Areas of Research
The Sydney Health Policy Network aims to link the health policy research and education activities of the University of Sydney in a fruitful and enjoyable academic enterprise.
It seeks new knowledge and interest in the translation of knowledge into policy and practice. It will connect academics and those who make the policy decisions for society, including health service providers and health and social agencies, both nationally and internationally.
Below is a sample of health policy activities currently being undertaken by Members of the Network.
Transport-accessibility, public transport and flexible transport services
Dr Rhonda Daniels, Senior Research Fellow in Public Transport
Transport contributes to health in two broad ways. Firstly, transport provides access to health services and to other opportunities which affect health such as work and education. Secondly, sustainable transport (walking, cycling and public transport) contributes to physical health through physical activity and through reducing the impacts of transport emissions and noise, and contributes to mental health through improving social inclusion. At the Institute of Transport and Logistics Studies, the public transport team, led by Professor Corinne Mulley, Chair of Public Transport, is researching accessibility with a focus on public transport. Current and recent research projects include explaining walking distance to public transport, understanding variations in travel time to key activities including health, and exploring the potential for flexible transport services to improve public transport in low density areas.
Children as consumers: effect of marketing on children’s health
Associate Professor Teresa Davis, Discipline of Marketing, Business School
This study uses data from 58 students across the ages of 7-12. It explores the possible links between television food advertising, purchase requests, food consumption patterns of school children using a combination of exposure and influence measures including consumption diaries. First, a content analyses of a week of advertisements during children’s programming on FTA tv was taped and the most frequently advertised food products were identified. A pre-exposure questionnaire asked various questions about healthy and non-healthy food and ‘right ‘ nutritional choices. Following this the parents of the children helped them keep a 2 week food dairy/ tv viewing log and activity journal. At the end of 2 weeks, They were also tested on various brand recall and recognition measures, finally they were asked to make snack choice between advertise unhealthy snack and a healthy snack.
Despite the children indicating their excellent understanding of ‘healthy vs unhealthy’ foods in the pre-measure. In the final choice task, they chose the ‘unhealthy’ option. The knowledge of good nutrition did not appear to affect Children’s choices. The highly advertised unhealthy alternatives appeared to be chosen more often than the ‘healthy alternative’.
An update from researchers at the University of Sydney Business School
Dr John Buchanan, Director, Workplace Research Centre
Health effects of job design and employment arrangements on workers: Over the years the Centre has applied its multi-disciplinary mode of analysis to issues of health and safety at work. This includes analysing what characteristics of workplaces increase the likelihood of work-related injury and illness and what interventions are effective in developing safety cultures that promote well-being at work. Recent studies include analysing demographic, work arrangement and relational factors that increase fear of work-related injury or illness in the construction, health & community services and general labour forces; the effect of work hours and fatigue in the mining sector, why intervention strategies are not working to reduce mental stress disorders in the disability workforce and understanding how systems of work common in the luxury hotel sector impact on the health of workers.
Employment arrangements and health service systems: Our work on the health workforce has examined how employment arrangements impact the provision of health services. Recent research has included a study of nurse-patient and skill mix across the NSW public hospital system and working conditions in NSW public hospital Emergency Departments. One of our major achievements has been obtaining joint AMA and NSW Nurses’ Association funding for a survey of working conditions in NSW Public Hospitals. This constituted one of the few source of original statistical data contributed to the 2009 Garling Inquiry into NSW Public Hospitals.
Workforce development in the health sector: The Centre is one of Australia’s leading institutes analysing the evolution of work and identifying its implications for skills. Initially most attention was devoted to understanding the tension in how labour is developed and deployed at workplace, sectoral and national levels – i.e. the dynamics of skill eco-systems. More recently we have explored how flows of learning and labour are connected and/or fragmented. This has resulted in growing attention being devoted to the notion of vocation as a concept that warrants closer analytical and policy attention. We have developed special understanding of these issues in the community services and health sectors.
Healthy Workers Portal: The WRC is currently working with the Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders and the Workforce Education and Development Group (WEDG) (both from the University of Sydney) to develop content and resources for a National Healthy Workers Portal. The Portal aims to provide national support for the effective implementation of workplace health promotion programs in Australian workplaces. We are also looking into further research opportunities in the area of health and wellbeing at work.
We are planning to continue applying our multi-disciplinary model of research practice to problems arising out of the intersection between work and health at a health system level (health service systems and labour standards; workforce development); health worker level (occupational health and safety research) and individual well-being level (health outcomes of work). We are especially interested in:
- The potential role of workplaces as site for promoting and delivering well-being.
- Generating robust scenarios of how the health workforce could potentially evolve on the next decade or so. We are especially interested in the potential of Clinical Service Networks of multi-disciplinary teams to provide an alternative model of health service delivery that avoids the problems of both ‘budget driven’ managerialism and approaches to excellence defined on the basis of occupational enclosure and exclusion.
Building an ethical and sustainable model for health professional recruitment to Australia: a case study of the Philippines
Professor Stephanie Short, Professor Charles Sampford, Professor Lesleyanne Hawthorne, Bronwyn Nardi, Emeritus Professor Howard Adelman, Professor James Buchan, Imelda Argel, Kanchan Marcus, Dr William Ransome, Anna To, Diana Schmalkuche & Cherie Ryan
Australia, like other English-speaking western countries, increasingly depends on recruiting health professionals educated abroad (currently more than 6,500 nurses a year) as a consequence of an ageing population, retention and geographical issues and outflows of local graduates. Concerns underlying health worker migration are many fold, two areas of prominence is ethics and sustainability; how to provide mutual benefits to both countries, including the individual nurses and long term viability of the health workforce.
Our ARC Linkage Project with Partner Organisation, Queensland Health is designed to develop an ethical and sustainable model for recruitment of health professionals from a developing to a developed country, ensuring fairness to the recruiting, the individual nurses and the source country by analysing a model in relation to other actual or potential models. The method involves analysing quantitative data sources of English test results and migration data with a particular focus on the Philippines. In Queensland, migrant Filipino nurses will be sourced through mail-out surveys and in the Philippines, key informants will be interviewed to provide evidence about their experience and perceptions of the current migration model. Directors of Nursing and Filipino registered nurses will also be interviewed which will gauge whether nurses have experienced any sense of marginalisation and determine their level of labour market integration. The final stages involve a comparative policy analysis of migration models to determine if there are any unintended consequences. We will then develop an ethical model for nurse migration to Australia and explore facilitators and barriers to successful recruitment, the extent to which recruits are able to secure registration to practice, and use their skills at an appropriate level in Australia. Significance of the research is timely, with the release of the WHO Global Code of Practice on International Recruitment of Health Personnel in 2010.
Professor Stephanie Short, Health Sciences
HealthGov, convened by Stephanie Short, Professor of Health Sciences, is an Australian network of researchers, health professionals, regulators and policy makers. It provides a forum for discussion, promotion and collaboration on research in health governance. Health governance addresses three inter-related areas: improved access to health care (through policies, programs and funding arrangements), good practice (through professional and ethical standards in education and practice) and safer patients (through regulatory systems). We will briefly introduce the network’s history and aims, some activities and current projects, and encourage anyone with an interest in health governance to join: http://sydney.edu.au/health_sciences/healthgov/
Integrating evidence into policy and sustainable service delivery: The ‘wobbly hub and double spokes’ model
Professor Craig Veitch, Mr Scott Griffiths, Associate Professor Michelle Lincoln, Professor Anita Bundy, Dr Gisselle Gallego, Professor Richard Madden, Dr Angela Dew, Ms Kim Bulkeley
Vast distances and workforce shortages limit access to health services in rural and remote NSW. This presentation outlines a 4.5 year NHMRC-funded Partnership project aimed at translating evidence into policy. A Faculty of Health Sciences team in partnership with Ageing, Disability and Home Care, Western Region are exploring current issues in therapist workforce and service delivery with the aim of developing, implementing and evaluating evidence-based policies for workforce utilisation in service delivery. Expected outcomes include increased access to allied health services in Western NSW and a sustainable program of policy monitoring and development.
Treatment for Lymphoedema
Robyn Sierla, Health Sciences
I am a clinician treating lymphoedema at Royal Prince Alfred hospital and am completing my masters of applied science in research. My interest is in timely referral and access to treatment services for those with lymphoedema. The UK and US have undertaken large scale studies comparing health costs ($) of treating lymphoedema against hospital admissions for cellulitis secondary to lymphoedema. These results show lymphoedema treatment to be cost neutral at worst, and cost effective at best.
Treatment access to public health services in Sydney is variable dependent on postcode and cause of lymphoedema. Understaffing of units results in waiting lists of 3 to 4 months for appointments. If you live in the northern suburbs and you have lymphoedema secondary to breast cancer you have access to a limited service at RNSH. If you have primary lymphoedema or lymphoedema secondary to melanoma and reside north of the harbour bridge, then you are reliant on the private (mostly unregulated) sector. Public services are available in the Eastern suburbs at Prince of Wales hospital, but only if your lymphoedema is subsequent to surgery that you had at the hospital.
My research looks at nationwide access, and access to treatment although poor in remote and regional Australia (35-40% with no access to a therapist), it is also poor in metropolitan Australia (20% with no access to a therapist). The survey also questions consumers on public and private lymphoedema treatment, with half of the population surveyed accessing private services. Satisfaction for treatment effectiveness, waiting times and cost was investigated. Services users report they are dissatisfied (median) with all three factors in the public health sector, being satisfied with treatment and wait times, and dissatisfied with cost for the private sector.
Treatment of lymphoedema is a cross disciplinary concern as referrals come from specialties of cancer services and palliative care, vascular specialists, infectious diseases, dermatology, etc. I could go on, but will stop myself before I really get on a roll… I think this is an area where health policy is needed as it very much falls between the cracks. I’d be interested in participating in an interest group (despite my lack of knowledge in health policy). I was recently involved in developing guidelines for provision of compression garments through Enable (PADP) and the changes at this level have already made some improvements in access to compression garments.
Sydney Medical School
Food policies to improve diets and reduce chronic disease in India
Shauna Downs, PhD Student, Menzies Centre for Health Policy
This project aims to examine trans fat in the Indian food supply using food supply chain analysis to: 1) determine the sources of trans fat 2) identify key points for policy interventions to reduce their consumption and 3) to determine the feasibility of these policies. The project will examine the processes and actors that take food from farm-to-fork, while identifying potential pressure points in the food supply for policy interventions. A feasibility assessment of the proposed policy interventions will be conducted with key stakeholders (including government ministries, public organizations and relevant leaders from the private sector) in India. This project has the potential to improve diets and help reduce chronic disease in India by identifying feasible multi-sectoral policy options. The novel use of food supply chain analysis will provide scope for applying this methodology to other key aspects of the food supply.
A comparative analysis of bowel cancer screening policy in Australia, New Zealand and the UK: evidence lost in translation?
Kathy Flitcroft, Sydney School of Public Health
My PhD is a comparative case study of the role of evidence in decisions about bowel cancer screening policy in Australia, New Zealand and the UK. There is solid evidence from meta-analyses of randomised controlled trials that biennial faecal occult blood test (FOBT) screening can reduce the relative bowel cancer mortality risk by up to 25%. Yet, based on this same evidence, the four countries of the UK and the Australian federal government have implemented markedly different FOBT screening programs, none of them optimal, while NZ has delayed implementation.
Our research illustrated the often tenuous relationship between the rhetorical discourse of evidence-informed policy and the practice of policy funding. It highlighted the potential operational inefficiencies that result in practice from insufficient funding of evidence-informed policies. Ironically, failure to properly fund policies based on evidence can undermine the original rationale for funding them in the first place.
How and when to intervene in cases of severe domestic squalor.
Clinical Professor John Snowdon, Psychiatry, Concord Clinical School
The prevalence of severe domestic squalor among people aged over 65 years in Central Sydney is 1 per 1000. Among younger adults it may be 1 per 5000. A majority of those living in squalor who are assessed by psychiatrists are found to have dementia, substance abuse (mainly alcohol) or schizophrenia, but some have depression, Asperger’s, developmental disability, OCD , personality disorder, or physical disability (e.g. stroke, visual impairment) . In a majority of cases, accumulation of items and/or refuse is observed. People with so-called ‘hoarding disorder’ (a term to be introduced, perhaps, in DSM-V) may seek attention from psychologists and want something done.
People referred to psychiatric services and a variety of community agencies because they live in very unclean conditions usually do NOT want anyone to intervene, though squalor and accumulation are commonly unhygienic , unsightly, odorous and sometimes dangerous: OH&S issues arise when community personnel are asked to visit, assess or intervene. Our experience in Central Sydney led to us convening a Reference Group to consider how best our various services and agencies could liaise and coordinate in order to provide optimum support and care for people living in unacceptably unclean dwellings. We developed guidelines and recommended creation of triage services with associated expertise to deal with cases of squalor, and thereby hopefully improve the quality of life of occupants and that of their neighbours and caring relatives.
The ‘Squalor Project’ team run by Catholic Community Services in Sydney was formed as a result; funding was provided through ADHC. Further research is planned, looking especially at frontal lobe function among those referred for assessment, and looking at so-called ‘animal hoarding’ (with the RSPCA). A second squalor and hoarding conference will be held in Sydney in February 2012.
Immunisation Research and Policy
Dr Jane Jelfs, National Centre for Immunisation Research & Surveillance of Vaccine Preventable Diseases (NCIRS)
The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS) is affiliated with both the Discipline of Paediatrics and Child Health and the School of Public Health, runs the Vaccines in Public Health elective for the Masters in Public Health (MPH), and currently supervises 7 PhD candidates. NCIRS commenced its fourth 4-year funding agreement ($16.2m) with the Commonwealth Department of Health and Ageing in 2010. Functions under this agreement include the technical secretariat to the Australian Technical Advisory Group on Immunisation (ATAGI), and analysis and reporting on several large data sets including the National Notifiable Diseases Surveillance Scheme (NNDSS), the Australian Childhood Immunisation Register (ACIR), and Adverse Events following Immunisation (AEFI). Work under the agreement also includes evaluations of national immunisation programs, conduct of the national serosurveillance program and, in collaboration with the University of NSW, modelling relevant to immunisation programs. NCIRS also conducts research, surveillance and training for NSW Health. In addition, NCIRS has a large clinical trial and social research program, funded through competitive grants and industry sponsors, which involves research collaborations both nationally and internationally.
Recent examples of how NCIRS translates research into policy include vaccines for rotavirus and pertussis. For rotavirus, suggestive evidence of a small but measurable increase in intussusception as an adverse outcome from rotavirus vaccines emerged from data reported by a hospital-based enhanced surveillance network NCIRS set up with the Australian Paediatric Surveillance Unit (PAEDS). This signal was further investigated in liaison with ATAGI and the Therapeutic Goods Administration (TGA), via application of self-controlled case series and case control methodologies to data sets at the NSW and national level. Through our work on national program evaluations, we provided data on the impact of rotavirus vaccine on gastroenteritis hospitalisations to generate an overall assessment of risk and benefit. For rapid public communication, a statement was issued electronically (http://www.tga.gov.au/safety/alerts-medicine-rotavirus-110225.htm) with publications being developed. For Pertussis, data from multiple sources (vaccine effectiveness studies on routine data sets, serosurveillance, and follow-up of a NHMRC funded clinical trial), have pointed to more rapid waning of immunity in children since the 18 month booster was discontinued in 2003. This is currently being considered by ATAGI.
Why have welfare-to-work policies been unsuccessful among those with mental illness?
Ashley McAllister, PhD Student, Menzies Centre for Health Policy
In order to explore this puzzle, this project examines the social assistance and health care systems in Australia and Canada to determine if the current systems adequately protect the needs of those with mental illness. In particular this project will attempt to identify possible policy responses to increase the social and economic participation of those with mental illness.