DEVELOPMENTS in the HEALTH

SECTOR and CANCER

MOGA/PCPA Joint Scientific Meeting Sydney -

13 August 2010

Professor Jim Bishop AO

Chief Medical Officer

Australian Government Department of Health and Ageing

Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)

7538

5004

4627

42104079 4063 3970

3793 3737 3696 36773540 3470

3359 33533129 3060 3008 2902 2870

2729 2687 2683

2151

1801 1781 1737

14371213

999852 767

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

1. Refers to insured population rather than resident population. 2. Current expenditure. 3. 2006. 4. 2007. Source: OECD, OECD Health Data, June 2010

Public expenditure on health Private expenditure on health

OECD HEALTH DATA 2010How Does AUSTRALIA Compare

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

SELF-ASSESSED PHYSICAL &MENTAL HEALTH, 2007

Source: AIHW Australia’s Health 2010

BROAD CAUSE MORTALITY TRENDS AUSTRALIA

Source: AIHW

All Cancer-

Mortality/Incidence ratios for selected countries -

2008

Source: IARC 2010.

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Kenya

Nigeria

Egypt

Viet N

amTurk

eyInd

iaChinaRuss

iaSou

th Afric

aGreec

eBraz

ilJa

pan

Czech

Rep

ublic

Italy

United King

domCana

daGerm

any

Sweden

New Zealan

dUSA

Austra

liaM

orta

lity-

to-in

cide

nce

ratio

MalesFemales

Changes in Deaths rates in Males using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

Changes in Deaths Rates in Females Using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

BREAST CANCER MORTALITY

NEJM 2005Source: NEJM 2005

Cancers with reducing death rates 1997 to 2006 –

all ages

Lung, -18.5Colon, -19.6 Prostate, -19.7

Leukaemia, -23.7

Stomach, -29.4

Head and Neck, -23.7

Bladder, -18.5

Testicular, -42.2

Breast, -13.8

Cervix, -38.3

NHL, -25.1

Unknown, -24.8

Rectum, -19.9

Bowel, -19.7

All cancers, -13.8

, -24.3

-18.5

Kidney, -24.1

, -15.2

-31.9

, -21.1

-19.0-19.0

, -18.9

-7.9

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

Male FemaleSource: Tracey et al, Cancer Institute NSW

FIVE YEAR SURVIVAL RATES -

2004

NSW

SEER

Non small cell lung 13% 14%

Colon 65% 67%

Rectum 66% 69%

Breast Cancer 89% 90%

Lymphoma (DL)

53% 53%

Source: Tracey et al –

Cancer Institute NSW

Projected YLLs

–

Three scenarios, Australia –

1980 to 2016

Source: Bishop et al –

Cancer Institute NSW

PROJECTED BURDEN of MAJOR DISEASE GROUPS, 2010

Source: AIHW Australia’s Health 2010

THE KEYS TO PREVENTION

0.0 2.0 4.0 6.0 8.0

Tobacco

Blood pressure

Overweight/obesity

Physical inactivity

Blood cholesterol

Alcohol

Fruit/vegetables

Illicit drugs

Air pollution

Unsafe sex

% DALYs

Total of 32%

Source: Table 4.1 AIHW Australia’s Health 2008

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

SMOKING IN AUSTRALIA

SMOKINGSTATUS

NSW VIC QLD WA SA TAS ACT NT AUS

Daily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6

Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3

Less than Weekly

1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5

Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1

Never smoked

56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4

National

Drug Strategy Household Survey 2007Source: 2007 Household Survey, Australian Government

AUSTRALIA’S RECORD IN TOBACCO CONTROL

Advertising Bans

Under the counter at retail sites

Banning smoking in restaurants, pubs and cars

Graphic warnings on cigarette packets

Anti-tobacco campaigns

Increase in tobacco excise

Plain packaging

OBESTITY INCREASING FOR ALL

Source: AIHW: Australia’s Health 2008

Increased Risk Body Fatness Oesophagus

Pancreas

Colorectal

Breast (PM)

Endometrum

Abnormal Fatness Colorectal

Reduced Risk Physical exercise Colon

SOURCE: World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007

OBESITY and CANCER

Total Cancer Cases and Deaths per year (1972 to 2036)

Source: Cancer Institute NSW

NSW Cancer Deaths, Major

Cancer Types (2007-2036)

Source: Cancer Institute NSW

Milestones in Cancer Control

Public health measures in smoking reduction , screening breast, cervix, bowel, health literacy

Adjuvant treatment of breast, lung and bowel cancer

New anti-cancer drugs and symptom control drugs

Cancer research changing practice

Cancer registries, data linkage and analysis

PRIORITY HEALTH AREAS

SOURCE: NHMRC Research funding 2010 facts book

PRIORITY HEALTH AREAS

HEALTH REFORM

PROPOSED STRUCTURES

National Health Performance Agency

National Pricing Authority

Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)

Preventative Health Agency

CURRENT INITIATIVES in

CANCER CONTROL

Australian health Survey

Tobacco Control initiatives

Cancer funding $2 billion 09/10

Four components run by ABS 2011-

2013

- Health Survey

-

ATSI Health Survey

-

Nutrition and Physical Activity Survey

-

Health measurement Survey

Around 50,000 participants

De-identified data available as summary statistics, tables

AUSTRALIAN HEALTH SURVEY

Integrated Cancer Centre ($526m) –

Camperdown and Parkville

Regional Cancer Centres ($560m) –

20 sites

announced

Digitalization of breast screening services

Access to new anti-cancer drugs ($613m)

Amalgamation Cancer Australia and NBOCC Programs

CURRENT INITIATIVES IN CANCER CONTROL

CLINICAL GUIDELINESSupports for Clinical Decision Making

Evidence Base

Highest Impact

Range of best practice tools

Successful implementation methods

Monitor and report

CLINICAL GUIDELINESHighest Impact

Greatest burden of diseaseGreatest harm from poor practiceGreatest demonstrated need:

-

New Standard of Care-

Proven variation in practice

Greatest time spent/cost to health system

Cancer Control in Australia is successful by international measures with more needed

Research breakthroughs have delivered population mortality reductions in Cancer

New research is needed in successful interventions for obesity, physical activity, diet and alcohol

Better methods of identifying susceptibility, early cancer and evidence-based interventions are urgently needed

CONCLUSIONS