Economic evaluation of a skin cancer prevention program in Australia : past achievements and future prospects

Objectives
Australia has the highest incidence of skin cancer in the world. Skin cancer prevention campaigns have been implemented in Australia for over two decades. The most notable is under the brand name, SunSmart. The aim of the current study is to assess the cost-effectiveness of SunSmart in the past and the potential cost-effectiveness of an ongoing national SunSmart program with optimal investment in the future.

Methods
An economic evaluation from a health sector perspective was conducted using the reduction in skin cancer incidence attributable to the SunSmart program modelled as the primary end-point. Historical SunSmart program expenditures were obtained from three representative states in three latitude zones, covering different levels of UVR exposure. Melanoma incidence rates from the three representative state cancer registers were used to model the health outcomes. Program effectiveness was assessed by the comparison between the well-resourced SunSmart state (Victoria) and the under-invested states (New South Wales and Queensland). Non-Melanoma Skin Cancer (NMSC) was modelled based on national survey results. 2003 was chosen as the reference year and future costs/outcomes over a 20 year time horizon were discounted at 3%.
The future level of investment in a national SunSmart was chosen to strengthen current practice by increasing current investment to a realistic and achievable level. This conservative increase in investment (expressed as ‘$ per capita’) reflected the investment level that has been achieved in Victoria over sustained periods. To model the potential cost-effectiveness of an upgraded national SunSmart program, a conservative approach was taken, whereby the same magnitude of effectiveness from 1988 to 2003 was applied to future skin cancer incidence.

Results
SunSmart in Victoria has saved 22,300 life-years, averted 27,900 disability-adjusted life-years(DALYs)(discounted) since its introduction in 1988 and achieved an incremental cost-effectiveness ratio (ICER) of $AUD 680 per life-year saved (LYS) and $AUD 540 per DALY averted. When the cost-offset from the estimated reduction in skin cancer treatment costs were taken into account, SunSmart achieved ‘dominance’. The net cost of SunSmart in the past was an estimated saving of $AUD 93 million. An upgraded national SunSmart for the next 20 years would save 91,000 life-years and avert 122,000 DALYs (discounted), involving an increased investment level from the current $AUD 0.07 per capita to the historical average of $AUD 0.28 per capita. The ICER for the upgraded SunSmart program was estimated at $AUD 940 per LYS and $AUD 700 per DALY averted. When the cost-offset is included, the program achieves dominance with a cost saving of $AUD 115 million – an estimated $AUD 2.32 return for every dollar invested between 2003 and 2022.

Conclusions
This study demonstrates that a sustained modest investment in skin cancer control is likely to be excellent value-for-money. While the available data base is certainly not prefect, key parameters would have to change dramatically for this conclusion to be challenged.

Grouper aquaculture in three Asian countries : farming and economic aspects

The study focussed on three key suppliers of fingerlings and live fish in Asia. Grouper hatchery businesses are lucrative even at low survival rates. The findings indicate that farming practices across these countries are similar. Most farmers adopt traditional practices and lack incentives to reduce cost, but remain proce focussed.

Is it art or knowledge? Deconstructing Australian Aboriginal creative making

Abstract Australian Aboriginal symbols are visual forms of knowledge that express cultural intellect. Being classified by a Western interpretation of “art” devalues thousands of years of generational knowledge systems, where visual information has been respected, appreciated and valued. This article highlights how Aboriginal creativity has little concept of aesthetical value, but is a cultural display of meaning relating to Creational periods, often labelled as The Dreamings. With over 350 different Aboriginal Nations in Australia, this article focuses of the Dharug Nation, located around the northern Sydney area of New South Wales. The Dharug term for the Creational period is Gunyalungalung—traditional ritualized customary lores (laws). These symbols are permanently located within the environment on open rock surfaces, caves and markings on trees. Whilst some symbols are manmade, others are made by Creational ancestral beings and contain deep story lines of information in sacredness. Therefore, creative imagery engraved or painted on rock surfaces are forms of conscious narratives that emphasise deep insight.Keywords: Aboriginal Art; Australia; visual knowledge; culture; traditional; symbols

Construction labor productivity convergence: a conditional frontier approach

Purpose-Understanding and simulating construction activities is a vital issue from a macro-perspective, since construction is an important contributor in economic development. Although the construction labor productivity frontier has attracted much research effort, the temporal and regional characteristics have not yet been explored. The purpose of this paper is to investigate the long-run equilibrium and dynamics within construction development under a conditional frontier context. Design/methodology/approach-Analogous to the simplified production function, this research adopts the conditional frontier theory to investigate the convergence of construction labor productivity across regions and over time. Error correction models are implemented to identify the long-run equilibrium and dynamics of construction labor productivity against three types of convergence hypotheses, while a panel regression method is used to capture the regional heterogeneity. The developed models are applied to investigate and simulate the construction labor productivity in the Australian states and territories. Findings-The results suggest that construction labor productivity in Australia should converge to stable frontiers in a long-run perspective. The dynamics of the productivity are mainly caused by the technology utilization efficiency levels of the local construction industry, while the influences of changes in technology level and capital depending appear limited. Five regional clusters of the Australian construction labor productivity are suggested by the simulation results, including New South Wales; Australian Capital Territory; Northern Territory, Queensland, and Western Australia; South Australia; and Tasmania and Victoria. Originality/value-Three types of frontier of construction labor productivity is proposed. An econometric approach is developed to identify the convergence frontier of construction labor productivity across regions over time. The specified model can provides accurate predictions of the construction labor productivity.

The importance of broadband for socio-economic development: a perspective from rural Australia

Advanced connectivity offers rural communities prospects for socio-economic development. Despite Australia’s national broadband infrastructure plans, inferior availability and quality of rural Internet connections remain persistent issues. This article examines the impact of limited connectivity on rural socio-economic opportunities, drawing from the views of twelve citizens from the Boorowa local government area in New South Wales. The available fixed wireless and satellite connections in Boorowa are slow and unreliable, and remote regions in the municipality are still without any Internet access. Participants identified four key areas in their everyday lives that are impacted by insufficient connectivity: business development, education, emergency communication, and health. Rural citizens often already face challenges in these areas, and infrastructure advancements in urban spaces can exacerbate rural-urban disparities. Participants’ comments demonstrated apprehension that failure to improve connectivity would result in adverse long-term consequences for the municipality. This article suggests that current broadband policy frameworks require strategic adaptations to account for the socio-economic and geographic contexts of rural communities. In order to narrow Australia’s rural-urban digital divide, infrastructure developments should be prioritised in the most underserved regions.

Critical factors influencing employment: a study of small manufacturing firms in South-East Australia

Compliance with legislation has been highlighted as a factor influencing the reluctance of small and medium sized enterprises to take on new employees. With the objective of determining factors influencing smaller firms in their employment decisions, mailed questionnaires were used to survey small to medium manufacturing businesses in the Australian States of Victoria and New South Wales. Significant critical factors and deterrents to further employment were identified.

McCoy and Clarke : their dispute over the age of Australia's black coal

From 1847 until his death in 1899, Professor Frederick McCoy, palaeontologist in Melbourne, maintained a war of words in the scientific literature with Rev. William Clarke, geologist in Sydney, concerning the age of Australia’s black coal deposits. McCoy was convinced that the coals were all of Mesozoic age and Clarke, during the period from 1847 to his death in 1878, maintained equally vehemently that they were Palaeozoic. In fact, Clarke was correct in placing the New South Wales coals in the Palaeozoic, and McCoy’s placing of the Victorian coals in the Mesozoic was also correct. The two men were both particularly stubborn and neither would admit that they might have been arguing about coals of differing ages. Both stood unbendingly by their Northern Hemisphere, European backgrounds, and neither would change their views in the face of new evidence from the Colonies.

Rural women and local economic development in south-west Victoria

In the 1990s, the appearance of women in leadership roles in local economic development organisations in small south-west Victorian towns heralded a change in gender relations in rural Australia. This paper contributes to an understanding of this process by investigating the actions and motives of women in leadership roles in small rural towns in south-west Victoria. The paper begins by establishing a framework of analysis based upon a notion of ‘paradigms in progress’. The argument is that in an increasingly interconnected world broader economic, social and political concerns encroach upon local cultures. In this process, older social paradigms or popularly accepted models for how the world works are either transformed, discarded or replaced on different levels. The different levels to which this paper refers are the macromodels of patriarchy, the mesomodels of economic development and the micromodels of leadership. It is the way that these levels intersect and how they are being changed that informs the explanation of women and leadership in south-west Victoria. The paper applies this framework to an analysis of interviews with 15 women in small towns in south-west Victoria. The paper concludes that women in the south-west have been able both to feminise the politics of local economic development as well as reposition the feminine in local social discourses.

Undergraduate pre-registration nursing education in Australia: a longitudinal examination of enrolment and completion numbers with a focus on students from rural and remote campus locations

Introduction: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories.
Method: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution.
Results: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22 811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002.
Conclusion: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.

Habitat use by the hymenosomatid crab Amarinus lacustris (Chilton) in two south-eastern Australian rivers

The hymenosomatid crab Amarinus lacustris is abundant in some south-eastern Australian rivers; however, little is known of its ecology. Patterns of habitat use by crabs in rivers may be affected by seasonal changes in river discharge. This study investigates population characteristics, timing of reproduction and patterns of habitat use by A. lacustris in five riffle and pool habitats from each of the Hopkins and Merri Rivers in south-west Victoria, Australia, sampled over a twelve-month period. Distribution of Amarinus lacustris was similar between the two rivers, but log-linear modelling showed that there was a strong association between crab sex, habitat occupied and time of year because female A. lacustris showed a shift from riffle to pool habitats during March and April, coinciding with the non-gravid period of the year. Male crabs also showed a change in relative occurrence, occurring most often in riffles during winter–spring (July–November) but being equally common in both habitats in summer–autumn (January–May). These patterns are probably the result of the reproductive cycle of A. lacustris, which appears to show both ontogenetic and sex-related changes in habitat use during its life cycle, taking advantage of seasonal fluctuations in flow regime that may assist egg/larval development and dispersal.

Style wars: revolution in the suburbs?

Is there a revolution occurring in the Australian suburb? From a brief examination of demographic, economic, political and aesthetic changes, it appears that the suburbs of the new century are very different from those of the last. With the demise of key underpinnings of the older suburban form—the sexual division of labour, particular family forms, localised communities and bucolic private gardens—has gone an end to official support of the expansive suburb and a major shift in their politics, planning, economies and relationship to the CBD and other centres. With falling household sizes has gone a seemingly contradictory trend toward larger houses on smaller blocks of land. In the context of these many changes along with urban containment and consolidation, this paper argues that there is a convergence occurring between the design of inner, middle and outer suburban dwellings. The negativity long heaped upon the suburban bungalow by the custodians of taste is being revisited. The style wars are easing, as suburban homes increasingly resemble those appearing in densified cities across the nation.

Human right to food security in refugee setting: rhetoric versus reality

Despite recent advances in the area of humanitarian responses and the publication and dissemination of various guidelines with regard to nutritional interventions, there is, however a paucity of studies which have examined the human right to food in complex emergencies. 186 countries including those affected by both human made and natural disasters and countries who are donors of humanitarian relief aid adopted the Rome Declaration on Food Security and World Summit plan of Action reaffirming “ the right to adequate food and the fundamental right of everyone to be free from hunger”. The human right to adequate and nutritious food in refugee settings implies that every refugee has physical and economic access to sufficient food to provide the necessary nutrients for effective physical and physiological functions and achieve well being. There are many grounds for believing that the current humanitarian responses to disasters more often violate than respect the human right to adequate and nutritious food. Using elements of household food security as our working framework this paper focuses on the complex ethical and moral questions raised by the conventional humanitarian assistance framework and in particular the issue of human right to food and household food security in refugee settings.

Exotic grass fuel in south eastern Australia

One potentially serious impact of environmental weed invasion is an alteration to the fuel characteristics and subsequent fire regimes of an area. Considerable global evidence indicates that environmental weed invasion may produce 'new' fuel types, but there is little documented evidence of the impact of invasive exotic species on fuel characteristics and fire regimes in south-eastern Australia. This study on the impact of invasive exotic grasses in southeastern Australia has revealed major changes to fuel characteristics, particularly fuel loads.

Income security of international students in Australia

Growth in the number of international students studying in English language countries has slowed in recent years and this development has generated extended debate amongst university managers and policy makers. In these discussions much attention has focussed on whether the slow down is to be explained by currency realignments, visa requirements, the quality of education, or the increasing competitiveness of the international education market. But what has attracted little attention is the fact that when parents and students choose in which country they will purchase a foreign education their choice is commonly influenced by the level of security that is perceived to characterise the range of options. What security means can take many forms and in this paper we focus on income security. Drawing on interview data from 9 Australian universities, we clarify the sources of international student income, the extent to which these students experience income security/insecurity, how they cope with income difficulties and/or ensure finances do not become a serious problem, and whether the nature of the information provided by governments and universities helps explain the extent of income insecurity manifest amongst international students in Australia. We argue that a significant proportion of international students studying in Australia do experience income insecurity and suggest that for both moral and economic reasons the government and the university sector should pay increased attention to this aspect of student need.