Core 1: Health Priorities in Australia Flashcards
Role of epidemiology
- Epidemiological data assists in the identification of Australia’s health needs, resources and priorities.
- Health promotion and expenditure is determined by data collected in relation to the current and future health needs of a population.
Who uses epidemiology?
Governments, public health researchers (Sydney Research School of Public Health), Health Departments (for eg. NSW Health, Vic Health)
Incidence
The number of cases (new and existing) in a population at a given time (covid cases (omicron and delta), influenza)
Prevalence
The number of new cases in a population at a given time
Mortality
Refers to the standardized death rate- deaths per 100, 000 people of the population. (The standardized death rate for Australia was 5.4 per 1000, with Indigenous Australia sitting at 9.6)
Infant mortality
The number of infant deaths. This is often regarded as the most important health indicator as it can predict adult life expectancy. It can be separated into neonatal (the first 28 days of life), post neonatal (after 28 days- the rest of the 1st year)
Morbidity
-Rates of prevalence and incidence of disease, illness, injury, hospital use, doctor admissions and disability.
Limitations of epidemiology
- Doesn’t account for significant variation amongst different communities and populations (Indigenous and Non-Indigenous Australians), doesn’t indicate levels of happiness, quality of life or impact of the illness.
- Doesn’t account for reasons of risk factors or circumstances
- Impact of the illness on the quality of life
- Doesn’t show why patterns or inequtities exist
- Data may be incomplete, inconsistient etc
Social justice principles
Principles which promote equity, diversity and supportive environments.
-They aim to increase autonomy and empowerment by increasing participation, access to health resources and information, and ensuring diversity to take into account people’s cultural beliefs.
Where are the social justice principles applied is Aus society?
Medicare: Public health care for all Australians is provided at no or little cost to the individual under medicare.
- Medicare safety net: A pre-determined amount set by the Australian Government for which medical expenses are subsidised once an individual or family have incurred the medical costs.
- PBS (Pharmaceutical Benefits Scheme):Prescription treatments considered to be lifesaving or for chronic illnesses are subsidised under the PBS (Cheaper medication- all people have access to equitable health)
Priority population groups
Priority population groups are identified as groups within Australian society who experience health inequities.
- these groups are identified as experiencing poor health with the implementation of the social justice principles, such groups should have equitable access to health.
- Promotion strategies must be put in place
Costs to the individual and community
When identifying priority health issues, its essential to identify the cost of the disease, illness or injury to the individual and the community- doesn’t have to be in a monetary sense
- Health issues have both direct and indirect costs to the individual and the community.
- When the health issue has a high cost to either the individual or the community then this gives reason as to why it is a priority
What are individual and community costs (direct and indirect)?
ID-Cost of medication, diagnosis, treatment, loss of income
II-The emotional stress, depression, burden on others (family and friends) and a reduced quality of life, social and emotional impact, emotional trauma of loss, lifestyle changes
CD-The cost of hospitalization, Medicare, prevention programs, pharmaceuticals, education and screening
CI-The cost of forgone earning, retraining replacement workers, absenteeism
Prevalence of a condition (IHI)
Priority health issues can be determined by how prevalent the health condition is.
- In Australia, this is usually concerned with chronic disease, injury and mental health issues
- These can place a burden on a population and due to this, it is important to priorities health funding and resources in these areas.
Potential for prevention and early intervention
- When identifying priority health issues it is essential to identify which issues are more likely to be preventable
- In the long run- resources can be used elsewhere
- Most health issues in Australia are caused by modifiable (preventable) risk factors (smoking, high fat diet, drinking etc)
- Early intervention strategies enable diseases to be identified before they become an increasing burden on a population
ATSI health issues extent and nature
When compared with non ATSI people, ATSI people have:
- An increased mortality rate
- Decreased lfie expectancy
- Increased youth suicide
- Increased kidney disease
- Increased chronic disease (Higher rates of cancer, diabetes and cardiovascular disease)
SC deteriminant- ATSI
History of being oppressed and exploited, intergenerational trauma.
- Still experiencing the consequences of the Stolen Generation- severing cultural, spiritual and family ties, Subject to racism and discrimination- low self-esteem and poor mental health, more likely to participate in excessive alcohol consumption and tobacco smoking.
- Increased domestic violence, disempowerment, decreased income effecting family life and relationships
SE determinant- ATSI
Low income, low education, no graduation from yr12 ( half as likely), low health literacy and awareness, unemployment
ENV determinant- ATSI
Remote areas, low medical access, labour intensive work opportunities, injury, waiting times, overcrowding (COVID), inadequate infrastructure
Individuals- ATSI
- Individuals have the responsibility to access information and participate in health promotion activities that are available to them- making choices that promote good health
- For example, eating healthy, engaging in physical activity
- Many communities are also encouraging ATSI people to pursue cares in health care to create strong support networks of health in ATSI communities.
Communities- ATSI
-Communities must work together to promote better health- involvement in design and implementation of health initiatives, Aboriginal medical services, Australian Indigenous Doctor’s Association, Community health initiatives should,
-Encourage community participation
Provide support for groups
-Creating awareness
-Working close with health professionals
-Reflecting the culture and values of the Indigenous community.
Governments- ATSI
-Responsible for creating health policies and health initiatives
-Improvements to infrastructure (housing, water, electricity, sewerage, transport)
-There are government agencies dedicated to improving the health of Indigenous Australians
The Office of Aboriginal and Torres Strait Islander Health (OATSIH)
Close the Gap iniative
Indigenous Chronic Disease Package
SC determinant- RAR
Greater ATSI population
- Family behaviours smoking and alchohol consumption
- Geographical isolation aids in children being raised in communities with higher smoking rates and rates of drinking- community and low health literacy
SE determinant- RAR
Decreased access to education and employment- especially at the tertiary level and limited opportunities for jobs
-Limited access to goods and services, such as healthy fresh food, heavy labour employment- mining, machinery, agriculture- physically laborious
ENV determinmant- RAR
Highrates of injury.
- Geographic and social isolation -decreasd access to health professionals- health facilities, specialist services and screening, increased need for transportation to such services
- Low health literacy leads to lack of health services access
- Environmental factors such as droughts, floods and bushfires.
- Occupational hazards in rural industries.
- High rates of accident and death in farming
- Poor access to health services.
Individuals- RAR
- Autonomy and self efficacy
- Decision making
- Remaining in school (CSU)
- Encouraging choices such as not smoking
Communities- RAR
Communities can address the health inequities by providing relevant health care and support services. This includes the development of Multi Purpose Service Programs that often connect with community services, and the development of community health centres with the services they offer.
Governments- RAR
- Funding of services- RFDS, Rural and remore general practice
- SARRAH
Nature- What is arterio and atherosclerosis?
Blood vessels HARDEN and lose their elasticity- narrowing of the arteries
Blood vessels become BLOCKED by fat or cholesterol- reducing or preventing blood flow
CHD and PVD
-Caused by a reduced supply of blood to the heart as coronary arteries narrow- could be a result of atherosclerosis
Affects the blood vessels in the limbs as the vessels becpme blocked or damaged- risk factors of smoking and diabetes.
Risk and protective factors for CVD
Age -Gender-Hereditary -Smoking-High fat diet -HBP -Obesity
High blood cholesterol -Lack of physical activity- sedentary lifestyle
Regular physical activity- Low fat diet -Low alcohol consumption -Low saturated fat diet- Low-salt deit- Stress management -Avoiding smoking
SC- CVD
- Men are less likely to access health care and ignore the symptoms of CVD
- ATSI, rural and remote peoples and low SES
- Family history- family habits
- Media exposure to effects of risk behaviours- smoking and diet
- Cultural diets- Asian (low fat)
SE- CVD
- Low SES or unemployed
- People in stressful working roles- high stress jobs
- People with low or no education levels
- Lack of physical activity, tobacco smoking, alcohol consumption- more inclined to eat cheap, fatty fast food as it is cheap.
ENV- CVD
Rural and remote people have decreased access to health services and information
- People in cities have increased access to health services and facilities
- Less preventative and treatment services available.
Groups at risk of CVD
People of low socioeconomic stauts, ATSI, Males, people over 65, smokers, high fat diet and low levels of physical activity, HBP, history of CVD
What is cancer?
Condition in which the body’s cells divide -Uncontrollably- random multiplication forms tumors and interrupts the normal function of the organ where it is located (skin, breast, lung etc) and can spread to other parts of the body
-Cancer can also be caused by carcinogens- radiation, alcohol, tobacco smoke
BC- P and R
- Regular mammograms and self breast examination to check for tumours
- Diet high in fruits and vegetables, as well as a low fat diet
-High fat diet, physical inactivity, late first pregnancy and not having children
LC- P and R
- Avoid or quit smoking tobacco
- Avoid exposure to hazardous materials
- Smoking and tobacco use
- Being exposed to second hand smoke (passive smoking)
- Occupational exposure
- Air pollution
- Gender, age, family history of lung cancer
SC- P and R
- Avoid excess sunlight- wearing sun protection (SPF, sunglasses, shade, covering clothing, wearing a hat)
- Monitoring sun exposure times
- Getting moles frequently checked
- Unprotected exposure to the sun
- Fair skin, moles
Cancer- sociocultural
- Family history
- ATSI: lung cancer- high smoking rates, cervical cancer- access to preventative treatment
- Increase health promoting behaviours to decrease risk
Cancer-socioeconomic
- Low SES or unemployed
- People who work outdoors (sun) or in certain industries where they may be exposed to carcinogens (asbestos removal)
- Low education levels and levels of health literacy
Cancer- environmental
-Rural and remote people have decreased access to health services and information (pre-screening)-People in cities have increased access to health services and facilities
Groups at risk (Bc, Lc, Sc)
Bc- Women who have no babies, obesity, 50 years old, early menstruation
Lc- Smokers, blue collar workers, absestos, over 50 years of age
Sc- lower latitudes, fair skinned people
Mental health nature and extent
Include a wide range of mental disorders-most prevalent being anxiety, affective dirosrders (like depression, substance abuse disorders (alcohol dependency), etc
- Can range in severity- determined by diagnosis
- Mental health problems and illnesses impact people’s ability to function socially, emotionally and cognitively
-45% of Australians between 15-85
Risk factors- mental health
Genetics, chemical imbalances in the body, hard life experiences, poor up-brining or family relationships, and drug use.
Protective factors- mental health
Positive social life, positive relationships, positive sense of self, self-control, good support networks, and resilience.
Groups at risk- mental health
Males
ATSI males
People who have suffered from traumatic life experiences
People with a family history of mental health problems and illnesses
People of low socioeconomic status
Young people (16-24) particularly males
Impact on the workforce- healthy aging
- Increased use of health services means an increase in our healthcare workforce
- More nurses, GPS, cleaners, caterers, physios, osteos, OTs- trained specifically for aged care
- The efficiency of the system must be improved- dealing with more patients
- Living Longer, Living better aged care reform package- Attraction, Retention, Renumeration, Education and Training
Impact on volunteers- healthy aging
- Volunteers can be informal: family, community groups
- Formal: Meals on wheels, Anglicare, Alzhiemer’s Australia
- Betweem 1995 and 2010 volunteer rates were icnreasing hoever between 2010-2014, these reates decreased to 31% from 36%.
- AGED CARE REFORM: increasing volunteer support networks, providing volunteers with training and support- similar to paid workforce
Impact of a growing population on carers
Community aged care packages- provides low level care giving basic support and assistance with daily activites
- Extended aged care at home- provifing a higher level of care than the community care package
- Extended aged care at home dementia- catering for the more complex needs of those with dementia
Institutional and non-instituitonal healthcare
I: Hospitals, public, private, psychiatry, nursing homes, ambulances
NI: GPs, specialists, dentists, allied health, community, research
Federal government responsibility for health services and facilities
- Provides policies and legislation
- Finances and funding to state hospitals
- Medicare and the pharmaceutical benefits scheme
- Health promotion initiatives and taxation
State government responsibility for health services and facilities
- Hospitals (womens and mental health, ATSI and dental)
- Health promotion
- Legislation and laws
Local government responsibility for health services and facilities
- Policies (WHS and community spaces)
- Community health clinics and services
- Support and volunteer groups- mens sheds etc
Aus- equity of access to HC and services
- AusGov aim to provide equitable HC
- Geo location and low education rates can decrease access
- ATSi population and facilities
- PBS MC
- RFDS
- Socioeconomic status
Expenditure for health intervention and prevention
- Early intervention and prevention refers to money spent on intervention during the early stages or disease, or preventing a disease from happening at all
- The determinants for chronic disease, injury and illness are modifiable
- Preventative cancer screening
- PBS- access= preventative
Impact of new and emerging technologies on health care
- Improvements in medical technology and treatment assist in decreasing the burden of disease by improving early detection and treatment of diseases, illnesses and injuries
- Cleft lip and palate scheme, CD benefits scheme, low ses miss out on these technologies
- HPV vaccines, key hole surgery, joint replacements, HIV medication, 3D imaging
Health insurance- medicare and private
- Medicare subsidises health care so individuals can access hospital care and most primary health expenses.
- Individuals who invest in private health insurance are not required to pay the Medicare levy and receive government rebates towards their insurance
- Dec gov expenditure
- SJ issue- discrepancy for low SES and high SES populations
Medicare examples
- Public hospital care
- Public hospital accommodation
- GP
- Child dental care
- Optical eye tests after surgery
- Prescription medicines
- Tests needed to treat illness- x ray and ultrasound
Private health insurance examples
- Private hospital care and accomodations
- Public hospital care accomodations
- Elective surgery
- Ambulance
- Allied health services- physio, dental, optical, massage and chiro
Alternative and complementary HC
Health care which is used instead of conventional medicines.
Health care which is used along side of or as well as conventional medicines.
Why have alt and compl health care approaches grown?
- WHO recognition
- UTS research centre for CAM
- Empowerment over HC choices, ineffectiveness of modern med, widespread availability of natural remedies, holistic notion of health, societal acceptance, migration of Chinese culture etc, pluralistic and individual society, internet access for personal research
Examples of CAM
-Acupuncture (needles), aromatherapy (oils), chiro (alignment, nervous, musculo), herbalism (plants), iridology (human eye), massage, meditation
Making informed consumer chocies regarding CAM
- Due to inconsistient regulation
- Evidence, treatment available, qualifications, experience and training, cost, private health insurance, complementary with medicine
What is the crux of health promotion?
Aims to educate people and equip them with the skills needed to have autonomous decisions about their health
-Ultimately improves the health status of individuals- reducing incidence and prevalence of diseases
Creating supportive environments
Increases an individuals ability to make health promoting choices
Building health public policy
Decisions for health promotion made by all levels of Government and NGO’s
Strengthening community action
Empower communities to implement action to address specific health needs
Reorienting health services
Shift from curative treatment-based health care to preventative health care
Developing personal skills
Improving personal and social development
OC Fed gov
Responsible for building public health policy, developing infrastructure and funding health promotion in order to create an environment that supports the improvement of health of all Australians
OC State gov
- Responsible for implementing public health policy that the federal government has developed, as well as delivering adequate health services throughout their respective states or territories
- Endorsing health promotion iniatives
OC Private sector
- Responsible for monitoring health promotion and ensuring that it is a healthy environment that supports the community’s wellbeing
- Ensuring the community has adequate access to health services and goods
OC Communities
- Responsible for the direct implementation of health promotion iniatives and ensuring that members of the community are actively participating
- HP is most effective when there is strong community action
- Eg. Meals on wheels
OC Individuals
- Responsible for developing personal skills by implementing what they learn through health promotion in their own lives
- For instance, adopting a healthy lifestyle by participating in daily physical activity and eating a healthy diet can prevent CVD and cancer
Benefits of intersectoral collaboration and HP partnerships
- Address social determinants outside the control of the health care system
- Improved population health and wellbeing
- Reduced demand for health care and services
- Collection of resources, knowledge and expertise, development of networks
- Allows partners to address current problems more effectively
- Respond better to future health problems
- Helps identify individual and community health priorities
- Better use of funding and resources
(SJP/HP) Developing personal skills
E: Inc access to HC and medicare
D: Providing HC info and education in various languages to promote efficacy
SE: Health info shared with community and family
(SJP/HP) Developing personal skills- Examples (NTS)
- Providing individuals with information about the health consequences of tobacco smoking, such as lung cancer and other respiratory diseases
- Empowering autonomy, allowing them to develop better heath habits that will prevent them from smoking tobacco.
(SJP/HP) Reorienting health services
E-Professional explore inequities to focus on prioritiy areas to reorient
D- Preventative services in culturally diverse communities
Multi-functioning facilities, remote doc services
(SJP/HP) Reorienting health services- Examples (NTS)
- Preventing people from smoking in the first place
- Clinics provide services such as Quit Now (gov)
- GPS prevent people from beginning to smoke
(SJP/HP) Strengthening community action
E-Access to community health groups increases the empowerment of individuals
D-Communities action for increased medical services and facilitates from government funding which are specific
SE-Increased access to services and facilities which promote empowerment e.g. walking trails, public pools, mental health services
(SJP/HP) Strengthening community action- Examples (NTS)
- Quit Now and Quit Line
- Anti-smoking workshops within at risk communities
- Anti-smoking meetings and workshops in community centres
(SJP/HP) BHPB
E-The increase of policies specific to improving health equity and outcomes allows for better health for all
D-Policies ensure that there is an adequate minimum level for health care for all Australian’s and specific policies where needed e.g. Close the Gap
SE-Policies are developed to support preventative health care and a supportive environment e.g. smoking laws, school speeding zones
(SJP/HP) BHPB- Examples (NTS)
- Government’s implementation of legislation aids in the building of healthy public policy
- Introduction of plain packaging where the brand of tobacco can’t be displayed no the boxes or made attractive to purchase
(SJP/HP) CSE
E-By taking care of others in the community, support, empowerment and health outcomes are increased
D-A diverse range of community groups and local government support increases access and the diversity of health services and facilities available
SE-provide opportunities for individuals and groups to become engaged in positive health decision making e.g. outdoor facilities and access to health information
(SJP/HP) CSE- Examples (NTS)
-Creating nonsmoking areas to encourage environments that promote good health
Mental health determinants (Sociocultural)
SC: Broken dysfunctional families and communities, history of mental health, communities where its bad to talk about feelings, high stress environments
Mental health determinants (Socioeconomic)
Mental health problems and illnesses are commonly associated with economic disadvantage, unemployment or under-employment, homelessness and reduced productivity. -Poor up-bringing and lower socioeconomic status, including homelessness. Furthermore, people who work in high stress jobs are more likely to suffer a mental health problem or illness.
Mental health determinants (Environmental)
-Geographic location and access to health services and technology. People living in rural areas have less access to mental health services and also have a culture of a tough male who does not suffer emotionally or mentally.
RURAL MENTAL HEALTH EXAMPLE
- RURAL ADVERSITY MENTAL HEALTH PROGRAM
- Connecting to psychologists through telehealth, online resources, outreach programs, destigmatisation from rural men,
