530656 research-article2014
RSH0010.1177/1757913914530656CURRENT TOPICS & OPINIONSCURRENT TOPICS & OPINIONS
CURRENT TOPICS & OPINIONS
A Health in All Policies response to disaster recovery Health in All Policies (HiAP) is an approach to public health work that builds off the determinants of health and wellbeing. Dr Anna Stevenson, Dr Alistair Humphrey and Sandy Brinsdon, public health specialists at Community and Public Health, look at the success of using a HiAP approach in Canterbury, New Zealand, following the aftershocks of the 2010 earthquake. The Helsinki Statement on Health in All The Disaster Policies (HiAP) released after the 8th A series of earthquakes struck Global Conference on Health Promotion, Canterbury, New Zealand, starting on held in June 2013, noted that ‘Health for Saturday 4th September 2010 at 4.35 all is a major societal goal of governments a.m. when the Greendale fault line and the cornerstone of sustainable ruptured for the first time in 16,000 development’. The writers explained that years. There was no loss of life resulting ‘Health in All Policies is an approach to from the first earthquake, of magnitude public policies across sectors that 7.1. However, there was considerable systematically takes into account the property damage both initially and in the health implications of decisions, seeks subsequent aftershocks, of which there synergies, and avoids harmful health were more than 10,000. These impacts in order to improve population aftershocks still continue, though with health and health equity’.1,2 less frequency, at the time of writing in Health in All Policies (HiAP) is an early 2014 and continue to cause anxiety approach to public health among many local work that builds on the residents. Health in All determinants of health and The most serious Policies (HiAP) is wellbeing. The Canterbury aftershock was on 22nd an approach to District Health Board February 2011 at 12:51 public health (CDHB) in New Zealand p.m. when a 6.3 work that builds has been leading a magnitude earthquake on the programme of work in this determinants of with its epicentre in area for several years, Christchurch City struck. health and beginning with a major Although of lower wellbeing. policy-level health impact magnitude than the original assessment on an urban fault rupture, the peak development strategy.3,4 Other significant ground acceleration (2.24 G) was one of projects have included joint appointments the highest ever recorded, and some across agencies, the development of areas of the city recorded a maximum guidelines on working with determinants modified Mercalli magnitude of 10. The for local government5,6 and the formation violence of this earthquake, combined of the Canterbury Health in All Policies with the time of day it struck, when the Partnership (CHIAPP),7 which has enabled city was full of workers enjoying their joined up organisational work plans across lunch break, contributed to the massive agencies. Towards the end of 2010, senior destruction of the central city and management and team leaders at ultimately led to the deaths of 185 citizens Community and Public Health (CPH) had and over 65,000 injuries. The central city begun regular training together, learning area remained cordoned off to the public about HiAP and how it might apply to the for over a year, and it is estimated that work of the public health unit (PHU).8 some 80% of its building stock has or will
be demolished. Outside the central city, entire suburbs have had to be abandoned leading to the displacement of communities, with more than 6,000 residential properties to be demolished. Under extremely difficult circumstances, the local acute hospitals and many primary care facilities kept running. The clinical response of the local health system has been documented elsewhere.9,10 Staff from the local PHU were deployed in the immediate response to deal with water and sanitary health (WASH) issues, infection control, food hygiene and the implementation of emergency health legislation invoked by New Zealand’s first and only declaration of a national disaster on 23rd February 2011. In addition, public health staff collected and analysed population-based health data – an essential component of intelligence gathering for the national incident controller. The response of the CDHB has been praised internationally along with many of the other acute responders.11
A Health in all Policies UNIT The PHU leadership team recognised that this was an opportunity to ‘leapfrog’ to the HiAP approach and consequently, immediately after the February earthquake, the unit was restructured in order to prioritise HiAP and support staff to utilise a determinants framework in all areas of their work. The New Zealand Ministry of Health provided a one off grant to support the establishment of a HiAP team within the unit to focus on
Copyright © Royal Society for Public Health 2014 May 2014 Vol 134 No 3 l Perspectives in Public Health 125 SAGE Publications Downloaded from rsh.sagepub.com at SIMON FRASER LIBRARY on June 2, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914530656
CURRENT TOPICS & OPINIONS recovery issues, particularly healthpromoting urban design. The HiAP team worked closely with, and were part of, a multi-agency ‘CHIAPP’,12 which had been formed after the 2010 earthquake to ensure that health and wellbeing would be embedded into all aspects of local and provincial government policy development, planning cycle and project development. This partnership identified priority areas for a HiAP approach and continued to support other sectors with capacity building and technical assistance. A total of 3½ years after the initial catastrophe, using a HiAP approach has led to an expansion of the work of public health staff, particularly in their
engagement with other agencies. The scope of protection work has widened beyond monitoring to include significant input to local and regional policy on issues such as air quality, water quality and building standards. Health promotion staff have created world-leading projects such as the social marketing campaign ‘All Right?’13 recognising the importance of mental health in a recovery. The HiAP team continues to lead major interagency collaborative projects with the result that public health input into major policy is now routinely sought at an early stage by our local and regional government partners. The story, so far, of the Canterbury recovery has highlighted the value of public health expertise in ensuring that
all agencies continue to consider health determinants in the recovery, in an evidence-based, equitable and sustainable fashion. The recovery is likely to take at least another decade, during which further development and research of the HiAP approach will be important. In Canterbury, the HiAP approach has enabled public health staff to improve the quality and reach of their work while ensuring a society-wide focus on health equity. Such was the value that an HiAP approach has become routine for Canterbury’s PHU, and we believe other public health agencies should seriously consider using HiAP routinely as best practice.
References 1.
2.
3.
4.
Leppo K, Ollila E, Pena S, Wismar M, Cook S. Health in All Policies: Seizing Opportunities, Implementing Policies. Helsinki: Ministry of Social Affairs and Health, 2013. World Health Organization, Ministry of Social Affairs and Health, Finland. Helsinki Statement on Health in All Policies. Helsinki: World Health Organization, Ministry of Social Affairs and Health, 2013. Stevenson A, Banwell K, Pink R. Assessing the impacts on health of an urban development strategy: A case study of the Greater Christchurch Urban Development Strategy. Social Policy Journal of New Zealand 2006; 29: 146–64. Mathias K. The Impact Evaluation of the Christchurch Urban Development Strategy Health Impact Assessment. Christchurch, New Zealand: Canterbury District Health Board (CDHB), 2008.
5.
6.
7.
8.
9.
Christchurch City Council, Canterbury District Health Board (CDHB). Integrated Planning Recovery Guide (Version 2.0). Christchurch, New Zealand: Christchurch City Council, CDHB, 2011. Christchurch City Council. Health Promotion and Sustainability through Environmental Design: A Guide for Planning. Christchurch, New Zealand: Christchurch City Council, 2008. Canterbury Health in All Policies Partnership (CHIAPP). Available online at: http://www.cph. co.nz/About-Us/Health-in-all-Policies/ (Last accessed 26th February 2014). World Health Organization, Government of South Australia. Adelaide Statement on Health in All Policies. Adelaide, Australia: World Health Organization, Government of South Australia, 2010. Ardagh MW, Richardson SK, Robinson V, Than M, Gee P, Henderson S et al. The initial
126 Perspectives in Public Health l May 2014 Vol 134 No 3 Downloaded from rsh.sagepub.com at SIMON FRASER LIBRARY on June 2, 2015
10.
11.
12.
13.
health-system response to the earthquake in Christchurch, New Zealand, in February, 2011. The Lancet 2012; 379(9831): 2109–15. Millar N. How an Earthquake Sped up Care Reform. Health Service Journal, 2013 March 14. Available online at: http://m.hsj.co.uk/5055925. article (Last accessed 10th April 2014) Timmins N, Ham C. The Quest for Integrated Health and Social Care: A Case Study in Canterbury, New Zealand. London: The King’s Fund, 2013. Canterbury District Health Board (CDHB). Final Evaluation Report for Canterbury Health in All Policies Partnership (CHIAPP). Christchurch, New Zealand: CDHB, 2012. Available online at: http://www.cph.co.nz/Files/ CHIAPPFinalEvaluation-Jun12.pdf (Last accessed 26th February 2014). All Right? Available online at: http://www.allright. co.nz/ (Last accessed 29th November 2013).
RSH0010.1177/1757913914530656CURRENT TOPICS & OPINIONSCURRENT TOPICS & OPINIONS
CURRENT TOPICS & OPINIONS
A Health in All Policies response to disaster recovery Health in All Policies (HiAP) is an approach to public health work that builds off the determinants of health and wellbeing. Dr Anna Stevenson, Dr Alistair Humphrey and Sandy Brinsdon, public health specialists at Community and Public Health, look at the success of using a HiAP approach in Canterbury, New Zealand, following the aftershocks of the 2010 earthquake. The Helsinki Statement on Health in All The Disaster Policies (HiAP) released after the 8th A series of earthquakes struck Global Conference on Health Promotion, Canterbury, New Zealand, starting on held in June 2013, noted that ‘Health for Saturday 4th September 2010 at 4.35 all is a major societal goal of governments a.m. when the Greendale fault line and the cornerstone of sustainable ruptured for the first time in 16,000 development’. The writers explained that years. There was no loss of life resulting ‘Health in All Policies is an approach to from the first earthquake, of magnitude public policies across sectors that 7.1. However, there was considerable systematically takes into account the property damage both initially and in the health implications of decisions, seeks subsequent aftershocks, of which there synergies, and avoids harmful health were more than 10,000. These impacts in order to improve population aftershocks still continue, though with health and health equity’.1,2 less frequency, at the time of writing in Health in All Policies (HiAP) is an early 2014 and continue to cause anxiety approach to public health among many local work that builds on the residents. Health in All determinants of health and The most serious Policies (HiAP) is wellbeing. The Canterbury aftershock was on 22nd an approach to District Health Board February 2011 at 12:51 public health (CDHB) in New Zealand p.m. when a 6.3 work that builds has been leading a magnitude earthquake on the programme of work in this determinants of with its epicentre in area for several years, Christchurch City struck. health and beginning with a major Although of lower wellbeing. policy-level health impact magnitude than the original assessment on an urban fault rupture, the peak development strategy.3,4 Other significant ground acceleration (2.24 G) was one of projects have included joint appointments the highest ever recorded, and some across agencies, the development of areas of the city recorded a maximum guidelines on working with determinants modified Mercalli magnitude of 10. The for local government5,6 and the formation violence of this earthquake, combined of the Canterbury Health in All Policies with the time of day it struck, when the Partnership (CHIAPP),7 which has enabled city was full of workers enjoying their joined up organisational work plans across lunch break, contributed to the massive agencies. Towards the end of 2010, senior destruction of the central city and management and team leaders at ultimately led to the deaths of 185 citizens Community and Public Health (CPH) had and over 65,000 injuries. The central city begun regular training together, learning area remained cordoned off to the public about HiAP and how it might apply to the for over a year, and it is estimated that work of the public health unit (PHU).8 some 80% of its building stock has or will
be demolished. Outside the central city, entire suburbs have had to be abandoned leading to the displacement of communities, with more than 6,000 residential properties to be demolished. Under extremely difficult circumstances, the local acute hospitals and many primary care facilities kept running. The clinical response of the local health system has been documented elsewhere.9,10 Staff from the local PHU were deployed in the immediate response to deal with water and sanitary health (WASH) issues, infection control, food hygiene and the implementation of emergency health legislation invoked by New Zealand’s first and only declaration of a national disaster on 23rd February 2011. In addition, public health staff collected and analysed population-based health data – an essential component of intelligence gathering for the national incident controller. The response of the CDHB has been praised internationally along with many of the other acute responders.11
A Health in all Policies UNIT The PHU leadership team recognised that this was an opportunity to ‘leapfrog’ to the HiAP approach and consequently, immediately after the February earthquake, the unit was restructured in order to prioritise HiAP and support staff to utilise a determinants framework in all areas of their work. The New Zealand Ministry of Health provided a one off grant to support the establishment of a HiAP team within the unit to focus on
Copyright © Royal Society for Public Health 2014 May 2014 Vol 134 No 3 l Perspectives in Public Health 125 SAGE Publications Downloaded from rsh.sagepub.com at SIMON FRASER LIBRARY on June 2, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914530656
CURRENT TOPICS & OPINIONS recovery issues, particularly healthpromoting urban design. The HiAP team worked closely with, and were part of, a multi-agency ‘CHIAPP’,12 which had been formed after the 2010 earthquake to ensure that health and wellbeing would be embedded into all aspects of local and provincial government policy development, planning cycle and project development. This partnership identified priority areas for a HiAP approach and continued to support other sectors with capacity building and technical assistance. A total of 3½ years after the initial catastrophe, using a HiAP approach has led to an expansion of the work of public health staff, particularly in their
engagement with other agencies. The scope of protection work has widened beyond monitoring to include significant input to local and regional policy on issues such as air quality, water quality and building standards. Health promotion staff have created world-leading projects such as the social marketing campaign ‘All Right?’13 recognising the importance of mental health in a recovery. The HiAP team continues to lead major interagency collaborative projects with the result that public health input into major policy is now routinely sought at an early stage by our local and regional government partners. The story, so far, of the Canterbury recovery has highlighted the value of public health expertise in ensuring that
all agencies continue to consider health determinants in the recovery, in an evidence-based, equitable and sustainable fashion. The recovery is likely to take at least another decade, during which further development and research of the HiAP approach will be important. In Canterbury, the HiAP approach has enabled public health staff to improve the quality and reach of their work while ensuring a society-wide focus on health equity. Such was the value that an HiAP approach has become routine for Canterbury’s PHU, and we believe other public health agencies should seriously consider using HiAP routinely as best practice.
References 1.
2.
3.
4.
Leppo K, Ollila E, Pena S, Wismar M, Cook S. Health in All Policies: Seizing Opportunities, Implementing Policies. Helsinki: Ministry of Social Affairs and Health, 2013. World Health Organization, Ministry of Social Affairs and Health, Finland. Helsinki Statement on Health in All Policies. Helsinki: World Health Organization, Ministry of Social Affairs and Health, 2013. Stevenson A, Banwell K, Pink R. Assessing the impacts on health of an urban development strategy: A case study of the Greater Christchurch Urban Development Strategy. Social Policy Journal of New Zealand 2006; 29: 146–64. Mathias K. The Impact Evaluation of the Christchurch Urban Development Strategy Health Impact Assessment. Christchurch, New Zealand: Canterbury District Health Board (CDHB), 2008.
5.
6.
7.
8.
9.
Christchurch City Council, Canterbury District Health Board (CDHB). Integrated Planning Recovery Guide (Version 2.0). Christchurch, New Zealand: Christchurch City Council, CDHB, 2011. Christchurch City Council. Health Promotion and Sustainability through Environmental Design: A Guide for Planning. Christchurch, New Zealand: Christchurch City Council, 2008. Canterbury Health in All Policies Partnership (CHIAPP). Available online at: http://www.cph. co.nz/About-Us/Health-in-all-Policies/ (Last accessed 26th February 2014). World Health Organization, Government of South Australia. Adelaide Statement on Health in All Policies. Adelaide, Australia: World Health Organization, Government of South Australia, 2010. Ardagh MW, Richardson SK, Robinson V, Than M, Gee P, Henderson S et al. The initial
126 Perspectives in Public Health l May 2014 Vol 134 No 3 Downloaded from rsh.sagepub.com at SIMON FRASER LIBRARY on June 2, 2015
10.
11.
12.
13.
health-system response to the earthquake in Christchurch, New Zealand, in February, 2011. The Lancet 2012; 379(9831): 2109–15. Millar N. How an Earthquake Sped up Care Reform. Health Service Journal, 2013 March 14. Available online at: http://m.hsj.co.uk/5055925. article (Last accessed 10th April 2014) Timmins N, Ham C. The Quest for Integrated Health and Social Care: A Case Study in Canterbury, New Zealand. London: The King’s Fund, 2013. Canterbury District Health Board (CDHB). Final Evaluation Report for Canterbury Health in All Policies Partnership (CHIAPP). Christchurch, New Zealand: CDHB, 2012. Available online at: http://www.cph.co.nz/Files/ CHIAPPFinalEvaluation-Jun12.pdf (Last accessed 26th February 2014). All Right? Available online at: http://www.allright. co.nz/ (Last accessed 29th November 2013).
