PART 2 OUTCOME PERFORMANCE REPORTS

PART 2 OUTCOME PERFORMANCE REPORTS

FINANCIAL SUMMARIES

All Outcomes: Financial Resources Summary

Reconciliation of Outcomes and Appropriation Elements 2002-03

OUTCOME 1 POPULATION HEALTH AND SAFETY

Promotion and protection of the health of all Australians and minimising the incidence of preventable mortality, illness, injury and disability.

Did you know...?

OUTCOME 1 POPULATION HEALTH AND SAFETY

PART 1: OUTCOME PERFORMANCE REPORT

The outcome also includes Food Standards Australia New Zealand (FSANZ) and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). FSANZ and ARPANSA produce their own annual reports.

For ease of reporting, the activities managed by the Population Health Division, Portfolio Strategies Division, Primary Care Division and Information and Communications Division are separated from those managed by TGA.

Major Achievements

Severe Acute Respiratory Syndrome

The National Meningococcal C Vaccination Program

At 30 June 2003, coverage in children turning 12 months of age is 36.5 per cent and uptake of the catch-up program in children up to five years of age is 33.7 per cent.

Increased Immunisation Rates

Challenges

HIV/AIDS

Performance Indicators (Effectiveness Indicators)

The Department’s performance against these indicators is discussed in the following outcome summary. Specific references to these indicators are marked by footnote.

OUTCOME SUMMARY—THE YEAR IN REVIEW

Australia’s response to SARS has demonstrated the importance of national leadership and the value of having in place established and well organised infrastructure such as the Communicable Disease Network of Australia, the Communicable Diseases Intelligence bulletin, the Public Health Laboratory Network and relevant epidemiological expertise. Both our domestic and international roles in SARS have demonstrated the quality of our public health practitioners, including our departmental officers, and the regard in which they are held by the World Health Organization (WHO).

At an international level, Australian experts worked with WHO in Hanoi, Beijing, Singapore and Manila to develop and implement the response. Australian epidemiologists led the WHO teams in Vietnam and China, and a large number of graduates from the Master of Applied Epidemiology course funded by the Australian Government undertook vital fieldwork in the region.

SARS reminds us that new diseases will continue to arise, as infectious agents mutate and adapt to exploit new ecological opportunities. The public health system has to be well prepared to deal with acute outbreaks, emerging infectious diseases such as Hepatitis C, as well as maintaining an effective response to longer term risks such as childhood infectious diseases and HIV/AIDS.

In addition to SARS, Australia has had to develop a response capacity to other new threats and risks associated with biosecurity. Improving efforts in communicable disease surveillance and management, developing preparedness for biosecurity threats, and enhancing food safety have been strong themes in the past year.

While communicable diseases have dominated the headlines, overwhelmingly the causes of ill health and premature death in Australia are chronic, non-communicable diseases, such as cardiovascular disease (including heart disease and stroke), cancer and diabetes, whose onset can be prevented or delayed by relatively straightforward preventive measures.

The WHO’s World Health Report 2002 noted that a relatively small number of modifiable risk factors are responsible for more than one third of the total burden of disease. These include the lifestyle factors of tobacco smoking, physical inactivity, poor nutrition (for example inadequate fruit and vegetable intake), excessive alcohol intake, and the biological factors of high blood pressure and cholesterol, overweight and obesity.

The World Health Report released a significant body of new evidence, detailing the past and potential impact of prevention on health status and health system costs and the demand for health care. It showed that cost-effective implementation of known preventive measures could deliver an extra six years of healthy life expectancy in developed countries such as Australia.

A new Australian report, Returns on Investment in Public Health, has quantified the returns on spending on preventive health measures. It shows that spending on a range of illness prevention measures over the past three decades—such as public health interventions against tobacco consumption, heart disease and immunisation against measles—has resulted in big savings. The study found, for example, that $155 was saved for every dollar spent on immunisation against measles since 1970.

Death rates for heart attack and stroke have fallen in Australia by well over 60 per cent since the 1970s, through advances in both prevention and treatment. The Returns on Investment report found that 70 per cent of the decline in heart attack deaths could be attributed to a decline in the risk factors of smoking, high blood pressure and high cholesterol, with $11 saved for every dollar spent on public health measures.

The gains which have been made in reducing the burden of chronic disease, especially heart disease, are threatened by the dramatic rise in the rates of overweight and obesity in Australia in recent years and related rises in the rates of diabetes. The National Obesity Taskforce, established by the Australian Health Ministers’ Conference in late 2002, is developing a national plan of action to combat the obesity epidemic, with an initial focus on obesity prevention in children and young people.

The Australian Government is committed to making prevention a fundamental component of a more effective and sustainable health care system. Prevention is important across the whole continuum of care, from prevention of disease through reduction in risk factors such as smoking, through early detection and management of biological risk factors such as high blood pressure and through effective management of established chronic disease. For those who are already ill, prevention works hand in hand with treatment. Prevention therefore needs to be addressed in the clinical setting as well as at a community or population level.

The Australian Government has moved to ensure that prevention becomes better integrated into the health care system as a whole, and in particular that it is strongly embedded in primary health care. The ‘Focus on Prevention’ package announced in the 2003-04 Budget provides a range of initiatives to begin this process.

The achievement of effective prevention requires the infrastructure to plan and deliver programs efficiently and effectively. In 2002-03 the Department therefore continued to build evidence and knowledge about the burden of disease, effectiveness of interventions and investment in workforce capacity and skills.

The Department has also continued to show leadership in international public health policies that support and inform best practice in Australia and accord with Australia’s health objectives. For example, the Department played a major role in Australia’s whole-of-government response to the Framework Convention on Tobacco Control (FCTC), including a leadership role in the Western Pacific region. In a landmark event for public health, the World Health Assembly in May 2003 unanimously adopted the Framework Convention, aimed at curbing tobacco-related deaths and disease throughout the world.

The Department’s achievements in Outcome 1: Population Health and Safety will be examined in detail under the following headings:

Health protection: includes the provision of a healthy and safe physical environment, and the control of disease through regulation and notification.

Health promotion: includes health education to help people make informed choices; and the promotion of policies and healthy environments that will help to make healthy choices easy choices.

Preventive health services: preventive services, such as screening and lifestyle advice, delivered to individuals through public or private primary health care practitioners or through organised programs.

National infrastructure and information: includes measures to improve the information and research base to enable informed policy and program decisions, and the workforce and infrastructure to support this.

The Australian Government uses a range of funding mechanisms for its investment in the National Public Health Program (NPHP) under Outcome 1. These mechanisms comprise Commonwealth Own Purpose Outlays (COPO represented 26 per cent of the NPHP outlays in 2002-03), Specific Purpose Payments (SPP) to the States and Territories broadbanded into Public Health Outcome Funding Agreements (PHOFAs represented 62 per cent of NPHP funding in 2002-03) and other SPPs (these represented 12 per cent of outlays for NPHP in 2002-03). This use of mixed funding mechanisms is underpinned by discrete roles for the different levels of government.

The major programs funded by the Australian Government through COPOs (see Figure 1.1) or SPP arrangements with the States are:

Health Protection

Immunisation¹³

continued increases in the number of fully immunised children. At 30 June 2003, 91.2 per cent of children aged 12 to 15 months (an increase of 16.3 percentage points from June 1997), and 89.3 per cent of children aged 24 to 27 months (an increase of 25.5 percentage points since June 1998) were fully immunised;

continued increases in the number of people aged 65 and over who were vaccinated under the Influenza Vaccine Program for Older Australians. Coverage was 69 per cent in 1999 and has increased in 2002 to 77 per cent;

the commencement of the National Meningococcal C Vaccination Program. Costing $298 million over four years, the program will provide access to free meningococcal C vaccine for approximately 6 million children and adolescents turning 1 to 19 years of age. In the first six months of the program, around one million doses of meningococcal C vaccine had been distributed;

the extension of the National Q Fever Management Program to include workers on dairy, sheep and cattle farms. Initially targeted at abattoir workers and sheep shearers, this national project aims to reduce the incidence of Q Fever in rural areas. Currently, more than 95 per cent of abattoirs have programs in place to screen and immunise their employees. Of the 60,000 people who received pre-vaccination screening, approximately 49,000 (86 per cent) have been vaccinated under the program; and

the ongoing successful implementation of the National Pneumococcal Vaccination Program which is a targeted vaccination program initiated in 2001 that aims to reduce the rate and severity of pneumococcal disease in high risk populations throughout Australia. Data published¹⁴ in 2003 indicated the uptake of the program was approximately 90 per cent in some key areas.

Along with declining vaccine preventable disease rates, another benefit of the high immunisation coverage rates achieved in Australia is the effect of ‘herd immunity’. ‘Herd immunity’ is a process where disease transmission is continually interrupted because of protection from the disease induced by sustained high immunisation rates in a community. This effect is very important as it provides some protection for unimmunised, or partially immunised, children by reducing the chances of them contacting a vaccine preventable disease.

HIV/AIDS and Hepatitis C Virus¹⁵

The cumulative total cases of HIV infection in Australia to 31 December 2002 was 19,680, with an estimated 13,422 people living with HIV in Australia during 2002. The annual number of new HIV diagnoses in Australia remained relatively low, with 815 in 2002¹⁶. To date, 6,258 Australians have died as a result of AIDS. The annual number of deaths has declined dramatically since the advent of new treatments, decreasing from 157 deaths in 2000 to 79 in 2002.

Under the current National HIV/AIDS Strategy, the Department has continued to provide funding for national HIV/AIDS education, prevention and promotion, HIV/AIDS research and Aboriginal and Torres Strait Islander sexual health programs. The strategy has achieved important goals:

HIV infection rates decreased early in the period of the current strategy;

deaths from AIDS-related illnesses have steadily declined from the already relatively low levels, and many HIV-positive people continue to have relatively good health;

improved understanding of the HIV/AIDS epidemic due to research and improved surveillance;

targeted HIV/AIDS education and prevention programs; and

establishment of partnerships at all levels of government with affected community, peak bodies, and the medical, allied health care and research sectors.

Hepatitis C virus is transmitted through blood-to- blood contact. To date, the majority of hepatitis C infections in Australia have occurred in the context of injecting drug use. To increase knowledge of hepatitis C, reduce transmission of hepatitis C in Australia and to improve care and support for those affected by hepatitis C, the Department has implemented initiatives through two four-year programs, namely the 1999-2000 Hepatitis C Education and Prevention Initiative and the 1999-2000 Council of Australian Governments (COAG) Supporting Measures Relating to Needle and Syringe Programs (NSPs).

Outcomes achieved under the 1999-2000 Hepatitis C Education and Prevention Initiative included the provision of targeted information through national peak bodies for those most at risk of infection, improved availability of education materials for people from culturally and linguistically diverse backgrounds, and the delivery of a range of education materials and training for health care professionals.

Outcomes achieved under the 1999-2000 COAG Supporting Measures Relating to NSPs included enhanced service delivery through: the development and dissemination of a range of education resources that assist NSP and pharmacy workers in their interaction with people who inject illicit drugs; the appointment of additional peer educators in the jurisdictions; increased operating hours for a range of NSPs; and increased education and counselling services for people attending NSPs.

In 2002, the Department commissioned independent reviews of the National HIV/AIDS Strategy, the National Hepatitis C Strategy, the National Centres in HIV Research, and HIV/AIDS and hepatitis C strategic research. Australia’s partnership approach and strategic frameworks were highly praised throughout the review process. The reports will contribute to our knowledge of the current and emerging issues relating to HIV/AIDS and hepatitis C, and will inform the Australian Government on the future direction of Australia’s management of these communicable diseases.

Environmental Health¹⁷

The Department continued to support specific strategic initiatives under the National Environmental Health Strategy, through a range of projects that promote healthy environments.

These have included:

the publication of the resource Healthy Homes, a guide to indoor air quality in the home for buyers, builders and renovators;

the publication of Human Health and Climate Change in Oceania: A Risk Assessment 2002. This report represents a first, key step in the development of a national public health response to the impact of climate change in the region; and

development of improved education and training programs in environmental health and incorporation of environmental health approaches into broader public health education and training.

In recognition of the important role played by Indigenous environmental health workers in many communities, a review of the size and characteristics of the Indigenous environmental health workforce was undertaken during 2002-03. This report will be used for consultations with key stakeholders in the second half of 2003 to develop specific policies that will guide development of the environmental health workforce that services Indigenous communities.

Food Policy¹⁸

Food Safety and Surveillance¹⁹

a review of OzFoodNet, a national surveillance system providing comprehensive, standardised information on foodborne illness, and coordination of cross border outbreak investigations and regulatory responses. The review recognised the value of OzFoodNet and recommended its continuation, with improved linkages to animal epidemiology and the whole of food chain production cycle;

a national gastrointestinal survey to provide a robust estimation of the annual incidence of gastroenteritis in Australia. The survey found that there are approximately 17.2 million cases of gastroenteritis each year, of which 5.4 million are food related; and

a report on an evidence-based assessment of the Australian food industry to identify the highest risk areas and the benefit to cost ratio of particular industries implementing food safety programs. Information from the national gastrointestinal survey and this report will be used to make better-informed decisions on food safety programs in Australia.

Antibiotic Resistance²⁰

health care associated infections caused by bacteria such as ‘Golden Staph’ (usually methicillin resistant Staphylococcus aureus), vancomyc in resistant enterococci and multi- resistant gram negative organisms such as Acinetobacter species;

the use of antibiotics in animals, particularly in stock feeds; and

the possibility of resistant bacteria being transmitted from animals to humans, and contributing to resistant infections in humans.

Throughout 2002-03 the Department continued to work collaboratively with other agencies, such as the Department of Agriculture, Fisheries and Forestry, to address the recommendations set out in the 1999 Report of the Joint Expert Technical Advisory Committee on Antibiotic Resistance. The key aim of the Department’s work in this area is to develop and coordinate a national antibiotic resistance management program to meet Australia’s particular needs.

Transmissible Spongiform Encephalopathies and Bovine Spongiform Encephalopathy (BSE)²¹

endorsement of recommendations for infection control management procedures to minimise the risk of transmission of classical forms of Creutzfeldt-Jakob disease (CJD) in Australian health care settings; and

agreement of the Communicable Diseases Network Australia to make all forms of CJD notifiable diseases.

Emerging Diseases²²

Further surveillance systems were initiated during 2002-03 as a result of Departmental research and coordination for antimicrobial resistant organisms that can be found in animals, animal-derived food and in human infections. Other significant achievements included publication of the invasive pneumococcal disease surveillance program.

Biosecurity²³

improved national coordination with Australian Government agencies and State and Territory health agencies through the establishment of the Australian Health Disaster Management Policy Committee;

development of the draft Bioterrorism Response Strategy; and

establishment of the National Medicines Stockpile. The stockpile provides Australian Government capacity to assist any State and Territory Governments in dealing with an emergency.

Health Promotion

Program. Illicit drugs is the largest single funded component under the National Public Health Program. A substantial proportion of the funding under Outcome 1 is directed towards addressing licit and illicit drug issues at both the Australian Government and State and Territory Government levels.

Illicit Drugs²⁴

During 2002-03, the Department continued to develop and implement a number of projects under the National Illicit Drug Strategy including the Non Government Organisation Treatment Grants Program and the Training Frontline Workers Initiative. In addition, as part of the Australian Drug Information Network,

Indigenous and multicultural specific pages were incorporated to capture relevant information for these sectors. A further 18 community grants were funded under the Community Partnerships Initiative.

The Department has continued to work with State and Territory Governments to ensure the ongoing roll-out and expansion of the COAG Illicit Drug Diversion Initiative in each jurisdiction. The diversion initiative is a national approach to diverting minor drug offenders away from the criminal justice system and into appropriate assessment, education and treatment. Diversion programs are operating in all States and Territories and enable the police, and in some jurisdictions courts, to divert eligible offenders to a range of approved services. There have been over 28,000 diversions since the commencement of the initiative.

A national evaluation of the COAG initiatives on illicit drugs was conducted by the Department of Finance and Administration and a final report completed in October 2002. The evidence indicated that the diversion program was worthwhile, had a positive impact on participants, and was gaining greater acceptance by police and other members of the criminal justice system. Following the evaluation, the Prime Minister announced in December 2002, a continued commitment to the Illicit Drug Diversion Initiative with $215 million allocated to a second phase of the initiative over four years from 1 July 2003.

Alcohol²⁵

the launch of a partnership between the Australian Government and the Australian music industry that endorsed the National Alcohol Campaign messages; and

in conjunction with key stakeholders, the Department produced a range of education materials that informed Australians on low risk drinking levels and behaviours. The materials were based on the National Health and Medical Research Council’s Australian Alcohol Guidelines and have been widely disseminated.

Tobaccos²⁶

completion of stage one of research into options for the development of new Australian health warnings for tobacco packaging; and

drafting of new national guidelines for smoking cessation by General Practice Education Australia.

The Department continued to play a prominent role in negotiations for the Framework Convention on Tobacco Control, and was appointed to the drafting group of 28 countries that resolved the most contentious issues during the February 2003 negotiating round. The departmental delegation strongly supported the convention on issues including advertising bans, protection from passive smoking and bans on sales to minors. The Department consulted extensively with other Australian Government departments and agencies, State and Territory Governments, industry bodies and the non- government sector throughout the negotiating process. The adoption of the convention by the World Health Assembly in May 2003 was a major milestone in global public health.

Sponsorship²⁷

Sponsorship funding was provided for Smoke Free Fashion, a joint sponsorship initiative between the Department and the Australian fashion industry. This initiative aimed to dispel the myth that smoking is glamorous and fashionable, and promoted positive non-smoking messages. Another phase of the National Tobacco Campaign ran for two weeks in May and June coinciding with World No Tobacco Day on 31 May 2003.

Nutrition²⁸

The majority of funding for nutrition activities by the Australian Government has been provided for the three year National Child Nutrition Program which has involved funding 111 community projects across Australia targeting the nutrition and long term eating patterns of children and pregnant women. During 2003, the Department continued to implement these projects and to identify best practice examples across different settings (for example, child care centres and school canteens) for wider dissemination.

Diet, Physical Activity and Obesity²⁹

New Australian standard definitions of overweight and obesity for children and adolescents were endorsed in December 2002 by the National Health Information Management Group for inclusion in the 12th edition of the National Health Data Dictionary. This will assist in accurate monitoring and surveillance of the prevalence of overweight and obesity and in determining effectiveness of interventions in younger age groups.

Injury Prevention³⁰

Health Across the Lifecourse³¹

Preventive Health Services

Breast Cancer Screening³²

Significant achievements for the program in 2002-03 included:

implementation of the new National Accreditation Standards for BreastScreen Australia;

development of a strategy to address factors related to the shortage of radiologists in the program; and

endorsement and implementation of the BreastScreen Australia National Information Statements.

Cervical Screening³³

Deaths from cervical cancer in the target age range of 20 to 69 years have fallen by 55 per cent between 1989 and 1999 (from 4.4 deaths from cervical cancer per 10,000 women in 1989 to 2.0 deaths per 10,000 women in 1999). ³⁴

Bowel Cancer Screening³⁵

From November 2002 when invitations commenced, to the end of June 2003, some 14,700 men and women had been invited to participate.

Significant achievements for the pilot in 2002-03 included:

development of a national Bowel Cancer Screening Register;

implementation of a communication strategy for pilot participants with accompanying support material;

collaboration with State Governments, Divisions of General Practice, cancer and other community organisations in each of the pilot sites; and

implementation of a hotline set up to respond to queries from people who have been sent invitations to participate in the pilot and others who may be interested in information about the pilot.

Family Planning Program³⁶

Sharing Health Care³⁷

Rural Chronic Disease³⁸

Many of the projects report significant health improvements within their communities. These include substantial weight loss, increased levels of physical activity and lifestyle changes that reflect a reduction in the risk factors for chronic diseases and the better management of chronic disease and injury.

National Infrastructure and Information

Capacity Building³⁹

New courses and innovative approaches have been developed in:

healthy ageing, chronic disease and injury prevention;

bridging education and employment in public health;

population health and primary care;

rural, remote and Indigenous health;

measuring risks and assessing health needs;

health systems, economics and law;

the environment and health; and

building and understanding evidence.

The ‘Sentinel Site for Obesity Prevention’, being developed with PHERP Innovations funding, illustrates the importance of workforce capacity in addressing a major health problem; obesity among children and adolescents in Australia. With a focus on training and upskilling in obesity prevention at the community level, the project aims to build the programs, skills and evidence needed to develop a comprehensive approach to tackling the underlying environmental causes of inactivity and unhealthy eating.

The Department also provided funding to the Royal Australian College of Physicians for a strategic national workforce initiative to strengthen and build general practice capacity in public health medicine. Six public health medicine registrar positions for general practitioners and/or those with advanced vocational training status in general practice have been established and registrars will undertake three years of advanced training in the priority areas of Indigenous health, rural and remote health, communicable diseases, ageing and environmental health.

Another national workforce initiative, which has been acknowledged as best practice in collaboration, addresses the critical shortage of high callibre biostaticians in Australia. The Biostatistics Collaboration of Australia (BCA) consists of biostatistical experts from universities, government and the pharmaceutical industry. Through a consortium of five Australian universities, the BCA is delivering post-graduate training in statistical methods with a strong emphasis on application in all areas of health and medical research.

These projects were among 40 innovative public health workforce development projects show- cased at the PHERP Innovations Conference on 29-30 May 2003 in Canberra. Stakeholder discussion of the wider issues surrounding public health workforce development, education and training acknowledged the Department’s strategic directions and partnership approaches as responsive to public health workforce needs.

Strengthening the Evidence Base⁴⁰

Partnerships⁴³

Major achievements included agreement on key priorities for action between the Alliance, the National Public Health Partnership and the National Health Priorities Action Council. These include better aligning the preventive strategies of the three bodies, with a focus on physical activity and nutrition.

Central to the Department’s capacity to make evidence-based decisions concerning priority areas for population health action is access to public health expertise and up-to-date research. During 2002-03, the members of the Australian Network of Academic Public Health Institutions continued to promote partnerships between academic institutions, government and non- government organisations in the delivery of public health education and research.

International Health

The Department led Australia’s delegation to the 53rd session of the WHO Western Pacific Regional Committee meeting in Kyoto, Japan, in September. Strong endorsement was given to Australia’s achievements in tobacco control as well as our contribution to the management of HIV/AIDS.

The Department collaborated with WHO in the regional launch of the 2002 World Health Report, in Brisbane, in October. The centrepiece was an analysis of burden of disease and risks to health. The Department is supporting a project to apply the WHO methodology in Australia and the region to quantify disease, disability and death that can be attributed to particular risks, calculate how much of the burden can be avoided if risk factors are reduced, and identify cost effective interventions.

On behalf of the WHO, the Department has been managing the Australian component of the World Health Survey. This survey of a representative sample of adult Australians will provide baseline information on the health of the population and the responsiveness of the health system. The survey is being run in more than seventy countries worldwide.

A major focus of international activity was the OECD three-year study of the performance of health systems, reasons for variations and directions for improvement. As well as assessing the comparative performance of aspects of Australia’s health system, the study is of direct relevance to domestic policy development with components on private/public health insurance, long term care, the economic impact of emerging technologies, workforce issues and waiting times. Australia is a major stakeholder with the Secretary, Jane Halton, co-chair of the project management group.

Australia’s standing in the Asia Pacific was strengthened through a policy dialogue and exchange of knowledge with international organisations such as WHO’s Western Pacific Regional Office and the Asia Pacific Economic Cooperation, and regional health ministries.

The Department contributed strategic policy input to the negotiation of Free Trade Agreements with Singapore, Thailand and the United States of America.

At the same time, bilateral relations under Memorandum of Understanding (MoU) arrangements with China, Indonesia, Japan and Thailand were productive. This included:

further consolidation with the People’s Republic of China through health information exchanges on communicable disease surveillance, notification and response systems;

on-going health cooperation with the Indonesian Ministry of Health culminated in a successful delegation to Jakarta for the Australia Indonesia Ministerial Forum;

significant progress in Australia’s relationship with Japan through the Australia Japan Partnership on a joint mental health research project; and

undertaking four projects on health cooperation with the Thai Ministry of Public Health.

The policy lessons of interactions with international organisations and other countries were distilled and circulated across the Department and other agencies via a quarterly journal, Health International.