A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, at the Clinical Research Excellence Conference - Melbourne 5 Aug 2010

1. IMPACT OF RESEARCH ON
AUSTRALIA’S HEALTH
Clinical Research Excellence Conference
MELBOURNE – 5 August 2010
Professor Jim Bishop AO
Chief Medical Officer
Australian Government Department of Health and Ageing

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

3. Health Expenditure as a share ofGDP, OECD Countries
16.0
11.2
10.7 10.5 10.5 10.4 10.2 9.9 9.9 9.8 9.7 9.7 9.4
9.1 9.1 9.0 9.0 8.7 8.7 8.5 8.5 8.4 8.1
7.8
7.3 7.2 7.1 7.0 6.9
6.5
6.1 6.0 5.9
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1. Current expenditure 2. 2006 3. 2007 Source: OECD Health Data 2010 June 2010
% GDP
Health Expenditure as a share
of GDP, OECD Countries

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

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

6. BROAD CAUSE MORTALITY
TRENDS AUSTRALIA
Source: AIHW

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

8. All Cancer- Mortality/Incidence
ratios for selected countries - 2008
Source: IARC 2010.
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Kenya
Nigeria
EgyptVietNam
Turkey
India
China
Russia
South
Africa
G
reece
Brazil
Japan
Czech
Republic
Italy
United
Kingdom
CanadaG
erm
anySweden
New
Zealand
USAAustralia
Mortality-to-incidenceratio
Males
Females

9. Changes in Deaths rates in
Males using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

10. Changes in Deaths Rates in
Females Using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

11. Cancers with reducing death
rates 1997 to 2006 – all ages
Lung, -18.5
Colon, -19.6 Prostate, -19.7
Leukaemia, -23.7
Stomach, -29.4
Head and Neck, -23.7
Bladder, -18.5
Testicular, -42.2
Breast, -13.8
Cervix, -38.3
NHL, -25.1
Unknown, -24.8
Rectum
, -19.9
Bowel
, -19.7
All cancers, -13.8
, -24.3
-18.5
Kidney
, -24.1
, -15.2
-31.9
, -21.1
-19.0
-19.0
, -18.9
-7.9
-45
-40
-35
-30
-25
-20
-15
-10
-5
0
Male Female
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. CANCER
Milestones in Survival Improvement
Prevention – Tobacco control
Early detection
•Screening
•Interventions
Better treatments – medical research
Clinical trials of better approaches
Evidence based standard practice

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

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

16. Changes in Incidence Rates for all Cancer in
Males using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

17. Changes in Incidence Rates in
Females using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

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

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

20. SMOKING IN AUSTRALIA
SMOKING
STATUS
NSW VIC QLD WA SA TAS ACT NT AUS
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
Weekly
1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5
Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1
Never
smoked
56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4
National Drug Strategy Household Survey 2007Source: 2007 Household Survey, Australian Government

21. AUSTRALIA’S INITIATIVES IN
TOBACCO CONTROL
 Advertising Bans
 Under the counter at retail sites
 Banning smoking in restaurants, pubs and cars
 Graphic warnings on cigarette packets
 Anti-tobacco campaigns
 Increase in tobacco excise
 Plain packaging

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

23. Increased Risk Body Fatness Oesophagus
Pancreas
Colorectal
Breast (PM)
Endometrum
Abnormal Fatness Colorectal
Reduced Risk Physical exercise Colon
Source:World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007
OBESITY and CANCER

24. Source: AIHW Australia’s Health 2010
PROPORTION OF ADULTS WITH
HIGH BLOOD PRESSURE
1980 to 1999-2000

25. Source: AIHW Australia’s Health 2010
CHRONIC PULMONARY DISEASE
MORTALITY 1980 to 2007

26. Source: AIHW Australia’s Health 2010
DEATH RATES FROM
INFECTIOUS DISEASES, 1922-2007

27. Source: AIHW Australia’s Health 2010
PREVALENCE OF CURRENT
ASTHMA 2007-08

28. Source: AIHW Australia’s Health 2010
PREVALENCE OF TREATED END
STAGE KIDNEY DISEASE 2000-2007

29. NSW Population Age Distributions,
Males (1977-2036)
Source: Cancer Institute NSW

30. Total Cancer Cases and Deaths
per year (1972 to 2036)
Source: Cancer Institute NSW

31. 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

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

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

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

35. PRIORITY HEALTH AREAS
SOURCE: NHMRC Research funding 2010 facts book

36. CANCER PUBLICATIONS
Australia Growth* World Australian
Share
2000 1,881 5.6% 88,604 2.0%
2002 2,000 3.5% 97,035 2.1%
2004 2,514 19.0% 110.390 2.3%
2006 3,035 14.1% 125,934 2.4%
_______________________________________________________________________
8 year period 17,917 70.4% 822,768 2.2%
_______________________________________________________________________
* From pervious year
Source: Cancer Institute NSW 2008

37. CLINICAL GUIDELINES
Supports for Clinical Decision Making
 Evidence Base
 Highest Impact
 Range of best practice tools
 Successful implementation methods
 Monitor and report

38. 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

39.  Focus on the major burden of disease and
their risk factors provides a basis for
improving the health of our community.
 Manipulation of the determinants of disease
show some successes but some challenges
 Application of new research to the high priority
disease burden provides new opportunities to
further improve outcomes for our population
CONCLUSIONS