Download Health Priorites in Australia #2

HSC CORE 1: HEALTH
PRIORITES IN
AUSTRALIA
How are priority issues in Australia’s health identified?
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Measuring health status
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Role of epidemiology: The role of epidemiology is defined as the study of rates and patterns of
illness, disease and injury amongst specific population groups. The information collected is via
hospital usage, health professionals and surveys. The identification of specific health trends is
then used to establish health priorities, and to guide the decision-making, resource allocation
and programs of all public and private sectors involved in health care and health promotion in
Australia. There is a signification limitation of Epidemiology as it does not provide information
about a person’s quality of life in a holistic sense, nor does it accurately describe the sociocultural, socio-economic and environmental determinants of health.
Measures of epidemiology
Morbidity (Prevalence and Incidence): refers to the patterns of illness, disease and injury
that do not result in death. Prevalence is the number of existing cases of a specific disease
or illness at any given time. Incidence is the number of new cases of a specific disease or
illness over a set period. E.g. 20000 people in Australia infected with HIV and
approximately 800 new diagnoses of HIV per year.
Mortality: is the measure of the number of people within a specified population that died
in any given year. E.g. Cardiovascular Disease accounted for 33.8% deaths in Australia in
2007.
Infant Mortality: is the number of deaths in the first year of life. E.g. the infant mortality
rate was 4.2 infant deaths per 1000 live births in 2007, and is decreasing at a steady rate.
Life expectancy: is an estimate of the number of years a person can expect to live at any
particular age. E.g. the life expectancy of a baby born in 2005 is 84 years if female and 79
years if male.
Identifying Priority Health Issues
Social Justice Principles:
Equity: is the fair allocation of funding and resources. For example, GPs who bulk bill
people with a Health Care Card
Diversity: Australia has a diverse population and the needs of the population needs to
met. Therefore, there needs to be sufficient health care services and facilities for all the
diverse groups within Australia.
Supportive environments: Australians have the right to be healthy and the environments
needs to support this concept. This can be achieved through the cost, availability and
ease of access.
A prime example of how social justice principles can be seem in practice is through Medicare.
Through Medicare, the right for all Australians to be healthy is acknowledge; we are provided
with access to adequate health care at an affordable cost or no cost at all; epidemiology is
used to promote equity by identifying health disadvantages that are experienced by some
groups, and strategies are implemented to redress the inequities; and we are able to
participate in promoting our own health through mechanisms such as seeking second
opinions, negotiating treatment options with doctors and electing to adopt additional health
cover through private health insurance if we choose. Medicare is equitable, caters for
diversity and provides a supportive environment in which all people can have access to
health care.
Priority Population Groups: Priority population groups are the criterion for how best to spend
money and distribute resources for health. Our population has subgroups of people who have
significantly different health statuses, and somehow we must cater for all needs. Population
groups that suffer health inequities include: ATSI’s and socio-economically disadvantage people
etc
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Prevalence of Condition: is the rates and trends of morbidity and mortality that highlight
problems of concern, and the allocations of funding and resources are directed accordingly. For
example, the decrease in deaths from CVD can be attributed to effective health promotion
strategies. However, increasing rates of Type 2 Diabetes indicate a need for a particular focus on
the related determinants and risk factors.
Potential for prevention and early intervention: The majority of the disease burden in Australia
can be attributed to chronic illnesses such as cancer, CVD and injury. The main risk factors of
these disease are related to an individual’s lifestyle and health-related behaviours (smoking, diet,
alcohol and physical activity levels). Therefore, health problems that are largely preventable, as
well as those that respond well to intervening in its early stages, deserve increase attention by
those involved in health promotion.
Costs to the individual and community:
Direct individual costs include the financial burden that is associated with illness
and disability such as ongoing medical costs (hospital charges, medications,
medical professional fees etc.) and loss of employment
Indirect individual cost include persistent pain and loss of quality of life, possible
exclusion from social activities, increase pressure on families to offer support and
the emotional toll of chronic illness.
Direct community costs include the vast funding of the Australian health care
system. Most of this supports primary health care and pharmacenticals, and the
nature of chronic illness tends to require high degress of medical intervention to
manage them
Indirect community costs include the premature loss of contributing and valuable
members of society and the cost of employers in absenteeism, decreased
productivity and re-training.
What are the priority issues for improving Australia’s health?
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 High levels of preventable chronic disease, injury and mental health problems
Cardiovascular disease (CVD)
Nature: CVD refers to all disease of the heart and blood vessels. Caused by a build-up
of fatty tissue inside of the blood vessels and the hardening of the blood vessels –
both of these affect the blood supply to the organs of the body.
3 types of CVD include:
1. Coronary Heart Disease: blockages in the vessels of the heart (i.e. Heart Attack)
2. Cerebrovascular Disease: blockages in the vessels of the brain (i.e. Stroke)
3. Peripheral Vascular Disease: blockages in the vessels in the limbs, other the
legs/feet
Extent: The leading cause of death (37% of all deaths in 2007) and sickness (3.5
million suffered CVD in 2008) in Australia
Both mortality and morbidity are decreasing for males and females – the result of
increased awareness of personal prevention strategies and improved medical
technology in both the detection and treatment of CVD
Survival from the attacks is improving
Risk Factors and Protection Factors
Non-Modifiable Risk
Modifiable Risk Factors
Protective Factors
Factors
- Smoking and alcohol
- Nutritious and
- Age: rates increasing
abuse
balanced diet
sharply over 65 years - Diet high in fat, salt
- Daily physical activity
of age
and sugar
- Responsible use of
- Gender: males suffer
- Low physical activity
alcohol
for CVD more
levels
- No smoking
- Family history
- High blood pressure
- Maintain healthy
and cholesterol levels
weight
- Being overweight
- Control stress levels
Determinants
Socio-cultural
Determinants
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Family history
Indigenous: high rates
of all risk factors
Gender: males are less
likely to engage in
preventative health
measures
Socio-economic
Determinants
- Low levels of
disposable income
- Unemployed
- Low level of education
Environmental
Determinants
- People who live in
rural and remote
communities
Groups at Risk: ATSI’s, Low SES
Cancer (skin, breast and lung):
Nature: A group of disease leading to the uncontrolled growth of abnormal body cells.
Leads to tumours which interrupt the normal functioning of the body, and which can
also spread to other parts of the body
Extent: Mortality and Morbidity rates are both increasing. This is due to our ageing
population and better detection.
Male: Prostate, Colorectal, Lung and Melanoma
Female: Breast, Colorectal, Lung and Melanoma
Males suffer more except in the 25-54 years age group, where female cancers (cervix,
breast etc.) occur at 3 times the rate.
Risk Factors and Protective Factors
Non-Modifiable Risk
Modifiable Risk Factors
Protective Factors
Factors
- Exposure to
- Avoid carcinogen e.g.
- Gender: specific
carcinogens such as
Slip, Slop, Slap
cancers
smoke, UV radiation
- Personal screening
- Age: leads to increased
from the sun
habits
risk
- Lifestyle behaviours,
- Public Screening
- Family History
such as smoking,
- Seeking early medical
- Genetic makeup e.g.
alcohol misuse and
intervention
being fair skinned
poor dietary habits
Determinants
Socio-Cultural
Determinants
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Smoking amongst
young females
Tanning habits, such
as excessive sun
exposure
Socio-economic
Determinants
- Unemployed: high rates
of smoking as a stress
relief
- Low levels of education
Environmental
Determinants
- People who work
outside
- People who live in
rural and remote
communities
- Exposure to chemicals
in the workplace
Groups at Risk: ATSI’s, Low SES, Males and Females, Other minor groups include
smokers, outdoor workers, young adults and people with fair skin
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Injury
Nature:
1. Road injuries and Motor Vehicle Accidents
2. Suicide and self-harm
3. Injuries around home
4. Workplace accidents
5. Acts of violence
6. Sports and recreational injuries
Extent: Leading cause of death in 1-44 years age groups (MVAs and suicide amongst
males)
Major cause of hospitalisation
Deaths from injuries are decreasing in frequency, especially MVAs
Risk Factors and Protective Factors
Modifiable Risk Factors
Non-Modifiable Risk
Protective Factors
Factors
- Age: elderly are more - Minimising driving
- Driving behaviour and
at risk of falls
distractions e.g.
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attitudes
Inadequate supervision
of children
Occupational hazards
Safe use of alcohol
Unsafe home
environment
Determinants
Socio-cultural
Determinants
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ATSI’s suffer more
injuries
Attitudes towards
driving and risk taking
amongst males
Family breakdowns
Societal pressure for
tougher road laws
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Gender: higher rates
of risk taking
behaviour and suicide
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Socio-economic
Determinants
- Low SES- higher rates
of hospitalisation from
injuries
- Low education- less
awareness of dangers
around the home
- Low income- makes it
harder to purchase
safety equipment
phones
Effective driver
education
Home modifications
for the elderly
Strong social support
to prevent suicide
Environmental
Determinants
- Workplace injuries are
most common in
agricultural settings
- Suicide is highest
amongst males from
rural and remote
regions
- Unsafe home
environments of
elderly people and
children can lead to
increased risk of injury
Groups at Risk: Elderly (falls), ATSI’s (MVAs and self-harm), Children (poisoning and
drowning)
 A growing and ageing population
Healthy ageing: The process of ageing can be a very demanding time. Physical, social, emotional
and financial difficulties come about, which markedly decrease a person’s quality of life. The
government research program ‘Ageing Well, Ageing Productively’ enables and empowers people
to live a healthy, productive and contributing life for as long as possible. This program will
benefit the individual, by ensuring a better quality of life and increased independence, and also
the wider community, through minimising the negative impact of an ageing population.
Increased Population Living with Chronic Disease and Disability: A larger elderly population
inevitably leads to more people living with chronic disease and diability. Improved medical
services such as preventatin screening programs and detection, widespread education
contribute to higher rates of diagnosed disease and illness. Elder people tend to suffer more
from CVD, cancer, arthritis, osteroporosis, anxiety and diabetes. The risk factors are modifiable
and lifestyle-based, and they place an enormous burden on the Australian health care system
not to mention health budget. These statistics are set to increase, making the efforts to
encourage healthy ageing more important. An example of this is encouraging young people to
develop healthy habits earlier such as not smoking, eating healthy, regular physical activity.
Demand for Health Services and Workforce Shortages: To meet the demands of the growing and
ageing population, the full range of health services will need to expand dramatically. This
increase needs to include more specialist health professionals, GPs, and emergency health
services such as ambulances, public hospitals, and more housing for people who require
assistance with basic living needs.
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Availability of Carers and Volunteers: There is a decline in the 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. There are over half a million
volunteers among those aged over 65 years old who volunteer for non-profit organisations. The
older Australians who volunteer in the paid and unpaid work are essential they help by carrying
out home visit, helping with food shopping, providing transport to medical, dental and hospital
appointments, and assisting with a wide range of other services that the aged may find useful,
including food preparation, home maintenance and personal care. A carer is any person who
assists a person because of that person’s age, illness or disability. Carers may be needed to assist
with tasks of daily living, such as feeding, bathing, dressing, toileting, transferring or
administering medications. On other circumstances, there may only be the need for assistance
with transport, financial or emotional support. The aged living in households most commonly
need assistance with property maintenance and health care because of disability. 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 will have a huge impact on the health services is
that the aged will have a higher demand for carers but as there is none, the government will need
to get more resources to look after them. This is likely to result in a shortage of carers in the
future.
What role do health care facilities and services play in achieving
better health for all Australians?
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 Health care in Australia
Range and types of health facilities and services
Category
Public health services- focus is on
prevention, promotion and protection of
population groups and the factors and
behaviours that cause illness rather than
treatment
Primary and community health care- are
usually the first health service visited by a
patient with a health concern
Hospitals- provide care for admitted
patients which is more commonly treatment
focused e.g. medication, monitoring and
treating conditions, surgery and care for the
extremely ill
Specialised health services – target
specialised health conditions such as mental
illness, sexual and reproductive health drug
and alcohol dependent
Goods
Examples
 Cancer screening
 Immunisation programs
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GPs
Ambulance services
Royal Flying Doctor Services
Dental
Public
Private
Mental
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Specialised medical practitioners
Reproductive health
Mental health
Palliative care
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Pharmaceuticals
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Responsibility for health facilities and services
Health care provider
Commonwealth Government
State/Territory Government
Local Government
Private organisations
Community groups
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Facilities and/or services provided
 Formation of national health policies
 Collection of taxes to finance the
health systems
 Provision of funds to state/territory
governments
 Special concern for ATSI
 Pharmaceutical funding
 Examples include: Red Cross Blood,
Royal Flying Doctors’ Service
 Hospital services
 Mental health
 Home and community care
 Family health services
 Women’s health
 Health promotion
 Vary from state to state
 Environmental control
 Home services
 Examples include: Meals on Wheels,
Antenatal clinics
 Private hospitals
 Dentists
 Alternative health services
(physiotherapy, chiropractor, etc.)
 Local needs basis
 Promote health
 Cancer Council, Dads in Distress,
Diabetes Australia, etc
Equity of access to health facilities and services: All Australians should have equal access to
health care facilities and services. This is achieved in Australia via Medicare, which can have
limitations. Medicare helps achieve equity via bulk bulling, language support. Despite this,
inequities exist for ATSI’s, low SES and people living in rural and remote areas.
Health care expenditure versus expenditure on early intervention and prevention: In 2007-08
health-care expenditure was $103.6 billion. Less than 2% of this figure was spend on preventable
services or health promotion. The main reason for this is a focus on cure rather than prevention.
HOWEVER, PREVENTION IS BETTER THAN CURE. The delay in tangible benefits of health
promotion and prevention also sways politicians and governments to prefer the instant and
measurable option of cure over prevention. Reasons for increasing funding for preventative
health strategies include:
 Cost effectiveness
 Improvement to quality of life
 Containment of increasing costs
 Use of existing resources
 Reinforcement of individual responsibility
 Maintenance of social equity
 Reduced mortality and morbidity
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Impact of emerging new treatments and technologies on health care, e.g. cost and access,
benefits of early detection: have the potential to significantly improve the health status of
Australia. Examples include image technology in keyhole surgery, drug advancements, prosthetic
limbs development, artificial organs and transplant technology. Having sustainable support of
these technologies is the challenge.
Health insurance: Medicare and private
Medicare is the health-care system for all Australians. Its aim is to provide equity in
terms of cost and access for health care services. Funding for Medicare comes from
income tax (1.5% of taxable income) and the Medicare levy surcharge (1% for highincome earners).
Advantages for Medicare:
o Free treatment as a public patient in a public hospital and free of subsidised
treatment by medical practitioners.
o Ever Australian is covered for 85% of the scheduled fee
o Bulk billing allows patients to pay nothing and the doctor receives the
scheduled fee from Medicare.
Private health insurance is extra insurance which covers private hospital and ancillary
or extra (dental, physiotherapy, naturopathy etc)
Advantages for Private:
o Shorter waiting times
o Hospital choice
o Own doctor of choice
o Ancillary benefits
o Avoiding increase tax
 Complementary and alternative health care approaches
Reasons for growth of complementary and alternative health products and services:
o World Health Organization recognition
o Proven results for many when traditional medicine had failed
o Desire for natural medicines
o Holistic nature
o Formal qualifications enhancing credibility
Range of products and services available
Alternative health-care approach
Description
Involves inserting needles into skin to relieve
Acupuncture
pain
Adjustments are made to the spine to realign
Chiropractic
correct body function
State of inner stillness
Meditation
System of muscle connective tissue
Bowen therapeutic technique
movement that realign the body and
balances energy flow
Holistic treatment aiming to treat the
Naturopathy
underlying cause as well as the symptoms of
the illness
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How to make informed consumer choices: it is important to investigate and critique health-care
providers and services. This includes: seeing what they offer, the benefits, experience,
qualifications, governing body and cost. Obtaining feedback and references may also assist.
Evaluating the use of products or services should also occur. The consumer should be doing
research prior to selecting the product or service.
What actions are needed to address Australia’s health priorities?
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Heath promotion based of the five action areas of the Ottawa Charter
The five action areas of the Ottawa Charter are:
 Developing personal skills
 Creating supportive environment
 Strengthening community action
 Reorienting health services
 Building health public policy
Levels of responsibility for health promotion: The Australian government, state and local
governments, non-government organisations, communities and individuals are all responsible
for promoting health. The benefits of partnerships in health promotion: The chance of successful
health promotion is greatly increased when all levels mentioned above collaborate towards one
common goal. This brings shared responsibility, ownership of the imitative and the chance to
pool resources. Therefore having a greater capacity to tackle and resolve complex health and
social problems that have eluded individual sectors for decades, resulting in improved
population health and well-being, and reduced demand for health care and social services in
future.
How health promotion based of the Ottawa Charter promotes social justice