Health promotion and health protection
Australian Institute of Health and Welfare (2022) Health promotion and health protection, AIHW, Australian Government, accessed 06 December 2023.
Australian Institute of Health and Welfare. (2022). Health promotion and health protection. Retrieved from https://pp.aihw.gov.au/reports/australias-health/health-promotion
Health promotion and health protection. Australian Institute of Health and Welfare, 07 July 2022, https://pp.aihw.gov.au/reports/australias-health/health-promotion
Australian Institute of Health and Welfare. Health promotion and health protection [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2023 Dec. 6]. Available from: https://pp.aihw.gov.au/reports/australias-health/health-promotion
Australian Institute of Health and Welfare (AIHW) 2022, Health promotion and health protection, viewed 6 December 2023, https://pp.aihw.gov.au/reports/australias-health/health-promotion
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A fundamental aim of any health system is to prevent disease and reduce ill health so that people remain as healthy as possible for as long as possible. The conditions in which we live, work and play influence our health behaviour and lifestyle choices.
Health promotion is a broad term. It focuses on preventive health – preventing the root causes of ill health – rather than on treatment and cure. Health promotion encompasses a ‘combination of educational, organisational, economic and political actions’ (Howat et al. 2003) to enable individuals and communities to increase control over and improve their health. This occurs with community participation through attitudinal, behavioural, social and environmental changes (Howat et al. 2003).
On this page, health protection is referred to as a subset of health promotion. Health protection is concerned with protecting individuals, groups and populations, using expert advice and collaboration to mitigate against emerging health threats related to infectious diseases, the environment as well as natural and ‘human-made disasters’ (Department of Health 2022a Ghebrehewet et al. 2016). Health protection examples include banning smoking in public places and seatbelt legislation (McIntyre 2021).
Preventive health activities such as breast screening are also referred to. These types of activities may prioritise groups based on risk factors such as age or include all people in the population, such as vaccinations.
There are a number of different groups across society who experience social inequalities and disadvantage resulting in health inequity – the unfair and avoidable differences in health status (AIHW 2022). An important part of health promotion and health protection is to assess the needs of these groups and tailor programs, activities and policies accordingly to address these differences in health risk factors.
The National Preventive Health Strategy refers to these groups of people, as ‘priority populations’ which include, but are not limited to:
- Aboriginal and Torres Strait Islander people (see Indigenous health and wellbeing; Profile of Indigenous Australians; and Determinants of health for Indigenous Australians)
- Culturally and Linguistically Diverse (CALD) people (see Reporting on the health of CALD populations in Australia)
- Lesbian, gay, bisexual, queer, intersex and/or other gender diverse people
- People with mental health conditions (see Mental health)
- People in low socioeconomic groups (see Health across socioeconomic groups)
- People with disability (see Health of people with disability)
- People living in rural, regional and remote areas (see Rural and remote health
All levels of government have an important role in overseeing health promotion and health protection, which can vary depending on the strategy or situation. For example, in health promotion, the Australian Government can impose fiscal measures such as taxes on items like cigarettes and alcohol to deter people from buying them – this is usually part of a broader strategy (see the tobacco control section). In late 2021, the Australian Government Department of Health launched the National Preventive Health Strategy 2021–2030, which provides a long-term approach to prevention in Australia.
Local government has responsibility for planning, building and designing new suburbs in their local area, which can harness urban design principles to promote opportunities for physical and mental wellbeing, such as through the provision of bike paths, or publicly available green space (see Built environment and health).
State governments have their own Public Health Acts, which aim to protect, promote and improve the health and wellbeing of the public in that jurisdiction, which are usually enforced by local government. State governments are also responsible for delivering preventive health services such as breast cancer screening, school-based immunisation programs and implementing settings-based measures for example, smoke-free laws.
Role of government in COVID-19
Under Australia’s federal system, cooperative arrangements between governments are necessary to deal with emergencies (Department of Parliamentary Services 2020). In the event of an immediate threat to the health or welfare of Australians, such as the COVID-19 pandemic, the Australian Government has a role to provide national leadership, policy advice, analysis, coordination and communication, and will work in partnership with the state and territory governments to protect the health of Australians (Department of Health 2022b). At a Commonwealth level, the Biosecurity Act 2015 gives extensive powers to prevent and control the entry and spread of serious communicable disease in Australia. This was used as a mechanism to determine requirements for travel into and out of the country through international border closures (Twomey 2020).
In March 2020, the National Cabinet was established to respond to the evolving health crisis from the COVID-19 pandemic. It is chaired by the Prime Minister and comprises all state and territory premiers and chief ministers.
Multi-jurisdictional committees such as the Australian Health Protection Principal Committee (AHPPC) and associated committees such as the Communicable Disease Network Australia, the Public Health Laboratory Network and the Australian Technical Advisory Group on Immunisation have played a vital role in providing advice and expertise during the COVID-19 pandemic and supporting National Cabinet. These committees work with governments and a range of experts from across health disciplines and clinical institutions to adopt national health protection policies, guidelines and plans.
In addition to their Public Health Acts, the state and territories also use emergency legislation to respond to emergencies such as a pandemic (Twomey 2020).
Australia has a long history of health promotion. Memorable campaigns such as ‘Slip Slop Slap’, ‘Life. Be in It’ and ‘Every cigarette is doing you damage’ are examples of population-targeted health promotion (AIHW 2018). The compulsory wearing of seatbelts in motor vehicles, random breath testing and 50 km/h residential street limits have been part of a more comprehensive road safety strategy, which uses both health promotion and health protection measures. Road deaths have reduced from 30 per 100,000 population in 1970 to 4.3 per 100,000 in 2020 (BITRE 2010, 2020).
Australia’s response to Human Immunodeficiency Virus (HIV) is also an example of effective health promotion (Smith et al. 2016). Since the 1980s, health promotion and prevention principles have been integral to 8 National HIV Strategies (Department of Health 2018a), such as partnerships between government and non-government organisations, clinicians, researchers and political parties and ‘active participation from affected communities’ (Smith et al. 2016). This approach has helped Australia to achieve a relatively low HIV prevalence by international standards (Brown et al. 2014). In 2020, the estimated prevalence of HIV in Australia was 0.14% (Kirby Institute 2021).
Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury. In 2018, around 38 per cent of disease burden was preventable and due to modifiable risk factors, such as tobacco use, overweight and obesity, poor diet, high blood pressure or alcohol use (AIHW 2021). While tobacco use continues to contribute the greatest amount of fatal disease burden and deaths in Australia, with almost 20,500 attributable deaths in 2018, overweight and obesity contributed to the most non-fatal burden in both males and females (AIHW 2021).
Smoking remains a major risk factor in contributing to health inequalities experienced by certain population groups (see Tobacco; Rural and remote health and; Health across socioeconomic groups). A recent study estimating the smoking attributable mortality for Aboriginal and Torres Strait Islander people found that smoking causes half of deaths in older Indigenous populations (Thurber et al. 2021).
The tobacco control measures of all Australian governments and public health organisations have been key to Australia’s success in tobacco control. Smoking rates have declined to historically low levels, particularly among children and youth. Between 1984 and 2017, the proportion of 16- and 17-year-olds smoking at least once in the previous week declined from 30% to 10%, and from 20% to just 3% among 12–15-year-olds (Guerin and White 2018; White and Williams 2016).
The latest data from the National Health Survey (NHS) 2020–21 estimates that 10.7% of Australians aged 18 and over are daily smokers (ABS 2021). Due to methodological issues these data cannot be compared with previous years, however rates have declined steadily over the last 30 years. The proportion of adults who are daily smokers has more than halved since 1989–90 from 28.4% to 13.8% in 2017–18 (NHS 2017–2018). For more information on Australia’s smoking rates see Tobacco.
In recent decades, Australia has progressively implemented a comprehensive suite of tobacco control measures including (Figure 1):
- staged tobacco excise increases
- smoke-free laws and policies
- social marketing campaigns
- measures to minimise the illicit tobacco trade
- plain packaging of tobacco products
- labelling tobacco products with graphic health warnings
- prohibiting tobacco advertising, promotion and sponsorship
- providing support for smokers to quit (Department of Health 2018b).
These measures form part of Australia’s National Tobacco Strategy (NTS) 2012–2018. The NTS, which is currently being updated, provides a national framework for all Australian governments and non-government organisations to work together to improve the health of Australians by reducing tobacco use and its associated harms. These types of tobacco control measures can also be considered as health protection.
Novel and emerging products, such as e-cigarettes present new challenges to prevent and reduce nicotine addictions (Department of Health 2021). A recent systematic review of global evidence on the health effects of nicotine electronic cigarettes found that e-cigarettes increase the risk associated with a range of adverse health outcomes, particularly in younger people, including addiction and lung injury (Banks et al. 2022).
The National Preventive Health Strategy also highlights the Australian Government’s commitment to reducing tobacco use and nicotine addiction as a priority and sets out targets to achieve a national daily smoking prevalence of less than 10% by 2025 and 5% or less for adults (aged 18 years and over) by 2030 as well as to reduce the daily smoking rate among Aboriginal and Torres Strait Islander people (≥15 years) to 27% or less by 2030.
This chart shows the decline over time of daily smoking rates for those aged 18 and over by sex. Between 1989-90 and 2020-21, the rate of daily smoking declined from 32% to 13% in males and 25% to 8.9% in females in 2020-21. The chart highlights dates from 1990 to 2020 when key tobacco control measures were introduced in Australia. For example, an advertising ban in print media in 1990.
A range of immediate and tangible health promotion strategies were employed in response to the first wave of the COVID-19 pandemic in 2020 to minimise the spread of the disease, to ensure the health and wellbeing of all Australians during the pandemic and to reduce the strain on the health system.
These strategies have included the development of educational resources and social marketing campaigns to promote hand hygiene and social distancing (Smith and Judd 2020). The kind of messaging in a pandemic needs to instruct, inform and motivate individual self-protective behaviours and encourage behaviour change. Meeting the specific communication needs of sub-populations helps the quality of the societal response (Vaughan and Tinker 2009).
More broadly, wide-ranging policy, regulatory and legislative measures were introduced, and state-legislated Public Health Acts were also invoked, which provided Chief Health Officers with additional powers to obligate citizens’ compliance with public health orders (ACT Health 2022) to prevent and contain the spread of the virus. There were also operational changes to settings where groups of people congregate, such as aged care, school classrooms and workplaces. Additionally individuals were expected to adhere to rules, such as wearing face masks in certain settings, staying at home during periods of lock down and using ‘check-in’ apps when entering a venue.
The public health protection measures have changed over time. A range of public health protection measures were implemented, adapted or eased at the discretion of jurisdictions in response to emerging evidence, new variants, and Australia’s epidemiological situation (Department of Health 2022).
Australia’s international borders were closed to all non-citizens and non-residents in March 2020 with exemptions only for immediate family (the international borders have since reopened). Under the Biosecurity Act 2015 requirements regarding air travel were introduced such as pre-flight COVID-19 testing for travellers entering Australia and requirements to wear face masks when flying internationally. The Department of Health publishes regular COVID-19 epidemiology reports which capture some of these point-in-time health protection measures.
As the pandemic progressed, safe and effective vaccines were developed and approved as another measure to protect the population against COVID-19 infection and to reduce transmission and severity of the virus. Under the Australian Government’s phased approach, those in greatest need and/or at highest risk, such as health care and frontline workers, aged care residents, older Australians, Aboriginal and Torres Strait Islander people and other priority populations such as those with a disability or with existing chronic conditions were eligible for a vaccine in the first phases of the roll-out.
As the vaccines became more available to the general adult population, large public venues were reorientated to provide preventive health services for mass ‘vaccination hubs’ in places like the Brisbane Convention and Exhibition Centre, Sydney Olympic Park and Melbourne’s Royal Exhibition Centre. This facilitated a more universal, equal and accessible approach for large-scale population vaccination. Commonwealth primary care providers, including General Practices and community pharmacies have delivered the majority of vaccinations in the program. Those people not eligible for Medicare were also included in the roll-out.
Since 8 November 2021, a third dose or ‘booster’ has become available to mitigate against waning immunity and the emergence of variants (Department of Health 2022). On 25 March 2022, a ‘winter booster’ became available to those at greatest risk of severe illness from COVID-19 (Department of Health 2022). For up-to-date information on COVID-19 vaccines, visit COVID-19 vaccines | Australian Government Department of Health (see Immunisation and vaccination).
Health promotion activities have been shown to be cost saving, whereby the cost of implementing the intervention is offset by savings associated with reductions in treating disease (Vos et al. 2010). Monitoring and evaluation are important to assess the performance of health promotion initiatives and provide the evidence that researchers, policy makers and service providers need on what works.
Evaluating the impact and cost of community and nationwide initiatives can be difficult. Directly attributing health outcomes to a specific initiative itself is a challenge, and this is further complicated when multiple strategies are being applied at once (for example, legislation, taxation and promotion campaigns). Evidence to support the effectiveness of health promotion initiatives may not be available for many years as health impacts and benefits may not manifest until years after the intervention has been implemented.
For more information on health promotion, see:
- Department of Health Preventive health
- World Health Organization Health promotion
- Australian Health Promotion Association
- Public Health Association of Australia
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