Table 2 Translation of PH12 with examples from real life implementation of interventions to improve public health

1

The ability to continually adapt collective fundamental beliefs leading to widespread change in the way things are, to solve multiple complex problems.

No real-world examples of Level 1 were identified within our interventions, so therefore we provide an aspirational example.

A local community experiences multiple environmental crises of bushfires and floods, followed by COVID-19 pandemic. In response to recognising the multiple interconnected complex crises, the community devises a co-created intervention to protect local forests and farmland in a co-ordinated way and simultaneously enhances large scale emphasis of locally sourced food into food systems. This type of triple duty action [4] would impact environment sustainability, community resilience, and public health.

2

A population-levelshift in fundamental beliefs on how complex problems are solved (a change in the way things are).

WHO STOPS: A local water authority champion addressing the taste of tap water at a regional level using a systems approach. – ‘Great Tasting Water Project’. An organisation expanded their remit from providing safe drinking water to providing safe drinking water that people want to drink.

3

Where a fundamental goal of a system is challenged and changed.

YCHANGe and WHO STOPS: When the traditional goal of a health service shifts from treating illness, to keeping people well and in their homes and community and this is written into the mission statement of the health service(s) and enacted in daily practice through multiple actions.

4

Governance structures to create and maintain consensus on a combination of various level 5-12 actions over time.

RESPOND: Established a ‘healthy schools’ collective rather than working with each school separately.

5

New modified rules that incorporate and bring accountability for change.

WHO STOPS: The grouping of water related policies at junior sport; sport stadium not selling sugar sweetened beverages drinks; junior basketball endorsing a “water only policy”.

6

Movement of vital information to shift power dynamics that opens up the decision making processes to more (and the right) people.

WHO STOPS and RESPOND: Sharing of the local child anthropometric data was an initial catalyst for change.

7

Initiating a movement toward a target that is self-reinforcing and gaining momentum in the desired direction.

WHO STOPS, RESPOND and YCHANGe: STOPS: Those in authority positions provided the authority and resources to work in a way that prioritises childhood obesity prevention ongoing.

8

Taking new action to stabilise a part of the system to achieve a specific intended goal.

WHO STOPS: A rural health service recognised the food it provided in its in-house cafe was not healthy. To try to limit or slow the purchase of unhealthy foods, a ‘green only’ (i.e. healthy) food policy was implemented.

9

Strategic planning to align timeframes with available resources, current readiness, and intended outcomes.

YCHANGe: The CEO of the health service strategically providing funding aligned with a new café development and policy mandate to meet an established ‘healthy food’ quota.

10

Building of new physical or providing financial infrastructure and/or improving physical movement through the system.

YCHANGe: new drinking fountains were installed in towns where no public access to free fresh water previously existed.

11

To maintain a ‘safeguard/safety net’ within our community or system to absorb reasonably foreseeable, but unexpected events without adversely affecting the way things are. This includes maintaining supportive environments, schools, workplaces

RESPOND: several organisations pooled financial resources to enable a project officer to be employed in one community to solely work on RESPOND.

12

To increase or decrease one isolated part (component) of the system that already exists within a community?

YCHANGe: Produced a brochure of the current physical activities available and the LGA put a sugar content of soft drinks sign on the fridge.