Suitability of the WHO 25 x 25 chronic disease targets and indicators for Australia

The World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of NCDs 2013‐2020 aims to reduce the burden of non‐communicable diseases by 2025, through action on nine targets measured by 25 indicators of performance. While the WHO 25 x 25 targets were cited as a key set of measures for Australia to assess and improve the health of the population, they must be tailored to the Australian context. This paper reviews the nationally available data relevant to the WHO 25 x 25 targets and indicators, identifying any gaps that exist. This report will be used to provoke discussion and inform the development of targets and indicators, based on the WHO model, but tailored to Australia’s population health needs

Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement

Drawing on leaked texts of potential provisions of the proposed Trans-Pacific Partnership Agreement, this health impact assessment found the potential for negative impacts in the cost of medicines, tobacco control policies, alcohol control policies, and food labeling. Overview The Centre for Health Equity Training Research and Evaluation (CHETRE) has been working with a group of Australian academics and non-government organisations interested in the health of the Australian population to carry out a health impact assessment (HIA) on the Trans-Pacific Partnership Agreement (TPP) negotiations. In the absence of official publicly available drafts of the trade agreement, the health impact assessment drew on leaked texts of potential provisions and formulated policy scenarios based on high priority health policies that could be affected by the TPP. The HIA found the potential for negative impacts in each of the four areas under investigation: the cost of medicines; tobacco control policies; alcohol control policies; and food labeling. In each of these areas, the HIA report traces the relevant proposed provisions through to their likely effects on the policy scenarios onto the likely impact on the health of Australians, focusing particularly on vulnerable groups in the Australian community. The report makes a number of recommendations to DFAT regarding the TPP provisions and to the Australian Government regarding the TPP negotiating process

Australian Family Diversity: an Historical Overview 1960-2015

Published version made available with permission from copyright owners.Over the past three decades, increasing attention has been paid to the diversification of Australian families, particularly with regard to both modes of family formation and family structure. Researchers have provided extensive accounts of, for example, lesbian mother families, families formed through surrogacy, grandparents parenting their grandchildren, and the lives of people who were donor-conceived. These accounts, among many others, have served to expand our understanding of what counts as a family, and the specific experiences and needs of a range of family groups. At the same time, however, changes in the political landscape have increasingly brought to the fore an emphasis upon one particular form: the heterosexual nuclear family formed through reproductive heterosex. As such, whilst on the one hand we have seen increased recognition and indeed celebration of family diversification, we have also seen something of a push back against this diversification. The present report was developed in order to facilitate a robust, empirically-based discussion of the topic of family diversification in Australia. The report highlights two key points that address both the fact of diversification outlined above, and concerns that have arisen in response to it: First, changes to the face of Australian families have been slow yet consistent over the past five decades. Such changes have been brought about by developments in the realm of reproductive science, legislative change, and shifts in public attitudes. In this sense, diversification reflects the reality of Australian society, rather than being the agenda of any one group. Second, despite changes to the face of Australian families, much remains the same. In other words, the information presented in this report highlights both continuity and change. In drawing upon data collected by, amongst others, the Australian Bureau of Statistics and the Australian Institute for Health and Welfare, available both publically and through request by the authors, this report presents an overview of key family-related areas. As such, it builds upon the significant work undertaken by the Australian Institute of Family Studies in their Diversity and Change in Australian Families report (de Vaus, 2004) by adding a historical component. Mapping changes and continuity across time provides researchers, policy makers, and members of the public with an informed understanding of Australian family diversification

The Trans Pacific Partnership Agreement negotiations and the health of Australians

The Trans Pacific Partnership Agreement has the potential to negatively impact the health of Australians by raising the cost of medicine and limiting the government\u27s ability to regulate tobacco and alcohol, argues this policy brief based on publicly available and recently leaked negotiating documents. Executive summary The purpose of this policy brief is to inform the debate from a health perspective in the final stages of the negotiations on the Trans Pacific Partnership Agreement (TPPA), particularly during meetings of chief negotiators and ministers in February 2014. This policy brief outlines the evidence about the potential health effects on the Australian community of actions related to the TPPA, based on publicly available and recently leaked negotiating documents. The purpose of the TPPA is to enhance each of the countries’ economic development and that this may lead to improved social and health development. However, although there may be positive impacts on the health and wellbeing of Australians resulting from economic growth, there are also many ways in which the TPPA has the potential to have negative impacts on the health of Australians. This policy brief examines the potential impact of provisions proposed for the TPPA on the health of Australians, focusing on two specific issues: the cost of medicines, and the ability of government to take major steps to improve the health of Australians by regulating the areas of tobacco and alcohol policy. In each of these areas we trace some of the pathways through which provisions that have been proposed for the TPPA may impact on the health of the Australian population, and the health of specific groups within the population. We highlight the ways in which some of the expected economic gains from the TPPA may be undermined by health and economic costs. Concerning the cost of medicine we focus on how proposed provisions in the TPPA could impact the affordability of medicines through several different routes: by delaying the availability of cheaper generic medicines, by altering the operation of the Pharmaceutical Benefits Scheme (PBS) making it more difficult to keep costs down, and by enabling pharmaceutical companies to sue the government over its pharmaceutical policies. These changes would increase the cost of the PBS for the government and taxpayers. Strategies to compensate for an increase in medication costs include increased cost-sharing, with patients assuming higher co-payments, or funding reallocation from other parts of the healthcare system. Provisions in the TPPA may impact the ability of Government to enforce existing policies and implement new policies that support public health. Australia is internationally recognised for the success of comprehensive strategies to reduce tobacco smoking. And more recently, there are multiple initiatives being proposed to achieve similar success to reduce harmful use of alcohol. We outline several of the many provisions in the TPPA that could affect tobacco and alcohol policies in Australia. Concerning tobacco these include an investor-state dispute settlement mechanism clause in the TPPA would provide more opportunities for tobacco companies to sue the Australian government over strong tobacco control measures. Rules about ‘indirect expropriation’ (i.e. depriving an investor of property, which, if broadly defined, can include intellectual property such as trademarks) and ‘fair and equitable treatment’ provide additional grounds for corporations to argue that their assets are being unfairly affected by government policies and laws. Provisions in the TPPA may impact the Government’s ability to implement effective alcohol control policies such as restrictions on liquor licences, bans or limits on alcohol advertising, and alcohol health warning labels. Concerning alcohol these include provisions in the Technical Barriers to Trade (TBT) Chapter of the TPPA which could limit possibilities for introducing innovative alcohol policies, such as requiring health warning labels. Provisions in the wine and spirits annex to the TBT Chapter may limit the options available to create a fully effective alcohol warnings scheme for wine and spirits. If Australia agrees to an investor-state dispute settlement (ISDS) mechanism applying to Australia, the alcohol industry will have access to a new legal channel to sue the Australian Government over alcohol policy decisions that adversely impact their investments. We conclude that while there is some potential for the TPPA to contribute to economic development, there is also significant risk that the economic gains which the TPPA may represent, as well as the health of the Australian community, will be threatened if certain proposed provisions are adopted for the TPPA. These include increased direct costs in terms of providing health care and increased use of hospitals, higher costs of obtaining pharmaceuticals, indirect costs associated with lost productivity across society, continuing or exacerbating inequalities in society, and worsening the health of Australia’s already vulnerable communities. Authored by: Katie Hirono, Centre for Health Equity Training, Research and Evaluation, University of New South Wales Deborah Gleeson, School of Public Health and Biosciences, La Trobe University Fiona Haigh, Centre for Health Equity Training, Research and Evaluation, University of New South Wales Patrick Harris, Centre for Health Equity Training, Research and Evaluation, University of New South Wale

Housing outcomes for groups vulnerable to homelessness: 1 July 2011 to 31 December 2013

Examines the housing outcomes of over 94,000 clients in four groups known to be vulnerable to homelessness: those experiencing domestic and family violence, young people presenting alone, people with problematic drug and alcohol use, and those with a current mental health issue. Summary In the 2 and a half years from 1 July 2011 to 31 December 2013, Specialist Homelessness Services (SHS) provided support to over 400,000 people. Some of these clients were at risk of losing their housing and others had already become homeless when they sought support. This analysis examines the housing outcomes of over 94,000 clients in four groups known to be vulnerable to homelessness: those experiencing domestic and family violence, young people presenting alone, people with problematic drug and alcohol use and those with a current mental health issue. The analysis found that: Those who were more socially and economically disadvantaged had poorer housing outcomes across all cohorts. These clients were more likely to be unemployed, had no income or were only on income support, had a past history of homelessness and had more complex presenting issues. Those who had the poorest housing outcomes were those who had problematic drug and alcohol use. Specialist Homelessness Services put considerable effort into preventing those most at risk of losing their housing falling into homelessness. Those clients who began support housed but went on to become homeless did so after having almost twice as many median days of support as those who maintained their housing (between 53 and 89 days). The majority of clients who were housed on presentation did not become homeless with the support of homelessness services.This was the highest for those with mental health issues (92% retaining housing) and for women experiencing domestic violence (87%). It takes considerable support by agencies to assist a person into housing. The group of clients who presented homeless and became housed were supported for the greatest median number of days with between 112 and 175 days of support. Many clients who remained homeless appeared less \u27housing ready\u27 than other clients. They were less engaged with the service system than those who became housed. They largely sought support for basic needs, had significantly fewer days of support (between 20 and 46 median days) and were less likely to request support for accommodation than those who became housed.       &nbsp

Assessment of the Australian Rheumatology Association Database for national population health monitoring: working paper

This working paper uses the Australian Institute of Health and Welfare\u27s recently developed assessment framework to assess the suitability of the Australian Rheumatology Association Database as a potential new data source for population health monitoring of inflammatory arthritis. Summary A wide range of existing data sources could potentially be used to improve our understanding of arthritis in the Australian population. This working paper uses an assessment framework recently developed by the Australian Institute of Health and Welfare (AIHW) to assess the suitability of the Australian Rheumatology Association Database (ARAD) as a potential new data source for population health monitoring of inflammatory arthritis. More than 400,000 Australians have rheumatoid arthritis, the most common form of inflammatory arthritis. This auto-immune disease causes chronic inflammation, pain and swelling of the joints and can greatly reduce a person\u27s quality of life. The ARAD, managed by the Australian Rheumatology Association, is a national registry that collects health information from individuals with inflammatory arthritis. It was primarily established to monitor the benefits and safety of new treatments, particularly the biological disease-modifying anti-rheumatic drugs (bDMARDs). The AIHW\u27s assessment of the ARAD for the purpose of national population health monitoring is that: it has the potential to fill a range of identified data gaps in relation to key questions for monitoring arthritis, including treatment outcomes, disease progression, quality of life and economic impacts it has well established administrative and governance arrangements in place to ensure data quality and compliance with legislative requirements it has limited coverage which could potentially be improved by combining with, or linking to, other similar data sources on balance, it is a data source with the potential to provide useful information for population health monitoring of inflammatory arthritis, particularly if used in combination with, or linked to, other data sources

Women and non communicable diseases (chronic conditions)

Non-communicable diseases (cancer, cardiovascular disease, diabetes, chronic respiratory conditions, and musculo-skeletal conditions) are the number one cause of death and disablement for women and men globally and in Australia, with increasing recognition that women and men experience those conditions differently. This position paper examines the gender dimensions of those diseases to raise awareness, and to inform prevention and treatment guidelines. Building on the inequities for women documented in the AWHN Position Paper on Women’s Health and Wellbeing, this paper highlights the specific areas where gender blindness is occurring and the areas where change is needed. Despite the prevalence of Non-communicable diseases (NCDs) among women, there has been little emphases and even less action, on the differences that women experience in these diseases. Most guidelines and policies on NCDs are gender neutral. This has meant that women with non-communicable diseases have not received the level of support and services needed to ensure the best possible outcomes or that necessary research and education into gender differences has been funded. The lack of research into gender differences and the consequent lack of education for health providers and the population generally, potentially promotes poorer outcomes for women and increases gender inequities. When there is mounting evidence that women’s experience of NCDs is different to that of men’s experience, the gender neutrality of policies, research and education programs contributes to gender inequities. The impact of NCDs on women’s lives, the differences in risk factors for women than for men and the social determinants of NCDs are highlighted. Specific risks include, that: Lung cancer is responsible for more women’s deaths than breast cancer although more women are diagnosed with breast cancer than lung cancer Mortality rates from lung cancer in women are continuing to rise while they have plateaued or are dropping among men Chronic Obstructive Pulmonary Disease (COPD) occurs at lower levels of exposure to tobacco smoking in women than men women with diabetes have a higher risk of stroke than their male counterparts women with diabetes have poorer survival after stroke than men. This paper also highlights the low rate of women in research trials and the low levels of reporting of sex-disaggregated findings. These indicate that treatment recommendations are more generalisable for males than females and the research benefits are therefore greater for men. In turn, this accords a lower status in research to women’s health. Failure to act on gender differences in non-communicable disease costs lives. It is no longer satisfactory for prevention and treatment guidelines to remain gender neutral. Leadership from governments and peak health bodies is required to drive change in both policy and research. Understanding the ways in which gender interacts with NCDs will be enhanced by explicitly mainstreaming gender in policy, research, treatment guidelines and professional and public education. This paper recommends actions that can be taken to redress these problems, and achieve gender aware, gender sensitive and gender transformative care for women. &nbsp

An AIHW framework for assessing data sources for population health monitoring: working paper

This paper outlines the Australian Institute of Health and Welfare\u27s (AIHW) assessment framework for determining the suitability of specific data sources for population health monitoring. AIHW\u27s Assessment Framework When identifying potential data sources for population health monitoring, it is important to ensure they are \u27fit-for-purpose\u27. The AIHW has developed a 3-step process to assess potential data sources for population health monitoring: Step 1 collects information about the data source Step 2 identifies the potential to inform key monitoring areas Step 3 assesses the quality of the data, using a modified version of the Australian Bureau of Statistics (ABS) Data Quality Framework (ABS 2009), to determine its \u27fitness-for-purpose\u27 by establishing its utility, strengths and limitations. The assessment framework has been designed for use by the AIHW and others with an interest in assessing new data sources for use in population health monitoring. With adaptation, it may also have wider applications in other sectors or subject areas. For an example of the application of the assessment framework, see the AIHW working paper Assessment of the Australian Rheumatology Association Database for national population health monitoring (AIHW 2014a)

Disability support services: services provided under the National Disability Agreement 2013–14

In 2013–14, an estimated 321,531 people used disability support services under the National Disability Agreement, including 4,200 who transitioned to the National Disability Insurance Scheme during the year. Summary In 2013-14, an estimated 321,531 people used disability support services under the National Disability Agreement (NDA)-a 9% increase since 2009-10, and a 3% increase since 2012-13. Of those who used NDA services in 2013-14: 44% used community support services, 41% used employment services, 18% used community access services, 14% used accommodation  support services, and 12% used respite services around three-quarters  (74%) were aged under 50, with an average age of 34 most (59%) were male majority (87%) were Australian-born 6% were Aboriginal and Torres Strait Islander people more than half (55%) had an intellectual or learning disability (44% as their primary disability) many needed at least some assistance with activities of daily living (68%), activities of independent living (82%), and activities of work, education and community living (86%) more than half (54%) lived with their families close to one-third (32%) of those aged 15 and over were not in the labour force 70% of those aged 15 and over who were in the labour force were unemployed an estimated 4,200 transitioned to the National Disability Insurance Scheme during the year

National opioid pharmacotherapy statistics 2014

Summary Dependence on opioid drugs is associated with a range of health and social problems that affect individual drug users, their family and friends, and the wider public. This bulletin presents information on the clients receiving opioid pharmacotherapy treatment, the doctors prescribing opioid pharmacotherapy drugs, and the dosing points that clients attend to receive their medication. Over 48,000 Australians received pharmacotherapy treatment for their opioid dependence on a snapshot day in June 2014 The number of people receiving opioid pharmacotherapy treatment almost doubled between 1998 (from around 25,000) and 2014, but growth in client numbers slowed in recent years (growing by 0.5-2% a year between 2011 and 2014). Heroin is the most common opioid drug leading people to pharmacotherapy treatment Clients were nearly twice as likely to report heroin as an opioid drug of dependence as they were for all opioid pharmaceuticals combined, however this varied by jurisdiction. Methadone continued to be the drug most commonly prescribed; the form in which buprenorphine is prescribed is changing Around two-thirds  (67%) of clients received methadone in 2014, and this has been relatively stable since 2006. The remaining third (33%) received 1 of 2 forms of buprenorphine. Of these, the proportion receiving buprenorphine only has fallen (from 24% to 13%) while the proportion receiving buprenorphine combined with naloxone has risen (from 5% to 20%) over the same period. Naloxone is added to buprenorphine to deter its injection. Opioid pharmacotherapy clients are getting older on average In 2014, around two-thirds  (69%) of clients were aged 30-49, and this has been fairly consistent since 2006. However, from 2006 to 2014 the proportion of clients aged less than 30 more than halved (from 28% to 10%), and the proportion of clients aged 50 and over more than doubled (from 8% to 21%). These trends indicate an ageing population of clients in pharmacotherapy treatment. Males and Indigenous Australians are over-represented in pharmacotherapy treatment Around two-thirds (65%) of clients receiving pharmacotherapy in June 2014 were male. Where reported, 1 in 10 (10%) clients identified as Indigenous and Indigenous Australians were around 3 times as likely to have received pharmacotherapy treatment as non-Indigenous Australians. Prescriber numbers have increased, and most work in the private sector The number of prescribers of opioid pharmacotherapy rose by 31% since 2012 (from 1,768 to 2,319). In 2014, most prescribers treated 1-5 clients (39%), worked in the private sector (82%) and were authorised to prescribe more than 1 type of pharmacotherapy drug (74%). Most dosing points were located in pharmacies Most clients need to attend a dosing point regularly to take their opioid pharmacotherapy drug under supervision. In 2013-14 there were 2,432 dosing point sites in Australia, and 9 in 10 (89%) were located in pharmacies