Noncommunicable Diseases (NCDs) are the world’s leading cause of death and disease. Laws targeting the main NCD risk factors, including tobacco, alcohol and unhealthy foods, are some of the most effective and cost-effective ways to prevent and control NCDs. However, law remains an underutilised tool for NCD prevention and control.

In 2014, the McCabe Centre for Law & Cancer (McCabe Centre) launched its flagship International Legal Training Programme (ILTP) to help raise the capacity of government lawyers from low- and middle-income countries in how to use the law to address cancer and other NCDs. Today, the ILTP has run 13 times, helping to build the capacity of 450 participants from 97 countries and territories.

In this presentation we will share lessons learned in developing and delivering the ILTP over the last decade from a ten-year impact assessment of the ILTP. The ILTP has contributed to NCD laws and policies in at least 30 countries, the defence of laws in at least five and the initiation of litigation against the tobacco industry to recover health care costs in at least one country. However, the ILTP’s role in preventing and controlling NCDs is likely to be much greater given laws in a further 13 countries have been hindered by factors including a lack of political will and powerful commercial interests. The presentation will outline some of the critical factors for maintaining a successful capacity building program across countries and cultures and identify key learnings from the last decade that may help others looking to implement long lasting capacity building programs.

The COVID-19 pandemic presented an unprecedented and ongoing challenge to Queensland’s health system. Throughout the early stages of the pandemic, the policy settings in Queensland focused effort on elimination, prevention and protecting the health of Queenslanders. This highlighted the critical role that public health plays in these responses across the state. Concerted pandemic efforts left the public health workforce depleted and fatigued, whilst highlighting the challenges in the decentralised public health governance arrangements.

A public health review undertaken within Queensland Health sought to explore the frontline and central office challenges and make recommendations for the future of public health in Queensland. The review sought to build on the opportunities, lessons learnt, and innovation achieved during the pandemic in order to create a more collaborative and sustainable system and workforce, and better health for all Queenslanders.

The review was finalised in March 2023 and all 83 recommendations were adopted for implementation across the system, the first time such an extensive system reform piece has been seen across public health in Queensland. The review recommendations extend out to 2032, when Brisbane is set to host the 2032 Olympic Games. This is timely given the critical role that public health plays in these types of events, across health protection and promotion, and disease prevention. With phase one of the implementation nearing completion (June 2025), it is timely to look back on the reform work undertaken to date and understand how this has already positively impacted the system. Phases two and three will focus on cementing progress, sustaining impact and continuous improvement.

Reform activities span across vision and strategy, governance and leadership, performance monitoring and accountability, legislation and public health regulation, public health intelligence, workforce capability and future preparedness.

Introduction: The Australian Government introduced Medicare-subsidised allied health services almost two decades ago to facilitate a multidisciplinary approach to chronic disease care; however, there is limited research investigating service use amongst people with diabetes. The aim of this study was to investigate patterns and predictors of Medicare-funded allied health service use amongst people with newly diagnosed diabetes.
Methods: This cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The study sample included 12,694 individuals aged ≥ 45 years (mean age 66 years) with newly diagnosed diabetes. Medicare claims (MBS) data provided by Services Australia were used to identify claims for general practitioner management plans (GPMPs), team care arrangements (TCAs), and diabetes-related allied health services up to 24-months post-diagnosis. Multinomial logistic regression models were used to test for associations between patient characteristics and service use.
Results: Approximately 60% of individuals with newly diagnosed diabetes received a GPMP and TCA (n=7741). Of these eligible individuals, 75% (50% of the total sample) claimed for an allied health service. Uptake was highest for podiatrists (43%) and dietitians (28%), and lowest for diabetes educators (10%) and exercise physiologists (10%). Amongst eligible participants, univariate analyses indicate the odds of claiming for ≥1 allied health service compared with no allied health services was greatest for women (OR 1.41, 95%CI 1.27,1.56) and individuals aged 60+ years (OR ≥1, range 1.44 -1.45). Fully adjusted models are currently underway.
Conclusion: Although women and older adults with diabetes are more likely to act on referrals to allied health services, our findings indicate early uptake of allied health services is suboptimal for all individuals with diabetes. Further research into barriers at the patient, practitioner, and policy level is needed to enhance management of diabetes in Australia and ensure equitable access to government-funded resources.

Prevention initiatives often struggle to demonstrate their impact, particularly when working toward long-term systems change. VicHealth's new Impact and Evaluation Framework (“Framework”) offers a structured approach to navigate the complexity of prevention by providing clear pathways to demonstrate the impact of its 2023-2033 Strategy. It will assist VicHealth to navigate the gradual and iterative process of systems change by providing data and insights to facilitate strategic learning and inform strategy development.

The Framework is designed to evaluate impact across four interconnected layers: funded initiatives, systems ways of working, systems change, and long-term aspirations. Each layer corresponds to different levels of control and influence, allowing VicHealth to track progress from immediate program outcomes through to population-level impacts. The Framework captures both quantitative and qualitative data and evidence through multiple methods including a minimum dataset for funded projects, systems monitoring approaches, and population health indicators. It also tracks the ways VicHealth engages, collaborates and learns with partners and communities through the system ways of working layer.

Impact measurement often focuses on technical frameworks while underestimating the importance of organisational readiness and internal alignment. This presentation explores how VicHealth used systems thinking and implementation science to build shared understanding and enthusiasm for its new Impact and Evaluation Framework, transforming how the organisation thinks about and measures prevention impact.

Key implementation strategies included early engagement with the Board to align the framework with governance needs, bringing together evaluation experts with internal teams to develop system theories of change and establishing internal system champions across organisational levels.

This case study demonstrates how combining systems thinking and implementation science can help prevention organisations navigate the cultural and political dynamics of changing how they demonstrate systems impact. It highlights the importance of building internal capability and shared purpose before expanding to external stakeholders.

Problem: Noncommunicable diseases and injuries (NCDIs) are the primary cause of death and disease burden in Cambodia. The National Strategic Plan (NSP) for the Prevention and Control of Noncommunicable Diseases 2022-2030 utilizes the World Health Organization’s 4x4 framework, which targets four key risk factors (tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol) and four significant diseases (cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases). However, research has highlighted the framework’s limitations in effectively addressing the NCDI burden in low- and middle-income countries, underscoring the need to assess its applicability in Cambodia’s context and align national strategies accordingly.

What you did: The Cambodia NCDI Poverty Commission was established in 2021 to aid in the national response to NCDIs. The Commission retrieved and analyzed modeled data from the Global Burden of Disease 2019 to estimate the burden of various NCDI conditions based on disability-adjusted life years (DALYs) and proportionate mortality.

Results: The analysis revealed discrepancies between 4x4 conditions and actual NCDI burden. The 4x4 conditions contributed to only 29.1% of total DALYs, while non-4x4 conditions accounted for 41%. Non-4x4 conditions with the highest proportions of DALYs include digestive disorders (7.6%), musculoskeletal disorders (5.1%), unintentional injuries (4.5%), mental disorders (4.4%), transport injuries (3.3%), and neurological disorders (3.2%). Regarding proportionate mortality, 4x4 conditions contributed to 46.3% of total deaths. Non-4x4 conditions accounted for 23.9%, among which digestive disorders (11.0%) and unintentional and transport injuries (6.9%) were responsible for the most tremendous burden.

Lessons: The 4x4 framework used in the NSP does not align with local context and epidemiology, causing conditions outside of this framework to be inadequately addressed by existing programs and policies. Adopting an expanded NCDI agenda will strengthen the national response to the growing NCDI burden in Cambodia.

Problem

For many years, VicHealth has worked alongside local councils to support the health and wellbeing of Victorians. Councils are legislated to address community health and wellbeing and play an important role in identifying local priorities, understanding the local context and leading localised, place-based interventions.

VicHealth listened and learned from Victorian communities and worked with councils and experts to identify meaningful prevention strategies that leverage the role and function of local government. Councils raised the need for longer term investment aligned with Municipal Public Health & Wellbeing Planning processes, providing more certainty and an opportunity for greater strategic alignment and community impact.

What we did

Established in 2021, the VicHealth Local Government Partnership (VLGP) enables a systemic and long-term approach to creating effective change and improve the health and wellbeing of children and young people. The VLGP currently includes 35 councils across Victoria who receive access to the following support: 
• Implementation and staffing funding to deliver actions outlined in the VLGP health promotion modules 
• Participation in a Community of Practice to collaborate and share knowledge across Victorian councils 
• Health promotion and prevention capability and capacity building, including access to world leading approaches and expertise. 

Results & Lessons

A mid-point evaluation of the VLGP found that council staff place a high value on the VLGP’s place-based and flexible approach to funding that is accommodating to each council’s context, needs, and priorities. The funding is a critical enabler for councils to engage with children and young people, promote the development of cross-sectoral partnerships and support councils to invest in longer-term health promotion activities.

However, councils also reported that there is a need for greater flexibility in the selection of actions within the module areas to ensure they best align with councils’ priorities and that the place-based and equity considerations could be enhanced through targeted support and module adaptations.