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There is overwhelming evidence that human lifestyles have impacted the earth's planetary boundaries, with profound impacts for generations to come. Without concerted action to shape a better future, children will bear the burden on their health and well-being throughout their lifetimes. Yet government priorities are frequently dominated by short-term concerns, and an over-reliance on economic indicators as a measure of human progress. To give today's - and tomorrow's - children the best chance of leading flourishing lives, a new approach is needed, which overcomes the 'presentist' bias in political decision-making and values measures of well-being beyond gross domestic product (GDP). The potential building blocks of such an approach can be seen in the promising early steps being taken by several countries, including Wales and New Zealand. This paper provides an overview of these efforts in the context of the recommendations of the WHO-UNICEF-Lancet Commission report 'A future for the world's children'.

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Ambulatory care sensitive conditions (ACSCs) are used as a measure of access to primary health care. The purpose of this study was to identify factors associated with variation in ACSC admissions at a small area level in Victoria, Australia. The study was ecologic, using Victorian Primary Care Partnerships (PCPs) as the unit of analysis. Data sources were the Victorian Admitted Episodes Dataset, census data from the Australian Bureau of Statistics, and the Victorian Population Health Survey. Age- and sex-adjusted total ACSC admission rates were calculated, and weighted least squares multiple linear regression was used to examine the associations of total ACSC admission rates by various predictor variables. Key variables were categorized into 1 of 4 framework components for analyzing access and use of health care services: predisposing, enabling, need, or structural. Enabling characteristics explained 61.70% of the variation in ACSC admission rates across PCPs. Socioeconomic characteristics (income, education) and percentage with poor self-rated health were important factors in explaining variations in ACSC admissions at a small area-level [R(2)=0.77]. Community-level variables differentially affect access to primary health care, with significant variation by socioeconomic status. This analytical approach will assist researchers to identify community-level predicators of access across populations at locations, including factors that may be affected by policy change.

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BACKGROUND: Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04. METHODS: Hospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED) and Accessibility/Remoteness Index of Australia (ARIA). Univariate and multiple logistic regressions were performed for both adult (age 18+ years) and paediatric (age <18 years) groups, reporting odds ratios (OR) and 95% confidence intervals (CI) for a number of predictors of ACSCs admissions compared to non-ACSCs admissions. RESULTS: Predictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively. CONCLUSIONS: Disadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population.

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OBJECTIVE: To analyse the implications of using different methods to predict diabetes prevalence for the future. APPROACH: Different methods used to predict diabetes were compared and recommendations are made. CONCLUSION: We recommend that all projections take a conservative approach to diabetes prevalence prediction and present a 'base case' using the most robust, contemporary data available. We also recommend that uncertainty analyses be included in all analyses. IMPLICATIONS: Despite variation in assumptions and methodology used, all the published predictions demonstrate that diabetes is an escalating problem for Australia. We can safely assume that unless trends in diabetes incidence are reversed there will be at least 2 million Australian adults with diabetes by 2025. If obesity and diabetes incidence trends, continue upwards, and mortality continues to decline, up to 3 million people will have diabetes by 2025, with the figure closer to 3.5 million by 2033. The impact of this for Australia has not been measured.

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In 1986, the Ottawa Charter alerted a new generation of health promotion practitioners to the benefits of working with the non-health sectors, including the commercial sector. Since then, the establishment of partnerships with government and non-government bodies has been advanced as a positive way of fostering policies that enhance health and well-being. The food and nutrition field has enthusiastically adopted partnerships between government, non-government and industry. In this article, we focus on the tactics employed by industry bodies to further their cause in a range of fields that are characterized by risk and contestation. We describe the nature of the alliances and interactions between commercial, scientific and government groups whose stated aim is to improve Australia's diet. Our analysis shows that these partnerships have been guided less by the ethos of the Ottawa Charter and more by the interests of the various parties: namely the food industry's need for credibility in making health claims, the financial imperatives of professional bodies and scientists whose public funding is inadequate, and government endorsement of public-private partnerships as the preferred mechanism for service delivery. The symbiotic relationship that is emerging between segments of the food industry and the nutrition professions raises questions about the independence of the dietary advice being given to consumers. We conclude by arguing for a research programme to investigate the consequences of intersectoral partnerships on the nutritional status of the population.

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