CORE 1_ Health Priorities in Australia PDF

WORD BANK ˚୨୧⋆｡˚ ⋆ Mortality The number of deaths in a group of people or from a disease over a specific time period, usually one year Infant mortality rate The number of infant deaths in the first year of life per 1000 live births Morbidity Pa...

WORD BANK ˚୨୧⋆｡˚ ⋆ Mortality The number of deaths in a group of people or from a disease over a specific time period, usually one year Infant mortality rate The number of infant deaths in the first year of life per 1000 live births Morbidity Patterns of illness, disease and injury that don’t result in death Epidemiology The study of the patterns and causes of health and disease in populations and the application of this study to improve health Life expectancy The length of time a person can expect to live Determinants A factor which decisively affects the nature or outcome of something Reorient Change the focus or direction of Carcinogen A substance, organism or agent capable of causing cancer Tumour Abnormal mass of cells in the body. Tumours can be both benign (non-cancerous) and malignant (cancerous), where malignant tumours contain cells that grow out of control and can invade surrounding tissue. Arteriosclerosis The thickening and hardening of the walls of the arteries The hardening of the arteries whereby artery walls lose their elasticity Carcinoma Carcinoma is a type of cancer that forms in epithelial tissue Metastasis The spread of cancer cells from the place where they first formed to another part of the body Remission A decrease in or disappearance of signs and symptoms of cancer Sarcoma A tumour that occurs in the bones and soft tissues Dementia Loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life CQ1: How are priority issues for Australia’s health identified? ˚୨୧⋆｡˚ ⋆ Measuring health status Role of epidemiology - Epidemiology: the study of the patterns and causes of health and disease in populations and the application of this study to improve health - Necessary to understand the health status of that population - Health status: the pattern of health of the population in general over a period of time  - Epidemiology considers patterns of disease in terms of: - Prevalence (number of cases that exist in a population at a specific time) - Incidence (number of NEW cases) - Distribution (the extent) - Apparent causes (determinants and indicators) - Epidemiology tells us: - Future health plans - Impact of disease and illness - Health status of a population - Trends in disease - Prevalence and incidence of disease - Treatments provided, hospital usage - Death, birth, illness and injury rates - Expenditure for consumers and government - Data is used by: - Government - Researchers - Health department officials - Health or medical practitioners - Limitations of epidemiology: - Reasons why people take risk e.g. higher road death in youth males - Variations among subpopulations e.g. indigenous vs non indigenous - Impact of the illness on quality of life - Data is incomplete or non existent - Why inequities exist - Contribution of factors Measures of epidemiology (mortality, infant mortality, morbidity, life expectancy) INFANT MORTALITY RATE - Number of deaths among children under (1 year old) in a given period - Expressed as a unit per 1000 live births in the same period - Australia’s infant mortality rate as of 2020 was 3.1 deaths per 1000 live births - Ranks us 12th against other OECD (Organisation for Economic Co-operation and Development) countries, below the average MORBIDITY - Refers to ill health in an individual and levels of ill health in a population/group - In Australia, disability-free years are increasing (people are living longer without chronic diseases) - Leading issues of morbidity in Australia are the increasing rates of: - Diabetes - Dementia - Those leading the burden of disease: - Cardiovascular disease - Oral health - Musculoskeletal disorders  - Mental health disorders MORTALITY - Leading causes of death in Australia: - Coronary heart disease - Dementia and alzheimer's - Cerebrovascular disease - Lung cancer - Prostate cancer (males) - Breast cancer (females) - Australia’s age-standardised death rate (SDR) for March 2022 was 41 per 100000 people LIFE EXPECTANCY - An indication of how long a person can expect to live - The age given is dependent on their age - Technically, it is the number of years of life remaining to a person at a particular age if death rates don’t change - Most commonly used measure is life expectancy at birth - 2022 life expectancy is 82.9 → males expecting to live 81.2 years → females expecting to live 85.3 years Identifying priority health issues - Government makes decisions about how they will address health problems using criteria - Question of how best to spend money and distribute resources is answered - Health issues that meet most of these criteria will be a priority area as they have the largest impact on society Social justice principles -Social justice aims to decrease or remove inequity from a population → health equality -Everyone has the right to equal health opportunities -Social justice recognises the importance to support the marginalised, disadvantaged or under represented groups of people in society - Purpose: - Seek to recognise and address both the health outcomes: - Incidence and prevalence of disease - Death rates - And the factors that influence health: - Socioeconomic status - Environment - Cultural factors EQUITY - “Means the resources are allocated in accordance with the needs of individuals and populations with the desired goal of equality of outcomes” - Results in particular groups receiving MORE funding and being identified as priority groups in Australia because they have poorer health outcomes - Example: Aboriginal and Torres Strait Islander People require additional funding and resources to improve health outcomes (example: close the gap campaign)  - Close the Gap Campaign: - Aim to close the Aboriginal and Torres Strait Islander health gap by implementing a human rights based approach to Aboriginal and Torres Strait Islander health - https://healthinfonet.ecu.edu.au/learn/health-system/closing-the-gap/closing-the-gap-targe ts/ DIVERSITY - Refers to the differences that exist between individuals and people groups - Australia is very diverse and requires a number of measures to be in place to ensure each group has access to health care and achieves good health outcomes - Example: providing brochures in multiple languages and having interpreters in hospitals SUPPORTIVE ENVIRONMENTS - Environments where “people live, work, and play that protect people from threats to health and that increase their ability to make health-promoting choices” - Government creates supportive environments for all people but looks at the environments of particular people groups to determine if these might be reasons for poorer health outcomes - Example: rural and remote people have environments that are not as supportive as others Priority population groups - These populations can be cultural, environmental, age based, economically based and ability based - Six priority population groups: - Aboriginal and Torres Strait Islander people → have the worst health outcomes in Australia with statistics matching developing countries - Socioeconomically disadvantaged people - People in rural and remote areas → have limited access to health care facilities, lower quality of fresh foods, and healthcare worker shortages limiting access to services - Overseas-born people - The elderly - People with disabilities - Epidemiology provides statistics to identify priority population groups that need extra resources in order to remove the gap in health outcomes - Further advances our knowledge of the sociocultural, socioeconomic and environmental determinants of health - Examples of epidemiology: - Males have higher rates of cancer than females - Aboriginal and Torres Strait Islander males and females can expect to live 10 years less than other Australians - People in remote areas have higher death rates than urban dwellers - Lower oral health is found in people of lower socioeconomic status - Priority population groups then become the focus of health promotion initiatives → receive more funding, and health programs get developed to meet their particular needs - Example: Royal Flying Doctors Service functions in remote areas to provide better access to health services Prevalence of condition - “The number or proportion (of cases, instance) in a population at a given time” → in relation to cancer, prevalence refers to the number of people alive who had been diagnosed with cancer - 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 → can be identified as a priority health issue in Australia - Current highly prevalent conditions which have become priority health issues: - Cardiovascular disease: has been a priority health issue for a long time in Australia and will continue to be long into the future - Cancers: have been a growing priority in Australia, although the decreased smoking rate is helping - Dementia and Alzheimer’s disease: affect many Australians today, particularly the elderly - Diabetes: prevalent in Australia with increasing incidence, making it a very high priority issue for Australia’s health - Cerebrovascular disease (stroke): like cardiovascular disease, continues to be a major health issue (and has similar underlying causes as cardiovascular disease) - Incidence refers to the number of NEW cases diagnosed in a specific time period - It is helpful to understand the current trends in diseases - Example: if the number of new cases in a 6 month period is less than it has been over the previous 6 months, the trend will be downward, showing a decreasing trend in the disease Potential for prevention and early intervention -The more potential for prevention and early intervention, the more likely the health issue will be made a priority PREVENTION - The easier it is to prevent disease, the more impact health promotion will have on the burden of the disease - Examples of diseases which have high potential for being prevented: - Type II diabetes - Hypertension - Cardiovascular disease - Obesity - These are lifestyle diseases mostly caused by inactivity and poor dietary choices - A particular preventative action that has been taken recently is to reduce smoking to reduce: - COPD - Cerebrovascular disease - Lung cancer EARLY INTERVENTION - If prevention cannot occur, early intervention is preferable, with higher rates of survival for those diagnosed and treated early for the condition - These diseases have higher rates of successful treatment when identified and treated early - Examples of diseases with potential for early intervention: - Cancer - Cardiovascular disease  - Musculoskeletal conditions (e.g. arthritis) Costs to the individual and community -Cost to the individual and community come in various forms: - Expenses - Time - Independence - Connection with other issues such as mental health issues HIGH COST DISEASE - CVD is very expensive to treat, often involving large surgical procedures, lengthy recovery periods, loss of independence, and income, and is linked with lower self-esteem levels - Also has high cost to the community: - Community pays for the surgery through Medicare taxes - The company that the person works for, loses money as they pay for sick leave and either pay for someone to cover them or lose the work that person was contributing - Cost to family and friends who might take time off work, become anxious about their relative’s health, and may be needed as a carer for the person as they recover LOW COST DISEASE - Musculoskeletal issues are not as costly - Osteoarthritis does not always require people to take time off work or have surgery - It is often treated through medications, though surgery can be needed at times (e.g. hip replacement) - It does not often cause depression in the sufferer and they don’t require a carer or cause the same level of stress for their family members CQ2: What are the priority issues for improving Australia’s health? ˚୨୧⋆｡˚ ⋆ Groups experiencing health inequities Aboriginal and Torres Strait Islander peoples The nature and extent of the health inequities - ATSI die at a much younger age and are more likely to experience disability and reduced quality of life because of ill-health - Life expectancy of Indigenous Australians is approximately 10 years less than the overall Australian life expectancy - Death rates for ATSI is 4x, and the child death rate is 2x that of their non-Indigenous counterparts - Infant mortality (2 or 3x higher than the overall Australian figure), and higher mortality rates - Mortality inequities (in comparison) - Mortality rates for 35-44 year olds is 4x - CVD accounts for approximately 25% of deaths, occurring at 1.5x the rate of non-Indigenous - Morbidity inequities: - Burden of disease is 2.3x - 3.3x more likely to have diabetes  - 2x suicide rate → 15-19 year olds, 5x rate - 2x mental health issues The sociocultural, socioeconomic and environmental determinants Sociocultural Socioeconomic Environmental - Higher rates of domestic - Less educated - Limited access to health violence - Less money - contributes to services due to location - Higher rates of imprisonment family upbringing - Difficulty accessing dentists - Low community self esteem - Lowest income bracket and GP’s due to long waiting - Loss of dignity with - Unemployment is higher- times/unavailability of community jobless families services - Feeling little control over their - Poor behavioural choices - Poorer living conditions - environment which increase risk factors rural remote (culture) - Restriction to connect with (smoking, inactivity) - Overcrowded and run down their traditional culture - Being poorer leads to lower housing - Racism - stress affecting health care - Lower safe drinking water in mental health - Lower health care leads to remote communities - History of discrimination more risk of disease - Living in remote areas often - Language barriers and poor - Indigenous students half as has higher mental issues, less access to health services likely to finish yr12 recreational opportunities - Poor literacy- leads to reduced capacity to use health information The roles of individuals, communities and governments in addressing the health inequities - Individuals are empowered by a number of interventions to make informed choices about their behaviours, and encouraged to reduce risk behaviours and increase protective behaviours - Each individual is responsible to promote their own health and the health of others - Improve ATSI people’s knowledge, accepting diversity, positive health choices, participating in ATSI community initiatives, volunteering - Communities are involved in the design and implementation of many of the closing the gap programs and interventions → includes: Australian Indigenous Doctors Association, National Aboriginal Community Controlled Health organisation, Aboriginal Community Controlled Health Services, and Aboriginal Medical Services - Advocate for change, involve community members in ATSI initiatives, awareness strategies, lobbying government, education programs for ATSI - Australian Government’s role is larger health promotion and funding → example: $805 million Indigenous Chronic Disease Package, aims to improve the way the health-care system prevents, treats and manages the chronic diseases that affect ATSI people - Funding ATSI programs, increasing doctors in ATSI communities, more services for ATSI people, increasing access to services - Close the gap initiative - Statement aims to achieve equality in health status by reducing infant mortality and increasing life expectancy in ATSI people  - Also includes closing the gap in education, and employment outcomes; along with improving accessibility of health care to ATSI people living in remote areas Why are they experiencing health inequities? - Less developed/lack of health services - Lower levels of empowerment - Sociocultural, socioeconomic and environmental determinants - Discrimination Socioeconomically disadvantaged people The nature and extent of the health inequities - Socioeconomically disadvantaged people have poorer outcomes in chronic diseases when compared to other Australians: - 40% higher death rates from coronary heart disease with a slower decline rate than the higher SES areas - 6x the incidence of lung cancer and worse survival rates - ⅓ higher rates of overweight and obese women and ⅔ higher amongst children - Higher mortality rates from all cancers combined - Lower life expectancy, self assessed health status, oral health and kidney disease - Double the rates of COPD - More likely to have diabetes The sociocultural, socioeconomic and environmental determinants Sociocultural factors - More likely to take part in risky health behaviour, or combinations of behaviours, which can lead to poorer chronic disease outcomes due to their peers and family → in 2011–12, people living in areas of lowest socioeconomic status were 2.3x as likely to smoke as those living in the highest Socioeconomic factors - Lower rates of income → reduces the options for health care and healthy behaviours → less choice in type of employment and have higher rates of hazardous work types such as transport - Lower levels of education → less informed about the choices they have and the services available to them Environmental factors - Higher rates of homelessness - Lack of shelter and living on the street affects physical and mental health - Higher rates of socioeconomically disadvantaged people in rural and remote areas when compared with urban areas The roles of individuals, communities and governments in addressing the health inequities Individuals - Focusing on good decision making and taking responsibility - Actions such as remaining in school or attending university improves SES - Individuals can also help promote health within family/friends by encouraging good health choices (e.g. not smoking, reducing alcohol intake) Communities  - Provide relevant health care and support services - PCYC: provide physical activity programs and welfare support for youth - Youth of the Streets: aims to improve health outcomes for socioeconomically disadvantaged people Government - Support community programs and providing funding for free/reduced cost health care - Medicare: - Provides free/subsidised treatment from a range of health professionals (e.g. doctors, optometrists, physiotherapists, specialists) - Medicare funds hospitals, medical services, and pharmaceuticals - Includes free patient care in hospitals and rebates for professional health services (Medicare Benefits Schedule) - Pharmaceutical Benefits Scheme (PBS): subsidised medicine - Goals of these schemes is to provide all Australians with adequate and affordable health care, regardless of their SES - Schemes are supported by social welfare arrangements with smaller costs to those who have particular income-support payments Why are they experiencing health inequities? - Reduced health literacy - Lack of access to medical services - Less money → poorer quality of life - Family influence with values and risk factors, e.g. drinking alcohol - Geographical factors People with disabilities The nature and extent of the health inequities - Nearly half of people 16-64 years old with disability report fair or worse compared to 5% of other Australians → people with severe or profound disability had higher rates of: - Young onset arthritis - Osteoporosis before age 45 - Young onset diabetes - Smoking - Overweight - Suicidal thoughts - Adults with disability more likely to experience high or very high levels of psychological distress than those without disability (29% compared with 17% in June 2021) The sociocultural, socioeconomic and environmental determinants Sociocultural - family, peers, media, religion, culture - Health of people with disabilities can be affected if they are socially excluded or marginalised → may face violence and discrimination related to their disability - A number of disabilities are genetic, which makes family and culture very important Socioeconomic - education, employment, income - People with disabilities are least likely to get a job as some may be unfit for work + lack of job opportunities  → because of this, they have lower incomes and may rely on welfare payments → people with disabilities are also more likely to live in poverty than those without a disability - Some are limited in their access to education as they may require schools specifically designed for them → can lead to reduced health literacy due to lack of education Environmental - geographic location, access to services and technology - People with disabilities often have reduced access to health services and some require technology to be mobile (which can be costly) → they are also disadvantaged if they live in a house that is inappropriate for their disability The roles of individuals, communities and governments in addressing the health inequities - Individuals can be limited in their ability to change their health - Some have no choice of food or activities they are involved in - People with disabilities should seek to increase their education utilising the services provided for them - Some could have been prevented by making better more informed lifestyle choices - Community support services: The Aging, Disability and Home Care community services: - Early intervention programs - Supported accommodation - Living skills programs - Social groups - Help finding employment - CIVIC - 3Bridges - Australian government established National Disability Strategy - DisabilityCare Australia: provides consistent assessment processes, improves service standards, develops the disability workforce - Also funds many community programs - NDIS (National Disability Insurance Scheme) - Aims to reduce the inequities experienced by people with disabilities - A scheme of the Australian Government that funds costs associated with disability - Legislated in 2013, went into full operation in 2020 - NDIS will provide an estimated 500,000 Australians who have permanent and significant disability with funding for supports and services → this includes supporting approximately 80,000 children with developmental delay - The NDIS also connects anyone with disability to services in their community → including connections to doctors, community groups, sporting clubs, support groups, libraries and schools - Examples of funding that NDIS provides for: - daily personal activities - transport to enable participation in community, social, economic and daily life activities - workplace help to allow a participant to successfully get or keep employment in the open or supported labour market - therapeutic supports including behaviour support  -help with household tasks to allow the participant to maintain their home environment - help to a participant by skilled personnel in aids or equipment assessment, set up and training - home modification design and construction - mobility equipment - vehicle modifications Why are they experiencing health inequities? - Discrimination - Decrease in mental health High levels of preventable chronic disease, injury and mental health problems - High levels of preventable chronic disease, injury and mental health problems are health priorities, where Chronic disease is Australia’s most pressing health priority - Most are caused by lifestyle choices and can be prevented or delayed by simple adjustments to people’s life choices Cardiovascular disease (CVD) Nature of the problem - Cardiovascular disease refers to all the diseases of the circulatory system (heart, blood vessels) - Include: coronary heart disease, stroke, myocardial arrhythmia, and heart failure - Atherosclerosis: build up of fat and plaque inside the arteries, which can block the blood vessels. → blockage can result in the death of cells that were relying on these arteries for their oxygen supply, e.g. heart attack - Arteriosclerosis: “hardening of the arteries” or thickening of arterioles - There are 3 major forms: - Coronary heart disease (ischaemic) - Stroke (cerebrovascular disease) - Peripheral vascular disease - Coronary heart disease is the most common where the arteries of the heart cannot deliver enough oxygen-rich blood to the heart - Includes heart attacks and angina - Heart attack results from momentary blockage of the artery to a section of heart muscle - Angina results from a partial blockage and produces chest pain, particularly during exercise - Stroke (cerebrovascular disease) is a temporary blockage of the blood vessels to the brain, resulting in the death of some brain cells, or a vessel begins to bleed, reducing the delivery of oxygen to part of the brain - Can result in a range of debilitations: communication, mobility, thinking and can be fatal - Peripheral vascular disease is a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs Extent of the problem - Highest burden of disease, for combined males and females - Mortality and morbidity are decreasing - 1 in 4 deaths  - Decrease in prevalence, due to: - Increase in prevention strategies - Decrease in risk factors Risk and protective factors Risk Protective Modifiable Non-modifiable Physical inactivity Family history Regular physical activity (60m/day) Obesity Regular health checks Smoking Balanced diet with low saturated fats Hypertension Sociocultural, socioeconomic, environmental determinants Sociocultural - Genetics play an important role - Growing up in a family that is overweight or obese, eats foods high in sugar and saturated fats or lives a sedentary lifestyle leads to children who grow up to live a similar lifestyle - Peers influence people to make poor health choices, e.g. pressure to smoke Socioeconomic - Higher levels of education help produce lower incidence of cardiovascular disease - Education also enables choice of employment - Cardiovascular disease has higher rates in blue collar employment (trades and labour) → linked with other lifestyle choices such as higher rates of smoking and drinking - Lower income levels result in fewer health related choices as many incur cost to the individual (e.g. gym, buying lean meats rather than regular meat) Environmentalw - People living in rural areas have higher rates of death from cardiovascular disease → speed of medical treatment for heart attacks/stroke greatly affects results - People who access medical treatment swiftly have less chance of disability or death resulting from their stroke or heart attack - Access to technology impacts survival rates, and is also used in medical checks to test for atherosclerosis, angina and other cardiovascular diseases Groups at risk - ATSI: 2.6x as many heart attacks as other Australians over 25 and are 1.7x as likely to have a stroke - Low socioeconomic status: 40% higher death rate from cardiovascular disease, higher rates of stroke - Rural and remote: higher burden from stroke compared with people in cities - Elderly: represent 15% of those who have coronary heart disease, account for 70% of people who had a stroke - Smokers have much higher rates of cardiovascular disease - Men have more cardiovascular disease than their female counterparts Cancer (skin, breast, lung) Nature of the problem  - Cancer refers to cells that have become abnormal and begin to multiply rapidly, and cannot be controlled by the body - Cancer cells invade surrounding tissues and can be deadly - To minimise the damage, the body places the abnormal cells into a sack, called a tumour - Tumours can be both benign (non-cancerous) and malignant (cancerous) → malignant tumours contain cells that grow out of control and can invade surrounding tissue - Cancer moves away from the original or primary site to other sites/organs of the body → metastasis or secondary cancer Extent of the problem - Cancer is the largest killer in Australia - Increasing morbidity, decreasing mortality - Death rates are decreasing - The probability of getting cancer before 85 years of age 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 Risk factors Lung Skin Breast Smoking Fair skin Family history Occupational exposure - e.g. asbestos Live in areas exposed to the sun High-fat diet Air pollution Number and types of moles Early onset menstruation Late menopause Obesity Late-age pregnancy Protective factors Lung Skin Breast Avoid exposure to tobacco smoke Avoid excess sunlight Regular mammograms Avoid exposure to hazardous materials Reduce exposure by wearing sun Self-examination protection Low fat diet with fruits and vegs Sociocultural, socioeconomic and environmental determinants Sociocultural - Australian culture has often revolved around the heat of summer, beaches and getting a tan - Recent educational actions, including advertising in the media have helped Australians know sun exposure increases the risk of melanoma of the skin - Genetics are inherited through family lines, and a history of cancer in the family increases the risk of cancer diagnosis - Behavioural risk factors can be affected by family and peers → people who have family/friends who smoke or are sedentary are more likely to adopt these lifestyle choices Socioeconomic  - People who have lower levels of education have lower levels of health literacy and are less aware of the risk factors/protective factors for a range of cancers - Lower levels of education also limit opportunities for employment - People who work outside have greater exposure to the sun, placing them at higher risk for skin cancers - People who work with radiation (e.g. X-ray, electromagnetic fields) have higher risk of cancer - Income can restrict access to health services, specifically specialists - People with lower socioeconomic status have higher rates of cancer and higher mortality rates Environmental - People living in rural and remote areas have higher mortality rates than other Australians → connected with their lack of access to specialists in cancer, and less technology being available for treatment - Rural and remote people need to travel to a major city for some cancer treatments - People who live on the beach are more inclined to be outside in the sun, which places them at more risk of skin cancers Groups at risk Lung Skin Breast Smokers Fair skinned people Obese Blue collar workers Outdoor workers (farmers) Over 50 Occupations exposed to asbestos People who avoid sun protection Have family history of breast cancer Over 50 years of age Menstruate early - Elderly: 70% of diagnosis and 80% of cancer deaths were in people over 60 years of age - Males: cancer incidence is 1.4x higher, death rates 1.6x higher - ATSI: 10% more likely to be diagnosed, 50% higher mortality rates from cancer - Low SES - Rural and remote: higher mortality rates, incidence is lower Mental health problems and illnesses Nature of the problem - Examples: depression, schizophrenia, personality disorders, PTSD - Illnesses cause suffering for those directly affected and often their family/carers and social network - Poor mental health in childhood and adolescence underpins a lack of self-care in adulthood → may result in drug abuse, physical neglect and early pregnancy - Mental health disorders in children and young people are a strong indicator of poor mental health in adulthood Extent of the problem - Morbidity increasing - 3rd highest burden of disease - 45% of Australians between 15 and 85 reported suffering from a mental health problem or illness in their lifetime - A higher proportion of males than females (48% compared with 43%) had experienced a mental disorder in their lifetime - Those aged 16–24 (26%) were most likely to have experienced symptoms of a mental disorder  - Anxiety is the most common mental health disorder (14.4%), followed by depression (6.2%) Risk and protective factors RISK PROTECTIVE - Drug use - Social acceptance as a legitimate health concern - Chronic disease (e.g. arthritis, CVD) - Awareness of social support structures (e.g. suicide - Perceived self-worth and sense of identity hotline, counselling, GP) - Coping skills - Strong sense of connectedness with family, friends - Stressful situations (e.g. family breakdown) and workmates - Grief - Support networks - Age (increased risk of dementia) - Personal resiliency skills - Males suffer mostly depression and addiction - Females suffer mostly depression and anxiety Sociocultural, socioeconomic and environmental determinants Sociocultural - Media and society have worked hard to reduce the stigma around mental health disorders and illnesses through advertising and other media programs - Community groups such as BeyondBlue help to raise awareness of mental health problems and illnesses around Australia - National Rugby League are chipping in to break down the characteristic male who has no emotion - People brought up in broken/dysfunctional families have higher rates of mental health problems and illnesses Socioeconomic - Mental health illnesses are associated with economic disadvantage, unemployment or under-employment, homelessness and reduced productivity - People who work in high stress jobs are more likely to suffer a mental health problem Environmental - People living in rural areas have less access to mental health services, and have a culture of a tough male who doesn’t suffer emotionally or mentally Groups at risk A growing and ageing population Health system and services - Increase of 20% in aged care facilities → higher burden of disease with chronic disease (e.g. CVD) and mental health support (e.g. depression) Health service workforce - Increased demand for workers - There is a shortage of people in the workforce → low paid industry = less attraction Volunteer organisations Carers of the elderly Healthy ageing - A process that includes various behaviour and choices that affect health, e.g. regular physical activity, good dietary choices, regular family contact and social activities, resilience to life’s circumstances - Goal of healthy ageing is to enable the elderly to maintain their health into old age → allows them to contribute to workforce longer, engage in society better → increases economic growth, decreases use of health services by the elderly - Healthy ageing involves people reducing their risk factors for disease, and preventing the progression of the disease after its onset, and reducing morbidity and mortality - Government aims to: - Prevent disease - Reduce illness and illness periods - Maintain economic contribution - Maintain social participation - Healthy ageing improves quality of life (QOL) and decreases disability adjusted life years (DALYs) (these are used to measure disease burden) Increased population living with chronic disease and disability - Chronic disease and disability are more prevalent in the elderly - Cancer, diabetes, cardiovascular disease, cerebrovascular disease and respiratory disease and mental health issues continue to impact Australian society and can lead to debilitating conditions → e.g. a person who survives a stroke may never walk again and may end up in a nursing home for the rest of their life - With rising survival rates from cancers and cardiovascular disease, the prevalence of people living with chronic disease and disability is rising - Common chronic diseases amongst the elderly: - 53% of the have a disability - 49% have arthritis - 38% have high blood pressure - 35% have hearing loss - Over 1 in 5 (22%) have cardiovascular disease - 15% have diabetes - 7% have cancer - 20% have vision problems, and - 93% of people with dementia are elderly Demand for health services and workforce shortages The health system and services - A growing and ageing population increases the demand for health services and creates workforce shortages in the health service as an increase in the workforce would be required - Concern that the ageing population will increase public spending on health and place unsustainable strain on the health system - Increase in age is associated with an increase in health conditions and disability - Increase in the people living past 85 who suffer from diseases such as arthritis, dementia and cancer, while the generation moving into the 65+ age group have higher levels of lifestyle diseases, e.g. diabetes  - Elderly visit health professionals more frequently than younger people → Consulting a health professional (98% compared to 90%) → Seeing a specialist (57% compared to 28%) → Hospitalisation (20% compared to 11%) - Last 10 years: number of people living in aged care facilities has risen by 20% → reflects the growing and ageing population, AND the increase in government-subsidised residential places - Aged care carries a high burden on the health system with all residents having chronic disease or illness - Many who live in these facilities (52%) have symptoms of depression Health service workforce - Increase in aged care facilities → increase in workforce training in aged care - Ageing population requires an adequate health workforce → number in the workforce, AND their distribution and skills - Concern: increased demand for workforce in the aged care sector and specialists - To address this growing demand for health services and workforce shortages is to focus on efficient coordination of care - Elderly have higher rates of disease and disability → coordinated care and focus on safe medication use would decrease the demand for health services → would reduce duplication of tests, medicating and medical records - Efficiency might be achieved through greater interaction with aged care services, focusing on care and setting it is provided in - ¼ aged care residents visit hospital a year, accounting for 9% of hospitalisations - Living Longer, Living Better (2012) aged care reform package → aims to address the attraction, retention, remuneration, education, training and career development of aged care workers Availability of carers and volunteers - Meals on wheels of the elderly - Carer is someone who provides assistance in a formal paid (64% of people receiving care use this) or informal unpaid role (83% use this) for someone due to illness, disease or disability - Care for the elderly needs to be varied in its approach in order to meet the demands - Aged care can be provided through community aged care or residential aged care - Care includes daily activities (e.g. bathing, cooking, home upkeep and administering medication) - Most informal unpaid carers are family members, particularly children or a spouse - Carers come from charities, religious institutions or the government - Three types of community care: - Community aged care packages: provide low-level care giving basic support and assistance with daily activities - Extended aged care at home: providing a higher level of care than the community aged care package - Extended aged care at home for dementia: catering for the more complex needs of those with dementia  - 31% of the elderly participate in voluntary work as carers, child minders, and volunteers - Elderly provide support for relatives and friends who are aged, sick, or living with a disability - Also provide regular care for their grandchildren under 12 Volunteer organisations - Volunteering is unpaid, wilful help given as time, service or skill to a formal organisation - Formal groups include: social groups (sport/recreational), religious groups, or heritage groups, AND civic participation which related to unions, professional associations or political parties - Volunteers often cook, drive, do housework, visit, or help the elderly shop - Examples: Anglicare, Alzheimer’s Australia NSW, Meals on Wheels, Nursing on Wheels - Rates of volunteers had increased between 1995-2010, but from 2010-2014, rates fell from 36% to 31% of people 18 and over - Falling rate needs to be turned around if Australia is going to appropriately care for the needs of our growing and ageing population CQ3: What role do health care facilities and services play in achieving better health for all Australians? ˚୨୧⋆｡˚ ⋆ Health care in Australia - Involve public and private services such as hospitals and nursing homes, GP’s, nurses, specialists, physiotherapists, dentists - Public is funded federally via the Medicare scheme - Private health services vary greatly in the type of medical specialty provided - Health-care system involves complex relationships between: - Commonwealth, state and local governments - Health insurance funds - Public and private providers of service (e.g. doctors) - Institutions (e.g. hospitals) - Other organisations, such as community health services - The system has provided: - Diagnosis - Treatment - Rehabilitation - Care for people with long-term illness or disability  Range and types of health facilities and services Institutional Non-institutional Hospitals Medical services provided by medical practitioners and - Public specialists, GPs - Private - Psychiatric Health related services, e.g. dental, optical, pharmaceutical, physiotherapy Nursing homes Community and public health services, e.g. supplying health Other services, e.g. ambulance equipment, aids and appliances Research organisations, e.g. National Health and Medical Research Council Health service Definition Public health services Public health interventions focus on maintaining the wellbeing of populations  rather than only individuals, and are aimed at protecting or promoting health or preventing illness. Public health services deal with the factors and behaviours that cause illness and other health problems, rather than the illness itself e.g. cancer screening, immunisation programs, health promotion and education. Primary care and community health care services Primary care and community health services are usually the first health service visited by a patient with a health concern. These services plan an important role in monitoring an individual’s health and managing many health conditions e.g. GP’s, ambulance, Royal Flying Doctors, Dental, community health, complementary/alternative health. Hospitals The hospital sector comprises public and private hospitals. Most hospital resources are consumed in providing care to admitted patients (inpatients). However, hospitals also provide high numbers of non-admitted services, e.g. emergency departments and outpatient clinics. There are also psychiatric wards. Specialised Health services These services include those provided by specialists both out of hospital and in private practice, e.g. specialists, reproductive health, mental health, palliative care, alcohol and drug treatment. Goods Medicines are mostly obtained by prescription or purchased over the counter without a prescription. Medicines are provided largely through pharmacies in the community and in hospitals. -Medicare levy surcharge is a levy paid by Australian taxpayers who do not have private hospital cover and who earn above a certain income → aims to encourage individuals to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public Medicare system HOSPITALS - PRIVATE AND PUBLIC - Public hospitals are operated and financed by the state governments and the Commonwealth Government - Provide more highly specialised and complex services, e.g. heart and lung transplants - They also provide same-day surgery, and take most of the non-admitted patients (outpatients) - Private hospitals are owned and operated by individuals and community groups - Provide same-day surgery and perform more short stay surgery, elective procedures and less complex procedures requiring less expensive equipment → e.g. eye, ear, nose, mouth, throat, musculoskeletal system, breast - Issue of equity of access to public hospitals → private patients have more rapid access to elective surgery (e.g. plastic, ear, nose and throat) than do public patients - Urgency categories have therefore been applied to patients’ conditions - “Australians are now waiting almost twice as long on average for planned surgery than they were 20 years ago, which is unacceptable” NURSING HOMES - Nursing homes provide care and long-term nursing attention for those who are unable to look after themselves (e.g. the aged, the chronically ill, people with dementia and people with a disability)  -Some cater specifically for young people with a disability -Three types of nursing homes: private charitable, private for profit, and state government → Commonwealth Government assumes responsibility for most of the financial cost - Aged-care assessment teams → ensure only highly dependent people are placed in residential care PSYCHIATRIC HOSPITALS - Treatment of people with severe mental illness has changed over recent years → moving away from institutional care to a system of care that integrates both hospital services and continuing care within community settings - Given the resulting reduction in extended hospitalisation of people with mental illness, the number of public psychiatric hospitals has fallen - Range of service providers for mental health care today includes GPs, private psychiatrists, community based public mental health services and specialised residential mental health-care facilities GENERAL PRACTITIONER (GP) - Community service and often the first point of access into medical and health services - Medicare covers the bulk of the cost, with many GPs choosing to add additional fees on top of that provided by the government, though there are still some who bulk bill - GPs have grown in order to reduce the use of emergency services, as a number of patients in emergency do not require emergency treatment, but access to the services of a GP DENTIST - Not generally covered by Medicare and require the patients to either pay out of pocket or through their private insurer - Some can claim rebates through Medicare under the Chronic Disease Benefit Scheme combined with the Allied Health Initiative ALLIED HEALTH PROVIDERS - Not normally covered by Medicare, but introduction of Allied Health Initiative has allowed some rebate to claimed - E.g. physiotherapist, osteopath, chiropractor, exercise physiologist, occupational therapist, and psychologists PHARMACEUTICAL SERVICES - Pharmaceutical services are funded through the Pharmaceutical Benefits Scheme (PBS) → provides partial payments for most prescription drugs - PBS provides extra funding for people with special needs, e.g. pensioners, concession cardholders, war veterans - Some people who are chronically ill or require regular long-term medications are protected from excessive cost by the PBS Safety Net - Aim of the Safety Net scheme is to ensure no-one is precluded for financial reasons from access to the medicines they need Responsibility for health facilities and services Commonwealth/Federal Govt. - Provides finances for health care - taxes and Medicare levy - Collection of taxes to distribute the finances to state governments for healthcare programs - Formation of national health policies (directs states to implement)  - Pharmaceutical Benefits Scheme State Govt. - Main provider of health services, facilities and institutions (e.g. hospitals, family health clinics, mental health, community and home care, family health services, dental health, nursing homes) - Regulation, inspection and licensing of health industry providers and services - State based health promotion - Funding and administering Immunisation Programs Local Govt. - Local health promotion - Vary from state to state - Monitor hygiene in food stores/restaurants - Waste disposal - Implement state government programs such as immunisation, Meals on Wheels - Recreational facilities Private Sector - Gyms, health related business - Private hospitals - Medical professions in private practice (GP, chiro, physio, dental) - Private organisation - National Heart Foundation, Cancer Council Communities - Local community events and services - Local needs based - Promotion - Breast cancer screening, Driver Reviver programs - E.g. Asthma Foundation, Diabetes Australia, Cancer Council Equity of access to health facilities and services - There are many barriers which hinder an individual accessing health facilities and services they may require - With medical advances comes greater opportunities to treat conditions - There is equity of access to health facilities and services to all Australians to an extent - The biggest action by the government to improve equity of access to health facilities and services was the introduction of Medicare and the Pharmaceutical Benefits Scheme - This has greatly removed cost as a barrier to a number of health medicines and basic health services. But not all - Health services such as dentists, physiotherapists, psychologists, or occupational therapists are not covered by Medicare → results in inequitable access to these services and not everyone can access them - An individual’s ability to access health care facilities and services can reflect their: - Socioeconomic status, e.g. low income = less access to health services - Knowledge of available services - Geographic location, e.g. rural areas = limited access to specific services (e.g. psychologist) - Cultural and religious beliefs - Access might also be affected by issues such as: - Shortages of qualified staff  - Lack of funding or equipment - Patient waiting lists for surgery or other treatments in public hospitals - Waiting times in outpatient clinics or emergency departments Socioeconomically disadvantaged 1. What health facilities do they have access to and WHY? - Medical services covered by Medicare, such as public emergency hospitals - Prescription drugs due to the Pharmaceutical Benefits Scheme 2. What facilities do they NOT have access to and WHY? - Services which are not covered by Medicare, e.g. allied health services (physiotherapist, psychologist) - Because, there is a separate cost for these services which they may not be able to afford 3. Implications on the health of these people? - They may have decreased health outcomes due to the limited access of “non-essential”, but still useful health services - Additionally, their knowledge regarding their health needs may be lower due to lower health literacy → lack of ability to navigate the health system 4. What can/has been done to INCREASE access for this group? - Bulk billing minimises out-of-pocket costs - Medicare - Pharmaceutical Benefits Scheme Health care expenditure versus expenditure on early intervention and prevention - Compares the treatment of disease and illness with prevention - For an effective health care model, Australia must seek early intervention and prevention, as well as treatment of disease and illness - Health-care expenditure: expenditure by Australian state and territory governments, as well as private health insurance, households and individuals - Health-care expenditure has steadily been increasing and will continue to increase if there is a focus on ‘curative’ medicine → e.g. it costs more to ‘cure’ a disease such as coronary heart disease once it has developed than it does to fund measures to prevent the illness occurring - Early intervention may focus on education, healthy eating practices, weight control and active lifestyle activities - Governments, individuals and communities are being made more accountable for their expenditures - Many people who have sound health due to positive health behaviours resent paying increased taxes to support those who choose inappropriate lifestyles → insurance companies recognise this, and charge higher premiums for smokers who wish to be covered for life insurance - Lifestyle factors could cause up to ~70% of all premature deaths - Yet, more than 90% of Australia’s health expenditure is allocated to treating and curing illnesses - It often takes years for prevention measures to translate into a reduction in the incidence of lifestyle-related diseases  - Preventative programs for cardiovascular diseases, cancer and traffic accidents have been visible over the past two decades - E.g. SunSmart, Stop/Revive/Survive, national cervical and breast screening programs, QUIT - As 82% of Australians see a GP at least once a year, frontline advocacy is an important form of health promotion → training programs for GP have made them more aware of the importance of preventative health - Together with treatment, early intervention and prevention programs have contributed to falls in mortality and morbidity rates - Strategies that could be used to prevent illness and death in the community include: - Educating school children about positive health behaviours - Better coordination among the various levels of government - Legislation - Higher taxes on products such as alcohol and tobacco - Provision of support programs to help people give up addictive habits such as smoking and high alcohol consumption Impact on emerging new treatments and technologies on health care, e.g. cost and access, benefits of early detection - Emerging new treatments and technologies → benefits to health outcomes, BUT also an increase in cost (raises questions of equity of access) - Examples of emerging treatments and technologies: - HPV vaccine aimed to reduce the incidence of HPV and cervical cancer - Keyhole surgery used for knees, kidneys, and hernias - Improved mechanics of replacement knees, hips, heart valves - Ultrasound and MRI used for internal imaging - New treatments and technology help improve early detection of various diseases and illnesses → also improves treatment and prevention which improves treatment outcomes and improves quality of life and life expectancy - Treatments and technology come at a cost → result in increased need for health care expenditure, and can only be accessible to people of higher socioeconomic status - Treatments and technology are also less available in rural and remote areas → need for rural and remote people to move into major cities TECHNOLOGY DESCRIPTION BENEFITS BARRIERS MRI Magnetic resonance imaging is a Individual benefits: It is a costly procedure → Medicare scan used to form pictures of the Produces very detailed pictures → does not cover these costs anatomy and the physiological allows for clearer detection of the There are limited MRI machines in processes inside the body. issue Australia → there is a lack of this Does not use x-ray radiation technology in remote areas, meaning It uses a strong magnetic field and Painless procedure those individuals need to travel radio waves to take pictures inside Community benefits: further the body. Can scan for tumours There is often a wait time for this → early intervention and prevention procedure It is especially helpful to collect of cancer  pictures of soft tissue such as organs Australia benefits: and muscles that don't show up on Reduces morbidity or mortality rates x-rays. → less burden of disease Keyhole Surgery Keyhole surgery is a type of Generally results in less pain, shorter Cost (Laparoscopy) non-invasive surgery that allows the hospital stays and faster recovery surgeon to perform a procedure times Lack of funding and equipment in inside the body through a small poorer areas incision in the skin. Since incisions are much smaller, it leaves a smaller amount of scarring Lack of equipment often means It uses an instrument called a laparoscopic training programmes laparoscope- a small, narrow tube Makes operating procedures far are the privilege of only the larger that has both a light source and a more accurate and less risky for the hospitals and cities camera on it, which illuminates and patient → smaller incisions reduces feeds back images of the inside of the risk of complications the body to a screen in the operating room. The size of the laparoscope means that it can be fed into the body through a small, keyhole-sized incision. Laser-fitted flexible endoscopes penetrate very small incisions and make repairs to hernias, kidneys, knees and other structures with new levels of precision. Health insurance: Medicare and private MEDICARE - Medicare is Australia’s universal health-care system, established to provide Australians with affordable and accessible health care - Funds to operate the Medicare system are obtained from income taxes and the Medicare levy (paid according to income level) → medicare levy is 1.5% of a person’s taxable income, but can vary according to circumstances - Medicare provides individuals with access to: - Free treatment as a public patient in a public hospital - Free or subsidised treatment by medical practitioners including GPs, specialists, and some specified services of optometrists and dentists - Regardless of what is charged, Medicare covers for 85% of an amount that is set down by the government as a common (scheduled) fee → some doctor charge more than the scheduled fee - Many doctor bulk bill patients: patient pays nothing and the doctor receives up to 100% (85% in the case of specialists) of the scheduled fee from Medicare - Medicare also covers optometrist services and oral surgery, but not private dentistry, physiotherapy, and chiropractic treatment PRIVATE HEALTH INSURANCE  - Many people choose to take out private health insurance → allows people to cover private hospital and additional expenses (e.g. dental, physiotherapy, chiropractic services) and aids (e.g. glasses) - Private health insurance benefits: - Shorter waiting times for treatment - Being able to stay in a hospital of their own choice - Being able to have a doctor of their own choice in hospital - Additional benefits, e.g. dental cover - Security, protection, peace of mind - Private rooms in hospital - Insurance cover while overseas - Lower levels of private health insurance are found among the young, the elderly, and other groups that have less available income - After the introduction of Medicare, many people opted out of private health insurance → fall in membership of private health insurance created pressures on the public health system → strain on the health system was caused mainly by the increasing demands for service from an ageing population and the increased numbers of ‘free’ Medicare patients - Lifetime health-care incentive: gives lower lifetime premiums to people who join a health insurance fund early in life and maintain their hospital cover, compared with the premiums for someone who joins after 30 → aimed to attract people to private health insurance Complementary and alternative health care approaches - Refers to healing practices that do not fall within the area of conventional medicine → e.g. hypnosis, naturopathy, meditation, herbalism, acupuncture, osteopathy - These practices have existed traditionally as alternatives to mainstream medicine, however, a growing acceptance of their role in supporting mainstream techniques has given the term ‘complementary’ - Alternative medicine has existed for many centuries, particularly in Asian countries → e.g. traditional Chinese medicines account for 30-50% of all medicines consumed in China - Australians are increasingly buying herbal remedies and consulting alternative health-care practitioners such as chiropractors, homoeopaths, naturopaths, and Chinese herbalists TYPES EXAMPLES Biologically based approaches Diets Herbs Vitamins Manipulative and body-based therapies Massage Chiropractic Osteopathy Mind-body interventions Yoga Spirituality Relaxation Alternative medical systems Homeopathy Naturopathy Ayurveda Energy therapies Heiki Magnets Qigong Reasons for growth of complementary and alternative health products and services - ⅔ of Australians are currently using CAM treatment - Social change, greater globalisation and societal trends towards individualism → improved access to information worldwide and less acceptance of traditional medical practices - People see CAM as an opportunity to exercise choice, exerting greater control over their health through empowerment → rise in consumption of organic foods provides evidence for strengthening consumer confidence in aspects of healthcare over which they have control - Other reasons for increasing popularity of CAM generally include: - WHO recognition of the usefulness of many alternative approaches and its endorsement of a list of medicinal plants to be used in the preparation of herbal medicines - Recognition that alternative medicines are the traditional medicines of the majority of the world’s population - Effectiveness of treatment for many people for whom modern medicine has proven ineffective - Desire of many people to have natural or herbal medicines rather than synthetically produced medicines - Holistic nature of alternative medicine - Strength of traditional beliefs - Increase migration and increased acceptance by Australians of the value of multicultural influences - Growth in CAM adds another dimension to medical health in its direction and expectations - Consumers, aided by medical information (available on the internet), have moved to exercise greater choice in addressing personal health care, particularly in areas where there appears an element of uncertainty with traditional approaches Range of products and services available ACUPUNCTURE - An ancient system of healing that has developed over thousands of years as part of the traditional medicine of Eastern countries - Involves inserting very fine needles into the skin, and then left in either briefly or for up to 20-30 minutes - Acupuncture is claimed to be effective in a wide range of conditions, stimulating the mind and the body’s own healing response CHIROPRACTIC - Based on the relationship between the spine and the functioning of the nervous and musculoskeletal systems  - Involves ‘adjusting’ the spine using specific rapid thrusts delivered by the hand or small instruments - Adjustments are aimed at correcting subluxations, removing interference to normal nervous system control over bodily function, and promoting healing and better health HERBALISM - Uses plants and herbs exclusively - Oldest form of medicine, and still used as a primary source of medicine for over 75% of the world’s population - Herbalists use the whole plant form of a medicine rather than chemical extracts from plants - Based on the belief that we have an innate ability to heal ourselves → thus, herbal medicines are used to restore and support the body’s own defence mechanisms - Herbal treatment is based on the individual’s symptoms, lifestyle and overall health NATUROPATHY - Focuses on the holistic treatment of the individual by seeking to address symptoms of illness as well as resolving underlying causes of illness - Naturopaths recognise the importance of developing a partnership with their clients, because it is important for the individual to take responsibility for making positive lifestyle changes How to make informed consumer choices - It is important to investigate the health service offered, and the credibility of the practitioner - A client needs to ask the following questions: 1. What is the treatment you offer? How can it benefit me? 2. What experience and training do you have? 3. What are your qualifications? 4. How much will the treatment cost? 5. Can this treatment be combined with conventional medication? - Important first step: gather such specific information about the nature of the alternative medicine, its credibility as an effective type of treatment, and the qualifications and experience of practitioners - Asking peers and community members about their experiences and recommendations can also be valuable - Some alternative medicines are considered to be very effective, and the WHO recognises them to be valuable and significant treatments → e.g. chiropractic medicine, naturopathy, and acupuncture are offered as university courses within Australia CQ4: What actions are needed to address Australia’s health priorities? ˚୨୧⋆｡˚ Health promotion based on the five action areas of the Ottawa Charter Develop personal skills Create supportive environments Strengthen community action Reorient health services Build healthy public policy  Levels of responsibility for health promotion https://pdhpe.net/health-priorities-in-australia/what-actions-are-needed-to-address-australias-health-priorit ies/health-promotion-based-on-the-five-action-areas-of-the-ottawa-charter/levels-of-responsibility-for-hea lth-promotion/ Governments Communities Individuals Developing Personal Skills Develop policies and provide Run education and training programs Seek to develop their own skills in funding towards developing personal to develop personal skills in relation relation to health. Enabled to take skill to health charge of their own health → e.g. K-10 PDHPE compulsory → e.g. Quit helpline, school → e.g. act on advice from GPs, education system research behavioural choices Reorienting Health Services Fund, research and create policies Conduct research, and be involved in Seek to make healthy life choices, around prevention and health the promotion of health. and help others to do the same, promotion. Looking at all the → e.g. cancer council conducts including participation in health determinants of health and not just research around cancer AND promotion. curative services promotes better choices in relation to → e.g. getting advice from a GP on → e.g. TV advertisements to the prevention of cancer quitting smoking promote healthy behaviours Strengthening Community Action Engage with community groups in Contribute to and take ownership of Promote community activities that the creation of policies. policies being empowered to act and promote health, be involved in → e.g. allowing communities to implement them. community actions. provide feedback on policies before → e.g. Aboriginal community → e.g. promote fun runs, engage in signing them off controlled health services community discussions around health Building Healthy Public Policy All levels of government are Contribute towards the development Act in accord with the policies responsible for the creation and of health policies and are involved in delivered. maintenance of policies that aim to carrying the policies out. → e.g. not smoking in public areas, improve health. → e.g. ATSI community not speeding in school zones → e.g. ‘Close the Gap’ statement of involvement in the development and intent, road safety laws, national implementation of ‘Close the Gap’ tobacco strategy Creating Supportive Responsible for the planning, Help maintain healthy environments Make better health choices using and Environments implementation and management of and promote healthy behaviours. maintaining the environment. infrastructure. → e.g. clean up Australia day, → e.g. putting rubbish in the bins → e.g. location of hospitals, parks, YMCA gyms provided community centres, waste removal The benefits of partnerships in health promotion, e.g. government sector, non-government agencies and the local community - If every area of the Ottawa Charter is well represented through a variety of strategies: - Risk of people/populations adopting poor health behaviours is reduced - People already engaged in poor health behaviours are encouraged to reduce/eliminate these actions → improvements in their health and a decreased burden on the health-care system  - Prospect of success is also increased if individuals, communities, governments, and non-government agencies work together in partnership towards achieving a common health goal - If an integrated health promotion program is implemented, this creates optimal conditions for achieving the program’s aims - Individuals and communities should be involved in the development of health promotion programs, to ensure their needs are met and empowers them to act in accordance with the promotion - Individuals and communities can be involved in activities such as: data analysis, community meetings, consultations and surveys - Government and non-government agencies need to share information → includes: research findings, funds, and connections - Helps ensure a more efficient health promotion as research is not doubled up and funding can be dispersed across multiple action areas - Also helps improve evidence-based health promotion - Allows for access to the resources and skills needed to understand and solve complex issues where possible solutions lie outside the capacity and responsibility of a single sector - Can be used to promote and achieve shared goals in a number of areas; e.g. policy, research, planning, practice and funding - Reinforces the view that all individuals, the community and governments have a responsibility to promote health - Ensure the action taken to address an issue and achieve health outcomes is a more effective, efficient and sustainable approach Benefits of partnership: - Address social determinants outside the control of the healthcare system - Improved population health and wellbeing - Reduced demand for health care and services - Collection of resources, knowledge, expertise development of networks - Allows partners to address current problems more effectively - Respond better to future problems - Helps to identify individual and community health priorities - Better use of funding and resources - Encourages empowerment - Improvement in social cohesion, sustainable human developments, dynamic society Government sector Non-government sector Local community (federal, state, local) (e.g. Cancer Council) Cancer - Education through - Daffodil Day supports - Become involved in mandatory PDHPE (K-12) cancer research, increased fundraising for Daffodil Day → educates on sun safety awareness - Health promotional campaigns Road Safety - Laws and legislations - Be street smart - Advocating for safer roads → speeding laws → educates young → e.g. more speed humps, → individuals who are about to speed cameras  drive about the road risks and safety procedures How health promotion based on the Ottawa Charter promotes social justice Equity Diversity Supportive Environments Developing Personal Skills All people should have access to Programs should be personalised to People share their skills and education and skill development cater for the diversity in our knowledge within their environment regardless of socioeconomic, population (ethnic, socioeconomic, making it more supportive. sociocultural and environmental geographic etc). → e.g. parents educate and model determinants. → e.g. health pamphlets in multiple for their children, who do the same → e.g. PDHPE class in K-12 languages utilising images in their peer groups Reorienting Health Services Health services must address the Health services must meet the Health services must help provide a inequities in health. diverse needs of the communities supportive environment. → e.g. mental health promotion, they are in. → e.g. Multi Purpose Service services in rural and remote → e.g. promoting balanced diet Program for rural and remote people locations amongst ATSI people Strengthening Community Action Equity both with and between Each community has its own Communities that become communities is important in health diversity and needs to be consulted empowered need an environment promotion. Communities of people in health promotion. that supports their healthy choices. suffering inequity in health need to → e.g. large Jewish population in This requires access and availability be utilised and empowered in order Bondi, Lebanese in Bankstown etc of services and facilities. to improve their health. should be empowered in relation to → e.g. bushwalks being maintained → e.g. ATSI involved in the health promotion initiative specific in the blue mountains to encourage development and implementation of for them locals to walk health promotion for ATSI Building Healthy Public Policy Public policy is designed with the Public policy accounts for the Policy should aim to produce an aim of producing equity in health diversity of our population, seeking environment that supports healthy status. to provide for all people groups. choices. → e.g. Medicare provides access to → e.g. The ‘close the gap’ initiative → e.g. no smoking in pubs and clubs health services for aims to remove the health inequity socioeconomically disadvantaged for ATSI people in 1 generation people Creating Supportive An environment is not supportive if In order to be supportive, the Creating environments that Environments it does not seek to provide equity. environment must also cater for the encourage healthy choices is vital in → e.g. increasing access to health diversity of the people in that health promotion. facilities for rural and remote people environment. → e.g. ensuring good parks for → e.g. providing translators for outdoor activities specific groups in specific community health centres/hospitals The Ottawa Charter in action DEVELOPING PERSONAL SKILLS - Requires the provision of information, education and life skill development - This increases options and control for individuals over their own health - It is essential to equip people for lifelong learning and to develop skills for coping with ill health  - This is done through school, home, and community settings REORIENTING HEALTH SERVICES - Is about the shift towards a system which promotes health, rather than curative services - Health services need to support the needs of individuals and communities to promote health, connecting the health sector with social, political, economic and physical environments - This requires greater health research and professional education and training - The shift is to focus on the needs of the entire individual, not just their injury, illness or disease STRENGTHENING COMMUNITY ACTION - Community action is strengthened through communities being involved in setting priorities, making decisions, planning strategies and implementing them to improve health outcomes - The goal is to empower communities which improves outcomes of health promotion BUILDING HEALTHY PUBLIC POLICY - Policy development at all levels seek to promote health - Includes: legislation, fiscal measures, taxation, and organisational change - Health, income and social policies are used to foster equity and ensures safer and healthier goods and services, healthier public services, and cleaner environments - Policies need to identify obstacles to health and seek to remove them, making the healthier choice the easiest one CREATING SUPPORTIVE ENVIRONMENTS - There is a link between people’s health and their environment, requiring a socioecological approach to health - Reciprocal maintenance of environments is the guiding principle - Work and leisure should promote health, not demote it - Thus health promotion should create safe working environments that are enjoyable, assess health impacts of developing infrastructure, and protect natural and built environments