INSPIRE Issue 34 - The Prevention Edition

THE PREVENTION EDITION

Welcome to the Prevention Edition of INSPIRE

This edition of INSPIRE is dedicated to the diverse and innovative health and medical research contributing to the broad theme of 'prevention'. It is not just about the presence or absence of ill health, it is also about leading a life of quality.

Advancing research into prevention is critical – it includes understanding social determinants, cultural determinants and commercial determinants of health and wellbeing and how to address health equality and reduce the burden of disease on individuals, the healthcare systems and the economy. We know this theme matters to you because we have had an overwhelming number of contributions. Advancing prevention is also one of the key priorities for Research Australia. We are advocating strongly for more systems-wide investment. This edition of INSPIRE demonstrates existing strengths and expertise in preventative health from among the Australian research pipeline.

From a groundbreaking longitudinal birth study revealing an iron crisis among Australian toddlers, to specific interventions like tailored meal boxes to meet the dietary and disability needs of those with neurological conditions, and non-invasive monitoring for heart transplant recipients, all reshaping patient care and improving outcomes. We also showcase programs that not only demonstrate the impact of prevention-focused investments on individuals, such as adult vaccination programs and falls prevention strategies, but how these underscore the economic and

societal returns of proactive preventative health measures. We also learn of the opportunities interdisciplinary research offers to health prevention, such as the use of system-thinking to transform chronic disease prevention. Improving health outcomes through advancing prevention recognises that health and wellbeing is not solely the responsibility of health departments, hospitals or pharmaceutical companies or any singular part of the pipeline. It requires a whole-of-system approach, considering factors such as climate change, housing, poverty, and geopolitics on health, but also how preventative health and medical research innovation then contributes back to these research and policy platforms. This edition showcases research that demonstrates the importance of health education and fostering healthy, sustainable environments. Prevention lies in our ability to be creative, take a systems-thinking approach, innovate boldly, and work collaboratively.

Thank you to our members who have shared their critical work with us in this issue. INSPIRE serves as a platform to showcase your stories and celebrate the vibrant and exceptional health and medical research community in Australia. We wish you the best for the festive season and we look forward to continuing to showcase incredible research and contribute to raising health literacy in the broader community in 2025, which is one approach to prevention itself!

Best wishes

Nadia and your Research Australia Team

L-R Sam Mills, Dr Talia Avrahamzon, Sabrina Stone, Amanda Stonestreet, Nadia Levin, Hayden Nichols

At GSK we unite science, technology and talent to get ahead of disease together. We aim to positively impact the health of 2.5 billion people by the end of the decade. Our bold ambitions for patients are reflected in new commitments to growth and a step-change in performance. We prioritise innovation in vaccines and specialty medicines, maximising the increasing opportunities to prevent and treat disease. At the heart of this is our R&D focus on the science of the immune system, human genetics and advanced technologies, and our world-leading capabilities in vaccines and medicines development.

In Australia, we offer a broad portfolio of innovative and established vaccines and medicines in infectious diseases, HIV*, oncology, and respiratory/immunology. Locally, we also work closely with leading researchers and clinicians to ensure that Australian patients can access the latest global innovations, as they happen. For more than forty years we have also recognised leaders in the Australian medical research community through the G GSK Award for Research Excellence

*Our HIV business is managed through ViiV Healthcare, a global specialist HIV company that GSK controls as majority owner, with Pfizer and Shionogi also as stakeholders.

Australian Health & Medical Research & Innovation

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INSPIRE is a publication of Research Australia Ltd ABN 28 095 324 379 384 Victoria Street Darlinghurst NSW 2010

Who can submit articles?

Any current member of Research Australia who would like to share a relevant story that affects their organisation including, philanthropic donations and their outcomes, research findings, and any other related health and medical research topic that affects the Australian population.

Submission guidelines & deadlines For information regarding how to submit and publishing deadlines visit the Research Australia website

Disclaimer

The opinions expressed in INSPIRE do not necessarily represent the views of Research Australia. Whilst every effort has been made to ensure accuracy, no responsibility can be accepted by Research Australia for omissions, typographical or inaccuracies that may have taken place after publication. All rights reserved.

The editorial material published in INSPIRE is copyright. No part of the editorial contents may be reproduced or copied in any form without the prior permission from Research Australia. © Research Australia 2024.

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My Twitter : @chriskere CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL My Twitter : @chriskere

EDITH COWAN UNIVERSITY

MONASH UNIVERSITY

ADVISORY SERVICES

Research Australia has provided specialist consulting and advisory services for many years. Our consultancy services continue to expand each year, driven by our unique expertise, reputation for high quality work, and strong relationships to drive outcomes and influence system change.

Most recently we have worked with state and federal governments, patient groups, industry, hospitals, and aged care. Some of the consulting services Research Australia provides are:

Market scanning – detailed analysis of who is undertaking what research to inform project planning and ensure projects target the right health and medical research stakeholders.

Policy advice – on the funding streams, government policy landscape and political interests that impact your projects’ success.

Sector consultation – facilitating engagement with the health and medical research community and the consumers who can best inform approaches to health and medical research.

Grants guidance – evaluating and reviewing grants opportunities and funding programs. m +61 2 9295 8546

k admin@researchaustralia.org

Australian Health & Medical Research & Innovation CONTENTS

Vaping: the challenge of keeping evidence up-to-date

Expanding the scope of breast screening services to include a preventive intervention

Exercise – no longer the ‘poor cousin’ of osteoporosis therapy

The Mental Health and Wellbeing of First Nations Children and Youth AI and a hyper-personalised physical activity assistant

EVENTS OVERVIEW OPINION POLL

On 23 September Research Australia launched our 2024 Public Opinion Poll. The session featured insights from Roy Morgan CEO Michelle Levine, who emphasised the significance of independent polling. The polling highlighted strong support for various areas, including mental health research, government investment in local medical product development, and an emphasis on trust in doctors for clinical trial participation. We also noted several ongoing trends, such as the sustained prioritisation of health research funding and note a decline in individual donations amid rising living costs. The opinion poll is available to view on the Research Australia website.

PRE-

ELECTION SUMMIT

Research Australia hosted a pre-election summit on 8 October 2024 in Canberra. The Summit brought together leaders from accross the health and medical research innovation pipeline to explore key issues impacting the future of the sector in Australia and discuss the key reforms needed to thrive. We heard from researchers, industry leaders, funders, Parliamentarians and Departmental officials throughout the day and we will use the themes explored to develop our Pre-Budget Submission and our 2025 Federal Election Strategy. We thank our valued member and sponsor, CSL, for supporting us to deliver this event.

Right: Senator the Hon Anne Ruston & Nadia Levin

Below: L-R Dr Chris Nave, A/Prof Cleola Anderiesz & Prof Trent Munro

AbbVie is a global, research-based biopharmaceutical company committed to discovering, developing and delivering innovative new medicines. We invest in research to build new understanding, find novel solutions for health challenges and are making significant advancements with a robust pipeline of potential new medicines.

For over ten years, we’ve dedicated ourselves to making a difference in people’s lives. Creating medicines and solutions that help patients, communities, and our world. We find answers that make lives better. And we won’t stop until we’ve raised the standard of treatment for all.

EVENTS OVERVIEW

UNIVERSITY ROUNDTABLE

On 20 November 2024, the Research Australia virtual University Roundtable was attended by 29 representatives from 20 member universities. November’s panel discussion included four eminent speakers with expertise in social determinants of health, participatory research methodologies with often marginalised or silenced communities, as well as leading reform agendas:

Professor Sharon Bessell Director, Children’s Policy Centre, Director Gender Equity and Diversity, Crawford School of Public Policy, ANU

Professor Robyn Norton AO Founding Director, The George Institute of Global Health and Conjoint Professor Medicine and Health, School of Biomedical Sciences, UNSW

Ms Fiona Cornforth, Head of Yahunda Wandi, National Centre for Epidemiology and Population Health College of Health and Medicine, ANU

Professor Anne Kavanagh Chair in Disability and Health, Melbourne School of Population and Global Health, Melbourne University

Panellists shared their research, highlighting the critical importance of focussing on social (and cultural, and commercial) determinants of health (and ill health). This included sharing their participatory research approaches they use to engage with those in the community we don’t often hear from to ensure we understand the impacts of social determinants of health on marginalised communities; and the implications on health service

ANTIMICROBIAL RESISTANCE (AMR) COMMUNIQUE

Research Australia hosted a stakeholder roundtable in August 2024, in partnership with CSIRO, bringing together over 20 experts in AMR including representatives from the research sector, professional associations, health industry and consumer groups.

The goal was to build consensus on the key priorities for achieving optimal prescribing of antimicrobials to reduce their overall use, including opportunities for a more patient-centric and multidisciplinary approach.

Optimal prescribing seeks to improve patient outcomes, enhance patient safety, reduce costs, supports equitable access, and ensures that antimicrobials are only used when needed, which helps to preserve their efficacy.

To coincide with World AMR Awareness Week, an initiative of the World Health Organisation, Research Australia launched a communique with cross-sector support that details key priorities to achieve optimal prescribing of antimicrobials across prevention, packaging and manufacturing, prescribing practice, and policy change. The focus of the communique is on prescribing of antimicrobials in primary and community healthcare settings, where the vast majority of human antimicrobial prescribing takes place.

Contact us to find out more about our advisory work.

systems, including embedding such approaches in health and medical research, teaching and university structures.

The panel stimulated robust discussion and some of the themes that emerged during both the presentations and the discussion included Australia is leading in some aspects of research and policy but in other aspects, not as strong as other nations; a need to have shared understanding of ‘community’ when we use the term community – for example, locational, cultural, workforce; the opportunities that exist in linking datasets in other sectors to health (for example, the National Disability Data Asset); and the need to understand intersectional experiences of discrimination.

TOP 10 TIPS FOR NHMRC GRANT SUCCESS COMMON PITFALLS AND HOW TO AVOID THEM

In November, Dr Tamika Heiden, Principal of the Research Impact Academy, generously shared her top 10 learnings she’s witnessed in supporting thousands of NHMRC grants with our members. The session provided essential tips for crafting a competitive application, including demonstrating impact and leadership and constructing an effective vision statement. Dr. Heiden also outlined strategies to avoid common mistakes and improve the likelihood of success. After her practical and insightful presentation, participants had the opportunity to engage in a Q&A and discussion.

The Digital Health Cooperative Research Centre (DHCRC) is advancing digital health innovation by linking academia, industry and government to accelerate research implementation, enable effective use of data, connect care, empower the health workforce and support consumers to confidently be in control of their health and wellbeing. As long-term supporters of the health and medical research sector we are proud to celebrate the significant contribution of all Australian researchers. digitalhealthcrc.com | info@dhcrc.com

CONGRATULATIONS TO THE WINNERS OF THE 21ST RESEARCH AUSTRALIA AWARDS

On 14 November, Research Australia hosted the 21st Health and Medical Research Awards Gala Dinner in Melbourne, celebrating Australia’s outstanding health and medical researchers, innovators, and advocates. The event was a night of inspiration and exceptional talent, highlighting the incredible achievements shaping our nation’s health and medical research sector and the future state of health for Australia.

These awards honour excellence across transformative research, impactful data innovations, and critical collaborations driving better health outcomes nationally and globally. As the national peak body for health and medical research innovation, these awards exemplify the thriving innovation and dedication within the sector.

The evening featured a keynote address from Assistant Minister for Health and Aged Care, and Assistant Minister for Indigenous Health,

the Hon Ged Kearney MP, and included insights from Deputy Premier of Victoria, the Hon Ben Carroll MP, Senator the Hon Anne Ruston, Shadow Minister for Health and Aged Care, and Victorian Senator Steph Hodgins-May, Greens Spokesperson for Science, Industry and Innovation.

OUR 2024 AWARD RECIPIENTS

The prestigious Peter Wills Medal , which recognises professionals who have strengthened Australia’s international reputation for health research and fostered collaboration across the sector was awarded to Clyde Campbell AM, founder of Shake It Up Australia. Clyde has an entrepreneurial spirit and a forward-thinking vision. After being diagnosed with Parkinsons, rather than waiting for others to find a solution, he chose to take action and be part of the change, actively contributing to the pursuit of a cure and driving innovation in the process.

Clyde launched Shake it up Foundation Australia and partnered with The Michael J. Fox Foundation to increase awareness and funding for Parkinson’s research to prevent, slow and stop the progression of the disease and ultimately lead us to a cure.

Clyde Campbell AM

Clyde Campbell AM and his table enjoying the evening.

L-R Dr Amy Page, Prof Christopher Barnett, Marketa Reeves & A/Prof Rebecca Glauert

The Hon Ged Kearney MP delivering the keynote address

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

OUR 2024 AWARD RECIPIENTS

The Discovery Award, sponsored by the Victorian Government Department of Jobs, skills, Industry and Regions (DJSIR) and presented by Deputy Premier and Minister for Medical Research and Minister for Education, The Hon Ben Carroll MP recognises an early career researcher whose paper/patent/discovery has already demonstrated its importance or impact. The winner of this award was Dr. Mustafa Atee, research lead at HammondCare’s Dementia Centre and co-founder of PainChek®, an AI-driven pain assessment for non-verbal dementia patients. Highly commended recipients were Dr. Jiayan Liao (UTS), an award-winning materials scientist, pioneering bioanalytical tools and imaging for early disease detection and Dr. Jin Ng, a WEHI researcher who innovates in lung cancer studies.

As the awards were hosted in Victoria this year, Research Australia acknowledges the leadership of the Deputy Premier and the Victorian Government’s commitment to advancing medical research, innovation, and manufacturing. We heard from the Deputy Premier about the direction Victoria has taken to strengthen its position as a global leader through initiatives like the partnership with Monash University to establish a centre for training the mRNA workforce and the creation of the Australian Centre for Artificial Intelligence in Medical Innovation at La Trobe University. The government’s support for public health research is equally commendable. The Burnet Institute, with backing from the Victorian Government, is leading vital work to improve indoor air quality, addressing challenges highlighted during the COVID-19 pandemic.

(CONTINUED)

The Hon Ben Carroll MP and Dr Mustafa Atee

The Hon Ben Carroll MP and Dr Jin Ng

The Hon Ben Carroll MP addressing the audience

L-R Dr Jiayan Liao, The Hon Ben Carroll MP, Dr Mustafa Atee & Dr Jin Ng

Advancing health for a changing world

The Advocacy Award celebrates outstanding contributions by individuals who raise community awareness and highlight the importance of health and medical research. Sponsored by AbbVie, the award was presented by Senator the Hon Anne Ruston and Shruti Chaturvedi from AbbVie. This year’s winner, Dr Jane Tiller (Monash University) championed Australia’s genetic discrimination ban in life insurance, leading advocacy and research to ensure safe participation in genomic research, impacting policy and genomic medicine. The highly commended recipients were Professor Meera Agar (UTS) who leads interdisciplinary research to improve palliative care for cancer and chronic illness patients and Professor Hanny Calache who established the Oral Health Economics Research Stream (OHERS) at Deakin University, promoting cost-effective oral health interventions and policies for Australia’s at-risk communities.

The Great Australian Philanthropy Award, presented by Research Australia Chair, Martin Bowles, celebrates personal philanthropy that is outstanding in its generosity, visionary, transformative, and impactful in Australian health and medical research This was awarded to Paul and Sue Taylor who have significantly supported the University of Queensland, enabling the creation of the Centre for the Business and Economics of Health with a focus on improving healthcare systems as a whole.

The Frontiers Research Award , sponsored by ANU and presented by Senator Steph Hodgins-May and Professor Ross Hannan, recognises the success of innovative health and medical research that extends beyond existing knowledge boundaries and/ or understanding within health and medical research. The winner of this award was the Centre for Microbiome Research (QUT) who have pioneered microbial studies to advance health, establishing Australia as a leader with projects like the Australian Human Microbiome Biobank

Senator the Hon Anne Ruston and Dr Jane Tiller

Paul Taylor

L-R Senator Steph Hodgins-May, Professor Patricia Davidson, Professor Gene Tyson, Associate Professor Simon McIlroy and Professor Ross Hannan.

L-R Prof Paul Lacaze, Dr Jane Tiller & Dr Adam Brotchie

The Department of Jobs, Skills, Industry & Regions

L-R Prof Kelvin Kong, Prof Misty Jenkins & A/Prof Azure Hermes

Prof Hanny Calache &

Prof Suzanne Robinson

L-R Prof Matthew Kiernan, Prof Jane Butler & Prof David Berlowitz

Dr Renee Health MLC &

Prof Steve Robson

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

The Digital and Data Innovation Award seeks to recognise innovators who are at the forefront of the innovative use of data. Sponsored by Digital Health CRC and presented by Professor Nicholas Fisk, AM the winner was the team behind the Deteriorating Aged Care Resident Index (RMIT, Telstra Health and Digital Health CRC) who developed Australia’s first digital tool to predict health deterioration in aged care, improving safety and quality for vulnerable residents. Highly commended was awarded to The Advanced Genome and Transcriptome Analytics Project (Children’s Cancer Institute) for their development of Australia’s largest computational biology team in paediatrics to support real-time precision medicine analysis for children with cancer.

The Health Services Research Award recognises leadership and outstanding contribution to health services by driving research that has led to a significant improvement in healthcare; and/or has championed the development of the health services research field. This year’s award, presented by Associate Professor Annette Schmiede, was won by internationally renowned cancer surgeon, Professor Christobel Saunders AO (University of Melbourne) for her contribution to the advancement of cancer care through research, teaching, and policy, significantly improving patient outcomes. Highly Commended recipients were the Genomic Autopsy Study team for their pioneering genomic diagnostics in perinatal death and international expert in Gestational Diabetes Mellitus, Distinguished Professor David Simmons (Western Sydney University).

The GSK Award for Research Excellence presented by Dr Alan Paul was won by Professor Matthew Kiernan AM (NeuRA) who is profiled later in this publication.

A NIGHT TO REMEMBER

The event is a celebration of Australia’s leading health and medical researchers, innovators, advocates and philanthropists. A celebration of what’s working well across the pipeline that enables us to be healthy as individuals, as communities and as a nation, as well as a contributor and driver of a healthy economy.

“We are proud to honour the exceptional talent that defines Australia’s health and medical research sector. These awards showcase how transformative ideas and collaborative efforts can address global health challenges and improve lives.”

We thank our generous supporters of the event, including premium event partner, the University of Melbourne, and award sponsors, for their continued investment in the future of Australian research.

As we look ahead, Research Australia remains committed to nurturing and championing the world-class researchers, innovators, and advocates who ensure that Australian health and medical research continues to lead on the global stage.

We look forward to another year of groundbreaking achievements. Keep an eye out for the call for nominations for the 2025 awards, opening early next year!

L-R Clare Russell (RMIT), Professor Karin Verspoor (RMIT), Dr Jennifer Beer (Telstra Health), Professor Nick Fisk (Research Australia), Isobel Frean (DHCRC).

Associate Professor Annette Schmeiede and Professor Christobel Saunders AO

L-R Cindy McLeish MP, Nadia Levin and Senator the Hon Anne Ruston

LEADING AUSTRALIAN SCIENTIST WINS THE 2024 GSK AWARD FOR RESEARCH EXCELLENCE IN RECOGNITION OF GROUNDBREAKING BRAIN DISEASE RESEARCH

Neurodegenerative diseases like motor neurone disease (MND) and frontotemporal dementia are among the most profound medical challenges of our time.

These conditions not only pose significant challenges to those affected, but also place immense strain on healthcare systems, families, and the broader community. As our population ages, understanding how we can prevent the onset of these diseases and mitigate their symptoms is critical.

An Australian researcher playing a pivotal role in advancing global understanding of how and why neurodegenerative diseases begin is Professor Matthew Kiernan, Chief Executive Officer and Institute Director at Neuroscience Research Australia (NeuRA) and Scientia Professor of Neuroscience at the University of NSW.

As an internationally renowned neuroscientist, Professor Kiernan is known for his work introducing techniques that have enabled scientists to study nerve cell communication. These discoveries have improved understanding of the mechanisms of neurodegenerative disease, helping scientists identify new therapeutic targets.

These achievements underscore his latest accolade, with Professor Kiernan recently announced as the 2024 recipient of the GSK Award for Research Excellence – one of the most prestigious awards available to the Australian medical community.

Accepting the honour, Professor Kiernan noted that it was an exciting time to be a neurodegenerative disease researcher, as “it is entirely possible that conditions like

dementia and MND will be manageable within the next two decades”.

It’s a bold prediction, but one to which he and his research team are firmly committed. He commented:

“For a long time, one of the key challenges facing neurologists was understanding how neurodegeneration begins in the brain. Our research has provided key information about the critical functional changes that happen prior to the onset of a neurodegenerative disease.

“We are now able to delineate between the normal function of the brain and the key mechanisms of disease. This new perspective is paving the way for innovative therapies and treatment options for conditions like MND and frontotemporal dementia.”.

LOOKING AHEAD TO THE FUTURE

With dementia expected to become a leading cause of death in Australia, Professor Kiernan said it was vital to continue championing all research endeavours.1 While there is no current cure, Professor Kiernan is optimistic devastating conditions like dementia and MND will become a thing of the past – noting that research and trials are the only path forward.

“We’d like to make sure that no Australian or international patient, ever has to face a diagnosis of motor neurone disease or dementia,” Professor Kiernan said. “These are now universally fatal conditions.”

“But given that we have developed preventative solutions and effective treatments for certain types of cancer and vascular disease, we know it is possible to find innovative solutions.”

ACCELERATING NEURODEGENERATION RESEARCH IN AUSTRALIA

Professor Kiernan says he will use the $100,000 AUD grant accompanying the GSK Award for Research Excellence to establish a clinical fellowship to underpin the development of a national clinical trials program. This will improve patient access to new trials and enable more robust assessment of clinical data.

“Further developing our national clinical trials program is a major priority for our team. This grant provides an important opportunity to establish a clinical fellowship focused on translational research and precision medicine approaches for all Australian patients.”

ABOUT THE AWARD

The GSK Award for Research Excellence is one of the most prestigious awards available to the Australian Medical Research Community. It has been awarded since 1980 to recognise outstanding achievements in medical research that are focused on improving human health both locally and globally.

“We are delighted to welcome Professor Kiernan to the distinguished list of the GSK Award for Research Excellence alumni members. His outstanding work deserves recognition – he really is paving the way when it comes to neurodegeneration research,” said Dr Alan Paul, Executive Country Medical Director at

GSK Australia.

“We are thrilled to support Matthew and his team, as they continue their endeavor to improve health outcomes for patients locally and globally.”

The 2024 GSK Award for Research Excellence (ARE) was presented to Professor Kiernan at Research Australia’s Health and Medical Research Awards in Melbourne in November.

ABOUT PROFESSOR KIERNAN

Professor Kiernan is a distinguished clinical academic and scientist renowned for his expertise in neurodegenerative diseases, particularly motor neurone disease (MND) and frontotemporal dementia (FTD). He earned his PhD at UNSW Sydney and completed his specialty training at Prince of Wales and Prince Henry Hospitals. His outstanding contributions to neuroscience were acknowledged with a Doctor of Science (DSc) award from UNSW in 2009. Professor Kiernan leads a team of multi-disciplinary researchers at NeuRA dedicated to advancing research in MND and FTD, focused on early detection, novel treatments and the fundamental mechanisms that underpin these neurodegenerative conditions. Professor Kiernan is NeuRA’s Chief Executive Officer and Institute Director.

Prof Matthew Kiernan & Dr Alan Paul

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

ENHANCING CHRONIC KIDNEY DISEASE CARE THROUGH DATA

How New Insights are Helping West Australians

UNDETECTED CHRONIC KIDNEY DISEASE

Chronic Kidney Disease (CKD) affects approximately 1 in 10 Australians, positioning it as a significant health issue. It is more prevalent than diabetes and greatly impacts those affected, frequently leading to serious health complications. CKD can remain undetected for years, with about 80-90% of cases going undiagnosed even among patients who are already seeing a doctor. This is because early-stage CKD often presents no symptoms, making detection challenging. Yet identifying CKD early is essential, as patients may be at significantly higher risk of heart-related health issues, even in the absence of symptoms, compared to individuals with healthy kidneys. To address gaps in detection and treatment, a project funded under Digital Health Cooperative Research Centre

in Western Australia has developed a large dataset linking kidney health data from public and private pathology providers with hospital and mortality records. Linkage of records was done using a technique that links data without sharing personally identifiable information. This novel resource, the WA CKD Data Asset, aims to deepen the understanding of CKD and its progression. By analysing the dataset, researchers, clinicians and health services can gain new insights into the prevalence of CKD in WA and address the needs of those most at risk through tailored prevention and treatment approaches and health service modelling and planning. The data asset includes de-identified information on over 2.5 million patients over a ten-year period, allowing for in-depth analysis of CKD patterns across various populations and over time.

BENEFITS OF LINKED HEALTH DATA

The WA CKD Data Asset offers numerous advantages for research and policymaking including to:

1. Track Disease Trends: By integrating data from hospitals and pathology providers, researchers can estimate the prevalence and incidence of CKD, determine how many people are in the early stages of the disease, and how many progress to more severe stages. This information can help target areas for early intervention strategies.

2. Identify Risk Factors: Early-stage CKD often presents no symptoms, making it difficult to recognise individuals at risk. This dataset can assist in identifying the factors that influence whether a person’s CKD progresses or stabilises, allowing for more tailored care approaches.

3. Estimate Healthcare Costs: Managing CKD can be costly, particularly as the condition advances. Data detailing expenses across different stages of the disease allows policymakers to evaluate the financial burden of CKD on the healthcare system. Furthermore, in combining healthcare costs with data on treatment effectiveness, alternative strategies can be compared to identify approaches delivering the best value for money.

4. Highlight Inequities: Disparities in CKD care and outcomes exist, particularly for Indigenous Australians and individuals living in remote areas. By examining variations in diagnosis, treatment, and health outcomes, researchers and health services can identify strategies to improve access to and quality of care for these communities.

FINDINGS SO FAR

Initial analysis of the WA CKD Data Asset has provided valuable insights:

• Higher Risk in Rural and Low-Income Communities: CKD is more prevalent among West Australians living in regional or remote areas compared to those in the Perth metropolitan areas. In regional and remote areas, the hospitalisation rate for CKD is twice that in Perth.

• Outcomes for CKD: In advanced stages of CKD, patients are more likely to experience more decline than improvement in health. At any stage, once diagnosed, many individuals with CKD face kidney failure or death within approximately three years.

• High Costs in Advanced Stages: As the severity of the disease increases, costs also rise, highlighting the need for early detection and prevention. Treatment for end-stage CKD accounts for 1.6% of Australia’s healthcare budget.

PATH TO BETTER CKD CARE

Insights from this data asset are assisting healthcare providers and policymakers in making informed decisions. Below are some ways this data is being applied:

1. Informed Public Health Policies: Linked data enables policymakers to understand the full impact of CKD on communities and identify effective methods for early detection. This supports public health strategies aimed at prevention and early intervention.

2. Improved Clinical Practices: Healthcare providers, including doctors, can leverage these findings to enhance patient care. For instance, they may increase routine testing for at-risk individuals or modify treatment plans based on factors that contribute to quicker disease progression.

3. Value-driven Resource Allocation: Access to comprehensive information on CKD-related costs enables decision-makers to allocate resources more effectively, especially in underserved rural areas where the disease burden is greater.

FUTURE OF CKD MANAGEMENT

This linked data project marks a major advancement in CKD research. This is the first time that public and private pathology data has been linked in this way, by integrating data from multiple sources, it enables researchers to more effectively analyse CKD trends and identify at-risk populations. These insights will contribute to enhanced patient care, early intervention strategies, and tailored approaches to managing CKD.

Ultimately, the WA CKD Data Asset serves as a model for other regions to develop similar resources, promoting a greater understanding of CKD and improving care throughout Australia. The project highlights the importance of investing in data-driven healthcare strategies to enhance outcomes for individuals affected by chronic conditions, especially in communities with limited access to care.

Authors: This article was prepared by Associate Professor Delia Hendrie on behalf of the Digital Health CRC Chronic Kidney Disease project team. The project team includes researchers from Curtin, La Trobe and Deakin Universities, in collaboration with policy makers, administrators and health professionals from the WA Country Health Services, WA Department of Health, and the WA Primary Health Alliance. The project is funded by partner organisations and the Digital Health CRC.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

UNLOCKING HEALTHY AGEING

Is there a skeleton key?

A person undergoing spine bone density (DXA) assessment.

CARDIOVASCULAR DISEASE

Cardiovascular disease, including heart attacks and strokes claim 20 million lives globally each year, often without warning. For those who survive, quality of life often declines, creating lasting challenges for families and communities. The underlying disease progresses silently over decades, highlighting the critical need for early detection to prevent these life-altering events.

HOW DO WE SCREEN FOR ASYMPTOMATIC CARDIOVASCULAR DISEASE CURRENTLY?

Asymptomatic cardiovascular disease is detected by imaging the heart and coronary arteries located in the neck. However, population-based screening for asymptomatic cardiovascular disease is not yet feasible because imaging relies on sophisticated instruments that are expensive to operate and not widely available.

MACHINE LEARNING TO UNLOCK THE POTENTIAL OF BONE DENSITY MACHINES.

In Australia each year over half a million older adults undergo bone density imaging to measure the amount of calcium in bone, which is a predictor of fragility fractures. We have pioneered a machine learning approach that repurposes inexpensive scans from these machines to measure calcium build up in the abdominal aorta – an established but widely underutilised marker of asymptomatic cardiovascular disease. As a proof of concept, our technology rapidly quantified abdominal aortic calcification in 8,565 individuals (mean age 75 years) undergoing bone density testing and showed that persons with moderate and high abdominal aortic calcification are two to three times more likely to have a heart attack, stroke or die over the next four years, compared to those with low levels of calcification. Moreover, our method recently showed that higher abdominal aortic calcification is associated with greater risk of non-cardiovascular outcomes including falls, fragility fractures, and later life dementia. These observations reinvigorated interest in vascular disease beyond the heart, revealing new complexities of cardiovascular pathology and its relationships with co-morbidities that occur later in life.

WHY IS KNOWING ABOUT ABDOMINAL AORTIC CALCIFICATION IMPORTANT?

The abdominal aorta is one of the earliest blood vessels where asymptomatic cardiovascular disease occurs. Abdominal aortic calcification often precedes calcification in the heart and coronary arteries. It also provides important information on how rapidly calcification in the heart will progress and identifies individuals that of high risk of heart attacks and strokes, even in people with no coronary artery calcification. Calcification of the abdominal aorta is also a marker of aortic stiffness and affects how blood flows in a way that could influence how well other organs in the body function.

Rapid quantification of abdominal aortic calcification can empower individuals and their healthcare teams to

initiate proactive measures, such as dietary and lifestyle improvements, to steer individuals toward cardiovascular health. Large randomised controlled trials have shown that when people with asymptomatic cardiovascular disease of the blood vessels in the neck and heart receive this information, they are more likely to engage in risk-reducing behaviours and make more informed decisions with their healthcare teams.

RECENT RANDOMISED TRIAL

We recently conducted a 12-week randomised controlled trial with 240 people, in which information on the extent of calcium in their abdominal aorta, combined with cardiovascular health education led to improvements in cardiovascular health markers, such as lipid profiles and estimated cardiovascular risk compared to education on cardiovascular health alone. Some quotes from people receiving their results are below.

The initial results for me have been life changing. I was most surprised to be informed of evidence of advanced blood vessel disease (my abdominal aortic calcification). This was confirmed by a CT scan, and I’ve consulted with a specialist.”

CHARTING THE ROAD AHEAD.

Our algorithm is currently being deployed in five international cohort studies totalling ~100,000 individuals. Data generated using our algorithm will enable us to perform well powered genetic epidemiology studies that can identify causal risk factors, improve risk prediction, and refine our understanding of molecular mechanisms of disease in a way that will inform the development of new therapeutics. This new chapter is supported by grants from the National Heart Foundation and the Medical Research Future Funded Cardiovascular Health mission. It involves a multidisciplinary collaboration between ECU’s Nutrition and Health Innovation Research Institute, Mater Research Institute at the University of Queensland, University of Western Australia, Flinders University and collaborators in the Unites States, United Kingdom and Canada.

Authors: Professor Joshua Lewis is a National Heart Foundation Future Leader Fellow at Edith Cowan University’s Nutrition & Health Innovation Research Institute. His research aims to develop better ways to identify and prevent blood vessel disease before the onset of heart attacks or strokes.

Dr John Kemp is a National Health and Medical Research Fellow at Mater Research at the University of Queensland. His research aims to prioritise genes as therapeutic targets for treating musculoskeletal and cardiovascular diseases.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

THE NATIONAL STATE OF ENDOMETRIOSIS

Growing media attention and advocacy has seen a much-needed increase in community awareness of endometriosis and new initiatives to support improved diagnosis and management of the condition. One of these initiatives is EndoMP, a management plan which seeks to integrate best practice evidence into general practice care.

Endometriosis has, until recently, been an under recognised condition. This has been in part, due to the well documented gender health gap where women’s health has taken a back seat, having been historically under researched and poorly invested in.

Endometriosis symptoms may go unmentioned or considered “normal” and women often wait years to have their symptoms addressed. So what is endometriosis, and how does it affect those who suffer from it?

Endometriosis is a chronic condition where endometrial tissue grows outside of the uterus, including on the ovaries and fallopian tubes. This causes an inflammatory reaction that can form scar tissue in affected areas and affect fertility. Symptoms include pelvic pain, pain during intercourse, bowel movements and urination, as well as nausea and fatigue. Pain can become so severe that women attend emergency departments, with more than 3,600 presentations recorded in Australia in 2021-2022. Endometriosis has serious implications for mental health, placing sufferers at increased risk of depression and anxiety. Symptoms have far reaching physical, social and psychological impacts and greatly impact quality of life and compromise women’s ability to participate in education, work and social activities. Globally, endometriosis affects 10% of reproductive-age people, and in Australia, around one in seven women have clinically confirmed or suspected endometriosis by age 44 - that’s 830,000 women in Australia alone.

DIAGNOSING ENDOMETRIOSIS

It may take up to eight years for Australian women living with endometriosis to receive a diagnosis. Evidence from the Australian Longitudinal Study on Women’s Health indicates these delays can reduce the chance of pregnancy by 33%. Treatment is designed to help women manage their symptoms and prevent suffering. Australian clinical guidelines recommend hormonal treatments such as the combined oral contraceptive pill or progestogen only contraception intrauterine device (IUD) as first line management. This approach can reduce pain and has no permanent effect on fertility. However, the low numbers of providers in community settings and cost of accessing long-acting reversible contraception (LARC) including IUDs remains a persistent obstacle for women seeking treatment. Inadequate MBS rebates discourage LARC provision in general practice, and not enough health professionals are seeking the necessary training. Tackling

these barriers is essential to improving women’s sexual and reproductive healthcare, including for endometriosis sufferers. So how can we ensure women receive the care they need?

BEST PRACTICE

First and foremost, achieving best practice in endometriosis diagnosis and management can be addressed with appropriate funding and support. More research is needed to improve our understanding and treatment of endometriosis, and more funding is required to help build the capacity of our health workforce to best manage this condition. In Australia, when someone is experiencing symptoms and seeking support, general practitioners (GPs) are their first point of contact, and are therefore well-placed to identify symptoms, diagnose and organise a treatment plan. In a world-first, in 2018 Australia developed a roadmap and blueprint to tackle endometriosis in a nationwide coordinated manner with the National Action Plan for Endometriosis. As part of this package, the Australian Government has funded the development of an Endometriosis Management Plan. The project is being led by the SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University in collaboration with the Royal Australian College of General Practice. The Endometriosis Management Plan (Endo-MP) project aims to develop and implement an endometriosis management plan to support health practitioners and patients to improve diagnosis and management of endometriosis and chronic pelvic pain in primary care settings. The endometriosis management plan has been co-designed with GPs and other health professionals, key stakeholders in endometriosis and chronic pelvic pain, and women suffering from these conditions. The endometriosis management plan will be pilot tested in a number of GP clinics in 2025 and is due for national roll out in 2026.

WHAT THE FUTURE HOLDS

We still have a long way to go in improving healthcare for women experiencing endometriosis and chronic pelvic pain in Australia. Improving access to first line treatments such as hormonal contraception and addressing the broader challenges of increasing GP training and MBS rebates is a big part of the puzzle. However, the National Action Plan, and funding for new initiatives such as the Endo-MP project, marks a big step towards improving support for endometriosis sufferers, and will hopefully make a positive difference for women experiencing these chronic health conditions.

Authors: The Endo MP Project from SPHERE (Monash University & the Sax Institute). For more information on the Endometriosis Management Plan please visit: Endo-MP (spherecre.org)

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

WEIGHT

The CSIRO Total Wellbeing Diet Online

OBESITY, A PUBLIC HEALTH CHALLENGE

Obesity is a complex condition which, at a population level, has significant individual, societal and economic impacts. In Australia 66% of the adult population is classified as overweight and about one in three are classified as obese. Australia’s National Obesity Strategy sets an ambitious goal to “halt the rise and reverse the trend in the prevalence of obesity in adults by 2030”.

THE SIGNIFICANT HEALTH BENEFITS OF MODEST WEIGHT LOSS

There are many reasons why it is difficult to lose weight, but the good news is that modest weight loss can have significant health benefits. A 5% body weight loss is associated with improved blood pressure, glucose control, and cholesterol [3] and has been accepted as clinically meaningful [4`], with 5-10% recommended for supervised weight loss [5, 6].

But losing weight, and keeping it off, is notoriously difficult. A cohort study of over 18 million health care seeking Americans found one in 10 adults achieved a 5% body weight loss. Among successful individuals, about half reported to do it on their own and the other half through a formal program. It is good to know that a ‘doit-yourself’ approach can work for those who are ready and motivated, but for others, joining a formal weight loss program can provide the support they need.

CSIRO TOTAL WELLBEING DIET

CSIRO Total Wellbeing Diet is a weight loss program built around a higher-protein diet plan. The program has evolved from clinical trials, to a popular series of books and in 2014 it launched as an online platform. Over 180,000 Australians have joined CSIRO Total Wellbeing Diet online.

WEIGHT LOSS IN THE FIRST 12 WEEKS

The profile of CSIRO Total Wellbeing Diet members can be summarised as, 95% classified as overweight or obese when they start (61% obese), mostly female (81%) with an average age of 51 years.

Members start their journey with a 12-week program. The average weight loss for those that finish is 5.8kg in 12 weeks (or 6.3% of their starting body weight), and the most successful group loses an average of 11.2kg in 12 weeks – which is close to 1kg per week. Six out of ten members achieve a weight loss of 5% or more of their body weight in 12 weeks; and one in six achieve 10% or more. Of those who start the program in the obese category, one in five are no longer classified as obese when they finish the 12-week program.

THE TYPICAL PATTERNS OF LONGERTERM WEIGHT LOSS

The trajectory of a longer-term weight loss is not usually linear. Research shows a weight loss “tick” curve, meaning that initial weight loss success is followed by a plateau at or around 6 months and then degrees of weight regain by 12 months. This is an important message. People can achieve meaningful weight loss with time, but there will likely also be periods of weight gain and weight maintenance (which in research is defined as a change in weight within 1.4kg).

Some members have been with CSIRO Total Wellbeing Diet for over 12 months which allows us to look more deeply at longer-term weight loss. In an analysis of over 24,000 members, the average weight loss was 6.7kg at 6 months, 6.2kg at 9 months and 5.5kg at 12 months, consistent with the “tick” curve observation. Importantly after 12 months, more than half the members had lost 5% of their body weight, and one in four had lost 10%.

Further to this, a subset of 6,600 members had enough data in the platform to allow patterns of weight loss to be explored. The most common pattern was weight loss in the first 6 months, followed by weight maintenance for 6 months which resulted in an average weight loss of 10.6kg at 12 months (or 11.9% of their body weight). Other common patterns were weight loss in the first 12 weeks and then maintenance for the remainder of the year (4.8kg weight loss or 5.7%); and weight loss over the first 9 months followed by weight maintenance (16.6kg or 17.1%). Although less common, only about 5% of members achieved this, consistent weight loss over 12 months resulted in an average weight loss of 22.3kg (equivalent to 21.7% of their body weight).

CONCLUSIONS

Given the prevalence of obesity and the challenges in losing weight, the results show the online program is effective for sustainable, longer-term weight loss. About one in five members are no longer classified as obese category following the 12-week program and one in two achieve clinically significant results after 1 year. Members who engaged with the platform most can achieve even greater weight loss success, but managing expectations prior to commencing a weight loss journey is important.

Acknowledgement: Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia’s national science agency, partner with Digital Wellness, an Australian digital health solutions company, to deliver CSIRO Total Wellbeing Diet online program.

Authors: Gilly A Hendrie, Danielle L Baird, Genevieve James-Martin, Emily Brindal, Paige G Brooker

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

PREVENTING INVASIVE PROCEDURES FOR CHILDREN WITH HEART TRANSPLANTS

For

children requiring heart transplants,

the journey doesn’t end after they receive their new heart.

Following transplantation, patients must undergo frequent invasive biopsies to check for heart rejection. To help prevent these invasive procedures, MCRI researchers are developing a noninvasive method for monitoring heart rejection from patient blood samples.

THE BURDEN OF CHILDHOOD HEART DISEASE (CHD) AND CURRENT CHALLENGES

Childhood heart disease (CHD) is a chronic disease that significantly burdens patients and their families, as well as the Australian healthcare system. In Australia, it is estimated that CHD affects 65,000 children and young people, with more than 2,400 Australian babies born every year with a form of CHD.

It is also one of the leading causes of death and hospitalisations in infants, with seven per cent of all infant deaths due to an underlying CHD.

Some CHD patients will go onto develop heart failure later in life, which has around 50 per cent survival rate within five years of diagnosis. The only option for CHD patients in

end-stage heart failure is a transplant, which despite being a lifesaving procedure is associated with high mortality rate and requires life-long immunosuppression to prevent organ rejection.

In addition to lifelong immunosuppression, patients require frequent endomyocardial biopsies (EMBs) to monitor for heart rejection. EMBs are highly invasive and expensive procedures where small pieces of the heart are removed under general anaesethetic, using a pincer-type tool inserted via a blood vessel catheter.

The heart biopsy samples are then analysed by pathologists to look for cellular changes or abnormalities, which could be a sign of heart rejection.

EMBs take up to 10 hours to perform in children and are typically taken seven times in the first year the following intervals post-transplant. The frequent hospital admissions, general anaesthesia and illness associated with the EMB procedure increase the risk of cardiac complications for transplant patients. In addition, EMBs pose a significant cost to the healthcare system with each procedure costing around $7,000.

Heart transplant rejection is currently monitored using invasive endomyocardial biopsies (EMBs) which we are aiming to replace with a less invasive flow-cytometry based assay using patient blood samples.

DEVELOPING A NON-INVASIVE MONITORING SOLUTION

To help prevent these invasive procedures and provide a better solution for heart transplant recipients, Murdoch Children’s Research Institute’s (MCRI) Professor Igor Konstantinov and Associate Professor Daniel Pellicci are developing a test that could monitor heart rejection without the risks involved with EMBs.

Professor Konstantinov said, “The majority of heart transplantations in children in Australia are performed at the Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine (CardioRegen), hosted at MCRI within The Royal Children’s Hospital (RCH), so our team are uniquely positioned to investigate alternative approaches to EMBs.

“This has allowed us to establish a biobank of over 500 blood samples collected from 81 transplant patients at the time of their EMBs. Using those blood samples, we are now validating the use of flow cytometry (using lasers to sort and analyse different cell types) as an accurate and minimally-invasive blood test to detect specific T-cell populations in paediatric heart transplant patients,” he said.

T-cells are an important type of white blood cell in the immune system and play a central role in the adaptive immune response. By identifying certain types of T-cells in blood that are associated with transplant rejection, it could be possible to predict which patients will reject their heart transplants.

Associate Professor Pellicci said, “Professor Konstantinov has previously developed a blood test to predict lowgrade transplantation rejection based on next generation sequencing (a method of analysing genetic material that allows for rapid sequencing of large amounts of DNA or RNA).

“Based on this work, we are currently profiling different types of T-cells using flow cytometric analysis of patient blood samples. This technology offers a faster, cheaper, and less stressful approach to check for heart rejection than the current method of EMBs.”

Professor Pellicci said, if successful, the blood test would result in an immediate 10-fold reduction in the cost of rejection surveillance and reduce the risk of surgical complications associated with EMBs.

A PATIENT’S PERSPECTIVE: TYLER’S STORY

Tyler Airey needed a heart transplant in 2010 at age 15 due to an undiagnosed inherited heart disease called dilated cardiomyopathy. Tyler’s heart muscle thinned and weakened in at least one chamber of the heart, causing the open area of the chamber to become enlarged (dilated).

Two years after the transplant Tyler was infected with the common Epstein-Barr Virus and developed Post-Transplant Lymphoproliferative Disease (a rare

Tyler Airey received a heart transplant when he was 15 years old due to an undiagnosed inherited heart disease.

complication of organ transplants that causes cancer to grow in the lymph system). He then underwent chemotherapy/monoclonal antibody treatment for around eight weeks.

“In the first few months to years after receiving a heart transplant, patients need to be close to the hospital and organise their life around appointments such as EMBs,” Tyler said. “This might involve extensive travel arrangements including accommodation.

“An EBM requires a lot of preparation both before and after for patients and their families, and the procedure is typically a whole day event, requiring fasting, inserting the IV cannula, anesthesia, resting and recovering.

Patients would have a lot more freedom and would be less burdened with the disruptions and challenges associated with EBMs if they could be prevented with a simple blood test,” he said.

If successfully translated into clinical practice, Professor Konstantinov and Associate Professor Pellicci said they hoped the blood test would help patients like Tyler prevent heart transplant rejection and improve their quality of life after transplantation.

Authors: Professor Igor Konstantinov is a Senior Research Fellow at MCRI and Co-Director of CardioRegen. He is an internationally renowned cardiothoracic surgeon with a distinguished track record in paediatric cardiology, including 480 publications directly relevant to heart failure, heart transplantation and univentricular palliation surgery.

Associate Professor Daniel Pellicci is Group Leader of MCRI’s Cellular Immunology and a CardioRegen Investigator. He is a world leader in the field of unconventional T cells and his research uses flow cytometry, protein biochemistry and transcriptome analysis to understand the role of immune cells in health and disease.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

INFANT

A NEW MODEL OF PREVENTIVE CARE FROM BIRTH

Promoting healthy lifestyle habits early in life is critical for optimal growth and development as well as prevention of chronic diseases later in life.

The INFANT program is an innovative model of preventative care that continues to evolve to meet the needs of both service providers and families.

The evidence-based INFANT program has supported more than13,000 families to date in establishing optimal feeding, nutrition, active play, and reduced screen time for their babies.

INFANT (INfant Feeding, Active play & NuTrition) is based on more than 15 years of research at the Institute for Physical Activity and Nutrition, Deakin University. It consists of four group sessions for parents and carers when their infants are 3, 6, 9 and 12 months old, with content reinforced via a mobile app. The sessions are delivered by INFANT-trained staff such as Maternal and Child Health Nurses and family support workers. In the sessions, parents receive contemporary, evidence-based information on infant feeding, active play and parental

wellbeing and importantly facilitated peer discussion where parents share experiences, learn from each other and build social connections.

THE BENEFITS OF INFANT

A successful randomised controlled trial with 540 families across Victoria in 2008 showed that relative to the control group, INFANT:

• Reduced sedentary time, with children watching 25% less television

• Improved diet, with children consuming 25% fewer sweet snacks

• Improved mothers’ dietary patterns, knowledge and self-efficacy

• Was engaging and useful for participants, providing opportunities for support and social connections.

Importantly, the INFANT research team has found that these outcomes are sustained, with benefits for children in terms of children’s diets and screen time continuing at age 3.5 and 5 years, highlighting the benefits of establishing these behaviors early in life.

Recent health economic modelling shows a one-serve reduction in discretionary food per week results in about $1.3 billion savings in healthcare costs during a lifetime, and could prevent more than 50,000 cases of type 2 diabetes and 20,000 cases of heart disease nationally. The INFANT program achieved a 1.7 serve reduction in discretionary foods per week at age 5 years.

Parents engaged with INFANT were also less likely to seek advice on feeding, activity or growth across the first 9 months of life from health services including parent helplines, GPs and paediatricians, with significant health cost savings estimated at $6.9 million annually from fewer GP and paediatrician visits alone.

SUCCESSFULLY INTEGRATING RESEARCH WITH POLICY AND PROGRAM DELIVERY

Following the trial, the program is being rolled out across Victoria through partnerships between Deakin University researchers, the Victorian Government Department of Health and health services, and now reaches more than 60% of Victorian local government areas. It has also been implemented by individual services in other states of Australia.

Key to this success has been the diversity of models of program delivery. This has included different health and early years professionals delivering the program including maternal and child health nurses, dietitians, health promotion officers, family support workers and bicultural workers. Typically, program delivery involves local partnerships between maternal and child health services, community and population health and sustained delivery

supported by embedding the program into local policies such as Municipal Health and Well Being Plans. Online training of health professionals to deliver the program has upskilled the workforce in early childhood nutrition and active play. This has led to key program messages and referral to the INFANT app also being integrated into individual consultations with parents in primary health care and other parenting programs such as supported playgroups.

NEXT STEPS - MAXIMISING IMPACT FOR INCLUSIVE ACCESS

Every parent, no matter where they live or their cultural background, should be supported to raise healthy, happy children. INFANT is well positioned for national scale up with online training available for health and early years professionals, along with comprehensive implementation and facilitator guides accessible online.

Our research suggests that despite widespread implementation of INFANT in Victoria, parents from culturally and linguistically diverse and more disadvantaged backgrounds are under-represented in the program. The program also needs to be adapted to meet the needs of First Nations families. From this year, INFANT parent resources are available in six community languages including Arabic, Chinese, Hindu, Punjabi, Urdu and Vietnamese - resources which were developed in partnership with Victoria’s Western Public Health Unit.

Our next steps are to secure funding for the national roll out of INFANT with a focus on supporting priority populations. We will continue to work with our partners to co-design adapted INFANT resources for First Nations and other cultural groups and to develop and test models of delivery to better reach these families.

If you would like to get involved in INFANT, or can help support the national roll out, we would love to hear from you! Please contact A/Prof Rachel Laws, email: r.laws@ deakin.edu.au, www.infantprogram.org.au

Authors: Professor Kylie Hesketh, Institute for Physical Activity and Nutrition, Deakin University: Kylie is Professor of Child Physical Activity and Public Health and co-founder of the INFANT program, with training in psychology, paediatric public health and behavioural epidemiology. Associate Professor Rachel Laws, Institute for Physical Activity and Nutrition, Deakin University: Rachel is an Associate Professor of Public Health Nutrition and leads the INFANT program. She trained as a dietitian and worked for 10 years in community and policy roles.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

LOW IRON LINK TO KIDS’ MENTAL HEALTH AND BEHAVIOUR ISSUES

ORIGINS, Australia’s biggest longitudinal birth study, has found a third of Australia one-year-olds have low iron – a problem which can affect speech, sleep, and appetite and potentially lead to neurocognitive, mental health and behavioural issues.

Early intervention could provide a cost-effective solution for affected children and their families.

Recent years have seen a doubling in wait lists to attend child health specialist appointments to treat mental

IRON Child Project Lead and Head of Paediatrics at Joondalup Health Campus, Dr Jamie Tan, with one of ORIGINS’ one-year-old participants

health and behavioural issues, causing financial strain on households and on the Australian health care system.

Groundbreaking longitudinal birth study, ORIGINS –a collaboration between The Kids Research Institute Australia and Joondalup Health Campus in Western Australia – has discovered that these issues could be caused by iron deficiency, and the treatment could be as simple as changes to diet and nutrition.

THE DISCOVERY

ORIGINS, the largest longitudinal study of its kind in Australia, is following 10,000 Western Australian children from their time in the womb into early childhood to better understand the developmental origins of disease and reduce the rising epidemic of non-communicable diseases.

Since 2017, families participating in ORIGINS have submitted biological samples, answered questionnaires, and shared access to their routine medical information for

ORIGINS paediatrician Dr Katie Britton with one-year-old ORIGINS participant, Samuel Barnett, and mother, Anna Callan

analysis, allowing researchers to gain new insights into ways to improve child and adult health.

To date, the ORIGINS Biobank has collected 400,000 biological samples and the ORIGINS Databank has accumulated 16 million data points, forming the online ORIGINS Data Catalogue.

Early in the project, the ORIGINS team made an alarming discovery after analysing samples from blood tests taken during the project’s one and three-year Kids Check appointments: a third of the one-year-olds’ samples were low in iron, and 60 per cent of blood samples from the three-year checks also appeared low in the vital mineral.

ORIGINS Co-Director and Professor of Paediatrics Desiree Silva said the findings effectively revealed an iron crisis among Australian’s toddlers, with huge implications for Australian families.

“Iron is crucial for infants and toddlers for a variety of reasons, including immunity and helping to carry oxygen in the blood to the body,” Professor Silva said.

If iron status is low, it can mean your toddler becomes tired, lethargic, develops fussy eating habits and sleeps poorly, with a longer-term effect on learning and neurodevelopmental issues.”

THE IRON CHILD

Convinced there was more she could do, Professor Silva created IRON Child – an ORIGINS sub-project using the ORIGINS Data Catalogue to develop mechanisms to prevent and treat issues caused by iron deficiency, before they become clinically significant. The project also aims to translate these findings to other communities to improve childhood wellness.

IRON Child Project Lead and Head of Paediatrics at Joondalup Health Campus, Dr Jamie Tan, said that by addressing issues caused by iron deficiency early, treatment could become relatively easy and cost effective for children and their families.

“We’re currently using a variety of methods to develop these prevention and treatment mechanisms, including undertaking patient focus groups to understand the barriers and enablers to detect and manage childhood iron deficiency,” Dr Tan said. “We’re also developing an AI platform to understand the prevalence and major contributing factors of iron deficiency in children aged one to five years.”

One aspect of the study could have particular significance both for families and the healthcare system, with the team investigating the association between low iron and child mental health, behavioural issues, and neurodevelopmental outcomes including ADHD, Oppositional Defiant Behaviour and childhood anxiety.

“A recent study of 400 University of Western Australia students found one in four students reported symptoms compatible with ADHD and had a significant history of iron deficiency,” Dr Tan said.

“With the huge number of specialist health appointment referrals currently overwhelming the healthcare system and Australian families, we urgently need to better understand the role iron plays in childhood mental health.”

IRON Child aims to shed light on the causal factors and impacts of iron deficiency in children and to provide patient and community-focused strategies that reduce the socio-economic pressures around iron deficiency, ultimately improving child physical and mental health.

“So far, 864 children across ORIGINS and IRON Child have been detected as being low in iron, with their guardians notified and a treatment plan provided to increase iron intake through diet and nutritional changes,” Dr Tan said.

“It’s our hope that the nutritional guidelines we’re developing for families as part of IRON Child will influence changes to national policy and provide a cost-effective treatment plan that benefits both the families and the healthcare system.”

Author: Professor Desiree Silva is the Co-Director of ORIGINS and Professor of Paediatrics at The University of Western Australia. She is the inaugural Director of Research at Joondalup Health Campus and provides a rural paediatric service. Dr Jamie Tan is the IRON Child Project Lead and Head of Paediatrics at Joondalup Health Campus, with a special interest in developmental and behavioural paediatrics.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

PREVENTING FETAL ALCOHOL SPECTRUM DISORDERS

Could anti-alcohol medications be our best weapon?

Arecent review has shown a lack of evidence for the safety of anti-alcohol medications in pregnancy. Why does this matter?

ALCOHOL AND PREGNANCY: A DANGEROUS MIX

Alcohol use during pregnancy poses devastating risks to both the mother and baby. These risks include stillbirth, pre-term birth and various congenital anomalies, as well as fetal alcohol spectrum disorders (FASD) which can result in lifelong consequences. As such, alcohol exposure in pregnancy is a leading cause of preventable congenital anomalies and developmental disability worldwide. Due to these health risks, guidelines recommend that

mothers should not consume alcohol while pregnant. While pregnancy can play a motivational role in reducing alcohol consumption, many will continue to consume alcohol when pregnant.

THE DIFFICULTIES FOR INDIVIDUALS WITH ALCOHOL USE DISORDERS

For individuals with an alcohol use disorder, stopping alcohol consumption can be extremely challenging. Even though they may want to stop drinking, physiological and psychological dependencies make quitting incredibly challenging. Additionally, for people with an alcohol use disorder, suddenly stopping alcohol consumption can cause severe alcohol withdrawal symptoms including insomnia, fever, hallucinations, and seizures. In severe

cases these symptoms can result in hospitalisation and even death. For pregnant individuals, alcohol withdrawal can also be experienced by the fetus, causing an increased risk of placental abruption, preterm delivery, fetal distress or even death.

MEDICATIONS THAT COULD MAKE A DIFFERENCE

Anti-alcohol medications (known as alcohol pharmacotherapies) can help those with an alcohol use disorder curb their dependence on alcohol. Medications like naltrexone and acamprosate help reduce heavy drinking and aid in maintaining alcohol sobriety. They achieve this by reducing alcohol cravings, as well as reducing the gratifying effects of alcohol. Both naltrexone and acamprosate are subsidised by the Australian Government to treat alcohol use disorders.

SAFETY IN PREGNANCY: THE MISSING LINK

Alcohol pharmacotherapies could also play an important role in reducing the known, severe harms associated with alcohol use during pregnancy, including FASD. However, the safety of alcohol pharmacotherapies in pregnancy is still unknown. A recent scoping review from our team found research in this area is incredibly limited and often contradictory. The review suggests that based on the currently available data, and the known teratogenic effects of alcohol, naltrexone could likely be considered in the treatment of alcohol use disorders during pregnancy. However, the lack of quantitative evidence means that pregnant individuals with alcohol use disorders are left with few treatment options, and medical professionals are left with complex decisions regarding their management.

FILLING THE EVIDENCE GAP

To unlock the potential of reducing alcohol related harm in pregnancy, prioritising research in this area is crucial. Clinical trials examining medication safety in pregnancy are usually avoided due to ethical concerns regarding the testing of drugs in pregnant patients. Therefore, researchers typically utilise observational, real-world data, looking at individuals in the general population who have taken these medications during their pregnancy. While this approach is useful for researching many types of medications, it can be difficult where the use of the medication in pregnancy is uncommon, as it is for alcohol pharmacotherapies. This means there isn’t a big enough sample size at any state level to make this research possible. As such, there is a need for national and international data to allow the safety of alcohol pharmacotherapies in pregnancy to be established. With more research and knowledge, alcohol

pharmacotherapies could be central in the alcohol-related harm, such as FASD, and the of maternal and child health outcomes worldwide.

FUNDING THE FUTURE OF MEDICATION SAFETY IN PREGNANCY

Investing in medication safety research in pregnancy is crucial from both a health and equity perspective. There is a lack of understanding in how medications impact pregnant individuals and their developing babies. This can either lead to preventable harm from the medication, or harm from the untreated medical condition. By prioritising research in this area, we can understand the risks and benefits of medications during pregnancy and support healthier outcomes for mothers and their children. Future research on both the safety and efficacy of medications to treat alcohol use disorders in pregnancy will enable healthcare providers and pregnant individuals to make informed decisions and embed evidence-based policy.

Lead author: Ebony Quintrell is a PhD candidate at the University of Western Australia’s School of Population and Global Health, and The Kids Research Institute Australia. Her research focuses on medication safety in pregnancy and alcohol use disorders, with a particular emphasis on health equity.

Co-authors: Dr Erin Kelty is a Senior Research Fellow at the University of Western Australia’ School of Population and Global Health.

A/Prof Caitlin Wyrwoll is an Associate Professor at The University of Western Australia’s School of Human Sciences.

A/Prof Alexander Larcombe is Head of the Respiratory Environmental Health Team at The Kids Research Institute Australia.

Ebony Quintrell

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

The Hunter Medical Research Institute (HMRI) Surgical and Perioperative Care Research Program

has been addressing the issue of prevention from various perspectives, with the ultimate goal of improving patient outcomes before, during, and after surgery.

To enhance patient care at the three stages of the surgical process, our researchers are currently working on multiple innovative and sustainable programs.

These programs include patient education on overtreatment and decision-making tools for thyroid cancer, prehabilitation programs for strength and fitness, and a post-surgical blood clot prevention trial evaluating intermittent compression devices.

PREVENTING OVERTREATMENT OF THYROID CANCER WITH A NEW DECISION AID

John Hunter Hospital’s Head of General Surgery, General and Endocrine Surgeon and Conjoint Associate Professor Christine O’Neill has created a decision aid to help patients make informed choices about thyroid cancer surgery. Decision aids help people think about choices they face. They describe what choices exist and provide information about options, including where reasonable, the option of taking no action.

In this case, the decision aid is a document that is given to patients to facilitate shared decision making around thyroid cancer surgery.

Associate Professor O’Neill says, “Thyroid cancer is being found in patients much more commonly, largely due to imaging (ultrasound, CT, MRI).

For many of these patients, cancers aren’t growing or causing symptoms. Much of the thyroid cancer diagnosed has a good prognosis with a survival rate of over 99 per cent.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

Research nurses Natalie Lott and Jeanene Douglas are leading

the

trial under the direction of Professor Steve Smith

Until ten years ago, all patients with thyroid cancer had their whole thyroid removed surgically (total thyroidectomy) and were treated with radioactive iodine via a capsule that is swallowed.

For those with low-risk thyroid cancer, this is not improving their survival rate. The risk is in the long-term psychosocial impact of the cancer diagnosis,”

With that in mind, Associate Professor O’Neill and her team are trying to prevent overtreatment of thyroid cancer by empowering patients with information about the reality of their cancer diagnosis and their treatment options. They are doing this with their new decision aid. “We have done a lot of work with patients trying to understand their short and long-term quality of life following a thyroid cancer diagnosis. One of the gaps we identified was a lack of credible information at the time of diagnosis and tools to assist with the decisions required around surgery for low-risk thyroid cancer”.

Following international guidelines to develop a decision aid (paper and web hybrid), Associate Professor O’Neill and her team conducted surveys and facilitated focus groups with clinicians and patients.

The aid is now subject to a multi-site acceptability trial, with the intended outcome that the aid will empower patients to feel informed about their diagnosis, to be more proactively involved in their health care decisions and ultimately to be more satisfied with their treatment outcomes.

PREHABILITATION TRIAL CSPRITES AIMS TO IMPROVE CANCER SURGERY RECOVERY

The CSPRITES clinical trial offers cancer patients a proactive approach to prepare for abdominal surgery by building strength and fitness before their procedure.

Led by University of Newcastle clinical physiotherapist from HMRI’s Surgical and Perioperative Research

Program, Dr Jennifer Mackney, this program centres on “prehabilitation”, preparing patients to be as healthy as possible before surgery to support a smoother recovery.

Dr Mackney says, “CSPRITES is a pre-surgery program which sees participants attend John Hunter Hospital three times across four weeks. These visits include a baseline fitness evaluation (questionnaires and interviews) and physical activity counselling”.

Participants receive a FitBit and inspiratory muscle training device. For the first two weeks they aim to increase their steps, physical activity and strengthen their diaphragm by using the device. This is done at home. They also receive a GP referral to get a team care plan for five Medicarefunded allied health sessions.

Over the following two weeks, participants are invited to attend the Kaden Centre for five high intensity interval training (HIIT) bike sessions and strength training.

Simultaneously, this is when support is introduced from a nutritional and psychological standpoint, to support recovery post-surgery.

Finally, participants are taught best practice respiratory techniques (i.e. deep breathing and coughing) to perform as soon as they wake up from surgery, to help reduce the rate of post-operative respiratory problems.

The CSPRITES trial is a comprehensive, multimodal initiative that brings together a team of physiotherapists, psychologists, dietitians, surgeons, anaesthetists, community health professionals, and cancer survivors.

This collaborative approach aims to address all aspects of patient well-being, ensuring thorough preparation for surgery and a reduced risk of complications.

According to a recent Australian study of 50 participants, and supported by larger global studies, approximately one in four people are likely to experience post-operative pulmonary issues that range in seriousness from collapse

to ICU admission. Each of these complications can cost, on average, $29,000 per patient.

Dr Mackney says, “We’re looking to expand to different hospitals and community partners across a wider geographical area. Having cancer can be expensive and we want to provide this program in the patients’ own community and at no cost so that everyone can access it. Our aim is to see prehabilitation funded clinically by NSW Health and to implement and expand this program.”

The current phase of the CSPRITES clinical trial is recruiting participants until the end of 2024.

DO INTERMITTENT COMPRESSION DEVICES WORK AFTER SURGERY? A TRIAL PUTS THEM TO THE TEST.

Ask a nurse or post-surgery patient about the efficacy of Sequential Compression Devices (SCDs), and you’ll likely get mixed feedback – some will describe them as restrictive, keeping patients in bed when they could be up and moving.

Are SCDs effective in reducing reduce or prevent postsurgical veinous thrombo-embolism (VTE)? This question drives an ongoing study across the Hunter New England, Central Coast, and Mid North Coast Local Health Districts.

Researchers Professor Steve Smith, Natalie Lott, and Jeanene Douglas from the University of Newcastle, HMRI, and John Hunter Hospital are investigating whether SCDs help prevent post-surgical VTE, including deep vein thrombosis and pulmonary embolism.

Dr Jennifer Mackney is the research lead on the CSPRITES surgery prehabilitation program.

The study was suggested by colorectal surgeon Professor Steve Smith. He says, “We are constantly looking for proof of outcomes with any surgical intervention, in addition to trying to minimise over treatment and waste.”

The study is investigating post-surgical outcomes for 4,130 patients over two and a half years across five public hospitals, including Tamworth, Port Macquarie, Gosford, Calvary Mater and John Hunter Hospital in Newcastle.

How the SCD trial works:

• Eligible surgery patients are divided into two groups

• Group one swears SCDs, while group two will not

• Both groups receive standard treatment, which includes Heparin (a low-dose blood thinner) and the use of compression stockings.

“We want to know if patient immobilisation post-surgery is truly necessary,” explains Lott.

Early movement boosts circulation and reduces risks like chest infections and bowel issues, yet research on SCDs remains limited. Gaining real insight into their impact is essential for advancing post-surgical care.

THE BOTTOM LINE FOR PATIENTS

Success in these programs all lead to cost-savings for the health system but the ultimate outcome we’re pursuing is improving the patient experience, be this through minimising the need for low-impact surgeries, helping people help themselves recover better, or ensuring that patients are as comfortable as possible during their recovery, the patient remains the core focus.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

THE CHARITY-FUNDED FELLOWSHIPS TRANSFORMING CHILDHOOD CANCER RESEARCH

Prioritising four research pillars, The Kids’ Cancer Project approaches research from a holistic perspective.

The Kids’ Cancer Project’s dream is simple – for no child to die from cancer. The national charity, founded in 1993 by Research Australia’s 2023 Advocate of the Year, Col Reynolds OAM, has a clear mandate to remain entrenched at the coalface of innovative childhood cancer research.

PHILANTHROPY’S PART IN RESEARCH

Funding researchers solely through philanthropy, The Kids’ Cancer Project’s philosophy is embedded in knowing that survival starts with science. The charity has funded over $70 million worth of research across 31 years and holds strong partnerships with several influential

groups, including The Australian & New Zealand Children’s Haematology/Oncology Group (ANZCHOG).

Backed by a $7.6 million commitment, the Col Reynolds Fellows are a cohort of upcoming researchers who are intent on improving the lives of kids with cancer. From a strong field of candidates, each of the 23 Fellows have been carefully selected by The Kids’ Cancer Project’s Research Advisory Committee to investigate all areas of childhood cancer.

THE FOUR PILLARS OF RESEARCH

Four priority research pillars underscore the different stages of research. Hypothesis-driven, innovative basic research that improves the understanding of the underlying mechanisms of childhood cancer forms the Discover pillar, while Translate follows high-quality clinical research programs informed by Discovery.

Support includes the aiding of children with cancer and their families with programs that reduce the long-term

Dr Kenny Ip, Molecular Neuroscientist & Col Reynolds Fellow

DR TERESA SADRAS’; RESPONDING TO ALL RELAPSE

Teresa Sadras, Molecular Biologist & Col Reynolds Fellow

effects of cancer treatment, while the final pillar – Build –sees researchers construct resources, infrastructure and tool kits designed to futureproof the childhood cancer research landscape.

DR IP’S IMPERATIVE

The funding of the molecular neuroscientist and Col Reynolds Fellow, Dr Kenny Ip, underpins the charity’s commitment to innovation in the kids’ cancer research space. Dr Ip’s research project focuses on developing new treatments for a recently identified high-grade glioma (HGG) subtype. The mutation is one of the deadliest brain tumours among children aged 4-6 and has no known cure.

The only treatment option for the HGG subtype is highdose radiation therapy, which can mean severe long-term neurotoxic effects for survivors. Alternative treatment options that have lower cytotoxic effects are scarce, which is why Dr Ip is focused on this research.

“As a molecular neuroscientist, I will be bringing in some of the most advanced neuroscience tools to carry out comprehensive brain-network mapping experiments to identify where in the brain the nerve cells that drive tumour progression are,” he says.

“I will then use this information to guide a targeted highthroughput drug screening program in the Drug Discovery Centre at the Children’s Cancer Institute.”

Much like Dr Ip, molecular biologist and Col Reynolds Fellow Dr Teresa Sadras’ career path has been boosted by the funding of The Kids’ Cancer Project. With over a decade’s worth of experience in studying deregulated signalling networks in blood cancers, Dr Sadras is now based at the Peter MacCallum Cancer Centre and holds a Gilead Research Scholar Award in Haematological malignancies.

Dr Sadras’ research centres around acute lymphoblastic leukaemia (ALL) arising from B-cells and looks at why approximately 10-15 per cent of children diagnosed with the disease will relapse, while others with a similar genetic make-up won’t. Those young patients who do relapse typically no longer respond to chemotherapy, giving little hope of survival.

Dr Sadras’ research is utilising sequencing approaches on matched diagnosis and patient samples, coupled with cell line models to investigate the causes and complications of ALL relapses. The ideal conclusion, she says, is straightforward.

“The ultimate goal of this work is to identify mechanisms that may predict relapse and develop new avenues of therapies for these patients,” she says,

“Understanding these mechanisms will be a critical step towards developing treatment options for children who currently have limited options, ultimately improving responses and survival.”

Dr Ip and Dr Sadras are just two of 23 Col Reynolds Fellows working in conjunction with The Kids’ Cancer Project to find better treatments and outcomes for kids with cancer.

Author: The Kids Cancer Project. For more information regarding the Col Reynolds Fellows program, visit www.thekidscancerproject.org.au/ research/col-reynolds-fellowships.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

Dr

MEASURING THE PREVENTIVE VALUES OF BREASTFEEDING FOR HEALTH AND PUBLIC HEALTH

Breastfeeding is widely recognised for its health benefits, reducing risks for a range of diseases in both infants and mothers. Yet, the broader importance of breastfeeding— for economic progress, environmental health, and sustainable development—has only recently come into focus.

Researchers from the Australian National University, in collaboration with Alive & Thrive and with support from the FHI 360 Global Nutrition Innovation Incubator, have developed two new resources, the Mothers’ Milk Tool and the Green Feeding Tool, to quantify breastfeeding’s preventive value not only in health, but also as an investable public health solution across sectors.

A PREVENTIVE HEALTH SHIELD

Breastfeeding is a foundational health intervention that lowers significant risks for both infants and mothers. Studies have shown that it reduces risks of childhood and later-life obesity, diabetes, and leukemia, while lowering maternal risks for postpartum depression, breast cancer,

and heart disease. Increasing breastfeeding globally could prevent over 823,000 child deaths and 20,000 maternal deaths annually.

Uniquely adaptable to changing disease environments, breastfeeding is commonly referred to as ‘the first vaccination’. Amidst emergencies or disasters and rising food insecurity, breastfeeding provides immediate and safe nutrition and care for infants and young children. By protecting communities and reducing the strain on health systems, breastfeeding stands out as an essential preventive measure for public health resilience.

BREASTFEEDING’S IMPACT ON GROSS DOMESTIC

PROFIT

Beyond health, breastfeeding brings substantial economic value by reducing health costs. However, the traditional exclusion of breastfeeding from economic metrics has kept it severely undervalued by policymakers.

Nobel laureates Amartya Sen and Joseph Stiglitz have stated that for true economic accuracy, non-market goods such as human milk should be included in GDP, making breastfeeding more visible to policymakers. The economic value of breastfeeding can be seen in three main areas:

1. Health cost savings: Sufficient breastfeeding helps reduce reliance on healthcare services due to lower rates of malnutrition and disease.

2. Productivity gains: Breastfeeding provides a unique source of nutrition essential for early cognitive development, and reduces maternal and child deaths, which benefits society in the long run.

Chea Chakriya | Alive & Thrive

3. Investment in care: Time and effort from mothers, alongside paid maternity leave, yield health benefits that ripple through families and communities.

The Mothers’ Milk Tool quantifies this unpaid care work and its economic contributions by providing macroeconomic estimates for around 140 countries. In Australia for example, around 51 million litres of milk a year is produced by breastfeeding mothers of children 0-3 years, whereas the biologically feasible potential production amounts to 143 million litres. This gap represents an annual economic loss of over $9.2 billion.

By translating breastfeeding into economic terms, this tool enables policymakers and investors to recognise the value of breastfeeding—and the cost of not supporting it. This economic visibility encourages investments in breastfeeding-supportive policies and infrastructure, from adequate paid maternity leave to marketing regulations for commercial milk formulas.

A GREEN SOLUTION

The environmental benefits of breastfeeding are also important. One third of the world’s greenhouse gas emissions come from the food system, with commercial milk formula (CMF) a contributor. Half of sales are of socalled toddler milk formula, stated by the World Health Organization to be unnecessary and possibly harmful. Formula production and consumption demand extensive resources over the product lifecycle; one kilogram of CMF can produce up to 14 kg of CO2 equivalent emissions and requires over 5000 litres of water.

Unlike CMF, breastfeeding generates minimal greenhouse gas emissions and waste, making it the sustainable infant and young child feeding practice in a world facing climate challenges. Breastfeeding exclusively for six months and continuing to two years and beyond is recommended for all country settings.

The Green Feeding Tool calculates the environmental footprint of CMF, providing policymakers and health advocates with insights into the environmental cost of low breastfeeding rates.

In 2011, the Gillard government introduced 18 weeks of paid maternity leave, enabling a 2% increase in breastfeeding rates among infants up to six months. This alone helped cut at least 2,000 tonnes of annual emissions and saved 945 million litres of water use.

Policies enabling breastfeeding can reduce environmental degradation from dairy production, including for CMF, and support the United Nations’ Global Nutrition Targets for breastfeeding.

By further considering investments in breastfeeding as a carbon offset in global financing arrangements for sustainable food, health and economic systems, we can amplify the contributions of breastfeeding to nutrition, health and climate objectives.

PREVENTIVE HEALTH INVESTMENT FOR HUMAN FUTURE

By preventing both immediate and long-term health issues, contributing to economic stability, and reducing environmental harm, breastfeeding stands out as a preventive health investment with lasting benefits.

With tools like the Mothers’ Milk Tool and Green Feeding Tool, developed through academic and civil society research collaboration, we now have essential metrics to guide policy and support breastfeeding on a global scale.

Investing in breastfeeding means investing in a healthier, more sustainable future for generations to come. It’s time to recognise—and act on—its preventive power.

Author: Dr Julie Smith is an awarded Australian Research Council Future Fellow, and Honorary Associate Professor at ANU. Her research focusses on the economics and regulation of markets in mothers' milk. She has been an expert advisor to WHO, US and Australian departments of health, and national and international NGOs. She previously worked in the Australian and New Zealand treasuries, at the Commonwealth Parliamentary Research Service, and at the Australia Institute.

Use Tools to Promote a Better World for Our Planet

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

LANDMARK STUDY HALVES SKIN INFECTIONS IN REMOTE ABORIGINAL KIDS

A large-scale Australian study that set out to See, Treat and Prevent skin infections in Aboriginal children living in remote Western Australian communities has not only halved the rate of skin infections, but empowered communities to take charge of prevention messages and ensure stronger skin health into the future.

Conducted by The Kids Research Institute Australia in close partnership with nine Aboriginal communities in Western Australia’s Kimberley region, the five-year SToP Trial set out to identify the best possible methods to See, Treat and Prevent painful skin sores and scabies.

Led by Professor Asha Bowen, Head of the Healthy Skin and ARF Prevention team at the Wesfarmers Centre of Vaccines and Infectious Diseases, based at The Kids, Clinical Professor at The University of Western Australia and Paediatrician at Perth Children’s Hospital, the SToP Trial is the first Australian healthy skin study to incorporate environmental health and health promotion elements as part of the ‘prevention’ arm of the research.

CORRELATION BETWEEN SKIN INFECTIONS AND LIFE THREATENING ILLNESS

“Skin sores, or impetigo, are a massive problem – our previous research has shown children living in Australia’s

Professor Asha Bowen shares the healthy skin books with One Arm Point Community Navigator Ms Janella Isaac.

remote Aboriginal communities have the highest rates of impetigo in the world,” Professor Bowen said.

“When left untreated, skin infections can cause lifethreatening illnesses including rheumatic heart disease (RHD), sepsis and kidney disease – all of which disproportionately affect Aboriginal and Torres Strait Islander Australians.

“Our aim for the SToP Trial was to not only decrease the burden of skin sores by 50 per cent, but also build the capacity of children and families to recognise skin infections through activities such as interactive workshops and co-developing health promotion resources written in both local languages and English.”

Researchers worked closely with community members and partnered with local health services – including Kimberley Aboriginal Medical Services, Nirrumbuk Environmental Health and Services, and the WA Country Health Service-Kimberley – to complete skin check-ups and yarn about the best approaches for local treatment and sharing prevention messages.

“The magnitude of the project was huge,” Professor Bowen said. “It was a tremendous effort by our entire Healthy Skin team - they conducted 3,084 skin checks and travelled more than 45,000 kms, completing a total of 81 community visits in order to gain a full picture of how skin infections affect kids and their families.”

REGULAR SKIN CHECKS KEY PRIORITY

The findings, published in The Lancet Child & Adolescent Health and eClinicalMedicine, revealed that while the rate of skin infections early in the study period was close to 40 per cent, this had been reduced to 20 per cent – two in every ten children – by the end of the trial.

“The results demonstrated that improved detection through skin surveillance in schools played the biggest role in achieving our outcome – having a strong focus on regular skin checks, communicating these results to the school, clinic and families, and really elevating skin health as a priority were the key factors we were able to identify in the SToP Trial,” Professor Bowen said.

“Ultimately, I would like to see Aboriginal children living in remote communities having the same rates of skin sores as any other child in Australia, which means getting it down to around one in every 20 children.

PREVENTION PRIORITISED BY COMMUNITY LEADERS AND ELDERS

The common theme in yarning sessions with community members was acknowledging prevention as the solution to the ongoing problem around skin infections.

“Our research highlighted the importance of environmental health and the availability of suitable, well-maintained living conditions, so we really need to advocate for solid investment in healthy housing and regular maintenance in order to achieve this,” Professor Bowen said.

CHRISTOPHE KEREBEL

“To support the sustainability of prevention, the results of the trial have now informed the National Healthy Skin Guidelines and Kimberley Skin Guidelines – a key reference for health care providers.”

For Dr Lorraine Anderson, Medical Director of the Kimberley Aboriginal Medical Services, the best outcome of the SToP Trial is seeing parents equipped with the new knowledge and resources gained from the study.

“The community response has been amazing – we are now seeing plenty of families coming into the health clinic with their kids after recognising they have a skin sore and knowing how important it is to seek treatment – that is very empowering for the parents,” Dr Anderson said.

USING THE RIGHT LANGUAGE

One Arm Point Community Navigator for the StoP Trial, Mayala Bardi Jawi woman Ms Janella Isaac, said the study team engaged community members to yarn with families and deliver messages in a language that resonated with the kids – an approach that had made a significant difference to the project’s success.

“The activities that were conducted in the community were so important, such as filming a hip-hop video that shared healthy skin messages in the children’s own words,” Ms Isaac said.

“If we are going to create any change, it’s through the next generations coming up, so it was really great to see the kids so engaged in learning how to prevent skin infections and singing the songs from the music video with their friends.

“A 50 per cent reduction rate for skin infections is really big news, and when you have a success rate like that, you know something has been done right.”

Visit The Kids Research Institute Australia website for more information on the Healthy Skin and ARF Prevention research underway by the Wesfarmers Centre of Vaccines and Infectious Diseases.

Author: Lead researcher Professor Asha Bowen is Head of the Healthy Skin and ARF Prevention team at the Wesfarmers Centre of Vaccines and Infectious Diseases, based at The Kids Research Institute Australia. A clinician-researcher, Professor Bowen is also a paediatrician in the Department of Infectious Diseases at Perth Children’s Hospital and holds affiliation with several universities including the Division of Paediatrics, School of Medicine at The University of Western Australia, Honorary Fellow at Menzies School of Health Research, Charles Darwin University, Adjunct Research Fellow at the Institute for Health Research, The University of Notre Dame Australia, and Honorary Senior Lecturer at the University of Cape Town. Professor Bowen is the current President of the World Society of Pediatric Infectious Diseases.

CHRISTOPHE KEREBEL

DISEASE PREVENTION AND THE FUTURE OF VACCINE DEVELOPMENT

Disease prevention is central to CSL’s vision for a healthier future.

As pioneers of influenza prevention and innovators in vaccines development, the impact of our Research and Development (R&D) team continues to grow on a global scale. Together with strategic partners, we are on a mission to enhance global preparedness to address current and emerging health challenges.

As a global leader in biotechnology, CSL’s mission is to develop and deliver innovative medicines and vaccines, that protect public health and help people with life-threatening medical conditions to live full lives. Central to this mission is ongoing medical research and development.

Over the last few decades, pandemic threats have been ongoing. From Severe Acute Respiratory Syndrome (SARS) in the early 2000s, to current avian influenza outbreaks, there’s strong evidence for vigilant virus surveillance, prevention strategies and international cooperation to mitigate the impact of emerging infectious diseases.

CSL has produced vaccines for five pandemics across multi-pathogens since 1918, and we are continuing to innovate vaccine technology. This includes: Spanish Flu (1919); Asian Flu (1957); Hong Kong Flu (1968); Swine Flu (2009); and most recently, COVID-19 (2021), through our partnership with AstraZeneca and the manufacturing of its COVID-19 vaccine in Australia.

STRATEGIC COLLABORATION AS A PATH TO PREPAREDNESS

“We are incredibly ambitious about what we want to achieve in disease prevention. To deliver, we need to

forge partnerships that will allow us to solve the health challenges we face today and be prepared for tomorrow.” Dr Michael Wilson.

Partnerships are vital for successful influenza prevention efforts. For many decades, CSL has worked with the World Health Organisation Collaborating Centres (WHO CCs) to play a key role in developing the critical materials that support the production of all influenza vaccines globally to protect human health. The WHO supplies CSL’s reassorting laboratory and other labs around the world with influenza viruses of interest where we generate high yielding viruses for vaccine manufacturing. The aim is to generate reassortant viruses, called candidate vaccine viruses (CVVs), that have the HA (hemagglutinin) and NA (neuraminidase) glycoproteins found on the surface of circulating influenza A strains, and internal genes that are high yielding for manufacturers, for either growth in eggs or growth in cells.

Throughout the influenza season, WHO CCs perform genetic and antigenic testing to understand if the current vaccine strains are well-matched to circulating viruses. If the WHO CCs decide that the vaccine requires an update, they will recommend a new vaccine strain for the upcoming influenza season, from the pool of reassortant viruses available. New reassortant viruses may also be generated.

Having been at the forefront of advances in reassorting, we have developed deep virology experience in working with and understanding these viruses. Working closely with WHO CCs ensures CSL and other vaccine manufacturers can quickly and efficiently produce enough

vaccine to meet the influenza vaccination needs of people around the world and help prevent the spread of influenza.

ADVANCING VACCINE DEVELOPMENT

Before the pandemic, most people had never heard of messenger RNA (mRNA) vaccines, but the world received a fast education when the technology was used in COVID-19 vaccines. This technology quickly helped address the needs of the COVID pandemic, but research and development focus has since turned towards some of the known challenges of first-generation mRNA –tolerability and duration of protection.1

Today, CSL continues to innovate on traditional egg-based influenza vaccine manufacturing, using cell and adjuvant technologies while exploring the next generation of mRNA vaccines; known as self-amplifying mRNA (sa-mRNA) vaccines.

“Self-amplifying mRNA vaccines provide a differentiated approach to mRNA vaccines by producing a multi-protein complex that makes more copies of the starting mRNA, ensuring there is enough protein to stimulate an immune response.” Dr Ethan Settembre

Self-amplifying mRNA technology demonstrates a strong immune response with a lower dose of mRNA template than first generation vaccines. Similar to mRNA, sa-mRNA technology gives the body instructions to help our immune systems recognise and fight disease but have an added feature that makes more copies of the instructions to further stimulate an immune response.2 This additional process is like an echo, where the initial sound is repeated for a finite amount of time.

Self-amplifying mRNA vaccines are then removed from the body through natural cell recycling processes — either the RNA is degraded in a cell or, in the more complete case, the cell itself is recycled by the body and elements are reabsorbed for use in other ways.3

CSL is exploring the sa-mRNA platform for COVID-19, seasonal flu and H5N1 (avian influenza) with trials underway in Australia and overseas.4,5,6,7

CONTINUED INNOVATION

CSL seeks to use innovative technologies to develop vaccines which provide best-in-class protection against public health threats. It is through a unique combination of true collaboration, where our scientists contribute ideas and effort with our partners, and innovation, that has driven CSL to succeed. This formula allows us to focus our skills on the fundamental drivers that generate disease and ultimately decrease the global disease burden.

Authors: Dr Michael Wilson, Senior Vice President and Head of Global Research, CSL ; Dr Ethan Settembre, Vice President of Research for Vaccines, CSL.

Dr Michael Wilson

Dr Ethan Settembre

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

Conceptual illustration of messenger RNA technology

Exercise is the most effective single fall prevention intervention, given the balance and strength required for staying upright.

THE URGENT CASE FOR A FALLS PREVENTION STRATEGY

Australia is a world leader in research into falls prevention.

Now there’s an urgent need to translate the evidence into policy action, write Professors Cathie Sherrington and Anne Tiedemann of the Prevention of Falls Injuries NHMRC Centre of Research Excellence.

We all know the possible serious consequences of an older person experiencing a fall. A fall can lead to injuries including broken bones and displaced joints, and can also result in a loss of confidence, increased dependency and reduced overall quality of life. In some people, falls are fatal.

Falls are the leading cause of injury-related deaths in Australia, and people over 65 account for 94% of all fallrelated deaths. Older Australians are 68 times more likely to die from a fall than people aged 15–64 years.

Every year, an estimated $4.3 billion is spent on treating injuries due to falls across all ages in Australia, including hospital, primary health care and other medical services such as imaging and pathology. In people aged 65 and older, fall-related injuries cost $2.3 billion each year.

These costs are born largely by our already over-burdened

healthcare system, though families face additional costs of caring for an older relative, home renovations and aged care costs.

As our population ages, these costs are likely to balloon if we fail to take preventive action.

The causes of falls are complex, and prevention requires a multifaceted approach that takes into consideration individual, familial, environmental, societal, political, cultural and health-system factors.

FALL PREVENTION INTERVENTION

Given the role of balance and strength in staying upright, exercise is the most effective single fall prevention intervention. Our 2019 Cochrane review of exercise for fall prevention included 108 trials and found the most effective forms of exercise were those that primarily target functional abilities or balance, exercise with multiple components (most commonly function/ balance and strength), or Tai Chi.

Exercise can prevent falls both in people who live in the general community, and in aged care facilities. Exercise reduces both the rate of falls (number of falls experienced per person) and the number of people who fall at least once per year (proportion of people who fall).

Some individuals will also require other interventions to address particular risk factors for falls including podiatry, cataract removal, and medication reviews. People at a high risk of falls may require adjustments to their home environments and advice on daily living tasks from an occupational therapist.

Considering the extent of the problems caused by falls in Australia, and the clear evidence about strategies to prevent falls, there’s a significant mismatch between this health issue and the political and policy attention it receives, as highlighted by the World Health Organization (WHO).

PREVENTING FALLS THROUGH POLICY

There has been no national focus on preventing falls in older Australians since the National Injury Prevention and Safety Strategy 2004 – 2014 and its adjunct document, the ‘National Falls Prevention Plan 2004 onwards’. While some local and state-based initiatives exist, there is little national coordinated action and resource sharing, and these efforts have been unsustainable without ongoing funding.

Our analysis of falls prevention policies identified the need for a comprehensive national policy dedicated to falls prevention, highlighting the need for multisectoral action.

We found existing policy documents generally lack clarity around implementation, how outcomes should be monitored and evaluated, and governance structures.

Sometimes fall prevention-related targets are specific, but they are limited to the provision of exercise-based programs that have limited capacity to reach a large proportion of the population.

The draft National Injury Prevention Strategy 2020–2030 is an important step forward and covers some factors that impact falls, such as housing standards and exercise programs, yet it lacks a comprehensive action plan and is yet to be adopted.

Our research has highlighted the need for a systemic and collaborative approach to falls prevention, leveraging the strengths and insights of various sectors and stakeholders.

We have shown the importance of including a range of factors involved in falls prevention policies, fostering collaboration across sectors, and establishing a clear plan that defines each actor’s role in enacting policy recommendations.

The only way to do this is through a national falls prevention strategy.

Our report, produced with colleagues at the Australia and New Zealand Falls Prevention Society (ANZFPS) and Neuroscience Research Australia (NeuRA), estimates implementing such a strategy would see a 30% reduction in falls injuries in Australia.

This would mean a quick return for the health sector, as well as longer-term co-benefits for the community including reduced risk of dementia, better heart health, mental health benefits and increased participation in society and reduced loneliness.

The United Kingdom, United States and New Zealand already have good national strategies on prevention of falls. We believe investing in falls prevention can’t wait to reverse this disturbing burden on public health.

For more information about Fall Prevention; Centre of Research Excellence Prevention of Falls Injuries

Authors: Professor Cathie Sherrington is Professor, Sydney School of Public Health, University of Sydney, leader of the CRE in Prevention of Falls Injuries and Deputy Director at the Institute for Musculoskeletal Health, at Sydney Local Health District.

Professor Anne Tiedemann is Professor of Physical Activity and Health at Sydney School of Public Health, University of Sydney, and leads the Institute for Musculoskeletal Health’s Healthy Ageing research.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

SHAPING THE FUTURE: SYSTEMS THINKING FOR CHRONIC DISEASE PREVENTION IN AUSTRALIA

To

drive effective change in

chronic disease prevention, understanding the broader systemic influences on health and wellbeing is essential.

Systems thinking addresses the root causes of complex problems by examining interactions between contributing factors, creating pathways to lasting solutions.

CHRONIC DISEASE IN AUSTRALIA

Australia is facing an increasing burden of chronic diseases, including mental health conditions, diabetes,

heart disease, and asthma. As of 2022, one in two Australians live with at least one chronic condition and approximately 15.4 million are living with a long-term health condition highlighting the urgency of finding effective, long-lasting solutions.

Chronic disease prevention has historically focused on individual behaviours encouraging lifestyle behaviour modification such as healthy eating and exercise, however such efforts alone are not sufficient.

To make a meaningful impact, we need to understand the broader, systemic factors influencing health outcomes. This is where systems thinking plays a crucial role. The Australian Prevention Partnership Centre (the Prevention Centre) has pioneered the use of systems thinking to transform chronic disease prevention.

Systems thinking is a way to make sense of a complex system that gives attention to exploring the interrelated parts, boundaries and perspectives within that system. By recognising the complex interplay between social, economic, environmental, and policy factors, systems thinking offers a way to design interventions that address root causes rather than just treating symptoms.

THE VALUE OF SYSTEMS THINKING

Systems thinking enables us to shift our mental models from linear to dynamic, helping us understand how different parts of a system interact and influence each other. This approach explores the interconnected elements of a complex problem by looking at the whole picture and identifying leverage points where interventions can have the greatest impact.

Unlike a linear or process-driven systematic approach, systems thinking is dynamic and considers the evolving nature of health challenges, allowing better resource allocation and offering sustainable solutions. This is because systems approaches enable us to identify the complex interplay of factors such as socioeconomic conditions, access to healthcare, lifestyle behaviours and policies that affect health and wellbeing.

Systems thinkers are also better equipped to anticipate challenging circumstances helping us make more nuanced decisions, to adapt and respond to changes in one area that may have ripple effects in another.

One of the key benefits of systems thinking is its ability to shift focus from short-term fixes to long-term solutions. By identifying the underlying causes of health problems, such as poor urban planning or limited access to healthy foods, this approach allows us to develop interventions that address these foundational issues. The Prevention Centre has supported systems thinking approaches in addressing issues like gestational diabetes, childhood obesity, physical activity, and alcohol-related harms.

Systems approaches also have the power to bring together multiple sectors such as health, education, social services and transport to develop coordinated strategies that target the broader determinants of health.

BUILDING SYSTEMS THINKING CAPABILITY

Globally, systems thinking is increasingly recognised as a vital tool to confront complex health issues. One of the Prevention Centre’s key initiatives has been to build the capability of Australia’s prevention workforce to incorporate systems thinking into their work. These efforts have involved providing our networks with practical tools for real-world application in prevention.

One Prevention Centre project examined how systems thinking has been used in research to tackle chronic disease. Key findings included the need for capacity building and ongoing, reflexive learning. The project

also emphasised the importance of establishing and maintaining strong relationships with government officials and policymakers. Participatory co-design processes, such as systems mapping, were found to be an effective way to foster these relationships and support policy decisions. This collaborative approach can lead to more impactful policies on issues like healthy food and nutrition, sugar-sweetened beverage taxes, and physical activity, ultimately making healthier choices more accessible to all Australians.

FUTURE STEPS

As the complexity of public health problems increases, so does the need for a prevention health workforce that is equipped to address them. In a rapidly changing world, systems thinking provides the flexibility needed to learn and adapt as new challenges arise. Building capability in systems thinking is, therefore, a critical next step. It will enable a more coordinated, efficient, and equitable approach to prevention.

Systems thinking shifts chronic disease prevention efforts from reactive to proactive by focusing on interconnected factors driving poor health outcomes. Embedding this approach into Australia’s prevention strategies across research, policy and practice will help create sustainable, long-term improvements for the health and wellbeing of future generations.

The Prevention Centre aims to equip prevention health system researchers, policymakers, and practitioners with the skills to use systems thinking effectively. In collaboration with our network, including systems thinking experts, we will explore the potential to institutionalise systems thinking and increase its perceived value among leaders.

In this way, we can collectively think across boundaries, designing impactful interventions that account for the broader determinants of health.

Authors: Dr Mishel Shahid is the Systems Science Manager at The Australian Prevention Partnership Centre at the Sax Institute and an Adjunct Research Fellow in the School of Medicine and Dentistry at Griffith University, Australia.

Nadia Mastersson is the Head of The Australian Prevention Partnership Centre at the Sax Institute and has led policy and practice improvements across the prevention continuum. The Australian Prevention Partnership Centre is funded by the Australian Government Department of Health and Aged Care, ACT Health, Cancer Council Australia, NSW Ministry of Health, Preventive Health SA, Tasmanian Department of Health, and VicHealth.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

$4.8 MILLION BOOST TO BUILD SUSTAINABLE SCHOOL HEALTH PROGRAMS

Billions of Australian dollars have been spent researching the best ways to embed healthy living practices in schools, and billions more have been spent implementing them. The challenge is how to get these initiatives adopted permanently.

Delegates from all states and territories of Australia gathered at Newcastle City Hall at the first of its size workshop, addressing the issue of national secondary school health interventions sustainability.

ENSURING SUSTAINABILITY BY EMBEDDING INTO SCHOOL PROCESSES

University of Newcastle Associate Professor Nicole Nathan, along with the Population Health research team at Hunter Medical Research Institute (HMRI), have received a $4.8 million, five- year MRFF grant to research a roadmap for implementation sustainability.

Associate Professor Nathan says, “Only 20 per cent of school-based initiatives that are implemented become sustained once active support ends. Things like ‘no hat, no play’ and ‘crunch and sip’ have become self-sustaining because they’ve become embedded into usual school processes.

“We need to find ways for our programs to not be addons but to become part of the school ethos. Programs like crunch and sip have become part of the culture of the school adopted by students, parents, as well as teachers,” she says.

A NATIONAL COLLABORATION

The first big step in this process has been to convene a national meeting to tackle this issue and figure out how to make these initiatives stick. The meeting, the first of its scale, took place at Newcastle City Hall on November 21st 2024 and featured presentations from University of Newcastle and HMRI Population Health researchers.

Associate Professor Nathan says, “This is the first time all the state and territory health and education departments have come together to address this issue of program sustainment. The aim of the meeting was to come up with a national approach to sustaining health promotion initiatives like healthy canteens, physically active uniforms, vaping, physical activity for everyone and mobile phone guidelines.”

And while there needs to be regional approaches – for example, some states may have different priorities due to contextual differences– the goal is to rally support for resilient innovations that can be sustained.

“We would love to create little utopias in schools where the students are hit with health messages both directly and indirectly. We know that people have to be exposed to these programs for a long time before they sink in but if we can hit it from all angles, we could end up with improved health literacy in our high school children,” says Associate Professor Nathan.

GENERATIONAL SHIFTS IN HEALTH

She also says that a benefit of the long-ranging work that has happened in this space is that the teachers graduating now grew up with these programs.

“When they think about things like in-class energisers, healthy canteens, mobile phone policies, vaping bans and options around school uniforms, they think ‘it’s just what we do’,” says Associate Professor Nathan.

This work dovetails with University of Newcastle and Population Health researcher Professor Luke Wolfenden’s findings on which health interventions work best for school-aged children.

In a paper titled ‘Strategies for enhancing the implementation of school based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use’, Professor Wolfenden and his team discovered that school-based interventions to prevent chronic disease need to be comprehensive, and that programs need to be supported by teacher training, parents (approval and support), teacher incentives, external expertise and the Department of Education and Department of Health.

Professor Wolfenden and his team were awarded a $5 million NHMRC grant in October 2024 to focus on preventing chronic disease by addressing two major chronic disease risk factors – nutrition and physical activity – within nonclinical settings, including schools.

Professor Wolfenden says, “Past research investments have done an incredible job of finding solutions capable of reducing much of the chronic disease burden. However, the health system is often unable to adopt those solutions in a timely way.”

Professor Wolfenden said only about 14 per cent of effective health programs or policies ever reached implementation.

“It takes on average about 17 years for those 14 per cent of programs to be adopted and delivered routinely in practice. This delay in implementation comes at a considerable cost to patients and the health system.

“We want to get the most effective interventions adopted as quickly as possible, and we want to make sure the prevention system is working in a coordinated, efficient way to help that occur,” he says.

The NHMRC-funded project called Transformative synergies: Using Learning Health Systems for Chronic Disease Prevention, also involves teams from the University of Sydney, Deakin, and Monash.

Author: Associate Professor Nicole Nathan is a trained physical education teacher with a PhD in public health, specialising in implementation and sustainability science.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

THE INEXTRICABLE LINKS BETWEEN HOUSING INSECURITY, DOMESTIC VIOLENCE AND POOR HEALTH AND WELLBEING

Safe,

secure and affordable

housing is key for prevention of domestic and family violence and its associated harms.

I just lost all trust in myself and everybody around me that I just cut them all out. So I used to just walk, I used to get my daughter in the pram and I would just walk whether it was raining, whether it was hail, thunder, anything. We would just walk until we couldn’t walk anymore, until we got to somewhere where it was warm enough and shelter that we were okay.”–

Survivor

CHOOSING BETWEEN HOMELESSNESS AND VIOLENCE

As housing availability and affordability reach crisis levels in Australia, research shows the key role provision of secure housing can play in preventing of the incidence and impact of domestic and family violence (DFV).

There are more than 120,000 people experiencing homelessness in Australia, with three million at risk – a 63% increase since 2016. Nearly one third of people who become homeless cite family violence or abuse as the main reason they need help. This translates to 9,120 women becoming homeless every year in Australia due to DFV.

The links between housing, DFV and women’s wellbeing are inextricably linked. Housing unaffordability, instability and unsuitability increase the risk of DFV; insecure and inadequate housing means women are less likely to leave the perpetrator, or more likely to return if they do.

For many victim-survivors, the threat of homelessness becomes an implicit or explicit pressure point that shapes their choices and limits their ability to resist coercion.

WHEN CHILDREN ARE INVOLVED

This coercive dynamic intensifies when combined with reproductive coercion, as pregnancy and parenting responsibilities significantly complicate the ability to secure alternative housing.

The intersection of housing instability and reproductive coercion creates a compound vulnerability where survivors may feel compelled to remain in abusive relationships or comply with reproductive demands due to fears of homelessness.

At the same time, victim-survivors experiencing DVF and/ or poor health are at greater risk of housing insecurity. They will often have suffered financial abuse and/ or have lost their savings or home when they leave their perpetrator, leaving them at heightened risk of homelessness.

The struggle to maintain stable housing often forces difficult choices between paying for accommodation and accessing essential medical care. Limited resources can make affording prescriptions, medical appointments, or preventive care impossible, while housing instability further complicates the ability to maintain consistent healthcare and medication regimens.

The implications are that DFV and gender-based housing marginalisation are significant causes of women’s poor health, including poor mental health, substance abuse, suicide, pregnancy complications, physical injuries and homicide.

HOMELESSNESS SERVICES UNDER FUNDED

Australia’s Specialist Homelessness Services are underfunded and are unable to meet a high rate of requests, with on average, nearly 295 unassisted requests per day; a total of around 108,000 unassisted requests for 2022–23.

DFV is the most common reason for seeking assistance, and the majority of unmet requests are from women. As a result, women who require specialist family violence support fall into homelessness or precarious housing in the private rental system and miss out on adequate risk management advice or housing security.

Interviews by the Healthy Housing CRE with women who had experienced domestic violence and housing

insecurity found the experience of journeying through crisis accommodation amplified harm and compounded their existing trauma.

The problem goes beyond the availability of social housing – the quality of that housing also has important impacts for victim-survivors.

Australia’s social and public housing environment is often not conducive to the recovery of someone who has experienced abuse from a partner. Poor quality crisis accommodation or an inability to afford housing are common reasons that women go back to the perpetrator.

THE NEED FOR SUITABLE HOUSING FOR VICTIM-SURVIVORS

Provision of suitable housing is key for prevention of both violence and poor health. There is an urgent need in Australia to improve gender responsive and traumainformed housing, especially crisis accommodation with pathways to long-term housing.

Research indicates that stakeholders need to prioritise housing that values residents and supports women’s recovery. Safety planning, which currently rests largely within the domain of health, should be a key concern in social housing policy.

Our research suggests the following policy and practice solutions:

• Infrastructure and development that expands access to safe housing for women, with a diversity of housing models

• Housing projects that offer wrap-around services for women such as legal, health or employment services

• Provision of secure occupancies through indexing rents to income, increasing rental subsidies for residents and women-led leases (whereby when the relationship breaks down, it is the man who must vacate)

• Committing to housing in diverse locations, including in gentrified and infrastructure-rich neighbourhoods, providing choice for victim-survivors and maintaining connections to community

• Trauma-informed design in that considers how the built environment can support wellbeing and improve the physical, psychological and emotional impacts of trauma (such as asking residents if they would like CCTV cameras, manned/controlled access entries, or balconies overlooking internal courtyards to promote passive community surveillance).

The complex intersection of unstable housing, DFV, and limited resources forces victim-survivors to make impossible choices between safety and shelter.

Addressing this crisis requires a comprehensive approach that combines affordable housing initiatives, perpetrator accountability, support services, and policy reforms to create sustainable pathways to safety and stability.

Authors: Dr Erika Martino, Research Fellow, Healthy Housing Centre of Research Excellence, the University of Melbourne

Dr Ang Li, Research Fellow, Healthy Housing Centre of Research Excellence

Briana Pike, SPHERE Centre of Research Excellence

Jessica Moulton, SPHERE Centre of Research Excellence

Excerpt from a comic zine, based on interviews with victim-survivors about their journeys through the crisis accommodation services landscape, interpreted through graphic storytelling. Image courtesy Healthy Housing CRE.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

Cooper is one of more than fifty consumers who share their experiences of the

and

IMPLEMENTATION AND EVALUATION FRAMEWORK DRIVING SUSTAINABLE SCALE

UP OF INTERVENTIONS TO REDUCE HEALTH INEQUITY AND PREVENT POOR HEALTH OUTCOMES

The Luminesce Alliance Health Systems

Implementation and Economics (HSIE) Platform’s evaluation framework is driving the sustainable scale up of interventions that reduce health inequities in children of priority populations, taking the project from Sydney Children’s Hospitals Network (SCHN) service across NSW and to other major hospitals Australia-wide.

health system

what could be done better, to inform the development of the PEACH Program.

Inequity in priority populations means that twice as many Aboriginal children are likely to die before their fifth birthday than their non-Aboriginal peers, children with disabilities are twice as likely to have more than four hospital admissions than their nondisabled peers, children living in Out of Home Care are two to three times more likely to die during childhood, and children from refugee and CALD (cultural and linguistically diverse) backgrounds have eight times higher chronic disease rates than their peers.

There are hundreds of great ideas for changing the health service and ensuring equitable health access and outcomes for children that reduce health inequity and prevent poor health outcomes.

However, most of these initiatives never achieve what they set out to do because either they are not implemented properly, or they are not fairly evaluated and therefore not sustainable.

The Luminesce Alliance’s Health Systems Implementation and Economics (HSIE) Enabling Platform seeks to change this. By embedding experts in implementation research, health economics and health services evaluation from the very start of projects, this platform aims to boost the chances of implementation success. The team gathers evidence to see if projects have had an impact on child health and have provided value for money – meaning they are more likely to be funded into the future.

‘What we’re trying to do is take what we have learnt from people on the ground, come up with innovative ways to improve their health care experience, then translate innovation back into real life system change; that’s what this platform is enabling researchers and clinicians to do,’ says the HSIE Enabling Platform Lead Investigator, Professor Raghu Lingam.

As an exemplar of this approach, Luminesce Alliance has funded the evaluation of the Providing Enhanced Access to Child Health (PEACH) Program.

This three-year program is improving equity in health services for children and young people from priority populations.

The HSIE Enabling Platform’s evaluation of PEACH, referred to as PEACH-E, is assessing impact on health outcomes within priority populations, exploring ways to better support staff in its implementation, and evaluating whether the program has been cost-effective.

PEACH aims to expand across NSW and Australia wide, with an implementation framework to ensure it will be sustainable into the future.

Conjoint Professor Karen Zwi, PEACH Lead Investigator, says the evaluation support has been invaluable to the success of PEACH.

‘The evaluation team have helped us assess whether or not the implementation is going according to plan, and we’ve constantly shifted and changed so that implementation is optimised throughout,’ she says.

‘The evaluation framework has enabled us to collect all the impact data from the beginning - not only the number of kids and how many times they’ve been seen, but what their health outcomes are, so we can assess whether their health has improved. And that informs the sustainability of the program.’

HOW PEACH IS CHANGING THE SYSTEM

Funded by the NSW Ministry of Health, PEACH focuses on actively identifying priority population patients and recording them in the hospitals’ systems. The program then provides recommendations for early access to health services and enhances the care they receive, such as making sure families are followed up actively and linked to support workers. It also supports health staff to provide cultural safety and equity for patients.

‘The ultimate goal is to improve their health access and outcomes, because we know that they have poorer outcomes for many reasons,’ says Seaneen Wallace, a proud Gungarri and Bundjalung woman who is working on the PEACH project.

‘PEACH is really looking at how we can provide tailored, personalised, patient-centered care. And those needs might be slightly different, depending on their background.’

Consulting with patients and carers is a key element of PEACH.

Some of the issues addressed include patient-friendly signage in different languages, and improved layout with toilet doors that aren’t too heavy for children living with disability.

The team have also consulted widely with health staff to find out better ways of creating change on the ground, including changing the electronic medical record system so it’s easy to identify whether a child is from one or more priority populations, with prompts to link families to appropriate support services.

Authors: Professor Raghu Lingam is Professor in Paediatric Population and Health Services Research at the UNSW Sydney, serves as an Honorary Professor at Kings College London and the Black Dog Institute (NSW) and is a Consultant Paediatrician within The Sydney Children’s Hospitals Network.

Professor Karen Zwi is a Consultant Community Paediatrician at Sydney Children’s Hospital, Randwick, Conjoint Professor at UNSW Sydney, and the Acting Clinical Services Director for Child Youth and Family in Northern Sydney Local Health District (NSLHD).

Seaneen Wallace is the Priority Populations Care Navigator, PEACH-E Project Co-Ordinator, Diversity Health, at The Sydney Children’s Hospitals Network, Randwick.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

PREVENTION AS A PRODUCTIVITY SUPERPOWER

Investment in adult vaccination can deliver $1.1bn net annual return

Investment in adult vaccination can be Australia’s superpower, delivering a potential $1.1 billion in benefits every year, according to a new report commissioned by GSK.

“Prevention: A Productivity Superpower”, examines the opportunity to increase access to vaccination and disease

prevention. Analysis demonstrates that every dollar invested to vaccinate adults against common illnesses provides a $3.50 economic return. This is achieved by reducing demands on health, government services and carers, boosting workplace productivity and economic participation, while also improving life expectancy and quality of life.

Independent economist Saul Eslake said immunisation was one of the most cost-effective public health measures, second only to clean water.

“As the population ages, vaccinations become even more valuable by helping Australians to live well for

By increasing investment in adult vaccination, the Government can help more adult Australians to live healthy and productive lives.

longer. Preventing disease is integral to Australia’s future economic resilience, as a healthy ageing population positively impacts workforce productivity, participation, and economic growth,” Mr Eslake said.

AN AGEING POPULATION IS A POWERFUL ECONOMIC FORCE

Economic growth has slowed, cost-of-living increases and inflation pressures are impacting households. Australia’s population is ageing. Demand for care and support services is escalating.

These are powerful economic forces that could lead to a future where government spending will outweigh revenue.

This places Australia at a critical decision point. Governments is making decisions on the reforms and investments that can secure economic sustainability.

“Prevention: A Productivity Superpower” is designed to help government make those decisions.

ADULT VACCINATION IS AN INVESTMENT

The report examines the cost-effectiveness of preventing diseases like shingles, influenza, respiratory syncytial virus (RSV), pertussis (whooping cough) and diphtheria. Vaccines to prevent these diseases are recommended for adults in the Australian Immunisation Handbook, but not fully funded by the Australian Government and provided through the National Immunisation Program (NIP). The analysis considered the investment required to deliver access to these vaccines and preventable disease costs including short- and long-term health system, productivity, tax, government services and carers implications.

The analysis showed that addressing gaps in adult immunisation as a priority can deliver a $1.1 billion net economic impact. This includes:

• $152 million return annually by vaccinating people aged 50 years for shingles.

• $303 million return annually by vaccinating all people for influenza.

• $687 million return annually by vaccinating people aged age 75 years and older, and high-risk populations 60 years to 74 for RSV.

The analysis also showed that not all recommended vaccines were cost effective. Pertussis and diphtheria vaccinations were not cost effective and not proposed for funding on the NIP.

IT IS TIME TO REBALANCE THE FUNDING OF HEALTH

GSK recognises there needs to be a balance between investment in vaccines and affordability, to ensure the ongoing growth of the economy and sustainability of the health system. This report demonstrates it is time governments re-balance funding of health.

The benefits of vaccinations have long been recognised by the community and health sector but they have been undervalued from a financial and economic perspective.

For example, the healthcare system puts a lower value on human life than other sectors of government, such as transportation. This means that the Australian Government is willing to invest more in a road safety measure than vaccines that will prevent disease. The Australian Government is also not willing to pay the same price for extending life or improving quality of life as other countries including Canada and England.

Reform of reimbursement systems and processes to recognise the value of vaccines and disease prevention is critical.

AN AMBITIOUS TARGET TO DRIVE RETURNS

Prioritising adult vaccination in delivery of the NIPdrawing on the success of the childhood vaccination experience - is essential to achieving and demonstrating the highest possible return on Australian Government investment.

This includes setting a 95 per cent adult immunisation target consistent with the childhood immunisation program and partnering with the community and health sector to increase vaccine awareness and confidence.

An opportunity to pave the way for a healthier future for all

While the report is focused on the economic case for investing in adult vaccination, it is important to remember that behind every cost-benefit analysis is a person, looking to thrive as they age and avoid the impact of disease.

Retired academic, GP and public health physician Associate Professor John Litt said it was important all Australians, regardless of location or economic status, have access to the vaccinations they need.

“Underinvestment in vaccination disproportionately affects our most disadvantaged communities. Enhancing vaccine access for adults will help secure health and economic wellbeing for Australians, paving the way for a healthier future for all,” said Associate Professor Litt.

CONCLUSION

The Australian Government has an opportunity to invest in adult vaccination, delivering better health outcomes and significant economic benefits. “Prevention: A Productivity Superpower” highlights the importance of reforming reimbursement systems and processes to acknowledge the long-term societal and financial value of vaccines and disease prevention. By prioritising adult vaccination within the NIP, the Government can ensure both immediate and future returns.

The full version of “Prevention: A Productivity Superpower” can be found here: www.au.gsk.com

Author: Andrew Thomas – General Manager, GSK Australia.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

HEALTH BEHAVIOUR AND MENTAL WELLBEING SURVEY

A comprehensive approach by CSIRO to better understand both health and mental wellbeing of Australians

Chronic conditions including cardiovascular diseases, cancer, and mental disorders are the leading causes of morbidity and mortality in Australia.

Such chronic conditions not only impact individual quality of life but significantly burden the Australian healthcare system and economy. It is estimated that many of these

conditions could be alleviated by addressing modifiable behavioural factors through health promotion and prevention initiatives.

A NATIONAL APPROACH TO HEALTH PROMOTION AND PREVENTION

To provide health and economic benefits, the National Preventive Health Strategy (NPHS) 2021–2030 published by the Department of Health and Aged Care, Australia, has identified key focus areas to reduce the burden of chronic conditions by modifying behavioural risk and protective factors. The NPHS focus areas include reducing tobacco use and nicotine addiction, improving access to and the consumption of a healthy diet, increasing physical activity, reducing alcohol and other drug harm, and promoting and protecting mental health.

To address these focus areas, the NPHS emphasises the need for frequent and accurate national data on health determinants to understand Australians’ current state of health and mental wellbeing. Existing population health surveys are infrequently administered. These surveys are not comprehensive with regards to measuring health outcomes in ways that include risk and protective health behaviours together as well as mental wellbeing as a core element of health.

ASSESSING THE CURRENT STATE OF HEALTH AND WELLBEING IN AUSTRALIA

CSIRO has developed a 30-minute Health Behaviour and Mental Wellbeing Survey, which is aligned with the NPHS focus areas. The online, self-administered survey captures a variety of health and wellbeing related information. A key survey component is the newly developed CSIRO 10-item Mental Wellbeing Scale, which measures modifiable and positive aspects of mental wellbeing. Other determinants of health captured include chronic conditions, health behaviours (smoking, eating, alcohol, physical activity, sleep) and social context. The survey enables continuous data collection and rapid reporting aligned with the NPHS focus areas, whilst advancing scientific understanding of the interactions between health and wellbeing.

OUTCOMES OF CSIRO HEALTH BEHAVIOUR AND MENTAL WELLBEING SURVEY

Data was analysed from 2,563 Australian adults (76% female) who completed the CSIRO Health Behaviour and Mental Wellbeing Survey in early 2024. Participants had an average age of 52 years. Approximately one third of participants had experienced financial hardship in the previous year (29%) and reported high to very high psychological distress (32%), while almost six in ten (57%) had a body mass index in the overweight or obese range. Over one third of the sample (36%) could not obtain at least one required health care service in the previous year due to access or affordability issues.

Three-quarters of the sample met between 3 to 5 recommendations for health behaviours, primarily for smoking (97%), alcohol use (72%), sleep (69%), physical activity (61%), and muscle strengthening (51%), but less so for the nutrition recommendations (e.g., 14% for daily vegetable intake). Meeting between 3 to 5 recommendations predicted 16-21% higher mental wellbeing, which increased with each additional recommendation met. Majority of participants lived with at least one chronic condition (71%) and many reported more

than one condition (42%). The most prevalent conditions were self-reported obesity based on body mass index (25%) and mental health disorders (23%). Living with three or more chronic conditions predicted 12% lower mental wellbeing.

TRACKING PROGRESS TOWARD NPHS TARGETS TO GUIDE PUBLIC HEALTH POLICY

The CSIRO Health Behaviour and Mental Wellbeing Survey provides a detailed overview of health behaviours and mental wellbeing in the Australian population. The sample was relatively advantaged compared to the general population. Ongoing recruitment will broaden sampling methods to ensure priority groups are appropriately represented. Nonetheless, a high prevalence of chronic conditions, along with financial difficulties and psychological distress, indicate widespread challenges with health and wellbeing. Future research will examine the importance of different types of health behaviours (risk or protective) and chronic conditions for predicting mental wellbeing outcomes.

As a cross-sectional study, CSIRO cannot determine causality between mental wellbeing and health behaviours or chronic condition status. Longitudinal data will be required to estimate the direction of these effects. Future work will also refine survey items for continuous measurement and monitoring with the overall aim of providing insights into population-level trends in health behaviours and mental wellbeing. Ongoing data collection will help track progress toward NPHS targets for key focus areas in a responsive and pragmatic way and guide public health policy and prevention initiatives. Securing more diverse samples and public health partnerships are the next steps towards achieving this goal.

Authors: Dr Naomi Kakoschke, Senior Research Scientist, Human Health Program, CSIRO, Adelaide

Dr Emily Brindal, Principal Research Scientist, Human Health Program, CSIRO, Adelaide

Dr Gilly A Hendrie, Principal Research Scientist, Human Health Program, CSIRO, Adelaide

Dr Caitlin Howlett, Research Projects Officer, Human Health Program, CSIRO, Adelaide Megan Rebuli, Research Dietitian, Human Health Program, CSIRO, Adelaide

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

PARTNERING FOR CHRONIC DISEASE PREVENTION

The NHRMC’s Partnership Centres for Better Health were a bold experiment in co-produced partnership research. Eleven years on, The Australian Prevention Partnership Centre (Prevention Centre) has important learnings to share.

The Prevention Centre was established in 2013 to improve the availability and relevance of research evidence to support health decision makers in chronic disease prevention.

In addition to producing internationally significant research, our aim has been to transform how researchers, policymakers and program practitioners work together to achieve outcomes that no single group could have achieved on its own.

The scale and complexity of our program of work has been substantial. We have brought together more than 900 researchers, policymakers and practitioners from across states and territories, nationally. This has included research co-production on a scale not previously seen in Australia, with almost 70 research projects involving a level of co-production.

Through these partnerships, we supported policy-relevant research and developed new approaches in research translation. Our methods and tools for prevention have been widely used around the country and internationally.

For researchers, our partnership model offered the chance to connect with a national network focused on chronic disease prevention. It provided opportunities to experiment with new approaches, access additional resources, and collaborate with experts to enhance the impact of their work.

Our partnership model also provided significant returns for our policy partners. This value included research targeting key policy priorities, forming relationships across the Prevention Centre’s broad network, and access to synthesised evidence and tools tailored to their needs.

We also found that the Prevention Centre helped partners expand their reach, increase the sustainability of their efforts, reduce research duplication nationwide, and create a unified voice for prevention.

The Prevention Centre was the only NHRMC Partnership Centre for Better Health to be re-funded for a second five-year term. In 2024, it became an embedded centre of the Sax Institute, with ongoing funding from our policy partners – testament to the value they place on this scale of collaboration.

As we enter the twelfth year of this national prevention collaboration, three central themes for nurturing impactful partnerships have emerged.

CREATE COLLABORATIVE LEADERSHIP

Research into the attributes of an effective chronic disease prevention system shows leadership and collaborative capacity are key. The Prevention Centre was funded to provide these attributes in a way that would not otherwise have been possible.

Having the independence, accountability and mandate to cultivate the collaboration was critical. It took us several years to gain momentum and pulling together so many people, agencies, processes and governance structures required considerable negotiation and time.

Nurturing partnerships requires significant ongoing work. We design purposeful strategies to engage and build a collaborative mindset, ranging from transparent governance to participatory dialogues, roundtables, and co-hosted events. We found shared goals and agendas, together with visible action inspired connection and commitment from both existing and new partners.

INVEST IN INFRASTRUCTURE FOR COLLABORATION, COMMUNICATION AND COORDINATION

When embarking on a partnership of our size and complexity, the decision to invest in infrastructure that facilitates collaboration has been instrumental to sustaining the partnership.

Establishing communities within partnerships helps address specific partner needs. Within the Prevention Centre, coalitions like the Collaboration for Enhanced Research Impact have supported advocacy efforts, while our 400+ Emerging Leaders Network and Communities of Practice provide networking and capability-building opportunities for early- and mid-career researchers, policymakers and practitioners.

The partnership has also added value by strengthening science communication, focused on sharing the practical implications of research to promote the importance of prevention.

Strong and transparent governance has been foundational, ensuring clear decision-making processes, responsibilities, and monitoring.

RECOGNISE THAT RELATIONSHIPS EXIST WITHIN A SYSTEM

The Prevention Centre was founded on the importance of systems thinking in the prevention of chronic disease. We recognise in partnerships, the dynamic and interconnected effect of many actors working together across a variety to achieve a shared vision.

Within the system, relationships between individuals are key. Particularly valuing diverse perspectives and fostering

mutuality. Trust is at the heart of forming and maintaining our relationships. Building trust requires reciprocity, openness, reliability, aligned values, and the ability to manage power imbalances and conflict.

Our relationships have been foundational to success –they have weathered political changes, tightening fiscal environments and relationship transfers with changes in key personnel over time.

RECOGNISING THE SCIENCE AND ART OF SUCCESSFUL PARTNERSHIPS

In our first eleven years, we have successfully established a new way of working that has benefited prevention researchers, policy makers and practitioners, with the goal of ultimately improving health outcomes of Australians.

Authors: Nadia Mastersson is the Head of The Australian Prevention Partnership Centre at the Sax Institute and has led collaborative coalitions across the prevention continuum.

Professor Andrew Wilson AO is Co-Director of the Leeder Centre for Health Policy, Economics and Data at The University of Sydney and former CoDirector of The Australian Prevention Partnership Centre from 2013 to 2023.

The Australian Prevention Partnership Centre is funded by the Australian Government Department of Health and Aged Care, ACT Health, Cancer Council Australia, NSW Ministry of Health, Preventive Health SA, Tasmanian Department of Health, and VicHealth.

Group of participants at the Preventive Health Conference 2024, Darwin. Image courtesy of the Public Health Association of Australia.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

MEETING THE HEALTH NEEDS OF THE CLIMATE EMERGENCY.

Climate change is one of the greatest health threats faced by humanity, and 2023 was our hottest year on record.

Professor Yuming Guo’s research helps policymakers and planners understand the shifting health needs posed by climate change, to protect good health, and deliver health services accordingly.

Air pollution, rising sea levels, environmental destruction and more frequent and intense heatwaves, megafires, floods and storms all pose immediate existential threats to humans.

They also carry longer-term challenges, like respiratory, cardiovascular and mental health problems, the emergence of novel infectious agents and changes to patterns of endemic infectious diseases. They increase health inequity, threaten clean water supplies, and have many other impacts that ripple out to health.

Monash University’s Professor Yuming Guo leads a team of researchers making these problems their priority.

PREVENTION, TO PROTECT GLOBAL HUMAN HEALTH

The Climate, Air Quality Research Unit runs a range of projects that embrace emerging technologies like machine learning, and harness unusual data sources such as satellite imagery and air quality monitors and map them to human health and demographic datasets.

“When we talk about prevention in the climate health space, there are several levels of hierarchy with levers that can be pulled,” he says. “Our research is about

understanding how much of our current morbidity and mortality can be ascribed specifically to climate change, and off the back of that, what can we predict about future health needs, given the likely path of the climate shift. This helps the influencers in each level make informed plans to protect human health.”

Individuals and communities can change personal behaviours to reduce their own risks, such as staying indoors on days of high air pollution or excessive heat. They can also educate and influence one another.

Organisations can set policies to reduce their environmental footprint at an industrial scale, and to protect their workers from harm on high-risk days.

Governments and urban planning authorities can plant more greenery. Foliage traps heat on hot days, and acts as a barrier to reduce the movement of air pollutants indoors. Planners can provide more public drinking fountains to combat heatwaves, and set zoning and housing quality standards to meet the demands of higher temperatures, more floods, intense storms and rising seas.

And finally, governments, urban planners and health leaders need to jointly create policy and provide health services based on changing health needs.

Air quality monitoring systems, alert systems for heatwaves, community education campaigns, plans to relocate vulnerable people to safe zones, and ensuring we have enough vaccines and medications to meet shifting

infectious disease patterns are just some of the ways we can prevent harm from climate change.

THE HEALTH IMPACTS OF THE MEGAFIRES OF 2020

“Since moving to Australia, the health impacts of exposure to fine particulate matter (PM2.5) in air pollution – in particular from bushfire smoke – has been a passion of mine,” Professor Guo says. “The long-term effects are under-studied, so we’ve done a lot of work understanding the health impacts of people living along Australia’s eastern seaboard after the megafires of 2020.”

More recently, his team have undertaken global estimations of the burden of smoke exposure from landscape fires.

In 2018, 221 deaths were recorded globally as a direct impact, but the team’s analysis of air quality data, demographic data, scientific literature and morbidity and mortality records showed that over 1.5 million deaths could be attributed to the fires, largely through respiratory and cardiovascular damage.

Their explorations of proximity to residential greenness have highlighted the health benefits for pregnant women, and with reduced biological ageing.

They’ve also mapped temperatures across time and space (0.5° x 0.5°) around the planet, and compared them with death records to assess the global mortality burden of heatwaves between 1990 – 2019, demonstrating complex regional disparities and a need to plan locally to protect health.

LONG TERM IMPACT ON HEALTH POST FLOODING AND CYCLONES

“We’ve got some interesting research happening right now, based on global datasets, around flooding and tropical cyclones. While the final results aren’t in, what we’re starting to see quite clearly is different patterns of lagging health impacts between them. The cardiovascular and mental health impacts of tropical cyclones tend to manifest immediately after the event, and last for a couple of weeks on average. But following flooding, similar effects tend to show up two weeks post-event, and last a lot longer.

“This is potentially a function of the different type of infrastructure damage we see between the two events. Cyclones often cause external damage to buildings, but following floods, people frequently dwell inside damp buildings, exposing them to fungal, bacterial and viral contaminants they wouldn’t normally reside alongside. And the health services needed to treat these people – for the physical and mental health distress they may experience - may also be disrupted by the flooding.

“With more and more of these natural climate disasters on the horizon, the ability to plan in advance is vital to prevention and recovery.”

Author: Dr Yuming Guo is Distinguished Professor of Global Environmental Health and Biostatistics & Head of the Monash Climate, Air Quality Research (CARE) Unit.

Professor Yuming Guo and the Climate, Air Quality Research Unit

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

VAPING: THE CHALLENGE OF KEEPING EVIDENCE

UP-TO-DATE

Living systematic reviews have emerged as an important tool for providing evidence during rapidly evolving public health crises like vaping.

Vaping has exploded globally amongst children and adolescents in recent years.

Public health deals with complex, wicked problems that often emerge or evolve without warning.

E-cigarette use (vaping) is a case in point. Vaping has exploded globally amongst children and adolescents in recent years, prompting recent action by the Australian Government to reform the regulation of vaping products. These reforms mean that the only legal way to vape is via a therapeutic pathway with supervision and advice from a medical professional (pharmacist or doctor).

Yet, at the time these policy reforms were made, there was no evidence available from randomised controlled trials to assess the potential impact of e-cigarette prevention or cessation-focused interventions targeting children and adolescent e‐cigarette use, tobacco use, or any unintended adverse effects.

Globally, the evidence on preventing harms of vaping is still emerging. How can we, as researchers, synthesis and communicate current evidence at the time it is needed by policymakers?

EMERGING PUBLIC HEALTH CRISES

Global pandemics such as COVID, increasing rates of obesity, and poor diet in children are other examples where governments must consider evidence that either does not yet exist or is very fast moving.

These issues are similar in that they involve numerous stakeholders, including commercial actors and different interest groups, and politics plays an important role in decision making.

The gold standard of evidence for prevention on these issues is systematic reviews. However, these may take years to produce, are infrequently updated, and can be out of date on publication.

The Cochrane Collaboration offers a solution, refined during COVID, that might address this issue: living systematic reviews.

LIVING SYSTEMATIC REVIEWS

Living systematic reviews initially involve a standard ‘baseline’ review, followed by regular scans for new evidence. This evidence is incorporated, synthesised and communicated as it becomes available.

This approach has become more feasible in recent years due to the advent of online platforms, linked data, and machine learning. Large research collaborations, data sharing and the growth of the citizen science movement have opened the possibility of continual updating and active monitoring of evidence as it emerges.

Living guidance came to the fore during COVID, when the Australian Living Evidence Collaboration formed the National COVID-19 Clinical Evidence Taskforce. This taskforce adopted a “living” approach to monitor the evidence as it emerged and used it to produce and update living guidelines to help clinicians provide best-

evidence COVID care.

Today, there are more than 150 living systematic reviews published in peer review journals. These include a recent review for Cochrane on interventions for increasing fruit and vegetable consumption in children aged five years and under. A review into interventions to prevent or cease electronic cigarette use in children and adolescents will be updated next year to incorporate new evidence that was not yet available at the time of publication in 2023.

Evaluations of living systematic reviews indicate this is a feasible and successful approach to keeping high-quality evidence synthesis continually up-to-date.

It is important to retain high methodological quality by retaining all core systematic review methods, with the addition of additional specific methods that are specified at protocol stage. For example, the frequency of continual evidence surveillance and updating should be explicit up front.

There also need to be sufficient resources and capacity to continually update the evidence, though with the advent of machine learning and/or citizen science, there is great potential for time and effort savings.

POLITICS CAN STILL TRUMP EVIDENCE

In November 2023, the Aotearoa/New Zealand Government unexpectedly scrapped the country’s pioneering legislation designed to create a smokefree Aotearoa. Innovative policies that were repealed included reducing the amount of nicotine in tobacco products to make them non-addictive, a “smokefree generation” that would ban the sale of tobacco products to those born after 2008, and drastically reducing the number of retailers permitted to sell tobacco.

This was contrary to overwhelming evidence and the wishes of the community, particularly the Māori community, which is disproportionately affected by tobacco harms and had supported the legislation.

The New Zealand Government’s action shook the global public health research community and highlighted the strong forces at play when it comes to restricting harms caused by commercial industries that produce harmful products.

It has never been more important for prevention researchers to support policy by providing timely, relevant and current evidence.

Authors: Dr Kylie Morphett, NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame

Dr Heidi Turon, National Centre of Implementation Science

Dr Meghan Finch, National Centre of Implementation Science

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

SUICIDE PREVENTION AND THE ROLE EVERY AUSTRALIAN PLAYS

Experts are arguing for a broader approach to suicide prevention to address social and economic factors, for a more proactive public health approach.

CHANGING THE APPROACH

Each year, according to the Federal Government’s Department of Health and Aged Care, around 3000 Australians die by suicide.

Suicide is also the main cause of death for people aged between 15 and 49 in Australia.

Globally, there are around 720,000 suicides each year, and many experts in the field argue that there is a particular need in low to middle income countries to address suicide rates.

These statistics are sobering.

In a new Lancet Public Health Series, published on World Suicide Prevention Day (10 September), a global team of academics argued for a major change in how societies perceive suicide, in order to work towards a reduction in suicide rates around the world.

WHERE IT STANDS NOW

The World Health Organization’s Mental Health Action Plan sets out a target to reduce the global suicide rate by one third by 2030.

While, broadly speaking, there has been a reduction in suicide rates globally, experts argue there is still a long way to go to addressing suicide rates.

There is also a need for more rigorous data in some parts of the world, particularly for poorer countries where suicide data collection is limited.

Co-lead on the Lancet Public Health series, Professor Jane Pirkis, explained that suicide isn’t just a clinical problem that requires a clinical solution.

“There has been a tendency for suicide to be viewed as a clinical problem, through the lens of someone’s mental health,” Professor Pirkis, who is also the Director of the Centre for Mental Health at the University of Melbourne, said.“What we argue for in the series is a much broader approach, a more nuanced approach to suicide prevention which encompasses a public health model.”

“That takes into account other factors such as financial downturn, unemployment, housing difficulties, gambling, substance misuse, domestic violence, racism or discrimination.”

“Those are factors at the societal level that are important in helping to build a bigger picture. We call them social determinants of suicide.”

“The relationship between social determinants and clinical risk factors is particularly important; the public health approach that we put forward does not negate the significance of clinical risk factors, but it provides a framework for understanding how these factors might arise or be exacerbated.”

CLINICAL CARE IS STILL CRITICAL

Clinical care plays a critical role, particularly when someone is in a suicidal crisis.

But the experts in this series argue that the greatest reductions in suicide are most likely to be achieved through public health measures that target the population as a whole.

While many mental health experts would agree that both social and economic factors, as well as existing mental health challenges, are important, historically the focus has been on individuals’ mental health status.

A policy shake-up, addressing the root causes and society’s role in prevention

Professor Pirkis said a public health approach is about influencing policies that have an impact on the social determinants of suicide.

Examples could include things like financial supports for people struggling at times of economic downturn, education campaigns to reduce engagement in gambling, as well as increasing public health messaging around family and domestic violence.

A whole-of-government approach, which may not typically be the approach taken in suicide prevention, would go some way to addressing suicide rates.

While many countries do have national prevention strategies, there is a need for a change in the way these are developed and adopted.

Professor Keith Hawton from the Centre for Suicide Research in the Department of Psychiatry at the University of Oxford, a co-lead on the series, said a policy re-think is required.

“National suicide prevention strategies are usually driven by departments of health and signed off by health ministers, as was the case in three-quarters of the national strategies identified in previous 2020 research,” he said.

“Moving suicide prevention beyond mental health alone will require a policy reset involving genuine whole-ofgovernment commitment.”

“National suicide prevention strategies need to reflect the impact on suicide of policies that sit outside the health sector as well as within it.”

He also argues people with lived experience should have a voice at the policy table.

“It’s also important to recognise that suicide prevention is not just the responsibility of governments and of frontline service providers,” Professor Hawton said.

“We need to go one step further and ensure that relevant communities, even commercial sectors are involved in suicide prevention, transforming a whole-of-government approach to a whole-of-society approach.”

“Everyone has a role to play, including those who have lived experience, who should be actively involved in our prevention strategies and policies.”

IF YOU NEED HELP CALL:

• Lifeline – 13 11 14

• Kids Helpline – 1800 55 1800

• Mental Health Crisis Assessment and Treatment Team in your state/territory

• Beyond Blue – 1300 224 636.

Author: Author: Danielle Galvin from the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

THE MENTAL HEALTH AND WELLBEING OF FIRST NATIONS CHILDREN AND YOUTH: A BETTER PATH FORWARD

Overall, the project found a need to create “communities of wellbeing”, local ecosystems able to support the development of positive mental health and wellbeing for First Nations children and youth.

CQUniversity’s Jawun Research Centre and two Aboriginal community-controlled organisations (ACCOs), Gurriny Yealamucka Health Service (Gurriny) and Deadly Inspiring Youth Doing Good (DIYDG), both in Far North Queensland. Gurriny is a culturally sensitive and holistic primary healthcare service supporting Yarrabah, Australia’s largest discrete Aboriginal community. DIYDG is a Cairns-based youth-led organisation with programs grounded in a kinship structure of care, aiming to inspire, equip, and empower children and youth. Project participants, including First Nations youth and service providers (most First Nations), shared their expertise, experiences and ideas in regard to the mental health and wellbeing of First Nations children and youth. Their information guided understanding of best practice preventive care; the structural barriers to such care; and a comprehensive framework for the positive mental health and wellbeing of young First Nations people.

GUIDELINES TO PREVENTIVE CARE

Participants emphasised the urgent need for preventive care and provided guidelines for such programmes. Most important was the provision of family-based integrated whole of person care, including mental and physical healthcare, but also social support (basic needs, housing, education, and employment services). Services needed both a strong cultural orientation and a trauma-informed approach with capacity to provide, or refer young people

Programs needed to be place-based and locally connected, including relationships with families and community, and connecting young people to local resources. A varied range of activities promoting child and youth wellbeing was needed, accommodating diverse interests and ages (eg. sports, arts, Cultural and on-country activities). These provided constructive diversionary experiences and opportunities to access positive role models and build life skills (eg. volunteering). Having dedicated facilities was also crucial, offering children and youth a familiar culturally and psychologically

Finally, services and programs needed to be young person centred and directed, and encourage child and youth empowerment and leadership, ensuring intergenerational transfer of wellbeing and ongoing positive First Nations

BARRIERS TO PREVENTIVE CARE

The project, however, found substantial barriers to the provision of such programmes. It found an imbalance in the prevention to crisis support spectrum, with only 32% of services working at the preventive end of mental

health and wellbeing, and a lack of services providing social support. Asynchronous to the best practice guidelines identified above, ACCOs made up only 23% of organisations providing services to First Nations children and youth, and typically worked at the crisis end of care while mainstream non-government organisations (NGOs) worked at the preventive end. Programmes were further obstructed by funding that was fragmented and shortterm; included accountability parameters inappropriate to First Nations models of care; and that disregarded community priorities.

STRUCTURAL CHANGE FOR SERVICES AND GOVERNMENT

Ultimately, the project found that shifting the trajectory for at-risk First Nations young people requires prioritising structural change at service and government levels. At the services level, ACCOs need to take the lead, with NGOs collaborating to provide culturally and locally appropriate programmes. This in turn requires investment in the development of ACCOs, and building cross-sector workforce capacity, with cultural awareness and traumainformed training provided as standard. It also requires a funding shift from crisis to prevention; and government working with ACCOS to find funding and accountability arrangements that work for communities.

A BETTER PATH FORWARD

Without change, and with young people constituting 51% of the First Nations population, the Closing the Gap targets will remain unattainable. Providing appropriate long-term preventive care is key to supporting First Nations children and youth onto a better future, but this must start with structural change. Without this, to paraphrase one service provider, “we will continue to have the same conversations again and again, yet First Nations children and youth will remain in crisis”.

Authors: All authors work at the Jawun Research Centre, CQUniversity. Dr. Alexandra van Beek, (senior researcher) utilises systems thinking to investigate the complex social underpinnings of mental health and wellbeing. Ruth Fagan, (senior researcher) is a First Nations researcher committed to community led research focusing on reforms through system change local decision making.  Prof. Janya McCalman (professorial research fellow) is a public health researcher with a focus on service systems that support the resilience, empowerment and wellbeing of First Nations Australians.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

EXPANDING THE SCOPE OF BREAST SCREENING SERVICES TO INCLUDE A PREVENTIVE INTERVENTION

The Health4Her program of research is using co-design and implementation science methods to embed a novel digital preventive intervention within breast screening services, with potential for extensive reach and benefit.

Alcohol consumption, physical inactivity and excess weight are established risk factors for breast cancer, and are important targets for prevention.

In Australia, alcohol consumption contributes to at least 6.6% of breast cancer cases and 18% of breast cancer

deaths. Excess weight and physical inactivity contribute to a further 7.5% and 2.5% of breast cancer deaths, respectively.

Even in very low amounts, alcohol consumption elevates breast cancer risk. While women drinking heavily have a 61% excess risk compared to non-drinkers, women drinking at low levels previously considered ‘safe’ (as little as half an Australian standard drink a day) are also at significantly elevated risk.

Research by our team and others shows that awareness of this risk is low, including among midlife and older-aged women, a population whose recent alcohol intake is strongly associated with breast cancer development, and whose drinking patterns are substantially riskier than for previous generations.

With nearly 1 million women screened by BreastScreen Australia annually, integrating a preventive intervention to target modifiable breast cancer risk factors has potential for extensive reach and benefit.

FORMATIVE RESEARCH

For the first phase, we partnered with Peter MacCallum Cancer Centre’s Lifepool to conduct a retrospective analysis of alcohol consumption data among their large community sample of breast screening service consumers. We also invited women from Lifepool to complete an online survey.

This work established need and acceptability of a preventive intervention integrated in breast screening. Of 49,240 breast screening service consumers, one in five were drinking at a level exceeding current Australian alcohol guidelines. Of 391 women surveyed, threequarters were unaware of the alcohol-breast cancer link, and nearly all supported adding 5 minutes to their screening appointment to receive breast cancer risk reduction information.

THE CO-DESIGNED PREVENTIVE INTERVENTION

We then co-designed a prototype digital preventive intervention, which was called Health4Her. Health4Her uses animation to raise awareness of the alcohol-breast cancer link, convey the health benefits of reducing alcohol consumption, and support women to maintain low-risk drinking levels. Alcohol information is presented alongside other breast cancer risk reduction information – increasing physical activity and maintaining a healthy weight –ensuring that the intervention is relevant for all women while discretely targeting alcohol consumption.

INTERVENTION IMPACTS

In the first hybrid effectiveness-implementation trial conducted with 557 women at Maroondah BreastScreen (Eastern Health, Melbourne; BreastScreen Victoria), the intervention – delivered on an iPad during the screening appointment – was found to be effective in increasing women’s awareness of the increased breast cancer risk associated with alcohol use, improved alcohol literacy more broadly, and also increased awareness of inactivity and excess weight as modifiable breast cancer risk factors.

Service staff were highly supportive of Health4Her as part of routine care, and were excited about playing a role in prevention. They also called for a self-completed version, to be viable for implementation in practice.

LATEST RESEARCH

During the latest stage, a self-completed version of Health4Her was co-designed with breast screening service consumers. Key goals were to further tailor the health information based on the latest evidence, and to co-produce interactive activities in order to increase engagement, improve information recall, and build upon the behaviour change techniques already incorporated.

We then conducted a second hybrid effectivenessimplementation trial with 143 women at Maroondah BreastScreen, where Health4Her was delivered via iPad.

We also conducted a pre-post pilot study, where 61 women accessed Health4Her offsite after their screening appointment using their own device. While the breast screening service still served as the mechanism and credible source for receiving the information, this approach allowed us to test a more easily scalable implementation strategy.

In addition to being effective in increasing women’s literacy regarding alcohol, inactivity and excess weight as modifiable breast cancer risk factors, the new version was also effective in reducing intentions to drink alcohol, and increasing intentions to be more physically active. Similar results were found for women in the pilot study accessing the intervention post-screening. These findings are important, as change in behavioural intentions is a key step in the behaviour change process. We also observed a significant decrease in drinking frequency among women participating in the pilot study.

Both participants and staff provided positive feedback about the new post-screening implementation strategy, and staff suggested adaptations to maintain the efficiency of breast screening services for future implementation (e.g. integration with the program-wide client information system, using an opt-out implementation approach).

NEXT STEPS

Our next steps are to broaden consumer co-design with a focus on health inequity groups, conduct a large trial powered to detect effects on alcohol consumption, and optimise the implementation strategy through ongoing collaboration with expert stakeholders. This will support wide-scale implementation, to promote breast health preventative behaviours among this large population who are not otherwise systematically receiving information and support to reduce their risk of breast cancer.

Authors: Dr Jasmin Grigg leads the Health4Her program of research. She is a Senior Research Fellow in Addiction Studies at Monash University and Turning Point, a leading Australian addiction treatment, research and education centre.

Professor Dan Lubman AM is Director of Turning Point and a Professor of Addiction Studies and Services at Monash University. Dr Darren Lockie is Clinical Director of BreastScreen Services at the Eastern Health Breast and Cancer Centre, and Chief Radiologist at Maroondah BreastScreen. Research Team: In addition to the Authors, Professor Robin Bell (Monash University), Ms Michelle Giles (Eastern Health), Dr Alex Waddell (Monash University), Dr Christopher Greenwood (Deakin University), Ms Peta Stragalinos (Eastern Health), Ms Charlotte Sutton (Eastern Health), Professor Patrick Olivier (Monash University), and Professor Victoria Manning (Monash University).

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

BRAIN BITES TAKES THE STRAIN OUT

OF THE KITCHEN

FOR THE NEUROLOGICAL COMMUNITY

Maintaining a healthy diet is crucial for people with neurological conditions or those at risk for them.

Research shows that diets like the Mediterranean and MIND (“Mediterranean-DASH Intervention for Neurodegenerative Delay) diets may help delay neurological diseases such as Parkinson’s and Alzheimer’s and lower the risk of having a stroke.

The MIND diet combines the Mediterranean and DASH diet to create a dietary pattern that focuses specifically on brain health incorporating leafy greens, berries, nuts, whole grains, fish, and olive oil, while cutting down on foods with lots of unhealthy fats.

BARRIERS TO LIFE CHANGING DIETS

Despite the potential benefits, implementing these diets in clinical trials presents unique challenges. People with neurological conditions often face numerous health and social obstacles that go beyond dietary behaviours alone. Cognitive impairments make it difficult to plan meals, follow recipes or remember cooking steps, while mobility issues complicate tasks like using utensils and preparing ingredients in the kitchen.

Furthermore, sensory challenges, such as poor temperature detection, increase the risk of burns

The Brain Bites Research Team with collaborators and participants during cooking simulation days at Edith Cowan University, Perth, Western Australia.

while apathy reduces the motivation to cook. Fatigue also compounds these challenges, making meal conceptualisation, preparation and execution overwhelming.

Grocery shopping can also be difficult, often requiring assistance with transportation and help navigating stores. Crowded spaces, bright lights, loud noises and trouble finding ingredients can be overwhelming, leading many to rely on less nutritious, pre-packaged foods and takeaways, affecting their health and well-being.

BRAIN BITES, MEETING THE NEED

Meal boxes offer a convenient way to support healthy eating by providing pre-portioned ingredients and simple recipes delivered to the door, eliminating store trips and ensuring access to fresh food. These boxes can be tailored to meet the dietary and disability needs of the neurological community, aligning with dietary recommendations and addressing specific challenges. The Brain Bites initiative emerged from consultations with people with lived experience to fill a major gap by creating a tailored meal box solution for individuals with neurological conditions.

Two co-design workshops were conducted to develop Brain Bites. The first, held in person at Edith Cowan University (ECU) in Perth, engaged people with lived experience of neurological conditions who shared their insights through sketches, sticky notes and whiteboard contributions.

The second workshop, conducted online, included a wide range of industry experts such as occupational therapists, speech pathologists, dietitians, neuroscientists, chefs, meal box companies, public nutritionists and not-for-profit representatives.

Stakeholders consistently expressed surprise that no tailored meal box solution for the neurological community exists, highlighting a clear need.

Dr. Travis Cruickshank and Dr. Jo Rees, working out of the Centre for Precision Health, Edith Cowan University, Perth, Australia, led a collaborative effort with neuroscientists, dietitians, public nutritionists, people with lived experience, not-for-profit organisations, and industry partners, including You Plate It, a local Western Australian meal box provider. This diverse group focused on developing the prototype and conducting a feasibility study.

A key contributor was recent MasterChef contestant Lachlan Whittle, who is a Huntington’s disease (HD) advocate and Brain Bites ambassador, combining his culinary skills with his personal experience to guide the project’s direction.

The team worked with Huntington’s Australia to tackle the unique challenges of HD, such as malnutrition and weight loss.

The project also engaged Kings Park Warriors and Beyond ABI, not-for-profits dedicated to supporting individuals with acquired brain injury, who face cognitive, sensory and motivational barriers when returning to cooking.

Together, these partnerships aimed to create a transformative solution that enhances daily nutrition and independence.

The Brain Bites team recently completed two feasibility trials that explored the safety and acceptability of the meal boxes, capturing key data such as how easy it was to receive, unpack, follow recipe instructions, prepare and cook.

The trials involved people living with HD and individuals with acquired brain injury (ABI). Both commenced with a simulation event held at ECU to enable optimisation of the meal box and were a critical step in assessing the safety and acceptability of meal boxes for the neurological community.

The team will utilise this feedback and the real-world outcomes to lay the groundwork to optimise the meal box and prepare for larger-scale clinical trials.

While promoting healthy eating is one of the goals, the central focus is to help individuals stay cooking in the kitchen for longer, or to return to cooking.

Cooking is strongly linked to self-worth and independence, while the inability to prepare meals often leads to supportive care or nursing home placement. The team believes the meal box solution can preserve or restore cooking abilities, potentially altering the course of neurological conditions and improving quality of life.

Engagement with industry partner You Plate It ensures rapid translation if proven safe and effective, a rare outcome in such initiatives.

Authors: Dr Travis Cruickshank is a senior research fellow within the Centre for Precision Health at Edith Cowan University who specialises in the design, delivery and evaluation of nonpharmaceutical treatment strategies for people living with neurological conditions.

Dr Jo Rees is an early career researcher and accredited dietitian within the Centre for Precision Health at Edith Cowan University, who specialises in delivery and evaluation of dietary interventions and supplements for clinical populations.

Research Team: Prof Simon Laws, Prof Amanda Devine, Ms Melanie Clark, Ms Mel Jolly, Dr Ros Sambell, Mr Lachlan Whittle, Mr Paul Baumgartner, Mrs Miffy Durham, Ms Shenane Hogg, Mr Cam Briscoe, Mr Gregg Oughton, Mrs Lenni Duffield

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

AI AND A HYPERPERSONALISED PHYSICAL ACTIVITY ASSISTANT

Professor Corneel Vandelanotte

By harnessing the power of artificial intelligence and machine learning, we’ve developed a digital assistant that uses real-time data and feedback loops to help people stay physically active, adapting to users’ needs at the right time and in the right way—a next-gen approach to prevention.

A NEW WAY FORWARD IN PHYSICAL ACTIVITY AND HEALTH

One of the best, easiest, and most affordable ways to improve health is to be physically active. Regular activity helps prevent cardiovascular disease, diabetes, some cancers, and can enhance mental health and quality of life. However, less than half of all Australians achieve the recommended 150 minutes of moderate-to-vigorous physical activity per week. This lack of physical activity contributes to higher health risks and rising healthcare costs. As such, there is a pressing need for scalable, affordable, and effective intervention approaches that can reach large numbers of people at low cost while remaining effective and make a meaningful health impact.

Face-to-face counselling by health professionals has proven effective, but it is not feasible or affordable at scale. Previous population-level interventions, such as those using phone, print, websites, or apps, are scalable but have shown only modest effects. This underscores the need for a radically new approach. Artificial intelligence (AI) and machine learning (ML) offer a promising avenue.

The complex and dynamic nature of physical activity behaviour requires highly personalised support that can be delivered at the right time, essentially creating a “just-in-time” adaptive digital assistant. Improvements in accessibility for ML applications now make it possible to develop systems that meet these needs. Thanks to funding from the NHMRC, Heart Foundation, and ARC, we have created a next-gen data-driven intervention designed to increase physical activity.

PRIVACY, TIMING, AND TONE

Before beginning software development, we conducted focus groups and co-creation workshops to shape our intervention’s design. Participants expressed interest in receiving notifications from a digital assistant but had differing preferences about the frequency, timing, tone, and content. They also wanted the assistant’s personality and appearance to be customisable. While participants were open to providing data for personalisation, they varied widely in how much information they were willing to share. Privacy considerations aside, people embraced the idea of using ML in exchange for a more functional and personalized activity assistant. This input made it clear that users want extensive personalisation and customisation options, though this added to the complexity and cost of developing the application.

Our digital assistant, now being tested in a randomised controlled trial, leverages ML in three key components:

1. Educational Conversations: We developed a series of interactive and educational “conversations” to help participants learn about physical activity and how to stay active. These cover topics such as developing habits, boosting self-confidence, and overcoming barriers. Using Natural Language Processing (NLP), the assistant tailors conversations based on each participant’s pre-existing knowledge and activity level. NLP algorithms understand freely written/spoken language, allowing for more natural human–computer interactions.

2. Nudge Engine: Based on nudge theory, this component delivers smartphone notifications to encourage activity by providing the right cue-toaction at the right time. Using a reinforcement learning technique (i.e., contextual bandit approach), the engine personalises the timing, frequency, context, and content of these nudges based on realtime feedback from activity trackers like Fitbit. The algorithms adapt based on what increases each user’s physical activity, reinforcing effective nudges and phasing out less effective ones.

3. Large Language Model: We integrated Google’s Gemini language model to provide coherent and relevant answers to any physical activity related questions users may have (e.g., “How can I stay active with a broken leg?”). Additionally, adaptive goal-setting and action-planning features support participants in with personalised daily and weekly activity goals, and the app links to a range of resources such as YouTube exercise videos.

In summary, our project combines cutting-edge technology to create a new type of health behaviour intervention. By using real-time data and reinforcement learning, we deliver highly personalised prompts to increase physical activity, offering a behavioural equivalent to precision medicine.

Author: Professor Corneel Vandelanotte leads the Physical Activity Research Group and the 10,000 Steps program at Central Queensland University. His research focuses on populationbased health behaviour change, developing and implementing innovative physical activity interventions using websites, apps, trackers, computer tailoring, and machine learning.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

EXERCISE – NO LONGER THE ‘POOR COUSIN’ OF OSTEOPOROSIS

THERAPY

“I came here for my bones, but I stay for everything else.”

–

Patient, The Bone Clinic

Prof Belinda Beck with a LIFTMOR participant at Griffith University, Gold Coast. LIFTMOR was the foundation clinical trial for the development of the ONERO™ exercise program.

Osteopenia (low bone mass) and osteoporosis (very low bone mass) occur most commonly in later life due to a tendency to lose bone as we age.

Both conditions greatly increase the risk of fracture from smaller impacts than would normally break a bone (hence the term ‘minimal trauma fracture; MTF). This can include a fall from standing height, lifting a grandchild, or even, in severe cases, rolling over in bed. Problematically, risk of falling also increases steeply as we age, compounding the increased risk of fracture due to low bone mass.

The prevalence of osteoporosis is staggering. Just in Australia, over two thirds of people over 50 have poor bone health, incurring one fracture every three minutes in 2023. The total economic burden of those fractures to taxpayers was almost $5 billion. The personal burden is even more troubling. In addition to increased mortality, pain and incapacity can reduce quality of life to the extent they prohibit independent living, thereby bringing about the move to aged care. Standard osteoporosis treatment is focussed on medicine, but bone medications are not always effective and can have unpleasant side effects, so most patients won’t take them.

Your bone mass is largely determined by your genes, but whether you achieve your genetic potential in youth and preserve it throughout life is strongly influenced by what you eat and how physically active you remain. Virtually any form of exercise applied consistently throughout life will prevent more bone loss than doing nothing at all, but to increase your bone mass, you must place loads on it that are greater than your everyday activities. When a person is at high risk of minimal trauma fracture, that sounds counter intuitive, but it is a principle that holds true for everyone, at every stage of life.

While traditionally, people with osteoporosis have been considered too frail to tolerate exertional exercise, in reality, there was no scientific evidence of either harm or benefit. Instead, countless clinical trials merely showed that gentle exercise (such as swimming, Pilates and Tai Chi) will not increase bone mass. Based on those findings, exercise was relegated to ancillary therapy for osteoporosis, at best. Conscious that animal trials had shown that exercise could increase bone if loads were sufficiently large, we undertook three human trials at Griffith University (LIFTMOR, LIFTMOR-M and MEDEXOP) to examine whether targeted high intensity resistance and impact training (HiRIT) could safely improve bone in people at risk of MTF when properly supervised. The answer was a resounding yes! Not only did HiRIT improve bone, but it reduced the risk of falls by notably improving physical function and balance. The next question was, could the program be safely implemented in the ‘real world’? To answer that question, we established The Bone Clinic.

We knew the key to safety and efficacy of HiRIT in a ‘real-world’ high-risk (and highly co-morbid) patient demographic would be expert supervision. The Bone Clinic is the first of its kind in the world – a translational research clinic established specifically to help people at risk of osteoporotic fracture through bone-targeted, supervised, exercise therapy (now called ONERO™). Clients receive bone density testing, health and functional assessment, dietary advice and ONERO™. Comprehensive, high-quality data is collected at every step of the client journey. Nine years and hundreds of clients later, those data show this highly targeted exercise indeed improves bone mass, muscle strength, physical function, balance, posture, and quality of life, reducing falls and fractures in the ‘real world’. As bone medications neither reduce falls, nor are appropriate for preventative therapy in healthy people, exercise is clearly no longer the ‘poor cousin’ of therapy for osteoporosis. In fact, our clinical trial, translational and implementation evidence has propelled it to the frontline of osteoporosis care.

We commonly hear, “I came here for my bones, but I stay for everything else”. Pleasingly, our data suggests that the benefits of ONERO™ are not confined to bone. It is wellestablished that resistance training can improve the health and capacity of most bodily systems, so it should come as no surprise that while people come to The Bone Clinic for their bones, they are further motivated to stay when they notice other benefits. Examples (with associated chronic conditions in brackets) include improvements in muscle strength, quality and function (sarcopenia, falls, frailty), metabolism (diabetes), blood pressure (cardiovascular disease) and mental health (depression, social isolation). Coupled with the sense of community and common purpose of group classes, this ‘bone-targeted’ intervention turns out to be something of a panacea for wellbeing so is highly appealing to many.

Online training is available to become a licensed ONERO™ practitioner so physiotherapists and clinical exercise physiologists around the world are now delivering it in their own clinics; thereby preventing osteoporotic fracture globally.

It is a true research-to-practice success story.

Author: Belinda Beck, PhD, is Professor of Exercise Science at Griffith University (Gold Coast campus) and Director of The Bone Clinic, Brisbane, QLD. She trained at University of Queensland, University of Oregon and Stanford University and has been undertaking research in the field of mechanical loading for bone health for 35 years.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

The Homer Hack Board of Directors.

THE HOMER HACK

The Homer Hack is a notfor-profit charity made up of a broad group of individuals who have a keen interest in the effects of Homer gene variants and other scaffolding genes on the day-to-day function of humans.

and carers. Our aim is to alleviate the challenge and isolation which families can otherwise experience when navigating rare disease and build evidence to inform the design of effective interventions.

The Homer Hack was born out of one family’s need for greater information when they were told that their son had a Homer gene variant. Before this information, the family had already navigated 14 years of misdiagnosis, multiple surgeries, invasive medical testing, repeated medical trauma, and incredible future uncertainty for their son. With this new information, the family invested in research to explore whether the Homer gene may have been causative in their son’s medical condition.

The mission of the Homer Hack is to raise awareness of and enable research and knowledge translation regarding the role of Homer and other scaffold genes in humans. Ultimately, the aim of the Homer Hack, as a charity is to ‘hack the Homer gene’ – that is, understand the role of the Homer gene in both human functioning and neurological conditions. Through awareness raising, education and evidence-building, the Homer Hack aims to improve outcomes for people living with Homer gene variants, their families

As evidence started to gather, it was clear that there was still little known about the family of Homer genes. There is however robust evidence about the important role that scaffold genes such as Homer play in human functioning, as well as Homer gene’s role in various neurological conditions.

As part of this family-led action, the Homer Hack was created to fund research to discover and translate knowledge, regarding how the Homer gene works and why it is important in human functioning. Our aim is that, with this knowledge, therapeutic interventions can be identified that lead to better outcomes for people living with Homer and other rare neurological scaffold gene variants. To enable this, since its inception, the Homer Hack has funded six research projects using a competitive grant round process. With its focus on both early career researchers and established national leaders in the field of neurosciences, investment in these projects aims to build evidence regarding the Homer family of genes, and bring these genes and their role in human functioning into focus for future collaborative research across institutions and within clinical trials.

To learn more about the role of the Homer family of genes on human functioning, watch this short video

For more information on The Homer Hack

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

AUSTRALIAN AND NEW ZEALAND UROGENITAL AND PROSTATE

The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group is one of Australia’s 14 Collaborative Clinical Trial Groups that brings together a world-leading multidisciplinary team of doctors, nurses, allied health care professionals, scientists, researchers, and community representatives, all working towards its mission of improving the lives of people affected by ‘Below the Belt’, bladder, kidney, testicular, penile, and prostate cancers through practice-changing multidisciplinary collaborative clinical trials.

ANZUP relies of the expertise of its 2,500 members, who are all dedicated to improving patient outcomes for over 35,000 Australians and 5,500 New Zealand people diagnosed with ‘Below the Belt’ cancers each year, that’s around 111 people every day! With support from the Federal Government via the Cancer Australia ‘Support for Cancer Clinical Trials Program’, ANZUP continues to work towards increasing the number of urogenital clinical trials in Australia to boost participation with focusses on addressing cancers of unmet clinical need and addressing disparities in outcome. There are currently 4 ANZUP trials open to recruitment, 15 in follow-up and 15 new trials in development. ANZUP also has a strong focus on translational research to further the understanding of the outcomes of its trials.

ANZUP major impacts include showing the effectiveness of hormonal treatment for prostate cancer which has contributed to the approval of Enzalutamide on the PBS for people diagnosed with prostate cancer, multiple trials that demonstrate

the benefits of the radio ligand therapy Lutetium PSMA alone or in combination with standard of care for advanced prostate cancer, and trials that have changed the way people with kidney, bladder, testicular and penile cancer are managed.

In their day-to-day work for ANZUP, members:

• Identify and present research opportunities via its ideas generation workshops, educational events and annual scientific meeting that will make a difference to the lives of their patients;

• Test their ideas through a pilot study to see whether this treatment or intervention has the potential to make the difference they believe it can;

• Conduct and report on small to large-scale impactful national clinical trials;

• Collaborate on international trials so there are far greater numbers of patients able to access the trial

• Promote the benefits of trials and their outcomes to the Australian and New Zealand community.

ANZUP continues to build on its impressive multidisciplinary membership while developing very strong relationships internationally and with other peak bodies such as the Prostate Cancer Foundation of Australia, Prostate Cancer Foundation of New Zealand, Cancer Councils, Movember, and other national cancer cooperative trials groups, COSA, as well as Government and industry to make an impact on the people who are affected by urogenital cancer.

Membership is free and open to anyone with an interest in urogenital research

The ANZUP team

SPINALCURE

Pioneering Advocacy, Research and a Cure for Spinal Cord Injury

It’s our anniversary! For 30 years SpinalCure has been advocating for and funding research to find a cure for spinal cord injury (SCI).

Back in 1994 there were many who doubted repairing a damaged spinal cord was possible at all. But today, as the late great Christopher Reeve said; “We live in a time when impossible and unsolvable are no longer a part of the scientific community’s vocabulary.”

And yes, progress is being made, but at times the journey towards a cure seems frustratingly slow. This is a symptom of two fundamental issues: The spinal cord is an unbelievably complicated system and curerelated spinal cord injury research has, sadly, been greatly underfunded in Australia.

SpinalCure works to address these issues.

SpinalCure is highly targeted with its research funding and is supported by an international Scientific Advisory Panel which helps select the very best scientists and avenues of research to ensure progress towards our goal.

Our current portfolio includes an industry collaboration to treat the inflammatory response and improve outcomes in acute injuries, and projects targeting neuron growth to repair the damaged spinal cord. It also includes basic research identifying new targets for testing and translation, and our flagship Project Spark—developing neurostimulation treatments to restore life changing levels of function in people with chronic injuries. Our impact is farreaching, with five clinical trials operating in five Australian states and four overseas sites.

SpinalCure is also leading the development of Australia’s first National Roadmap to a Cure. The Roadmap brings scientists, clinicians, industry, community and government together to determine and work towards agreed research priorities over the next five years. With the first treatments on the

horizon, the Roadmap will guide how we will address commercialisation challenges.

We know that our research is already changing lives. Lives like Sheree Palmer’s, a mother of two who was paralysed by a spinal embolism. After participating in our eWALK neurostimulation trial, Sheree relished the experience of walking again for the first time in 14 years. To learn more about Sheree’s story visit: https://bit.ly/40MLL7N

Despite this, more than 20,000 Australians continue to live with the devastating consequences of a spinal cord injury (SCI), which costs the Australian economy a staggering $3.7billion a year. Given the enormity of this cost, more funding from philanthropy and government is paramount. Because a cure for SCI is no longer a matter of if, or indeed a matter of when. It’s a matter of how much.

To find out more about SpinalCure, visit: www. spinalcure.org.au

Sheree Palmer during the eWALK neurostimulation trial.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL

THE LAST WORD

This edition of Inspire has focussed on the broad theme of prevention – showcasing a breadth of diversity in what preventative health means to our members.

One underlying theme has been on the nonmedical factors of what keeps us well, or unwell – such as the social determinants of health such as housing, income, education, employment, food security - or cultural determinants of health including access to health care on Country for First Nations peoples and communities; or commercial determinants of health, those conditions created by commercial actors that are responsible for ill health.

When it comes to the non-medical determining factors of health and wellbeing there is overwhelming evidence of the disproportionate impact and poorer health for some: First Nations communities; women and gender diverse; people with disability; those living in regional and remote locations. And for some, these are compounded leading to multiple layers of negative determinants and risk factors, including intersectional discrimination leading to experiences of intersecting racism, ableism, sexism across our health, and other systems (education, employment, justice), intensifying poorer health outcomes.

The health and medical research sector plays a critical role in responding to this disproportionate impact and in addressing more equitable health outcomes across Australia, and globally.

Central to all these approaches is the need to elevate the voices of those often marginalised, yet disproportionately impacted by health inequities. The MRFF’s Priorities 202426 include ‘consumer-driven research’ as a priority. The National Health Prevention Strategy also highlights the

importance of specific research partnerships with priority populations.

Yet how do we do this with what we often label as ‘hard to reach’ communities? How do we ensure the most marginalised, silenced or those not in the room are included and participate meaningfully in health and medical research? What can other disciplines share about participatory research methodologies, reciprocity and community engagement? It is incumbent on all of us as part of the health and medical research community to continue to find ways to elevate all voices, especially those we think are too hard to reach.

In this edition of Last Word, we wanted to offer space to those we don’t often hear from through showcasing some of our members who focus on prevention, social, cultural or commercial determinants of health, as well as being committed to elevating marginalised voices.

Research Australia had the privilege of hearing from these exceptional leaders during the November University Roundtable. Below are some snippets from the discussions.

THE VOICES OF CHILDREN

Professor Sharon Bessell is the Director of the Children’s Policy Centre and the Poverty and Inequality Research Centre and her research demonstrates the critical importance of incorporating children’s rights and participatory methods in the form of child centered research workshops.

“For people who’ve never done research with children, it’s often assumed that you can’t have a sensible conversation about the social determinants of health or the drivers of poverty with a six year old….I’d suggest that research with children that genuinely listens to them gives us a knowledge base that enriches our understanding of both social and commercial determinants and gives us greater evidence to complement what we already have, to be able to genuinely understand how we shift those social determinants.”

THE VOICES OF WOMEN AND GENDER DIVERSE POPULATIONS

Professor Robyn Norton’s work through the Centre for Sex and Gender Equity in Health and Medicine and the NHMRC and MRFF, has led to a recent statement mandating that researchers must include women and gender-diverse populations in their studies, with funding contingent on compliance.

She says “fundamentally it’s going to mean for universities and researchers that they really have to take into consideration ‘have they included women and gender diverse populations in their research? Are they accounting for sex and gender in the research that they do?’ Because if they don’t, then their research will not be funded and their research will not be published. This is not just an issue though for researchers in Australia. This is a worldwide change in the way in which we must do research.”

THE VOICES OF FIRST AUSTRALIANS

Ms Fiona Cornforth, Head of Yardhura Walani, at the National Centre for Epidemiology and Population Health has a primary mission to strengthen the health and wellbeing of Aboriginal and Torres Strait Islander communities.

Professor Sharon Bessell, is the Director of the Children’s Policy Centre and the Poverty and Inequality Research Centre at Crawford School of Public Policy, at the Australian National University. Professor Bessell is currently leading a transformative research program focussing on the development of a child-centered framework for assessing multidimensional child poverty: More for Children

Professor Robyn Norton AO, is the Founding Director of The George Institute for Global Health and co-established The George Institute’s Global Women’s Health Program in 2018 and more recently the Centre for Sex and Gender Equity in Health and Medicine, a partnership with the Australian Human Rights Institute at UNSW and Deakin University. Professor Norton is Professor of Public Health at UNSW Sydney and Emeritus Professor of Global Health at Imperial College London.

In her words, “there’s very little we do that’s outside of a community partner giving us the say so or directing that we prioritise their research…. a number of big projects nationally on quantitative and qualitative research. We create impact at systems level, producing evidence that informs national and international level policy and services. But it goes right through to community level impact as well on programs and services. So we really do demonstrate how community priorities do serve the nation.”

THE VOICES OF PEOPLE WITH DISABILITY

Professor Anne Kavanagh is a social epidemiologist and international leader in health inequalities research and motivated by her own lived experience, Professor Kavanagh’s work focuses on understanding how social determinants impact health outcomes for individuals with disabilities. She says “people who have family members with disability or have disability themselves will understand the ways in which disadvantage plays out so profoundly in disabled people’s lives for a variety of reasons. Discrimination, not being able to participate in the workforce, all sorts of negative assumptions, community attitudes, poor housing….”

Ms Fiona Cornforth is Head of Yardhura Walani, at the National Centre for Epidemiology and Population Health, ANU. Fiona is of the Wuthathi peoples of the far north-east cape of Queensland with family roots also in Zenadth

Kes (the Torres Strait Islands). Under Fiona’s leadership, Yardhura Walani’s drives its primary through conducting high quality health and wellbeing research of local, national and international significance led by the priorities of communities, offering programs of training and education, for community, policy makers, and at under and post graduate levels.

Professor Anne Kavanagh is a social epidemiologist and international leader in health inequalities research. She is the inaugural Chair of Disability and Health and Head of the Disability and Health Unit in the Centre for Health Equity, Melbourne School of Population and Global Health. Collaborating with advocates, governments, and communities, Professor Kavanagh promotes the critical importance of lived experience in providing invaluable insights that can shape research questions and methodologies, decision making processes, and ensuring they are relevant and grounded in real-world contexts.

Author: Dr Talia Avrahamzon is Research Australia’s Head of Policy and Advocacy with extensive experience in strategic public policy, research, program development, implementation and evaluation.

CHRISTOPHE KEREBEL

CHRISTOPHE KEREBEL