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Secretary’s Review

The year 2008–09 has been busy, exciting and filled with challenges and achievements, as we worked to deliver the Australian Government’s priorities for health and aged care.

The Government’s commitment to reforming the health and hospital system was reflected in the May 2008–09 Budget, which contained almost 130 health and ageing measures, and saw the Department’s budget rise above $51 billion. The Government’s intention to build on this and establish a more far reaching reform agenda was forecast when it set up the National Health and Hospitals Reform Commission to look at long-term challenges such as access to services, the growing burden of chronic disease, population ageing, inefficiencies and the escalating costs of new health technologies. The Department’s role in the Commission’s work is discussed below.

The measures outlined in the Budget focused on improving the capacity of the states and territories to deliver health services, and ensuring that people in the community can access appropriate care when and where they need it. Preventing avoidable illness and improving the health and wellbeing of the community, particularly in children, were major objectives, as were providing essential infrastructure for communities in need, and increasing research and cancer treatment. A major priority was to close the gap in life expectancy between Indigenous and non-Indigenous people.

While detailed information on the steps we took to implement these measures can be found throughout this Annual Report, most notably in Part 2, some of our major accomplishments are discussed below. In reflecting on this past year, I am pleased to acknowledge that while at times we were required to work long and hard, departmental staff consistently showed commitment and creativity in implementing new initiatives and maintaining all our other important activities.

The worldwide economic crisis had an impact on government programs and on this portfolio. We have worked with the Government to identify options for savings, either through reduced effort in some areas, or greater efficiency through restructuring programs. Within the Department, we have had to reconsider how our resources are allocated, to ensure the higher priority activity has the human resources required.
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Our Highlights

Health and Hospitals Reform Commission

On 25 February 2008, the Government established the Health and Hospitals Reform Commission to develop and oversee a long-term health reform plan for Australia. We played a key part in supporting the Commission to undertake this important work, by informing the community about its role and encouraging people to contribute to the reform process. The Commission received over 500 initial submissions, which informed a series of discussion papers and an interim report. The Commission’s final report: A healthier future for all Australians was released on 28 July 2009 and has been the catalyst for public consultations led by the Prime Minister and the Minister for Health and Ageing.

The Department will compile and analyse feedback from these consultations and the new yourHealth website (www.yourhealth.gov.au), to inform Council of Australian Governments (COAG) discussions about how our health system stays relevant, timely, appropriate, and most importantly, one of the best in the world.

Elective Surgery Waiting Lists

In 2008–09, the Department worked with the states and territories to ensure sustainable improvements in the delivery of elective surgery through stage one of the Elective Surgery Waiting List Reduction Plan. This involved administering funding to the jurisdictions to reduce the number of patients waiting longer than clinically recommended for surgery. The national target of 25,278 additional procedures set for 2008 was exceeded by 64 per cent. As at 31 December 2008, the number of patients waiting longer than recommended was 22,615, which compares favourably with the 33,654 overdue an operation as at 30 September 2007. The states and territories will continue to receive funding in 2009–10 to support elective surgery system improvements, with rewards to go to those jurisdictions that meet reduction targets.

We also helped increase hospitals’ capacity to make surgery more efficient and reduce waiting lists, through implementation of the second stage of the Elective Surgery Waiting List Reduction Plan. Funding supported the construction of additional operating theatres in the Geelong and Frankston hospitals in Victoria, and facilities in the Royal Darwin and Alice Springs hospitals in the Northern Territory. In addition, funding helped hospitals such as the Children’s Westmead Hospital in New South Wales to purchase new surgical equipment and improve their management of elective surgery.
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Extension of the Australian Health Care Agreements

The Department administered $10.257 billion to extend the terms of the 2003–08 Australian Health Care Agreements by one year to the end of 2008–09, which included the provision of an additional $500 million base health care funding to the states and territories. This, combined with more generous indexation provisions under new Health Specific Purpose Payments, put public hospital services on a more sustainable footing for the future.

National Healthcare Agreement

Collaboration with the states and territories contributed to the successful negotiation of the National Healthcare Agreement as part of COAG reforms to Commonwealth-State financial relations. The agreement replaced the previous Australian Health Care Agreements and aims to shape the health system around the needs of patients, their families and communities; and focus on disease prevention and injury management, not simply the treatment of illness. It supports an integrated approach to the promotion of healthy lifestyles, and diagnosis and treatment of illness across the continuum of care. It also aims to ensure that people are provided with timely access to quality health services based on their needs, and not their ability to pay.

The introduction of the new National Healthcare Agreement will require the Department to exercise a strong policy focus on its effective implementation and performance measurement, together with analysis of challenges and responses to the long-term sustainability of funding and service standards.

National Primary and Preventative Health Care Strategies

One of our key priorities this year was to look at how to build a stronger primary care system that not only puts patients at the centre of that care, but also focuses on helping people to stay well so they can actively participate in life and work.

National Primary Health Care Strategy
With the assistance of an External Reference Group of primary health care experts, the Department developed Building a 21st Century Primary Health Care System – A Draft of Australia’s First National Primary Health Care Strategy, which was released by the Prime Minister and the Minister for Health and Ageing on 31 August 2009. Informed by more than 260 submissions received in response to the discussion paper Towards a National Primary Health Care Strategy, the draft strategy outlines a long-term view of what can be reasonably expected from Australia’s future primary health care system. For governments at different levels, health professionals, their representative organisations and the many others involved in health care, the strategy is intended to establish a shared vision of a modern primary health care system with the objective of coordinating effort and driving change.

Drafting the strategy encouraged the Department to consider the strengths of our current primary health care system that can be built upon, and the major pressure points. It also provided us with the opportunity to canvass new approaches to meeting future needs.

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National Preventative Health
On 9 April 2008, the Minister for Health and Ageing announced the establishment of a Preventative Health Taskforce to provide evidence-based advice on preventative health programs and strategies, focusing on the burden of chronic disease caused by obesity, tobacco and excessive alcohol consumption. It was our role to support the taskforce in its development of the National Preventative Health Strategy, by facilitating public consultations, commissioning research and analysing submissions. Launched by the Minister for Health and Ageing on 1 September 2009, the strategy comprised a roadmap for action and a number of technical papers.

As the Government moves to respond to these primary and preventative health care strategies, the Department will provide policy advice and analysis on possible reform ideas. We will also develop specific initiatives, and manage effective communication and consultation across government and with our stakeholders.

GP Super Clinics

The purpose of GP Super Clinics is to bring together general practitioners, nurses, allied health professionals and other health care providers, to deliver team based health care and medical services that are tailored to the specific needs of the rural, regional and outer metropolitan communities in which they will be located.

During the year, the Department held information and consultation sessions with state and territory health services around the country, to hear directly from community members and local health care providers about what was important for them. This feedback contributed to the negotiation and signing of 19 funding agreements which will see the establishment of GP Super Clinics in places such as Palmerston in the Northern Territory, Modbury and Noarlunga in South Australia, and Wanneroo in Western Australia.

We will work with State and Territory Governments and funding recipients in 2009–10, as these clinics are built and become operational, to improve integration between privately practising health care professionals working in the GP Super Clinics, and state and territory funded services.
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Health through Prevention

A priority this year was to support the community to become and remain well by implementing a range of preventative health initiatives. For example, the Department introduced the Healthy Kids Check on 1 July 2008, to help ensure that every four year old child has a basic examination to see if they are healthy, fit and ready to learn before starting school. Children in years three to six were taught to grow, cook and eat fresh food through the Stephanie Alexander Kitchen Garden Program. In addition, we provided parents with information on healthy eating, physical activity and age appropriate development for young children through the distribution of the Get Set 4 Life – healthy habits for healthy kids guide.

Young people were educated on the harms associated with the use of illicit drugs such as Ice, speed and ecstasy through the National Drugs Campaign, which also provided information on seeking professional help to stop. At the same time, the successful Measure Up campaign encouraged adults to measure their waists to see if they are at risk of developing a serious disease, and to take steps to prevent ill health.

We provided funding to 2,777 sporting organisations to build a culture of responsible drinking at the grassroots level, and established the Clubs Champions program to help promote responsible drinking practices in sporting codes. This effort saw seven major sporting organisations sign up to the initiative. In addition, we supported the expansion, improvement or construction of over 100 small to large sport and recreation facilities across the country, to help people participate, get fit and stay healthy.

The important National Bowel Cancer Screening Program continued during the year, until a fault was discovered in the faecal occult blood test kit, which resulted in the reporting of false negative results for about three per cent of participants. Working with the pathology provider and Medicare Australia, the Department quickly made sure that all 389,911 participants potentially affected by the faulty kits were notified. We expect screening to recommence once the Therapeutic Goods Administration has listed a replacement kit on the Australian Register of Therapeutic Goods and we are satisfied that it is fit for use in this program.

Teen Dental Care

Dental check-ups help prevent cavities and other dental diseases, and the need for more expensive dental procedures later on in a person’s life. This year, the Department implemented the Teen Dental Program to encourage teenagers to care for their teeth, and to maintain good oral health habits once they leave home. We worked with Medicare Australia and Centrelink to develop a voucher system through which eligible teenagers can receive their preventative check from a private dentist and claim the benefit from Medicare Australia. Alternatively, the dentist can choose to bulk bill the check directly from Medicare. Eligible teenagers may also use the voucher in public dental clinics, including school-based clinics.
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Maternity Services

While Australia is one of the safest countries in the world in which to give birth, the Australian Government has identified that nationally coordinated services can improve the quality of maternity services provided, particularly for rural and Indigenous women. In 2008–09, the Department took the first step in developing a comprehensive plan for maternity services in the future, by reviewing the services available to women today. The review was led by the Commonwealth Chief Nurse and Midwifery Officer, and canvassed a range of issues including antenatal services, birthing options, postnatal services, and support for women in the perinatal period. An extensive consultation process with consumers, clinicians and non-government organisations helped inform the development of the final report: Improving Maternity Services in Australia – the Report of the Maternity Services Review. Released by the Minister for Health and Ageing on 21 February 2009, the report highlighted the importance of reform in maternity services taking place within a strong framework of safety, quality and collaborative care. It also informed the development of a broad range of measures announced in the 2009–10 Budget, which the Department will implement in collaboration with the states and territories to ensure a coordinated approach across Australia.

Indigenous Health

Indigenous health continues to be our most confronting health challenge. While Australians have one of the highest life expectancy rates in the world, coming second to Japan, there is an unacceptable gap in life expectancy for Indigenous people, who are generally less healthy than the rest of the community. The Department worked to address this important issue though a range of initiatives specifically focused on achieving improved health outcomes for Indigenous people.

For example, population health programs communicated the dangers of tobacco use to Aboriginal and Torres Strait Islander communities, to assist people to quit and to reduce smoking rates. This is particularly important as smoking alone counts for 20 per cent of Indigenous deaths. Some 8,500 patients of urban and rural Aboriginal Community Controlled Health Services received medication access and assistance through the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People Pilot Program. We also collaborated with the states and territories, and stakeholders to improve Indigenous people’s access to primary care, social and emotional wellbeing services, and drug and alcohol treatment and rehabilitation.

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Care for Mothers and Children
The Department funded 30 primary health care services across Australia to provide mothers and babies with antenatal and postnatal care, with the aim of reducing high rates of infant mortality and low birth weight among Indigenous babies. We also continued to implement the Australian Nurse Family Partnership Program, a home-visiting program that assists women to develop positive health behaviours and child rearing practices. This year we funded a further two Aboriginal community controlled health services to deliver the home visiting program, bringing the total to five. We anticipate a further two primary health care sites will be selected to implement the program in 2009–10.

Health Workforce
Critical to improving Indigenous health outcomes is making sure that appropriately trained people are available to provide care and services, particularly in rural and remote areas. This year, the Department helped establish the Remote Area Health Corps to expand and support the number of doctors, nurses and allied health professionals working across the primary health care sector. This project successfully added to the short-term health workforce in the Northern Territory, by attracting health professionals from urban areas around Australia to areas where additional health personnel are required.

We also worked with key stakeholders to encourage Indigenous people to enter the nursing profession, by developing targeted recruitment, mentoring and support arrangements; and implemented new national qualifications for Aboriginal Health Workers, so that the important services these people provide, such as primary health care, immunisations and community health education, are at a consistent standard across the nation.

Reducing the Burden of Cancer

Cancer is Australia’s biggest killer, with more than 39,000 related deaths and 100,000 cases diagnosed every year. During 2008–09, the Department worked to reduce the burden of cancer by providing support for people living with cancer, their families and their carers; and increasing knowledge through research.

Negotiations with stakeholders saw arrangements put in place for two prostate cancer research centres in Melbourne and Brisbane which will develop non-invasive diagnostic tests for detecting this disease, and research new therapies; and the establishment of youth cancer networks to provide coordinated services, support and care to teenagers and young adults with cancer. We also provided funding for the Olivia Newton-John Cancer and Wellness Centre in Melbourne; and a new Children’s Cancer Centre at the Women’s and Children’s Hospital in Adelaide. Construction of these important centres will commence in 2009–10.
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Health Infrastructure Investment

The Department commenced implementation of the Government’s $10 billion Health and Hospitals Fund, to support a range of capital investments that will equip the health system with renewed or refurbished hospitals, major hospital facilities, medical technology equipment, and medical research facilities. We negotiated a number of funding agreements for projects that will be of real benefit to the community. For example, the construction of a new block at Nepean Health Services, which is to include an ambulatory procedures centre with 60 overnight surgical beds and a ten bed medical assessment unit will provide people living in Western Sydney with better access to services and help reduce surgical waiting times.

Over the next financial year, the Department will administer funding for a range of facilities including the Lifehouse Sydney Cancer Centre at the Royal Prince Alfred Hospital and the Parkville Comprehensive Cancer Centre in Melbourne; a world-class brain research centre at the Australian National University’s John Curtin School of Medical Research (the Eccles Institute for Brain and Vision Research); and a state-of-the-art centre at the Royal Children’s Hospital, Melbourne, which will research common disorders in childhood, including childhood cancer, allergy and immune disorders and adolescent depression.

Caring for Older Australians

Today there are more than two million Australians aged 70 and over, comprising nearly 10 per cent of the population, and this number is expected to double in the next 20 years. As the number of aged people in our community increases, so too does the need to provide them with the care they require.

In 2008–09, the Department allocated 470 new transition care places to assist older people leaving hospital to return home and receive low intensity therapy services such as physiotherapy, nursing support and/or personal care services. The new transition care places were allocated to each state and territory based on the population aged 70 years and over, and Aboriginal and Torres Strait Islander people aged 50 and over. The states and territories will make these places operational during 2009–10.

The Department implemented the first round of zero real interest loans to encourage aged care providers to build or expand residential aged care and respite facilities in areas of high need, where providers might not normally invest. This resulted in the offer of loans for 1,348 residential aged care places around the country. We also delivered reforms in fee arrangements for residential aged care. Previously, self-funded retirees paid higher income-tested fees because most of their income was counted under the income test. Changes now ensure that pensioners and self-funded retirees are now treated the same, regardless of whether they are on a pension or private income.

Improving Access to Medicines

A number of new drugs were listed and extended on the Pharmaceutical Benefits Scheme to treat people with conditions such as kidney disease, migraine, psoriasis and urinary incontinence. The listing of TysabriŽ (natalizumab) will help patients suffering from relapsing-remitting multiple sclerosis. Gemcitabine EbeweŽ was also added to treat cancer conditions such as breast cancer, epthelial ovarian cancer, non-small cell lung cancer and bladder cancer.

This year also saw NaglazymeŽ funded under the Life Saving Drugs Program, to treat eligible people with Mucopolysaccharidosis Type V1 (Maroteaux-Lamy Syndrome), an extremely rare, debilitating and life-threatening disease. As a long-term enzyme replacement therapy, NaglazymeŽ can help extend and improve the quality of a patient’s life.
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Pandemic Influenza (H1N1) 2009

An issue that had a significant impact on the community this year was the outbreak of the Pandemic (H1N1) 2009 (commonly known as ‘Swine Flu’). While for most people this new virus was a mild disease, for some it was very serious, and sadly, we have had a number of deaths in Australia.

When the Australian Government was notified on 24 April 2009 by the World Health Organization of outbreaks in Mexico and the United States of America, the Department activated the National Incident Room. With advice from the Australian Health Protection Committee, we carefully monitored unfolding events and worked with border agencies, state and territory public health units, airlines and airports to ensure border measures were introduced in a timely and consistent manner across the country, which helped delay entry of the disease into Australia for several weeks.

The Department deployed various components of the National Medical Stockpile. The purchase of an additional 1.6 million courses of the antiviral drug Relenza (zanamivir) bolstered the supply of medicines to treat pandemic influenza. We also placed an order with CSL Ltd to secure supplies of the first batches of H1N1 Influenza 09 vaccine. We will be rolling out a vaccination program for the new H1N1 vaccine with our state and territory colleagues in early 2009–10, after sufficient trial data is received. The priority groups to receive the first batches of vaccine will be frontline health workers, and those in vulnerable groups such as pregnant women and people with chronic disease. When more vaccine is available, it will be offered to the wider community.

Ministerial Team

In June 2009, we welcomed The Hon Warren Snowdon MP as Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery. The Hon Mr Mark Butler MP joined the portfolio at the same time as Parliamentary Secretary to the Minister for Health and Ageing, following Senator the Hon Jan McLucas’s decision to relinquish her portfolio responsibilities to focus on her role as Senator for Queensland.

Organisational Changes

Executive Team

In January 2009, Professor John Horvath AO stepped down from his role as Commonwealth Chief Medical Officer. John came to us as a Clinical Professor of Medicine at Sydney University, with a long history as a specialist renal physician at the Royal Prince Alfred Hospital. Prior to his appointment, John had worked with the Department through his role as Chair of the Australian Medical Workforce Advisory Committee. While John’s achievements over five years as Chief Medical Officer are numerous, I would like to note his contribution to Australia’s National Chronic Disease Strategy, a key policy document that has enduring influence of the national development of policy in this critical area. John provided an invaluable contribution to the Australian Government’s response to emergency events such as the Indian Ocean tsunami and preparing for the threat of an Avian influenza pandemic. He was also instrumental in the establishment of the Department’s Office of Health Protection; and in the development of a national reform package for organ donation which will help establish Australia as a world leader in organ donation for transplantation.

We welcomed distinguished cancer physician, Professor Jim Bishop AO as the new Chief Medical Officer in February 2009. Professor Bishop has been recognised for his service to medicine, particularly in the field of cancer treatment and research and through the development of innovative policy, improved public awareness and service delivery programs. As Chief Medical Officer, he plays a key strategic role in developing and administering major health reforms.

After six and a half years as Deputy Secretary, Mr Philip Davies left the Department at the end of February 2009. Philip was a valued member of the Executive who played a key leadership role in many important areas of our work. For example, Philip was involved in establishing the National Blood Authority; setting up the National Health Call Centre Network; and managing the health care component of the Northern Territory Emergency Response. He also made a significant contribution to the development of the National E-Health Strategy and the roll-out of the Government’s GP Super Clinics program.

In late May 2009, Deputy Secretary Mr David Kalisch was appointed by the Assistant Treasurer to the role of Commissioner at the Productivity Commission. David was with us for three and a half years, during which he contributed to many of our COAG health achievements, such as the expansion of health workforce training, the development of the Commonwealth’s mental health strategy, and the extensive health reforms and enhanced health funding agreed last year as part of the changed federal financial arrangements. Health Ministers’ agreement to the new National Registration and Accreditation Scheme for health professions represents a landmark in Australian health care, of which David can be proud.

These positions will be filled in the near future.
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Divisional Structure

Organisational changes were not limited to the Executive team. It became clear to me during the year that we needed to arrange our resources and responsibilities as best as possible to effectively achieve the Government’s objectives. While these organisational changes are discussed in the Departmental Overview, of particular note is the establishment of the Health Workforce Division, which is carrying out COAG’s health workforce reforms and assisting with the implementation of the new National Registration and Accreditation Scheme for health professions.

Staff Survey Results

We held our sixth annual Staff Survey in November 2008, for the first time electronically, during which 77 per cent of staff at work participated. I believe this continued strong participation rate reflects that staff are committed to the survey as one of the major opportunities to make their views known. The survey results demonstrated that we have continued to exceed both public and private sector benchmarks on most drivers which motivate staff, and in the measure of staff satisfaction. This is an excellent result. It is also pleasing that we achieved significant improvements; and saw increases in the number of staff participating in performance feedback activities.

While the results are positive, there is still work to be done to ensure that the Department is an employer of choice, and that our people continue to be motivated, enthusiastic, and committed to the important work that we do. In 2009–10, we will work to improve communication and information sharing, and help staff understand how their, or their team’s work, contributes to the Department’s strategic directions. We will also look at ways in which people can better input ideas on the organisation’s work and operation.

Staff Generosity

Despite the increased pressures from the year’s busy operational environment, and a significant ongoing reform agenda, our people continued to find the time to support each other, and the community, through fundraising and volunteer work. I never fail to be impressed by the selfless dedication of individuals who support their colleagues in times of ill health or personal tragedy; and the enthusiasm of those who ride, walk and run to support community activities, and give, even in times of financial hardship. I was particularly impressed when I learnt that staff had donated over $94,000 to the Victoria Bushfires Appeal. This was a fantastic result.
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Our Way Forward

The Department has had a very busy but successful year, and achieved the strategic objectives set down in the 2008–09 Health and Ageing Portfolio Budget Statements.

During the coming year we will further the Australian Government’s health reform agenda, support new health and hospital infrastructure and deliver major reform through the National Healthcare Agreement, to fund public hospitals, train doctors and nurses, and tackle key pressure points in the public health system.

We will aim to improve the supply of health professionals in rural and remote areas, through targeting existing incentives and providing additional non-financial support to rural doctors; and support the training of more doctors, nurses and allied health professionals by funding additional general practice training places and establishing a new national workforce agency.

The Department will build on the national health effort to close the gap on life expectancy for Indigenous people, by addressing eye and ear health, dental care, and pathology services; and implement initiatives that enable Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme access for nurse practitioners and midwives working in collaboration with doctors.

Residential aged care services will be assisted to operate viably in regional, rural and remote Australia though increased subsidies, and we will work to ensure that the needs of older Australians are properly assessed when they enter aged care. We will continue to improve Medicare’s long-term sustainability, by making changes to the extended Medicare safety net. This will help ensure access for people with prolonged health care needs, and provide financial assistance to those with one-off high health care costs. In addition, we will encourage community participation in sport and recreation, by funding safe and modern sport and recreation projects, and infrastructure.

A comprehensive discussion of the Department’s key objectives for the next reporting year can be found in the 2009–10 Health and Ageing Portfolio Budget Statements, which is available on our website at www.health.gov.au.

Jane Halton PSM
Secretary
Department of Health and Ageing

Chief Medical Officer’s Report

This is my first report as the Chief Medical Officer. In taking up this role I have joined a very hard working and cohesive team of professional and dedicated individuals. It has been a delight to be part of this team. Health systems around the world face great challenges. It is a privilege to work to address and manage these challenges on behalf of the Australian people.
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The Health of the Nation

Overall Australians enjoy good health, with a life expectancy of over 81 years which, internationally, is second only to Japan.1 This good health reflects a population aware of risky behaviour and avoiding most, efforts of our public health professionals, and the overall high standard of our acute health care system.

Fifty six per cent of Australians aged 15 years and over, who responded to the 2004–05 National Health Survey considered their own health to be either very good or excellent, whilst a further 27 per cent considered themselves to be in good health.2

Figure 1: Fatal and Non-Fatal Burden of Major Disease Groups, 20033


Figure 1: Fatal and Non-Fatal Burden of Major Disease Groups, 2003

(a) Includes intentional and unintentional injuries.
(b) Includes maternal conditions, nutritional deficiencies, non-malignant neoplasms, skin diseases, oral health conditions and ill-defined conditions. Source: Begg et al. 2007.


The maintenance of good health, through a good life style and health system, is of fundamental interest to the Australian community, which expects optimal care driven by ongoing improvements from medical research. Such expectations are placed in the context of a substantial burden of chronic disease, some related to risky behaviour, population growth and ageing, and on a background of serious disease requiring medical intervention.

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The Burden of Disease in Australia

The major burden of disease in our community is caused by, in order, cancer, cardiovascular disease, mental illness, neurological disease and chronic respiratory disease.4 Taken together these conditions represent nearly 70 per cent of the total burden of disease in Australia.

The prognosis for many people with serious diseases is improving, while population ageing and growth increases the number of individuals with chronic disease presenting to our health system.

Table 1: Proportion of Total Disease Burden Attributed to Determinants of Health, 2003 (Per Cent)5

DeterminantMalesFemales Persons
Tobacco smoking 9.6 5.8 7.8
High blood pressure 7.8 7.3 7.6
Overweight/obesity 7.7 7.3 7.5
Physical inactivity 6.4 6.8 6.6
High blood cholesterol 6.6 5.86.2
Alcohol
Harmful effects 4.9 1.6 3.3
Beneficial effects –1.1 –0.9 –1.0
Net effects 3.8 0.7 2.3
Low fruit/vegetable consumption 2.7 1.5 2.1
Illicit drugs 2.7 1.2 2.0
Occupational exposures 2.6 1.3 2.0
Intimate partner violence n.a. 2.3 1.1
Child sexual abuse 0.3 1.5 0.9
Urban air pollution(a) 0.8 0.7 0.7
Unsafe sex 0.5 0.7 0.6
Osteoporosis <0.1 0.3 0.2
Joint effect(b) 35.1 29.1 32.2

n.a. Not available.
(a) Estimate for long-term exposure; an additional 0.3% is attributable to short-term exposure.
(b) Estimate of the joint effect of all studied determinants, taking into account the overlapping effect among determinants on causal pathways. Source: Begg et al. 2007.


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Disease Prevention

Many diseases can be partly prevented by greater control of common risk factors including tobacco smoking, obesity, lack of physical activity and poor diet. Control of tobacco consumption in Australia has been a major success story, with Australia reporting one of the lowest smoking prevalence rates globally.

Figure 2: Prevalence of Daily Smoking, Population Aged 15 Years and Over, Selected OECD Countries, 20066


Figure 2: Prevalence of Daily Smoking, Population Aged 15 Years and Over, Selected OECD Countries, 2006

Notes:
1. Data are for the year specified, or one to three years earlier or later. No data within this range were available for the Slovak Republic.
2. The prevalence of 16.8 per cent for Australia reported here is for persons aged 15 years and over.
Sources: Organisation for Economic Co-operation and Development, 2007, OECD health data 2007: statistics and indicators for 30 countries. Paris: OECD; data from the Australian Institute of Health and Welfare, The 2007 National Drug Strategy Household Survey 2007.7


However, around 17 per cent of adult Australians smoke daily, and tobacco smoking remains the largest cause of preventable disease in our community. Lung cancer is a major consequence of smoking. While lung cancer rates have fallen substantially over the last 20 years, lung cancer remains the major cause of cancer deaths in both men and women in Australia, and will remain so for the next 20 years.

Obesity, or high body weight, however, is a less successful story. Obesity rates in Australia increased from 1995 to 2004–05, according to the most recent available data on body size. The World Health Organization (WHO) has labelled obesity an epidemic because of its dramatic increase worldwide over the past 20 to 30 years.

An analysis by the WHO shows that Australia’s rate of obesity among males and females 15 years and over (24 per cent and 25 per cent) is much lower than that in the United States of America (37 per cent and 42 per cent). However, it is similar to that in Canada (24 and 23 per cent) and the United Kingdom (22 and 24 per cent).

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Figure 3: Trends In Overweight and Obesity Prevalence, by Age8


Figure 3: Trends In Overweight and Obesity Prevalence, by Age

Source: Australia’s Health 2008, Australian Institute of Health and Welfare.


Excess body fat is linked to a range of preventable health conditions, including type 2 diabetes, cardiovascular disease and certain cancers. High body weight is estimated to be responsible for 7.6 per cent of the total burden of disease in Australia, placing it third, just behind tobacco smoking and high blood pressure.9 The rise in obesity is also likely to lead to an increase in type 2 diabetes over the next 20 years.

A key element to support disease prevention and the management of chronic disease is successful intervention by professionals in primary care. Prevention and early intervention constitutes world’s best practice and will reduce the burden of late presentations with advanced disease on our health system. In 2008–09, these issues were addressed by the Australian Government by commissioning the Primary Health Care Strategy and the National Preventative Health Strategy. These major reports will provide valuable direction for the Australian Government in 2009–10 in these important areas.
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Pandemic (H1N1) 2009 Influenza Outbreak

Within weeks of my appointment in April 2009, the WHO declared outbreaks of the novel pandemic (H1N1) 2009 Influenza virus infection a ‘Health Emergency of International Significance’. On 11 June 2009, the WHO raised its pandemic alert to level 6, declaring a pandemic of this H1N1 Influenza 2009. The alert level is based on the geographical spread not the capacity of the virus to cause disease.

Since April 2009, the Australian Government, through the Department’s National Incident Room, has been coordinating our national effort. This effort was initially successful in delaying the virus from entering Australia and containing small outbreaks. This allowed time to better understand its key scientific and clinical characteristics.

The Australian Health Management Plan for Pandemic Influenza was used as an evidence-based guide for Australia’s response. The plans activated included DELAY and CONTAIN. These levels focus Australia’s efforts on delaying the arrival of an infection into Australia, or containing the virus once it has arrived. Following these activities, it was clear that the pandemic (H1N1) 2009 Influenza caused mild disease in most, but severe disease in some, and was best described as moderate overall. A new phase of PROTECT was inserted into the plan’s framework to recognise the moderate nature of the disease and to focus efforts on those more likely to be severely affected. The focus of this phase of the plan is on identifying the people in whom disease may be severe, and providing medical care and interventions to reduce likely suffering.

The H1N1 Virus

This virus is made up of four genetic components: two swine, one human and one bird. Pandemic (H1N1) 2009 Influenza is a highly transmissible virus between humans. This genetic form is new and there is no immunity to this viral infection in the Australian population. However, the infection rates appear lower in people over 60 years for reasons that are not clear. It has been speculated that exposure to similar viruses in 1957 and 1968 may have conferred some protection. However, such minimal immunity, if present in some Australians over 60 years old, cannot be relied on as a public health measure. Therefore, we must consider the population is unprotected until a specific vaccine is available later in 2009, or people obtain immunity following infection.

We also know that such viruses tend to modify over time and their genome can mutate more substantially at anytime, changing their effectiveness for the worse or attenuating their effects. Such genetic changes could also confer antiviral drug resistance, as is the case with some seasonal influenza strains.

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Clinical Description

The clinical picture of the disease is now well described. Pandemic (H1N1) 2009 Influenza is a disease that is mild in the great majority of cases but severe in some. The overall characterisation of this infection is a moderate disease. This virus appears more transmissible between individuals than seasonal influenza and because the population does not have immunity, it is expected that more people will be affected than with seasonal influenza.

The clinical picture is that of influenza symptoms, mainly affecting younger people with an average age of 19 years. The symptoms may be short lived, and mild in the great majority of cases. The patient may not have all the symptoms of influenza, in some cases making the disease hard to differentiate from other minor seasonal infections. However, this influenza can be moderate or severe, and in these cases patients may respond well to antiviral treatment, provided it is given early, particularly in the first 48 hours. Those with poor outcomes overseas are primarily those with other underlying medical conditions especially asthma, chronic obstructive airways disease (such as emphysema), heart failure, renal disease, immunosuppression and obesity. The deteriorating influenza patient has been characterised by respiratory difficulty (hypoxia) and health professionals have been alerted that this should act as a trigger for rigorous medical intervention.

Since this disease is predominantly in the young, these medical conditions are less likely to occur. Pregnant women have been identified as another group at risk of poor outcomes from influenza. However, healthy young people can also have moderate or severe disease, albeit at low frequency. As the number of infections increases, even where the great majority recover well, the small percentage of cases that are severe can represent a substantial number of people.

Transmission of H1N1 Influenza 2009 in Schools

There is evidence of the importance of schools in the initial transmission of new pandemic viruses which have a higher infection and transmission rate in children. The public health evidence about the optimal method of school intervention is not as strong at this time. However, the attack rates in adults residing with school children may be two to three times higher and school holidays prevent seasonal influenza by around 20 per cent. During this outbreak, school intervention policies were pursued successfully in the United Kingdom, Japan, Hong Kong and the United States of America. Once the disease is circulating in the community a focus on the transmission of the virus in schools is less important except to reduce its spread through improved hygiene.

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Management of the Influenza Season 2009

Efforts to successfully mitigate the spread and impact of this infection have been aimed to lower possible poor outcomes and avoid deaths. Further monitoring has been implemented to provide real evidence of the best approaches and to ensure the most vulnerable or those at risk are treated optimally.

Public health measures have been aimed to prudently delay the entry and spread of the infection, and reduce the expected peak of the disease in mid-winter, including in those with severe infections and in poor health.

As the infection became established in Australia, the National Medicine Stockpile was opened so that supplies of antiviral and personal protection equipment were available to jurisdictions. The Australian Government committed funds to procure a specific pandemic (H1N1) 2009 Influenza vaccine that will be available later in the year. Australia will be one of the first countries to offer such protection to its population.

In addition, the National Health and Medical Research Council provided a fast track funding scheme for pandemic (H1N1) 2009 Influenza research. Forty-one projects covering all aspects of science and the public health response were funded, committing $7 million. These projects will report to a symposium of Australian Chief Medical Officers, states and territories, and public health experts in December 2009.

National Professional Registration

The National Registration and Accreditation Scheme for health professions will deliver improvements to the safety and quality of Australia’s health services through a modernised national regulatory system for health practitioners. Through this scheme, there will be a requirement that practitioners and employers (such as hospitals) report individuals who are placing the public at risk of harm, which includes conduct that places the public at risk of harm either through a physical or mental impairment affecting practise or a departure from accepted professional standards. Institutions must also report practitioners who practise or have practised while under the influence of drugs or alcohol, or have engaged in sexual misconduct during practise.

The scheme will initially cover ten health professions: chiropracty, dentistry (including dentists, dental therapists, dental hygienists, dental prosthetists and oral health therapists), medicine, nursing and midwifery, optometry, osteopathy, pharmacy, physiotherapy, podiatry and psychology. The new scheme will be independent and will develop standards for health practitioners where no other external body undertakes that role. We expect that external accrediting bodies such as the Australian Medical Council and the Australian Pharmacy Council will continue to operate.

The scheme will have a national board, responsible for registering courses and training programs, which will decide whether the accreditation standards, courses and training programs are approved for the purposes of registration. We plan to expand the scheme in 2012 to include Aboriginal and Torres Strait Islander health practitioners and Chinese medicine practitioners. Medical radiation practitioners will also be regulated under the scheme.

I welcome the very high level of participation by consumers, practitioners and regulatory bodies during the consultation process to develop the scheme. Over 1,000 people attended forums and the Department received over 650 written submissions in response to consultation papers issued in 2008 and 2009.
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Health Workforce Australia

In June 2009, legislation was passed to establish a new health workforce agency, Health Workforce Australia, through which we hope to expand Australia’s health workforce and improve the skills of those currently working in the health sector. The agency will operate across both the health and education sectors and jurisdictional responsibilities in health, to devise national solutions that effectively integrate workforce planning and policy.

The agency will focus on implementing workforce reform, devising solutions that integrate workforce planning and policies, and develop complementary changes to education and training. We aim to establish governance arrangements to ensure a national approach that supports all jurisdictions. The agency will administer a new system to manage the clinical training of pre-registration health students from all disciplines. The target groups are all health profession students, their clinical training providers and universities.

The Department has had some success in recruiting staff internationally, and we aim to build on this by consolidating all jurisdictional international recruitment actions within the agency, to improve the recruitment of nurses, and dental and allied health professionals.

The agency will develop more effective governance arrangements for health workforce training, planning and policy development. The agency will also ensure best value for money for the workforce initiatives, a more rapid and substantive workforce planning and policy development environment, and will provide advice to Health Ministers on relevant workforce issues.
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National Approach to Organ and Tissue Donations

In 2008, there were 259 deceased donors whose generosity, and that of their families and loved ones, enabled life-saving kidney, heart, lung, liver and pancreas transplants for 1,000 Australians. Just over 80 per cent of donors in 2008 donated more than one of their organs.10 Deceased organ and tissue donors assisted hundreds of patients in need of a cornea or heart valve replacement. Many more benefited from life-transforming tissue transplants that were only possible through the generous and selfless acts of tissue donors and their families.

Historically, the organ donor rate in Australia has been low compared with those of countries with comparable health systems. In 2008, Australia recorded a donation rate of 12.1 donors per million population. This compares with the top performing countries of Spain (34.2), Belgium (25.5), the United States of America (24) and Austria (20.3).11 Australia’s rate of solid organ donation has been static over the past decade, while the need for transplants continues to grow. As at 1 January 2009, 1,625 patients were on waiting lists for organ transplants.

The Australian Government is committed to improving Australia’s organ and tissue donation rate and significantly reducing the waiting time for transplants. On 2 July 2008, the Prime Minister, the Hon Kevin Rudd MP, announced Commonwealth funding of $151.1 million over four years for a program to reform organ and tissue donation practice in Australia. Following endorsement by the Council of Australian Governments on 3 July 2008, the reforms have the highest level of commitment from all Australian governments.

We know also that there is a high level of support for organ and tissue donation in the community. Presently, over 5.5 million Australians, or about 37 per cent of the eligible population, are registered as donors on the Australian Organ Donor Register. However, an additional one million organ donor registrations since 2002 has not resulted in a sustained increase in actual organ donations or transplants. The approach to community awareness and education needs now to focus on converting increased donor registrations to an increase in the rate of organ and tissue donation for transplantation.

To this end, the reform program is focusing on improving hospital resources and building community awareness about organ donation, which are two proven key drivers of increases in donation rates. Nationally consistent processes and systems beginning in the local hospital, together with ongoing community and professional education, have shown to deliver lasting improvements in organ donation rates in the world’s top performing countries.

Under the Government’s reforms, all suitable patients will be considered as potential donors and their families will be asked and given the opportunity to make an informed choice about donating their family member’s organs. A new national communications program will encourage all Australians to talk to their family, friends and loved ones about organ donation and their wishes in the event of their unexpected death. In practice, the family is always asked to confirm the wishes of a potential deceased donor. Therefore knowing the wishes of the donor is critically important.

To implement the reforms, the Australian Government has established a new Australian Organ and Tissue Donation and Transplantation Authority, and a national network of organ and tissue donation agencies. Dedicated organ and tissue donation specialist hospital staff have been recruited and there is additional funding for hospitals to meet the costs of donation processes. National professional and community awareness and education campaigns are being developed and there is additional bereavement support for the families of deceased donors. Safe, equitable and transparent transplantation processes are being implemented, including the establishment of a new national eye and tissue donation network to ensure the coordination and consistency of eye and tissue donation and transplantation processes.

All this activity is being coordinated through the national authority, which is working closely with the Department and all State and Territory Governments to ensure the reforms are implemented in a timely and effective way.

The Australian, State and Territory Governments have taken great strides over the past 12 months or so to introduce the new organ donation system. While it is still early days, 2008 did register a 30 per cent increase in the number of organ donors compared with the number of donors in 2007. This is an encouraging development and one that we hope will continue as the new system becomes fully operational.
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Health Research

During 2008–09, the National Health and Medical Research Council invested in research in priority areas such as Indigenous health, diseases imposing the greatest health burden into the future and chronic disease. The council works to provide research that is at the forefront of international advances in health and medical research. Currently the council supports research into: developing and evaluating vaccines that induce long-lasting T-cell immunities, which protects people from seasonal and pandemic influenza; reducing the psychological problems associated with trauma; the dynamic interactions between major disease-carrying bacteria and their human hosts; and the role of the immune system in cancers, chronic viral infections and autoimmune diseases.

Important research into primary care supported during 2008–09 (and committed to into future years) included: reducing the prevalence of smoking and diabetes in Indigenous communities; improving risk assessments into cardiovascular disease; improving the management and treatment of childhood obesity; and meeting the needs of carers of patients with advanced cancer.12

Research at the international level has focused on primary health care and system reforms. The focus on primary care puts people, and their expectations, at the centre of health care. Improving primary health requires widespread reforms to other systems, such as human resources, creating healthier communities and ensuring that the health system itself contributes to health equity.13

Greater investment in health system research was recognised by the WHO as one of the most effective and cost-efficient ways to improve the health of communities. In 2008–09, a WHO taskforce advocated for a system research approach, noting that greater investment in research into health systems may produce significant benefits at a minimal cost, especially for resource-constrained countries.14

One area identified by the WHO as a research priority was looking at ways to transform health systems so that they provide universal access and social health protection. The goal of improving access to health care has led to increased adoption of technology for remote diagnosis, monitoring and consultation. For example, in Chile, health professionals transmit electrocardiograms immediately when they suspect a patient has a myocardial infarction, or heart attack.

The exam itself is performed locally, and the data analysed by specialists at a national centre, who then confirm or deny diagnosis remotely via email or fax.

The National Health and Medical Research Council supported research that incorporated assessments of the effectiveness of remote diagnosis and treatment of chronic heart failure in rural and remote Australia, through its National Institute of Clinical Studies. This research identified the benefits of remote diagnosis in supporting patients and reducing deaths from chronic heart failure. The service is available through the National Heart Foundation’s Heartline call centre (1300 36 27 87).

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Professor John Horvath AO

This report marks the first for me as the Chief Medical Officer, with the majority of the year reported during the tenure of my predecessor, Professor John Horvath AO. John Horvath has made a remarkable and important contribution to health in Australia over the last five years and we are all in his debt for his outstanding work.

Professor Horvath emphasized the evidence-base, depth and quality of expert advice to Government on the big issues. He worked with experts and expert panels to get the best medical scientific approach to issues, and together they provided advice on pandemic planning, vaccine strategy, heparin contamination, tissue donation and many other issues. Professor Horvath was also instrumental in the establishment of Australia’s first Office of Health Protection, which has worked so hard recently dealing with the pandemic (H1N1) 2009 Influenza outbreak. He also worked on health issues related to food safety and the balance between public health interest, the needs of the food production industry and Australia’s relationship with international trading partners. He advised on the health issues relating to the safety of beef imports and Bovine spongiform encephalopathy.

His own achievements in working to develop a structured approach to health workforce, national registration and tissue donation will have positive long-term effects in Australia’s health system. It has been my pleasure to work with him this year. His advice and assistance has been invaluable, and I look forward to working with Professor Horvath again in his roles as a member of the Australian Organ and Tissue Donation and Transplantation Advisory Council and the National Health and Medical Research Council Management Executive Committee, and as board member of the Centenary Institute of Cancer Medicine and Cell Biology, the Garvan Research Institute, and the Australian Government Advisory Committee (WHO Collaborating Centre for Reference and Research of Influenza).

Professor Jim Bishop AO
MD MMed MBBS FRACP FRCPA
Chief Medical Officer

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1 Australian Institute of Health and Welfare Australia’s Health 2008, page 27.


2 Australian Institute of Health and Welfare Australia’s Health 2008, page 29. Results of the survey can be found in the National Health Survey Summary of Results 2004–05, available at www.abs.gov.au.


3 Adapted from ‘Table 2.17: Fatal and non-fatal burden of major disease groups, 2003’, Australian Institute of Health and Welfare Australia’s Health 2008, page 55.


4 Australian Institute of Health and Welfare Australia’s Health 2008, page 54.


5 Adapted from ‘Table 4.1: Proportion of total disease burden attributed to determinants of health, 2003 (per cent)’, Australian Institute of Health and Welfare Australia’s Health 2008, page 114.


6 Adapted from ‘Figure 4.8: Prevalence of daily smoking, population aged 15 years and over, selected OECD Countries, 2006’. Australian Institute of Health and Welfare Australia’s Health 2008, page 136.


7 Available at www.aihw.gov.au.


8 Adapted from ‘Trends in overweight and obesity prevalence, by age’. Australian Institute of Health and Welfare Australia’s Health 2008, page 160.


9 Begg, S.,Vos, T., Barker, B., Stevenson, C., Stanley, L., and Lopez, A D., 2007, The burden of disease and injury in Australia 2003, Australian Institute of Health and Welfare.


10 Australia and New Zealand Organ Donation Registry Report 2009.


11 International Donation and Transplantation Activity. IRODaT 2008 report (preliminary data).


12 For further discussion of research, see Report on the Operations of the NHMRC Strategic Plan 2007–2009, available at www.nhmrc.gov.au.


13 For further information see The World Health Report 2008: Primary Care – Now more than ever, available at www.who.int.


14 For further information see Scaling up research and learning for health systems: now is the time, available at www.who.int.


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