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Senate Select Committee on Health
16/04/2015
Health policy, administration and expenditure

ATMACA, Councillor Adem, Mayor, Hume City Council

CADDICK, Mrs Margarita, Director, City Communities, Hume City Council

EMONSON, Dr Graeme, Chief Executive Officer, Knox City Council

EVANS, Ms Monica, Acting Coordinator, Healthy Together Geelong, City of Greater Geelong

HARRINGTON, Ms Patience, Chief Executive Officer, City of Wodonga

HOLLINGWORTH, Ms Michelle, Program Manager, Healthy Together Knox, Knox City Council

HOOPER, Councillor Paul, Mayor, Ararat Rural City Council

HUNT, Ms Angela, Manager, Community Development and Client Services, Ararat Rural City Council

LOCKWOOD, Councillor Peter, Mayor, Knox City Council

PARTON, Ms Kathy, Manager, Community Wellbeing Department, Knox City Council

PRITCHARD, Ms Karen, Manager, Aged and Disability, City of Greater Geelong

RUYG, Mrs Sharon, Manager, Preventive Health, Healthy Together Grampians Goldfields

TAYLOR, Ms Claire, Coordinator, Healthy Together Wodonga, City of Wodonga

YOUNG, Ms Elizabeth, Prevention Partnership Program Manager, Hume City Council

Evidence from Dr Emonson, Councillor Lockwood and Ms Parton was taken via teleconference—

CHAIR: We very much appreciate your being able to come and join us this morning for the roundtable.

Councillor Hooper : It is more like a square table today!

CHAIR: A square table it is. Healthy Together Communities is the title of the group that is gathered here. We have a number of organisations here. Would those who have an opening statement raise their hands. Mrs Sharon Ruyg, for everyone?

Mrs Ruyg : I am just going to make an introductory statement for the group. Thank you for the opportunity to present to you today. Our presentation relates to clause (c) of the terms of reference for this inquiry:

… the impact of reduced Commonwealth funding for health promotion, prevention and early intervention …

This delegation is made up of elected and appointed representatives from within local government areas across Victoria who are Healthy Together communities, which is part of the Victorian preventative health strategy that commenced through funding from the federal government under the National Partnership Agreement on Preventive Health, or NPAPH, with additional funding from the state of Victoria. I will hand over to Councillor Hooper.

Councillor Hooper : I represent a community that has an obesity rate of 55 per cent. In our opinion, we continue to fund a broken health system and model by ignoring investment in preventative health—it costs $180 billion annually to continue to deal with the effects of obesity—when we know that $1 spent now saves $5 down the track. From Ararat's perspective, we perceive that there is no greater time and no greater need than there is now for national leadership on preventative health and to deal with the effects of obesity, and the ongoing effects of that.

Councillor Atmaca : Thank you for the opportunity for us to present to you. I represent Hume City Council, which encompasses 188,000 people and is one of the fastest growing municipalities. The figures are that 70 babies a week are born, or two kindergarten rooms a week; and we have 55 new migrants arriving in our municipality every week. We have seen obesity rates—which have already been mentioned so I will not go into figures—between 2001 and 2011, in Hume only, increase by 238 per cent. We see prevention, as mentioned earlier, as being very important. The councils offer groundwork prevention for our communities through workplaces and schools, and it is about educating the community about better health. Because as councils we are at the community level, I think we do it best, but we need a long-term commitment from all levels of government to continue our work. Preventative health measures are not a short-term solution, as we all know. We need long-term investment in our community to make sure that, through education and other programs, in the future we do not have the problems we have today. It is like we have to turn the clock back to try and resolve the issue of obesity and, basically, bad health. Good health means a better quality of life for our community, and I think it is a cost-effective way to keep that quality of life continuing. So it is a small change that can have a big impact. Again, I think that long-term investment in this field is vital.

CHAIR: Thank you very much, Councillor. Is there anybody else who wanted to make an opening statement? Mr Lockwood.

Councillor Lockwood : Thank you. I just want to stress the importance of the three levels of government—local, state and federal—working together to align the policies, resources and action. Local government has a unique capacity to make a difference. In Knox, we have reached 51,000 people out of our population of 155,000, so this program is being effective. Obesity, as we know, is a national problem, and preventative health issues do not occur in one municipality or one state; they occur across the nation, and everyone has a role to play.

As we have heard already, in the absence of sustained funding to complement and bolster existing programs, it is unclear, without this kind of prevention program, how we will actually address the problems we are facing of chronic disease in our communities. Knox has added value to our community and benefited from the alignment. I think we are doing well. We are reaching all sorts of people, businesses, schools et cetera right across the community. I will leave it at that. Thank you.

CHAIR: Did anyone else want to make initial remarks? No. First of all, may I say that this is the largest participatory representative group we have had so far. It speaks to something that is quite remarkable: we have noticed in our visits through Victoria that the integration of care is already quite significantly advanced when compared to other parts of the country. Earlier in the week, we heard from experts in New Zealand who talked about the ways in which they are integrating health care and working in their local communities. You have indicated that you would like to focus on our third term of reference—reduced Commonwealth funding for health promotion, prevention and early intervention. That does connect intimately with other areas that we have put a lot of focus on. Health promotion, prevention and early intervention requires access to doctors.

I think it is fair to say that we have had representation from the Royal Australian College of General Practitioners, the AMA and health experts who say that putting a co-payment on access to doctors or a price signal that prevents people from seeking help from doctors early would expand the problems you have articulated. That is the evidence we have received. We know there was no consultation with those key agencies or doctors beforehand. We have also heard of the widespread concern across the country about a reduction of $57 million over 10 years from the tertiary health sector and about the tearing up of national partnership agreements. I am really glad to focus on health promotion, prevention and early intervention. You are the first group to make it a significant focus, but it is not an isolated piece of work. Perhaps I can go first to Councillor Atmaca. Clearly a 238 per cent increase in obesity in Hume is a very significant increase over a pretty short period of time. What was it?

Councillor Atmaca : From 2001 to 2011.

CHAIR: Over 10 years that is a very significant change. What is the council's engagement across a number of fronts in trying to address this? On the promotion side and the prevention side, but do you do anything on the early intervention side as well? How do you interact with local health agencies at different levels? What, if any, change has been a part of the urban design principles you employ as evidence based best practice?

Councillor Atmaca : I have some notes here, but I might also refer to my officers for some other information. For example, the way we have been working with our community is through physical activity and healthy eating activation, reaching to the grassroots level. We have included things like Jamie's Ministry of Food mobile kitchen, and people are invited to learn to cook. We have a very low socioeconomic area in Hume around Broadmeadows and the 3047 postcode. Figures show that the consumption of vegetables and fresh food was very low, compared to the rest of Australia. So we focused on trying to get that fresh food into people's homes. As a low socioeconomic area, it is a lot easier for people to spend $10 or $15 on a pizza or takeaway burgers rather than cooking fresh food for the family. Of course, that exacerbates the problem of obesity.

CHAIR: James?

Councillor Atmaca : Jamie Oliver's kitchen.

CHAIR: How did you make that connect into your community? Where did it operate? How did you fund the engagement? Who participated to make it an ongoing, rather than a one-off, event?

Councillor Atmaca : I will pass over to our director.

Mrs Caddick : I think Liz Young, who is our program manager for Healthy Together Hume, is probably best placed to answer that question in detail.

Ms Young : Jamie's Ministry of Food was a partnership with the Goode Foundation and the Department of Health and Human Services in Victoria. It provided an opportunity to go to our 12 local communities to teach skills around food literacy and better cooking, to challenge some of the notions about takeaway food being cheaper than buying fresh fruit and vegetables and to upskill our community by focusing on the lower socioeconomic areas. I guess Jamie's is close to finishing up; we have got one more of our Healthy Together Communities sites to visit. Certainly utilising Jamie Oliver's name and profile has been a significant way for us to then leverage other opportunities in our communities.

CHAIR: You said there were three sources of funding there; could you please restate those and, if you can maybe on notice—give us the amounts that were invested.

Ms Young : The funding came from the state government through the Healthy Together Victoria policy. That was originally funded through the NPAPH agreement on preventive health, so it would probably be dual sources there. I would then probably take it on notice—

Senator JACINTA COLLINS: Sorry to interrupt: was that the first such agreement? The national agreement on preventive health?

Ms Young : Yes, that is correct.

Senator JACINTA COLLINS: That was the first such national partnership in terms of prevention?

Ms Young : That is correct. That is originally where we received that significant source of funding to try to make an impact on preventative health. In terms of the cost around Jamie's Ministry of Food Mobile Kitchen, I will have to take that question on notice.

CHAIR: Thank you. Could you provide us with the breakdown of where those moneys came from. There was the loss of the National Preventive Health Agency—I think they have restored its existence through a disallowance motion in the Senate, so there is a vehicle sitting there, but it has got no money attached because the money was removed by the federal government. Clearly there is passion about preventive health that that symbolically represents. Is there anything else you wanted to add about the program—how you integrated it and to what degree you found it effective and ongoing?

Councillor Atmaca : I tried to go and have a look at how it was going, and they said I would have to book in to do that, but it was booked out! It was quite good to see so many people taking advantage of the learning and cooking classes that we did offer. At the same time—and it is something small—we put small portable gardens around the caravan so people could take home herbs and other things that had been grown in the pots. It was a way of teaching some families who maybe do not have any vegetables in their homes about fresh food, basically. We find that, and this an important part, that it is a generational thing. If people grow up eating fast food and it is what they have always known, then when they get to an age where they have children, that is what the children see. It is like changing people's mindset with education through these programs where they get exposed to other foods. Believe it or not, I know people who live in that area who never eat vegetables. One person I know will only eat sausages and a steak, and of course food from a very popular hamburger outlet. That is his diet. So that person—

CHAIR: It is not the ABC. You can actually name it!

Councillor Atmaca : Okay—Hungry Jack's and McDonald's. He loves those outlets, and his kids are also going along those lines. And I think that he is only one of thousands in the community, so it is a generational thing—people are brought up and have that problem, then it is followed through with the next generation as well. We find that. We have had some other programs which have been popular. I am a Kangaroos supporter, and we all know the champion football player, Daniel Wells. We use him as an ambassador to increase the profile of healthy eating through our businesses and also our school community. We have a morning businesses breakfast where there is a healthy breakfast—and it is not a sitting down event, it is standing up—and we get Daniel Wells out to speak to members. One very important one we did was to go into the workplaces, and we had a healthy eating regime for them. Then we would acknowledge the companies that were involved in it within our community. I will hand over to Elizabeth Young for a short brief on that.

Ms Young : Adding to what Councillor Atmaca has said, I should also say that the way that we are working is a settings-based approach, so when we mention the workplaces setting we are also working at a childhood setting and also at a community setting. The idea is that the more that we can work across where people live, learn, work and play, the more likely it is that we will have an impact in terms of preventive health. The focus around workplaces was really seeing an enormous opportunity to improve worker health right across the community—hopefully and ideally then linking in to what they take home to their family as well. That is just one approach, and I think you will hear many more today.

CHAIR: Wonderful. Senator Di Natale, did you want to ask any questions before we move on from that? We will invite other comments as well.

Senator DI NATALE: Yes. I am not sure if this is the right place. I do not know if you want to get a bit of context, but I am interested in learning a bit more about how the changes in the last budget—the $370 million that was cut out of the National Partnership Agreement—impacted on the work that you do. Are you happy for us to go there now?

CHAIR: Yes. Is there anything else about your work that you want to put on the record or any innovation that you think we need to record today? That would then be a natural movement.

Ms Hunt : I would like to add to what was being talked about within that context of settings. From a systems based approach, that is happening not only in one local government area. All 14 local government areas are working towards the same approach where we work with the schools, we work with employers, we work in all sorts of different settings and areas where people are. I think the key that we have been looking to work towards is that this is not just the business of health services; this prevention is the business of everybody, whether or not you have people that you are employing. Across the community, this is everyone's responsibility. It cannot just sit with health services. There has to be leadership from right across and from all levels of government. That is really the way that we focus, and I think that happens across all of the Healthy Together sites and reaches even further into those that are not Healthy Together sites through the systems approach, where we can look at policy, where we can look at it from multiple angles, where community themselves are empowered and educated to be able to do things. Sometimes the project things are the things that look glossy and that people can see and focus on, but a lot of that systematic work that happens through policies, whether it be at federal, state or local level or within workplaces or schools, helps to vault around the impact and support the work that communities are doing as well. So I just wanted to add that.

CHAIR: Is there anybody else in the room who wants to make more broad comments?

Ms Harrington : Can I could just make a comment? This is the first time in my 25 years of working in the health system and local government where I have seen the three levels of government truly aligned, where the federal, state and local health outcomes and expectations have shared the same measures, the same goals. That has been extremely powerful. I think a reflection of how distressed we feel is the number of people here today. We have seen three years in Victoria where over 600,000 Victorians have been reached. At Wodonga we have changed our local planning scheme as a product of Healthy Together just to make sure that, as we plan—and we are one of the fastest growing cities—our people have good access to healthy, fresh food. How our cities are designed is very much part of that, right through to the preschools we run. We have seen a complete policy renewal within our preschools within the services that we offer. We also have partnerships at the local level that we have not realised before. Regarding community health, as you indicated, we understand that health prevention is an early part of the health continuum, but we have had a strength in partnership with community health like I have not witnessed before where you are seeing more effective use of dollars and more effective implementation of programs as a result of those shared measures. So it is exciting to see something that is driven from the federal sphere and some KPIs that are really being reflected locally. Private sector investment is also very considerable in this project, and that is something we can provide you with information on.

CHAIR: One of the concerns we have is that while you are talking in the present tense you are just about at the end of achievement that the funding enabled. The funding that enabled this has now gone. That goes to Senator Di Natale's question on the impact of the withdrawal of federal funding and leadership with regard to this.

Ms Harrington : I was involved very early with the state government in this program's design and implementation, and there was at least a decade of thinking that we had around this. With all due respect, we are not here to debate whether health prevention works. This program has been named by the World Health Organization, and the federal government itself is a signatory to the global action plan, of which obesity is one priority. We have been named in The Lancet and in Australian Doctor. The recognition of this program and its impact has been fundamental. We are going to lose what is significant cultural change in the way we empower our people and our citizens to take care of themselves rather than rely on a system.

Senator DI NATALE: Tell us what that means, because some of us have worked in health; others have not. Often we talk about it in broad terms but we had $370 million taken out of the national partnership agreement. I remember having an exchange with the minister responsible during Senate estimates and being reassured that all the work that was being done would continue to be done, which begs the question: how have we wasted $370 million?

CHAIR: We could do it with nothing then; we could do it with no money.

Senator DI NATALE: That is right. But what is really hard sometimes in that setting is to work out: what does this program look like—

CHAIR: Who is going to miss out.

Senator DI NATALE: who misses out; and what is actually going on on the ground? We talk about it as systems approaches and all these lofty theoretical discussions but we do not hear enough about the work that you are doing on the ground, so it is an opportunity for me to learn more about that and be able to communicate that.

CHAIR: Ms Taylor, it looks like you are leaning in there.

Ms Taylor : Yes, I am. On the ground this translates into one massive community collective effort in a way that we have not seen before. It really translates into the early-year settings where we have 95 per cent of our early years that we are working with in creating health-promoting spaces. What that means is that all of our early learning centres are focusing on healthy eating, physical activity and how they promote that for their kids and families in their communities.

Senator DI NATALE: How do you engage with them? How do you engage with your early learning centres? You are saying that 95 per cent of kids who are in that environment are going to be influenced by the work that you are doing.

Ms Taylor : Absolutely they are.

Senator DI NATALE: Talk me through how that happens.

Ms Taylor : We have the Victorian Healthy Together achievement program for early learning centres and for schools.

Senator DI NATALE: What is that?

Ms Taylor : It is a program that looks at eight benchmarks: everything from healthy eating, physical activity, mental health, sexual health—that is for secondary schools. But there is a whole range of benchmarks within that and we go into a service, we engage the service—

Senator DI NATALE: Who goes in?

Ms Taylor : Our staff go in. Our highly-skilled workforce go in and work with our community leaders—

Senator DI NATALE: They would generally be health promotion officers.

Ms Taylor : Yes, and they engage these services to work with them. We do not go in and say, 'We're going to do it for you'; we go in and say, 'We're going to do it with you.' We partner with them and we get that bind at principal level, director level, of those services. They establish health and wellbeing teams within those centres that drive that program throughout that centre. We support, we resource, we link and we connect but we do not go in and do it for them.

It is a different way of activating community, and I think it is working. You just have to look at some of the inspirational strategies that they come up with themselves to drive change, because they understand their local context. They understand their families far better than we do, but it is about us equipping them to go, 'How are you going to improve healthy eating for your kids? What are the messages going back to families in your communities? How do we do this together?' It is amazing some of the work that they come up with and then they start to experience that not just in early learning centres but you are hearing it in workplaces as well. So the mums who have children at the centre are now getting these health-promoting messages as well from some of the workplaces in our community.

Senator DI NATALE: Again, so we have got early learning. Schools, I imagine, are similar to what you have just described.

Ms Taylor : Yes, absolutely.

Senator DI NATALE: What happens in a workplace?

Ms Taylor : It is actually quite similar. Again, in the achievement program for workplaces we engage the CEOs or workplaces and the directors. We align their goals and say, 'Employee health is really important.' We have got—

Ms Harrington : I think your point about what has happened at Knox is a brilliant one—your workforce, weight loss and eating good food.

CHAIR: Who is going to speak about that? Ms Hunt, Ms Pritchard or Ms Evans? It is Ms Hollingworth.

Ms Hollingworth : We were just talking about my workplace, Knox City Council—and my CEO Graeme can probably attest to this. We have used the team program on our own council as a way of being a leader in that space to other businesses and we have engaged 45 businesses across Knox. One of the key things is around saying, 'We need to create that health-promoting environment and ensure that our staff have access to healthy food, physical activity and opportunities.' Today, Graeme gave an award to one of our internal departments that has collectively lost 80 kilos over the last year. That may seem a small thing, but that is within the context of council being a healthy workplace. We work with other workplaces and this is the way to scale things up across a whole municipality of 150,000 people.

Senator DI NATALE: Talk us through some of the things that you have done? I am a concrete thinker. Tell me about the things you have done in your workplace that have allowed that to happen?

Ms Hollingworth : Graeme, please butt in if you want to with any of this. Graeme is chair of our staff health and wellbeing committee. Leadership internally is really important. We now have healthy catering. All our catering now is through healthy catering. We have contracted caterers can meet Traffic Light. I do not know if you know about that. It classified food.

CHAIR: Yes. Red, amber and green food coding.

Ms Hollingworth : That applies to the procurement of all our catering, which we estimate to be about $150,000 a year. We have also introduced staff opportunities for physical activity at lunchtime and after work. We have a partnership with a leisure service to provide those opportunities. We have a standing work day protocol with standing desks. On the ground, that is what that looks like. It is council being a leader in that space. If I could throw to my CEO to add his leadership perspective.

Dr Emonson : If I could build on Michelle's comments. We have approached it as a health-promoting organisation and we very deliberately and specifically use that terminology. Not only do we want our staff to live healthier lives; we also want to show a leadership influence within the local community in that space. We have approached it from the many facets of leadership. We rolled out very obvious things like changing our catering to make sure that we truly understand what food we are eating where council is providing that food. We have provided all sorts of opportunities throughout the workplace to make sure our people are less sedentary by giving them the opportunity to stand up and walk around, and by encouraging walking meetings. We have a committee which is cross-organisational that is looking at a whole range of things, including not only healthy food but physical activity and how we can encourage our people to be more physically active.

As Michelle said, I had the opportunity this morning to recognise one of our teams—a blue collar team with a staff of eight. Traditionally, you would not have seen them as health champions, but through the influence of hearing the messages constantly and it being reinforced within the organisation, mid last year they set about to lose the equivalent weight of their lightest team member and that happened to be 80 kilos. I was really proud this morning to be able to recognise that—in fact, they have gone past that now. They proudly stood up in front of their blue collar colleagues this morning and talked about how it had changed their lives and how that was influencing their home lives as well with their family and their friends.

There is no one, single fix. It is not short term; it is long term. I think that is one of the serious consequences of the withdrawal of funding 30 June this year. We are talking about generational change—long-term systems, community-wide change—which needs a period of time. Local government is ideally placed to be leading this with the support of others. We have a team of 11 working across our community, which quite frankly as a local government on our own we would not be able to do. We are best placed to do it, but we would not have the resources to do it. From the longitudinal study aspect, to cut short this program by three years I think is a really serious lost opportunity for Australia.

Senator DI NATALE: The other question is how you go out into the workplaces. Is it demand driven? Do you do outreach and let people know about what is going on and then people opt in? Is that what normally happens in the workplace environment?

Dr Emonson : Michelle can back up, but it is both of those. We are broadly encouraging workplaces to get involved. We are approaching workplaces directly. As you will appreciate, there are some who are early adopters and we are looking for them to be champions within their own sectors. It is a universal approach and that is on many fronts, but we have been quite targeting some of the larger employers. For example, Parmalat has their state head office here in Knox, in Rowville. They are a large employer and have both office space and blue-collar workers. They were early adopters but great champions and they are really proud of the work they have done. We have been very happy to work with them and encourage them, by talking to others not only in Knox but also in the broader sector about their achievements.

Ms Evans : I would like to contribute to what Graeme has just commented on. In Geelong we are seeing a big shift with the business community. We work with 78 workplaces, in Geelong, and that amounts to around 28,000 employees across those workplaces. Those workplaces, in the initial phase, were starting to think about health and wellbeing of their staff in a more traditional sense, looking at running a series of programs—maybe some yoga classes and some activity classes. They were looking at a much more traditional approach to the way they support the health and wellbeing of their staff. Now that tide has turned, as we are moving through the program or initiative. They are now starting to think a bit more broadly around the connections with those businesses into the broader community. They are thinking about their policy platforms, their environmental platforms and their influence on the broader community as to how they can influence the local health of the community.

We are working quite closely with the chamber of commerce and our G21 committee to look at how we can improve the health of the community—as Angela was saying earlier—to make it more owned by the community as opposed to owned by the health system. Those workplaces are working more broadly with the community and the council to look at planning and strategy policies across the council, because they are now starting to demand healthy environments. We are working on two levels. The Achievement Program provides an opportunity to increase demand through early-learning centres, primary schools, secondary schools and workplaces. Then we can meet that demand by shifting and modelling the supply—what the health providers are doing in supporting those settings and what the council is doing in relation to supporting those settings, in terms of supply.

It is both a supply and demand scenario. Of the Healthy Together Achievement Program settings, in Geelong we have 138 children's settings and 78 workplaces and they are starting to demand specific policy requirements, changes, services and products from council and from the local community. They are demanding a health-promoting environment.

CHAIR: Once you have discerned these needs—obviously, you are doing ongoing audits to come up with this information, and the next layers look like what you have achieved—how do you go about funding that? Is it entirely out of the resources of the local council or has it been through this federal-state money that has been priming the system, and what happens when that money runs out?

Ms Pritchard : Without the funding through the Healthy Together Victoria program, we would not have been able to run the program at all through the workplaces or the children's services settings. It is totally dependent on that. If the money runs out at 30 June—as is proposed—we will all be in dire straits, in terms of how we continue to support those workplaces and children's-services settings in maintaining the achievements they have reached to date. It does risk tapering off and not having the full impact that we had hoped it would have on a population basis.

CHAIR: It is a pretty specific example of where money spent in health is described as a 'cost' by the provider of the fund or perceived as a cost where the community is receiving it and using it as an investment. Clearly, that is what you are all seeing. Hansard is not very good at recording nodding, but they are all nodding almost in unison! Let us just put that on the record. There is a hand up: Ms Hunt, did you want to add to that?

Ms Hunt : Yes. Thinking along the investment lines, if we speak about health and wellbeing around our larger employers in Ararat, these days, we will be cut off halfway through by them talking to us about what they are doing within their workplace and how they are changing their environment entirely. We have a workplace alliance that has formed with those that have signed up to be health-promoting workplaces, and they work together. They work challenges across different workplaces. They are very proud of the work they have done. On top of that, they are not only doing it because they are nice people. They are improving their bottom line as a business, because their lost days have decreased dramatically. Those are the things that they start to talk about as businesses. It is an investment. They are seeing, at a local level, immediate improvements to their bottom line because they have a healthier workforce.

Senator DI NATALE: Let me play the devil's advocate. They could continue to do that after the funding has gone. Is it the fact that you have the one person or the people who are employed at a local government level who are just driving and coordinating it and bringing those people together? I imagine what will probably happen is there might be a few groups that continue and say, 'This has been good for us; we want to continue', and then over time that will fall away?

Ms Hunt : Yes, and that was the other part I wanted to talk about. Without this funding, there is no doubt that, for small rural councils—I cannot speak for other councils—there is no way we can continue this work. I do not see it as being work that we have to do forever. Everything that we do, and I would say that would be across all areas, is intended to embed sustainability. We are just not ready yet. It is just too soon. Other efforts are being funded for 30 years. This has had probably two to three years of funding. The only reason we have been able to continue in these last nine months is that all of the CEOs and mayors from these local governments went to the state government and said: 'You must finish this at least for the next 12 months. You cannot not fund this.' To have 14 CEOs and mayors that are involved in Healthy Together Victoria is a really loud demonstration that we are not yet ready to let go of it. We cannot let go of it yet. We cannot possibly fund it ourselves at the moment. I do not think anyone sees it as being something that has to be in place forever. Sustainability is being considered by working across all those areas and by empowering those workplaces to be able to see for themselves that it is not, from a workplace perspective, just about being nice. It is of good value to them in the end. It is just not embedded yet.

CHAIR: What message do you need to send through this committee in terms of recommendations that we need to make? Ask what you want.

Ms Evans : We need more time.

Ms Hunt : More time.

CHAIR: Can we go to Sharon Ruyg, and then I will come to you, Councillor.

Mrs Ruyg : Very clearly, what Healthy Together Victoria has done for these 14 local government areas, and more broadly for the whole state, is take an approach that is on multiple levels and has multiple strategies. What we would be seeking is the reinstatement of the partnership agreements, in particular in terms of what was funded to Victoria and the approach that Victoria has taken. It was well considered. It was evidence-based. It was setting an infrastructure in place that we have referred to as the achievement program today. That is one of the tools that has been available to not just the 12 Healthy Together Victoria communities but the whole state. Victoria's approach was, at a very high level, to bring together key stakeholders to lead in prevention, with a desire to build a preventive health system. A key message from our group today—and I would ask others to add to it—is that we are seeking prevention to be funded at equal levels to health, in terms of the acute sector, in the long term for Australia. We know for every dollar spent there is a five-dollar saving, and that has been brought to this inquiry previously.

We are in a position of evaluating the work that we have done. We have a global audience. You heard from New Zealand. New Zealand has invested in Healthy Together Victoria's approach. It is also being looked at by other parts of the world. It would be very unfortunate for our nation to not be stepping up at a time when the World Health Organization is making those statements. The next decade needs to be an investment in prevention. It is very important that that message is heard. These local governments are making a concerted, coordinated effort which involves leadership; it involves a talented, skilled workforce; it involves governance.

The fact that we have local governments—representing rural, regional and metropolitan communities—who have travelled to Colac today demonstrates that we want to make the message very clear that it is an important piece of work. It is on the verge of being able to be delivered at scale. All of us would be in a position where we could be talking to you about the neighbouring municipalities—the neighbouring regional partnerships that we have—who are wanting to find out more about the systems approach and apply it to their practices. The alignment and everything is ripe for doing this work at scale. It would be a tragic result if, come 30 June, neither state nor federal governments recognise what is being achieved here in Victoria.

CHAIR: You have made some pretty clear calls in your submission to us today in your desired outcome section there. We do note the recommendations that you are asking us to make. Thank you very much. Given that the Senate has used the legislative capacity that it has to disallow the government's action on getting rid of the national partnership health organisation, there is a vehicle that continues to await funding. I guess everyone is mindful that there is a budget being delivered. What you are asking for is, essentially, able to be delivered through that vehicle because the vehicle still exists.

I have indicated, Councillor Atmaca, that you would get the opportunity to make some remarks.

Councillor Atmaca : The passion sort of made me jump in earlier; I apologise for that. You can see the passion around the room. Councils also have a tight budget and when we see that a CPI increase will be introduced in Victoria that means there will be less capacity for us to raise funds. When councils do not build a new building for a footy oval people can live with that. They think, 'Yeah, it might happen next year or the year after, once we've got funding.' But what we are talking about here is health.

We are so passionate about it because it affects people's health. It is not a building which might be built in two years; this is funding to improve people's health. You asked a good question earlier: what would happen if the cuts went? If the cuts went, even metropolitan councils would find it difficult to follow through a program such as this at this level. As I mentioned earlier councils start at the grass roots, from when babies are born through until when they are in the nineties. We provide a service throughout. We are the best link for the community to provide this preventative health through our child and maternity healthcare centres, which we go through with the kids, through to our youth programs and our senior citizens.

I think it is very important that the funding continues throughout that stream, where we can follow this program through to make sure that obesity levels are kept down. If we do not get the funding we are going to see the 238 per cent increase going up to 400 per cent or 500 per cent. The 50-plus per cent obesity is going to go up to 60 per cent or 70 per cent. I think that, with a modern country such as Australia, and the financial resources that we have, we can stop this. It is a long-term thing. You cannot expect, in three years, to turn obesity rates in Australia around. I think it is very important that this continues. If we do not do it there will be more people putting pressure onto the health system in the future. We do not want people to pay $7 or $5 excess. We do not want them to go to the doctor when they are elderly. I think it is prevention now that will stop that in the future.

CHAIR: I will just give Ms Parton or Councillor Lockwood the opportunity to put any remarks on the record before we advance to any other issues. Mr Lockwood do you want to say anything?

Councillor Lockwood : I just want to reiterate that the 12 councils, 12 CEOs, 12 mayors are stepping up and showing some leadership here to speak in favour of this program that is actually getting some results. It is looking very good and, over the three years, it will definitely succeed. We are exceeding expectations already and the continued funding of this program is essential. It is very important for the health of our community.

Ms Parton : To complement Councillor Lockwood, I would agree. I think the key here is that we know it is working. I think it was Patience who said that there is already evidence that a health promotion approach makes a huge difference. There is evidence of the outcomes. We know it is working at a local level. The loss for us of this funding would be incredibly significant on our population, our organisation and all the settings we have talked about. We would have a serious impact on the progress we are making. I think that is really significant. This has been an unprecedented approach. We really would see the value of its continuation quite incredibly on our population.

CHAIR: We have not heard from Mrs Caddick.

Mrs Caddick : I think you can probably sense the passion and the unified voice that local government represented here today is speaking with. I want to illustrate a couple of really exciting things that I have observed happening in the northern metropolitan area of Melbourne. Just last week in the regional management forum which is seven northern metropolitan councils, of which two have been fortunate to have the Healthy Together program, the seven councils came together so that the two councils that had received the funding could share the learnings and the practices. The other five councils were keen to hear how they could embrace those learnings and practices and filter them out into their municipalities. Northern metropolitan Melbourne is probably home to a good third of Victoria's population. So that is the sort of reach and scale that this program can have.

I have also been particularly heartened because the point that has been made about working in partnership is a really important one. In Hume City we work with Whittlesea, which is a neighbouring municipality, and we have one large tertiary hospital, Northern Hospital. The Population Health Advisory Committee of that hospital has initiated discussions with the councils, with Medicare Locals, which will soon be replaced with the Primary Care Partnerships in community health, and they are saying 'We want to work on the prevention end.' They do not mean that they want to be delivering prevention programs. They are saying 'We want to work with you and assist you in making sure that those prevention efforts happen so that we have not got people queueing up and coming into our emergency doors.' So there is a really great momentum happening at this point in time, working across the health sectors but working with all levels of government to really make a difference and turn around the health of the Australian population to one where we have more people living healthy lives and fewer people needing to be serviced by the secondary and tertiary end of the health system.

CHAIR: Councillor Hooper, you made an opening remark but is there anything you want to add at this point?

Councillor Hooper : In Ararat's example, a lot of it was leadership. In a poor socioeconomic municipality, such as Ararat, our immediate neighbours being Pyrenees and Central Goldfields, with certain circumstances aligning, if you exclude nutrition we have gone from the bottom quartile of all health measurements into the top quartile of all health measurements in 18 months. So the upside of these sorts of programs, combined with fantastic local leadership, is enormous. Ararat is a classic example of that. It can happen.

CHAIR: They are extraordinary statistics. Could you provide us on notice with more detailed information I am sure there would be many people interested in hearing the story and trying to put a face on what this could look like in communities right across the country. Sometimes the news can lead to depression and a sense of things that cannot happen but when we hear things like this it certainly lifts my spirits, and I can see you are all excited by it, so it is very important to try to record that.

Before we move on to the broader conversation, in light of your comment I have a question about the research. Who is undertaking the research? How advanced is it and where is it being published?

Senator DI NATALE: Then an evaluation of how well it is working now.

CHAIR: Absolutely.

Senator DI NATALE: I will just give that some context too. You probably do not have to convince us. I suspect you have probably got senators who are broadly sympathetic to funding prevention. I will speak for myself, but hopefully I am speaking for others. Our job is to try to have the information at our disposal to demonstrate that this is effective and to provide us with the opportunity to advocate on your behalf. I think the really critical question is: how do we know this stuff works? What have you done in terms of evaluating the program to demonstrate it has been effective?

Ms Hollingworth : It comes back to your question about how the NHPA funding enable that. The state government of Victoria at the time took that money and decided to do something different. That is because what has happened in the past—and this may have happened in other states—was that often smaller programs were funded in a more protracted way with little buckets of money, whereas they wanted to set up a whole infrastructure around a prevention system. That is because we have a judicial system and we have a health system or an 'illness' system, but we do not have a prevention system. They wanted to set that up.

What they did with that is that they also funded the 12 sites that you have in front of you, as well as set-up that architecture. We are lucky in Victoria that we have the Victorian population health survey that comes out every two years. That gives is population level data around what you have heard today in terms of physical activity, nutrition and obesity rates. All of that comes from that very sophisticated data management process. They got that and they funded the 12 sites to have the state-wide architecture, as well as how this would look in a local context. This is where the interesting part is: each of our local governments was matched with another local government that did not get the dose.

CHAIR: So you have got a comparative study.

Ms Hollingworth : I use the word 'dose' because it does resonate with people. The dose is actually the people. The workforce on the ground, so the 120 people who are across Victoria in each of those local government, are the dose. These things cannot happen unless we are meeting with childcare services, if we are not meeting with primary schools and if we are not working with disability services. That cannot happen without people. That is the dose.

Each site is matched with another local government. The issue with this is, as you know, the NHPA agreement went on to 2018, because they had to give them an extension. Victoria thought, 'Good, we have got nine years now to plan for that approach and to then at the end have sophisticated data that this makes a difference.' What happened in 2014 with the pulling of that $110 million was that a huge research project is actually at risk of not being able to be delivered. We actually do not know which local government we are matched with, as that is happening at the state government level.

Senator DI NATALE: It is a blind test.

Ms Hollingworth : Yes. This is very sophisticated. This is very well designed. We do not know what the outcome of that is and, if we are not funded, we will never know. We will never be able to prove that.

Senator DI NATALE: Would you be able to get an interim report that demonstrates—

Ms Hollingworth : We will be able to get our Victorian population health survey to each of our LGAs and track that over time, but again there is a two-year lag without. People can butt in here: we are also doing it at a local level, but that will not give us a population level approach. We want to be able to see this out to the end to prove that Healthy Together Victoria is the answer to the federal government signing up to the World Health Organization—

Senator DI NATALE: If they were to cut it off by the end of June, we would have to wait a couple of years and then we would get some information that might tell us—

Ms Hollingworth : By then your infrastructure is gone and you have no way to scale that data.

Senator DI NATALE: I know. It is after the fact.

Ms Harrington : The whole system is designed with in-process measures as well. Just to let you know, the whole model was designed with research capturing everything that has happened within it. There are in-process measures that are available on the high level of policy and strategy and also for all of these local governments. The sophistication of the measures of what is happening with our people is good and available, but whether that is going to give the federal government its answers to its $58 billion obesity problem in terms of, 'Hey, we've made a difference,' is what we risk.

Ms Young : I would add that Hume City Council has actually undertaken some community indicators as an interim measure between the Victorian population health survey data in order for us to actually see how we are tracking. We have actually used the same questions and methodologies, so once again we are comparable. We have actually seen an increase in fruit and vegetable consumption from 2012 to 2015, which is the period of time that Healthy Together Victoria has actually been in the community. We have also seen an increase in physical activity and a decrease in sedentary behaviour overall, and we know that those are, very clearly, two indicators around population health outcomes.

CHAIR: Ms Hunt?

Ms Hunt : Just on the availability and collection of data when it comes to these things, the Population Health Survey data comes out, I think, every three years, but it means that we have six years to wait. We will find out in six years time whether what we do now has had an effect or not. From our perspective, when trying to provide evidence, that is just not fast enough. So we have done our own work—well, we were fortunate enough, throughout an 18-month period, to be able to do some data collection, which happened via Roy Morgan Research, because people kept saying to us: 'Show us the data. Show us it is working.' We have just received the data that came out that was collected right before Healthy Together started; that has just been received now.

CHAIR: So your baseline data in fact has just been delivered?

Ms Hunt : It is all too old. We do not want to work that slowly. We do not want to take three to six years to find out if what we are doing is working. So we have been able to do that. It is not necessarily going to be recognised data, but it is something that we do take—

CHAIR: So is the less controlled and more dynamic data that you are generating still echoing the design principles of the overarching piece of research?

Ms Hunt : Yes.

CHAIR: Have any of you established partnerships with academic institutions or leading academics who are doing this as part of PhD studies or postdoctoral work? Who is writing up what you have got on the ground, essentially?

Ms Hunt : I do not have the full details, but I know our health service—East Grampians Health Service—is currently doing a research project. We have been fortunate that—despite the fact that our hospital understands that, for us to have a healthy community, they lose money—they are still interested in being a partner in prevention with us. So we are pretty lucky there, I think. And that is what it takes for us to be able to have hospitals involved in it, as part of that partnership. They know that a healthy community means no dollars for hospital beds and those sorts of things. Our CEO at East Grampians Health Service has recently engaged for a research project to occur for us here, in our municipality, but I am not sure—

CHAIR: If you could give us some more information about that, that would be very helpful, and any data analysis that has gone on. Ms Hollingworth?

Ms Hollingworth : I might defer to Ms Harrington.

Ms Harrington : I think it is important to understand that the Victorian state government, when this systems approach was designed, actually did identify a research component, and there was a separate organisation that was developed and put into place with a board of management, directly about researching a health prevention systems approach, and that is what is happening with this program. CEIPS is also connected internationally—

CHAIR: What is that?

Ms Harrington : It is a centre for innovation in preventive health. This is a separate new body that was set up by the Victorian state government.

Senator DI NATALE: When was that established?

Ms Harrington : That was established at the point that Healthy Together Victoria was established. We looked at that research body; it is, as you are indicating, Senators, really important to get that professional robustness in the system.

Senator DI NATALE: Is their only focus on this piece of—

Ms Harrington : No, it is a broader focus, and certainly they have those international connections, which we can provide you with.

Senator DI NATALE: Can I just say also what would be helpful—

CHAIR: Ms Young, I think, wanted to make a comment, and then I will go straight to you, Senator.

Ms Young : I just wanted to add that academic institutions are involved, and they actually are quite considerable. Monash, La Trobe and Melbourne universities all have varying aspects of it, and Deakin University also hosts the centre for obesity. All of those institutions are currently involved in varying aspects of the research and evaluation of Healthy Together Victoria. It has so many different components that there have essentially been different elements of it. For example, we have been doing some research around a healthy food basket, on: 'What is the cost to get a healthy food basket in your community?' So we have a longitudinal study in place that has had some initial findings that demonstrate that a healthy food basket is actually more expensive or cheaper in different communities. So that access data is really essential; it is essential that we can monitor that and see that the interventions that we are putting in place are actually having an impact on the cost of access to healthy food.

CHAIR: Or appropriate to the context, given the data that you have.

Ms Young : Correct.

Senator DI NATALE: It would be helpful for the committee if any published data and anything that would lend weight to the effectiveness of this program could be submitted to the committee. It would be useful for us in compiling our report. Because it is such a distributed initiative, I am not sure how you as individuals would go about doing that.

Ms Pritchard : We are very lucky that the Department of Health and Human Services is in the process of collecting a lot of data as well, through CEIPS and through their own other resources. Our coordinator of our Healthy Together team has been seconded for three months to help coordinate some of that data collection. So I would think it would be available in a few months.

Senator DI NATALE: We might think about writing to the department as a committee and requesting some of that. It might be helpful.

CHAIR: Absolutely. Seeing as we cannot go to the federal level, we might get some information from the state. We have a competition for attention from Ms Hollingworth and Ms Taylor.

Ms Hollingworth : We might be saying the same thing. Research evaluation is a key component of the model that was delivered in each local government context. We have specific roles that were assigned through the funding, through the service agreement with the department of health, and one of them was a research and evaluation officer. This was part of the original model: to ensure that we did provide research and evaluation to the process as we go along. We certainly know that we want to contribute to something that is going to say, 'This is the model for obesity prevention for Victoria and, in turn, Australia.' All of us would say that we get that, we know that and we want to deliver on that. We just need this funding to get us to that point.

CHAIR: Ms Taylor, did you want to add anything to that?

Ms Taylor : I was just going to mention that the Department of Health and Human Services do have a well-thought-out evaluation framework that sits behind this. It looks at multiple intervention and at how the system is working together for that collective impact. I think it is really important to emphasise the early indicators of success that are coming out of communities. That is things like realignment of dollars towards prevention, through new and existing partnerships. It is things like the new networks form—where we are realigning those networks that have a health focus, whether it be in the early years or whether it be some of the occupational health and safety networks; they are really bringing the lens onto prevention. The sign-ups to the achievement programs are fantastic early indicators of success, and there is a difference between the communities that have the dosage—the Healthy Together communities and the staffing—versus the communities that do not. The Healthy Together achievement program is available to the whole of Victoria, but the difference in sign-ups versus those that have the dollars invested versus those that do not, and the level of engagement with those different services—whether it be workplaces, schools or early learning centres—are some of the really early indicators of success, that level of community activation that we can hang our hats on.

We have people coming to us now saying, 'How do we get involved? I've got a block of land over here; could we do a community garden?' We are seeing this tipping point in our communities where we have activated our communities so much that they are excited about health and they want to work with us to improve the health of the community. We have got a Voices for Health initiative, which is local health champions who have got together and are standing up and saying, 'We'll be your local voices for health. You can use our existing social media networks. You can use our existing networks.' We have reached into the elderly cits, we he have reached into some of the harder-to-reach groups, such as the Aboriginal population, through having these stewarded people as voices for health. They are going into those networks that are harder to reach for us.

When you look at the way we have uniquely worked—and I would say it would be absolutely across the 14 different local government areas—with our local contacts, we have adapted what we are doing. We have taken new strategies in and we have been at the forefront of innovation and change, I would say. It is a tough job but, on the flip side, it is one of the most exciting and rewarding jobs around—

CHAIR: Very dynamic.

Ms Taylor : Absolutely.

CHAIR: What about other states? Are there any other states—

Ms Taylor : I don't know much about the other states.

CHAIR: Are you talking with any other states about—they are probably a bit envious.

Ms Hollingworth : Only that I know that with the NPAPH money—it was given, as you know, to each state and each state then determined the way that it would deliver it—we did know through conversations with other states that after May, after the NPAPH was defunded, there were some states where those particular initiatives did stop. We are fortunate in Victoria that the state government at the time did invest in us to continue for a year, but we know that that was not the case across Australia. You would probably have to take that on notice and ask the state government. The Department of Health and Human Services would probably have the answer to that.

CHAIR: The timing of the state election seems to make a bit of a difference. We might see if we can discern what has happened state by state.

Ms Young : OPAL was a large-scale, quite innovative, approach to obesity, and that was in South Australia. I know that, as a result of the cut of the NPAPH, that suffered significantly. They were doing some amazing, groundbreaking work that the Department of Health and Human Services could absolutely fill you in on.

Senator DI NATALE: Is smoking—for example, in workplaces—part of anything that you do? We have talked about physical activity and nutrition, but we have not mentioned other issues.

CHAIR: I have the same question, but I wanted to expand it to mental health—all other areas where preventive work can go on. Is it just about obesity? That is clearly what you have been speak about most prominently, but what else is there?

Ms Evans : There are five priority areas in workplaces, of which smoking, reducing alcohol consumption, and mental health form part. Mental health, smoking and tobacco control form part of the promotion and achievement program within schools and children settings. They are definitely both there.

Mental health, particularly for the Geelong region, is fairly hot in the press at the moment. We have beyondblue coming to town next week. There is a beyondblue board meeting happening on Monday night, with community leaders sitting around with the board. On Tuesday morning we have a beyondblue breakfast around mental health in the workplace. We have 550 people going to that breakfast. That is an indication of the amount of priority around mental health in the workplace and of the workplaces we are working with wanting to be involved and see what sorts of support services there are and programs they can run to support the mental health of their workplaces. There will be a community event happening in the afternoon, which will have around 600 students from local schools attending, as part of a broadbrush approach to talk about mental health in the community. Mental health is part of the whole equation, and smoking is definitely part of the equation.

CHAIR: With regard to mental health, and this region in particular, the last time the committee came to Victoria we went to Geelong. One of the things that we really try to do, and we have had great support, is to get the committee out of the cities and have a look at the different contexts. You would probably be aware from 7.30 on Monday that there was a report on mental health that was concluded in November. There has been a significant delay in the government's releasing that. Because of pressure, it seems to have leaked that in part on Sunday. Today the whole report is out. It was leaked rather than released properly. One of the things that I understand is a recommendation of the report is the moving around of money. The accountants are in charge: 'We will pull it out of hospitals and put it into prevention.' Clearly, you are passionate about prevention, but when I was in Geelong—we visited the hospital—one of the things we found in the emergency setting was reports of people presenting with severe acute mental illness episodes needing to be held in that emergency department for three or four days. From the way they described it, they were already facing a crisis of management in the acute sector. As prevention advocates, what is your view about this latest 'pull it out of emergency and put it into prevention'?

Ms Hollingworth : I just need to go back to go forward, if that makes sense. When the national partnership agreement originally came out, there were indicators in there around physical activity and nutrition, and there was no benchmark or indicators around smoking or mental health. So it was very much focused on those two key risk factors. Of course, when funding is pushed out at outcomes or attached to that, in our service agreements we all have to contribute to those. What happened was this. When you have the achievement program, which is around health-promoting workplaces, schools or communities, the way you make a health-promoting environment is to involve your community, whether that is your school community or your early years community, and then that approach is engagement. So you engage with the school, the early years service or the community and ask them: 'What are the issues that are relevant to you?'

We certainly did not go in and say: 'Oh, you want mental health and wellbeing? No, can you please just focus on healthy eating because that's what's in the benchmark.' We wanted to work with them and say, 'If mental health is your key issue, if workplace stress is your key issue, then we will support you as a health-promoting service, school and environment to combat that in your own setting.' We have often used physical activity. As we know, it is a key determinant to help people with issues around mental health and wellbeing. We know that people who are more physically active and engaged in their community have lower episodes of those.

We cannot show what is happening in the ED around presentations of mental health issues. We are trying to look upstream: why are the people in that ED? Is that through lack of engagement in their own community, not being supported at their workplace or not being supported through school in creating those healthy environments? I think all of us are nodding a bit with that. We do not go in with particular priorities. It is about that community environment deciding what that is, and we will support them through that. That may mean that those initial outcomes may not have been achieved in a little box, because we are working with those communities to create those healthy environments.

CHAIR: So the complexity is part of your response capacity, and the engagement with the mental health and other elements is really community health-seeking conversations that you had?

Ms Hollingworth : Yes—and what are the protective factors for mental health and wellbeing? We funded a program through Communities That Care that looks at key risk factors for young people. It is around not focusing so much on priority areas but on what is the engagement with the school? How do they interact with their community? How do they feel—self-esteem? There are all those other elements that, as a society, we need to firmly build. We can do that through an achievement program, but it is still about creating those healthy environments.

Ms Hunt : I can just add to that. Prevention for all of us, I think, is not just about even those things that are obvious to us. What happens within the workplaces is that they often do take the obvious option to them as they are learning and trying to understand about the people who work for them as well. I think employers and people in those settings are starting to learn more about the people who are in there as they are doing these health and wellbeing programs. Yes, physical activity and nutrition are the easy options, but I think that, as time goes on, they will start to get it and learn that we can dig deeper and we can be more complex about the things that we do, whether that be about family abuse—it could be anything. It could be about drug and alcohol abuse or tobacco use or whatever it might be. In the interim we see people saying, 'Yes, I'm choosing these as my priorities,' but then, as they start to learn more and they start to see themselves as being part of this whole system that takes care of health and wellbeing, I think we will start to see more and more layers of what prevention can do. In that question about, 'We take it from here and we put it there,' it is not just for one thing; it is for so many elements of what makes up who we are and what makes us contributing people in this society. It is every element that can be touched on, if that workplace or that setting choose to do it because it has become an issue for them.

Mrs Ruyg : One of the features of the Victorian approach was that, in the time that Healthy Together has been in place, there was the very first Victorian health and wellbeing plan released by the state government, from 2013 to 2015. It is going to be in the next iteration as we speak. There is development underway. That strategy also encouraged local councils right across the state to identify their health and wellbeing priorities and to work collaboratively.

We all, as local councils, have health and wellbeing plans: the Municipal Public Health and Wellbeing Plan. A very strong feature that emerged state wide was the priorities of healthy eating, physical activity, addressing tobacco and harmful risks of alcohol, and mental health. It would fair to say for all of us that our focus, as Ms Hollingworth referred to, when the arrangement between the federal government and the state was put in place, was around the four key priorities of healthy eating, physical activity, smoking and harmful risks of alcohol consumption.

An example for us, when we take it down to the community level, is that each community is able to identify from the state data what the key challenges that it faces around health and wellbeing are. As a result of that, there are a range of different priorities that have emerged. I work in a Healthy Together community that covers three local government areas, so we worked with our three councils in the development of those health and wellbeing plans. Each of them has responded to its own context, but still addressing those priorities. One of ours, Pyrenees Shire, has the highest rates of smoking in the state, at 23.2 per cent of the population. As a result of that, through an approach like Healthy Together, it raises the need for strong leadership at the local level. That particular council advocated within its community around smoking and tackling the issues. If you unpack that in terms of, 'What does it look like as a response state wide?' that has evolved to a relationship with the Cancer Council here in Victoria and Quit. We have been talking to them about how we apply a community-wide approach to tackle smoking within that particular municipality. It looks at what is happening in the shops that sell cigarettes. It is: how do we take a whole-of-community approach?

I think for us, because we work in Ararat Rural City Council as well, we have a lot of learnings from the way that the Ararat community responded to being named as one of the country's fattest towns. From the work that has happened in Ararat, we have started to see our other communities saying, 'Well, how do we tackle our biggest issue in a whole-of-community way, as Ararat did?' So it is about changing the culture and shifting the way that people see the norm. We are seeing evidence of that across many of the health challenges that influence the health state.

CHAIR: We heard from the Medicare Locals when we were down here last and now with the new PHN, and I have to indicate that Jason Trethowan was hopeful of being here. But with the announcement of the PHN it was a little unpredictable because nobody was quite sure what was going to happen. I believe he has had to suddenly take off and do that. He was more than happy to give his time to you, because we know how many of you have come together. For the primary healthcare networks, as they move forward, replacing the Medicare Locals, all of the councils and the state, this is a collaborative effort. The Abbott government tore up the partnership and removed themselves from it. They do not want to put the money in.

But one of the things we have been hearing about in our committee is an alternative model of looking at funding GPs called a blended payment model, where the partnerships with the doctors and what you do could be enhanced by changing a fee-for-service model—where you go to the doctor and he gets paid to see you—to a blended payment, where the town of Ararat are enrolled with their doctors. Part of the doctors' payment that makes up their business model becomes payment for health outcomes, so it changes it from an illness model. Certainly it has to deal with illness, but there is an emphasis on a health and wellbeing dimension to what the GPs do.

I will just ask one of you, in concluding: what are your thoughts about a shift in the GP world and your current levels of engagement with that part of the health sector? Does anybody want to have a go at that one? Ms Harrington and Ms Young?

Ms Harrington : That actual model was piloted in New Zealand, I think about 15 years ago—Active Script?

CHAIR: Yes.

Ms Harrington : Certainly those of us who were around in those days looked at how we could work with our GPs to introduce that, and there were some great examples around the state. Absolutely, GPs need to be an integral part of any healthy community, but I just want to make the comment that Healthy Together is about empowering people to take charge of their own health without visiting a GP, without even going to a community health centre. The excitement and some of the measures that we see on the ground today have been exactly about that. I will hand over to somebody else.

Ms Young : I would also say that, right back to when the Ottawa Charter for Health Promotion was created for health through the WHO, reorientating health dollars was a really important aspect of that and of the way that we see health. I think that it has to be a continuum. It is not necessarily reorientating dollars for the expense of another but seeing that everyone in the health system has a role in prevention. Perhaps this opportunity looks at ways in which GPs do have a role in that prevention continuum but also recognises that there are other players, and they all have to be involved in order to have an effective response.

CHAIR: Thank you very, very much. We really appreciate the time that you have given us. I know that, when you come to things like this and you walk away, you think, 'Oh, I should have said that, and I should have said this,' because there is not enough time for us to hear the collective wisdom of all of the people who work with you, let alone what you have to bring to us today. I thank you for your care and the way that you have given us really great information today, and I invite you to provide us with other information that you think can assist us in the way we might make recommendations for the nation through our report through the Senate. Thank you once again.

Proceedings suspended from 13:06 to 13:52