Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Tier 3—Effective/appropriate/efficient—3.03 Health promotion
Why is it important?:Health promotion enables people to increase control over, and to improve their health and its determinants. Health promotion activities are designed to improve or protect health within social, physical, economic and political contexts. Health promotion includes public policy interventions (e.g., packaging of cigarettes, seat belt laws), information to support healthy lifestyles (e.g., smoking, alcohol and drug use, physical activity, diet), social marketing (e.g., sunscreen, safe sex) and mass media campaigns (e.g., drink-driving, road safety). Health promotion also includes promoting social responsibility for health, empowering individuals, strengthening community capacity and addressing determinants of health. Currently there are limited methods for measuring the nature, level, and reach of health promotion programs and activities.
Findings:In 2008–09, total government expenditure on public health for selected health promotion activities was estimated to be around $36 for each Indigenous Australian and $13.70 for each non-Indigenous Australian. Expenditure for the prevention of hazardous and harmful drug use was $34.80 per Indigenous Australian and $7.20 per non-Indigenous Australian. These estimates are likely to understate expenditures on health promotion as it is often embedded within other funding sources and programs (e.g., funding for GPs).
Based on BEACH survey data for the period April 2006 to March 2011, selected clinical treatments related to health promotion were provided in 31% of all clinical treatments provided by GPs to Indigenous Australians. This included general 'advice/education' which was provided in an estimated 11% of all clinical and therapeutic treatments, followed by 'counselling/advice related to nutrition and weight' (6%) and 'advice/education/treatment' (5%). 'Counselling/advice related to smoking' was provided in 3% of all clinical treatments provided to Indigenous Australians, which, after adjusting for differences in the age structure of the two populations, was 2.6 times the rate for non-Indigenous patients. 'Counselling/advice related to alcohol' was provided in 2% of all clinical treatments among Indigenous patients which was 2.5 times the rate for non-Indigenous patients.
In 2010–11, 92% of Aboriginal and Torres Strait Islander primary health care services offered health promotion/education programs; 78% influenza immunisation, 78% woman's health programs, 77% child immunisation, 76% dietary and nutrition programs, 75% antenatal care, 72% child growth monitoring programs and 71% organised pneumococcal immunisation. Aboriginal and Torres Strait Islander primary health care services offered a range of health promotion activities including community-based education and prevention groups (71%), living skills groups (such as dietary and nutrition) (65%) and sport/recreation/physical education groups (65%). Health promotion activities are also a key feature of programs run by Aboriginal and Torres Strait Islander substance use specific services, with 85% running cultural groups and 83% running community-based education and prevention groups. As of June 2010, 91% of services funded through the Healthy for Life program provided brief interventions for smoking and alcohol, while 91% had programs for nutrition, and 90% for physical activity and emotional well-being.Top of Page
Implications:A range of health promotion initiatives are being implemented under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes which has a focus on preventive health and primary health care. For example, the Indigenous Chronic Disease Package (ICDP) includes evidenced-based social marketing activities to reduce the prevalence of chronic disease risk factors; and the development of partnerships with local Indigenous community and media organisations and a specialist Indigenous communications consultant. The ICDP also includes funding for a National Network of Regional Tackling Smoking and Healthy Lifestyle Teams across 57 regions nationally (see measure 2.18). In 2010–11 this included 21 Regional Tobacco Coordinators, 22 Tobacco Action Workers and 43 Healthy Lifestyle Workers. The Tackling Smoking workforce will implement community-based smoking prevention and cessation activities tailored to local communities. Healthy Lifestyle Workers will promote improved nutrition and physical activity and will seek to reduce the lifestyle risk factors that contribute to preventable chronic disease. The Australian Government also supports VIBE Australia to deliver health promotion products and activities, targeting young Indigenous Australians.
The COAG National Partnership Agreement for Preventive Health ($872.1 million over nine years) is the largest investment ever made by an Australian Government in preventive health and seeks to address the rising prevalence of lifestyle related chronic disease by laying the foundations for healthy behaviours in the daily lives of Australians. Australian governments are funding the Australian National Preventive Health Agency (ANPHA—established on 1 January 2011) and two major health promotion campaigns—the National Tobacco Campaign and the Measure Up (anti-obesity) campaign (both administered by ANPHA). ANPHA has a broad remit to provide advice to governments and support activity in the key areas of tobacco cessation, harmful alcohol consumption and obesity prevention.
Factors in designing effective health promotion interventions for Indigenous communities include: involving local Indigenous people in design and implementation of programs; acknowledging different drivers that motivate individuals; building effective partnerships between community members and the organisations involved; cultural understanding and mechanisms for effective feedback to individuals and families; developing trusting relationships, community ownership and support for interventions (Black 2007). Family-centred approaches across the life course have also been recommended in the prevention of chronic disease (Griew et al. 2007).
Table 39—Expenditure for selected public health activities, by Indigenous status, 2009–10Top of Page
|Selected public health activities:|
Indigenous Expenditure ($m)
Non-Indigenous Expenditure ($m)
Indigenous Expenditure per person ($m)
Non-Indigenous Expenditure per person ($m)
|Selected health promotion|
|Food standards and hygiene|
|Breast cancer screening|
|Cervical cancer screening|
|Prevention of hazardous and harmful drug use|
|Public health research|
Source AIHW health expenditure databaseTop of Page
Table 40—Proportion of funded Aboriginal and Torres Strait Islander primary health care services that undertook selected preventative health care and screening activities, 2010–11
|Preventative health care and screening activities:|
% of all responding services
|Health promotion/ education|
|Routinely organise influenza immunisation|
|Women's health programs|
|Dietary and nutrition programs|
|Antenatal/ maternal programs|
|Child growth monitoring|
|Routinely organise pneumococcal immunisations|
|Infectious diseases programs/ education|
|Physical activity programs|
|Outreach health promotion|
|Men's health programs|
|Sexually transmissable infection contact tracing|
Source: AIHW analysis of OATSIH Services Reporting 2010–11Top of Page
Figure 150—Proportion of clinical treatments provided by GPs, age-adjusted, by Indigenous status, 2006–07 to 2010–11
Source: AIHW analysis of BEACH survey of general practice AGPSCCTop of Page
Figure 151—Selected health promotion programs conducted in discrete Indigenous communities located 10km or more from a hospital, 2006
Source: AIHW analysis of ABS 2006 Community Housing and Infrastructure Needs Survey (CHINS)Top of Page