What will it take to improve prevention of chronic diseases in Australia? A case study of two national approaches.

Objective Despite being a healthy country by international standards, Australia has a growing and serious burden from chronic diseases. There have been several national efforts to tackle this problem, but despite some important advances much more needs to be done. From the viewpoint of diverse stakeholders, the present study examined two approaches to controlling chronic disease in Australia: (1) the 2005 National Chronic Disease Strategy (NCDS); and (2) the 2008 National Partnership Agreement on Preventive Health (NPAPH). Methods Individual and small group semistructured interviews were undertaken with 29 leaders across Australia, reflecting a diverse cross-section of senior public health managers and program implementation staff from state and territory health departments, as well as academics, thought leaders and public health advocates. A grounded theory approach was used to generate themes relevant to the research. Results There is general support for national approaches to the prevention of chronic disease. The NCDS was viewed as necessary and useful for national coordination, setting a common agenda and serving as an anchor to align jurisdictional priorities and action. However, without funding or other infrastructure commitments or implementation plans, any expectations as to what could be meaningfully achieved were limited. In contrast, although jurisdictions welcomed the NPAPH, its associated funding and the opportunity to tailor strategy to their unique needs and populations, there were calls for greater national leadership as well as guidance on the evidence base to inform decision making. Key aspects of successful national action were strong Australian Government leadership and coordination, setting a common agenda, national alignment on priorities, evidence-informed implementation strategies, partnerships within and across governments, as well as with other sectors, and funding and infrastructure to support implementation. Conclusions Both the NCDS and NPAPH were seen to have overlapping strengths and weaknesses. A key need identified was for future approaches to focus on generating more sustainable, system-wide change. What is known about the topic? Despite some important advances, chronic diseases remain Australia's greatest health challenge. In efforts to tackle this increasing burden from chronic diseases, several large-scale, national initiatives have been released in Australia over recent years, including the 2005 NCDS and the 2008 NPAPH. What does this paper add? From the viewpoint of practitioners, policy makers, advocates, researchers and public health thought leaders, this paper examines the usefulness and significance of the NCDS and NPAPH as national initiatives for achieving improvements to the prevention of chronic disease. What are the implications for practitioners? By better understanding how previous countrywide chronic disease initiatives were viewed and used at national, state and local levels, this research is well placed to inform current, planned and future large-scale, population-level health initiatives.