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what impacted health status in the 1900s

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Health

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1

what impacted health status in the 1900s

  • poor housing/environmental conditions

  • lack of safe water and sanitation lead to higher rate of infectious diseases

  • healthcare was expensive; many were untreated

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reasons why infectious diseases increased

  • poor air quality

  • inadequate food storage

  • human waste collection; resulted in waterborne diseases

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Trend in life expectancy

increased drastically

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Why did life expectancy increase?

  • increased due to access to healthcare

  • decline of infant mortality/U5MR

  • things have become more safe/less accidents

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patterns of mortality

  • infectious and parasitic

  • cancers

  • CVD

  • injury and poisoning

  • respiratory diseases

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Infectious and Parasitic Diseases

infectious - transmitted from person to person (TB, small pox, hepatitis, STI's)

parasitic - occurs when. parasites enter the body (worms, skin mites, lice)

^^ these conditions increased due to living conditions

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Cancers

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

  • peak in cancer in 1900 due to smoking

  • advances in med tech can result in increase as diagnoses increase

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CVD

circulatory disease: circulation of blood: heart attack, angine, stroke, high bp

peak in 1960s -> mortality decreased

  • rates of CVD diagnosis are increasing, but mortaality is decreasing due to more med tech

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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 and surgical care.

  • safety laws brought in place have decreased this

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respiratory diseases

  • diseases which impact and affect lungs and other parts that are involved in breathing (pneumonia, asthma)

  • pneumonia and influenza, now replaced with COPD

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Define public health

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

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old public health

government actions that focused on changing the physical environment to prevent the spread of disease, such as providing safe water, sanitation and sewage disposal, improved nutrition, improved housing conditions and better work conditions

1900 to 1950

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Old public health policies and practices

  • the establishment of government funded water and sewage systems and better sanitation. (reduce diarrhoea, typhoid, cholera)

  • quarantine laws

  • better quality housing

  • improved nutrition

  • improved working conditions

establishment of public health campaigns

  • more hygienic birthing practices

  • antenatal and infant welfare services

discovery of vaccines eradicated many diseases

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biomedical approach

focus on physical or biological aspects of disease and illness. it is a medical model practiced by doctors and health professionals and is associated with the diagnosis, treatment and cure of disease.

1900 to current

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features of biomedical approach

  • focuses on individuals who are ill

  • Concerned with disease, disability, illness

  • Relies on services provided by professionals

  • Quick fix

  • Relies on tech to diagnose, treat and cure

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Strengths of the biomedical model

  • funding brings improvements in tech and research

  • many illnesses and conditions to be effectively treated

  • extends life expectancy

  • improves quality of life and HALE

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limitations of biomedical model

  • relies on professionals, med equipment so costly

  • doesn't always promote good HW (things can be repeated as it doesn't focus on the cause)

  • not every condition can be treated

  • expensive

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advancement in medical technology

  • X-rays: improved ability to diagnose conditions, improved treatment options

  • medicines: developed meds such as antibiotics to treat and reduce symptoms

  • CT scans: make diagnoses of diseases such as CVD more accurate, improves treatment

  • drugs such as blood thinning meds can reduce risk of heart attack

  • stethoscope: invention of this tool allowed health professionals to listen for fluid on lungs so infections can be detected

  • vaccines: vaccines reduced and eradicated many leading causes of death such as polio, TB, small pox

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social model of health/new public health

an approach to health that expands the traditional focus on individual behaviour change to one that considers the ways in which physical, sociocultural and political environments impact on health. Also referred to as the social model of health.

1970s to now

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Why was new public health introduced?

there was a concern towards the 1970s as mortality and morbidity of lifestyle disease increased.

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five key principles of social model of health (IAREA)

  • involves intersectoral collaboration: groups (public and private) working together to focus on improving health

  • acts to enable access to healthcare: ensuring that services are available and affordable, taking into consideration aspects such as culture, gender and ethnicity.

  • acts to reduce social inequalities: Reduce inequalities (eg: gender, SES, location, physical environment) in relation to health status and health services.

  • empowers individuals and communities: Provides individuals and the community with the resources they need to address factors that influence their HW, therefore individuals are able to participate in decision making about their HW. empower with knowledge

  • addresses the broader determinants (or factors) of health: Examining underlying factors that contribute to health and addressing those determinants. Includes social, economic and environmental factors. Broader discriminants include gender, culture, race, SES, location.

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examples of social model policies

  • unprocessed do not have GST tax - making healthier foods affordable, encouraging healthy eating

  • no hat no play - reduces exposure to UV, prevents skin cancer

  • banning smoking in public places - reduces risk of passive smoking and exposure to tobacco smoke -> asthma

  • speed limit laws - prevent road accidents

  • 120 hour learner permit driving

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Advantages of the social model of health

  • promotes good HW and assists in preventing disease

  • less expensive

  • focuses on vulnerable population groups

  • education can be passed on through generations

  • responsibility for HW is shared

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disadvantages of social model of health

  • Not every condition can be prevented

  • It does not promote the development of technology and medical knowledge

  • It does not address the health concerns of individuals

  • Health promotion messages may be ignored

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relationship between biomedical and social

both models work together

CVD: prevented by reducing risk factors (exercising and eating healthy) <- social. medical treatments and advancements help with diagnosis and treatment (bypass surgery, blood thinner meds)

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Define health promotion

the process of enabling individuals to increase control over and to improve their health

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overview of ottawa charter

  • It was developed from the social model of health by the WHO to reduce inequalities in health.

  • This Charter was introduced at a health conference in Ottawa, Canada 1986.

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3 strategies for health promotion

Enable, Mediate, Advocate

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enable

support people with information, opportunities, resources and skills that they need to make choices that support good health.

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mediate

actions by all levels of government, the health sector, non-government organisations, industry and the media to achieve good health.

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advocate

Favourable advocacy for health through political, economic, social, cultural, environmental, behavioural and biological factors. Promoting and supporting initiatives that promote health on behalf of the whole community.

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priority areas of ottawa charter

bad cats smell dead rats

  1. build health policy

  2. create supportive environments

  3. strengthen community action

  4. develop personal skills

  5. reorient health services

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build healthy public policy

  • Relates to decisions made by government and organisations in relation to healthcare policy, rules and regulations.

  • Include changes that will help to make healthier choices easier and contribute to healthier, safer, cleaner and more enjoyable services and environments.

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create supportive environments

  • a supportive environment is on that promotes HW by being safe, stimulating, satisfying and enjoyable

  • Build links between individuals and their environment

  • Promotes environments that encourage safe, stimulating and enjoyable living and working conditions.

  • Encourages individuals to support and help each other to make healthy choices

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strengthen community action

Focuses on building links between individuals and the community and centres around the community working together to achieve a common goal

  • gives community sense of ownership

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develop personal skills

  • Individuals need to gain life skills and information through health promotion and education.

  • Skills and knowledge should be gained and supported at home, school or work and used to make choices that will improve health

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Reorient health services - Ottawa charter

  • Groups to work together to support healthcare professionals in moving beyond biomedical services

  • Stronger emphasises on health promotion as opposed to focusing only on diagnosing and treating illness.

  • Healthcare services need to focus on their care on the needs of the whole person

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Funding the health care system

  • financial resources that are provided to keep the healthcare adequately staffed and resourced so they are able to provide a high level of care.

  • more ppl can receive treatment by reducing the amount they contribute

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sustainability in the healthcare system

sustainability: meeting needs of present without compromising ability of future generations to meet their needs.

relates to capacity of health system ti provide a workforce and infrastructure into the future and to be innovative and responsive to emerging needs through interventions such as research and monitoring

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Access to health care

an accessible health system is one that can provide all ppl with timely access to quality health services based on needs (not ability to pay and regardless of where they live)

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equity in health care system

health system must take into account the differences to make sure it is fair and equitable

differences include: social, economic, geographic, etc

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describe medicare

Medicare refers to Australia's universal health insurance scheme,

  • it provides subsidized health services for all Australians by fed government

established in 1984

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medicare safety net

Provides extra financial assistance for those that incur significant out of pocket costs for Medicare services

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What is covered by Medicare?

in hospital expenses:

  • accomodation and treatment for patient in public hospital

  • if patient chooses to be treated in private hospital or private patient in public hospital, govt will pay 75% of schedule fee

out of hospital expenses:

  • consultation fees for doctors

  • test such as x-rays

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What is not covered by Medicare?

  • cosmetic/unnecessary procedures

  • most costs associated with private hospital care

  • ambulance services

  • allied services; physio, psychologists,

  • most alternative medicines; acupuncture, remedial massage

  • health related aid; glasses, hearing aids

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advantages of medicare

  • choice of doctor for out fo hospital expenses

  • reciprocal agreement between countries

  • for all Australian citizens

  • covers test and examinations, doctors and specialist fee and some procedures

  • medicare safety net

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disadvantages of medicare

  • no choice of doctor for in hospital

  • waiting lists for many treatments

  • doesn't cover alternative therapies

  • often doesn't cover full amount

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How is Medicare funded?

  • medicare levy: 2% income tax payable by taxpayers

  • medicare levy surcharge: high income earners without private health are to pay an extra tax of 1-1.5%

  • general taxation

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how can medicare improve health status/HW ?

medicare provides health services to individuals at a subsidised rate by fed govt, this can affect health status by providing cheap access to health services to those who may not have been able to afford it meaning disease are caught early or prevented increasing life expectancy and decrease morbidity.

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how is funding reflected through medicare

Medicare funds part or all of the fees associated with health services, including doctor and specialist consultations, pathology tests and fee-free treatment in public hospitals.

  • funded through general taxation, medicare levy and surcharge

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how is sustainability reflected in medicare

  • determining which services will be subsidised through medicare, preserve funds for the necessary services. not all services are covered therefore more sustainable

  • medicare levy increased to assists in providing necessary funds to maintain health system

  • highly trained staff -> efficient health system

  • co payment and safety net amounts increased each year

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how is access reflected through medicare

  • provides access to all ppl of all backgrounds

  • medicare provides funding for phone/vid consultations for those out of major cities

  • those who require treatment urgently/more urgent get it first hence waiting times

  • ppl can choose out of doctor hospital therefore make the right choice for them.

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how is equity reflected through medicare

  • ppl who access services more are given additional financial support (safety net)

  • mental health treatments (therapy sessions) covered by medicare for those who have mental health disorders

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advantages and disadvantages of PBS

advantages:

  • access subsidised medication

  • concessional co payment

  • safety net

disadvantages:

  • not all medication listed

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describe the PBS

  • pharmaceutical benefits scheme

  • administered by fed govt which subsidises essential medication to people with prescription

  • covers more than 5000 brands

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How can the PBS improve the health status/HW of Australian citizens?

Australians who require essential medications to treat/cure chronic conditions such as asthma can obtain medicines due to reduced cost, prolonging life expectancy

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how is funding reflected through PBS

funded by federal govt

essential medications are subsidised through PBS providing treatment fo many conditions

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how is sustainability reflected through PBS

  • review medicines available continually therefore those that are most needed are available. not sustainable to fund all medications

  • fed govt body verifies effectiveness of medications, improved treatment, less costly treatment in future, less reliance on healthcare

  • cost of copayment increases each year

  • PBS is biomedical and social - treat and prevent, reduce need for costly treatment

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how is access reflected through PBS

  • all citizens and permanent residents are entitled to access subsidised medication through PBS

  • concessional co payments promote access to essential meds for low income earners

  • available to all AUS regardless of income, culture, location

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how is equity reflected through PBS

  • PBS safety net provides further assistance to those who require essential medications

  • concessional co payment provides assistance to low income/unemploymed ppl

  • many indigenous can qualify for reduced PBS co payment amounts under closing the gap iniative.

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NDIS

  • national disability insurance scheme

  • funded by federal, state, territory governments

  • provides services and support for people with permanent, significant disabilities and their family/carers

  • aims to help individuals under 65years with a permanent, significant disability to live an ordinary life

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key assistance areas of NDIS (x4)

  1. access to mainstream services and supports (education, healthcare, public housing, aged care)

  2. access to community services and supports (sport clubs, libraries, community groups)

  3. maintain informal support arrangements (unpaid help from family and friends)

  4. receive reasonable and necessary funded supports (financial support and funding for assistive technology)

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how can NDIS improve HW/health status ?

The NDIS provides support to people suffering from a permanent or significant disability and assists them in living an 'ordinary life', The NDIS provides assistance to ppl to access to community services, which can improve spiritual HW as they may feel as they belong

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how is funding reflected in NDIS

  • funded by fed and state/territory govts

  • NDIS provides funding for a range of resources (assistive tech)

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how is sustainability reflected through NDIS

  • each person receives individualised support, therefore only neccessary funds are spent

  • NDIS aims to provide support which will assist in improving a persons lifetime, making it sustainable as it is lifelong

  • allows ppl to go workforce -> earn and pay tax

  • ppl with disability are encouraged to live an 'ordinary' life, ongoing reliance on healthcare is reduced

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how is access reflected through NDIS

  • rolled out in every region of AUS, those in major cities can access it

  • NDIS improves access to health services and other mainstream services for ppl with disability

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how is equity reflected through NDIS

  • individualised support ensures that those with more significant needs receive more assistance. those that have more sever disabilities receive care and support they need

  • focus is those who experience disability and enables ppl to access mainstream services such as healthcare so they can receive treatment for common conditions

  • NDIS promotes equity as it enables eligible people to work -> sense of purpose (spiritual HW)

  • those who need NDIS dont need to pay more towards funding that those who dont. NDIS is not income tested

  • NDIS targets ppl with disability and have extra needs such as the need for assistive tech. promote social HW

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describe private health insurance

  • optional for of health insurance in addition to medicare

  • consumers must may a premium in return for payment towards health related costs not covered by medicare

two main components:

  1. private hospital care

  2. extra's cover (physio, dentists)

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advantages of private health insurance

  • Access to private hospital care

  • Choice of doctor in private and public hospital

  • Shorter waiting times for some procedures

  • Other allied services are covered depending on premium paid

  • Helps to keep the costs of operating Medicare under control

  • High income earners with private health insurance do not have to pay the additional tax, called the Medicare levy surcharge

  • Government rebate for eligible policy holders 'Lifetime Health Cover' incentive

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disadvantages of private health insurance

  • Costly in terms of the premiums that have to be paid

  • Sometimes have a 'gap', which means the insurance doesn't cover the whole fee and the individual must pay the difference

  • Qualifying periods apply for some conditions (such as pregnancy)

  • Policies can be complex to understand and so create confusion for the average person

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private health incentives

  1. private health insurance rebate

  2. lifetime health cover

  3. medicare levy surcharge

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Private health insurance rebate

  • income tested rebate(refund) provided to private health holders on premiums paid.

  • rebate varies from 9% - 27% based on income

INCREASES AFFORDABILITY OF PRIVATE HEALTH INSURANCE

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Lifetime health cover

People who take up private insurance after the age of 31 pay an extra 2 per cent on their premiums for every year they are over the age of 30.

ENCOURAGES YOUNGER PPL TO TAKE PHI AND KEEP FOR LIFE

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Medicare levy surcharge

an additional 1-1.5 per cent tax on high income earners who do not have private health insurance

ENCOURAGES HIGH INCOME EARNERS TO TAKE OUT PHI

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how can private health insurance improve health status/HW ?

those that take out PHI have greater level of cover and choice in their medical treatment. therefore, they may be able to diagnose and treat health conditions earlier, which could result in a higher life expectancy.

This also helps those in the public sector as there is less pressure placed on public health system therefore decreasing wait times for surgery which can decrease mortality and morbidity.

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how is funding reflected through PHI

  • PHI mainly funded through individual

  • PHI provides most of the funding for private hospitals

  • fed govt funds the PHI rebate; more affordable

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how is sustainability reflected through PHI

  • PHI takes pressure off medicare making the health system more sustainable

  • incentive schemes put in place by govt assist in maximising funding for private system . reduces strain on public system

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how is access reflected in PHI

  • PHI provides access to other services not covered by medicare

  • PHI reduces waiting times for elective surgery, therefore those in public system can access it quicker

  • incentive schemes make PHI more affordable therefore more ppl can access it

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how is equity reflected through PHI

  • low income earners receive more rebate

  • those aged 65+ receive greater rebate and lifetime cover is waived if they have PHI

  • medicare levy surcharge is only applicable for high income earners

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Why is smoking targeted?

  • it is a preventable risk factor

  • a leading cause of preventable, premature death

  • smokings costs a significant amount in australia

  • affects vulnerable population groups

  • exposure to environmental tobacco smoke causes disease and premature death to those who dont smoke

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who is at risk of smoking?

disadvantaged populations

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smoking related laws

  1. Smoking was banned at areas commonly used by children and young people for recreational sporting activities.

  2. It is an offence to smoke in a vehicle where there is a person under the age of 18 present. Ban applies regardless of car moving, windows open, etc. (since Jan 2010)

  3. Ban on smoking in government school grounds became effective (July 2009)

  4. Smoking was banned in covered areas of train station platforms, tram stops, bus stops. (2006)

  5. bans complement those implemented in December 2012, which prohibit smoking at all Victorian patrolled beaches.v

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how does the quit campaign address smoking

  • anti smoking health promotion campaign

  • joint venture between vic govt, Vichealth, health foundation, cancer council

PROGRAM INITIATIVES:

  • Mass media campaigns

  • community support

  • quitline - phone/online counselling

  • quit coach

  • quitbuddy app

  • i can quit calculator

  • quit txt

  • online resources

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QUIT- build healthy public policy

  • provide research and advice to government to implement policies and laws relating to banning smoking in public places, tobacco tax, tobacco packaging, tobacco advertising

they do not implement laws

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QUIT create supportive environments

  • quitline is staffed with highly trained professionals to provide support

  • aboriginal quitline creates a culturally safe and supportive environment by using aboriginal specialists with additional training in cultural sensitivity

  • quit program provides personalised counselling services

  • online support through the website

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QUIT- strengthen community action

  • quit program developing specific campaigns working with specific population groups; aboriginal Quitline enhancement project

  • a joint venture between organisations

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QUIT - develop personal skills

  • health warnings on cigarette packages and mass advertising fact sheets on the quit website

  • tips on the website

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QUIT - Reorient health services

  • government and non government investment in anti smoking policies to prevent smoking → health services are working towards ways to prevent people from engaging in smoking behaviours

  • quit provides a free training program for health professionals which provide health professionals with knowledge and skills relating to assisting smokers to quit.

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effectiveness of QUIT (HW and health status)

QUIT is helping to improve the health promotion of populations health as it helps individuals to stop smoking, not only reducing there risk of Lung Cancer and other forms of cancer, but reduces the rate of Second Hand smoke in the air, reducing the risk of others suffering from Asthma. In this, The physical dimension of health and wellbeing is achieved as individuals are able to have a healthier functioning respiratory system, reducing the rate of morbidity and Mortality in Populations.

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effectiveness of quit in relation to HW (3 marks)

the quit campaign has been effective in promoting HW in australia specifically physical HW with. a reduction of smoking related disease. This is due to quit leading to a reduction in the percent fo the population that smoke over the last decade, causing a reduction in the total burden of disease caused by smoking related diseases and conditions.

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effectiveness of QUIT (action areas)

there have been many improvements since quit was established. The Quit campaign produces factsheets which can be found on their website as well as creating graphic images to educate individuals about the impacts of smoking which enable individuals to develop personal skills. Additionally, the quit campaign creates supportive environments as it has a support phone line which allows individuals to communicate with professionals to assist with their quitting journey. Furthermore, the Quit campaign also has an aboriginal quit line which can make it more appropriate and make it more accessible for vulnerable population groups such as the indigenous community. In addition, Quit provides government bodies with advice to build public policies which is an example of building healthy public policy. Overall, Quit includes all aspects of the Ottawa Charter and has proved to be extremely effective as it provides education, it is culturally appropriate and there it has been successful in helping many help quitting.

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name of indigenous initiative

fitzroy stars football club

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describe initiative

  • A football club, based in Melbourne, which aims to promote a healthy lifestyle

  • Aims to provide opportunities and open pathways to employment and education

  • Aims to form strong connections between indigenous and nin indigenous communities.

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how does the FSFC improve HW of indigenous ppl

physical HW: encourages and builds healthy habits such as fitness, nutrition -> maintain healthy body weight

social HW: enables people to spend time together developing meaningful relationships. aims to foster reconcilliation and can improve social HW

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FSFC and action areas

strengthen community action:

  • vichealth, oxfam and aboriginal advancement league worked together to reactivate the program

  • families and community memebrs work together which keeps club running

create supportive environments:

  • creates supportive social and physical environment as it provides a saafe place to participate in sport and socialise. bot build links between individual and environment and encourage healthy behaviours.

develop personal skills:

  • educates ppl with skills that relate to nutrition and employment. enables ppl to be more health literate. employment skills enable individuals to gain a job and earn an income

reorient health services:

  • use health professionals to present sessions on a weekly basis on importance of preventative healthcare such as quitting smoking and receiving regular health checks

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evaluate the indigenous initiative criteria x7

  • is the program culturally approapriate?

  • feedback

  • have improvements already occurred

  • are ppl and communities being empowered

  • education is provided

  • a specific need of the group is being targeted

  • is the program receiving adequate funding

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FSFC - is program culturally approapriate

  • based in aboriginal community

  • many indigenous ppl are able to volunteer

  • inclusiv eof culture

  • health professionals arent indigenous, having indigenous staff may make it more culturally approapriate.

  • is effective but could be improved

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FSFC - education is provided

  • forms of education is the program include skills learnt to maintain nutrition and skills needed to seek employment

  • professionals present weekly sessions which relate to preventative healthcare and its importance ^^ info helps many improve their health

  • some info that is provided may be ignored or individuals may not pay attention to it

overall is effective, but info could be portrayed multiple ways to improve

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aboriginal road to good health

  • type 2 diabetes six week prevention program

  • work with indigenous communities and aims to promote healthy lifestyles including how to prevent type 2 diseases

  • program is free

  • run by indigenous health workers

educates participants on:

  • how different foods affect HW

  • what food is food, cheap and easy to make

  • how to spend money wisely

  • how to maintain a healthy weight

  • what to look for on a food label

  • how to choose healthy foods

  • how to prevent disease

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how does the aboriginal road to good health improve HW

physical HW: • Educating Indigenous people about what foods have a negative impact on your health, making them less likely to consume these foods and more likely to consume nutritious foods. As a result their body is more likely to function optimally and free of disease, which can positively impact physical health and wellbeing.

social HW: as the program is free, ppl are able to bring other ppl which can enhance their bonding and help to maintain a meaningful relationship which improves social HW.

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