Themes

AHPI will organise its research around the four principal themes adopted by the Institute for its research, education and service activities. These themes are The Future; Equity; Serious and Continuing Illness; and Governance. Using the third theme, serious and continuing illness, as a platform, AHPI conducts research that examines equity and the future as they relate to the prevention, control and service provision for these conditions. Likewise, governance issues in relation to health care, especially those that pertain to the Commonwealth-State split in responsibility for the provision of publicly funded health services, derive in part from the way these matters are thrown into bold relief as we attempt to cope, as a nation, with the rising prevalence of serious and continuing illnesses.

The Future

In 2003 and 2004, Professor Leeder worked at Columbia University at the Center for Global Health and Economic Development. Professor Leeder’s work, together with his Columbia colleagues, received worldwide publicity when Jeffrey Sachs launched their report, entitled A Race against Time, in April 2004. It concerned the prospects for less developed countries, both socially and economically, in the light of increasing rates of cardiovascular disease. With research funding from the Initiative for Cardiovascular Health Research in Developing Countries (ICHealth), Professor Leeder continues to work on the economic consequences of cardiovascular disease and the translation of these economic insights into effective preventive and control strategies through the recruitment of industry, labour and top order treasury and finance ministers from these nations. A recent grant of $US500,000 to ICHealth will enable the research workers to pursue this research more vigorously in future.

Dr Masoud Mirzaei is a PhD candidate with the Australian Health Policy Institute who is also exploring cardiovascular disease in the developing world. Dr Mirzaei is analysing changes in coronary heart disease (CHD) and its population risk factors in different regions of the world during the 20th Century. His thesis aims to identify the patterns and rank the determinants of the trends in CHD (rise and decline) over this period to find applicable CHD control policies and strategies for non-civil societies of developing countries.

In Australia, workforce issues are a major theme in the consideration of the future in healthcare. Staff at the Australian Health Policy Institute are researching the future needs of the health workforce and exploring how the current education of health care professionals may be strengthened in order to meet these needs. Jennifer Smith, Anne-marie Boxall and Amanda Dominello have conducted and analysed interviews with key stakeholders from across the health system. The first outcome of this research was the creation of a submission for the Productivity Commission’s Health Workforce Study. This submission synthesised the main themes discussed in the interviews and a copy of the submission may be found at http://www.pc.gov.au/study/healthworkforce/subs/sub087.pdf

Equity

AHPI seeks to conduct research into ways in which we can preserve equity as a guiding principal in health service provision, given the changing disease and health profile of Australia and the changing methods of healthcare financing. Anne-marie Boxall is a PhD student who is conducting research into the social, political and economic circumstances that form the background for countries to enact universal health insurance.

Serious and Continuing Illness

Research into the appropriate policies to guide and provide for the management of patients with serious and continuing illness is of critical importance in Australia, given the increasing number of people at risk. The Institute has applied for research funding with colleagues from the Australian National University to optimise prevention and care for Australians with, or at risk of, serious and continuing illness. Funds have also been sought to conduct a randomised trial and economic analysis of the effects of integrating health promotion with community services for frail elderly Australians.

Stephen Leeder and colleagues at Westmead and Blacktown hospitals in Western Sydney have a grant proposal before the NHMRC to explore the value of aerobic exercise training for people with advanced chronic obstructive pulmonary disease. Dr Jennifer Smith, a NHMRC post-doctoral fellow, is working with AHPI as part of her capacity-training program on the importance of sensory impairment among older people as a cause of their decompensation in the community. Hearing and visual impairments are also major problems in their own right, and Dr Smith has written a review of the research literature relating to elements that should be included in a hearing policy for Australia. Professor Leeder is associated with Professor Paul Mitchell and Dr Smith and others in the Blue Mountains Eye Study. This serves as the base plate for Dr Smith’s empirical work and provides many opportunities for research-based policy development.

In relation to asthma, for which Professor Leeder has a lifelong interest and which has been the topic of much of his research, the Childhood Asthma Prevention Study is ongoing in Sydney. The policy implications of the findings in this randomised control trial relate to data for the development of health policies about the environment for at-risk children of parents with strong personal and family history of asthma and related conditions.

In addition, a Diabetes Unit is currently being established within the AHPI. This Unit will concentrate on policies and systems to promote access to optimal standards of diabetes prevention and care. The engagement of consumers and civil society in health care decision-making, and the creation of healthier environments, will be of key interest. Initial projects will focus on the development of nationally agreed outcomes and indicators for diabetes patient education, testing a model for enhancing secondary prevention systems in the Pacific Island setting, and designing a consumer - industry engagement policy.

Governance

Dr Jim Gillespie, Senior Lecturer in Health Policy is using the methods of contemporary history and public policy analysis to investigate the roots of current policy dilemmas. Dr Gillespie will assess the effects of federalism, changing policy networks and the health professions as well as broader political crises and ideologies in shaping - and limiting - the structural reform of the health system. Dr Gillespie’s research program will be complemented by that of Associate Professor Giles’ who intends to explore practical and workable reforms that will break the current impasse in reform of Commonwealth/State relations in health. Christine Giles joined the University of Sydney as Associate Professor in the School of Public Health and will be working with AHPI on its research and teaching programs.