Letteratura scientifica selezionata sul tema "Community-based Environmental Health Action Project (Australia)"

The findings of the Australian National Committee on Violence and the outcomes of a National Symposium on Alcohol and Violence have encouraged an interest in locally based initiatives to deal with the problem of alcohol-related violence in and around licensed premises in Australia. The first initiatives to emerge were in the form of local accords between police and licensees, with varying degrees of input and support from local government, licensing authorities, the various liquor industry associations, and the local community. To date none of these accords has had any legislative backing nor been underpinned by signed agreements, relying solely on the cooperation of the various parties. The early success claimed by the pioneering accords has resulted in their proliferation throughout Australia. This paper reviews three of the better-known accords, the West End Forum Project, the Surfers Paradise Safety Action Project, and the Geelong Local Industry Accord. Some general conclusions are made regarding the factors that are important with respect to the sustainability and efficacy of these approaches.

This paper outlines a project funded by the World Health Organization (WHO) in the Hills Mallee Southern Region of rural South Australia. The project involves trialling guidelines produced by the WHO to assist regional health services to develop and support partnerships for health development with community groups and organisations. The guidelines suggest the following steps: identifying what Health Development Structures exist in their region by making an inventory of community groups and organisations in their area; analysing them for potential collaboration; and building sustainable alliances for health promotion and joint action on broader health issues. Six hundred community groups and organisations were identified and from the responses an inventory summarising the activities of 228 groups has been prepared. Seventy five percent of these groups and organisations consider that their activities relate to health and 28% have worked with a health service, although few had participated in 'joint projects' with the formal health sector. Detailed case studies were conducted with five groups from which a set of principles for partnership development was established.

The National Empowerment Project is an innovative Aboriginal-led community empowerment project that has worked with eight Aboriginal and Torres Strait Islander communities across Australia over the period 2012–13. The aim of the Project was to develop, deliver and evaluate a program to: (1) promote positive social and emotional well-being to increase resilience and reduce the high reported rates of psychological distress and suicide among Aboriginal and Torres Strait Islander people; and (2) empower communities to take action to address the social determinants that contribute to psychological distress, suicide and self-harm. Using a participatory action research approach, the communities were supported to identify the risk factors challenging individuals, families and communities, as well as strategies to strengthen protective factors against these challenges. Data gathered during Stage 1 were used to develop a 12-month program to promote social and emotional well-being and build resilience within each community. A common framework, based on the social and emotional well-being concept, was used to support each community to target community-identified protective factors and strategies to strengthen individual, family and community social and emotional well-being. Strengthening the role of culture is critical to this approach and marks an important difference between Aboriginal and Torres Strait Islander and non-Indigenous mental health promotion and prevention activities, including suicide prevention. It has significant implications for policy makers and service providers and is showing positive impact through the translation of research into practice, for example through the development of a locally run empowerment program that aims to address the social determinants of health and their ongoing negative impact on individuals, families and communities. It also provides a framework in which to develop and strengthen culture, connectedness and foster self-determination, through better-informed policy based on community-level holistic responses and solutions as opposed to an exclusive focus on single-issue deficit approaches.

The Zero Tolerance Campaign against violence to women and children is a hard hitting, controversial campaign designed to raise public awareness and provoke debate about male abuse of power in the areas of domestic violence, rape and sexual assault, and child sexual abuse. Zero Tolerance is also an example of best practice in cross sectoral co-operation. The campaign comprises a statewide initiative involving the Health Promotion Unit of the South Australian Health Commission, the Domestic Violence Resource Unit, Family and Community Services, community health workers and local community action groups throughout the state. The process of bringing together a wide range of individuals from very different backgrounds and differing perspectives to work collaboratively on a controversial, innovative project led to extensive examination and defining of the issues involved. The planning process included a microcosm of the debate which Zero Tolerance intends to generate in the community. Resolution of the issues raised, employed many of the strategies developed and identified as best practice in the field of primary health care. The paper explores the challenges and rewards in the context of working collaboratively through the planning of a controversial initiative and identifies the merits of a campaign which has built on a diverse range of knowledge. Zero Tolerance, as a campaign, has the scope to be adapted in a variety of culturally and socially diverse initiatives as it becomes identified as an example of international best practice developed to stop violence against women and children.

Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the individual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically diverse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017–2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015–2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and $15,432,239 in 2020. This is projected to increase to between $18,922,844 and $24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups—comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)—was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy.

This paper reports findings from interviews and focus groups conducted within a multi-dimensional action research project concerning medication management among Indigenous Australians. Participants were Aboriginal people with mental health problems, carers and family members, and health and social service workers from different regions in South Australia. A meta-analysis of findings from each regional project component was conducted, and major themes conceptualised and developed into a coherent summary. The findings revealed problems of a magnitude not previously realised - mental health problems (including alcohol and drug problems) and medication management among Aboriginal people clearly are major issues requiring immediate and sustained attention if the health and welfare of the Australian Indigenous population are to be improved. Findings concerned eight major areas: social and emotional wellbeing issues; stressors on Aboriginal health services and providers; training for the Aboriginal health workforce; mainstream health services for Aboriginal people; trust and confidentiality within Aboriginal health services; English language literacy and numeracy skills of Aboriginal clients; remote living arrangements for many Aboriginal people; problems with alcohol use; and institutionalised and individual racism in the community at large.

Creating a stable and sustainable health workforce in regional, rural and remote Australia has long been a challenge to health workforce planners, policy makers and researchers alike. Traditional health workforce planning is often reactive and assumes continuation of current patterns of healthcare utilisation. This demonstration project in Far North Queensland exemplifies how participatory regional health workforce planning processes can accurately model current and projected local workforce requirements. The recent establishment of Primary Health Networks (PHNs) with the intent to commission health services tailored to individual healthcare needs underlines the relevance of such an approach. This study used action research methodology informed by World Health Organization (WHO) systems thinking. Four cyclical stages of health workforce planning were followed: needs assessment; health service model redesign; skills-set assessment and workforce redesign; and development of a workforce and training plan. This study demonstrated that needs-based loco-regional health workforce planning can be achieved successfully through participatory processes with stakeholders. Stronger health systems and workforce training solutions were delivered by facilitating linkages and planning processes based on community need involving healthcare professionals across all disciplines and sectors. By focusing upon extending competencies and skills sets, local health professionals form a stable and sustainable local workforce. Concrete examples of initiatives generated from this process include developing a chronic disease inter-professional teaching clinic in a rural town and renal dialysis being delivered locally to an Aboriginal community. The growing trend of policy makers decentralising health funding, planning and accountability and rising health system costs increase the future utility of this approach. This type of planning can also assist the new PHNs to commission health services that meet the needs of the population and contribute to service and system improvement and innovation.

Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice.

Purpose – The health promoting school model is rarely implemented in relation to sexuality education. This paper reports on data collected as part of a five-year project designed to implement a health promoting and whole school approach to sexuality education in a five campus year 1-12 college in regional Victoria, Australia. Using a community engagement focus involving local and regional stakeholders and with a strong research into practice component, the project is primarily concerned with questions of capacity building, impact and sustainability as part of whole school change. The paper aims to discuss this issue. Design/methodology/approach – Using an action research design, data were collected from parents, students, teachers and key community stakeholders using a mixed methods approach involving surveys, interviews, document analysis and participant observation. Findings – Sexuality education has become a key school policy and has been implemented from years 1 to 9. Teachers and key support staff have engaged in professional learning, a mentor program has been set up, a community engagement/parent liaison position has been created, and parent forums have been conducted on all five campuses. Research limitations/implications – The translation of research into practice can be judged by the impact it has on teacher capacity and the students’ experience. Classroom observation and more longitudinal research would shed light on whether the espoused changes are happening in reality. Originality/value – This paper reports on lessons learned and the key enabling factors that have built capacity to ensure that sexuality education within a health promoting, whole school approach will remain sustainable into the future. These findings will be relevant to others interested in building capacity in sexuality education and health promotion more generally.

In the early years of the 21st century environmental health has to contend not only with the more 'traditional' and essentially localised environmental risks to human health. We now face the additional challenges posed by a range of 'modern' environmental health issues. These are characteristically more complex, more ubiquitous, and much less clearly defined than any we have previously encountered. They have been brought about through rapid industrial expansion, technological advances that have transformed our social structures and the emergence of a global economy that is now forging ahead in the face of ever-increasing socio-economic inequity. These are problems that are not amenable to traditional environmental health solutions. They call instead for new, innovative and integrative strategies based on cooperative and collaborative working partnerships. This thesis explores the question of what needs to be done to build capacity for such partnerships among environmental health stakeholders in Australia. The current situation is clarified through a critical review of the author?s professional career, the historical development of environmental health practice, the different knowledge constructs of four distinguishable stakeholder groups and the objectives and guiding principles of Australia's National Environmental Health Strategy. A case study of a federally funded collaborative environmental health project serves to highlight some of the inherent challenges of intersectoral partnership and community participation. The metaphor of the spider's web illustrates the imperative of such partnerships among stakeholder groups and across all geographical scales from the local to the global. Finally, the barriers to be overcome in building environmental health capacity are analysed through a force field analysis. The study concludes with an analysis of the constituents of action necessary to develop the partnering capabilities of the various stakeholders, to build supportive community and organisational infrastructures and to demonstrate the political will of government to support change.

In the mid-1980s, the impact of three decades of uranium processing near rural Fernald, Ohio, 18 miles northwest of Cincinnati, became the centre of national public controversy. When a series of incidents at the uranium foundry brought to light the years of contamination to the environment and surrounding farmland communities, local citizens’ groups united and demanded a role in determining the plans for cleaning up the site. One citizens’ group, Fernald Residents for Environmental Safety and Health (FRESH), formed in 1984 following reports that nearly 300 pounds of enriched uranium oxide had been released from a dust-collector system, and three off-property wells south of the site were contaminated with uranium. For 22 years, FRESH monitored activities at Fernald and participated in the decision-making process with management and regulators. The job of FRESH ended on 19 January this year when the U.S. Secretary of Energy Samuel Bodman and U.S. Environmental Protection Agency Administrator Stephen Johnson — flanked by local, state, and national elected officials, and citizen-led environmental watchdog groups including FRESH — officially declared the Fernald Site clean of all nuclear contamination and open to public access. It marked the end of a remarkable turnaround in public confidence and trust that had attracted critical reports from around the world: the Cincinnati Enquirer; U.S. national news programs 60 Minutes, 20/20, Nightline, and 48 Hours; worldwide media outlets from the British Broadcasting Company and Canadian Broadcasting Company; Japanese newspapers; and German reporters. When personnel from Fluor arrived in 1992, the management team thought it understood the issues and concerns of each stakeholder group, and was determined to implement the decommissioning scope of work aggressively, confident that stakeholders would agree with its plans. This approach resulted in strained relationships with opinion leaders during the early months of Fluor’s contract. To forge better relationships, the U.S. Department of Energy (DOE) who owns the site, and Fluor embarked on three new strategies based on engaging citizens and interested stakeholder groups in the decision-making process. The first strategy was opening communication channels with site leadership, technical staff, and regulators. This strategy combined a strong public-information program with two-way communications between management and the community, soliciting and encouraging stakeholder participation early in the decision-making process. Fluor’s public-participation strategy exceeded the “check-the-box” approach common within the nuclear-weapons complex, and set a national standard that stands alone today. The second stakeholder-engagement strategy sprang from mending fences with the regulators and the community. The approach for dispositioning low-level waste was a 25-year plan to ship it off the site. Working with stakeholders, DOE and Fluor were able to convince the community to accept a plan to safely store waste permanently on site, which would save 15 years of cleanup and millions of dollars in cost. The third strategy addressed the potentially long delays in finalizing remedial action plans due to formal public comment periods and State and Federal regulatory approvals. Working closely with the U.S. and Ohio Environmental Protection Agencies (EPA) and other stakeholders, DOE and Fluor were able to secure approvals of five Records of Decision on time – a first for the DOE complex. Developing open and honest relationships with union leaders, the workforce, regulators and community groups played a major role in DOE and Fluor cleaning up and closing the site. Using lessons learned at Fernald, DOE was able to resolve challenges at other sites, including worker transition, labour disputes, and damaged relationships with regulators and the community. It took significant time early in the project to convince the workforce that their future lay in cleanup, not in holding out hope for production to resume. It took more time to repair relationships with Ohio regulators and the local community. Developing these relationships over the years required constant, open communications between site decision makers and stakeholders to identify issues and to overcome potential barriers. Fluor’s open public-participation strategy resulted in stakeholder consensus of five remedial-action plans that directed Fernald cleanup. This strategy included establishing a public-participation program that emphasized a shared-decision making process and abandoned the government’s traditional, non-participatory “Decide, Announce, Defend” approach. Fernald’s program became a model within the DOE complex for effective public participation. Fluor led the formation of the first DOE site-specific advisory board dedicated to remediation and closure. The board was successful at building consensus on critical issues affecting long-term site remediation, such as cleanup levels, waste disposal and final land use. Fluor created innovative public outreach tools, such as “Cleanopoly,” based on the Monopoly game, to help illustrate complex concepts, including risk levels, remediation techniques, and associated costs. These innovative tools helped DOE and Fluor gain stakeholder consensus on all cleanup plans. To commemorate the outstanding commitment of Fernald stakeholders to this massive environmental-restoration project, Fluor donated $20,000 to build the Weapons to Wetlands Grove overlooking the former 136-acre production area. The grove contains 24 trees, each dedicated to “[a] leader(s) behind the Fernald cleanup.” Over the years, Fluor, through the Fluor Foundation, also invested in educational and humanitarian projects, contributing nearly $2 million to communities in southwestern Ohio, Kentucky and Indiana. Further, to help offset the economic impact of the site’s closing to the community, DOE and Fluor promoted economic development in the region by donating excess equipment and property to local schools and townships. This paper discusses the details of the public-involvement program — from inception through maturity — and presents some lessons learned that can be applied to other similar projects.