Sunday, September 16, 2012

Population Health Congress – Conference Report

The Population Health Congress took place on 9 – 12 September 2012 in Adelaide.
The SA Health Minister, John Hill, spoke on the first day.  I always find these presentations interesting as we get a sense of the increasing demand and the big decisions governments have to take in allocating resources.
A few points about the South Australian health system:
  • The SA Government spends 28% of the state budget on health with growth funding at 9%. If this continued without the agreements with the Commonwealth then the entire state budget would be spent on health by 2032.
  • Demand for services is increasing and one of drivers of the demand are varied, including the ageing of the population and higher incidence of complex and chronic  conditions.
  • Smoking rates have lowered from 37% in  1974 to 19% in 2007
  • Obesity: 25% of children aged 5-17 years are currently overweight or obese.
  • Cancer, heart disease, obesity, infertility, sleep apnoea can be attributed in part to lifestyle decisions.
As we age we are more likely to require hospitalisation in any given year.  Over the age of 65, we are twice as likely to need a hospital bed in the next year, and when we are over 85, we are five times more likely to need a hospital bed.

Core to changes currently underway in the health system is the focus on public health and improving primary health care. Lifestyle and behaviour change are increasingly important factors to improving the health of the community.  Minister said that the key to this is for people to understand that we have responsibilities to improve our own health.  Now at times the use of ‘responsibilities’ is also involved with shaming and blaming people for our ‘lifestyle’ decisions without consideration of the social determinants of health. 
Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.
This is where the SA Government has got it right.  The Minister acknowledged that good public health requires a comprehensive approach and if we leave health care to the health sector we will not achieve the goal of a healthy community. South Australia leads the way in the public health field with the adoption of the Health in All Polices (HiAP) and was described by one speaker as being the perfect union of understanding and action
Minister Hill outlined one of the programs that the SA Government has funded to address obesity rates in particular communities. OPAL (Obesity Prevention And Lifestyle) started in 2009.  It is based on a French program that was conducted in two towns (EPODE).  The results were that a whole-of-community approach could have a major impact on turning around childhood obesity.
The plenary sessions were excellent. A few of the highlights were:
Global health, climate and economics: What is the impact of change? - Richard Horton, Editor of the Lancet
Public health engagement in trade policy: Lessons from the Trans Pacific Partnership Agreement  - Professor David Legge, Scholar Emeritus, School of Public Health and Human Biosciences, La Trobe University and Deb Gleeson, Lecturer, School of Public Health and Human Biosciences, La Trobe University
Aboriginal health in a changing world - Jonathan Carapetis, Director, Telethon Institute for Child Health Research
The Spirit Level: Why equality is better for everyone - Professor Richard Wilkinson, Social Epidemiology, University of Nottingham - Via video link
Indigenous health – modern myths and legends - Professor Papaarangi Reid, Head of Department of Maori Health, Faculty of Medical and Health Sciences, University of Auckland
The questions from the floor are sometimes the best bit of conferences.
One of the questions from the floor was asking how to change the culture of the public service so that bureaucrats are thinking about people, rather than focussing on water, transport, electricity and other assets and investments. There was a sense that shifting the thinking is a big step. There was acknowledgement that government departments involved in human services are already thinking like this. Concern was expressed about the environmental and economic agencies who seem not to be thinking about people but focussing on assets. There was agreement that by couching planning issues in terms of equity and access that we can orient that work of the economic, planning and environmental areas to understand how the work they do informs the overall wellbeing of the community.
Overall I felt a little flat after the Congress. It is not just the enormity of the change that needs to take place but also a sense of an opportunity lost. Certainly there is great benefit in bringing together the epidemiologists, health promotion and public health groups and there was a fair degree of celebration on what has been achieved and optimism about how we can improve the health of our community in the face of significant challenges.  It is also good to see so many young professionals with the opportunity to conduct research and present at the conference. 
Consumers seemed to be invisible in many of the papers. While I saw some excellent research it was about us and rarely did we seem to be identifying the research projects and scoping the objectives.  I would like to see our public health colleagues partner with consumers at the system level rather than focus our involvement at the individual patient or local community level.
There was great potential to harness the expertise and willingness in the room to identify some priority areas that we could work on.  For example, I think there is great scope to elevate the profile of the public health agenda in the work of Medicare Locals.  From what I learnt, Medicare Locals are well funded and can be using that to build relationship with the community and to progress the pubic heath agenda. At the national level there are partnerships developing between the players.  I would like to see statements that we can use at the state and territory level to move this on. A renewal of the Adelaide declaration would have been very powerful.
Still, a very useful conference and it has given me lots of things to think about.

Darlene Cox
Executive Director

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