CORE 1 - Health priorities in Australia Flashcards
Epidemiology
study of the patterns and causes of health and diseases in populations, used to improve health. It involves data collected from hospitals, GPs and census information to provide a picture of Australia’s health status.
Epidemiology considers patterns of disease in terms of: (CDIP)
- Causes (i.e. determinants and indicators)
- Distribution (i.e. the extent)
- Incidence (i.e. number of new cases occurring in a population)
- Prevalence (i.e. number of cases in a population at a specific time)
what does epidemiology tell us and who uses these measures
- basic health status of Australians in terms of quantifiable ill health
- Data is then used to provide trends in disease incidence and prevalence along with info about ethic, socioeconomic and gender groups.
- it collects data regarding death rates, birth rates, illness, injuries, treatments provided, work days lost, hospital usage and money spent by the government.
- Researchers
- Government
- Health practitioners
Limitations of empidemiology
- Statistics and data can be manipulated by interpreters and are open to bias
- They focus on the negative measurable aspects of health and not the positives i.e. wellbeing and quality of life
- Doesn’t always show variations between population subgroups e.g. Aboriginal and non-aboriginal Australians
- Doesn’t accurately indicate quality of life in terms of level of distress, impairment, disability or handicap (little about impact of illness).
- Cannot provide whole health picture e.g. data on mental health is almost non-existent
Measures of epidemiology
- Mortality
- Infant mortality
- Morbidity
- Life expectancy
Mortality
Number of deaths in a group of people or from a disease over a certain time period
- leading causes of death = coronary heart disease, dementia and Alzheimer’s, cardiovascular disease, lung cancer, chronic obstructive pulmonary disease.
Infant mortality
Number of infant deaths in the first year of life per 1000 live births. This measure is considered the most important indicator of health status of a nation, and can also predict adult life expectancy.
Infant mortality rates in Australia have declined due to:
- Improved medical diagnosis and treatment of illness
- Improved public sanitation
- Health education
- Improved support services for parents and newborn babies and children
- Rates are higher in ATSI attributed to complications of pregnancy, labour and delivery.
- Australia has shown significant progress in reducing infant deaths with death rates halving between 1986 and 2010 (ABS 2013; ABS 2011a; AIHW 2012). Programs and resources directed at intensive care units, increased community awareness of the risk factors for sudden unexpected deaths in infancy (SUDI), and reductions in vaccine-preventable diseases through national childhood immunisation programs have been particularly successful.
Morbidity
Refers to patterns of illness, disease and injury that do not result in death. Illness, disease and injury are conditions that reduce quality of life, either temporarily or permanently. (incidence and prevalence)
Measures of morbidity:
- hospital use
- doctor visits and Medicare statistics
- health surveys and reports
- disability and handicap
Disease burdens:
- Coronary heart disease
- Other musculoskeletal
- Back pain and problems
- Chronic obstructive pulmonary disease
- Lung cancer
Incidence
morbidity
Number of new individuals who contract a disease during a period of time (Frequency of a disease)
Prevalence
morbidity
all individuals affected by the disease at a particular time
Life expectancy
The length of time a person can expect to live
Life expectancy is increasing due to:
- Lower infant mortality
- Declining death rates for cardiovascular disease
- Declining rates from cancer
- Fall in death from traffic accidents
- Increased technology for diagnosis of treatment
Priority health issues
- cardiovascular health
- cancer control
- injury prevention and control
- mental health
- diabetes mellitus
- asthma
- arthritis and musculoskeletal conditions
How to identify priority health issues
- Social justice principles
- priority population groups
- prevalence of condition
- potential for prevention and early intervention
- costs to individual and community
Social justice principles
Social justice aims to decrease or remove inequity from a population. This would mean that there is a health equality. Social justice is a life of choices and opportunity, free from discrimination. Everyone has the right to equal health opportunities.
The social justice principles seek to recognise and address both the health outcomes, such as: incidence and prevalence of disease, and death rates, and the factors that influence health, such as: socioeconomic status, environment, and cultural factors.
Equity: resources are allocated in accordance with the needs of individuals and populations with the desired goal of equality of outcomes.
- This results in particular groups within Australia receiving more funding and being identified as priority groups in Australia because they have poorer health outcomes than other Australians (e.g. ATSI).
Diversity: Refers to the differences that exist between individuals and people group. Many measures need to be in place to ensure each people group within our diversity has access to health care and achieves good health outcomes (e.g. providing brochures in multiple languages)
Supportive Environments: Environments where people live, work and play that protect people from threats to health and that increase their ability to make health-promoting choices. The government looks at the environments of particular groups to determine if these might be reasons for poorer health outcomes (e.g. rural and remote).
Australian Government implemented social justice strategies
- All Australians should have access to a comprehensive range of health care services regardless of financial status
- Health services should be of a consistently high quality across Australia
- There should be continuity of health care across the health care system with appropriate referral to a higher level service
- Strategies developed and implements to reduce ill health and premature death
Priority population groups
identified when certain population groups are MORE greatly affected by certain causes of illness and death then the rest of the population. These groups experience a high incidence of conditions.
Epidemiology provides statistics on these population groups and allows the government to identify priority population groups that need extra resources to remove the gap in health outcomes. Priority population groups then become the focus of health promotion initiatives. They receive more funding and health programs get developed to meet their needs.
Examples
- males have higher rates of cancer than females
- ATSI males and females can expect to live 10 years less than the non-ATSi population
- People in remote areas have higher death rates than urban dwellers
- Lower oral health is found in people of lower socioeconomic status
Prevalence of condition
The prevalence of a condition is used to determine the number of people affected by the health issue. The higher the prevalence the greater the health issue, which may then be identified as a priority health issue in Australia.
Prevalence = the number or proportion (of cases, instances, and so forth) in a population at a given time.
e.g. In relation to cancer, prevalence refers to the number of people alive who had been diagnosed with cancer
There are many current conditions that are high in prevalence and have become priority health issues. These include:
- Cardiovascular disease – has been a priority health issue for a long time in Australia and will continue to be long into our future.
- Cancers – have been a growing priority in Australia, although the decreased smoking rate is helping.
- Dementia and Alzheimer’s disease – affect many Australians today, particularly the elderly.
Potential for prevention and early intervention
The easier it is to prevent a disease the more likely a health promotion will have an impact on the burden of the disease and reduce its incidence. If prevention cannot occur, then early intervention is preferable, with higher rates of survival for those diagnosed and treated early for the condition.
Epidemiological data showing the prevalence of a health issue can be used to determine funding priorities. Over time data reflects improvements in some areas and indicates where greater concern should be focused in other areas. This determines how funds should be allocated.
E.G. increased smoking rates in females will result in greater rates of lung cancer and CVD, therefore female smoking could be targeted through health promotion.
- Diseases that can be prevented: Type 2 Diabetes, hypertension, cardiovascular disease, obesity.
- Diseases benefited by early intervention: Cancer, CVD, musculoskeletal conditions
priority health = Costs to the individual and community
Costs to individual
- Can be direct or indirect
- direct: those that can be measured, usually through financial means; for example, cost of treatment, cost of replacement labour or lost working hours
- indirect: include factors such as emotional trauma and relationship breakdown
- The impact of health conditions on the individual’s physical health can vary from minor pain to permanent disability or death
- Dealing with minor physical health problems can be overcome in a short time with appropriate treatment and medication. Examples of permanent physical effects are spinal cord injury from an accident, limb amputation caused by peripheral vascular disease, and mastectomy (breast removal) to remove a cancerous tumour
Cost to community
- The annual economic cost alone related to the diagnosis, treatment and care of the sick is over $30 billion. This includes the costs of hospitalisation, medical treatments, pharmaceuticals, health insurance and illness prevention.
- The indirect costs of ill-health to the community are not included in the dollar figures. Indirect costs include loss of income and workplace productivity as a result of illness or premature death, travel costs of patients, and the costs of caring for an ill person at home.
- There are several factors indicating that Australia’s health system might come under financial pressure in the future; ageing population, more informed population, increase use of medicare, advances in technology.
Groups experiencing health inequities
- ATSI
- Low SES
Groups experience health inequities - ATSI
nature and extent of inequities
- Experience the largest gap in health outcomes in Australia
- life expectancy 10 years lower than other Australians
- Infant mortality rate is 2x rate of non-ATSI
- Suffer from high rates of lifestyle diseases (e.g. Type 2 Diabetes, CVD)
- Mental health (e.g. youth suicide is 5x higher in
determinants Sociocultural - Little education and money - High rates of domestic violence - Disempowerment from oppression and discrimination experienced (contributes to lack of respect for non-ATSI and the ability to help their health)
Socioeconomic
- Low employment rate because of low education level
- Unemployment and poor education lead to negative behavioural choices (more risk factors)
Environmental
- Less access to health services i.e. regular check-ups, rural area
- Little access to technology (lack of knowledge and skills)
Roles of communities, individuals, Gov. in addressing
Individuals
- must have a level of responsibility for their health. This can be done by ensuring good knowledge, education and improving behavior towards health. This must be consistently practiced through generations to break the cycle.
Communities
- Play a big part in the design and implementation of closing the gap campaign.
Government
- provides funding; helps create programs improve health
- different programs for different issues I.e. ABSTUDY (free edu.), med.
Groups experiencing health inequities - low ses
nature and extent of inequities
- Increased risk of lifestyle disease (40% higher mortality rates from CVD and 6x incidence lung cancer)
- High obesity rates due to lack of healthy food and exercise
- Lower life expectancy and higher mortality rates from
determinants
Sociocultural
- More likely to participate in risky behaviours, increasing risk of lifestyle diseases
- Higher rates of smoking (lung disease) and second hand smoke, increasing chances of younger generations smoking
- Family and peers influence negative eating and exercise habits
Socioeconomic
- Lower levels of education causing limited health literacy and increased risky behaviours
- Lack of employment and income means less access to health care and healthy food, increasing disease (e.g. type 2 diabetes, cancer)
- Types of employment more trade based, increases risk of injury
Environmental
- High rates of homelessness, lack food – effects physical and mental health
- Limited income and access to Centrelink as they have no living address
- Lack of access to health services, because of money and transport issues
Roles of communities, individuals, Gov. in addressing
Individuals
- can take responsibility for their own health by staying in school or attending university to improve overall education on health and increase likelihood of employment.
- Encouraging friends and family to make good health choices (e.g. not smoking) is beneficial.
Communities
- can provide health care and support services for youth welfare (‘Youth of the Streets’). Community events (e.g. barbeques) can improve mental health and health behaviours.
Government
- provides funding to improve overall health and access to services and treatments (‘Medicare’, ‘Centrelink’, ‘PBS’).
High levels of preventable chronic disease, injury and mental health problems
- cardiovascular disease
- cancer (skin, breast, lung)
- injury
CVD
- nature
- extent
- risk/protective factors
- determinants
- groups at risk
- CVD = all diseases of the circulatory system including heart and blood vessels
- The main cause of many of these diseases is atherosclerosis, which refers to the buildup of fat and plague inside the arteries, which can block the blood vessel. A blockage can result in death of cells that were relying on these arteries for their oxygen supply – such as in a heart attack.
- Atherosclerosis (i.e. build-up of fatty and/or fibrous material on interior walls of arteries)
- Arteriosclerosis (i.e. hardening of the arteries whereby artery walls lose elasticity)
- Coronary heart disease (i.e. manifests as a heart attack or angina)
- Heart attack (i.e. caused by complete closure of a coronary artery by atherosclerosis, it may occur when a blood clot forms and blocks a narrowed artery)
- Angina (i.e. chest pain that occurs when heart has insufficient supply of oxygenated blood)
- Stroke (i.e. results from a blockage of blood flow to brain)
- Peripheral vascular disease (i.e. result of reduced blood flow to lower body)
- leading cause of specific death in Australia
- The current trend in death rates because of coronary heart diseases is downward – falling 73% in the last 30 years. This downward trend is mostly due to improvements in medical and surgical treatments.
- The rate of strokes has fallen by 25% in the last 10 years, while the total number of people who have had a stroke has increased by 6% over the same period.
- Coronary heart disease being biggest cause of death and cerebrovascular as 2nd
- Largest and most costly disease burden in Australia
- Mortality rates decreased due to medical and surgical advancements
- leading cause of specific death in Australia
- Risk Factors
- hypertension (high blood pressure)
- physical inactivity
- obesity
- smoking
Protective factors
- regular physical activity,
- health checks and balanced diet low in saturated fat.
- Sociocultural – family, media, peers, religion and culture
- Family history of CVD increases risk
- Asians less likely because of low fat diet
- ATSI more risk because low SES and education
- Media exposure of smoking effects on health led to reduced smoking rates
Socioeconomic – employment, income, education
- Low SES or unemployed have higher mortality rates because limited income means less access to health services and healthy food
- Low levels of education increase risk because lack of health literacy and knowledge
Environmental – geographical location and access to health services/location
- Rural and remote people are at a higher risk, because of less access to services and technology e.g. electrocardiogram
- ATSI (2x likely to have heart attack, 1.7x for stroke)
- Low SES (40% higher mortality rates of CVD and stroke)
- R/R higher disease burden of stroke
- Elderly
- Smokers
- ATSI (2x likely to have heart attack, 1.7x for stroke)
