All Core1

HOW ARE PRIORITY ISSUES FOR AUSTRALIA'S HEALTH IDENTIFIED?
Measuring health status

Health status: describes the state of health of an individual, community or population of a region/country,
measured against an identifiable standard

role of epidemiology

- epidemiology: study of patterns and causes of health and disease in populations
- aim: to improve health (eg. fund allocation, national health priorities, groups at risk)

what can epidemiology tell us?

- shows health inequities (eg. groups at greatest risk of specific disease/s)
- identifies priority areas for resource allocation
- shows the effectiveness of current health programs

who uses these measures?
- Government (eg. federal government allocates funds and influences policy and research, often
undertaken by the National Health and Medical Research Council. Local and state levels reinforce
these policies, such as the newly introduced lockouts at 1.30am and alcohol curfew at 3.30am in
Newcastle in order to reduce the risk of injury MVAs, falls)
- health services (eg. tailoring services to better meet the needs of the current Australian
population, such as meeting the need for more employees in the nursing field to care for the
increasing amounts of elderly falls)
- manufacturers and individuals (ie. to educate themselves on how to best protect themselves from
disease/s, as well as the risk factors of the disease)

Do they measure everything about health status?
- No
- statistics do not show the quality of life of the individuals represented
- surveys are subjective (open to personal interpretation) and, therefore, may be inaccurate

measures of epidemiology

- mortality: death rates and their specific causes and distribution in the population (ie. by age,
gender, geographic location)
- infant mortality: annual deaths of children under 1 year of age, per 1000 live births
- morbidity: rates of illness and disease and their distribution. Includes:
~ prevalence: existing cases
~ incidence: new cases
- life expectancy: average number of years an individual or population group can expect to live after
birth

current trends

infant mortality
- 1998-2008: DECLINING - male infant mortality rate decreased from 5.5 to 4.6 deaths per 1,000 live
births. The female infant mortality rate declined from 4.5 to 3.6

Mortality
- DECREASING - Death rate decreased from 6.9 deaths per 1,000 people in 1991 to 5.7 deaths per
1,000 people in 2010

life expectancy
- INCREASING -
- From 1910-2010:life expectancy for both males and females increased by over 25 years (ABS)
- 2010: males at 79.7 and females at 84.2
- reasons for increase:
first half of the 20th Century - improved living conditions (eg. water, sewerage, food quality,
health education)
second half of the 20th Century - advances in technology (eg. mass immunisation, antibiotics)
and increased knowledge and understanding of the risk and protective factors of disease/s

Identifying priority health issues (SPPPC)

Social justice principles

- Includes: equity, diversity and supportive environments
- Aim: decrease/eliminate inequity, promote diversity as a right of people in the Australia
community and establishing environments that are supportive of all people
- Example: increased funding for aboriginal medical services in rural areas might allow more people
in the area to train as doctors and nurses, who return to their local areas and benefit all population
groups (role modelling)

Priority population groups

- Priority population groups: those experiencing health inequities (worse health than the rest of
Australia due to a range of socioeconomic and environmental factors
- Example: ATSI, rural/remote, elderly, disabled, low SES, overseas born

Prevalence of condition

- Prevalence: existing cases of a disease
- Example: CVD are a major cause of death is Australia. However, trends show a decline in the
prevalence of CVD due to improved health promotion and disease management
- Example: Lung cancer prevalence is rising in female (smoking trend) indicating that action is
needed by health authorities

Potential for prevention and early intervention

- People have the potential to change their health outcomes if given appropriate help
- Example: young people at risk of Type 1 diabetes can be helped by early intervention

Costs to the individual and community

- Death, disease and illness are costing individuals and the community highly, in terms of financial
and social costs. In order to reduce the costs associated with illnesses, specific (priority) areas are
targeted for intervention to allow better health outcomes
- Example: road injuries, skin cancer and diseases caused by smoking all cost the community lives
and loss of productivity, placing financial burdens of governments and families. Therefore, these
diseases become priority health areas for resource allocation, especially in relation to prevention
strategies
- Example: costs for individual
~ Direct: treatment, labour replacement, lost income
~ Indirect: emotional trauma, relationship breakdown
- Example: costs for community
~ Direct: hospitalisation, health insurance, pharmaceutical use or treatments
~ Indirect: reduced productivity, absenteeism, replacing workers

Why is it important to prioritise?

The government has limited resources so it must address the conditions which meet the SPPPC criteria,
otherwise budget blowouts would create massive economic deficit, causing inadequate coverage of the
most needful area of health / populations

WHAT ARE THE PRIORITY ISSUES FOR IMPROVING AUSTRALIAS HEALTH?

Improving the equity of health outcomes for all Australians is a priority issue for health systems and
services. This means that allocation of health resources to all Australian individuals and groups must be
fair, appropriate and adequate. Addressing those individuals and groups which suffer greater health
inequities (ie. statistics evidencing higher amounts of chronic disease/s in a specific population) is a
priority issue

Groups experiencing health inequities

Aboriginal and Torres Strait Islander peoples

The nature and extent of the health inequities
- Reduced quality of life due to ill health and earlier death rates
- Greater levels of CVD:
~ Currently the leading cause of death among Indigenous Australians, with a mortality rate
nearly 3 times that of non-Indigenous Australians
~ 2005 NATSIHS: prevalence = 1 in 8 (12%) of Indigenous Australians had a long-term CVD
condition (1.3 times more likely than general Australian population)
- Greater levels of diabetes:
~ ABS 2005 = prevalence over 3 times higher than non-Indigenous Australians
~ ABS 2004-08 = mortality rate 7 times higher than non-Indigenous Australians
- Increased rates of health-risk behaviours: smoking, alcohol abuse, exposure to violence and family
breakdown
- ABS 2006-08: ATSI have over 3 times the infant mortality rate than non-indigenous Australians
- 20% of ATSI live in remote areas, leading to poorer access to health services

The sociocultural, socioeconomic and environmental determinants

Sociocultural
- Displacement led to a loss of spiritual connection to their ancestral spirits and the land, resulting in
increased rates of mental illness (ABS 2008 - suicide accounted for 4.2% ATSI deaths)
- Racism has also been a factor in the high rates of mental illness among the population
- High levels of domestic violence in the home has led to feelings of insecurity and many ATSI have
turned to drugs and alcohol as a coping strategy this led to high levels of substance absue, which
is a major risk factor in most chronic disease/s

Socioeconomic
- Indigenous students are more than half as likely to complete year 12. This leads to poor literacy,
affecting their capacity to utilize health information, whilst reducing their ability to find
employment
- Higher unemployment (16% ATSI unemployed vs. 5.2% for general population)

Environmental
- Poorer living conditions, with overcrowded and run-down housing
- Majority of ATSI live in rural/remote areas, leading to reduced access to HC services / facilities,
limited safe drinking water

The roles of individuals, communities and governments in addressing the health inequities

Individuals
- involved in community action (eg. advocating for ATSI health initiatives, such as the Healthy for
Life Australian government initiative)
- ATSI health professionals volunteering (eg. ATSI doctors providing free seminars to their
community), therefore role modelling to their community and empowering them to follow in their
footsteps
- signing petitions which advocate for increased time, effort and funding into ATSI health
promotions
- donate money to NGOs which assist in improving the health of ATSI (eg. Bunjilaka Aboriginal
Cultural Centre, which encourages ATSI to express themselves and, once again, connect to their
spirituality through art forms)
- embrace changes, such as ATSI peoples embracing a change from a sedentary lifestyle to healthy
lifestyle through increased exercise and healthy eating in order to reduce the risk of chronic
disease/s

Communities
- Aboriginal Community Controlled Health Services (ACCHS): providers of health services in many
rural and remote areas, and focus on delivering holistic and culturally appropriate primary health
care services to the Aboriginal communities they serve
- Aboriginal Medical Services (AMS): health care services run by the local ATSI community. This
makes health care more inclusive and culturally appropriate (eg. screening, counselling, HC
transport assistance, health education)

Government
- Office of ATSI Health (OATSIH): deliver mainstream ATSI health services
- National Aboriginal Community Controlled Health Organisation (NACCHC): Advocates for ATSI
health improvements
- Closing the Gap initiative: uses mass media to help educate ATSI on the importance of HC and
risk and protective factors of certain diseases, and also issues pamphlets and organises fundraising
activities to help raise awareness and encourage greater support for ATSI peoples

Socioeconomically disadvantaged people


- Poor levels of education (reduced understanding of health education) > high unemployment > low
income > poor housing > reduced access to and less likely to be engaged in health care services and
facilities
- Higher mortality and infant mortality
- Higher levels of morbidity (eg. disability, chronic disease/s)
- Reduced life expectancy (2007 ABS in NSW the gap between the highest and lowest SES group
in males 4.3 years and 2.6 years in females)


Sociocultural
- Often single parent family structure due to family breakdown. This often leads to increased mental
illness (16% in most disadvantaged areas compared with 11% in the least disadvantaged areas)
- Social problems (often as a result of unemployment and sense of despair / helplessness) which
leads to increased crime, drugs use, smoking, violence and vandalism

Socioeconomic
- Low level of education (low skill base0
- Higher unemployment (2011: 16% ATSI unemployed vs. 5.2% for general population)
- Low income (reduced access to health care)
- Poverty (leading to increased illness due to reduced quality of water, inadequate sewerage and
sanitation)

Environmental
- A majority live in medium and high-density housing developments. This evidences the reduced
alternatives for housing (due to poor income). These areas also experience higher levels of social
problems


Individuals
- Accept a degree of responsibility for lifestyle choices (eg. choosing to smoke cigarettes)
- Embrace changes (eg. knowing that smoking contributes to ill health and, therefore, embracing a
change to quit)
- Get involved in community action (eg. local BBQ fundraisers, attend nightcare van visits)

Communities
- Fundraising events to increase awareness of the inequities suffered by those with low SES and
donate this money to NGOs which assist those with low SES (eg. St. Vincent De Paul Society)
- Need NGO representatives (eg. Red Cross representative) to educate Australians of the
seriousness of the inequities suffered by those with low SES and, therefore, encourage donations
of money, food and clothing from the general population

Government
- Free or low cost HC (Medicare and PBS)
- Promotion of HC education through mass media sources (equal access)
- Compulsory PDHPE curriculum K-10 in NSW

People in rural and remote areas


- High mortality levels (AIHW 2010: Rural mortality rates are up to 3 times higher than city rates)
- Reduced life expectancy due to low wages and, therefore, reduced access to health care (AIHW
2010: rural live 7 years less than city people)
- More work-related injuries and MVAs (ie. boredom and sense of unfulfillment in the country can
lead to increased risk-taking behaviour)


Sociocultural
- Increased mental stress and pressure on those working on the land
- Feelings of despair and helplessness with the lack of opportunities (eg. employment) available

Socioeconomic
- Reduced levels of education leading to reduced employment and income. Therefore, reduced
access to HC services and facilities
- Reduced levels of education also means that the individual finds it harder to interpret and
understand health promotion initiatives

Environmental
- Isolation from large communities (relationships) leads to higher prevalence of mental health
problems (2010 ABS: suicide rates 30% higher than cities)
- Hazardous occupations (eg. farming machinery) leading to increased levels injury
- Lack of access to health services
- Poorer living conditions (eg. reduced access to fresh adequate water supply) in a harsher
environment
- Less access to basic necessities (eg. healthy food costs more money and rarely any exercise
facilities)


Individuals
- Volunteer or donate money to help develop services and increase rural access to HC (eg. 12 doctors
rotating monthly to assist rural access to HC)
- People in rural and remote areas taking advantage of services when available

Communities
- Australian Rural Health Education Network (ARHEN): works to sustain health and medical services
in the bush and provides training and education opportunities for health professionals linked to
rural placements for graduates

Government
- Multi-purpose Service Program: deliver aged care, health and community services in rural and
remote communities
- Medical Specialist Outreach Assistance Program: offers scholarships and grants to support rural
health professionals
- Rural Health Priority Taskforce: gives advice to NSW government about improving health services
in rural and remote areas

Overseas-born people


Migrants generally enter Australia with better health than the Australian-born population (mainly due to
governmental selection criteria for OS immigrants). However, as time goes their health declines due to:
- High levels of unemployment, leading to lower SES
- Lack of English, resulting in increased unemployment and knowledge of available HC services
- Stress associated with re-settlement and racism, leading to mental illness

OS born are also:
- less likely to exercise
- more likely to become overweight (changes in diet, eg. from Japan to Australia, to more fat and
salt)
- less likely to report medical conditions
- less likely to immunize children


Sociocultural
- language barriers (leading to reduced understanding of HC promotion and initiatives and lack of
knowledge of available resources)
- stress from relocation, unfamiliar culture and lack of contact from their original culture (often
leading to increased mental illness especially depression and anxiety)
- different understanding of health and illness, and varying expectations of HC

Socioeconomic
- relatively healthy when entering Australia, but SES may fall depending on housing and
employment opportunities

Environmental
- unfamiliar surroundings and reduced knowledge of available HC


Individuals
- volunteer to help with language barriers (assist in translation)
- OS people using available services and, therefore, role modelling and encouraging others to use
available services

Communities
- Encourage community members from OS to use available services
- Train in Culturally and Linguistically Diverse (CALD) programs to assist people from OS struggling
with interpreting health information

Governments
- Australian Translating and Interpreting Service (ATIS): uses voice recognition technology to
identify the language requested and automatically connects the person with an interpreter in that
language. Also provides On-site interpreting
- NSW Multicultural Health Communications Service: provides non-English speakers with health
information access (eg. phone, on-site translation and printed materials)

People with disabilities


- difficulty meeting constant HC requirements
- higher unemployment
- often require physical access to buildings via ramps or similar and may need a constant carer
- suffer many negative stereotypes which can make life more difficult


Sociocultural
- social stigma (stereotyping and discrimination) leading to mental illness

Socioeconomic
- reduced employment levels and, hence, reduced income

Environmental
- constant physical access required to buildings (eg. ramps, reserved parking spaces, more space in
public toilets)


Individuals
- volunteer to be a disability support carer
- donate to disability-supporting NGOs
- advocate for increased disability support
- the disabled using available services and facilities, therefore, role modelling and encouraging other
to do the same

Communities
- Council of Social Services NSW: provide day programs, transition to work programs and disability
action planning
- Disability Council NSW: advises the government on disability matters, raises community
awareness of the sufferings of the disabled and promotes disabled participation in available
services and facilities

Governments
- Development of hand rails, ramps and lifts to improve mobility and access
- financial assistance of carers through disability support pension, ensuring that they care for the
person periodically

The elderly


- increased prevalence of arthritis, respiratory illnesses, musculoskeletal conditions and sensory
problems, resulting in low SES
- increased pressure / demand on HC services


Sociocultural
- age resulting in feelings of inadequateness

Socioeconomic
- reduced employment opportunities, leading to reduced income and, therefore, reduced access to
HC

Environmental
- often have transport difficulties and, hence, find it harder to travel to HC facilities (reduced access)


Individuals
- volunteer to be an elderly carer or do aged care home visits
- donate money to NGOs
- advocate for assistance and donations to NGOs which support the elderly
- elderly people role modelling though using available services and facilities and encouraging other
to do so

Communities
- getting involved in home and residential aged care services (eg. visiting aged care homes once a
fortnight)
- visiting and checking up on elderly neighbours
- running community BBQs to fundraise money for NGOs, such as Home and Community Care
(HACC) or Extended Aged Care at Home (EACH) or Community Aged Care Packages (CACP)

Governments
- financial assistance through Medicare, PBS and the aged pension
- support carers through the carer allowance

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

Cardiovascular disease (CVD)

Nature of problem
- All diseases involving the heart and blood vessels
- Coronary heart disease, stroke, peripheral vascular disease
- A major economic and health problem in Australia

Trends
- Morbidity:
~ DECREASING
~ Prevalence: national average for CVD is 21.5%
~ Incidence: increases with age (especially those over 65 years)
- Mortality:
~ DECREASING
~ CHD is the leading cause of death in Australia, followed by stroke
~ CVD kills one Australian every 12 minutes
~ Death rates are declining since 1970 due to prevention strategies and improved medical
management (eg. daily exercise, low fat and low salt diet to reduce BP and
Risk factors
- Smoking
- Physical inactivity
- Overweight or obesity
- High fat diet
- Alcohol abuse
- High blood pressure and high cholesterol
- Poor nutrition
- Diabetes

Groups at risk
- Those over 65 years
- Indigenous people
- Socioeconomically disadvantaged people
- Rural and remote Australians

Sociocultural Determinants Socioeconomic Determinants Environmental Determinants
- Family history of CVD
(genetically prone)
- Indigenous: higher rates of all
risk factors
- Males: less likely to engage in
preventative health measures
- Unemployment = Low levels of
disposable income (less access
to healthy foods and gym
memberships)
- Low level of education (reduced
knowledge of risk and
protective factors)
- People who live in rural and
remote communities (less
access to HC, gyms and healthy
foods cost more)

Cancer

Nature of the problem
- Cancer can arise in any organ or tissue of the body. It occurs when normal cell division in the body
becomes uncontrolled and the abnormal cells spread throughout the body, producing malignancy
- Types of tumours:
~ Benign tumors arent cancerous. They can often be removed, and, in most cases, they do
not come back. Cells in benign tumours do not spread to other parts of the body.
~ Malignant tumors are cancerous and are made up of cells that grow out of control. Cells in
these tumours can invade nearby tissues and spread to other parts of the body.

Skin cancer:
Trends
- Morbidity:
~ INCREASING
~ Prevalence: Australia has the highest levels of skin cancer in the world. Melanoma rates are
rising, with more males than females affected
~ Incidence: increases with age
- Mortality:
~ DECREASING
~ In 2011, the risk of dying from cancer before the age of 85 was 1 in 4 for men and 1 in 6 for
women
~ In 2011, there were 43,221 deaths due to cancer

- Smoking amongst young
females
- Tanning habits (eg. excessive
sun exposure or solarium usage)
- Unemployed: higher rates of
smoking
- Low levels of education (ie. less
awareness of warning signs and
personal testing)
- People who work outdoors
- People who live in rural and
remote communities
- Exposure to chemicals in the
workplace (eg. asbestos)

Risk factors
- Exposure to the suns rays (UVA and UVB)
- Solariums and social attitudes about having a good tan

Protective factors
- Reduce exposures to the suns rays, especially during the main part of the day (11am 2pm)
- Slip, Slop, Slap, Seek
- Check skin regularly for changes to moles and freckles
- Avoid the use of solariums

Groups at risk

Skin Cancer:
- Outdoor workers
- Those with fair skin and blue eyes

Lung cancer: a malignancy in the lungs

Trends
- Morbidity
~ MALES: DECREASING
~ FEMALES: INCREASING
~ Incidence: 1 in 2 Australian men and 1 in 3 Australian women will be diagnosed with cancer
by the age of 85
~ Prevalence: there were 9,703 new lung cancer diagnoses in Australia in 2007
- Mortality:
~ DECREASING
~ Lung cancer is the major cause of cancer deaths in Australia
~ Male death rates are higher

Risk factors
- Smoking tobacco is the greatest risk factor
- Exposure to asbestos and chemicals

Protective factors
- Quitting smoking
- Be aware of symptoms (eg. cough that doesnt get better, coughing up blood) as surgery to
remove a tumour if found early, has a higher survival rate
- Early intervention to prevent children becoming passive smokers

Groups at risk
- Smokers
- Passive smokers
- Older people
- Indigenous Australians

Breast Cancer: Cancer cells grow in the breast and spread to other parts of the body if not detected and
removed early.

Trends
- Morbidity:
~ INCREASING
~ Prevalence: occurs more in women
~ Incidence: increases with age
- Mortality:
~ DECREASING
~ Survival rates are increasing due to early detection through the BreastScreen Australia
screening program and improvements in treatment

Risk factors
- High fat diet
- Excess alcohol intake
- Hormone replacement therapy taken for over 4 years
- Late pregnancy and menopause
- Family history of breast cancer

Protective factors
- Self-examination of the breasts to detect lumps and observe changes
- Screening programs
- Health promotion campaigns to alert and educate women about early detection

Injury

Road injury
Suicides
Other injuries from fires, falls, machinery, drowning, poisoning, drowning

Trends
- Mortality: DECREASING
- Morbidity: DECREASING
- Injuries are a leading cause of death among young people and the major cause of death in the first
half of life
- Road injury deaths have declined since the early 1970s, due to a range of interventions designed to
improve road safety
- Many injured people are left with serious disability or long term conditions.
- The largest male rates for injury leading to hospitalization for young adults are from road crashes
and interpersonal violence
- Deaths by suicide have reached a 10 year peak: there is more than one new attempt in Australia
every 10 minutes

Groups at risk
- Young adult males rate higher for mortality from injury (increased risk-taking to impress peers)
- People in rural areas (increased risk-taking from boredom)
- Children (eg. poisoning, drowning)
- Indigenous Australians

Protective factors
- National Injury Prevention and Safety Promotion Plan 2004-2014
- Abiding Road Safety laws and education
- Mental health illness health promotion initiatives for education and prevention
- Pool fencing
- Reduction of excess alcohol intake and use of illicit drugs (to reduce risk-taking)

- Indigenous people suffer more
injuries
- Attitudes towards driving and risk
taking amongst males
- Family breakdown, leading to social
isolation of young people
- Societal pressure for tougher road
laws (eg. P plate regulations)
- Societal awareness of hazardous
environments
- Low SES: higher rates of
hospitalisation from injuries,
especially MVAs (risk taking
often as a result of boredom)
- 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 environment
of elderly people and children
can lead to increased risk of
injury

Mental Health Problems and illnesses

Mental health problems and illnesses affect the perceptions, emotions, behaviour and social wellbeing of
individuals. Examples include anxiety, depression, bipolar disorders, schizophrenia and dementia

Trends
- Morbidity:
~ INCREASED (possibly due to more people reporting issues)
~ Prevalence: 18-24 years olds have the highest prevalence
~ Incidence: Almost half (45%) Australians will experience a mental illness in their lifetime
- Mortality: REDUCING

Protective factors
- Taking on board information from health promotion programs to seek help
- Use available help centres (eg. websites, telephone counselling)

Groups at risk
- Both sexes and all ages are affected
- The number of older Australians with dementia is predicted to increase
- Females experience anxiety and depression as the main cause of mental illness

Sociocultural Determinants Socioeconomic Determinants Environmental
Determinants
- Family breakdown: lack of support
- Difficult life circumstances (eg.
abuse)
- ATSI: Increased alcohol and drug
abuse, and difficult life circumstances
- Elderly people: increased social
isolation and grief
- Unemployed: higher rates of
depression
- Low education: less knowledge
of risk factors
- People in financial distress (eg.
farmers during a drought)

- Living in remote regions:
lack of support and medical
services
- Stigma amongst males and
being tuff
- Lack of emotional support
(eg. family breakdown)

Diabetes

- Diabetes is a disorder of the bodys levels of insulin
- Type 1 diabetes is insulin dependent and people need injections of insulin and to follow a careful
diet. Without treatment it is fatal.
- Type 11 diabetes is non-insulin dependent and may remain undiagnosed for years. It is often
referred to as a mature onset diabetes
- Gestational diabetes can occur in pregnancy
- Serious long term effects include the risk of blindness, kidney problems, amputation of the lower
limbs, heart attack, stroke and impotence.

Trends
- Morbidity: INCREASING
- The incidence of diabetes is rising in Australia and across the world
- Type 2 diabetes, once mainly affecting older people is becoming more common in childhood.

Risk factors
- Obesity
- Physical inactivity
- Poor nutrition

Protective factors
- A healthy lifestyle

Groups at risk
- Indigenous Australians are at a higher risk, almost three times that of non indigenous Australians
- Type 2 diabetes people over the age of 50
- Gestational diabetes pregnant women who are obese.

- Indigenous: 10-30% may have
diabetes and many are undiagnosed
- Being Chinese, Indian or Pacific
Islander
- Social acceptance of binge drinking
- Ageing population
- Being time poor - leading to
increased reliance on convenient food
(often fast-food high in fats and salts)
- Low SES: more likely to have
poor diet, drink excessive
alcohol, be physically inactive
and overweight
- Low education: less
awareness of prevention
strategies and health lifestyle
behaviours
- Technology has led to a more
inactive society (eg. popularity
of video games)
- People from rural and remote
and Indigenous: have difficulty
accessing medical services
- Junk food advertising to
children

Respiratory disease

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is commonly known as emphysema or chronic
bronchitis. It is a serious, progressive and disabling disease in which destruction of lung tissue and
narrowing of the air passages obstruct oxygen intake, causing chronic shortness of breath and coughing.

Trends
- ATSI: higher rates of smoking
- Family history

- Increased smoking amongst low
SES
- Low income: less money for
preventative medication
- Low SES: more likely to be
exposed to occupational hazards
- Higher rates of pollution in cities
- People who live in remote
region are further from
emergency services
- Childrens exposure to passive
smoke

Risk factors
- Smoking (this is the major risk factor)
- Environmental exposure to tobacco smoke, air pollution, occupational dusts and chemicals

Protective factors
- COPD is worsened by respiratory infections such as influenza so vaccination is a protection
- Obviously quitting smoking before its too late is the main prevention

Asthma

Asthma is an inflammatory disease of the air passages that makes them prone to narrowing too easily and
too much, causing episodes of shortness of breath, wheezing and coughing

Trends
- During the 1980s and 1990s there was a substantial worldwide increase in asthma.
- In recent years this trend appears to have plateaued, although the prevalence of asthma in
Australia is high by international standards
- There has been a recent decrease in prevalence among children and young adults

Risk factors
- Family history or other allergic conditions
- Parental smoking
- A major respiratory infection during the first two years of life
- Exposure to domestic allergens
- Other triggers may include house mite dust, exercise, pollen, cold weather and throat/chest
infections

Protective factors
- Learning to manage the condition
- Avoiding known allergens
- Not smoking

Groups at risk
- The condition affects all age groups and ranges in severity from mild to severe and is sometimes
life-threatening.
- Boys under 15 years have a higher prevalence, but after the teenage years, asthma is more
prevalent in females
- Females overall had a significantly higher prevalence than males

A growing and ageing population

An increased population living with chronic disease and disability is negatively impacting on the health
system and health care services- with longer waiting lists for treatments and a severe lack of HC
professionals to meet the demand. This is also resulting in increased health care costs (eg. hefty costs of
implementing and using technology - such as imaging machines and rising pharmaceutical costs)

Healthy ageing

Enabling and empowering people to live a healthy, productive and contributing life for as long as possible
through a lifetime of activities and behaviours undertaken to reduce risk of disease. This is a key strategy
of the Australian government as it reduces HC costs by minimising the amount of elderly using services

Increased population living with chronic disease and disability

- A larger elderly population inevitably leads to more people living with chronic disease and
disability
- Dementia, Alzheimers and arthritis are the most common forms of disease experienced by the
elderly
- 81% of those aged 85 years+ have a disability

Demand for health services and workforce shortages

- To meet the demands placed upon our government and society by a growing and ageing
population, the full range of health services will need to expand dramatically
- Example: an initiative to assist in reducing the burden and pressure on HC services =
Stay on your feet program
- Example: government service which assists frail people to remain at home through high-level care
= Extended Age Care at Home (EACH)

Availability of carers and volunteers

Carer: any person who provides assistance in a formal paid role or informal unpaid role to a person
because of that persons age, illness or disability (eg. assist with tasks of daily living, transport, financial or
emotional support (Home and Community Care HACC -provides the bulk of home and community based
services for older people)

Government responses to these shortages include recommendations to:
Increase the number of university places to train doctors and nurses.
Increase the retention and re-entry to workforce of qualified health workers.
Provide greater health service access for rural, remote and indigenous communities by introducing
practice nurses and registered Aboriginal health workers to provide ongoing support for patients
with chronic disease.

Assess impact of the growing and ageing population on: The Health Care System/Services, Elderly
Carers, Volunteer organisations

The ageing population will have a huge impact as it will result in a much larger demand for all forms of HC.
This will place more pressure on existing HC services, carers and volunteers as there is not enough to meet
the high demand.

However, the following strategies could be undertaken to encourage people join HC services:
- Higher pay
- Certificates of recognition from employers so they can get other jobs
- Increase awareness of the need for HC people through media outlets
- Tax cuts for carers and volunteers
- Free HC for carers and volunteer

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 available

Responsibility for health care facilities and services

Commonwealth (Federal)
Government
- Form national health policy
- Control funds through taxes and budgets
- Provide funds to state government/s
- Provide assistance programs (ensuring the SJPs) Medicare and PBS
- Provide special support programs National Heart Foundation, Royal
Flying Doctors Service
State and Territory
Government
- Deliver preventative health services that support wellbeing
- Prioritising health care spending
- Establishing and reinforcing healthy public policy
- Meet accountability and public health goals
- Work in partnership (for best results)
Private sector - Provide diverse, culturally specific, high quality and affordable services
Local Government - Environmental controls
- Implementing and monitoring of activities (example:
Murrumbidgee holds a free BBQ lunch to entice men to
a Health Information Session as part of Men's Health Week)
- Collection and transport of wastes
- Early childhood clinics
- Building practices
- Meals on wheels.
Community groups - Develop partnerships (with best use of resources)
- Address specific needs with their population groups and meet those
needs
- Cater for diversity allow access (equity, diversity, supportive
environments)
- Example: healthy cooking/eating lessons targeted for overweight
regions
Individuals and families - With appropriate support, take greater responsibility for our own health
- Develop supportive, nurturing relationships which can help strengthen
coping abilities
Industry and business - Develop products, services and marketing which encourage healthy
choices and promote a culture of healthy living
- Pursue healthy workplace initiative which can also increase employee job
satisfaction and business productivity
Media - Provide meaningful information on risks to health, reinforce messages
about healthy behaviours and be responsible in depicting unhealthy
behaviours

Equity of access to health care facilities and services

HORIZONTAL EQUITY: Provides equal treatment for similar needs
- Example: Medicare provides equal access to Health Care
- Example: PBS provides equal access to medicines for all Australians

VERTICAL EQUITY: Priority treatment for groups with greater needs
- Example: ATSI and Rural groups have access to the Royal Flying Doctors Service due to their
geographic disadvantage
- Example: OATSIH (Office ATSI Health) offers funds for range of indigenous specific controlled
Health Services

Health care expenditure versus expenditure on early intervention and prevention

In 2007-08 Health-care expenditure was $103.6 billion (AIHW). Less than 2% of this figure was spent on
preventable services or health promotion.

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

New treatments and technologies have the potential to significantly improve the health status of
Australians

Examples:
- development of new machinery mammograms, breast screening
- image technology in keyhole surgery
- improvement in materials reducing the risk of infections
- drug advancements decreasing mortality rates and significant reductions in pain
- prosthetic limb development reducing the burden of disabilities
- artificial organs and transplant technology increasing life expectancy

Health insurance: Medicare and Private Health Insurance

Medicare (1984)
- Universal system of health insurance which makes health care accessible to all Australians (based
on universality, equity, simplicity)
- Funded by medicare levey (1.5% taxable income) and general government taxes
- Reimburses 85% of the scheduled fee (amount set by government for specific service)
- Some practices offer bulk billing, where the patient pays nothing and the doctor receives the
equivalent of 85% of the scheduled fee

Positives:
- Doctor visits
- Hospital treatment/accommodation
- Eye tests
- oral surgery
- x-ray

Negatives:
- No ancillary benefits
- Examples: dentist, physiotherapy, ambulance, home nursing, glasses, medicines, private
treatments, choice of doctor

PBS (Pharmaceutical Benefits Scheme)
- PBS drugs are subsidised by Commonwealth Government for people with special needs
- Example: pensioners, low income earners, chronically ill
- Once an individual or family has paid a set amount, PBS medicines are cheaper for the rest of the
year known as the PB Safety Net Scheme

Private Health Insurance (used to top up)
- Covers private hospital and ancillary benefits not covered by Medicare (positive)
- Examples: dental, optical, shorter waiting time, choice of doctor / hospital / private hospital room
sport registration / equipment

Negatives:
- Expensive cost whether used or not
- gap difference between cost and benefits.
- Medicare levy must still be paid

Complementary and alternative health care approaches

Alternative health care approaches are natural therapies advocating better health and healing without
drugs or surgery. They may complement traditional medical care or be substituted wholly or partly for
modern medicine. During the last two decades of the 20
th
century the practice of alternative health care
expanded significantly.

Reasons for growth of complementary and alternative health products and service

- Alternative health care education courses for practitioners
- Greater awareness of alternative health care among populations
- Belief in a more natural or holistic approach to medicine relatively low technology input
- WHO recognition of the usefulness of some alterative HC approaches (eg. yoga for stress)
- A more open and accepting society than in the past
- Persuasive marketing campaigns
- Increased availability
- Disillusionment or dislike of conventional medical treatment
- A belief in natural therapies due to family, religious, spiritual or other values (reccomendations)
- Used for centuries, herbal
- Curiosity or experimentation

Range of products and services
- Acupuncture: insertion of fine needles into skin to stimulate mind/bodys healing process
- Aromatherapy: use of pure essential oils to modify mind, body and spirit
- Bowen technique: muscle, connective tissue movements which realign the body and stimulate
energy flow
- Chiropractic: adjustments made to spine to realign correct body function
- Herbalism: use of plants/herbs for medicinal qualities
- Iridology: analysis of iris to detect signs of illness, followed by application of naturopathic
treatments
- Massage: remedial sports, therapeutic - muscles are warmed and stretched by physical
manipulation
- Meditation: state of inner stillness which calms mind, spirit
- Naturopathy: holistic treatment using range of natural therapies to treat symptoms and underlying
causes of illness
- Homeopathy: use of potent homeopathic medicines (toxic substances in smallest quantities) to
stimulate bodys own healing power.

How to make informed consumer choices

Develop personal consumer skills (RSR method=research, select, reassess)

Research
- Gathering information from local practitioners, ask questions: costs, benefits, effectiveness, side
effects, use alongside traditional medicines
- Experiencing chosen treatment: asking those whove tried it (recommendations), researching
medical journals
- Researching qualifications required to practice: from reputable sources (Government websites)

Select
- Best treatment option and practitioner that suits
- Or decide against it

Reassess
- Is treatment meeting expectations?
- Is health improving or worsening?
- Need for change?

WHAT ACTIONS ARE NEEDED TO ADDRESS AUSTRALIAS HEALTH PRIORITIES?

Health promotion based on the five action areas of the Ottawa Charter

Levels of responsibility for health promotion

Commonwealth (Federal) government
- Establish and enforce policies, laws and legislation to support and promote positive health
- Provide funding for health promotion initiatives (eg. swap it-dont stop it)
- Provide funding for research (prevention and cure of key diseases)
- Establish organisations (eg. AIHW Australian Institute of Health and Welfare - to identify health
priority issues)

State and territory government
- Deliver preventative health services that support wellbeing
- Prioritising health care spending
- Establishing and reinforcing healthy public policy
- Meet accountability and public health goals
- Work in partnership (for best results)

Private sector
- Provide diverse, culturally specific, high quality and affordable services

Local communities
- Develop partnerships (with best use of resources)
- Address specific needs with their population groups and meet those needs
- Cater for diversity allow access (equity, diversity, supportive environments)
- (eg. healthy diet and cooking lessons targeted for overweight regions)

Individuals
- Take responsibility for their choices and empowered to make their own decisions
- Take advantage of available facilities and services
- Develop personal skills (eg seeking help from support groups) and teach others

The benefits of partnerships in health promotion

- More effective: greater capacity to tackle and resolve complex health or social problems, resulting
in a healthier population and, thus, a reduced demand for health care and social services
- Shared responsibility allows pooling of resources (eg. expertise, funding) which allows partners to
address current problems more effectively and positions them to respond better to future issues
- Cost effective and reduced pressure on one source
- Reductions in duplication of effort amongst different sectors
- Increased support and encourages participation by all
- Increased reliability and accuracy of evidence through increased research when in a partnership

How health promotion based on the Ottawa Charter promotes social justice

ACTION AREA EQUITY DIVERSITY SUPPORTIVE
ENVIRONMENTS
Building healthy public
policy
PBS ABstudy provides
assistance for ATSI
people to study further
education (uni, tafe)
Health care card (assists
in health care service
payments and the cost
of certain prescriptions)
Young driver education
as a compulsory
program in schools (year
10-11)
Creating supportive
environments
The minimum level of
safety equipment
provided in certain
industries falls under law
Signs in hospitals in a
variety of different
languages
Making condoms readily
available in public places
Strengthening
community action
Groups that promote
health issues for
minority groups (eg.
senior citizen support
groups)
www.ruralhealth.org.au
(non-government
organisation for rural
and remote health)
Lobbying councils to
install lighting at public
exercise facilities
(increase exercise after-
hours)
Developing personal
skills
All children are free to
attend school (eg. public
school system) and
undertake compulsory
PDHPE course year 7-10
Everyone has access to
Medicare
Government programs
to assist individuals to
learn English and,
therefore, find it easier
to access health
information (eg.
Australian
Translating and
Interpreting Service)
Media campaigns for
breast and testicular
cancer self-diagnosis
Reorienting health
services
Greater resources for
ATSI health (priority
population group at
greater risk of chronic
disease)
Interpreter services in
hospitals
Smoking quit-line
Partnerships within the
community

Ottawa charter in action

Five action areas of the Ottawa Charter (PE Classes Smell Rotten)

Building healthy Public Policy: all decisions made by all levels of government related to health
improvement
- Examples: legislation, policies, budget, taxes, laws (such as learner driver hours must be 120+ to
increase road awareness, resulting in less accidents)

Creating Supportive Environments: focusses on increasing peoples ability to make health-promoting
choices
- Examples: no smoking in pubs and clubs, shaded areas around local pools, free access to public
parks

Strengthening Community Action: gives communities chance to identify and implement actions that
address their health concerns
- Examples: Lions Club Driver Reviver, Alcoholics Anonymous, Breakfast Clubs at Schools

Developing Personal Skills: health prevention that supports personal and social development of the
individual
- Examples: education and information regarding a healthy diet, adequate exercise, importance of
sun protection, helmets and seat belts and how to access HC information to empower individuals
and gain skills

Reorienting Health Services: changes in the attitude and organisation of health services
- Examples: health professionals visiting school to educate on asthma management programs,
getting buses to rural areas for blood tests / mammograms / bowel cancer check-ups, ATSI doctors
visiting ATSI communities to educate on the importance of HC

Critically analyse the importance of the five action areas of the Ottawa Charter through a study of
TWO health promotion initiatives related to Australias health priorities

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HOW ARE PRIORITY ISSUES FOR AUSTRALIA'S HEALTH IDENTIFIED?

Measuring health status

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