Monash University researchers have unlocked the blueprint of how Australia's health system can make better use of antenatal lifestyle coaching to improve patient outcomes and dismantle entrenched health inequality.
The study, published in the journal Value in Health, found focusing resources on women above the healthy weight range offers the greatest health gains, and delivering programs routinely through public hospitals is the most powerful way to close the health inequality gap.
Diet and physical activity coaching is already a proven evidence tool for preventing conditions like gestational diabetes and, consequently, type 2 diabetes. This research is the first to show how delivery of these programs should be prioritised to reduce health inequalities for socioeconomically disadvantaged women.
Lead author Dr Melanie Lloyd, from the Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences (MIPS), said the health system should move away from a "one-size-fits-all" approach, where lifestyle advice is often unstructured or inconsistent.
Antenatal lifestyle interventions are currently not delivered by default in Australia's healthcare system, but the evidence from the previous research suggests they are beneficial and cost-effective.
By integrating targeted programs into routine antenatal care, researchers said the health system could address unfair gaps that exist across the community.
"Pregnancy is a major life event where health system engagement is at its peak. Delivering sensitive, co-designed programs to support women during this vital stage is a fair and effective use of Australia's healthcare resources," Dr Lloyd said.
"Lifestyle coaching delivers a significant boost to public health, focusing on prevention, and striking the balance between maximising health gains and making smart use of healthcare resources.
"Our research provides the evidence needed to choose strategies that improve health on average and actively work to close the health gap, regardless of bank account or postcode."
Professor Zanfina Ademi, senior author and Head of Health Economics and Policy Evaluation Research at the Centre for Medication Use and Safety at MIPS, said the findings provide a clear path to creating a more sustainable and equitable healthcare budget.
"Our findings offer a roadmap to create a more sustainable and equitable healthcare system where fairness and fiscal responsibility can go hand-in-hand," Professor Ademi said.
"All of the program options studied, whether offered to all pregnant women or focused on groups with greater health needs, were shown to improve overall health and help reduce unfair differences in health, compared with current care.
"Targeted approaches based on clinical risk achieved a better balance between maximising health gains and reducing health inequalities.
"We now have the evidence needed to move beyond broad-brush policies and prioritise resources where they will have the biggest impact on both health outcomes and the economy."
The research represents the first application of Distributional Cost-Effectiveness Analysis (DCEA) in Australia and globally to evaluate a women's health intervention. DCEA is a new economic framework designed to assess both efficiency and fairness in health policy decisions.
The study was co-authored by Professor Richard Cookson (University of York and University of Singapore), who developed the DCEA methodology used in the research, with contributions from Sheridan Rodda (Monash University), Jedidiah Morton (Monash University and the Baker Heart and Diabetes Institute), Yanan Hu (University of Technology Sydney), Emily Callander (Monash University and University of Technology Sydney), and Helena Teede (Monash University and Monash Health).
The research was funded via the MRFF "Healthy Lifestyle in Preconception, Pregnancy and Postpartum – HiPPP – Personalised Medicine meets Public Health in the first 2000 days". (CIA Professor Helena Teede, and Health Economics lead Professor Zanfina Ademi CIJ, both from Monash University).
Read the research paper: doi.org/10.1016
