- This is one approach to HIA from within a Government setting. There are other approaches. We have grown out of our conditions.
- We've stolen stuff from Quebec to inform our approach in South Australia. Looking at their legislation (10 years before we got ours) and giving it an SA twist and the comradeship that Quebec gave us.
- How much of this was planned? Just enough, often we were making it up as we went along.
- 1.5 million people mostly in Adelaide
- Public health care system budget $4 billion a year (30% of State Budget)
In the beginning we wre doing HIAs but the kind of response we were getting was mixed. This was because:
- No clear mandate
- Came in late into the process
- Little change to change things
- Perceived to be remote and judgemental
- Seen as the bearer of bad news
- For us we found that there were no self evident truths (as we thought)
Ilona Kickbusch helped to kick start us in a new direction through the Thinker in Residence Scheme.
- See did not saying and doing very much different for what we were doing
- But because she came with her own authority and charisma from another country she helped to raise the agenda and set health in the context of the social and economic agenda.
- Complimented government on what was already being achieved and the strategi clan you have can achieve what you require, it did not need explicit health goals, not what other sectors could do for health but rather what we as Health can do for other sectors.
- We used HiAP as the approach, we developed a proof of concept with willing departments and got our first mandate from the State Cabinet. Did not ask for a seperate structure but bonded with existing structures. Created a group of Chief Executives from other departments and the CE for Health was explicitly not part of that group.
- Had to start by listening and be prepared to stop and collaborate.
- The perfect is the enemy of the good - previously we were trying to have health at the top of all agenda this time we wanted to have it somewhere.
- Health is a resource for living and not an end in itself.
- Had humility and respect
Where did HIA fit in?
- Used it flexibly where they fit in the context of the overall process, the strategic dimension
- Did a number of Health Lens Analyses
Needed
- We did not have a mandate but took a leap of faith and built our mandate
- We built the framework in the hope that people would come
- Now we have a South Australian Public Health Act 2011 as legislation is the strongest expression of a mandate
Lessons
- Mandate needs to be built and renewed ov time
- Ned to adapt and reinvent and be agile
- Needs to be useful and seen to be
- Working on subsidiarity to permeate it across the whole system rather than in one unit within Public Health
Two thought to leave you with:
- HiAP, what's in a name, what is it, don't like to use it as a noun "Hiap" it's a health jargon phrase, Is it a process, a goal of government or a slogan - for us it has been a process and hope that it will at some point in time become a goal of government.
- My problem with "All" in HiAP, we are tapping into an egalitarian value, equity for all, but outside of health it has TOTALITARIAN implications...so I'd like to suggest SHiP...p SOME HEALTH in POLICIES...please
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