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This chapter focuses on obesity to exemplify the broader need for a more thoroughgoing integrative approach to health. The authors begin by sampling some of the key adverse consequences of obesity at the biological, psychological, and societal levels. Since an awareness of such costs can degenerate into a blaming response toward higher-weight people, the authors then address the pernicious issue of weight stigma and highlight its erroneous suppositions by drawing attention to the complex (and still inadequately understood) drivers of obesity that operate at the environmental level in interaction with individual vulnerability factors. The discussion then moves on to examine obesity intervention approaches across the various psychological, medical, and societal scales. The authors conclude by offering an integrated model for understanding obesity that can inform coordinated policy and action.

This chapter explores the policy activism of people who work in government agencies, using empirical material that traverses a range of agencies and policy matters in the health sector. In considering what the term 'policy activist' might mean, different issues arise depending on whether these policy activists are working inside the government or are based in community organisations and networks. For community-based activists the major issue concerns the integrity of their role in the policy process, whereas for the policy insider the issue resides in deciding whether or not they are an activist. Alternatively, rather than bringing their activism with them, people may develop an activist orientation through working in government agencies. Health professionals working in service delivery may take up the cause of their client group, and try to influence policy on their behalf. The contemporary environment of government agencies in the health arena lends itself to an immanent activist engagement.

We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m2 or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.

Multi-disciplinary specialist services have a crucial role in the management of patients with obesity. As demand for these services increases, so too does the need to monitor individual service performance and compare outcomes across multiple sites. This paper reports on results from the publicly funded Canberra Obesity Management Service. A descriptive observational study was conducted on new patients who attended an initial medical review from July 2016 to June 2017. Baseline characteristics, comorbidities, attendance, service utilization and outcomes were collated until June 2018. Of the 162 patients identified, 64% continued to attend beyond initial medical review. Dietetics was the most commonly accessed allied health service, followed by exercise physiology and psychology. Very low-energy diet was the most commonly trialled intensive intervention, followed by pharmacotherapy and bariatric surgery. Mean baseline weight for those who continued beyond initial medical review was 142.0 kg (SD 26.6 kg), with a mean weight change of -6.2 kg (SD 10.2 kg) and a mean change in percentage body weight of -5% (SD 7%). Clinically significant weight loss was achieved in 36% of these patients, with a further 47% achieving weight stabilization. Mean Depression, Anxiety and Stress Scale scores reduced from 8-6-8 to 7-5-5, and mean Epworth Sleepiness Scale scores decreased from 8/24 to 6/24. Polysomnography referrals were made for 37% of all new patients, 87% of whom were diagnosed with varying degrees of obstructive sleep apnoea. We present these findings in the hope that they may serve as an example for data collection, individual service monitoring and comparison across multiple obesity services.

We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p

DIABETES PATIENTS USING MOBILE TABLET DEVICES Sora Park, PhD, Sally Burford, PhD, Leif Hanlen, PhD, Paresh Dawda, MBBS/DRCOG, Paul Dugdale, PhD/FAFPHM, Christopher Nolan, MBBS/PhD, John Burns, Adjunct Professor News & Media Research Centre, University of Canberra, ACT, Australia; Data61, University of Canberra, Australian National University, ACT, Australia; Ochre Health Medical Centre, ACT, Australia; College of Medicine, Biology & Environment, Australian National University, ACT, Australia; College of Medicine, Biology & Environment, Australian National University, Canberra Hospital, ACT, Australia; University of Canberra, ACT, Australia Corresponding Author: sora.park@canberra.edu.au

Aim To explore the implementation of poslansia, a community-based integrated health service implemented across Indonesia to improve the health status of older people through health promotion and disease prevention. Methods Data analysis of 307 poslansia surveyed in the 4th wave of Indonesia Family Life Survey (IFLS-4). We examined the services provided in the programme, resources and perceived problems. Results The services provided by poslansia focused mostly on risk factor screening and treatment for minor illness, and less on health promotion activities. Lack of support from community health centres, no permanent place for holding poslansia and lack of participant interest in joining the programme were associated with fewer services provided in the programme (P < 0.05). Conclusion The findings indicate existing support from the community, community health centres and related institutions for poslansia is not adequate for optimal service function. Health awareness among the older population should also be increased for programme sustainability.

Difficult living conditions in urban areas could result in an increased risk of developing depression, particularly among women. One of the strong predictors of depression is poverty, which could lead to inequality in risk of depression. However, previous studies found conflicting results between poverty and depression. This study examines whether depression was unequally distributed among young and middle-adult women in Indonesia׳s major cities and investigate the factors contributed to the inequality.Data from 1117 young and middle-adult women in Indonesia׳s major cities (Jakarta, Surabaya, Medan, and Bandung) were analysed. Concentration Index (CI) was calculated to measure the degree of the inequality. The CI was decomposed to investigate the factor contributing most to the inequality.The prevalence of depression was 15% and more concentrated among lower economic group (CI=-0.0545). Compared to the middle-adult group, the prevalence of depression among women in the young-adult group was significantly higher (18% vs 11%, p0.05) and more equally distributed (CI=-0.0343 vs CI=-0.1001). Household consumption expenditure was the factor that contributed most to inequality in both group. Other factors contributing to inequality were smoking in young-adult group and marital status in middle-adult group. Contribution of education to inequality varied for different age groups.Depression is more concentrated among the lower economic groups, with household expenditure being the major factor contributing to the inequality. This finding emphasises the importance of primary care level mental health services, particularly in poorer urban communities.This study is based on a cross-sectional data, and only assesses social determinants of depression. These determinants are important to address in addition to biological determinants and other factors.

Although hypertension has been recognized as one of the major public health problems, few studies address economic inequality of hypertension among urban women in developing countries. To assess this issue, we analysed data for 1400 women from four of Indonesia's major cities: Jakarta, Surabaya, Medan and Bandung. Women were aged ⩾15 years (mean age 35.4 years), and were participants in the 2007/2008 Indonesia Family Life Survey. The prevalence of hypertension measured by digital sphygmomanometer among this population was 31%. Using a multivariable logistic regression model, socioeconomic disadvantage (based on household assets and characteristics) as well as age, body mass index and economic conditions were significantly associated with hypertension (P

Networks in health care typically involve services delivered by a defined set of organizations. However, networked associations between the healthcare system and consumers or consumer organizations tend to be open, fragmented and are fraught with difficulties. Understanding the role and activities of consumers and consumer groups in a formally initiated inter-organizational health network, and the impacts of the network, is a timely endeavour. This study addresses this aim in three ways. First, the Unbounded Network Inter-organizational Collaborative Impact Model, a purpose-designed framework developed from existing literature, is used to investigate the process and products of inter-organizational network development. Second, the impact of a network artefact is explored. Third, the lessons learned in inter-organizational network development are considered. Data collection methods were: 16 h of ethnographic observation; 10 h of document analysis; six interviews with key informants and a survey (n = 60). Findings suggested that in developing the network, members used common aims, inter-professional collaboration, the power and trust engendered by their participation, and their leadership and management structures in a positive manner. These elements and activities underpinned the inter-organizational network to collaboratively produce the Health Expo network artefact. This event brought together healthcare providers, community groups and consumers to share information. The Health Expo demonstrated and reinforced inter-organizational working and community outreach, providing consumers with community-based information and linkages. Support and resources need to be offered for developing community inter-organizational networks, thereby building consumer capacity for self-management in the community.

This study designed a framework for assessing the stewardship function of the oral health system in Islamic Republic of Iran. The modified RAND Corporation/University of California Los Angeles (RAND-UCLA) Appropriateness Method was used in a 2-step process that combined literature evidence and the collective judgement of experts. After a comprehensive literature review, policy instruments related to stewardship components were extracted as candidate standards and categorized according to the 6 sub-functions of stewardship (accountability; defining strategic direction; alignment of policy objectives and organizational structure; regulation; intersectoral leadership; and generation of intelligence). Five key informants then rated the appropriateness of the 85 standards on a 5-point Likert scale. The 38 highest ranked standards, including at least 2 standards in each of the 6 sub-functions, formed a set of proposed standards for evaluating the current stewardship of oral health system. Piloting of the instrument will be reported separately.إطار لتقييم القوامة في نظام صحة الفم في جمهورية إيران الإسلاميةباهاره تهاني، شهرام يازداني، محمد خوشنيفيسان، بول دوغدالي، ثمين صديقي، أريزو ابن أحمديوضعت هذه الدراسة إطار عمل لتقييم وظيفة القوامة في نظام صحة الفم في جمهورية إيران الإسلامية. وتم استخدام الطريقة المعدلة لمؤسسة البحث والتقييم التابعة لجامعة كاليفورنيا في لوس أنجلوس على خطوتين للربط بين البيِّنات المنشورة والرأي الجماعي للخبراء. وبعد إجراء مراجعة شاملة للنّشريات، تم استخلاص النصوص الخاصة بالسياسات المتعلقة بعنصر القوامة كمقاييس مقترحة، وتم تصنيفها وفقاً للوظائف الفرعية الست للقوامة (المساءلة، والتوجهات الاستراتيجية المحددة؛ وترتيب أهداف السياسيات؛ والهيكل التنظيمي؛ والتنظيم، والقيادة المشتركة بين القطاعات، وإنتاج المعلومات). ثم قام خمسة مبلِّغين رئيسيين بتقييم مدى ملاءمة المعايير البالغ عددها 85 مقياساً وفقاً لمقياس ليكرت ذي النقاط الخمس. وقد شكلت المقاييس التي حصلت على أعلى ترتيب والبالغ عددها 38 مقياساً، بما فيها مقياسان على الأقل في كل من الوظائف الفرعية الست، مجموعة من المقاييس المقترحة لتقييم القوامة الحالية لنظام صحة الفم. وسيتم تقديم تقرير عن هذه الأداة بشكل منفصل.Cadre d’évaluation de la gouvernance du système de santé bucco-dentaire en République islamique d’Iran.La présente étude a conçu un cadre d’évaluation de la fonction de gouvernance du système de santé bucco-dentaire en République islamique d’Iran. La Méthode modifiée de détermination de la pertinence des indications de la Rand Corporation et de l’Université de Californie Los Angeles (Rand/UCIA) a été utilisée, dans un processus en deux étapes, combinant les données probantes de la littérature et le point de vue collectif d’experts. Après un examen exhaustif de la littérature, des instruments de politiques liés aux composantes de gouvernance ont été extraits en tant que normes candidates puis classés en catégories selon les six sous-fonctions de gouvernance (responsabilisation, définition d’une orientation stratégique, harmonisation des objectifs politiques et de la structure organisationnelle, réglementation, direction intersectorielle et production de données). Cinq informateurs clés ont ensuite attribué une note à la pertinence de 85 normes sur l’échelle de Likert en cinq points. Les 38 normes les mieux notées, dont au moins deux normes dans chacune des six sous-fonctions, ont formé un ensemble proposé pour l’évaluation de la gouvernance actuelle du système de santé bucco-dentaire. Le pilotage de l’instrument fera l’objet d’un rapport distinct.

OBJECTIVE: \ud \ud A nurse-led Parkinson's service was introduced at Canberra Hospital and Health Services in 2012 with the primary objective of improving the care and self-management of people with a diagnosis of Parkinson's disease (PD) and related movement disorders. Other objectives of the Service included improving the quality of life of patients with PD and reducing their caregiver burden, improving the knowledge and understanding of PD among healthcare professionals, and reducing unnecessary hospital admissions. This article evaluates the first 2 years of this Service.\ud \ud METHODS: \ud \ud The Context, Input, Process, and Product Evaluation Model was used to evaluate the Parkinson's and Movement Disorder Service.\ud \ud CONTEXT: \ud \ud The context evaluation was conducted through discussions with stakeholders, review of PD guidelines and care pathways, and assessment of service gaps. Input: The input evaluation was carried out by reviewing the resources and strategies used in the development of the Service.\ud \ud PROCESS: \ud \ud The process evaluation was undertaken by reviewing the areas of the implementation that went well and identifying issues and ongoing gaps in service provision. Product: Finally, product evaluation was undertaken by conducting stakeholder interviews and surveying patients in order to assess their knowledge and perception of value, and the patient experience of the Service. Admission data before and after implementation of the Parkinson's and Movement Disorder Service were also compared for any notable trends.\ud \ud RESULTS: \ud \ud \ud CONTEXT: \ud \ud Several gaps in service provision for patients with PD in the Australian Capital Territory were identified, prompting the development of a PD Service to address some of them. Input: Funding for a Parkinson's disease nurse specialist was made available, and existing resources were used to develop clinics, education sessions, and outreach services.\ud \ud PROCESS: \ud \ud Clinics and education sessions were implemented successfully, with positive feedback from patients and healthcare professionals. However, outreach services were limited because of capacity constraints on the Parkinson's disease nurse specialist. Product: The Service has filled an important health need in the local context; 98.3% of patients surveyed reported that the Service met their needs and helped them understand their care plan, achieving the primary objective of improving patient self-management. Interviews with stakeholders provided positive feedback about the value and usefulness of the Service, and healthcare professionals reported improvement in their knowledge about PD management. The evaluation also identified ongoing gaps in service provision and highlighted areas for potential improvement. No discernible trends in admission rates before and after the implementation of the Service were identified.\ud \ud CONCLUSION: \ud \ud The introduction of a nurse-led PD service has had a positive impact on the provision of care for patients with PD and is a valued service. The evaluation highlighted some ongoing gaps in service provision and has generated some recommendations to address these.

Advance Care Planning is an increasingly important consideration in health care service provision. Barriers to Advance Care Planning including lower prioritization than clinical care, and the complex logistics of completing the documentation have been identified in the literature and clinical practice. The Chronic Care Program within Canberra Hospital and Health Services introduced mobile and outpatient Advance Care Planning Clinics for care coordinated patients with chronic diseases, to address some of these barriers and facilitate end-of-life care discussion amongst this patient group. The implementation of the clinics was evaluated, looking at the practicality of running these clinics within existing resources and patient acceptability. The number of Statement of Choices completed was used as a marker of whether the clinics led to an increase in Advance Care Planning amongst this patient group. The introduction of the clinics received positive feedback from patients and was able to beimplemented without requiring additional external resources. Following introduction of the Advance Care Planning clinics, an increase in the proportion of patients with a completed a Statement of Choices was seen.

To minimise the health impact of pandemic influenza, general practice will need to provide influenza-related and non-influenza primary health care, as well as contribute to the public health goal of disease control. Through interviews and workshops with general practitioners, nurses and policy leaders between March and July 2006, and literature analysis, we identified potential models of general practice in an established pandemic, and assessed their strengths and weaknesses. Three possible clinical models were identified: a default model of no change to service delivery; a streamed services model, where general practices reorganise themselves to take on either influenza-specific care or other clinical services; and a staff-determined mixed model, where staff move between different types of services. No single model or set of strategies meets the needs of all general practices to deliver and sustain the essential functions of primary health care during an established pandemic. Governments, general practice and the relevant peak professional bodies should decide before a pandemic on the suite of measures needed to support the models most suitable in their regions. Effective participation by general practice in a pandemic requires supplementary infrastructure support, changes to financial and staffing patterns, a review of legislation on medicolegal implications during an emergency, and intensive collaboration between general practices.

The emergence of digital health, wearables, apps, telehealth and the proliferation of health services online are all indications that health is undergoing rapid innovation. Health innovation however has been traditionally slow, high cost and the commercialisation journey was not a guaranteed path to adoption outside the setting where it was developed whether in a hospital, university, clinic or lab. Most significant with this new explosion of health innovations is the sheer volume. The startup revolution, mobile health, personalised heath and globalisation of knowledge means that consumers are demanding innovations and are pulling health innovations through commercialisation with new modes of funding such as crowdsourcing and direct vendor purchases. Our Australian team initiated a project to use machine learning, data mining and classification techniques to bring together and analyse this expansion of heath innovations from all over the world. Following two years of data aggregation and quality analysis we present our findings which are applied to over 200,000 innovations from more than 25,000 organisations. Our findings have identified the dynamics and basis for a marketplace for health innovations that could assist innovators, health practitioners, consumers, investors and other health participants to research, evaluate and promote these innovations.

Background : Inhabitants of rural areas can be tempted to migrate to urban areas for the type and range of facilities available. Although urban inhabitants may benefit from greater access to human and social services, living in a big city can also bring disadvantages to some residents due to changes in social and physical environments. Design : We analysed data from 4,208 women aged >15 years old participating in the fourth wave of the Indonesia Family Life Survey. Chronic condition risk factors – systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and tobacco use – among women in four major cities in Indonesia (Jakarta, Surabaya, Medan, and Bandung) were compared against other cities. Fractional polynomial regression models were applied to examine the association between living in the major cities and SBP, DBP, BMI, and tobacco use. The models were also adjusted for age, education, employment status, migration status, ethnic groups, and religion. The patterns of SBP, DBP, and BMI were plotted and contrasted between groups of cities. Results : Chronic condition prevalence was higher for women in major cities than in contrasting cities ( p

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia’s success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.

Background The patient-as-professional concept acknowledges the expert participation of patients in interprofessional teams, including their contributions to managing and coordinating their care. How- ever, little is known about experiences and perspectives of these teams. Objective To investigate (i) patients’ and carers’ experiences of actively engaging in interprofessional care by enacting the patient- as-professional role and (ii) clinicians’ perspectives of this involvement. Design, setting and participants A two-phased qualitative study. In Phase 1, people with chronic disease (n = 50) and their carers (n = 5) participated in interviews and focus groups. Phase 2 involved interviews with clinicians (n = 14). Data were analysed thematically. Findings Patients and carers de scribed the characteristics of the role (knowing about the condition, questioning clinicians, coordi- nating care, using a support network, engaging an advocate and being proactive), as well as factors that influence its performance (the patient– clinician partnership, benefits, barriers and applica- bility). However, both patients and carers, and clinicians cau- tioned that not all patients might desire this level of involvement. Clinicians were also concerned that not all patients have the required knowledge for this role, and those who do are time-con- suming. When describing the inclusion of the patient-as-profes- sional, clinicians highlighted the patie nt and clinician’ s roles, the importance of the clinician–patient relationship and ramifications of the role Conclusion Support exists for the patient-as-professional role. The characteristics and influencing factors identified in this study could guide patient engagement with the interprofessional team and support clinicians to provide patient-centred care. Recognition of the role has the potential to improve health-care delivery by promoting patient-centred care.

In this study, we assess the strengths, challenges and opportunities regarding the oral health system stewardship in Iran.A mixed methodology was used, comprised of a quantitative questionnaire using the functional standards, semi structured interviews with key stakeholders and document review. The level of current attainments of each standard was determined based on a Likert-type scale. Literature review was completed to find official documents of national organizations.The responsibility of policy development of oral health care at the national level mostly falls on the Oral Health Bureau. This office has formulated a strategic plan for its policy-making and has considered the required capacity to implement them. However, the Bureau has some problems in enforcing its regulatory framework, especially in the private sector. There are rigorous problems in managing information and using them for evidence-based decision making. Setting and allocation of operational budgets for implementing the policies is only partially attained, as is monitoring and evaluating the performance.While the Ministry of Health and Medical Education has achieved some stewardship measures, it still needs further improvements in the oral health system. It needs to strengthen its information system and its executive capacity to implement the proposed regulations. The Ministry must improve accountability in the oral health system, especially the provider accountability.

Bridget Morrissey1,∗, Claudia Strugnell 2, Mary Malakellis 2, Jill Whelan3, Lynne Millar 2, Steven Allender2, Boyd Swinburn4 1 School of Health and Social Development, Deakin University, Burwood, Melbourne, Victoria, Australia 2WHO Collaborating Centre for Obesity Prevention, Population Health Strategic Research Centre, Deakin University, Waterfront, Geelong, Victoria, Australia 3 The CO-OPS Collaboration, WHO-CC, Population Health Strategic Research Centre, Deakin University, Waterfront, Geelong, Victoria, Australia 4 School of Population Health, University of Auckland, Auckland, New Zealand

A decade after the introduction of Medicare, various pressures had emerged in the financing of general practice. The National Health Strategy suggested these could be addressed by supplementing the Medicare benefits program with other payment systems. The Commonwealth government introduced the better practice program (BPP) in late 1994. Through the BPP, the Commonwealth makes payments to general practices calculated according to a formula. Using Medicare claims data, the formula takes into account practice size, patient loyalty to the practice and practice location. The BPP formula is oriented to the free choice of doctor by patients, and free choice of practice location by doctors. It is the exercise of these freedoms that, through the operation of the formula, determines the size of BPP payments. This arrangement is an example of a distinctively neo-liberal mode of government.

Background The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. Method We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. Results Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. Conclusions In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5–16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.