THE CONTRIBUTION OF EPIDEMIOLOGY TO THE DEFINITION OF HEALTH GOALS AND TARGETS FOR AUSTRALIA

Hearth goals and targets may be used to improve the efficiency of inve stment of resources for health care and the promotion of health the be tter to fulfil the values and expectations of society. Australia has b een developing health goals and targets since 1985. The first step was the establishment of the Better Health Commission that year. Its prop osals led to the states and territories undertaking concerted health p romotion activities through the National Better Health Program. Subseq uently the health-care system as a whole, through the 1993 Medicare ag reement, endorsed the goals and targets approach. Epidemiology has pla yed a major role in every step in this process. initially it was used to establish health status baselines or to point to serious data defic its which stopped a baseline being set. It provided data about the bur den and distribution of illness in the community. It was used critical ly to appraise evidence about aetiology and the fraction of illness at tributable to modifiable risk factors and the effectiveness of interve ntions, and to provide estimates of potential years of life lost throu gh illness and injury. This has contributed, along with economic analy sis which is a critically important corollary, to the definition of he alth care priorities. Epidemiology, while being necessary for these de velopments, however, has not been sufficient. This 'insufficiency' has three elements. First, existing epidemiological knowledge and methods have been inadequately applied or the data have been missing, or dist orted by inappropriate interpretation. Second, there are now goals and targets in health literacy, the health care system, and the environme nt where epidemiological methods (and hence data) are poorly developed or nonexistent. Third, the development of policies leading to program mes to achieve the goals and targets is political and multidisciplinar y, and it would be inappropriate to expect epidemiology to be sufficie nt for this process. The challenge for epidemiology in regard to the f urther definition of health goals has several aspects. First, much rem ains to be done to fill the holes in the information fabric about heal th in society. Second, currently available data are not optimally asse mbled for easy use in this exercise and more work is needed, by meta-a nalysis and through other methods. Third, there are developing areas ( the global environment, health literacy, and aspects of the health car e system itself) where epidemiology must develop new and more appropri ate analytical methods. Finally, the training of epidemiologists shoul d equip them with skill to participate effectively in multidisciplinar y development of health policy.