Output 1.3 Public Health Services
Improving the health status of the ACT population by:
- reducing the susceptibility to illness using interventions to promote behaviour changes
- altering the ACT environment to promote the health of the population
- promoting interventions that remove or mitigate population health hazards.
This includes programs to:
- evaluate and report on the health status of the ACT population
- assist in identifying particular health hazards
- apply measures to reduce the public health risk from communicable diseases, environmental hazards and the supply of medicines and poisons.
|Output 1.3: Public Health Services|
|Compliance of licensable, registrable and non-licensable activities at time of inspection||85%||76%1||85%|
|Response time to environmental health hazards, communicable disease hazards relating to measles and meningococcal infections and food poisoning outbreaks is less than 24 hours||100%||97%||100%|
The Population Health Division is headed by the Chief Health Officer, who is appointed under the Public Health Act 1997 and reports to the Director-General of ACT Health. The Chief Health Officer is required to report biennially on the health of the ACT population and address specific health-related topics. This is done through the Chief Health Officer's Report.
The Population Health Division has primary responsibility for the management of population health issues in ACT Health. The division undertakes the core functions of prevention, assessment, policy development and assurance, and contributes to local and national policy, program delivery and protocols on population health issues.
The Health Improvement Branch (HIB) is responsible for policy and program delivery in the areas of health promotion and preventive health. The HIB also collects, analyses and disseminates information on the health status and health-related behaviours of the ACT population, which can be used to monitor, evaluate and guide health planning and policy.
The Health Protection Service manages risks and implements strategies for the prevention of, and timely response to, public health incidents. This is achieved through a range of regulatory and policy activities in areas such as food safety, communicable disease control, environmental health, emergency management, pharmaceutical products, tobacco control and analytical services.
The Office of the Chief Health Officer (OCHO) is responsible for providing public health advice, both internally and externally to the division, and undertaking high-level project and policy work on behalf of the Chief Health Officer.
Policy priority areas for the OCHO include gene technology, climate change, the whole-of-government Healthy Weight Initiative, and the whole-of-government Initiative on Injury Prevention.
- The Population Health Division fulfilled its statutory and national reporting requirements for 2013-14. These included the collection of data for, and maintenance of, the ACT Cancer Registry and Maternal and Perinatal Data Collection. The Population Health Division fulfilled national reporting requirements on public health expenditure, cancer incidence and mortality, and maternal and perinatal statistics for the ACT.
- On 20 June 2014, the Acting ACT Chief Health Officer released the ACT Chief Health Officer's Report 2014. The report is a legislated requirement under the Public Health Act 1997 and profiles the health of the ACT population, including mortality, morbidity, health-service use and social factors influencing health. The report is to be tabled in the Legislative Assembly in August 2014 in accordance with the act.
- The Population Health Division published three health series publications in the reporting period:
- Health status of children in the ACT: Results from the 2007-10 ACT General Health Survey
- Substance use and other health-related behaviours among ACT secondary students: Results of the 2011 ACT Secondary Students Alcohol and Drug Survey
- Perinatal mortality in the ACT, 2006 to 2010.
The results of these three reports are supporting informed policy and program development across the ACT.
- The Population Health Division has a survey program that supports the monitoring of ACT population health trends. Survey results are published in a number of reports and health series publications, which are used to inform health policy and program development. The survey program includes:
- the ACT General Health Survey, a telephone computer-assisted technology household survey which collects information on a range of factors influencing health status
- the ACT Secondary Students Alcohol and Drug Survey, a classroom-based questionnaire conducted every three years, collecting information on risk behaviours of ACT secondary school students, including alcohol, tobacco and illicit drug use
- the ACT Year 6 Physical Activity and Nutrition Survey, a classroom-based questionnaire conducted every three years on children's weight status, physical activity and nutrition.
- In 2013-14, the Population Health Division continued to strengthen its quality systems in population health data collection and reporting. This included continuing work on the development of systems for the electronic transmission of maternal and perinatal data in the ACT and ongoing collaboration with maternal perinatal data providers to improve the accuracy, completeness and timeliness of data provision.
- The Population Health Division continued to build local capacity in data linkage between key population health data collections by updating and extending the data collections available for linkage. The division experienced a significant increase in requests for access to data for linkage projects, most likely driven by increased awareness of the facility and increased availability of data for linkage. To ensure the best practice management of access to data for linkage projects, staff received training on ethics and data linkage.
- Since 1 September 2013, all food businesses in the ACT have been required to appoint a food safety supervisor. The food safety supervisor is responsible for ensuring that hygiene and food safety standards are achieved and maintained in food businesses. This requirement ensures a trained food safety supervisor is able to provide food safety advice and guidance at each registered food business.
- In February 2014, a team of nine public health officers conducted food inspections during the three-day National Multicultural Festival. Inspections were conducted to minimise the risk to public health from poor food handling and to ensure food handlers were aware of safe food-handling processes. More than 200 inspections were conducted during the event. Public health officers routinely looked for potential breaches of the Food Act 2001 that would give rise to unacceptable food safety risks, including inadequate temperature control, poor handwashing facilities and inappropriate food storage. A number of food safety breaches were identified, resulting in six incidents of voluntary disposal of food. No food was seized.
- Prior to the event, public health officers undertook two information sessions for community stallholders. One session provided important food safety requirements and compliance information. In the second, which was requested by the South Pacific Islander community, information was provided on food safety and the exemption granted under the Medicines, Poisons and Therapeutic Goods Act 2008 for the consumption of kava at the National Multicultural Festival. Food safety requirements also applied to the consumption of kava, including the use of ladles and single-use cups.
- The Health Protection Service updated the food stall guidelines for the National Multicultural Festival. The guidelines help food stall organisers meet food safety requirements. The food stall guidelines include:
- a checklist for operators
- a fact sheet on the set-up of food stalls and facilities required
- a fact sheet on food handling and food safety.
The Health Protection Service has translated the documents into 11 languages to improve food stall operators' understanding of food safety requirements at future festivals.
- The Population Health Division has expanded the ambient air monitoring network by establishing an Ambient Air Quality National Environment Protection Measure Performance Monitoring Station in the Belconnen region. This station will assist with policy development on, and the assessment of, ambient air quality. The station became operational in Florey at the end of February 2014.
- The Population Health Division undertook public consultation on options to expand the Medicines Advisory Committee and change the requirements for prescribing controlled medicines under the Medicines, Poisons and Therapeutic Goods Act 2008. The consultation found most stakeholders supported an expansion of the Medicines Advisory Committee membership from three to seven members and the streamlining of controlled medicine prescribing through the use of a standing controlled medicines approval.
- In response to previous consultation outcomes, the Health Protection Service amended the Medicines, Poisons and Therapeutic Goods Regulation 2008 to enable the ACT to carry out Commonwealth Government initiatives for the continued dispensing of Pharmaceutical Benefits Scheme medicines in defined circumstances and the supply and PBS claiming of medicines from standardised medication charts in residential aged care facilities.
- The Health Protection Service received external funding to conduct a desktop exercise to test the public health response to a deliberate water contamination event in the ACT. The Health Protection Service formed a working group with the Australian Federal Police, ACT Policing and ACTEW Water to develop the exercise concepts. The exercise was conducted on 16 May 2014 at the National Museum of Australia and was attended by representatives from the Population Health Division, Canberra Hospital and Health Services, Calvary Healthcare ACT, ACTEW Water, the Australian Federal Police, ACT Policing, the ACT Ambulance Service and stakeholders from the ACT Government. A number of issues were raised and lessons learnt from the exercise, and the report highlighted issues and made recommendations to strengthen future responses.
- In June 2014, the Health Protection Service responded to a case of meningococcal disease in an Australian Defence Force Academy Officer Cadet. In accordance with national guidelines, the Health Protection Service worked closely with Australian Defence Force Academy personnel to identify close contacts of the case and distribute information about meningococcal disease to the broader Australian Defence Force Academy community. Twelve contacts were provided with clearance antibiotics. Since 2004, there have been 40 notifications of meningococcal disease in the ACT, including this case. Prior to this case, the last case in the ACT was in July 2013. There has been a significant reduction in the incidence of invasive meningococcal disease in the ACT since the introduction of the meningococcal C vaccine in 2003.
- In 2013-14, two cases of measles were notified in the ACT. One person acquired their infection overseas and the other case was linked to an overseas-acquired case. An increase in overseas-acquired measles cases was also observed nationally in 2013-14, highlighting the importance of measles vaccination, especially prior to overseas travel. The Health Protection Service investigates and implements disease control measures for each confirmed case of measles under national guidelines. Since the beginning of 2009, 25 cases of measles have been notified in the ACT, of which 13 were associated with an outbreak linked to a school in late 2011.
- The Health Protection Service hosted a forum for the staff of aged care facilities on 8 May 2014. The primary aim of the forum was to provide the facilities with information to increase their preparedness for influenza season. It covered topics such as infection control measures, surveillance data and outbreak management. Presenters at the forum included staff from the Health Protection Service and Canberra Hospital. More than 22 people from ACT aged care facilities attended the forum.
Issues and challenges
- The Population Health Division implemented new confirmation methods for food pathogens. In recent years, there have been major food-borne outbreaks of gastrointestinal illness. The introduction of these new confirmation methods will help to reduce testing turnaround times, deliver better responsiveness, and provide the community and businesses with an improved outcome.
- Since 1 September 2013, all food businesses in the ACT have been required to appoint a food safety supervisor. Some non-profit community organisations were adversely affected by this regulation due to the costs associated with training a food safety supervisor. On 21 November 2013, the Minister for Health, Katy Gallagher MLA, announced that community organisations operating temporary food stalls selling lower-risks foods, such as barbeque foods, would be exempt from the requirement to register as a food business and have a food safety supervisor.
- The 2011 Auditor-General's Report identified the need to address a shortage of skilled environmental health officers in the ACT. ACT Health collaborated with the University of Canberra to establish a local accredited environmental health course. However, due to insufficient enrolments, the Bachelor of Environmental Health course did not proceed. Students who had enrolled in the course were transferred to other science-based courses at the university.
- A large-scale public health response was required to comply with a national Therapeutic Goods Administration directive issued on 1 May 2014 to quarantine batches of the anaesthetic Propofol. The national quarantine was called due to suspected contamination of certain batches of Propofol with the bacteria Ralstonia pickettii. The Health Protection Service coordinated the ACT response to the national directive through activation of the Emergency Operations Centre from 2 to 6 May 2014. Significant liaison and coordination with stakeholders was required to identify potential users and stock holdings among ACT hospitals, dental surgeries and day procedure units. Ongoing liaison was required to determine territory holdings of the quarantined batches and stock holdings of usable alternatives to ensure surgical service provision was not adversely affected. A multi-agency after-action review was conducted at the Health Protection Service on 14 May 2014. A number of recommendations arose from the review. The Health Protection Service will work with stakeholders to address the issues raised to improve arrangements for future responses.
- A multi-agency health response was required to investigate and manage cases of a toxicological syndrome consistent with ingestion of death cap mushrooms, Amanita phalloides, that occurred in a family group between 24 and 30 April 2014. The public health investigation into the source of the poisoning was undertaken by the Health Protection Service in conjunction with the Australian Federal Police and ACT Policing. Clinical case management was undertaken by Calvary Health Care ACT and the Canberra Hospital and Health Services division. A multi-agency after-action review was conducted on 13 May 2014 at the Health Protection Service. A number of recommendations arose from the review. The Health Protection Service will work with stakeholders to address the issues raised to improve arrangements for future responses.
- Development work for a website featuring air quality data has been ongoing. The aim is to give the public access to ambient air quality data for the Canberra region, with a view to having an Air Quality Index to provide an overall rating of ambient air quality.
- The Health Protection Service is progressing with amendments to the Medicines, Poisons and Therapeutic Goods Regulation 2008 to allow the prescription of controlled medicines under a standing controlled medicines approval. The changes are aimed at minimising the regulatory burdens imposed on health professionals responsible for the safe supply of controlled medicines and at providing patients with timely access to therapy. The changes will be supported by the real-time collection of pharmacy dispensing data to minimise the harms of controlled medicine abuse, misuse and diversion.
- The changes announced on 21 November 2013 to the regulation of food sold by certain non-profit community organisations require amendments to the Food Act 2001 and subordinate legislation. These amendments include the removal of registration, notification and food safety supervisor requirements for temporary non-profit community organisations. The Health Protection Service expects this body of legislative work to be completed in 2014.
- The Health Protection Service continues to work on developing and improving enforcement strategies for food safety in the ACT. The Health Protection Service is working towards greater engagement with industry by increasing regulatory transparency and establishing an industry-stakeholder reference group. The Health Protection Service is developing regulatory tools-for example, guidelines, manuals and procedures-for public health officers to support the inspection process and to improve regulatory consistency and industry confidence in food safety regulatory activities. The Health Protection Service will systematically publish regulatory tools such as inspection forms and manuals to facilitate increased regulatory transparency. The Health Protection Service continues to work on improving data integrity and the efficiency and effectiveness of food safety services.
- ACT Health has a dual role in emergency management. Under the ACT Emergency Plan, ACT Health is the lead agency for some types of emergencies and a supporting agency for all of the others. Section 148 of the Emergencies Act 2004 directs that an ACT Emergency Plan be prepared and that the Emergency Plan include provision for a disease or epidemic emergency. The ACT Emergency Plan directs that ACT Health prepare sub-plans covering communicable disease and pandemic emergencies and a generic Health Emergency Plan.
- The Population Health Division commissioned an independent external review of the effectiveness of ACT Health's organisational approach to emergency management. The objective of the review was to provide ACT Health with independent, external analysis and opinion on the effectiveness of the directorate's current approach to emergency management and make recommendations for improvement. The review was conducted between May and June 2014. It included analysis of current legislation, plans and policy, and interviews with executives and managers who execute emergency management arrangements. A report with eight recommendations was provided to the Population Health Division at the end of the process. The division will now work to develop a formal response to the review report and liaise with the ACT Health Executive Council in 2014-15 to implement the agreed recommendations and strengthen organisational arrangements.
- The Health Improvement Branch is developing a new web platform to report on national and local indicators, as well as other population health priorities. At 30 June 2014, the project was at the proof-of-concept phase. It is due to be completed by 30 June 2015. The project aims to increase the utility of population health information for stakeholder groups.
- An independent review of the ACT Cancer Registry will be undertaken in 2014. Recommendations will be made on various aspects of the registry to inform future directions.