Technical Paper 1:
Obesity in Australia: a need for urgent action
4.7.1 - Health workforce
- 1 - Executive summary
2 - Obesity in Australia- 3 - Obesity prevention
4 - Potential initiatives- 4.1 - Reshaping the food supply towards lower risk products and pricing
- 4.2 - Food composition
- 4.3 - Food subsidies
- 4.4 - Protect children and others from inappropriate advertising of unhealthy foods and beverages
- 4.5 - Improve public education and information
- 4.6 - Reshape urban environments towards healthy options
- 4.7 - Strengthen, upskill and support primary health care and public health workforce to support people in making healthier choices
- 4.8 - Maternal and child health
- 4.9 - Close the gap for disadvantaged communities
- 4.10 - Build the evidence base, monitor and evaluate effectiveness of actions
- Conclusion
- References
- Addendum for October 2008 to June 2009
The public and primary health workforce is an essential component of any public health program to reduce obesity and promote health. While not the frontline in tackling obesity-promoting environments, the primary healthcare setting is the frontline for dealing with many individuals and represents a valuable opportunity to intervene in the prevention of unhealthy weight gain across a broad spectrum of the Australian community.
Around 85% of Australians visit a doctor at least once a year.[2] However, there is currently no systematic screening for metabolic risks in primary care. There is also a lack of funded referral pathways to allied health professionals, as well as a lack of primary care engagement with the range of risk modification and healthy living programs provided by, for example, non-government organisations, the fitness industry and the commercial weight loss sector. In order to enable these systems and networks to operate in coordinated and effective partnerships, there is a need to develop standards, accreditation requirements and directories, and to provide appropriate education and training to primary and public healthcare professionals.
Having an appropriate level of public and primary health workforce is important to support population and community-based activities, such as working with local schools to assist them in implementing school canteen guidelines; working with local governments to assist in making their local plans supportive of health; and working with community groups to promote activities such as walking groups. The public and primary healthcare workforce is also crucial to the success of any comprehensive social marketing campaign, by helping to direct messages to identified target groups and providing additional knowledge and support in the community. The workforce would consist of a range of health professionals, including public health nutritionists based in regional centres, health promotion officers specialising in physical activity, based in regional centres, and generalist health promotion workers in towns and rural centres. These officers could be employed in a range of settings including local governments, state/territory governments and non-government organisations. This level of capacity is currently lacking in most jurisdictions in Australia.
There is a range of Health Equality Targets from the ‘Close the Gap’ report that aim to provide an adequate workforce to meet Aboriginal and Torres Strait Islander health needs. We need to ensure the implementation of these targets in order to increase the recruitment, retention, effectiveness and training of health practitioners working within Aboriginal and Torres Strait Islander health settings, and to build the capacity of the health workforce. This includes establishing programs that increase the availability of a multidisciplinary workforce in Aboriginal and Torres Strait Islander health at the local level.[171]
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Further research on the role of multidisciplinary teams in the treatment of overweight and obesity is needed. There is evidence that programs delivered by multidisciplinary teams may be more effective at maintaining weight loss[129] when typically there is a high degree of relapse in weight loss for overweight and obese people.[128, 130] There are clear benefits of team care in improving chronic disease management,[131, 132] and sub-optimal management of chronic disease in general practice has been attributed to the absence of multidisciplinary teams within many general practices.[133]
Multidisciplinary patient care teams may include health professionals from a range of areas, such as a physician, dietitian, exercise expert, nurse and behavioural therapist/psychologist.[132] Such teams are proposed in the Australian Government’s Super Clinics policy with GPs and allied health professionals providing lifestyle modification advice and promoting better multidisciplinary care, located in one facility. Similarly, the New South Wales state government recently announced a $36 million state-wide strategy to address obesity, which includes the establishment of nine specialised Medical and Surgical Clinics across the state to provide multidisciplinary medical programs and bariatric surgery for those who are morbidly obese. Staff will include specialist physicians, diabetes nurses, psychologists and physiotherapists. Bariatric surgery will be considered for patients who fit certain criteria if all medical treatment options have been tried unsuccessfully.
The New South Wales strategy also includes a state-wide social marketing campaign promoting healthy eating and physical activity; a healthy advice telephone line providing information and coaching including follow-up calls and tailored counselling, based on the Quitline model, to be staffed by trained health professionals such as dietitians, nurses and exercise scientists; a parenting program to support parents of overweight and obese children; and the establishment of an Obesity Prevention Research Centre.[134]
Research among GPs has found that the impact of existing incentives to encourage a multidisciplinary approach to patient care (i.e. the Enhanced Primary Care (EPC) Chronic Disease Management (CDM) Medicare items) is restricted by:
- A lack of available community allied health services.
- Limited funding and eligibility of services under Medicare.
- Waiting times for state allied health services (as these services are now increasingly concentrated on recently hospitalised patients).[133]
Expand the supply and support training of relevant health workers such as primary healthcare workers, health promotion workers, nutritionists and dietitians.
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