Newsletter of the Public Health Association of Australia Inc.
No need to reinvent the wheel!! Immunisation Program support by Medicare Locals By Angela Newbound, Immunisation SIG Co-convenor Once again, changes to Primary Health Care are imminent. We have adjusted from having 110 Divisions of General Practice in 2008 to 61 Medicare Locals in 2012. From July 2015, these 61 Medicare Locals will cease to exist and be replaced by 31 Primary Health Networks (PHNs). Although this moving landscape creates many challenges for staff, providers and the community, we are pleased that Primary Health and the Immunisation Program will remain on the Abbott Government agenda. Throughout this journey, Immunisation Program Coordinators have provided support and educational opportunities to immunisation providers, kept the community informed of the importance of timely immunisation and developed resources to meet local needs. The Immunisation Coordinators have constantly remained committed, visionary and eager to roll up their sleeves and get the job done. And what a great job they have done in this challenging speciality! Not only have the Coordinators dealt superbly with changing geographical and organisational landscapes, they have been instrumental in rolling out a multitude of immunisation program changes, delivered education around new vaccines, policies, procedures and recommendations to providers and attended community events to disseminate immunisation messages. Education has been delivered via quick breakfast or lunch time discussions, one hour updates, webinars, tele/video conferences and full day workshops and have encompassed all aspects of the immunisation program from cold chain/ vaccine management to anaphylaxis management. These sessions have been invaluable to the professional development of health professionals unversed to the immunisation program and have addressed local matters, national recommendations and topical issues such as Q Fever, Travel and Seasonal Influenza vaccination. Medicare Locals have supported and developed a wide range of strategies and resources to help facilitate changes in provider practice or to inform community about the importance of immunisation. Attending local schools, childcare centres and kindergartens and community events such as farm fairs, NAIDOC Week and Spirit Festival to promote immunisation has occurred across the nation. Resources developed for providers and community have been in a multitude of styles. Darling Downs-South West Queensland Medicare Local (DDSWQML) developed colourful plastic bath ducks for immunisation promotion to the 12 – 18 month age range and small brightly coloured ‘Dinosaur’ drink bottles for the 4 year olds. These have been a great success and have helped DDSWQML keep on track to maintain immunisation coverage rates above 90% in all age cohorts. Through a local primary school competition, the Goldfields – Midwest Medicare Local (GMML) superhero mascot ‘Neddy Needle’ was developed to promote immunisation coverage within the Aboriginal community. Neddy was designed to appeal to children of all ages and cultural backgrounds and was a distribution source for the ‘Immunisations are for Everybody’ Activity Book. This initiative was rewarded with a $20,000 GSK Grant! Congratulations GMML. Continued on next page The Public Health Association of Australia is the major organisation for public health practitioners in Australia with more than 40 health related disciplines represented in its membership. The Association makes a major contribution to health policy in Australia and has branches in every state and territory. Any person who supports the objectives of the Association is invited to join.
Vol 32, No 6 July 2015
Inside this issue… No need to reinvent the wheel!! 1 Dr Robert Grant NY Story
Commission on the status of Women 59 (CSW 59) at the Unitied Nations in New York: Personal Reflections 4 The evolution of the Heatlhy Eating Pyramid 5 Using new age media for public health a recent seminar in Victoria
PHAA President’s Award
Workplace drug testing as a health and safety strategy 9 Smoke-free strategies help disadvantaged smokers stub out 11 PHAA Congratulates...
What you missed at the 2015 CO-OPS National Workshop 12 PHAA endorsed Encephalitis Guideline published 13 Ten things I learnt from my PhD - ‘Making Salient Messsages for Indigenous Tobacco Control’ 14 Aboriginal Health and Medical Research Council of NSW Chronic Disease Regional Workshops 15 Health in Developing Countries 18 Fertility Week 2015 to focus on obesity 19 Office Bearers
New Members -June 2015 22
No need to reinvent the wheel!! Continued from previous page A range of colourful posters have been developed by a number of Medicare Locals. A poster displaying the recommended injection sites was developed by the Lower Murray Medicare Local (LMML), a pictorial poster identifying the immunisation scheduling points throughout life was developed by the Gippsland Medicare Local (GML) and a poster to remind providers of hepatitis A and pneumococcal vaccination for Aboriginal children was developed by Perth Central and East Metro Medicare Local (PCEMML). School Based Immunisation Programs received attention from Great South Coast Medicare Local (GSCML) and Gold Coast Medicare Local (GCML). A strong holistic approach was a key factor for increasing adolescent immunisation coverage rates within the GSCML region. Through the establishment of a Local Government networking group and working closely with General Practices, HPV vaccination rate increased to over 90%. A simple administrative approach was adopted by General Practice providers whereby the HPV reporting form was attached to the vaccine box with an elastic band to prompt the provider to report the administered doses to the HPV Register. GCML successfully initiated a direct mail out strategy, removing the reliance on students and teachers to deliver consent forms to parents. This initiative increased consent form return rates and, to date, has increased immunisation rates in one school by 11.15%. The ‘Has your Tot had their Shots’ campaign has, no doubt, been instrumental in achieving high immunisation coverage in the Far North Queensland Medicare Local (FNQML) region. A suite of resources including fridge magnets, recall postcards, bravery certificates, bookmarks and posters were developed as part of this campaign to promote immunisation. To assist with increasing immunisation rates in the Central Adelaide and Hills Medicare Local (CAHML) region, immunisation reminder fridge magnets were developed and distributed to provider sites, parents at community events and to Aboriginal parents through the universal home visiting scheme. During an Immunisation Blitz involving 19 Child Care Centres situated in areas of low coverage, a total of 1,017 Australian Childhood Immunisation Register (ACIR) history checks were undertaken and 2 immunisation clinics were provided at a Child Care Centre with an Aboriginal focus. All parents were contacted and advised of their child’s immunisation status. Incorrect or missing data was updated and parents were advised of the 3½ - 4 year old scheduling point change and how to update incorrect address details where required. An online pneumococcal algorithm tool has been developed to assist providers to manage the complexity of pneumococcal vaccination for those with medical risk factors. The tool development was supported by an education grant from Pfizer and will be hosted on the Influenza Specialist Group (ISG) website. ‘Lulu’s Good Day’ immunisation story book and suite of resources to promote 4 year old immunisations and undertaking a total of 613 ACIR checks at Primary Schools in the region were successful initiatives of the Country South (South Australia) Medicare Local (CSSAML). While the majority of children were fully vaccinated, it emerged that children born overseas were at risk of being under-immunised against the Australian Immunisation Schedule. In addition to providing face-to-face educational opportunities, CSSAML also funded and supported 32 Registered Nurses to complete the SA Health Understanding Vaccines and the National Immunisation Program online course. Increasing adult immunisation coverage in the Aboriginal community was another key focus and resulted in immunisation days targeting pertussis booster and MMR vaccinations. This wide range of targeted activities and approaches by Medicare Local (and former Divisions of General Practice) Immunisation Program Coordinators has increased the rates of children considered ‘fully immunised’ across all assessed age cohorts in Australia e.g.: 24 - <27 month old children considered ‘fully immunised’ has increased from 73.63% in 1999 to 91.23% in 2014. Thank you to the Immunisation Program Coordinators who submitted information for this article. We remain hopeful that much of what has been initiated and developed by the Medicare Locals will be embraced by the PHNs. With fewer PHNs we hope there will be the opportunity for them to collaborate and share resource initiatives to minimise workforce time and preserve valuable health dollars. There is no need to ‘re-invent the wheel’! The PHAA would like to thank all the Immunisation Program Coordinators from all 61 Medicare Locals for their dedication, passion, initiative and expertise and also the previous Australian Medicare Local Alliance (AMLA) for their professional assistance and guidance. The support provided to immunisation providers and the information and resources provided to the wider community is greatly appreciated. We wish you well in your future endeavours.
Perth Central and East Metro ML
Dr Robert Grant NY Story By Australian Indigenous Doctors’ Association Dr Robert Grant recently graduated from a Masters of Public Health in Epidemiology at one of the world’s most prestigious Universities, Columbia University in New York. Robert is of Kamallaroi descent, but grew up in Mittagong NSW with his parents and two brothers. ‘I have always been interested in the sciences, and chose to study a Bachelor of Medical Science,’ Robert said. ‘This increased my interest in both science and medicine and led me to study medicine at Sydney University, where I graduated in 2011.’ Robert first joined the Australian Indigenous Doctors’ Association (AIDA) in 2009 when he attended their annual networking event, which supports Aboriginal and Torres Strait Islander medical students and doctors throughout their medical journey. ‘AIDA has been a great support since I first attended Robert Grant on Brooklyn Bridge the Brisbane conference in 2009. I have met some great friends and inspiring people. The conferences are a great way to learn, network and share stories about culture and health. I was very disappointed to miss the last one in Melbourne and I’m sure AIDA 2015 will be a fantastic opportunity for students and doctors alike.’ Robert completed his residency at Royal Prince Alfred Hospital, before doing locum emergency work in his home town for six months to save up for the Charles Perkins Study tour to the United States of America and the United Kingdom. ‘We visited Stanford, Columbia, New York, Harvard, Oxford and Cambridge. Prior to the tour I was pretty set on studying at either Oxford or Cambridge. However, I found the people at Columbia very welcoming, as well as an outstanding curriculum. New York City has the most extensive public health campaigns and resources of any place in the world, so I’m definitely happy with my choice.’ Given Robert’s previous medical degree, he was given permission to complete the course in one year, half the time it normally takes. ‘The course itself was hard work, with over 60 assessments to be completed in the first semester alone,’ Robert said. ‘Thankfully my medical knowledge has put me at a significant advantage making it more manageable.’ ‘Much of the course focused on the social determinants of health, which is particularly relevant to Aboriginal health. I will be doing an internship in South Dakota at the Northern Plains Tribal Epidemiology Centre over July and August. I am hoping to translate some of the research performed on Native Americans into research into Aboriginal populations down the track. ‘Life in New York has been great. I lived on campus and walked roughly 100m to all of my classes. There is never a dull moment in New York with dozens of fantastic museums (which are free for Columbia students), shows and nightlife. I made friends outside the public health course by playing for the Columbia Rugby team, and was named captain. ‘I hope to start surgical training in the near future. I am still undecided as to which surgical specialty I will strive for but have previously been interested in cardiothoracic surgery. As mentioned above I also plan on using my knowledge gained from this course to perform research into Aboriginal health, most likely in regards to cardiothoracic disease.’
Commission on the Status of Women 59 CSW 59 at the United Nations in New York: Personal Reflections By Jaya Earnest, PhD, Convenor, International Health SIG, International Health Programme, Curtin University, Western Australia In March 2015 I had the wonderful experience of attending the Commission on the Status of Women 59 (CSW 59), in an annual event held at the United Nations in New York along with parallel sessions held by NGOs. I represented the Australian Federation of University Women (AFUW), the Public Health Association of Australia, Ishar Multicultural Women’s Health Centre and Curtin University. The theme of the NGO CSW 59 Consultation Day on 8 March 2015 was to ‘Celebrate Women’s Movements 19752015’. The strong message from Phumzile Mlambo-Ngcuka, the South African Executive Director of UN Women, was that, as of 2015, no country in the world had achieved gender equality. The important role played by civil society and engaging men in the process of gender equality cannot be under emphasised. She made an urgent call for Global Gender Equality by 2030. She called on all of us citizens to hold our leaders and ourselves accountable and implement legislation that addresses gender inequality. Along with Prof Shirley Randell, PhD, AO Hon.DLitt also from Australia but currently working in Bangladesh, I presented a case study on ‘Implementing Gender Equality and Women’s Empowerment: a comparative analysis on achieving gender equality in Rwanda and Australia through education, empowerment and mentoring’. Success stories of ten migrant women in Western Australia representing government, academia, private sector, community, civil society and not-for-profit sectors who have made a difference to the communities they belong to, their work places and who also empower other migrant women, were presented. The personal narratives highlighted the concepts of empowerment, resilience, mentoring, and family and how they impact women. All women showcased in the presentation were passionate community advocates and displayed strength and resilience. The presentation resonated with the vital and uncontested importance of education, the desire to be empowered, the capacity to be resilient and adaptive and the importance of giving back to the community. The key recommendations made were to continue to provide women with avenues to feel empowered, to have opportunities to further their education, to offer adaptive structures and mechanisms that build resilience and to grow strong communities where both men and women are engaged in constant growth. It has been 20 years since the Beijing Declaration and Platform for Action and change has been insufficient and slow. The new UN Political Declaration in 2015 has been criticised for not involving women’s groups and activists working on the ground, and some activists state that the declaration may be taking some steps backwards due to important exclusions and weak language. There is no reference to women’s sexual and reproductive health and rights, despite years of affirmative language at the CSW. While the final Declaration makes mention of the standalone gender equality goal, the lack of commitment to gender equality in the sustainable development process sends the wrong message about the critical links between women’s human rights and development. The UN Women post-2015 position paper calls for the inclusion of women’s empowerment, gender equality and women’s rights in the Sustainable Development Goals and the post2015 development framework highlighting the importance of women’s freedom from violence: women’s abilities to have participation, leadership and a voice; and the necessity for women to have access to resources. The future approach by governments around the world should be comprehensive and address social, environmental and economic dimensions and challenge the structures underpinning genderbased discrimination. Each goal outlined by UN Women position paper has a set of indicators, allowing changes to be monitored so that targeted objectives can be measured. Jaya and Shirley presenting with Shamsi Kazimbaya, and Donatha Gihana from Rwanda. [Jaya taught Shamsi and Donatha in the Master’s programme at the Centre for Gender, Culture and Development in Kigali, Rwanda]
Similarly, Graduate Woment International (GWI) previously the International Federation of University Women (IFUW) urges the post2015 development agenda to include universal Continued on next page
Commission on the Status of Women 59 (CSW 59) at the United Nations in New York: Personal Reflections Continued from previous page and free access to a quality secondary education. Employment Gender inequality in employment can be reduced by prohibiting gender discrimination in workplaces, and promoting the education of girls in science, technology, engineering and mathematics (STEM) as well as in information and communications technology (ICT). GWI as a member of the Collaborative for Harnessing Ambition and Resources for Girls’ Education (CHARGE) has pledged to support 10,000 girls over the next 5 years transitioning from secondary school or university to work through a mentoring program, as well as helping to increase the number of female secondary school teachers in sub-Saharan Africa. Another area of focus is the economic empowerment of women, especially vulnerable migrant women. It was a wonderful week of sharing in New York and meeting up with colleagues from all over the world - much has been achieved in order to prevent violence against women, gender equality and gender economic empowerment but we still have a long way still to go. There needs to be a platform of action - a giant long standing push where monitoring is important. The world needs to change and take on board both men and women in a change for equality.
The evolution of the Healthy Eating Pyramid By WA Branch Nutrition Australia first introduced the Healthy Eating Pyramid in 1980, based on a ‘more to less’ concept developed in Sweden in the 1970s. It was designed as a simple, conceptual model for people to use as an introduction to adequate nutrition. Since then the Pyramid has continued to evolve, always with the same aim: to encourage Australians to eat a varied and balanced diet in line with current dietary guidelines. The unrivalled success of the Healthy Eating Pyramid as an educational tool over the last 35 years is due to its simplicity, and it continues to be in great demand by publishers, educators, health workers and the general public. There is a nice trip down memory lane on our website for members who may recall earlier iterations of the pyramid. After 18 months of collaboration amongst all divisions of Nutrition Australia, but largely led by Caitlin Syrett in Victoria, in May 2015 we launched the latest version of the Healthy Eating Pyramid with a fresh look and targeted health messages, based on the 2013 Australian Dietary Guidelines. The 2015 Healthy Eating Pyramid depicts the types and proportions of foods the average ‘healthy’ Australian should consume in one day for good health. It depicts whole foods and minimally-processed foods in the five core food groups, plus healthy fats, as the foundation of a balanced diet that’s based on the Australian Dietary Guidelines. It also encourages drinking water, enjoying herbs and spices, and limiting salt and added sugar. One notable change to the Pyramid is the separation of each food group to provide clearer information on the proportion each one contributes to a balanced daily diet. This greater level of detail was in response to information from consumers, educators and health professionals, without compromising the original Pyramid structure. The Healthy Eating Pyramid is designed to be used alongside the Australian Dietary Guidelines and Australian Guide to Healthy Eating; as another tool to help the Australian public choose foods to promote healthy eating and their own wellness. Since its launch, the Healthy Eating Pyramid has been lauded by many health professionals and organisations. According to our media data, in the first three weeks since the launch we have had over 250 clips on TV, radio, print and online; with a reach of over 10,000,000 people. The news was very popular on social media as well, with over 1200 posts and an estimated reach of over 5,000,000 people. We are thrilled with the reception the new Pyramid has received as we believe it shows that the public have been hungry for simple, uncluttered, information.
Using new age media for public health a recent seminar in Victoria VICTORIAN Branch News
Hannah George, Communications Lead PHAA Victoria Branch
“there needs to be a targeted message and a purpose behind it” New age, or digital media, has opened up an array of options to connect like never before. Given the emergence of modern media in recent years, PHAA Victoria Branch set about to explore how we can engage these media forms to relay public health messages to the right audience. With a panel of experienced digital media and public health professionals on board, including Dr Megan Lim, Reema Ratron, Dr Stefen Schutt and Dr Jim Black, we organised a seminar for Wednesday 25th March to explore the use of digital media in the public health space. In keeping with the theme, we utilised Eventbrite to assist us in creating and promoting the seminar and also created a hashtag especially for the event; #PHAAVICsocialmedia. Dr Megan Lim from Burnet Institute spoke at the event about her research which focuses on the role of new communications technologies in public health. She has conducted a series of studies into how these technologies (mobile phones, smartphone apps and social networking sites) can be used for health promotion. Reema Ratron, Health and Medicine Editor at The Conversation, spoke about her various experiences in the digital space. Reema has worked in the research sector in Sydney and Melbourne, most recently at The Florey Neurosciences Institute. She previously worked as a sub-editor at The Korea Times and the International Herald Tribune's local supplement in Seoul.
Dr Stefen Schutt is a Research Program Leader at Victoria University’s Centre for Cultural Diversity and Wellbeing. Stefan's research interests are based on people’s everyday use of digital technologies, fitting in well with our seminar topic. Stefan is the co-founder of The Lab, a technology club for young people with Asperger's Syndrome, and creator of the Lewis and Skinner online signwriting document archive. In his previous role, Stefan ran the VicHealth-funded Avatar and Connected Lives projects, which researched the use of technology by disadvantaged young people. Dr Jim Black from the Melbourne School of Population and Global Health discussed his on-going research in Mozambique and how this relates to the use of digital technology in the public health space. As part of this research, Jim has evaluated the use of mobile technology as an innovative tool to support primary health care. He emphasised the importance of thoroughly testing technology, including mobile applications, before releasing it to the public. The overarching message from all four speakers was that whilst these new technologies provide professionals with an opportunity to get their message out into the public in a new and exciting way, it shouldn’t be used just because it’s there; there needs to be a targeted message and a purpose behind it. Choosing the most appropriate digital channel and doing it well is more important than simply being visible on every channel just because it’s available. Often, ‘less is more’ in relation to utilising the digital space to promote public health messages. Overall, feedback from the event was overwhelmingly positive, with many attendees reporting that it had provided them with great ideas regarding technology and health messages. Attendees also felt the seminar was educational and relevant to their studies in public health and they appreciated the relevant and diverse range of topics and speakers who gave real examples of how to use social media to convey public health messages. Approximately 50 people attended the seminar, including students, professionals and committee members, reflecting the interest in the seminar topic. The ‘Using new age media for public health’ seminar was a pertinent example of the importance of choosing relevant topics when planning events for public health students and professionals.
PHAA President’s Award By Heather Yeatman, PHAA National President It is with great pleasure that I present Dr Roscoe Taylor, a long-term, active member of the PHAA with a President’s award. Roscoe retired on 3 April 2015 after 12 years as Director of Public Health and more recently Chief Health Officer in Tasmania. He had worked in public health since 1990 and prior to that held public health physician posts in Victoria and Queensland.
He led a strong preventative focus for the State’s health system during his tenure, using unique commentary in his landmark State of Public Health Reports to call attention to the social factors that affect health and highlighting the terrible and widening disparities in health outcomes between those of lower and higher socio-economic status in Tasmania. The Minister for Health, Hon Michael Ferguson, announced his retirement saying “On behalf of all Tasmanians I thank Dr Taylor for his outstanding contribution to improving public health in the State. Dr Taylor is respected and trusted by Tasmanians, and has been the person we’ve all looked to for advice and reassurance on major public health issues. Under Dr Taylor’s leadership, Tasmania has maintained a strong national public health and prevention presence, often leading the way with new systems and initiatives.” Roscoe has been a key force behind the success of the Tasmanian Branch of the PHAA, including working with the PHAA CEO to re-invigorate the Branch at the time when Ingrid Van Der Mei became the Branch President. Roscoe’s contributions to advancing public health outcomes in Tasmania and nationally make him an outstanding candidate for a PHAA President’s Award. I’m sure his commitment to public health will continue to be influential in Tasmania and PHAA also wishes him well for a long and enjoyable retirement.
CAPHIA 2015 PUBLIC HEALTH TEACHING AND LEARNING FORUM
STRIVING FOR EXCELLENCE IN SCHOLARSHIP FOR PUBLIC HEALTH TEACHING & LEARNING The Henry Jones Art Hotel, 25 Hunter Street, Hobart, 10-11 September 2015 The next CAPHIA 2015 Public Health Teaching & Learning Forum follows the Population Health Congress in Hobart on 6-9 September 2015. The Forum Program will include papers and workshops on: Teaching and learning innovations; Teaching and learning research publication benefits; Partnerships; Internationalisation; Indigenous public health curriculum development & teaching Keynote Presentations Using Publications to Improve Public Health Teaching & Learning Innovations and Outcomes Prof Stephen Leeder AO, School of Public Health, University of Sydney Engaging students in public health - Tips from the West Prof Jane Heyworth, School of Population Health, UWA Increasing engagement in teaching and learning with audience response technology Prof Philip Baker Professor of Epidemiology, School of Public Health and Social Work, QUT, Brisbane Forum Registration & Earlybird Discount The Registration Form is available at www.caphia.com.au with a discount for Earlybird Registration before Monday, 20 July 2015. For more details please contact the CAPHIA office on (02) 6171 1306 or firstname.lastname@example.org The COUNCIL OF ACADEMIC PUBLIC HEALTH INSTITUTIONS AUSTRALIA (CAPHIA) is the peak national organisation that represents Public Health in Universities that offer undergraduate and postgraduate programs and research and community service activity in public health throughout Australia www.caphia.com.au
Experience the DIFFERENCE!
Foundations of Public Health Epidemiology
21 September – 2 October 2015 This ten day intensive course provides you with an overview of the principles and concepts underpinning epidemiology. Presented by an experienced public health professional and researcher, these sessions focus on study designs, casual inference, data analysis and interpretation as they apply to specific diseases and conditions. You will learn how to design and evaluate epidemiologic studies, understand epidemiologic information and communicate effectively. The course is offered by the School Health Sciences, University of South Australia, located at the South Australian Health and Medical Research Institute (SAHMRI), Adelaide. Course content › Introduction to epidemiology thinking › Causation and casual inference › Measuring disease occurrence and casual effects › Types of epidemiologic studies › Infectious disease epidemiology › Dealing with biases › Random error & role of statistics › Analysing epidemiologic software › Measuring interactions › Epidemiology in clinical settings and disease control › Using regression models in epidemiologic analysis › Surveillance and outbreak response › Program management
For further information Associate Professor Theo Niyonsenga email@example.com School of Health Sciences enquiries 08 8302 1370 unisa.edu.au/health/FPHE
Workplace drug testing as a health and safety strategy By Ken Pidd, Deputy Director, National Centre for Education and Training on Addiction (NCETA), Flinders University South Australia
The past few years have seen substantial growth in the number of Australian workplaces adopting drug testing as a health and safety strategy. Underpinning this growth is the assumption that testing can detect drug using employees, and that risk to health and safety is eliminated by removing these employees from the workplace. However, the degree to which drug testing effectively eliminates, or minimises, drug related risk to workplace health and safety is debatable. The full potential of drug testing as a useful tool to help manage drug related risk to workplace health and safety can only be realised if it is introduced as part of a comprehensive and integrated workplace health and safety response. In situations where testing is the main focus of the response, or where testing is introduced as a standalone strategy, it is likely to be of limited effectiveness and can result in unexpected negative outcomes. One of the main limitations of testing is the inability to detect impairment. The most common methods of workplace testing are urinalysis, saliva testing and breath analysis. While breath analysis detects alcohol impairment, urinalysis and saliva testing for other drugs only detect past consumption, not impairment. Urinalysis is particularly problematic as it detects drug use that occurred several days or weeks prior to the test and has limited ability to detect drug use that occurred immediately (0 - 4 hours) prior to the test.
In addition, one of the most common workplace testing strategies (random testing) is limited in its ability to detect drug using employees. The random selection of small proportions of employees on an intermittent basis means that it is likely that in any given year some employees will be screened more than once, while others will not be screened at all. Australian prevalence data indicate that most employed drug users use irregularly or occasionally, with only a relatively small proportion using weekly or more often. Thus, the statistical probability of detection by intermittent random testing is low. Research has indicated that a random testing rate of 50% (50% of the workforce randomly tested once a year, or 10% of the workforce randomly tested 5 times a year) would result in only 40% of daily users and 5% of less frequent users being detected. Workplace testing can also have unexpected negative outcomes for workplace health and safety. Post-accident testing can result in the under reporting of minor accidents, injuries and near misses, or delayed treatment seeking for injuries. Workplace testing can also result in employees changing their behaviour to avoid detection, rather than changing their behaviour to reduce drug related risk to health and safety. Nowhere is this more evident than in the mining industry, where there is substantial anecdotal evidence of workers shifting from cannabis to methamphetamine use in order to minimise risk of detection. Urinalysis, which has a long window of detection for cannabis compared to methamphetamine, is commonly used in mining. Thus, drug using mining employees can minimise the risk of detection by changing from cannabis to methamphetamine use. While the prevalence of testing is increasing in Australian workplaces, the evidence base for its effectiveness is limited - only a handful of rigorous evaluation studies have been conducted worldwide. Together, these studies indicate that testing has, at best, limited effectiveness in deterring employee drug use or improving workplace health and safety. However, these studies also indicate that when combined with other responses tailored to the specific needs and resources of individual workplaces, testing can be a useful tool for reducing drug related risk to health and safety. The effectiveness of testing is likely to be further enhanced if the combined response includes strategies to minimise the likelihood of unexpected negative outcomes known to be associated with workplace testing.
Primary health care in Australia is again in the midst of change with Medicare Locals closing and the opening of Primary Health Networks. This year, in lieu of the annual conference held by the recently closed Australian Medicare Local Alliance, PHAA will host leading international and national speakers at the National Primary Health Care Conference at the National Convention Centre, Canberra from 2-4 November 2015. This conference will provide a platform for the sector to engage, challenge and exchange ideas, where pivotal issues for the future of primary health care in Australia will be discussed and where delegates will learn from the experience, opinions and perspectives of sector leaders and their peers. If you are interested in the future of primary health care in Australia, get involved in the event by registering as a delegate, submitting an abstract or becoming a sponsor or exhibitor. For more information go to: http://www.phaa.net.au/events/event/ NPHCC Â or contact Danielle at firstname.lastname@example.org or 02 6171 1305.
Smoke-free strategies help disadvantaged smokers stub out By Rachael Bagnall, Cancer Council Queensland Despite significant achievements in the reduction of smoking among the general population, smoking prevalence among disadvantaged Australians, including people with mental illness, alcohol and drug addictions, Aboriginal and Torres Strait Islander people and people who are homeless, remains markedly high. People in these marginalised groups are more likely to start smoking earlier, are more likely to be heavier smokers and are less likely to quit smoking than the general population. Consequently, people from disadvantaged communities are more likely to die from tobacco-related disease than the general population. Reducing the smoking prevalence among the disadvantaged would not only enhance the health of this group but has the potential to reduce financial stress and social deprivation. Display of resources at Townsville Forum on Addressing the high smoking rates among disadvantaged groups Smoking in Disadvantaged Communities is a priority action area for Cancer Council Queensland as it presents an opportunity to make further meaningful reductions in rates of smoking in Queensland. Cancer Council Queensland is working to address this issue in three ways. First, we have hosted free forums around Queensland to inform, connect and upskill professionals who work with disadvantaged Queenslanders about tobacco control and smoking cessation. We have conducted forums in Brisbane, Townsville and Cairns, attracting over 100 professionals, and intend to host forums in other regions with an interest in addressing smoking in disadvantaged groups. Second, Cancer Council Queensland are conducting pilot projects with two social and community service organisations; Brisbane Recovery Services and Roma House. The pilot projects aim to build the capacity of these organisations to effectively address smoking through policy enhancement, system improvements, staff training, program development and education. We have a pre-existing collaborative relationship with both organisations which have expressed a keen interest in working with Cancer Council Queensland to enhance the way they address smoking. Finally, we have established the first Queensland Smoking in Disadvantaged Communities Network to link likeminded individuals with one another and provide opportunities for upskilling and collaboration in this vital area. Members of the network receive quarterly newsletters, opportunities to collaborate with peers and opportunities for professional development and training. For more information or to join the Queensland network on smoking in disadvantaged communities, contact Rachael Bagnall on email@example.com or 3634 5348.
PHAA Congratulates... PHAA would like to congratulate the two individual PHAA members listed below who have significantly contributed to public health in Australia and have been recognised in this year's Queen's Birthday Honours. OFFICER (AO) IN THE GENERAL DIVISION Dr Lynette Maree ROBERTS AM - for distinguished service to community health through executive and governmental advisory roles in a range of public outreach and education initiatives aimed at improving cardiovascular wellbeing. MEMBER (AM) IN THE GENERAL DIVISION Professor Fredrick Clive WRIGHT - for significant service to dentistry, particularly in the area of population oral health, as an academic, educator, administrator and research scientist.
What you missed at the 2015 CO-OPS National Workshop By CO-OPS Collaboration On 19 - 20 May 2015 more than a hundred health professionals gathered in Melbourne, as part of the CO-OPS National Workshop, to discuss the best approaches to tackle the obesity crisis. Attendees came from a range of settings including local government, NGOs, hospitals, community health and private practice. The evidence is clear: if we have any hope at preventing obesity at a community level we need to consider a whole-of-system’s approach that includes a variety of agents in different settings, using multiple strategies. Workshop participants were introduced to Group Model Building (GMB) as an example of how a complex system can be understood when broken down into its components. GMB provides a framework that helps identify the complex relationships that exist between the various elements in a system. Participants worked Rachel Sutherland from Hunter New England Health towards identifying the key leverage points that might District receiving the Excellence award from Dr Penny have the biggest impact on obesity. They went on to Love, Director of CO-OPS formulate a list of action ideas that would have the potential to reduce the alarming rates of overweight and obesity in their community. The event’s program included a number of featured presentations from practitioners and academics including Professor Marj Moodie talking about the cost of obesity and Professor Boyd Swinburn highlighting the take home messages from the recent Lancet Series on Obesity.
Winners of the 2015 National Obesity Prevention Community Awards announced The National Workshop was also an opportunity for CO-OPS to recognise some of Australia’s leading obesity prevention initiatives by awarding its annual Obesity Prevention Community Awards. The Awards showcase initiatives that demonstrate excellence and leadership in community-based approaches to the prevention of obesity. The 2015 awards categories included Excellence, Planning and Design, and Implementation and Evaluation. Congratulations to all winners. Excellence in Obesity Prevention • Winner: Good For Kids, Good for Life - Hunter New England Health District, NSW • Honourable mention: Active By Community Design (ABCD) - Wide Bay Medicare Local, Qld Planning and Design in Obesity Prevention • Winner: Healthy Eating Local Policies & Programs (HELPP) - Flinders University, SA • Honourable mention: Good Start - Queensland Health, Qld Implementation and Evaluation in Obesity Prevention • Winner: Active By Community Design (ABCD) - Wide Bay Medicare Local, Qld • Honourable mention: The Healthy Lifestyle Program for rural women (HeLP-Her Rural) - Monash University, Vic Continued on next page
What you missed at the 2015 CO-OPS National Workshop Continued from previous page
Obesity Symposium - Policy responses to obesity prevention in Australia The CO-OPS National Workshop was followed by an obesity symposium on policy. Co-hosted by CO-OPS and the Prevention Research Collaboration (University of Sydney), the symposium provided insight into what it takes to make and change policy to help tackle the obesity pandemic. Academics, policy makers, bureaucrats, advocacy specialists and practitioners shared the latest evidence as well as their personal experience and knowledge about what it means to implement/influence policies for obesity prevention. If you were unable to attend the events, you can access the video recordings of all speakers’ presentations online at www.co-ops.net.au Important notice: unfortunately, the Federal funding for the CO-OPS has been discontinued. The CO-OPS brand and support services will therefore no longer be available from the 1 July 2015. The CO-OPS website will remain online until the 31 July 2015.
PHAA endorsed Encephalitis Guideline published A comprehensive guideline for the investigation and management of encephalitis in Australia and New Zealand has just been published in the Internal Medicine Journal (IMJ). Encephalitis is a challenging condition associated with mortality in up to 10% of cases and a potential for significant neurological morbidity in survivors. Infectious causes of encephalitis may be of public health concern such as vaccine preventable diseases, zoonoses or emerging infectious diseases in our region e.g. measles, varicella, influenza, Hendra virus, Australian bat lyssavirus, Murray Valley encephalitis virus, Japanese encephalitis virus, enterovirus 71, Dengue and Nipah virus. The development of the guideline has been led by the Australasian Society for Infectious Diseases (ASID) Clinical Research Network chaired by Professor Cheryl Jones. Membership of this group includes ASID members with an interest in encephalitis across Australia and New Zealand, and non-ASID members with expertise in public health and neurology. PHAA reviewed the guideline and gave endorsement through the ‘One Health’ Special Interest Group. Free access online is available at the IMJ homepage at:http://onlinelibrary.wiley.com/journal/10.1111/ (ISSN)1445-5994 Dr Philip Britton and Dr Keith Eastwood Please contact Dr Britton for further information (firstname.lastname@example.org)
Ten things I learnt from my PhD – ‘Making Salient Messages for Indigenous Tobacco Control’ By Dr Gillian S Gould, NHMRC Research Fellow, University of Newcastle
As a GP and Tobacco Treatment Specialist I have worked for 10 years with Aboriginal communities in coastal NSW to collaboratively develop targeted strategies including quit groups, schools programs and health professional training. Quit rates are dropping for Indigenous Australians but are still high in Aboriginal subgroups such as pregnant women (50% in NSW), men and women aged 25-34 years, and remote smokers (up to 80%). My recently completed PhD at James Cook University reflected on three questions: Are messages getting through about the harms of tobacco to Indigenous peoples? Can we do better? And, if so, how? My PhD included seven publications on research and development of targeted anti-tobacco messages, pregnant Aboriginal smokers and Aboriginal men and women of reproductive age. Ten things I learnt from this research: 1. The majority of Aboriginal smokers surveyed in coastal NSW are highly aware of the threat from smoking. Several local programs have been conducted in the area, and there Recruiting Aboriginal smokers at Saltwateris access to media campaigns. When perceived threat is high Freshwater Festival 2014 and perceived efficacy for change is also high, people are more likely to intend to quit. Those with high threat and low efficacy are less likely to intend to quit, but at least have smoke-free homes. A smaller group (mostly men) have low perceived threat and low efficacy, they do not intend to quit, are unlikely to have smoke-free homes, and tend to be ‘in denial’. 2. Messages for Aboriginal pregnant smokers need special consideration. Messages can be too confronting in pregnancy. For some women the effects on the foetus are intangible. Messages do not correspond with women’s lived experience: women see other family members who smoked and their babies did not appear to be affected. 3. It appears that messages about smoke-free homes have been ‘driven home’. Most Aboriginal smokers smoke outside and have smoke-free rules. Community members are challenging each other about smoking and insist friends and family do not smoke near their kids. 4. Talking to a health professional is associated with an Aboriginal smoker having a high intention to quit smoking, but the quality of health professional support is reported as very low for 40% of smokers interviewed. People need more hands-on help to quit. Health professional training can improve the quality of smoking cessation care. 5. There is a lack of access to evidence-based therapies for pregnant smokers. The first choice of quit medicines in pregnancy is oral forms of nicotine replacement therapy (NRT) but this is not subsidised on the Pharmaceutical Benefit Scheme (PBS) and is expensive to buy. This disadvantages Aboriginal women and women from low socioeconomic groups. I chair a committee of the Australian Association of Smoking Cessation Professionals to improve access for Aboriginal women, and am lobbying government and pharmaceutical companies to list oral NRT on the PBS, but so far little progress has been made on this important issue. 6. A global inconsistency of approaches for research on media messages for Indigenous tobacco control makes it difficult to compare approaches across and within populations. So far in Australia there is no evidence that high recall rates of media messages by Aboriginal peoples have translated into increased quit rates. 7. Australian organisations developing anti-tobacco messages use appropriate methods with Aboriginal community consultations almost universally, and pre-tests in over 70%. The analysis of my national study of 47 organisation representatives revealed two key factors are important in making salient anti-tobacco messages: I call these ‘cultural understanding’ and ‘rigour’. Continued on next page
Ten things I learnt from my PhD – ‘Making Salient Messages for Indigenous Tobacco Control’ Continued from previous page 8. When developing targeted anti-tobacco messages, Australian organisations are faced with cultural challenges irrespective of their orientation as Aboriginal or non-Aboriginal organisations. Organisations need adequate time to develop community consultation processes and to pre-test messages. Funding cycles should accommodate this. Pre-empting these cultural challenges may provide economies. 9. Evaluation of anti-tobacco programs could be strengthened. This corresponds with the Federal Government’s new focus on outcome measures for the Tackling Indigenous Smoking program. 10. Collaborations are essential to achieve synergy of organisational strengths. Aboriginal organisations are highly skilled at ‘cultural understanding’ and non-Aboriginal organisations at providing evaluative structure. Different organisational types working together build each other’s capacity. [This research was mainly in NSW, so I respectfully use the term Aboriginal to refer to participants.]
Aboriginal Health and Medical Research Council of NSW Chronic Disease Regional Workshops By Jo Coutts, Katarina Curkovic & Kerri Lucas, AH&MRC Providing continual professional development (CPD) to respond to patient and setting needs is a requirement for many health care professionals, however little attention has been given to the process of developing CPD (Clark et al 2015). This article showcases the processes undertaken to develop CPD tailored training for Aboriginal Community Controlled Health Services (ACCHS) through the Aboriginal Health and Medical Research Council of NSW (AH&MRC) Chronic Disease Program. The main aim of the AH&MRC Chronic Disease Program is to provide support to their member services in the area of chronic disease prevention and management. One key component of this support is providing appropriate training opportunities in chronic disease prevention and management for ACCHS staff and is based on member feedback from previous educational events and regular communication channels (such as site visits, other educational activities, feedback forms and email networks). The need for localised and/or regional training opportunities was evident in the AH&MRC Chronic Disease Program Evaluation 2013 where regional and rural ACCHS staff highlighted the need for access to localised, culturally appropriate chronic disease training that would otherwise be unavailable to them unless at a metropolitan location. Yearly workshops are organised in different regional locations to address the needs of ACCHS staff by increasing training opportunities that are generally not available to the sector, with each workshop having a different focus and training to ensure that a board range of training is provided. In February and March 2015 the AH&MRC Chronic Disease Program organised four regional NSW workshops for their ACCHS members. The AH&MRC Chronic Disease Program approached Exercise is Medicine (EIM)® and the Australian College of Nursing (ACN) to tailor existing courses for ACCHS staff, with a focus on EIM® and an update of current diabetes care and management.
Leigh Bourke presenting Continued on next page
Aboriginal Health and Medical Research Council of NSW Chronic Disease Regional Workshops Continued from previous page The decision made by the AH&MRC Chronic Disease Program to partner with EIM® and ACN was to ensure that training content was developed so that health professionals could receive both the expertise of these professional associations as well as culturally appropriate evidence based tailored training. This ‘tailored training’ approach for health professionals working in Aboriginal primary health care is an important step in contributing to the reduction of health inequities of Aboriginal people (Bennett et al 2013). After the selection of topics, the development to tailor these workshops required two processes - a review of existing course structure and content and feedback to the EIM and ACN trainers for adapting training content appropriately and secondly ensuring workshop trainers were culturally appropriate. Having trainers understand the context of ACCHSs staff who deliver Aboriginal health services in a culturally appropriate way is paramount to the success of the training. Both of these activities are an essential requirement to ensure the development of effective training. This process reflects the expectation of the ACCHSs sector and is an important contributing factor to the success of the AH&MRC Chronic Disease Program in supporting ACCHS staff: “AH&MRC are great - very attentive to our needs. Always excellent workshops.” (Narooma participant) The first day of the workshop focused on the importance of exercise in the prevention and management of chronic diseases and the role of an Accredited Exercise Physiologist (EP). A local EP was sourced by EIM® in each location to facilitate this training. The second day focused on diabetes management and included topics on the types of diabetes, the diabetic foot, support services, self management and psychosocial aspects. ACN sourced Credentialed Diabetes Educators (CDE) to facilitate the day and workshop participants received CPD points for their attendance. The use of a local presenter, building on local community knowledge and cultural awareness training helped facilitate open discussion and showcased the benefits that local EPs can provide. This increased educational and networking opportunities for ACCHS staff, who may not have previously known of any existing EPs locally or the benefit to care they can provide. These unique and tailored training opportunities reflected key areas of success within the Chronic Disease Program, with the recent workshop having 80% of participants from 14 ACCHS in attendance. The successful combination of providing cultural awareness training to workshop trainers to understand the unique challenges of working in an ACCHS setting, as well as delivering workshops in a culturally appropriate manner, has contributed to positive outcomes: “Presenter has a great voice and manages the group well. He balances the sitting time with activities... (Forster participant, Exercise is Medicine Workshop) Evaluation of the training is an important component of the tailored training approach. Pre- and post-evaluation at each workshop showed participants had increased their knowledge of diabetes care and management (Likert Scale). The delivery of engaging culturally appropriate training which is designed specifically for local health professionals needs in an ACCHS setting is an important factor in contributing to this increased knowledge. After each training evaluation is completed by workshop participants and any improvements to future training content are incorporated into the next training workshop. Changes to the educational content of the workshop included requests by participants to include Aboriginal specific data on levels of exercise in the EIM® component, plus extend the existing diabetic foot care component in the diabetes update to make it more applicable to Aboriginal patients care in an ACCHS clinical setting. Developing tailored training workshops for ACCHS health professionals which is delivered by local, culturally appropriate health professionals is an effective way to ensure quality service delivery in the management and care of chronic disease. This approach meets the needs of ACCHS staff that need ongoing locally-based training opportunities to build their clinical expertise and contributes to the ongoing success of the AH&MRC Chronic Disease Program: “The best comprehensive education on diabetes I have had.” (Bourke participant, Diabetes Update) The AH&MRC Chronic Disease Program remains committed to working with ACCHS and other organisations to provide the most culturally appropriate, localised chronic disease health educational training for regional health professionals to improve health outcomes of Aboriginal communities in NSW.
CONGRESS SCHOLARSHIPS ANNOUNCED We’re delighted to announce that a limited number of scholarships will be available for the Population Health Congress 2015 taking place at the Hotel Grand Chancellor, Hobart from 6 – 9 September 2015.
Funded by the Congress, the following scholarship opportunities are now available: INDIGENOUS SCHOLARSHIPS STUDENT SCHOLARSHIPS INTERNATIONAL SCHOLARSHIPS Scholarships are for the amount of the full conference registration fee, with assistance additionally going towards travel and accommodation expenses. To apply for a Congress scholarship, please visit www. populationhealthcongress.org.au APPLICATIONS CLOSE 31 JULY 2015
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Health in Developing Countries By Dr Kamal Hussein, PHAA member Access to basic medical treatment and primary healthcare by the majority of the population in developing countries is a big challenge. Factors affecting access may include the size of country’s population, health care expenditure and communication infrastructure. Those who are in remote rural areas, in conflict zones, or under autocratic rule of an oppressive regime have the least level of access. Dr Outback, a newly trained medical practitioner, returned to his rural community in Burma during the late 1980s where he encountered patients with a wide range of infectious diseases, malnutrition, acute emergencies and trauma but had to work with very limited diagnostic and therapeutic resources. Dr Outback struggled to cope with the rising number of patients - a challenge he had never experienced at medical school. Kamal Hussein In the wee hours of early morning on a rainy day of July 1989 a man in his 80s came to see Dr Outback to request a home visit to see his terminally ill son. According to the elderly man, his son had been discharged from the 16 bedded township hospital that night after being there for 5 days. He had been diagnosed as suffering from cerebral malaria and was on quinine drips (an anti-malarial drug) during his hospital stay. The township medical officer, the only doctor in charge of the hospital, was on a trip to the state capital city for a meeting and the whole hospital was left under the supervision of a paramedical staff. As the condition of the patient deteriorated despite treatment in hospital, his relatives were told to take him home in order to avoid the funeral inconvenience. Dr Outback knew that there were two types of discharge from hospitals for severely ill patients presenting with acute emergencies in resource poor situations: one is vertical discharge (ambulatory with full or partial recovery) and the other is horizontal discharge (death or eventual death). The discharge of this patient was horizontal. Dr Outback accompanied the elderly man but needed to be quick as he had to return to his surgery to treat several ill patients, some of whom would be travelling from far away. On his visit, he saw that the patient was deeply comatose and markedly dehydrated. Surprisingly, his blood pressure and heart rate were within normal range. Upon quick examination, the doctor felt that the patient’s neck was a bit stiff. Without any diagnostic facility, Dr Outback was careful not to miss two treatable common diseases in Burma which can present in any format: malaria and tuberculosis. The doctor then gave a treatment based on a provisional diagnosis of tuberculosis meningitis. He wished that he could do basic laboratory and imaging tests to confirm the diagnosis, unfortunately none were available, nor could he refer the patient anywhere. The best thing he could do was to give an empirical treatment with his best clinical knowledge. Dr Outback put on an intravenous line for rehydration, nasal tube for feeding and oral medicines. He planned for antibiotics to treat tuberculosis as well as other forms of bacterial meningitis. He then left the patient in the care of a layman who knew how to handle intravenous line and nasal tube due to experience gained while caring for his chronically ill mother some years before. The doctor visited the patient in the afternoon and again at night. There was no electricity, no other medical facility, no admission or ward facility in his humble practice. The following morning, the patient’s level of consciousness and dehydration were barely improved. However, Dr Outback felt that he should continue the same treatment plan and on the third day the patient could talk single words and showed other signs of recovery. The patient fully recovered over the subsequent months with continued anti-TB treatment and is alive and well until today. This scenario represents only the tip of the iceberg of the challenges in developing countries and not everyone is fortunate enough to survive like this patient. Although this event portrayed the scenario of 25 years ago, nothing much has been improved since. In fact the situation is getting worse due to recent conflicts. The governments of OECD and other developed countries should give more attention to communicable diseases such as tuberculosis and malaria in developing countries.
Fertility Week 2015 to focus on obesity The ‘Your Fertility: Supporting Reproductive Choices’ program is an evidence-based program aimed at increasing knowledge in the community and among health professionals. Its provides information about the factors that influence fertility and pregnancy health to allow people to make informed and timely childbearing decisions. Fertility Week is a major program event in the Your Fertility annual calendar. The fourth national Fertility Week will run from 1st to 7th September 2015 and will highlight the impact of obesity on fertility and pregnancy health. Obesity is one of the great public health challenges today in high-income societies. It is estimated that more than half of Australian women and men of reproductive age are overweight or obese. Most people know that being overweight or obese increases the risk of health problems such as heart disease and diabetes. But many are unaware that this also reduces fertility and the chance of having a healthy baby. The research that underpins the Your Fertility messages shows that: •
Obesity contributes to a less favourable environment for eggs and sperm and this can cause epigenetic changes which can affect the health of the baby at birth and in adulthood.
Obesity can cause hormonal changes that interfere with ovulation and reduce a woman’s fertility. Obese women take longer, on average, to conceive than women in the healthy weight range and are more likely to experience infertility.
In men, obesity is associated with lower fertility. This is likely due to a combination of factors including hormone problems, sexual dysfunction and/or other health conditions linked to obesity.
Overweight and obese women are more likely to develop high blood pressure and diabetes during pregnancy, have induced labour and be delivered by caesarean section.
Overweight and obese women are more likely to experience miscarriage, have a stillbirth, have a baby weighing more than 4.5 kilograms at birth (macrosomia), and have a child who is at increased risk of future childhood and adult obesity and its associated health problems.
In obese women, even a modest weight loss of 5-10% improves fertility and the chance of conceiving. Also, some dietary and lifestyle interventions that limit pregnancy weight gain can improve outcomes for both mother and baby.
Men and women are twice as likely to make positive health behaviour changes if their partner does too. A joint approach to losing weight and increasing physical activity by partners who want to have a baby will improve their chances of achieving this goal.
Your Fertility is funded by the Australian Government Department of Health and the Victorian Department of Health and Human Services and undertaken by the Fertility Coalition, including the Victorian Assisted Reproductive Treatment Authority (VARTA – lead agency), Andrology Australia, Jean Hailes for Women’s Health and the Robinson Research Institute at the University of Adelaide. In addition to Your Fertility social and traditional media activities, Fertility Week 2015 is promoted by campaign partners including LiveLighter, Cancer Council Australia and via events for health professionals. Fertility Week 2015 will include the 2015 Louis Waller Lecture which will focus this year on obesity and pre-conception health. To support Fertility Week 2015, contact VARTA on (03) 8601 5250 or firstname.lastname@example.org. For more information visit www.yourfertility.org.au, visit the Your Fertility Facebook page, Twitter profile and Instagram.
The Communicable Diseases Network Australia, the Public Health Laboratory Network along with the Public Health Association of Australia Inc. wishes to thank the following organisations for their support to the Communicable Disease Control Conference 2015
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