PDH/PE

1. PDH/PE Personal Development, Health and Physical Education Core 1:Health Priorities in Australia

2. Health priorities in Australia • How are priority areas for Australia health identified? • Measuring health status Health status is a term used to describe the state of health of an individual, the community or the population of a region of country, measured against an identifiable standard.

3. Role of epidemiology • Epidemiology is the study of the patterns and causes of health and disease in populations, and the applications of this study to improve health. • Historically referred to as the study of ‘epidemics’ of infectious disease. • The disadvantage of using epidemiology as a measure of health status is that the statistics do not tell us the quality of life of the individual that is being represented.

4. Measures of epidemiology • Different measures of epidemiology are: Mortality, or death rates and the causes and distribution of these deaths over the population by age, gender, population group, or geographical location. • Infant mortality or the rate of death of infants per number of live births. • Morbidity or the rates of illness and diseases, and their distribution.

5. Measures of epidemiology • Life expectancy or the number of years an individual or population group can expect to live after birth, according to gender or population group. • Statistics on the rates of death, sickness and disease are compiled by the Australian Bureau of Statistics ABS. This information is used by Commonwealth, state and community health departments and organisations to determine the distribution of funds for health care. Statistical data can be collected for various groups in the population as well as for the population as a whole.

6. What can epidemiology tell us? • Through the collection of data, epidemiology studies can identify specific factors relating to health. • The disadvantage of epidemiology is that statistics do not tell us the quality of life that the individual represented

7. Who uses these measures? • Epidemiological data and information about population health can be used by a variety of people agencies as evidence to improve their decision making, planning and implementation of health programs and strategies.

8. Who uses these measures? • Department of health and Ageing use mortality, disease prevalence and cancer screening to inform the development of policies like the National Chronic Disease Strategy. • NSW Health use data on health status, health expenditure, equity, demographic changes, community expectations and health workforce shortages to identify challenges in its State Health Plan. • NSW Department of Education use data collected about sports injuries to develop safe guidelines for the implementation of sport in schools

9. Who uses these measures? • Hospitals use data about the application of health services, incidence of diseases and the health workforce to plan staff training and recruitment in order to meet community needs • Pharmaceutical companies use data about life expectancy, application of medicines and attitudes to health to develop and market pharmaceutical products • Doctors use data about health determinants, disease monitoring and groups at risk to inform decisions about preventive actions, diagnosis and prescription

10. Current trends - Mortality • Australia’s population has increased 11.8% from 1997 – 2006. Population of people aged 65 years and over has increased from 12.1% to 13% • The standardised death rate in 2006 of 6 deaths per 1000 in the standard population was the lowest on record, steady decline from 7.6 deaths per 1000 in 1997. • Males accounted for 51.3% of deaths in 2006, down from 52.4% 1997. • Females accounted for 48.7% of deaths in 2006, an increase from 47.6% in 1997. • Ratio of male deaths per 100 female deaths has decreased from 110 in 1997 to 105.2 in 2006.

11. Leading causes of deaths • For males, coronary heart disease CHD, lung cancer cerebrovascular disease STROKE caused 32.4% of deaths in 2005. • Other hearth diseases, prostate cancer and chronic obstructive pulmonary disorder COPD were the next most common causes. • For females, coronary heart disease, cerebrovascular and other heart diseases caused 32.5% of all deaths.

12. Leading causes of deaths • Dementia, breast and lung cancer were the next most common causes • Cardiovascular diseases CVD were the number one cause of death in 2005, totalling 35% of all deaths. • Females were 10% more likely to suffer from a CVD than males. • Death rates for coronary heart disease and stroke have declined consistently since 1960

13. Cancers • Cancer 30% of all deaths in Australia in 2005. • Lung, prostate and colorectal cancers were the leading causes of death for males • Lung, breast and colorectal cancers were the leading causes of death for females • Make deaths from cancer occurred at a rate of 1.3 for every female death

14. Diabetes • New diabetes cases are increasing however diabetes related deaths have declined slightly to 2.7% of all deaths in 2005 • Diabetes was named as an associated cause in 6.4% of all deaths

15. Mental illness • Mental or behavioural disorders accounted for 2.7 deaths per 100,000 persons (excluding suicide and dementia) and had decreased significantly since the 1990’s • Females were more likely to suffer death as a result from mental or behavioural disorder while males were a result from psychoactive substance abuse

16. Injury • Suicides accounted for 1/5 deaths by injury in 2005 • Motor accidents and falls each accounted for a quarter of all injury related deaths • Males were more likely to die from injury than females at a ratio of 1.7 male deaths for every female death • Falls were the only injury category that female death rates were higher than males death rates

17. Morbidity • Morbidity data describes sickness and illness within a population as opposed to mortality data that describes causes of death. • Illness and injury cause much suffering, disability, premature mortality and impose significant costs on society in terms of health system use and lost productivity in the workplace

18. Major causes of illness • Cancer at 19% is the leading cause of disease burden followed by cardiovascular disease at 18% then mental disorders at 13% • Heart attack rates are falling and survival from attacks is improving Diabetes prevalence has doubled in the last 2 decades • Kidney disease has recorded an increase with cases of end-stage kidney disease tripling in the last 25 years High levels of preventable chronic disease, injury and mental health problems • Complete questions

19. High levels of preventable chronic disease, injury and mental health problems • Cardiovascular disease CVD All diseases involving the heart Coronary heart disease, stroke, vascular disease • Trends Leading cause of death in Australia Death rates declining due to prevention Stroke is leading cause of death for both males and females

20. High levels of preventable chronic disease, injury and mental health problems • Positive lifestyle factors and improved disease management have contributed to an annual decline in death rates since 1970 • People aged over 65 are more likely to suffer from CVD • Risk factors Smoking, physical inactivity, overweight or obesity, high fat diet, alcohol abuse, high blood pressure and cholesterol, poor nutrition and diabetes • Groups at risk Older people, indigenous people, socioeconomically disadvantaged people and rural and remote Australians

21. Cancer • Cancer can arise in any organ or body tissue • Occurs when normal cell division in the body becomes uncontrolled and unstoppable. The cells then spread throughout the body producing malignancy • Skin cancer – Melanoma Most dangerous skin cancer Spreads throughout the body • Trends Australia has largest level of skin cancer in the world Rates are rising, more males affected than females

22. Cancer • Risk factors Exposure to suns rays, solariums and attitude “healthy tan” • Protective factors Reduce exposure to suns rays, wear protective clothing e.g. hat, long sleeve shirts and sunscreen, check skin regularly for changes in moles and freckles , take care with solarium use • Groups at risk Children, adolescents, young adults, outdoor workers

23. Lung cancer • Is a malignancy in the lungs • Trends Is the major cause of cancer deaths in Australia Male deaths are higher Female death rates have risen gradually • Risk factors Smoking is the greatest factor, exposure to asbestos and chemicals

24. Lung cancer • Protective factors Not smoking, quitting smoking, being aware of symptoms e.g. cough not getting better and early intervention to prevent children becoming future smokers • Groups at risk Smokers, passive smokers, older people and indigenous people

25. Breast cancer • Cancer cells grow in the breast and spread to other parts of the body • Trends Have the highest rates for women Males are also diagnosed with breast cancer Survival rates increasing due to early detection

26. Breast cancer • Risk factors High fat diet, excess alcohol intake, hormone replacement therapy taken over 4 years, late pregnancy and menopause and family history • Protective factors Self examination, screening programs and health promotion campaigns

27. Injury • Is a large cause of health care costs • Leading cause of deaths among young people • Suicide has become a more common cause of death than transport related injury • Three and a half more males than females committed suicide in 200 • Road injury deaths have declined since early 1970’s due to intervention strategies being introduced to improve road safety • Has a major but often preventable impact on Australia’s health • Major cause of death in first half of life • Many injured people left with series disability or long term conditions

28. Injury • Largest male rates were from road crashes and interpersonal violence • 60+ year old females have higher injury rates due to falls causing injuries such as hip fractures as compared to males • Suicide is the most frequent cause of injury deaths among males overall • Decline in road deaths has slowed recently • From late 1990’s declines in drug-related deaths and suicides • Groups at risk Young adult males, people in rural areas, children and Indigenous Australians

29. Injury • Protective factors National Injury Prevention and Safety Promotion Plan 2004-14, road safety laws and education, pool fencing, reduction of excess alcohol intake and use of illicit drugs • Diabetes Is a disorder of the body’s levels of insulin. Type I is insulin dependant and can be fatal if not treated Type II is non-insulin dependant, may be undetected for years, known as mature-onset diabetes Gestational diabetes can occur during pregnancy Long term effects include blindness, kidney problems, lower limb amputations, heart attack, stroke and impotence

30. Injury • Trends Numbers rising in Australia and across the world Type II once mainly affected older people, now becoming more common in childhood • Risk factors Obesity, physical inactivity and poor nutrition • Groups at risk Indigenous Australians, people over the age of 50 for type II, gestational diabetes for pregnant women

31. Respiratory disease - COPD • Chronic obstructive pulmonary disease COPD is known as emphysema or chronic bronchitis • Destruction of the lung tissue and narrowing of the air passages obstructs oxygen intake and gas exchange • Shortness of breath and coughing • Risk factors Smoking is the major risk factor, environmental exposure to pollutants • Protective factors Quitting smoking, not smoking, vaccination for influenza

32. Respiratory disease – Asthma • Is an inflammatory disease of the air passages that makes them become narrow causing wheezing, coughing and shortness of breath • Trends During the 1980’s and 1990’s there was a world wide increase Recent years trends has plateaued Australia has high level compared to international standards Recent decrease among children and young adults

33. Respiratory disease – Asthma • Risk factors Family history, allergic conditions, parental smoking, major respiratory infection during first 2 years of life, exposure to domestic allergens and triggers including pollen, dust, exercise, cold weather and chest or throat infections • Protective factors Learning to manage the condition, avoiding known allergens and not smoking • Groups at risk Affects all age groups and ranges in severity, boys under 15 years but after teenage years females with asthma are more prevalent and females have had a significantly higher prevalence overall than males

34. Identifying priority health issues • The Australia Government makes decisions on where to allocate funding and address the health problems confronted by the nation. • This is achieved through considering: • Social justice principles - A set of values that recognises the impact of discrimination, past disadvantage, structural barriers to equality, as well as other social factors. It is concerned with reducing inequity by supporting the most disadvantaged people in society • Example – Medicare is designed to provide basic health care to all Australians regardless of religion, socioeconomic status, location or cultural background

35. Identifying priority health issues • Priority population groups – Are those experiencing inequities however which group has priority? Decided through community consultation, media attention, demands of lobby groups to parliament and epidemiology all play a part in the decision making process • Prevalence of the condition – Major causes of death and illness that are shown in statistics point to a need to prioritise • Potential for prevention and early intervention – The capacity to identify and change health damaging risk behaviours provides great potential for improving health outcomes through education and health promotion strategies

36. Identifying priority health issues • Costs to individuals and communities – The costs imposed on the community may include ‘direct’ costs that are borne by the health care system or ‘indirect’ costs that may be borne by the family or other sectors of the community

37. What are the priority issues for improving Australia’s health? • Australia ranks as one of the healthiest nations in the world. We have a high life expectancy, low mortality rate and an improving health status. • However this is not shared by all by all groups. Aboriginal and Torres Strait Islander people suffer extraordinarily poor health status. Other groups that also share health inequities and different health status include socioeconomically disadvantaged people, people in rural areas, overseas-born people, the elderly and people with disabilities. • Currently 75% of Indigenous Australians live in cities and regional areas while 25% live in remote areas.

38. What are the priority issues for improving Australia’s health? • The life expectancy of a male Indigenous Australian in 2001 was 59 years. This was the same life expectancy of a non indigenous male in 1910 • The life expectancy of a female Indigenous Australian in 2001 was 65 years. This was the same life expectancy of a non indigenous female in 1922 • The gap between indigenous and non-indigenous life expectancy is approximately 22 years

39. Indigenous Australians mortality rates • The mortality rates for Indigenous Australians continue to be unacceptably high compared to other Australians • Between 2001 and 2005 the death rates for Indigenous males and females in most states were almost 3 times higher than non Indigenous males and females • The 5 leading causes of death were Diseases of the circulatory system and cancers

40. Indigenous Australians mortality rates • Endocrine, metabolic and nutritional disorders (including diabetes) • Respiratory diseases • Injuries (injuries caused by transport, assault, self-harm were responsible for deaths amongst young Indigenous males at 3 times the non-Indigenous rate • There are however positive trends occurring with the Indigenous rates decreasing significantly in Western Australia between 1991 and 2005 • Throughout Australia the gap between Indigenous and non-Indigenous infant mortality rates has closed considerably since 1991

41. Indigenous Australians morbidity rates • The burden of disease among Indigenous Australians represents 3.6% of all disability yet they represent only 2.5% of the total population • In 2004-2005 Indigenous adults were twice as likely as non-Indigenous Australians to report their health as fair or poor – 29% compared to 15% as well as twice as likely to report high levels of psychological distress compared to non-indigenous adults • Main Causes of poor health include mental disorders, circulatory diseases, diabetes, respiratory diseases, cancers, musculoskeletal conditions, eye and ear problems and kidney disease (markedly increased between 2001 and 2004-2005 • Indigenous people were hospitalised at a rate 5 times higher than the rate of non-indigenous people and at a rate 14 times higher for care involving dialysis

42. Indigenous Australians morbidity rates • Fewer Indigenous people suffer skin cancers and prostate cancers • Rates of asthma, back pain and hearing problems amongst Indigenous Australians have declined between 2001 and 2005 • Sociocultural, socioeconomic and environmental determinants • Indigenous Australians experience significant socioeconomic and Sociocultural challenges. • Since European settlement, cultural divisions and conflicts, ill-advised or ineffective programs of integration, separation, education and welfare support have all contributed to the poor state of Indigenous health.

43. The most critical challenges for Indigenous Australians include • Lower incomes – median income for Indigenous families in 2006 was approximately 55% of non-Indigenous families • Higher rates of unemployment – in 2006 the Indigenous unemployment rate was 16% The non-Indigenous rate was 5% • Lower educational attainment – the number of Indigenous people who completed Year 12 was approximately half of non-Indigenous people • Lower rates of home owner ship – the number of Indigenous families who either owned or were purchasing a home in 2006 was half the number of non-Indigenous families 34% compared to 69% • The social determinants discussed have contributed and influenced the exposure to the following risk factors

44. The most critical challenges for Indigenous Australians include • Tobacco use – was the main contributor to the burden of disease among Indigenous Australians. In 2004-2005 50% of the Indigenous population were smokers and smoking rates are double those of non-Indigenous Australians. • Alcohol consumption – In 2004 – 2005, 1 in 6 Indigenous Australians reported chronic levels of risky drinking and binge drink at twice the rate of other Australians • Illicit drug use – twice as many Indigenous Australians over 15 years (28%) reported illicit drug use. • Overweight and obesity – more than 50% of Indigenous Australians are over weight (similar to non-Indigenous rates)

45. The most critical challenges for Indigenous Australians include • Poor nutrition – little difference between Indigenous and non-Indigenous Australians however fresh fruit intake is slightly lower in rural communities • Physical inactivity – indigenous Australians in particular females were more likely to be sedentary or exercise at low levels • Exposure to violence – 2002 national Aboriginal and Torres Strait Islander Social Survey NATSISS reported Indigenous exposure to violence was twice the rate of non-Indigenous Australians which had doubled since 1994. Exposure was 3 times more likely in rural communities • Poor housing conditions – In 2004 overcrowding affected 1 in 4 Indigenous Australians

46. Positive news • Year 10 and beyond school retention rates increased between 1998 – 2007 and the difference between Indigenous and non-Indigenous retention rates decreased • Labour force participation increased from 52% to 54% between 2001 – 2006 • Home ownership rates increased from 31% in 2001 to 34% in 2006 • The unemployment rate decreased between 2001 - 2006 from 20% to 16% for Indigenous people aged 16 – 64 years • Between 2001 – 2006 the year 12 completion rate increased from 20% to 30%

47. Roles of individuals, communities and governments in addressing the health inequities • Aboriginal health is a major problem for this nation. Given the poor state of current health indicators, the current strategies and programs have had limited success. • Indigenous health status results from the interaction of multiple determinants and requires a multi-faced response from the health care system. Therefore a “intersectoral” approach based on partnerships between people and agencies at many levels from a variety of sectors is needed.

48. Government • There are 2 peak agencies which coordinate Indigenous health services at the federal government level with a 3rd peak body in NSW that overseas at a state level. • 1. The Office of Aboriginal and Torres Straight Islander Health OATSIH– has been established within the Department of Health and Ageing to bring greater focus to the Australian Governments delivery of mainstream health services to Indigenous Australians. • Is responsible for administering and funding ATSI community controlled health and substance use services • OATSIH provides direct grants to around 245 organisations of which around 80% are ATSI community controlled or managed

49. Government • 2 The National Aboriginal Community Controlled Health Organisation NACCHO – agency that works with the Department of Families, Housing, Community Services and Indigenous affairs. • Is the national Aboriginal health body representing Aboriginal Community Controlled Health Services throughout Australia • 3. The Aboriginal Health and Medical Research Council of NSW AH&MRC – is the peak body for Aboriginal health in NSW. • Is comprised of over 60 Aboriginal Community Controlled Health Organisations throughout the state

50. Government • Provides services that include – • Health service delivery, supporting Aboriginal community health initiatives, development and delivery of Aboriginal Health Education, research in Aboriginal health data and policy development and evaluation