Australia’s health status is generally improving, but there is potential for further gains in several areas. The National Health Priority Areas (NHPA) initiative seeks to focus public attention and health policy on those areas that contribute most to the burden of illness in the community, particularly if the burden can be significantly reduced. It is a process of collaborative activity involving the Commonwealth, State and Territory Governments, and builds on previous activity under the banner of ‘National Health Goals and Targets’. The NHPA initiative provides a national approach to tackling the five identified priority areas: cardiovascular health, cancer control, injury prevention and control, mental health and diabetes mellitus.
In its fifth biennial report, Australia’s Health 1996, the Australian Institute of Health and Welfare (AIHW) charted national achievements in health. The gains made in life expectancy over the past several decades summarise some of these achievements. Lower incidence of many previous major causes of death and illness is another important indicator of the nation’s ability to implement effective prevention measures. The capacity of the Australian health system to respond to new, unpredictable health risks is also well demonstrated by steady decreases in the incidence of HIV/AIDS throughout the late 1980s and 1990s.
Some of these achievements have been made possible by reductions in risk. Significant declines in tobacco smoking and an increased proportion of adults undertaking physical exercise are two examples of these improvements. An increasing uptake of population-based screening programs, such as mammography and Pap smear testing, are further examples.
There is little doubt that, generally, health of Australians is among the best in the world and is continuing to improve. However, the diseases and conditions reflected as National Health Priority Areas represent areas where a concerted effort could achieve significant gains in the health status of the nation.
For example, while continually improving, the nation’s death rate for injury is still relatively high in certain age groups (15–24 years and 75 years and over), and a high proportion of these deaths are preventable. Cancer remains one of the nation’s biggest killers and, with continuing advances in screening, early intervention, management and continuing care, provides an opportunity for achieving significant health gains. While cardiovascular disease continues to decline, it still remains the leading cause of death in Australia, and significant numbers of Australians remain at risk. Mental illness affects many Australians, and there are increasing opportunities to reduce its impact through a range of specific interventions targeted at certain groups. Finally, the rising death rate for diabetes, particularly in the Indigenous population, is a major concern.
The NHPA initiative, endorsed jointly by the Commonwealth, State and Territory Governments, focuses on these important issues, and is an excellent opportunity to close the gap in health outcomes between population groups. A changing focus of accountability in government, from inputs (for example, total expenditure) to outputs and outcomes, has led to an increasing emphasis on the measurement of activities and the impact that these activities have. In the health sector, this has seen a general shift in emphasis from a focus on service providers and inputs, to a system also incorporating a focus on outcomes and the consumer. The National Health Goals and Targets initiative (Commonwealth Department of Human Services and Health 1994) reflected this shift in emphasis and, as such, enshrined a systematic process of monitoring health outcomes. It focused on identifying the information needs required to determine the extent to which strategic interventions result in, or contribute to, changed health status.
The NHPA process will build on this valuable platform and seek to take this one step further. This will be achieved through working in close collaboration with State and Territory Governments as well as health professionals and peak non-government bodies, and concentrating on improving information systems across the health continuum, incorporating information on health status, prevention, early intervention, treatment and the ongoing management of the chronic condition. The NHPA work program will also include the identification of appropriate action which may help in reaching the targets set.
The health outcomes approach of the NHPA initiative is informed by a nationally consistent framework, developed by a Working Party on Health Outcomes Activities and Priorities appointed by the National Health Information Management Group (NHIMG). The framework, detailed in Appendix 1, views health as a continuum of care with outcomes to be monitored at all levels of prevention, treatment and support.
At its October 1996 meeting, the Australian Health Ministers’ Advisory Council (AHMAC) endorsed the recommendations of the National Health Information Management Group (NHIMG) to focus on improving health outcomes within this defined framework. AHMAC also has accepted a revised definition of a health outcome put forward by the NHIMG, in that ‘a health outcome is a change in the health of an individual, a group of people or a population, which is wholly or partially attributable to an intervention or series of interventions‘.
The NHPA work program focuses on considerations such as these, and is consistent with the latest developments in health taking place through greater collaboration between the Commonwealth and State and Territory Governments. The role of the Commonwealth in health administration is changing, with its focus not only on health service funding (with a diminishing role in service delivery) but also on promoting quality of health care and public health improvement.