ACHSE Broadcast 21 August 2002: Managing for Indigenous health outcomes

1. ACHSE Broadcast21 August 2002:Managing for Indigenous health outcomes Robyn McDermott Barbara Schmidt Terry Mehan

2. Things are changing • The global health transition and its determinants • Consequences of epidemic chronic diseases • The social gradient in risk behaviours and outcomes • Implications for health services

3. DALYs, by broad cause group 1990 - 2020 in Developing Countries (baseline scenario) % 50 1990 2020 25 DALY = Disability adjusted life-year Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Injuries Noncommunicable conditions Source: WHO, Evidence, Information and Policy, 2000

4. Intermediate Risk Factors/Diseases • Hypertension • Diabetes • Obesity • Blood Lipids Noncommunicable Diseases: Risk Factors and Endpoints • Risk Determinants • Age, Sex • Genes • Behavioural • Risk Factors • Tobacco • Nutrition • Alcohol • Physical Activity • Coronary • heart disease • Stroke • Diabetes Compl. • Peripheral • vascular disease • Several cancers • COPD/emphysema Endpoints Socio-economic, Cultural & Environmental Conditions

5. Burden of disease attributable to the major risk factors in Australia, 1996(% of total DALYs)Source: Mathers et al. Bull WHO, 2001

6. Smoking prevalence in Queensland in 1998 by SESSource: Queensland Statewide Health Survey, 1998

8. Rate ratios for lung cancerRural, remote and Indigenous communities, QueenslandSource: HIC Circular No. 54, Feb 2000

9. Mortality inside and outside capital cities in Australia, 1986 and 1996All Causes, age standardised rates/100,000Source: Sexton et al, MJA 2000

10. CHD Mortality within and outside capital cities in Australia, 1986 and 1996Age-standardised rates/100,000Source: Sexton et al, MJA 2000

11. Proportion of population in each SEIFA quintile,Northern Zone and QueenslandSource: 1996 Census

12. Food Availability - The Healthy Food Access Basket study (May/Apr, 2000) • The HFAB study looked at market items in three baskets. These were: • Fruit and Vegetables basket • Healthy Food Access Basket (pictured left) • Tobacco and Take-away basket

13. Prevalence of diabetes, Indigenous NQ (WPHC) and Australia (AusDiab), 1999-2000

14. Determinants of incident Type 2 diabetes in a population • Overweight/obesity (central obesity) • Birth weight/weight gain in young adulthood • Physical inactivity • Tobacco smoking • Harmful/hazardous alcohol consumption • Intra-uterine exposures (glycemia, chronic “stress”, tobacco, low micronutrient density) • Chronic, systemic stress in the social environment • Lifetime SES

15. Diabetes mellitus - Hospital Separations

16. The Chronic Disease Strategy PREVENTION EARLY DETECTION MANAGEMENT Tobacco smoking Registers and recall systems, and standard treatment protocols for: - Diabetes - Cardiovascular disease - Renal disease - Chronic respiratory disease - Sexually transmitted infections - Mental Health Annual adult health check Physical activity & nutrition Women’s health checks Alcohol Strategy Healthy young women/babies Brief Interventions Safe Sex Children’s health checks Immunisation Mental Health Environmental Health

17. How can we improve technical efficiency in PHC level management of chronic disease? Registers Recall systems Expert systems (Best practice, “EBM”, skilled workforce) Information systems (Wagner, 1996)

18. Prevention:Whose job? • Health services • Education • Community organisations • Local government • Transport • Food, tobacco, alcohol industries • Others

19. Focusing the work of primary health care in Indigenous communities

20. Enhanced Model of Primary Health Care • Changing the way we do business • Framework for enhancing services at community level • Identifies the core activities of PHC in Indigenous Communities • Required inputs • Necessary supports • Required outcomes

21. Enhanced Model of Primary Health Care

22. Enhanced Model of Primary Health Care INFORMATION EXCHANGE • Health Indicators • Services currently provided • Budget and revenue • Community issues & needs identified through consultation

23. Enhanced Model of Primary Health Care

24. Enhanced Model of Primary Health Care PARTNERSHIPS • EXAMPLES • All of Government • - Meeting Challenges Making Coices • Regional • - Draft MOU with Apunipima • Community • - Partnership agreement- Yarrabah

25. Enhanced Model of Primary Health Care

26. Enhanced Model of Primary Health Care EVIDENCE BASED PROGRAMS • STRATEGIES • CHRONIC DISEASE STRATEGY • PUBLIC HEALTH APPROACH • COLLABORATIE PRACTICE MODEL

27. The Chronic Disease Strategy PREVENTION EARLY DETECTION MANAGEMENT Tobacco smoking Registers and recall systems, and standard treatment protocols for: - Diabetes - Cardiovascular disease - Renal disease - Chronic respiratory disease - Sexually transmitted infections - Mental Health Annual adult health check Physical activity & nutrition Women’s health checks Alcohol Strategy Healthy young women/babies Brief Interventions Safe Sex Children’s health checks Immunisation Mental Health Environmental Health

28. Enhanced Model of Primary Health Care

29. Enhanced Model of Primary Health Care REQUIRED SUPPORT • INFORMATION SYSTEMS • Primary Care Information Systems (Better Health Outcomes Project) • WORKFORCE • Workforce plan developed to: • - Shape the future workforce • - Increase indigenous employment • Innovative workforce strategies to improve recruitment and retentions of all staff

30. Enhanced Model of Primary Health Care

31. Enhanced Model of Primary Health Care QUALITY APPROACHES • PRIMARY CLINICAL CARE MANUAL • CHRONIC DISEASE MANAGEMENT PROTOCOLS • STANDARD HRM PRACTICES • DEVELOPMENT OF QUALITY STANDARDS FOR PRIMARY HEALTH CARE CENTRES

32. Enhanced Model of Primary Health Care

39. The Chronic Disease Strategy PREVENTION EARLY DETECTION MANAGEMENT Tobacco smoking Registers and recall systems, and standard treatment protocols for: - Diabetes - Cardiovascular disease - Renal disease - Chronic respiratory disease - Sexually transmitted infections - Mental Health Annual adult health check Physical activity & nutrition Women’s health checks Alcohol Strategy Healthy young women/babies Brief Interventions Safe Sex Children’s health checks Immunisation Mental Health Environmental Health

41. ACHSE Broadcast21 August 2002:Managing for Indigenous health outcomes Robyn McDermott Barbara Schmidt Terry Mehan