Better health and ageing for all Australians

Population Health Division (PHD)

National Partnership Agreement on Preventive Health(NPAPH)
Healthy Children
Scoping Statement and Guiding Policy Principles

NPAPH Part 1: Introduction and overview, Part 2: Healthy children - Terminology, Scoping Statement and Guiding Policy Principles

In this section:

    Part 1: Introduction and overview

    1.1 Purpose

    This document, developed in consultation with states and territories, is designed to provide guidance in developing jurisdictional implementation plans and support a consistent approach to the implementation of the Healthy Children initiative under the National Partnership Agreement on Preventive Health (NPAPH).

    1.2 Objectives

    The objective of the NPAPH is to reduce the risk of chronic disease by reducing the prevalence of overweight and obesity, improving nutrition and increasing levels of physical activity in adults, children and young people through the implementation of programs in various settings. The NPAPH provides funding for:
    • settings based interventions in pre-schools, schools, workplaces and communities to support behavioural changes in the social contexts of everyday lives and focusing on improving poor nutrition, and increasing physical inactivity. For adults also focusing on smoking cessation and reducing harmful and hazardous alcohol consumption;
    • social marketing for adults aimed at reducing obesity and tobacco use; and
    • the enabling infrastructure to monitor and evaluate progress made by these interventions, including the National Preventive Health Agency and research fund.

    1.3 Outputs

    To realise these objectives, the Healthy Children initiative will fund states and territories to deliver a range of programs:
    1. building on existing efforts currently in place, while adapting them to suit demographic and other factors in play at various sites;
    2. covering physical activity, healthy eating, primary and secondary prevention;
    3. in settings such as child care centres, pre-schools, schools, multi-disciplinary service sites, and children and family centres; and
    4. including family based interventions, settings based interventions, environmental strategies in and around schools, and breastfeeding support interventions.

    1.4 Evidence Base

    The interim results of the Australian Bureau of Statistics National Health Survey 2007-08 show the proportion of combined overweight or obese children aged 5 -17 years increased from 20.8 per cent in 1995 to 24.9 per cent in 2007-08.1 Further, results from the 2007 Australian National Children’s Nutrition and Physical Activity Survey indicate that:
    • the proportion of children meeting the guidelines for fruit intake (1-3 serves per day depending on age group and gender) declines with age (61 per cent for 4-8 year olds, 51 per cent for 9-13 year olds and 1- 2 per cent for 14-16 year olds); and
    • the proportion of children meeting the guidelines for vegetable intake (2-4 serves per day depending on age group and gender) decreases with age (22 per cent for 4-8 year olds, 14 per cent for 9-13 year olds and 5 per cent for 14-16 year olds).2
    Key factors emerging from the international and national literature that can determine the success and sustainability of health promotion programs suitable for children and young people include:
    • Well established project planning and implementation ensures the identified needs and interests of children are met. A participatory approach to planning the program structure and content involving the key influencers in children’s lives is beneficial.
    • Recognition of the role of the family and community and involvement in key activities.
    • A focus on good nutrition and physical activity.
    • Structural support for healthy lifestyles including safe places and spaces for physical activity and increased access to healthy food.
    • Effective and consistent communication of the aims and purpose of the program to build positive engagement.
    • Multi-component programs can ensure a variety of behavioural risk factors, issues and strategies are addressed to engage greater numbers of children and young people with different preferences and health needs and ensure lasting change.
    • Monitoring and evaluation of all program components should be established during program planning and inception. Top of page

    Part 2: Healthy children - Terminology, Scoping Statement and Guiding Policy Principles

    2.1 Terminology

    For the purposes of the Healthy Children initiative in the NPAPH, the following terms are defined:

    Access and equity is about ensuring that individuals, families and populations are not further disadvantaged in a health and social sense through the programs and activities delivered as part of the NPAPH. It requires consideration of a range of factors that can impact on access to, reach of and appropriateness of programs for certain populations, removing or reducing barriers to health and access to health-based activities. Programs must support equity of outcomes for all by increasing opportunities and removing or reducing barriers for participation. There are a number of interacting factors that must be considered in addressing access and equity, for example:
    • the size of the organisation or setting and relative capacity to access, take up, participate in and/or be reached by programs and implement programs;
    • consideration of the characteristics of children and young people, and their families at both a group and individual level including gender, cultural and linguistic background, Aboriginal and Torres Strait Islanders, people with a disability, physical location and socio-economic status. These factors should be considered in program design, delivery and evaluation;
    • equity of outcome that considers all the elements above in relation to the outcomes for individuals (for example, were there organisations and individuals who experienced better results than others in the same cohort); and
    • elements outlined in the Australian Government’s Social Inclusion Toolkit.3
    Children, for the purposes of this initiative, are defined as children and young people from birth to 16 years of age. Young people between the ages of 16 and 18 years are included in the definition of children if they are not participating in higher education as this setting is best addressed by the Healthy Communities and Healthy Workers initiatives.

    Healthy living programs, in the context of this initiative, are those programs that cover physical activity and healthy eating. The use of the term ‘program(s)’ is inclusive of activities targeting individuals, groups of individuals and of activities that are of an organisational wide, enabling or capacity building nature. This may include policy enhancement, system change and minor supporting infrastructure improvements directly related to the implementation in the specific setting that are made to facilitate and support the health of children and young people and associated with behavioural change. The following language will be used to describe the hierarchy of elements of the NPAPH:
    1. NPAPH initiatives, such as Healthy Children;
    2. jurisdictional programs (i.e., state and territory programs or activities implemented according to an agreed plan); and
    3. activities within jurisdictional programs; local government programs or pilot programs..
    Primary and secondary prevention definitions are drawn from The Language of Prevention, National Public Health Partnership (2006)4 and in the context of the Healthy Children initiative mean:
    • Primary prevention - limiting the incidence of disease and disability in the population by measures that eliminate or reduce causes or determinants of departure from good health, control exposure to risk and promote factors that are protective of good health; and
    • Secondary prevention – reduction of progression of disease through early detection, usually by screening at an asymptomatic stage, and early intervention.
    Quality assurance framework, accreditation and standards or other relevant material are already in place and/or currently being developed by the Australian Government under the NPAPH. Programs and program providers will be encouraged to have regards to relevant accreditation processes in order to receive funding under the initiative from jurisdictions.

    2.2 Scope

    Consistent with the objectives and expected outcomes of the NPAPH, the policy scope for the Healthy Children initiative is summarised below:

    2.2.1

    The focus of the initiative is the prevention of lifestyle related chronic disease through addressing the modifiable lifestyle risk factors of poor nutrition and physical inactivity through sustained behaviour change for children and young people.

    2.2.2

    The primary target group is children and young people and program funding should be directed to these groups taking into account the key role and involvement of the family, particularly parents. Setting based initiatives may involve making the environment more supportive of healthy lifestyles. For example, food and physical activity policies, training of relevant health professionals, curriculum development and activities that target children and their families directly or indirectly through a child care or school setting, and child behaviours through combined parent/child interventions. Top of page

    2.2.3

    Substantial built environment or infrastructure improvements are beyond the scope of the NPAPH and this initiative.

    2.2.4

    Mental health is not included as a performance benchmark under the NPAPH. While programs may have a mental health element, this should not be the sole focus of the program.

    2.2.5

    Programs should ensure a positive body image is promoted and that emphasis is on a healthy lifestyle. This should involve consideration of the target audience for programs and individuals and groups who may be vulnerable to forming a negative body image. For example, programs that target groups such as teenage girls may need different support and messages than programs for very young children or for primary school aged children.

    2.2.6

    Programs should focus on preventive health activities and the promotion of healthy behaviour. Programs with a tertiary management focus (i.e., the clinical management of existing chronic conditions) are not within the preventive scope of this initiative. However, individuals already participating in tertiary treatment programs are not to be excluded. Note that only preventive programs may attract funding.

    2.2.7

    New and innovative programs can be implemented where gaps exist for children and young people, and their families, or existing programs can be adapted or extended to suit demographic and other factors.

    2.2.8

    Programs can be delivered in settings such as child care centres, pre-schools, schools, multi-disciplinary service sites, children and family centres and potentially other less formal settings such as play groups or youth sporting groups.

    2.2.9

    Programs may take the form of settings based initiatives, strategies in and around schools and early childhood settings, and breastfeeding support interventions. Programs must focus on delivery of activities within the defined setting. Delivery of program activities exclusively in the home is not within the scope of the initiative.

    2.2.10

    Programs should actively support breastfeeding, where relevant.

    2.3 Policy Principles - General

    2.3.1

    Programs under the initiative should be focused on primary and secondary prevention.

    2.3.2

    Funding for programs should be invested in:
    • significant enhancements or expansions to existing program(s) that have already demonstrated they are efficacious;
    • new programs that have demonstrated efficacy elsewhere that are directly translatable to the initiative setting;
    • programs that can demonstrate significant innovation and/or promise from initial results, but lack formal evidence to demonstrate effectiveness; and/or
    • programs that have a high likelihood of being sustainable beyond the funding received under this initiative (should the program be effective and there is a demonstrated continuing need).

    2.3.3

    Programs should reflect the requirements of the Australian Government’s Social Inclusion Toolkit.

    2.3.4

    Access and equity in terms of both access to programs and equity of outcomes as a result of participation in programs must be a key consideration.
    2.3.5Participation in NPAPH programs is voluntary. However, the voluntary participation requirement does not override specifications of existing or new setting-based legislative requirements or policies (e.g., food supply, curriculum, and requirements for physical activity).

    2.3.6

    Programs and associated evaluations should not further stigmatise obesity and other applicable health conditions and behaviours and should promote a positive body image. Programs should also consider the potential for any negative body image messages and have appropriate management strategies in place.

    2.3.7

    Measures must be in place to protect the privacy of individuals as appropriate. Programs must comply with applicable legislation in relation to consent to collect personal and health information and the use, access, storage and disclosure of this information.

    2.3.8

    Program providers may be expected to comply with specified requirements, including quality assurance frameworks, standards or other guidance in existence or currently being developed under the NPAPH.

    2.3.9

    Programs should be developed and implemented in consideration of relevant local enablers and barriers (i.e. appropriate stakeholder consultation and support, infrastructure issues and different industry and workforce requirements).

    2.3.10

    Funding under the initiative may be used to extend existing programs or create new programs. However, the duplication of funding already allocated at a state and territory level, or by an organisation should not be permitted.

    2.3.11

    Programs will not be funded if they support, promote or utilise sponsorship of food or beverage products considered to be high in sugar, salt and saturated fat, or of tobacco and/or alcohol or promote sedentary behaviour.

    2.3.12

    Consistency and complementarity with programs already in place should be considered. An assessment of possible efficiencies and effectiveness should be undertaken that recognises activities in other settings (i.e. the community and workplaces).

    2.3.13

    Programs should have monitoring systems in place to ensure they are capable of reporting in an accurate and timely way on the achievement of program outputs in accordance with performance monitoring and evaluation requirements under the NPAPH.

    2.3.14

    Programs should have mechanisms in place for continuous quality improvement. Monitoring and evaluation arrangements should, where possible, be developed to help facilitate evaluation at a national level.
    And specifically for the Healthy Children initiative Top of page

    2.3.15

    Programs that have a clinical risk assessment component should have identified clear and appropriate referral pathways in place that include complementary support activities that aim to address and lead to a reduction in identified lifestyle risk factors.

    2.3.16

    Programs should emphasise the importance of healthy lifestyles, good nutrition and regular physical activity and should include a comprehensive mix of interventions. This includes both universal approaches and targeted interventions for children and young people who may be at high risk of overweight/obesity, physical inactivity and/or have poor nutrition.

    2.3.17

    Consideration should be given to populations of children and young people at higher risk of overweight or obesity, physical inactivity and/or poor nutrition, in particular socioeconomically disadvantaged populations and Aboriginal and Torres Strait Islander communities.

    2.3.18

    Programs should complement existing effective programs and policies for children and young people.

    2.3.19

    Programs should explicitly support breastfeeding where relevant.

    2.3.20

    Programs should comply with requirements for working with children and young people in each state and territory.

    2.3.21

    Programs must be safe and appropriate for children and young people and their parents and families.

    1 Australian Bureau of Statistics (2009); National Health Survey 2007-08 – Summary of results, Canberra
    2 Australian National University (2007); Children’s Nutrition and Physical Activity Survey – Fact Sheet – Key Findings 2007, Canberra
    3 www.socialinclusion.gov.au/Documents/SIToolKit.pdf (link available at the time of publishing)
    4 National Public Health Partnership (2006), The Language of Prevention, Melbourne.