Health Issues in Local Governments

Smoking

Smoking kills an estimated 15,000 Australians and costs Australia $31.5 billion in social (including health) and economic costs (1). Tobacco smoking is the single largest preventable cause of premature death and disease in Australia (2).

Smoking prevalence rates have dropped continuously in Australia, due to increased taxes on cigarettes, plain packaging, strict advertising laws, and education and information campaigns such as the Quit Campaign (3). In a comparison of adult daily smoking rates from 2001 to 2014-15 total smoking rates dropped from 22.3% of the Australian population in 2001, to 14.7% in 2014-15 (1).  In Western Australia, the smoking rate is currently 11 per cent (3).

The Australian Council on Smoking and Health (ACOSH) encourages Local Governments to consider implementing actions in line with the ACOSH seven actions to achieve a Tobacco Free Western Australia by 2025:

1. Public education campaigns
  • Incorporate information about the harms of tobacco and benefits of smoke free environments in Council e-newsletter, website and other communications to raise awareness among staff, Councillors and the community.
  • Use World No Tobacco Day (31 May) and other health-related key dates as an opportunity to raise awareness of harms of smoking and promote specific smoke free events with staff, Councillors and the community through Community Development and Art programs.

2. Reduce smoking among Indigenous Australians and disadvantaged groups
  • When possible, promote and refer Indigenous community members to the local Tackling Indigenous Smoking (TIS) program within local Aboriginal Community Controlled Health Organisation for effective quitting support.
  • Encourage Aboriginal Community Controlled Health Organisations, Aboriginal community groups, and other disadvantaged groups receiving Council funding and/or using Council facilities (meeting rooms, parks, pools etc.) to implement smoke free initiatives.

3. Stronger enforcement of the legislation to prohibit sales to minors
  • In the absence of State reforms, liaise with the WA Department of Health to conduct periodical monitoring and enforcement of the legislation that prohibits sales to minors within the Local Government area.
  • When retailers are found to be selling tobacco to minors, report to the WA Department of Health for further action.

4. Reduce the availability of tobacco and increase license fees for tobacco sellers
  • Seek a Council resolution to advocate to the WA Department of Health to reduce the availability of tobacco within the Local Government area.

5. Eliminate community exposure to second hand smoke
  • Extend smoke free areas to outdoor public venues including public transport waiting areas, taxi ranks, outdoor child care facilities, the Council’s ticketed events, the Council’s Business District, pedestrian malls and shopping centre entrances.
  • Limit the use of electronic cigarettes in areas where smoking combustible cigarettes is prohibited.
  • Encourage not-for-profit organisations and community groups that receive Council funding and/or use Council venues (meeting rooms, parks, pools etc..) to implement smoke free events.

6. Encourage ethical investments and reject any donations from the tobacco industry
  • Encourage staff and Councillors to invest ethically, and ensure Council funds are not invested in tobacco companies or there subsidiaries; and
  • Develop and adopt a policy on ethical investment.(4)

Case Study: Yarning it up

The Public Health Advocacy Institute of Western Australia (Fairway), produces a yearly Indigenous Storybook, a document providing examples of community programs around WA which have positively influenced the health of the community, often with minimal funding. The eighth edition in Fairway’s Indigenous Storybook series featured a program for smoking cessation designed for metropolitan Aboriginal adults. The program, Yarning it up, is a workshop delivered across the South Metropolitan area by the South Metropolitan Population Health Unit in partnership with Derbarl Yerrigan Health Service (5).

The program uses two slogans to communicate their message: “Quitting tobacco is a journey. It was a journey of discovery now it is a journey of recovery” and “It took time to be a smoker so it takes time to be a non-smoker.”  Workshop sessions involve an explanation of the tobacco model and information is presented through sitting down and yarning. The sessions run for one hour, and include triggers and barriers to quitting smoking, a personal recovery plan and educational information in regards to tobacco. A list of support services is also provided.

Although there has not been long term data collection of the number of participants who have permanently quit smoking, the program regularly receives positive feedback for its gentle and relevant approach. The program has also produced and released a book highlighting the personal journeys and views on tobacco from former participants. The program was evaluated in 2014, and evaluators found that the program made significant progress in changing attitudes and increasing knowledge about smoking amongst the Aboriginal people of north and south metropolitan Perth (6). 

Aboriginal Health

As part of the longest continuing culture in the world, the Aboriginal and Torres Strait Islander (Indigenous) people of Australia have shown remarkable resilience and adaptability in the face of considerable adversity. However, despite a proud cultural heritage, the health of Indigenous people in Australia is substantially poorer than that of non-Indigenous people, and statistics on life expectancy for the two groups continue to be vastly different. For Indigenous people born in 2010-2012, life expectancy is estimated to be 10.6 years lower than that of the non-Indigenous population for males (69.1 years compared with 79.7) and 9.5 years for females (73.7 compared with 83.1) (7).   The leading cause of death in Indigenous Australians is circulatory disease, followed by cancer (8).  Indigenous people are more likely to die from cardiovascular diseases, cancer, diabetes, kidney disease, respiratory disease, suicide or in traffic accidents than non-Indigenous people (9).  The overall death rate for Aboriginal and Torres Strait Islander people is up to six times higher than for non-Indigenous people.

In his Apology to Australia’s Indigenous Peoples in 2008, Prime Minister Kevin Rudd set out a statement of intent to close the gap between Indigenous and non-Indigenous Australians on life expectancy, educational achievement and employment opportunities, and to halve the gap in infant mortality rates between Indigenous and non-Indigenous children (10).

The resulting Closing the Gap initiative set targets to increase the quality and length of life for Indigenous people and to decrease the gap between Indigenous and non-Indigenous people in Australia by 2031. Each year the Prime Minister releases a report which tracks progress towards the targets. The 2017 Prime Minister’s Closing the Gap Report showed that the target to close the gap in life expectancy by 2031 is not currently on track (11). One of the reasons for this is a reduction in deaths from circulatory disease has been offset by a rise in the Indigenous mortality rate from cancer, causing the gap to widen. However a 9% decline in smoking rates is expected to create improvements in health outcomes in the future. The target to halve the gap in child mortality by 2018 was also not on track in 2017. However, significant progress has been made, with the gap narrowing by 31 per cent from 1998-2015. In the report, the Government stated that improvements in key factors will continue to narrow the gap in the coming year (11).

PHAIWAs annual Children’s Environment and health Local Government Report Card Project included a category for Aboriginal Child Health, and in 2013-2015 the winner of this category was the City of Armadale. The City’s programs include Drug Aware Ignite basketball, a “sports based intervention program which offers the opportunity for young men and women to keep active, develop leadership skills, and gain formal qualifications and work alongside positive role models” (12).  In 2016, there were 423 participants registered in the program, with 87% identifying as Aboriginal or Torres Strait Islander (12). 

Fairway's Indigenous Storybook, a document providing examples of community programs around WA which have positively influenced the health of the community, includes examples such as
  • a health promotion board game invented by a doctor in the Kimberley, which shows players how their health choices can affect their lives; and
  • the Aboriginal Environmental Health Program in the City of Greater Geraldton, which assists with cleaning up homes and communities, and also promotes cleanliness in the community to slow the spread of illness (13).  
WA Local Governments can use the goals of the Closing the Gap project as well as examples from Fairway and Local Governments to create opportunities for education and healthy lifestyle encouragement for Aboriginal and Torres Strait Islander children and adults in their communities.

Chronic disease

Chronic diseases are non-infectious health conditions which usually have a number of contributing factors, develop gradually, and have long-lasting effects. Chronic diseases, including heart disease, stroke, some types of cancer, type 2 diabetes and lung diseases are the leading causes of death and disability in Australia. Other common chronic diseases include chronic kidney disease, oral diseases, osteoarthritis and osteoporosis. Many chronic diseases persist throughout the lifespan.

The prevalence of chronic diseases in Australia’s population is increasing. This has been attributed to lifestyle factors such as smoking, and poor diet, as well as early detection and improved treatments for diseases that previously caused death (3).

Lifestyle related risk factors for chronic diseased include tobacco smoking, harmful use of alcohol, overweight and obesity, physical inactivity and poor nutrition. These risk factors on their own may lead to illness, but if multiple risk factors are present, there is an increased risk of developing chronic disease (3). Once chronic disease is present, the severity of the disease can be reduced by avoiding those risk factors.

There are also links between mental health, chronic disease and risk of injury. People with chronic disease are more likely to report having a mental disorder than people who do not have a chronic disease, and people with mental illness are more likely to experience chronic diseases due to a higher prevalence of lifestyle risk factors. People with mental illness are also at greater risk of injuring themselves (accidentally or deliberately) and experiencing injury at the hands of others (3). 

Local Governments can address chronic disease within their communities by commencing or continuing to run programs which address physical activity, healthy eating, smoking and alcohol and drug use.

Climate Change

Anthropogenic climate change is the gradual change in the climate caused by the release of high levels of greenhouse gases as a result of human activity (14).   By 2012, the global average temperature had increased by 0.85 degrees Celsius over the previous 130 years (15).  The impacts of climate change include effects on the social and environmental determinants of health, such as clean air, safe drinking water, sufficient food and clean water (16). 

Climate change can also have a negative effect on health, through high air temperatures leading to increased deaths from cardiovascular and respiratory disease; increased pollen in the air causing asthma attacks; increased intensity and frequency of flooding causing contamination of freshwater supplies, heightened risk of water-borne diseases and increased breeding grounds for disease-carrying insects; longer transmission seasons of vector-borne diseases and to alter their geographic range;  and an increase of up to 250,000 deaths per year worldwide from malnutrition, malaria, diarrhoea and heat stress (15).

Climate change mitigation aims to reduce the extremity of climate change by reducing the emission of greenhouse gases and increasing carbon sequestration. Mitigation strategies include less car use, increasing the use of renewable energy and increasing the amount of trees planted to absorb carbon dioxide in the atmosphere (16). Local Governments are often involved in climate change mitigation through their environment and sustainability programs. Health programs in Local Governments also assist with climate change mitigation, through encouraging people to walk, cycle or use public transport rather than driving a car, and through campaigns which encourage their communities to eat healthily and growing their own food.

Climate change adaptation is the “adjustment or preparation of natural or human systems to a new or changing environment which moderates harm or exploits beneficial opportunities” (14). A number of Western Australian Local Governments have prepared a Climate Change Adaptation Plan to assist their community to address the risks they will face as the consequences of climate change become stronger.

The Town of Cottesloe’s Local Adaptation Action Plan 2011-2016 identified the most extreme risks climate change would pose to the Town as :

  • environmental water quality
  • vector management (mosquitoes)

Other key risks identified were:

  • threat to infrastructure from erosion, inundation and extreme storm events
  • impact of climate changes on infrastructure, drainage and waste water networks
  • impact on native bushland areas and landscaped gardens (17).

The Plan sets out the responsibility for the Town’s Principal of Environmental Health to monitor the key determinants affecting human health. Adaptation actions for vector management in the Town includes investigating mosquito complaints, and conducting follow-ups when required by the Department of Health. The action also includes cataloguing complaints regarding mosquito breeding in the Town’s records management system (18).

Other methods for Local Governments to address the public health implications of climate change include:

  • review their planning for climate change preparedness to ensure that public health implications are recognised and appropriate strategies are designed and implemented to ensure community resilience (19).
  • ensure enhanced social cohesion and social supports for people vulnerable to heat stress, such as older people living alone (19).
  • plant trees and creating greater canopy cover in urban areas to increase shading and cooling. The Alga Street Tree Discussion Paper recommends planting trees at regular intervals of 6 to 12 metres along both sides of the street as well as on median strips to provide valuable shading.  Increasing the access to the natural environment can also ‘help tackle mental health problems, boost physical activity, reduce overweight and obesity and reduce the incidence of coronary heart disease.’(20) 

Many of these suggestions were collected from the South Australian Public Health Plan, which has Preparing for Climate Change as a key priority. More information is available on the SA Health website .

Injury

Injury is the fourth leading cause of death and hospitalisation in Western Australia (21). In 2012, Western Australians experienced approximately 227,000 injury events that resulted in emergency department visits, hospital admissions, or fatalities (22).

Injuries occur at a substantial cost to the community. In 2012, injuries cost the WA health system almost $1.2 billion (22). When quality of life costs, loss of paid productivity, and long-term care costs are included, the cost of injury in WA in 2012 expands to almost $9.6 billion (22).
Injury involves intentional or unintentional harm to a person resulting from contact with an object, substance or another person, either through the transfer of excessive energy or the sudden absence of vital elements, such as oxygen (23,24). Current injury prevention priorities as outlined in the Western Australian Health Promotion Strategic Framework 2017-2021 include childhood injuries, falls in older adults, road crash, water-related injuries, and interpersonal violence (25).

Injuries are preventable, and Local Governments can take action on injuries by adopting a public health approach to injury prevention. The Public Health Advocacy Institute of WA  provides a resource (26) that guides Local Governments through the process of developing injury prevention programs, including needs assessment, partnership development, planning goals, objectives and strategies, program implementation, and program evaluation. The resource also provides case studies on Local Government injury prevention activities.

Injury prevention activities can target physical and social environments as well as individual and behavioural factors (23).  Injury Prevention in Western Australia: A Review of Statewide Activity for Selected Injury Areas (27) outlines a range of recent injury prevention activities in Western Australia and relevant risk and protective factors for injury.
Local Governments can obtain support for injury prevention activities from a number of non-government agencies and programs:

Injury Matters, formerly known as Injury Control Council of WA, leads the way in preventing injury and supporting recovery by providing programs and services that enable Western Australians to live long and healthy lives. Programs include Know Injury, Stay On Your Feet® and Road Trauma Support WA.

Know Injury provides Local Governments with knowledge, professional development, resources, and networking opportunities to support injury prevention in Western Australia. Know Injury can assist Local Governments to identify local injury prevention priorities, develop program evaluation skills, understand social marketing for injury prevention, and enhance knowledge on a range of injury areas, including community responses to violence, alcohol-related harm, and suicide and self-harm. 

Stay On Your Feet® provides Local Governments with information, free resources, grants, and support to reduce falls and fall-related injuries among older adults living in the community. Local Governments can take action to prevent falls by applying for a Stay On Your Feet® grant, distributing Stay On Your Feet® community resources and organising free peer-led presentations, or providing community-based strength and balance fitness programs for older adults.

Kidsafe WA can provide workshops and presentations to parent, carer and professional groups targeting child injury prevention to raise awareness of the risks of injury and tips to prevent these from occurring. Kidsafe WA has a range of resources available to order. The website provides more information on how Kidsafe WA can support Local Governments’ engagement with the community to prevent childhood injuries.

Royal Life Saving WA is the leading water safety education organisation in WA who aims to empower the community to be safe when they are in, on or around the water and to lead efforts to reduce the impact of drowning. Partnerships are integral to achieving their goals and Royal Life Saving WA have a number of opportunities available to work with local governments including:
  • Safety and risk management – home swimming pool safety (including pool barrier inspections), public swimming pool audits and inland waterway audits
  • Community education – toddler drowning prevention, alcohol and water safety, public swimming pool safety, swimming and water safety programs
  • First aid training
  • Research and data – drowning data, public swimming pool injury data, swimming and water safety participation data

The National Disability Insurance Scheme (NDIS)

The NDIS forms the most significant social service reform since Medicare was introduced in 1975. The NDIS was introduced as a response to the Productivity Commission’s 2011 Inquiry into Disability Care and Support in Australia, which found that there was “a significant level of unmet demand for disability services which impacts upon the lives of people with disability, their families and carers.” (28) 

Under the current system, State Governments contracted disability service providers to deliver specified services. This resulted in service provision varying across different states. The person receiving support was usually assigned to one disability service provider and restricted to the supports that agency provided, even when they wanted something different. It was also difficult for people to change service providers. The Inquiry described the shortcomings of the current system, and proposed a replacement system (28). The NDIS aims to provide people with disabilities with greater control over the services they access.

The Productivity Commission’s use of the word ‘insurance’ in the NDIS reflects the need to ensure that the community pools resources to provide reasonable long-term supports for people acquiring a significant disability (28). Individuals are assessed by the nature, frequency and intensity of their support needs, to determine whether they fit the criteria to access three tiers of services. A support co-ordinator will work with individuals to develop a personal plan about what they would like to achieve, and this plan is then translated into an individualised support package. Because the NDIS assigns funding to individuals, traditional service provider agencies will lose their government contracts and have to compete in a market environment to attract customers.

The NDIS has been trialled in various Australian sites over the last three years, and currently provides funding packages to more than 25,000 Australians under 65. The scheme will become fully operational in July 2019, at which time there will be approximately 460,000 recipients of funding packages (29).   

The roles of the NDIS would be to minimise the impacts of disability through:

  • promoting opportunities for people with a disability;
  • creating awareness by the general community of the issues that affect people
  • with a disability, and the advantages of inclusion; and
  • drawing on its data and research capabilities to engage with other agencies to improve public health and safety (30).

Under the NDIS, most people will receive an entitlement to particular supports, such as person-centred active support, aids and appliances. Individuals can decide which service providers to engage, or supports can be arranged by a disability support organisation. It is also possible for individuals to elect to have an individualised budget if they are able to manage their budget directly and wish to do so (30).

In July 2017, the NDIS will be formally launched in WA. On February 1, 2017, the State and Commonwealth Governments signed a bilateral agreement to formalise the local administration of the NDIS under a nationally consistent model. The bilateral agreement aims to ensure that all Western Australians with disability will have access to the NDIS and be entitled to the reasonable and necessary supports they need. Operational details of the locally-administered model will be co-developed with Western Australians to shape the NDIS to meet WA’s needs. The NDIS will be rolled out in WA over three years. The roll-out schedule by Local Government area is available on the Disability Services Commission website.
 

References

1. Australian Government. 2016. Tobacco Control key facts and figures. Department of Health. Retrieved on 27/3/17 from http://www.health.gov.au/internet/main/publishing.nsf/content/tobacco-kff 
2. Australian Government. 2013. Education: history of the National Tobacco Campaign. Department of Health. Retrieved on  http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-educat
3. Department of Health, Western Australia. 2012. WA Health Promotion Strategic Framework 2012–2016. Perth: Chronic Disease Prevention Directorate, Department of Health, Western Australia.
4. ACOSH. 2017. Seven Actions to achieve a Tobacco Free Western Australia by 2025. Retrieved on 25/5/17 from  https://s3-ap-southeast-2.amazonaws.com/juiceboxcreative-acosh/wp-content/uploads/2016/04/06041257/J664-ACOSH-7Actions8ppBrochure-r14.pdf 
5. PHAIWA. 2016. Indigenous Storybook 7E. Retrieved on 27/4/17 from http://www.phaiwa.org.au/wp-content/uploads/2015/12/The-WA-Indigenous-Storybook-7th-Edition.pdf
6. Evaluation of the Aboriginal Tobacco Control Project http://www.healthinfonet.ecu.edu.au/uploads/resources/29700_29700_tobacco-project-logic.pdf 
7. Australian Government. 2014. Life Expectancy. Australian Institute of Health and Wellbeing. Retrieved on 5/1/17 from http://www.aihw.gov.au/deaths/life-expectancy/
8. Australian Government. 2017. Closing the Gap: Prime Minister’s Report 2017. Department of Prime Minister and Cabinet. Retrieved on 22/2/17 from http://apo.org.au/files/Resource/dpmc_ctg-report-2017.pdf
9. Australian Indigenous HealthInfoNet (2016) Summary of Aboriginal and Torres Strait Islander health, 2015. Retrieved 23/3/17 from http://www.healthinfonet.ecu.edu.au/health-facts/summary
10. AIATSIS. 2017. Apology to Australia's Indigenous People. Retrieved on 21/4/17 from https://aiatsis.gov.au/explore/articles/apology-australias-indigenous-peoples
11. Australian Government. 2017. Closing the Gap: Prime Minister's Report 2017. Retrieved on 8/3/17 from http://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2017.pdf
12.   PHAIWA. 2016. 2015 Showcase: The Children’s Environment and Health Local Government Report Card Project.
13. PHAIWA. 2011. The West Australian Indigenous Storybook. The Kimberley and Pilbara Edition. Retrieved on 25/4/17 from http://www.phaiwa.org.au/wp-content/uploads/2015/12/The-WA-Indigenous-Storybook-1st-edition.pdf
14. United States Environmental Protection Agency. 2016. Glossary of Climate Change Terms. Retrieved on 25/3/17 from https://www3.epa.gov/climatechange/glossary.html
15. World Health Organisation. 2016. Climate change and health. Factsheet. Retrieved on 02/02/17 from http://www.who.int/mediacentre/factsheets/fs266/en/
16.UN Environment. 2016. Climate Change Mitigation. Retrieved on 25/5/17 from http://www.unep.org/climatechange/mitigation
17. Town of Cottesloe. 2011. Local Adaptation Action Plan 2011-2016. Retrieved on 22/2/17 from http://coastaladaptationresources.org/PDF-files/1187-Cottesloe-LAAP-2011.pdf 
18. Discussion with Town of Cottesloe 2/3/17
19. South Australian Government. 2014. South Australia: A better place to live.Retrieved on 16/1/17 from http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/legislation/public+health+act/state+public+health+plan
20.  WALGA. 2015. Street Trees Discussion Paper. Retrieved on 1/5/17 from http://www.walga.asn.au/Policy-Advice-and-Advocacy/Environment/Climate-Change/Climate-Change-Projects-and-Resources.aspx 
21.  Ballestas T, Xiao J, McEvoy S, Somerford P. The Epidemiology of Injury In Western Australia, 2000 - 2008. Perth: Department of Health WA; 2011.
22.  Hendrie D, Miller T, Randall S, Brameld K, Moorin R. Incidence and costs of injury in WA 2012. Perth: Chronic Disease Prevention Directorate Department of Health WA; 2016.
23. Sleet DA, Liller KD, White DD, Hopkins K. Injuries, injury prevention and public health. American Journal of Health Behavior. 28(Suppl 1):S6–12.
24. Li G, Baker SP, editors. Injury Research: Theories, Methods, and Approaches [Internet]. Boston, MA: Springer US; 2012 [cited 2017 Mar 2]. Available from: http://link.springer.com/10.1007/978-1-4614-1599-2
25. Chronic Disease Prevention Directorate. Western Australian Health Promotion Strategic Framework 2017 - 2021. Perth, WA: Department of Health; 2017.
26. Boss A, Stoneham M. Placing injury prevention on the Local Government agenda. Public Health Advocacy Institute WA. (Comissioned by Department of Health, Western Australia); 2014.
27. Department of Health, Western Australia. Injury Prevention in Western Australia: A review of statewide activity. Perth: Chronic Disease Prevention Directorate, Department of Health; 2015.
28. Productivity Commission 2011, Disability Care and Support, Report no. 54, Canberra.
29. Laragy, C. 2016. Understanding the NDIS: how does the scheme work and am I eligible for funding?
Retrieved on 4/1/17 from https://theconversation.com/understanding-the-ndis-how-does-the-scheme-work-and-am-i-eligible-for-funding-5872623. 30. Productivity Commission. 2010. Overview booklet – Inquiry report – Disability Care and Support. Retrieved on 4/1/17 from http://www.pc.gov.au/inquiries/completed/disability-support/report/disability-support-overview-booklet.pdf