Output 1.6 Early intervention and prevention
Increasing the focus on initiatives that provide early intervention to, or prevent, healthcare conditions that result in major acute or chronic health care burdens on the community.
The key strategic priorities for intervention and prevention are reducing the level of youth smoking in the ACT and maintaining immunisation rates for children above 90 per cent.
ACT Health undertakes several activities aimed at increasing the focus on initiatives that provide early intervention to, or prevent, health conditions that may result in major acute or chronic health care burdens on the community.
Early intervention is managed in many ways including the Health Directorate screening programs such as BreastScreen, cervical screening, and newborn hearing screening, as well as through immunisation programs.
The Health Directorate supports a comprehensive range of programs aimed at primary prevention to reduce the onset, causes and complications of chronic diseases.
ACT Health primary prevention programs are aimed at better understanding, quantifying and preventing chronic disease across the wider ACT population.
- The ACT maintained its position as the jurisdiction with the highest life expectancy in Australia. Projections suggest that life expectancy in the ACT will continue to increase over coming years. By 2015, life expectancy at birth in the ACT is projected to be 83.1 years for males (up 2.4 years from 2007) and 86.5 for females (up 2.5 years from 2007). Cancer, mental disorders and cardiovascular disease are the leading contributors to the total burden of disease in the ACT, contributing nearly half of the total disease burden.
- ACT Health will receive $8.75 million in facilitation payments through the National Partnership Agreement on Preventive Health (NPAPH) from July 2010 to June 2018. The partnership has been extended within the existing funding envelope, to add a further three years, from June 2015 until June 2018. The NPAPH is aimed at stimulating action in preventing chronic disease. The NPAPH funds the delivery of five different initiatives: Social Marketing; Healthy Children; Healthy Workers; Healthy Communities; and Enabling Infrastructure.
- Social Marketing: In December 2012, an ACT-developed campaign, ‘Beyond Today...it’s up to you’ was launched to encourage healthy lifestyles and smoking cessation among the Aboriginal and Torres Strait Islander community.
- Social Marketing: In March 2013, information was sent to approximately 25,000 ACT residents aged 45-49 years to advise them of free health checks and the Get Healthy Service. Medicare Australia website data shows that the number of people claiming the health check Medicare Benefits Schedule items 701, 703, 705, 707 in the ACT in March–April 2013 had doubled compared to the same period in the previous year. Two weeks following the mail out, Get Healthy ACT data showed that the average number of participants joining the service had almost tripled.
- Healthy Children: ACT Health is receiving $4.09 million over seven years from July 2011, to deliver programs aimed at reducing the rates of overweight and obesity in children aged 0–18 years. These include:
- – Healthy food at school: an initiative to transform the healthy food and drink culture in ACT schools, in around 75 schools over the next five years. The program targets children from pre-school to Year 6.
- – It’s your move: a research intervention with Deakin University, targeting high schools to increase physical activity and healthy eating and aiming to reduce unhealthy weight gain in young people aged 12–16 years.
- – Ride or walk to school: an initiative to encourage riding and walking to school in a minimum of 60 schools over the next five years.
- Healthy Workers: ACT Health is receiving $3.66 million over seven years for the delivery of programs that promote and support healthy lifestyles in and through ACT workplaces. The Healthy Workers program has achieved the following in 2012‑13:
- – Healthier Work: The ACT Healthier Work Service was launched in May 2012 and has conducted site visits to over 100 ACT workplaces. A workplace incentives grants program was conducted in 2013 with 27 workplaces supported to initiate or consolidate staff health and wellbeing programs.
- – Public sector health promotion: In partnership with the Chief Minister and Treasury, ACT Health supported the development of an ACT whole-of-government Workplace Health and Wellbeing Policy which was endorsed in May 2012. It also implemented a comprehensive staff health and wellbeing program within ACT Health known as ‘my health’ and facilitated a staff survey and public consultation on the development of a healthy food and drink choices policy for staff, volunteers and visitors to ACT Health facilities.
- Healthy Communities Initiative (HCI): This initiative receives funding under the NPAPH and aims to reduce the prevalence of overweight and obesity among adults not in paid employment in the Inner North of Canberra. Achievements in 2012‑13 included:
- – increased coverage of programs such as Heart Foundation Walking and Heartmoves, to increase physical activity and improved nutritional intake
- – increased nutrition education by Community Health Dietitians, introduction of outreach clinics delivered by Continuing Care nursing and allied health staff, and improved food and nutrition intake through the Red Cross Foodcents program
- – increase in numbers of people participating in active recreation.
- Following a successful public consultation program, the Chief Minister announced a refocused Health Promotion Grants program. A new ‘Healthy Canberra Grants’ round will focus on tackling obesity across the population, and on improving children’s health, including improving eating habits through school canteens and food education. A new ‘Health Promotion Innovation Fund’ will be also be introduced. This fund will offer smaller value grant funding opportunities several times per year.
- The ACT Health Food and Nutrition Strategic Framework 2012–18 was released in September 2012. This framework highlights healthy eating and optimal nutrition as priorities for the Health Directorate and creates greater recognition of the importance of nutrition in optimising health outcomes.
- To effectively tackle rising rates of overweight and obesity, broad action is required beyond the traditional health sector to make healthy choices easier in our neighbourhoods, workplaces and schools. Under the Whole of Government Healthy Weight Initiative, all Directorates of the ACT Government are working together to develop and implement actions to increase physical activity and improve nutrition across the ACT population. The development of the ACT’s first whole of government action plan on obesity prevention is underway. The Whole of Government Healthy Weight Initiative was allocated $0.3 million under the 2012‑13 ACT budget over three years.
- The ACT continued to achieve high childhood immunisation coverage in the general population. Coverage rates for children in all three cohorts were consistently above the national average. In 2012‑13, ACT childhood immunisation coverage rates remained above the national target of 90 per cent for 12-month-old children. ACT Health’s target of 92 per cent of 1-year-old children being fully immunised was exceeded in all quarters (93.1 per cent, 93 per cent, 92.5 per cent and 92.6 per cent).
- In July 2009 the National Partnership Agreement on Essential Vaccines was implemented. The objective of this Agreement is to improve the health and wellbeing of Australians through the cost-effective delivery of the National Immunisation Program. The Agreement sets out performance benchmarks that must be achieved for the ACT to be eligible for an incentive payment. The performance benchmarks associated with the essential vaccines Agreement are:
- maintaining or increasing vaccine coverage for Indigenous Australians
- maintaining or increasing coverage in agreed areas of low immunisation coverage
- maintaining or decreasing wastage and leakage
- maintaining or increasing vaccination coverage for 4-year olds.
- The ACT cannot be assessed against benchmark 2 (maintaining or increasing coverage in agreed areas of low immunisation coverage), as the ACT does not have any identified areas of low immunisation coverage.
- In 2012‑13 the ACT achieved two of the three assessable benchmarks—maintaining or decreasing wastage and leakage (benchmark 3) and maintaining or increasing vaccination coverage for 4-year olds (benchmark 4).
- The ACT did not meet the performance benchmark 1, maintaining or increasing vaccine coverage for Indigenous Australians. The ACT only improved on the immunisation rates for Aboriginal and Torres Strait Islander children in the 4-year cohort. There was a drop in immunisation coverage for Aboriginal and Torres Strait Islander children at 12–15 months and 24–27 months. As there are very low numbers of Aboriginal and Torres Strait Islander children in each cohort the coverage data can fluctuate widely. For the period 1 April 2011 to 31 March 2012 the mean immunisation coverage for Aboriginal and Torres Strait Islander children in the ACT was:
- – 12–15 months—81.5 per cent
- – 24–27 months—91.6 per cent
- – 60–63 months—91.0 per cent.
- For the period 1 April 2010 to 31 March 2011, the mean immunisation coverage for 4-year old children in the ACT increased by 0.9 per cent from the previous year and was 92.3 per cent.
- The ACT Immunisation Strategy 2012–2016, was launched on 17 December 2012. It aims to expand the focus of immunisation to whole of life and to reduce hospital admissions for vaccine preventable diseases, particularly in high-risk groups. The primary objectives of the Strategy are to:
- – ensure the ongoing appropriateness, quality, safety and effectiveness of the ACT immunisation program
- – maintain or improve our current immunisation coverage
- – maintain or decrease our current levels of vaccine-preventable diseases in the Canberra community, thereby decreasing the pressures on primary health care such as GPs, walk in centres and tertiary health facilities such as hospitals, especially emergency departments
- – support and maintain the current high quality immunisation workforce with education and resources.
- As pregnant women are at higher risk of severe disease from influenza, the vaccine is recommended and funded for all pregnant women. There has historically been a low uptake of the influenza vaccine with pregnant women. To increase the influenza vaccination rates Health Protection Service liaised with the maternity units of TCH, Calvary and John James. Influenza promotion to parents and education to staff was provided. The vaccine is now offered to all women who are admitted to the antenatal units or outpatients of the antenatal clinics at TCH. Posters have also been provided to General Practitioners, obstetricians, child care centres and libraries.
- The Human Papillomavirus (HPV) vaccination program for boys commenced in 2013 and is offered to 12–13 year old boys (Year 7) via a school program with a two-year catch-up component for boys in Year 9. Under the National Immunisation Program (NIP) boys in Year 7 are eligible to receive the funded vaccine. As part of a catch-up program, boys in Year 9 in 2013 and 2014 are also being offered the vaccine. The vaccine is administered by the school health team. Boys in Year 10 and above who are 15 years of age or younger are able to access the vaccine through their general practitioner.
- To promote this new vaccination program the Health Protection Service and the Division of Women, Youth and Children provided communication to stakeholders which included:
- – letters and information to General Practitioners and general practice staff
- – articles in the ‘Immunisation Newsletter’
- – media releases, education events and information on the ACT Health website.
- HPV vaccination course consists of three vaccinations. The administration of the first dose of the HPV vaccination program was completed by May 2013. A total of 5,739 doses of vaccine were administered to eligible students. Preliminary data indicates that the following coverage rates have been achieved for the first dose:
- – Year 7 girls—82.5 per cent
- – Year 7 boys—79.2 per cent
- – Year 9 boys—72.0 per cent.
- The Cervical Screening Program captures and reports data over a 2-year period as recommended by the National Cervical Screening Program. As of 30 June 2013, the ACT participation rate for the target population was 57.14 per cent. The AIHW report, Cervical Screening in Australia 2010–2011, again puts the ACT in the top three jurisdictions in Australia for participation in cervical screening and first overall in Australia for the five-year participation rate.
- During 2012‑13, the Cervical Screening Program actively promoted cervical screening among community groups. The main message in this promotion is for young women to continue screening even if they have been vaccinated against HPV. Program staff have attended several notable women’s health promotional events around the ACT to promote screening in the community. In addition several print media campaigns were implemented to promote screening among women in community publications as well as ACT Government publications targeting ACT Government staff. Several new brochures were designed and produced.
- BreastScreen ACT & SE NSW is part of a national population breast screening program that is aimed at reducing deaths from breast cancer through early detection. Further information can be found under Cancer Services on page 160 of this report.
- Newborn Hearing Screenings are provided to every newborn in the ACT and aim to identify babies born with significant hearing loss and introduce them to appropriate services as soon as possible. Further information can be found under Division of Women, Youth and Children on page 143 of this report. School-based nursing programs include immunisations and kindergarten health checks. The School Youth Health Nurse Program promotes positive health outcomes for young people by providing access to a nurse in the high school setting. Further information can be found under Division of Women, Youth and Children on page 143 of this report.
- As part of the Commonwealth-funded National Bowel Cancer Screening Project, endoscopy services are provided to patients. Further information can be found under Division of Medicine on page 133 of this report.
- Forty per cent of all Well Woman’s Checks were provided to women from culturally and linguistically diverse backgrounds. This is above the target of 30 per cent, and is the same result as in the 2011‑12 period.
- Ninety-six per cent of eligible children aged 0 to 14 who entered substitute and kinship care in the ACT were seen by the Child at Risk Health Unit’s Out-of-Home Care Clinic. This is above the target of 80 per cent, and an increase of 16 per cent from the 2011‑12 period.
- In May 2013, the ACT Minister for Health endorsed the ACT Chronic Conditions Strategy—Improving Care and Support 2013–2018, building on the previous strategy. The ACT Chronic Conditions Strategy—Improving Care and Support 2013–2018 sets the direction of care and support for those living with chronic conditions in the ACT and outlines a collaborative approach to this vitally important area of healthcare. Implementation and evaluation of the Strategy is being overseen by the ACT Primary Health and Chronic Disease Steering Committee.
Issues and challenges
- The immunisation coverage rates for Aboriginal and Torres Strait Islander children in two of the three cohorts (12–15 months and 24–27 months) decreased in 2012‑13.
- The very low numbers of Aboriginal and Torres Strait Islander children in the ACT means that ACT Aboriginal and Torres Strait Islander coverage data should be read with caution as the immunisation coverage rates can fluctuate greatly. Coverage rates can vary dramatically between cohorts and between reporting periods.
- Increasing and maintaining high immunisation coverage rates in Aboriginal and Torres Strait Islander children will continue to be a challenge. The Health Protection Service is actively pursuing different strategies to increase immunisation rates for Aboriginal and Torres Strait Islander children including: phone contact with children identified as overdue for immunisations, discussions with stakeholders, liaising with Winnunga Nimmityjah Aboriginal Health Service and investigating immunisation promotion opportunities with the Aboriginal and Torres Strait Islander community.
- Working collaboratively with the ACT Medicare Local, Closing the Gap unit to produce resources and educate communities on the importance of immunisation.
- Health Protection Service undertakes a quarterly mail-out to parents of children who are recorded in the Australian Childhood Immunisation Register as overdue for immunisation. This letter advises parents or guardians that their child is overdue for immunisation, reminds them of the importance of vaccination and enables any administered but unrecorded immunisations to be entered onto ACIR.
- Following the successful implementation of the Whole of Government Healthy Weight Initiative, the ACT Government will commence collaborative action to reduce the burden of injury on the ACT population. Injury accounts for approximately 7 per cent of the burden of disease in the ACT, and addressing this issue is pivotal to reducing the incidence of premature mortality, chronic disability and the associated health system costs.
- The Minister for Health launched Future Directions for Tobacco Reduction 2013–2016 on World No Tobacco Day (31 May 2013). The purpose was to inform the Canberra community of the 12 initiatives proposed by ACT Health in tobacco control. These initiatives aim to investigate restricting access to tobacco to reduce demand and control supply and restricting places of tobacco use. The areas that will be looked at include outdoor areas at public swimming pools, children’s playgrounds, among many others, where measures could be taken to reduce smoking and protect non-smokers from the effects of environmental tobacco smoke. The timeframes are outlined in Future Directions, with work on each initiative phased over the life of Future Directions.
- In 2012 the Population Health Division was successful in winning an Australian Research Council Grant in partnership with the Australian National University. This grant will enable the development of methods by which research in population health can be better used by policy-makers. In 2012‑13 work began with decision-makers and policy advocates to identify barriers to the uptake of research evidence in population health and to develop a training model to improve processes by which researchers and policy-makers work together. Tools to assist policy-makers use evidence will be developed following this study.