Tackling our health crisis

The Australian Partnership Prevention Centre is working on solutions to halt the increasing trend of chronic health conditions.

Health Agenda magazine
October 2016

Australia has one of the best health systems in the world but it could also be described as a ‘sickness system’: of general practice, hospitals, specialists and acute care facilities geared towards treating people who have health issues.

What if there could be a similar network and system around prevention? Before people need care, what if there could be a workforce, structures, resources, programs and environmental frameworks in place to provide a preventive rather than a treatment model?

That’s the goal of The Australian Prevention Partnership Centre (TAPPC), a nationwide collaboration involving research, policy and practice with the aim of developing ‘an effective, efficient and equitable system for the prevention of lifestyle-related chronic disease’.

Prevention rather than cure

A review of the burden of chronic disease in Australia makes it clear why our country needs such a system. Lifestyle-related chronic disease is our nation’s biggest health problem, with factors such as smoking, harmful alcohol use, poor nutrition and physical inactivity causing massive increases in diseases such as cardiovascular and respiratory disease, cancer and diabetes.

These chronic diseases are the leading cause of death in Australia and affect the lives of millions of people every day. Half of all Aussies are living with a chronic condition, with 40 per cent of those aged from 45 to 64 having two or more, and it’s estimated 75 per cent of women and 80 per cent of men over the age of 20 will be overweight or obese by 2025.

“There’s a lot of evidence to show preventive health initiatives are both effective and cost effective,” says Associate Professor Sonia Wutzke, Deputy Director of the TAPPC. “So we need that focus on prevention in the interest of controlling the onset of chronic diseases and the associated significant personal, social and economic costs.”

The bigger picture

To be effective, getting to the complexities surrounding the root causes of these problems is a fundamental issue. “There’s a belief that it’s very individually driven – that if a person doesn’t eat well or exercise enough, it’s an individual choice,” Professor Wutzke says.

“While individual choice is a factor, we want to create a situation where the easiest choice for that individual is also the best choice for their long-term health. The complexity in that is there’s not just one thing that affects chronic disease. It’s the whole environment in which we live, our education, access to things like health services, fresh food, bicycle lanes and safe green spaces to exercise, all the different factors that interconnect to create a situation that will enable or impede a person’s choices.”

To bring all of these different aspects together the TAPPC takes a cause-and-effect overview approach in order to understand and manage complex problems to see all their connected and interrelated components. “If you understand that complexity, you might be better able to identify more places to intervene, where perhaps there could be a knock-on effect – a small change in one part might have a significant impact because of that interdependency with other parts,” she explains.

What does the future look like?

The centre has about 150 investigators working on 35 different projects, all of which have a different focus. One example is the Creating Liveable and Healthy Communities project, which looks at factors such as access to safe green space, having active transport options and the impacts of those structures on enabling people to exercise.

The team, led by Professor Billie Giles-Corti from the University of Melbourne, is developing ways of measuring the key features that make our cities liveable and how they impact public health. In earlier work, the team identified 11 domains of liveability likely to contribute to health and wellbeing: crime and safety, education, employment and income, health and social services, housing, leisure and culture, local food and other goods, natural environment, public spaces, transport, and social cohesion and local democracy.

They’re now using geographical information systems, to analyse how much each of these domains affects liveability.

The aim is to create a national, built-environment database from which liveability indicators could be applied to studies of population health as a tool for researchers, policy makers and practitioners and researchers.

“As researchers, we can’t change the built environment,” says Professor Giles-Corti. “We must work with the policy makers responsible for creating the built environment and provide them with evidence about optimal city design to create good health.”