How are priority issues for Australia’s health identified?

 Measuring Health Status

o Role of epidemiology
 Epidemiology is the study of disease in groups or populations
through the collection of data and information, to identify patterns
and causes
 Epidemiology considers the patterns of disease in terms of
prevalence, incidence, distribution and apparent causes
o What can epidemiology tell us?
 Identifying areas of need so that specific prevention and treatment
interventions can be specifically targeted
 Determining priority areas for the allocation of government funding
 Monitoring the use of health care services and facilities
 Evaluating the effectiveness of any prevention and treatment
programs
 Monitoring the major causes of sickness and death to identify any
emerging issues and inequalities between groups
o Who uses these measures?
 Policy developers at all levels of government
 The manufacturers of health products
 The providers of health services
 Individual consumers
o Do they measure everything about health status?
 No, they do not take into account the individual's quality of life or
burden of disease
 They are always backdated
 Fail to explain ‘why’ health inequities persist
 Don’t account for health determinants
 Rapid changes in health can make some data irrelevant
o Measures of epidemiology (Mortality, infant mortality, morbidity, life
expectancy)
 Mortality: The number of deaths in a group of people or from a
disease over a specific time period, usually one year
 Infant Mortality: The number of infant deaths in the first year of
life per 1000 live births
 Morbidity: Refers to patterns of illness, disease and injury that do
not result in death. illness , disease and injury are all conditions
that reduce our quality of life, either temporarily or permanently
 Life Expectancy: The length of time a person can expect to live
 o Current Trends in Life Expectancy

Health Issue: Trend: Female/Male:

Cardiovascular  Deaths: decreasing  Higher in males

disease CVD  Morbidity: decreasing
 Accounting for 30% of mortality
 Higher in ATSI and low-
socioeconomic groups.

Cancer  Deaths: Decreasing  Higher in males

 Morbidity: increasing  Effects ¼ males
compared to 1/6
females.

Diabetes  Deaths: Increasing  Slightly more prevalent

 Morbidity: Increasing in females.
 Both morbidity and mortality are
increasing unlike other
indicators

Mental illness  Deaths: decreasing  Higher in females.

 Morbidity: increasing

Injury  Deaths: decreasing  Mortality rates:

 Morbidity: increasing (largely significantly higher in
due to falls-ageing population) males (risk taking
behaviours)

Asthma  Deaths: decreasing  Males- significantly

(respiratory  Morbidity: decreasing decreasing.
diseases)  Females: small rise.

 Identifying Priority Health Issues

o Social Justice Principles
 Equality of rights
 Eliminates discrimination, provides freedom, enables
civil and political rights
 Equality of opportunities
 Provides a level playing field so that all individuals are
able to fulfil their potential
 Equity in living conditions
 Allows societies to decide which differences in wealth
are acceptable and fair, and to redistribute wealth when
needed via public assistance
o Principles of Social Justice
 Equity
 Fairness in terms of opportunity to access health care
and services and it the allocation and distribution of
services
 People entitled to the basic right of healthcare access,
needs to be a more even spread of resources
 Geographic location impedes health resource access
 May need to improve resource allocation for some
groups to achieve the same health outcomes
 Diversity
 Acknowledgement and acceptance of a wide range of
beliefs, values, attitudes and ethics
 Health promotion initiatives and health resources need
to be adapted to cater for all people to ensure
individuals can become more knowledgeable and
inclined to access health care
 Need to consider diversity to meet needs of different
groups
 Supportive Environments
 Ones that support all individuals and communities to
make positive health choices to maximise their health
outcomes
 Environments may need to be modified
 Encourage a social responsibility for health →
individuals are empowered to participate in planning
and decision making to improve their health
 Selected priority issues must reflect the principles of
social justice
o Priority Population Groups
 Priority population groups are those identified through social
justice principles as being in greater need of assistance. These
groups include: Indigenous people, rural and remote area
populations, socio economically disadvantaged, veterans,
prisoners and overseas born people.
o Prevalence of Condition
 Current number of cases of illness or condition
 How common the condition is within the community
 High prevalence indicates health and economic burden on
community
o Potential for Prevention and early Intervention
 To improve health status by encouraging individuals to change
their poor behaviour but this may be difficult due to their
situation e.g Low SES
 Prevention and intervention techniques are more cost effective
than treatment
 Prevention and early intervention may lead to improved health
status as most social and individual determinants can be
modified
o Costs to the Individual and Community
 Individual Non-Financial Costs:
 Physical: pain, disability
 Social: isolation, long term hospitalisation, pressure on
relationships
  Emotional: low self esteem, hopelessness, emotional
trauma
 Individual Financial Costs:
 Costs associated with treating the effects of the health
problem
 Examples: hospital charges, medical practitioner fees,
drug therapies, rehabilitation and travel costs
 Community Costs:
 Funding of Australia’s public healthcare system
 Direct costs: money spent on treatment, diagnosis,
care and cost of prevention.
 Indirect costs: Loss of productivity and output when
workers are unable to work or die prematurely (follow
on effects of direct costs)

What are the Priority Issues for Improving Australia’s health?

 Groups Experiencing Health Inequities
o Aboriginal and Torres Strait Islander Peoples
 Lower life expectancy
 Higher levels of CVD, diabetes, cancer and Obesity.
 Main causes of poor health: mental disorder, diabetes, cancer,
kidney disease, respiratory disease, circulatory diseases and
ear/eye problems.
 Higher infant mortality-due to poor living condition, access to
vaccines, preventative measures and education.
 Indigenous people rent more than buy
 Indigenous people are likely to have an overcrowded house
 Homelessness in indigenous Australians is higher than non-
indigenous people
 NAPLAN results are lower than non indigenous people
 Half of year ⅞ indigenous students stayed at school until Year
12

Socio-economic Socio-cultural Environmental

Low home ownership 2 times higher smoking Less access to services

rate

Lower education Low physical activity Less access to

 Low literacy levels technology
 Less HSC completion

Low incomes Increased obesity Less access to fresh

food

Low employment rate Increased substance Less access to

abuse education

High homelessness rate (14 times Increased excessive Living rural and remote
higher) drinking

More overcrowding in houses Increased domestic Transport issues

violence
 Government Community Individual

 Funding  Establish what inequities  Role model

 Deliver services exist and what they (Positive)
 Establish programs need  Taking
 Policy development  Empower individuals to preventative
 Work with be part of the decision action
communities making  Lower risk
 Research + data  Provide health care behaviours
evaluation services  Education
 Education  Education promotion  Develop skills
 Culturally  Preventative measures
appropriate services  Create safe environment
 Provide health care  Employment
systems opportunities
 Inconsistency in  Improve daily living
funding / support conditions (E.g housing)
o Socioeconomically Disadvantaged People
 Determinants

Socio cultural Socio economic Environmental

 High smoking  Low income  Lower safe working

 High risk taking  Low education environment
 Excessive drinking  Low  Less access to
 Poor diet employment services
 High obesity  More labour
 Less use of preventative intensive
measures
 More discrimination
 Single parent families
 Lower exercise rates

 High Levels of Preventable Chronic Disease, injury and Mental Health

problems
o Nature of Cardiovascular Disease

Disease Definition

Cardiovascular Damage to, or disease of, the heart, arteries, veins and/or
Disease (CVD) smaller blood vessels

Coronary Heart The poor supply of blood to the muscular walls of the heart by its
Disease own blood supply vessels, the coronary arteries.

Stroke A stroke results from a blockage of the blood flow to the brain.
Also known as cerebrovascular disease

Peripheral Vascular The result of reduced blood flow to the legs and feet, usually due
Disease to atherosclerosis and/or arteriosclerosis
Atherosclerosis Build up of fatty and/or fibrous material on the interior walls of
arteries

Arteriosclerosis The hardening of the arteries thereby artery walls lose their
elasticity

Heart Attack Generally caused by the complete closure of a coronary artery by

atherosclerosis

Angina Chest pain that occurs when the heart has insufficient supply of
oxygenated blood

Heart Failure Is a reflection of the heart's inability to cater for the demands
placed on it during everyday life.

Social Effect on cardiovascular disease

Determinant

 The risk of CVD increases with age

Age  Congenital heart disease is one of the leading causes of
death in the first year of life.

o Cancer (Skin, Breast, Lung)

o Diabetes
 A Growing and Ageing Population
o Healthy Ageing
 Due to the ageing population, the government has responded
by encouraging people to plan for financial security in later life.
 They have provided the elderly with a wide variety of services
and support based on their needs.
 As the population is ageing, it has become a priority for the
government to encourage healthy ageing enabling people to
contribute for as long as possible.
 The government has appointed and Ambassador for Ageing
who is responsible for:
 Promoting positive and active ageing
 Encouraging the contributions made by older people
 Promoting community government programs and
initiatives to public
 Assisting older people to access these programs.
 By improving and increasing the health of the elderly, there is a
smaller burden of disease as well as a less dire economic
impact.

o Increased Population living with Chronic Disease and Disability

 As well as increased survival rates of disease and illness there
is also an increased number of Australians with a chronic
disease or disability due to an ageing population.
  Chronic, non-communicable diseases account for
approximately 80% of the total burden of disease in Australia
and it is estimated to be responsible for about ¾ of all deaths
by 2020.
 Future levels of chronic diseases could be reduced if younger
people control the more significant risk factors for developing
chronic disease such as smoking, obesity, drinking and
inactivity.

o Demand for Health services and Workforce Shortages

 In order to combat the increased demand for health services,
the government has proposed a number of initiatives including:
 Increased residential aged care places.
 More funding for dementia care in aged care.
 Attracting, retaining and training aged care workers.
 As many more people are suffering poor health, there is a
shortage in those able to contribute to the workforce. To
combat this governments, have improved Australia’s
retirement income system by:
 A means-tested age pension is available to provide income for
people after retirement.
 Compulsory superannuation cover for eligible employees.
 Voluntary, private superannuation contributions and other
forms of private savings are also encouraged.
o Availability of Carers and Volunteers
 Australia’s workforce consists not only of paid workers, but
also carers and volunteers, who are ageing along with the rest
of the populations.
 Australians over the age of 55 contribute approximately
$75billion per annum in unpaid caring and volunteering
activities.
 It is projected that there will be little growth in the number of
available carers, compared to the anticipated rise in demand
for home-based support.
 This is likely to result in a shortage of carers in the
future.

https://www.aihw.gov.au/getmedia/3be568f2-d938-4575-bf1f-8742bad4d2ce/ah16-2-
2-how-much-does-australia-spend-on-health-care.pdf.aspx Australias health 2016

Advantages Disadvantages

 Low SES enables access  Doesn’t cover everything

 Bulk billing  Out of pocket costs
 Subsidization of basic health care  Higher tax
 Reduce social inequity  Greater waiting times (e.g surgeries)
 Free hospital care (public)  No choice of doctor
 Free  Sharded wards
o Optometrist
o Pathology
o X-rays
What role do Health Care Facilities and Services play in Achieving
better Health for all Australians?
 Health Care in Australia
o Range and types of health facilities and services
o Responsibility for health facilities and services
o Equity of access to health facilities and services
o Health care expenditure versus expenditure on early intervention and
prevention
o Impact of emerging new treatments and technologies on health care,
e.g the cost and access, benefits of early detection
o Health insurance: Medicare and private
 Complementary and alternative health care approaches
o Reasons for growth of complementary and alternative health products
and services
 Recognised by the World Health Organisation (WHO) as
another source of alternative health care service.
 Individuals becoming more culturally open minded and willing
to try non-traditional and natural methods of health care.
 Due to the private health rebate alternative medicine is added
to Medicare etc.
 Perceived by some as a chance to exert greater control over
their own health
 Holistic→ not just about the body
 Desire to have natural rather than synthetic medicine
 Individual effectiveness
 Complementary health care:
o A group of diagnostic and therapeutic
disciplines that are used together with
conventional medicine. An example of a
complementary therapy is using acupuncture in
addition to usual care to help lessen a patient's
discomfort following surgery.
 Alternative health care:
o A variety of therapeutic or preventive health-
care practices that are not typically taught or
practiced in traditional medical communities and
offer treatments that differ from standard
medical practice.
o Range of products and services available
 Acupuncture
 Involves inserting needles into the skin→ claims to
stimulate mind and body
 Chiropractor
 Alignment of spine→ better functioning nervous and
musculoskeletal systems
 Herbalism
 study of botany and use of plants intended for
medicinal purposes or for supplementing a diet.
 Massage
 Induces relaxation, reduces blood pressure, stress and
anxiety
 Osteopathy
 Osteopathy is a type of alternative medicine that
emphasizes manual readjustments, myofascial release
 and other physical manipulation of muscle tissue and
bones.
 Aromatherapy
 Use of pure essential oils to influence mind, body and
spirit (Used for depression, sleep disorders, stress and
anxiety.)
 Iridology
 Iridology is an alternative medicine technique whose
proponents claim that patterns, colors, and other
characteristics of the iris can be examined to determine
information about a patient's systemic health
 Naturopathy
 a system of alternative medicine based on the theory
that diseases can be successfully treated or prevented
without the use of drugs, by techniques such as control
of diet, exercise, and massage.
 Homeopathy
 Aims to stimulate individuals healing powers
o How to make informed consumer choices
 It is critical that measures are put into place to ensure
appropriate standards are met when these products and
services are delivered.
 Involves similar skills and strategies as making any consumer
choice
 Using the Research, Select, and Reassess process for making
informed consumer choices can be useful as it encourages
consumers to research, select and reassess their choices.
 This model helps consumers to evaluate information
critically through questioning, and to do this on an
ongoing basis.
 Cost
 Can it be combined with conventional medication
What actions are needed to address Australia’s health priorities?
 Health promotion based on the five action areas of the Ottawa charter
o Levels of responsibility for health promotion

Federal State NGO’s Commun Individua

ity l

 Funding  Healthy  Research  Managing  Responsib

 Developin canteen into priority communit le for their
g health strategie issues y services own health
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 Create ment wellbeing critical modify risk
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 Taxation such as conditions health in
 Encourag schools that  Encourag community
e  Deliver contribute to e activities
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on tive health s to take
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states services ty for physical
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WHO with both
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ents
 Provide
and
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 Provide
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 o The benefits of partnerships in health promotion, e.g. government
sector, non government agencies and the local community
 Allows access to the resources and skills needed to
understand and solve complex issues where possible solutions
lie outside the capacity and responsibility of a single sector //
share knowledge, resources, information, equipment, data and
skills
 Duplicates efficiency and effectiveness
 Sense of community and increases participation and health
status
 Empower individuals and provides them with a choice and
opportunities such as decision making and participation
increases health outcomes
 Funding used more effectively
 Common goal
 Individuals / communities needs heard
 More responsible and flexible services
 Health info can be more widely spread
 Framework for effective health promotion
o Developing personal skills –
 Aimed at improving the knowledge and skills of individuals so
they are able to make more informed health decisions for
themselves and have the capacity to be a positive influence on
those around them.
 It is about empowering the individual through education and
learning new skills, enabling them to make positive choices
about their health and lifestyle.
o Creating supportive environments –
 A supportive environment significantly increases the chance of
a person being able to make positive changes to their health.
The place they live and the people around them can either
create barriers to good health or in optimal conditions help to
break down barriers. It is about creating an environment, which
promotes an individual to make healthy lifestyle choices
through making a safe, healthy, and stimulating work, school
and community environment.
o Strengthening community action –
 Valuing diversity is central when aiming to strengthen
community action. Each community is unique and different so
must be consulted about the development of health promotion
strategies intended to improve their health.
 It is about the community coming together to enhance health
and to work together to raise awareness for different illnesses
and diseases.
o Reorienting health services –
 Encourages the health sector to move beyond its traditional
role of providing curative services.
 It is about taking the emphasis away from just curing a disease
to preventing it.

o Building healthy public policy –

 Through implementing legislation, policies and fiscal
measures, governments can work towards creating equity
among individuals and across different populations. Laws can
 ensure that all people are treated fairly, irrespective of their
social markers.
 It is about governments working together including federal,
state and local, to create policies and legislations that support
healthy choices for all aspects of health.

 How health promotion based on the Ottawa Charter promotes social justice
o
 The Ottawa Charter in action

Action Area National Tobacco Strategy 2012-2018

Developing  Making sure children get age appropriate information about

Personal Skills smoking including information about short term effects and
other ‘un-glamorous’ aspects
 tailored , personalised repeated counselling from a trained
provider, either by phone or face to face

Creating Supportive  Improving the effectiveness of health warnings

Environments  Ensuring that all indoor areas of workplaces and public
places are covered by legislated prohibitions

Strengthen  Promoting clear and consistent messages and rules about

Community Action smoking
 Ensure Aboriginal and Torres Strait Islander organisations
are represented on expert and decision making committees

Reorient Health  Training multilingual pharmacists and other health

Services professionals in areas with large numbers of particular
communities
 Distribute media releases in community languages to
relevant multicultural media across the country

Building Healthy  Enforcing existing laws banning sales to minors

Public Policy  Limiting visibility of tobacco products
Action Area National Road Safety Campaign

Developing Personal  Driver education in school about risk factors involved with
Skills drink driving, fatigue, speeding and risky driving
 Bike safety at school
 Defensive driving classes

Creating supportive  Speed humps

Environments  Double demit
 Taxi ranks outside clubs/pubs

Strengthen  Driver reviver

Community Action  Lollipop people
 School zones

Reorient Health  Support and counselling for offenders of drink driving

Services offences
 Police addressing schools about alcohol and driving
 Regular TV advertising showing risks/ consequences of
dangerous driving

Building Healthy  Seatbelts

Public Policy  Lowering speed limits in school areas/ residential areas
 Compulsory helmet use both bikes and motorbikes