Health in Hunter New England	Table of contents Chapter introduction On this page: Data table Commentary References Print version Downloadable files
	Implications of the Report for health service planning and action

Uses of the Health in Hunter New England

The Health in Hunter New England (HHNE) report includes a wide variety of health status indicators of the Hunter New England population. These assist identification of the health needs of Hunter New England residents, enabling a picture to be developed of the demands placed upon Hunter New England Health's services. The HHNE report will be a useful resource for a wide range of health care workers, health administrators and managers and non-health agencies, as well as providing health information to the general community. Whilst individual users will decide how they wish to utilise the report, the overall aim is to provide health information to assist development and delivery of health services. This is ultimately driven by Hunter New England Health's service planning framework. Procedures are in place to identify priority health needs and develop services to address these needs. The HHNE report provides one source of health information for this planning process, and helps to ensure that delivery of health care is based on the best available evidence.

The Executive Summary of the report gives an overview of the major health status findings, illustrating the major strengths and weakness of Hunter New England population's health. In this section, these findings have been used to identify the major opportunities for health gain and recommendations made regarding health issues that continue to require attention. Subsequent to this, interventions and strategies need to be identified and implemented that address these issues in the most appropriate and effective manner. Such health promoting activities may be delivered either integrally within broader, curative health service frameworks or as distinct population health interventions. Resources for the development, planning and delivery of evidence-based health services that have been proven to improve health outcomes are available to assist this process.

Major areas for investment

The Health in Hunter New England confirms that Hunter New England residents experience a not dissimilar pattern of mortality and disability to that found across Australia. Cardiovascular disease, cancer, mental health and injury make up the majority of the overall disease burden, together with some continuing poor perinatal outcomes such as low birthweight and prematurity. These observations are to be expected, given that the Hunter New England is a microcosm of the greater Australian population. Continued high rates of smoking, excess alcohol intake, sub-optimal diet and low levels of physical activity in many within the population are the major drivers contributing to this overall burden of chronic disease. Hunter New England residents do experience poorer health outcomes for some health issues and there are also areas of special need, often concentrated in low socio-economic groups within the Hunter New England population. These findings confirm the need to implement programs that will address these major determinants of disease and periodically review Hunter New England health outcomes to evaluate our success.

Disability-adjusted life years or DALYs are a summary measure of population health that combine both years of life lost and quality of life lost due to disability. They are not a perfect measure but can assist in the development of priorities. DALY measures for the Hunter New England, prepared by the Australian Institute of Health and Welfare will be included in a later edition of the report. The chart below illustrates the major causes of mortality and disability in Australia, showing that cardiovascular disease, cancer and mental health comprised 54% of total disability- adjusted life years in 1996. We can expect a similar pattern in Hunter New England residents.

In terms of risk factors for ill-health, tobacco stands out as the single greatest contributor to disease in the Australian Burden of Disease Study (Mathers, 1999). Other disease risk factors shown in the chart below, relate to lifestyle and health behaviours such as physical inactivity; diets high in refined carbohydrates, saturated fats and sugar and low intakes of vegetables, complex carbohydrates and fibre; and other drug use such as alcohol (although some health benefits are obtained from moderate alcohol intake). These health behaviours result in high rates of overweight and obesity, hypertension and diabetes (resulting in increased risk of cardiovascular disease), as well as cancer and injury. Mental health benefits have also been shown to flow from regular physical activity and sedentary lifestyles may have negative impacts on mental well-being. Apart from the above behavioural risk factors, broader social determinants of health, such as income inequality and poverty, access to health services, lack of employment and various environmental exposures were not captured in the Australian Burden of Disease study but nonetheless have a significant if unmeasured impact and should not be overlooked.

Proportion of total disease burden attributed to selected risk factors by YLL and YLD Contributions, Australia, 1996

In the Hunter New England, total (all-cause) mortality is higher than the state average for both men and women. This is primarily due to higher rates of cardiovascular disease in both men and women, and higher rates of injury death in Hunter New England males. Variation in death rates also occurs across the Hunter New England, with some residents in some rural areas experiencing greater mortality than those in urban areas. Smoking continues to be the major contributor to ill-health and death with over 600 deaths and over 4,000 hospitalisations of Hunter New England residents each year attributable to tobacco use.

Given the above findings within the Australian and Hunter New England populations, we can summarise the major population health needs in terms of diseases and their risk factors, the health services required to prevent and treat them and other factors that impact on the population's health status as follows:

1. Priority health issues and major contributors to disease burden
· Cardiovascular disease
· Cancer
· Injury - falls
· Mental Health
· Pregnancy and the new born

2. Risk factors and health behaviours impacting on the above health issues
· Smoking cessation
· Alcohol (encouraging moderation)
· Physical activity
· Diet
· Sun protection
· Safe sex

3. Access to and use of health services to promote health
· GP access
· Immunisation
· Care in pregnancy and early childhood
· Blood pressure and blood sugar monitoring
· Breast, bowel, prostate and cervical cancer screening

4. Other activities impacting on population health status
· Multisectoral interventions e.g. transport, education, employment policy.
· Environmental protection
· Community design - access to safe and health promoting environments and facilities
· Advocacy for mental health

Of the above issues, prevention of tobacco use would perhaps have the single biggest impact on reducing the overall disease burden.

Changing behaviours such as smoking cessation, improving diet and increasing physical inactivity is difficult with strong drivers working against health improvement. A multi-strategic approach has been shown to be most effective in encouraging behaviour change. The Ottawa Charter for Health Promotion (1986) identifies five key strategies essential for the success of any health improvement initiative:
· Building healthy public policy
· Developing personal skills
· Creating supportive environments
· Strengthening community action
· Reorienting health services.
These need to occur within an environment that enables participation, provides mediation between target audiences and other stakeholders, and fosters public health advocacy.

The Ottawa Charter for Health Promotion - developed at the 1st International Health Promotion Conference, 1986

Furthermore, it has been shown that:
· a settings based approach to health promotion, such as in schools or workplaces, provides opportunities for implementation of comprehensive strategies
· target group participation is essential for success, people have to be at the centre of any health promotion activity
· health learning fosters participation, empowering people to take part in health promotion activities.

A variety of such strategies need to be identified and utilised when addressing the above priority health issues.

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