Victorian public health and wellbeing plan 2023–27

Sexual and reproductive health is important for every Victorian. This includes focusing on reducing the impact of blood-borne viruses (BBV) and sexually transmissible infections (STI). Sexual health is not only important to people in their reproductive years but also across life stages. This includes puberty, through menopause and the senior years.

Shared benefits across priorities

Good sexual and reproductive health contributes to improvements across a broad range of other health and wellbeing priorities. For example, promoting healthy lifestyles for women transitioning through menopause will improve mental wellbeing, physical health and healthy ageing.¹ Sexual and reproductive health is more than just physical health and wellbeing. It affects gender equality and includes the right to healthy and respectful relationships, safety and freedom from violence.

Improving health equity

Sexual and reproductive health is a human right. Women and gender diverse people often face barriers to accessing helpful and affordable services to help manage sexual and reproductive health. ¹ This includes services related to menstruation, fertility, chronic conditions (polycystic ovary syndrome and endometriosis), pelvic pain, contraception, STI and menopause. ¹

Gender equality is essential for positive sexual reproductive health which is influenced by gender norms, power dynamics, gender expectations and gender bias that exists across systems. Stigma and discrimination can be barriers to accessing sexual and reproductive health or viral hepatitis services. These barriers can contribute to missed and late diagnoses, disease progression, onward transmission, more costly tertiary care and reduced quality of life. Addressing stigma, racism and discrimination will support Victorians to feel confident and culturally safe to access prevention services, testing, treatment and support.²

Targeted actions and collaborations can contribute to more equitable health outcomes. For example, the burden of BBV and STI varies markedly across population groups and geographical areas of Victoria. By addressing disparity of access to services we help to achieve more equitable, sexual and reproductive health outcomes and wellbeing. ²

Driving action to improve sexual and reproductive health

Building and strengthening system capacity is key to delivering accessible, affordable and inclusive sexual and reproductive health services.

Work to support a life-course approach for girls and women will drive better sexual and reproductive outcomes. It is important that we normalise health-seeking behaviours, such as participation in human papillomavirus (HPV) vaccination and cervical screening programs. This will ensure prevention and early diagnoses of diseases such as cervical cancer.¹ This is crucial for timely treatment of STI and BBV to reduce negative impacts on health and wellbeing. For example, a delayed diagnosis of STI can lead to long-term health issues and affect fertility and reproductive health.¹

Promoting good sexual and reproductive health relies on health services that are inclusive, safe and appropriate, with access to accurate information and testing, treatment, and timely support and services (including access to affordable contraception).

What we want to achieve

• Support Victorians to access culturally safe sexual and reproductive health services that are free from stigma, racism and discrimination.
• Strengthen the sexual and reproductive health of Victorian women, girls and gender diverse people across the life course, with a focus on areas such as menstrual health, contraception, abortion and assisted reproductive treatment.
• Eliminate hepatitis B and hepatitis C as a public health concern by 2030, eliminate congenital syphilis by 2030 and the virtual elimination of new HIV transmissions by 2025.
• Support Victorians to achieve optimal sexual and reproductive health and reduce the transmission and impact of BBV and STI.
• Ensure health professionals have the skills, knowledge and attitudes needed to deliver culturally safe, non-stigmatising, non-judgemental best-practice sexual and reproductive health and viral hepatitis prevention, testing, treatment and care.
• Improve sexual and reproductive health and viral hepatitis services and outcomes by increasing the quality and completeness of data and research.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Strategy overview and system enabler plan 2022–30
• Victorian sexual and reproductive health plan 2022–30
• Victorian Aboriginal sexual and reproductive health plan 2022–30
• Victorian hepatitis B plan 2022–30
• Victorian hepatitis C plan 2022–30
• Victorian HIV plan 2022–30
• Victorian sexually transmittable infection (STI) plan 2022–30
• Victorian women’s sexual and reproductive health plan 2022–30.

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome 1.1 Victorians have good physical health
• Outcome 1.3 Victorians act to protect and promote health.

Guidance for taking action to improve sexual and reproductive health

Evidence-based guidance, polices, strategies and plans can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• Victorian sexual and reproductive health and viral hepatitis strategy 2022-30 for sexual and reproductive health and viral hepatitis, policy and legislation.
• Access guidance on sexual health, including sexual and reproductive health strategies.
• Programs and services for sexual health, viral hepatitis and HIV.

References

1. Victorian Department of Health 2022, Victorian women’s sexual and reproductive healthplan 2022–30. Melbourne: State Government of Victoria.
2. Victorian Department of Health 2022, Victorian sexual and reproductive health and viral hepatitis strategy: strategy overview and system enabler plan 2022–30. Melbourne: State Government of Victoria.

Tobacco use is still the leading contributor to burden of disease and premature deaths in Victoria, despite considerable progress in reducing smoking rates. Tobacco use is responsible for 9.3 per cent of disease burden and 13.3 per cent of deaths in Australia.¹ There are concerns this will increase with the uptake of e-cigarette use.

E-cigarettes are devices that deliver an aerosol by heating a solution that users breathe in. The solution may or may not contain nicotine. The aerosol is commonly referred to as ‘vapour’. Using an e-cigarette is commonly known as ‘vaping’.

Tobacco harms our health through use, harms others through second-hand exposure and negatively impacts our environment. Smoking increases the risk of chronic diseases such as heart disease, diabetes, kidney disease, eye disease, stroke, dementia, certain cancers (for example, oral cancer), gum disease and respiratory diseases such as asthma, emphysema and bronchitis.²

Smoking has a significant economic impact, with an estimated total cost of $136.9 billion dollars in 2015–16. This includes tangible costs, such as life lost and health care costs, and intangible costs, such as premature mortality and lost quality of life due to ill-health.³

Responding to the emergence of e-cigarette use

One of the greatest causes for concern is the potential for another generation of young people to become addicted to nicotine through e-cigarettes, undermining years of progress in reducing tobacco-related harm.

Urgent action is needed to decrease the rates of e-cigarette use, particularly among young Victorians. While e-cigarettes have not been around long enough for us to know the long-term impacts, we do know that use of e-cigarettes (even short-term use) has resulted in poisoning, acute lung injury, injuries and burns, toxicity and death, and neurological conditions, including seizures.⁴

Shared benefits across priorities

Reducing harm from tobacco and e-cigarette use can drive improvements in physical health and wellbeing, including sexual and reproductive health.

Quitting tobacco smoking and e-cigarette use is recommended to improve fertility and reproductive health. Smoking during pregnancy is shown to carry risks for the health of mothers and babies, including low birthweight, pre-term birth and perinatal death.⁵ Quitting smoking during pregnancy helps mothers to have a healthy pregnancy and supports babies to have the best start in life.

Reducing tobacco and e-cigarette use supports our environment and overall planetary health. These products harm the environment through plastic waste, fires, pollution and by decreasing our air quality.⁴ Tobacco production has negative impacts on our environment at every stage including growth, manufacturing, distribution and disposal.⁵

Improving health equity

The rapid rise in availability and use of e-cigarettes is a threat to public health that requires urgent action. We need to continue to prioritise working in partnership with people and communities that experience higher rates of tobacco smoking. This includes people who live in rural Victoria, Aboriginal Victorians, young Victorians, people with serious mental illnesses, Victorians who identify as LGBTIQA+, and people who have alcohol and drug disorders.^{2, 7}

The smoking rate among Aboriginal people is declining at a faster rate than for non-Aboriginal people, although it remains disproportionately high.² Smoking rates are higher among adults who live in rural Victoria (14.1 per cent), compared to those in metropolitan Victoria (11.5 per cent).⁷

Targeted action is also needed to improve the health and wellbeing of mothers and babies. While smoking at any time during pregnancy has decreased, there are groups that have higher rates, including Aboriginal mothers (43 per cent), mothers aged under 20 years (34 per cent) and mothers aged 20–24 years (21 per cent).⁸

Driving action to reduce harm from tobacco and e-cigarette use

Coordinated efforts to reduce tobacco and e-cigarette use will reduce inequities for people who experience multiple forms of disadvantage. It will also reduce the negative economic, social and environmental impacts associated with tobacco and e-cigarette use.

What we want to achieve

• Strengthen the regulatory framework in relation to the availability of tobacco and e-cigarette products in Victoria. Reduce the number of environments in which a person can smoke.
• Prevent the uptake and reduce the harms associated with smoking and vaping, including second- and third-hand exposure, through ongoing support and strengthening tobacco and e-cigarette regulation in Victoria.
• Embed a national approach to tobacco and e-cigarette reform, through implementation of the National Tobacco Strategy 2022–2030
• Support the use of e-cigarette products through a medically supervised pathway, only for the purposes of smoking cessation and the treatment of nicotine addiction.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• National Tobacco Strategy 2022–2030

Outcomes

Outcome 1.3 Victorians act to protect and promote health.

Guidance for taking action to reduce harm from tobacco and e-cigarettes

Evidence-based guidance, policies, strategies and plans can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008.

• See the Department of Education for guidance on reducing and preventing smoking and vaping in education settings.
• Information on tobacco reforms and PDF copies of ‘no smoking or vaping’ signs for premises to download and print.
• Access to City of Melbourne for a step by step guide for local government to support creating smoke and vape-free areas.
• Quit Victoria for resources and tools for community health promotion.
• Access guidance from the Tackling Indigenous Smoking Resource and Information Centre.
• Additional training, guidance and enforcement material regarding the Tobacco Act 1987, and information about the Municipal Association of Victoria’s service agreement is available for council Environmental Health Officers on the PHHub. Environmental Health Officers can email tobacco.policy@health.vic.gov.au for details on how to access these resources.

References

1. Australian Institute of Health and Welfare 2022, Australian burden of disease study 2022. Canberra: AIHW. Cat. no: BOD 37.
2. Australian Institute of Health and Welfare 2019, Alcohol, tobacco & other drugs in Australia. Canberra: Government of Australia.
3. Whetton S, Allsop S, Tait R, Scollo M, Banks E, Chapman J, et al 2019 ‘Identifying the social costs of tobacco use in Australia in 2015/16’, National Drug Research Institute.
4. Banks E, Yazidjoglou A, Brown S, Nguyen M, Martin M, Beckwith K, et al. 2022, ‘Electronic cigarettes and health outcomes: systematic review of global evidence’, Canberra: Australian National University.
5. Consultative Council on Obstetric and Paediatric Mortality and Morbidity 2022, Victoria’s mothers babies and children 2020 report and presentations. Melbourne: State Government of Victoria.
6. World Health Organization 2022, Tobacco: poisoning our planet. Geneva: WHO.
7. Victorian Agency for Health Information 2022, Victorian Population Health Survey 2020. Melbourne: State Government of Victoria.
8. Australian Institute of Health and Welfare 2022, Australia's mothers and babies. Canberra: Australian Government.

The new Wellbeing in Victoria: A Strategy to Promote Good Mental Health (coming soon) will be a subset of the Victorian public health and wellbeing plan 2023–2027. It will focus on promoting and supporting wellbeing, and reducing the prevalence of mental distress, suicidality, alcohol and drug harms, while more fully supporting people’s journey through these challenges.

In 2022, we experienced the third year of the COVID-19 pandemic, with high case numbers and rises in the cost of living that were compounded by rising inflation and interest rate increases. The report from a survey conducted in 2022 found Australians’ subjective wellbeing showed a pattern of decline.¹ The average wellbeing score for people aged 18–25 years was the lowest in 21 years.¹

Shared benefits across priorities

By prioritising good mental health and wellbeing, we reduce stigma, increase social connection, improve physical health, promote productivity and create safer environments. Our mental health and our physical health are linked. People experiencing poor mental health may be at increased risk of poor physical health and developing chronic health conditions, such as diabetes and heart disease². Similarly, people with poorer physical health, including overweight and obesity, may be more likely to experience poorer mental health.³

Actions across a range of health and wellbeing priorities in a variety of settings can contribute to improvements in wellbeing. Taking action to improve healthy eating and active living, tackling climate change and its impacts on health, and reducing tobacco-related harm, are all shown to improve wellbeing and reduce the risk of developing a mental illness. For example, as little as 60 minutes of physical activity per week can prevent up to 17 per cent of incidents of depression.⁴

Being physically active, eating a healthy diet, quitting smoking and engaging with the natural environment also play an important role in improving health outcomes for people diagnosed with a mental illness.^{5, 6, 7}

Improving health equity

The Wellbeing Strategy will be underpinned by principles of equity and focus on actions beyond the mental health care system. It will be complemented by:

• a Diverse Communities Framework and Blueprint, which moves beyond prevention and promotion to include treatment, care and support in the mental health care system
• a Suicide Prevention and Response Strategy, which takes a specific lens of, and response to, suicidality and suicidal crisis.

All three of these strategies were recommendations of the Royal Commission into Victoria’s Mental Health System.

Driving action to improve wellbeing

Wellbeing is a key determinant of overall health, and is a complex combination of a person's physical, mental, emotional and social health factors. A strong sense of wellbeing contributes to good mental health. Actions that support high levels of wellbeing are a major driver of social and economic prosperity, contributing to better learning, increased creativity, greater productivity, better quality relationships, improved physical health and longer life expectancy.^{8, 9}

As the determinants of wellbeing lie beyond the mental health care system, a collaborative approach by whole-of-government, businesses and communities will be critical to effect lasting change in the places where we live, grow, learn, work and age.

What we want to achieve

The Wellbeing Strategy contains priority actions across a range of settings and sectors, which will respond to the wellbeing needs expressed by thousands of Victorians through extensive consultation.

These wellbeing needs are:

• Having our basic needs met before we can focus on other aspects of wellbeing.
• Feeling safe and being respected for who we are.
• Feeling connected to each other, our communities, cultures and spaces around us.
• Understanding how we can navigate our wellbeing through the ups and downs of life
• Having opportunities to create meaning in our lives.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Wellbeing in Victoria: A Strategy to Promote Good Mental Health (coming soon)
• Diverse Communities Mental Health and Wellbeing Framework and Blueprint for Action (coming soon)
• Victoria's Mental Health Reform Plan
• Victoria's Anti-Racism Strategy 2024-2029
• Victorian suicide prevention framework 2016–2025
• Victorian suicide prevention and response strategy 2024-34
• Victorian eating disorders strategy 2024-31

Outcomes

Outcomes for the Wellbeing Strategy will be linked to the Mental Health and Wellbeing Outcomes and Performance Framework, as well as to the Victorian public health and wellbeing outcomes framework:

• Outcome 1.2 Victorians have good mental health
• Outcome 1.3 Victorians act to protect and promote health
• Outcome 4.1 Victorians are socially engaged and live in inclusive communities.

Guidance for taking action to improve wellbeing

Evidence-based guidance, polices, strategies can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• Wellbeing Promotion Office
• Statewide wellbeing plan
• For guidance on mental health and wellbeing in schools, see Mental Health in Schools on the Department of Education website
• Workwell for resources to create mentally healthy workplaces.
• For small businesses, please see Business Victoria (see resources in languages other than English).

References

1. Crowe M, Capic T, Singh M, et al. Australians' subjective wellbeing in 2022: Climate change, mental distress, mood and social connection: Deakin University; 2023.
2. Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, et al. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019;81(3):265-80.
3. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220-9.
4. Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB, Silva ES, et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry. 2018;175(7):631-48.
5. Czosnek L, Lederman O, Cormie P, Zopf E, Stubbs B, Rosenbaum S. Health benefits, safety and cost of physical activity interventions for mental health conditions: A meta-review to inform translation efforts. Mental Health and Physical Activity. 2019;16:140-51.
6. Astell-Burt T, Feng X. Association of Urban Green Space With Mental Health and General Health Among Adults in Australia. JAMA Network Open. 2019;2(7):e198209-e.
7. Firth J, Solmi M, Wootton RE, Vancampfort D, Schuch FB, Hoare E, et al. A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360-80.
8. Maccagnan A, Wren-Lewis S, Brown H, Taylor T. Wellbeing and Society: Towards Quantification of the Co-benefits of Wellbeing. Social Indicators Research. 2019;141(1):217-43.
9. Kansky J, Diener E. Benefits of well-being: Health, social relationships, work, and resilience. 2017;1:129-69.

Good nutrition is essential for health and wellbeing because it helps achieve and maintain a healthy weight, protects against chronic disease (including cardiovascular disease, type 2 diabetes, dementia, and certain cancers), and supports a healthy immune system.

Poor diet, overweight and obesity are leading contributors to chronic disease and premature death in Victoria, accounting for 5.4 per cent and 8.4 per cent of preventable burden of disease respectively.¹

For infants and children, breastfeeding and healthy eating provides the nutrition required for optimal physical and cognitive development, and good oral health. High consumption of sugars is the main cause of tooth decay. Tooth decay can be prevented by reducing free sugar intake to less than 10 per cent of total energy intake, and ideally, reducing this even further minimises the risk of tooth decay throughout life.^2,3

Shared benefits across priorities

Diets that are consistent with Australian Dietary Guidelines are beneficial for health and have a lower carbon footprint which supports our environment.⁴ This includes diets high in vegetables and fruit, and wholegrains, and low in highly processed discretionary foods. Nutritious diets also have clear benefits for good mental wellbeing across all ages and stages of life.

Environments that support healthy eating will improve physical health, mental wellbeing and planetary health. This requires ensuring everyone has access to healthy, safe and more sustainable food.

Improving health equity

Supporting improved dietary intake and chronic disease prevention improves population health across the life course.⁵ Multiple strategies are needed to improve healthy eating across all age groups. Prioritising action in communities at greater risk of diet-related poor health is crucial to improving health equity.

For example, food insecurity is a continuing issue that has been worsened by the effects of COVID-19 pandemic and the rising cost of living.⁶ In 2020, one in four Victorian adults (25.6 per cent) were ‘definitely’ worried or ‘sometimes’ worried about running out of money to buy food.⁷

Driving action to increase healthy eating

Improving sustainable food systems and promoting healthy food environments will support more Victorians to adopt healthy diets and will improve the health of our environment.

Food environments influence the foods and drinks we buy and consume. Unhealthy food environments that provide easy access to prominently advertised and often cheap discretionary foods and drinks makes it harder to eat for good physical and mental health. Creating healthy food environments in public sector and community settings is a key strategy for improving healthy eating.

Our food system is made up of activities related to the production, processing, transport and consumption of food, and food waste and re-use. There are key challenges our food system faces, such as severe weather events, which are becoming more frequent and intense due to climate change. These events have resulted in interruptions to the delivery of affordable, safe and healthy food, at the same time as contributing to rising food prices.

As our food system continues to face challenges, biosecurity is crucial for preventing and managing the harms caused by pests and diseases. This will protect and enhance our food systems, communities and environments. We can protect our farms and parks, our pets and gardens, the cultural integrity of the landscape, the safety of our food and the success of our industries, by taking action to promote biosecurity in Victoria.

What we want to achieve

• Increase access, availability and consumption of a wide variety of nutritious foods such as fruit and vegetables, as recommended by the Australian Dietary Guidelines. ⁸
• Prioritise implementation of policies that promote the uptake of healthy foods and drinks in key public settings (including health services, schools, early childhood services, workplaces, sport and recreation settings and events).
• Reduce children’s exposure to marketing of discretionary foods and drinks to reduce consumption.
• Promote healthy and more equitable, sustainable food systems across Victoria, with a focus on priority populations.
• Scale evidence-based approaches that promote breastfeeding and support parents and caregivers to provide good nutrition for infants and young children throughout their first 2,000 days of life.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Victorian Action Plan to Prevent Oral Disease 2020–2030
• Healthy kids, healthy futures: Victoria's five-year action plan to support children and young people to be healthy, active and well.

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome 1.3 Victorians act to protect and promote health.

Guidance for taking action to increase healthy eating

Evidence-based guidance, polices, strategies and plans can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• Healthy eating guidance
• Healthy eating strategies, policies and guidelines
• Healthy kids, healthy futures
• Helping our learners eat well on the Department of Education website

References

1. Australian Institute of Health and Welfare 2021, Australian Burden of Disease Study 2018. Canberra: AIHW.
2. Moores CJ, Kelly SAM, Moynihan PJ 2022 ‘Systematic review of the effect on caries of sugars intake: ten-year update’, Journal of Dental Research: 101(9):1034–1045.
3. World Health Organization 2015, Guideline: Sugars intake for adults and children. Geneva: WHO.
4. Ridoutt B, Baird D, Hendrie GA 2021, ‘Diets within environmental limits: the climate impact of current and recommended Australian diets’, Nutrients: 13(4):1122.
5. Sacks G, Kwon J, Vandevijvere S, Swinburn B 2021, ‘Benchmarking as a public health strategy for creating healthy food environments: an evaluation of the INFORMAS Initiative (2012–2020)’, Annual Review of Public Health: 1;42:345–362.
6. Miller K, Li E 2022, Foodbank Hunger Report 2022. Yarraville: Foodbank Australia.
7. Department of Environment Land Water and Planning 2019, Victoria’s climate science report 2019. Melbourne: State Government of Victoria.
8. National Health and Medical Research Council 2013, Australian dietary guidelines. Canberra: Australian Government.

Active living supports everyone, at all stages of life, to live healthy, engaged and purposeful lives. Only half of Victorian adults meet the physical activity guidelines for sufficient physical activity (53.0 per cent of women, and 48.7 per cent of men). ¹

Regular physical activity is a well-known protective factor for preventing and managing chronic disease including cardiovascular disease, type 2 diabetes and certain cancers.² Physical activity also plays an important role in improving quality of life, managing and decreasing pain, and promoting mental wellbeing. ^{2, 3}

Physical activity is particularly important for children because it supports optimum development, learning and growth. It also establishes the patterns for a lifelong trajectory of active living.⁴

Physical activity is declining in children, and recreational screen time is increasing. Recreational screen time of two hours or more per day increased by 14.9 per cent between 2013 and 2021 for children aged 5–12 years old.⁵

Shared benefits across priorities

The benefits of active living extend beyond physical health. Regular physical activity (including active transport) improves mental health, helps to mitigate climate change, can reduce risk of injury and improve reproductive health.

The mental health benefits of regular physical activity can improve self-esteem, mood and sleep quality. ^{3, 6} Evidence also shows that spending time in green spaces and connecting with nature improves mental wellbeing by reducing anxiety and depression and can provide opportunities for social interaction and community connections. ^{7, 8}

Active transport modes such as walking and riding work to mitigate climate change through reducing traffic congestion, lowering carbon emissions from transport and improving air quality.^{9, 10}

Improving health equity

Active living should be culturally appropriate, accessible, and inclusive for all Victorians. There are clear opportunities to advance equity by prioritising Victorians who face added barriers to living an active life. This includes women and gender diverse people, senior Victorians, people from lower socioeconomic backgrounds, Victorians with disability, Aboriginal Victorians, people with health conditions or physical limitations and multicultural and multifaith communities.¹¹

Being physically active as we age is important for maintaining mobility and independence and can help improve and maintain cognitive function, memory and attention, lower the risk of dementia, and maintain independent living for longer. ^{11, 12, 13} Providing active transport options can offer opportunities for community connections and reduced social isolation.

For women and LGBTIQA+ communities, safety is a key driver of participation in outdoor physical activity. ^{14, 15} Action to promote safe environments and to decrease racism can enable women, particularly multicultural and multifaith women, to be active in public spaces and neighbourhoods, and increase public transport use. ^{16, 17}

Driving action to increase active living

Taking action to ensure both our built environments and natural environments are healthy, safe, inclusive and accessible, will support more Victorians to be physically active.

Integrating healthy design principles into land-use planning supports physical activity (and connectivity) through the creation of infrastructure and by ensuring available amenities in our parks and open spaces. ¹⁸

Reducing barriers to being physically active in our natural environment is also important. Regreening urban areas and increasing access to safe open spaces can promote liveability and increase local biodiversity. ¹⁹ This also helps to reduce the urban heat island effect and mitigate against the health related impacts of climate change.

What we want to achieve

• Integrate healthy design principles into land-use planning to ensure improved health and wellbeing by increasing levels of physical activity through active transport modes, such as walking and riding.
• Improve safe access to parks, public open spaces and recreation opportunities in nature and provide opportunities for Victorians to connect with nature.
• Promote movement and reduce sitting time in workplaces, schools, at home and during leisure time.
• Increase participation in sport and active recreation, with a focus on Victorians who face barriers to participation

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Strategy for walkable Communities (for release 2023–24)
• Active Victoria 2022-26 – A strategic framework for sport and active recreation
• Victorian Health Building Authority Universal Design Policy

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome: 1.3: Victorians act to protect and promote health.

Guidance for taking action to increase active living

Evidence-based guidance, polices, strategies and plans can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• Active living guidance on actions to increase active living across all settings.
• Physical activity guidelines and initiatives to support health and wellbeing
• Access the Victorian Government’s Healthy kids, healthy futures five-year action plan to support children and young people to be healthy, active and well.
• See Plan Victoria for the state-wide vision for how Victoria will grow over time.
• See Department of Transport and Planning to find out more about active transport, including walking and cycling.
• See Sport and Recreation Victoria to find out more about community sports.
• See Department of Education to find out more about active schools.

References

1. Victorian Agency for Health Information. Victorian Population Health Survey 2019 Melbourne; 2020.
2. World Health Organization 2022, Physical activity. Geneva: WHO.
3. Posadzki P, Pieper D, Bajpai R, Makaruk H, Könsgen N, Neuhaus AL, et al 2020, ‘Exercise/physical activity and health outcomes: an overview of Cochrane Systematic Reviews’, BMC Public Health: 20(1):1724
4. Chaput J-P, Willumsen J, Bull F, Chou R, Ekelund U, Firth J, et al 2020, ‘WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: summary of the evidence’, International Journal of Behavioral Nutrition and Physical Activity: 17(1):141.
5. Department of Education and Training 2023, Victorian child health and wellbeing Survey 2021. Melbourne: State Government of Victoria.
6. Twohig-Bennett C, Jones AP 2018, ‘The health benefits of the great outdoors: a systematic review and meta-analysis of greenspace exposure and health outcomes’, Environmental Research: 166:628–637.
7. Astell-Burt T, Feng X 2019, ‘Association of urban green space with mental health and general health among adults in Australia’, JAMA Network Open: 2(7):e198209-e.
8. Geneshka M, Coventry PA, Cruz J, Gilbody S 2021, ‘Relationship between green and blue spaces with mental and physical health: a systematic review of longitudinal observational studies’, International Journal of Environmental Research and Public Health: 18.Brand C, Dons E, Anaya-Boig E, Avila-Palencia I, Clark A, de Nazelle A, et al 2021, ‘The climate change mitigation effects of daily active travel in cities’, Transportation Research Part D: Transport and Environment: 93:102764.
9. Brand C, Dons E, Anaya-Boig E, Avila-Palencia I, Clark A, de Nazelle A, et al 2021, ‘The climate change mitigation effects of daily active travel in cities’, Transportation Research Part D: Transport and Environment: 93:102764.
10. Mizdrak A, Blakely T, Cleghorn CL, Cobiac LJ 2019, ‘Potential of active transport to improve health, reduce healthcare costs, and reduce greenhouse gas emissions: a modelling study’, PLoS One: 14(7):e0219316.
11. Australian Institute of Health and Welfare 2018, Physical activity across the life stages. Canberra: AIHW. Cat. no. PHE 225.
12. Australian Institute of Health and Welfare 2022, Dementia in Australia. Canberra: AIHW. Cat. no. DEM 2.
13. Iso-Markku P, Kujala UM, Knittle K, Polet J, Vuoksimaa E, Waller K 2022, ‘Physical activity as a protective factor for dementia and Alzheimer’s disease: systematic review, meta-analysis and quality assessment of cohort and case–control studies’, British Journal of Sports Medicine: 56(12):701–709
14. Johnson M, Bennett E 2015, Everyday sexism: Australian women’s experiences of street harassment. Canberra: The Australia Institute.
15. Hill A, Bourne A, McNair R, et al 2020, Private lives 3: the health and wellbeing of LGBTIQ people in Australia. La Trobe University: Australian Research Centre in Sex, Health and Society.
16. Ben J, Elias A, Issaka A, Truong M, Dunn K, Sharples R, et al 2022, ‘Racism in Australia: a protocol for a systematic review and meta-analysis’, Systematic Reviews: 11(1):47.
17. Ma L, Liu Y, Cao J, Ye R 2022, ‘The impact of perceived racism on walking behavior during the COVID-19 lockdown’, Transportation Research Part D Transportation Environment: 109:103335.
18. National Heart Foundation of Australia 2023, Healthy active by design. Available from: https://www.healthyactivebydesign.com.au/.
19. Kelly D, Davern M, Farahani L, Higgs C, Maller C 2022, ‘Urban greening for health and wellbeing in low-income communities: a baseline study in Melbourne, Australia’, Cities: 120:103442.

Consumption of alcohol and other drugs (AOD) is a significant preventable cause of disease and death in Victoria. It is associated with a wide range of health and wellbeing impacts.

While the impacts of drug use on health and wellbeing can vary, related harms can impact physical health through increased risk of chronic disease, exposure to infectious diseases, and mental health and wellbeing impacts.¹

Shared benefits across priorities

The drivers of AOD use are complex and interact with many other health outcomes and determinants of health. AOD-related harm often co-exists with poor mental health and wellbeing.² Actions to improve mental health and wellbeing can reduce AOD-related harms as they are inextricably linked through shared risk and protective factors.

Reducing AOD-related harms has broad-reaching benefits across many areas of public health and wellbeing. This includes reducing the spread of blood-borne viruses, physical and mental impairments associated with drug overdoses, and may help prevent family violence and decrease the number of road incidents associated with AOD use.³

Improving health equity

AOD use has complex biological and social determinants, and affects individuals, families and communities in different ways. Some groups are affected more than others, particularly Aboriginal Victorians, people with co-occurring mental health conditions, LGBTIQA+ communities and people in contact with the criminal justice system.^{3, 4} For example, improving health equity for Aboriginal people living in Victoria includes supporting AOD services that are culturally safe, and strengthening community-led services to address the determinants of AOD use. ⁵

Driving action to reduce harm from AOD

Over the next four years, we will increase service capacity and capability, and drive contemporary, holistic health-led responses to reduce harm from AOD. We will also continue to integrate mental health and AOD services for people with co-occurring needs.

There were 1031 overdose deaths in Victoria over the period July 2020 – June 2022 and 75 per cent of these deaths were determined to be unintentional. ⁶ Pharmaceutical drugs contributed to three-quarters of all deaths due to overdoses during this period. ⁶

For adult men and women, the risk of dying from alcohol-related disease and injury remains below 1 in 100, if no more than 10 standard drinks are consumed each week, and no more than four standard drinks are consumed on any one day. ⁷ The long-term risk of alcohol-related disease and injury can be lowered by drinking less often and drinking less on each occasion.⁷

What we want to achieve

• Provide contemporary and holistic health-led responses to AOD use that reduce stigma, increase help-seeking and reduce preventable harms.
• Continue to integrate AOD and mental health services to support people living with mental illness and substance abuse or addiction.
• Offer safe and accessible treatment options that are responsive to individual needs and support better outcomes for people and their communities.
• Increase accessibility by implementing targeted health-led responses to AOD harm, including new public intoxication responses, continuation of the medically supervised injecting service, and public health warnings enabled by drug surveillance activity.
• Reduce the risk of overdose by supporting increased access to opioid pharmacotherapy and naloxone.
• Drive increased knowledge and awareness of what makes a safe and accessible AOD service, including evaluation and research, as part of the Alcohol and Drug Research Innovation Agenda.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Wellbeing in Victoria: A Strategy to Promote Good Mental Health 2024–2034
• National Drug Strategy 2017–2026
• Balit Murrup: Aboriginal social emotional wellbeing framework 2017-2027
• National Preventive Health Strategy 2021–2030

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome 1.2 Victorians have good mental health
• Outcome 1.3 Victorians act to protect and promote health.

Guidance for taking action to reduce harm from alcohol and drug use

Evidence-based guidance, polices, strategies and plans can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• Prevention and harm reduction.
• Alcohol and Other Drug policy, research and legislation including guidance for service delivery and catchment planning.
• Drug alerts for information about high risk drug products that may be circulating in Victoria.
• Guidance on the role of the Mental Health and Wellbeing System in reducing alcohol and drug related harms.
• Health based response to Public Intoxication
• Alcohol and other drugs in schools on Visit the Department of Education website

References

1. Australian Institute of Health and Welfare 2023, Illicit drug use. Canberra: AIHW. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/illicit-drug-use#h….
2. Degenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, et al 2018, ‘The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2016’, The Lancet Psychiatry: 5(12):987–1012.
3. Department of Health and Aged Care 2017, National drug strategy 2017–2026. Canberra: Australian Government.
4. Hill A, Bourne A, McNair R, et al 2020, Private lives 3: the health and wellbeing of LGBTIQ people in Australia. La Trobe University: Australian Research Centre in Sex, Health and Society.
5. Aboriginal Health and Wellbeing Partnership Forum 2023, Victorian Aboriginal health and wellbeing partnership agreement action plan 2023–2025. Melbourne: VACCHO and the Victorian Department of Health.
6. Coroners Court of Victoria 2022, Victorian overdose deaths. Quarterly update to June 2022. Melbourne: Coroners Court of Victoria.
7. National Health and Medical Research Council 2020, Australian guidelines to reduce health risks from drinking alcohol. Canberra: National Health and Medical Research Council.

Climate is a key determinant of health that affects other determinants and health equity. Climate change affects health in many ways – both directly and indirectly. Direct impacts include morbidity and mortality associated with extreme events such as heatwaves, floods, drought and bushfires. Indirect impacts are associated with ecological and land-use change (including changes in the spread of infectious diseases), along with worsening air, food and water quality.^{1, 2, 3}

Our climate is changing due to greenhouse gas emissions, which are causing a rise in average global temperatures and disruption of ecosystems. In Victoria, climate change is evident through increasing average temperatures, decreasing average rainfall and an increase in fire danger.⁴ Without significant action to reduce emissions locally and globally, the changes to our climate will become more extreme.⁵

There are opportunities to improve the health and wellbeing of Victorians at scale. Strategies to reduce emissions, mitigate the future impact of climate change and support adaptation are important in preventing the harms that climate change can have on people’s health.

Shared benefits across priorities

Both climate change mitigation and adaptation-focused activities can create conditions that have benefits across a range of health and wellbeing priorities.

For example, initiatives to improve active transport, such as walking and riding, can help mitigate climate change impacts by:

• reducing transport-related emissions
• producing shared benefits through improving air quality
• increasing opportunities for physical activity.⁶

Initiatives focused on improving equitable access to safe and healthy food, and the sustainability of food systems will help to mitigate emissions and deliver health and wellbeing benefits. Action to reduce emissions may also contribute to improvements in mental wellbeing, particularly for young Victorians affected by climate anxiety.

A greater focus on collaborative efforts to improve the health of our environment through climate action will minimise the impact of changing patterns of communicable diseases and will help manage the threat of increasing antimicrobial resistance in the community.

Improving health equity

Climate change is widens existing inequalities, and disproportionately impacts the health and wellbeing of those more vulnerable.

For example, people who are financially disadvantaged are more likely to be affected by the impacts of climate change, as they are more likely to live in areas prone to extreme weather events, more likely to live in poor quality or insecure housing, and less likely to be able to afford cooling and heating and insure their homes.⁷

There are significant opportunities to work across government and with priority communities to drive system change and share benefits in key areas, such as food, water, planning, transport, education and emergency management, to tackle climate change and its impacts on health, while also reducing inequity.

Driving action to tackle climate change and its impacts on health

Our health and wellbeing depend on a healthy environment. A safe climate, access to clean water, good quality air, safe and nutritious food, and healthy, natural environments, are essential for good health and wellbeing.³

Climate change is already affecting the health and wellbeing of many Victorians. For example, climate change is contributing to changes in the spread and distribution of disease-causing pathogens and vectors. In 2022, Victoria responded to two significant public health incidents caused by pathogens that are considered unique public health threats for the state – mpox (monkeypox) and Japanese encephalitis – while also managing an increase in people affected by other mosquito-borne diseases associated with flooding events.

Fast action is needed to make rapid, significant cuts in greenhouse gas emissions and to adapt to climate change. Further delays risk missing a rapidly closing window of opportunity to secure a liveable and sustainable future.⁸

What we want to achieve

• Increase action to reduce greenhouse gas emissions across systems at the scale and pace required to reduce the impacts on health and wellbeing and realise associated health co-benefits.
• Create resilient and safe communities that can adapt to the public health impacts of climate change.
• Accelerate action to support communities to adapt to climate change and its impacts on health.
• Share successes and promote good practice examples of climate action.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Health and human services climate change adaptation action plan 2022–2026
• Victoria’s Air Quality Strategy
• Regional climate change adaptation strategies
• Protecting Victoria’s Environment – Biodiversity 2037

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome 5.1 Victorians belong to resilient and liveable communities
• Outcome 5.2 Victorians have access to sustainable built and natural environments.

Guidance for taking action to tackle climate change and its impacts on health

Evidence-based guidance, policies, strategies and plans can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• Guidance and information, including specific guidance to support local councils to tackle climate change and its impacts on health through municipal public health and wellbeing planning.
• Access information on the climate and health pathway available through Victoria’s Achievement Program, which aims to create healthier early childhood services, schools and workplaces.
• Visit the Department of Energy, Environment and Climate Action for information on state-wide climate action as well as guidance to support local action.
• Visit Climate Change in Australia for climate information, projections, tools and data, including the latest Victorian Climate Projections reports and fact sheets.

References

1. Department of Families, Fairness and Housing 2022, Health and human services climate change adaptation action plan 2022–2026. Melbourne: State Government of Victoria.
2. Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, et al. 2015, 'Health and climate change: policy responses to protect public health', Lancet, 386(10006):1861–1914.
3. World Health Organization 2021, Climate change and health. Geneva: WHO.
4. Department of Environment Land Water and Planning 2019, Victoria’s climate science report Melbourne: State Government of Victoria.
5. The Bureau of Meteorology 2022, State of Climate 2022. Canberra: Australian Government.
6. Buse CG, Patrick R 2020, ‘Climate change glossary for public health practice: from vulnerability to climate justice’, Journal of Epidemiology Community Health: 74(10):867–871.
7. Friel S 2022, ‘Climate change, society, and health inequities’, Medical Journal of Australia: 217(9):466–468.
8. Intergovernmental Panel of Climate Change 2022, Climate Change 2022: impacts, adaptation and vulnerability. United Nations: IPPC.

People who experience violence are affected in all areas of their health and wellbeing, including poorer physical, sexual and reproductive health outcomes, reduced mental wellbeing and sometimes loss of life.

Violence takes many forms including physical, emotional, psychological, financial and sexual violence. It also includes coercive control, intimate partner violence, elder abuse or actions that limit someone’s freedom and independence.¹

Violence is largely a gendered issue, perpetrated overwhelmingly by men against women.² Women experience higher rates of violence including sexual violence, stalking and sexual harassment.

Hospital admission rates due to assault are higher for men. But many women do not present to hospital, or present for other reasons when they experience family or sexual violence. Therefore, women are under-represented in hospital admissions data.³

Shared benefits across priorities

Family violence and sexual violence is a significant public health issue. The trauma of family violence and sexual violence can impact a person’s ability to work, their financial security and access to safe, affordable housing. Family violence can affect children’s emotional, behavioural and social wellbeing, including attendance and achievements at school.

Violence also affects sexual and reproductive health outcomes for women, who are at increased risk of violence at particular life stages, including while pregnant or while separating from a relationship.⁴

AOD use has a significant influence on the incidence rate of violence in our communities, and action to reduce these harms will result in better outcomes for Victorians, including reducing rates of community, family and sexual violence.

Family violence and violence against women increases during and after a natural disaster or crisis such as bushfires or floods.⁵

Improving health equity

Some groups are at higher risk of all types of violence. Evidence is emerging that this may be due to social beliefs and practices, gender stereotyping, norms and structures, including economic inequality between men and women. Barriers that reduce people’s ability to seek assistance increase the likelihood that victim survivors remain unsafe, unsupported and at a higher risk of violence.

Aboriginal women and Aboriginal children are at higher risk of violence compared with other Victorians. ⁶ The cumulative effects colonialisation and individual, institutional and structural violence, bullying and racism over the generations have contributed to widespread poverty, disadvantage, pervasiveness of family violence and the severity of its impact on Aboriginal people today. ⁷

Senior Victorians are at risk of elder abuse, an area of family violence requiring targeted action. This type of family violence is perpetrated against older people, usually by a family member.⁹⁸

Driving action to prevent all forms of violence

The public health system needs to address the determinants of violence at a structural level. Actions to promote gender equality, positive attitudes towards ageing, and the right for all Victorians to be treated with respect and dignity, are crucial for preventing all forms of violence, and will benefit all Victorians, regardless of age, sex or gender. Strengthening statewide and local partnerships will deliver better outcomes in line with national and statewide strategies that aim to prevent family violence.

What we want to achieve

• Build a community-wide approach to preventing family, sexual and gendered violence to ensure every Victorian is treated equally with respect and dignity.
• All Victorians who experience violence receive the support they need when they need it, and work with people who use violence and hold them to account for their behaviour.
• Victorians experiencing violence can access culturally safe supports and services that are free from stigma, racism and discrimination and are empowered to make decisions about their safety and wellbeing.
• Work with men and boys to change attitudes and behaviours that can lead to violence and engage all Victorians in practical and creative ways to learn about respectful, safe and equitable relationships.
• Embed Aboriginal-led prevention and responses to victim survivors of violence.
• Identify and respond to cultural, social and technological shifts and their impact on the nature of family and sexual violence and prepare to respond to new forms of perpetration of family violence.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• The National Plan to End Violence against Women and Children 2022–2032
• Ending Family Violence – Victoria’s Plan for Change
• Free from violence – second action plan 2022–2025
• Victorian primary prevention of elder abuse framework (for release in 2023–24)
• Dhelk Dja: Safe Our Way – Strong Culture, Strong Peoples, Strong Families 2018–2028.

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome 2.1 Victorians live free from abuse and violence.

Guidance for taking action to prevent all forms of violence

Evidence-based guidance, polices, strategies and plan are provided below. Action in these areas will help to prevent all forms of violence and improve the health and wellbeing of Victorians.

This guidance can be used across all settings, particularly local council who have a responsibility to prepare Municipal Public Health and Wellbeing Plans.

• For guidance on family violence and violence against women, visit Respect Victoria and Family Safety Victoria.
• Visit the Department of Families, Fairness and Housing for information on family violence support services and violence prevention programs for people who have experienced family violence.
• Gender inequality is a driver of violence against women. Access Our equal state: Victoria’s gender equality strategy and action plan, Victoria’s roadmap for the next four years of action in gender equality.
• For guidance on elder abuse, visit Seniors Online Victoria.
• Resources are available for multicultural and multifaith communities are available from Ethnic Communities’ Council of Victoria.
• Visit MAV for family violence prevention resources specific to local councils.

References

1. Government of Victoria 2022, Free from violence second action plan (2022–2025). Melbourne: State Government of Victoria.
2. Department of Education 2019, Victorian Student Health and Wellbeing Survey: summary findings 2018. Melbourne: State Government of Victoria.
3. Victorian Department of Health 2022, Victorian women’s sexual and reproductive health plan 2022–30. Melbourne: State Government of Victoria.
4. Department of Families, Fairness and Housing 2020, Family violence reform rolling action plan 2020–2023. Melbourne: State Government of Victoria.
5. Victoria FS 2019, Nargneit Birrang: Aboriginal holistic healing framework for family violence. Melbourne: State Government of Victoria.
6. Victorian Injury Surveillance Unit 2022, Injury deaths Victoria 2017–2019. Melbourne: Monash University.
7. Australian Human Rights Commission 2021, Elder abuse. Available from: https://humanrights.gov.au/elderabuse.

Antimicrobial resistance (AMR) is a growing threat in Victoria, across our nation and globally. AMR affects the health of all humans and animals.

While antimicrobial medicines such as antibiotics, antivirals and antifungals have saved millions of human and animal lives, wide overprescribing and misuse have contributed to AMR.

AMR refers to when microorganisms that cause infections (bacteria, fungi, viruses and parasites) cannot be treated properly, because they have developed resistance to antimicrobial medicines, such as antibiotics.

Microorganisms that have become resistant to antimicrobials can spread quickly through people and animals, and spread through food, soil and water systems.

As a result of AMR, antimicrobial medicines are less effective. This means that common infections such as urinary tract infections and pneumonia have become even harder to treat. Taking action to reduce AMR will help antimicrobial medicines remain effective against infections.

In many countries, antimicrobials have been widely used in animal production, not only to improve animal health, but also to enhance animal growth rates and raise agricultural productivity. The use of antimicrobials, however, can lead to AMR and the transmission of resistant genes and bacteria between species. This compromises animal welfare, reduces food production and food security, increases food safety concerns and can result in economic losses to farmers. The greater the use of antimicrobials, the greater the risks and consequences.

Shared benefits across priorities

Reducing AMR can drive improvements across other public health and wellbeing priorities such as sexual and reproductive health. The bacteria that cause gonorrhoea (an STI) is becoming more resistant to the common antibiotics used for treatment, and is an emerging issue here in Victoria, Australia and globally.¹ AMR is linked with climate change, including via bacterial growth rates associated with higher temperatures. ²

Improving health equity

Victorian health services are already affected by AMR. From 2018 to 2021, there were 35 outbreaks of a resistant organism in Victorian hospitals and long-term residential care facilities. While AMR can affect anyone at any age, people in aged care facilities are particularly vulnerable, due to the higher rate of certain types of infections, weakened immune systems, multiple comorbidities and close living proximities. AMR can lengthen recovery, result in longer hospital stays and possibly death.

The use of antimicrobial medicines is decreasing in Australia, and this helps us fight AMR, however we are still behind other developed countries. ³ Evidence shows that in Australia, antimicrobial medicines are used the most in lower socioeconomic areas. This may be due to higher rates of susceptibility to infectious diseases or misuse of antimicrobial medicines. ⁴

Driving a One Health and planetary health approach

The early stage of the COVID-19 pandemic showed us the impacts of having infections we cannot treat. Climate change, population growth, international travel and the global economy are all intertwined challenges that are increasing the effects of AMR and communicable disease threats more broadly.

Coordinated, longer-term actions are needed to ensure antimicrobial medicines are used appropriately to stay effective. A ‘One Health’ approach is required to address AMR. This involves:

• working and listening closely to communities
• taking coordinated action across all sectors where antimicrobials are used
• collaboration with global entities seeking to reduce AMR and protect animal, human and planetary health.⁵

What we want to achieve

• Increase awareness and understanding of AMR across human health, animal health, food production and environmental sectors.
• Strengthen surveillance systems and research on antimicrobial resistance across human, animal and environmental sectors.
• Develop comprehensive, consistent and evidence-based policies and interventions with cross-sector and sector-specific priorities to reduce antimicrobial resistance.
• Embed optimal antimicrobial usage and stewardship practices across human and animal health sectors.
• Establish a planetary health approach, including a One Health methodology, towards AMR surveillance and response.

Targeted strategies

Implementation occurs through statewide, regional and local partnerships to drive collective action aligned with:

• Victorian antimicrobial resistance strategy 2023–2033 (for release in 2023–24)
• Australia’s National Antimicrobial Resistance Strategy – 2020 and beyond

Outcomes

Prevent and mitigate the negative impacts of antimicrobial resistance on human and animal health in Victoria.

Guidance for taking action to reduce antimicrobial resistance across human and animal health

Evidence-based guidance, polices, strategies can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

• See the Australian Government for guidance on how reducing AMR across multiple settings and to access Australia’s National Antimicrobial Resistance Strategy.
• Antimicrobial Resistance - Victoria's response
• Department of Agriculture for guidance on reducing AMR across livestock and animals.

References

1. Department of Health 2022, Victorian sexually transmissible infection (STI) plan 2022–30. Melbourne: State Government of Victoria.
2. Magnano San Lio R, Favara G, Maugeri A, Barchitta M, Agodi A 2023, ‘How antimicrobial resistance is linked to climate change: an overview of two intertwined global challenges’, International Journal of Environmental Research Public Health: 20(3).
3. Australian Commission on Safety and Quality in Health Care 2019, Antimicrobial medicines dispensing from 2013–14 to 2017–18. Canberra: ACSQHC.
4. Review on Antimicrobial Resistance 2014, Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. United Kingdom: Wellcome Trust.
5. World Health Organization 2021,Tripartite and UNEP support OHHLEP’s definition of ‘One Health’. Geneva: WHO.

Injury is a complex public health issue that covers a broad range of causes. These include unintentional injury from falls, transport, sport and recreation, drowning, poisoning, burns and consumer product injuries. Injury may also be intentional due to suicide, self-harm and all forms of violence.

Injury is a major cause of morbidity and mortality across the world. It is both predictable and preventable.¹ The impact of injury and associated injury harms can be profound for individuals, families and communities, and may result in loss of income and productivity, reduced social participation, physical and psychological impairment. It can also affect daily living and quality of life.

Shared benefits across priorities

Injury prevention has many benefits across other public health priorities such as mental health, prevention of violence and road safety. For example, actions to reduce injury relating to road trauma also aim to increase physical activity, neighbourhood liveability, productivity and lower carbon emissions. Equally, tackling climate change can reduce the risk of injury associated with events such as bushfires, floods and heatwaves, along with other physical and mental harms.

Paired with good nutrition, strength training promotes good bone health, which reduces the risk of bone fractures from falls. Exercise programs that include strength and balance training have been demonstrated to reduce the rate of falls by 23 per cent in older adults living in the community and reduce the number of people experiencing one or more falls by 15 per cent.² Regular physical activity promotes active ageing by improving life expectancy and quality of life.

Improving health equity

Despite efforts to prevent falls in high-risk settings, including in the community, hospitals and residential aged care, the rates of death and hospitalisation due to falls-related injury continues to rise, especially among female Victorians aged 65 years and over.^3,4 The rate of admissions and emergency department presentations increases with age among older Victorian adults. Males account for 70 per cent of all unintentional injury deaths in people aged 65 years old and over. ³

Two-thirds of all Victorian drownings occur in open waters (rivers, creeks, beaches, lakes, dams and the ocean), and males account for 64 per cent of drowning deaths.⁵ Prevention approaches to encourage Victorians to safely enjoy recreation in and around water is needed to reduce the number of drownings and water-related injuries to zero.⁶

People living in rural and regional Victoria have lower life expectancy and a higher disease and injury burden than those living in major cities.⁷ Farm workers report worse mental health and are less likely to visit a general practitioner or mental health professional compared with non-farm workers, and have higher rates of suicide, compared with other occupations.⁸

Driving action to reduce injury

Targeted primary prevention approaches to falls and fall-related injury impacts are recommended. This is particularly the case in high-risk settings and for Victorians at high-risk of falls, such as older people in the community. We can prevent injury by encouraging safe behaviours, facilitating safe environments and reducing hazards. It is important to take a systems approach to coordinating evidence-based interventions, including creating safe environments and providing information on injury prevention and safety, alongside accessible health services for injury prevention and management.

What we want to achieve

• Decrease injury and associated harms across the Victorian population, with an emphasis on priority populations that are vulnerable to injury. These include children, young adults, older adults, Aboriginal Victorians, rural and regional communities and people experiencing socioeconomic disadvantage.
• Increase community awareness and education of injury prevention and safety risks to promote safe behaviours, proactive self-management of injury risks and reduction of hazards.
• Align action with national and statewide strategies, evidence-based interventions and best practice guidance to prevent falls and falls-related injury and promote healthy and active ageing.
• Continue delivering services that address safety, health and wellbeing for families and farmers in rural and regional communities and facilitate a culture of safety and positive health behaviours.
• Reduce injury, death and disability from road trauma and improve access to sustainable and active transport options.

Targeted strategies

Implementation occurs through statewide regional and local partnerships to drive collective action aligned with:

• Victorian Ageing Well Action Plan 2022–26
• National Injury Prevention Strategy 2020–2030
• National Road Safety Strategy 2021–2030
• Victorian Water Safety Strategy 2021–2025
• Victorian Road Safety Strategy 2021-2030

Outcomes

The Victorian public health and wellbeing outcomes framework:

• Outcome 1.1 Victorians have good physical health.

Guidance for taking action to reduce injury

Evidence-based guidance, polices, strategies and plans are linked below. These can be used by agencies involved in local and regional planning and service delivery (particularly local councils required to prepare Municipal Public Health and Wellbeing Plans under the Public Health and Wellbeing Act 2008).

To access injury data for your local area, visit the Victorian Injury Atlas.

Visit the Department of Health for falls prevention and healthy ageing and the Australian and New Zealand Falls Prevention Society.

Find a Victorian falls and balance service near you by using the Victorian Falls and Balance Directory.

For road safety visit the Department of Transport and Planning and the Transport Accident Commission. The current Road Safety Action Plan is now available.

For sport injury prevention visit Sport and Recreation Victoria.

For workplace safety and injury prevention visit WorkSafe Victoria.

For specific health and safety information for farmers and rural communities visit Agriculture Victoria, National Centre for Farmer Health and Farmsafe Australia.

Access Victorian Government information and resources on drowning prevention and water safety.

References

1. Australian Institute of Health and Welfare 2023, Injury in Australia. Canberra: AIHW.Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al 2019, ‘Exercise for preventing falls in older people living in the community’, Cochrane Database of Systemic Reviews: 1(1):Cd012424
2. Pham T, Hayman, J. 2023, Injury deaths Victoria 2018-2020. Edition 26. Melbourne: Victorian Injury Surveillance Unit, Monash University Accident Research Centre.
3. Hayman J, , Berecki-Gisolf J. 2023, Unintentional hospital treated injury Victoria 2021/22. Edition 27. Melbourne: Victorian Injury Surveillance Unit, Monash University Accident Research Centre..
4. Live Saving Victoria 2022, Victorian Drowning Report 2021/22. Melbourne: Life Saving Victoria.
5. Government of Victoria. Victorian water safety strategy 2021–25. Melbourne: State Government of Victoria.
6. Australian Institute of Health and Welfare 2021, Rural and remote health. Australia’s Health. Canberra: AIHW; 2022.
7. Brew B, Inder K, Allen J, Thomas M, Kelly B 2016, ‘The health and wellbeing of Australian farmers: a longitudinal cohort study’, BMC Public Health: 16(1):988.

The best available, relevant, and reliable evidence should be used to inform decisions regarding use of resources and selection of interventions that promote and protect public health and wellbeing.

Where a health risk poses a serious threat, lack of full scientific certainty should not be used as a reason to postpone measures to prevent or control the health risk.

The prevention of disease, illness, injury, disability, and premature death is preferable to remedial measures. Capacity building and other health-promotion activities are central to reducing differences in health status and promoting the health and wellbeing of the people of Victoria.

Decisions relating to the Act should be made in transparent, systematic and appropriate ways that include promoting a good understanding of public health issues to Victorians. Victorians should be given access to reliable information in ways that are easily understood and have opportunities to be involved in policy and program development.

Decisions that are made and actions that are taken relating to the Act should be proportionate to the identified health risk sought to be prevented, minimised or controlled.

Collaboration: Public health and wellbeing, in Victoria and at the national and international levels, can be enhanced through collaboration between all levels of government and industry, business, communities and individuals.