What requires public health action?

The National Framework for Protecting Australia’s Children 2021-2031 has endorsed a public health model that includes early intervention and support for families experiencing complex biopsychosocial and economic disadvantages and involved in child protection systems. In Australia, infants are more likely to receive child protection services and be admitted to out-of-home care than any other age group, and a growing chorus of parents, advocates, service providers, and researchers are expressing concerns regarding the number of infant removals and how child protection processes in the perinatal period (conception to one year following birth) impact the health and wellbeing of families. Enhanced understanding of available support and child protection processes in the perinatal period is needed to inform policy and practice that supports family health and wellbeing.

What have we learned and how?

Our qualitative research study explores professionals’ perspectives on perinatal support and child protection processes. Staff from fifteen government and non-government organisations—based in Perth, Western Australia, and providing services within health, welfare, legal, and Aboriginal Community Controlled sectors—participated in the research. Focus groups and interviews were conducted using a semi-structured interview schedule that included questions about processes, services, supports, gaps, and challenges. Framework analysis identified cross-sector collaboration as a recurring theme, with professionals identifying the need for: more collaborative partnerships with parents and between government and non-government services; clearly articulated care coordination and support pathways, and wrap-around family support provided by specialists from multiple disciplines and services.

How will this be used in practice?

Findings from the focus groups and interviews have informed subsequent co-creation sessions conducted with professionals and parents, and a draft model outlining care coordination and support pathways for families involved in perinatal child protection processes has been developed.

What future actions are needed?

Future action is needed to: pilot and evaluate the model within organisations; ensure that lived experience advisors and the Department of Communities are involved in the ongoing development of coordinated care; and enhance cross-sector collaboration to provide holistic support that helps families with newborn babies avoid entering or returning to the child protection system.

Background: Bowel cancer screening is key for timely diagnosis to improve patient outcomes. Although, currently, the National Bowel Cancer Screening Program rates in Tasmania are low and recently decreased from 48.9% (2019-20) to 44.4% (2020-21).
Aim: To co-design a bowel cancer awareness and screening education strategy with a remote Tasmanian community for rural/remote Tasmanians.
Method: Semi-structured interviews and two co-design group workshops were conducted with a remote Tasmanian community. Initially, sixteen community members were interviewed, to identify barriers and enablers to seeking bowel cancer information, awareness, and screening in rural/remote Tasmania. Findings informed the group workshops. To co-design the education strategies with local relevance, two group workshops were run with 14 community members and three local healthcare providers.
The Tasmanian Collaboration for Health Improvement and Cancer Voices Australia assisted researchers to involve consumers with lived experiences of bowel cancer and screening. Five consumers reviewed the interview guide and content for workshop one, for plain language and relevance. Researchers connected with Population Screening and Cancer Prevention Tasmania and discussed potential collaboration in the education strategy implementation phase for rural/remote Tasmanians.
Results: Two multi-component education strategies were developed through the workshops; community education events and a local media campaign. Both components should run alongside one another twice a year, to align with other rural health screening programs e.g., BreastScreen bus. Strategies should be locally designed and tailored to and by the community, to remain as intended. Eight community members stayed involved in this study to develop the components designed in the workshops. Once the education is fully developed, it will be piloted in two rural/remote communities. Researchers intend to collaborate with established networks to expand the education across rural Tasmania.
Future actions: This study showed stakeholder collaborations throughout the study is vital for successful research outcomes. Consumer involvement in the research methods ensured participants understood the research topic. Involving the study target group (community members) and key stakeholders (healthcare providers) as participants in the co-design phase ensured optimal engagement and enthusiasm, within the design, development, and future implementation of the education strategies.

Context and aim: Alcohol-related harm, requiring presentation to an emergency department (ED), is a significant burden. The Mental Health Commission (MHC) has partnered with East Metropolitan Health Service (EMHS) and Royal Perth Hospital Emergency Department (RPH ED) to pilot the Western Australian Model for Violence Prevention (WA MVP) project. The WA MVP aims to develop a violence prevention model to reduce alcohol related presentations (ARPs) to RPH ED and impact on community safety. We present preliminary data for the first six months and discuss translational outcomes and future directions.

Methods and analysis: ARPs in patients aged ≥16 years were identified using a survey tool at triage or retrospective medical record review. Between October 2023 and March 2024, 4323 (11%) of 39,546 presentations to RPH ED were ARPs. The median age was 39 (range 16–96 years) and two-thirds were male (n=2896, 66%). The most common triage score was 3 (n=1916, 42%). The median ED length of stay was 4.6 hours. The highest proportion of ARPs by day of the week was Saturday (21%) and hour of the day was 0100-0159 (24%). The three most frequent diagnoses were injury (n=1132, 26%), alcohol intoxication (n=658, 15%) and psychiatric (n=327, 7%).

Translational outcomes: Working collaboratively with the MHC, EMHS and other key stakeholders including the Western Australian Police, St John Ambulance, lived experience representatives and Aboriginal Health Liaison Officers, we will have a localised understanding of alcohol-related harm to inform targeted community-based interventions. This includes a collaborative effort to map alcohol purchase and incident ‘hotspot’ locations

Future actions: Addressing this complex issue will require a harm minimisation approach, including public health messaging and education. Systemic responses that address the causes of alcohol related violence are vital to reduce alcohol related harm and improve community safety.

The Fairfield Health Partnership (FHP) and the Fairfield City Health Alliance (FCHA) are inter-government collaborations aimed at improving the health and wellbeing in Fairfield City, NSW.

Located in south-west Sydney, Fairfield City is a vibrant community of more than 211,000 people from over 108 countries. It is the most disadvantaged Local Government Areas in NSW and one of the most disadvantaged in Australia. Fairfield City is a Settlement City - 56% of residents were born overseas and 70% speak a language other than English at home. Several social determinants lead to poorer community health outcomes. Fairfield City records higher rates of unemployment and lower levels of tertiary-level education, household income and people with private health insurance than greater NSW.

Established in 1995, the FHP is a bi-level government partnership between Fairfield City Council (FCC) and the South Western Sydney Local Health District (SWSLHD) that identifies and addresses the evolving health needs of Fairfield City. The FHP has influenced both partners in prioritising community wellbeing in organisational planning and advocacy. Key achievements of the FHP include integration of health into Council’s core strategies, advocacy to upgrade health infrastructure such as Fairfield Hospital, successful tobacco-control initiatives, place-based response to COVID-19, embedding health principles in urban planning, free community-centered physical activity programs and the development of healthy food policies.

The work of the FHP is complimented by the FCHA, a tri-level partnership between FCC, SWSLHD and South Western Sydney Primary Health Network. Established in 2018, the FCHA focuses on improving access to health services. Key objectives include improving health literacy, strengthening local GP services and implementing preventative strategies to address gambling harm.

These partnerships are innovative examples of how effective cross-sector collaboration can have meaningful health and social impacts for community. These collaborations leads to healthier people, healthier places and strengthened collaboration between Council and Health partners.

Mobile food vendors are a growing but poorly understood component of community food environments in Australia. Existing research on food environments has mainly focussed on mapping the locations of traditional food businesses and little attention has been given to monitoring the mobile food vendor industry. This study assessed the practicality and usefulness of tracking mobile food vendor attendance at community events in East Metropolitan Perth in 2022.

Thirteen Local Government Authorities (LGAs) were asked to provide information on mobile food vendors that attended community events in 2022. A database was constructed, and descriptive statistics calculated. Vendors were classified as primarily selling beverages, desserts, or meals, and whether they had been Certified Healthier Vendors according to Healthway’s traffic light system.

There were 74 community events held across 11 LGAs in East Metropolitan Perth in 2022, with a total of 224 different mobile food vendors participating. On average, each event hosted 14 vendors, though this ranged from 1 to 54. Only a small percentage (14%) of vendors attended 10 or more events that year, and just nine of them (4%) were Certified Healthier Vendors.

LGAs have an important role in selecting and recruiting mobile food vendors for their community events which can attract large numbers of the public, influencing the food and drink available. Under the Public Health Act 2016, LGAs in Western Australia have a statutory responsibility for protecting community health and wellbeing. Through the Act, LGAs have the power to influence types of foods and drinks available at community events, and many LGAs have public health plans which include actions to improve access to healthy options at community events.

Incorporating mobile food vendors into the geospatial mapping of community food environments is important. Identifying mobile food vendors that attend community events more frequently could help target health promotion interventions effectively. Mapping their attendance is feasible and can provide valuable insights for public health strategies. Given the frequency and scale of community events, further monitoring and research are necessary to determine the appropriate public health response.

What is the problem/issue that requires public health action? [Context and aim]
Growing evidence supports the integration of occupational health and safety and worksite health promotion. However, the triggers and the methods for planning and implementing such integrated approaches remain vastly unclear.

What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]
This scoping review aimed to fill this gap by searching 43 databases (e.g. PubMed, Web of Science Core Collection, all EBSCOhost databases, MEDLINE, Scopus, Embase). Of the 7142 results identified initially, systematic screening led to 13 articles meeting the objectives of this review. Of the 13 articles, five were about physical activity interventions, with a focus on modifying behavioural and environmental risk factors of physical inactivity. Ten articles first set specific work-related issues to be addressed, including physical inactivity, sleep problems, neck pain, and musculoskeletal pain. Only five articles pointed to the necessity of understanding the influences of pre-existing knowledge in the interventions of integrated approaches and the heterogeneity of mental perceptions in workers, indicating that a comprehensive needs assessment of workers is not widely applied. Five articles acknowledged that tailoring and flexibility of integrated approaches were key success factors, and nine articles reported the benefits of utilising online platforms to implement integrated approaches. Last, three articles highlighted that intervention sustainability should be further improved.

How has this been used in practice? [Translational outcomes]
Future integrated interventions should consider not only tailoring, flexibility, and delivery modality, but also the appropriate level of outcome changes to suit the actual needs of workers. Identification of work-related issues regarding the target workers could be a useful starting point when planning integrated approaches.

What actions should we take in the future to address the problem/issue? [Future actions]
Further research is required on work-related issues other than physical activity, with an in-depth and thorough exploration of workplace contexts warranted. Intervention researchers and practitioners should consider more consistently how to enhance intervention sustainability and scalability, particularly at the early stages of intervention development. A comprehensive needs assessment in workers is warranted.

Introduction: There are a wide range of interventions that can be implemented to improve dietary intake. In addition to improving health, these interventions may also positively influence broader outcomes, resulting in social, educational and/or environmental co-benefits of intervention. While there have been studies exploring co-benefits of nutrition interventions, these impacts need to be quantified to assess the overall benefits of interventions. This review investigated the quantified co-benefits of nutrition policies, programs and interventions.
Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number CRD42022358139). Five databases (Medline Complete, Global Health, Environment Complete, SocINDEX and Embase) were searched for studies published between January 2012 and 13 September 2022. Three concepts and their related terms were applied across all databases: (1) co-benefits, (2) interventions, and (3) nutrition interventions or food systems interventions with a nutrition component. Non-health outcomes were classified into the domains of social, educational, and environmental co-benefits Studies were assessed for risk of bias using the Mixed Methods Appraisal Tool (MMAT) and the Cochrane Methods Risk of Bias 2 (RoB 2) tool.
Results: Out of 20 studies, the most frequently reported outcome domain was educational outcomes (n=10), followed by social (n=8) and environmental (n=4). There was an overlap in the number of co-benefits within studies. Most studies reported generally positive impacts of multi-component interventions on educational and social co-benefits. Outcome measurement instruments varied, particularly for social outcomes, which limited conclusions on the magnitude of co-benefits of nutrition policies and programs.
Conclusion: Identification of the co-benefits of nutrition initiatives provides a more holistic assessment of the societal value of these initiatives. Development and standardisation of co-benefit outcome measures and measurement instruments will enhance understanding of the impact of diet and nutrition interventions, beyond health outcomes.

What is the problem/issue that requires public health action?
The implementation and long-term sustainment of public health programs and policies are not being optimally monitored. This reduces the chance of successful implementation, successful long-term sustainment, optimal adaptation, and optimal spending and use of resources and finances. To counter this, programs and policies should implement monitoring systems that provide a structured cycle of collecting relevant implementation data and applying this data to make improvements to their programs and policies. Developing an effective monitoring system requires guidance regarding the features of what forms a monitoring system. However, to our knowledge, there is currently no collated review of the features of monitoring systems, subsequently hindering the ability to develop and implement effective monitoring for public health programs and policies. Consequently, we conducted a scoping review to identify the features of public health program and policy monitoring systems.

What do we know or have we learned to address this problem/issue, and how has this finding been derived?
The scoping review searched a variety of grey literature sources and academic journals. Data was taken from all sections of publications to derive features of public health program and policy monitoring systems in community settings. Quantitative data, including the unit of analysis, was extracted. Qualitative data concerning the features of monitoring systems was extracted and coded into four main categories: (1) Plan, prepare, and revise; (2) Monitoring activities (featuring data collection, synthesis, and dissemination); (3) System appraisal; and (4) Stakeholder engagement. For data synthesis, Best Fit Synthesis was employed, which involved deductively coding data against a pre-determined framework. Following this, inductive secondary thematic analysis was used to identify features and generate recommendations for future monitoring system development.

How has this been used in practice?
The results from this coding will inform the development of future monitoring systems for public health programs and policies in community settings. Furthermore, by providing guidance for implementing monitoring systems, we hope that the reporting of monitoring systems within studies improves so that effective adaptions of monitoring systems dependent on aim and context begin to emerge.

What actions should we take in the future to address the problem/issue?
Include and document monitoring systems used in public health initiatives and utilise the information this review provides. Implementing and testing the effectiveness of monitoring systems in different contexts will be the key to sustaining future public health initiatives and improving our understanding of monitoring systems.

What is the problem/issue that requires public health action?
Systemic change is needed to overcome chronic food insecurity. A shift towards prevention in the food relief sector could improve health and social impacts, but limited guidance is available to achieve this. In South Australia (SA), a food security partnership was established between government health and human service sectors in 2016, which engaged the community food relief sector in producing a Charter of principles for reorienting practice towards outcomes. In 2021, a research partnership project was initiated with government and food relief organisations, to explore use of the Charter principles and to co-produce resources for service and system improvement.

What have we learned to address this problem/issue, and how has this finding been derived?
Interviews, evidence review, and co-design of resources and tools were used. Findings revealed a lack of visibility of the Charter’s vision, and varied enactment of the principles. Ongoing needs included: (1) Collaboration across the community sector and government for coordinated systems; (2) Implementation of nutrition guidelines and healthy food procurement; (3) More dignified, values-based services driven by community preferences; (4) Evolved service models offering social support and connection; (5) Relationship-building and tools for data collection and impact evaluation.

How has this been used in practice?
Nine practical service elements were co-created with all partners, tested during co-design with food relief staff and volunteers, then were transformed into a self-assessment tool, to guide quality improvement and orient towards outcomes. The tool is currently being piloted and validated with the community food relief sector.

What actions should we take in the future to address the problem/issue?
Actively pursuing implementation of the new service elements could guide food relief service and system improvement. Knowledge and tools co-produced in this partnership can be used to evolve food relief funding and service provision, so that it becomes more coordinated and integrated, accessible, delivered in a dignified and non-stigmatising way, and is oriented towards prevention of food insecurity.

What is the issue that requires public health action?
Health program funding is often siloed around a particularly health condition or risk factor. But co-occurring health issues are common, and many people value a more holistic approach to health and wellbeing. For people in Alcohol and Drug (AOD) recovery, chronic dental issues are widespread, often caused or exacerbated by AOD use. Missing teeth or poor oral health impacts has a ripple effect on what people can eat, confidence, self-worth, interactions with other people and motivation to change. But cost and stigma are barriers to addressing this.

What have we learned to address this issue?
Through a collaboration between an AOD organisation, a community homelessness service with a dental clinic, and a retired volunteer dentist, free comprehensive dental care has been offered to all residents at ‘The farm’ [residential rehabilitation program] for the last two years. The pilot program was codesigned with clients and has been evaluated by The University of Notre Dame. The evaluation includes dental treatment data, pre and post surveys, client interviews and staff feedback.

How has this been used in practice?
The integration of this trauma informed oral healthcare program within AOD recovery has yielded substantial benefits for individuals and the organisation, and has enhanced motivation to address AOD issues and remain in the recovery program. It has now been adapted for one of the regional communities Palmerston is based in, and findings informed a submission to a federal inquiry on access to dental services, advocating for people with AOD dependence to be recognised as a priority group.

What actions should we take in the future?
While this program is implemented in an AOD residential setting, its findings are highly relevant to other populations facing barriers to accessing oral healthcare, and individuals or communities embarking on recovery.