Evaluation of NCD risks, NCDs and NCD monitoring frameworks in Australia and Indonesia

Non-communicable diseases (NCDs) are now the leading cause of death and disability in Australia and Indonesia. Globally, up to 60-70 per cent of deaths are caused by largely preventable diseases. NCDs represent a complex group of conditions that share the characteristics of chronicity and non-transmissibility; many are associated with significant stigma and are determined, to varying degrees, by living conditions and behaviours. Many NCDs are preventable through modification of risks and exposures in early life – for example, poor diet and tobacco smoking – and early detection and treatment of health risks such as hypertension, overweight and obesity.

Health policy in both Australia and Indonesia has included a focus on NCD (to varying degrees), however this has been predominantly focused on conditions arising during adulthood; we increasingly understand that NCDs impact across the whole life-course. NCDs that emerge in childhood and adolescence provide a particularly important target for intervention, as this can improve the health of young people now, their health as adults, and the health of the next generation. Strategies to reduce NCDs have been hampered by an inadequate definition of NCD. We now understand that NCDs extend beyond cardiovascular disease, stroke, diabetes and cancer (the typical focus of policy) to include other important conditions such as mental disorder.

The quality and availability of national health data on NCDs varies in both Australia and Indonesia. There are a range of agencies with valuable data collections, such as the Ministry of Health’s RISKESDAS in Indonesia and National Health Survey from the Australian Bureau of Statistics. However, significant gaps exist in the frequency of data collection, the methodology employed, and the outcomes, risks, and determinants which are reported on. A reporting framework is generally defined as a group of indicators brought together to describe the status of a given population. A strong reporting framework accompanied by well-defined indicators provides the basis of accountability for NCDs in Australia and Indonesia.

The overarching aim of this project is to define a comprehensive reporting framework for NCDs in Australia that builds on those currently in use.

The specific objectives are to:

• Define a reporting framework for NCD outcomes, risks and determinants that is of specific public health and policy relevance to Australia and Indonesia, separately;
• Map data, assess the quality of currently collected data, and define clear indicators to apply to the reporting framework;
• Analyse the available data to describe a profile of NCD and its risks for Australia and Indonesia;
• In Australia: Consider what a NCD reporting framework for Aboriginal and Torres Strait Islander Australians might include; and
• In Indonesia: Consider sub-national variation in key NCDs.

The research developed a reporting framework for NCD outcomes, risks and determinants. The reporting framework was defined using a modified priority setting approach. For key age-groups across the life, the team defined the key NCD outcomes and risks by considering public health relevance and policy relevance. For NCD determinants we used the Commission on Social Determinants of Health (Closing the Gap in a generation) to consider key determinants, and additionally consulted a broad range of stakeholders and reviewed current data collection systems. By exploring the NCD framework could be populated by sound, nationally representative, data the research was able to come to the findings that;

• NCDs extend beyond cardiovascular disease, diabetes, cancer and chronic respiratory disease (the traditional focus of policy). Reporting of NCDs in both Australia and Indonesia should include a focus on musculoskeletal disorders, poor mental health, neurological disease (including dementia), chronic skin conditions, vision and hearing defects, endocrine disorders and gynaecological conditions, given these all contribute to the burden of disease in both countries and are all to some degree preventable. Key to prevention in both countries is a measure of risk factors and determinants.
• NCDs occur across the life-course and not just in adulthood. NCDs that emerge in childhood and adolescence provide a particularly important target for intervention as this can improve the health of young people now, their health as adults, and the health of the next generation.
• Current data systems in Australia and Indonesia measure some, but not all, relevant NCDs, and do so across differing age groups. There is a need to continue to invest in objective measures, and extend this across the life-course in both countries. One area of strength in Australia, our cancer registry, could be an area of improvement for Indonesia. Inter-country collaboration to improve data collection methods for cancer in Indonesian could be an opportunity to extend data collection on key NCDs.
• Indigenous Australians have a distinct profile of NCD – in general, NCDs occur earlier in the life-course and to a greater severity. There is a distinct policy context, and unique opportunities for response. As such, a distinct NCD reporting framework is required.
• NCDs vary sub-nationally in Indonesia. Geographic health inequity across the archipelago requires regular monitoring in order to take advantage of unique opportunities to elicit change.

Outputs

• You can’t fight an enemy you can’t see: improving data on NCDs
• Australia country report
• Australia summary report
• Indonesia country report
• Indonesia summary report
• Indonesian version of Indonesia summary report

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