Background: The COVID-19 pandemic disrupted healthcare systems globally and may have heightened stroke risk through inflammatory and thrombotic pathways. This study assessed excess stroke mortality in Japan during the pandemic, with a focus on disparities by age, sex, and region.
Methods: We conducted a nationwide analysis using death certificate data from all 47 Japanese prefectures between 2015 and 2022. Stratified Poisson regression models, based on pre-pandemic data (2015–2019), were used to estimate expected stroke deaths for 2020–2022 by prefecture, age group (<40, 40–49, 50–59, 60–69, 70–79, 80+), and sex. Excess mortality was defined as observed minus expected deaths.
Results: Japan recorded 7,747 excess stroke deaths during 2020–2022, a 2.5% increase over expectations. Disparities were evident across all dimensions. The Tokyo metropolitan region accounted for the highest absolute excess (Tokyo: 1,627; Saitama: 1,217; Chiba: 927; Kanagawa: 587), while per-capita mortality was highest in western rural areas (Okayama: 10.3; Kagoshima: 9.7; Wakayama: 8.4 per 100,000). In total, 30 of 47 prefectures experienced net excess mortality. Older adults were disproportionately affected: 4,617 excess deaths occurred among those aged 70–79, and 4,164 among those aged 80 and above. In contrast, younger age groups (<60) showed deficit mortality. Males experienced greater excess mortality than females (4,931 vs. 2,816 deaths).
Conclusions: Stroke mortality during the COVID-19 pandemic in Japan revealed significant disparities by age, sex, and region. While urban centers bore the highest absolute burdens, rural western prefectures suffered the greatest per-capita impacts. Older adults and men were especially vulnerable. These findings highlight both the direct effects of COVID-19 and indirect consequences of healthcare disruption, underscoring the need for age- and region-specific strategies to strengthen health system resilience.

Background: Emergency Departments (EDs) globally are increasingly overcrowded, with ‘frequent attenders’ (FAs; ≥4 visits/year) contributing significantly. This study examined characteristics and predictors of FAs at Rockhampton Hospital to inform potential population-level public health interventions.
Methods: Retrospective analysis of de-identified ED presentation data (July 2021–December 2024) was conducted. Descriptive statistics identified the proportion and characteristics of low (4–10 visits), moderate (11–20 visits), and extreme (20+ visits) frequent attenders. Multivariable logistic regression models were developed to identify predictors for each group.
Results: On average, 7.4% (n=2,312) of patients attending ED were FAs, yet they contributed to 26.8% of all visits (n=14,567). Majority (93%) were low frequent attenders. The average length of stay of a FA patient was 1 hour longer than a non-FA patient, and extreme FAs had a later daily peak presentation time (9-10pm) than low FAs (9-10am).
The main age categories were 20-39 (28.4%, n=667) and 60+ (29.5%, n=692). 21% of patients had an Indigenous status, compared to 14% in the non-FA cohort. None of these variables changed significantly between FA groups.
The overall main predictors were smoking (OR 4.00, P<0.001), alcohol and substance use (OR 2.85, p<0.001), pension status (OR 2.61, P<0.001), unemployment (OR 1.40, p<0.001) and female (OR 1.30, p<0.001). Key presentation predictors were Obstetrics/Gynaecology (OR 2.18 p<0.001), General Medical (OR1.74, P<0.001), Mental Health (OR 1.37, p<0.05) and Pain (OR 1.34, p<0.05).
These significant predictors varied within the different FA cohorts – in the extreme FA group, main predictors of Pain (OR 17.42, p<0.05), Cardiac (OR 16.90, p<0.05) and General Medical (OR 13.96, p<0.05) all increased significantly.
Conclusion: This novel data shows different FA cohorts can be categorised by their key predictors. Based on these findings, an additional study is being carried out to explore the perspective of the FA patients, through a value-based healthcare approach.

Background
Mental disorders are among the top ten leading causes of disease burden worldwide. Addressing the high rates of mental ill-health and promoting population wellbeing requires coordinated government action across departments and agencies. Increasing recognition of the social determinants of mental health, such as education and housing, highlights the limitations of policies developed solely within the health sector. Despite growing awareness of the need for integrated cross-governmental approaches, implementation in Australia remains limited. A deeper understanding of barriers and enablers of cross-government policymaking, potentially including power dynamics, or issues around implementation is essential to inform more effective national mental health strategies. This study engages policymakers, drawing on their past experiences, to determine the ‘essential ingredients’ necessary for impactful, system-wide change in mental health and wellbeing.
Method
This project, which is currently underway, explores cross-governmental approaches to mental health through in-depth semi-structured interviews and focus groups with policymakers, government officials and frontline workers involved in designing or implementing cross-sectoral health and wellbeing policies. Participants are being recruited from NSW, other Australian states, and internationally, to promote interdisciplinary dialogue and to pinpoint innovative practices. Transcripts will be analysed using thematic analysis, incorporating some elements of discourse analysis.
Results
Findings are expected to reveal key mechanisms, barriers and enablers of effective cross-governmental collaboration aimed at improving mental health and wellbeing outcomes. Participants will share experiences and case studies of past initiatives, which will inform the development of practical guidance for designing and implementing collaborative policies. This research aims to support policymakers, government officials and frontline workers in advancing integrated mental health strategies.
Conclusion
This study contributes to Australian public health discourse by examining how holistic government approaches can address ‘wicked’ societal problems. By exploring how interdepartmental collaboration occurs and how mental health is prioritised across sectors, the project seeks to generate the necessary evidence to create a blueprint for effective cross-governmental collaboration in mental health and wellbeing.

Although cancer remains the leading health burden in Australia,(1) the COVID-19 pandemic, which emerged in 2020, became a competing health priority for many chronic conditions.(2) Campaigns on cancer prevention and early detection were likely overshadowed during this time. We investigated changes in the knowledge of common cancer symptoms following the onset of the COVID-19 pandemic in regional Western Australia (WA).
Between 2018 and 2020, the ‘Find Cancer Early’ mass media campaign featured the ‘Rural Doctors’ video advertisement and ‘Yellow Checklist’ printed media to raise awareness about the symptoms of the five most common cancers. Post-campaign evaluation surveys were administered to regional WA residents aged 40 years and older and examined participants’ ability to recall these symptoms and campaign awareness.
The average number of symptoms recalled was lower in 2020 (mean=1.32) than in the pre-pandemic years (mean=1.72; p<0.001). After adjusting for the pandemic time-period, having campaign awareness (Prevalence Ratio (PR)=1.99; p<0.0010) and females (PR=1.28; p=0.002) were associated with better symptom knowledge, while older age was associated with poorer knowledge (PR=0.76; p=0.007).
Campaign awareness remained linked to better cancer symptom knowledge during the COVID-19 pandemic, highlighting the critical role of cancer education campaigns amid times of global health challenges. Additionally, regional subpopulations including males and older adults, should be targeted for future campaigns.

1. Find Cancer Early [Internet]. Cancer Council Western Australia, 2024 [cited 2025 Mar 25]. Available from: https://www.findcancerearly.com.au/
2. Australian Institute of Health and Welfare. Australian Burden of Disease Study 2023 [Internet]. Canberra: Australian Institute of Health and Welfare, 2023 [cited 2025 Mar 25]. Available from: https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2023
3. Baral S, Rao A, Rwema JO, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya RN, Kamarulzaman A, Millett G. Competing health risks associated with the COVID-19 pandemic and early response: A scoping review. PLoS One. 2022 Aug 29;17(8):e0273389.

Effective public health (risk governance and risk communication) in the Pacific is often challenged by geographic isolation, uneven infrastructure, and fragmented communication between regions. This presentation introduces an innovative, no-blame inter-regional dashboard developed to support communication, coordination, and shared learning across diverse Pacific contexts. Co-designed with local stakeholders, the dashboard captures environmental, operational, infrastructure, and public health risks through informal audits and in-country activities, synthesised into a regional format.

Rather than enforcing standardisation, the dashboard respects local market priorities and socio-cultural variation—translating risks and capacities in context-specific ways. By calibrating relative risk rather than forcing direct equivalency, it enables a “values-aware” comparison across regions. This approach fosters understanding between different governance cultures while reinforcing ownership and relevance at the local level. It is not a performance ranking tool but a communication catalyst—anchored in mutual curiosity, positive accountability, and shared purpose.

Built on public health values of transparency, participation, equity, and community empowerment, the dashboard also aligns with Sustainable Development Goals (SDGs) 3 (Good Health and Wellbeing), 9 (Industry, Innovation and Infrastructure), 13 (Climate Action), and 17 (Partnerships for the Goals). Its visual simplicity masks underlying technical sophistication—integrating complex datasets into intuitive formats for decision-makers and local leaders alike.

Preliminary implementation has shown promise in breaking down entrenched communication silos, encouraging peer-to-peer engagement, and creating space for proactive regional planning without blame or punitive oversight. This presentation outlines the development, application, and early impact of the dashboard, offering transferable lessons for regions seeking to build resilient, collaborative systems of public health risk governance.

References: WHO (2021), UNDRR (2020), OECD (2018) Principles on Risk Governance

Background
Burden of disease describes the impact of living with and dying prematurely from different diseases or injuries. The Australian Burden of Disease Study (ABDS) 2024 estimated the health impact of 220 diseases and injuries on the Australian population.

Methods
The ABDS quantifies years of healthy life lost from living with disease and injury (non-fatal burden) or dying prematurely (fatal burden). Total burden is measured in disability-adjusted life years (DALY). Estimates for 2024 are calculated based on projections using historical trends.

Results
In 2024, 5.8 million years of healthy life were lost. Living with illness or injury caused more total disease burden than dying prematurely (54% vs. 46%). Over the period 2003 to 2024 there was a 10% decline in the rate of total disease burden. This was driven by a 26% decrease in the rate of fatal burden while the rate of non-fatal burden increased by 7%.
In 2024, the 5 disease groups causing the most burden were cancer, mental health & substance use disorders, musculoskeletal conditions, cardiovascular diseases and neurological conditions. Together, these accounted for two-thirds (64%) of total disease burden.
When considering individual diseases, coronary heart disease (CHD) was the leading cause of burden for every reference year. However, the burden from CHD showed the largest absolute reduction over time, which was mainly driven by large declines in fatal burden. Dementia was the leading cause of burden among females. For young people, mental health conditions and suicide and self-inflicted injuries were the leading contributors to disease burden.
Males and females born in 2024 could expect to live an average of 88% and 86% of their lives in full health respectively.

Conclusions
The 2024 ABDS provides the most up-to-date estimates of disease burden in Australia. It provides an important evidence base to inform health policy and service planning.

Background: Health equity frameworks have emerged as important tools for health systems to integrate equity principles into policies, programmes, and service delivery. This scoping review mapped existing health equity frameworks across Australian health systems to identify strengths, gaps, and innovative practices.
Methods: We identified publicly available health equity frameworks from Australian health systems (2000-2025). Documents were sourced from government health departments, Local Health Districts, Hospital and Health Services, Primary Health Networks, and Aboriginal Community Controlled Health Organisations. Using structured data extraction and thematic analysis via NVivo, we examined definitions of equity, theoretical foundations, stakeholder involvement, areas of action implementation mechanisms, and accountability measures across 50 identified frameworks, with 21 reviewed in-depth.
Results: Six main theoretical models underpinned frameworks: social determinants of health (67%), proportionate universalism (36%), intersectionality (24%), human rights, critical race theory and anti-racism, and life-course approaches. Aboriginal-led frameworks consistently integrated Indigenous self-determination, intergenerational perspectives and cultural safety principles. Five key framework components emerged: conceptual foundations; scope; priority action areas; knowledge and evaluation; and, implementation. Six domains of action were identified: governance, leadership and accountability; engagement and partnership; workforce and capacity; service design and delivery; determinants of health equity; and data, evidence and knowledge. However, significant gaps included limited accountability mechanisms, vague partnership models, and insufficient detail on operationalising equity principles and lack of evaluations.
Conclusions: While Australian jurisdictions demonstrate growing commitment to health equity frameworks, most lack concrete implementation detail and accountability measures. Considerations for the developing Equity Frameworks include clearly defining purpose and scope, establishing actionable implementation pathways with dedicated resources, integrating proportionate universalism and intersectional approaches, and addressing both individual behaviour change, systems and structural determinants.

Introduction: While drowning is a major cause of death in children and young adults, survivors of drowning may suffer long-term neurological and physical impairment due to hypoxic brain injury, which has not been well documented in the Australian context. Methods: Individuals aged 0–25 admitted to NSW hospitals for drowning or immersion between 2001 and 2019 were identified from administrative datasets. The control group included patients of the same age with only superficial injuries and no pre-existing specified health conditions. Index admissions and socio-demographic characteristics were presented. New diagnoses of neuropsychological and behavioral disorders (ICD-10-AM F and G codes) following the index admission were compared between groups. Results: There were 1,934 drowning cases, with 1,871 survivors. The most frequent drowning places were swimming pools (38.3%), other specified locations (24.9%) such as quenching tanks and reservoirs, and natural water (18.9%). Among survivors, 53.7% were children under five, while 42.6% of the control group were over 16 years old. Nearly half of the survivors and the control group were from the most socioeconomically disadvantaged areas (deciles 1–4). Subsequent admissions with a diagnosis of specific mental, behavioral or nervous system problems occurred in 9.73% of survivors. Compared to the control group, drowning survivors were more likely to have disorders of psychological development, epilepsy and related disorders, cerebral palsy, and other central nerve system diseases. Conclusion: Notable limitations are the inherent difficulties in assigning appropriate controls retrospectively, and missing information about diagnoses made in non-hospital settings. Despite these limitations, the long-term impact on families and the health system after non-fatal drowning are considerable, and that monitoring trends in outcomes among drowning survivors may be important. In addition to highlighting the need for increased investment in drowning prevention, the findings indicate a need for research into how to optimize outcomes for drowning survivors.

Background

Domestic and family violence has profound, long-term implications for women, children and families. For women, it is a leading cause of trauma, homelessness, and negatively impacts their mental and physical health. Consequently, for refugee women, DFV can negatively impact the settlement and integration across multiple domains.

Prevention initiatives are critical to reduce the risk of these harms and a range of human services already conduct screening to identify and address needs and concerns for women (e.g., ante-natal care). Asking women directly about experiences of abuse increases disclosure and creates opportunities for supportive and timely responses. Refugee women face multiple barriers to disclosure and help-seeking and identifying and responding to DFV among refugee women demands skills and culturally- tailored responses. In addition, prevention initiatives are enhanced when women can access them at multiple touchpoints.

Preventing DFV among refugee women

The Safety and Health After Arrival (SAHAR) study over three years, funded by the Australian Research Council and SSI, was led by researchers at the University of Wollongong. It tested a culturally-tailored approach at an additional touchpoint, settlement services, of DFV screening and response for newly arrived refugee women. SAHAR demonstrated the feasibility of implementing DFV screening in this setting, finding that screening is accepted and supported by refugee women, including those who themselves had experienced DFV.

Practice and Policy Implications

For most women, SAHAR was their first experience of being asked about DFV underscoring that settlement services provide an additional touchpoint to expand DFV prevention. Settlement workers reported that asking about DFV aided their practice and was supported by SAHAR’s clear and simple tools, dedicated training and specialised mentoring support. Settlement policy and programs should consider embedding DFV screening and response in settlement services to provide a culturally-tailored pathway to prevent DFV among newly arrived refugee women.

Problem
Australia needs urgent youth justice reform. In 2022–23, 4,542 young people aged 10 to 17 years were under youth justice supervision on an average day in Australia, with 3,743 (82%) supervised in the community and 828 (18%) in detention. In NSW, young people with disability have higher rates of contact with the youth justice system than those without disability.

There is a clear intersection between Fetal Alcohol Spectrum Disorder (FASD), child protection, out-of-home care and incarceration. National data show 75% of children and young people with FASD are in contact with the child protection system. In a youth detention centre in WA, 36% of young people had FASD.

Methods
We reviewed literature on actions to improve health outcomes for adolescents with FASD in contact with the youth justice system. The PHAA Justice Health Policy Statement was updated to recognise the needs of young people, including those with disability.

Results
Prevention of FASD and contact with the justice system benefits society by minimising economic, personal and social costs.

Trifold action is proposed:
1. There is a need for ongoing investment in the prevention of harm from prenatal alcohol exposure, screening and early identification of FASD in young people, and early intervention to decrease their risk of contact with the justice system.
2. The justice system needs reform to minimise the incarceration of children, particularly those with disability. Investment is needed in evidence-based diversion programs that provide treatment for underlying disorders as alternatives to incarceration.
3. The justice system must invest in staff training to increase awareness of FASD.

Lessons
Community-based support for young people with FASD can mitigate behavioural issues by promoting social inclusion. Substantive action at multiple levels is urgently required to address the challenges faced by young people with FASD within the Australian justice system.

Objectives: While the detrimental effects of excessive screen time (ST) on physical health are well-documented, its impact on children's mental health status (MHS), particularly through indirect pathways, is less understood. This study examines the relationship between ST and children’s MHS, focusing on the mediating roles of sleep quality (SQ) and prosocial behavior (PrSB). Specifically, it investigates how variations in ST impact SQ and PrSB, and how these factors relate to MHS among children aged 10-11 years.
Methods: Data from 7,458 children aged 10–11 years were drawn from the nationally representative Longitudinal Study of Australian Children (LSAC). Ordinal logistic regression was used to estimate the associations between ST, SQ, PrSB, and MHS. A bootstrapped mediation model was employed to estimate the indirect effects of ST on MHS through SQ and PrSB.
Results: Higher ST was significantly associated with poorer MHS. Children with 3–5 hours and more than 5 hours of daily ST had higher odds of poorer MHS (OR=1.61, 95% CI:1.42 to 1.83; and OR=2.54, 95% CI: 2.11 to 3.06, respectively) compared to those with low ST (<3 hours). PrSB significantly mediated this relationship, with higher ST linked to 29% lower odds of PrSB (OR=0.71, 95%CI: 0.601 to 0.842), and lower PrSB associated with poorer MHS. The indirect effect through PrSB was statistically significant (bootstrap 95% CI: 0.14 to 0.49). While better SQ was associated with improved MHS, it did not mediate these associations.
Conclusions: Excessive ST is associated to poorer MHS, with PrSB serving as a significant mediator. High ST not only directly worsens MHS but also indirectly affects it by reducing PrSB. While better SQ was associated with improved MHS, it did not mediate the ST-mental health relationship. Further research should explore how specific types of screen activities relate to mental health in children.

Introduction
Oral health-related quality of life OHRQoL evaluates perceived physical and mental health. In the context of children and adolescents, it helps in understanding the impact of oral health on the lives of children and their families. Oral diseases affect the oral cavity and create a negative impact on quality of life as well. This paper explored the OHRQoL, and the factors associated with it among adolescents attending Islamic boarding schools (IBS) in Pakistan.
Methods
We conducted a cross-sectional study in four IBS in Lahore, Pakistan from May-June 2024. The children (12-17 years) able to read and write in local Urdu language were included to complete the Child Oral Health Impact Profile (COHIP) questionnaire. We used linear regression to identify the association between OHRQoL and associated factors adjusting for potential confounders.
Results
From the 534 participants, mean ± SD scores were calculated: OHRQoL 99.4 ±23.44 (range 0-140), oral health and wellbeing 24.78±7.08 (range 0-40), functional wellbeing 19.32±4.76 (range 0-24), social and emotional wellbeing 24.64±7.77 (range 0-32), school environment 14.32±2.61 (range 0-16), self-image 14.46±5.91 (range 0-24), treatment expectancies 8.51±2.30 (range 0-12) and overall health 2.64±1.17 (range 0-4). Healthy teeth [AOR 0.12 (95% CI 0.10–0.14)], healthy gums [0.11 (0.09–0.13)], no gum bleeding [0.09 (0.07–0.11)], no toothache in last 12 months [0.08 (0.06–0.11)], planning to seek dental treatment [0.06 (0.04–0.08)], and girls [0.19 (0.02–0.07)] were strongly associated with OHRQoL score.
Conclusion
Higher OHRQoL was found to be associated with better oral health determinants. OHRQoL impacts children’s oral health and health-seeking behaviour. If the children are visiting the dentist for regular checkups and have better oral health, it can improve their overall quality of life.

Australia’s national goal of less than 5% daily smoking prevalence by 2030 (1) is typically considered consistent with a tobacco ‘endgame’ (2). Australia has world-leading policies including tobacco plain packaging, cigarette stick warning labels, and comprehensive advertising bans, and some of the strongest policies globally on vaping products. Australia’s National Tobacco Strategy has a commitment to explore supply reduction strategies (1), however there are currently few supply-side policies in place. Australia also faces increasing challenges with illicit tobacco (3).

Few countries have experienced no legal tobacco sales; those that do have received limited research attention. Brunei is currently the only country with no commercial tobacco sales due to the tobacco industry not supplying products and no retailers holding tobacco sales licences for over a decade (4). Bhutan has previously had a comprehensive ban on tobacco sales, which discontinued during the COVID-19 pandemic (5). This presentation will explore the experiences of both countries and lessons that could be applied in the Australian context.

Methods include secondary data analysis of youth and adult survey data and content analysis of publicly available policy documents and research. Results will be presented on the impact of policies on smoking and e-cigarette use prevalence, illicit tobacco trends, and how to maximize policy effectiveness.

Reference list

1. National Tobacco Strategy 2023–2030 [Internet]. Available from: https://www.health.gov.au/resources/publications/national-tobacco-strategy-2023-2030?language=en
2. Puljević C, et al. Closing the gaps in tobacco endgame evidence: a scoping review. Tob Control. 2022 Mar 1;31(2):365–75.
3. Puljević C, et al. Smoking out Australia’s growing illicit tobacco market: Current trends and future challenges. Int J Drug Policy. 2024 May 1;127:104424.
4. Global Tobacco Index 2021 [Internet]. Available from: https://factsheets.globaltobaccoindex.org
5. Aneja K and Gopal S. Bhutan reverses sales ban on tobacco. Available from: https://blogs.bmj.com/tc/2023/02/01/bhutan-reverses-sales-ban-on-tobacco/