HSC Core 1: Health Priorities in Australia

How are priority areas for Australias health identified?

Measuring Health Status
MEASURES OF EPIDEMIOLOGY
MORTALITY- death rates within a population
INFANT MORTALITY- the number of deaths in the first year of a childs life within a
population
MORBIDITY- sickness rates within a population
LIFE EXPECTANCY- the number of years a person has or is expected to live
ROLE OF EPIDEMIOLOGY
Epidemiology focuses largely on the gathering and interpretation of statistics.
Epidemiological findings are used to determine the health priorities for a population
group.
Determine which aspects of health need to be focused on for health promotion and
disease prevention.
Epidemiology can give us information on:
PREVALENCE- the number of cases of disease that exist in a population at a point in time. (Existing
cases)
INCIDENCE- The number of new cases of diseases occurring in a population at a point in time. (New
cases)
EXTENT-severity of problem
DETERMINANTS- Underlying or associated factors that influence the likelihood of a disease or illness.

The health status of Australians
CURRENT TRENDS
Life expectancy for both males and females has increased (Males 79 yrs, Females 84 yrs).
This is due to improved technology, health promotion
The leading cause of death in Australia currently is CVD accounting for 36% of all deaths in
Australia.
The major causes of death/illness are: CVD (declining slowly, but still the major contributor
to all deaths), Cancer (Incidence is increasing, lung cancer is the major killer in men, breast is
the major killer in women), Injuries (deaths declining by almost half over the past 20 yrs).

GROUPS EXPERIENCING HEALTH INEQUITIES MADE WORS
ABORIGINAL AND TORRES STRAIT ISLANDERS lower life expectancy rates at birth (Males-
59yrs, Females- 65 yrs), higher mortality rates at all ages compared to those of non-
indigenous culture, infant mortality rates 3 times higher than the national average. These
statistics are all preventable with proper health care, improved education and more
appropriate laws in regards to what their income is spent on, etc.
SOCIOECONOMICALLY DISADVANTAGED GROUPS is measured by income level, education
level and occupation. People of a low socioeconomic status have a higher infant mortality
rate; they have low levels of education, which therefore leads to higher levels of blood
pressure in both sexes and obesity in both sexes
AUSTRALIANS BORN OVERSEAS statistics show that Australians born overseas are less
likely to have lower death rates and hospitalisation rate. There are also some inequities that
exist between Australians born overseas and people born in Australia such as:
Higher rates of mortality from lung cancer for people from the UK and Ireland
Lower incidence of skin cancer for Australians born overseas
PEOPLE LIVING IN RURAL AND ISOLATED LOCATIONS the health of people living in rural
areas is much poorer compared to people living in city areas. The reasons for this statistic
are that people living in these areas are more likely to:
Be smokers
Be overweight
Drink alcohol in excessive amounts
Have lower levels of education
PEOPLE WITH DISABILITIES in 2003, 20% of Australias population were affected by some
sort of impairment. Around 15% of the population affected was under the age of 65. The
actual number of people living with a disability is increasing as a result of an ageing
population. Trends show that the prevalence of disability among older people has not
changed much over the past five years.

MEN AND WOMEN 25-64 YEARS OF AGE this age group occupies 53% of the total
population. As the age increases in, so does morbidity and mortality rates. For males, lung
cancer is the biggest killer, and for women, breast cancer is the major killer. Differences in
morbidity and mortality rates may be a result to attitudes towards health between the sexes
and differences in health behaviours.

OLDER PEOPLE the reasons for an aging population are improvements in medical
technology. Cancer and CVD are the major diseases affecting this age group (65+) and due
to the improvements in technology, these 2 diseases will be reduced.





Identifying priority areas SCP123

SOCIAL JUSTICE PRINCIPLES

Social justice is a value that aims at decreasing or eliminating inequality, while establishing
environments that are supportive of all people. When identifying a NHPA they look at the
groups that have inequalities in both mortality and morbidity rates, social, cultural and
environmental factors as well as their access to resources (rural), information and
education.
COST TO INDIVIDUALS
Medical expenses may be more than the individual can afford. This creates financial stress
upon the individual as well as emotional stress. This stress affects the individuals ability to
pay other debts that they have in the case of ongoing treatment.
COST TO COMMUNITY
DIRECT money spent on diagnosing, treating and caring for the sick as well as prevention
INDIRECT the cost that business goes through when people become too sick or die. It
places a burden on the families.
PRIORITY POPULATION GROUPS
When there are large amounts of groups that suffer from inequalities. These groups include:
Aboriginal & Torres Strait Islander People
Socioeconomically disadvantaged people
Australians born overseas
People living in rural and isolated locations
People with disabilities
Women/men
Older people

PREVALANCE OF CONDITION

This refers to the number of cases of that disease within a population at a specific point in
time. Greater prevalence affects the cost associated with the disease of both the community
and the individual.

POTENTIAL FOR CHANGE

Most of Australias largest causes for illness and death are due to modifiable lifestyle
behaviours. This means that they can be prevented through change. Environmental, social,
cultural and political factors all play a part and must be addressed in order for the health
status of Australia to improve.


What are the priority areas for improving Australias health?

Priority areas for action

CARDIOVASCULAR DISEASE (CVD)

NATURE OF THE PROBLEM there are 3 major forms:
Coronary which is a poor supply of blood to the walls of the heart
Stroke which is a lack of oxygen to the brain
Peripheral vascular disease which is a slow flow of blood to the limbs
CVD is the leading cause of sickness and death in Australia

EXTENT OF THE PROBLEM (TRENDS ONLY) CVD related deaths accounted for 36% of all
deaths in 2004
Coronary accounted for 19.2% of male deaths and 17.7% of female deaths
Stroke deaths accounted for 7.1% of male deaths and 11.3% of female deaths
Other heart disease accounted for 4.8% of male deaths and 6.7% of female deaths
Mortality rates have been declining over the past few years. In 1996 CVD accounted for 42%
of all deaths compared to 36% in 2004.
CVD was responsible for 7% of all hospitalisations in 2003-04.
Morbidity rates are also steadily decreasing.

RISK FACTORS there are modifiable and non-modifiable. The non-modifiable factors are:
Age as you get older, you increase your risk of contracting CVD
Family History if someone in your family had CVD you could possibly contract it
Gender males are at higher risk than females
The modifiable risk factors are:
Smoking which increases your chances of contracting CVD by 5 times
Lack of physical activity which leads to heart and circulatory problems
High fat diets puts more pressure on the heart and lungs because of the raised blood
fat levels and cholesterol

SOCIAL DETERMINANTS (OR SOCIALLY-BASED CASUAL FACTORS)
Low socio-economic status leads to unhealthy eating behaviours, smoking excessive
alcohol consumption.
Access to healthy foods, health care facilities and recreational amenities may lead to
improved health and nutrition
Promotion from the media may raise peoples awareness to the risks associated to
CVD
Indigenous people are less likely to use the services provided by the government,
therefore they are putting their health at risk.

GROUPS AT RISK
People with a diet high in fat
Smokers
People over the age of 65
People with a family history of CVD
Blue-collar workers
People with little or no education


CANCER

NATURE OF THE PROBLEM cancer is an uncontrolled growth and spread of abnormal cells.
There are 2 kinds tumours, benign and malignant. Benign tumours are non cancerous (do
not spread to other parts of the body) and grow slowly. Malignant tumours are cancerous
and do spread to other parts of the body. They starve the surrounding tissues of vital
nutrients and can cause death and serious sickness.

EXTENT OF THE PORBLEM (TRENDS ONLY) cancer accounted for 28% of all deaths in 2004.
Over the past decade there has been an increase in incidence in all cancers (lung, breast,
and skin, prostate, colorectal and cervical cancers). It occurs more in people that are
experiencing inequities more than it occurs in people that dont have the inequities. The
most common type of cancer in males is lung cancer and the most common type of cancer
in women is breast cancer. As age increases, so does an individuals risk of contracting
cancer.

RISK FACTORS there are modifiable and non-modifiable.the non-modifiable risk factors
include:
Age
Gender
Family history
The modifiable risk factors include:
Smoking which increases your risk of contracting lung cancer
Excessive sun exposure increases your risk of contracting skin cancer
For women, never giving birth increases their risk of contracting breast and cervical
cancers

SOCIAL DETERMINANTS (OR SOCIALLY-BASED CASUAL FACTORS)
Education people are more aware of the signs of cancer
Legislation there is now a smoking ban in some public places, therefore creates a
safer working environment
Improved technology and ease of access to health services
People have changed their attitude towards smoking due to health promotion
initiatives seen on TV and in newspapers.
GROUPS AT RISK
Socioeconomically disadvantaged
Smokers
People with a diet of high fat
Low fibre diets
People with fair skin
Women who havent had babies
People with a family history of cancer


ASTHMA

NATURE OF THE PROBLEM Asthma is a disease that affects the respiratory system or
airways. It narrows the individuals airways causing difficulty in inhaling oxygen. This
happens because:
The inside of the airways becomes swollen
The mussels contract around the airways
Increased mucus blocks the airways

EXTENT OF THE PROBLEM (TRENDS ONLY) trends of mortality and morbidity include:
Mortality rates over the past 10 years have decreased over the past 10 years
Australia has the highest death rate from asthma in the world among young people
Asthma is the most common reason for children to be admitted to hospital

RISK FACTORS asthma is likely to occur because of:
Chest infections
Allergies
During or after intense exercise
Cold air
Exposure to chemicals
Tobacco smoke
Strong odours and scents
Air pollution
Colds and flu
Using drugs such as aspirin
Preservatives in food, flavourings and colourings

If someone in your family has asthma, you are more likely to develop it

SOCIAL DETERMINANTS (OR SOCILALLY-BASED CASUAL FACTORS) - can be linked to family
history, for example if someone in your family has asthma, you have an increased risk of
contracting asthma. Asthma can be triggered by:
Cold and flu
Tobacco and smoke
Inhaled allergens, such as:
- Pollens
- Animal hair
- Dust mites
- Air pollution
- Strong odours and scents
- Change in temperature
- Exercise.
GROUPS AT RISK asthma is more common in people who:
Are prone to allergies
Have parents who are asthmatics or experienced a severe chest illness when they
were very young
Had a mother that smoked during pregnancy
Are exposed to passive smoking
Are young (younger children are at a higher risk of developing asthma).

ARTHRITIS AND MUSCOLOSKELETSAL CONDITIONS
NATURE OF THE PROBLEM osteoarthritis is the degeneration of cartilage in the joints and
causes pain and stiffness in the joints, swelling, restricted movement and weakened muscle.
Rheumatoid arthritis is disease when the immune system attacks the tissues ling the joints
and has the same symptoms that osteoarthritis has on the body. Osteoporosis is the
deterioration of the structure where bones become thin and weak. It leads to fractures and
functional problems.
EXTENT OF THE PORBLEM (TRENDS ONLY)
In 2004, 49% of people aged 65+ and 1% under 25 experienced symptoms of
osteoarthritis
In the same year 6 million Australians experienced arthritis or a musculoskeletal
condition
It causes more disabilities than any other illness or disease, with 20% of people with
the condition experiencing a disability
SOCIAL DETERMINANTS (OR SOCIALLY BASED CASUAL FACTORS)
Age as you get older, the chances of you contracting it increases
Gender more common in females, back pain more common in males
Socioeconomic status higher prevalence in people of low socioeconomic status
Education increased education leads to healthy behaviours, signs of symptoms and
knowledge of risk factors and can result in an early diagnosis
GROUPS AT RISK
People over 65
People with a family history of the disease
Overweight people
Post-menopausal women
People who have broken bones earlier in life
What role does health promotion play in achieving better
health for all Australians?
Approaches to health promotion
WHAT IS HEALTH PROMOTION (PEEGGS)
Health promotion is the process of enabling people to increase control over, and to
improve their health. Health promotion focuses on improving skills and capabilities and
participation by individuals is necessary. To improve these skills, the following
environmental supports are used:
Physical supports hospitals, nursing homes and surgeries
Educational supports community education, school education and information
Economic supports it is vital that the government allocates sufficient money to
support health and welfare so that it functions correctly
Government legislation laws that protect us, such as quarantine laws
Government regulations controls that ensure communities maintain levels of
health, hygiene in food preparation shops
Social supports people that assist in health care, doctors, nurses, counsellors and
social workers
THE SHIFT FROM AN INDIVIDUAL LIFESTYLE APPROACH TO THE NEW PUBLIC HEALTH
APPROACH
Individual Lifestyle Approach concentrated on health education to persuade individuals to
modify behaviours that impacted health.
New Public Health Approach concentrated on empowerment of individuals and
community participation rather than blaming bad health on an individual.
In previous years, people used to believe that germs caused sickness, and didnt focus on
lifestyle behaviours. The reasons behind poor lifestyle behaviours were not even
considered. At this time the public health system invested all their energy and resources
into providing increased health care services. High quality health care services were viewed
as the major vehicle for improvements in our populations health.

Characteristics of the new public health approach
EMPOWERMENT OF INDIVIDUALS
Emphasis was placed on enabling people to make the changes required through provision of
education, the teaching of life skills, providing equal access to resources and providing
opportunities to make changes


COMMUNITY PARTICIPATION
Successful health promotion requires the mediation between governments, health
professionals, organisations, researchers, media, industry, communities, families and
individuals.
RECOGNITION AND SOCIAL DETERMINANTS OF HEALTH
Health is now resulting in factors such as income, education, employment, living location
and conditions, culture and access to health services. A major aim of the new approach is to
reduce inequities in health status by promoting health of all people. To do this the
economic, social and environmental conditions must be taken into account.
Major health promotion initiatives
THE OTTAWA CHARTER FOR HEALTH PROMOTION (1986) (DBSCR)
There are 5 action areas for the Ottawa Charter:
1. Develop Personal Skills health promotion needs to provide people with
information, education and life skills. People can then make their own decisions and
have control over their own health. Personal skills can be provided for in the home,
at school, at work and within the community

2. Build Healthy Public Policy Includes legislation and regulation, financial incentives,
taxation and organisational change. Seeks to help the people of Australia

3. Strengthen Community Action this is to build a supportive and strong community
base so that they are ready to deal with making decisions, planning and
implementing health promotional strategies

4. Create Supportive Environment we need to take care of each other, out
communities and out natural environment. This stimulates and satisfies

5. Re-orient Health Services this stresses that the health sector should not
concentrate solely on the treatment of illness and disease, but also focus on disease
prevention and health promotion. It relies on a collaborative effort between the
government, organisations, communities, individuals and the health sector.

THE JAKARTA DECLARATION FOR HEALTH PROMOTION (1997)

Evidence was provided to suggest that the participation of people in the decision-making
process of health promotion ensured its effectiveness and successful participation was only
possible if there was adequate access to education and information.
There are 5 identified priorities:
1. Promote Social Responsibility for Health these should pursue policies and practices
which do not harm the health of individuals, protect the environment and help
sustain resources, restrict production and trade of harmful products, discourage
unhealthy marketing practices and include equity-focused health impact
assessments as an integral part of policy development.

2. Increase Investments for Health Development to ensure the right education and
the right information is being sent out to that in need, this priority wants to increase
the money being distributed to health development.

3. Consolidate and Expand partners for Health different areas of the community need
to work together to improve health.

4. Increase Community Capacity and Empower the Individual communities and
individuals need to be provided with adequate information along with access to
resources and the ability to participate in the decision-making process.

5. Secure an Infrastructure for Health Promotion this priority aims to make sure all
aspects of health are safe and durable for consumers and individuals.

AUSTRALIAS HEALTH (AIHW PUBLICATION)

The Australian government has set out to establish its own plan of action to improve the
health status of our nation. Their report contained information on mortality and morbidity
rate in Australia, health care costs and services, information on the national health priority
areas, along with discussion on health inequality groups and developments in public health.

What role do health care facilities and services play in
achieving better health for all Australians?
Nature of health care in Australia
ROLE OF HEALTH CARE
The role of health care in Australia is to:
Reduce inequalities within health
Share health benefits among all
Realize the importance of quality for all in a normal lifespan rather than trying to
extend life
Provide services and facilities to meet the health needs of all Australians



RANGE AND TYPES OF HEALTH FACILITIES AND SERVICES
There are institutional and non-institutional:
INSTITUTIONAL:
Public Hospitals are government owned, used for medical treatments usually
requiring overnight stays.
Private Hospitals individually and community based such as medical procedures
usually requiring overnight stays.
Psychiatric Hospitals used for treatment of people suffering mental disorders
Nursing Homes long term care for those unable to look after themselves e.g.
elderly
NON-INSTUTIONAL:
Medical Services refers to G.P.s and specialists.
Dental Services services related to teeth and gum disorders.
Pharmaceuticals drugs and medicine. Most drugs are supplied through
pharmaceutical benefits scheme.
Community Health Services services that are community based such as mental
health services, meals on wheels and baby health centres.
Professional Services other health services, such as podiatrists, physiotherapists,
chiropractors and ambulance officers.
ACCESS TO HEALTH FACILITIES AND SERVICES
Closely related to environmental factors.
People from a low socioeconomic background have poorer access to health care
facilities. This is partly due to lack of finances. Low SES is also linked to a lower level
of education; this may mean less knowledge of risk factors of illness and disease,
treatment options and also consumer behaviours.
Access to health facilities and services is also poorer for those from rural and remote
areas. This is obviously due to distance from facilities and the decreased
opportunities for specialist care.

RESPONSIBILITY FOR HEALTH CARE
COMMONWEALTH GOVERNMENT
Sets policy and legislation regarding health
Provides funding for health care
Looks after health care for war veterans and special Aboriginal health care programs
STATE GOVERNMENT
Provide the actual health services (hospitals)
Responsible for development of state health promotion campaigns
Regulation of facilities and personnel

LOCAL GOVERNMENT
Local health promotion campaigns
Provision of community health services
Monitoring and regulation of health standards within the community
PRIVATE SECTOR
Provides services such as private medical practices and private hospitals
Contributes to research and resources to specialist health areas
Businesses and companies provide health care facilities such as workplace gyms.
COMMUNITIES
Provide community services such as meals on wheels
INDIVIDUALS
Responsibility lies within individuals to make wise decisions regarding their own
health care

Funding of health care in Australia
HEALTH INSURANCE (PUBLIC AND PRIVATE)
PUBLIC HEALTH INSURANCE
Aims to make health care accessible to everyone. It is funded by taxes and Medicare
reimburses 85%. Bulk billing is when the doctor only charges the 85% of the scheduled fee
and the patient then pays nothing.
Medicare was established in 1984, it is a system of health insurance which reimburses large
amounts of medical and hospital expenses.
If there is an emergency, it will be treated much better than private
PRIVATE HEALTH INSURANCE
Private health insurance provides opportunity to choose a doctor, accommodation of single
rooms and a shorter stay. It has the two largest insurers being Medicate private and MBF. It
accommodates people with middle to high socioeconomic status.
The technology and facilities supplied are not as good as public.
It also offers dental, physiotherapy and chiropractic services.
COSTS OF HEALTH CARE TO CONSUMERS
Programs that are trying to enforce prevention rather than cure strategies have been
recognised by governments and funding for these strategies has increased. Preventing
illness would prove to be cost effective as it would result in huge savings; prevention also
leads to an improvement to quality of life. If we use existing structures such as a GP, they
can educate us on ways to prevent an illness, and by us being responsible for our own
health, allows us to choose our own behaviours.
HEALTH CARE EXPENDITURE VERSUS HEALTH PROMOTION EXPENDITURE
A focus on medical treatments to cure illness exceeds the allocation of public health
resources. Health promotion on the other hand uses the funding to address the public the
issues of health and trying to prevent it, rather than cure it.
Alternative health care approaches
REASONS FOR GROWTH OF ALTERNATIVE MEDICINES AND HEALTH CARE APPROACHES
World Health Organisation recognises the usefulness of medicinal plants to be used
in preparation of herbal medicines
The ineffectiveness of modern medicine on certain individuals
The desire to have natural, rather than synthetically produced medicines
Traditional beliefs for many cultures
RANGE OF SERVICES AVAILABLE
Acupuncture inserting very fine needles into the skin to stimulate the mind and
assist the body in the healing process.
Aromatherapy use pure essential oils in modifying the mind, body and spirit.
Chiropractic aims to correct or remove interference to normal nervous system
control over the body.
Herbalists herbal treatment is used to restore and support the bodys own defence
mechanisms.
Iridology uses the movements of the eye to identify the individuals physical,
emotional and spiritual wellbeing.
Naturopathy seeks to address symptoms of illness as well as resolving underlying
causes of illness.
HOW TO MAKE INFORMED CONSUMER CHOICES
It is important to make informed decisions when choosing an alternative health care
approach. The individual needs to investigate the services on offer, the costs, the
qualifications and experience of the practitioner, and the health claims being made before
committing to it.




Jacob Walkerden