A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO to theUniversity of Melbourne Medical Alumni 2010

1. AUSTRALIA’S
FUTURE HEALTH
University of Melbourne Medical Alumni 2010
Melbourne – 19 November 2010
Professor Jim Bishop AO
Chief Medical Officer
Australian Government Department of Health and Ageing

2. OECD HEALTH DATA 2010
How Does AUSTRALIA Compare
Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)
8,000
7538
7,000
6,000
5004
5,000 4627
4210
4079 4063
3970
4,000 3793 3737
3696 3677
3540 3470
3359 3353
3129 3060
3008
2902 2870
3,000 2729 2687 2683
2151
2,000 1801 1781 1737
1437
1213
999
852
1,000 767
0
1 Refers to insured po pulatio n rather than resident po pulatio n. 2. Current expenditure. 3. 2006. 4. 2007. So urce: OECD, OECD Health Data, June 201
. 0
Public expenditure on health Private expenditure on health

3. AUSTRALIA’S RANKING AMONG
OECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010

4. SELF- ASSESSED PHYSICAL
& MENTAL HEALTH, 2007
Source: AIHW Australia’s Health 2010

5. MAJOR DISEASE
BURDEN in
AUSTRALIA

6. PROJECTED BURDEN of
MAJOR DISEASE GROUPS, 2010
Source: AIHW Australia’s Health 2010

7. BROAD CAUSE MORTALITY
TRENDS IN AUSTRALIA
Source: AIHW

8. AGED ADJUSTED DEATH RATES
From CVD, 1907 - 2006
Source: AIHW Australia’s Health 2010

9. Mortality-to-incidence ratio
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Ke
ny
a
Ni
Source: IARC 2010.
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ria
Eg
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Vi t
et
Na
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Tu
rk
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In
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Ch
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Ru
So ss
ut ia
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Af
ric
a
G
re
ec
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Br
az
il
Cz Ja
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h n
Re
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bl
ic
Un
ite Ita
d ly
Ki
ng
do
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Ca
na
da
G
er
m
an
Sw y
Ne ed
w en
Ze
al
an
d
US
Au A
st
ratios for selected countries - 2008
ra
lia
Males
Females
ALL CANCER – MORTALITY/INCIDENCE

10. CHANGES IN DEATH RATES IN
MALES - using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

11. CHANGES IN DEATH RATES IN
FEMALES - Using Joinpoint
Analysis
Source: Tracey et al – Cancer Institute NSW

12. 5 year Survival Rates
2004
NSW SEER
Non small cell lung 13% 14%
Colon 65% 67%
Rectum 66% 69%
Breast Cancer 89% 90%
Lymphoma (DL) 53% 53%
Source: Tracey et al – Cancer Institute NSW

13. TOTAL CANCER CASES & DEATHS
per year (1972 to 2036)
Source: Cancer Institute NSW

14. TRENDS IN LEADING CAUSES
OF DISEASE BURDEN 2003-2023
Source: AIHW Australia’s Health 2010

15. HOW CAN HEALTH
BE
IMPROVED ?

16. THE KEYS TO PREVENTION
Tobacco
Blood pressure
Overweight/obesity
Physical inactivity
Blood cholesterol
Alcohol
Fruit/vegetables
Illicit drugs
Air pollution Total of 32%
Unsafe sex
0.0 2.0 4.0 6.0 8.0
% DALYs
Source: Table 4.1 AIHW Australia’s Health 2008

17. AUSTRALIA’S RANKING AMONG
OECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010

18. SMOKING IN AUSTRALIA
SMOKING
NSW VIC QLD WA SA TAS ACT NT AUS
STATUS
Daily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6
Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3
Less than 1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5
Weekly
Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1
Never 56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4
smoked
National Drug Strategy Household Survey 2007Australian Government
Source: 2007 Household Survey,

19. OBESTITY INCREASING
FOR ALL
Source: AIHW: Australia’s Health 2008

20. Budget 2010-11
Anti-smoking campaigns ($27.8m)
COAG agreed
• Increased tobacco excise
• Plain packaging
• Restricting internet advertising of tobacco products
• Further funding for National Binge Drinking Strategy
($50m)
• Survey of Australia’s Health ($54m)
National Preventative Health Agency (Spring Session)

21. NATIONAL PREVENTATIVE
HEALTH AGENCY
• Builds on the National Partnership Agreement on
Preventative Health ($872.1m over 6 years)
• Establishment and operational by early 2011 ($17.6m)
• Specific responsibilities:
- National Social Marketing ($102m over 4 years)
- Preventative Health Research fund ($13.1m
over 4 years)
- Preventative Health Workforce audits and
strategy ($0.5m over 2 years)

22. AUSTRALIAN HEALTH SURVEY
 Four components run by ABS 2011-13
- Health Survey
- ATSI Health Survey
- Nutrition and Physical Activity Survey
- Health measurement Survey
 Around 50,000 participants
 De-identified data available as summary statistics,
tables

23. Commonwealth Government Health and
Hospital expenditure under the NHHN
Source: Commonwealth Budget Papers, DOHA and PMC Analysis

24. HEALTH REFORM
 Increasing expenditure to $15 billion 2010/11
 Additional $7.3 billion over 4 years
 Local Hospital Networks (LHN) 60% Federal
Funds (60% of research and teaching)
 Medicare locals (100% Federal funds)
 GP Superclinics – multi disciplinary teams
(100% Federal Funds)

25. BUDGET 2010-11
e-Health – connecting patients, providers and information
systems
The Government will establish a personally controlled
electronic health record system ($466.7m)
The system will:
• Enable people – and their chosen health provider - to
access online their key health information when and where
it is needed, for their care across the health system.
• Allow people to register online to establish a personally
controlled electronic health record from 2012-13
• Rigorous governance
• Privacy maintained

26. HEALTH REFORM
KEY NEW STRUCTURES
 National Performance Authority
 Independent Hospital Pricing Authority
 Expanded Australian Commission of
Safety and Quality in Health Care
(ACSQHC)

27. CLINICAL GUIDELINES
SUPPORTS FOR CLINICAL
DECISION MAKING
 Evidence Base
 Highest Impact
 Range of best practice tools
 Successful implementation methods
 Monitor and report

28. CLINICAL GUIDELINES
Highest Impact
 Greatest Burden of disease
 Greatest harm from poor practice
 Greatest demonstrated need:
- New Standard of Care
- Proven variation in practice
 Greatest time spent/cost to health system

29. REVIEW OF CLINICAL GUIDELINES
N – 313
N %
CANCER 17 5%
CARDIOVASCULAR 18 6%
RENAL 22 7%
MENTAL ILLNESS 22 7%
NEUROLOGICAL 0 0%
INJURIES 13 14%
CHRONIC RESPIRATORY 0 0%
DIABETES 11 4%
OTHER 173 67%
TOTAL 313 100%
Buchan et al 2006

30. MILESTONES IN
CANCER CONTROL
 Public health measures in smoking reduction,
screening breast, cervix, bowel, health literacy
 Adjuvant treatment of breast, lung and bowel
cancer
 New anti-cancer drugs and symptom control drugs
 Cancer research translated into practice
 Cancer registries, data linkage and analysis

31. BREAST CANCER
MORTALITY
NEJM 2005
Source: New Engl.Journ. Med: 353:17

32. PROJECTED YLLs – Three
scenarios, Australia – 1980 to 2016
Source: Bishop et al – Cancer Institute NSW

33. NON-COMMERCIAL CANCER
RESEARCH EXPENDITURE, 2004
(A$ per CAPITAL)
Source: Eckhouse et al (2007), ABS

34. NHMRC STRAGEGIC PLAN
2010 -12

35. Project Grants - Success Rates
3600
3200
Number of applications
2800
19% Not recommended for
funding (score < 4)
2400 37%
24%
25%
2000
39% 3344
1600 58%
42% Fundable, but
44%
41% 43% not funded
48% 49%
33%
1200 42%
40%
800 37% 36%
36% 34% 34%
400 27% 27% 23%
21%
30% 23% 23% 22% 22% 21% Funded
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of Application

36. NHMRC Supported
Research Workforce
10000
NHMRC Supported Workforce
8000
6000
4000
2000
0
2003 2004 2005 2006 2007 2008 2009 2010
F u ll Tim e P a rt Tim e

37. NHMRC Support for National
Health Priorities Areas

38. Percentage of Expenditure by Broad
Research Area (2000 and 2010)

39. NHMRC Support for
Translational Research
Translational funding mechanisms
 Partnership Projects for Better Health
 Partnership Centres for Better Health
 Centres of Clinical Research Excellence
 Centres of Research Excellence in Population Health
Research, & Health Services Research
 National Health Research Enabling Capabilities Scheme
 Industry Development awards

40. NHMRC Project Grants
Clinical Trials Expenditure
$70 300
Millions
$60
250
$50
200
$40
150
$30
100
$20
50
$10
$0 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Total Expenditure Number of Grants

41. Harmonization of Multi-centred
Ethical Review (HoMER)
 National Statement for Ethical Conduct of Human
Research (2007)
 Process supported by AHMAC conducted by
NHMRC
 Certification of ethical review processes – first round
 Roles, responsibilities, templates published
 NHMRC working with States and Territories

42. CONCLUSIONS
 Australia faces substantial challenges in Chronic diseases
with longer life and life style diseases
 The overall burden of disease is reducing with the
exceptions of cancer, dementia and diabetes with ongoing
mental health needs
 Health reform offers opportunities for prevention, new
models of care and translational research
 New structures, guidelines and indicators need a solid
research and evidence base to improve patient outcomes