Health Priorities in Australia Flashcards
Measuring health status
- role of epidemiology
- measures of epidemiology (mortality, infant mortality, morbidity, life expectancy)
- role of epidemiology
The study of rates and patterns of illness, disease and injury among specific population groups.
- The information monitors major disease rates, identify the areas of need, determine priorities, health care facilities and evaluate the effectiveness of health care
- Identification of specific trends is then used to establish health priorities.
- Epidemiology is used by governments, doctors, hospitals, manufacturers of health products, pharmaceutical companies, individual consumers
- measures of epidemiology
Mortality
- The number of deaths for a given cause in a given population, over a set time period.
- Main causes - coronary heart disease (CHD), Alzheimer’s and dementia, stroke and lung cancer.
- Males - CHD, lung cancer, dementia & Alzheimer’s, stroke, chronic obstructive pulmonary disease-COPD
- Females - dementia and Alzheimer’s, CHD, stroke, lung cancer, COPD.
Infant mortality
- The number of deaths in the first year of life per 1000 live births.
- 4.1 infant deaths per 1000 live births in 2010 and is decreasing at a steady rate.
Morbidity
- The rates, distribution and trends of illness, disease and injury in a given population.
- Main causes - CVD, mental health problems, back pain and problems, arthritis and asthma.
- Males (48%) - CVD, back pain and problems, mental health conditions, arthritis, asthma.
- Females (52%) - mental health conditions, CVD, arthritis, back pain and problems, asthma
Life expectancy
- An estimate of the number of years a person can expect to live at any particular age.
- A baby born in 2010 is 84 years if female, 79 years if male.
Prevalence
The number or proportion(of cases, instances) in a population at a given time.
E.g. in relation to cancer, prevalence refers to the no. of people alive who had been diagnosed w/ cancer.
Incidence
Refers to the number of new cases diagnosed in a specific time period, usually a year.
Identifying priority health issues
- social justice principles
- priority population groups
- prevalence of condition
- potential for prevention and early intervention
- costs to the individual and community
- social justice principles
- priority population groups
The Australian Government examines social justice principles including equity, diversity, and supportive environments to identify disadvantaged population groups and priority health issues. This allows the government to recognize and address health inequities among certain groups in Australian society to ensure they are a priority for resource allocation required to improve health. E.g. By examining equity, ATSIs can be identified as a priority group that require greater support to achieve health outcomes through initiatives such as Close the Gap
- prevalence of condition
The acknowledgment of the prevalence of conditions by the Australian government identifies diseases and illnesses with a high proportion of a particular population. Epidemiological data reveals the risk factors which indicate the need for change to the government. E.g. As lung cancer is increasing its prevalence within Australia, the government is supporting individuals through the National Tobacco Strategy.
- potential for prevention and early intervention
The identification of priority health issues can be reflective of an individual’s environmental situation. By preventing and intervening with disease and illness it forces the government to make it a priority health issue, hence making treatment of the condition more successful. E.g. Due to increasing rates of type II diabetes the health initiative Girls Makes Your Move encourages women to avoid sedentary behaviour, hence preventing type II diabetes.
- costs to the individual and community
Costs to the individual and community must be examined by the government to articulate the various forms of costs as it often creates a large burden on society. Through taxation and medical bills, the government is able to distinguish and measure the costs needed in the healthcare system. E.g. Cardiovascular Disease(CVD) is very expensive to treat as it requires financial costs for the surgical procedure, recovery time, lack of independence, lack of income, and increased absenteeism to the community.
Groups experiencing health inequities
- ATSI
- people in rural and remote areas
- socioeconomically disadvantaged people
- overseas-born people
- the elderly
- people with disabilities
- ATSI
Nature
- Account for 2.8% of the Australian population mostly in QLD and NSW(2016)
- Areas that ATSI live in major cities, inner rural, rural/remote
- 28% of ATSIs has completed year 12, meanwhile 57.6% of non-ATSIs
Extent Mortality + Infant Mortality - Higher rates for all causes of death. - 1.8 times as likely to die from CVD - Infant mortality rate twice as high Morbidity - 3.5 times as likely to have diabetes - 1.6 times as likely to be obese Life expectancy - 10-12 years lower - 28% had completed Year 12, compared with 57.6% of non-ATSIs.
Sociocultural determinants
- Family: 1.6 times more likely to be obese → children adopt an unhealthy diet and physical inactivity habits of the family.
- Peers: 39% smoke compared to 14% → more likely to conform and adopt these behaviours → lung cancer.
Socioeconomic determinants
- Education: 28% completed Year 12, compared to 57.6% → lack of knowledge of risk and protective factors, ∴ increased risk behaviours. e.g. smoking and physical inactivity.
- Income: 2.5 times as likely to be in the lowest income bracket → inability to make healthy choices e.g. buy fruit and vegetables and private health insurance
Environmental determinants
- Access to health services: 1/9 speak ATSI language at home → difficulty understanding and being understood by healthcare workers → limits their treatment choices and outcomes
- Technology: more likely to live rurally and remotely → poor distribution of medical technology needed for early detection and prevention. E.g. mammograms → lower survival rates.
- ATSI(roles of individuals, communities, and government)
Individual
Individuals have a role in addressing ATSI health as they have a responsibility to participate in protective or risk behaviours that determine the level of health they achieve. When provided with the resources/support to actively participate in their own health education, ATSI can become confident in making positive health choices. e.g. Aboriginal Healthy Lifestyle Program works with local ATSI communities to promote healthy eating and exercising regularly. As an individual demonstrates these healthy lifestyle choices they promote the health of other ATSI people by being a positive role model. E.g by quitting smoking after accessing the Can’t Even Quit mobile app, and influencing others to do the same, ATSI health inequities will be reduced.
Communities
The role of communities in addressing ATSI health inequities is to initiate community activities that provide empowerment over health. These services accurately identify the priorities and values of the community to advocate for change. E.g. the Yiriman project was developed by ATSI elders and delivers strategies that address issues of self-harm and substance abuse in local youth. Communities also provide culturally appropriate healthcare services to create supportive environments where all ATSI’s are enabled to achieve health. E.g. Aboriginal Medical Service is operated by the local community to offer culturally suitable services such as health education and immunisation.
Governments
The Australian government has a responsibility to take modern approaches to organise health services to strengthen preventative health actions. Designing and implementing health initiatives and policies promotes the reduction in health inequities amongst ATSI people. E.g. ABSTUDY offers a group of payments to help with the costs of study for financially disadvantaged ATSI students, hence encouraging education amongst ATSI communities. The government also provides ongoing funding through research and monitoring programs such as the Close the Gap campaign which aims to reduce the indigenous disadvantage across life expectancy, education, infant mortality and employment by 2030.
- Rural and Remote areas
Nature
- Represent 32% of the Australian population(29% rural and remote 3%)
- The main causes: CHD, CVD, motor vehicle accidents and injuries and COPD
- Death rates increase with increased remoteness with the very remote having 1.5 times the rate of major cities.
Extent
Mortality + Infant mortality
- 1.3 times higher death rates in R&R areas
- 2.6 times the higher infant mortality rates
Morbidity
- 69% of R&R people are obese comparatively to 61% in major cities
- 1.3 times more likely to suffer from CVD
- Higher rates of mental health - connected to stigma
Life expectancy
- Decreases with remoteness, 7 years lower for males and 6 years lower for females in very remote areas.
Sociocultural determinants
- Family - 69% overweight or obese compared to 61% children adopt unhealthy diet and physical inactivity habits of family.
- Peers - 26.5% smoke compared to 14.8% → more likely to conform and adopt these behaviours → lung cancer.
Socioeconomic Determinants
- Education - reduced access to education, especially tertiary → lack of knowledge of protective and risk factors, therefore, increased risk behaviours. e.g. smoking and physical inactivity.
- Employment - more likely to have blue-collar employment, especially as farmers and miners → greater exposure to injury in hazardous occupations.
Environmental Determinants
- Geographical location - travel longer distances to access goods and services on poorer quality roads → rate of deaths due to land transport accidents 5.4 times higher.
- Access to health services - 253 employed medical practitioners per 100000 population compared to 409 → reduced access to preventive measures (mammograms) and treatment (chemotherapy).
- Rural and Remote areas (role of individuals, communities, and government)
Individual
Individuals have a role in addressing R + R health as they have a responsibility to participate in protective or risk behaviours that determine the level of health they achieve. When provided with the resources/support to actively participate in their own health education, R + R’s can become confident in making positive health choices. e.g. Beyond Blue online information sources inform R + R individuals about risk factors surrounding mental health issues therefore encouraging them to reduce behaviours such as drug abuse. As an individual demonstrates these healthy lifestyle choices they promote the health of other R + R people by being a positive role model. E.g by enrolling in a Charles Sturt online university course and influencing others to do the same R + R health inequities will be reduced
Communities
The role of communities in addressing R + R health inequities is to initiate community activities that provide empowerment over health. These services accurately identify the priorities and values of the community to advocate for change. E.g. Rural Adversity Mental Health Program is coordinated by R + R people and delivers strategies that address mental health inequities experienced by people living in these areas. Community organisations also aim to improve access to health services in R + R areas. E.g the Royal Flying Doctors Service provides primary health care, emergency aeromedical retrieval, and trusted health advice throughout R + R Australia.
Governments
The Australian government has a responsibility to take modern approaches to organise health services to strengthen preventative health actions. Designing and implementing health initiatives that action positive changes in legislation and funding, promotes the reduction in health inequities amongst R + R people. E.g. The Isolated Patients Transport and Accommodation Assistance Scheme provide financial assistance for people who need to travel long distance for treatment. The government also provides ongoing funding through research and monitoring programs such as the Workforce Incentive Program which encourages doctors to deliver services in R + R areas, through financial incentives.
High levels of preventable chronic disease, injury, and mental health problems
- cardiovascular disease(CVD)
- cancer
- diabetes
- respiratory disease
- injury
- mental health problems and illnesses
- CVD
Nature
All conditions of the heart and blood vessels
- Atherosclerosis - build up of fatty and/or fibrous material on the interior wall of arteries → placing stress on heart ∴ less elastic → increases blood pressure ∴ less oxygen flow
- Arteriosclerosis - the hardening of the arteries whereby artery walls lose their elasticity.
- Coronary heart disease(CHD) - poor blood supply(usual in coronary arteries) to the heart
- Heart attack - the blood flow to the heart suddenly stops, preventing supply of oxygen.
- Myocardial infarction - usually due to blockage
- Coronary thrombosis - obstructing clot within an artery
- Coronary occlusion - sudden and complete blockage of blood and oxygen
- Angina - chest pain as heart has an insufficient supply of oxygenated blood
- Stroke/cerebrovascular disease - blockage of the blood flow to the brain → depriving oxygen ∴ impairing bodily function(paralysis)
- Heart failure - the heart’s inability to cater for the demands placed on it, unable to pump blood as it cannot repair damage of either heart attack(left) or HBP(right)
- Peripheral vascular disease - reduced blood flow to the limbs
Extent Mortality - Leading cause of death - 26% of all deaths in Aus - 1.4 times as high for males as for females
Morbidity
- ¼ deaths due to CVD
- ATSI were 50% higher to have CVD then non-ATSI
- Hospitalisation rates were 30% higher in R&R areas for CVD
Risk and protective factors and groups at risk
Non-modifiable risks
- Family history People with a family history of cardiovascular disease are more prone to developing the disease themselves. (family history)
- Gender: Males are more at risk of coronary heart disease than are females. (males)
- Age: risk increases with age this is often the result of the slow progression of atherosclerosis (elderly)
Modifiable risks
- Smoking - doubles chance of having a heart attack or stroke (blue collar workers).
- Physical inactivity - closely linked to other risk factors(Low SES).
- Hypertension - increased stress on the heart
- High alcohol intake - damages heart muscle
- Obesity/overweight - contributes to atherosclerosis(ATSI)
Protective factors
- Physical activity
- Balanced diet
- Regular doctor visits
- Minimal exposure to tobacco smoking
- Maintain healthy levels of blood pressure and cholesterol
Sociocultural factors
- Family - family history increases risk of CVD
- Peers - influence due to use of alcohol and acts of smoking → conformity
Socioeconomic factors
- Education - lack of education → decreased health literacy and knowledge surrounding informed health choices ∴ increased risk behaviours
- Employment - higher rates of CVD in blue collar jobs as they are often linked to lifestyle choices that increase risk of CVD. e.g. smoking and alcohol consumption
Environmental factors
- Geographical location - rural and remote are 1.3 times more likely to suffer as they have higher rates of risk behaviours → 26.5% smoke compared to 14.8%.
- Access to health services - rural and remote 253 employed medical practitioners per 100000 population compared to 409 → reduced access to preventive measures (electrocardiogram monitors) and treatment.
- skin cancer
Nature
- Uncontrolled and abnormal growth of skin cells
- Melanoma - 10%, most dangerous as malignant
- 90%, least dangerous and cured with treatment
Extent Mortality - X3 since 1992 - 5 year survival rate - 90% Morbidity - ⅔ people will be diagnosed by 70
Risk factors and groups at risk
Non-modifiable risk
- Family history: hereditary fair skin that burns (northern European)
- Males (59%) are more likely than females (41%) (men).
- Living in areas that receive a lot of sun (low latitudes).
Modifiable risks
- Unprotected exposure to UV radiation. e.g. sun and solariums (blue-collar workers).
Protective Factors
- Wearing sunscreen and protective clothing. e.g. hat and sunglasses
- Seeking shade between 10 am and 4 pm
- Monitoring moles and freckles
Sociocultural determinants
- Family - the inheritance of genes for fair skin → burn easier.
- Peers - peers who tan and believe tanning is attractive → more likely to conform and adopt these behaviours.
Socioeconomic determinants
- Education - lower levels → lack knowledge of protective and risk factors, therefore increased risk behaviours. e.g. tanning without the use of protection and using solariums.
- Employment - higher rates in blue-collar jobs and other outdoor work → increased exposure to the sun.
Environmental determinants
- Geographical location - people who live in hotter climates that receive greater amounts of sun (low latitudes) → increased sun exposure.
- Access to health services - rural and remote 253 employed medical practitioners per 100000 population compared to 409 → reduced access to preventative measures and treatment. e.g. skin checks and dermatologists.
- breast cancer
Nature
- the abnormal or uncontrolled growth of cells in breast tissue.
- Invasive - grow in the healthy breast tissue and are malignant → illness or death.
- Non-invasive - contained within the milk ducts or lobules and ∴ aren’t fatal, but can increase risk of developing invasive.
Extent Mortality - 2nd most common cause of cancer-related death in females (14.9%) - 5 year survival rate is 91% - Death rate decreasing Morbidity - Affects ⅛ women - Incidence more than doubled since 1982.
Low socioeconomic status people are a group at risk as they are accountable for 39% of breast cancer cases. Also, people living in rural and remote areas are at risk of breast cancer as 40% of the women diagnosed at a late stage lived in rural areas compared with 36% of women in urban areas.
Low socioeconomic status(SES) people are a group of breast cancer are affected by the socioeconomic determinant of education. With lower levels of education, hence lower health literacy, limiting the knowledge and awareness of protective factors to implement such as taking part in breast cancer screening. The lack of education increases the number of risk factors an individual may take, for example by increasing the exposure to radiation. Low SES people are also impacted by the socioeconomic determinant of income, with lesser income rates, which restricts an individual’s ability to access facilities and resources in order to prevent or treat breast cancer. This is evident in the 5-year survival rate after a diagnosis of breast cancer in its earliest stage being 100% compared to 32% if diagnosis occurs at the latest stage.
People living in rural and remote areas are a group at risk of breast cancer, impacted by environmental determinants including access to health services and technology. This is because having a decreased ability to use preventative measures and treatments due to limiting access to facilities, increases the risk of being diagnosed with breast cancer. In addition, it heightens mortality rates for those who are diagnosed due to their reduced access to mammograms, biopsies and chemotherapy. This is seen by having 22 medical specialists per 100,000 population in very remote areas compared to 143 per 100,000 population in major cities.
- lung cancer
Nature
- the uncontrolled growth of abnormal cells in one or both lungs
- Non-small cell lung cancer (NSCLC) - 80%
- Small cell lung cancer (SCLC) - starts at the middle of the lungs and spreads more quickly
Extent
Mortality
- Leading cause of cancer deaths in Australia
- Male lung cancer accounts for 21% of all cancer deaths - female 17%
Morbidity
- 1/13 men and 1/21 women by 85.
- Incidence decreased in males by 32% and increased in females by 72% since 1982.
Aboriginal and Torres Strait Islander(ATSI) people are a group at risk of lung cancer because 43.4% of ATSI’s smoke compared to 15.1% of non-ATSI. Alongside, lower socioeconomic status people, specifically blue-collared workers as in the lowest socioeconomic bracket the incidence of lung cancer is 54.2 per 100,000 people compared to 31.5 per 100,000 in the highest bracket.
ATSI people are a group at risk of lung cancer being affected by the socio-cultural determinant of peer influence, due to the effect of peer pressure encouraging an individual to take part in acts of smoking which is the leading cause of lung cancer deaths. Lung cancer accounts for 1 in 4 cancer deaths, which could be attributed to the high prevalence of risk behaviours among peers. Also, the influence of socioeconomic determinant of education affects ATSI, as there is a likelihood of diagnosis at a later stage of the disease, which is commonly seen in conjunction with a lower likelihood of receiving or completing treatment for lung cancer.
Lower socioeconomic status people in particular blue-collar workers are a group at risk of lung cancer, they are impacted by socioeconomic determinants of employment and education. This is because having a lower level of education results in a lack of health literacy, leading to the incapability of knowing the possible effects of smoking. This lack of education increases the likelihood of becoming a blue-collar worker therefore rendering these manual labourers a group at risk of lung cancer. This is due to the participation in risk behaviours such as smoking and their exposure to asbestos and other harmful chemicals in their workplaces which increases the risk of developing mesothelioma, resulting in a much higher prevalence of lung cancer in comparison to white-collared workers.
- diabetes
Nature
- Condition affecting the body’s ability to take glucose (sugar) from the bloodstream to use it for energy
Type 1 (insulin dependent) - 12%
- body produces minimal amounts of insulin or none at all ∴ inject an artificial supply of insulin
- Glucose is unable to pass through bloodstream into blood cells due to lack of insulin∴ increase blood sugar levels
- Most common in children and young adults
Type 2 (non-insulin dependent) - 85%
- Insufficient or ineffective amounts of insulin produced by the pancreas
- Glucose in the bloodstream and insulin unable to pass into body cells due to build up of fat → high blood sugar levels.
- Most commonly occurs in adults 50+.
Gestational - 3%
- occurs in pregnancy and in most cases disappears after the birth, but the woman has an increased risk of developing diabetes later in life
- Similar to type 2
Extent
Mortality
- 6th leading cause of death
- Accountable for 10% of Australian deaths
56% were due to type 2 diabetes (9,500 deaths)
Morbidity
- 1.7 times as high for males as females
- 1/17 people
- 1989 - 2015 prevalence tripled from 1.5% to 4.7%
Risk and protective factors and groups at risk
Non-modifiable risks
- Higher prevalence for males than females, 7% of men and 5% of women(men)
- Family history(family)
- 50+ years (elderly)
Modifiable risks
- Obese (ATSI - 1.6 times more likely)
- Smoking (rural and remote)
- Alcohol consumption (blue collar workers)
- Protective factors
- Limit alcohol intake
- Regular check ups
- Physical activity
- Balanced diet - low in sugar and saturated fats
Sociocultural factors
- Culture - ATSI 3.5 times as likely as well as those with Chinese, Indian, or Pacific Island backgrounds.
- Family - people with a family history of diabetes, especially a close relationship are more likely to develop it.
Socioeconomic factors
- Education - lower levels → of limited knowledge surrounding protective factors ∴ increased risk behaviours. e.g. smoking and physical inactivity.
- Income - lower levels → unable to make healthy choices e.g. fruits, vegetables, and gym
Environmental factors
- Geographical location - R&R higher rates of risk behaviours e.g. 26.5% smoke compared to 14.8%
- Access to health services - R&R medical practitioners per 100000 population compared to 409 → reduced access to preventative measures and treatment. e.g. (CGM) technology.
