Public Health and Management of Chronic Disease

The many years of successful public health campaigns to reduce smoking in the community, working in cooperation with the National Heart Foundation and similar organisations, have significantly reduced the impact of heart disease, once the greatest killer of men and women in often their most productive years. Mortality from heart attacks is down from 88.7 per 100,000 population in 1995 to 53.0 in 2002. Australia now rates amongst the best of the OECD countries for survival after a heart attack.2

Similar excellent outcomes have been seen for survival of women with cervical cancer, with 76 per cent of women still alive five years after diagnosis.3 Mortality in the past decade has fallen from 3.2 per 100,000 in 1995 to 1.7 in 2002,4 due to Australia’s very active cervical screening program. However, there remains a challenge for health professionals to continue to encourage women aged 18 to 69 years to participate in the National Cervical Screening Program and to manage those women with screen-detected abnormalities and those who present with symptoms of cervical cancer.

It was exciting that this year a vaccine became available to immunise women against future infections with four of the human papillomavirus types that cause significant disease. It was particularly exciting that this vaccine was pioneered by an Australian scientist, Professor Ian Frazer. The vaccine has the potential to protect Australian women from developing cervical cancer. A national immunisation program for girls aged 12–13 years, and a catch-up program for girls aged 14–18 years and women aged 18–26 years, have already started. The vaccine is offered free of charge to these women and girls.

Like the successful National Cervical Screening Program, Australia has had a breast cancer screening program for nearly 20 years. As technology is changing and new imaging techniques are available, the BreastScreen program is being reviewed to ensure that our screening program continues to be equal to world best practice. A committee of international and Australian experts is reviewing the entire program and will make recommendations to the Commonwealth, and State and Territory governments on the best way forward.

The National Bowel Cancer Screening Program began this year. After a few months this program was achieving participation rates of 30 per cent and that rate is continuing to rise. Preliminary figures from the program show that, after nine months of screening using faecal occult blood tests, 44 adenomas and 29 cancers have been detected. These numbers indicate the program’s potential to achieve its goal of reducing the mortality and morbidity associated with bowel cancer in Australia.

The new public health challenge for Australia is the burden that obesity and its subsequent effects are likely to place on health and wellbeing. Emerging data shows that an increase in obesity is not only a problem of middle age but is also affecting children from a very early age. The epidemic of obesity not only predisposes individuals to diabetes and all its attendant complications, but for nearly 50 years obesity has been known to be a major risk factor for heart disease. The gains we have made from smoking cessation may well be overtaken by obesity unless we can reverse the obesity trend. The Government has initiated a wide variety of programs that are consistent with the National Chronic Disease Strategy, from primary prevention, exercise and healthy eating in school to early detection programs, with the health check for people aged 45 years and over and improved management strategies available as a result of improved access to lipid-lowering agents on the Pharmaceuticals Benefit Scheme. We are also examining a new screening tool – The Absolute Risk Assessment – that may be more sensitive at detecting people at risk of developing cardiovascular disease.

The Australian Better Health Initiative is picking up on the strategic intent outlined in the National Chronic Disease Strategy by promoting healthy lifestyles, disease prevention pathways, risk-mitigation strategies, improving primary care interventions and care pathways, etc. The development of the National Chronic Disease Strategy highlighted several areas where seamless delivery of care could be enhanced by increasing patients’ access to ambulatory health care services. New items on the Medicare Benefits Schedule have been created to meet these concerns, such as ‘for and on behalf of’ items for practice nurses, items for case conferencing in cancer care, and new item numbers for long, complex consultations with consultant physicians. The initiatives will go a long way to improving effectiveness of primary health care for patients with complex chronic disease.

The number of adult Australians being admitted to hospital for asthma-related conditions (10.05 per 10,000 population) or experiencing mortality from asthma for individuals aged 5–39 years (0.40 per 100,000 population) compares unfavourably with the OECD average (5.82 and 0.18 respectively).5 The Asthma Awareness Campaign was launched in May 2007 to raise awareness of the seriousness of asthma and to encourage individuals to take action by visiting a doctor and taking preventive and management measures through a written asthma action plan. In addition, from 1 November 2006, the Asthma 3+ Visit Plan was replaced by the Asthma Cycle of Care in the Medicare Benefits Schedule, which seeks to improve asthma management. I hope the investment by the Government and the commitment by many expert health professionals will improve the outlook for all patients with asthma.



We have sustained high rates of immunisation, and excellent results in decreases of vaccine-preventable diseases. For example, Australian influenza vaccination rates of people aged 65 plus years are the highest for all OECD countries, at 79.1 per cent, compared with the OECD average (54.6 per cent).6

But some challenges remain. There has been an increase in the incidence of pertussis in Australia (65.8 per 100,000 population) in comparison with other OECD countries (United Kingdom 1.0; United States, 8.9).7 This situation is due to differences in surveillance practices as well as clinical and laboratory investigations of chronic cough in adults. New vaccines for children have been added to the current immunisation schedule over time, such as rotavirus, Haemophilus influenzae type b (Hib), chickenpox and pertussis. Additional vaccines for meningococcus, hepatitis B, influenza and pneumococcus are available for adolescents and adults.

The Australian Childhood Immunisation Register was established ten years ago to record the immunisation coverage of children aged 0–7 years against various preventable diseases, including measles, mumps, rubella, tetanus and polio. By March 2007, 91.0 per cent of all Australian children aged 12 months had been immunised.8 The Government has decided to scope the feasibility of establishing a national whole-of-life immunisation register to monitor child, adolescent and adult vaccination. Additional aims are to improve health and reduce unnecessary vaccinations for people who do not remember when they had their last shot.


2 OECD Health Data 2006. Causes of Mortality, Acute myocardial infarction, Deaths per 100,000 population (standardised rates).
3 OECD 2007 Health Care Quality Indicators Project. (Chart 6.13a:Cervical cancer, 5-year relative survival rates, latest available).
4 OECD Health Data 2006 Causes of Mortality, Malignant neoplasms of the cervix, Deaths per 100,000 females (standardised rates).
5 OECD 2007 Health Care Quality Indicators Project. (Chart 6.15: Asthma mortality rates, ages 5 to 39 years, 2005 and Chart 6.16: Adult asthma admission rates. Per 10,000 population ages 18 and over, 2005).
6 OECD 2007 Health Care Quality Indicators Project. (Chart 6.21a: Influenza vaccination rates ages 65 and over, 2005 or latest available).
7 OECD 2007 Health Care Quality Indicators Project. (Chart 6.24: Incidence of vaccine preventable diseases, 2005 or latest available. Per 100,000 population).
8 Australian Childhood Immunisation Register. 31 March 2007.