Jennie Roe Manager, Medicare Locals Taskforce (ANPHA)

Driving community health

improvement through prevention

2007 – Preventive health identified as key element in national health reform agenda

2008 – National Partnership Agreement on Preventive Health – landmark state, territory and Commonwealth agreement

2009 – National Health and Hospitals Reform Report

– National Preventative Taskforce Report: Australia the healthiest country by 2020

2010 – Government agrees to establish national prevention infrastructure

– Australian National Preventive Health Agency Act 2010 passed (Nov)

2011 – ANPHA established (1 January 2011)

Preventive health reforms

(Legislated) functions of the Agency

• Provide evidence-based advice to Health Ministers on prevention

• Analyse and disseminate information on prevention – essentially to build the evidence

• Report on the State of Preventive Health – every two years

• Build results-oriented partnerships with those engaged in prevention – State governments, private sector, NGOs, industry, community

• Strengthen the national coordination of social marketing for preventive health

• Manage award schemes for excellence in preventive health

Focus initial efforts on:

Obesity Tobacco Harmful use of alcohol

• CEO – Advises all Health Ministers – Reports to C/wealth Minister

• Budget – C/wealth funded – 2012-13: $5.4m (operational) $39m (programs) ~ 40 staff

ANPHA Advisory Council

• Commonwealth

• States and Territories

• Experts in public health

4 x Expert Committees

1. Alcohol

2. Tobacco

3. Obesity

4. Research

Governance

Preventive Health Indicators

WHOLE OF

AUSTRALIA

LEGEND

Proportion of persons (18+) at risk of long-term harm

from alcohol (based on 2009 NHMRC guidelines);

Proportion of persons (18+) who are daily smokers

Proportion of obese & overweight (measured) adults

(18+); (proportion obese)

National Health Survey 2011-12 age standardised to 2001.

25.3% 16.9% 66.0%

(29.4%)

24.2% 22.6% 63.7%

(28%)

18.2% 17.4% 66.1%

(28.7%)

19.9% 17.5% 65.4%

(30.5%)

18.5% 14.8% 61.1%

(27.7%)

21% 13.4% 63.6%

(25.2%)

22.8% 23.2% 64.1%

(28%)

17.5% 16.8%

61.9%

(25.9%)

19.4% 16.5% 63.2%

(28.1%)

Regional variations in overweight and obesity

WHOLE OF

AUSTRALIA

LEGEND

Proportion of obese (measured)

adults (18+); age-standardised

29.4%

28.0%

28.7%

30.5%

27.7%

25.2%

28.0%

25.9%

28.1%

66.0%

61.1%

63.7%

66.1%

61.9%

64.1%

63.6%

65.4%

63.2%

Proportion of overweight and obese (measured) adults (18+);

age-standardised

REGIONALITY

Major Cities - 61.6%

Inner Regional - 66.8%

Outer Regional - 68.4%

Rural & Remote - 72.8%

Obesity • New Shape Up Australia campaign and resources

• Guidelines re monitoring of unhealthy food advertising to children

• Healthy eating guidelines

Harmful use of alcohol • National Binge Drinking Strategy

• Community Sponsorship Fund

• Community Level Initiatives grants

• New campaign and materials

• Issues paper examining the case for a minimum alcohol price

Tobacco • New National Tobacco Campaign and resources

• National Network on Smoking and Disadvantage /

Symposium

“Fun police”

WHO Health Definition

Health is a state of complete

physical, mental and social wellbeing

… and not merely the absence of disease or

infirmity

(This definition has not been amended since its development in 1948)

Health Care

– what are the

causes of disease?

How to treat disease?

How to prevent disease?

Health

– what are the

‘causes’ of health?

What contributes

to good health?

What makes keeping or

attaining good health easier?

questions get modified & improved

What improves health?

• Health care – antibiotics, medications, surgical procedures

• Healthy behaviours – nutrition, physical activity, sun safety, not smoking, non-risky alcohol consumption

• Preventive health and early detection interventions – immunisation, screening

• Healthy environments (incl through regulation and policy) – food security and safety, public sanitation, safer roads and cars, safer workplaces, vector control

• Political and economic security (incl educational attainment)

Road fatalities 1968-2008

Source: National Preventative Health Taskforce, 2009

Source: OECD analysis of national health survey data: Fit not Fat Policy Update 2012

projected overweight & obesity rates

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

75%

1970 1980 1990 2000 2010 2020

Year

Pro

po

rtio

n o

verw

eigh

t/o

bes

e

- - - - Past projection

New data points

USA England

France

Canada

Korea

Australia

The influence of built environments

• Built environments can work against adoption of healthy behaviours

• Local food supply:

• fresh food / markets v. fast food outlets

• How to influence urban planning to promote:

• physical activity?

• community connectedness?

• access to public transport?

• access to local services?

• “Making healthy choices easy choices”

• Priority driven research agenda – obesity, alcohol

• Fellowships

• Research Grants

• National Preventive Health Research Strategy

• Symposia and evidence briefs

Emerging strategic themes:

• Economic case for prevention

• Social determinants

• Data

• Translational capacity

• Skills for researchers and research users

• Partnerships and collaborations

Research – Building evidence and workforce capability

NHMRC Partnership Centre – Systems Perspectives on Preventing Lifestyle Related Chronic Health Problems

• Broader systems that shape lifestyles and health consequences

• Partnership funding commitment for 5 years:

– ANPHA, 2 x state health departments, private health fund

– NHMRC matching partners’ funds

• Academic and system investigators – led by Prof Andrew Wilson

• Build, analyse and disseminate evidence

• Facilitate replication, scale-up, adaptation and expansion of

efforts for sustainable change

“ … we have a fragmented health system with a

complex division of funding responsibilities and

performance accountabilities between different levels

of government.” (NHHRC, 2009)

(… and this is just the public sector!)

• Multiple programs, funders, inflexible requirements

• Patchy integration across primary care sector

– and between PC and other sectors

(aged care facilities, hospitals, community health)

• Complex web for people to navigate

A complex health care system

Aims:

• Keep people healthy and participating in society

• Minimise avoidable hospital admissions

Key priorities:

• Improve access and reduce inequity

• Better manage chronic conditions

• Increase the focus on prevention

• Improve quality, safety, performance and accountability

Primary health care reform Primary health care reform

Elements:

1. Grants program – targeting effective

preventive interventions through

primary care, esp. for disadvantaged,

at-risk and hard to reach groups

2. Evidence collection – nationally

consistent data and rigorous evaluation

to strengthen evidence

3. Knowledge network – to build

capability, share learnings and promote

uptake amongst MLs

Disease Prevention and Health

Promotion in Medicare Locals

• Embed evidence-based focus on prevention and population health

• Where evidence is lacking, seek to generate it through robust data

collection and evaluation

• Stimulus funding for Medicare Locals to collaborate with local

partners and States foundation for local sustainability

• Local solutions for local needs

• Social disadvantage and high needs

• High visibility of learnings as projects progress

– promote uptake of effective preventive activities across MLs

Critical foundations

Collaborate with ANPHA and NHMRC Partnership Centre

Standard framework for evaluation:

• common set of basic indicators (where appropriate)

• robust data collection

• assess similar outcome measures across a range of

interventions, population groups, settings

• measures re strength of partnerships, healthy communities,

differentials across population groups

Share learnings and experiences in real time

Generating evidence

Queensland initiatives

Health Promotion Navigator Project

• increase awareness of lifestyle risk factors and locally

support available

• development of a web application – identify risk of

CVD, diabetes, kidney disease

• subsidised access to programs and services for

outlying / disadvantaged people

Partners: Bundaberg Regional Council, CQ University, IMPACT (community NGO),

Bundaberg and Rural Health Services

Active by Community Design

• engage local communities re needs, priorities

• create healthy environments that promote active living

• increase usability of community parks and spaces

• community partners to provide labour and expertise to

develop trails and paths, active play equipment, design

activity and park-based social inclusion programs

They got it right 30+ years ago

1978 – Declaration of Alma-Ata

• Primary health care

• Inter-relationship of health, education, housing etc

• Community development

• Health for all

1986 – Ottawa Charter for Health Promotion

• Build healthy public policy

• Create supportive environments

• Strengthen community actions

• Develop personal skills

• Reorient health services