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Targeting a growing problem

Centre for Health Economics researcher Dr Leonie Segal is studying publicly funded health initiatives to see which ones work, and why. The study results will influence future government spending on programs aimed at making Australians healthier. ROBYN ANNS reports.

Despite the millions of dollars spent by governments on the development and promotion of community health improvement programs, many of the schemes have never been comprehensively assessed for their effectiveness -- until now.

The Centre for Health Economics at Monash University has been commissioned by the Commonwealth Department of Health and Ageing to analyse the cost-effectiveness of a variety of publicly funded initiatives aimed at changing harmful lifestyle behaviours, specifically smoking, physical inactivity, poor nutrition and alcohol abuse.

Dr Leonie Segal: "If we can reduce obesity in Australia through effective campaigns, we can reduce health costs dramatically."
Photo: Melissa Di Ciero

Researcher Dr Leonie Segal says the centre is trying to ascertain what community health initiatives and education programs actually cost, what they achieve and which ones work best for the money spent on them.

The researchers have studied about 30 initiatives, launched between 1985 and 2003 in Australia, the US, UK and Europe. The initiatives include the UK Fighting Fit Fighting Fat media campaign aimed at weight reduction in the general population; an Australian workplace and community program called GutBusters to help men lose weight; the Active Script program in Australia, New Zealand and the UK in which GPs prescribed an exercise regimen for sedentary patients; a Western Australian media and community-based campaign to promote fruit and vegetable consumption; a national tobacco campaign to help Australian smokers quit; and a US mass media campaign to promote awareness of alcohol abuse and support for consumer reduction.

To assess the effectiveness of the initiatives, the researchers have employed the internationally recognised Quality Adjusted Life Year (QALY) methodology as the yardstick. QALYs measure numbers of years lived and quality of life during those years, using a sliding scale from zero (death) to one (perfect health).

Dr Segal says using QALY enabled the researchers to assess the health interventions equally in the area of their impact on mortality and quality of life, regardless of their mode of delivery. "This way, the government can use its health program budget more effectively," says Dr Segal.

But she says the government should also do more to support people once they adopt a government-promoted health regimen. "The message is getting through that people can improve their health by losing weight, giving up smoking, becoming more physically active and improving their diets. But that message is more effective if combined with direct assistance through professionals such as dieticians, peer group support or, if appropriate, prescription weight-loss medication."

Dr Segal says lifestyle highly influences the incidence and progression of the common chronic diseases of modern Western societies such as heart disease, type 2 diabetes, stroke, some types of cancers and arthritis.

"The most important of these lifestyle behaviours are physical inactivity, poor nutrition, tobacco smoking and alcohol abuse. While physical inactivity and a high fat diet are both independently significant, they are particularly important because, combined, they are responsible for our increasingly overweight population," she says.

Dr Segal identifies obesity as one of Australia's major health issues: "If we can reduce obesity in Australia through effective campaigns, we can reduce health costs dramatically. For instance, type 2, or adult onset, diabetes is a growing phenomenon in developed countries such as Australia, where obesity is common.

"In the first year after diagnosis, type 2 diabetes may cost the community about $1000 in treatment for a patient. That figure can blow out to $5000 a year over the next decade if the disease is unchecked, rising to more than $50,000 a year to treat any resultant renal (kidney) failure.

"However, if the patient loses weight in the early stages of the disease, the symptoms may resolve. In those at high risk of diabetes, losing weight can prevent or delay onset of the disease."

The centre will deliver the results of its health program evaluations to the federal government later this year.


For more information, visit the Health Econonmics unit website.