Epidemiology: Measuring Australia's Health Status

• Measuring health status aids in monitoring Australia's health, setting priorities, and guiding health policies, with epidemiology playing a vital role.

The Role of Epidemiology

• Epidemiology is the study of disease patterns and their causes within populations.
• It involves collecting and analyzing data from hospitals, GPs, surveys, and census records to evaluate national health.
• Epidemiology offers data on incidence, prevalence, and trends of diseases across different population groups, such as ethnic, socioeconomic, and gender groups.
• Key health indicators like death rates, birth rates, illnesses, injuries, and healthcare spending are tracked.
• Researchers, government agencies, health officials, and medical practitioners use epidemiology to identify health priorities and causes of disease.
• Epidemiology is limited because it focuses on measurable data, often overlooking quality of life, mental health, and other health determinants.
• Data interpretation in epidemiology is subject to bias.

Measures of Epidemiology

• Infant Mortality Rate: Deaths of infants under one year of age per 1,000 live births. Australia's 2020 rate was 3.1, ranking 12th among OECD countries.
• Morbidity: Measures levels of illness in a population
• Disability-free years are increasing in Australia, but rates of diabetes, dementia, cardiovascular disease, and mental health disorders remain major concerns.
• Mortality: Tracks death rates and leading causes of death, like coronary heart disease, dementia, cerebrovascular disease, and cancers
• Australia's 2022 standardized death rate was 41.0 per 100,000 people.
• Life Expectancy: The average number of years a person is expected to live based on current death rates
• In 2022, the average life expectancy in Australia was 82.9 years (81.2 for males, 85.3 for females).

Identifying Priority Health Issues

• Social justice principles aim to reduce inequity, promote inclusivity, and create supportive environments.
• Equity ensures resources are allocated based on individual and population needs for equal outcomes; for example, Aboriginal and Torres Strait Islander peoples receive additional resources due to poorer health outcomes.
• Diversity recognizes and accommodates differences between individuals and groups
• Australia's multicultural population requires multilingual brochures and interpreters to ensure equitable healthcare access.
• Supportive Environments includes addressing environmental factors for specific groups, such as rural and remote communities with limited healthcare access, to protect health and promote healthy choices.
• Social Justice Principles address both health outcomes and influencing factors, such as socioeconomic status, environment, and cultural influences.
• Certain groups in Australia experience poorer health outcomes: cultural groups like Aboriginal and Torres Strait Islander peoples, geographical groups like rural and remote populations, and age-based groups like the elderly and economically disadvantaged.
• Epidemiology provides data on health disparities, helping identify priority groups and inform health policies, highlighting factors like gender, geography, and socioeconomic status.
• For example, Aboriginal Australians live 10 years less than other Australians, and rural residents have higher death rates.
• Prevalence refers to the proportion of a population affected by a condition at a given time; higher prevalence indicates a more widespread health issue.
• For example, cardiovascular disease, cancer, dementia, and diabetes are prevalent conditions in Australia.
• Incidence tracks the number of new cases of a disease in a specific time period. It helps monitor trends to determine whether a disease's occurrence is increasing or decreasing.
• Conditions with high prevention potential or that benefit from early intervention are prioritized and improve treatment outcomes, especially for diseases like cardiovascular disease and type 2 diabetes.
• Preventable diseases include lifestyle-related conditions like type II diabetes, hypertension, and cardiovascular disease.
• Reducing smoking rates is a key preventive measure for diseases like COPD, cerebrovascular disease, and lung cancer.
• Early Intervention: Conditions like cancer and cardiovascular disease have high success rates when treated early as early diagnosis and treatment increase survival and reduce disease progression.
• High-cost diseases like cardiovascular disease involve expensive treatments, long recovery, and loss of productivity, affecting individuals and the community through healthcare costs and economic loss.
• Low-cost diseases like musculoskeletal issues may require less intensive treatment, and their broader societal impact is smaller, though they still affect individuals' quality of life.

Groups Experiencing Health Inequalities

• ATSI people have a life expectancy 10 years lower than non-Indigenous Australians, but it's improving.
• Higher mortality in every age group, with deaths from circulatory diseases, diabetes, and digestive conditions significantly higher.
• Leading causes of disease burden are mental health and substance disorders.
• Higher rates of kidney disease, diabetes, obesity, cancer, and youth suicide compared to non-Indigenous Australians, and mental health issues are also more prevalent.
• Low education and income, higher rates of domestic violence, and incarceration.
• Lower employment rates (51% vs. 76% for non-Indigenous), higher poverty rates, and worse access to healthcare and education.
• Poor access to healthcare in remote areas, overcrowded and poor housing conditions, and higher rates of homelessness.
• Individuals are empowered to make healthier choices and reduce risk factors.
• Communities are involved in designing programs and interventions like Indigenous health services.
• The government implements programs like the $805 million Indigenous Chronic Disease Package, Close the Gap initiative, and funding for health services in remote areas.
• Disadvantaged people experience poorer health outcomes due to lower education and income, leading to risky behaviours like smoking, obesity, and alcohol abuse, and higher rates of chronic diseases.
• Risky behaviours are more common in low-income households
• Low education and income limit access to healthcare and healthy lifestyles.
• Poorer access to healthcare in remote areas, including fewer doctors and specialists.
• Individuals are encouraged to make better health decisions and stay in school
• Communities offer programs to support health like physical activity initiatives
• The government provides funding through Medicare and social welfare programs to ensure equitable healthcare.
• People in Rural and Remote Areas have higher death rates, especially from heart disease, cancer, accidents, and suicide
• Health outcomes worsen with remoteness.
• High rates of smoking and poor health behaviors often linked to socioeconomic status
• Limited job opportunities and lower education levels result in poorer health choices
• Access to healthcare is limited due to fewer doctors and long travel distances.
• Individuals are encouraged to make better health decisions and seek education, while government supports programs like the Royal Flying Doctor Service and Rural General Practice Program.
• 27% of Australia's population is overseas-born, with 18% from non-English speaking countries; they generally have better health initially but experience a decline over time.
• Overseas-born people have lower death rates and longer life expectancy, but some groups face higher rates of cancer or diabetes-related deaths, fewer mental health issues and injuries but poorer self-assessed health.
• Language barriers limit health access and employment opportunities, along with reliance on ethnic communities for social support.
• Individuals can improve health through English classes and healthier lifestyles
• Communities can offer language support, and the government provides services like translation and Medicare for migrants.
• Elderly Australians face chronic diseases and reduced independence, with high rates of arthritis, diabetes, and dementia.
• Family dynamics and social isolation are key factors, and reduced income from retirement limits healthcare access, along with environmental factors in rural areas.
• The elderly can improve health through physical activity and social engagement.
• The government supports aging through chronic disease prevention and healthcare access, and communities provide services like Meals on Wheels.
• 1 in 5 Australians has a disability, with many needing help with daily activities, higher rates of chronic conditions and mental health comorbidities.
• Family and community play a role, disabilities are more common among Indigenous Australians and the elderly and socioeconomic factors affect access to services.
• Individuals can seek education and make healthier choices, communities provide support services.
• The government offers Disability Care Australia and community programs.

Health Care in Australia

• Hospitals provide emergency care, surgery, rehabilitation, and midwifery; public hospitals are covered by Medicare, while private hospitals require payment or insurance.
• Nursing Homes: Care for the elderly and those with chronic conditions
• Funded mostly by the government, with private homes requiring additional payments.
• General Practitioners (GPs) are the first point of contact for healthcare, with most costs covered by Medicare, and after-hours GP services have increased.
• Dentists are not covered by Medicare, and Allied Health Providers include physiotherapists, chiropractors, and psychologists, with some rebates available.
• Pharmaceutical Services are subsidized by the Pharmaceutical Benefits Scheme (PBS).
• Australian health ministers oversee health facilities, focusing on system improvement and health disparities, with state/territory governments regulating public and private services.
• The Commonwealth funds most hospitals, primary health services, and research; state/territory governments fund public hospitals and some community health services, while private providers fund private hospitals, medical services, and some health goods.
• Access to healthcare in Australia is uneven, with metropolitan areas having better access than remote areas and disadvantaged groups face barriers.
• Rural & Remote Areas have limited access to hospitals, specialists, and private healthcare, while Aboriginal and Torres Strait Islander (ATSI) experience poorer access due to wait times, cost, unavailable services, and cultural issues.
• Low Education Levels can limit health access.
• 2.4% of people delayed seeing a GP, 14.8% delayed seeing a dentist, and 5.8% delayed seeing a specialist due to cost, with 16.6% waited longer to see a GP and insurance coverage is lower in disadvantaged groups.
• Government Initiatives like Medicare & PBS have reduced costs but exclude some services, and Royal Flying Doctors & Telehealth provide remote access.
• Australia spends over $160 billion annually, with major costs in hospitals (38%), primary health care (36%), and other services (20%)
• Focuses on reducing risk factors like smoking, poor diet, and lack of exercise.
• Australia spends $2.2 billion on prevention (1.4% of health budget)
• Prevention improves health outcomes
• Interventions should balance low cost and high health benefits.
• WHO suggests policies like tobacco control, better diets, and regular screenings.
• New treatments improve disease detection and outcomes, but high costs can increase healthcare expenditure.
• Universal health cover for all Australians, funded through taxes (2% levy); it provides free or subsidized hospital care, GP, and specialist treatments
• Private health insurance gives provides more choice, faster access to surgeries, and covers ancillary services to higher-income earners.
• Medicare helps reduce health inequities, but private insurance offers more choice and faster care, though it can deepen social inequities.