Output 1.6 - Early Intervention and Prevention

The aim of Output 1.6 to improve 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 such as obesity and diabetes

  • reducing risky health behaviours, such as smoking and alcohol consumption

  • maintaining high levels of immunisation.

Overview

ACT Health undertakes 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:

  • screening programs, such as BreastScreen, Cervical Screening and Newborn Hearing Screening

  • immunisation programs

  • health promotion programs and initiatives

  • behaviour-changing campaigns.

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.

Performance against accountability indicators

The ACT continued to achieve high childhood immunisation coverage in the general population. Coverage rates for children all three cohorts were consistently above the national average. The ACT achieved the highest coverage rate of all states and territories in all quarterly reports for children at 12 months of age.

In 2014–15, 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 (92.5 per cent, 93.1 per cent, 92.9 per cent and 92.9 per cent).

Well Women’s Checks were provided to 40 per cent of women from Culturally and Linguistically Diverse (CALD) communities. This is in line with the target of 40 per cent, which is an increase in target from 30 per cent in 2013–14. In collaboration with the Health Improvement Branch, which oversees the Cervical Screening register, eligibility criteria for Well Women’s Checks were reviewed to include:

  • young women who had previously not initiated a cervical screening test

  • women who have not been screened for over three years.

This is believed to be consistent with the eligibility criteria targeting vulnerable women.

93 per cent of children aged 0–4 years 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 90 per cent.

More information: For additional information, see C.6 Statement of performance, Output 1.6: Early Intervention and Prevention.

Promoting healthy lifestyle choices

The cessation of the National Partnership Agreement on Population Health (NPAPH) in the 2014–15 Federal Budget created significant funding shortfalls for health promotion programs. However, the ACT Government continued to support the majority of NPAPH-related programs for 2014–15 and has provided additional support in the 2015–16 budget through its Healthier Lifestyles initiative.

During 2014–15, Population Health Division continued to deliver initiatives aimed at improving the health of the population in a range of settings and population groups including children, families and workers.

Children

ACT Health delivers programs aimed at reducing the rates of overweight and obesity in children and young people aged 0–18 years.

The Kids at Play (Active Play) Program contributes to improved developmental outcomes for children aged three to five years in Early Childhood Education and Care (ECEC) services. Thirty-five ECEC services in Canberra participated in the program in July 2014.

Forty schools are involved in the Fresh Tastes: healthy food at school Program, which aims to improve student and teacher knowledge of and access to healthy food and drinks. Fresh Tastes provides curriculum support in:

  • nutrition education

  • growing food

  • healthy cooking

  • healthy food and drink options.

A number of businesses and community organisations partner and support the schools. Out of 50 school canteens assessed annually, over one-third showed a decrease in unhealthy food on their menus.

The Healthy Food at Sport Program aims to increase healthy food choices available to children and young people through sporting canteens. Fifty-two ACT primary schools are involved in the Ride or Walk to School (RWTS) Program, which aims to increase physical activity. The program is delivered by the Physical Activity Foundation through a Healthy Canberra Grant. It provides support for teacher professional development and workshops on:

  • bikes and helmets

  • self defence

  • BMX riding.

ACT Health continues to work with cross-government partnerships with other directorates to develop an extension of RWTS named Active Streets to trial infrastructure improvements around schools and identify strategies to better engage parents.

The It’s Your Move is a high school research intervention program conducted with Deakin University. It aims to increase physical activity and healthy eating and reduce unhealthy weight gain in young people aged 12–16 years. Numerous positive outcomes were demonstrated including improved student attitudes, knowledge and behaviours related to physical activity and nutrition. The rates of overweight and obesity in the target group decreased or remained stable over the study period. This program has informed the development of It’s Your Move phase two involving nine ACT high schools.

Families

The Good Habits for Life Program is a locally-developed behaviour change campaign, which targets families with young children, and encourages physical activity and healthy eating. The campaign website has received over 30,000 visits since its launch in November 2014.

Workers

ACT Health delivers programs to promote and support healthy lifestyles within, and through, ACT workplaces.

The ACT Healthier Work Service has been developed by Health Improvement Branch and implemented with WorkSafe ACT. It supports ACT workplaces to implement staff health and wellbeing programs. Over 100 local businesses are engaged in the program and over 50 businesses across a range of sectors achieved Healthier Work recognition. From 2015–16 onwards the Healthier Work Service will be delivered through Access Canberra.

ACT Health runs ‘my health’, which is a comprehensive staff health and wellbeing program Healthy Workers | ACT Health for the ACT Health workforce of over 6,000 employees. As a part of the program, ACT Health introduced the Healthy Food and Drink Choices Policy to increase the range and number of healthy food and drink choices available to staff, volunteers and visitors at ACT Health facilities and events. As a result:

  • drink vending machines are largely compliant with the policy

  • ‘junk food’ advertising has been removed from Canberra Hospital lifts

  • contracts for food outlets across ACT Health include a requirement to comply with the Policy.

Grants

The ACT Health Promotion Grants Program provided $1,838,730 in grants to a wide range of community-based organisations. The grants fund activities that help improve health outcomes and minimise the risk of developing chronic disease. The focus of grants funding has been on identified population health issues, including overweight and obesity, and smoking and alcohol-related harms.

Early intervention and prevention programs

BreastScreen ACT is part of a national population breast screening program that is aimed at reducing deaths from breast cancer through early detection.

More information: For detailed information about BreastScreen ACT, see the B.2 Performance analysis, Output 1.4: Cancer Services section.

During 2014–15, the ACT Cervical Screening Program:

  • promoted an updated message of ‘regular cervical screening test’ to community groups using print media, at women’s health events and through 98 per cent of general practices

  • delivered a radio advertising campaign to promote screening to women from the Aboriginal and Torres Strait Islander community, and women from non-English speaking backgrounds, in 21 language groups.

As part of the Commonwealth-funded National Bowel Cancer Screening Program (NBCSP), endoscopy services are provided to patients. In 2014–15, CHHS operated a colonoscopy pathway to support NBCSP participants for those referred to the service.

The School Youth Health Nurse works with a preventative focus in high schools including activities associated with:

  • early identification

  • brief intervention

  • harm minimisation.

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.

More information: For detailed information, see B.2 Performance analysis, Output 1.1: Acute Services Early intervention and prevention.

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. Work to increase awareness of this valuable service has seen demand grow by 60 per cent over 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

  • introduce them to appropriate services as soon as possible.

More information: For detailed information, see B.2 Performance analysis, Output 1.1: Acute Services, Early intervention and prevention.

The results of the kindergarten health checks are now sent to the family’s GP (if nominated on the consent form) for ongoing support.

The School Kids Intervention Program (SKIP) commenced as a pilot on March 2015. This program is for children 4–12 years who are overweight, either on the:

  • 85% percentile or above with co-morbidities or

  • 95% percentile without co-morbidities.

The program is family-oriented and incorporates multidisciplinary information, including

  • nutrition

  • paediatric (medical)

  • psychology

  • exercise physiology.

SKIP received 30 referrals in the three months since commencement.

The Dental Health Program collaborates with child and family centres to provide oral health information and support to families of young children. Key activities of this collaboration include:

  • conducting outreach dental assessments

  • facilitating dental appointments

  • educating parents.

The First Smiles Program promotes early intervention for young children with a strong focus on early childhood caries and dental trauma prevention and management. Dental assessments and information sessions are delivered to children at:

  • playgroups

  • preschools

  • community events, for example, Floriade.

ACT Health funded the ACT Medicare Local (now the Capital Health Network) to run a 12 month demonstration primary health care service aimed at disadvantaged ACT citizens attending the Early Morning Centre in the city. This commenced in June 2014 and continued throughout 2015.

Implementation of the ACT Primary Health Care Strategy 2011–2014 was completed in December 2014 with all 47 sub actions implemented or in progress. A new document to steer the direction of future primary health care-related activities in the ACT is being developed.

Immunisation rates

From the beginning of 2013, the Human Papilloma Virus (HPV) vaccine, Gardasil, was offered to boys and girls in Year 7. The catch-up program for male Year 9 students ceased in December 2014. The ACT remains above the national average in students receiving the full three-dose HPV vaccine. Preliminary data on the HPV vaccine administered through the school immunisation program indicates the following uptake rates for the 2014 calendar year:

  • Year 7 students: 78%

  • Year 9 boys: 66 %

Throughout the school year, the school-based immunisation program also provides students with booster doses of the:

  • varicella (chickenpox) vaccine

  • combined diphtheria, pertussis and tetanus vaccine.

During 2014–15, the Maternal and Child Health (MACH) Service delivered 11,838 early childhood immunisations.

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:

  • 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 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 all three of the assessable benchmarks (benchmarks 1, 3 and 4).

More information: For information on the status of Aboriginal and Torres Strait Islander immunisation, see Strategic Objective 14: Addressing Gaps in Aboriginal and Torres Strait Islander Immunisation Status.

Implementing the ACT Immunisation Strategy 2012–2016 continued, with work targeted at maintaining ACT immunisation coverage rates and reaching vulnerable community members.

Changes to the National Immunisation Program continue to be implemented within the ACT. One new change in 2015 is the expansion of the program to include providing the influenza vaccine free for all Aboriginal and Torres Strait Islander children aged six months to five years.

In March 2015, the Australian Immunisation Handbook (10th Edition) was amended to recommend that the pertussis (whooping cough) vaccine be provided for women in their third trimester of pregnancy. In April 2015, ACT Health introduced a funded Antenatal Pertussis Vaccination Program aimed at protecting both mother and her newborn from whooping cough. Vaccines and promotional materials were delivered to all GPs and antenatal clinics as part of the program.

PHD undertook a quarterly mail-out to parents of children who were recorded in the Australian Childhood Immunisation Register as overdue for immunisation, either because:

  • they have not been vaccinated or

  • their vaccination has not been recorded on the register by their immunisation provider.

The letter advised parents or guardians that their child was overdue for immunisation, reminded them of the importance of vaccination and enabled any administered but unrecorded vaccinations to be entered onto the register.

In March 2015, PHD commenced sending reminders to parents for their child’s upcoming four-year-old immunisation. In 2015–16, this will be expanded to include children due for their one-year and 18-months vaccinations.

Future directions

Promoting healthy lifestyle choices

ACT Health will continue to contribute strongly to implementing actions listed in the Towards Zero Growth: Healthy Weight Action Plan. The action plan is a crucial element of efforts aimed at reducing the burden of disease associated with overweight and obesity.

The PHD chairs the ACT Healthy Weight Initiative Food Environment Implementation Group (FEIG) and the Evaluation Implementation Group (EIG).

Under the auspices of the FEIG, additional drinking water fountains have been installed in public places to increase access to, and promote, drinking water.

The Minister for Heath accepted a report from the Heart Foundation ACT, which highlighted the extent of marketing of unhealthy food and beverages to children in the ACT. The EIG has made significant progress in:

  • improving the collection of biometric data in General Practice

  • collecting data in relation to the usage of ACT Government walking and cycling infrastructure.

Reducing risky behaviours

PHD will continue to focus on services and programs that prevent chronic disease and reduce related health care costs across the ACT community. The focus for 2015–16 will be on reducing lifestyle risk factors that lead to:

  • overweight and obesity

  • diseases such as cancer, diabetes and cardiovascular conditions.

The PHD will also focus on monitoring health trends and outcomes and making that data and evidence available in a timely and accessible fashion for decision-making.

Immunisation rates

PHD will continue to work with the Department of Health during 2015–16 to implement changes to the National Immunisation Program Schedule. A number of new vaccines are to be added to the schedule, including the Diphtheria, Tetanus, and Pertussis (DTP) booster for children aged 18 months, which will be added in October 2015.

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

  • investigating immunisation promotion opportunities with the Aboriginal and Torres Strait Islander community.