Training group leaders how to include people with chronic disease in community activities

Abbott S; Vassallo A et al.(2010) Centre for Clinical Governance Research in Health, University of New South Wales and the Centre for Health Stewardship, Australian National University, College of Medicine Biology and Environment

The purpose of this package is to help support the inclusion of people with chronic disease in community activities in a local area. It contains information and resources to help plan, deliver and evaluate educational activities within a local community. The first section details the aim, rationale and background for the development of this package. The overall aim of this package is to educate community group leaders about chronic disease issues. Community leaders equipped with such knowledge will be better able to support people with chronic disease to manage their conditions while encouraging their participation in community group activities.

Life is health is life: Taking action to close the gap: Victorian Aboriginal evidence-based health promotion resource

Life is health is life by the Victorian Government, Department of Health and the Victorian Health Promotion Foundation, provides information and guidance for action to improve the health and life expectancy of Aboriginal Victorians.

It brings together stories of promising health promotion practice from across Victoria and a review of the scientific literature. It provides the evidence for effective interventions that can be used in health promotion planning.

This resource is designed for people who work in community and women's health services, Aboriginal community controlled health services and local government. It will also be useful to others who are working to close the gap.

Diabetes prevalence in Australia: detailed estimates (AIHW)

This report presents the most up-to-date estimates of the number of people with diagnosed diabetes in Australia based on self-reports to the Australian Bureau of Statistics' 2007-08 National Health Survey. The number of people with diabetes is presented by diabetes type, age, sex, state of usual residence and remoteness.

New guide to help parents talk to their children about sex

Parents seeking guidance and understanding about how best to share their values and educate their children about sexuality will benefit from a unique resource released by WA Health. Talk Soon. Talk Often. A guide for parents talking to their kids about sex outlines how parents can initiate regular and relaxed conversations about sexuality and relationships.

Chief Health Officer Dr Tarun Weeramanthri said the resource was developed after independent research identified a clear need among WA parents for support and advice on how to discuss sexuality with their children from a young age through adolescence. It also offers support for parents in helping their children understand the public nature of digitally transferred information such as Facebook, sex and the law, preventing child sexual abuse, and how to discuss their beliefs about pornography.

Mental ills based in community

COMMUNITY-BASED mental health care is set to be the main plank in the NSW Government's mental health policy. This is the message NSW Mental Health Minister Kevin Humphries brought with him to the weekend's Rural Mental Health Conference at Opal Cove.

Health effect of wind turbines

ABC Local; Margaret Burin
A Senate committee investigating the effects of wind farms on health has found some people living near turbines have suffered ill effects. But the committee, which received more than 1,000 submissions, also says there is no conclusive link. It handed down seven recommendations to the Federal Government, including commissioning more research and installing an independent arbitrator to deal with complaints.


ABC News coverage

Expenditure on health for Aboriginal and Torres Strait Islander people 2008-09 (AIHW)

In 2008-09, total health expenditure for Aboriginal and Torres Strait Islander people was estimated at $3,700 million. The average health expenditure per person for Indigenous Australians was $6,787, compared with $4,876 for each non-Indigenous Australian. Correspondingly, the Indigenous to non-Indigenous per person health expenditure ratio was 1.39.

This report, the sixth in the series, again shows that Indigenous Australians are more likely than non-Indigenous Australians to rely on public hospital services. In 2008-09, per person expenditure on public hospital services for Indigenous Australians was more than double that for non-Indigenous Australians - an expenditure ratio of 2.25.

Media release

Commentary :Playing number games with Indigenous Australians' health

Diabetes and poor mental health and wellbeing: an exploratory analysis (AIHW)

Diabetes and poor mental health and wellbeing are both common health conditions in Australia and contribute substantially to the overall burden of disease. A large proportion of people with diabetes are also living with poor mental health and wellbeing, with 41.6% of adult Australians with diabetes also reporting medium, high or very high levels of psychological distress. Australians with diabetes are significantly more likely than other Australians to have poor mental health and wellbeing.

Media release

The 45 and Up Study

We all want to live healthier and more fulfilling lives for as long as possible and we all want this for our children, grandchildren and others.

The 45 and Up Study is the largest study of healthy ageing ever undertaken in the Southern Hemisphere. Over 265,000 men and women aged 45 and over across NSW have been recruited (about 10% of this age group) and will have their health followed over the coming decades.

Information collected through the 45 and Up Study will be used by policy agencies and by researchers to help gain a better understanding of how to prevent and provide the best possible health care for common health conditions such as cancer, cardiovascular disease, arthritis, depression, Alzheimer's disease and diabetes.

Aboriginal injury prevention projects

The NSW Department of Health is establishing a four year program to provide grants to fund and evaluate demonstration projects that aim to prevent injury among Aboriginal people as part of the NSW implementation plan for the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes. NSW Health has engaged the Sax Institute to assist in designing and implementing this project. The Sax Institute will consult with a Reference Group and Aboriginal communities to set priorities.

This is one of three reviews subsequently commissioned to inform the program. It reviews peer-review and grey literature evaluations of the effectiveness of Australian Indigenous initiatives published 1995-2010 to answer the following questions with specific terms of reference provided:

What are the most effective strategies/projects/programs that have been implemented for the prevention of injury amongst Aboriginal populations?
What types and causes of injury have successfully been addressed by these strategies?
What types and causes of injury have not been successfully addressed (or addressed at all) by these strategies?
What are elements that contribute to success or failure in such strategies?

Working with Indigenous children, families, and communities: lessons from practice

Planning and delivering services to Aboriginal and Torres Strait Islander children, families, and communities can be a complex task for practitioners and policy-makers. Social problems are often deeply entrenched, and need to be approached with consideration of historical, social, community, family and individual factors. Furthermore, as Australian Indigenous cultures are not homogenous, Indigenous communities can differ considerably. Indigenous communities often have characteristics specific to geographic location, with significant variation evident across urban, rural, and remote communities.

Methods that child and family services can use to support Indigenous families and communities include:

* working with (rather than working "on") Indigenous communities;
* ensuring your service is culturally competent;
* focusing on attracting and retaining the right staff;

* cultivating networks and relationships;
*adopting an action research approach.

Many Indigenous families and communities in contemporary Australia face immense challenges. Their strength and resilience is compromised by multiple complex problems, including historical and ongoing dispossession, marginalisation, and racism, as well as the legacy of past policies of forced removal and cultural assimilation (Human Rights and Equal Opportunity Commission, 1997). These issues contribute to the high levels of poverty, unemployment, violence, and substance abuse seen in many Indigenous communities. They also impact negatively on Indigenous children, who demonstrate poor health, educational, and social outcomes when compared to non-Indigenous children (Australian Institute of Health and Welfare, 2009).

Review of efficiency measurement methodologies to inform hospital resource allocations in NSW

The Centre for Efficiency and Productivity Analysis conducted this review to identify efficiency modelling methodologies and data considerations relevant to Australia and of use to NSW Health and the Independent Hospital Pricing Authority in driving decisions about hospital resource allocation.Key findings include:

• Measures of efficiency relevant to health funding and price benchmarking decisions include cost efficiency, input-oriented technical efficiency and cost-allocative efficiency.

• There are two main efficiency modelling techniques to estimate the production technology: stochastic frontier analysis and data envelopment analysis.

• There were more than 100 applications of stochastic frontier analysis and data envelopment analysis modelling techniques to hospital data. The most comprehensive and relevant applications were conducted by the Productivity Commission in 2009 and 2010. The Commission found that, on average, Australian hospitals can potentially reduce inputs by 10% and still produce the same quantities and types of outputs.

• The Commission identified a number of data problems that will limit the use of efficiency modelling techniques (and any other technique) in informing hospital funding and price benchmarking decisions. These include: a lack of consistent data on capital costs (especially for public hospitals); the medical costs of doctors exercising their rights of practice in public hospitals; staffed beds in public and private hospitals; and measures of quality (including rates of hospital-acquired infections).

Chronic Disease Guidelines

The rise in the burden of chronic diseases has important implications for health systems in Australia and around the world. Chronic disease is estimated to be responsible for more than 80% of the burden of disease and injury suffered by Australians. Integral to the effective management of chronic disease is the availability of appropriate, quality services and tools. The evidence suggests an approach that includes primary health care health service re-orientation to chronic disease management, use of patient information recall systems, as well as evidence based guidelines and protocols.

The Chronic Disease Guidelines 3rd edition 2010 have been developed to guide health practitioners in providing best practice prevention, early detection and management of chronic disease with a standardised set of tools and information. This 3rd edition is a synthesis of contemporary evidence-based principles and practices and has been developed collaboratively with input from a range of clinical experts and clinical networks from Queensland Health, the Royal Flying Doctor Service and Apunipima-Cape York Health Council.

End-stage kidney disease in Australia: total incidence, 2003-2007 (AIHW)

The incidence of end-stage kidney disease is an important indicator of the health of the Australian population and valuable for healthcare planning. In the past we have been limited to counting only individuals treated with dialysis or transplant. However it is recognised that many people with end-stage kidney disease might not receive these treatments for a variety of reasons. This report presents a new method for counting the total incidence of end-stage kidney disease which also includes those not treated with dialysis or transplant. This method indicates that for every new case treated with dialysis or transplant there is one that is not, although the vast majority of these are elderly.

Media release

Patient activity within private hospitals continues to grow

The number of patients who were discharged from private hospitals grew by 6.7% in 2009-10, according to a report released by the Australian Bureau of Statistics. There was an increase in the number of private hospital beds across Australia in 2009-10. Acute hospitals increased by 286 beds (1.2%), while free standing day hospitals increased by 327 beds (13.1%). The only reduction was in psychiatric hospitals which were reduced by 45 beds (-2.9%). Acute hospitals were recorded as having 23,465 beds, psychiatric hospitals 1,461 and free standing day hospitals 2,822.

Key indicators of progress for chronic disease and associated determinants: data report (AIHW)

With preventive health now a major focus of health reform in Australia, this report provides information about the prevalence of those chronic diseases for which behavioural changes, or increased screening practices, can reduce onset, assist in management, or prevent death. The report contains current prevalence rates, and where possible, shows trends in chronic conditions over time. Statistics about the determinants of chronic disease assist in planning of prevention programs and strategies. When monitored over time, they may also help explain and predict any changes in chronic disease trends.

Media release

It's My Health: Consumer Website

 It's My Health is a new consumer health website published by Reed Business Information the producers of Australian Doctor and New Scientist.
The publisher describes the resources on their website as: Australian,Based on evidence,Easy to access and understand,Empowering to you, Speaks to people personally – not lecturing or authoritarian. The information on the website is divided into the following sections: Conditions, Symptoms Checker, Healthy Living and Recipes.

Prevalence of Type 1 diabetes in Australian children, 2008 (AIHW)

Type 1 diabetes is a serious, life-long disease which causes a major health, social and economic burden for individuals with the disease, their families and the community. Prevalence of Type 1 diabetes in Australian children, 2008 presents for the first time estimates of the prevalence of Type 1 diabetes in children aged 0-14 years in 2008, based on Australia's National Diabetes Register data. In 2008, it is estimated that over 5,700 children aged 0-14 years had Type 1 diabetes in Australia. The prevalence rate increased with age and varied by state and territory. Assuming that new cases of Type 1 diabetes in 0-14 year old children continue increasing at the rate observed between 2000 and 2008, it is estimated that the prevalence rate will increase by 10% between 2008 and 2013.

Media release

Using Social Media to Improve Healthcare Quality

Like it or not, our patients are using social media, and Twitter, Facebook, Linked-In and other social media sites is where our healthcare services need to be, because it is where our clients are.

Part 1: Introduction and Key Issues in the Current Landscape: a guide to current practice and future promise, by The Change Foundation, Canada captures the first phase of a project, in which the Innovation Cell undertook a series of systematic scans of the social media environment to understand how it intersects with healthcare, particularly in Canada. As a result of these scans, they are able to describe current leading practices, challenges, lessons, opportunities and limitations related to the use of social media in healthcare. Here they introduce the idea that healthcare organisations can use social media as a tool for quality improvement by tapping into the growing presence and power of online conversations. Through numerous examples from across North America – and by presenting the first open and user-editable Canadian directory of healthcare organisations using social media – Part 1 of the guide (like the forthcoming eToolkit) provides a snapshot of where we are now in this fast-changing world. It also explores important ethical issues, particularly around privacy and data control, that healthcare  organisations must understand as they begin to navigate this new territory.

Interview with Cathy Fooks of the Change Foundation

The health of Australian males (AIHW)

Drawing on a wide range of data sources, The health of Australian males provides a snapshot of the health of Australia's males. Examples of the report's detailed findings include: males born between 2007-2009 can expect to live 24 years longer than males born between 1901-1910; around two-thirds of adult males and one-quarter of boys are overweight or obese; nearly half have ever had a mental health condition; nearly one-quarter have a disability and nearly one-third have a chronic health condition; 16% of males do not use any Medicare services in a year.

Media release

Commentary from "The Australian"

Women seek health solace in cyberspace

The internet has become the first port of call for people seeking health information. But the trend has sparked questions for health professionals and researchers. Exactly who is accessing this information, and what are they looking for on the internet?

Dr Julie-Anne Carroll undertook research into this topic and co-published a paper called Geekdom for Grrrls Health: Australian Undergraduate Experiences Developing and Promoting Women's Health in Cyberspace.

Dr Carroll said there is an increasing reliance on the internet for health information across all ages. One of the main findings of her research was the fact that women prefer government and semi-government sources above all others. They don't like flashy websites, and while they participate in websites with discussion forums, many women use those forums to find support rather than obtain core health information. They also discovered online is not a threat to traditional primary healthcare.

World Report on Disability (WHO)

The first ever World report on disability, produced jointly by WHO and the World Bank, suggests that more than a billion people in the world today experience disability. People with disabilities have generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their everyday lives.

The report provides the best available evidence about what works to overcome barriers to health care, rehabilitation, education, employment, and support services, and to create the environments which will enable people with disabilities to flourish. The report ends with a concrete set of recommended actions for governments and their partners.

This pioneering World report on disability will make a significant contribution to implementation of the Convention on the Rights of Persons with Disabilities. At the intersection of public health, human rights and development, the report is set to become a "must have" resource for policy-makers, service providers, professionals, and advocates for people with disabilities and their families.

Young Australians: their health and wellbeing 2011 (AIHW)

Young Australians: their health and wellbeing 2011 is the fourth in a series of national statistical reports on young people aged 12-24 years.

It provides the latest available information on how Australia's young people are faring according to a set of national indicators of health and wellbeing. Death rates have fallen considerably among young people, mainly due to declines in injury deaths. Most young people are achieving national minimum standards for reading, writing and numeracy, are fully engaged in study or work, and have strong support networks. There are some favourable trends in risk and protective factors, such as declines in smoking and illicit substance use.

But it is not all good news. There is a high rate of mental disorders among young people, and road transport accidents, although continuing to decline, are still a major cause of death among young males. Too many young people are overweight or obese, are not doing sufficient physical activity or eating enough fruit and vegetables, and are drinking alcohol at risky levels. Aboriginal and Torres Strait Islander young people are far more likely to be disadvantaged across a broad range of indicators.

Media release

National Health Reform : delivering outcomes for Australians

National Health Reform : delivering outcomes for Australians provides a summary of the Commonwealth's assessment of progress towards key National Health Reform milestones as at 1 June 2011.

If you want to to know more about what the National Health Reform promises, go to the Department of Health and Ageing website where there is a detailed description.

Reposted from Library Clippings

Australian Family Physician special mental health issue

This month's issue of AFP is devoted to mental health, and the articles are available freely online. Included are studies on:

* Antidepressant use
* Mental health risk assessment : a guide for GPs
* Anxiety disorders
* Assessment and management in general practice
* Managing borderline personality disorder and substance use : an integrated approach
* Anxiety and depression : online resources and management tools
* Patient initiated aggression

Please contact your library if you have problems downloading any journal articles.

The Digital divide as a health issue

The Federal Government's National Digital Economic Strategy (released on 31 May, 2011) has substantial health implications.

The digital divide: a profound public health issue that needs work is a recent article in the Croakey health issues blog. Don Perlgut, CEO of the Rural Health Education Foundation, is concerned that with the introduction of the National Broadband Network, over 3 million Australians will be disadvantaged by their lack of information technology skills in regards to public health. "If you are poor, Indigenous, old or disabled and live in outer regional/remote areas of Australia, your chances of being 'online ready' are pretty low. And who are the people who will most need the chronic disease monitoring systems the Government is starting to put in place? The poor, the elderly, the disabled and the residents of outer regional and remote Australia."

The Croakey blog is a forum for debate and discussion about health issues and policy. It is moderated by journalist Melissa Sweet, with regular contributions from a panel of medical experts. It is related to the online social commentary publication, .

Rural Health Education Foundation statement

Planning for the end of life for people with dementia: part two

Planning for the end of life for people with dementia: part two by Colleen Cartwright of Alzheimer's Australia.

The general reluctance in our society to discuss end-of-life issues translates into a failure by many to prepare properly for the end of life. This includes not making wills, expressing wishes about funeral arrangements, considering the need to make powers of attorney or give directions for care through advance directives.

The consequence is that the failure to think in advance about end-of-life issues will impact not only on the quality of life of the individual in their final years and months, but also on those around them. End-of-life issues are, by their nature, complex, personal and sensitive, but they are made all the harder if the wishes of the person concerned are not properly understood or set out.

The first part of this publication , which was released on 4 April 2011, explained the legal options that people can exercise now in respect of planning for the end of life. These include advance care planning, preferred place to die, refusal of treatment and withdrawal of treatment.

This second publication considers what additional options might become available in the future that people with dementia could access towards the end of their lives. These could include euthanasia and assisted suicide.

Free guide to dealing with the aftermath of emergencies.

Australian Red Cross has launched a free guide for families who are dealing with trauma. The booklet, 'Helping Children and Young People Cope With Crisis', is for parents whose children have experienced a traumatic event, like the recent floods, fires or cyclones. The need for this resource was identified following extensive consultations after the 2009 Victorian bushfires.

The booklet includes personal stories and suggestions from parents who have experienced emergencies across Australia, as well as tips from leading child trauma psychologists on how to manage and respond to the reactions.

ABC Coverage

2010-11 AMA Indigenous Health Report Card - "Best Practice in Primary Health Care for Aboriginal Peoples and Torres Strait Islanders"

The 9th Australian Medical Association (AMA) Indigenous Health Report Card 2010-11 examines models of best practice in primary care for Aboriginal peoples and Torres Strait Islanders and makes a number of strong recommendations to governments to greatly improve Indigenous health outcomes.

Chair of the AMA Indigenous Health Taskforce, Dr Steve Hambleton, said that more needs to be done in a practical way to build on the momentum of significant Government investment of more than $1.6 billion to Close the Gap in Indigenous Health. He said the gap in life expectancy would not close unless all Aboriginal and Torres Strait Islander peoples have full access to high quality primary health care. The AMA Report Card identifies some of the more successful primary health care models that reduce barriers to access and promote high quality health and clinical outcomes for Indigenous patients.

Press Release

Report Card Long version

Report Card Summary

The Garnaut Review 2011: Australia in the Global Response to Climate Change

The Garnaut Review 2011: Australia in the Global Response to Climate Change examines how developments in science, diplomacy, political culture and the economy have affected the national interest case for Australian climate change action. The Garnaut Climate Change Review was commissioned by the Commonwealth, state and territory governments in 2007 to conduct an independent study of the impacts of climate change on the Australian economy. This is the final report of that study. This summary of the book brings together some of the main ideas and recommendations from the book. This follows seven months of careful research, analysis, expert studies and consultation, which have examined major developments in the past three years in the climate science, global greenhouse gas emissions, international progress on climate change mitigation, Australia's land and electricity sectors, innovation and technology, and carbon pricing.

Global Health Observatory (World Health Organization)

The Global Health Observatory data repository provides access to over 50 datasets on priority health topics including mortality and burden of diseases, the Millennium Development Goals (child nutrition, child health, maternal and reproductive health, immunization, HIV/AIDS, tuberculosis, malaria, neglected diseases, water and sanitation), non communicable diseases and risk factors, epidemic-prone diseases, health systems, environmental health, violence and injuries, equity among others. In addition, the GHO provides on-line access to WHO's annual summary of health-related data for its 193 Member states: the World Health Statistics 2011.

Contribution of chronic disease to the gap in mortality between Aboriginal and Torres Strait Islander people and other Australians

Chronic diseases are major contributors to the mortality gap between Aboriginal and Torres Strait Islander and other Australians. About 80% of the mortality gap for people aged 35 to 74 years is due to chronic diseases, measured in terms of potential years of life lost. The major contributors are heart diseases, diabetes, liver diseases, chronic lower respiratory disease, cerebrovascular diseases and cancer.

Access to health and services for Aboriginal and Torres Strait Islander people [AIHW]

Aboriginal and Torres Strait Islander people (Indigenous Australians) typically die at much younger ages than other Australians and are more likely to experience disability and reduced quality of life because of ill health. One important contributor to health and wellbeing is access to health services. This paper examines Indigenous Australians' use of a range of health services, including those that provide preventive, primary and community health, hospital or specialised care.

CELLS alive

The Cells Alive website was created by scientist Jim Sullivan, and it includes images, animations, and descriptions that tell about the function of various cells.

Older people leaving hospital: a statistical overview of the Transition Care Program in 2008-09

Older people leaving hospital: a statistical overview of the Transition Care Program in 2008-09 presents key statistics on the characteristics and services provided to older people who are eligible for residential aged care directly after discharge from hospital. The program aims to improve recipients' independence and functioning. At 30 June 2009 there were 2,228 places providing transitional care to older people leaving hospital. During 2008-09, around 12,600 individuals received just over 14,000 episodes of transition care.

A Picture of NSW Children

A Picture of NSW Children is a data book website which provides demographic information on the children and young people of NSW aged 0-17 years and their families.  It includes information about child care and education, health and well-being, economic well-being, harm and injury, crime, and information about the communities in which children live. It is produced by the NSW Commission for Children and Young People in collaboration with the Social Policy Research Centre (SPRC) at UNSW.

Stress may increase risk for Alzheimer's disease

Stress promotes neuropathological changes that are also seen in Alzheimer's disease. Scientists from the Max Planck Institute of Psychiatry in Munich have discovered that the increased release of stress hormones in rats leads to generation of abnormally phosphorylated tau protein in the brain and ultimately, memory loss.

Media awards for responsible reporting of suicide: Experiences from Australia, Belgium and Denmark

This study aimed to examine the experiences of Australian, Belgian and Danish award recipients in preparing stories on suicide, and consider the impacts of the awards for these recipients and for media professionals more broadly

Semi-structured telephone interviews were conducted with the majority (14 out of 15) of past recipients of the awards in the three countries of interest.

Mobile phones and cancer : the debate continues

Mobile phone users may be at increased risk from brain cancer and should use texting and hands-free devices to reduce exposure, the World Health Organisation's cancer experts say. Radio-frequency electromagnetic fields generated by such devices are "possibly carcinogenic to humans", the International Agency for Research on Cancer (IARC) announced at the end of an eight-day meeting in Lyon, France.

Experts "reached this classification based on review of the human evidence coming from epidemiological studies", pointing to an increased incidence of glioma, a malignant type of brain cancer, Jonathan Samet, president of the work group said. Two studies in particular, the largest conducted over the last decade, showed a higher risk "in those that had the most intensive use of such phones", he said in a telephone news conference.

Sydney Morning Herald report

WHO statement and summary

Trends in access to dental care among Australian adults 1994-2008 (AIHW)

Trends in access to dental care among Australian adults 1994-2008 reveals that between 1994 and 2008 half of all Australians visited a dentist most years and the proportion of those who visited for a check-up increased from 46% to 55%. However, there were growing inequalities in the use of dental care. People on low incomes, those who live in rural areas and those without dental insurance did not have the same gains in visiting a dentist regularly for a check-up compared to higher income earners, urban dwellers and those with dental insurance.

Media release

The determinants of health in rural and remote Australia

The determinants of health in rural and remote Australia, National Rural Health Alliance, Fact Sheet 28, 20 May 2011

'Health' is a very broad notion, affected by a wide range of individual characteristics, behaviours and contextual factors. Those contextual factors that fall within social, economic and environmental domains are usually referred to as 'the social determinants of health'

The National Rural Health Alliance fact sheets provide an overview of health issues in rural Australia. Other recent fact sheets in the series include : The extent of the rural health deficit ; Rural maternity services, and Medicare locals in rural Australia.

Overweight and Obesity in Adults in Australia: A Snapshot [ABS]

The increase in overweight and obesity rates in recent decades is a major public health concern in many countries including Australia. Before 1980, obesity rates were generally well below 10%, but have doubled or tripled in many countries since then. In no less than 13 countries in the Organisation for Economic Co-operation and Development (OECD), 50% or more of the adult population is now classified as being either overweight or obese, with Australia's obesity rate the fifth highest, behind only the United States, Mexico, New Zealand and the United Kingdom. Sedentary lifestyles which have come about due to increasing affluence and the modernisation of society, and changes to diets containing more energy-dense foods are believed to be the main causes in the rise in overweight and obesity rates.