Developing the Evidence Base for Community-Governed Health Promotion and Prevention

1. Developing the Evidence Base for Community-Governed Health Promotion and Prevention 21st ANZAM Conference 2007 ‘managing our intellectual and social capital’ Sydney, Thursday 6th December Ms Vicky Totikidis Centre for International Corporate Governance Research, Faculty of Business and Law, Victoria University, Melbourne. NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

2. Stage Two: Community Health Information Collaboration Stage One: Community Health Evidence Base Stage Three: Evaluation of Community Centered Health Promotion Community Centered Health Promotion Community Centered Health Promotion and Prevention in an Australian Context NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

3. Rationale • Community governance of health promotion together with evidence about the health of a community is essential to the success of community health collaborations and to community empowerment and change. NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

4. What is Community Governance? • Community governance can be distinguished from corporate governance by its focus on communities rather than corporations and health & wellbeing rather than profits • Can be defined as ‘community level management and decision-making that is undertaken by, with, or on behalf of [for] a community, by a group of community stakeholders’ NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

5. Evidence Based Health Promotion: What Is It And Where Did It Come From? • Need for EBHP recognised by the World Health Organization & governments, researchers & public health & health promotion professionals around the world • EBHP is difficult to define and is often debated • Evidence assists decision making • Origins in evidence-based medicine (mid 19th century, Paris) NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

6. Figure 1. Guiding and evaluative evidence in community health interventions Guiding Evidence: Evidence about the health issues that need to be addressed in the intervention Evaluative Evidence: Evidence about the effectiveness of interventions Community Health Intervention Guiding And Evaluative Evidence NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

7. Evidence for Community Governance of Health Promotion Should be: Educative, informative & empowering for community members - ‘Knowledge is Power’ Should be guided by knowledge of: • National Health Priority Areas • Community health status • Determinants of health • Inequalities NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

8. National Health Priority Areas • Arthritis and musculoskeletal conditions • Asthma • Cancer control • Cardiovascular health • Stroke • Diabetes mellitus • Injury prevention and control • Mental health NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

9. Determinants Determinants Determinants Person/ Community B Health Status Person/ Community A Health Status Person/ Community C Health Status Health Differences Inequalities Disparities Inequities (should not exist) Determinants, Differences and Community Health Status Model NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

10. Determinants of Health • The ‘range of personal, social, economic and environmental factors which determine the health status of individuals or populations’ (Nutbeam 1998:6) • Hundreds of determinants or factors that impact on one’s health, either negatively or beneficially • Examples include: age, weight, gender, culture, drugs, nutrition, poverty, heredity and environmental conditions • Determinants can also be categorised as risk and protective factors NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

11. Health Status • The level of illness or wellness of a population at a particular time, measured through life expectancy, mortality, disability and disease prevalence rates • Level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures • The National Health Priority Areas may be viewed as several of numerous indicators of health status NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

12. Differences in Health • Inequalities, disparities and inequities in health all refer to differences in health among individuals and communities • ‘The term inequity has a moral and ethical dimension. It refers to differences which are unnecessary and avoidable but, in addition, are also considered unfair and unjust’ (Whitehead, 1991:5) NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

13. Determinants Determinants Determinants Person/ Community B Health Status Person/ Community A Health Status Person/ Community C Health Status Health Differences Inequalities Disparities Inequities (should not exist) Conclusion Detailed information on National Health Priority Areas, Community health status, Determinants of health and Inequalities would provide an important evidence base to guide the community governance of health promotion and improve community health and wellbeing NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101

14. Person/ Community A Health Status Improved community health and wellbeing Person/ Community B Health Status Person/ Community C Health Status NationalHealth and Medical Research Council Public HealthPostgraduate Research Scholarship405101