Transcript Prevention of diabetes the time is now

Prevention of diabetes and CVD:
it can be done
Dr Christine Connors
Director, Preventable Chronic Disease Program
Department Health & Families
Overview
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Burden of disease
Prevention works
Current policy environment
What’s happening in CA
Observed Prevalence Rates
NT Aboriginal community disease prevalence 2006
20%
Central
18%
Top End
16%
Australia
14%
12%
10%
8%
6%
4%
2%
0%
Hypertension
Diabetes
IHD
Renal
COPD
So urces: Chro nic Disease Register, Ho spital M o rbidity data and A B S Natio nal Health Survey (2004/5)
Diabetes by region and age
Observed Prevalence Rate
60%
Central
50%
Top End
40%
Australia
30%
20%
10%
0%
<15
15-34
35-49
>=50
Age Group (Years)
Sources: Chronic Disease Regist er, Hospit al M orbidit y dat a and ABS Nat ional Healt h Survey (2004/ 5)
Trends in avoidable hospitalisation
Hospital
separations
per 100 000
18000
16000
NT Indigenous
Vaccine
Acute
Chronic
Hospital
separations
per 100 000
18000
16000
14000
14000
12000
12000
10000
10000
8000
8000
6000
6000
4000
4000
2000
2000
0
0
NT non-Indigenous
Vaccine
Acute
Chronic
Li SQ et al. (2009) Avoidable Hospitalisation in Aboriginal and non-Aboriginal people in
the Northern Territory MJA
Milestones in smoking prevalence in Australia
No Butts
Campaign
No butts Phase out smoking
campaign
in federal
workplaces
Vic
Tobacco
Act
40
Male 18 +
35
30
25
National
Tobacco
Campaign
Pack
health
labelling
regulations
introduced
NRT
available
for sale in
Australia
C/W
implement
tax by stick
MCG
Smokefree
Female 18+
1st QUIT
Campaigns
%
Gaming
venue
bans
Smoking
banned
on domestic
airlines
4
rotating
pack
health
warnings
20
Smokefree
dining
15
Tobacco
Ads
banned
Print
Media
Age for sale
of cigarettes
 16 to 18
 in
excise
duty
Federal bans
on tobacco
sponsorship
of sports &
arts
10
POS advertising
bans
Health warnings on
packs
Remaining tobacco
sponsorship removed (exc.
Significant international
events)
5
198
0
1983
198
6
198
9
199
2
199
5
199
8
Prevalence in current smokers survey 1980—2007
Source: Centre for Behavioural Research in Cancer, Cancer Council of Victoria
Copyright © 2009 The Cancer Council.
200
1
200
4
200
7
Infant mortality < 1 year, 1986 to 2004
No. deaths per
NT Aboriginal
1000 livebirths
NT non Aboriginal
Australia
50
40
30
20
10
Fearnley, E. & Li. SQ. (2006) Health Gains Planning
Fact Sheet No. 4: Mortality in the NT, 1981-2004. NT DHCS, Darwin
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
0
Trends in % children underweight
30
25
20
EA
DR
Kath
Bark
CA
15
10
5
0
1999
2000
2001
2002
2003
2004
NT % Children< 5years underweight
18
16
14
12
10
NT
8
6
4
2
0
2004
2005
2006
2007
2008
Social determinants
– NTG Closing the gap
– COAG Close the gap
– NT intervention
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PHC expansion and reform (EHSDI)
Education
Housing
Employment and business opportunities
– Private sector support jobs
NTG Closing the Gap
• “Budget 2009 delivers more housing, health,
education and child protection services in
remote areas”
• “Tackling Indigenous disadvantage is a key
focus of the Northern Territory Government and
$63.5 million delivered as part of Budget 2009 is
part of our five-year $286 million closing the gap
package.
“Little Children Are Sacred”
Report recommendations included:
Use PHC centres as service hubs as part of the
development of integrated health and welfare
responses in remote communities
Successful submission from NT
• $200 million PHC services
2008/09-2011/12
PHC expansion and reform
• Transition to community control
• Expanded services
– focus on population health programs
– Core services including prevention
• Reform
– Community control
– CQI
– Hub services
NT Department Health & Families
Corporate Plan 2009-2012
Six Priority Action Areas
1.
Promoting and Protecting Good Health and
Wellbeing and Preventing Injury
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Focusing on health promotion and minimising unhealthy
behaviours and their impacts
Improving health awareness to reduce cost pressures on the
health system that are derived from preventable chronic
diseases
Assist in ‘closing the gap’ in health outcomes and life
expectancy between Aboriginal and non Aboriginal populations
in the NT
NT Chronic Conditions Prevention and
Management Strategy 2010-2020
 Social determinants of health
 Primary Prevention
 Secondary prevention and early intervention
 Self management support
 Care for people with chronic conditions
 Workforce planning and development
 Information, communication and disease management
systems
 Continuous quality improvement
COAG Preventative Health
Partnership agreement
2009-2014
• Focus on obesity
• Community programs through Local government
• Early childhood: child care settings
• Schools: physical activity and nutrition policies
• Workplaces: healthy worker programs
• Social marketing: national
• Incentive payments linked to ambitious targets
The Healthiest Country by 2020
Obesity - Priorities for Action
 Drive environmental changes throughout the community
 Drive change within the food supply
 Embed physical activity and healthy eating in everyday life
 Encourage people to improve their levels of physical
activity and healthy eating
 Reduce exposure of children and others to marketing of
energy-dense nutrient-poor foods and beverages
Local government,
community, NGO’s
OBESITY: Shared responsibility
•Healthy Places and Spaces
planning guidelines adopted
•COAG Healthy Communities
initiative implemented
State and Territory Governments
•Health Impact Assessment in all policy
development
•Fund programs that promote health eating
in schools, workplaces and community
Individuals and Families
Australian Government
•Positive role modelling for children
•Turn off TV and be active as a family
•Eat one healthy meal together each day
•Use active transport
•Reduce sitting time
•Limit eating food with high sugar, fat
and salt
•Research economic barriers and tax
incentives promote production, access
and consumption of healthy foods
•Reduce advertising before 9pm of high
fat energy dense food
•Review legislation to promote and
support workplace programs
Food and Beverage Industry
•Partner in Healthy Food
Compact to drive change in food
supply
•Work with AG to implement
national food labelling
Advertising industry
•Increase marketing of healthy
food and beverages
•Work with government to
promote physical activity and
healthy eating through social
marketing
Workplaces
Indigenous communities
•Work with community
organisations and government to
implement comprehensive
programs that promote healthy
eating and physical activity
•Strengthen maternal and child
health services
•Implement policies that
•Incorporate Health and Physical education promote healthy eating and
physical activity
into National Curriculum
•Support active transport
•Support active transport
•Offer employees access to
•Provide community access to school
workplace programs
recreation facilities after hours
Schools
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Tobacco: priorities for action
Make tobacco significantly more expensive
Social marketing
Eliminate exposure to second hand smoke in public places
Ensure all smokers in contact with health services are
supported and encouraged to quit
 Work in partnership with Indigenous groups to boost
efforts to reduce smoking and exposure to tobacco
products
 Boost efforts to discourage smoking amongst
disadvantaged groups
 Assist parents and educators to discourage tobacco use
and protect young people from second hand smoke
Prevention activities in CA
Health promotion approach
• Needs assessment
• Understand contributing factors and where
public health staff can assist
• Use evidence to identify most effective
actions
– PHT technical papers
• Planning and evaluation
– Public health bush book
– QIPPS
Ottawa Charter
Health Promotion Actions
Use them all, all of the time
• Create Supportive Environments
• Strengthen Community Actions
• Develop Personal Skills
• Build Healthy Public Policy
• Reorient Health Services
• Mediate
• Advocate
Diabetes in pregnancy
• Screening for diabetes in pregnancy
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Limited knowledge and confidence amongst PHC staff
Pre-existing undiagnosed DM has significant complications
Management by local PHC team
Supported by outreach midwives, Obstetrician
• Diabetes Antenatal clinic (DANCE) at ASH
• Weekly clinic with Obstetrician, midwife and diabetes
educator at ASH
• Virtual clinic
• Limited specialist staff
• High prevalence (approx 20% pregnancies)
Schools
• Mooditj program
– Target group: children aged 10-14 years
• Delivered in schools and also weekend sessions, 10 week program
– Wellness program
• Focuses on developing self esteem, body image, puberty,
resilience, goal setting, problem solving, sexual issues
– Need dedicated Coordinators to expand delivery
• Alukura: womens health education program: high
schools, teenage girls
• Headspace: work with young people in Alice Springs,
tobacco
• The Gap youth centre’; physical activities
Schools
• Nutritionists assist school canteen staff to implement new school
canteen policy
• Ad hoc nutrition sessions in classrooms
– Local and visiting staff
– Nutrition curriculum in DET but not being delivered
• Red Cross Breakfast program
• School nutrition program (mainly lunches) funded by DEEWR, AGI
– Local women run the program at Tara and Wilora
• Remote stores
– Many have local policies to refuse service to children during school
hours
– Usually close 1200-2.00pm
• School holiday program: “Deadly Treadlies”
– Recycle old bikes and teach kids to maintain
– Recently defunded
Community programs
• Women’s centres
– Cookbooks, cooking for elderly, frail &
disabled
• Wok cooking
• Store tours
• Cooking demonstrations
• “Eat Better Move More” program
Community programs: physical activity
• Limited infrastructure
– Basketball courts but often no night lights
– 35 communities:5-6 have gym equipment
– Limited numbers of Sport & recreation officers
• Previously often focused on kids
• Recently working with Heart Foundation
– Active After School program: frequently unqualified
staff
• Group activities
– Organised sport
– Walking groups
– Dance classes
Population approaches
• Improving food availability and
quality
– Outback Stores
– 8 stores in CA
– employ dietician
• Cost and food security major issue
• Mae Wirru store policy NPY Lands
– Nutrition policy, healthy product
placement, ban on soft drinks
• Remote Indigenous Stores and
Takeaways project
Smoking rates in pregnancy
Aboriginal women 2005
70
60
50
East Arnhem
Dwn remote
Katherine
Barkly
Alice remote
NT NA
40
30
20
10
0
1st visit`
36 wks
Tobacco control
Limited comprehensive programs to date
Perception “not a problem in CA”
Taxation and social marketing most effective
But…
BI, NRT, smoke free policies, Quit programs
Community education and local social marketing
Local smoke free outdoor policies:
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card games, social gatherings
NT Tobacco Action Plan
New legislation 2 January 2010
Prevention: it can be done
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Systematic organised approach
Resourced
Evidence based
Community development
Evaluation and research