Health Priorities in Australia PDF

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Wardle

CORE 1Health Priorities in Australia CQ1 - How are health priority issues identified in Australia? ● Measuring health status

❏ Role of epidemiology 

- Epidemiology is the study of patterns and causes of health and disease in populations, and its application to improve health. - Role: monitors and identifies causes or specific need areas, and evaluates & tracks trends.

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- Researchers and government bodies use epidemiology. 

- Benefits: ➔ Epidemiology tells us, quantifiably, the measures of ill health present in Australia. ➔ Provides us with trends in disease incidence and prevalence. ➔ Provides us with information regarding ethnic, socioeconomic, and gender groups (i.e. immigrants, refugees, ATSI groups). ➔ Epidemiology helps identify priority health issues and possible causes of disease or illness. ➔ Provides information about provides information about ethnic, socio economic and gender groups (i.e. immigrants, refugees, ATSI groups).

Wardle - Limitations: ➔ Statistics and data can be manipulated by the interpreters and open to bias (i.e. manipulating data to gain resources, money, etc.). ➔ Tendency to focus on the negative measurable aspects of health rather than the positive aspects (i.e. wellbeing, quality of life). ➔ Epidemiology does not account for determinants of health (socio economic, socio cultural, environmental). ➔ Doesn't provide why the causes of ill health diseases occur. ❏ Measures of epidemiology - Mortality = death rate 

- Infant mortality = death rate among children under the age of 1, per 1000 live births 

- Morbidity = illness 

- Life expectancy = indication of life duration 

❏ Table/graph data Mortality - Death rate declining (79 per 1000): still high due to ageing/growing population. 

- Leading causes of death: coronary heart disease, dementia & Alzheimer’s, cerebrovascular disease, lung cancer, CVD. 

Morbidity 

- Disability-free years increasing. 

- Increased rate of diabetes and dementia. 

- CVD, mental health disorders most costly. 

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Life expectancy

Wardle - 2012: males 79.9 (6th in the world), females 84.3 (7th in the world) Infant mortality - Decreasing: sits at 3.78 per 1000 live births ● Identifying priority health issues

❏ Social justice principles - Includes: equity, diversity & supportive environments. 

- Equity: resources allocated in accordance with the needs of individuals and populations (determine priority groups). 

- Diversity: refers to the differences existent between individuals and groups, e.g. interpreters at hospitals. 

- Supportive environments: are environments in which people situate & work that can haul threats to health and increase their ability to make healthpromoting choices. 

- The social justice principles seek to recognise and address factors that influence and impact health outcomes. 

❏ Priority population groups - Priority population groups are those that don’t achieve the same health outcomes as rest of the population, e.g. ATSI 

- Epidemiology can identify priority population groups such as ATSI 10yr lower life expectancy 

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- They’re the focus of health promotion initiatives.

Wardle ❏ Prevalence of condition - Prevalence: the number of existing cases in a population at a given 

time. - Incidence: the number of new cases in a population at a specific time period. 

- The higher the prevalence, the higher the priority. 

- E.g. CVD, diabetes. 

❏ Potential for prevention and early intervention - Potential for prevention: the ability to avoid the conditions occurrence. 

- Makes treatment more successful. 

- If prevention can occur, more likely health promotion can reduce the burden. 

- Early intervention preferable if prevention can’t occur. 

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- Lifestyle diseases have high preventative potential. 

- Cancers have potential for early intervention. ❏ Costs to the individual and community - Costs to the individual and the community include: money, time, mental health, independence and employment. 

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- E.g. cancer is a high cost disease. - There are direct and indirect effects of disease.

CQ2- what are the priority issues for improving Australia’s health? ● Groups experiencing health inequities

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ABORIGINAL AND TORRES STRAIT ISLANDERS ❏ The nature and extent of the health inequities - ATSI experience the largest gap in health outcomes in Australia 

- Life expectancy 10 years lower than non-indigenous 

- Have higher death rates in each age group  

- More likely to suffer from chronic health conditions 

- Have: 7x more kidney disease, 3x more diabetes 

- Increased rates of depression & anxiety 

- 3x higher infant mortality rates 

- Increased mortality for CVD, cancer & diabetes 

- Smoking rates are twice that of non-indigenous 

- Increased obesity ❏ The sociocultural, socioeconomic and environmental determinants 

Sociocultural determinants

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- Family, peers, religion, culture and media 

- Higher rates of domestic violence 

- Less educated + low income contributes to family upbringing - Ongoing effects of colonisation, e.g. social dislocation, loss of culture,

Wardle identity & self-worth 

- Lower standards of living 

- Make 25% of NSW prisoners Socioeconomic determinants 

- Education, employment & income 

- 2008: 2.5x more likely to be in the lowest income bracket & 4x less likely to be the top income bracket 

- 2014-15: 50% unemployed (20% more than non-ATSI), & 30% less completing year 12 than non-ATSI 

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Environmental determinants - geographic location and access to health services & technology

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- Access to health services is poorer 

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- Higher rates of homelessness 

- More likely to live in rural/remote areas ❏ The roles of individuals, communities and governments 

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- Individuals are empowered by interventions to make informed choices about their behaviour. - Communities and ATSI leaders were are involved in the design and implementation of many of the ‘Close the Gap’ programs & interventions. - E.g. Australian Indigenous Doctors Association. - Governments have widespread health promotion and funding, e.g. $805 million Indigenous Chronic Disease Package. - ‘Close the gap’ (all gov. levels) aims to achieve equality in health status by reducing infant mortality, and increasing ATSI life expectancy, including education and employment programs.

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PEOPLE IN RURAL AND REMOTE AREAS 

❏ The nature and extent of the health inequities - Shorter life expectancy and higher rates of mortality & morbidity 

- Very remote has 1.5x death rate of major cities 

- Main cause of this is CHD, circulatory disease, and transport accidents 

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- Lack of proximity to health services, and specialists 

- Higher rates of diabetes, CVD, cancer and mental health problems

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- Higher rates of injury - occupational hazards 

- Physically inactive, poor diet, higher smoking rates ❏ The sociocultural, socioeconomic and environmental determinants 

- Remoteness, socioeconomic disadvantage, ATSI population & gaps in health information makes it hard to determine the implications of remoteness. 

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- Sociocultural: the portion of ATSI living in remote areas contributes to the poorer health outcomes. - The poorer indicators of health influence children (family), e.g. families that smoke have second hand smoke. - Socioeconomic: lower health literacy. - More likely to work in the primary industry, thus hazardous occupations w/higher rates of tobacco usage and alcohol consumption. - Environmental: less GP’s, and access to health services/technology, long distances to travel.

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❏ The roles of individuals, communities and governments  

- Individuals can focus on taking responsibility for their health and those around them.

Wardle - Individuals can complete school and extend in online university or Charles Sturt University to improve knowledge, health literacy, employment/income. 

- Communities can provide relevant healthcare and support services e.g. Multi- Purpose Service Programs. 

- Government funds rural/remote programs to assist in the delivery of healthcare services. 

- E.g. Patient Assisted Travel Scheme or Health promotion campaigns 

(RTA). 

- E.g. Royal Flying Doctors Service provides: healthcare clinics, medical evacuations, medical chests, remote consultations.

● High levels of preventable chronic disease

❏ Cardiovascular Disease (CVD) Nature - All diseases of the circulatory system (heart & blood vessels) 

- Main cause of CVD is atherosclerosis (causes blockages) 

- Main categories of CVD: coronary heart disease (heart, e.g. heart attack), peripheral vascular disease (limbs, e.g. gangrene), cerebrovascular disease (brain, e.g. stroke) 

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- Other: atherosclerosis (narrowing), arteriosclerosis (hardening), angina (chest pain) & hypertension (HBP) Extent

Wardle - CVD used to be the leading cause of death in Australia and used to be largest burden of disease & cost. 

- Death rates are decreasing (accounts for approx. 30% of deaths in Aus) 

- 1 in 5 Australians have it. - 73% decrease in the last 30 years due to medical & surgical treatment improvement. 

Risk / protective factors 

- Risk factors: hypertension (high blood pressure), physical inactivity, obesity & smoking. 

- Protective factors: regular physical activity, regular health checks, a balanced diet low in saturated fats. 

Determinants 

- Genetics 

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- Peers and family influence diet & exercise decisions. 

- Health literacy and knowledge influences lifestyle choices.    

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- Certain employment = higher rates of CVD, e.g. tradies. - rural/remote = higher death rates of CVD. Groups at risk - ATSI, SES disadvantaged, smokers, males, rural/remote

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- Higher income = increased access to health services and technology.

- ATSI 2.5x more heart attacks & 1.5x more likely to have a stroke - Low SES = 40% higher death rates by CVD - More estrogen = better cholesterol (males) ❏ Cancer (skin, breast, lung)

Wardle Nature - Cancer: A group of diseases leading to the uncontrolled growth of abnormal body cells. Leads to tumors which interrupt the normal functioning of the body, which can spread. 

- Tumors can be both benign (non-cancerous) and malignant (cancerous & invades surrounding tissue). 

- Skin, breast and lung most concerning. 

Extent 

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- First leading cause of death in Australia. 

- Five-year Survival rates increasing & death rates declining. - Increased incidence (26%) due to ageing population & better detection from enhanced technology and education.

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- 3.6% of the population diagnosed with cancer. 

Risk / protective factors 

- Risk factors: smoking, alcohol, poor diet, physical inactivity, family history, occupation exposure (e.g. sun), exposure to carcinogens (e.g. asbestos). 

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- Protective factors: regular check-ups, balanced diet, sun-safety, regular physical activity, avoid carcinogens. - Non-modifiable risk factors: gender, age, family history, genetic makeup. Determinants Sociocultural:

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- Culture of sun exposure and tans in Australia. 

- Genetics inherited by family. 

- Family/peers influence behaviours (diet, exercise).

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- Media promotes sun safety/melanoma awareness. 

- Smoking amongst young females. Socioeconomic:  

- Lower education = lower health literacy 

- Some occupations have greater sun exposure 

- Income can restrict access to specialists and health services 

- Lower SES linked with higher rates of cancer Environmental: 

- Rural/remote areas have higher mortality rates and generally need to travel to major cities for treatment. Groups at risk - Elderly: 80% of cancer deaths from people 60+  

- Males: 1.6x higher death rates than females 

- ATSI: 50% higher mortality rates 

- rural/remote 

- Socioeconomically disadvantaged communities 

- Smokers ❏ Diabetes Nature 

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- Diabetes: a disease that affects the body’s ability to take glucose from the bloodstream for energy. - Caused by a malfunctioning of the pancreas leading to insufficient insulin levels, responsible for regulating blood glucose level (BGL). - Type 1 (Insulin Dependent Diabetes): autoimmune disorder, need

Wardle insulin injections & monitor diet + physical activity. - Type 2 (Non-Insulin Dependent Diabetes): breakdown in the efficiency of insulin, due to poor diet & exercise. 

- Gestational: similar to type 2, but occurs during pregnancy. 

- Diabetes can be the underlying cause of other chronic diseases (heart, liver, etc). 

Extent  

- 6th leading cause of death in Australia 

- Type 2 most common 

- Diabetes rates have doubled over the last 20 years 

- Contributes to 10% of all deaths 

- 1 million people in Australia diagnosed with diabetes (4%) Risk / protective factors

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- Risk factors: family history, obesity, imbalanced diet (high sugar, fats & alcohol), smoking, hypertension. 

- Protective factors: regular physical activity, well balanced diet, no smoking, managing blood pressure. 

- There are modifiable & non-modifiable risk factors. 

Determinants 

Sociocultural: 

- People of Chinese, ATSI, Indian background more likely to be diagnosed with type 2 diabetes. 

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- Family/peers of poor diets and sedentary lifestyles more likely. - Social acceptance of binge drinking.

Wardle - Ageing population. 

Socioeconomic: 

- Low SES have higher rates of smoking, alcohol consumption, imbalanced diets, obesity and physical activity (type 2). Environmental: - People outside major cities are more likely to be diagnosed with type 2 diabetes. 

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- More sedentary lifestyles from technological advancements e.g. video games. Groups at risk

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- Family and history genetics. 

- ATSI 3x more likely to have diabetes. 

- Type 2 more common in males, and more prevalent in the elderly.

● A growing and ageing population

In the last 50 years: - Decreased birth rate. 

- Increased life expectancy, decreased mortality. 

- Sustained rates of immigration from overseas. 

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❏ Healthy ageing

Wardle - Healthy ageing is a process of including oneself in various behaviour factors such as regular physical activity, good dietary choices, social activities, etc. 

- The goal of healthy ageing is to enable the elderly to maintain their health into old age which; ➔ allows them contribute to the workforce longer, and; ➔ engage in society better. - As a result, this decreases the use of health services by the elderly. Healthy ageing involves people reducing their risk factors for disease, and preventing the progression of the disease after its onset and reducing morbidity and mortality. - “Ageing Well, Ageing Productively”. 

❏ Increased population living with chronic disease and disability 

- Australia’s ageing population = increased chronic disease and disability. This is because its more prevalent in elderly. 

- Chronic disease is the greatest issue for Australia’s health and has a large burden on the population. 

- With rising survival rates from cancer, CVD, etc., prevalence of people living with chronic disease/disability is rising = increased health care expenditure and need for aged care facilities. 

- E.g. 93% of people with dementia are elderly. 

❏ Demand for health services and workforce shortages 

The health system and services: 

- Concern that the ageing population will increase public spending on health and place an unsustainable strain on the health system. 

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- Last 10 years, number of people living in aged care facilities has risen by 20% with all residents having illness/chronic disease.

Wardle - Aged care carries a high burden on the health system with all their residents having chronic disease or illness that ultimately increase the demand health services. 

Health service workforce: 

- Increase age care facilities = increase workforce training in aged care and issues surrounding chronic diseases and disabilities. 

- Adequate health workforce essential in quantity and skill. 

- To address this there is a focus on efficient coordination of care and safe medication use to decrease the demand for health services and workforce. 

- The Living Longer, Living Better aged care reform package aims to address the attraction, retention, remuneration, education, training and career development of aged care workers, in order to address workforce shortages. 

❏ Availability of carers and volunteers Carers of the elderly: - A growing and ageing population, with the increase in chronic disease/disability require an increase in carers and volunteers. 

- A carer is someone who provides assistance to the ill, disabled, etc, either formally paid or informally unpaid (e.g. family such as a spouse). 

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- Care for the elderly needs to be varied in its approach to meet the demands. - Aged care can be provided through community or residential aged

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care. - Care provided often includes activities such as bathing, cooking, home upkeep, and medication administration. - Carers come from charities, government. 

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- Elderly: provide regular grandchild care & make 31% of voluntary carer work.

Wardle Volunteer organisations: 

- Volunteering is unpaid, willful help given to a formal organisation. 

- Formal groups include charities, social groups, religious groups. 

- E.g. Meals on Wheels, Anglicare, Independent Community Living Australia. 

- 1995-2010 volunteers increased, but decreased between 2010-2014. 

- It is vital this falling rate is turned around if Australia is going to appropriately care for the needs of our growing and ageing population.  

CQ3 - What role do health care facilities and services play in achieving better healt...