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HLN004 Lecture 4 Prevention Works - Frameworks, strategies and approaches

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  • 1. HLN004 Chronic Conditions Prevention and Management Lecture 4: Prevention Works – Frameworks, Strategies and Approaches Semester 1, 2013 1 CRICOS No. 00213JQueensland University of Technology
  • 2. Outline• Prevention stages• Population approach & life-course approach• Prevention in clinical practice• Prevention works? Where can we find the evidence?• Global strategies for the prevention of chronic health conditions• Prevention in Australia – Recent developments• Prevention in Queensland – Recent developments 2 R a university for the real world CRICOS No. 00213J
  • 3. Prevention‘Approaches and activities aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing the progress of the disorder or reducing disability’ (WHO) 3 R a university for the real world CRICOS No. 00213J
  • 4. Clinical course of a chronic condition: Four prevention stages AFMC Primer on Population Health, Canada R a university for the real world CRICOS No. 00213J 4
  • 5. Prevention targeting individuals and populations AFMC Primer on Population Health, Canada a university for the real world R CRICOS No. 00213J 5
  • 6. Prevention• Is the key to reducing the prevalence of chronic conditions• Can reduce the personal, family and community burden of disease, injury and disability• Can allow better use of health system resources• Can generate substantial economic benefits, which, although not immediate, are tangible and significant over time• Can produce a healthier workforce, which in turn boosts economic performance and productivity (National Preventative Health Taskforce, 2008) R a university for the real world CRICOS No. 00213J 6
  • 7. Population approach• Population approaches seek to reduce the risks throughout the entire population• Address causes rather than consequences• Small reductions in the exposure of the population to risk factors such as tobacco use, unhealthy diet and physical inactivity can lead to population-level reductions in cholesterol, blood pressure, blood glucose and body weight 7 R a university for the real world CRICOS No. 00213J
  • 8. Life-course Approach• The impact of risk factors of chronic conditions increases over the life-course• Emerging body of evidence that points to the need to take greater account of the impact of cumulative and interactive exposures to both risk and protective factors (biological, behavioural, social and environmental) over the life-course• Successful interventions in middle and older age will reap major short term benefits• In the LONGER term, interventions EARLY in life have the potential to reduce substantially the chronic conditions pandemic (WHO, 2005) 8 R a university for the real world CRICOS No. 00213J
  • 9. Evidence for a lifecourse approach• Adverse events such as foetal exposure to tobacco smoke, low birth weight, malnutrition, repeated infections and abuse and neglect in the early years of life help establish predispositions to a range of chronic conditions in adulthood• Social support is an independent aetiological and prognostic factor for CHD and may also be protective to diabetes and depression• Social relationships or lack thereof constitute a major risk for health- rivaling the effects of smoking, high blood pressure, blood lipids and obesity 9 (National Public Health Partnership, 2001) R a university for the real world CRICOS No. 00213J
  • 10. Chronic diseases across the lifespan (Darnton-Hill, Nishida and James, 2004) 10 R a university for the real world CRICOS No. 00213J
  • 11. Socioeconomic influences on CVD from a life-course perspective Socioeconomic positionIntra-uterine Educational and Working Income and conditions Environmental Conditions and Assets Conditions Income Birth Childhood and Adulthood Old Age Adolescence Low Birth Job Stress Inadequate Weight Smoking Smoking Medical care Growth Diet Exercise Diet Retardation Exercise 11 Atherosclerosis CVD Reduced R Function a university for the real world CRICOS No. 00213J (National Public Health Partnership, 2001,p.27)
  • 12. Lifecourse perspectiveThree main messages for the prevention of chronic conditions are:1. The earlier the intervention the better2. Intervene at strategic points in time3. Intervene whenever there is an effective intervention (Hertzman & Power, 2003; Queensland Health, 2008, p.69) 12 R a university for the real world CRICOS No. 00213J
  • 13. Prevention in clinical practice 13 R AFMC Primer on Population Health, Canada:a university for the real world Influences on clinical practice (adapted from CRICOS No. 00213J Walsh & McPhee)
  • 14. Office systems for improving prevention in practice• Preventive care flow sheets• Reminders for patients• Visual prompts in office• Patient information and patient-held preventive records• Chart reminders• Prevention prescriptions• Health risk appraisal• Computerized tracking systems AFMC Primer on Population Health, Canada 14 R a university for the real world CRICOS No. 00213J
  • 15. Where can we find the evidence? 15 Ra university for the real world CRICOS No. 00213J
  • 16. Levels of evidence 16 Ra university for the real world CRICOS No. 00213J
  • 17. Useful websites• Cochrane Library: http://www.thecochranelibrary.com/view/0/index. html• Health Evidence (McMaster University, Canada): http://www.healthevidence.org/• The Guide to Community Preventive Services (the Community Guide): www.thecommunityguide.org 17 R a university for the real world CRICOS No. 00213J
  • 18. Some examples 18 Ra university for the real world CRICOS No. 00213J
  • 19. R 19a university for the real world CRICOS No. 00213J
  • 20. Community guide example• The Community Preventive Services About the Intervention Task Force recommends team-based • Team members who most often worked with care to improve blood pressure control patients and primary care providers were on the basis of strong evidence of pharmacists and nurses. effectiveness in improving the • Medication management roles for team members were implemented in three proportion of patients with controlled different ways. Team members could: blood pressure and in reducing systolic – Change medications independent of (SBP) and diastolic (DBP) blood the primary care provider pressure. Evidence was considered – Change medications with primary care strong based on findings from 77 provider approval or consultation studies of team-based care organized – Provide only adherence support and primarily with nurses and pharmacists hypertension-related information, with working in collaboration with primary no direct influence on prescribed care providers, patients, and other medications professionals. www.thecommunityguide.org 20 R a university for the real world CRICOS No. 00213J
  • 21. Prevention of Chronic Conditions: Global Response 21 R a university for the real world CRICOS No. 00213J
  • 22. Global response to address Chronic Conditions 2000 Global Strategy for the prevention and Control of Noncommunicable Diseases 2003 WHO Framework Convention on Tobacco Control 2004 Global Strategy on Diet, Physical Activity and Health Resolution WHA60.23 on Prevention and control of noncommunicable diseases: implementation of the global 2007 strategy WHO Report on the Global Tobacco Epidemic, 2008 2008 Resolution WHA61.4 on Strategies to reduce the harmful use of alcohol Action Plan for the Global Strategy for the Prevention and2008-2013 Control of Noncommunicable Diseases 2010-2011 Global Status Report on NCDs – NCDs Country Profiles R 22 a university for the real world CRICOS No. 00213J
  • 23. WHO and the prevention of chronic conditions• WHO recommends development of integrated approach targeting all major common risk factors for CVD, DM, cancer, and chronic respiratory diseases (CRD) – most cost-effective way to prevent and control – responds to need of intervention to address common risk factors and need to integrate health promotion, primary, secondary and tertiary prevention, and related programs across sectors and different disciplines. 23 R a university for the real world CRICOS No. 00213J
  • 24. WHO and the prevention of chronic conditions WHO has proposed a range of population based strategies to address chronic disease• Laws and regulations• Tax and price interventions• Improving the built environment• Advocacy• Community based interventions• School-based interventions• Workplace interventions• Screening (WHO, 2005) 24 R a university for the real world CRICOS No. 00213J
  • 25. Strategies/ interventions to address tobacco consumption• Increased tobacco taxes – Broaden and extend integrated tobacco cessation system – Build upon existing resources in hospitals, primary care and community settings to increase access to services equitably• Sustained social marketing campaign – Motivate tobacco users to quit – Informs tobacco users of the dangers of all types of tobacco use – Inform about different options and resources available• Smoke-free public areas/ places 25 R a university for the real world CRICOS No. 00213J
  • 26. Strategies to decrease alcohol consumption• Maintain and reinforce socially-responsible pricing – Establishing minimum pricing per standard drink across all alcoholic beverages indexed to inflation – Maintaining average prices at or above the consumer price index – Adopting disincentive pricing policies for higher alcohol content beverages to create disincentives for the production and consumption of higher strength alcoholic beverages, and to reduce the overall per capita level consumption of ethyl alcohol• Strengthen targeted controls on alcohol marketing and promotion 26 R a university for the real world CRICOS No. 00213J
  • 27. Strategies to decrease alcohol consumption• Ensure effective controls on alcohol availability – Ensuring that there is no increase in hours of sale – Ensuring that the overall population density of on- and off - premise outlets per capita does not increase – Not undertaking further privatization of “off -premise” alcohol retail sales• Increase access to brief counseling interventions 27 R a university for the real world CRICOS No. 00213J
  • 28. Strategies to increase physical activity• Physical education in school curriculum• Evaluate/ monitor physical activity within context of national recommendations• Support active transport – Provide funding for dedicated infrastructure• Workplace based physical activity policy 28 R a university for the real world CRICOS No. 00213J
  • 29. Strategies to improve nutrition• National food and nutrition strategy• Compulsory food skills in education curriculum• Support healthy eating in publically funded institutions• Mandatory menu labelling in food service organisations 29 R a university for the real world CRICOS No. 00213J
  • 30. Meanwhile, in Australia Ra university for the real world CRICOS No. 00213J 30
  • 31. Prevention in Australia – Recent Developments• 2008 – National Preventative Health Taskforce (NPHT) established to advise on the actions needed in preventative health for Australia• 2009 – NPHT produced the National Preventative Health Strategy (“Australia: The healthiest country by 2020”)• 2010 – Government response: “Taking preventative action – A response to Australia: The healthiest country by 2020” 31 R a university for the real world CRICOS No. 00213J
  • 32. National Preventative Health Strategy - GoalsBy 2020:• Halt and reverse the rise in overweight and obesity• Reduce the prevalence of daily smoking to 10% or less• Reduce the proportion of Australians who drink (short-term risky/high risk levels to 14%; long- term risky/high risk levels to 7%)• Contribute to the ‘Close the Gap’ target for Indigenous people, reducing the life expectancy gap between indigenous and non-indigenous people 32 R a university for the real world CRICOS No. 00213J
  • 33. Why obesity, tobacco and alcohol?Keys to prevention: Top seven selected risk factors and the burden of disease Tobacco Blood PressureOverweight/obesity Physical Inactivity Blood Cholesterol In total modifiable risk factors cause: Alcohol 32% of burden of disease Low fruit and Vegetables 0 1 2 3 4 5 6 7 8 9 % DALYS (National Preventative Taskforce, 2008- Adapted from AIHW, Australia’s Health 2008, Table 4.1)a university for the real world R CRICOS No. 00213J 33
  • 34. National Preventative Health Strategy – How?1. Shared responsibility – developing strategic partnerships2. Act early and throughout life3. Engage communities4. Influence markets and develop coherent policies5. Reduce inequity6. Working with Indigenous Australians to close the gap7. Refocus primary healthcare towards prevention 34 R a university for the real world CRICOS No. 00213J
  • 35. Government’s response to National Preventative Health Strategy• Critical infrastructure• World’s strongest tobacco crackdown• Addressing alcohol misuse, especially binge drinking• Tackling obesity• Building on broader government support for children and low income communities• Prevention for Indigenous Australians 35 R a university for the real world CRICOS No. 00213J
  • 36. What about Queensland? 36 Ra university for the real world CRICOS No. 00213J
  • 37. Previous Queensland InitiativesStrategic documents for the prevention of Chronic Conditions in Queensland include:- Queensland Strategy for Chronic Disease 2005–2015- The Health of Queenslanders: Prevention of Chronic Disease 2008- Strategic Directions for Chronic Disease Prevention 2009-2012Around $16 million was invested into the health of Queenslanders in the areas of nutrition, physical activity and healthy weight• Over 100 co-ordinated nutrition and physical activity initiatives undertaken as part of:- Eat Well Be Active - Healthy Kids for Life Action Plan- Eat Well Queensland 2002-2012- Be Active Queensland 2006-2012- Queensland Aboriginal and Torres Strait Islander Food and Nutrition Strategy 37 (Queensland Health, 2005; Queensland Health 2009) R a university for the real world CRICOS No. 00213J
  • 38. Strategic Directions for Chronic Disease Prevention 2009-2012 38 (Queensland Health 2009) R a university for the real world CRICOS No. 00213J
  • 39. Prevention in Queensland: 2012 onwards...• Queensland Health Strategic Plan 2012–2016 http://www.health.qld.gov.au/about_qhealth/docs /strategic-plan-12-16.pdf• Blueprint for better healthcare in Queensland (February 2013) http://www.health.qld.gov.au/blueprint/docs/print. pdf 39 R a university for the real world CRICOS No. 00213J
  • 40. Queensland Health Strategic Plan 2012–2016• Outcome relevant to Prevention: (1) Health services emphasise keeping people well, and avoiding unnecessary hospitalisations through: – Develop funding strategies that promote increased activity by service providers in health promotion, screening/monitoring of high-risk cohorts and early intervention – Improving quality and use of evidence base for individual and community health promotion and reducing rates of chronic disease – Protect the population’s health by providing services that manage preventable environmental health hazards as well as the prevention and control of communicable diseases. 40 R a university for the real world CRICOS No. 00213J
  • 41. Blueprint for better healthcare in Queensland (2013)• Stronger focus on delivery of healthcare (treatment) rather than on preventative services• Individual’s responsibility to manage their own health• Broad media & community campaigns (i.e. education)• Cost (and responsibility) shifting of preventative services from State Government to Federal Government through Medicare Locals• Health Partnerships: engaging community groups in the provision of preventative healthcare (outsourcing of preventative services) 41 R a university for the real world CRICOS No. 00213J
  • 42. Blueprint for better healthcare in Queensland (2013)• “Ultimately, people are responsible for managing their own health” (p.17)• “Queenslanders will be encouraged to take responsibility for their own health through broad-based community messaging” (p.17)• “There is a need to re-align the day-to-day delivery of preventative health services at the local level. Experience over many years has demonstrated that these measures should be more closely aligned with the activities of community-based practitioners. Increasingly, Medicare Locals will address this opportunity (...) The Australian and State Governments will collaborate on disease prevention and mass media strategies.” (p.17) 42 R a university for the real world CRICOS No. 00213J
  • 43. Prevention policies and strategies in your country of origin? 43 R Reclaimingmyfuture.com a university for the real world CRICOS No. 00213J
  • 44. Additional References• AFMC, Primer on Population Health (http://phprimer.afmc.ca/inner/primer_contents)• Australian Government. (2010) . Taking Preventative Action – A Response to Australia: The Healthiest Country by 2020 – The Report of the National Preventative Health Taskforce. Commonwealth of Australia, Canberra• Darnton-Hill, I., Nishida, C. and James, W. (2004). A lifecourse approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutrition. 7(1A), 101-121.• National Preventative Health Taskforce. (2008). Australia: The Healthiest Country by 2020. Commonwealth of Australia, Canberra.• National Preventative Health Taskforce. (2008). Technical Report 1. Obesity in Australia: a need for urgent action. Commonwealth of Australia, Canberra.• National Health Priority Action Council. (2006). National Chronic Disease Strategy. Australian Government Department of Health and Ageing, Canberra.• National Public Health Partnership. (2001). Preventing Chronic Disease: A Strategic Framework. National Public Health Partnership, Melbourne.• Queensland Health. (2009). Strategic directions for chronic disease prevention 2009-2012. Division of the Chief Health Officer, Brisbane• Queensland Health. (2008). The Health of Queenslanders 2008: Prevention of Chronic Disease. Second Report of the Chief Health Officer Queensland. Queensland Health, Brisbane.• Queensland Government. (2012). Queensland Health Strategic Plan 2012-2016. Queensland Government, Brisbane.• Queensland Health. (2013). Blueprint for better healthcare in Queensland. Queensland Government, Brisbane• WHO. (2005). Preventing Chronic Disease: a vital investment. WHO, Geneva.• WHO. (2008a). 2008-2013 Action Plan for the Global Strategy for the prevention and control of Noncommunicable Diseases. WHO, Geneva.• WHO. (2008b). Prevention and Control of noncommunicable diseases: Implementation of the global strategy. WHO, Geneva. 44 R a university for the real world CRICOS No. 00213J