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How are priority issues for Australia’s health identified?

 Measuring health status

 Role of epidemiology
 Measures of epidemiology (mortality, infant mortality, morbidity, life
expectancy)

 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

 Measuring health status:

Role of epidemiology – Epidemiology aims to identify the patterns of health and disease,
and analyse how health services and facilities are being used.
Prevalence – The number of cases of disease in a population at a specific time
Incidence – The number of new cases of disease occurring in a population

Measures of epidemiology – The common indicators of the health of a community

Mortality – Is the number of deaths in a group of people or from a disease over a specific
time period, usually one year.
Infant mortality – The infant mortality rate is the number of infant deaths in the first year of
life per 1000 live births.
Morbidity – Refers to patterns of illness, disease and injury that do not result in death.
Life expectancy – Is the length of time a person can expect to live.

 Identifying priority health issues:

Social justice principles – Relate to eliminating inequity in health, promoting inclusiveness of

diversity and establishing supportive environments for all Australians.
Priority population groups – Aims to identify priority population subgroups with inequitable
health status is important for determining health priority issues.
Prevalence of condition – Prevalence refers to the number of cases in the population at a
given time; the higher the prevalence the higher the priority.
Potential for prevention and early intervention – Potential for prevention means ability to
avoid the condition from occurring, Early intervention refers to the greater success of
treatment is the condition is identified early
Costs to the individual and community – Disease and illness can place a great economic and
health burden on the individual, which can be measured in terms of financial loss, loss of
productivity, diminished quality of life and emotional stress. [Direct and Indirect]
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What are the priority issues for improving Australia’s health?

 Groups experiencing health inequities

 Aboriginal and Torres Strait Islander peoples (ATSI)
 People in rural and remote areas

 High levels of preventable chronic disease, injury and mental health problems
 Cardiovascular disease (CVD)
 Cancer (Skin, Breast, Lung)
 Mental health problems and illnesses

 A growing and ageing population

 Healthy ageing
 Increased population living with chronic disease and disability
 Demand for health services and workforce shortages
 Availability of carers and volunteers

 Groups experiencing health inequities

ATSI – Experience much poorer level of health compared to non-Indigenous people.

Nature and extent of health inequities:

o Lower life expectancy
o Higher mortality rates
o Higher death rates from cancer and circulatory diseases
o Higher mortality rates from preventable causes
Trends:
- Decline in death rates from all causes for Indigenous males
- Similar decline in death rates for Indigenous females

Determinants of Indigenous health:

Health reports confirm that ATSI people are disadvantaged compared to other Australians
based on Socioeconomic indicators (Education, Employment, Income)
Sociocultural factors also have an impact towards higher health risk factors (Family, Friends,
Community)

Individuals, Communities and Government:

Individuals – are empowered to make informed choices about their own behaviour.
Communities – and leaders of ATSI people were and are involved in many of the Closing the
Government – Gap programs and interventions (Aboriginal Community Controlled Health
Services). The Close the Gap initiative is a statement of intent signed by Australia’s
governments (state, territory & commonwealth). This statement aims to achieve equality in
health status by reducing infant mortality, and increasing life expectancy in ATSI people.
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People in rural and remote areas – Remoteness doesn’t equate to poor health, but plays a
role in it. Living in rural and remote areas are more likely to smoke, drink a lot of alcohol,
overweight/obese, physically inactive.

Nature and extent of health inequities:

People living in rural and remote areas have shorter lives and higher rates of disease.

Determinants of health in rural and remote area:

Lower levels of socioeconomic indicators (education and income), Higher costs of living
(Food, fuel), Housing costs less
Worse off environmental factors [Higher rates of injury] (Farming, mining) (Low quality
roads) (Less access to health care)

Individuals, Communities and Government:

Individual – remain in school, and seek employment (Increased knowledge and income
leads to more informed choices about health
Communities – Increase of community health centres that provide health services
Government – Initiatives to assist in the delivery of health care (Royal Flying Doctor Service)

 High levels of preventable chronic disease, injury and mental health problems

CVD – Refers to damage to, of disease of, the heart, arteries, veins and/or smaller blood
vessels.

The nature of cardiovascular disease:

Coronary heart disease – The poor supply of blood to the muscular walls of the heart by its
own blood supply vessels, the coronary arteries
Stroke – The interruption of the supply of blood to the brain
Peripheral vascular disease – Disease of the arteries, arteries and capillaries that affect the
limbs, usually reducing blood supply to the legs

The extent of cardiovascular disease in Australia:

Decline of CVD overall (Improved medical and surgical treatment)
Cardiovascular disease accounted for 29 per cent of all deaths among Australians in 2015
Cardiovascular disease is a leading cause of disability, with around 1.4 million Australians
estimated to have a disability associated with cardiovascular disease

Risk factors and protective factors for cardiovascular disease:

Risk Factors Protective Factors
Can’t control:  Regular physical activity
 Family history of heart disease  Regular health check-ups
 Gender  Eating a balanced diet
 Advanced age  Avoid exposure to tobacco
Can control:  Limit alcohol use
 Smoking  Correctly managing stress
 Obesity and overweight conditions
 Physical inactivity
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Determinants of CVD:
Socioeconomic – Low income leads to poor diet choices, lack of education leads to poor
health choices
Sociocultural – Family history of CVD = higher risk, ATSI at risk due to low socioeconomic
factors
Environmental – People living in rural/remote areas are more at risk (limited access to
health care services, technology (electrocardiogram monitor), health information)

Groups most at risk:

o Cigarette smokers
o People with family history of cardiovascular disease
o People with high-fat diets
o People aged over 65 years
o Males

Cancer (Skin, Breast, Lung) – Cancer refers to a diverse group of several hundred diseases
with a common feature — the uncontrolled growth and spread of abnormal body cells.

The nature of Cancer:

There are 2 forms of Tumour:
Benign (non- cancerous) – They generally grow slowly, surrounded by a capsule that tends
to control their spread.
Malignant (cancerous) – where malignant tumours contain cells that grow out of control
and can invade surrounding tissue.
There are multiple cancers, most of which are named according to their location in the body
(Skin, lung, prostate, bowel, cervical)

The extent of cancer in Australia:

Incidence Mortality
o Leading killer in Australia o Accounts for 30% of death in
o On the increase Australia in 2017
o Increase in breast & skin cancer o Men are more likely to have cancer
(due to aging population) and die from it
o Cancer mortality rate fell slightly
from 1991-2017
Lung cancer – Leading cause of cancer deaths in Australia
Breast cancer – Second most common cause of cancer deaths in Australia
Skin cancer – Most common of all skin diseases affecting Australians (Highest skin cancer
rates in the world)

Risk factors and protective factors for cancer:

Risk factors:
Lung Cancer Breast Cancer Skin Cancer
o Smoking o Family history o Fair skin (White)
o Occupational o High fat diet o Lots of exposure to
exposure (Asbestos) o Obesity sunlight
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o Air pollution o Late Menopause
Protective factors:
Lung Cancer Breast Cancer Skin Cancer
o Avoid smoking o Balanced diet o Avoid exposure to
o Avoid exposure to o Regular sunlight
hazardous materials mammograms o Be sun smart (wear
(Asbestos) hat, glasses,
sunscreen)

Determinants of Cancer:
Socioeconomic – Working outdoor (High exposure to sun), occupations involving contact
with hazardous materials (Asbestos)
Sociocultural – Family history of cancer = higher risk, Higher risk for ATSI due to poor
lifestyle choices
Environmental – People living in rural and remote areas have less access to health services
(Breast screening devices)

Groups at risk:
Lung Cancer Breast Cancer Skin Cancer
o Smokers o Women who have o People with fair skin
o Over age of 30 never given birth (White)
o People exposed to o Obese women o People in outdoor
hazardous material o Women who start occupations
(Asbestos) menstruating at a o People that have
young age high exposure to
o Direct relative with sunlight and do not
breast cancer use protection
(Sunscreen)

Mental health problems and illness – According to the US Surgeon General: Mental health is
described as the successful performance of mental function, resulting in productive
activities, fulfilling relationships with other people, and ability to adapt to change and cope
with adversity

The nature of mental illness:

Examples of mental health illnesses – depression, schizophrenia, personality disorders,
major depression and post-traumatic stress disorder.
Poor mental health in childhood = lack of self-care in adulthood

The extent of mental illness in Australia:

Mental health is slightly on the incline
Almost half of Australians between 15 and 85 reported suffering from a mental health
problem or illness in their lifetime.
Mental health problems and illnesses are the third most costly disease in Australia.
People accessing mental health care services is on the incline
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Risk factors and protective factors:

Risk Factors Protective Factors
Individual o Difficult temperament o Easy temperament
(overly shy) o Socially competent
o Poor social skills (Positive self-
o Risk taking behaviours identity)
(Illicit substance use) o Regular physical
o Family history of mental activity
disorders
Others o Domestic violence o Supportive family
(Family, Peers, School) o Poor influencing peers o Positive peer role
(Peer pressure to use models
drugs) o Supportive
o Poor student-teacher relationship with
relationship communication
o Subject to bullying

Health determinants of Cancer:

Socioeconomic – People with low socioeconomic status or who are unemployed are more
likely to have mental health problems (Engage more in substance abuse)
Sociocultural – ATSI are more at risk to suicide/depression due to higher alcohol abuse,
people exposed to bullying
Environmental – People living in rural or remote areas have less access to mental help
services (Beyond blue – low internet connection/bad reception)

Groups at risk:
o People who have/are experiencing trauma
o People experiencing stress
o Elderly
o People with physical illness (Mainly terminal illness)
o ATSI
o People affected by alcohol/drugs

 A growing and ageing population:

Healthy ageing – Healthy aging is a process that includes various behaviour and choices that
affect health, such as regular physical activity, good dietary choices, regular family contact
and social activities, as well as resilience to life’s circumstances.
The goal of healthy aging is to enable the elderly to maintain their health into old age, which
allows them to contribute to the workforce longer, and engage in society better.
Healthy ageing = less use of health services by elderly = less economic burden
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Increased population living with chronic disease and disability – As Australia’s population
continues to age, there is an increase in population living with chronic disease and disability.
Chronic disease and disability are more likely to occur in elderly
With rising survival rates from cancers, cardiovascular disease and other major diseases,
prevalence of people living with chronic disease and disability is rising and increases the
population of the elderly.
Increased population living with chronic disease and disability = economic burden and need
for age care facilities

Demand for health services and workforce shortages – As a consequence of an increase in

the Australian population living with a chronic disease or disability, the demand for health
and aged care services has risen.
The government has introduced a number of initiatives:
o Increased residential aged care places
o More funding for dementia care in aged care
o Incentives for people to remain in their homes
The government has taken action by improving Australia’s retirement income system by:
o All Australian employers are required to provide compulsory superannuation cover
for all eligible employees.

Availability of carers and volunteers – Caring and volunteering activities are beneficial to the
economy, and older Australians make a substantial contribution as volunteers and carers. It
is projected that there will be little growth in the number of available carers, compared with
the anticipated rise in demand for home-based support. This is likely to result in a shortage
of carers in the future.
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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
 Responsibility for health facilities and services
 Equity of access to health facilities and services
 Health care expenditure versus expenditure on early intervention and prevention
 Impact of emerging new treatments and technologies on health care (Cost and
access, benefits of early detection)
 Health insurance: Medicare and private

 Complementary and alternative health care approaches

 Reasons for growth of complementary and alternative health products and
services
 Range of products and services available
 How to make informed consumer choices

 Health care in Australia:

Range and types of health-care facilities and services – Health facilities and services can be
institutional, such as: hospitals, and nursing homes; or non-institutional, such as: General
practitioners, dentists, research groups, and pharmaceutical services.
Hospitals – provide a wide range of services, including: emergency care, elective surgery,
rehabilitation, and midwifery services.
Nursing homes – provide services for people suffering from chronic disease or disability, and
mostly care for the elderly.
General Practitioners – are a community service and often the first point of access into
medical and health services.
Allied health providers – include: physiotherapist, osteopath, chiropractor, exercise
physiologist, occupational therapist, and psychologists.
Pharmaceutical services – are funded through the Pharmaceutical Benefits Scheme.

Responsibility for health-care facilities and services – Health-care facilities and services in
Australia are provided by government organisations and a range of private and community
groups.
Commonwealth Government – Is concerned with the formation of national health policies
and control of health system financing through the collection of taxes.
State and territory governments – Provide health and community services.
State and territory health authorities principal functions:
o Health services
o Mental health programs
o Dental health services
o Women’s health programs
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The state and territory government provide funds to:
o Community health services
o Public hospitals
o Public health activities
Private sector – Provides a wide range of services (Private hospitals, dentists, alternate
health services (Chiropractors))
Local government – Responsibilities vary from state to state, but mainly concern
environmental control and a range of personal, preventative and home care services
Community groups – Formed largely on a local needs basis and established to address
problems specific to an area or region

Equity of access to health facilities and services – Is about the health system’s ability to
provide affordable and appropriate health care to people when they require it.
An individual’s ability to access health-care facilities and services can reflect their:
o Socioeconomic status
o Knowledge of available services
o Sociocultural factors (Religious beliefs)
o Environmental factors (Location)
The Government has instituted services such as the Royal Flying Doctors, e-Health records
and Telehealth. The biggest action by the government for equity is Medicare and the
Pharmaceutical Benefits Scheme.

Health-care expenditure versus early intervention and prevention expenditure – Health-care

expenditure is the allocation of funding and other economic resources for the provision and
consumption of health services.
Health-care expenditure has steadily been increasing and will continue to do so while the
focus is on ‘curative’ medicine; that is, the focus is on curing a disease or illness, rather than
preventing it.
Major prevention activities include: good hygiene, safe environments, sanitation, and a
good food and water supply.
The main early intervention strategy currently used in Australia is cancer-screening
programs (breast, prostate, skin etc)
Making a decision about early intervention and prevention strategies often comes down to
cost and health benefits.
Strategies that could be used to prevent illness and death in the community include:
o Better education about positive health behaviours
o Higher taxes on cigarettes and alcohol
o Restriction on advertising
Strong arguments for increasing the funding and support for preventative health strategies:
o Cost-effectiveness (Prevention is cheaper then cure)
o Improvement to quality of life (Prevention = Longer and healthier life)
o Containment of increasing costs (Minimises cost to health care)
o Maintenance of social equity (Prevention = greater equity in health care system)
o Use of existing structures (Using existing community structures (GP) rather than
special services
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o Reinforcement of individual responsibility for health (Empowers individuals to take
control of their life)
Impact of emerging new treatments and technologies on health care – The impact of
emerging new treatments and technologies on health care includes many benefits to health
outcomes, but also an increase in cost and raises questions of equity of access.
Much of this relates to health technologies used in diagnostic procedures, such as
ultrasound, keyhole surgery and magnetic resonance imaging (MRI).
Examples of developments in emerging treatments and technologies include:
o Advances in image technology used in key hole surgery make operating procedures
far more accurate and less risky for the patient.
o Eye conditions treated with drugs rather than lasers
o Easier to quit smoking by creating tablets that target nicotine receptors

Health insurance: Medicare and private

Medicare – The provision of Medicare in Australia has improved Australia’s health and
reduced inequities in health throughout the country.
Advantages Disadvantages
o Covers a large cost of the primary o Has little choice of care provider
health care o Does not cover most ancillary care
o Covers costs incurred by a patient in providers.
hospital
o Funded through tax system
o Provides free hospital care
o Free/subsided care from local GP
and other health care professionals

Private – Private health insurance brings with it the benefits of not paying the Medicare levy
surcharge and often has the private health insurance rebate (government contribution to
your health insurance).
Advantages Disadvantages
o Benefits those of higher SES o Costs more for the user
o Provides greater funds to the
available to those of lower SES
o Choice of specialist, GP within
hospital system
o Avoids waiting list (Faster
treatment)
o It covers some of the costs for
ancillary care
o Covers some preventative actions
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 Complementary and alternative health care approaches

Refers to healing practices that do not fall within the area of conventional medicine.

Reasons for the growth of complementary and alternative health products and services –
Complementary health products and services are used together with western medicine,
while alternative health products and services are used instead of western medicine.
Trend towards CAM has a lot to do with social change
Reasons for growth:
o World health organisation (WHO) recognition of the usefulness of many alternative
approaches
o Effectiveness where modern treatment fails
o Growing multiculturalism in AUS
o Desire of many to have natural/herbal medicine

Range of products and services available

Natural medicines – Herbs, nutrition, homeopathy, Chinese medicine
Supplementation – Vitamins, minerals, oils, protein, vegetable powders
Physiological treatment – Physiotherapy, osteopathy, chiropractic therapy, exercise
psychology, remedial massage, occupational therapists, acupuncture
Energy based treatments – Crystals, some forms of massage, acupuncture, reiki

How to make informed consumers choice – An important first step in making informed
choices is to gather such specific information about the nature of the alternative medicine,
its credibility as an effective type of treatment, and the qualifications and experience of
practitioners.
Itisimportanttomakeinformeddecisionswhenchoosinganalternativehealth-careapproach.The
individual needs to investigate the services on offer, the costs, the qualifications and
experience of the practitioner, and the health claims being made before committing to it.
How do you know who to believe?:
To find out who you can believe you should ask a series of questions:
o What qualifications do you have?
o Are you registered?
o What evidence is there for this treatment?
o Are there side effects?
What do you need to help you make informed decisions?:
o You need to be educated about the product/treatment (From sources such as –
Journals, academic websites)
o Know what the possible side effects are
o Evidence for the effectiveness of the treatment
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What actions are needed to address Australia’s health priorities?

 Health promotion based on the five actions areas of the Ottawa Charter
 Levels of responsibility for health promotion
 The benefits of partnerships in health promotion (Government sector, Non-
Government agencies, Local community)
 How health promotion based on the Ottawa Charter promotes social justice
 The Ottawa Charter in action

 Health promotion based on the five actions areas of the Ottawa Charter

Levels of responsibility for health promotion – Australian governments, communities and

individuals all play a role in responsibility for health promotion.
Individuals, Communities, Governments are all involved in the Ottawa Chatter
Individuals – Play an important role in developing personal skills in relation to health
Communities – Are central in strengthening community action, and creating supportive
environments for health.
Governments – The government is particularly vital in building healthy public policy,
creating supportive environments and re-orienting health services.

The benefits of partnerships in health promotion (Government sector, Non-Government

agencies, Local community) – In order for health promotion to be most effective all involved
in health must be utilised. The benefits of partnership in health promotion include:
addresses needs of individuals and communities, more comprehensive health promotion,
better results in health promotion goals, empowers individuals to act, more efficient health
promotion (no doubling up and reduced waisted time/money) [Healthy Spaces and Places.]

How health promotion based on the Ottawa Charter promotes social justice – The principles
of social justice (equity, diversity and supportive environments) are an essential part of
effective health promotion.
WHO state that health promotion should advocate, enable, and mediate.
Health promotion aims to reduce inequities in health status, ensuring equal opportunities
and resources for health.
Developing personal skills – Developing personal skills is aimed at improving the knowledge
and skills of individuals so they:
o Are able to make more informed health decisions for themselves
o Have the capacity to be a positive influence on those around them.
Creating supportive environments – A supportive environment significantly increases the
chance of a person being able to make positive changes to their health.
Strengthening community action – Each community is unique and different so must be
consulted about the development of health promotion strategies intended to improve their
health.
Reorientating health services – Reorienting is adjusting a position, direction or approach to
suit particular circumstances.
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The process of reorienting health services encourages the health sector to move beyond its
traditional role of providing curative services.
Building healthy public policy – Through implementing legislation, policies and fiscal
measures, governments can work towards creating equity among individuals and across
different populations.

The Ottawa Charter in action – For an area of the Ottawa Charter to be properly addressed
in a health initiative there must be many strategies that represent the area within the
campaign.
We can think of the Ottawa Charter as a well-coordinated army that surrounds and attacks
poor health behaviours or encourages positive health behaviours.

Close the Gap (2008):

Build healthy public policy – the ‘Close the Gap Statement of Intent’.
Create supportive environments – Close the Gap seeks to train health professionals, ensure
fresh healthy food and develop housing and waste supplies/removal systems to improve
housing quality.
Strengthen community actions – Closing the Gap involves ATSI people and community
groups/elders in the panning at local and regional levels.
Develop personal skills – Closing the Gap seeks to increase ATSI education levels and
provides primary health care services through Aboriginal Community Controlled Health
Services.
Reorient health services – Closing the Gap seeks to utilize primary health care to both
prevent and promote health in balance with curative services. The latest Prime Ministers
Report on Closing the Gap identifies that the Closing the Gap health promotion is only
partially on track to meet its targeted goals.

Road Safety (2010):

Build healthy public policy – Legislation: fixed speed cameras in NSW, & 50Km/h urban
speed limit.
Create supportive environments – Road Safety has sought to make speeding socially
unacceptable using the ‘Speeding – no one thinks big of you’ campaign. Roads have also
been upgraded with higher safety standards, and cycle ways have been constructed to
separate cyclists from traffic.
Strengthen community actions – Road Safety works with community-based organisations to
provide ‘driver reviver’ stops to combat fatigue related accidents.
Develop personal skills – Road Safety introduced the Graduated Licensing Scheme and
school education programs to improve the knowledge and driving ability of young drivers.
Reorient health services – The many campaigns increase road safety awareness and
promote a preventative approach to road safety issues. This health promotion has been
successful in reducing road fatalities since 2010 and reduced hospitalisations from road
related accidents.