HS1401 Quiz 1 Cheatsheet PDF

Week 1: Specialist Medical Services Demography Health Definition: a state of complete physical, mental and social well- - specialist care provided by a specialist m...

Week 1: Specialist Medical Services Demography Health Definition: a state of complete physical, mental and social well- - specialist care provided by a specialist medical practitioner or facility The distribution of populations can be defined at multiple being and not merely the absence of disease or infirmity - focussed on specific health conditions levels: local (e.g., neighbourhood composition), regional (e.g., - includes care provided by hospital clinics and specialist medical practices: northern Queensland), national-Australian population, global- Determinants of Health dermatologists, cardiologists, urologists world Biological Factors: genetics, age, sex, and inherited conditions - does not operate in isolation, part of larger working system - demography is a central component of societal contexts and Behavioural Factors: lifestyle choices such as diet, physical activity, - accessed via referral and assessment from primary care services (e.g. GP) social change smoking, and alcohol consumption Social Determinants of Health: the conditions in which people are born, Hospitals in Australia What is Demographic Data grow, live, work, and age. Include factors such as socioeconomic status, - hospital services are provide by a mix of private and public institutions Age, gender/sex, ethnicity, education, occupation, place of education, employment, and social support networks - public hospitals: funded by the government and provide free/low-cost residence, family structure, income Environmental Factors: includes air and water quality, housing conditions, treatment workplace safety - private hospitals: offer services to those with private health insurance Exploring Demography Globally – Less vs. More Developed Health Services: Access to quality healthcare services, including - hospitals accounted for 40% of all health expenditure in 2021-22 Less developed countries: high levels of fertility, high levels of preventative, curative, and palliative care - hospital services are for admitted and non-admitted patients, includes infant mortality (low vaccine uptake, poverty, lack of access to Policy and Governance: government policies and regulations on healthcare emergency care, surgery, maternity services, and specialized treatment healthcare), a high prevalence of infectious diseases including funding, access to services, public health initiatives, and health education HIV/AIDS, high levels of out-migration to more developed Health Policy countries Australia’s Population Health policy refers to decisions, plans, and actions that are undertaken More developed countries: low fertility patterns, women - Population: 26.8 million to achieve specific health care goals within a society having babies at later ages, some populations with below - Most people live in major cities; around 28% live in rural and remote - defines a vision for the future replacement levels of fertility, large numbers of migrants from areas - helps to establish targets and points of reference for the short and less developed countries - 3.8% (984,000) of people identify as Aboriginal and/or Torres Strait medium term Islander - outlines priorities and the expected roles of different groups while Importance of Demographic Data - 30.7% were born overseas building consensus and informing people - allows health professionals and health planners to - 5.5 million people have a disability understand the characteristics of their community so they can Health Policies in Australia plan health care services Indicators of Health - developed at federal, state, and local government levels - ensures health care services match population health care - Life expectancy - funding and resource allocation needs - Mortality (death), disability and morbidity (illness/disease) statistics. For - regulations and standards for quality and safety in healthcare (health - can assist health professionals make informed decisions to example leading causes of death and prevalence of diabetes facility accreditation, health practitioner licensing) improve health care delivery - Infant mortality - public health initiatives (vaccination, anti-smoking, alcohol restrictions) - allows deeper insight into what is needed to prevent disease - Self-assessed health status and to promote health and well being Complications of Health System - examining data over a period of time can help to identify Australia’s Health Status - a combination of public, private, and individual funding and management trends in health - Male life expectancy – 81.2 years Australian Government responsibilities: overarching policy and - Female life expectancy – 85.3 years performance, Medicare, schemes, veteran’s health, primary health care Demographic Data and COVID-19 - Approx. 30 years longer than it was in the 1800s services, aged care, private health insurance (support and monitoring) - In just 2 years, the COVID-19 reversed over 10 years gains in - Life expectancy in Australia decreased in 2020-2022 (by 0.1 years for State, territory, and local government responsibilities: public hospitals, both life expectancy at birth and healthy life expectancy males and females from 2019-2021) screening/immunization services, community and mental health services, - Sub-populations most vulnerable to infection: Age (older - We are living longer free of disability and illness public dental clinics, ambulance/emergency/patient transfer services populations and people with pre-existing medical conditions - 56% of Australian’s rate their health as ‘excellent’ or ‘very good’ have higher risk of morbidity and mortality), Gender (men are - Death rates have a downward trend (from 1907-2018 death rates fell) Australian Government (developing Australia’s national health policies) more at risk of worse outcomes and death, independent of (driven by a decline in infant and child mortality) - all policy decisions made by governments emerge from a complex age, with COVID-19), Ethnicity (increasing evidence suggests - Difference between death rates for males and females has narrowed process, involving various stakeholders that individuals from certain ethnic groups may have worse across time (better prevention and management of cardiovascular disease) - the Australian government department of health is responsible for clinical outcomes from COVID-19) (2020-2021 upward shift in death rates for males – impact of COVID-19) national policy and service planning - Tracking demographic data is important because: assists with - the national cabinet works to identify health reform opportunities prioritising health care interventions (e.g., immunisation Leading Causes of Death rollout), informs health leaders and governments when Males: coronary heart disease, dementia/Alzheirmer’s, COVID-19, lung Australian Government (assessing Australia’s health performance) imposing restrictions to lessen the chance of community cancer, cerebrovascular disease - National health policies are informed by the Australian health transmission Females: dementia/Alzheirmer’s, coronary heart disease, cerebrovascular performance framework (AHPF) disease, COVID-19, lung cancer - AHPF is a tool that was devised to assess the performance of the Demographic Transition Australian healthcare system - Before the start of the demographic transition: life Challenges to Australia’s Health - the objective of the AHPF is “to improve health outcomes for all expectancies were short, fertility rate was high, population Chronic conditions: such as cardiovascular disease, cancer, diabetes, and Australians and ensure the sustainability of the Australian health system” growth was slow, populations were young respiratory diseases are the leading causes of morbidity and mortality - the framework assess the health care system as a whole: health status, - Global population trends 1700-2100: life expectancy Mental health: conditions such as depression, anxiety, and substance determinants of health, health system and health system context (increasing), total fertility rate (decreasing), population size abuse - health indicators are used to measure change over time (increasing), population growth rate (increase and then Obesity: 32% of Australian adults live with overweight or obesity in 2022; decrease), population 65 more males than females; increases with age; associated with chronic Health Datasets (increasing) diseases Major datasets in Australia include: birth and death registration, census Infectious disease: Australia has effective control measures for many data (ABS), national health survey (ABS), health administrative data, Model for Demographic Transition infectious diseases; has occasional outbreaks of diseases and requires household income and labour dynamics in Australia survey, my health - Stage 1 (pre-industrial): high death rate & high birth rate, vaccination programs and public health initiatives for disease management record slow population growth (this balance until late 18th century) Ageing population: Australians are living longer, more health services - data linkage of “big data” has become an increasingly important approach - Stage 2 (industrialising): death rate starts to fall sharply, birth needed in older age to understanding health service delivery rate remains high, prior to the mid 20th century, improved food handling, water supply, sewage, and personal hygiene Health is not Equal Across the Population Health Data – Challenges - Stage 3 (mature): birth rate falls sharply, fall in death rate - Within Australia, specific population groups are at higher risk of: poor - importance of good data collection, good record keeping, data safety begins to level off, mainly a response to social changes (e.g., health, higher rates of illness, disability, and death, and lower life - Primary care: no ongoing data collection on reasons for GP visits or access to contraception, increased incomes, improved expectancy treatment provided (AIHW is developing a National Primary Health Care education, and status of women) - These population groups include: aboriginal and Torres strait islander Data Collection) - Stage 4 (post-industrial): both birth & death rates level off at people, people in lower socioeconomic groups, rural and remote-dwelling - projects using the national health data hub can provide better insights low levels, birth rates may drop to below replacement level people, people with disability, veterans, prisoners into a person’s journey through the health system (integration of care) (e.g. shrinking pop) - Across the lifespan, from birth to older age, there are potentially - Stage 5 (declining): a decline in the overall population as the vulnerable groups within the population: children, mothers, young people, Our Health System is Evolving death rates becomes higher, and birth rates decrease, old aged - As health care professionals we are exposed to changes in the way we developed countries (Economical constraints: cost to raise a diagnose, treat, and manage conditions (technologies, research and large family is increasing in many developed countries, Societal Healthcare Services in Australia evidence-based practice) shift: couples choosing to have children later in life to pursue Australia’s healthcare system is a complex mix of public and private - nowadays health care professionals are linked to colleagues in the wider careers), negative population rate is not an immediate effect services designed to provide comprehensive care to the population international community (rapid transmission of information, global and may take generations including: primary care and primary health care, specialist medical companies for medical technologies and more interconnected) services; hospital care; pharmacy including the PBS; diagnostic pathology; Population Pyramids public health – population level interventions including Our Health System Faces Challenges - Age: sex structure of a country can be studied through vaccination/screening; mental health – community and acute care; allied - management of chronic conditions in an ageing population population pyramids, a graphical representation of population health (physio, OT, SP, psych); dental care; aged care (residential aged - costs of care are rising, demand is increasing structures care, home care packages, community support services); community care - health data: security, privacy, equitable access to technology - overall shape of pyramid indicates the potential for future (health promotion, disease prevention); disability care (NDIS) - workforce challenges: shortages and safety growth - infectious disease control: preparation and management - Four representations of population age/sex structure provide Primary Care and Primary Health Care an overall example of what a pyramid for different levels of - Typically, an individual’s first point of contact with the health system Week 2: population growth would look like: rapid growth (very high - Generally, individuals do not require referrals for this level of care What is Demography youth, very low elderly), slow growth (more youth than old - Situated in the community, e.g., general practice, community health Demography is the statistical study of human populations (the size, but not rapid), zero growth (all very similar), negative growth - Services provided by General practitioners, nurses, dental practitioners, structure and distribution of populations and how these change over time) (higher elderly than youth) indigenous health workers, pharmacists, and allied health practitioners - population size: how many people? - Manage a wide range of health issues, including long-term management - growth of decline: change over time? Demography of Rural/Remote Areas of chronic conditions - population processes: levels & trends in fertility, mortality, & migration - Australians living in rural and remote areas face unique - Make referrals to specialist services (when needed) - structure: how many males and females there are of each age? challenges due to their geographical location - census is the most common way to collect demographic data - Generally poorer health outcomes influenced by a variety of Difference Between Primary Care and Primary Health Care - in Australia there is a census every five years (most recent in 2021) demographic characteristics: disadvantages in education, Primary care: biomedical model (treatment, rehabilitation, medical care reduced employment opportunities, hazardous occupations, and/or disease management) less income Primary health care: social model (principles of equity, acceptability and - Access to health care services limited, however high cultural competence) (includes primary care services) hospitalisation rates Primary Source of Demographic Data Epidemiological Study An Age-old Issue: Older Australians and Aged Care Australian Bureau of Statistics Designs - can be observational: the 1. Demographic, Societal, and Epidemiological Trends Sourcing Demographic and Epidemiological Data investigator just observes - Local government websites: e.g. the Townsville city council has community and records (may be profiles descriptive or may be - Primary Health Network Needs Assessments: e.g. the north Queensland descriptive and analytical) Older Australians: Defined as individuals 65+ years (50+ for Aboriginal and Torres Strait Islanders); diverse in age, culture, and experiences. Primary Health Network web page - can be - State Government Reports: e.g. the Health of Queenslanders experimental/interventional: Population Aging: - Australian Institute of Health and Welfare the investigator o Projected Australian population in 2022: 27.1 million, with 16% (4.2 million) aged 65+. ‘experiments’ Week 3: o Life expectancy: Males – 81.2 years; Females – 85.3 years. Health Risk Factors Descriptive Observational o Leading diseases: Cancer, cardiovascular, and neurological conditions. - Risk factor is any attribute, characteristic or exposure of an individual that Studies o COVID-19 has a disproportionate impact on this age group. increases the likelihood of developing a disease or injury - describe the occurrence of Societal Factors: - types of risk factors include: biomedical, behavioural, environmental, social a risk factor/exposure/health o Homelessness: 16% of homeless Australians are 55+. outcome in a population o Education: Nearly half have a Year 12 education level or below. Biomedical Risk Factors - are observational only: the o Employment: 15% still working; retirement age averages at 55 but rising. - biomedical risk factors are bodily states that have an impact on a person’s risk investigator does not change o Income Sources: Primarily pensions, superannuation, wages, or salary. of disease anything - Biomedical risk factors include: high blood pressure (hypertension), abnormal - focuses on a population at a lipids (cholesterol and triglycerides), impaired glucose regulation (a major point in time or over time 2. Aged Care Quality Standards precursor for Type 2 diabetes) Case Reports / Case Series Behavioural Risk Factors - detailed description of a Aged Care Act 1997: Sets obligations for aged care providers receiving government subsidies, aiming to ensure affordable, high-quality care. - a person’s health is influenced by health behaviours or risk factors that are part disease or association of their individual lifestyle (rare/unusual condition or Key Stakeholders: Federal and state ministers, Aged Care Quality and Safety Commission, National Aged Care Advisory Council, and industry organizations (e.g., Blue Care, RSL). - behavioural risk factors include: overweight/obesity, insufficient physical characteristics) activity, alcohol use, tobacco use, diet - Weak evidence, but may Quality Standards: Introduced in 2019, focusing on patient-centered care rather than task- oriented service. Standards include: prompt further investigations 1. Consumer dignity and choice Alcohol with more rigorous study 2. Ongoing assessment and planning Alcohol consumption is declining in Australia designs 3. Personal and clinical care 4. Services/supports for daily living - Case Report: only one case 5. Organizational environment Tobacco - Case Series: report of a 6. Feedback and complaints 7. Human resources Tobacco smoking is declining in Australia group of case reports 8. Organizational governance (usually over short period of Geographical Variation – Risk Factors time) - risk factors differ depending on the area in which an individual resides - Example: case series of 3. Health Care Professionals in Aged Care - people who live in outer regional/remote areas have increased rates of: people presenting with smoking, risky alcohol consumption, daily sugar consumption unusual health concerns (Pneumocystis carinii Workforce Roles: Prevalence of Health Risk Factors in Australia, by Remoteness in 2022 pneumonia) in the early o Registered Nurses: Administer medication, monitor residents, treat wounds, liaise 1980s with doctors/allied health, and support families. Risk Factor Major Inner Outer Remote o Allied Health: Provide mobility and pain assessments, exercise programs, equipment prescriptions, fall management, and skin care. Cities Regional Regional (%) Ecological Studies (%) (%) (%) - also called correlational o Other Staff: Includes care staff, general practitioners, maintenance, kitchen, cleaning, volunteers, and administrative roles (HR, finance, etc.). Current daily smoker 7 10.5 11.4 20.4 studies Exceeded lifetime alcohol 26.1 30.6 32.7 - all data about the outcome and exposure are collected at 4. Modes of Healthcare for Older Australians risk guideline High blood pressure 21.6 22 21.5 the population level (not Inadequate fruit intake 56.1 56.9 59.9 individual level) Inadequate vegetable 94.2 92.8 92.6 - Often use existing datasets Community Aged Care: Increasingly popular, allowing older Australians to remain at home longer. Challenges include staffing, safety, and limited care packages. - Example: investigate the consumption Insufficient physical activity 40.1 41.2 44.8 relationship between air Residential Aged Care: For high-care needs, with funding from residents and government. Services include assistance with ADLs, nursing, medication, and respite care. pollution levels and Overweight or obese 66.7 68.1 69.6 respiratory diseases across different cities 5. Key Health and Social Challenges Geographical Variation – Health Outcomes When compared to those living in major cities, people living in rural/remote Descriptive Cross-Sectional communities have: - lower life expectancy Study Health Issues: Increased chronic diseases (CVD, Type 2 diabetes) and dementia. - higher rates of suicide - snapshot of: frequency and Rising Aged Care Demand: Need for both community and residential services, with older adults characteristics of a condition generally accessing healthcare more frequently. - lower birth weights and higher rates of teenage pregnancy - higher rates of death due to land transport accidents in a population at specific point in time Resource Strains: Requires more funding, policy reforms, and quality of care improvements, highlighted by the 2021 Royal Commission into Aged Care Quality and Safety. - higher occurrence of many health conditions (asthma, coronary heart disease, osteoarthrosis, diabetes, lung cancer) Analytical Observational Chronic Conditions in Australia Studies What is Epidemiology - examines the relationship - epidemiology is the “study of people” and the wider populations 1. Definition and Characteristics between a risk - traditionally defined as a “branch of medical science that studies epidemics” Chronic Conditions: Long-lasting with persistent effects, requiring long-term management. factor/exposure and a health Types: Includes non-communicable diseases, mental illness, trauma, disability, and genetic disorders. “the study of the distribution and determinants of health-related states in outcome specific populations; and application of this study to try and control problems” Key Traits: - are observational only: the - a health-related state does not describe illness alone; it may describe the Primarily non-communicable but can include chronic communicable diseases. investigator does not change Often involve multiple risk factors and complex causes. absence of disease which can be equally as important anything May have gradual onset but sometimes begin suddenly. - analytical observational Commonly lead to disability, reduced life expectancy, and multi-morbidity (two or more chronic conditions). Solving Health Problems studies aim to identify 2. Demographics and Epidemiology - epidemiology provides the information needed for evidence-based best associations (cannot Prevalence: practice Leading cause of death and disability, accounting for 90% of deaths in Australia. demonstrate the cause’ of - epidemiologists use the scientific methods to: study natural history and In 2014-15, over 50% of Australians had at least one chronic condition; 23% had two or more. the health outcome, can Age: Chronic conditions are more common with age, affecting 29% of those 65+ with three or more prognosis of disease, understand the distribution of health conditions within a conditions. guide further research) population, determine factors that may influence (or cause) a health condition, Socioeconomic Status: Higher rates of multi-morbidity in disadvantaged groups (14% in high-SES areas vs. - Examples: cross-sectional, design and implement health interventions to control and prevent disease 25% in low-SES areas). case-control, cohort studies Common Chronic Conditions: The Epidemiological Approach Mental Health: 20% (4.8 million) Australians, most common among ages 15-44. Observational Studies: Musculoskeletal: Back pain (16%, 4 million) and arthritis (15%, 3.6 million), prevalent in ages 45-64 and 65+. - What? (case definition), Who? (person), Where? (place), When? (time), Why? Example Leading Causes of Death: Cardiovascular disease, cancer, COPD, diabetes. (causes and determinants), So what? (drawing inferences: prevention and - British doctors study control) Aboriginal and Torres Strait Islander Population: Higher chronic disease burden, with earlier onset by up to - HILDA Survey-Australia 20 years. (followed over life course to John Snow and the Broad Street Pump 3. Common Risk Factors explore a range of health - Snow’s studies of cholera in 1854 earned him the title “the father of modern Lifestyle Risks: issues, data on household, Overweight/Obesity: 66% of adults, 28% of children. epidemiology” family, income, employment, Smoking: Declined from 24% in 1991 to 12% in 2019. - Improved water safety in London: resulting in cholera, typhoid, and other Alcohol Use: High-risk factor for males aged 14-44. disability, education) enteric infectious diseases largely disappearing in many countries. Also saving of Poor Diet and Physical Inactivity. - Australian Longitudinal Rural Health Determinants: millions of live over the years Study of Women’s Health Higher rates of smoking, alcohol use, sugary drinks, overweight/obesity, and disability. Limited access to healthcare, fresh food, and safer job options. British Doctors Study Experimental Studies: COVID- 4. Economic Impact - first large-scale prospective study into the effects of smoking Cost to Government: $77.1 billion spent in 2017-18. 19 - began in 1951: Sir Richard Doll and Sir Austin Bradford Hill Costliest Conditions: Cardiovascular, oral health, mental health, musculoskeletal diseases (36% of allocated - early clinical trial of mRNA- - Established the linkage between tobacco smoking and cause-specific mortality health expenditure in 2008-09). 1273 vaccine for COVID-19 Impact: Increasing economic burden with high healthcare costs, productivity loss, and social care demands. (the risk of death from lung cancer; myocardial infarction and chronic obstructive - followed over two years to pulmonary disease) 5. Preventable Chronic Conditions evaluate different doses of The government focuses on managing 10 preventable conditions, including asthma, cancer, cardiovascular - Results have influenced decisions about quitting (half of the smokers died from the experimental vaccine for diseases, COPD, diabetes, mental health disorders, and osteoporosis. tobacco-related disease, and half of these deaths occurred in middle age) Statistics: safety and effectiveness to (stopping smoking at any age is adequate to gain additional years of life Accounted for 51% of hospitalizations in 2017-18. prevent COVID-19 Responsible for 89% of deaths in 2018. expectancy) Contributed to 66% of the total disease burden (fatal and non-fatal). Primary Health Care in Australia Hospitals in Australia Health Care Practitioners in Australia 1. Definitions 1. Structure of the Hospital System 1. Overview of the Australian Health Workforce Primary Care: Frontline biomedical Public Hospitals Composition: Approximately 1 in 7 Australians work in healthcare (75% care, typically reactive, provided by doctors, dentists, allied health, and o Owned and managed by state/territory governments. female, 25% male). nurses. o Funded by both state/territory and federal governments. Work Settings: o Focus: Treatment, o Account for the largest spending component in the o Hospitals (31%) rehabilitation. healthcare system. o Residential aged care (16.2%) o Funding: Mostly fee- for-service, includes Private Hospitals Registered Practitioners: Around 825,720, with nursing and midwifery Medicare-funded o Funded by non-government sources, primarily through being the largest group (56%). bulk-billing and gap payments. o fees and private health insurance. Often owned by commercial organizations (e.g., Ramsay, Indigenous Participation: Participation of Aboriginal and Torres Strait Islander Peoples is low across professions. Primary Health Care (PHC): Broader, o Healthscope). Historically, many were owned by church or charitable Training: Most health workers have tertiary qualifications. social model, both proactive and reactive, encompassing a range of groups. community services. Hospital Services 2. Key Health Professions o Principles: Equity, o Includes 24-hour medical and nursing care, surgical, acceptability, cultural obstetric services, emergency departments, intensive care competence, units (ICUs), rehabilitation, and palliative care. affordability, universality. o Larger hospitals may provide specialist services like Nursing and Midwifery: Largest professional group, essential to hospitals and aged care. psychiatric inpatient clinics. Allied Health: 2. PHC in Practice 2. Hospital Usage and Capacity o Includes professions like physiotherapy, occupational therapy, psychology, and paramedicine. o Experienced a 40.2% increase in practitioners since 2015 Community services based on the due to demand from an aging population. social model of health. Public Hospitals: 695 in total, reduced from 746 due to reclassification. Dentistry: Essential services include: Private Hospitals: 657, showing a growth trend. o Around 25,000 practitioners, mostly in private practice. o Health education, Beds: o Dental teams include technicians, hygienists, and therapists. safe water/sanitation, maternal/child o Public hospitals: 2.5 beds per 1,000 people. Pharmacy: health, o Private hospitals: 1.4 beds per 1,000 people, growing at o Approximately 36,000 pharmacists, mostly in retail with immunizations, ~3.3% annually. some in hospitals (~15%). disease control, o Funded under the Pharmaceutical Benefits Scheme (PBS). common disease treatment, essential drugs provision. 3. Hospital Workforce Sports Exercise Science and Exercise Physiology: o Focuses on clinical interventions and chronic disease management. 3. The Comprehensive PHC Approach Includes medical officers, nurses, diagnosticians, allied health, o Evolving across community health, aged care, education, administrative, and personal care staff. and research. Workforce has grown by about 3.4% annually since 2016–17, with Biomedicine: Community Participation: 421,737 staff in public hospitals as of 2020–21. o Medical scientists work with doctors, pathologists, and technicians in hospitals. Communities are involved in service planning and evaluation. o Majority female workforce (66.6%) and primarily over 35 Interdisciplinary Services: Promotes 4. National Healthcare Agreement years of age. accessibility, equity, and sustainability. Person-Centered Care: Empowers A collaborative agreement among Australian governments defining the 3. Informal Health Workforce individuals to prevent illness and operational standards and funding for public hospitals. promotes health literacy. Aims to ensure affordable, high-quality healthcare and the sustainability Evidence-Informed Services: of the system. Carers: Around 2.65 million informal carers provide unpaid support, often for the elderly, disabled, or chronically ill. Delivered by qualified professionals. Demographics: Predominantly aged 35-54, spending an average of 35.2 5. National Safety and Quality Health Service (NSQHS) Standards hours weekly on care. 4. Aboriginal Community Controlled Health Organizations (ACCHOs) Established: Mandatory since January 2013 for all hospitals. 4. Health Workforce Planning Focused on the health and wellbeing Purpose: Protect the public from harm and improve health service quality. of Aboriginal and Torres Strait Definition: Assessing future human resource needs and creating plans to Islander communities. Eight Standards: meet those needs. Provide culturally appropriate, 1. 2. Clinical Governance Partnering with Consumers Challenges: Ensuring balanced distribution of healthcare services, comprehensive care addressing 3. Preventing and Controlling Healthcare-Associated especially between rural and metropolitan areas. physical, social, emotional, and spiritual health. 4. Infection Medication Safety Considerations: Services include: 5. 6. Comprehensive Care Communicating for Safety o Demographic changes, increasing chronic disease, and technological advancements. o General medicine, 7. Blood Management immunizations, 8. Recognizing and Responding to Acute Deterioration health education, mental health Examples: 5. Geographic Distribution support, dental, allied 1. Partnering with Consumers: Systems for patient-centered health. care, enhancing consumer health literacy. 2. Preventing Healthcare-Associated Infections: Infection control systems, antimicrobial stewardship. Rural and Remote Areas: 5. Key PHC Reform Elements in Australia o Poorer access to allied health professionals. 6. Challenges for Australian Hospitals o Aboriginal and Torres Strait Islander communities often have limited healthcare access. Need for Reform: Aging population, o New graduates are often placed in rural areas but face chronic diseases, rural service retention challenges. maldistribution, rising service costs, Digitization and Innovation: Adapting to technological changes. Queensland’s Health Workforce: digital health needs, disaster impacts. Worker Safety: Exposure to biological (COVID-19, HIV), chemical, o High demand for skilled professionals in primary care due to ergonomic, and physical hazards. aged care and disability reform. 10-Year Plan (2022–2032): Funding and Governance Complexities: Coordination between state and o Nursing shortages expected, particularly in very remote o Stream 1: Future- federal bodies. areas. focused care using technology (e.g., Service Planning: Addressing sector demands and integrating with telehealth). health, social, and welfare services. 6. Impact of COVID-19 on the Health Workforce o Stream 2: Person- centered care with System Limitations: Workforce shortages, especially in rural/remote areas. funding reform, community control. Infection Control: Ongoing challenges with COVID-19 and other diseases. Frontline Challenges: Higher infection rates among healthcare workers o Stream 3: Locally than the general population. integrated care through joint 7. COVID-19 Impact on Hospitals Mental Health Impact: Increased anxiety, depression, and PTSD in health workers due to COVID-19. planning and commissioning. Pandemic Responses: Emergency Department Activity: Declined by 1.4% in 2020, then o Fast-tracked registration for experienced practitioners. 6. Role of Primary Health Networks (PHNs) increased by 7% in 2021 after restrictions eased. o Telehealth expansion to reduce infection risk and improve Elective Surgeries: Reduced due to COVID-19 restrictions, with an 8.3% o service access. Mental health support initiatives like the Essential Network decrease in public hospitals and a 5.7% decrease in private hospitals. (TEN) project. Established in 2015 to improve health service efficiency through local planning. 8. Worker Safety Concerns 7. Global Health Workforce Challenges Responsibilities include: o Assessing local health Biological Risks: Infectious diseases like COVID-19, TB, HIV. needs, coordinating Papua New Guinea (PNG): service delivery, and ensuring effective use Chemical Hazards: Exposure to drugs, disinfectants. o Aging workforce and low numbers in critical areas like of government funds. Ergonomic Risks: Physical strain from patient transfers. midwifery. Structure: 31 PHNs across Australia, Stress and Violence: Resulting from staffing shortages and rotating shifts. o Poor working conditions and insufficient training capacity. o Maldistribution of skills, with many specialists in including 7 in Queensland. Physical Hazards: Including radiation, heat, and noise exposure. administrative roles instead of clinical practice. o COVID-19 highlighted the shortage, with one physician per 20,000 people. Paying the Bills: Health Expenditure and Funding in Australia Public Health and Prevention The Future of Health in Australia 1. Role of Government in Health Expenditure 1. Definition of Public Health 1. Current Challenges in Health Service Delivery Primary Funders: Federal and State governments are the main CEA Winslow’s Definition: “The science and art of Growing Demand: Aging population, rising chronic conditions, contributors. preventing disease, prolonging life, and promoting health evolving technology, and treatment advances. through organized efforts of society and informed choices Other Funding Sources: of individuals and communities.” Lifestyle and Socioeconomic Factors: Increasing healthcare o Private health insurance, workers' expectations, financial pressures, and health inequities (e.g., poverty, inadequate infrastructure, exposure to harmful compensation, third-party insurers, charities, and individuals. industries). 2. History of Public Health Disparities: Vulnerable groups include unemployed, Aboriginal and Torres Strait Islander peoples, and those in rural/remote areas. 2. Health Expenditure Trends Old Public Health: Focused on improving living conditions through infrastructure, policy, and legislation in the 19th 2. Key Priorities for the Future and early 20th centuries (e.g., sanitation, clean water). Government Health Expenditure: New Public Health: Emerged in the 1980s-90s with a social o Total: $94.4 billion in 2020–21 by the federal approach to address the social determinants of health, People: Emphasize person-centered care, empower individuals to government, primarily for Medicare Benefits social justice, and equity. Schedule (MBS), Pharmaceutical Benefits take charge of their health, and introduce social prescribing (non- Scheme (PBS), Department of Veterans Affairs medical activities like meditation, social clubs). o (DVA), and public hospitals. State and territory governments spent $61.6 3. Core Functions of Public Health Prevention: Focus on early intervention, especially for chronic and oral health issues. billion, with half dedicated to public hospital services. 1. Population health monitoring. Region: Improve rural/regional health through local service pathways and community care. Non-Government Health Expenditure: 2. 3. Responding to health and emergency hazards. Ensuring environmental, occupational, and food safety. Culture: Prioritize Aboriginal and Torres Strait Islander health o Estimated at $64.9 billion in 2020–21. 4. Health promotion (addressing social determinants and through culturally-centered services. o Individuals contributed $33.2 billion, a 9% 5. inequalities). Prevention of illness (early detection and intervention). Health Workforce: Support workforce safety, encourage increase from the previous period. 6. Health and wellbeing management. multidisciplinary collaboration, and address aging and o Private health insurance funded 8.2% ($18.0 7. Ensuring a competent workforce. international dependency in certain areas. billion). 8. Sustainable organization structure (financing and resource management). Climate Change: Prepare for health impacts from extreme 9. Advocacy, communication, and social mobilization. weather, air quality issues, and disruptions to food/water supply. 3. Funding Responsibilities 10. Public health research and policy translation. Digital Health: Leverage technology for efficient care delivery, data access, and patient empowerment. 4. Levels of Prevention Federal Government: Covers primary healthcare, PBS, aged 3. Impact of Climate Change on Health care, health research, NDIS, and DVA services. State and Territory Governments: Oversee public health Primary Prevention: Aims to prevent disease onset (e.g., services, community health, and patient transport. lifestyle changes, immunizations). Health Risks: Increased vulnerability to bushfires, floods, and Individuals: Responsible for most dental services, non-PBS medications, allied health, and some out-of-pocket expenses. Secondary Prevention: Early detection and intervention to heatwaves, affecting physical and mental health. halt disease progression (e.g., screening, smoking cessation). Social and Psychological Effects: Trauma from displacement and Tertiary Prevention: Reduces disability and promotes disrupted resources, causing distress, depression, and PTSD. 4. Medicare System rehabilitation (e.g., chronic disease management, support groups). Mitigation Needs: Consider housing, green spaces, and community resources to reduce impacts, especially for those in poverty. Example - Motor Vehicle Accidents: Overview: Established in 1984, Medicare is a tax-funded o Primary: Road design and safety regulations. system ensuring universal access to healthcare. o Secondary: Seat belts and airbags. 4. Advancements in Digital Health Funding: Partially funded by a 2% levy on taxable income. o Tertiary: Emergency medical services. Coverage: Technology-Enabled Care (TEC): Includes digital media, mobile o GP and specialist visits, public hospital services, 5. Major Public Health Achievements in Australia devices, and health tech that aids practitioners and patients by improving efficiency, reducing errors, and increasing access. optometry, and pathology. o Most allied health services are not covered unless prescribed by a GP’s chronic disease 1. Reduction in neural tube defects. Benefits: plan. 2. Widespread immunization and disease control. o For Practitioners: Streamlined record access, 3. Reduction in HPV-related cancers. better-informed decisions, error reduction, and COVID-19 Impact: Increased usage of MBS services by 13% 4. Decreased dental decay. increased collaboration. from 2020-2022, largely due to more pathology tests and telehealth services. 5. Decline in smoking rates. o For Consumers: Enhanced communication, easier 6. Fewer road fatalities and injuries. record management, and empowerment in Strengthening Medicare: Federal Budget 2023 allocated $5.7 7. 8. Gun control laws reducing fatalities. HIV containment. preventive actions. billion over 5 years to enhance GP and telehealth bulk billing. 9. Early intervention for cancers like bowel and breast cancer. o For the Health System: Decrease in adverse events, avoidable hospitalizations, and test duplications; improved access for rural populations. 5. Private Health Insurance 6. Immunization 5. Key Digital Health Initiatives Funding: Contributed $18.0 billion in 2020–21. Australia’s immunization system is highly effective, with a Benefits: National Immunization Program (NIP) achieving 94% coverage by 2017. Australian Digital Health Agency: Oversees the National Digital o Offers choice of doctor and hospital, and covers Health Strategy with programs like My Health Record, telehealth, certain “extra” services like allied health. National campaigns have addressed diseases like measles, and electronic prescriptions. Government Incentives: Tax rebates and a Medicare levy rubella, and rotavirus. My Health Record: A national digital health record system for surcharge for high-income earners to encourage uptake. sharing health information, accessible through myGov. As of 2019, all Australians have a record unless opted out. 7. Slip, Slop, Slap Campaign 6. Selected Health Schemes in Australia Telehealth: o Methods: A campaign to reduce skin cancer by promoting sun safety, 1. 2. Remote monitoring. Store-and-forward (sharing data especially effective for those under 40. Pharmaceutical Benefits Scheme (PBS): between providers). o Ensures access to affordable medicines, with a Shows how public health campaigns can impact behavioral 3. Real-time consultations. government subsidy on prescription changes and disease reduction. o Benefits include reduced travel, faster service, and medications. continuity of care, with Medicare funding for primary care since July 2022. o Recent reform (2023) reduced general patient 8. Future Public Health Challenges Electronic Prescriptions: Introduced in 2020, prescriptions are sent co-payment from $42.50 to $30.00. via SMS or email using a ‘token’ system. Active Script List (ASL) o Opposition from the Pharmacy Guild due to allows management of multiple medications. concerns over supply shortages and financial impact on pharmacies. Rising Non-Communicable Diseases: Increased obesity, mHealth: Mobile health apps and wearables (e.g., blood pressure National Disability Insurance Scheme (NDIS): sedentary lifestyles, and poor diets. monitors, glucose sensors). Health apps cover categories like o Supports Australians under 65 with permanent, Aging Population: Poses additional healthcare challenges. healthy living, diagnosis, monitoring, personal health records, and reminders. significant disabilities. Health Inequities: Disparities across population sub-groups. o Challenges include a complex eligibility process, Climate Change and Globalization: Emerging global health inadequate fund allocations, and workforce 6. Barriers to Digital Health Adoption shortages. threats. o Federal government pledged $910 million over COVID-19: 4 years (from 2023) to enhance service delivery and support access in remote and First Nations o Uncertain future with potential new variants Concerns: Privacy/security, inconsistent app quality, lack of impacting vaccination effectiveness and training, potential liability, and costs to users. communities. public health responses. Oral Health Care: User Consultation: Important for designing TEC that meets actual needs to ensure high adoption rates. o Total spend on dental care was $11.1 billion in 9. Sustainable Development Goals (SDGs) 2020–21. o Cost remains a barrier for some; 29% of adults 7. Future Implications for Health Professionals (35–54) missed dental care due to expense. o Debate over implementing a universal dental Universal call to action to: scheme for subsidized oral health. o End poverty, protect the planet, and ensure Empowered Consumers: Patients play an active role in managing health and well-being. their health. 7. Future Considerations Goal 3: Good Health and Well-Being, covering aspects such Prevention-Focused Care: Greater emphasis on early intervention. as: o Reducing maternal and child mortality. Integrated Care: New funding models and multidisciplinary approaches. o Combatting communicable and non- Universal Dental Scheme: The potential cost is around $5.6 billion per year, with workforce expansion required. communicable diseases. Technological Agility: Efficient data access and utilization across o Road safety and traffic injury reduction. health services. Changing Health Needs: Population changes will affect health o Expanding access to universal health demands, necessitating updates in funding and workforce planning. coverage.