Healthy and Connected Panel Discussion: CQU Festival of Change
ON SEPTEMBER 15TH, CQUNIVERSITY HOSTED THE SEVENTH OF NINE EVENTS IN THEIR ANNUAL FESTIVAL OF CHANGE - A FREE ONLINE LEARNING FESTIVAL DESIGNED TO CELEBRATE AND INSPIRE CHANGEMAKING. THE 2020 FESTIVAL OF CHANGE FOCUSED ON OPPORTUNITIES TO TRANSFORM COMMUNITIES, GROW RESILIENCE AND DRIVE POSITIVE CHANGE.
Healthy communities need more than just health care providers – they need access to fresh and affordable food, fitness and recreation facilities, education options and a wide range of opportunities to support connectedness and community purpose.
Moderated by Lara Carton, CQUniversity’s Director of Social Innovation, hear Australian leaders Monica Davis, Rohan Fitzgerald and Colleen Tribe discuss the range of services, innovations and opportunities that contribute to community health and connectedness in regional Australia.
The Panelists
Monica Davis lives in Cooma NSW and is the Education Director for Country University Centres. In this role she focuses on student support and collaborations with Australian universities to make higher education more accessible to regional, rural and remote students.
Monica has a strong focus on research and documenting the success of the Country Universities Centres. In 2019 she published a paper in the peer-reviewed Journal of Student Success on Student Engagement, and is currently working on projects in regional career advice for mature aged students, and building self-efficacy for students studying by distance. She is also a member of the executive of the Society of the Provision of Education in Rural Australia, and was the convener for the recent Best Practice in Regional Study Hubs Symposium.
Rohan Fitzgerald commenced as the WDHS Chief Executive in August 2014. He was previously Chief Executive at Stawell Regional Health and has held senior management and board positions across the health sector over many years.
He is passionate about creating healthy communities. In 2015 he led WDHS to become the first public health service in Australia to remove sugary drinks from sale. Recognising more needed to be done to stem rising rates of chronic disease he introduced a 100% healthy food policy for food sold by the health service to staff and visitors and served at its’ events.
Colleen Tribe is the General Manager of Roseberry Qld, delivering programs in housing and tenancy, youth shelters, early intervention mental health, high intensity psychological services and clinical care coordination to young people, youth and family services, education and employment pathways.
Having worked in the Central Queensland for more than 20 years, Colleen has achieved success leading and managing a cross section of areas in education, and is now devoted to continually growing Roseberry Qld, and ensuring regional areas are serviced adequately. Colleen also has an array of experience on boards - currently serving on the QCOSS, Rio Tinto Here for Gladstone, Advisory Board, Gladstone Area Promotion and Development Board (GAPDL) and CQUniversity Gladstone Regional Engagement Committee. She enjoys the professional learnings from each, being part of a leadership team and giving back to the community.
Highlights from the Panel
(listen to the podcast for full details)
[Lara Carton] - We know that healthy communities need more than just health care providers. They need access to fresh affordable food, fitness/recreation facilities, education options, local services often provided by local government, and a wide range of opportunities to support connectedness and community purpose.
Today, our expert panel will discuss their role and the role that their organisation plays in building the health and connectedness of the people and the systems within their own community.
Colleen, I might start with you today. We're interested in understanding what's the basis or the ingredients for a healthy and connected community, and that might be specific just to your region around Central Queensland and Gladstone, or you might want to interpret it as broader than that. We’re particularly interested in also understanding some of the community or social issues arising in your region?
[Colleen Tribe] - Thanks Lara. I think that I'll start with the word connected. ‘Connected’ is said to be the umbrella for ensuring that we have a healthy community. We really found that during COVID, particularly the isolation period here that we had in Queensland, we needed to make sure that people still felt connected, even though they were staying home.
We have found that there has been an increase in mental health issues that have been exacerbated by the COVID period. On the housing side of our services, we have a dignity hub [and] probably had up to 120 people access that hub weekly.
Having to close it down during isolation, we found that was very problematic for people because sometimes that was their only connection to community. So, that had a large effect on the community. We had as part of the recovery plan to ensure that the staff at the dignity hub still made connections to people, even though it was from their homes and socially distanced. That small amount of time that we made with that connection made all the difference in the world to ensuring that health and community remained.
[Lara Carton] - That's fantastic. It's really that personal contact and that recognition of people as individuals isn't it that you're focusing on? Rather than looking at people as having generic needs or common needs, it's really taking that very personalised approach to meeting their needs?
[Colleen Tribe] - I think it's really important to keep that personal level.
Once we start losing that, we start losing the purpose of what we're about and the organisation takes on something completely different. I think that we are really lucky here in Central Queensland because we are very connected to the community.
[Lara Carton] - That's great, thank you so much Colleen. Monica, I'm interested in your experience. When we're talking about community, you have many communities that the Country Universities Centre has within its remit. I'm interested in how you understand the concept of a healthy and connected community when your stakeholders are spread really broadly across regional New South Wales?
[Monica Davis] - Thanks Lara. As you know, I work with the Country Universities Centre. We are a network of regional study hubs across New South Wales, and the Country Universities Centre started in Cooma in 2013 and it was driven by the Cooma community. The Cooma community knew that they were looking for ways to keep young people in our towns, but also for a way to attract professionals to come to our town as well. In looking for ways to retain people and build on activities that they're able to do in the community, both for themselves continuing their professional development, but also for spouses and children as well, to be able to have a further pathway into education.
Each of these centres is community owned and is supported by the central office in Cooma, and what we found is that one of the key tenants of the Country Universities Centre is that we're empowering communities to bring that change that they want to see themselves. We've recognised that education is a key part to building a healthy community.
It both feeds into workforce pathways and workforce flows, but it also adds to the cultural depth of the community. We also find that it builds aspiration, building on the concept that if you can see it, then you can be it. But beyond that, we find that each community has its own special challenges that they need to work towards. We’ve found that the secret to that is through community empowerment, making sure that everybody has the resources and knowledge to build a solution that's specific to their region, and builds upon their unique understanding of what can work to build in the community.
[Lara Carton] - That’s fantastic, thank you for that. It's the most amazing story of success, isn't it? The growth of the Country Universities Centre and the fact that you're just about to embark on opening so many more. I think it really shows how you've managed to develop a model that meets the needs, as you say, of all of those various communities.
Rohan, I might move on to you. When we talk about healthy and connected communities, it's probably a bit simplistic to say that hospitals are integral to something like that. I’m really interested in understanding how you see your role and that of the hospital service in the town of Hamilton and the broader region? Maybe you can reflect a little bit on some of the work you're doing at the moment?
[Rohan Fitzgerald] - Thanks, Lara. By way of background, our organisation has eight hundred staff, we service a population of sixteen thousand people, we provide emergency department services, other services, twenty-four hours a day. [This includes an] ICU Intensive Care Unit, medical ward, surgical wards, and we provide around one hundred and seventy-five aged care beds across our local area as well. It’s a very complex organisation, large regional community, and we're always looking at ways in which we can support people to be healthier, and it's easier said than done. It is a real struggle.
I get very passionate about supporting people to be healthier, and I always bring it back to my personal life because it increases my level of passion and sometimes frustration at what I'm seeing across our society and the political spectrum, in terms of the apathy that we sometimes see, with people lacking drive and energy to get the job done.
The thing that really gets on my goat is that my kids, in a regional area, die sooner than someone who lives in metropolitan Melbourne. Why is that? How does that happen? My kids are going to have more chronic disease than someone in metropolitan Melbourne, and our perspective, it's about how do we then support people to change their mindset.
That is a significant dilemma for us as a health sector. The drive for us as public hospitals, for aged care providers and others to actually stimulate community conversations to be a little bit controversial aren't really there. Because everyone is concerned about playing a high-risk game, it's hard when you put yourself out there and you challenge the status quo, because no one wants to be vilified for having a different opinion. A few years ago, I'll just touch on one of the things I've done, and this was the one that wasn't successful so it's probably good to talk about it. I called for a sugar tax to be applied across Australia and I started activating a local community and Channel Seven got a hold of it and ran it up the flagpole.
I have never had so many negative comments in all my life in relation to generating a public discussion. But you’ve got to be courageous with these sorts of things. You’ve got to absorb as a health leader some of the negativity because that is going to ultimately lead to transformational change that's required within our sector.
It's unacceptable that we have a million people a year that are admitted to public hospitals across Victoria with a primary diagnosis of diabetes. What do we know about type two diabetes? It's completely preventable through diet and exercise! As an organisation, our focus is really looking at community engagement, but we're not funded for that.
Organisations have to shift their thinking, (from my perspective), to being around what you should be doing to what you need to be doing to assist the community to actually be healthier. That vision in itself, of creating healthy communities has then led us to be the first public health service across Australia to remove sugary drinks [from our hospitals], in 2015 I think it was.
Now that really surprised me from a leadership perspective that one small thing that we could do had not been done by any other public hospitals at that stage. In fact, it was quite a controversial move. I had people calling me up telling me that I needed to bring back all of the fizzy drinks that we had got removed from our internal cafeteria. But the profound impact that those decisions make ripple throughout the community over many, many years. But once again, as a leader and as a large organisation within the rural communities, it’s incumbent upon me to make some tough calls and to at times, lead a conversation with the community. That's very much what we've done.
[Monica Davis] - Rohan, can I add to some of the things you started out the discussion with? Especially where you were saying why do my kids have lower opportunities than someone in a metropolitan area. I think that really feeds into what you're saying about the vision being most important. Once you understand that problem, and you refuse to accept that that is the way it is and should be, that's the first point to start from. It sounds so simple, but I often find that in a regional area, we're told to accept a lower standard of healthcare, education, so on, and so forth.
We know that when we look at university education, you are half as likely to have a university degree if you're from a regional area than if you're from a metropolitan area. Every now and again I'll come across someone who says, “well, why does someone in a regional town need a university degree?”
That sets you back even further from even starting to solve that problem, [not being able to] agree that there is a problem that should be fixed. I think you're completely right in setting that vision. Once you have that vision confirmed, then you can start to make some progress from there.
[Rohan Fitzgerald] - I think the vision needs to be more than just the organisations and large institutions. The vision needs to be for community members and younger people in particular.
[Lara Carton] - I think what's coming through for me in this conversation is how important it is for one person or a small group of people to maybe have a vision that the community can aspire to more and expect more. It takes this coalition of people to really take a leadership charge and bring the rest of the community along the way. Colleen, is that how it feels for you sometimes in Gladstone, that you’re fighting against the stream to be able to advocate for your clients and the services that they need?
[Colleen Tribe] - I think it's a little bit different in Gladstone, particularly because we are an industrial town. We have quite a few large companies in Gladstone that really promote higher education, apprenticeships, traineeships and things like that. The thing that we're fighting against is we're working for the most vulnerable people in the community, so I understand what Rohan is saying in that the demographic we are working with comes in even differently again, in that people that are being targeted to go on to tertiary education or apprenticeships and traineeships are doing quite well.
But our clientele, we need to advocate for them even more so, in that they are competing against people that ordinarily they wouldn't even think themselves worthy to compete against. We're trying to lift that attitude and that that mindset.
[Lara Carton] - Have you noticed that that's even harder in the current environment with COVID-19 bearing down on people? Maybe we’re certainly seeing young people feeling some greater sense of limitation around what their future might look like. How's that impacting on your work, and particularly young people?
[Colleen Tribe] - I think that looking at the economic recovery, and how that's going, people are really focused on making sure that jobs are retained or are given back to people that have lost jobs. The focus on young people getting jobs, traineeships or apprenticeships has lost a little bit of momentum. The other thing that we're noticing up here is that there seems to be an increase in women that are unemployed. That has increased and that's problematic as well. We know we need to make sure that the focus is across the board.
[Lara Carton] – Monica, I’m interested in your students. You mentioned that sometimes the perception in regions is not to aspire to higher education, but obviously, you're doing an amazing job driving that aspiration. How are your students feeling about their sense of the future? Are you seeing that driving more of an interest in in training and education at the moment?
[Monica Davis] - I think that there is in people who are looking at studying from regional areas often a high aspiration. But, there's not much guidance around how to surpass those roadblocks. Like Rohan said, kids in regional towns say, “look, I'm not smart enough. I didn't get the ATAR for it, and it's too expensive.”
A lot of those barriers that sit there become prohibitive for a regional kid. We find that in starting to overcome some of those problems, access, opportunity and support, once you start to remove some of those barriers, it becomes obvious to people that they can do that and that starts to open up those dreams a little bit more.
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Whether that's saying, “I've always dreamed of being a nurse, but I didn't want to go away to university, and I can't get away to do the practical placements.” Once you start to find some of those solutions, then that really starts to tap into that optimism and seeing those opportunities as being a reality.
The other part of that triangle that we often talk about is support because there are challenges both in getting to university, but also staying there as well, [especially] for online students. We know that they had traditionally very high attrition rate. Making sure that they have a community, a learning community around them to support them to stay in that study.
Making sure that they feel as if they belong as a student, and we can do that by connecting them with other students in the region, and also by making sure that if they hit a roadblock, then they've got the support that they need. I think that in providing those opportunities and access that does certainly change the perception of regional people. I think that also with greater connectivity through the internet, that starts to open up some more opportunities as well. We're seeing more and more universities offer courses online, and that starts to I guess widen the horizon a little bit further as well.
[Lara Carton] - Rohan, we first got to know you at the university because you were talking to us about education, and it was very much around a personalised, localised approach to developing people in your region and for your future employees. Do you want to tell us a little bit about why a CEO of a hospital is so focused on education?
[Rohan Fitzgerald] - If you look at the social determinants of health, education is right up there in terms of being a priority to improve health outcomes. I'm a little bit different when it comes to what things we need to do as a health service, but I feel that I have an obligation to my local community. I live here, I love the people that I live with, I have a great connection to my local community, and I want to see them succeed. Sometimes that means taking risks and that means looking at innovative education models, models of delivery of care within our organisation and that's why we sort of came up with a solution with CQU to look at how we can deliver a Bachelor of Nursing program in the Western District area.
We don't have any university for 100 kilometres either side of us. There was a suggestion that the university services that were actually coming out to the region were going to be reduced over time as well.
It's really essential from that perspective, looking at their future needs as an organisation and our requirements for a really highly qualified skilled nursing workforce, that we needed to look at what would be a local solution. What we've seen is actually a better outcome in terms of the capability of those students who've gone through the CQUniversity program, because it's almost going back to the old days where someone is training within the organisation and developing their skills within the organisation. What we've done recently is expand on that and we said we just don't want to stop at a bachelor's level program, we want a master's level program as well, which we've put in place over the course of the last few years. At the back end of that we're working with the TAFE colleges as well, and supporting our staff in terms of micro credentials, and there’s been a lot discussed around micro credentials recently. From my perspective, I think they are really ideal tool.
We've got this pathway where people can now go from micro credentials, through to a TAFE program through to a Bachelor of Nursing program, and then through the higher education and masters and potentially PhD level. I think that's a marvellous outcome for local and regional communities that didn't exist three or four years ago.
[Lara Carton] - You mentioned when you started talking about some of the public health initiatives such as reducing soft drink, for example, that you found that some people were really challenged by the hospital or you raising what might be seen as some challenging or unusual conversations beyond what they might expect you to do. Do you see that as you progressively introduce new conversations to the community?
It was soft drinks and health initiatives and reducing obesity, and it's education and looking at employment pathways and promoting education as a way of raising general aspiration. Do you see that the community's perception of the hospital and you is changing? Are those conversations getting easier to introduce each time you introduce something that might not be seen as typical of a health service?
[Rohan Fitzgerald] - I think it's important to be genuine about these sorts of things. It needs an honesty; you really need to believe what you're talking about. Now, everything you do in rural areas in particular, and Monica was talking about this, is a team game. Everyone needs to be involved on the team. Now people participate at different levels, there's no doubt about that. But you do need to have an engagement strategy that allows people to come into what you're trying to achieve. That’s very much what we've been successful in doing over the course of the last few years.
[Lara Carton] - I'm conscious we've got questions coming in thick and fast from the audience. The first question that we've gotten, Colleen I might ask you to consider this one. We live in a society which has a sick care model rather than a health care model. We address health problems after people are sick rather than being radically proactive in health and wellness promotion. How would you go about addressing this imbalance, or is that already what Rosebery is doing?
[Colleen Tribe] - We have developed an adaptable living program at Rosebery and are really catering for low income households on how to cook a nutritious meal on a low income and following on from that we have a couple of youth shelters.
Our adaptable living program includes a nutrition program including that how to cook a meal on a low income or a nutritious meal with minimal cost. We're trying to as far as sick care actually go the other way and make sure that we have that early intervention before we get to that. A lot of our clients are coming from intergenerational poverty, so that is the environment that they've come from.
Those quick meals possibly weren't nutritious because some people are not able to understand that nutritious meals don't have to be expensive.
[Lara Carton] - Really interesting Colleen. One of the questions that's coming as a follow up is do you have any research or data on the positive impact of the community development work you've been doing in relation to improvements in mental and physical health?
[Coleen Tribe] - Yes, we have data like there’s no tomorrow.
We have eighteen different programs with Rosebery and tracking data along the K10 with Headspace. We have different data systems that we collect, but I think the most important data that you never collect is that anecdotal talking to clients and seeing how they are and seeing how they are progressing.
There's conversations, and we can't just enter everything onto a computer, we need to have those as well. Sit down and have a yarn with people, see how they're really tracking, making sure that we take the time to listen.
[Lara Carton] - Monica, I'm interested in how you're able to track the impact of the work that you're doing in the individual communities you going into?
[Monica Davis] - That's a really interesting question. We've got some very direct measures of how we track that impact. That includes looking at student numbers, and how students are progressing through their degree. Over the bigger picture, like Rohan said, a lot of these are long term studies or long-term projects that we're looking to have an impact. One of the things we're really interested in is what's the impact of the demographics of a town.
We know that in regional areas [there] is often a big hollowing out through the population through the 18 to 35-year-olds, where most of them will leave a regional area and move to a metropolitan area. That's something we're watching really closely, and I'm eagerly awaiting the 2021 census to try and see whether we're having an impact on that scale to see that data as well.
I'm really looking at how in a bigger picture we can impact those communities. We’ve been looking at some really interesting connections between students and workforces, and whether we can start to work more closely with workforces to say, “okay, this is where the need is now, but in five years’ time, what will those needs be?” For example, we're just about to open a centre in Parkes, which has been identified as a special activation precinct, and we know that will be the hub for the Inland Rail. So, what can we do now to try and have that longer-term impact? Especially keeping in mind that higher education takes some time, part time degrees take eight years. How can we integrate that to have those seamless connections and collaborations between helping people feed into study and onwards into workforce through there?
[Lara Carton] - Fantastic, thank you for that. Look, we've got time just for one more question. The question that's come in from the audience, and I might open it up to see who wants to address it, is how can we go about learning from Indigenous communities and traditional ways of knowing about healthy and connected communities
[Colleen Tribe] - I'll start off, we have lots of conversations with Indigenous communities looking at family setup, and how we can listen and learn with that family set up. Also, [we do this] with young people and how family can help young people.
[Lara Carton] – Are you finding that that's part of the data gathering that you're getting from your community, and that that's influencing the way you deliver your services now? Or is that something that you're looking to incorporate further into the future?
[Colleen Tribe] - I think that we've got a long way to go in making sure that we are culturally aware and working with our Indigenous and traditional landowners. I think that particularly with young people, we need to make sure that we're doing the right thing by communities, restorative justice and things like that. I think we've got a long way to go Lara.
[Rohan Fitzgerald] - I’ll say that we’ve got to learn a lot from Indigenous cultures, generally, in terms of holistic health care. Health care shouldn't just be about sick people, it's about the spirituality of health care.
[Health care] is about the emotional support that we need to provide people with mental health issues that are associated with in just general day to day living. Until we start to think more broadly about individuals as being not just individuals who are inwardly looking, but inwardly and outwardly looking, we're not going to achieve the outcomes that we're aspiring to in terms of a healthier future.
It's a significantly complex problem, but it's one that we can learn a lot from Aboriginal culture in particular. Applying those traditional techniques to society and societal values, that will improve health outcomes for people today.
[Lara Carton] - Thank you. Monica?
[Monica Davis] - As Colleen and Ron both said, those connections with community and family are so incredibly important, particularly for Aboriginal and Torres Strait Islander people. We find that across the CUC we have a very high proportion of Indigenous students, much higher than we often see in a metropolitan university.
Across the network, nine and a half percent of our students have an Indigenous background, and in towns like Maury and Narrabri, it's as high as 20%. Whereas across Australia, for university students, it's only 1.8%.
What we find is that in our student cohorts, they’re quite representative of the communities that they come from. In Broken Hill, 11% of students are Indigenous, and we know that the Indigenous population of Broken Hill is quite similar to that as well. Once those opportunities are there, and you can work with an understanding of how important that connections with community and family can be, then it removes a lot of those barriers that are usually perceived for people from Aboriginal or Torres Strait Islanders to take up. There's then opportunity for education.
[Lara Carton] - Fantastic, thanks so much, everyone. We started this conversation talking about anchor institutions, and I think what I've really taken from this is that in order to get change in, particularly in often regional tight knit communities, it takes more than just an organisation. It takes an individual or individuals who really have a vision to drive change, and to aspire to more for their community and on behalf of their community.
Very much about taking a long-term view, recognition that change can often be a challenge, not only for the people that you hope will benefit, but also for the systems and the organisations around you. One of the things I really picked up on is that in order for healthy and connected communities to be sustained, it needs to be inclusive at all stages, that it's not just led by senior people leading important organisations. It needs to be inclusive of all of the people who are affected by the change. I'd really like to thank our panel, Monica, Colleen, and Rohan, I've really enjoyed speaking with each of you. While I know a lot of you through the work you do with us as a university, it's been fantastic to hear the three of you in conversation and put your different work in context.
