Queensland Election Submission 2012 - SAVE LIVES REDUCE AVOIDABLE HOSPITAL ADMISSIONS KEEP OLDER QUEENSLANDERS HEALTHY AND AT HOME TACKLE OBESITY ...
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Queensland Election Submission 2012
SAVE LIVES
REDUCE AVOIDABLE
HOSPITAL ADMISSIONS
KEEP OLDER QUEENSLANDERS
HEALTHY AND AT HOME
TACKLE OBESITY
CLOSE THE GAP FASTER
REDUCE HEALTH EXPENDITURE
IMPROVE WORKFORCE PARTICIPATION
AND PRODUCTIVITY
1
Heart Foundation Queensland Election Submission 2012
Why take action on heart disease and stroke? Addressing the risk factors for cardiovascular
The Heart Foundation is seeking a commitment to disease will improve outcomes for all major chronic
these policy proposals to address the devastating diseases (see Appendix 1). Investment in prevention
impact of heart disease and stroke – two of will save costs, save lives, keep people in the
Queensland’s leading causes of death and burden of workforce and keep Queensland families together.
disease. Queensland’s Chief Health Officer reports the
substantial untapped potential for prevention and the
Cardiovascular disease - including heart attack,
stroke, heart failure, angina, vascular disease and indisputable evidence of the power of prevention1.
hypertension - is the most expensive disease group
in Australia and a major cause, if not the leading Cardiovascular disease is Queensland’s costliest
cause, of potentially preventable hospitalisations. disease:
These policy proposals offer a range of strategies • cardiovascular disease costs more than any
and cost effective investments which will: other disease ($5.9 billion or 11% nationally in
2004/05)1
• save lives • the cost to Queenslanders was estimated to be
• reduce avoidable hospital admissions $1.16 billion per annum
• keep older Queenslanders healthy and living at • hospital care is the leading cause of
home
expenditure for cardiovascular disease,
• tackle obesity
• Close the Gap faster accounting for 50% of all costs, with out-of
• reduce health expenditure hospital medical services accounting for a
• improve workforce participation and productivity further 19%1
Reducing cardiovascular disease is the key The costs of healthcare are not sustainable:
to improving the health of Queenslanders1.
Queenslanders need a government that will plan and • hospitalisation rates are expected to double
create healthier communities and implement well from 1.52 million hospitalisations per year in
funded prevention policies. Queensland in 2006/07–2007/08 to over 3
million by 20301
• health and residential aged care expenditure in
The Heart Foundation is Australia’s leading Australia is projected to triple from $85 billion to
heart health organisation representing: $246 billion from 2003 to 2033, representing an
increase from 9.3% of gross domestic product
• 700,000 Queenslanders who live with heart to 12.4%1
disease, stroke and blood vessel disease2
• 114,000 Queenslanders who are at high risk
of having a heart attack or stroke and Economic benefits
hospitalisation in the next five years3
• 90% of Queenslanders who have at least one • investment in research, prevention and
risk factor for cardiovascular disease4 clinical management in Australia has been
• all Queenslanders who want lead healthier
shown to reduce heart attacks and heart
lives
disease deaths and arrest the growth in
health costs
Many Queenslanders remain at higher risk of heart • every dollar invested in cardiovascular
disease and stroke as a result of risk factors that can research has provided an eight-fold return
mostly be prevented: to the community; the highest return from
any form of medical research5
• high blood pressure • public health campaigns aimed at reducing
• high blood cholesterol heart disease in Australia have an
• being physically inactive
• being overweight or obese estimated benefit-cost ratio of more
• eating a diet high in saturated fats and low in than11:16
fruit and vegetables
• smoking
1
Heart Foundation Queensland Election Submission Summary 2012
Annual Heart Foundation Government
Heart Care Investment to deliver to deliver
Heart Attack Prevention and Care Program
1. Save lives from heart attack by educating Queenslanders
about the Warning Signs of Heart Attack
$ 1 million
2. Provide the My Heart, My Life resource to all heart patients $200,000
Support people with heart disease and heart failure
3. Improve clinical support for better treatment and
management of heart disease and heart failure
$250,000
4. Increase the number of Queenslanders participating in
cardiac rehabilitation
$ 5 million
5. Increase the support from allied health professionals for
Queenslanders living with heart failure
$ 2 million
6. Increase access to palliative care services in hospital
and at home for people dying from heart failure
$ 6 million
Regional Heart Health Program
7. Support more Queenslanders living in regional and
remote communities by investing in a regional heart
$150,000
health program
Aboriginal and Torres Strait Islander Heart Health Program
8. Provide My Heart My Family Our Culture resources to
Aboriginal and Torres Strait Islander heart patients
$200,000
9. Invest in cardiac trials for Indigenous people by allocating
Closing the Gap funds to the State-wide Cardiac Clinical
Network
$ 1 million
Healthy Living
Obesity & Healthy Living Program
10. Help older Queenslanders be active by supporting the
Heart Foundation Walking program
$250,000
11. Invest in an ongoing campaign to increase fruit and
vegetable consumption and production
$3 million
12. Reform food policies to inform consumers:
a) Ban junk food advertising to children
b) Legislate kilojoule content on menu boards
Low cost
13. Strengthen physical activity and healthy eating in
schools
Low cost
Active Transport and Congestion Busting Initiatives
14. Invest in a campaign to increase active travel
participation and public transport patronage
$3 million
15. Reduce speed limits to 40kph in built up areas and
30kph in heavy pedestrian areas, including schools
Low cost
16. Invest in the implementation of the Queensland Cycle
Strategy 2011-2021
Match to need
17. Develop, fund and implement a Queensland Walking
Strategy
Match to need
Tobacco Control Program
18. Increase investment in reducing the impact of tobacco,
including prevention and education campaigns and Quit
$10 million
19. Reform smoking laws to reduce smoking rates and
reduce avoidable hospitalisations
Low cost
Heart Research
Strategic Heart Research Initiative
20. Invest in increasing Queensland’s heart research
capacity to attract more competitive funding to
$300,000
Queensland
2
Heart Attack Prevention and Care Program
1. Save lives by educating Queenslanders about the warning signs of heart attack
Annual Investment: $1 million
Commitment: Investment in the Heart Foundation’s life saving Warning Signs of Heart Attack campaign.
Heart attacks tear families apart and create a huge
burden on the health system, with emergency care, Why do we need a campaign?
expensive medical intervention and often lifelong
treatment costs. Many heart attacks can be avoided • Queensland death rates from heart disease
and treated earlier to reduce deaths, heart damage are 11% higher than the Australian average9
and costs. Improving people’s understanding and • heart disease caused 32,728 hospitalisations
response to warning signs will provide the greatest in Queensland in 2007/089
benefit. • the 8,507 cardiovascular deaths in Queen
land in 2007 accounted for one-third of all
deaths – an increase of 781 or 10% on the
• a heart attack is an urgent, life threatening 7,726 deaths in 20061. (Heart attack was the
emergency largest single cause of death)
• one in every four people who have a heart • the number of repeat heart attacks is
attack die within one hour of their first ever expected to increase by more than 40% by
symptoms 20207
• one half of all deaths from heart attack
occur outside of hospital4
The Heart Foundation pilot of this campaign
on the Gold Coast in 201010 found that:
Heart Foundation Warning Signs of Heart Attack
Campaign • 70% of people with symptoms of heart attack
were not recognising or responding to the
The Heart Foundation’s Warning Signs of Heart warning signs quickly
Attack campaign helps people recognise heart attack • one in four people with heart related
warning signs and understand the importance of complaints took more than 12 hours to
calling Triple Zero (000) quickly. Delays cost lives present to Hospital
and result in many heart attack survivors having • only 60% of people arrived at hospital by
more heart muscle damage, longer and more ambulance despite most living within 20km of
frequent future hospitalisations and permanent the Hospital
disability.
Australian hospitals treat 46,000 heart attack cases Heart Attack: Time is Muscle
each year and more than 10,000 patients die1, many
100
unnecessarily. Early treatment within 1-2 hours of
symptoms saves lives and reduces disability, but the
Myocardial Salvage (%)
80
benefit rapidly declines with delays in treatment (see
Figure 1). Sadly, few people respond quickly enough 60
and average patient delay – the time to recognise
40
and respond to the warning signs – is 6.4 hours8.
Emergency ambulance services can save lives
20
and reduce heart muscle damage in the period
immediately following a heart attack4 but they are 0
not being accessed quickly enough. 0 4 8 12 16 20 24
Time From Symptom Onset to Reperfusion Therapy
(hours)
Gersh BJ, et al. JAMA . 2005;293:979-
2005;293:979-986.
Figure 1
3
The My Heart, My Life information pack provides support by giving a comprehen
heart patients, their families and carers.
In Queensland, prior to My Heart, My Life, patients were not receiving a compre
2. Provide the My Heart, My Life resource to all Queensland heart patients
information pack. Instead, they received incomplete or inaccurate brochures and
Annual Investment: $200,000 or support when leaving hospital. Research with heart patients show
information
Commitment: Continued
in-oneprovision of MyMy
My Heart, Heart,
LifeMy Life, the free, standard information pack for all heart
resource.
patients in Queensland. More than 110,000 Queenslanders have received the Heart Foundation’s My
Heart, My Life since 2008. Current funding finishes on
11 30 June 2012.
Heart Foundation research has found that:
• 81% of patients who received My Heart, My Life found it useful and the in
Supporting people who have hadclear language,
a heart attack easy toAunderstand diagrams,
recent Deloitte detailedReport,
Access Economics explanations
ACS of the
or heart surgery to understandinformation
and manage on their in Perspective:
making lifestyle changes The importance of secondary
condition saves lives, improves quality of life, and
• 79% of patients stated they prevention
wouldhighlighted
7
that thechanges
make lifestyle number ofafter reading th
reduces hospital re-admissions and health care Australians dying from repeat heart attacks is
• health professionals found the resource useful to provide to patients with
costs. expected to increase by over 40% by 2020. These
that prompts patients torepeat ask questions
heart attacks are expected to demand an
The My Heart, My Life information pack provides additional 9,000 hospital beds and claim the lives of
About 137,000
support by giving a comprehensive take-homeQueenslanders
guide are7,500
over living with coronary
Australians heart
each year. disease.
Already Most of th
the annual
12
to help heart patients, have anginaand. carers.
their families People need support after heart
cost of repeat a heart attack
attacks to return
in Australia to a normal life
is $8.4
another heart attack and further hospital
billion 7
. admissions. More than 20% of people
are likely to experience another heart attack, heart surgery or stroke within one
In Queensland, prior to My Heart, My Life, The Report7 found that:
A recent
patients were not receiving Deloitte Access Economics Report, ACS in Perspective: The importanc
a comprehensive
highlighted
heart health information they number of• Australians
that the
pack. Instead, 86% of heartdying attack from
survivors don’theart
repeat know or
attacks is exp
received incompleteby or inaccurate brochures underestimate the chances
2020. These repeat heart attacks are expected to demand an additional of another heart attack 9,00
and photocopies or very
liveslittle information
of over • fewer than one in three understand
7,500orAustralians each year. Already the annual cost of repeat hea that heart
support when leaving hospital.
7 Research with disease is a chronic condition
billion .
heart patients shows they prefer to receive the • one in four fail to maintain positive lifestyle
all-in-one My Heart, My Life resource. changes
The Report7 found that: • one in three stop taking their medication as
• 86% of heart attack survivors directeddon’t know or underestimate the chances o
Heart Foundation research•11 has fewer
foundthan
that:one in three understand that heart disease is a chronic condi
• one in four fail to maintain positive
The Report 7
lifestyle
, based changes
on patient research in 2011,
• one
• 81% of patients who received MyinHeart,
threeMystop strongly recommends the
Life taking their medication as directed need for high quality
found it useful and the information valuable, information for patients and their families to reduce
7
The Report
containing clear language, easy ,tobased on patientthe
understand
risk and burden
research in 2011, of repeat heart
strongly attacks and the need
recommends
protect patients.
diagrams, detailedpatients theirfamilies to reduce the risk and burden of repeat heart attacks
andoftheir
explanations
conditions and step-by-step information on
making lifestyle changes
• 79% of patients stated they would make lifestyle
changes after reading the resource
• health professionals found the resource useful
to provide to patients with easy to understand
information that prompts patients to ask
questions
About 137,000 Queenslanders are living with
coronary heart disease. Most of these have had a
heart attack or have angina12. People need support
after a heart attack to return to a normal life, to return
to work and to avoid another heart attack and further
hospital admissions. More than 20% of people who
have had a heart attack are likely to experience
another heart attack, heart surgery or stroke within
one to five years13.
4
Support people with heart disease and heart failure
3. Improve clinical support for better treatment and management of heart disease and heart
failure
Annual Investment: $250,000
Commitment: Investment in the Heart Foundation’s clinical support program that provides training,
resources and support for health professionals working with people with heart disease and heart failure.
The Heart Foundation needs government funding to continue this work. Current funding ends on 30
June 2013.
The Heart Foundation’s clinical support program • 622 health professionals in Queensland have
includes a senior clinical role to lead and manage attended a Motivational Interviewing workshop
the program. This role drives policy into practice, • 269 health professionals across Queensland
delivers health professional training and produces have attended a one day Motivational Interviewing
educational resources for health professionals to intensive skill-building workshop
better support heart patients.
In collaboration with Queensland Health, general Health professionals report that as a result of
practice and other health stakeholders, the program their training:
aims to:
• “More patients will achieve better outcomes”
• improve self-management by people at risk of, or • “Patients play an active role in their
living with, heart disease or heart failure intervention and decide on the goals they
• provide educational resources and training wish to achieve, so outcomes are likely to
• provide access to the latest information for heath positively impact upon a person’s life and be
professionals and patients long lasting”
• improve access to cardiovascular prevention and
treatment
• assist people to identify and understand the
warning signs of heart attack
• inform and educate women about their heart
health risks
• evaluate clinical evidence and trends in health
care delivery
Training in behaviour change management,
in particular Motivational Interviewing, was
overwhelmingly requested by acute cardiac hospital
staff14, to assist their patients to better manage their
heart health. Motivational Interviewing is a technique
used by health professionals to support clients to
make healthy lifestyle changes (such as being more
active, improving their nutrition, quitting smoking or
losing weight) in order to help to self-manage their
chronic disease, including heart disease and heart
failure.
The Heart Foundation has since worked with
Australian Motivational Interviewing experts to
provide Motivational Interviewing training from 2009-
2011, including:
• 3,802 health professionals have received a
Professional Development Kit on Motivational
Interviewing
5
4. Increase the number of Queensland heart patients participating in cardiac rehabilitation
Annual Investment: $5 million
Commitment: Increase investment in cardiac rehabilitation services for all Queenslanders, including
an increase in funding for a comprehensive state-wide cardiac rehabilitation service and ongoing
funding of a State-wide Cardiac Rehabilitation Coordinator in Queensland Health.
Cardiac rehabilitation saves lives, improves People who attend cardiac rehabilitation improve
productivity and reduces hospitalisation and health their exercise tolerance, symptoms, cholesterol
costs. All Queensland heart patients deserve the levels, sense of wellbeing, their chances of quitting
opportunity to know about and participate in a smoking and their survival rates. Patients who
cardiac rehabilitation program, but three out of four don’t participate in cardiac rehabilitation have more
heart patients never receive cardiac rehabilitation adverse risk profiles and poorer knowledge of risk
services. factors19.
Cardiac procedures in Australia have increased Despite substantial evidence supporting the benefits
considerably from 1993-94 to 2007-08, with the of cardiac rehabilitation, attendance and participation
number of hospitalisations for heart attack increasing in existing programs is alarmingly low. In 200320,
by 80% and for unstable angina by 33%15. However, 70% of eligible patients in Queensland did not attend
once people are in hospital, they’re staying for a cardiac rehabilitation and this has not improved over
shorter time. This means that, more than ever, time16, due largely to a lack of dedicated funding and
people need cardiac rehabilitation support when they low referral rates21. Current cardiac rehabilitation
return home after a cardiac event.
services also fail to meet the needs of some
individuals and people at the highest risk of cardiac
Patient research shows that 86% of heart attack
events, including Aboriginal and Torres Strait Islander
survivors either don’t know or underestimate the
people22.
chances of a repeat event, fewer than one third
understand the chronic nature of their condition, one
The Health Quality and Complaints Commission’s
in four fail to maintain positive lifestyle changes and
Management of acute myocardial infarction on or
one in three stop taking their medication as directed7.
following discharge or transfer standard (2010)23
The Heart Foundation strongly supports the ten emphasises the need to ensure that all patients
recommendations from the State-wide Cardiac have access to lifestyle modification strategies and
Rehabilitation Reform Project and is calling are referred to a cardiac rehabilitation program on
for the allocation of adequate funding for their discharge. Clearly, these standards are not being
implementation. met.
The recent Deloitte Access Economics7 report
Reduce hospital re-admissions and health recommends that in response to the increase in
care costs the number of Australians dying from repeat heart
• more than 20% of people who have attacks, action is needed to provide:
previously had a heart attack are likely to
experience another heart attack or stroke 1. A structured framework for patients post hospital
within one to five years13 discharge for long term management and support
• after a heart attack, cardiac rehabilitation 2. 100 per cent referral to rehabilitation programs
reduces people’s chances of returning to and services with active follow up post discharge
hospital with another heart attack, but 3. High quality ongoing maintenance programs to
only 25% of people ever receive cardiac support lifestyle changes
rehabilitation services16 4. Access for patients to psychosocial support
services post event - and proactive follow-up post
event
Cardiac rehabilitation benefits people of all ages and 5. High quality information for patients and their
is associated with reduced hospital re-admissions, families to support sound decision making
better quality of life and improved symptoms .
Research has found a 35% increase in survival five
years after a heart attack or coronary artery blockage
among people who attended cardiac rehabilitation
compared with those who did not18.
6
5. Increase the access to and support from allied health professionals for Queenslanders living
with heart failure
Annual Investment: $ 2 million
Commitment: Increased funding for the state-wide heart failure multidisciplinary care program to
improve access to allied health professionals, especially psychologists and dietitians.
Heart failure is a chronic, progressive, incurable Multidisciplinary heart failure care includes25.
condition. It occurs when the heart muscle becomes
increasingly too weak to pump blood throughout the • biomedical care
• self-care education and support
body as effectively as normal. Heart failure is caused
• psychosocial care
by heart muscle damage from a heart attack, quite • palliative care
often because of patient delay responding to warning
signs, or by poorly managed high blood pressure, Many people whose condition is not managed
both of which are prevalent conditions. effectively continue to frequent hospital, often
unnecessarily.
The Heart Foundation represents the 60,000
The number of Queenslanders living with heart
Queenslanders who are living with heart failure24. failure will continue to grow and we need to manage
their care more effectively to improve their health
People living with heart failure need support from and quality of life and to reduce the soaring costs
a multi-disciplinary team of health professionals of hospital re-admissions. It is estimated that
in acute and primary health care to manage their heart failure accounted for 7.7% of avoidable
hospitalisations for chronic conditions in 2001-0226
condition. Heart failure has distressing symptoms
and, unless systematically addressed, the costs of
that can last and worsen for many months or years avoidable hospitalisations will significantly grow.
before people die. There is convincing evidence that
people who have been hospitalised with heart failure A comprehensive heart failure program is needed
and receive multidisciplinary care have better health in Queensland. The current state-wide heart failure
outcomes and fewer hospitalisations than those who service in Queensland provides 23 multidisciplinary
care services to patients with heart failure. However,
do not25.
10% of people over 65 will develop heart failure25 and
current heart failure services will simply not cope.
7
re reaches their end stage of life, access to palliative care service
eart Foundation is calling for improved access to palliative care ser
ailure.
6. Increase access to palliative care services in hospital and at home for people dying from heart
failure
achieve the best possible quality of life for the individual, their car
Annual Investment: $6 million
care does not depend on any specific medical diagnosis, but on th
Commitment: Increased investment in palliative care services for people dying from heart failure
because current services are inadequate.
f life by addressing physical symptoms such as pain or nausea, as
27
al andMany social needswho
people in Queensland .have
It also provides
heart failure, Recent physical and
national data show psychosocial
that 84% of all palliative s
a chronic, progressive and incurable condition, are care beds nationally are allocated for people with
dying without the support of palliative care services cancer but only 3% are allocated to people with
to assist their end of life. This is due to a lack of cardiovascular disease28. The Queensland data show
availability of heart failure beds in the acute hospital a similar trend, with 86% of all palliative care beds
at 84% of all palliative care beds nationally are allocated for people
setting, as well as poorly funded and resourced
services to support those who wish to die at home.
allocated for people with cancer, and only 3.4% to
28
cardiovascular disease. As a result, palliative care
eople with cardiovascular disease . The Queensland data show a
Once a person with heart failure reaches their end
services in Queensland are inadequate to support
bedsstageallocated
of life, access tofor people
palliative with
care services in cancer, and only 3.4% to cardiovas
the needs of the large and increasing number of
Queenslanders dying from heart failure.
Queensland is limited. The Heart Foundation is
vices inforQueensland
calling are inadequate
improved access to palliative care services to support the needs of the la
As well as a shortage of palliative care beds, there is
for people with end stage heart failure.
landers dying from heart failure. a lack of coordination of medical, nursing and allied
The aim of palliative care is to achieve the best services for people who are terminally ill with heart
possible quality of life for the individual, their carers failure. People with heart failure are increasingly
tive care beds, there is a lack of coordination of medical, nursing a
and their family. The need for palliative care does
not depend on any specific medical diagnosis, but
choosing to be cared for at home during the end
stages of life and need more support.
erminally ill with heart failure. People with heart failure are increasin
on the person’s needs27. It maintains quality of life
by addressing physical symptoms such as pain
g the end stages of life and need more support.
or nausea, as well as helping with emotional,
spiritual and social needs27. It also provides
physical and psychosocial support from diagnosis
to end-of-life care.
8
Foundation Regional Heart Health Program
Annual Investment: $150,000
Commitment: Investment
Regional HeartinHealth
the Heart Foundation’s Regional Heart Health Pro
Program
incidence of poor heart health in regional Queensland, including amongst Aborig
people.
7. Support Queenslanders living in regional and remote communities by investing in the Heart
Foundation Regional
TheHeart Health Program
state-wide Regional Heart Health Program aims to reduce the high burden
regional
Annual Investment: and remote Queensland, including Aboriginal and Torres Strait Islande
$150,000
Commitment: Investment in the Heart Foundation’s Regional Heart Health Program to reduce the high
The health
incidence of poor heart HeartinFoundation will provide
regional Queensland, strategic
including direction,
amongst Aboriginalleadership and operationa
and Torres Strait
Islander people. Queensland-wide program to prevent, manage and reduce the burden of heart a
disease in regional communities.
The state-wide Regional Heart Health Program aims The state-wide manager role will work to integrate
This Regional Heart Health Program will encompass:
to reduce the high burden of cardiovascular disease heart health priorities across the breadth of work by
management
in regional and remote• Queensland, and coordination
including of aFoundation;
the Heart team of Regional Heart
implementing theHealth
followingpositions
byIslander
Aboriginal and Torres Strait privatecommunities.
business. BHP Billiton Cannington
priority actions hasQueensland:
in regional agreed to fund a North Qu
Health Manager based in Townsville over the next three years. The Heart Fo
of six people working in regional Queensland and is seeking Queensland Go
The Heart Foundation will provide strategic direction, • Maximise the uptake of Heart Foundation Walking
state-wide manager role.
leadership and operational management of a groups
• strengthening
Queensland-wide program and maintaining
to prevent, manage relationships
• Improve with peak
tobacco control bodies and
implementation other rele
locally
Indigenous and mainstream
and reduce the burden of heart attack and other
health sectors to improve the heart health of reg
• Better hospital care for Aboriginal and Torres Strait
Queenslanders, including Aboriginal and Torres Strait Islander people.
cardiovascular disease in regional communities. Islander people experiencing heart attack
The state-wide manager role will work tothe
• Increase integrate
uptake ofheart health priorities
cardiovascular health across
Heart Foundation; implementing
This Regional Heart Health Program will encompass: the following priority actions
checks in primary healthcare in regional Queens
• Maximise the uptake of Heart Foundation
• Disseminate Walking
consumer groupsincluding; My
resources
• Improve tobacco control implementation
• management and coordination of a team of
locally
Heart, My Life and My Heart My Family Our
• Better hospital care for Aboriginal and Torres Strait Islander people experien
Regional Heart Health positions and operations Culture
• Increase the uptake of cardiovascular health checks in primary healthcare
to be funded by private business. BHP Billiton • Support the roll out of the Warning Signs of Heart
• Disseminate consumer resources including; My Heart, My Life and My Heart
Cannington has agreed to fund a North Attack campaign locally
• Support the roll out of the Warning Signs of Heart Attack campaign locally
Queensland Regional Heart Health Manager • Trial health professional education and training
• Trial health professional education and training program; Motivational Intervie
based in Townsville• over the next with
Integrate three the Queenslandprogram;
years. Motivational Interviewing Toolkit
Government’s Rheumatic Heart Disease Proje
The Heart Foundation aims to build a team of six • Integrate with the Queensland
• Advocate for the improved heart health of regional Queenslanders, Government’s including
people working in regional Queensland
Islander peopleand is Rheumatic Heart Disease Project
seeking Queensland Government funding for the • Advocate for the improved heart health of regional
state-wide manager role. Queenslanders, including Aboriginal and Torres
• strengthening and maintaining relationships with Strait Islander people
peak bodies and other relevant stakeholders
in both the Indigenous and mainstream health
sectors to improve the heart health of regional and
remote Queenslanders, including Aboriginal and
Torres Strait Islander people.
9Aboriginal and Torres Strait Islander Heart Health Program
8. Provide My Heart My Family Our Culture resources to health professionals and Aboriginal and
Torres Strait Islander heart patients to Close the Gap faster
Annual Investment: $200,000
Commitment: Investment in the state-wide dissemination of culturally appropriate heart health resources
for Aboriginal and Torres Strait Islander people who have had a heart attack, and those at high risk.
To Close the Gap on Indigenous life expectancy, it is • 94% of respondents believed the pack improved
critical that we improve the heart health of Aboriginal their client’s awareness and knowledge about
and Torres Strait Islander people. Cardiovascular prevention of heart disease and risk factors
disease is the biggest killer and the greatest single • 77% believed it improved their own awareness
contributor to the gap in life expectancy between • 65% of respondents had talked their clients
Aboriginal and Torres Strait Islander people and through the resources; not just distributed the
non-Indigenous Australians. Approximately 28% package
(146,000) of Australia’s total Indigenous population • 55% of respondents had personally handed out
resides in Queensland. the packs to their Indigenous patients
Death rates for coronary heart disease, mainly heart These resources are now ready to be further
attack, among Aboriginal and Torres Strait Islander developed and disseminated throughout Queensland
people in Queensland are about double non- Aboriginal and Torres Strait Islander communities.
Indigenous rates1. Significantly, Indigenous people Health professionals strongly believe that neither
aged 25-45 years are 15 times more likely to suffer
patients nor health services should have to pay for
from a fatal heart event than other Australians1.
these resources for a patient group with high need.
The Heart Foundation has developed the
My Heart My Family Our Culture education program
to address the critical shortage of targeted heart
health resources for Indigenous people and
communities. The resources include materials for
health professionals and for Indigenous people. The
development of My Heart My Family Our Culture
has involved a great deal of community consultation
and has been widely praised for its content and
usefulness.
The My Heart My Family Our Culture resources have
been successfully trialled and used in group settings
including family groups, as well as with individuals
in community and hospital settings. The resources
have evaluated well, receiving very positive feedback
from health professionals. It helped them to engage
appropriately with Aboriginal clients and they felt the
resources were culturally relevant and extremely
useful.
The evaluation of My Heart My Family Our Culture
among health professionals found that:
• 89% of respondents believed the pack helped
to communicate the message to the Indigenous
community
109. Invest in cardiac trials for Indigenous people by allocating existing Closing the Gap funds to
the State-wide Cardiac Clinical Network
Annual Investment: $1 million
Commitment: Allocation of existing funding through the Closing the Gap Implementation Plan to ensure
the significant gap in cardiac care for Aboriginal and Torres Strait Islander people is closed.
Existing funding urgently needs to be allocated to:
A report from the Australian Institute of Health
and Welfare30 found that compared with other
• conduct specific trials using multiple strategies in a
Australians, Aboriginal and Torres Strait Islander
cardiac setting such as Aboriginal Liaison Officers
people had:
in hospital cardiac wards, cultural competency
training and identification processes
• 3 times the rate of major coronary events,
• continue funding a full-time Queensland Health
such as heart attack
Coordinator role to progress these priority actions
• 1.4 times the out-of-hospital death rate from
in collaboration with the State-wide Cardiac
coronary heart disease
Clinical Network
• more than twice the in-hospital death rate
from coronary heart disease
Death rates for coronary heart disease among
• a 40% lower rate of being investigated by
Indigenous Queenslanders are about double those
angiography
for non-Indigenous people1. By reducing these death
• a 40% lower rate of coronary angioplasty or
rates to that of the total population, Indigenous
stent procedures
Australians could gain 6.5 potential years of life
• a 20% lower rate of coronary bypass surgery
expectancy29.
One area where significant gains could be made is
The Heart Foundation is advocating for the
in improving hospital care. There is strong evidence
implementation of 15 key recommendations31
that Aboriginal and Torres Strait Islander people who
to address these disparities in care. These
present to hospital with a heart attack do not receive
recommendations offer practical measures for
hospital care equivalent to other Australians with the
clinicians, health services and hospitals to deliver
same condition.
quality care.
Hospital care for Aboriginal and Torres Strait
Islander people continues to be inequitable and it
is essential that Queensland’s State-wide Cardiac
Clinical Network can access funds to conduct
cardiac trials specifically with, and for, Aboriginal
and Torres Strait Islander people. There is currently
no transparent mechanism to access Closing the
Gap Implementation Plan funding across multiple
strategies.
11Obesity and Healthy Living Program
10. Help older Queenslanders be active by supporting the Heart Foundation Walking program
Annual Investment: $250,000 ($750,000 over 3 years)
Commitment: Ongoing investment in the Heart Foundation Walking program. Current funding with the
Queensland Government, through Sport and Recreation Queensland, finishes on
30 June 2012.
Heart Foundation Walking provides Queensland’s
largest network of free community walking groups, Heart Foundation Walking Successes:
with 320 free walking groups and 4,800 regular
walkers. Over 20,000 Queenslanders have • 2000 new walkers recruited in 2011
participated over the past 12 years. We work in
• 49 local government regions covered
partnership with area coordinators in local agencies
to establish walking groups in local communities led • 17 shopping centre groups where
by volunteer walk organisers. people can walk in a safe air-conditioned
environment
Heart Foundation Walking is accessible to people • 3 remote Aboriginal and Torres Strait Island
who most need it and have few choices in physical groups run by local people (Torres Strait,
activity programs; including: Woorabinda Aboriginal Shire and Aurukun
Aboriginal Shire)
• previously inactive, older women and men • 3 Culturally and Linguistically Diverse
• people living in greater socio-economic walking groups (Ethiopian, Hazaran and
disadvantage Liberian women)
• people living alone or with relatively few social • 90% of participants continue to walk after
connections one year – much higher than the 50%
achieved by a typical community based
Free walking programs keep people out of hospital physical activity program at 6 months
and actively engaged in their community. A survey of
over 4,000 Queenslanders in the Heart Foundation’s
recent Heart Health Challenge found that 57% of Heart Foundation Walking has succeeded in
people said they would be more active if there were increasing people’s physical activity levels. Among
local walking or cycling groups near where they live. walkers who were still participating after 12 months33
we found that:
Heart Foundation Walking provides a safe, healthy
and social community environment. Of walkers • people who were sedentary when they joined
surveyed32, 85% reported the program is important increased their walking by 3 hours and their total
for their social and mental wellbeing and 94% for physical activity by nearly 4 hours per week
their physical wellbeing. This suggests that walkers • people who were insufficiently active when they
join for the health benefits, but stay for the social joined increased their walking by 1 hour and their
benefits. total physical activity by 2 hours per week
• people who were already sufficiently active when
they joined maintained their walking and total
physical activity levels.
Increasing the physical activity of adults who are
sedentary or insufficiently active, is one of, if not the
best, investments in public health. Heart Foundation
Walking achieves this.
1211. Invest in an ongoing campaign to increase fruit and vegetable consumption and
production
Annual Investment: $3 million
Commitment: Increased investment in social marketing campaigns to support healthier eating in our
community. The Heart Foundation is recommending that the successful Go for 2 and 5 campaign be
re-funded in Queensland due to its early success.
Only 8% of Queensland adults are eating enough Re-instating this campaign would support the
vegetables and fruit. Low intake of vegetables and implementation plan activities in the Social Marketing
fruit is estimated to cause 31% of heart disease and Initiative (SMI) of the National Partnership Agreement
11% of strokes1. To counteract this unhealthy trend on Preventive Health37, designed to complement
and the daily exposure to advertising of unhealthy the national social marketing campaign; Swap It,
foods, governments need to invest in evidence- Don’t Stop It. It would also help increase demand for
based social marketing to support people to make vegetables and fruit and provide economic benefit for
healthier food choices. Queensland farmers and regional communities.
Queensland’s new economic development
framework, Food for a growing economy, commits Economic benefits from increasing fruit and
to delivering evidence-based nutrition messages, vegetable intake from 3.5 serves to 4.6 serves
promoting fresh Queensland fruit and vegetables34. per day:
Ongoing campaigns to reduce smoking have been • estimated savings of $50 million per year
some of the most successful campaigns proving in acute treatment services throughout
that reductions are highly related to the levels of Queensland while Go for 2 and 5 was
media expenditure35. Well-funded, sustained media running36
campaigns rank second only to price increases as a • an extra $9.3 million in retail sales of fruit and
key to reducing smoking. vegetables in Brisbane in the first month of
the campaign38. The report concluded that
Like all social marketing campaigns, to achieve the Go for 2 and 5 campaign investment
ongoing behavioural change, enough money contributed to this positive impact on demand
needs to be spent. Based on 15 years experience • economic benefits would also be realised
in Australia and from international studies, it has from further spending on Go for 2 and 5
been recommended that media spending on QUIT by individuals and businesses through
campaigns should be high enough to achieve at least production gains in working, household
700 TARPS (Target Audience Rating Points) per activities and leisure, and by government
month35. through taxation gains as a result of people
not becoming ill or retiring from the workforce
The Go for 2 and 5 campaign successfully achieved prematurely39
its aim to increase fruit and vegetable consumption
with an increase from 3.5 serves to 4.6 serves per
day while the campaign was running; even though It has been estimated in Australia that an increase
the full four years funding was not spent ($4.4 million in two extra daily serves of vegetables or one
over 4.5 years). Queensland Health survey results extra daily serve of fruit per person would result
after the campaign showed36: in a decrease of 1,250 new cases of disease, 780
deaths, and 9,400 DALYs (Disability Adjusted Life
• 57% of survey respondents had tried to make Years) each year39. This would reduce the estimated
changes to their diet in the last two months and $206 million of national preventable ill-health sector
half of these said they had tried to eat more fruit costs in 2008 associated with inadequate fruit and
and vegetables vegetable consumption by 34% ($71 million).
• 91% of these reported they were successful
1312. Reform food policies to inform consumers:
a) Ban junk food advertising to children
b) Legislate kilojoule content on menu boards of fast food chains
Annual Investment: Low cost
Commitment: Instigate regulation and legislation to protect children and inform consumers about the
food they are eating. This kind of reform can bring about positive social change and support individuals
who want to make healthier food choices.
The next Queensland Government can effectively Australian children are being exposed to about 10
use legislation and regulation to protect children from food advertisements every day, most for unhealthy
junk food advertising and help Queenslanders make foods and the research concluded that this is
healthier choices by supporting legislation to provide contributing to the prevalence of childhood obesity by
nutrition information on menu boards. In addition, an estimated 10% to 28%45.
the Queensland Government should continue to Removing the advertising of foods and beverages
support federal reform to ensure a good front of pack high in sugar and fat from 7-8am and 3-9pm Monday
labelling system on nutrition content of the foods we to Friday and 6am-1pm Saturday and Sunday, was
buy in supermarkets. by far the most cost-effective of 13 interventions
assessed for reducing adolescent and childhood
Overweight and obesity are now the leading cause of obesity46.
premature death and disability in Queensland, with
1 in 3 adults overweight and 1 in 4 obese, and 1 in
4 children overweight or obese1 . Despite a target to
cut overweight and obesity in Queensland by one-
third by 2020, these rates have increased by 3.3%
for men and 6.3% for women40. Doing nothing is no
longer an option.
a) Ban junk food advertising to children
The Heart Foundation is seeking a commitment to
ban junk food advertising to children. Almost 90% of
people favour stronger government restrictions41.
Television advertising influences children’s food
preferences, purchase requests and consumption
patterns42 and most of the extensive marketing Advertising restrictions would also help to maximise
directed at children is for foods with a high content returns on government investment in social
of fat, added sugar and/or salt. Restricting television marketing campaigns as there would be less
advertising of high fat and/or high sugar food and competition with advertisements for unhealthy foods.
beverages was found to be one of the most cost- Research has found that advertising nutritious
effective, population-based interventions available foods promotes positive attitudes and beliefs about
today43. these foods, and yet we continue to see 73% of
all advertisements shown during kids programs
Despite the introduction of self-regulation by the promoting foods and drinks that are high in fat, salt
food industry in 2009, a recent study by the CSIRO44 and sugar, with little nutritional value47.
found that there has been no change in the level of
junk food advertising in the hours that most children
are watching television. Self-regulation is clearly not
working, so legislative reform is needed.
14d at home.
ACT,b) the legislation
Legislate for fast foodwould
chains toapply to cafés,
show kilojoule quick
As in NSW and service restaurants
the ACT, the legislation wouldand
apply snac
e outlets
contentinon Queensland
menu boards or 50 outlets nationally.
to cafés, quickFood outlets would
service restaurants and snack be
food requir
chains that have 20 or more outlets in Queensland or
The Heart Foundation is seeking political
of standard
commitment tofood items
pass the onlegislation
proposed their menu
to boards
50 outlets at the point
nationally. of sale.
Food outlets This
would be will he
required
pareensure
theQueensland
energy consumers
contentareofgiven meals and make
the same informed
to display choices
the kilojoule content about
of standard foodthe
itemsitem
on their menu boards at the point of sale. This will
ume.information on the kilojoule content of food on sale at
fast food outlets as consumers in NSW and the ACT.
help Queenslanders compare the energy content of
meals and make informed choices about the items
they purchase and consume.
umers, retailers will also need to display the total daily energy intake for com
To support the needs of consumers for
energy intake is 8700 kJ.
information about what they’re eating away
To further help consumers, retailers will also need to
display the total daily energy intake for comparison:
from home, the Heart Foundation published an The average adult daily energy intake is 8700 kJ.
u board is to make it quick and easy for The
theaimconsumer
independent review of the available evidence to
to understand how ma
of the menu board is to make it quick and
guide policy and legislation in this area48:
they choose the menu item. easy for the consumer to understand how many
• eating out has become part of our kilojoules they will consume if they choose the menu
item.
daily routine, but we often significantly
rt Foundation is calling for a full nutrition information panel for all standard foo
underestimate the energy in foods we buy,
his would give consumers a fuller pictureIn addition, the Heart Foundation is calling for a full
of what they’re eating, including sat
which is why it’s important to give people
nutrition information panel for all standard food items
d sugars and fibre.
the facts onsite and online. This would give consumers a fuller
• in 2009, 4.5 million Australians visited a fast picture of what they’re eating, including saturated fat,
food outlet (chain and independent store) trans fat, salt, added sugars and fibre.
on also wants to see incentives for the food industry to reformulate food recip
every day
The Heart Foundation also wants to see incentives
• food eaten away from home has been shown
king methods to make them healthier. An independent industry-funded, healt
for the food industry to reformulate food recipes,
to be more energy dense and of larger
n campaign is also needed. ingredients and cooking methods to make them
portion size than meals prepared at home48.
healthier. An independent industry-funded, health
driven consumer education campaign is also needed.
15that activity. Smart Moves requires that every student is provided an effective 3
every day at school. However, teachers often don’t feel adequately prepared to
need training and support. The Heart Foundation is calling for adequate teache
Movesphysical
13. Strengthen is successful.
activity and healthy eating in schools
Annual Investment: Low cost
The TravelSmart
Commitment: Strengthen measuresSchools program
to increase is activity
physical another and initiative to increase
healthy eating children’s ph
in our schools.
increase
Programs the number
such as Smart of children
Choices, Smart Moves andwalking,
TravelSmart cycling
Schoolsorhave
using
goodpublic transport
intentions, but to get
38 schools participated in the program and 135 schools will be targeted in 2012
have been less effective in their implementation.
While this program has achieved some success, progress will be slow while ch
School is an ideal setting for physical activity The TravelSmart Schools program is another
and healthyto large
eating volumes
initiatives. Whileofa fast traffic,
number of mostly made
initiative up of children’s
to increase concerned parents
physical activity dropping
levels.
need
initiatives have beensupportive legislation
introduced into Queenslandsuch as:
It seeks to increase the number of children walking,
schools, they• arereducing
not achieving their potential.
speed limits around schools
cycling orto 30kph
using public transport to get to and from
• increased
Too many children public ortransport
are still overweight obese. A services at discounted fares
school. In 2011, 38 schools participated in the
program and 135 schools will be targeted in 2012.
• 49incentives
national survey to leave
of 12,000 students cars
in years 8-11at home.
across 237 schools found that:
• 1 in 4 students are overweight or obese, with a
significantly higher rate in low socio-economic
areas
• 85% of students don’t engage in sufficient activity
for health
• 76% are not meeting the daily recommended
intake of four vegetable servings daily
• 59% are not meeting the daily recommended
intake of three servings of fruit daily
• 1 in 3 drink four or more cups of soft drink, cordial
or sports drink a week
• more than half (51%) tried a new food or
drink product in the past month that they saw
advertised
Smart Choices was introduced into Queensland
schools to ensure all food and drink supplied in state
schools reflects the Australian Guide to Healthy
Eating50 and the Dietary Guidelines for Children and
Adolescents in Australia51. This policy applies to all While this program has achieved some success,
situations where food and drink is supplied in the progress will be slow while children continue to be
school environment (tuckshops, vending machines,
exposed to large volumes of fast traffic, mostly made
school excursions, fundraising, classroom rewards,
up of concerned parents dropping their children to
sports days etc).
school. Parents need supportive legislation such as:
The Heart Foundation supports the strengthening of
Smart Choices to improve its effectiveness so that • reducing speed limits around schools to 30kph
all students benefit from healthier choices. Increased • increased public transport services at discounted
monitoring and accountability is essential. fares
• incentives to leave cars at home.
Smart Moves was introduced to increase student
participation in physical activity and to improve the
quality of that activity. Smart Moves requires that
every student is provided an effective 30 minutes
of physical activity every day at school. However,
teachers often don’t feel adequately prepared
to provide effective activities and need training
and support. The Heart Foundation is calling for
adequate teacher training to ensure Smart Moves is
successful.
16Active Transport and Congestion Busting Initiatives
14. Invest in a campaign to increase active travel participation (walking, cycling, public
transport) and public transport patronage
Annual Investment: $3 million
Commitment: Investment in a comprehensive campaign to encourage the benefits of public transport
and increase patronage. On average, people using public transport spend 41 minutes walking and/or
cycling as part of their daily travel, compared to 8 minutes per day for people using private transport 52.
Active travel and planning for healthy communities We urgently need to reduce car trips and introduce
must be a priority for a healthy Queensland measures to increase active travel for the health and
because of its great potential to reduce congestion economic benefits to our community. Congestion is
and pollution and increase the physical activity of not only inconvenient, but it’s costly. It’s estimated
Queenslanders. People who are not physically active that the social costs of congestion in Australia are
are more likely to have risk factors for heart disease rising strongly, to an estimated $20.4 billion by
and most other preventable chronic diseases. 202056.
Integrated land use and transport planning will
provide the best long term gains in levels of physical
Investing in congestion busting measures is also
activity.
popular with the community. An Auspoll survey57,
Practical guides for planners and legislators on commissioned by a consortium including the Heart
how to plan for healthier communities have been Foundation, found that 87% of Australians support
developed by the Heart Foundation in partnership government investment in addressing congestion
with government and planning stakeholders; Healthy and 85% want the Government to fund better
Spaces and Places53 and Queensland’s Active, planning to make walking and cycling for transport
healthy communities resources54. more convenient.
The Heart Foundation recommends that people An Australian Vision for Active Transport58, developed
achieve a minimum of 30 minutes a day of moderate- by key stakeholders including the Heart Foundation,
intensity physical activity for health. People who advocates for increased active transport with the
actively travel don’t need to find an extra 30 minutes following recommendations:
a day of physical activity, because they are achieving
it as part of their everyday life. 1. Reorientate transport policy to prioritise and fund
an integrated approach to walking, cycling and
A social marketing campaign to promote active
public transport
travel and these benefits should result in increased
2. Set clear goals and targets for walking, cycling
public transport patronage, cycling and walking;
thereby reducing congestion as well. Supportive and public transport use and ensure they are met
infrastructure and policy changes are also needed 3. boost funding for infrastructure that supports
to get the greatest benefit out of this campaign, active transport and monitor and evaluate this
including: investment
4. Provide programs that increase use of existing
• increase the capacity of the public transport and new active transport infrastructure – eg
system through more regular connected services school-based cycling education courses,
• make public transport more affordable community walking and cycling programs, social
• continue timetable improvements marketing initiatives
• prioritise infrastructure projects such as the Cross- 5. Support urban redesign through the Healthy
River Rail Project and station refurbishments. Spaces and Places Project53 to promote active
communities
Improving the affordability of public transport would 6. Introduce physical activity impact assessments
increase patronage, instead of current trends. Public on all planning and policy decisions
transport costs have increased by 48% in Brisbane 7. Support work-based programs and incentives to
over the last five years55. Affordability has had a encourage walking, cycling and public transport
further blow with a new 15% increase on fares from use; such as walk and ride to work programs,
1 January 2012. subsidised cycle fleets and bus passes
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