The Chronicle
Volume 27, Issue 3, october 2016 PublIcatIon of the chronIc DIseases network
IN THIS ISSUE...
+ From the CDN Team...p1 + 2016 Conference...p1 + 2016 Conference Keynote
Speaker Abstracts...p4 + NT CDN Recognition Awards 2016...p5 + 2012-2013 Annual Progress Report of the NT CCPMS 2010- 2020...p7 + NT & Far North Qld Diabetes in Pregnancy Partnership...p8 + Healthy Under 5 Kids - Partnering with Families Pilot...p10 + 2015 Market Basket Survey...p11 + Menzies Media Release...p12 + Australian Indigenous
HealthInfoNet Media Release..p13 + Chronic Condition Journal Articles of Interest...p14
The Chronic Diseases Network was set up in 1997 in response to the rising impact of chronic conditions in the NT. The Network is made up of organisations and individuals who have an interest in chronic conditions.
These include:
• Aboriginal Medical Services of the
• NTArthritis & Osteoporosis Foundation of the NT
• Asthma Foundation of the NT
• Cancer Council of the NT
• Healthy Living NT
• Heart Foundation - NT Division
• Medicare Local NT
• Menzies School of Health Research
• NT Health
The Chronic Diseases Network
nt Department of health
The Chronicle CDN Editorial Committee
Chronic Disease Network T: 08 8985 8174
Contributions appearing in The Chronicle do not necessarily reflect the views of the editor or DoH.
Contributions are consistent with the aims of the Chronic Diseases Network and are intended to:
• Inform and stimulate thought and action
• Encourage discussion and comment
• Promote communication, collaboration, coordination and collective memory
From the CDN team
Welcome to the final edition of The Chronicle for 2016.
Thank you to all who have provided articles for the three editions this year.
And a further thank you to the Editorial Committee for all your assistance.
It has been fantastic to get The Chronicle back up and running.
Look out for us in 2017!
The Public Health Association of Australia 44th Annual Conference and 20th Chronic Diseases Network (CDN) Conference 2016 was held in Alice Springs from 18 to 21 September 2016.
Over 300 delegates from the Northern Territory, Australia and beyond attended the conference themed ‘Protection, Prevention, Promotion’ - Healthy futures: Chronic conditions and public health. This theme was derived from World Federation of Public Health Associations Global Charter for Public Health, focusing on protection, prevention and promotion. The conference presented the fields of both public health and chronic conditions.
Continued on Page 2 Conference Partners Banners Conference Satchel
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Over the two and a half days, the conference showcased 12 keynote speakers, one oration address, 73 concurrent sessions, 15 tabletop presentations, and 35 poster displays.
The conference was opened by Hon. Catherine King MP, Federal Shadow Minister for Health and Hon. Dale Wakefield MLA, NT Minister for Territory Families. The opening address was presented by Janet Anderson, Acting Chief Executive NT Department of Health.
Featured within the conference program was a Dangerous Consumptions Panel. Keynote speakers discussed briefly their topic and then took questions from the audience.
Panellist included:
• Professor Heather Yeatman (Head, School of Health and Society and Professor in Public Health and Population Health) presenting
‘Eating can kill you!’, we all must eat but what to eat and how much has become problematic.
• Dr John Boffa (Chief Medical Officer Public Health, Public Health Division, Central Australian Aboriginal Congress) presenting
‘Damming the Rivers of Grog’, alcohol consumption statistics and discussing the evidence of effective strategies to reduce the levels of dangerous consumption.
• Associate Professor Diana Egerton-Warburton (Director of EM Research, Monash Medical Centre, Monash Health and Adjunct Clinical Associate Professor, Monash University) presenting ‘Alcohol harm in emergency departments’, the highlights of the ACEM Alcohol Harm project.
• Dr Devin Bowles (Executive Director, National Alliance for Action on Alcohol) presenting ‘Advocacy and alcohol case study: The Fizzer Awards’, examining the media campaign by the National Alliance for Action on Alcohol The Fizzer Awards to educate the public about how government action could reduce alcohol related harm.
Another feature in the conference program was the specific Aboriginal and Torres Strait Islander health stream that ran throughout the conference program.
A few highlighted abstracts were:
• ‘Uti Kulintjaku Iwara: the path to clear thinking’ (Speaker Emma Trenorden), a project initiated by senior Anangu women concerned about the wellbeing of young people in their communities.
• ‘Indigenous Australians using technology to stay strong while living with chronic disease: The Stay Strong App’ (Speaker Michelle Sweet), an App culturally adapted tabled-based application designed for health professionals to use with Indigenous clients in primary care settings to address mental health and wellbeing concerns.
• ‘An innovative approach to improving infant food supplies in remote Central Australia’ (Speaker Sophie Nolan), CAHS pilot study undertaken across four remote stores with an aim to improve infant food supply by increasing awareness of the Guidelines for Supply of Infant Food in Remote Stores.
• ‘Family Tree of Chronic Conditions’ (Speaker Robyn Jones), a culturally- appropriate visual resource and DVD to help explain how chronic conditions occur which has been piloted in four Aboriginal communities in the top end.
• ‘Impact of obesity on chronic disease in Top End young adults’ (Speaker Gurmeet Singh), findings of two longitudinal studies were presented showing
obesity is a major risk factor of chronic disease risk and is increasingly seen in later years.
Continued on Page 3 Continued from Page 1
Dangerous Consumption Panel on Day 2
Conference Program
Publication of The Chronic Diseases Network
This year, the Australian Government Department of Health funded 47 Aboriginal and Torres Strait Islander delegates to attend the conference. These delegates were sponsored with conference registration, travel and accommodation.
Delegates originated from rural and remote communities such as Maningrida, Gove and Mount Isa. The support provided to these delegates from the Australian Government Department of Health was greatly appriciated.
The conference included other networking events such as exhibition booths, a Conference Welcome Reception, NT CDN Recognition Awards evening and Conference Dinner at Ooraminna Station Homestead.
Thank you also to the 2016 Conference Sponsors.
For featured Conference Keynote Speakers, please see Page 4
For information on the NT CDN Recognition Awards 2016 and winners, please see Page 5
Further information on the conference can be found at:
https://phaa.eventsair.com/QuickEventWebsitePortal/phaa-cdn-conference/eis Continued from Page 2
Australian Government DoH Sponsored Delegates
Conference Welcome Reception
Conference Dinner at Ooraminna Station Homestead
View of the MacDonnell Ranges from the Alice Springs Convention Centre
The Chronicle
‘We only have one chance – What Public Health has to do’
Professor Bettina Borisch, Professor of Social and Preventative Medicine, University of Geneva and Executive Director of the World Federation of Public Health Associations Headquarter Geneva
Public Health is a broad, multiprofessional, intersectorial and interdisciplinary field. This is at the same time its beauty and strength and its weakness and problem. In terms of recognition and reputation, PH has frequently the Cinderella role in the fairy tale; the era of biotechnological inputs around health has overshadowed the advances that PH has brought - and will still bring - to societies. I’ll present on how today’s global setting is urging us to go out and seek for alliances to get the policy makers on the way that will assure health for all.
‘Social determinants in Health Departments: The health systems’s role in action on social determinants (and why health ministers can’t fob determinants off as too hard, or somebody else’s problem)’
Mr Martin Laverty, Chief Executive Officer, Royal Flying Doctors Service
Most thinking on social determinants of health revolves around observation of problems, rather than offering of solutions. Offering a review of recent evidence on what social determinant interventions have been shown to improve health outcomes, Martin Laverty will endeavour to propose an action plan for health departments to take the next step in action on social determinants.
‘An integrated model of child and family services as a core part of comprehensive primary health care’
Ms Donna Ah Chee, Chief Executive Officer of the Central Australian Aboriginal Congress Aboriginal Corporation Aboriginal infant mortality rates have declined in Alice Springs over the past 40 years. This partly reflects the success of the Central Australian Aboriginal Congress and the hospital system in improving maternal and child health over the years. Aboriginal community controlled primary health care services (ACCPHCS) like Congress have a special relationship with families in pregnancy and in the early years up to Pre-school because of an ongoing relationship built on trust. Furthermore, ACCPHCS’ provide a holistic integrated model for comprehensive child and family services that targets parents and the child through centre-based and outreach services.
‘Accountability and action for chronic disease prevention in Australia’
Ms Rosemary Calder AM, Director, Australian Health Policy Collaboration
‘The state of reconciliation in Australia – Our history, our future, our story’
Mr Justin Mohamed, Chief Executive Officer, Reconciliation Australia
In the 25 years since CAR was established, the concept of reconciliation has taken a holistic approach that encompasses rights, as well as so-called symbolic and practical actions. Over this time, reconciliation has introduced a greater focus on the relationship between Aboriginal and Torres Strait Islander peoples and non- Indigenous Australians and opened up national debate on prejudice, discrimination and racism. It has raised broader questions about our national identity
and the place of Aboriginal and Torres Strait Islander histories, cultures and rights in our nation’s story.
Reconciliation can no longer be seen as a single issue or agenda and the contemporary definition of reconciliation must weave all of these threads together. Reconciliation Australia have defined reconciliation as five key dimensions; race relations, equality and equity, institutional integrity, unity and historical acceptance. These five dimensions do not exist in isolation. They are interrelated and Australia can only achieve full reconciliation, including health equality, if we make progress in all five areas. The nation’s progress towards reconciliation is only as strong as the least advanced dimension.
‘Rheumatic Heart Disease – Australia’s public health challenge’
Professor Elizabeth Sullivan, Assistant DVC (Research)/
Professor of Public Health, Deputy Vice-Chancellor (Research)
‘Doing old business in a new way’
Mr Rohan Corpus, State Manager – Indigenous Cardiac Outreach Program (ICOP), Queensland Health
Indigenous Health in the hands of Aboriginal & Torres Strait Islander people is pivotal to closing the health gap. Further significance, is the importance on Indigenous Australians leading & influencing Health Outcomes.
‘How the Gap is not closing and solutions to rectify this’
Professor Gracelyn Smallwood, Adjunct Professor at James Cook University and Professor at Central Queensland University
Copies of some keynote speaker presentations and con- current session presentations have been made available on the official conference website:
https://phaa.eventsair.com/QuickEventWebsitePortal/
phaa-cdn-conference/eis/Agenda
2016 Conference Keynote Speakers
Publication of The Chronic Diseases Network
NT Chronic Diseases Network Recognition Awards 2016
The Awards were held at the Alice Springs Convention Centre on Monday 19 September 2016.
Dr Christine Connors (CDN Steering Committee Chair) and the Hon. Warren Snowdon MP, Member for Lingiari, joinlty presented the Awards to recipients.
All nominees deserve congratulations on their commitment to their work.
Award Categories for 2016:
• Chronic Disease Health Promotion/ Program Delivery Award recognises a team or organisation that has
implemented a program based on key principles of health promotion. It recognises programs that have provided significant improvement and/or innovation in health service delivery.
• Aboriginal and Torres Strait Islander Health & Leadership Award (Male and Female) recognises Aboriginal and Torres Strait Islander workers currently working in the field of chronic disease who have made an outstanding contribution to Aboriginal health in the Territory.
• Outstanding Contribution to the prevention and management of Chronic Conditions in the Northern Territory recognises an individual who has made an outstanding contribution in chronic conditions and have considered factors such as best practice, innovation, leadership, mentoring, advocacy, strategic planning, policy or research.
Award Winners
Diabetes Antenatal Care and Education Team
Alice Springs Hospital, Baker IDI and Menzies School of Health Research
2016 Chronic Disease Health Promotion/ Program Delivery Award
The Diabetes Antenatal Care and Education team, otherwise known as DANCE, comprises Alice Springs Hospital, Menzies School of Health Research and Baker IDI. In 2003, the DANCE Clinic, commenced at Alice Springs Hospital with a specialist obstetrician, midwife and diabetes educator. To provide better access to care for remote women managing diabetes whilst pregnant, and reduce the need for remote women to travel, a virtual DANCE Clinic was also established. The virtual Clinic was an original and innovative method of linking remote based clinicians with specialist services, well before the uptake of telehealth. Awareness among primary care clinicians of the dangers of hyperglycaemia in pregnancy has increased through the collaborative efforts of the DANCE Clinic and the Diabetes in Pregnancy research arm.
Julie Hill
Central Australia Health Service
2016 Aboriginal and Torres Strait Islander Health & Leadership Award
Julie Hill coordinates the Strong Woman Strong Babies Strong Culture Program in the Barkley region, this includes management of community based Strong Women Workers. The commitment and leadership that she applies to both the program and to working towards improving the health of Aboriginal people has been outstanding and has greatly contributed to the sustainability of the program in Central Australia. For over 10 years Julie has played a vital role in mentoring new and existing Strong Women Coordinators and Strong Woman Workers, this has entailed years of ongoing frequent travel for extended periods of time.
Continued on Page 6 Paula Van Dokkum, Stacey Svenson and
the Hon. Warren Snowdon
Julie Hill and the Hon. Warren Snowdon
The Chronicle
Charlie Gunabarra Top End Health Service
2016 Aboriginal and Torres Strait Islander Health & Leadership Award
Charlie Gunabarra is a Senior Aboriginal Health Practitioner based at Maningrida Community with over 40 years’
experience. He has been instrumental in supporting and creating better health outcomes for the people of Maningrida through his ability to walk and work in both the Clinical aspect of health and his understanding of how an Indigenous Community operates. Charlie is a strong advocate for Men’s Health and has led the way in developing Men’s Groups in the community and surrounding outstations. He was instrumental in the introduction of a separate entrance for men entering the Maningrida clinic, which has seen a significant increase in males presenting to the clinic and taking responsibility for their health.
Joanne Duncum Tangentyere Council
2016 Outstanding Contribution to the prevention and management of Chronic Conditions in the Northern Territory
Joanne Duncum is a Chronic Disease Care Coordinator with Tangentyere Council. She has incredible capacity to work with people in complex, vulnerable circumstances with chronic disease and to get results by working in partnership with her clients. Joanne improves overall wellbeing of her clients by acknowledging that all day-to-day activities impact on a person managing their condition and goes to great lengths to address their needs. She is a great advocate for her clients and ensures their wishes and health are at the forefront of every interaction with other health professionals / service providers.
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Charlie Gunabarra and the Hon. Warren Snowdon
Joanne Duncum and the Hon. Warren Snowdon
CDN Recognition Award Winners for 2016 CDN Recognition Award Ceremony
Publication of The Chronic Diseases Network
2012-2013 Annual Progress Report of the Northern Territory Chronic Conditions Prevention and Management Strategy 2010-2020
Most of us are more than familiar with the unsettling fact that the Northern Territory has the highest burden of disease in Australia - with a disproportionate prevalence in the NT’s Indigenous and remote populations.
To combat this, Government and non-government health organisations joined forces to establish the Chronic Disease Network in 2010. This in turn led to the development of the Chronic Conditions Prevention and Management Strategy 2010-2020 (CCPMS). The strategy has been designed to reduce the impact of chronic conditions on our community and to improve the health and wellbeing of all Territorians.
The third annual progress report for the CCPMS has now been completed. The report highlights progress against the CCPMS priority action areas by the Department and partner organisations. In particular, this report highlights:
improvements to the chronic conditions information management systems, including access to electronic client health records; a new routine reporting system; and an integrated continuous quality initiative (CQI) program across remote primary health care, the provision of specific training, including face-to-face and on-line modules, to improve knowledge and skills in the chronic care sector; as well as workforce development across the Government and Aboriginal community-controlled primary health care providers.
The report also highlights challenges in relation to the social determinants of health, including only a marginal increase in the total number of Aboriginal staff employed in Department of Health (DoH); a decline or little change in school attendance, employment of Aboriginal people; and the disproportionate numbers of Aboriginal people living in overcrowded households.
Alongside the progress and activities of the CCPMS, this report presents population profile and risk factor updates, as well as trend data on seven chronic conditions and eight key actions areas.
The seven chronic conditions Key action areas identified in the strategy - Cardiovascular disease - Action on social determinants of health
- Rheumatic heart disease - Primary prevention
- Type 2 diabetes - Early detection and secondary prevention
- Chronic airways disease - Self-management support
- Chronic kidney disease - Care for people with chronic conditions
- Chronic mental illness - Workforce planning and development
- Cancers (that are associated with common - Information, communication and disease risk factors for other chronic conditions) management systems
- Continuous quality improvement
The report has been submitted to and endorsed by the NT Health Minister and the DoH Executive.
The Northern Territory Department of Health acknowledges all the stakeholders who contributed to and provided feedback in the development of this report.
The full report can be found here: http://digitallibrary.health.nt.gov.au/prodjspui/handle/10137/681
Northern Territory & Far North Queensland Diabetes in Pregnancy Partnership
By NT DIP Partnership team at Menzies: Louise Maple-Brown, Renae Kirkham, Marie Kirkwood, Lynice Wood, Alison Simmonds, Sian Graham, Elizabeth Death, Elizabeth Hammond, Cherie Whitbread; and at Baker IDI, Alice Springs, Paula van Dokkum and Jo Kelaart; on behalf of NT DIP Partnership
Diabetes in pregnancy (DIP) both carries significant risks and provides an early opportunity for intervention in the life course for both mother and baby. We have developed a partnership between researchers, health care providers and policy organisations regarding diabetes in pregnancy in the NT, with recent expansion now to Far North Queensland.
We aim to improve clinical care and outcomes of diabetes in pregnancy and future health outcomes for both the mother and her baby through a multi-faceted approach. The NT DIP Partnership involves 3 arms, with 5 partners, as outlined in Figure 1.
The Northern Territory Diabetes in Pregnancy Clinical Register has been in use since December 2011 and to date 1570 women are involved. A recent survey revealed that not many NT health clinicians who provide care for pregnant and postpartum women are aware of the clinical register. Therefore a focus now is on providing greater awareness of its clinical utility in assisting with care coordination and quality improvement for women with DIP.
For further details on the NT DIP Clinical Register, including how to apply for access and to refer a woman, please see Policies, Forms and Guidelines (particularly the “Referral to Clinical Register” and the “Web Based Register Access Policy” pdf’s) at the following link.
http://www.health.nt.gov.au/Chronic_Conditions/Diabetes_in_Pregnancy_Clinical_Register/index.aspx
Models of care
There have been a number of changes documented for models of care of DIP since the commencement of the Partnership. Changes have been documented through various Partnership activities (including workshops and annual reports) as well as focus groups with 49 health professionals from across the NT. Thank you to all of you who have participated in these activities, your contributions have been much appreciated.
We have recently submitted a manuscript outlining some of the changes which include those of improved
relationships, communication, education, integration of quality improvement activities and co-ordination of care. We expect to see further improvements to care delivery through the continued support of formal processes and structures.
The post-partum period is another important time-point for the mother and baby’s health, thus we are now conducting focus groups with health professionals to gain insight into current practices in post-partum care for NT women with DIP, in order to identify barriers and enablers to improve our models of care in the post-partum period.
Continued on Page 9
The Chronicle
PANDORA (Pregnancy and Neonatal Diabetes Outcomes in Remote Australia) Research Study
PANDORA is our longitudinal birth cohort study, a detailed research study. Recruitment to PANDORA is in its 5th year, with over 1000 women, with and without diabetes in pregnancy throughout the NT who have volunteered to participate in this study. We plan to recruit until the end of this year.
In early 2016, we commenced microbiome and epigenetics sub-studies involving cord blood and mouth swabs. Our cord blood collection rates for PANDORA participants are averaging 60%, and we have collected 40 cord bloods that are to be used for epigenetic analysis. The midwives in the hospitals at RDH and ASH have been very supportive of our program and without their hard work we would not have been able to achieve such good cord blood collection rates. In mid-July we transferred 40 paired buccal swabs and 20 cord blood samples to our partner laboratory and are awaiting the analyses for telomere length that are currently being performed on these samples . For our microbiome sub-study, we are investigating the gut microbiome of our infants from birth to 3 years. Our numbers are small presently but this important sub-study will continue for a number of years.
Following up the PANDORA study participants
Recontacting women after their babies’ birth, at the three time points of 6 weeks, 6 months and between 2 and 3 years, continues for the whole PANDORA cohort. As many of the participants are now coming into or even passed their final follow-up time point for this phase of the study we are increasingly focusing our efforts on completing collection of this important clinical information. This involves contacting clinical care organisations such as general practices, pathology companies and Aboriginal Community-Controlled Health Services to obtain the relevant information that PANDORA participants have given their consent for us to collect from the time of their enrolment in the study until their child reaches 12 years.
PANDORA Mothers is a post-partum pilot study for Aboriginal mothers, using research nursing staff/research health workers who have more specialized knowledge of DIP and management strategies. The study aims to improve completion of recommended post-partum checks for Aboriginal women with either GDM or Type 2 diabetes. Women who join the PANDORA Mothers study are followed up after the birth of their baby for two years at certain time points, 3 monthly for women with type 2 diabetes and 6 weeks, 6 months, 1 year and 2 years post-partum for women with gestational diabetes. The study commenced in 2016 and currently 33 Top End Women and 16 women from Central Australia with DIP have volunteered to participate in PANDORA Mothers.
PANDORA Wave 1, which is a sub-study of PANDORA, relates to the clinical assessment of a sub-group of mothers with and without diabetes and their infants in order to identify predictors of chronic conditions such as obesity, diabe- tes and heart disease later in life. The team are visiting communities to see mothers and infants (18-48 months old) across the NT (started in April 2016); to date 93 mums and their infants have been seen.
The NT DIP Partnership, including PANDORA, has grown over the past few years and is a large program of work involving many researchers, health care providers, policy organisations and participants. Thank you to all who have been involved and we welcome contact from others interested in further details – we look forward to continuing our work together.
For further details please contact Libby Hammond at Menzies on 89468612 or [email protected] Continued from Page 8
Publication of The Chronic Diseases Network
Healthy Under 5 Kids - Partnering with Families Pilot
“Well Child” services in the Northern Territory (NT) are provided predominately by the NT Government Department of Health (DOH); Aboriginal Medical Services (AMS) and General Practitioners (GP). Within DOH Primary Health Care there are two different Well Child health programs – one for children and families in remote settings and one for children and families in urban settings.
The urban child health services is provided through the Child & Family Health (C&FH) stream delivered by specialist qualified child health nurses. In the remote areas, child health services are predominantly provided by remote area nurses (RAN) and Aboriginal health practitioners (AHP) who are supported by visiting specialist outreach qualified child health nurses delivered via DOH Primary health care services. Differing Well Child health assessments, schedules and information systems exist in operation with the potential to compromise the provision of quality child health services in terms of health care for infants, toddlers and young children. In order to adopt evidence based best practice principles in child health programs across the NT, a more standardised and systematised child health program was needed to deliver a more effective, measurable improvements in the outcomes for children.
In 2014, DOH embarked on developing a more standardised approach for the provision of routine Well Child health assessments to children under five years old (living in the Northern Territory and accessing NT Government child health services), utilising current available evidence of effectiveness and multidisciplinary expert opinion when no evidence is available. This systemisation aim is to contribute to better overall data analysis. Rather than having information systems collect ‘similar data’ but not the same data, all systems will now collect comparable data, which can then be analysed more readily by service providers. Better more meaningful reported data allows health service program developers and managers to better understand the magnitude of regional and local child health issues and hopefully facilitate a more efficient allocation of resources, including human resources to support and better meet child health service delivery needs. In 2016, the new program Healthy Under 5 Kids - Partnering with Families was completed with the decision to pilot the new program. 12 pilot sites across the Northern Territory representing both urban and remote services across all 5 regions were selected.
In the Healthy Under 5 Kids – Partnering with Families Pilot program, health professionals were identified to play a significant role in leading best practice in child and family health services across the Primary Health Care (PHC) sector. To prepare these key staff prior to the program implementation, a 4 day workshop was held in Nhulunbuy, Darwin and Alice Springs. This workshop provided learning sessions aimed at increasing the knowledge of the fundamental components of the program and the opportunity to develop competence in the delivery of those components. The content was derived from practice changes, current best practice updates, results from clinical audits and topical issues within child health practice. Standards of practice incorporated into the workshop included a number of learning objectives from understanding the impact of the early years on the child and why interventions in the early years are an effective public health strategy, to increasing knowledge of the HU5K-PF program and schedule and the importance and rationale for comprehensive Well Child assessments.
In total, 32 staff attended these workshops, representing staff from all of the pilot sites and in addition staff from Central Australia Aboriginal Congress and Miwatj Health Aboriginal Corporation.
For more information, please contact Janice Finlayson at Child Youth Health Strategy Unit, DoH on 08 8985 8047 or [email protected]
The Chronicle
2015 Market Basket Survey
The 2015 Market Basket Survey (MBS) is the sixteenth annual survey of remote community stores in the Northern Territory (NT). The MBS collects information on the cost of a basket of foods that would meet the average energy and nutrient needs of a family of six for a fortnight. Information is also collected on the quality, variety and availability of a selection of healthy foods, and store management characteristics.
81 remote stores were surveyed between April and June in the 2015 survey. Results from the 2015 survey showed that the cost of the food basket was, on average, 41% higher in remote stores than in a Darwin supermarket. The proportion of income required to purchase the food basket in remote communities was 33% compared to 23% for the same basket of foods from a Darwin supermarket. The cost of the food basket decreased by 1% in remote stores and increased by 8% in the Darwin supermarket between 2014 and 2015.
Positive trends are emerging from the MBS results, particularly regarding the availability and variety of some healthy foods. For example, there has been an increase in the number of varieties of fresh fruit and vegetables available in remote stores since 2000. Additionally, there has been a greater increase in the cost of some ‘unhealthy’ products compared to some healthier products in remote stores.
Full results of the 2015 survey are from this website:
http://health.nt.gov.au/Nutrition_and_Physical_Activity/
Publications/index.aspx
Publication of The Chronic Diseases Network
Economic Report Reveals Menzies Amoung Most Cost Effective in Health Research 3 August 2016
Economic analysis just published, reports Menzies School of Health Research is one of Australia’s most cost-effective health research institutes working to close the gap for health outcomes for Aboriginal and Torres Strait Islander people.
Deloitte Access Economics modelled the costs and benefits of Menzies’ activities, in The social and economic contribution of the Menzies School of Health Research in 2015 report, which return $2.70 to the economy for every dollar invested across the Northern Territory, Australia and the Asia-Pacific.
Director of Menzies, Professor Alan Cass, said Menzies headquartered in Darwin in northern Australia, has its key focus on improving the health and wellbeing of Aboriginal and Torres Strait Islander people and communities across the wider region.
The report revealed a total economic benefit of $1.1 billion with a net benefit of $697.9 million across the region.
‘Over the past 30 years, Menzies has consolidated its position as the leading health research institution in northern Australia,’ Professor Cass said.
The report outlines a core contribution by Menzies to the development of northern Australia to strengthen educational, health and economic partnerships with Australia’s neighbours across the region.
‘Our activities generate significant economic benefit to the Northern Territory, Australia and the Asia-Pacific, and we hold a five out of five Australian Government ranking for excellence in clinical research, which indicates we perform well above world standard,’ Professor Cass said.
Menzies also partners with communities and health services across the Asia-Pacific region to address priority health issues.
‘We work across the Asia-Pacific in over 20 countries, on over 150 research projects and programs.
‘Our globally-recognised clinical research to eliminate malaria in the region, includes a roll-out of better malaria treatments which have resulted in a 47 per cent reduction in malaria-related deaths in Papua, Indonesia,’ Professor Cass said.
Media contact: Emmanuelle Clarke - Senior Media and Events Officer Telephone - 08 8946 8485 Email - [email protected]
Menzies School of Health Research is Australia’s leading medical research institute dedicated to improving Indigenous, global and tropical health. We have a 30 year history of scientific discovery and public health
achievement. Menzies works at the frontline, joining with partners across the Asia-Pacific as well as Aboriginal and Torres Strait Islander communities across northern and central Australia. We collaborate to create new knowledge, grow local skills and find enduring solutions to problems that matter.
The Chronicle
Media Release
New tobacco portal aims to help reduce smoking amoung Aboriginal and Torres Strait Islander People 8 August 2016
A new Tackling Indigenous Smoking portal has been launched as part of the Health Department’s Tackling Indigenous Smoking (TIS) Programme. Produced by Edith Cowan University’s Australian Indigenous HealthInfoNet, the portal is one component of the programs run by the National Best Practice Unit for Tackling Indigenous Smoking (NBPU TIS) of which the HealthInfoNet is a partner.
The free-to-access online portal is the ‘go to’ place for Tackling Indigenous Smoking Workers to access the Tackling Indigenous Smoking Resource and Information Centre (TISRIC). It also contains a comprehensive collection of videos and programs, and workforce information such as conferences, jobs, courses and other events. The social media platforms also provide an opportunity for the workers to network and support each other.
The NBPU TIS consortium is led by Ninti One Ltd, and includes the Health Research Institute at the University of Canberra and the Smoking Research Institute at the University of Sydney. The main role of the consortium is to provide advice and support to the Tackling Indigenous Smoking Workers in the implementation of effective strategies and programs to reduce the levels of smoking in their communities. The National Coordinator is Professor Tom Calma AO.
Tobacco smoking is the most preventable cause of death among Aboriginal and Torres Strait Islander people and is one of the key focuses of the COAG health initiatives.
The new portal is located on the Australian Indigenous Alcohol and Other Drugs Knowledge Centre (AIAODKC) web resource and can be used by anyone interested in or working in the area of smoking reduction
(www.tacklingsmoking.org.au).
Professor Tom Calma AO, National Coordinator Tackling Indigenous Smoking said ‘The TIS portal will be a valuable resource for the TIS grant recipients, to enable them to access: relevant and current information on smoking
cessation; and strategies and guides to help encourage people to not take up smoking. It’s all about sharing and learning’.
Spokesperson:
Professor Neil Drew - HealthInfoNet Director Telephone - 08 9370 6155 Mobile - 0418 901 468 Email - [email protected] Ninti One contact:
Alicia Gigante - Communications Officer.
Telephone - 08 8211 0434 Email - [email protected]
About the HealthInfoNet: Since 1997, the Australian Indigenous HealthInfoNet web resource
www.healthinfonet.ecu.edu.au has been informing practice and policy in Aboriginal and Torres Strait Islander health by making research and other knowledge readily accessible. In this way, the HealthInfoNet contributes to closing the gap in health between Aboriginal and Torres Strait Islander peoples and other Australians. Working in the area of translational research with a population health focus, the HealthInfoNet makes research and other information available in a form that has immediate, practical utility for health practitioners and policy-makers in the area.
Publication of The Chronic Diseases Network
Chronic Condition Journal Articles of Interest
Cardiovascular Disease
‘Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study’
Authors: Joshy G, et al.
This study’s aim was to investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality. Prospective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009 were included in the New South Wales study.
Study population was 172 630 individuals aged 45–75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline. During a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke. In those reporting no teeth versus ≥20 teeth left, risks were increased for HF, PVD and all-cause mortality. The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums. This study concludes that tooth loss and, to a lesser extent, self-rated health of teeth and gums, are markers for increased risk of IHD, PVD and all-cause mortality. Tooth loss is also a marker for increased risk of HF.
BMJ Open. 2016. 6 (8). Doi: 10.1136/bmjopen-2016-012386
‘Prevention of cardiovascular disease in rural Australian primary care: an exploratory study of the perspectives of clinicians and high-risk men’
Authors: Kinsman L, et al.
Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention.
This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25 000 participated. One hundred and fifty-eight high-risk men completed the questionnaire.
Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n = 20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.
Australian Journal of Primary Health. 2016. Doi: 10.1071/PY15091 Diabetes
‘Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control’
Authors: Abell SK, et al.
This study’s purpose was to compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes. The study was set as a historical cohort study in a specialist diabetes and maternity network in Victoria. Participants included all singleton births (at least 20 weeks’ gestation) from 2010–2013 (107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes). Data was extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression/ Results of the study showed the mean body mass index was higher for women with type 1 diabetes than for women without diabetes, the median gestation period for their babies was shorter and they were more likely to be large for gestational age (LGA). Women with type 1 diabetes were more likely to have had labour induced, a caesarean delivery, or a pre-term birth; their babies were more likely to have shoulder dystocia, hypoglycaemia, jaundice, respiratory distress or to suffer perinatal
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death. In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death. To conclude, women with type 1 diabetes, even when managed in a specialist setting, still experience adverse obstetric and neonatal outcomes. Poor glycaemic control is not wholly responsible for adverse outcomes, reinforcing the importance of other risk factors, such as obesity and weight gain.
Medical Journal of Australia. 2016. 205 (4). Pg. 162-167. Doi: 10.5694/mja16.00443
‘Factors associated with duration of inpatient hospital stay for patients with diabetes mellitus admitted to a medical unit in a community public hospital’
Authors: Lee MH, et al.
The aim was to examine predictors of duration of inpatient hospital stay in people with diabetes mellitus to assist implementation of strategies to reduce hospital stay. This audit prospectively studied patients with diabetes mellitus admitted to a medical unit of an Australian community public hospital. Other outcome measures included glucose treatment optimisation and access to GP and diabetes-specific healthcare professionals. Comparison was made to patients without diabetes mellitus who were admitted concomitantly. Diabetes patients represented 26% of admissions over a 2-month period. In total, 73% had seen a GP within the prior 6 months. Patients with diabetes mellitus (n = 79) had a median age of 69 years; 53% were male and median HbA1c was 65 mmol mol–1 (8.1%). Diabetes mellitus was associated with a longer inpatient stay (P = 0.03), particularly among patients admitted with vascular disease.
Age >65 years and seeing <3 members of the community-based diabetes mellitus multidisciplinary team (MDT) in the 2-years pre-admission were independently associated with a longer stay (P = 0.02). In total, 10% were referred to an endocrinologist on discharge. Involvement of more of the diabetes-specific MDT, with a skilled GP, in primary care is recommended as it may shorten inpatient hospital stay, improve glycaemia and reduce demand for limited specialist endocrinologists.
Australian Journal of Primary Health. 2016. Doi: 10.1071/PY16036
‘Building the evidence for integrated care for type 2 diabetes: a pilot study’
Authors: Browne JL, et al.
Integrated care models have the potential to reduce fragmentation in the health system and improve outcomes for people with type 2 diabetes. A pilot evaluation of an integrated care model for people with type 2 diabetes in Melbourne, Australia, is reported on. Two studies were conducted: (1) a 6-month pilot randomised controlled trial (n = 56) evaluating the impact of the integrated care model relative to hospital outpatient clinics; and (2) a cross-sectional study (n = 92) of patients attending the two services. The primary outcome was diabetes-specific distress; secondary outcomes were perceived quality of diabetes care, diabetes-specific self-efficacy and glycated haemoglobin (HbA1c).
There was no effect of service setting on diabetes-specific distress. Participants from the integrated care setting perceived the quality of diabetes care to be higher than did participants from the hospital clinics. Significant HbA1c improvements were observed over time, but with no effect of service setting. The model holds promise for people with type 2 diabetes who need more specialist/multidisciplinary care than can be provided in primary care. Patients’
evaluations of the quality of diabetes care received at the integrated care service are very positive, which is likely to be one of the key strengths of the integrated model.
Australian Journal of Primary Health. 2015. Doi: 10.1071/PY15020
‘Role to telehealth in diabetic foot ulcer management – A systematic review’
Authors: Singh TP, et al.
This systematic review’s objective was to review the use of telehealth in subjects with diabetic foot ulcer; evaluating its clinical outcomes, diagnostic accuracy, cost-effectiveness and behavioural perceptions. Studies included in the review were conducted in Australia, USA, the Netherlands, Denmark, Poland and UK. A total of 948 identified studies were evaluated against the inclusion criteria. Eleven eligible studies were included for review. Patients with diabetic foot ulcer had to have telehealth guided management. Telehealth systems were evaluated against at least one of the following: clinical implications on ulcer healing and disease prognosis; diagnostic accuracy; cost-effectiveness;
behavioural perceptions among health professionals or patients. Eleven eligible studies were included for review.
Studies that evaluated telehealth against clinical outcomes were underpowered by study design, sample sizes and short duration follow-up. Telehealth systems demonstrated good intra- and inter-observer reproducibility,
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high diagnostic accuracy and agreement with live assessments. Authors rationalised the cost-effectiveness of their respective telehealth systems, but could not support this with long-term cost analysis. Both patient and health professionals responded positively towards telehealth in surveys and face-to-face interviews. To conclude, telehealth yields high diagnostic accuracy, reproducibility and positive behavioural perceptions. However, it is not clear if telehealth use in diabetic foot management has favourable clinical and economic outcomes. More long-term prospective controlled trials on larger populations are needed to further characterise our findings.
The Australian Journal of Rural Health. 2016. 24 (4). Pg. 224-229. Doi: 10.1111/ajr.12284 Chronic Mental Illness
‘Systematic review of youth mental health service integration research’
Authors: Kinchin I, et al.
Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases.
Inclusion criteria were: published 1998–2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12–25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.
Australian Journal of Primary Health. 2016. 22 (4). Doi: 10.1071/PY15114 Cancer
‘Cancer screening education: Can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia’
Authors: Cullerton K, et al.
Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities
living in Brisbane, Queensland. Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally- tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post- education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population’s beliefs about reducing risk by cancer screening. There were 159 participants in the three cancer screening education sessions. Overall participants’ knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n = 146).These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening.
Health Promotion Journal of Australia. 2016. 27(2). Pg. 140-147. Doi: 10.1071/HE15116 Continued from Page 15
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Aboriginal and Torres Strait Islander Health
‘The economic benefits of eliminating Indigenous health inequality in the Northern Territory’
Authors: Zhao Y, Venuri SR & Arya D
This study’s objective was to estimate the potential economic benefits of closing the Indigenous health gap by quantifying the economic burden associated with Indigenous health inequality in the Northern Territory. A cost-of- illness study was conducted from a societal perspective for NT residents for the period 2009–2013. The total cost of the Indigenous health gap was estimated by calculating the cost differences between Indigenous and non-Indigenous populations in health services, lost productivity and lost life-years on the basis of data from the 2011 census, as well as on burden of disease, health expenditure, welfare, taxation and other published financial data. The total and per capita costs in three categories were analysed: direct health costs, the indirect costs of lost productivity, and intangible costs associated with premature deaths. Results showed the excess cost of the Indigenous health gap was estimated to be $16.7 billion for the 5-year study period, equivalent to 19% of the NT gross state product. The excess costs associated with the Indigenous health gap included 22% caused by higher health expenditure for servicing the gap, 35% attributable to lost productivity caused by illness, and 43% associated with lost life-years. The findings highlight the long term potential benefits of the Australian governments’ Closing the Gap initiative for the NT. Successful implementation of this initiative will require improving government services by combating discrimination, developing local economies, overcoming poverty, and reducing the disadvantages associated with remoteness.
The Medical Journal of Australia. 2016. 205 (6). Pg. 266-269. Doi: 10.5694/mja16.00215
‘Role of non-Indigenous researchers in Indigenous health research in Australia: a review of the literature’
Authors: Gray MA & Oprescu FI
This paper explores the body of knowledge around Indigenous health research and aims to outline what roles are appropriate for non-Indigenous researchers within Indigenous health research in Australia. A literature review was conducted using CINAHL, PubMed and Scopus in May 2015. The search terms were ‘non-Indigenous researchers’
AND ‘Indigenous health research’ and other combinations of these terms. Additional documents were sourced by hand using the reference lists of key articles. Seven thematic categories were identified: (1) Closing the Gap: implications for research; (2) history of Indigenous research; (3) developing Indigenous research using a capacity-building approach; (4) the cultural interface between Western paradigms and Indigenous knowledge; (5) ethical Indigenous research; (6) culturally safe Indigenous research; and (7) positive roles for non-Indigenous researchers in Indigenous research. It is important that non-Indigenous researchers become more aware of culturally appropriate ways in which to undertake Indigenous research and to ensure that the research undertaken is safe, ethical and useful for participants. Fostering partnerships between non-Indigenous academic organisations and researchers and Indigenous health researchers is an important development that can promote and enhance the emerging field of Indigenous inquiry. Actively contributing to capacity building with Indigenous researchers and research initiatives is a key role that non-Indigenous researchers and academic institutions can have in improving Indigenous health. Self-determination through health research capacity building and evidence-based advocacy may provide the most useful outcomes for Indigenous people.
Australian Health Review. 2016. 40 (4). Pg. 459-465. Doi: 10.1071/AH15103
‘Low HIV testing rates among people with a sexually transmissible infection diagnosis in remote Aboriginal communities’
Authors: Ward JS, et al.
This study was conducted to determine the rates of HIV testing among people who had received positive test results for chlamydia, gonorrhoea and trichomoniasis, or who had been tested for syphilis. Pathology data for the period January 2010 – December 2014 from 65 remote Aboriginal communities participating in the STRIVE trail of sexually transmissible infection (STI) control were analysed. Rates of HIV testing within 30 and 90 days of an STI test (for chlamydia, gonorrhoea or trichomoniasis), the result of which was positive, and within 30 days of a test for syphilis;
factors independently associated with concurrent HIV testing. Study results showed that 31.8% of 15 260 positive STI test results were linked with an HIV test within 30 days of the test (including 5.6% not on the same day), and 34.8%
within 90 days; 44.1% were linked with syphilis testing within 30 days. 53.4% of all those tested for syphilis were also tested for HIV within 30 days. Multivariate analysis found that HIV testing was more likely for men, in geographical regions 3 and 4, in association with positive STI test results during 2012, 2013 or 2014 (v 2010), and in association Continued from Page 16
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with positive test results for gonorrhoea or chlamydia. Similar associations with these factors were found for syphilis testing. The study concludes a significant challenge in Aboriginal health is avoiding an increase in the number of HIV infections. One critical intervention in this regard is timely and appropriate testing. Adhering to screening recommendations is clearly an aspect of the delivery of sexual health services to remote communities that can be improved in striving to achieve this aim.
Medical Journal of Australia. 2016. 205 (4). Pg. 168-171. Doi: 10.5694/mja15.01392 Public Health
‘Visualising linked health data to explore health events around preventable hospitalisations in NSW Australia’
Authors: Falster MO, Jorm LR & Leyland AH
The objective of this study was to explore patterns of health service use in the lead-up to, and following, admission for a ‘preventable’ hospitalisation. 266 950 participants in the 45 and Up Study, in New South Wales were included in the study. Data on hospital admissions, general practitioner visits and other health events were used to create a visual representation of health service used. For each participant, health events were plotted against time, with different events juxtaposed using different markers and panels of data. The visualisations revealed patterns of clustering of GP consultations in the lead-up to, and following, preventable hospitalisations, with 14% of patients having a consultation on the day of admission and 27% in the prior week. There was a clustering of deaths and other hospitalisations following discharge, particularly for patients with a long length of stay, suggesting patients may have been in a state of health deterioration. This study did not find evidence of limited use of primary care services in the lead-up to a preventable hospitalisation, rather people with preventable hospitalisations tended to have high levels of engagement with multiple elements of the healthcare system. As such, preventable hospitalisations might be better used as a tool for identifying sicker patients for managed care programmes. Visualising longitudinal health data was found to be a powerful strategy for uncovering patterns of health service use, and such visualisations have potential to be more widely adopted in health services research.
BMJ Open. 2016. 6 (9). Doi: 10.1136/bmjopen-2016-012031
‘Economic costs of chronic disease through lost productive life years (PLYs) amoung Australians aged 45-64 years from 2015 to 2030: results from a microsimulation model’
Authors: Schofield D, et al.
This study’s objective was to project the number of older workers with lost productive life years (PLYs) due to chronic disease and resultant lost income; and lost taxes and increased welfare payments from 2015 to 2030. Using a microsimulation model, Health&WealthMOD2030, the costs of chronic disease in Australians aged 45–64 were projected to 2030. The model integrates household survey data from the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers (SDACs) 2003 and 2009, output from long-standing microsimulation models (STINMOD (Static Incomes Model) and APPSIM (Australian Population and Policy Simulation Model)) used by various government departments, population and labour force growth data from Treasury, and disease trends data from the Australian Burden of Disease and Injury Study (2003). Respondents aged 45–64 years in the SDACs 2003 and 2009 formed the base population. Main outcome measures were lost PLYs due to chronic disease; resultant lost income, lost taxes and increased welfare payments in 2015, 2020, 2025 and 2030. The study projected 380 000 (6.4%) people aged 45–64 years with lost PLYs in 2015, increasing to 462 000 (6.5%) in 2030—a 22% increase in absolute numbers. Those with lost PLYs experience the largest reduction in income than any other group in each year compared to those employed full time without a chronic disease, and this income gap widens over time. The total economic loss due to lost PLYs consisted of lost income modelled at $A12.6 billion in 2015, increasing to $A20.5 billion in 2030—a 62.7% increase. Additional costs to the government consisted of increased welfare payments at
$A6.2 billion in 2015, increasing to $A7.3 billion in 2030—a 17.7% increase; and a loss of $A3.1 billion in taxes in 2015, increasing to $A4.7 billion in 2030—a growth of 51.6%. To conclude, there is a need for greater investment in effective preventive health interventions which improve workers’ health and work capacity.
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The Chronic Disease Network acknowledges the participation and support of the CDN Steering Committee members from the following organisations:
