unit 3 aos 2 hhd

changes in aus health status over time

• improved life expectancy males and females

• decreased mortality rates

• increased prevalence noncommunicable diseases

• decreased prevalence communicable diseases

categories of disease

CRICI

• cancers

• respiratory diseases

• infectious + parasitic diseases

• cardiovascular diseases

• injury and poisoning

disease categories and trends over time

• cancers: decreased over time (e.g. lung cancer decreased prevalence as smoking rates decreased)

• respiratory: general decrease then sudden increase bc COVID-19

• infectious + parasitic: decreased over time as living conditions + tech improved → child mortality, overall mortality rates decreased

• cardiovascular: have decreased but still high levels

• injury and poisoning: public health actions have decreased this significantly e.g. compulsory wearing seatbelts

public health def

collective effort to improve popul’s health status and how govs monitor, regulate and promote it

why was health st from earlier times not optimal

• poor living conditions

• minimal access clean water

• minimal access sanitation

• less knowledge on good hygiene practices

• overcrowding and poor housing quality

some initiatives with ‘old’ public health

• improved clean water access

• improved sanitation

• mass immunisation programs (not discovery of vaccines themselves)

• better quality housing

• better quality food + nutrition

• safer working conditions

health promotion def

process of letting ppl increase control over their health to improve it

biomedical approach to health def

physical aspects of disease and illness involving med practices by health professionals to diagnose, treat, cure disease

features of biomedical approach

• focus on ill individuals

• focus on treatment rather than cause (when cond already present)

• involves disease, illness, disability

• relies on health services by health professionals

• relies on tech to diagnose, treat, cure

advances in med technology e.g. (biomedical approach)

• discovery of antibiotics to treat and reduce mortality rates from infectious diseases

• drug development to treat high bp → reduce morbidity + mortality rates from cardiovascular disease via hypertension management

• scans

biomedical approach to health — strengths

• allows many diseases effectively treated via tech improvements

• extends life expectancy

• improves life quality → HALE

biomedical approach to health — limitations

• relies on health professionals and tech → costly → not always affordable to all

• may not always promote good h&w — bc focused on solutions rather than causes of conditions

• not all conditions can be cured/treated → hence optimal h&w may not be restored

social model of health def

approach recognises improvements in popul h&w achieved by addressing physical, sociocultural, political envos

• focuses on cause rather than solution

ottawa charter for health promotion

approach by WHO aims to reduce health inequalities by 5 action areas used as basis to improve health outcomes

the 5 action areas of the Ottawa Charter

BCSDR (bad cats smell dead rats)

• build healthy public policy

• create supportive envos

• strengthen community action

• develop personal skills

• reorient health services

OTTAWA CHARTER — build healthy public policy

• decisions by govs and orgs about laws and policies to improve popul’s health

• e.g, compulsory wearing of seatbelts

OTTAWA CHARTER - create supportive envos

• promote healthy physical + sociocultural envo for comm so it’s safe, stimulating, satisfying and enjoyable to promote h&w

• e.g. providing shaded areas in school playgrounds

OTTAWA CHARTER - strengthen community action

• comm involved in planning or implementing a program to achieve common goals of improving their h&w

• e.g. parents working with school and canteen staff to serve healthier foods

OTTAWA CHARTER - develop personal skills

• gaining education of health-related knowledge and skills that let ppl act in specific ways to affect improve their h&w

• e.g. ability to read food labels and find the energy contents of diff foods to compare them

OTTAWA CHARTER - reorient health services

• changing health system so it promotes h&w → like focus on prevention instead treatment of conditions and considering factors apart from disease as h&w from health professionals — more holistically

• e.g. docs discuss regular exercise to pre-diabetic patients for prevention of development

— changing health system by encouraging health profs to focus on prevention over treatment and to consider h+w more holistically

social model of health — strengths

• promotes good h&w through prevention rather than treatment

• can be less expensive

• more holistic approach to h&w (focus on all dimensions)

• focus on vulnerable popul grps

• health education can be passed generationally

• responsibility for h&w is shared

social model of health — limitations

• not every condition can be prevented (doesn’t benefit those already diagnosed)

• doesn’t promote medical advancements e.g. tech

• may not address specific h&w concerns of inds e.g. those sick not focused on

• health promotion messages may be ignored — relies on public cooperation

lung cancer as an example of health approaches improving health outcomes — social model of health + health promotion

• anti-smoking campaigns as a health promotion campaign

• making tobacco products more expensive

• lack of tobacco adverts + sold in plain packaging

• health warnings on cig packets

• banning smoking in pubs + clubs

• has caused effective reduction in smoking rates

lung cancer as an example of health approaches improving health outcomes — biomedical approach

• early diagnosis and treatment of lung cancer important bc has high fatal risk

• improvements in med tech → has increased chance of ind surviving 5 years after diagnosis + better palliative care

• diagnosed by ways like chest x-rays, CT scans, PET scans, bone scans

• treatment by ways like chemotherapy, radiotherapy, removing affected lung parts

palliative care def

improvement of life quality for patients with life-threatening illness → manage symptoms, relieve pain and suffering

old public health def

gov actions that were focused on changing physical envo to prevent disease spread e.g. via improved sanitation and access to clean water

the role of health promotion in improving popul health

create conditions that encourage healthier lives and prevent ill health

• diff to biomedical model that treats conditions already formed

why are some issues targeted by health promotion more than others

• contribute more to aus burden of disease

• cause great economic cost e.g. through health care, absenteeism

• have modifiable component that can be addressed to improve

1. why health promotion > biomedical model

2. why biomedical > health promotion

1. lower cost for govs to prevent ill health than treat

2. not all diseases/conditions like injuries can be prevented

— hence important to invest in both

health promotion focus — Quit campaigns for smoking and vaping

• develops personal skills: provide advice and practical strategies for quitting → increase ability of ppl to manage cravings

• creates supportive envo: provide support throughout quitting process by telephone service that anyone can access

• strengthen community action: Aboriginal Quitline has Aboriginal Australian specialists and community members with training to assist ppl with smoking/vaping cessation in culturally appropriate way

• build healthy public policies: Quit advices govs on smoking and vaping laws e.g. no smoking in certain public places

• reorient health services: Quit has online training program for health professionals so they can advise clients in quitting (before disease develops? prevent > treat)

e.g. how Quit campaigns can impact health outcomes

• health status impact: decrease prevalence of smoking related conds like cardiovascular disease and cancer

• h+w impact: reduced smoking rates → higher levels fitness in popul → promote physical h+w

health promotion focus — the Good Sports program for alcohol and drug misuse

• build healthy public policy = gives expert advice on developing illegal drug policies in sport clubs

• creates supportive environment = moves away from alcohol culture and create fam friendly sporting clubs

• develops personal skills = promotes positive behaviour around alcohol so young club members can increase ability in decision making skills to reduce alcohol related harms

• strengthens community action = parents and clubs reduce junior players exposure to alcohol and create positive playing envo + older players act as role models

• reorient health services = gives support networks and assistance for members with mental illness to access health professionals before issue escalates

e.g. how Good Sports program can impact health outcomes

• health status impact: reduce risk of members driving drunk hence reduced mortality rates from road trauma

• h+w impact: members can socialise freely knowing it’s a safe envo to do so → form support networks and meaningful relationships → promote social h+w

health promotion focus — Victorian Road Safety Strategy for road safety

• strengthens community action = collective response by govs, industry and vic community to allow safer roads by planning and implementing strategies

• create supportive envo = AI cam systems can detect seatbelt absence and illegal phone use to allow safer roads and drivers

• build healthy public policies = creating new laws and penalties to remove risky drivers from roads e.g. alcohol driving limit laws

• develop personal skills = makes signs that can be seen along roads advising safe behaviour → increase drivers ability to assess if they are fit to drive safely

e.g. how Victorian Road Safety Strategy can impact health outcomes

• health status impact: safer roads means less risk road accidents hence fewer deaths and increased life expectancy

• h+w impact: safer roads means less risk road accidents → less risk injury → ppl can spend time with friends and form meaningful relationships → promote social h+w

health promotion focus — SunSmart for skin cancer

• develops personal skills = media education campaigns increase ppl ability to recognise conditions for extra sun protection like wearing sunscreen

• create supportive envos = promote building shades and using UV app thru day so ppl away from direct sun when dangerous conds

• strengthens comm action = assists orgs like schools to implement sun safety measures like having sunscreen for kids to use at break times

• build healthy public policies = assists schools in policies like no hat no play when outdoors during breaks

• reorient health services = promotes GPs to increase awareness on UV exposure effects

social justice

fairness in society based on principles like

• human rights (freedoms every person entitled to despite individual characteristics)

• equity (disadvantaged grps have their challenges addressed, more support to those who need it) — consider diff situations of inds so those disadvantaged that need more support can get it

• access (all ppl have adequate resource access)

• participation (everyone has voice and opportunity)

e.g. health inequalities of ATSI vs non-ATSI

• higher mortality rates

• higher rates underweight babies and infant mortality

• higher burden of disease rates

health promotion focus for First Nations — Closing the Gap

• strengthen community action: ATSI consulted and help plan + implement agreement alongside govs

• build healthy public policy: has targets formed by govs that influence policies to improve ATSI popul health

health promotion focus for First Nations — Deadly Choices initiative

• develop personal skills: education programs provides cooking programs and tobacco cessation strategies for popul to gain ability to cook nutritious food and resist smoking cravings

• reorient health services: health workers promote annual health check so they can identify risks of health concerns hence focus on preventing them prior to onset

• strengthen community action: ATSI community members plan and implement health services in culturally appropriate way

health promotion focus for First Nations — Tackling Indigenous Smoking (TIS) initiative

• reorients health services: Quitskills training program gives health workers knowledge to support ATSI people to quit smoking → focus on prevention > treatment of associated diseases

• create supportive environment: regional tobacco grants allow local orgs to implement tobacco cessation activities and Quitline services

• build healthy public policy: advises aus gov on policies to to reduce smoking among ATSI and close the gap

• develop personal skills: developed a children’s book promoting healthy behaviour + lack of tobacco use → increase kids ability to refuse smoking opportunities as they are aware of negative effects

evaluating initiatives to improve First Nations health — considerations of whether effective or ineffective

1. make judgement statement about level of effectiveness (use format) — either start or end

2. identify action area ottawa charter for hp

3. outline how used in case study/program (quote and explain it)

4. outline how this increase program engagment (use format)

5. link to improved h&w (dimensions and key words) for inds

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• no. people that have accessed / participated

• feedback from participants

• action areas of Ottawa Charters evident

• whether culturally appropriate

• whether specific needs addressed

program effectiveness — ottawa charter for hp action areas format

• develop personal skills = ‘knowledge learnt can be passed on to friends and fam, increasing program reach’

• create supportive envo = ‘increase likelihood ppl feel comfortable accessing program, increasing no. participants’

• strengthen community action = ‘comm involved may encourage others to engage in program by creating trust, increasing participation rates’

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• for step where state effectiveness: “ the (program name) is an effective program to promote h+w as it includes various action areas of the ottawa charter for health promotion” — either at start or end of response

federal gov initiatives to promote healthy eating

• aus dietary guidelines

• aus guide to healthy eating

• ATSI guide to healthy eating

evaluating initiatives to promote healthy eating — considerations of whether effective or ineffective

• ease of understanding (e.g. using visual guides for those with lower literacy levels, language range)

• access (e.g. resources are free of charge, available online)

• inclusiveness (relates to diff popul grps)

• relevance (should work towards an imp need in community)

• effectiveness (expected or already achieved objectives across popul grps)

• sustainability (ability for program to continue in future)

the aus dietary guidelines notes

• developed by NHMRC — fed gov body

• addresses causes of the increase in diet-related conds and diseases in seen in aus population over time

• used by health professionals, educators etc

• promotes aus popul to develop healthy dietary patterns, reduce risk of developing diet-related conds, and reduce risk developing chronic conds

the aus dietary 5 guidelines

1. to achieve + maintain healthy body weight, be physically active, choose amounts of nutritious foods and drinks to match your energy needs

2. enjoy wide variety nutritious foods from the five groups (veges, fruit, grain, protein foods, dairy foods — vital foods grow people daily) daily and drink plenty water

3. limit intake foods with sat fats, added salt, added sugar, alcohol (discretionary foods)

4. encourage, support and promote breastfeeding (promotes ideal infant growth and. development)

5. care for your food (prepare and store safely to avoid food-borne diseases, food poisoning)

strengths and limitations of aus dietary guidelines

strengths:

• available free download online (no cost and geo barrier)

• accounts for diff needs for diff inds e.g. diff life span stages, vegetarians and vegans, ppl of diff cultures, pregnant women etc

• accessible in low vision format

• provides serving sizes for food grps for more effectiveness

limitations:

• written format hence low literacy levels hard to understand

• only in eng

• based on needs of average person hence not specific to all (e.g. those with serious diet conds not considered)

the aus guide to healthy eating

visual tool in aus dietary guidelines for ppl to plan + eat recommended food proportions daily

• shows proportions of five food grps consumption

• promotes water consumption

• suggests limiting discretionary foods

• recommends small amount healthy fats

label the aus guide to healthy eating proportions

+ plenty water

+ use small amounts discretionary foods, healthy fats

the ATSI guide to healthy eating

visual tool in aus dietary guidelines for ppl to plan + eat recommended food proportions daily that also has FN trad foods e.g. kangaroo meat, bush fruits

food selection models (aus and ATSI guide to healthy eating) strengths and limitations

strengths:

• multiple languages available

• applies to all ages

• visual presentation allows those low literacy understand

• based on latest scientific research → more effective

• large range foods from diff cultures

limitations:

• doesn’t show serving sizes → more subjective

• doesn’t consider composite foods e.g. pizza (has multiple grps in it)

• based on average popul needs → do not consider some ppl with specific dietary needs → not applicable to everyone

how has food intake in aus changed over time

less nutrient-dense whole foods → more energy-dense processed foods — has caused increased rates diet related conds

what are the main factors as challenges to nutritional change

• personal

• sociocultural (commercial too)

• environmental

personal factors as challenges to nutritional change — list

— relates to ind’s characteristics

• willpower and taste prefs

• attitudes and beliefs

• h+w factors

personal factors as challenges to nutritional change — willpower and taste prefs

people prefer certain foods than others

e.g. foods high in fat, salt, sugar → flavour enhancers → stimulate taste buds and cause dopamine release → creates cravings for these foods hence removing these foods hard

taste prefs often form over time period hence can be hard to change

personal factors as challenges to nutritional change — attitudes and beliefs

can complicate diet changes

e.g. =

• perception that healthy food is bland

• ignorance of negative effects unhealthy foods for taste

• beliefs like vegetarianism

• restriction of certain foods (e.g. religion)

personal factors as challenges to nutritional change — h+w factors

e.g those with allergies may not be able to eat some healthy foods

those experiencing poor emotional / mental h+w may rely on dopamine release from unhealthy foods to enhance mood

sociocultural factors as challenges to nutritional changes — list

• socioeconomic status

• employment status

• fam and peer grp

• commercial factors (dppm)

sociocultural factors as challenges to nutritional change — socioeconomic status

• education, income, occupation all influence foods

• lack of nutritional knowledge and cooking skills = people eat unhealthy meals

• lack of literacy = consumers may not accurately assess food labels and hence control their food intake patterns

• if lower income = cannot afford more costly healthy food

• some occupations may consume foods based on nearness to employment place → e.g. may access fast food and reduce ability to consume healthy diet

sociocultural factors as challenges to nutritional change — employment status

• if both parents working full time then less time spent preparing healthy food → hence more ready-made foods consumed

• when working outside people may eat from locations near employment area → affects regular diet

sociocultural factors as challenges to nutritional change — family and peer group

• family may increase familiarity of certain foods (esp to kids) hence may be difficult to change to non-familiar foods

• social settings can impact choices of food as people may be influenced by others choices

• cultural background of family may influence typical foods consumed

sociocultural factors as challenges to nutritional change — commercial factors

private sector (economy not run by gov like companies) influence popul food intake:

• distribution and affordability = prices set by retailers often influence affordability of foods + price generally increases if food has travelled larger distance

• processing = addition of additives and preservatives to prolong foods shelf life and enhance flavour

• packaging and labelling = foods packed to be more visually appealing can cause increased consumption + labelling may be misleading

• marketing strategies = media like ads on television, in newspaper, on radio etc can increase people’s exposure to certain foods hence increasing likelihood of consumption (esp for kids that see specific ads between cartoons etc)

envo factors as challenges to nutritional changes — list

• geographic location

• workplaces

• housing envo

• transport

(green world happy tomorrow)

environmental factors as challenges to nutritional change — geographic location

— where ppl live influence food available to them

• ppl outside major cities may have more limited food options

• those in remote areas may rely on processed + non-perishable foods → not as healthy

• suburbs with lower SES may have more fast-food outlets

environmental factors as challenges to nutritional change — workplaces

• some workplaces offer food at canteens → influence ability to control diet

• workplaces without cooking facilities can also decrease food preparation and diet control

environmental factors as challenges to nutritional change — housing envo

• facilities available in house (e.g. fridges, microwaves etc) can influence meal options → if lack of facilities can limit food options as cannot prepare and store properly

environmental factors as challenges to nutritional change — transport

• availability of roads, paths etc can influence access to food outlets

• if lack of transport access (e.g. no vehicle, no public transport) → ppl may rely on foods closer to homes → reduce ability to make nutritional change

health system def

all activities that primary purpose is to promote, restore and maintain health

common elements of health systems

• funding models

• professional workforce

• reliable info to base decisions + policies

• up-to-date facilities

• logistics for meds and tech

2 main components of aus health system

• public health care

• private health care

public health care def

aus gov provides services and schemes including public hospitals, Medicare, PBS, NDIS

private health care def

not funded by gov directly includes private health insurance, private hospitals, med professionals in private practices

medicare def

aus’s universal public health insurance scheme funded by fed gov to give all eligible (australians, permanent residents, those from countries with reciprocal agreement) access to subsidised health care

what does medicare cover overall

• out of hospital expenses

• in hospital expenses

• medicare safety net

medicare cover — out-of-hospital expenses

COVERS SCHEDULE FEE OF ESSENTIAL HEALTHCARE SERVICES

• pay all/some fees for essential healthcare services (e.g. GP consultation fees, specialist consultations, tests and examinations like blood tests, eye tests)

• medicare benefits schedule lists services medicare gives schedule fee for

• schedule fee: amount money gov finds suitable for specific med services based on reasonable average → a set amount given to that service (however depending on ind’s doctor this schedule may be less than actual fee → remainder paid by patient as patient co-payment)

• if doc charge only schedule fee = no patient co-payment = service has been bulk-billed

• when inds access specialist services = medicare contribute 85% of standard schedule fee (which may be diff to specialist actual fee) = patient co-payment required

medicare cover — in-hospital expenses

• as a public patient in public hospital — accomodation and treatment covered

• if ind chooses to admit in private hospital or if private patient in public hospital — cover 75% of schedule fee for treatment services but not to accomodation, meds, theatre fees etc

medicare cover — medicare safety net

once ind/family contributed significant amount out-of-pocket costs for medicare services in one year → gov gives more financial support → make medicare services cheaper for rest of year

services covered by medicare e.g.

• GP and specialist consultations

• optom eye tests

• x-rays

• some dental procedures + services for some children 2-17 yrs under child dental benefits scheme

what is not covered by medicare

• in home nursing care and treatment

• ambulance services

• services not clinically necessary (e.g. cosmetic procedures usually not covered)

• most private hospital costs (only cover 75% schedule fee)

• most dental exams and treatments

• most allied health services (unless GP referral or in public hospital)

• alternative meds unless GP involved

• health aids like glasses

• meds

• med costs when someone else responsible

advantages of medicare

• choice of doctor for out-of-hospital services

• available to all aus citizens

• reciprocal between aus and other countries lets australians access free health care there

• covers tests, exams, schedule fee for consultations etc

• medicare safety net provides extra financial support to those need it

disadvantages of medicare

• no choice of doctor for in-hospital treatment

• waiting lists for many treatments

• doesn’t cover alternative services

• often doesn’t cover full doctor fee (only pay schedule fee)

how is medicare funded

• medicare levy

• medicare levy surcharge

• general taxation (revenue from above doesn’t meet full medicare operating costs hence this helps to fund)

medicare levy def

2% tax placed on taxable income of most taxpayers to fund medicare

(special circumstances or low incomes exempted)

medicare levy surcharge def

EXTRA 1-1.5% TAX PLACED ON TAXABLE INCOMES OF THOSE WHO DON’T HAVE PRIV HEALTH INSURANCE ESP HIGH INCOME EARNERS

those without private health insurance earning more than certain amount pay extra tax → surcharge % increases as income increases from 1 to 1.5%

• purpose: encourage inds to take out private health insurance to reduce demand hence financial pressure of medicare (esp high income earners)

the pharmaceutical benefits scheme def

fed gov contribution to aus public health system by subsidise essential meds so ppl only make patient co-payment

the PBS safety net

those paying more than certain amount out-of-pocket expenses for PBS-listed meds in a year provided extra support so they only have to pay concessional co-payment rate ($7.70 instead of usual $31.60)

which meds covered under PBS

• most essential prescription meds (including diff brands of same med) → meds under this category reviewed thrice a year by PBAS → they consider conditions med used for, clinical effectiveness, safety, cost-effectiveness before making +ve rec to include in PBS

• meds not covered by PBS need patient pay full amount

the national disability insurance scheme

national insurance scheme funded by fed gov that provides support for people with permanent significant disabilities + their carers to help them live normally

NDIS eligibility requirements

• under 65

• must live in aus and be citizen or have permanent visa or protected special category visa

• condition likely to be permanent

• condition significantly reduce ability to participate in tasks/activities so need assistance from others, or with assistive tech or can’t even with these things

• condition affects capacity for social and economic participation

• likely to require NDIS support for lifetime

NDIS process

if age, residency, disability requirements met → develop individualised plan with support for ind’s goals and aspirations (e.g. more independence, community involvement etc) → plan includes functional support for daily living, support for pursuing goals and assistance for ind to organise how to manage plan over time

what can NDIS plan help ind’s to do

• access mainstream services and supports (e.g. accessing teachers in education system or accessing justice system — NDIS can provide resources like transport or carer assistance if needed)

• access community services (e.g. sports clubs or libraries)

• maintain informal support arrangements (help from fam and friends)

• receive funded supports (NDIS can pay for supports to help ind live normal life and achieve goals, for assistive tech like mobility cane, wheelchair etc and for carers) → increase independence

private health insurance def

additional insurance type where members pay premium in return for payment towards healthcare costs not covered by Medicare

premium def

amount members pay for insurance

hospital separations def

episodes of hospital care that start with admission and end with transfer/discharge/death

insurers classify their hospital policies to one of four tiers for hospital cover

• gold — covers most categories hospital treatment (rehab, brain and nervous, heart and vascular, assisted reproductive)

• silver — covers second most categories hospital treatment (rehab, brain and nervous, heart and vascular)

• bronze — covers second fewest categories hospital treatment (rehab, brain and nervous)

• basic — covers fewest categories hospital treatment (rehab)

private health insurance coverages

• private hospital cover

• general treatment cover (services not covered by medicare like physios, dentists etc)

• combined cover (hospital and gen treatment cover)

what does medicare cover for private hospital treatments

75% of treatment schedule fee

fees charged with private hospitals

they usually charge more than schedule fee → medicare covers 75% of schedule fee → priv health insurance can sometimes pay all reminder sometimes cannot → if not patient pay rest = the gap

private health insurance incentives types

• private health insurance rebate

• lifetime health cover

• medicare levy surcharge

• age-based discount