Annual Report - Outcome 1 – Population Health

Table of contents

Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 1 aims to reduce the occurrence of preventable mortality, illness and injury in Australians. The Department worked to achieve this outcome by: managing initiatives under the programs outlined below; providing regulatory policy advice for radiation protection and nuclear safety; and regulating therapeutic goods, industrial chemicals and gene technology.

Programs Administered Under Outcome 1 (Program Objectives in 2008–09)

Program 1.1 – Chronic Disease – Early Detection and Prevention

Promote and support the prevention of chronic disease, through the adoption of healthy lifestyles.
Improve the early detection of breast, cervical and bowel cancer.

Program 1.2 – Communicable Disease Control

Reduce and control the spread of HIV/AIDS, Hepatitis C and sexually transmissible infections.
Support workforce development and targeted health education programs.

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Program 1.3 – Drug Strategy

Support research to monitor emerging trends in drug use and best practice in regard to prevention and treatment.
Raise community understanding of drug-related issues and their impact on mental health.
Complement state and territory programs.

Program 1.4 – Food and Regulatory Policy

Provide direction and leadership in food policy issues.
Support the Australia and New Zealand Food Regulation Ministerial Council and its committees.
Support national stakeholder communication.

Program 1.5 – Immunisation

Protect against major vaccine preventable diseases through the provision of vaccines and immunization advice to the Australian community.

Program 1.6 – Public Health

Lead and coordinate the chronic disease prevention agenda in Australia.
Contribute to the development and maintenance of national population health infrastructure and workforce capacity.
Strengthen the evidence-base for prevention.
Support the evaluation of the efficiency and effectiveness of public health activities through the Priority Setting Mechanism.

This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 1 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 1 was managed in 2008–09 by the Population Health Division, the Mental Health and Chronic Disease Division, the Regulatory Policy and Governance Division, the Therapeutic Goods Administration, the National Industrial Chemicals Notification and Assessment Scheme, the Office of Health Protection, and the Office of the Gene Technology Regulator. The Department’s State and Territory Offices also contributed to the achievement of the outcome.
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Major Achievements for the Outcome:

Development of the National Partnership Agreement on Preventive Health as a basis for intensifying the prevention of obesity, tobacco and the excessive consumption of alcohol (see Curbing Obesity, Tobacco and Excessive Alcohol Consumption);
Increased national immunization coverage rates through the ongoing delivery of the Immunise Australia Program in partnership with states and territories (see Targeted Disease Prevention);
Increased young people’s awareness of illicit drugs, their harms, and avenues for support through stage one of the Illicit Drug Use – Targeting Young Methamphetamine Users campaign (see Reducing the Demand, Supply and Harm Caused by Illicit Drug Use);
Reduced the regulatory burden to sections of the therapeutic goods industry through a regulatory reform amendment Bill passed by Parliament (see Enhancing Therapeutic Goods Regulation); and
Addressed the human health and environmental risks of the chemical triclosan, used in a wide range of consumer products, by finalising the world’s first comprehensive assessment (see Ensuring a More Responsive Industrial Chemicals Regulatory Scheme).

Challenges for the Outcome:

A lower than anticipated number of participants in lifestyle modification programs for people at risk of type 2 diabetes (see Curbing Obesity, Tobacco and Excessive Alcohol Consumption); and
The discovery of a fault in the faecal occult blood test kit used in the National Bowel Cancer Screening Program, which resulted in the reporting of false negative results in an estimated three per cent of participants (see Targeted Disease Prevention).

Key Strategic Directions for 2008–09 – Major Activities

Curbing Obesity, Tobacco and Excessive Alcohol Consumption

The burden of chronic disease caused by obesity, tobacco and the excessive consumption of alcohol adversely affects the quality of people’s health and lives, and places cost pressures on both the health system and the broader economy. In 2008–09, the Department implemented a range of initiatives to help reduce the incidence of chronic disease and its precursory risk factors. These activities included contributing to national preventative health reforms, and delivering initiatives that specifically address obesity in children and adults, tobacco use, alcohol consumption, and type 2 diabetes.

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National Preventative Health Care

A major achievement for the Department was the role it took in developing the National Partnership Agreement on Preventive Health. The Department, with states and territories, investigated options for addressing overweight and obesity, smoking and excessive alcohol consumption (including binge drinking) in order to design the interventions funded through the National Partnership Agreement.

The agreement was formalised through the Council of Australian Governments in November 2008 and funding under the agreement will commence in 2009-10, during which time the Department will support the delivery of locally based interventions and social marketing initiatives. It will also establish infrastructure to monitor and evaluate progress, including the Australian National Preventive Health Agency.

The Department also supported the Preventative Health Taskforce in its development of the National Preventative Health Strategy. This involved: facilitating over 40 public consultations, with almost 1,000 participants; commissioning research on topics such as environmental influences of unhealthy weight and social determinants of health; and collating and analysing 397 submissions. The taskforce submitted the National Preventative Health Strategy to the Government in June 2009. The Government is considering the recommendations of the strategy in conjunction with those of the National Health and Hospitals Reform Commission and the National Primary Health Care Strategy.

Childhood Obesity

In October 2008, the Department released the results of the 2007 Australian National Children’s Nutrition and Physical Activity Survey, which found that most of the 4,000 children surveyed were active and of a healthy weight. However, children were eating less than the recommended amounts of fruit, vegetables and dairy foods, and more than the recommended amount of sugar, saturated fat and salt. In addition, 17 per cent of children aged two to 17 years were overweight, and six per cent of this age group were obese.

To help address childhood obesity, the Department introduced a number of initiatives that promoted positive behavioural changes in relation to healthy eating, physical activity and healthy weight. For example, the Department introduced the Healthy Kids Check on 1 July 2008, so that the health of every four year old child in Australia can be examined prior to starting school (discussed further in the Outcome 5 Primary Care chapter). The Department also promoted healthy food choices through the Stephanie Alexander Kitchen Garden Program, by teaching children in years three to six to grow, cook and share fresh food. Forty-four schools across Australia participated in the program in 2008–09. The Department will fund more schools from September 2009.

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Alcohol Consumption and Tobacco Use

Reducing the use of tobacco and alcohol is proven to lessen the burden of chronic diseases and avoid the social problems associated with their consumption. Through the National Binge Drinking Strategy, the Department funded 19 community organisations to tackle the problem of binge drinking in their local areas. These included: a binge drinking minimisation project targeting vulnerable target groups in Brisbane and Toowoomba in Queensland; a Drink Safe Community initiative in Broken Hill in New South Wales; and a Grog and You project to reduce binge drinking among youth in Indigenous communities east of Katherine in the Northern Territory.

The Department funded 2,777 sporting organisations to build a culture of responsible drinking at the grassroots level, and established the Club Champions program to help foster leaders in the promotion of responsible drinking practices in sporting codes. Seven major sporting organisations signed up to this initiative. In addition, the Department launched a comprehensive two-year national advertising campaign in November 2008, which confronted young people with the consequences of binge drinking.

Efforts in curbing tobacco use continued in 2008–09 with a range of measures under the National Tobacco Strategy to prevent the uptake of smoking. These included: encouraging and assisting smokers to quit; eliminating harmful exposure to tobacco smoke among non-smokers; and where feasible, reducing harm associated with the continuing use of, and dependence on, tobacco and nicotine. In 2009–10, the Department will implement a plan for the strategy, which was approved by former Parliamentary Secretary to the Minister for Health and Ageing, Senator the Hon Jan McLucas, on 15 December 2008. The Department is planning to review the National Tobacco Strategy 2004–2009, and to develop a new strategy to cover 2010–2014.

The Department finalised a comprehensive evaluation of the graphic health warnings on tobacco product packaging which found that they met their intended purpose. The final report, Evaluation of the Effectiveness of the Graphic Health Warnings on Tobacco Product Packaging 2008 is available at www.health.gov.au.

In addition, the Department contributed to the World Health Organization’s Framework Convention on Tobacco Control, which is the first global public health treaty aimed at advancing international cooperation to protect present and future generations from the preventable health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. The Department played a key role in the development of guidelines in relation to the packaging and labelling of tobacco products and tobacco advertising, promotion and sponsorship.

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Key Fact for 2008–09: World No Tobacco Day Regional Award

The Department was awarded a World No Tobacco Day Regional Award on 31 May 2009 by the World Health Organization in Geneva in recognition of its contribution to tobacco control. The award reflected the Department’s efforts in consistently developing strong and effective health warnings; and successfully implementing these health warnings using effective media campaigns, many of which have been followed and adopted by other countries such as Canada and New Zealand.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes and accounts for approximately 92 per cent of the burden on individual health and the health system, brought about by diabetes. It is largely preventable with modifiable risk factors including obesity, low physical activity and an unhealthy diet. Many people with diabetes are not aware that they have it.

In 2008–09, the Department implemented the Council of Australian Governments’ Diabetes – Reducing the Risk of Type 2 Diabetes initiative, in collaboration with the State and Territory Governments, to help delay, or possibly prevent, the development of type 2 diabetes by targeting risk factors. As part of this, the Department distributed a risk assessment tool (discussed in the Outcome 5 Primary Care chapter) and nationally agreed standards and accreditation guiding principles for lifestyle modification programs. The Department also worked with the Australian General Practice Network to deliver lifestyle modification programs for people at risk of type 2 diabetes through the Divisions of General Practice Network.

A challenge for the Department in 2008–09 occurred when the number of people participating in lifestyle modification programs in 2008–09 was lower than anticipated. During 2009–10, the Department will work to increase the number of participants by better promoting the program through the Australian General Practice Network. It will also work with the network to implement an online minimum data collection system to measure the success of the lifestyle modification program.

Funding for the above activities was sourced from Programs 1.1 – Chronic Disease – Early Detection and Prevention; 1.3 – Drug Strategy; and 1.6 – Public Health.
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Targeted Disease Prevention

Targeting disease prevention encompasses curbing infectious and chronic diseases that are preventable, and combating these diseases in target sub-populations. In 2008–09, the Department undertook targeted disease prevention activities through initiatives that focused on screening and reducing the rates of bowel cancer, breast cancer, and sexually transmissible diseases. The Department also managed a range of immunisation initiatives.

Bowel Cancer

Bowel cancer is the second most common cause of cancer-related deaths in Australia after lung cancer, with 80 people in Australia dying each week from the disease. Screening remains the best way to detect bowel cancer in its early stages. On 1 July 2008, the Department commenced phase two of the National Bowel Cancer Screening Program, inviting approximately 800,000 Australians aged 50, 55 and 65 years to participate.

On 11 May 2009, the Department suspended issuing invitations following advice from the contracted pathology provider that it had discovered a fault in the faecal occult blood test kit introduced on 1 December 2008 which resulted in the reporting of false negative results in an estimated three per cent of participants. The Department notified all 389,911 participants potentially affected by the faulty kits, working with the contracted pathology provider and Medicare Australia, which managed the program’s register. The program will recommence once the Therapeutic Goods Administration has listed the replacement kit on the Australian Register of Therapeutic Goods and the Department is satisfied that the replacement kit is fit for use in the program.

The Department will continue to send invitations in 2009–10. It will also work with the State and Territory Governments to trial alternative delivery models that meet the specific needs of Indigenous communities, continuing trials that commenced in Queensland and Victoria this year.

Breast Cancer

Since the introduction of the BreastScreen Australia program in 1991, breast cancer mortality has dropped from 30.5 per 100,000 women in 1991 to 23.7 per 100,000 women in 2005. In 2008–09, the Department continued to work with the states and territories to provide free mammographic screening through the program specifically targeted at well women aged 50 to 69 years. Women aged 40 to 49 and over 70 years old were also eligible to attend screening.

The Department also managed an evaluation of BreastScreen Australia, which assessed the program’s appropriateness, efficiency and effectiveness. The evaluation also identified issues and opportunities for improvement. The Department prepared a draft evaluation report that will be considered by health ministers in 2009–10.

Sexually Transmissible and Blood Borne Virus Infections

During 2008–09, the Department funded four National Research Centres to undertake work in clinical research, epidemiology and the prevention of blood borne viruses and sexually transmissible infections. The Department also commenced a review of the leadership and governance arrangements for national strategies in December 2008 which led to the establishment of the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections. A review of the appropriateness, efficiency and effectiveness of national strategies, and recommendations for the next iteration of the strategies is now underway. The advisory committee will oversee the remainder of the review, and provide independent advice on the framework for the revised strategies to the Minister for Health and Ageing.

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Key Facts for 2008–09: Sexually Transmissible Disease Rates Across the Years

AIDS diagnoses continue to fall due to effective antiretroviral therapies, with the rate declining from 1.2 per 100,000 for the period 1998–2002 to 1.0 per 100,000 population for the period 2003–07.
The number of new HIV diagnoses in Australia has increased over the past eight years, and increased from 1,007 cases in 2006 to 1,051 cases in 2007.
Between 2004 and 2008, the rate of diagnosis of hepatitis C infection in Australia declined by 19 per cent from 65.1 cases per 100,000 population to 52.7 cases per 100,000, in 2008.
Chlamydia remains the most frequently reported notifiable condition in Australia with approximately 58,405 reported cases in 2008. This represents a rate of 274 cases per 100,000 population, a 10 per cent increase over the 2007 rate.

Immunisation

The Department managed a number of immunisation initiatives to help reduce the incidence of mortality caused by vaccine preventable diseases. A major achievement was the finalisation of a new National Partnership Agreement on Essential Vaccines between the Australian, State and Territory Governments, which outlines arrangements for the funding and delivery of a national, coordinated approach to reduce vaccine preventable diseases by maintaining and improving vaccination rates through the Immunise Australia Program. The Department collaborated with the states and territories to develop the agreement, and expects that the national partnership will optimise national coverage rates, particularly where coverage is lower than the national average among Indigenous participants and four year old children.

The Department also commenced work with the states and territories to develop a National Immunisation Strategy, which will provide a framework for preventing, managing, controlling and monitoring vaccine preventable diseases. It will help improve immunisation coverage, particularly where there is a high incidence of vaccine preventable disease and low coverage rates. In addition, the strategy will integrate immunisation strategies with other important public health interventions such as screening.

The Department funded the development of the Human Papillomavirus National Vaccination Register to monitor the coverage of immunisation and to facilitate the payment of an administrative fee to general practitioners who provide vaccination information. At the end of 2008–09, 5.9 million doses of the Human Papillomavirus vaccine had been distributed in Australia and almost one million women had been registered as having at least one dose of vaccine.

Funding for the above activities was sourced from Programs 1.1 – Chronic Disease – Early Detection; 1.2. – Communicable Disease Control; 1.5 – Immunisation; and 1.6 – Public Health.
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Reducing the Harm Caused by Illicit Drug Use

Providing young people with information about illicit drugs such as methamphetamines, ecstasy and cannabis, and supporting best practice in regards to prevention and treatment are important for reducing the demand, supply and harm caused by illicit drugs. This can help prevent physical and mental health problems for users, and social costs for the wider community.

In 2008–09, the Department developed and implemented phase four of the National Drugs Campaign – Illicit Drug Use – Targeting Young Methamphetamine Users initiative to raise awareness of the harms associated with illicit drug use and to encourage and support young people’s decision not to use. The campaign also encourages people to seek help from professional services. A major achievement was the launch of stage one on 19 April 2009, which targeted 15 to 25 year olds about Ice, speed, ecstasy and cannabis through advertising, public relations and online activities through www.drugs.health.gov.au.

The Department will launch stage two of the campaign in 2009–10, using evidence-based, targeted communications to engage the different types of young people who are at risk of, or are currently using, methamphetamines, ecstasy and cannabis. The communication strategies will motivate illicit drug users to reconsider their use, and to seek support to stop.

Funding for the above activity was sourced from Program 1.3 – Drug Strategy.
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Supporting Child, Youth, Women’s and Men’s Health

Improved Health and Wellbeing of Children and Young Australians

The early years of a child’s life significantly influences their future health, development and wellbeing. In 2008-09, the Department led a number of projects to help ensure that children have the best opportunity to develop physically, emotionally and cognitively. For example, the Department worked with the states and territories and the National Health and Medical Research Council, to develop national evidence-based antenatal care guidelines. The Department anticipates that a draft set of guidelines will be released for public consultation in 2010.

The Department also collaborated with the states and territories and other Australian Government agencies, to progress activities that support the improved health and wellbeing of children and young people, including the development of a National Early Childhood Development Strategy – Investing in the Early Years – and the National Framework for Protecting Australia’s Children 2009–2020 (available at www.coag.gov.au).

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Addressing Gender Specific Issues

The health of Australian men and women is important. Both genders take on a myriad of responsibilities in an increasingly busy society and despite many improvements in health, not all people in Australia have benefited equally. Men and women have different life and health experiences due to biological, psychological, economic, social, political and cultural attributes and opportunities associated with being male and female.

In 2008–09, the Department played an integral role in developing a national men’s health policy, to address male specific health issues and discrepancies in access to services. This involved drafting consultation papers and undertaking forums in each state and territory, during which the Department sought feedback from around 1,200 stakeholders. The Department also distributed close to 600 copies of the Developing a Men’s Health Policy for Australia – Resource Kit to individuals and groups. The Department expects to finalise the national men’s health policy in late 2009.

The Department also drafted Developing a Women’s Health Policy for Australia: setting the scene and Development of a New National Women’s Health Policy Consultation Discussion Paper 2009 (available at www.health.gov.au), and consulted with women’s health organizations through a roundtable session, to help inform the development of a women’s health policy. Following this session, the Department invited the same organisations to consult with their members/organisations on specific areas of women’s health, and to provide tailored submissions to the Department by 30 June 2009. The Department expects to finalise the national women’s health policy in 2010.

Funding for the above activities was sourced from Program 1.6. – Public Health.
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Increased Focus on Indigenous Australians’ Health

A key Government priority in 2008–09 was to ensure that all population health programs contribute to closing the gap in health outcomes between Aboriginal and Torres Strait Islander populations and the wider Australian community, particularly in the areas of maternal and child health, chronic disease factors, and tobacco control.

A particular focus under this outcome was on addressing smoking rates in Aboriginal and Torres Strait Islander communities through the Indigenous Tobacco Control Initiative. Targeting Indigenous Australians who smoke in all age groups, but in particular young smokers, the initiative communicates the dangers of smoking and assists people to quit. It also aims to build an evidence base by funding formative research to understand reasons behind the higher rates of smoking, and barriers to quit. In 2008–09, the Department funded six projects under the initiative to help achieve these objectives in a broad range of Indigenous health care settings (community based, general practice and Aboriginal Medical Services). The Department will expand on this number of projects by calling for more submissions through an open funding round in 2009–10.

Funding for the above activity was sourced from Program 1.3 – Drug Strategy. Discussion relating to other Indigenous-specific activities can be found in most outcome chapters, in particular Outcome 8 Indigenous Health.

Enhancing Therapeutic Goods Regulation

Ensuring the Australian community has timely access to therapeutic goods that are of high quality and are safe and effective for their intended purpose is an ongoing priority. In 2008–09, the Department, through the Therapeutic Goods Administration, began a comprehensive program of reforms to ensure that the therapeutic goods regulatory scheme remains contemporary, responsive and consistent with community standards and international best practice. These reforms were developed after extensive consultation with stakeholders.

A major achievement was the development of legislative amendments to implement the reform program. The legislative changes that received Royal Assent include: enabling medical devices to be stockpiled for emergencies; reducing the regulatory burden for sponsors and manufacturers of therapeutic goods; and increasing transparency and access to information. Further amendments to legislation and regulations are expected in 2009–10 to support the continued implementation of the regulatory reform program including: introducing a new framework for the regulation of homoeopathic and anthroposophic medicines; and implementing of new arrangements for the separate scheduling of medicines and chemicals.

Funding for the above activities was sourced from the Special Account for the Therapeutic Goods Administration.
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Responsive, Efficient and Effective Gene Technology Regulation

The Gene Technology Regulator, supported by the Department’s Office of the Gene Technology Regulator, aims to protect the health and safety of people and the environment by regulating dealings with genetically modified organisms. The Regulator has statutory powers specific to the regulation of genetically modified organisms, and administers the gene technology legislation, which includes functions such as prohibition of certain activities, decisions on issuing licences, certifications, accreditations, technical review of regulations; and can delegate roles and responsibilities to employees of the Office, where appropriate.

Enhanced Efficiency and Effectiveness

The Department, through the Office, focused on protecting the health and safety of people and the environment by assisting the Gene Technology Regulator in the regulation of dealings with genetically modified organisms. In 2008–09, the Gene Technology Regulator initiated a review of the Gene Technology Regulations 2001, to ensure that they are up-to-date with scientific advances and the regulatory requirements are commensurate with risk.

The review will continue over the next year and it is anticipated that amendments to the regulations will take effect by the end of 2009–10 following the endorsement of the Gene Technology Ministerial Council.

Strengthened Bilateral Arrangements

The Office continued bilateral arrangements with other Australian Government regulators such as Food Standards Australia New Zealand, the Australian Pesticides and Veterinary Medicines Authority, and the Australian Quarantine Inspection Service, to ensure that any risks to the health and safety of people and the environment are managed effectively through coordinated action plans and decision-making. These arrangements help to avoid duplication in the regulation of genetically modified organisms and products.

Funding for the above activities was sourced from the Office of the Gene Technology Regulator Special Account.
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Ensuring a More Responsive Industrial Chemicals Regulatory Scheme

Ensuring that the regulatory scheme for industrial chemicals responds to potential risks to human health will protect the community from unnecessary harm. In 2008–09, the Department, through the National Industrial Chemicals Notification and Assessment Scheme, worked to minimise the regulatory burden for industrial chemicals (including those used in cosmetics and domestic products) while protecting human health and the environment. The Department worked to achieve this by implementing and evaluating numerous reform initiatives.

For example, the Department finalised reforms that will reduce duplication of the assessment effort and streamline regulatory requirements for certain classes of chemicals. As a result, the Department can now use assessments of certain classes of chemicals conducted, produced and completed by regulatory counterparts in Canada and other Australian regulatory agencies, thereby reducing the regulatory requirements for low hazard or low risk chemicals. Through these reforms, the Department provided the community with faster access to safer chemicals.

A major achievement was the finalisation of the review of the human health and environmental impacts of the chemical triclosan, which is used in personal care and cosmetic products because of its antimicrobial properties. This was the first comprehensive human health and environmental assessment of triclosan in the world. The Department was able to conclude that while the human health risks are generally low, there are some circumstances where further management measures are required. The Department also identified some uncertainty about the environmental impact and recommended targeted sampling studies to validate assumptions underpinning the assessment.

Funding for these activities was sourced from the National Industrial Chemicals Notification and Assessment Scheme Special Account under a full cost recovery model.
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Performance Information for Outcome 1 Administered Programs

Program 1.1 – Chronic Disease – Early Detection and Prevention
Indicator:	Participation rates in breast cancer, bowel cancer, and cervical screening programs which have a sound evidence-base and are responsive to new and emerging trends.
Reference Point/Target:	Maintain participation in breast cancer, bowel cancer and cervical screening programs.
Result: Indicator met.
The latest data for the BreastScreen Australia program shows an increase in participation (including in regional and very remote areas) from 55.7% for 2003–04 to 56.9% in 2005–06 for the target group of women aged 50 to 69 years. Early analysis of available data for bowel screening indicates that the participation rate for 2008–09 remains at approximately 40%, consistent with the participation rate reported at June 2008. The suspension of the program for part of the year may influence the participation rate for 2008–09, and into the future. Final data will be available in late 2009. The latest available data for the National Cervical Screening Program shows an increase in the two-year participation rate from 60.6% in 2005 and 2006 to 61.5% in 2006 and 2007 for the target age group of women aged 20 to 69 years. The three-year and five-year participation rates to 2007 were 74.0% and 86.4% respectively.
Indicator:	Establishment of a Preventative Health Care Taskforce and development of a National Preventative Health Care Strategy.
Reference Point/Target:	Preventative Health Care Taskforce established by June 2008. National Preventative Health Strategy submitted to Minister by June 2009.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to reflect that the National Preventative Health Strategy would be ‘submitted’ to the Minister by June 2009, not ‘established’.
Result: Indicator met.
The Preventative Health Taskforce was established in April 2008 to provide the Government with advice on addressing chronic disease caused by obesity, tobacco and excessive alcohol consumption. The taskforce developed and submitted a National Preventative Health Strategy to the Minister for Health and Ageing for consideration within the stipulated timeframe.
Indicator:	Implementation of initiatives targeting nutrition, physical activity, obesity, overweight and injury.
Reference Point/Target:	Initiatives implemented in accordance with respective dates and targets.
Result: Indicator met.
The Department implemented a number of initiatives targeting nutrition, physical activity, obesity and overweight in accordance with their respective dates and targets. Examples include: a national toll-free 24-hour breastfeeding helpline (1300 MUM2MUM) to provide breastfeeding information and peer support for mothers and their families. Between October 2008 and June 2009 the helpline received over 37,000 calls; nationally recognised courses and other educational opportunities for health professionals and breastfeeding counsellors attended by over 2,000 health professionals; and the Measure Up social marketing campaign, to raise awareness of the link between chronic disease and lifestyle risk factors. The campaign (with television, radio, print, outdoor and online coverage) was run in October to November 2008 and March to April 2009.

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Program 1.2 – Communicable Disease Control
Indicator:	Improved knowledge, attitude and behaviours in relation to communicable diseases and associated health risks through targeted health promotion and disease prevention campaigns, including social marketing.
Reference Point/Target:	Improvements in knowledge, attitudes and behaviours in relation to disease and health risks.
Result: Indicator met.
The Department improved knowledge, attitudes and behaviours in relation to disease and health risks included by: funding, along with State and Territory Governments, the ‘Enjoy Life. Take Control. Stop HIV/AIDS’ activities, as part of World Aids Day (1 December 2008). The Department also took a lead role in organising the event and distributing resources through the states and territories. The theme’s positive approach targeted reducing the stigma surrounding HIV/AIDS; targeting priority populations and the general public through resources and information sessions promoting the 2009 Australia’s National Hepatitis Awareness week (18 to 24 May 2009); and informing young Australians aged 15 to 29 years about the transmission, symptoms, treatment and prevention of sexually transmissible infections through the National STI campaign. The campaign’s secondary audience included health care workers such as general practitioners, sexual health workers and Aboriginal Medical Services staff.
Indicator:	Effective communicable disease prevention and detection in accordance with a sound evidence-base and with responsiveness to new and emerging trends. Measured through notification rates for HIV/AIDS, Hepatitis C, and Sexually Transmissible Infections.
Reference Point/Target:	A positive impact on notification rates of HIV/AIDS, Hepatitis C and Sexually Transmissible Infections.
Result: Indicator substantially met.
In 2008–09, the Department implemented national strategies to improve notification rates of HIV/AIDS, hepatitis C and sexually transmissible infections; and funded qualitative research into knowledge, attitudes, beliefs and behaviours, which provides data for evidence-based approaches to education and prevention activities. Whilst notification rates for AIDS, hepatitis C and gonorrhoea have declined, notification rates for HIV and chlamydia have risen (refer to data in Key Facts for 2008–09: Sexually Transmissible Disease Rates Across the Years under Targeted Disease Prevention).
Indicator:	A new national strategic approach that identifies priority actions to reduce the transmission of sexually transmissible and blood borne viral infections developed through an evaluation and review of existing strategies. The new strategy will be endorsed by the Australian Health Ministers’ Conference.
Reference Point/Target:	Evaluation and review of existing national strategies, development of a new strategy, and its endorsement by the Australian Health Minsters’ Conference completed by 30 June 2009.
Result: Indicator substantially met.
A final report on the evaluation and review of the existing national strategic framework has been received from the consultant. Acceptance of the final report will complete Stage One of the review proccess. Stage Two of the review commenced in 2008–09, overlapping with Stage One. The requirements for Stage Two were discussed at the inaugural meeting of the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections, in March 2009. Writing groups for each strategy, consisting of stakeholders and subject matter experts have been formed and have held meetings to progress the writing task. Draft strategies will be presented to the Australian Health Ministers’ Conference in late 2009.

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Program 1.3 – Drug Strategy
Indicator:	Reduced community harm caused by the misuse of licit drugs and the use of illicit drugs. Measured by monitoring the number of Australians using tobacco, consuming alcohol at harmful levels and using illicit drugs.
Reference Point/Target:	Continued reduction in the population using tobacco or illicit drugs, and/or consuming alcohol at harmful levels.
Result: Indicator substantially met.
The number of Australians aged 14 years or older counted as daily smokers, declined from 3.3 million (21.8%) in 1998 to 2.9 million (16.6%) in 2007. Whilst the proportion of Australians aged 14 years and older regularly drinking at risky levels has remained relatively stable between 2004 and 2007, there has been a small increase. According to 2007 data, 8.6% drank at levels considered risky or high risk for both short-term and long-term harm, compared with 8.3% in 2004. A significant decrease in the regular use of illicit drugs has been observed, falling from 15.3% in 2004 to 13.4% in 2007. While cannabis remains the most commonly used illicit drug in Australia, recent use was seen to decline significantly from 11.3% in 2004 to 9.1% in 2007. The proportion of the population recently using methamphetamines also declined over the same period from 3.2% to 2.3%. These data are sourced from the 2004 and 2007 National Drug Strategy Household Surveys (available at www.aihw.gov.au).

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Program 1.4 – Food and Regulatory Policy
Indicator:	Compensate licit importers of Kava affected by the June 2007 ban on Kava, with the intent to reduce community harm caused by misuse of Kava.
Reference Point/Target:	Comprehensive ‘buy back’ of Kava from permit holders who have paid for Kava or became bound to pay for Kava, on or before, 25 June 2007.
Result: Indicator met.
The kava ‘buy back’ scheme was fully implemented and completed by 13 June 2008. Of the eight kava detainments made by Australian Customs, six importers signed a deed of assignment and release to transfer ownership of the kava to the Commonwealth for destruction. The six importers were paid a total of $48,822.49 (GST inclusive), with the last payment made on the 9 April 2008. The remaining two importers re-exported the detained kava at their own expense. The total cost of the kava ‘buy back’ scheme was $161,565.89 which included a payment made on 13 June 2008 to Australian Customs for kava storage and destruction costs of $112,743.40. No further payments were made after 13 June 2008.
Indicator:	Effective support provided to the Australia and New Zealand Food Regulation Ministerial Council.
Reference Point/Target:	All meetings conducted.
Result: Indicator met.
The Department supported the Australia and New Zealand Food Regulation Ministerial Council through the provision of secretariat services by conducting two scheduled meetings of the council and nine meetings of its subcommittees, and holding two national stakeholder communications forums.
Indicator:	Effective input into food standards development.
Reference Point/Target:	Input provided into all standard notifications.
Result: Indicator met.
The Department provided input to all 29 standard notifications in 2008–09, within set timeframes.

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Program 1.5 – Immunisation
Indicator:	The implementation of new immunisation registers and the linking of recently introduced vaccines to existing incentive schemes will continue to support and enhance high immunisation coverage rates across targeted cohorts. The effectiveness of immunisation programs will be evaluated by monitoring notification rates of vaccine preventable diseases.
Reference Point/Target:	Increase in immunisation from the previous year. A positive impact on notification rates of vaccine preventable diseases.
Result: Indicator met.
The Department introduced the National HPV Register in June 2008 which, as at 30 June 2009, had received 2.6 million notifications. This initiative has seen 84.8% (approximately 18,400) of invited general practitioners opting to record administered doses of Gardasil® on the register. Immunisation rates in 2008–09 continued to be high, with the national average rate of immunisation being almost 93% at two years of age (this compares with 92.8% in 2007–08).

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Program 1.6 – Public Health
Indicator:	Skilled public health workforce is available to address critical threats of public health and safety.
Reference Point/Target:	Increased public health workforce capacity including the number of Indigenous Australian students and academics.
Result: Indicator met.
The Department helped increase public health workforce capacity in Australia through initiatives such as: masters of public health programs, workforce projects in epidemiology, bio-statistics and public physician training, which assisted the training of up to 1,600 students; the development of a National Curriculum Framework to support Indigenous leadership and public health expertise across the sector; and the development of core competencies in public health and a plan for implementation across universities.
Indicator:	Health economic evaluations of investments in disease prevention and health promotion undertaken.
Reference Point/Target:	All programs scheduled for evaluation are assessed.
Result: Indicator met.
In 2008-09, the Department, as part of the evaluation of Breastscreen Australia, undertook an economic evaluation and modelling study. No other major programs funded under the National Public Health Program were due for evaluation in 2008-09.

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Performance Information for Outcome 1 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:	Quality, relevant and timely advice for Australian Government decision-making measured by ministerial satisfaction.
Reference Point/Target:	Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:	Production of relevant and timely evidence-based policy research.
Reference Point/Target:	Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
The Department provided high quality and timely evidence-based policy research to support the development of the new National Partnership Agreement on Preventive Health. The Department also investigated options for addressing overweight and obesity, smoking and excessive alcohol consumption (including binge drinking) in order to design the interventions funded through the National Partnership Agreement.

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Output Group 2 – Program Management
Indicator:	Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator not met.
The actual Administered expenses for Outcome 1 were 1.6% below budgeted expenses. This was primarily due to delays in contracted program deliverables and longer than expected negotiations for a number of funding agreements.
Indicator:	Stakeholders participate in program development through a range of avenues, such as surveys, conferences, meetings, and submissions on departmental discussion papers.
Reference Point/Target:	Stakeholders participate in program development.
Result: Indicator met.
The Department offered a wide range of stakeholders the opportunity to participate in policy and program development. For example, the Department: directly engaged State and Territory Governments in a collaborative effort to develop a national approach to chronic disease management and prevention, through the Australian Population Health Development Principal Committee; consulted with the food industry to improve the availability of healthy food options and increased consumer awareness and understanding of the link between food choices and health outcomes; and worked with a range of state and territory based peak organisations and health professionals in the development of the national men’s and women’s health policies.

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Performance Information for Outcome 1 Regulatory Activities

Output Group 2 – Program Management
Indicator:	Evaluations and appeals of decisions in relation to: entry of products onto the Australian Register of Therapeutic Goods; and dealings with genetically modified organisms.
Reference Point/Target:	100% of evaluations are made within legislated timeframes. 100% of appeals of decisions are considered within legislated timeframes.
Result: Indicator met.
The Therapeutic Goods Administration completed: 414 (100%) Category 1 and 1,174 (100%) Category 3 evaluations for prescription medicines within legislated timeframes (255 and 45 working days, respectively); no Category 2 evaluations; and 103 (100%) Design Examination Conformity Assessments for medical devices within the 255 day legislative timeframe. As a result of the business process improvements implemented to deal with the application backlog for medical devices in 2007–08, significant efficiencies have been gained and processing times for the inclusion of medical devices on the Australian Register of Therapeutic Goods are now within timeframes agreed between the Administration and industry. The Office of the Gene Technology Regulator evaluated 352 (100%) applications received in 2008–09 within the statutory timeframes. The Gene Technology Regulator accredited six organisations and certified 242 physical containment facilities. The Regulator also issued 14 licences for dealings not involving intentional release of genetically modified organisms into the environment, 13 licences for dealings involving intentional release of genetically modified organisms into the environment, and variations to 83 previously issued licences.

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Table 2.3.1.1: Number of Prescription Medicines Submissions to the Therapeutic Goods Administration

	2006–07	2007–08	2008–09
Category 1	406	438	445
Category 2	0	0	0
Category 3	966	1,203	1,197

Source: Data extract from Strategic Integrated Management Environment System – Prescription Medicines Subsystem.
Category 1 refers to an application to register a new prescription medicine or change to a medicine not meeting the requirements for Category 2 or Category 3 applications.
Category 2 refers to an application to register a prescription medicine where two independent evaluation reports from acceptable countries are available.
Category 3 refers to an application involving changes to the quality data of medicines already registered and not involving clinical, non-clinical or bioequivalence data.

Indicator:	Assessments and responses to appeals of decisions in relation to industrial chemicals are made within legislated timeframes.
Reference Point/Target:	100% of appeals of decisions are considered within legislated timeframes. 96% of New Chemicals assessments considered within legislated timeframes and 100% adherence to legislated timeframes for Existing Chemicals.
Result: Indicator met.
There were no appeals in 2008–09. Ninety-six per cent (217) of New Chemicals assessments were considered within legislated timeframes; and 100% (2) adhered to legislated timeframes for Existing Chemicals.
Indicator:	Licensing and surveillance audits of Australian and overseas manufacturers are performed within target timeframes.
Reference Point/Target:	100% of audits of Australian manufacturers and 90% of audits of overseas manufacturers are performed within target timeframes.
Result: Indicator substantially met.
The Therapeutic Goods Administration performed 435 audits during 2008–09, with 374 (86%) performed within the target timeframe. This compares with 410 audits in 2007–08, of which 395 (96.3%) were performed within target timeframes. There were no overdue audits at the end of 2008–09. A risk assessment is undertaken for all overdue audits.
Indicator:	Efficient post-marketing surveillance testing of therapeutic goods measured by the number tested.
Reference Point/Target:	Minimum of 800 products tested.
Result: Indicator met.
In 2008–09, the Therapeutic Goods Administration, through its Office of Laboratories and Scientific Services, tested 1,024 products consisting of 2,300 samples. In addition, the Therapeutic Goods Administration completed protocol release evaluations for 745 batches of biological medicines. This compares with 818 products and 2,038 samples in 2007–08, and 817 products and 1,739 samples in 2006–07.
Indicator:	Compliance with conditions in licences to undertake dealings with genetically modified organisms. Measured by the percentage of field trials inspected.
Reference Point/Target:	Minimum of 20% of field trials inspected.
Result: Indicator exceeded.
The Office of the Gene Technology Regulator inspected a total of 59% (28) field trial sites planted to genetically modified crop plants. This compares with 51% of field trials inspected in 2007–08, and 37% in 2006–07.
Indicator:	High level of compliance with the Therapeutic Goods Act 1989.
Reference Point/Target:	Reports of alleged breaches are assessed within 10 working days and appropriate response initiated.
Result: Indicator met.
In 2008–09, the Therapeutic Goods Administration received 1,068 alleged offence reports of breaches of the Therapeutic Goods Act 1989 from stakeholders, including members of the public, industry, local and international law enforcement agencies, and regulatory agencies. This compares with 1,107 reports in 2007–08 and 653 in 2006–07. During the year, the Therapeutic Goods Administration acknowledged receipt, in writing, of all identifiable complaints within ten working days. During this year, 818 of the alleged offence reports were investigated to completion, with 468 formal warnings issued to persons/companies. Ten persons/companies were charged and convicted of 98 criminal offences, and one company and its director were found to be in contravention of civil penalty provisions in the Therapeutic Goods Act 1989 by the Federal Court.
Indicator:	High level of compliance with the Gene Technology Act 2000.
Reference Point/Target:	Reports of alleged breaches are assessed within ten working days and appropriate response initiated.
Result: Indicator met.
In 2008–09, there was one alleged non-compliance requiring formal investigation and it was concluded that there was no risk to the health and safety of people and the environment and no further action was required.
Indicator:	High level of compliance with the Industrial Chemicals (Notification and Assessment) Act 1989.
Reference Point/Target:	Potential breaches are investigated within 100 working days for 95% of cases.
Result: Indicator met.
The National Industrial Chemicals Notification and Assessment Scheme compliance team investigated all 30 potential breaches during the year within 100 days of receipt of complaint or identification of the breach (100%). This compares with 46 reports of breaches in 2007–08 and 63 in 2006–07.
Indicator:	Effective communication and consultation with stakeholders measured by stakeholder survey.
Reference Point/Target:	Majority of stakeholders satisfied with the Therapeutic Goods Administration’s communication and consultation processes.
Result: Indicator met.
Formal stakeholder consultation undertaken by the Therapeutic Goods Administration included: liaison within the medical devices sector to implement a range of business process improvements and to achieve regulatory change; public consultation in relation to the possible use of third party conformity assessment bodies for medical devices supplied in Australia, the regulation of custom-made medical devices, and the development of the Australian Regulatory Guidelines for Medical Devices; and consultation as part of the development of two new regulatory frameworks – in vitro diagnostic devices and biologicals. In June 2009, the Therapeutic Goods Administration conducted an online survey to seek stakeholders’ feedback on the effectiveness of its communication and consultation processes. A total 1,618 respondents provided feedback on their satisfaction; this data will be used to make improvements to current communication and consultation processes. Figure 1.1 shows that 63% of respondents were satisfied or very satisfied with the Therapeutic Goods Administration’s communication processes, and 54% of those who had been involved in consultation were satisfied or very satisfied with the Administration’s consultation processes.

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Figure 2.3.1.1: Stakeholder Satisfaction with the Therapeutic Goods Administration’s Communication and Consultation

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Source: Therapeutic Goods Administration online survey, June 2009.

Indicator:	Timely and thorough consultation with stakeholders on regulatory change in relation to genetically modified organisms.
Reference Point/Target:	Seek input from stakeholders on proposed amendments to the Gene Technology Regulations 2001.
Result: Indicator met.
The Office of the Gene Technology Regulator conducted targeted consultation with regulated organisations, the states and territories and Australian Government agencies to inform its review of the Gene Technology Regulations 2001. Submissions received contributed to the development of proposed amendments to the regulations.
Indicator:	Timely and appropriate consultation with all stakeholders in relation to industrial chemicals.
Reference Point/Target:	All relevant stakeholders (community, governments and industry) consulted.
Result: Indicator substantially met.
The National Industrial and Chemicals Notification and Assessment Scheme’s Industry Government Consultative Committee, Community Engagement Forum and Technical Advisory groups on confidential listing of chemicals on the national inventory met throughout the year. Multi-stakeholder advisory groups were established for major activities such as the implementation of the review of the existing chemical assessment program, which met as required. The National Industrial and Chemicals Notification and Assessment Scheme also established an Industry Engagement Group to provide a forum for ongoing technical issues, particularly in relation to the notification and assessment requirements for chemicals not yet in the national inventory and available for use in Australia. The National Industrial and Chemicals Notification and Assessment Scheme’s States and Territories Memorandum of Understanding Group did not meet as its membership and terms of reference were under review.
Indicator:	Influential role in international assessments, regulatory approaches, and methodologies for incorporation, as appropriate, into Australian industrial chemicals assessment and management systems.
Reference Point/Target:	Active participation in international harmonisation activities and progression of bilateral relationships.
Result: Indicator met.
The National Industrial and Chemicals Notification and Assessment Scheme was an active participant in several groups of the Organisation for Economic Co-operation and Development’s chemicals program. This involved: chairing a project steering group in the Working Party on Manufactured Nanomaterials; leading the development of a world wide survey of the use of certain perfluorinated chemicals; and chairing the New Chemicals Clearing House, which exchanged information on regulatory issues related to the notification and assessment of new chemicals. In addition, the National Industrial and Chemicals Notification and Assessment Scheme signed a cooperative arrangement with the United States Environmental Protection Agency’s Office of Pollution Protection and Toxics; and progressed the bilateral exchange of information with New Zealand.
Indicator:	Facilitate cooperation and harmonisation in the implementation of regulation of genetically modified organisms.
Reference Point/Target:	High degree of cooperation with relevant regulatory agencies.
Result: Indicator met.
The Office of the Gene Technology Regulator facilitated cooperation and harmonisation through activities such as: the ‘Regulator’s Forum’, which met in May 2009 to exchange information between regulatory agencies and identify areas for collaboration and coordination in 2009–10; and participation in meetings for the revision of the Australian/New Zealand Standard Safety in Laboratories, Part 3: Microbiological aspects and containment facilities. This work contributed to the harmonisation of Office of the Gene Technology Regulator requirements for physical containment facilities with those of other national agencies, such as the Australian Quarantine and Inspection Service, and more broadly with those organisations complying with Standards Australia.
Indicator:	National Industrial and Chemicals Notification and Assessment Scheme cost recovery activities undertaken in accordance with the Industrial Chemicals (Notification and Assessment) Act 1989.
Reference Point/Target:	100% adherence to legislated and departmental requirements.
Result: Indicator met.
The National Industrial and Chemicals Notification and Assessment Scheme complied with all (100%) legislated and departmental requirements during 2008–09.

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Outcome 1 – Financial Resources Summary

	(A) Budget Estimate 2008–09 $’000	(B) Actual 2008–09 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2009–10 $’000
Program 1.1: Chronic Disease - Early Detection and Prevention
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	40,979	46,881	5,902	45,024
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	7,391	7,163	(228)	6,823
Revenues from other sources	304	313	9	312
Subtotal for Program 1.1	48,674	54,357	5,683	52,159
Program 1.2: Communicable Disease Control
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	21,589	20,856	(733)	22,328
Annual Appropriation Bill 2 (Other Services)	2,366	2,364	(2)	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	3,990	3,866	(124)	3,683
Revenues from other sources	164	169	5	168
Subtotal for Program 1.2	28,109	27,255	(854)	26,179
Program 1.3: Drug Strategy
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	138,065	131,657	(6,408)	121,471
Annual Appropriation Bill 2 (Other Services)	64,024	59,222	(4,802)	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	25,163	24,388	(775)	22,812
Revenues from other sources	1,037	1,065	28	1,151
Subtotal for Program 1.3	228,289	216,332	(11,957)	145,434
Program 1.4: Food and Regulatory Policy
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	584	50	(534)	579
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	11,190	11,101	(89)	10,037
to Special Accounts	(11,123)	(11,035)	88	(9,972)
Revenues from other sources	3	3	-	3
Special Accounts
OGTR Special Account	8,047	7,919	(128)	8,240
NICNAS Special Account	9,504	8,731	(773)	9,266
TGA Special Account	100,442	92,457	(7,985)	102,232
Subtotal for Program 1.4	118,647	109,226	(9,421)	120,385
Program 1.5: Immunisation
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	33,493	31,538	(1,955)	25,105
Annual Appropriation Bill 2 (Other Services)	8,200	8,179	(21)	-
Special Appropriations
National Health Act 1953 - Essential vaccines	412,566	410,678	(1,888)	3,850
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	5,613	5,440	(173)	5,182
Revenues from other sources	231	238	7	237
Subtotal for Program 1.5	460,103	456,073	(4,030)	34,374
Program 1.6: Public Health
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	73,329	67,506	(5,823)	78,144
Annual Appropriation Bill 2 (Other Services)	173,916	174,127	211	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	11,512	11,157	(355)	10,628
Revenues from other sources	474	488	14	485
Subtotal for Program 1.6	259,231	253,278	(5,953)	89,257
Total Resources for Outcome 1	1,143,053	1,116,521	(26,532)	467,788
Outcome 1 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	21,259	22,279	1,020	21,301
Output Group 2: Program Management	152,683	141,183	(11,500)	150,405
Total Departmental Resources	173,943	163,462	(10,481)	171,706
Average Staffing Level (Number)	1,030	1,030	-	1,020

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