The Australian Governments 2005 National Chronic Disease Strategy: Prevention across the continuum
Question
Using the Australian Government’s 2005 National Chronic Disease Strategy as the context of this essay
• Select one ACTION area from this document
1. Prevention across the continuum
2. Early detection and early treatment
3. Integration and continuity of prevention and care
4. Self-management
• Critically analyze the literature and current local and national services to discuss and evaluate the successful or unsuccessful implementation of the nominated action area
8011NRS Chronic Illness and Palliative Care – Assessment Two 1
Griffith University
School of Nursing and Midwifery
8011NRS: Chronic Illness and Palliative Care
Semester 1, 2010
8011NRS Chronic Illness and Palliative Care – Assessment Two 2
ASSESSMENT TWO GUIDELINES
PRESENTATION
Please ensure that your paper adheres to the following presentation principles:
• A standard Griffith University assignment cover sheet must be attached to the assignment prior to submission
• Include a title page detailing your name, student number, the course title, the title of the assignment and the word count of your assignment.
• You must support your paper with a minimum of 15 appropriate recent references from the professional scholarly literature (which means information should be primarily sourced from authoritative sources such as refereed journals, books, and government reports). NB: Literature published more than five years ago is not considered to be “recent”.
• Use a separate page for the reference list. Standard APA Publishing Manual (5th ed) (2001) referencing style is to be used consistently throughout your paper. Do not supply a bibliography (ie, only include references in the reference list that correspond with your in-text citations).
• Provide an assignment that conforms to an acceptable standard for academic essay presentation, with page numbering, double-line spacing, margins of at least 2 cm, and font size of at least 11 Arial/12 Times New Roman. Your assignment must be well written with correct spelling, sentence and paragraph structure.
• Headings are permissible, however, all new concepts should be introduced and the essay should flow well. Bullet points and numbering are NOT appropriate in this academic essay.
Answer
Name of student:
Course name:
Class name:
Date assignment due:
Contents
Prevention across the continuum.. 4
Various approaches being used in the prevention of risk factors for chronic disease. 7
Future prospects in prevention strategies. 8
The prevention process: the transition from evidence to policy. 10
Starting early and the key directions to be considered. 12
Impact of healthcare interactions in reducing the risk factors of chronic disease. 13
Introduction
The development of the Australian National Chronic Disease Strategy can be traced to the decision that was made by the Australian Health Ministers’ Advisory Council, which, in 2002-2003, agreed to the task of developing a national strategic policy approach to prevention and care of chronic diseases among Australians. The national approach contains two main elements: the National Chronic Disease Strategy and the five National Service improvement Networks for purposes of providing support.
ORDER HEALTHCARE PAPER NOW
Both the strategy and the frameworks were prepared by a group of individuals and expert groups, including policymakers, clinicians, members of various non-governmental organizations, peak consumer bodies, and other health organizations. They are designed in such a way that they inform various stakeholders in the health sector, with the result being that they do not target a general audience.
Each of the frameworks was structured in such a way that it reflects the various phases of the journey of the patients, including reduction of risk, early diagnosis, management of acute conditions, provision of long-term care and care relating to the advanced stages of the disease. This paper will critically analyze the existing literature one of the core areas addressed through the Australian Government’s 2005 National Chronic Disease Strategy (NCDS): prevention across the continuum. This paper will critically analyze recent literature in order to discuss and evaluate the successful or unsuccessful implementation of measures relating to the prevention of chronic disease across the continuum, with regard to the implementation framework spelled out in the 2005 National Chronic Disease Strategy (NCDS). To do so, this paper will assess two types of risk factors: biomedical risk factors and behavioral and social risk factors. The biomedical risk factors highlighted include high blood cholesterol, excess weight, high blood pressure, depression, and genetic factors. The behavioral and social risk factors include tobacco smoking, poor health during early childhood, poor diet and nutrition, physical inactivity, high-risk alcohol use, social isolation, and excessive sun exposure.
Prevention across the continuum
The diseases that were targeted by the NCDS include asthma; diabetes; cancer; stroke, heart, and vascular disease; and osteoarthritis, osteoporosis, and rheumatoid arthritis. The prevention strategy is always carried out through a range of agreed-upon national directions, all of which underpin collaborative measures at all levels. This ensures that priorities and investments are well aligned and are working together in an efficient manner (Corbett, 2005)
The preventative objective of the NCDS entails prevention and/or delay of the onset of chronic among individuals and population groups (Ostbye & Yarnall, 2005). This objective is best accomplished within a continuum of prevention and care. The core elements of this continuum include early detection, assessment, multidisciplinary care planning, self-management support, evidence-based clinical management, care coordination, psychosocial support, rehabilitation, ongoing monitoring and end of life care (Beaglehole et al, 2008).
In order for the task of ensuring that there is prevention across the continuum to be achieved, there is a need for a population health approach to be adopted, whereby emphasis is on improving the health status of the entire population as well as reduction of inequalities among various population groups. Recognizing the needs of all population groups and communities in Australia is one of the things that need to be done in order for special challenges to be confronted for the benefit of all groups and populations that are disproportionately affected the problem of chronic disease. These groups include the Torres Strait Islander peoples, the Aborigines, older Australians, people with mental illness, mental and physical disabilities and those who are socio-economically marginalized (Hawkes, 2006).
The NCDS envisaged a program of action where the needs of all the Australian people would be addressed, regardless of their linguistic backgrounds; educational and socio-economic backgrounds; types of settings, either rural or remote communities; and various stages of one’s lifespan. With such a holistic foundation having been put in place, the most difficult task was to implement the ambitious prevention strategies in order to ensure that the chronic disease situation does not get any worse than it is today.
The preventive measures put in place by NCDS were aimed at focusing on both the risk and protective factors influencing the way in which chronic disease develops. Risk factors were defined as those variables that increase the possibility of a disease developing or progressing. The population health approach pays attention to economic, social, cultural and environmental factors that affect health directly while at the same time influencing behavioral factors that can affect one’s health and equitable access to health care (Asaria et al, 2008).
On the other hand, health promotion simply represents a process of social and political adjustments, so that the right actions partake in pursuit of strengthened skills and capabilities among individuals (Glasziou et al, 2005). These skills and capabilities have been proven to be very critical in bringing about transforming the social, economic and environmental conditions that definitely alleviate many negative effects on individual and public health. In this regard, some of the factors to focus on as part of NCDS implementation include employment, income, social inclusion, and education.
According to the Australian Institute of Health, prevention is “an action aimed at reducing or eliminating or reducing the causes, onset, complications or recurrence of disease”. Lifestyle modification and other forms of prevention can greatly help the well-to-do population, those people at risk and even those with chronic disease. Lifestyle modification entails exercising regularly and eating healthy foods. Through prevention, the onset of many risk factors can be avoided.
Six risk factors have been identified and categorized into two groups, namely biomedical risk factors; and behavioral and social risk factors (Halcomb et al, 2008). Biomedical risk factors include high blood cholesterol, excess weight, high blood pressure, depression, and genetic factors. The behavioral and social risk factors include tobacco smoking, poor health during early childhood, poor diet and nutrition, physical inactivity, high-risk alcohol use, social isolation, and excessive sun exposure.
According to National Health Priority Action Council (NHPAC) (2006), some of these risk factors are very common to some major chronic diseases (physical inactivity, tobacco smoking, harmful alcohol use, poor diet and nutrition, excess weight, high blood pressure, and high blood cholesterol. Together, these risk factors account for nearly a third of the Australian burden of chronic disease. To put this into sharp focus, nine out of every ten Australians possess at least one of these risk factors. Additionally, research has shown that 54% of all males and 45% of females have a combination of two risk factors or even more.
Jordan & Briggs (2008) indicate that it is possible for major gains to be achieved through targeting prevention interventions that relate to the most common risk factors, especially those that underlie a wide range of chronic diseases. Furthermore, risk reduction interventions and health promotion efforts are needed across the disease continuum, and not merely for the case of healthy people.
Various approaches being used in the prevention of risk factors for chronic disease
Australia seems to have made significant progress in efforts to prevent chronic disease (Grant & Chittleborough, 2006). For some of the chronic diseases such as asthma and some cancers, the mortality rates are falling. The wellbeing of individuals with these diseases has improved while the cost to the economy has reduced significantly (Beaglehole et al, 2009).
The country has also succeeded in leading the world in tobacco control efforts. Between 1991 and 2004, the daily rates of tobacco smoking declined by 30%. However, about 3 million Australians are still daily smokers (Armstrong & Gillespie, 2007). Additionally, 45% of all Torres Strait Islanders and Aboriginal peoples say they are daily smokers. Patterns of alcohol consumption have remained considerably stable from 1991 and 2004, although about 10% of all people above the age of 14 consume alcohol at levels, which, in the long term, are considered risky to health.
In sharp contrast, obesity has been on the rise, with the most rapid increase being recorded within the last 20 years. This is why Australia is ranked in the club of the fattest nations, alongside the United States and the United Kingdom (O’Dea, 2005). About nine million adults in Australia are obese or overweight, while 3.3 million are categorized in the group of high-risk obese individuals. Of the greatest concern, though, is the research finding that between 1985 and 1995, obesity among children tripled.
According to Halcomb et al (2005), the worrying trend in fitness among Australians is attributed to the fact that the number of Australians who regularly undertake sufficient physical activity in order to achieve health benefits has decreased significantly. For instance, more than half of all Australian adults are not sufficiently active whereas 32% of all children never engage in any form of physical exercise.
ORDER HEALTHCARE PAPER NOW
Nutrition problems in Australian manifest themselves in the form of inadequate consumption of fruits and vegetables. Poor calcium intake is also common. It is estimated that increasing fruit and vegetable consumption by only one serve every day would resulting in savings among to $157 million of the money that the Australian government spends in the healthcare system every year with regard to heart disease alone (Newman et al, 2006). Likewise, increasing the daily dietary intake of Calcium would reduce today’s high prevalence of osteoporosis in Australia.
Today, Australia has put in place many national prevention strategies, including Healthy Weight 2008, National Hepatitis C strategy 2005-2008, National Tobacco Strategy 2004-2009, Be Active Australia 2005-2009, National Drug Strategy 2004-2009, Eat Well Australia 2000-2010, among many others (Walker, 2009).
Future prospects in prevention strategies
The task of achieving prevention outcomes is far from a simple one. The Ottawa Charter contains an outline of various health promotion actions that can make transform difficult preventative tasks into simple NCDS undertakings. These actions include building public policy, strengthening community action, creating supportive environments, reorienting health services and developing personal health-related skills.
The best health promotion strategies are those that integrate several approaches. For instance, tobacco smoking in Australia has reduced as a result of many wide-ranging efforts such as regulation, legislation and fiscal strategies that emphasize on the need to increase the extent to which people have access to many smoke-free environments. Other measures include the provision of financial disincentives for limited tobacco advertising and smoking. In most cases, these efforts have bee preceded by community-based support work, mainly through advocacy and involvement by non-governmental organizations.
Various integrally-implemented directions are needed across the chronic disease management continuum in order for the goal of prevention to be achieved with maximum efficiency and minimum costs to the Australian government. The creation of health environments is also important, especially through the acknowledgment of the integral links that embody the physical, social and mental wellbeing of all individuals and groups (Jordan & Osborne, 2006).
Education, home, workplace and community environments are very critical in the task of ensuring good health among all people (Warren et al, 2008). These are important settings whereby various protective factors, including good nutrition and physical activity, are actively promoted and risk factors such as excessive sun exposure and tobacco smoking, reduced. These are also the settings whereby a better understanding of healthy lifestyles is encouraged and reinforced.
One of the ways through which the NCDS has been pursuing the chronic disease prevention goals is through a focus on strategies that promote good health and healthy living (Knight& Senior, 2006). For instance, in Tasmania, various state government departments are in the process of implementing a cross-sector ‘cluster’ initiative through which healthy wellbeing issues are tackled in response to the vision of priorities that are community-driven (Harris & Zwar, 2007). The cluster is in such a way that it is possible for a whole-of-government approach to be used in addressing health issues that are too complex to be left in the hands of only one department.
Strong communities that constitute all community members are very essential when it comes to the task of creating a healthy environment. In such settings, communities feel the need to seek empowerment so that they can identify various risk and protective factors that are relevant to their contexts. Community action is needed in order for the appropriate approaches to be adopted in the task of pursuing environmental, behavioral, and organizational change that is required for the community to achieve its health needs.
With the framework laid down by NCDS, the main role of health sector leadership is to work in a setting where there are partnerships with all the relevant sectors and communities. Through proper leadership, the right opportunities can be created so that people are able to make healthy choices. A good example is town planning whereby people can be influenced to walk to and from their places of work more often.
The prevention process: the transition from evidence to policy
Dennis et al (2008) state that the prevalence rate of prevalence disease continues to rise, thereby placing more and more demands on the existing healthcare systems. The risk factors associated with the chronic disease continue to increase as well. In Australia, estimates generated through disability-adjusted life-years indicate that currently, chronic disease accounts for 70% of the burden of health problems in Australia (Dennis et al, 2008). By 2010, this percentage is expected to increase to 80%.
According to Dennis et al (2008), primary care has an integral role to play in the management of the chronic disease. Against this backdrop, Dennis et al (2008) undertook a comparative study involving a qualitative review of synthesized data in order to focus on the available evidence for the overall effect of interventions on the way in which various chronic physical illnesses are managed in countries that are comparable to Australia.
Part of the outcome of the research showed that the Chronic Care Model is a good source of an insightful framework that facilitates a proper understanding of the way in which chronic disease should be managed. Consultation with all stakeholders was noted to be very useful if the ideal policy options are to be identified, spelled out, and transformed into courses of action, complete with time limits (Dennis et al, 2008).
Dowrick (2006) says that there is a mismatch between evidence and policy in the manner in which preventive measures for chronic disorders are being undertaken. In the fiscal year 2000-2001, more than $35 billion was spent in health care, a figure that represents two-thirds of the total budget allocation for the health sector. The NCDS, according to Dowrick (2006), should provide Australians with high-quality information on their condition in a continuous and properly coordinated manner.
The ambitious Australian strategy, if successfully implemented, will contribute greatly towards meeting all the requirements that are needed to drastically reduce suffering as a result of chronic disease. The key question is on what needs to be done in order to move it through a transition from a set of words and phrases into a highly effective set of properly implemented deeds and courses of action that are time-bound, cost-effective and efficient (Dowrick, 2006).
In order for the disparity between evidence and action to be bridged, chronic illness should be promoted on the various agendas of policymakers in order for the necessary political and economic changes to be instituted within the Australian health care system. Structures need to be put in place in order to reduce, and ultimately, eliminate all the inequalities that exist in the country, while at the same time maximizing efficiency in resource allocation. What is not clear, according to Dowrick (2006), is whether such structures would be suitable at the state or at the federal level of government and the role that should be played by the private sector. The main problem here is determining the person who would offer Australian the best value. Additionally, the transition from evidence to the policy must entail a change of the general practice policy, especially with regard to matters of early detection of various chronic conditions.
Starting early and the key directions to be considered
. The earlier the prevention process is embarked on, the higher the likelihood of success. First, the progress of ongoing monitoring and implementation should be measurable. All national prevention strategies should be periodically verified in order for policymakers to ensure that efficiency is always maintained as per the set-out procedures. In terms of creating healthy environments, there is a need for organizational and public policy changes to be made as the need arises as part of the creation and support of environments that promote health.
One of the areas where the NCDS is yet to record a clear win is in the adoption of a whole-of-life approach. The risk reduction efforts are not being seen to start as early in life as they should. There is strong evidence to show that the early-life experience of children has a profound influence on their wellbeing and health later in life. Many risk factors are known to increase vulnerability to many chronic conditions during adulthood, for example, repeated infections, malnutrition, low birth weight, alcohol, abuse, and neglect.
Improvement in maternal mental and physical health as well as supporting healthy pregnancies is very critical to bringing about the prevention of many risks as well as the accompanying enabling home environments. Wakerman (2005) indicates that full breastfeeding for not less than six months of a child’s life is a source of numerous health benefits for infants. It is also a potential source of benefits that last for an individual’s entire lifespan. Breast-fed infants have reduced the likelihood of developing hypertension, some infectious diseases and chronic diseases that are diet-related diseases later on in life. Conservative estimates indicate that $11.5 million can be saved annually in Australian just by increasing the prevalence of breastfeeding from today’s level of 60% at three months to 80%.
Impact of healthcare interactions in reducing the risk factors of chronic disease
The NCDS provides opportunities for as many healthcare encounters with professionals as possible. This not only increases the opportunities for health promotion, but it also makes it possible for people to know about ways of reducing risks. The Australian government has a crucial role to play of ensuring that disadvantaged groups have as much access to healthcare professionals as those who have access to many economic and social opportunities.
The capacity for health workers to identify various social, behavioral and biomedical factors for chronic illness must be strengthened if the NCDS policy framework is to function in the right way. The Australian Institute of Health and Welfare (2005) highlights the opportunities that can be achieved through widespread education programs in order to deter the most common behavioral risk factors (namely nutrition, smoking, physical and alcohol use), from causing an increase in chronic diseases among Australians. The Australian Institute of Health and Welfare report also underpins the various initiatives (for example Life scripts) that enable general practitioners to give assistance to patients so that they can adopt healthier lifestyles through modification of risky behaviors.
Monitoring the level of progress in the Australian NCDS policy, like in any other healthcare initiative undertaken in the country, is a difficult thing to do. The answer to solving the hurdles that are presented by NCDS is provided by Lock et al (2005), who says that the pressing need for an evidence base that is felt today is justified and that various prevention interventions should be put in place for monitoring and surveillance purposes.
While use of alcohol and tobacco can be determined easily through counting the population, population trends regarding diet and nutrition; biomedical risk factors and physical activity are not clearly understood. This means that the implementers of the preventative measures across the continuum will have a difficult task of countering risk factors relating to these areas (Brenda & Grant, 2007).
Conclusion
In conclusion, since the establishment of the National Chronic Disease Strategy in 2005, the Australian government has made significant strides in combating the threat of chronic disease. The first step towards achieving the achievement of this goal, that of putting preventative measures in place, has also pursued and considerable levels of success achieved.
However, there are many policy challenges that need to be dealt with before all individual and community groups can be said to have witnessed the evening out of existing disparities in healthcare coverage, specifically with regard to risk factors for chronic disease. Priority should be on dealing with the existing mismatch between evidence and policy in the task of implementing preventative policies.
References
Armstrong, B. & Gillespie, J. (2007). Challenges in health and health care for Australia, MJA 187(9), 485-489.
Asaria, P. Chisholm, Mathers, Ezzati, D. & Beaglehole, C. (2008). Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use, The Lancet, 370(9604), 2044-2053.
Australian Institute of Health and Welfare (2005). Health system expenditure of Diseases and Injuries in Australia 2000-2001 (2nd Ed.) Health and Welfare Series No. 21, AIHWC Cat No HWE-28, Canberra: AIHW.
Beaglehole, R. Epping-Jordan, Patel, J. Chopra, V. Ebrahim, S. Kidd, M. & Haines, A. (2009). Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care, The Lancet, 372(9642), 940-949.
Beaglehole, R. Ebrahim, S. Reddy, S. Voûte, J. & Leeder S. (2008). Prevention of chronic diseases: a call to action, The Lancet, 370(9605), 2152-2157.
Brenda, T. & Grant, B. (2007). Is There A Future For Quantifying Drinking In The Diagnosis, Treatment, And Prevention Of Alcohol Use Disorders? Alcohol and Alcoholism, 42(2), 57-63.
Corbett, S. (2005). A Ministry for the Public’s Health: an imperative for disease prevention in the 21st century? MJA 183(5), 255-257.
Dennis, S. Zwar, N. Griffiths, R. Roland, M. Hasan, I. Davies, G. & Harris, M. (2008). Chronic disease management in primary care: from evidence to policy, MJA, 188 (8), 53-56.
Dowrick, C. (2006). The Chronic Disease Strategy for Australia, MJA, 185(2), 61-62.
Glasziou, P. Irwig, L. & Mant, D. (2005). Monitoring in chronic disease: a rational approach, BMJ, 330 (5), 644-648.
Grant, J. & Chittleborough, C. (2006). The North West Adelaide Health Study: detailed methods and baseline segmentation of a cohort for selected chronic diseases, Epidemiologic Perspectives & Innovations 3(4), 412-434.
Halcomb, E. Davidson, P. Salamonson,Y. & Ollerton, R. (2008). Nurses in Australian general practice: implications for chronic disease management, Journal of Clinical Nursing, 17(5), 6 – 15
Halcomb, E., Davidson, P. Daly, J. Yallop, J. & Tofler, G. (2005). Nursing in Australian general practice: Directions and perspectives, Australian Health Review 29, 156–166.
Harris, M. & Zwar, N. (2007). Care of patients with chronic disease: the challenge for general practice, MJA 187(2), 104-107.
Hawkes, C. (2006). Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases, Globalization and Health 2(4), 17-37.
Jordan, J. & Briggs, A. (2008). Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach, MJA 189 (10), 9-13.
Jordan, J. & Osborne, R. (2006). Chronic disease self-management education programs: challenges ahead, Rapid Online Publication, 15 Nov 2006 retrieved on May 15, 2010, from http://www.mja.com.au/public/issues/186_01_010107/jor10642_fm.pdf
Knight, A. & Senior, T. (2006). The common problem of a rare disease in general practice, MJA, 185(2), 82-83.
Lock, K. Pomerleau, J. Causer, L. Altmann, D. & McKee, M. (2005). The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet, Bulletin of the World Health Organization, 83(2), 16-46.
National Health Priority Action Council (NHPAC) (2006). National Chronic Disease Strategy, Canberra: Australian Government Department of Health and Ageing
Newman, L. Baum, F. & Harris, E. (2006). Federal, State, and Territory government responses to health inequities and the social determinants of health in Australia, Health Promotion Journal of Australia, 17(3), 217-276.
O’Dea, K. (2005). Preventable Chronic Diseases among Indigenous Australians: The Need for a Comprehensive approach, Heart, Lung and Circulation, 14(3), 167-171.
Ostbye, T. & Yarnall, K. (2005). Is There Time for Management of Patients With Chronic Diseases in Primary Care? Annals of Family Medicine, 3 (2), 209-214.
Wakerman, J. & Chalmers, E. Humphreys, J. Clarence, C. Bell, A. Larson, A. Lyle, D. & Pashen, D. (2005). Sustainable chronic disease management in remote Australia, MJA 183(10), 64-68.
Walker, A. (2009). Multiple chronic diseases and quality of life: patterns emerging from a large national sample, Australia, Chronic Illness, 3(3), 202-218
Warren, C. Jones, N. Eriksen, M. & Asma, S. (2008). Patterns of global tobacco use in young people and implications for future chronic disease burden in adults, The Lancet, 367(9512), 749-753.