Pdhpe Notes -Health Priorities in Australia 3 PDF

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PDHPE NOTES Core One Health Priorities in Australia

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HOW ARE PRIORITY AREAS FOR AUSTRALIAS HEALTH IDENTIFIED? Measuring Health Status

Role Of Epidemiology Epidemiology is the study of disease among particular populations or groups in society. It Provides information to assist planning and decision making about health expenditure, health priority areas and health promotion initiatives from local, state and national perspectives. This enables conclusions to be drawn about the health status of different populations. Prevalence: Number of cases of disease that exists in a defined population at one point in time. Incidence: Number of new cases of disease occurring in a defined population over a period of time. Measures of Epidemiology Mortality Death Rates. Indicates how many people die in a particular population, how they died and over what period. Expressed per 100,000. Infant Mortality Indicates the number of infant deaths in the first year of life per 1000 live births. Morbidity (Disease and sickness rates) Examines the prevalence and incidence of disease and sickness in a specific population. Life Expectancy Indicates the number of years a person is expected to live. 

Critique the use of Epidemiology to describe health status by considering such questions as:

What can Epidemiology tell us? The statistics and findings of Epidemiology can help researchers and health authorities to:  Describe and compare patterns of health of groups, communities and populations  Identify needs and allocate resources  Evaluate strategies and behaviours for prevention and control of disease  Promote behaviours to improve health status of the overall population Who uses these measures? Researchers, Health Practioners, Government Health Officials. All levels of government, health service providers, Individual consumers. Do they measure everything about health status? No. They do not  Always show the variations of health status among population’s subgroups (eg: aboriginal and non-aboriginal Australians.)  Accurately indicate quality of life – statistics tell little of degree and impact of illness  Provide a whole picture, data in some areas is limited/non existent, i.e. mental health  Provide reasons as to “Why” these problems exist  Account for social, economic and cultural factors that shape health.

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The Health Status of Australians

Current Trends Life Expectancy – Improved 40% since 1901-1910 Male Female 75 81 Major Causes of Illness and Death MALES

FEMALES

Coronary Heart Disease

Coronary Heart Disease

Lung Cancer

Cerebo Vascular Disease

Cerebo Vascular Disease

Other Heart Disease

Other Heart Disease

Dementia and Related Conditions Breast Cancer

Prostate Cancer

Lung Cancer

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Groups Experiencing Health Inequalities

Aboriginal and Torres Strait Islanders  Rates of Diabetes, infant mortality, high blood pressure are higher  Death rates are higher for almost every specific major cause of death  Life expectancy 20 years less than other Australians  Infant mortality rates are more than three times higher Socio-Cultural Factors  Poor Public Health: inadequate housing, water and waste disposal  Access to Health Services: Geographical isolation  Historical Dispossession: contributed to economic disadvantages and poor health status Socio-Economically Disadvantaged  Determined by income, occupation and education  Leads to financial limitations  More likely to die from CVD  Higher rates of: youth unemployment, infant mortality, high blood pressure, smoking, children levels of chronic asthma Result  Lack of income and education can reduce opportunities of employment  Housing  Inadequate knowledge and practice of nutrition  Affects ability to raise the standard of living  Higher suicide rates, higher probability of risk-taking behaviours

Overseas Born Australians  Immigrants on arrival in Australia have better health than Australian born. However this decreases with length of residence. Why? Government’s highly selective health criteria  Less likely to: be in a healthy weight range, to immunise, exercise, report mental health problems. People Living in Rural and Isolated Areas  Poorer Health Status  Higher: death from injury, death rates, infant mortality Why? Result  Lack of Access to Health care  Lower economic status effects occupational hazards  Poorer overall living standards (living environment) People with Disabilities  Limitation of normal functioning abilities (mainly physical)  Prejudice may affect their mental/emotional health  Lower life expectancy and higher morbidity rates  Financial constraints, lack of access to employment, needs for ongoing health care Gender    

Male Smoke more  lung cancer/heart disease Work more risky jobs High contact sports High risk of motor vehicle accidents

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Female Live Longer (genetic advantage, behavioural patterns, work less strenuous or risky) More prone to Eating Disorders Make better use of medical assistance

 Gap is closing between genders.      

Elderly People Ageing population Life expectancy increasing Greatest cause of mortality: cancer, coronary heart disease, stroke CVD has decreased due to: awareness of risk factors, medical advances Common conditions: Arthritis, Visual and Hearing problems, Hypertension Dementia and Hip Fractures

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Identifying Priority Areas

Social Justice Principles Social Justice refers to the notion of eliminating inequity in health and promoting inclusiveness of diversity and establishing supportive environments for all Australians. Rights: Equal opportunity to achieve optimal health Access: Ability to use a range of health services Participation: In planning and making decisions about local and community health Equity: Fair allocation of resources and entitlements without discrimination -

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Priority Population Groups Groups within society, which has been identified as “at risk” of developing a particular disease. The identification of these priority population subgroups with inequitable health status is important for determining health priority areas. An example is ATSI who suffer higher death rates from heart disease. Prevalence of condition Epidemiological data provides a path for determining the priority areas, by revealing the prevalence of disease and illness. High prevalence rates of a disease indicate the health and economic burden that the disease or condition places on the community. Eg: CVD is the leading cause of preventable death and will therefore take priority. Costs to Individuals Disease/illness can place a large financial burden on an individual, measured in terms of: Financial loss, Loss of productivity, Diminished quality of life Emotional stress. Costs to the community Illness, disease and premature death all place en economic burden on the community. Direct costs: money spent on diagnosing, treating and caring for the sick, plus the money spent on prevention. Indirect costs: Value of output lost when people become too ill to work, or die prematurely (loss of productivity) Potential for Change Majority of priority areas in Australia result from preventable lifestyle behaviours. However not as easy as changing the individual: socio-cultural, environmental factors need to be addressed For change to occur, individual and environmental factors must be addressed

How do we identify priority areas for Australia’s health? In terms of: - Social Justice Principles - Prevalence of condition - Priority population groups - Costs to individual - Costs to community - Potential for change How do socio-cultural, physical or economic environmental factors affect the health status of populations? Health inequities exist not solely because of poor health choices made by individuals, but because of the environmental factors that shape how individuals and communities live. Environmental factors include socio-cultural, which is to do with the attitudes, beliefs and influences that exist in different groups within society; physical which relates to air and water quality, pollution, proximity to health services and areas conducive to good health, economic which has direct links with health (the wealthier a community is, the better informed it is to make healthy decisions, the better off it is to be able to afford to make its environment healthy and the more likely it is to avoid unhealthy behaviours. How is health status linked to gender? The inequity in the health status of males and females may be attributed to: Biological factors: increased female morbidity is due to childbirth, menstruation and menopause Gender based variations in reporting illness – eg: men tend not to perceive symptoms and seek medical help as readily as females Social factors: eg: risk taking behaviours are considered more acceptable for men. However, these differences have decreased in recent years, reflecting a change in gender roles and relationships. What role does the principle of social justice play? Considerations of the social justice principles help identify the need to address the health inequities that exist in Australia. There are groups in Australia that do not enjoy the same level as health as the rest of the population (ATSI, socio-economically disadvantaged, etc.) The reasons for the differences are largely socially related. The social justice principles of equity, access, participation and rights help direct health promotion to address these differences. Why is it important to prioritise? In order to provide some common direction in national health. Prioritising helps focus funding and attention towards the areas of greatest need.

WHAT ARE THE PRIORITY AREAS FOR IMPROVING AUSTRALIA’S HEALTH?  Priority Areas for Action Cardiovascular Disease (CVD) - Major health and economic burden on Australia - 36% of deaths in 2004 - General term to cover all diseases of the heart and circulatory system - Can be coronary heart disease (poor supply of blood) stroke (interruption of supply of blood to brain) or peripheral vascular disease (disease of arteries etc that affects limbs) Social Justice Principles - 36% of deaths in 2004 - Significant differences in population subgroups - New technologies have led to improved prevention and treatment (trends have decreased) Priority Population Groups - ATSI  Death rates from CVD twice as high as other Australians - Over 65  2/3rds of those with Coronary Heart Disease are over 65 - Low Socio-Economic: Lower education which leads to higher incidence of risk factors Prevalence of the Condition - 36% of all deaths in 2004 - Prevalence increases as an individual ages - Considerable decline in death rates over the last 30 years (technology and reduction in risk factors) Cost to Individuals/Communities - In 2002, was the most costly disease for Aus Health System - $55B and likely to increase with ageing population - New technologies have lead to higher costs to communities with direct (hospitals/nursing homes/drugs) and direct (sick leave of loss earnings, burden on families, loss of quality and quantity of life) Potential for Change - Most risk factors are preventable – inactivity, smoking, obesity, diet, alcohol abuse, blood pressure, cholesterol - The use of health promotion has seen good results in the past Cancer - Rapid growth and spread of abnormal cells caused by cells receiving the wrong message. Creates a lump or tumour, usually. Social Justice Principles - Cancer is the second leading cause of death - In 2001 almost 1/3 of people who died had malignant cancer - Its risk increases with age Priority Population Groups - Currently accounts for 30% of male deaths, 25% female deaths Prevalence of Condition - In 2000, approx 459,000 new cancer cases reported - Second biggest killer in Australia, 30% of male deaths, 25% of female deaths - Highest to lowest incidence: colorectal, breast, prostate, melanoma, skin, and lung. Costs to individuals/Communities - 2.8 Billion to Australia - Indirect costs include loss of earnings, sick leave and decreased productivity

Potential for Change - Many preventable, many hereditary - Educating people on risks of smoking, sun exposure, benefits of prevention/screening Injury - A trauma, poisoning or other condition of rapid onset to which factors and circumstances external to the person contributed significantly Social Justice Principles - 4th leading cause of death in Aus Priority Population Groups - 0-14 year old group most likely to sustain injury, 25% - Car accident injuries prevalent in 25-34 age group (34%) - Death rates from injuries increase with remoteness Prevalence of the condition - 2000/05 18% of population had sustained a recent injury (4 weeks) Costs to individual/communities - 2000/2001 it was 8% of Health expenditure - 223 million was spent on intentional harm including suicide and homicide Potential for Change - Many has already been done, OH&S in workplace and safety features in cars - Decreased, peaking in 1970 - Putting chemical out of reach of children Mental Health - Disease or condition that affects a persons ability to cope with daily tasks and the emotional or cognitive capacity to function Social Justice Principles - 2003, mental illness was among 10 leading causes of disease burden in Aus - 13% burden of disease Priority Population Groups - Low socio-economic status have higher prevalence 16% - Disability, homeless - Divorced/separated 18-20% experience mental/behavioural problems Prevalence of condition - 11% reported currently have long term mental/behavioural problem (04/05) Costs to individuals/communities - Mental health represents 4.5% of all hospital separations in 03/04 - 12% of total days spent by patients in hospitals - $3b – 6% of total health expenditure Potential for Change - Alcohol use - Inactivity – 75% had low levels of exercise Diabetes - Body is unable to maintain normal blood glucose levels - Juvenile onset - Late onset - Gestational diabetes Social Justice Principles -2004 was major cause of death Priority Population Groups - Elderly for both types

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Indigenous Australians reported diabetes 3x at the level of other Australians 29% of diabetics live in low socio economic status – 14% in higher socioeconomic - Overweight/obese 10x more likely to suffer from Late onset Prevalence of Condition - 2004/05  3.6% of Australians suffered from diabetes Costs to individuals/communities - 2000/2001  1.7% Of national expenditure, $3000 per sufferer Potential for Change - Very possible, many risks preventable - Increase physical activity/decrease obesity, better diets Asthma - Chronic respiratory disease in which narrowing of a person’s airways causes difficulty in breathing and maintaining a sufficient airflow in and out of lungs Social Justice Principles - 2004, 313 deaths from Asthma – 2/3 were female Priority Population Groups - Indigenous Australian’s  15% affected in 2006 - 19% in over 45s against 9% overall - Australia has higher prevalence, 11% - UK 9% Prevalence of the condition - 10% of Australians reported in 04/05 – 2 mil Australians approx Costs to individuals/communities - 693$ million – 1.9% of all health expenditure Potential for Change - Decrease smoking - Increase awareness for treatment – ventilators

The Four-Priority Areas Selected 1) CVD 2) Cancer 3) Diabetes 4) Injuries  The nature of the problem  Extent of the problem (trends only)  Risk Factors  Social Determinants  Groups at risk 1) CVD Nature of Problem

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Extent of problem

Risk factors

Groups at risk and Social Determinants

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All diseases involving the heart and blood vessels Relates to the health of organs that depend on strong blood supply. Major CVD’s are: o Coronary Heart Disease o Stroke o Heart Failure o Peripheral Vascular Disease Mainly caused by atherosclerosis- abnormal fat build ups, cholesterol etc

Major economic and health problem in Australia – accounting for 40% of deaths - Mortality declining in males and females - CVD is largely preventable - Males are more likely - Decline in mortality due to improved medical care (drugs for BP) and reduction in risk behaviours Lifestyle factors: - High B.P. - High blood fats - Overweight/obesity - Lack of physical activity - Smoking (5x more likely) - Diabetes, alcohol, the pill Non modifiable: - Age: Risk increases - Gender: males, increased risk - Heredity: Family history = more prone - Older people - Indigenous people - Socio-economically disadvantaged people - Rural and remote Australians

2) Cancer Nature of Problem

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Extent of problem

Risk factors

Groups at risk and Social Determinants

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3) Diabetes Nature of Problem

Extent of problem

Risk factors

Groups at risk and Social Determinants

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Occurs when normal cell division in the body becomes uncontrolled, and the abnormal cells spread throughout the body, causing further damage Malignant – Cancerous tumour – Benign – Non-cancerous tumours Mainly; lung, melanoma (+ other skin), colorectal, prostate, cervical and breast cancer Incidence increases with age Cancer is larger contributor of disease and burden Male cancers are higher after 55 years Tends to vary between types Smoking Environmental hazards (asbestos, radiation, etc) Overexposure to UV rays Heredity factors Alcohol and Diet Increases with age Men have higher risk of being diagnosed with cancer and higher risk of dying of it than women Men generally eat worse, smoke and drink more than woman and work in more “at risk” environments

Metabolic disease in which high blood glucose levels result from defective insulin secretion or insulin production - Type 1 – Insulin dependent and need injections and careful diet. Without treatment is fatal. - Type 2 – “Adult onset diabetes” Non insulin dependent, can go undiagnosed for years. Reduced levels of insulin - Incidence of diabetes is higher in Australia - Up to 1.7 million Australians have diabetes, half of which are undiagnosed - Up to 60% of cases of type 2 can be prevented - 6th leading cause of death in Aus - Overweight (type 2) - High blood pressure (Type 2) - Heredity (Type 1) - Physically inactive - Unhealthy eating Disproportionately prevalent in: - Older Australians - ATSI - Family history - Overseas born aus - Areas of low SES (poor nutrition – low PA)

4) Injury Nature of Problem

Extent of problem

Risk factors

Groups at risk and Social Determinants

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Road injury Suicides Spinal cord injuries Firearms injuries Injuries to children Other injuries from fires, falls, machinery, drowning, poisoning and homicide Main cause of death for children + young adults Major cause of hospitalisation Mortality from injury is declining Greater attention to prevention (Workplace oh&s) Smoking Environmental hazards (asbestos, radiation, etc) Overexposure to UV rays Heredity factors Alcohol and Diet Young adult males higher rate of mortality from injuries People in rural areas Children Indigenous Australians

WHAT ROLE DOES HEALTH PROMOTION PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? Approaches to Health Promotion  What is Health Promotion? It is the process of preventing ill health. It aids to advance the health of individuals and communities through intervention. It also helps empower individuals and communities by providing support to increase control over and improve health. This means that - Political - Social - Environmental - Economic - Behavioural Aspects all need to interact to establish a climate that is fully supportive of individual and community well being. Health promotion can be targeted at 3 levels of prevention: 1) Primary - all activities carried out to prevent onset of disease/injury. Includes: ...