Strategic Plan 2013-2025
Strategic Plan 2013-2025 Toi Te Ora Public Health Service (Toi Te Ora) is one of twelve public health units funded by the Ministry of Health and is the public health unit for the Bay of Plenty and Lakes District Health Boards (DHBs). Toi Te Ora s key role is to plan and deliver services that promote, protect and improve population health, prevent ill health and minimise the risk of disease and injury through population based interventions. The service places an emphasis in its work on reducing inequalities in health outcomes and improving the health of Māori, children (including maternal health), and young people. Toi Te Ora suggests the idea of enduring wellbeing. Toi is the name of a celebrated ancestor in the Eastern Bay of Plenty and Ora is to be alive, well and healthy. Reviewed: July 2015 Review Date: July 2018 Green corridor image courtesy of Rotorua Lakes Council. Lake Taupo image courtesy of Taupo District Council. 1
Strategic Plan 2013-2025 Executive Summary Purpose Toi Te Ora s purpose is to improve and protect the health of the population with a focus on reducing inequalities in health. Vision Toi Te Ora s vision is Enduring Health and Wellbeing for All. Toi Te Ora also aligns its work to the Bay of Plenty and Lakes DHBs respective strategic visions of Healthy, Thriving Communities Kia Momoho Te Hāpori Oranga and Healthy Communities Mauriora. Values Toi Te Ora s values are: Compassion show compassion Attitude have a will-do attitude Responsiveness be responsive Excellence strive for excellence with diligence Priority Populations Toi Te Ora s priority populations are Māori, children (including maternal health), and youth 1. Goals In 2013 Toi Te Ora adopted five strategic goals aimed to improve the health of the population living in the Bay of Plenty and Lakes districts and as a mechanism to bring focus to our work. Three goals focussed on the health of the population within the two districts and the remaining two focussed on the organisation s wellbeing and on the quality of service delivery. This 2015 refresh of the Strategic Plan takes into account changes in the national and regional environment and reaffirms that the public health goals remain a priority. The service s commitment to quality and to staff wellness is now seen as a way of working rather than being aspirational long-term goals. For 2015-2025, Toi Te Ora has reaffirmed its public health goals: To reduce childhood admission to hospital from acute rheumatic fever, respiratory infections and skin infections, each by 2/3 in five years.* To reduce childhood obesity by 1/3 in 10 years.* To reduce the proportion of year 10 students smoking by 2/3 in five years.* The baseline year for each of the three goals remains 2013. Toi Te Ora is committed to a process of continuous quality improvement and to embedding a culture of staff wellbeing and engagement. 1 Children and Youth are defined as 0-18 years of age. *From 2013 2
Background Strategic Fit The World Health Organisation has provided considerable leadership for a settings based approach to public health provision. Toi Te Ora s service delivery model reflects this approach and its programmes of work are based around a number of public health settings including: The physical environment The wider health sector Marae Workplaces Education settings The wider community Toi Te Ora has adopted a Health in All Policies approach to its work. Health in All Policies is about improving public policies across the health sector, with other sectors, and with communities. It promotes trusting relationships and engages stakeholders to assess the impacts of all major decisions from a health perspective. This means systematically identifying the likely health implications prior to decisions being made. Health in All Policies seeks to avoid harmful health impacts in order to improve societal goals, population health and health equity. Challenges for Public Health The New Zealand Government is committed to its Better Public Services policy direction, which for health creates an environment where services are encouraged to work together to deliver health care in a coordinated and cooperative manner. The aim of this policy is to support people to be kept healthier within their communities through the delivery of more services, and to ensure they wait less time for services. Aligned to this policy direction is a set of health targets that provide performance measures for the health sector to improve health outcomes and service quality at local and national levels. In the Ministry of Health s Statement of Intent 2013 to 2016 one of three high level outcomes is that New Zealanders are healthier and more independent. Improving health literacy will be important to achieving that outcome. Health literacy is about individuals having the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions 2. Toi Te Ora is committed to working with others to improve the health literacy of the population. Additionally, within the current fiscal environment there is a need for health services to work more efficiently and effectively to achieve priority goals and targets. There is also a need for more prevention and reducing demand on treatment services. Toi Te Ora is committed to working across a range of sectors, including health, to achieve public health outcomes. Population Trends At the time of the 2013 census there were 206,000 people living in the Bay of Plenty DHB area and 98,000 people living in the Lakes DHB area accounting for approximately 4.9% and 2.3% of the national population, respectively. The latest projections used by the Ministry of Health to estimate DHB populations for 2015 show a population of 221,000 for BOPDHB and 104,000 for Lakes DHB. The 2013 census showed that a slightly higher proportion of the Bay of Plenty DHB population (18.5%) were aged 65 years or more compared with New Zealand as a whole (14.3%). The proportion of Māori for the Eastern Bay of Plenty (44%) and Lakes DHB (32%) is significantly higher than the proportion for New Zealand as a whole (14%). 2 Kickbusch, et al, 2015. 3
Approximately 25% of the Bay of Plenty DHB and 34% of the Lakes DHB populations live in high deprivation areas (NZDep2013 Quintile 5). The Bay of Plenty DHB population is projected to increase by 10% over the next ten years, while the Lakes DHB population expected to increase by less than 1%. However, of greater impact, the age structure of both DHB populations will change significantly with declining birth rates and a higher proportion of people aged over 65 years. Health Issues The prevalence of chronic conditions, in particular obesity and diabetes, is increasing in New Zealand as in most countries. These conditions are placing an increasing burden on both the population and the health system. At the same time New Zealand has a persistent legacy of infectious diseases, particularly in children, which are related to poverty and poor housing. These include rheumatic fever, skin and respiratory infections. The trends in both chronic and infectious diseases highlight areas where Toi Te Ora works with society to address factors that contribute to this health burden. For example, Toi Te Ora advocates for improvements to the quality of existing homes to make them warmer and to reduce crowding. Alcohol related harm is a significant health issue and one that continues to require focus and resource. Toi Te Ora is involved through its legislated responsibilities under the Sale and Supply of Alcohol Act 2012 as well as with its health improvement work, particularly within settings such as workplaces and schools. Māori Health Improving the health of Māori is a key priority for Toi Te Ora. This work aligns with Government targets and both Lakes and Bay of Plenty DHBs strategic goals. Toi Te Ora is committed to the principles of Whanau Ora and embeds them at both a service and programme delivery level. Both the Whanau Ora Tool and the He Pou Oranga Framework are applied across programmes to help ensure the effectiveness of initiatives aimed at improving Māori health outcomes. Toi Te Ora s three public health goals have a strong equity focus. Māori experience disproportionate harm from tobacco, rheumatic fever, skin and respiratory infections and childhood obesity. Toi Te Ora will continue to work closely with Māori Health Services of both DHBs to achieve its goals and will align its service delivery with their respective Māori Health Plans. Child Health and Youth Toi Te Ora continues to prioritise the health of children and recognises this must include the health of women prior to, during, and soon after pregnancy. The level of child poverty in New Zealand, the Government s focus on vulnerable children, and the need to reduce inequalities emphasises the importance of this work. New Zealand child health outcomes are a concern with infectious diseases still accounting for a significant number of avoidable hospital admissions. 4
Improving outcomes for children and young people, including maternal health, is crucial to realising a child s potential. It is important that our tamariki and rangatahi grow up in supportive environments which encourage and nurture positive health outcomes. The potential health gain for children from effective public health initiatives is life long and will have a positive benefit for the whole community. Goal Setting Toi Te Ora s public health goals address some major population health challenges, concentrating on the service s priority populations. As a public health unit covering a large geographic region and diverse demographic spread, the goals provide the service with its direction, help to address gaps in service and enable Toi Te Ora to work with and support other groups. Goal setting enables prioritisation of skills, knowledge, partnerships and funding to achieve the goals set. In conjunction with the Lakes and Bay of Plenty Population Advisory Group it was agreed in 2013 that Toi Te Ora s priority populations would be Māori, children (including maternal health) and youth; and that public health goals focusing on childhood infections, obesity prevention, and reducing tobacco use would have the greatest impact on improving the health of children and reducing inequalities within these populations. Toi Te Ora s goals are aligned with national and local health priorities and targets including the Better Public Services goal to reduce rates of rheumatic fever, the Smokefree Aotearoa 2025 goal and an increased focus on childhood obesity. Each DHB has its own rheumatic fever target with plans in place to achieve these. The prevention of childhood skin and respiratory infections fits with the two district health boards drive to lower ambulatory sensitive hospitalisation rates, which is monitored on an ongoing basis. Achievement against the childhood smoking goal will be measured using results from the existing national year 10 survey with the focus on preventing smoking initiation, rather than cessation. Achievement against the childhood obesity goal will be measured against data from the B4-school check and the NZ health survey data. These goals cannot be achieved by Toi Te Ora alone and require considerable collaboration with other health and non-health agencies. Using the Health in All Policies approach Toi Te Ora will continue to work with DHBs, councils, Healthy Families New Zealand and primary health organisations to address areas of common interest. The focus on staff wellness and engagement as a way of working every day reflects management s commitment to providing a positive work environment. This will be supported through maintaining Toi Te Ora s WorkWell Gold Accreditation. Finally, Toi Te Ora remains committed to delivering high quality public health services and delivering on its regulatory and contractual responsibilities within an agreed and evidence-based quality framework and will continue to incorporate this focus in its day-to-day work. Goals The following section outlines the three goals in detail and the high level outcomes for each. Toi Te Ora s goals and priorities are in line with Ministry of Health direction, the Midland region s focus, the Bay of Plenty and Lakes DHBs goals, priorities and Māori Health Plans. Further detail can be found in Appendix One. 5
Public Health Goals Childhood Infections Goal To reduce childhood admission to hospital from acute rheumatic fever, respiratory infections and skin infections, each by 2/3 in five years. Rationale The incidence of acute rheumatic fever, respiratory infections and skin infections are more common in New Zealand than in comparable OECD countries. All disproportionately affect children living in lower socioeconomic circumstances, and Māori and Pacific children. A significant proportion of all hospital admissions are potentially preventable through addressing a range of risk factors, health literacy and access to healthcare. Definitions For this goal, childhood is defined as aged zero to 14 years for acute rheumatic fever and aged zero to five years for both respiratory and skin infections. High level outcomes required to achieve this goal are: 1. Improved housing 2. Improved hygiene and self-care 3. Improved healthcare 4. Improved health literacy 5. Improved non-household childhood settings 6. Reduced smoking 7. Improved nutrition. Childhood Smokefree Goal To reduce the proportion of year 10 students smoking by 2/3 in five years. Rationale Smoking harms almost every organ in the body, and is responsible for nearly 5,000 deaths per annum. Tobacco use as at 2015 is the single biggest preventable cause of death in New Zealand; at least 50% of all regular cigarette smokers die from a smoking related condition. Smoking initiation is very unusual beyond childhood. The mean age of smoking initiation among New Zealand youth is 14.8 years and the focus of this goal is on preventing smoking initiation. Definitions For this goal, year ten students are aged 14 and 15 years. High level outcomes required to achieve this goal are: 1. Reduced smoking initiation rates 2. Reduced harm to non-smokers from second hand smoke 3. Non-smoking and smokefree becomes the norm 4. Increased smoking cessation rates 5. Improved health literacy. 6
Childhood Obesity Goal To reduce childhood obesity by 1 /3 in 10 years. Rationale Obesity is a major risk factor for a number of non-communicable diseases including ischaemic heart disease, type 2 diabetes, stroke, musculoskeletal conditions and some cancers. The issue is considered to become the leading preventable cause of health loss in New Zealand, overtaking the impact of tobacco smoking, by 2016. In children, obesity can be a factor in psychological issues, muscle and joint problems, hypertension and type 2 diabetes. Children who are obese have a much higher risk of being obese as adults and developing a non-communicable disease in later life. The first 1,000 days of life (from conception to a child s second birthday) are important in determining and influencing longer term health outcomes in childhood and adulthood. Maternal health (before and during pregnancy), and infant health are priority concerns for health promotion in order to achieve long term health gains for the population. Specifically, improving maternal nutrition, reducing the prevalence of smoking in pregnancy, and increasing the duration of breastfeeding of infants are important objectives that are likely to contribute to reducing the prevalence of childhood obesity as well as providing many other short and long term health benefits. Definitions For this goal, childhood is defined as aged zero to 14 years. High level outcomes required to achieve this goal are: 1. Improve children s nutrition 2. Improve maternal and infant health 3. Ensure children have an age appropriate amount of sleep 4. Increase children s physical activity 5. Improved health literacy. Implementation of the strategic goals This updated strategic plan sets a clear direction for Toi Te Ora over the next 10 years. The plan is underpinned by its annual plans which provide detailed strategies and activities that will support the achievement of each goal. 7
Appendix One Ministry of Health National Level Health and Disability System Outcomes New Zealanders lead longer, healthier and more independent lives New Zealand s economic growth is supported Ministry of Health Intermediate Outcomes Good health and independence are protected and promoted A more unified and improved health and disability system People receive better health and disability services The health and disability system and services are trusted and can be used with confidence Overarching Health Sector Goal Better Public Services National Health Targets 2015/16 Increased Immunisation Better diabetes and cardiovascular services/more heart and diabetes checks Better help for smokers to quit Better Public Services Results Supporting vulnerable children 5 Year Targets Result 3: Increase infant immunisation rates and reduce the incidence of rheumatic fever Result 4: Reduce the number of assaults on children 8
Bay of Plenty DHB Local Level DHB Vision Healthy, Thriving Communities - Kia Momoho Te Hāpori Oranga DHB Strategic Outcomes People take greater responsibility for their health People stay well in their homes and communities People receive timely and appropriate care DHB Focus Areas Māori health - achieving equity Health of older people Child and youth Chronic conditions Lakes DHB Local Level DHB Vision Healthy Communities, Mauriora! DHB Strategic Outcomes People are supported to take greater responsibility for their health People stay well in their homes and communities People receive timely and appropriate care DHB Focus Areas Child, youth and maternal health Mental health and addiction services Health of older people Managing long term conditions 9
Toi Te Ora - Public Health Service Our Vision Enduring Health and Wellbeing for All Our Emphasis Reducing inequalities Our Population Priorities Māori health Children and youth, including maternal health Our Goals Reduce childhood admissions to hospital from acute rheumatic fever, respiratory infections and skin infections each by 2/3 in five years Reduce childhood obesity by 1/3 in ten years Reduce the number of year 10 students smoking by 2/3 in five years Our Programme Areas Health Improvement Health Services Development Health Protection Our Focus Areas Social environments Education Workplaces Public health infrastructure Environmental health Communicable disease 10
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