1. Prevention of diabetes and CVD: it can be done Dr Christine Connors Director, Preventable Chronic Disease Program Department Health & Families

2. Overview Burden of disease Prevention works Current policy environment What’s happening in CA

3. NT Aboriginal community disease prevalence 2006

4. Diabetes by region and age

5. Trends in avoidable hospitalisation NT Indigenous 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 1998/991999/002000/012001/022002/032003/042004/052005/06 Hospital separations per 100 000 NT non-Indigenous 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 1998/991999/002000/012001/022002/032003/042004/052005/06 Hospital separations per 100 000 Vaccine Acute Chronic Li SQ et al. (2009) Avoidable Hospitalisation in Aboriginal and non-Aboriginal people in the Northern Territory MJA

7. Vic Tobacco Act Pack health labelling regulations introduced NRT available for sale in Australia MCG Smokefree C/W implement tax by stick Smokefree dining Gaming venue bans 1 st QUIT Campaigns 4 rotating pack health warnings Smoking banned on domestic airlines Tobacco Ads banned Print Media  in excise duty Federal bans on tobacco sponsorship of sports & arts Age for sale of cigarettes  16 to 18 Health warnings on packs Remaining tobacco sponsorship removed (exc. Significant international events) POS advertising bans No Butts Campaign Milestones in smoking prevalence in Australia Male 18 + NationalTobaccoCampaign 198 0 1983198 6 198 9 199 2 199 5 199 8 200 1 200 4 10 5 20 15 30 25 35 40 % Prevalence in current smokers survey 1980—2007 Source: Centre for Behavioural Research in Cancer, Cancer Council of Victoria Copyright © 2009 The Cancer Council. 200 7 Phase out smoking in federal workplaces Female 18+ No butts campaign

9. Infant mortality < 1 year, 1986 to 2004 Fearnley, E. & Li. SQ. (2006) Health Gains Planning Fact Sheet No. 4: Mortality in the NT, 1981-2004. NT DHCS, Darwin

10. Trends in % children underweight

11. NT % Children< 5years underweight

13. Social determinants –NTG Closing the gap –COAG Close the gap –NT intervention PHC expansion and reform (EHSDI) Education Housing Employment and business opportunities –Private sector support jobs

14. 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.

15. “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

16. 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

17. NT Department Health & Families Corporate Plan 2009-2012 Six Priority Action Areas 1.Promoting and Protecting Good Health and Wellbeing and Preventing Injury –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

18. 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

19. 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

20. The Healthiest Country by 2020

21. 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

22. Local government, community, NGO’s 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 Food and Beverage Industry Partner in Healthy Food Compact to drive change in food supply Work with AG to implement national food labelling Individuals and Families 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 Australian Government 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 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 Advertising industry Increase marketing of healthy food and beverages Work with government to promote physical activity and healthy eating through social marketing Schools Incorporate Health and Physical education into National Curriculum Support active transport Provide community access to school recreation facilities after hours Workplaces Implement policies that promote healthy eating and physical activity Support active transport Offer employees access to workplace programs OBESITY: Shared responsibility

23. 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

24. Prevention activities in CA

25. 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

26. 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

27. Diabetes in pregnancy Screening for diabetes in pregnancy 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)

28. 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

29. 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

30. Community programs Women’s centres –Cookbooks, cooking for elderly, frail & disabled Wok cooking Store tours Cooking demonstrations “Eat Better Move More” program

31. 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

32. 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

33. Smoking rates in pregnancy Aboriginal women 2005

34. 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: card games, social gatherings NT Tobacco Action Plan New legislation 2 January 2010

35. Prevention: it can be done Systematic organised approach Resourced Evidence based Community development Evaluation and research