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Australia's Future Health

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO to theUniversity of Melbourne Medical Alumni 2010

A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO to theUniversity of Melbourne Medical Alumni 2010

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  • 1. AUSTRALIA’S FUTURE HEALTHUniversity of Melbourne Medical Alumni 2010 Melbourne – 19 November 2010 Professor Jim Bishop AO Chief Medical Officer Australian Government Department of Health and Ageing
  • 2. OECD HEALTH DATA 2010 How Does AUSTRALIA Compare Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)8,000 75387,0006,000 50045,000 4627 4210 4079 4063 39704,000 3793 3737 3696 3677 3540 3470 3359 3353 3129 3060 3008 2902 28703,000 2729 2687 2683 21512,000 1801 1781 1737 1437 1213 999 8521,000 767 0 1 Refers to insured po pulatio n rather than resident po pulatio n. 2. Current expenditure. 3. 2006. 4. 2007. So urce: OECD, OECD Health Data, June 201 . 0 Public expenditure on health Private expenditure on health
  • 3. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  • 4. SELF- ASSESSED PHYSICAL & MENTAL HEALTH, 2007 Source: AIHW Australia’s Health 2010
  • 5. MAJOR DISEASE BURDEN in AUSTRALIA
  • 6. PROJECTED BURDEN of MAJOR DISEASE GROUPS, 2010Source: AIHW Australia’s Health 2010
  • 7. BROAD CAUSE MORTALITY TRENDS IN AUSTRALIA Source: AIHW
  • 8. AGED ADJUSTED DEATH RATES From CVD, 1907 - 2006 Source: AIHW Australia’s Health 2010
  • 9. Mortality-to-incidence ratio 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ke ny a NiSource: IARC 2010. ge ria Eg yp Vi t et Na m Tu rk ey In di a Ch in a Ru So ss ut ia h Af ric a G re ec e Br az il Cz Ja ec pa h n Re pu bl ic Un ite Ita d ly Ki ng do m Ca na da G er m an Sw y Ne ed w en Ze al an d US Au A st ratios for selected countries - 2008 ra lia Males Females ALL CANCER – MORTALITY/INCIDENCE
  • 10. CHANGES IN DEATH RATES INMALES - using Joinpoint Analysis Source: Tracey et al – Cancer Institute NSW
  • 11. CHANGES IN DEATH RATES IN FEMALES - Using Joinpoint Analysis Source: Tracey et al – Cancer Institute NSW
  • 12. 5 year Survival Rates 2004 NSW SEERNon small cell lung 13% 14%Colon 65% 67%Rectum 66% 69%Breast Cancer 89% 90%Lymphoma (DL) 53% 53% Source: Tracey et al – Cancer Institute NSW
  • 13. TOTAL CANCER CASES & DEATHS per year (1972 to 2036) Source: Cancer Institute NSW
  • 14. TRENDS IN LEADING CAUSESOF DISEASE BURDEN 2003-2023 Source: AIHW Australia’s Health 2010
  • 15. HOW CAN HEALTH BE IMPROVED ?
  • 16. THE KEYS TO PREVENTION Tobacco Blood pressure Overweight/obesity Physical inactivity Blood cholesterol Alcohol Fruit/vegetables Illicit drugs Air pollution Total of 32% Unsafe sex 0.0 2.0 4.0 6.0 8.0 % DALYsSource: Table 4.1 AIHW Australia’s Health 2008
  • 17. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  • 18. SMOKING IN AUSTRALIASMOKING NSW VIC QLD WA SA TAS ACT NT AUS STATUSDaily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3Less than 1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5WeeklyEx-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1Never 56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4smoked National Drug Strategy Household Survey 2007Australian Government Source: 2007 Household Survey,
  • 19. OBESTITY INCREASING FOR ALL Source: AIHW: Australia’s Health 2008
  • 20. Budget 2010-11Anti-smoking campaigns ($27.8m)COAG agreed• Increased tobacco excise• Plain packaging• Restricting internet advertising of tobacco products• Further funding for National Binge Drinking Strategy ($50m)• Survey of Australia’s Health ($54m) National Preventative Health Agency (Spring Session)
  • 21. NATIONAL PREVENTATIVE HEALTH AGENCY• Builds on the National Partnership Agreement on Preventative Health ($872.1m over 6 years)• Establishment and operational by early 2011 ($17.6m)• Specific responsibilities: - National Social Marketing ($102m over 4 years) - Preventative Health Research fund ($13.1m over 4 years) - Preventative Health Workforce audits and strategy ($0.5m over 2 years)
  • 22. AUSTRALIAN HEALTH SURVEY Four components run by ABS 2011-13 - Health Survey - ATSI Health Survey - Nutrition and Physical Activity Survey - Health measurement Survey Around 50,000 participants De-identified data available as summary statistics, tables
  • 23. Commonwealth Government Health and Hospital expenditure under the NHHN Source: Commonwealth Budget Papers, DOHA and PMC Analysis
  • 24. HEALTH REFORM Increasing expenditure to $15 billion 2010/11 Additional $7.3 billion over 4 years Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching) Medicare locals (100% Federal funds) GP Superclinics – multi disciplinary teams (100% Federal Funds)
  • 25. BUDGET 2010-11e-Health – connecting patients, providers and information systemsThe Government will establish a personally controlledelectronic health record system ($466.7m)The system will:• Enable people – and their chosen health provider - to access online their key health information when and where it is needed, for their care across the health system.• Allow people to register online to establish a personally controlled electronic health record from 2012-13• Rigorous governance• Privacy maintained
  • 26. HEALTH REFORM KEY NEW STRUCTURES National Performance Authority Independent Hospital Pricing Authority Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)
  • 27. CLINICAL GUIDELINES SUPPORTS FOR CLINICAL DECISION MAKING Evidence Base Highest Impact Range of best practice tools Successful implementation methods Monitor and report
  • 28. CLINICAL GUIDELINES Highest Impact Greatest Burden of disease Greatest harm from poor practice Greatest demonstrated need: - New Standard of Care - Proven variation in practice Greatest time spent/cost to health system
  • 29. REVIEW OF CLINICAL GUIDELINES N – 313 N %CANCER 17 5%CARDIOVASCULAR 18 6%RENAL 22 7%MENTAL ILLNESS 22 7%NEUROLOGICAL 0 0%INJURIES 13 14%CHRONIC RESPIRATORY 0 0%DIABETES 11 4%OTHER 173 67%TOTAL 313 100%Buchan et al 2006
  • 30. MILESTONES IN CANCER CONTROL Public health measures in smoking reduction, screening breast, cervix, bowel, health literacy Adjuvant treatment of breast, lung and bowel cancer New anti-cancer drugs and symptom control drugs Cancer research translated into practice Cancer registries, data linkage and analysis
  • 31. BREAST CANCER MORTALITY NEJM 2005Source: New Engl.Journ. Med: 353:17
  • 32. PROJECTED YLLs – Threescenarios, Australia – 1980 to 2016 Source: Bishop et al – Cancer Institute NSW
  • 33. NON-COMMERCIAL CANCERRESEARCH EXPENDITURE, 2004 (A$ per CAPITAL) Source: Eckhouse et al (2007), ABS
  • 34. NHMRC STRAGEGIC PLAN 2010 -12
  • 35. Project Grants - Success Rates 3600 3200Number of applications 2800 19% Not recommended for funding (score < 4) 2400 37% 24% 25% 2000 39% 3344 1600 58% 42% Fundable, but 44% 41% 43% not funded 48% 49% 33% 1200 42% 40% 800 37% 36% 36% 34% 34% 400 27% 27% 23% 21% 30% 23% 23% 22% 22% 21% Funded 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year of Application
  • 36. NHMRC Supported Research Workforce 10000NHMRC Supported Workforce 8000 6000 4000 2000 0 2003 2004 2005 2006 2007 2008 2009 2010 F u ll Tim e P a rt Tim e
  • 37. NHMRC Support for National Health Priorities Areas
  • 38. Percentage of Expenditure by Broad Research Area (2000 and 2010)
  • 39. NHMRC Support for Translational ResearchTranslational funding mechanisms  Partnership Projects for Better Health  Partnership Centres for Better Health  Centres of Clinical Research Excellence  Centres of Research Excellence in Population Health Research, & Health Services Research  National Health Research Enabling Capabilities Scheme  Industry Development awards
  • 40. NHMRC Project Grants Clinical Trials Expenditure $70 300Millions $60 250 $50 200 $40 150 $30 100 $20 50 $10 $0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Total Expenditure Number of Grants
  • 41. Harmonization of Multi-centred Ethical Review (HoMER) National Statement for Ethical Conduct of Human Research (2007) Process supported by AHMAC conducted by NHMRC Certification of ethical review processes – first round Roles, responsibilities, templates published NHMRC working with States and Territories
  • 42. CONCLUSIONS Australia faces substantial challenges in Chronic diseases with longer life and life style diseases The overall burden of disease is reducing with the exceptions of cancer, dementia and diabetes with ongoing mental health needs Health reform offers opportunities for prevention, new models of care and translational research New structures, guidelines and indicators need a solid research and evidence base to improve patient outcomes

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