Background:

Melbourne is confronted by increasing trends in chronic health conditions, ageing populations, rapid population growth, climate change, and challenges to the provision of hard and soft infrastructure. These ‘wicked problems’ have many interdependencies and are multi-causal. They are also highly resistant to resolution using traditional public health approaches such as: water/sanitation; scientific breakthroughs; social security/Medicare; and risk factors and lifestyle.

Methods:

This paper outlines the approach taken by the Victorian Department of Health’s (DH) regional metropolitan teams to tackle the key determinants of health by embracing the ‘fifth wave’ of public health, namely complex adaptive system thinking (Hanlon et al, 2011). Each Region has developed an Operating Model for managing the health service system, and promoting an intersectoral, whole of government approach to improving population health outcomes. In particular, DH has worked systematically to engage and influence key existing governance structures such as Regional Management Forums (RMF), which facilitate collaboration between state government departments and local governments. Through university collaboration, DH has supported RMFs to: assess urban liveability, health and equity; address critical issues facing the regions; and deliver on key priorities.

Results/Discussions:

Our approach has resulted in a greater capacity to address equity and confront the social determinants of health such as transport, employment, affordable housing, and education. This dynamic systems approach has enabled better understanding of both the complex systems that are the cause of public health issues, and the characteristics of prevention systems that might hold the solutions and lead to effective and sustained interventions.

Conclusions/implications:

This work supports complex adaptive systems approaches that: (i) focus on the health of populations; (ii) address the determinants of health and their interactions; (iii) base decisions on evidence; (iv) increase upstream investments; (v) apply multiple strategies; (vi) collaborate across sectors and levels; (vii) employ mechanisms for public involvement; and (viii) demonstrate accountability for health outcomes.