National Preventative Health Strategy

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The Healthiest Country by 2020
National Preventative Health Strategy
Professor Mike Daube Deputy Chair - National
Preventative Health Taskforce October 2009
Acknowledgements R. Moodie, D. Holman, M.
Scollo, M. Swanson, D. Sullivan, S. Chapman, M.
Schultz, S. Allsop, Taskforce Secretariat, The
Age
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What this talk is about

• The Preventative Health Taskforce
• Progress and process
• Priorities for action obesity, tobacco,
  alcohol, national infrastructure
• Comprehensiveness

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Satius est initiis mederi quam fini
Desiderius Erasmus (1466-1536)
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SUCCESSES IN PREVENTION

• Examples
• Tobacco
• Immunisation
• HIV/AIDS
• SIDS
• Road Trauma

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Road fatalities in Australia 1968 - 2008
4000
1968
1990 Speed camera programs introduced
nationally Compulsory wearing of bike helmets
(Vic) Black Spot programs introduced
3500
3000
1973 Seatbelt legislation mandatory nationally
2001 Alcohol interlock devices introduced
1998 Introduction of 50 km/h speed limits in
residential areas
1970 Victoria is the first state to introduce
mandatory seatbelts
2500
1976 Random breath testing began Child
restraint legislation introduced
2005 Expanded roadside drug testing
2000
1988 National roadside breath testing Speed
cameras introduced
1500
1989 Introduction of intensive road safety
advertising Zero blood alcohol for young
drivers Motor Vehicle Standards Act
1992 Bike helmets mandatory
1000
2003 Roadside drug testing (Vic)
500
1968
0
1971
1977
1983
1989
2001
1995
2007
1974
1980
1986
2004
1998
1992
1968
Source Transport Accident Commission 2009
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The power of comprehensive approaches
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• This means that between 1970 and 2007
• 630,394 people were NOT injured, and
• 45,557 were NOT killed
• ..because of the introduction, progressively
  over time, of
• seatbelts
• speed limits,
• alcohol limits and
• enforcement relating to these road safety
  initiatives,
• education campaigns, regulating safer cars and
  roads

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current smokers Australians 18,
19802007males and females
Source Centre for Behavioural Research in Cancer
using ACCV and NDSHS data
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WA 2008 Australian School Students Alcohol and
Drug (ASSAD) Survey
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Male lung cancer rates per 100,000 today as low
as they were in 1963
Sourcehttp//www.aihw.gov.au/cdarf/data_pages/mor
tality/index.cfm
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Death rates for COPD in men now as low as they
were in late 1950s
Sourcehttp//www.aihw.gov.au/cdarf/data_pages/mor
tality/index.cfm
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• (The Government).. will treat preventative
  health care as a first order economic challenge
  because failure to do so results in a long term
  negative impact on workforce participation,
  productivity growth and the impact on the overall
  health budget.
• K. Rudd, June 2008

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Chair Professor Rob Moodie Deputy
Chair Professor Mike Daube
Members Professor Paul ZimmetProfessor Leonie
SegalDr Lyn RobertsMr Shaun LarkinMs Kate
CarnellDr Christine ConnorsDr Linda Selvey
The Taskforce was announced on 9 April
2008. Members have been appointed for three years.
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• Purpose
• To provide evidence-based advice to government
  and health providers both public and private
  on preventative health programs and
  strategies and
• To support the development of a National
  Preventative Health Strategy.

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In its first 15 months, the Taskforce will
deliver to the Minister for Health and Ageing

• advice on a Preventative Health Partnership
  between the Commonwealth and the States and
  Territories (provided in August 2008)

• a longer three year work plan for the duration
  of its appointment (by September 2008)

• a National Preventative Health Strategy (by
  June 2009).

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The Strategy will

• Provide a blueprint for tackling the burden of
  chronic disease currently caused by obesity,
  tobacco, and excessive consumption of alcohol.

• Will be directed at primary prevention.

• Will address all relevant arms of policy and
  all available points of leverage, in both the
  health and non-health sectors, in formulating
  its recommendations.

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Consultations A broad range of participants from
peak national/state associations and local
stakeholders

• Hobart ? Sydney
• Launceston ? Adelaide
• Darwin ? Mt Gambier
• Alice Springs ? Perth
• Dubbo ? Kalgoorlie
• Canberra ? Melbourne
• Brisbane ? Wodonga
• Cairns

Indigenous groups including the National
Indigenous Health Equality Council Ministers
individual meetings State government officials
in all states and territories Round Table
thematic, with various groups and sectors
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• 400 Submissions
• Plus
• Health and Hospital Reform Commission
• House of Reps Inquiry into Obesity

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• Why act?
• Prevention of premature death and illness
• Do we risk the next generation of Australians
  living shorter lives?
• Improve workplace productivity and participation
• Better allocation of resources (decrease
  overloading of the health, welfare and police
  systems)
• The market as it currently works fails our health
  obesity is a commercial success and market
  failure

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• Put together, smoking, obesity, harmful use of
  alcohol, physical inactivity, poor diet and the
  associated risk factors of high blood pressure
  and high blood cholesterol cause approximately
  32 of Australias illness

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• Obesity Current Snapshot
• The number of overweight and obese adults
  increased from 4.6 million in 1989-90 to 5.4
  million in 2004-05.
• Approximately 25 of children are overweight or
  obese, up from an estimated 5 in the 1960s.
• The mean waist circumference increased between
  2000 and 2005, and weight increase was most
  pronounced in young adults, particularly women.
• The total financial cost in Australia of obesity
  alone, not including overweight, was estimated at
  8.3 billion in 2008.

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• We risk the next generation of Australians living
  shorter lives

Prevalence of overweight and obesity in
Australian children aged 7-15 years, 19852007.
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• Recent trends in Australian children predict
  that their life expectancy will fall two years by
  the time they are 20 years old, setting them back
  to levels seen for males in 2001 and for females
  in 1997.
• (As from Holman C and Smith F. Implications of
  the obesity epidemic for the life expectancy of
  Australians. Report to the Public Health Advocacy
  Institute of Western Australia 2008)

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• Tobacco Current Snapshot
• Tobacco use is currently the single biggest
  preventable cause of death and disease in
  Australia
• Smoking rates among Indigenous Australian are
  more than double those in the rest of the
  community
• Almost one in five pregnant women report smoking
  during pregnancy, including 42 of teenagers and
  52 of Indigenous women, posing serious risks to
  the mothers, and long-lasting and far-reaching
  effects on their offspring.

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• Alcohol Current Snapshot
• 83 of Australians are drinkers, and 1.4 million
  Australians consume alcohol on a daily basis.
  Overall per capita consumption of alcohol in
  Australia is high by world standards, with the
  country currently ranked within the top 30
  highest alcohol-consuming nations, out of a total
  of 180 countries.
• Consumption accounts for 3.2 of the total burden
  of disease and injury in Australia 4.9 in males
  and 1.6 in females.
• The annual tangible net cost to the Australian
  community from harmful drinking is estimated to
  be almost 11 billion.
• It is also estimated that alcohol is responsible
  for insurance costs totalling 14 million a year.

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Taking strategic and sustained action can

• prevent hundreds of thousands of premature deaths
  and chronic illness between now and 2020 and
  beyond
• minimise the impending overload of the health and
  hospital systems
• increase the productivity of Australias
  workforce
• assist in avoiding the health and social costs
  that would otherwise be incurred
• improve the health status of those who are most
  disadvantaged (especially Indigenous Australians)

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• The Strategy supports people to make healthy
  choices become
• the easiest
• the most common
• the most preferred choices
• ..It proposes the close engagement of
  governments, health groups, industry and other
  stakeholders

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• The Strategy sets out a phased roadmap for
  action that is
• Progressive
• Determined
• Comprehensive
• Sustained
• ..over the next ten years and
  beyond

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• Whats different?
• Comprehensive approach issues, key groups, etc
• Strategy phased, specific
• Formula (adaptable)
• Stretch targets but achievable
• Governmental commitment
• Responsive regulation

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• Whats missing?
• Three issues
• Havent solved all worlds problems..
• (But starting point remit as given other
  issues addressed in specific and
  infrastructure.etc.)

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• 2020 Targets

• Halt and reverse rise in overweight and obesity
• Reduce daily smoking from 16.6 to 10.0 or less
• Reduce the proportion who drink at short term
  harm from 20 to 14 and the proportion drinking
  at longer term harm from 10 to 7
• Contribute to the Close the Gap target for
  Indigenous people

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• What difference will the Strategy make?
• 1 million fewer Australians will smoke
• Premature deaths in almost 300,000 Australians
  now living will be prevented
• 330,000 fewer alcohol related hospitalisations
  can be achieved (at a cost saving of nearly 2
  billion to the national health sector by 2020)
• obesity can be stabilised at current levels -
  reduce an estimated 1.25 million deaths..and
  save half a million lives between now and 2050

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• Obesity - 10 linked steps
• 1. Drive environmental change
• - throughout the community to increase levels of
  physical activity and reduce sedentary behaviour
• 2. Drive change within the food supply
• - to increase availability and demand for
  healthier food products
• 3. Embed physical activity and healthy eating in
  everyday life

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• 4. Encourage people to improve their levels of
  physical activity and healthy eating
• - through comprehensive social marketing
• 5. Reduce exposure of children and others to
  marketing, advertising, promotion and
  sponsorship
• - of energy-dense, nutrient-poor foods and
  beverages
• 6. Strengthen, skill and support primary
  healthcare and public health workforce
• - to support people to make healthy choices

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• 7. Address maternal and child health
• - enhancing early life and growth patterns
• 8. Support low income communities
• - to improve their levels of physical activity
  and healthy eating
• Reduce obesity prevalence and burden among
  Indigenous Australians
• Build the evidence base, monitor and evaluate
  the effectiveness of actions

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Environmental change Key actions

• create a new Prime Ministers Active Living
  Council
• develop a business case for a COAG Active Living
  National Partnership Agreement
• conduct research on economic barriers and
  enablers, policies and tax incentives to inform a
  national active living framework and action plan

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Drive change within the food supply Key
actions

• develop a comprehensive National Food and
  Nutrition Framework
• commission a review of economic policies and
  taxation systems
• develop methods for using taxation, grants,
  pricing, incentives/subsidies to promote
  production, access to and consumption of
  healthier foods
• agree a Healthy Food Compact between governments,
  industry and health organisations
• introduce food labelling on front of packs and
  menus to support healthier food choices

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Workplace programs

• Introduce
• a national accord to establish best practice
  workplace programs
• a voluntary industry scorecard, benchmarking and
  awards scheme for workplace health
• nationally agreed accreditation standards for
  providers of workplace health programs
• action research to strengthen effective workplace
  health promotion programs
• a national workplace health leadership program
  with resources, tools and best practice
  guidelines

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School Programs

• Ensure
• HPE for all Australian children as part of the
  second stage of national school curriculum
  development
• a requirement for at least two hours of physical
  activity per week for students K10
• national program to support implementation of
  new curriculum, including guidance and
  professional development opportunities
• expanded coverage of out-of-school-care programs

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Community Programs

• Develop partnerships with
• COAG to develop a national series of
  comprehensive 5 year intervention trials
  including in disadvantaged and Indigenous
  communities
• ALGA eg local councils to adopt Healthy Spaces
  and Places planning guidelines
• Community leaders to develop a new Healthy and
  Active Families initiative

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Comprehensive social marketing Key actions

• work with states and territories to implement a
  comprehensive, sustained social marketing
  strategy to increase healthy eating, physical
  activity and reduce sedentary behaviour
• build on the Measure Up and Go for 2 and 5
  campaigns
• choose messages most likely to reduce prevalence
  in socially disadvantaged communities
• provide extra reach to these groups

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Exposure of children and others to marketing,
advertising, promotion and sponsorship of EDNP
foods and beverages Key actions

• phase out television advertising before 9pm and
  promotion to children and others of unhealthy
  food beverage products
• develop and adopt an appropriate set of
  definitions and criteria for determining EDNP
  foods and beverages
• introduce a responsive regulation approach to
  monitor and evaluate the impact of voluntary self
  regulation of childrens exposure to unhealthy
  food advertising

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Tobacco 11 steps for action

• 1. Make tobacco products significantly more
  expensive
• 2. Increase the frequency, reach and intensity of
  social marketing campaigns
• 3. End all forms of advertising and promotion of
  tobacco products
• 4. Eliminate exposure to second hand smoke in
  public places

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Tobacco

• 5. Regulate manufacturing and further regulate
  packaging and supply of tobacco products
• 6. Ensure all smokers in contact with health
  services are encouraged and supported to quit
• 7. Work in partnership with Indigenous groups to
  boost effort to reduce smoking and exposure to
  tobacco among Indigenous Australians
• 8. Boost efforts to discourage smoking in other
  highly disadvantaged groups

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Tobacco

• 9. Assist parents and educators to discourage
  tobacco use and protect young people from second
  hand smoke
• 10. Ensure the public, media, politicians and
  other opinion leaders remain aware of the need
  for sustained and vigorous action to discourage
  tobacco use
• 11. Ensure implementation and measure progress
  against and towards targets

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Make tobacco products significantly more
expensive Key actions

• Ensure that the average price of a packet of 30
  cigarettes is at least 20 (in 2008 terms)
  within three years
• Contribute to developing and implementing
  international agreements
• Introduce a national strategy to combat illicit
  trade of tobacco
• .Australia is one of the lowest tobacco
  countries
• in the OECD (16/18)

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Social marketing campaigns Key actions

• Increase the frequency, reach and intensity of
  social marketing campaigns
• Design messages and place media to ensure reach
  with young smokers and socially disadvantaged
  groups
• This does require dollars -
  but just like any
• good advertising we know it works

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Advertising and promotion Key actions

• end all remaining forms of advertising and
  promotion of tobacco products, including where
  feasible, through new and emerging forms of media
• amend legislation to ensure tobacco is out of
  sight in retail outlets
• eliminate the promotion of tobacco products
  through design of packaging

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Exposure to second hand smoke in public places
Key actions

• Amend current legislation to
• Prohibit smoking in any public place where
  children are likely to be exposed
• Ensure children are not exposed to tobacco smoke
  in cars
• Protect against second hand smoke in workplaces
  including outdoor areas

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Regulation of manufacturing, packaging and
supply Key actions

• Improve consumer information related to tobacco
  products
• Tighten and enforce legislation to eliminate
  sales to minors
• Governments to regulate design, contents and
  emissions and establish a regulatory body to
  advise on disclosure issues
• Investigate the feasibility of legal action by
  governments and others against tobacco companies

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Encouragement to quit Key actions

• Ensure state and territory healthcare services
  are smoke free, indoors and outdoors
• Increase availability of Quitline services and
  resource Quitline to respond to enhanced social
  marketing activity
• Ensure NRT is affordable for those for whom it is
  clinically appropriate

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Disadvantage Key actions

• Major focus on Indigenous smoking, including
  placing specialist Tobacco Control Workers in
  Indigenous community health organisations
• Support for other disadvantaged groups, such as
  people with mental health problems

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Support, monitoring and measuring progress Key
actions

• Ensure public is constantly alerted to
  information about tobacco and the impact of new
  research findings
• Establish a National Tobacco Strategy Steering
  Committee
• Address current gaps in surveillance systems to
  ensure targets are met

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Alcohol 8 key actions

• 1. Improve the safety of people who drink and
  those around them
• 2. Increase public awareness and reshape
  attitudes to promote a safer drinking culture
  in Australia
• 3. Regulate alcohol promotion
• 4. Reform alcohol taxation and pricing
  arrangements to discourage harmful drinking

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Alcohol 8 key actions

• 5. Improve the health of Indigenous Australians
• 6. Strengthen, skill and support primary
  healthcare to help people make healthy choices
• 7. Build healthy children and families
• 8. Strengthen the evidence base

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Improve safety Key actions

• harmonise liquor control regulations and
  implement best practice on nationally consistent
  approaches to policing and liquor control laws
• increase available resources for policing and
  enforcement of liquor control
• through COAG, develop a national partnership
  model of policing and enforcement

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Public awareness Key actions

• develop a comprehensive, sustained national
  social marketing and public awareness strategy,
  building on current state and federal campaigns

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Regulate promotions Key actions

• In a phased approach, phase out alcohol
  promotions
• - advertising during live sport broadcasts
• - advertising during high adolescent/child
  viewing times
• - sponsorship of sport and cultural events
• Introduce responsive regulation
• - monitor the voluntary approach to alcohol
  promotions agreed by MCDS (April 2009)
• - develop co-regulatory approaches where gaps
  in effectiveness are found
• - introduce legislation if co-regulatory
  approaches are ineffective

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Reform alcohol taxation and pricing
arrangements Key actions

• commission independent modelling for a
  rationalised (tiered, volumetric) tax and
  excise regime for alcohol that discourages
  harmful consumption and promotes safer
  consumption
• direct a proportion of revenue from alcohol
  taxation towards initiatives that prevent
  alcohol-related societal harm

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Other initiatives Key actions

• Develop a more comprehensive network of
  alcohol-related referral services and programs
  to support behaviour change in primary
  healthcare
• Increase access to health services for
  Indigenous people who are drinking at harmful
  levels and support locally developed
  initiatives in Indigenous communities
• Establish a multi-site trial of alcohol
  diversion programs

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Other initiatives Key actions

• Protect the health and safety of children and
  adolescent brain development
• Promote informed community discussion about the
  appropriate age for young people to begin
  drinking
• Support parents in managing alcohol issues at all
  stages of childrens development
• Improve systems of alcohol data collection
• Develop a set of essential indicators on alcohol
  consumption, health and social impacts

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Infrastructure Key actions

• Establish a National Preventive Health Agency
• Create a web-based clearing house for
  organisational plans achievements and conduct
  periodic surveys of barriers and enablers to
  action
• Establish a national recognition and awards
  scheme
• Undertake a workforce audit and develop a
  workforce strategy

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• Establish prevention as a priority for the
  Health Workforce Australia Agency
• Implement and extend the National Health Risk
  Survey program
• Develop a National Strategic Framework for
  preventive health research supported by
• strategic research fund
• research register
• network of research centres

Infrastructure
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REACTIONS
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Health Groups

• Very supportive
• Some wanted more
• Some minor comments re not addressing all social
  ills (rapidly countered by others)

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INDUSTRIES

• Tobacco opposed
• Alcohol largely opposed
• Food/junk food support education, etc. oppose
  restrictions, regulation, legislation

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GOVERNMENT

• Release September 1
• Open for comment
• Action already NPA
• Minister By not acting we are killing people
• Further responses later this year/early next year

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• Sitting on our hands is
• not an option
• Rob Moodie

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The Healthiest Country by 2020
National Preventative Health Strategy
www.preventativehealth.org.au