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HSC CORE 1: HEALTH

PRIORITES IN

AUSTRALIA

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How are priority issues in Australias health identified?

Measuring health status- Role of epidemiology: The role of epidemiology is defined as the study of rates and patterns of

illness, disease and injury amongst specific population groups. The information collected is via

hospital usage, health professionals and surveys. The identification of specific health trends is

then used to establish health priorities, and to guide the decision-making, resource allocation

and programs of all public and private sectors involved in health care and health promotion in

Australia. There is a significant limitation of Epidemiologyas it does not provide information

about a persons quality of life in a holistic sense, nor does it accurately describe the socio-

cultural, socio-economic and environmental determinants of health.

Summary:

- Epidemiology is the study of disease in groups or populations. (data and information collection)

- The role of epidemiology is applying the study of patterns and causes of health and disease inpopulations to improve health.

Measures of epidemiologyMorbidity (Prevalence and Incidence): refers to the patterns of illness, disease and injury

that do not result in death. Prevalence is the number of existing cases of a specific disease

or illness at any given time. Incidence is the number of new cases of a specific disease or

illness over a set period. E.g. 20000 people in Australia infected with HIV and

approximately 800 new diagnoses of HIV per year.

Mortality: is the measure of the number of people within a specified population that died

in any given year. E.g. Cardiovascular Disease accounted for 33.8% deaths in Australia in

2007.Infant Mortality: is the number of deaths in the first year of life. E.g. the infant mortality

rate was 4.2 infant deaths per 1000 live births in 2007, and is decreasing at a steady rate.

Life expectancy: is an estimate of the number of years a person can expect to live at any

particular age. E.g. the life expectancy of a baby born in 2005 is 84 years if female and 79

years if male.

Summary:

- Morbidity: Rate of illness and disease (refer to prevalence and incidence)

- Mortality: Death rates

- Infant mortality: Death rates of children under 1 year.

- Life expectancy: Average number of years predicted to live.

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Critique the use of epidemiology to describe health status considering questions like?

- What can epidemiology tell us?It can tell us specific factors relating to health.

It can also:

- Who uses these measures?Doctors

Manufactures of health products (e.g. pharmaceutical

companies)

Hospitals

Department of Education (government)NSW Health (government)

- Do they measure everything about health status?

It doesn't take into account the social and environmental

determinants that influence health.

Doesn't show variations in sub-groups (ATSI people)

Doesn't accurately show quality of life.

Doesn't answer 'why' health inequities persist.

Doesn't provide the whole picture, data on some areas in incomplete

e.g. there is a lack of data on mental health.

Summary:

- Epidemiology tells us the specific factors relating to health.

- People who use these measures of epidemiology include: hospitals, doctors,

governments, etc.

- Epidemiology doesn't take into account the social, environmental, cultural, economic or

social factors that affect health.

Identifying Priority Health Issues

- Social Justice Principles: (PRESDA)!!!!!!Participation: is communities and individuals being involved in the decision making of

improving their own health. E.g. Setting up a healthy school canteen.

Rights: The laws that protect human rights should also protect human health.

Equity: is the fair allocation of funding and resources. For example, GPs who bulk bill

people with a Health Care Card

Supportive environments: Social, environmental and political conditions all effect health

and need to be included in decision making. Australians have the right to be healthy and

their environment needs to support this concept. This can be achieved through the cost,availability and ease of access.

http://www.google.com.au/url?sa=i&source=images&cd=&cad=rja&docid=PrLSBfG3go-ejM&tbnid=WS38HD32T6XWYM:&ved=0CAgQjRwwAA&url=http://alltheragefaces.com/&ei=3iFZUazRKK-ziQeunIHgCg&psig=AFQjCNFq0l-7hkhaF5SQwlRr3MPtr-5_Qw&ust=1364882270705939http://www.google.com.au/url?sa=i&source=images&cd=&cad=rja&docid=PrLSBfG3go-ejM&tbnid=WS38HD32T6XWYM:&ved=0CAgQjRwwAA&url=http://alltheragefaces.com/&ei=3iFZUazRKK-ziQeunIHgCg&psig=AFQjCNFq0l-7hkhaF5SQwlRr3MPtr-5_Qw&ust=1364882270705939

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Diversity: Acknowledging the needs of all members of society. This allows for a wider

range of solutions to health problems to become available. E.g Australia has a diverse

population and the needs of the population needs to met. Therefore, there needs to be

sufficient health care services and facilities for all the diverse groups within Australia.

Access: Removing barriers to allow all people are provided with health services,

regardless of their circumstances.A prime example of how social justice principles can be seem in practice is through Medicare.

Through Medicare, the right for all Australians to be healthy is acknowledge; we are provided

with access to adequate health care at an affordable cost or no cost at all; epidemiology is

used to promote equity by identifying health disadvantages that are experienced by some

groups, and strategies are implemented to redress the inequities; and we are able to

participate in promoting our own health through mechanisms such as seeking second

opinions, negotiating treatment options with doctors and electing to adopt additional health

cover through private health insurance if we choose. Medicare is equitable, caters for

diversity and provides a supportive environment in which all people can have access to

health care.

Social justice principles.

Social justice means that the rights of all people in our community are dealt with fairly and

equitable. Public policies should ensure that all people have equal access to health care

services. People living in isolated communities should have the same access to clean water

and sanitation as a person living in an urban area. People of a low socioeconomic

background should receive the same quality health services that a person in a higher

socioeconomic income receives. Information designed to educate the community must be

provided in languages that the community can understand.

Priority population groups:

- The health priority areas established by the government include cardiovascular disease,

cancer, injury, mental health and diabetes. Priority population groups are the

criterion for how best to spend money and distribute resources for health. Within

each of these priority areas certain groups in our population have been identified

as at risk of developing these diseases. By identifying at risk population

groups, government health care expenditure can be directed towards these

groups to attempt to reduce the prevalence of the disease.

E.g. ATSI's are socio-economically disadvantaged people who are more likely to develop

CVD, mental illness, diabetes, etc.

Prevalence of condition:

- Analysing statistics allows us to interpret the prevalence of a condition or disease, thus

funding and resources are allocated accordingly. (Prevalence-how common a condition

is in the community). Morbidity statistics are reliable indicators of the prevalence of a

condition. Hospital admissions and health surveys are two examples of how statistics are

accumulated to give us a picture of the health status of a population. E.g. the decrease in

deaths from CVD is due to effective health promotion strategies, however increases in

type 2 diabetes indicates a need for focus on the related risk factors and determinants.

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Potential for prevention and early intervention:

All of the health priority areas that have been identified have the potential to change the

incidence and mortality of the particular disease and condition. For instance

cardiovascular disease has some very highly preventable risk factors including smoking

and lack of physical activity. An individual could modify their lifestyle by stoppingsmoking and taking up regular exercise in order to decrease the risk of developing

cardiovascular disease. Other diseases and conditions, if detected in the early stages,

can be treated successfully. Hence, preventable health problems deserve increased

attention.

Costs to the individual and community:

Direct costs: ALL ABOUT THE MONEY: The money spent on diagnosing,

treating and caring for the sicks, plus the money spent on prevention.

Indirect costs: THE CONSEQUENCES OF ILLNESS/DISEASE:The value of the output lost when people become too sick to work or die

prematurely, e.g. costs of missed work, unemployment, retraining in the

workplace.

For example: If someone develops chronic illness.

Direct individual costs include: $$$$ financial burden, costs associated with illness

and disability such as ongoing medical costs (hospital charges, medications,

medical professional fees etc.) and loss of employment.

Indirect individual cost include: pain, emotional burden, depression, mental illness,

decreased motivation, lower of quality of life, possible exclusion from socialactivities, increase pressure on families to offer support.

Direct community costs include: costs relating to education, health promotion and

funding for hospital treatments.

Indirect community costs include: workers lost, decreased productivity and

re-training.

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Summary:

- Priority population groups:

Groups who have higher rates of morbidity and mortality rates of particular conditions.

These include Aboriginal and Torres Straight Islanders who have higher rates of CVD,

Cancer and Diabetes and a much lower life expectancy than other Australians.

- Prevalence of condition:

Prevalence refers to the number of current cases of a disease or condition.

Epidemiological data can be used to determine what diseases and conditions are most

prevalent, which are improving or declining and can be used to determine funding

priorities.

- Potential for change:

The potential for change is considered when determining priority areas. By allocatingresources to focus on a particular disease there needs to be the potential to minimise the

extent of that illness. Eg: for cancer if we can get people to stop smoking we can have a

big impact on the extent of cancer. This therefore has potential for change.

- Costs to individuals and community: The cost to the individual refers to

the physical (pain, discomfort, immobilisation), social (loss of social contact, increased

dependence on others, loss of confidence), emotional (stress, depression, mental anguish)

and spiritual cost (loss of meaning in life).

Direct Costs: $$$ refer to the actual financial cost in relation to the illness. This includes

diagnosis and treatment.

Indirect Costs: refer to the emotional, and physical cost to the individual (pain, stress,

depression).

Cost to the community include:

Direct: costs relating to testing, education, healthpromotion,funding to hospitals fortreatment.

Indirect: loss of productivity for companies.

http://pdhpe12.pbworks.com/w/page/10661223/Identifying%20Priority%20Areashttp://pdhpe12.pbworks.com/w/page/10661223/Identifying%20Priority%20Areas

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What are the priority issues for improving Australias health?

Group experiencing health inequities:

- Aboriginal and Torres Strait Islander People (ATSI)

High levels of preventable chronic disease, injury and mental health problems

- Cardiovascular disease (CVD)

Nature: CVD refers to all disease of the heart and blood vessels. Caused by a build-up

of fatty tissue inside of the blood vessels and the hardening of the blood vessels

both of these affect the blood supply to the organs of the body.

3 types of CVD include:

1. Coronary Heart Disease: blockages in the vessels of the heart (i.e. Heart Attack)

2. Cerebrovascular Disease: blockages in the vessels of the brain (i.e. Stroke)3. Peripheral Vascular Disease: blockages in the vessels in the limbs, other the

legs/feet

Extent: The leading cause of death (37% of all deaths in 2007) and sickness (3.5

million suffered CVD in 2008) in Australia

Both mortality and morbidity are decreasing for males and femalesthe result of

increased awareness of personal prevention strategies and improved medical

technology in both the detection and treatment of CVD

Survival from the attacks is improving

Risk Factors and Protection Factors

Non-Modifiable Risk

Factors

Modifiable Risk Factors Protective Factors

- Age: rates increasing

sharply over 65 years

of age

- Gender: males suffer

for CVD more

- Family history

- Smoking and alcohol

abuse

- Diet high in fat, salt

and sugar

- Low physical activity

levels

- High blood pressure

and cholesterol levels

-

Being overweight

- Nutritious and

balanced diet

- Daily physical activity

- Responsible use of

alcohol

- No smoking

- Maintain healthy

weight

-

Control stress levels

Determinants

Socio-cultural

Determinants

Socio-economic

Determinants

Environmental

Determinants

- Family history

- Indigenous: high rates

of all risk factors

- Gender: males are less

likely to engage in

preventative health

measures

- Low levels of

disposable income

- Unemployed

- Low level of education

- People who live in

rural and remote

communities

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Groups at Risk: ATSIs, Low SES

- Cancer (skin, breast and lung):

Nature: A group of disease leading to the uncontrolled growth of abnormal body cells.

Leads to tumours which interrupt the normal functioning of the body, and which can

also spread to other parts of the body

Extent:Mortality and Morbidity rates are both increasing. This is due to our ageing

population and better detection.

Male: Prostate, Colorectal, Lung and Melanoma

Female: Breast, Colorectal, Lung and Melanoma

Males suffer more except in the 25-54 years age group, where female cancers (cervix,

breast etc.) occur at 3 times the rate.

Risk Factors and Protective Factors

Non-Modifiable Risk

Factors

Modifiable Risk Factors Protective Factors

- Gender: specific

cancers

- Age: leads to increased

risk

- Family History

- Genetic makeup e.g.

being fair skinned

- Exposure to

carcinogens such as

smoke, UV radiation

from the sun

- Lifestyle behaviours,

such as smoking,

alcohol misuse and

poor dietary habits

- Avoid carcinogen e.g.

Slip, Slop, Slap

- Personal screening

habits

- Public Screening

- Seeking early medical

intervention

Determinants

Socio-CulturalDeterminants

Socio-economicDeterminants

EnvironmentalDeterminants

- Smoking amongst

young females

- Tanning habits, such

as excessive sun

exposure

- Unemployed: high rates

of smoking as a stress

relief

- Low levels of education

- People who work

outside

- People who live in

rural and remote

communities

- Exposure to chemicals

in the workplace

Groups at Risk: ATSIs, Low SES, Males and Females, Other minor groups include

smokers, outdoor workers, young adults and people with fair skin- Injury

Nature:

1. Road injuries and Motor Vehicle Accidents

2. Suicide and self-harm

3. Injuries around home

4. Workplace accidents

5. Acts of violence

6. Sports and recreational injuries

Extent: Leading cause of death in 1-44 years age groups (MVAs and suicide amongst

males)

Major cause of hospitalisation

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Deaths from injuries are decreasing in frequency, especially MVAs

Risk Factors and Protective Factors

Modifiable Risk Factors Non-Modifiable Risk

Factors

Protective Factors

- Driving behaviour andattitudes

- Inadequate supervision

of children

- Occupational hazards

- Safe use of alcohol

- Unsafe home

environment

- Age: elderly are more

at risk of falls- Gender: higher rates

of risk taking

behaviour and suicide

- Minimising driving

distractions e.g.phones

- Effective driver

education

- Home modifications

for the elderly

- Strong social support

to prevent suicide

Determinants

Socio-cultural

Determinants

Socio-economic

Determinants

Environmental

Determinants

- ATSIs suffer more

injuries

- Attitudes towards

driving and risk taking

amongst males

- Family breakdowns

- Societal pressure for

tougher road laws

- Low SES- higher rates

of hospitalisation from

injuries

- Low education- less

awareness of dangers

around the home

- Low income- makes it

harder to purchase

safety equipment

- Workplace injuries are

most common in

agricultural settings

- Suicide is highest

amongst males from

rural and remote

regions

- Unsafe home

environments of

elderly people and

children can lead to

increased risk of injury

Groups at Risk: Elderly (falls), ATSIs (MVAs and self-harm), Children (poisoning and

drowning)

A growing and ageing population

- Healthy ageing: The process of ageing can be a very demanding time. Physical, social, emotional

and financial difficulties come about, which markedly decrease a persons quality of life. The

government research program Ageing Well, Ageing Productively enables and empowers people

to live a healthy, productive and contributing life for as long as possible. This program willbenefit the individual, by ensuring a better quality of life and increased independence, and also

the wider community, through minimising the negative impact of an ageing population.

- Increased Population Living with Chronic Disease and Disability: A larger elderly population

inevitably leads to more people living with chronic disease and disability. Improved medical

services such as prevention screening programs and detection, widespread education contribute

to higher rates of diagnosed disease and illness. Elder people tend to suffer more from CVD,

cancer, arthritis, osteoporosis, anxiety and diabetes. The risk factors are modifiable and lifestyle-

based, and they place an enormous burden on the Australian health care system not to mention

health budget. These statistics are set to increase, making the efforts to encourage healthy

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ageing more important. An example of this is encouraging young people to develop healthy

habits earlier such as not smoking, eating healthy, regular physical activity.

- Demand for Health Services and Workforce Shortages: To meet the demands of the growing and

ageing population, the full range of health services will need to expand dramatically. This

increase needs to include more specialist health professionals, GPs, and emergency health

services such as ambulances, public hospitals, and more housing for people who require

assistance with basic living needs.

- Availability of Carers and Volunteers: There is a decline in the availability of carers and

volunteers. Caring and volunteering activities are beneficial to the economy, and older

Australians make a substantial contribution as volunteers and carers. There are over half a million

volunteers among those aged over 65 years old who volunteer for non-profit organisations. The

older Australians who volunteer in the paid and unpaid work are essential they help by carrying

out home visit, helping with food shopping, providing transport to medical, dental and hospital

appointments, and assisting with a wide range of other services that the aged may find useful,

including food preparation, home maintenance and personal care. A carer is any person whoassists a person because of that persons age, illness or disability. Carers may be needed to assist

with tasks of daily living, such as feeding, bathing, dressing, toileting, transferring or

administering medications. On other circumstances, there may only be the need for assistance

with transport, financial or emotional support. The aged living in households most commonly

need assistance with property maintenance and health care because of disability. It is projected

that there will be little growth in the number of available carers, compared with the anticipated

rise in demand for home-based support. This will have a huge impact on the health services is

that the aged will have a higher demand for carers but as there is none, the government will need

to get more resources to look after them. This is likely to result in a shortage of carers in the

future.

What role do health care facilities and services play in achieving

better health for all Australians? Health care in Australia

- Range and types of health facilities and services

Category Examples

Public health services- focus is on

prevention, promotion and protection ofpopulation groups and the factors and

behaviours that cause illness rather than

treatment

Cancer screening

Immunisation programs

Primary and community health care- are

usually the first health service visited by a

patient with a health concern

GPs

Ambulance services

Royal Flying Doctor Services

Dental

Hospitals- provide care for admitted

patients which is more commonly treatment

focused e.g. medication, monitoring andtreating conditions, surgery and care for the

Public

Private

Mental

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extremely ill

Specialised health servicestarget

specialised health conditions such as mental

illness, sexual and reproductive health drug

and alcohol dependent

Specialised medical practitioners

Reproductive health

Mental health

Palliative care

Goods Pharmaceuticals

- Responsibility for health facilities and services

Health care provider Facilities and/or services provided

Commonwealth Government Formation of national health policies

Collection of taxes to finance the

health systems

Provision of funds to state/territory

governments

Special concern for ATSI Pharmaceutical funding

Examples include: Red Cross Blood,

Royal Flying Doctors Service

State/Territory Government Hospital services

Mental health

Home and community care

Family health services

Womens health

Health promotion

Local Government

Vary from state to state

Environmental control Home services

Examples include: Meals on Wheels,

Antenatal clinics

Private organisations Private hospitals

Dentists

Alternative health services

(physiotherapy, chiropractor, etc.)

Community groups Local needs basis

Promote health

Cancer Council, Dads in Distress,

Diabetes Australia, etc

- Equity of access to health facilities and services: All Australians should have equal access to

health care facilities and services. This is achieved in Australia via Medicare, which can have

limitations. Medicare helps achieve equity via bulk bulling, language support. Despite this,

inequities exist for ATSIs, low SES and people living in rural and remote areas.

- Health care expenditure versus expenditure on early intervention and prevention: In 2007-08

health-care expenditure was $103.6 billion. Less than 2% of this figure was spend on preventable

services or health promotion. The main reason for this is a focus on cure rather than prevention.

HOWEVER, PREVENTION IS BETTER THAN CURE. The delay in tangible benefits of health

promotion and prevention also sways politicians and governments to prefer the instant and

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measurable option of cure over prevention. Reasons for increasing funding for preventative

health strategies include:

Cost effectiveness

Improvement to quality of life

Containment of increasing costs

Use of existing resources

Reinforcement of individual responsibility

Maintenance of social equity

Reduced mortality and morbidity

- Impact of emerging new treatments and technologies on health care, e.g. cost and access,

benefits of early detection: have the potential to significantly improve the health status of

Australia. Examples include image technology in keyhole surgery, drug advancements, prosthetic

limbs development, artificial organs and transplant technology. Having sustainable support of

these technologies is the challenge.

- Health insurance: Medicare and privateMedicare is the health-care system for all Australians. Its aim is to provide equity in

terms of cost and access for health care services. Funding for Medicare comes from

income tax (1.5% of taxable income) and the Medicare levy surcharge (1% for high-

income earners).

Advantages for Medicare:

o Free treatment as a public patient in a public hospital and free of subsidised

treatment by medical practitioners.

o Ever Australian is covered for 85% of the scheduled fee

o Bulk billing allows patients to pay nothing and the doctor receives the

scheduled fee from Medicare.

Private health insurance is extra insurance which covers private hospital and ancillary

or extra (dental, physiotherapy, naturopathy etc)

Advantages for Private:

o Shorter waiting times

o Hospital choice

o Own doctor of choice

o Ancillary benefits

o Avoiding increase tax

Complementary and alternative health care approaches- Reasons for growth of complementary and alternative health products and services:

o World Health Organization recognition

o Proven results for many when traditional medicine had failed

o Desire for natural medicines

o Holistic nature

o Formal qualifications enhancing credibility

- Range of products and services available

Alternative health-care approach Description

Acupuncture

Involves inserting needles into skin to relieve

pain

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ChiropracticAdjustments are made to the spine to realign

correct body function

MeditationState of inner stillness

Bowen therapeutic technique

System of muscle connective tissue

movement that realign the body andbalances energy flow

NaturopathyHolistic treatment aiming to treat the

underlying cause as well as the symptoms of

the illness

- How to make informed consumer choices: it is important to investigate and critique health-care

providers and services. This includes: seeing what they offer, the benefits, experience,

qualifications, governing body and cost. Obtaining feedback and references may also assist.

Evaluating the use of products or services should also occur. The consumer should be doing

research prior to selecting the product or service.

What actions are needed to address Australias health priorities? Heath promotion based of the five action areas of the Ottawa Charter

The five action areas of the Ottawa Charter are:

Developing personal skills

Creating supportive environment

Strengthening community action

Reorienting health services

Building health public policy

- Levels of responsibility for health promotion: The Australian government, state and local

governments, non-government organisations, communities and individuals are all responsible

for promoting health. The benefits of partnerships in health promotion: The chance of successful

health promotion is greatly increased when all levels mentioned above collaborate towards one

common goal. This brings shared responsibility, ownership of the imitative and the chance to

pool resources. Therefore having a greater capacity to tackle and resolve complex health and

social problems that have eluded individual sectors for decades, resulting in improved

population health and well-being, and reduced demand for health care and social services in

future.

-

How health promotion based of the Ottawa Charter promotes social justice