Monday 7 March

King launches $40 million first phase for Cancer Control Action Plan

The Government has targeted an extra $40 million funding for cancer control in the first phase of the Cancer Control Action plan, says Health Minister Annette King.

Ms King says the plan takes account of the clear advice from the Cancer Control Taskforce that cancer must be tackled on a number of fronts, and that is why the new funding is right across the spectrum from prevention to treatment, palliative care, support and rehabilitation, and research.

“I am particularly pleased the package includes new funding of $8.6 million for prevention initiatives, including an exciting extension of the successful fruit in schools programme.”

Ms King says the plan also includes nearly $6 million to top up existing palliative care, support and rehabilitation, and $4 million more for cancer treatment drugs, an increase of 11 per cent, to fund new drugs and widen current access.

"This funding is on top of cancer control initiatives already happening at District Health Board and national level, and I am confident that this money will give added impetus to specific priorities put forward by the taskforce.

From July the Ministry of Health will offer eligible primary schools the chance to apply to be part of the free fruit scheme, where all students will get one piece of fresh fruit each day at their school. “The first criteria is to be a Health Promoting school with programmes in all four cancer prevention areas --- nutrition, physical activity, SunSmart and smokefree. The funding is designed to increase the number of Health Promoting schools right across New Zealand, although schools will have to provide a well-reasoned case based on the benefits they will receive from participating in the scheme, with an initial emphasis on high-need schools.

“The Ministry will also be looking to see if there are partnership opportunities which may help our dollars go further and make the scheme available to as many schools as possible as quickly as possible.

"This scheme makes it easier for children from all backgrounds to make healthy choices and that will have long-term positive spin-offs in many health areas, not just cancer prevention."

Within the funding package, some of the target activities for the 05/06 year include: - $13.2 million breastscreen age extension (announced previously), and evaluation of colorectal screening policy - $6.4 million in primary prevention activities (e.g. Healthy Eating, Healthy Action, free fruit in schools, Health Promoting schools, DHB innovation funding) - $2.2 million for smoking cessation services, including initiatives to stop young people starting - $6.0 million palliative care, support and rehabilitation - $5.3 million for treatment services including an extra $4 million for cancer drugs - $3.2 million in research and development - $1.1 million workforce development

Ms King says a shortfall in funding of about $5 million for hospice services has been identified by a working group involving Hospice New Zealand, DHBNZ and the Ministry. “The new funding brings Government funding up to the level it needs to be to support hospice and community palliative care.”

The new $4 million funding for cancer drugs will enable Pharmac to purchase new drugs for cancer patients and to widen the access to treatments already subsidised. “This could include drugs for breast cancer, colorectal cancer and lung cancer. Pharmac has broadened access to cancer drugs in recent years, including funding Glivec, for example, and has been looking at other proposals. This additional funding will enable Pharmac to make more progress.”

Ms King says several other initiatives are also coming close to fruition. “Applications for positions on the new Cancer Control Council have closed and the makeup will be known by the end of next month. The council has been set up to provide leadership in cancer control, to monitor and review implementation of the Strategy and to foster collaboration and co-ordination. Applications for the new Ministry of Health Principal Advisor Cancer Control have closed, and an appointment is also expected by the end of April.”

Questions and answers

What is the Cancer Control Strategy?

The strategy is designed to help co-ordinate the delivery of cancer prevention, cancer treatment, palliative care, support and rehabilitation services. The World Health Organisation recommends all member countries develop overall cancer control strategies.

What is the Cancer Control Implementation plan?

The plan identifies 110 outcomes and 240 actions, with the philosophy of many taking small steps to bring about significant change.

What is the Cancer Control Council?

The council will advise the Minister of Health, independently from the Ministry of Health. The council's membership is intended to reflect stakeholders and the sector. Applications for positions on the council have closed and appointments should be completed by the end of April.

What is happening to the Cancer Control Taskforce?

The cancer control taskforce has completed its work, to advise the Ministry on actions to implement the Cancer Control Strategy. Its recommendations are now being implented.

What does extra palliative care, support and rehabilitation funding mean for hospices?

A review of hospice funding that will be completed by the end of March. Currently, the amount of public versus community funding is different for each of the 38 hospices. There has been difficulty in collecting useful data as some hospices do not have volume information. It is essential that any additional funding for hospices and the wider palliative care sector, including support and rehabilitation, is administered via DHBs on a population basis to ensure that funding is directed to the greatest need. This additional funding moves all hospices toward a 70 per cent government funding.

How will the $4 million in cancer drugs be spent? It will give PHARMAC the opportunity to fund more new drugs for cancer patients, and to widen access to treatments that are already subsidised. These could include drugs for breast cancer, colorectal cancer and lung cancer. PHARMAC will continue to ensure that new funding would be allocated for drugs that offered good value for the available funding. PHARMAC has been actively considering proposals to fund cancer treatments, and having additional funding would mean that a number of these could be progressed. PHARMAC has been able to provide greater access to cancer drugs in recent years, including funding Glivec for chronic myeloid leukaemia, and widening access to letrozole for breast cancer, and having more funding could enable even greater access to be provided for more new medicines.

What is the background to the free fruit in schools programme?

Fruit in Schools originated in the United Kingdom as a nationwide programme that provides a free piece of fruit to schoolchildren on every school day. Based on the UK scheme, a New Zealand pilot study was carried out in Term one of 2004 in ten pairs of decile one schools in the Auckland and Northland regions. Within each pair, one school received free fruit and the other provided the control group. The effectiveness of the programme was determined by comparing changes in fruit intake between the intervention and control groups. Before the intervention, over 40 percent of participating children reported consuming no fruit, compared to only 22 percent of the pupils in the intervention group at follow-up. Interestingly, increased fruit consumption was associated with decreased consumption of pies. Further, teachers rated the scheme 10 out of 10 and used the programme as a teaching opportunity and reported classroom benefits such as greater alertness and concentration.

What are Health Promoting Schools

Health Promoting Schools is a world wide movement developed by the World Health Organisation. HPS supports schools to promote the health and well being of the school community. There are three areas that HPS addresses: curriculum teaching and learning, school organisation and ethos and community links and partnership. The HPS process assists schools to identify health issues of the students and develop a plan of action with implementation priorities. HPS advisors are available to schools to provide support in the needs assessment process and information and resources to assist schools and communities to take on programmes and policies to improve health.

HPS was introduced into New Zealand in 1996. There is a national network of regional HPS co-ordinators who meet regularly Mainstream and Maori implementation resources have been developed and ongoing workforce development is provided. A national Health Promoting Schools Association was established four years ago. Nationally, there are about 25 HPS advisors and most public health nurses deliver services in schools using an HPS framework. There is a tripartite agreement between SPARC and the Ministries of Health and Education that focuses on improving well being of students through improving nutrition and physical activity.

Why would you want to be an HPS?

Schools that become HPS model make a conscious effort to consider and improve all areas of the school to become a healthier place for its schools community. Health Promoting Schools have access to extra resources and support to make schools healthier places and to raise student awareness of how to prevent illness and promote wellbeing.

How does it work? HPS advisors and public health nurses identify schools interested in promoting health and well being and present the HPS way of working to Boards of Trustees, principal and parents. If the school decides to commit to becoming an HPS, a Memorandum of Understanding is signed clarifying what the schools will provide, and what support they can expect from their DHB’s HPS advisor. A HPS team is formed with representatives from students, senior management, teachers, parents, health professionals etc, a needs assessment is undertaken, and an action plan developed. Schools often form HPS geographic clusters so that support can be offered to new HPS by those more experienced.

Where are the HPS?

They are located throughout New Zealand in both rural and urban centres. The majority are in primary schools, but there are also intermediate and secondary schools, as well as Kohanga Reo and Kura Kaupapa, who are HPS.

How many schools are there involved

About four hundred schools across New Zealand are involved, some as active participants and some in the early stages of HPS development.

How much money does the government spend on HPS

Ministry of Health funds services of about $2,800,000 per year to provide HPS advice and support to schools

Has it been evaluated- how do you know it will work?

In 1997 there was a national stocktake of HPS programmes in schools. In 2001, a three and a half year evaluation of HPS in Northland and Auckland was completed. There have also been evaluations in Australia and Europe. If HPS is sustained over time there are many promising indicators of success. HPS works best where there is good support from the principal, senior managers and Boards of Trustees and HPS is school owned and driven,

What difference has it made/will it make to kids health and wellbeing?

Impacts have included improved nutrition through provision of healthy food options in the tuck shops and discouraging parents to send junk food to school in lunch boxes, reductions in bullying and violence at school, shade shelters and water fountains being installed, fitness trails developed, decreases in suspension rates etc

How do schools become involved?

They contact their local DHB Public Health service and ask for an HPS advisor.

Who provides the support to schools?

The HPS is supported by the HPS advisor from their local DHB, elects an HPS team from the school community who ‘drive’ the initiative in the school. Schools wanting more information should contact their local DHB public health service.

How will you choose which schools get to be HPS or get the FIS programme?

Criteria have been developed for selection. The primary criteria for selecting schools to participate are that they are an existing or emerging Health Promoting School. Other criteria are that the school:

1. Must be a primary school or primary-intermediate (year 0-8).

Must demonstrate they are actively working towards all four cancer prevention areas:

Must present a well-reasoned case focussing on the need for a FIS programme. These may include: SES profile Well being issues, High health care needs as identified by PHNs.

This is a long-term approach that needs families to change eating patterns. How will you involve families and communities in the FIS?

One of the three foundations of an HPS approach is having strong community links and partnerships. The FIS programme would need to involve more than teachers handing out fruit and vegetables to children at school.

A comprehensive approach would require good nutrition and physical activity programmes as part of the Health and Physical Activity Curriculum, school policies that promote healthy eating and engagement of parents and whanau in supporting good food choices. e.g. schools have initiated special shared lunches, healthy food days etc, and invited family and community members.

ENDS

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