Disease prevention: How are we fairing?

1. Disease prevention:How are we fairing? 9 November 2007 Roscoe Taylor Director of Public Health Director, Population Health

3. Action across the continuum of prevention & care: example of type 2 diabetes

5. Preventable Environmental Health Hazards over Two Centuries(McMichael, 2006) Energy use and greenhouse gas emissions: climate change health impacts Burden of disease (indicative only, not to scale) Urban air pollution Infectious diseases Road trauma Obesity 1800 2000 1900 Sanitation (infra-structure) Smoke control: zoning, fines Food safety: laws, regulations Clean air laws Seat belts, drink-driving, road design Industrialisation Modernisation Globalisation

6. Death and its causes

7. Top 10 Causes of Death* in Tasmania, 2004 * as a % of total age standardised deaths Source: ABS, Causes of Death, 2004, cat. no. 3303.0, Table 1.9

8. Avoidable MortalityRatefor Tasmanians Aged < 75 Years

10. Social gradient & health Michael Marmot argues convincingly that: Low control over life & Social disengagement …are the most powerful explanatory factors

13. AIHW 2007 These 14 risk factors explain 32.2% of Burden of Disease

15. The SNAPPsapproach we use to address common risk factors for chronic conditions • Smoking • Nutrition • Alcohol • Physical Activity • Psychosocial

16. The challenge:Prevention strategies that WORK at the Psychosocial level Without taking the “PS” and socio- economic factors into account, strategies that focus on individual behavioural change probably won’t work, and even environmental measures will be less effective

17. What are weto do about SNAPPs, and what still needs to happen? Trying

18. “S” is for….. Smoking

19. Proportion of Tasmanians Currently Smoking Source: National Health Surveys 1995, 2001, 2004/5; Tasmania Together (Revised) 2006

20. Australia: 1950-2000Smoking-attributed deaths: % of all deaths at ages 35-69

21. Smoking in Pregnancy • Tasmania (2005): 27.6% • NSW: 14.8% • Tasmanian Public patients: 35.7% • Private patients: 8.3% • RR for Low Birth Weight Baby = 2.55

23. Proportion of Tasmanian Secondary School Students Currently Smoking* 1984-2005 *smoked within last 7 days; Source: Cancer Council, ASSAD Surveys

24. Try this on your next date!

26. Do health providers always ask their clients how many cigs they smoke, and advise them to quit?

27. “N” is for nutrition

28. Tasmanians Aged 18 Years and Over who are Overweight or Obese, 1989/90-2004/5 Source: ABS, NHS 1989/90 – 2004/5; Tasmania Together (Revised) 2006

29. Number of obese older people 1980 - 2000(AIHW, 2003)

30. Prevalence of chronic conditions by weight status in men (AIHW, 2003)

31. “Obese people should perform hard work, eat only once a day, take no baths, and walk naked as much as possible.”Hippocrates quoted in Diabetes Care (2003) 26;11:3172-78)

32. In the modern era we have better solutions … …..Sanitised tape worms!

33. We have to create supportive environments Cool Canteen Accreditation program Aims to help school canteens increase the availability of and promote safe and healthy food and drinks (*)

34. Creating Supportive Environments Breastfeeding promotion Aims to increase community acceptance of and support for breastfeeding

35. Creating Supportive Environments Nutrition Promotion Funding for the Eat Well Tasmania Campaign to promote enjoyable healthy eating

36. Strengthening Community Action Family Food Patch (peer educators) advocate for healthy eating at a local level.

37. Prevalence and consequence of Malnutrition in older people • Malnutrition is common among elderly • Malnutrition may lead to : • Higher risks of infection • Slow wound healing • Longer hospital stays • Poorer longer term health outcomes • Poor quality of life

38. Mature Tastes Healthy Settings Capacity Building Quality Improvements Community Development

39. The Action Steps of Mature Tastes Step 1: Use planning tool to identify, prioritise and plan to address key nutrition issues. Step 2: HACC services action priorities. Menu changes Nutrition Policy Staff training Health Promotion Nutrition Screening Step 3: Evaluation and further planning.

40. Some questions • How would your service identify whether older patients were malnourished or at risk of malnutrition? • Do you know whether malnutrition in your service’s older patients will be prevented by the care they receive when you discharge them?

41. Standard serves 1955 & 2001(courtesy of Dept Human Nutrition, University of Otago) 1955 Fries 72g Coke 200ml 2001 Fries 205g Coke 950ml

43. And now we come to “A”, for Alcohol….

44. We’ve come a long way…

45. Alcohol Related Harms • Alcohol responsible for 4% of the global burden of disease (WHO) • Alcohol causally related to 60 different medical conditions (Ridolfo & Stephenson) • Alcohol causally related to a range of injuries, other social harms as well as hospital admissions • As population consumption increases, harm also increases correspondingly

46. Tasmanian Population Response • Under development – watch this space • Establish a monitoring system allowing analysis of alcohol related trends • Explore legislative change in support of safer drinking environments • Focus on availability and marketing issues as a harm reduction measure

47. Tasmanian Targeted Response • Focus on adult drinking as well as that of youth • Strategies to build resilience in early childhood • Strategies to address Foetal Alcohol Syndrome Disorder • Explore introduction of workplace strategies

48. How does socio-economic status affect alcohol consumption?

49. “P” is for Physical Activity… ….the hardest of all the risk factors, to get moving?

50. Proportion of Population who do not Exercise Sufficiently* to Avoid Chronic Disease *includes no exercise, sedentary, and low level exercise Source: ABS, NHS 1995, 2001, 2004/5; Tasmania Together, Revised, 2006