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«The suggested recommendations contained in the following submission prepared by the Heart Foundation aim to support the Tasmanian Government achieve ...»

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Submission to the Healthy

Tasmania Five Year Strategic Plan

Consultation Draft

The suggested recommendations contained in the following submission prepared by the

Heart Foundation aim to support the Tasmanian Government achieve its goal to make

Tasmania the healthiest population in Australia by 2025

Heart Foundation submission to the Healthy Tasmania Five Year Strategic Plan Consultation Draft

Contents

Introduction

Summary of Recommendations

Examples of activities to be considered by the Intersectoral Board

1. SHORT TERM GAIN

As recommended by the TCDPA submission, invest in tobacco control to a minimum of $2.4 million per year over the four-year period 2016-2017 to 2019-2020 with sufficient allocation of funding from this to achieve a minimum of 700 Target Audience Rating Points (TARPS) per month, every month.

2. SHORT TO MEDIUM TERM GAIN

That, as recommended by the TCDPA submission, the Government, through recommendations provided by the Intersectoral Board, develop a range of health indicators, set health targets based on these indicators, and commit to regularly monitoring and reporting against these indicators.

That, as outlined in the TCDPA’s submission to this consultation, models for anticipatory care need to be implemented. The Heart Foundation believes there will be specific short to medium term benefits to implementing better referral and participation in cardiac rehabilitation, as well as better anticipatory care management of those with heart failure.

3. MEDIUM TO LONG TERM GAIN

That, as outlined in the TCDPA’s submission to this consultation, 5% per annum of the infrastructure budget be transferred to public transport infrastructure that supports active living (such as walking, cycling and public transport), to support Tasmanians to be healthiest population in Australia by 2025, and contribute to reducing our carbon footprint.

That, as outlined in the TCDPA’s submission into this consultation, a State Policy for Healthy Communities be adopted in Tasmania.

That a Tasmanian Food and Nutrition Coalition is established in Tasmania................. 13 Contact

–  –  –

Introduction The Heart Foundation, as the Chair and Secretariat of the Tasmanian Chronic Disease Prevention Alliance (TCDPA) has been responsible for authoring and coordinating the input into the TCDPA’s and Health in All Policies (HiAP) Collaboration’s submissions to this consultation.

We do not intend to repeat all of the information contained within the TCDPA and HiAP Collaboration’s submission, but wish to advise that we are in full support of the submissions provided, and the recommendations made by the TCDPA and the HiAP Collaboration in their submissions.

We therefore support the recommendations from the TCDPA’s submission which are repeated on the following page.

–  –  –

Summary of Recommendations Recommendation 1: That the Government considers the submissions that were presented to the Joint Select Committee on Preventative Health Care when finalising the Healthy Tasmania Five Year Strategic Plan.

Recommendation 2: That a whole-of-government State Strategic Plan be developed for Tasmania.

Recommendation 3: That a State Policy for Healthy Spaces and Places (as advocated for by the Heart Foundation) could be introduced as one of the first components of the State Strategic Plan.

Recommendation 4: That (as outlined in the Heart Foundation’s 2016-17 budget submission) the State Government increases the proportion of funding allocated for prevention, from 1.9% to 5% by 2020. This would be achieved by increasing funding for prevention (sourced through various streams of State Government funding) to the equivalent of 3.0% of the annual Department of Health and Human Services Budget in 2016-17, and increase by annual increments of 0.75% in 2017-18 and 2018-19 and by 0.5% in 2019-2020 (totaling the equivalent of 5.0% of the annual Department of Health and Human Services budget by 2019-2020).

Recommendation 5: That (as outlined in the Heart Foundation’s 2016-17 budget submission) a transfer of 5% per annum of the infrastructure budget, is allocated to public transport, pedestrian and cycling infrastructure, equating to $1.5 million per annum (based on the 2015-16 infrastructure budget). This funding should be tied to matched funding from local government, equating to an investment of $12 million ($6 million from State and $6 million from local governments) over four years.

Recommendation 6: That a Health in All Policies approach be adopted in Tasmania, as outlined in the Health in All Policies Collaboration (of which the TCDPA is a member) submission to this consultation process, in order to drive the intersectoral action required to improve the health and wellbeing of Tasmanians.

Recommendation 7: That the HiAPC’s proposed Intersectoral Board identify the measures, benchmarks, targets, surveillance, KPIs, performance measures that should be collected and monitored, giving consideration to those listed in this submission. These should be recommended to, and adopted by the Tasmanian Government, and the Government commit to their ongoing monitoring. This will provide the evidence base for policies and programs to be implemented, as well as provide a better understanding of the health of Tasmanians.





Recommendation 8: That among the targets that the Intersectoral Board sets, that similar targets for the proportion of patients receiving Integrated Health Checks (similar to those adopted in New Zealand), are applied to all publicly funded community/primary health services in Tasmania. That the Government work with Primary Health Tasmania to encourage the introduction of similar targets in general practice.

Recommendation 9: That amongst the targets set by the Intersectoral board, a target for smoking prevalence is set for Tasmania – and that the Government continues to invest in present successful evidence-based strategies as set out in the Tasmanian Tobacco Action Plan.

Recommendation 10: That tobacco control initiatives are funded to a minimum of $2.4 million per year over the four-year period 2016-17 to 2019-2020, with sufficient allocation of funding to achieve a minimum of 700 Target Audience Rating Points per month, every month as part of a comprehensive tobacco control program.

29 February 2016 Page 4 of 16 Heart Foundation submission to the Healthy Tasmania Five Year Strategic Plan Consultation Draft Recommendation 11: That among the targets set by the Intersectoral Board, similar targets for the proportion of patients receiving brief interventions for smoking (similar to those adopted in New Zealand), are set for all publicly funded hospitals and community/primary health services in Tasmania.

Recommendation 12: That the Intersectoral Board provides advice to the Government on what evidence-based initiatives should be implemented in Tasmania to work towards the goal of Tasmania being the healthiest population in Australia by 2025.

In addition to the above recommendations, the Heart Foundation would also like to offer the following examples of activities (drawn from some of the proposals in the Heart Foundation’s 2016-2017 State Budget Submission and the TCDPA and Public Health Association of Australia’s joint submission to the Green Paper 1), that the HiAP Collaboration’s proposed Intersectoral Board (once established) could consider when determining initiatives for the Healthy Tasmania Five Year Strategic Plan.

These activities are provided as examples of where some short, medium and long-term gains could be made. It should be noted that these recommendations all impact on lower socioeconomic groups and are progressive in their nature and involve joined-up and collaborative action by multiple agencies.

1 Tasmanian Chronic Disease Prevention Alliance and Public Health Association Australia (2015) Submission to the One

Health System, Better Outcomes Green Paper. Found:

https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0004/186871/TCDPA_and_PHAA.pdf Accessed 28/02/2016

–  –  –

Examples of activities to be considered by the Intersectoral Board

1. SHORT TERM GAIN As recommended by the TCDPA submission, invest in tobacco control to a minimum of $2.4 million per year over the four-year period 2016-2017 to 2019-2020 with sufficient allocation of funding from this to achieve a minimum of 700 Target Audience Rating Points (TARPS) per month, every month.

Tobacco is the single largest cause of preventable death and disease in Australia and is accountable for 15,000 deaths each year 2.

Data from the Australian Bureau of Statistics shows that Tasmania has the highest proportion of current smokers of all states and territories. The proportion of people over the age of 18 who reported that they were current smokers 3 in Tasmania in 2011-12 was 23.2% which is well above the national average of 18.1% 4.

In 2010, Tasmania had the second highest proportion of women (23%) who smoked during their pregnancy. Maternal smoking continues to be more prevalent among younger women;

particularly those aged less than 20 years (35.7%) and between 20-24 years (30.8%) 5.

The now defunded National Partnership Agreement on Preventive Health’s target to reduce the prevalence of daily smoking to 10% by 2018 is an ambitious one and is mirrored in the Tasmanian Tobacco Action Plan 2011-2015 6.

There has recently been significant tightening of the tobacco control legislation in Tasmania, for which the Government is commended. There has also been increased funding in recent years to enable increased investment in media and social marketing campaigns (one of the most effective strategies to reduce smoking rates), along with the provision of additional support to those who require it to quit.

In 2013-2014 the Department of Health and Human Services committed just over $1.7 million to help Tasmanians give up smoking 7. Whilst the commitment for 2013-14 was 2 Australian Institute of Health and Welfare, The burden of disease and injury in Australia 2003, Canberra, 2007.

3 Includes daily smokers, current smoker weekly (at least once a week) and current smoker less than weekly.

4 ABS (Australian Bureau of Statistics), 4364.0 - Australian Health Survey 2011-12, Australian Bureau of Statistics 2012 5 Care reform. 2011. Council of Obstetric and Paediatric Mortality and Morbidity Annual Report 2011. DHHS.

6 Tobacco Action Coalition. 2010. Tasmanian Tobacco Action Plan 2011-2015. DHHS 7

Tobacco Control Coalition (2016). Tasmanian Tobacco Action Plan | Year 4 Report. DHHS Found:

http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0007/175777/Tobacco_Action_Plan_Year_4_Report.pdf Accessed 28/02/2016.

–  –  –

slightly greater than previous years (and greatly improved from the allocations prior to 2010), it continues to be insufficient. Best practice recommends that national funding should be at least $7.40 annually per capita in Tasmania 8. This equates to approximately $3.7 million each year in Tasmania, with the State Government taking on the greatest responsibility to fund a comprehensive Tobacco Control Program.

This is still a conservative recommendation as the Australian National Tobacco Strategy 2004-2009 recommends that $7.40 per capita be spent annually in Tasmania as a minimum, and that up to $14.80 should be spent, which would equate to approximately $7.4 million each year.

It is known that well-funded media campaigns can reduce smoking prevalence. Exposure of the highest rate of Gross Rating Points (GRPS) at about 838 has contributed to smokers being four times more likely to have quit two years later 9. The Preventative Health Taskforce Report recommends campaigns should be high enough to achieve at least 700 TARPs per month. The Tasmanian Tobacco Action Plan and the A Healthy Tasmania policy documents now recognise this level of media saturation. It appears that the current level of funding (achieved by both funding from the Department of Health and Human Services and the Tasmanian Medicare Local) has now been able to achieve this every month, assuming that the national tobacco campaign advertising continues to be aired at the levels it has been aired previously. The Commonwealth Government recently reduced its funding for the national anti-tobacco television campaign, and in recent months, campaigns have not been aired nationally. Our proposal of $2.4 million per year over the four-year period 2016-2017 to 2019-2020 would ensure that we can maintain the reach of a minimum of 700 TARPs per month, every month, and would also provide increased capacity to enable other supporting tobacco cessation and control activities in Tasmania.

Even if we were able to reduce smoking rates in Tasmania to 15%, there are potential annual savings of up to $14.7 million in healthcare costs, $12.5 million in lost production and leisure, 4,740 less cases of new disease, 150 less deaths, and 2,130 disability adjusted life years saved 10. These savings far exceed the investment.

We also reaffirm our support for Recommendation 11 of the TCDPA position - That among the targets set by the Intersectoral Board, similar targets for the proportion of patients 8 Commonwealth of Australia, National Tobacco Strategy 2004-2009, Ministerial Council on Drug Strategy, Commonwealth of Australia 2005 9 National Preventative Health Taskforce, Australia: The healthiest country by 2020: Technical Report No. 2 - Tobacco control in Australia: making smoking history, 2009 10 By applying Tasmania’s proportion to the modelling found in The health and economic benefits of reducing disease risk factors Research Report. VicHealth, 2009

–  –  –

receiving brief interventions for smoking (similar to those adopted in New Zealand), are set for all publicly funded hospitals and community/primary health services in Tasmania.

2. SHORT TO MEDIUM TERM GAIN

That, as recommended by the TCDPA submission, the Government, through recommendations provided by the Intersectoral Board, develop a range of health indicators, set health targets based on these indicators, and commit to regularly monitoring and reporting against these indicators.



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