Sustaining action for NCD prevention at the population scale

Dr Melanie Crane delivered this presentation at the Public Health Association of Australia’s (PHAA’s) annual prevention conference in Brisbane, 11-13 May 2022.

Multiple factors have been found to influence the sustainability of health interventions. Yet what we know is derived from mainly small-scale interventions on studies which have been implemented for no more than a few years. This is very limited and may be inapplicable to sustaining population health interventions which require the whole health system; and for investing in longer-term population health improvements.

These two studies provide valuable systems thinking insights sustaining population health interventions in Australia including the influence of macro/external environment factors such as pollical priorities and funding structures and the agility of programs and their management to adapt to external forces:

1. qualitative interviews with key population health managers and policymakers making decisions at the local, state or national-scale in government and non-government organisations to understand perspective;
2. quantitative data on theoretical factors influencing sustainability from publicly available websites of NCD prevention interventions.

From 14 stakeholder interviews we identified four key barriers for sustainment:

1. short-term political and funding cycles;
2. competing public priorities within health and broader public agenda;
3. silo thinking within health service delivery;
4. the fit of the program to population needs.

Various approaches to overcome barriers included long-term planning, flexible program design/management, leadership and partnerships, evidence generation, and system support structures.

From a search of interventions on lifestyle modifiable risk factors for NCDs we identified 90 international interventions (in English) which had been sustained 4-37 years (mean 14.7 years). Those sustained longer (>mean) were mainly North American, and behavioural interventions composed of face-to-face or digital interactive resources. These interventions had generally undergone some modification from their original and a greater proportion were commercially, or government funded, and fewer were delivered through partnerships or community involvement.