Core 1 Health Priorities in Australia Summarised PDF

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Core 1, PDHPE, Health priorities in Australia summarised...

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PDHPE HSC Summaries – Core 1 Health Priorities in Australia How are priority issues for Australia’s health identified? • Measuring health Status - Role of Epidemiology Epidemiology is the process of data and information collection. It is the study of disease and illness in groups/populations. It considers the pattern of disease in terms of: - Prevalence: number of existing cases of disease in a population - Incidence: number of new cases of disease in a population Epidemiology focuses on gathering + interpreting epidemiological statistics e.g. ‘Australia’s Health 2006’. These reports show info on mortality/infant mortality rates, morbidity rates, life expectancy, health resources, costs associated with ill-health, private health insurance info, medication etc. Its role is to help researchers and health authorities to: - describe and compare patterns of health in groups communities and populations - identify health needs and allocate health care resources accordingly - evaluate health behaviors and strategies to help control and prevent disease - identify and promote behavior’s that can improve the health status of the overall population Epidemiology does have its limitations. It doesn’t: - always show significant variations in health status among populations + sub-groups like ATSI - accurately indicate quality of life - account for social, economic and cultural factors that also affect the health of individuals. - Measures of Epidemiology The major measurements used epidemiology are: 1. Mortality: death rates within a population 2. Infant mortality: the number of deaths occurring in an infants first year of life in a population 3. Life Expectancy: the number of years a person has to live 4. Morbidity: the sickness rates within a population - Current trends in life expectancy Increased life expectancy for Australians over decades had increased significantly due to: - reduced infant mortality rates from improved medical diagnosis + treatment of illness - declining mortality rates for CVD, some cancers and some motor vehicle accidents - the improved medical interventions e.g. advanced screening techniques The life expectancy for Australian males is roughly 79 and for Australian females its about 81. Australians live longer than people in any other nation in the world except Japan (81.4).

- Current trends for the major causes of morbidity and mortality for the general population, comparing males to females Most common causes of death are: 1. Diseases of heart and blood vessels e.g. CVD, stroke 2. Cancer 3. Diseases of the respiratory system 4. external causes e.g. car accidents 5. Mental and behavioral Disorders 6. Diseases of the Nervous system -

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death rates are lower than Australian born population Main causes of death are CVD (like heart disease and strokes), some cancers and respiratory diseases. Diseases that are largely preventable life-style diseases have been increasing, such as CVD, obesity, Alzheimer’s, dementia and cancer. Heart disease, lung cancer and stroke have all remained relatively stable Significant decrease in the death rates from circulatory and respiratory diseases in males Stable death rates for respiratory system and genitioury diseases have remained stable for women Some of the leading causes of death like heart disease, stroke, and some cancers, the death rates are decreasing. This reduction of these diseases is mainly due to: • improving medical technology methods + medicines • Improved levels of education about leading a healthy life-style + consequences of inactivity, a poor diet and unhealthy behaviors like smoking. infant mortality rate is a good indicator of general health + well-being of a population Morbidity levels increase as distance away from major cities increase. The falling rates of diseases that were once fatal but are now likely to be overcome are continuing to fall e.g. heart attacks and strokes Diseases tending to rise are largely self inflicted life-style diseases, such as STD’s, mental/behavioral problems, diabetes and obesity. Most of these are increasing because of Australia’s unhealthy life-style behaviors like poor diet, physical inactivity, unsafe sex practices and smoking. Improvement in coronary heart disease treatment is good but still contributes to most of the mortality rates of any single condition Large increases in obesity leads to most of the rapidly rising diabetes incidence Infant Mortality

Mortality

Morbidity

• Identifying priority health issues There are 5 factors that identify that something is a priority health issue: 1. Social Justice Principles 2. Priority population groups 3. Prevalence of the condition 4. Potential for change (preventions and early intervention) 5. Costs to the individual and community - Social Justice Principles Social justice refers to the notion of eliminating inequity in health, promoting diversity and establishing supportive environments for all Australians. The Social Justice Principle aim to make the health system fair and equal to everyone in the population, not leaving anyone out. Thus in identifying priority areas we must look for areas of inequality in: - Mortality + morbidity rates - Social, cultural and environmental factors - Access to resources, information and education - Priority Population Groups This principle is closely linked to the SJP. The many diverse sub-groups in the Australia reflect its diverse and multicultural population. It is important to identify the priority population groups suffering health inequities are important for determining health priority issues because it allows health authorities to: - determine the health disadvantages of groups in the population - better understand the social determinants of health - identify the prevalence of disease and injury in specific groups - determine the needs of groups in relation to the principles of social justice The following groups suffer health inequities: ATSI, socio-economically disadvantaged, immigrants, rural + isolated dwellers, disabled, women, men and elderly. - Prevalence of Condition The number of existing cases a disease/illness in a population. Prevalence of a condition can: - to a certain extent provide info on health status of a population - Help identify risk factors which can indicate the potential for change in a health area. But ultimately the prevalence rates of a disease show the health and economic burden the disease places on the community. Thus high prevalence of a condition will show that a particular condition is a priority health issue.

- Costs to individuals and community Disease/illness can place great economic and health burden on the individual in terms of financial loss (e.g. treatment cost, medication and rehab may be more than individual can afford), reduced productivity (i.e. affect individuals ability to be productive, may need to stop work and reduces ability to earn money), diminished quality of life and emotional stress (emotional stress, social upheaval and pain/suffering). Illness/disease and premature death all place an economic burden on community. Costs can be direct or indirect. Direct costs are hospital/medical/pharmaceutical expenses, money spent on research, prevention programs and education. Indirect costs aren’t directly related to health system such as absenteeism, reduced productivity, burden on family/carers and decreased quality of life. 7 groups accounting for most expenditure are: 1) CVD – $5.5 billion 2) Nervous system disorders – $4.9billion 3) Musculoskeletal problems – $4.6 4) injury and poisoning - $4 5) Respiratory diseases - $3.7 6) Mental disorders - $3.7 7)oral health – $3.4 Thus if a condition is costly to the individual and the community it will be a priority health issue if it fills all the other criteria for identifying a NHPI. - Potential for Change (Potential for prevention and early intervention) Most of Australia’s major causes of morbidity and mortality are due to modifiable life-style behaviours. This means that they are largely preventable and have great potential for change. However changing individual behaviours and choices is not so simple. For change to occur we must address both individual behaviours and environmental determinants. Most of the chronic diseases and problems have social and individual determinants, so prevention and early intervention may lead to improved health status.

What are the Priority Issues for Improving Australia’s Health? • Groups experiencing health inequities - Aboriginal and Torres Strait Islanders (ATSI) Nature and Extent of the health inequities - Lower life expectancy rates at birth for males and females (life expectancy 17 years lower than non-ATSI) - Higher mortality rates for all ages compared to non-ATSI population - Higher mortality rates from preventable diseases like CVD (ATSI death rates are 3 times higher) - high death rates from circulatory diseases, injuries, respiratory diseases, cancer, endocrine + digestive disorders - Infant mortality rates 3 times higher than national average - However the death rates from all causes for ATSI males is declining, similar for ATSI females - ATSI experience a much poorer level of health, die younger, get sick more often and are more likely to have a reduced quality of life compared to the non-ATSI population. Socio-cultural, socioeconomic and environmental determinants 1. Socio-cultural: determinants of health include family, peers, media, religion and culture. 2. Socioeconomic: determinants of health include employment, education and income 3. Environmental: determinants of health include geo-graphical location (e.g. country/isolated area could affect access to services/professionals etc) and access to health services and technology. The roles of individuals, communities and governments in addressing the health inequities Health is not only the responsibility of the individual. Governments and health authorities also recognise that people cannot always choose a particular life-style. The government and health authority’s role aims for health promotion and illness prevention campaigns attempt to address the determinants of health that have an impact upon health or affect people’s ability to make healthy decisions. The community also effects an individuals health in positive and negative ways, for example the people in the community and what they can do Reasons why ATSI experience health inequities - ATSI more likely to be of low SES, therefore less money to buy healthy more expensive food, further education and use health facilities. - This lack of education negatively affects their dietary, exercise and sexual choices. Thus they likely to have poor diet, be inactive, have unsafe sex and make bad behavioral choices i.e. smoking. Less likely to partake in free health care services like cancer screening programs. - They have minimal medical facility access and more likely to be of low SES and low education level. Thus more likely to smoke, which adversely affects their health. - Socio Economically Disadvantaged (SES = Socio Economic status) The nature and extent of the health inequities People who are characterized as having a low income, poor housing, poor education level and unskilled work are considered to be socio economically disadvantaged. There is a consistent and significant relationship between people SES and their health. Low SES tends to be a risk factor for ill-health. The following is nature + extent of inequities experienced by SE disadvantaged: - Have higher levels of mortality + morbidity (higher SES have lower rates of infant mortality + mortality from preventable causes). - Lower SES have lower education levels, thus less educated about their health, the decisions they make, and accounts for their strictly limited employment opportunities. Less informed about their health. - Low levels of education indicate higher levels of high blood cholesterol, which is directly associated with their poor diet. - The decline in heart disease rates is greater in higher SES groups - Prevalence of smoking is high in low SES and tends to decrease as occupational status rises e.g. 25.9 % of low SES areas smoke.

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Less informed about health, therefore less inclined to use preventative health services like immunization, dental check-ups and pap-smears. In summary SE disadvantaged groups are sick more often, die younger + have higher rates of mortality from most causes of death.

Reasons why socio economically disadvantaged experience inequities Low SES: - Have less money to buy healthy more expensive food, further education and use health facilities. - Their lack of education negatively affects their dietary, exercise and sexual choices. Thus they likely to have poor diet, be inactive, have unsafe sex and make bad behavioral choices i.e. smoking. Less likely to partake in free health care services like cancer screening programs. - They have minimal medical facility access and more likely to be of low SES and low education level. Thus more likely to smoke, which adversely affects their health.

• High levels of preventable chronic disease, injury and mental health problems -

Cardiovascular Disease (CVD)

Why CVD was listed as a NHPI (National Health Priority Issue) Social Justice Principles: SJP’s try to make the health system fair and equal, ensuring everyone in the population has equal access. CVD is listed as a NHPI because not everyone shares equal health in regard to CVD, therefore it’s a priority issue to try to eliminate the inequity caused by CVD. This aim may be assisted by greater education, detection methods and access to treatment centers. Priority Population Groups: the main groups affected by CVD are the aged, ATSI and low SES groups. CVD is listed as a NHPI because it affects a diverse range of the Australian population. As your age increases your risk of CVD increases, which is why the elderly are a priority pop group (2/3 of CVD cases are aged 65+). The ATSI population is 2x as likely to contract CVD, thus there a priority pop group. Low SES groups are also at a much higher risk to CVD, mainly because low SES and ATSI are linked with poor diet, low levels of education + greater incidence of smoking. Prevalence of Condition: number of new cases that CVD has affected in a pop at a certain time. It’s the leading cause of death in Australia + accounts for 36% of deaths in 2004. It is a NHPI because the prevalence of CVD is the highest of any disease, problem or injury. Costs to the individual and community: CVD is a NHPI because it is the most expensive disease. The costs to the individual are: loss of job, pay for treatment/rehab, physical pain, mental suffering, death, relationship problems, burden on family members etc. Cost to community is huge, it accounts for the most health expenditure in Aust à 5.5 billion in 2001 and being 11% of Aust total allocated heath system expenditure. Potential for change: CVD is a NHPI because it has the potential for change (for the burden of the major causes of CVD and sickness to be reduced). It has the potential to change because it is largely preventable. Te decline in CVD death rates is due to both improved medical technology increasing survival rates + the improving education about life-style choices and behaviours. Nature of the problem CVD is all diseases of the heart and blood vessels. The 3 major types are: - Coronary HD or ischemic HD(poor blood supply to the heart) - Stroke or cerebro-vascular disease (poor blood supply to the brain) - Peripheral Vascular Disease (poor blood supply to the limbs) The underlying cause in most CVD cases is atherosclerosis. Atherosclerosis: is when a blood vessel such as an artery, becomes clogged with fat/cholesterol deposits. An atherosclerotic artery has less space for the blood to flow through Arteriosclerosis: is when the fatty deposits on artery walls increase and the arteries become hard and less elastic. Therefore it cannot expand + contract as easily when transporting blood. Heart Attack (myocardial infarction, coronary thrombosis or coronary occlusion): is a form of coronary heart disease. It occurs when blood flow to heart muscle stops due to atherosclerosis of coronary arteries.

Angina: is a form of coronary heart disease. Its the name given to chest pain caused by inadequate supply of oxygenated blood to heart muscle, triggered by physical exertion, cold weather and emotional arousal. Extent of the problem - leading cause of death (36% of all deaths) - the mortality rate for CVD is declining - males have a higher risk of CVD across all ages compared to females - death or risk of CVD increases with age (49% of all deaths above age of 85 is from CVD) - low SES groups more likely to die from CVD than those of higher SES - ATSI are 2x more likely of dieing from CVD than other Australians - Populations in rural areas have higher risk of CVD than urban populations - CVD deaths higher in TAS, NSW, and NT and lowest in WA - CVD is most expensive disease in terms of direct health care expenditure à 5.5 billion being 11% of Aust total allocated health system expenditure. Risk Factors and Protective Factors The risk factors are either modifiable or non-modifiable: - Modifiable risk factors: smoking, raised blood cholesterol, high blood pressure, physical inactivity, obesity, a poor diet and diabetes. - Non-modifiable Risk Factors: age, sex and family history. Some protective Factors are: - enjoy and consume a nutritious and healthy diet low in fat, salt, sugar and cholesterol - exercise regularly - don’t smoke - appropriately managing stress - low consumption of alcohol These protective factors practiced regularly will work as effective preventatives to CVD and to many other preventable chronic diseases. Socio-cultural, socioeconomic and environmental determinants A person’s health is not only influenced by their individual health decisions, rather health is also influenced by the socio-cultural, socioeconomic and environmental determinants. Socio-cultural Culture: your own culture can affect the eating and social behaviours of a person of that culture e.g. some cultures many men smoke and everyone eats the traditional foods regardless of their nutritional value, which can increase the risk of CVD. Peers: may influence you’re dietary and exercise habits which can either positively or negatively affect your risk to CVD. Environmental Geographic Location: is where you live and where the availability of preventable facilities and doctors are in your area. It can influence your risk to CVD because rural populations have less access to preventative facilities and services like doctors. Socioeconomic Socio Economic Status: The low SES population is more likely to be smokers, less likely to utilize health care facilities and have a poor education, thus will have less money to buy healthy food negatively influencing their dietary, exercise and health choices resulting in the population having a much higher chance of contracting CVD. Education: people with a poor education will be less informed about the consequences of inactivity, poor diet and smoking, making them more likely to lead an unhealthy life-style increasing their risk to CVD. Whereas people with a higher SES will be more likely to make healthy choices. Employment: significant relationship between money and someone’s health. Generally, the more money you have the better the persons health. Therefore the better employment opportunities you get offered the more money you will earn. The more money the more access to better health care facilities like private health funds etc. the less money you have the less likely you will be educated about healthy life-style choices increasing your risk to CVD.

Groups at risk Indigenous Australians, low SES, males, smokers, uneducated, older Australians aged over 65, unemployed, high cholesterol and hypertension (high blood pressure), obesity, inactivity, blue collar workers and people with a family history. - Cancer (skin, breast, lung) Why was cancer listed as a NHPI? Prevalence of the Condition: cancer is listed as a NHPI because it is the leading cause of death in Australia accounting for about 29% of deaths. 1 in 3 men and 1 in 9 women would be directly affected by ca...