Epidemiology: Disease Patterns and Public Health

• Epidemiology studies disease patterns in populations and quantifies why they occur.
• Data on death rates, birth rates, illnesses, injuries, treatments, work days lost, hospital usage, and money spent by consumers and the government is used in epidemiology.

Identifying Patterns

• Epidemiology identifies health and disease trends.

Analysing Usage

• Health services and facilities utilisation is examined.

Resource Allocation

• Epidemiology findings help direct healthcare resources.

Key Epidemiological Concepts

• Prevalence is the number of disease cases in a population at a specific time.
• Incidence is the number of new disease cases occurring in a population.
• Distribution is the extent of disease spread within a population.
• Determinants are factors contributing to disease occurrence and spread.

Limitations of Epidemiology

• Statistics and data can be manipulated and are open to bias.
• Focuses on negative measurable aspects, neglecting wellbeing and quality of life.
• Doesn't account for individual, sociocultural, socioeconomic, and environmental health determinants.
• Variations in health status among subgroups may not be shown accurately.
• Mental health data may be incomplete or absent.
• Provides little data on the impact of disease and illness.

Infant Mortality Rate

• The number of deaths among children aged under 1 year in a given period.
• Expressed per 1,000 births.
• In Australia 2020 there were 3.1 deaths per 1,000 births.
• Neonatal mortality occurs in the first 28 days.
• Post-neonatal mortality occurs in the remaining year.
• Neonatal mortality is influenced by maternal and neonatal healthcare quality.
• Australia's infant mortality rate remained at 3.2 deaths per 1000 live births in 2022.

Morbidity

• Refers to ill health in an individual or a population that doesn't result in death.
• Reduces quality of life, temporarily or permanently, such as chronic illnesses.
• Provides a broader perspective compared to mortality statistics.
• Leading causes of morbidity in Australia include diabetes and dementia.

Mortality

• The number of deaths in a population.
• Leading causes of death in Australia include Coronary heart disease, Dementia and Alzheimers, Cerebrovascular disease and Lung cancer
• Prostate cancer is a leading cause of death in males.
• Breast cancer is a leading cause of death in females.

Mortality Rate Declines

• Death rates are decreasing due to increased education and health promotions, including deaths caused by Cardiovascular disease, Car accidents and COPD (Chronic Obstructive Pulmonary Disease) alongside Cancer

Life Expectancy

• The length of time a person can expect to live.
• Calculated based on current death rates and reflects overall health and quality of life.
• It does not account for future changes in death rates.
• As of 2022, Australia's life expectancy is 81.2 years for males and 85.3 years for females.

Social Justice Principles

• Values that aim to decrease or eliminate inequity, promote inclusiveness of diversity, and establish supportive environments.
• Example: Equal access to resources, health services, education, and information to reduce diabetes incidences.
• Social justice principles include Equity, Diversity and Supportive environments

Equity in Resource Allocation

• Resources are allocated based on the needs of individuals and populations to achieve equality of outcomes.
• Particular groups in Australia receive more funding as a result of having poorer health outcomes than other Australians.
• Example: Aboriginal and Torres Strait Islander People need extra funding and resources to improve health outcomes.

Diversity

• The recognition of differences among individuals and cultures.
• Measures in place to ensure each culture has healthcare access and achieves good health outcomes.

Supportive Environments

• Environments where people live, work, and play that protect people from threats to health and increase the ability to make health-promoting choices.
• The government assesses environments of particular groups to identify reasons for poorer health outcomes.

Priority Population Groups

• Indigenous Australians face health disparities, and require culturally appropriate healthcare services.
• Rural and remote residents often experience limited access to health services and face unique environmental challenges.
• Socio-economically disadvantaged may struggle with healthcare costs and have higher rates of chronic diseases.
• Veterans, Prisoners, and Overseas born each has specific health needs requiring intervention and support.

Use of Epidemiology for Population Groups:

• Population group statistics gives governments, organizations, and researchers resources to remove health outcome inequalities.
• Improves our understanding of sociocultural, socioeconomic, and environmental health determinants.
• Priority population groups become the focus of health promotion initiatives that require more funding, and health programs can be developed to meet their particular needs.

Prevalence

• The number or proportion of cases in a population at a given time.
• In relation to cancer, it refers to the number of people alive who have been diagnosed with cancer.
• Used to determine the number of people affected by the health issue.

Prevalent Conditions

• Conditions high in prevalence include Cardiovascular disease, Cancers, Dementia and Alzheimer's disease, Diabetes and Cerebrovascular disease.

Incidence

• Incidence refers to the number of new cases diagnosed in a specific time period.
• Incidence helps to understand current trends in diseases.
• Example: a decreasing trend will occur if the number of new disease cases in a 6 month period is less than it was over the previous 6 months.

Potential for Prevention and Early Intervention

• Prevention and early intervention will make treatment more successful.

Prevention Strategies

• The easier it is to prevent diseases, the more likely it is that health promotion will have an impact on the burden of the disease and reduce its incidence.
• Examples of diseases with high potential for prevention include type 2 diabetes, hypertension, cardiovascular disease and obesity.
• Lifestyle diseases are often caused by inactivity and poor dietary choices.
• Example: Reducing smoking prevents lung cancer and cerebrovascular disease.

Early Intervention

• If prevention is not possible, then early intervention is preferable, with higher rates of survival for those diagnosed and treated early for their condition.
• Examples include all cancers and cardiovascular disease.

Costs

• Expenses and Time

Direct Costs of Health

• Prevention includes public health campaigns and vaccination programs.
• Diagnosis includes medical tests and screening consultations.
• Treatment includes hospital admissions, pharmaceuticals, and rehabilitation.

Indirect Costs of Health

• Quality of life includes reduced wellbeing and life satisfaction due to chronic illness.
• Relationships include strain on personal relationships.
• Productivity includes loss of work hours and reduced economic output.

High cost disease

• Cardiovascular disease is expensive to treat.
• CVD often involves large surgical procedures, lengthy recovery periods, loss of independence, and income and is linked with lower self-esteem levels.

Community Costs of CVD include:

• The community pays for surgery through Medicare taxes.
• The company the person works for loses money as they pay for sick leave, and either pay someone to cover them, or lose the work that person was contributing.
• There is a cost to family and friends who might take time off work, become anxious about their relative's health, and may be needed to be a carer for the person as they recover.

Groups Experiencing Health Inequities: Aboriginal and Torres Strait Islander People

• ATSI people experience the largest gap in health outcomes in Australia.
• They currently have a life expectancy 10 years lower than non-Indigenous Australians.
• ATSI peoples life expectancy is on the increase , but the gap between them and non-Indigenous Australians does not seem to be shrinking.
• ATSI people have higher death rates in each age group than other Australians but this is improving, and the gap is decreasing.
• ATSI death rates between the ages of 35-44 are 4x that of non-Indigeous Australians due to challenges health inequities.
• ATSI child death rates are 2x that of non-Indigenous Australians due to challenges in early life, nutrition and access to healthcare but this is improving, and the gap is decreasing.
• ATSI people suffer from larger mortality rates from circulatory disease, nutritional diseases and type 2 diabetes.
• ATSI people are more likely to suffer from long-term health conditions with the current leading cause of disease burden being mental health and substance disorders.
• Historical injustices and systemic inequalities mean that the life expectancy gap between ATSI peoples and other Australians has been a long issue.
• Life expectancy for ATSI people is still increasing, the gap is still persistent, and highlights the need for more effective interventions.
• Circulatory disease has a higher rate of disease and strokes.
• Endocrine and metabolic has a 5x risk, with diabetes being severe with 3x higher numbers, and kidney disease having 7x higher numbers.
• Mental health and substance abuse is the leading cause of mortality, where female suicide rates are 6x higher, and male suicide is 4x higher.
• Digestive conditions are linked to dietary factors and limited access to nutritious foods.
• ATSI families are less educated and have less money, which can contribute to the family upbringing of unhealthy exercise and dietary choices.
• The disempowerment they feel due to many years of oppression and discrimination from non-Indigenous Australians goes back to the invasion of the first fleet and the white Australia policy.
• 51% of working-age ATSI people were employed in 2016, compared to 76% of non-Indigenous Australians, which effects expenditure on food and healthcare facilities.
• Unemployment and poorer education levels lead not only to poor behavioural choices but also to poorer mental health conditions.
• Lower household income, level of education and employment status has a very large impact on health outcomes and contributes to the health gap.
• Centrelink has a program called ABSTUDY, which provides financial support for Aboriginal and Torres Strait Islander students.
• ABSTUDY takes the financial burden of education off ATSI people, so they can focus their earnings into healthier lifestyle habits to prevent diseases.
• People can switch their diet from one of high salts and sugars, to one with more nutritional benefits to decrease the incidence of diabetes in ATSI people.
• ATSI people's access to health services is poorer than other Australians which contributes to the gap in health outcomes.
• Impacts access to health services and technology.
• ATSI people reported having difficulty accessing health services, such as dentists and GPs due to long waiting times of the services being inaccessible.
• Exposure to environmental pollutants and lack of clean water sources in some areas contribute to health concerns among ATSI people.
• Many ATSI communities are located in remote areas, which limits access to healthcare facilities and specialized medical services.

Cultural Health Considerations

• Culturally appropriate healthcare can be delivered through ATSI nurses and doctors as well as developing and implementing healthcare services that respect and incorporate ATSI cultural practices and beliefs.

Government Initiatives to Adress Cultural Health Issues

• Through $805 million Indigenous Chronic Disease Package. Aims to improve the way healthcare prevents, treats and manages the chronic diseases that may affect Indigenous Australians.

Closing the Gap

• Acknowledges key risk factors for chronic disease in the Indigenous community and supports improved chronic disease management, follow-up, and capacity of primary care workforce, in order to deliver care to Indigenous Australians with chronic disease.

Health Inequity Solutions

• Empowering ATSI communities to lead and design health programs that address the specific needs and priorities.
• Implementing policies to improve education, housing, and economic opportunities for ATSI people.
• Ongoing collection and analysis of health data to track progress and identify areas for targeted intervention.

Socioeconomically Disadvantaged People

• High SES have better health outcomes, and more resources for healthcare and healthy activities.
• Middle SES have moderate health outcomes, and some access to healthcare and healthy choices.
• Low SES have poor health outcomes, and limited resources for healthcare and healthy living.
• The relationship between socioeconomic status and health is known as "the social gradient of health".

Social Gradient of Health

• People with higher financial standing are more able to make lifestyle choices that positively impact their health outcome such as food consumed and activities participated in.
• Higher SES have demonstrably lower rates of smoking.
• Higher SES have demonstrably higher rates of physical activity.

Nature and Extent of the Health Inequities

• Socioeconomically disadvantaged people have poorer outcomes with chronic diseases than other Australians.
• There are higher death rates from coronary heart disease with slower decline in lower SES areas.
• There is a higher incidence of lung cancer and worse survival rates for it, as well as higher mortality rates from all cancers combined.
• People from low SES have a lower life expectancy.

Causes of Health Inequities

• A likely diabetes link comes from lack of education on cooking nutritious food and doing regular physical activity. Furthermore, food selected are cheaper alternatives such as highly processed foods.
• There are a lot of factors that influence eating habits with a large emphasis from family, religion and cultural background.
• Lower SES have been shown to model risky behavior in young family members
• Lower SES individuals have been shown to have poorer outcomes due to income limitation.
• Individuals in low SES areas are more likely to take place in risky behavior overall, with influences to be Obese/ Overweight, risky drinking & physically inactive.
• People born in a lower SES household are less likely to be able to leave that class, due to overall decreased levels of education and lack of guidance.
• This reduces the options for healthy choices as there may not have been adequate education on how to improve their health.
• Further financial limitation puts lower SES individuals in positions of labor that can have hazardous risks, or potential unemployment.
• Unemployment can severely affect mental health.
• Economically disadvantaged people have a higher rate of homelessness.

Homelessness

• Brings several physical and mental health detriments.
• Limits overall ability to access services like Centrelink.
• Centrelink is more accessible with a stable living address
• There are higher rates of socioeconomically disadavantaged people living in rural and remote areas, placing them at a disadvantage regarding healthcare.

Focus Good Health for People

• Overall good decision making and responsibility taken for health.
• Improving financial ability via further qualifications.
• Promoting good choices for friends and family.
• Communities are able to build support services to assist.
• Governments can provide funding Medicare and PBS to support low socioeconomic individuals with greater access to care and medications.

The Roles of Individuals, Communities and Governments

• Individuals can focus on good decision making and take responsibility for their own and others' health.
• Communities can provide relevant health care and support services.

Government support to address inequalities

• Governments can better access through Medicare and PBS for low socioeconomic individuals with greater access to care and medications.

Health Facilities and Services Range

• Primary healthcare refers to the first point of contact when seeking relevant support. It focuses on basic care and health prevention.

Example points of contact

• General practitioner (GP), Nurses, Dentists

Secondary healthcare

• Involves specialized care given through referral from other healthcare professionals.

Types of services include

• Specialists such as Oncologists or Cardiologists

Public Hospitals

• Operated through government systems. The public can access specialized surgeries or emergency care.

Medicare

• Medicare covers many costs and allow public to access healthcare
• Nursing home - Medicare is used to support nursing home residences
• Nursing homes are projected to grow over the next few decades due to population increasing
• There are both private and public options, although government heavily funds regardless.
• Specialized treatment to severe cases can be provided through specialized care centers
• Mental illness can sometimes be approached on a base level
• Allied health such as GPs can provide care outside of hospital premises. Although specialists can be used as needed.

Medicare Cost

• Medicare generally covers cost of GP appts, but some providers add on extra fees.

Pharmaceuticals

• Pharmaceuticals are mainly supplied over multiple types of sale for the public. Medicare can be used to subsidized in situations. There may subsidies depending on the type.

Commwealth Government Support

• Commonwealth government provides national health policies and funding to relevant systems.

Main roles provided

• The government supports medical research, public health programs and high-level residental Medicare funding.

State Level Responsibilities

• State level contributions provide the bulk of community services. As well as overlooking the promotion of health.
• Government support the contribution between Medicare and Private hospitals.
• Local run government focus on more preventable health and social care.
• With services such as cancer support, alcohol and drug abuse ect

Public Sector

• Private service such as private hospitals, and alternative medicine.

Equity Of Access

• Medicare support equity through healthcare to ensure it's accessible for all
• Medicare mainly helps those who are lower socio-economic who would otherwise be unable to afford
• There are several challenges to equity, such as the location of the services. Rural location makes access difficult and technology might need to be implemented

Role Of the Government

• Medicare and PBS provide lower cost of healthcare to ensure access
• Medicare does not cover all physio and psychology services
• Australia looks towards prevention - Healthcare expenditures are usually on treating an aliment where earlier action can minimize issue

Preventative Care

• Overall improve health and life quality - Preventative medicine reduce risk and promote health, whereas curative practices try to correct actions when the disease has occurred.

Spending of Healthcare

• Over 90% is on treating sickness, rather than fixing the underlying problem
• Benefits may not be immediately visible, making it a challenge when wanting to demonstrate effectiveness.

Benefits of increased spending

• Preventative care overall saves money and admissions to hospital. With increases to overall heath it will also boost social equity and encourage all Australians to participate.

Health Strategies in Australia

• Government tax on tabacco and alcohol provide benefit. Screening programs such as cervical cancers and yearly checkups should be performed effectively.

Pro's and Con's

• While prevention expands lifespan and reduces disease rates, some researchers argue that prolonging life may increase chronic illnesses in old age.

Technologies in healthcare

• There can be questions of ethics
• Overall, medicine aims for better diagnosis, better treatment, accurate outcomes and increased effectivness

Emerging treatments via

• CT and Ultrasound scans
• Enhanced accuracy can be useful in situations
• There has been the development of specialized machinery for less pain through methods such as keyhole.

Preventative technology

• Prevents cancer through methods such as HPV vaccine and regular testing. These all overall increase survival rate and reduce mortality levels.

Benefits of tech

• Higher levels of patient outcomes and enhancement to precision, and enhancement to cost.

Limitations To Technology

• High setup cost can make it inaccessible to people, mainly those in rural.

Medicare Support

• Medicare provides universal healthcare to all Australians and aims to make it affordable and accessible. It mainly comes through a high amount of medicare taxations.
• These cover free public patients and subsides from most specialists.

Medicare Limitations

• There is little support between physio or chiro services. This may lead to long wait times. There is good accessibility encouraged, but more time being taken.

Private Insurance

• Extra purchases provide more service that isn't overall provided with Medicare.
• Individuals may not have to wait as long or the ability to properly select staff.