2022

Topic	Presenter(s)
Communicable disease	Unprecedented times: Communicable disease control in the early 21st Century — Dr Suzanne McEvoy
First Nations Health	Foundations to build on - Let's yarn about Aboriginal & Torres Strait Islander Health — Dr Dawn Casey and Dr Karen Nicholls
	Designing for hauora Māori aspirations in the reform of the NZ Health system — Chad Paraone
Mental health	Mental health and the public health interface — Associate Professor David Mitchell
Public Health Medicine | Training	Advanced Training in Public Health Medicine — Dr Tony Gill
	Joy, frustration, regret, gratitude and hope: The privilege of working in public health — Professor Rob Moodie

2021

Topic	Presenter(s)
Community health	Assessment of apparent cancer clusters — Professor Tim Driscoll
Environmental health	The climate crisis - Prescription for action — Dr Kate Charlesworth
Global health	Planetary health - Protecting and promoting human health in the anthropocene epoch — Professor Tony Capon
Health policy and management	Pandemic Management — Professor Raina MacIntyre
	The health impacts of e-cigarettes: implications for public health policy and practice — Professor Emily Banks
Vaccination	Yellow fever: Vaccination centres and providers — Professor Peter Leggat
	Measuring vaccine impact – principles and examples — Professor Peter McIntyre

2020

Topic	Presenter(s)
Health policy and management	Strengthening public health messages using mass media — Dr Becky Freeman

Questions

Question 1

You are a public health physician working in your state/territory health department. You have been asked to develop an immunisation program targeting under-vaccinated populations who may attend state/territory health facilities for other health concerns.

The program will be delivered over 4 years and includes specific funding of nurse immunisers to build capacity and train clinical staff to routinely deliver opportunistic vaccination to patients at higher risk of poor outcomes from vaccine-preventable diseases.

Target populations include people with mental health conditions, alcohol and other drug use disorders and other chronic medical conditions who experience barriers to accessing community-based vaccination services. The premise of the program is ‘vaccination is everyone’s business’.

The first year of the program will be a pilot focusing on a select group of Local Health Districts. Subsequent years will be informed by implementation findings of the first year of the program.

Local Health Districts will be responsible for delivering activities they undertake to increase vaccination in target populations and will be required to report activities and outcomes to the jurisdictional health department.

• How would you develop an evaluation plan for the program. Include some examples of key program indicators in your answer. (80%)
• What are some potential barriers to program implementation that an evaluation might want to capture? (20%)

Question 2

You are a public health physician working in your state/territory health department. You are supporting the tobacco and e-cigarette team and have been asked to lead the development of a state-/territory-wide policy on the use of nicotine vaping products in state/territory health facilities. Clinical views are diverse and differ between speciality groups.

• What approach would you take in developing this policy? Include in your answer some of the key considerations that may inform the policy position.

Questions

Question 1 - Opioid agonist treatment in prisons  

A Norwegian study examined the effects of provision of opioid agonist treatment during incarceration on the risk of all-cause and overdose mortality at 6 months after release, among people diagnosed with opioid use disorder before incarceration.

In the analysis, the authors used linked data from the Norwegian Prison Release Study (nPRIS), which includes all people in prison in Norway between Jan 1, 2000, and Dec 31, 2022; the Norwegian Cause of Death Registry; the Norwegian Prison Registry; the Norwegian Patient Registry; and Statistics Norway.

The main findings are shown in the Table.

• Describe the findings in the table (40%)
• What factors may have contributed to these findings? (40%)
• What other metrics could be used to evaluate the effectiveness of OAT during incarceration on post-incarceration mortality? (20%)

Question 2 – Artificial sweeteners and cardiovascular risk

Xylitol is a sugar alcohol that is commonly used as a low-calorie sweetener, for example in artificially sweetened beverages. A recent study aimed to examine the role of xylitol in the risk of cardiovascular events.

A group of 2149 people were enrolled from patients undergoing elective diagnostic coronary angiography.

Patients had plasma xylitol fasting levels measured at baseline, through a previously validated metabolomics methodology.

The group was followed up for 3 years for the development of major adverse cardiovascular events (MACE). MACE were defined as death (all-cause), nonfatal myocardial infarction, or nonfatal cerebrovascular 5 accident (stroke) during follow-up.

Analysis was by tertiles, defined by the relative levels of xylitol in plasma.

The main findings are shown in the Figure.

Right panel: Hazard ratios (HR) for incident 3-year MACE based on univariable and multivariable Cox proportional hazards regression analysis. Data points indicate HR, and 95% confidence intervals are represented by line length.

Multivariable adjustments include age, sex, smoking, diabetes, systolic blood pressure, LDL cholesterol, and HDL cholesterol. 

• Describe and interpret the findings of the study (50%).
• What other sources of information would you consider when assessing the relationship between xylitol in artificially sweetened beverages and the risk of cardiovascular events? (50%)

Questions

Question 1

You are a public health physician working at a regional public health unit. Today, media are reporting a story about an elevated number of cancer cases among people connected to a local school. The story reports people have several different types of cancer. The minister has asked for the issue to be investigated.

• How would you go about investigating this cluster? (70%)
• What particular communications issues will you need to address? (30%)

Question 2

You are a public health physician working at a metropolitan public health unit. A local community group has undertaken testing of backyards in an inner city suburb for lead. One area was found to have elevated levels of lead. The group found that these houses were built on land that was previously a rail yard where train carriages where stripped and repainted.

• How would you go about assessing the human health risk for the lead levels? (70%)
• How would you communicate with the local community? (30%)

Questions

1. Cryptosporidium Outbreak

You are a public health physician working in a mostly urban Public Health Unit in your jurisdiction. You have been asked to continue the management of an outbreak of Cryptosporidium gastroenteritis thought to be linked to public swimming pools. The graph below describes Cryptosporidium notifications to date in your Public Health Unit (first 10 weeks of 2024) and notifications for the equivalent periods in 2022 and 2023, by week of onset. It is now the start of week 11 in 2024 and there is increasing local media interest in the outbreak.

Detail your approach, including the steps you will take in managing this outbreak?

Questions

1) You are a Public Health Physician working within the Maternal and Child Health team at the National Aboriginal Community Controlled Health Organisation (NACCHO). NACCHO has been funded by the Australian Government Department of Health and Aged Care to develop a Maternal and Child Health Plan to progress Closing the Gap in maternal and child health outcomes for Aboriginal and Torres Strait Islander families.

• Why would a plan such as this be important?
• What are some key considerations in the development of the plan?

Questions

1) You're a public health physician working in a regional local public health unit. Your unit has recently conducted a community survey to gather views on expanding smoke and vape free zones in public settings in the region. Over 90% of survey respondents have expressed support for expanding smoke and vape free zones. Your director has tasked you with working with the six local councils in your region to share the survey findings and work to develop a region-wide policy to support smoke and vape free zones.

Outline your approach to this task. (100%)

2) You're a public health physician working in your state Department of Health. Recent sweeping reforms have seen the dissolution of the state’s gambling harm reduction agency. The health minister has come under fierce criticism, with community, health and research groups calling for more action to prevent gambling harm, including banning all gambling advertising, limiting online betting and reducing the number of pokie machines. You have been tasked with developing a state strategy for gambling harm prevention.

• Outline your approach to developing this strategy. (80%)
• How would you navigate potential lobbying from the gambling industry? (20%)

Questions

Question 1
You are a public health physician working in a state health department and have been tasked with developing a strategy to address Rheumatic Heart Disease.

• How would you undertake this task? (80%)
• Describe three or more areas the strategy will focus on (20%)

Question 2
You have been asked to prepare a brief for the CEO of the Aboriginal Community Controlled Health Organisation (ACCHO) you work for. The CEO is attending a Ministerial Hearing in two weeks focused on health workforce issues in remote and rural areas.

• What are the key issues you will include in the brief? (70%)
• How will you undertake consultation to inform the subject matter in the brief, given the short time-frame you have been presented with? (30%)

Questions

Question 1 | Cervical cancer data
The Health Minister is concerned by a report on social media claiming there has been no change in cervical cancer deaths in Australia since the HPV vaccine was introduced. National data on cervical cancer from the Australian Institute of Health and Welfare are shown below.

In Australia, the National Cervical Screening Program was introduced in 1991 and the National HPV Vaccination Program commenced in 2007.

• Interpret the data shown in these figures. (40%)
• What other data could you use to evaluate the effectiveness of the screening and vaccination programs? (60%)

Questions

Question 1 | Planning

Electronic cigarettes (e-cigarettes) are a significant public health issue. Use of e-cigarettes has rapidly increased across the community in the last few years, with the highest rates of use among adolescents and young people who do not smoke. Most products sold in the community contain high concentrations of nicotine. There is some evidence e-cigarette users who do not initially smoke go on to take up smoking. As relatively new products, little is known about both the acute and long-term harms of e-cigarettes and the Commonwealth government is planning to ban all products outside of the prescription pathway to protect the community. Ensuring compliance and enforcement of the ban will be the responsibility of both Commonwealth and state/territory governments.

You are a public health physician working in your jurisdictional health department. You have been asked to lead the development of a surveillance strategy to monitor the impact of the Commonwealth reforms for the next 1-5 years in your jurisdiction.

How would you go about this task and what types of data would you collect to assess impact?

Question 2 | Evaluation

Stepping Out is a free 8-week falls prevention program for adults aged 65 years and over (45 years and over for Aboriginal people) who have had a fall. It has been in operation for 2 years and is based on a similar program delivered in the United Kingdom.

The face-to-face program focuses on preventing falls, active living and maintaining independence in older adults. The primary objective of the program is to prevent fall related health service use. The program is delivered state-wide by local health districts and includes groups delivered specifically for Aboriginal people, and culturally and linguistically diverse older adults.

While the evidence base supporting balance and functional exercise to decrease the rate of falls is strong, the health department (the funder of the program) is interested in understanding whether the primary objective of the program is being met and whether the target population is benefitting from participation.

You are a public health physician in the jurisdictional health department and have been asked to lead an evaluation of the program to inform whether funding should be continued.

• How would you approach the evaluation of the program? (80%)
• What barriers might you expect to see impacting program participation/success? (20%)

Questions

Question 1
You are a public health physician working at a regional public health unit. Today, media are reporting a story about an elevated number of cancer cases among people connected to a local school. The story reports people have several different types of cancer. The minister has asked for the issue to be investigated.

• How would you go about investigating this cluster? (70%)
• What particular communications issues will you need to address? (30%)

Question 2
You are a public health physician working at a metropolitan public health unit. A local community group has undertaken testing of backyards in an inner city suburb for lead. One area was found to have elevated levels of lead. The group found that these houses were built on land that was previously a rail yard where train carriages where stripped and repainted.

• How would you go about assessing the human health risk for the lead levels? (70%)
• How would you communicate with the local community? (30%)

Questions

Question 1 | Communicable Disease Control
A case of measles
You are the Public Health Physician on duty Tuesday morning when you receive a call from your State/Territory Laboratory of a positive measles PCR result from a throat swab in a 4-year-old female child. You immediately call the GP who ordered the test the previous day and learn that the child is unwell with a fever and rash and has recently returned from the Philippines where there is an ongoing measles outbreak.

1. Detail the immediate steps you will take in the next few hours to respond to this situation.

2. Briefly outline the additional steps you will take in the coming days.

Question 2 | A One Health approach to outbreak management
In the last two weeks your regional Public Health Unit has received 12 laboratory notifications of Salmonella infection, more than you would expect. Four of the 12 notifications have been typed as Salmonella Typhimurium (responsible for most Salmonella infections in Australia), and 2 are still awaiting typing. However, your laboratory has just rung to advise testing has confirmed serotype Salmonella Enteritidis (SE) in the other 6 samples. Clinical notes on these laboratory forms do not mention recent overseas travel. You are aware of outbreaks of Salmonella Enteritidis in Australia in the past which were linked to specific poultry farms.

Describe the steps you will take to respond to this Salmonella Enteritidis outbreak, with an emphasis on how you will include a One Health approach in this response.

Questions

Question 1
You are a public health physician working in a regional local public health unit. Your catchment has a large agricultural sector, particularly dairy farming. Recent analyses by your unit’s epidemiologist demonstrate that the region has a disproportionate burden of Q Fever disease with 25% of the state’s Q Fever cases, despite representing 4% of the population. In recent discussions with the agricultural sector, you learn that the agricultural workforce is highly transient consisting of many overseas workers. Your Director has tasked you with investigating this further and developing a health promotion program to raise awareness of Q Fever disease amongst agricultural workers in your community.

• Outline your approach to this task. (80%)
• What would you need to consider regarding communications to key stakeholders about this program? (20%)

Question 2
You are a public health physician working in the Australian Department of Health and Ageing. The Department has recently released the National Roadmap for Improving the Health of People with Intellectual Disability to address serious health inequities faced by people with intellectual disability. You have been tasked with developing a national health promotion program for adults with an intellectual disability to improve their mental and physical health and wellbeing.

• Outline your approach to developing this program.
• How would you ensure that key stakeholders from the disability community are involved in the design of the program?

Questions

Question 1 | Evaluation

You are a public health physician working in the state health department Blood Borne Virus policy team. You have been asked to design and implement an evaluation of a statewide home-based Hepatitis C and HIV screening program using dried blood spot samples targeting groups at high risk of transmission. The program has been running for 3 years and involves participants registering online to receive a postal test kit which they use at home and send back for results. Results are given via text message (for negative results) or phone call (for results that require further testing).

Describe how you would go about the task of designing the evaluation of this program, including the measures you would use.

Question 2 | Planning

You are a public health physician in a regional Public Health Unit. A recent report has highlighted that your region has some of the highest rates of smoking in pregnancy in the state. Your Public Health Unit has been provided with 3 years of funding to develop a program to address this problem and your Director has assigned you with designing the program.

• How would you go about designing and implementing the program? (70%)
• What barriers might you expect in the implementation of this program? (30%)

Questions

Question 1 | Antiviral study results
A retrospective cohort study was conducted overseas, looking at the effect of an antiviral treatment in non-hospitalised patients with COVID-19.

The study population comprised all patients in a large health district who were aged ≥65 years and were diagnosed with COVID-19 in the community between January and March 2022. Patients also had to be at high risk for progression to severe disease, and deemed eligible to receive the treatment (based on drug interactions and other comorbidities).

The primary outcome of the study was hospitalisation due to COVID-19, in the 35 days after treatment or diagnosis.

Test, prescribing, and hospitalisation data was obtained from a national COVID database, which contained data on all COVID-19 PCRs and recorded rapid antigen tests, all antiviral prescriptions, and public hospital admissions. The majority of hospitals in the region were public hospitals.

The association between treatment and COVID-19 outcomes was estimated with the use of a multivariate Cox proportional-hazards regression model, and adjustment was made for sociodemographic factors and coexisting illnesses.

45,304 patients were diagnosed with COVID-19 in the study period and considered eligible for inclusion. Of these, 2,483 were treated with the antiviral, and 42,821 were not treated.

Hospitalisation due to COVID-19 occurred in 11 treated patients (14.7 cases per 100,000 person-days) and in 766 untreated patients (58.9 cases per 100,000 person-days). The adjusted hazard ratio for hospitalisation due to COVID-19 was 0.27 (95% confidence interval 0.15 to 0.49). These findings are also shown in the Figure.

a) Interpret the primary findings of the study. (30%)

b) What could explain these results? (40%)

c) What else would you want to know to understand whether the antiviral should be included in COVID-19 treatment guidelines in Australia? (30%)

Question 2 | COVID-19 and BCG
Bacillus Calmette-Guérin (BCG) vaccination has been reported to offer broad protection against respiratory infections, in addition to protection again tuberculosis infection and severe disease.

A study was conducted in 2020 to assess the relationship between BCG vaccination and COVID-19 morbidity and mortality globally.

The study collected data on BCG vaccination policies and coverage in 97 countries from the open-source ‘BCG Atlas’ database. Incidence of COVID-19 cases and deaths in these countries was taken from WHO or other public databases tracking the COVID-19 pandemic.

The study found there was a strong inverse association between the BCG vaccination coverage of a country and the number of COVID cases and deaths in that country. That is, countries with higher rates of BCG vaccination reported lower rates of COVID-19 cases and deaths.

Based on these findings, the authors suggested that BCG vaccination should be used to protect against COVID-19 infection and death.

a) What are the limitations of this type of study? (30%)

b) What other methods could be used to assess whether BCG protects against COVID-19 morbidity and mortality? (70%)

Questions

Question 1
You are a Public Health Physician working in the State government. At a recent meeting, the Minister of Health raised concerns regarding the increased notifications of Congenital Syphilis in your state in 2021-2022. He is concerned that current Health Promotion measures are not effective and are failing the community.

Due to this the Minister has asked that a prevention strategy be developed for reproductive health over the next 3 years that clearly identifies priority populations, areas for intervention and evaluation measures that can be used as evidence of efficacy.

Outline how you would design this Health promotion strategy, addressing the specific criteria that have been requested.

Question 2
The Bureau of Statistics in your country has recently released data on smoking habits for the 2020-2021 financial year.

“Almost one in ten (9.3%) people aged 18 years and over had used an e-cigarette or vaping device at least once, while 2.2% reported currently using a device. Around 14% of 12 to 17- year-olds have ever tried an e-cigarette, with around 32% of these students having used one in the past month”

You are a public Health Physician working in a Public Health unit for your local government area, that covers a multicultural population of approximately 1 million people. These findings have alarmed your Chief Executive. They have approached you as a Public Health Physician to understand the issue locally and develop a Health Promotion strategy that addresses vaping.

Outline how you would approach development and implementation of this strategy in your local area.

Questions

Question 1
You are a public health physician working at a regional public health unit. Today, local media is reporting a story about an elevated number of cancer cases among workers at a local factory. The story reports people have several different types of cancer. The CE has requested you investigate

• How would you go about investigating this cluster? (70%)
• What particular public communications issues will you need to address? (30%)

Question 2
You are a public health physician working at a state department of health. At 4:30pm, you receive a call from a colleague at the Environmental Protection Authority. This colleague advises you that the EPA has just been notified by a chemical plant that this plant has had an accidental release of an unknown quantity of a chemical called Chromium VI (hexavalent chromium). The chemical is a yellow coloured liquid and there is a concern that it may have been deposited in a residential area close to the plant.

• How would you respond to this information? (70%)
• What particular public communication issues will you need to address? (30%)

Questions

Question 1 | Clostridium difficile cases in a hospital

You are a public health physician working in a communicable disease control unit. You receive a phone call from the infection control practitioner in a tertiary hospital reporting that two current adult inpatients on a medical ward have been diagnosed with Clostridium difficile infection. The infection control practitioner is seeking your advice on the appropriate response.

What is your advice and what actions will you take?

Question 2 | Pertussis in neonatal ward staff member

You are a public health physician working in a communicable disease control unit. You have received a phone call from the infection control practitioner in a tertiary hospital reporting that a staff member in the neonatal ward has confirmed pertussis.

You have been asked to lead the unit’s response. How would you manage this situation?

Questions

Question 1
The CEO of an Aboriginal Community Controlled Health Organisation (ACCHO) is concerned that Aboriginal and Torres Strait Islander peoples who need organ transplants are not receiving them at the same rate as non-Indigenous peoples. They are concerned people are not being referred for surgery and feel there are many barriers for Community. The CEO has asked you to develop a Transplant Plan for Aboriginal and Torres Strait Islander peoples. How do you proceed?

Question 2
You are working for the national peak body supporting Aboriginal community-controlled health organisations (ACCHOs) around Australia which provide comprehensive primary health care to Aboriginal and Torres Strait Islander people. Your organisation is establishing a suicide prevention program for ACCHOs to implement in remote areas. Your role is to lead the development of a monitoring and evaluation framework. Describe your approach and key considerations for framework development and content.

Questions

Question 1
You are a public health physician working in a state health department. The prevalence of tobacco smoking in the non-Indigenous population is 15%, but in the Indigenous population is over 70%. Your director has asked you to develop a smoking cessation program targeting the Indigenous population in the state.

Outline the steps in developing this program.

Question 2
You are a public health physician working in the federal Department of Health. The recently released report from the Intergovernmental Panel on Climate Change (IPCC) on land management notes that the world must turn towards healthy plant-based diets to curb climate change. You have been asked to develop a health promotion program encouraging people to eat less meat and more vegetables.

Outline how you would develop your program.

Questions

Question 1 | Gastroenteritis outbreak in a hospital ward
You are the on-duty public health physician in a primarily urban Public Health Unit. You have been rung by the infection control practitioner (ICP) from the nearby general hospital to say they appear to have an outbreak of vomiting and diarrhoea in one of their general medical wards with, to date, six inpatients and two staff unwell with symptoms, all with onset in the last 48 hours.

Outline the steps in developing this program.

Question 2 | Introduction of RSV Vaccine to National Immunisation Program
The Commonwealth government has just announced funding under the National Immunisation Program for a childhood RSV (respiratory syncytial virus) vaccine to be introduced in 12 months’ time. You have been asked by the Director of the Communicable Disease Control Branch to plan for the introduction of this new vaccine.

Outline how you would develop your program.

Questions

Question 1

You are the Director of Public Health at a regional public health unit. The local fire and rescue services requests that you join a multiagency group coordinating the response to and recovery from a large, high energy fire involving peanuts at a bird food factory. The group involves the fire and rescue service, the EPA, the local government authority and the police. A specific concern about this fire is that laboratory studies indicate that peanut allergen is not deactivated by high temperatures. The factory is on an industrial estate with a residential area approximately 200m south, in the direction of the initial plume. Police have issued a shelter-in-place message, although the plume is buoyant and dispersing effectively. The fire was brought under control in 48hrs, but it was then decided that a “controlled burn” technique would be used to extinguish the fire, meaning it was likely to continue for another 2 or 3 weeks. During this time, fire water containing peanut oil and other contaminants would be recycled through a local pond. 

Describe how you and your team will contribute to the multiagency response and recovery to this incident? 

Question 2

You are public health physician at a state health department. The state experiencing a severe mouse plague in rural areas. A Director of Public Health from an affected region contacts you for advice. They have received separate notifications from two different local hospital about individuals presenting unwell following domestic use of a rodenticide containing zinc phosphide. Zinc phosphide is licensed for agricultural use only and releases phosphine when exposed to moisture. The Director of Public Health reports that, anecdotally, people are resorting to off-label use of zinc phosphide because of a shortage of rodenticides approved for domestic use. 

What advice would you give and how would you assist?

Questions

Question 1

Residents surrounding an industrial and hazardous waste landfill disposal depot have long complained of increased numbers of birth defects and cancers. The landfill is in a peri-urban region of a large city. This issue has been the subject of a number of investigations by the environment protection agency. A recent study concluded that there was an increase in brain cancers in residents living around the waste depot (see table). Residents want the waste depot to be shut down immediately. The Health Minister has asked for advice on the strength of the evidence. The results are presented below.

1. What is a standardized incidence ratio (SIR) and how is it calculated?
2. How would you interpret the results?
3. What further information could be useful to support any advice to the Minister?

Question 2

A prospective study investigated the risk factors for hepatitis C seroconversion in intravenous drug users and reported hazard ratios for a range of modifiable and non-modifiable risk factors for hepatitis C sero-conversion. This study also calculated population attributable risks (PAR) for each of five modifiable risk factors as well for a combination of the modifiable risk factors (see table). Overall, five potentially modifiable risk factors (sharing needles/syringes, sharing other injecting equipment, assisted injecting, frequency of injection and not being in drug treatment) accounted for approximately 50% of HCV cases observed. A new program is being developed to reduce the incidence of hepatitis C in intravenous drug users.

1. Can you explain what is meant by PAR?
2. How would use the PARs to help you decide the modifiable risk factors to target?
3. What other information would be useful in deciding the modifiable risk factors to target?

Questions

Question 1

You are working as a public health physician in a regional ACCHO, and the CEO lets you know the Board would like their ACCHO to start a local kidney dialysis service, so community members don’t need to travel. What steps do you take in response to this request? 

Question 2

You are working as a public health physician in an urban ACCHO, and the Board has requested you take a more proactive approach to the prevention of chronic health conditions. They are particularly keen to see a strong preventive approach to child and adolescent health and ask you to develop a strategy. What is your approach?

Questions

Question 1

Your State’s new Drug and Alcohol Court aims to reduce recidivism through better managing substance dependence. Offenders can be issued with a Drug and Alcohol Treatment Order which requires compliance to monitoring, e.g. urine tests two to three times per week, and treatment options including, in some cases, residential rehabilitation. The Government has announced plans to build a new Government-run residential rehabilitation facility to supplement existing NGO-run facilities.

A local Aboriginal leader has expressed reservations about what the new facility will mean for Aboriginal people and has called for a culturally appropriate residential rehabilitation facility to be built.

You are a public health physician in your State Health Department’s Alcohol and Other Drug Branch. You have been asked to consider this issue and lead the development of a plan for the new facility.

• Describe the process you will undertake to develop the plan, including the consultation process (70%)
• What are the key matters to be included in the plan? (30%)

Question 2

An innovative sexual health program was established at the local university two years ago. It generated some controversy at the time. It consists broadly of the following:

• Promoting safe sex practices via awareness raising and education strategies and increasing condom availability
• Encouraging students to present for regular sexual health checks to the student health centre whether they have STI symptoms or not

The student population is quite diverse, comprising both Australian resident and overseas students and including a broad range of ethnic groups. The program steering committee, consisting of University management, senior academics and student representatives, has brought you in as a consultant and asked you to evaluate the program.

Outline the key elements of the plan for your proposed evaluation.

Questions

Question 1 | Aboriginal and Torres Strait Islander
You are the line manager for a team comprising mostly public health nurses and health promotion officers in a regional public health unit where the population demographics include three isolated Aboriginal nation clans each with estimated populations of about 1500. In the middle of an annual immunisation campaign that requires your staff to give immunisations directly to these Aboriginal communities, an elder from one of the nation clans calls you in a very agitated state telling you that one of your nurses has immunised an entire family for the second time in this campaign. This elder tells you that this nurse made very racist comments, did not believe the parents of the family that all the children had been immunised already that season, and had very rudely said that even if this was the case having a second flu shot would be okay because of the family’s 'living conditions'.

How do you respond immediately during the elder’s call?

What next steps will you prioritise in your investigations as the line manager and how would you resolve this complaint?

Question 2 | Health promotion
You are a public health physician working in a state health department. The prevalence of tobacco smoking in the non-Indigenous population is 15%, but in the Indigenous population is over 70%. Your director has asked you to develop a smoking cessation program targeting the Indigenous population in the state.

Questions

Question 1 | Cryptosporidium outbreak
You are a public health physician working in your state/territory health department. You have been asked to take over the management of an outbreak of Cryptosporidium gastroenteritis thought to be linked to public swimming pools. The graph below describes Cryptosporidium notifications to date in your jurisdiction (first 10 weeks of 2020) and notifications for the equivalent periods in 2018 and 2019, by week of onset. It is now the start of week 11 in 2020.

Detail your approach, including the steps you will take in managing this outbreak?

Question 2 | Two Hepatitis B cases
Your Public Health Unit has just identified two incident cases of hepatitis B in persons who have received renal dialysis. Initial enquiries confirm that both cases received dialysis at the same renal dialysis unit on a number of occasions in the last six months.

You have been asked to lead the investigation of this incident.

Describe the steps you would follow in investigating this incident and what outcome(s) you would be seeking to achieve.

Questions

Question 1
You are working in a metropolitan public health unit. Several large bushfires are burning around your district and have begun to encroach on residential areas. High winds in the direction of the metropolitan centre are predicted and you’ve just been notified that several thousand people are about to be advised to evacuate within the next 4 hours. A list of community centres and halls in safe areas will be provided to them. Outline what you would do over the next hours and days.

• What are the three main areas of public health response in this situation?
• Explain how you would investigate this issue

Question 2
You are a public health physician working in the Environmental Health Branch (EHB) of the State Health Department. The Government has just confirmed a plan to remediate a legacy contaminated site and use the land for a large new residential development. Existing residents adjacent to the site have commenced campaigning for the project to be abandoned and the land left untouched. They have cited overseas evidence of the risks of remediation and have concerns that both the remediation and new residents will increase traffic congestion.

The Health Minister has made a commitment to the local community that a “Health Study” will be undertaken. The Chief Health Officer (CHO) and the Director of EHB have asked you to rapidly prepare a brief to allow the Minister to make a decision about the form of the Health Study. The brief needs to include reference to the Framework for Human Health Risk Assessment and some study options.

• What key information will you include in your brief? (70%)
• What study options are available? (30%)

Questions

Question 1
You are working as a public health adviser in the Maternal and Child Health Unit of a State Health department. There has been a public campaign, initiated by a parents’ group, to include genetic susceptibility testing for Type 1 diabetes as part of the State’s Newborn Screening Program. You have been asked to prepare a paper that details the advantages and disadvantages of such a program. Your manager has asked you to focus on the following questions:

• What are the merits of screening for susceptibility to Type 1 diabetes? (30%)
• What issues need to be considered in the development, design and implementation of such a screening program? (70%)

Question 2
You are part of team that is investigating adverse health effects in miners of rare earths^*. There is increasing demand for these elements for the manufacture of batteries and electronic components. However, there are concerns about the health effects on miners of these minerals. You have been asked to develop a research question (and a supporting paper) to investigate the possibility of an increased incidence of lung cancer in these miners.

• What do you think would be an appropriate study design? What are the advantages and disadvantages of this kind of study? (50%)
• What would be the exposure of interest, and how would you define and measure it? (15%)
• What would be the outcome of interest, and how would you define and measure it? (15%)
• What other issues would you need to consider? (20%)

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^* The rare earths are a group of 17 elements:

• the lanthanides (cerium, dysprosium, erbium, europium, gadolinium, holmium, lanthanum, lutetium, neodymium, praseodymium, promethium, samarium, terbium, thulium, and ytterbium)
• scandium and yttrium

These minerals are often found together with thorium and uranium

Questions

Question 1
In November 2020, your Chief Health Officer assigned you overall planning responsibility for the roll-out of the national COVID-19 vaccination program in your State. Phase 1a of the program (priority front-line health staff, quarantine and border workers, residents and staff of Aged Care facilities – 700,000 persons Australia-wide) commenced successfully this week, with Phase 1b (other HCWs, other critical emergency service workers, elderly adults >70 years, Aboriginal and Torres Strait islander people >55 years, younger adults with an underlying medical condition or disability – 6.1 million persons Australia-wide) to begin in 6-8 weeks’ time.

• Describe the process you used to develop the Phase 1 roll-out plan, and the key elements of the plan (60%)
• What additional complexities will you need to address in Phase 1b (20%)
• How will you monitor and evaluate the entire program? (20%)

Question 2
You have recently been appointed the Environmental Sustainability Lead for a large metropolitan health service. You are required to develop an Environmental Sustainability Plan for the health service.

• How would you go about developing the Plan? (40%)
• What are the key action areas that need to be included in the Plan? (40%)
• How will you evaluate the plan (20%)