Pdhpe - Core #1 Health Priorities in Australia Notes PDF

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PDHPE Core 1 - Health Priorities in Australia Notes...

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PDHPE CORE #1 - HEALTH PRIORITIES IN AUSTRALIA HSC NOTES  How are priority issues for Australia’s health identified?  ● -

measuring health status role of epidemiology measures of epidemiology (mortality, infant mortality, morbidity, life expectancy)

 Epidemiology is the study of patterns and causes of health and disease in populations. The role of epidemiology is to identify specific factors relating to health such as number of cases of a disease / injury, group most affected, rates of disease / injury, trends (increasing / decreasing) ● Epidemiology provides information on the distribution (or patterns) of disease, illness and injury and on the likely causes (or determinants) within groups or populations.

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 What Can Epidemiology Tell Us?: ● Epidemiology serves many purposes. These include: ➢ monitoring the major causes of sickness and death to identify any emerging issues and inequalities between groups ➢ 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 healthcare services and facilities  Who Uses Epidemiology? ● Epidemiological information is used to inform the decision- making of many groups within the community. These include: ➢ policy developers at all levels of government ➢ the manufacturers of health products ➢ the providers of health services ➢ individual consumers. ● An example of how epidemiology has been applied is in the area of heart disease. ● Epidemiology indicates that deaths from heart disease are decreasing, especially in males aged over 45 years. ● This is an indication that previously implemented management strategies have been effective.      

Measures of Epidemiology: ●

The major measures used to determine the health of a population are: Measures

Explanation

Mortality Rate

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This is also called death rate, and is a measure of the number of deaths from a specific cause in a given period of time (usually a year)

Morbidity Rate

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This rate provides information about the level of disease in specific populations. The main indicators used are prevalence and incidence.

● Life Expectancy

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This is the average number of years a person of a given age and gender can expect to live

Infant Mortality Rate

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This is a measure of the annual number of deaths of children under 1 year of age per 1000 live births.

 In terms of the morbidity rate, prevalence is the number of current cases of a specific illness or disease (for example, 20 000 people in Australia infected with HIV) and incidence is the number of new cases of a disease or illness in a set time period (for example, approximately 800 new diagnoses of HIV per year) ● The most important indicator of a nation's health status is : INFANT MORTALITY ●

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identifying priority health issues - social justice principles - priority population groups - prevalence of condition - potential for prevention and early intervention - costs to the individual and community

 Social Justice Principles: ● Social justice is a set of values that recognises the impact of discrimination, past disadvantage, structural barriers to equality, as well as other social factors. ● In health, the principles of social justice can include : ➢ Participation (in planning and decision making in regards to health) ➢ Equity (balanced distribution of resources to all groups) ➢ Access (providing equal access to health services + information) ➢ Supportive Environments (all population groups should have access to supportive environments in regards to their health)

➢ Diversity (cultural, religious, and other differences must be accepted) If a health issue is caused / affected because some of these Social Justice Principles have not been met, then that is a large cause for concern. ● eg : ATSI have higher rates of CVD and some reasons for this are that they do not receive equity of resources, equity of access, nor do they all live in environments that are supportive : Thus CVD meets this particular part of the selection criteria.  ●

 Priority Population Groups: ● When assessing whether a health issue meets this criteria, the following questions must be asked : ➢ 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? ➢ If the answer to these questions is YES, then that particular health issue meets this part of the criteria. ➢ Eg ATSI have significantly higher levels of CVD than Non ATSI peoples.  Prevalence of Condition: ● When assessing whether a health issue meets this criteria, the following questions should be considered : ➢ 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? (referring to incidence) ➢ If the answer to these two questions is YES, then that particular health issue meets this part of the criteria. ➢ Eg CVD is reported as being the underlying cause in 35% of all deaths in Australia, thus it meets this criteria as there is a large number of people affected by it.  Potential for Prevention and Early Intervention: ● For a health condition to meet this criteria, it must have the ability to be either completely prevented or treated successfully if there is early intervention. ● In order to ascertain this, the following questions need to be addressed:  ➢ Is this health problem the result of risk factors or determinants that can be changed or modified? ➢ Can the harm caused by this condition be reduced by earlier detection and intervention? ➢ Can the impact of this condition be predicted and reduced by understanding changes in the population? ➢ If the answer to these questions is YES, then that particular health condition meets the criteria for Prevention & Early Intervention  ➢ Eg Lung Cancer can be dramatically reduced / prevented by encouraging people to quit / not take up smoking.

➢ Eg Deaths from Breast Cancer are more likely to be reduced if family history is studied and regular screening is encouraged.  Costs To The Individual and The Community: ● To meet this criteria, the following question needs to be addressed : ➢ Does this condition impose HIGH or INEQUITABLE costs on its sufferers and their communities? ● Costs imposed on individuals include : ➢ Financial Costs of Treatment / Medications : Loss of Job ➢ Physical Cost of lost mobility or functionality ➢ Emotional suffering caused by chronic pain / depression ➢ Social Cost from damaged relationships and family suffering ● Direct Costs imposed on the community include : ➢ Financial Costs of providing hospital and medical services ➢ Cost of subsidising pharmaceuticals + medical research ● Indirect Costs imposed on the community include : ➢ Cost of premature death, lost productivity, insurance costs ➢ Cost of support services, cost of retraining programs ● Eg : Cancers, CVD, and mental disorders made the greatest contribution to the burden of disease in Australia. 

 What are the priority issues for improving Australia’s health? ●

 groups experiencing health inequities - Aboriginal and Torres Strait Islander peoples - socioeconomically disadvantaged people - people in rural and remote areas - overseas-born people - the elderly - people with disabilities

 What Is An Inequity? ● An inequity refers to a situation or an action that lacks fairness or justice. ● When we refer to groups that are experiencing inequities in relation to health, this means that their level of health is lower than others as a result of situations that are not fair and equitable. ● These inequities are what cause inequalities in the health status of particular population groups.  Nature and Extent of the Inequities - ATSI People: ● ATSI suffer from a large number of health inequities. These include : ➢ Lower life expectancy: ATSI - 62 Years; Non ATSI – 81 Years

➢ Higher Mortality Rates – ATSI 3 times higher than non ATSI ➢ Infant Mortality Rates – ATSI 3 times higher than non ATSI ➢ Injuries (transport, assault, self harm) – ATSI 3 times higher ➢ ATSI hospitalised at 5 times the rate of non ATSI ● Mortality rates have decreased in some areas, and the gap between ATSI and non ATSI infant mortality rates has closed significantly since 1991.  Sociocultural, Socioeconomic & Environmental Determinants - ATSI People: ● There are a number of factors that contribute to the inequalities suffered by ATSI. These factors are known as determinants and can be broken up into three areas : 1. Sociocultural Determinants: ➢ are those factors that someone is exposed to as a result of the “culture” they are brought up in. ➢ In this context, the “culture” relates to specifically race (ATSI), but this is not always the case. ➢ Some of the socio cultural determinants of health that ATSI people are exposed to are : ❏ Lower educational attainment (50% less ATSI finish Year 12) ❏ Lower rates of home ownership ❏ A sense of a “loss of control” of their lives ❏ Cultural incompatibility with many aspects of Australia’s political, legal and educational systems ❏ A lack of positive role models in some areas of society 2. Socioeconomic Determinants: ➢ These are determinants that affect how much money people have to spend. ➢ The World Health Organization has identified Poverty as the greatest barrier to good health. ➢ Thus it can be inferred that a population group that is exposed to negative socioeconomic factors are at a significant risk of suffering from lower levels of health. ➢ Some of the socioeconomic determinants that ATSI are exposed to are : ❏ Lower incomes (the median income for ATSI families is almost half that of Non ATSI families) ❏ Higher rates of unemployment (3 times the rate of Non ATSI) ❏ Reduced access to health care services and medicines ❏ Exposure to the numerous risk taking behaviours that generally go hand in hand with lower socioeconomic status populations (eg  Tobacco use, High levels of dangerous alcohol consumption, illicit drug use etc) 3. Environmental Determinants ➢ The physical environment surrounding a population will also play a role in determining its health status.

➢ Some examples of the environmental determinants that directly affect ATSI are: ❏ Overcrowded Housing ❏ Run Down Housing ❏ Water supply in remote communities ❏ Training for ATSI environmental officers ❏ Transport issues (lack of access to transport) ❏ Communication Issues (language, lack of trust of outsiders) ❏ The surrounding physical environment involving people undertaking unhealthy behaviours (eg illicit drug use)  The Roles of Individuals, Communities and Governments In Addressing the Health Inequities - ATSI People: ● Aboriginal health is a major problem for this nation. ● Indigenous health status results from the interaction of multiple determinants, and requires a similarly multi-faceted response from the healthcare system. ● This should include an ‘intersectoral’ approach, based on partnerships between people and agencies at many levels and in a variety of sectors. 1. Government: ➢ There are two peak agencies which coordinate Indigenous health services at the federal government level, while a third peak body in New South Wales oversees Indigenous health at a state level. ❏ The Office of Aboriginal and Torres Strait Islander Health (OATSIH) OATSIH provides direct grants to around 245 organisations, of which around 80% are ATSI community controlled or managed. ❏ The National Aboriginal Community Controlled Health Organisation (NACCHO) This agency works with the Department of Families, Housing, Community Services and Indigenous Affairs. It is the national peak Aboriginal health body representing Aboriginal Community Controlled Health Services throughout Australia. ❏ The Aboriginal Health and Medical Research Council of NSW (AH&MRC) This is the peak body for Aboriginal health in New South Wales and is comprised of over 60 Aboriginal Community Controlled Health Organisations throughout the state. The AH&MRC provides vital health and health-related services. 2. Communities: ➢ OATSIH, NACCHO and the AH&MRC all aim to improve the access of Indigenous people to primary healthcare services. ➢ These agencies base their strategies on the principle of working in partnership with the Aboriginal and Torres Strait Islander community controlled health sector. ➢ Improved access and stronger delivery of comprehensive primary healthcare at the community level are the most sustainable ways of making

3.

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a significant long-term difference to Indigenous health status. ➢ Aboriginal Community Controlled Health Services (ACCHSs) and Aboriginal Medical Services (AMSs) are primary healthcare services initiated and operated by the local Aboriginal community. Individuals: ➢ There is a strong focus in many Aboriginal Health Services on : ❏ providing education and support for Indigenous mothers and children ❏ increasing the number of Aboriginal health workers, community support workers and medically trained staff ❏ increasing community capacity by empowering individuals. Health services focus on improving the knowledge and skills of community members. Women and mothers are often targeted as custodians of health knowledge and practice. A recent initiative to target men’s health has also been introduced and funded by OATSIH. The Healthy for Life (H4L) Program provides support for local health services and programs, including improved health training and education for Indigenous people.

  Socioeconomically Disadvantaged People: ● Socioeconomic status (SES) describes the ‘position’ or ‘power’ of a person or group in the community. ● Socioeconomic disadvantage is the existence of: ➢ limited material resources (including income) ➢ reduced access to educational opportunities ➢ less safe working conditions ➢ lower employment status ➢ worse living conditions during childhood ➢ less access to services ➢ greater likelihood of racism or discrimination.  The Nature and Extent Of The Inequities: ● A strong relationship has been identified between low socioeconomic status and lower health status. ● People from areas of lower socioeconomic status: ➢ are more likely to suffer cardiovascular disease, diabetes, asthma, mental illnesses and arthritis ➢ lose more years of life due to diabetes, cardiovascular disease, road traffic accidents and lung cancer ➢ experience lower life expectancy as a result of these and other causes

 The Sociocultural, Socioeconomic and Environmental Determinants: ● The determinants that affect socioeconomically disadvantaged people include: ➢ Inadequate income ➢ Single parent family structure ➢ Poverty ➢ Family Breakdown ● These can all contribute to low SES, and by their nature they increase the likelihood of a person to have: ➢ reduced access ➢ limited resources ➢ restricted educational opportunity and control over their life ● As a result of these determinants, people from areas of lower socioeconomic status are more likely to be exposed to an environment where: ➢ there are daily smokers ➢ people eat less than the recommended servings of fruit and vegetable ➢ people are overweight or obese ➢ people are sedentary or physically inactive ➢ people report higher levels of psychological stress ➢ people are more likely to visit a doctor or emergency clinic ➢ people are more likely to depend on government assistance ➢ people are more likely to avoid the use of preventative health services ● Just as low SES appears to lead to poor health, so poor health can lead to low SES. ● This can result in a cycle of problems. ● For example : illness or disability might cause unemployment or reduced capacity to work or study. ● This would lead to reduced income, which might limit capacity to pay for medical services like dental checkups, or health insurance. ● In turn, this would contribute to a lower level of health, which might restrict employment opportunities, and so the cycle continues.  The Roles of Individuals, Communities and Governments In Addressing the Health Inequities: 1. Government: ➢ At the national level, Medicare and the Pharmaceutical Benefits Scheme (PBS) are programs designed to address the needs of the socioeconomically disadvantaged, by providing lower cost health services and medications for those who can least afford them. ➢ The key priorities in the State Health Plan are for other government and non-government services and the private sector to work together and bridge the health gap between the people with the best health and those with poorer health in New South Wales. ➢ Some of the specific areas include : 

❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏

child health and wellbeing immunisation mental health Obesity sexual health oral health chronic disease urban planning Tobacco drugs and alcohol

 2+3 Communities & Individuals : ● In order for the government strategies to be successful, services and information must be successfully delivered into the most disadvantaged communities.  ● Reduced exposure to risk factors and better delivery of primary care services is critical in order to reduce the inequitable burden of disease these communities suffer. ● The prevention of disease and the management of illness within communities rather than hospitals will become increasingly important and relevant to changing needs. ● This will require the development of an increasingly community-based health workforce. ● As socioeconomic disadvantage is caused by many different factors, any agencies that can provide community healthcare, childhood services, parenting and maternity services, community language services, housing assistance, employment training, home care, meals, migrant services, education and other services that address the actual causes of low SES will improve the health outcomes of low SES people.    

● high levels of preventable chronic disease, injury and mental health problems -

Cardiovascular disease (CVD) Cancer (skin, breast, lung) Diabetes Respiratory Disease Injury Mental health problems and illnesses

Cardiovascular Disease: Syllabus Dot Point Nature Of The

Explanation

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Cardiovascular diseases are diseases of the heart and the blood

Problem ●

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Extent Of The Problem

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Risk and Protective Factors

vessels. One of the major contributing factors to cardiovascular disease is a buildup of fatty tissue (called atherosclerosis) on the inside lining of the arteries. Coronary heart disease occurs when the blood supply to the heart is decreased by a narrowing (usually caused by atherosclerosis) in one or more of the coronary arteries. Cerebrovascular disease (stroke) is an interruption (usually caused by atherosclerosis) of the blood supply to the brain results in what is commonly known as a ‘stroke’. Peripheral vascular disease is a type of cardiovascular disease that affects the blood vessels in the limbs. Hardening of the arteries that interferes with blood supply to the muscles and skin is known as arteriosclerosis Cardiovascular disease is the second leading cause of disease  Accounts for approximately 35% of all deaths in Australia Death rate increases sharply with age (causes the greatest number of deaths among older people) Mortality rates are decreasing Incidence is decreasing Leading cause of mortality

Non Modifiable Risk Factor...