Disease prevention: How are we fairing

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Disease preventionHow are we fairing?

• 9 November 2007
• Roscoe Taylor
• Director of Public Health
• Director, Population Health

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Action across the continuum of prevention care
example of type 2 diabetes
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Preventable Environmental Health Hazards over Two
Centuries (McMichael, 2006)
Energy use and greenhouse gas emissions climate
change ? health impacts
Burden of disease (indicative only, not to scale)
Urban air pollution
Infectious diseases
Road trauma
Obesity
1800
2000
1900
Sanitation (infra-structure)
Food safety laws, regulations
Smoke control zoning, fines
Seat belts, drink-driving, road design
Clean air laws
Industrialisation
Modernisation
Globalisation
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Death and its causes
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Top 10 Causes of Death in Tasmania, 2004
as a of total age standardised deaths
Source ABS, Causes of Death, 2004, cat. no.
3303.0, Table 1.9
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Avoidable Mortality Rate for Tasmanians Aged lt
75 Years
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Social gradient health

• Michael Marmot argues convincingly that
• Low control over life
• Social disengagement
• are the most powerful explanatory factors

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AIHW 2007
These 14 risk factors explain 32.2 of Burden of
Disease
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The SNAPPs approach we use to address common
risk factors for chronic conditions

• Smoking
• Nutrition
• Alcohol
• Physical Activity
• Psychosocial

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The challengePrevention strategies that WORK at
the Psychosocial level

• Without taking the PS and socio- economic
  factors into account, strategies that focus on
  individual behavioural change probably wont
  work, and even environmental measures will be
  less effective

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What are we to do about SNAPPs, and what
still needs to happen?
Trying
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S is for..
Smoking
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Proportion of Tasmanians Currently Smoking
Source National Health Surveys 1995, 2001,
2004/5 Tasmania Together (Revised) 2006
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Australia 1950-2000Smoking-attributed deaths
of all deaths at ages 35-69
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Smoking in Pregnancy

• Tasmania (2005) 27.6
• NSW 14.8
• Tasmanian Public patients 35.7
• Private patients 8.3
• RR for Low Birth Weight Baby 2.55

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Proportion of Tasmanian Secondary School Students
Currently Smoking 1984-2005
smoked within last 7 days Source Cancer
Council, ASSAD Surveys
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Try this on your next date!
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Do health providers always ask their clients how
many cigs they smoke, and advise them to quit?
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N is for nutrition
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Tasmanians Aged 18 Years and Over who are
Overweight or Obese, 1989/90-2004/5
Source ABS, NHS 1989/90 2004/5 Tasmania
Together (Revised) 2006
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Number of obese older people 1980 - 2000 (AIHW,
2003)
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Prevalence of chronic conditions by weight status
in men (AIHW, 2003)
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Obese people should perform hard work, eat only
once a day, take no baths, and walk naked as much
as possible.Hippocrates quoted in Diabetes
Care (2003) 26113172-78)
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In the modern era we have better solutions
..Sanitised tape worms!
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We have to create supportive environments

• Cool Canteen Accreditation program
• Aims to help school canteens increase the
  availability of and promote safe and healthy food
  and drinks
• ()

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Creating Supportive Environments

• Breastfeeding promotion
• Aims to increase community acceptance of and
  support for breastfeeding

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Creating Supportive Environments

• Nutrition Promotion
• Funding for the Eat Well Tasmania Campaign to
  promote enjoyable healthy eating

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Strengthening Community Action

• Family Food Patch (peer educators) advocate for
  healthy eating at a local level.

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Prevalence and consequence of Malnutrition in
older people

• Malnutrition is common among elderly
• Malnutrition may lead to
• Higher risks of infection
• Slow wound healing
• Longer hospital stays
• Poorer longer term health outcomes
• Poor quality of life

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The Action Steps of Mature Tastes
Step 1 Use planning tool to identify, prioritise
and plan to address key nutrition issues.
Step 2 HACC services action priorities.
Menu changes
Nutrition Policy
Staff training
Health Promotion
Nutrition Screening
Step 3 Evaluation and further planning.
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Some questions

• How would your service identify whether older
  patients were malnourished or at risk of
  malnutrition?
• Do you know whether malnutrition in your
  services older patients will be prevented by the
  care they receive when you discharge them?

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Standard serves 1955 2001 (courtesy of Dept
Human Nutrition, University of Otago)
1955 Fries 72g Coke 200ml
2001 Fries 205g Coke 950ml
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And now we come to A, for Alcohol.
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Weve come a long way
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Alcohol Related Harms

• Alcohol responsible for 4 of the global burden
  of disease (WHO)
• Alcohol causally related to 60 different medical
  conditions (Ridolfo Stephenson)
• Alcohol causally related to a range of injuries,
  other social harms as well as hospital admissions
  
• As population consumption increases, harm also
  increases correspondingly

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Tasmanian Population Response

• Under development watch this space
• Establish a monitoring system allowing analysis
  of alcohol related trends
• Explore legislative change in support of safer
  drinking environments
• Focus on availability and marketing issues as a
  harm reduction measure

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Tasmanian Targeted Response

• Focus on adult drinking as well as that of youth
• Strategies to build resilience in early childhood
• Strategies to address Foetal Alcohol Syndrome
  Disorder
• Explore introduction of workplace strategies

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How does socio-economic status affect alcohol
consumption?
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P is for Physical Activity

• .the hardest of all
• the risk factors,
• to get moving?

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Proportion of Population who do not Exercise
Sufficiently to Avoid Chronic Disease
includes no exercise, sedentary, and low level
exercise Source ABS, NHS 1995, 2001, 2004/5
Tasmania Together, Revised, 2006
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Live Life Get Moving Tasmanian Physical
Activity Plan 2005 -2010

• Premiers Physical Activity Council
• Four action areas/goals
• Participation
• People
• Policy
• Places
• Coordinated action required across all 4 areas
  and across sectors

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Some projects and strategies

• Evidence-informed social marketing campaigns
• Get Active program
• Move Well Eat Well (Schools)
• Good Fuel for Police (DHHS will be next!...)
• Healthy community framework for local
  communities
• Guideline development around land use planning
  and the Healthy By Design Guidelines (PPAC and
  Heart Foundation)
• Monitoring and surveillance (major deficiency).

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How do health services ensure that physical
activity is seen as part of treatment?
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Recent national events Prevention

• ? (weak) National Chronic Disease Strategy
• ? Service Improvement Frameworks
• ? Abolition of NPHP
• ? (mod) Australian Better Health Initiative
• ? COAG Human Capital Reform Diabetes
• ANZ Food Regulation MinCo
• ? Resources diverted / wasted on
  politically motivated mass media
• ? Federal election

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Summary

• To get good traction with prevention, strong
  Government intervention is needed.

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and bold interventions in the marketplace are
called for
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Thank you for your time
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What we dont want DHHS to do for its clients?
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The continuum of prevention and care

• Primary Prevention protection of health by
  measures that eliminate or reduce the causes or
  determinants of departures from good health,
  control exposure to risk, and promote factors
  that are protective of health.
• Secondary Prevention early detection of
  asymptomatic biological changes or asymptomatic
  disease, and prompt and effective intervention to
  address these departures from good health.
• Tertiary Prevention measures to reduce or
  eliminate long-term impairments, disabilities and
  complications from established disease and
  prevent or delay subsequent events.

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Supporting people with chronic conditions to
change behaviour

• It is relatively easy to identify the risks that
  will increase a persons likelihood of developing
  a chronic disease, but working with people to
  change these risk factors is a challenge faced by
  all health practitioners.
• Easy to call it Non compliance or are
  different tactics required?
• Self management has been identified as an
  essential key element in health systems that
  effectively address chronic disease

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Self management

• Uses principles of both health promotion and risk
  reduction
• The person is at the centre of their own health
  care
• Builds skills and confidence
• Enhanced by supportive communities and health
  care providers
• Involves all levels of the health system

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Supporting people to manage their own risk
factors and chronic conditions

• Health Practitioners
• New skills to integrate into practice Health
  coaching, Mentoring Flinders Partners in Health
  Tools to assess clients self management skills
• For clients
• Community based programs Stanford Chronic
  Disease Self management Program Condition
  specific education classes peer led Diabetes
  cooking classes, exercise groups
• For the System
• A coordinated model of care that supports clients
  to manage their condition in partnership with
  health practitioners i.e. the Chronic care Model
• Policy Level
• National Chronic Disease Strategy
• Tasmanian Health Plan Primary Health Care
  services

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Prevention is not merely proactively applying a
disease model to what we do