HSC CORE 1: HEALTH PRIORITES IN AUSTRALIA

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 Epidemiology as it does not provide information about a persons quality of life in a holistic sense, nor does it accurately describe the sociocultural, 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 in populations to improve health.

Measures of epidemiology
Morbidity (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.

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.

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.

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 stopping smoking 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 social activities, 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.

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 allocating resources 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, health promotion, funding to hospitals for treatment. Indirect: loss of productivity for companies.

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 females the 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 Modifiable Risk Factors Protective Factors Factors - Smoking and alcohol - Nutritious and - Age: rates increasing abuse balanced diet sharply over 65 years - Diet high in fat, salt - Daily physical activity of age and sugar - Responsible use of - Gender: males suffer - Low physical activity alcohol for CVD more levels - No smoking - Family history - High blood pressure - Maintain healthy and cholesterol levels weight - Being overweight - Control stress levels Determinants Socio-cultural Determinants Family history Indigenous: high rates of all risk factors Gender: males are less likely to engage in preventative health measures

Socio-economic Determinants - Low levels of disposable income - Unemployed - Low level of education

Environmental Determinants - People who live in rural and remote communities

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 Modifiable Risk Factors Protective Factors Factors - Exposure to - Avoid carcinogen e.g. - Gender: specific carcinogens such as Slip, Slop, Slap cancers smoke, UV radiation - Personal screening - Age: leads to increased from the sun habits risk - Lifestyle behaviours, - Public Screening - Family History such as smoking, - Seeking early medical - Genetic makeup e.g. alcohol misuse and intervention being fair skinned poor dietary habits Determinants Socio-Cultural Determinants Smoking amongst young females Tanning habits, such as excessive sun exposure

Socio-economic Determinants - Unemployed: high rates of smoking as a stress relief - Low levels of education

Environmental Determinants - 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

Deaths from injuries are decreasing in frequency, especially MVAs Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Protective Factors Factors - Age: elderly are more - Minimising driving - Driving behaviour and at risk of falls distractions e.g. attitudes - Gender: higher rates phones - Inadequate supervision of risk taking - Effective driver of children behaviour and suicide education - Occupational hazards - Home modifications - Safe use of alcohol for the elderly - Unsafe home - Strong social support environment to prevent suicide

Determinants Socio-cultural Determinants ATSIs suffer more injuries Attitudes towards driving and risk taking amongst males Family breakdowns Societal pressure for tougher road laws

Socio-economic Determinants - 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

Environmental Determinants - 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 will benefit 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 lifestylebased, 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

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 who assists 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 Public health services- focus is on prevention, promotion and protection of population groups and the factors and behaviours that cause illness rather than treatment Primary and community health care- are usually the first health service visited by a patient with a health concern Hospitals- provide care for admitted patients which is more commonly treatment focused e.g. medication, monitoring and treating conditions, surgery and care for the Examples Cancer screening Immunisation programs

GPs Ambulance services Royal Flying Doctor Services Dental Public Private Mental

extremely ill Specialised health services target specialised health conditions such as mental illness, sexual and reproductive health drug and alcohol dependent Goods Responsibility for health facilities and services Health care provider Commonwealth Government Specialised medical practitioners Reproductive health Mental health Palliative care Pharmaceuticals

State/Territory Government

Local Government

Private organisations

Community groups

Facilities and/or services provided 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 Hospital services Mental health Home and community care Family health services Womens health Health promotion Vary from state to state Environmental control Home services Examples include: Meals on Wheels, Antenatal clinics Private hospitals Dentists Alternative health services (physiotherapy, chiropractor, etc.) 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

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 private Medicare 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 highincome 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 Involves inserting needles into skin to relieve Acupuncture pain

Chiropractic Meditation Bowen therapeutic technique

Adjustments are made to the spine to realign correct body function State of inner stillness System of muscle connective tissue movement that realign the body and balances energy flow Holistic treatment aiming to treat the underlying cause as well as the symptoms of the illness

Naturopathy

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