What will it take to improve prevention of chronic diseases in Australia? A case study of two national approachesSonia Wutzke A B D , Emily Morrice A B , Murray Benton C and Andrew Wilson A B
A The Australian Prevention Partnership Centre, Ultimo, NSW 2007, Australia. Email: firstname.lastname@example.org
B Menzies Centre for Health Policy, University of Sydney, NSW 2006, Australia. Email: email@example.com
C Inca Consulting Pty Ltd, Sydney, NSW 2000, Australia. Email: firstname.lastname@example.org
D Corresponding author. Email: email@example.com
Australian Health Review 41(2) 176-181 https://doi.org/10.1071/AH16002
Submitted: 6 January 2016 Accepted: 20 April 2016 Published: 16 June 2016
Objective Despite being a healthy country by international standards, Australia has a growing and serious burden from chronic diseases. There have been several national efforts to tackle this problem, but despite some important advances much more needs to be done. From the viewpoint of diverse stakeholders, the present study examined two approaches to controlling chronic disease in Australia: (1) the 2005 National Chronic Disease Strategy (NCDS); and (2) the 2008 National Partnership Agreement on Preventive Health (NPAPH).
Methods Individual and small group semistructured interviews were undertaken with 29 leaders across Australia, reflecting a diverse cross-section of senior public health managers and program implementation staff from state and territory health departments, as well as academics, thought leaders and public health advocates. A grounded theory approach was used to generate themes relevant to the research.
Results There is general support for national approaches to the prevention of chronic disease. The NCDS was viewed as necessary and useful for national coordination, setting a common agenda and serving as an anchor to align jurisdictional priorities and action. However, without funding or other infrastructure commitments or implementation plans, any expectations as to what could be meaningfully achieved were limited. In contrast, although jurisdictions welcomed the NPAPH, its associated funding and the opportunity to tailor strategy to their unique needs and populations, there were calls for greater national leadership as well as guidance on the evidence base to inform decision making. Key aspects of successful national action were strong Australian Government leadership and coordination, setting a common agenda, national alignment on priorities, evidence-informed implementation strategies, partnerships within and across governments, as well as with other sectors, and funding and infrastructure to support implementation.
Conclusions Both the NCDS and NPAPH were seen to have overlapping strengths and weaknesses. A key need identified was for future approaches to focus on generating more sustainable, system-wide change.
What is known about the topic? Despite some important advances, chronic diseases remain Australia’s greatest health challenge. In efforts to tackle this increasing burden from chronic diseases, several large-scale, national initiatives have been released in Australia over recent years, including the 2005 NCDS and the 2008 NPAPH.
What does this paper add? From the viewpoint of practitioners, policy makers, advocates, researchers and public health thought leaders, this paper examines the usefulness and significance of the NCDS and NPAPH as national initiatives for achieving improvements to the prevention of chronic disease.
What are the implications for practitioners? By better understanding how previous countrywide chronic disease initiatives were viewed and used at national, state and local levels, this research is well placed to inform current, planned and future large-scale, population-level health initiatives.
References National Preventative Health Taskforce. Australia: healthiest country by 2020 – National Preventative Health Strategy – Overview. Canberra: Commonwealth of Australia; 2009.
 Australian Institute of Health and Welfare (AIHW). Australia’s welfare 2015. Australia’s welfare series no. 12. Catalogue no. AUS 189. Canberra: AIHW; 2015.
 Institute for Health Metrics and Evaluation. DALY estimates for Australasia. 2014. Available at: http://www.healthmetricsandevaluation.org [verified 5 January 2016].
 Council of Australian Governments. Better health for all Australians. Action plan. Canberra (AUST): COAG; 2006].
 Australian Government Department of Health and Ageing. COAG – Reducing the risk of type 2 diabetes. 2007. Available at: https://www.health.gov.au/internet/budget/publishing.nsf/Content/BC9E49EDBCEFB951CA257CA0003FF4CC/$File/hfact31.pdf [verified 5 January 2016].
 Council of Australian Governments. National Healthcare Agreement 2012. 2012. Available at: http://www.federalfinancialrelations.gov.au/content/npa/healthcare/national-agreement.pdf [verified 5 January 2016].
 Australian Government, Department of Health. National Public Health Partnership’s Nutrition Strategy and Action Plan – Eat Well Australia, 2000–2010. 2000. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-food-nphp.htm [verified 5 January 2016].
 Commonwealth of Australia. National Tobacco Strategy, 2004-2009: The Strategy. 2004. Available at: http://apps.who.int/fctc/reporting/Australia_annex7_national_tobacco_strategy2004_2009.pdf [verified 5 January 2016].
 National Public Health Partnership. Be Active Australia: A Framework for Health Sector Action for Physical Activity. 2005. Available at: http://www.hnehealth.nsw.gov.au/hneph/physical%20activity/Documents/be-active-australia.pdf [verified 5 January 2016].
 Commonwealth of Australia. Healthy Weight 2008. Australia’s Future: The National Action Agenda for Children and Young People and their Families. 2003. Available at: http://www.healthyactive.gov.au/internet/healthyactive/publishing.nsf/Content/healthy_weight08.pdf/$File/healthy_weight08.pdf [verified 5 January 2016].
 National Health Priority Action Council. National chronic disease strategy. Canberra: Australian Government Department of Health and Ageing; 2006.
 Council of Australian Governments. National partnership agreement on preventive health. Canberra: Commonwealth of Australia; 2008.
 Australian Institute of Health and Welfare (AIHW). Australia’s health series no. 14. Catalogue no. AUS 178. Canberra: AIHW; 2014.
 Australian Government, Department of Health. National Strategic Framework for Chronic Conditions Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc [verified 5 January 2016].
 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19 349–57.
| Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.CrossRef | 17872937PubMed |
 Biggs A. Budget review 2014–2015: health funding agreements: Parliament of Australia. 2014. Available at: http://www.aph.gov.au/about_parliament/parliamentary_departments/parliamentary_library/pubs/rp/budgetreview201415/healthfunding [verified 5 January 2016].
 World Health Organization (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO; 2013.
 Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Milbank Q 2012; 90 421–56.
| Large-system transformation in health care: a realist review.CrossRef | 22985277PubMed |
 Swanson RC, Cattaneo A, Bradley E, Chunharas S, Atun R, Abbas KM, Katsaliaki K, Mustafee N, Meier BM, Best A. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan 2012; 27 iv54–61.
| Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change.CrossRef | 23014154PubMed |
 Best A, Saul J. Complexity and lessons learned from the health sector for country system strengthening. Background paper for the USAID Experience Summit on strengthening country systems. West Vancouver: InSource Research Group; 2012.
 Spicer N, Walsh A. 10 best resources on the current effects of global health initiatives on country health systems. Health Policy Plan 2012; 27 265–9.
| 10 best resources on the current effects of global health initiatives on country health systems.CrossRef | 21551120PubMed |