Public Health Funding Proposal: Cardiovascular Health

This public health funding proposal, titled "With love, from your Heart", addresses the critical need to improve cardiovascular health within Aboriginal and Torres Strait Islander communities in Australia. The proposal highlights the disproportionately high prevalence of cardiovascular diseases in this population, attributed to preventable risk factors like smoking, alcohol consumption, sedentary lifestyles, and social determinants such as socioeconomic disadvantage and limited access to healthcare. The project aims to reduce both biomedical (obesity, hypertension, hyperlipidemia) and behavioral (smoking, poor diet, lack of exercise) risk factors through a multifaceted approach. This includes a 3-month program incorporating exercise and nutrition classes, educational sessions on healthy behaviors, and advocacy for improved access to healthcare services, subsidized medications, and transportation. The project will target Indigenous Australians aged 18-64 residing in remote areas, with an initial cohort of 50 participants, and utilizes a detailed evaluation plan to assess the effectiveness of the interventions. The proposal emphasizes the importance of addressing social determinants, providing a comprehensive strategy to improve cardiovascular health outcomes, and seeking funding to implement and expand the program.

Running head: PUBLIC HEALTH PROPOSAL
PUBLIC HEALTH PROPOSAL
Name of the Student:
Name of the University:
Author note:

1PUBLIC HEALTH PROPOSAL
Abstract
It has been estimated by the Parliament of Australia, that one the key National Priority Areas is
the need to mitigate the rising prevalence rates of cardiovascular diseases across the nations.
Further, the key factors underlying as determinants of such high rates of cardiovascular diseases
have been attributed to preventable aspects such as smoking, alcohol, sedentary lifestyle and lack
of exercise. Aboriginal and Torres Strait Islander communities in Australia have been estimated
to possess greater susceptibilities towards cardiovascular disease acquisition due to greater
engagement in the above harmful behaviors along with prevalence of social determinants
associated with exclusion, income, employment and education. Hence, the following public
health funding proposal will aim to improve cardiovascular disease health in Indigenous
Australians through implementation of behavioral, educational, biomedical and advocacy
interventions.

2PUBLIC HEALTH PROPOSAL
Table of Contents
Background..........................................................................................................................2
Rationale..........................................................................................................................2
Determinants....................................................................................................................3
Project Details......................................................................................................................5
Project Plan..........................................................................................................................6
Strategies and Activities..................................................................................................6
Proposed areas of Funding...............................................................................................8
Evaluation Plan....................................................................................................................9
Process Evaluation...........................................................................................................9
Outcome Evaluation........................................................................................................9
Strengths, Limitations and Recommendations....................................................................9
References..........................................................................................................................11

3PUBLIC HEALTH PROPOSAL
Background
Rationale
According to the data presented as per the National Health Priority Areas Initiative
(NHAI), by the Parliament of Australia, it has been estimated that cardiovascular diseases
contribute to the largest number of deaths across the Australian population, at the prevalence rate
of 41.9% or 53, 989 deaths during the year 1996. During 1993-94, it was estimated that
cardiovascular diseases account as the group of diseases exerting the highest medical
expenditures at 12% or $3.719 billion [1]. Diseases associated with the cardiovascular system,
imply deficits in the functioning of the heart and associated circulatory processes, namely,
peripheral vascular disease, coronary artery disease and stroke [2]. Life threatening
cardiovascular diseases like stroke, are a major determinant of nearly 25% of all cases of
chronic, long term disability across Australia and may result in permanent, debilitating damages
such as partial or complete paralysis, communication difficulties and decreased ability to
perform basic social engagement or activities of daily living [1]. Hence, considering the
detrimental impact on quality of life due to such diseases coupled with their alarmingly high
prevalence factor, there is an immediate need to address this issue on a public and community
health level – hence, formulating a key rationale for the following public health proposal.
As postulated by the Heart Foundation, an estimated 12% of Australians reporting a
diagnosis of cardiovascular disease comprised of Aboriginal and Torres Strait Islander peoples or
Indigenous Australians. Further data reflects that Indigenous Australians have 20% greater
susceptibility of acquired cardiovascular diseases in comparison to non-Indigenous populations
[3]. Additionally, as addressed by the Australian Government, the underlying causes of such

4PUBLIC HEALTH PROPOSAL
cardiovascular diseases have been observed to be associated with biomedical or behavioral risk
factors which are reversible or preventable, such as: high blood cholesterol, high blood pressure,
smoking, consumption of alcohol, obesity, increased sedentary lifestyle and lack of adherence to
the Australian Physical Activity Guidelines [4]. According to the Heart Foundation, it was
estimated in 2012-2013 that almost 20% of Indigenous Australians were inflicted with
hypertension, which was 16% higher in comparison to non-Indigenous communities, at the age
of 18 and above. Additionally, 95% of Indigenous Australians admitted to smoking daily with
over 43% of such communities who are aged 15 years and above engaging in excessive smoking
– high number 2.4 times higher in comparison to Australians who are non-Indigenous. Over 29%
and 39% of Indigenous communities have been estimated to be overweight or obese, while 61%
of Indigenous Australians have been calculated to engage in sedentary lifestyles and lack of
physical activity engagement [3]. Hence, considering the high rate of Indigenous Australians to
engage in preventable risk factors as compared to non-Indigenous populations, the need of the
hour is to address immediate mitigation of cardiovascular diseases across this vulnerable
population - hence, forming the additional rationale for this public health proposal.
Determinants
The high rates of cardiovascular disease prevalence across Indigenous Australians can be
attributed to a number of social determinants – which imply factors at the social level which play
a key contribution in an individual’s and a community’s health status. In the case of Indigenous
Australians residing especially in remote areas, the key social determinants which may
contribute to their existing alarming cardiovascular status, can be attributed to low
socioeconomic position comprising of reduced income and social disadvantage and social
discrimination comprising of reduced employment, education and healthcare accessibilities [5].

5PUBLIC HEALTH PROPOSAL
According to the Australian Human Rights Commission, it has been estimated that Indigenous
Australians residing in remote areas with reduced accessibility, are socially more disadvantaged
and belong to a compromised socioeconomic position resulting in reduced accessibility to
healthcare services, appropriate housing and treatment infrastructure, adequate sewerage and
waste disposal systems and food and water sources which are free from contamination [6]. Such
social determining factors result in Indigenous Australians being increasingly susceptible to
infectious diseases and chronic health and metabolic conditions such as cardiovascular diseases.
Further, a key social determinant which can contribute to Indigenous Australians increased
susceptibility to chronic conditions such as cardiovascular diseases include social discrimination
and social exclusion [7]. This results in Indigenous Australians receiving reduced accessibility to
employment and educational opportunities, further resulting in reduced income and inadequate
levels of academic education which can prevent such communities from accessing or
comprehending healthcare resources providing information on cardiovascular disease implication
and prevention [8]. Further, increased social exclusion results in Indigenous Australians gaining
reduced accessibility to healthcare services resulting in adequate reporting, diagnosis, treatment,
prevention and management and hence, increased aggravation of cardiovascular symptoms [9].
Hence, considering the complex interplay of social determinants and health associated risk
factors resulting in compromised cardiovascular status among Indigenous Australians, especially
those living in remote areas or regions with reduced accessibility, and the emergence of a
National Priority Areas Initiative, there is need to immediately address such issues among such
populations in the form of a public health funding proposal plan.

6PUBLIC HEALTH PROPOSAL
Project Details
Project Title: “With love, from your Heart” – a public health funding initiative to
improve cardiovascular health status among Aboriginal and Torres Strait Islander communities
of Australia.
Expected Length: It is estimated that the public health plan will last for 3 months,
following the results and evaluation of which, a public health plan of longer duration may be
implemented.
Target Population: As evident from the previous discussion, the target population will
comprise of Indigenous Australian communities residing in remote areas - considering their
increased risk of social disadvantage [10]. Further, the target Indigenous population will
comprise of both males and females, with a mixed age group comprising of adults aged between
18 to 64 years. A total of 50 Indigenous Australians will be recruited for the public health plan,
after the implementation and evaluation of which, future public health plans with a larger
population may be implemented.
Project Aim/Goal: The aim of this public health project is to reduce the biomedical and
behavioral risk factors associated with cardiovascular diseases for the purpose of improving the
cardiovascular health status among Aboriginal and Torres Strait Islander Australians residing in
remote areas.
Objectives: Hence, in alignment with the above the primary goal identified, the public
health project will be implemented based on the following objectives:

7PUBLIC HEALTH PROPOSAL
1. To reduce the biomedical risk factors of cardiovascular diseases such as
overweight/obesity, hypertension and hyperlipidemia among Indigenous Australians
residing in rural areas, through implementation of nutritional and exercise interventions.
2. To reduce the behavioral risk factors of cardiovascular diseases such as smoking, alcohol,
nutritional imbalanced diet consumption and sedentary lifestyle among Indigenous
Australians in rural areas, through implementation of educational interventions.
3. To reduce the detrimental effect of social determinants contributing to the cardiovascular
diseases among Indigenous Australians in rural areas, through provision of voucher
facilities, subsidized healthcare and transport services.
Project Plan
Hence, considering the above identified details of the project, the following strategies and
activities will be implemented for successful outcomes of the public health funding plan.
Strategies and Activities
Biomedical Strategies: As discussed previously, it can be observed that cardiovascular
diseases across Indigenous communities primarily occur due to biomedical and physiological
aspects such as obesity, high blood pressure and high levels of cholesterol in the blood, the
effects of all of which can be reversed [11]. Obesity across individuals is associated with higher
rates of adipose tissue accumulation in body tissues resulting in fatty streak deposition across
blood vessels – key contributor in cardiovascular diseases. Such cardiovascular risk factors are
further aggravated in the presence of additional risks such as excessive levels of pressure and
cholesterol in the blood. Such symptoms, result in increased exertion on the heart and subsequent
susceptibility to cardiovascular diseases – hence, requiring immediate mitigation across the

8PUBLIC HEALTH PROPOSAL
Indigenous population [12]. It has been evidenced that an adherence to an moderate exercise plan
of 75 to 150 minutes per week as per the Physical Activity Guidelines by the Department of
Health, can reverse the effects of obesity and chronic metabolic conditions such as
cardiovascular diseases [13]. The above risk factors may also be reversed with the intake of a
balanced diet comprising of core food groups, recommended by the Australian Dietary
Guidelines [14]. Hence, considering the same and using demonstrative, kinesthetic and practical
teaching strategies, the proposed public health plan will comprise of Indigenous participants
being engaged in a exercises and nutrition activities. This will involve a 3 month long aerobic
exercise program delivered by a Fitness Practitioner and cooking classes discussing cost
effective, nutritious cooking as per the national recommendations, delivered by a nutritionist.
This will benefit the Indigenous participants by educating them on nutritious diet and cooking
strategies as well as exercise, resulting improved health literacy, engagement in healthy diet and
exercise habits and hence, the improved reduction in cardiovascular risk factors. [15].
Behavioral Strategies: It has been observed that due to socioeconomic disparities and
social exclusion, Indigenous Australians lack awareness on the harmful consequences and
increased susceptibilities to engagement health behaviors risky to cardiovascular health, such as
smoking and alcohol consumption, increased sedentary lifestyle engagement and decreased fruit
and vegetable and increased salt consumption. Hence, with the aid of reading and writing based
learning strategies, Indigenous participants will be engaged in educational activities [16]. This
will comprise of 3 month long group discussion based classes where a community nurse
practitioner and nutritionist will impart teaching on importance and strategies of cardiovascular
health maintenance and consequences of engagement in harmful health behaviors, using audio-
visual technologies and distribution of reading resources like procedures and handbooks. This

9PUBLIC HEALTH PROPOSAL
will benefit the Indigenous participants by improving their knowledge on risks underlying u u
unhealthy diet and lifestyle habits and strategies to improve them resulting in greater motivation
to engage in behaviours apt for optimum cardiovascular health [17].
Healthcare opportunities and Benefits: As evidenced by the discussion on social
determinants contributing to compromised cardiovascular condition, Indigenous Australians
have reduced accessibility and affordability to healthcare services and educational resources.
Hence advocacy based strategies will be implemented in the proposed public health program to
reduced the health effects of these apparently stark health disparities [18]. This will comprise of
the project assessor collaborating with healthcare organizations to provide discount vouchers,
separate healthcare establishments or separate community health professionals who can provide
subsidized cardiovascular services, medications, free health checkups and monitoring of body
weight, blood pressure and blood cholesterol to the residential areas of these Indigenous
populations considering their remote location and reduced healthcare accessibility [19].
Additional advocacy based strategies and activities will include collaboration with a community
support group who can advertise and advocate for employment opportunities in this population
as well as collaboration with ambulatory facilities of the previously identified healthcare
organization who can provide free of cost or subsidized transportation to these communities for
improved healthcare accessibility and quality of life. This will be benefit the participants by
reducing the health disparities associated with social exclusion and by improving their
accessibility to cardiovascular healthcare and educational resources [20].
Proposed areas of Funding
Hence, as observed from the above strategies and interventions, the proposed public
health intervention project for improved cardiovascular health across Indigenous Australians

10PUBLIC HEALTH PROPOSAL
residing in remote areas will require funding in various aspects of resource collection and health
professional recruitment [21]. Hence, funding will be required for the purpose of recruiting
health professionals like fitness practitioners, nutritionists, community health workers, nurses
and transport personnel. Funding will also be required for the purpose of obtaining educational
resources and equipment to be used to demonstrate impart exercise and nutritional knowledge to
the Indigenous participants [22].
Evaluation Plan
Process Evaluation
Process evaluation will comprise of continuously monitoring the effects of this project
while it is being implemented. Hence, for process evaluation, weekly discussion sessions will be
undertake among the project implementer and the chosen healthcare professionals in order to
obtain feedback on the responses of the participants as well as health professionals notions on
possible improvements. Additional process evaluation strategies will involve weekly sessions
where participants will be asked to reflect and provide their feedback on their experiences of the
project [23].
Outcome Evaluation
Outcome evaluation comprises of monitoring the efficacy of the project based on results
obtained. Hence to conduct the same, community health workers will collect reports of blood
pressure, anthropometrics and cholesterol from participants, before and after project
implementation, which are key biomarkers of cardiovascular health assessment. Additionally,
project rating scales and feedback interviews will be conducted to obtain final review of the

11PUBLIC HEALTH PROPOSAL
participants on the their perceived strengths, limitations and possible improvements of the
project [24].
Strengths, Limitations and Recommendations
One of the major strengths of this project lie in its incorporation of comprehensive
behavioral, biomedical and advocacy strategies covering all requirements of cardiovascular
health improvement in Indigenous communities residing in remote areas, as per national
recommendations established by the Department of Health [25]. However, it must be noted that,
the participants comprise of ethnically diverse populations with unique healthcare practices and
hence, may not be willing to comply to the project’s strategies and activities. Hence, it is
recommended that health professionals engaged in the project implement cultural competent
strategies, respect participants’ cultural preferences and obtain consent prior to administration of
interventions [26].
Scientific Evidence
To ensure that the proposed funding proposal is of considerable validity and significance,
the project has been developed taking insights from the research by [27]. The study researched
that administration of a resistance training and aerobic exercise plan for 12 weeks, reduced
percentage of body fat, heart rates and overall fitness across Indigenous Australian men and
women [27].
Further, as evidenced by the Department of Health, it has been found that implementation
of comprehensive nutritional interventions, comprising of nutrition education, provision of food
free of cost and health assessment, results in positive changes across Indigenous populations, in

12PUBLIC HEALTH PROPOSAL
terms of weight gain, levels of cholesterol, food intake and levels of insulin and glucose in blood
[28].

13PUBLIC HEALTH PROPOSAL
References
1. Australian Parliament House. The National Health Priority Areas Initiative – Parliament
of Australia [Internet]. Aph.gov.au. 2019 [cited 13 June 2019]. Available from:
https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/
Parliamentary_Library/Publications_Archive/CIB/cib9900/2000CIB18.
2. Sahle BW, Owen AJ, Mutowo MP, Krum H, Reid CM. Prevalence of heart failure in
Australia: a systematic review. BMC cardiovascular disorders. 2016 Dec;16(1):32.
3. The Heart Foundation. Cardiovascular risk profile of Aboriginal and Torres Strait
Islander peoples [Internet]. The Heart Foundation. 2019 [cited 13 June 2019]. Available
from: https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-
australia/cardiovascular-risk-profile-of-aboriginal-and-torres-strait-islander-peoples.
4. Australian Institute of Health and Welfare. National Health Priority Areas [Internet].
Aihw.gov.au. 2019 [cited 13 June 2019]. Available from:
https://www.aihw.gov.au/getmedia/78bc02fd-a75e-4f25-a0ae-b27f7bb2a4b2/bdia-
c06.pdf.aspx.
5. Arnold L, Hoy W, Wang Z. Low birthweight increases risk for cardiovascular disease
hospitalisations in a remote Indigenous Australian community–a prospective cohort
study. Australian and New Zealand Journal of Public Health. 2016 Apr;40(S1):S102-6.
6. Australian Human Rights Commission. Social determinants and the health of Indigenous
peoples in Australia – a human rights based approach | Australian Human Rights
Commission [Internet]. Humanrights.gov.au. 2019 [cited 13 June 2019]. Available from:

14PUBLIC HEALTH PROPOSAL
https://www.humanrights.gov.au/about/news/speeches/social-determinants-and-health-
indigenous-peoples-australia-human-rights-based.
7. Oetzel JG. Addressing health inequities in cardiovascular health in Indigenous
communities: Implementation process matters as much as the intervention itself.
International journal of cardiology. 2018 Oct 15;269:325-6.
8. Fisher M, Baum FE, MacDougall C, Newman L, McDermott D. To what extent do
Australian health policy documents address social determinants of health and health
equity?. Journal of Social Policy. 2016 Jul;45(3):545-64.
9. Thompson G, Talley NJ, Kong KM. The health of Indigenous Australians. The Medical
Journal of Australia. 2017 Jul 3;207(1):19-20.
10. Chenhall RD, Senior K. Living the Social Determinants of Health: Assemblages in a
Remote Aboriginal Community. Medical anthropology quarterly. 2018 Jun;32(2):177-95.
11. Mbuzi V, Fulbrook P, Jessup M. Effectiveness of programs to promote cardiovascular
health of Indigenous Australians: a systematic review. International journal for equity in
health. 2018 Dec;17(1):153.
12. Calabria B, Korda RJ, Lovett RW, Fernando P, Martin T, Malamoo L, Welsh J, Banks E.
Absolute cardiovascular disease risk and lipid‐lowering therapy among Aboriginal and
Torres Strait Islander Australians. Medical Journal of Australia. 2018 Jul;209(1):35-41.
13. Department of Health. Department of Health | Australia's Physical Activity and Sedentary
Behaviour Guidelines and the Australian 24-Hour Movement Guidelines [Internet].
Health.gov.au. 2019 [cited 13 June 2019]. Available from:
https://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-
phys-act-guidelines.

15PUBLIC HEALTH PROPOSAL
14. Nutrition Australia. Australian Dietary Guidelines: Recommended daily intakes |
Nutrition Australia [Internet]. Nutritionaustralia.org. 2019 [cited 13 June 2019].
Available from: http://www.nutritionaustralia.org/national/resource/australian-dietary-
guidelines-recommended-daily-intakes.
15. Calabria B, Korda RJ, Lovett RW, Fernando P, Martin T, Malamoo L, Welsh J, Banks E.
Absolute cardiovascular disease risk and lipid‐lowering therapy among Aboriginal and
Torres Strait Islander Australians. Medical Journal of Australia. 2018 Jul;209(1):35-41.
16. Burgess CP, Sinclair G, Ramjan M, Coffey PJ, Connors CM, Katekar LV. Strengthening
cardiovascular disease prevention in remote indigenous communities in Australia's
Northern Territory. Heart, Lung and Circulation. 2015 May 1;24(5):450-7.
17. Crengle S, Luke JN, Lambert M, Smylie JK, Reid S, Harré-Hindmarsh J, Kelaher M.
Effect of a health literacy intervention trial on knowledge about cardiovascular disease
medications among Indigenous peoples in Australia, Canada and New Zealand. BMJ
open. 2018 Jan 1;8(1):e018569.
18. Gibson O, Lisy K, Davy C, Aromataris E, Kite E, Lockwood C, Riitano D, McBride K,
Brown A. Enablers and barriers to the implementation of primary health care
interventions for Indigenous people with chronic diseases: a systematic review.
Implementation Science. 2015 Dec;10(1):71.
19. Oetzel J, Scott N, Hudson M, Masters-Awatere B, Rarere M, Foote J, Beaton A, Ehau T.
Implementation framework for chronic disease intervention effectiveness in Māori and
other indigenous communities. Globalization and health. 2017 Dec;13(1):69.
20. Bailie C, Matthews V, Bailie J, Burgess P, Copley K, Kennedy C, Moore L, Larkins S,
Thompson S, Bailie RS. Determinants and gaps in preventive care delivery for

16PUBLIC HEALTH PROPOSAL
Indigenous Australians: a cross-sectional analysis. Frontiers in public health. 2016 Mar
10;4:34.
21. Alston L, Allender S, Peterson K, Jacobs J, Nichols M. Rural inequalities in the
Australian burden of ischaemic heart disease: A systematic review. Heart, Lung and
Circulation. 2017 Feb 1;26(2):122-33.
22. Pettigrew S, Jongenelis MI, Moore S, Pratt IS. A comparison of the effectiveness of an
adult nutrition education program for Aboriginal and non-Aboriginal Australians. Social
Science & Medicine. 2015 Nov 1;145:120-4.
23. Ralph AP, Read C, Johnston V, de Dassel JL, Bycroft K, Mitchell A, Bailie RS, Maguire
GP, Edwards K, Currie BJ, Kirby A. Improving delivery of secondary prophylaxis for
rheumatic heart disease in remote Indigenous communities: study protocol for a stepped-
wedge randomised trial. Trials. 2016 Dec;17(1):51.
24. Rice K, Te Hiwi B, Zwarenstein M, Lavallee B, Barre DE, Harris SB. Best practices for
the prevention and Management of Diabetes and Obesity-Related Chronic Disease among
indigenous peoples in Canada: a review. Canadian journal of diabetes. 2016 Jun
1;40(3):216-25.
25. Vasant BR, Matthews V, Burgess CP, Connors CM, Bailie RS. Wide variation in
absolute cardiovascular risk assessment in Aboriginal and Torres Strait Islander people
with Type 2 diabetes. Frontiers in public health. 2016 Mar 8;4:37.
26. McDermott RA, Schmidt B, Preece C, Owens V, Taylor S, Li M, Esterman A.
Community health workers improve diabetes care in remote Australian Indigenous
communities: results of a pragmatic cluster randomized controlled trial. BMC health
services research. 2015 Dec;15(1):68.

17PUBLIC HEALTH PROPOSAL
27. Esgin T, Johnston N, Rowley K, de Villarreal ES, Newton R. Effect of 12 weeks
combined aerobic and resistance training on fitness, arterial stiffness and body
composition in Indigenous Australian men and women. Journal of Science and Medicine
in Sport. 2017 Nov 1;20:43.
28. Department of Health. Department of Health | Nutrition [Internet]. Health.gov.au. 2019
[cited 16 June 2019]. Available from:
https://www.health.gov.au/internet/publications/publishing.nsf/Content/oatsih-evidence-
socialhealth-toc~nutrition.