Health Care Initiatives and the Challenges of Health System Reform: Early Intervention and Prevention Options

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Those of us working in Australia’s health care system are constantly reminded of the essential paradox surrounding our efforts to sustain good health at a population level through preventative care and illness management programmes. In recent years it has become obvious to health systems managers that the demands being placed upon health care resources are growing out of control and leading us to commit in excess of 15% of our GDP on health care (1-3). The paradox in this growing demand for health care is, as demonstrated in numerous studies and reports, that many of the health problems we are devoting enormous resources (financial and human) to manage, need not occur at all (4, 5). There are numerous examples of such misplaced priorities ranging from essentially preventable metabolic syndrome, type 2 diabetes and cardio-vascular disease, to preventable health related crises resulting from social and family dislocation due to gambling addiction. In many of these situations, the preventive approach could reduce demand significantly if we had the space and time to move our investments in health care to earlier intervention approaches rather than spending the vast majority of our resources on reactionary, end point programmes. In this paper we will examine some of the outstanding areas in which we are paradoxically committing major resources to dealing with health related problems that need not occur at anywhere near the rates that they currently impacting upon our health systems. Most health programmes such as coordinated care for chronic illness and diabetes management, only focus on the end stage of illness management when the demand of managing diagnosed chronic illness takes precedence over preventing the next generation of sufferers. In conclusion we will explore the potential of peer education progammes to positively influence the health related behavior and lifestyle choices of our younger generations as a hedge against rising rates of preventable chronic illness in these age groups due, apparently, to a growing trend of youth inactivity, poor dietary choices and the added social and emotional pressures of modern living (6-8).

Stream: Knowledge Systems and Methodologies

Paper: ,

I have a background in education; secondary teaching (English and Mathematics), school development, curriculum consulting and organizational change. My work in the health sector has focused mainly on developing integrated primary care programmes, coordinated care and chronic illness management strategies to improve health outcomes and funding efficiencies in rural and remote communities in South Australia. From 1996 to 2000 I led the rural component of the South Australian COAG coordinated care trial and my PhD, completed in the School of Medicine, faculty of public Health at University of Western Australia, was based on this work. From 2001 to 2004 I managed the Sharing Health Care SA chronic disease self-management project in rural South Australia; a project of the Spencer Gulf Rural Health School. I am currently a chief investigator and project manager with the Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander health in South Australia. This is an NH&MRC funded collaborative project between the Aboriginal Health Council of South Australia (AHCSA) and Flinders University. I am also a chief investigator with the Centre for Metabolic Fitness in the University of South Australia and involved in a range of programmes through the University of Adelaide Rural Clinical School and Spencer Gulf Rural Health School.

Associate Professor Malcolm Battersby is Associate Professor in Psychiatry at Flinders University. He is Director of the Centre for Anxiety and Related Disorders, Intensive Gambling Treatment service at Flinders Medical Centre. He has established the Master of Mental Health Sciences at Flinders University which provides training in cognitive and behavioural therapy for a wide range of health professionals. His team has developed a unique method of treatment of problem gambling using cognitive behaviour therapy. His research interests include self-management of chronic conditions which has led to the NHMRC Centre for Clinical Research Excellence in Aboriginal and Torres Strait Islander Health ($1.9 million) and a Harkness Research Fellowship in the United States. His research interests in problem gambling include suicide and the treatment of problem gambling. He also established the Flinders Human Behaviour & Health Research Unit which has developed an education program for chronic condition self-management, now provided to over 2000 health professionals across Australia.