HSC Core 1: Health Priorities in Australia

How are priority issues for Australias health identified?

Measuring health status: To develop a health profile of a community or population,

specific information is gathered from sources such as the Australian Institute of Health and
Welfare and non-government organisations (Cancer Council and the Heart Foundation).

For the Government and other key organisations need to study health statistics so that:
they can make informed health decisions.
They target health issues that have a problem in the community. E.g. Diabetes
(health priorities)

Role of Epidemiology: The study of the health of a nation.

Provides information on the distribution (or patterns) of disease, illness and injury
and on the likely causes (or determinants) within groups or populations.

Measures of epidemiology:
Life expectancy Average number of years a person of a given age and gender can
expect to live. HOW LONG ARE PEOPLE LIVING?
Infant mortality Measure of the annual number of deaths of children under 1 year
of age per 1000 live births. HOW MANY INFANTS ARE DYING?
Morbidity rates Provides information about the level of disease in specific
populations. HOW MANY PEOPLE HAVE THE DISEASE?
Incidence: Number of newly diagnosed cases of a disease (E.g. How many people
were diagnosed with Breast Cancer in 2013).
Prevalence: Total number of cases of existing in a population. (E.g. How many
women in total have Breast Cancer in Australia).
Mortality Measure of the number of deaths from a specific cause in a given period
of time. (usually a year) HOW MANY PEOPLE ARE DYING FROM A DISEASE?

Identifying priority health issues: At the National Health Summit (1993) the health
ministers of Australia agreed that national goals and targets should be stated and form the
basis of national health policy. From the summit, there is continued acknowledgement of
the need to re-orientate policies and programs towards health prevention and
improvement, rather than simply curative mea
sures and health care services.

Social justice principles: Everyone has the right to equal health opportunities.
The principals of social justice:
Equity Making sure resources and funding are distributed fairly and without
discrimination
Supportive environments Refers to both the physical and social aspects of our
surroundings, access to resources for living and opportunities for empowerment.
 Celebrating diversity involves all community groups in planning and making
decisions about health issues. As well as:
o Recognising the cultural and social diversity of society and examining and
evaluating diverse values, beliefs and attitudes
o Recognising the contributing of social, cultural, economic and biological
factors to individual values, attitudes and behaviours
o Exploring different views about issues such as gender roles, physical activity,
peer-group relationships, sexuality, cultural beliefs and what constitutes a
healthy environment
o Exploring conflicting values, morals and ethics for well-being when making
decisions

Priority population groups: Includes socio-economically disadvantaged people, Aboriginal

and Torres Strait Islander people, people living in rural and remote areas, the elderly, people
with disabilities and people who were born overseas.

Prevalence of condition: Another criterion for the selection of a priority issue was the
current number of cases of the illness or condition. Epidemiology shows that the most
prevalent conditions are:
Cardiovascular disease
Cancer
Injury
Mental health
Diabetes
Asthma

Potential for prevention and early intervention: The incidence of lifestyle-related

conditions can be reduced through behavioural change and environmental modifications,
whereas non-lifestyle related health problems is limited to change and progress is more
reliant on research and medical advances.

Costs to the individual: The impact on the physical, social and emotional health of people
experiencing a condition will vary from individual to individual.
Indirect cost: More difficult to measure, include factors such as emotional trauma and
relationship breakdown.
Direct cost: Those that can be measured, usually through financial means, including cost of
treatment, cost of replacement labour or lost working hours.
Serious illness or injury can result in:
Social isolation
Long-term hospitalisation and lack of mobility
Pressure on relationships and family structures

Costs to the community: Health is a HUGE cost to community. Annual economic cost
(diagnosis, treatment and care) = over $30 billion.
Indirect costs include loss of income and workplace productivity because of illness or
premature death, travel costs of patients, and the costs of caring for an ill person at home.
Factors indicating that Australias health system might come under financial pressure in the
future:
An aging population
A more informed population
Increased use of Medicare
Advances in medical technology

What are the priority issues for improving Australias health?

Groups experiencing health inequities: There are enormous inequalities in the health
status of population groups within Australia. They include:

Aboriginal and Torres Strait Islander peoples: Compared to the rest of Australia, Aboriginals
and Torre Strait islanders generally die younger, are more likely to experience disability and
illness.
Leading causes of death Circulatory disease, cancer, diabetes and respiratory
disease.

Men Women

Other Other

27% 30% Intentional self 30% Intentional self

36%
harm harm

Assault Assault
8%
18%
35% Transport
16% Transport
accidents accidents

Major health issues Mental health (history of the new settlement, loss of land and
culture, high rates of premature mortality, high levels of incarceration, family
separation), diabetes, kidney disease, asthma, skin diseases and communicable
diseases are common.
Causes of inequities lack of access to health services, social factors such as
dispossession, dislocation and discrimination, disadvantaged in education, housing,
income and employment, physical environmental factors.

Socio-economically disadvantaged people: Socio-economic status is determined by income,

occupation and education. 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
Are more likely to suffer from long term health conditions such as diabetes, heart
disease, arthritis, mental health problems and asthma
Less likely to engage in preventative measures such as pap smears and dental check
ups
Are more likely to suffer domestic violence and family breakdown
These problems arise due to financial limitations due to a lack of education, income or
occupation.

People in rural and remote areas: People living in rural and remote areas have poorer
health than those living in cities and metropolitan areas because of:
Lack of access to health services
Lower socio-economic status
Occupational hazards
Poorer overall living conditions (harsher environments)
More likely to smoke
Drug and alcohol abuse

Overseas-born people: When immigrants first come to the country they have generally
better health than Australians, although as they stay and become permanent residents
health deteriorates. This can be because:
Socio-economic disadvantage
Poor language skills that limit their access to employment, health information and
community services
The stress associated with resettlement
Less likely to immunise the children
Less likely to exercise
Less likely to report medical conditions

Elderly: Australia has an aging population. The most common health problems among old
people are:
Cancer
Coronary heart disease
Stroke
Arthritis
Vision and hearing problems
Dementia

People with disabilities: A disability is defined as any limitations to normal functional

abilities. The most common are:
Arthritis
 Respiratory disease
Circulatory disease
Musculoskeletal disorders
Sensory disorders
Mental disorders
A handicap is defined as a more sever disability, and relates to an individuals limitations as
experienced in more complex tasks such as caring for ones self, moving and
communicating. Such as:
Psychiatric conditions
Head injury
Brain injury
Disabled people often experience inequities such as financial constraints, lack of
employment and difficulty accessing health services.

High levels of preventable chronic disease, injury and mental health

problems: Chronic disease causes suffering and disability which reduces quality of life. The
most common include:

Cardiovascular disease: Includes all the diseases and conditions of the heart and blood
vessels.
Risk factors:
Age Risk increases as people age
Heredity People with a family history are more prone to develop the disease
Gender males are more at risk of heart disease than women
Smoking Smokers are 5 times more likely to develop cardiovascular disease
High blood pressure One of the most common causes of heart disease
Lack of physical activity people who do not engage in physical activity regularly can
have a less efficient heart, higher levels of blood fats and a tendency to gain weight.
Protective factors:
Maintain healthy levels of blood pressure and blood cholesterol
Quit smoking
Enjoy healthy eating
Visit the doctor regularly
Be physically active
Achieve and maintain a healthy weight
The people most at risk are:
Males
Aboriginal and Torres Strait islanders
Socio-economically disadvantaged people
Those born in Australia

Cancer: Refers to a group of diseases that result when the process of cell division becomes
uncontrolled. These cells multiply randomly and form tumours.
There are 4 types of cancer:
Carcinoma cancer of epithelial cells (skin, throat, mouth, 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
Skin cancer: Carcinoma cancer
Risk factors:
Exposure to the sun
Excessive exposure to the sun during childhood
Having fair skin
Having a large number of moles
Other hereditary factors
Protective factors:
Reduce exposure to the sun
Use sunscreen
Use sunglasses and hats
Education
Breast cancer: Carcinoma
Risk factors:
Gender
Family history
Lifestyle factors
Obesity
Old age at pregnancy
Protective factors:
Healthy lifestyle
Reasonable aged pregnancy
Preventative measures
Early detection
Lung cancer: Carcinoma
Risk factors:
Gender
Age
Family history
Smoking
Exposure to carcinogenic chemicals (asbestos and lead)
Protective factors:
Dont smoke/quit smoking
Early detection
Reduce exposure to chemicals
Groups most at risk:
Smokers
People who are socio-economically disadvantaged
People with high-fat, low fibre diets
People with a family history of cancer
People with fair skin
People who spend long periods of time exposed to the sun
Women who have never given birth
Diabetes: is a hereditary or developmental disease caused by the improper functioning of
the pancreas.
HYPOglycaemia: Insufficient sugar in the blood.
HYPERglycaemia: Too much sugar in the blood.
Diabetes type 1: Not a lifestyle disease. It is an auto-immune disease and cannot yet be
prevented.
Diabetes type 2: Results from a combination of genetic and environmental factors. There is
a strong genetic predisposition although, the risk is greatly increased when associated with
lifestyle factors such as high blood pressure, overweight or obesity, insufficient physical
activity, poor diet and the apple shape body type.
Groups at risk of diabetes:
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
Aboriginal and Torres Strait islanders

Respiratory disease: A disease that destroys the lung tissue and narrows the air passages to
obstruct oxygen intake, causing chronic shortness of breath.
Risk factors:
Tobacco smoking
Respiratory infections
Exposure to environmental tobacco smoke
Indoor and outdoor air pollution
Occupational dusts and chemicals
Groups at risk:
Aged over 65 and over
People who smoke
Are prone to allergies
Young children (asthma)
Aboriginal and Torres Strait islanders
People from low socio-economic areas
People from non-English spoken backgrounds

Injury: Harm caused by any form of external violence.

Risk factors:
Suicide is linked to social factors such as high levels of unemployment, higher levels
of illicit drug use and increased breakdown in family structure
Depression
Lack of access to counselling and treatment
Speeding
Alcohol
Fatigue when driving
Overcrowding
 Driver inexperience
Environmental conditions
Lack of supervision
Protective factors:
Improvement of car safety
Wearing a helmet
Pool fencing
Smoke alarms
Electrical cut-off switches
Dont take unnecessary risks
Groups at risk of injury:
Elderly people (mostly by falling)
Males aged 15 24
Drivers who speed and/or drink-drive
Young children
Workers in high-risk occupations (mining or construction)

Mental health problems and illness: Mental health has significant impacts on the person,
economic, their social wellbeing, their family and their friends. 1 in 5 Australians will
experience mental illness at some stage of their lives.
Psychotic: Mental illness in which the person loses touch with reality. E.g. schizophrenia and
bipolar disorder.
Non-psychotic: Mental illness in which the person experiences exaggerated feelings of
anxiety, depression and/or fear which can become so overwhelming it interferes with their
ability to complete day to day tasks.
Risk factors:
Genetic factors
Biochemical factors
Family relationships
Environment
Stress
Seasons
Personality
Groups at risk:
Those with a family history
Indigenous males
Those who are frequently exposed to a stressful environment
Those who have experienced significant trauma in their lives
Those with certain personality types e.g. perfectionists

A growing and aging population: Australia has an aging population which is because
of two factors: We are having less babies and we are living longer.

Healthy ageing: Healthy ageing is concerned with quality of life, independence and
lengthening the number of healthy years. All Australians, regardless of age, should have
access to appropriate employment, training, learning, housing, transport, cultural and
recreational opportunities and care services.

Increased population living with chronic disease and disability: The leading causes of death
include:
Coronary heart disease *also lead to disability
Cerebrovascular disease (particularly stroke)
Heart failure
Lung cancer
Colorectal cancer
Prostate cancer
Breast cancer
Emphysema
Dementia
Alzheimers disease
Demand for health services and workforce shortages: The growing and ageing population is
increasing the demand for health care, and therefore increasing national health
expenditure. Likely to be driven by a combination of factors:
Relative health price increases
A growing population
The aging population
Non-demographic growth in health care expenditure in particular
*The older you get, the more you demand healthcare

Availability of carers and volunteers: There are several age care services in Australia:
Private
Religious
Charitable organisations
State, territory and local governments
Community care (carer come to home)
Residential age care (For older person who cannot live at home because of ageing,
illness or disability)
High-level residential care: Provides nursing when required, meals, laundry, cleaning and
personal care.
Low-level residential care: Aids with meals, laundry and personal care.

What roles do health care facilities and services play in achieving

better health for all Australians?

Health care in Australia: Before health care was a curative process adopted by medical
professionals in response to illness or injury.
Today they aim to improve quality of life through health promotion initiatives that improve
the lifestyle of the nation. (prevention > cure)
Range and types of health facilities and services: A combination of public and private
sectors deliver health services, which are provided by the following professionals:
A range of medical practitioners
Nurses
Other health professionals (physio, chiro, natural therapists)
Hospitals
Clinics
Government and non-government agencies
Specialised health services (mental health specialist, alcohol and drug treatment
services

Responsibility for health facilities and services: Responsibility for the funding and delivery
of health services is split among all levels of government, and among many groups within
the public and private sectors.
Public sector: Companies and corporations that are government run.
Private sector: For-profit businesses that are not owned or operated by the government.
Voluntary sector: Charities and non-profit organisations.

Equity of access to health facilities and services: Access to health facilities and services is
essential to health and wellbeing.
Medicare:
POSITIVE Aims to allow equal access to all Australian citizens regardless of location and
socio-economic status.
NEGATIVE Some individuals and groups continue to find it difficult to access appropriate
health services and facilities. Medicare does not fully cover, or provide access to a range of
medical services.
Access is difficult to access for people in rural and remote areas, people that do not
understand the system (from other cultural backgrounds), and hospitals may not be able to
always help people because of overcrowding and lack of bed availability.

Health care expenditure versus early intervention and prevention expenditure: Today 90%
of money goes towards curative measures rather than preventative measures. Expenditure
in prevention would shorten hospital waiting lists and decrease the amount of lifestyle
related diseases, although not much money would be saved as there are many people that
are already ill and need curative treatments.

Impact of emerging new treatments and technologies on health care: Health care
expenditure has greatly increased, because of:
Population increase Pay more to look after more people.
Inflation E.g. 1 billion a decade ago was much more than it is today.
Australias wealth Has increased in the last 20 years, spend extra wealth on health.
Medical research and technology New treatments discovered can be expensive.
Ageing population Older people require more medical care.
Health expenditure is accelerating faster than we thought and there are concerns whether
Australia can sustain the long-term health budget.
The main factors for the recent increase are:
More expensive medical treatments
 More visits to doctors and other health care professionals by people of all ages
Ageing population
To try decrease health expenses the government and organisations are encouraging:
A better-informed population on health
Screening
Preventative measures
Less invasive check-up treatments
Less cost to the individual and the community
Greater chance of recovery]
Medicare

Health insurance: Medicare and Private

Medicare: Is designed to guarantee every Australian resident has access to low-cost
medical, optometric, and hospital care. (Prevents huge medical costs to individuals)
Medicare does cover Medicare does not cover
85% of the fee of out of hospital General dental services
services such as GPs, specialists, X- Private patient hospital costs
rays, pathology tests Ambulance
75% of the fee of medical services Home nursing
provided in hospital Physiotherapy
85% of the cost of eye tests Speech therapy
Full cost of accommodation and Chiropractic services
treatment by hospital-appointed Podiatry
doctors for public patients in Psychology
recognised public hospitals Acupuncture
Full cost of X-rays and pathology Glasses and contact lenses
tests for public patients Hearing aids
75% of in hospital medical Medicines
procedures performed by oral Some medical costs incurred
surgeons overseas
Free out-patient services in some
public hospitals
Private health insurance: Offers insurance cover for various services provided in public and
private hospitals, and a range of cover for non-hospital health and health-related services,
such as dentistry, physio, chiro, podiatry, spectacles and pharmaceuticals.
BASICALLY, pay extra to get more cover and to cover the things Medicare doesnt.

Complementary and alternative health care approaches: Is a group of diverse

medical and health care systems, practices and products that are not generally considered
part of conventional medicine. E.g. Acupuncture, naturopathy, herbal medicine etc.
Reasons for growth of complementary and alternative health products and services:
Money spent on alternative health care is increasing. Popularity of these methods have
increased because:
Designed to prevent illness occurring (prevention)
Now seeing it as something along-side orthodox medicine to help improve and
maintain health more efficiently
Increase in trained personnel
More courses available at universities
Dangers and side effects associated with some pharmaceuticals
Private insurances are recognising it and placing it on their benefits list

Range of products and services available:

Acupuncture Painless insertion of very fine needles into the skin at certain points
to relieve pain and manage conditions such as asthma.
Chiropractic treatment To relieve pain and improve health through the
manipulation of the spine.
Osteopathy Manual deep-tissue massage and the manipulation of the spine, joints
and surrounding tissue to reduce back pain, joint problems and muscular disorders.
Naturopathy Involves treating the whole person by harnessing the bodys natural
ability to heal itself by including massage, relaxation techniques, herbal medicine
and nutrition.
Herbal medicine Using plants and plant extracts to create natural medicine.
Homeopathy The notion that using substances (usually herbal or mineral) that
produce symptoms of illness in a healthy person will cure that same illness in a sick
person. Given a very small dosage of the substance.
Yoga Reducing stress and lower blood pressure through a combination of
breathing exercises, physical postures and meditation.
Aromatherapy A combination of specialised massage techniques using blends of
different oils to treat stress and skin disorders.

How to make informed consumer choices: To avoid falling for false health information or
products, ensure you are aware of things that sound unbelievable (lose 10 kilos in a week
with this product), put thought and time into selecting a natural therapist and ensure the
practitioner is accredited before using the service.
Department of fair trading ensures that advertising is truthful and not misleading.

What actions are needed to address Australias health priorities?

Health promotion based on the five action areas of the Ottawa Charter: Over
the last 20 years there has been rapid growth in the way health issues are addressed
through health promotion.
Health promotion: A comprehensive social and political process, not only including actions
directed at strengthening the skills and capabilities of individuals, but also action directed
towards changing social, environmental and economic conditions to lessen their impact on
public and individual health.
Ottawa charter: Framework for health promotion, that aims to educate the mass
population by individuals and the community working together (partnership) to create a
healthy country.
5 Action areas:
Developing personal skills
Creating supportive environments
Reorientating health services
Building healthy public policy
Strengthening community action

Levels of responsibility for health promotion:

Everyone is responsible for promoting health, either as an individual, member of a
family or community
Coordinated action by all governments, by health and other social and economic
sectors, non-government and voluntary organisations, local authorities, industry and
the media.
Professional and social groups and health personnel have the responsibility to
mediate between differing interests in society for the pursuit of health.
The Ottawa Charter aims to develop partnerships and support networks with public, private,
government, non-government and international organisations to create and maintain
actions to improve health.

Responsibility at the national level: To create an environment for improving health by:
Providing coordination and leadership
Encouraging state, federal and territorial collaboration
Providing the public with information and resources they need
Working together with international bodies to share information
Developing infrastructure to establish and support a social health approach
Responsibility at state and territorial level: work together to:
Develop healthy public policies
Balance investments
Regularly provide health information
Develop health goals and effective frameworks or structures that improve the health
of the entire population and reduce inequities
Responsibility of the private sector: To ensure that it provides a safe and healthy working
environment that has opportunities for continuous learning, as well as protecting the
environment and contributing to the overall well-being of the community.
Responsibility at the community level: Developing partnerships that address the
determinants of health. E.g. Government provides funding to health related organisations
(Heart Foundation, Cancer Council) to:
Support research
Plan and provide high quality services that promote health
Share information and resources designed to have optimum health impacts
 Involve the individuals who have interest in setting priorities and implementing
programs
Responsibility of the individual: Can contribute by:
Taking responsibility for our own health and well-being
Actively seeking out the information to make informed health decisions
Building supportive communities
Participating in community activities that have an impact on health

The benefits of partnerships in health promotion: improving health is a shared

responsibility
Intersectoral collaboration: The teamwork among health and other groups to improve
health outcomes. The potential benefits of adopting, supporting and sustaining an
intersectoral action approach:
A greater capacity to tackle and resolve complex health and social problems that
result in improved population health and well-being, and reduced demand for health
care and social services in the future
Pooling of resources, knowledge and expertise, and development of networks, that
will allow partners to address current problems more effectively and set them up to
respond to future issues better
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 unity, provide increased opportunities for
sustainable human development, and create a more dynamic and vibrant society.

How health promotion based on the Ottawa Charter promotes social justice: The Ottawa
Charter promotes social justice as it is designed to provide access to health opportunities for
all members of society.
The Ottawa charter refers to health promotion as the process of enabling people to
increase control over, and to improve, their health

The Ottawa Charter in action: The 5 action areas of the Ottawa Charter (developing
personal skills, reorientating health services, creating supportive environments, building
healthy public policy, strengthening community action) reflect the public health approach,
with emphasis on social justice issues.
The 6 priority issues for investigation are:
Cardiovascular disease
Cancer
Diabetes
Respiratory disease
Injury
Mental health problems and illnesses