Health Priorities In Australia

1. Investigate the following Critical Questions: How are priority issues for Australia’s health identified? What are the priority issues for improving Australia’s health? What role do health care facilities and services play in achieving better health for all Australians? What actions are needed to address Australia’s health priorities? Health Priorities In Australia

2. How are priority issues for Australia’s health identified? Critical Question Content: • measuring health status -role of epidemiology -measures of epidemiology (mortality, infant mortality, morbidity, life expectancy) • 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

3. How are priority issues for Australia’s health identified? Measuring Health Status The Role of Epidemiology Epidemiology is used by governments and health related organisations to obtain a picture of the health status of a population, to identify the patterns of health and disease, and analyse how health services and facilities are being used. What does Epidemiology tell us? • Incidenceof morbidity and mortality (how many new cases are occurring). • Prevalenceof morbidity and mortality (how many existing cases are occurring). • The extent of the problem. • Factors that are directly linked to morbidity and mortality. What doesn’t epidemiology tell us? • Statistical information tells us little about the severity of illnesses and how this impacts upon a person’s quality of life. It does not identify peoples’ level of distress, impairment, disability or handicap. • Epidemiology data is sometimes lacking on certain health issues for which gathering detailed information is difficult e.g. mental illness. • It doesn’t address the reasons why health inequities exist. • Information is gathered on incidence of disease and death and related risk factors but often neglects other factors such as cultural and economic factors.

4. How are priority issues for Australia’s health identified? Measuring Health Status How do we use epidemiology to improve the health of Australians? • To identify health inequalities between sub-populations. • To establish priorities, enabling efficient use of funds. • To develop preventative programs and monitor health care services. • To monitor and evaluate programs. Who uses Epidemiological measures? • Epidemiology provides valuable scientific information about disease and associated risk factors. It has been useful in providing various health related organisations and associations in providing a basis for investigating issues such as the impact of social, cultural and economic factors that support health or cause disease. As a result, epidemiological data can assist health organisations in establishing a plan of action to address any relevant health concerns within a population.

5. How are priority issues for Australia’s health identified? Measuring Health Status Extension Information Recently health authorities have acknowledged the need to adopt a measurement approach that focuses on the health of populations more than the disease of the individuals. To address inequalities in health we must go beyond the disease and its risk factors to the environmental and social frameworks in which individuals live. The epidemiological process must incorporate a social perspective to identify and combat the leading causes of sickness and death in Australia, and to reduce inequalities in health. To reduce health inequalities, factors such as poor access to health services, low socioeconomic status, attitudes to illness and health promotion, limited education about self-care and health practices must be addressed.

6. How are priority issues for Australia’s health identified? Measuring Health Status Measures of Epidemiology There are four measures of epidemiology: mortality, infantmortality, morbidity and life expectancy. Mortality Current trends in mortality in the general population of Australia: • Australians who died of cardiovascular disease made up around one-third of all deaths in 2007. • Deaths from heart attacks have decreased. • Deaths from dementia and Alzheimer’s have increased. • Deaths from cancer have increased and represent nearly one-third of all deaths. • Lung cancer is the most prevailing cancer causing death. • The top three leading causes of death are 1) Heart disease, 2) Stroke and 3) Lung cancer

7. How are priority issues for Australia’s health identified? Measuring Health Status Similarities in death rates between males and females include: • A general decrease in death rates associated with infectious and parasitic disease, blood diseases, nervous system diseases, circulatory diseases, respiratory diseases, digestive diseases, skin diseases, musculoskeletal diseases, genitourinary diseases, perinatal diseases, congenital diseases, ill-defined conditions and injury and poisoning. • Increased death rates associated with mental disorders. • Death rates associated with motor vehicle accidents have decreased. Differences in death rates between males and females include: • In general, death rates for males is considerably higher than that of females. • Death rates associated with motor vehicle accidents is considerably higher in males than females. • Deaths associated with COPD and lung cancer has decreased in males but has increased in females. • Leading cause of deaths for males is Cardiovascular disease, followed by lung cancer and then stroke. • Cardiovascular disease, followed by dementia and Alzheimer's disease and then lung cancer.

8. How are priority issues for Australia’s health identified? Measuring Health Status International comparisons of mortality include: Australia V’s USA • The United States of America have a considerably higher rate of deaths resulting from all causes for both females and males in comparison to Australia. • Reasons may include: higher rates of violent crime, increased dietary risk factors, higher obesity levels, sedentary lifestyle, climatic considerations, poorer access to health care for lower socioeconomic groups. Australia V’s all other OECD Countries: • Australia has the third lowest death rates for males and the second lowest death rate for females in comparison to all other OECD countries. • Notably, the gap between the mortality rates for males and females is smaller than all except Iceland.

9. How are priority issues for Australia’s health identified? Measuring Health Status Infant Mortality • This measure is considered to be the most important indicator of the health status of a nation and can also predict adult life expectancy. • The infant mortality rate in Australia has declined steadily over the past few decades. This trend can be attributed to: -improved medical diagnosis and treatment of illness - improved public sanitation - health education - improved support services for parents and newborn babies and children. Extension Information • Despite the continued decline, infant mortality still accounts for two-thirds of all deaths of children aged 0-14 years. • Additionally, the infant mortality rate is higher among indigenous infants. Most of these deaths can be attributed to congenital malformations.

10. How are priority issues for Australia’s health identified? Measuring Health Status Morbidity Information about the incidence and prevalence of conditions in the total population gives us a broader perspective on the nations' health than that provided by mortality statistics.

11. How are priority issues for Australia’s health identified? Measuring Health Status In reference to the previous table: The disease that had a significant burden on health but caused a relatively low fatal component is: • Mental disorders - apart from suicide, many mental conditions do not cause death, rather they impact the quality of life. Reasons why mental disorders may cause a low incidence of death may be due to medical intervention as it can be very effective in treating mental illness. Conclusions that one can draw from the table of statistics on infectious disease are: • While infectious diseases are not prevalent in modern Australia, those infectious diseases that are still present have a significant fatal component e.g. HIV/AIDS, Hepatitis. The ability to effectively treat and cure these conditions has not been adequately achieved, thus if a person is infected then death as a result of the infectious disease is likely.

12. How are priority issues for Australia’s health identified? Measuring Health Status Extension Information Morbidity measures and indicators include: • Hospital use – provide some measure of the rates of illness and accidents in a community. This is identified through records of the cause and number of administrations. • Doctor visits and medicare statistics – provides some measure of the rates of illness and accidents in a community. This is identified through records of reasons for consultation, rates of consultation and also days absent from school or work. • Health surveys and reports – these can provide a range of key health indicators and bring together an extensive range of health information. • Disability and handicap – the incidence of disease or accident can lead to impairment, disability and handicap. This can lead to a reduced ability to function normally, earn an income and live a healthy life. Information can be obtained regarding disability and handicap to measure morbidity through increased doctor consultations are a result of the impairment and number of people on a disability pension.

13. How are priority issues for Australia’s health identified? Measuring Health Status Life Expectancy • At birth, life expectancy is a common indicator of health status and is often used as evidence in statements about the improved health of Australians. • The table below outlines life expectancy rates for Australians throughout a range of periods of time.

14. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Identifying priority health issues allows governments and administrators to make decisions about allocating health resources to have the greatest impact on the health of Australians. The principles underpinning the identification of priority health issues include: • Social justice principles • Priority population groups • Prevalence of condition • Potential for prevention and early intervention • Costs to the individual and community

15. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Social Justice Principles • Social justice means that the rights of all people in our community are considered in a fair and equitable manner. While equal opportunity targets everyone in the community, social justice targets the marginalised and disadvantaged groups of people in our society. Public policies should ensure that all people have equal access to health care services. People living in isolated communities should have the same access to clean water and sanitation as a person living in an urban area. People of a low socioeconomic background should receive the same quality health services that a person in a higher socioeconomic income receives. Information designed to educate the community must be provided in languages that the community can understand. • A focus on social justice aims to reduce the level of health inequalities in Australia. The four principles of social justice are equity, access, participation and rights.

16. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Priority Population Groups Within the identified priority health issues for Australian’s certain groups in our population have been identified as at increased risk of developing these diseases or health conditions. By identifying at risk population groups, government health care expenditure and health promotion initiatives can be directed towards these groups to attempt to reduce the prevalence of the disease. Epidemiological information reveals that the priority population groups within Australia include: • Aboriginal and Torres Strait Islander people • Socioeconomically disadvantaged people • People in rural and remote areas • Overseas-born people • The elderly • People with disabilities

17. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Prevalence of Condition Epidemiological data provide a guiding path for determining the priority areas for Australia’s health. Epidemiology also provides information on the incidence of mortality and morbidity in the Australian population and thus, to a certain degree, on the health status of the population. It reveals the prevalence of disease and illness, and helps us to identify risk factors. These risk factors can then indicate the potential for change in a health area. High prevalence rates of a disease indicate the health and economic burden that the disease or condition places on the community. Potential for Prevention and Early Intervention The majority of disease and illness suffered by Australians result from poor lifestyle behaviours. It is difficult to change behaviours as they often reflect the environmental situation in which an individual lives. For change to occur, we must address both individual behaviours and environmental determinants. Most of the chronic diseases, injuries and mental health problems have social and individual determinants that can be modified so prevention and early intervention may lead to improved health status.

18. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Cost to the Individual and Community Disease and illness place a great deal of economic and health burden on an individual and community. It can be measured in terms of financial loss, loss of productivity, diminished quality of life and emotional stress. The impact of disease in economic terms can be explained by the following: • Direct costs include money spent on diagnosing, treating and caring for the sick plus the money spent on prevention. • Indirect costs are the value of the output lost when people become too ill to work or die prematurely. E.g. Cost of foregone earnings, absenteeism and the retraining of replacement workers.

19. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Extension Work: Social Justice Principles Examine the poster ‘CLOSE THE GAP’ and discuss the campaign. Your response should be no longer than a page and it should address: How the campaign aims to address social justice principles. How the campaign is focusing on a health priority issue to improve Australia’s health.

20. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Extension Work: Potential for prevention and early intervention ‘BreastScreen Australia program still yielding results’ Click on the link BreastScreen Australia read through the information and answer the following questions: • Describe the trend for breast cancer mortality rates between 1990 and 2005. • How often is breast cancer screening recommended? • Explain how breast screening acts as an early intervention program to reduce the prevalence of breast cancer in Australia.

21. How are priority issues for Australia’s health identified? Identifying Priority Health Issues Extension Work: Prevention and early intervention Choose one example of a chronic disease or illness: for example cancer, cardiovascular disease, diabetes, asthma or depression. • For the chronic disease or illness that you selected, is there potential for early intervention and prevention? Explain. • Do you think that your selected disease or illness should be a priority for Australia’s health? Explain your answer. • How do the trends in the incidence and prevalence of cardiovascular disease support the idea that it is a disease that benefits from early intervention and prevention strategies?

22. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Extension Work: Cost to the individual and the community Costs of Cardiovascular Disease Click on the link Cardiovascular diseases are Australia's costliest read through the information and answer the following questions: • What was the direct health care expenditure on cardiovascular disease in 2004-05? • Was the cost of treating and managing cardiovascular disease higher in males or in females? • On which age group in the population is health care spending highest?

23. What are the priority issues for improving Australia’s health?

24. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Unfortunately, the generally improved health status for Australians is not shared Australian-wide. There are some fundamental differences in the level of health of particular groups in our generally affluent society. These differences exist in terms of: • The unequal distribution of some illnesses or conditions throughout the population (across different cultures, geographic locations, ages and genders). • Health inequities; that is the unjust impact on the health status of some groups due to social, economic, environmental and cultural factors, such as income, education, availability of transport and access to health services Major indicators such as the incidence and prevalence of disease and different rates of sickness, hospitalisation and death, point to areas in which inequities exist.

25. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Groups experiencing health inequities in Australia include: • Aboriginal and Torres Strait Islander peoples • socioeconomically disadvantaged people • people in rural and remote areas • overseas born people • the elderly • people with disabilities.

26. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal Health

27. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal Health

28. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal Health Refer to page 21 of your work booklet and complete the following activity: Research and analyse Aboriginal and Torres Strait Islander peoples and ONE other population group experiencing health inequities from the list above by investigating: • The nature and extent of the health inequities • The sociocultural, socioeconomic and environmental determinants • The roles of individuals, communities and governments in addressing the health inequities You will find the information at: Australia's Health 2010 Download the ‘Australia’s Health 2010’ document

29. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal Health Nature and Extent of Health Inequalities Summarised: • Lower life expectancy rates at birth for both males and females. Life expectancy for indigenous people is 17 years lower than the life expectancy of non-indigenous people. • Higher mortality rates at all ages compared with the rates for non-indigenous people. In the four states/territories with the largest indigenous populations, 70% of indigenous people who died were younger than 65 years, compared with the 21% of non-indigenous people who died younger than 65 years. • Higher mortality rates from preventable causes compared with Australia as a whole. Death rates were almost three times as high for indigenous males and females as for the non-indigenous population.

30. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal Health • High death rates from diseases of the circulatory system (including heart disease and stroke), injuries (including motor vehicle crashes, homicide and suicide), respiratory disease (including pneumonia), cancer, endocrine disorders (specifically diabetes and digestive disorders. • An infant mortality rate that is three times higher than the national average. • Trends in the health status of Aboriginal and Torres Strait Islander Peoples include: a decline in death rates from all causes for indigenous males (reflecting a similar reduction for all Australian males) and a similar decline in death rates for indigenous females.

31. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Extension Work: Age distribution of deaths among indigenous and non-indigenous people 2001-2005 In figure 3.5 identify the age group that experiences the highest proportion of deaths among: a) indigenous people and b) non-indigenous people. Compare the proportions of deaths of indigenous and non-indigenous Australians in the 0-24 age group. Suggest reasons for the difference. Propose reasons for the higher proportion of deaths among indigenous people in the 25-44 years age group compared with the same age group among non-indigenous people.

32. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Extension Work: Aboriginal Health Inequalities Click on the link Indigenous Infant Mortality Rates read the media release and complete the following questions: • Identify areas in which there has been an improvement in the health and welfare of indigenous people. • Suggest two reasons for a declining trend in mortality rates among indigenous Australians. • Summarise the health inequities that exist in the indigenous population.

33. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Extension Work: Treating Kidney Disease in Alice Springs Click on the link Kidney Disease read the media release article and complete the following questions: • What is the purpose of the Alice Springs ‘Purple House’? • What priority health issue does this facility aim to address? • What does the article suggest is the extent of advanced kidney disease in Alice Springs? • Identify the barriers that have prevented indigenous people of the Pintupi communities from successfully undertaking dialysis treatment in the past. • Explain why this health service is succeeding where others have failed. • Identify the roles of the various people and organisations in supporting and operating this health service.

34. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal Health The sociocultural, socioeconomic and environmental determinants in detail To support the second part of your response complete the following instructions. Click on the link Australia's Health 2010 and then go to: • Page 242 for determinants and risk factors • Page 68 for Environmental Determinants overview • Page 78 for Socioeconomic Determinants overview • Page 80 for Sociocultural Determinants overview (knowledge, attitudes and beliefs)

35. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities Aboriginal and Torres Strait Islander Peoples The roles of individuals, communities and governments in addressing Aboriginal and Torres Strait Islander People’s health.

36. What are the priority issues for improving Australia’s health?Groups Experiencing Health Inequities People in Rural and Remote Areas

37. Terminology 1 Prevalence is the number of cases of disease that exists in a defined population at a point in time. Incidence is the number of new cases of disease occurring in a defined population over a period of time. Impairment is a loss or abnormality of body structure or of a physiological or psychological function. Mortality refers to the number of deaths in a given population from a particular cause and/or over a period of time. Infant Mortality refers to the number of infant deaths in the first year of life per 1000 live births. Morbidity is the incidence or level of illness, disease or injury in a given population. Life Expectancy is the length of time a person can expect to live. It refers to the average number of years of life remaining to a person at a particular age, based on current death rates. COPD refers to Chronic Obstructive Pulmonary Disease. It is a long-term lung disease that reduces airflow in and out of the lungs, making it difficult to breathe. Smoking is the major cause of COPD. To learn more visit: http://www.mhcs.health.nsw.gov.au/publication_pdfs/8095/AHS-8095-ENG.pdf OECD stands for Organization for Economic Co-operation and Development. It is an organization for developed countries that accept the principles of representative democracy and a free market economy. To learn more visit: http://www.mapsofworld.com/oecd-member-countries.htm Congenital Malformations are a physical defect present in a baby at birth that can involve many different parts of the body, including the brain, heart, lungs, liver, bones, and intestinal tract. Congenital malformation can be genetic, it can result from exposure of the foetus to a malforming agent (such as alcohol), or it can be of unknown origin. Return to previous slide

38. Terminology 2 Handicap refers to a perceived social disadvantage that results from an impairment or disability Equity is concerned with creating equal opportunities for health and with bringing health differentials down to the lowest levels possible. Access is concerned with providing all individuals with the same level of access to health care opportunities in Australia. Participation is concerned with ensuring that individuals are given the opportunity to be involved in decisions being made about health and health care in Austrlia. Rights is concerned with ensuring that the rights of all people in our community are considered in a fair and equitable manner. Priority Health Issues refers to high levels of preventable chronic disease, injury and mental health problems in Australia. These conditions can be further identified as: • cardiovascular disease (CVD) • cancer (skin, breast, lung) • diabetes • respiratory disease • injury • mental health problems and illnesses Return to previous slide

39. Terminology 3 Risk Factors refers to specific lifestyle behaviours that contribute to the development of a health condition. Inequities are unfair differences in levels of health status between groups in a society. Sociocultural determinants of health include the way we are influenced by our family, peers, media, religion and culture. Socioeconomic determinants of health include employment, education and income level. Environmental determinants of health include geographical location, and access to health services and technology. Return to previous slide