Progress Through Partnerships
Highlights of Public Health Activities in Australia Highlights of Public Health Activities in Australia Progress Through Partnerships Through Progress
i © Copyright: National Public Health Partnership
This work may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgment of the source and provided no commercial usage or sale is to be made. Reproduction for purposes other than those indicated above requires the written permission of the National Public Health Partnership, GPO Box 1670N, Melbourne 3001, Victoria, Australia.
The NPHP Secretariat would like to acknowledge and thank the many individuals who contributed to the compilation of this report, including all those involved in the NPHP work program, staff from the Commonwealth Population Health Division and the numerous program areas within state and territory health authorities that provided material for Part III of the report.
ISBN Number 0 7311 7602 2
Further copies: Contact the National Public Health Partnership Secretariat, 120 Spencer Street, Melbourne 3001, Victoria, Australia. Telephone: (61 3) 9637 5512 Facsimile: (61 3) 9637 5510 Email: [email protected] Website: www.dhs.vic.gov.au/nphp
ii Preface
This 1998–99 Annual Report of the National Public Health Partnership is the first comprehensive report on our work. It highlights the Partnership’s progress in addressing its main shared priorities and in developing a comprehensive coordinated national public health effort. This national effort is complemented by the public health activity undertaken in all jurisdictions that make up the Partnership, and the report provides a snapshot of just some of the huge range.
The Partnership’s work program has three main themes. First, it is attempting to achieve better coordination and efficiency of public health effort across jurisdictions. This includes examination of the legislative and organisational differences between jurisdictions and proposing options that could achieve greater harmonisation of public health efforts. Second, it is examining ways to improve the effectiveness and quality of public health effort through development of best practice options, improved common information collections and comparison of different interventional approaches. Third, it is concerned with the maintenance and further development of a strong public health infrastructure and this principally means workforce development. While all of these themes are important to individual jurisdictions, the capacity of each jurisdictions to address them individually in the face of competing day-to-day priorities is limited. The Partnership provides a mechanism for a more efficient collaborative effort while recognising the specific needs and policies of the different constituent jurisdictions.
Part II of the Report summarises activity on the twenty-two specific national public strategies. Many of these strategies commenced outside the Partnership framework, initiated through Commonwealth leadership, but largely rely on the infrastructure of the States and Territories for translation of policy into service delivery. The Partnership structure provides a mechanism to look at greater coordination across these separate strategies, many of which share common features and common approaches to intervention. This section of the report provides, for the first time in one place, a background to each strategy and the achievements for 1989–99.
The snapshots provided in Part III of the report are examples of activities in different jurisdictions which provide a glimpse of the rich diversity of public health activities for which Australia is gaining a growing international reputation. Many examples represent innovation, and a willingness to try different approaches that is critical to effective public health. The examples also illustrate the need to continue to recognise the specific needs of particular jurisdictions.
In providing this report, the Partnership aims to achieve an accurate reflection of the major commitment of all governments in Australia to promotion of public health, and an indication of shared priorities.
Dr Andrew Wilson Chair of the National Public Health Partnership Group
iii Contents
Part I: NPHP Achievements and Progress Report—1998/99 1 1. A Brief Background to the National Public Health Partnership 2 1.1 The Partnership Work Program 2 1.2 Operational Arrangements for Implementing the Partnership Work Program 2 1.3 The NPHP Evaluation and Monitoring Strategy 3 1.4 The Partnership—Three Years On 4 1.5 Information Dissemination and the NPHP Communication Strategy 5 1.6 Summary 6
2. Priority Action Areas: Infrastructure Development Projects 7 2.1 Public Health Information Developments in the National Public Health Information Working Group 7 2.2 National Strategy Coordination 10 2.3 Legislative Reform 13 2.4 Public Health Planning and Practice Improvement 17 2.5 Research and Development 20 2.6 Workforce Development 21
3. National Public Health Partnership Advisory Group 24
4. Facilitating Collaboration in National Public Health 25 4.1 Work Auspiced by the Partnership 25 4.2 Work Undertaken by Joint Committees/Collaborative Approaches 27
5. Providing Strategic and Technical Advice 30
6. Watching Briefs and Strategic Alliances 32 6.1 National Health Priority Areas 32 6.2 Strategic Planning in Injury Prevention 32 6.3 Child Health 32
7. Appendices 34 Appendix A: NPHP Structure 34 Appendix B: NPHP Group Members 1998/99 35
iv Part II: National Public Health Strategies—Update 1998/99 37 Introduction 38
A Glimpse at Infrastructure for Public Health Service Delivery Across Australia 39
Healthy Growth and Development Strategies 42 The National Public Health Nutrition Strategy 42 Acting on Australia’s Weight Strategy 43 Developing an Active Australia 44 National Breastfeeding Strategy 45 National Environmental Health Strategy 46 National Drug Strategy 47 National Alcohol Action Plan 50 National Tobacco Strategy 50 National Indigenous Australians’ Sexual Health Strategy 52 National Strategy for an Ageing Australia 53 Women’s Health 54
Preventing Communicable Diseases 55 National HIV/AIDS Strategy 1996/97–1998/99 55 National Immunisation Program 56 National Communicable Diseases Surveillance Strategy 58
Mental Health 59 National Youth Suicide Prevention Strategy 59 National Mental Health Strategy 60
Injury Prevention 62 Strategic Planning Injury Prevention 62
Prevention of Chronic Disease 64 National Diabetes Strategy 64 The National Cervical Screening Program 65 The National Breastscreen Program 67 National Cancer Strategy 69 National Asthma Action Plan 70
v Part III: Public Health Highlights and Achievements 1998/99 71 Introduction 72
1. Responding to Public Health Emergencies 73 Public Health Response to the 1998 Sydney Water Crisis 73 The Victorian Gas Crisis 74 South Australia—Epidemiological investigation of Salmonella Typhimurium Phage Type 135a Infection Associated with Orange Juice in SA 75
2. Improving Environmental Health 78 Tasmania—Health Impact Assessment 78 Queensland—Improving Indigenous Environmental Health 79 Indigenous Environmental Health in Western Australia 80
3. Preventing Communicable Disease 81 Queensland—Well Person’s Health Check 81 ACT—Management of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infected Health Care Workers 82 Tasmanian Immunisation Activities 83 WA—Sexual Health Program 84
4. New Approaches to Preventing Chronic Disease 86 Northern Territory—Preventable Chronic Diseases Strategy 86 Victoria—Diabetes Activities 87 WA—Nutrition & Physical Activity Program 88
5. Partnerships for Health Development 90 Strategic Partnerships—the Queensland Public Health Forum 90 The NSW Parliamentary Drug Summit 91 WA—The Alcohol and Other Drugs Program 92
6. A Focus on Population Groups 94 Promoting Young People’s Health in Queensland 94 Beating the Tyranny of Distance in Queensland—Health Services for Rural and Remote Women 95 Review of the Northern Territory Women’s Health Policy 97
7. Strengthening the Evidence Base for Public Health 99 The Victorian Burden of Disease Study 99 ACT—Investigation of the Appropriateness of Food and Environment Microbiological Testing in Addressing Health Outcomes 100 The NSW Health Survey Program 101 Tasmania—Healthy Communities Survey 102 The South Australian Pregnancy Outcome Statistics Unit 103 South Australian Cancer Registries 104
vi 8. Training and Workforce Development 106 NSW Public Health Officer Training Program 106 NT—Public Health Demonstration Projects 108
9. Legislation as a Contemporary Public Health Tool 110 ACT Tobacco Control Program—‘Smoke-free ACT’ 110 Food Safety Victoria—Leading the Food Law National Reform 111 Tasmania—Change Management in Public and Environmental Health 112
vii viii NPHP Achievements and Progress Report—1998/99 Achievements and Progress and Progress Achievements
1 1. A Brief Background to the National Public Health Partnership
Australian Health Ministers endorsed the proposal for a National Public Health Partnership (NPHP) on 4 July 1996. The NPHP is an intergovernmental working arrangement to plan and coordinate national public health activities, provide a more systematic and strategic approach for addressing public health priorities, and provide a vehicle to assess and implement major initiatives, new directions, and best practice.
The Partnership’s objectives include: • improving the health status of all Australians, in particular population groups most at risk; • improving collaboration in the national public health effort; • developing better coordination and increased sustainability of public health strategies; • strengthening public health infrastructure and capacity nationally; and • enhancing the capacity of States and Territories to respond to local priorities.
1.1 The Partnership Work Program The NPHP work program recognises that its intergovernmental partnership is one aspect of public health infrastructure in Australia, providing a vehicle for coordinating and bringing together resources and expertise from across the public health sector.
In developing a national public health agenda and providing leadership, the establishment phase of the Partnership has focused on building national infrastructure and capacity, to achieve sustainability across existing programs and to respond to immediate and emerging needs. Activities to sustain existing programs include developing strategic partnerships, strengthening the information base for evidence-based public health policy and practice, and developing population health approaches for the health system to adopt. As the Partnership enters its third year, work in these areas is placing greater emphasis on building partnerships and alliances and working collaboratively with other parts of the public health sector.
Program priorities include: • improving public health practice; • developing public health information systems; • reviewing and harmonising public health legislation; • implementing national public health workforce development initiatives; • strengthening national public health research and development capacity; • improving the coordination of national public health strategies; and • developing standards for the delivery of core public health functions.
The NPHP document Strategic Directions 1998–2000, which the Australian Health Ministers’ Conference endorsed in 1998, sets out a work program to achieve the Partnership’s objectives. This section of the Annual Report, reviews the Partnership’s achievements during 1998/99.
1.2 Operational Arrangements for Implementing the Partnership Work Program The National Public Health Partnership Group is responsible for implementing the Partnership’s work program. The Group comprises the chief health officer or director of public health from each of the Commonwealth, State and Territory health authorities, and senior representatives from the National Health and Medical Research Council and the Australian Institute of Health and Welfare. It reports to the Commonwealth and State and Territory Health Ministers through
2 Part 1: NPHP Achievements and Progress Report—1998/99 the Australian Health Ministers’ Advisory Council (AHMAC), of which it is a formal subcommittee. A diagram of the reporting structure for the NPHP and a list of its membership during 1998/99 are attached (Appendices A and B).
Over time, each member of the Partnership will be responsible for at least one major project on the NPHP work program—that is, it will be lead agent for a project. The following lead agents and their projects provide evidence of the success of this approach to project management: • SA—involved in initiating work on Computer Assisted Telephone Interview (CATI) population health surveys and notifiable diseases model mechanism. • Victoria—National Legislative Schemes, Development of Leadership Skills and chairing of the Computer Assisted Telephone Interview (CATI) Technical Working Group. • NSW and Tasmania—the Role of Local Government in Public Health in Australia (phase 1). • Queensland—Public Health Laws and Indigenous Health (approved in May 1999). • Commonwealth—Drafting Model Provisions for Certification of Immunisation Status. Development of Chronic Disease Prevention Strategy; developing Communicable Diseases Strategy; Chairing of the National Strategy Coordination Working Group (until May 1999) and the meetings of Chairs of National Strategies. • Northern Territory—chairing the National Strategy Coordination Working Group, from May 1999. • Australian Institute of Health and Welfare—chairing the National Public Health Information Working Group.
Secretariat Support The Innovation and Support Unit in the Victorian Department of Human Services continued to provide secretariat support, which was funded by the Commonwealth Department of Health and Aged Care. Throughout 1998/99, the Queensland Department of Health has provided significant additional secretariat support for the Legislation Reform Working Group. This role has now been handed to the Innovation and Support Unit. The Australian Institute of Health and Welfare has provided secretariat support (partly funded by the Commonwealth Department of Health and Aged Care) for the National Public Health Information Working Group since the working group’s inception.
Non-government Sector The Partnership recognises the role of the non-government sector in the national public health effort through the NPHP Advisory Group. The Advisory Group ensures that key national non- government organisations with a broad interest in public health have direct input to the Partnership’s work program, and that the Partnership is fully informed of service provider and consumer perspectives on its work program. A report on the Advisory Group’s work over the past year is provided in Section 3 of this report.
1.3 The NPHP Evaluation and Monitoring Strategy In mid-January 1999, a consortium from La Trobe University and Queensland University of Technology began to implement the Partnership’s Monitoring and Evaluation Strategy. The consortium is supported by an evaluation working group and a high-level reference panel. The panel comprises key national and international public health figures, including Professors D’Arcy Holman and Robert Beaglehole.
Part 1: NPHP Achievements and Progress Report—1998/99 3 The Evaluation and Monitoring Strategy aims to: • provide information and analyses of partnership processes, and feedback to the Partnership to assist in its continuing development; • enable regular review of the Partnership’s progress towards its objectives and ultimately, determine whether it has met them; • assess the impact of the work program; • assess whether the Partnership acted in accordance with its principles and fostered their wider acceptance in public health practice in Australia; • assess the extent to which the partners have fulfilled their roles and responsibilities.
The evaluation team will use a range of approaches to measure the Partnership's progress in these areas. They include collaboration between the evaluators and Partnership participants to monitor the Partnership’s key processes, using methods including: • observing Partnership and Working Group meetings; • developing case studies based on comprehensive analysis of specific questions of interest to the Partnership Group; and • interviewing key stakeholders to supplement information gained by observing meetings and developing the case studies.
The evaluators have begun work on the first case study and have designed a protocol to help them monitor key Partnership processes.
Further information on the Evaluation and Monitoring Strategy can be obtained from the NPHP website—http://dhs.vic.gov.au/nphp/
1.4 The Partnership—Three Years On In July last year, the Australian Health Ministers’ Conference endorsed the Partnership Group’s Strategic Directions 1998–2000, which set out in detail the Partnership’s work program for that period. The Health Ministers also considered the Partnership Group’s first annual progress report and noted the work done during the Partnership’s establishment phase.
Since endorsing the strategic directions document, the Australian Health Ministers’ Advisory Council (AHMAC) has: • endorsed the National Public Health Information Development Plan, prepared by the NPHP’s National Public Health Information Working Group; • endorsed the Best Practice Guidelines for Strategy Development, developed for the Partnership by the National Strategy Coordination Working Group, and the Partnership’s continuing work to develop a broader, more efficient framework for coordinating national public health strategies; • endorsed the proposal that the Partnership use existing or created technical advisory groups to provide expert advice on issues on the Partnership agenda; • referred the development of a national response to the issue of passive smoking to the Partnership’s Legislation Reform Working Group.
The past twelve months have therefore been a time of significant development for the Partnership, particularly in establishing alliances within the public health sector and across the health system. As it becomes more established, the Partnership is seen increasingly as a way to achieve maximum impact and optimum outcomes for the sector’s effort on priority issues, particularly those focusing on infrastructure development.
4 Part 1: NPHP Achievements and Progress Report—1998/99 Despite its emphasis on longer-term developmental issues, the Partnership’s work program is not static—it can also encompass issues requiring a quicker response that are referred to it by its members or strategic partners. An example is the coordinated background papers the NPHP prepares for submission to national reviews as they occur, such as the two papers it presented to the Health and Medical Research Strategic Review. Others include responses to health issues that require a prompt public health perspective. Examples are the need for new guidelines to screen refugees’ health and an agreed mechanism to expedite new screening protocols following the arrival of the Kosovar evacuees; and sharing information on public health threats and crises such as the Victorian gas crisis and the contamination of Sydney’s water supply.
1.5 Information Dissemination and the NPHP Communication Strategy A two-way flow of information and ideas between key stakeholders and interest groups is central to the Partnership’s success. Accordingly, the Partnership Group has continued to implement its communication strategy to invite constructive input from stakeholders, build awareness and understanding of the NPHP among interest groups, and to ensure that the Partnership Group is informed about the community’s ideas and concerns.
The Partnership Group recognises, however, that its stakeholders have different levels of interest in the Partnership’s work. The communication strategy therefore includes a variety of channels. In 1998/99 these included: • the quarterly newsletter; • the regularly updated website, with links to members’ sites, and the inclusion of subsites (eg that of the National Environmental Health Forum); • re-prints of Public Health in Australia, a document for international audiences; • forums or seminars on the Partnership’s work; • providing articles and presentations for the newsletters, journals and conferences of other organisations; • inviting individuals and organisations to comment on NPHP discussion papers; and • inviting people and organisations to participate in working parties or attend Partnership Group meetings for particular agenda items.
Part 1: NPHP Achievements and Progress Report—1998/99 5 Finally, the members of the Partnership Group itself have a valuable role to play in disseminating information. The agendas of Partnership Group meetings cover a wide range of topics and include an open forum so that members can share interesting information about public health practice issues that are not on the formal work program.
1.6 Summary This report illustrates the emphasis the Partnership puts on partnerships and alliances. The Partnership is simply a mechanism to achieve public health goals—it could not fulfil its work program without the involvement of numerous public health stakeholders.
While the NPHP is an alliance of governments, to achieve its work program the Partnership relies on non-government agencies, academic institutions and individuals in the public health sector to build capacity and develop infrastructure across Australia’s public health landscape.
6 Part 1: NPHP Achievements and Progress Report—1998/99 2. Priority Action Areas: Infrastructure Development Projects
As stated in the Memorandum of Understanding to establish the NPHP, one of the Partnership’s objectives is to strengthen the nation’s public health infrastructure and capacity. The Partnership’s priority action areas seek to address the following targeted infrastructure issues: • public health information; • legislative reform; • improving public health planning and practice; • coordinating public health strategies; • research and development; and • workforce development.
Projects in these areas focus on issues of medium-term system development that are the foundation of program delivery. While vital to an effective, efficient public health system, these infrastructure issues are often difficult to address in the short term. The Partnership’s focus on them is a major contribution to the national public health effort, drawing together stakeholders from across the sector.
This section summarises the achievements and highlights of activities to develop infrastructure undertaken in each of the Partnership’s priority action areas.
2.1 Public Health Information Developments in the National Public Health Information Working Group The National Public Health Information Working Group The National Public Health Information Working Group (NPHIWG) has been active in promoting and developing public health information and in developing its role in the national public health information infrastructure. This role is endorsed through the recommendations of the National Public Health Information Development Plan. NPHIWG provides a forum for discussing and advancing national public health information issues.
Dr Richard Madden, Director of the Australian Institute of Health and Welfare (AIHW), chairs the Working Group. The NPHIWG secretariat is located at the AIHW and is partly funded by the Commonwealth Department of Health and Aged Care.
Major projects undertaken during the year were: • the National Public Health Information Development Plan; • the Public Health Expenditure Project; • establishing the National Computer Assisted Telephone Interview (CATI) Health Survey Technical Reference Group; and • developing the National Biomedical Risk Factor Survey proposal.
Further information on each of these areas of work is provided below.
The Working Group has also been active in providing substantive input to the Australian Bureau of Statistics Household Survey Program consultation process, and development of the child and youth health information frameworks.
Part 1: NPHP Achievements and Progress Report—1998/99 7 The National Public Health Information Development Plan Background Public health policy makers, practitioners, researchers, analysts, advocates and consumers need appropriate, timely and valid public health information to monitor the health status of the Australian population. Such information also supports the planning, implementation, and evaluation of health interventions and public health programs in Australia.
At the request of the Partnership’s National Public Health Information Working Group its secretariat, located at the AIHW, prepared a plan to improve Australia’s public health information. Developing the National Public Health Information Development Plan involved broad consultation that included a workshop of 120 invited participants held in September 1998, and consultation with national groups.
The Partnership and the National Health Information Management Group endorsed the Plan before the Australian Health Ministers’ Advisory Council endorsed it in April 1999.
Outcomes The National Public Health Information Development Plan • identifies the priority areas and actions necessary to improve national public health information and recommends developing: – a national public health information infrastructure to facilitate cooperative activities; – a national public health information system with a capacity to improve the quality of information; • indicates that while it is necessary for the public health sector to manage public health information, the information should be developed in a close and cooperative relationship with national health information processes; • identifies high priorities relating to both data content and data management.
The Plan will be released in August 1999. The National Public Health Information Working Group is responsible for implementing it, and this will be a priority in 1999–2000. A detailed work program to implement the Plan is being drawn up by the NPHIWG secretariat in consultation with all NPHIWG members.
Public Health Expenditure Project Background The National Public Health Expenditure Project is being undertaken by the AIHW, with funding from the Commonwealth Department of Health and Aged Care, to develop reliable estimates of public health investment in Australia, both in the public and non-government sectors. The Commonwealth is also providing financial assistance to State and Territory Governments to assist jurisdictions build capacity to collect this important information on a routine basis. The project is being developed to overcome an absence of reliable information on public health investment in Australia, in both the public and non-government sectors.
8 Part 1: NPHP Achievements and Progress Report—1998/99 Outcomes Developing meaningful public health expenditure data will result in positive outcomes, including: • a more reliable basis for comparing investment in public health to investments in the rest of the health sector; • data that can assist in measuring the cost-effectiveness of public health programs; and • the ability to make international comparisons of public health expenditure.
National CATI Health Survey Technical Reference Group Background This group was established because a number of jurisdictions that conduct or intend to conduct Computer Assisted Telephone Interview (CATI) population health surveys wanted to develop consistent and comparable surveys.
The National CATI Health Survey Technical Reference Group has been set up as a sub- committee of NPHIWG. Its role is to develop and provide expert advice on developing national best practice in CATI health surveys, including: • consistency of national data; • appropriate CATI modules and questions; • technical and logistical infrastructure; and • determining CATI health survey priorities to meet specific national, State and Territory needs.
Strong links have been established with the US Center for Disease Control initiatives regarding telephone health surveys in the USA.
Outcomes CATI surveys are an important means of collecting public health data. Coordinated and consistent national CATI health surveys will improve national comparability and hence the value of the data. This work will be valuable in improving coordination of major public health data collections.
National Biomedical Risk Factor Survey (NBRFS) Proposal Background A National Biomedical Risk Factor Survey of Australian adults, including the taking of blood samples, has been proposed, and aims to address gaps in health information in Australia and provide data for public health planning. Although the large national health surveys conducted by the Australian Bureau of Statistics until 1995 have provided valuable information on health- related issues, none of the surveys has included blood sampling.
The proposal for the National Biomedical Risk Factor Survey is being developed under the auspices of the National Public Health Partnership, with the support of the NPHIWG. Such a survey would be part of the ABS Health Survey. The project proposal is being discussed with a range of specialist clinical interests, as well as information specialists.
Outcomes The Survey, which is part of the National Public Health Information Development Plan, was endorsed as a high priority subject to further work including the development of a business case for presentation to AHMAC.
Part 1: NPHP Achievements and Progress Report—1998/99 9 2.2 National Strategy Coordination The Aim of Improved Coordination of National Public Health Strategies Over the past twenty years, national public health strategies have been a key response to public health issues in Australia. There are currently more than twenty such strategies at different stages of development (see Part II of this Report for an update on all national public health strategies).
The achievements of some of these strategies and their contribution to improved health and social outcomes for Australians are recognised worldwide. However there is great potential for a more consolidated effort across national programs. This has been noted in evaluations of several national public health strategies, and is a comment made often by public health practitioners who work with local communities.
Efforts to improve coordination of public health strategies have therefore continued to be a priority for the Partnership during 1998/99. The infrastructure issues that either help or hinder effective coordination and collaboration have been a focus of the Partnership’s work to improve the coordination of national strategies.
Major areas of the Partnership’s work on national strategy coordination during 1998/99 are described below.
The National Strategy Coordination Working Group The Partnership’s National Strategy Coordination Working Group comprises jurisdictional representatives and members appointed for their expertise in national strategy policy and delivery. Its tasks address issues of national strategy coordination and collaboration, as summarised below.
Best Practice in Strategy Development One of the Working Group’s major projects over the past year has been to complete the Best Practice Guidelines on Development of National Public Health Strategies. The guidelines were endorsed by the NPHP and subsequently by AHMAC, in May 1999.
The guidelines can now be applied to the development of new public health strategies and the review of existing programs. They were developed in consultation with Commonwealth, States and Territory health authorities and other stakeholders in the national strategy coordination process, and draw on evidence of best practice over the past twenty years of designing and implementing public health strategies in Australia.
A New Approach to Coordinating Public Health Strategies The Best Practice Guidelines on Development of National Strategies are one section of a larger Partnership document— the Guidelines for Improving National Public Health Strategies Development and Coordination. Among other issues, the latter document gives preliminary consideration to developing a broader, more efficient framework for coordinating national public health strategies.
10 Part 1: NPHP Achievements and Progress Report—1998/99 At this stage it is proposed that such a framework focus on two major areas of public health activity: • preventing chronic disease, with the aim of promoting more integrated and efficient action across common risk factors, and • promoting better linkages across strategies that address surveillance and control of communicable disease.
In April 1999, AHMAC decided to support further work on this approach. The Population Health Division of the Commonwealth Department of Health and Aged Care will take the lead role on this work under the auspices of the National Strategy Coordination Working Group. Further information is provided in the boxes below.
Local Coordination To date, much of the Partnership’s work on national strategy coordination has focused on national, State and Territory levels of strategy implementation. This is because better coordination at these levels should eventually improve outcomes for health consumers at the local service delivery level.
However, to complement this approach, the Partnership has recently begun to plan a project that will look at coordination and integration at the local level, examining how coordination efforts by service delivery agencies can have a ‘bottom-up’ effect on improving coordination nationally.
The project aims to identify sustainable models of coordinated public health service delivery. The project will also highlight State and Territory approaches that can support such local level integration.
The development phase of this project was conducted during 1998/99, and advice on the project sought from the Partnership’s non-government advisory group. The project will commence in early 1999/2000, starting with case studies of good practice in integrated local service delivery. Queensland will take the lead agency role.
Collaborative Work on Priority Action Areas—Indigenous Health and General Practice In September 1998, the Working Group, the Chairs of National Public Health Strategies, and the NPHP Advisory Group held a joint meeting that helped to promote links between these three groups.
The meeting brought together a diverse group—the Chairs, with specific expertise in particular program areas and public health disciplines; representatives of key non-government organisations; and jurisdictional representatives—to discuss proposals to promote coordination in the priority action areas of general practice, Indigenous health, and collecting public health data/information.
One result of this liaison is planning for a project to develop Best Practice Guidelines for Strategy Development, Audit and Evaluation with Aboriginal and Torres Strait Islander Peoples. Work on the project will begin in 1999/2000.
Part 1: NPHP Achievements and Progress Report—1998/99 11 The Chairs of National Strategies The Chairs of National Public Health Strategies have continued to meet twice yearly. While the initial meetings were primarily about sharing information, networking and identifying areas of possible collaboration, the agenda is now much wider.
A major benefit of the meetings has been the increasing number of informal links established between the Chairs of individual strategies, and the capacity to arrive at shared understandings of important issues affecting many strategies.
The Chairs are also kept informed of work across the Partnership’s work program. They are briefed on projects in priority action areas such as workforce development, research and development, and improving public health planning and practice.
Links between the Chairs of strategies and the Joint Advisory Group of the General Practice Partnership Advisory Council (known as the ‘JAG’) have also been promoted, with meetings of each group receiving regular briefings on the work of the other. Information on strategy priorities for general practice activity in public health has also been collated to highlight opportunities to improve coordination of strategies delivered in the general practice setting.
Work with the Commonwealth Dept of Health and Aged Care Population Health Division A National Framework for Chronic Disease Prevention Many modifiable risk factors are common across a number of chronic diseases and conditions. It is generally considered to be more effective to target these risk factors as part of a comprehensive approach rather than develop separate prevention strategies for individual disease categories.
The need for integrated and coordinated action on prevention is highlighted in each of the National Health Priority Area reports on cardiovascular health, diabetes and mental health, and the benefits of such an approach detailed in the Partnership’s Guidelines for Improving National Public Health Strategies Development and Coordination.
In addition, some risk factors and health promoting factors are common to a wider range of health problems. For example, early childhood experiences can influence mental health, substance abuse, susceptibility to infection, and likelihood of chronic disease in adult life. Many settings for preventive interventions, such as schools, general practice and the workplace, are also common across a range of health issues. A more coordinated approach to prevention also offers efficiencies for service providers in these settings, as well as ensuring more consistent health advice for consumers and population groups.
Development of a national framework for chronic disease prevention acknowledges that one of the major health challenges facing Australia into the next century is the projected growth in rates of chronic, non-communicable disease.
Continuing work on this project will be a priority into the 1999/2000 year.
Meetings of Commonwealth Public Health Strategy Secretariats In a development related to the meeting of the Chairs of national strategies, the Population Health Division of the Commonwealth Department of Health and Aged Care has established a regular meeting of national public health strategy secretariats. The meetings provide an opportunity to share information, identify common issues across strategies, and update departmental officers on the outcomes of the Chairs’ meetings.
12 Part 1: NPHP Achievements and Progress Report—1998/99 Future Projects for the NPHP in National Strategy Coordination Future national strategy coordination projects include the following: • implementing the framework for national public health strategies coordination, including the application of strategies to the key priority areas of Indigenous health and general practice; • developing guidelines for best practice in working with Indigenous communities in the coordinated delivery of public health strategies; • greater engagement with the National Health Priority Areas; • greater involvement of Chairs of national strategies in progressing priority issues; • developing an evaluation framework for national strategy coordination, to complement the Best Practice Guidelines.
2.3 Legislative Reform The Partnership recognises that legislation is an important tool to advance public health policy. The Competition Principles Agreement requires that all jurisdictions review legislation for restrictions on competition. This has given the Partnership an opportunity to ensure that public health law is examined not only for restrictions on competition, but with a view to modernising and harmonising public health legislation nationally.
The Partnership’s Legislation Reform Working Group (LRWG) has members from each State, Territory and the Commonwealth. Its work program aims to: • produce information and resources to support national public health legislative review activities; • be a reference point and source of expertise in public health law; • explore the parameters of public health law; and • disseminate information on public health law.
Achievements 1998/99 Over the past 12 months, good progress has been made in implementing the LRWG’s work plan. The work plan has been endorsed by the AHMC. The three major areas of focus on the workplan comprise Reporting and Communication, Development of a Legislators’ Toolkit, and providing a reference point for expertise in public health law.
Specific achievements over the past twelve months include the following:
Reporting and Communication In addition to regular reporting to the Partnership Group and its Advisory Group, establishing a national network of public health legislators and policy makers enabling information sharing not previously achieved.
Providing a Reference Point for Expertise in Public Health Law The LRWG has established collaborative links with the following organisations by providing best practice public health legislation policy advice and assisting in developing national uniformity of various legislation: • the National Uniformity Implementation Panel (Radiation Control); • National Occupational Health and Safety Commission; • Australia and New Zealand Food Authority; • Communicable Disease Network of Australia and New Zealand;
Part 1: NPHP Achievements and Progress Report—1998/99 13 • National Tobacco Policy Officers Group; • Therapeutic Goods Administration (National Review of Drugs, Poisons and Controlled— Substance Legislation); and • Commonwealth State Consultative Group on Gene Technology.
Other work that falls under this aspect of the workplan includes developing first stage research papers on the topics of uniform therapeutic goods legislation, and passive smoking, as described below.
Promoting Uniform Therapeutic Goods Legislation The objective of this project is to advocate the adoption of uniform therapeutic goods legislation within Australia. The principal strategy is to assess whether the Therapeutic Goods Act has been reviewed in accordance with the requirements of the National Competition Policy. The Legislation Reform Working Group has assessed the extent to which a report on the review of the Commonwealth Therapeutic Goods Administration, undertaken by management consultants KPMG, meets the requirements of States in relation to National Competition Policy legislation review requirements. The working group is now consulting the Therapeutic Goods Administration to assess whether there is other evidence to support a conclusion that the Act has been reviewed in accordance with National Competition Policy requirements.
Passive Smoking The AHMAC has given the LRWG responsibility for developing a national response to passive smoking. The response will focus on children’s exposure to environmental tobacco smoke in homes and cars, and people’s exposure to environmental tobacco smoke in public places and workplaces.
The Commonwealth Department of Health and Aged Care has provided funding to the Royal Australasian College of Physicians for a pilot education project encouraging parents and carers to provide smoke free environments for children.
A best practice legislative model is being developed as a guide for States and Territories considering action on exposure to environmental tobacco smoke in public places and workplaces. It will comprise guiding principles, examples of core provisions, and background information setting out the context and rationale for the proposed approach. The package will be recommended to the Partnership Group for presentation to AHMAC for endorsement. The model approach is intended to help jurisdictions design and benchmark their own strategies and action plans.
The Commonwealth has taken the lead agency role for this work.
Legislators’ Toolkit Work on production of a ‘legislators’ toolkit’ has been a major area of activity for the LRWG over the past year. The toolkit will be an information resource to support national public health legislative review activities, and to assist public health legislators and policy makers.
14 Part 1: NPHP Achievements and Progress Report—1998/99 As part of this work the LRWG has produced first stage research papers on the following topics: • Notifiable Disease (model mechanism for incorporating a national list of notifiable disease into a uniform legislative framework); • Certification of Immunisation Status; • Cross Border Management of the Risk of Infectious Disease; and • Confidentiality and Privacy in Public Health Legislation (privacy principles).
The working group has also commissioned follow-up work to develop an options paper on national legislative schemes, and model provisions on the Certification of Immunisation Status.
Each of the research papers is described below.
Notifiable Disease The LRWG has compiled a research paper on the current status of the notification of disease in Australia. The paper is based on information provided by the legal policy officers from the States and Territories. It consists of information about the legislative basis and individual diseases that are being notified in each jurisdiction. The paper highlights the differences in reporting of diseases that occur between the States and Territories and that make it very difficult to gather accurate national statistics for the surveillance of long-term public health. It is planned that the paper will help make the notification of diseases more uniform by facilitating the development of a nationally consistent notifiable diseases list and case definitions, and by drafting instructions for best practice legislation about notification requirements and in response to infected persons. This project will be carried out with the Communicable Diseases Network of Australia and New Zealand, the National Communicable Disease Surveillance Strategy Implementation Group and the National Centre for Epidemiology and Population Health.
Developing Draft Model Provisions for the Certification of Immunisation Status on School and Child Care Entry Starting with a mapping exercise, the LRWG (with the Commonwealth as lead agency) developed principles to identify each jurisdiction’s current legislative arrangements and to form the basis of certification legislation. The Partnership endorsed the principles, which included: definitions of certification, protecting confidentiality and privacy, and conscientious objection. Draft recommendations were presented for these principles and the LRWG endorsed them in May 1998. In July 1998, AHMC endorsed the LRWG workplan which identifies the development of a uniform national approach for immunisation certification and best practice model provisions for inclusion in the Legislators’ Toolkit. The recommendations have informed the first draft of provisions for best practice models. This draft is being reviewed and the feedback will be reflected in a final version. The draft model provisions are designed to assist public health practitioners in identifying children in schools and child care centres who are at risk in an outbreak of a vaccine-preventable disease.
Cross Border Management of Risk of Infectious Disease The varying approaches to infectious disease control across jurisdictions inspired the Legislation Reform Working Group to compile a draft paper, including a comparison of each jurisdiction’s public health order powers, to enable an assessment of the feasibility of recognising such orders across borders. The paper—Report on the Mechanisms and Desirability of Incorporating ‘Corresponding Law’ Provisions into Australian Infectious Disease Legislation—considers the
Part 1: NPHP Achievements and Progress Report—1998/99 15 context, limitations and discrepancies highlighted in the current State and Territory infectious disease control laws. It also discusses the problems and benefits associated with developing a national legislative mechanism to recognise and apply orders from one jurisdiction in a second jurisdiction, that is, a corresponding law arrangement. The paper makes recommendations about ways in which the State and Territory infectious disease control laws could be amended to facilitate such a scheme, and assesses the desirability of the scheme.
Given the information presented in the paper, the LRWG noted the substantial challenges of achieving a common approach across jurisdictions and decided against a corresponding law arrangement. Pursuing another recommendation contained in the paper, the LRWG is developing principles for the management of infected persons which can be used in amending infectious disease control laws in the future.
Confidentiality and Privacy in Public Health Legislation The LRWG has obtained expert advice on the current legal status of the transfer of confidential data across jurisdictions. In November 1998 it endorsed a draft paper titled Confidentiality and Privacy Provisions in Public Health: The Transfer of Information between Australian Jurisdictions. As well as examining the State, Territory and national laws that affect information flow, the paper considered privacy issues and examined a common basis for standardising information flow across Australia. The LRWG endorsed the paper in November 1998. It is the basis for an additional paper that is being prepared about developing principles for protecting privacy in public health. It is intended that the next step will be to develop administrative protocols for disclosure of information to operate in conjunction with the Privacy Principles, and drafting instructions for defining the circumstances in which release of information is permitted on public health grounds. This project has been carried out in conjunction with the Communicable Diseases Network of Australia and New Zealand and the Privacy Commissioner.
Implementation Options for National Legislative Schemes in Public Health The LRWG has also commissioned an options paper on constitutional issues around the implementation of national legislative schemes in public health.
As there is no specific power in the Federal Constitution to legislate in the area of health it is difficult to implement national legislative schemes in public health. Nevertheless, work to develop such schemes includes the national review of drugs legislation, the national review of pharmacy legislation, the national work on radiation safety, and work by the Australia and New Zealand Food Authority (ANZFA) on the implementation of nationally uniform food legislation. Although all this is happening outside the LRWG work program, the working group wants to provide as much assistance as possible for these and other initiatives that may arise out of its program.
The development of the options paper on national legislative schemes is intended to assist work and thinking in the area. It is also intended that selected final recommendations and options from the paper will be included in the legislators’ toolkit for jurisdictions to use should they wish to promote or support a national legislative scheme. At the time of writing, the LRWG is considering the draft options paper.
Victoria has taken the lead agency role for this work.
16 Part 1: NPHP Achievements and Progress Report—1998/99 Future Directions Work will continue to finalise the legislators toolkit in 1999/2000, and on developing models of best practice legislation for: • implementation options for national legislative schemes in public health; • certification of immunisation status on entry to schools and child care; • notifiable diseases list (auspice body); • public health laws and Indigenous health; • confidentiality and privacy; • the application of risk management principles in public health legislation; • legislative implementation of Health Impact Assessments; and • passive smoking in relation to public places and exposure of children in the home and car (auspice body).
In addition, further research is proposed on: • the extent to which civil litigation is an issue for public health screening programs, and • mapping of the current role of local government in public health in Australia.
2.4 Public Health Planning and Practice Improvement It can be difficult for public health to measure its success and to communicate the value of investing in public health to decision makers outside the public health sector. The Partnership’s work on public health planning and practice improvement has sought to address this difficulty by considering ways to enhance a systematic and evidence-based approach to public health planning and practice.
A Planning Framework for Public Health Practice A major project in the planning and practice improvement area has been to develop a planning framework for public health practice. The draft framework suggests a common language and method for describing the activity of different public health programs. It sets out a systematic process for reaching agreement, at any level of the system, on the mix or portfolio of interventions to address public health issues. The draft framework’s starting point is that all public health activity is concerned about managing the determinants of health. It analyses public health issues from this perspective, identifies and appraises options for intervening, and selects a balanced portfolio of interventions based on an explicit decision-making process.
The draft framework’s aims include: • promoting a common and more consistent approach to determining public health interventions based on clear decision-making criteria; • collaboration between different public health areas that are addressing common determinants of health; and • making the work of public health and its achievements more transparent.
A significant achievement in the past twelve months has been to engender broad support for the principles of the draft planning framework for public health practice. During the year, the draft framework was widely circulated and the subject of consultations with a broad audience. Subsequently, more work has been done on the draft framework, including redrafting to clarify the concepts and make the language more user-friendly. Trials of the draft framework in the areas of injury, nutrition and environmental health will test its utility as a planning tool and the results will be reflected in the final document.
Part 1: NPHP Achievements and Progress Report—1998/99 17 A Delphi Study on Public Health Functions The draft Planning Framework for Public Health Practice raised the matter of defining public health functions. This issue has been discussed internationally, most recently by the World Health Organization (WHO), which undertook an international study on defining ‘essential’ public health functions in 1997. The WHO recommended that countries conduct their own studies to define public health functions nationally—a task the Partnership commenced in mid-1999.
The Partnership’s Delphi Study on Public Health Functions aims to elicit opinions from public health experts on the features of public health functions in Australia. The project is important for public health in Australia. An agreed list of the characteristics of public health functions can provide a common reference point for any exercise where a standard definition of public health activity is needed, including work involving capacity building, expenditure or workforce mapping, and setting performance standards.
Resource Allocation for Public Health Resource allocation is another major infrastructure issue considered by the Partnership in 1998/99. It commissioned Dr John Deeble of the National Centre for Epidemiology and Public Health at the Australian National University to write a background paper on resource allocation for public health. The paper—Resource Allocation in Public Health: An Economic Approach— considers the application of economic evaluation tools to public health resource allocation and the particular issues that need to be considered in applying these methods to this area of health care. It suggests that multiple approaches to resource allocation are needed for different levels of public health. It explores issues such as the attributable risk factors aspect of the burden of disease, which would provide data needed to consider the cost-effectiveness of public health interventions, program-budget marginal analysis, and health benefits groups. A forum is planned for August 1999 to explore these issues further and to determine the next steps for this area of work. The paper, which has been endorsed for release by the NPHP, is a significant resource for those involved or interested in an economic perspective on public health funding, policy making and infrastructure development.
Quality in Public Health In 1998, a background review was completed on quality in public health. The review summarised the general current trends and approaches in quality and considered their relevance to public health. It also conducted a limited sample survey of public health professionals’ attitudes and knowledge to quality. The final paper provides a basis for promoting and improving quality in public health.
Discussion papers by public health experts were commissioned through the Commonwealth Department of Health and Aged Care to inform Partnership Group decisions about a stronger quality approach for public health. The papers identify the current challenges for quality in public health and suggest ways forward. The Partnership Group aims to clarify a direction and an action plan on quality in public health by the end of 1999.
18 Part 1: NPHP Achievements and Progress Report—1998/99 Public Health Laboratories Financing Project (first phase) The Public Health Laboratories Financing Project aims to identify mechanisms, including financial ones, to improve, wherever necessary, the accessibility and use of laboratory services and information for public health purposes. Organisations involved in the project are the Partnership Group, the Communicable Diseases Network of Australia and New Zealand (CDNANZ), the Public Health Laboratory Network (PHLN) and the National Centre for Disease Control (NCDC) of the Commonwealth Department of Health and Aged Care.
During 1998/99, a consultancy was commissioned to describe and analyse the situation in State, Territory and national public health laboratory services. The consultants, from the National Centre for Epidemiology and Population Health at the Australian National University, interviewed health authorities and laboratory personnel in all jurisdictions. The report on the first phase of the project identifies issues and gaps in the use of laboratory services for public health purposes, and suggests possible approaches, including the use of financial tools, to address the identified issues. The next phase of the project will determine the services to be treated as public health laboratory services, further discuss capacity definition and take account of relevant work being done across jurisdictions.
A great deal of effort went into obtaining consensus to commence such a project, which involves considerable cooperation and input from all jurisdictions. The fact that consensus was reached illustrates the potential of the Partnership as a mechanism for tackling complex public health issues.
Future Directions for 1999/2000 Activities for the next financial year include: • developing the Planning Framework for Public Health Practice to improve and facilitate a more structured approach to managing public health; • reaching consensus on public health functions in Australia; • determining quality systems for application in public health; • identifying resource allocation methods for public health; • developing models for financing laboratory activity that has public health significance.
Part 1: NPHP Achievements and Progress Report—1998/99 19 2.5 Research and Development The Health and Medical Research Strategic Review—An Opportunity for National Action on Public Health Research Issues Over the past 12 months, the Partnership’s research and development work plan has sought to maximise the opportunities presented by the Commonwealth Government’s ‘Health and Medical Research Strategic Review’. The final report of the review was released in early 1999.
The review presented the Partnership with a major opportunity to raise the profile of particular aspects of public health research in the health research arena. The Partnership submitted a background paper to the Review, comprising input from all its members, and was twice consulted as a group by the review Chairman, Mr Peter Wills.
Much of the Partnership work on research and development over the past twelve months has sought to build on the issues the Partnership Group presented to the Review.
The Partnership Group was pleased that the final Review report reflects much of the Partnership’s contribution.
Work With the NHMRC In the year under review, opportunities for the Partnership to collaborate with the NHMRC have been a very positive result of its work on research and development.
One opportunity has been the agreement by the NHMRC and the Partnership Group, subsequently endorsed by AHMAC, that the Partnership will seek technical advice on issues as needed, through the use of technical advisory groups.
The Partnership currently accesses technical advice from informal and formal groups concerned with national programs and strategies. This new process will involve the establishment of new, project-specific technical advisory groups when existing bodies or mechanisms cannot provide the required advice. This is in line with the approach taken by the NHMRC. Some existing groups that currently provide expert advice to the Partnership Group will formally become Partnership technical advisory groups.
NHMRC and the Partnership Group agreed to this approach in recognition of the need for a coordinated, strategic method for seeking technical advice on priority public health issues, and the role the Partnership can play in facilitating the provision of that advice. Where appropriate, the advice and information arising from the technical advisory groups may be referred to the NHMRC for endorsement.
Work has also begun on developing guidelines and criteria to evaluate evidence on public health interventions. The NHMRC’s Health Advisory Committee (HAC) raised the idea to produce the guidelines with the Partnership, seeing it as a priority that could be appropriately addressed by the Partnership with (HAC) support. Such guidelines would parallel the NHMRC’s established work in producing guidelines for clinical practice and underpin the Population Health Evidence Base Advisory Mechanism announced in the May 1999 Federal Budget.
This collaboration between the Partnership and the NHMRC will continue into 1999/2000, when it will focus on setting priorities in public health research, a classification scheme to promote
20 Part 1: NPHP Achievements and Progress Report—1998/99 public health research, and other important issues raised by either body. A regular joint process for setting priorities is being planned
Other Research and Development Work During the Period of the Health and Medical Research Strategic Review In late 1998, the Partnership released a paper entitled The National Public Health Partnership and Public Health Research and Development in Australia to indicate its thinking on research and development. The paper identified key issues in public health research and development in Australia, and the possible role of the Partnership in addressing them. The actions suggested for the Partnership included: • assembling research agendas; • facilitating research transfer; • focusing on opportunistic projects; • clarifying roles and responsibilities of those bodies involved in funding public health research; acknowledging the investment in public health research and development by: – the NHMRC; – the AIHW; – each jurisdiction; – national non-government organisations; and – institutions that carry out public health research. • supporting the synthesis of research based knowledge; • advocating public health research; • fostering international links on public health research matters.
The paper drew together the outcomes of workshops the Partnership conducted during 1998 on public health research and development. The workshops drew on the expertise of research and development experts across the public health sector. The first involved noted international public health figures Professors Len Syme and David McQueen, and members of the Public Health Association Research Advisory Group. Research and development priorities were highlighted as a result of this workshop.
2.6 Workforce Development Achievements during 1998/99 One of the Partnership’s major objectives in the work program is to produce advice on national public health workforce development issues, in consultation with public health practitioners, policy makers, researchers and other industry stakeholders.
During 1998/99, highlights of the Partnership’s work in this area of infrastructure development have included: • engaging key stakeholders and raising the legitimacy of public health workforce development; • consensus on priorities for initial attention by the Partnership Group; • providing a basis for the States and Territories to consider local public health workforce development issues, and a process for establishing or broadening stakeholder networks; • enhancing capacity to initiate collaboration with key national non-government organisations on specific projects that aim to draw on these organisations’ expertise with a view to benefiting their constituencies; • contributing to the national review of the Public Health Education and Research Program (PHERP) institutions;
Part 1: NPHP Achievements and Progress Report—1998/99 21 • developing the workforce aspects of the proposed National Environmental Health Strategy; • commencing a systematic and continuous approach to monitoring and planning public health workforce training needs and capacity.
Background In late 1997, the Partnership established an interim planning group to advise on national public health workforce priorities. The planning group supervised the completion of background papers that reviewed national efforts in public health workforce development and suggested priorities and potential objectives for the Partnership.
The Partnership Group subsequently agreed to consult States and Territories on the priorities identified in the papers, to confirm the strategic directions in workforce development set out for the Partnership, and to gain broader input to the process of setting priorities. The Interim Planning Group and key people involved in the jurisdictional consultation considered the major outcomes of the consultations and sent a list of possible areas of Partnership focus to the Partnership Group to consider.
The jurisdictional consultations were extremely helpful in determining the direction of the Partnership’s work in this area, as well as providing very useful forums for sharing information about public health workforce developments locally. Further information on the consultations is provided below.
Consultations In the second half of 1998, members of the Partnership Group facilitated State and Territory consultations in which they canvassed the views of a cross-section of individuals and organisations about public health workforce development. The consultations sought responses and input to: • a common set of questions relating to the most appropriate role for the Partnership in this area; • the best approaches to achieve more systematic and coordinated workforce development; • priority issues; • any gaps in the current system; and • ways to improve development opportunities.
The jurisdiction-based consultations were supplemented with a survey of national organisations, and a workshop entitled The New Public Health Workforce Beyond 2000 at the Public Health Association (PHA) Annual Conference, held in September 1998. The workshop was held under the joint auspices of the Partnership Group and the PHA.
The themes that emerged from the consultations formed the basis of recommendations for action. In considering these recommendations, the Partnership Group agreed to initial action to target workforce development issues in health promotion, environmental health, public health leadership skills, and investigating methods for a systematic approach to monitoring and planning workforce development.
Ongoing Work on Priority Workforce Development Issues Discussions with representatives of PHA and the Australian Health Promotion Association (AHPA) have led to an agreement in May 1999 to establish a committee, under the joint
22 Part 1: NPHP Achievements and Progress Report—1998/99 auspices of the Partnership Group and the AHPA, to review and make recommendations on national action to address health promotion workforce issues.
In considering issues related to health promotion workforce development, the Partnership Group also discussed issues and options for a public health staff exchange scheme. This work is continuing with a broadened focus on the role of exchange in facilitating organisational change.
In May 1999, the National Environmental Health Forum (NEHF) convened a national workshop in partnership with the Australian Institute of Environmental Health and the PHA’s Environmental Health Special Interest Group. The workshop—Environmental Health Practitioners: Future Challenges, Future Needs—looked at the needs of the Environmental Health workforce and built on the consultations held during the development of the National Environmental Health Strategy.
The Partnership Group has supported the notion of addressing the three key areas identified by the NEHF workshop for priority action. It developed plans for the strategic review of undergraduate education and continuing professional development in environmental health, and by developing mechanisms to increase environmental health research.
The Partnership has agreed to a project to assess the need for and the supply of environmental toxicology expertise in public health, with a view to proposing action to fill any unmet need. This work coincides with the National Health and Medical Research Council’s planned review of funding for the National Research Centre for Environmental Toxicology (NRCET).
The Partnership is also developing a background paper on issues and options for Partnership Group action on leadership skills in public health. It is intended that the paper address the need for these skills at all levels and consider opportunities for links to existing programs, particularly in the health sector. The paper will take into account the consideration already given to this issue in a number of jurisdictions and by the Partnership Advisory Group.
Based on the current literature, work is underway on a paper that will identify core public health disciplines for researching approaches to more systematic monitoring and planning of workforce development. This work, together with the consensus study on core public health functions (see section 2.4), will also have implications for strategic approaches to other priority areas in the Partnership’s work plan.
Future Priorities Future priorities are to enhance public health workforce development by: • establishing a framework to monitor and plan the workforce, which informs employers and education and training providers; • addressing priorities for improving the core workforce responsible for health promotion and environmental health functions; • facilitating the development of leadership skills across all levels of the public health workforce; and • encouraging national public health strategies to work cooperatively and systematically to identify common needs for workforce development.
Part 1: NPHP Achievements and Progress Report—1998/99 23 3. National Public Health Partnership Advisory Group
The National Public Health Partnership Group Advisory Group ensures that key national non- government organisations, with a broad interest in public health, have direct input into the Partnership Group's work program, and that the National Public Health Partnership remains fully informed of service provider and consumer perspectives on its work program.
Over the last year the Advisory Group has been meeting the challenge of providing advice to the Partnership on its broad work program and developing a view of how the group can meet its Terms of Reference.
The Advisory Group has provided advice to the National Public Health Partnership Group on its Planning and Practice Work Program and Communication Strategy, and has played a fundamental role in helping to determine Partnership priorities.
Recently, the Advisory Group had a planning day where it developed an outline for a Work Plan for 1999–2000 and established its priorities, and its key roles and functions. A statement of principles to guide its work and a number of strategies to meet its Terms of Reference were also an outcome of the planning day.
A central feature of the Work Plan is a portfolio approach where members of the Advisory Group follow (or ‘shadow’) a particular National Public Health Partnership work area.
This will provide an efficient means for the Advisory Group to keep abreast of the Partnership Group's broad program so that the flow of information and ideas between the Advisory Group and the Partnership Group can occur productively and efficiently.
Two further key roles identified by the Advisory Group Work Program are in the area of information provision and consultation. An Information Forum for community organisations and representatives, giving background information on the National Public Health Partnership Group and details of its work program and implications for local services, was piloted last September in Victoria. It is hoped that the Advisory Group, working with the National Public Health Partnership Secretariat, can conduct these forums in other States and Territories throughout the remainder of 1999.
A further role the Advisory Group has defined as important is to facilitate collective feedback and comment to the Partnership Group on its work program, and where necessary, identify particular issues that might require coordinated feedback from the Advisory Group and its constituent organisations.
It is anticipated that the Advisory Group work program will continue to evolve and develop as issues of concern to, and priorities of, the non-government sector are consolidated.
24 Part 1: NPHP Achievements and Progress Report—1998/99 4. Facilitating Collaboration in National Public Health
As detailed in the Memorandum of Understanding that establishes the National Public Health Partnership, part of the Partnership’s role is to foster collaboration and coordination in the national public health effort and to facilitate the contribution of all providers of public health services to the Partnership work program.
The Partnership’s work program is therefore about working with other stakeholders in the public health sector, facilitating coordination, focusing effort and attention on priorities, and adding value to aspects of the national public health effort.
This may involve establishing formal subcommittees of experts in an area of public health activity, or contributing to projects that are managed or driven by other organisations and bodies rather than through the Partnership itself. An example of this latter approach is the Partnership’s involvement in the Australian Health Promotion Association’s work to develop the health promotion workforce.
The Partnership arrangement contributes to the range of expertise that is brought to bear on a particular project and ensures high-level attention is given to the issue being addressed.
This section provides examples of projects that highlight the range of collaborative projects to which the Partnership contributes.
4.1 Work Auspiced by the Partnership The National Environmental Health Strategy (the National Environmental Health Forum) Early in 1999, the National Environmental Health Forum (NEHF) finalised the draft National Environmental Health Strategy; in May 1999 the Partnership Group endorsed it. The NEHF, a technical advisory committee to the Partnership, developed the strategy with Commonwealth, State and Territory health departments, Local Governments and key stakeholder groups. The strategy recognises that environmental health covers a broad range of disciplines and aims to provide a national framework for cooperation between all sectors.
The strategy identifies 15 priority issues. Five are for development at a national level: health impact assessment, information, standards and guidelines, water, and workforce. It is proposed that implementing the strategy, the implementation framework, and other associated activities, will be the primary responsibility of a national body, the ENHealth Council, which will build on the achievements of the NEHF.
Most of this work will not start until 1999/00.
Further information is available from Dr Kevin Buckett, Department of Health and Aged Care, phone (02) 6289 3700.
Implementing the Food and Nutrition Policy (the Strategic Intergovernmental Nutrition Alliance) The Strategic Intergovernmental Nutrition Alliance (SIGNAL) was established in December 1997 as the Partnership’s public health nutrition arm. The Partnership Group endorsed its terms of reference at its November 1998 meeting. SIGNAL is responsible to the Partnership Group and through it, to the Australian Health Ministers’ Advisory Council. SIGNAL’s core business is to advise on the implementation of
Part 1: NPHP Achievements and Progress Report—1998/99 25 Australia’s national food and nutrition policy and to strategically manage national nutrition promotion priorities.
SIGNAL provides, for the first time, a national forum for governments to work together to ensure a consistent and coordinated approach to developing and implementing policy and strategy.
In 1998/99, SIGNAL agreed that its key focus areas for the next two years would be: • finalising the development of the National Public Health Nutrition Strategy, which will include the development of an Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan; • increasing the consumption of fruit and vegetables; • preventing overweight and obesity; and • through its networks, promoting and disseminating The Australian Guide to Healthy Eating.
Key achievements in 1998/99 included: • commissioning ARTD Management and Research Consultants to complete Stage 2 of the National Public Health Nutrition Strategy; • establishing the National Aboriginal and Torres Strait Islander Nutrition Working Party to advise on the development of the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan; • commissioning research to inform the development of an action plan to increase the consumption of fruit and vegetables; and • establishing the National Obesity Prevention Group (and two sub-groups focusing on adult overweight and obesity, and childhood obesity) to progress the implementation of the national strategy for preventing overweight and obesity.
Further information about SIGNAL is available from Fidelma Rogers at the Department of Health and Aged Care, on (02) 6289 8009.
Advice on Arboviruses (National Arbovirus Diseases Management and Control Group) During 1998/99 the Partnership Group agreed to establish a national Arbovirus Diseases Management and Control Group, under the Partnership’s auspices, to advise on issues related to arbovirus disease control. The new group combines two existing arbovirus surveillance and research working groups and will become a formal technical advisory group to the Partnership, reporting through the Communicable Diseases Network of Australia and New Zealand (CDNANZ).
Terms of reference for this consolidated national group have been developed in consultation with the existing jurisdictional working groups and the CDNANZ.
Victoria has taken the lead agency role in coordinating the group’s establishment. The Commonwealth will manage the group in the longer term.
Further information on the Arbovirus Technical Advisory Group is available from Mr Greg Sam, Surveillance and Management Section, Commonwealth Department of Health and Aged Care, phone (02) 6289 6859.
26 Part 1: NPHP Achievements and Progress Report—1998/99 4.2 Work Undertaken by Joint Committees/Collaborative Approaches The Mental Health Promotion and Prevention Action Plan In June 1997, the Partnership Group and the AHMAC National Mental Health Working Group (NMHWG) agreed to auspice the National Mental Health Promotion and Prevention Working Party. The working party developed an action plan for promoting mental health and preventing illness that was endorsed by both the Partnership Group and the NMHWG, and released in 1999.
The Promotion and Prevention Action Plan outlines a 5-year strategic framework and plan to promote positive mental health and lessen mental health morbidity by diminishing risk and enhancing protective factors.
Extensive consultations were undertaken in developing the plan. The draft plan and a request for written comment were mailed to stakeholder groups across the country. Feedback was also sought through meetings held in each State and Territory during October 1998. These consultations involved the directors of mental health and invited participants, including Partnership Group members, jurisdictional representatives, non-government organisations, carers, consumers and service providers.
Overall response to the plan was very positive, and stakeholders made many valuable comments about it. The consultation process indicated a clear need and desire for structured and coordinated activity to advance mental health promotion and illness prevention.
With the plan completed, the working party moves into the next phase of its work: implementing national strategies and activities. A work plan has been drawn up, setting out priority activities.
The working party membership will continue to include nominees of both the Partnership and the NMHWG, to ensure direct links with State and Territory mental health and population health initiatives and expertise.
Further information is available from Kerry Webber, Mental Health Branch, Department of Health and Aged Care on (02) 6289 8430.
The General Practice Partnership Advisory Council/NPHP Joint Advisory Group on General Practitioners and Public Health (JAG) The Joint Advisory Group on General Practitioners and Public Health (JAG) comprises five nominees of the Partnership Group and five representatives of the General Practice Partnership Advisory Council (GPPAC). Professor Peter Baume chairs the group.
Part 1: NPHP Achievements and Progress Report—1998/99 27 The JAG was established in December 1998 to provide advice to the Department of Health and Aged Care about increasing the public health role of general practitioners. Several recommendations made by the General Practice Strategy Review Group in its report, General Practice: Changing the Future Through Partnerships, relate to the JAG’s work.
The JAG met for the first time in February 1999 and has endorsed the following roles for the group: • stimulating and oversighting debate in Australia on the role of general practice in population health activities, drawing on evidence and international experience; • overseeing an evaluation of the impact of different models of practice and remuneration on general practitioners’ capacity to get involved in population health activities; • recommending structural elements needed to bed down the role of general practitioners in population health activities, for example, mechanisms for reviewing evidence, including the social circumstances relating to ill health (low socio-economic status, unemployment, low levels of education) and disseminating best practice and other information; • liaising with other organisations involved in developing remuneration arrangements for general practitioners working in population health, with particular reference to remuneration for services provided outside fee-for-service arrangements; and • developing and overseeing specific work to increase general practitioners’ involvement in population health activities, including developing and oversighting work that focuses on target groups, such as Aboriginal and Torres Strait Islander peoples, and others defined by socioeconomic status, National Health Priority Areas etc.
The Group also provides advice on a consultancy being undertaken by Dr Michael Bollen on behalf of the Department. Dr Bollen, who is consulting widely with the general practice community and relevant agencies, will report to the Department on options for increasing the role of the general practitioner in ways that are acceptable to the profession.
The Group will also advise on the development and progress of a consensus statement on general practitioners and public health. It is anticipated that both the GPPAC and the Partnership Group will endorse such a statement, which will provide a base for developing a national policy and planning framework for general practitioners and public health. There is also research to be done to provide an evidence-based foundation to the role of general practitioners in public health.
The Joint Advisory Group has also agreed to develop initial work by the Partnership’s National Strategies Coordination Working Group on national strategies and general practice. Specifically, it will provide a tool for identifying interventions in strategies that general practitioners are asked to implement. The work will be undertaken by a working party of the Joint Advisory Group, which will consult the Chairs of national public health strategies in developing this tool.
The Group’s work will continue for some time. It is already proving very competent and effective in advising the Department on complex issues relating to the role of general practice in the broader public health arena.
Further information is available from Helen Sutherland, General Practice Branch, Department of Health and Aged Care, phone (02) 6289 3633.
28 Part 1: NPHP Achievements and Progress Report—1998/99 Envisioning Public Health in the 21st Century In October 1998, the Partnership, the Department of Health and Aged Care and the Victorian Health Promotion Foundation co-sponsored a workshop on emerging public health issues. The workshop—Envisioning Public Health in the 21st Century—took advantage of the visit to Australia by Professor Len Syme, Professor Emeritus of Epidemiology, at the School of Public Health, UC Berkeley.
Leaders from diverse fields discussed issues that included the global context for public health. The workshop identified factors that must be taken into account to ensure readiness to address public health issues. These included the changing nature of work, human settlement patterns, global governance, population and resource relationships, and technological change. It concluded that the four major areas for attention to ensure preparedness for the 21st century were: • a strategic research and development agenda to build alliances between research, policy and practice; • mobilising leadership and investment across diverse sectors; • strengthening family functioning and community capacity for public health action; and • establishing health gain as an identified and credible criterion in economic policy formulation.
The Partnership Forum to be held next year will provide a timely opportunity to identify the sector’s response to these issues, and incorporate them into the Partnership’s work program as appropriate.
Part 1: NPHP Achievements and Progress Report—1998/99 29 5. Providing Strategic and Technical Advice
Many of the issues on the Partnership’s formal work program require medium to longer-term action to achieve results. This applies in particular to those projects that aim to strengthen national public health infrastructure. The Partnership is, however, an effective mechanism for providing a response to more immediate public health issues, or those that require strategic, high-level action in the shorter term.
A good example over the past twelve months has been the Partnership’s submission of background papers to various national reviews, such as the Health and Medical Research Strategic Review. The Partnership is a forum through which a national public health response can be provided to reviews of national public health legislative schemes, funding programs and strategies, without preventing individual jurisdictions from providing their own, more local, response to the same reviews.
Over the past twelve months, the Partnership has provided background papers to the following: • The Health and Medical Strategic Research Review (the Wills Review) (refer to section 2.5) • The National Drug Strategic Framework—response to request for comments on the framework • The Public Health Education and Research Program
Partnership meetings can also provide a useful forum for discussing public health issues that may require more immediate attention and decisions on the most appropriate short-term response. The membership of the Partnership Group facilitates this as it comprises senior level representatives and decision makers from each of its member jurisdictions.
Examples over the past twelve months include the Partnership’s response to the revised Ventilation Standard on Indoor Air Quality, developing guidance on industry sponsorship of public health initiatives, and a review of guidelines for health screening of refugees. Each of these strategic tasks is described in more detail below.
Ventilation Standard on Indoor Air Quality At its meeting in February 1999, the Partnership Group’s attention was drawn to proposed amendments of Australian Standard 1668.2 relating to ventilation design. The health sector was concerned that the amendment failed to account for health risks in determining minimum ventilation rates for environmental tobacco smoke control.
As a result of these concerns a nominee of the National Environmental Health Forum (NEHF) became involved in the process for amending the Standard. At the time of writing, the Standards Australia committee reviewing the guidelines was revising the introductory part of the Standard to better outline its relationship to health.
The Partnership and the NEHF, however, support further changes to the Standard to ensure that the revised version reflects health interests in full.
The NEHF, the Partnership and its member jurisdictions were able to respond quickly and collaboratively to this issue to ensure that public health issues were considered before the Standard was finalised.
30 Part 1: NPHP Achievements and Progress Report—1998/99 Industry Sponsorship of Public Health Initiatives In late 1998, the Partnership Group released a background paper entitled Issues for Consideration in Industry Partnerships for Public Health Initiatives. The paper had its origins in a National Environmental Health Forum request for advice on whether it was appropriate for the public health sector to consider the suitability of generic industry sponsorship of pubic health activities.
Issues of private sponsorship of public health activities have been a recent topic of international discussion. The Partnership paper, which sought to outline an Australian perspective on some of those issues, has been circulated widely and received well by the sector.
Review of Guidelines for Health Screening of Refugees The arrival of the Kosovar evacuees in Australia in mid-1999 and the need to develop new health screening and care protocols appropriate to this group highlighted the inadequacy of current refugee screening protocols, and the lack of an agreed mechanism to expedite the development of such a protocol. At its meeting in May 1999, the Partnership Group agreed to a national task group, to be convened by the Commonwealth Chief Medical Officer on behalf of the Partnership, to review current guidelines, legislation and practices for screening the health of refugees in the context of the general migrant health screening program. The guidelines will focus on facilitating the rapid development of specific protocols in response to changing refugee populations and situations. A process to enable endorsement, when required, of nationally agreed specific protocols will also need to be developed.
Future Directions—Establishing the NPHP Technical Advisory Groups As discussed in Section 2.5 (Research and Development), the Partnership intends to seek the advice of formal technical advisory groups when it needs expert advice on national public health standards and guidelines. These groups may be existing, or established by the Partnership for a particular project.
The existing National Environmental Health Forum is one of the first groups to become a formal technical advisory group to the Partnership. The new National Arbovirus Diseases Management and Control Group will also provide technical advice to the Partnership, through the Communicable Diseases Network of Australia and New Zealand, on issues related to mosquito-borne disease.
The establishment and use of technical advisory groups by the Partnership, as part of the process of considering of priority public health issues, is designed to promote links across the sector, and to ensure that the deliberations of the Partnership Group are well informed.
Part 1: NPHP Achievements and Progress Report—1998/99 31 6. Watching Briefs and Strategic Alliances
In addition to the projects undertaken in the Partnership’s agreed priority work areas, there are broader public health issues and initiatives on which the Partnership Group has a ‘watching brief’ or has input in ways other than establishing a formal working group or conducting a project. Many of these are listed in the Partnership’s strategic directions document endorsed by AHMC last year.
Three examples of the issues on which the Partnership has kept a watching brief during the 1998/99 year are summarised below.
6.1 National Health Priority Areas The National Health Priority Committee and the National Public Health Partnership Group make sure they know about each other’s work through standing agenda items and briefings from the members in common. Three members of the NPHP Group are also members of the National Health Priorities Committee.
More recently, and in collaboration with the Commonwealth, work has begun on a national chronic disease prevention strategy that incorporates the prevention aspects of the National Health Priority Areas. Work to date was endorsed by AHMAC at its meeting in April 1999, and will be progressed by the NPHP and the Commonwealth during 1999/2000.
6.2 Strategic Planning for Injury Prevention The National Injury Prevention Advisory Council (NIPAC) is developing National Priorities for Injury Prevention. The Partnership remains informed of this work through regular updates on the national strategic priority planning on injury prevention. The Partnership Group will be asked to endorse the National Priorities for Injury Prevention before it is sent to AHMAC and Health Ministers.
Injury prevention was also chosen to trial the implementation of the Partnership’s Planning Framework for Public Health Practice and work on this will continue into 1999/2000.
6.3 Child Health Child health issues are relevant to a number of the Partnership’s priority action areas and projects because they are intersectoral and affect a range of public health issues. During 1998/99 the Partnership considered a scoping paper on child health activities being undertaken across the country so it could identify areas where it may be able to assist. The Partnership Group is also aware of the work South Australia is doing for AHMAC to prepare a status report on implementing the National Health Plan for Young Australians.
In light of this work, Partnership Group members agreed to keep a watching brief on developments in child health. Through agenda items at meetings it remains informed of significant developments, including recent research linking pre-natal development and experiences in the first five years of life to health in adulthood.
32 Part 1: NPHP Achievements and Progress Report—1998/99 Conclusion With the consolidation of the Partnership mechanism, its particular strengths, and the places it can add value, are more evident. Most obviously, as a national approach to improving public health systems and structures, the Partnership’s focus on infrastructure development over the longer term will enhance the capacity to provide appropriate and effective public health services within communities.
The development of major strategic plans in areas fundamental to public health, the formation and facilitation of strategic alliances with key areas in which public health has a role, the promotion of public health with key stakeholders across the health sector, and the expansion of public health literacy, are achievements to be built on in the coming year.
The formative years of the Partnership have positioned it well to address the many challenges in the priority areas identified. Most importantly, however, the efforts of all those dedicated to public health and those who recognise the contribution to be made to community well-being will continue to be an essential underpinning for the realisation of national public health objectives.
Part 1: NPHP Achievements and Progress Report—1998/99 33 7. Appendices
Appendix A: NPHP Structure
Australian Health Ministers’ Conference
Australian Health Ministers’ Advisory Council
Queensland Victorian Health Department Department of Human Services
Department of Human New South Services Wales Health South Department Australia
Tasmanian Northern Department of Territory Health and National Health Human Public Health Services Services Partnership Group New Zealand NPHPG Ministry of Advisory Health Group –observer Health Commonwealth Department Department of of Western Health and Australia Aged Care
Australian Australian Capital Territory Institute of Chairs of Department National Health and of Health and National Strategies Welfare Community Care Health and Medical Research Council
National Public Health Infrastructure Public Health Issues Progressed in Program and Planning Development Projects partnership with Strategic National Bodies Support
34 Part 1: NPHP Achievements and Progress Report—1998/99 Appendix B: NPHP Group Members 1998/99 NSW QLD Dr Andrew Wilson (Chair from Jan 99) Dr Diana Lange (to Feb 99) Chief Health Officer/Deputy Director General Chief Health Officer Public Health NSW Health Department Queensland Department of Health
VIC Dr John Scott (from Feb 99) State Manager Public Health Services Prof John Catford Queensland Department of Health Director Public Health and Development Division TAS Department of Human Services Dr Mark Jacobs ACT Director Dr Doris Zonta (to Nov 98) Public and Environmental Health Service Chief Health Officer/Executive Officer Department of Health and Human Services Population Health Group NT Department of Health and Community Care Dr Shirley Hendy Dr Shirley Bowen (from Dec 98) Chief Health Officer Chief Health Officer/Executive Officer Assistant Secretary Population Health Group Public Health, Family and Children’s Services Department of Health and Community Care Territory Health Services
SA Commonwealth Mr Jim Dadds (to Jan 99) Ms Liz Furler (Chair to Nov 98) A/g Executive Director First Assistant Secretary Public & Environmental Health Services Population Health Division Department of Human Services Department of Health and Aged Care
Prof Brendon Kearney (from Jan 99) Ms Jan Bennett (to May 99) Executive Director Statewide Division A/g First Assistant Secretary Department of Human Services Population Health Division Department of Health and Aged Care WA Mr Brian Corcoran (from Jun 99) Dr Paul Psaila-Savona (to Aug 98) First Assistant Secretary Executive Director, Public Health Health Department of WA Population Health Division Department of Health and Aged Care Ms Prudence Ford (to Jan 99) Acting General Manager, Public Health Health Department of WA
Dr Rowan Davidson (from Jan 99) A/g General Manager Public Health Services Health Department of WA
Part 1: NPHP Achievements and Progress Report—1998/99 35 NHMRC Prof Stephen Leeder (to Nov 98) Dean, Faculty of Medicine University of Sydney NSW
Prof George Rubin (from Nov 98) Director, Effective HealthCare Australia University of Sydney NSW
AIHW Dr Richard Madden Director Australian Institute of Health and Welfare
New Zealand (observer) Dr Gillian Durham Director of Public Health and Deputy Director General New Zealand Ministry of Health
NPHP Advisory Group (observer) Prof Brian Oldenburg (from July 98) Chair NPHP Advisory Group
36 Part 1: NPHP Achievements and Progress Report—1998/99 National Public Health Strategies—Update 1998/99 National Public Health Strategies
37 Introduction
The work of many public health practitioners in Australia is linked directly to the twenty or so national public health strategies that comprise the major platform for Australia’s response to a wide range of public health issues. This section of the report provides an update on each of the current national public health strategies, and some that are being developed.
The section also provides a brief overview of how public health activities, programs and statutory responsibilities are delivered at state/territory and local levels. While the strategies discussed in this section are national programs, their effective implementation depends largely on the public health infrastructure and delivery systems in each state and territory. Australia’s federal system of government means that delivering public health services relies on collaboration between the various levels of government and non-government organisations, each of which play a significant part in implementing national policy and responding to public health issues at the local level. The overall success of this national collaboration is demonstrated by the number of Australia’s public health strategies that have received worldwide attention for their achievements and contribution to improving and maintaining the population’s health.
Contact details for each national strategy discussed in this section are provided. Unless otherwise stated, contacts are located within the Commonwealth Department of Health and Aged Care, which has primary carriage of national strategy policy development.
Information on most of the national public health strategies is also available at www.health.gov.au/pubhlth/strateg/index.htm
The Commonwealth Department of Health and Aged Care's website address is www.health.gov.au/
38 Part 2: National Public Health Strategies—Update 1998/99 A Glimpse at Infrastructure for Public Health Service Delivery Across Australia
While the Commonwealth has a broad policy leadership and financing role in health matters, the states and territories are largely responsible for the delivery of public sector health services and the regulation of health workers in the public and private sectors. While some jurisdictions have a decentralised system (such as NSW’s Area Health Services, and Queensland’s Zonal Public Health Units), others operate on a more centralised basis (such as WA and SA). Local government also plays an important role in the provision of services, as do non-government organisations (NGOs). Yet these arrangements vary across jurisdictions as individual jurisdictions are responsible for making their own institutional arrangements for the delivery of public health programs and setting individual priorities and divisions of labor.
Service delivery arrangements for six areas of public health activity—immunisation, laboratory services, environmental health, health promotion, food standards and hygiene regulation, and breast screening programs—are described below, illustrating both the similarity and diversity of approaches nationally.
1. Immunisation The National Immunisation Program is a joint program between the Commonwealth and states and territories which aims to improve Australia’s immunisation coverage rates. The Commonwealth is responsible for the provision of funds for the purchase of vaccines and states and territories fund the service delivery components of the program, including the purchase and supply of vaccines to immunisation providers. There is an immunisation co-ordinator in each state, who co-ordinates a range of immunisation providers—general practitioners, local councils, community health centres and, in the ACT and Northern Territory, public health clinics. Victoria has strong local government involvement in service delivery, through its local government Maternal and Child Health Centres.
The National Immunisation Program has built strong linkages and partnerships with general practitioners. Funding is provided to Divisions of General Practice for immunisation incentive schemes. It also continues to work with the Office of Aboriginal and Torres Strait Islander Health in the Commonwealth Department of Health and Aged Care and the National Aboriginal Community Controlled Health Organisation (NACCHO) in relation to immunisation issues in indigenous communities.
2. Laboratory Services The organisation of public health laboratory services differs between jurisdictions, although the essential tasks are similar. The laboratories vary in the institutional location of different types of work, the role of the public and private sectors and the relationship between the health departments and the laboratories themselves. Although some laboratories remain part of the various state health departments and subject to their budgetary control, most are managed independently with contracts as their only link with the public health surveillance mechanism. Two States—Victoria and Queensland—have almost completely separated diagnostic and public health work but only Queensland has concentrated most public health laboratory functions in a single institution. In Western Australia and South Australia a dominant institution combines most public health microbiological work with diagnostic services. New South Wales has the most decentralised public system, mostly hospital-based. Tasmania and the Territories rely, to varying degrees, on the services of both specialised laboratories in other states and private providers.
Part 2: National Public Health Strategies—Update 1998/99 39 3. Environmental Health Environmental health is highly intersectoral in nature, requiring collaboration between numerous government departments, local councils, academic and non-government organisations. While all states have an environmental health unit within their health department’s structure, (with varying responsibilities nationally) a number of other state-level non-health bodies will have responsibility for management of environmental health issues. The degree of involvement of the non-health sector depends on each state’s particular infrastructure arrangements and division of responsibilities between portfolios, as well as the type of issue. Radiation health for example, is the responsibility of the state Environment Protection Authority in NSW, while in all other states the issue is managed by the state health authority. Water treatment activities, however, while traditionally a health sector responsibility, are increasingly being handed to the non-health sector, or contracted out for private provision of services.
While state agencies tend to focus on legislative and policy development issues in environmental health, the responsibility for surveillance and enforcement is shared with local government and non-government organisations. Local government involvement in a range of environmental health issues differs across jurisdictions. In part, this is due to legislative differences within Local Government Acts. For example, sanitation is the responsibility of local councils in most jurisdictions, however, state agencies manage sanitation services in Western Australia, the Northern Territory and Queensland. As for water treatment, however, sewage and waste services are increasingly being managed outside the health sector, or contracted to private providers.
4. Health Promotion Each of the States and Territories has a central, designated program area, at the state level, that is responsible for setting priorities for, overseeing and, on some issues, implementing health promotion activities. Nonetheless, the extent of the program infrastructure varies considerably between jurisdictions. In some states health promotion services may be coordinated by a discrete program area, such as the Queensland statewide health promotion unit, in others, health promotion coordination may be the responsibility of a program area that oversees broader population health activities, such as WA’s Chronic Disease and Health Enhancement Branch, within its Public Health Division. Three states (Victoria, WA and the ACT) also have well-established health promotion foundations. Queensland will establish its own health promotion foundation within the next few months, and Tasmania is giving consideration to the establishment of such a body in that State.
In addition to health promotion programs co-ordinated by state agencies and local councils , there is a wide range of non-government organisations, professional associations, academic, community and consumer organisations involved in the delivery of health promotion interventions. In Victoria, South Australia, Tasmania, Queensland and the ACT, the community health system, together with non-government organisations, has been the mechanism for almost all program delivery. In New South Wales and Western Australia, separately-funded, designated health promotion programs have been established in each area or regional health service, and work within, or in collaboration with, the community health system.
In all jurisdictions, health promotion requires significant intersectoral collaboration, involving liaison between health agencies and those outside the health sector—for example, organisations in the education, transport, sport and arts sectors.
40 Part 2: National Public Health Strategies—Update 1998/99 5. Food Standards and Hygiene Regulation All jurisdictions have their own food hygiene regulations, and these, together with food standards, are predominantly administered at the state-level by departments of health and primary industry, and by local governments. How these responsibilities are split will vary however—in Victoria and the ACT responsibility is concentrated in the state health department, while in other jurisdictions, responsibility is split across both health and primary industry. In administering the regulations, the state agencies concentrate on the legislative aspects of this area of public health activity, as well as educative and advocacy roles, while local government is responsible for monitoring and surveillance activities, and regulatory enforcement. There is also some non-government sector involvement—in South Australia, for example, inspections of farms are carried out by non-government organisations.
6. Breast Screening Programs In many jurisdictions, breast cancer screening is coordinated by state/territory health agencies. Exceptions are Victoria and Western Australia, where the non-government Breastscreen Victoria and Breastscreen WA have responsibility for the statewide co-ordination of breast screening, and NSW, where the statewide coordination unit is located in an area health service. The breast screening coordination units in each jurisdiction are responsible for ensuring that local screening programs adhere to nationally agreed standards, as determined by the national public health strategy, Breastscreen Australia.
Across jurisdictions, the actual delivery of breast screening services may be through regional health services; dedicated services, such as the breastscreen services in WA and SA; the private sector (Tasmania); or a mixture of public and private providers, as in Victoria. In Queensland a partnership between public and private providers provides a mobile screening service for rural and remote women.
Non-clinical aspects of breast screening programs (such as promotion of the program and community and professional education) are delivered by NGOs or professional organisations such as the Royal Australian College of General Practitioners.
Summary While this is a limited selection of public health activity, it demonstrates the complexity of public health service delivery within Australia. The variety of systems in place nationally are a product of history, to some extent, with infrastructure being developed in response to local needs and based on existing structures of health administration. While the diversity of infrastructure may have consequences for the delivery of national public health programs, requiring consultation with different stakeholders in each state, and adaptation to local delivery systems, such diversity emphasises the need for a national focus on outcomes and shared objectives, and recognition that each jurisdiction will have its own requirements and systems in place to achieve these.
The National Public Health Partnership has a role to play in fostering a nationally shared vision for public health, where this is required. It can also provide a vehicle for sharing information, expertise and skills across jurisdictions to assist in meeting nationally agreed public health goals.
Part 2: National Public Health Strategies—Update 1998/99 41 Healthy Growth and Development Strategies
Contact Details The National Public Health Nutrition Strategy Primary Prevention The National Public Health Nutrition Strategy (NPHNS) aims to implement the 1992 national Unit Food and Nutrition Policy. The goal of the policy is to improve health and reduce the Phone: preventable burden of diet-related early death, illness and disability among Australians. (02) 6289 8009 The NPHNS is being developed in two stages. Stage 1, developed in 1997 by Deakin University, clarified roles and defined a strategic approach to implementing public health nutrition policy for government health agencies. The Strategic Intergovernmental Nutrition Alliance (SIGNAL) was established by the Commonwealth to coordinate policy implementation as an outcome of Stage 1.
Stage 2, which commenced in June 1999, will focus on other stakeholders relevant to public health nutrition, including the food industry; peak health, welfare and nutrition bodies; the academic sector; and related government agencies. With this input a comprehensive national strategy for all Australians will be developed, aimed at achieving a high level of ownership and support throughout the Australian food and nutrition sector.
A National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan is being developed concurrently with and as a key component of Stage 2 of the nutrition strategy, and will form part of the broader strategy. This project is being managed jointly by the Population Health Division and the Office for Aboriginal and Torres Strait Islander Health.
Management Structure SIGNAL is overseeing the development of Stage 2 of the nutrition strategy and has established a working group of members to provide advice on the project.
A National Aboriginal and Torres Strait Islander Working Party has been established to oversee the development of the Indigenous Aboriginal and Torres Strait Islander nutrition component of the strategy. This group will also report to SIGNAL.
Key Achievements in 1998/99 ARTD Management and Research Consultants were contracted in May 1999 to develop Stage 2 of the nutrition strategy.
A senior project officer was appointed in June 1999 to develop the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan.
Future Directions for 1999/00 The final nutrition strategy, which will include both of the above components, will be completed early in 2000. The strategy will contain recommendations to SIGNAL to be implemented in the latter part of 1999/00 and beyond.
42 Part 2: National Public Health Strategies—Update 1998/99 Coordination and Partnerships The National Public Health Nutrition Strategy, the Acting on Australia’s Weight—a strategic plan for the prevention of overweight and obesity strategy, and the Developing an Active Australia strategy are coordinated through overlaps in the membership of their national committees. These committees are SIGNAL, the National Obesity Prevention Group and the Strategic Intergovernmental Forum on Physical Activity and Health respectively.
Acting on Australia’s Weight Strategy Contact Details In 1997 the National Health and Medical Research Council (NHMRC) released a report entitled Primary Prevention Acting on Australia’s Weight: a strategic plan for the prevention of overweight and obesity. The Unit report: Phone: • sets out the evidence for focusing on the prevention of overweight and obesity to (02) 6289 8830 complement the significant effort already being directed towards management and treatment; • recommends changes in the environments in which people live to make it easier for them to be physically active and consume a healthy diet; and • sets a goal for the recommended 10-year implementation period to prevent further weight gain in adults, with a view to reducing the proportion of the adult population that is overweight or obese, and ensure the healthy growth of children.
Following the release of Acting on Australia’s Weight, the Commonwealth Department of Health and Aged Care commissioned the development of a detailed implementation strategy. This work, completed in January 1999, was undertaken by Health Strategies Deakin at Deakin University in association with the National Heart Foundation. The implementation strategy lists priority actions for a range of organisations for the 10-year implementation period.
Management Structure A National Obesity Prevention Group, chaired by Professor Ian Caterson, Professor of Human Nutrition, University of Sydney, has been established to advise on implementing the strategy. This group, which met for the first time on 21 June 1999, has a formal relationship with the National Public Health Partnership (NPHP) through the Strategic Intergovernmental Nutrition Alliance (SIGNAL)—the public health nutrition arm of the NPHP.
Key Achievements in 1998/99 A detailed implementation strategy was developed and the National Obesity Prevention Group was established to advise on implementing the strategy.
Future Directions for 1999/00 The initial work plan for the National Obesity Prevention Group is to develop guidelines on best practice in preventing and managing obesity, with a particular focus on childhood obesity and on adult overweight and obesity.
Coordination and Partnerships Membership of the National Obesity Prevention Group includes representatives of SIGNAL and the Strategic Intergovernmental Forum on Physical Activity and Health. The National Obesity Prevention Group has a reporting relationship with both these groups.
Part 2: National Public Health Strategies—Update 1998/99 43 Contact Details Developing an Active Australia Mr Bill Bellew, The Developing an Active Australia: a framework for action for physical activity and health Chair, SIGFPAH, strategy is intended to encourage and support acceptance of regular, moderate-intensity NSW Department physical activity as a key means for the population to achieve and maintain improved health of Health status. It involves identifying and removing barriers to participation, through a focus on the Phone: settings where people live, work and play. An important feature of this strategy is the need for (02) 9391 9583 a close working relationship with other sectors.
Ms Penny Graham, A forum of members from all State and Territory health departments and the Commonwealth Secretariat provide national direction for implementing the Strategy. SIGFPAH, Key Achievements in 1998/99 Commonwealth Department Health Key achievements for the year include: and Aged Care • establishing the Strategic Inter-Governmental Forum for Physical Activity and Health (SIGFPAH)—its inaugural meeting was held 6/7 May 1999; Phone: • launching the National Physical Activity Guidelines for Australians in May 1999; (02) 6289 7939 • Progressing strategies identified in Developing an Active Australia: A framework for action for physical activity and health within the categories of education, environments, infrastructure and monitoring; • completing a baseline survey of physical activity at the population level and commissioning a follow-up survey; • various Commonwealth/State agencies participating on a communications/local strategy targeting inactive older Australians; • running a workshop with the Australian Divisions of General Practice to both raise awareness of the importance of physical activity as a health intervention, and to develop strategies to increase the level of moderate physical activity of the population in the general practice setting.
Future Directions for 1999/00 The workplan for the next financial year includes: • developing an agreed Work Plan for SIGFPAH work; • continuing to monitor data on levels of physical activity in the population including a follow-up survey on Physical Activity Levels of Adult Australians; • further work with general practitioners, particularly linking to primary prevention, chronic disease initiatives and other health priority areas; These strategies are identified in the Active Australia & General Practice (1999) report; • gathering the evidence for measuring physical activity among Australian children; • assisting in the development of a National Action Plan for the Active Australia Alliance; • supporting work on sustainable transport including cycling (through Australia Cycling—the National Strategy 1999–2004), walking and active transport; • investigating opportunities with the environment sector, to increase incidental physical activity through initiatives such as Living Cities and the Greenhouse Challenge.
44 Part 2: National Public Health Strategies—Update 1998/99 Coordination and Partnerships Through SIGFPAH, Active Australia links with: • the National Public Health Nutrition Strategy, through the Strategic Intergovernmental Nutritional Alliance (SIGNAL), the nutrition arm of the NPHP; • the National Obesity Prevention Group (Acting on Australia’s Weight); • the Chairs of National Strategies; • the Active Australia Alliance; • the Department of Transport, through Australia Cycling—the National Strategy 1999–2004.
National Breastfeeding Strategy Contact Details The 1996/97 Budget included a Federal Government commitment, through its policy document Primary Health Throughout Life, to increase the initiation and duration of breastfeeding, particularly for Prevention Unit babies under 6 months of age (Australia’s target is 80 per cent of babies at least partially Phone: breastfed by the year 2000). A total of $2 million was allocated to the National Breastfeeding (02) 6289 7704 Strategy. These projects addressed a diverse range of breastfeeding issues, including: educating http://www.health. families and health professionals, developing national accreditation standards for maternal and gov.au/pubhlth/ infant care services from hospital to community, Aboriginal and Torres Strait Islander health strateg/brfeed/ worker education, workplace support and ongoing monitoring of breastfeeding rates.
Management Structures The breastfeeding strategy is coordinated within the Population Health Division of the Department of Health and Aged Care. SIGNAL will continue to oversee the strategy as part of its focus on maternal and child health—one of four priority areas under the National Public Health Nutrition Strategy.
Key Achievements in 1998/99 Major achievements during the year included developing and distributing breastfeeding resources. Examples include: • Releasing and distributing the Health Professional Breastfeeding Education kit to all practising general practitioners and paediatricians, baby health clinics and pharmacies in Australia. The kit contained practical, evidence based information to assist health professionals in supporting breastfeeding. • The release of the family education tip cards and low literacy materials directed at families— fathers in particular, and to ethnic and cultural groups, and disadvantaged socioeconomic groups. • Developing national accreditation standards for maternal and infant care services from hospital to community. • Releasing two reports for indigenous health service providers—one investigating current training in breastfeeding support and infant nutrition for indigenous health workers, the other reviewing current interventions and best practice in supporting breastfeeding and appropriate infant nutrition.
Part 2: National Public Health Strategies—Update 1998/99 45 Future Directions for 1999/00 Work will now focus in the following areas: • antenatal education—developing a practical evidence-based client resource/education package for antenatal educators (June–December 1999); • workplace support—developing and implementing resources and strategies to help women in employment breastfeed (Sep 1999–May 2000); • national monitoring—within the Food and Nutrition Monitoring and Surveillance Project, develop a protocol and definitions to collect reliable national data to monitor breastfeeding in Australia (December 1998–December 2000).
The area of maternal and child health is currently under examination as a key focus for the National Public Health Nutrition Strategy to be finalised in early 2000.
Coordination and Partnerships There is coordination between the following initiatives and strategies: • The National Breastfeeding Strategy has a reporting relationship with SIGNAL, which oversees the National Public Health Nutrition Strategy. • The Aboriginal and Torres Strait Islander component of the National Public Health Nutrition Strategy is being informed by the previous work under the Breastfeeding Strategy on current training needs in breastfeeding support and infant nutrition for indigenous health workers, and the review of current interventions and best practice in supporting breastfeeding and appropriate infant nutrition.
Contact Details National Environmental Health Strategy Director, The National Environmental Health Strategy has been developed through the collaborative Environmental efforts of the Commonwealth, State and Territory health departments, Local Governments and Health Section key stakeholder groups. It recognises that environmental health covers a broad range of Phone: disciplines and aims to provide a national framework for cooperation between all sectors. The (02) 6289 3700 development of a national framework increases the ability and capacity of those providing environmental health services in Australia by outlining clear processes for improving the http://hna.ffh.vic. assessment, prevention, control and management of environmental health hazards. gov.au/nphp/ envforum/index.htm Management Structures The ENHealth Council, which is responsible for implementing the strategy, will report to the Australian Health Ministers’ Conference through the National Public Health Partnership Group.
46 Part 2: National Public Health Strategies—Update 1998/99 Key Achievements in 1998/99 The National Public Health Partnership Group endorsed the strategy at its meeting of 26/27 May 1999. A key activity in implementing the strategy is to establish a new national body—the ENHealth Council—that will have primary responsibility for implementing the strategy through its implementation framework and other associated activities. Most of this work will not begin until 1999/00.
AHMAC recommended the approval of the strategy out of session, and agreed to the formation of ENHealth Council. The Strategy will be forwarded to AHMC for endorsement and appointment of a Council chair.
Fifteen priority issues have been identified. Five are to be developed at a national level: health impact assessment, information, standards and guidelines, water, and workforce.
Future Directions for 1999/00 As the ENHealth Council is responsible for implementing the strategy, it will consider each of the priority issues, identify outcomes to be achieved and set timeframes for those activities.
A priority for 1999/2000 is to conduct audits to determine the current position and identify gaps for specific or priority action. The audits will include: the type and collection of environmental health information and data; the status of existing postgraduate environmental health education; research on environmental health being funded; the status of health impact assessment in Australia; and current Australian and international environmental health guidelines and standards.
Specific programs on Indigenous Environmental Health Workforce and other Environmental Health Workforce capacity building and support will also be priorities, as will establishing contacts and partnerships with key stakeholder groups.
Coordination and Partnerships Collaboration between all levels of government, academia, public health, industry and the community are pivotal to the successful implementation of the strategy. The ENHealth Council is structured to reflect those links. In addition, the Implementation Framework identifies the lead agencies and partners responsible for various activities and outcomes.
National Drug Strategy Contact Details The National Drug Strategic Framework 1998/99 to 2002/03 presents a shared vision, a Director, National framework for cooperation, and a basis for coordinated action to reduce the harm caused by Drug Strategy Unit drugs in Australia. The framework maintains the policy principles of the previous phases of the Phone: National Drug Strategy and adopts the major recommendations of Mapping the Future: An (02) 6289 8725 evaluation of the National Drug Strategy 1993–1997. The framework has been prepared under the direction of the Ministerial Council on Drug Strategy (MCDS) and provides a nationally coordinated and integrated approach to reducing the harm arising from the use of licit and illicit drugs, including alcohol, tobacco and pharmaceutical drugs.
Part 2: National Public Health Strategies—Update 1998/99 47 Governance Prime Minister and the Council of Australian Governments The Prime Minister has taken a lead interest in national drug policy through the development of the National Illicit Drug Strategy. He has also placed drug issues high on the national agenda through discussion with State Premiers at the Council of Australian Governments (COAG) meetings.
Ministerial Council on Drug Strategy The Ministerial Council on Drug Strategy (MCDS) brings together Commonwealth, State and Territory Ministers responsible for health and law enforcement to collectively determine national policies and programs to reduce the harm caused by drugs. In Mapping the Future, Single and Rohl (1997) identified the Ministerial Council as one of the major strengths of Australia's National Drug Strategy. Under the new National Drug Strategic Framework, the Council will continue to function as the peak policy and decision-making body for reducing the harm caused by licit and illicit drugs in Australia.
Australian National Council on Drugs The Australian National Council on Drugs (ANCD) was established by the Prime Minister on 16 March 1998. The Council ensures that the expert voice of the non-government sector and experts working in the drug field reaches all levels of government and influences policy development. It has broad representation from volunteer and community organisations, law enforcement, education, research and drug treatment sectors. The Council aims to provide Ministers with independent, expert advice on matters to do with licit and illicit drugs and to enhance the partnership between governments and the non-government and community sectors in developing and implementing policies and programs to redress drug-related issues.
Intergovernmental Committee on Drugs The Intergovernmental Committee on Drugs (IGCD) consists of senior officers representing health and law enforcement in each Australian jurisdiction—appointed by their respective health and law enforcement Ministers—and officers with expertise in identified priority areas, such as representatives of the Australian Customs Service and the Department of Education, Training and Youth Affairs. The Committee provides policy advice to Ministers on the full range of drug-related matters and is responsible for implementing National Drug Strategy policies and programs, as directed by the MCDS. The Ministerial Council has endorsed the IGCD as the appropriate body to determine the priorities for and coordinate the activities of the national expert advisory committees and to ensure that policies, strategies and directions are consistent with the National Drug Strategic Framework.
National Expert Advisory Committees The national expert advisory committees provide expert advice to the MCDS, IGCD and ANCD. Committee members are selected for their expertise in health, law enforcement, providing community-based service, education, research, government and industry. To date, national expert advisory committees have been established for tobacco, alcohol, illicit drugs, and school- based drug education. A national drug research strategy committee and a monitoring and evaluation coordination committee have also been established.
48 Part 2: National Public Health Strategies—Update 1998/99 Advisory Structures for the National Drug Strategic Framework, 1998–99 to 2002–03
Prime Council of Australian Minister Governments
National Drug Strategy Indigenous Ministerial Council on Australians Reference Group Drug Strategy APAC Subcommittee on Intentional Misuse of Pharmaceutical Drugs
Methadone and Other Australian National Intergovernmental Treatment Subcommittee Council on Drugs Committee on Drugs These committees provide advice to IGCD and links with other national strategies
National Expert National Expert National Expert National National Drug Monitoring and Advisory Advisory Advisory Advisory Research Evaluation Committee on Committee on Committee on Committee on Strategy Coordination Tobacco Alcohol Illicit Drugs School Drug Committee Committee Education*
These committees tasked with the development of National Drug Action Plans under the National Drug Strategic Framework as endorsed by MCDS in November 1998
* The National Advisory Committee on School Drug Education also reports to the Ministerial Council on Education, Training and Youth Affairs.
Key Achievements in 1998/99 • Endorsement of the National Drug Strategic Framework 1998/99 to 2002/03 following extensive public consultation; • Agreement through COAG to a range of new national initiatives; • Implementation of the National Illicit Drug Strategy—the Commonwealth has allocated $516 million over four years to a range of initiatives, including supply control, law enforcement, prevention, education and treatment; • Establishment of new national expert advisory committees for tobacco, alcohol, illicit drugs and school drug education; • Endorsement of the National Tobacco Strategy as the first action plan under the National Drug Strategic Framework; • 1998 National Drug Strategy Household Survey.
Future Directions for 1999/00 Future directions for the National Drug Strategy include: • developing national drug action plans for alcohol, illicit drugs, school drug education; • developing a National Drug Monitoring and Evaluation Strategy; • developing a National Drug Research Strategy; • continuing to implement the National Illicit Drug Strategy; • implementing the COAG initiatives.
Part 2: National Public Health Strategies—Update 1998/99 49 Coordination and Partnerships The partnerships between the Commonwealth and the States and Territories, and between health and law-enforcement agencies, have been a hallmark of Australia’s National Drug Strategy. They are widely recognised as contributing to its success. In Mapping the Future, Single and Rohl (1997) recommended that in addition to maintaining current partnerships during this phase of the strategy, attention should be given to enhancing partnerships with other sectors. Therefore, an additional priority is to develop closer working relationships between the three tiers of government and affected communities (including drug users, their families, and those affected by drug-related harm), community-based organisations, business and industry, the medical profession, and research institutions. In recognition of this, and acknowledging that a partnership approach is still evolving, Building Partnerships is the theme for this next phase of the National Drug Strategy. Links with other strategies has been identified as a priority area under the framework.
Contact Details National Alcohol Action Plan Director, Tobacco The National Expert Advisory Committee on Alcohol (NEACA), one of the expert committees and Alcohol reporting to the Intergovernmental Committee on Drugs (IGCD), is providing guidance on the Strategies development of a National Alcohol Action Plan. The National Alcohol Action Plan will form one Phone: of several national drug action plans developed under the National Drug Strategy. (02) 6289 7688 The Plan is intended to provide a framework for action at jurisdictional and national level to reduce the harmful consequences of alcohol consumption. It is envisaged the Plan will be complemented by a broader strategic plan (the National Alcohol Strategic Plan), which will provide more detail on the issues and priorities for interventions.
It is anticipated that a draft Plan will be released for public consultation early in 2000 for comment and input from a broad range of stakeholders.
Contact Details National Tobacco Strategy Director, Tobacco The Ministerial Council on Drug Strategy endorsed the National Tobacco Strategy 1999 to and Alcohol 2002–03 at its meeting in June 1999. The strategy is consistent with calls from the World Health Strategies Organization to implement comprehensive tobacco control strategies. It aims to improve the Phone: health of all Australians by eliminating or reducing exposure to tobacco in all its forms. (02) 6289 7688 To achieve this goal, the strategy focuses on preventing uptake of tobacco use by non smokers (especially children and young people), and reducing the number of users of tobacco products, the exposure of users to the harmful consequences of tobacco products, and exposure to tobacco smoke.
To achieve these outcomes the strategy identifies six key areas for action: • strengthening community action; • promoting cessation of tobacco use; • reducing availability and supply of tobacco; • reducing tobacco promotion; • regulating tobacco; and • reducing exposure to environmental tobacco smoke.
50 Part 2: National Public Health Strategies—Update 1998/99 The strategy provides a framework for all jurisdictions to develop and implement tobacco action plans at a local level.
Management Structure The National Tobacco Strategy is one of several national drug action plans developed with the support of expert national advisory groups for the Ministerial Council on Drug Strategy (as illustrated in the National Drug Strategy governance chart on page 49).
Key Achievements in 1998/99 1998/99 saw the development phase of the strategy. This included an extensive national consultation process completed during the first half of 1999. It targeted more than 750 State, Territory and national stakeholders in tobacco control and drew submissions from more than 120 respondents from government, non-government and retail sectors. In addition, a public consultation process was completed, with advertisements placed in more than 77 newspapers in national, metropolitan and regional press. Workshops held in seven jurisdictions provided opportunity for feedback and for the strategy to be refined. The strategy was revised, taking into account the information gathered during the consultation process, then presented to the Ministerial Council on Drug Strategy for endorsement in June 1999.
Future Directions for 1999/00 In 1999/2000, activity under the strategy framework will begin in jurisdictions.
State and Territory Governments will develop their own tobacco action plans and report on their activities to the Ministerial Council on Drug Strategy in June 2000.
The National Expert Advisory Committee on Tobacco, one of the expert committees reporting to the Intergovernmental Committee on Drugs (IGCD), will establish recommendations on key priorities for 1999–2000. The Intergovernmental Committee on Drugs will be responsible for determining the priorities for attention.
Coordination and Partnerships The National Tobacco Strategy identifies partnerships at international, national and local levels. It notes Australia’s contribution to the WHO Tobacco Free Initiative and its links to the National Public Health Partnership and to principal strategies developed within public health (e.g. the School Drug Education Strategy, Active Australia, the National Diabetes Strategy, the National Asthma Campaign, and the National Drug Strategy). In addition, the strategy identifies networks between national and State and Territory organisations, especially with the non-government sector through agencies such as the National Heart Foundation and the Anti-Cancer Councils in each jurisdiction.
Part 2: National Public Health Strategies—Update 1998/99 51 Contact Details National Indigenous Australians’ Sexual Health Strategy Assistant Director, The National Indigenous Australians’ Sexual Health Strategy 1996–97 to 1998–99 (NIASHS) was Health Issues launched on 26 March 1997. The strategy is an integral part of the 3rd National HIV/AIDS Section, Office of Strategy 1996/97 to 1998/999. It offers a comprehensive approach to preventing the spread of Aboriginal and HIV and other sexually transmitted diseases in Aboriginal and Torres Strait Islander Torres Strait communities. The strategy addresses four main areas: prevention; treatment, care and support; Islander Health workforce issues; and research and data collection. A core element is to strengthen Phone: comprehensive primary health care. The strategy places particular emphasis on measures (02) 6289 5175 designed to meet the needs of Aboriginal and Torres Strait Islander people living in rural and remote areas.
Management Structures The NIASHS was developed by a working party of the Australian National Council on AIDS and Related Diseases (ANCARD) in response to evidence presented in the review of the second National HIV/AIDS Strategy. The National Indigenous Australians’ Sexual Health Working Party is responsible for reporting to the Minister, through ANCARD, on progress in implementing the NIASHS.
The NIASHS is administered through the Office for Aboriginal and Torres Strait Islander Health (OATSIH) within the Commonwealth Department of Health and Aged Care. The OATSIH also provides secretariat support to the National Indigenous Australians’ Sexual Health Working Party.
Key Achievements in 1998/99 Almost 80 per cent of the NIASHS budget is allocated to the States and Territories for projects that are demonstrably effective and that fall within the strategic framework identified in the NIASHS. Funded projects reflect the breadth and diversity of responses required to address Indigenous sexual health effectively in different jurisdictions. Almost all jurisdictions have developed comprehensive implementation plans; Aboriginal Community Controlled Health Organisations are working collaboratively with State and Territory governments to address them. Many projects involve the employment of male and female Aboriginal Health Workers in both Aboriginal Community Controlled Health Organisations and State-funded programs. These positions often provide, among other things, clinical treatment, counselling, contact tracing and STD/HIV education.
Since the NIASHS began, significant gains in STD control have been documented in high- prevalence areas. The introduction of Azithromycin has improved patient compliance and reduced the prevalence of donovanosis among communities in central Australia. The incidence of syphilis has declined in some areas and recent work demonstrates that improvements in access and delivery of STD services in remote communities reduce the prevalence of gonorrhoea.
52 Part 2: National Public Health Strategies—Update 1998/99 Progress is also being made on national initiatives in Indigenous sexual health. Some of the key achievements in 1998/99 are as follows. • A manual—STD Control in Remote Aboriginal Communities: A Manual for Clinic Workers— has been developed and distributed broadly; • A comprehensive localised screening program—the ‘Well Person’s Screening Program’ (see also Part III, page 81 of this Report)—has been developed and is running as a pilot program in Far North Queensland. It has been designed to address the current pool of asymptomatic infections with which individuals unknowingly infect their partners. To overcome stigma around sexual health issues, the program also includes screening for diabetes, heart and liver disease. This innovative project is achieving very promising results and other States and Territories are very interested in adopting a similar approach; • The establishment of an Aboriginal and Torres Strait Islander gay and transgender research and education project, administered through the Australian Federation of AIDS Organisations and funded by OATSIH.
Future Directions for 1999/00 A primary focus of the 1999/2000 financial year will be to consolidate the sexual health programs established in each State and Territory during the first two years of the strategy’s implementation. A sustained effort over several years will be required before significant improvements in Indigenous sexual health will be observed.
A mid-term review of the strategy’s implementation will be undertaken in 1999/2000. The review will be a formative evaluation to assess the extent to which the NIASHS recommendations, particularly a shift in focus toward the early detection of STDs in Aboriginal and Torres Strait Islander people, have been implemented. The review will report on the effectiveness of the implementation process thus far and inform the development of a more comprehensive evaluation and monitoring framework for the NIASHS. It is not expected that the review will result in a significant change in focus.
Coordination and Partnerships The NIASHS is an integral component of the National HIV/AIDS Strategy.
National Strategy for an Ageing Australia Contact Details The National Strategy for an Ageing Australia is the Government’s key policy response to the Director, Older 1999 International Year of Older Persons. It will provide a long-term whole-of-government Australians Policy approach to developing policies to meet the identified challenges and opportunities. Section, Office for Older Australians The strategy has four themes: Phone: 1. helping Australians to be independent and to provide for their later years through (02) 6289 5212 employment, life-long learning and financial security; 2. delivering quality heath care through new approaches to service delivery, coordinated care and independent living; 3. improving attitudes to older people and ageing, and related lifestyle issues such as personal safety, housing, transport, recreation and community support; and 4. encouraging healthy ageing and the role of general practitioners in maintaining the wellbeing of older people.
Part 2: National Public Health Strategies—Update 1998/99 53 Management Structures The following structures to address the four themes are in place: • an Interdepartmental Working Group, specific to each theme, is responsible for drafting an initial discussion paper on each theme; • an Interdepartmental Committee, overarching all four areas, clears the papers; and • a Ministerial Reference Group provides the overall direction for developing the discussion papers and the national strategy and provides final clearance for all products.
Achievements in 1998/99 The National Strategy for an Ageing Australia Background Paper was developed during the year and distributed in April 1999 to key stakeholder groups and other areas of government for comment on the proposed process and content of the strategy.
Future Directions for 1999/00 The four discussion papers will be developed during 1999/2000 and distributed for comment by mid December 1999. The national strategy will be developed for release in early 2000.
Coordination and Partnerships The National Strategy for an Ageing Australia is discussed at the ‘Chairs of National Strategies’ meetings, which are facilitated by the National Public Health Partnership.
Contact Details Women’s Health Chairs of National Since 1997/98, funding for women’s health is included in the Public Health Outcome Funding Strategies Agreements (PHOFAs). representative: Dr Dorothy Broom, Key Achievements 1998/99 National Centre for Funding for Women’s Health Australia—the Australian Longitudinal Study on Women’s Health— Epidemiology and was extended for a further five years. Outcomes from this study will assist in determining future Population Health, priorities in women’s health. Australian National University, Future Directions for 1999/00 Canberra ACT 0200 Further consideration will be given to incorporating a gender analysis into population health Phone: activity at the national level. (02) 6249 5546 Coordination and Partnerships Departmental • At the November 1998 meeting of the Chairs of National Public Health Strategies, the issue of contact: Director, incorporating a gender perspective in the work of national strategies was discussed. Population Health • A women’s health representative will continue to attend meetings of the Chairs of National Strategies Section Strategies. Phone: • Representatives from the former Australian Health Ministers’ Advisory Council’s (02) 6289 8037 Subcommittee on Women and Health spoke at the February 1999 meeting of the National Health Priority Committee about incorporating a gender perspective into its work.
54 Part 2: National Public Health Strategies—Update 1998/99 Preventing Communicable Diseases
National HIV/AIDS Strategy 1996/97–1998/99 Contact Details The National HIV/AIDS Strategy 1996/97–1998/99 was launched on 18 December 1996. The Assistant Director, strategy confirms the commitment to those features that have underpinned Australia’s success to HIV/AIDS & date in dealing with HIV/AIDS: non-partisan political support and the partnership between the Hepatitis C Section affected communities (including people living with HIV/AIDS), governments at all levels and Phone: medical, scientific and healthcare professionals. The strategy provides the framework for an (02) 6289 8067 integrated response to the HIV epidemic in the context of sexual health and related communicable diseases, including hepatitis C and sexually transmitted diseases. The goals of the strategy are to eliminate transmission of HIV and to minimise the personal and social effects of HIV infection.
Management Structures Management structures for the strategy include: • the Commonwealth Government, which has overall responsibility for coordinating the national response to HIV/AIDS and other communicable diseases; • the Australian National Council on AIDS and Related Diseases (ANCARD), which is the Federal Government’s key advisory body on HIV/AIDS and related communicable diseases such as hepatitis C; • State and Territory governments, which are responsible for providing leadership at the level of their jurisdiction; • the Intergovernmental Committee on AIDS and Related Diseases (IGCARD), which is the forum for regular Commonwealth, State and Territory liaison on policy, programs and implementation of initiatives related to HIV/AIDS; and • Parliamentary Liaison Groups, which ensure that the Commonwealth Parliament is regularly informed about the latest HIV-related developments and provide a non-partisan forum to discuss policy.
Estimated HIV Incidence, Observed AIDS Diagnoses and Projected AIDS Incidence*
3,000
2,500 HIV incidence AIDS diagnoses 2,000 Projected AIDS incidence
1,500 Number 1,000
500
0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year
* Observed AIDS diagnoses adjusted for reporting delay, HIV and projected AIDS incidence estimated by back-projection. Source: HIV/AIDS, Hepatitis C and Sexually Transmissible Infections in Australia Annual Surveillance Report 1999, edited by the National Centre in HIV Epidemiology and Clinical Research.
Part 2: National Public Health Strategies—Update 1998/99 55 Key Achievements in 1998/99 Achievements and highlights in 1998/99 include: • reformation of the ANCARD Legal Advisory Working Group; • awarding $1 million to twelve hepatitis C research projects; • producing and publishing the ANCARD Clinical Trials and Treatments Advisory Committee document A Model of Care for HIV Infection in Adults; • increased activity to address the issue of HIV/AIDS and hepatitis C in prisons; and • the ANCARD Review of the third National HIV/AIDS Strategy, Proving Partnership.
Future Directions for 1999/00 The current strategy concludes on 30 June 1999. ANCARD has recently published a review of the strategy. It found that overall, a national strategic approach continues to be the most effective and efficient way of ensuring an effective, coordinated response to HIV/AIDS across Australia. The review also found that despite Australia’s achievements in responding to HIV/AIDS, we face significant challenges in maintaining the relevance of our response in view of the changing nature of the epidemic.
A fourth national HIV/AIDS strategy is currently being developed. It is expected to come into effect in mid to late 1999.The first National Hepatitis C Strategy, which will be separate but linked to the HIV/AIDS strategy, will also be developed during this period and come into effect later in the year.
Coordination and Partnerships To facilitate the strategy’s implementation, ANCARD has cross-representation with IGCARD and has established links with other strategy areas. IGCARD is also represented on two ANCARD subcommittees. Liaison with bodies overseeing other relevant strategies—for example, the Australian National Council on Drugs—occurs predominantly through meetings of the Chairs of National Strategies facilitated by the National Public Health Partnership.
Contact Details National Immunisation Program Immunisation The National Immunisation Program is a joint program between the Commonwealth and States Section and Territories that aims to improve Australia’s immunisation coverage rates. The Phone: Commonwealth is responsible for providing funding to States and Territories for the purchase (02) 6289 8253 of vaccines. The States and Territories fund the service delivery components of the program, including purchasing and supplying vaccines to immunisation providers.
Management Structure The National Immunisation Committee oversees the implementation and delivery of the National Immunisation Program. Members include representatives of the Commonwealth, State and Territory Governments, the Royal Australian College of General Practitioners and the National Aboriginal Community Controlled Health Organisation. The chair is Dr Cathy Mead, Assistant Secretary, Communicable Diseases and Environmental Health Branch, Population Health Division.
56 Part 2: National Public Health Strategies—Update 1998/99 Proportion of Children Fully Immunised at 1 Year of Age—Australia
88 86 84 82 80 % 78 76 74 72 70 68 Mar 97 Jun 97 Sep 97 Dec 97 Mar 98 Jun 98 Sep 98 Dec 98 Mar 99 Quarter
Key Achievements in 1998/99 Highlights in 1998/99 include: • The implementation of measures under the Immunise Australia: A Seven Point Plan, announced in February 1997, has resulted in a marked increase in Australia’s immunisation coverage rates. At 30 June 1999 data from the Australian Childhood Immunisation Register (ACIR) indicated that 86.1 per cent of Australian children one year of age were fully immunised according to the NHMRC Recommended Immunisation Schedule. This represents an 11.2 per cent increase from the first available ACIR data in March 1997 of 74.9 per cent. • Delivering the Measles Control Campaign over the period August/November 1998. The campaign offered a second dose of measles, mumps, rubella vaccine to all primary school aged children. A serosurvey conducted after the campaign showed that 94 per cent of children aged 6–12 years were immune to measles, a rise from 84 per cent before the campaign. • Implementing a national Influenza Vaccine Program for older Australians, which provides free influenza vaccine to all Australians aged 65 years and over. State and Territory governments report that they experienced a high demand for this vaccine in the period leading up to winter and that vaccination coverage rates among older people have significantly increased this year. An evaluation of the program later this year will assess the cost-effectiveness of this program and actual coverage rates achieved.
Future Directions for 1999/00 The Australian Childhood Immunisation Register will be evaluated between August and November 1999.
A revised edition of the Australian Immunisation Handbook, including a revised Australian Standard Vaccination Schedule, will be published in 1999/00.
The first year of the Influenza Vaccine Program for older Australians will be evaluated between September 1999 and February 2000.
Further progress will be made towards eliminating measles in Australia. This will include revising the NHMRC publication Measles: Guidelines for the Control of Outbreaks in Australia.
Part 2: National Public Health Strategies—Update 1998/99 57 Coordination and Partnerships The National Immunisation Program has built strong links and partnerships with general practitioners, in particular through cross membership of relevant committees such as the General Practice Immunisation Incentives Advisory Group, the National Immunisation Committee and the Australian Childhood Immunisation Register Management Committee. It also continues to work with the Office of Aboriginal and Torres Strait Islander Health (OATSIH) and the National Aboriginal Community Controlled Health Organisation (NACCHO) on immunisation issues in indigenous communities.
Contact Details National Communicable Diseases Surveillance Strategy Surveillance and The National Communicable Diseases Surveillance Strategy was an initiative of the Chief Health Management Officers of Australia. It aims to reduce the social and economic impact of communicable Section diseases on the Australian population by providing a national framework to monitor Phone: communicable diseases and to plan and prioritise interventions. The strategy is based on (02) 6289 7674 existing infrastructure and legislative mandates.
Management Structures A strategy implementation committee was initially established comprising senior public health medical officers in State and Territory health authorities and representatives of public health professional organisations. The committee’s role was assumed in 1998 by the Communicable Disease Network of Australia and New Zealand (CDNANZ).
Key Achievements in 1998/99 The key elements of the strategy have been largely implemented and completed before 1998/99.
One element of the strategy that began in 1998/99 is a project to assess the national capacity to collect, analyse and report communicable diseases surveillance data. This project is being undertaken by a private consultant who will report to the CDNANZ in the second half of 1999.
Future Directions for 1999/00 In 1999/00, the main components of the strategy will be consolidated as a foundation for a comprehensive communicable diseases framework, which has been recommended to the National Public Health Partnership.
58 Part 2: National Public Health Strategies—Update 1998/99 Mental Health
National Youth Suicide Prevention Strategy Contact Details The National Youth Suicide Prevention Strategy commenced in 1995. The strategy aims to Promotion and address Australia’s youth suicide rates, which are high in comparison with a number of other Prevention Western nations. The strategy recognises the complexity of preventing youth suicide and the Section, Mental links between preventing youth suicide and promoting emotional and social health and Health Branch wellbeing. Phone: (02) 6289 8331 Management Structures A National Advisory Council for Youth Suicide Prevention has been appointed. It includes nominees of relevant State and Territory Ministers, suicide prevention experts and community representatives.
Key Achievements in 1998/99 • Over 2,500 general practitioners and community health personnel were trained in suicide prevention; • An education and training resource guide, which critically reviews available suicide prevention training programs, was released and is available on the Internet; • National Youth Suicide Prevention programs were completed and evaluated and will form the basis of ongoing suicide prevention activity in Australia; • A life promoting media strategy was developed and its launch involved other key Ministers and media self-regulating agencies; • A second national stocktake of suicide prevention programs was undertaken; and • Resources for parents to encourage them to support the mental health of their children were published and distributed widely.
Future Directions for 1999/00 It is expected that the entire strategy will be evaluated early in 2000. The evaluation will document the main lessons learned through implementing a nationally coordinated approach to preventing youth suicide and develop recommendations to inform the Government and key community groups on the future development of national suicide prevention policy.
A new initiative, the National Suicide Prevention Strategy, will be undertaken at the completion of the current National Youth Suicide Prevention Strategy. The new strategy will continue the current youth suicide prevention program and extend it to other age groups and high-risk groups such as young adult males, older Australians and rural and remote residents.
A national framework for suicide prevention is being developed. Once the framework document has been finalised and endorsed by relevant Ministers, it will provide a framework for implementing the National Suicide Prevention Strategy and other activities between a range of jurisdictions, community and business partners.
Coordination and Partnerships A Commonwealth Agencies Working Group has been established to develop links with other relevant national programs.
Part 2: National Public Health Strategies—Update 1998/99 59 Contact Details National Mental Health Strategy Director, The National Mental Health Strategy, adopted by all Health Ministers in April 1992, provides Promotion and a collaborative framework to assist the States, Territories and the Commonwealth governments Prevention section, in pursuing the national reform agenda for mental health. The principle aims of the strategy Mental Health are to: Branch, • promote the mental health of the Australian community; Phone: • where possible, prevent the development of mental health problems and mental disorders; (02) 6289 8430 • reduce the impact of mental disorders on individuals, families and the community; and • assure the rights of people with mental illness. http://www.health. gov.au/hsdd/ The strategy was extended for a further five years mentalhe/ (1998/2003) and the second National Mental Health Plan was developed to provide a national framework for future activity in reforming mental health services. Implementation of the second plan will contribute significantly to improved treatment, care and quality of life for Australians with mental illness, their families and the community in general.
Management Structures The National Mental Health Working Group oversees the implementation of the National Mental Health Strategy. The working group reports through the Australian Health Ministers’ Advisory Council. It consists of representatives of the Commonwealth and each State and Territory government, consumers and carers. Progress on achieving the strategy’s aims is reported annually in the National Mental Health Report.
Key Achievements in 1998/99 • The second National Mental Health Plan was released, in July 1998. • Reform of publicly funded mental health services continued, with over 50 per cent of resources now directed to the community sector. • The Mental Health Council of Australia was established as the non-government sector peak body to represent and promote the interests of the mental health sector and advise on mental health in Australia. • The National Survey of Mental Health and Well-Being (adult component) was released in March 1998. The survey reports on mental health needs in the Australian population. • The Mental Health Promotion and Prevention National Action Plan was released in January 1999. It outlines a 5-year strategic framework and action plan to promote positive mental health and lessen mental health morbidity by diminishing risk and enhancing protective factors. • An initiative was funded to educate general practitioners in primary mental health care through the Divisions of General Practice and to improve links between general practitioners and specialist mental health services, both public and private. • A draft report on depression was developed for Health Ministers’ consideration.
60 Part 2: National Public Health Strategies—Update 1998/99 Future Directions for 1999/00 The second National Mental Health Plan identifies three priorities for future action in mental health reform: • mental health promotion, prevention and early intervention; • ensuring linkages and partnerships are developed with mental health services, and the range of services, agencies and other sectors which deliver services to people with, or at risk of developing mental health problems; and • improving the quality and effectiveness of mental health services.
Under the second National Mental Health Plan depression is identified as an area for priority activity. Depression is also the focus of the mental health National Health Priority Area initiative. A national depression action plan will be developed as part of these two initiatives.
Coordination and Partnerships Consultative mechanisms have been established in the areas of criminal justice, education, parenting, primary and community care, housing and supported accommodation, general practice, Indigenous mental health, and suicide prevention.
Part 2: National Public Health Strategies—Update 1998/99 61 Injury Prevention
Contact Details Strategic Planning Injury Prevention Director, Injury The main objective of strategic planning in injury prevention is to provide a broad framework Prevention Section, for national activity in areas of high priority for immediate action where the health sector can Phone: and should take a leading role. These priority injury prevention issues are: (02) 6289 7186 • falls in older people; • falls in children; • poisoning; and • drowning.
These areas were selected on the basis of the burden of injury, existing evidence, and potential benefits from proven and promising interventions.
Management Structures The National Injury Prevention Advisory Council (NIPAC) was established in October 1997 by the Commonwealth Department of Health and Aged Care to provide the Department with independent advice on injury prevention issues. The Council has representatives from State and Territory Governments, researchers, practitioners and non-government organisations. The Hon Dr Michael Wooldridge appointed the present chair, Professor Peter Vulcan, on 6 January 1999.
Key Achievements in 1998/99 The key achievements for 1998/1999 were the development, production and distribution of two reports, Directions in Injury Prevention Report 1: Research needs, and Directions in Injury Prevention Report 2: Injury Prevention Interventions—good buys for the next decade. The reports were launched at the Third National Conference on Injury Prevention and Control, held in Brisbane in May 1999.
Directions in Injury Prevention Report 1: Research needs provides literature reviews that integrate the current knowledge base of the health workforce and identify the causes of injury, high-risk population groups and special risk factors. The primary aim of the report is to advance injury prevention—either directly by the health sector or in partnership with it—by providing a robust framework as a basis for future activities.
The overall aim of Directions in Injury Prevention Report 2: Injury Prevention Interventions— good buys for the next decade is to promote discussion to identify and formulate an agreed list of the ‘good buys’ or best investments in injury prevention in Australia for the coming decade.
Injury prevention is one of the three public health areas participating in the trial of the National Public Health Partnership’s Planning Framework for Public Health Practice (see Part I, section 2.4 of this report). The National Injury Prevention Advisory Council has agreed that the framework approach could be applied to the issue of poisoning by pharmaceutical products among people aged 20 years and under. A project brief for the trial is being prepared.
62 Part 2: National Public Health Strategies—Update 1998/99 Future Directions for 1999/00 The two reports mentioned above provide the foundation for National Priorities for Action in Injury Prevention, which is nearing completion. The future directions and interventions focus on the four priority areas: falls and fall-related injury in older people and children, poisoning and drowning.
The program Prevention of Falls in Older People is a 1999/2000 Budget initiative to support work to reduce the number of falls. The initial actions of the Department of Health and Aged Care are to undertake a wide scoping exercise and consult key stakeholders on significant issues.
Coordination and Partnerships The Department is responsible for providing national leadership in Australia’s response to the prevention of injuries. National priority planning for injury prevention involves consulting NIPAC and takes into account the roles and responsibilities of the States and Territories. Links will be made with other national strategies, such as mental health, environmental health, and other relevant areas of the Department such as the Office of Aboriginal and Torres Strait Islander Health. These links will provide opportunities to address some of the high-risk factors and high-risk population groups associated with injury, for example, alcohol consumption and young males. The implementation phase will involve collaborating with all jurisdictions to provide continuity and consistent approaches and to strengthen the infrastructure for injury prevention.
Deaths Due to Injury and Poisoning, Australia 1997
Other and Undetermined 3% Homicide 4%
Transportation 26%
Suicide 35% Unintentional Drowning 4% 58% Poisoning 5%
Falls 15% Fires/flame/scalds 1% Other unintentional 8%
Prepared by AIHW National Injury Surveillance Unit using ABS deaths data.
Part 2: National Public Health Strategies—Update 1998/99 63 Prevention of Chronic Disease
Contact Details National Diabetes Strategy Assistant Director, The National Diabetes Strategy (NDS) will assist governments and service providers in Health Priorities identifying key areas for action aimed at improving the health of Australians with or at risk of Management diabetes. Section The National Diabetes Strategy document is in three parts. Part 1 provides key information on Phone: the epidemiology of diabetes, its costs and major issues that need to be addressed. Part 2 (02) 6289 7468 outlines the mission, principles and goals for the strategy. Part 3 provides a strategic framework http://www.health. that links proposed activities and performance measures to each goal. An operational/ gov.au/hsdd/nhpq/ management plan is being developed in consultation and collaboration with State and Territory pubs/nhpa.htm Governments and the diabetes community.
Management Structures The National Diabetes Strategy is a combined Commonwealth and State/Territory initiative. The work of the NDS has been progressed through the Commonwealth-State Diabetes Forum as well as the Commonwealth Diabetes Taskforce, which provides advice on diabetes to the Commonwealth Minister.
Key Achievements in 1998/99 Significant work undertaken with Commonwealth funds in the past twelve months includes: • establishing a diabetes register to provide incidence data; • starting the National Diabetes Prevalence Study; • implementing the visual impairment programs in each State and Territory, which build on the National Health and Medical Research Council’s Clinical Practice Guidelines for the Management of Diabetic Retinopathy; • developing the Community Awareness of Diabetes Strategy (CADS), which will target key groups such as general practitioners and people with a family background of diabetes to help find those people with diabetes who do not know they have the disease. The CADS will be launched in November 1999; • developing clinical practice guidelines for type 2 diabetes.
Future Directions for 1999/00 The aim of the National Diabetes Strategy is to: • ensure appropriate attention is given to primary prevention, including reducing risk and effective, high quality management of diabetes research; • establish an effective partnership between governments, health care professionals, non-government Photo source: Highlights of organisations, consumers and carers; Government Support and for Diabetes 1999. • build on experience and success to Courtesy of Victorian date. Department of Human Services.
64 Part 2: National Public Health Strategies—Update 1998/99 The National Cervical Screening Program Contact Details The National Cervical Screening Program, established in 1991, develops policy and Director, Cancer infrastructure in support of a nationally coordinated approach to preventing cervical cancer. The Screening program aims to facilitate a comprehensive, high quality and efficient screening service that is Phone: accessible to all Australian women. It does so by: (02) 6289 7194 • informing women that cancer of the cervix can be prevented by the early detection and management of precursor lesions (i.e. early changes to the cells of the cervix that may lead to cancer); • encouraging women to have regular two-yearly Pap smears in accordance with the national cervical screening policy; • improving the reliability and accessibility of services for taking and testing Pap smears; and • optimising the management of women with screen detected abnormalities.
Management Structures The program is implemented through coordination units in each State and Territory. The units work in partnership with the Commonwealth, professional groups and independent experts on the program’s National Advisory Committee (NAC).
The NAC has demonstrated that formal access to a body of experts who support the principles of the screening program can advance the adoption of the screening policy and the program work agenda.
The NAC is divided into four working groups that advise on specific areas of the Committee’s workplan. They are: • the Policy and Cost-Effectiveness Working Group; • the New Technologies Working Group; • the Quality Assurance Working Group; and • the Education, Communication and Recruitment Working Group.
Key Achievements in 1998/99 Quality Assurance Performance standards have been introduced for Australian laboratories performing cervical cytology. Laboratories will be assessed against the standards as part of the formal accreditation process undertaken by the Australian Government. The standards became mandatory on 1 July 1999.
As part of ongoing quality assurance in the screening pathway, the Royal Australian College of Obstetricians and Gynaecologists were contracted to develop standards for Colposcopy and Treatment. The standards are due to be released in late 1999.
Communication and Recruitment A national media campaign supporting the national screening policy was aired in mid-1998 and again in mid-1999. Campaign evaluation and feedback from States and Territories suggests that the campaign had a significant impact on screening rates.
It is now ten years since cervical screening was first piloted. To document the milestones since the introduction of cervical screening, the Program is preparing a report on a decade of change. The report is due to be released at the end of 1999.
Part 2: National Public Health Strategies—Update 1998/99 65 Age-standardised Mortality from Cervical Cancer, Australia, 1982–1996
6
5 20–69 years 4 All ages 3
2
Deaths per 100,000 women 1
0 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 Year
Source: Breast and Cervical Cancer Screening in Australia: 1996–1997. Australian Institute of Health and Welfare, Breastscreen Australia and National Cervical Screening Program, 1998, page 65.
Cytology Registries Program reporting and monitoring are linked to State/Territory-based Cervical Cytology Registries. The registries have a key role in caring for women by providing back-up reminders to women for routine screening and follow up of abnormal Pap smears. They also provide clinical information and performance data to medical practitioners and pathology laboratories. The Australian network of registries was completed this year when the Queensland Registry commenced operations in February.
Program Reporting and Monitoring Last year (1998) saw the publication of the AIHW report Breast and Cervical Cancer Screening in Australia 1996–1997, which provided the program with vital data on seven key performance indicators. The second edition of this report, which will give statistics from 1997/1998, is due late in 1999.
Future Directions for 1999/00 Practice Incentives Program The National Cervical Screening Program is working with the General Practice Financing Section of the Department of Health and Aged Care to explore opportunities for GP incentive payments to be tied to cervical screening levels as a part of the Practice Incentives Program. This initiative is aimed at general practitioners, who currently provide 80 per cent of screening services, to encourage high levels of screening coverage in their practice populations. It has the potential to significantly lift national screening rates.
Quality Assurance The program is developing a project that will assess the current standards of cervical histology reporting, including the reliability, repeatability and accuracy of reporting. The objective of the project is to standardise and improve histology reports by consensus and education, and to explore options with stakeholders for developing more comprehensive guidelines.
66 Part 2: National Public Health Strategies—Update 1998/99 Policy Review Projects As a mature program that has made considerable progress towards achieving its original aims, the next challenge for the National Cervical Screening Program is to improve its performance in terms of quality and cost effectiveness. The program will be reviewing the national screening policy and developing an evaluation strategy for the year 2000. Projects are being developed to underpin these processes. In particular, the program will be undertaking: • an international benchmarking project; • a cost-effectiveness study of the program; and • research into ‘over-screening’.
Coordination and Partnerships The program is exploring mechanisms for working more closely with the BreastScreen Australia Program on cross-program issues. It has also been participating in the National Public Health Partnership Chairs of National Strategies and Strategy Secretariat forums.
The National Breastscreen Program Contact Details The National Program for the Early Detection of Breast Cancer, now BreastScreen Australia, was Assistant Director, established by the Commonwealth and the States and Territories in 1991. The program provides Cancer Screening free screening mammograms at two-year intervals, mainly to women aged between 50–69 years Section who are most at risk of developing breast cancer. In doing so, the program aims to achieve Phone: significant reductions in the mortality and morbidity of women attributable to breast cancer. (02) 6289 7944 BreastScreen Australia has a network of dedicated, accredited screening and assessment services in more than 500 locations throughout Australia. The services are provided by fixed, relocatable and mobile screening units. They vary in size: some cover vast geographical areas; others part of a city. The program includes recruitment, screening, and assessment up to and including histological and cytological diagnosis of breast cancer.
Management Structure BreastScreen Australia is a cost-shared program, delivered by the State and Territory Governments under the Public Health Outcome Funding Agreements. The program is guided by the BreastScreen Australia National Advisory Committee, which includes representatives of all of the States and Territories, relevant professional groups, and consumers and Aboriginal and Torres Strait Islander peoples. The committee provides advice and guidance to ensure the program operates in a manner and to standards that are nationally agreed.
The following working groups support the work of the National Advisory Committee: • the Monitoring and Evaluation Working Group • the National Quality Management Committee • the Communication and Education Working Group • the Policy Review Working Group • the Workforce and Training Working Group • the New Technologies Working Group
Part 2: National Public Health Strategies—Update 1998/99 67 Participation of Women in BreastScreen Australia by Age Group, Australia, 1996–1997
100 90 80 70 60 50 40 Participation % 30 20 10 0 40–44 45–49 50–54 55–59 60–64 65–69 70+ Age Group
Source: Breast and Cervical Cancer Screening in Australia: 1996–1997. Australian Institute of Health and Welfare, Breastscreen Australia and National Cervical Screening Program, 1998, page 13.
Key Achievements in 1998/99 The first national breast and cervical screening report—Publication of Breast and cervical cancer screening in Australia 1996–1997—was published during the year. It presents data on a new set of indicators for the breast and cervical cancer screening programs.
During the year the Monitoring and Evaluation Working Group developed an evaluation plan for the BreastScreen Australia Program. The plan presents a set of evaluation questions in three key areas: • overall outcomes—relating to the program’s impact on breast cancer morbidity and mortality; • economic outcomes—relating to the program’s cost-effectiveness; and • process outcomes—relating to the program’s performance in terms of its stated objectives.
Priority evaluation projects have been identified and are about to commence. The plan will be reviewed annually and the outcomes of the evaluation will be incorporated into policy review.
The National Quality Management Committee monitors and advises on quality management issues and oversees all pathways through the accreditation process. A review of the national accreditation requirements has recently commenced.
Future Directions for 1999/00 Monitoring and Evaluation Infrastructure will be developed to support the ongoing monitoring of the National BreastScreen Program. Negotiations will take place between the Commonwealth and State and Territory Health Departments, the Australian Institute of Health and Welfare and the Cancer Registries to develop the infrastructure to collect and analyse data for the timely reporting of interval cancer rates within the program.
68 Part 2: National Public Health Strategies—Update 1998/99 A data dictionary of definitions will be developed to ensure that data to monitor and evaluate the program is standardised. Supporting algorithms for the key performance indicators for the annual AIHW report and to monitor the National Accreditation Requirements will be developed and documented.
Communication and Education A targeted communication strategy will be developed, including the identification of those who are not attending the program and the reasons for their non-attendance. This project involves a survey of non-attenders and data analysis to identify characteristics of areas of high and low participation.
Annual Achievement Report A report will be produced to highlight the program’s achievements and the work carried out by the working groups and to present data against the national performance indicators.
Policy Review A consultancy will review policy relating to the program’s response to symptomatic women who participate in the BreastScreen Program.
Coordination and Partnerships The Cancer Screening Section of the Commonwealth Department of Health and Aged Care is changing its staffing structure and liaising with related areas of the department to improve coordination within and between the national screening programs.
National Cancer Strategy Contact Details A national cancer strategy is being developed and is expected to be submitted to Australian Director, Health Health Ministers in 2000. The strategy will provide a solid foundation for effective action by all Priorities stakeholders in the area of cancer control. The strategy will be based in part on Cancer Control Management Towards 2002, a report by the National Cancer Control Initiative to the Commonwealth. Section Phone: Management Structures (02) 6289 6885 The Cancer Strategies Group (CSG) is overseeing the development and implementation of the national cancer strategy. The CSG is a sub-committee of the National Health Priority Committee. http://www.ncci. Its members represent the government and non-government sectors. org.au
Key Achievements in 1998/99 The national cancer strategy is being developed.
A new contract with the Anti-Cancer Council of Victoria in February 1999 enabled the National Cancer Control Initiative to continue to provide policy advice to the Commonwealth and to manage a range of strategic projects.
Ongoing funding for the National Breast Cancer Centre was provided in the 1999/00 Budget, enabling the Centre to maintain its key role in improving the way breast cancer is managed in Australia.
Part 2: National Public Health Strategies—Update 1998/99 69 Future Directions for 1999/00 In the second half of 1999, a priority setting method known as ‘program budgeting and marginal analysis’ will be trialed. If successful, the method will be used to set priorities for the national cancer strategy.
Coordination and Partnerships As cancer control is a diverse and complex area, the proposed national strategy will build on and complement existing strategies.
Contact Details National Asthma Action Plan Asthma and The National Asthma Action Plan is being developed. The plan will set out key priorities for Special Projects asthma over the next three years to determine how the new funding of $9.2 million over three Section, Health years, announced in the 99/2000 Federal Budget, will be spent in the asthma area. Two stages Services Division of consultation on the plan have been completed and the final action plan is scheduled for Phone: completion by September 1999. (02) 6289 7778 In developing the action plan, strategies have been identified that may offer opportunities for http://www.health. collaboration with other areas of the public health sector, in particular, tobacco, environmental gov.au/hsdd/nhpq/ health, mental health, physical activity, healthy ageing, and child and youth health. Once key asthma/index.htm priorities have been identified in collaboration with stakeholders, further discussions will be held on developing these links.
70 Part 2: National Public Health Strategies—Update 1998/99 Public Health Highlights and Achievements 1998/99 Highlights and Achievements
71 Introduction
For this section of the Report, members of the Partnership were asked to provide examples of programs and activities that demonstrate leadership; are innovative; illustrate responsiveness to public health crises; or provide information on established, successful approaches to addressing major public health issues, such as tobacco-related harm and immunisation. The resulting input from each jurisdiction demonstrated that the types of public health activities undertaken by individual states and territories are many and varied.
Despite the diversity of contributions to this section, the articles when read together do highlight the issues that jurisdictions have in common. For example, it is clear that obtaining timely, useful data on the population’s health status is a core public health function for all states and territories, and that the methods for gathering this information are similar. The majority of States and Territories are also faced with the issue of ensuring access to health services by rural and remote populations—see for example the information from Queensland on health services for rural and remote women, and Tasmania’s approach to improving immunisation rates for rural children. Further, the importance of flexibility in responding to local needs and consultation with stakeholders is reflected in many of the contributions.
It is also clear that infrastructure issues, such as public health information development and public health workforce training are key issues nationally. This supports the National Public Health Partnership’s focus on infrastructure and capacity building activities as priority areas of its work program.
Insofar as this section of the Report provides a tool for public health information dissemination, contributing to best practice and the promotion of linkages between programs, a contact for further details on each project has been included.
72 Part 3: Public Health Highlights and Achievements 1998/99 1. Responding to Public Health Emergencies
Public Health Response to the 1998 Sydney Water Crisis Background In the 1980s, laboratory studies identified cryptosporidiosis as an important cause of diarrhoea in children and among persons with AIDS. In the early 1990s, outbreaks of cryptosporidiosis were reported in child-care settings, and a South Australian study suggested that consumption of spring or tap water was a possible risk factor for illness. In the mid-1990s, large outbreaks Contact Details were linked to contaminated swimming pools in eastern Australia. These findings prompted Dr Jeremy initiatives including mandatory notification of cryptosporidiosis in some states and— McAnulty, increasingly—environmental testing of water. The health implications of positive environmental Medical testing remain unclear, however. Epidemiologist, Water Contamination Communicable Diseases and In July 1998, routine testing identified Cryptosporidium oocysts and Giardia cysts in treated Control Unit Sydney drinking water. Knowledge that massive outbreaks of cryptosporidiosis and giardiasis traced to contaminated municipal drinking water have been reported overseas prompted NSW Phone: Health to issue a series of boil water alerts to the public in response to these findings. (02) 9391 9250 Enhanced testing continued to identify apparently very high levels of these parasites in August and September.
Process by Which the Crisis was Addressed NSW Health convened an expert advisory group of public health, infectious diseases, microbiology and engineering specialists to advise on the public health response to the water contamination. Subsequently protocols were developed to guide the further issuing and revoking of boil water alerts, advice to consumers, health care facilities, manufacturers and others regarding ways to reduce risk of acquiring cryptosporidiosis through consumption of Sydney water.
These events provided an opportunity to examine the relationship between environmental findings and human health effects. NSW Health initiated enhanced surveillance for diarrhoea in general, and for cryptosporidiosis and giardiasis in particular, through sentinel agencies including laboratories, general practitioners, emergency departments, pharmacies and nursing homes.
Major Outcomes Apart from expected day-to-day variations in reports of diarrhoea, there was a sharp increase in stool specimens submitted to laboratories and an associated mild increase in expected reports of giardiasis in the week following the boil water alert. At the same time there was no significant increase and very few reports of cryptosporidiosis in Sydney residents (0–2 per week). Apart from background fluctuations, sentinel sites reported no increases in the number of cases of diarrhoea. No outbreak of illness associated with drinking Sydney water was identified.
Future Directions The crisis prompted the development of protocols for implementation of boil water advisories. Cryptosporidiosis remains an emerging disease in Australia. Further epidemiological and microbiological research is necessary to improve our understanding of risk factors for cryptosporidiosis and giardiasis in Australia, and of the implications of positive environmental tests for human health.
Part 3: Public Health Highlights and Achievements 1998/99 73 The Victorian Gas Crisis An emergency statewide gas shutdown in Victoria in September 1998 was a true test of the response capacity of the Public Health and Development Division of Victoria’s Department of Human Services. The sheer scale of the crisis, and initial Esso predictions of several weeks delay before reconnection could occur, took everyone by surprise. Playing a major role, the Division responded to environmental issues, provided the media with accurate information, Contact Details kept the community informed, and monitored health trends and impacts of the crisis. Steven Loporchio, Public Health and Stage One Development The impact of the State losing its gas supply during the last weeks of winter required fast and Division effective public health strategies, in two stages. The first concerns for living without gas were Phone: about how to maintain healthy and nutritious diets, personal and domestic hygiene and safety (03) 9637 4754 in domestic and commercial premises. Issues then emerged around food safety and handling, burns and scald injuries, electrical safety, risks associated with the use of barbeques indoors, and psycho-social concerns.
A specially-created ‘Home Health Support’ telephone hotline helped up to 2,000 callers an hour with information and advice. Staff processed requests for exemptions and helped clear the confusion among the general public, industry and institutions.
Surveillance systems, which informed the Division’s media and communications strategies, were quickly set up to help anticipate emerging public health issues. Specific safety messages went out via the media in response to news of burns and scalds injuries rising as people sought alternatives to gas.
During the first weekend, the Division’s Board prepared a media risk management strategy and communications plan. This ‘map’ indicated a clear direction amidst the initial frenetic activity.
Media and public education activities, developed with the Media Unit, included Ministerial press releases, interviews with media spokespeople, external ambassadors for public health messages, cooking demonstrations, supermarket launches and television segments.
The Division produced and distributed more than 2 million copies of ‘Fact Sheets’, for the general public and industry. Altogether, twenty-two fact sheets were developed in two series and distributed through the Department’s Regions, local government, community health centres and GP Divisions. Some were distributed through supermarkets, McDonalds, and from radio stations’ mobile vans. All Fact Sheets were available on the Division’s website as they were developed.
Radio and television shows willingly assisted by changing scheduled program material, even on national shows, to include public health messages for the Victorian community.
Multicultural communications were coordinated and monitored by the State Emergency subcommittee that included Divisional representation.
74 Part 3: Public Health Highlights and Achievements 1998/99 Stage Two The second stage of health and safety concerns came when gas supplies were restored and people were able to relight their gas appliances. Public personal safety messages on how to prevent flashburns and hair singe were issued, and a special food industry campaign was designed to warn the public and food premises about not using food that had been stored during the thirteen days of the gas crisis.
Communications involved consultation with many internal and external groups including the Red Cross, the Government Response Centre, the government’s gas authority, Gas Safe, and the major gas supply network, VENCorp.
Lessons learned from the crisis included the critical need for central response capacity and a broad range of public health skills; and the importance of having good contact lists and mechanisms. The crisis highlighted the usefulness of good media relations and creative use of that means of communication, particularly when distribution of printed material proved difficult. The crisis also demonstrated the acute nature of public health practice in such circumstances.
South Australia—Epidemiological investigation of Salmonella Typhimurium Phage Type 135a Infection Associated with Orange Juice in SA Salmonella infection is a notifiable disease in South Australia, and between 1994 and 1 June 1999 notifications were received for 3,341 cases of Salmonella infection of all serovars.
In February 1999, an apparent cluster of six cases of Salmonella Typhimurium phage type 135a Contact Details was detected by the Communicable Disease Control Branch of the SA Department of Human For further Services. An investigation was launched with detailed food histories taken from notified cases. information on the These interviews were conducted to generate hypotheses about potential food sources for the investigation, outbreak. Communicable disease control units in other states were asked if they had seen an please contact: increase in cases—none had noted an increase at that time. Dr Robert Hall, Department of The Investigation Human Services For the purposes of the investigation, a case was defined as a case of Salmonella Typhimurium phage type 135a infection notified from 1 January 1999, and who was the first case notified in Phone: his or her household. (08) 8226 7177
To 31 May 1999 a total of 502 cases was notified. Onset of disease for the first case was on 12 January, and there was a rapid increase in the numbers of cases with onset of symptoms over a period of three weeks from 1 February 1999 (Figure 1).
Food consumption histories were obtained from 26 cases in wide ranging hypothesis-generating interviews. These interviews consisted of inquiry about the foods eaten at any time in the 10 days before illness. Cases reported they had collectively eaten several hundred different foods.
A case-control study was conducted to investigate differences in food consumption between cases and controls. At this stage 54 cases had been notified. The foods recorded in the initial interviews were ranked in order of frequency of consumption by the cases. The most
Part 3: Public Health Highlights and Achievements 1998/99 75 Number of Notified Cases of S Typhimurium (135a) by Day of Onset, 1/1/1999 to 31/5/1999
40 Case-control study 35
30 Orange juice withdrawn 25
20
15
10 Number of Notified Cases 5
0 1/1/1999 5/3/1999 25/5/1999 Day of Onset
frequently consumed foods were included in a questionnaire for a case-control study. Twenty- four people affected by the illness, and 72 controls (people from the community without gastrointestinal illness) completed the questionnaire. A case-control study allows the computation of the odds ratio, a quantitative estimate of the risk of illness associated with foods included in the questionnaire. Odds ratios of foods which are significantly greater than one may be interpreted as indicating increased risk of illness.
The 72 controls were selected from a database maintained by the Behavioural Epidemiology Unit of South Australian residents who have agreed to participate in health related surveys. This database is produced by the Social Environmental, Risk Context Information System (SERCIS). SERCIS is a computer-assisted telephone interviewing system, that has been established to collect population health data from the SA community. The database is based on a random sample of SA residents, and contains some 44,000 adults and 5,000 children. The size of the database permits the analysis of data on a regional basis and provides reliable health estimates for planning and policy development.
For this investigation, three healthy controls per case were selected from the SERCIS database. They were matched on age (to 5-year age class), sex, and postcode of residence (the same postcode, or, if no respondents were available from the postcode, from the nearest postcode with an available age and sex-matched control). Potential controls who had suffered from any gastrointestinal symptoms in the previous month were not selected.
In an unmatched analysis four foods were associated with being a case namely, orange juice, hot dogs, sandwiches and chicken nuggets (Table 1). Each of these foods had an odds ratio significantly greater than one, indicating an increased risk of illness associated with the food.
Odds Ratios for Foods Significantly Associated With Being a Case Food Odds ratio 95% confidence interval Orange juice 6.43 1.67–36.04 Hot dog 5.67 1.17–29.69 Sandwiches 6.53 1.85–23.79 Chicken nuggets 5.42 1.42–21.28
76 Part 3: Public Health Highlights and Achievements 1998/99 Eighty-five other foods were not significantly associated with illness.
Analysis of the risk associated with orange juice revealed differential risks according to brand of juice. Nippy’s orange juice had the highest odds ratio (9.57, with a 95% confidence interval of 2.45–39.42). Other orange juices were not significantly associated with infection, except for Daily Juice orange juice (odds ratio of 5.67, with a confidence interval of 1.22–27.77). A stratified analysis was made to investigate the possibility of confounding between Nippy’s and Daily Juice orange juices. This analysis found a non-significant association between infection and consumption of Daily Juice orange juice. These results indicate that there was a strong epidemiological association between drinking Nippy’s orange juice and becoming ill with Salmonella Typhimurium phage type 135a infection.
A sample of Nippy’s orange juice, bought from a supermarket on 5 March 1999, tested positive for Salmonella Typhimurium phage type 135a. A second sample of Nippy’s orange and passionfruit juice purchased from a different supermarket on 9 March 1999 also tested positive for Salmonella Typhimurium phage type 135a. Nippy’s orange juice was therefore considered to be the most likely source of the outbreak.
In the investigation that followed, Salmonella Typhimurium phage type 135a was cultured from fungicide and wax used to coat the oranges prior to shipment from a packing shed which supplied Nippy’s. Oranges from a wholesaler who received oranges from the same packing shed were also considered to be responsible for a number of cases of Salmonella Typhimurium phage type 135a infection in Victoria.
Control Measures On the day the source of the Salmonella outbreak was determined, Nippy’s orange juice was withdrawn from sale. A communication strategy was put in place to inform the community about the risk of infection, and to answer queries. The manufacturer of Nippy’s orange juice was closely involved in the implementation of the recall and communication strategies, and the company’s willingness to cooperate and be involved in the public health response was a key element in the control of the outbreak.
As a result of the outbreak, food standards for orange juice are being reviewed, and consideration is being given to introducing pasteurisation requirements for orange juice.
A Collaborative Response The staffs of a range of organisations were involved in the investigation. In addition to the cooperation of the company, the investigation relied upon the resources and expertise of staff in the Department’s Communicable Disease Control Branch, Environmental Health Branch, and the Centre for Population Studies in Epidemiology; as well as staff from the Institute of Medical and Veterinary Sciences, local government, and the Department of Human Services in Victoria. The investigation was a large-scale collaborative effort, drawing on a wide range of skills.
Part 3: Public Health Highlights and Achievements 1998/99 77 2. Improving Environmental Health
Tasmania—Health Impact Assessment There has been increasing international interest in the past few years in predicting the health impacts of proposed developments. In Australia, the need for Health Impact Assessment (HIA) processes and legislation was identified by the National Health and Medical Research Council (NHMRC) 1994 Report National Framework for Environmental and Health Impact Assessment. Contact Details This report drew on international research, consultation and methodology to provide a Mark Jacobs, framework for including HIA into development approval processes, specifically Environmental Public & Impact Assessment (EIA). Environmental In 1996, under the Environmental Management and Pollution Control Act (EMPCA) Tasmania Health Service became the first state in Australia to require, by law, HIA to be done as an integral part of the Tasmanian Dept Environmental Impact Assessment process, if directed by the Director of Public Health. of Health and Human Services Tasmania developed draft guidelines for Health Impact Assessment to assist with this process, Phone: and in 1997 was commissioned by the Commonwealth Department of Health and Aged Care to (03) 6233 6620 produce national Health Impact Assessment Implementation guidelines.
These guidelines are designed to be integrated into existing Environmental Impact Assessment processes when required for specific development proposals. They include background and general discussion of issues in Health Impact Assessment, predicting impacts, susceptibility, sustainable development, mitigation of impacts and the specific information required in a Health Impact Statement, such as: • site description; • description of the development; • description of the population potentially affected by the development; • health status of the community; • existing infrastructure; • potential health impacts; and • public consultation processes.
Appendices and industry specific guidelines are also being developed.
A draft of these guidelines has been sent to the National Environmental Health Forum (NEHF) for consultation.
78 Part 3: Public Health Highlights and Achievements 1998/99 Queensland—Improving Indigenous Environmental Health The health of Aboriginal and Torres Strait Islander peoples is a priority agenda item for Queensland Health’s Public Health Services. The root of many health problems in Indigenous communities results directly from entrenched environmental factors. Queensland Health is committed to identifying, monitoring and remedying environmental health factors influencing Indigenous health, specifically in relation to housing, water supply, sewage disposal, Contact Details community development and in the development of a sustainable Indigenous environmental Scott Webber health workforce. Phone: As part of the consultation process for the development of an Aboriginal and Torres Strait (07) 3234 0962 Islander Environmental Health Strategy over the next 12 months, a scoping paper was Email: prepared. The scoping paper identifies a number of key factors for the future successful webbers@health. management of environmental health in this State including: qld.gov.au • community involvement in and control of environmental health systems; • provision of effective environmental health programs and services together with a work force skilled to deliver them; • an infrastructure supportive of environmental health programs; • adequate relevant information on and for Indigenous communities; • enhancement of environmental health knowledge in the communities; • reducing cultural barriers which have the potential to affect behaviours and communication; • adoption of a holistic approach to health which includes education and economic development.
The scoping paper sets out a framework for a Queensland strategy which will: • address the issue of improving environmental health holistically, through a cooperative approach; • be sensitive to specific cultural needs; • focus on identified priority areas; • recognise the different environmental health risks in rural, remote and urban communities; and • define and delineate the roles of key organisations supporting environmental health.
This targeted approach is expected to contribute positively to a long term reduction in mortality and morbidity in Indigenous populations attributable to environmental health factors.
Significant achievements in Indigenous environmental health have also been made through the work of zonal public health units. The following initiatives have and will continue to promote the health of Indigenous people and communities of Queensland: • Coordination of an environmental health worker workshop held on Thursday Island and compilation of a report on the development of an environmental health worker strategy for Queensland. • Development and wide cross-government, council and environmental health worker distribution of a bi-monthly environmental health worker newsletter. • Employment of an additional Indigenous Environmental Health Coordinator to liaise with and support Indigenous environmental health workers together with the development of two Indigenous environmental health worker traineeship positions.
Part 3: Public Health Highlights and Achievements 1998/99 79 • Introduction of the Australian Institute of Environmental Health Foodsafe program into an Indigenous island community and support to two Indigenous communities to participate in next year’s tidy towns competition. • Development of template duty statements for community-based environmental health workers and improved environmental health auditing protocols for Indigenous communities. • Development of two culturally appropriate health promotion packages (Mr Germ & Flossie the Mossie). These and other initiatives will be supported by a series of simple environmental health fact sheets.
Queensland Health continued to support students undertaking TAFE’s Indigenous environmental health diploma course. Over 50 environmental health worker trainees have graduated and now represent 85 per cent of Indigenous communities in the state. Five of these graduates are now enrolled in further environmental health degree studies.
The full-time employment of several environmental health workers with community councils has contributed to numerous significant improvements to environmental health standards. Localised intersectoral collaboration contributes greatly to a more coordinated and productive approach to addressing environmental health issues in Indigenous communities.
Indigenous Environmental Health in Western Australia The Health Department of Western Australia was host to two national forums in Broome in May 1999. The first was a National Indigenous Environmental Health Workers Conference, funded by the Commonwealth and organised by the WA Environmental Health Service, to consider a range of issues affecting Indigenous environmental health workers throughout Contact Details Australia. Following that conference, the 2nd National Indigenous Environmental Health Further information Workshop was attended by over 100 delegates. It considered a number of topical issues but on Indigenous largely concentrated on progressing outcomes from the preceding conference. The outcomes of environmental the conferences have now been referred to the National Environmental Health Forum for health issues in WA consideration. is available from Commonwealth funding has also been secured to trial the Colilert field water test kit in Dr Michael Jackson Indigenous communities throughout Australia. Potentially, Colilert could be used as a prime Email: means of testing potable water in the 80% of Aboriginal communities in Western Australia michael.jackson@ which currently have no water testing. The Health Department of WA has initiated and will health.wa.gov.au coordinate the national trial, to be conducted in Western Australia, Northern Territory, South Australia, Queensland and New South Wales until June 2000.
80 Part 3: Public Health Highlights and Achievements 1998/99 3. Preventing Communicable Disease
Queensland—Well Person’s Health Check The Well Person’s Health Check is an innovative new Indigenous health strategy being jointly delivered by Queensland Health, the Commonwealth Office for Aboriginal and Torres Strait Islander Health, the Apunipima Cape York Health Council, and Indigenous communities across far north Queensland. Contact Details Whilst primarily funded through sexual health funding as part of Queensland’s implementation Mark Counter of the National Indigenous Australian’s Sexual Health Strategy, the program takes an holistic view of health screening for sexually transmissible infections, diabetes, indicators for health Phone: kidney and liver disease, and recording related food and alcohol intake. (07) 3234 1153 Email: The program relies heavily on the support of each community and does not commence until all counterm@health. community concerns have been addressed. The Apunipima Cape York Health Council has qld.gov.au taken prime responsibility for this role, but works in conjunction with the project management team from the Tropical Public Health Unit based in Cairns. A checklist of 20 separate issues are addressed with each community including responsibilities of all parties during the screening, strategies to assure community participation, agreements on tests to be conducted, methods for achieving true informed consent, treatment protocols including follow up of chronic conditions and ownership of data.
Once all details have been negotiated and dates and sites agreed, the Project Management team commences arranging the vast array of details required to implement a successful screening, including equipment orders, and courier and pathology laboratory arrangements. Staff, including replacements and back ups for each of the 10 stations that include registration, informed consent, collection of blood, urine and anthropometric data that comprise the screening program, must all be trained in their specific tasks.
Personal contact in the lead up to and during the screen by local Indigenous health workers reminds participants of the need to attend before breakfast to ensure fasting blood sugars are collected. As compensation for their early start, once participants have passed through all ten stations, they are treated to a healthy community breakfast prepared by community volunteers under the supervision of nutritionists attached to the project team.
Within several days results begin to flow back from pathology, and all sexually transmissible infections are quickly treated by the medical staff attached to the program of the clinic. Participants may opt to not have sexual health data recorded in their regular clinic files. In some cases, additional tests may also be taken at this time to help provide additional clinical data required to confirm a diagnosis.
On completion of the screen, a complete set of pathology data is provided to the Tropical Public Health Unit, who then combine it with anthropometry and dietary data collected and prepare both an individual report on the health of each participant, as well as a summarised non-identified community report on the overall health of the community. Both the individual and community reports are presented back by members of the project team and local general practitioners within two months of the completion of each screen.
Part 3: Public Health Highlights and Achievements 1998/99 81 Since the commencement of the program, six key Indigenous communities have been screened, with participation rates averaging around 85 per cent, however this is closely dependent on the thoroughness of the initial consultation. Current plans for 1999/2000 aim to screen a further seven communities from across far north Queensland.
The success of the program in far North Queensland has now led to the trial of ‘metropolitan’ Well Persons Health Checks in southern and central parts of Queensland, in an effort to establish a methodology that will work best in settings where indigenous communities are more closely integrated with the wider community and options for access to primary health care services more diverse.
ACT—Management of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infected Health Care Workers In April 1998 the Department began work on the first ACT-wide infected Health Care Worker (HCW) policy. The policy was developed with reference to relevant Australian State and Territory health department guidelines, as well as National Health and Medical Research Council recommendations. The Policy is directed at all health care workers, but more Contact Details specifically to those performing exposure prone procedures. Further information on the Policy may The key objective of the Strategy is to minimise the risk of transmission of a blood borne virus be obtained from: from a health care worker to a patient or client and to provide Katrina Scott a framework for managing and supporting health care workers with blood borne viral infections. Phone: (02) 6205 1376 A number of stakeholders were involved in the development of the Policy including the Sexual Health and Blood Borne Disease Advisory Committee, the Australian Medical Association, the ACT Division of General Practice, the Royal Australian College of Nursing, the Australian Dental Association, the ACT AIDS Action Council, Hepatitis C Council, all ACT hospitals, ACT Community Care, ACT Ambulance Service, Professional Registration Boards, the Australian Infection Control Association and ACT Workcover.
In May 1999 the Policy was launched by the ACT Minister for Health and Community Care, Michael Moore.
Key Issues Addressed by the Policy The Policy recommends that all health care workers involved in Exposure Prone Procedures be aware of their status and seek serological testing for HIV, hepatitis B and C every 12 months, or sooner if a significant exposure to blood or body substances occurs in the interim.
If a health care worker involved in exposure prone procedures is infected with either HIV, hepatitis B or C they have a responsibility to notify the Chief Health Officer (CHO). The medical practitioner caring for that health care worker is also legally required to notify the Chief Health Officer, due to Hepatitis B, C and/or HIV being a notifiable disease. The Chief Health Officer, at their discretion, may then refer the incident to an Advisory Panel for consideration.
82 Part 3: Public Health Highlights and Achievements 1998/99 The Advisory Panel’s role includes: • determining the potential infectivity of persons referred and degree of risk of transmission; • providing, on a case by case basis, advice on modifying work practices of infected health care workers; • providing supplementary specialist occupational advice to physicians of health care workers infected with blood borne viruses, occupational health and safety physicians and professional bodies; • advising individual health care workers or their advocates on how to obtain guidance on work practices; • reviewing the literature on occupational transmission of blood borne viruses and refer any changes relevant to current ACT Department of Health and Community Care policy; • advising health care workers of organisations they may wish to contact to discuss issues raised by the policy’s process (ie the Discrimination Board, AIDS Action Council, Hepatitis C Council, professional organisations).
Future Directions Copies of the Policy are to be sent to all Health Care Workers operating in the ACT. The policy will be reviewed on an annual basis.
Tasmanian Immunisation Activities Tasmania is leading the way in legislative strategies aimed at increasing immunisation coverage. An important initiative for this year was the implementation of provisions in the Public Health Act 1997 requiring school and child care entry documentation on immunisation status. This encourages immunisation and also enables the exclusion of unimmunised children and adolescents during a declared outbreak of vaccine preventable disease. The Act also requires Contact Details local government to provide an immunisation service. Dr Avner Misrachi, Senior Medical Tasmania is also making good progress toward meeting the national year 2000 immunisation Officer, Public and target. The most recent Australian Childhood Immunisation Register (ACIR) data coverage report Environmental indicates that Tasmania currently has an average 87.2% of children up to 15 months who are Health Unit, fully immunised, which is above the national average of 84.9%. These significant improvements Department of in immunisation coverage in Tasmania can be attributed to the fully implemented State Health and Human Services Immunisation Strategy, along with national initiatives. Phone: National Measles Control Campaign (03) 6233 3775 The 1998 Measles Control Campaign, aimed at improving immunisation levels for measles, Email: mumps and rubella among primary school children, was an outstanding success in Tasmania avner.misrachi@ with over 35,300 children being immunised. This involved the cooperative efforts of general dchs.tas.gov.au practitioners and councils with the programs achieving 77% immunisation coverage of children aged 5–12 years. These results compared favourably with the overall national average of 74% based on the most recent analyses.
School Based Hepatitis B Immunisation Program Another important initiative introduced in Tasmania in 1998 was a hepatitis B immunisation program with recent 1999 data revealing increasing numbers of councils implementing this program in schools. The latest results indicate that 74% of pre-adolescent children in schools have received their first dose of hepatitis B.
Part 3: Public Health Highlights and Achievements 1998/99 83 Outreach Services Outreach Immunisation Project Christine Long, Immunisation programs in Tasmania are provided by general practitioners and local Manager, Family government in conjunction with medical officers. Tasmania does not have in place a program Child and Youth using independent registered nurses as immunisation providers. These arrangements mean that Health Services immunisation services in Tasmania are significantly less accessible in smaller rural communities. Phone: (03) 6337 2836 The Tasmanian Immunisation Strategy provided for nurse immunisation to be considered once Email: all strategies in the plan had been implemented. The Tasmanian Department of Health and fcyhs.north@dchs. Human Services received Commonwealth funding under the Public Health Outcome Funding tas.gov.au Agreement to undertake an outreach immunisation demonstration project. The project commenced in early 1999 following a comprehensive consultation process with key stakeholders.
The Outreach Immunisation project was designed to test if immunisation by registered nurses would increase immunisation coverage in rural and remote areas characterised by low levels of immunisation coverage, limited access to general practitioners and local government immunisation services.
Project methodology involved a preliminary survey to determine qualitative and quantitative base line measures against which project outcomes will be compared and evaluated.
The project is progressing well and the Division of General Practice and the communities involved in the trial have welcomed the services provided.
WA—Sexual Health Program In 1998/99, the Sexual Health Program has placed considerable emphasis on developing the infrastructure to diagnose and manage sexually transmissible diseases through training of health care providers. The Program has worked closely with the Office of Aboriginal Health to ensure that staff in rural and remote areas of WA are also able to access quality training and continuing Contact Details education about sexually transmitted disease control. The emphasis on reducing the personal, Dr Jag Gill social and health impact of HIV/AIDS, STDs and hepatitis C has continued. Further, the Email: partnership with non-government organisations, which are better positioned to provide services jag.gill@health. to the target groups, has been strengthened. wa.gov.au Improving access to treatment and care has been accompanied by a decline in the number of notifications for a number of sexually transmissible diseases.
Six Month Period Jan–June 1999 Jan–June 1998 New HIV diagnoses 23 33 Chlamydia (genital) 960 1249 Gonorrhoea 516 777 Syphilis (primary & latent) 37 49
84 Part 3: Public Health Highlights and Achievements 1998/99 The Sexual Health Program’s chlamydia public awareness campaign entered its second phase in 1999, with the production of two new television advertisements. The campaign built on the success of Phase 1 by utilising television, radio and print advertisements to promote awareness and the simplicity of testing and treatment of chlamydia among sexually active young adults. A mail out to general practitioners and health professionals was conducted as part of the campaign to supply promotional and educational resources, as the public was advised to “see your doctor about the simple test”.
The Travel Safe Campaign was another effective public health strategy implemented by the Sexual Health Program during 1998–1999. The aim of the Campaign was to reinforce the real risk of sexually transmitted diseases (STDs) and blood-borne diseases (BBDs) and to minimise incidence of STDs and BBDs among WA residents who travel overseas and interstate. The target groups were people age 18–25, business travellers aged 18–55, and mining industry personnel. A wide range of strategies was used for the Campaign, including radio and press advertisements and on the ground elements. A radio advertisement addressing the issues of skin piercing was developed and used in conjunction with the two ads from 1996. These had been run under the banner of “Don’t bring back any nasty souvenirs” and thus addressed HIV/AIDS, STDs and BBDs. On the ground strategies supported the mass initiatives, with the focus on increasing the availability of TravelSafe resources including resources for people from culturally and linguistically diverse backgrounds, through general practitioners, travel agents, airports, tertiary institutions and youth hostels.
Since July 1998 an enhanced Gonorrhoea Surveillance Pilot project has been implemented in the metropolitan area with the support of general practitioners. Improving information on the epidemiology of STDs will help to ensure public health interventions are better targeted.
Access to clean needles and syringes reduces the transmission of HIV among injecting drug users. However, the prevalence of hepatitis C among people who inject drugs is already well established, and shows the need for continued and expanded education about means of transmission as well as to a range of sterile injecting equipment. The Sexual Health Program has continued to promote harm minimisation approaches and to emphasise the need for safe disposal of used injecting equipment. As a response to hepatitis C, availability of injecting equipment other than needles and syringes (for example, sterile swabs and sterile water) was improved through an increased range of products available for retail in community pharmacies.
Consultation with the tattooing industry preceded the development of a publication on Healthy Body Art, which tells people contemplating having a tattoo the procedures necessary to prevent the risk of acquiring a blood-borne virus. Infection control workshops were conducted in July and August of 1998 to assist body art operators effectively implement the Code of Practice for Skin Penetration Procedures, which came into effect in June 1998.
Part 3: Public Health Highlights and Achievements 1998/99 85 4. New Approaches to Preventing Chronic Disease
Northern Territory—Preventable Chronic Diseases Best Buys and Strategy Key Result Areas The Northern Territory Preventable Chronic Diseases Strategy 1. Improving maternal health and infant At the end of a century where communicable diseases have become birthweight much less of a threat in the developed world, a great unmet 2. Breastfeeding and Contact Details challenge of public health is to stem the rise and impact of chronic promotion of child Tarun non-communicable diseases. Such diseases include heart disease, growth Weeramanthri, diabetes, high blood pressure, kidney disease and chronic airways 3. Decreasing childhood Community disease. No health service provider would be unfamiliar with them. Physician infections through Territory Health While there are no perfect models of non-communicable disease better environmental Services control, the challenge in the NT is particularly profound, mainly health conditions because of the high proportion of indigenous people who bear a 4. Childhood and adult Phone: disproportionate burden of disease. Many people have more than immunization (08) 8922 8513 one condition. It makes no sense to address each condition 5. Maternal and Email: separately, since common factors directly underlie them, most childhood education tarun.weeramanthri notably poor nutrition, inadequate environmental health, alcohol 6. Alleviate poverty @nt.gov.au misuse and tobacco smoking. ‘Lifestyle’ choices here are particularly 7. Promote ‘sense of reflective of environmental constraints rather than personal control’ and mental preferences. In relation to food, for example, WHO (The Solid well-being Facts:1998) identifies that “the important public health issue is the 8. Smoking cessation and availability and cost of healthy nutritious food. Access to good prevention programs affordable food makes more difference to what people eat than 9. Brief intervention for education”. Food prices in Darwin are higher than towns of similar hazardous alcohol use size in other parts of Australia, and higher across the NT than other 10. Nutrition, weight loss states. They are particularly high, and variety of choice is and physical activity particularly restricted, in rural and remote settings, which is where programs in high risk two-thirds of NT Aboriginal people live. populations 11. Early detection of The NT Preventable Chronic Diseases Strategy (PCDS) has been chronic diseases and developed over the last two years as an integrated response to the underlying risk rising impact of chronic diseases, particularly the rising number of factors Aboriginal people on renal dialysis. It is premised on the belief that 12. Use of blood pressure these diseases are potentially preventable. A life course approach lowering drugs to has been taken that includes antenatal, childhood and adult prevent progression influences on the development of chronic diseases. Options to of kidney disease improve primary prevention, early detection and disease 13. Prevention of management approaches are seen as complementary, rather than complications of competing. diabetes 14. Aggressive But how much of one should be done, and how much of another? management of heart The answer depends on a balance of evidence, historical experience, attacks and known local demographics and cost effectiveness data. A number of ‘best cardiovascular disease buys and key result areas’ based on these criteria have been 15. Rehabilitation and compiled. The list is comprehensive, relevant to the NT, and outreach programs contains a range of social and medical initiatives (see box at right). (cardiac, respiratory, renal)
86 Part 3: Public Health Highlights and Achievements 1998/99 Not all of these best buys and key result areas can be actioned immediately, but an agenda has now been set, and will be worked on over time. The implementation challenge will necessarily involve a great deal of long term and intersectoral work.
The Preventable Chronic Diseases Strategy is being constantly reworked to incorporate new ideas and different viewpoints. It is now a key Territory Health Services strategy and a departmental priority. As such, it is being actively written into operational business plans. Health service providers are being asked to prioritise the prevention and management of chronic disease in their daily work plans, and to find suitable ways to implement the strategy locally.
The Preventable Chronic Diseases Strategy approach is innovative in its over-riding commitment to integration, and has influenced the development of the National Framework for Chronic Disease Prevention. It will remain a ‘working strategy’, needing regular review as new evidence and new ideas arise.
Victoria—Diabetes Activities Like other States and Territories, Victoria has established a Diabetes Taskforce to consider and make recommendations about the delivery of effective, efficient and appropriate diabetes services. The Taskforce plays a key role in Victoria’s support for the National Diabetes Strategy, and has developed an action plan with five key priority areas for action: gestational diabetes mellitus, shared care, health services planning, visual impairment and foot complications. Contact Details Further One of the Taskforce’s major projects during 1998/99 has been the production of Clinical information on Guidelines for the Management of People with Diabetes. The guidelines, adapted with permission diabetes activities from a document produced by the NSW Health Department*, were produced in collaboration in Victoria may be with Diabetes Australia (Victoria) and the Victorian Department of Human Services. Health care obtained from: practitioners and organisations are the target audience for the guidelines which provide Ms Kay Mills, strategies to improve clinical management, and quality of life, for people with diabetes. Department of Human Services The Guidelines have a strong focus on preventing diabetes complications and list strategies related to diabetes education and awareness of psychosocial issues, as well as promotion of Phone: physical activity, healthy eating and a healthy lifestyle for those with diabetes. (03) 9637 4026
The guidelines have been widely circulated and well received by the health sector.
A second major project of the Taskforce has been developing Gestational Diabetes Mellitus Screening, Diagnosis and Management Guidelines. Based on the recommendations of the Australasian Diabetes in Pregnancy Society which were published in the Medical Journal of Australia in 1998, the guidelines have been designed to quickly identify key strategies both during and following pregnancy for medical and allied health professionals who will be seeing women at these stages. These guidelines have been disseminated to all Victorian obstetricians, GPs with an interest in obstetrics and antenatal care, dietitians, community health nurses, endocrinologists and midwives. They are an important tool in working towards improved management and follow up of women diagnosed with gestational diabetes mellitus (GDM), 50 per cent of whom will develop diabetes within 20 years. It is also anticipated that more effective education of women with GDM will lead to improved levels of empowerment. The Guidelines will be launched in July 1999.
Part 3: Public Health Highlights and Achievements 1998/99 87 Copies of both sets of guidelines are available by contacting Diabetes Australia on (03) 9654 8777
Victoria is actively involved in initiatives which aim to address lifestyle risk factors which are important in prevention and management of diabetes, including: • Active for Life which aims to – increase opportunities for all Victorians to participate in regular physical activity; – increase community and professional awareness of the benefits of physical activity; and – strengthen partnerships between key sectors and agencies. • VicHealth uses sports and arts settings for health promotion in an innovative and cost effective manner to improve health. Program funding is based on criteria which includes: achieving change and healthy environments within sports and arts settings in the areas of smoking control, healthy food options and safe alcohol practices. Partnerships have been developed with Diabetes Australia to promote generic health messages that are relevant to diabetes prevention (for example, Eat Well, Live Well). • Healthy Eating, Healthy Victoria, is the implementation strategy for the Victorian Food and Nutrition Policy. The strategy includes seven priority issues and identifies a number of arenas for action. Existing projects include the development of a healthy eating communication strategy with a primary focus on promoting variety in the diet (consistent with the Dietary Guidelines for Australians) and action to enhance healthy eating and physical activity in organised care settings.
* NSW Health Department. The Prinicples of Diabetes Care and Guidelines for the Clinical Management of Diabetes Mellitus in Adults, NSW Health Department, 1996.
WA—Nutrition and Physical Activity Program The WA Nutrition and Physical Activity Program aims to increase the prevalence of healthy eating and physical activity behaviours consistent with the Dietary Guidelines for Australians. To achieve this, the Program has implemented a comprehensive range of strategies to promote better nutrition. Major outcomes and achievements for 1998/99 include: Contact Details • The Nutrition Team produced and featured healthy eating segments in the 26 episodes of the All About Food television program screened on Channel Nine. Dr Moira • Educational and promotional resources were developed and distributed to teachers, canteen McKinnon managers and school health nurses for schools’ Fruit ‘n’ Veg Week. Over 80,000 primary Email: school children from nearly 400 primary schools participated. In addition, the ‘Kids in the moira.mckinnon@ Kitchen Kit’ was produced and distributed to all primary schools in the state to ensure health.wa.gov.au teachers had up-to-date nutrition education resources to utilise in the classroom. • Other states in Australia were assisted in the implementation of the successful Fruit ‘n’ Veg campaign, developed by the Health Department of Western Australia. • The Healthy Catering Plan and Good Food for Child Care videos for food service personnel have been developed and produced. On-line versions of the Food Service Planning for Child Care short course and Healthy Catering short course, which have been accredited by the National Training Council, have also been developed. This was part of the Cent$ible Food Service Project, a joint initiative with Curtin University and funded by Healthway.
88 Part 3: Public Health Highlights and Achievements 1998/99 • Over 190 child care centre cooks and coordinators have been trained and over 45 centres have received accreditation as part of the Start-Right, Eat-Right Award and training course for children’s Long Day Care Centres. This was part of the Cent$ible Food Service Project, a joint initiative with Curtin University and funded by Healthway. • New strategies to reach low-income groups were piloted to extend Food Cent$, a project to improve nutrition through improved food budgeting, selection and preparation skills. • Based on successful evaluation, the Food Cent$ project at the Foodbank was expanded. Activities include weekly classes for staff of the 280 welfare agencies that access the Foodbank and development of guidelines for food parcels. This project is funded by a grant from Healthway. • Other states, such as Queensland, have been assisted in implementing the Food Cent$ project in their jurisdictions. • The Program Plan for the Aboriginal Food and Nutrition Policy for Western Australia was compiled to raise Aboriginal awareness of the importance of nutrition. This was a joint initiative with the Office of Aboriginal Health. • Sixty two Aboriginal Health workers were trained to use the Aboriginal Nutrition Manual to implement nutrition education in their communities. • Seven companies entered 19 products in the third annual Nutrition Awards to the Food Industry, a joint project with the Food Centre of WA to encourage production of processed foods consistent with the Australian Dietary Guidelines. • Two additional local government authorities joined the Healthy Choices Award scheme, which aims to increase healthier choices available when eating out. • The fourth Annual State Nutrition Conference was held. The theme was Healthy Eating for Children of the 21st Century. • The Child and Antenatal Nutrition Manual was revised, produced and distributed to all child health nurses and other health professionals in the state to assist in the provision of accurate and consistent advice on nutrition. • The Breast Feeding Action Group began implementing the strategic plan to promote continuation of breast feeding of infants beyond 6 months of age. A wide range of community, health and academic organisations is represented on the Group.
Chef training as part of the “Cent$ible Food Service Project”.
Part 3: Public Health Highlights and Achievements 1998/99 89 5. Partnerships for Health Development
Strategic Partnerships—the Queensland Public Health Forum Collaborative working relationships between a range of organisations have been a feature of public health practice for many years. However, public health literature indicates that intersectoral collaboration has often failed, despite the best intentions of the people involved. Recent literature has explored the reasons for this and noted the need to strengthen strategic alignment between organisations and sectors. This is particularly required at the senior Contact Details management level to harness significant organisational commitment, rather than relying largely Denise Montague on collaborative working arrangements between organisations and sectors at the local or Phone: operational level. (07) 3360 2612 The establishment in October 1998 of the Queensland Public Health Forum is an innovative Email: and strategic initiative which aims to develop a sustainable public health approach involving denise.montague multisectoral strategies that target the main determinants of health. The creation of the Forum @health.gov.au was the major outcome of the Public Health Partnerships in Queensland Symposium, which was held in July 1998. The Symposium’s participants agreed that organisations and sectors whose activities influence the health of Queenslanders needed to develop and utilise an acceptable and effective means of working together.
Forum membership is comprised of senior management representatives from key state, Commonwealth and local government organisations; and professional, tertiary education, non- government, and consumer sectors, as well as several individuals invited for their specialist expertise. There are currently 24 permanent members.
Queensland Health does not control the Forum, nor does it have a formalised lead agency role. This is significant for two reasons: • responsibility for the success of the Forum is shared equally and it is hoped that this will result in strengthened commitment; and • the Forum’s vision and objectives are a synthesis of organisational agendas around public health.
The Forum’s vision is ‘Improved health and reduced health inequalities in Queensland through a strong and sustainable public health approach involving multisectoral strategies which target the main determinants of health’. The current work plan includes the development of an intersectoral planning framework, identification of priority health issues and priority population groups for collaborative planning, and development of a communication strategy. This work is undertaken by working groups consisting of members and relevant staff from member organisations.
The Forum meets quarterly, with the working groups progressing items between meetings.
The Forum member organisations have committed to an initial Forum lifespan of three years. During the initial year there are two primary streams of work: • to formalise organisational issues to ensure the Forum’s processes and the behaviour of individual members adhere to best practice principles of intersectoral collaboration; and • to identify priorities and develop and implement a planning framework to address these.
90 Part 3: Public Health Highlights and Achievements 1998/99 The Forum will develop a process to enable identification of roles, responsibilities, duplication and gaps which need to be addressed. Indigenous health and food and nutrition have been identified as the Forum’s primary priorities for intervention.
The Forum has also committed to an evaluation of its effectiveness through a rigorous participatory action research process. A proposal has been submitted to the National Health and Medical Research Council to support this evaluation. The purpose of the evaluation is to learn about how organisations can work together successfully in a sustainable approach through an iterative process of planning, doing, reflecting and modifying. It is believed the evaluation will assist the Forum members and the broader public health field to develop a theory and practice base that improves the capacity for working in partnership and the capacity of partnerships to be sustained.
The NSW Parliamentary Drug Summit Background Illicit drug use has emerged as a major issue of political and community concern in recent years. Increasing fatal opiate related overdoses, decreasing age of initiation to injecting drug use and a rise in the numbers of young people experimenting with cannabis have focused greater attention on: Contact Details • the efficacy and capacity of drug treatment programs; Dr Jennifer Gray, • the quality of existing drug education and prevention programs; Director, NSW • the policy directions of the criminal justice system; Drug Strategy • the need for a Whole of Government, Whole of Community approach. Email: The Process [email protected]. nsw.gov.au The Premier of NSW called for the Parliamentary Drug Summit to find new answers and new solutions to achieve better outcomes in managing and preventing illicit drug use. The Drug Summit was held over 5 parliamentary days, from 17–21 May 1999 and was attended by Parliamentarians from both of Houses of Parliament, from all political parties.
The NSW Drug Summit incorporated 5 days of debate, plenary presentations and issues-based working parties within Parliament, as well as pre-Summit consultations in regional cities and site visits to treatment agencies and service providers.
State, national and international experts from a range of disciplines were invited to participate and provide advice to the politicians. Active debate was encouraged and consensus decision making was the goal. Invited delegates were drawn from a range of backgrounds, including health, education, social services, criminal justice, researchers, non-government organisations, and community advocacy and consumer groups.
Major Highlights/Outcomes • Recognition that solutions that will most benefit the community are those that can successfully divert drug users away from the criminal justice system into treatment. • Models of ‘support coordination’ are to be piloted that link clients accessing needle and syringe exchange programs and treatment programs to social services including housing, employment, child care, education and training.
Part 3: Public Health Highlights and Achievements 1998/99 91 • An understanding of the complexity of illicit drug use and a realisation that no one treatment is able to provide a “cure” to drug misuse. • A need to improve community involvement in preventing and managing illicit drug use, with the development of localised responses. • A call for more treatment places with appropriate levels of funding. • A system of accreditation for treatment clinics and programs to improve the quality of overall delivery. • The possibility of non-government organisations establishing medically supervised injecting facilities. • Expansion of general practitioner and pharmacist involvement in delivering drug treatment. • Need to significantly expand current drug and alcohol training programs, both at a specialist and generalist level. • Proposed introduction of Drug Action Teams across the State to better manage and coordinate local policy and programs and assist local communities to develop effective local responses.
Future Directions The Drug Summit has provided an opportunity to strengthen and better co-ordinate the response to illicit drug use across government in NSW. Over 160 resolutions were passed from those developed by the working parties. A NSW Drug Summit Plan of Action has been developed to progress the resolutions from the Summit. This document is available at www.nsw.gov.au/drugsummit1999.
The Alcohol and Other Drugs Program—Western Australia The Alcohol and Other Drugs Program of the Health Department of Western Australia plays a leading role in the attempt to reduce alcohol-related harm caused by the excessive consumption of alcohol.
Contact Details Amendments to the Liquor Act in 1998 included a new primary objective ‘to minimise the harm or ill health caused to people, or any group of people due to the use of liquor’. This increased Dr Moira the responsibilities of the Executive Director of Public Health and the role of the Alcohol and McKinnon Other Drugs Program in monitoring applications for extended trading permits and new liquor Email: licenses and identifying and objecting to situations considered likely to result in increased moira.mckinnon@ alcohol-caused harm. Successful interventions by the Executive Director of Public Health have health.wa.gov.au been carried out in this regard.
The successful Host Responsibility ‘Be a good host’ campaign, started in 1998, was continued this year. The Public Health Division is a key organisation in the collaboration organising the project (including the WA Police Service, WA Drug Abuse Strategy Office, the Office of Racing and Gaming, Healthway and the liquor industry). The campaign targets licensed bar patrons and hosts and guests at social events where alcohol is served, with the aim of increasing awareness of safe service practices and acceptance of these. The campaign achieved high levels of recall, credibility and approval with both target groups, as well as considerable support from licensed bar staff.
92 Part 3: Public Health Highlights and Achievements 1998/99 The Alcohol and Other Drugs Program continued to target excessive alcohol consumption among young people through its Respect Yourself campaign. The ‘Think before you drink’ campaign featured the popular science celebrity Dr Karl Kruszelnicki, who launched this year’s campaign by visiting local universities promoting responsible drinking. The campaign informed adults about ways in which to plan ahead and act to control the effects of alcohol. Two out of three binge drinkers reported that the campaign had a positive impact on their knowledge, attitudes or drinking-related behaviours.
The Alcohol and Other Drugs Program continued to play an important role in the establishment and maintenance of alcohol accords and supporting local government to develop alcohol policy. This year, the program worked closely with the Kimberley region to develop resources which map out the variety of drinking restrictions in the Kimberley for visitors to the region.
Fremantle Dockers Australian Football League players (Daniel Bandy and Sean McManus) watch policewoman (Anne Stephens) breath test a student volunteer as part of the Drink Check Alcohol Education Program.
Part 3: Public Health Highlights and Achievements 1998/99 93 6. A Focus on Population Groups
Promoting Young People’s Health in Queensland In addition to its long-standing activity in the area of Health Promoting Schools, Public Health Services in Queensland Health has recently been charged with the responsibility for implementing two new initiatives—the Young People at Risk and the School Based Youth Health Nurse programs. Taken as a whole, these programs represent a significant investment in the Contact Details improvement of the health status of young people, particularly for those of high school years. Ms Sophie Dwyer Through its Integrated Planning and Management Reporting System, the task of Public Health Services has been to develop linkages between these initiatives at the strategic and operational Phone: level. This will help to ensure the delivery of coherent and comprehensive public health (07) 3247 5661 interventions for this important target group. Email: sophie_dwyer@ The Young People at Risk Program—a community development program addressing issues health.qld.gov.au of youth suicide—was established in 1995 as a pilot, and disseminated across the state in 1998–99. Activities include: • the development of local profiles of youth services and youth issues; • training and dissemination of best practice in young people’s mental health; • development of resources; • supporting local community networks in identifying and implementing youth health initiatives including programs to increase peer support and develop personal skills such as coping and communication skills; and • media advocacy to promote positive images of young people.
School Based Youth Health Nurse Program—this year, the Queensland Government announced an initiative to employ 100 nurses over four years to work with clusters of high schools (the School Based Youth Health Nurse Program). While these staff are located within community health services, Public Health Services is responsible for zonal and statewide coordination through its zonal public health units and Statewide Health Promotion Unit. The nurses will provide primary health care, including professional clinical nursing assessment, health counselling and referral. Also, the nurses will be collaborating with the schools’ health/welfare committees to introduce the health promoting schools program. The first group of nurses to join The Health Promoting Schools Program—since 1992, Queensland Health has been working Queensland Health’s with Education Queensland on the development of Health Promoting Schools across the state. School Based Youth Recent developments in this Program include: Health Nurses Program. • steps towards incorporation and independence of the Queensland Health Promoting Schools Network; • development of a joint statement by the Ministers of Health and Education endorsing Health Promoting Schools; • development of guidelines for health workers working in schools; • development of particular interventions for implementation by schools, for example, Germbusters and Kidsafe; and • development of a Health Promoting Schools manual for schools and health workers.
94 Part 3: Public Health Highlights and Achievements 1998/99 Establishing partnerships and linkages In the first instance, the task has been to ensure statewide, zonal and local coordination between the initiatives, to ensure a coherent relationship with the target group (young people) and stakeholders, schools in particular. To achieve this, Public Health Services has: • linked the three initiatives as three programs within the one Outcome Area Plan—Young People’s Health. Statewide Outcome Area Plans are developed for all action areas within Public Health Services in Queensland. Other initiatives addressing the health needs of young people, such as the recently published Review of the Sexual Health of Young People at Risk are also included within this Outcome Area. Representatives of each unit, local and statewide, with programs in this area, participate in the planning, monitoring and reporting process. • Provided training to the School Based Youth Health Nurses in the Health Promoting Schools framework and methodologies. The formation of the single planning group allows for the development of one training program for the three youth health programs in the future. • Ensured that issues relevant to one strategy are incorporated into the others. For example, recommendations of the Review of the Sexual Health of Young People at Risk are being taken up in the Young People at Risk Media Strategy. • Developed a coherent needs assessment and evaluation framework based on the recommendations of the NHMRC report Effective School Health Promotion: Towards Health Promoting Schools.
Outcomes The impact of this integrated population group planning framework has been: • recognition of the inter-relatedness of health determinants; • planning using a client/target group focus rather than a disease or risk factor focus; • increased efficiency in service planning and delivery; • utilisation of the knowledge and skills of a range of health professionals and disciplines in service delivery; and • improved communication and cooperation within Public Health Services, District Health Services and externally with other stakeholders, particularly Education Queensland.
Beating the Tyranny of Distance in Queensland—Health Services for Rural and Remote Women Queensland Health has developed a range of unique strategies to meet the preventive health needs of rural, remote and isolated women in Queensland. Information on these innovative programs is provided below. Contact Details Mobile Women’s Health Nurses Angela Beitz Over the last 9 years Queensland Health has Phone: progressively developed a network of thirteen (07) 3234 1484 Mobile Women’s Health Nurses—specially trained Email: registered nurses who provide an outreach angela_beitz@ women’s health service to rural, remote and health.qld.gov.au isolated women. These nurses provide a holistic women’s health service including education, health promotion, community development, clinical services such as cervical screening, Mobile Women’s Health Nurse, Beth Anderson counselling and referral. from Mt Isa, loading the 4 wheel drive.
Part 3: Public Health Highlights and Achievements 1998/99 95 A truly ‘mobile’ service, Mobile Women’s Health Nurses travel an average of 160,000 km to rural and remote communities every 12 months to conduct women’s health clinics and during this time will conduct over 2,400 Pap smears, reaching in many cases, un-screened or under-screened women.
Visiting Female GP Service In partnership with the Commonwealth Department of Health and Aged Care and Divisions of General Practice, Queensland Health provides a visiting female general practitioner (GP) service in rural/remote communities where access to GPs, particularly a female GP, is limited. The visiting female GP provides a complementary service to existing primary health care services, and in most cases, works closely with Queensland Health’s Mobile Women’s Health Nurses.
The Royal Flying Doctor Service (Queensland Branch) has recently taken over the management of the Rural and Remote Women’s Health Program, and will become a new partner in the Memorandum of Understanding (MOU) for the Program which was developed in early 1999.
The MOU addresses issues such as roles and responsibilities of the partners, management structures, communication, consultation processes and planning principles directed towards the successful implementation of the service. It aims to ensure that services are planned appropriately in terms of collaboration with existing services, seeks to minimise duplication of services, and ensures vital referral networks are in place so that rural/remote women receive appropriate treatment or follow-up services when needed.
Breastscreening for Women in Rural and Remote Areas The BreastScreen Queensland Cairns Service, established in 1994, is an example of a successful joint venture achieving optimal health outcomes for women. Queensland Health and the Calvary Breast Clinic, joined forces to deliver free high quality breast cancer screening services to the women of Cairns and surrounding regions. In its first year of operation 6,000 women were screened. This financial year, it is expected well over 8,000 women will attend the Service.
Given this success, in early 1999 the contract between public and private stakeholders was further extended with launch of a relocatable screening service for Far North Queensland (FNQ). The relocatable service allows women in rural and remote areas of FNQ access to the BreastScreen Queensland Program. Since commencing operation in April the specially outfitted four wheel drive truck has travelled to Mossman and Mt Garnet screening more than 400 women.
The newly constructed vehicle for the relocatable service is a 4 x 4 wheel drive truck with a purpose-built body. The vehicle will house the mammography equipment required, and transport both the service and staff by road and barge. The sensitive imaging equipment transported in the vehicle will be protected from vibration by air-bag suspension which has been fitted on the rear axle. The body of the truck is air-conditioned to protect the equipment and film from damage caused by heat and humidity. A large tailgate required to safely load and unload the equipment was specially constructed for the vehicle.
Local community health centre facilities will be used for screening with films processed back at the BreastScreen Queensland Cairns Service’s fixed unit in Cairns. The service will travel on a two year timetable visiting locations including Burketown, Doomadgee, Bamaga and Weipa.
These examples of the partnerships being forged by Queensland Health in the area of women’s cancer screening services highlights the bridges being built between government departments, the Division of General Practice, and the private and public sector to improve the health of all women living in Queensland.
96 Part 3: Public Health Highlights and Achievements 1998/99 Review of the Northern Territory Women’s Health Policy In 1997 the ABS estimated there were 88,316 Comments from women at the females in the Northern Territory (NT), of which consultations approximately 27 per cent identified as …help us to take control of our health Indigenous. The average age of NT females is 27 throughout our lives. …we want more responsive, quality years, one third live in rural or remote Contact Details services that use a coordinated and communities and one in five were born overseas. preventive approach. Jenne Roberts, NT …we want to see better health outcomes for Women’s Health The health status of women in the NT is as good young women, Aboriginal women and Advisor, Women’s as or better than their counterparts in the women from diverse cultural backgrounds. Health Strategy southern States, with the significant exception of Unit Aboriginal women. Although there have been Territory women say… Phone: improvements in Aboriginal health over the last …that service provider attitudes and the (08) 8999 2932 ten years the gap between the health of way they treat clients is a critical health Aboriginal and non Aboriginal women is issue. increasing in the NT. …we need clear and appropriate information to make informed decisions. Aboriginal women are ten times more likely to …genuine respect for cultural difference is die of respiratory disease than the national essential. …we are particularly concerned that average, are two and half times more likely to young women are unaware that they are die from cardiovascular disease than other NT shaping their own health for the future. women and 12 times more likely to die of …Well Women’s services are cervical cancer than other NT women. comprehensive, appropriate and important. …Antenatal care is very important and we Using funds provided under the Public Health want it to be based in the community. Outcomes Funding Agreement, the Women’s …we want more choice of birthing services, Health Strategy Unit, Territory Health Services with safety and support for births outside the (THS) undertook a review of the Northern hospital system Territory Women’s Health Policy during 1998/99. …we want services to recognise that out A new policy was developed using a needs are interrelated and take a holistic comprehensive consultation process, and the view. findings were integrated with a thorough analysis …violence has got to stop! We must improve on the major gains made through of epidemiological and demographic data. the NT Government domestic violence strategy. The original policy, developed in 1992, provided …don’t make us say it over and over, get an effective framework for the development and on and implement the recommendations! implementation of women’s health services and the reorientation of mainstream services. Territory women from diverse cultural However, many changes have taken place within and linguistic backgrounds, including the health sector along with significant Aboriginal women say… improvements in approaches to women’s health …we want the choice of female health and services for women. practitioners as well as bilingual programs …we want culturally effective care The three stage consultation process heard from women in the community, health service Aboriginal women of the Territory say… …we want greater choice for birthing providers and those making the decisions about services with support for ‘birthing on health services. The broad based consultation country’.
Part 3: Public Health Highlights and Achievements 1998/99 97 gathered the opinions of women throughout the Territory. ‘We asked the women directly and we asked them to ask their friends and families as well’.
Special effort was made to include particular groups of women perceived to have less access to the consultation process. This included Aboriginal women, women from diverse cultures, lesbian women and women in remote areas.
Consultation with these groups involved special workshops and consulting women with extensive networks after they canvassed issues with the groups they were representing.
A highlight of the consultations were five meetings hosted by Aboriginal health organisations. One of these enthusiastically attended meetings was the largest in the Territory. A highly successful initiative involved a team of bilingual health educators consulting with key women from culturally and linguistically diverse backgrounds.
The result is a revised policy with five objectives: • support increased capacity for self-responsibility; • provide more appropriate, quality services; • reduce preventable illness, disability and early death; • improve the health of Aboriginal women; and • improve access for young women to health information and services.
To achieve these objectives the plan provides suggested strategies for fully implementing minimum standards of service delivery, an education campaign to increase capacity for self- responsibility, improved maternal health, services for women with breast cancer, and assisting communities to address violence.
98 Part 3: Public Health Highlights and Achievements 1998/99 7. Strengthening the Evidence Base for Public Health
The Victorian Burden of Disease Study A year ago, the Public Health and Development Division of the Victorian Department of Human Services and the Australian Institute of Health and Welfare initiated the Victorian and Australian Burden of Disease Studies respectively with the aim of providing a comprehensive assessment of ill health, or ‘burden of disease’, in Australia. Both studies use the methods of the Global Burden of Disease Study developed by Harvard University, the World Bank and WHO, Contact Details but adapt them to the Australian context. It is expected that many of the emergent innovations Dr Theo Vos from this adaptation will contribute to the next Global Burden of Disease 2000 study. Epidemiology Section, Public The preliminary results of these studies are attracting considerable attention within Australia and Health and internationally. The first of a series of reports on the Victorian study is to be published shortly Development and presents a detailed analysis of premature mortality attributable to over 130 diseases, injuries Division and risk factors in 1996 with projections to 2016. Phone: The Mortality Burden Attributable to Selected Risk Factors, Victoria, 1996 (03) 9637 5401
Tobacco 9.3% 16.7%
Obesity 9.5% 8.4%
Physical Inactivity 9.3% 7.3%
High Blood Cholesterol 4.6% Female 3.9% Male High Blood Pressure 11.5% 8.6%
Alcohol Benefit 3.4% 5.0% 2.4% Alcohol Harm 7.1% -10,000 0 10,000 20,000 30,000 Mortality burden in years of life lost (and % of overall mortality burden)
The key findings of this report are as follows: • In 1996, Victorian men had a life expectancy at birth of 76.1 years and women 81.7 years, figures which are slightly higher than the Australian average and which approach the highest life expectancy figures recorded internationally of Sweden and Japan. Available information suggests, however, that life expectancy in Aboriginal men may be between eight and 18 years shorter than the state average. In women, the gap is estimated to be as large as nine to 18 years. • Cardiovascular disease and cancer are, each, responsible for about a third of the years of life lost due to premature mortality. Injuries are a greater cause of mortality burden in men (12 per cent) than in women (five per cent). • Socio-economic disadvantage is an important predictor of years lost due to cardio-vascular disease, smoking-related illness, digestive disorders and causes of infant and childhood mortality. Rural residence, especially in the least populated parts of Victoria, is the most important predictor of premature mortality from injuries. Traffic accidents, suicide, machinery accidents and drowning are the main types of injury responsible for this difference.
Part 3: Public Health Highlights and Achievements 1998/99 99 • Risk factors, such as smoking, physical inactivity, high blood cholesterol, hypertension, alcohol and obesity are responsible for large proportions of the overall mortality burden. • On the whole, a further improvement in life expectancy of 4.6 years in men and 3.6 years in women is predicted in twenty years time. Cancer is expected to become the leading cause of premature mortality, largely because cancer mortality trends are less favourable than those of cardiovascular disease. Dementia, illicit drug use and renal failure are predicted to show substantial increases in life years lost.
Other highlights associated with this work include a two-day visit by Dr Alan Lopez, Acting Director, Epidemiology and Burden of Disease Division of the World Health Organisation, hosted by the Victorian Department of Human Services and VicHealth. During this visit, Dr Lopez, co-author of the ‘Global burden of Disease Study’, gave a presentation on the ‘Global Burden of Disease and the Plans for a New GBD 2000 project’. Dr Theo Vos from DHS and Dr Colin Mathers of AIHW presented at the same forum on ‘The Global Burden of Disease—Implications for Australia and Victoria’.
In addition, Public Health and Development Division has been successful in attracting to Australia the next International Burden of Disease Network Meeting, as well as the annual Harvard University and WHO two-week training workshop on burden of disease and cost- effectiveness. Both events will be held at the Cumberland Hotel in Lorne in early November 1999 and are expected to attract up to 100 people from around the world. The success of this bid was dependent on significant financial contributions from both the Commonwealth Department of Health and Aged Care and the Victorian Department of Human Services, and the benefits are expected to be shared by Australia and its neighbours in the Asia-Pacific region.
Investigation of the Appropriateness of Food and Environment Microbiological Testing in Addressing Health Outcomes The ACT’s Government Analytical Laboratory is proposing to conduct a review of the appropriateness of food and environment microbiological testing. It is hoped that the review will establish whether the present system of microbiological testing of ACT food and waters is Contact Details adequately addressing the health outcomes of the community. If this proposal is accepted, the Geoff Millard, ACT review will be restricted in its first phase to food/water borne illnesses contracted in the ACT. Government Analytical It is proposed that information on the level and types of illness suspected to be food or water Laboratory borne be collected from a number of sentinel general practitioners within the ACT. The Laboratory is also exploring the inclusion of a number of questions about levels of such illness Phone: in the population in the forthcoming ABS National Health Survey. It is hoped that this (02) 6205 8709 information will provide a more accurate picture of the number of people affected by food and water borne disease each year. It will also be used to determine the severity of the illness in the population according to one of four outcomes: 1. sick but did not seek medical attention; 2. sick and sought medical attention; 3. sick and was hospitalised due to relevant illness; or 4. died due to relevant illness.
100 Part 3: Public Health Highlights and Achievements 1998/99 The review will use a number of indicators to determine the appropriateness of the current microbiological testing regime, including: • the estimated number of the ACT public contracting gastro-enteritis* each year; • the estimated number of ACT public attending a general practitioner presenting with relevant symptoms; • the number of admissions to hospital due to illness relevant to this investigation (ICD-9/10 coding); • notifications of relevant diseases; • any deaths due to relevant illness; and • trends over time.
It is proposed to put a costing on the health outcomes of the illness, and in the light of this information, determine whether the ACT’s present microbiological testing regime appropriately addresses the priorities of the health outcomes.
* approximately 30% of gastro-enteritis infections are food borne and about half of food borne infections do not present as gastro-enteritis
The NSW Health Survey Program Developments in the NSW health system, in parallel with national developments, are creating new imperatives to improve population health. Meeting these imperatives requires information about key aspects of population health so that we can monitor progress. The need for improved population health information in NSW will continue to grow, with the development and increasing sophistication of contracting and performance management processes, and the Contact Details system-wide shift towards outcomes-focused and evidence-based approaches. Ms Margaret Williamson, To help fulfil requirements for population health information, the NSW Health Department, in Manager, Health consultation with key stakeholders, has developed the NSW Health Survey Program, an exciting Survey Program new program of annual population health surveys across New South Wales. Unit Survey Method Email: The surveys provide information about self-reported health status, health risk factors, health [email protected]. service use and satisfaction with health services to inform and support planning, contracting nsw.gov.au and policy development both in the 17 Area Health Services and across the State. Telephone interviewers conduct the surveys using a computer-assisted telephone interview (CATI) system from a special purpose call centre. All interviewers are specially trained and supervised by Epidemiology and Surveillance Branch staff. The Program aims to ensure the information collected is of high quality, confidential, timely and cost-effective. A number of strategies are employed to ensure that survey participants are representative of the population of NSW. These include random sampling of phone numbers and respondents and interviewing in English and the major language groups spoken in NSW including Chinese (Cantonese and Mandarin), Arabic, Vietnamese, Italian and Greek.
Part 3: Public Health Highlights and Achievements 1998/99 101 Information Collected The first survey was conducted in 1997, and over 17,000 NSW residents aged 16 years and older were interviewed about their health. Information was collected to help address five of the NSW health priority areas: • cancer (risk factors, screening); • cardiovascular disease (prevalence, risk factors); • mental health (prevalence of depression and anxiety); • asthma (prevalence, severity and management); and • diabetes (prevalence, screening for complications and management).
The 1998 NSW Health Survey collected information on core questions used in 1997 and additional information on oral health and cervical cancer screening. This survey will provide data for trend analysis and allow aggregation with 1997 data for subgroup analysis.
Baseline information about children's and older people's health status, health behaviours and patterns of community and service use and satisfaction is sparse. In 1999/2000, two new surveys have been developed to address the information needs about the health of people 65 years and over and children aged 12 years or younger.
Tasmania—Healthy Communities Survey The Tasmanian Healthy Communities Survey was a major public health initiative of 1998/99 receiving considerable media and community attention. 25,000 surveys were mailed to Tasmanian adults randomly selected from the electoral roll.
There was an extremely positive and encouraging community response to the survey with a Contact Details total of 18,673 surveys returned; of those, 15,104 were completed for a return rate of 60%. Jeanette Lewis, When the “return to senders” are subtracted from the total, the “effective” return rate climbs to Consultant, almost 72%. Information Analysis The publication of the first Healthy Communities Survey report is planned for late August 1999. Phone: The report will take a state wide focus and will cover: (03) 6233 4713 • profile of Tasmania’s health status • health related quality of life Email: • wellbeing and general quality of life jeanette.lewis@ • health related beliefs, behaviours and risk factors dchs.tas.gov.au Additional reports will be produced throughout 1999/00. These will cover: district/community profiles; health and wellbeing in rural Tasmania; detailed risk behaviours and beliefs with national comparisons; economic viability and its relationship to health status; key protective factors; and factors important to wellbeing and quality of life.
This new information on the determinants of health and wellbeing is an important first step towards progressing the Government’s development of a 10-year plan for a healthy Tasmania and a Social and Economic Plan for Tasmania.
102 Part 3: Public Health Highlights and Achievements 1998/99 The South Australian Pregnancy Outcome Statistics Unit The principal role of the South Australian Pregnancy Outcomes Statistics Unit is to contribute to the State’s endeavour to reduce the frequency of adverse outcomes of pregnancy to the lowest level practicable. The Unit seeks to identify those population sectors most at risk so that preventive interventions can be directed accordingly. The Unit undertakes a broad State-wide monitoring of pregnancy characteristics, problems and outcomes and characteristics of perinatal Contact Details care to assist hospitals and allied health agencies to evaluate their services. Ms Joan Scott
Routine Practices Phone: (08) 8226 6380 • Surveillance of pregnancy characteristics and outcomes, obstetric problems and characteristics of perinatal care in SA—this is achieved by administering the State’s perinatal data collection; a collection based on midwife reporting. The data have been collected since 1981, so that trends in mortality, low birthweight, other adverse outcomes, obstetric practices and a range of risk factors can be monitored for the intervening period. Monitoring is undertaken by obstetric history, sociodemographic characteristics and place of birth. For example, the data are used to indicate changes in obstetric practice, characteristics of women and frequency of pregnancy complications and whether differences in frequency of adverse outcomes between high-risk groups, (such as Aboriginal women and other socially disadvantaged groups), and the remainder of the community are reducing.
• Secretarial assistance to the State’s Maternal, Perinatal and Infant Mortality Committee, which monitors the epidemiology of maternal, perinatal and post-neonatal infant deaths in SA, so that high-quality services can be assured and patterns of cause of death can be established. The data are collected for this purpose from death certificates, the State Coroner, autopsy reports and medical practitioners, under legislative protection.
• Surveillance of the prevalence of congenital abnormalities in SA—data collected by the Unit are complemented by data collected for children up to five years of age by the SA Birth Defects Register at the Women’s and Children’s Hospital. The Unit provides ongoing staff and data support to the Register. The data collected on congenital abnormalities are sent to the national surveillance unit in Sydney and to an international clearinghouse for international surveillance purposes. South Australian data are used to investigate concerns about environmental hazards. They also are used to monitor the impact of prenatal screening and will have an important role, for example, when evaluating the effects of periconceptional dietary folic acid supplementation on the prevalence of neural tube defects.
• Monitoring the frequency of terminations of pregnancy, using statutory notifications from medical practitioners and hospitals. This indicates the relative frequency of unwanted pregnancies by sector of the population, and therefore where family planning services may need to focus.
• The Unit also contributes to the newly-formed National Perinatal Data Development Committee, which meets regularly to discuss issues related to data collection, such as standard data definitions, minimum data sets, and quality assurance.
Part 3: Public Health Highlights and Achievements 1998/99 103 In addition, the Unit provides regular feedback of data to hospitals, other health centres, and the public. Annual reports are prepared based on the data collections administered by the Unit for QA and related purposes. In addition to State-wide reports, each South Australian hospital with 100 or more births per year receives an individualized report for comparative purposes. Smaller hospitals receive aggregate data for their hospital category.
Finally, the Unit regularly provides information, advice, and statistics to school, undergraduate and postgraduate tertiary students for their projects. Advice and information and, in many cases, detailed perinatal data, are provided in response to requests from Government Departments, local councils, metropolitan and rural hospitals, a variety of health professionals and community organisations, members of the public and the media, from South Australia, interstate and overseas.
South Australian Cancer Registries Cancer is a highly significant public health problem, and it is increasing in importance over time. To be able to determine the extent of the problem, detect any changes in disease patterns over time and make some assessment of the effectiveness of interventions, it is essential to have timely, reliable health statistics. Contact Details During 1998/99 the South Australian (SA) population-based and hospital-based cancer registries Dr Wayne Clapton (directed by Associate Professor David Roder) have continued their tradition of collecting and South Australian reporting timely, high quality, epidemiological cancer surveillance data. The population-based Cancer Registry registry has been in operation since 1977. The hospital-based registries, known by some as Phone: clinical registries, have been in operation in the major public teaching hospitals in Adelaide for (08) 8226 6362 over ten years and in a major private hospital for the last year.
Cancer incidence, mortality and survival in South Australia as a whole (and its geographical areas) in specific years, and over time, are monitored in the population-based registry. The institutional experiences of various cancer types in relation to case loads, stage and differentiation, prognostic indicators, types of primary treatment and survival are monitored in the hospital-based registries. Though owned by the respective clinicians, each hospital-based registry interacts closely with the population-based registry under specific legislative arrangements.
Though cancer is a legislatively mandated notifiable disease in South Australia, the quality of data is enhanced considerably by the good relationships that the SA Cancer Registry maintains with those assisting it with its activities. This ethic of trust and cooperation is an essential adjunct to the formal legislative arrangements.
Cancer Registry Activities Data from the SA Cancer Registries have contributed to a wide variety of cancer prevention and control activities such as, anti-smoking programs, the promotion of healthy diets, sun protection, cancer treatment and quality assurance activities, and to cancer screening programs (eg, BreastscreenSA and the SA Cervix Screening program).
104 Part 3: Public Health Highlights and Achievements 1998/99 In addition to its activities within the South Australian Government arena, the SA Cancer Registry has interactions with many other individuals and organisations, locally, nationally and internationally.
Because of its currency, the SA Cancer Registry data have been used at the national level as an early warning signal of changes in cancer trends in Australia. For example, in the early 1990s, it quickly flagged a marked rise in prostate cancer incidence. This enabled early national investigations into the cause—attributed to increased contemporaneous use of prostate specific antigen (PSA) testing, which was enabling diagnosis of previously undetectable tumours. Thus the fear that some major new aetiological factor was causing an epidemic of prostate cancer in Australian men was averted.
The 1999 Cancer Registry Report The 1999 SA Cancer Registry Report was released in July 1999. It reports data up to and including 1998. Every Annual Report is keenly sought by a wide audience such as: politicians, health service providers, academics, researchers, health service planners, students, administrators and the general public. Over many years, it has proven to be an essential tool and reference source for cancer prevention and control activities in South Australia and more widely throughout Australia and internationally.
In addition to the routine descriptive tables, the report’s chapters describe a number of important results in relation to specific cancers at the population and hospital levels. One of the most important findings of the 1999 SA Cancer Registry Report is the observation of a sixteen percent reduction in mortality in female breast cancer in the 50 to 69 year old age group between the periods 1985–96 and 1997–98. Little change in mortality was seen in the younger or older age groups. The 50 to 69 year old age group is the primary target group for the population-based mammography screening program. Therefore, this is the first evidence at a population level in Australia that screening may be having a beneficial effect—in conjunction with increased detection of earlier stage tumours and improved treatment measures.
Only a very limited number of the printed 1999 Report remain in stock. However, the full report is also available on the Public and Environmental Health Service (SA Department of Human Services) website at http://www.dhs.sa.gov.au/PEHS/
Part 3: Public Health Highlights and Achievements 1998/99 105 8. Training and Workforce Development
NSW Public Health Officer Training Program A highly skilled and flexible public health workforce is required to effectively promote and protect the health of the population and to meet the public health challenges ahead. One vehicle for developing such a workforce in NSW is the NSW Public Health Officer Training Program run by the NSW Department of Health. Contact Details Background Dr Lynne Madden, The Program was initiated in 1990 to produce public health professionals able to plan, Coordinator, NSW implement and evaluate health interventions from a population perspective. An urgent need for Public Health such a workforce emerged when Area Health Services in NSW were made responsible not only Officer Training for the management of the acute health care facilities in their areas but also for the protection, Program promotion and maintenance of the health of all their residents. Email: [email protected]. The aim of the Program is to produce graduates who: nsw.gov.au • understand the range of public health issues facing the population of NSW; • understand how public health professionals in different parts of the health system work to resolve these issues; • are competent to work strategically with others to resolve these issues themselves.
The Program provides three years of structured supervised competency-based learning for people who have completed postgraduate studies in public health. The Program is open to people from medical and non-medical backgrounds and is accredited by the NSW Vocational Education and Training Accreditation Board (VETAB) to award a Graduate Diploma of Applied Epidemiology. In April 1999 the Program was reaccredited unconditionally for a further five years.
Training is provided primarily through supervised work placements each of 6–12 months duration and all Officers are required to spend at least 6 months in a rural placement. This on- the-job learning is supplemented by regular off-the-job training sessions.
Competency development The training addresses 11 core competency areas in: • professional practice; • management; • epidemiology and biostatistics; • information management; • communication; • health policy; • health promotion; • health care evaluation; • infectious diseases; • risk assessment/management; and • health economics.
106 Part 3: Public Health Highlights and Achievements 1998/99 These competencies, identified through ten years of training experience by the Program and 18 months of consultation with public health professionals throughout the State, are consistent with the international literature. Since they were completed in February this year the competencies have created a great deal of interest amongst those responsible for public health workforce development. For example, the Australasian Faculty of Public Health Medicine is currently considering adopting a modified version to direct the learning of Faculty trainees.
The public health agenda is dynamic and the Program has responded to changing workforce needs. Two new streams of training have recently been developed, the first for Aboriginal and Torres Strait Islander people and the second in the field of drug and alcohol (see below).
Aboriginal and Torres Strait Islander Public Health Scholarships One way to improve the health of Aboriginal and Torres Strait Islander people is through the development of an appropriately skilled Aboriginal health workforce, including a public health workforce. In 1997, following wide consultation with the local Aboriginal and public health communities in NSW and with the assistance of a multisectoral working party, a scholarship program was developed to support Aboriginal people through a year of full-time postgraduate public health study at the Centre for Clinical Epidemiology and Biostatistics at the University of Newcastle. Scholars who successfully complete their studies are invited to join the Program. Now in its third year, the achievements include the award of seven scholarships and the employment of five Aboriginal Public Health Officers.
Drug and Alcohol This specialist stream of training was developed to meet an identified need for public health managers and researchers able to address drug and alcohol issues from a population perspective. In 1998 the Program recruited a first intake of Public Health Officers whose training focuses on the public health aspects of drug and alcohol issues. These Officers develop the same competencies as their colleagues but their work experience is customised to relate to drug and alcohol issues.
Summary The NSW Public Health Officer Training Program provides broad training that enables graduates to apply their learning in many different spheres of public health practice. Consequently programs like this form one part of a strategic approach to public health workforce development.
Part 3: Public Health Highlights and Achievements 1998/99 107 NT—Public Health Demonstration Projects During 1998/99, funding under the national Public Health Outcome Funding Agreement (PHOFA) was combined with Territory Health Services resources to enable a number of training projects to be undertaken in the East Arnhem Region of the Northern Territory; a public health education and training database to be produced and the continued development of a Public Contact Details Health Manual. Kez Hall, Director, Course Development for Community Health Staff in Remote Areas of the NT Public Health Strategy Unit One of the training projects developed during 1998/99 comprised two public health short courses, developed to complement relevant sections of the Public Health Manual (known as the Phone: Public Health Bush Book), to be published later this year. The short course Sharing Health (08) 8999 2720 Information has a focus on sharing public health information with individuals and families or in Email: a general community setting while the focus of the Brief Intervention short course is the [email protected] community health centre setting. The courses were developed using units of competency from the Community Services Training Package and also complement the Aboriginal Health Worker and Torres Strait Islander National Competency Standards.
The courses were developed for all community based health professionals (nurses, doctors, Aboriginal Health Workers and allied health professionals) and were trialed in four East Arnhem communities. As well as curriculum development and accreditation, evaluation was a critical element of the projects’ outcomes. Sustainability and portability issues were also taken into consideration during development of the training package.
As a result of trials undertaken, a number of changes were made to the courses’ content and the delivery method. Sharing Health Information can be delivered either as a workshop or as a self directed learning package and is suitable for delivery to multi-disciplinary teams with a range of skill levels. The short course in Brief Intervention involves a great deal of interaction between participants and was found to work well when delivered as a workshop for multi- disciplinary teams.
A resource package has been developed to accompany the short courses. It is intended that the courses will be built into Territory Health Services professional development for public health and primary health care providers.
Hands On: the Public Health Education & Training Database In May 1998, the Public Health Strategy Unit within Territory Services (THS) undertook a project to produce a database of public health education and training available in the Northern Territory. This project responded to a perceived need for greater coordination of public health education and training in the Northern Territory.
The project was overseen by a steering committee with members from THS, the Cooperative Research Centre for Aboriginal and Tropical Health (CRC), and Menzies School of Health Research.
Hands On, the outcome of the project, was published in March 1999 on the THS Intranet, NT Government Intranet and the Internet. Hands On consists of a database, an on-line form for training providers to update or add new course details and a list of hyperlinks to related Public Health sites. A hard copy is also available.
108 Part 3: Public Health Highlights and Achievements 1998/99 The information gathered reflects the whole spectrum of education and training offered by NT education and training providers, from higher education courses to VET training and non- accredited workshops. The database also has links to institutions offering Public Health education and training in other states.
For Further Information Hands On can be located on the Internet address: http://www.nt.gov.au/nths/publichealth/hands/hands.shtml
The Public Health Bush Book Territory Health Services is soon to release the Public Health Bush Book Volumes 1 and 2. The Public Health Bush Book is a resource for all public health and primary health care providers who want to strengthen their health promotion and disease prevention practice. It has been written specifically for teams who work with Aboriginal communities in the Northern Territory and more than 100 health and community service providers throughout the NT contributed to its development.
The Public Health Bush Book resource aims to: • provide a range of strategies and ideas and a variety of tools to assist staff to work more effectively within a Primary Health Care model. • to include something for everyone who works with Aboriginal people.
The Public Health Bush Book emphasises brief and early intervention, disease and harm prevention and health promotion strategies. It focuses on strategies to address the direct causative or risk factors for ill health, namely misuse of alcohol and other drugs, inadequate environmental health and hygiene and poor nutrition. In addition, it suggests how staff can use these strategies, both when people present for treatment at the health centre and in the course of everyday life and work with an Aboriginal community. It aims always to recognise and reinforce the capacity of individuals, families, groups and communities to know what to do and how to do it.
For experienced workers, it provides a useful check for evaluating current work practices and extending them. For the less experienced, it serves as a resource to guide efforts in developing sound public health practices.
The Public Health Bush Book is presented in two volumes: • Volume One: Strategies and Resources outlines the theory and a range of strategies and resources for practice in the field. It includes step by step guides to processes and strategies and a range of checklists and work sheets to assist teams in planning and evaluating their work. It also includes a list of contact phone numbers for further information and assistance. • Volume Two: Facts and Approaches to Three Key Public Health Issues provides a background to three key, underlying public health issues facing remote communities: Alcohol and Other Drugs, Environmental Health and Food and Nutrition. It includes facts, issues and approaches in the three areas. It will be useful in gaining an overall understanding of their impacts on health and what can be done about them.
It is intended to supply copies of the Public Health Bush Book to all rural and urban Community Health Centres.
Part 3: Public Health Highlights and Achievements 1998/99 109 9. Legislation as a Contemporary Public Health Tool
ACT Tobacco Control Program—‘Smoke-free ACT’ The key objective of this public health program is to protect the health of the ACT community by reducing or eliminating their exposure to tobacco and environmental tobacco smoke.
Achievements during 1998/99 Contact Details 1998–99 has seen major achievements in tobacco control and passive smoking harm minimisation in the ACT. These achievements have been recognised as world leading. Ms Margo Goodin, Director, Tobacco In November 1998 the last phase of landmark ACT passive smoking legislation, the Smoke-free Control Program, Areas (Enclosed Public Places) Act 1994, came into effect. This required licensed premises, such Health Protection as nightclubs, clubs, pubs, bars, taverns, hotels and the casino to become smoke-free. Service, However, licensed premises that meet strict mechanical ventilation requirements can obtain an ACT Department exemption to allow limited smoking areas. of Health and Community Care Therefore, smoking is now prohibited in all enclosed public places in the ACT except Phone: restaurants and licensed premises which have obtained an exemption. (02) 6205 1720 A public awareness campaign was conducted to increase community awareness of the changes. The campaign involved television, newspaper and bus-side advertisements; a media launch; newspaper print articles; and radio talkback.
To ensure smooth implementation of the new smoking arrangements within licensed premises, newsletters and fact sheets were developed to inform proprietors of licensed premises of the changes and to provide compliance advice. Free no-smoking signs were also made available.
Future Directions • The implementation of amendments to the Tobacco Act 1927 concerning restrictions on tobacco sales, advertising and promotion. • The anticipated transfer of responsibility for tobacco retails and wholesale licensing to the Registrar of Tobacco in the Department of Health and Community Care. • Development of refinements to the Smoke-free Areas (Enclosed Public Places) Act 1994, with regard to the exemption system.
110 Part 3: Public Health Highlights and Achievements 1998/99 Food Safety Victoria—Leading in Food Law Regulation Reform Food Safety Victoria, within the Division of Public Health and Development, Victorian Department of Human Services, oversees the implementation of the Food Safety Strategy. The Strategy is a Victorian Government initiative introducing preventative, risk based management practices to the 50,000 strong Victorian food industry member companies. Contact Details The Food Safety Strategy is implemented as a co-operative and consultative venture between Ms Ellen Kitson the Victorian State Government portfolios of Health, Primary Industry, Trade Development and Executive Officer, Local Government, the 78 Local Government municipalities, the regulatory authorities Food Safety overseeing dairy and meat industries and key industry associations. An independent Ministerial Victoria, Public advisory group, the Food Safety Council, provides strategic advice to the Minister for Health on Health and the implementation of amendments to the Victorian Food Act 1984, mandating food safety Development programs in all registered food businesses. Division Food Safety Programs Phone: Food safety programs, which incorporate a risk assessment and management plan for (03) 9637 4998 foodborne hazards in food processes, will be introduced in a progressive manner across all sectors of the food industry according to a risk categorisation priority system. ‘Class A’ premises, for example, include those businesses whose predominant consumer fits in the vulnerable group of aged, very young and immuno-suppressed. Businesses such as aged care homes, child care services and hospitals had a target date of 31 March 1999 by which to adopt their food safety programs. Full implementation of food safety programs is planned to conclude at the end of 2000.
Food Safety Victoria has focussed its activities on assisting industry and regulators to manage the cultural and structural change brought about by the shift to documented risk management systems. Food Safety Victoria has addressed over 3,000 business proprietors, facilitated training for environmental health officers employed by Local Government and published numerous guidelines and support documents on aspects of food safety programs and their administration.
Communication Strategy Food Safety Victoria’s communication strategy recognises that many members in the State food industry have culturally diverse backgrounds and may have literacy difficulties. Food Safety Victoria publishes translations of key documents in a range of languages other than English and seeks to have all its documentation in ‘Plain English’.
Other Activities Aside from the Victorian implementation of the Food Safety Strategy, Food Safety Victoria has participated in the national food reform process being managed by the Australia New Zealand Food Authority (ANZFA). ANZFA is developing the Food Safety Standard which will extend the mandatory adoption of food safety programs to the national industry.
Food Safety Victoria also provides assistance to the Disease Control Section in the investigation and management of foodborne illness incidents.
Part 3: Public Health Highlights and Achievements 1998/99 111 Tasmania—Change Management in Public and Environmental Health Under the Public Health Outcomes Funding Agreement, the Tasmanian Department of Health and Human Services received Commonwealth approval to undertake a number of demonstration projects. Tasmania submitted a number of proposals to support implementation of new legislation and improve public health planning and decision making strategies. Contact Details A major area of activity for the Public and Environmental Health Service during 1998/99 has Sue Moir, been the implementation of the Change Management in Public and Environmental Health State Coordinator, project. The project supports the introduction of the Tasmanian Public Health Act 1997 and Environmental Food Act 1998 and demonstrates an innovative approach to managing health reform at a local Health level. Phone: (03) 6233 2707 The project aimed to increase the capacity of local government and industry to appropriately implement their statutory responsibilities under the new legislation. The project’s focus was on Email: strengthening alliances with local authorities in the promotion of public health to facilitate a [email protected]. move towards a contemporary systems based approach. This is particularly important given gov.au local government’s leadership role in the implementation of public health legislation.
In addition, a community development approach is being used to work with the food manufacturing and retail industry. This will implement a systems approach to managing food safety and food quality issues in partnership with individual industries, relevant associations and local government.
The project’s focus was on developing interventions at the point of production and manufacture, and reducing reliance on reactive measures such as prosecution or reputation damaging food recalls. Linkages between food safety programs and nutrition promotion were also explored.
Other Activities Under the Project • Developing information systems for the implementation of new public health legislation including reporting capabilities and documentation of procedures in the areas of water and contaminants, communicable diseases and vaccine management. • Conducting a media campaign on new tobacco legislation to raise community awareness and a pilot survey of compliance with tobacco legislation using a teenage volunteers model. • Providing training and exercises for local government Environmental Health Officers and air conditioning contractors to develop appropriate responses in the event of an outbreak of Legionnaires disease in Tasmania. • Developing a manual for Local Government to provide practical assistance in the implementation of the new public health legislation. The manual was both printed and placed on the Internet. • Piloting and evaluating the use of video conferencing for information and discussion sessions with local government Environmental Health Officers on issues relating to the implementation of new legislation.
112 Part 3: Public Health Highlights and Achievements 1998/99 • Supporting food safety training by local government including purchase and distribution of ‘food safe’/‘food-safe plus’ kits to encourage local government to provide/support food handler training within their local areas. • Evaluating of publicly funded institutions where food is prepared to determine risk and utilisation of food safety planning, including the identification of best practice and priorities and processes for action. • Supporting the application by the School Canteen Advisory Committee of an accreditation scheme to enable schools to understand food safety issues and implementation options.
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