Chapters 5 - 7 of the jurisdiction and legislation in the country PDF

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Improvements in Australia’s health status since 1900 Australia’s ‘old’ public health When first established, the ‘old public health’ had focus on improving hygiene, sanitation and environmental health, as a result of the range of different infectious diseases causing ill health and mortality at the time. The priority of public health was illness prevention and the treatment of conditions Access to clean water, as well as increased access to toilets and sewerage systems, lead to a decrease in infectious diseases such as cholera and diarrhoea. Australia’s first evidence of Public Health was established with the arrival of the First Fleet in 1788, with the establishment of the NSW public hospital system. Several medical staff arrived with the first fleet, and a temporary hospital was set up on Sydney cove before permanent hospitals were built. It wasn’t until 1850 that public health administration commenced in NSW, with the focus on infectious disease and sanitation. In 1881, the first board of health was formed in response to the smallpox epidemic. The first Commonwealth department of health was formed in 1921, with a focus on dental services, health, quarantine and medical research.

Australia’s health status in early 1900’s Poor housing and inadequate environmental conditions can lead to dangerous health problems for those in middle- and working-class families. A lack of safe water and sanitation was the major problem, and lead to infectious diseases such as whooping cough, smallpox, tuberculosis, diphtheria, pneumonia and diarrhoea. Without a nationally funded medical system such as Medicare (1984), health care was very expensive, so many of people’s diseases were left untreated. The health care system helped only those who could afford it. Australia's health status in early 1900’s Increased risk of infectious diseases was due to: • poor air quality due to the rise of factories. 

inadequate food storage and preparation.

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waste collection being performed by ‘nightmen’, who deposited it into main waterways, which resulted in an increase of diseases such as cholera.

Improvements over time Public health in Australia is responsible for a 27-year increase in life expectancy this century (approximately). Life in the 1900’s was very different compared to Australia today. The living conditions in 1900 were very poor, overcrowded, and unhygienic, allowing infectious diseases – such as typhoid, smallpox, influenza, and cholera – to claim the lives of millions. The Bubonic plague in 1900, bought in by Chinese and Indian ships, affected many people. Suburbs with lower socio-economic statuses were affected most, due to the spread of disease from rats.

Vaccine – preventable conditions With the invention of vaccines, many infectious diseases now had a treatment; in the 1930’s, Australia began the first mass vaccine program. The vaccines for the conditions below are now carried out within the first 18 months of a child’s life. Since the introduction of vaccination for children in Australia in 1932, deaths from vaccine preventable diseases have fallen by 99%, despite a threefold increase in the Australian population over that period.

Infectious and parasitic diseases Up until 1932, infectious and parasitic disease caused at least 10% of all deaths each year, deaths were highest amongst the very old and very young. With improves living conditions in the early 20th century, effective water and sewerage supplies including toilets, improvements in food quality and health education saw an increase in life expectancy. Chronic diseases such as circulatory disease and cancer soon replaced infectious and parasitic diseases as the main cause of death of older people. Infection control measures and improved medical facilities, alongside health promotion awareness and preventative action such as handwashing had become common practice.

Circulatory diseases Circulatory diseases, also known as cardiovascular diseases, involve diseases of the heart and blood vessels such as heart attack, stroke and coronary heart disease.

Biomedical approach to health The Biomedical Model of Health focusses on the physical or biological aspects of disease and illness. It is a medical model practiced by doctors and health professionals and is associated with the diagnosis, treatment, and cure of disease. The Biomedical Model of Health is often referred to as a ‘band aid’ approach to health care as it treats the illness, injury, or disease, but does not look at the causes of illness or injury. The aim of The Biomedical Model of Health is to return the patient to their ‘pre-illness’ health. The Biomedical Model of Health relies heavily on health care practitioners such as doctors and specialists, and the use of medical technology

Strengths and limitations strengths Life expectancy extended and quality of life improved Leads to significant advances in medical technology and research Most people and conditions can be treated and ‘cured’

Limitations The ‘fix-it’ approach doesn’t promote good health Relies on costly medical technology and practitioners Not all conditions can be treated or cured

Example of medical technologies in treating cardiovascular disease A variety of medical technologies can be used in treating individuals with cardiovascular disease. • Pharmaceuticals o blood pressure medication o blood thinners o cholesterol lowering medication • Surgeries o bypass surgeries o pacemaker o stenting • Other medical interventions o defibrillator

key characteristics of new public health The new public health approach identifies that there are a number of physical, environmental and socio-cultural factors that can impact on health.

The aim of the new public health is to prevent illness, disease and injury from occurring by modifying the risk factors. New public health is about health promotion and is focused at the population level, as opposed to the individual

The role of health promotion in improving health status The Grim Reaper TV advertisement was one of the most effective health promotion campaigns in Australia’s history. It was a very confronting – and therefore, controversial – advertisement aimed at raising awareness of the HIV/Aids virus. Articles on HIV/AIDS appearing in the Sydney morning herald 1986 - 2004 Number of Year mentions 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

98 439 274 313 235 226 242 285 326 333 275 231 169 172 158 216 155 218 163

Social model of health The social model of health is an approach to health care that recognises that improvements in health and wellbeing can only be achieved by directing effort towards addressing the physical, socio-cultural, and environmental factors of health that have an impact on individuals and population groups. • •

The social model was developed in the late 1970’s. The social model was developed in response to increases in preventable lifestyle related diseases, such as cardiovascular disease, type 2 diabetes, obesity.

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The social model focuses on educating the public. Key components of the social model are health promotion and policy development.

Principals The social model of health is based on 5 key principles: •

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Address the broader determinants of health o Focus on more than the behavioural factors o Social, economic, and environmental determinants Acts to reduce social inequities o Reduce the barriers that may prevent people from experiencing good health such as income, race, gender. o Aim to ‘level the playing field’. Empowers individuals and communities o Give people the knowledge and skills needed to allow them to participate in the decisions that positively impact their health. Acts to enable access to healthcare o Address the social and environmental barriers that may restrict someone's ability to access healthcare, such as location, income. Involves intersectoral collaboration o Government and non-government groups working together to address barriers and improve health outcomes for all.

Principals – obesity prevention •

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Addresses the broader determinants of health o Make affordable access to culturally appropriate healthy foods. o Ensuring affordable access to recreational facilities to encourage physical activity, such as well-lit walking tracks. Acts to reduce social inequities o Health-promotion campaigns such as Live Lighter free access to resources, such as the 12 week meal and activity planner, to allow all members of the community to be able to access these resources o Live Lighter has resources to download in a variety of different languages. Empowers individuals and communities o Workplaces running healthy cooking demonstrations to develop employee skills on preparing healthy lunches. o Nutrition education programs in primary and secondary schools. Acts to enable access to healthcare o Provision of bariatric services (eg lap-band surgery) in public hospitals via Medicare. Involves intersectoral collaboration o Federal government working alongside Heart Foundation and Cancer Council to implement the Live Lighter program

strengths Aimed at a population level; therefore, more cost effective. Encourages good health through disease – prevention Health messages can be passed down to future generations Can be targeted to vulnerable population groups

Limitations Health messages may be ignored Not all conditions can be prevented (for example, genetic conditions) Doesn’t assist those who are already sick

Ottawa charter for health promotion An approach to health development by the World Health Organization, that attempts to reduce inequalities in health. The Ottawa Charter for Health Promotion was developed from the social model of health and identifies three basic strategies for health promotion, which are enabling, mediating, and advocacy. Strategies for health promotion Enable – ensuring equal resources (education, employment) and opportunities are available to all people to allow them to achieve equal health Mediate – resolve conflict to produce outcomes that promote health Advocate – actions that seek to gain support to make changes to improve health determinants for everyone

Building healthy public policy Building healthy public policy refers to decisions (laws, policies) made by government and organisations that affect health. Laws and policies that make it easier to practice good health (or harder to practice bad health). • • • • •

No hat, no play in kindergartens and primary schools Fresh fruit and vegetables are exempt from GST No jab, no play - immunisation legislation in childcare centres Mandatory pool fencing 120 hours supervised driving practice for Learner drivers

Creating supportive environments Create supportive environments is about making it easier for people to make healthy choices by providing a physical and social environment that promotes health rather than detracts from it.

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councils installing shade cloths over playgrounds bike paths and walking tracks the Quitline online and phone counselling services Kids Help Line counselling Red Frogs at Schoolies

Red Frogs now have their own App for you to use at Schoolies/Leavers (Australia & Bali Only). So if you have an iPhone or Android smartphone, go to the respective stores and download the app. Features of Red Frogs: - Request a walk home - Pancake bookings

Strengthening community action Strengthen community action refers to involving many different groups within the community to work towards a common goal of improving health. The priority works to build links between individuals and communities to encourage communities to be involved in the development of health promotion campaigns and feel a sense of ownership. Health promotion programs that have wide community involvement and a broad range of groups (government, educators, community groups) working together, are generally more successful. Local Men’s Shed programs are supported by a number of groups including VicHealth and local governments.

Developing personal skills Developing personal skills is about providing people with the skills they need to be able to take control of their health and make healthy choices. This priority area is about education, specifically the development of health-related knowledge (health literacy).

Reorienting health services Reorienting health services is about shifting the health system towards prevention, as opposed to focusing on cure. Reorienting health services is moving from the biomedical model to a health promotion focus.

A doctor’s waiting room often has preventative messages on their wall, such as reducing tobacco smoking, or preventative measures for type 2 diabetes. New cervical screening program saves lives  Prevents up to 30 per cent more women from developing cervical cancer because it detects HPV, an early risk indicator for cervical cancer.  The previous Pap test detects cervical abnormalities after they occur.

Recap – biomedical and social models of health VCAA defines the biomedical model of health as focusing on the physical or biological aspects of disease and illness. It is a medical model of care practised by doctors and health professionals and is associated with the diagnosis, cure and treatment of disease The social model of health is a conceptual framework within which improvements in health and wellbeing are achieved by directing effort towards addressing the social, economic and environmental determinants of health. The model is based on the understanding that in order for health gains to occur, social, economic and environmental determinants must be addressed.

Relationships between biomedical and social models of health Both the biomedical and social model of health are practiced in conjunction with each other to improve health in Australia. Strengths and limitations The limitations of one model is generally seen as a strength in the other model, and vice versa.

Biomedical model Individual focus Focus on cure Not all conditions can be treated

Social model Population focus Focus on prevention Not all conditions can be prevented

The health care system Overview of the health system Australia spends about $170 billion a year on health - a sector that includes more than 1,300 hospitals, employs about 385,000 nurses, midwives and medical practitioners, and provides a diverse range of services. A day in the life of our healthcare system…

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616,000 subsidised prescriptions dispensed (PBS) 381,000 visits to a general practitioner (GP) 246,000 pathology tests 79,000 visits to a specialist 27,000 hospitalisations - 59% in the public sector 27,000 allied health services provided 24,000 contacts made at community mental health care services 20,000 presentations to a public hospital emergency department - 10% end up being admitted to hospital 1,900 people admitted for elective surgery in public hospitals

How the Australian healthcare system is funded

Expenditure overtime

Medicare What Is medicare? Established in 1984, Medicare is Australia’s universal health insurance scheme. Medicare is known as a universal health insurance scheme as it is available to all Australian residents, regardless of income, location, and culture. Medicare aims to ensure all Australians are able to access basic healthcare that is subsidised by the government, when and where they need it. Who can access Medicare? • •

All Australian permanent residents. Those people from countries with a reciprocal agreement, some of which include New Zealand, United Kingdom, Italy, Sweden, and Norway. year Total mil. Per person no. Total mil 2001 – 02

220.7

11.2

7828.5

2002 – 03

221.4

11.1

8115.5

2003 – 04

226.4

11.2

8600.0

2004 – 05

236.3

11.6

9922.9

2005 – 06

247.4

12.0

10976.3

2006 – 07

257.9

12.2

11 735.6

2007 – 08

278.7

13.0

13 006.5

2008 – 09 2009 – 10

294.0 308.4

13.4 13.8

14 321.9 15 477.1

2010 – 11

319.1

14.1

16 377.4

Medicare – what is and isn’t covered covered

Not covered

General Practitioner consultation fees (scheduled fee) Treatment and accommodation as a public patient in a public hospital Eye tests performed by an optometrist

X-rays Pathology tests (blood tests)

Most dental examinations and treatments Accommodation costs in a private hospital (treatment costs are covered up to 75% of the scheduled fee) Alternative therapies including, chiropractic services, physiotherapy, naturopathy and remedial massage Health aids including, hearing aids, glasses and contact lenses Ambulance services

Bulk billing Bulk billing is a term used when a service provider (GP, optometrist, etc.) chooses to charge the patient no more than the scheduled fee for their services. In these cases, there will be no ‘out of pocket’ costs for the patient to pay. The service provider (the doctor or GP for example) is paid directly by the government for their services. Bulk billing services are considered to be ‘free’ for the patient.

Scheduled fee and patient co-payments The scheduled fee is the amount the government, via Medicare, contributes towards the costs of treatments and services. Essentially it works like a ‘recommended retail price’. If the service provider chooses to charge more than the schedule fee for their service the patient will have to make up the difference. These charges are called ‘out-of-pocket’ expenses or patient co-payments. Service cost - scheduled fee = patient co-payment Example: Bulk billing GP consultation Service cost – scheduled fee = amount of patient co-payment $37.05 – $37.05 = $0.00 co-payment Example: non bulk billing GP consultation Service cost – scheduled fee = amount of patient co-payment $64.00 – $37.05 = $26.95 co-payment

Medicare safety net

The Medicare safety net aim to protect those who have a heavy reliance on medical services from high ‘out-of-pocket’ expenses. Once an individual, or family’s, out-of-pocket expenses have reached the threshold amount, the Medicare services for that individual or family are charged at a cheaper rate for the remained of the year. Medicare Safety Net threshold (2017) = $2,056.30 After this amount has been paid in out-of-pocket costs the individual or family will receive 80% back on any future out-of-pocket costs for the rest of the year. Example: GP consultation = $60 Scheduled fee = $37.05 Out-of-pocket costs = $22.95 After the MSN has been reached the out-of-pocket costs will be 80% less $22.95 - 80% = $4.60

Medicare – advantages and disadvantages advatages Available to all Australian citizens Basic health tests and treatments are provided at little or no cost Reciprocal arrangements with other countries allows Australian citizens to access subsidised/free health care in other countries Allows patients to choose their own doctor for out-of-hospital services

disadvantages Waiting lists for many non-emergency treatments Doesn’t cover many common alternative treatments such as massage May not cover all costs of doctors and specialist fees if charged more than the scheduled fee Does not allow patients to choose their doctor for in-hospital treatments

Sustainability In relation to the Australian health care system, sustainability refers to the ability to continu...