Core 1 Notes

Core 1.A: How are Priority Issues for Australias Health Identified?
Measuring Health Status
Health status used to describe the current state of health of an individual a group or
population
Health status measured in terms of
o Mortality
o Infant mortality
o Morbidity
o Life expectancy
Role of Epidemiology
Used by governments & health related organisations to obtain a picture of the health status
of a population
o Identify patterns of health & disease
o Analyse how health services & facilities are being used
Epidemiology considers patterns of disease in terms of:
o Prevalence
o Incidence
o Distribution (extent )
o Apparent causes (determinants indicators)
Measures of Epidemiology
Mortality
Number of deaths in a group of people or from a disease over a specific period of time,
usually one year
o Statistics death rates
E.g. the number of deaths in Australia increased from 45305 in 1907 to 130714 in 2005
Infant mortality
The number of deaths that occur during the first year of life
Expressed as a number of deaths per 1000 live births
o E.g. in 2007 there were 1200 infant deaths in Australia, representing 42 deaths per 1000 live
births. This was a reduction of 11% from 2006
Morbidity
Rates of illness & disease
Data describes the number of cases of specified diseases & conditions in specific population
groups
Prevalence existing cases
Incidence number of new cases
Life Expectancy
The average number of years of predicted life a person has remaining at a specified age
Assuming current mortality patterns remain the same
o E.g. an Australian female born in 2007 can expect to live 83.6 years. A male born in 2007 can
expect to live 78.9 years
Identifying Priority Health Issues
Social justice principles
Priority population groups
Prevalence of condition
Potential for prevention & early intervention
Costs to the individual & the community

Health issue that meets most of this criteria will be made a priority
o Greater spending
o Resource allocation
Social J ustice Principles
Does this health issue being considered justify the expectations of social justice?
Are there groups so disadvantaged that they need more support to achieve good health?
Can this health issue be improved by applying the principles of social justice?
The Principle of social justice include
o Rights
Equitable opportunities for all individuals to achieve good health
o Equity
Fair allocation of resources & entitlements without discrimination
o Access
The availability of health services, information & education
o Participation
The empowerment of individuals & communities to be involved in planning & decision making
for good health
Priority Population Groups
Does a specific group within the population suffer higher prevalence of this condition?
Can this health issue be improved by targeting a specific population group?
o Rural & remote
o ATSI
o Low Socioeconomic status
o Elderly people
Prevalence of Condition
Does this health problem affect a large number of people within the population?
Is there evidence that the extent of this health problem is increasing?
o CVD are reported to be the underlying cause of 35% of all deaths in Australia
increased prevalence rates of a disease indicate health & economic burden
Potential for Prevention & Early Intervention
majority of diseases > poor lifestyle behaviours
Is this health problem the result of risk factors or determinants that can be changed of
modified?
Can the impact of this condition be predicted & reduced by understanding changes in the
population?
Can the harm caused by this condition be reduced by earlier detection & intervention?
Difficult to change individuals behaviours >reflect the environmental situation in which they
live
Determinants of health inequities across Australia include:
o Socioeconomic status
o Support networks
o Access to information & health services
o Employment status
o Housing
o Environmental infrastructure
Address both individual behaviours & environmental determinants
Costs to the Individual & Community
Does this condition impose high or inequitable costs on its sufferers & their communities?
o Financial
Lost employment
Medications
o Physical
Lost mobility
Functionality
o Emotional
Chronic pain
Depression
o Social
Damaged relationships
Family suffering
Direct/indirect costs
o Direct
Money spent on diagnosing, treating, caring
o Indirect
Value of output lost
Forgone earnings
Absenteeism
Retraining of replacement workers
Core 1.B: What are the Priority Issues for Improving Australias
Health?
Groups Experiencing Health Inequalities
Elderly: ability to access services, chance of suffering from injuries/falls,
ATSI: (12) alcohol consumption, living conditions, education, lack of basic necessities,
life expectancy 20 years less & infant mortality 2-4 times higher than general Aus pop,
hospitalisation 50% higher, twice as likely to smoke cigarettes, drinkers in population more
likely to binge, higher death rates from diabetes, exposure to violence, obesity levels

High Levels of Preventable Chronic Disease, Injury & Mental Health Problems
Cardiovascular Disease (CVD)
Cancer
Diabetes
Cardiovascular Disease
Nature: all disease of the heart & blood vessels
Extent: 40% of all deaths, rates due to assessing modifiable risk factors
Risk Factors: smoking, high blood fat, decreased physical activity(inefficient heart & CV sys.),
hypertension (high blood pressure), age, heredity, gender
Social Determinants: SES( alco/smoke), edu, ATSI, rural areas ( access to health facilities)
Groups at risk: smokers, high blood pressure, overweight, fam history, ATSI (twice as
common), people > 65
Health Promotion Initiatives: City to surf, Red tick(heart foundation), Walk to work day, Life,
be in it, World heart day


Cancer
Nature: cell division becomes uncontrolled, forming tumours
o Benign tumour = no threat of spreading
o Malignant tumour = potential to spread
Extent: 27% of all deaths, due to screening
o Mortality Most common: lung cancer for men & breast cancer for women
o Morbidity the most diagnosed: prostate cancer for men & breast cancer for women.
Risk Factors: Smoking, exposure to UV, heredity (fair skin), family history, obesity
Social Determinants: SES, education, ATSI
Groups at Risk: smokers, SES disadvantage, high fat, uneducated, fair skinned, family
history
Health Promotion Initiatives: Quit, Slip Slop Slap, No Hat No Play, World No Tobacco
Day, Me No Fry, Daffodil Day
Diabetes
o Nature: improper functioning of pancreas
o Hyperglycaemia: increased sugar levels
o Hypoglycaemia: decreased sugar levels
o Extent: worlds fastest growing disease, increased by 30% last 5 years
o Type 1: insulin dependant
o Type 2: non-insulin dependent diabetes mellitus
o Risk Factors: obesity, high blood pressure, high alc consumption
o Social determinants: SES, age, physical inactivity, consumption of fast foods
o Groups at Risk: Family history, overweight, elderly (>65), un-exercised, ATSI, SES

A Growing & Ageing Population
Healthy Ageing
Priority for govt to encourage health ageing to enable people to contribute for as long as
possible
Sickness or injury working years are likely to be shortened,
o Reduction in economic growth
Promote good health through life as well as disease prevention
Ambassador for ageing
o Promoting positive & active ageing
o Encouraging contributions made by older people
o Promoting community govt programs & initiatives to the public
o Assists old people to access these programs
Ageing well, ageing productively
o Disease prevention
o Reducing illness periods
o Maintaining economic & social participation
Lead to better heal outcomes for older Australians reducing economic burden on govt
Increased Population Living with Chronic Disease & Disability
Ageing population led to an increase in the number of Australians with chronic disease or
disability
Chronic non communicable diseases 80% total burden of disease
if younger people control more significant risk factors
o Smoking
o Obesity
o Excessive drinking
o Physical inactivity
Demand for Health Services & Workforce Shortages
Demand for health & aged care services
Initiatives to meet needs of older Australians:
o Provision of nurses
o Expansion (role of nurses)
o community care (meals on wheels)
Concern people suffering poor health unable to contribute to workforce leading to general
shortages of labour, govt response:
o Means tested age pension
o Compulsory super annuation cover
o Voluntary, private superannuation contributions
Encourage people to plan for financial security & independence:
o economic burden on govt as population ages
Availability of Carers & Volunteers
Older Australians contribute:
o Paid workers
o Carers
o Volunteer
o Family members
o $75 billion per annum in unpaid caring & volunteering activities
Caring & volunteering activities beneficial to economy
Older Australians make substantial contributions as volunteers & carers
Half a million volunteers over 65 non profit organisations
Projected little growth in the number of available carers, compared to anticipated rise in
demand for home based support
o = shortage of carers in future
Core 1.C: What Role do Health Care Facilities & Services Play in
Achieving Better Health for all Australians?
Health Care in Australia
Range & Type of Health Care Facilities & Services
Institutional: government owned, e.g. hospitals, nursing homes
Non-institutional: individually owned businesses e.g. dental services, specialists

Access to Health Facilities & Services:
Medicare provides all Australian citizens with basic health care, but does not cover all
medical services e.g. physio.
SES status & position effect ease of access

Responsibility for health care facilities & services
split between all levels of government:
Commonwealth: legislations, policies e.g. war veteran policies
State: provides health services, e.g. hospital, family health services
Local: health promotion campaigns
Communities: provide voluntary services e.g. meals on wheels
Private Sector: private hospitals, dentists, alternative health services, religious charity groups.
E.g. National Heart Foundation, Council
Individuals: responsibilities to make wise decisions for health care & screening behaviours
Equity of Access to Health Facilities & Services
Ability to access can reflect:
o Socioeconomic status
o Knowledge of available services
o Geographic isolation
o Cultural & religious beliefs
Access might be affected by such issues:
o Shortages of qualified staff
o Lack of funding or equipment
o Patient waiting lists
o Waiting times in out patient clinics & emergency dept
Health services inaccessible to those who cant afford them(not covered by Medicare)
o Physio
o Dentist
Can also be influence by:
o Knowledge & understanding (health information, services available)
o Lack of education
o Poor literacy skills
o Language barrier (migrants)
Health Care Expenditure Vs Expenditure on Early Intervention &
Prevention
o health promotion may save money long term but difficult to take money from curative sectors
o health care expenditure still far exceeds expenditure on illness prevention & health promotion
o health promotion most cost effective way in which to address the social issues of health
o strategies include
education
coordination between various levels of government
restrictions on advertising
legislation
higher taxes
alcohol
tobacco
o strong arguments for funding preventative health strategies
cost effectiveness
quality of life
containment of costs
maintenance of social equity
use of existing structures
reinforcement of individual responsibility for health
Health Insurance:
o Private/public private companies = HCF, Manchester Unity & Public = Medicare

Medicare Private Health Insurance
Who pays? Commonwealth government
Tax Payers
Commonwealth Government
Private Contributors
How paid for? Levy or tax linked to salary Monthly premiums for various forms of cover
What Benefits? Basic medical services (doctors
& specialists)
Choice of GP
Basic hospital services in public
hospitals
Specialist health care
Cover for 85% of the scheduled
fee for medical services
Hospital cover
- hospital services
- doctor of choice
- hospital of choice
- private or public hospital
Ancillary services e.g. dental, optical,
chiropractic
Some special benefits e.g. sports equipment
Cover while overseas
Complementary & Alternative Health Care Approaches
Reasons for Growth of Alternative Medicines & Health Care Approaches
o WHO recognition of usefulness, endorsement of a list of medical plants
o knowledge of alternatives
o dissatisfaction with existing services
o open mindedness
o professionalism in alternative medicine
o media attention

Range of Products & Services Available
o Acupuncture: needles to stimulate changes in energy balance & restore health
o Chiropractic: spinal displacements relieved through manipulation of the spine
o Herbal medicine: traditional custom herbs used as alternative to pharmaceutical drugs
o Colonic therapy: water used to clear lower intestine to relieve backache/head ache, skin
problems, bad breath & fatigue
o Aromatherapy
o Herbalism

How to make Informed Consumer Decisions
o seek verification
o advice from GP
o family/friends
o qualifications
o cost
o How can it benefit?
o Can it be combined with conventional medicines?
Core 1.D: What Actions are needed to Address Australias Health
Priorities?
Health Promotion Based on the Five Action Areas of the Ottawa Charter
Levels of Responsibility for Health Promotion
Responsibility for promoting health applies at many levels, including:
individuals & families
groups in the community & industry (schools, workplaces, media)
all levels of government local, state & commonwealth
NGOs - Australian & international
The Benefits of Partnerships in Health Promotion
Intersectoral collaboration
o Between government sector, non government agencies and local communities
If every area of the Ottawa Charter is well represented through a wide variety of strategies
then:
o risk of people or population adopting poor health behaviours
o people already engaged in poor health behaviours are encouraged to or eliminate these
actions = burden on health care system, health
The chance of effective health promotion relies heavily on how it is planned, delivered &
evaluated
It must be enabling & done by, with & for people not just imposed of them = encourages
participation
health of individual or population = effective strategy
The full potential of an approach is only realised when providers are connected & integrated
How Health Promotion Based on the Ottawa Charter Promotes Social
J ustice
Developing personal skills
o Improves a persons ability to access information and services
o Also empowers them to defend their rights
Building Health Public Policy
o Leads to the creation of supportive environments for individuals
o Individuals may feel involved in the development of policy
Strengthening Community Action
o This can raise awareness of peoples rights, promote equity and facilitate participation by
community members
o Individuals can participate actively in health promoting events
Creating Supportive Environments
o Increases access, encourages participation and improves living conditions
Reorienting Health Services
o Improves access to health services and promotes equity by supporting the disadvantaged





Analysing the National Tobacco Strategy
Strategy Ottawa Charter Reasons for Effectiveness of Strategy
Regulation of place of sale
Enforcing existing laws banning sales
to minors
Limiting visibility of tobacco products
Building public
policy
Harsh laws & fines ensure that
retailers will not be
tempted to sell tobacco products to
minors.
People will not be reminded that they
need tobacco
products if they are not on display.
Regulation of place of use
Ensuring that all indoor areas of
workplaces &
public places are covered by legislated
smoking
prohibitions
Extending smoke-free environments
legislation to
specifically cover all elements of the
recreation &
hospitality sectors
Creating
supportive
environments



Smokers may be encouraged to give
up or at least
reduce smoking because of the
inconvenience
caused by not being able to smoke at
work or when
they socialise.
Non-smokers are protected in their
workplace &
social settings from passive smoking.
Regulation of products
Requiring manufacturers to make
cigarettes less likely
to start house fires & bushfires
Building public
policy
The general public will be protected
from the potential
harms caused by littering of cigarette
butts.
Cessation services & treatment
Advice from doctors & other health
Reorienting
health
Smokers are supported by health
professionals to
providers
Intensive counselling & treatment at
specialist
clinics catering specifically for nicotine-
dependent
patients who are discharged from a
hospital visit
related to a chronic disease
services give up smoking in order to improve
existing health
conditions that are a result of tobacco
use rather than
merely treating the illness.

Community support & education
Making sure children get age-
appropriate
information about smoking including
information
about short-term effects & other un-
glamorous
aspects
Helping children develop skills to
resist
experimenting & to avoid becoming
addicted
Developing
personal
skills
Education from many sources at a
young age will
deter young people from smoking
irrespective of
their family environment.
Young people will be equipped with
refusal skills to
assert their position against smoking to
their peers.
Addressing social, economic &
cultural
determinants of health
Aboriginal & Torres Strait Islander
peoples
Find & support quitters who can
speak about
the benefits to their lives (feeling better,
extra
resources available, improved capacity
to cope
etc.)
Ensure Aboriginal & Torres Strait
Islander
organisations are represented on expert
&
decision-making committees
The Centre for Excellence in
Indigenous Tobacco
Control has been funded to develop
culturally
appropriate indigenous tobacco control
resources
Strengthening
community
action


Aboriginal & Torres Strait Islander
smokers may be
more inclined to listen to quit messages
from those
who have been smokers & are
members of their
community.
Key stakeholders are represented,
which will
ensure that various cultural
considerations will be
acknowledged when making decisions.
These resources will be targeted
specifically at the
Aboriginal & Torres Strait Islander
community,
which will ensure that there are no
cultural barriers.

Analysing the National Action Plan on Mental Health
Strategy Ottawa Charter Reasons for Effectiveness of Strategy
Expanding early intervention services
for youth in the
early stages of their serious mental
illness
Developing
personal skills
Young people will be provided with
information &
skills to better manage their mental
illness while
being supported by health
professionals.
Funding to support state-wide 24-hour
mental health
access by telephone & the web
Creating
supportive
environments
People will have access to qualified
counsellors at
Any time of the day to support them
with advice.
Build the capacity of indigenous
communities to
provide culturally appropriate suicide
Strengthening
community
action
Indigenous people will be able to have
input into
programs that will best address their
prevention
activities
needs while
Being culturally appropriate.
Mental health content in tertiary
curricula through
mental health training modules
Reorienting
health services
More health workers will be
trained in supporting
People with mental illness.
Training of Aboriginal mental health
first aid
instructors
Strengthening
community
action
Indigenous people will be able to
identify people
in their community who are at risk of
developing or
Showing signs of a mental illness.
Better access to psychiatrists & general
practitioners through Medicare
Building public
policy
The financial burden of seeking
specialised care will
Be removed from people with mental
illness.