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PDHPE Y12 > Core 1 IQ1: How are priority issues for Australia's health identified? > Flashcards

Core 1 IQ1: How are priority issues for Australia's health identified? Flashcards

1
Q

Why is it necessary to identify health priority issues within a population?

A

Necessary to understand the health status of that population and its subgroups.

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2
Q

What is the health status of a nation?

A

It is the pattern of health of the population in general over a period of time.

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3
Q

What is a way to measure health status?

A

Using epidemiology

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4
Q

What is epidemiology?

A

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined population, through the collection of data from hospitals, health care practitioners.

Focuses on the more negative qualities of health and wellbeing as opposed to the positive such as patterns of illness, injury etc

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5
Q

Who uses epidemiology?

A

Used by governments and health-related organisations to obtain a picture of the health status of a population, to identify patterns of health and disease and analyse how health services and facilities are being used

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6
Q

Why is epidemiology important?

A

It can help shape policy decisions and evidence based practice by identifying risk factors for disease and targets for preventative healthcare

Provides a basis for investigating issues such as the impact of social, cultural and eco factors that support health or cause disease

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7
Q

What are the measures of epidemiology?

A

Mortality, infant mortality, morbidity, life expectancy

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8
Q

Does epidemiology measure everything about health status? What are it’s disadvantages? (5)

A

No. Epidemiology has many limitations. For example, stats and data like epidemiology can be manipulated and is open to bias.

Doesn’t account for the determinants of health; individual, sociocultural, socioeconomic and environmental factors

Fails to explain ‘ why health inequities persist’

Doesn’t always show the significant variations in health status among population subgroups (i.e. Aboriginal and non Aboriginal Australians)

Might not indicate QOL in term’s of people’s level of distress, impairment, disability or handicap. It tells us little about degree and impact of illness

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9
Q

What 4 types of patterns are of a disease are considered? (Describe them)

A

Prevalence - number of cases of disease in a population at a specific time

Incidence - the number of new cases of disease occurring in a population

Distribution - the extent

Apparent causes - determinants and indicators

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10
Q

How can observations and stats from epidemiology help with researches and authorities? (4)

A

describe and compare the patterns of health of
groups, communities and populations

identify health needs and allocate health-care resources accordingly

evaluate health behaviours and strategies to control and prevent disease

identify and promote behaviours that can improve the health status of the overall population, such as eating less fat and more fibre.

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11
Q

What are 5 sources to collect data for epidemiological studies? (just rmbr 5)

A

Disease incidence

Disease prevalence

Contact with health care providers

Hospital use

Injury incidence

Money spent on health care

Births

Deaths

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12
Q

Why might stats from epidemiology have some limitations? (3)

A

The varying reliability of data

Numerous sources of info

imprecise methods of data collection

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13
Q

What is mortality?

A

Mortality is the number of deaths in a group of people or from a disease over a specific time period, usually one year. `

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14
Q

What is morbidity?

A

Examines the prevalence and incidence of disease and sickness in a specific population

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15
Q

What is infant mortality?

A

Indicates the number of infant deaths in the firsts year of life per 1000 live births

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16
Q

What is life expectancy?

A

Indicates the number of years a person is expected to live

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17
Q

What is the trend in life expectancy at birth in Aus?

A

It has been increasing over the past decades

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18
Q

Do females have a higher life expectancy than men?

A

Yes

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19
Q

What is the change in life expectancy for females from ____ to ____?

A

shift from 80.1 in 1990 to 85.3 in 2020

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20
Q

What is the change in life expectancy for males from ____ to ____?

A

73.9 in 1990 to 81.2 in 2020

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21
Q

What was the gender gap in life expectancy in 1990? How has it improved in 2020?

A

Gap of 6.2 years in 1990, to gap of 4.1 years in 2020

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22
Q

What was the global avg life expectancy at birth in 2015 compared to Aus?

A

Global avg; 71.4 years

Aus 11 years higher at 82.4

Gap has been maintained since 2015

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23
Q

What are the causes of reductions in death rates? (4)

A

Can be attributed to:

Lower infant mortality

Declining death rates for cardiovascular disease

Declining overall death rates from cancer

Fall in deaths from traffic accidents

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24
Q

Why is the life expectancy greater now than in the past?

A

This may be because medical knowledge and management has improved not necessarily because some health problems no longer exist.

There is better healthcare and hygiene, healthier lifestyles, improved medical care, access to antibiotics and vaccines, clean water, recognition of sport as important in our life

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25
Q

What has the greater life expectancy led to?

A

It has led to an increased demand for health services that cater for the elderly, an increasing need for nursing homes and the need to provide care for a growing number of dependent people. Has an economically negative impact

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26
Q

What is the trend in infant mortality in Aus?

A

Has been decreasing from the past decades

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27
Q

What are some of the causes of a decline in infant mortality in Aus?

A

Improved medical diagnosis and treatment of illness

Improved public sanitation (unsanitary practices increase the likelihood of getting diseases –> mortality)

Health education

Improved support services for parents, newborn babies and children (i.e. immunisation programmes)

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28
Q

What is the trend in infant death rates from ____ to _____?

A

5 deaths per 1000 live births in 1998 compared to 3.2 deaths per 1000 live births in 2020

A significant decrease from around 70 per 1000 in 1911

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29
Q

What was the difference in infant mortality rate of ATSI to non ATSI in 2018?

A

1.8 times greater for ATSI infants, compared to non-ATSI infants

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30
Q

What are chronic diseases?

A

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time

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31
Q

What are the indicators of morbidity?

A

Hospital use (the cause and number of admissions to hospital)

Doctor visits and medicare statistics (indicates the reasons for doctor vissists and the no. of visits)

Health surveys and reports (provides a range of key health indicators and bring together an extensive range of health information. )

Disability and handicap (incidence of a disease or accident which lead to impairment, disability and handicap, i.e. a person incurring an injury in an accident)

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32
Q

What is a good indicator of morbidity? (HAVE TO DOUBLE CHECK WITH SIR)

A

Chronic conditions

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33
Q

What are some examples of chronic conditions which affect morbidity rates?

A

Coronary heart disease , diabetes, asthma, dementia

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34
Q

What is the change in those with coronary heart disease per 100, 000 from 1980 to 2020 for males?

A

414 –> 68 per 100 000

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35
Q

What is the change in those with coronary heart disease per 100, 000 from 1980 to 2020 for females?

A

209 to 32 per 100 000

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36
Q

What has caused the declining coronary heart disease rates?

A

Linked to reductions in some risk factor levels (including smoking), better treatment and care

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37
Q

What is the change in prevalence of diabetes from 2000 to 2020? (for morbidity) Why?

A

2.4% –> 4.3% in 2020

Caused by sedentary lifestyles and unhealthy dietary changes

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38
Q

What is the prevalence of asthma between 2007 to 2018?

A

Stays at around 10%

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39
Q

What is the change in prevalance of dementia in 2018 to 2022? (for morbidity)

A

219 000 in 2018 with dementia

401 000 in 2022 with dementia

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40
Q

What is the % of multimorbidity (comorbidity) of Australians in 2017-18?

A

20%

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41
Q

What is the trend in the mortality rate from 2000 to 2022?

A

2000 - 128, 300 deaths

2022 - 190, 394 deaths

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42
Q

What is the trend in mortality from coronary heart disease?

A

The general trend is that the death rate has been decreasing - as of 2019, since 1980, CHD death rate has fallen by 42% from 30, 700 to 17, 700

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43
Q

What is the trend in mortality from cerebrovascular disease?

A

Has decreased over time by 82% from 1968 to 2015. From 202 deaths /100, 000 to 36/ 100 000

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44
Q

What are the factors for identifying priority health issues? (2)

A

How much they contribute to the burden of illness in the community

Potential for reducing this burden

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45
Q

What do priority health issues include? (3)

A

The health inequities experienced by certain groups within our society

Our growing and ageing population

High levels of chronic disease and other health problems evident in our society

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46
Q

What is included in determining the disease burden on the community and its potential to be reduced? (5)

A

Social justice principles

Priority population groups

Prevalence of the condition

Potential for prevention and early intervention

Costs to the individual and community

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47
Q

What are social justice principles?

A

refer to values “that favour measures that aim at decreasing or eliminating inequity; promoting inclusiveness of diversity; and establishing environments that are supportive of all people.”

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48
Q

What do the social justice principles include?

A

The social justice principles include:

equity,
diversity, and
supportive environments.

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49
Q

What does equity mean? Example

A

Equity means that the resources are allocated in accordance ith the needs of individuals and populations with the desired goal of equality of outcomes

PEOPLE GET ACCESS TO SAME OPPORTUNITIES

Results in particular groups within Aus receiving more funding and being identified as priority groups in Aus because they have poorer health outcomes such as ATSI people receiving greater funding

50
Q

What do supportive environments mean? Example?

A

Supportive environments are environments where “people live, work and play that protect people from threats to health and that increase their ability to make health-promoting choices.”

51
Q

What does diversity mean? Example- how?

A

Diversity refers to the differences that exist between individuals and people groups. Australia is a very diverse multicultural country, which requires a number of measures to be in place to ensure each people group has access to health care and achieves good health outcomes.

Providing brochures in multiple languages and having interpreters in hospitals are examples of being inclusive of diversity.

52
Q

What is the purpose of social justice principles?

A

Seeks to recognise and address both the health outcomes such as incidence

53
Q

What are examples of population groups which are achieving poorer health outcomes compared to the rest of Aus?

A

Cultural groups such as Aboriginal and Torres Strait Islanders (ATSI), elderly, those with low socioeconomic status. People with poor health outcoms often fit into multiple priority groups.

54
Q

How is epidemiology used to address the health of priority population groups?

A

Allows the gov, other organisations, and researchers to identify priority population groups that need extra resources in order to remove the gap in health outcomes

55
Q

What is an example of epidemiology used to discover priority population groups regarding certain health outcomes? (4)

A

Males have higher rates of cancer than females

ATSI males and females can expect to live 10 years less than other Australians

People in remote areas have higher death rates than those in urban areas

Lower oral health found in people of lower socioeconomic status

56
Q

What is an example of using health programs to help improve the health outcomes of those in priority population groups?

A

An example is the Royal Flying Doctors service which functions in remote areas to provide better access to health services, improving the health outcomes of the rural priority group which has been shown to have higher death rates than does in urban areas due to lack of access to health

Also development of programs like Telehealth improving access to healthcare services for those in rural areas

57
Q

How is the identification of priority population subgroups with inequitable health status important for determining health priority issues? (4)

A

Allows health authorities to:

Determine the health disadvantages of groups within the population

Understand the social determinants of health

Identify the prevalence of mortality and morbidity in specific groups

Determine the needs of groups in relation to the principles of social justice

AND JUST IN GENERAL ALLOWS FOR THEE IDENTIFICATION OF HEALTH PRIORITY ISSUES FOR CERTAIN SUBGROUPS OF PEOPLE

58
Q

What is prevalence?

A

Number or proportion of cases in a population at a given time. The prevalence of a condition is used to determine the number of people affected by the health issue

59
Q

How is prevalence used to identify priority health issues?

A

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 Aus

It will allow us to identify risk factors, and this identification can indicate the potential for change in a health area

60
Q

What is incidence?

A

Very different to prevalence, and refers to the number of new cases diagnosed in a specific time period and is helpful to understand the current trends in diseases

61
Q

What are some current condition which are high in prevalence and have become priority health issues? (5)

A

Cardiovascular disease - Has been a priority health issue for a long time in AUs, and will continue to be into the future

Cancers - Has been growing priority in Aus, although the decreased smoking rate is helping

Dementia - Affects many Australians today particularly the elderly

Diabetes - Increasing incidence, making it very high priority issue for Aus health

Cerebrovascular disease - Continues to be a major health issue

62
Q

What is the cause for the majority of diseases and illnesses suffered by Australians?

A

Result from poor lifestyle behaviours. These lifestyle behaviours often reflect the environmental situation in which the individual lives

63
Q

What are some determinant of health inequities in Aus?

A

Socioeconomic status, access to information and health services, employment status, housing, support networks and environmental infrastructure

64
Q

What is needed to create change and prevent or intervene earlier with diseases?

A

For change to occur, we must address both individual behaviours and environmental determinants. Most chronic diseases, injuriees have social and individual determinants that can be modified so prevention and early intervention may lead to improved health status

65
Q

What is health promotion?

A

It is the process of enabling people to increase control over and to improve their health

66
Q

What is the difference between prevention and early intervention?

A

Prevention - Attempting to prevent problem from arising in the first place

Early intervention - providing support at the earliest possible stages when health problems do occur, to help minimise the impact

67
Q

What is an example of prevention?

A

Attempting to reduce smoking in order to reduce diseases that are linked to and caused by smoking such as COPD, Cerebrovascular disease and Lung cancer

68
Q

WHen should prevention and early intervention be used?

A

Prevention should be the first course of action, any health governing body wants to insure that the illness doesn’t initially happen, however after that, early intervention is preferable to help prevent the disease from worsening

69
Q

What is an example of early intervention?

A

All cancers (especially bowel cancer, as seen in Aus gov free testing kit)

Cardiovascular disease

Musculoskeletal conditions such as arthritis

70
Q

What is Australia’s free testing kit for bowel cancer? What is the purpose? (EXAMPLE)

A

It is a form of early intervention. Essentially, the Aus gov sends out free bowel screening tests to individuals above 50 every two years. This has beneficial impacts as screening for bowel cancer can reduce deaths from the disease by between 15% and 25%

71
Q

How do diseases/illnesses place eco and health burdens on the individual?

A

Cost of treatment, medication and rehab may be more than individual can afford. May also affect the individual’s ability to be productive. Reduces the individual’s ability to earn and maintain their QOL

Causes emotional stress and social upheaval.

I.e. ) Expenses, time, independence and connection with other issues such as mental health

72
Q

What are the two ‘costs’ of illnesses to the community?

A

Direct and indirect costs

73
Q

What are direct costs for the community?

A

Money spent on diagnosing, treating and caring for the sick, plus the money spent on prevention.

As community pays for this kinda stuff with their taxes

74
Q

What are the indirect costs for the community?

A

The value of the output lost when people become too ill to work or die prematurely (i.ee. the cost of forgone earnings, and retraining replacement workers)

75
Q

What is an example of a high and low cost disease?

A

High - CVD (cardiovascular disease)

Low - musculoskeletal issues such as osteoarthiritis

76
Q

Why is CVD considered a high cost disease?

A

Very expensive to treat, often involving large surgical procedures, lengthy recovery periods, etc.

Has high costs to the community, as community pays for surgery through Medicare taxes. Company loses money as they pay for sick leave and for someone to cover them. Also cost to family and friends who may be anxious about relative’s health and may be needed to be a carer for the person

77
Q

Why is osteoarthritis considered low cost?

A

Although its painful, it doesn’t require people to take time off work or have surgery. It doesn’t cause too many mental disorders such as depression and doesn’t create too much stress for family and friends

78
Q

How are priority issues for Aus’s health identified?

A

The government uses the principles of social justice, considers the costs of the issue for individuals and the community, as well as the prevalence of the condition and potential for prevention or early intervention that will reduce the impact or occurrences of the issue.

The government also considers particular population groups that may need to be prioritised because of gaps in quality of health.

79
Q

What are the direct and indirect costs of illness on an individual?

A

Direct: Cost of medication and treatment, and loss of income

Indirect: The emotional stress, depression, burdens on others, and reduced QOL

80
Q

What role do the principles of social justice play?

A

Principles of social justice in health care focus on eliminating inequity in treatment and care.

81
Q

Why is it important to prioritise health issues?

A

Allows fair allocation of resources and funding. Applying principles of social justice enables identification of priority population groups and seek to provide funding and resources to create supportive environments to improve health

It is also important to ensure that money and resources aren’t wasted. Principles of social justice and priority population groups are identified. Funding should go towards diseases that are prevalent in society and that have a large cost on the individual and community. Has to be allocated to high cost issues such as CVD cancer diabetes or dementia to ensure greatest impact of resources and funding

Ensure that we target issues that can be prevented, or wherre early intervention has a large impact on the cost of the disease for both individuals and community. Ensure wwe prioritise health issues where prevention is possible such as type 2 diabetes, or where early intervention has a large impact on health outcomes (cancer)

Therefore, it is important for Australia to prioritise the health issues to ensure that resources and funding are not wasted and to ensure we are moving towards fair and equitable health for all Australians. Prioritising health issues ensures the greatest impact of the health promotion on Australia’s health.

82
Q

What will determine a priority health issue using social justice principles?

A

Means that the differences between individuals and people groups are considered and addressed, and thus a certain health issue is determined by looking at the prevalence of certain diseases of different disadvantaged groups

Identification of certain people groups and considering each individual people group to identify health issues which are specific to them, because epidemiology helps explain their health issues

83
Q

Why is the prevalence of the condition also considered in identifying priority health issues in Aus?

A

If the issue is prevalent, it will become a priority so that the health of more people is improved by addressing the one issue. I.e targeting smoking rates to reduce CVD

84
Q

How does the potential for early intervention and/or prevention affect identification of priority health issues?

A

If a health issue can be preventd through changes in lifestyle etc, that health issue will be more prioritised as it can prevent deteriorating health. Prevention is always better than early intervention. Early intervention for diseases such as cancer also have beter survival rates if cancer is found early and treated ealry, and thus early intervention can help to improve health outcomes

85
Q

How does the costs to the individual and the community affect the identification of priority health issues?

A

A health issue which has a high cost for the individual and the community is more likely to be prioritised as it will provide the most benficial impact for the individual and the community, meanwhile smething that has a low cost wont have as beneficial of an impact

86
Q

What is the overall leading causes of mortality in Aus? (2020)

A

2022:
1. Coronary Heart disease; 16587
2. Dementia, including Alzheimer; 14575
3. Cerebrovascular disease; 9470
4. Lung Cancer; 8457
5. COPD

2020:
1. Coronary Heart disease; 15, 604 (61/ 100, 000)

  1. Dementia, including Alzheimer; 14 464 (56/100, 000)
  2. Cerebrovascular disease; 8 994 (35/100, 000)
  3. Lung Cancer; 8013 (31/ 100, 000)
  4. Chronic Obstructive Pulmonary Disease (COPD); 5, 910 (23/ 100, 000)

(https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia)

87
Q

What is coronary heart disease?

A

Damage or disease in the heart’s major blood vessels.

The usual cause is the build-up of plaque. This causes coronary arteries to narrow, limiting blood flow to the heart.

88
Q

What is the trend + data of CHD mortality rates for males? (1980-2019)

A

It has been declining by around 80%, falling from 414 to 73 per 100, 000 population

In 2010, caused 16% of death –> 11.9% of death

89
Q

What is the trend + data of CHD mortality rates for females? (1980 - 2019)

A

Falling from 209 to 37 per 100 000 population for females

Fell from 14.3% of total deaths in 2010 to 8.5$ in 2020

90
Q

What is the overall trend in deaths due to dementia?

A

Increased from 9200 in 2010 to 14500 deaths in 2020

91
Q

What is the trend + data of dementia mortality rates for males? (2010-2020)

A

Increase from 3, 049 to 5, 346 people

Increase from 4% in 2010 to 6.2% in 2020

92
Q

What is the trend + data of dementia mortality rates for females? (2010-2020)

A

Increase from 6, 148 to 9, 118

Increase from 8.7% in 2010 to 12.2% in 2020

93
Q

Is stroke the same as cerebrovascular disease?

A

It is a major subset of Cerebrovascular disease, and contributes to the large number of cerebrovascular diseases

94
Q

What is the change in number of stroke deaths from 1980 to 2019? (generally)

A

Declined by 30%, from around 12, 100 to 8, 400

95
Q

What is the trend + data for stroke/cerebrovascular disease mortality for men?

A

1980 - 2019; Fell from 108 to 24 deaths per 100, 000

2010 - 2020; 5.9% of total deaths –> 4.7% of total deaths

96
Q

What is the trend + data for stroke/cerebrovascular disease mortality for women?

A

1980 - 2019; Fell from 98.8 to 25.4 deaths per 100, 000

2010-2020; 9.8% of total deaths to 7.2% of total deaths

97
Q

What is the general trend in mortality from lung cancer?

A

It has been decreasing from ~42/ 100 000 in 1982 to ~27/100 000 in 2020

98
Q

What is the trend + data for lung cancer mortality for men?

A

Dropped from ~80/ 100, 000 to ~32/ 100 000 (from 1982 to 2020)

Decreased from 6.7% of all deaths in 2010 to 5.6% of deaths in 2020

99
Q

What is the trend + data for lung cancer mortality for women?

A

Increased from ~16/ 100 000 to ~21/ 100 000 (from 1982 to 2020)

Increased from 4.5% of all deaths in 2010 to 4.8% of deaths in 2020

100
Q

What is the trend in COPD (Chronic obstructive pulmonary disease)?

A

Has decreased dramatically

101
Q

What is the trend + data for COPD mortality for men?

A

For men aged 45 and over, it has decreased from 228 to 76 per 100 000 people (1980 to 2018)

Stagnated at around 4.1% of total mortality in males (from 2010 to 2020)

102
Q

What is the trend + data for COPD mortality for women?

A

Slight increase from 3.5% to 3.7% of total mortality in females (from 2010 to 2020)

103
Q

What is the ranking of the leading causses of mortality for men?

A

Coronary Heart Disease (74 / 100 000)

Dementia (42/ 100 000)

Lung Cancer (35/ 100 000)

Cerebrovascular disease (30/ 100 000)

Prostate cancer (27 / 100 000)

104
Q

What is the ranking of the leading causes of mortality for women

A

Dementia ( 70 / 100 000)

Coronary Heart disease ( 48 / 100 000)

Cerebrovascular disease (40 / 100 000)

Lung Cancer (27 / 100 000)

Breast Cancer (23 / 100 000)

105
Q

What are the age groups to know the leading 3 causes of death (8)

A

Under 1, 1-14, 15 - 24, 25-44, 45-64, 65 - 74, 75 -84, 85+

106
Q

What are the top 3 causes of death for Australians under 1?

A

Perinatal and congenital conditions

Other ill defined causes

Sudden infant death syndrome

107
Q

What are the top 3 causes of death for Australians 1-14?

A

Land transport accidents

Perinatal and congenital conditions

Brain cancer

108
Q

What are the top 3 causes of death for Australians 15-24?

A

Suicide

Land transport accidents

Accidental poisoning

109
Q

What are the top 3 causes of death for Australians 25-44?

A

Suicide

Accidental poisoning

Land transport accidents

110
Q

What are the top 3 causes of death for Australians 45-64?

A

Coronary Heart disease

Lung cancer

Suicide

111
Q

What are the top 3 causes of death for Australians 65-74?

A

Lung cancer

Coronary heart disease

Chronic obstructive pulmonary disease

112
Q

What are the top 3 causes of death for Australians 75-84?

A

Coronary Heart disease

Dementia including Alzheimer’s disease

Lung cancer

113
Q

What are the top 3 causes of death for Australians 85+?

A

Dementia including Alzheimer’s disease

Coronary Heart disease

Cerebrovascular disease

114
Q

What is the trend in road fatalities? WHy?

A

It has been decreasing, as various changes to our roads have been implemented such as tougher laws on speeding and P Plate system. Also seat belts made compulsory in cars and introduction of speed cameras have decreased road fatalities

115
Q

What stat can be used to show morbidity?

A

You can use burden of disease

116
Q

What is the rank in the top 5 disease causing burden of disease in 2022?

A

Coronary Heart disease

Dementia

Back pain

COPD

Anxiety disorders

117
Q

What are the top 10 chronic conditions in terms of prevalence and give a percentage

A

Mental and behavioural conditions - 20.1%

Back problems - 15.7%

Arthritis - 12.5%

Asthma - 10.7%

Diabetes - 5.3%

Heart, stroke and vascular disease - 4%

Osteoporosis - 3.6%

Chronic Obstructive pulmonary Disease (COPD) - 1.5%

Cancer - 1.6%

Kidney disease - 1.1%

118
Q

What are the top 4 leading causes of burden of disease

A

Cancer - 18%

CVD - 13%

Mental illness - 12%

Injury and poisoning - 8%

119
Q

What is the trend in morbidity for CVD, CHD and cerebrovascular disease? WHat is the trend in mortality?

A

All of them are decreeasing in morbidity

All of them are decreasing in morttality

120
Q

What is the morbidity trend for cancers (lung, colorectal, prostate, breast, melanoma)

Trend in mortality?

A

Morbidity: Lung - stagnated, Colorectal - decrease, Prostate - decrease, Breast - stagnate, Melanoma - increase

Mortality: Lung, colorectal, prostate and breast cancer are decreasing whereas melanoma is stagnating

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