Introduction

1. Making Tasmania the healthiest State by 2025 by social determinants of health pathway - high risk, high returns Ms Leonie Young, Inaugural Chair, Ministerial Health and Wellbeing Advisory Council, THC, 26-27 July 2014

2. Introduction • Rural Alive & Well (Tas) Board Director; National Chair, Australian Gynae Cancer Foundation; beyondblueambassador • Former CEO of beyondblue: the national depression initiative, 2003-2010 • Fmr State Manager, DoHA, NT, 2000-2003 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

3. Ministerial Health and Wellbeing Advisory Council • Established in 2011 under A Healthy Tasmania • Nine independent community leaders • Voluntary, advisory positions • Multi-sectoral representation (Menzies, TasCoss, Heart Foundation, Kickstart Arts, Cradle Coast Council, corporate business, Lifeline, COTA) • Reported to Cabinet & Govt via Minister for Health • Secretariat provided by Population Health, DHHS • Two-year sitting term;Thriving Tasmania Report, 2013 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

4. Advisory CouncilTerms of Reference • Priorities: • Identify appropriate measures to improve health and reduce social inequities • Provide advice on the best approaches to place-based health and wellbeing • Roles and Responsibilities: • Provide expert advice to government based on individual experience, collective skills, field of interest • Advocate for action on the underlying determinants of health and inequity across sectors • Build the community of interest in A Healthy Tasmania Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

5. Advisory Council’s Approach Determinants of Health (Dahlgren & Whitehead, 1992) Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

6. Challenges of Tasmania’s Population - no part of the Tas pop considered to be an urban centre. The ABS classifies the majority of Tas as inner or outer regional. Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

7. “People living outside of major cities in Australia have worse outcomes on leading indicators of health and access to health care. They have higher rates of obesity, smoking and risky alcohol consumption. Their rates of potentially preventable hospitalisations are also higher and they are less likely to gain timely access to aged care.” COAG Reform Council 2013 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

8. “Poverty kills people.” Late Professor Gavin Mooney. …Thousands of Tasmanians are dying prematurely or unnecessarily, and struggling against ill-health and poor wellbeing to the detriment of their productivity and our community. Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

9. Risk factors by remoteness, 2011-12 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

10. Mortality rates by remoteness (per 1,000 population), 2011 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

11. Potentially avoidable mortality from all-causes, under 75 years, Australia, 2009 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

12. 6 Top Causes of Death: Tas vs Aust ABS Cat. No. 3303.0, Deaths Australia 2010 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

13. Cancer Mortality Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

14. Age-standardised mortality rate Ischaemic heart disease Tasmania, 1978-2010 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

15. HWAC findings • Improving health in Tasmania was not about increasing the number of beds in hospitals or relocation of health services – less about health servicing - consistently more about health system reform and tackling the causes of illness, sdoh, including: • Improving health literacy; linking IT and patient care systems, improving collaboration and integration, coordination, access and transport • More investment in education, for adults and children, boosting literacy and numeracy skills and adopting a cradle to career view; • Increasing rates of employment, tackling long term unemployment with targeted approaches, providing work-ready and return to work training programs; • Boosting the economy – many regional and rural towns struggling with industry and business closures, reducing workforce and increasing reliance on welfare; • Improving access to safe and secure, affordable housing, across the state; • Building social engagement – improving people’s connectivity in the community; • Supporting corporate enterprise, encouraging small business development, public and private sector investment. Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

16. Recent progress • Tasmanian Health Assistance Package (TML) • Medicare Local – SDoH Project • Social Determinants of Health Network • Thriving Families Healthy Communities Program in Community Houses; establishment of Child & Family Centres • Joint Parliamentary Select Committee on Preventative Health Care; SDoH Network; and Health in all policies framework • Tasmanian Lead Clinician’s Group • Redevelopment of Tasmania’s Health Plan; THO’s • Advisory Council’s Mapping Report • Very high number of health and wellbeing activities happening within Tasmania; millions of dollars across 3 levels of government plus private health funding – very little coordination, integration, data linking, information or resource sharing or collaboration across projects. Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

17. Identified potential opportunities • Health Literacy programs and initiatives • Place-Based Approaches – community driven and resources – with a social determinant’s focus • Leadership across sectors to align effort: • Public Health Advisory Council • State Public Health Plan • State Policy for Healthy Land-Use and Urban Planning • Health intelligence and evidence capability Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

18. Shared urgency of status quo, risks abound • Thriving Tasmania - everyone has a role to play • Insufficient TasGovt treasury funds to attend to current levels of illness, disease, mental illness, remedial education programs, disability, aged care, stroke recovery, juvenile justice, unemployment and rehabilitation requirements to name a few of the urgent issues; • All of us are affected through mortality, morbidity, low productivity, low economy, low education rates in our struggling and iniquitous state for our children, grandchildren and ageing parents; maintain status quo = no progress • How to reach goal of Tasmania healthiest State by 2025, fragmented, body part, separate, silo approach to date Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

19. Urgency of case, new champions Urgent Case for change: Evidence-Based Action • evidence base established, shared goals, informed high level leadership looking to make a difference • Population health reports, burden of disease data, New and existing champions • New governments, new opportunities, new Premier, Health & Community Services Ministers, new policies, shared commitment to statewide action and improving health and sdoh outcomes, complemented by strong bipartisan support for sdohreforms in Tasmania • partnership in health models, AMA, Menzies, Utas, Medicare local, primary care infrastructure, bipartisan support, across sectors, matched by community expectations Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014

20. Champions, resources, high potential for state of excellence, healthiest State 2025 • New Tasmanian government elected on a bold and shared commitment to the community to build a Tasmania we can be proud of; to rebuild health services, to invest in education to create a job-ready generation; planning to build a modern economy, a plan to build a prosperous Tasmania; and we now have that opportunity …. • Together with Federal support, pooled resources, partnerships, collaborative planning, strong state-wide policies and drawing on support across sectors for a thriving Tasmania, we can improve our health and sdoh outcomes; • World-wide, national and local examples of improving health, wellbeing, employment, education, and the economy by engaging communities do exist. Tasmania, defined by our relatively small population within an island border gives opportunity for a coordinated, integrated state of excellence; a population health, shared funding model with the Commonwealth, beyond 3 year election cycles. • We have the urgent case and just now, the right political, community, federal and state bipartisan support, its not a continuing competition to the bottom, we’ve won already. • If we start now, building on our shared commitment and shared goals, we can be the healthiest State by 2025 Leonie Young, Chair, Ministerial Health and Wellbeing Advisory Council Tasmanian Health Conference 2014