HSC Core 1 Flashcards
Role of Epidemiology
The study of disease and illness in a given population over a period of time
Epidemiological data
Identifies prevalence and incidence of disease and illness as well as patterns and measures which may reduce the occurrence of the disease. Enables decisions about health issues to be made based off the data. Health promotion and expenditure is determined by data collected in relation to the current and future health needs of the population
Prevalence of disease
The number or portion of people who are living with the disease in a population at a given point in time
Incidence
The number or proportion of NEW cases arising in a particular population with a given point in time (usually 1 year)
Mortality
The number of people within a population which have died in a given year
Epidemiology Indicators
Life expectancy - The average number of years a person is expected to live
Mortality - The number of people within a population which have died in a given year
Infant mortality - The death rate for those under 1 year age within a given population
Morbidity - The measure of disease or disability rates within a given population
What can epidemiology tell us?
Health status of a population
Prevalence and incidence of disease
Treatments provided, hospital usage
Trends in disease
Death, birth, illness and injury rates
Expenditure for consumers and government
Who uses the epidemiological data?
Government
Health department officials
Researchers
Health or medical practitioners
Limitations of epidemiology
Reasons why people take risks
Impact of the illness on quality of life
Why inequities exist
Variations among sub-populations
Data is incomplete or nonexistent
Current trends in Australia’s health
Males:
1. Coronary Heart disease
2. Dementia including alzheimers disease
3. Lung Cancer
4. Cerebrovascular disease
5. Chronic obstructive pulmonary disease
Females:
1. Dementia including alzheimers
2. Coronary heart disease
3. Cerebrovascular disease
4. Lung Cancer
5. Chronic obstructive pulmonary disease
Identifying priority health areas
Social justice principles
Potential for prevention and early intervention
Priority population groups
Prevalence of a condition
Cost to the individual and community
Social justice principles
Principles which promote equity diversity and supportive environments
MEDICARE
Medicare safety net:
A pre determined amount of money set by the Australian government for which medical expenses are subsidised once an individual or family have incurred the medical costs ($560.40)
Medicare: public health care for all Australians is provided at no or little cost to the individual under the Medicare
Pharmaceutical benefits scheme (PBS):
Prescription treatments considered to be life saving, or for chronic illnesses are subsidised under the PBS
Priority population groups
- groups in Australian society which experience health inequities and difficulties
First Nations Australians
People who are socioeconomically disadvantaged
People living in rural and remote areas
People born overseas
The elderly
People with disabilities
The Royal Flying Doctor Service ✈️
Developed to increase the health outcomes for people living in rural and remote areas and communities of First Nations Australians. The service aims to increase access to services, facilities, and health education through:
- aeromedical health services, remote community health clinics
- doctor and medical practitioner incentive program to encourage medical professionals to work in remote communities
- developing culturally diverse health services
- increasing funding for First Nations Australian’s health
Burden of disease
An estimated impact of disease and injury on an individual or community. This is determined by the effect of death or disability
First Nations peoples populations experience 2.3 times more disease burden than non First Nations peoples populations
Potential for prevention and early intervention
When identifying priority health issues it’s essential to identify issues which are more likely to be preventable
Most health issues in Australia are caused by modifiable risk factors
Early intervention is possible through modification of a risk, meaning the burden of the disease can be reduced
Early intervention strategies enable diseases to be identified before they become an increasing burden on a population. E.G. The implementation of screening services such as cancer screening, have decreased the mortality rates due to early detection and prevention.
Modifiable risk factors
Smoking
High cholesterol
High blood pressure
Over weight
Diabetes
Stress
Smoking
Sedentary lifestyle
Costs to the individual and community
When identifying priority health issues it is essential to identify the cost of the disease, illness or injury to the individual and community. These costs can either be direct such as financial burden or indirect costs like an individuals mental health as a result of cancer diagnosis.
Direct Cost = monetary costs of diagnosing and treating a patient
Indirect cost = difficult to measure costs such as a patients mental health and other effects stemming from illness e.g. loss of wages when a person is unable to work
Individual and community costs
Individual costs
- cost of medica, treatment
- loss of income
- reduction in quality of life
- social and emotional impact
- emotional trauma due to loss
- lifestyle changes
Community Costs
- funding for medical treatment
- co-morbidities
- economic loss due to leave from work
- loss of skilful community members
Aboriginal and Torres Strait Islander people
ATSI peoples experience health inequities in all areas of health. They have the largest health gap of all population groups in Australia, because they experience such inequities, they are identified as a “priority population group”
Life expectancy - Aboriginal and Torres Strait islander life expectancy at birth for the period 2020-2022 was 71.9 years for males and 75.6 for females
Infant mortality - The death rate for indigenous infants was 1.9 times the rate of non- indigenous infants (5.9 and 3.0 per 1,000 lives births, respectively
Mortality - the 3 leading causes of death for indigenous Australians were coronary heart disease, diabetes, and chronic obstructive pulmonary disease, whereas for non-indigenous Australians they were coronary heart disease, dementia including alzheimers and cerebrovascular disease (figure 5)
Morbidity - In burden of disease among aboriginal and Torres Strait islander peoples was 2.3 times more than non-indigenous Australians
The leading 5 disease groups:
Mental and substance use disorders (anxiety, depression and drug use)
Injuries (falls, road traffic injuries, suicide
CVD diseases - coronary heart disease, rheumatic disease
Cancer and other neoplasms (lung cancer and breast cancer and musculoskeletal conditions such as back pain and problems and osteoarthritis
Nature and extent of health inequities
Nature = the basic features of something or the characteristics of something
Extent = the amount of cases or inequities which exist or have spread within the population group
Socioeconomic, sociocultural and environmental determinants
Sociocultural determinants
Factors contributing to health from family, peers, religion, culture and media
Socioeconomic determinants
Factors contributing to health from education, employment and income
Environmental determinants
Factors contributing to geographical location, access to health services and technology
Roles of individuals, communities and governments
Individuals: empowerment, increase protective behaviours
Communities: involvement in design and implementation of health initiatives, aboriginal medical services
Governments: close the gap initiative, indigenous chronic disease package
People in rural and remote areas
People living in rural and remote areas in Australia experience more health inequities than people living in regional and metropolitan areas.
In Australia, about 28% of our population are living in rural and remote areas. Environmental location is identified as a determinant of health, highlighting that people who live in rural and remote areas are more likely to experience poorer health than those not living in rural areas.
- they are isolated and have limited access to health care and facilities
Nature and extent of health inequities
Rural and remote
When compared with people living in regional and major cities, individuals experience:
- higher rates of chronic illnesses such as CVD, diabetes, cancer
- higher rates of injuries and road accidents
- higher rate of liver diseases
- higher rates of suicide
Indicators of poor health include increased rates of: obesity, smoking, inactivity, alcohol consumption
Socioeconomic, Sociocultural and environmental determinants
Sociocultural - greater First Nations Australians population, family behaviours e.g. smoking, alcohol consumption, lower activity rates and family history of obesity
Socioeconomic - decreased access to education and employment, limited access to goods and services, exposure to ‘heavy labour’ employment e.g. mining, machinery and farms, strong sense of community
Environmental - decreased access of health professionals, decreased access to health facilities and screening, increased need for transportation for health treatment, decreased health education, low health literacy leads to lack in access to services
Roles of individuals, communities and governments in rural, remote
Individuals
Empowerment
Increase protective behaviours
Maintaining enrolment in educational programs
Communities
Health services tailored to the community multipurpose centres
Community support groups
Community fundraisers
Governments
Royal flying doctor service
Rural and remote general practice program
High levels of preventable chronic disease, injury and mental health conditions, cardiovascular disease
- nature of problem
Chronic diseases:
Cardiovascular disease - refers to any disease which affects the circulatory system. The circulatory system is made up of the heart, blood vessels (arteries, veins) and blood. CVD is identified as a preventable chronic disease.
Arteriosclerosis = hardening and/ or narrowing of the arteries
Atherosclerosis = when a build up of fatty tissues in the interior walls of the arteries occurs
Coronary Heart disease - results from a poor supply of blood to the muscular walls of the heart by the coronary arteries. Angina - temporary loss of blood to the heart
Stroke - the interruption of the supply of blood to the brain
Peripheral vascular disease - diseases of the arteries, arterioles and capillaries that affect the limbs, usually reducing blood flow to the legs. Can result in the amputation of limbs.
Congenital heart disease - heart disease as a baby or at birth
Extent of the problem
CVD causes 27% of deaths in Australia
1.2 million Aus have 1 or more heart or vascular conditions
Coronary heart disease remains number one contributor or mortality
Cancer is the second largest killer in Aus
The probability of getting cancer before 85 years of age is 1 in 2 for males and 1 in 3 for females
Mortality rates have decreased by 17% in the past 20 years
Extent of the problem
CVD is Australia’s number 1 killer.
CVD kills 1 in every 4 Australians, in 2021 it was the underlying cause of death in 42,700 deaths (25% of all deaths)
Heart disease kills more men than any other disease. In 2021, the leading cause of deaths for males was coronary heart disease, accounting for 12% of the deaths, with death rates twice as high for males as for females.
Prevalence - 1 in 6 Australians are living with CVD, accounting for more than 4 million Australians
The prevalence of CVD has been decreasing overtime (declining approximately 80% since 1980’s) due to research into risk factors, medications and early intervention.
CVD is responsible for 1.2 million hospitalisations every year
In remote and very remote areas in Australia, hospitalisation rates due to CVD are 35% higher than in major cities
Financial Burden:
CVD costs the Australian health system $12.7 billion every year
Incidence and effects of heart attacks in Australia
Heart attack is a leading cause of hospitalisation and death in Australia, claiming on average 19 lives everyday
CVD health among Indigenous Australians
Heart disease is the leading cause of death among aboriginal and Torres Strait islander peoples, causing over 1 in 10 deaths
Indigenous Australians are almost twice as likely to die from CVD than non-indigenous people
Risk factors and protective factors
Risk Factors:
Age
Gender
Heredity
Smoking
High fat diet
High blood pressure
Obesity
High blood cholesterol
Lack of physical activity
Protective factors:
Regular physical activity
Low fat diet
Low alcohol consumption
Low saturated fat
Low salt diet
Stress management
Avoid smoking
Socioeconomic, sociocultural and environmental determinants
Sociocultural:
Family history, ATSI rural and remote peoples and low SES
Media exposure to effects of risk behaviours e.g. smoking and diet
Socioeconomic: Low SES or unemployed, people in stressful working roles, low or no education levels
Environmental: Rural and remote people have decreased access to health services and information, people in cities have increased access to health services and facilities
Cancer
Chronic, long lasting disease
Uncontrolled growth of body cells, can develop in any type of tissue
Second leading cause of death after CVD
Metastasis - malignant cells which invade body tissues or organs
Most common = skin cancer (decrease - health campaigns), breast cancer - (increased amount of cancer but at an acute phase) lung - decreased in men but increased in women because women smoked later than men did
Nature of cancer:
Neoplasm - An abnormal mass of cells that’s forces itself it’s way among healthy cells and interferes with their functioning
Tumour - A visible swelling or lump caused by a clump or ‘sack’ of abnormal cells
Malignant cells - cancerous cells which aren’t contained, allows them to spread and invade healthy tissues
Beginning cells - non cancerous cells which grow slowly within a capsule - best type of cancer to get because it’s contained and can’t spread
Classifications of cancer
Carcinoma affects: skin, respiratory, gastrointestinal, urinary tracts, breasts
Develops within the epithelial tissue which lines the body surface and organs e.g. skin cancer
Sarcoma affects: muscles, tendons, cartilage
Develops in connective tissues (bone, muscle, cartilage) e.g. bone and soft tissue tumours
Leukaemia affects: bones, liver, spleen
Develops within the bone marrow
Lymphoma affects: infection - fighting organs, glands, spleen
Develops within the immune system affecting lymphocytes (white blood cells) e.g. Hodgkin’s lymphoma
The most common types of cancer
- breast cancer
- skin cancer
- prostate cancer
- colon cancer
- bladder cancer
- non-Hodgkin’s lymphoma
- kidney cancer
- leukaemia
- lung cancer
Breast Cancer
Breast cancer is the abnormal growth of the cells lining the breast lobules or ducts. These cells grow uncontrollably and have the potential to spread to other parts of the body.
It is estimated that more than 20,600 people were diagnosed with breast cancer in 2023
Symptoms: Lumps on the breasts, nipple discharge, change in size or shape of breast, rash, or red swollen breasts
Risk Factors of breast cancer: increasing age, family history, previous breast cancer diagnosis, starting your period before age 12.
Lung Cancer
Lung cancer is a type of cancer that starts when abnormal cells grow in uncontrolled ways in the lungs
Tobaccos smoke is the leading cause of lung cancer
Symptoms of lung cancer include: cough that doesn’t go away, chest pain and shortness of breath
The 2 main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under the microscope.
In 2023, and estimated 238,340 people (117,550 men and 120,790 women) will be diagnosed with lung cancer, and 127,070 people will die from the disease
14, 782 new cases of lung cancer will be diagnosed in Australia (7696 males and 7086 females)
Skin Cancer
Occurs when skin cells are damaged by overexposure to UV radiation from the sun
3 main types of skin cancer: Basal cell carcinoma, squamous cell carcinoma, melanoma (the most dangerous form of skin skin cancer)
Risk factors - sunburn, tanning, solariums
The extent of the problem (trends)
Cancer is the second largest killer in Australia
Death rates are decreasing, with survival rates increasing
The probability of getting cancer before 85 years is 1 in 2 for males and 1 in 3 for females
The risk of dying from cancer is 1 in 4 for males and 1 in 6 for females
Lung, breast, colon, prostate and skin cancers have the highest mortality rates
Mortality rates have decreased by 17% in the past 20 years
The incidence of skin cancer has almost halved in the past 30 years
Mortality rates decreased - as we finding cancers at acute phase and improving survival rates
Slight increase in incidence - we diagnose more it becomes more accessible and affordable, we have a growing population
Cancer Risk Factors
Lung = smoking, occupational exposure, air pollution
Skin = fair skin, fair or red hair, live in areas exposed to sun, prolonged exposure, number and type of moles
Breast = family history, high fat diet, early onset of menstruation, late menopause, obesity, late age pregnancy
Cancer protective factors
Lung = avoid exposure to tobacco smoke, avoid exposure to hazardous materials
Skin = Avoid excess sunlight, reduce exposure by wearing sun protection
Breast = regular mammograms, self- examination, diet high in fruits and vegetables, low fat diet
Socioeconomic, cultural, environmental factors
Sociocultural = family history, First Nations Australian lung cancer - smoking rates cervical cancer - access to preventative treatment
Socioeconomic = low SES or unemployed, people who work outdoors, occupations exposed to carcinogens (asbestos), low education levels
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
Lung - smokers, blue collar workers, occupations exposed to asbestos, over 50 years of age
Skin - fair skin and red hair, outdoor work, people who avoid sun protection
Breast (women who:) have never given birth, obese, over 50, menstruate late, late menopause
Mental health problems and illnesses
Examples: schizophrenia, personality disorders, major depression and ptsd
- these illnesses cause as much suffering for those directly affected and often for their family/carers/social network
Poor mental health in childhood and adolescence may underpin a lack of self- care in adulthood
Drug abuse, physical neglect and early pregnancy are examples of poor health choices that may result
Mental health disorders in young children are a strong indicator of poor mental health in adulthood
Depression
Depression has a life time prevalence - one in seven Australians will experience depression in their lifetime
Depression has the third highest burden of all diseases in Australia (13%) and also third globally
Depression is the number one cause of non- fatal disability in Australia (23%). This means that on average, people with depression live with this disability for a higher number of years than people suffering from other non- fatal diseases such as hearing loss and dementia
Bipolar
Bipolar disorder may be experienced by up to 1% Australians over their lifetime (no gender difference)
The lifetime risk of bipolar 2 disorder is up to 5% (rates higher with women) early onset of bipolar disorder in childhood is rare
The most common risk period is mid to late adolescence
Amongst people with bipolar disorder, there is typically a 10-20 year interval from first mood episode to diagnosis
Anxiety disorders
Definition - Feelings of anxiety that are so frequent, overwhelming and/or out of proportion to an event that they impact negatively on a persons everyday life
Key features - Most common mental health problem include phobias, post traumatic stress disorders, panic disorders and obsessive compulsive disorder
Depression
Definition - Feeling sad, low or moody for long periods of time or to an extreme extent, often for no reason, these feelings impact on a persons life to the point of making it difficult to function normally
Key features - includes major or clinical depression ( which lasts for two weeks or longer, psychotic depression which can cause delusions, hallucinations and paranoia and bipolar disorder
Bipolar disorders
Periods of extreme levels of emotion that range from extreme highs (mania) to extreme lows (depression) these emotions can often bear little relationship to what is occurring in the persons life, although they can be triggered by life events
Key features:
Bipolar disorder 1 - person is more likely to experience mania for longer periods of time and experience psychotic symptoms
Bipolar 2 - person does not experience psychotic symptoms and is more likely to experience episodes of mania that last for shorter periods of time e.g. a few days or hours
Schizophrenia
Definition - not a single illness, but a cluster of illnesses with some overlapping signs and symptoms
Key features - symptoms include hallucination, delusions, disorganised thinking/behaviour, loss of motivation/emotional feeling and disrupted speech
Mental health the extend of the problem (trends)
Over 2 in 5 (44% or 8.6mil) Australians aged 16-85 are estimated to have experienced a mental disorder at some time in their life, with 1 in 5 (21% or 42mil) having experienced a a mental disorder in the previous 12 months
Anxiety disorders such as social phobia are the most common type of disorder affecting 1in 6 (17% or 3.3 mil) Australians, followed by affective disorders such as depressive episode (8%) and substance use disorders (3% - alcohol dependence)
Almost 1 in 7 (14%) children and adolescents aged 4-17 years are estimated to have experienced a mental illness in the previous 12 months
Mental and substance use disorders were estimated to responsible for 13% of the total burden of disease in 2015, placing it 4th as a broad disease group after cancer (18%) musculoskeletal conditions (13%) and CVD diseases (14%) (AIHW 2021)
Risk factors and protective factors
Risk factors:
- a history of mental illness in a blood relative, such as parent or sibling
- stressful life situations - financial problems, loved ones death etc
- an ongoing (chronic) mental condition such as diabetes
- use of alcohol and/or drugs
- previous mental illness
There’s no way to prevent mental illness. Ensuring that you control stress level is critical, especially when managing symptoms
Protective factors:
- personal attributes, ability to cope with stress, face adversity and problem-solving skills
- Physical health and healthy behaviours
- Physical activity levels
- Social support and inclusion
- Strong cultural identity and pride
Many organisations work to optimise mental health in the community, help people avoid mental illness, and reduce alcohol and other drug related harms. These include community inclusion, organisations, education and promotion, programs and research institutions.
The determinants
Sociocultural:
Peers and family can affect mental illness by influence of drug and alcohol use as well as low physical activity levels and unhealthy diet which are all potential risk factors
Social media can contribute to mental illness by also influencing people either positively (increasing protective factors) or negatively (increasing risk factors), although it is seen to mostly impact negatively
Religion can also cause a sense of relief for individuals and place of belonging which increases mental health wellbeing
Socioeconomic:
Those who have low SES are often exposed to unhealthy habits or financial stress or trauma which can lead to poor mental health
Issues with income can accumulate stress causing mental illness
May be hard to pay for psychiatrists or psychologists
Environmental:
Those living rurally would need to travel for GP or psychologists
Can live far away from help services
Determinants of health
Social cultural determinants
- Aboriginal and Torres Strait Islander peoples are more risk of suicide and depression due to higher levels of drug and alcohol abuse, compared to other Australians
- People with a family history of mental illness are at more risk
- People who have had a falling out with peers, or who have been exposed to bullying are more at risk
Socio economic determinants
- People with a low socio economic status or who are unemployed have higher rates of mental health problems as these groups tend to engage more in substance abuse, compared to those of a higher socio economic status
Environmental determinants
- Rural young males are at a higher risk of suicide than urban young males because they have less access to support services and fewer job prospects
Groups at risk
- Suicide every day six Australians die from suicide and 30 people will attempt to take their own life. It’s increasing and is the leading cause of death for young people aged 25 to 44 second leading cause for young people 15 to 24.
- Males are 3 to 4 times more likely to take their own life than females
- Females are more likely to attempt or be hospitalised for intentional self harm than males
- amount middle-aged and older males 40 to 49 and 85/30 to 59
- Twice as high in young indigenous Australians compared to non-indigenous Australians
People who partake in drugs and alcohol
Leading to things such as depression, anxiety and drug use are substantial components of overall disability and morbidity
Survivors of trauma and violence
People who have experienced recent crisis or trauma
People under stress
People suffering chronic depression
Elderly people
People with a physical illness, particularly terminal
People affected by drugs and/or alcohol
People who have made previous suicide attempts
People talk about ending their lives
Indigenous people
Indigenous youth
Teenagers, particularly those for whom life seems worthless
LGBTIQ people
A growing and ageing population
Australia’s population is a growing and ageing population. This growing and ageing population is one of Australia’s health priorities because with a growing population comes an increase in disease burden and healthcare demands.
Product of life expectancy, and decreased birth rates. The increasing survival rates for chronic diseases mean that the elderly population have greater prevalence or major diseases, such as cancer, CVD disease, diabetes and musculoskeletal disorders, as well as suffer greater levels of disability
The population living with chronic disease and disability increase the demand for health services, which cause workforce shortages and a greater need for carers and volunteers.
Alternative healthcare
Healthcare which is used instead of conventional medicines
Complementary healthcare
Healthcare which is used along side of for or as well as conventional medicines
Acupuncture
Ancient Eastern healing system – traditional Chinese medicine
Uses fine needles which are inserted into the skin
Aids in stimulating the mind and the body’s healing process
Mostly used for pain management and recovery
Combined with other practices, e.g. massage/chiropractor
Aromatherapy
French term meaning healing through oils but dates back to ancient Egyptian times
The use of essential oils to influence or modify the mind body or spirit
Oil can be vaporised bathed in or used during massage
Used for the treatment of depression, poor sleep, stress or anxiety
Chiropractic
Based on the relationship between the spine, nervous system and musculoskeletal system
Adjustments are made to the spine to remove interference to normal nervous system control, promoting healing and better health
Herbalism
The oldest form of medicine which uses plants and herbs as medicine or supplements to restore the body
75% of the world population uses herbalism
Based on the individuals symptoms, lifestyle and overall health
Iridology
Analysis of the human eye to detect signs of physical, emotional and spiritual well-being
Natural pathic treatments are prescribed to improve general and immune health
Naturopathy = a combination of one or more alternative and or complementary healthcare service e.g. herbalism and aromatherapy in combination with lifestyle changes
Massage
Oldest and simplest form of therapy
Induces relaxation and reduces blood pressure stress and anxiety levels
Remedial therapeutic sports and Swedish massage
Becoming increasingly popular among athletes to assist with rehabilitation and decreased recovery times
Meditation
State of inner stillness which focuses on an object breathing phrase or mantra
Strengthen immune system improved sleep lower blood pressure and increased motivation and self esteem
Becoming increasingly popular among athletes to control anxiety and arousal
Health promotion based on the social justice principles
Empowerment of individuals
If individuals are feeling empowered they become more responsible for their own health
Each individual has the right to access health despite their race, religion, culture SES status, gender or location
Action areas of the OTTAWA charter
Creating supportive environments
Developing personal skills
Reorienting Health Services
Strengthening community action
Building healthy public policy
Promotion of developing personal skills
ACCESS - increases access to health care and services (Medicare)
DIVERSITY - providing health information and education in various languages and for different cultures
SUPPORTIVE ENVIRONMENTS - Health information and skills are shared within the community/family
Promotion of reorienting health services
ACCESS - health professional explore inequities in health to focus on priority areas e.g. heart disease, mental illness
DIVERSITY - Increase in preventative services increases knowledge of culturally diverse communities
SUPPORTIVE ENVIRONMENTS - the introduction of multi functioning facilities such as medical centres and remote doctor services allows for easier access to health services and facilities
Promotion of strengthening community action
ACCESS - access to community health groups increases the empowerment of individuals
DIVERSITY - communities action for increased medical services and facilities from government funding which are specific to their communities needs
SUPPORTIVE ENVIRONMENTS - increased access to services and facilities which promote empowerment e.g. walking trails, public pools mental health services
Promotion of building healthy public policy
ACCESS - the increase of policies specific to improving health equity and outcomes allows for better health for all
DIVERSITY - policies insure that there is an adequate minimum level for healthcare for all Australian and specific policies were needed e.g. close the gap
SUPPORTIVE ENVIRONMENTS - policies are developed to support preventative healthcare and a supportive environment e.g. smoking laws school speeding zones
Promotion of creating supportive environments
ACCESS - by taking care of others in the community support empowerment and health outcomes are increased
DIVERSITY - diverse range of community groups and local government support increases access and the diversity of health services and facilities available
SUPPORTIVE ENVIRONMENTS - government and communities provide opportunities for individuals and groups to become engaged in positive health decision-making e.g. outdoor facilities and access to health information
