Melbourne School of Population and Global Health - Research Publications
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ItemThe Republic of Indonesia health system review(WHO Regional Office for South-East Asia, 2017)Overview: Government investment in health has increased in Indonesia over the past two decades, but it is still inadequate. The insufficient facilities and workforce needed for public services has encouraged the growth of private health facilities. While noncommunicable diseases (NCDs) are emerging as new priorities, problems of maternal and child health, nutrition and communicable diseases continue to persist. The progress on maternal mortality and communicable diseases has been slower, with maternal mortality remaining high (210 deaths per 100 000 live births in 2010), and continuing high incidences of tuberculosis (TB). Risk factors for NCDs, such as high blood pressure, high cholesterol, overweight and smoking are increasing. Indonesia remains the only country in Asia, and one of 10 worldwide, not to have ratified the WHO Framework Convention on Tobacco Control (FCTC). Indonesia also suffers from significant regional disparities in terms of health status and quality, availability, and capacity of health services. Despite this, indicators of overall health status in Indonesia have improved significantly over the last two and half decades, with life expectancy rising from 63 years in 1990 to 71 years in 2012; under-five mortality falling from 52 deaths per 1000 live births in 2000 to 31 deaths in 2012, and infant mortality falling from 41 deaths per 1000 live births in 2000, to 26 deaths in 2012. Indonesia has also experienced an increase in health infrastructure, including primary and referral health facilities, in the last two decades. Inpatient beds in both public and private hospitals as well as primary health centres (puskesmas) have increased. Human resources for health have also grown in the last two decades, with increases in health worker to population ratios. However, the ratios of hospital beds, puskesmas, and physician to population remain below WHO standards and lag behind other Asia-Pacific countries. Indonesia faces the challenge of increasing health expenditures, as nominal health spending has been steadily increasing in the last eight years, by 222% overall. Although there has been a substantial increase in health spending at the national level, health spending as a proportion of gross domestic product (GDP) remains below average among the low-to-middle-income countries (3.1% of GDP in 2012). The Government’s share of total health expenditure also remains low, at only 39%, whereas private, primarily out-of-pocket (OOP) expenditure, is 60%. Commencing in 2014, the government has introduced a national health insurance scheme (JKN: Jaminan Kesehatan Nasional) which progressively aims to expand coverage to cover the whole population by 2019. Moving forward, the challenge for the Government is to manage the expansion of this scheme, while addressing regional disparities in service quality and accessibility, managing resources effectively, containing costs and minimizing fraud, engaging the private sector, and maintaining investment in health promotion and prevention programmes.
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ItemDeveloping a Career Access Program (CAP) for people with intellectual disability in the Victorian public sector: The evidence base to inform the development and implementation of CAP(Department of Health and Human Services and The University of Melbourne, 2019)
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ItemEnvironmental scan of suicide prevention activity in Australia: Summary Report(Centre for Mental Health, University of Melbourne, 2023-07)The National Suicide Prevention Office provided a grant to the University of Melbourne’s Centre for Mental Health to conduct an environmental scan of the government-led suicide prevention system in Australia to contribute to its workplan, particularly its development of the National Suicide Prevention Strategy. The scan was conducted from August 2022 to January 2023, utilising three key methods: a review of documents, interviews with key informants, and a review of programs and services. Findings demonstrated that Australia’s suicide prevention efforts are significant but that there are many opportunities to further progress suicide prevention and response efforts.
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ItemSuicide Prevention Research Priorities: Final Report(Centre for Mental Health, University of Melbourne, and Suicide Prevention Australia, 2022)Background and aim: Suicide continues to be a major public health challenge in Australia with significant individual, community, and societal impacts. Targeted and timely research efforts are essential to effectively address this challenge in a rapidly changing world. Building on our earlier research priority setting exercise conducted in 2017, the present project aimed to inform future priorities in Australian suicide prevention research and identify shifts in research emphasis over time. Method: We examined current research priorities in Australian suicide prevention research by reviewing grants and fellowships funded and peer-reviewed journal articles published during 2017-2022, which were categorised according to an existing classification framework. We also surveyed key stakeholders with a known interest in suicide prevention research as to where future research emphasis should be placed and categorised their responses according to the same framework. Replicating the methodology from our earlier exercise, enabled us to contrast current and future research priorities and identify any shifts in research emphasis over time. Key findings: Overall research investment and publication output in Australian suicide prevention research has increased significantly in 2017-2022, with 393 journal articles published and 110 grants and fellowships funded to the tune of $45.1m. This represents more than a quadrupling of total research funding over a 5-year period and a 50% increase in annual publication output compared to our earlier exercise conducted over a 7.5-year period in 2010-2017. Recent research funding efforts are starting to manifest key changes in the types of research called for by stakeholders, while the associated evidence base is yet to fully materialise in publications. Notably, intervention studies (43%) emerged as the most frequently funded study type, while epidemiological research continued to dominate in published articles (59%). Mirroring stakeholder identified priorities, recent grants and publications reflected a relative shift in emphasis away from suicide and a greater focus on suicide attempts. Young people continued to be the most commonly researched target group. While digital and online settings featured strongly in research funding, stakeholders prioritised research in community settings. Four percent of articles and one quarter of grants noted the inclusion of people with lived experience or co-design. Conclusions: The recent boost in national research funding for suicide prevention is encouraging and commensurate with the significant scale of the task ahead to develop the evidence base and more effective solutions to address the persistent public health challenge of suicide in Australia. Research funding efforts are driving key changes in research emphasis called for by stakeholders, including a stronger emphasis on intervention research. While publications are also showing some positive signs, the required evidence base on effective interventions, protective factors, and social determinants is yet to fully materialise in this literature to support practice. To effectively address suicide in Australia in the future, it will therefore be important to maintain the overall thrust and direction of national research investment, coupled with a stronger emphasis on research translation. The present findings suggest that key priority areas for future suicide prevention research should address suicide attempts, protective factors, social determinants, community settings, and interventions, and focus on strengthening effective research translation into practice.
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ItemSHINE protocol for specifying model inputs, including rapid review and cross walking(University of Melbourne, 2023)
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ItemA socio-ecological exploration of adolescent violence in the home and young people with disability: The perceptions of mothers and practitioners(Australia's National Research Organisation for Women's Safety, 2022)An emerging body of research into adolescent violence in the home (AVITH) has signalled concerns about the disproportionate rates of young people with disability receiving family violence services and legal responses to violence at home (Campbell et al., 2020). However, research about AVITH has typically collapsed disability into binaries with children labelled as “disabled” or “not disabled”. Existing research often implies disability has a causal link to the use of violence and no attention is paid to the specific behaviours or the social and interactional context in which these behaviours arise. This project aims to begin filling this evidence gap. The publication signals the project’s second and final report. It shares findings from exploratory qualitative research to generate new knowledge about the intersections between AVITH and young people with disability. The intention is to begin to lay the foundations for sustained and nuanced dialogue about the issues and experiences of young people with disability and AVITH. The research team ran in-depth semi-structured interviews with mothers who had experienced AVITH and practitioners with direct experience working with young people with disability and AVITH. All participants were from metropolitan and regional areas of Victoria, Australia. Initial plans to speak with young people with disability themselves were reconsidered in response to Covid-19 lockdowns across Victoria. The research team acknowledges that the voices of young people remain missing from this field and will pursue avenues to centre their lived experiences in future research projects. The study found that current responses to AVITH tend to rely on models designed to address domestic and family violence (DFV). These models often understand the use of violence as an attempt to have power and control over another person. However, this did not always reflect mothers’ experiences. While many mothers and families had prior experiences of DFV and found the impacts of AVITH comparable, they perceived that young people with disability were using violence to control themselves rather than exert control over others. While mothers noted “pockets of good practice”, the study also identified wide multi-sectoral failures to effectively respond to the needs of children and young people with disability who use violence and their families. The study is part of a larger body of work funded by ANROWS focused on the experiences and impacts of domestic and family violence (DFV). Other projects include work on the DFV experiences of children with disability, the connections between DFV and mental health issues among children, the connections between adverse childhood experiences (ACES) and sexually harmful behaviours and offences among boys and young men, and strengthening service responses for Aboriginal and Torres Strait Islander children and women.
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