health priorities in Australia

hsc pdh, core 1

epidemiology

study of patterns of disease in a population

burden of disease

measure of the impact a particular disease/condition has on a population; calculation of the number of healthy years of life that are lost due to that disease/condition

measures of epidemiology

mortality rate, infant mortality rate, morbidity rate, life expectancy

mortality rate

number of deaths from a disease/condition in a population during a specific time period

infant mortality rate

number of deaths in children under 1 years of age in a population during a specific time period

morbidity rate

number of individuals with an disease/condition in a population during a specific time period

life expectancy

how long can individual is expected to live at any given time

measures of morbidity

prevalence and incidence

prevalence

the total number of cases of a particular disease/condition at any given time

incidence

the new number of cases of a particular disease/condition which are diagnosed during a specific time period

who uses epidemiology

governments, health researchers, health professionals, health organisations

role of epidemiology

gain an overall picture of the health of a population, identify strengths and weaknesses, allocate resources and funding where it is needed, identify strategies and promote behaviours to improve health

limitations of epidemiology

only reports on physical health and not social and emotional factors, published data may be already out of date, provides little data on the impact on QOL of a disease/condition, doesn’t explain why certain diseases/conditions occur

current leading causes of death

cancer (all) and cardiovascular disease

top 5 causes of deaths for males

CHD, dementia and alzheimer’s, lung cancer, cerebrovascular disease, prostate cancer

top 5 causes of death for females

dementia and alzheimer’s, CHD, cerebrovascular disease, lung cancer, breast cancer

5 most commonly diagnosed cancers

breast, prostate, bowel, melanoma, lung

identifying priority health issues

social justice principles, priority population groups, prevalence of condition, potential for prevention and early intervention, costs to the individual and community

→ SPPPC (S-triple P-C)

which consideration has the most impact when governments are prioritising health issues

burden of illness in the community and the potential for reducing this burden

→ potential for prevention and early intervention

social justice principles

equity, diversity, supportive environments

→ SEED

what is social justice

acknowledging all groups in society should have equal access to good health services and opportunities

priority populations groups

ATSI populations, elderly, rural and isolated communities, disabled, low SES groups

→ Always Eat Really Dry Lettuce

prevalence of the condition

the more individuals are diagnosed with a particular disease/condition, the more priority it is given over other diseases/conditions

current prevalent conditions

cardiovascular disease, cancers, dementia and alzheimer’s, diabetes, cerebrovascular disease

potential for prevention and early intervention

diseases/conditions that can be prevented/improved easily will have priority over non-modifiable conditions for health promotion

diseases prevented through lifestyle changes

cardiovascular disease, lung cancer, diabetes

diseases prevented through early intervention

all cancers, musculoskeletal conditions (eg. arthritis)

costs to the individual

treatment, time and money lost from work, social and emotional costs (eg. social isolation, mental distress), physical costs (pain and suffering)

costs to the community

health care and services, loss of productivity in the workplace, health insurance, health promotion, research

direct costs

directly relating to the disease/condition, eg. costs of diagnosis and treatment

indirect costs

not directly relating to the disease/condition, not always measured in currency, eg. reduced QOL, emotional costs on family and relationships, costs associated with time lost from work

how does CVD impact the costs of the individual

expensive to treat, large surgical procedures and lengthy recovery periods, loss of independence and income, linked with lower self-esteem levels

how does CVD impact the costs of the community

surgery is paid for using Medicare taxes, employment place must pay for sick leave and a replacement worker, emotional and financial costs to family and relationships who take time off work to be a carer and become anxious

nature and extent of the heath inequities for ATSI communities

life expectancy is roughly 10 years less, infant mortality rate is twice as high, more likely to experience disability and reduced QOL

sociocultural determinants impacting ATSI communities

family/peers:

• higher rates of smoking

• higher rates of alcohol

• higher rates of violence including domestic violence

culture:

• language barriers

• discrimination and racism leads to higher rates of mental illness

• traditional view of health is different to Western medicine

socioeconomic determinants impacting ATSI communities

education:

• lower levels of school completion

employment:

• lower levels of employment and higher unemployment

• work in more hazardous occupations

income:

• lower average income

• inability to afford “extra” health care

environmental determinants impacting ATSI communities

geographic:

• poorer quality, overcrowded housing

• poorer air, food and water quality

• poorer sanitation

access to health services and technology:

• distance to health services

role of governments in addressing the ATSI health inequities

provide basic health services in Indigenous communities, fund health promotion initiatives targeting Indigenous communities, involve Indigenous communities in their decision-making process

example of governments addressing the ATSI health inequities

Close the Gap initiative → aimed to reduce the gap between the life expectancy of ATSI communities and non-Indigenous Australians

role of communities in addressing the ATSI health inequities

provide culturally relevant health services, lobby governments for improved services, involve themselves in local health initiatives

example of communities addressing the ATSI health inequities

Yiriman project → created by elders of 4 different language groups, targets young people in the community who are suffering from self harm and substance abuse

role of individuals in addressing the ATSI health inequities

take responsibility for their own health by reducing risk behaviours and engaging in positive health behaviours, volunteering in local ATSI health initiatives, work to improve their own education and living conditions

nature and extent of the heath inequities for R&R communities

mortality rates increase with remoteness, significant deaths from CVD, injury, diabetes, cancer and mental illness, higher rates of ill health

sociocultural determinants impacting R&R communities

family/peers:

• higher levels of smoking

• higher levels of alcohol abuse

socioeconomic determinants impacting R&R communities

education:

• remote learning as opposed to in person learning

employment:

• occupational hazards leading to higher rates of death and illness (farming and mining)

income:

• lower average income

• inability to afford '“extra” health care

environmental determinants impacting R&R communities

geographic location:

• harsher environments

• poorer roads

• poor overall living conditions

• less access to fresh food and other necessities

• social isolation leading to depression

access to health services and technology

• lack of access to health services and facilities

• poor distribution of medical specialists and medical technology

role of governments in addressing the R&R health inequities

improving infrastructure such as roads, provide more quality health services and facilities, provide incentives to attract and retain health workers

role of communities in addressing the R&R health inequities

be involved in planning and decision making about health issues and needs, advocate and lobby governments, provide community support groups

role of individuals in addressing the R&R health inequities

accept responsibility for adopting health promoting behaviours and reducing risk behaviours, educate themselves on the risk factors and behaviours, take part in community initiates to improve health

what is cardiovascular disease (CVD)

all diseases of the heart and blood vessels

nature of the problem for CVD

four main types:

• coronary heart disease

• cerebrovascular disease

• peripheral vascular disease

• heart failure

main causes are atherosclerosis and arteriosclerosis

what is coronary heart disease

poor blood supply to the heart (angina and heart attacks)

what is cerebrovascular disease

AKA stroke, poor blood supply to the brain

what is peripheral vascular disease

poor blood supply to the limbs

what is heart failure

the heart is less effective at pumping blood around the body

what is atherosclerosis

blood vessels becoming clogged with fat or cholesterol

what is arteriosclerosis

hardening of the arteries

extent of the problem for CVD

• 2nd leading cause of mortality in Australia

• coronary heart disease is most common cause of CVD

• males have a higher mortality rate

• CVD mortality increases with age

• CVD mortality rates have decreased recently

risk and protective factors for CVD

non-modifiable risk factors: age, sex, family history

modifiable risk factors: smoking, risky alcohol consumption, insufficient physical activity, high blood pressure, poor nutrition, being obese

protective factors: engage in physical activity, eat a balanced diet

sociocultural determinants impacting CVD

age:

• risk of CVD increases with age

sex:

• females have greater prevalence of CVD than males

• males have higher mortality rates of CVD than females

socioeconomic determinants impacting CVD

education:

• more educated individuals are less likely to participate in risk behaviours (eg. smoking, not exercising, not eating a balanced diet)

employment:

• blue collar occupations have higher death rates

• poor working conditions can lead to increased risks

income:

• stressful financial situation can raise blood pressure

• harder to afford healthy food (eg. fruit and veg)

• can’t afford some health services

environmental determinants impacting CVD

geographic location:

• R&R communities have higher rates of CVD

• harder to get healthy foods in some areas

access to health services and technology:

• not having access means you are more likely to suffer/die from CVD (eg. lack of diagnosis, lack of prevention methods)

groups at risk for CVD

ATSI community, R&R communities, elderly, smokers, individuals with high blood pressure, individuals with high cholesterol

what is cancer

uncontrolled growth of abnormal body cells, leads to the build up of tissue masses called tumours

what is a benign tumour

does not invade or spread to other body tissues

what is a malignant tumour

can spread through the bloodstream, or lymph system to other parts of the body

what is metastasis

the spreading of a malignant tumour

nature of the problem for cancer

main cancer mortalities:

• males: lung, prostate, bowel

• females: lung, breast, bowel

main cancer morbidities:

• males: prostate, melanoma, bowel, lung

• females: breast, bowel, melanoma, lung

extent of the problem for cancer

• leading cause of death and burden of disease in Australia

• incidence is increasing (skin is consistent)

• mortality is decreasing

risk and protective factors for lung cancer

risk factors: smoking, occupational exposure, air pollution

protective factors: avoid exposure to tobacco smoke and other hazardous chemicals (eg. asbestos)

risk and protective factors for skin cancer

risk factors: fair skin, red hair, live in areas exposed to the sun, number and type of moles

protective factors: avoid excess sunlight, reduce sun exposure, regular checkups, self checkups

risk and protective factors for breast cancer

risk factors: early menstruation, late-age pregnancy, high-fat diet

protective factors: regular mammograms, self-examination, balanced diet

sociocultural determinants impacting cancer

family:

• family history

culture:

• smoking rates higher in ATSI (lung cancer)

socioeconomic determinants impacting cancer

education:

• low education levels make you less aware of the risk factors

employment:

• outdoor workers (sun exposure and skin cancer)

• occupations exposed to carcinogens (asbestos and lung cancer)

income:

• low SES might not be able to afford treatments and screenings

environmental determinants impacting cancer

access to health services and technologies:

• R&R have decreased access (eg. pre-screening)

  • due to geographic location

groups at risk for cancer

lung:

• smokers

• blue collar workers

• occupations exposed to airborne carcinogens

• over 50

skin:

• southern hemisphere dwellers

• fair skinned people

• outdoor occupations

• people who avoid sun protection

breast:

• have never given birth

• obese

• over 50

• family history

• menstruate early

• late menopause

what is injury

caused by any form of external violence

nature of the problem for injury

main hospitalisations: falls, suicide, transport-related injuries, poisonings

extent of the problem for injury

• most common death in the first half of life

• falls are most common hospitalisation

• highest mortality rate in individuals over 65

• decreasing mortality and prevalence

risk and protective factors for injury

risk factors: work environment, reckless driving, drink driving, social isolation

protective factors: manage stress, don’t stand on tall things, keep chemicals away from children

sociocultural determinants influencing injury

age:

• old people are more prone to dangerous falls

• teens and young adults are more likely to have risky behaviours

family:

• lack of supervision of children

socioeconomic determinants influencing injury

education:

• less aware of dangerous situations or substances

employment:

• workplace injuries are common for agricultural jobs

income:

• low ESE individuals can struggle to purchase safety equipment

environmental determinants influencing injury

geographic location:

• legislation is different in each area (RBTs, school zones, compulsory seat belts, speed bumps, better roads)

access to health services and technologies:

• more likely to suffer from the injury if the services are far away

groups at risk for injury

ATSI, young children (drowning, poisoning), elderly (falls), R&R communities, unsafe drivers

a growing and ageing population

healthy ageing, increased population living with chronic disease and disability, demand for health services and workforce shortages, availability of carers and volunteers

→ HIDA

what is healthy ageing

individuals participating in protective behaviours and reducing risk factors as they age

goal of healthy ageing

• enable the elderly to maintain health (decreases the use of health services by the elderly)

• allows elderly to contribute to the workforce longer (increases economic growth)

• helps the elderly to engage in society

what is a chronic disease

a disease that persists over a long period of time

why is there an increased population living with chronic disease and disability=

• elderly are exposed to risk factors for a greater period of time

• prevalence of chronic disease and disability increases with age

• better screening and detection results in higher rates of chronic disease

most common chronic diseases for the elderly

• coronary heart disease

• stroke

• cancer

• alzheimer’s and dementia

• respiratory conditions

• arthritis

• musculoskeletal conditions

demand for health services reasons

• increasing number of elderly

• increasing chronic disease rates

most commonly demanded health services for the ageing population

GPs, dental services, hospitals, community care

what is the health workforce

the individuals employed to provide health care

reasons for the shortage of healthcare workers in Australia

low numbers of healthcare students being trained, working hours per week have decreased, retirement of healthcare workers

measures to improve the shortage of healthcare workers

investment in the healthcare sector, registration schemes for healthcare workers, national healthcare system as opposed to state healthcare systems

availability of carers and volunteers

carers and volunteers are declining in numbers while the number of people requiring informal care is increasing

organisations that rely on carers and volunteers

meals on wheels, aged care facilities, Home and Community Care Program

solutions to increase availability of carers and volunteers

create financial security for carers if they continue to work, recognise the contributions of volunteers, establish organisations to harness and promote the role of volunteers

example of an organisation that promotes the role of volunteers

Volunteers Australia

examples of local volunteer organisations for the elderly

easy care gardening, little bay coast centre for seniors, anglicare