Who is responsible for health?
According to the World Health Organization (external site), the factors that determine a person’s health are considered to be the conditions in which a person is born, grows up, lives, works and ages and in turn influences their opportunity to be healthy, their risk of illness and life expectancy. Influencing these determinants of health is considered to be a shared responsibility and is beyond the scope of any one agency or level of government.
State Governments, non-government agencies and local government each play a role in helping to support and drive improvements to the health and wellbeing of the WA population, be it at a state-wide or local community level.
The public health challenges of today requires the support, collaboration and innovative across all levels of government and health sectors to work together to create lasting improvements to the health of Western Australians.
The Public Health Act 2016 recognises this shared responsibility, and has embedded the requirement for public health planning (under Part 5 of the Public Health Act) at both a State Government and local government level. Establishing the legal requirement for public health planning is an important step in elevating the importance and commitment to public health across both tiers of government, and creates the opportunity to establish stronger partnerships that aim to influence the determinants of health in some way.
What is the purpose of public health planning?
The requirement for public health planning strengthens the need to better plan for public health and wellbeing by State and Local Government. It will also help to align the public health objectives and policy priorities of government more effectively, with the ultimate aim of making sure State and local governments are working in unison and directing resources targeting areas of greater public health need.
Public health planning is about taking a proactive approach to preventative health, with the focus being on achieving long-term public health outcomes through the planning process.
The intention is to support local governments to assess and ensure that their resources are used in the most appropriate and efficient way to address the public health needs of their local population rather than increase the number of services provided.
What is the role of the State Government and public health?
State government agencies are primarily responsible for state-wide development, coordination and delivery of a wide range of policies, programmes and services.
Although the Department of Health is considered to be one of the leading agencies who delivers hospitals and health services, as well as public health policies and programmes for Western Australians, there are a number of government agencies with a responsibility for providing policy support and services that lead to positive public health outcomes. This includes the Department of Local Government, Sport and Cultural Industries, Department of Transport, Department of Education, and Mental Health Commission, to name a few.
Some of the key roles of State Government agencies are to:
- establish laws governing specific public health risk activities which are enforced either at a State or local government level including legislation related to food handling and hygiene, asbestos management, pesticide safety, contaminated lands, tobacco control, public buildings and water management
- implement specific services for the community such as hospitals and aged care facilities
- provide policy advice to ministers and the community on a range of health related issues
- manage large infrastructure projects such as main roads or entertainment centres and
- develop state-wide programmes that target specific health behaviours such as the livelighter campaign, active transport, could I have it campaign and think mental health
What is the purpose of the State Public Health Plan?
The Public Health Act 2016 requires the Chief Health Officer to prepare a public health plan that applies to the whole of the State. The State Plan must:
- Identify the public health needs of the State
- Include an examination of data relating to the health status and health determinants in the State
- establish objectives and policy priorities for the promotion, improvement and protection of public health and the development and delivery of public health services
- identify how, based on available evidence, the objectives and policy priorities are proposed to be achieved
- describe how the Chief Health Officer proposes to work with local governments and other bodies to achieve these objectives and priorities
- include a strategic framework for the identification, evaluation, and management of public health risks in the State
The Chief Health Officer released the inaugural State Public Health Plan in 2019. An updated State Public Health Plan is currently in development and will be released within 12 months of implementation of Part 5 of the Public Health Act 2016.
What is the role of local government in public health?
Local governments are often considered to be ‘closest to the people’ not only because of the range of services they provide to various local community groups, but also because of the effect of these services on community health and wellbeing. Collectively, these services impact on the determinants of health of residents.
The work of local government is varied, but it touches almost all areas of our day to day life – whether we live in cities, towns or country areas. Local government looks after a variety of programmes and services that all have a big impact on the communities health. These services generally include:
- infrastructure and property services, including local roads, bridges, footpaths, drainage, waste collection and management
- provision of recreation facilities, such as parks, sports fields and stadiums, golf courses, swimming pools, sport centres, halls, camping grounds and caravan parks
- health services such as water and food inspection, immunisation services, toilet facilities, noise control and meat inspection and animal control
- community services, such as child-care, aged care and accommodation, community care and welfare services
- building services, including inspections, licensing, certification and enforcement
- planning and development approval
- administration of facilities, such as airports and aerodromes, ports and marinas, cemeteries, parking facilities and street parking
- cultural facilities and services, such as libraries, art galleries and museums
- water and sewerage services in some states, and
- other services, such as abattoirs, sale-yards and group purchasing schemes.
Improving public health requires recognition within local government of exactly what health services and assets are delivered and what public health outcomes are being achieved.
What is the purpose of a Local Public Health Plan?
The Public Health Act requires each local government to produce a public health plan that applies to its local district.
A local plan must be consistent with the State Public Health Plan whilst responding to local public health risks. The plan must:
- identify the public health needs of the local government district
- include an examination of data relating to health status and health determinants in the local government district
- establish objectives and policy priorities for the promotion and protection of public health in the local government district
- describe the development and delivery of public health services in the local government district and
- include a report on the local government’s performance of its functions under the Act
What is meant by being consistent with the State Public Health Plan?
The State Public Health Plan will identify the objectives and policy priorities for the State, and thereby provide a framework for local government to consider and adapt as necessary to reflect the particular risks prevailing in its district.
The Local Public Health Plan must be consistent with the State Public Health Plan. Being “consistent” means that local governments should:
- consider the objectives and policy priorities outlined in the State Public Health Plan to determine their relevance to the local district
- determine what services, programmes and projects are or could be implemented at the local level to promote, improve and protect people, related to the objectives and policy priorities identified in the State Public Health Plan, that are applicable to the local district.
In some cases, the objectives and policy priorities in the State Public Health Plan may not be relevant. Local Governments are entitled to come to a decision that does not necessarily reflect one or more of the objectives and policy priorities in the State Public Health Plan, provided that local governments have considered them and are able to demonstrate how their conclusion was reached.
Given the specific requirement to consider the State Public Health Plan, it is recommended that the reasons for making decisions (which could be subject to review or public scrutiny) are clear and able to be demonstrated. In particular, decision makers should be able to show that the local government considered the various objectives and policy priorities where relevant, and outline reasons for the decision not to include in the Local Public Health Plan e.g. why they may not be applicable to the local district.
When deciding on what objectives and policy priorities are applicable to the local district, information collected as part of section 45(4), which involves reviewing the health status and health determinants of the local district, will be relevant when deciding what priorities are applicable.
When must the first Local Public Health Plan be produced?
Part 5 of the Act provides for public health planning and will not come into effect until stage 5 of implementation. Once Part 5 is in effect each local government has two years to produce the first Local Plan.
WA Health is aware that many local governments are interested in developing their Local Plans before Part 5 comes into effect and is highly supportive of this.
To support this process the Chief Health Officer has released the State Public Health Plan.
There is no specific planning process that must be followed when developing a public health plan, or a one size fits all template. This ensures that local government is provided the flexibility and autonomy needed to develop individualise plans.
Local government can utilise any method that suits their needs in order to achieve the requirements of the Act.
Will public health plans impose onerous obligations on local government?
To minimise the number of separate planning processes required of local government, Local Plans may be integrated with the existing planning processes under the Local Government Act 1995.
To support the development of the plans, the Department of Local Government and Communities (external site) has developed the Local Government Integrated Planning and Reporting Framework (external site) and a range of other tools and resources.
The Department of Health encourages local government to incorporate public health planning using this established framework.
Who is responsible for developing the Local Public Health Plan?
The task of whom is responsible for developing the plan is at the discretion of each local government. The Public Health Act does not specify any specific skills or qualifications that are needed to develop the plan.
Local governments can allocate the task of developing the local plan to any person. This may include:
- allocating the task to existing staff such as authorised officers or any other person with the skills and knowledge of public health and strategic planning
- establish a steering committee of relevant stakeholders to guide the process. This could include councillors, with other representatives from the community, business and government agencies to provide input as required or
- engaging a consultant.