Healthcare Assignment: Intervention Plan to Prevent NCDs in Tasmania

Question

Task: Healthcare Assignment Instructions: Develop a detailed evidence-based intervention plan to prevent non-communicable diseases in Tasmania. The Tasmanian Government report ‘The State of Public Health Report 2018’ provides a broad overview of the population, determinants of health and self-reported chronic conditions. You can choose to target the entire Tasmanian population or a geographic region for your planned intervention.
It is expected that you will design a complex intervention with multiple strategies. Construct an argument that will compel decision-makers to support and invest in your intervention plan.

Answer

Intervention summary statement
The intervention plan presented in this healthcare assignment focuses on combatting the increase reported chronic cases of various non-communicable diseases (NCDs) in the Tasmanian island in Australia which is occupied predominantly by aboriginal people. Most of the NCDs include chronic respiratory diseases, most cancers, cardiovascular diseases and diabetes which is a rising concern in Tasmania due to its poor health infrastructure. The intervention plan and its constituent strategies are mostly based on the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020. This provides a basic road map for the health authorities along with a set of policy options that would help reduce premature mortality from NCDs by 15% within the next 5 years (World Health Organization, 2016). Since the intervention plan would be focused mostly on Hobart and Southern Tasmania, catering to the chronic needs in this specific area would not take much time or effort. This is mostly a regional strategic approach that would promote well-being in the focused area. The intervention plan would target avoiding mortality and morbidity in the region, enhance the protective factors, minimize exposure to risk factors and minimize the underlying socio-economic burden of the NCDs. The strategic approaches that will be incorporated in the intervention plan focus on 4 specific areas. The first area is targeted towards the development of multisectoral policies and partnerships that help in NCD prevention and control. The second area would target to reduce the NCD risk factors while amplifying the protective factors (World Health Organization, 2011). The third area is the response of the Tasmanian health system to counter NCD and its risk factors. The final aspect is to conduct NCD surveillance and further research for academic programs.

Issue identification
The state public health report published by the Tasmanian government in 2008 provides the well-being and health statistics of the people which mostly comprise the aboriginal people. Despite significant growth in life expectancy of Tasmanians over the last few decades, there is still a considerable gap with Australia and the island state has the second-lowest life expectancy of all states and territories in the nation. There are areas like infant mortality and population mortality rates where Tasmania have shown a significant decline over the years. However, diseases whose incidence increases with age like cancerhave been experienced by the Tasmanians aged over 65. The data also shows that due to population ageing, there is a 30% increase in cases each year which is around 500 additional new cases for the Tasmanian population. This growth can be attributed to the lack of awareness of the disease in the region which results in people exposed to smoking, excess alcohol consumption, poor nutrition and a sedentary lifestyle (Mayige, Kagaruki, Ramaiya and Swai, 2011). Also, avoidable mortality which preventing death before the age of 75 has decreased despite the various intervention levels. This makes it evident that the current public health approach by the federal government is unable to offer the adequate quality of intervention plans in the Tasmanian regions. Additionally, there are other health inequalities in Australia that are quite prominent when it comes to Tasmania. The disability levels of the lower socioeconomic status groups, as well as the premature death rates, are quite high as compared to the most advantaged groups in society. It is due to these issues; the intervention plan needs to be incorporated for non-communicable diseases as it forms the majority of the chronic cases in Tasmania. Without immediate action, the difference in mortality rate between Tasmania and other states in Australia would grow even more and make the health inequalities wider. The targeted group for the intervention plan is focused on the people of indigenous origin which is 3.5% of the population and especially the Tasmanian aboriginals who are mostly exposed to underlying causes of NCDs.

Policy support
The intervention plan needs to be supported through sets of policies and strategies to ensure proper organizational implementation in the Hobart and southern Tasmanian region. One key strategic policy is to control tobacco for preventing NCDs and this should be emphasized as much as possible. Multiple priority action areas need to be addressed of which governance caters to the political support. Implementing public policies in sectors like environment, agriculture, transport taxation and education can influence NCD-related health. The strategic objective should be focused on reducing the inequalities across various socio-economic classes and improving health for all. Additionally, it is necessary to achieve coherence between the nutrition or health policy and trade or economic policies as there is a correlation between the two (Pan American Health Organization (PAHO), 2014).

Ensuring that the policymakers and experts are working together prevents any misconception about the evidence of findings regarding NCDs. Policies related to the prevention of NCDs and health promotion should also be prioritized and requires an organizational effort from the government. Tightening the pharmaceutical policies and preventing inappropriate use of medicines can reduce the risk factors associated with NCDs. For interventions on a population level, fiscal and marketing policies are key and can effectively influence the demand, access and affordability of trans fat food, alcohol and tobacco. As these constitute the primary factors behind the cause of NCDs, implementing coherent tax policies on all tobacco products can comprehensively reduce the usage. Salt, fats and sugars in food are to be targeted through nutrition policies as foods and beverages high in free sugar need to be reduced through public interventions (Machado et al., 2019).

The evidence base for the intervention
To effectively implement the intervention plan in Tasmania, it is necessary to determine its cost-effectiveness from existing systematic reviews. As stated earlier, the intervention plan is loosely based on the WHO global action plan 2013-2020 and would use a similar cost structure to make appropriate available resources. As the WHO action plan for the European region to prevent and control non-communicable diseases have already worked successfully, a similar strategic approach in the Tasmanian region could help with the basic guidelines. The priority areas that should be targeted with the intervention plan include governance andhealth systems. It is important to implement surveillance, research, monitoring and evaluation in the governance area as collecting data and analytics can act as indicators of success. Next, priority interventions are required at a population level where fiscal and marketing policies can help with the promotion of healthy consumption. Reformulating and improving products like salt, fats, and sugars should be reduced while also promoting active living and mobility (World Health Organization, 2020). Even clean air should be prioritized at the population level due to its influence on NCDs. Other priority interventions should also be targeted at the individual level for a more effective outcome. Cardio-metabolic risk assessment and management is necessary to control raised blood pressure which is a key risk factor for NCDs. These are indirectly linked to excessive use of tobacco and high cholesterol. Subsequently, early detection and effective treatment of major NCDs is also crucial as it can reduce the mortality from various cancers as well as reduce the burden of other NCDs. In the WHO European action plan, early detection of cancer revealed metastatic state in 30-40% of cases (World Health Organization, 2013). It is by raising awareness regarding the early signs and symptoms of NCDs among the general public, effective detection of diseases can be done. Another individual priority intervention can be incorporating vaccination and control of relevant communicable diseases. A lot of the NCDs are caused by infection from malnutrition and poor sanitation. Other supporting interventions can also help the process which includes the promotion of musculoskeletal and oral health as they might be linked to NCDs (Hunter and Reddy, 2013). Even promoting mental health is essential in this context as it would reduce the onset or exacerbation of NCDs (Cheema, Robergs and Askew, 2014). All of these approaches in the intervention plan have been successfully incorporated in the WHO European region and proven to be effective in terms of both cost and disease control. Each of the priority or support interventions mentioned for individual or population level either directly or indirectly influence the determinants of health problems in context to NCDs. It also provides the rationale behind the intervention approach that provides the theoretical underpinnings of the approaches. Incorporating a similar approach and action plan in the Tasmanian region can prove to be effective and help deal with the surge in NCDs over the years. It can also help reduce the inequalities with other Australian states in terms of health and well-being which showcases the access to healthcare for various socio-economic groups.

Context analysis
The context in which the intervention plan for Tasmania would be incorporated is a part of the global burden of non-communicable diseases. The growth of NCDs all across the globe is a major problem especially in neglected aboriginal regions like the Tasmania state of Australia. Being a burden to both theeconomy and health care systems, the increase of NCD is a major barrier for socio-economic development in many nations (World Health Organization, 2014). In 2008, about 36 million deaths can be attributed to NCDs of which 48% was from cardiovascular diseases, 21% from cancer, 12% from chronic respiratory diseases and 3.5% from diabetes (World Health Organization, 2016). According to the WHO, the estimated deaths from NCD would likely increase by 15% between 2010-20. The measure for the NCD burden can be derived by adding the years of life lost and years lived with a disability which is presented as Disability Adjusted Life Years (DALYs). Studies conducted in 2010 indicated that 54% of DALYs were attributed to NCDs which was only 43% in 1990 and gradually increased over the years.

In context to Tasmania, the average life expectancy of males were 77.4 years and females were 82.3 years which was the second-lowest for Australian states. The data available on the prevalence of population health risk factors in Tasmania is quite limited but the life expectancy gap would likely widen over time. This is predominantly due to the increased level of tobacco addiction by the young female population that resulted in poorer health outcomes (Freeman, Chapman and Storey, 2008). About 3.5% of the Tasmanian population comprises indigenous people and their average life expectancy is about 17 years less than the general population. For this reason, the intervention plan would be mostly focused on Hobart and Southern Tasmania as the majority of the aboriginal population is situated there. Also, the intervention plan can be an approach to address and implementation of practical measures to the inequity faced by the aboriginal people. Another key issue that Tasmania is currently facing is its ageing population as it is a challenge for meeting the service demands of health care delivery. As the need for health services increases considerably after the age of 65 due to the prevalence of chronic conditions, this ageing population might hinder the implementation of the intervention plan for the general population. Moreover, projections indicate that by 2040, about 30% of the Tasmanian population would be above the age of 65. As a result of this, the availability of resources in the health care system might tilt towards the elderly population and result in shifted focus from the general population. However, this barrier to implementing the intervention plan can be overcome by interacting directly with the key stakeholders of the intervention plan. This includes the policymakers in the federal government, health practitioners working closely with them and the community members. The policymakers are a part of the federal government and should deal with the development of policies and their implementation and promotion in the general population. Monitoring the policies would constitute a part of the government actions required for the plan (Boutayeb and Boutayeb, 2005). However, they need to work closely with the health practitioners and service providers to help develop policies derived from findings and research. The practitioners should also be in charge of the design of implementation of the intervention plan and can use a similar approach to the WHO European region. The community members can act for increasing awareness and ensuring more aboriginal people are exposed to early detection and treatment for a more effective outcome.

Aims and objectives
The intervention plan aims to considerably reduce the disease burden from NCD and avoid premature death by taking necessary preventive measures and actions while also improving the well-being and quality of life of the population in Tasmania.
The objectives of the intervention plan are as follows.

1. To take a systemic approach on the risk factors of the underlying causes of NCDs.
2. To improve the health care system in Tasmania and prevent and control NCDs more effectively.

Strategies
The strategies for implementing the intervention plan are divided into 4 lines of action and would cater towards 9 targets based on various success indicators.

These strategic lines of actions are as follows.
1. Reducing the NCD risk factors and emphasizing the protective measures for the diseases.
2. Surveillance and research for NCD for plans.
3. Development of multisectoral policies and partnerships resulting in NCD prevention and control.
4. Health system response to NCD and the associated risk factors.

As evident from the action plan of WHO in the European region, the early detection and prevention of NCDs are crucial to reducing the risk factors. This is where the Tasmanian health care system is unable to provide adequate resources or personnel and should be improved by the federal government intervention (Wagner and Brath, 2012). As for targeting the indigenous and aboriginal people to reduce inequity, it is necessary to involve the community members in the awareness process. Also, addressing the educational issues among the aboriginal population can help in the detection of early symptoms and reduce the risk factors.

Resources
The budget summary for the intervention plan has been presented below along with the resources required for the plan. The majority of the funding would be acquired from the federal government along with the help of external investments from the UN and WHO.

Evaluating impact
The indicators and expected outcomes of the intervention plan are presented below.

Indicators of Success
1. NCD prevention and control partners involved with the intervention plan.
2. Formulation of NCD policy documents.
3. Several stakeholders involved.
4. A total number of conducted meetings regarding sensitization.
5. Increase in budgetary allocations.
6. Increase in percentage of health coverage.

7. Establishing functional inter-ministerial committee for NCD.
8. Regions allocated for NCD funding.
9. The number of policy and decision markers sensitized.
10. Qualified staff allocated in the NCD section.
11. The number of health facilities with Integrate NCD services.
12. NCD community groups established.
13. The number of hospitals with rehabilitation services.

Expected Outcomes
1. Attracting other partners for future intervention plans to NCD prevention and control.
2. Adequate funding of the intervention plan and its appropriate functioning.
3. Improved access to health care finance mechanisms in context to NCD.
4. Well-coordinated operation of NCD activities.
5. Implementing NCD prevention and control activities.
6. A 30% reduction in mean salt consumption.
7. NCD health education implemented in schools.
8. Increased community awareness of healthy food.

References.
Boutayeb, A. and Boutayeb, S., 2005. The burden of non-communicable diseases in developing countries. International journal for equity in health, 4(1), pp.1-8.

Cheema, B.S., Robergs, R.A. and Askew, C.D., 2014. Exercise physiologists emerge as allied healthcare professionals in the era of non-communicable disease pandemics: a report from Australia, 2006–2012. Sports Medicine, 44(7), pp.869-877.

Freeman, B., Chapman, S. and Storey, P., 2008. Banning smoking in cars carrying children: an analytical history of a public health advocacy campaign. Australian and New Zealand journal of public health, 32(1), pp.60-65.

Hunter, D.J. and Reddy, K.S., 2013. Noncommunicable diseases. New England Journal of Medicine, 369(14), pp.1336-1343.

Machado, P.P., Steele, E.M., Levy, R.B., Sui, Z., Rangan, A., Woods, J., Gill, T., Scrinis, G. and Monteiro, C.A., 2019. Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: vidence from a nationally representative cross-sectional study. BMJ Open, 9(8), p.e029544.

Mayige, M., Kagaruki, G., Ramaiya, K. and Swai, A., 2011. Non-communicable diseases in Tanzania: a call for urgent action. Tanzania Journal of Health Research, 13(5).

Pan American Health Organization (PAHO), 2014. Plan of Action for the Prevention and Control of Noncommunicable Diseases in the Americas 2013-2019. Wagner, K.H. and Brath, H., 2012. A global view on the development of non-communicable diseases. Preventive medicine, 54, pp.S38-S41.

World Health Organization, 2011. Scaling up action against noncommunicable diseases: how much will it cost?

World Health Organization, 2013. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization. World Health Organization, 2014. Global status report on noncommunicable diseases 2014 (No. WHO/NMH/NVI/15.1). World Health Organization.

World Health Organization, 2016. Action plan for the prevention and control of noncommunicable diseases in the WHO European Region. Proceedings of the Regional Committee for Europe 66th Session.

World Health Organization, 2016. Action plan for the prevention and control of noncommunicable diseases in the WHO European Region. Proceedings of the Regional Committee for Europe 66th Session.

World Health Organization, 2020. Noncommunicable diseases: Progress monitor 2020. World Health Organization.