While Australia has one of the best health systems in the world, and technology, medical interventions and medicines continue to improve, a growing number of Australians are developing diseases and suffering premature death because of avoidable lifestyle risk factors. During 2007–08, the Department worked to address this issue by managing a range of initiatives to help people to stay healthy, or to help them improve their health, now and into the future.
Working with the states and territories, the Department implemented elements of the Council of Australian Governments Australian Better Health Initiative to, amongst other things, encourage healthy people to avoid chronic disease through healthy lifestyle choices. This included a community and school grants program to help ‘at risk’ target groups, such as children, adolescents, young women and Indigenous communities, to increase their levels of physical activity and adopt good eating habits. Through this initiative, the Department saw 320 grants awarded in 2007–08 to not-for-profit community organisations to conduct healthy eating and/or physical activity projects across Australia. This included the FITKIDZ project in Armidale, New South Wales, and the Active Rural Communities project in Bunbury, Western Australia.
Other activities involved a Healthy Active National Schools Competition, which encouraged primary school children to develop a campaign for their peers that promoted healthy, active lifestyles. Over 100 entries were received from schools across the country.
Smoking during pregnancy is known to cause significant adverse health outcomes, including an increased likelihood of bleeding during pregnancy, premature birth and an unhealthy birth weight for babies. In 2007–08, the Department managed the National Smoke-Free Pregnancy Project to help women stop smoking during and after pregnancy. The project was designed to establish effective, sustainable and realistic tobacco brief interventions for pregnant women who smoke, by training midwives in public birthing services throughout Australia in brief intervention techniques.
The Smoke-Free Pregnancy Assessment and Intervention Form is used to prompt and record the smoking and pregnancy brief intervention with the pregnant woman and her partner. The form is then incorporated into the woman’s medical records. The brief intervention is based on the internationally recognised ‘5As’ (Ask, Advise, Assess, Assist/arrange, Ask Again) framework for brief intervention and includes education about the availability of the Quitline services and faxed referrals to these services to support behaviour change.
The Department also worked to promote responsible drinking practices through the distribution of health promotion resources throughout the community. This included the distribution of a range of products designed to highlight the Alcohol Australian Guidelines and the Standard Drink concept.
In addition, the Department worked across the Government, jurisdictions, and with stakeholders, to ensure complementary efforts in addressing alcohol abuse. Achievements included the development and endorsement of national tobacco and binge drinking strategies. These strategies will be implemented in the new year. A priority will be addressing binge drinking among young Australians, by supporting community level initiatives to confront the culture of binge drinking, particularly in sporting organisations. Early intervention initiatives will help young people assume personal responsibility for their drinking, and the Department will deliver an advertising campaign to confront young people with the costs and consequences of binge drinking.
Many Australians, particularly those over 40, are at risk of developing type 2 diabetes through lifestyle factors relating to nutrition and physical activity. Without effective interventions, by 2030 around 3.3 million Australians are likely to have type 2 diabetes.
In 2007–08, the Department contributed to the Commonwealth’s input to the Council of Australian Governments Reducing the Risk of type 2 Diabetes initiative, by developing a new Medicare Item – Type 2 Diabetes Risk Evaluation. Released on 1 July 2008, the item enables general practitioners to review patients aged 40 to 49 years who are at high risk of developing type 2 diabetes, and instigate early interventions to help prevent the disease. The new financial year will see the Department working with the Divisions of General Practice network to deliver lifestyle modification programs for this target group.
Much work has been undertaken over the last few years to reduce the spread of sexually transmitted and blood borne viral infections. Positive results include declining rates of AIDS diagnoses, which have fallen from a population rate of 1.5 per 100,000 over the period 1997–2001, to 1.2 per 100,000 between 2002 and 2006. This decline reflects the wide availability of effective antiretroviral therapies. The per capita rate of diagnosis of hepatitis C infection has also declined over the past five years to 61.1 per 100,000 population in 2006, representing a 25 per cent reduction since 2002.1
While this is good news, rates of sexually transmissible infections have generally increased. For example, the most recently confirmed data show that the population rate of diagnosis of human immunodeficiency virus (HIV) infection has continued its gradual increase over the previous five years to 5.1 per 100,000 population. The population rate of diagnosis of Chlamydia in 2006 was 232 per 100,000 population, representing a 12 per cent increase over the rate in 2005.2
In 2007–08, the Department facilitated the Australian Health Ministers’ endorsement of Custodial Settings Guidelines addressing hepatitis C in custodial settings, and the National Guidelines for the Management of People with HIV Who Place Others at Risk. The Department also updated the National Hepatitis C Resource Manual, a resource highly valued by health care workers. The manual aims to enhance the health outcomes of people affected or potentially affected by hepatitis C, by providing standardised, accurate and current information about hepatitis C and associated issues to a wide range of health care providers.
In addition, the Department implemented stage 1 of a targeted grants program for testing Chlamydia. Stage 1 incorporated a range of innovative projects targeting high risk groups including young people, Aboriginal and Torres Strait Islander people, homosexually active men and pregnant women. The projects are being conducted in urban, rural and remote Australia, including hospitals and community centres.
1,2 Source of data: National Centre in HIV Epidemiology and Clinical Research (NCHECR). HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2007. NCHECR, The University of New South Wales, Sydney, NSW; Australian Institute of Health and Welfare, Canberra, ACT. 2007.
Through the Department’s strong relationships with the states and territories, the Immunise Australia Program continued to deliver high immunisation coverage rates with 92.8 per cent of non Indigenous and 91.8 per cent of Indigenous children at two years of age being fully immunised in 2007–08. Maintaining a high proportion of immunisation coverage in children will be a priority for the Department in the new year. The Department will continue to work with the states and territories to improve immunisation coverage and surveillance through the Australian Immunisation Agreements and policy forums such as the National Immunisation Committee.
The Department added the rotavirus vaccine to the National Immunisation Program in July 2007. Rotavirus gastroenteritis is a highly infectious virus causing severe diarrhoea and is responsible for around half of all cases of hospitalisation of children less than five years of age. The rotavirus vaccine is now available from general practitioners and other immunisation service providers such as local community immunisation clinics.
Work continued in the areas of early detection and prevention of cervical cancer through the National Cervical Screening Program and the free delivery of the human papilloma virus vaccine. Since the introduction of the National Cervical Screening Program there has been a 48 per cent reduction in the incidence of cervical cancer. Human papilloma virus is a very common virus, with four out of five people having it at some stage of their lives. In some cases, it can increase a woman’s risk of cervical cancer. A major achievement was the distribution of 3.4 million doses of the vaccine to school girls between the ages of 12 and 18 years, and to young women under the age of 27 years through general practitioners and community immunisation clinics. A National HPV Register is being developed on behalf of the Department by the Victorian Cytology Services. Information collected by the register will be used to evaluate the effectiveness of the vaccine in reducing cervical cancer in the longer term, and to inform future policy.
The Department aims to improve the rates of early detection, and reduce the number of bowel cancer-related deaths each year, through the National Bowel Cancer Screening Program. A major achievement in 2007–08, was the distribution of approximately 627,000 screening invitations to eligible people across Australia (bringing the total number of invitations sent between 1 August 2006 and 30 June 2008 to over one million). Invitees included people turning 55 or 65 years of age between 1 May 2006 and 30 June 2008, and those involved in the pilot program. These people were invited to complete a faecal occult blood test in the privacy of their own home and mail it to a pathology laboratory for analysis.
At 30 June 2008, the participation rate for the program was approximately 40 per cent. A national register tracks participants through the screening pathway. Data indicates that 52 cancers have been reported to the program register so far.
The Department continued to administer funding to the highly successful Illicit Drug Diversion Initiative, which diverts non-violent drug offenders away from the criminal justice system and into assessment, education and treatment services. A national evaluation of the initiative in 2007 indicated that it is being implemented widely, with police and court-based diversion programs operating in every state and territory. There are currently more than 30 initiative-funded diversion programs operating nationally, almost double the number that were operating in 2003. As at 30 June 2006, approximately 108,000 diversions had occurred since the program began in 1999. The Department also increased treatment options for those seeking help with their substance abuse, by supporting a number of non-government treatment organisations through programs such as the Non-Government Organisation Treatment Grants Program and the Amphetamine-Type Stimulants Grants Program.
To improve the alcohol and other drugs sector’s capacity to help people with their addictions, the Department funded a number of workforce development initiatives. These included the Improved Services for People with Drug and Alcohol Problems and Mental Illness initiative, from GO to WHOA psychostimulant training package which assists health professionals to manage and treat users of psychostimulants, and the Indigenous National Alcohol and Other Drug Workforce Development Program. The Pilbara Aboriginal Alcohol and Drug Program and the development of the Indigenous Risk Impact Screen were also supported.
The Department developed and implemented the National Drugs Campaign to inform people about how illicit drug use can affect a person’s health, relationships, work or study, and quality of life. The campaign also suggests positive alternatives to drugs, as well as options for seeking help. The Department also launched the National Cannabis Prevention and Information Centre to provide a free, confidential telephone helpline, an informative website for the general community and professionals (<www.ncpic.org.au>), and training and treatment options for the workforce. Through these, the centre aims to reduce the use of cannabis, and related harms in Australia and support services which deliver treatment to those with cannabis problems.
A major achievement was the development of nationally agreed responses to the use of meth/amphetamine through the National Amphetamine-Type Stimulants Strategy. Endorsed by the Ministerial Council on Drug Strategy in May 2008, the strategy addresses problems associated with the use of amphetamine-type stimulants, recommending actions to prevent and reduce the supply and use of drugs. It also aims to improve people’s access to quality treatment and develop the workforce, organisations and systems providing care.
The Department collaborated with government agencies, states and territories, health professionals, the law enforcement sector, consumers and other stakeholders, to develop the responses. The development of the document means that the Australian community should see a decrease in amphetamine-type stimulant use, be better educated about the risks and harms associated with this group of illicit drugs, and if needed, have access to treatment and support services equipped with an appropriately skilled workforce. In response to the National Amphetamine-Type Stimulants Strategy, the Department is developing an education program about illicit drug use targeting young people who use meth/amphetamines.
The National Pregnancy Support Helpline provides women with free, confidential and professional advice about options for where there is unplanned pregnancy. The Department monitored the quality of service and usage of the helpline to ensure it provided professional non-directive counselling and was available seven days each week on a 24 hours basis. In 2007–08 there were 4,369 calls to the helpline.
The Department, in conjunction with State and Territory Governments and the National Health Medical Research Council, commenced the development of National Evidence-Based Antenatal Care Guidelines in 2007–08. Expected to be completed by 2010, the guidelines will be a key tool to assist health professionals to provide the most effective and appropriate antenatal care.
Breastfeeding in the early weeks of a child’s life can be difficult and supporting women who have difficulties is important in raising the rate of breastfeeding in Australia.
In 2007–08, the Department commenced work on the upgrade of the Australian Breastfeeding Association’s existing telephone counselling service to a new national toll-free 24 hour helpline. When fully operational in December 2008, the service will provide all new mothers who want to breastfeed with access to one-to-one expert support. The Department will monitor the helpline to ensure it provides quality service to breastfeeding mothers and their partners.
The Department produced the Get Set 4 Life Guide – Habits for Healthy Kids for parents of children aged four years. The guide provides parents with practical information about healthy living habits such as healthy eating, playing and learning, skin and sun protection and hygiene. The guide will be provided to all parents and/or carers as part of the Healthy Kids Check that is undertaken in conjunction with the four year old immunisations.
The Department also jointly funded – with the Department of Agriculture, Fisheries and Forestry, and the Australian Food and Grocery Council – a National Children’s Nutrition and Physical Activity Survey. This major achievement resulted in the collection of data on the foods consumed and physical activities undertaken by over 4,000 children aged 2 to 16 years. The survey also measured data on height, weight and waist circumference. The first results will be released in 2008 and will be used to inform the development of preventative health policies and programs and healthy food products.
The Innovative Health Services for Homeless Youth Program was piloted in 1991, following the Human Rights and Equal Opportunity Commission’s (1989) Our Homeless Children (Burdekin) report, which found that homeless young people with chronic health problems are reluctant to seek treatment through mainstream services because they see them as judgemental or unsympathetic to their situations.
The Department extended the Innovative Health Services for Homeless Youth Agreements with the states and territories in 2007–08, to ensure that homeless and otherwise at-risk youth aged 12 to 24 years can continue to access mainstream and specialised health services.
A priority identified in the 2007–08 Health and Ageing Portfolio Budget Statements was to develop options for regulating an expanded nuclear industry with the Australian Radiation Protection and Nuclear Safety Agency. Following a change of government objectives in 2007, this project did not proceed. The Australian Radiation Protection and Nuclear Safety Agency, however, undertook other ongoing regulatory and advisory activities, with the aim of protecting people and the environment from the harmful effects of radiation. Discussion on the agency’s work during the year can be found in the 2007–08 Annual Report of the Chief Executive Officer of the Australian Radiation Protection and Nuclear Safety Agency.
Another change in direction occurred on 16 July 2007 when the New Zealand Government announced that it would not proceed with legislation to enable the establishment of the Australia New Zealand Therapeutic Products Authority – a joint agency for the regulation of therapeutic products. While this postponed negotiations between Australia and New Zealand, agreement for a joint scheme remains in place.
The Department, through the Therapeutic Goods Administration, reviewed the work it had undertaken up until this point, so the proposed regulatory reforms could be used to contribute to the safety and efficacy of medicines and therapeutic devices in Australia. This resulted in a reform package which focuses on increasing the transparency and availability of consumer information, and enhancing post-market monitoring and product safety. The reforms also propose ways to reduce regulatory burden on industry. Should the Australian Government agree with the proposed reforms in 2008–09, the Department will manage the legislative changes necessary to implement the reform agenda, following a series of consultative workshops with a diverse range of stakeholders.
A 2005–06 independent review of the Gene Technology Act 2000 found that the national gene technology regulatory scheme and the Act had worked well in the five years following their introduction, and that no major changes were required. However, it also suggested a number of minor changes to improve the operation of the Act. In 2007–08, the Department, through the Office of the Gene Technology Regulator, amended the Gene Technology Act 2000 and the Gene Technology Regulations 2001, and acted on the review’s recommendations.
The Department, through the Office of the Gene Technology Regulator, provided information and training to organisations about the legislative and non legislative changes to processes and procedures resulting from the review. The most notable of legislative changes was the streamlined process for assessing licence applications for limited and controlled release of genetically modified organisms to the environment. The Department also supported the Regulator in the issue of revised Guidelines and Forms for the Certification of Physical Containment Facilities, and in a ‘Regulator’s Forum’ which was convened with the heads of other Australian Government regulatory agencies to further cooperation and minimise regulatory duplication. In addition, the Office of the Gene Technology Regulator developed a framework for Post Release Review to support ongoing oversight of general/commercial releases of genetically modified organisms. The review was incorporated into the revised Risk Analysis Framework published in November 2007.
As recommended by the review of the Act, the Office of the Gene Technology Regulator established the new Gene Technology Ethics and Community Consultative Committee which commenced on 1 January 2008.
A major achievement was the Department’s contribution to the control and eradication of an outbreak of equine influenza in Australia. In September 2007, the Department supported the Parliamentary Secretary in making the Gene Technology (Equine Influenza Vaccine) Emergency Dealing Determination 2007, which temporarily authorised the importation, transportation, possession, use and disposal of two genetically modified vaccines: ProteqFlu and ProteqFlu Te.
This involved the rapid preparation of risk assessment advice by the Gene Technology Regulator, and coordination of input across the Department and with other Australian and State and Territory Government agencies. The Office of the Gene Technology Regulator also monitored compliance with the conditions of the determination, inspecting sites in Queensland, Victoria, New South Wales and the Australian Capital Territory (all of which were fully compliant).
Ensuring that workers, the public and the environment are protected from the risks posed by pesticides and other chemicals used in the community is an important part of the Department’s work. During the year, the Department assessed the risks of such substances, provided advice to the Government on potential human health effects, and established risk-based health standards to promote safe use by the public and/or workers.
The Department led the development of chemical policy advice on matters relating to national and international chemical negotiations, harmonisation issues and treaties, to protect Australians and the international community through a consistent and cooperative approach to chemical control and regulation.
The Department also contributed to the National Drug Strategy by providing regulatory advice on drug controls and administering a regulatory framework for the importation/exportation of certain drugs – such as narcotics, anabolic steroids and antibiotics – to ensure licit use in accordance with international and national obligations.
A focus was also on protecting people and the environment from risks posed by industrial chemicals. Through the National Industrial Chemicals Notification and Assessment Scheme, the Department contributed to action on four potentially dangerous chemicals which were found present in consumer items such as toothpastes, cosmetics and children’s toys. These chemicals included formaldehyde, diethylene glycol, 1,4 butanediol, and methyldibromo glutaronitrile. Working in cooperation with other government agencies, the Department recommended controls that restrict the presence of these chemicals in certain consumer products to protect public health and ensure consumer safety. The Department also provided advice on formaldehyde in accommodation units used for housing workers in the Northern Territory, and worked to restrict the use of certain lead compounds in industrial inks and surface coatings.
Many ingredients in cosmetic products are classed as industrial chemicals. To make sure these products are safe, the Department introduced a new cosmetics standard, to amend the regulatory status of certain cosmetic products and to improve the consistency of requirements across this product range. The Department also delivered a comprehensive education and awareness campaign to achieve a strong industry understanding of, and compliance with, the new arrangements.
A major achievement was the implementation of major reforms coming out of the 2006–07 Existing Chemicals Program Review, to make the framework for the assessment and management of existing chemicals more flexible and responsive. The Department improved its processes for engaging and communicating with industry and the community. Preparatory work was also undertaken to improve mechanisms to identify chemicals of concern. While the review of the regulatory arrangements for hard surface disinfectant products did not progress as quickly as anticipated, an independent review of the current arrangements has now been undertaken. The Department consulted with the public on reform options, with the consultation period being extended at the request of industry stakeholders, and the Department is now formulating advice to Government before finalising the arrangements in 2008–09.
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