HHD- Changes in Australia's Health Status

What are the categories of diseases?

Infectious and parasitic diseases, cancers, injury and poisoning, respiratory diseases and cardiovascular diseases.

What are infectious diseases?

Can be transmitted from one person to another. E.g. Tuberculosis, smallpox.

What are parasitic diseases?

Occurs when parasites- such as worms, skin mites, body lice enter the body.

-These were caused by poor living conditions such as water and food supplies being contaminated, rubbish in the streets and public waste facilities not being well-maintained.

What is cancer?

Refers to a group of conditions in all parts of the body where the cells become abnormal and multiply.

What are cardiovascular diseases?

Include heart attack, angina, stroke and high blood pressure. CVD affects the heart and blood vessels.

What are respiratory diseases?

Diseases affecting the lungs and other parts of the body involved in breathing- they include pneumonia, influenza, asthma and COPD.

What is injury and poisoning?

Deaths from injury and poisoning include those from motor vehicle and other accidents, suicide, assault, poisoning, drowning, burns and falls, and complications from medical or surgical care.

What is public health?

-Is the ways in which governments monitor, regulate and promote health status and prevent disease.

-Public health actions, which focus on the physical environment.

What is old public health?

Government actions that focused on changing the physical environment to prevent the spread of disease, such as providing safe water.

What are old health policies and practices?

Improved water and sanitation, better quality housing and fewer slums, better quality food and nutrition, introduction of quarantine laws, safer working conditions, more hygienic birthing practices, provision of antenatal and infant welfare services, mass immunisation program.

What are mass vaccination programs? (Old public health)

-Vacations help to treat a range of infectious diseases.

-Helped bring huge reductions in morbidity and mortality from diseases such as small pox and polio.

What is clean drinking water?

Establishment of government-funded water systems, such as dams, fluoridation and delivery systems so people had clean water to drink. This reduced infectious diseases such as typhoid and chorea.

What are sewage systems?

Systems and infrastructure designed to keep human waste separate from water supplies, and garbage removal programs to keep rubbish away from residential areas. This helped reduce infectious diseases such as gastroenteritis, improving mortality rates.

What is the biomedical approach?

-Sometimes referred to as the ‘quick fix’ or ‘band aid’ approach.

-Focuses on the physical or biological aspects of disease or illness.

-Involves diagnosing, curing and treating disease- individuals are the focus of this approach.

-Addressing the reasons for this illness are the not the centre of the biomedical model; the condition itself is the focus.

What are the features of the biomedical approach?

-Relies on technology, relies on services provided by doctors, specialists and hospitals, concerned with disease, illness and disability.

-E.g. Sphygmomameter and stethoscope enabled doctors to measure blood pressure in the early 1900s. In the 1950s, the heart-lung bypass machine allowed surgeons more time to undertake complex heart procedures.

What are the advances in medical technology?

Following WW2, the discovery of antibiotics meant a reduction in infectious diseases such as pneumonia and syphilis.

How long has the biomedical model existed?

-1900-today.

-Has been working to treat disease and injuries since well before 1900 and continues to evolve to this day.

How long has the old public health model existed?

Worked to primarily prevent infectious, diseases and injuries by focusing on the physical environment. The benefits of old public health are still experienced to this day.

How long has the social model of health existed?

Works to primarily prevent lifestyle related diseases.

What are the strengths of the biomedical model?

Funding brings about improvement in technology and research- Without the biomedical approach to health, there would be relatively little information about how to treat and diagnose illness.

It extends life expectancy- Many causes of death that were common in the past, such some infectious diseases, can be treated and cured.

What are the weaknesses of the biomedical model?

It relies on professional health workers and technology and this is therefore costly- As knowledge and technology has also increased, some machines required for diagnosis and treatment can cost millions of dollars and can only treat a small number of patients.

Not every condition can be treated- Cancer is an example of a condition that has treatments available, but in many cases, no cure.

What is the social model of health?

-Towards the 1970s, the leading causes of mortality and morbidity changed.

-The impacts of infectious diseases decreased while the impact of lifestyle diseases increased.

-This led to the belief that if individuals were made aware of the consequences of their health behaviours, they would take action to change their behaviour.

What is health promotion?

The process of enabling people to increase control over and improve their health.

What are the priority actions for the Ottawa Charter?

-Build health public policy.

-Create supportive environments.

-Strengthen community action.

-Develop personal skills.

-Reorient health services.

Acronym: Bad Cats Smell Dead Rats.

What is "Build healthy public policy”?

-Directly relates decisions made by governments and organisations in relation to healthcare policy, rules and regulations.

Examples- Legislation to ban smoking in public places.

What is “Create supportive environments”?

-Builds links between individuals and their environments (economic, physical, social).

Examples-

-Provide support groups such as new mothers groups.

-Quitline.

-Shaded areas in playgrounds.

What is “Strengthen community action”?

-Communities head to work together to achieve set priorities.

-It is about a combined effort from key stakeholders.

Examples-

-Government immunisation strategy- involving media, doctors, schools and parents working together to achieve higher immunisation rates.

What is “Develop personal skills”?

-Education is the key aspect of this action area.

-Skills and knowledge should be given and supported in school and at work.

Examples-

-Year 12 road safety programs.

What is “Reorient health services”?

-Groups to work together to support healthcare professionals in moving beyond providing biomedical services.

-Places a stronger emphasis on health promotion as opposed to focusing on diagnosing and treating illness.

Examples-

-Doctor discussing stopping smoking to asthma patients.

What are the achievements of the biomedical model in terms of cancer?

-Advancements in medical technology and focused on treating the condition not the cause.

-Improvements in specialised treatment, such as radiation therapy and chemotherapy.

-Improved diagnostic tools and test to help improve cancer.

What are the achievements of the social model in terms of cancer?

-Focuses on the cause of the disease and the health behaviours involved.

-Increased taxation on tobacco.

-Banned smoking in public places.

-SunSmart school programs.

Why is smoking targeted?

-Indigenous populations are more likely to smoke tobacco, contributing to a higher burden of disease.

-People living outside of major cities are more likely to smoke. tobacco, contributing to higher burden of disease.

-The economic impact of smoking is significant- estimated cost of at least $31 billion per year.

How does QUIT build healthy public policy?

-Increased taxation resulting in higher price of tobacco has seen a decrease in smoking.

-Smoke-free areas through legislation: pubs, public transport, hospital and flights.

How does QUIT create supportive environments?

-Quitline is staffed by highly trained professionals who provide support throughout the quitting process (social).

-Aboriginal Quitline- uses Aboriginal specialists to create a culturally safe and supportive environment.

How does QUIT strengthen community action?

Quit assists health professionals, community groups and population groups to decrease the prevalence of smoking.

How does QUIT develop personal skills?

-Provides education about the risks of smoking and the benefits of quitting.

-Provides education advice and practical strategies to assist people in quitting. E.g. factsheets, stories hub, facts and evidence.

How does QUIT reorient health services?

-Provides free online learning training program for health professionals to assist them in focusing on changing the behaviour (smoking) rather than treating illness associated with smoking.

-These health professionals include: GPS, eyecare, pharmacists, mental health workers, maternal health providers, oral health providers.

What impact does QUIT have on health status?

Decreased prevalence of smoking-related conditions such as cancer, CVD and respiratory disease.

What is social justice?

Relates to fairness within society and is based on the following principles: participation, human rights, equity and access.

What is the closing the gap initiative?

Aims to:

-Close the gap in life expectancy within a generation.

-Halve the gap in mortality rates for Indigenous children under five within a decade.

-Halve the gap for Indigenous students in reading, writing and numeracy within a decade,

How do you evaluate initiatives?

-Need to show an understanding of the features that make a program effective.

-Need to provide specific details of an aspect of the program that makes it effective or ineffective.

-Action areas of the Ottawa Charter that are evident in this initiative.

-Whether the program is culturally appropriate for Indigenous Australians- is it made by Indigenous Australians or have their input? Is it made available in their language?

-Whether the program addresses a significant issue for Indigenous Australians.

Why is there a need to promote healthy eating in Australia?

Poor food intake is becoming a key factor in contributing to the burden of disease in Australia: obesity, CVD, type 2 diabetes.

What is the first Guideline of the Australian Dietary Guidelines?

To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.

What is the second Guideline of the Australian Dietary Guidelines?

Enjoy a wide variety of nutritious food from these five food groups everyday: plenty vegetables, fruit, grain, lean meats and dairy.

What is the third Guideline of the Australian Dietary Guidelines?

Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.

What is the fourth Guideline of the Australian Dietary Guidelines?

Encourage, support and promote breastfeeding.

What is the fifth Guideline of the Australian Dietary Guidelines?

Care for your food; prepare and store it properly.

What is the aim of the Australian dietary guidelines?

Reduce risk of developing diet related conditions.

What are the advantages of the ADGS?

-Deals with food groups and not nutrients, which means it is easier for the public to understand.

-Takes into account specific age groups.

What are the disadvantages of ADGs?

-Provides very general advice.

-No information on serving sizes or number of servings within the Guidelines (have to read further information).

-No visual aids.

What is the role of the Australian Guide to Healthy Eating?

-Visually represents the proportion of the five food groups recommended for consumption each day.

-Outlines foods and drinks to limit.

-Visually helps with understanding of Guideline 2 and 3.

What are the strengths of the Australian guide to healthy eating?

-Visual, makes it easy to understand.

-Highlights importance of water to good health.

-Applies to people of all ages and cultures.

What are the limitations of the Australian guide to healthy eating?

-It is difficult to classify mixed foods.

-Does not provide specific advice for (food allergies).

(Challenges in bringing about nutritional changes) What are personal factors?

-Willpower and taste preferences.

-Attitudes and beliefs.

-Health and wellbeing factors.

What are sociocultural factors?

-Education, income, occupation.

How does education pose a challenge?

Lack of it can lead to a lack of nutritional knowledge and cooking skills (consumption of unhealthy meals; inability to read food labels; not understanding portion size).

How does income pose a challenge?

Direct relationship with affordability of food and therefore influences the food people buy and eat.

How does occupation pose a challenge?

Some occupations can influence what people eat (e.g. trades and truckies on the road a lot and therefore may choose convenience foods higher in fat, salt and sugar).

What are commercial factors?

-Relate to the impact that the private sector has on health and wellbeing. Impacts can be positive through activities such as the production and distribution of essential medicines and can also be negative such as the increased availability and marketing of energy-dense foods.

-Significant impact on food intake and therefore can present challenges in bringing about nutritional change include: supply chains, marketing strategies, sponsorships, use of celebrities, etc.

What are environmental factors?

-Earliest food experiences most people have are shaped by family- cultural and religious background may include ties to tradition.

-Geographic location, workplaces, housing environment and transport.

What is in the public sector of the health system?

Public hospitals, medicare, PBS, NDIS.

What is in the private sector of the health system?

Private health insurance, private hospitals and medicare practitioners in private practices.

What is medicare?

-Australia’s universal health insurance scheme.

-It gives all Australians access to healthcare that is subsided by the federal government.

(Medicare covers) What are out of hospital expenses?

-Consultation fees for doctors.

-Tests such as x-rays, blood test, eye test.

What are in hospital expenses?

-As a public patient in a public hospital, accommodation and treatment is covered.

-If a patient chooses to be treated in a private hospital or as a private patient in a public hospital, the government will pay 75% of the schedule fee.

What are schedule fees?

The amount that medicare contributes towards certain consultations and treatments.

What is bulk billing?

When the doctor or specialist changes only the schedule fee.

What are patient co-payments?

The payment made by the consumer for health products or services in addition to the amount paid by the government.

What is the medicare safety net?

-Provides extra financial assistance for those who incur significant out of pocket costs for medicare services.

-Once an individual has contributed a certain amount out of their own pocket ($560.40) in a calendar year, further financial support is provided by the government.

-If you have a concession card, you reach the safety net threshold when you spend more than $20070.20.

What is not covered by medicare?

-Ambulance is not covered by medicare.

-Cosmetic surgery.

(How is medicare funded) what is medicare levy?

Additional % income tax payable by most taxpayers.

What is the medicare levy surcharge?

-Extra tax payable by high-income earners without private health insurance.

-Individuals-$97,000+

-Families- $194,000+ per year.

-Generally ranges from 1-1.5% extra tax depending on income.

-General taxation.

What is PBS (pharmaceutical benefits scheme)?

-Subsidises essential medications to people with a prescription.

-The patient must make co-payment for these medications and healthcare card holders pay even less.

-Large overall expenses for PBS-listed medicines are also minimised through the PBS safety net.

-Once a person has spent $1494,90, the patient pays only a concessional co-payment of $6.30 rather than the normal $38.80.

What is NDIS?

Provides services and support for people with permanent, significant, disabilities and their families and carers.

-Under 65.

What is private health insurance?

-An optional form of health insurance that can be purchased in addition to Medicare.

-Members pay a premium in return for payment towards health-related costs not covered by Medicare.

Two components:

-Private hospital care.

-Extras cover.

-The level of cover provided varies depending on the policy and premium paid.

What is private health insurance rebate?

-Income tested rebate provides to private health insurance holders on the premiums paid.

-The rebate varies from 9%-27% depending on income.

-This increases affordability.

What is lifetime health cover?

-People who take up private health insurance after the age of 31 pay an additional 2% on their premiums for every year they are over the age of 30.

-This encourages younger people to take out private health insurance earlier and keep it for life.

3.Medicare levy surcharge.

4.Age based discount.

What is SAFE?

Sustainability, access, funding, equity.

What is sustainability?

-Capacity to provide a workforce and infrastructure, such as facilities and equipment, into the future.

-Can provide for the current generation without jeopardising the needs of future generations.

What is access?

Can provide all people with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.

What is funding?

-Financial resources that are provided to keep the health system adequately staffed and resourced so a high level of care is available for those who need it.

-Refers to what they provide funding for patients.

What is equity?

-Differences between population groups need to be taken into account.

-People who need more support get provided with more support (people who need less support, get less support).

How does smoking cause lung cancer?

The chemicals in tobacco smoke cause damage to lung cells, increasing the risk of cancerous cells. This risk increased with the amount and duration of smoking.

How does smoking cause COPD?

Long-term exposure to lung irritants like tobacco smoke or chemicals can cause damage to your lungs and airways, leading to COPD.

How does smoking cause a stroke?

Smoking contributes to stroke by increasing the risk of blood clots, which can block arteries.

How does smoking cause atherosclerosis?

Damages blood vessels and promoting plaque build up, which narrows and stiffens arteries, reducing blood flow.

What is cholera?

It is primarily spread through contaminated food and water that has been soiled by human faeces causing poor sanitation to be a major risk factor for the spread of it. It is a potentially deadly diarrheal disease.

What is gastroenteritis?

Caused by viruses, bacteria or parasites. These infections can spread through contaminated food, water or surfaces, or via contact with another person.

What is smallpox?

Was a highly contagious and deadly disease caused by the variola virus, it was successfully eradicated globally through a successful vaccination campaign.

What is polio?

Highly infectious viral disease that causes paralysis and in severe cases, death.

How does Medicare demonstrate sustainability by limiting services?

-Medicare only covers healthcare that is deemed as ‘medically necessary’.

-This enables them to keep costs under control and continue to cover services in the future.

How does Medicare demonstrate sustainability by providing subsidised medical treatment?

-More people are likely to access healthcare earlier, preventing the development of more serious health conditions down the track.

-This prevention reduces the need for more expensive treatment later on, keeping the costs of Medicare under control and more sustainable for the future.

How does Medicare provide access?

-Removes financial barriers for accessing healthcare, as it provides basic healthcare at little or no cost.

-All permanent Australian residents are able to access Medicare, regardless of their income, culture and location.

How does Medicare provide access in relation to hospital treatments?

-Can choose doctor for out-of-hospital treatments- appropriate for cultural needs or personal preference.

-Medicare hospital treatments operate on a triage system. Patients who are the most in need receive treatment first.

How does Medicare uphold funding?

Medicare is funded through three financial sources: the Medicare levy, the Medicare levy surcharge, and general income tax.

How does Medicare uphold equity?

-Medicare Safety Net- assists individuals/families w significant medical costs.

-Allowing low income earners to be exempt from the Medicare Levy provides extra financial support.

How does private health insurance uphold sustainability through the public system?

-Reduces the strain on the public system - treated sooner.

-This leads to improvements in the overall health of the population.

-Will be able to meet Australia’s healthcare needs.

How does private health insurance uphold sustainability through incentive schemes?

Increases the number of people who take up private health insurance - reduces reliance on the public healthcare system.

How does private health insurance uphold access?

-Greater access to healthcare services not covered by Medicare.

-Waiting times for elective surgeries are shorter for private patients + public.

How does private health insurance uphold funding?

Largely funded by the premiums paid by customers.