IMPACT OF RESEARCH ONAUSTRALIA’S HEALTH

Clinical Research Excellence ConferenceMELBOURNE –

5 August 2010

Professor Jim Bishop AOChief Medical Officer

Australian Government Department of Health and Ageing

Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)

7538

5004

4627

42104079 4063 3970

3793 3737 3696 36773540 3470

3359 33533129 3060 3008 2902 2870

2729 2687 2683

2151

1801 1781 1737

14371213

999852 767

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

1. Refers to insured population rather than resident population. 2. Current expenditure. 3. 2006. 4. 2007. Source: OECD, OECD Health Data, June 2010

Public expenditure on health Private expenditure on health

OECD HEALTH DATA 2010How Does AUSTRALIA Compare

Health Expenditure as a share of GDP, OECD Countries

16.0

11.210.7 10.5 10.5 10.4 10.2 9.9 9.9 9.8 9.7 9.7 9.4 9.1 9.1 9.0 9.0 8.7 8.7 8.5 8.5 8.4 8.1 7.8

7.3 7.2 7.1 7.0 6.96.5

6.1 6.0 5.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1. Current expenditure 2. 2006 3. 2007 Source: OECD Health Data 2010 June 2010

% GDP

Health Expenditure as a share of GDP, OECD Countries

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

SELF-ASSESSED PHYSICAL &MENTAL HEALTH, 2007

Source: AIHW Australia’s Health 2010

BROAD CAUSE MORTALITY TRENDS AUSTRALIA

Source: AIHW

Source: AIHW Australia’s Health 2010

AGED ADJUSTED DEATH RATESFrom CVD, 1907 -

2006

All Cancer-

Mortality/Incidence ratios for selected countries -

2008

Source: IARC 2010.

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Kenya

Nigeria

Egypt

Viet N

amTurk

eyInd

iaChinaRuss

iaSou

th Afric

aGreec

eBraz

ilJa

pan

Czech

Rep

ublic

Italy

United King

domCana

daGerm

any

Sweden

New Zealan

dUSA

Austra

liaM

orta

lity-

to-in

cide

nce

ratio

MalesFemales

Changes in Deaths rates in Males using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

Changes in Deaths Rates in Females Using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

Cancers with reducing death rates 1997 to 2006 –

all ages

Lung, -18.5Colon, -19.6 Prostate, -19.7

Leukaemia, -23.7

Stomach, -29.4

Head and Neck, -23.7

Bladder, -18.5

Testicular, -42.2

Breast, -13.8

Cervix, -38.3

NHL, -25.1

Unknown, -24.8

Rectum, -19.9

Bowel, -19.7

All cancers, -13.8

, -24.3

-18.5

Kidney, -24.1

, -15.2

-31.9

, -21.1

-19.0-19.0

, -18.9

-7.9

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

Male FemaleSource: Tracey et al, Cancer Institute NSW

5 YEAR SURVIVAL RATES 2004

NSW

SEER

Non small cell lung 13% 14%

Colon 65% 67%

Rectum 66% 69%

Breast Cancer 89% 90%

Lymphoma (DL)

53% 53%

Source: Tracey et al –

Cancer Institute NSW

CANCER

Milestones in Survival Improvement

Prevention –

Tobacco control

Early detection •Screening•Interventions

Better treatments –

medical researchClinical trials of better approachesEvidence based standard practice

PROJECTED BURDEN of MAJOR DISEASE GROUPS, 2010

Source: AIHW Australia’s Health 2010

TRENDS IN LEADING CAUSESOF DISEASE BURDEN 2003-2023

Source: AIHW Australia’s Health 2010

Changes in Incidence Rates for all Cancer in

Males using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

Changes in Incidence Rates in Females using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

THE KEYS TO PREVENTION

0.0 2.0 4.0 6.0 8.0

Tobacco

Blood pressure

Overweight/obesity

Physical inactivity

Blood cholesterol

Alcohol

Fruit/vegetables

Illicit drugs

Air pollution

Unsafe sex

% DALYs

Total of 32%

Source: Table 4.1 AIHW Australia’s Health 2008

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

SMOKING IN AUSTRALIA

SMOKINGSTATUS

NSW VIC QLD WA SA TAS ACT NT AUS

Daily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6

Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3

Less than Weekly

1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5

Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1

Never smoked

56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4

National

Drug Strategy Household Survey 2007Source: 2007 Household Survey, Australian Government

AUSTRALIA’S INITIATIVES IN TOBACCO CONTROL

Advertising Bans

Under the counter at retail sites

Banning smoking in restaurants, pubs and cars

Graphic warnings on cigarette packets

Anti-tobacco campaigns

Increase in tobacco excise

Plain packaging

OBESTITY INCREASING FOR ALL

Source: AIHW: Australia’s Health 2008

Increased Risk Body Fatness OesophagusPancreasColorectalBreast (PM)Endometrum

Abnormal Fatness Colorectal

Reduced Risk Physical exercise Colon

Source:World

Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007

OBESITY and CANCER

Source: AIHW Australia’s Health 2010

PROPORTION OF ADULTS WITH HIGH BLOOD PRESSURE

1980 to 1999-2000

Source: AIHW Australia’s Health 2010

CHRONIC PULMONARY DISEASEMORTALITY 1980 to 2007

Source: AIHW Australia’s Health 2010

DEATH RATES FROMINFECTIOUS DISEASES, 1922-2007

Source: AIHW Australia’s Health 2010

PREVALENCE OF CURRENT ASTHMA 2007-08

Source: AIHW Australia’s Health 2010

PREVALENCE OF TREATED ENDSTAGE KIDNEY DISEASE 2000-2007

NSW Population Age Distributions,

Males (1977-2036)

Source: Cancer Institute NSW

Total Cancer Cases and Deaths per year (1972 to 2036)

Source: Cancer Institute NSW

Milestones in Cancer Control

Public health measures in smoking reduction,

screening breast, cervix, bowel, health literacy

Adjuvant treatment of breast, lung and bowel

cancer

New anti-cancer drugs and symptom control drugs

Cancer research translated into practice

Cancer registries, data linkage and analysis

BREAST CANCER MORTALITY

NEJM 2005Source: New Engl.Journ. Med: 353:17

Projected YLLs

–

Three scenarios, Australia –

1980 to 2016

Source: Bishop et al –

Cancer Institute NSW

NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004

(A$ per CAPITAL)

Source: Eckhouse

et al (2007), ABS

PRIORITY HEALTH AREAS

SOURCE: NHMRC Research funding 2010 facts book

CANCER PUBLICATIONS

Australia

Growth* World

AustralianShare

2000 1,881 5.6% 88,604 2.0%

2002 2,000 3.5% 97,035 2.1%

2004 2,514 19.0% 110.390 2.3%

2006 3,035 14.1% 125,934 2.4%_______________________________________________________________________8 year period 17,917 70.4% 822,768 2.2%_______________________________________________________________________* From pervious year

Source: Cancer Institute NSW 2008

CLINICAL GUIDELINESSupports for Clinical Decision Making

Evidence Base

Highest Impact

Range of best practice tools

Successful implementation methods

Monitor and report

AUSTRALIAN HEALTH SURVEY

Four components run by ABS 2011-13

- Health Survey

-

ATSI Health Survey

-

Nutrition and Physical Activity Survey

-

Health measurement Survey

Around 50,000 participants

De-identified data available as summary statistics, tables

Focus on the major burden of disease and their risk factors provides a basis for improving the health of our community.

Manipulation of the determinants of disease show some successes but some challenges

Application of new research to the high priority disease burden provides new opportunities to further improve outcomes for our population

CONCLUSIONS