunities and skills needed to make self-determination and self-management of health and wellbeing a realistic and achievable goal. BCH provides services to people and communities in the City of Ballarat and the Shires of Golden Plains, Moorabool, Pyrenees and Hepburn. For some services we reach across the Grampians region and beyond. In our integrated health promotion work BCH has a primary focus on Ballarat and Golden Plains but will also work in partnership with Shires, health organisations and other relevant stakeholders to support the delivery of local government health and wellbeing priorities that align with BCH health promotion priorities in the local government areas of Pyrenees, Moorabool and Hepburn. Our Values And Beliefs 3 Our Reach 3 Our Approach to Developing Our Plan 4 Our Priority Areas 2017-2021 6-11 Ararat Pyrenees Ballarat Hepburn Aligning Planning For Collective Impact 12 Our Action Plan 2017-2021 14-17 Our Implementation Approach 18-19 Monitoring and Evaluation 19 Primary Catchment Area Secondary Catchment Area Golden Plains i Ballarat Community Health was established in 1993 following the amalgamation of Sebastopol Community Health Centre (est. 1979) and Wendouree Community Health Society (est. 1989) Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 2 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 3

Our Approach to Developing Our Plan Our Priority Areas 2017 2021 The Ballarat Community Health Strategic Prevention plan encompasses all BCH prevention and health promotion activity funded by the Department of Health and Human Services (DHHS), including: Integrated Health Promotion (IHP); Innovative Health Services for Homeless Youth (IHSHY); and Blood Borne Viruses and Sexually Transmitted Infections (BBV/STI). Our prevention work is further strengthened by health promotion undertaken across other areas of the organisation. Healthier eating and active living Improving youth mental health and wellbeing Preventing family and community violence Development of the BCH IHP plan was a 12 month process beginning in late 2016. Planning was guided by the Victorian Public Health and Wellbeing Plan 2015-2019 (VPHWP) and the DHHS public health and wellbeing planning guidelines. Working from the six priorities i i identified in the VPHWP, BCH staff reviewed health indicators data for our local communities, consulted with key internal and external stakeholders, and critically reviewed current IHP activities. Plan development was an iterative process with the Health Promotion Team working concurrently in a back-andforth progression between data and stakeholders to identify our three priority areas and develop our integrated plan. BCH also receives funding from DHHS for preventative work around Blood Borne Viruses/Sexually Transmitted Infections and through this funding undertakes work to improve sexual and reproductive health, which is also a VPHWP priority. 1 Analysis of data relevant to the six VPHWP priorities and policy review 2 3 4 5 6 7 8 BCH wide priority planning workshop Participating in Primary Care Partnership priority planning workshops in relevant catchment areas Development of shared priority action plan Development of final BCH strategy and action plan Checking BCH priorities against catchment area municipal health and wellbeing priorities Deciding on final BCH priorities aligned with catchment and municipal priorities Consultation and detailed needs analysis for youth mental health and wellbeing priority ii The six health priorities are healthier eating and active living; tobacco-free living; reducing harmful alcohol and drug use; improving mental health; preventing violence and injury; and improving sexual and reproductive health Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 4 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 5

Healthier Eating and Active Living Key Data A nutritious diet, adequate, sustainable food supply and regular physical activity are essential to physical and mental health and wellbeing. However, for a variety of reasons, many people in Ballarat do not meet healthy eating or physical activity guidelines. Poor diet is contributing to high levels of obesity and a range of chronic diseases including coronary heart disease, Type 2 diabetes, some cancers, and dental caries. Low levels of physical activity and high levels of sedentariness are also key risk factors for cardiovascular disease, along with colon and breast cancers, Type 2 diabetes and osteoporosis. 2 While significant impact has been made on other modifiable risk factors such as smoking, there are still very high numbers of people who are not meeting healthy eating or physical activity guidelines. This is contributing to the high proportion of people in Central Highlands who are overweight or obese and have associated chronic health conditions. Highlighting the importance of this issue, healthier eating and active living has been chosen as a shared prevention priority for the Central Highlands Region. 61% of adults in Ballarat are overweight or obese/victoria 50% 3 2 ½ serves of vegetables a day are consumed by people in Ballarat half the recommended amount. 5 13% of adults in Ballarat are daily sugary drink consumers /Victoria 11.2% 3 12% of Ballarat s population required emergency food relief assistance at least once during the last year 6 27% of Victorian children and young people are overweight or obese 4 54% of Ballarat adults are not doing enough physical activity each week 3 Ballarat children aged 2-4 years have twice the rate of potentially preventable hospitalisations for dental conditions compared to Victoria 7 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 6 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 7

Improving Youth Mental Health and Wellbeing Key Data Mental ill-health is the number one issue facing young people worldwide. It is the leading cause of disability in those aged 10-24 years, contributing to 45% of the overall burden of disease. 8 Mental ill-health also puts individuals at greater risk of intentional self-harm and suicide. Certain groups of young people are at higher risk of poor mental health and mental illness; they include young people who have experienced trauma, racism and discrimination, socio-economic disadvantage, and those with limited or inadequate family and/or social supports. 9 The impacts of mental ill-health can be significant and long lasting, with mental health issues associated with impaired academic achievement, disengagement from school and education, unemployment, poor social functioning and substance abuse. 10,11 As adolescence is the peak age of onset for many mental health disorders 10,11 it is importantly also a period in which there is great potential to increase protective factors associated with mental wellbeing and reduce the risk factors associated with mental illness. Prevention strategies include building resilience, enhancing community connections and social supports, promoting healthy lifestyles, reducing discrimination and encouraging active participation in the community. 1/4 young Australians (aged 16-24) experience a mental health condition each year 12 Suicide is the leading cause of death for young Australians 15-24 years 13 13% of young people in Ballarat reported very high psychological distress 14 35% of hospital admissions for young people in Ballarat aged 15-24 years were for intentional self-harm injuries / Victoria 31% 15 64% of young people surveyed in Ballarat indicated they had a trusted adult in their life 14 80% of young males with mental health issues don t get help 16 70% of young females with mental health issues don t get help 16 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 8 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 9

Preventing Family and Community Violence Key Data Family and community violence and the fear of this violence have significant negative impacts on the physical and mental health and wellbeing of our community. Alcohol consumption is a contributing factor to violence. 2 Family violence impacts primarily on women and children. Some groups within our communities, including Aboriginal and Torres Strait Islander peoples and women with disabilities, are at greater risk. Seeking and obtaining help is also more difficult for these groups and for people living in rural, regional or remote areas and from culturally and linguistically diverse backgrounds. 17 To prevent family violence, the underlying attitudes and social conditions that allow family violence to continue must be targeted. This involves: challenging and changing harmful attitudes towards women and children promoting gender equality encouraging respectful relationships 17,18 Men, on the other hand, are at greatest risk of community and street violence. ABS data indicates that in 2012, Victorian men were around 90% more likely than women to have experienced physical assault in the previous year. 2 Men are also most likely to be the perpetrators of this violence. Social attitudes of some men and women that accept violence between men and popular media can reinforce this. 2 Alcohol consumption, including single occasion risky (binge) drinking, is correlated with community and family violence. 36% Family violence rates in Ballarat are 36% higher than state levels 19 77% Women are the affected family member in 77% of reported cases of family violence 15 30% Children are present in about 30% of reported family violence cases 15 2x The rate of alcohol related family violence incidents in Ballarat is particularly high double the rate of state levels 15 88% of the most popular porn displays violence against women 20 more than 60% of girls and 90% of boys have seen online porn 21 22% of Australians were the victim of an alcohol-related incident in 2016 (verbally abused, physically abused or being put in fear) 22 67% of young people in Victoria (aged 16-29 years) risked injury from a single occasion of (binge) drinking at least once in the previous year 23 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 10 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 11

Aligning Planning for Collective Impact Our Integrated Health Promotion priorities for 2017-2021 align with the VPHWP 2015-2019 priorities, the municipal health and wellbeing plans of the key local government areas in our catchment area and the strategic health prevention priorities of our key partners. Changing population health outcomes is a significant challenge as the drivers for poor health outcomes are highly complex and multifactorial. If we are to achieve our vision, particularly for individuals and communities currently facing significant health challenges, we know that we need to work in partnership with local government and other local health and community organisations in order to avoid duplication or isolated effort and generate the greatest improvements in health. We are also committed to delivering an integrated approach to health promotion across our organisation. Local governments, health providers and community organisations across the Central Highlands and neighbouring PCP catchment areas have jointly committed to working together on the shared prevention priority healthy eating, active living. Improving mental health or a related focus on enhancing community connections is a key priority for all local governments in our catchment area. BCH is focusing specifically on youth mental health and wellbeing as it fits well with our existing expertise, reach and influence. Preventing family violence and improving gender equity is a key priority for municipal health and wellbeing plans in our catchment areas. The City of Ballarat has an additional focus on community safety which is also evident in our plan. Aligning our effort is focused not only on working with external partners but also aligning effort across our own organisation. This plan encompasses all BCH s prevention and health promotion activity funded by DHHS including Integrated Health Promotion (IHP), Innovative Health Services for Homeless Youth (IHSHY) and Blood Borne Viruses and Sexually Transmitted Infections (BBV/STI). Our Integrated Health Promotion plan is further strengthened by the health promotion work undertaken across other areas of the organisation, working along the continuum from primary prevention through to managed care. Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 12

Our Action Plan 2017-2021 2021 Focus Area Our Objectives Our Strategies How We Will Track Our Progress Funding Healthier eating and active living Increase access and availability of healthy food. Increase fruit and vegetable consumption to meet national guidelines. Promote water as the drink of choice and reduce consumption of sugary drinks. Support and promote incidental and structured programs to increase physical activity to meet national guidelines. Decrease sedentary behaviour. Leadership and advocacy Lead and strengthen initiatives and partnerships to improve access to nutritious food for vulnerable groups. Create supportive environments Support early childhood services, schools and workplaces to create healthier environments that promote healthier eating and active living. Build capacity and enable skills Conduct programs to provide opportunities for children, families and employees to gain knowledge and skills to improve healthy eating and physical activity behaviours, with a particular focus on young people and broader community members at risk of homelessness and our other priority populations and neighbourhoods. Number of partners wanting to address food security. Number of food relief programs supporting clients to meet the national guidelines for fruit and vegetable consumption. Number of early childhood services, schools and workplaces working towards meeting healthy eating (including water drink of choice) and physical activity guidelines. Number of people supported to increase physical activity levels. Number of people supported to increase fruit and vegetable and reduce sugary drinks consumption. IHP IHSHY Other BCH funding sources Improving youth mental health and wellbeing Increase young people s community engagement, connections and support. Increase young people s resilience. Reduce prevalence of mental illness in young people. Decrease youth suicide. Reduce the stigma of mental illness. Promote and support environments that enhance protective factors for youth mental health Support settings to create healthier environments that promote mental health and wellbeing. Build capacity and skills to support mental wellbeing Provide opportunities for young people to develop social connections, with a particular focus on young people from our priority populations and neighbourhoods. Deliver capacity-building activities and skill development that support youth mental health and wellbeing. Number of educational institutions registered with the Achievement Program and working toward the mental health benchmark. Number of schools participating in programs to promote positive youth mental health. Number of opportunities/activities provided to enhance social connections for young people. Number of participants in training and capacity building programs. Number of youth led programs. IHP IHSHY headspace Other BCH funding sources Number of partners working on youth mental health prevention. Preventing family and community violence Increase understanding and application of respectful relationships. Increase gender equity. Reduce the rate of alcohol and other drug related harm. Leadership and advocacy Support and strengthen a primary prevention approach to address family violence, in partnership with the community. Create supportive environments Support the roll out of the Respectful Relationships Program and related activities in schools and other key settings. Build capacity and enable skills Support young people and the broader community to reduce risk taking behaviour associated with alcohol and other drugs, with a particular focus on our priority populations and neighbourhoods. Number of local organisations and workplaces supported to sign up to and implement CoRE (Communities or Respect and Equality Regional Action Plan) activities. Number of schools registered with the Achievement Program and working towards the sexual health and alcohol and drugs benchmarks. Number of co-design programs to addressing key objectives. Numbers engaged in harm minimisation programs. IHP BBV/STI IHSHY Other BCH funding sources Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 14 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 15

Our Action Plan 2017-2021 2021 Ballarat Community Health undertakes work under the VPHWP priority of Improving Sexual and Reproductive Health, funded through DHHS BBV/STI funding. In developing this section of the plan, consideration has been given to the priority action areas in the VPHWP, the Victorian Hepatitis C Strategy 2016-2020 and the Third National Sexually Transmissible Infections Strategy 2014-2017. A high level overview of this work is provided in the table below. Focus Area Our Objectives Our Strategies How We Will Track Our Progress Funding Reducing the incidence of blood borne viruses and sexually transmitted infections. Reduce the incidence of chlamydia and the rate of newly acquired HIV and Hepatitis C. Reduce the stigma and discrimination experienced by people living with Hepatitis C and HIV. Create supportive environments Provide programs in a variety of settings to increase knowledge about prevention of Hepatitis C and STIs, support services, referral pathways and treatment. Build capacity and enable skills Work in partnership with local health services and educational facilities to support workers in raising awareness around Hepatitis C, HIV and STI transmission and treatment options available. Number of participants in education programs. Number of organisations and participants in capacity building programs. Increased access to appropriate treatment and care for people living with Hepatitis. BBV/STI Other BCH funding sources Ballarat Community Health, as a health promoting organisation, also undertakes significant health promotion work along the prevention continuum (from primary prevention to managed care), funded from a range of government and nongovernment sources and fee for services. This work contributes significantly to our three prevention priorities, as well as to the other three VPHWP priorities: namely improving sexual and reproductive health (through our sexual health clinic); tobacco free living (through our smoking cessation programs) and reducing harmful alcohol and drug use (through our pharmacotherapy network activities and suite of alcohol and other drug services). We also provide a range of services and supports that focus on improving mental health across all age groups. Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 16 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 17

Our Implementation Approach Our Implementation Approach Place Based Approaches Place based approaches are a key platform for the delivery of integrated health promotion as they recognize that the environments in which people live, work and learn, play an important role in shaping individual and community health and wellbeing. BCH will take a place based approach by targeting our health promotion work at key settings in Ballarat and surrounding areas. The key settings that we will focus on are: Early childhood services Schools and other educational settings Workplaces Sporting clubs We will also use community events as an opportunity to undertake activities relevant to our key priorities. BCH will focus our work on three key neighbourhoods in the City of Ballarat Wendouree West Delacombe Sebastopol We are focusing our effort on these neighbourhoods as: BCH has sites operating in or near these neighbourhoods We know that there are poorer health outcomes in these communities related to higher and persistent levels of disadvantage across the wider determinants of health. 24 BCH will work with the relevant organisations in these areas including Neighbourhood Houses and Men s Sheds. Other neighbourhoods may be included or targeted for particular programs when relevant data or community feedback indicates a specific neighbourhood need. Life Course Approach A life course approach helps to focus attention at key transition points where opportunities to intervene can have the greatest impact. This has influenced our decision to focus our efforts on improving mental health of young people. With most mental illnesses emerging in adolescence and early adulthood, this is a critical time for prevention activities that develop resilience and capability. A life course approach has also influenced our choice of settings as focusing our health promotion efforts on early childhood settings and schools sets up health promoting behaviours that will have benefits throughout life. We also know that getting older increases the risk of ill health and disability and that this also provides opportunities for secondary prevention and health promotion efforts. People-Centred Approaches BCH recognizes that our consumers, their families and carers and the broader community are at the centre of our efforts to improve health and wellbeing. We are committed to working with young people, BCH consumers, and key health and community partners, to co-design and co-produce our health promotion programs and interventions. BCH knows that health is not the same for everyone and that certain groups in our community experience significant health and wellbeing inequities. We commit to focusing health promotion effort on a number of priority populations that we already work with including but not limited to: Young people and broader community members who are homeless or at risk of homelessness Children and young people in out of home care Refugees and migrants LGBTIQ community People with disabilities Monitoring and Evaluation Our objectives, as outlined in our action plan, focus on longer term outcomes as outlined in the Public Health and Wellbeing Outcomes Framework. Short and medium term indicators have been developed to assist in tracking progress towards these longer term outcomes. This will ensure that we are tracking and reflecting on our progress and refining and adapting our annual implementation plan, in light of our progress, in order to ensure our strategies and activities are effective in supporting longer term changes to our community health outcomes. Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 18 Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 19

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American Journal of Psychiatry. 1995; 152(7), pp. 1026-1032. 11. McGorry PD, Goldstone SD, Parker AG, Rickwood DJ, Hickie IB. Cultures for mental health care of young people: an Australian blueprint for reform. The Lancet Psychiatry. 2014; 1 (7), pp.559-568. 12. Department of Health. Prevalence of mental disorders in the Australian population 2009. Available at www.health.gov.au/internet/publications/publishing.nsf/ Content/mental-pubs-m-mhaust2-toc~mental-pubs-m-mhaust2-hig~mental-pubs-m-mhaust2-hig-pre 13. Australian Institute of Health and Welfare. Suicide and hospitalised self-harm in Australia: Trends and analysis. Canberra: AIHW; 2014. Available at: http://www.aihw. gov.au/workarea/downloadasset.aspx?id=60129549727. 14. Victorian Department of Education and Early Childhood Development. Adolescent Community Profile: City of Ballarat 2010. Available from: http://www.education.vic. gov.au/documents/about/research/acpballarat.pdf 15. Vaughan N. Central Highlands Primary Care Partnership: Population health and wellbeing profile. Ballarat: CHPCP; 2016. Available from: http://www.chpcp.org/ 16. Sawyer M, Kosky RJ, Graetz BW, Arney F, Zubrick SR, Baghurstet P. 1997 National Survey of Mental Health and Wellbeing child component. Aust N Z J Psychiatry. 2000 Apr;34(2):214-20. DOI: 10.1080/j.1440-1614.2000.00729.x 17. State of Victoria, Royal Commission into Family Violence: Summary and recommendations, Parl Paper No 132 (2014 16). Available from: http://www.rcfv.com.au/ MediaLibraries/RCFamilyViolence/Reports/Final/RCFV-Summary.pdf 18. Implementing the Victorian Public Health and Wellbeing Plan 2015-2019, Taking action the first two years (Department of Health and Human Services) 19. Victoria Police. Family incident reports: 2009/10 to 2013/14. Melbourne: Victoria Police. Available from: http://www.police.vic.gov.au/content.asp?a=internetbridging Page&Media_ID=72311 20. Walker S, Temple-Smith M, Higgs P, Sanci L. It s always just there in your face : young people s views on porn. Sexual Health. 2015; 12, pp. 200-206. 21. Fleming MJ, Greentree S, Cocotti-Muller D, Elias KA, Morrison S. Safety in cyberspace: Adolescents safety and exposure online. Youth and Society. 2006; 38 (2), pp. 135 54. 22. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016: Detailed findings. Canberra: AIHW; 2017. Available at: https://www.aihw. gov.au/getmedia/15db8c15-7062-4cde-bfa4-3c2079f30af3/21028.pdf.aspx?inline=true 23. VicHealth. A snapshot of Victoria s alcohol culture 2014: Selected findings. Melbourne: Vichealth; 2014. Available from: https://www.vichealth.vic.gov.au/ media-and-resources/publications/a-snapshot-of-victorias-alcohol-culture 24. Vinson T, Rawsthorne M. Dropping off the edge 2015: Persistent communal disadvantage in Australia. Australia: Jesuit Social Services & Catholic Social Services; 2015 Ballarat Community Health recognises and celebrates the diversity of the community within which we work. We acknowledge and respect the Wadawurrung Elders past and present as the traditional custodians of the land on which our centres operate and their continuing connection to their Country. We acknowledge the important place of all Aboriginal and Torres Strait Islander people who live in our area as the first people of Australia. We welcome and work with people of all ages and health status, of all races, abilities, gender identities, sexual orientations, religious, cultural and linguistic backgrounds and financial status. Ballarat Community Health Integrated Health Promotion Prevention Strategy 2017 2021 20

ACN 136 362 993 ABN 98 227 492 950 Registered Office 12 Liburne Street, LUCAS 3350 Inquiries & Correspondence PO Box 1156, BAKERY HILL, VIC, 3354 T 03 5338 4500 F 03 5338 0520 E info@bchc.org.au