Introduction: Climate change is a growing major public health concern, with rising attention to its effects on mental health. Research shows that local built environment, such as housing quality and neighbourhood characteristics, can influence individuals’ vulnerability to climate-related hazards and therefore their associated mental health impacts. While substantial research has documented the separate effects of the built environment and climate change on mental health, the potential of the built environment as a preventative measure against climate-driven mental health risks remains unexplored. As a tool for advancing health equity, further research is needed to guide preventative urban development and adaptation responses that leverage built environment to reduce mental health vulnerabilities in a warming world.
Methods: We will present the initial findings from our scoping review, where we are conducting secondary analysis of published data exploring frameworks addressing pathways between climate change, built environment, and mental health. The systematic scoping review of peer-reviewed and grey literature will be conducted in accordance with Arksey and O’Malley’s methodological framework and Joanna Briggs Institute recommendations. Articles included in the scoping review will present a theory, model or framework incorporating relevant built environment pathways through which climate change may impact mental health outcomes.
Results: This scoping review will identify and synthesise existing frameworks describing the relationship between built environment (e.g., housing and neighbourhood design), policy and planning mechanisms, climate change, and the impacts on mental health outcomes.
Conclusion: We anticipate this review will provide an evidence-base of frameworks and models through which climate-adaptive and resilient urban design can positively impact mental health service planning and outcomes. It will support local urban planning policy development in utilising built environment as a preventative health measure, along with highlighting future priorities for decision makers and research to harness built environment for health equity relating to mental health vulnerabilities in a heating planet.

Lived experience involvement is a vital and valuable way to ensure that policy and research lead to tangible changes. The involvement of people with a lived experience and community members is often relegated to an afterthought in the development of prevention policy, programs, and research. This is a missed opportunity to ensure that design and decisions align with the genuine needs of the communities whose health we aim to improve and needs we aim to serve, and to increase community trust. Prioritising community and lived experience from the outset can build resonance and improve overall efficacy of our outputs.

We have utilised a variety of methods to include community members and people with a lived experience in our policy development processes across the spectrum of cancer control. This includes community member peer-review processes, one-on-one consultations, inclusion in expert working groups, and development of Community Reference Groups. Each approach offered distinct insights, which we will discuss in this presentation.

Our experience has highlighted several key learnings, including the importance of inter-organisational collaboration to identify and involve interested people with lived experience, tailored approaches and increased flexibility for engagement, and providing multiple feedback avenues to create safe spaces for community voices. Successes included having a robust remuneration protocol, clear and frequent communication, and a transparent engagement process.

This presentation will detail our successes and challenges, as seen by participants, to inform policymakers, program managers, and researchers, on the value of involving community in the design and development of policy and programs. We aim to inspire others to adopt engagement processes which are genuine, modern and agile; prioritising participation that adds value to the community and the work.

The South Australian Population Health Survey (SAPHS) is a state-wide population health survey managed by Preventive Health SA, which aims to monitor the health status of all South Australians. The SAPHS has been collecting information about the health of South Australians since July 2018. In addition, Preventive Health SA coordinates a survey called Population Health Survey Module System (PHSMS). The PHSMS is an ‘omnibus-type’ service available to government and non-government organisations to obtain data on a range of population health and wellbeing issues within South Australia. This survey aims to provide an alternative data source for indicators not already covered in the SAPHS.
Prior to 2020, SAPHS and PHSMS were predominantly used to play an important role in the development of health services by providing information to policy makers, providers and researchers about the health of the community, the performance of the health care system, and its impact on people of varying social, economic, and illness levels.
This changed considerably in 2020 when SAPHS and PHSMS were used to monitor South Australia’s community sentiment to South Australia’s response to the COVID-19 pandemic. Questions were added to SAPHS to collect ongoing confidence in the state government and SA Health’s handling of the pandemic, as well as monitoring the community’s perceptions on level of restrictions, barriers to PCR testing and vaccine hesitancy. This could be analysed by population groups to determine who the government should target with their communication.
Post COVID pandemic, SAPHS and PHSMS have continued to be used to monitor community sentiment on a variety of issues. These include looking into important policy topics such as the tobacco-free generation, restrictions on alcohol advertising on Government of South Australia public transport assets, and restrictions on unhealthy food and drink advertising on Government of South Australia buildings, facilities and public transport assets.

Problem:
Less than half of adults in Western Sydney Local Health District (WSLHD) meet recommended physical activity guidelines, with neighbourhood factors like the availability of public toilets, impacting walking habits. Residents cite locked toilets and a lack of any toilet as barriers to walking, for both recreation and commuting. The disability and inclusion sector also calls for accessible toilets open during daylight hours. As WSLHD’s population grows and densifies, the demand for public toilets will increase, presenting Councils—the primary providers of public toilets in public open space — with the complex and often political task of providing unlocked toilets with managing safety and other potential risks.

What you did:
WSLHD established a Public Amenities Network, including representatives from each Council, to support increased toilet opening hours by addressing common challenges, solutions, best practices, and change enablers and barriers. Submissions have been made to local and state government agencies advocating for more toilets open for use. Our work has quantified the change in open public toilets from 2018 to 2023.

Results:
Between 2018 and 2023, the number of Council-owned public toilets in WSLHD open during daylight hours increased by 11%. This was achieved by extending hours for some existing toilets and adding new toilets with specified daylight opening hours. Key enablers of this change included political support and evidence of community demand. Costs and concerns about anti-social behaviour (and its perceptions) remain barriers to opening more toilets during daylight hours.

Lessons:
Public toilets spark strong, often conflicting reactions within communities and organisations. Yet, change is possible with respectful interventions, thoughtful planning, management and communication.

Background: Liveability refers to aspects of the built and natural environment of neighbourhoods that make a place enjoyable, safe and healthy to live. Liveability is made up of domains e.g. housing, or food environment, each with specific indicators linked to health and wellbeing improvements. However, evidence suggests that liveability models take a normative focus, rarely including measurements sensitive to the needs of the people with disability. This study aimed to explore how people with disabilities in Tasmania experience their neighbourhoods.

Methodology: The study utilised a cross-sectional survey informed by a consultation group of people with disability. Adults self-identifying as living with disability in Tasmania were recruited via convenience sampling. The survey was structured around the normative liveability domains, and made up of questions relevant to people with disability as identified by the consultation group and literature review. Questions sought to gauge perceptions and satisfaction of respondents with aspects of their neighbourhoods. Descriptive analysis was used to understand mean and modal responses, dispersion, frequencies and distribution.

Findings: 103 participants completed the survey. 57% of respondents resided in regional centres (Modified Monash Model level 2), and 36% in small rural towns (level 5); 57% were homeowners. Neighbourhood satisfaction was moderate on a global satisfaction question using 0-5 scale (mean 3.8, SD 1.8), and for the domains of natural environment (mean 3.8, SD 1.1), and parks and public places (mean 3.8, SD 1.5). Satisfaction was lowest for the domains of walkability (mean 2.3, SD 1.6) and social environment (mean 2.9, SD1.4). Questioning on neighbourhood issues revealed frequent challenges across all liveability domains, with the most respondents identifying issues with walkability (n=88), social environment (n=83), and transportation (n=70).

Conclusion: Overall neighbourhood satisfaction was higher than satisfaction with the combined liveability domains indicating additional factors may have contributed to global neighbourhood satisfaction.

Local-level health policies and interventions are an important context for addressing inequities in health. Yet, government policies and societal values that are shaped by power imbalances can exacerbate health inequities. To guide government and intersectoral partners on how to better consider power dynamics and rebalance power in intervention development and implementation, we i) conducted a systematic review of the international literature to identify and describe how power has been rebalanced in local health equity interventions and ii) conducted an explanatory case study of a locally-driven COVID-19 vaccination program in regional Australia that rebalanced power toward community.

Our systematic review identified 38 studies, describing a range of health equity interventions including community organising interventions, health or advocacy education programs, community funding initiatives, and government policies. Interventions that enhanced community power often increased health equity knowledge and developed critical reflection, leadership and advocacy skills. Interventions that challenged and transformed structural and institutional power inequities did so by simultaneously acting on multiple types of power, such as network, discursive, moral and expert power. The explicit use of power-centred frameworks was also key to equalising power dynamics in the development and implementation of health equity interventions.

Shifting power from governments and intersectoral partners to community was further illustrated in our case study where “placing community in the driver’s seat” underpinned the COVID-19 vaccination program’s success. A shared vision for health equity and a history of collaborative, community-led initiatives, enabled local government and partners to build the partnership skills and trust needed to transfer decision-making power to community. It also highlighted the “grit and guts” that local leaders need to challenge inequitable power dynamics in health structures and systems.

Our findings offer practical real-world examples of how power imbalances can be tangibly identified and addressed by local policymakers and partners to advance health equity.

The Problem

In Western Australia, drive-through fast-food outlets near schools and homes continue to be approved despite widespread community opposition during public consultations. The proliferation of fast-food outlets undermines efforts to enhance community health and exacerbates poor diets. The WA Sustainable Health Review final report recommended changes to planning laws to limit unhealthy food outlets and improve access to nutritious options, including near schools.

In February 2024, developers sought approval for a mixed-use development that included three 24/7 fast-food outlets, a medical centre, a service station and a vehicle wash opposite a primary school in a newly established residential area.

What We Did

Cancer Council WA worked with Hammond Park residents and parents of Hammond Park Primary school to oppose the fast-food outlet component in the proposal. Strategies included a rally on 16 February 2024 with media invited, a petition to City of Cockburn opposing the development and letters to City of Cockburn councilors and relevant WA Members of Parliament. We provided template letters for residents to voice objections, alongside Cancer Council WA’s official submission.

Results

Despite our advocacy efforts, the development was approved. There was significant media coverage of the rally, with an estimated audience reach of almost two million. A positive outcome was the case prompted Chris Tallentire MLA, Member for Thornlie to contact Cancer Council WA to support further advocacy for changes to planning laws, specifically a petition to the WA Legislative Assembly on 18 June 2024 calling for urgent reform.

Lessons

This case underscores the need to integrate community voices and public health into planning laws. Strong opposition to drive-through fast-food outlets near schools highlights the importance of prioritizing community health in policymaking. Working with community was demonstrated to be a remarkable advocacy collaboration, with community engagement assisting with generating media and political support.

Context: Whilst there are many frameworks and assessment tools that exist for understanding and evaluating community resilience to climate change and disasters, there is limited research that explores community resilience from a public health perspective. Few frameworks and assessment tools exist for measuring health-related community resilience in the context of climate change, with limited agreement on dimensions and indicators that measure these, as well as minimal consideration of diverse communities and inequalities. Research is needed that draws together public health knowledge with existing work on climate change and disaster resilience to inform evidence-based policy and public health interventions that are specific to the health risks of sudden and slow-onset climate change.

Aims: To (1) identify and assess the dimensions and indicators of community resilience to the health and wellbeing impacts of environmental and climate change; and (2) determine which dimensions and indicators have established ways of being measured and what gaps remain in their operationalisation.

Methods: A scoping review of academic and grey literature focused on the dimensions and indicators of community resilience to the health and wellbeing impacts of environmental and climate change.

Outcomes: Synthesis of findings from the literature highlighted key dimensions and indicators of community resilience to the health and wellbeing impacts of climate change to inform a pre-liminary framework.

Impact: The findings of this scoping review contribute to improved understanding of community resilience to the health and wellbeing impacts of environmental and climate change and provide an initial foundation from which to establish more precise place-based community interventions, including the measurement of community resilience. The findings of this review therefore contribute to an important progression in long-term public health preparedness and protection, as well as interdisciplinary and strength-based research that informs both policy and practice.

Title: "Promoting Health Equity Through Community-Centric Prevention Policies"

Abstract:

Policy/Practice: Due to social determinants of health like poverty and education, cultural obstacles, and limited access to specialized preventive care, health disparities in marginalized communities continue to exist. The varied demands of various populations are frequently not met by traditional one-size-fits-all methods in preventive health programs, which leads to differences in health outcomes.

What We Did: In order to address the prevention of chronic diseases in underprivileged communities, we put into practice a community-driven intervention strategy that emphasized equitable health policy. We co-designed culturally appropriate preventative programs with community organizations, health professionals, and local leaders. Workshops on health literacy, risk factor assessments, and availability of helpful tools for behavior change were all part of these initiatives.

Results: As a result of our intervention, participants' involvement with preventive care improved, as seen by higher rates of chronic disease screening, improved health literacy, and increased adoption of healthy lifestyle habits. Interestingly, when compared to typical programs, community-specific efforts showed better rates of persistent preventative behaviors.

Lessons: This paradigm emphasizes how important community involvement and culturally sensitive approaches are to creating successful preventive health measures. Important takeaways include the importance of prioritizing resources for high-need areas, encouraging cross-sector collaboration, and include community perspectives in policy formation. This strategy provides a scalable framework for attaining long-term health equity across a range of groups, highlighting the significance of equity-focused policies that adjust to the particular requirements of marginalized communities.

Globally, refugees face different challenges in accessing healthcare services in the host countries. These challenges are often exacerbated by political factors in distributing limited resources in the healthcare system. Since World War II, Australia has played an important role in settling refugees following continuous modifications in its policies to enhance the quality of life in this population. However, there is a need to see the most current policy-related problems refugees face in terms of accessing their health needs. This study investigates refugees' challenges in accessing healthcare services in Brisbane, Queensland, Australia.
This qualitative study utilised in-depth interviews for data collection, having two main groups of participants, including GP clinics as primary healthcare providers and collaborative organisations supporting the well-being of refugees in QLD, Australia. As a part of a comprehensive community needs assessment model, the study specifically examined normative and expressed needs related to refugees' challenges rooted in political and decision-making perspectives. The Ottawa Charter for Health Promotion provided a guiding framework, and data were analysed using MAXQDA 22.
The analysis identified several main themes within the Ottawa Charter’s five action areas, highlighting policy-related barriers limiting refugees' access to available healthcare services. These themes included “political barriers to policy changes”, “lack of proper multicultural health policy”, “inadequate resource allocation”, “lack of representation in decision-making discussions”, “trust deficits with law enforcement”, and “cultural incompetencies in the healthcare system”. The second part of the findings focused on participants' recommendations for overcoming these barriers.
Meeting the policy-related barriers in the healthcare system will improve refugee's access to health services and improve the population's overall well-being.

Problem: Intimate Partner Violence (IPV) and Reproductive Coercion and Abuse (RCA) are pervasive public health issues in Australia, impacting up to 40% of patients in primary healthcare settings. Community health services often lack structured protocols for IPV/RCA screening and staff education, limiting secondary prevention opportunities and access to supportive resources for those affected.

What You Did: The Safe to Tell Project (2021–2024), funded by the Department of Communities, Department of the Prime Minister and Cabinet, and Department of Local Government, Sport and Cultural Industries, was a three-part pilot across three community health services in Western Australia. The It’s Okay to Say Project, under this umbrella, adapted Sexual Health Quarters’ validated IPV/RCA screening tool for use with disability clients. The Community Health Project piloted screening and education at two women’s health sites, adapting tools to be inclusive of CaLD (Culturally and Linguistically Diverse) communities. The Primary Health Project trained over 93 healthcare professionals in Perth on how to recognise, respond, and refer patients experiencing IPV/RCA, with an additional co-designed module on understanding the unique ways IPV/RCA affects LGBTIQA+ individuals. Together, these projects established trauma-informed, universal screening processes aligned with WHO recommendations for routine IPV/RCA screening.

Results: Across the projects, It’s Okay to Say screened 55 clients, over half of whom reported IPV/RCA experiences. The Community Health Project screened 253 clients, with 56% disclosing IPV/RCA. The Primary Health Project trained 93 healthcare providers across 30 clinics, with over 70% of staff (100% of GPs) reporting increased confidence in managing IPV/RCA cases. Infrastructure adaptations, including improved privacy and referral pathways, enhanced the supportive environment for disclosure. Accredited training from these projects is now available nationally, promoting scalability across healthcare settings.

Lessons: Effective IPV/RCA screening in healthcare settings requires adaptable, supportive environments. Addressing staff turnover and offering periodic refresher training are essential for consistency and sustainability. Co-design with disability, CaLD, and LGBTIQA+ communities underscored the importance of inclusivity, with diverse stakeholder engagement critical for the long-term success of IPV/RCA screening and education in Australia.