Curriculum standards

Knowledge guides

LG17: Non-communicable diseases and conditions, prevention, and control

Key conditions

Advanced Trainees will have a comprehensive depth of knowledge of the epidemiology of non-communicable diseases and their risk factors, disease burden in populations, and prevention and control pathways.

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Cluster Investigation

Advanced Trainees will know the scientific foundation of disease cluster investigation. They will be able to interpret results from multiple lines of investigation (surveillance and routinely reported health data, environmental monitoring, and epidemiological study) and synthesise these to develop action plans.

Advanced Trainees will know how to communicate the investigation to individuals affected, relevant settings (e.g. workplaces, schools), families, community, the media, and to report to the relevant parties.

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Epidemiology

Advanced Trainees will know how to analyse surveillance data to support the management of chronic disease, mental illness and injury and their risk factors and to detect trends and events requiring an immediate response.

Advanced Trainees will know how to assess the public health impact of risk factors and interventions aimed at reducing the impact of non-communicable disease.

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Important specific issues

Advanced Trainees will identify important public health issues and the impact of these on the public health management of non-communicable diseases

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Conditions

Cancers
Cardiovascular disease
Chronic kidney disease
Chronic liver disease
Chronic lung disease, such as:
- chronic obstructive pulmonary disease
- lung fibrosis
Chronic pain
Injury, such as:
- intentional
- unintentional
Mental illness
Metabolic diseases, such as:
- type 2 diabetes
- obesity
Neurodegenerative diseases, such as dementia
Adverse reproductive outcomes, such as:
- fertility variations
- preterm or small for gestational age
- developmental issues (environmental injury)
- perinatal mortality and key infant outcomes, such as birthweight and infant mortality rates
- maternal morbidity / mortality
Relevant other non-communicable diseases, including those with inequitable distribution

Risk factors

Absence of social and emotional wellbeing
Alcohol
Drug abuse
Denial and abuse of human rights
Deprivation
Domestic violence
Inactivity and sedentary behaviour
Overweight / Obesity
Poor nutrition
Problematic gambling
Tobacco smoke and e-cigarette exposure
Other disease-specific risk factors

Prevention

Health promotion programs addressing risk factors, focusing on:
- building healthy public policy and legislation
- creating environments supporting health
- healthcare services and systems
- individuals and health literacy
- strengthening community action
Primordial, primary, secondary, and tertiary prevention
Relevant legislative frameworks
Relevant governmental / non-governmental organisations
Harm minimisation of tobacco, vaping and e-cigarettes, drugs, and alcohol, including:
- demand reduction
- harm reduction
- supply reduction
Priority populations:
- Aboriginal and Torres Strait Islander peoples
- Māori (tangata whenua)
- Pacific peoples
- homeless
- LGBTQIA+ people
- lower socioeconomic status
- people in custodial settings
- people experiencing unstable housing
- people who inject drugs
- people of refugee and/or asylum seeker background
- rural and remote
- youth

Public health management

Harm minimisation
Health promotion program development, implementation, operation, and evaluation
Mapping and collaboration with relevant stakeholders
Policy, advocacy, legislation, and regulatory change
Population health surveillance and screening
Transition to sustainable future

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

consider the impact of the situation on individuals, workplaces, family, and the wider community
dentify relevant epidemiology, disease sequelae, and public health prevention and control pathways

Manage

advise on evidence-based public health management
consider and advocate for intersectoral and multisectoral approaches to management
recognise potential complications of disease and their management, and initiate preventative strategies

Consider other factors

identify individual, social, cultural, environmental, and other health determinants, and legal responsibilities, in public health management of risk factors and conditions

Procedures

Establish known details to date
Decide whether to investigate further
Consult relevant documentation:
- cluster investigation protocol
Understand team functions
Engage with relevant stakeholders
Ensure effective management of cases is underway
Investigations, such as epidemiological investigation and exposure assessment:
- recognise limitations of study power, and the role of chance
- use appropriate analyses, such as Poisson and small area analyses
Recognise when to escalate or expand investigation
Ensure control of sources of risk, such as environmental pollution
Communicate to gather relevant public health information and disseminate findings and recommendations to a variety of audiences, including stakeholders, public, and the media, including effective oral and written communication

Monitor access and use of health technologies and interventions

Diagnostic services
Ethical, regulatory, and resource implications
Health care systems – private / public
Health insurance-based systems / Out-of-pocket costs
Pharmaceuticals
Public health implications of genetic factors and technologies, including their roles in:
- determining causality
- epidemiological research
- health care
- screening
Treatment services

Screening

Screening as a secondary prevention strategy
Features of organised population screening programs
Potential benefits and harms of population screening programs
Current and forthcoming programs in Australia / Aotearoa New Zealand
Criteria for introducing a new program in Australia / Aotearoa New Zealand
Implementation and delivery of programs
Evaluation, quality assurance, and improvement of programs:
- potential sources of bias in evaluation – volunteer, lead-time, length
- design of studies to evaluate programs

Surveillance

Descriptive epidemiology of health problems
Uses:
- detection of patterns of chronic disease, such as geographic and time trends
- future projections
- health advocacy
- identifying at-risk populations
- links to services, such as notifiable diseases
- monitoring and evaluation of interventions / public health programs
- research, such as generating research questions
- resource allocations
- health technologies and health care usage
Elements of a surveillance system:
- case definition
- confidentiality
- cycle of surveillance
- incentives to participation, such as for clinicians
- population under surveillance
Approaches to surveillance:
- active versus passive
- information systems
- laboratory-based surveillance
- notifiable disease reporting
- record linkage
- registries
- sentinel events
- surveys
Analysis of surveillance data:
- advanced techniques to adjust for sampling designs
- descriptive statistics
Attributes of surveillance systems:
- fit-for-purpose
- simplicity
- flexibility
- data quality
- acceptability
- sensitivity
- predictive value
- accuracy and completeness of descriptive information
- representativeness
- timeliness
- stability

Awareness and analysis of systems particularly as they relate to inequities:
- quality and safety, such as high morbidity and mortality around women’s health in regional, rural, or remote hospitals
Using an equity lens to understand and analyse public health issues and systems so everyone can attain their full potential for health and wellbeing