PHS Report Asthma - Case Study assignment for Population Health and Society Description of the PDF

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Case Study assignment for Population Health and Society
Description of the health issue and epidemiological data
Analysis of the social and environmental determinants
Description of relevant services...

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Population Health and Society Report: Gary Description of the health issue and epidemiological data Asthma is a chronic respiratory disorder that causes sporadic breathing difficulties. It is characterised by two main pathophysiological elements: airway hyper-responsiveness and inflammation in the airways. The constriction of the airways results in symptoms including coughing, tightness in the chest, wheezing, and shortness of breath. Harmful particles in the air such as air-borne fungal spores and tobacco smoke can trigger an asthmatic response. Gary is a teenage Aboriginal boy diagnosed with asthma. The prevalence of asthma among Indigenous Australians is twice as high as that of non-Indigenous Australians with a rate ratio of 1.9 (Australian Institute of Health and Welfare, 2019). Moreover, the prevalence of asthma in children between the ages of 0-14, was higher in boys (12.1%) than girls (7.9%) within 2017-18 (Australian Bureau of Statistics, 2018). Limitations in data exist as the triggers and symptoms vary across age and gender (Australian Institute of Health and Welfare, 2020). Asthma affects quality of life by impacting comfort levels, stress tolerance, and functional ability (McDonald et al., 2018). The National Asthma Council Australia (2020) recognises this impact and directs every asthma patient to have an individually written Asthma Action Plan, as there is no cure for asthma, but treatment can moderate symptoms.

Analysis of the social and environmental determinants Social determinants of health include ethnicity and social class. The distal determinant of culture has impacted the health of many Indigenous Australians. A study containing 33,833 Victorian residents revealed that the Indigenous population were four times more likely to have experienced racism than non-Indigenous Victorians, identifying school systems as one of the most challenging experiences (Markwick et al., 2019). Between 2014-15, a median weekly income for Indigenous Australians was $542, in comparison to $852 for nonIndigenous Australians, classifying the majority of Indigenous Australians as having low socioeconomic status (Australians Together, 2020). Research by the Australian Institute of Health and Welfare (2018) has highlighted women who attain a higher level of socioeconomic resources and educational attainment also have reduced stress levels. Inequalities in health are reflected through the social gradient of health. A lower socioeconomic status is a common trend among Indigenous Australians, which directly correlates to a lower health status. Due to Gary’s poor housing conditions and geographic

20191304 location, these environmental determinants have negatively impacted his health. Living in Condobolin, intermediate determinants including resources and access to services are adversely impacted. Australians living in rural areas are six times more likely to not have an available general practitioner nearby in comparison to those living in major cities (Australian Institute of Health and Welfare, 2018). Consequently, this limitation affects Gary’s ability to manage his asthma effectively. Furthermore, research by Anderson et al. (2017) showed factors contributing to poor child health were environments consisting of “damp and mildew”; therefore, the mouldy environment that Gary has been exposed to appears to be a potential trigger to his asthma. Description of relevant services Within 2016-19, the total government cost in supporting asthma was projected at $4 billion (National Asthma Australia, 2018). Reactive upstream measures include Medicare, which works by bulk billing patients through the Medicare Benefits Scheme (MBS) when patients see a doctor; additionally, the Pharmaceutical Benefits Scheme (PBS) works by reducing medication costs such as inhalers (Private Health, n.d). The Australian Government Department of Health has implemented the Tackling Indigenous Smoking (TIS) program as a preventative measure. It uses evidence-based activities such as group counselling to educate Indigenous communities about the dangers of smoking. Hence, the passive smoke from Gary’s mother’s smoking can act as a direct contributor to Gary’s asthma. In 2018, the Turnball Government provided an additional $7.6 million in funding to the Australia’s Asthma Child and Adolescent Program (AACAP). The program provides education and resources to help adolescents within a Community Support Program (CSP); it was created in recognition of adolescents living in rural areas to self-manage their asthma more effectively (Department of Health, 2018). The National Aboriginal Community Controlled Health Organisation (NACCHO) has helped many Indigenous communities by providing vital Environmental Health Worker’s (EHW). These workers enhance the safety and health of communities by supplying services such as health-related infrastructure issues, for example, the mould present in Gary’s home (Australian Indigenous HealthInfoNet, n.d). Critique of services Medicare is a Commonwealth-only program, setting policy parameters around how much funding is available and the funding targets. Future strategies are in motion for examining whether meso-organisations can be integrated into the health care system, allowing

20191304 opportunities to close negative health outcome gaps in rural areas (Wells & Root, 2015). To examine the evidence-based activities used by the TIS program, the Be Our Ally Beat Smoking (BOABS) study adopted the TIS program activities by using a randomised controlled trial to investigate the effects of an intensive counselling intervention aimed at stopping smoking in rural Aboriginal communities. Of the 216 participants, results showed 522% of participants who originally had no intention of quitting ended up stopping their use of tobacco at the final follow up (Marley et al., 2012). The study determined the impact community support has towards lifestyle behaviours, and how this intervention could help Gary and his mother’s health overall. A study incorporating the AACAP into five Western Sydney schools, revealed an increased awareness regarding asthma. When comparing data from the beginning of the study, asthmatic students had “fewer asthma attacks”, “improved quality of life” and” reduced absenteeism” over a one-year period of the program being introduced (Otim et al., 2014, pp. 439). A comprehensive review looking at the health and wellbeing of Indigenous staff working within Aboriginal health services was examined using 26 electronic databases (Deroy & Schutze, 2019). Two key themes identified in the review were EHW attaining recognition and professional development. These themes correspond to the success of the program for both the individual worker and the Indigenous Australian community. Recommendation Through my research the Australian healthcare system has some strong and affordable midstream and downstream determinants to support asthma patients. It is my recommendation that Gary joins a CSP to receive guidance from the AACAP. This would provide him a sense of autonomy towards managing his asthma. Also, Gary’s mother may have the desire to quit smoking, but being in a low socioeconomic position she may not have a means to successfully quit. In understanding this, I would recommend Condobolin begin a TIS program within its community; this would provide her with a chance to better her physical and mental health all whilst lower Gary’s risk of exasperating his asthma. Finally, the mould present in the home can be a risk factor to the health of all four children. To resolve this issue, I would advocate for EHW to assist in its removal. This would benefit Gary and the family whilst simultaneously supporting the community.

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References Andersen, M., Williamson, A., Fernando, P., Wright, D., & Redman, S. (2017). Housing conditions of urban households with Aboriginal children in NSW Australia: Tenure type matters. BMC Public Health, 18(1), 70. https://doi.org/10.1186/s12889-017-4607-y Australian Bureau of Statistics. (2018, December) National Health Survey: First Results, Australia (No. 4364.0.55.001) Australian Indigenous HealthInfoNet. (n.d) Environmental health https://healthinfonet.ecu.edu.au/learn/determinants-of-health/environmental-health/ Australian Institute of Health and Welfare. (2019). Asthma. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma Australian Institute of Health and Welfare. (2020). Australia's children. https://www.aihw.gov.au/reports/children-youth/australias-children Australian Institute of Health and Welfare. (2018). Australia's health 2018. https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus Australians Together. (2020). Indigenous disadvantage in Australia. https://australianstogether.org.au/discover/the-wound/indigenous-disadvantage-inaustralia/ Department of Health (2018, June 27) $8 million in funding to support asthma patients (Media release) https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/8-million-infunding-to-support-asthma-patients Deroy, S., & Schutze, H. (2019). Factors supporting retention of aboriginal health and wellbeing staff in Aboriginal health services: A comprehensive review of the literature. International Journal for Equity in Health, 18 (1), 70. https://doi.org/10.1186/s12939-019-0968-4 Jenkins, C., Chang, A., Poulos, L., & Marks, G. (2009). Asthma in Indigenous Australians: So much yet to do for Indigenous lung health. Medical Journal of Australia, 190(10), 530-531. https://doi.org/10.5694/j.1326-5377.2009.tb02550.x

20191304 Markwick, A., Ansari, Z., Clinch, D., & Mcneil, J. (2019). Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: A cross-sectional population-based study. BMC Public Health, 19(1), 309. https://doi.org/10.1186/s12889-019-6614-7 Marley, J., Atkinson, D., Nelson, C., Kitaura, T., Gray, D., Metcalf, S., & Maguire, G. (2012). The protocol for the be our ally beat smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health, 12(1), 232. https://doi.org/10.1186/1471-2458-12-232 McDonald, V., Hiles, S., Jones, K., Clark, V., & Yorke, J. (2018). Health-related quality of life burden in severe asthma. The Medical Journal of Australia, 209 (S2), S28-S33. https://doi.org/10.5694/mja18.00207 National Asthma Australia. (2018) National asthma strategy 2018 (Publication No. 11983) https://www.health.gov.au/sites/default/files/documents/2019/09/national-asthmastrategy-2018_0.pdf Otim, M., Jayasinha, R., Forbes, H., & Shah, S. (2014). Building evidence for peer-led interventions: assessing the cost of the adolescent asthma action program in Australia. Australian Journal of Primary Health, 21(4), 438-443. https://doi.org/10.1071/PY14066 Private Health (n.d) Medicare https://www.privatehealth.gov.au/health_insurance/what_is_covered/medicare.htm The National Asthma Council Australia. (2020). How is asthma treated? https://www.nationalasthma.org.au/understanding-asthma/how-is-asthma-managed. Wells, L., & Root, J. (2015). Strengthening medicare to improve health outcomes. Australian Economic Review, 48(3), 298-304. https://doi.org/10.1111/1467-8462.12124

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