Efforts to develop, support and evaluate innovation are critical for advancing the protection and improvement of public health.
Many examples of innovation in policy, research, practice and community-led initiatives featured at the Congress, and presenters also highlighted areas where innovation is needed.
Innovation in policy development
The Climate and Health Alliance is taking a leadership role in developing a National Strategy on Climate, Health and Well-being to fill a gap in national policy development.
Ms Fiona Armstrong, executive director of the Alliance, outlined a draft framework for the strategy, which was developed following extensive consultation with health care and policy stakeholders.
The draft framework identifies as critical areas for policy development: health-promoting and emissions-reducing policies; supporting healthy communities; education and capacity building; inter and intra -government collaboration; emergency and disaster preparedness; a sustainable and climate-resilient health care sector; and research.
Global benchmarking showed Australia lags behind on climate change and health policy, Ms Armstrong told the Congress.
The Alliance, which formed in 2010, is itself an example of the innovative development of coalitions within the health sector for creating change extending beyond the health sector.
Other innovative coalitions profiled at the Congress included the National Centre for Justice Health Partnerships and the Rethink Sugary Drink project, a partnership between 13 health and community organisations.
Experiments with universal basic income schemes were another policy innovation featuring at the Congress.
Dr Ilona Kickbusch said Finland was piloting a universal basic income pilot as part of measures to tackle unemployment. It was “a trial that could lead to the greatest societal transformations of our time,” she said.
India was also considering such a scheme as a measure for fighting poverty, she said. Guaranteeing all citizens enough income to cover their basic needs would promote social justice and empower the poor to make their own economic choices, as well as being easier to administer.
Innovation in funding prevention
With investment in prevention so inadequate in many countries, especially Australia, there is an urgent need for innovative approaches to raising funds.
Professor Marj Moodie, a health economist and a Principal Research Fellow at Deakin University, gave many examples of the use of hypothecated taxes for raising prevention dollars, while also having direct health benefits.
Some of the money raised from a soft drinks tax in Mexico was used to install water fountains in disadvantaged areas, while in the United States, the Philadelphia City Council is using revenue from such a tax for early childhood education and to improve parks and recreation centres.
Many Congress speakers proposed a tax on sugary drinks as a fiscal policy innovation that would have a significant impact in reducing obesity rates as well as having other health benefits, including for children’s oral health.
Indeed, the potential for public health gains from innovation in taxation policy generally was a recurring theme throughout the Congress, in particular for addressing inequity.
Social impact bonds
Professor Moodie also profiled the use of social or health impact bonds as a policy innovation for raising private investment for public good projects, although she also noted there were challenges involved.
Social impact bonds, which are being piloted in Victoria and explored in other States, involve a market-based approach to pay for “evidence-based interventions that reduce health care costs by improving social, environmental and economic conditions essential to health”.
Professor Moodie said social impact bonds had been used to reduce the incidence and severity of asthma in an impoverished, polluted city in California, by generating investment in environmental remediation efforts in the homes of people with severe asthma who were frequent users of emergency and hospital services.
In NSW, social impact bonds had been used in a Uniting Care program to reduce the number of children in foster care by returning them to their families and preventing new admissions to foster care.
Professor Moodie said philanthropy offered another opportunity for raising funds for prevention. For example, the Centre for High Impact Philanthropy was a unique and trusted authority for donors around the world seeking to maximise the social impact of their funds.
“Philanthropy is largely untapped to date in the area of obesity prevention programs,” she said.
Innovation in anti-racism
A number of speakers and sessions highlighted the need for innovation in research, policy and practice to tackle racism, at interpersonal and institutional levels.
New Zealand researchers Dr Heather Came and Emma Rawson presented about efforts to address racism in New Zealand, including racism within public health units.
One example profiled was STOP International Racism (STIR), a movement of public health academics, activists and everyday people who are working towards transforming institutional racism in public health in New Zealand.
Dr Came outlined a national strategy to end racism, which includes addressing historical racism, the racial climate, transforming public institutions and mobilising civil society.
Professor Yin Paradies, from Deakin University, discussed plans for a conference in November this year to examine what progress has been made in addressing institutional racism since the term was coined 50 years ago.
He also previewed a forthcoming large-scale project to investigate racism and antiracism within the Australian “netsphere”.
A number of speakers highlighted the need to address institutional racism that contributes to the over-incarceration of particular groups, including Aboriginal and Torres Strait Islander people, and African American people in the United States.
Innovation in health literacy
The concept of health literacy has evolved enormously in recent years, according to two leaders in the field, Professor Richard Osborne and Mr Roy Batterham from Deakin University.
Health literacy is now seen as extending far beyond an individual’s interaction with health services, and the concept of “public health literacy” also encompasses a community’s decisions affecting health.
Professor Osborne said improving health literacy in populations gives a foundation for citizens to play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity.
Meeting the health literacy needs of the most disadvantaged and marginalised groups and societies would speed progress in reducing inequities in health and beyond, he said.
Professor Osborne and Mr Batterham described the international impact of the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-designing local interventions to improve health literacy and equity of access.
The WHO is using the Ophelia model in national demonstration projects in China, Egypt and Myanmar, and many other countries are also working with this approach.
A wealth of resources to support work to improve communities’ health literacy is available at the Ophelia website.
One of the most significant advances in prevention science in recent years has been the shift to a focus on systems approaches.
The Congress heard many examples of the use of systems science, including Healthy Together Victoria, a whole-of-system approach to prevention that looks at settings as systems, for example, schools, workplaces and community venues.
Changes that have occurred through this approach include initiatives for walking to school and safe drop-off zones, involving input from local councils, urban planners and schools.
Presentations highlighted how change in one area of a system can trigger changes in another. For example when one district health service stopped the sale of sugary drinks in its canteens, vending machines and other sites, this had a ripple effect, as more than a dozen other district health services also removed sugary drinks across their sites.
University of Sydney researchers who presented at the Congress – Professor William Bellew, Professor Adrian Bauman, Dr Becky Freeman and Mr James Kite – described another example of innovation in theory and practice: social counter-marketing.
The Congress heard that social counter-marketing typically involves opposing a policy position or harmful marketing. But it also can involve tackling unhealthy socio-cultural norms that have been created or promoted through corporate activities.
Examples of social counter-marketing include Booze Free Sport, a campaign generating community support to remove unhealthy alcohol sponsors from professional sports and, in the United States, the Alcohol Justice project, which describes itself as “the industry watchdog”.
Health Minister for a Day project
Another conceptual innovation involves reframing the growing “citizen science” movement as an opportunity for creating wider engagement with public health.
Professor Penny Hawe, from the University of Sydney, said citizen science projects, like the Cochrane Collaboration’s Cochrane Crowd, provide opportunities for stimulating wider engagement and understanding of population health science.
A report on the Congress produced by The Australian Prevention Partnership Centre said Professor Hawe is working on a project called Health Minister for a Day, which provides a game-style electronic interface to involve citizens in real life trade-offs between investing in different health interventions.
“People will be able to evaluate information that is presented about things like smoke-free areas or school breakfast programs and make decisions as if they were Health Minister,” she said.
“The model will then extrapolate the impact of this on health and health equity.”
Many examples of local and community-driven innovation were profiled at the conference. These included interventions to reduce access to sugary drinks, at Alfred Health and its onsite retailers, and at YMCAs. In both cases, there was no change in total sales but a reduction in sugary drink sales.
The Arnhem Land Progress Aboriginal Corporation also reported on impressive improvements in remote community stories from using price, promotion and placement to encourage sales of healthy foods.
Another noteworthy intervention is a Parents’ Voice campaign for fast food outlets to serve kids’ meals with water, using the hashtag, #waterwiththat.
Hashtag activism is also being used by a Rethink Sugary Drink campaign that seeks to engage Aboriginal and Torres Strait Islander people using the hashtag, #DrinkWaterUMob.
The Congress also heard about innovative efforts to reduce salt intakes.
The Subway Australia food chain described its success in reducing salt in its products, stating that they had removed six tonnes of salt from the Australian diet each year since 2009.
Meanwhile, attendees at a breakfast session hosted by VicHealth learnt about alternatives to using salt in cooking, including through the use of herbs and spices.
The explosion of apps and other digital products for health and fitness is providing both opportunities and challenges for public health.
Speakers raised concerns about potential conflicts of interest in the development of such apps, and noted a lack of transparency about who funds, develops, owns, and invests in digital health apps.
However, the Congress also heard about a VicHealth project, the Healthy Living Apps Guide, which reviewed more than 500 apps in 2015–16, most of which focused on physical activity.
Most of these apps scored poorly on the evidence-based rating scale, suggesting that while health apps are popular, few are likely to support sustained behaviour change.
However, the Congress also heard about a number of apps being developed and rigorously evaluated as part of research projects.
Developing apps in a crowded market
Ms Becky White, a PhD candidate at Curtin University in Perth, described the development and evaluation of Milk Man, which aims to get men thinking and talking about breastfeeding and ready to be a father. It was developed in response to evidence showing that fathers can influence the breastfeeding environment.
Milk Man provides a space for men to talk to each other, delivers time-specific information and provides a complete library of evidence based information, in an engaging format using humour and pop culture references.
The app uses engagement strategies including gamification, social connectivity and push notifications and has been developed and tested with members of the target group, and with experts in the field.
Ms White said the biggest challenge for health developers, given intense competition in the apps market, is to develop apps that people want to download and continue using.
During discussion in the session, delegates suggested that apps are a wasted opportunity if they are not also being used to collect data to drive wider public health work.
Other sessions also heard about the use of apps to promote awareness of Aboriginal and Torres Strait Islander cultures and knowledges, and the use of SMS messaging to promote healthy behaviours, such as smoking cessation and weight loss.
However, the presentations and associated discussions underscored that many questions remain about the effectiveness of such interventions, and that further work is needed to demonstrate their worth.
Presenters also emphasised the importance of using theories for behaviour intervention to inform app development, and recommended greater collaboration between app developers and health professionals.
Resources and further information
- Climate and Health Alliance: National Strategy for Climate, Health and Wellbeing
- Social impact bonds in Victoria
- Stop Institutional Racism
- The Ophelia (OPtimising HEalth LIteracy and Access) website
- WHO: The mandate for health literacy
- A health literacy questionnaire
- A conceptual framework for social counter marketing
- Alcohol Justice, in the US
- Cochrane Collaboration’s Cochrane Crowd
- Alfred Health: limiting sugary drinks
- Parents’ Voice: water with that campaign
- Rethink Sugary Drink
- Drink Water U Mob - part of the Rethink Sugary Drink campaign
- Epoch: early prevention of obesity in childhood
- The Achievement Program for support creating healthier environments (Victorian Government and Cancer Council Victoria)
- Resources for increasing the supply and/or consumption of fruit and vegetables
- Heart Foundation tips on reducing salt intake
- City of Sydney: Walking Strategy and Action Plan 2015–2030
- Heart Foundation resources for promoting walking
- The Healthy Living Apps Guide from VicHealth
- The Parent Infant Feeding Initiative and the Milk Man App
- More than 30 Aboriginal Apps
- Why public health should embrace the autonomous car