How We Work
“Public health is the ‘art and science of preventing disease, prolonging life and promoting health through the organised efforts of society’ ”
– World Health Organisation, 1988
Toi Te Ora is the Public Health Unit for the Bay of Plenty and Lakes Districts.
Our Focus Areas
Our strategic direction focuses on six areas which will enable us to be more innovative and flexible in our public health approaches. The areas reflect current and emerging public health issues and incorporate many of the aims and activities of those we work alongside. Our focus areas provide us with direction to the work we undertake to protect the health of the population.
To maximise our work across our focus areas, we have adopted two overarching strategic approaches to guide our work.
Biophilic Public Health
Biophilic public health is underpinned by our commitment to Wai Ora and the core kaupapa of Māori understanding that the health of nature and of people is entwined and interconnected. A biophilic public health approach recognises the innate human affinity (or inborn ‘love, awe and respect’) for nature and that humans require the benefits of a thriving natural influence on our daily lives and experiences for our physical and mental health and wellbeing
Therefore, biophilic approach to public health brings a focus on how public health initiatives and interventions can be shaped and transformed to produce multiple benefits for the health and wellbeing of people, other species and ecosystems, both directly and indirectly. This is from both a local and global perspective, as well as in the short term and long term for subsequent generations. This means our practice of public health includes concern for current population health issues such as equity, obesity, chronic disease risks and mental health as well as native species, ecosystem health, biodiversity and climate change. In turn, this informs our advice and actions on issues such as urban design, transport, food and nutrition, and how the health of people and nature is promoted and enhanced in the places where we live, learn, work and play. It allows our programmes to implement an ecological model of public health, shaped by the values of love, awe and respect for nature, relevant to today’s challenges and issues, and also increasingly aligning with the United Nations Sustainable Development Goals.
Health in All Policies
Health in All Policies recognises that positive health outcomes and health equity cannot be achieved by the health sector alone, and further, the responsibility for positive community health sits with the whole of the community within their various spheres of influence. Health in All Policies is about improving public policies across the health sector, across 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 Polices seeks to avoid harmful health impacts in order to improve societal goals, population health and achieve health equity.
Public health is about the health of populations rather than medical treatment of individuals, and looks beyond health care services to the aspects of society, environment, culture, economy and community that shape the health status of populations.
Good public health is based on creating conditions that enable people to have the best opportunities for health and wellbeing throughout their life. It also requires the input of and partnership with agencies beyond the health sector.
Learn more about Public Health from the Ministry of Health.
Toi Te Ora Public Health focuses on the achievement of health equity, in particular for Māori.
The Ministry of Health's definition of equity is:
In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.
Learn more about health equity from the Ministry of Health.
Determinants of Health
Determinants of health are the circumstances in which people are born, grow up, live, learn, work and age. They are also the wider set of forces and systems affecting these circumstances, for example, economic and development policies, geographic and climatic environments, social norms, social policies and political systems.
A Health Map for the Local Human Habitat, Barton and Grant (2006) based on a public health concept by Dahlgren and Whitehead (1991).
Individually, we have little direct control over many health determinants. For example, the local economy affects employment opportunities, which in turn affects income, which influences the quality of housing and food we can afford. All of these things then affect the health and wellbeing of our whole family.
Income, employment, education and housing have considerable impacts on our health; much more than the delivery of health services. The level of educational achievement directly affects health outcomes. People who are socially and economically advantaged have better health outcomes than those living in poverty. These situations describe health inequity. Inequity is about unfair and avoidable differences between groups.
Health inequities are not about ‘making bad choices’, ‘bad genes’ or not accessing medical care. Health inequities usually stem from avoidable structural problems in our communities.
The challenge for all sectors is to work together to create fair and just policies and systems. Different inputs for different groups may be required in order to achieve equivalent outcomes, as shown in the diagram:
Find out more:
- An introduction to the determinants of health - World Health Organisation
- A collection of articles and information about determinants of health and equity in New Zealand - Health Promotion Forum of New Zealand
Health in All Policies
The determinants of health illustrate that our health and wellbeing is influenced by much more than access to quality healthcare. The factors that affect our health are often many and complex, and lie outside health services and health policies.
Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. It improves accountability of policy makers for health impacts at all levels of policy making. It includes an emphasis on the consequences of public policies on health systems, determinants of health and wellbeing (WHO, Helsinki Statement on Health in All Policies, 2013).
A key feature of HiAP is a formal collaborative arrangement for policy making and planning. It acknowledges that the work of many organisations and agencies contribute to community health and wellbeing and the best policy and planning outcomes arise from that collaboration. It is community-centred with a focus on health and wellbeing outcomes.
Health in All Policies is an approach that both Bay of Plenty and Lakes District Health Boards have committed to.
Please contact our Healthy Policies team for more information.
Click on the image to view a HiAP infographic.
HiAP in Practice
Canterbury District Health Board leads HiAP in New Zealand, having held formal collaboration agreements with their local authorities for over ten years. In their experience, HIAP work has both strategic and technical components:
- Strategic aspects may include new forms of governance/leadership; shared goals and budgets; new understanding of decision-making and processes of different organisations; and the reframing of issues for shared understanding.
- Technical aspects may include undertaking a Health Impact Assessment and/or other types of impact assessment; joint work plans; capacity building activities; cross sector projects, data collection and analysis, and community consultation.
Find out more
- Bay of Plenty District Health Board Health in All Policies Position Statement
- Lakes District Health Board Health in All Policies Position Statement
- Community and Public Health Canterbury District Health Board public health website that has lots of useful information about HiAP including ten concise information sheets.
- Helsinki definition of HiAP the internationally accepted definition of HiAP and links to international HiAP resources.
“How To” guides
- HiAP: A Guide for State and Local Governments US guide from the Public Health Institute
- The South Australia Approach to HiAP Background and Practical Guide by the Government of South Australia
- World Health Organisation HiAP Training Manual Aimed at central government agencies but has a useful international perspective.
International conference declarations
- The Adelaide Statement on Health in All Policies Report from the International Meeting on Health in All Policies, Adelaide, Australia, 2010
- The Helsinki Declaration of Health in All Policies Arising from the 8th Global Conference on Health Promotion, Helsinki, Finland, 2013
Evaluation of HiAP
- Evaluation of Health in All Policies: concept, theory, application An evaluation of the South Australian approach to HiAP published in Health Promotion International
- Executive summary of the Final Evaluation Report for Canterbury Health in All Policies Partnership (CHIAPP), 2012. This is an evaluation of the CHIAPP partnership and builds on similar evaluations in 2011 and 2010.
- Canterbury Health in All Policies Partnership Self Evaluation and Monitoring Tool (2015) The CHIAPP Leadership Group intends to use this tool, at least annually, for the purposes of self-evaluation.
Health Impact Assessment
Our health and wellbeing is influenced by much more than access to quality healthcare. The factors affecting our health (the determinants of health) are often much broader and more complex than what the health sector can address and it is the policies of councils and other non-health sectors that make an important difference to our health and wellbeing.
Health Impact Assessment (HIA) is a systematic way of identifying the potential impacts on the wellbeing and health of the population from any proposed policy, strategy, plan or project, early in the process.
HIA identifies potential impacts and makes evidence-based recommendations to enhance positive effects and to minimise or remove negative effects. This ensures people-centred outcomes and that everyone has the same opportunities to be healthy.
Ideally HIA should be considered for all significant policies. It is most effective when used early in the policy development process, where policy alternatives are being considered but before a commitment to any particular option has been made.
Where a Health Impact Assessment fits in the Policy Process:
HIA supports a Health in All Policies approach to keeping our community well. The Healthy Policies team at Toi Te Ora is able to undertake Health Impact Assessments and may be able to support your organisation through this process. Please contact Healthy Policies for more information.
Find out more:
- Ministry of Health Information and resources about HIA including a library of completed HIAs, and a New Zealand ‘how to’ guide.
- Quigley and Watts are Wellington based public health consultants with vast experience in HIA both in New Zealand and internationally
- Centres for Disease Control US government information and resources about HIA
- Human Impact Partners Private US site that contains helpful information, including a short video, for people new to HIA
- Pew Charitable Trust A library of HIA undertaken in the US
To support and enable good health and wellbeing in our communities, Toi Te Ora Public Health supports and works alongside a wide range of agencies, government and non-government organisations.
Some of our partners include:
- Ministry of Health
- Ministry for Primary Industries
- Ministry of Education
- Health Promotion Agency
- Healthy Families New Zealand
- Healthy Families Rotorua
- Bay of Plenty District Health Board
- Lakes District Health Board
- Western Bay Primary Health Organisation
- Eastern Bay Primary Health Alliance
- Ngā Mataapuna Oranga
- Rotorua Area Primary Health Services
- Tauranga City Council
- Whakatāne District Council
- Western Bay District Council
- Rotorua Lakes Council
- Taupō District Council
- Ōpōtiki District Council
- Kawerau District Council
- Bay of Plenty Regional Council
- Waikato Regional Council
- Sport Bay of Plenty