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HSC PDHPE Core 1 – Health Priorities in Australia

HSC PDHPE CORE 1: HEALTH PRIORITIES IN AUSTRALIA

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CORE 1 – Health Priorities in Aust. 
Overview 
• How are priority issues for Australia’s health 
identified? (epidemiology, health issues) 
• What are the priority issues for improving 
Australia’s health? (ATSI, SES, CVD, Cancer, Ageing) 
• What role do health care facilities and services 
play in achieving better health for all Australians? 
(medicare, alternative health care, insurance, public vs private) 
• What actions are needed to address Australia’s 
health priorities? (Ottawa Charter)
HSC PDHPE Core 1 – Health Priorities in Australia
How are priority issues for 
Australia’s health 
identified?
SYLLABUS 
Students learn about: 
• 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 
Students learn to: 
• critique the use of epidemiology to role of 
epidemiology describe health status by 
considering questions such as: 
-what can epidemiology tell us? 
-who uses these measures? 
-do they measure everything about health 
status? 
• use tables and graphs from health reports to 
analyse current trends in life expectancy and 
major causes of morbidity and mortality for the 
general population and comparing males and 
females 
• argue the case for why decisions 
are made about health priorities by 
considering questions such as: 
-how do we identify priority issues for 
Australia’s health? 
-what role do the principles of social justice 
play? 
- why is it important to prioritise?
How are priority issues for Australia’s 
health identified? 
Measuring health status: 
•“Health is a state of complete physical, mental and social well-being and not 
merely the absence of disease” (WHO, 1946) 
•To develop a health profile of a community or population, specific information is 
gathered from various sources. 
•A large proportion of this information is collated annually by government 
organisations, such as the: 
• Australian Bureau of Statistics (ABS) 
http://www.abs.gov.au/ausstats/abs@.nsf/Products/E064ECE543403651CA2576F600122A30?opendocument 
• Australian Institute of Health and Welfare 
http://www.aihw.gov.au/publications/aus/ah10inbrief/ah10inbrief.pdf 
• nongovernment agencies (such as the Cancer Council and the Heart 
Foundation). http://www.cancer.org.au/home.htm, http://www.heartfoundation.org.au/Pages/default.aspx
How are priority issues for Australia’s 
health identified? 
Measuring health status: 
Role of epidemiology : 
•Information on the health of a nation is gathered in many areas, including life 
expectancy, infant mortality rates, morbidity rates and use of health care services 
(for example, hospital admissions and Medicare claims) 
•The study of this information is known as epidemiology. Epidemiology provides 
information on the distribution (or patterns) of disease, illness and injury and on 
the likely causes (or determinants) within groups or populations. 
•Epidemiology considers the patterns of disease in terms of: 
• Prevalence: is the number of current cases of a specific illness or disease (for example, 
20 000 people in Australia infected with HIV) 
• Incidence: is the number of new cases of a disease or illness in a set time period (for 
example, approximately 800 new diagnoses of HIV per year). 
• Distribution 
• Determinants 
• It describes and compares the patterns of health groups, communities and 
populations.
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HSC PDHPE Core 1 – Health Priorities in Australia

  • 1. CORE 1 – Health Priorities in Aust. Overview • How are priority issues for Australia’s health identified? (epidemiology, health issues) • What are the priority issues for improving Australia’s health? (ATSI, SES, CVD, Cancer, Ageing) • What role do health care facilities and services play in achieving better health for all Australians? (medicare, alternative health care, insurance, public vs private) • What actions are needed to address Australia’s health priorities? (Ottawa Charter)
  • 3. How are priority issues for Australia’s health identified?
  • 4. SYLLABUS Students learn about: • 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 Students learn to: • critique the use of epidemiology to role of epidemiology describe health status by considering questions such as: -what can epidemiology tell us? -who uses these measures? -do they measure everything about health status? • use tables and graphs from health reports to analyse current trends in life expectancy and major causes of morbidity and mortality for the general population and comparing males and females • argue the case for why decisions are made about health priorities by considering questions such as: -how do we identify priority issues for Australia’s health? -what role do the principles of social justice play? - why is it important to prioritise?
  • 5. How are priority issues for Australia’s health identified? Measuring health status: •“Health is a state of complete physical, mental and social well-being and not merely the absence of disease” (WHO, 1946) •To develop a health profile of a community or population, specific information is gathered from various sources. •A large proportion of this information is collated annually by government organisations, such as the: • Australian Bureau of Statistics (ABS) http://www.abs.gov.au/ausstats/abs@.nsf/Products/E064ECE543403651CA2576F600122A30?opendocument • Australian Institute of Health and Welfare http://www.aihw.gov.au/publications/aus/ah10inbrief/ah10inbrief.pdf • nongovernment agencies (such as the Cancer Council and the Heart Foundation). http://www.cancer.org.au/home.htm, http://www.heartfoundation.org.au/Pages/default.aspx
  • 6. How are priority issues for Australia’s health identified? Measuring health status: Role of epidemiology : •Information on the health of a nation is gathered in many areas, including life expectancy, infant mortality rates, morbidity rates and use of health care services (for example, hospital admissions and Medicare claims) •The study of this information is known as epidemiology. Epidemiology provides information on the distribution (or patterns) of disease, illness and injury and on the likely causes (or determinants) within groups or populations. •Epidemiology considers the patterns of disease in terms of: • Prevalence: is the number of current cases of a specific illness or disease (for example, 20 000 people in Australia infected with HIV) • Incidence: is the number of new cases of a disease or illness in a set time period (for example, approximately 800 new diagnoses of HIV per year). • Distribution • Determinants • It describes and compares the patterns of health groups, communities and populations.
  • 9. Who uses epidemiology? • An example of how epidemiology has been applied is in the area of heart disease. Epidemiology indicates that deaths from heart disease are decreasing, especially in males aged over 45 years. This is an indication that previously implemented management strategies have been effective. • Although epidemiology can provide statistical information on the incidence, trends and population groups most at risk of illness and disease, it fails to explain the socio-cultural factors that contribute to negative health behaviours. • More recently, epidemiology has been challenged regarding this shortcoming, and has also been challenged as focusing primarily on physical health issues. • Health promotion campaigns that are designed in response to the statistics obtained through epidemiology alone, but which ignore social influences, can be ineffective. • For example, epidemiology identifies 17–25-year-old males as being at high risk of injury from motor vehicle accidents, and it also identifies the risk factors that contribute to these accidents; for example, speed and alcohol. But epidemiology does not say why young males are more likely to engage in this risk behaviour and what the influencing factors are. • http://www.youtube.com/watch?v=c2nvAFOk7x0
  • 10. • Activity: • Epidemiological findings are often presented in the form of statistical data. Discuss whether statistics always present the full story.
  • 11. Measuring health status: Measures of epidemiology :
  • 12. Current trends in Aust. Health
  • 13. Current trends in Aust. Health
  • 14. Current trends in Aust. Health • Life expectancy and death • Australia’s life expectancy at birth continues to rise and is among the highest in the world—almost 84 years for females and 79 years for males. • Death rates are falling for many of our major health problems such as cancer, cardiovascular disease, chronic obstructive pulmonary disease, asthma and injuries. • Coronary heart disease causes the largest number of ‘lost years’ through death among males aged under 75 years, and breast cancer causes the most among females.
  • 16. Current trends in Aust. Health
  • 17. Current trends in Aust. Health
  • 18. Current trends in Aust. Health
  • 19. Current trends in Aust. Health
  • 20. Current trends in Aust. Health
  • 21. Current trends in Aust. Health
  • 22. Current trends in Aust. Health • Diseases • Cancer is Australia’s leading broad cause of disease burden (19% of the total), followed by cardiovascular disease (16%) and mental disorders (13%). • The rate of heart attacks continues to fall, and survival from them continues to improve. • Around 1 in 5 Australians aged 16–85 years has a mental disorder at some time in a 12-month period, including 1 in 4 of those aged 16– 24 years. • The burden of Type 2 diabetes is increasing and it is expected to become the leading cause of disease burden by 2023. • The incidence of treated end-stage kidney disease is increasing, with diabetes as the main cause.
  • 23. Current trends in Aust. Health
  • 24. Current trends in Aust. Health
  • 25. Current trends in Aust. Health
  • 26. Current trends in Aust. Health
  • 27. Current trends in Aust. Health
  • 28. Current trends in Aust. Health
  • 29. Current trends in Aust. Health
  • 30. Current trends in Aust. Health • Health risks • Risk factors contribute to over 30% of Australia’s total burden of death, disease and disability. • Tobacco smoking is the single most preventable cause of ill health and death in Australia. • However, Australia’s level of smoking continues to fall and is among the lowest for OECD countries, with a daily smoking rate of about 1 in 6 adults in 2007. • Three in 5 adults (61%) were either overweight or obese in 2007–08. • One in 4 children (25%) aged 5–17 years were overweight or obese in 2007–08. • Of Australians aged 15–74 years in 2006–2007, less than half (41%) had an adequate or better level of health literacy. • Rates of sexually transmissible infections continue to increase, particularly among young people. • Use of illicit drugs has generally declined in Australia, including the use of methamphetamines (the drug group that includes ‘ice’).
  • 31. Current trends in Aust. Health
  • 32. Current trends in Aust. Health
  • 33. Current trends in Aust. Health
  • 34. Current trends in Aust. Health
  • 35. Current trends in Aust. Health
  • 36. Current trends in Aust. Health
  • 37. Current trends in Aust. Health
  • 38. Current trends in Aust. Health Cause of sickness/Death Overall trend Males Females Incidence Mortality Incidence Mortality CVD (all types) Incidence: Mortality: Cancer in general Incidence: Mortality: Lung cancer Incidence: Mortality: Breast cancer Incidence: Mortality: Melanoma Incidence: Mortality: Diabetes Incidence: Mortality:
  • 39. Cause ofC urrent trends in Aust. Health sickness/Death Overall trend Males Females Incidence Mortality Incidence Mortality CVD (all types) Incidence: decreasing Mortality: Decreasing decreasing decreasing decreasing decreasing Cancer in general Incidence: increasing Mortality: Decreasing increasing decreasing increasing decreasing Lung cancer Incidence: decreasing Mortality: Decreasing decreasing decreasing increasing increasing Breast cancer Incidence: increasing Mortality: Decreasing increasing decreasing Melanoma Incidence: increasing Mortality: Increasing increasing increasing increasing increasing Diabetes Incidence: Increasing Mortality: Slight increase increasing Slight increase increasing Slight increase
  • 40. Current trends in Aust. Health Life stages • Mothers and babies • The proportion of females having caesarean sections has continued to increase over the latest decade, from 21% in 1998 to 31% in 2007. • The perinatal death rate of babies born to Indigenous mothers in 2007 was twice that of other babies. • Children and young Australians • Death rates among children and young people halved in the two decades to 2007, largely due to fewer deaths from transport accidents. • More children are being vaccinated against major preventable childhood diseases, with 91% (the target level) being fully vaccinated at 2 years of age. • Land transport accidents and intentional self-harm accounted for 2 in every 5 deaths (42%) among young Australians (aged 15–24 years) in 2007. • People aged 25–64 years • The main causes of death in this age group in 2007 were coronary heart disease for males (14% of their deaths) and breast cancer for females (12%). • Older Australians • For older people, the main causes of death are heart disease, stroke and cancer. • At age 65, Australian males can now expect to live a further 19 years to almost 84 years of age, and females a further 22 years to almost 87.
  • 41. Current trends in Aust. Health Groups of special interest • People with disability are more likely than others to have poor physical and mental health, and higher rates of risk factors such as smoking and overweight. • Compared with those who have social and economic advantages, disadvantaged Australians are more likely to have shorter lives. • Indigenous people are generally less healthy than other Australians, die at much younger ages, and have more disability and a lower quality of life. • People living in rural and remote areas tend to have higher levels of disease risk factors and illness than those in major cities. • Compared with the general community, prisoners have significantly worse health, with generally higher levels of diseases, mental illness and illicit drug use than Australians overall. • Most migrants enjoy health that is equal to or better than that of the Australian-born population—often with lower rates of death, mental illness and disease risk factors. .
  • 42. Identifying priority health issues: • Although Australia’s health status has improved over the years, many people still experience health conditions that are, to some degree, preventable. • This is particularly so for groups such as Aboriginal and Torres Strait Islander peoples and the socio-economically disadvantaged. • With a view to making significant progress in improving the health status of all Australians, the vision for national health information in the years ahead is to improve the health of populations. • The priority areas are: • cardiovascular health • cancer control • injury prevention and control • mental health • diabetes mellitus • asthma • arthritis and musculosketetal conditions This selection of priority areas was based on five specific criteria: • principles of social justice • priority population groups • prevalence of condition • potential for prevention and early intervention • costs to individuals and the community.
  • 43. Social justice principles • Social justice aims to decrease or remove inequity from a population. This would mean that there is a health equality. • Social justice is a life of choices and opportunity, free from discrimination • Everyone has the right to equal health opportunities. Social justice recognises the importance to support the marginalised, disadvantaged or under-represented groups of people in society • Equity involves making sure resources and funding are distributed fairly and without discrimination. Health equity means that all people have access to the health services and support they need at the time that they need it. • Inequity refers to differences in health status due to living conditions. E.G poor access to healthy food, living in violent community, stressful work, less recreational facilities, lack of access to health care etc • Examples: • 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.
  • 45. Social Justice Principles Review • Define ‘social justice’. What role is played by the principles of social justice? • Explain why social justice is a fundamental component of health programs. • One of the principles of social justice is that ‘all Australians should have access to a comprehensive range of health care services regardless of financial status’: a) Identify the government policies that have been implemented to meet this principle. b) Describe how effective these strategies have been. • Identify the main differences between equality and equity
  • 46. Priority Population Groups • Priority health issues are identified when certain population groups are MORE greatly affected by certain causes of illness and death then the rest of the population. • These priority population groups are those that are shown by research to experience an unnecessarily high incidence of the condition. • The priority groups identified are: – socio-economically disadvantaged – Aboriginal and Torres Strait Islanders – People living in rural and remote areas – Elderly – People with disabilities – People who were born overseas. • ACTIVITY: • Describe the criteria for identifying priority population groups. • Discuss the purpose of singling out priority population groups. Are there any groups that have been overlooked?
  • 47. Prevalence of Condition • Another criterion for the selection of a priority issue was the current number of cases of the illness or condition • The seven priority issues account for the large majority of deaths recorded every year in Australia, and also for a significant number of the recorded hospital episodes, hence, are priority issues. • Activity: Discuss the reasons for the importance of prioritising. Does this mean other health issues might be neglected? What if the prevalence of another health condition increases
  • 48. Potential for Prevention and Early Intervention • Priority health issues are identified when a disease is preventable or has the potential for intervention • Most of Australia’s major causes of illness and death are due to modifiable lifestyle behaviours. These are known as Lifestyle diseases. • For health problems that are not lifestyle-related the potential for change is extremely limited and progress is more reliant on research and medical advances • Education and awareness of risk factors can lead to behaviour change and a reduction in incidence. Such risk factors include smoking, sun exposure and drink driving. • Environmental modifications can also contribute to a reduction in incidence; for example, shaded areas to reduce skin cancer, dual-lane highways to reduce road injury, and lean beef and low-fat milk to reduce heart disease. • To simply blame individuals for their behaviour ignores the social, economic, cultural and political forces at work in society. • Activity: Explain why the ‘potential for prevention and early prevention’ was a criterion in the identification of priority issues
  • 49. Costs of ill-health to the individual and community • Cost of ill-health to the individual • Costs can be categorised as either direct or indirect. • Direct costs are those that can be measured, usually through financial means; for example, cost of treatment, cost of replacement labour or lost working hours. • Indirect costs are more difficult to measure. They include factors such as emotional trauma and relationship breakdown. • The impact of health conditions on the individual’s physical health can vary from minor pain to permanent disability or death. Dealing with minor physical health problems can be overcome in a short time with appropriate treatment and medication. • Examples of permanent physical effects are spinal cord injury from an accident, limb amputation caused by peripheral vascular disease, and mastectomy (breast removal) to remove a cancerous tumour. • Permanent physical health problems that result from an illness or accident will, for many people, have effects that reach far beyond the physical: – Social isolation – Long-term hospitalisation and lack of mobility – Pressure on relationships and family structures – Emotional Wellbeing – self esteem/depression etc
  • 50. Costs of ill-health to the individual and community • Cost of ill-health to the Community • The annual economic cost alone related to the diagnosis, treatment and care of the sick is over $30 billion. This includes the costs of hospitalisation, medical treatments, pharmaceuticals, health insurance and illness prevention. • The indirect costs of ill-health to the community are not included in the dollar figures. Indirect costs include loss of income and workplace productivity as a result of illness or premature death, travel costs of patients, and the costs of caring for an ill person at home. • Australia’s expenditure on health • Australia’s expenditure on health has been fairly constant. Measured in terms of Australia’s total wealth—known as gross domestic product (GDP)—expenditure on health has been about 8 per cent each year for the last 20 years • There are several factors indicating that Australia’s health system might come under financial pressure in the future. These include: • an ageing population • a more informed population • increased use of Medicare • advances in medical technology
  • 51. Costs of ill-health to the individual and community Cost of ill-health to the Community • AGING Population • Life expectancy at birth for the Australian population has increased by over 20 years since the beginning of the twentieth century. • Whether this will cause a big increase in health costs is uncertain. • The people who live longer might be healthier, and they might require less health care than older people do today. However, there is still concern that having an older population might place an extra burden on Australia’s health costs. • They rely heavily on the health care system and health professionals
  • 52. Costs of ill-health to the individual and community Cost of ill-health to the Community • A more informed population • Health promotion and illness-prevention messages have resulted in a population more informed about ill-health. • This might result, in turn, in an increase in the use of health services, especially in relation to prevention. • In the longer term, spending money on prevention and early detection of illness might decrease overall health costs. • In the short term, however, having a more informed and health conscious population does tend to cause people to use more medical services than previously, and this puts immediate pressure on the health care budget.
  • 53. Costs of ill-health to the individual and community Cost of ill-health to the Community • Increased use of Medicare • The ease and simplicity that Medicare has brought to health care has resulted in a steady increase in the use of doctors’ services, especially in urban areas where there are many doctors. • This might result in longer-term benefits if conditions are detected earlier and prevented from developing into more serious (and expensive) problems. • There is also concern that the ease and simplicity of Medicare might lead to some people seeing doctors for trivial matters • The effect of Medicare on health costs is thus a complex matter. Overall, Medicare helps to keep down costs because the government does have some control over the fees charged for services.
  • 54. Costs of ill-health to the individual and community Cost of ill-health to the Community Advances in medical technology • Improved technology has resulted in a wider range of treatments available. • Many of these treatments utilise the latest expensive technology; for example, organ transplants, use of lasers, joint replacements, open-heart surgery. • People obviously want the best possible treatment, but costs are increasing as a result • Activity: Discuss how an illness or injury can have an impact on the social health of an individual. • Explain why it is difficult to measure the social cost of ill-health.
  • 55. How are priority issues identified Revision 1. Outline the measures of epidemiology 2. Describe the current trends in life expectancy and the major causes of morbidity and mortality. 3. Outline the differences in health status by gender. 4. Describe how priority health issues are identified. 5. Analyse current trends in life expectancy and major causes of morbidity and mortality for the general population. 6. Account for the differences in the health status of men and women in Australia. 7. Justify why cardiovascular disease has been identified as a health priority issue in Australia 8. Discuss why mortality, morbidity and life expectancy are important indicators of health status. 9. Discuss why it is important for the Australian Government to prioritise health issues when determining health policy 10. Discuss the limitations of using epidemiology to describe the current health status of a population
  • 56. What are the priority issues for improving Australia's health?
  • 57. Syllabus students learn about: • groups experiencing health inequalities -aboriginal and Torres strait islander peoples -socioeconomically disadvantaged people - people in rural and remote areas -overseas - born people - the elderly -people with disabilities • high levels of preventable chronic disease, injury and mental health problems -cardiovascular disease (CVD) -cancer (skin, breast, lung) -diabetes -respiratory disease -injury - mental health problems and illnesses • a growing and ageing population -healthy ageing -increased population living with chronic disease and disability - demand for health services and workforce shortages -availability of carers and volunteers
  • 58. Aboriginal and Torres strait islander peoples The nature and extend of the health inequities • No greater contrast in the extremes of health status can be found in Australia than that between Aboriginal and Torres Strait Islander peoples and the rest of the Australian population • ATSI die at a much younger age and are more likely to experience disability and reduced quality of life because of ill-health • The life expectancy of Indigenous Australians is approximately 10 years less than the overall Australian life expectancy • The life expectancy at birth of a male is approximately 67 years and for a female is approximately 73 years. • Death rates for Aboriginal and Torres Strait Islander peoples are higher for every specific major cause of death • Infant mortality (estimated at two to three times higher than the overall Australian figure) and higher mortality rates.
  • 59. Aboriginal and Torres strait islander peoples The nature and extend of the health inequities • The leading causes of death in the ATSI population are circulatory diseases, cancer, diabetes and respiratory diseases. • Indigenous females and males are, respectively, four and five times as likely to die from avoidable causes. • Indigenous people are five times as likely to die from heart attack • Twice as likely to die from cancer • 18 times as likely to die from diabetes • Twice as likely to die from suicide. • Indigenous Australians are more likely to die from transport accidents, intentional self-harm and assault than other Australians. Injury rates are around three times those of the total Australian population • http://www.youtube.com/watch?v=vIuK_F80X08 • http://www.oxfam.org.au/explore/indigenous-australia/close-the-gap
  • 60. Aboriginal and Torres strait islander peoples The nature and extend of the health inequities • Trauma and grief related to the history of a new settlement invading Indigenous communities, the impact of colonisation by Europeans, loss of land and culture, high rates of premature mortality, high levels of Jail, family separations and Aboriginal deaths in custody have been identified as underlying the great burden among Indigenous people of ‘mental health problems’, which may lead to ‘mental illness’. • Diabetes is a major health problem among Indigenous people. Overall, diabetes is around three-and-a-half times more common among Indigenous people than among other Australians. Only around one-half of people with diabetes know they have the condition. • One in three Indigenous people have eye and/or sight problems, such as refractive error (requiring glasses for correction), cataract (clouding of the lens), trachoma (a bacterial infection that can lead to blindness if untreated) • Nearly twice as many Indigenous six-year-olds as non Indigenous six-year-olds have tooth decay.
  • 61. Socio-cultural, socio-economic and environmental determinants for ATSI
  • 62. The roles of individuals, communities and governments in addressing the health inequities Government • Government attempts to the health of ATSI by bring in new policy and reforms. • Government agencies such as ‘The Aboriginal Health and Medical Research Council of NSW (AH&MRC)’ aim to improve the access of Indigenous people to primary health care services: These combined services include: •Ensure basic health standards are being met •Supporting aboriginal community health initiatives •Research in aboriginal health •Policy development and evaluation Community • The nature of the services provided varies from one community to another, though generally they include clinical care, health education, promotion, screening, immunisation and counselling, as well as specific programs such as men's and women's health ,aged care, transport to medical appointments, hearing health, sexual health, substance use and mental health. Individuals • Educational services are needed to be built and increasing the number of aboriginal health workers is needed to be done. • Health services focus is on improving their knowledge and community skills. •Empowering the individual to make wise decisions is ultimately the main aim
  • 63. ATSI Revision • Discuss why the financial resources devoted to improving Indigenous health have so far had little impact. • Apart from financial support, identify other strategies that have been introduced to improve Indigenous health. Evaluate how effective they have been. • Propose alternative strategies that could be introduced to reduce health inequities in the Indigenous population.
  • 64. Socio-economically disadvantaged people Nature and extent of inequalities • A person’s socio-economic status is determined by several factors: – Income – Occupation – Education • Socio-economically disadvantaged people are those who, as a result of one or more of these factors, experience significant financial limitations. • Inequalities occur as a result of socioeconomic differences in material resources, access to educational opportunities, safe working conditions, effective services, living conditions in childhood, racism and discrimination • Socio-economically disadvantaged people: – have reduced life expectancy – are more likely to die from cardiovascular disease – respiratory disease and lung cancer – have higher infant mortality – have higher levels of blood pressure – are more likely to smoke – are more often generally sick.
  • 65. Socio-economically disadvantaged people Nature and extent of inequalities • SES disadvantaged people are more likely to suffer from long-term health conditions, such as diabetes, diseases of the circulatory system (which include heart disease and stroke), arthritis, mental health problems and respiratory diseases (including asthma) • Socio-economically disadvantaged people are far less likely to engage in preventative health behaviours, such as having ‘Pap’ smears and dental check-ups. • Unemployment is also a major issue because it is significantly higher than the national rate. Unemployment can lead to a sense of helplessness, and is therefore linked to social problems, including drug use, violence, vandalism and crime. It a factor contributing to depression and suicide in young people. • Department housing often experience higher levels of social problems. EG. domestic violence, vandalism and family breakdown. • Low income and education can reduce alternatives regarding employment, housing and nutrition, and can generally affect the ability to raise standards of living. • Socio-economic disadvantage is considered to be the most important indicator of poor health in Australia
  • 66. Socio-cultural, socio-economic and environmental determinants for SES
  • 67. The roles of individuals, communities and governments in addressing the health inequities Government • Federal and state Government committed to making improvements in funding and policies to reduce health inequities. Strategies by the government aim to improve the access of SES people to better health. These services include: •Medicare •Pharmaceutical Benefit Scheme (PBS) •Immunisation programs •Oral checkups •Subsidised child care for low income families Community • The nature of the services provided varies from one community to another, though generally they include clinical care, health education, promotion, screening, immunisation and counselling, as well as specific programs such as men's and women's health ,aged care, transport to medical appointments, hearing health, sexual health, substance use and mental health. Individuals • Educational services are provided to individuals to help them help themselves. • Health services focus is on improving their knowledge and community skills. •Empowering the individual to make wise decisions is ultimately the main aim
  • 68. FYI - People in rural and remote areas Nature and extent of health inequities • More likely to suffer acute and chronic injury • Experience lower life expectancy • Reported less likely to have good health • More likely to have high levels of psychological distress amongst males Sociocultural, socioeconomic and environmental determinants People living in rural and remote areas were more likely to: • Drink risky amounts of alcohol • Be overweight/obese • Ate less fruit • Experience lower birth weight, particularly among teenage mothers Roles of individuals, communities and governments in addressing the health inequities Government State health Plans are needed to: •Attract and retain more health professionals in rural and remote communities •Provide sustainable quality health services •Make health services more accessible Communities In order to run health services, it is essential that rural communities are able to attract and retain properly trained staff.
  • 69. FYI - Overseas-born people Nature and extent of health inequalities • Suffer higher levels of psychological distress ( due to wars, or language problems) • Hospital rates 20% lower than other Australians • Are hospitalised for diseases according to country of birth, at greater levels than others. E.g. heart attacks are more likely to happen to people born in India whilst breast cancer is more common for women from England and Northern Ireland. • Lower deaths than Australian – born people. Sociocultural, socioeconomic and environmental determinants • Current daily smoking – Oceania • Lower levels of exercise – North Africa and Middle East • Consume less fruit and veg than others • Overweight and obese – Oceania and southern and eastern Europe Roles of individuals, communities and governments Government The main approach by governments to the health of people born overseas is to provide translation and language services to improve communication of health issues and access to health services among culturally and linguistically diverse communities (CALD). Communities The critical role of communities is to provide support for their members by advocating, promoting and engaging in the use and delivery of culturally appropriate health services. The training and education of CALD community and members to join and support the healthcare profession is the most enabling of all strategies.
  • 71. Cardiovascular Disease (CVD) • Its the disease of the heart and blood vessels. There are 3 main types of CVD: – Coronary heart disease – Cerebrovascular disease (stroke) – Peripheral vascular disease • Despite the health achievements made, cardiovascular disease is still the major cause of death in Australia. • Coronary heart disease • Coronary heart disease is the most common type of cardiovascular disease and accounts for just over 20 per cent of all deaths. It occurs when the blood supply to the heart is decreased by a narrowing (usually caused by atherosclerosis) in one or more of the coronary arteries. • If the blockage severely decreases blood flow to the heart it can lead to a condition called angina. Angina is chest pain that occurs as a result of cramping of the heart muscle due to constricted arteries. • In some cases the decrease in the blood supply can result in a more serious sudden heart attack, which can be fatal. • http://www.youtube.com/watch?v=n8P3n6GKBSY&feature=related
  • 72. Cardiovascular Disease (CVD) • Atherosclerosis- http://www.youtube.com/watch?v=fLonh7ZesKs • Angina- http://www.youtube.com/watch?v=RXuPBaKzmfM • Cerebrovascular disease (stroke) • Cerebrovascular disease is a disease of the arteries of the brain. An interruption (usually caused by atherosclerosis) of the blood supply to the brain results in what is commonly known as a ‘stroke’. • A stroke can also occur as a result of a blood vessel bursting in the brain. The effects that a stroke has on the person will depend on which part of the brain has had its blood supply restricted. • http://www.youtube.com/watch?v=6h7Frkj96yM&feature=fvw
  • 73. Cardiovascular Disease (CVD) • Peripheral vascular disease • Peripheral vascular disease is a type of cardiovascular disease that affects the blood vessels in the limbs. • Hardening of the arteries that interferes with blood supply to the muscles and skin is known as arteriosclerosis. • This disease has close links to smoking, and to diabetes and certain other diseases. In extreme cases, this can result in gangrene and possibly limb amputation. • http://www.youtube.com/watch?v=I4jxjWIbWyg&feature=related • Activity: Explain the effect atherosclerosis would have on a persons blood pressure
  • 74. Extent of and trends in CVD • Leading cause of death in Australia (about 35% of all deaths) • Second leading cause of burden of disease (cost, social, emotional costs etc) following cancer • Despite this being the leading cause of death, there has been a downward trend for all cardiovascular disease • The death rate increases sharply with age and causes the greatest number of deaths among older people • The decline in cardiovascular disease can be attributed to two main factors: • Improved medical care (for example, drugs to manage blood pressure) • A reduction in risk behaviour that contributes to cardiovascular disease (for example, smoking)
  • 75. Extent of and trends in CVD
  • 76. Extent of and trends in CVD • Males are more likely to die from CVD then females • Death rates significantly increase with age. CVD accounts for 48% of all deaths over 85 • Lower SES are more likely to have CVD • ATSI are twice as likely to have CVD, compared to non – ATSI • People from rural areas are more likely to have CVD, then urban
  • 77. Risk factors and protective factors for cardiovascular disease Risk factors • Some risk factors for cardiovascular disease cannot be modified. The non-modifiable risk factors for cardiovascular disease are: – Age : The risk of cardiovascular disease increases as people age; this is often the result of the slow progression of atherosclerosis. – Heredity :People with a family history of cardiovascular disease are more prone to developing the disease Themselves. – Gender: Males are more at risk of coronary heart disease than are females.
  • 78. Risk factors and protective factors for cardiovascular disease Risk factors • Other risk factors for cardiovascular disease can be modified. The modifiable risk factors for cardiovascular disease are: – Smoking : Smokers are up to five times more likely to develop a cardiovascular disease than are non-smokers. Chemicals contained in cigarette reduce oxygen-carrying capacity of the blood. – High blood pressure—Blood pressure is one of the most common causes of heart disease; high blood pressure is linked to a high-salt diet and being overweight – High blood fats—High levels of cholesterol and triglycerides (types of lipids or ‘fats’) in the blood significantly increase the chances of cardiovascular disease. – Overweight and obesity—People who are overweight are at an increased risk of heart disease because obesity is linked to high blood pressure and an increased level of blood fats. – Lack of physical activity—People who do not engage in regular physical activity can have a less efficient heart, higher levels of blood fats and a propensity to gain weight. • other possible influences include poor nutrition, alcohol, the contraceptive ‘pill’ (especially coupled with smoking) and diabetes
  • 79. Risk factors and protective factors for cardiovascular disease Protective Factors • Protective factors are the opposite of risk factors in that they help lower a person’s chances of developing heart disease. – Maintain healthy levels of blood pressure and blood cholesterol—Regular blood pressure and cholesterol checks will assist in early identification and management of any factors associated with heart disease. – Quit smoking—Stopping smoking is the single most important action a person can take to reduce his or her risk of cardiovascular disease. – Enjoy healthy eating—Healthy eating means enjoying a variety of foods from different food groups. – Visit the doctor regularly—Regular visits to the doctor can assist in maintaining any early signs of risk for cardiovascular disease. This includes assessing blood pressure, cholesterol, family history and lifestyle factors. With this information, a doctor can provide individualised advice on the best ways for the patient to lower his or her risk and lead a healthy-heart lifestyle. – Be physically active—Regular, moderate-intensity physical activity is good for the heart. Engaging in at least 30 minutes of physical activity can help lower blood pressure, lower blood cholesterol and assist in maintaining a healthy weight range. – Maintain a healthy weight—Being overweight and carrying too much weight around the waist are risk factors for cardiovascular disease and diabetes. Therefore, maintaining a healthy body weight by eating healthily and participating in regular physical activity will act as a protective factor to cardiovascular disease.
  • 80. CVD Personal Reflection • Do you have a family history of CVD? • Are you 55 or above? (hope not!) • Are you male or female? • Are you a present or past smoker? • What level is your cholesterol? • Are you at a healthy weight range? • How high is your blood pressure? • Are you regularly involved in physical activity?
  • 81. Socio-cultural, socio-economic and environmental determinants of CVD Social Determinant Effect on CVD AGE • Risk increases with age •Congenital heart disease is one of the leading causes of death in a child’s first year of life SEX •Females have a greater prevalence then males (why??) •Males are more likely to die then females from CVD SOCIO-ECONOMIC STATUS •Lower SES are more likely to get CVD •Many behavioural risk factors for CVD are more prevalent among people of lower SES (physical inactivity, obesity, hypertension) •Low SES are likely to have 3 or more risk factors •Low SES is linked to other social determinants such as poorer education, poorer working conditions and poor living conditions EDUCATION •Education leads to greater knowledge of risk factors •Higher educated people are less likely to smoke, more likely to engage in PA and eat healthier meals. All these decrease CVD. EMPLOYMENT •Blue collar occupations have higher risk of CVD. This is linked to higher levels of smoking and physical inactivity. •Unemployment leads to lower SES
  • 82. Socio-cultural, socio-economic and environmental determinants of CVD Social Determinant Effect on CVD GEOGRAPHIC LOCATION •Rural populations have higher death rates of CVD •Larger proportion of rural are ATSI, who have higher rates of CVD •Geographic location also impacts on other social determinants such as: transport, communication, health services, employment, SES and social isolation. CULTURE •Migrants have lower CVD then Australian born •Death rates increase though once migrant has lived in Australia for 10 or more yrs. •Support networks are not so good •Culture can cause barriers to health services (language differences) ACCESS TO SERVICES •People who do not have easy access to health care die more from CVD due to lack of diagnosis, prevention and treatment. •Lack of access could be due to cost, distance, knowledge, language or lack of facilities. PHYSICAL ENVIRONMENT •Well designed neighbourhoods that provide recreational facilities, good roads, street lights assist with PA •Unsafe alcohol consumption can be controlled through the regulation of alcohol outlets (bars, liquor shops and clubs)
  • 83. • ACTIVITY: • Create a postor illustrating the groups most at risk of CVD. Use images from the internet, magazines etc to build a profile. • Put these poster up around the classroom once completed
  • 84. Game Show - CVD • This population is twice as likely to die from CVD in Australia • ATSI • TWO determinant affecting CVD rates... Give details • AGE, SEX,SES,EDUCATION,EMPLOYMENT,GEOGRAPHIC LOCATION, CULTURE, ACCESS TO SERVICES, PHYSICAL ENVIRONMENT • Another name for High blood pressure • Hypertension • Death rates for CVD have _______________ over the past 30yrs • Decreased • PVD is poor blood supply to the _________ • Limbs • Are males or females at greater risk of CVD? • Males • Most risk factors for CVD are ____________ • Preventable/modifiable • A heart attack is usually the result of blockage of which arteries • Coronary • CVD accounts for nearly ___________ percent of all deaths in Australia • 40 • Lack of blood supply to the brain is called a ________ • Stroke • Another name for chest pains
  • 85. CANCER (LUNG, BREST and SKIN)
  • 86. Cancer (skin, lunch, breast) • Cancer is the uncontrolled growth of abnormal body cells. • Abnormal growth of cells leads to the build up of tissue masses called tumours • Tumours can be benign (non-cancerous) or malignant (cancerous) • Benign tumours do not spread, but malignant spread through bloodstream or the lympth system (body defence system) to get to other parts of the body. • They then form an new tumour (a secondary cancer) and begin invading the surrounding cells again. • There are various types of cancer. Some develop slowly; some quickly. • Some have known causes; others are of unknown cause. • Cancers are classified according to thearea of the body where they initially began: – Carcinoma - cancer of epithelial cells (including skin, mouth, throat, breasts and lungs) – Sarcoma —cancer of bone, muscle or connective tissue – Leukaemia —cancer of the blood-forming organs of the body – Lymphoma —cancer of the infection-fighting organs of the body • http://www.youtube.com/watch?v=LEpTTolebqo
  • 87. Extent of and trends in cancer • Cancer is the 2nd leading cause of death in Australia. • Cancer currently accounts for about 30% of all male deaths and 25% of female • The risk of being diagnosed with cancer before the age of 75 years is 1 in 3 for males and 1 in 4 for females. • The risk before age 85 years is higher, at 1 in 2 for males and 1 in 3 for females. • Since the 1990s, cancer has replaced cardiovascular disease as the greatest cause of years of life lost or fatal burden • In the past 15 years the incidence rate of melanoma has increased more rapidly than that of any other type of cancer • Reasons for the increase in cancer incidence include: – exposure to risk factors (for example, ultraviolet radiation) – improvements in the quality of detection techniques (mammograms) – more widespread use of personal detection (self-examination for breast cancer) – people being less likely to die from other causes (for example, from coronary heart disease and accidents)
  • 88. Extent of and trends in cancer • Analyse the following slides from AIHW 2010 on cancer and make notes regarding further trends and the extent of cancer
  • 91. Comparison of incidence and Mortality
  • 96. Risk factors and protective factors for cancer
  • 97. Risk factors and protective factors for cancer Skin cancer • The major cause of skin cancer is exposure to the sun’s ultraviolet rays. • The sun is at its most damaging between the hours of 11.00 am and 3.00 pm. • Exposure to sunlight increases the chances of skin cancer later in life. • Further risk factors include having fair skin (which readily burns) and having a large number of moles. These are hereditary factors, which cannot be modified. • Protective factors include slip/slop/slap/seek/slide (shirt/sunscreen/hat/shade/sunnies) • http://www.youtube.com/watch?v=YzYHwzSE1VY • http://www.youtube.com/watch?v=vaoSfy5-mp4
  • 98. Risk factors and protective factors for cancer • Breast cancer • There are still many unanswered questions regarding the cause of breast cancer. • The major risk factor that is unavoidable is, of course, gender. • Family history of breast cancer increases the risk of developing the disease. • Risk factors associated with lifestyle are believed to be obesity, and a late maternal age (over 40 years) at the time of the first full-term pregnancy. • Regular self examination and checkups are recommended for all women past 25 years old, especially if a family history exists
  • 99. Risk factors and protective factors for cancer • Lung cancer • The risk factors related to lung cancer that are unmodifiable are gender, age and family history. • Risk factors that can be modified include smoking and exposure to carcinogenic chemicals; for example, asbestos and lead. • People who are regular smokers are up to 20 times more likely to develop lung cancer. • It is never too late to give up smoking because the body has the capacity to repair the damage done by smoking, and thus reduce the risk of lung cancer. • http://www.youtube.com/watch?v=6NfMjaVOs6g&feature=related • http://www.youtube.com/watch?v=D0mUHzmnN_4&feature=related • http://www.youtube.com/watch?v=lEc-Rsv9pMc&feature=related
  • 100. Socio-cultural, socio-economic and • Skin caencenr vironmental determinants • The incidence of skin cancer is increasing as a result of improved education relating to detection. • Education and media health promotion strategies have alerted the community to the importance of detecting skin anomalies early, and reporting for medical advice. • This increased education and awareness has resulted in common, less harmful skin cancers being recorded and treated more frequently than in the past, thus resulting in a higher rate of incidence. • In Australia, society has for many decades regarded a suntan as ‘healthy’ and attractive. There has been a shift in attitudes, however, and it is now less fashionable to aspire to the traditional image of the ‘bronzed Aussie’ lifesaver. • Exposure to the sun in the workplace, and in recreational and school activities, is of concern with respect to rates of skin cancer.
  • 101. Socio-cultural, socio-economic and • Breast ecanncevr ironmental determinants • The increased incidence of breast cancer in females can, in part, be linked to changes in family structure and the changing role of women in society. • The average age at marriage is now later, as is the average age of a female’s first pregnancy. • This delay is a response to greater financial demands placed on young families, and the desire of females to focus on establishing a career before having a family. • The result has been more females experiencing their first full-term pregnancy after the age of 40 years, and thus increasing their risk of breast cancer
  • 102. Socio-cultural, socio-economic and • Lung canecernvironmental determinants • The incidence of lung cancer is decreasing in males, reflecting a decrease in the smoking rate over the past two decades. • Improved education and effective health promotion strategies have contributed to this behavioural change, as has society’s changing attitude to smoking. • People are more aware of passive smoking and less tolerant of other people’s smoking, especially in public areas and the workplace. • Improved workplace safety codes and equipment have also resulted in reduced exposure to carcinogenic substances (for example, asbestos) in the workplace. • People of low socio-economic status, however, are more likely to be employed in occupations that involve exposure to dangerous materials, and involve high-risk tasks. These occupations include mining and construction. • In females, the incidence of lung cancer has increased, and smoking levels in young females remain high. • The changing role of females in the workplace might be a cause for this increase in lung cancer. Females are challenging traditional gender roles and stereotypes, and are more active in a range of occupations that previously were the domain of males. These occupations are, in most cases, more ‘high-powered’, which can lead to higher stress levels. • The media might also have a negative influence through the promotion of high-profile, attractive females smoking, and in the promotion of a link between smoking and weight control (which is, of course, important in relation to perceptions of body image)
  • 103. Groups at risk of Cancer
  • 104. Cancer Revision 1 Identify the three leading causes of: a) cancer in males and females b) cancer mortality in males and females. 2 The increase in cancer incidence has been partly attributed to improvements in detection techniques. a) Identify the steps that are available to individuals to detect cancers at the earliest possible time. b) Explain why some people do not take full advantage of available screening services. c) Propose how screening services could be further promoted and utilised. 3 a) There have been significant increases in melanoma (a form of skin cancer) over the last 15 years. Explain why this is so. b) Describe the steps that have been taken to reduce the incidence of skin cancer
  • 106. Diabetes Mellitus • The incidence of diabetes is on the rise in Australia and across the world. • Recent increases in the number of people with diabetes have led to claims that it has now risen to ‘epidemic’ proportions. • Diabetes is a hereditary or developmental disease caused by the improper functioning of the pancreas • This results in a disturbance in the sugar levels (glucose concentration)of the blood. • If there is insufficient sugar in the blood, the condition is known as hypoglycaemia. • Too much sugar in the blood is known as hyperglycaemia. • Type-1 (insulin dependent) diabetes is not a lifestyle disease. • Type-2 diabetes results from a combination of genetic and environmental factors. Although there is a strong genetic predisposition, the risk is greatly increased when associated with lifestyle factors such as: – high blood pressure – overweight or obesity – insufficient physical activity – poor diet – ‘apple shape’ body where extra weight is carried around the waist.
  • 107. Diabetes Mellitus • A person with diabetes has an increased risk of coronary heart disease and atherosclerosis. • Diabetes is also linked to kidney failure, nerve disease in the lower limbs and blindness. • Type 1 - http://www.youtube.com/watch?v=_OOWhuC_9Lw • Type 2 - http://www.youtube.com/watch?v=nBJN7DH83HA&feature=related • Gestational - http://www.youtube.com/watch?v=A-8de9LuVJQ
  • 108. Extent of and trends in diabetes • There has been a significant increase in the number of people with diabetes in Australia over the last 20 years, and it is now a major cause of morbidity and early mortality. • Where diabetes was the underlying cause of death, common conditions listed as associated causes included coronary heart diseases, kidney-related diseases, stroke and heart failure. • There have not been major changes in the death rate from diabetes • More than half (56 per cent) of the people with diabetes also have a disability. • Diabetes is the eighth leading cause of disease and injury in Australia. • Diabetes increases the risk of coronary heart disease and stroke and, when this contribution is added, diabetes is then ranked fourth out of all diseases. • It is projected that by 2023, type-2 diabetes will be the leading specific cause of disease burden for males and the second for females. • Australia has a relatively low prevalence of overall diabetes compared with other countries, ranking the third lowest in 2006
  • 109. Extent of and trends in diabetes
  • 110. Extent of and trends in diabetes
  • 111. Risk factors and protective factors for diabetes • Insulin-dependent diabetes (type 1) • Insulin-dependent diabetes is more common in children and young adults, and is caused by the failure of the pancreas to supply sufficient amounts of insulin to convert glucose into energy. • The cause of insulin dependent diabetes is not confirmed, but is possibly linked to genetic factors and to viral infections contracted while young. • It can also be caused by biological interactions and exposure to environmental agents among genetically predisposed people. • Type-1 diabetes is managed by artificially supplying the body with insulin through regular injections
  • 112. Risk factors and protective factors for diabetes • Non-insulin-dependent diabetes (type 2) • Age is a risk for type-2 diabetes and genetic predisposition is shown by family history and ethnic background. • Unlike type-1 diabetes, non-insulin-dependent diabetes has strong links to lifestyle. • Type-2 diabetes occurs in adults, and is related to obesity, physical inactivity and an unhealthy diet. It is related to high blood pressure, the intake of too much saturated fat and refi ned sugar, and high alcohol consumption. • As such, it is controlled through strict dietary measures and weight reduction. • The protective factors for diabetes include: – regularly participating in physical activity – eating a well-balanced diet – consuming no or little alcohol – limiting the intake of saturated fat and refined sugar – maintaining a healthy weight range.
  • 113. Groups at risk of diabetes • Groups at risk of type-2 diabetes are: – those aged over 65 years – those with a family history of adult onset diabetes – people who are overweight those with high intakes of saturated fat and refined sugar – people who frequently consume alcohol – those who engage in little or no exercise. • ATSI peoples have markedly higher rates of diabetes (specifically type 2) • Six per cent of the total Indigenous population has diabetes/high-sugar level. • The prevalence of diabetes among Indigenous people is almost three times as high as that of non-Indigenous Australians. • There are also higher rates of diabetes among other sections of the Australian community, namely those living in more remote areas, those with lower SES and those born overseas.
  • 114. Diabetes Revision 1 Define diabetes. 2 Describe the differences between type-1 diabetes and type-2 diabetes. 3 Diabetes is considered to be under-reported. Explain why this is so. 4 Discuss the links between the social acceptance of alcohol and the increase in diabetes.
  • 115. FYI - Injury Nature of the problem The term accidents and injuries is used by the World Health Organization to classify deaths resulting from external causes. Extent of problems (trends) • More than 1 in 20 Australians were hospitalised as a result of injury between 2005-2006. • Injuries cased by falls continue to grow in prevalence as a result of an increase in the ageing population Risk factors • Age and gender as well as a person occupation. • Risks from vehicles are due to driver experience, speed, alcohol, driver fatigue and multiple passengers Groups at risk Indigenous people , rural and remote people , socioeconomically disadvantaged people, prisoners, people born overseas, veterans Sociocultural, socioeconomic and environmental determinants Example Media has promoted increased independence of young people through social networking, technology and marketing. Increased independence in an affluent society can result in increased access to motor vehicles. In particular young males with their characteristics and sense of impunity, can impact on a disproportionate number of traffic accident deaths for this group
  • 116. FYI Mental health problems and illnesses Nature of the problem Mental health disorders and mental illness are related conditions that affect the emotional, cognitive behavioural and social wellbeing of the sufferer. Mental health disorders are diagnosable illnesses that can include anxiety, depression substance abuse disorders, dementia, bipolar disorder and schizophrenia. Extent of the problem (trends) • 2005 – mental or behavioural disorders accounted for 2.7 deaths per 100 000 persons • 6.5% of Australians over 65 years suffer from dementia – two thirds o these are females • Dementia is increasing. This is a result of Australia's ageing population Groups at risk Indigenous people , rural and remote people , socioeconomically disadvantaged people, prisoners, people born overseas aged 20 – 34 years and who have never been married, veterans. 25-44 year old males. Sociocultural, socio economic and environmental determinants When their ability to cope is compromised by drugs and alcohol, racism, bullying, negative thoughts, hereditary traits, social isolation and other factors the likelihood of mental problems or disorders is increased.
  • 117. A growing and ageing population
  • 118. A growing and ageing population • Australia has a growing and ageing population. • Older Australians are people aged 65 years and over. • This group makes up approximately 13 per cent of the population. • The proportion of the population aged 65 years and over is projected to rise by between 27 per cent and 30 per cent by 2051. • The ageing of the population is caused by two factors. • First, Australian families are, on average, having fewer children. • The second factor contributing to the ageing population is that we are living longer. • With fewer babies being born, and more people living longer, it is inevitable that the population will become progressively older. • With the population ageing and people living longer, there are more people, particularly those at older ages, who have a disability and are limited in their ability to participate in physical activity • There is thus added pressure on health care services. • Health expenditure increases with age as the greatest costs increase in ones last years of life. • Health care professionals are stretched
  • 119. Growing and ageing population Healthy ageing Healthy older Australians: • Less likely to leave the workforce for health reasons • Are more likely to enjoy retirement • Contribute more to their own communities (volunteers) • Have fewer healthcare needs • Experience less chronic disease and disability • Place less pressure on the national health budget and healthcare system • Australian males aged 65 can expect to live to be 83.1 years, while 65-year-old females have an expected life span of 86.4 years
  • 121. Growing and ageing population Increased population living with chronic disease and disability
  • 122. Growing and ageing population Increased population living with chronic disease and disability • As the age of the sufferer increases, so does the level of disability experienced: – CVD – Cancers – Chronic lung disease – Obesity – Injurious falls – Diabetes type 2 – Poor emotional and psychological wellbeing • Coronary heart disease and cerebrovascular disease (particularly stroke) are the two leading causes of death among older males and females • Lung cancer is the third most common cause of death for older males and the fifth for older females. Colorectal cancer is also high for both sexes, and prostate cancer and breast cancer are two important sex-specific causes of death. • Dementia and related disorders, such as Alzheimer’s disease, still cause many deaths among older Australians. Diabetes is the main underlying cause of death. • For those aged 85 years and over, influenza and pneumonia and kidney failure are among the top causes.
  • 129. Growing and ageing population Increased population living with chronic disease and disability • Some of the most commonly reported chronic conditions are: – Vision and hearing problems – Back pain and disc problems – Hey fever and allergies – Arthritis • Largest increase in chronic disease has occurred in diabetes • Chronic disease impacts on Australia’s burden of disease as it is determined by a a combination of the effect of death AND disease • ACTIVITY • Explain how the concept of ‘healthy ageing’ differs from the good health practices that are promoted for young people. • There is an increasing amount of Australians living with chronic illness or disease. Examine the effects this has for the health care system and its services. • Discuss the roles that carers and volunteers can play in helping people manage chronic disease and disability.
  • 130. Growing and ageing population Demand for health services http://news.theage.com.au/national/govt-ignoring-aged-care-crisis-20090106-7b3g.html • During the last 25 years the Australian medical workforce has increased much more rapidly than the population. • Factors contributing to this include the growing and ageing of the population. • The demand for health care increases with age, and medical workforces are derived from the demand for health care. • Those 55 years and older are the heaviest consumers of medical services. • The rising national health expenditure is likely to be driven by factors: – relative health price increases – a growing population – the ageing of the population • When older people are discharged from hospital, they are less likely than younger people to return to their usual residence, and more likely to enter aged care or die. • Public health efforts can help preventable illness and disability as they age. EG. Screening programs, immunisation programs.
  • 131. Growing and ageing population Demand for health services • Older people rely more heavily on the following health professionals: – Doctors (GP’s) – Dentists – Specialists (bone, heart etc) – Hospitals – Pharmacies – Disability support workers – Counsellors • All these contribute to the wellbeing of the aged population • ACTIVITY • Research at least 2 of these health professionals in depth
  • 132. Growing and ageing population Workforce shortages • A shortage in the health care system exists when the supply of workers can’t meet the demand of health needed • The demand for health care services will increase with the ageing population and improved health technology (better detection and treatments) • Reasons for shortages: – Low numbers of health care professionals being training – Health care professionals working fewer hrs per week – Retirement of health care workers (more then are being trained)
  • 133. Growing and ageing population Availability of carers and volunteers • Most assistance to the elderly comes from family and friends • Service providers that offer aged care in the community and through aged care homes include a mix of private and religious or charitable organisations, as well as state, territory and local governments. • Most older Australians prefer to stay in their own homes, so there are a number of programs available to help with daily living activities that may have become harder for these people to manage on their own. This is called community care • The Home and Community Care (HACC) program aims to meet basic needs to maintain a person’s independence at home and in the community. They include: – Community nursing – Domestic assistance – Personal care – Meals on Wheels – Anglicare – Home modification and maintenance – Transport and community-based respite care.
  • 134. Growing and ageing population Availability of carers and volunteers • For the older person who can no longer live at home because of ageing, illness or disability, there are publicly funded places in aged care homes. This is called ‘residential aged care’ • High-level care provides nursing care when required, meals, laundry, cleaning and personal care, while low-level care gives the person assistance with meals, laundry and personal care. • Older people can struggle with everyday events such as loosing drivers license, mowing the lawn, doing the shopping, loss of a loved one, or even understanding new technologies. • The cost for family caring for the elderly may be: – Financial – family loss of earnings to look after loved one, cost of treatments – Social and Emotional – stress and less opportunity to care and look after own family – National labour force – as more people look after elderly, less people can work, leading to less taxation revenue and therefore increase of treatment costs.
  • 135. Growing and ageing population Availability of carers and volunteers
  • 136. What are the priority issues for improving Australia’s health REVISION • Providing Equity in health does not mean giving equal resources to all population groups. Why? • Not all population groups experience good health. Discuss. • Identify the groups in Australia that experience health inequities. • Outline the major health issues that have an impact on the health status of Australians • Describe the leading causes of death in the ATSI population • Discuss the risk factors and protective factors for health for each of the following: a) Aboriginal and Torres Strait Islander peoples b) socio-economically disadvantaged people • Discuss how the changing nature of the lifestyle patterns of Australians has an impact on the incidence of two major causes of sickness and death. • Outline the major determinants that contribute to the incidence of two of the major causes of sickness and death in Australia. • Assess the impact that the health status of Australians has on the provision of health care facilities and services • Explain why the level of health of older people in Australia is different from that of other population groups in Australia • Assess the impact of a growing and ageing population on health care in Australia
  • 137. What role do health care facilities and services play in achieving better health for all Australians?
  • 140. Health care in Australia • Because the major causes of sickness and death relate to lifestyle, the aim is to improve quality of life through health promotion initiatives that establish environments that enhance positive health behaviour. • The role of health care is to achieve a delicate balance between resources for prevention and resources for treatment. • This changing emphasis towards prevention has been seen in numerous national health campaigns. Examples include HIV/AIDS, breast cancer and mental health. • In summary, the role of health care is no longer simply curative. • Instead, it is concerned with ensuring an improvement in the health of the population as a whole through a combination of preventative strategies and clinical medical care
  • 141. Health care in Australia Range and types of health facilities and services TYPE DESCRIPTION Public Hospital Government owned, used for medical treatments, caters for overnight stays. Medicare covers most payments Private Hospital Individually and community owned, private insurance required. Often has many additional benefits Psychiatric Hospital Used for treatment of people suffering mental illness Nursing Homes Long term care given to people who can’t look after themselves. EG. The elderly/chronically ill Medical Services Refers to GP’s and specialists EG cardiologist, dermatologists, Dental Services Services related to teeth and gum disorders Pharmaceuticals Drugs and medicines. Most drugs are supplied through the pharmaceutical benefits scheme (PBS). Also people can get prescriptions from GP and Over The Counter drugs Professional Services Other health services such as physiotherapists, chiropractor, ambulance Community Health Services Meals on wheels, baby health centres – community based
  • 142. Health care in Australia
  • 143. Health care in Australia Responsibility for health care facilities and services WHO DESCRIPTION Commonwealth Government •Sets policy and legislation (PBS) •Provides funding for health care •Looks after war veterans and ATSI programs State Government •Provides the ACTUAL health services. EG the hospitals •Develops state programs. EG ATSI health in NT •Controls health facilities and employment of staff Local Government •Develops local health promotion campaigns. EG Healthy canteens •Provision of community health services. Private Sector •Provides private medical services and private hospitals •Contributes to research. EG national heart foundation, cancer council, diabetes Australia •Business and companies provide health care facilities. EG workplace gyms Communities •Provides community (often voluntary) services such as meals on wheels, home nursing etc Individual •Responsibility lies with individuals to make wise decisions regarding their need for appropriate health care and effective screening behaviours
  • 144. Health care in Australia Equity of access to health facilities and services • Access to health services and facilities is essential to health and well-being. • The cornerstone of Australia’s health care system is Medicare. Medicare is designed to allow simple and equitable access to all Australian citizens regardless of location and socio-economic status. • Supporting programs, such as the Medicare Safety Net (the amount of what ppl need to pay is capped) and Pharmaceutical Benefits Scheme (government subsidising medicines) , are also in place to promote equity of access. • Although, in principle, equity of access is the intention, some individuals and groups find it difficult to access appropriate health services and facilities. • Medicare does not fully cover, or provide access to, a range of medical services that are vital for maintaining good health. This places people of low SES at a disadvantage. EG speech therapy and physiotherapy. • Access to health services has also been hampered in recent years by overcrowding and lack of bed availability in public hospitals. • Access can also be difficult for people in rural or remote areas • People from non-English speaking backgrounds and different cultures might also not take full advantage of the services available to them. • Actively involving these communities in the establishment and delivery of their health services will result in more effective care and improved health choices.
  • 145. Health care in Australia • ACTIVITY • Identify the ways in which the community takes responsibility for the individual health problems • Do you think that the community’s level of responsibility should be greater or less? Justify you answer • Outline the factors that influence access to health care facilities and services A) Identify the health care services most relevant to you at this point in your life. B) Are they easily accessible? C) Is the quality of service adequate?
  • 146. Health care in Australia Health care expenditure versus early intervention and prevention expenditure
  • 147. Health care in Australia Health care expenditure versus early intervention and prevention expenditure
  • 148. Health care in Australia Health care expenditure versus early intervention and prevention expenditure
  • 149. Health care in Australia Health care expenditure versus early intervention and prevention expenditure
  • 150. Health care in Australia Health care expenditure versus early intervention and prevention expenditure • The majority of health expenditure is on health goods and services, such as medications and hospital care. • A major matter of consideration for all levels of government is the delicate balance of treatment versus early intervention and prevention. • In recent times significant steps have been taken in the area of health promotion and illness prevention. • Health promotion and prevention programs were supported by an increase in funding during the 1990s. • Despite this increase, more than 90 per cent of government health expenditure is still allocated to curative services. • With Australia’s leading causes of death and illness being lifestyle-related, the argument that prevention will be more cost-effective than cure has gained considerable support.
  • 151. Health care in Australia Health care expenditure versus early intervention and prevention expenditure • Prevention programs that have been implemented include: – school medical and dental services – immunisation programs – the fluoridation of water supplies – anti-smoking campaigns – the National Campaign Against Drug Abuse – the National Mental Health Strategy – National HIV/AIDS Program. • Despite the strength of the arguments supporting an increase in preventative measures over curative, there seems little hope for a significant shift in government expenditure in the short term. • Governments are reluctant to cut back on funding to curative health services and divert it towards preventative strategies. • The reason for this is that the results, especially financial savings, are not seen in the short term. • For example, a large amount of expenditure dedicated to reducing the number of young people who smoke or to limiting sun exposure will not be reflected in lower cancer rates— and resultant financial savings—for 15–30 years. For a government currently in office, that expenditure might be more beneficial politically if used to shorten hospital waiting lists or to provide for other over-burdened curative services
  • 152. Health care in Australia Health care expenditure versus early intervention and prevention expenditure • DEBATE the following thoughts: • Governments are reluctant to divert money from curative to preventative measures because it might not win them votes at the ballot box. (For example, closing a hospital or decreasing hospital bed numbers could be politically costly.) What is your opinion of this? • Are there other reasons for so much health expenditure being devoted to cure and so little to prevention?
  • 153. Health care in Australia Impact of emerging new treatments and technologies on health care • Medical technology refers to the proceducers, equipment and processes by which medical care is delivered. • High tech medicine is often linked to high quality health care. • Enhanced quality of health occurs when new technology produces better diagnosis, quicker and more effective treatment. • Technology may also produce new remedies or findings. EG. – New cancer and heart disease drugs – New vaccine developments – Gardasil for cervical cancer – Keyhole surgery brings quicker recovery times – Laser surgery is less invasive – PET (positron emission tomography) allows detection of tumours that may now be found using MRI or CT scans http://www.youtube.com/watch?v=J9pOTlC3IJg&feature=related – Use of robots in surgery http://www.youtube.com/watch?v=k3gIa_w4GXQ • Technology accounts for a large increase in health care costs • Technology advances allow medical workers to diagnose and treat greater numbers • Screening improvements result in higher detection, therefore greater costs in care • Technology increases peoples ability to survive illness and disease. This means they live longer and therefore may contract illnesses later on in life
  • 154. Health care in Australia Impact of emerging new treatments and technologies on health care • Vaccines like Gardasil (cervical cancer) has been recommended for all females between 12-26. The government covered this cost of 3 injections at a price of $460 per person. This naturally raises the health care costs. • Better screening and diagnosis means people are finding illness and disease more effectively. This means that long term treatment should be shorter and therefore less expensive. • Technology advances have seen more day surgeries only. Lowering cost of prolonged stays in hospital. • Technology: – Improves quality of life – Faster return to productivity in the workforce – Better emotional wellbeing for patient and carers • The threat of legal action also puts pressure on medical workers to use latest tech. • Equity considerations need to be made. Making it available to all is important. Mobile breast screening is a good example • People of lower SES are more likely not to have access to latest technology
  • 155. Health care in Australia Health insurance: Medicare and private • Medicare is health insurance that ensures all Australians have access to free or low-cost medical, optometrical and hospital care. Australians are also free to choose private health services. • Medicare was introduced in Australia in 1984 as a national system of health care funding. • It is designed to protect people from the huge costs of sickness and injury by providing free or subsidised medical care, and free hospital treatment in public hospitals. All Australian residents are eligible for Medicare benefits. • Medicare is funded from general taxation revenue plus an additional contribution known as the Medicare Levy. • The Medicare Levy is 1.5 % of each taxpayer’s income, and people pay it in addition to their ordinary income tax. • Individuals and families on higher incomes may have to pay a 1 per cent surcharge in addition to the Medicare Levy if they do not have private health insurance. • The government introduced this change in the hope of encouraging more financially able people to take out private health cover, and thus ease the pressure on the public health system
  • 156. Health care in Australia Health insurance: Medicare and private • http://www.youtube.com/watch?v=eqo9MAmyWQM - medicare and pharmaceutical benefits scheme • http://www.youtube.com/watch?v=5cA2hihzmYA&feature=channel – private vs public health • http://www.youtube.com/watch?v=ta9NjDBwetg&feature=channel Medicare levy surcharge • ACTIVITY • Outline the benefits of private health insurance • Propose why some people choose not to take out private health insurance
  • 157. Health care in Australia Health insurance: Medicare and private Medicare does cover Medicare does not cover • 85 per cent of the MBS fee for out-of-hospital services provided by registered medical practitioners (for example, GPs, specialists, X-rays, pathology tests) • Private patient hospital costs (other than dental examinations and treatment) • 75 per cent of the MBS fee for medical services provided in-hospital • General dental services •The full cost of accommodation and treatment by hospital-appointed doctors for public patients in recognised public hospitals • Ambulance • The full cost of X-rays and pathology tests for public patients • Home nursing • 85 per cent of the cost of eye tests • Physiotherapy • 75 per cent of in-hospital medical procedures performed by oral surgeons (general dental services are covered by Medicare) • Speech therapy • Free out-patient services in some public hospitals • Chiropractic services • Podiatry • Psychology • Acupuncture • Glasses and contact lenses
  • 158. Health care in Australia Health insurance: Medicare and private • Pharmaceutical Benefits Scheme • The Pharmaceutical Benefits Scheme (PBS) was introduced by the Commonwealth Government in 1986. • This scheme subsidises most prescription medicines bought at pharmacies in Australia. The major aim of the PBS is to allow all individuals, regardless of socio-economic status, access to necessary prescription medication.
  • 159. Health care in Australia Health insurance: Medicare and private Private Health Insurance
  • 160. Complementary and alternative health care approaches • Reasons for growth of complementary and alternative health products and services • Complementary and alternative health care approaches is a group of diverse medical and health care systems, practices and products that are not generally considered to be part of conventional medicine. • Australians spend approximately $1 billion per year on alternative health care • Complementary therapies are so-called because they are not necessarily designed to replace orthodox medicine, but are an additional approach that can be used alongside traditional treatments. Treatments such as acupuncture and osteopathy, and the use of herbal medicines, are now far more common than they once were • Another reason for the growth in alternative medicines and health care approaches has been the increase in the number of trained personnel as a result of courses now being provided in some universities • The popularity of alternative medicines and health care is also linked to a reaction in the community against the use of conventional drug-based medication, and a preference by some people for the holistic approach offeredby natural therapies where diet and lifestyle are discussed.
  • 161. Complementary and alternative health care approaches • Reasons for growth of complementary and alternative health products and services • People are also starting to show a greater interest in natural health care because it is designed to prevent illness occurring, whereas conventional medicine is largely reactive. • Another reason for the growth of alternative health care is that some private insurers are now recognising natural therapies and placing them on their benefits list. • ACTIVITY • Explain why alternative medicines are called ‘complementary therapies’. • Describe the factors that have contributed to the increased acceptance and popularity of alternative medicines and approaches. • Outline how a health consumer can ensure that an alternative approach is of some value. • Describe what recourse the consumer has if the treatment is unsuccessful.
  • 162. Complementary and alternative health care approaches • Range of products and services available Type Description Acupuncture Uses fine needles to stimulate change in the energy balance of body to restore health. Can be used for pregnancy and stress also http://www.youtube.com/watch?v=WzMUhD8hecU&feature=channel Aromatherapy Uses oils from nature (plants, flowers) to stimulate or relax the body. Can also maintain resistance from disease. Chiropractic Manipulation of the spine to correct spinal displacements http://www.youtube.com/watch?v=O5wB-iSUsYg&feature=related Herbal Medicine Herbs are used following traditional customs as an alternative to pharmaceutical drugs. Iridology Diagnoses the state of the body from examination of the iris (eye) Naturopathy Based on the belief that the body can heal and maintain itself. Herbs, vitamins, and diet are used to help the person take responsibility for their own health. Many terminal cancer patients try this method. Can be used also for adhd treatment also. Reflexology Reflexes in the feet and hands relate to most the body and can promote healing and relaxation. http://www.youtube.com/watch?v=DRtvN6VLw5s&feature=channel Yoga Yoga has been found to reduce stress and lower blood pressure through a combination of breathing exercises, physical postures and meditation. Osteopathy Osteopathy involves manual deep-tissue massage and the manipulation of the spine, joints and surrounding tissue to alleviate back pain, joint problems and muscular disorders
  • 163. Complementary and alternative health care approaches • How to make informed consumer choice • Despite the increased acceptance of alternative health care approaches there are still many treatment options promoted as cures or remedies that have been designed by unscrupulous dealers attempting to take advantage of people desperate to obtain relief from ailments • It can be difficult to gain information regarding alternative health care. • Many drug companies fund much of the medical research, therefore not much research is dedicated to alternative medicine research as this could take away some of their earning potential
  • 164. WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS REVISION • Evaluate health care in Australia in relation to social justice principles. • Describe the advantages and disadvantages of Medicare and private health insurance. • There is a range of health services and information available to the individual. Justify the factors you would consider when deciding on the suitability of health services and information. • Propose the reasons for the growth of alternative health care approaches in Australia. • Describe how many sectors of the community share the responsibility for health care in Australia • Explain how a greater focus on health promotion and prevention could lead to a decrease in health expenditure in the long term
  • 165. What actions are needed to address Australia's health priorities. Core 1
  • 166. Students le arn about : • health promotion based on the five action areas of the Ottawa Charter: – levels of responsibility for health promotion – the benefits of partnerships in health promotion, e.g. government sector, non-government agencies and the local community – how health promotion based on the Ottawa Charter promotes social justice – the Ottawa Charter in action
  • 167. Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being. - WHO, 2010
  • 169. Health Promotion • http://www.youtube.com/watch?v=FZXVM_ad3No – irish mental health • http://www.youtube.com/watch?v=AY5AILaXDdA&feature=fvw – get active • http://www.youtube.com/watch?v=SfAxUpeVhCg – anti smoking • http://www.youtube.com/watch?v=fnYu9X6b0XE – micro sleep • http://www.youtube.com/watch?v=iCCt-Bo07oc – anti violence • Health Promotion (HP) is a combination of science, medicine, practical skills and beliefs aimed at maintaining and improving the health of all people. • Just as important HP, recognises the importance of changing determinants: – Social (drink driving is socially unacceptable) – Economic (investing in health is important) – Environmental (setting up speed zones, smoke free areas etc) • Health promotion is not just the TV ad or billboard, rather, it involves research, policy development and enforcement and education of the general public.
  • 170. Health promotion based o the five action areas of the Ottawa Charter: • Levels of responsibility for health promotion • Health promotion is not just the responsibility of the health sector but requires a coordinated action by all governments as well as by health and other social and economic sectors, non-government and voluntary organisations, local authorities, industry and the media. • The Ottawa Charter was developed in 1986 to build a global ‘all for health’ movement as a means to realise the right to health of all humans. The five action areas of the Ottawa Charter are: – developing personal skills – creating supportive environments – strengthening community action – reorientating health services – building healthy public policy. – http://pdhpe12.pbworks.com/w/page/10661231/Ottawa-Charter-for-Health-Promotion-(1986) • The charter aims to develop partnerships and support networks with public, private, government, non-government and international organisations to create and maintain actions to promote health
  • 171. Health promotion based o the five action areas of the Ottawa Charter: • Levels of responsibility for health promotion
  • 173. Health promotion based o the five action areas of the Ottawa Charter: • The benefits of partnerships in health promotion • Effective health promotion must involve the cooperation of a variety of government and non-government organisations. • The public health approach acknowledges that effective health promotion requires inter-sectoral involvement. • It also emphasises the importance of creating an environment that is fully supportive of positive health behaviours and actively involves the community. • Inter-sectoral (governments, NGO, community groups, schools, businesses, recreation groups etc) action about a health concern makes possible the joining of all the knowledge available about the health concern • It also allows for access to the resources and skills needed to understand and solve complex issues where possible solutions lie outside the capacity and responsibility of a single sector. • Another benefit is the development of a stronger community network.
  • 174. Health promotion based o the five action areas of the Ottawa Charter: • The benefits of partnerships in health promotion • The National Mental Health Strategy brought together federal government departments with state and territorial governments, community groups, professional associations and private sector organisations to develop an intersectoral response to addressing mental health issues. • Intersectoral action results in increased public awareness; implementation of a range of health, social service, criminal justice and housing services; and networks of partners who continue to work together • There are significant potential benefits to be realised from adopting, supporting and sustaining an intersectoral action approach, including: • a greater capacity to tackle and resolve complex health and social problems that have eluded individual sectors for decades, resulting in improved population health and well-being, and reduced demand for health care and social services in future • a pooling of resources, knowledge and expertise, and development of networks, that will allow partners to address current problems more effectively and position them to respond better to future issues • reductions in duplication of effort among different partners and sectors • new collaborative and inclusive ways of working together that will enable partners to contribute to improvements in social cohesion, provide increased opportunities for sustainable human development, and create a more dynamic and vibrant society.
  • 175. Health promotion based o the five action areas of the Ottawa Charter: • The benefits of partnerships in health promotion • CASE STUDY
  • 176. Health promotion based o the five action areas of the Ottawa Charter: • The benefits of partnerships in health promotion • CASE STUDY
  • 177. Health promotion based on the five action areas of the Ottawa Charter: • The benefits of partnerships in health promotion • Activity • In pairs, create a list of different sectors of the community that are involved in health promotion. EG – Government puts in legislation like no smoking on public transport etc. Analyse for: • Road safety • Skin Cancer • Smoking is a major health concern in Australia. Conduct a review of health promotion strategies designed to reduce smoking. Argue the benefits that partnerships have had on health promotion in relation to smoking.
  • 178. Health promotion based on the five action areas of the Ottawa Charter: • The 5 action areas of Ottawa Charter • The action areas applied to address heart disease: • Reorientating health services – This could include strategies for screening programs to identify risk factors sch as obesity and hypertension. Free check ups for people in high risk categories such as males over 45 and training for doctors to identify high risk patients. • Developments personal Skills – This could include strategies for courses in time management, yoga or other stress management techniques and PDHPE lessons that educate students about nutrition and exercise. • Creating supportive environments – This could include strategies for smoke free zones, workplaces that reduce exposure to tobacco smoke and programs such as QUIT that provide social support to smokers who are trying to give up. • Building healthy public policy – This could include strategies such as no GST applied to fruit and vegetables and high taxes on cigarettes and alcohol. • Strengthening community action – This could include strategies such as healthy canteens in schools, breakfast exercise groups in local communities or community obesity forums.