THEO MURPHY (AUSTRALIA) HIGH FLYERS THINK TANK

Preventative health: Science and technology in the prevention and early detection of disease

University of Sydney (Eastern Avenue Complex), Thursday 6 November 2008

Executive summary

The Australian Academy of Science High Flyers Think Tank on preventative health – the first to be supported by The Royal Society – the national academy of science of the UK and the Commonwealth – through the Theo Murphy (Australia) Fund, was held in Sydney on 6 November 2008. It brought together recognised health care and health research experts as speakers and discussion leaders, with approximately 90 early- and mid-career researchers nominated by their organisations for their promise as future leaders. Their task was to consider how science and technology applications can contribute to improving the health of Australians through disease prevention by identifying gaps in knowledge and potential solutions.

The Think Tank coincided with concerns in Australia and in many other countries about significant increases in illnesses such as cancer, metabolic syndrome (including diabetes and heart disease), mental health (particularly anxiety and depression), and infectious diseases. Modern lifestyles are contributing to obesity and its associated medical problems in adults and children, and the comparatively poorer health of indigenous populations and people in isolated communities is a major issue. Preventative initiatives are the key to improving both the physical and mental health of growing populations while reducing the escalating cost of healthcare.

These health concerns have prompted a number of initiatives by the Australian Government, with two of the most prominent being the establishment of the National Preventative Health Taskforce[1] and the development of a National Primary Health Care Strategy[2]. The Taskforce's role is to provide evidence-based advice to governments and health providers on preventative health programs and strategies with an initial focus on the burden of chronic disease caused by obesity, tobacco and the excessive consumption of alcohol. The findings of this Think Tank are intended to be of value to both policy developers and decision makers in establishing priority areas for future interventions.

The major focus of the Think Tank was the discussions stimulated by a series of presentations by leading researchers in cancer, mental health, metabolic syndrome and infectious diseases. Each provided his or her perspective on the extent to which research in basic biological sciences (including genomics, proteomics, metabolomics and bioinformatics), genetic susceptibility to disease (including the effects of environmental exposure and human behaviours), disease screening and early diagnosis, and specific interventions (including vaccination and drug therapies) currently apply or could be applied to the prevention or reduction of the consequences of cancer, mental health, metabolic syndrome or infectious diseases.

Participants then divided into breakout groups to consider the application of these science applications in reducing the incidence or consequences of illness in each of the four target health areas. A summary of the presentations and breakout group discussions are provided in this report, as well as introductory comments by Professor Paul Zimmet, a member of the Taskforce's Obesity Working Group, and Professor Chris Goodnow, director of the Australian Phenomics Facility. The report concludes with overviews prepared by Professor Mike Daube, Taskforce deputy chair, and Think Tank co-convenor Professor John Chalmers.

The Think Tank outcomes provide strategies and recommendations to help address the preventative health challenges arising from the diseases under consideration. However, the discussion also identified that a number are relevant to all or most of these illnesses, as well as other areas identified as national health priorities.

Recommendations

1. Undertake a national health survey every five years to enable disease and risk factor trends to be analysed and monitored. Australia is currently behind some poorer developing countries in collecting this type of data.

2. Following the Preventative Health Taskforce's phase 1 report in June 2009 – which will focus on obesity, tobacco and alcohol – other areas which might be adopted for its next phase include child health, mental health and infectious disease. There should be strong overlaps between these new initiatives and the earlier work of the Taskforce.

3. While acknowledging potential barriers such as complex IT infrastructures and privacy considerations, hospital and institutional data bases should increasingly be linked and data sets integrated, to assist researchers in identifying health risks. In turn, these data sets could be linked with Medicare and Pharmaceutical Benefits Scheme data as well as national mortality and morbidity registers. Universal patient identifiers and increased attention to support hospital-based researchers should be recognised as critical to successful outcomes. Governments should adopt and support a culture of integrating research to improve current and future outcomes.

4. Establish a national biological repository of tissue samples with prior consent of patients to enable future research applications. While there are many biobanks and tissue banks in Australia, these are generally small, under-resourced and not well linked to each other. The NHMRC might take a leadership role in fostering development of such a national repository.

5. Improve linkages between funding bodies – such as the ARC and NHMRC – to facilitate the integration of human health and relevant animal studies.

6. Reduce excessive reporting requirements beyond those expressed in the NHMRC National Statement on Ethical Conduct in Human Research, and multiple ethical clearances, which together act as significant barriers both to research programs and the integration of researchers into multi-centre, multidisciplinary teams.

7. Strengthen and expand the role of the National Preventative Health Taskforce by requiring inputs and accountability from a range of relevant federal and state agencies, including those responsible for water, food and the environment, that are essential for a holistic approach to public health. Such strategies need to address gaps in the treatment of disadvantaged, indigenous Australians and other minority groups. This will necessitate broad investment in education – such as in cancer predisposition and healthy lifestyle choices – at every level, and funding preventative strategies that not only have a strong evidence base but are also likely to impact on a broad range of physical and mental health outcomes.

1. www.preventativehealth.org.au/

2. www.health.gov.au/internet/main/publishing.nsf/Content/PHS-DiscussionPaper