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HSC PE Summary

Measuring health status - Role of Epidemiology To develop a profile of a communities health through statistics. Information is gathered in many ways/areas which include: - Mortality -Life Expectancy - how long were expected to live -Infant Mortality Rates - Birth to 1 -Morbidity Rates - illness and disease. Stats taken from doctors and hospitals -Use of health care services Epidemiology provides information on the distribution or patterns of disease, illness and injury and on the likely causes or determinants within groups or populations. What can epidemiology tell us? Can give occurrence of disease or illness (prevalence and incidence), distribution patterns (looking at trends and subgroups), determinants and prevention and control measures, the current status of Australia's health, trends, priority issues and actions needed to address these. Who uses these measures? Government employees, researchers, medical practitioners, social workers. Enables informed decisions to be made, judge the resources that need to be allocated, assess the most effective way of allocating the resources and establishing action plans to meet current and future health needs. Funding the health system and promotions, i.e. slip, slop, slap, wrap Do they measure everything about health status? Limitations: - Value of data depends if health professionals and political leaders interpret it accurately - Statistical in nature and objective - e.g. life expectancy says how long we are expected to live for but it doesn't measure quality of life - e.g. mortality and morbidity - hard to determine contribution of health determinants such as sociocultural factors, the media - Generalisation and can stereotype people e.g. statistically, people in Nambucca have a lower life expectancy, however, there are sub groups that have a higher life expectancy. Trends in Life Expectancy -Slowly rising -Females are ahead of males on life expectancy, but the gap is slowly decreasing (in 05', deaths 51.4% males and 48.6% females)Life expectancy females - 83.7 Males - 79 -Since the 20th century, we have moved away from Communicable Diseases (measles, mumps) to Lifestyle Diseases e.g. CVD, Cancer. Increasing because of health promotion messages, education programs on signs and symptoms, encouragement to seek treatment Males have a higher rate of cancer, significantly higher for injury, and higher diabetes

Higher prevalence of CVD in females (55% vs 45%), asthma, long term mental and behavioural problems Major Causes of Morbidity Eyesight problems, Arthritis, Back problems, Hearing problems Major Causes of Mortality -CVD-Cancer-Respiratory disease -Injury Identifying priority health issues - Social justice principles Refers to notion of eliminating inequity in health, promoting inclusiveness of diversity and establishing supportive environments for all Australians. Principles of social justice: Equity - all peoples have a right to a basic level of health without discrimination (Medicare) Access - availability of health care services to all, this includes education e.g. breast cancer van Participation - the empowerment of individuals and communities to be involved in planning and decision making for good health e.g. surf club Rights - equitable opportunities for all individuals to achieve good health e.g. close the gap Example of social justice principle is Medicare. It is equitable and accessible being available to all Australians without discrimination. PBS is also an example -priority population groups A specific group of people that suffers more from disease than anyone else. CVD - ATSI, low socioeconomic, smokers, overweight people Cancer - skin cancer (white Australians, outdoor workers), lung cancer (smokers, occupational workers (asbestos)), breast cancer (females). Injury - Car accidents (17-25 males), drowning and poisoning (under 10's), falls (elderly). Population groups that experience health inequalities - ATSI, low SES people, rural and remote people, overseas-born people, the elderly and people with disabilities. Strategies that target these groups: Royal Flying Doctor Service, implementing incentive programs for medical practitioners and dentists to go rural and remote, 17% more funding for ATSI health services, NSW Multicultural Health Communication Service (culturally and linguistically knowledgeable) -prevalence of condition The incidence of mortality/morbidity caused by the health priority areas e.g. CVD, Cancer, injury. (Looking at stats). Proportion of burden of disease - CVD 18%, Cancer - 19.4%, Injury - 7% Mental Disorders - 13.3% -potential for prevention and early intervention Potential for change. Can I/Community/Government impact on limiting the risk factors associated with the priority area? Get money's worth by directing resources towards health problems that can be prevented, or that may benefit from early intervention strategies. All health problems that cause the greatest disease burden in Aus have contributing factors that are preventable, so the potential

to reduce prevalence of these health problems is large. E.g. significant resources go to health promotion initiatives designed to improve attitudes about smoking, high blood pressure and overweight/obesity. -costs to the individual and community Individual - hospital charges, medical practitioner, drug therapies, rehabilitation, travel costs, loss of income, funeral cost Pain and experience suffered, reduction in quality of life, unable to participate in activities, impact on family and friends, emotional trauma, family or friends may need to take on the role of carer, loved one, permanent disability, stress, depression Community - funding Australia's public health care system, economic loss through decreased productivity, premature loss of valuable member of community, loss of persons knowledge, skills, experience How do we identify priority issues for Australia's health? Social justice principles - Equity e.g. Close the Gap - close the life expectancy gap, making services and facilities available and subsidising. Access e.g. Diabetes Bus that does diabetic tests in rural or remote areas. Participation - having a say in your health e.g. surf clubs. Rights - right to a basic standard of health e.g. Medicare. Priority Population Groups - specific groups that are affected by a problem, e.g. smokers are affected by lung cancer. Prevalence of Condition - how wide spread is it e.g. CVD. Potential for prevention and early intervention - working to eliminate risk factors e.g. campaigns of diet, exercise. Costs to the individual and community - how much time off work, insurance, funerals, emotional costs, loss of work, loss of productivity, loss of assets. What role do the principles of social justice play? To make sure that everyone receives an equal level of health. Why is it important to prioritise? So we have specific targets, not wasting money, efficient use of money and resources. Groups Experiencing Health Inequalities - Aboriginal and Torres Strait Islander peoples The nature and extent Decreased life expectancy - on average 17yrs below Increased mortality rates in all health priority areas 70% died under age 65, compared to our 20% Increased mortality for preventable causes - 3x as much Infant mortality 3x higher than national average Increased CVD Increased diabetes High smoking Less education

The sociocultural, socioeconomic and environmental determinants Socioeconomically disadvantaged- can't afford to make healthy lifestyle choices, higher rates of CVD, diabetes, asthma - Employment - mostly manual labour which has more injuries and is high risk - Unemployment - Education - low levels of education doesn't allow for informed decision making - Access to facilities - rural or remote areas, financial state (dentist not covered by Medicare) - Environment/Location - overcrowded housing, lack of facilities i.e. water, sewage, garbage disposal (all leads to high risk of disease), rural and remote living - Sociocultural - family- has a strong relationship to family and community e.g. child might not go to Uni because parents have to support other children. They borrow things from each other (hard to get ahead in life). -Decreased income -Disposition - Half as likely to complete yr 12 Behavioural risk factors - smoking, alcohol consumption at risky levels, illicit substance use, physical inactivity, lower rate of veggie and fruit consumption The roles of individuals, communities and governments in addressing the health inequities Individuals - their responsibility to: Developing personal skills Education Informed decisions Volunteer Role Model Participate in safe sex Say no to drugs Cut down behavioural risk factors Communities: their responsibility is to: Provide facilities e.g. Aboriginal Health Centre Make access easy Transport Culturally aware Lobby Govt for funding Strengthen Community Action Government, their responsibility is to: Build healthy public policy Funding Promotion Initiation e.g. close the gap Laws and regulations Close the Gap - a culturally appropriate and effective way to address health issues. Aims to - reduce health inequalities experienced by ATSI people. To achieve equality in health status, infant mortality

and life expectancy. In other areas - literacy and numeracy levels, educational achievement and employment outcomes. Funding is provided for specific quit smoking programs and workforce training. Establishing specific health services for ATSI that are initiated, controlled and operated by Indigenous communities, has potential to increase the level of access for ATSI by providing health care that is holistic and culturally sensitive. They offer clinical care, screening programs, preventative health care activities, health related and community support services, social and emotional wellbeing services, substance use treatment, transport to medical appointments Socioeconomically Disadvantaged People Nature and Extent: High smoking (biggest risk for 3 main killers) Poor diet Less education Lower life expectancy Increased CVD Obesity Teen Pregnancy Increased mental health Workplace injury (blue collar) Make less use of preventative health services e.g. immunisation, family planning, Pap smears - Higher rates of infant mortality - Higher mortality and morbidity - Less educated about their health so higher levels of blood pressure and cholesterol, higher BMI

Sociocultural/ Socioeconomic/Environmental Determinants Decreased education Decreased income Decreased employment Decreased private health access Decreased Housing Roles of Individuals, Communities and Government Individual Safe sex practices Decrease smoking Better diet Exercise Increase Education Communities Youth Centres PCYC (police run youth centre) Community transport Meals on Wheels The community is responsible for housing applications (e.g. reduce overcrowding of SES people)

Government Funding e.g. bulk bill Health Access e.g. Medicare Pharmaceutical Benefit Scheme (PBS) Health promotion Laws

High levels of preventable chronic disease, injury and mental health problems. - Cardiovascular disease The Nature of the Problem CVD is a term used to describe all health conditions that affect the heart and blood vessels. Cardiovascular disease includes: -Coronary heart disease (heart attack and angina) - Heart occurs when a blood vessel supplying the heart itself is suddenly blocked completely, threatening to damage the heart and its functions. Angina - short episodes of chest pain can occur periodically when the heart has a temporary deficiency in its blood supply. -Cerebrovascular disease (stroke) - blood supply to brain is interrupted by a clot or atherosclerosis or blood vessel bursts -Heart failure- when the heart functions less effectively in pumping blood around the body. Atherosclerosis is the underlying cause of of most of these conditions. This is when there is the build up of fatty/fibrous material on the interior walls of the arteries. Extent of the Problem CVD causes approx 40% of all deaths in Australia. Leading cause of disability for 6.9% of Australia's population. CVD accounts for 18% of the overall disease burden in Australia (2003). Most of CVD burden was due to YYL to premature death and they represent 29% of total YYL for Australians in 2003. Most expensive disease in terms of direct health care expenditure at $5.9 billion, 11.2% of the health systems expenditure in 2004. Downward trend since the 1960's. Risk Factors and Protective Factors Modifiable - smoking, high blood pressure, high blood cholesterol, insufficient physical activity, overweight and obesity, poor nutrition and diabetes. Non-Modifiable - age, gender, family history Sociocultural, Socioeconomic and Environmental Determinants Sociocultural: -family history -Asians are less prone due to a generally low fat diet -ATSI people -Media exposure on the effects of smoking on health have led to a reduction in smoking rates & therefore a declining trend for CVD rates Socioeconomic:

-low income (can't afford fruit and veg , limited access to using certain health facilities) -low education (poor health choices, less knowledge about how to access and use health services) Environmental: - People living in rural and remote areas are more at risk due to less access to health information, services and technology Groups at Risk -smokers -people with family history -people with high fat diets -overweight and obese people - people over 65 -males -high blood pressure -tradies

Cancer (skin, breast and lung) Cancer is a disease of the body's cells. The uncontrollable growth and spread of abnormal body cells. Tumours are swellings or enlargements caused by a clump of abnormal cells. Benign tumours will not spread whereas malignant tumours will spread. Cancer is the 2nd most cause of morbidity and mortality. There has been a decrease in mortality. Skin Extent 434 000 Australians are treated for non melanoma skin cancer each year. Melanoma is the 4th most common cancer in Australia, representing 10% of all cancers. Symptoms include non healing sores, new spots, freckles or moles that change size, colour and shape. Risk Factors Over exposure to UV radiation, fair skin, fair or red hair and blue eyes, number and type of moles. To prevent slip, slop, slap, wrap Groups at Risk Tradies People over 50 People with outside occupations Breast Cancer Second most common invasive cancer in women, after non-melanoma skin cancer. More than 12 700 women are diagnosed each year. 1 in 9 women aged 85 and over risk being diagnosed and 1 in 767 men. Risk Factors

Increasing age, family history, exposure to female hormones, obesity and excess alcohol consumption, early menstruation, late age first pregnancy, high fat diet. Prevention - regular checks, healthy lifestyle, supportive bras. Lung Cancer Lung cancer is the 5th most common cancer. Approx 9560 people are diagnosed each year, about 9% of all cancers. The risk of being diagnosed by age 85 is 1 in 12 for men and 1 in 24 for women. In 2006, there were 7397 deaths from lung cancer. Risk Factors Cigarette smoking Passive Smoking Exposure to chemicals e.g. asbestos Prevention - don't smoke, avoid smoke and avoid being in hazardous environments Sociocultural, Socioeconomic, Environmental Sociocultural: ATSI people People aged over 65 Socioeconomic: Education Employment status Occupation Income People from low socioeconomic backgrounds have higher rates of cancer Environmental: Workplace influences Tobacco smoke Groups at Risk ATSI people Low socioeconomic people People aged over 65 Men Smokers

Nature A significant cause of mortality, morbidity and persistent (physical, intellectual and physiological) disability in the community. Injuries are often preventable. Injury is the result of many different causes:

Transport related, falls, self inflicted, burns and scalds, drowning, poisoning, interpersonal violence, industry related, consumer products, sport and recreation Extent Caused 6% of deaths in 2005 Causes 47% of death in males and females ages 1-44 Main cause of premature death Major cause of hospital admissions Male mortality rate from injury 2x the female rate Risk Factors Lack of judgement- inexperience Peer pressure, attitudes towards risk Showing off Unsafe environments e.g. no pool fencing Not following road rules Sociocultural, economic and environmental determinants Cultural Injury hospitalisations higher for indigenous children Indigenous 3x more likely to die in an accident Media exposure of laws relating to road use and consequence of road trauma has helped reduce injury rates Economic Males and females with low SES 2.2x more likely to die in traffic accident and 1.4x for suicide People with less income are more likely to engage in risk taking behaviour No employment or income = no money to buy safety devices to prevent childhood injuries Environmental Rural and remote areas - risk of workplace injuries, are more exposed to dangerous machinery People in rural areas are more likely to commit suicide, due to unemployment, less access to support networks Groups at Risk elderly children adolescents rural and remote

A growing and ageing population - Healthy Ageing The concept of healthy ageing describes the ongoing activities and behaviours people undertake as they age to reduce the risk of illnesses and disease and increase their physical, emotional and mental health. There are specific issues that need support such as arthritis and musculoskeletal conditions, recovery from conditions such as CVD, management of dementia and diabetes.

As a consequence of our ageing population, the government has responded by encouraging people to plan for financial security and independence. The government is also trying to encourage people to work as long as possible to increase economic growth. An ambassador for ageing is responsible for: -positive and active ageing -encourage contributions by older people -promoting programs for the elderly -increasing access to these -Increased Population living with chronic disease & disability With an increase in people surviving CVD, strokes and cancers, more and more people are suffering from chronic diseases, 80% of the total burden of disease in Australia. And will account for 3/4 of all deaths by 2020. This can be reduced by younger people not being involved in high risk factors i.e. smoking, obesity, excess drinking & physical activity. Most common conditions: -vision and hearing problems - back pain and disc problems - hay fever and allergic rhinitis - arthritis -Demand for Health Services & Workforce Shortages With increase in population & people with chronic disease or disability, the demand for health care has increased. The government is catering for by: -more nurses for emergency and high demand areas -the expansion of the roles of nurses -increase in community care i.e. home service Because more people are suffering poor health & unable to work there is a labour shortage. Government is; -means testing age pension (only some people can get pension like centrelink) -compulsory superannuation -voluntary super These encourage people to plan for financial security & independence -Availability of Carers and Volunteers Australia's workforce consists not only of paid workers but also carers and volunteers, who are ageing with the rest of the population. Older people can contribute in these ways i.e. unpaid carers and volunteers contribute approx. $75 billion per annum (very beneficial to economy). This is falling and it is likely to cause a shortage in the future. Assess the impact of a growing and ageing population on: -the health system and service The impact of the growing and ageing population has a negative and positive influence on the health system and service. Unfortunately, with the growing ageing population there is an increase in expenses such as extra medical facilities, equipment, personnel and increased taxes. It also means

an increase in morbidity with chronic diseases and disability. However, an increase in facilities and personnel means more employment, jobs, volunteers and income. Another positive side could be the amplifying of Government incentives such as encouraging financial security. The impact of the growing and ageing population I think will have a negative impact on the health system by being extremely costly to society through taxes as well as an emotional pressure on families to look after their elderly people. The Government is trying to cover costs through initiatives, but I don't believe it's enough to cover costs and this will create a financial burden for the workers in future generations. -Health Service Workforce The impact the growing and ageing population will have a positive and negative effect on the health service workforce. Jobs will increase due to the rising levels of new facilities and centres; this means more jobs and money in the area and community. However, the positions may not be able to be filled by trained personnel. -Carers of the Elderly With a growing aged society we will have an increase in chronic disease/disabled people. These people require specialised and sometimes constant care. This will see a large rise in the need for carers, or people to help and look after these people. The carer industry/workforce will grow with the growth of the ageing population. This will be good for those seeking jobs in the industry as there will be plenty of potential. However, if we cannot provide skilled people to fill these positions, or afford them, then our aged population will suffer dramatically from a lack of this important health service. -Volunteer Organisations Volunteer organisations such as Meals on Wheels can be very beneficial for our ageing population. However, the organisations may be in trouble in the future; with a rising ageing population an increase in volunteers is needed but may not necessarily occur. With the increase in retirement it means an increase in volunteers. These people have years of experience and have developed skills. However, many retirees are not volunteering, which means that these skills and education are going to waste and not giving back to society through volunteer work. I would hope to see government incentives or encouragement to communities to use these retirees and their skills. What role do health care facilities and services play in achieving better health for all Australians? health care in Australia

- Range and types of health facilities and services Institutional - facilities and services offered by hospitals, psychiatric wards, nursing homes, hostels and ambulance. Non-Institutional - includes medical and other medical services like GP, phsyio, chiropractor, pharmacy, dentist, radiology, pathology We are moving more away from institutional to integration of services and care within the community. - Responsibility for Health Facilities and Services Commonwealth/Federal Gov - Policy making and coordination -Financing/Budgeting

-Legislation -Fiscal policy e.g. Medicare and PBS State Gov - Policy making and coordination -Financing/Budgeting -Legislation -Fiscal policy Prime responsibility for providing health and community services. Some principles functions of the state include: -hospital services -mental health programs -health promotion e.g. Media campaigns, e.g. Life Be in it Health education public hospital services, community health services, patient transport, distributing funds, policy/law making. Liaise with communities, services e.g. health education Private Sector Provides a wide range of services, such as private hospitals, dentists and alternative health services National Heart Foundation is an example of private sector - receives funding from government Local Gov Monitoring sanitation, hygiene standards of food outlets, waste disposal, Meals on Wheels - Equity of Access to Health Facilities and Services An individual's ability to access health care facilities and services can reflect their: socioeconomic status knowledge of available services geographic isolation cultural and religious beliefs shortages of qualified staff lack of funding or equipment patient waiting lists language barriers (e.g. migrants and some ATSI) Ranges of measures have been introduced to address some access issues: Royal flying doctor services Programs and incentives encouraging health professionals to work in rural and remote areas translation services Medicare

Medicare, however, doesn't cover some essentials such as dentistry, so is inaccessible by those who can't afford it.

There are 2 dimensions to equity of access. The first is horizontal, which refers to equal treatment for comparable needs E.g. Medicare & PBS, which aims to provide the majority of Australia with equal access to basic healthcare. The second dimension involves the priority treatment of these groups with increased health needs and medical access to health facilities and services E.g. ATSI - Health Care Expenditure VS Expenditure on Early Intervention and Prevention In 2005-06, Australia spent approx $87 billion on health, less than 2% of this was spent of preventative services or health promotion. Health care expenditure is more focused on 'curative' medicine rather than prevention. The benefits of preventative health services or promotion are: reduced morbidity increased life expectancy enhanced quality of life reduced impact on carers, family and friends Cost effective - substantial savings in treatment costs + productivity in the workplace

For example, it costs more to 'cure' a disease such as coronary heart disease once it has developed than it does to fund measures to prevent the illness occurring. In this example, early intervention might focus on early education, healthy eating practices, weight control and active lifestyle activities. In contrast, curative measures such as treatment of heart disease, stroke, clogged blood vessels, kidney failure, blindness and foot/leg amputation are more costly and contribute considerably more to health expenditure. Preventative practices could include: educating school children about positive health behaviours restrictions on advertising legislation higher taxes on products such as alcohol and tobacco

Early intervention is vital in increasing survival rates and the likelihood of recovery, particularly from serious health conditions such as cancer. Annual health expenditure in Australia is approx $59 billion dollars. This is an average of approx $4000 per person or $4718 per indigenous person State and local gov expenditure - 23% Commonwealth - 45% Non Gov Private Industries e.g. mbf, McGrath foundation - 31% In 2006, the Australian Government spent $1 476 million dollars on health promotion (that is intervention and prevention e.g. immunisation). This represents 1.8% of total expenditure on health. - Impact of Emerging New Treatments and Technologies E.g. benefits of early detection New treatments and technologies offer the potential for significant improvements in health care = rise in health status. Challenge is to have resources to support emerging technologies and treatments so they can be effectively adopted and integrated into health care = rise in health care costs. For example, cost for MRI machines were very expensive, to fund purchase, larger budgets were needed or cost savings needed to be made. Similarly, when new treatments or surgical techniques

are developed, there are significant costs associated with accessing these and issues in how the knowledge and skills are shared among practitioners. Drugs to treat HIV, very expensive but critical to survival of people with HIV, so gov placed it on PBS. - Health Insurance: Medicare and Private Medicare is designed to be equitable and accessible to all. Every Australian is covered for 83% of an amount considered common (scheduled fee). Medicare also covers optometrists and oral surgery. Disadvantages - some important services only partially covered or not at all e.g. dental services, waiting lists and means a more basic physical environment, limitations to the level of choice available, e.g. no choice of doctor in hospital Private Health Insurance is used to top up health cover, allows for private hospitals, Dr of choice, ancillary (dental, physio, chiro, massage, acupuncture etc). Private Health Insurance gives you shorter waiting times, cover overseas, hospital of choice and nominated percentage of cover. Disadvantages - costly, premiums must be paid regardless of level of use, premiums do not always cover all expenses. Complementary and alternative health care approaches

- Reasons for growth of complementary and alternative health products and services Reasons for increase: - increased in trained personnel with establishment of Australasian College of Natural Therapies further advancing the credibility of these areas - community against use of conventional drug based medication now prefers holistic approach - private health coverage - Range of Products and Services available Aromatherapy (the inhalation of the scent of healing herbs and oil), Chiropractic (the manipulation of bones, muscles and joints to alleviate pain), Homeopathy, Naturopathy, Reflexology, Meditation (relaxation of body parts and clearing the mind of thoughts), Shiatsu, Magnetic Therapy, Biofeedback - How to make informed consumer choices - Education - Check Qualifications/ Accreditations - Business Presentation - shop compared to backyard - Assertiveness - Research (internet) - Ask people who have been/ recommendations - History

Health Promotion based on the five action areas of the Ottawa Charter

- Levels of responsibility for health promotion Australian Government Funding of AIHW to collect health related data, and then using that data to inform the development of strategic plans to manage ill health and enhance wellbeing. The data collected allows the government to monitor social justice in the health system reveals that certain groups experience health disadvantages - priority issue- fund a range of initiatives to address the inequalities health promotion - the development of dietary guidelines and physical activity recommendations e.g. Go for 2&5 State and Local Governments NSW government campaigns such as Healthy Canteen Strategy reflect guidelines Create supportive environments for physical activity Non Government and corporate strategies Cancer Council and National Heart Foundation - specific health promotion responsibilities Individuals Responsibility for their own health - making themselves aware of certain lifestyle behaviours and modifying them accordingly Seeking appropriate health as early as possible Schools - making people aware of health behaviours. Mandatory PE from K to 10 Developing Personal Skills is an individual's responsibility: - modifying behaviour, e.g. stopping smoking will reduce the risk of developing CVD -what personal skills are needed? E.g. education, ability to say 'no' - information (obtained from internet, school, hospitals) - support services where skills can be obtained - school, community groups e.g. AA, government initiatives e.g. Quit Now Creating Supportive Environments is an individual and communities responsibility: -personal support networks - social group, family - community services to support people - AA, Quit Now - environment modification Strengthening Community Action - 'Drink - don't sink' campaign to target teenage drinking and heavy drinking - Having a certain amount of power to exert - seeing problems in the community and knowing they have the power to change it Reorientating Health Services - AA, Quit Now, National Stroke Foundation, Diabetes Australia, Cancer Council - These services are aimed at prevention, promotion and care - These services equitable to all and can be accessed via the internet - Factors that restrict equitable access could be geographical isolation, no access to tv, computers - Building Health Public Policy (explained below)

- The Benefits of Partnerships in Health Promotion sharing responsibility for health promotion and tapping into the expertise and resources that each partner brings to the initiative reinforcing the view that all individuals, the community and the government have a responsibility to promote health get 'buy-in' (involved in decision making) not being told what to do or just ask for money, but rather involved in the process. People are more motivated and driven to achieve outcomes pooling resources e.g. financial, time, commitment, expertise can be shared cost effectiveness, each member is able to provide knowledge, skills, services/ and or resources at a reduced price E.g. in terms of skin cancer - cancer council and sunscreen companies join together Health promotion based on the Ottawa Charter promotes social justice

Developing Personal Skills Equity - All children have the opportunity to attend school, and PDHPE is mandatory, as a result they have had explicit opportunities to develop a broad range of health knowledge and skills. Diversity - All Australians have the right to access health through Medicare, documents are provided in different languages so that migrants can access services. Supportive Environments - empowering individuals by giving them knowledge and skills which they can pass on to others. Media campaigns raise awareness of preventative approaches and help people to identify signs and symptoms. Creating Supportive Environments Equity - For outdoor work, employers often provide sun protection as compulsory. Diversity - Media campaigns designed to reduce social stigmas, e.g. mental illness, assist people in acknowledging that they may have a problem and seeking help. Destigmatising (remove associations of shame or disgrace form mental illness) health issues helps acknowledge the diversity of people's experiences, and their capacity to lead fully functioning lives while managing health conditions. Supportive Environments - Banning smoking on public transport and in public buildings creates environments that support people's right to be healthy. Lighting and security of local bike paths so they can be used early morning and evening, supporting physical activity. Strengthening Community Action Equity - resources - whether financial, structural or human- must be equally available to all communities in order to optimise potential for health promotion success. This could include grants, donations, program funding or provision of expertise.

Diversity - Each community is unique and different, promotion strategies must acknowledge diverse nature. E.g. Programs that prove effective in indigenous populations always have indigenous people involved in their development to ensure that cultural aspects are especially considered Supportive Environments - Social rights can sometimes be tied up with the right to be safe and healthy. Some community groups have taken action in circumstances where parks and other physical activity spaces are deemed to be unsafe. Lobbying councils, police and other organisations can lead to health enhancing changes such as lighting, improved facilities and increased police patrols. Reorientating Health Services Equity - The allocation of proportionally greater amount of health resources to address the health of ATSI peoples is a clear strategy to reduce health inequality currently experienced by this group. Diversity - Culturally and linguistically diverse communities have access to high quality health information in a language they understand to prevent a barrier to access Supportive Environments - Encouraging organisations outside traditional health care to adopt health promotion approaches is an equally important strategy. Health organisations that have typically had a treatment focus have increasingly adopted a preventative focus as well. Building Healthy Public Policy Equity - bulk-billing which is built into Medicare helps to reduce cost as a barrier for people seeking access to medical care. Highly valuable feature for people with low SES Diversity - programs such as Abstudy help to support ATSI peoples continue continue with formal education, thus potentially having an indirect but positive impact on reducing health inequities Creating Supportive Environments- developing road safety education programs that target behaviours of specific groups, such as speeding and young male drivers, helps correct the right of all people using the roads to be healthy and safe. The Ottawa Charter in Action

Close the Gap Build Healthy Public Policy Realignment of priority issues for Australia's health to include groups experiencing inequity Develop Personal Skills $19 million smoking reduction program targeting indigenous communities Abstudy Creating Supportive Environments Government commitment to ensuring the full participation of ATSI peoples and their representative bodies in all aspects of addressing their health needs Strengthen Community Action Inaugural Health Equality Summit held in March 2008

Corporate Reconciliation Action plans Reorientate Health Services Increased Funding for ATSI health services Provision of health care made available via ATSI specific services

Canteen Menu Planner Fresh Tastes @School initiative aims to provide healthy and nutritious foods that reflect national dietary guidelines. Developing Personal Skills - Helps students take the knowledge they learn in PDHPE and practically apply to own eating habits - Generates discussion of healthy eating among students, their parents and teachers Creating Supportive Environments - By establishing canteens that only offer food options in the healthy part of the food spectrum, an environment is created which strongly supports healthy behaviours - A healthy canteen supports those people who wish to make healthy choices, and it also encourage others to take healthy options by limiting the potential for them to make unhealthy choices Strengthening Community Action - Initiative involves supporting schools, and in particular canteen managers, in their planning and preparation - Encouraging community input means core components of strategy would be implemented, but the precise details would be flexible and program could be structured to meet specific needs of school community - Community action can be encouraged by establishing a canteen committee Reorientating Health Services - NSW health has expanded their charter and begun to take on an important role in leading preventative approaches to ill health - The funding allocation further emphasises its commitment to reorientating the NSW public health service to play a greater role in prevention Building Healthy Public Policy - Decision to hold an Obesity Summit in NSW parliament, in response to concerns about increases in overweight and obesity, was gov action. Several important funding and policy decisions followed this summit. - The decision by the DET to adopt the initiative as a matter of policy for all government schools clearly demonstrates this healthy public policy in action