Public Health Research & Practice最新文献

Primary health care provides a comprehensive range of preventive care for the Australian population. Prevention is now a core activity of general practice, and engagement of a range of non-medical providers and digital tools has enhanced its capacity. There are promising strategies to further engage primary health care from both the government and the profession. However, funding, workload and systemic barriers have frustrated adoption and implementation over the past decade. These need to be addressed for further progress to be achieved.

Objectives The value of engaging health service users and their families (consumers) in research is increasingly being recognised in planning and evaluating health services to meet diverse needs. This project aimed to co-design a strategic consumer involvement framework and implementation plan for a public Australian hospital and health service. Methods A co-design approach was used to adopt a framework and develop an implementation plan across five stages: (1) an initial consultation with key stakeholders, (2) a survey of health service staff about involving consumers in research at the health service, (3) three group sessions using Nominal Group Technique with health service consumers and staff that explored barriers and solutions to involving consumers, (4) data synthesis, and (5) a workshop of key stakeholders to develop and refine the implementation plan. Three consumer partners contributed to protocol development, research design, data analysis, and manuscript writing. Results Survey and group session data highlighted a need for governance, infrastructure, capacity building, and leadership and culture within the organisation to support the involvement of consumers in research at the health service. These aligned with the South Australian Health and Medical Research Institute (SAHMRI) Framework domains. Implementation strategies were adjusted on the basis of insights from the local context to facilitate adoption within the health service. Conclusions By better supporting consumers and researchers to work together in health service research, organisations can enhance the relevance, quality, and impact of their research efforts. This project provides a valuable blueprint for developing a local, contextualised approach to promoting effective consumer-researcher relationships in Australian public health services.

As First Nations public health professionals, we critically examine the National Preventive Health Strategy 2021-2030 (NPHS) and its shortcomings in addressing the structural determinants of health inequities affecting Aboriginal and Torres Strait Islander peoples (hereafter respectfully, First Nations peoples). Although the NPHS aspires to a systems-based and equitable approach, we argue that it fails to meaningfully engage with the enduring impacts of colonisation, systemic racism, and intergenerational trauma. By focusing predominantly on individual behavioural risk factors, the strategy neglects the broader sociopolitical and cultural contexts that continue to drive poorer health outcomes in our communities. True progress in preventive health requires a fundamental shift - one that centres First Nations self-determination; embeds our ways of knowing, being, and healing; and invests in community-led solutions. We call for the re-Indigenisation of the health system, not as a gesture of inclusion, but as an assertion of our sovereignty, knowledge, and leadership in shaping our own health futures. We conclude with a series of actionable recommendations for policymakers grounded in structural reform and driven by the urgent need for systems transformation led by, and accountable to, First Nations peoples.

Australia has the world's highest skin cancer rates. The keratinocyte cancers (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) are the most common and costly, yet unlike melanoma, they are not nationally registered, and the lack of registry data hinders control efforts. The Tasmanian cancer registry collects data on BCC and SCC incidence, revealing concerning trends and high-risk groups. International examples show how registry data inform policy and prevention. Comprehensive registration would enable similar benefits for Australia. We propose a phased approach, starting with high-risk lesions, alongside standardised pathology reporting and the potential use of artificial intelligence, and recommend an evaluation of the cost of this integrated strategy.

Objectives Australians receive healthcare services subsidised by the Medicare national health insurance scheme, including through the Chronic Disease Management Initiative supporting primary care management of chronic conditions. The use of such subsidised services by people with chronic non-cancer pain (CNCP) is unknown. This study examined Medicare-subsidised service use, including Chronic Disease Management items, allied health service use, and specialist attendances, among Australians prescribed opioids for CNCP. Methods Medicare Benefits Schedule claims data for the period 1 January 2012-31 December 2018 were linked to a longitudinal cohort of 1206 adults prescribed opioids for CNCP. Service use was compared with the general population to examine whether individuals with CNCP make greater use of such services and factors associated with service use (including demographics, socioeconomic status, pain scores and opioid treatment characteristics, and physical and mental health scores) were examined. Results Use of primary, allied health, and specialist services among adults with CNCP was high when compared with the general population. Over 3years, 928 participants (76.9%) received Chronic Disease Management items, mostly care plans (n =825, 68.4%). Private health insurance and living in a major city were associated with increased odds and rates of any specialist and pain medicine specialist attendances (private insurance and specialist attendances: adjusted odds ratio 4.29, 99.5% confidence interval 2.32-7.91; major city and pain specialist attendances: adjusted incident rate ratio 1.70, 99.5% confidence interval 1.12-2.56). Conclusions Australians prescribed opioids for CNCP have a high use of subsidised primary, allied health, and specialist services. However, sociodemographic disparities were apparent, and there remains a need to improve specialist service accessibility for Australians who are uninsured and living in regional/remote areas. There is also a need to evaluate whether care delivered through current Medicare initiatives is meeting the needs of Australians with CNCP.

Given that the focus of this journal is the connection between public health research, policy and practice, our reflections at this 10-year point in the journal's history are upon lessons to be drawn from recent efforts to achieve effective, evidence-based prevention in Australia. The accompanying commentaries on progress in critical areas of public health action (refer to Part 2 - centring First Nations sovereignty; Part 3 - engaging the primary care sector; Part 4 - extending gains in tobacco control) highlight that there have been numerous commitments to prevention policies and programs alongside continued difficulties in achieving the required quality and continuity of implementation. In order to realise the aspirations that are held regarding these and other prevention priorities, it will be vital to strengthen the essential enablers of successful implementation, namely governance, organisation and investment. Fortunately, Australia is well placed in this regard, with the National Preventive Health Strategy (NPHS) and Australian Centre for Disease Control (ACDC) providing opportunities for leadership and coordination across sectors and agencies. Yet neither of these potential pillars for prevention policy and practice at a national level are being used in ways that have been hoped for. The blueprint for implementation promised in the NPHS has not been developed, while the ACDC has had its scope of responsibility constrained to communicable disease control, despite calls from leading health organisations for this to include Australia's large burden of chronic disease and injury. Although the progress being won in a number of areas of public health should be acknowledged, the continuation of sporadic and disjointed policy implementation will mean that the nation fails to achieve the lasting health, social and economic benefits that may be gained from sustained, evidence-based prevention. It is clear that the need for evidence gathering, critical analysis, advocacy and learning through practice in diverse arenas of prevention activity is as apparent now as when Public Health Research & Practice commenced publication 10years ago.

Ten years ago, Australia's tobacco plain packaging laws significantly shifted the tobacco control landscape. The smoking rate for people aged ≥18 years has continued to decline from 16.4% in 2013 to 11.1% in 2022-23. In 2023, the tobacco control policy inertia that had occurred since the introduction of plain packaging was finally addressed with the passage of a comprehensive package of reforms. These measures focus on tighter regulation of tobacco products. However, in recent years the tobacco control discourse in Australia has been hijacked by the surge in vape use. In June 2024, the Australian Government passed legislation that closed significant loopholes in vaping legislation. The now strict controls on where vapes can be sold highlight the lack of control over the supply of cigarettes. An expert group to the World Health Organization Framework Convention on Tobacco Control is preparing a report for the next Conference of the Parties that will consider a broad range of measures including how and to whom tobacco products can be sold, what types of tobacco products can be sold, and what structural changes could be made to the tobacco industry. This presents an opportunity for Australia to once again implement transformative, world-first policies. As the tobacco industry continues to develop new products that exploit vagaries in public health policy, so too must tobacco control continue to evolve.

Objective To quantitatively describe the healthcare needs of a cohort of kindergarten children in a low-socioeconomic rural community to inform school entry health check programs and school-based healthcare services. Study type Medical record review. Methods Data were extracted from the community health electronic medical records of children who started primary school in 2019 at one of the five study schools and who received at least one occasion of service from a nurse-led School-Based Primary Health Care Service for a health or developmental concern. Data extracted included demographics, presenting concerns, challenges to accessing care, service activities, and referrals. Results Of the 140 children enrolled in kindergarten in the sample schools, 84 (60%) had an occasion of service for a health or developmental concern. Of these 84 children, speech and language concerns (43%) were most frequently observed, followed by metabolic/nutrition (26%), behaviour (16%), and vision (16%) concerns. Evidence of challenges to accessing care was identified in 40% of cases. Sixty percent of identified children were referred to another provider. Conclusion The high prevalence of health and developmental concerns and challenges to accessing care found in this study supports the need for school entry health check models that provide ongoing support to families.

Objectives Although we have scientific and policy discussions on the need for oral health care, rarely have populations been asked about their expectations regarding this important matter. Therefore, the public voice has been absent from these discussions. This study aims to quantify public support among working-age Australian adults regarding the essentiality of oral health care and assess whether oral health care affordability differs by sociodemographic characteristics. Study type Descriptive analysis of nationally representative data from Australia. Methods Using cross-sectional survey weights, we analysed data from wave 18 (2018) of the Household, Income and Labour Dynamics in Australia study. The analysis included 11,028 working-age Australians aged 20-54years. Results Almost all (96.4%) working-age Australian adults considered oral health care as essential; however, 6.5% do not get treatment due to lack of affordability. Higher proportions of specific disadvantaged groups, such as the unemployed, those with lower educational attainment, lower income, and participants with disability, reported not availing themselves of oral health care due to lack of affordability compared to less disadvantaged groups. Conclusion Overwhelmingly, working-age Australian adults considered oral health care to be essential. The vast majority reported getting oral health care when needed, indicating no major affordability concerns. However, the lack of affordable dental care was a barrier, particularly for the disadvantaged groups, preventing them from accessing oral health services. This highlights the need to provide equitable oral health care, ideally by implementing the principles of universal oral health coverage.

Objective After-action reviews (AARs) are used to systematically examine the functions, capabilities and barriers impacting effective pandemic responses. This paper describes the methods used for and the lessons learnt from undertaking the first formal state-wide AAR of the public health response to COVID-19 in New South Wales (NSW), Australia. Type of program A state-wide AAR was applied to examine the public health response to COVID-19 conducted by Health from January 2020 until May 2022. Methods The AAR was conducted between March and November 2022. The World Health Organization ARR approach was used and involved six stages including: (1) AAR design, (2) AAR planning, (3) team debriefs, (4) workshop preparation, (5) consensus workshop and (6) AAR report review and finalisation. Results The AAR process involved over 100 people across the NSW network through surveys, team debriefs and workshops. The stepped process used to complete the review, with standardised templates, was found to be acceptable and feasible. The preparatory stage elicited important insights, provided an opportunity for structured reflection and helped identify themes for discussion in the workshop. Feedback methods included two participant satisfaction surveys and one post-implementation review session, which identified strengths in the process and areas that could be modified for future iterations of other public health reviews in NSW. Lessons learnt The AAR process successfully engaged multi-disciplinary pandemic response staff in a systematic reflection process. The process was perceived by most participants as a highly valuable opportunity to reflect and it led to important findings to improve public health emergency responses. It is important that the scope of the AAR is well understood by participants and that the psychological needs of the workforce are considered in the AAR process. There is merit in applying such reviews as standard practice in future public health emergencies.