Output 1.6-Early intervention and prevention
Improving the health and wellbeing of the ACT population through a range of programs, services and initiatives, focused on early intervention, prevention and health promotion. The key strategic priorities for early intervention and prevention include encouraging and promoting healthy lifestyle choices to decrease the rates of conditions like obesity and diabetes and reducing risky health behaviours such as smoking and alcohol consumption and maintaining high levels of immunisation.
ACT Health undertakes several activities aimed at increasing the focus on initiatives that provide early intervention to health conditions that may result in major acute or chronic health care burdens on the community.
Early intervention is managed in many ways, including ACT Health screening programs such as BreastScreen, Cervical Screening and Newborn Hearing Screening, as well as immunisation programs.
ACT Health 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 quantifying and preventing chronic disease across the ACT population.
- The ACT maintained its position as the jurisdiction with the highest life expectancy in Australia. In 2012, the life expectancy of ACT residents was 81.2 years for males and 85.1 years for females. 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 continued to work to the National Partnership Agreement on Preventive Health (NPAPH). This was a funded initiative from 2010 due to run until 2018. However, the Federal Budget for 2014-15 ceased the funding from 1 July 2014. Aimed at stimulating action in preventing chronic disease, the NPAPH funded the delivery of five different initiatives. NPAPH-funded initiatives progressed during 2013-14 were:
- Healthy Children: ACT Health delivered programs aimed at reducing the rates of overweight and obesity in children aged 0-18 years. These included:
> Kids at Play (Active Play): contributes to an increase in active play by children aged three to five years in Early Childhood Education and Care (ECEC) services in the ACT. The 2013 Kids at Play (KAP) Repeat Impact Evaluation undertaken with the Heart Foundation reported that during phase 3 of Kids at Play (June 2012 to September 2013) 156 educators from 39 ACT ECEC services were involved in 17 KAP training sessions, and 104 activity van visits were delivered to 62 Long Day Care (LDC) services, three Family Day Care (FDC) schemes, one independent preschool, eight playschools and 12 ACT Government preschools.
> Fresh Tastes: healthy food at school: aims to increase knowledge and availability of healthy food and drinks in ACT primary schools. Twenty-four schools signed up to the three-year Fresh Tastes program in the first six months of recruitment. Fifty-nine schools undertook a menu assessment, with 17 of these having had an annual menu review showing a 34 per cent decrease in 'red' or unhealthy foods and a 20 per cent increase in 'green' or healthy foods.
> Ride or Walk to School (RWTS): encourages primary school students across the ACT to ride or walk to school. Twenty schools developed action plans. Physical Activity Foundation received an ACT Health Healthy Canberra Grant to implement the RWTS program in 30 more schools. Four cycling related professional development workshops were implemented for 49 teachers. The Health Improvement Branch continued to work across government to increase the number of children able to ride or walk to school , including developing RWTS maps for eight schools, with another 10 maps under development.
> It's Your Move ACT: this research intervention with Deakin University targets high schools to increase physical activity and healthy eating and aims to reduce unhealthy weight gain in young people aged 12-16 years. Results of this research are expected by the end of 2014. Across the three implementation schools there are significant changes to improve health and wellbeing of students and staff, including an increase in physical activity opportunities, changes to the food environment in the schools, and policy guidelines written to restrict 'red' or unhealthy food and drink availability in school.
> Healthy Food@Sport: aims to increase healthy food choices available to children and young people through sporting canteens. The program worked with 19 clubs in 2013-14. An evaluation of the pilot clubs is currently underway.
- Healthy Workers: ACT Health delivered programs to promote and support healthy lifestyles in and through ACT workplaces.
> Healthier Work: ACT Healthier Work undertook site visits to 42 individual ACT workplaces. The external evaluation of Healthier Work continues to inform service strategies. To further enhance workplace engagement, a Healthier Work Recognition Scheme was developed along with additional capacity-building activities, such as networking sessions and health and wellbeing training.
> Public sector health promotion: ACT Health continued to support the ACT whole-of-government Workplace Health and Wellbeing Policy through the implementation of a comprehensive staff health and wellbeing program known as 'my health' for ACT Health employees. A key achievement was the endorsement in December 2013 of the Healthy Food and Drink Choices Policy for ACT Health staff, volunteers and visitors to ACT Health facilities. The policy is being implemented gradually, so that by March 2015 staff, food outlet operators and vending machine suppliers will have had time to make the necessary changes.
- Healthy Communities Initiative (HCI): The initiative aimed to reduce the prevalence of overweight and obesity among adults not in paid employment in the Inner North of Canberra and received its final funding under the NPAPH for the year ended 30 June 2014. Achievements included:
> delivering the Australian Red Cross FOODcents program in partnership with Community Health Dietitians to service providers and community members through a mix of training, education sessions and development of resources. This builds the capacity of this workforce to provide nutrition advice to clients they work with.
> increasing the number of people participating in active recreation.
> neighborhood gardens in public housing complexes providing improved access to fresh produce as well as increasing social connectedness and community safety.
> providing outreach mini-health checks for marginalised communities, including flu vaccinations and improved referral pathways to primary health care.
- Social marketing: Achievements included the ongoing promotion of the ACT-developed campaign, 'Beyond Today... it's up to you' to encourage healthy lifestyles and smoking cessation among the Aboriginal and Torres Strait Islander community.
- The refocused ACT Health Promotion Grants Program opened its two new funding opportunities for applications on 24 August 2013. Healthy Canberra Grants focus on tackling obesity across the population and on improving children's health, including improving eating habits through school canteens and food education. The Health Promotion Innovation Fund focuses on the same priorities as the Healthy Canberra Grants and offers smaller value grant funding opportunities several times per year.
- The Towards Zero Growth: Healthy Weight Action Plan was launched by the Chief Minister on 14 October 2013. Since then, implementation groups comprising representatives from all ACT Government directorates, key nongovernment organisations and academic institutions have been working collaboratively to implement the actions in the plan.
- Responsibility for the coordination and oversight of the Healthy Weight Initiative and implementation of the actions listed in the action plan was formally transferred from ACT Health to the Chief Minister and Treasury Directorate in May 2014.
- The Health Protection Service undertook consultation from 21 March to 12 May 2014 as part of Future Directions for Tobacco Reduction in the ACT. Submissions were welcomed on options for restricting access to tobacco through increased tobacco licence fees and changes to licensing schemes. Section B.3 Community engagement in this report contains more information on the consultation.
- 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 2013-14, 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 one-year-old children being fully immunised was exceeded in all quarters (92.7 per cent, 93.3 per cent, 92.7 per cent and 93.4 per cent).
- The National Partnership Agreement on Essential Vaccines 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:
i. maintaining or increasing vaccine coverage for Indigenous Australians
ii. maintaining or increasing coverage in agreed areas of low immunisation coverage
iii. maintaining or decreasing wastage and leakage
iv. maintaining or increasing vaccination coverage for four-year-olds.
The ACT cannot be assessed against benchmark 2, as the ACT does not have any identified areas of low immunisation coverage.
In 2013-14 the ACT achieved three of the three assessable benchmarks (benchmarks 1, 3 and 4).
- Implementation of the ACT Immunisation Strategy 2012-2016 continued, with work targeted at maintaining ACT immunisation coverage rates and reaching vulnerable community members.
The Human Papillomavirus Vaccination Program for boys commenced in 2013 for boys aged 12 to 13 (in Year 7) through a school-based immunisation program, with a two-year catch-up component for boys in Year 9.
Preliminary data on HPV vaccine delivered through the school immunisation program indicates the following uptake rates for the 2013 calendar year:
- Year 7 girls: 80.2 per cent
- Year 7 boys: 78.7 per cent
- Year 9 boys: 68.7 per cent.
- The Cervical Screening Program captures and reports data over a two-year period as recommended by the National Cervical Screening Program. At 30 June 2014, the ACT participation rate for the target population was 58.04 per cent. The Australian Institute of Health and Welfare (AIHW) report Cervical screening in Australia 2010-2011 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 2013-14, the Cervical Screening Program actively promoted an updated message about regular cervical screening to community groups and to reflect the change recommended by the Australian Government Medical Services Advisory Committee (MSAC) in late April 2014. Several print media campaigns were implemented to promote the updated screening message among women in the community. Brochures were also updated to reflect this change. Program staff attended notable women's health events in the ACT to promote screening, including the Women's Health Information Forum organised by Women's Centre for Health Matters (WCHM) and the Control and Choice Expo 2014 organised by Advocacy for Inclusion for people with disabilities.
- During 2013-14, Population Health Division commenced a partnership with the Australian National University, after winning an Australian Research Council grant in 2012. This grant will enable the development of methods for policymakers to better use research in population health. In 2013-14 the academic partners held interviews with decision-makers and policy advocates and implemented an online survey 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 policymakers work together. Tools to assist policymakers to use evidence will be developed following this study. As part of this study, a PhD student commenced a Research Translation Internship placement in the Population Health Division.
- ACT Health is a founding funding partner in the National Health and Medical Research Council's The Australian Prevention Partnership Centre (TAPPC). TAPPC focuses on the interrelation of health and non-health systems with regard to primary prevention and chronic health problems and will undertake an integrated program of work designed to enable policy and program developers to make better decisions about the strategies and structures to prevent lifestyle-related chronic conditions in Australia. The work of TAPPC aligns well with the key ACT Government initiative Towards Zero Growth: Healthy Weight Action Plan.
- BreastScreen ACT 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 in the section Output 1.4 Cancer Services on page 52 of this report.
- School-based nursing programs:
- Immunisations: From the beginning of 2013, the HPV vaccine, Gardasil, was offered to boys in Year 7 as well as girls, with the catch-up program for male Year 9 students ending at the end of 2014. The average uptake of this vaccine in the male student population has been 80 per cent.
- Kindergarten health checks: For the first time in 2014, the results of the kindergarten health check are being sent to the family's GP (if nominated on the consent form) for ongoing support.
- The School Youth Health Nurse works in high schools with a preventive focus, including early identification, brief intervention and harm minimisation activities. The nurse is often the first point of contact for young people, their families and school community members seeking information, advice and support in health matters. Further information can be found in section B.2 under Division of Women, Youth and Children on page 68 of this report.
- The Asthma Nurse Educator Service provides asthma education and support to children, young people, families and community groups. The focus is on clients understanding and managing their asthma to prevent acute episodes. The demand for this service has increased by 60 per cent in the last five years.
- 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 68 of this report. As part of the Commonwealth-funded National Bowel Cancer Screening Program, endoscopy services are provided to patients. Further information can be found in section B.2 under Division of Medicine on page 34 of this report.
- Well Women's Checks were provided to 42 per cent of women from culturally and linguistically diverse communities. This is above the target of 30 per cent, and an increase of 2 per cent from the 2011-12 period.
- 100 per cent of children aged 0 to 14 who entered substitute and kinship care in the ACT were referred to 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 10 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 strategy 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 health care. Implementation and evaluation of the strategy is being overseen by the ACT Primary Health and Chronic Condition Steering Committee (PH&CCSC).
- The ACT Minister for Health launched the ACT Primary Health Care Strategy 2011-2014 on 14 December 2011, building on the previous Primary Health Care Strategy and setting the direction for primary health care into the future. The strategy aims to improve integration between general practice and the wider healthcare sector in provision of primary health care. The strategy has been developed within the context of the outcomes of the Council of Australian Governments (COAG) health reforms and a range of existing health-related strategies and plans. Implementation of the strategy is being overseen by the ACT Primary Health and Chronic Condition Steering Committee (PH&CCSC).
Issues and challenges
- 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 parents of 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. The Health Protection Service has been working collaboratively with the ACT Medicare Local Closing the Gap unit on the production of immunisation resources and education for relevant communities.
- The 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, either because they have not been vaccinated or because their vaccination has not been recorded on the register by their immunisation provider. 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 vaccinations to be entered onto the register.
- Health Promotion will continue to focus population-based health promotion initiatives on contributing to the ACT Government Healthy Weight Initiative in both children's settings and workplace settings. This will include the launch of a social marketing campaign targeting parents of children to increase engagement in healthy lifestyle behaviours.