HEALTH PRIORITIES IN AUSTRALIA

FOCUS QUESTION 1 HOW ARE PRIORITY AREAS FOR AUSTRALIAS HEALTH IDENTIFIED?
MEASURING HEALTH STATUS Prevalence refers to the number of cases of disease that exists in a defined population at a point in time. Occurrence, commonness. Incidence refers to the number of new cases of disease occurring in a defined population over a period of time . Role of epi e!iolo"# Epidemiology considers the patterns of disease in terms of prevalence, incidence, distribution and determinants. It describes and compares the patterns of health groups, communities and populations. Me$%&'e% of epi e!iolo"# Mortality death rates!" indicates how many people die in a particular population, how they died and over what period. Expressed per #$$ $$$. Infant mortality" indicates the number of infant deaths in the first year of life per #$$$ live births Morbidity disease and sic%ness rates!" examines the prevalence and incidence of disease and sic%ness in a specific population &ife expectancy" indicates the number of years a person is expected to live. HEALTH STATUS OF AUSTRALIANS C&''e() )'e( % &ife Expectancy 'rends (s life expectancy increases so does our ageing population. Increased life expectancy has led to an increase demand for health services that cater for the elderly, increase in nursing homes and the need to provide care for a growing number of dependant people. Ma)or *auses of +ic%ness and Illness ,iseases of the circulatory system were the leading causes of death for both men and women in -$$#, followed by cancer, in)uries and then respiratory diseases. G'o&p% e*pe'ie(+i(" i(e,&i)ie% Ine.uality is the une.ual distribution of illness or conditions throughout the population. Ine.uity is in)ustice in regard to social, economic and cultural factors. Examples" Income, education, access to heath services, location. (boriginal and 'orres +trait Islander Peoples Mortality from preventable causes is twelve to thirteen times higher than (ustralia as a whole.

/igher mortality rates than the non0indigenous population for almost all causes of death. Infant mortality rate is two to four times higher than the national average. /ospitalisation rates are two to five times higher than the total population. +ocioeconomically ,isadvantaged People 'hey are more li%ely to drin% alcohol at harmful levels, smo%e, become obese, have raised blood pressure and have diseases such as cardiovascular disease, respiratory diseases and cancers. /igh levels of disease are associated with lower socioeconomic status mainly due to the limitations of reduced access to services which provide diagnosis and treatments, and the lac% of education. (ustralians 1orn Overseas 'hey often have lower mortality and hospitalisations rates, as well as lower rates of disability and lifestyle related factors. 'his is believed to result from" ( self selection process which includes people who are willing and economically able to migrate and a government selection process that involves a certain eligibility criteria based on health education, language and )ob s%ills. (s the time of residence in (ustralia lengthens, the more li%ely overseas0born (ustralians are to adopt the (ustralian lifestyle and hence death rates increase for migrants and approach those of (ustralian born people. People &iving in 2ural and Isolated &ocations 'he mortality rate for males and females who live in remote areas is 3-4 higher than those who live in ma)or (ustralian cities. 'here is less access to health services and they are heavily affected by environmental issues. 'hey tend to suffer from heart disease, in)ury, diabetes, suicide and the effects of alcohol. People with ,isabilities ,isability is defined in terms of the lac% of ability to perform everyday functions or activities. In #553 a survey was conducted by the (ustralian 1ureau of +tatistics which showed #64 of all (ustralians approx. 3.- million people! were diagnosed with some %ind of disability. 'hey also found the most common disabilities were musculos%eletal arthritis!, hearing loss and mental disorders. (lso that 7.#4 of (ustralian are classified as handicapped. 8omen 'he most fre.uently reported conditions for women aged #9 years and over were diseases of the nervous system and sense organs, respiratory conditions, arthritis and circulatory conditions. /eart disease %ills more women more than any other disease due to their lifestyle and nutrition. 8omen ma%e much greater use of medical services. Men 'he most fre.uently reported conditions for men aged #9 years and over were diseases of the nervous system, sense organs respiratory conditions and circulatory conditions. Men have a -94 higher death rate then women. Men on average live for six years less than women.

Older People 'he elderly do suffer from health ine.uities because they ma%e up the ma)ority of the population and aren:t supported as they should be due to lac% of resources, time and effort. 'he elderly earn less and can not pay for proper treatment. 'hey may not %now about the symptoms of the disease and may not recognise that they need treatment for it. 'he elderly may suffer from cardiovascular disease, cancer, stro%e and diseases of the respiratory system. 'heir life expectancy is also increasing. IDENTIFYING PRIORITY NEEDS 'he process of identifying priority areas see%s to focus attention on areas believed to be the most significant in affecting the community and for those areas that have potential for health gains. (vailable funds have to be allocated according to the areas of highest priority. +ocial )ustice principles. +ocial )ustice means that the rights of all people in our community are dealt with fairly and e.uitable. Public policies should ensure that all people have e.ual 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 bac%ground should receive the same .uality 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. 'he health priority areas established by the government include cardiovascular disease, cancer, in)ury, mental health and diabetes. 8ithin each of these priority areas certain groups in our population have been identified as ;at ris%< of developing these diseases. 1y identifying ;at ris%< population groups, government health care expenditure can be directed towards these groups to attempt to reduce the prevalence of the disease. Prevalence of condition. (nalysing statistics allows us to interpret the prevalence of a condition or disease. Prevalence0how common a condition is in the community!. Morbidity statistics are reliable indicators of the prevalence of a condition. /ospital admissions and health surveys are two examples of how statistics are accumulated to give us a picture of the health status of a population. *osts to community. /ealth priorities for government are determined by a number of factors. 'his includes the expense of illnesses. 'he six disease groups that account for the most health expenditure in (ustralia are" ,igestive system diseases including dental services" ##.64 of total health system costs. *irculatory disorders" ##.=4 Musculos%eletal problems" 5.94 Mental disorders" 6.74

In)ury" 6.34 2espiratory diseases" 6.$4 Potential for change (ll of the health priority areas that have been identified have the potential to change the incidence and mortality of the particular disease and condition. >or instance cardiovascular disease has some very highly preventable ris% factors including smo%ing and lac% of physical activity. (n individual could modify their lifestyle by stopping smo%ing and ta%ing up regular exercise in order to decrease the ris% of developing cardiovascular disease. Other diseases and conditions, if detected in the early stages, can be treated successfully. +ome conditions and diseases may in fact start to increase as our population ages and our lifestyle becomes more sedentary. FOUCUS QUESTION -. WHAT ARE THE PRIORITY AREAS FOR IMPRO/ING AUSTRALIAS HEALTH? PRIORITY AREA *ardiovascular ,isease *?,! *ardiovascular disease refers to damage to or disease of the heart, arteries, veins and smaller blood vessels. *ardiovascular disease can be attributed to a number of modifiable ris% factors. @ature" 'here are three ma)or forms of cardiovascular disease" Coronary heart disease, stroke and peripheral vascular disease Atherosclerosis is the build0up of fatty andAor fibrous material on the interior walls of arteries. Arteriosclerosis is the hardening of the arteries whereby artery walls lose their elasticity. Extent of the Problem" *ardiovascular disease accounts for 7-4 of all deaths among (ustralians0#55B. *oronary heart disease represents -B4 of all deaths and 9=4 of all cardiovascular disease deaths +tro%e accounts for #$4 of all deaths. Peripheral vascular disease accounts for 34 of all deaths. 'he declining prevalence of cardiovascular disease is due to a reduction in the levels of ris% factors and improved medical care and treatment. 2is% >actors" Unmodifiable" ( family history of the disease, gender, advancing age. Modifiable" +mo%ing, raised blood fat levels, high blood pressure, obesity, abdominal obesity, physical inactivity. Croups at 2is%. 'obacco smo%ers, people with a family history of the disease, people with high blood pressure hypertension!, people who consume a high fat diet, people over B9, males, Dblue collar: wor%ers *ancer @ature" *ancer refers to a large group of diseases that are characterised by the uncontrollable growth and spread of abnormal cells. 'here are two types of tumours benign and malignant. Extent of the Problem" On average, one in three men and one in four women will be affected by cancer in their life time.

*ancer is the only ma)or cause of death in (ustralia which is increasing in incidence in both sexes. *ancer in males occurs more fre.uently then those in females, except in young to middle aged women were the chances of cancer is three times higher than men due to cancers of the cervix, breast, ovary and uterus. *ancer accounted for -=4 of all deaths in (ustralia in #55B. 'he ma)or types of cancer that account for deaths in (ustralia include" &ung, breast, colon, prostate and melanoma. Lung Cancer is the ma)or cause of cancer death, accounting for -$4 of all cancer deaths. &ung cancer death rates have declined for men but have increased for women, yet male rates are still three times those of women. &ung cancer is largely preventable considering that smo%ers are ten times more li%ely to develop lung cancer than non0smo%ers. Breast Cancer affects on in fifteen women in (ustralia and is more common in women ages over 7$ years, as breast cancer accounts for #=.74 of all cancer deaths. Skin Cancer is due to prolonged exposure to ultraviolet radiation. (ustralia:s s%in cancer rates are the highest in the world and its incidence has .uadrupled in the last two decades. It accounts for -.54 of all cancer deaths. Colorectal Cancer is the cancer of the colon or rectum. It is the second most common cause of cancer related death in (ustralia. Prostate Cancer is the second most common cancer for men and appears to be increasing. Cervical Cancer is one of the most preventable cancers with regular pap smears. It accounts for -4 of cancer deaths. 2is% >actors" Lung Cancer: 'obacco smo%ing, occupational exposure to carcinogens, air pollution. Breast Cancer: ( family history of the disease, high fat diet, early onset menstruation, late menopause, obesity. Colorectal Cancer: /igh inta%e of fats, low inta%e of complex carbohydrates and dietary fibre, excessive alcohol consumption, obesity. Skin Cancer: >air s%in which burns rather than tans, prolonged exposure to sun and ultraviolet rays, the number a types of moles on the s%in. Prostate Cancer: >amily history, high fat diet. Cervical Cancer: (n early age of first sexual intercourse, sexual intercourse with many partners, a male partner who has intercourse with a number of other female partners, viruses such as genital warts. Croups at 2is%" Lung Cancer: *igarette smo%ers, people exposed to occupational or environmental haEards, people wor%ing in blue0collar occupations, men and women aged over 9$ years. Breast Cancer: 8omen who have never given birth, obese women, women aged over 9$ years, women who have a direct relative with breast cancer, women who do not practice self0examination, women who start menstruating at an early age, women who have late menopause. Colorectal Cancer: Obese males and females, people with high fat diets and low fibre diets, males aged 9$ years and over. Skin Cancer: People in lower latitudes, people with fair s%in, people in outdoor occupations, people who spend time in the sun with out sunscreen, hats etc. Prostate Cancer: Males aged over 9$ years, males who have a direct relative with prostate cancer.

Cervical Cancer: 8omen who have early first intercourse, women aged over 9$ years, women who neglect screenings such as pap smears, women who smo%e Mental /ealth @ature" Poor mental health in childhood and adolescence may underpin a lac% of self care. ,rug abuse, physical neglect and early pregnancy are examples of poor health choices which may result to mental disorders. Extent of the Problem" (n estimated #=.=4 of (ustralian adults had experienced the symptoms of a mental disorder. Foung adults aged #60-7 years had the highest prevalence of a mental disorder. +uicide is the leading cause of in)ury as it accounted for 3-4 of all in)ury death in #55=. +uicide is the leading cause of death for people aged #90-7 years in (ustralia. (ustralia had the highest rate of youth suicide recorded in industrialised countries. 2ural males have higher rates of suicide compared to urban males. 2is% >actors" 'he ris% factors of suicide include" depression, mental illness, physical illness, social isolation. 'he ris% factors of depression include" mental illness, chemical changes within the brain, drug and alcohol abuse, life stresses, high anxiety, negative experiences. Croups at 2is%" 'he groups at ris% of suicide include" people suffering chronic depression, elderly people, teenagers, young gays and lesbians, people with a physical illness. ,iabetes @ature" ,iabetes mellitus is a condition affecting the body:s ability to produce glucose from the bloodstream and use it for energy. 'he pancreas functions poorly and produces insufficient insulin and the glucose can not enter the cells. nsulin!dependant diabetes mellitus " #ype $ne is where the body produces minimal insulin or none at all. 'hey need to in)ect an artificial supply of insulin. %on!insulin!dependant diabetes " #ype #&o is where the pancreas has the ability to produce insulin but it the amount is insufficient or the inulin is not effective. Extent of the Problem" @early one in four (ustralian adults over the age of -9 has a type of diabetes. 'he incidence of diabetes has risen significantly, approximately -B4. (ustralia ran%s ninth among 39 countries with a high prevalence in diabetes. (boriginal and 'orres +trait Islander people the highest prevalence rates of type two diabetes. ,iabetics have a reduced life expectancy and diabetes can contribute to coronary artery disease. 694 of diabetics have type two diabetes, which is related to lifestyle factors. 2is% >actors" 'ype one diabetes is an autoimmune disease when the body starts attac%ing its own tissues!, which may be triggered by a virus or environmental factors.

'he ris% factors of type two diabetes include" 1eing 9$ and having high blood pressure, being 9$ and overweight, being 9$ and having one or more family members with diabetes, being over B9, having had a heart disease or heart attac%, having had gestational diabetesG Croups at 2is%" 'he elderly, those who have poor lifestyles, people who are obese, (boriginal, 'orres +trait Islander, Pacific Islander people, *hinese, Indian, those who have had polycystic ovary syndrome. In)ury @ature" 'hose that are caused by any form of external violence. 'his includes in )uries and death suffered from M?(s and wor%place accidents, suicide, violence, drowning and poisoning. ,ue to the nature of the problem, there is usually significant emotional trauma associated. Extent" In)uries caused by accidents, poisoning, suicide and violence are the most common cause of death in (ust. 'hey account for approx. B4. /ighest rate occurs in the #90-7 yrs age brac%et =#4!. 'he three main causes of death from in)ury are" +uicide" In the early #55$:s, was the leading cause of in)ury death. In #55B, suicide accounted for 3B4 of all in)ury deaths. 'here has been an increase in suicide in young adults, particularly males. M?(s" (ccount for approx. 3$4 of all in)ury deaths. 'here has been a consistent downward trend. *hild accidents" Most common cause of death for children under #7 yrs involve, in order" 'ransportation ,rowning Poisoning >alls 1urnsAscalds 'rends are showing significant decreases 2is% factors" >or the ma)or causes of in)ury there are specific sets of ris% factors" +uicide" Increased brea%down in family structure. ,epression &ac% of access to .uality counseling and treatment Mental disorder Inappropriate modeling M?(s" +peeding (lcohol >atigue @o seat belt Overcrowding ,river inexperience Environmental conditions. *hild (ccidents"

&ac% of supervision Hnsafe environment 'he reduction in transport deaths can be attributed to" Improved safety and training devices /elmet legislation Other cycling and pedestrian safety initiatives +ocial determents Fouth suicide" &ifestyle patterns IJ higher levels of depression +ee% independence IJ unemployment, homelessness, inability to develop relationships, drugs &ac% of access to appropriate support M?(:s" 'he media Image of masculinityArite of passage *hild accidents" Parents in full0time employment Hnsupervised children @o safety implementations &ac% of parental education Croups at ris% 'he elderly falls!, Males #90-7 yrs, ,rivers who speedAdrin%, and drive, Foung children, 8or%ers in high0ris% occupations WHAT ROLE DOES HEALTH PROMOTION PLAY IN ACHIE/ING 0ETTER HEALTH FOR ALL AUSTRALIANS? APPROACHES TO HEALTH PROMOTION W1$) i% 1e$l)1 p'o!o)io( 'ealth Promotion involves activities that are aimed at improving health and preventing illness. Dprevention is better than the cure: Public 'ealth is a combination of science, medicine, practical s%ills and beliefs aimed at maintaining and improving the health of all people. %e& Public 'ealth is the totality of activities organised by a society to protect people from disease and not to promote their health. 'hese activities occur in all sectors in society and include policies which support health. #he $tta&a Charter for 'ealth Promotion is a framewor% for health promotion which was made in #56B. /ealth promotion recognises the social, economic, environmental, and behavioural and lifestyle factors which contribute to the prevalent lifestyle related diseases of today. /ealth promotion involves" Physical support, Economic support, Covernment legislation, +ocial support, and Educational support and Covernment regulations. PEC+EC! /ealth promo can be targeted at 3 levels of prevention" #. Primary before disease! -. +econdary at the early sign of disease!. 3. 'ertiary after disease sets in!

S1if) f'o! $( i( i2i &$l life%)#le $pp'o$+1 )o 1e$l)1 p'o!o)io( )o )1e (e3 p&4li+ 1e$l)1 $pp'o$+1 Individual &ifestyle (pproach to /ealth Promotion is based on the principle that the ma)or causes of morbidity and mortality within (ustralia are diseases resulting from poor lifestyle behaviour choices. 'his approach ta%es a medical view, emphasising public illness rather than public health. It focuses on understanding the causes of illness rather than allocating resources to reduce illness. It emphasises the role of the individual in improving their health status, assuming that a change in individual lifestyle behaviour will improve health. 'herefore, health promotion programs under this approach are aimed at changing the individual behaviour. Its limitations include" its inability to recognise the social, economic and environmental factors that have an impact on health, it assumes that improved %nowledge about health issues can change individual behaviours, is assumes that all individuals are able to change their behaviours and it is based on the idea that behaviour change is solely the responsibility of the individual. 'he new public health approach recognises the importance of all social sectors: influence on contributions to the health of the population. It attempts to broaden our understanding of health by considering the underlying environmental factors that influences our health and by ensuring that social, physical and economic environments promote health. 'he most significant shift to a new public health approach to health promotion was the 8orld /ealth Organisation:s development of the Ottawa *harter in #56B. 'he charter provides structures and principles of the new public health promotion such as" ,isease prevention and health promotion, social )ustice, community participation, a holistic and positive view of health. CHARACTERISTICS OF THE NEW PU0LIC HEALTH APPROACH Empowerment of the Individual 'he social, economic and physical environments of some people prevented them from changing their health behaviours which made the old public health approach ineffective. Individual empowerment refers to an individual:s ability to ma%e decisions about having personal control over their health and lives. *ommunity Participation *ommunity participation in health promotion depends on community empowerment which includes" the %nowledge of local people to identify local health issues, community partnerships with health professionals and support for a public voice for the health of the local community. 'he community sectors that contribute to the positive promotion of health include" 'he *ommonwealth Covernment, +tate governments, &ocal governments, 1usiness and industry, @on0government organisations and Intersectional action.

2ecognition of the +ocial ,eterminants of /ealth 'he social determinants of health include" the distribution of income, poverty and wealth, access to and conditions of wor%, living conditions and environments access to health services and information, education, housing and social support. Policy change is needed for the ine.uities in income distribution and living environments to improve health. INDI/IDUAL LIFESTYLE APPROACH - Own responsibility - &isten to info 0 *urative measures NEW PU0LIC HEALTH APPROACH 0 Participate in /P Prevention and cure - Inter0sectoral collaboration 0 Participate in /P -

Role of individuals Role of 1e$l)1 p'ofe%%io($l% Role of communities

0 ?ery little

MA5OR HEALTH PROMOTION INITIATI/ES 'he Ottawa *harter for /ealth Promotion #56B! is an action plan for all nations to underta%e in the goal of achieving health for all by -$$$. 1uilding a public health policy, *reating supportive environments, +trengthening community action, ,eveloping personal s%ills, 2eorienting health services. 'he charter is significant because it gave direction to health promotion through clear definitions, action plans and positive involvement. 'he >ourth International *onference on /ealth Promotion was held in Ka%arta in #55=. It produced the Ka%arta ,eclaration, which reaffirms the principles of the Ottawa *harter and urges health promotion to build on and expand partnerships for health with all sectors of the community. 'he Ka%arta ,eclaration promotes social responsibility for health, the provision of supportive environments and a settings approach for the promotion of health. It promotes social responsibility for health, increased investments for health development in all sectors, consolidates and expands partnerships for health, increases community capacity and empowers the individual, secures an infrastructure for health promotion. Go2e'(!e() 'e%po(%e% International level" Ottawa *harter #56B, Ka%arta ,eclaration #55= @ational level" /ealth for all (ustralians report #566, @ational 1etter /ealth Program #565, Coals and 'argets for (ustralia:s /ealth in -$$$ #553, 1etter /ealth Outcomes for (ll (ustralians #557, @ational /ealth Priorities Initiative #559A#55B, (ustralia:s /ealth #556A-$$$ +tate level" @+8 /ealth *orporate Plan #5560-$$3, 1reast +creen @+8, *ervical *ancer etc.

Co!!&(i)# Re%po(%e% Each areaAregion is re.uired to develop a strategic plan for health promotion and annually report on its implementation to the public health division of @+8. (rea /ealth +ervices have their own initiatives which are relevant to their community. 5$6$')$ De+l$'$)io(. 'he Ka%arta ,eclaration resulted from the 8orld /ealth Organisation:s >ourth International *onference on /ealth Promotion. It offers a vision and focus for health promotion into the -# st century. 'he declaration reaffirms the Ottawa *harter, the importance of health promotion and the five action areas set out in the *harter as being essential for success. It also noted that comprehensive approaches that use combinations of the five action areas are more effective 'he Ka%arta ,eclaration" recognises that there are new challenges in relation to addressing the determinants with poverty posing the greatest threat to health recognises the importance of particular settings such as schools, wor%places and cities for health promotion stresses the need for new responses such as the creation of new partnerships for health to address the emerging threats to health. 'he five priorities for the Ka%arta ,eclaration are" ()promoting a social responsibility for health *)increasing investments for health development +)consolidating and e,panding partnerships for health -)increasing community capacity and empo&ering the individual .)securing an infrastructure for health promotion/ Participants in this conference were all committed to sharing the messages of the Ka%arta ,eclaration with their governments, institutions and communities, and putting the proposed actions into practice. OTTAWA CHARTER 7189:; 1ased on 9 action areas" ,eveloping personal s%ills" /ealth education in schools Media campaigns Luit smo%ing programs

2eorienting health services" Increased funding to health research ,octors wor%ing with child0care services to encourage immuniEation Pharmacists wor%ing with community centers to encourage more preventative strategies 1uilding healthy public policy" &egislation restricting cigarette advertising +mo%e0free areas *ompulsory swimming pool fences +trengthen community action" /ealth0promoting schools &ions club Ddriver reviver: stations +elf0help groups ((! *reate supportive environments" Creenhouse emission targets Protection of forests Elimination of *>*:s FOCUS QUESTION. WHAT ROLE DO HEALTH CARE FACILITIES AND SER/ICES PLAY IN ACHIE/ING 0ETTER HEALTH FOR ALL AUSTRALIANS? NATURE OF HEALTH CARE IN AUSTRALIA /ealth care facilities diagnose, treat and rehabilitate the ill and in)ured. 'hey have the important role of preventing and promoting health. Role of 1e$l)1 +$'e (ustralia:s health care involves a strong partnership between public health initiatives and medical care. 'his aims to balance the need for both prevention and treatment. /ealth services are financed, organiEed and delivered by public and private sources Private practitioners doctors, physios, etc! on a fee0for0service basis, provide health services, while the government and private insurance companies finance these services. /ealth care in (ustralia is about clinical diagnosis, treatment and rehab. 'here is an increasing focus on health education and promo. R$("e $( )#pe% of 1e$l)1 +$'e f$+ili)ie% $( %e'2i+e% I(%)i)&)io($l 1e$l)1 +$'e No(<i(%)i)&)io($l 1e$l)1 +$'e - Public and private acute care - Medical services CP:s, general! hospitals pathology! - Public psychiatric hospitals - ,ental - @ursing homes and hostels - Pharmaceuticals - (mbulance - (dmin and research - Other pro services physio, etc!

A++e%% )o He$l)1 F$+ili)ie% $( Se'2i+e% (ccess to health facilities and services is about the health system:s ability to provide affordable and appropriate health care. It includes patient waiting times in public hospitals for emergency care, outpatient services and elective surgery. (ccess also refers to e.uitable distribution of health facilities and services to all sections of the (ustralian population. 'he ma)ority of (ustralians have access to fundamental medical care through the national health insurance system Medicare. Hnfortunately, this health insurance system does not cover all health services, so some health services are inaccessible to those who can not afford them. (n individual:s ability to access services and facilities can also be influenced by their %nowledge of health information and the services available to help them. Re%po(%i4ili)# fo' He$l)1 C$'e 'he *ommonwealth Covernment is mainly concerned with the formation of national health policies and the control of health system financing through the collection of taxes. +tate and 'erritory Covernments have the prime responsibility for providing health and community services. 2esponsibilities include" /ospital services, mental health programs, dental health services, etc. Private +ector provides a range of services such as private hospitals, dentists and alternative health services. &ocal Covernment is mainly concerns environmental control and a range of personal, preventative and home care services. 'hey include monitoring of sanitation and hygiene standards in food outlets, waste disposal and immunisation. *ommunity Croups include the (sthma >oundation and ,iabetes (ustralia. FUNDING OF HEALTH CARE IN AUSTRALIA He$l)1 I(%&'$(+e 7P&4li+ $( P'i2$)e; Medicare is a system of health insurance which is accessible to all (ustralians. It reimburses a large amount of medical and hospital expenses that individuals incur. Every (ustralian is covered for 694 of an amount that is considered to be a scheduled fee. Private health insurance is an extra insurance which allows people to cover private hospitals and ancillary expenses. People with private insurance have shorter waiting times for treatment, staying in hospitals that they want, having their own choice of doctor in hospital, private rooms in hospitals, ancillary benefits and insurance cover while overseas. 'he Covernment also introduced a 3$4 rebate system for those who have private health insurance. Co%)% of He$l)1 C$'e )o Co(%&!e'% >unding for health promotion and illness prevention has increased in recent years. /owever, more than 5$4 of (ustralia:s health expenditure is allocated to curative services. +trategies that could be used to prevent illness and death in the community include the education of school children about positive health behaviours, better coordination among the various levels of Covernment, restrictions on

advertising, legislations and higher taxes on products such as alcohol and tobacco. 'hese strategies promote a higher level of personal health and improved .uality of life. +trong arguments for increasing the funds of preventative health care include" *ost effectiveness, improvement to .uality of life, containment of increasing costs, maintenance of social e.uity, use of existing structures and the reinforcement of individual responsibility for health. He$l)1 C$'e E*pe( i)&'e 2e'%&% He$l)1 P'o!o)io( E*pe( i)&'e /ealth care expenditure in (ustralia far exceeds expenditure on illness prevention and health promotion. (n emphasis on medical treatments to cure illness dominates the allocation of public health resources and spending. 'he new public health model focuses on the social factors that lead to ill health, which will hopefully lead a shift away from medical dominance to the allocation of more funds to support health promotion strategies. ALTERNATI/E HEALTH CARE APPROACHES Re$%o(% fo' G'o3)1 of Al)e'($)i2e Me i+i(e% $( He$l)1 C$'e App'o$+1e% 'he 8orld /ealth Organisation:s recognition of the usefulness of many traditional medicines, the recognition that the ma)ority of the worlds population use traditional medicines, the effectiveness of the treatment for people who found modern medicine as being ineffective, the desire of many people to have natural or herbal medicines rather than synthetically produced medicines and the holistic nature of alternative medicines. R$("e of Se'2i+e% A2$il$4le Acupuncture o 1ased on *hinese beliefs that proposes energy *hi! flows through the body via meridians o 'hrough the insertion of fine needles into certain points along meridians, it is believed health benefits can results. o Hsed for pain relief and control of asthma and arthritis Aromatherapy o Hsed to treat stress and s%in disorders o Involves special massage techni.ues using blends of oils and the burning of incenses. o 'he benefits are claimed to be holistic. Chiropractic o 2elieves pain and improves health o Involves spine manipulation o 'he theory is that ailments are the result of poorly aligned vertebrae. o *hiropractors believe that because of the nervous system, ad)usting the spine can improve health %aturopathy

Involves treating the whole person by harnessing natural abilities of self0healing o (dapts a variety of tailored therapies, such as" Massage 2elaxation /erbal medicine @utrition o (ims to use natural resources in order to put the body in the right state so that it can heal itself o Ho3 )o M$6e I(fo'!e Co(%&!e' C1oi+e% It is important to investigate the service offered and the credibility of the practitioner. (s% .uestions li%e" 8hat are your .ualificationsM /ow much will the treatment costM *an I afford thisM ,o I really need thisM 8ill it do what it claims to doM (re there any ris%sM 'o ma%e an informed decision about health care you need education, information, a range of options and confidence in your right to ta%e responsibility for your own health care. FOCUS QUESTION. WHAT ACTIONS ARE NEEDED TO ADDRESS AUSTRALIAS HEALTH PRIORITIES? DE/ELOPING PERSONAL S=ILLS ,eveloping personal s%ills focuses on health promotion that supports personal and social development of the individual. It aims at increasing the education and %nowledge of the individual in order for the individual to have more control over their health and environment. Mo if#i(" Pe'%o($l 0e1$2io&'% Peoples values, attitudes and beliefs will influence whether they will use the %nowledge learned and change their health behaviours. 'his re.uires the development of s%ills such as" ,ecision ma%ing, communicating, assertiveness, time management, planning and problem solving. G$i(i(" A++e%% )o I(fo'!$)io( $( S&ppo') 'o improve and maintain the health of all (ustralians, it is important to find ways to provide e.uitable access to information and support services. People who experience ine.uities in gaining access to information and support include those who experience physical isolation, low socioeconomic status, poor literacy s%ills, languageAcultural barriers. CREATING SUPPORTI/E EN/IRONMENTS 'his action area focuses on the places people live, wor% and play and on increasing people:s ability to ma%e health0promoting choices. It is concerned with our lifestyles and our social and physical environments. I e()if#i(" Pe'%o($l S&ppo') Ne)3o'6% $( Co!!&(i)# Se'2i+e% /aving emotional, social or financial support from people who are close can greatly influence the individual:s ability to change. I e()if#i(" So+io +&l)&'$l> P1#%i+$l> Poli)i+$l $( E+o(o!i+ I(fl&e(+e% o( He$l)1

If health promotion is to be effective, it must address the social, cultural, physical, political and economic factors that affect people:s lives. STRENGTHENING COMMUNITY ACTION 'he focus of this area is giving communities the chance to identify and implement actions that address their health concerns. 'he new public health approach advocates the active involvement of communities, in partnership with health practitioners and government authorities, in the promotion of health. It encourages communities to identify health priorities specific to their population and initiate action to help address these priorities. E!po3e'i(" +o!!&(i)ie% )o )$6e $+)io( 'he focus is on giving communities the chance to identify and implement actions that address their health concerns. *ommunity empowerment involves" - +etting health priorities - Ma%ing decisions collaboratively - Planning strategies - Identifying and effectively using resources - Implementing and evaluating strategies *ommunity resources include" - +chools - 8or%places - +elf0help groups - &ocal governments - *ommunity health centers - ,octors - 'he media - Interest groups REORIENTING HEALTH SER/ICES ( refocusing on the well0being of the whole person compliments traditional roles of diagnosis, treatment and rehabilitation. 'his re.uires changes in the attitude and organisation of health services and changes to professional education, training and research. I e()if#i(" T1e R$("e of Se'2i+e% A2$il$4le 'here are a range of services available through the large number of primary health0care services. Examples" *linical services, patient education, counselling, information source, e.uitable access, hospitals, women:s health centres, baby health centres. G$i(i(" A++e%% )o Se'2i+e% (ccess to health services depends on re.uirements of each service, physical location, community awareness of its availability and the affordability of the service. /ealth care services are accessible to all (ustralians through the public insurance scheme Medicare. 0UILDING HEALTHY PU0LIC POLICY

Public health policy is made at all levels of government and it includes legislation, policies, taxation and organisational change. I e()if#i(" T1e I!p$+) of Poli+ie% o( He$l)1 'he combination of compulsory health policy and legislation, policing or monitoring of legislation, and increased community awareness through media campaigns will ensure a positive impact on health. I(fl&e(+i(" Poli+# It is important to gain community support in order to influence public health policy through advocacy. De+i i(" W1e'e )o Spe( )1e Mo(e# >unding needs to be allocated to health0promotion programs that target the health priority areas, thereby improving health in these areas and reducing expenditure on treatment and rehabilitation. Appl#i(" )1e $+)io( $'e$% )o p'io'i)ie% &H@C *(@*E2 +MONI@C! ,E?E&OPI@C PE2+O@(& +NI&&+ *(2,IO0 I@KH2IE+ ?(+*H&(2 2O(, ,I+E(+E I@KH2IE+! Mass - Education - ,river media regarding ris% education campaigns factors. - &icense +trong - More scheme messages importance - 2eduction on on diet and of ris%s cigarette nutrition 1(*, labels seatbelts! DLuit: - +peed, wor%shops fatigue and campaign materials s +mo%e0free - +pecialised - ,ual Eones gyms lanes Media *urves! - +peed - 8al%ingAridin coverage Eones g trac%s - D,river - >ood 2eviver: changes - (irbags, - >ree road cholesterol design chec%s - *hild restraints *ommunity - /eart - +chool advocacy >oundation traffic Political rules action - Improved roads - +afe public transport

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