Health and Human Development 1&2

KEY CONCEPTS in VCE
HEALTH & HUMAN

DEVELOPMENT THIRD EDITION
UNITS 1 & 2
KEY CONCEPTS in VCE
HEALTH & HUMAN
DEVELOPMENT THIRD EDITION
UNITS 1 & 2
Andrew BEAUMONT
Lee-Anne MARSH
Agatha PANETTA
Series editor:
Meredith FETTLING
Third edition published 2014 by
John Wiley & Sons Australia, Ltd
42 McDougall Street, Milton, Qld 4064
First edition published 2010
Second edition published 2012
Typeset in 10.5/12 pt Berkeley LT
© Andrew Beaumont, Lee-Anne Marsh, Agatha Panetta, Meredith Fettling 2010, 2012, 2014
The moral rights of the authors have been asserted.
National Library of Australia

Cataloguing-in-publication data
Author: Beaumont, Andrew.

Title: Key concepts in VCE health & human development. Units 1 & 2 /Andrew Beaumont,
Lee-Anne Marsh, Agatha Panetta.
Edition: 3rd ed.
ISBN: 978 1 118 59908 2 (pbk)
978 1 118 59906 8 (ebook)
978 1 118 59897 9 (loose-leaf)
Notes: Includes index.
Target audience: For secondary school age.
Subjects: Health behaviour — Study and teaching (Secondary) — Victoria — Textbooks.
Human growth — Study and teaching (Secondary) — Victoria — Textbooks.
Health education (Secondary) — Victoria — Textbooks.
Other authors/
contributors: Panetta, Agatha. Marsh, Lee-Anne.
Dewey number: 613
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CONTENTS
About eBookPLUS ix
Acknowledgements x
Unit 1 The health and development of Australia’s youth 1

CHAPTER 1 The individual human development of Australia’s youth 2
1.1 The human lifespan: an overview 4
1.2 Exploring individual human development: physical 9
1.3 Exploring individual human development: social 11
1.4 Exploring individual human development: emotional and intellectual 14
1.5 Individual human development during youth: physical 19
1.6 The impact of biological determinants on youth development 22
1.7 Individual human development during youth: social, emotional
and intellectual 28
KEY SKILLS The individual human development of Australia’s youth 31
Chapter 1 review 35
CHAPTER 2 The health of Australia’s youth 38

2.1 What is health? 40
2.2 The health status of Australia’s youth 48
2.3
The health status of Australia’s youth: morbidity and burden of disease 53
2.4 The impact of biological determinants on youth health 58
2.5
Understanding the interrelationships between health and
individual human development during youth 62
KEY SKILLS The health of Australia’s youth 64
Chapter 2 review 70
CHAPTER 3 Nutrition during youth 72

3.1
Introduction to the nutrients required during youth:
carbohydrates, protein and fats 74
3.2
Introduction to the nutrients required during youth: water,
calcium and iron 80
3.3
Introduction to the nutrients required during youth: vitamins A, B, C and D 85
3.4
The interrelationship of major nutrients 88
3.5
Consequences of nutritional imbalance 95
3.6
Food selection models as tools to promote healthy eating during youth 99
KEY SKILLS Nutrition during youth 105
Chapter 3 review 108
CHAPTER 4 T he determinants of health and individual human

development of Australia’s youth 110
4.1 Determinants of health and individual human development
during youth: four categories 112
4.2
Determinants of health and individual human development
during youth: behavioural 115
during youth: physical environment 124
during youth: social environment 128
KEY SKILLS The determinants of health and individual human
development of Australia’s youth 134
CHAPTER 5 Health issues facing Australia’s youth 138
5.1 Health issues facing Australia’s youth 140
5.2 A health issue in focus: anxiety and depression, part 1 150
KEY SKILLS Health issues facing Australia’s youth 164
Unit 2 Individual human development and health issues 173

CHAPTER 6 Health and individual human development during
the prenatal stage of the lifespan 174
6.1 Fertilisation 176
6.2 Prenatal development 179
6.3 The health status of Australia’s pregnant women and unborn babies 182
KEY SKILLS Determinants of prenatal health and development 188
CHAPTER 7 The determinants of health and individual human

development during the prenatal stage 192
7.1 Determinants of health and individual development
during the prenatal stage of the lifespan: biological 194
during the prenatal stage of the lifespan: behavioural 199
during the prenatal stage of the lifespan: physical environment 206
during the prenatal stage of the lifespan: social 209
7.5 Determinants that act as risk and/or protective factors in
relation to one health issue 212
7.6 Strategies and programs designed to promote prenatal health
and individual development 219
development during the prenatal stage 224
CHAPTER 8 The health and individual human development

of Australia’s children 230
8.1 Principles of individual human development 232
8.2 Development during infancy 235
8.3 Development during early childhood 239
8.4 Development during late childhood 242
8.5 The health status of Australia’s children: mortality 244
8.6 The health status of Australia’s children: morbidity 247
KEY SKILLS The health and individual human development
of Australia’s children 252

development of Australia’s children 256
9.1
The determinants of health and individual human development 258
9.2
Biological determinants: genetics 260
vi
Contents
9.3 Biological determinants: birth weight and body weight 266
9.4 Behavioural determinants: breastfeeding 270
9.5 Behavioural determinants: vaccination 272
9.6 Behavioural determinants: eating habits and level of physical activity 276
9.7 Behavioural determinants: oral hygiene 282
9.8 Physical environment determinants: tobacco smoke in the home 284
9.9 Physical environment determinants: housing environment and
fluoridation of water 286
9.10
Physical environment determinants: access to recreational facilities 290
9.11
Social environment (family) determinants: parental education 292
9.12
Social environment (family) determinants: parenting practices 294
Sections 9.15 onwards
9.13
Social environment (community) determinants: media 297
containing Key
9.14
Social environment (community) determinants: access to
Knowledge 2.5 and Key
health care 299
Knowledge 2.6 can be
KEY SKILLS The determinants of health and individual human found online in your
development of Australia’s children 302 eBookPLUS.
CHAPTER 10 The health and individual human development

of Australia’s adults 308
10.1
Early adulthood: physical and social development 310
10.2
Early adulthood: emotional and intellectual development 315
10.3
Middle adulthood 318
10.4
Late adulthood 322
10.5
The health status of Australia’s adults 327

of Australia’s adults 334

development of Australia’s adults 338
11.1 Biological determinants: genetics 340
11.2 Biological determinants: body weight 345
11.3 Biological determinants: blood pressure 348
11.4 Biological determinants: blood cholesterol 353
11.5 Behavioural determinants: sun protection and smoking 355
11.6 Behavioural determinants: physical activity 360
11.7 Behavioural determinants: food intake 363
11.8 Behavioural determinants: alcohol use 366
11.9 Behavioural determinants: drug use 369
11.10 Behavioural determinants: sexual practices 373
11.11 Physical environment determinants: housing and
workplace safety376
11.12 Physical environment determinants: neighbourhood
safety and access to health care381
11.13 Social determinants: the media, level of education,
employment status and income387
11.14 Social determinants: the workplace and community belonging391
11.15 Social determinants: living arrangements and social support396
11.16 Social determinants: family and work–life balance399
development of Australia’s adults 404
Contents vii
CHAPTER 12 Health issues facing Australian adults 412
12.1 Determinants that act as risk and/or protective factors in relation
to obesity 414
12.2 Determinants that act as risk and/or protective factors
in relation to cardiovascular disease 417
12.3 Determinants that act as risk and/or protective factors in relation
to cancer 421
in relation to type 2 diabetes 424
in relation to mental illness 427
12.6 Government strategies and programs to promote health
and individual human development of adults 431
12.7 Strategies and programs designed to promote health
and individual human development of adults 437
KEY SKILLS Health issues facing adults 440
Index 445
viii Contents
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Acknowledgements
Various data throughout the chapters have been sourced Chris Rogers, 280 (top)/© Miodrag Gajic, 295/Tomaz Levstek,
from the Australian Institute of Health and Welfare (AIHW). 324 (top), 355/© Lisa Kyle Young, 363/Anne Clark, 374 (bottom)/
The authors and publisher would also like to thank the cre8tive_studios, 384/Sebastian Kaulitzki, 387/narvikk • John
following copyright holders, organisations and individuals Wiley & Sons Australia: pages 80/Taken by Kari-Ann Tapp, 376/
Photo by Coo-ee Picture Library, 379 (top)/Taken by Kari-Ann
for their assistance and for permission to reproduce
Tapp • John Wiley & Sons, Inc.: page 234 (left and right)/
copyright material in this book. Figure 29.14 (c and e) from Principles of Anatomy & Physiology
by Tortora & Grabowski, 10th edition, © 2003, John Wiley &
Images: Sons, Inc. • Mission Australia: page 128 (bottom)/Extract
• Alamy Limited: pages 7/© Eliane SULLE, 174–5/© Frans Lanting from Mission Australia’s Youth Survey 2012, available at http://
Studio, 436/© David Hoffman Photo Library • Australian Bureau www.mayouthsurvey.com.au • National Health and Medical
of Statistics: pages 215 (centre), 345 (top), 348 (bottom), 358, Research Council: page 99 • National Heart Foundation: page
360 (bottom), 374 (top)/Australian Bureau of Statistics; National 437 (bottom) • © Newspix: pages 286/Renee Nowytarger, 385/
Notifiable Disease Surveillance System, 378 (top and bottom), 381 Joanna Fincham, 434/Ben Swinnerton • PhotoAlto: page 150
(left), 394, 415 (top), 418 (bottom), 421 (bottom), 424 (bottom), (bottom)/©Patrick Sheándell O’Carroll • © Photodisc: pages 61,
428 (bottom) • AAPEC — Australian Action on Pre-Eclampsia: 74 (top), 85, 86 (top), 155 (bottom), 270, 299 (bottom and
page 222 (bottom) • Australian Institute of Health and Welfare: top), 319, 360 (top), 370, 399 • Royal Life Saving Society: page
pages 182, 184 (top), 209, 245 (bottom), 245 (top), 247, 248 141 (bottom) • Shutterstock: pages 2–3/NotarYES, 5 (bottom)/
(top and bottom), 252, 327 (top and bottom), 328 (bottom), Peter Bernik, 5 (top)/timquom, 10 (bottom)/Rido, 14 (top)/
366 (bottom); 49, 67 (top), 118 (bottom), 120, 125 (bottom), Inna Astakhova, 16/Diego Cervo, 28/Pressmaster, 38–9/YanLev,
141 (top), 144 (middle), 146 (bottom), 147, 164, 165, 166, 167 40/© Jorge Salcedo, 2009, 42/Andresr, 43 (top)/© AVANA, 2009,
(top)/Graphs taken from Young Australians: their health and wellbeing 44 (bottom)/Stuart Jenner, 45 (bottom)/Charles T. Bennett, 48/
2011; 125 (top)/Graph taken from Young Australians: their health and Ahturner, 53/Alexander Raths, 72–73/Monkey Business Images, 74
wellbeing 2007; 244 (top), 250 (bottom), 251/Graphs taken from (bottom)/andreasnikolas, 75 (top)/Elena Schweitzer, 78 (bottom)/
Making Progress: the health, development and wellbeing of Australia’s Elenadesign, 78 (middle)/Eugene Sergeev, 78 (top)/isak55, 83/
children and young people 2008; 303/Graph taken from A Picture of © Sebastian Kaulitzki, 2009, 86 (bottom)/Jeka, 96/© Sandra Voogt
Australia’s Children 2009; 353 (bottom)/Graph taken from Australia’s 2011, 110–11/auremar, 113/Solovyova Lyudmyla, 119/Monkey
Health 2008; 369 (bottom)/Graph taken from 2010 National Drug Business Images, 122 (bottom)/Iakov Filimonov, 122 (top)/
Strategy Household Survey Report; 383 (top), 390/Graphs taken Monkey Business Images, 128 (top)/Monkey Business Images,
from Australia’s Health 2010. Reproduced with permission from 131 (bottom right)/Lev Kropotov, 132/l i g h t p o e t, 142 (top)/
Australian Institute of Health and Welfare • © Banana Stock: evgenymate, 148/© Shevelev Vladimir, 153/Sylvie Bouchard,
pages 239 (bottom), 242 (bottom), 290 • Better Health Channel: 154/© Tracy Whiteside, 155 (top)/bikeriderlondon, 156/Andresr,
page 221/Reproduced with permission from Better Health 162/© Lisa F. Young, 2009, 184 (bottom)/Denis Kuvaev, 192–3/
Channel, Department of Health, Victoria • beyondblue: pages 158 Janna Golovacheva, 199/holbox, 200 (bottom)/Vasaleks, 201/
(bottom), 222 (top)/Reproduced with permission of beyondblue Valua Vitaly, 206/Zurijeta, 214 (bottom)/Karl J Blessing, 219/
• Cancer Council Victoria: pages 343/Illustration by Con Stamatis, Monkey Business Images, 220 (top)/Maurizio Milanesio, 230–1/
356/Reproduced with permission of Cancer Council Victoria stefanolunardi, 232 (top)/Marina Dyakonova, 235 (bottom)/
• © Centers for Disease Control and Prevention (CDC): pages 25, Hannes Eichinger, 235 (top)/Andrey_Kuzmin, 236/Alexey
26 (top), 212 (right), 266 (bottom), 268, 300 • Copyright Losevich, 237/Denis Omelchenko, 239 (top)/VikaRayu, 240/Tom
Clearance Center: page 212 (left)/Reprinted by permission from Wang, 242 (top)/jean Schweitzer, 243/Oksana Kuzmina, 256–7/
Macmillan Publishers Ltd • ©Diabetes Australia: page 437 (top) BestPhotoStudio, 258/YanLev, 260 (top)/© aquatic creature,
• © Digital Vision: pages 6, 112 (bottom), 138–9, 328 (top), 349 2009, 266 (top)/Santibhavank P, 267/Vibe Images, 272/Dmitry
(right), 366 (top) • © Fairfax Syndications (Photos): page 393/ Naumov, 276/Monkey Business Images, 277/Maryna Pleshkun,
Joe Armao • © Getty Images: pages 46/Fuse, 58/Science Photo 280 (bottom)/© Monkey Business Images, 2009, 282 (bottom)/
Library, 75 (bottom)/STEVE GSCHMEISSNER, 86 (middle)/Science © Hirlesteanu Constantin-Ciprian, 2009, 282 (top)/gorillaimages,
Photo Library, 115 (bottom)/Jodi Jacobson, 200 (top)/Southern 288/© Eric Cote, 2009, 289/Konstantin Chagin, 292/Monkey
Illinois University, 213/Anne Ackermann, 214 (top)/UIG via Getty Business Images, 293/wavebreakmedia, 294/Iakov Filimonov,
Images, 217/BSIP/UIG, 238/Dorling Kindersley, 350 (bottom)/ 308–9/© Dana E. Fry, 310 (right)/© Yuri Arcurs, 2009, 311/
© Living Art Enterprises/Photo Researchers, 357/Science Photo Deklofenak, 312 (bottom)/© Mikhail Tchkheidze, 2011, 312 (top)/
Library, 383 (bottom)/Ben Edwards, 433/Vicky Kasala Productions taro911 Photographer, 315/Ariwasabi, 320 (bottom)/kuleczka,
• Haemophilia Foundation: page 196/© Haemophilia Foundation 320 (top)/michaeljung, 323/Cheryl E. Davis, 324 (bottom)/
Australia (HFA) 2013 www.haemophilia.org.au • Healthdirect Diego Cervo, 325/Darren Baker, 338–9/Kzenon, 340/© Jack
Australia: page 220 (bottom) • © iStockphoto: pages 8/pollypic, Cronkhite, 2009, 342/© Alexander Raths, 345 (bottom)/© Jakub
10 (top)/Pascal Genest, 11 (bottom)/Paperboat, 17 (bottom)/ Cejpek, 2009, 348 (top)/Andrey_Popov, 353 (top)/Berents, 354/
Anetta Romanenko, 17 (top)/walkerphotography, 29/asiseeit, 30 Yuganov Konstantin, 369 (top)/Shcherbakov Ilya, 373/© vgstudio,
(top)/Chris Schmidt, 115 (top)/Shane White, 118 (top)/ranplett, 2009, 375/Pressmaster, 377 (top)/wavebreakmedia, 381 (right)/
126 (bottom)/Devon Stephens, 126 (top)/Carrie Bottomley, 140/ © Johanna Goodyear, 2009, 391/mast3r, 392/mast3r, 396/
rrocio, 160/Galina Barskaya, 178/© ktsimage, 232 (bottom)/ © Yuri Arcurs, 397/© amrita, 2009, 400 (bottom)/Ivonne Wierink,
© Sveta Kashkina, 263/© Ruslan Anatolevich Kuzmenkov, 264/ 400 (top)/© Deklofenak, 401/Monkey Business Images, 412–13/
x
Acknowledgements
Robert Kneschke, 414/grynold, 415 (bottom)/MarFot, 421 (top)/ Fields a sports venue for everyone’ by Nadja Poljo, Berwick
Lightspring, 422 (bottom)/Romanchuck Dimitry, 422 (top)/Daniel Leader, 23/02/11 © News Limited. This work has been licensed
Rajszczak, 427/ARENA Creative, 428 (top)/luxorphoto, 429/ by Copyright Agency; 302–3/‘Passive smoke: Kids’ health at risk’,
bikeriderlondon, 438/Blend Images, 439/Monkey Business Images Woman’s Day, 15 June 2010 © ninemsn Pty Ltd; 313–14/‘Not
• SANE Australia: page 158 (top)/Reproduced with permission quite grown up’ by Sarina Lewis, The Sydney Morning Herald
from SANE Australia www.sane.org • Susan Astley, Professor, 12 November 2010. © Fairfax Media; 316/‘Half of young people
PhD, University of Washington: page 216 • Transport Accident unable to read well, Australian Bureau of Statistics report finds’
Commission, Victoria: page 167 (bottom) • VicHealth: page 435 by Justine Ferrari, The Australian, 24 July 2008 © News Limited;
325–26/‘Baby boomers to fill the gaps in life-stage wasteland’ by
Text: Bernard Salt, The Australian, 25 November 2010 © News Limited;
• Australian Bureau of Statistics: pages 49, 397 • ABC: pages 147–8/ 331–3/‘Losing your self’ by Miriam Cosic, The Sydney Morning
‘Youth chlamydia rate on the rise’ by Michael Turtle, first published Herald, 2 March 2013 © Fairfax Media; 371–2/From ‘Men risk
by ABC Online, 8 October 2007. Reproduced by permission of health for a boost of youth’ by Jill Stark and Cameron Houston,
the Australian Broadcasting Corporation and ABC Online. © 2007 The Sunday Age, 10 May 2009 © Fairfax Media; 382/‘Stonnington’s
ABC. All rights reserved. • Australian Institute of Health and crime rate plummets’ by Liam Ryan, Stonnington Leader, 15 June
Welfare: pages 115 (table 4.1)/Table taken from Young Australians: 2010 © News Limited; 392/‘Overwork, mental stress costs $30
their health and wellbeing 2011; 117 (table 4.4), 119 (table 4.5)/ billion’ by Simon Benson, The Advertiser, 13 March 2012 © News
Tables taken from 2007 National Drug Strategy Household Survey Limited; 402–3/‘Five ways to balance work and life; by Lakshmi
(first results); 144 (table 5.2), 151 (table 5.6)/Tables taken from Sing, body+soul (online) © News Limited; 423/‘Push for cancer
Young Australians: their health and wellbeing 2007; 144 (table 5.3), screening of smokers’ by Robyn Riley, Sunday Herald Sun,
288 (table 9.11), 328 (table 10.1), 329 (table 10.2), 330 19 February 2012 © News Limited; 426/‘Australians ignorant on
(table 10.4)/Tables based on Australian Institute of Health and dangers of type 2 diabetes to their health’ by Jordanna Schriever,
Welfare material; 146 (tables 5.4 and 5.5)/Tables taken from 2010 The Advertiser, 11 March 2013 © News Limited • Centers for
National Drug Strategy Household Survey report; 246 (table 8.3)/ Disease Control and Prevention: page 268 • Department of Health
Table taken from A picture of Australia’s children 2009; 329–30 and Ageing: pages 431–2/From the Department of Health and
(table 10.3), 361 (table 11.5), 388 (table 11.9), 389 (table 11.10), Ageing webpage ‘Physical Activity’, used by permission of the
405 (table 11.14), 406 (table 11.15)/Tables taken from Australia’s Australian Government • Department of Health Victoria: page 274
Health 2010 • Better Health Channel: page 88/Table created • Kidsafe QLD Inc.: page 287 • Mission Australia: page 131/Extract
with data sourced from Better Health Channel, 205/Reproduced from National Survey of Young Australians 2010: Key and emerging
with permission from Better Health Channel, Department of Issues, available at www.mayouthsurvey.com.au • National Rural
Health, Victoria • beyondblue: page 46/‘Confronting the issue’ Health Alliance: page 208/media release, 11 May 2012 • National
by Leonie Young (beyondblue) and Chris Tanti (headspace), Health and Medical Research Council: page 279/The Australian
published in Moorabbin/Glen Eira Standard, 21 November 2007. Dietary Guidelines • Telegraph Media Group: pages 12–13/
Reproduced with permission from beyondblue and headspace ‘Cry of an Enfant Sauvage’ by Elizabeth Grice, 17 July 2006,
• Community Kitchens: page 386/Reproduced from www. The Daily Telegraph • Tribune Media Services: page 7/‘Bedtimes
communitykitchens.org.au with permission from Peninsula Health, could pinpoint the end of adolescence’ by Andy Coghlan, New
Victoria • Copyright Agency Limited: page 82/‘Strong bones key Scientist, 8 January 2005 © 2005 Reed Business Information —
to health’ by Angela Thompson, Illawarra Mercury, 2 August 2008 UK • Victorian Curriculum and Assessment Authority: All
© Fairfax Media; 113/‘Fit dads mean healthy kids — study’ by chapter openers, pages 3, 39, 309/VCAA Study Design: Health
Vikki Campion, The Daily Telegraph, 18 August 2008 © News and Human Development 2010–2013/All Victorian Curriculum
Limited; 126–7/‘Whitehorse gymnasts left high and dry’ by and Assessment Authority (VCAA) material is copyright and is
Gareth Trickey, Herald Sun, 3 October 2008 © News Limited; reproduced with permission. For more information, go to www.
145/‘Bingeing women take risks’ by Mario Xuereb, The Sunday Age, vcaa.vic.edu.au The VCAA does not endorse and is not associated
7 September 2008 © Fairfax Media; 152/‘Mental illness ravaging with this product.
nation’s youth’ by Jill Stark, The Age, 3 April 2009 © Fairfax Media;
159/‘Fewer people receiving mental health treatment’ by Adam
Cresswell, The Australian, 24 October 2008 © News Limited;
Every effort has been made to trace the ownership of
203/‘Please don’t do what I did, pleads mother who drank’ by copyright material. Information that will enable the
Renee Switzer, The Age, 22 April 2007 © Fairfax Media; 233/‘Spare publisher to rectify any error or omission in subsequent
the comparisons’ by Michael Grose, published in ‘Body & Soul’, reprints will be welcome. In such cases, please contact the
Sunday Herald Sun, 26 April 2009 © News Limited; 291/‘Casey Permission Section of John Wiley & Sons Australia, Ltd.
Acknowledgements xi
1.1 Understanding health Unit 1
THE HEALTH AND
DEVELOPMENT OF
AUSTRALIA’S YOUTH
AREA OF STUDY OUTCOME

1 Understanding youth Describe the dimensions of, and the interrelationships within and between,
health and human youth health and individual human development, and analyse the health status
development of Australia’s youth using appropriate measurements.
2 Youth issues Describe and explain the factors that have an impact on the health and
individual human development of Australia’s youth, outline health issues
relevant to Australia’s youth and, in relation to a specific health issue, analyse
strategies or programs that have an impact on youth health and development.
The individual human development

Key of
nutrients
Australia’s
for health 1 1
youth • CHAPTER 5
1.1
CHAPTER 1
Chapter 8
Understanding health
The individual human
development
Global health of
and
Australia’s
human youth
development
WHY IS THIS IMPORTANT?
Individual human development is a constant process that
starts with conception and ends with death. The youth
stage of the lifespan is one of great change and significant
development. Having an understanding of the development
that occurs during this stage can provide an insight into the
triumphs and challenges experienced by many youths.
Key knowledge
1.1 definitions of physical, social, emotional and intellectual development
(pages 4–18)
1.2 characteristics of, and interrelationships between, physical, social,
emotional and intellectual development during the lifespan stage of
youth (pages 19–30).
Key skills
• define health and individual human development
• describe characteristics of, and interrelationships between, the
different types of individual human development during the lifespan
stage of youth
• explain the biological determinants of health and development and
discuss the impact on the development of youth.
Figure 1.1 Development becomes

more obvious as people age.
2 UNIT 1 • The health and development of Australia’s youth

1.1 Understanding health KEY TERM DEFINITIONS
abstract thought a complex thought process where
ideas are the focus rather than tangible objects
adolescent growth spurt a period of rapid physical
growth experienced during puberty
biological determinants factors relating to the body
that affect health (e.g. genetics, hormones, body weight)
body mass index (BMI) a measure of body mass to
height, used to ascertain overweight and obesity levels
complexity the quality of being intricate or complex
concrete thought a simple thought process that centres
on objects and the physical environment
determinants of health factors that raise or lower the
level of health in a population or individual. Determinants
of health help to explain or predict trends in health and
why some groups have better or worse health than others
(AIHW, 2006).
developmental milestone a significant skill or event
occurring in a person’s life: for example, learning to walk,
getting a job or having children
embryo a developing human from around the second
week of pregnancy until the end of the eighth week
emotional development the development of the full
range of emotions and the optimal way of dealing with
and expressing them
fertilisation the point in time when the sperm fertilises the
egg, the genetic material fuses and development begins
fine motor skills the manipulation and coordination of
small muscle groups such as those in the hands
genetic potential the genetic capabilities and limitations
of an individual’s genetic make-up
gross motor skills the manipulation and coordination of
large muscle groups such as those in the arms and legs
hormone a chemical messenger that results in changes
in the body
individual human development the series of orderly,
predictable changes that occur from conception until
death. Development can be physical, social, emotional or
intellectual.
intellectual development the development of processes
in the brain such as thought, knowledge and memory
metabolism the sum of all chemical reactions in the
body. It allows body structures to carry out their functions.
nutrient dense describes foods that contain a large
amount of nutrients such as vitamins and minerals
physical development changes to the body and its
systems. These can be changes in size (i.e. growth),
complexity (e.g. the increase in complexity of the nervous
system) and motor skills (e.g. learning to walk).
primary sex characteristics body parts that are directly
involved in reproduction and form what are commonly
referred to as ‘genitals’ and organs of reproduction
puberty biological changes that occur during youth and
prepare the individual for sexual reproduction
rite of passage a cultural event or ceremony that
signifies an achievement in a person’s development
secondary sex characteristics traits arising from changes
in both males and females at puberty. They are neither
directly related to reproduction nor present at birth.
social development the increasing complexity of
behaviour patterns used in relationships with other people
(VCAA)
youth 12 to 18 years of age; however, it should be
acknowledged that classifications for the stage of youth
can differ across agencies (VCAA)
The individual human development of Australia’s youth • CHAPTER 1 3

1.1
The human lifespan: an overview
KEY CONCEPT Understanding the stages of the human lifespan
An understanding of the human lifespan and the various stages within it allows
analysis and discussion of health and individual human development that occurs
for people at different times throughout their lives.
The human lifespan can be broken up into different stages (figure 1.2), although
different cultures and societies have different ways of defining the stages. One thing
that all groups agree on is that the human lifespan starts at conception and ends
at death. In Australian society, as in most Western societies, there are a number of
stages that humans go through as they get older.
Late
adulthood Prenatal
Middle
adulthood
Infancy
Early
childhood
Late
childhood
Early
adulthood
Figure 1.2 Stages of the human Youth

lifespan
Prenatal
The prenatal stage begins when a sperm penetrates an egg (figure 1.3) in a process
known as fertilisation, to form one complete cell, called a zygote. The prenatal
stage continues until birth and is characterised by the development of the body’s
organs and structures, and substantial growth. The unborn baby goes from being
a single cell (smaller than a quarter of a millimetre across) to consisting of more
than 200 billion cells at birth and weighing around 3.5 kilograms on average. This
process takes 40 weeks to complete. In terms of rate of growth, the prenatal stage
is by far the fastest growth period of all the human lifespan stages. It is also one of
the most uncertain in terms of making it all the way through the pregnancy and
the process of birth.

The term ‘infant’ comes
from the Latin infans, which
translates to ‘without speech’ or
‘unable to speak’.
Figure 1.3 The prenatal stage begins

when one sperm penetrates the egg.
Infancy
As with most lifespan stages, there is debate about when infancy finishes. Everyone
accepts that it starts at birth, but when does the infant become a child? Historically,
infancy was considered to continue until the onset of speech. However, because
infants can vary greatly in the time at which they start speaking, many organisations
and professionals in this field have adopted the view that this stage ends with the
second birthday (approximately). Therefore we will also use the second birthday as
signifying the end of the infancy period.
Infancy is a period of rapid growth with many changes. A newborn baby is
obviously very different from a two year old. By the time an infant turns two, they
have developed their motor skills and can walk, use simple words, identify people
who are familiar to them, play social games — and throw tantrums when they do
not get what they want.
Many of the developmental milestones that the infant achieves will have some
sort of bearing on how they develop in later years. This concept will be explored in
more detail in later chapters.
Childhood
Like infancy, the start and end of the childhood stage is a difficult thing to define.
Most people say that it ends at the onset of puberty. As the age of the onset of
puberty shows great variation among individuals, this study uses the 12th birthday
to signify the end of childhood.
The development that occurs in childhood is substantial, so it is worthwhile
considering this lifespan as being divided into early childhood and late childhood.
Early childhood
Early childhood starts at the end of infancy and continues until the sixth birthday.
This stage is characterised by slow and steady growth, and the accomplishment of
many new skills. The child learns social skills that will allow them to interact with
other people. They will make friends, be able to eat with adults at the table and Figure 1.4 Learning to ride a bike is
become toilet trained. a milestone for most children.

1.1 The human lifespan: an overview
Late childhood
Late childhood starts at the sixth birthday and ends at age 12. Like early childhood,
late childhood is characterised by slow and steady growth. There are many physical,
social, emotional and intellectual changes that occur as the child moves through
this stage. These include refining reading and writing skills, developing long-term
memory, understanding gender stereotypes and refining motor skills.
Youth
The youth stage of the lifespan has steadily lengthened over the past 100 years.
This has resulted from puberty starting earlier, and young people taking longer to
gain independence and reach maturity in other aspects of their lives. As a result,
the youth stage of the lifespan is perhaps the hardest to define. We will assume
that youth starts at 12 years of age and continues until 18, although this may vary
depending on the research used. The youth stage is characterised by rapid growth,
increased independence and sexual maturity.
This stage of the lifespan is concerned with moving from childhood to adulthood.
Youth must undergo vast physical changes in order to achieve sexual maturity, and
therefore the ability to reproduce. Youth will also undergo significant social, emotional
and intellectual changes as they become accustomed to greater independence, more
complex relationships and the development of life goals (figure 1.5).
The end of youth is characterised by a level of maturity in the physical, social,
emotional and intellectual changes that have been occurring.
Figure 1.5 Friends play an influential

role in development during youth.
The terms ‘adolescent’ and ‘adult’ come from different forms aspect of the transition between childhood and adulthood.
of the Latin word adolescere, meaning ‘to grow up’. For Young people now spend more time reaching maturity in
adolescent and adult, it means ‘growing up’ and ‘grown up’ other areas such as tertiary study, finding a career, living
respectively. with their parents and gaining financial independence.
The term ‘adolescence’ has generally come to mean the As a result, the term ‘youth’ is now more commonly used
period between the onset of puberty and the cessation of to describe the stage between childhood and adulthood
growth (i.e. physical maturity). As society has changed over because it encompasses all the changes experienced during
the years, the physical changes are seen as being only one this transition, not simply the physical changes.

Early adulthood
Early adulthood begins at 19 and ends at 40. Physically, this stage is characterised
by the body reaching its physical peak around 25–30 followed by a steady decline
in body systems thereafter. Some growth may continue at the beginning of early
adulthood, but all stages of adulthood are essentially periods of maintenance and
repair as opposed to the periods of growth experienced in the earlier lifespan stages.
People in this age group often decide on a career and may become quite career
focused. Young adults may also choose their life partner, get married and/or have
children. These events lead to many physical, social, emotional and intellectual
changes.
Case study
Bedtimes could pinpoint the Women reach this peak at 19.5 years old on average,
and men at 20.9 years. After that, individuals gradually
end of adolescence return to earlier and earlier sleeping patterns, until
things go haywire in old age.
Andy Coghlan
Roenneberg, thinks that the peak in lateness is
The end of puberty, or sexual maturation, is well the first plausible biological marker for the end of
defined. It is the point when bones stop growing. But adolescence.
for adolescence, the transition from childhood to adult- If it is a physiological effect, forcing teenagers to get
hood, there is no clear endpoint. to school for, say, 8 am, could be a mistake, Roenneberg
‘I don’t know of any markers for it,’ says Till says. They probably take nothing in for the first two
Roenneberg of the Centre for Chronobiology at the lessons because they are still in biological ‘sleep time’,
University of Munich in Germany. ‘Everyone talks and end up with a horrendous sleep deficit by the
about it but no one knows when adolescence ends. It weekend.
is seen as a mixed bag of physical, psychological and
Source: Edited extract from New Scientist, 8 January 2005.
sociological factors.’
© 2005 Reed Business Information — UK. All rights reserved.
[The study of 25 000 individuals of all ages] reveals
Distributed by Tribune Media Services.
a distinct peak of night-owlishness at around age 20.
Case study review

1 What aspect of sleeping patterns may signify the end of adolescence
(youth) according to the study?
2 Discuss why starting school at 8 am could be a ‘mistake’ for adolescents.
3 (a) Create a survey that could be used to find out about the sleeping
patterns of youths and young adults. Some questions to consider
are:
• What time do you go to bed?
• What time do you wake in the morning?
• Do you sleep during the day as well? If so, for how many hours?
• Do you get sleepy during the day?
• How do your sleeping patterns change on the weekend compared Figure 1.6 Sleeping is important to most
to Monday to Friday? What about your holiday sleeping patterns? adolescents.
(b) Hand the surveys out to people in the youth stage (your class could
be a good place to start) and to those in their 20s and 30s.
(c) Collate and present the results (graphs and tables are useful for this). Be sure to include the total number of hours
of sleep for each person and the average for each age group.
(d) Did you find any patterns or trends in the results?
(e) Did they support the findings of the study in Europe?

1.1 The human lifespan: an overview
Middle adulthood
Middle adulthood begins at 40 and continues until the age of 65. The events
that occur during this period vary from culture to culture and from individual to
individual.
Some of the more common characteristics of this lifespan stage include stability
in work and relationships, the further development of identity including the
maturation of values and beliefs, financial security, physical signs of ageing and,
for women, menopause. During this stage, an individual’s children may gain
independence and leave home, giving the parent a new sense of freedom. Sometimes
this can also create a sense of loss or loneliness, often referred to as ‘empty nest
syndrome’. Many individuals in the middle adulthood stage will experience the
joy of becoming grandparents for the first time, although this can occur in late
adulthood as well.
Late adulthood
Late adulthood, the final stage of the lifespan, occurs from the age of 65 until death.
Figure 1.7 Late adulthood is often This period is characterised by a change in lifestyle arising from retirement and
characterised by increased leisure financial security (for most). It can include greater participation in voluntary work
time. and in leisure activities such as golf and bowls (figure 1.7). Many older people may
also have to endure the grief associated with the death of friends or a spouse.
As health begins to decline significantly, older people tend to reflect on their lives
and achievements. This may provide a sense of satisfaction or regret, depending on
how they assess the choices they have made in their lives.
TEST your knowledge APPLY your knowledge

1 (a) When does the human lifespan start? 7 Why might other cultures define stages of the
(b) When does it finish? lifespan differently?
2 (a) What are the stages of the human lifespan? 8 (a) How might the experiences of youth in Australia
(b) When does each stage start and finish? differ from the experiences of youth in a country
(c) i. Which lifespan stage is the longest? like Africa?
ii. Would this be the same for everyone? (b) Are there any experiences you think are
Explain. common to youth across the world?
(d) Why are the starting and end points of some 9 (a) Brainstorm factors that may affect the age at
lifespan stages difficult to classify? which a person reaches their physical peak.
3 Discuss the difference between youth and puberty. (b) How could someone prolong their peak physical
4 Why is it difficult to pinpoint the end of youth? condition?
5 (a) Why has the period of youth been getting 10 Work individually or with a partner to identify key
longer over the past 100 years? words you would use to explain each lifespan stage.
(b) How many of these reasons relate to the (a) What sort of words did you come up with for
physical changes that occur during youth? What each stage?
aspects of life do they relate to? (b) Were the words used for each lifespan stage
6 What developmental milestones are used to signify positive or negative?
independence? (c) Where do you think these ideas come from?
(d) Would they be the same if someone from
another culture played this game? Why?
11 Design a concept map that summarises three
aspects for each lifespan stage that you think
help define the stage. Images from newspapers,
magazines and/or the internet can be used for this
activity.

1.2
Exploring individual human development: physical
KEY CONCEPT Understanding the characteristics of the physical dimension of

individual human development
Individual human development encompasses the changes that people experience

from conception until death. Development is often characterised by milestones that
are predictable and occur in a sequential order. Going through puberty, learning
Interactivity:
to walk or learning the skills required to interact with others are examples of
Time Out: ‘Development’
milestones associated with individual human development.
Searchlight ID: Int-1429
In this course, we will examine four types or dimensions of individual human
development (figure 1.8). All four dimensions are interrelated and therefore affect
each other. We will explore these relationships in more detail later. It is important
to understand the four dimensions of development before investigating the
Physical
characteristics that are common during youth.
Physical development
Intellectual Social
Physical development refers to the changes that occur to the body and its systems.
It includes external changes that you can see, such as changes in height, and
internal changes you cannot see, such as the increasing size of the heart. Physical
development includes growth as well as motor skill development. Various aspects Emotional
associated with physical development are summarised in figure 1.9.
Figure 1.8 The four dimensions

of individual human development
Physical
development
Nervous
system
Respiratory
Decline of system
Growth Increases in complexity body systems
e.g. people get e.g. structures within Motor skill Circulatory
e.g. wrinkling of the skin,
bigger until the the brain become development system
reduced functioning of
end of puberty more complex the respiratory system Digestive
system
Fine motor skills Gross motor skills

e.g. writing, cutting with e.g. running, throwing
Figure 1.9 Aspects of scissors, tying shoelaces a ball, riding a bike
physical development
System
Reproductive
Motor skills Organ system
Muscular
Motor skills refer to the control of system
the muscles in the body. Imagine
Tissue
a newborn baby. It has very
underdeveloped motor skills
Skeletal
(e.g. uncoordinated limbs). As system
Cell
the infant gets older, motor skills
will develop and movements
will gradually become more Figure 1.10 Physical development of
controlled and deliberate. the body, from a cell to the whole body

1.2 Exploring individual human development: physical
Motor skills can be classified as either fine or gross:

• gross motor skills refer to movements that involve large muscle groups such as
walking, throwing, skipping and kicking
• fine motor skills involve control over the smaller muscle groups such as those
used for writing, tying shoelaces, cutting with scissors and manipulating the
mouth to speak.
Growth and development of body systems

From early in the uterus, the embryo begins to develop the cells that will become the
vital organs and systems required to sustain life in the outside world (figure 1.11).
The changes in size and increase in complexity that take place in these organs and
systems are important parts of physical development. Examples of systems in the
body include the circulatory system and the immune system.
Growth refers to organs and systems getting bigger in size. It is an important
aspect of physical development. Much growth occurs during puberty, which is why
Figure 1.11 Humans experience their youth is considered a rapid growth period along with the prenatal and infancy
fastest rate of growth while in the stages (figure 1.11). Childhood is characterised by slow and steady growth, while
womb.
the three adulthood stages are predominantly periods of maintenance. Even though
growth stops at the end of puberty, individuals keep on developing physically for
the rest of their lives. The decline in body systems that people experience in later
lifespan stages is also part of physical development.
Decline of body systems

The body’s systems decline in function as a normal part of ageing. Most individuals
reach their physical peak in the early 20s to early 30s. After this point, most of the
systems — such as the muscular system, circulatory system and skeletal system —
generally decline at a rate of about 0.5 to 2 per cent per year. Most of the decline
takes place over a long period of time. In fact, people might not realise they have
changed until they look back at old photographs of themselves. Like all aspects of
development, ageing happens to everyone. Most of the changes are predictable, but
there will be individual variations in when they occur. This is due to a number of
factors, including:
• differences in rate and timing of development. Due to genetic and hormonal
differences, some individuals will start the ageing process at a younger age than
others, and some will age at a faster rate.
Figure 1.12 By the age of 70, many • behaviours. Not smoking, eating a balanced diet and exercising can slow the rate
signs of ageing are evident. of ageing.

1 Explain what is meant by ‘individual human 6 Use the Infant running weblink
development’. in your eBookPLUS to find the
2 Using examples, define physical development. link for this question.
3 (a) What does ‘increase in complexity’ mean? (a) Watch the video.
(b) List one example of a body part that increases (b) Describe how the running style of an infant
in complexity. compares to that of a youth or an adult.
4 Explain the difference between growth and 7 Draw a line graph showing the rate of growth
development. across the lifespan. Place the lifespan stages
5 Even though the ageing process begins in the on the horizontal axis and the rate of growth
20s or 30s, why is it often not evident until much (no growth, slow, medium and fast) on the
later in life? vertical axis.

1.3
Exploring individual human development: social
KEY CONCEPT Understanding the characteristics of the social dimension of

While the physical aspect of development is often

the most easily recognisable, there are significant
social, emotional and intellectual changes that also Behaviours
occur as people move through the lifespan. e.g. being
considerate
Social development Relationship

skills
People from different cultures are raised with e.g. conflict
Social roles
different values and skills relating to how they are e.g. son/daughter,
resolution and
employee, friend
expected to interact with others. A newborn child open
communication
knows very little about how to interact with others;
it must learn the appropriate social skills and
Social
behaviours. Social development refers to the social development
skills and behaviours that are learnt from a young
age. Examples of social development are summarised
in figure 1.13 and include:
• behaviours — learning what is appropriate
Communication
behaviour in a range of situations and how skills
Values and beliefs
individuals behave around others (figure 1.14). e.g. valuing honesty
e.g. written and
or compassion
Being a good listener and being generous are two oral
towards those less
communication
examples of behaviours that people may learn. fortunate
• social roles and expectations — Humans spend a
lot of their time in different groups and will often
Figure 1.13 Aspects of social
have distinct roles within those groups. Examples
development
include the role of employee, friend, son/daughter,
coach and team-mate. Each role will generally have a set of behaviours, skills and
expectations associated with it. Gender roles are another example of social roles and
relate to behaviours that are culturally acceptable for males and females. Although
many of these roles and expectations have broken down over the past decades,
some cultures still have distinct roles for males and females. These roles are learnt
from a very young age and shape many aspects of the wider society. Examples of
traditional social roles related to gender include:
–– males working and females staying at home to look after the children
–– men mowing lawns and women cooking
–– girls playing with dolls while boys play with trucks
–– men and women dressing differently (e.g. women wearing skirts and men
wearing trousers).
• values and beliefs — determining what is important to an individual. Throughout
life, many people will stand up for what they believe in, and knowing what
they believe in is the first step in this aspect of development. Values and beliefs
assist in the development of an identity (see page 15) and are formed through
interactions with family, friends, wider society and the media.
• communication skills — being able to effectively communicate with different
groups of people. This is an important aspect of development and continues
to be built upon over the years. For example, talking to an elderly grandparent
requires different skills than talking to a brother, sister or school friend.
Figure 1.14 Learning behaviours,
• relationships — knowing how to behave in a relationship and what is expected. such as table manners and using a
This will be continually refined over time. It often requires establishing mutual knife and fork, are important aspects
respect and taking the time to listen to each other’s point of view. of social development in Australia.

1.3 Exploring individual human development: social
Case study
Gone to the dogs: the girl case — neglect on this scale was too shameful to
acknowledge — even though it has been of huge and
who ran with the pack continuing interest to psychologists who believe feral
children can help resolve the nature–nurture debate.
Elizabeth Grice
What is known about ‘the Dog Girl’ has been passed
She bounds along on all fours through long grass, down orally, through doctors and carers. ‘She was like
panting with her tongue hanging out. When she reaches a small animal. She walked on all fours. She ate like a
the tap she paws at the ground, drinks noisily with her dog,’ is about as scientific as it gets.
jaws wide open and lets the water cascade over her head. Last month, British child psychologist Lyn Fry,
Up to this point, you think the young woman could an expert on feral children, went to Ukraine with a
be acting — but the moment she shakes her head Channel Four film crew to meet Miss Malaya, who now
and neck free of droplets, exactly like a dog when it lives in a home for the mentally disabled. Five years
emerges from a swim, you get a creepy sense that this after a Discovery Channel program about her, they
is something beyond imitation. Then she barks. wanted to see if she had integrated into society. Ms Fry
The furious sound she makes is not like a human wanted to find out how far the girl was still damaged —
being pretending to be a dog. It is a proper, chilling, and to see a reunion with her father.
canine-like burst of aggression and it is coming from ‘I expected someone much less human,’ says Ms Fry,
the mouth of a young woman dressed in T-shirt and the first non-Ukrainian expert to meet Oxana. ‘I’d heard
shorts. stories that she could fly off the handle, that she was
This is 23-year-old Oxana Malaya reverting to very uncooperative, that she was socially inept, but she
behaviour she learnt as a young child when she was did everything I asked of her.
brought up by a pack of dogs on a rundown farm near ‘Her language is odd. She speaks flatly as though it’s
the village of Novaya Blagoveschenka in Ukraine. an order. There is no cadence or rhythm or music to
When she showed her boyfriend what she once was and her speech, no inflection or tone. But she has a sense
what she could still do — the barking, the whining, the of humour. She likes to be the centre of attention, to
four-footed running — he took fright. It was a party make people laugh. Showing off is quite a surprising
trick that went too far and the relationship ended. skill when you consider her background. In the film,
Miss Malaya is a feral child, one of only about 100 Miss Malaya looks uncoordinated and tomboyish.
known in the world. The story goes that, when she was When she walks, you notice her strange stomping
three, her indifferent, alcoholic parents left her outside gait and swinging shoulders, the intermittent squint
one night and she crawled into a hovel where they kept and misshapen teeth. Like a dog with a bone, her first
dogs. No one came to look for her or even seemed to instinct is to hide anything she is given.
notice she was gone, so she stayed where there was She is only 1.52 metres tall but when she fools
warmth and food — raw meat and scraps — forgetting about with her friends, pushing and shoving, there is a
what it was to be human, losing what toddler’s language palpable air of menace and brute strength. The oddest
she had and learning to survive as a member of thing is how little attention she pays to her pet mongrel.
the pack. ‘Sometimes, she pushed it away,’ says Ms Fry. ‘She
A shameful five years later, a neighbour reported a was much more orientated to people.’
child living with animals. When she was found, at the After a series of cognitive tests, Ms Fry concluded
age of eight in 1991, Oxana could hardly speak and ran that Miss Malaya had the mental capacity of a six-
around on all fours barking. year-old and a dangerously low boredom threshold. She
Though she must have seen humans at a distance, can count but not add up. She cannot read or spell her
and seems occasionally to have entered the family name correctly. She has learning difficulties, but she
house like a stray, they were no longer her species. is not autistic, as children brought up by animals are
Judging from the complete lack of documentation sometimes assumed to be.
about her physical and psychological state when Experts agree that unless a child learns to speak by
found, the authorities were not keen to record her the age of five, the brain misses its chance to acquire

language, a defining characteristic of being human. ‘It was dirty, terribly rundown and primitive,’ says Ms
Miss Malaya was able to learn to talk again because Fry, ‘but in Ukrainian terms, very desirable. Her carers
she had some childish speech before she was aban- are good people with the best interests of their charges
doned. At an orphanage school, they taught her to walk at heart, though there is no therapy as such. Oxana is
upright, to eat with her hands and, crucially, to talk. doing things she is good at.’
Through an interpreter, Miss Malaya tells Ms Fry It was here that the reunion with her father was
that her mother and father ‘completely forgot about staged a few weeks ago.
me’. They argued and shouted. Her mother would hit In the film, they stand awkwardly apart and it is ages
her and she would pee herself in terror. She says she before anyone speaks. Miss Malaya breaks the silence.
still goes off by herself into the woods when she is ‘Hello,’ she says. ‘I have come,’ replies her father. The
upset. Although she knows it is socially unacceptable to exchange is moving in its halting formality. ‘I thank
bark, she certainly can. you that you have come. I wanted you to see me milk
Miss Malaya seems to be happy looking after cows at the cows.’
the Baraboy Clinic’s insalubrious farm, outside Odessa. Source: The Age, 19 July 2006.
Case study review

1 Explain how Miss Malaya’s social development has been affected by her early
life experiences.
2 Discuss how Miss Malaya’s physical development has been/may be affected
by her experiences.
3 Discuss why Miss Malaya may have forgotten how to talk but remembers
how to bark.
4 Using examples from the article, explain why development that occurs in
early life is important.

1 Using examples, explain social development. 3 (a) Make a list of all the people or groups from
2 What is meant by ‘social roles’? Provide three which we learn social skills.
examples. (b) Which of these do you think has had the
greatest influence on your own social
development? Explain.
4 Make a list of social skills that are generally learned
from the family.
5 Would learning to use a knife and fork be a part of
social development in all cultures? Explain.
6 In small groups, find or write lyrics to a song that
depicts an aspect of social development during youth.

1.4 E xploring individual human development:
emotional and intellectual
KEY CONCEPT Understanding the characteristics of the emotional and

intellectual dimensions of individual human development
Emotional development
Emotional development refers to developing
the full range of emotions, and learning
appropriate ways of dealing with and expressing
these emotions. Good emotional development
encourages positive self-esteem. Some specific
examples of emotional development are
summarised in figure 1.16 and are explained in
more detail below:
• self-concept — how individuals see themselves.
They may have different views about different
aspects of themselves, such as their academic
ability, social skills and physical capabilities.
Self-concept also influences the formation of
an individual’s identity (see page 15).
• awareness of emotions — how individuals
identify which emotions they are feeling. As
people experience a range of emotions, they
become better at identifying those emotions.
Love and jealousy are emotions that can be
confusing when experienced for the first time.
• management of emotions — how individuals
control their emotions in different situations.
Figure 1.15 Throwing tantrums is a characteristic that most children Desire, guilt and jealousy are common
overcome as they develop emotionally. emotions that people want to control. For
example, instead of getting upset at not being
selected for the soccer team, a person can
direct this energy into training harder in order
to have a better chance of selection next time.
Management of emotions
Self-concept
The ability to control
Relates to how someone
emotions in an
sees themselves
appropriate manner
Emotional
development Expression of emotions
Awareness of emotions
The ability to express
The ability to recognise Radio
emotions in an
the emotions experienced
Figure 1.16 Aspects of emotional appropriate way
development
• appropriate expression of feelings — how individuals show their emotions in

an appropriate way. This skill develops over time, which is why toddlers, rather
than adults, are more likely to throw temper tantrums when they do not get
their way (figure 1.15).

Case study: Identity
Identity is the establishment of the more common associations

of a unique personality and include:
encompasses aspects of both social • searching for meaning in life
and emotional development. It • finding one’s place in the world,
refers to how an individual defines where the greater good of the uni-
him/herself, and is based on the verse and those in it is important
values and beliefs of that indi- • seeing oneself as a small part of
vidual. There are various aspects a bigger universe
of identity — including physical, • acknowledging forces both
sexual, political, religious and inside and outside individuals
ethnic identity — and the different that are separate from the phys-
aspects may develop at different ical and mental functioning of
times. Although an identity will living things.
generally be firmly formed by the Religion is an organised form
later stages of youth, aspects of it of spirituality that is based on
will be modified throughout life. culturally and historically based
In early youth, identity is often guidelines (or doctrine). As part of
based on parental expectations their search for spirituality, some
and occurs without exploring people will explore religions —
alternatives. As youths develop, or turn away from the religion in
they may begin to question this which they were raised.
identity and actively experiment Many factors contribute to
with alternatives in an attempt to identity formation. They include:
find an identity that suits them. • culture/ethnicity
During this process, the individual • parents
may change hobbies quickly, • siblings
explore various possibilities for • friends
future careers, and sample different • school
clothing and hair styles, musical • society.
genres and friendship groups. Once an identity has been
As abstract thought develops, committed to, people feel more
many youths will explore their comfortable about themselves. This
spirituality. Spirituality is an aspect can contribute to increased self-
of identity that means different esteem and also help to guide their
things to different people. Some moral decisions.
eLesson:
Clarifying self-identity and self-
Case study review worth
1 What is meant by the term ‘identity’? Searchlight ID: eles-1043
2 What factors could cause someone to change aspects of their identity later in life?
3 Explain the difference between spirituality and religion.
4 (a) Answer this question 10 times: ‘Who am I?’
(b) i. Rank your answers according to how well they define who you are,
where ‘1’ is the answer that best defines you and ‘10’ is the answer that
least defines you.
❛ sample different
ii. For what reasons did you choose the answer you ranked as ‘1’? clothing and hair
(c) Next to each answer, write down who you think influenced this aspect of
yourself the most. styles, musical
(d) i. Which influence featured the most times?
ii. Do you think this influence is the biggest determinant of identity? Explain.
genres and
friendship groups ❜
1.4 Exploring individual human development: emotional and intellectual
Intellectual development
Intellectual development refers both to the processes that occur within the brain
and to the increasing complexity of the brain. Aspects of intellectual development
are summarised in figure 1.17 and are explained in more detail below.
• knowledge — this becomes more complex as people develop intellectually. The
longer a person has been developing intellectually, the more opportunities they
have to gain knowledge.
• language — knowledge of language and the way it can be used develops
continually over the human lifespan.
• memory — retaining information and being able recall it. Memory abilities change
throughout the lifespan and can decline in the latter parts of adulthood. Using this
section of the brain can help to promote a good memory into late adulthood.
• abstract thought — being able to think about concepts and ideas rather than
just the physical objects you can see (concrete thought).
• creativity and imagination — thinking in new ways. Both creativity and
imagination can be developed by exposure to many different experiences
including books, music and other people.
• problem solving — finding a way from the current state to the desired goal
Figure 1.18 Intellectual development
is rapid during the early years but it
when no clear path exists. Problem solving is one of the most complex of all
continues throughout the lifespan. thinking processes. Examples include trying to fit a number of commitments
into a given timeframe, figuring out what has caused a computer to crash or
calculating how much weight a new (as yet unbuilt) bridge can hold. Trial and
error is an important part of problem solving.
• attention — focusing on one aspect of the environment while ignoring others.
Attention is an important aspect of intellectual development as it assists in the
learning of new material. Young children can focus their attention for shorter
periods of time than older children. Attention can be developed by attaching an
intrinsic (or internal) reward, such as attaching satisfaction to completing a task.
The more a person enjoys the matter requiring attention, the longer they can
focus their attention on it.
Knowledge
Attention Language
Intellectual
development
Problem
Memory
solving
Creativity Thought patterns

and (abstract versus
imagination concrete)
Figure 1.17 Aspects of intellectual

development

Many aspects of intellectual development occur in the younger years, but
intellectual development continues throughout the lifespan as people learn skills
associated with pursuing careers, raising children, becoming grandparents or
taking up hobbies.
Interrelationships between the four dimensions

of development
While the four dimensions of
development have their own A different peer group can
definitions and characteristics, influence identity formation and
none of them occurs in isolation. self-concept. They may see
themselves differently to other
All four dimensions influence people their own age.
each other as a person matures,
and there is no limit to which any
single aspect of development can Social development
influence another. Figure 1.19 Early puberty may mean that Intellectual development
they socialise with older Physical Early puberty can
and the paragraphs that follow people. This can impact social development contribute to sporting
outline some possible impacts experiences. These experiences Early onset of success in young males,
can shape aspects puberty which could lead to learning
on the different dimensions of
like behaviours. of sports strategies.
development based on different
scenarios.
Figure 1.19 The possible impacts
A person’s social skills (social on social, emotional and intellectual
development) can influence the social group with which they associate. This in development for a youth who starts
turn can affect social habits such as food consumption (e.g. eating at food courts). puberty (physical development) earlier
Food consumption has a direct impact on physical development, as the foods than his/her peers
eaten contribute to the development of the body’s systems such as bones, muscles
and organs (physical development). An individual’s ability to socialise and
communicate may affect their self-concept (emotional development),
as they are able to make friends more easily. Being a good listener
(social development) might mean that the individual learns from
others, such as parents and grandparents (intellectual development).
A youth’s self-concept (emotional development) might determine
if they take risks, such as trying out for a sports team at school.
Taking such risks can ultimately enhance motor skill development,
for example, if they make the team (physical development). Self-
concept may also influence whether someone is willing to have a
discussion with a friend’s parents. This type of interaction can
assist in developing communication skills and behaviours (social
development). Valuing intrinsic rewards such as satisfaction and
achievement (emotional development) can contribute to a person
applying themselves at school and therefore developing knowledge
(intellectual development).
Youths with higher intellectual development may have a greater
knowledge of the benefits of nutrition and exercise, and may therefore
have more advanced motor skills and greater development of bones,
muscles and organs (physical development). Those with high levels Figure 1.20 Early physical
of intellectual development may associate with people of similar intellect. The peer development (as experienced by the
group in turn influences the development of behaviours and communication skills boy on the right) can influence other
(social development). Youths who succeed academically may receive praise from aspects of development.
their parents, which can enhance self-concept (emotional development).

1.4 Exploring individual human development: emotional and intellectual
Classifying developmental milestones

Developmental milestones refer to the changes and achievements that occur
throughout the lifespan. Examples include learning to walk and talk, completing
basic mathematics problems, getting married, having children, choosing a career,
finishing high school and experiencing love. Some of these milestones are
easily classified into one of the four dimensions of development. For example,
learning to walk is an aspect of physical development. But what about learning to
talk (figure 1.21)? Muscles must be manipulated to make coherent sounds (physical
development) and words must be learnt (intellectual development). Obviously,
speech allows the individual to communicate (social development). Examples such
as these can be classified into any one or all of these three dimensions.
There are many other examples of milestones that do not fit neatly into one of
the four dimensions. Therefore when classifying a developmental milestone, you
should justify why you have chosen a particular dimension for that milestone.
Figure 1.21 Learning to talk

encompasses aspects of physical, social
and intellectual development.

1 Explain the difference between self-concept and 5 Draw pictures/collect magazine photos and
self-esteem. create a collage representing examples of the
2 (a) Using examples, define emotional development. type of development that might occur in each
(b) Using examples, define intellectual development. lifespan stage. Ensure that the four dimensions of
3 (a) Discuss the difference between concrete and development are addressed.
abstract thought. 6 (a) Find lyrics to a song that focuses on a dimension
(b) List one example of thought that illustrates: of development.
i. concrete thought (b) Print the lyrics and share them in small groups.
ii. abstract thought. (c) Discuss what the lyrics are saying about
4 Classify the following as examples of physical, development.
social, emotional or intellectual development: 7 Select two of the following developmental
(a) The changes to sex organs that occur during milestones and complete a diagram similar to that
puberty in figure 1.19 for each one:
(b) Learning to use a graphing calculator • Learning to do gymnastics (physical development)
(c) Deciding to join a religious group • Leaving school in year 11 to start an
(d) Pattern baldness that occurs in many males apprenticeship (social development)
(e) A musician writing a song for the first time • Passing a driver’s licence test and getting a car
(f) Finding a way to fix a banging door (social development)
(g) A person perceiving themselves as intelligent • Learning to play a musical instrument (intellectual
(h) A person deciding that they value honesty more development)
than not hurting someone else’s feelings • Being in love for the first time (emotional
(i) Developing the skills required to discuss issues development).
with parents Remember that the selected milestone should be in
(j) Increase in the complexity of the skeletal system the centre of the diagram with the possible effects
in a developing foetus on the other three dimensions of development
(k) Using words to express emotions coming out from it.
(l) Developing beliefs relating to ethical issues such 8 Use the Child-safe toys weblink in your
as abortion eBookPLUS to find the link for this question.
(m) Changes in height that occur during childhood (a) View the video on child-safe toys.
(n) Moving in with a partner (b) Which dimensions of development are targeted
(o) Selecting a career path. by these toys?
(c) Design a toy that would help develop motor
skills in a baby/infant.

1.5
Individual human development during youth: physical
KEY CONCEPT Understanding the physical development that occurs

during youth
Youth is a time of rapid development. Although the physical changes that occur
during this stage are often the most well known, significant changes also take place
in the social, emotional and intellectual dimensions of development. The average
youth will end this lifespan stage by being physically capable of reproduction;
being seen as an adult in the eyes of the law; finishing compulsory education; being
legally allowed to drink alcohol, drive, vote and join the army; and making many
other decisions for themselves. We will explore the individual human development
that occurs during youth in each of the four dimensions of development, beginning
with physical development.
Physical development during youth

The youth stage of the lifespan is a time of rapid physical development that
commences at puberty. Puberty is triggered by hormones released in the pituitary
gland (in the brain) and causes many changes in the body including an increase in
the rate of growth, a refinement of gross and fine motor skills, and the development
of primary and secondary sex characteristics.
Growth
The adolescent growth spurt is one of the most easily 25
recognisable signs of puberty. During the growth spurt, the Boys
individual will grow at the fastest rate since infancy (figure 1.22). Girls
According to the Go For Your Life initiative (www.goforyourlife. 20
Height gain (cm/year)
vic.gov.au), on average a girl will gain 16 centimetres in height

and 16 kilograms in weight, while boys will gain an extra 15
20 centimetres in height and 20 kilograms in weight. The
growth spurt happens at different times for females and males,
with girls generally experiencing their growth spurt between the 10
ages of 10 and 13, and boys between 12 and 15. The growth
spurt usually lasts for two to three years.
5
As well as changes in height, youth experience changes in
body composition. In males, increases in muscle mass and the
broadening of the shoulders in relation to the waist result in a 0
more triangular body shape. For females, the hips widen and 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
the fat to muscle ratio increases. Most fat is deposited in the Age (years)
mid-section, including the thighs and hips, resulting in the Figure 1.22 The rate of growth
hourglass figure seen in many adult females. across the lifespan
Fine and gross motor skills

During the adolescent growth spurt, arms and legs lengthen and body proportions
change. As these changes occur, different body parts may grow at different rates.
As a result, some youth may experience periods of time when arms and legs
are disproportionate to the rest of the body. This can contribute to some youth
experiencing difficulty controlling their limbs in a co-ordinated manner, in the way
they were able to during childhood.
As the body continues to mature, the individual will gain more control over it.
By the end of puberty however, the arms and legs are proportionate to the rest of
the body. The extra strength and endurance gained during puberty increase the
ability to carry out many motor skills in adulthood.

1.5 Individual human development during youth: physical
Primary and secondary sex characteristics

Primary sex characteristics are those parts of the body that are directly involved
in reproduction. During puberty, changes occur to the organs of reproduction
commonly referred to as the ‘genitals’. Although present at birth, these organs only
develop and become fully functional during puberty. The primary sex characteristics
that develop for males and females during puberty are shown in red in figure 1.24.
s Age in years Boys Age in years

9 10 11 12 13 14 15 16 17 18 19 9 10 11 12 13 14 15 16 17 18
ormone production triggers • Hormone production triggers puberty

uberty
• Growth spurt
Growth spurt begins begins
Hair begins to appear on genitals and under • Testes and
scrotum grow
rms • Hair appears
reast buds appear on genitals
cne begins and under
arms
• Penis begins
• Breasts grow
to lengthen
• Hips widen in proportion to waist • Muscles grow,
• First period (menarche) shoulders
broaden
• Sperm
production
starts
• Ovulation and menstruation begin • Acne begins
• Voice changes
• Physical maturity reached

• Facial and chest hair appears
• Physical maturity reached
Girls Age in years Boys

8 9 10 11 12 13 14 15 16 17 18 19 9 10 11 12
• Hormone production triggers • Hormone production trigg

puberty
• Growth sp
• Growth spurt begins begins
• Hair begins to appear on genitals and under • Testes and
scrotum gr
arms • Hair appea
• Breast buds appear on genitals
• Acne begins and under
arms
• Pe
• Breasts grow
to
• Hips widen in proportion to waist •M
• First period (menarche) sh
br
• Sp
pr
st
• Ovulation and menstruation begin • Ac
Figure 1.23 The timing of puberty • Physical maturity reached

Source: Adapted from www.bibalex.org.
Secondary sex characteristics arise from changes that occur to both males and
females but are not directly related to reproduction and are not present at birth.
Examples of secondary sex characteristics for males and females are shown in blue
in figure 1.24.
There is wide variation in the timing of when puberty begins, although girls
generally start before boys. Girls commonly reach puberty between the ages of
8 and 13, and boys between the ages of 10 and 15. The average ages at which
selected events associated with puberty occur are outlined in figure 1.23. These

changes and the timing and rate at which they are occur are largely due to biological
determinants, in particular genetics, hormonal changes and body weight.
Adulthood Adulthood
During During
puberty puberty
Before Before
puberty puberty
Skin becomes oily Skin becomes oily
Body hair develops including Facial hair appears

underarm and pubic hair
Voice lowers
Increased fat to muscle ratio
Shoulders broaden
Breasts develop
Increased stature
Hips widen
Increased muscle mass
Body hair develops including pubic,

underarm, chest and arm hair
First ovulation Penis enlarges
First menstruation First ejaculation
The ovaries, uterus, vagina, Testes grow and start

labia and clitoris enlarge in size producing sperm
Key:
Primary sex characteristics
Secondary sex characteristics
Figure 1.24 The primary sex characteristics that develop for males and females
during puberty
TEST your knowledge 5 (a) Looking at figure 1.22, outline two differences
in the growth spurt as experienced by males and
1 Using examples, explain:
females.
(a) primary sex characteristics
(b) What leads to these differences?
(b) secondary sex characteristics.
6 Use the Puberty weblink in your eBookPLUS to find
2 During which lifespan stage are the primary sex
the link for this question.
characteristics first created?
(a) Research one of the hotspots for either males
3 Using figure 1.24 as a guide, draw a Venn diagram
or females. (Be sure to look at the animation for
summarising the changes that males and females
each hotspot in the bottom right-hand corner.)
undergo during puberty.
(b) Present your findings to the class or in small
APPLY your knowledge groups.
7 Prepare an educational guide or poster for
4 Use figure 1.23 to answer the following questions. prepubescent children outlining the changes that
(a) At what age span does the growth spurt begin occur during puberty.
for males and females?
(b) Identify two of the differences between males
and females as shown in the graph.
(c) Which milestone shows the greatest variation
for females?

1.6 T he impact of biological determinants on youth
development
KEY CONCEPT Understanding the impact of biological determinants on the

development of youth
Determinants of health and development:
an introduction
Hormonal
changes There are many factors that influence the health and individual
human development of youth. Some of these are genetic and out of
the individual’s control, some are choices that people make, and some
form part of the society and environment in which the individual lives.
These factors act together to determine health and individual human
development and hence are termed the ‘determinants of health and
Biological development’, sometimes shortened to the ‘determinants of health’.
determinants The biological determinants are concerned with the body’s cells,
tissues, organs and systems, and how they function. They include
genetics, hormonal changes and body weight (see figure 1.25). Due to
the many physical changes that occur during youth, biological factors
are particularly significant. As a result, some of these will be investigated
Body
Genetics as the development and health of youth are explored.
weight
The behavioural, physical environment and social determinants also
play a significant role in the health and individual human development
of youth and will be explored specifically in chapter 4.
Figure 1.25 Biological determinants
of health Genetics
The term ‘genetics’ refers to the biological information that is passed down from
parents to children at the point of conception. Most cells in the human body
contain this genetic blueprint, which
Sections of DNA are called genes and control contributes to many aspects of health
many aspects of health and development. and individual human development
Each nucleus contains 23 pairs of for youth.
chromosomes. One chromosome Most cells contain a nucleus
in each pair is from the mother and (figure 1.26). The nucleus controls
the other is from the father. the functions of the cell including the
reproduction of cells and the timing of
development. Within the nucleus there
are structures called chromosomes.
The chromosomes contain links of
DNA called genes. Although genetics
have a significant impact on individual
human development during youth,
it should be remembered that other
factors also play large roles.
Physical appearance is also largely
determined by genetics. A person has
genetic potential in many aspects
of their physical appearance (e.g.
height, weight, skin colour, freckles,
The chromosomes hair and eye colour, muscle mass and
The nucleus contains the genetic contain strands of DNA. facial features). Remember that other
material for the human body,
the chromosomes. determinants also play a part, and they
Figure 1.26 The nucleus of the cell
can be just as influential as genetics.
contains the genetic material needed For example, a person who has the
for life. genetic potential to be tall might not

consume sufficient nutrition and so could end up shorter than the maximum
height possible according to their genetic potential.
Genetics determine sex, which has a large impact on the different physical
characteristics of males and females such as genitals and reproductive systems.
Genetics also influence the types and amounts of hormones that are released
during puberty and therefore influence the physical changes that occur during
youth. While genetics influence the timing of the release of these hormones, it is
the hormones themselves that cause the changes associated with puberty.
Hormonal changes
Hormones are an example of a biological determinant
and are responsible for the process of puberty.
Hormones are chemicals that are released by special
parts of the body called glands. The series of glands Blood vessel
Hormone
in the body make up the endocrine system. There are
numerous glands in the body and some of the main Target cell
ones are shown in figure 1.28. Hormones play an Not a target cell
important role in bringing about changes in physical Receptor
Gland
development during youth. When hormones are
released from the glands, they are transported through
the bloodstream and circulate around the body.
Certain cells around the body are sensitive to different
hormones and will react when the particular hormones
are present in the blood (see figure 1.27). Figure 1.27 Hormones act on specific
Different hormones act on different parts of the cells and bring about many of the
physical changes associated with
body and are essential for many aspects of life such as
puberty.
metabolism, growth, cell death, the menstrual cycle in
women and puberty in youths. Hormones are the trigger for puberty and will play
a role in the physical state of both females and males for life.
Hormone changes during youth are caused by many factors including genetics
and body weight. It is the release of hormones that triggers puberty and results in
the changes in physical development that occur during this stage. The different
proportions of hormones released in males and females contribute to the different
changes that occur between the sexes.
Hormones also influence when and how quickly an individual develops, and
there is great variation in the rate of development. This is partly why some
individuals start puberty at eight and others may not start until 16. The duration
of puberty also varies greatly and can last from two to eight years. Generally
speaking, the earlier an individual starts puberty, the faster they move through it
(although this has no bearing on final height). Rate and timing of development can
affect other aspects, such as motor skill development. Early puberty contributes to
increased strength and endurance, which can contribute to greater participation in
activities that promote motor skill development. Social development can also be
affected by early puberty. Those who start puberty early might be expected to act in
a more mature manner because they look older than their actual age. They may also
socialise with youth who are older and this can also affect their social development.
During puberty, growth hormone is released at around double the amount
that was present during childhood. This leads to a faster rate of growth than was
experienced during childhood. The amount of growth hormone released may
influence final height. Growth hormone is also responsible for other aspects of
growth that take place during the youth stage, including an increase in muscle mass
and an increase in the size of the organs. These changes improve the functioning of
the body and contribute to the peak physical development that is usually reached
in early adulthood.

1.6 The impact of biological determinants on youth development
1. The hormone that starts puberty is gonadotropin-releasing hormone (GnRH). GnRH is

released from the hypothalamus and triggers the pituitary gland to release two more hormones,
luteinising hormone (LH) and follicle-stimulating hormone (FSH).
2. LH and FSH 2. LH and FSH

are released Hypothalamus are released
from the from the
pituitary gland. Pituitary gland pituitary gland.
Thyroid gland
3. LH and FSH 3. LH and FSH

act on the act on the
ovaries and testes and
stimulate the cause them
production to produce
and release of and release
oestrogen. testosterone.
Ovaries Testes
The thyroid gland produces the hormone thyroxine, which regulates the rate of metabolism in the body.
This hormone is essential to regulate the energy produced by the body, for the development of the
nervous system and muscles, and for the growth of long bones. These functions are particularly relevant
during youth as the individual undergoes significant development in these areas.
4. Although found in both sexes, 4. Although found in both sexes, testosterone

oestrogen is present in higher amounts Growth hormone is released is present in higher amounts in males. It is
in females. It is responsible for the from the pituitary gland responsible for the development of the male
development of the female reproductive in greater amounts during reproductive organs including the penis,
organs including the uterus and vagina. puberty, increasing the rate prostate gland and scrotum. Testosterone also
Oestrogen also increases fat deposits, of growth and leading to the produces muscle development, voice changes
promotes breast development and plays growth spurt in youth. and facial hair sprouting experienced by males
a role in regulating the menstrual cycle. during puberty.
Figure 1.28 The glands and hormones responsible for the changes experienced during puberty
Body weight
Maintaining a healthy body weight is beneficial for development during youth.
Body weight that does not fall within the healthy range can have a number of
effects on youth development. Genetics play a role in body weight, as does food
intake. When people do not have a balanced food intake, many nutrients required
for optimal development and health are absent from the diet or not present in the
right amounts. This is the result of not eating enough nutrient dense food.
Body weight can affect individual human development in many ways. Young
people who are either underweight or overweight/obese may not be eating enough
of the foods that provide adequate nutrition. This can mean that optimal physical
development is not achieved during puberty. The individual may not be as tall as they
should be, or may not develop optimal bone density. They might not participate in
sporting events, which could have a negative effect on their motor skill development.

As with all effects on an individual, the impact of body weight on social,
emotional and intellectual development will vary, but some examples could include:
• missing out on social experiences can affect communication skills
• coping strategies may be developed to deal with feelings of loneliness and affect
emotional development
• being victimised at school can affect concentration levels and impact on
intellectual development.
Generally, body weight is measured using the body mass index (BMI). The BMI is
calculated using the following formula:
Weight (kg)
BMI =
Height (m)2
So for someone who is 170 centimetres and weighs 68 kilograms:
68 (kg)
BMI =
1.7 (m)2
68
=
2.89
= 23.5
For adults, the BMI score is compared to set figures to determine if a person is
underweight, a healthy weight, overweight or obese (although waist circumference
is increasingly being used as an indicator of health risks associated with excess body
weight). This cannot be used for youth because they are growing and their body
proportions and fat levels change as they grow. Therefore the BMI-for-age charts
must be used (figures 1.29 and 1.30). They compare youth to other individuals of
the same age and sex, and give a more accurate indicator of overweight or obesity
than the adult charts.
BMI BMI Obese
32 32 At risk of obesity
Normal weight
30 30
28 28
26 26
24 24
22 22
20 20
18 18
16 16
14 14
12 12
kg/m2 kg/m2 Figure 1.29 BMI chart for boys

aged 2–20 years
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Source: Adapted from US Centers for Disease
Age (years) Control and Prevention, www.cdc.gov.

1.6 The impact of biological determinants on youth development
BMI BMI Obese

32 32 At risk of obesity
Normal weight
30 30
28 28
26 26
24 24
22 22
20 20
18 18
16 16
14 14
12 12
Figure 1.30 BMI chart for girls kg/m2 kg/m2

aged 2–20 years
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Source: Adapted from US Centers for Disease
Control and Prevention, www.cdc.gov. Age (years)
The rates of overweight and obesity for young Australians in 2010–11 are shown
in figure 1.31. These rates have steadily increased over the past 25 years.
80
Underweight Normal Overweight (but not obese)
Obese Overweight/Obese
70
60
50
40
30
20
10
Figure 1.31 Rates of overweight/

obesity in Australian teenagers, 0
2010–11 12–15 16–17
Although overweight and obesity are well-publicised issues for youth,underweight

poses a significant challenge for many, particularly females. The media plays a

significant role in attitudes towards underweight, in that being thin is often related
to beauty in popular culture. Females are at significantly higher risk of being
underweight. In cases of underweight, the onset of puberty is often delayed. Current
research indicates that individuals must reach a certain weight before puberty will
begin as nutrient and fat stores must be sufficient to support the development
that will occur. The average age at which puberty begins has decreased in recent
decades and some researchers believe this is due to increasing rates of overweight
and obesity.
The rate of physical development may also be slowed in underweight youth
as the nutrients required for building new tissues are not present in the diet in
the right amounts. This can be particularly detrimental to building optimal bone
density.

1 Outline what is meant by ‘biological determinants 7 (a) Calculate the BMI and determine the weight
of health and development’. range (according to figures 1.29 and 1.30) for
2 Using genetics as the basis of your discussion, each of the following:
outline why people often look like a combination of i. a 10-year-old boy who is 140 centimetres tall
both their parents. and weighs 47 kilograms
3 Explain how each of the following can impact on ii. an 18-year-old female who is 175 centimetres
the development of youth: tall and weighs 52 kilograms.
(a) Genetics (b) i. A 15-year-old boy with the same height and
(b) Hormonal changes weight as the 10-year-old boy would fall into
(c) Body weight which weight category?
4 Prepare a summary table for the hormones and be ii. Why is there a difference between the two?
sure to include: 8 Use the Genetics weblink in your eBookPLUS to
(a) the name of the hormone find the link to this question. Watch the animation
(b) the gland that secretes it and complete the following.
(c) the role it plays in physical development during (a) What is DNA?
puberty. (b) What is a gene?
5 Draw a flow chart that shows how the hormones (c) What is a chromosome?
act on the body for both males and females. (d) Draw a diagram to illustrate your explanations.
6 (a) What is BMI? 9 Use the BMI weblink in your eBookPLUS to find the
(b) How is it calculated? link for this question.
(c) Explain why the BMI of youths is compared to (a) Fill in your details and find your BMI.
percentile charts rather than the set values used (b) If a six-year-old had the same BMI as you, how
for adults. would they be classified according to the graph?
(c) Suggest reasons for this.

1.7 I ndividual human development during youth:
social, emotional and intellectual
KEY CONCEPT Understanding the social, emotional and intellectual

development that occurs during youth
Social development during youth

Even though considerable physical changes occur during youth, the social changes
can be just as intense. Youth generally move from being essentially dependent
on parents, to being largely independent. They learn how to act among different
groups, and change the way they behave according to the situation. The types of
interactions that occur also change as youth are given greater freedom and treated
more like adults. As a result, their communication skills are further developed.
As individuals socialise with a broader social group during this stage, they are
Figure 1.32 Socialising helps youth often exposed to new beliefs and values. These may relate to religion, politics,
learn vital social roles.
global issues such as the economy, and social justice issues such as discrimination
and racism. As a result of this exposure, youths will generally start to form their
own beliefs and values, and these can influence with whom they continue to
socialise. This is an important aspect of social development.
In forming their own values and beliefs and struggling to become independent,
youths can often come into conflict with their parents or other caregivers. Up until
this point, parents often make most of the decisions for their child. During youth,
relationships with parents are often reorganised in such a way that both the child
and parent have a say in decision making. As a result of this struggle, (and the
other changes that youths experience, such as identity formation, social changes
and puberty) youths may disagree with parents more often, which can lead to
escalating conflict. However, most young people emerge from this stage with a
deeper understanding of their parents and vice versa.
The peer group is extremely influential at this stage. Many of the social
experiences that youths encounter are due to their peer group. The group may
influence their choice of clothing, style of music and types of activities they
participate in. As individuals strive for their own independence, they may spend a
majority of their free time with their peers, possibly experimenting with different
behaviours within the peer group. Some of these behaviours may be considered
‘risky’ such as smoking cigarettes and experimenting with alcohol.
The nature of relationships changes during this time as many peer groups start
to include members of the opposite sex. This can further develop communication
skills and provide youth with opportunities to experience new types of relationships.
Many individuals will experience their first intimate relationship with another
person during this stage, and some will experience their first sexual relationship.
New skills, such as conflict resolution and compromise, are learned and/or
developed as a result of these relationships. Towards the end of the youth stage, the
individual will usually have developed a clearer sexual identity and may be looking
for a serious relationship.
At the beginning of the youth stage, the individual may become preoccupied with
what others think of them and feel that others are judging them. This is often the
result of the physical changes being experienced. As they move through the youth
stage and become more comfortable with themselves, they generally become less
concerned with what others think and more concerned with who they are as a person.
Youth often develop a greater concern for others as a result of these experiences.
Culture and family also play a significant role in the social development of
youths. Some cultures have particular rites of passage linked to this stage. Youths
may be allowed to stay home alone for the first time when parents go out, learn to
drive, get a job, make their own transport arrangements to and from school and
social engagements, go out on a date, or consider future career paths.

Emotional development during youth
As with social and physical development, the emotional changes that occur during
youth are significant. As a result of all the changes that youth go through, the
way they view themselves and how they deal with these feelings may also change.
In the early stages of youth, individuals might be very self-conscious and begin
asking themselves, ‘Am I normal?’ As a result of these feelings, youth might explore
strategies, such as consulting with friends, in order to deal with these emotions
effectively.
Youths also start to look less childlike and more mature, so people begin to treat
them differently. Young people need time to adjust to this change.
The release of hormones during youth can bring about extremes in mood that can
cause conflict with others, often parents and other family members. Consequently,
youth may experience negative emotions such as isolation, rejection and loneliness.
As the body matures, the mind changes as well, and youth might seek emotional
independence. For example, they might try to solve their own problems instead of
consulting parents. This may lead to feelings of satisfaction if they succeed or
despair if they fail. Experiencing these emotions can encourage the individual to
take more responsibility for their actions and provide ways to accept emotions —
both positive and negative — that occur as a result of this responsibility (e.g. guilt,
remorse, happiness, fulfilment).
As the nature of relationships changes, youth may also seek intimacy
and affection within those relationships. They might experience
emotions such as love and lust (figure 1.33).
Towards the end of the youth stage, the individual will have been
exposed to a range of emotions and will generally be able to recognise
them accurately when they arise. Most youth will also have an
understanding of the appropriate ways of expressing those emotions.
Most older youth will be able to adequately express their feelings in
words, and this helps to regulate their emotions.
As youths explore different values and settle on their beliefs, they
may have deeper feelings of who they are as people. This aspect of
emotional development often continues into adulthood. If they are
satisfied with the person they have become, they may emerge from Figure 1.33 Some youths will
the youth stage with a great sense of pride and achievement not experience the emotions associated
experienced previously. with a relationship for the first time.
Intellectual development during youth

During youth, physiological changes occur in the brain and in the way that the
young person perceives problems. These changes result in significant advances in
intellectual development. Youth begin to see ‘grey’ areas in problems when they
would have seen only ‘black and white’ in the past. During this stage, the brain
structures mature and abstract thought develops, as opposed to the concrete
thought relied upon in childhood. Information can be processed more efficiently,
and groups of concepts that were viewed individually might now be linked together
and viewed as an interrelated whole.
Examples of intellectual development during this stage include the following.
• Reasoning skills increase. As youth are presented with problems, they start to
apply related knowledge to the problems in order to make educated guesses. In
contrast, most children can see only concrete solutions.
• The ability to create hypothetical solutions and evaluate the best options develops.
This comes from previous experiences and from applying old knowledge to new
situations.

1.7 Individual human development during youth: social, emotional and intellectual
• Focus on the future increases. This may guide intellectual development — for
example, students wanting to study science might develop an interest in learning
about scientific principles and choose science courses at school.
• Thinking becomes more informed. Youths can distinguish between fact and
opinion and may challenge views put to them by others, including adults.
• More complex concepts are learned at school. As a result, youths may develop
an understanding of how they learn best (e.g. visual versus aural learners).
Some research suggests that the frontal lobe (a part of the brain) is not fully
developed until the end of puberty — possibly not until the 20s. The state of the
brain during these years may make youths favour immediate rewards and disregard
long-term consequences. It is thought that this aspect of brain development may
account for why youth are more likely to take risks than children or adults.
Figure 1.34 Towards the end of youth, individuals generally start to shift their attention to
learning things associated with their interests and possible career paths.
TEST your knowledge Figure 1.35

1 List three changes that occur for youth in each of Triangle problem
the following dimensions of development:
(a) social
(b) emotional
(c) intellectual.
2 Explain why conflict with parents often occurs as
youth form their own values and beliefs, and gain
independence.
3 (a) Make a list of the aspects of development that
can be influenced by the peer group.
(b) Make a list of risky activities that youth might
participate in with their friends.
4 Explain why individuals in early youth might be
preoccupied with what other people think of them. 8 Matt is in year 7 and started puberty 12 months
5 Discuss what is meant by ‘emotional independence’. ago. As a result, he is more physically developed
than his friends, whom he has had since primary
APPLY your knowledge school. Matt has begun to excel at football because
6 ‘When I was a boy of 14, my father was so ignorant he is taller and stronger than the other boys of his
I could hardly stand to have the old man around. age. He has started to socialise with his brother’s
But when I got to be 21, I was astonished at how friends, who are in year 9. They are similar in size
much he had learnt in seven years.’ What do you to him and he feels more ‘normal’ when he spends
think this quote (by American author Mark Twain) is time with them. As they are two years older than
trying to say? Matt, they do different things when they socialise,
7 (a) How many triangles are shown in figure 1.35? including spending time at the shopping centre
(b) Compare your answers with other students. and going to local discos. One of the reasons Matt
(c) Do you think a child would be able to answer enjoys spending time with older people is that he
this problem? Why? feels it makes him look ‘cool’ in the eyes of other
(d) Think of another example of a brain teaser/ year 7 students.
problem that children and youths might answer (a) Describe the physical changes Matt has gone
differently. through (or will go through) over the next few
years.
(b) Explain how Matt’s physical development could
be affecting his:
i. social development
ii. emotional development
iii. intellectual development.

KEY SKILLS The individual human development of Australia’s youth
KEY SKILL Define individual human development ❶ The definition does not have to be
exactly the same as the textbook
It is essential to be able to define individual human development. A definition definition, but it must convey the
should include reference to the four dimensions of development (physical, social, same concept.
emotional and intellectual).
In the example below, the term ‘individual human development’ is defined. ❷ Examples assist in demonstrating
understanding.
Individual human development refers to the changes that humans experience
from conception until death.❶ Individual human development (sometimes simply
❸ The four areas of development
referred to as ‘development’) includes the predictable, orderly changes that occur should be mentioned.
and can be physical (such as growth and motor skill development),❷ social (such as
communication skills), emotional (such as learning to control and effectively express
emotions) and intellectual (such as changes in thought patterns).❸
KEY SKILL Describe characteristics of, and interrelationships

between, the different types of individual human
development during the lifespan stage of youth
Youth is a time of rapid development, and the common aspects of development
should be known. In addition to the physical changes that occur, the social,
emotional and intellectual changes are also significant. Some questions will focus
on one dimension of development and others will be more open. Be sure to read
the question carefully to determine the main focus or requirement.
In the following scenario or case study, Tan is in grade six and she has just
started puberty. The following response outlines the physical changes that Tan will
experience as she❹ moves through puberty. ❹ Keep your answer focused on
Tan can expect to go through many physical changes during this stage of females.
development. Tan’s ovaries will produce more oestrogen, which will be responsible
for many of the changes that occur in the coming years.❺ ❺ Remember that not all physical
changes can be seen. Some occur
Tan will begin to develop breasts, although this process takes some years to inside the body such as the changes
complete. She will start to grow pubic hair, underarm hair and leg hair. Her voice in hormone production.
will deepen and she will undergo❻ a growth spurt that will see her add around
16 centimetres to her height and 16 kilograms in weight. At the end of puberty, ❻ Provide a range of changes that
her bones will have finished developing and her height will not increase much occur. Make sure that primary and
secondary sexual characteristics are
more. As a result of the growth spurt, Tan’s body proportions will change and covered.
fat will be deposited around her hips. Her hips will also widen, preparing her
body for reproduction. Tan’s menstrual cycle will begin. This marks the beginning ❼ Use key terms where appropriate.
of her ability to reproduce. Her primary sexual characteristics❼ will also develop
as her body prepares itself for reproduction (e.g. the enlarging of her vagina
and uterus).
A key requirement of this skill is to develop the ability to predict possible
outcomes for an individual, in all dimensions of development, in a particular
scenario or set of circumstances. Having a detailed knowledge of the four
dimensions of development is the first step in achieving this.
In this scenario (or case study), Ben is 16 and has just left school to begin a
plumbing apprenticeship. A discussion of how Ben’s development might be affected
by his leaving school and beginning full-time employment is presented below.
❽ If the question does not specify,
Ben’s development might be affected in the four key dimensions: physical, social, ensure that all dimensions of
emotional and intellectual.❽ development are covered.
Physical: He may miss out on playing sports at school, and this could affect his
motor development. He may learn new manual skills in the workplace that may
enhance his motor development.
Social: He will learn to communicate effectively with a range of people in a
professional manner.

Key skills The individual human development of Australia’s youth
Emotional: His identity may change as he begins to see himself differently as he

gains more skills and responsibilities.
Intellectual: Ben will miss out on the traditional academic concepts learned at
❾ Not all outcomes will be entirely school; however, he will learn a new set of skills associated with his trade.❾
positive or entirely negative. Try to
achieve a balance.
KEY SKILL Explain the biological determinants of
health and development and discuss the impact on the
development of youth
In order to complete this key skill, knowledge of the biological determinants
of health and development is important. As well as being able to explain the
biological determinants of health and development, the ability to predict the likely
effect of these determinants on the development of youth is also required. You may
also be required to use the biological determinants to explain possible reasons for
differences in the development between individuals. Remember that the focus of
this key skill is on youth and any discussion should be about this particular age
group.
Completing a summary table (such as table 1.1) can provide practice in
predicting likely effects of biological determinants on youth development.
Table 1.1 A summary table for analysing the impact on development of the biological
determinants
Determinant: Body weight
Area of development Possible impact on youth
Physical
Social
Emotional
Intellectual
Consider the following example:

Trent and Mai-Lin are both 13 years old and are in year 7 at the same school.
Although it would be expected that Mai-Lin would have started puberty earlier
than Trent, this is not the case. Trent started puberty 18 months ago which is
relatively early for a male, whereas Mai-Lin has not yet started puberty. Mai-Lin is
slightly underweight with a BMI of 14, whereas Trent has a BMI of 27, which for a
male of his age puts him in the obese category.
❿ As the task is to identify and
discuss the determinants, the first To identify biological determinants of health and development, and discuss how
step is to identify the determinant. they might influence the differences in development experienced by Trent and
Then discuss how it may have led Mai-Lin, a response might be as follows.
to the differences in health and
development. Genetics:❿ Even though females, on average, start puberty earlier than males,
Trent’s genes may be responsible for his earlier start to puberty.
Body weight: Body weight is linked to the onset of puberty and the fact that
Mai-Lin is underweight could have contributed to her delayed onset of puberty.
⓫ Ensure the link between the
determinant and the aspect of health Trent on the other hand, is classified as obese which may have contributed to his
or development is clearly established. relatively early onset of puberty.⓫

PRACTISE the key skills
1 Define individual human development.
2 Glenn is 14. He has just moved away from the family home to attend boarding
school.
(a) Glenn is in which lifespan stage?
(b) Discuss ways that attending boarding school could impact on Glenn’s physical,
social, emotional and intellectual development.
3 Jacob and Zoe have both just started puberty. Discuss the role that hormones play
in the development that each will experience over the coming years.
4 The graph in figure 1.36 shows the rate of growth for James compared to the
average male youth.
(a) Discuss how James’ rate of growth differs from that of the average male.
(b) Using biological determinants as the basis of your answer, discuss possible
reasons for this difference.
(c) Discuss how James’ physical development may have affected his social and
emotional development.
30
James
Average
25
Height gain (cm/year)
20
15
10
Figure 1.36 Average
rate of growth
0 for male youths
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 compared with
Age (years) James’ growth rate
5 List three aspects of physical, social, emotional and intellectual development that
occur during youth.
Key skills exam practice

6 Fabio and Mandie are both 14 and attend the same school. They are active individuals
who started puberty in the past 18 months.
(a) Identify two similarities in the physical development that occurs at their stage of the
lifespan.
(2 marks)

Key skills The individual human development of Australia’s youth
(b) Identify two differences in the physical development that occurs at their stage of the
lifespan.
(2 marks)
(c) Identify two hormones that contribute to the physical development being
experienced by Fabio and/or Mandie and explain the role they play in physical
development.
(6 marks)
(Adapted from the VCAA exam paper, 2005, Q. 4)

CHAPTER 1 review
Chapter summary
• The human lifespan begins at conception and ends at death. Each stage has
characteristics common to most people.
• The start and finish of some lifespan stages has been debated over the years, and
different groups and organisations may define the lifespan stages differently. For the
sake of this course, the lifespan stages, and the start and end of each stage, are:
–– prenatal: fertilisation until birth
–– infancy: birth to 2nd birthday
–– early childhood: 2 years of age to 6th birthday
–– late childhood: 6 years of age to 12th birthday
–– youth: 12 years of age to 18th birthday
–– early adulthood: 18 years of age to 40th birthday
–– middle adulthood: 40 years of age to 65th birthday
–– late adulthood: 65 years of age until death.
• Development refers to the orderly, predictable and sequential changes that occur
in individuals from conception to death. Development occurs in the physical, social,
emotional and intellectual dimensions.
• Some milestones may represent more than one dimension of development. Learning
to use a knife and fork is an example of both physical development (manipulating the
muscles to hold and move the knife and fork adequately) and social development (the
socially expected way to eat most meals).
• Physical development involves internal aspects (development and growth of body
systems and organs) and external aspects (motor skill development and growth). It
includes the decline in body systems.
• Youth is considered a period of rapid growth.
• The physical changes that occur during puberty can be classified as either primary or
secondary sex characteristics.
• The development experienced throughout life is determined by a broad range of factors
called determinants. Interactivities:
• Biological determinants relate to the state and functioning of the body and include Chapter 1 crossword
genetics, hormones and body weight. Biological determinants play a significant role Searchlight ID: Int-2889
in the physical development experienced by individuals in the youth stage of the Chapter 1 definitions
lifespan. Searchlight ID: Int-2890
• Genetics contribute to many aspects of development including height, the timing of the
onset of puberty, sex and physical appearance.
• Hormonal changes are largely responsible for the physical changes that occur during
puberty and can affect the onset and rate of physical development during youth. Growth
hormone is responsible for many of the changes that occur in height at this time.
• The rate of overweight and obesity has increased over time and impacts on the onset
of puberty for youth.
• Body mass is often measured using the body mass index (BMI). For adults, BMI scores
are judged according to set values. For youths, however, BMI classifications are based
on percentile charts because youths are undergoing rapid growth and experiencing
changes in body proportions.
• Social development refers to the social skills, behaviours, capabilities and roles that
people learn through interacting with others.
• Youth is a time of rapid social development. Values and beliefs are formed in this stage
and youths interact with a wider range of people, including increased interactions with
those of the opposite sex.
• The peer group is an important influence on social development as it contributes to the
development of behaviours and communication skills.

Chapter 1 review
• Emotional development refers to the way that people deal with and express the
emotions they experience. It includes self-concept.
• Individuals experience a wider range of emotions during youth and learn to recognise
and deal with them more appropriately.
• Identity is an important aspect of social and emotional development and relates to the
unique personality and way that an individual defines him/herself.
• Intellectual development refers to the processes occurring in the brain and includes
knowledge, language, memory and problem solving.
• The brain continues to develop during youth and contributes to more developed
thinking and reasoning skills.
• Youths often become more focused on knowledge related to possible career paths.
• The four dimensions of development are interrelated and all affect each other.

1 Define individual human development. 4 Make a list of physical, social, emotional and
2 Draw a concept map outlining the four dimensions intellectual characteristics that occur for people of
of development. For each dimension, include five your age.
characteristics that occur throughout the lifespan. 5 Write a newspaper article titled ‘The long and
3 Explain why puberty is no longer used to signify the winding road — youth of today’.
start of the youth stage of the human lifespan. 6 ‘Youth really lasts from age 12 until age 25’.
Working in groups, debate this statement.

CHAPTER 2
The health of
Australia’s youth
The health of Australia’s youth is generally good, and
improvements are continually being made in most areas.
An understanding of the concept of health is important if the
health of our young people is to be adequately analysed
and evaluated. Areas for possible improvement can then
be identified and current interventions can be evaluated.
Predictions can also be made about the health impacts of
current trends and issues. Understanding the role biological
determinants play is also useful in explaining specific health
concerns facing young people.
KEY KNOWLEDGE
1.3 definitions of health and the limitations of these definitions
(pages 40–1)
1.4 characteristics of, and interrelationships between, physical, social and
mental dimensions of health (pages 41–7)
1.5 measurements of health status, including life expectancy, incidence,
prevalence, trends, morbidity, mortality, disability adjusted life years
(DALYs) and burden of disease (pages 48–57)
1.6 the health status of Australia’s youth (pages 48–57)
1.7 biological determinants of health and individual human development
of Australia’s youth, including genetics, body weight and hormonal
changes (pages 58–61)
1.8 the interrelationships between health and individual human
development during the lifespan stage of youth (pages 62–3, 68–9).
KEY SKILLS
• define health
• explain the limitations of definitions of health
• describe the characteristics of, and interrelationships between, the
dimensions of health
• explain health status measurement terms
• interpret and analyse data on the health status of Australia’s youth
using appropriate measurements
• explain the biological determinants of health and development and
discuss the impact on the health of youth
• explain the interrelationships between health and human development Figure 2.1 The health of Australia’s
during the lifespan stage of youth. youth is generally good.
38 UNIT 1
4 • The
Global
health
health
andand
development
human development
of Australia’s youth
KEY TERM DEFINITIONS
burden of disease a measure of the impact of diseases
and injuries; specifically it measures the gap between
current health status and an ideal situation where
everyone lives to an old age free of disease and disability.
Burden of disease is measured in a unit called the DALY
(VCAA).
disability adjusted life year (DALY) a measure of
burden of disease. One DALY equals one year of healthy
life lost due to premature death and time lived with
illness, disease or injury (VCAA).
Down syndrome a genetic condition characterised by
having three chromosomes on the 21st pair instead of
two. Individuals exhibit distinct facial features, reduced
muscle mass and impaired intelligence.
genetic predisposition an inherited tendency to
exhibit certain traits (e.g. being tall) or to develop certain
conditions (e.g. cancer) based on genetic make-up
haemophilia an inherited condition characterised by an
inability of the blood to clot
health ‘a state of complete physical, mental and social
wellbeing and not merely the absence of disease or
infirmity’ (WHO,1946)
health indicators standard statistics that are used to
measure and compare health status, e.g. life expectancy,
mortality rates, morbidity rates
health status ‘an individual’s or a population’s overall
health, taking into account various aspects such as life
expectancy, amount of disability and levels of disease risk
factors’ (AIHW, 2008)
incidence refers to the number (or rate) of new cases of
a disease/condition in a population during a given period
infirmity a state of being weak, especially from old age
lethargic tired; lacking energy or mental awareness
life expectancy an indication of how long a person can
expect to live if the current death rates remain unchanged
mental health ‘State of wellbeing in which the
individual realises his or her own abilities, can cope with
the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her
community.’ (WHO, 2009)
morbidity refers to ill-health in an individual or levels of
ill-health in a population
mortality refers to deaths in the population
muscular dystrophy an inherited condition
characterised by progressive muscle wasting
physical health relates to the efficient functioning of the
body and its systems, and includes the physical capacity to
perform tasks and physical fitness (VCAA)
prevalence the number or proportion of cases of a
particular disease or condition present in a population at a
given time (AIHW, 2008)
social health being able to interact with others and
participate in the community in both an independent and
cooperative way
Turner syndrome a genetic condition characterised
by having only one full chromosome on the 23rd pair.
Sufferers are females of small stature who cannot
reproduce.
years lost due to disability (YLD) a measure of how
many ‘healthy’ years of life are lost due to illness, injury or
disability
years of life lost (YLL) a measure of how many years of
expected life are lost due to premature death
The health of Australia’s youth • CHAPTER 2 39

2.1 What is health?
KEY CONCEPT Understanding the definitions of health and their limitations, and
the interrelationships between physical, social and mental health
Understanding the concept of ‘health’ is important for gaining an accurate

knowledge of the level of health experienced in Australia. This understanding
allows areas for improvement to be identified and targeted. A deep understanding
Interactivity:
of health will also allow for predictions to be made about the likely effect that
Time Out: ‘Dimensions
of health’
introduced strategies and actions will have on the health of individuals.
Searchlight ID: int-1421
Defining health
There has been ongoing debate about the meaning of health since the first
commonly accepted definition was released by the World Health Organization
(WHO) in 1946:
‘health is a state of complete physical, mental and social wellbeing and not merely
the absence of disease or infirmity. ’
Although this is a broad definition, it is the one used by health professionals

to define health. It was the first definition to consider health as being more than
just the physical aspect, and recognises the other types or dimensions of health —
social and mental. The use of such a broad definition to make a judgement about
whether a person is healthy or not can be difficult (figure 2.2). Although it moves
beyond disease and infirmity, it does not give everyone the opportunity to be
considered healthy. For example, trying to achieve ‘complete’ wellbeing in even
one of the dimensions of health identified is very difficult. Therefore it has been
argued that this definition makes good health unattainable for most people.
In 1986, the WHO clarified the definition by saying that health is:
‘a resource for everyday life, not the objective of living. Health is a positive concept
emphasising social and personal resources, as well as physical capacities. ’
With this in mind, the definition of health becomes more inclusive and more
achievable. The focus on ‘personal resources’ and ‘physical capacities’ means that
health is dependent on an individual’s own situation, and a person can be
considered healthy even if they do not have ‘complete’ wellbeing in the areas of
physical, social and mental health.
You will notice that the fourth word of the original WHO definition of health
is ‘state’. This is a key word for understanding the concept: health is a ‘state’ and,
as a result, is also dynamic. This means that it is
always changing (although the levels of change
may not always be obvious). Health can be
optimal one moment, and then events such as
accidents, illness, relationship breakdown and
stressful incidents can change the state of health
very quickly. Health can also improve quickly. A
person with a migraine who is experiencing poor
health can rest and possibly take medication
that will return their health to an optimal level.
In 1986, the Better Health Commission (BHC)
described health in the following way:
’Good health implies the achievement of a
dynamic balance between individuals or groups
and their environment. To the individual, good
Figure 2.2 Would this man be considered healthy using the WHO definition? health means improved quality of life, less

sickness and disability, a happier personal, family, and social existence, and the
opportunity to make choices in work and recreation. To the community, good
health means a higher standard of living, greater participation in making and
implementing community health policies, and reduced health-care costs.’
This definition is more inclusive than the original 1946 definition and builds
further on the capabilities of the individual. The individual’s environment is also
mentioned in this definition, and the environment exerts a huge influence on health.
The physical, social and mental dimensions of health

When people talk about health, they are often talking about physical health, or
rather, physical ill-health. Although some information or data is available relating
to social and mental health, physical ill-health is generally easier to measure and
has become the main focus of many health statistics. Although the physical aspect
of health is very important, it is not the only one that needs to be considered. As
stated in the WHO definition, health encompasses the social and mental state of
the individual as well as the physical state, and there is an increasing understanding
of the importance of these other dimensions of health.
Physical health
Physical health refers to the current condition of the body and its systems. Most
aspects of physical health can be readily measured or observed (see figure 2.3).
Physical
fitness
Functioning
of body Body weight
systems
Aspects of Blood
Energy levels
physical health cholesterol
Feelings of
Blood
physical
pressure
wellbeing
Levels of
illness
Figure 2.3 The indicators of

physical health
Physical health can be measured using indicators such as:

• physical fitness. Physical fitness means being able to complete activities such as
daily chores, exercise and incidental physical activity such as walking or riding
to school without exhaustion or extreme fatigue (figure 2.4).
• weight measurements in relation to height. A person who is physically healthy
has a weight that is appropriate for their height and is not carrying excess weight.

2.1 What is health?
Figure 2.4 Fitness is an aspect of

physical health.
• blood cholesterol levels. Excessive blood cholesterol can increase the risk of
cardiovascular disease (sometimes called ‘heart disease’). Elevated blood cholesterol
levels may indicate that the intake of saturated and trans fats is excessive.
• blood pressure levels. Blood pressure refers to the force that blood places on the
walls of the blood vessels as the heart beats. High blood pressure indicates that
the blood vessels are not in optimal shape and the heart is working too hard.
High blood pressure is often a symptom of cardiovascular disease and can occur
as a result of a range of factors such as food intake, genetics and other diseases.
• the absence or presence of illness. A person who is physically healthy will have
an immune system that is functioning adequately and is capable of resisting
infection and disease.
Aspects of physical health that cannot typically be measured include:
• feelings of physical wellbeing. The way a person feels physically can be an
indicator of physical health. Being free from pain, tightness and discomfort are
some examples that might indicate feelings of physical wellbeing.
• energy levels. Physical health includes having enough energy to adequately carry
out daily tasks that might include school activities, socialising and a part-time
job. Lack of energy usually means that the individual’s body systems are not
functioning adequately. This could be the result of many factors including food
intake, exercise levels, illness and stress levels.
• functioning of the body’s systems. Physical health is ultimately reliant on the
functioning of the body’s systems. If the systems are functioning adequately,
the person will usually display other characteristics of physical health (such as
physical fitness; normal levels of blood pressure, blood cholesterol and energy;
freedom from disease; feelings of wellbeing).

There are many factors that can influence physical health such as food intake,
sleep patterns, exercise levels and genetics. Although these factors contribute to
the level of health experienced, it is the physical state that they result in — such
as a healthy immune system or an ideal body weight — that is considered to be a
physical aspect of health.
Social health
Interacting with other people is an important
aspect of human nature (figure 2.5). Social
health refers to these interactions and their
quality. Someone who is experiencing a good
level of social health typically has a good
network of friends and a supportive and
understanding family, with all their social
needs met.
Like all dimensions of health, social health is
dynamic and can change quickly. An individual
can have a network of friends and a supportive
family until they move away from home.
Suddenly those interactions become more
difficult, and their social health can suffer.
Figure 2.5 Interaction with friends
is an important aspect of social health
and can affect mental health.
Friendship
networks
Aspects of
social health
Relationships
Social needs
with family
met
members
Figure 2.6 The indicators of social
health
Mental health
Mental health refers to a ‘state of wellbeing in which the individual realises his or her
own abilities, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her community’ (WHO, 2009).
This includes thoughts and the impact that a person’s feelings have on themselves.
Positive mental health might include managing day-to-day activities with low levels
of stress, being able to lead an independent life and being resilient in the event of
misfortune.
If a person is feeling particularly stressed, then the mental aspect of their health
may be compromised (figure 2.8). This area of health also includes levels of self-
esteem and confidence.

2.1 What is health?
Self-esteem refers to how people feel about themselves. Having positive self-
esteem means that people feel good about themselves. Self-esteem influences
behaviour, as those with positive self-esteem are more likely to speak their mind
and act independently and responsibly.
Self
esteem
Aspects
Thought
of mental Confidence
patterns
health
Levels of
stress
Figure 2.7 The indicators of mental

health
Confidence relates to believing in one’s own worth and ability to succeed.

Having confidence can help people accept challenges, such as volunteering to give
a speech, and increase their chances of success because they are not concentrating
on failure. Individuals may have different levels of confidence in different aspects
of their lives. Although it is based on past experiences, confidence can change
rapidly as a result of factors such as one’s personal appearance or comments made
by others.
It should be noted that mental health is not the opposite of mental illness.
Mental illness refers to certain mental disorders, whereas mental health is broad
and will vary for an individual from day to day. Mental health can be affected by
life events such as breaking up with a partner, having a death in the family or being
dropped from a sports team.
Figure 2.8 Stress can be a

detrimental aspect of mental health.
44
UNIT 1 • The health and development of Australia’s youth
The interrelationships between the dimensions
of health Optimal
health
The three dimensions of health are interrelated; that is, they all affect each
other (figure 2.9). Although they will not all be affected in the same way Physical
or to the same degree, a change in one will usually have some effect on the health
other two. For this reason, all three dimensions of health need attention in
order to achieve optimal health (see box).
Exactly how do the dimensions of health affect each other? Consider a Mental Social
youth who has suffered a broken leg (physical health) and is recovering in health health
hospital (figure 2.10). While in hospital and during the recovery phase, their
health could be affected in numerous ways:
• physical health Figure 2.9 The three dimensions of
–– may not be able to exercise, so health are interrelated.
fitness levels reduce
–– could gain weight as physical
activity levels decrease OPTIMAL HEALTH
–– immune and other body systems Optimal health refers to the
may be affected by the food given in highest level of health an
individual can realistically
hospital (this could have positive or
attain. Everyone is born with
negative effects on health, depending a different genetic potential
on what the diet was like before) and is influenced by different
• social health environments. As a result, every
–– might make new friends in hospital individual’s level of optimal
–– could socialise with doctors and health will be different.
nurses
–– may get a lot of visits from family
members they would not normally
see
–– will not be able to socialise with
friends at school and during leisure
time
• mental health
–– might be happy or sad to miss out
on school
–– may be depressed about missing
out on socialising with friends and
family
–– could experience feelings of
loneliness
–– may feel like they are a burden on
their family.
Not all of the effects on health are
negative. Sometimes a negative event can
produce positive effects on one or more
of the dimensions of health. You may
also have noticed that there is a range
of effects on the various dimensions of
health. It is impossible to state exactly
how an individual’s health will be affected
by a particular event because everyone
is unique and each situation is different. Figure 2.10 This youth’s social and
We can, however, predict possible effects mental health may be affected by his
on health. physical health.

2.1 What is health?
It is also important to note that the effect on health will not always have a
physical cause. For example, a relationship break-up (non-physical cause) can lead
to a loss of appetite (physical health). If the newly single individual used to spend
a lot of time with their partner’s friends, they may now have to find a new group of
friends (social health). The person may experience a loss of confidence and doubt
their own worth (mental health).
The following case study looks at the effect of excessive alcohol use on mental
health.
Case study
Confronting the issue

By Chris Tanti (headspace) and Leonie Young
(beyondblue)
headspace, the National Youth Mental Health Founda
tion, and beyondblue: the national depression initia
tive, welcome the Brumby Government’s commitment
to addressing the spiralling alcohol abuse, particularly
with young people.
We agree with the Premier that alcohol is one of the
biggest social issues facing Victoria, and it is one of the
biggest threats to young Victorians.
However, it is not just the rise in hospital emergency
department admissions for alcohol use that needs to be Figure 2.11 Excessive alcohol use can have negative
effects on the physical, social and mental dimensions
acknowledged when dealing with this issue. of health.
Too often we think of drug and alcohol use in
isolation and the mental health concerns in respect to
this use are neglected. We can no longer afford to ignore the social, physical
We urge the Alcohol Action Taskforce to take and mental health implications of alcohol use among
a holistic approach and focus on mental health, our young people.
particularly depression and anxiety, as a precursor to Nor can we continue to ignore the rise in depression,
alcohol use in our young people. anxiety and other mental health conditions and their
The relationship with pre-existing depression and relationship with substance use.
other mental health issues is one of the strongest Parents and the community have the opportunity
predictors of young people taking up and continuing to take the lead in reducing alcohol consumption and
alcohol use at the alarming rate indicated by Premier educate young people on the dangers of alcohol use.
Brumby. Source: Moorabbin/Glen Eira Standard, 21 November 2007.
Case study review

1 (a) How could excessive alcohol use affect the physical, social and mental health
of young people?
(b) Are all of the effects negative?
2 (a) What does it mean when mental illness is described as a ‘precursor’ to alcohol
use?
(b) Brainstorm a list of other factors that may increase/decrease the risk of
participating in dangerous alcohol consumption.

TEST your knowledge 12 (a) Brainstorm factors that may affect social health.
(b) Suggest ways that social health could be
1 What is the WHO definition of health?
improved.
2 (a) What does it mean when health is said to be
13 (a) Brainstorm factors that may affect mental
‘dynamic’?
health.
(b) List examples that show the dynamic nature of
(b) Suggest ways that mental health could be
health.
improved.
3 What is meant by the term ‘optimal health’?
14 Give two examples of how the three areas of health
4 (a) Which dimension of health is usually the focus
can affect each other or interrelate.
of health statistics?
15 Look at figure 2.8 and suggest ways that this man’s
(b) Suggest reasons that might account for this.
physical and social health could be affected by his
(c) When we talk about health, why is it often current state of mental health.
‘ill-health’ that we are actually talking 16 Tom is a year 11 student who enjoys playing football
about? and socialising with friends in his spare time. He
5 What are the three dimensions of health? List two has a part-time job that allows him to earn enough
examples for each. money to fund his social life and to save money
for a car. In the past few months, Tom has been
APPLY your knowledge trying to convince his parents to allow him to leave
6 Suggest some limitations of the 1946 WHO school and get a job as an apprentice plumber.
definition of health. Tom’s parents have been trying to persuade him to
7 Would you be considered healthy at this point in finish year 11 and then try to get an apprenticeship.
your life according to the original WHO definition? This issue has caused a lot of conflict within the
Why? household. Tom has been feeling stressed about
8 Discuss the similarities and differences in the two being at home and is therefore avoiding the house
definitions of health presented. Which definition do as much as possible. In the past week, he has been
you prefer? Explain. sleeping at a friend’s house and has not been doing
9 Devise your own definition of health that you the things that he normally does, including going to
think is appropriate. Share your definition with his job and playing football.
the class. (a) How has Tom’s health been affected by the
10 Why might the WHO definition of health have been conflict with his parents?
more appropriate in 1946 than it is now? (b) Suggest examples from the case study that
11 (a) Brainstorm factors that may affect physical represent each of the three dimensions of health
health. (physical, social and mental).
(b) Suggest ways that physical health could be (c) Suggest ways that Tom could return his health
optimised. to an optimal state.

2.2 The health status of Australia’s youth
KEY CONCEPT Understanding measurements of health status and the health

status of Australia’s youth: self-assessed health status, life expectancy and
mortality
What is health status?

An understanding of health status and the statistics that indicate health status
allows informed judgements to be made about the health of various groups.
Health professionals often refer to an individual’s or group’s health status, which
is the level of health being experienced by an individual or a population after taking
into account factors such as life expectancy, disability rates and risk of disease. It is
useful to think of health status as a continuum (figure 2.12). An individual’s place
on the continuum is a product of the three dimensions of health.
Severe Neutral (no discernible Optimal

ill-health illness or wellness) health
Figure 2.12 Health status can be thought of as a continuum.
As already mentioned, health is a dynamic state — it is continually changing.

Usually these changes in health status are fairly minor; for example, developing a
cold may slightly affect physical, social and mental health for a short period of time.
Major changes in health status are less common; for example, if someone experiences
the death of a loved one, their mental health might take some time to recover.
Measuring health status

Measuring health status is useful for a number of purposes. First, it allows
judgements to be made about the health of individuals, groups or populations.
With this information, government and non-government organisations can
take action to improve health in areas that need it. Second, it allows trends to
be identified in health status over time. This can provide valuable feedback on
actions that have already been implemented. Such information can further guide
interventions aimed at improving health. There are a number of ways of measuring
health status and these measures are collectively known as health indicators.
It can take some time for health statistics to become public — often around
three years before data can be accurately collated and released. Some statistics are
released only every two years (biannually) or less often. As a result, some statistics
quoted in this book may date back to the early 2000s, yet they represent the most
recent statistics available. Generally speaking, the rates and ratios derived from
statistics change slowly over time, so even older statistics are relevant to what is
happening today. Further, many statistics are available only for set age groups
(often 12–24). When these statistics are used, it is important to remember that
they include a proportion of those in the early adulthood stage.
Australia is one of the healthiest countries in the world and Australia’s youth
(those aged 12–18) are among the healthiest individuals in the country.
The health status of Australia’s youth is generally good (figure 2.13). There
Figure 2.13 The youth stage of the
have been constant improvements over time in most aspects of health. In order to
lifespan is generally characterised by adequately assess the health of Australia’s youth, it is important to understand the
good health. methods used for reporting health.

The self-assessed health status of Australia’s
youth
Self-assessed health status is based on an individual’s own perception of their
health. People are asked to rate their level of health and wellbeing. Responses range
from excellent, very good, good, fair and poor. Young Australians generally rate
their own health positively. Figure 2.14 shows the self-assessed health status of
young Australians at selected ages.
100
Excellent or very good
90
Good
80 Fair or poor
70
60
Per cent
50
40
30
20
10
0
Male Female Male Female Male Female
15–17 years 18–24 years Total 15–24 years
Figure 2.14 Self-assessed health status of young people aged 15–24 years, 2007–08
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE
140, Canberra, p. 16.
Life expectancy
Life expectancy is one of the most common methods used to measure health
status. It gives an indication of how long a person can expect to live if the current
death rates stay the same. (Unless stated otherwise, the numbers refer to a person
born today.) Table 2.1 shows life expectancy data for people of different ages in Table 2.2 Life expectancy for
Australia. Australia’s youth and early adults at
different ages
Table 2.1 Life expectancy at different ages, 1901–10 and 2009–11 Age Males Females
Age Males Females 12 80.3 84.6
1901–10 2009–11 1901–10 2009–11 13 80.3 84.6

14 80.3 84.6
Birth 55.2 79.7 58.8 84.2
15 80.3 84.6
30 66.5 80.8 69.3 84.9
16 80.3 84.6
65 76.3 84.1 77.9 87
17 80.3 84.6
85 87.7 91.2 89.2 92.2
18 80.4 84.7
Source: Adapted from AIHW and ABS data.
19 80.4 84.7
20 80.4 84.7
According to the Australian Bureau of Statistics (2010), the life expectancy of a
child born in 2011 was 79.7 years for a male and 84.2 years for a female. Compare 21 80.5 84.7
this to a life expectancy of 55.2 years for males and 58.8 years for females born 22 80.5 84.7
between 1901 and 1910 (table 2.1). This represents an increase in life expectancy 23 80.5 84.7
of more than 20 years in the past century. The life expectancy of Australians is 24 80.6 84.8
constantly improving while death rates are decreasing. 25 80.6 84.8
The life expectancy for Australia’s youth reflects the high figures experienced by
Source: Adapted from Australian Bureau of
all age groups in this country. According to table 2.2, a male aged 12 could expect Statistics, Life tables, Australia, 2009–11, ABS
to live to 80.3 years and a male aged 21 could expect to live to 80.5 years. cat. no. 3302.0.55.001.

Table 2.3 Mortality rates by age group and sex, 2007

Mortality
Age Males Females Persons Male : female ratio
Mortality refers to deaths in a population.
0–4 117.3 91.1 104.5 1.3 The mortality rate is therefore an
5–9 11.2 8.5 9.9 1.3 indication of how many deaths occurred
10–14 11.7 9.8 10.7 1.2 in a population in a given period of
15–19 49.0 21.6 35.7 2.3 time for a specific cause/all causes.
20–24 63.7 25.3 45.1 2.5
Mortality rates are usually presented
per 100 000 population in a 12-month
25–29 79.1 34.2 57.0 2.3
period. Some mortality rates are shown in
30–34 98.4 38.2 68.4 2.6 table 2.3.
35–39 122.5 64.6 93.4 1.9 A mortality rate of 21.6 per 100 000
40–44 165.5 89.6 127.4 1.8 means that, on average, 21.6 females in
45–49 231.5 151.6 191.1 1.5 every 100 000 died in 2009 in this age
50–54 352.8 224.7 288.1 1.6
group. According to the ABS, there were
727 716 females in this age group in
55–59 517.0 316.9 416.1 1.6
2009, which equals 157 deaths.
60–64 820.6 479.7 650.0 1.7 The male : female ratio means that in
65–69 1 328.3 781.7 1 052.4 1.7 2009 an average of 2.3 males died in this
70–74 2 236.6 1 321.7 1 763.0 1.7 age group for every female that died in
75–79 3 867.6 2 361.0 3 058.6 1.6 this age group.
80–84 6 877.8 4 658.4 5 602.8 1.5
Youth death rates are low compared
to other age groups (figure 2.15) and
85+ 14 435.9 12 487.6 13 153.3 1.2
have decreased significantly since 1970
Source: Adapted from AIHW data. (figure 2.16).
140
Males
120 Females
Death rates per 100 000
100
80
60
40
20
0
0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39
Age
Figure 2.15 Death rates for infants, children, youths and early adults, 2009
Source: Adapted from AIHW and ABS data.
Youth has among the lowest death rates of all lifespan stages (figure 2.15). This
is because they have survived childhood, where factors associated with childbirth
and genetic abnormalities cause many deaths, and their bodies have generally not
had enough time to develop lifestyle conditions such as cardiovascular disease
and cancer. Deaths from accidental causes such as car accidents and drowning
contribute significantly during the youth stage. Such causes are classified as
‘injuries’. Specifically, injuries include:
• road accidents
• suicide
• drowning
• fires
• falls.

180
160
TRENDS
Death rates per 100 000
140 A trend is a general movement

or pattern. Sometimes trend
120
data is valuable because it tells
100 us what has been happening to
80 the data over a period of time.
60 For example, the death rate
40
for those aged 15–19 in 2005
was 49 per 100 000. This figure
20
may seem high considering that
0 youth is one of the healthiest
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
stages of the lifespan. Yet
Year when we see the trend data,
it shows that the rates have
Figure 2.16 Death rates for Australians aged 15–19, 1970–2009 actually decreased significantly
Source: Adapted from AIHW data. compared to years gone by (see
figure 2.16).
Years of life lost (YLL) due to premature death is another way of measuring and
comparing mortality. If a person dies from a given condition 30 years before the
predicted life expectancy for their age, then they have contributed 30 YLLs to that
particular cause of death. For example, if a 20-year-old female dies in a car crash,
and life expectancy for females that age is 84, then 64 years have been added to
the YLLs for injuries.
The YLLs that were caused by a range of conditions among young Australians
are shown in figure 2.17.
For Australia’s youth, road traffic accidents are the leading cause of years
of life lost, and injury-related deaths account for the top three causes of YLLs.
Cancer is the leading non-injury related cause of death, followed by nervous
system and sense disorders that include epilepsy and muscular dystrophy. Note
that ‘other causes’ is not considered to be a leading cause of death because it
encompasses a range of conditions, each of which on its own contributes very
few YLLs.
Respiratory diseases
(including asthma)
Drowning
Cardiovascular disease
Congenital abnormalities
Endocrine and metabolic Males 10–14
disorders Males 15–19
Nervous system/
sense disorders Females 10–14
Other causes
Females 15–19
Cancer
Other injuries
Suicide
Road traffic accidents
0 1000 2000 3000 4000 5000 6000 7000 8000

Years of life lost (YLLs)
Figure 2.17 Years of life lost (YLLs) for selected conditions by sex and age group
Source: Adapted from AIHW data.

TEST your knowledge 7 (a) Describe the trend in death rates as shown in
figure 2.16.
1 What percentage of 15–24 year olds assessed
(b) What factors may have led to this trend?
their health as excellent or very good in 2007–08,
8 What are the top three causes of death for males
according to figure 2.14?
and females?
2 Using table 2.1, explain how life expectancy
9 (a) State what the acronym ‘YLL’ stands for and
changed from 1901–10 and 2009–11 for:
explain what it means.
(a) males at birth
(b) Outline how YLLs are calculated.
(b) females at birth.
10 (a) Which sex contributes more YLLs to the burden
3 (a) Using table 2.2, explain what happens to life
of disease according to figure 2.17?
expectancy as individuals move through youth
(b) Suggest reasons for this.
and into the early adulthood stage of the
lifespan.
APPLY your knowledge
(b) Suggest reasons that account for this change.
4 What is mortality? 11 Discuss why death rates might be a more useful
5 Examine table 2.3 and answer the following statistic than the total number of deaths.
questions: 12 Examine table 2.3 and complete the following:
(a) Which age group has the greatest male:female (a) Graph the male:female mortality ratio across the
ratio for mortality? lifespan as shown in table 2.3.
(b) What does this number (ratio) mean? (b) Describe the pattern with regard to male:female
(c) Discuss reasons that may account for the ratio mortality rates across the lifespan.
identified in part (a).
6 (a) According to figure 2.15, how do death rates
change for 10–14 year olds compared with
15–19 year olds?
(b) Suggest reasons for this change.

2.3 The health status of Australia’s youth: morbidity and
burden of disease
Understanding measurements of health status and the health status of

Australia‘s youth: morbidity and burden of disease
Morbidity
Not all conditions end in death, so it is useful to examine
the effect that non-fatal conditions have on a population
(figure 2.18). This is where morbidity data is useful.
Morbidity refers to ill-health — including disease, injury
and disability — in an individual, and the level of ill-health
in a population. So the morbidity rate refers to the rate of
ill-health in a population in a given period of time.
There are two ways of considering morbidity:
• the number of people reporting a condition (often
represented as a percentage of a population, or the
incidence and prevalence rates)
• the years lost due to disability (YLDs), where one YLD is
equal to one ‘healthy’ year of life lost. Figure 2.18 Many conditions do not
By using two methods, it is possible to examine which conditions are the most end in death but still affect youth
common and which conditions have the biggest impact on health. health and development.
Incidence and prevalence

Incidence and prevalence are two measures used to present morbidity data.
Incidence refers to the number of new cases of a condition in a given period of
time (usually 12 months) and prevalence refers to the total number of cases of a
condition at a given time. Both incidence and prevalence data can be shown as the
total number or the rate (often per 1000 or per 100 000 population).
Incidence data is useful for identifying which conditions are increasing in
diagnosis and which ones are decreasing. This can assist the government and
health organisations in allocating resources and taking action to improve the health
status of Australia’s youth.
Table 2.4 shows the incidence rates (per 1000) for selected age groups and
conditions in 2003.
Table 2.4 Incidence rates for selected conditions, per 1000 population, 2003
Males Females
10–14 15–19 10–14 15–19
Upper respiratory tract infections 1691.0 1590.2 1544.6 2070.3

Diarrhoeal diseases 704.5 704.5 861.1 861.1
Back pain 100.8 18.8 0.7 233.2
Dental caries 250.0 269.5 250.0 269.6
Anxiety and depression 9.2 11.3 11.3 15.3
Migraine 12.0 9.2 20.5 23.2
Asthma 7.5 1.0 8.7 6.0
Falls 9.4 7.7 3.8 1.6
Acne 4.7 6.2 1.8 5.7
As can be seen from table 2.4, the incidence rate for migraine was 12 for every
1000 males in the 10–14 age bracket. In 2003, there were approximately 706 500
males in this age group. To calculate the total number of new cases, multiply the

2.3 The health status of Australia’s youth: morbidity and burden of disease
rate per 1000 by 706.5 (as there are 706.5 groups of 1000 in 706 500) to get the
total number of new cases in 2003:
706.5 × 12 = 8478.
So in 2003 there were approximately 8478 new cases of migraine among males
in the 10–14 year age group.
The prevalence, or total cases, of selected conditions are shown in table 2.5.
Table 2.5 Prevalence of selected conditions, 2003
Males Females
10–14 15–19 10–14 15–19

Interactivity:
Asthma 88 076 63 203 59 095 58 346
Time Out: ‘Patterns of
morbidity and mortality’ Anxiety and depression 17 796 47 328 23 195 56 735
Searchlight ID: int-1646 Migraine 16 990 23 053 14 813 33 522
Attention deficit hyperactivity 36 369 15 270 14 487 5 704
disorder
Dental caries 13 105 13 956 12 464 13 347
Eczema 5 737 4 528 19 024 15 933
Alcohol dependence 0 32 864 0 435
Acne 5 629 12 090 2 128 8 102
Back pain 3 181 4 639 2 198 5 427
Source: Adapted from www.aihw.gov.au data.
Statistics on prevalence can be useful for comparing the number of individuals

suffering from certain conditions during a specified period of time. As with
incidence, information about prevalence can assist with allocating resources
and planning for the future. It also ensures that trends can be identified over time
so that the health system can adapt to cater for the changing needs of Australia’s
youth.
The rate of each condition can be calculated if the approximate population is
known. First, divide the population number by 1000 (or 100 000 if you want to
display the rate per 100 000).
For example, in 2003 there were approximately 671 900 females in the 10–14
age group:
671 900 ÷ 1000 = 671.9.
In other words, there were 671.9 groups of 1000.

To calculate the rate, divide the number of individuals suffering from the
condition by 671.9. For asthma (table 2.5), there were 59 095 females in this age
group suffering from asthma:
59 095 ÷ 671.9 = 87.9 cases per 1000 females in this age group.
YLDs
Years lost due to disability (YLDs) is a measure of the impact of morbidity on a
group or population. YLLs and YLDs are equal in value, in that one YLL and one
YLD are each equal to one healthy year of life lost.
It would be difficult to compare the effect of asthma on an individual with
the effect of losing a leg in a car crash. They are very different conditions
and would impact on an individual in different ways. In order to address this
issue, the World Health Organization has given the most common conditions
a disability weight, which is an indication of the severity of the condition and

how much it interferes with normal life. The disability weights are incorporated
into the YLD formula, so all YLDs are relative and different conditions can be
compared.
The graphs below show the breakdown of YLDs for males (figure 2.19) and
females (figure 2.20) in 2003. While YLLs are generally male-dominated, YLDs
were slightly higher for females in 2003 (57 616 for males and 67 840 for females).
Females experience higher rates of YLDs for most conditions, with injuries being a
notable exception.
2% 1%
2% 1% 2% 1%
8% 3% 1%
7%
9%
13%
9%
59%
10% 58%
14%
Mental disorders
Other Mental disorders
Injuries Other
Nervous system and sense Chronic respiratory diseases
organ disorders Nervous system and sense
Chronic respiratory diseases organ disorders
Communicable diseases, maternal Communicable diseases, maternal
and neonatal conditions and neonatal conditions
Cardiovascular disease Injuries
Nutritional deficiencies Cardiovascular disease
Endocrine and metabolic disorders Nutritional deficiencies
Figure 2.19 Proportion of YLDs Figure 2.20 Proportion of YLDs attributed
attributed to selected causes, males to selected causes, females aged 10–19,
aged 10–19, 2003 2003
Source: Adapted from AIHW data. Source: Adapted from AIHW data.
Burden of disease
Burden of disease is a health indicator that combines mortality data with morbidity
data so that conditions that contribute differently to death and illness can be
compared. For example, cancer causes a lot of death and illness while a chronic, or
long-term, condition such as asthma causes a lot of illness but much less death. In
the past, it was hard to compare these two conditions and decide where valuable
funding should go. Burden of disease data was created to help overcome this
problem.
Burden of disease is measured in disability adjusted life years (or DALYs,
pronounced ‘dally’), where 1 DALY is equal to one year of ‘healthy’ life lost due to
premature death or living with a disability/illness. Using DALYs, it is possible to
compare the impact of different conditions equally — those that cause death, those
that cause disability and illness, and those that cause both (table 2.6). So a person
who has lived a healthy life — but dies suddenly 30 years earlier than the current
life expectancy of their age — has contributed 30 DALYs. In contrast, a person who
is still alive but has spent their last 10 years at only ‘half health’ has contributed
five DALYs.

2.3 The health status of Australia’s youth: morbidity and burden of disease
Table 2.6 Ten leading causes of burden of disease and injury for 10–19 year olds
in Australia, 2013
Condition DALYs % of total DALYs
Mental disorders 73 415 49.6

Injuries 21 014 14.2
Chronic respiratory disease 14 084 9.5
Nervous system and sense organ disorders 11 701 7.9
Skin diseases 3 815 2.6
Cancers 2 931 2.0
Cardiovascular disease 2 837 1.9
Musculoskeletal diseases 2 238 1.5
Acute respiratory infections 1 813 1.2
Diabetes mellitus 1 528 1.0
DALYs are calculated by adding YLLs (years of life lost) and YLDs (years lost due
to disability), as shown in figure 2.21.
YLLs YLDs DALYs
Figure 2.21 The equation for DALYs
Australia’s youth experience a significantly greater number of YLDs than YLLs.

According to data from the Australian Institute of Health and Welfare, in 2003
those aged between 10 and 19 had 125 446 YLDs compared to 22 498 YLLs,
giving a total of 147 944 DALYs. The top 10 causes of DALYs (with a breakdown of
YLLs and YLDs) for this age group is shown in figure 2.22.
Diabetes mellitus
Acute respiratory infections
Musculoskeletal diseases
Table 2.7 Leading specific causes of Cardiovascular disease
burden of disease and injury (DALYs) Cancers
for 10–19 year olds, 2003 YLLs
Skin diseases
YLDs
Condition DALYs Nervous system and sense organ disorders
Anxiety and depression 51 100 Chronic respiratory disease
Asthma 15 583 Injuries
Road traffic accidents 8 106 Mental disorders
Migraine 6 517
0 10 20 30 40 50 60 70 80
Substance use disorders 6 274 DALYs (000s)
Schizophrenia 5 145
Figure 2.22 Burden (YLL, YLD and total DALYs) for the top 10 causes of DALYs for
Eating disorders 4 522 10–19 year olds, 2003
Suicide and Source: Adapted from AIHW data.
self-inflicted injuries 3 850
Anorexia nervosa 2 312
Up to this point, the broad categories of burden of disease for youth have been
Bulimia nervosa 2 211
examined. In table 2.7, specific causes of burden of disease for all youth (male and
Source: Adapted from AIHW data. female) are presented.

TEST your knowledge 9 Explain how anxiety and depression can be the
leading burden of disease (DALYs) for young
1 (a) What is meant by the term morbidity?
Australians when these conditions cause relatively
(b) Explain why it is useful to examine morbidity
few deaths.
data in addition to mortality data.
10 Why might it useful to look at the total number of
2 (a) State what the acronym ‘YLD’ stands for and
people suffering from a condition as well as YLDs
explain what it means.
contributed by each condition?
(b) What are the top three causes of YLDs for young
11 In 2003, the approximate populations of various
Australians according to figure 2.22?
age groups were:
3 (a) Which sex contributes more YLDs to the burden
• 706 500 males in the 10–14 age group
of disease?
• 703 800 males in the 15–19 age group
• 671 900 females in the 10–14 age group
4 (a) What is a DALY?
• 672 800 females in the 15–19 age group.
(b) What is the benefit of using DALYs instead of
Using this information and the data presented in
morbidity or mortality data?
tables 2.4 and 2.5, complete the following:
APPLY your knowledge (a) How many new cases of upper respiratory
infections occurred for:
5 Using data to support your response, write a i females aged 15–19?
paragraph discussing the health status of Australian ii males aged 15–19?
youth. (b) How many new cases of anxiety and depression
6 If the incidence for a condition drops to 0 per were recorded for:
100 000 population, does this also mean the i males aged 10–14?
prevalence will be 0? Explain. ii females aged 10–14?
7 The Australian Bureau of Statistics predicts that (c) What was the rate of prevalence for asthma for:
the population of Australia could reach 30 million i males aged 15–19?
in around 2030. If the incidence for cancer was ii females aged 15–19?
474 cases per 100 000 persons and the prevalence (d) What was the rate of prevalence for anxiety and
for cancer at the same time was approximately depression for:
1740 cases per 100 000, approximately how many i males aged 15–19?
people: ii females aged 15–19?
(a) will be diagnosed with cancer in 2030?
(b) will be suffering from it (in total)?
8 (a) Which three conditions lead to the most burden
of disease as shown in table 2.6?
(b) For each of the three conditions, explain
whether you think most DALYs would be
attributable to mortality or morbidity.

2.4
The impact of biological determinants on youth health
KEY CONCEPT Understanding the impact of biological determinants on the

health of youth
As well as affecting their development, genetics, hormones and body weight also
contribute to the health experienced by young people.
Genetics
Genetics have been explored in chapter 1 in relation to their impact on development
during youth, but they also play a role in health outcomes. Although genetics play
a significant role in determining the health of youth, it is worth remembering that
there are other factors that also play a role. For instance, a person with genes that
increase the likelihood of being overweight might exercise and eat healthy foods
and thereby maintain an ideal body weight.
Genetics determine the body structures that males and females have, which
dictates some forms of illnesses experienced by the different sexes. For example,
females do not have testicles and therefore cannot develop testicular cancer. For
males however, testicular cancer is one of the most common forms of cancer
among youth. Unlike females, males do not have a cervix and are therefore not at
risk of cervical cancer.
Genetic conditions are conditions caused by an abnormality in the genes. Such
conditions often occur at conception if there is an abnormality when the sperm
and egg fuse together. These conditions are referred to as genetic abnormalities
(or anomalies) and examples include Down syndrome (figure 2.23) and Turner
syndrome. Sometimes the genes for certain genetic conditions may already be
present in the mother or father and can be passed on to the children. These
conditions are called inherited conditions and examples include haemophilia and
muscular dystrophy. All genetic conditions can impact on the health of youth. The
condition may make the youth unable to participate in certain activities due to the
risk of injury or to be more susceptible to illness.
Figure 2.23 Down syndrome

occurs as a result of having three
chromosomes, instead of two, on the
21st pair.

Individuals can also have a genetic predisposition to certain diseases and
conditions. One person may be more likely to develop cancer and another
may be more likely to have asthma. However, other determinants (including
behavioural and environmental) may also play a key role. Therefore, a person
who is predisposed to cancer may not develop it due to their behavioural and
environmental determinants. Many leading causes of mortality and morbidity for
youth have a genetic predisposition, including cancer, depression and anxiety,
respiratory conditions such as asthma, and endocrine conditions such as diabetes.
Genetics contribute to personality. Personality in turn contributes to many
aspects of health including the likelihood of taking risks. This can influence the risk
of sustaining injuries from risk-taking behaviours. Personality may also influence
sociability which can impact on social health.
As you saw previously, genetics also influence the timing and rate of hormone
release during youth and this may contribute to health outcomes. Some studies
suggest that females who start puberty early may be at increased risk of breast
cancer in later life. In males, early onset of puberty may be associated with
increased strength and sporting prowess, which may enhance other areas of health
for these individuals (e.g. mental or social health). Those who develop early may
socialise with older people, and some studies suggest that they are more likely to
experiment with drugs and alcohol at an early age which can also impact on health
by increasing the risk of injuries. eBook plus
Hormonal changes eLesson:

Hormones are the chemical messengers that contribute to many of the changes that Teen brain
occur during youth and also have numerous impacts on health. Quite often, an Searchlight ID: eles-0224
imbalance of hormones or impaired response to hormones is responsible for these

impacts. A combination of genetics, stress and environmental factors are thought to
be responsible for most hormonal imbalances and impaired hormonal responses.
Insulin is the hormone responsible for controlling blood glucose levels. If insulin
is not produced or the body’s cells are resistant to it, diabetes may occur. Diabetes is
a condition characterised by an inability to control blood glucose levels. The three
types of diabetes are type 1, type 2 and gestational diabetes, all of which can affect
youth. Type 1 diabetes occurs mainly in childhood and youth and is characterised by
an inability of the body to produce insulin. Insulin must be administered regularly
to control blood glucose levels. Between 2001 and 2007, the incidence of type 1
diabetes increased by 41 per cent among youth. In the past, type 2 diabetes was
considered an older person’s disease, but rates among youth have increased in the
past decade. Type 2 diabetes is characterised by insufficient amounts of insulin being
produced or an inability of the body to utilise the insulin that is produced. Type 2
diabetes is closely related to obesity and behavioural factors such as physical activity
and food intake. Gestational diabetes can occur during pregnancy, and pregnant
youth may therefore be affected by it. Gestational diabetes usually disappears after
the baby is born, however those experiencing this condition are more likely to be
diagnosed with type 2 diabetes later in life. If left untreated, diabetes can contribute
to a range of health concerns including cardiovascular disease, kidney disease, limb
amputations, blindness and premature death.
A range of hormones contribute to the regulation of body weight. Leptin, for
example, is a hormone that plays a role in regulating the amount of fat that is
stored in the body. Ghrelin is a hormone that influences appetite and promotes
feelings of hunger. An imbalance of or resistance to these hormones can increase
the risk of underweight, overweight or obesity in youth.
Cortisol is often referred to as the ‘stress hormone’ and plays a number of roles
in the body. In small amounts, cortisol can assist youth in dealing with stressful
situations by providing a short burst of energy and decreasing feelings of pain.

2.4 The impact of biological determinants on youth health
However high and prolonged levels of cortisol in the blood stream can contribute
to prolonged stress and impact on mental health. If cortisol levels remain high for a
period of time, it can contribute to a range of health conditions including reduced
immune system function which can increase the risk of infections and disease.
Hormones are responsible for sperm production in males and regulation of the
menstrual cycle in females. The regular fluctuations of hormones in females can
contribute to other aspects of health such as mood changes and abdominal pain.
Testosterone in males is thought to have an influence on their higher rates of risk-
taking and ultimately injury.
Polycystic Ovarian Syndrome, or PCOS, is a condition that occurs in females
with a hormonal imbalance. Too much insulin or testosterone or both is often
the cause of PCOS. PCOS is thought to affect 12 to 18 per cent of female youth.
Females who experience PCOS may also experience:
• Irregular menstrual cycles — menstruation may be less or more frequent due to
less frequent ovulation
• Amenorrhoea — some women with PCOS do not menstruate, in some cases for
many years
• Excessive hair growth and acne — possibly due to increased testosterone
• Mood changes — including anxiety and depression
• Obesity.
Medical assistance should be sought if an individual suspects PCOS, as a range
of treatment options are available.
As testosterone levels increase in both males and females during puberty,
oil glands in the skin of the face, neck, back, shoulders and chest grow bigger
and secrete more oil. Bacteria on the skin and blocked pores can result in acne,
which consists of mild to severe outbreaks of blackheads, pimples and cysts.
Acne is common among male and female youth although males often experience
more severe outbreaks and females may experience outbreaks at different times,
according to the hormonal activity of their menstrual cycle. Acne may lead to
scarring and can impact on mental health if self-esteem is affected. A range of
treatment options exist for youth experiencing acne and medical assistance should
be sought in severe cases.
Changes in hormone levels also contribute to increased perspiration (or sweating)
in youth. Although perspiration has no smell, it provides a breeding ground for
bacteria who feed off it. Acids are produced by the bacteria which contribute to
increased rates of body odour among youth. Body odour can impact on the social
and mental health of the youth if the condition goes untreated.
Increased levels of human growth hormone contribute to the increases in growth
experienced during puberty. This growth increases the size of body systems and
tissues including the cardiovascular, respiratory and musculoskeletal systems.
These changes generally increase endurance and strength which are aspects of
fitness (physical health).
Body weight
Maintaining a healthy body weight is beneficial for health. Body weight that does
not fall within the healthy range can have a number of effects on youth health.
Body mass index (BMI) is often used to make judgements on underweight, normal
weight, overweight and obesity. See page 25 for an explanation of BMI.
Genetics and hormones play a role in body weight, as do a range of other factors
such as food intake and levels of physical activity.
Being underweight can have a range of effects on the health of an individual if
they lack the nutrients required for optimal health. Physical health can be affected
in a number of ways including a weakened immune system, increasing the risk of
contracting diseases such as influenza. Anaemia may also occur if the nutrients

required for blood production are not present, leading to feelings of
lethargy. If the youth lacks energy, they may not be able to participate
in their regular activities, and this can impact on social and mental
health. Physical fitness may also be reduced as it becomes increasingly
difficult to exercise. In the long term, the risk of osteoporosis increases
if the nutrients required for building bone mass are deficient.
Overweight and obesity rates have increased significantly among
youth in recent years and also have a range of impacts on health. In
the short term, the risk of developing a range of conditions, including
asthma and cardiovascular conditions, increases with increased body
weight.
As well as having an impact on physical health, overweight and
obesity could have many associated effects on social and mental
health. The exact impact would depend on the individual in question
but could include:
• Social marginalisation — those who are overweight or obese might
be excluded from certain activities by others. They might not be
invited to parties or asked to join sporting teams. The individual
Figure 2.24 Maintaining an ideal
might also be victimised by their peers, which could have a negative body weight can have many health
impact on mental health. benefits for youth.
• Self-esteem issues — those who are overweight or obese might feel negative
about their body, which can influence other areas of their life such as social
participation.
Many of the effects of being overweight or obese occur in the long term. Youths
who are overweight or obese have a higher chance of becoming obese adults and
therefore developing one or more of the following conditions in the future:
• Cardiovascular disease — a high-fat diet contributes to a build-up of plaque on
the artery walls, increasing the chance of heart attack and/or stroke.
• Some cancers — it is thought that high-fat, low fibre diets can increase the risk
of colorectal cancer.
• Respiratory problems — excess weight can put pressure on the lungs, making
breathing more difficult.
• Arthritis — excess weight places extra pressure on joints, which can increase the
rate at which cartilage is worn down.
TEST your knowledge 5 Sarah is 16 and has a BMI of 15.

(a) In which category (underweight, normal weight,
1 What is the difference between a genetic
overweight or obese) does this place Sarah?
abnormality and an inherited condition?
(You will need to refer to the BMI chart on
2 Outline three ways in which hormones can impact
page 26.)
on the health of youth.
(b) What might the short- and long-term health
APPLY your knowledge implications be for Sarah if she maintains this
BMI?
3 Do all youths have the same risk of skin cancer? 6 Select one genetic disease and research information
Explain, making reference to genetics. about it. Include a description of the condition, how
4 Bill is 12 years old and has a BMI of 26. common it is and how it can impact on health and
(a) In which category (underweight, normal weight, individual human development.
overweight or obese) does this place Bill? (You 7 Explain how being underweight may impact on the
will need to refer to the BMI chart on page 25.) social health of an individual.
(b) What might the short- and long-term health 8 Explain how being obese could impact on the
implications be for Bill if he maintains this BMI? mental health of an individual.

2.5 nderstanding the interrelationships between health
U
and individual human development during youth
KEY CONCEPT Understanding the interrelationships between health and

Health and development have a direct relationship with each other (figure 2.25). If
health is optimal, then development will generally be optimal as well. Conversely, if
either health or development is not optimal, it will generally affect the other in a
Development negative way.
Youth is a time of significant change and both health and development can be
impacted in a number of individual by these changes. The following examples
outline some impacts on health and individual human development that could
Health occur as a result of the interrelationships that exist between these two concepts.
A youth who is not experiencing good physical health may also experience lower
levels of social and mental health. Consider a youth who is suffering from influenza
(physical health). They may have to stay home, so they cannot socialise with their
Figure 2.25 Health and development friends (social health) and may also feel frustrated and upset about having to stay
have a direct relationship. at home (mental health). If they lose their appetite, they may not get the nutrients
they require from their diet, and this could affect the development of their
bones and muscles (physical development). The lack of social interaction could
affect the development of their communication skills (social development), and
missing school could mean they miss
learning key concepts (intellectual
Intellectual development). Their self-concept
Absence from school could could decrease as a result of missing
mean missing out on
learning key concepts out on various experiences and feeling
that they are no longer seen as a key
Emotional
part of their normal activities and
Self-concept could decrease groups (emotional development).
as a result of missing out on Conversely, consider a youth who
various experiences and not is experiencing good social health.
feeling part of a group
Possible impacts They will generally feel good about
on development themselves (positive self-esteem, which
Social
Lack of social interaction could
is mental health) and might be better
affect development of able to concentrate at school (impacting
communication skills on intellectual development) and take
the time to look after themselves
Physical physically (impacting on physical
A person May lose appetite and not get health).
suffering from nutrients
Radiorequired from diet,
influenza affecting development of
Similarly, a youth who has optimal
(physical health) bones and muscles intellectual development might be
better informed about what foods they
should eat. Their choice of diet could
Social affect their immune system (physical
May have to stay home, so
would not be able to socialise health) and the growth of their body
with friends systems (physical development). They
Possible impacts might not be anxious about their
on health grades at school and may therefore
Mental have positive mental health.
May feel frustrated and upset Examples of the possible effects
about having to stay home
on the health and development of a
youth suffering from glandular fever
Figure 2.26 Possible impacts on health and development as a result of suffering are summarised in table 2.8. It is
from influenza difficult to say exactly how health

and development will affect each other in every instance because every person is
different, and effects on health and development will produce different outcomes
for each individual. Note that not all of these examples are negative.
Table 2.8 Possible effects on the health and development of a youth suffering from glandular fever
Area of health/development Possible impact
Physical health The immune system may be weakened while the infection is fought, making the person more susceptible to
secondary infections. They may also be continually lethargic and generally feel unwell.
Social health They may be forced to take weeks off school and so will miss out on opportunities to socialise with friends.
However, they may get a lot of visitors, which could lead to interactions with people they would not normally
socialise with (e.g. aunts and uncles, family friends).
Mental health They may feel depressed at being bedridden and missing out on leisure activities such as sport, music and
socialising with friends.
Physical development Motor skills may be affected as the person misses out on opportunities for physical activity. Diet may be restricted,
so inadequate nutrients might be ingested with effects on various body systems (e.g. blood production).
Social development Social development might be halted as the person may not be socialising with anyone outside their family.
Conversely, they may develop some skills in communicating with older people (if extended family members visit,
as suggested in the ‘social health’ section of this table).
Emotional development They may experience sorrow and despair as a result of being indoors for an extended period of time. However,
they may learn how to effectively deal with these emotions by talking about their experiences to parents or
siblings.
Intellectual development They may miss out on extended periods of school time, thereby affecting the skills normally practised and learnt
at school. Their ability to concentrate may be minimised by lethargy.
TEST your knowledge Table 2.9 A summary table for analysing possible
effects on health and development
1 Explain the relationship between health and
development. Use examples in your explanation. Area of health/
development Possible impact
APPLY your knowledge Physical health
2 Sally, a year 9 student, is an only child who has Social health Has few friends at her new
always had good social health. She has always school. Spends her free time
been popular at school and had a wide network of at home with her mum and
friends, both male and female. That was until last dad when they are home.
month, when her dad was offered a promotion that Mental health
required her family to move to Germany almost Physical development
immediately. Sally is now attending a new school,
but language barriers and being the ‘new kid’ have Social development
prevented her from making many friends at this Emotional development
stage. Consequently, her social health has suffered.
She has become rather withdrawn and just wants to
go back to her old school in Australia. 3 (a) Write your own case study about a person
Copy and complete table 2.9, listing the possible experiencing positive or negative health or
effects on Sally’s health and development of her development.
family’s move to Germany. (One has been done for (b) Get a partner to complete a table (like table 2.9)
you as an example.) outlining the possible effects on the other
areas of health and development, based on the
information in your case study.
4 How might the physical development that occurs
during the youth stage of the lifespan affect the
social and emotional development that individuals
experience?

KEY SKILLS The health of Australia’s youth
KEY SKILL Define health and explain the limitations of the

definitions of health
As these two skills are closely related, they are explained together. To provide an
adequate definition of health, knowledge of a range of definitions is beneficial.
Although the WHO definition is acceptable, there may be occasions on which it
is necessary either to expand on this definition or discuss the limitations of it.
Being familiar with the Better Health Commission definition and understanding
the differences between it and the WHO definition should ensure a sound
understanding of the concept of health and why it can be difficult to define.
One approach to a discussion of the possible limitations of the WHO’s definition
of health might be as follows.
The World Health Organization defines health as➊ ‘a state of complete physical,
❶ Stating the definition provides a good mental and social wellbeing and not merely the absence of disease or infirmity’❷
point of reference for the remainder (WHO, 1946).➌
of the discussion.
This definition is very broad and makes no reference to the circumstances that
individuals may experience. For example, a person with asthma would not be
❷ It is worth memorising the WHO
definition of health. considered to have ‘complete’❹ physical wellbeing and could not be considered
healthy according to this definition. This is despite the fact that many asthmatics
❸ Provide a reference if using the WHO manage their condition effectively, have excellent physical fitness and excel in
definition. sports.❺ Likewise, a person who suffers from depression may manage their
condition well, have a broad network of friends and maintain optimal mental
❹ Make references to specific words health. To say that health refers to the best possible state of physical, social and
that limit the scope of the definition.
mental functioning a person can realistically attain might be a better definition as
everyone has the opportunity to be considered healthy.❻
❺ Use examples to substantiate claims.
❻ Suggesting another definition that PRACTISE the key skills

accounts for the limitations of the
original definition can be useful. The first commonly accepted definition of health was devised by the World Health
Organization (WHO) in 1946. Since that time, there has been wide debate about
defining health.
1 What is the WHO definition of health?
2 Suggest two limitations of this definition.
3 Suggest and then justify a definition for health that might be more appropriate.
KEY SKILL Describe the characteristics of, and

interrelationships between, the dimensions of health
The first step in mastering this key skill is to know the three different dimensions
of health: physical, social and mental. A useful approach is to practise identifying
the dimensions of health in case studies or in examples drawn from personal
experience.
When describing the interrelationships between the dimensions of health, it
might be necessary to describe the possible effects on health in a scenario or context
that is totally unfamiliar. Again, practising identifying possible effects on health
can be beneficial. Start by thinking of something (a set of circumstances such as
relationship breakdown, illness or stress) that could affect one of the dimensions
and then brainstorm ways that the dimensions of health could be affected by it.
When doing this, remember that all three dimensions of health will be affected
including the dimension where the initial effect occurred. For example, a condition
such as rheumatoid arthritis (which relates to physical health) will lead to other
impacts on physical health (such as reduced fitness) as well as impacting on social
and mental health.

1.1 Understanding health
An explanation of social health might be as follows:

❼ Using words like ‘current state’ helps
Social health refers to the current state of personal relationships, such as to distinguish between social health
friendships,❼ and the quality of interactions with others. Someone with optimal and social development.
social health, for instance, might have their social needs met by an understanding
family and a supportive network of friends.❽ ❽ Use examples to add substance to
In the following scenario, Josie has just broken up with her boyfriend of six your explanation.
months and is feeling upset and anxious. During the course of the relationship
Josie had begun to associate with her boyfriend’s friends. She now feels that she
has neglected her own friends and that it may be difficult to re-establish links with
them.
The following response explains how Josie’s breakup may have affected her ➒ If the question doesn’t specify, cover
health.❾ all three dimensions of health.
As Josie is feeling upset and anxious, she may not be eating properly and
exercising. This may impact on her fitness levels and her body weight, which is an ❿ Link the example to the dimension of
aspect of physical health.❿ She is upset and anxious, which is an aspect of mental health.
health; and her friendship circle has been thrown into turmoil, which is social
health.⓫ ⓫ Social and mental health are also
covered.

4 Read the case study below, ‘Anissah’s story’, and answer the questions that follow.
Anissah is in year 10 at school. She loves school and is involved in many
extracurricular activities, including the annual drama production, the netball team
and the school band. She has played clarinet in the school band since year 7 and
has many friends who also play in the band. Last week, Anissah tried out for this
year’s band but missed out on a place as she had not had time to practise the
prescribed piece in the weeks leading up to auditions. She has felt devastated by
not getting into the band and has not wanted to attend school at all. Her mother
has let her stay home for a few days while she tries to deal with this experience.
Anissah has also withdrawn from her other usual activities as she tries to accept
not being a part of the band for this year.
(a) Health relates to three different dimensions. List the three dimensions and
briefly explain what is meant by each one.
(b) Suggest ways that not getting into the school band could impact on the three
dimensions of health in Anissah’s case.
KEY SKILL Explain health status measurement terms

When explaining health status, try to avoid using the term ‘health status’. Using the
term ‘health status’, without supporting explanation and examples, will not clarify
this concept for someone who is unfamiliar with it. It is important to remember
that health status is related to overall wellbeing (physical, social and mental), not
just those aspects that can be measured. Although the physical aspect of health
is often the focus of data, the social and mental aspects of health are equally as
important when explaining health status. It is important to have knowledge of the
⓬ There are a number of important
key health measurement terms, including life expectancy, incidence, prevalence, aspects of this explanation, the most
trends, morbidity, mortality, disability adjusted life years (DALYs) and burden of important of which is what DALYs
disease. As well as being able to define these terms, it is important to know what actually measure.
they mean when data is presented about them. ⓭ The inclusion of the word ‘healthy’
Consider the following explanation of the term ‘DALYs’. is a critical aspect of the definition.
DALYs are Disability Adjusted Life Years and are the unit of measurement of Without it, the meaning would be
burden of disease.⓬ One DALY is equal to one year of ‘healthy’⓭ life lost through quite different.
premature death, disability, illness or injury. DALYs are calculated by adding Years
⓮ Including the formula for calculating
of Life Lost (due to premature death) to Years Lost due to Disability (i.e. YLL + DALYs demonstrates detailed
YLD).⓮ understanding of the term.

Key skills The health of Australia’s youth

5 Explain what is meant by the term ‘health status’.
6 The current life expectancy in Australia is around 82 (both sexes combined).
(a) Define the term ‘life expectancy’.
(b) Morbidity is another measure used to provide information about health status.
Explain what is meant by ‘morbidity’.
7 What does a life expectancy tell us about the level of morbidity being
experienced?
KEY SKILL Interpret and analyse data on the health status

of Australia’s youth using appropriate measurements
This key skill relates to the interpretation and analysis of data. Data concerning
health status are presented using a range of different measurements and an
understanding of the measures commonly used will assist in developing this skill.
Measures used to present data relating to health status include:
• life expectancy
• incidence
• prevalence
• morbidity
• mortality
• disability adjusted life years (DALYs)
• burden of disease (i.e. YLL and YLD).
To become proficient at data analysis, it is necessary to be able to interpret
data available in the form of graphs, tables and charts. A range of activities in this
chapter provides the opportunity to practise this skill. The following steps offer a
systematic approach to interpreting graphs and tables:
1. Read the title of the graph or table — the title usually gives an indication about
what information is presented in the graph. It may be located at the top of the
graph or next to the figure number.
2. Read the horizontal and vertical axis (for a bar graph) and look at the units (e.g.
is it %, year, number, rate, proportion, $, etc).
3. Look at the key if there is one — this helps identify various elements of the data.
4. Read any notes that relate to the data — there may be additional written information
at the bottom of the graph explaining various elements of the graph. An element
of the data that may not make sense may become clear after reading these notes.
5. Look for trends, similarities and differences between the data. This will enable a
better understanding of the data that the graph is actually presenting.
Figure 2.27 describes the injury death rate over time for males and females.
120
100
Rate per 100 000
Males
80 Females
60
40
20
0
Figure 2.27 Injury death rate over
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
time for males and females
Source: GRIM books, AIHW, accessed 9 July 2009. Year

Using data provided in figure 2.27, a response to the task ‘Describe two trends
in the injury death rates as experienced by males and females’ might include the
following points.
• Death rates for males and females both decreased between 1980 and 2007.⓯
• Males experienced higher death rates due to injuries between 1980 and 2007. ⓯ Use information from the graph, such
as dates, to substantiate your answer.
• The death rate for males decreased more than the death rate for females due to
injuries between 1980 and 2007. The male death rate decreased by around 45 per ⓰ Using figures from the graph shows
100 000⓰ (approximately 95 per 100 000 in 1980 down to 50 per 100 000 in an ability to interpret the data and
2007). The death rate for females decreased by around 10 per 100 000 (down draw conclusions from it.
from around 30 per 100 000 in 1980 to around 20 per 100 000 in 2007).

8 List three steps that should be taken when interpreting data from a graph.
9 Figure 2.28 shows the rate of injury and poisoning hospital separations for young people aged 12–24, in 2008–09.
4000
Males
Hospital separations per 100 000
3500 Females
3000
young people
2500
2000
1500
Figure 2.28 The rate
1000 of injury and poisoning
hospital separations for
500
young people aged 12–24,
0 2008–09
12–14 years 15–19 years 20–24 years Source: AIHW 2011, Young
Australians: their health and
Age group wellbeing 2011, p. 35.
(a) i. What was the approximate hospital separation rate for injuries and poisoning for males aged 15–17 in 2008–09?
ii. What was the approximate hospital separation rate for injuries and poisoning for females aged 15–17 in 2008–09?
(b) According to figure 2.28, what trend is evident in regard to the hospital separation rate for injuries and poisoning for
males as they age?
0 Figure 2.29 shows death rates for young people from 1980 to 2007.
1
Deaths per 100 000 young people
140
Male
120 Female
100 Persons
80
60
40 Figure 2.29 Death
rates for young
20 people aged 12–24,
1980–2007
0
Source: Adapted from
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 AIHW data.
(a) Identify two trends in death rates as shown in figure 2.29.

(b) Besides death rates, outline three differences in health status between male and female youth.

Key skills The health of Australia’s youth
KEY SKILL Explain the biological determinants of health

and development and discuss the impact on the health
of youth
As well as impacting on youth development, biological determinants including
genetics, hormonal changes and body weight impact on youth health. As well as
being able to explain the biological determinants of health, the ability to predict
the possible effect of these determinants on the health of youth is also required.
You may also be required to use the biological determinants to explain possible
reasons for differences in the health experienced between individuals. Remember
that the focus of this key skill is on youth and any discussion should be about this
particular age group.
Completing a summary table (like table 2.10) can provide practice in predicting
likely effects of biological determinants on youth health.
Table 2.10 A summary table for analysing the impact on health and development of the
determinants
Determinant: Hormonal changes
Area of health Possible impact on youth
Physical
Social
Mental
Consider the following example where the impact of hormonal changes on the
⓱ Specific hormones are identified and health of youth is discussed.
knowledge of their role in youth is
outlined. Human Growth Hormone is responsible for increasing the rate of growth
experienced during youth. Testosterone⓱ is responsible for increasing muscle mass
⓲ The dimension of health is identified. in males. Increased size and strength increases the ability of youth to exercise for
extended periods of time and also increases strength. As a result, fitness can
increase (physical health⓲). Increased fitness may enhance self-esteem which is an
aspect of mental health. Increased self-esteem may contribute to increased
⓳ Possible impacts on mental and social participation in social activities which enhances social health.⓳
health are identified.

1
1 Explain how insulin can impact on the health of youth.
12 Discuss how hormones can impact on the body weight of youth.
13 Explain how an increase in body weight could impact on the health of youth.
14 Explain possible impacts on health for a youth who is underweight.
KEY SKILL Explain the interrelationships between health

and human development during the lifespan stage of youth
The prerequisite for this key skill is to have a thorough knowledge of concepts
of health and development. They are very different concepts and students often
make the mistake of using these terms interchangeably. To help clarify these
concepts, a useful approach is first to try explaining the difference between health
and individual human development; then, try classifying examples as being related
either to health or development.
Once accustomed to this approach, practise identifying the possible effects on
youth health and development as a result of a selected event or condition. Ensure all

dimensions of health and areas of development are addressed. Another aspect of this
skill is being able to explain how individual human development can impact on health
and vice versa. Discussing hypothetical case studies with a partner, or completing
tables like the one in table 2.9 (see page 63), can help with developing this skill.
Sarah is in year 11 and has just been diagnosed with leukaemia. She will spend
the next two months undergoing chemotherapy and as a result will miss a lot of
school.
A possible approach to a discussion of how Sarah’s condition may impact on her
development follows.
Sarah’s condition could impact on her development in the following ways: ⓴ Make reference to the type of
development being explained.
Physical development:⓴
She will miss out on school and sport, which may impact on her motor skill
development. While she is undergoing treatment, she may have a diminished An aspect of physical development
appetite, which may mean her bones do not develop to their full potential.
Social development:
As Sarah will be missing out on social activities, she may miss out on opportunities
to refine communication skills. She will have to communicate with health
An aspect of social development
professionals, however, and this may enhance her communication skills. She may
learn valuable relationship skills as a result of not getting to see her friends daily,
gaining an appreciation of their important role in her daily life. An aspect of emotional development
Emotional development:
Sarah will experience a range of emotions that most likely she will not have
experienced before. She may learn how to deal with and express these emotions An aspect of intellectual development
effectively.
Intellectual development:
All four dimensions of development
Sarah may learn skills to assist in improving her health. Knowledge relating to are covered. The discussion maintains
diet and exercise is an example of these skills. a focus on development.

5 Briefly outline the relationship between health and development.
1
16 Lindy is in year 12 and has just quit her job at the local supermarket to focus
on her VCE. As a result, she will not have money to spend on activities that she
has enjoyed in the past such as going out with friends, shopping and her gym
membership.
Explain how quitting her job may impact on the health and development
of Lindy.

17 Puberty is a time of significant change for youth and this can have a range of impacts
on health and development.
(a) Discuss how puberty could impact on the mental health and emotional
development of youths.
4 marks
(b) Refer back to Anissah’s story on page 65 to complete the following question.
Suggest one way that each aspect of Anissah’s physical, social and mental
development could be affected by not getting into the school band.
3 marks

CHAPTER 2 review
Chapter summary
• Health can be defined in a number of ways, but it is always seen as a state that can
change from day to day.
• Health has been defined in a number of ways and most definitions have their
advantages and disadvantages. The most common definition of health comes from the
World Health Organization (1946) and is:
‘a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity. ’
Blood pressure
Cholesterol Presence or
levels absence of disease
Body weight Energy levels
Physical
health Functioning of
Fitness
body systems
Health
Confidence Network of friends
Mental Social
State of
health health
Self-esteem relationships
with family
Emotional and State of

Levels of stress psychological relationships with Social needs met
wellbeing school/work mates
Figure 2.30 A summary of the dimensions of health and examples that relate to each one
• All three areas of health influence each other, and people may experience different
levels of health in all three dimensions at any one time.
• Health status is an overall statement of the level of health being experienced by an
individual, group or population.
• Australia’s youth generally experience excellent health status.
• Life expectancy, mortality, morbidity and burden of disease measures are all used to
assess health status.
• Life expectancy is how long a person can expect to live if current mortality rates
continue unchanged.
• For a male born in 2009, the life expectancy was 79 years and for a female it was
84 years.
• Life expectancy and death rates are continually improving for Australia’s youth.

• Mortality refers to deaths in a population. The mortality rates for Australia’s youth are
among the lowest when compared to other lifespan stages.
• Morbidity can be measured using YLDs, incidence and prevalence.
• DALYs are used to measure burden of disease and are calculated by adding YLLs
and YLDs.
• Males are more likely to experience premature mortality than females. Interactivities:
Chapter 2 crossword
• Females generally experience slightly more YLDs than males.
• Injuries contribute most to YLLs. Within the ‘injury’ category, road traffic accidents
Chapter 2 definitions
cause the most deaths for youth.
• Mental health disorders contribute most to the overall burden of disease for youth.
• Biological determinants relate to the state and functioning of the body and include
genetics, hormones and body weight.
• Genetics contribute to many aspects affecting health such as sex, genetic predisposition
to disease, and genetic and inherited conditions.
• Hormone levels change significantly during youth. Impacts of these changes can include
acne, body odour, polycystic ovarian syndrome and increased fitness levels. Hormonal
imbalance can also impact on youth and can contribute to overweight and obesity,
diabetes and decreased immune function.
• The rate of overweight and obesity has increased over time and now poses a
considerable health risk for youth including an increased risk of conditions such as
cardiovascular disease, type 2 diabetes and mental health issues.
• Underweight is also a significant issue for youth and can contribute to low levels of
energy and an increased risk of osteoporosis later in life.
• Health and development are also interrelated and will affect each other throughout the
lifespan. Optimal health will generally result in optimal development and vice versa.

1 Define: 4 Why can defining health be difficult?
(a) health (according to the World Health 5 Explain two ways in which being overweight can
Organization) impact the health of youth.
(b) life expectancy 6 (a) Discuss examples of how development can
(c) mortality affect health during the youth stage of the
(d) morbidity lifespan.
(e) burden of disease. (b) Discuss examples of how health can affect
2 Explain, using examples, what is meant by: development during the youth stage of the
(a) physical health lifespan.
(b) social health
(c) mental health.
3 Use a Venn diagram to show the similarities and
differences between health and development.

1.1
CHAPTER 3
Nutrition during youth

Nutrition is one of the most important factors affecting the
health and individual human development of Australia’s youth.
Adequate nutrition is required for many aspects of youth
development. Nutrition has a direct relationship to aspects
of individual human development such as bone and organ
development. It also affects development indirectly by, for
example, providing energy that allows the youth to concentrate
at school, thereby promoting intellectual development. In
recent decades, the nutritional status of Australia’s youth has
declined and is contributing to health and developmental
issues. To develop a deep knowledge of these issues, it is
important to learn about the nutrients, the roles they play
in optimising health and development, and the short- and
long-term consequences of nutritional imbalance. A range of
food selection models exist to assist youth in food selection.
Understanding these models can assist youth in achieving a
balanced nutrient intake and in achieving optimal health and
individual human development.
Key knowledge
2.1 the function of major nutrients for the development of hard tissue,
soft tissue, blood tissue and energy (pages 74–94)
2.2 the consequence of nutritional imbalance in a youth’s diet on short-
and long-term health and individual human development (pages 95–8)
2.3 food selection models as tools to promote healthy eating during
youth (pages 99–104).
Key skills
• explain the functions of major nutrients for the development of hard
tissue, soft tissue, blood tissue and energy during youth
• explain the possible consequences of nutritional imbalance in a youth’s
diet on short- and long-term health and individual human development
• explain how food models can be used as a tool to promote health.
Figure 3.1 As youths gain

independence, their food choices
become particularly important for
future health and development.

reduce the burden of disease attributable to the conditions and diseas
that make up the NHPAs.

agoraphobia an anxiety related disorder where the individual fears
leaving environments that they know well (particularly their home)
anaemia disease
autoimmune a condition characterised
a disease causedbyby a reduced
the body’sability
immune system
of the normal
attacking body to body
delivercells
enough oxygen to the cells due to a
lack of healthy red blood cells
benign abnormal cells that do not invade and destroy nearby healthy
basal
tissue metabolic rate (BMR) the amount of energy
(non-cancerous)
required to sustain basic functioning of the human body
direct cost costs associated with providing health services such as
cartilage
diagnosis and connective
treatmenttissue that protects
to people and of
as a result cushions
a particular condition
the joints, and provides structure and support to various
gross domestic product (GDP) an indicator of the wealth of a country
body tissues
the market value of all goods and services produced in a country in a
givencell differentiation the process in which body cells take
year
on their specialised function (e.g. skin cells or muscle cells)
health promotion the process of enabling people to increase control
over,cell
andmembrane
to improve, the outer
their layer of a cell that provides
health
structural support for the cell and allows nutrients, gases
indirect cost costs not directly related to diagnosis and treatment of t
and waste into and out of the cell
disease, but occur as a result of the person having the disease, such as
cellular
loss of respiration the process whereby oxygen and
productivity
fuel are converted into energy
intangible things that cannot be measured physically or with a
cholesterol
monetary a type
measure, suchof as
fat pain
required
andfor optimal functioning
suffering
of the body that in excess can lead to a range of
job control how much say an individual has on how they do their job
health concerns including the blocking of arteries
whether they feel their opinions are valued within their workplace, an
(atherosclerosis). Can be ‘bad’ low-density lipoprotein
how much influence they have over the direction their career takes
(LDL) or ‘good’ high-density lipoprotein (HDL).
key stakeholders people, groups and organisations who are involved
co-enzyme usually a vitamin or mineral that binds with
or affected by a course of action
protein to allow chemical reactions such as metabolism
malignant abnormal cells that invade and destroy nearby healthy tiss
to occur
mammogram a type of x-ray used to examine breasts. Often used for
collagen fibrous protein found in connective tissue that
the detection of breast cancer.
is the main component of cartilage, ligaments, tendons,
metastasise
bone andwhenskin cancer has spread from one site to another
National Health Prioritytissue
connective tissue Areas
thatA iscollaborative
involved in theinitiative
structureendorsed by t
Commonwealth
and support of Government
body cells and and all state and territory governments.
systems
The NHPA initiative seeks to focus the health sector’s attention on
dental caries decay of teeth caused by a breakdown in
diseases and conditions that have a major impact on the health of
the tissues making up the tooth
Australians. The NHPAs represent the disease groups with the largest
discretionary foods includes foods and drinks not
burden of disease and potential costs (direct, indirect and intangible)
necessary to provide the nutrients the body needs, but
the Australian community.
that may add variety. However, many of these are high
neoplasm from Greek, neo = ‘new’ and plasia = ‘tissue’. A new and
in saturated fats, sugars, salt and/or alcohol, and are
abnormal growth of tissue in some part of the body.
therefore described as energy dense.
tumour a group or cluster of abnormal cells
fortified having a nutrient artificially added to increase
nutritional value
glycaemic index (GI) a scale from 0 to 100 indicating
the effect on blood glucose of foods containing
carbohydrates
haemoglobin a component of blood, largely consisting
of iron and protein, that transports oxygen throughout
the body
hard tissue tissues in the body that form hard
substances such as bones, teeth and cartilage
kilojoule (kJ) a unit for measuring energy intake or
expenditure
macronutrients nutrients that are required in large
amounts (protein, carbohydrates and fats)
micronutrients nutrients that are required in small
amounts (vitamins and minerals)
osteoporosis a condition characterised by a reduction
in bone mass that makes bones more likely to break and
fracture
peak bone mass the maximum bone mass (i.e. density
and strength) reached in early adulthood
soft tissue organs and tissues in the body that connect,
support or surround other structures. They include skin,
muscles, tendons, ligaments, collagen and organs.
vegan a type of vegetarianism that excludes foods of
animal origin including eggs and dairy
Nutrition during youth • CHAPTER 3 73

3.1 I ntroduction to the nutrients required during youth:
carbohydrates, protein and fats
KEY CONCEPT Understanding the major nutrients required during youth
When we eat, the foods are broken down in the process of digestion to release the
nutrients. These nutrients are then used by the body for many functions related
to health and development including the production of energy and blood and the
development of hard and soft tissues.
Some foods have more nutrients in them than others, and some have nutrients
that other foods may not have at all. The best way to maintain a balanced diet is
to eat a wide variety or many different types of foods (figure 3.2). There are six
categories of nutrients that are needed for optimal health and individual human
development.
They are:
• carbohydrates (including fibre)
• protein
• fats
• vitamins
• minerals
• water.
Carbohydrates, protein and fats are needed by the body in large amounts and are
Figure 3.2 Eating a range of foods often called macronutrients, while vitamins and minerals are called micronutrients
is the best way to ensure adequate because they are only needed in very small quantities. Regardless of the quantity
nutrition.
needed by the body, each nutrient has a different role to play and all are important
for health and individual development.
Carbohydrates
Interactivity: The main function of carbohydrates is to provide fuel for energy. As youth are growing
Time Out: ‘Food sources at a rapid rate, a lot of energy is required for metabolism and growth. Glucose is
of nutrients’ the preferred fuel for energy in the human body and carbohydrates are rich in
Searchlight ID: int-1423 glucose, and as a result should provide the majority of an individual’s energy needs.
Carbohydrates allow an individual to maintain high activity levels, which can
provide opportunities to develop motor skills and also the energy to concentrate at
school and therefore develop intellectually.
Carbohydrates are broken down and the glucose
molecules are absorbed into the bloodstream, from
where they are taken into the cells and stored, ready
for use. In terms of energy production, one gram of
carbohydrates will produce 16 kJ of energy.
Glucose (and therefore carbohydrates) that is not
used by the body is stored as adipose (or fat) tissue.
If a person eats too much carbohydrate, they can
gain weight because this increases the amount of
glucose stored as fat. This process can be reversed
if glucose is needed by the body.
Most carbohydrates are found in foods of plant
origin. Common examples are potatoes, rice, pasta,
most breakfast cereals and fruit (figure 3.3).
However, carbohydrates are also found in sugar
and foods containing added sugar such as soft
drinks, cordial, lollies and chocolate. These foods
contain few other nutrients besides carbohydrates
Figure 3.3 Pasta is a good source of so are not considered to be good food sources of
carbohydrates. this nutrient.

Fibre
Fibre is a type of carbohydrate that is required for the optimal health and individual
human development of youth. Found in all foods of plant origin, fibre does not get
absorbed by the body. Rather, it travels through the digestive system, acting like a
cleaner as it moves. The benefits of fibre in the diet are numerous for youth:
• Fibre acts to reduce the amount of glucose that is absorbed by the digestive
system, thereby reducing the energy provided by the foods eaten. It also pro
vides a feeling of fullness (satiety), so decreases the amount of energy consumed
from other foods. Both of these characteristics of fibre
assist in weight maintenance.
• Fibre reduces the amount of cholesterol that is absorbed
by the body, which reduces the risk of cardiovascular
disease later in life.
• Foods containing fibre are generally high in a range of
vitamins and minerals, which improves overall nutrient
intake. This is particularly important for youth as their
nutritional requirements increase due to the growth they
experience.
• Fibre absorbs water, which adds bulk to the faeces. This
assists in regular bowel movements, which decreases the
chances of becoming constipated.
According to the National Health and Medical Research
Council, youths should be consuming around 22–28 grams
of fibre per day. Examples of foods that contain fibre are:
• 3/4 cup bran flake cereal (4.5 grams of fibre)
• two slices wholemeal bread (4.5 grams of fibre)
• one apple and one orange (5.5 grams of fibre)
• two cups mixed raw vegetables (10 grams of fibre)
• 1/4 cup baked beans (3 grams of fibre).
As fibre absorbs water, increased fibre intake should be
accompanied by increased water consumption. Figure 3.4 Grains and seeds are an excellent source of fibre.
Protein
Protein has two main functions in the body. Its main function
(and probably the most important for youth development)
is to build, maintain and repair body cells. This includes
the cells required to build soft tissues such as muscles and
organs, hard tissue such as bone and the production of blood
tissue (figure 3.5). The second function of protein is to act as
a fuel for producing energy. If a person does not have enough
glucose (from carbohydrates) to use for energy production,
protein can be used as a secondary source of energy. In
times of starvation, muscle and other body cells may be
broken down so the protein contained within them can be
used for energy. Protein yields about 17 kJ per gram when
being used for energy. If eaten in excess, protein is stored
as adipose or fat tissue and can contribute to obesity in the
long term.
Protein is made up of smaller building blocks called amino
acids. There are 20 different types of amino acids that
humans need to function properly. Eleven of these, called Figure 3.5 Protein is a key component of all body tissues, like
the non-essential amino acids, can be synthesised (or made) these muscle fibres.

3.1 Introduction to the nutrients required during youth: carbohydrates, protein and fats
in the body from other amino acids. The other nine, called essential
Protein content of selected foods amino acids, cannot be synthesised in the body and must therefore be
of animal origin (g of protein consumed (figure 3.8). To ensure that all amino acids are being
per 100 g of food item)
consumed regularly, protein from a range of different sources should be
Beef eaten. Many people get much of their protein requirements from meat,
Pork which is often rich in essential amino acids. Vegetarians must ensure
Tuna they consume a large variety of non-meat protein sources to ensure that
Chicken (thigh)
Salmon
their nutritional needs are being met. These foods include nuts, beans,
Cheddar cheese lentils and tofu.
Lamb Some food sources are termed ‘complete proteins’ because they
Chicken breast contain all the essential amino acids in the quantities required for
Egg individual human development. They are usually found in vast amounts
Milk
in animal products (figure 3.6). Some proteins can also be found in
0 10 20 30 40 many foods of plant origin (figure 3.7). These are usually incomplete
g per 100 g proteins and need to be eaten with other protein sources to ensure that
Figure 3.6 The protein content of selected all required amino acids are consumed.
foods of animal origin
Protein content of selected foods

of plant origin (g of protein
per 100 g of food item)
Protein
Pumpkin seeds
Peanut butter
Almonds
Pistachios
Tofu
Oats
Cashews Essential amino Non-essential
Hazelnuts acids amino acids
Lentils
Wheat bread
0 10 20 30 40
g per 100 g
Complete proteins Incomplete proteins Can be made in the
Figure 3.7 The protein content of selected foods Contain all essential Do not contain all body from essential
of plant origin amino acids essential amino acids amino acids
Figure 3.8 Proteins can be classified as essential and non-essential amino acids.
Fats
Fats (sometimes referred to as lipids) play a number of roles in youth health and
individual human development. Although fats are often associated with negative
effects on the body, they are required for adequate health and development
throughout the lifespan and are an essential part of a balanced food intake.
Like carbohydrates, the main function of fats is to act as a fuel for energy. Fats
are a richer source of energy than carbohydrates and protein, yielding 37 kJ per
gram. This is why foods packed with fat but little else are referred to as ‘energy
dense’ foods. How much fat to include in the diet should be determined by the
amount of energy required by the individual. Balance is the key here. Remember
that most of an individual’s energy should come from carbohydrates.
Fats are required for a number of other processes including the development and
maintenance of cell membranes. Cell membranes form an important component of
body cells and therefore blood and soft tissues. They are responsible for maintaining
the structure of cells and allowing the transport of nutrients, gases and waste into

and out of cells. Fats are a key component of the cell membrane and are required
throughout life for adequate cell function.
Fats are an important part of a balanced diet for youths, but there are different
types of fats and some are healthier than others (see figure 3.9). Some fats can
actually lead to poor health and should be kept to a minimum in the diet.
Based on their chemical make-up, fats can be classified into four broad
categories: monounsaturated, polyunsaturated, saturated and trans fats. Total fat
intake should account for around 25 per cent of the total energy requirement (with
carbohydrates and protein making up the other 75 per cent). Of this 25 per cent, Interactivity:
the majority should come from monounsaturated fats. Approximate recommended Time Out: ‘Which fat?’
percentages of total energy intake from the different types of macronutrients are Searchlight ID: int-1424
shown in figure 3.10.
Fats (lipids)
Monounsaturated Polyunsaturated Saturated Trans
Omega-3 Omega-6
Figure 3.9 There are four different categories of fats.
Protein 20%
Lipids 25%
Carbohydrates 55%
Monounsaturated
10%
Polyunsaturated
5%
Saturated 9%
Trans fats 1%
Figure 3.10 Macronutrients (with a breakdown of lipids), and the average percentage of
total energy intake each should make up (approximate values only)

3.1 Introduction to the nutrients required during youth: carbohydrates, protein and fats
Monounsaturated and
polyunsaturated fat
Monounsaturated and polyunsaturated fats are considered
the ‘good fats’. They carry out the necessary functions of
fats and also have some health benefits. The greatest health
and development gains for youth can be achieved by
replacing saturated and trans fats with monounsaturated
and polyunsaturated fats. This can help reduce the risk
of diet-related diseases later in life, such as heart disease.
Monounsaturated fats are liquid at room temperature
and begin to solidify if placed in the refrigerator. Foods
rich in monounsaturated fats include olive oil, avocado,
canola oil, nuts, and peanut butter. Because all fats contain
37 kJ of energy per gram, all will lead to weight gain and
the associated effects on health if eaten in excess.
Figure 3.11 Nuts are a great source There are two main categories of polyunsaturated fats:
of the ‘good’ fats.
omega-3 and omega-6. Polyunsaturated fats are generally
liquid at room temperature and when refrigerated. Food
sources for these fats include:
• omega-3 — fish (particularly oily fish such as mackerel,
trout, sardines, tuna and salmon), canola and soy oils,
and canola-based margarines
•
omega-6 — mainly nuts, seeds and oil made from
corn, safflower and soy.
Many people in Western countries consume too many
omega-6 fats which, like all fats, can increase the risk
of obesity and associated conditions including heart
disease.
Saturated and trans fats

Saturated and trans fats are sometimes known as ‘bad fats’
Figure 3.12 Fats that come from because they increase cholesterol levels in the blood and
animals and are solid at room
temperature are normally saturated.
can therefore contribute to heart disease in the long term.
This pork fat is one example. Although consuming saturated and trans fats will satisfy
the energy and other requirements provided by other
types of fats, they should be replaced where possible.
Saturated fats are generally found in foods of
animal origin (figure 3.12) and are often solid at room
temperature. You can see saturated fat in fatty cuts of
meat as the marbling throughout the meat or the fat that
forms along the ends of cuts of red meat. Other foods
containing high levels of saturated fat include full-cream
milk, cream and cheese, most fried takeaway food, and
most commercially baked goods such as pastries and
biscuits.
Although small amounts of trans fats are found
naturally in certain foods, most trans fats are created
when liquid oil is converted into solid fat by a process
called hydrogenation. For this reason, they are generally
found in processed foods such as pies, pastries and
Figure 3.13 Trans fats are often
cakes (figure 3.13). Margarines and solid spreads made
present in baked goods such as for cooking are sometimes high in trans fats, as are the
doughnuts, biscuits and cakes. products made from them.

1 What are the six categories of nutrients? 10 Explain how eating insufficient carbohydrates could
2 List the main function of carbohydrates. affect the physical, social, emotional and intellectual
3 How much energy does one gram of carbohydrate development of youth.
produce? 11 Discuss the possible short- and long-term effects on
4 Outline the main functions of fibre. a youth who does not consume adequate amounts
5 Does fibre contribute to energy intake? Explain. of fibre.
6 (a) What is the main function of protein? 12 Using mind mapping software, or by copying
(b) How can protein enhance the physical figure 3.14, complete a mind map summarising
development of youth? information relating to the functions and food
7 (a) Is fat required in the diet? Explain. sources of carbohydrates, including fibre.
(b) Which fats are considered the ‘good’ fats? Why?
(c) Which fats are considered the ‘bad’ fats? Why?
8 Why should overall fat intake be limited?
9 (a) What percentage of energy should come from
each of the macronutrients?
(b) Explain why most of our energy needs should
come from carbohydrates instead of fats and
protein.
Function
Functions
Fibre
Carbohydrates
Food sources
Food sources
Figure 3.14 Concept map summarising the functions and food sources of
carbohydrates (including fibre)

water, calcium and iron
Water
Although it has no nutritional value, water is the most important nutrient for
human survival. Water makes up around 55 to 75 per cent of body mass and is
needed for numerous functions within the body, including:
• as a medium for all chemical reactions required to provide energy and produce
soft tissue
• as a key component of many cells, tissues and systems
• as a key component of blood.
Being adequately hydrated allows chemical reactions in the body to occur
effectively, which is important for periods of rapid development such as the youth
stage of the lifespan. Sufficient water intake allows the body’s systems to function
adequately and the body as a whole to function properly. This means an individual
can effectively go about their day-to-day activities. Water intake can also assist in
weight maintenance as it helps to reduce hunger while contributing no kilojoules
or energy. When dehydrated, a person will often lack alertness and the ability to
concentrate. They may not have the energy to participate in physical activities,
which can impact on motor skill development. They may not be able to concentrate
at school, which can directly impact on intellectual development.
All foods have some water content (figure 3.15) and contribute to total water
intake, as do fluids such as milk. Water should also be consumed in its pure form
(i.e. from the tap or in bottled form) to meet hydration needs. Although they
contain a large percentage of water, softdrinks and sports drinks often contain high
amounts of sugar and other additives, so their consumption should be limited.
Figure 3.15 Foods such as fruits and vegetables have a high water content,
but water should also be consumed in its pure form.
Calcium
Calcium is one of the key nutrients required for the building of bone and other
hard tissues (such as teeth and cartilage) and is therefore extremely important
during periods of rapid growth such as during youth.

The youth stage signifies the greatest increase in bone density and contributes
significantly to achieving optimal peak bone mass. It is therefore vital that youth
get enough calcium during these years to build as much bone density as possible.
The greater the bone density during this stage, the less chance the individual will
have of developing osteoporosis later in life (figure 3.16).
Calcium is found in most dairy products (figure 3.17). Milk, cheese and yogurt
are all rich sources of calcium. Other sources include sardines and salmon (with
bones), green leafy vegetables (broccoli, spinach), fortified soy milk, tofu made
with calcium sulfate and fortified orange juice.
Men
Women
Bone mass
20 40 60 80 100
Figure 3.16 Changes in bone mass
Age (in years) with age
Oxalic acid is present in spinach

and binds to the calcium
molecules, preventing all of the
calcium from being absorbed.
In fact, if oxalic acid is present
when calcium is eaten, only
5 per cent of the available
calcium may be absorbed.
For this reason, it is important
to obtain calcium from other
sources as well, such as dairy
(which does not contain oxalic
acid).
Figure 3.17 Dairy products such as

milk are a rich source of calcium and
help to build peak bone mass.

3.2 Introduction to the nutrients required during youth: water, calcium and iron
Case study
Strong bones key to health Illawarra, is telling her daughter’s story in the hope
it will help arrest a worrying trend towards poor
By Angela Thompson nutrition among a body image-conscious generation of
When Tracy Spark’s daughter shed 15 kilograms in adolescent girls.
four months her mother knew something was drasti- According to Wollongong nutritionist Anita
cally wrong. Needham, those who fail to achieve peak bone
The teenager’s school results had gone downhill mass during adolescence are more likely to develop
because she couldn’t concentrate, her hair had begun to osteoporosis.
fall out and she was icy to touch. ‘While we’re young it’s good to stockpile the calcium
The physical effects of anorexia were shocking, but we get from dairy products so that you offset the effect
it was only when routine blood tests were carried out of ageing on bone loss and therefore you reduce the
during treatment that Ms Spark learnt the full horror risk of osteoporosis,’ she said.
of what was happening to her daughter, then 14, on the ‘Unfortunately many people exclude dairy foods
inside. when trying to lose weight, and in doing so miss out
Tests showed the girl’s bones were being leached on valuable sources of calcium and other essential
of calcium to feed a body deprived of the essential nutrients.’
mineral. ‘Recent clinical studies show that including three
‘At a time when she should have been laying down
dairy serves in a weight-reducing diet may in fact result
calcium in her bones for later on, her body was actually
in more weight and body fat loss,’ she said.
taking calcium out of her bones to survive,’ Ms Spark
At the Sparks household, it was a lesson learnt the
said.
‘I work in the field and I was lost. I assumed eating hard way.
disorders were an issue when you became skeletal. ‘She does focus on eating healthily now,’ Ms Sparks
I didn’t realise people get very ill a long time before said of her daughter, who did not want to be named.
they get to that stage.’ ‘I’m a big believer in your body knowing what it
On the eve of National Healthy Bones Week, Ms needs and she absolutely adores dairy food.’
Spark, now a nutrition coordinator for Healthy Cities Source: Illawarra Mercury, 2 August 2008.
Case study review

1 How was the development of Ms Sparks’ daughter affected by not consuming
enough calcium?
2 Why do a lot of people cut dairy products out of their diet?
3 Explain why getting adequate calcium in the diet is very important during the
youth stage of the lifespan.
Iron
Iron is an essential part of blood. As blood volume increases during youth, iron is
needed in greater quantities (figure 3.18).
Iron forms the ‘haem’ part of haemoglobin, which is the oxygen-carrying part of
blood. A person who does not get enough iron may develop anaemia, a condition
characterised by tiredness and weakness. Individuals with anaemia struggle to
generate enough energy to complete daily tasks such as school work, sport and
socialising.
Red meat is a rich source of iron but it often contains high levels of saturated
fat. As a result, leans cuts of meat should be chosen and iron should also be gained

from other sources. A balanced, varied diet is the best way to get
adequate amounts of iron.
Foods providing iron include:
• lean red meat
• turkey and chicken
• fish, particularly oily fish (e.g. mackerel, sardines and pilchards),
fresh, frozen or canned
• eggs
• nuts (including peanut butter) and seeds
• brown rice
• tofu
• bread, especially wholemeal or brown bread
• leafy green vegetables, especially curly kale, watercress and broccoli.
Iron from meat is usually absorbed best, although vegetarians can Figure 3.18 As blood volume
still get enough iron if they eat a variety of foods. Vitamin C changes increases during the youth stage of
the chemical make-up of iron from non-meat sources and increases the amount the lifespan, iron is required in higher
amounts to make red blood cells.
absorbed. Vitamin C should therefore be eaten if iron absorption needs to be
maximised.
Case study
A close up on anaemia How are blood cells produced?

Blood cells are constantly being produced in the bone
Anaemia is a condition characterised by a deficiency in marrow, at a rate of millions per second. Bone marrow
the number or quality of red blood cells. is a spongy tissue in the cavities of bones that is respon
Red blood cells are responsible for transporting sible for generating the key components of blood,
oxygen to cells around the body to allow them to carry including red blood cells. Bone marrow requires certain
out their normal functions. One of the components nutrients, including iron, folate and vitamin B12, to be
of red blood cells is a protein called haemoglobin. able to create red blood cells.
Each red blood cell contains a haemoglobin molecule In Australia, iron deficiency is one of the most
and it is this molecule that gives red blood cells their common causes of anaemia. If there is not enough iron
red colour. When transported to the lungs, oxygen in the diet, the body will use stored supplies from the
molecules attach themselves to the haemoglobin and liver. Once this reserve is used up, the bone marrow
are carried through the network of blood vessels until will not be able to make enough haemoglobin and
they are absorbed by a cell. anaemia may result.
Anaemia occurs when there is a reduced level of red
blood cells or haemoglobin in the blood. What causes anaemia?
In those with anaemia, the heart pumps harder in Anaemia can have many causes, and although com-
an attempt to ensure adequate levels of oxygen are monly associated with a deficiency in iron, folate and/
delivered to the cells. During exercise, meeting the or vitamin B12, anaemia can also occur as the result of:
demands of the cells becomes increasingly difficult and • malabsorption — this occurs when the nutrients
the individual can become exhausted. that are consumed are not able to be used. It can be
Anaemia isn’t a disease itself, but the result of a caused by conditions such as coeliac disease.
malfunction somewhere in the body. Females are • inherited disorders — some blood disorders such as
particularly susceptible to anaemia, with some estimates thalassaemia and sickle cell disease can be inherited
suggesting that around one in five menstruating females from parents and can lead to anaemia
and half of all pregnant females are anaemic. Youth • chronic conditions — conditions such as rheumatoid
experiencing puberty are also at an increased risk as arthritis and tuberculosis can contribute to anaemia
blood volume increases, which increases the demand • bone marrow conditions — such as cancer or
for red blood cells and haemoglobin. infection
(continued)

3.2 Introduction to the nutrients required during youth: water, calcium and iron
• blood loss — due to injury, surgery, cancer, stomach How is anaemia treated?
ulcers, heavy periods or giving blood frequently Treatment for anaemia depends on the severity and the
• rapid growth or times during which large amounts cause of the condition. In any case, the cause must be
of energy are required — such as puberty or while addressed in addition to treating the symptoms.
pregnant. Vitamin and mineral supplements may be required
in the case of dietary deficiency. Iron injections may
What are the symptoms of anaemia?
be required if iron levels are particularly low. Note
Depending on the severity, the symptoms of anaemia that iron supplements should be used only under the
can include: direction of a doctor. The human body does not excrete
• pale skin iron efficiently, which can contribute to iron poisoning
• tiredness if the dose is not monitored.
• weakness
• shortness of breath How can anaemia be prevented?
• blood pressure drops on standing up suddenly — Anaemia caused by deficiencies in dietary intake can
sometimes caused by blood loss, such as during a be prevented by making sure that certain foods are con-
heavy menstrual period sumed on a regular basis, including lean meats, nuts and
• headaches legumes, fruit and vegetables and dairy products. Those
• fast pulse who do not consume any animal products (known as
• irritability vegans) may have to increase their intake with fortified
• difficulty concentrating foods or vitamin and mineral supplements.
• cracks or redness of the tongue Anaemia caused by an underlying health condition
• appetite loss may not be able to be prevented as it is caused by a fault
• strange food cravings (including the desire to eat dirt in the cell-making process. Treatments are available to
or rice, a condition known as pica). relieve the symptoms in these cases.
Source: Adapted from www.betterhealth.vic.gov.au.
Case study review

1 Briefly explain anaemia.
2 Discuss haemoglobin and the role it plays in the body.
3 How might someone know if they are anaemic?
4 Research the blood disorders that can cause anaemia and prepare a brief
summary of each.
5 Explain how anaemia could impact on the health and development of youth.
6 Discuss why female youth are more susceptible to anaemia than male youth.
7 Discuss why youth is a higher risk lifespan stage for anaemia than adulthood.
TEST your knowledge (a) Identify two trends evident in the graph.
(b) Use the graph to help you explain a possible
1 (a) List three functions of water.
difference in health outcomes between males
(b) Why would it be a good idea to replace most
and females in older age.
drinks with plain water?
2 Why is calcium required in the body?
3 (a) List three foods that contain high levels of
calcium. 7 Explain how being dehydrated could affect the four
(b) Even though spinach has a lot of calcium, it is dimensions of development in youth.
not considered the best food source of dietary 8 List the likely symptoms of not getting enough
calcium. Explain why this is so. calcium.
4 Describe the role of iron in the body. 9 Which other stages of the lifespan would require
5 Why is iron required in greater amounts during the higher rates of:
youth stage of the lifespan? (a) calcium?
6 Refer to figure 3.16. (b) iron?

vitamins A, B, C and D
Vitamin A
Vitamin A is required for cell division and is therefore an important aspect of any
growth that occurs in the body. There are many aspects of physical development Interactivity:
that involve growth during the youth stage of the lifespan, so requirements for Time Out: ‘Vitamins and folate’
vitamin A increase at this time. Skin, muscle, organ, bone and blood cells all divide Searchlight ID: int-1425
rapidly during youth and therefore require vitamin A.

Vitamin A also plays a role in cell differentiation. Due to the rapid speed of
growth during youth, cell differentiation occurs at a rapid rate and contributes to
the increased need for this vitamin. Vitamin A has also been shown to promote the
development of bones.
Vitamin A assists with the development of immune system function by promoting
mucus development in the lungs and airways. This lining of mucus is a defence
mechanism against bacteria and viruses. Vitamin A also helps in the development
of antibodies required to fight infection.
The best sources of Vitamin A can be found in red, yellow and orange coloured
fruits and vegetables including raw carrots, sweet potatoes, squash, spinach and
rockmelon (figure 3.19).
Figure 3.19 Yellow, orange and

red fruit and vegetables are good
sources of vitamin A.
Vitamin D
The main role of vitamin D is in the absorption of calcium from the intestine
into the bloodstream. Lack of vitamin D can lead to low levels of calcium being
absorbed and bones becoming weak. Fish (e.g. tuna, salmon, mackerel, sardines
and herring) is the best source of food-based vitamin D. Fortified milk, breakfast
cereals and orange juice can also contain vitamin D, but it is important to check
the packaging.

3.3 Introduction to the nutrients required during youth: vitamins A, B, C and D
Most Australians get enough vitamin D from exposure to sunlight (figure 3.20),
during which UV rays are converted to vitamin D in the skin. However, there is
growing evidence to suggest that some groups in Australia are deficient in vitamin D
because they rarely go out into the sun. Youth with dark skin or those who always
cover up when outdoors can become deficient in vitamin D. While moderate
exposure without any degree of sunburn is healthy, excessive exposure leading to
sunburn is a major risk factor for skin cancer and should always be avoided.
Vitamin C
Vitamin C is important for the structure of tissues within the body and is required
for building collagen. Collagen is a protein that is required for the formation of
skin, scar tissue, connective tissue, bone, tendons, ligaments, and blood vessels
(figure 3.21). In this role, vitamin C allows the other components of tissues to be
held together.
Vitamin C is important in promoting the absorption of iron and is therefore an
important nutrient in the production of blood.
Humans can neither make their own vitamin C in the body nor store it effectively
Figure 3.20 Most Australians get (as other animals can do). Therefore, a daily intake of vitamin C is important for
enough vitamin D from exposure to normal individual human development and functioning.
sunlight, but those with restricted Vitamin C is found in many fruits and vegetables including kiwi fruit, broccoli,
access to sunlight might be deficient. blackcurrants, oranges and strawberries. It is easily destroyed when exposed to
heat and air, so fresh fruit and vegetables provide the best source of vitamin C.
B-group vitamins
Vitamins B1, B2 and B3
The B-group vitamins include vitamins B1, B2 and B3 (also known
as thiamine, riboflavin and niacin respectively). These vitamins
are essential in the process of metabolising or converting the fuels
(carbohydrates, fats and protein) into energy.
A lack of these nutrients can lead to a lack of energy. As energy is
essential for growth, a lack of the B-group vitamins can contribute
to slowed growth of hard and soft tissues.
Rich sources of the B-group vitamins include Vegemite,
wholegrain cereals and breads, eggs, meats, fish, dark-green leafy
vegetables and milk. The B-group vitamins are very delicate and
Figure 3.21 Collagen is a key component easily destroyed through cooking and processing. Getting enough of
of these tendons. these vitamins from whole grains and unrefined sources is the best
way to ensure that the recommended intake is met.
Folate (vitamin B9)

Folate is a B-group vitamin that is essential for growth and development. It plays
an important role in DNA synthesis and is therefore required for cells to duplicate
in periods of growth. (It also occurs in periods of maintenance, but not to the same
degree.)
Folate also plays a role in the development of red blood cells, and a deficiency
in folate can lead to anaemia. Note that anaemia can be caused by a deficiency in
iron (called iron-deficiency anaemia) or in folate (called folate-deficiency anaemia).
Figure 3.22 A lack of folate can lead
to anaemia and therefore tiredness.
Anaemia is characterised by tiredness, so the youth might no longer participate in
This can have numerous effects on the daily activities. This in turn can affect all types of individual human development
development of youth. (figure 3.22).

Folate is found in green leafy vegetables, citrus fruits, poultry and eggs. Many
cereals, breads and fruit juices are fortified with folate. The form of folate added to
foods is a synthetic form of folate known as folic acid.
Vitamin B12
Vitamin B12 is another B-group vitamin that is required for adequate development
during youth. Although it has a number of roles in the body, its main function
during the youth stage is for the formation of red blood cells. It works with folate in
this capacity, ensuring the red blood cells are not only the correct size but also the
correct shape to enable oxygen to be transported throughout the body. A deficiency
of vitamin B12 can increase the chance of becoming anaemic. Having this condition
can prevent youths from participating in normal activities and therefore have a
wide range of effects on their development.
Most foods of animal origin contain some vitamin B12 but particularly good
sources include meat, eggs and cheese. Because vitamin B12 is found only in food
sources of animal origin, vegans are at particular risk of being deficient in this
vitamin.

1 (a) What is cell differentiation? 5 Describe the effects on development of youth who
(b) Explain the difference between cell are deficient in:
differentiation and cell division. (a) vitamin A
2 What is the main role of vitamin D in the body? (b) vitamin D
3 Why are vegans at particular risk of vitamin B12 (c) vitamin C
deficiency? (d) B-group vitamins.
4 Explain the role of the following nutrients and 6 Create a mind map that summarises the function
why each is important for youth health and/or and food sources of the vitamins covered in this
development: chapter.
(a) vitamin A
(b) vitamin C
(c) folate
(d) vitamins B1, B2 and B3.

3.4 The interrelationship of major nutrients
KEY CONCEPT The function of major nutrients for the development of hard
tissue, soft tissue, blood tissue and energy
Although all the key nutrients have their specific functions, they must work
together or interrelate to carry out four major processes in the body:
1. provision of energy
2. production of blood
3. formation of soft tissue
4. formation of hard tissue.
Each nutrient is like a piece of the puzzle, so although its role may be minor in
the process, without it, the process cannot be carried out effectively. The four major
processes and the nutrients required for each will be explored in more detail in the
following section.
Provision of energy
Energy is required in all cells so they can carry out their functions. Cells without
energy — like cells without oxygen — will die. As well as being needed for physical
activity, energy is essential to sustain life and keep body systems functioning
adequately. The amount of energy needed to sustain life (i.e. to keep the major
organs functioning) is known as the basal metabolic rate (BMR).
About 70 per cent of an individual’s total energy expenditure is devoted to BMR
requirements. The other 30 per cent is needed for physical activity and digestion.
A number of factors influence BMR. They include:
• age — BMR generally decreases with age, mainly due to lower muscle mass.
The effect of ageing decreases BMR by about 2 per cent per decade after the
age of 20.
• growth — individuals undergoing growth (such as in youth) require more energy
to build tissues and increase blood volume.
• body size — larger people have a higher BMR as they have more cells which in
turn require more energy to maintain their function.
• body type — muscle requires a higher BMR than fat as muscle cells are more
active and therefore require more energy to maintain their function.
• dieting — can cause the body to conserve energy. This lowers the BMR.
• sex — males tend to have a higher BMR. The higher muscle mass in most males
contributes to this difference.
Table 3.1 The energy used in selected • environmental temperature — the body has to work harder to maintain
activities (kJ per kg per hour) temperature in hot or cold environments, therefore raising the BMR.
Energy
In Australia, energy is measured in kilojoules (kJ). A kilojoule contains one
Activity (kJ/kg/h) thousand joules. The exact meaning of a joule is quite technical but some examples
of how much energy is used in specific activities will help put it into perspective.
Sitting quietly 1.7
The approximate amount of energy used in certain activities is shown in table 3.1.
Writing 1.7
As the energy required for physical activity only makes up a fraction of a person’s
Standing relaxed 2.1 total energy requirement, it is useful to look at total energy requirements. The
Driving a car 3.8 approximate total energy requirement per day (kJ) based on an individual with
Vacuuming 11.3 moderate physical activity levels is shown in table 3.2.
Walking rapidly 14.2 The amount of energy contained in food is also measured in kilojoules. This
Running 29.3
makes it easier to compare energy intake with energy output. The amount of energy
contained in certain foods is shown in table 3.3. If more energy is consumed than
Swimming (4 km/hour) 33.0
is needed for metabolism, digestion or physical activity, it is stored as fat and
Rowing in a race 67.0 contributes to weight gain. If more energy is used than is consumed, the individual
Source: Better Health Channel, www.
will lose weight. In either case, health and individual human development are
betterhealth.vic.gov.au. affected.

Table 3.2 Average energy requirements for individuals of selected ages, by Table 3.3 The approximate energy content of
sex and based on moderate physical activity levels selected foods
Males Females Approximate

Food kilojoules
Age Energy requirement Age Energy requirement
White bread (1 slice) 290
13 11 200 13 10 000
Wholemeal bread (1 slice) 270
14 11 900 14 10 300
Egg (boiled) 330
15 12 600 15 10 600
Egg (Fried) 417
16 13 200 16 10 700
Skim milk (250 mL) 380
17 13 700 17 10 800
Yoplait Creamy Original Yogurt (175 g) 745
18 14 000 18 10 900
Butter (1 tsp) 120
Source: Adapted from www.nhmrc.gov.au. Roast beef (lean, 150 g) 1070
Hamburger mince (1 patty) 1050
Chicken breast (no skin, roasted 605
The provision of energy involves two groups of nutrients — without fat, 100 g)
those nutrients required for fuel (the sources of energy), and those Chicken breast (with skin, roasted 920
nutrients that enable the fuel to be converted or changed into energy. without fat, 100 g)
As discussed earlier in this chapter, carbohydrates, lipids and 1 medium T-bone steak (trimmed 960
protein are the fuel or sources of energy. These fuels are broken down of fat)
into simpler forms and then transported to the cells for immediate Sausages (pork, grilled) 1015
use or stored in various sites around the body (e.g. the liver and Lettuce (1 cup) 20
fat cells). The nutrients needed for energy production to occur are
Broccoli (1/2 cup) 115
shown in figure 3.23 (page 90).
Thiamine, riboflavin and niacin (the B-group vitamins) form Carrot (1 medium) 170
co-enzymes that bind to other substances and convert the fuels Potatoes (boiled, 100 g) 340
into forms that can be used by the cells. The B-group vitamins are Apple (1 medium) 230
transported to the cells by water, and many of the chemical reactions Banana (1 medium) 390
that occur in producing energy take place in water. Popcorn (air-popped, no oil, 1 cup) 115
Oxygen is required in the process of energy production. It is
Ice-cream (vanilla, 1 scoop) 375
transported to the cells by haemoglobin, which is largely made up of
iron and protein. The process whereby energy is released and used Snickers Bar (1 bar) 1175
by the body is known as cellular respiration. Potato chips (50 g) 990
Pasta (1 cup, cooked) 830
French fries (small serve, 100 g) 1510
Blood production 1 sausage roll 1500
Blood needs to be produced on a constant basis and even more so Domino’s Supreme Deep Pan Pizza 835
(1 slice)
when growth is occurring at a rapid rate. As youths are in a period
of rapid growth, their need for the nutrients required for blood McDonald’s Big Mac 2060
production increase significantly. Blood is made up of three main Hungry Jack’s Whopper Cheese 3184
components: KFC nuggets (6 pieces) 1090
• plasma — makes up approximately 55 per cent of blood and Subway (six inch sub, roasted chicken) 1240
contains clotting material and transports nutrients, gases, Drinks
hormones and waste
Cola softdrink (375 mL) 655
• red blood cells — make up around 44 per cent of blood and
contain haemoglobin, which carries oxygen, carbon dioxide and Apple juice (125 mL) 210
other gases Orange juice (250 mL) 335

• white blood cells — make up around 1 per cent of blood and are Water (250 mL) 0
important for fighting disease and infection.
The blood cells are made in the bone marrow, which is a spongy tissue found
inside the large bones of the legs, hip, spine and skull.
Protein forms a major part of all three components of blood. In the case of red
blood cells, iron binds with protein to form haemoglobin. Haemoglobin makes up

Carbohydrates,
lipids and protein
Are the fuel for
energy
B-group vitamins
Allow the release
of energy
Iron
Forms a part of
haemoglobin, essential
for carrying oxygen
around the body
Water
Transports the
B-group vitamins and
is also required for
chemical reactions
to take place
Figure 3.23 The nutrients required

for energy production
around 33 per cent of the weight of red blood cells and is responsible for carrying
oxygen around the body.
Vitamin C plays a number of roles in blood formation. It helps in the absorption
of iron from plant sources, making more iron available for haemoglobin production.
It is also important in the formation of healthy blood cells. Red blood cells live
for only 100 to 120 days and therefore require constant regeneration. The human
body produces around two million new red blood cells per second. In order for this
volume of red blood cells to be produced, cell division must occur at a rapid rate.
Vitamin A is essential for cell division and is therefore required for this process.
When a cell divides, the DNA must be replicated so each cell has a complete
set of DNA. Although a mature red blood cell does not contain DNA (as it has
no nucleus), immature blood cells do contain DNA. Folate and vitamin B12 are
required for DNA synthesis and so are vital for red blood cell development. Water
is the main component of blood plasma and many of the chemical reactions that
produce the components of blood need water.
The nutrients required for the production of blood are outlined in figure 3.24.

Protein
Main building material
and also forms the ‘globin’
Vitamin C part of haemoglobin
Forms connective tissue
and assists in
iron absorption
Lipids
Required for the
formation
of cell membranes
Plasma
55%
Vitamin A
Required for cell division
Red
blood cells
44%
Iron
Required for ‘haem’
part of haemoglobin
production
White
blood cells
1%
B6, folate and B12

Required for DNA Water
synthesis and red blood The main component
cell formation of blood
Figure 3.24 The components of
blood and the nutrients required for
blood production
Formation of soft tissue

Soft tissue includes skin, muscles, tendons, ligaments, collagen and organs. They
are categorised as soft tissue because they are soft compared to the other tissues
that make up the human body (hard tissue).
The development of soft tissue needs many nutrients for maintenance
throughout the lifespan but, when the size of the soft tissue expands during times
of growth, greater amounts of nutrients are needed. These nutrients are summarised
in figure 3.25.
Protein is the main building material for soft tissue, as it is for all body cells.
Protein is broken down into amino acids through the process of digestion and
then rebuilt into protein required by the body. This process requires the nutrient
folate.

Protein
Folate
Promotes cell
division and tissue
growth
Vitamin C
Muscles
Lipids
Maintains and develops
cell membranes
Organs Tendons
Vitamin A
Water
Medium for chemical Ligaments Skin
reactions and present in
soft tissue cells
for soft tissue formation
Vitamin C plays an important role in the process of soft tissue development by

providing collagen. Collagen is like glue for the body’s cells and tissues, holding
them together and giving them structure.
Lipids are required for the maintenance and development of cell membranes,
which are the outer layer of all human cells. When soft tissues grow, more cells are
created, thus increasing the need for lipids.
Vitamin A is required for cell division. It is therefore required for the generation
of new soft tissue cells.

Formation of hard tissue
Hard tissue includes bones, teeth and cartilage, which contain minerals and
vitamins. Hard tissue can break if it is not strong enough.
The body cannot store all of the nutrients needed to make hard tissue, so these
nutrients are required throughout the lifespan. They are needed in greater amounts
during periods of growth such as during youth.
The nutrients required for hard tissue development are summarised in
figure 3.26.
Protein, vitamin C and vitamin A play similar roles in hard tissue development
as they do in soft tissue development.
Protein is the main building material for hard tissue development and, with
vitamin C, forms the collagen matrix for the bone. (The collagen matrix is like an
outline for the bone structure.) Vitamin A assists in the cell division of the new
cells that are needed by both the collagen matrix and the hardening materials.
Once the collagen matrix is laid down, calcium and phosphorus bind together to
make calcium phosphate. This calcium phosphate is then deposited into the holes
of the collagen matrix to give the bone strength.
Vitamin D assists the absorption of calcium in the small intestine and a lack of
this vitamin can result in weak bones.
Protein
Vitamin C
Vitamin A
Calcium
Hardening material of
hard tissues
Vitamin D
Required for the absorption
of calcium
Bones Teeth Cartilage

for hard tissue formation

TEST your knowledge iii. Sitting at home quietly for a total of

five hours
1 (a) Which nutrients are required for more than one
iv. Walking rapidly to and from school for a
process in the body?
total of 30 minutes
(b) Do they play the same role in all processes?
v. Taking a one-hour driving lesson
2 (a) Design a silly sentence or acronym to remember
(c) Calculate the total energy requirement for Chris
the nutrients required for energy provision,
for this day.
blood production and hard and soft tissue
(d) Calculate the energy balance for Chris during
formation.
this day (subtract the energy used from the
(b) Share your response with other students and
energy consumed).
decide on the best ones.
(e) i. If 37 000 kJ result in around one kilogram of
excess weight, calculate how much weight
Chris would lose/add if he maintained this
3 The 24-hour intake of food and drink for Chris, a intake and expenditure of energy for a
17-year-old male, is shown below. full year.
• 2 fried eggs on white toast with 2 tsp of butter ii. Discuss how this weight gain/loss might affect
• 175 g yogurt Chris’s health and development.
• 250 mL orange juice 4 Which lifespan stages would require higher
• 1 sausage roll amounts of the nutrients needed for each of the
• 500 mL water following processes? Explain each answer.
• 1 Big Mac (a) Energy provision
• 1 small serving French fries (b) Blood production
• 375 mL cola (c) Soft tissue formation
• 1 apple (d) Hard tissue formation
• 300 mL water 5 In small groups, select one of the processes (hard
• 2 slices of leftover pizza tissue, soft tissue, energy or blood production) and
• 1 medium T-bone steak design a poster, multimedia presentation or video
• 200 g potatoes that could be used to educate youth about the
• 1 carrot nutrients required for the process and examples of
• 1 banana foods that may supply these nutrients.
• 250 mL apple juice 6 Use the Bone mass weblink in your
• 2 scoops of vanilla ice-cream eBookPLUS to find the link for this
(a) Using table 3.3, calculate the total energy intake question. Watch the video and answer
for Chris. the following:
(b) Chris weighs 70 kilograms, has a BMR of (a) Between which ages of youth is one-quarter of
around 7200 kJ/day and uses around 1200 kJ/ peak bone mass built for males and females?
day for digestion. Using table 3.1, calculate (b) How much of the adult peak bone mass is built
the extra energy that Chris will expend by during the pubertal growth spurt?
engaging in each of the activities below in one (c) Why is dairy an ideal choice for bone
day. You will need to multiply the amount of development?
energy the activity uses (in kJ/kilogram/hour) (d) How much does the risk of fractures increase
by Chris’s weight (in kg) by the amount of time for those who avoid dairy and calcium-fortified
he performed the activity (in hours). An Excel foods?
spreadsheet can be used to do this. (e) i. What pattern tends to occur in the calcium
i. Writing at school and at home for a combined intake of children as they age?
total of four hours ii. What factors account for this?
ii. Running around at football training for one (f) How can obesity increase the risk of fractures?
hour

3.5 Consequences of nutritional imbalance
KEY CONCEPT Understanding the consequence of nutritional imbalance in a

youth’s diet on short- and long-term health and individual human development
Youth is the third-fastest period of growth in the lifespan. During the adolescent
growth spurt, the average female youth can expect to grow 16 centimetres in height
and gain 16 kilograms in weight, and the average male youth can expect to grow
20 centimetres and put on 20 kilograms in weight. For this physical development
to occur, all of the nutrients required for the four processes — soft and hard tissue
formation and the production of energy and blood — must be eaten in appropriate
proportions. When nutrient intake is balanced, appropriate levels of nutrients
are available to carry out these processes effectively and the development of youth
is optimised.
The importance of food intake during youth is not limited to ensuring that
optimal individual human development occurs. Balanced nutrient intake also plays
a significant impact in promoting the health of youth.
If the nutritional intake of youth is not balanced and nutrients are not consumed
in appropriate proportions, the risk of a range of consequences for health and
individual human development increases. These consequences can occur as a result
of the over- or under-consumption of specific nutrients and can occur in both the
short and long term.
Short-term consequences
The consumption of a variety of nutrients is required regularly to carry out various
processes including the production of energy. If these nutrients are not present, or
are in incorrect proportions, these processes may not occur effectively.
Carbohydrates are broken down and the glucose molecules that result are
absorbed into the bloodstream, from where they are taken into the cells and stored,
ready for use. The amount of glucose contained within carbohydrate-rich foods,
and how much such foods affect the levels of blood glucose, is
measured using a system called the glycaemic index (GI). The High GI
Blood glucose level
glycaemic index rates foods from 1 to 100 based on how quickly Low Gl
they cause blood-glucose levels to rise. Foods that cause blood
glucose to increase sharply are called high GI (with a score of
more than 70) while those that have a more sustained impact on
blood glucose are called low GI (with a score less than 55). Those
in-between these numbers are termed medium GI. Eating foods
with a low GI rating gives a more sustained energy release and can
therefore assist in carrying out the biological processes required 0 1 2 3
during the day. In contrast, high GI foods give a quick rush of Time after meal (hours)
glucose that then drops off just as quickly (figure 3.27). As blood
glucose levels decrease, hunger increases. As a result, high GI Figure 3.27 The effect on blood glucose of high and low
GI foods
foods can contribute to overeating.
In addition to carbohydrates, B-group vitamins and iron also contribute to the
production of energy. If these nutrients are not consumed on a regular basis, energy
levels may decrease, impacting physical health. Reduced energy levels also impact
on an individual in many ways such as not having the energy to:
• socialise — which impacts social health
• exercise — affecting fitness, an aspect of physical health
• concentrate at school — affecting intellectual development.
Fibre is a type of carbohydrate made up of the indigestible parts of plant matter.
Fibre assists in regulating bowel movements and providing feelings of fullness.

Adequate fibre intake can reduce the risk of constipation and overeating in the
short term. Fibre also reduces the absorption of glucose and cholesterol into the
blood stream. This acts to decrease blood glucose and blood cholesterol levels in
the short term.
Figure 3.28 Foods like cakes, biscuits

and donuts have a high GI that gives a
quick rush of glucose.
Water is essential for the optimal functioning of body systems throughout the
lifespan. Dehydration can affect many processes within the body and contribute
to a range of short-term impacts as a result. Common symptoms of dehydration
include thirst, dry mouth, headaches, decreased blood pressure, dizziness, fainting,
tiredness and constipation. In the most severe cases, dehydration can lead to
unconsciousness and death.
Long-term consequences
As well as contributing to short-term consequences, nutrient imbalance is associated
with many long-term consequences impacting on health and development,
including dental caries; underweight, overweight and obesity; chronic conditions
such as cardiovascular disease, colorectal cancer and osteoporosis; slowed growth;
anaemia; and increased risk of infection.
Sugars are a type of carbohydrate found naturally in some foods such as fruit
and honey, and added to many processed foods such as cakes and soft drinks.
As well as providing a fuel for energy production, sugars provide a food source
for bacteria in the mouth. These bacteria produce acids which can contribute to
dental decay and the development of dental caries. Dental caries can impact mental
health as a result of reduced self-esteem if the individual’s appearance is altered.
Intellectual development may also be affected if the individual misses school as
a result of ongoing treatment. If left untreated, diseases such as periodontitis can
occur. Periodontitis is a condition characterised by inflammation and infection of
the tissues that support the teeth. In the long term, periodontitis can lead to the
loosening and loss of teeth.
Although required as a fuel for energy production, if eaten in excess,
carbohydrates, fats and protein are stored as adipose (fat) tissue. Over time, this can
lead to weight gain, overweight and/or obesity. The most immediate consequences
of overweight and obesity in youth are social discrimination (associated with poor
self-esteem and depression), negative body image and eating disorders. Overweight
youth are more likely to develop sleep apnoea, have a reduced ability to exercise,

and show early signs of metabolic consequences, such as hypertension, high blood
glucose and high blood cholesterol.
Overweight and obesity rates have been steadily increasing for youth over time
(see figure 3.29). Overweight youth are more likely to be overweight or obese as
adults, which increases the risk of a range of conditions including type 2 diabetes,
cardiovascular disease, some cancers and arthritis.
30
Obese
Overweight
25
20
Per cent
15
10
0
1985 1995 2007* 1985 1995 2007*
Males Females
* Figures are for 9–16 years
Figure 3.29 Prevalence of overweight and obesity among males and females aged
7–15 years, 1985, 1995 and 2007
Source: Adapted from Australian Institute of Health and Welfare 2004, Risk factor monitoring, a rising epidemic: obesity in
Australian children and adolescents and Australian National Children’s Nutrition and Physical Activity Survey 2007.
As well as contributing to weight gain, excessive protein consumption can

reduce the ability of the body to absorb calcium which can contribute to reduced
bone density and osteoporosis later in life.
Fibre provides feelings of fullness without contributing significantly to energy
intake. As a result, adequate fibre intake can assist with weight management in the
long term. It also assists with regulating bowel movements and has been linked to
lower rates of colorectal cancer in the long term.
Saturated and trans fat increase the process of atherosclerosis by increasing
levels of low density lipoprotein (LDL) in the blood. Low density lipoprotein is
a type of cholesterol that can stick to the walls of blood vessels which causes the
blood vessels to narrow. This process can eventually restrict blood flow or stop it
completely. Atherosclerosis is the underlying cause of many types of cardiovascular
disease, including heart attack and stroke. Monounsaturated and polyunsaturated
fats work to reduce levels of LDL cholesterol in the blood and can therefore assist in
reducing the risk of cardiovascular disease in the long term. Like all fats, however,
over-consumption can contribute to obesity and its associated effects.
Although overweight and obesity are significant issues for youth, underweight
is also a concern. Underweight often indicates undernourishment in which the
nutrients required for optimal health and development are not present.
Severe undernourishment, as occurs in many individuals with an eating disorder,
can contribute to long-term developmental problems. Growth may be slowed as
the nutrients required for hard tissue formation are not present. Although peak

bone mass is not reached until early adulthood, bone density increases significantly
during youth. Calcium, phosphorus and vitamin D are all essential nutrients for
this process. If intake is deficient in these nutrients, weakened bones may be the
result. In many cases, this will develop into osteoporosis later in life.
Soft tissues are constantly repaired and replaced, and nutritional balance is
needed to ensure the nutrients required to carry out this process are present in
appropriate levels. Protein, vitamin C, vitamin A, folate, fats and water are all
required for the growth and repair of soft tissues. Without adequate amounts of
these nutrients, muscles and organs may not develop to their full potential.
As blood cells are produced constantly, adequate intake of the nutrients required
to make blood, such as iron, folate and vitamin B12, are required to ensure the
amount of blood produced meets the needs of the growing youth. Vitamin C is also
important as it assists with iron absorption. If these nutrients are under-consumed,
anaemia can occur. Anaemia is characterised by an inability of the blood to carry
adequate oxygen around the body. Symptoms of anaemia include tiredness and
weakness, so the youth might no longer be able to participate in daily activities.
Anaemia may affect development by creating:
• an inability to participate in the weight-bearing activities that are needed to
increase bone density, which can result in reduced bone mass
• an inability to participate in physical activity, which can impair motor skill
development
• insufficient energy to have a part-time job, which can affect social development
such as learning the role of an employee
• constant feelings of tiredness, which may generate a range of negative emotions
such as helplessness and isolation.
As well as providing energy and aiding in the formation of hard tissue, soft tissue
and blood, nutrients are required to keep all bodily systems functioning correctly.
The immune system, for example, requires a nutritional balance to function
effectively. Protein and vitamin A are key nutrients in immune system function. If a
person is deficient in protein or vitamin A, their immune system may not function
correctly, increasing the risk of disease or infection.

1 (a) Explain the glycaemic index. 6 Explain how carbohydrate, protein and fat intake
(b) Outline the consequences that a high GI diet can can contribute to obesity.
have on the health of youth. 7 Discuss how youth could reduce the risk of
2 (a) Discuss how nutritional imbalance may developing osteoporosis in later life.
contribute to low energy levels. 8 Explain how being underweight could impact on
(b) Explain three ways in which this could impact on youth health and development.
youth health and/or development. 9 Discuss how anaemia could impact on youth health
3 Outline the role that fibre can play in optimising and development.
health in the short term. 10 Design a poster or short video outlining the
4 (a) Explain how nutritional imbalance may contribute possible short- and long-term effects of nutritional
to dental health problems among youth. imbalance among youth.
(b) Discuss how dental caries could impact on
youth:
i. health
ii. development.
5 Explain anaemia.

3.6 F ood selection models as tools to promote healthy
eating during youth
KEY CONCEPT Understanding food selection models as tools to promote

healthy eating during youth
To assist youth in consuming a balanced diet and reducing the risk of short- and
long-term consequences associated with nutritional imbalance, a number of food
selection models have been produced. Food selection models are tools that help
youth to select foods that will meet their nutritional needs, without consuming
too many energy dense foods. Examples include the Australian Guide to Healthy
Eating and the Healthy Living Pyramid.
The Australian Guide to Healthy Eating

and the Australian Dietary Guidelines
The Australian Guide to Healthy Eating is a food selection model that
reflects dietary patterns divided into portions from each of the five
food groups — fruit, vegetables, grains, lean meats (or alternatives),
and milk, yoghurt and cheese products — representing the
proportion of these food groups required each day (see figure 3.30).
The Australian Guide to Healthy Eating is based on the Australian
Dietary Guidelines. The Australian Dietary Guidelines are targeted
towards health professionals, including dietitians, nutritionists,
general practitioners (GPs), nurses, educators, government policy
makers, the food industry and other interested parties. The Australian
Guide to Healthy Eating is a visual representation of the foods
recommended for a healthy balanced diet according to the Australian
Dietary Guidelines. Both the Australian Guide to Health Eating and
the associated Dietary Guidelines will be discussed in this section.
The purpose of the Australian Guide to Healthy Eating and the
Australian Dietary Guidelines is to reduce the risk of diet-related
conditions and diseases such as obesity, cardiovascular disease and
type 2 diabetes, while promoting health and development through
optimal food intake. The Australian Guide to Healthy Eating shows
the proportions of foods that should be consumed from each of the
five food groups according to the Australian Dietary Guidelines.
Figure 3.30 The Australian Guide to
Serving numbers and sizes from each of the five food groups and healthy fats and Healthy Eating
oils are included in the Australian Dietary Guidelines to assist youth in planning
their daily food intake.
Table 3.4 Australian Dietary Guidelines recommended serves from the five food groups for 12–18 year olds
Recommended number of serves per day

Vegetables Grain (cereal) foods per day, Lean meats, poultry, fish, Milk, yoghurt, cheese
and legumes/ mostly wholegrain and/or eggs, tofu, nuts and seeds, and/or alternatives
Age (years) beans Fruit high cereal fibre varieties and legumes/beans mostly reduced fat
Males 12–13 5½ 2 6 2½ 3½
14–18 5½ 2 7 2½ 3½
Females 12–13 5 2 5 2½ 3½
14–18 5 2 7 2½ 3½
Pregnant (up to 5 2 8 3½ 3½
18 years)
Breastfeeding 5½ 2 9 2½ 4
(up to 18 years)
Note: Additional amounts of the Five Food Groups or unsaturated spreads and oils or discretionary food choices are needed only by people who are taller or more active to
meet additional energy requirements.

3.6 Food selection models as tools to promote healthy eating during youth
Information is also included in the guidelines to provide youth with examples of

foods that make up a single serve.
Table 3.5 Examples of single serves

Vegetables and 75 g (½ cup) cooked green or Brassica or cruciferous vegetables
legumes/beans
75 g (½ cup) cooked orange vegetables
75 g (½ cup) cooked dried or canned beans, chickpeas or lentils, no added salt
75 g (1 cup) raw green leafy vegetables
75 g starchy vegetables (e.g. ½ medium potato, or equivalent of sweet potato,
taro, sweet corn or cassava)
75 g other vegetables, e.g. 1 medium tomato
Fruit 150 g (1 piece) of medium-sized fruit, e.g. apple, banana, orange, pear
150 g (2 pieces) of small fruit, e.g. apricots, kiwi fruit, plums
150 g (1 cup) 125 mL (½ cup) 100% fruit juice
diced, cooked or
30 g dried fruit, e.g. 4 dried apricot halves, 1½ tablespoons of sultanas
canned fruit
Grain (cereal) 1 slice of bread or ½ a medium roll or flat bread (40 g)
foods per
½ cup cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur
day, mostly
or quinoa (75–120 g)
wholegrain and/
or high cereal ½ cup cooked porridge (120 g), 2/3 cup wheat cereal flakes (30 g) or ¼ cup
fibre varieties muesli (30 g)
3 crispbreads (35 g)
1 crumpet (60 g) or 1 small English muffin or scone (35 g)
¼ cup flour (30 g)
Lean meats, 65 g cooked lean red meats (e.g. beef, lamb, pork, venison or kangaroo) or ½ cup
poultry, fish, of lean mince, 2 small chops, 2 slices of roast meat (about 90–100 g raw weight)
eggs, tofu, nuts
80 g cooked poultry (about 100 g raw weight) e.g. chicken, turkey
and seeds, and
legumes/beans 100 g cooked fish fillet (about 115 g raw weight) or 1 small can of fish, no
added salt, not in brine
2 large eggs (120 g)
1 cup (150 g) cooked dried beans, lentils, chickpeas, split peas, or canned beans
170 g tofu
30 g nuts or seeds or nut/seed paste, no added salt*
Milk, yoghurt, 1 cup (250 mL) milk — fresh, UHT long life or reconstituted powdered
cheese and/
1/2 cup (120 mL) evaporated unsweetened milk
or alternatives,
mostly reduced 3/4 cup (200 g) yoghurt
fat
40 g (2 slices or 4 x 3 x 2 cm piece) hard cheese, e.g. cheddar
1/2 cup (120 g) ricotta cheese
Table 3.6 Australian Dietary Guidelines 1 cup (250 mL) soy, rice or other cereal drink with at least 100 mg of added
recommended fat intake for youth calcium per 100 mL
Unsaturated
spreads and Fats play an important part in many processes such as the development of cell
Age (years) oils per day membranes, fuel for energy production and regulation of cholesterol. Unsaturated
Boys 12–13 1½ fats are the healthiest options and should be included in the food intake of
14–18 2
youth. The Australian Dietary Guidelines recommend the following amounts of
unsaturated fats for youth.
Girls 12–13 1½
Food items counting as ‘one serve’ of unsaturated fats are shown below:
14–18 2
Unsaturated spreads and 10 g polyunsaturated spread
Pregnant (up 2 oils per day
to 18 years) 10 g monounsaturated spread
Breastfeeding 2 7 g polyunsaturated oil,
10 g tree nuts, peanuts or nut pastes/butters
(up to 18 years) e.g. olive or canola oil
100
Discretionary foods are food and drinks not necessary to provide the
nutrients the body needs, but which add variety. However, many of these are
high in saturated fats, sugars, salt and/or alcohol, and are therefore described as
energy dense. The Australian Guide to Healthy Eating and the Australian Dietary
Guidelines encourage youth to consume these foods only sometimes, and in small
amounts.
With the information provided by the Australian Guide to Healthy Eating
Healthy Eating Pyramid and the Australian Dietary Guidelines, it is possible to
evaluate the daily food intake of an individual.
Applying the Australian Guide to Healthy

Eating and the Australian Dietary Guidelines
If the food and drinks consumed in a 24-hour period are recorded, it is possible
to evaluate that particular day’s intake against the recommended number of
serves within the Australian Dietary Guidelines. This information can then give
some indication as to the adequacy of both the amount of food consumed and
the proportion of different food groups consumed. It is important to remember
that individual differences exist and the foods eaten in a 24-hour period do not
necessarily reflect overall dietary patterns. The following foods were consumed by
Scott, a 16-year old male, in a 24-hour period:
Table 3.7 Scott’s food consumption for one day
Breakfast Morning tea Lunch Afternoon tea Dinner
Bowl of wheat ¾ cup of 1 medium Cooked pasta 3 slices of roast meat

flake cereal (60 g) yoghurt roll with dish (1½ cups 75 g mashed potato
with full-cream salad (75 g of cooked pasta) 2 slices of bread with
milk (1 cup). total) monounsaturated
margarine (20 g total)
75 g of cooked peas
75 g of cooked carrots
2 slices of Small can of 1 vanilla Milkshake Fruit salad (150 g)

toast with tuna slice (3 cups of full
monounsaturated cream milk,
margarine (20 g), chocolate
and 2 slices of topping)
cheese
250 mL freshly 1 can of soft Water 1 apple 250 mL pineapple juice

squeezed orange drink
juice
1 banana
These foods can be broken down into their parts in order to classify them into
the five food groups. Creating a table like table 3.8 can be useful for doing this.
Refer to table 3.5 to see how many serves are present in each food item. For
example, the bowl of wheat cereal with milk would contribute two serves to the
‘grain’ group and one serve to the ‘milk’ group. Including a column for unsaturated
fats and discretionary food items is important as, even though these foods are
not considered a food group, they can have significant impacts on health. The
breakdown for Scott’s 24-hour food intake is shown in table 3.8.
Instead of having to write each food in the table (as was done in table 3.8),
ticks or marks can be placed under each food group as you go through each item
consumed (as shown in table 3.9).

Table 3.8 Scott’s food consumption, broken down into the five food groups
Grain (cereal) foods

Vegetables per day, mostly Lean meats, poultry, Milk, yoghurt,
and wholegrain and/ fish, eggs, tofu, cheese and/or Unsaturated
legume/ or high cereal fibre nuts and seeds, and alternatives, mostly spreads and Discretionary
beans Fruit varieties legumes/beans reduced fat oils foods
1 salad from orange wheat flake cereal small can of tuna full-cream milk from margarine soft drink
roll juice cereal from toast
2 mashed orange wheat flake cereal roast meat cheese slices from margarine vanilla slice
potato juice toast from toast
3 peas banana toast roast meat (1/2 serve) yoghurt margarine chocolate
from bread topping
4 carrots apple toast full-cream milk from margarine
milkshake from bread
5 pineapple roll from lunch full-cream milk from
juice milkshake
6 pineapple roll from lunch full-cream milk from
juice milkshake
7 fruit pasta
salad
8 pasta
9 pasta
10 bread from dinner
11 bread from dinner
Total
4 7 11 2½ 6 4 3
serves
Table 3.9
Grain (cereal) foods Lean meats, poultry,

Vegetables per day, mostly wholegrain fish, eggs, tofu, Milk, yoghurt, cheese Unsaturated
and legume/ and/or high cereal fibre nuts and seeds, and and/or alternatives, spreads and Discretionary
beans Fruit varieties legumes/beans mostly reduced fat oils foods
In order to do this accurately, you need to know how much of each food group
was in each item. If no amounts are given, you can base your judgements on what
an average serve might be (but some accuracy will be sacrificed). You may be able
to do this more accurately for foods that you have eaten yourself.
Once the number of serves from each group has been estimated, they can be
compared with the recommendations for someone of Scott’s age (males, 14–18,
from table 3.4).
Table 3.10 Scott’s intake compared to the recommended intake
Vegetables Grain (cereal) foods Lean meats, poultry, Milk, yoghurt,

and per day, mostly fish, eggs, tofu, cheese and/or Unsaturated
legume/ wholegrain and/or high nuts and seeds, and alternatives, mostly spreads and Discretionary
beans Fruit cereal fibre varieties legumes/beans reduced fat oils foods
Males
5½ 2 7 2½ 3½ 2 ‘Limit intake’
14–18
Scott’s
4 7 11 2½ 6 4 3
intake
Although Scott’s diet is varied, he may be consuming too many of some food
groups. Some specific observations include:
• he ate adequate amounts from the meat group
• he consumed only 4 serves of vegetables and should be consuming 5½

• he consumed 7 serves of fruit and should be consuming 2 serves
• he consumed 11 serves from the grain group, which is 4 serves above the
recommended amount
• he consumed 6 serves of dairy foods instead of the recommended 3½ serves
• he consumed more unsaturated fats than recommended for someone his age
• he may be consuming too many ‘discretionary’ foods.
Some advice regarding Scott’s diet could include:
• ensure that the amount of foods from the meat group is not decreased
• increase the amount of vegetables consumed
• reduce the amount of fruit being consumed — even though fruit contains many
important nutrients, it also has a relatively high amount of natural sugar, which
adds to the total kilojoules
• drink water instead of fruit juice in the morning and with dinner
• replace soft drink with a glass of water
• replace the vanilla slice at lunch with carrot and celery sticks
• replace the discretionary food items with healthier alternatives.
The Healthy Living Pyramid

The Healthy Living Pyramid was developed by Nutrition Australia, a non-
government organisation.
The pyramid represents foods from the basic food groups and arranges them
into three levels, indicating the proportion of different types of food that should be
consumed (see figure 3.31). The Healthy Living Pyramid
promotes youth health and development by encouraging
food variety and a diet with minimal fat, adequate fibre,
limited salt and sufficient water, balanced with physical
activity.
The ‘move more’ section of the pyramid encourages
physical activity to expend the energy gained from food.
This reduces the risk of obesity and related conditions
including cardiovascular disease and type 2 diabetes.
The ‘eat most’ layer contains food of plant origin. These
foods should make up the majority of any meal. These
foods are nutrient dense and low in fat. They assist in
providing youth with optimal amounts of carbohydrates,
vitamins and minerals.
The ‘eat moderately’ layer in the middle of the pyramid
shows foods that should make up a third or less of any
meal. It contains food mainly of animal origin, including
fish, lean meat, eggs, chicken, milk, cheese and yoghurt.
These foods provide protein, minerals (particularly
calcium and iron) and B-group vitamins.
The ‘eat in small amounts’ layer contains foods that
should be present in only small amounts in a meal. They
are often processed and high in sugar and/or fat. These
foods are energy dense and do not contribute significant
amounts of nutrients to the diet. They can contribute to a
range of conditions including obesity and cardiovascular
disease.
The pyramid encourages individuals to drink water due
to the fact that it provides the best source of hydration
for the body, without adding extra sugar to the diet. Figure 3.31 The Healthy Living Pyramid
It also suggests that salt should not be added to food. © The Australian Nutrition Foundation Inc.

Salt is a rich source of sodium, and although sodium is an essential nutrient, many
Due to the release of the Australians consume excess amounts, which can contribute to hypertension.
Australian Dietary Guidelines
in 2013, the Healthy Living The Healthy Eating Pyramid for Lacto–ovo Vegetarians
Pyramid is being updated. To The Healthy Eating Pyramid for Lacto–ovo Vegetarians is similar to the Healthy
check the progress of this Living pyramid but contains only meat-free foods. The major difference between
update, check the Healthy these two pyramids is in the ‘eat moderately’ layer. This layer contains dairy
Living Pyramid products and tofu in the lacto–ovo vegetarian pyramid. Tofu contains relatively
weblink in your high levels of protein and iron, and is a good substitute for meat.
eBookPLUS. The Health Living Pyramid and Healthy Eating Pyramid for Lacto–ovo
Vegetarians provide youth with a simple visual tool that promotes healthy food
intake. However, serving sizes and provisions for composite foods, such as pizza or
casserole, are not included, which may make following the model difficult.
TEST your knowledge (c) i. Of which food groups did Dallas consume the
optimal amount?
1 Explain what is meant by a ‘food selection model’.
ii. Explain how consuming an optimal amount of
2 Identify two food selection models that can be used
these foods might promote Dallas’ health.
by youth to promote health and individual human
(d) i. Which food groups did Dallas not consume
development.
enough of?
ii. Explain how not consuming enough of these
APPLY your knowledge foods might affect Dallas’ health.
3 Explain the difference between the Australian Guide (e) i. Of which food groups did Dallas consume too
to Healthy Eating and the Healthy Living Pyramid. much?
4 (a) Identify the five food groups identified in the ii. Explain how consuming too much of these
Australian Guide to Healthy Eating. foods might affect Dallas’ health.
(b) Identify the key nutrients provided by each group. (f) Why might it be more accurate to assess food
(c) Explain how these nutrients can impact on youth intake over three days instead of only one?
health and development. (g) Explain the changes Dallas could make to her
5 Outline the short- and long-term consequences that diet to more closely reflect the recommendations
may occur for Scott if he continues consuming the of the Australian Guide to Healthy Eating and
foods shown in table 3.7 on a daily basis. the Australian Dietary Guidelines.
6 Consider the following food intake of Dallas, a 7 Record your own food and drink intake over a
13-year-old female. 24-hour period.
Breakfast: (a) Estimate the number of serves consumed from
2 pieces of toast with 10 g of monounsaturated each food group using a similar method to that
margarine outlined in table 3.8.
1 cup of orange juice (b) Prepare an analysis of your intake. Be sure to
Snack: include the following:
1 small carton of yoghurt (200 g) i. Identify food groups where intake was
3 tablespoons of sultanas adequate.
Lunch: ii. Identify food groups where consumption was
A toasted sandwich (2 pieces of bread, 2 slices of deficient.
cheese, 10 g of monounsaturated margarine) iii. Identify food groups where consumption was
1 can of soft drink excessive.
Snack: iv. Discuss the possible short- and long-term
1 banana consequences of your diet if it continued over
1 glass of water time.
Dinner: v. Suggest changes that could be made to
½ cup of cooked rice with 65 g of cooked beef, minimise the risk of any short- or long-term
1 cup of cooked vegetables and 7 g of olive oil consequences identified in part iv.
1 cup of fruit salad (c) i. Discuss any difficulties you had in classifying
(a) Complete a table similar to table 3.8 for Dallas’ each food item.
food intake. ii. Explain how these challenges could be
(b) Compare Dallas’ intake to the guidelines given overcome.
in tables 3.4 to 3.6.

1.1 Understanding
KEY SKILLS health
Nutrition during youth
KEY SKILL Explain the functions of major nutrients for the

production of hard tissue, soft tissue, blood tissue and
energy during youth
This key skill requires knowledge of the nutrients needed to carry out different
functions in the body, namely the development of hard and soft tissue, blood
production and the provision of energy. As well as knowing which nutrients are
required for these processes, knowledge of the role each one plays is essential.
Visual tools such as concept maps, flow charts and equation diagrams can be used
to consolidate this information. The following example relates to the production of
energy:
Iron — forms Water —

Carbohydrates, B-group a part of transports the B-
fats and vitamins — haemoglobin, group vitamins and
protein — + allow the + essential for + is also required for
= Energy
production
provide the release of carrying oxygen chemical reactions
fuel for energy energy around to take place
the body
Figure 3.32 How energy is produced in the body
In the following example, the nutrients required to produce bone (a hard tissue)
and the role each plays are outlined:
Protein❶: the main building material for hard tissue. Protein binds with vitamin C
❶ The nutrient is named.
to produce the collagen matrix, the outline for hard tissues.❷
Vitamin C: binds with protein to form the collagen matrix.
Vitamin A: assists in the division of the new cells needed by both the collagen ❷ The function of the nutrient
matrix and the hardening materials. is outlined and its role in the
Calcium and phosphorus: bind together to form calcium phosphate, the hard development of hard tissue is
identified.
ening material for bones.
Vitamin D: assists in the absorption of calcium in the small intestine. A lack of
❸ The roles of a range of nutrients
this vitamin can result in weak bones.❸ required for hard tissue development
are discussed.

1 Devise a summary diagram outlining the roles of the major nutrients required for
soft tissue production.
2 Discuss the roles of the nutrients required for blood production.
KEY SKILL Explain the possible consequences of nutritional

imbalance in a youth’s diet on short- and long-term health
and individual human development
Each nutrient has a role to play in the body, but both under- and over-consumption
of nutrients can contribute to a range of short- and long-term consequences for
youth. It is important to understand the effect that too little, or too much, of
each nutrient can have on the body. By understanding the role of the nutrients,
predictions can be made about the likely consequences on health and development.
Most of the short-term effects will be on physical health and development; it will
then be possible to predict the potential impact of these effects on the other areas
of health and development. For example, insufficient carbohydrates (which are a

Key skills Nutrition during youth
fuel for energy) could make an individual feel tired (physical health). Feeling tired
can have other implications for health and development, such as not wanting to
go to school (intellectual development and social health could be affected by this).
Long-term consequences can occur in all areas of health and development, as
a result of nutritional imbalance over an extended period of time. The role the
nutrients play in these consequences must be understood. A summary table can
be useful for brainstorming the possible short- and long-term consequences of
nutrient imbalance.
Possible short- and long-term
consequences of under- Possible short- and long-term
Nutrient consumption consequences of over-consumption
Consider the following example, which discusses the possible short- and long-
term consequences on the health and development of youth who consume a diet
high in fibre.
Fibre assists in the removal of waste products in the digestive tract and promotes
regular bowel movements. In the short term❹, this can prevent constipation
❹ Short-term consequences are
addressed. (physical health). If an individual is not constipated, they may be able to concentrate
better at school, which can enhance intellectual development.❺
❺ Possible consequences for Fibre is made up of the indigestible parts of plant matter. As a result, fibre
development are included. provides feelings of fullness without adding excess kilojoules. In the short term,
this can prevent overeating. In the long term❻, this can assist with weight
❻ Long-term consequences are also management and prevent the risk of overweight and obesity. Decreased risk of
included.
obesity can enhance self-esteem (mental health). Individuals of optimal body
❼ Consequences on different areas weight may be more able to exercise and promote fitness (physical health) and
of health and development are motor skill development (physical development). Fibre has also been shown to
explored. decrease the risk of colorectal cancer in the long term (physical health).❼

3 Explain the possible short-term consequences of a high-GI diet on youth health
and development.
4 Explain the possible long-term consequences of a low-GI diet on youth health and
development.
5 Explain the possible short- and long-term consequences on health and
development for a youth consuming low levels of iron.
KEY SKILL Explain how food models can be used as a tool

to promote health
In order to become proficient in this skill, knowledge of different food selection
models is necessary. The Australian Guide to Healthy Eating and the Healthy
Living Pyramid are two food selection models that can be used by youth as tools
to promote health. Understanding how they can be used is an important aspect of
this skill. Using these tools to analyse and plan food intake can assist in developing
a deeper understanding of each model.
A typical scenario in which food selection models could be used to assist in
promoting the health of youth is explored in the following case study. ‘Simon is a
16 year old who enjoys playing football. He recently made the representative side
in his region and is now committed to training three nights a week and playing
every Sunday. He also trains in the gym at school twice a week. He has been
purchasing his lunch from the school canteen most days of the week and buys food

from takeaway outlets on his way home from football training. Simon is unsure
whether he is consuming all the foods he should be to provide the nutrients he
needs to maintain optimal health and development’. To discuss a possible solution
to Simon’s eating challenges, one approach might be to identify a food selection
model, describe it, and then discuss how it could be used to assist Simon in
consuming a healthy food intake.
An initiative established to promote healthy eating is the Australian Guide to
Healthy Eating.❽ The Australian Guide to Healthy Eating is a food selection model
❽ The initiative is identified.
devised by the Federal Government. It is comprised of a poster that breaks the five
food groups into the proportions in which they should be consumed on a daily
basis.
The largest section of the graph, and therefore the food group that should be
consumed in the greatest proportion, is the grain group. This includes food items
such as cereals, breads and rice. Around a third of all foods should come from this
group.
The next section is the vegetables and legumes/beans group. Around a third of
all foods should come from this group.
The third group is the lean meats and poultry, fish and eggs. Around one-seventh
of all foods should come from this group.
The fruit group and dairy products such as milk, yoghurt and cheese are the
final two food groups. Each of these should account for around one-eighth of all
foods consumed.
The guide recommends drinking plenty of water, using only small amounts of
healthy fats such as canola and olive oils, and limiting discretionary foods such as
those containing alcohol or high levels of saturated fat, salt and/or sugar.❾
❾ The food selection model is explained
The Australian Guide to Healthy Eating can assist Simon in adopting a healthy in greater detail.
diet, but some of his circumstances may reduce his ability to follow it closely. The
guide is in graphical form, which might make it easier for Simon to understand it
and make changes to his diet.❿ The Australian Guide to Healthy Eating does not
❿ Key aspects of the Australian Guide
include serving sizes, which might make it hard for Simon to consume adequate to Healthy Eating are included. It is
amounts from each food group.⓫ He would have to consult the Australian Dietary important to avoid being too general
Guidelines to access this information. As Simon purchases a lot of his foods, he and to provide examples specific to
Simon where possible.
will have to learn to break composite foods down into their parts so he can classify
them into one of the five food groups. He may be able to do this by keeping a food ⓫ Aspects of the model that may limit
diary of all the food and drink he consumes. He can then take some time to practise Simon’s ability to follow it are also
breaking these items down to their primary components. If Simon gains an discussed.
understanding of the components of different items available from the canteen and
takeaway outlets, he may be able to choose foods that more closely reflect the ⓬ Ways of increasing Simon’s
understanding of the model and so
proportions outlined in the guide.⓬ improve his diet.

6 Identify two similarities between the Australian Guide to Healthy Eating and the
Healthy Living Pyramid.
7 Obesity rates among youth in Australia have been steadily increasing over the
past 20 years. Explain how the Healthy Living Pyramid could be used to assist
individuals in reducing their energy intake.
8 Jackie is 14 and has just become a vegetarian. Identify one food selection model
and explain how it could assist Jackie in consuming foods that will provide her
with the nutrients she needs to maintain optimal health and human development.

CHAPTER 3 review
Chapter summary
• There are six categories of nutrients required for optimal health and individual human
development; carbohydrates, protein, fats, water, vitamins and minerals.
• Youth require a balance of the six categories of nutrients in order to maintain optimal
Interactivities: health and individual human development.
Chapter 3 crossword
• The main function of carbohydrates is as an energy source.
• Fibre is a type of carbohydrate that is indigestible. It has numerous health benefits, such
Chapter 3 definitions as reducing hunger, and decreasing cholesterol and glucose absorption. This can assist
Searchlight ID: int-2896 in weight maintenance. Fibre also acts to clean the digestive system and reduce the
chance of colorectal cancer later in life.
• Protein is required for the growth, maintenance and repair of body cells and structures.
It can also be used as an energy source.
• The main function of fats is as a fuel for energy production. They are also a key
component of cell membranes.
• Monounsaturated and polyunsaturated fats are a better choice than saturated and trans
fats because the latter contribute to high levels of LDL cholesterol.
• Water is required for many body processes, including functioning as a medium
for all chemical reactions in the body and forming an important part of blood and
soft tissues.
• Calcium is an important component of hard tissues and is required to achieve optimal
peak bone mass.
• Iron is required for haemoglobin in blood and a deficiency can lead to anaemia.
• Vitamin A is required for cell division and cell differentiation.
• Vitamin D is required in order for calcium to be absorbed in the small intestine and
therefore assists in building hard tissue.
• Vitamin C is required for collagen production and assists with the absorption
of iron.
• The B-group vitamins are required to release energy from carbohydrate, protein
and fat.
• The key nutrients interact to produce energy, blood, hard tissue and soft tissue.
• If energy intake and expenditure are not roughly the same, weight gain or loss will
result.
• Nutrient imbalance can result in a range of short- and long-term consequences for
youth.
• Short-term consequences include lack of energy, a spike in blood glucose levels,
overeating and constipation.
• Long-term consequences include dental caries, periodontitis, overweight and obesity,
type 2 diabetes, cardiovascular disease, sleep apnoea, arthritis, osteoporosis, colorectal
cancer, anaemia and increased risk of infection.
• The short- and long-term consequences can impact on all areas of the health and
development of the individual.
• Food selection models can be used as tools to assist youth in preventing nutritional
imbalance.
• The Australian Guide to Healthy Eating presents the five food groups in the proportions
in which they should be consumed.
• The Healthy Living Pyramid contains three layers relating to the foods that individuals
should ‘consume most’, ‘consume moderately’, and ‘eat in small amounts’.

TEST your knowledge (the nutrient can be written above their head if they
sit with their back to the whiteboard) but are not
1 What is the difference between macronutrients and
told which nutrient they have. They then take turns
micronutrients?
at asking questions. Each time the answer to the
2 Draw up a table similar to the one below and
question is ‘no’, they lose their turn and the next
complete it for each key nutrient.
player asks a question. Play continues until a correct
Nutrient Function/s Food sources guess is made. Incorrect guesses are counted as a
‘no’ and the player loses their turn.
6 (a) Conduct a survey of current nutritional intake
APPLY your knowledge and trends in your school.
3 Prepare a booklet that outlines the considerations (b) Collate the results and comment on the
for youth food intake, with a focus on providing the nutritional adequacy of the sample group’s diet.
nutrients required for the production of hard tissue, (c) What are the possible short- and long-term
soft tissue, energy and blood. consequences if these trends continue?
4 Comment on the likely short- and long-term (d) Use a food selection model to suggest changes
consequences that may occur if youth consume too that the students could make to improve their
much/too little of the key nutrients. diet.
5 Play a game of ‘nutrient celebrity head’. Three
players are selected and assigned a nutrient each

CHAPTER 4
The determinants of health and

of Australia’s youth
The youth stage of the lifespan is one of great change. In
general, the health and individual human development of
Australia’s youth is good although there are some areas that
could be improved. Understanding the factors that influence
health and development during this stage is vital for ensuring
that young people live the fullest lives possible and achieve
optimal individual human development.
Key Knowledge
2.4 determinants of the health and individual human development of
Australia’s youth (pages 112–14), including at least one from each of
the following:
–– behavioural, such as sun protection, level of physical activity, food
intake, substance use, sexual practices, skills in developing and
maintaining friendships and seeking help from health professionals
(pages 115–23)
–– physical environment, such as tobacco smoke in the home, housing
environment, work environment, access to recreational facilities
(pages 124–7)
–– social environment: family and community, such as family cohesion,
socioeconomic status of parents, media, community and civic
participation (sport, recreation, arts and faith-based activities) and
access to education (pages 128–33).
Key Skill
• explain the determinants of health and individual human development
and analyse their impact on youth using relevant examples.
FIGURE 4.1 The youth stage of the

lifespan is one of vast change.

atherosclerosis the build-up of plaque on blood vessel
walls, making it harder for blood to get through
behavioural determinants the actions or patterns of
living of an individual or group that affect health (e.g.
smoking, sexual activity, participation in physical activity,
eating practices)
determinants of health factors that raise or lower the
level of health in a population or individual. Determinants
of health help to explain or predict trends in health and
why some groups have better or worse health than others
(AIHW, 2006). Determinants can be classified in many
ways such as biological, behavioural and those relating to
the physical and social environment.
family cohesion the closeness or bonds between family
members
metastasise when cancer cells spread from the primary
site to other areas of the body
physical environment the physical surroundings in
which we live, work and play. The physical environment
includes water and air, workplaces, housing, roads,
nature, schools, recreation settings and exposure to
hazards.
resilience refers to an individual’s ability to face and cope
with stressful and difficult situations, and to recover after
misfortune
sedentary undertaking no or very low levels of physical
activity
sexually transmissible infections (STIs) a range of
conditions that are generally transmitted sexually from
one person to another
skin cancer uncontrolled cell growth in one of the layers
of the skin
social determinants aspects of society and the social
environment that impact on health, such as poverty, early
life experiences, social networks and support
socioeconomic status (SES) a measure of an individual’s
or family’s economic and social position within society
relative to others, usually based on education, occupation
and income
Australia’s youth: H & IHD determinants • CHAPTER 4 111

4.1 eterminants of health and individual human
D
development during youth: four categories
KEY CONCEPT Understanding the determinants of the health and

development of Australia’s youth
There are many factors that influence the health and individual human development
of youth. These factors act together to determine health and development and
hence are termed the ‘determinants of health and development’, sometimes
shortened to the ‘ determinants of health’.
There are four determinants
of health and individual human
development (see figure 4.2)
Behavioural Physical
determinants environment
Biological determinants have a
significant impact on the health
and development of youth and
were explored in detail in chapters
1 and 2. In this section, we will
Biological Social
explore three other determinants
determinants environment that relate to the decisions young
people make and the physical
and social environments in which
they live.
The three determinants to be
Determinants explored in this chapter are:
of health and
development
• behavioural determinants
• physical environment
• social environment.
Figure 4.2 All four categories of the

determinants of health combine to
produce an individual’s health status Behavioural determinants
and development.
Behavioural determinants focus on the decisions people make and how they choose
to lead their lives. Nutrition and food intake is a significant behavioural factor and
was explored in detail in chapter 3. Other examples of behavioural determinants
include using sun protection, participating in physical activity, the use of various
substances, skills in developing and maintaining friendships and seeking help from
health professionals.
Physical environment
The physical environment encompasses the physical things that make up the
environment such as air and water, and available facilities such as housing,
recreation and health care. Aspects of the physical environment can directly impact
on health by affecting the body’s systems. Air and water quality can make people
sick or promote good health (figure 4.3). Unhygienic or unsafe housing can spread
disease and contribute to injuries. Mental health can be compromised if individuals
do not have their own space within their physical environment. Social health
is influenced by those who share the physical environment with an individual.
For example, those who share a house, go to the same school or work with the
individual, will impact on the person’s social health by providing opportunities for
interaction and the formation of relationships.
Figure 4.3 Environmental Individual human development can also be affected by the physical environment.
pollution is an aspect of the physical The opportunities provided for physical activity in the environment, for example,
environment that affects health. will influence motor skill development and social development.

Case study
Fit dads mean healthy kids:

study
By Vikki Campion
Dads have the power to influence the health and fitness
of the whole family.
University of Newcastle academics have found
children copy their father’s diets and exercise regimes
and will now trial a world-first study — Healthy
Dads, Healthy Kids — funded by the Hunter Medical
Research Institute.
The six-month study follows evidence that children
mimic their fathers over their mothers when it comes to
healthy eating and exercise.
Associate Professor Philip Morgan, who heads the
new program, saw astounding results in a previous trial
involving 165 overweight children.
He found children who lost the most weight had
fathers who were engaged in the new eating and
exercise plan.
In a separate trial involving 65 men in an online
weight loss program, he found the children of men
involved — and even their wives — also shed kilos.
‘Mum can purchase and prepare the food but dads
will often have less greens, or just meat and potato. The Figure 4.4 Fathers are important role models for
kids think “mum makes me eat this” and she is painted their children.
as the bad guy,’ Professor Morgan said.
‘Fathers influence the food and physical activity change, they sleep better, and have much more fun
habits in the home through their behaviours, attitudes together.’
and approach to food and eating, and act as a role Dad Steve Tingey said he hoped his two daughters
model to their children.’ Nikita, 2, and Caitlin, 4, would use him as a role model.
Professor Morgan said mothers, as primary care ‘I enjoy fatherhood very much; apart from my wife
givers, were easier to inform but when fathers make they are my two best friends. I hope they still use me as
changes the whole family becomes healthier. a guide as they grow up,’ he said.
‘We have seen striking results,’ he said. ‘These dads ‘We eat together, kick a soccer ball around together,
are still allowed to have a beer and enjoy things in play wrestle, tickle, and watch TV together. It’s no
moderation. It was subtle changes to their nutritional surprise that they take that in.’
habits that made the difference. They see their lives Source: Daily Telegraph, 18 August 2008.
Case study review

1 Make a list of the ways in which the family as a social determinant influences
health and individual human development.
2 (a) Discuss the differences between the influence of fathers and mothers
highlighted in this story.
(b) What reasons were provided to explain this?
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 113
4.1 Determinants of health and individual human development during youth: four categories
Social environment
The social environment refers to the ‘social situation’ in which people live. This
includes the people with whom an individual associates, the decisions that are
made on behalf of the community (e.g. policies and laws), and the position of
an individual compared to others in the society (based on factors including
income and occupation). These factors influence the opportunities available to an
individual and are related to the level of health and individual human development
experienced by that person.
The family provides an important part of our social environment. For young
people especially, the family is generally the main social contact and provider of
many resources such as shelter, food, clothing, emotional support and educational
eBook plus opportunities. Family cohesion and the socioeconomic status (SES) of parents are
examples of social factors that are influenced by the family.
Interactivity: Most individuals live in a community. The quality of the relationships within
Time Out: ‘Determinants the community and the services available in the community can affect health and
of health’ development. Examples of social factors influenced by the community include
Searchlight ID: int-1422 media, access to resources which enable community participation in areas such as
sport, recreation, arts and faith-based activities, and access to education.
TEST your knowledge (b) Justify your choices and discuss your responses
with other students.
1 (a) Explain the three determinants of health and
3 (a) Make a list of the determinants that have an
development addressed in this section.
impact on your health and development.
(b) Give one example for each.
(b) Rank them in order from ‘most influential’ to
‘least influential’.
(c) Discuss your list in small groups.
2 (a) Which group of determinants do you think 4 ‘The social environment often leads to the health
would have the greatest impact on the health behaviours that people engage in’. Write a response
and development of: (either agreeing or disagreeing) to this statement
i. a five-month-old baby in Sydney? using examples to support your point of view.
ii. a 16-year-old mother in Ethiopia?
iii. a 45-year-old unemployed person in
Melbourne?
iv. a 70-year-old retired grandparent in remote
Western Australia?

D
development during youth: behavioural
KEY CONCEPT Understanding the behavioural determinants of the health

and development of Australia’s youth
Behavioural determinants eBook plus
During childhood, a lot of the health behaviours that people engage in are based
on the decisions made for them either by law and policy makers, or by their family. eLesson:
As individuals enter the youth stage, they start to take more responsibility for the The dangers of a deadly tan
choices they make. The choices made during this stage can have short- and long- Searchlight ID: eles-0222
term consequences for the individual.
Sun protection
Australia’s climate is among the harshest in the world
and skin cancer is the most commonly diagnosed cancer.
Sunburn is one of the biggest risk factors for skin cancer
(figure 4.5). Skin cancers can be categorised into two
groups: melanoma and non-melanoma skin cancers.
Non-melanoma skin cancers are the most commonly
diagnosed skin cancers and comprise approximately
95 per cent of all skin cancers. Such cancers are generally
easily removed but can lead to complications if left
undiagnosed and untreated for extended periods of time.
Melanoma skin cancer, on the other hand, is an aggressive
form of skin cancer that can metastasise and cause death
if not treated.
The amount of UV radiation that a person is exposed to
during childhood and youth is one of the most detrimental
risk factors for skin cancer. People with fair skin that burns
easily, those with freckles and/or moles and those with a Figure 4.5 Sunburn should be avoided because it is one of the
biggest risk factors for skin cancer.
family history of skin cancer are also at an increased risk.
Although skin cancer becomes more common in later life,
young people are still at great risk. In fact, according to the Australian Institute of
Health and Welfare in 2011, skin cancer was the most commonly diagnosed cancer
among people aged 12–24, accounting for around 30 per cent of all newly
diagnosed cancers. A key reason for this is that youths are less likely to engage in
sun protection behaviours than adults (table 4.1).
Table 4.1 Sun protection behaviours during peak UV periods among young people aged
12–24 years, 2003–04 and 2006–07 (per cent)
2003–04 2006–07
Sun protection behaviours 12–17 years 18–24 years 12–17 years 18–24 years
Head wear (hat, cap or visor) 38 37 29 33
15+ sunscreen 37 36 37 33
3/4 length or long top 11 11 9 12
3/4 length or long leg-cover 37 37 30 37
Stayed mostly in the shade 19 26 20 22
Wore sunglasses 23 52 24 47
Figure 4.6 Surgery is commonly
Sunburnt 25 22 24 19 required to remove skin cancer, and
it often causes scarring because the
Note: Multiple responses were permitted therefore the total responses exceed 100 per cent.
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. surrounding tissue is usually removed
PHE 140, Canberra, p. 72. as well.
4.2 Determinants of health and individual human development during youth: behavioural
While overexposure to UV rays can cause skin cancer, insufficient exposure can
also be detrimental. Exposure to UV rays triggers the production of vitamin D in
the skin. This nutrient is required to assist in the absorption of calcium, which
is turn is needed for the development of bones. Lack of UV exposure can lead
to a deficiency in vitamin D and therefore a lower than optimal bone mass. This
increases the chances of fractures and osteoporosis in later life. However, a lack of
sun exposure is not a significant problem for youth in Australia.
Physical activity
According to a study carried out by the Cancer Council and the National Heart
Foundation of Australia in 2009–10, 15.4 per cent of those in secondary school
years 8 to 11 participated in levels of physical activity recommended by the
national guidelines to obtain a health benefit (table 4.2). However, many young
people were sedentary.
Physical activity is an important part of a healthy, balanced lifestyle. Patterns
established in youth can carry through to adulthood and increase the likelihood
of maintaining an ideal weight. Other short- and long-term benefits of physical
activity include the prevention of:
• cardiovascular disease — being obese is a risk factor for cardiovascular disease.
Exercise can assist in maintaining an optimal body weight and maintaining
cardiovascular health.
• high blood pressure — overweight and obesity are risk factors for high blood
pressure. Maintaining a healthy body weight through exercise can help to reduce
this risk.
• some forms of cancer — exercise can enhance immune function and improve
the body’s response to cancerous growths.
Table 4.2 Proportion of students meeting physical activity recommendations over the past
week by sex and year level
Males Females All
Total 21.8% 8.3%* 15.4%
Year Level
8 24.1% 10.4% 17.6%

9 22.1% 9.5% 16.3%
10 22.0% 7.1% 15.0%
11 18.7% 5.9% 12.6%*
* Significant difference at p<0.01

Source: Cancer Council Victoria 2011, ‘Prevalence of Meeting Physical Activity Recommendations in Australian
Secondary Students’, National Secondary Students’ Diet and Activity (NaSSDA) survey 2009–10.
Many forms of physical activity (e.g. tennis, golf and soccer) promote social
interaction, which is an aspect of social health. Youth may also be exposed to
different social groups and learn different social skills, which is an area of social
development.
Physical activity can have a positive impact on mental health. Exercise has been
shown to relieve stress and anxiety. As well as providing an outlet for excess energy,
physical activity releases hormones in the body that can promote feelings of well-
being and therefore positive mental health.
Physical activity can also affect individual human development:
• Exercise (particularly weight-bearing exercise) assists in strengthening bones and
increasing bone density, which promotes physical development.

• Individuals participating in physical activity may learn new games and strategies
associated with different sports, promoting intellectual development.
• Concepts such as sharing and taking turns can be reinforced by cooperative
exercises such as team sports, which promote social development.
Substance use
Youth is often a stage of the lifespan where people experiment with different push
over? substances. The reasons for this are related to youths experimenting with Table 4.3 Mean age of initiation of
aspects of their identity and to the brain development that makes youths more lifetime drug use, Australia, 2010
likely to take risks. Some of substances most commonly experimented with by
Substance Age first tried
youth are summarised in tables 4.3 and 4.4.
Many of these substances can lead to health issues in the short and long term. Tobacco 16
Effects could include hospitalisation, accidents, conflict with friends and family, Alcohol 17
financial difficulties, legal issues, organ damage, mental illness and various forms Illicits
of cancer. Marijuana 18.5
Drug use Painkillers/analgesics 21.8

Steroids 22.9
According to the Australian Institute of Health and Welfare in 2008, illicit drug use
includes: Meth/amphetamine 20.9
• using illegal drugs Cocaine 23.3
• using substances as inhalants (e.g. glue and petrol) Hallucinogens 19.8
• using prescription medicine for non-medical purposes. Inhalants 19.5
Illicit drug use during youth has been linked to many physical health problems, Ecstasy 22.2
such as:
Heroin 21.4
Table 4.4 Recent use of illicit drugs (last 12 months): proportion of the population aged Source: Adapted from Australian Institute
12 years or older, 2007 of Health and Welfare 2010, 2010 National
drug strategy household survey: first results,
Age group Canberra.
Substance 12–15 16–17 18–19 12–19
Marijuana 2.7 15 19 9.9
Painkillers/analgesics 1.1 2.5 2.4 1.8
Steroids 0 0 0.4 0.2
Heroin 0 0.2 0.7 0.2
Meth/amphetamine 0.4 1 2.9 1.2
Cocaine 0.2 1 2 0.8
Hallucinogens 0.1 0.7 2.8 0.9
Inhalants 0.6 1.2 1.0 0.8
Ecstasy 0.5 4.9 9.1 3.8
Source: Adapted from Australian Institute of Health and Welfare 2008, 2007 National drug strategy household
survey: first results, Drug Statistics Series number 20, cat. no. PHE 98, Canberra, p. 27.
• blood-borne diseases (when injected) — needles can transfer diseases from one
person to another. Hepatitis C and HIV are two diseases that can be spread by
sharing needles.
• violence — the behaviour of people using drugs can be altered. This can make
them more prone to violent acts that can result in physical injuries.
• malnutrition — adequate food intake is often not a priority to those suffering
from a drug addiction. Drug use may also interfere with appetite and further
contribute to malnutrition. In addition, some substances can affect the retention
of different chemicals in the body. For instance, some painkillers can reduce the
retention of vitamins and minerals. All these can weaken the immune system
eBook plus
and make youth more susceptible to infection and disease.
• cardiovascular disease — some illicit substances can significantly increase heart
eLesson: rate and blood pressure, which can contribute to cardiovascular disease in youth
Ice addiction
• certain cancers — the risk of most cancers is increased when substances are
Searchlight ID: eles-0223
smoked
• drug overdose resulting in disability/death — body systems can shut down if the
body has an adverse reaction to the substance.
As well as the effects on physical health, substance use can have an impact on
the social and mental health of youths. For example, the risk of developing mental
illnesses is higher for drug users. Many illicit drugs can cause hallucinations and
an altered perception of reality, and can change the chemical make-up of the brain.
The chemical changes occurring in the brain can act as a trigger for a range of
mental illnesses such as depression, anxiety and psychosis. If drug use leads to
mental illness, the risk of suicide may also be increased.
If an individual experiments with drugs, the effects can extend to their circle of
friends. Some friends might disapprove and distance themselves. If other friends
Figure 4.7 Experimental drug use are similarly experimenting with drugs, the individual might spend more time with
can lead to a range of other health this group of people. Either way, drug use will generally affect social health.
issues.
Long-term substance use can have a range of effects on individual human
development. The person may not be able to hold down a job or participate in
full-time study. This can affect social development, as they do not learn the social
skills associated with full-time employment or tertiary education. The individual
might also find it hard to maintain a relationship in which valuable social skills
such as communication and sharing are further developed. It can also have an
impact on intellectual development, as the knowledge that could have been gained
may never be learned. Drug use can leave people with insufficient money to pay
for social experiences such as holidays or to attend gatherings such as weddings,
which could further impact on social development.
Because the mental health of an individual might be affected by substance use,
emotional development does not have a secure foundation on which to build. If a
person is using drugs to escape their problems, they will not get the opportunity to
deal with their issues and mature emotionally.
According to the Australian Institute of Health and Welfare, many factors can
put young people at risk of drug use. They include:
• maternal drug use during pregnancy
• early behavioural problems
25
• emotional problems and early exposure to drugs
Males
• peer antisocial behaviour
20 Females
• poor parental control and supervision
• poor family bonding
15 • drug use among family members
Per cent
• poor connection with family, school and community

10 • academic failure
• low self-esteem
5 • leaving school early.
0 Tobacco
1998 2001 2004 2007 The percentage of young Australians who smoke has decreased
Year significantly over the past decade (figure 4.8), although around
13 per cent continue to smoke. Tobacco has many effects on youth
Figure 4.8 Daily smoking rates among young people health in the short and long term. In the short term, tobacco smoking
aged 14–24 years, by sex, 1998–2007
Source: Australian Institute of Health and Welfare 2011, Young Australians:
increases heart rate and blood pressure. The immune system can also
their health and wellbeing 2011, cat. no. PHE 140, Canberra, p. 75. be adversely affected, increasing the risk of developing an infection.
118
Smoking is less acceptable than it was in the past, and laws have been passed
that prohibit smoking in many public spaces. This means that youths must leave
venues to smoke. Continually leaving a social activity to smoke could affect social
experiences for young people. The financial costs associated with tobacco smoking
could leave less money available for other activities such as socialising with friends.
People with depressive symptoms are more likely to smoke, although it is not clear
if smoking contributes to depression or vice versa. There is also evidence that tobacco
use has a relationship with the use of other drugs such as alcohol and marijuana.
The longer a youth smokes, the more likely they are to develop long-term
conditions including:
• cardiovascular disease — tobacco smoking increases the rate of atherosclerosis
in the body and therefore increases the risk of cardiovascular disease
• many forms of cancer — tobacco smoke can facilitate the development of
cancerous cells in many parts of the body, including the lungs and breasts
• respiratory conditions such as emphysema.
As fitness levels decrease, the young smoker may be less inclined to participate
in sporting activities. This could affect all areas of development including
motor skills and social development. It could also make the youth less likely to
participate in sporting activities in later life, which could lead to an increased risk
of cardiovascular disease and cancers.
Alcohol use
Alcohol is the most common social drug used in Australia. Table 4.5 shows the rate
of alcohol consumption across age groups.
Table 4.5 Alcohol consumption of people aged 12 years or older at risk of short-term harm,
by age and sex, 2010 (per cent)
Drinking status 12–15 16–17 18–19 14–19

Males
Risky(a) — at least weekly 0.4 4.3 22.9 9.5
Risky — at least monthly(b) 1.9 15.7 23.0 14.4
Risky — at least yearly(c) 1.4 14.3 13.7 10.4
Low risk 17.6 35.0 27.9 30.3
Abstainer(d) 78.7 30.7 12.5 35.4
Females
Risky — at least weekly 0.4 5.6 11.5 6.1
Risky — at least monthly 5.6 17.5 34.4 20.9
Risky — at least yearly 3.9 11.7 9.8 9.5
Low risk 14.5 32.5 29.4 28.1
Abstainer 75.6 32.5 14.9 35.4
(a) For males, the consumption of 7 or more standard drinks on any one day. For females, the consumption of 5 or
more standard drinks on any one day.
(b) At least monthly but not as often as weekly
(c) At least yearly but not as often as monthly
(d) Has not consumed alcohol in the past 12 months
survey: supplementary tables.
In moderation, alcohol poses minimal risks to health. Excessive alcohol intake,

however, puts individuals at an elevated risk of many causes of morbidity and
mortality. Experimentation with alcohol often starts during youth (figure 4.9) when
the individual may not have the knowledge, experience or supervision to moderate
their drinking. As a result, binge drinking is the major concern associated with Figure 4.9 Many youths experiment
alcohol consumption by youth. Binge drinking results in many hospitalisations with alcohol.
and other short-term effects on youth health each year. In fact, according to the
Australian Institute of Health and Welfare’s 2010 National drug strategy household
survey, youths often experience one or more negative short-term effects associated
with binge drinking. Examples of these include:
• violence
• accidents such as drowning
• unsafe sexual practices
• unconsciousness
• vomiting.
Excessive alcohol consumption may begin in youth and continue into adulthood.
The long-term effects associated with alcohol consumption include:
• cardiovascular diseases
• type 2 diabetes
• certain types of cancer
• mental illness.
Youth might socialise with other young people who drink and, while under the
influence of alcohol, could behave in a way they regret. Their mental health may
suffer as a result of feelings of regret and guilt.
The individual human development of youth can also be significantly affected
by alcohol consumption. Alcohol can reduce the absorption of nutrients, which
can contribute to malnutrition. If the essential nutrients required for physical
development are not present, then body systems such as the skeletal and muscular
system may not develop optimally.
Socialising regularly under the influence of alcohol could prevent the individual
from developing social skills while sober, and they might begin to rely on alcohol
to make friends or socialise effectively. Their self-concept could be affected by
alcohol consumption, especially if they had negative experiences while drinking.
Excessive alcohol consumption can lead to lethargy (tiredness), which can
reduce concentration levels and ultimately performance at school, which can affect
intellectual development. Alcohol can also affect brain function and therefore
Sexual practices
Sexual development is a significant milestone occurring in the youth stage of the
lifespan. Some people start experimenting with sexual behaviour at this point in
their lives (figure 4.10). Being involved in a sexual relationship may affect the
people that an individual associates with, especially if their friends are not sexually
active. The person may attach feelings of love to the sexual relationship, which
can impact on mental health and emotional development. It may also increase the
feelings of sadness and loss should the relationship end.
70
Males
60 Females
Persons
50
Per cent
40
30
20
Figure 4.10 Proportion of students
in years 10 and 12 who have ever had 10
sexual intercourse, 2002 and 2008
0
Source: Australian Institute of Health and Welfare
2011, Young Australians: their health and wellbeing
Year 10 Year 12 Year 10 Year 12
2011, cat. no. PHE 140, Canberra, p. 81. 2002 2008

The sexual practices that young people undertake can have long-term
consequences. Teenage pregnancy and sexually transmissible infections (STIs) are
two examples. The more sexual activity that a person engages in, the greater their
chance of contracting an STI or conceiving a baby.
STIs are passed from one person to another through sexual contact. This
includes oral, genital and anal sex. The rates of many STIs increased between
2000 and 2005, the latest data available at the time of writing. This includes HIV/
AIDS, chlamydia and gonorrhoea. According to the Australian Institute of Health
and Welfare in 2007, half of all STI notifications in 2005 were for people aged
12–24 years.
STIs have a range of effects on health. Diseases such as HIV and herpes have no
cure and stay in the body for life. Although treatments are available for HIV, the
virus slowly destroys the immune system and can lead to an increase in infections
such as pneumonia and to premature death. Genital herpes is the same virus that
causes cold sores and can cause recurrent blisters on or around the genitals.
All STIs can have long-term consequences ranging from fever and infertility to
death, but (other than HIV and herpes) they can be cured with antibiotics or other
medication. Some STIs have few or no symptoms in some people, so they can go
undiagnosed for a long period of time, increasing the impact of the infection on
the person.
Social health could be affected by a person contracting an STI. If it is contracted
within a relationship, the relationship could break down.
STIs can affect mental health by contributing to stress and anxiety. The individual
might feel embarrassed and uncomfortable about having to discuss sexual issues
with their doctor and then inform previous sexual partners. They could also feel
anxious about their condition and may experience feelings of denial.
The impact of contracting an STI on individual human development would
depend on the type of STI contracted, the amount of time the person suffers from
it and the personality of the individual concerned. Self-esteem could suffer from
contracting an STI, but the person could also learn to deal with the emotions they
experience as a result of the STI (e.g. anger, fear, remorse) or develop assertiveness
by confronting the person who infected them.
Skills in developing and maintaining friendships

As already discussed, the peer group is increasingly influential during youth. Young
people rely on each other more heavily as they move through this stage of the
lifespan.
The skills required for developing and maintaining friendships begin to develop
early in the lifespan and are refined further during youth. Common skills required
to develop and maintain meaningful friendships include:
• Being trustworthy — being able to keep secrets and maintaining trust
• Accepting other’s mistakes — not judging people based on past mistakes
promotes acceptance
• Sharing and compromising — sharing possessions, ideas, goals, space and
interests promotes deep friendships. Compromising is essential in order to
maintain friendships.
• Listening — active listening is important in maintaining adequate levels of
communication.
• Commitment — friends are committed to each other and dedicate time to spend
with one another when possible.
• Being supportive — one of the key benefits of friendship is to provide each other
with support in times of need. Youth is a time of vast change and friends can
support each other through these events.
• Participating in conversations — real friends value each other’s opinions and

want to hear what the other has to say.
• Providing compliments — providing positive feedback to others is required for
the promotion of self-esteem and shows others that their friends care.
• Being honest — although compliments are important, friends are often in a
position to be honest with each other when advice is sought. Respect should
always be maintained when offering advice.
Using these skills in interactions with others is influential in developing
and maintaining meaningful relationships. Developing mutual and respectful
Figure 4.11 Friends can be a great
support during youth. friendships during youth can provide a valuable resource for all individuals
involved (figure 4.11).
Having mutual and respectful friendships means that the individual is valued for
who they are. This allows youth to express their feelings without being judged, to
discuss concerns about the present and future and to share experiences with those
they trust. Friendships give an alternative to the family from which youth can seek
advice and gain support during times of crisis. Friends can also guide each other
through the sometimes difficult period of youth and assist in building resilience.
Developing and maintaining a friendship requires effort from all the individuals
involved. As a result, friendships can dissolve if the effort is not made. Friendships
during youth can influence many aspects of health and development. Friends may:
• influence other behaviours that youth participate in such as exercise, substance
use and risk-taking activities. All of these can affect physical health and
development.
• encourage social development by engaging the youth in a range of social
activities. These may assist in building communication skills and social roles.
• encourage and support each other. This promotes mental health.
• lead the youth to experience strong bonds with individuals outside the family,
promoting emotional development.
Seeking help from health professionals

As medical technology and knowledge have advanced over the past century, many
conditions have become curable and/or preventable. Health professionals can
help youths in numerous ways, particularly in providing treatment and advice
about optimising health and individual human development (figure 4.12). Health
professionals can:
• give advice about nutrition, which can promote physical health and individual
human development
Figure 4.12 Health professionals • provide immunisation against conditions such as meningococcal infection,
can help youths in numerous ways, which can enhance physical health
including giving advice. • give advice on stress and anxiety management, which is an aspect of mental
health
• correct eye disorders, which can promote intellectual development.
Parents often make choices for children in deciding when to seek help from
health professionals, but during youth the responsibility falls on the individual
to make the decision to seek help when issues arise. Youth may be intimidated
at the thought of visiting a health professional or may feel they have to manage
issues themselves. Confidentiality is another major concern of many youth. They
may not want their parents to know the nature of their medical conditions and
may fear that the health professionals will discuss these issues with their parents.
Youth are eligible to obtain their own Medicare card and can therefore visit doctors
by themselves, which ensures confidentiality. However, maintaining open lines
of communication with parents is an important aspect of maintaining all areas of
health and individual human development. As a result of failing to access health

care, any health and development issues and concerns may go unaddressed. Over
time, these issues can lead to physical complications and increase feelings of stress
and anxiety.
According to the Australian Psychological Society, the following patterns with
regards to youth accessing professional help have been noted:
• Young people are more likely to seek help from friends as opposed to health
professionals.
• Males are less likely to seek help for mental health problems than females, and
this can contribute to higher suicide rates among males.
• Youths do not access health services at the same rates as people in other lifespan
stages.
TEST your knowledge started to feel a burning sensation and has seen
some redness around her vagina. She has become
1 Why is skin cancer more common later in life when
worried and suspects that her boyfriend has recently
adults exercise more sun protection behaviours than
had other sexual partners and has given her an STI.
youths?
Kate is too embarrassed to talk to her friends and is
2 (a) Identify two trends evident in table 4.2.
(b) Discuss reasons that may account for the trends avoiding going to the doctor.
identified in part (a). (a) Identify ways that Kate’s physical, social,
3 (a) Which sex is more likely to exercise overall? emotional and intellectual development could
(b) Why do you think this is the case? have been affected by her sexual experience.
(b) What advice would you give Kate if she
APPLY your knowledge approached you asking for help?
(c) Suggest ways that Kate could have decreased
4 Brainstorm a list of the short- and long-term effects
her chances of contracting an STI.
of substance abuse.
(d) Brainstorm reasons why Kate might not be
5 How could substance abuse lead to conflict in
willing to visit a health professional.
relationships?
6 What is the average age at which lifetime smokers (e) Suggest a strategy that could be introduced
start smoking? to combat STI infection rates for people of
7 Tobacco has been referred to as the ‘gateway’ drug, Kate’s age.
meaning it often leads to experimentation with 2 Select one of the behavioural determinants covered
1
other drugs. Explain why tobacco may lead to other in this chapter and draw up a table to show
drugs. how it might affect all aspects of the health and
8 Do you think that most people who have tried illicit development of youth.
drugs also have a history of alcohol use? Explain 13 Use the Sexual health weblink in your eBookPLUS
your response. to find the link for this question.
9 (a) In what ways can weekly drinking be more of a (a) i. Click on the ‘sexual practices’ icon down the
concern than daily drinking? bottom.
(b) What associated effects can this type of drinking ii. Click on ‘STI’.
have on health? iii. Research three STIs and produce a fact file on
10 (a) Discuss how risky alcohol consumption patterns each one. Discuss these conditions in small
change as youth get older, according to table 4.5. groups.
(b) Outline possible reasons for these changes. (b) i. Click on the ‘home’ icon down the bottom of
(c) Discuss how these changes could impact the page.
on youth health and individual human ii. Place the cursor over the ‘true stories’ icon
development. and select ‘pregnant’.
11 Kate is in year 12 and has a boyfriend two years iii. Watch the slide show.
older than her. Two weeks ago, she decided to have iv. Discuss how this event could impact on this
sex with him for the first time. She was a virgin and girl’s development.
had wanted to wait until she was in a committed v. Brainstorm ways that the girl’s health may be
relationship before having sex. A few days ago, she affected by this incident.
D
development during youth: physical environment
KEY CONCEPT Understanding the physical environmental determinants of

the health and development of Australia’s youth
The physical environment encompasses many factors that have a direct impact
on health and individual human development such as air quality, the housing
and work environments, and access to facilities for recreation and health care.
Aspects of the physical environment are often out of the individual’s control but
their relationship with health and individual human development makes them
significant determinants in the lives of youth.
Tobacco smoke in the home

When a non-smoker is exposed to environmental tobacco smoke (ETS), they
are exposed to more than 4000 different types of chemicals. The impact of ETS
on youth health and individual
70 human development can be
12–17 years significant. ETS can prevent lungs
60
functioning at their optimal level,
50 which could have an adverse effect
on physical activity and therefore
40 motor development. Young people
Per cent
exposed to ETS are also more likely

30 to suffer from asthma and other
breathing problems. Exposure to
20
ETS leaves people more likely to
10 become sick and increases their
risk of developing heart disease by
0 25 to 30 per cent and lung cancer
No one at home regularly Smokes inside the home Only smokes outside the by 20 to 30 per cent.
smokes home Young people in households
Household smoking status with a smoker are more likely to
Figure 4.13 Household smoking status of young people aged 12–17 years, 2007–08 take up smoking themselves, and
Source: Adapted from Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, this can have long-term effects on
cat. no. PHE 140, Canberra, p. 115.
their health and individual human
development. The household smoking status of young people in 2007–08 is
shown in figure 4.13. According to the ABS National Health Survey (NHS), between
1995 and 2007–08 the proportion of Australian households with dependent
children where household members smoked inside decreased from 31 per cent to
12 per cent.
Housing environment
Youth generally spend a lot of time at home, and the housing environment can
affect their health and individual human development.
Some of the physical aspects of the housing environment that can affect health
and development include:
• indoor pollutants. Dust and tobacco smoke, for example, can cause asthma and
other respiratory conditions.
• drinking water quality. Inadequate water quality can lead to infections or
dehydration.
• warmth. People living in dwellings that are damp, cold or mouldy are at greater
risk of respiratory conditions, meningococcal infection and asthma.

• the number of bedrooms (figure 4.14). Cramped living conditions can lead to
stress and other mental health issues.
• safety of the housing. An unsafe housing environment can increase the risk of falls,
electrocution and other injuries.
Research published by the Australian Housing Urban Research Institute suggests
that overcrowded houses are associated with a greater risk of infectious disease and
poor mental health. As young people are usually dependent on others, they may
have little control over the number of people who share their living environment.
60
15–19 years
50 20 –24 years
40
Per cent
30
20
10 Figure 4.14 Self-reported adequacy

of the number of bedrooms in
0 households of young people aged
Much less than Less than Adequate More than Much more than 15–24 years, 2001
adequate adequate adequate adequate Source: Australian Institute of Health and Welfare
Self-reported adequacy of the number of bedrooms 2007, cat. no. PHE 87, Canberra, p. 136.
Work environment
Many youths will take on a part-time job for the first time during this stage or
will leave school to commence full-time employment (figure 4.15). Work allows
the individual to earn their own income and develop skills relating to all areas of
development. In the work environment, the young person may learn skills such
as cooking, cleaning, cooperation, and responsibility. But there are often risks
associated with the workplace as well.
Full-time study only
Full-time work only
Full-time work and part-time study
Full-time study and part-time work
Full-time study and full-time work
Part-time study and part-time work

15–19 years
Part-time study only
20–24 years
Part-time work only
Figure 4.15 Participation in
Not in study or work education and/or employment among
young people aged 15–24 years, 2009
0 10 20 30 40 50 Source: Australian Institute of Health and Welfare
Per cent 2011, cat. no. PHE 140, Canberra, p. 132.
Occupational health and safety laws in Australia are designed to ensure that
employers provide a safe environment for all of their employees, including youth.
These laws relate to physical space as well as machinery, training and supervision.
4.3 Determinants of health and individual human development during youth: physical environment
They are intended to promote the health and individual human

development of those working in Australia.
The physical space in which a youth works can impact on their health
and development. Working outdoors for instance can leave them exposed
to UV radiation and other elements such as heat and cold, all of which can
affect physical health. The tools and instruments that young people use at
work can lead to injuries such as strains and cuts. Youths may be required
to stack shelves, which can increase strength but also the likelihood of
back injury.
Many youths work in fast-food outlets or other commercial kitchens.
Facilities within these environments pose particular risks to youths
including:
• burns from hot water, deep fryers, ovens and other appliances
Figure 4.16 The work environment • falls and injury caused by slippery floors
can present youths with many • cuts and lacerations from sharp objects.
opportunities and risks.
Unpleasant or unfavourable working conditions can also influence mental
health by affecting self-esteem and contributing to feelings of depression.
The distance of the workplace in relation to the home can also provide
opportunities and risks for health and individual human development.
Riding or walking to work can increase the level of physical health and
promote physical development, but traffic conditions might increase the
risk of injury.
Access to recreational facilities

Opportunities for physical activity are affected by the facilities available
to people (figure 4.17). As many youth do not drive, the distance from
home to a venue will influence whether or not they become involved in
activities that interest them. Recreational facilities (e.g. sporting grounds,
parks, beaches, natural environments and social clubs) provide young
people with opportunities for social interaction and physical activity.
Figure 4.17 Access to recreational
facilities such as surf beaches affects
These in turn promote physical, social and mental health. Having access
the activities in which people to recreational facilities also promotes individual human development
participate. because motor skills, social skills, self-concept and knowledge of different
activities can be increased.
Case study
Whitehorse gymnasts left The school is yet to complete its plans for the former
town hall.
high and dry Whitehorse Gymnastics Club vice-president Alison
Dunn said the council had done little to help move the
By Gareth Trickey
club’s members.
More than 500 gymnasts will be evicted from their ‘In 30 years we’ve never had to ask for any help, and
training centre after a council failed to pitch in for a now we are asking for some help,’ she said.
new lease or a training centre. The club approached Whitehorse Council three
The Whitehorse Gymnastics Club has called Wal weeks ago with a plan to move to another building.
Wicking Hall, in Blackburn South, home for the past The proposal was dashed after the club failed
10 years. But Orchard Grove Primary School, which to persuade Whitehorse councillors of the value of
owns Wal Wicking Hall, terminated the lease in June. moving.

‘After the meeting everyone was really positive and ‘Due to increased enrolments, Orchard Grove Primary
it was great, but then we got an email saying no one School now needs full access to the gymnasium during
was interested,’ Ms Dunn said. ‘We were told we had the day for its educational programs and assemblies,’
to lobby and that we had three councillors on our side she said.
and we had to lobby to get five. Then they tell us there ‘The school council has not yet made any final
is nothing they can do. decision regarding the use of the gym outside school
‘We’ve been dealing with State Government and hours but is hopeful of finding an arrangement that
Federal Government politicians, and everyone has been would cater also to community groups.’
telling us they are behind us emotionally, but no one is Sport and Recreation Minister James Merlino
doing anything.’ encouraged the club to work with the council to
Orchard Grove Primary School principal Jan Oliver gain access to any available funding or vacant sport
said the needs of the school’s students were the top facilities.
priority. Source: Herald Sun, 3 October 2008.
Case study review

Make a list of the effects that losing their training facility could have on the
physical, social and mental health of the gymnasts.
TEST your knowledge that is considered less than adequate and much
less than adequate in terms of the number of
1 How can environmental tobacco smoke affect the
bedrooms?
health and development of young people in the:
(b) Why might this scenario be particularly difficult
(a) short term?
for youth?
(b) long term?
(c) How could inadequate housing lead to poor
2 List three aspects of the housing environment
health? (Remember that health is not just
that can affect health and individual human
physical.)
development. 8 Use the Young Workers weblink in your
3 Outline some benefits to your health that have eBookPLUS to find the link for this question, eBook plus
occurred as a result of participating in recreational and use the fact sheets to answer the
activities (make sure you cover the three areas of following questions.
health). (a) What rights do young workers have in the
4 (a) Using the data in figure 4.15, estimate the workplace?
proportion of males and females aged 15–24 (b) Discuss the options for youth if they are unsure
who have some form of job. about completing a task at work.
(b) Discuss the impact that having a job can have on (c) Explain how the work environment can impact
youth health and development. the health and individual human development of
youth.
APPLY your knowledge 9 (a) Make a list of recreational activities (within
5 Suggest reasons why indoor tobacco smoke has a 15-minute walk of home) that you could
decreased in recent years. participate in.
6 Why would young people whose parents smoke be (b) How often do you use these facilities?
more likely to take up the habit themselves? (c) Are there any facilities not located in your area
7 (a) According to figure 4.14, approximately what that you would use if they were closer?
percentage of 15–24 year olds live in housing (d) Compare your list with a classmate.
D
development during youth: social environment
KEY CONCEPT Understanding the social environmental determinants of the

health and development of Australia’s youth
Social environment
Social determinants of health and individual human development affect youth in
numerous ways. Some of these social factors are related to the influence of the
family and others are related to the wider community in which youth live.
Youths rely on their families for many aspects of their lives. Parents,
siblings and extended family members guide young people through their
childhood and youth, when development is occurring at a rapid rate.
Physical, social, emotional and intellectual development are all influenced by
family members. The health behaviours (e.g. food intake and exercise) that
young people partake in are also influenced by family members (figure 4.18).
The wider community such as schools, sporting groups and social/
cultural groups play an important role in influencing the health and
individual development of youth. They provide opportunities for young
people to be involved in the community in which they live, which can
promote health. Social determinants within the community include the
media, community and civic participation and access to education. Each of
these determinants will be explored in more detail.
Figure 4.18 The family is an
important determinant of health and Family cohesion
development. Family cohesion refers to the closeness or bonds within a family. The ability of
families to get along is an indicator of family cohesion and data relating to this
measure are shown in figure 4.19. According to the Australian Institute of Health
and Welfare, family cohesion, or lack thereof, is a risk factor for youth health
and individual human development. It is difficult to say whether lack of family
cohesion leads to poor health and development outcomes or vice versa. Issues such
as substance abuse, mental illness and suicide may be the result of poor family
cohesion or may in fact lead to it.
If the family is close, then social health may be reliant on the family. If the family
is not close, then friends may play this role. The family may also provide a resource
for young people. They can discuss their problems and seek advice. This could
increase the level of mental health experienced.
Individual human development is also influenced by the family. A family that
regularly socialises and communicates could assist in the development of social
skills and the emotional development of youth. Intellectual development could
also be improved by gaining new knowledge from family members such as parents
and grandparents.
35 32.9
31.031.2 Females %
30 29.0
Males %
25
21.120.1
Per cent
20
15 12.3
10.4
10
6.7
Figure 4.19 The ability of families to 5.4
5
get along according to young people
aged 15–19, 2012 0
Source: Mission Australia youth survey 2012. Excellent Very good Good Fair Poor

According to the National Youth Survey published by Mission Australia in 2012,
82.0 per cent of people aged between 11 and 24 ranked family relationships as one
of the most valuable things in their lives. Friendships with those other than family
members came first at 83.2 per cent.
Socioeconomic status of parents

Socioeconomic status (SES) includes three key areas: education, occupation and
income. The relationship between socioeconomic status and health is undeniable.
People from higher SES groups have lower mortality and morbidity rates and
display lower rates of risk factors.
In terms of the effects that socioeconomic status has on youth health and
development, it is important to also look at the socioeconomic status of the youth’s
parents. For youth living under their parents’ roof and undertaking full-time
education, the socioeconomic status of parents is directly related to the
socioeconomic status of youth. It is therefore generally the socioeconomic status of
parents that influences the health and individual human development of youth.
Unemployment among parents (figure 4.20) can have long-term effects on the
development, educational outcomes and employment prospects of young people. eBook plus
Families without an employed parent generally have low incomes and therefore
live in lower economic circumstances with less economic stability. Long-term eLessons:
unemployment can lead to high levels of stress, family conflict and social isolation, Revising roles within
which can in turn have an impact on the health and individual human development relationships
of the youth. A low income could also mean that money is not available to spend Searchlight ID: eles-1042
on resources that can promote health and development — adequate food, social Influence of family and peers
experiences (e.g. dining out or going to a concert), or the purchase of computers, Searchlight ID: eles-1040
internet access, musical instruments/lessons, adequate housing or new clothing.
45
Child 10 –14 years
40 Dependent student
15 –24 years
35
30
Per cent
25
20
15
10
5
Figure 4.20 Young people in families
0 where no parent is employed, 2006–07
Couple parent Lone-parent All families Source: Adapted from ABS data.
Lack of education can lead to unemployment or low-paid employment. Low-

paying jobs can have effects that are similar to unemployment but are not as severe.
Media
The media influences many of the decisions youth make (figure 4.21). By eBook plus
influencing social trends — from food items to clothing, music and recreational
activities — the media has a pronounced impact on the health and development eLessons:
of youth. In recent decades the use of media (particularly electronic and social Influence of global events
media) has increased significantly. This exposes young people to many forms of Searchlight ID: eles-1041
information.
4.4 D
eterminants of health and individual human development during youth:
social environment
Exposure to many forms of media can have negative or

positive influences on health and development. Media
Television
can be a valuable education tool. Access to the internet
and television can promote learning and intellectual
development if the material being viewed is age appropriate
and relevant. On the other hand, many youth spend hours
Internet Radio at a time on activities such as browsing the internet,
engaging in social media, watching television and playing
video games (collectively called ‘small screen recreation’).
These forms of media expose youth to a range of subjects
and themes that can have a detrimental impact on their
Media
Video
Music health and development. The violence and explicit
games language and images often presented in the media may
influence the way youths communicate or behave around
others, which affects social development. Stereotypes that
Figure 4.21 Common forms of media that influence youth
portray certain groups of people in a negative light (e.g.
men being violent) are often displayed in the media. As values are being formed
during youth, the internet and television can be extremely influential.
Social media sites such as Facebook, Twitter and Tumblr allow youth to interact
online. This can assist with developing and maintaining friendships and enhance
social and mental health by facilitating online interaction and promoting self-
esteem. It can also have negative effects on social and mental health by being
used as a platform to bully, harass or exclude others. Social media may reduce
face-to-face interaction among youth, which can contribute to reduced social and
emotional development by limiting the experiences youth have.
Advertising is prominent in most forms of media and can influence the behaviour
of youth in their choices of food, non-alcoholic drinks and alcohol. This can have
both long and short-term impacts on health and development.
Youth who spend a lot of time engaged in small screen and social media may
spend less time exercising, socialising and studying. As a result, physical health
may be affected by weight gain, social skills may not be learned and knowledge
development may be limited. The amount of time spent on small screen recreation
compared to other forms of recreation is shown in figure 4.22.
44
Education Travel Culture Social Small screen recreation
Hours of sedentary activity/week
40
36
32
28
24
20
16
12
8
4
0
Year 6 boys Year 6 girls Year 8 boys Year 8 girls Year 10 boys Year 10 girls
Figure 4.22 Sedentary recreational activities by sex and school year

Source: Adapted from NSW Centre for Overweight and Obesity 2010, NSW Schools Physical Activity and Nutrition Survey
(SPANS) 2010: Full Report, Sydney: NSW Department of Health, p. 216.
The Australian government’s physical activity recommendations for children and

young people state that no more than two hours should be spent on small screen
recreation on any one day. The percentage of youths reporting more than two hours
of small screen recreation per day is shown in figure 4.23.
130
90
Males
80 Females
Persons
70
60
Per cent
50
40
30
20
10
0
School day Weekend
Figure 4.23 Proportion of secondary school students exceeding the national guidelines for
small screen recreation, on school days and weekends, 2009–10
Source: Adapted from Cancer Council Victoria 2011, ‘Prevalence of Meeting Recommendations for Small Screen Recreation in
Australian Secondary Students’, National Secondary Students’ Diet and Activity (NaSSDA) survey 2009–10.
Community and civic participation

Being involved in community groups gives young people a social network and can
generate a sense of achievement and worth (figure 4.24).
Although relatively few young people volunteer compared to people in other
lifespan stages (table 4.6), many youth are involved in sport, recreation, arts and
faith-based activities. This gives them a chance to mix with like-minded people,
which promotes social health and is a source of relaxation and stress relief, which
promotes mental health.
Table 4.6 Percentage of young people aged 15 to 19 years involved in selected activities, 2012
National 2012 % Female % Male %
Sports (as a participant) 78.4 76.8 80.9
Sports (as a spectator) 73.0 70.7 76.6
Volunteer work 60.5 65.8 52.0
Arts/cultural activities 52.0 59.4 40.0
Student leadership activities 47.4 51.3 41.0
Youth groups and clubs 38.2 38.2 37.9
Religious groups or activities 37.8 40.3 34.0
Environmental groups or activities 27.8 29.6 24.9
Political groups or organisations 9.2 8.7 10.0

Note: Items are listed in order of national importance.
Source: Mission Australia Youth Survey 2012.
Self-concept is a key area of emotional development that can be significantly

enhanced by volunteering or being involved in other community activities.
By contributing to the community in which they live, young people can derive a Figure 4.24 Volunteering can
sense of pride and pleasure, enhancing self-esteem. provide a connection with society.
4.4 D
eterminants of health and individual human development during youth:
social environment
Access to education
Education is one of the key defining aspects of youth. Education in schools and
higher education institutions such as universities and TAFEs provides opportunities
for youth to develop knowledge and skills that will prepare them for work in later
years and enhances their social, emotional and intellectual development.
The resources available in each school will also influence the type of education
received by youth. Having access to multimedia and information technology
resources can increase their opportunities.
Education is also linked with better health outcomes (figure 4.25). Those with
higher levels of education report lower levels of illness and better mental health
than those with lower levels of education. Education can promote awareness of
healthy behaviours such as not smoking tobacco and maintaining adequate levels
of physical activity. Those with higher levels of education are also more likely to
secure jobs with better pay and prestige, which can lead to lower levels of stress
and more income to pay for things like private health insurance and an adequate
food supply.
Figure 4.25 Education has a relationship with health outcomes, but not all youths have
access to it.
A number of factors can contribute to youth not accessing education services.

They include:
• geographical barriers — those in rural and remote areas of Australia may find it
difficult to get to a school because it could be hundreds of kilometres away.
• social/cultural factors — some parents may not place importance on formal
schooling. As a result, children may be home-schooled or may receive little or
no formal education.
• socioeconomic reasons — some individuals may not be able to meet the
costs associated with education (particularly tertiary education), and this may
influence their decision on whether to continue with formal study.
132
TEST your knowledge 10 Using figure 4.21, brainstorm how each form
of media might impact on health and individual
1 Explain what is meant by family cohesion.
human development in both positive and negative
2 List the three components that make up SES.
ways. (A table might be useful for this.)
3 Why is it important to look at the SES of parents
11 Brainstorm a list of social factors in the
when estimating the effect that SES has on youth?
community that affect your health and individual
4 List three ways that media could affect the health
human development. Compare your list with
and/or individual human development of youth.
someone else’s.
5 Identify two trends from figure 4.23.
12 (a) Design a survey that could be used to gauge
6 Outline factors that might prevent youths from
people’s participation in community and civic
accessing education.
activities. Make sure your questions allow data
collection about:
APPLY your knowledge • the nature of the activities
7 (a) What percentage of males and females aged • how often people participate
15–19 rated their family’s ability to get along as • the perceived health benefits of participation.
fair or poor? (b) Use the survey to collect data on youth
(b) Explain how their family’s fair or poor ability participation and collate the results.
to get along could impact on the health and (c) Draw conclusions about community and civic
individual human development of youth. participation in your school.
8 What effect might caring for a parent have on the 13 Select one form of social media and design a
health and development of a young person? pamphlet that could be used to educate youth about
9 Discuss the ways that having no parent in paid the positive and negative aspects of its use.
employment could affect the health and individual 14 Explain how education could promote health and
human development of youth. individual human development among youth.
development ofinAustralia’s
Key skills Variations youth
health within Australia
KEY SKILL Explain the determinants of health and

individual human development and analyse their impact on
youth using relevant examples
In order to complete this key skill, a knowledge of the determinants of health
and development is important. As well as being aware of the three determinants
addressed in this chapter (behavioural, physical environment and social
environment), the ability to predict the likely effect of at least one factor or example
from each determinant is also required. Remember that the focus of this key skill is
on youth and any discussion should be about this particular age group.
Completing a summary table (like table 4.7) can provide practice in predicting
likely effects.
Table 4.7 A summary table for analysing the impact on health and individual human
development of the determinants
Determinant: Media
Area of health Possible impact on youth
Physical
Social
Mental
Area of development
Physical
Social
Emotional
Intellectual

Ralph is 15 years old and in year 10 at school. He has well developed motor
skills and excels in football and cricket. Earlier this year, Ralph sustained an injury
during a cricket match and could not play sport for four months. His body
weight increased during that time and his BMI now places him in the ‘overweight’
category.
To identify two determinants of health and development, and discuss how each
❶ Note that a choice is given in this might influence the health and/or❶ individual development experienced by Ralph,
scenario and links can be made to a response might be as follows.
health and/or individual human
development. Behavioural — physical activity❷: Ralph had to take four months off sport after
his injury, which may have decreased his overall levels of physical activity. If
❷ As the task is to identify and discuss Ralph is not getting as much physical activity as he did in the past, this may
the determinants, the first step is be contributing to his increase in body weight, which is an aspect of physical
to identify the determinant. Then
discuss how it may have contributed health❸.
to aspects of Ralph’s health and/or Physical environment — access to recreational facilities: If Ralph lives relatively close
individual human development. to recreational facilities such as ovals and sporting clubs, this may have influenced
his ability to become involved in a range of sports and activities. By being able
❸ Identifying the aspect of health and/
or development can assist in ensuring to play a range of sports, Ralph’s motor skills may have been enhanced (physical
a clear link has been made. development)


1 (a) Explain what is meant by the term ‘determinants of health and development’.
(b) List the three categories of determinants of health addressed in this chapter
and explain (using examples) what is meant by each one.
2 Natalie is in year 11 at a school in Melbourne. She lives with her mother and
brother and has a good network of friends. Natalie’s mother has recently become
unemployed and is currently looking for work. Her mother is a smoker and smokes
in their house. Although Natalie plays netball with her school friends at the local
sports centre once a week, she has started to put on weight in recent months and
this has taken her above her healthy body weight. In recent weeks, Natalie has been
going out with her friends and experimenting with alcohol and smoking cigarettes.
(a) Identify four examples of determinants of health and development for Natalie.
(b) Explain their possible impact on her health and development.

3 Danny is 15 and left school around the same time he was kicked out of home by his
stepfather. He has been spending his time with a group of older people on the streets and
they have introduced him to drugs. One night, Danny was out with his friends and he
decided to try ecstasy. After two hours, he began hallucinating and started thinking that his
friends were out to get him. He could not control his thoughts and by the next day was in
a psychiatric hospital diagnosed with drug-induced psychosis (where perception of reality
is altered and people see, hear, smell and touch things that are not there). Psychosis can be
treated but many individuals will experience further episodes of psychosis in the future.
(a) Identify three examples of determinants of health and development for Danny.
3 marks
(b) Select one of these and explain how they may affect Danny’s health and development.
4 marks
(c) Discuss ways that Danny’s illness may impact on his:
i. social health
ii. social development.
4 marks
(d) Explain how Danny’s family situation may impact on his recovery from his illness.
3 marks
CHAPTER 4 review
Chapter summary
• The level of health and development experienced throughout life is determined by a
broad range of factors called determinants.
• Behavioural determinants and the physical and social environment all combine to affect
youth health and development.
• Behavioural determinants include the behaviours that people engage in that have an
impact on health and development, including smoking and exercise.
• A lot of the behaviours that youths engage in can have long-term consequences.
Habits that are established during this stage are important for future health and
development.
• Lack of sun protection remains an issue for Australian youth although awareness of its
importance has increased in recent years.
• Levels of physical activity are not as high as they should be and contribute to a range of
health and developmental problems.
• Tobacco, alcohol and substance use is often first tried during the youth stage and can
lead to lifelong health problems.
• Chlamydia rates have more than doubled in recent years. Infections among youths and
early adults are largely responsible for this increase.
• A number of skills are required to develop and maintain friendships.
• Mutual and respectful friendships can be a great support for youth as they develop.
• Health professionals are a valuable resource in terms of maintaining optimal health and
development yet many youth are reluctant to seek help from them.
• The physical environment includes air and water quality and pollution. The physical
environment in Australia generally promotes good health.
• Housing issues such as unsafe housing and overcrowding can contribute to injuries and
mental health issues.
• Many youth start employment during this stage of the lifespan, and the work
environment can present many challenges and opportunities for health and
development.
• Indoor tobacco smoke can cause detrimental health outcomes for young people such as
respiratory problems.
• Having access to recreational facilities can promote physical activity and social
interaction, which be beneficial to health and development.
• The social environment refers to the people in the environment and the impact
they have on our health. Social factors can be related to family or the wider community.
• The family is an important component of the social environment that influences
many aspects of health and development such as schooling and the formation
eBook plus of values.
Interactivities: • The media is extremely influential with regards to the recreation pursuits youth
participate in and the information that is made available to them.
Chapter 4 crossword
• Community participation such as volunteering can build links between the individual
and society, which can enhance health and development.
• Levels of education are related to levels of health but some youths are unable to access
education, particularly higher education.

APPLY the key skills someone living in a city. Explain the possible
consequences these differences may have on health
1 Explain what is meant by ‘determinants of health’.
and development.
4 Select an area of health that could be improved
for young people and design a strategy that the
2 For each of the determinants of health and government could introduce to address the issue.
development, list one example and discuss how it 5 Choose five of the following and suggest ways they
can influence the health and development of youth. might influence social development during youth:
3 Brainstorm how the determinants of health and peers, parents, siblings, school, workplace, music,
development might differ for someone living in media, and sporting teams.
remote Australia (the outback) compared with
CHAPTER
Chapter 5
8
Health issues facing

Global health and
Australia’s youth
human development
Although the health of Australia’s youth is very good, a number
of preventable health issues continue to affect the health and
individual human development of many young people. You will
be required to investigate one of these issues in depth. A brief
overview of a range of topics is included, and after reviewing
the outline of issues, you will be able to work with your teacher
to select an issue to research in greater detail. A comprehensive
look at mental health is also included to provide you with an
idea of the depth required in your research and report.
Key Knowledge
2.5 health issues facing Australia’s youth such as mental health, weight
issues (including obesity), injury (including injury and death from
drowning), tobacco smoking, alcohol use, illicit substance use and STI
prevention (pages 140–9)
2.6 the key features of one health issue for Australia’s youth (pages 150–3),
including:
–– its impact on all dimensions of health and individual human
development (pages 154–5)
–– its incidence, prevalence and changes over time (trends) (pages 150–1)
–– determinants of health that act as risk and/or protective factors
(pages 155–6)
–– government, community and personal strategies or programs
designed to promote health and individual human development of
youth (pages 158–60)
–– the range of health care services available to youth and their
rights and responsibilities in accessing and using relevant services
(including Medicare) (pages 160–3).
Key Skills
• analyse data to draw informed conclusions about the range of health
issues facing Australia’s youth
• describe a specific health issue facing Australia’s youth
• gather information on a selected health issue related to youth using a
range of sources such as primary data, print and electronic material
• analyse information on a selected youth health issue and draw
informed conclusions about personal, community and government FIGURE 5.1 The health of Australia’s
strategies and programs to optimise youth health and development youth is excellent, but there are
a number of issues that require
• identify the range of health care services available to youth and discuss attention.
their rights and responsibilities in accessing and using these services.

allied health services health services provided by health
professionals that are distinct from doctors, nurses and
dentists. These services exist in conjunction with clinical
health professionals and include physiotherapists, speech
therapists and occupational therapists.
binge drinking consuming seven or more standard
drinks for males or five or more standard drinks for
females in one sitting
complementary health services (also referred to as
alternative medicine); health services that operate outside
the boundaries of modern medicine (e.g. naturopathy,
acupuncture and chiropractic services)
illicit drugs illegal substances, or legal drugs used in an
illegal manner
psychotic a state in which the individual experiences a
loss or distortion of reality
sexually transmissible infections (STIs) a range of
conditions that are generally transmitted sexually from
one person to another
stigma a negative stereotype
Health issues facing Australia’s youth • CHAPTER 5 139

5.1 Health issues facing Australia’s youth
KEY CONCEPT Understanding health issues facing Australia’s youth — weight

issues (including obesity), injury (including injury and death from drowning),
tobacco smoking, alcohol use, illicit substance use and STI prevention
As explored in chapter 1, the health of Australia’s youth is generally good. If further

improvements to health in this area are to be made, however, the current issues facing
Australia’s youth must be explored. There are numerous issues that can be improved
by either behaviour change or early intervention. Your task will be to explore one of
these issues and produce a detailed report. Some of the issues you can research will
be briefly outlined in the coming section. These outlines are not intended to provide
you with a detailed explanation, but rather, just enough information for you to make
a decision as to which issue you want to learn more about.
Weight issues
Underweight, overweight and obesity all impact significantly on youth health and
development.
In 2007, around 5 per cent of those aged 14 to 16 were considered to be
underweight. Underweight can indicate that the nutrients required for optimal health
and development are not present. The effects of being underweight can include:
• Greater risk of infection and disease, as a result of a weakened immune system.
• An inability to concentrate at school due to low levels of energy (physical health)
thereby impacting intellectual development.
• Delayed puberty. Low body weight can contribute to delayed puberty and when
it does commence, developmental processes such as increases in bone and
muscle mass may not be achieved.
The percentage of overweight and obese children and youth has more than
doubled over the past two decades and continues to increase. The Obesity Society
in 2008 estimated the current levels of overweight and obesity among Australian
youths to be around one in four. Obesity in youth can have lifelong implications and
contribute to many leading causes of death among adults, such as cardiovascular
disease, some cancers and type 2 diabetes. If the youth carries the extra weight into
adulthood, the risk of developing these conditions continues to increase. In the
short term, youth can suffer from psychological distress, cardiovascular disease and
type 2 diabetes. The increased prevalence of overweight/obesity among youth is
due to the combination of changes to food intake and the development of sedentary
lifestyles. The National Physical Activity Guidelines recommend that young people
participate in at least 60 minutes of moderate to vigorous physical activity every
Figure 5.2 Overweight and day. Examples of moderate exercise include medium-paced cycling, swimming and
obesity are increasing among young brisk walking. Examples of vigorous exercise include jogging and basketball.
Australians.
Table 5.1 Percentages of young Australians engaging in different levels of activity, 2008
Males Females
15–17 18–24 15–17 18–24
Moderate to high 49.0 41.3 34.7 26.2

Low 31.0 31.6 40.0 42.7
Sedentary 19.8 27.2 25.2 31.1
Source: Adapted from ABS, National Health Survey, 2007–08.
Table 5.1 shows the activity levels of young people. Those classified as sedentary
or low (engaging in no exercise to little exercise respectively) were considered to be
getting not enough physical activity.

Injury
‘Injury’ is an umbrella term that refers to a range of causes of mortality and
morbidity, including traffic accidents, suicide and poisoning, and drowning and
near drowning. All injuries are considered to be preventable, which can add to the
impact that they have on individuals. Although death rates from injury have
decreased significantly over the past 20 years, it is still the leading cause of death
for youth in Australia (AIHW, 2011).
Transport accidents (largely motor vehicle accidents) Land transport accidents
were the most common cause of injury death for both
males and females in 2007 (see figure 5.3). Suicide
Injuries not resulting in death can lead to disability and Undetermined intent
various lifelong conditions, which also have the potential
Accidental poisoning
to significantly impact the health and individual human Male
development of youth and their families. Assault Female
The youth stage of the lifespan has specific relationships Exposure to other factors
with both the type and rate of injuries experienced.
Accidental falls
Rates of injury are significantly higher than in most other
lifespan stages, largely due to the stage of development Accidental drowning
that youth are experiencing. Developing independence Other
increases the opportunity for decision making, which
can, in turn, increase risk-taking behaviour. Brain 0 5 10 15 20 25 30 35 40
development, substance use, the peer group, the media Per cent of external cause of death
and other social pressures can play a role in the high rates Figure 5.3 Injury and poisoning
of injuries experienced among youth. deaths among young people aged 15
to 24, by external cause of injury, 2007
Drowning and near drowning are a significant contributor to injury among youth.
Source: Young Australians: their health and
In 2012, there were 45 drowning deaths among those aged 15 to 24. Of those, wellbeing, 2011.
89 per cent were male (Royal Life Saving Society Australia, National Drowning
Report, 2012).
Drowning can occur in a range of locations. The sites of drowning death for
youth in 2011–12, compared to the five-year average, are shown in figure 5.4.
16
14
14 5 year average
12 11/12 11
10
8 8
8 7 7
6 5
4 4
4 3
2 2 2
2 1 1 1 1
0
h
ch
ur
ks
ol
er
n
t
oo
ow
po
a
th
ba
bo
c
a
re
Ro
Be
ag
kn
ar
St
g
pa
/L
in
/H
Un
k/
/S
am
m
e
an
ub
re
im
/D
ce
r/C
ht
Sw
ke
O
t
ve
Ba
La
Ri
Figure 5.4 Drowning deaths of young people aged 15 to 24 by location, five-year average,
2011–12.
Source: Royal Life Saving Society Australia, National drowning report, 2012.
Risk-taking behaviours, including alcohol consumption, are particularly

significant during youth and have a strong relationship with drowning injury and
death. In 2011–12, alcohol played a significant factor in drowning deaths in the
15 to 19 years age group, with 20 per cent of all cases known to involve alcohol.
Reducing drowning deaths in young people aged 15 to 24 years is the second goal
of the Australian Water Safety Strategy 2012–15. Objectives include undertaking

research to determine underlying factors leading to drowning and implementing

strategies to address risk-taking behaviour and the impact of alcohol.
Tobacco smoking
Youth is a critical time in the development of tobacco
addiction, and those who do not smoke during youth are less
likely to smoke later in life. Smoking increases the chances
of premature death and a range of conditions including
cancer, cardiovascular disease and respiratory illness. Even
though AIHW figures show that smoking rates steadily
declined between 1991 and 2007, tobacco use is the single
most preventable cause of ill-health and death in Australia,
contributing an estimated 7.8 per cent of the total burden
of disease. This equates to more drug-related hospitalisations
and deaths than alcohol and illicit drug use combined.
According to the AIHW’s 2007 National drug strategy
Figure 5.5 Lifetime smokers household survey, males had their first full cigarette at age 15.2 years on average
generally start smoking during youth.
and females at 16.5 years (figure 5.5). Rates of smoking among young people are
Percentage of population
25
20 Males
Females
15
10
0
15–17 18–24
Age group
Figure 5.6 Proportion of current smokers by age and sex, 2011–12
Source: ABS, Australian health survey: first results, 2011–12.
Alcohol use
Youth is a stage when many people experiment with alcohol consumption. In
moderation, alcohol consumption causes few health problems. However, excessive
alcohol intake — such as binge drinking — during youth is associated with higher
rates of injury deaths and violence, can impact on brain development, and increases
the risk of alcohol-related problems later in life.
The AIHW in 2008 estimated that harm from alcohol was the cause of 3.8 per cent
of the burden of disease for males and 0.7 per cent for females, ranking it sixth in
terms of causes of burden of disease.
Youth under the age of 18 are recommended not to consume any alcohol as their
bodies and brains are experiencing rapid development. For youth aged 18, in order
to reduce the risk associated with alcohol consumption, the Department of Health
and Ageing recommends not consuming more than:
• two standard drinks on any day (to reduce lifetime risk)
• four standard drinks on any day (to reduce short-term risks).
It also states that:
• Drinkers under the age of 15 years are much more likely than older drinkers to
undertake risky or antisocial behaviour connected with their drinking.
• Risky behaviour is more likely among drinkers aged 15 to 17 years than older
drinkers. If drinking does occur in this age group, it should be at a low-risk level
and in a safe environment supervised by adults.

Standard drink guide
eLesson:
Teenage alcohol
1.1 1.6 0.8 1.2 0.6 0.9

285 mL 425 mL 285 mL 425 mL 285 mL 425 mL
Full strength beer Mid strength beer Light beer
4.9% alc/vol 3.5% alc/vol 2.7% alc /vol
MID LIGHT
BEER BEER BEER
MID LIGHT
BEER BEER BEER
1.5 1 0.8
375 mL 375 mL 375 mL
Full strength beer Mid strength beer Light beer
4.9% alc/vol 3.5% alc/vol 2.7% alc /vol
Spirits
Pre-mix
Spirits
1.5 1.2 1 22 1
375 mL 300 mL 30 mL 700 mL 30 mL
Pre-mix spirits Pre-mix spirits Spirit nip Bottle of spirits Spirit shot
5% alc/vol 5% alc/vol 40% alc/vol 40% alc/vol 40% alc/vol
1 1.5 1.5 7.5

60 mL 170 mL 150 mL 750 mL
Figure 5.7 Common examples of
Sherry glass Average serve of Average serve Bottle of wine
alcoholic drinks and the number of
20% alc/vol sparkling wine/ of wine 12.5% alc/vol
standard drinks contained in each
champagne 12.5% alc/vol
Source: Adapted from ‘The Australian standard
11.5% alc/vol
drink’, www.alcohol.gov.au.
Standard drink information is printed on all prepacked alcohol containers

(figure 5.7). Table 5.2 shows how many standard drinks are harmful to people over
18 years of age. This information is supposed to act as a guide only, because
everyone is different. The way that the body breaks alcohol down depends on body
weight, metabolic rates, food consumed and gender. The proportion of young
people who drink to risky levels is shown in figure 5.8.

Table 5.2 Alcohol consumption associated with harm among people over 18 years
Alcohol consumption
associated with harm Short-term harm Long-term harm
Risky High-risk Risky High-risk
Males 7 to 10 standard drinks on 11 or more standard drinks 29 to 42 standard drinks 43 or more standard drinks
any one day on any one day per week per week
Females 5 to 6 standard drinks on 7 or more standard drinks 15 to 28 standard drinks 29 or more standard drinks
any one day on any one day per week per week
Source: Australian Institute of Health and Welfare 2007, Young Australians: their health and wellbeing 2007, cat. no. PHE 87, Canberra, p. 83.
100
Abstained/low risk
90
Risky/high risk
80
70
60
Per cent
50
40
30
20
10
0
12–17 years 18–24 years 12–17 years 18–24 years
Short-term harm Long-term harm
Figure 5.8 Proportion of young people who drink at risky or high-risk levels for short- or
long-term harm, 2007
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE 87,
Canberra.
As most youth are not of legal drinking age, the environment in which they
drink can promote or discourage excessive alcohol consumption. The places where
youth consume alcohol are detailed in table 5.3.
Table 5.3 Usual place of alcohol consumption by age group, 2010
Age group (years)

Place 12–15 16–17 18–19 20–29
In my home 35.1 36.1 50.7 70.9
At friend’s house 37.1 49.2 58.7 56.9
At private parties 59.2 72.4 61.1 50.6
At licensed premises 1.1 7.7 71.2 62.9
At restaurants/cafes 2.5 4.8 35.9 46.2
At workplace – 0.9 4.6 5.9
At raves/dance parties 8.6 16.9 28.8 15.4
In public places 12.9 9.6 8.2 6.2
In a car 1.4 5.2 6.8 4.4
At school/TAFE/university, etc. 0.7 0.6 5.9 3.2
Somewhere else 16.0 7.3 5.1 3.4
Notes
1. Base is recent drinkers.
2. Respondents could select more than one response.
survey: detailed findings, p. 84.

Case study
Bingeing women ‘take risks’ ‘Binge drinking results in a decreased ability to make
clear decisions and can enable individuals to engage in
By Mario Xuereb behaviours that they would not if sober,’ said Geetanjali
Chander, an assistant professor at Johns Hopkins.
Women who binge drink are far more likely to
‘Regardless of why they choose to drink, many people
catch sexually transmitted diseases and agree to
do not perceive the potential risk or harm that may result
risky sex acts they would otherwise avoid, warns a new from binge drinking,’ Professor Chander said.
study. The director of the Centre for Adolescent Heath at
Those who drank more than five alcoholic drinks in Melbourne’s Royal Children’s Hospital, Susan Sawyer,
one session were most at risk, according to researchers said the results were not surprising.
at Johns Hopkins University in the US. ‘This reinforces the need to think seriously about not
Binge drinking increases the risk of women just youth patterns of alcohol consumption, but adult
contracting gonorrhoea and participating in sex acts — patterns of drinking,’ she said.
such as anal sex — to which they would not usually A report into young Victorians’ sex lives by the
consent, the study found. centre, Family Planning Victoria and the Royal
The study, to be published in the journal Alcoholism: Women’s Hospital said 25 per cent of sexually active
Clinical & Experimental Research, monitored patients students reported they were drunk or high during their
of a sexually transmitted diseases clinic over 13 most recent sexual encounter.
months. They interviewed 671 people being treated for Professor Sawyer said that over recent years women
STDs, most of whom were heterosexual. were tending to drink more than previous generations.
Women binge drinkers were five times more likely to ‘Of equal concern is that we know when young
contract gonorrhoea than other women. They were also people are extremely drunk they are at much greater
three times more likely to have anal sex, and twice as risk of sexual assault and other behaviours that normally
likely to have several partners compared with teetotal they’d view as regrettable,’ she said.
women. Source: Sunday Age, 7 September 2008.
Case study review

1 What health issues are of particular concern for binge-drinking women?
2 Explain why binge-drinking women are more likely to take risks than those
who do not binge drink.
3 What gender-specific issues can you think of that affect men who binge
drink?
Illicit substance use

Youth is a common time to experiment with drugs and other substances. If misused,
these substances can lead to a range of short- and long-term effects on health and
individual human development. Although the impacts will depend on the type of
drug, how it is taken and the duration of use, some common impacts include social eLesson:
isolation, mental illness, poor academic performance, unemployment, increased Marijuana madness
rate of criminal behaviour and family breakdown. Those who experiment with Searchlight ID: eles-0227
substances during youth are more likely to develop substance abuse issues later in
life, which further increases the risk of health conditions.
Some of the common substances used during youth include marijuana,
amphetamines (including ecstasy and crystal meth), cocaine and heroin.
The reasons for trying drugs are complex. Like most risk-taking behaviours, drug
use arises from a combination of factors. Reasons for trying illicit drugs are shown
in table 5.4, and the rates of drug use among young people are shown in table 5.5.

Table 5.4 Factors influencing first use of any illicit drug, lifetime users aged 14 years or older,
by sex, 2010
Males % Females % Persons %
Factor 2010 2010 2010
Curiosity 78.8 79.3 79.0

Peer pressure 47.6 50.2 48.8
To do something exciting 20.3 19.7 20.0
To enhance an experience 12.6 13.0 12.8
To take a risk 8.8 9.1 8.9
To feel better 5.5 6.6 5.9
Family, relationship, work or school 4.6 5.9 5.2
problems
Don’t know/can’t say 2.8 2.1 2.5
Traumatic experience 2.1 4.0 2.9
To lose weight 0.5 1.5 1.0
Other 2.7 1.8 2.3
Notes
1. Base is those who had used an illicit drug in their lifetime.
2. Respondents could select more than one response.
Source: Australian Institute of Health and Welfare 2011. 2010 National drug strategy household survey report. Drug
statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 169.
Table 5.5 Illicit drug use by age, 2010
Period 14–17 18–19 20–29
In lifetime 18.7 37.0 51.3

In the last 12 months 14.5 25.1 27.5
In the last month 6.0 16.1 14.9
In the last week 2.3 9.8 9.0
Source: Australian Institute of Health and Welfare 2011. 2010 National drug strategy household survey report. Drug
statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 87.
STI Prevention
Youth is often a time of sexual exploration (figure 5.9), and this can have both
short- and long-term effects on young people. If youth participate in unsafe sex,
they may expose themselves to a range of sexually transmissible infections (STIs).
70 STIs are passed from one person to another through sexual contact.
Males
60 Females
This includes oral, genital and anal sex.
Persons Many STIs, such as chlamydia and syphilis, can have long-term
50 effects on health and development if not treated. Treatment is often
40 not sought as the condition may not have obvious symptoms. Other
Per cent
STIs, such as herpes and human immunodeficiency virus (HIV),

30
are incurable and can impact on health throughout the rest of the
20 individual’s life.
According to the AIHW (2011), youth may be at an increased risk
10
of STIs due to a lack knowledge about these conditions, inconsistency
0 with condom use, and lack of communication and negotiation skills
Year 10 Year 12 Year 10 Year 12
which can make using condoms difficult.
2002 2008
As many youths have not decided on a long-term partner, there
Figure 5.9 Students in Year 10 and 12 who have ever
is potential for STIs to spread at high rates in these age groups.
had sexual intercourse, 2002 and 2008
Source: Australian Institute of Health and Welfare, Young Australians:
Chlamydia, for example, is particularly common among youth, and the
their health and wellbeing 2011, p. 81. rates have increased in recent years (see figure 5.10).

1400
Males
1200 Females
Persons
Notifications per 100 000
1000
young people
800
600
400
200
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Figure 5.10 Chlamydia notification rates among young people aged 12 to 24 years, 1998–2008
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE 140,
Canberra, p. 52.
The prevention of STIs is important to promote the health and individual

human development of youth in Australia. Avoiding sexual contact is the safest
way to prevent contracting an STI. For those who are sexually active, using a
condom during sexual contact can reduce the risk of contracting an STI. In 2008,
32 per cent of sexually active students did not use a condom at their most recent
sexual encounter (AIHW, 2011).
Case study
Youth chlamydia rate on University of Sydney researcher Melissa Kang, who

is presenting the findings at the Australasian Sexual
the rise Health Conference currently being held on the Gold
Coast, says a worrying development has been the
By Michael Turtle, youth affairs reporter
increasing lack of concern young people have shown to
Health professionals are trying to cope with an explo- contracting the infection.
sion in the rate of chlamydia infections in Australia, ‘One of the statistics that I feel worried about from
particularly among young people. our research is that nearly three-quarters of young
The sexually transmitted disease, which can lead people said that they didn’t care if they had chlamydia
to infertility, often has no symptoms and poses a or not,’ she said.
challenge for screening programs. ‘Even if they thought they were at risk, they didn’t
In the last five years infection rates in Australia have care about it.’
almost doubled. Dr Kang says some young people are not getting
Every year since 1999, when national data started tested because they did not know where or how to best
being collected, the figure has gone up and it is quite go about it, while others are worried about the cost.
likely that many young Australians are living with the She says another deterrent is related to embarrassment.
infection without realising because quite often there are ‘They’re feeling embarrassed, perhaps worried
no obvious symptoms. about having a positive diagnosis, worrying about
A new survey of university students has found that confidentiality and actually talking to the doctor or the
only a quarter of sexually active people had ever been health provider about their sexual history, those sort of
tested for chlamydia. things,’ she said.
(continued)

It is that attitude that has prompted renewed calls for a

national screening program for all young people at risk to
be automatically tested by general practitioners (GP).
However, researcher and rural GP Natasha Pavalan says
many doctors are currently confused about when they
should be testing patients.
‘I guess it’s not yet entirely clear to the broad spectrum
of GPs that chlamydia screening as such is expected of
them or is part of their role,’ she said.
‘In the research we’ve done, the GPs are pretty clear that
if it was made clear to them that that was their role, they
would be more than happy to do it. They do feel that it is an
appropriate thing for GPs to be expected to do.’
Dr Pavalan says young female doctors are more likely
to encourage patients to be tested for chlamydia probably
because they understand the issues better themselves.
Figure 5.11 Testing for many STIs requires a simple
Screening of partners blood test.
Another problem present with an ad hoc system of
testing is informing the sexual partners of an infected
person that they should also get checked. ‘If a program is developed, it needs to be clear whose
‘Both the individual GP and the individual patients role that is and how it should be done.’
are thinking primarily about that person in front of But according to Dr Kang, one of the biggest hurdles
them and that comes through strongly in the women we the health system faces in tackling chlamydia is getting
interviewed as well,’ Dr Pavalan said. young people to the doctor in the first place.
‘They’re much more concerned with getting ‘We know that young people don’t access their
themselves sorted than they are with their partners.’ doctor anyway,’ she said.
Notifying previous and current partners is essential
‘That they’re not likely to go to a GP for any sort of
to reduce the rates of infection.
health concerns.’
Dr Pavalan found many doctors are confused about
Dr Kang has also done research on new and inno-
the current system though and do not understand what
vative ways to reach young sexually active Australians.
is required of them.
She also asked them whether it should be the GP’s She is working on a project that uses the internet
role to inform partners and she heard concerns about to connect them straight into doctors who can give
privacy and cost. advice.
‘GPs were also concerned about the potential if they Other projects being presented at the conference on
were expected to do those occasions, then how much the Gold Coast have found success in using sporting
time is that going to take for a medic’s time that’s not clubs and music to encourage young people to get
paid as part of their core business and how much time tests.
would it take their staff,’ Dr Pavalan said. Source: ABC News, 8 October 2007, www.abc.net.au.
Case study review

1 Why is chlamydia a particular concern for youth?
2 Brainstorm the determinants of health and individual human development
that may make youth more likely to contract chlamydia compared to
individuals of other ages.
3 What advice would you give to young people to assist them in avoiding
chlamydia?
4 Discuss why young people might be reluctant to get tested for chlamydia.
5 Do you think doctors should be able to tell the sexual partners of patients
infected with chlamydia? Why?

1 Explain why each of the following are a significant 9 Devise a strategy that could be implemented to
health issue for youth: reduce the rates of overweight and obesity in
(a) weight issues school-aged children.
(b) injury 10 Design a poster that could be used to reduce the
(c) tobacco smoking risk of injury among youth.
(d) alcohol use 11 What factors have led to the decrease in smoking
(e) illicit substance use rates since 1991?
(f) STI prevention 12 Do you agree with parents allowing youth to drink
2 Use a concept map to brainstorm the possible alcohol? Explain your response.
impacts of obesity on the health and individual 13 (a) Are youth more likely to be at risk of short-
human development of youth. Be sure to address or long-term effects on their health from
all dimensions of health and individual human consuming alcohol?
development in your answer. (b) Why would this be the case?
3 Why might overweight or obese people be more 14 (a) Create a list of consequences that would be
susceptible to psychological distress? considered short-term effects of heavy drinking.
4 (a) Explain how physical activity levels change as (b) Create a list of consequences that would be
people get older according to table 5.1. considered long-term effects of heavy drinking.
(b) Discuss factors that may contribute to these 15 Why might alcohol consumption cause more
patterns. disability adjusted life years (DALYs) for males
5 Suggest two ways that injuries among youth could compared to females?
impact on the health and/or individual human 16 Brainstorm a list of determinants that could
development of their family. decrease the risk of tobacco smoking, alcohol use or
6 (a) What percentage of young people drink in their illicit substance use.
own home? 17 Devise a strategy that could be used to reduce
(b) Does this mean that parents are supporting their tobacco, alcohol or drug use among youth.
child’s drinking? Explain. 18 What factors could account for the rising rates of
7 (a) Identify two changes in the patterns of where chlamydia over time?
people drink as they move from the youth stage 19 What determinants of health and development
to the early adulthood stage of the lifespan. could increase the risk of youth contracting an STI?
(b) Discuss possible reasons for these changes and 20 Brainstorm ways that contracting an STI could impact
share your results in small groups. on the health and development of a young person.
8 What were the main reasons for individuals trying 21 Use the Ask 500 weblink in your eBookPLUS to
illicit drugs? answer the following questions. eBook plus
(a) Create an account and set up a survey to
determine the views of people on a youth health
issue.
(b) Check the results in a couple of days and print
the data.
(c) Discuss your results in small groups.

5.2 A health issue in focus: anxiety and depression, part 1
KEY CONCEPT Understanding the key features of one health issue relevant to
Australia’s youth — a description of anxiety and depression and the incidence,
prevalence and changes over time (trends) of mental illness
Mental health and, in particular, anxiety and

depression, have been selected as a focus issue for
Anxiety
this chapter. This section presents a detailed look
at the issue and contains similar information that
should be evident in your own research task.
Attention
deficit
hyperactivity
Eating
disorders
Mental health issues
disorder
(ADHD) Mental health issues affect a large number of
Australians over the course of their lives, and many
of these issues have their origins in the youth stage
Mental of the lifespan.
illnesses/ The term ‘mental illness’ is an umbrella term that
disorders encompasses a number of conditions, including
anxiety and depression. These conditions can
affect the way a person thinks, acts and feels.
Such conditions are also referred to as ‘mental
Bipolar
Schizophrenia
disorder disorders’ (figure 5.12). These disorders have a
set of symptoms that can be used to diagnose and
subsequently treat the condition.
Mental health problems, on the other hand,
Depression have a negative impact on mental health and
may occur as a result of life stresses. These are
often temporary and disappear with time. Mental
health problems are generally not as severe as
Figure 5.12 Common mental mental disorders and do not usually get medically
illnesses/disorders diagnosed.
There are a range of mental illnesses, and the signs and symptoms vary both in
their nature and severity depending on the type experienced. Some mental illnesses
do not greatly interfere with daily life and can be effectively treated. On the other
hand, some can be quite severe. These are known as psychotic mental illnesses.
During a psychotic episode, the individual loses touch with reality and may see,
hear, smell or taste things that are not there.
The rates of mental illness are high among youth and contribute significantly to
the overall burden of disease in this age group.
The incidence, prevalence and trends of

mental illness among youth
According to the Australian Bureau of Statistics, in 2007 about one in four 16–24
year olds had symptoms of a diagnosed mental illness in the previous 12 months.
However, up to 70 per cent of young people do not seek help when they are
feeling mentally unwell (headspace.com.au), so the rates of people suffering from
mental illnesses may be higher than reported.
There have been some fluctuations in the rates of mental illness over time but the
Figure 5.13 Around one in four AIHW found that the overall rates of mental illness have remained fairly constant
people will be affected by mental in the 10 years to 2007 (Making progress: the health, development and wellbeing of
illness. Australia’s children and young people, 2008).

Deaths of young people from mental disorders have steadily decreased from 1997
to 2007 (figure 5.14). Many of these deaths are due to substance use disorders, and
a reduced availability of heroin during this period was largely responsible for the
decline.
4.5
4.0 Males
Females
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Figure 5.14 Deaths from mental and behavioural disorders for young people aged 15–19 by
sex, 1997–2007
Mental disorders contribute more to the burden of disease for youth than any
other condition. Of the conditions included under the ‘mental disorders’ umbrella,
anxiety and depression are the two most common among both male and female
Australian youth and will therefore form the focus of the exploration of this issue
(table 5.6).
Table 5.6 Burden (YLL, YLD and DALYs) of major disease groups for 15–24 year olds, 2003
DALYs % of DALYs % of
Rank Males (000) DALYs Females (000) DALYs
1 Anxiety and 17 868 17.4 Anxiety and 29 946 31.8

depression depression
2 Road traffic accidents 10 380 10.1 Asthma 6 641 7.1
3 Schizophrenia 9 795 9.6 Migraine 6 217 6.6
4 Suicide and self- 7 320 7.1 Other genito-urinary 5 676 6.0

inflicted injuries diseases
5 Heroin or polydrug 5 657 5.5 Schizophrenia 3 754 4.0

dependence and
harmful use
6 Alcohol dependence 4 848 4.7 Road traffic 3 572 3.8

and harmful use accidents
7 Migraine 3 539 3.5 Personality disorders 2 622 2.8
8 Cannabis dependence 3 520 3.4 Bulimia nervosa 2 576 2.7

and harmful use
9 Personality disorders 3 130 3.1 Bipolar disorder 2 450 2.6
10 Bipolar disorder 2 672 2.6 Anorexia nervosa 2 063 2.2
All causes 102 476 100.0 All causes 93 985 100.0
Source: Australian Institute of Health and Welfare 2007, Young Australians: their health and wellbeing 2007,

Case study
Mental illness ravaging He said far greater levels of family breakdown

than in previous generations were causing significant
nation’s youth emotional turmoil for young people. Parents often
did not recognise that a teenage mood swing could be
By Jill Stark, health reporter
a sign of something more serious. And many young
Alarming new figures have revealed that one in four people suffered in silence, unaware that their distress
young people are battling a mental illness, with many was not normal.
problems triggered by drug and alcohol abuse. ‘This is a national emergency, it’s a huge, big public
The first snapshot of Australia’s mental health in health problem,’ Professor McGorry said. ‘But I’m not
a decade shows Generation Y is being ravaged by sure the sense of urgency from Governments is as great
depression, anxiety disorders and substance abuse. as the need.
Australian Bureau of Statistics data reveals that ‘I don’t think they realise how much investment and
26 per cent of people aged 16 to 24 — about 650 000 political support is needed to address this. Without it
people — suffered mental illnesses last year. I think we’re going to see continuing deterioration.
Anxiety problems, including panic attacks, obsessive Imagine if there was increased level of heart disease or
compulsive disorder and post-traumatic stress, were cancer but the service system was not responding to it;
the most common, with 15 per cent of young people there would be an outcry.’
affected. Around 13 per cent suffered conditions Professor McGorry warned parents that the ABS
related to dependency on alcohol or other drugs such figures could be an underestimate.
as sleeping pills, amphetamines and heroin. A further ‘These are annual prevalence figures so that’s just a
7 per cent had mood illnesses such as depression and one-year snapshot, whereas cumulatively, by the time
bipolar disorder. they get to 25, the risk is even higher.
The figures come after a summit of mental health ‘Everyone who’s got a teenage kid must realise that
experts last week declared a ‘state of emergency’ in they have got a one-in-three chance of developing a
youth mental health. They said young Australians significant mental health problem by the age of 25,’
with mental disorders, many of which develop in he said.
adolescence, were at greater risk of suicide, self-harm Despite the huge demand for help, more than two
and drug addiction because of gaps in treatment. million people did not receive appropriate treatment.
The new figures come from face-to-face interviews David Crosbie, chief executive of the Mental Health
with almost 9000 Australians aged 16 to 85, using Council of Australia, found the findings ‘startling’.
World Health Organisation diagnostic tools. ‘Ten years ago around 38 per cent of people (with
Professor Pat McGorry, head of the Orygen mental illnesses) were getting services, now it’s about
Research Centre and one of Australia’s leading experts 35 per cent, so things are getting worse,’ he said.
on youth mental health, said the figures had not ‘Mental health is really the Cinderella of the health
improved in 10 years, suggesting a systemic failure in system — it’s just not treated as seriously.’
treatment. Source: The Age, 24 October 2008.
Case study review

1 What proportion of young people are reported to suffer from mental
illness?
2 What factors have resulted in no improvement in figures in 10 years,
according to Professor McGorry?
3 David Crosbie suggests that ‘things are getting worse’ because fewer
youths are accessing treatment for mental illness. Suggest possible reasons
for this.

What is anxiety?
Anxiety disorders cover a range of conditions including phobias, panic disorder
and generalised anxiety. Anxiety disorders are characterised by an uneasy emotional
state that may be brought on by an actual or perceived threat
to the safety and wellbeing of the individual (figure 5.15).
Everyone experiences anxiety at one time or another, but if
the anxiety starts to interfere with a person’s normal activities,
an anxiety disorder may be diagnosed. Anxiety disorders
can be treated in a range of ways including medication and
therapy.
What is depression?
Everyone feels sad from time to time, but depression is more
than this. Depression is a debilitating condition in which the
feelings of sadness or worthlessness continue for an extended
period of time. It is usually more severe than just ‘feeling
down’. A person suffering from depression may withdraw
from their normal activities, suffer from sleep disturbances
Figure 5.15 Stressful experiences
and experience a decreased or increased appetite which can such as bullying can be a risk factor
impact on health and individual human development. for anxiety and depression.
TEST your knowledge 9 Using books and the internet, conduct research to
find information relating to an issue of your choice.
1 (a) Explain what the term ‘mental illness’ means.
Arrange this information into paragraphs and
(b) What does the term ‘mental health problems’
diagrams to produce an explanation of what the
refer to?
issue is.
(c) Outline the difference between these terms.
10 Use the Young Australians weblink in your
2 (a) What is a psychotic episode?
eBookPLUS to find the link for this question.
(b) Why would these be considered more severe
(a) Search this and other websites and
than other mental illnesses?
documents for incidence, prevalence and
3 According to table 5.6, what percentage of DALYs
trend data* relating to a health issue of your
are attributable to anxiety and depression for males
choice. Make sure your data relates to Australian
and females respectively?
youth.
4 (a) According to headspace, what percentage of
(b) What challenges were you presented with
young people do not seek help when they are
when searching for data? Brainstorm ways
feeling mentally unwell?
these hallenges could be eliminated or
decreased.
5 Explain the difference between anxiety and
(c) What other websites did you use to find
depression.
information, and what factors did you use to
make judgements on the authenticity of the data?
APPLY your knowledge (d) i. Suggest three other sources of information
6 Would the statistics in table 5.6 be completely where data regarding this issue could be
accurate? Explain. gathered.
7 (a) Which causes in table 5.6 have a relationship ii. If possible, access these sources and add
with mental illness? any extra information to your previous
(b) What percentage of DALYs do they contribute research.

*Note that if no trend data is presented, you can try searching older
for males and females respectively?
releases of Young Australians: their health and wellbeing to collect
8 (a) Describe one trend from figure 5.14. older data. These figures can then be compared to current statistics to
(b) Suggest reasons for this trend. determine any trends.

KEY CONCEPT Understanding the key features of one health issue relevant to
Australia’s youth — the impact of anxiety and depression on all dimensions of
health and individual human development and the determinants of health that
act as risk and/or protective factors for anxiety and depression
Anxiety and depression can have a range of effects on health and individual human
development, depending on the severity being experienced. The determinants
of health and development that act as risk and protective factors for anxiety and
depression can also vary considerably from person to person. The effects of anxiety
and depression, as well as determinants that act as protective and risk factors, will
be explored in this section.
The impact of anxiety and depression

on health
Anxiety and depression can affect health in a number of ways, as listed below.
Physical health
• Self-harm — people suffering from depression may be prone to hurting
themselves or to attempt suicide. Taking pills and cutting oneself are two
common forms of self-harm with direct effects on physical health.
• Lack of sleep — individuals experiencing depression may have disturbed sleep
patterns. The body might not be adequately rested and they may therefore be
unable to cope with day-to-day tasks.
• Lack of physical activity — a person who withdraws from regular activities
might not get enough physical activity. This can mean that the body is not in an
optimal state.
• Substance and alcohol abuse — people experiencing anxiety and depression are
more likely to abuse drugs and alcohol, which can affect the body’s systems.
Social health
• Social isolation — many individuals suffering
from anxiety and depression will remove
themselves from social interactions. This
may impact on the friendship network of
the individual and magnify the effects of the
condition.
• Strained family relationships — family
life may be interrupted during depressive
episodes. Family bonds might become weaker
as a result.
Mental health
• Poorer quality of life — people suffering from
anxiety or depression often back away from
the things in life that used to make them
happy. This can lead to a lower quality of life
Figure 5.16 Individuals suffering
and a continuing cycle of negative thoughts
from anxiety and depression may that can contribute to an increased risk of
isolate themselves from others. suicide and self-harm.

The impact of anxiety and depression on
Anxiety and depression can also affect the four dimensions of individual human
development in the ways outlined below.
• Impaired development from lack of nutrition — youth is a stage of rapid growth,
so nutrition is very important. If the youth suffers from a loss of appetite, they
may not get adequate nutrients to meet the requirements for growth.
• A lack of physical activity may impact on bone density and growth as weight-
bearing exercise is important for strong bones.
Social development
• Forgone social experiences — important experiences such
as associating with members of the opposite sex and rites
of passage such as school formals assist in developing the
young person’s social skills (figure 5.17). If they miss out
on these experiences, their social skills may not develop as
well as they could have.
• Impacts on self-esteem and confidence — people suffering
from ongoing anxiety or depression are less likely to
be employed than those who do not suffer from one of
these conditions. Employment can promote feelings of
satisfaction and can lead to a more positive self-concept. Figure 5.17 Youths with mental
Unemployment can have the opposite effect. illness may miss out on important
social events, and this loss can affect
their health and development.
• Higher school dropout rates — according to the Australian Institute of Health
and Welfare, youth suffering from mental illness are less likely to finish
secondary school than those without a mental illness. Many important skills that
are normally learned at school may not be attained.
• Lack of concentration at school — a student in poor mental health may not
concentrate as much at school. They may also not complete homework tasks,
and this can affect intellectual development.
Determinants of health that act as risk and/or

protective factors
Anxiety and depression are often diagnosed for the first time in youth or early
adulthood. Research suggests that 75 per cent of mental health disorders begin
before the age of 25 years (www.headspace.org.au). In fact, the causes can reach
back into early childhood or even prenatally. While the exact causes of these
conditions are unknown, there are many determinants that can contribute to or
protect an individual from anxiety and depression, so it is most likely that these
conditions arise from a combination of factors.
Anxiety and depression can increase the chances of risky health behaviours such
as self-harm, social withdrawal and substance abuse. These in turn can intensify the Figure 5.18 Physical activity is a
cycle of mental ill-health. Some specific determinants that act as risk and protective protective factor for anxiety and
factors include the following. depression.

Biological
• Genetic factors — those with a family history of mental illness are more likely to
develop a mental illness themselves.
• Prenatal brain damage — damage caused during the prenatal period from injury
or teratogens (agents that can cause birth defects) can raise the risk of anxiety
and depression.
• Body weight — those who are overweight and/or obese are more likely to
develop anxiety and depression.
Behavioural
• Substance use — use of illicit drugs is linked to depression.
• Food intake — adequate nutrition acts to keep the body and mind in optimal
condition, which may help protect individuals from anxiety and depression.
• Physical activity — physical activity has been shown to reduce feelings of stress,
depression and anxiety (figure 5.18).
• Access to recreational facilities — youth without access to recreational facilities
may not have many opportunities for physical activity and/or the opportunity to
participate in activities that they value. This can lead to increased rates of anxiety
and depression.
• Work environment — an unsafe work environment can increase the risk of
injury among youth and, as a result, can be a source of anxiety.
Social environment
• Family situation — a supportive family life, free from conflict and abuse, is a
protective factor for anxiety and depression (figure 5.19).
• Early life experiences — negative experiences early in life are a risk factor for
mental illness.
• Socioeconomic situation — those in a lower socioeconomic situation are more
likely to develop anxiety or depression.
• Conflict between parents — this can lead to an unstable family situation, which
is a risk factor for anxiety and depression.
Figure 5.19 A supportive family is

a protective factor for anxiety and
depression.

• Failure to achieve academically — those who do not achieve academically are
more likely to have a mental illness such as anxiety or depression. As with all
risk factors, it is difficult to say whether the mental illness contributes to low
academic achievement or vice versa.
• Social networks — those with good social networks are less likely to develop a
mental illness.
• Social harmony — social harmony is a protective factor for mental illness.
• Social isolation — this is both a risk factor for, and a consequence of, mental
illness.
• School environment — bullying can increase the chances of mental illness such
as anxiety or depression. A supportive school environment can be a protective
factor for mental illness.
TEST your knowledge (b) Is it possible that Mike has a mental illness?
Discuss.
1 List five risk factors for anxiety and depression.
(c) Explain how Mike’s current situation may affect
2 List five protective factors for anxiety and
his health and individual human development.
depression.
(d) Suggest ways that Mike could improve his
mental health.
8 On your own or with a partner, select an issue
3 Select one effect that anxiety or depression can affecting youth (your teacher may also decide to
have on any area of health and discuss how this choose one issue for the class to consider).
could flow on to the other areas of health and (a) Use a concept map or summary table to
individual human development. brainstorm:
4 Select one effect that anxiety or depression can i. the possible impacts of this issue on all
have on any area of individual human development dimensions of health and individual human
and discuss how this could flow on to the other development
areas of health and individual human development. ii. the determinants of health and development
5 Why is it difficult to say whether the risk factor that may contribute to the selected issue.
leads to anxiety and depression, or vice versa? (b) Which determinant do you think has the
6 Why would it nearly always be a combination of greatest influence? Justify your choice and
factors that lead to anxiety or depression? discuss your responses with the rest of
7 Mike is 18 and has been experimenting with drugs the class.
and alcohol for the past three years. In the past 9 Use the Mental health case studies weblink
few months he has been feeling depressed and has in your eBookPLUS to find the link for this
lost his usual enthusiasm for life. As a result, he has question.
dropped out of his TAFE course and quit his part- (a) Read through some personal accounts of young
time job. Mike now relies on financial government people with mental health issues.
assistance but this has not been enough to support (b) Discuss these in small groups and identify ways
his lifestyle. At the moment he spends most of his that each individual’s health and development
days sitting around the house that he shares with has been or may be affected by their situation.
three friends, who are also alcohol and drug users. (c) Summarise the advice that has been provided by
(a) Identify the determinants of health and others to assist these individuals.
individual human development that may be (d) Brainstorm other ways that these individuals
affecting Mike. could improve their mental health.

KEY CONCEPT Understanding the key features of one health issue relevant
to Australia’s youth — government, community and personal strategies or
programs designed to promote the health and development of youth, health
care services available to youth and the rights and responsibilities of youth in
accessing and using relevant services
Both anxiety and depression have been the subject of numerous strategies that aim
to improve the health and individual human development of those experiencing
these conditions.
Australia’s health system also provides opportunities for youth to seek care
relating to their mental health and there are a range of rights and responsibilities
that apply to youth accessing these services.
Strategies and programs designed to promote

mental health
Mental illnesses such as anxiety and depression have been increasingly in the
public spotlight in recent years. Despite this, many young people suffering from
these conditions do not seek or receive help.
There are many government and community strategies and programs aimed at
reducing the rates of anxiety and depression, and improving the overall mental
health of Australians. Some are focused on youth in particular, while others are
aimed at the whole population. Some of these strategies and programs focus on the
stigma attached to mental illness while others aim to improve personal
skills, early detection and/or treatment.
Government and community strategies/programs

SANE Australia
SANE Australia is a national charity working for a better life for people
affected by mental illness, including anxiety and depression. Through
education and campaigning, SANE aims to assist those with mental illness
as well as their families. SANE provides a helpline for those dealing with
mental illness and educational resources such as books, DVDs and online
resources (figure 5.20).
Figure 5.20 SANE Australia is a SANE also acts to reduce the stigma associated with mental illness through
national charity working for a better strategies such as ‘Stigmawatch’, where media that promote stigma associated
life for Australians affected by mental with mental illness are contacted with an explanation of the damage that can be done
illness. by promoting such views. Stigmawatch also congratulates media for good coverage.
ebsite: www.sane.org
w
Helpline: 1800 18 SANE (7263)
Youthbeyondblue
Youthbeyondblue is the youth arm of beyondblue and focuses on young people aged
12 to 25 years. Youthbeyondblue aims to raise awareness of depression and anxiety
by reassuring young people that it’s okay to talk about depression and anxiety, and
to get help when it’s needed.
Youthbeyondblue.com provides an informative website with information for
young people about depression and anxiety, and where to get help. Youthbeyondblue
also provides young people with an opportunity to share their experiences of
depression and anxiety, their ideas and thoughts, and general information about
getting help and getting better. In this forum, young people can also respond to
Figure 5.21 The beyondblue logo other people’s stories.

Case study
Fewer people receiving such services, and that those missing out, men and
young people, were seeing little improvement in their
mental health treatment treatment.
‘We were shocked in 1997 to find that only 38 per
By Adam Cresswell, health editor
cent had access to services in the past year,’ Professor
A smaller proportion of people with a chronic Hickie said.
mental health condition is getting treatment now ‘Once that became clear, it became a goal to increase
than 10 years ago — a finding that has shocked access to care. If we were shocked in 1997, we are
experts and called into question the effectiveness staggered now. We should never have gone for 10 years
of the $1.8 billion poured into the neglected sector without knowing whether all the money we were
since 2006. spending was having any effect.’
National figures published by the Australian Bureau Professor Hickie called for new and innovative
of Statistics yesterday show that of the 3.2 million policies, such as delivering more mental health
people who had a mental health disorder in the previous care through community services, and better use of
12 months, only 35 per cent obtained treatment communications technologies and private providers.
services — less than the 38 per cent reported in the The study, conducted between August and December
previous survey in 1997. last year, indicated no reduction in the need for mental
And 2.1 million Australians recorded in the latest health treatment. It found 45 per cent of Australians
survey as having had a mental problem in the previous would experience a mental health problem at some
year did not use the health services, but felt they had stage in their lives, and that 20 per cent had a mental
missed out. problem in the past year.
The figures, contained in the latest National Survey Among people aged 16–24, the rate was more than
of Mental Health and Wellbeing, have prompted calls a quarter.
for a rethink of mental health policies. Mental Health Council of Australia chief David
Brain and Mind Research Institute executive Crosbie said the figures were deplorable.
director Ian Hickie, a long-standing advocate of ‘When you think it’s no better than it was 10 years
reform in mental health services, said many experts ago, and with all the investment and the rejigging of the
had expected the access figure to rise to at least 50 per existing system and the talk about reform, you have to
cent after the huge cash injections of recent years, wonder if it reaches real people in real communities,’
including the $1.8 billion package pledged by John he said.
Howard in 2006 and subsequent announcements by ‘As well as supporting the current system, we
most states. need a lot more new and different services, and
But Professor Hickie said that instead the report community-based services. The bottom line is we
showed Australia had been tipping ‘new money into are just not reaching people with a mental health
old services’ such as GP consultations. This meant disorder.’
the people benefiting the most, middle-aged women,
were the same people who had always most used Source: The Australian, 24 October 2008.
Case study review

1 (a) How has Australia poured ‘new money into old services’ according
to Professor Hickie?
(b) Who was most likely to benefit from this?
2 (a) What ‘new and innovative policies’ does Professor Hickie
call for?
(b) With a partner, select one of these suggestions and devise a plan for
implementing it.

Personal strategies that promote

mental health
As well as the government and community strategies and programs
put in place to combat anxiety and depression, there are a number of
things that individuals can do to promote their own mental wellbeing.
They include:
• Communicating with friends and family — this is a very effective
way of promoting mental health (figure 5.22). Effective communication
means that individuals can discuss their problems and solve issues
before they become seemingly unmanageable.
• Seeking help from medical professionals — this assists in
promoting mental health. Mental health problems can therefore be
professionally identified before they develop into clinical anxiety or
depression.
• Taking time for relaxation enhances mental wellbeing — strategies
such as undertaking hobbies, exercise and meditation can all help
Figure 5.22 Talking to friends and
family can improve mental wellbeing.
with relaxation.
Strengthening the protective factors already mentioned is obviously
a key determinant in mental health promotion.
Mental health care services available to youth

As well as government, community and personal programs and strategies, youth
can access a range of health care services for both preventative and curative mental
health care. In Australia, mental health care services are provided in a number
of ways, including general practitioners, specialists such as psychologists and
psychiatrists, and hospital care. Many of these services are either fully or partially
funded through Medicare.
Medicare
Medicare is Australia’s universal health-insurance scheme. Established in 1984, it
gives all Australian citizens, permanent residents and people from countries with
a reciprocal agreement access to health care that is subsidised by the government.
Countries with a reciprocal agreement include New Zealand, the United Kingdom,
the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Malta and Norway.
As a result of this agreement, Australian citizens can also access subsidised health
care in those countries if they require treatment while abroad.
Youth aged 15 and over are able to apply for their own Medicare card. A
Medicare card can be used for:
• making a Medicare claim for a paid or unpaid doctor’s account
• visiting a doctor who bulk bills
• getting treatment as a public patient in a public hospital
• filling a Pharmaceutical Benefits Scheme prescription at a pharmacy
Youth enrolled in Medicare can receive subsidised treatment for a range of health
services including:
• doctors’ consultations (including specialists) and associated treatments
• tests and examinations by doctors
• x-rays and pathology tests
• eye tests performed by optometrists
• free treatment in public hospitals
• subsidised treatment in private hospitals.
Medicare covers most ‘clinically necessary’ hospital and doctors’ fees. Any
cosmetic or elective procedures are generally not covered. Other services not covered

by Medicare include dental examinations, home nursing treatment and ambulance
services. A number of treatments that exist in addition to mainstream medicine are also
generally not covered by Medicare. Some of these services are referred to as allied
health services and include physiotherapy, occupational therapy, speech therapy, eye
therapy, podiatry and psychology. Complementary health services are also generally
not covered and include chiropractic services, acupuncture and hypnotherapy.
Allied and alternative health services may be covered by Medicare in some cases,
especially if they are referred by a GP.
General practitioners and specialist services

In relation to mental health, youth can access a range of health services. General
practitioners (GPs) are often the first contact youth have with the health system.
In 2010–11, around 12 per cent of all GP encounters were related to mental
health. GPs provide a range of services including treating mental health issues and
referring individuals to specialists. Mental health specialists include psychologists,
psychiatrists, mental health nurses, occupational therapists, social workers and
Aboriginal health workers. These services are provided in a range of settings;
for example, in hospital, consulting rooms, home visits and over the phone. In
2010–11, over 5.6 million Medicare-subsidised mental health-related services were
provided by psychiatrists, psychologists and other allied health professionals to
over 916 000 patients.
Hospital care
Hospital emergency departments also play a significant role in treating mental
health issues and, in addition to GP consultations, can be the initial point of
contact with the health system for youth. A 2004 Victorian study of emergency
department presentations found that emergency departments were used as an
initial point of care for those seeking mental health-related services for the first
time, as well as an alternative point of care for people seeking after-hours mental
health care (Victorian Government Department of Human Services, 2006). In
2008–09, around 7 per cent of all hospital separations for those aged 12–24 were
related to mental health (AIHW, 2011). Almost two-thirds of the mental health-
related emergency department occasions of service were resolved without the need
for admission or referral. Most of the remaining mental health-related occasions of
service were admitted to hospital.
Rights and responsibilities of youth in using

health services
There are a number of rights and responsibilities that youth have when accessing
health care services to promote health, including those services addressing anxiety
and depression. These rights and responsibilities are established to ensure that
the best possible outcomes are achieved for the individual’s health. Many young
people are not aware of their rights, and this is a contributing factor for youth not
accessing health services.
The rights and responsibilities of youth in accessing health care are outlined below:
• The right to privacy. Any information about an individual must be treated
confidentially. If the doctor deems a young person (under the age of 18) to be
mature, then parents do not have to be informed of consultations or treatment. If
the person is deemed not mature by the doctor, then parents may be informed.
In most cases, those aged 14 years or older demonstrate the maturity to make
their own decisions, but this will of course depend on the individual and the
nature of the consultation and/or treatment.

• The right to a second opinion. Regardless of the illness, all patients have the right
to a second opinion or to be dealt with by a different worker without fear of
victimisation.
• The right to use public health services. Most people residing in Australia have the
right to use Medicare, which can provide treatment free of charge. Those aged
15 and over are entitled to their own Medicare card.
• The right to help develop a treatment plan. Individuals have the right to assist in the
development of a treatment plan that suits them (figure 5.23).
Figure 5.23 Individuals can and

should be involved in devising
treatment plans.
• The right to refuse treatment. A person can usually refuse treatment. However, in
extreme cases, where the individual with a mental illness is a risk to themselves
or the community, they may be held against their will in a psychiatric hospital.
In these cases, the person does not have the right to leave that care but can
appeal against their detention.
• The right to complain about treatment. If the youth feels that their treatment has
not been satisfactory, they can lodge a complaint through the Health Services
Commissioner (www.health.vic.gov.au/hsc).
• The right to have a family member or friend present during consultations. Some
people feel more comfortable with a friend or relative present, and health
workers should respect this right.
• The right to be treated with respect and dignity. All human beings have certain
rights, including the right to dignity and respect. If a person feels that they
have not been treated with dignity and respect, a complaint can be made. In
addition to the range of rights, users of health care services also have a number
of responsibilities that include:
• The responsibility to give accurate accounts of medical history, and behavioural factors.
Health workers cannot decide on the best treatment options if they have only
half the story. It is therefore in the patient’s best interests to be completely honest.
Health workers are there to help, not to judge.
• The responsibility to keep appointments. Appointments can be difficult to get for
certain services. Every time someone fails to keep an appointment, another
person effectively misses out on care.

• The responsibility to tell medical staff if they do not intend to follow treatment. If a
person does not agree with a treatment plan or intends to not follow it, they
should communicate this with their health worker so that a more appropriate
plan can be devised.
• The responsibility to work with medical staff to make the most of the opportunities
available to improve their health. Medical professionals can provide opportunities
to improve health (e.g. by giving advice on how to alter behavioural factors), but
the responsibility to act on these opportunities lies with the patient.
• The responsibility to treat others with respect and dignity. All humans have these
rights and are entitled to be treated in this manner.
• The responsibility to respect the privacy of others. All people receiving and giving
care are entitled to their privacy.
TEST your knowledge 10 (a) Research government and non-government

strategies that are employed to address an issue
1 (a) What is SANE Australia?
of your choice.
(b) How does it promote health and individual
(b) Produce a summary on the strategy and include
human development?
the following information:
2 (a) What is Youthbeyondblue?
i. name of the organisation/level of government
(b) How does it promote the health and individual
ii. aims/goals of the organisation/strategy
human development of those suffering from
iii. a description of how they attempt to achieve
mental illness?
their goals.
3 (a) Explain Medicare.
(c) How can you tell if the strategy is a government
(b) Discuss the range of health care services
or non-government initiative?
available to youth through Medicare.
11 Brainstorm the personal strategies that may assist
4 Does a doctor have to report medical issues to the
youth in reducing the impact of a selected health
parents of young patients? Explain.
issue. Consider the determinants that increase the
APPLY your knowledge risk of the issue when answering this question.
12 Use the Medicare Information weblink in your
5 Why would it be beneficial for an individual to assist eBookPLUS to find the link to this question. eBook plus
in devising their treatment plan? Prepare a brochure that could be used to educate
6 How could you improve your personal skills to assist secondary school students about the services
in the prevention of mental illness? provided under Medicare.
7 Discuss the characteristics a doctor would look for
in evaluating a young person’s maturity.
8 Why is it important to consider getting a second
opinion for any serious condition?
9 (a) Which rights and responsibilities were you
not aware of with regards to accessing health
services?
(b) Would knowledge of these rights and
responsibilities change the way you feel about
accessing health services? Explain.

Key SKILLS Health issues facing Australia’s youth
KEY SKILL Analyse data to draw informed conclusions

about the range of health issues facing Australia’s youth
This key skill requires the ability to use information presented (in the form of
tables, graphs or case studies, for instance) and combine it with existing knowledge
about health and development in order to draw conclusions about issues facing
Australia’s youth.
Whenever using information presented, take time to understand what the
information is saying. If it is presented in graphical form, follow the steps presented
in the skills section at the end of chapter 2. If it is in written form, always re-read
the information carefully. It is easy to miss key information on a first reading.
In the following example, data about the patterns of injury and poisoning
mortality rates over time (figure 5.24) are analysed, trends identified and
conclusions drawn.
80
12–14 years
70 15–19 years
20–24 years
60
50
40
30
20
10
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Figure 5.24 Injury and poisoning death rates for young people aged 12–24 years, 1997–2007
Source: Australian Institute of Health and Welfare, Young Australians: their health and wellbeing, 2011.
Overall, mortality rates due to injury and poisoning have decreased over time.❶
❶ A general statement is made relating
to the trend evident in the graph. Rates for those aged 15–19 decreased from around 45 deaths per 100 000 people
in 1997 to around 25 per 100 000 in 2007.❷ During the same period, mortality
❷ Data are used to support the general rates due to injury and poisoning decreased for those aged 20–24 from around
statement. 65 deaths per 100 000❸ to around 35 per 100 000. The mortality rates for those
aged 12–14 remained fairly stable over time at around 10 per 100 000. The graph
❸ Correct units are used. shows that those aged 12–14 are the least likely to die from injury and poisoning
compared to those aged 15–19 and those aged 20–24. Those aged 20–24 are most
❹ Conclusions are drawn. likely to die from injuries and poisoning of the three age groups.❹


9
Males
8 Females
Persons
0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Figure 5.25 Accidental poisoning death rates for young people aged 12–24 years,
1987–2007
Source: AIHW, Young Australians: their health and wellbeing, 2011.
1 Analyse the data relating to accidental poisoning death rates over time for males
and females and draw a conclusion about the differences between the two
groups.
2 Use the Young Australians weblink in your eBookPLUS to find the eBook plus
link for this question.
(a) Find data relating to an issue of your choice.
(b) Analyse the data and draw a conclusion relating to your selected health issue.
KEY SKILL Describe a specific health issue facing

Australia’s youth
To complete this key skill, you must describe in detail one health issue that faces
Australia’s youth. As the issue of mental health is explored in detail in this chapter
already, it may be useful to explore another issue to demonstrate this key skill.
To give a comprehensive overview, in addition to being able to describe the issue,
it is important to provide any related information.
For example, to describe injuries, it is required to explain what they are, how
they affect the sufferer and their causes. The following is a description of injuries as ❺ The characterising features of injuries
are identified.
a health issue facing Australia’s youth.
‘Injury’ is a term that refers to the physical damage that can occur to the body as
a result of trauma.❺ Examples of injuries affecting youth include drowning, car ❻ Examples related to youth are
identified.
crashes, suicide and poisoning❻. Mortality rates from injuries have declined in
recent years but they still remain the leading cause of death for youth in Australia.❼
During youth, males have significantly higher rates of injury deaths than females. ❼ The reason why injury is considered a
health issue is identified. In this case,
As well as mortality, injuries can result in lifelong disability and contribute it is due to the high rates of mortality
significantly to morbidity. When not fatal, injuries can require hospitalisation and and morbidity.
ongoing treatment, including rehabilitation. Factors such as alcohol and drug use,
risk-taking behaviours and the influence of the peer group can act to increase or ❽ Factors that can increase or decrease
decrease the risk of sustaining injuries.❽ the risk of injuries are identified.

Key skills Health issues facing Australia’s youth

3 Identify and describe one issue for Australia’s youth that has become increasingly
significant in the past 20 years.
4 Identify and describe one issue for Australia’s youth that is more likely to lead to ill
health later in life.
KEY SKILL Gather information on a selected issue related

to youth health using a range of sources such as primary
data, print and electronic material
This key skill encompasses the research component of this outcome. The section
‘Researching your own health issues’ available in your eBookPLUS provides detailed
advice on how to complete this key skill.
Information should be gathered from a range of sources and presented in a
variety of ways including discussions, tables, graphs, and other media such as
podcasts. Information should relate to different aspects of the issue and can include
morbidity (including prevalence and incidence where appropriate), the impact
on mortality, differences between males and females, the amount of money spent
addressing the issue, and strategies devised to address the issue. The data must
relate to youth, although other lifespan stages can be included when they are used
as a basis of comparison with youth.
It is important to record where information comes from, so a source can be
presented for each piece of data and can also be recorded in a bibliography.
In the following example, selected data relating to injuries are presented.
In 2005, the Australian Bureau of Statistics collected information about injuries
❾ When relevant, the data source is sustained in the past four weeks for which an action was taken (for example,
explained.
receiving medical treatment or reducing usual activities).❾ Young people aged
❿ The source of the information is listed. 12–24 were found to have high rates of injury with 23 per cent reporting an injury
in the previous four weeks, second only to children (ABS, National Health Survey,
2004–05).❿
Land transport accidents
Suicide
Undetermined intent
Accidental poisoning
Assault Male
Female
Exposure to other factors
Accidental falls
Accidental drowning
Figure 5.26 Injury and poisoning Other

deaths among young people aged
15–24 years, by external cause of injury 0 5 10 15 20 25 30 35 40
Source: AIHW National Mortality Database. Per cent of external cause of death

Injuries contribute more to mortality for youth in Australia than any other cause,
⓫ A range of sources are used.
with land transport accidents the single greatest cause of injuries, followed by
suicide (AIHW, Young Australians: their health and wellbeing, 2011).⓫ As shown in
⓬ Information relating to hospitalisation
figure 5.26, males experience a greater percentage of injury deaths than females. rates is presented. Note that no
Hospitalisation analysis of the information is required
Rates of hospitalisation due to injuries are shown in figure 5.27.⓬ These for this key skill.
data show that males and females in the 15–19 age group are more likely to be
hospitalised due to injuries compared to those aged 12–14 and 20–24. In all age ⓭ Differences and similarities between
males and females are identified.
groups, males are more likely to be hospitalised than females.⓭,⓮
⓮ Students should state what the data
show rather than merely including a
graph.
4,000
Males
Hospital separations per 100 000 young people
3,500 Females
3,000
2,500
2,000
1,500
1,000
500
0
12–14 15–19 20–24
Age group (years)
Figure 5.27 Injury hospital separation rates for young people 2008–09⓯ ⓯ Information is presented in a range of
Source: AIHW, Young Australians: their health and wellbeing, 2011, p. 35. ways.
⓰ Data on a range of indicators relating

to the issue are presented (although
In the 2008–09 financial year, injury expenditure was around $5.5 billion, to cover an issue such as injuries
representing almost 5 per cent of total allocated health expenditure in that year adequately, more data would be
required than presented in this
(AIHW, Australia’s health 2012).⓰ section).
The TAC produce a range of initiatives including advertising campaigns, with
the aim of reducing the incidence and severity of injuries occurring as a result ⓱ Information relating to prevention,
of road accidents. The Everybody Hurts campaign is an example of this (see treatment or care with regard to the
figure 5.28)⓱ issue can be included.
Everybody hurts when you speed. Figure 5.28 An anti-speeding

advertisement produced by the
Transport Accident Commission
The Everybody Hurts campaign is an advertising strategy aimed at encouraging

people to reduce their speed and therefore their risk of sustaining injuries
on Victorian roads. Everybody Hurts utilises social media such as Facebook to
personalise road safety messages. It also provides a website that contains clips of
the all the different people who are affected by road trauma.


5 For an issue of your choice, collect information relating to:
(a) morbidity (including incidence and prevalence where appropriate), mortality
and burden of disease data
(b) differences between males and females
(c) the amount of money spent addressing the issue
(d) personal, community and/or government strategies or programs designed to
address the issue.

There are many issues facing Australia’s youth. If continual improvements to health status
are to be made, these issues must be addressed. Individuals, communities and governments
implement a range of strategies and programs in order to optimise health and development.
6 List three issues that impact on the health and development of Australia’s youth.
3 marks
7 Select one of the issues identified in question 6 and describe it briefly.
Issue selected _____________ Description __________________________________________
4 marks
KEY SKILL Analyse information on a selected youth health

issue and draw informed conclusions about personal,
community and government strategies and programs to
optimise youth health and development
This key skill requires statements to be made about the information and data that
have been collected on a selected health issue.
To begin an analysis of the issue, examine the trends that have become evident
and the associated impact on youth health and development. In addition, analyse
a range of personal, community and government strategies or programs that have
been implemented to address the issue. Comment on their actual or possible
effectiveness. For this, a critical approach is required. For instance, there may be
financial constraints that prevent the strategy from being more effective than it is.
It is not expected that all comments will be positive. There will no doubt be room
for improvement evident in at least some of them.
In the following example, the data and information on injuries are analysed and
conclusions about the TAC’s ‘Everybody hurts when you speed’ campaign are made.
Although the focus here is on a community program, this skill should also be
applicable to personal and government strategies and programs.
Injury rates are high among Australian youth, with males more likely to
experience injuries than females. In 2008–09, males aged 12–14 and 15–19 were
more than twice as likely to be hospitalised due to injuries compared to females.

For instance, males aged 12–14 experienced a hospitalisation rate of around 2500
⓲ Statements relating to injuries among
hospitalisations per 100 000 people, compared to around 900 hospitalisations per Australian youth are made, with
100 000 people for females.⓲ data from the graph used to provide
Those aged 15–19 were significantly more likely to be hospitalised than those statistical evidence.
aged 12–14. For example, rates for males aged 12–14 were around 2500 per 100 000
compared to rates of around 3500 per 100 000 people for males aged 15–19.⓳ ⓳ Trends relating to hospitalisations
are identified based on the data
Land transport accidents were the most common cause of injury death among presented.
Australian youth in 2007. Around 35 per cent of all injury deaths were due to land
transport accidents, with males accounting for around three-quarters of all land
transport deaths.
The TAC’s ‘Everybody Hurts’ campaign utilises media (including social media) to
⓴ Elements of TAC’s ‘Everybody Hurts’
reach its audience. Young people are often engaged in social media so may be more campaign are discussed.
likely to be exposed to its message. Everybody Hurts aims to educate people by
accessing their social media profiles and making personalised messages relating to Possible limitations of the campaign
the impact of injuries sustained on roads.⓴ are identified.
Not all young people at risk of road injuries access social media and not all will
be exposed to the ‘Everybody Hurts’ message. Youth is a time of risk taking for A conclusion is drawn and points
some individuals and even if they are exposed to the Everybody Hurts campaign, made to support the conclusion.
they may not respond to the message within it.
Overall, the Everybody Hurts campaign is effective as it targets speed, which The likely impact of the campaign is
outlined.
is a major cause of land transport accidents, the major cause of injury death
among young people. The campaign acts to reach young people via media that
they engage in, particularly social media. This may encourage youth to think
twice about risk taking on the road and may decrease the rate of injury death
among youth.

8 Analyse the information you collected for the previous key skill. In doing so, ensure
that you:
(a) make statements summarising the information collected
(b) identify trends
(c) discuss possible impacts on youth as a result of the information collected
(d) draw conclusions about a strategy or program designed to address the issue
(including the likely effectiveness of the strategy or program).
KEY SKILL Identify the range of health care services

available to youth and discuss their rights and responsibilities
in accessing and using these services
The first part of this key skill is identifying the range of health care services available
to youth. Discussion of these services is not necessary but an understanding of
them is essential to ensure that appropriate services are identified for the given
issue or situation. Medicare provides a range of health care services in Australia
and is a key concept for this key skill.
The second part of this skill requires a discussion of the rights and responsibilities
of youth in accessing these services.
In the following example, health care services relating to injuries are identified
and the rights and responsibilities relating to the use of them are discussed.
Health care services available to youth relating to injuries issues include:
• Ambulance services
• General practitioners
• Emergency departments at public hospitals

• Rehabilitation services
A range of services available to youth
are identified. • Allied health professionals such as physiotherapists
Youth have a number of rights and responsibilities when accessing health
A range of rights relating to accessing services, including:
health care services (including • Those aged 15 and over have a right to obtain their own Medicare card and use
Medicare) are discussed. Medicare-funded services. This allows youth to make their own appointments
for consultations and treatments.
A range of responsibilities are • Youth have a right to choose their own general practitioner (GP). Medicare
discussed.
subsidises the cost of GPs’ services regardless of which GP the individual
accesses.
• Youth have a right to have their privacy protected. Consultation and treatment
plans are not discussed with other people. This includes parents, provided the
youth is considered to be mature.
• Youth have a responsibility to be honest with their health care professional with
regards to their medical history and relevant behavioural factors so the most
appropriate type of care can be provided.
• Youth have a responsibility to keep all medical appointments. This assists the
health care system in treating as many people as possible.

9 In relation to a health issue of your choice:
(a) Identify a range of health care services available for youth.
(b) Discuss the rights and responsibilities associated with using these services.
10 Design a poster aimed at educating youth as to the range of health care services
available relating to STI prevention.

CHAPTER 5 review
Chapter summary
• Overweight and obesity rates have increased in recent decades and this is a risk factor
for a range of other health concerns such as psychological distress, cardiovascular Interactivities:
disease and type 2 diabetes. Increased consumption of energy-dense foods and a Chapter 5 crossword
decrease in physical activity levels have contributed to this issue. Searchlight ID: int-2897
• Injuries are the leading cause of death for youth and are higher for males. Chapter 5 definitions
• Youth is a stage of experimentation, but tobacco, alcohol and drug use can have far- Searchlight ID: int-2898
reaching implications.
• Tobacco smoking rates have decreased over time, but smoking still poses a risk to
the health of many individuals. The youth stage of the lifespan is when most lifelong
smokers develop their habit.
• Binge drinking increases the risks associated with alcohol consumption.
• Rates of STIs have increased over time, especially chlamydia infection.
• Anxiety and depression cause the largest burden of disease among Australian
youth.
• There are a number of other mental illnesses that affect young people such as bipolar
disorder, schizophrenia, eating disorders and substance use disorders.
• Mental illnesses affect the health and development of youth in many different ways.
• Up to 70 per cent of youth with a mental illness do not seek help.
• The rates of mental illness have been fairly stable over the 10 years to 2007.
• The death rates for mental and behavioural disorders decreased significantly in the
years to 2004.
• Biological, behavioural, environmental and social determinants can either protect a
person against, or put them at risk of, developing a mental illness.
• A number of strategies have been implemented to address the issue of mental illness in
Australian society, including SANE Australia and Youthbeyondblue.
• Personal strategies such as relaxation and communication can protect individuals from
mental illness.
• A range of health care services are available to youth, many of which are fully or
partially funded by Medicare.
• Medicare is Australia’s universal health insurance scheme.
• Services covered by Medicare include general practitioners, specialist services and
hospital treatment.
• Young people have rights when accessing mental health services including the
right to:
–– privacy
–– a second opinion
–– use public health services
–– help develop a treatment plan
–– refuse treatment
–– have a person present with them
–– be treated with respect and dignity.
• The responsibilities associated with using these services include the responsibility to:
–– give the health worker accurate health information
–– keep appointments
–– tell medical staff if they are not going to follow treatment plans
–– work with medical staff to optimise treatment
–– treat others with respect and dignity
–– respect the privacy of others.

Chapter 5 review

1 What are the major health issues for Australia’s 2 Select one health issue and explain the
youth in relation to: determinants of health that together may influence
(a) morbidity? the decisions a person makes regarding this issue.
(b) mortality?
(c) overall burden of disease?

1.1 Understanding health Unit 2
Individual
human development
and health issues
AREA OF STUDY OUTCOME

1 Prenatal health and Describe and explain factors that affect the health and individual human
individual development development during the prenatal stage.
2 Child health and Describe and explain factors that affect the health and individual human
individual development development of Australia’s children.
3 Adult health and Describe and explain the factors that affect the health and individual human
individual development development of Australia’s adults.
CHAPTER 6
Health and individual human

development during the prenatal
stage of the lifespan
The development that occurs during the prenatal stage lays
the foundations for development across the rest of the lifespan.
Maintaining adequate health prior to and during pregnancy
is a key factor in achieving optimal health and development
in the unborn baby. Having an understanding of the health
and development that occurs during this stage of the
lifespan allows informed decisions to be made to ensure the
promotion of optimal wellbeing among pregnant women and
unborn babies.
KEY KNOWLEDGE
1.1 the process of fertilisation (pages 176–8)
1.2 physical development from conception to birth, including the features
of the germinal, embryonic and foetal stages (pages 179–181)
1.3 the health status of Australia’s pregnant women and unborn babies
(pages 182–7)
KEY SKILLS
• describe the characteristics of physical development from conception
to birth
• interpret data on the health status of pregnant women and
unborn babies
Figure 6.1 The influences on

health and development are already
evident on this foetus.
174 UNIT 2 • Individual human development and health issues

amniotic fluid the fluid surrounding the embryo/foetus
that protects the unborn baby
antepartum relating to the period directly before birth
blastocyst a cluster of cells in which some cell
differentiation has occurred
cell differentiation when cells take on specialised roles
congenital abnormality sometimes called ‘congenital
anomaly’, a condition characterised by malformed body
parts (either external such as limbs or internal such as
organs) that is present at birth
endometrium the nutrient-rich lining on the uterine wall
in which the ovum (blastocyst) embeds or that is expelled
every month if pregnancy does not occur
haemorrhage excessive bleeding
implantation occurs when a cluster of cells that will
become an embryo attaches itself to the endometrium
intracytoplasmic sperm injection a process whereby a
single sperm is injected directly into an ovum
jaundice a condition that can affect newborn babies.
Symptoms may include a yellow tinge to the skin and
whites of eyes, drowsiness, feeding difficulties and dark
urine.
mandatory fortification a law that requires certain
nutrients to be added to specific foods during production
morula a solid ball of cells created from a zygote
placenta an organ that allows the transfer of nutrients,
gases and wastes between mother and foetus
regenerate regrow to replace damaged, old or dead
cells or tissue
teratogen anything in the environment of the embryo
that can cause defects in development. Examples include
tobacco smoke, alcohol, shellfish, prescription medication
and some diseases like measles.
ultrasound a tool that uses high-frequency soundwaves
to create a visual representation of something that can
usually not be seen. Ultrasound is used to monitor foetal
development.
zygote a full cell resulting from the fusion of a sperm
and an ovum
6.1 Fertilisation
KEY CONCEPT The process of fertilisation
The start of human life is dependent upon the genetic material provided by each
parent. In order to gain an understanding of the prenatal stage of development, we
will first explore fertilisation and the cells required for this process to occur.
Sperm and ova

Most cells in the human body contain a ‘nucleus’, which is like the brain of the
cell. It contains the genetic material or blueprints that allow human cells to keep
reproducing throughout the lifespan, although some types of cells regenerate more
than others.
Sperm and ova (singular ovum, sometimes referred to as ‘egg’) are the names
given to the male and female sex cells respectively. Sperm production in males
starts during puberty and sperm form in the testes at a rapid rate (over 12 billion
per month). Ova form in the ovaries before the female is even born. Once born,
the female already has all the eggs that she will have for life. These eggs will mature
once puberty occurs.
When sperm and ova are created, they take a random half of the individual’s
genetic material to essentially make half a cell. These two half-cells (one from each
parent) are able to join to make a complete cell called a zygote in a process called
fertilisation.
Fertilisation
Fertilisation (sometimes referred to as conception) occurs when a sperm penetrates
an ovum and the genetic materials fuse together to make a single cell called a
zygote. The zygote contains 23 chromosomes from the sperm and 23 chromosomes
from the ova. The individual resulting from this single fertilised cell will therefore
display some characteristics of each of their parents and many combinations of
the two (figure 6.2). Body cells split in different ways each time a sperm or egg is
created, resulting in the vast variation typically seen among siblings.
Father’s genetic information Mother’s genetic information
46 46
chromosomes chromosomes
23 chromosomes 23 chromosomes 23 chromosomes 23 chromosomes
46 46 46 46
chromosomes chromosomes chromosomes chromosomes
Figure 6.2 When sperm and ova form, normal body cells split to contain half the genetic
material of a normal cell.

In most cases, fertilisation occurs in a female’s fallopian tubes (see figure 6.3).
During sexual intercourse, sperm is deposited in the vagina and swims towards
the fallopian tubes. If an ovum is present, any sperm that reach it will compete
to break through the egg’s membrane. In order to do this, the sperm release an
enzyme that breaks down the outer barrier of the egg. Once a sperm has penetrated
the membrane, other sperm are blocked from entering by electrical impulses
released by the egg. If more than one sperm were to enter, the zygote would have
an incorrect amount of genetic information and would not survive.
Fallopian tubes
Uterus
Uterine wall
Ovum Ovary
2 Sperm swimming through
uterus and tubes
3 Fertilisation of
ovum by sperm Cervix
Vagina 1 Sperm deposited in
vagina during sex
Figure 6.3 Fertilisation takes place in one of the fallopian tubes and the complete cell
moves into the uterus, where it implants in the lining of the uterus.
In-vitro fertilisation
Around one in five couples experience fertility problems and rely on other methods
to carry out the process of fertilisation. One of the most common techniques used
to assist with fertilisation is called in-vitro fertilisation. In-vitro fertilisation involves
extracting ova from the woman’s ovaries and mixing them with sperm outside
the woman’s body, often in a petri dish. If a zygote is created in this way, it can
be implanted in the woman’s uterus using a long, hollow needle, or frozen to be
implanted in the future (see figure 6.4).
Step one — Injection of Step two — Extraction of ova Step three — fertilisation Step four — incubation Step five — implantation
hormones
Fallopian Ovary Ova are
tube Uterus extracted
Ova
Sperm
Cervix
Vagina
Hormones are Ova are extracted Sperm and ova are The zygote is incubated The zygote is placed in the
injected to promote from the ovary. mixed in a petri dish at 37 degrees for around uterus using a flexible tube.
the maturation of to allow fertilisation 2 days (until the zygote
multiple ova. to occur. consists of around 8 cells).
Figure 6.4 The steps involved in the in-vitro fertilisation process
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 177
6.1 Fertilisation
Often, multiple embryos will be implanted in the hope

that at least one will result in a full-term pregnancy.
Only about one in five IVF treatments results in a full-
term pregnancy; the older the woman, the less the
chance of success. Multiple births occur in about one-
quarter of those instances where IVF does succeed.
For a range of reasons, in some cases sperm do
not reach the egg or cannot penetrate the membrane
of the egg. In these instances, a single sperm can be
directly injected into an ovum in a process called
intracytoplasmic sperm injection (see figure 6.5). The
embryo can then be implanted into the endometrium
in the same manner as in-vitro fertilisation.
The sperm and ova used in the process of in-vitro
fertilisation may be obtained from the man and woman
seeking the pregnancy. At other times, the ova and/or
sperm are provided by known or anonymous donors.
Figure 6.5 An intracytoplasmic If the parents’ sex cells are used, the child will have the
sperm injection involves injecting a same genetic mix as if conceived naturally. This will not be the case if one or more
single sperm directly into an ovum. donor cells are used.
TEST your knowledge (c) Which chromosome must the sperm have
to create:
1 When does sperm production begin in males?
i. a girl?
2 When are ova formed?
ii. a boy?
3 Where is an ova fertilised for most couples?
(d) How long does an egg survive after ovulation?
4 Explain why babies show traits of both parents.
(e) Why is it important for millions of sperm to be
5 Use a flow chart to outline the process of
released?
fertilisation.
(f) How does the egg ensure that only one sperm
6 Use a flow chart to outline the process involved in
penetrates it?
in-vitro fertilisation.
(g) Why is it important that only one sperm enters
7 Explain why twins are more common with in-vitro
the egg?
fertilisation.
(h) What is a fertilised ovum called?
(i) Explain how the fertilised egg ends up with half
the mother’s chromosomes and half the father’s.
8 Why would it be important for both the mother 0 Use the IVF weblink in your eBookPLUS
1
and father to maintain good health leading up to find the link for this question. eBook plus
to pregnancy? (a) For how long does the menstrual
9 Use the Fertilisation weblink in cycle last?
your eBookPLUS to find the link eBook plus
(b) When is the egg released?
for this question. (c) How are the eggs drawn from the ovary?
(a) What is the entrance to the uterus called? (d) How is the embryo transferred back into
(b) Where are the chromosomes located in sperm? the mother?

6.2 Prenatal development
KEY CONCEPT Physical development from conception to birth, including the

features of the germinal, embryonic and foetal stages
Once fertilisation occurs, the prenatal stage of development commences. Even

though the foundations of social, emotional and intellectual development start at
this stage, the physical aspect of development is the most noticeable. Development
during this stage is the most rapid of all lifespan stages. The prenatal stage is
generally divided into three stages: the germinal, embryonic and foetal stages (refer
to figure 6.6).
Germinal Prenatal Foetal

(0–2 weeks) stage (9–40 weeks)
Embryonic
(3–8 weeks)
Figure 6.6 Stages of prenatal
development
Germinal stage
The germinal stage starts at fertilisation and ends with implantation.
Implantation begins around day five and ends around days 10–12. When
fertilised, the newly formed cell (zygote) travels down one of the fallopian tubes
while constantly dividing. Around three to four days after fertilisation, when there
are about 16 cells, the zygote takes on a spherical shape and is now known as
a morula. At around five days after fertilisation, when it is made up of around
64 cells, the morula transforms to include an outer cell mass, an inner cell mass
and a hollow, fluid-filled centre called the blastocyst cavity. At this stage, the
morula is known as a blastocyst. The inner cell mass of the blastocyst will become
the embryo and the outer cell mass will eventually become the placenta.
When it reaches the uterus, the blastocyst implants itself in the endometrium.
At this point, it becomes known as an ‘embryo’.
Embryonic stage
The embryonic stage starts at implantation and ends at the eighth week. This
stage is characterised by cell differentiation. This is when the cells start taking on
specialised roles such as heart cells, skin cells and bone cells.
This stage is perhaps the most critical for human development. Most internal
and external organs and systems are formed during this stage, and the brain and
spinal cord are almost complete by the end of it (although they will grow in size
and increase in complexity for years to come).
While the embryo is only around 2 centimetres in length by the end of this
stage, many of the internal organs and systems have begun to form. These include
the circulatory system, the stomach and kidneys, lungs, the nervous system and
the digestive system. Although sex is determined at conception, the internal sex
organs begin to form during the embryonic stage but will not be complete for
another eight weeks.
6.2 Prenatal development
The limbs start out as buds emerging from the torso and continue to grow
and develop during this stage. Fingers and toes also begin to form by the end of
the embryonic stage. By the eighth week, the embryo becomes distinctly human
looking, although the head and neck still account for around half the embryo’s
total length and the brain makes up almost half of its body weight.
Because major organs and systems are formed during this time, the embryo is
very sensitive to environmental influences. Teratogens such as tobacco, alcohol
and medication are particularly influential during this stage of development.
At the eighth week, the embryo has begun to form every major organ and system,
and many are close to completion. In fact, 90 per cent of the structures found in
an adult human can be found in an eight-week-old embryo. The remainder of the
prenatal stage is characterised by rapid growth and the maturing of these organs.
Foetal stage
The foetal stage starts at the ninth week of pregnancy and continues until birth at
around 40 weeks (figure 6.7). During this stage the unborn baby is referred to as
a ‘foetus’. The foetus measures only a few centimetres in length at the beginning of
this stage and about 50 centimetres by the end. Although this stage is characterised
by rapid growth, many other developmental milestones occur as well.
Foetal growth from

8 to 40 weeks
Embryo Foetus 16 20 24 28 32 36 40
at 8 weeks at 12 weeks
Figure 6.7 The growth pattern of the foetus
All organs and systems formed in the embryonic stage — including the lungs,
digestive system, liver and kidneys — mature and are functioning in the early
stages of foetal development.
The placenta is fully developed and functioning at 14 weeks. It is a disc-shaped
temporary organ, largely made up of blood vessels that facilitate the exchange of
substances between mother and foetus. The placenta acts like a kidney, lung and
digestive system for the foetus by supplying the foetus with oxygen, nutrients and
immune support, and removing wastes such as urine and carbon dioxide. It is
connected to the foetus by the umbilical cord, which is made up of two arteries
and one vein. The umbilical vein supplies the foetus with nutrient-rich oxygenated
blood from the placenta, and the umbilical arteries return deoxygenated and
nutrient-depleted blood to the placenta. The placenta is also connected to the
uterus of the mother, and her blood forms pools in the placenta. The blood
vessels of the umbilical cord complete a ‘U-turn’ while passing through pools of
the mother’s blood in the placenta. This allows the exchange of nutrients, oxygen
and wastes through the thin walls of the placenta without the foetal blood coming
into direct contact with the blood of the mother (see figure 6.8). The placenta also
produces hormones, such as progesterone, that assist in maintaining pregnancy.

Sex organs start taking shape and, by around the 15th week, Mother’s
the sex of the foetus may be identifiable by an ultrasound. blood
A female foetus will have produced millions of eggs but this vessels
number will be reduced by the time she is born. The testes of
a male foetus will be producing testosterone.
Movement occurs in almost all parts of the foetal body
and becomes more noticeable as the foetus grows. Reflexes
such as sucking and grasping are highly responsive and will
continue to develop throughout this stage. The foetus displays
Placenta
a breathing movement but its lungs are filled with amniotic
fluid, not air.
Tooth buds form in the gums in the second half of the foetal Arteries
stage. The bones, which mainly consist of cartilage, also start
to harden or ossify around this time. This is a process that will
continue until the end of puberty.
The senses begin to function around 25 weeks after Umbilical
fertilisation, and the foetus may respond to light, sound and cord
touch. These senses become more sensitive throughout the Vein
remainder of the foetal stage.
Fat is deposited under the skin during the later weeks of the
foetal stage. This assists with temperature regulation after birth.
Figure 6.8 The placenta connects

the foetus to the uterine wall of the
mother, providing the foetus with
nutrients and oxygen and removing
its waste products.
TEST your knowledge 7 Use the Teratogens weblink in your eBookPLUS to

find the link for this question.
1 (a) What are the three stages of prenatal
(a) When is the development of each of the
development? eBook plus
following systems at risk of being affected by
(b) When does each stage start and finish?
teratogens?
(c) What are the characteristics of physical
i. Central nervous system
development that occur during each stage?
ii. Heart
2 (a) What are teratogens?
iii. Limbs
(b) Make a list of teratogens.
iv. Eyes
(c) When do you think the unborn baby would be
v. Ears
most at risk from teratogens? Explain.
vi. Palate
3 (a) What is the placenta?
vii. Teeth
(b) Do all women have a placenta? Explain.
viii. Genitals
4 (a) What is amniotic fluid?
(b) When is the embryo at risk of nutritional
(b) Why is it important for the developing embryo/
deficiencies?
foetus?
(c) During which week of prenatal development is
5 Draw up a table with three columns and provide
the embryo/foetus most susceptible to damage
examples that represent the key characteristics of
from environmental factors?
physical development in each of the three stages of
8 Using the Prenatal development weblink in your
prenatal development. eBook plus
eBookPLUS and the information in this section,
APPLY your knowledge devise a timeline of prenatal development.
6 ‘Prenatal development would be impossible without

the placenta.’ Discuss this statement.
6.3 The health status of Australia’s pregnant women
and unborn babies
KEY CONCEPT Understanding the health status of Australia’s pregnant women

and unborn babies
More than a quarter of a million babies are born in Australia each year. The health
of pregnant women is vital to ensure that these babies develop optimally and are
in the best possible health throughout the pregnancy and when born. Babies born
healthy are more likely to experience good health throughout their life. Pregnant
women and unborn babies in Australia generally experience a high level of health,
although there are some exceptions to this. Examining the health of pregnant
women and their unborn babies helps identify where improvements to health may
be possible.
The health status of unborn babies

Data relating to the health status of unborn babies is often combined with babies in
the first weeks of life. As a result, some figures relate to those in the prenatal and/
or infancy stage of the lifespan.
Perinatal mortality
Perinatal mortality relates to the death of babies before birth (over 20 weeks
gestation) and up to 28 days after birth. In 2009, the perinatal mortality rate was
estimated to be 9.2 perinatal deaths for every 1000 births. Perinatal death rates
vary for different population groups in Australia. In 2009, the perinatal death
rate per 1000 total births ranged from 8.6 for babies of mothers aged 25–29 to
14.2 for babies of mothers aged 40 or older. The perinatal death rate for babies
of teenage mothers was 12.8 per 1000 births. Babies born to Aboriginal or Torres
Strait Islander mothers had a perinatal mortality rate twice that of babies born to
non-Indigenous mothers.
Improvements in perinatal mortality rates have been made over the past 30 years,
with rates now around a quarter of those reported in the 1970s. Rates are now
lower in Australia than other comparable developed countries (figure 6.9).
20
United Kingdom
United States
Number per 1000 births
15 New Zealand
Canada
Australia
10
0
1978 2005
Year
Note: Data are based on the WHO definition of perinatal mortality, which includes deaths of at least
1000 grams birthweight, or 28 weeks gestation (if birthweight is unavailable), and neonatal
deaths of up to 7 completed days after birth. This differs slightly from the definition used in
Australia for the National Perinatal Data Collection, which includes all deaths of at least 400g
birthweight or at least 20 weeks gestation, and includes neonatal deaths within the first 28 days.
Figure 6.9 Perinatal mortality trends, Australia and other selected countries, 1978–2005
Source: Australian Institute of Health and Welfare, Australia’s health 2012, page 63.

The main causes of perinatal mortality are congenital abnormalities (or
anomalies), spontaneous preterm birth and unexplained antepartum death
(see figure 6.10).
35%
26%
Other causes
Congenital abormalities
Spontaneous preterm births
Figure 6.10 Causes of perinatal
Unexplained antepartum deaths mortality, per cent of total, 2009
Source: Adapted from Li Z, Zeki R, Hilder L &
Sullivan EA, 2012. Australia’s mothers and babies
2010. Perinatal statistics series no. 27. Cat. no.
16% PER 57. Canberra: AIHW National Perinatal
23% Epidemiology and Statistics Unit.
Congenital abnormalities, sometimes referred to as ‘birth defects’, accounted for

26.5 per cent of all perinatal deaths. Congenital abnormalities often result from
missing or ill-formed body structures. They may have a genetic, infectious or
environmental origin, although in most cases it is difficult identify their cause.
Spontaneous preterm births relate to births where labour begins without medical
intervention between the 20th and 37th weeks of pregnancy. The organs of babies
born prematurely are often not developed enough to function adequately outside
the uterus. Most babies born prematurely will survive, but spontaneous preterm
births still contribute to 22.9 per cent of all perinatal deaths. The lungs are the last
organs to develop and respiratory problems contribute significantly to the deaths
that do occur.
Unexplained antepartum death contributes 15.7 per cent of perinatal deaths.
Unexplained antepartum deaths relate to babies who are born with no signs of life.
The causes of these deaths are unknown.
Prenatal morbidity
Many causes of morbidity among unborn babies go undiagnosed until after birth.
As a result, data are not available relating to many aspects of health status in the
prenatal stage. Conditions that may be diagnosed in unborn babies include neural
tube defects and Down syndrome.
Neural tube defects
The neural tube is a casing that encloses the brain and spinal cord
during the embryonic stage of development. The edges of the neural
tube fuse together in around the third week of pregnancy. Neural tube
defects (NTDs) are a group of conditions that occur when the neural
tube does not fuse completely. The part of the neural tube that does
not fuse will determine the type of defect experienced (see figure 6.11).
These conditions can lead to morbidity and mortality in unborn babies,
depending on their location and severity.
There is strong evidence that adequate folate intake can reduce the
risk of NTDs in unborn babies. The neural tube fuses early during the
pregnancy and many women may not know they are pregnant at this Spina bifida Anencephaly Encephalocele
point in time. As a result, women who may become pregnant should Figure 6.11 The area of the neural
ensure that adequate amounts of folate are being consumed prior to tube affected will determine the type
fertilisation where possible. of neural tube defect experienced.
6.3 The health status of Australia’s pregnant women and unborn babies
Based on data from the three Australian states that fully monitor NTDs (Victoria,
South Australia and Western Australia), there has been a small decline in the overall
prevalence of NTDs per 10 000 births between 1998 and 2008 (figure 6.12). The
introduction of mandatory fortification for all commercially baked bread (except
organic bread) is thought to be largely responsible for this decrease.
15
12
Per 10,000 births 9
6
Figure 6.12 Overall prevalence of
neural tube defects in Victoria, South
Australia and Western Australia, 3
1998–2008.
Source: Australian Institute of Health and Welfare, 0
Australia’s health 2012, page 62. 1998 1999 2000 2000 2002 2003 2004 2005 2006 2007 2008
Year
Down syndrome
Down syndrome is a condition caused by a chromosomal abnormality. For people
with Down syndrome, there are three chromosomes on the twenty-first pair instead
of the usual two (see figure 2.23, page 58). This extra chromosome
produces a number of symptoms common to many people with this
condition, including:
• Eyes — nearly all people with Down syndrome have a slight upward
slant of the eyes.
• Face — this is often rounded and tends to have a flat profile.
• Stature — babies with Down syndrome are usually smaller and
weigh less at birth than others. Children tend to grow more slowly
and are commonly smaller than other children their age. Adults with
Down syndrome are commonly smaller than the general population.
• Slowed intellectual development — those with Down syndrome
will reach the same milestones as other babies, but may take longer
Figure 6.13 This little girl displays to achieve them.
the facial features typical of Down Besides slowed intellectual development and the physical characteristics,
syndrome. individuals with Down syndrome are no different to others in the population.
Down syndrome is the most common chromosomal abnormality in Australia
and between 45 and 60 babies are born with Down syndrome every year.
The health status of pregnant women

Maternal mortality
Maternal mortality relates to deaths among pregnant women where the cause of
death is attributed to the pregnancy itself. Pregnant women in Australia experience
low maternal mortality rates compared to most other countries, although there is
some variation among population groups within Australia. Between 2003 and 2005,
maternal mortality rates for Aboriginal or Torres Strait Islander women were more
than two and a half times as high as for other women. There were 21.5 deaths per
100 000 women giving birth, versus 7.9 per 100 000 for non-Indigenous women.
Causes of maternal mortality include cardiovascular conditions and haemorrhage
(excessive blood loss). In most cases, these conditions do not lead to death and are
managed with medical intervention.

Although most women will not experience a diagnosed condition during
pregnancy, there are a number of conditions that can impact on the health and
development of both the mother and the baby. Conditions that can affect pregnant
women include gestational diabetes, mental health problems, pre-eclampsia and
ectopic pregnancy.
Maternal morbidity
Vast changes occur in a woman’s body during pregnancy, and a range of conditions
can develop as a result. Common conditions during pregnancy include gestational
diabetes, mental health issues, pre-eclampsia and ectopic pregnancy.
Gestational diabetes
Gestational diabetes is a form of diabetes that can occur during pregnancy in
women who have not previously been diagnosed with diabetes. Like all forms
of diabetes, gestational diabetes is characterised by high blood glucose levels.
Gestational diabetes usually goes away after pregnancy but can return during
subsequent pregnancies.
High blood
glucose levels
in mother
Brings extra glucose

to baby
Causes baby to put

on extra weight
Figure 6.14 Gestational diabetes can

contribute to high birth weight of
the baby.
Gestational diabetes occurs in around 5 per cent of all pregnancies and is more
common in older women and those who are obese. This condition can impact on
women in numerous ways including:
• high blood pressure
• pre-term labour
6.3 The health status of Australia’s pregnant women and unborn babies
• longer hospital stay than mothers without gestational diabetes

• increased risk of developing type 2 diabetes
• increased risk of cardiovascular disease.
Gestational diabetes increases the risk of many adverse outcomes for the
developing baby including high birth weight, respiratory conditions and jaundice.
Mental health
Maternal mental health issues such as depression have been traditionally associated
with the period after birth, but research now suggests depression is a significant
cause of ill health among pregnant women. According to the Australian Institute
of Health and Welfare, around 8.9 per cent of Australian women experience
depression during pregnancy. This figure increases to 15.7 per cent in the period
after birth (AIHW, 2012). Although mental health problems during pregnancy can
often be treated, in some cases they can contribute to self-harm and increased risk
of maternal mortality.
Pre-eclampsia
Pre-eclampsia is a disorder of pregnancy characterised by hypertension, protein in the
urine and fluid retention (also known as oedema) leading to swollen hands, feet and
face. Pre-eclampsia is the most common pregnancy disorder in Australia, affecting
between 5 and 10 per cent of all pregnant women. One to two per cent of cases are
severe enough to threaten the lives of both the mother and her unborn child.
Protein in the urine
High blood pressure
Oedema
Figure 6.15 Common signs of pre-

eclampsia. The signs of pre-eclampsia
often cannot be ‘felt’ and regular
healthcare is essential to make an
early diagnosis of this condition.
Pre-eclampsia generally occurs in the latter stages of pregnancy and often displays
no symptoms. As a result, regular medical check-ups throughout pregnancy are
recommended.
The only cure for this condition is the delivery of the baby. Pre-eclampsia
accounts for one in five inductions and one in six Caesarean sections in Australia.
The reasons for the development of pre-eclampsia are not known, but genetic
factors and the placenta seem to play significant roles. For reasons unknown, pre-
eclampsia tends to be more common in first-time mothers than those experiencing
subsequent pregnancies. The mother’s blood pressure usually returns to normal
after the baby and placenta are delivered.

In its most severe forms, it can cause problems in the kidneys, liver, brain and
blood. It is difficult to predict who will be affected, but certain women appear to be
more at risk than others, including:
• Women experiencing their first pregnancy
• Those with pre-existing high blood pressure or some other types of vascular
disease
• Women with a family history of the condition
• Diabetics
• Women pregnant with multiple foetuses.
Ectopic pregnancy
An ectopic pregnancy occurs when, instead of implanting in Foetus
the uterus, the embryo implants elsewhere in the mother’s
reproductive system. The fallopian tubes are the most common
site of implantation in ectopic pregnancies (see figure 6.16),
but implantation can occur in a range of other places including Fallopian
tube
the abdomen and cervix. In Australia, around five in every
1000 pregnancies are ectopic and in most cases, the embryo
does not survive. The fallopian tubes are not large enough to Uterus
accommodate the growing embryo and the placenta cannot
access the nutrient rich lining of the uterus. Symptoms can
include cramping, abdominal pain and vaginal bleeding. One
in five cases of ectopic pregnancy will cause the fallopian tube Figure 6.16 The fallopian tubes are
to rupture and bleed excessively, which is a medical emergency the most common site of implantation
and needs immediate surgery. in ectopic pregnancies.
TEST Your Knowledge (b) pre-eclampsia

(c) prenatal depression
1 Explain the following terms:
(d) ectopic pregnancy.
(a) perinatal mortality
10 Create an information booklet or short video that
(b) maternal mortality.
could be used to inform women of common health
2 Describe perinatal mortality rates between 1978
conditions experienced during pregnancy.
and 2005 in Australia.
11 Use the Pre-eclampsia weblink in your eBookPLUS
3 Identify and describe the three main causes of eBook plus
to find the link to this question.
perinatal mortality in Australia.
Watch the clip about pre-eclampsia.
4 Explain why morbidity data relating to the prenatal
(a) What signs are required for a diagnosis of
stage are not readily available.
pre-eclampsia.
5 (a) What is the neural tube?
(b) When does pre-eclampsia generally occur?
(b) Explain each of the three types of neural tube
(c) Why is it important to make the diagnosis of
defect.
pre-eclampsia?
6 Explain why folate consumption is important prior
(d) What risk factors are identified for pre-
to fertilisation.
eclampsia?
7 Explain how gestational diabetes can contribute to
12 Use the Ectopic pregnancy weblink in your
high birthweight babies. eBook plus
eBookPLUS to find the link to this question.
8 Explain the following:
(a) Where can the embryo implant in an ectopic
(a) gestational diabetes
pregnancy?
(b) pre-eclampsia
(b) What are the risk factors for ectopic pregnancy?
(c) ectopic pregnancy.
APPLY Your Knowledge

9 Explain how each of the following could impact on
the health of pregnant women:
(a) gestational diabetes
KEY SKILLS Determinants of prenatal health and development
KEY SKILL Describe the characteristics of development

from conception to birth
The key requirement for this key skill is to be able to describe the development that
occurs from conception until birth. An understanding of the process of fertilisation
and the physical changes that occur during the three stages of the prenatal stage of
the lifespan is essential.
Consider the following example, which is a discussion of the development that
would be taking place during the embryonic stage in the prenatal stage of the
lifespan:
❶ The start and end points of the The embryonic stage of prenatal development begins when the embryo implants
embryonic stage are identified. in the uterus and ends at the eighth week of pregnancy.➊
The embryonic stage is characterised by cell differentiation where the cells start
❷ The major characteristic of the stage taking on specialised roles such as brain, bone, skin and muscle.❷ Most organs and
is identified and examples provided systems are formed during the embryonic stage including the circulatory, nervous
to illustrate understanding.
and digestive systems.
Limbs, fingers and toes begin to develop and by the end of the embryonic stage
the embryo is distinctly human-looking, although it is only around 2 cm long. The
head and neck make up half the length of the embryo.

1 Explain the process of fertilisation
2 Lois is eight weeks pregnant. Describe the changes Lois’ unborn baby will go
through between now and the end of the pregnancy.
3 Outline the characteristics of the germinal stage of prenatal development.
KEY SKILL Interpret data on the health status of pregnant

women and unborn babies
This key skill requires the analysis of data related to the health of pregnant women
and unborn babies. Data can be presented in a number of ways. To revisit this
skill, refer to the key skills section of chapter 2 (pages 66–7) and follow the steps
outlined there. Knowledge of the basic issues concerning the health status of
pregnant women and unborn babies will be beneficial in applying this key skill.
9
8
7
6
5
4
3
2
1
0
5
5
97
97
98
98
98
99
99
99
99
00
00
1
2
3–
6–
9–
2–
5–
8–
1–
4–
7–
0–
3–
7
0
19
19
19
19
19
19
19
19
19
20
20
Figure 6.17 Maternal mortality rate, per 100 000 women giving birth

In the following example, the data in figure 6.17 are analysed and conclusions
❸ Rates have decreased overall, but
drawn about the health status of Australia’s pregnant women. there were some increases. Including
In describing the trends evident in this graph, the following three statements can the qualifier ‘generally’ takes this into
be made. However, there are important considerations to be taken into account. account.
• Generally,❸ maternal mortality rates decreased between 1973–75 and 2003–05.❹
• Maternal mortality rates were around 8.2 deaths per 100 000 women giving ❹ Reference is made to the span of
years over which the trend occurred.
birth in 1973–75 compared to around 3.8 per 100 000 women giving birth in Try to avoid making statements such
2003–05.❺ as ‘maternal mortality rates have
decreased’, as this indicates that the
• There were three periods of time when maternal mortality rates increased. trend is currently occurring when the
These increases were relatively minor, with the exception of the period between data do not support this.
1991–93 and 1994–96 when rates increased from around 3.5 to 6 deaths per
100 000 women giving birth.❻ ❺ Data from the graph are used and
the correct units and time periods
identified.

❻ Exceptions to the overall trend are
4 The following data show perinatal mortality rates according to the age of identified. In this case, increases
the mother. in maternal mortality rates are
identified and data used to illustrate
understanding.
16
Perinatal mortality rate (per 1000 births)
14
12
10
0
Younger than 20–24 25–29 30–34 35–39 40 and over
20
Age of mother
Figure 6.18 Perinatal mortality rate per 1000 births
(a) Describe the trend evident in the graph above.

(b) What conclusion can be drawn relating to the age of the mother and perinatal
mortality rates?
CHAPTER 6 review
Chapter summary
eBook plus • Sex cells such as sperm and ova hold genetic material from each parent.
• Fertilisation is the process whereby the genetic material of the sperm and ovum fuse
Interactivities: together to make a complete cell called a zygote. This process usually occurs in the
Chapter 6 Crossword fallopian tube.
Searchlight ID: int-2899 • In-vitro fertilisation can be used when fertilisation cannot occur naturally. In IVF,
fertilisation occurs outside the mother’s body and the embryo is placed in the uterus in
Chapter 6 Definitions
the hope that implantation will occur.
• Intracytoplasmic sperm injection involves injecting a single sperm into an ovum. This
procedure can be used when the sperm cannot fertilise the ovum naturally.
• Fertilisation marks the beginning of the prenatal stage of the lifespan.
• The prenatal stage can be divided into the germinal, embryonic and foetal stages.
• Growth during the prenatal stage is the fastest of all lifespan stages.
• Teratogens can have a large impact on the developing baby.
• The germinal stage is characterised by rapid cell division.
• The embryonic stage is characterised by organ development.
• The foetal stage is characterised by rapid growth.
• The placenta is an organ that facilitates the transfer of nutrients, liquids and gases from
mother to baby.
• Most mothers and their unborn babies experience good health in Australia, although a
number of health concerns do occur.
• Perinatal mortality rates relate to deaths that occur in babies from 20 weeks gestation
up to 28 days after birth.
• Perinatal mortality rates are comparatively low in Australia, although some population
groups experience higher rates that the national average. Younger mothers, older
mothers and Indigenous mothers all experience higher perinatal mortality rates than the
average.
• The main causes of perinatal mortality are congenital abnormalities, spontaneous
preterm birth and unexplained antepartum death.
• Neural tube defects and Down syndrome are two conditions that are often diagnosed
during pregnancy.
• Maternal mortality rates relate to deaths of pregnant women. Maternal mortality rates
are low in Australia.
• Causes of maternal morbidity include gestational diabetes, mental health issues, pre-
eclampsia and ectopic pregnancy.

1 Explain the process of fertilisation. 5 (a) Find a strategy that has been put in place to
2 Discuss one option for a couple experiencing address a major concern for the health and
difficulties achieving pregnancy. development of pregnant women or unborn
3 (a) Outline the major characteristics of the germinal, babies and prepare a fact sheet about it.
embryonic and foetal stages of prenatal (b) If you have time, present your findings to
development. your class.
(b) Explain why the prenatal stage of development
is so important for future development.
4 Discuss two health concerns for pregnant women.

1.1
Chapter 7
CHAPTER 8
individual
Global health
human
anddevelopment
during
humanthedevelopment
prenatal stage
Why is this important?
The determinants of health and individual human development
are important during the prenatal stage because they
significantly influence the health and development of both the
pregnant woman and her unborn baby. How effectively the
body functions, the lifestyle choices made by parents,
the physical environment in which parents live and social
determinants such as the education of parents can have an
effect on health and individual human development during the
prenatal stage.
The determinants of health and development are vital in
understanding the range of health issues that can impact on
pregnant women and unborn babies, including spina bifida,
low birth weight, foetal alcohol syndrome and gestational
diabetes. Understanding how the determinants act as risk and
protective factors allows a range of government, community
and personal strategies and programs to be implemented
promoting health and development during the prenatal stage
of the lifespan.
Key knowledge
1.4 determinants that have an impact on health and individual human
development during the prenatal stage of the lifespan, including at
least one from each of the following:
• biological, such as genetics (pages 194–8)
• behavioural, such as maternal nutrition prior to and during
pregnancy, parental smoking, alcohol and drug use during
pregnancy, and vaccination (pages 199–205)
• physical environment, such as tobacco smoke in the home and
access to healthcare (pages 206–8)
• social, such as parental education, parental income, parental health
and disability and access to healthcare (pages 209–11)
1.5 determinants that act as risk and/or protective factors in relation to
one health issue such as spina bifida, low birth weight, foetal alcohol Figure 7.1 The prenatal stage is
syndrome or gestational diabetes (pages 212–18) the first stage of the lifespan and a
1.6 government, community and personal strategies and programs range of determinants contribute
to the health and individual human
development of pregnant women
pregnant women and unborn children (pages 219–23). and their unborn babies.

Key skills
• explain the determinants of health and
individual human development and their
impact during the prenatal stage of the
lifespan using relevant examples
• describe a specific health issue affecting
the prenatal stage of the lifespan and draw
informed conclusions about personal,
community and government strategies and
programs to optimise prenatal health and
development.

carrier a person who has inherited a genetic trait or
condition but does not display the trait or symptoms. They
are able to pass the gene on to their children, who may or
may not display the trait or symptoms.
chromosomes strands of DNA that contain genetic
information
developmental milestones physical, social, emotional
and intellectual developments that most children achieve
by specific ages
endocrine system the system in the body that regulates
the production and release of hormones (through the
glands)
foetal alcohol syndrome describes a range of features
seen in babies who have been exposed to alcohol while in
the womb
genes the blueprint of the body that controls growth,
development and how the body functions
haemophilia an inherited condition characterised by
an inability of the blood to clot. Both males and females
can carry the gene for haemophilia, but the condition is
usually present only in males.
hormone a chemical in the body that causes a change in
the functioning of a specific tissue or organ
inherited condition a condition that is passed down
from parents to children
Listeria monocytogenes bacteria that can increase
the risk of stillbirth, miscarriage and premature labour in
pregnant women
maternal nutrition the dietary intake of the mother
during pregnancy
neural tube defects failure of the neural tube (which
develops into the central nervous system) to close during
the development of the embryo, resulting in spina bifida
sex-linked chromosome genetic material that
determines the sex of the developing baby
vaccination the administration of a micro-organism of a
disease to bring about an immune response
Key nutrients for health • CHAPTER 5 193

7.1 eterminants of health and individual development
D
during the prenatal stage of the lifespan: biological
KEY CONCEPT Understanding the biological determinants that have an impact

on health and individual human development during the prenatal stage of
the lifespan
The prenatal stage of the lifespan is when the foundations are laid for later life.
Optimal health and development during this stage is important to help promote
optimal heath and development throughout the lifespan.
The health and individual human development of unborn babies are influenced
by a range of factors including:
• biological influences such as genetics
• behavioural factors, such as maternal nutrition prior to and during pregnancy,
parental smoking, alcohol and drug use during pregnancy, and vaccination
• physical environment, such as tobacco smoke in the home and access to
health care
• social factors, such as parental education, parental income, parental health and
disability, and access to health care.
Understanding the determinants that influence the health and development
experienced during the prenatal stage allows personal, community and government
strategies to be implemented to optimise the health and development of unborn
babies in Australia.
Biological determinants
Genetics
An unborn baby begins life as a single cell containing the genetic information
passed down from the mother and father. This information dictates much of the
individual human development that occurs throughout the prenatal stage and
throughout life.
In chapter 6, you learnt how, at fertilisation, the genetic make-up of the unborn
child is determined. The genes that a child inherits from their biological parents
have a significant impact on the child’s health and individual human development.
Genes are the blueprint of the body because they control growth, development and
how the body functions. An unborn baby’s genetic make-up determines:
• the rate and timing of development in the uterus as a result of the excretion of
hormones from the glands of the endocrine system
• whether the unborn baby is male or female
• the development of genetic conditions such as haemophilia
• the development of chromosomal abnormalities including Down syndrome.
Genes are part of the chromosomes, which are long strands of deoxyribonucleic
acid (DNA) that contain genetic information and are found in the nucleus of human
cells. Each human cell — except blood cells, which have no nucleus — contains
46 chromosomes in 23 pairs. Of the 23 pairs, one pair is called the ‘sex-linked’
chromosome because it determines the sex of the individual. Our genetic make-up
is determined by the combination of genes that occur at the point of fertilisation.
Fifty per cent of an individual’s genes are passed down from the biological father
and 50 per cent from the biological mother. It is this combination of genes that
determines the physical characteristics of the individual (e.g. facial features, sexual
characteristics and eye colour), as well as genetic conditions and chromosomal
abnormalities.

Genetic conditions
Sometimes the genes for certain genetic conditions are already present in the
mother or father and can be passed on to the children. These conditions are called
inherited conditions and examples include cystic fibrosis and haemophilia.
Cystic fibrosis is the most common life-threatening genetic disorder among
light-skinned people. Whether or not an unborn baby will have cystic fibrosis is
determined at the time of fertilisation. An abnormality on the seventh chromosome
causes cystic fibrosis but, in order to develop the condition, two defective
chromosomes must be inherited, one from each parent. Individuals with one
defective gene will not display the condition, but are considered to be ‘carriers’.
If two carriers have a child, they have a 25 per cent chance of producing a baby
with cystic fibrosis and a 50 per cent chance of producing a child that is a carrier
(see figure 7.2).
Mother Father
Carrier Carrier
(no symptoms) (no symptoms)
Each child inherits one copy of the gene from
the mother and one copy from the father.
Possible combinations:
Cystic Normal gene cancels Cystic Cystic

fibrosis out the effect of the fibrosis fibrosis
gene defective gene. gene gene
This individual has only one cystic Normal Carrier Carrier Affected This individual has two defective
fibrosis gene so will not have the genes and will therefore have
condition, but will be a carrier. cystic fibrosis.
Chromosome with normal gene
Chromosome with cystic fibrosis gene
Figure 7.2 How the inherited condition cystic fibrosis is passed on
Although cystic fibrosis can be detected in the prenatal stage, it is often not
diagnosed until the baby is born. This condition results in the secretion of a thick
mucus that affects the lungs, pancreas, liver and reproductive system. In the lungs,
the mucus clogs small air passages and traps bacteria. This causes repeated bouts of
infection, and the blockages can result in irreversible damage to the lungs.
Sex-linked genetic conditions

As explained earlier, each human egg and each human sperm contain one set of
23 chromosomes, with the 23rd chromosome being the one that determines the
sex of the individual. Each cell in the female body contains two ‘X’ sex-linked
chromosomes, but each cell in the male body contains one ‘X’ and one ‘Y’ sex-linked
chromosome. Because every female egg contains one set of chromosomes,
every egg will have only the ‘X’ sex-linked chromosome. In contrast, each
male sperm can have either an ‘X’ sex-linked chromosome or a ‘Y’ sex-linked
chromosome.
This explains why the gender of a developing baby is determined by the sperm.
If an ‘X’ sperm fertilises an ‘X’ egg, then the result is a female baby. If a ‘Y’ sperm
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 195
7.1 D
eterminants of health and individual development during the prenatal
stage of the lifespan: biological
fertilises an ‘X’ egg, then the result is a male baby

(figure 7.3).
Some genetic conditions are carried on the ‘X’
chromosome. There are few genetic conditions related
to genes on the ‘Y’ chromosome. One normal copy of
a gene on the ‘X’ chromosome is usually sufficient for
Sperm carries either an All female eggs normal function. Women (‘XX’ chromosomes) who
‘X’ chromosome or a contain an
‘Y’ chromosome. ‘X’ chromosome.
may have a defective copy of a gene on one of the
two ‘X’ chromosomes are protected by the normal
gene on the second ‘X’ chromosome.
‘X’ sperm fertilises an ‘X’ egg Female baby
Conditions such as colour blindness are much
‘Y’ sperm fertilises an ‘X’ egg Male baby more prevalent among men (‘XY’ chromosomes) as
Figure 7.3 The sex of a child is colour blindness is carried on the ‘X’ chromosome, of
genetically determined. which males have only one copy. Therefore, males do not have the protective factor
of a second chromosome carrying a normal gene.
Haemophilia is another example of a genetic condition where the gene is carried
on the ‘X’ chromosome (figure 7.4). Haemophilia is a rare condition that affects
approximately 2300 Australians, most of whom are males. It is passed on by
females who carry the haemophilia gene and by males who have the condition.
Individuals with haemophilia do not have one of the essential factors required to
form a blood clot. This means they are prone to bleeding, particularly internally.
Bleeding may occur as a result of injury or trauma or can occur spontaneously.
Treatment involves the injection of the missing blood-clotting factor. If the bleeding
is not stopped, it can result in pain and swelling. People with haemophilia may
suffer from arthritis, chronic pain and joint damage as a result of bleeding into
joints and muscles over a period of time.
Haemophilia Genetic Inheritance
or = has an X chromosome with the “haemophilia” genetic alteration
or = has an unaltered X chromosome
When the father has haemophilia and When the mother carries the altered gene
the mother is unaffected causing haemophilia and the father is unaffected
Father Mother Father Mother
XY XX XY XX
XY XY XX XX XY XY XX XX
None of the sons will have haemophilia. There is a 50% chance at each birth that a son will have haemophilia.
All of the daughters will carry the gene. There is a 50% chance at each birth that a daughter will carry the gene.
Some might have symptoms. Some might have symptoms.
© Haemophilia Foundation Australia (HFA) 2013 www.haemophilia.org.au
Figure 7.4 Haemophilia is a genetic condition that is carried on the ‘X’ chromosome.

Chromosomal abnormalities
Abnormalities during the creation of sperm and ova can cause a range of conditions
in the unborn baby. Most often, these conditions arise as a result of too many or
too few chromosomes.
A common chromosomal abnormality is trisomy, where there are three copies of
a specific chromosome instead of the usual two. In most cases, an embryo with a
trisomy will not survive. In these cases, the pregnant woman has a miscarriage. The
miscarriage often occurs in the early stages of pregnancy, often before the woman
realises she is pregnant.
The risk of trisomy abnormalities increase with the age of the mother. The
approximate risks are:
• 1 in 1300 at age 25
• 1 in 1000 at age 30
• 1 in 400 at age 35
• 1 in 100 at age 40
• 1 in 35 at age 45.
Other chromosomal abnormalities occur when part of a chromosome is missing,
duplicated or attached to the wrong part of the chromosome.
Common chromosomal abnormalities include:

• Down syndrome — Down syndrome (also known as Trisomy 21)
occurs when there are three copies of the 21st chromosome. One of
the most common chromosomal conditions, individuals with Down
syndrome generally have an intellectual disability and characteristic facial
features.
• Trisomies 13 and 18 — These trisomies usually are more severe than
Down syndrome, but less common. Babies with either of these conditions
often have severe intellectual disabilities and physical birth defects. Most
babies born with these conditions die before their first birthday.
• Turner syndrome — Turner syndrome affects girls who are missing all or
part of one of their X chromosomes. They are usually infertile and do not
undergo the normal changes associated with puberty. Turner syndrome can
result in short stature and cardiovascular and kidney problems.
• Triple X syndrome — Girls with this condition have an extra X chromosome.
Affected girls generally have no physical birth defects, experience normal
puberty and are fertile. Affected girls usually have normal intelligence,
though many have learning problems. As the effects of this condition are
subtle, many of those affected go undiagnosed.
• Klinefelter syndrome — This condition affects only boys and is
characterised by having two, and sometimes more, X chromosomes in
addition to their Y chromosome. Affected boys usually have normal
intelligence, although may have learning difficulties. As adults, they
produce lower-than-normal amounts of the male hormone testosterone and
are infertile.
• XYY syndrome — This condition affects males, who have an extra Y
chromosome. XYY syndrome results in fertile males who generally have
normal intelligence although some experience learning, behavioural and/
or speech problems. Some with this condition are taller than normal. Like
triple X females, many affected males don’t know they have a chromosomal
abnormality.
7.1 D
eterminants of health and individual development during the prenatal
stage of the lifespan: biological

1 What determines the genetic make-up of an 7 Using examples, explain what the difference is
individual? Explain. between a genetically inherited condition and a
2 Outline three aspects of health and/or development chromosomal abnormality.
during the prenatal stage that are influenced by 8 ‘Genetics play the most significant role in the health
genetics. and individual human development of unborn
3 With reference to sex-linked chromosomes, explain babies.’ Discuss.
how sex is determined. 9 Using the internet, research:
4 What are the chances of a mother and father who (a) ways that inherited and chromosomal conditions
are carriers of cystic fibrosis having a child with the can be tested for during the prenatal stage.
condition? Explain why this is the case. (b) what genetic testing relates to. How could this
5 Explain why sex-linked conditions sometimes affect information be used prior to pregnancy?
only either males or females.
6 Explain the term ‘trisomy’.

D
during the prenatal stage of the lifespan: behavioural
KEY CONCEPT Understanding the behavioural determinants that have an

impact on health and individual human development during the prenatal stage
of the lifespan
The behavioural determinants that impact on prenatal health and development

are related to the behaviours and choices of the parents, both before and during
pregnancy. Examples include maternal nutrition status, parental smoking, alcohol
and drug use during pregnancy, and vaccination.
Maternal nutrition
Figure 7.5 Maternal nutrition

is important for the health and
individual human development of the
growing baby.
For women of child-bearing age, ensuring a healthy balanced diet prior to becoming
pregnant is important for preparing the body for the demands of carrying a baby. A
woman’s nutritional status during pregnancy is dependent on the nutritional reserves
that are built up in her body prior to conception. Women who have nutritional
deficiencies prior to conceiving a child are likely to have these deficiencies during
pregnancy, particularly as the body faces additional nutritional demands because
of the growing baby. It is particularly important that women consume the required
amount of folate, iron and calcium prior to and during pregnancy.
Ensuring good nutrition prior to conception is also important because the
ongoing development of the foetus is dependent on the health of the embryo.
Upon implantation, the embryo divides into two types of cells — those that
form the foetus and those that form the placenta. In undernourished women, a
greater proportion of cells are likely to form the placenta rather than the foetus,
which means the foetus will be relatively small when it begins its growth, and its
7.2 D
eterminants of health and individual development during the prenatal stage
of the lifespan: behavioural
development in the uterus will be restricted. There is an increased risk that the
baby will be low birth weight when born.
Folate (folic acid)

Folate is a B-group vitamin that is required for the formation of red blood cells,
which transport oxygen around the body. It also assists with DNA synthesis, cell
growth and the development of the nervous system of the foetus. Adequate folate
consumption before and during pregnancy reduces the risk of neural tube defects
in the baby. Neural tube defects involve damage to the brain and spine, and to
the nerve tissue of the spinal cord. The vertebrae or skull may not close properly
during development, which results in the spinal cord or brain being exposed and
placed at risk of further damage.
Spina bifida is the most common neural tube defect and occurs when the spinal
nerves protrude through the gap in the unclosed vertebrae instead of growing
down the middle of the spinal column. Spina bifida may result in one or more of
the following symptoms:
• walking difficulties, which may result in the inability to walk
• reduced sensation in the legs and feet
• increased risk of burns and pressure sores due to limited feeling
• urinary and faecal incontinence
• sexual dysfunction
• deformities of the spine, commonly referred to as scoliosis (figure 7.6).
Another type of neural tube defect is anencephaly, a condition in which the brain
Figure 7.6 Lack of folate before and skull do not develop properly. Babies with anencephaly are either stillborn or
and during pregnancy can result in
neural tube defects that may cause
die soon after birth.
deformities of the spine. Good sources of folate include green leafy vegetables, poultry, eggs, cereals, citrus
fruits and legumes. In Australia, many cereal products are fortified with folate.
Iodine
Iodine is a mineral that is required in greater amounts during pregnancy
to promote optimal brain and nervous system development. If iodine
is deficient during pregnancy, the consequences can be serious and
include stunted growth and intellectual disability.
Countries that have a sufficient iodine concentration in the
soil generally get enough iodine from crops grown on the land.
In countries that do not have enough iodine in the soil (such as
Australia), iodine is added to other food items. In Australia, most
iodine comes from iodised salt and bread fortified with iodised salt,
but is also present in fish, seaweed, eggs, cow’s milk and strawberries.
Australians are reducing their intake of salt as a result of the
increasing rates of cardiovascular disease, so people are now at
an increased risk of iodine deficiency and need to ensure their
requirements are being met by other dietary sources, especially
Figure 7.7 Pregnant women during pregnancy. In Australia, recent studies conducted in Victoria and New
need to choose a wide variety South Wales indicate mild-to-moderate iodine deficiency in all groups.
of foods in order to meet the
nutritional requirements of
their baby. Iron
Iron is a mineral that is required in greater amounts during pregnancy due to the
increased demand for oxygen for the developing foetus as well as the increased
energy needs of the mother. During pregnancy, there is an increase in blood volume
to cater for the developing baby as well as the enlarging reproductive organs of
the mother. Iron is needed for haemoglobin, a component of blood that carries
oxygen around the body. Good sources of iron include red meat, fortified cereals,

egg yolks, legumes, nuts and green leafy vegetables. Vitamin C assists with the
uptake of iron from the small intestine. High-fibre diets, alcohol and tannic acid in
tea can interfere with iron absorption.
Lack of iron can lead to iron-deficiency anaemia, resulting in the body not having
enough iron to form haemoglobin. In pregnant women, iron-deficiency anaemia
can increase the risk of a premature birth and a low birth weight baby.
Calcium
Calcium is required for the strengthening of bones and teeth. During pregnancy,
calcium is required to meet the needs of the developing foetus as well as ensuring
the maintenance of bone mass for the mother. Good food sources of calcium
include dairy products such as milk, cheese and yogurt. If a pregnant woman
does not consume the required amount of calcium-rich foods, the calcium that the
developing baby needs will be leached (or taken) from the mother’s bones. This
could lead to osteoporosis in later life.
To ensure that the dietary needs of the mother and baby are met, pregnant
women should choose from a wide variety of foods. These include:
• plenty of fruits and vegetables
• plenty of wholegrain breads and cereals
• moderate amounts of low-fat dairy foods and lean meats, chicken and fish
• small amounts of foods high in fat, sugar and salt
• dried beans and lentils, and nuts and seeds.
Some foods contain the bacteria Listeria monocytogenes, which increase the risk
of miscarriage, stillbirth or premature labour. For this reason, pregnant women
should avoid the following foods:
• soft-serve ice-cream
• unpasteurised foods and soft cheeses such as camembert and ricotta
• pre-cooked or prepared cold foods such as quiches, delicatessen meats, salad
from buffets
• raw seafood such as oysters and smoked seafood such as salmon.
Foods that contain high levels of mercury can put the baby at risk of delayed
development in the early years. The effects may not be noticed until the child
fails to reach developmental milestones at the expected age. It may also result
in difficulties with memory, language and attention span. Women need to be
selective about the type of fish they consume during pregnancy, as some fish have
significantly higher levels of mercury than others. Shark, swordfish, barramundi,
gemfish, orange roughy and southern bluefin tuna should all be avoided.
Parental smoking during pregnancy

Smoking during pregnancy is a significant risk factor for a number of conditions
for both the mother and her unborn baby. Tobacco smoke contains thousands
of chemicals, and acts to reduce oxygen flow to the placenta and exposes the
developing foetus to numerous toxins. Maternal smoking increases the risk of a
range of health and developmental conditions of the unborn baby including:
• spontaneous abortion
• ectopic pregnancy
• prematurity
• complications of the placenta
• birth defects
• lung function abnormalities Figure 7.8 Tobacco or alcohol use
• respiratory conditions during pregnancy can harm the
• perinatal mortality. developing baby.
7.2 D
According to the Australian Institute of Health and Welfare (2012), there is

evidence that the more cigarettes a mother smokes, the higher the risk of poor
birth outcomes.
Maternal smoking rates are higher in some population groups including
Indigenous women, teenagers, single mothers and mothers with lower
socioeconomic status. According to a survey taken by the AIHW in 2009, almost
half of Aboriginal and Torres Strait Islander mothers reported smoking during
pregnancy (49.3 per cent), compared with 12.1 per cent of non-Indigenous women
who gave birth. Of all teenage mothers, 36.7 per cent reported smoking. Data on
maternal smoking are shown in table 7.1.
Table 7.1 Women who gave birth, by tobacco smoking status during pregnancy and state and
territory, 2010
NSW Vic Qld WA SA Tas ACT NT Total
Smoked 11.2 11.8 17.2 12 17.4 23 11.2 25.5 13.5
Did not smoke 88.7 86.3 81.8 83.7 81.1 76.2 88.4 67.8 85.2
Not stated 0 1.8 1 4.2 1.5 0.7 0.3 6.8 1.3
Total 100 100 100 100 100 100 100 100 100
Source: Adapted from Australian Institute of Health and Welfare, Australia’s mothers and babies 2010.
Alcohol use during pregnancy

Small head Alcohol can cause problems for women even before pregnancy because it may
Epicanthal Low nasal
(skin) folds bridge interfere with fertility. Therefore women who are trying to fall pregnant should limit
their consumption of alcohol or stop it altogether. The consumption of alcohol
Small eye during pregnancy can cause significant harm to the unborn child. When alcohol
Flat openings is consumed by a pregnant woman, it crosses the placenta from the mother’s
cheeks blood to the baby’s blood. This can result in foetal alcohol syndrome (figure 7.9).
Short A foetus that is severely affected by foetal alcohol syndrome is at risk of dying
nose
before birth. The alcohol may harm the development of the nervous system of the
Smooth Thin foetus, including the brain. It may also narrow the blood vessels in the placenta
philtrum upper lip and umbilical cord, thereby restricting blood supply to the foetus. The impact of
foetal alcohol syndrome on the health and individual human development of the
Underdeveloped jaw unborn child is described in table 7.2.
Figure 7.9 Foetal alcohol syndrome
is seen in the facial features of Table 7.2 Impact of alcohol consumption on the health and individual human development
affected children. of the unborn child
Impact of alcohol Impact of alcohol consumption on

consumption on health physical development
Increased risk of premature birth Low birth weight

Increased risk of stillbirth Smaller head circumference (microcephaly)
Undernourishment of the Small eyes and epicanthal folds
growing baby due to alcohol Flattened face, including the bridge of the nose due to earlier
blocking the absorption of than normal cell changes in the baby’s face during development
nutrients
Underdeveloped vertical ridges between the nose and upper lip
Reduction in the amount of (philtrum)
oxygen available to the baby
due to alcohol narrowing the Smaller lower jaw (micrognathia)
blood vessels in the placenta Heart defects
and/or umbilical cord resulting Restriction of movement of elbow and knees due to tightening
in the restriction of blood supply of ligaments, muscles, tendons and skin around the joints
Source: Adapted from ‘Foetal alcohol syndrome’, Better Health Channel, www.betterhealth.vic.gov.au.

Heavy consumption of alcohol, particularly in the first trimester (three months)
of pregnancy, is considered to be particularly dangerous to the foetus. The World
Health Organization recommends that pregnant women consider not consuming
alcohol at all.
Case study
Please don’t do what I did, ‘I went to so many doctors who didn’t want to listen,
wouldn’t give me any information or referrals.’
pleads mother who drank She decided to attend a conference on FAS in
Canada and met a doctor who was able to diagnose
By Renee Switzer
her boys using their background information and from
Elizabeth Russell lives with the guilt that she ruined viewing their facial features on a photograph. ‘I felt
her sons’ lives after drinking during her pregnancies. absolutely distraught. I felt guilty that I had risked my
But now she is trying to prevent other women from son’s (health) and I had more or less ruined his life.’
unknowingly doing the same. Ms Russell said she had ‘absolutely no idea’ about the
Ms Russell is a recovering alcoholic who in 2001 risks of drinking alcohol while pregnant.
found that her addiction had physically harmed her two ‘I stopped smoking and I took vitamins and had no
sons. Her elder son, 26, was diagnosed with ‘alcohol idea that alcohol could cause any damage. In fact, my
exposed neurodevelopmental disorder’ and the younger doctor basically said to me alcohol wasn’t a problem’.
son, 22, has full foetal alcohol syndrome (FAS). Since her sons have been diagnosed Ms Russell has
People with these conditions are born with birth written two books on her family’s experience with FAS
defects that can involve brain damage, as well as as well as others’ experiences. She is now fighting to
facial abnormalities. As adults they can experience have national alcohol guidelines changed to advise
developmental delays, learning difficulties and women to avoid all alcohol while pregnant. ‘From
behavioural problems. personal experience with friends of mine, doctors are
But for Ms Russell, it wasn’t until her boys were still saying it’s OK to drink when you’re pregnant.
older, and she had seen a number of doctors, that their Abstinence is by far the best and I’ll fight to the end
conditions were diagnosed. about that because abstinence says it’s crucial, whereas
‘My youngest son was getting into a lot of trouble (the current guidelines) are sort of nonchalant, it’s not
from 13 years on and before that he had some strange really going to matter and, boy, it matters.’
behaviours. But when he was working he started using Ms Russell is also lobbying to have diagnostic clinics
drugs, alcohol, going out in the middle of the night. I just set up in major cities around the country so that alcohol
didn’t know what was going on with him,’ she said. ‘He’d related conditions can be identified.
been diagnosed with ADHD so I did some research on ‘There’s nobody who is able to diagnose properly in
that and then found out foetal alcohol syndrome existed.’ Australia. There are about 70 clinics in Canada and not
Ms Russell went to her doctor, who she says, asked one in Australia.’
her why she would put herself through such trauma. Source: The Age, 22 April 2007.
Case study review

1 What are the possible effects of foetal alcohol syndrome?
2 What made Ms Russell seek medical advice regarding her son?
3 Why is Ms Russell lobbying for national alcohol guidelines to be changed so that
women are advised to avoid all alcohol while pregnant?
Drug use during pregnancy

Drug use during pregnancy may have a significant effect on the health and
individual human development of the foetus. Some medications or drugs will
cross the placenta and potentially harm the unborn child. Side effects may include
7.2 D
withdrawal symptoms, developmental delay, intellectual disability, birth defects,

premature birth and stillbirth. The types of drugs that may be harmful include:
• medicines (e.g. some prescription drugs, over-the-counter medicines, herbal
remedies or nutrition supplements)
• tobacco and alcohol
• caffeine
• illegal drugs (e.g. cannabis, heroin, cocaine, amphetamines)
• other substances used as inhalants (e.g. glue or aerosols).
The potential for harm to the unborn child depends on a range of factors
including:
• the type of drug being consumed
• how the drug is taken
• the amount taken
• how often it is taken
• whether the drug is used alone or in combination with other drugs
• the response of the baby to the drug
• the gestational age of the unborn baby
• the level of health of the mother.
Table 7.3 outlines the possible effects of drug use on the health and individual
human development of the unborn baby.
Table 7.3 Possible effects of drug use on the health and individual human development of
the unborn child
Possible impact on health and/or individual

Type of drug human development
Over-the-counter and Birth defects may be caused by some antibiotics, anticonvulsant

prescription medications, medication (e.g. for the treatment of epilepsy), drugs that treat some
nutritional supplements rheumatic conditions, some thyroid medications, some blood thinning
and herbal medicine medications, and high doses of vitamin A. Medicines are given a risk
category by the Australian Drug Evaluation Committee according to
their safety during pregnancy.
Tobacco Increased risk of miscarriage and stillbirth, low birth weight, premature
birth
Greater risk of sudden infant death syndrome (SIDS)
Alcohol Increased risk of foetal alcohol syndrome
Caffeine Increased risk of miscarriage, premature birth and stillbirth if consumed
heavily
Illegal drugs Cannabis — increased risk of poor or delayed growth
Heroin — increased risk of low birth weight, premature birth, foetal
distress, stillbirth, blood-borne viral diseases, infant drug withdrawal
after birth
Cocaine — increased risk of miscarriage, poor or delayed growth, birth
defects (e.g. brain, heart, genitals, urinary system), stillbirth
Amphetamines — increased risk of miscarriage, premature birth, birth
defects (e.g. smaller head size, eye problems, cleft palate, limb and
brain defects), increased heart rate, infant drug withdrawal after birth
Substances used as drugs, Increased risk of miscarriage, low birth weight, birth defects, sudden
e.g. inhalants infant death syndrome (SIDS)
Source: Adapted from ‘Birth defects and drugs’ and ‘Pregnancy and drugs’, Better Health Channel,
www.betterhealth.vic.gov.au.
Vaccination
Vaccination plays an important role in reducing the spread of many conditions
in Australia. Even though over 90 per cent of the population are up to date with
their vaccinations, most vaccine preventable diseases still occur in Australia. The
prenatal stage of development is particularly susceptible to many of the effects of

vaccine preventable diseases. Specific diseases and their possible impact on the
unborn baby include:
• rubella — can cause defects in the brain, heart, eyes and ears of the baby. It also
increases the risk of miscarriage and stillbirth
• chickenpox — can cause defects in the brain, eyes, skin and limbs of the baby
• measles — increases the risk of miscarriage, premature birth or stillbirth
• mumps — increases the risk of miscarriage
• hepatitis B — can be passed on to the baby during birth. The mother and baby
can also become carriers of hepatitis B (when they have been infected and the
virus has not been cleared from their body).
• influenza — increases the risk of miscarriage, premature birth or stillbirth, and
increases the risk of severe illness and death in the mother
• whooping cough — can cause pneumonia, seizures, conditions affecting the
brain and the death of a baby (Source: Better Health Channel, Department of
Health, Victoria).
A possible side effect of some vaccines is mild fever which can increase the risk
of developmental abnormalities in the developing baby. As a result, vaccinations
will generally not be given during pregnancy. The exception to this is the influenza
vaccine which is deemed safe for pregnant women and can decrease the risk of
developing fever as a result of the disease itself.
To reduce the risk of contracting one of the vaccine preventable diseases, women
who are planning a pregnancy should ensure their vaccinations are up to date prior
to fertilisation. Once pregnant, women can also reduce their risk of contracting
disease by regular hand washing, avoiding international travel and avoiding close
contact with sick people.
TEST your knowledge 11 Explain the possible impacts of three vaccine-

preventable diseases on the health and/or
1 Explain the importance of folate, iodine, calcium
development of the unborn baby.
and iron to the developing baby and/or mother
during pregnancy.
2 Explain why nutrition is an important consideration
prior to pregnancy. 12 You have been appointed as a maternal and child
3 Outline three possible effects on the unborn baby of health nurse. What advice would you give a first-
maternal smoking. time mother about nutrition, tobacco, alcohol and
4 Identify the state/territory that had the highest rates drug use, and vaccination?
of maternal smoking in 2010. 13 Devise a one-day eating plan for a pregnant
5 What is the recommended alcohol level for woman, taking into account the foods that should
pregnant women? be consumed in greater amounts and those that
6 Explain the possible impact of alcohol consumption should be avoided.
on the developing baby during pregnancy. 14 Use the Foetal alcohol syndrome weblink in your eBook plus
7 Outline the effects of foetal alcohol syndrome on eBookPLUS to find the link to this question.
the health and individual human development of (a) How does alcohol pass from the mother to the
unborn babies. baby during pregnancy?
8 Why should pregnant women avoid foods such as (b) What are the characteristics of FAS?
soft cheeses, shellfish and soft-serve ice-cream?
9 Why should pregnant women avoid fish that
contain high levels of mercury?
10 The use of drugs can have a significant impact
on the health and individual human development
of the unborn child. What factors determine the
potential harm that can occur as a result of drug
use during pregnancy?
7.3 eterminants of health and individual development during
D
the prenatal stage of the lifespan: physical environment
KEY CONCEPT Understanding the physical environment determinants that have

an impact on health and individual human development during the prenatal
stage of the lifespan
Aspects of a pregnant woman’s physical surroundings can impact on the health and
development of her unborn baby. Factors within the physical environment that
can impact on the unborn baby include tobacco smoke in the home and access to
health care.

Tobacco smoke in the home increases the risk of passive smoking among pregnant
women. Passive smoking means breathing in other people’s tobacco smoke. Exhaled
smoke is called exhaled mainstream smoke. The smoke drifting from a lit cigarette
is called sidestream smoke. The combination of mainstream and sidestream smoke
is called second-hand smoke or environmental tobacco smoke.
Tobacco smoke cools quickly which prevents it from rising. As smoke is
heavier than air, it tends to hang in mid-air rather than be dispersed into the
atmosphere. This increases the amount of second-hand smoke people breathe as it
is concentrated in the lower half of the room.
For pregnant women who live with one or more smokers, the home can be source of
exposure to second-hand smoke. Rates of tobacco smoke in the home have declined in
the last decade, reflecting the continuing decline in the prevalence of smoking as well
as an increase in smokers confining their smoking to outside the home environment.
In 2010, more than three-quarters (77 per cent) of Australians lived in homes where
no-one regularly smoked, and 18 per cent lived with one or more people who smoked
only outside the home. However, 5 per cent of non-smokers were exposed to smoke
from another resident at home at least once a day (AIHW, 2012). Data are not available
regarding the rate of pregnant women who were exposed to tobacco smoke in the
home, but given the exposure rates applying to all non-smokers, it is reasonable to
assume that some pregnant women would be exposed.
Figure 7.10 Tobacco smoke in the

home can have similar impacts on the
unborn baby as maternal smoking.

Exposure to environmental tobacco smoke can contribute to the same health
and development effects as maternal smoking including:
• spontaneous abortion
• ectopic pregnancy
• prematurity
• complications of the placenta
• birth defects
• lung function abnormalities
• respiratory conditions including asthma
• perinatal mortality.
Access to health care

Prenatal health care (also called antenatal care) is an important part of pregnancy
and there is a strong relationship between regular prenatal health care and positive
health outcomes for both mother and baby. The purpose of prenatal health care is
to monitor the health of the mother and baby, monitor growth of the baby, provide
health education and advice to the mother, identify any risks to the mother and
baby, and provide medical interventions if necessary.
The World Health Organization recommends pregnant women access prenatal
health care at least four times during their pregnancy to increase the likelihood of
receiving effective maternal health interventions.
During prenatal health checks, a number of tests and measures are often
taken, including body weight, an ultrasound, blood pressure, blood glucose and
foetal heart rate. These allow the health and individual human development of
the pregnant woman and unborn baby to be assessed. If issues are detected,
interventions can be put in place.
The birthing process is a time when medical intervention is often required
and, if adequate health care is not accessible, any complications arising can go
untreated and impact the health and individual human development of both
mother and baby.
Geographical factors such as the location of relevant services can impact
on a woman’s ability to access prenatal health care. Many women in rural and
remote areas struggle to access health services during pregnancy due to the time
taken to reach them. As a result, the health of both mother and baby can be
compromised.
In 2009, two-thirds (65 per cent) of women attended at least one antenatal
visit before 14 weeks gestation, although 11.9 per cent of women did not receive
antenatal care until after 20 weeks. Around 80 per cent of women in major cities
and inner regional areas in New South Wales, South Australia and the Northern
Territory received antenatal care in the first 14 weeks of pregnancy, compared with
73.7 per cent of women residing in remote and 53.1 per cent of women in very
remote areas.
Stress in pregnancy can have a negative impact on both mother and baby.
A 2011 study indicates that women who have to travel for more than one hour
to access antenatal care are nearly eight times as likely to experience moderate or
severe stress as mothers who have this care close to home (National Rural Health
Alliance, 2012). A 2010 survey of rural families found only 12 per cent of the
respondents felt they had good access to maternity services (National Rural Health
Alliance, 2012).
7.3 D
eterminants of health and individual development during the prenatal stage of
the lifespan: physical environment
Case study
Spare a thought for rural Mothers’ health is an important determinant of the

health and wellbeing of children and communities. So
mums on Mother’s Day this Sunday let’s remember the mothers who live in
rural and remote areas of this country. They face the
Every woman in Australia has the right to safe, afford-
challenges of distance, isolation, poorer health and
able maternity services as close to home as possible.
worse access to health services than women in the
This is something most people would agree with — and
cities — and so often with their renowned fortitude and
something that is within the nation’s power to deliver.
resilience.
But in recent years more than half of Australia’s small
Some of the steps towards improved maternal health
maternity units, many of them in rural areas, have been
in rural and remote Australia are spelled out in the
closed. This Sunday, Mother’s Day, is a timely reminder
National Maternity Services Plan, 2010–2015, endorsed
of the importance of maternal and child health. This is
by State, Territory and Commonwealth Governments.
vital for mothers everywhere in Australia, for their babies
The Plan’s goal is to maintain Australia’s standard of
and children, and ultimately for the health of the nation.
safety and quality in maternity care and to improve
Over time, the number of procedural GPs in rural
access to services and choice of models of care.
areas has been falling, while the number of rural women
For more information on maternal health, use the
giving birth has been increasing. Also significant is the
Rural health weblink in your eBookPLUS,
fact that the prevalence of midwives decreases with
where you can find Fact Sheet 25, Rural eBook plus
distance from capital cities, while the birth rate increases.
Maternity Services: Investing in the Future, just
Money can be saved in the short term by closing small
updated this month, and Fact Sheet 31, Women’s Health
rural maternity units, but this transfers cash costs to
in Rural Australia.
families and also imposes costs on mothers and babies
Source: http://nrha.ruralhealth.org.au/cms/uploads/mediareleases/
through increased risk and family dislocation. Stress in
mr_110512_final.pdf
pregnancy has a detrimental effect on mother and baby.
Case study review

1 Discuss how financial costs may increase for pregnant women who cannot access
health care locally.
2 Brainstorm possible reasons for increased levels of stress among pregnant women
who cannot access health care close to their homes.
TEST your knowledge 6 Suggest two ways in which prenatal health care
could promote the health and/or individual human
1 What is the difference between mainstream and
development of an unborn baby.
sidestream tobacco smoke?
7 Discuss two reasons why those who do not have
2 Explain why second-hand smoke can be particularly
health services near their homes may not access
damaging when indoors.
health care.
3 Discuss how tobacco smoke in the home can impact
8 Use the Environmental tobacco smoke weblink in
on the health and development of the unborn baby.
your eBookPLUS to find the link to this activity.
4 Outline the purpose of prenatal health care.
Watch the advertisement on environmental
tobacco smoke during pregnancy. Create eBook plus
another advertisement that educates about
5 Design a poster that could be used to educate the dangers of tobacco smoke in the home
people of the dangers of tobacco smoke in the during pregnancy.
home during pregnancy.

D
during the prenatal stage of the lifespan: social
KEY CONCEPT Understanding social determinants that have an impact on health

and individual human development during the prenatal stage of the lifespan
Once fertilisation has occurred, unborn babies rely on their mother to achieve
optimal health and development during the prenatal stage. The society in which
the mother lives and the social factors that impact on her life, will also contribute
significantly to the health and development of her unborn baby. Social factors
include parental education, parental income, parental health and disability, and
access to health care.
Parental education
The parents’ level of education can impact the developing baby in a number of ways.
Knowledge of health behaviours (also known as ‘health literacy’) can increase the
probability of parents caring for themselves in ways that promote the health and
development of their unborn baby. Accessing health care, consuming nutritious
food, being vaccinated, not smoking, avoiding teratogens such as alcohol and drugs,
and preventing illness are more likely to occur in those who are educated about the
benefits of maintaining optimal health during pregnancy. These behaviours promote
optimal health and individual human development in the unborn baby and reduce
the risk of conditions such as preterm birth, low birth weight and birth defects.
Parental education also increases employment opportunities and the ability to
generate an adequate income.
Parental income
Parental income is often related to the education of parents. Educated parents are
more likely to have a higher paying job and are more able to access a range of
health-promoting resources during the prenatal stage of the lifespan. Income can
improve the ability of parents to provide resources such as prenatal health care
and adequate nutrition which can enhance
2500 7
outcomes for the unborn baby by promoting Cases
optimal growth, health and development. Rate 6
Having an adequate income may also assist 2000
in decreasing stress levels as parents may be 5
more comfortable knowing they can provide
Per 100 live births

the necessary resources for their child. 1500
4
Number
Specific population groups are often

more likely to experience the effects of low 3
1000
income during pregnancy, including teenage
mothers, Indigenous Australians and those 2
from low socioeconomic status groups. 500
Socioeconomic status is a measure that 1
combines the levels of education and income,
and occupation status. Those with higher 0 0
socioeconomic status have higher paying 1 2 3 4 5 6 7 8 9 10
jobs, higher levels of education and higher (Lowest) (Highest)
status occupations. These components are Socioeconomic status

often, but not always, interrelated so a person Figure 7.11 Number and rate of
with a higher level of education is more likely to get a higher paying job that has a babies born with low birth weight
according to socioeconomic status
high status within the community. Socioeconomic status has a relationship with the Source: Australian Institute of Health and Welfare,
number and rate of low birth weight babies as shown in figure 7.11. Australia’s Health, 2012, p. 61.
7.4 D
of the lifespan: social
Parental health and disability

The level of health experienced by parents influences the health and individual
human development of developing babies in a number of ways. In some cases,
conditions experienced by the mother can directly impact on the development of
the baby. In others cases, parental illness or disability can impact on the unborn baby
indirectly by influencing the ability of parents to provide the resources necessary for
the optimal health and development of their unborn baby, such as earning an income.
Health concerns for pregnant women include:
• Gestational diabetes. This condition occurs in around 5 per cent of pregnant women
and can impact the developing baby in a number of ways, including an increased
risk of higher than normal birth weight, respiratory conditions and jaundice.
• Pre-eclampsia. High blood pressure during pregnancy causes the mother’s blood
vessels to constrict. This results in reduced blood flow to the uterus which can
impact on the growth of the baby.
• Stress. Stress during pregnancy releases hormones that may impact on the unborn
baby in a number of ways. Some research suggests that stress can contribute to
premature birth and may also impact brain development.
• Infections. Most infections in pregnant women do not impact on the developing
baby in the majority of cases but some infections can. If this occurs, the impacts
can be significant. Vaccination prior to pregnancy can reduce the risk of many of
these conditions, as was explored on pages 204–5. Infectious diseases that can
affect the developing baby include:
–– rubella — can cause defects in the brain, heart, eyes and ears of the baby. It
also increases the risk of miscarriage and stillbirth.
–– chickenpox — can cause defects in the brain, eyes, skin and limbs of the baby.
–– measles — increases the risk of miscarriage, premature birth or stillbirth.
–– mumps — increases the risk of miscarriage.
–– hepatitis B — can be passed on to the baby during birth. The mother and
baby can also become carriers of hepatitis B (when they have been infected
and the virus has not been cleared from their body).
–– influenza — increases the risk of miscarriage, premature birth or stillbirth,
and increases the risk of severe illness and death in the mother.
–– whooping cough — can cause pneumonia, seizures, conditions affecting the
brain and the death of a baby.
• Medication may be required for diseases and conditions which may impact on
the unborn babies’ health and individual human development, as explored in
section 7.2.
Parents experiencing optimal health may be more able to provide the resources
required for optimal health and development of their unborn baby. Parental disability
and health conditions, on the other hand, may limit the ability of parents to adequately
care for themselves and their unborn baby. If a parent requires care as a result of their
illness or disability, this can further decrease the ability to provide resources for the
mother. Factors including employment, nutrition, health care, stress management
and exercise may become difficult if the health of the parents is not optimal.

Although access to health care may be limited due to factors related to the physical
environment such as geographical location of resources, many social factors also
impact on access to health care. Education, cultural factors and income can all
enhance or limit the ability of pregnant women to access health care.
If parents have a sound understanding of the benefits of health care during
pregnancy, they may be more likely to access these resources. By accessing health

care throughout the pregnancy, the mother’s and baby’s health and development
can be monitored and interventions put in place if necessary. Education is often
a key component of health care and the knowledge of parents with regards to
promoting optimal health and development of their unborn baby can be enhanced.
Cultural factors can contribute to some pregnant women not accessing
health care. Around 25 per cent of Australians were born overseas, reflecting
the multicultural nature of Australian society. Language barriers and differences
in beliefs about pregnancy and health care can contribute to some women not
accessing health care.
Indigenous mothers are less likely to access health care during pregnancy than non-
Indigenous Australians. In 2010, of Indigenous mothers who gave birth at 32 weeks
or more, 77.7 per cent had five or more visits, compared with 92 per cent of non-
Indigenous mothers. Indigenous Australians across the lifespan often record lower
rates of health care usage than their non-Indigenous counterparts. According to the
2008 National Aboriginal and Torres Strait Islander Social Survey, almost 30 per cent
of Indigenous people aged 15 and over experienced problems accessing services
and almost 10 per cent experienced problems accessing a doctor. Overall, 1.3 per
cent reported barriers to accessing services due to discrimination, and 2.3 per cent
reported barriers due to services not being culturally appropriate (AIHW, 2012).
Although many prenatal health services can be accessed free of charge through
Medicare, other services require a patient co-payment. Those with low incomes may
not access health care during pregnancy as a result of the costs involved. This may
increase the risk of complications going untreated throughout the prenatal stage.
TEST your knowledge 3 Besides geographical location of resources, discuss

factors that may limit access to health care.
1 Explain two ways in which each of the following
may impact on the health and/or individual human
development of an unborn baby.
(a) parental education 4 ‘Social factors often influence the behaviours of
(b) parental income parents which, in turn, impact on the health and
(c) parental health and disability development of unborn babies’ Write a response to
(d) access to health care this statement.
2 (a) Describe the trend relating to the rate of low birth
weight babies according to socioeconomic status,
as shown in figure 7.11.
(b) Discuss possible reasons for this trend.
7.5 eterminants that act as risk and/or protective factors
D
in relation to one health issue
KEY CONCEPT Understanding the determinants that act as risk and/or

protective factors in relation to one health issue such as spina bifida, low birth
weight, foetal alcohol syndrome or gestational diabetes
As we have seen, there are a range of health issues that can

Day 16 Neural plate affect the mother and unborn baby during the prenatal
Neural stage of the lifespan. Many determinants of health and
groove development play a role in decreasing or increasing the risk
Day 18 The sides of the plate
of these issues occurring. An understanding of these issues
fold in and the determinants that play a role in their development
is important in implementing personal, community and
government strategies to reduce the risk of negative
outcomes during pregnancy. Common issues include spina
Day 22 The sides of the plate
fuse together bifida, low birth weight, foetal alcohol syndrome and
gestational diabetes.
Neural crest
cell
Spina bifida
Spina bifida is a condition that occurs when the neural
tube (see figure 7.12) in the embryo fails to close properly
Day 24 The neural tube is (see figure 7.13).
formed The effects of spina bifida will vary from case to case,
1 depending on the number of nerves exposed and damaged.
2 In some cases, symptoms will be minor but in more
severe cases, the individual may be paralysed and require
3 assistance to carry out daily tasks such as feeding, washing
and toileting.
Neural tube
The neural tube is a cylindrical structure

that will house the brain and spinal
cord of the embryo. Before the tube is
formed, the outer cells of the embryo lay
flat to make a neural plate. From around
day 16 to 24 after fertilisation, the neural
plate folds in on itself and the sides fuse Vertebra
together to form the neural tube. Dura mater
Figure 7.12 How the neural tube
is formed
Spinal cord
Source: Reprinted by permission from Macmillan
Publishers Ltd: ‘The origin and development of glial cells
in peripheral nerves’ by Jessen & Mirsky, Nature Reviews Spinal fluid
Neuroscience, Vol. 6, Iss. 9, pp. 671–682, © 2005.
Figure 7.13 Spina bifida occurs when the neural tube fails to close properly during the
prenatal stage. As a result, the nerves of the spinal cord protrude out of the back instead
of running down the middle of the spinal cord. The nerves become damaged, leading to
moderate to severe disabilities.

Although the exact causes of spina bifida are not completely understood, there Table 7.4 Prevalence of spina bifida in
appear to be a number of factors or determinants that can either increase or decrease babies, by age of mother
the risk of developing this condition. These factors will be explored in greater detail. Prevalence
Age (years) (per 10 000 births)
Biological less than 20 8.3
Certain genetic conditions can increase the risk of developing spina bifida, including 20–24 7.3
trisomy 13 and trisomy 18. Trisomy 13 is a condition in which there are three copies 25–29 6.3
of the 13th chromosome instead of the usual two. In Trisomy 18, there are three
30–34 4.7
copies of the 18th chromosome. These conditions are rare and contribute to a range
of development issues in addition to an increased risk of spina bifida. 35 and over 7.5
There is a relationship between spina bifida and the age of the mother. The overall Source: Adapted from Macaldowie A & Hilder L
prevalence of spina bifida is higher at the extremes of reproductive age; that is, among 2011. Neural tube defects in Australia: prevalence
before mandatory folic acid fortification. Cat. no.
women aged less than 20 years and women aged 35 years or more, than among PER 53. Canberra: AIHW.
women aged 20 to 35 (see table 7.4). The exact cause of this relationship is not known.
Behavioural
The use of saunas and spas exposes the pregnant woman to a
hot environment and increases body temperature. Excess heat
during early pregnancy has been shown to increase the risk of
spina bifida (see figure 7.14).
Folate is a nutrient (also known as Vitamin B6) that is essential
for normal cell division and the production of new cells. Folate
is particularly important during periods of rapid growth, as
occurs during the prenatal stage. Folate has been shown to be a
significant protective factor in the development of spina bifida.
The neural tube closes early in the pregnancy, often before
the woman knows she is pregnant. As a result, all women of
childbearing age where pregnancy is possible should ensure
they consume adequate amounts of folate.
Exposure to excessive heat early in pregnancy may increase the
risk of spina bifida. If the physical environment is excessively
hot, the risk may be increased.
Exposure to agents such as solvents, pesticides and x-ray
radiation may increase the risk of spina bifida, although the
exact link is unknown.
The prevalence of spina bifida increases with remoteness of Figure 7.14 The use of spas during
residence. The exact reason for this trend is not known but it may be linked to reduced pregnancy can increase the risk of
access to health care and differences in food availability in rural and remote areas. spina bifida.
Social
Maternal fever raises body temperature and may increase the risk of spina bifida as Table 7.5 Prevalence of spina bifida
a result. Women who experience illness that increases body temperature may be at based on place of usual residence
an increased risk of having a baby with a neural tube defect. Prevalence of
In 2009, the Australian Government introduced mandatory fortification of bread Place of usual spina bifida (per
with folate. This aims to decrease the prevalence of neural tube defects as folate residence 10 000 births)
intake is increased. Major cities 5.5
Accessing health care prior to pregnancy can increase parental knowledge of Rural 6.5
folate intake and other precautionary measures such as avoiding hot environments.
Remote 11.1
This may reduce the risk of spina bifida.
Those with adequate education surrounding maternal nutrition and pregnancy Source: Adapted from Macaldowie A & Hilder L
2011. Neural tube defects in Australia: prevalence
may ensure folate intake is adequate prior to conception. This can decrease the risk before mandatory folic acid fortification. Cat. no.
of spina bifida in the unborn baby. PER 53. Canberra: AIHW.
7.5 Determinants that act as risk and/or protective factors in relation to one health issue
Low birth weight

The birth weight of babies has a significant impact on health and individual
human development in both the short and long term. Adequate birth weight often
indicates that the body’s systems have developed optimally in the prenatal stage,
therefore decreasing the risk of health issues after birth. Low birth weight, on the
other hand, may indicate that the body’s systems are underdeveloped and the risk
of a range of health and development problems increases, including:
• risk of infection as a result of an under-developed immune system
• respiratory conditions, such as bronchitis
• reduced lung function
• feeding difficulties, leading to lack of nutritional intake
• increased risk of bradycardia (a slowing of the heart rate)
• apnoea (a short-term suspension of breathing)
• jaundice — the yellowing of the skin due to the immature liver being
unable to process the compound bilirubin, which is found in the blood (see
figure 7.15)
• increased risk of asthma during childhood
• poor sucking and swallowing reflexes
• damage to the retina of the eye, resulting in sight difficulties including
blindness
• increased risk of deafness
• greater likelihood of impaired learning capabilities
• greater likelihood of impaired growth and motor skill development.
Figure 7.15 Jaundice is characterised

by yellowing of the skin.
Figure 7.16 Low birth weight

can impact on a baby’s health and
development in a number of ways.
In later life, low birth weight can contribute to high blood pressure, type 2
diabetes and cardiovascular disease.
Low birth weight can be classified according to three categories as shown in
figure 7.17. As birth weight decreases, the risk of health and development problems
increases. Those classified as having ‘extremely low birth weight’ have a higher risk
of complications compared to those classified as having a ‘very low’ or ‘low’ birth
weight.

Low birth weight
babies
Very low birth weight Extremely low birth

Low birth weight —
— between 1000 weight — below
below 2500 grams
and 1500 grams 1000 grams
Figure 7.17 The classification of low birth weight babies
There are many factors or determinants that can contribute to low birth weight.
These can be biological, behavioural, physical environment and social determinants.
Biological
Babies born under 37 weeks gestation have an increased rate of low birth weight.
Less time spent in the uterus means less time to grow and develop, especially in
the foetal stage, when the rate of growth increases significantly.
Maternal age also has a relationship with birth weight. Young mothers (especially
those under 15 years of age) and older mothers (those over 45 years of age) have
higher rates of low birth weight babies (see figure 7.18).
9
8
Percentage
5
15–19(a) 20–24 25–29 30–34 35–39 40 and over Figure 7.18 Prevalence of low birth
weight by age of mother
Age group (years)
Source: Australian Institute of Health and Welfare,
(a) Includes liveborn babies born to women aged less than 15 years. 2007 National Perinatal Data Collection.
Babies born to parents who are of small stature or were of low birth weight
themselves may have an increased risk of being born with low weight. Genetics
appear to play a part in this relationship.
Behavioural
Maternal food intake is vital for supplying the unborn baby with the nutrients
required for optimal development. An inadequate supply of nutrients can lead to
underdevelopment of the foetus.
Smoking, excessive alcohol consumption and drug use during pregnancy
contribute to higher rates of low birth weight.
Environmental tobacco smoke can have similar effects on the unborn baby as maternal
smoking. Exposure to tobacco smoke increases the risk of a low birth weight baby.
Women in remote areas may have fewer health services in the areas in which
they live. This can decrease access to health care which can mean that slowed
growth is not detected and goes untreated, contributing to low birth weight.
Social
Parental health is a key factor contributing to birth weight. Illness of the mother
during pregnancy can increase the risk of having a low birth weight baby. Infections
in the uterus can lead to early labour, while other infections, such as chickenpox
and rubella, can cause slowed growth.
Parental education and income influence the behaviours of the mother during
pregnancy. Those with the knowledge and the means to access resources such as a
nutritious food intake may reduce the risk of having a low birth weight baby.
Prenatal health care includes constant monitoring of the baby’s growth and
development. If the foetus is experiencing slowed growth, interventions such as
dietary change can be put in place to reduce the risk of low birth weight.
Foetal alcohol syndrome

The consumption of alcohol during pregnancy has been shown to impact the
health and individual human development of the unborn baby in many ways. The
severity of the impacts will depend on a range of factors including the amount of
alcohol consumed and the susceptibility of the foetus. Common effects include:
• harm to the development of the nervous system, including the brain. Research
shows that alcohol can damage developing brain cells. Impaired brain development
in those experiencing foetal alcohol syndrome can impact on intellectual
development and contribute to behavioural problems throughout life.
• under-nourishment of the growing baby. Alcohol can
impact on the absorption of nutrients leading to low
birth weight and under-developed organs.
• triggering of changes in the development of the baby’s
face, resulting in the typical foetal alcohol syndrome
facial features (see figure 7.19).
The biggest factor associated with an increased risk
of foetal alcohol syndrome is the amount of alcohol
consumed and how often it is consumed throughout the
pregnancy. Frequent binge drinking is associated with
especially high risks.
The 2009 Australian alcohol guidelines recommend
that pregnant women abstain completely from alcohol
during pregnancy. In 2010, the majority of pregnant
women either reduced their alcohol consumption
while pregnant (48.7 per cent) or abstained (48.9 per
cent). The proportion of pregnant women abstaining
during pregnancy increased between 2007 and 2010
(40.0 per cent in 2007 to 48.9 per cent in 2010).
Although alcohol consumption is the greatest risk
factor for foetal alcohol syndrome, a range of factors can
contribute to an increased risk. Those with lower levels
of education, for example, may not fully understand
the risks associated with alcohol consumption during
pregnancy. This may increase the likelihood of the
Figure 7.19 Foetal alcohol syndrome mother to drink at risky levels.
results in characteristic features in the
Individuals who experience poor mental health during pregnancy may be more
baby’s face.
Source: © 2013 Susan Astley PhD, University of
likely to consume alcohol in an attempt to numb feelings of sadness and despair.
Washington. The health and development of the foetus may be affected as a result.

Women who access health care may discuss their alcohol consumption patterns
with a health professional. Strategies may then be put in place to reduce alcohol
consumption if intake is considered to be at a risky level.
Gestational diabetes
Gestational diabetes is characterised by high blood glucose levels. It occurs in
around 5 per cent of all pregnancies and can impact on women in a number of
ways, including:
• high blood pressure
• pre-term labour
• longer hospital stay than mothers without gestational diabetes
• increased risk of developing type 2 diabetes
Gestational diabetes also increases the risk of many adverse outcomes for the
developing baby including higher than normal birth weight, respiratory conditions
and jaundice.
There are numerous factors that can either decrease or increase the risk of
developing gestational diabetes.
Biological
Women who have a genetic predisposition to type 2 diabetes are at a higher risk of
developing gestational diabetes during pregnancy.
Advancing age has been noted as a risk factor for gestational diabetes. The
proportion increased with age from 4.1 per cent for women aged under 35 to
7.3 per cent for women aged 35–39 and 10.3 per cent for women aged 40 or over
(AIHW, 2010).
Body weight is one of the major factors in determining the risk of gestational
diabetes. Overweight and obesity at the time of fertilisation significantly increase
the risk factors for the development of gestational diabetes. Ensuring body weight is
within the normal range before pregnancy occurs can reduce the risk of developing
Figure 7.20 Pregnant women

who are overweight or obese have
an increased risk of developing
Behavioural
Food and alcohol intake prior to and during pregnancy can impact body weight.
Although gaining weight is a normal and required aspect of pregnancy, those who
consume an energy-dense diet and consume alcohol are at greater risk of becoming
overweight or obese, which increases the risk of gestational diabetes.
Physical activity acts to burn off excess energy. Sedentary lifestyles, on the other
hand, can contribute to weight gain and gestational diabetes.
Women who live in areas where health care is accessible may be able to receive
health education prior to pregnancy occurring. They may be provided with
strategies to assist them in losing excess body weight prior to becoming pregnant.
Social
Parental education is a key factor in preventing the onset of gestational diabetes.
Those who are educated are more likely to understand the risk factors for gestational
diabetes and act to reduce their risk of developing this condition.
Having adequate income can assist in affording resources such as health care and
nutritious foods, which can, in turn, assist with weight management and decrease
the risk of gestational diabetes.
Cultural factors can prevent some people from accessing health care. Indigenous
Australians for example, are less likely to access health care during pregnancy,
which can contribute to the higher rates of gestational diabetes experienced. Body
weight also plays a role in this difference, but access to health care could provide
knowledge about the risks associated with development of gestational diabetes.
Use the Gestational diabetes weblink in your eBookPLUS to watch a video
about this condition.
TEST your knowledge 3 (a) Describe foetal alcohol syndrome.

(b) Discuss the factors that may contribute to
1 (a) Explain how the neural tube forms.
alcohol consumption during pregnancy.
(b) Explain what is meant by a ‘neural tube defect’.
4 (a) Explain gestational diabetes.
(c) Describe spina bifida.
(d) Explain why folate intake is important prior to (b) Discuss the effects of gestational
fertilisation in reducing the risk of spina bifida. diabetes.
(e) Besides nutrition, discuss the determinants of (c) Discuss the determinants of health and
health and development that can increase the individual human development that can increase
risk of spina bifida. the risk of developing gestational diabetes.
2 (a) Identify what constitute low, very low and
extremely low birth weights. APPLY your knowledge
(b) Outline the possible effects of low birth weight. 5 Devise a poster, multimedia presentation or short
(c) Discuss the determinants of health and video that educates parents about the risk and
individual human development that can increase protective factors associated with a health issue of
the risk of having a low birth weight baby. your choice.

7.6 S trategies and programs designed to promote prenatal
health and individual development
KEY CONCEPT Understanding government, community and personal strategies

and programs designed to promote health and individual human development
of pregnant women and unborn children
As explored in the last section, there are a number of issues that can impact on
the health and individual human development of pregnant women and their
unborn babies. In response to these and other issues, a number of programs and
strategies have been designed to reduce the risk of negative outcomes and promote
the health and development of mothers and babies during the prenatal stage of
the lifespan. These programs and strategies exist at a government, community and
personal level.
Government programs and strategies

All levels of government, federal, state/territory and local, implement strategies and
programs to promote the health and individual human development of pregnant
women and their unborn babies.
Federal government
Medicare is Australia’s universal health insurance scheme that provides free or
subsidised treatment for all Australians through the public health system. Pregnant
women can access a range of Medicare-funded health services throughout their
pregnancy, including free treatment in public hospitals. By making health care
more affordable, Medicare increases accessibility to prenatal health care which can
assist with early detection of issues during pregnancy and medical intervention
when required. Medicare also assists in providing professional health workers such
as nurses, midwives, doctors and obstetricians to assist with the birthing procedure
at no charge to the patient.
Figure 7.21 Medicare covers the

costs of many prenatal health services.
Food Standards Australia New Zealand is the federal government body

responsible for making laws relating to the food industry. In Australia, numerous
7.6 Strategies and programs designed to promote prenatal health and individual development
laws have been implemented in an attempt to increase the intake of

nutrients required for the optimal health and development of unborn
babies. Iodine and folate intake, specifically, have been shown to be
deficient across the population and deficiency of these nutrients can
contribute to a range of birth defects during pregnancy, including neural
tube defects and impaired brain development.
Mandatory fortification laws require food manufacturers to add iodine
and folate to specific food products. Since 2009, all salt used in bread
manufacturing (except organic bread) must be iodised salt. Similarly, all
bread products (except organic bread) must contain added folate. Bread
was selected as the subject of mandatory fortification laws as most people
consume bread on a regular basis and regular consumption may decrease
the risk of the defects associated with deficiency of iodine and folate.
The federal government provides a free phone and online service for
pregnant women and new parents who have a baby up to 12 months of age.
The Pregnancy, Birth and Baby service provides information and advice on
topics such as maternal nutrition, breast feeding, a baby’s development and
sleeping habits as well as direction to maternity-related services including
specialist and support services.
Through the Immunise Australia program, the federal government
provides free influenza vaccines for all pregnant women. Pregnant women
are at high risk of severe consequences of influenza infection. The Australian
Figure 7.22 Most bread in Australia Government aims to provide greater protection against influenza for pregnant
is fortified with folate and iodine. women, by making influenza vaccine available, free of charge.
Figure 7.23 The Pregnancy, Birth

and Baby service logo
The National Perinatal Depression Initiative is a federal government strategy

developed in conjunction with all state and territory governments. It aims to
promote the mental health of pregnant women, providing:
• routine and universal screening for perinatal depression
• follow up support and care for women assessed as being at risk of or experiencing
perinatal depression
• workforce training and development for health professionals
• research and data collection
• national guidelines for screening for perinatal depression
• community awareness.
Victorian Government
The Victorian Government has established the ‘Having a baby in Victoria’ website
that aims to educate pregnant women and those planning pregnancy. It contains
links to health services, dietary advice, general pregnancy information and
information about the availability of support services.
The Maternal and Child Health Line is a Victorian Government service that is
staffed by qualified maternal and child health nurses who provide callers with

information, support and advice regarding child health, maternal and family health,
and parenting issues. This is a free service for all Victorians.
Established by the Victorian Government, the Better Health Channel provides
online health and medical information for the Victorian community. It contains
information to educate parents about issues relating to pregnancy and childbirth.
Fact sheets are available on topics such as:
• folate during pregnancy
• foetal alcohol syndrome
• pregnancy and exercise Figure 7.24 The Better Health
• pre-eclampsia Channel logo
• gestational diabetes
• ectopic pregnancy.
The Healthy Mothers, Healthy Babies program aims to promote prenatal health
of pregnant women and their unborn babies by addressing risk behaviours and
providing support during pregnancy.
The Healthy Mothers, Healthy Babies program targets pregnant women
who are unable to access prenatal care services or require additional support
because of their socioeconomic status, culturally and linguistically diverse
background, Aboriginal and Torres Strait Islander descent, age or residential
distance to services.
The program operates in the outer growth suburbs of Melbourne that have high
numbers of births, higher rates of relative socioeconomic disadvantage and lower
service accessibility.
The aim of the Healthy Mothers, Healthy Babies program is to improve the
health and wellbeing of mothers and babies by:
• facilitating access to prenatal, postnatal and other health and human services
• supporting women throughout their pregnancy
• delivering key health promotion messages that enable healthy behaviours in
pregnancy and beyond.
Healthy Mothers, Healthy Babies program is not a clinical antenatal care service
but acts to complement existing services by linking women into services early,
providing additional support that is not available in current services, and promoting
a continuum of care for the woman by working with maternity and maternal and
child health services.
Local government
Maternal and child health centres are located in every local government area in
Victoria, which are jointly funded by state and local governments and usually
managed by local government. The centres are staffed by highly qualified maternal
and child health nurses, with support from a range of other health professionals.
Pregnant women can seek advice relating to their pregnancy and receive prenatal
health care at these centres.
Community programs and strategies

Community programs and strategies are often developed by non-government
organisations and have a specific focus with regards to prenatal health and
development. beyond babyblues, You2 Program and Australian Action on Pre-
eclampsia are examples of community programs and strategies.
beyond babyblues
beyondblue is an independent, not-for-profit organisation working to increase
awareness and understanding of depression and anxiety in Australia, and to reduce
7.6 Strategies and programs designed to promote prenatal health and individual development
Figure 7.25 The beyondblue logo
the associated stigma. Part of beyondblue’s work relates to maintaining positive

mental health during pregnancy and early parenthood. Through the ‘beyond
babyblues’ initiative, a range of resources are provided for health professionals,
women and their families including:
• online training for health professionals
• printed resources for health professionals
• resources for expectant and new parents
• the ‘Just Speak Up’ website, which provides a forum for people to share their
experiences with prenatal and postnatal depression and anxiety.
You2
The You2 initiative was developed by Diabetes Australia with the aim of preventing
gestational diabetes and supporting those with the condition. The You2 website
provides practical advice relating to healthy eating, exercise and prenatal health
care. The online blog allows women with gestational diabetes to share their stories
and provide support to others with the condition.
Australian Action on Pre-eclampsia (AAPEC)

Australian Action on Pre-eclampsia Inc. (AAPEC) is a Victorian association set
up to provide support and information to families who are experiencing or have
experienced pre- eclampsia. The organisation aims to educate the public and health
professionals about the prevalence and risks of pre-eclampsia, and campaigns
for greater awareness of this condition. AAPEC publishes regular newsletters,
provides brochures, organises educational seminars and workshops, and raises funds
to promote research into the prevention and early detection of pre-eclampsia.
Figure 7.26 The AAPEC logo

Personal programs and strategies
Many of the personal strategies that individuals can employ during pregnancy relate
to addressing the factors that can be modified to optimise the health and individual
human development of themselves and their unborn babies. Examples include:
• Maintaining healthy body weight can reduce the risk of gestational diabetes.
• Ensuring nutrient intake is adequate leading up to pregnancy and taking
supplements if required, specifically folate and iodine supplements, can reduce
the risk of neural tube defects.
• Having regular prenatal health checks assists in monitoring health and
implementing changes required to promote health and individual human
development.
• Increasing education levels relating to pregnancy, including attending antenatal
classes, provides information and strategies relating to the birthing procedure.
• Avoiding teratogens such as raw fish, soft cheeses, alcohol, drugs, x-rays and
tobacco can reduce the risk of conditions such as low birth weight.
• Ensuring vaccinations are up to date prior to pregnancy reduces the risk of
infection and disease during pregnancy.
• Reducing the risk of infection by avoiding contact with those who are ill and
maintaining adequate levels of hygiene.
• Reducing stress levels can assist in maintaining optimal mental health.
TEST your knowledge (a) Explain each piece of information.

(b) Discuss how it could promote health and
1 Identify three government strategies and/or
development of pregnant women and/or
programs and explain how each can promote
unborn babies.
the health and individual human development of
7 Use the Better Health Channel weblink in your
pregnant women and/or their unborn babies.
eBookPLUS to find the link for this question. eBook plus
2 (a) Briefly explain mandatory fortification.
(a) Search the Better Health Channel site and find
(b) i. Which nutrients are the subject of mandatory
three fact sheets relating to pregnancy.
fortification laws?
(b) Discuss how the information provided in these
ii. Discuss why these nutrients are a focus of
fact sheets could assist in promoting the health
mandatory fortification laws.
and development of pregnant women and/or
3 (a) Identify the federal government’s phone and
unborn babies.
online help service.
8 Use either the beyond babyblues, You2 or
(b) Discuss two ways in which this service may
Australian Action on Pre-eclampsia weblink in eBook plus
promote health and development of pregnant
your eBookPLUS to find the link for this question.
women and/or unborn babies.
Prepare a fact sheet on one of these programs/
4 (a) Explain the Healthy Mothers, Healthy Babies
organisations and discuss how it could promote
program.
health and development of pregnant women/
(b) Explain how the program works to promote
unborn babies.
health and development of mothers and babies.
9 Use the Just Speak Up weblink in your eBookPLUS
5 Discuss how local governments contribute to eBook plus
to find the link for this question.
improved health and individual human development
(a) Describe the Just Speak Up initiative.
for pregnant women and unborn babies.
(b) Discuss how the Just Speak Up initiative could
promote the health of pregnant women.
10 Create a pamphlet that could be given out at
6 Use the Having a Baby in Victoria maternal health centres to assist in educating
weblink in your eBookPLUS to find eBook plus
pregnant women about personal strategies that
the link for this question. may promote their and their unborn baby’s health
Find three pieces of information and development.
that could be used to promote the
health and development of pregnant
women and/or unborn babies. For each one:
development during the prenatal stage

individual human development and their impact during the
prenatal stage of the lifespan using relevant examples
In order to demonstrate this skill, a thorough understanding of the determinants
of health and individual human development and how they relate to the prenatal
stage of the lifespan is essential. The ability to use relevant examples to demonstrate
this understanding is expected. When outlining the determinants of health and
individual human development, it is important to remember the following:
• Understand at least one factor or example relating to each determinant, i.e. one
biological, behavioural, physical environment and social environment example.
• Focus on factors that are relevant to the prenatal stage of the lifespan and ensure
that the discussion makes reference to how the selected factor impacts on health
and human development during this stage.
• To clearly demonstrate an understanding of the impact of a selected determinant
of health on health and individual human development during the prenatal
stage, it is important to be able to outline what the factor is.
• The determinants of health and individual human development help explain or
predict trends in health. When outlining the impact of a selected determinant,
explain the way in which it impacts on the health and individual human
development during the prenatal stage.
Consider the following example where the biological determinant of health and
individual human development is explained and one example is discussed with
regards to the possible impacts on health and human development during the
prenatal stage of the lifespan.
Biological determinants are factors relating to the body that impact on health
❶ An explanation of the biological and human development.➊
determinant is provided.
Genetics are an example of a biological determinant➋ that is particularly relevant
during the prenatal stage of the lifespan.
❷ The example to be discussed is
identified. Genetics relate to the genetic information passed from parents to the unborn
baby at fertilisation.➌ During the prenatal stage, genetics can impact on health in a
❸ A brief outline of genetics is included. number of ways. Genetic conditions such as haemophilia can be passed down from
the unborn baby’s parents. Haemophilia is a sex-linked condition that is generally
carried by females and occurs in males. It is characterised by an inability of blood
to clot. Chromosomal abnormalities such as Down syndrome are also related to
genetics. Three copies of the 21st chromosome are present instead of two. Down
syndrome is characterised by intellectual disability.➍
❹ Genetics are linked to a number of
health outcomes. Genetics also contribute to individual human development during the prenatal
stage. The sex of the unborn baby is determined by the 23rd pair of chromosomes.
❺ Genetics are also linked to individual An unborn baby with an ‘XY’ pairing will be male and an unborn baby with ‘XX’
human development. will be female.➎

1 (a) Explain the physical environment as a determinant of health and individual
human development.
(b) Identify one example of a physical environment determinant and explain
how it can impact on health and individual human development during the
prenatal stage of the lifespan.
2 Behavioural determinants relevant to the prenatal stage of the lifespan include
maternal nutrition prior to and during pregnancy, parental smoking, alcohol and
drug use during pregnancy, and vaccination.
Select one of these examples, and explain how it can impact on health and
individual human development during the prenatal stage of the lifespan.

KEY SKILL Describe a specific health issue affecting

the prenatal stage of the lifespan and draw informed
conclusions about personal, community and government
strategies and programs to optimise prenatal health and
development.
For this key skill, knowledge of one health issue relevant to the prenatal stage is
essential. Issues include spina bifida, low birth weight, foetal alcohol syndrome
and gestational diabetes. The first step of this skill is to be able to describe the
issue. The determinants of health and development that increase or decrease the
risk of the issue are an important aspect of the description.
The second part of this skill relates to the personal, community and government
strategies and programs that aim to optimise health and development during the
prenatal stage. Knowledge of these strategies and programs is required and the
ability to draw informed conclusions relating to how they can optimise health and
development is necessary.
In the following example, gestational diabetes is described.
Gestational diabetes is characterised by an inability of the body to utilise glucose
effectively. Instead of being transported into the cells, glucose remains in the blood ❻ Characteristics of the issue are
described.
stream and is filtered out through the kidneys and eventually passed in the urine.❻
As a result of the excess blood glucose present, extra energy is provided to the
❼ Possible impacts of the condition are
foetus, which can result in high birth weight.❼ Mothers who are overweight or outlined.
obese have an increased risk of gestational diabetes. Food intake and exercise
prior to pregnancy impact body weight and also play a role in the onset of this ❽ Relevant determinants of health are
condition. Advancing age and a genetic predisposition also increase the risk of discussed.
gestational diabetes.❽
In the next example, strategies that can assist with optimising health and ❾ Personal strategies are linked to
development during the prenatal stage are discussed. In this instance, reducing the
risk and impacts of gestational diabetes are the focus.
❿ A community program is identified
Personal strategies, including maintaining healthy body weight before and during and explained.
pregnancy, can reduce the risk of gestational diabetes. Accessing expert advice on
behaviours such as food intake and exercise to assist in maintaining healthy body ⓫ A government strategy is discussed.
weight is also beneficial in reducing the risk of gestational diabetes.❾
Community strategies such as the You2 program provide support for those with
gestational diabetes.❿ The online blog allows sufferers to share their experiences of
gestational diabetes. Individuals can provide advice and support to each other to
assist with dealing with the impacts of this condition.
The Victorian Government’s Healthy Mothers, Healthy Babies program provides
support to population groups at increased risk of health concerns during pregnancy,
including gestational diabetes.⓫ Vulnerable individuals are linked to health services
to ensure that education and health care are provided throughout the pregnancy to
reduce the risk of developing the condition. For those diagnosed with gestational
diabetes, blood glucose levels can be monitored and relevant interventions put in
place to reduce the impact of the condition.

3 Issues affecting the prenatal stage of the lifespan include spina bifida, low birth
weight, foetal alcohol syndrome and gestational diabetes.
(a) Select one of these issues and explain it briefly.
(b) Discuss the determinants of health and individual human development that
can decrease or increase the risk of this health issue.
Key skills The determinants of health and individual human development during
the prenatal stage
4 A range of personal, community and government strategies exist to promote

health and individual human development during the prenatal stage of the
lifespan.
(a) Identify two personal strategies and explain how each can promote health and
individual human development during the prenatal stage of the lifespan.
(b) Discuss one community strategy that is designed to promote prenatal health
and individual human development.
(c) Discuss a range of government programs and/or strategies that aim to
promote health and individual human development during the prenatal stage
of the lifespan.

CHAPTER 7 review
Chapter summary
• A range of determinants of health and individual human development impact on
eBook plus
both pregnant women and their unborn babies during the prenatal stage of the
lifespan.
Interactivities:
• Biological determinants are factors affecting the body that impact health and individual
Chapter 7 Crossword
human development and include genetics.
• Genetics determine numerous aspects of health and development during the
Chapter 7 Definitions
prenatal stage including the sex of the baby, genetic conditions and chromosomal
abnormalities. Searchlight ID: int-2902
• The behavioural determinants that impact on prenatal health and development are
related to the behaviours and choices of the parents both before and during pregnancy.
Examples include maternal nutrition prior to and during pregnancy, parental smoking,
alcohol and drug use during pregnancy, and vaccination.
• Adequate nutrition is important in ensuring that the nutrients required for optimal
health and individual human development of the unborn baby are present. Deficiency
of specific nutrients such as folate and iodine can contribute to health concerns such as
spina bifida and intellectual disability.
• Parental smoking causes toxic substances to cross the placenta. This increases the risk
of birth defects and perinatal mortality.
• Alcohol use during pregnancy can lead to foetal alcohol syndrome. Foetal alcohol
syndrome increases the risk of premature birth, heart defects, behavioural problems and
a range of physical characteristics.
• A range of drugs can impact on the unborn baby including prescription and illegal
drugs, and caffeine. Side effects include low birth weight, increased risk of miscarriage
and delayed growth.
• Vaccination is important prior to pregnancy to reduce the risk of infection and disease
in the mother. The unborn baby is particularly susceptible to the impacts of diseases
such as influenza that can result in birth defects and miscarriage.
• The physical environment relates to the physical surroundings in which people live,
work and play. Examples include tobacco smoke in the home and access to health care.
• Tobacco smoke in the home can cause chemicals in tobacco smoke to cross the
placenta and impact the unborn baby in numerous ways, including spontaneous
abortion, prematurity and birth defects.
• Where people live impacts on their ability to access health care. Those in rural and
remote areas, in particular, may not be able to access local health services. Lack of
access to health care can contribute to adverse health and development outcomes as
conditions may not be diagnosed and treated.
• Social determinants relate to aspects of society and the social environment that impact
on health and development. Examples relevant to the prenatal stage of the lifespan
include parental education, parental income, parental health and disability, and access
to health care.
• Parental education influences the behaviours of parents during the prenatal stage
of development including accessing health care, nutrition, tobacco use and alcohol
consumption. It also impacts on the income of the parents.
• Parental income influences the ability of parents to access health-promoting goods and
services during the prenatal stage, such as nutritious food and health care.
• Optimal parental health during pregnancy assists in promoting the health and
development of the unborn baby. Ill health and disability, on the other hand, can limit
the ability of the parents to provide all the necessary resources for their unborn baby.
Infectious diseases can interfere with normal development if they cross the placenta
and infect the baby.
• Social factors such as income, education and culture can limit the ability of individuals
to access health care during the prenatal stage of the lifespan.
Chapter 7 review
• A range of health issues are a concern during the prenatal stage of the lifespan,
including spina bifida, low birth weight, foetal alcohol syndrome and gestational
diabetes.
• Spina bifida occurs when the neural tube fails to close properly. Genetic conditions,
maternal age, folate deficiency, exposure to excessive heat, parental illness and
education all play a role in the development of spina bifida.
• Low birth weight is classified as a baby under 2500 grams at birth. Premature birth,
maternal age, genetics, maternal nutrition, tobacco and alcohol use, tobacco in the
home, access to health care, parental health and parental education and income all play
a role in low birth weight.
• Foetal alcohol syndrome is characterised by developmental issues such as intellectual
disability, low birth weight and changes in the facial features of the baby. Alcohol use,
parental education, maternal health and access to health care play a role in foetal
alcohol syndrome.
• Gestational diabetes is characterised by an inability to transport glucose from the blood
stream into the cells. It can contribute to high birth weight in the baby and increased
risk of type 2 diabetes in the mother. Risk factors include overweight and obesity,
advancing age, genetic predisposition, food intake, alcohol consumption, physical
inactivity, lack of access to health care, and low levels of parental education and
income.
• A range of government, community and personal strategies and programs have been
implemented to promote prenatal health and development.
• Government initiatives include Medicare, mandatory fortification laws, the Pregnancy,
Birth and Baby Service, Immunise Australia, The National Perinatal Depression Initiative,
the Having a Baby in Victoria Program, the Maternal and Child Health Line, Better
Health Channel, the Healthy Mothers, Health Babies program, and Maternal and Child
Health Services.
• Community initiatives include Beyond Babyblues, the You2 program and Australian
Action on Pre-eclampsia.
• Personal strategies include accessing health care, maintaining adequate nutrition, not
smoking or consuming alcohol, increasing education, avoiding teratogens and being
vaccinated.
TEST your knowledge 2 Select one health issue and complete the following
table:
1 Discuss the possible impacts on health and
Issue Description Determinants that act as risk or
individual human development during the protective factors
prenatal stage of the lifespan in relation to one: Biological Behavioural Physical Social
environment
(a) biological determinant
3 Select one government, community and personal
(b) behavioural determinant
strategy and/or program and explain how it can
(c) physical environment determinant optimise health and individual development during
(d) social determinant. the prenatal stage of the lifespan.

1.1
CHAPTER 8
Chapter
The health
Global andand
health individual human
development
human of Australia’s children
development
Development that occurs during the infancy and childhood
stages builds on the foundations laid down in the prenatal
stage and plays a significant role in the development that will
occur across the rest of the lifespan. Maintaining adequate
health is a key factor in achieving optimal development and
vice versa.
Having an understanding of the health and development
that occurs during these stages of the lifespan allows informed
decisions to be made for the promotion of optimal wellbeing
among children.
KEY KNOWLEDGE
2.1 physical, social, emotional and intellectual development from birth to
late childhood (pages 235–43)
2.2 the principles of individual human development (pages 232–4)
2.3 the health status of Australia’s children (pages 244–51).
KEY SKILLS
• describe the characteristics of individual human development from birth
to late childhood
• interpret data on the health status of Australia’s children.
Figure 8.1 Childhood is a time

of significant individual human
development, influenced by a
range of factors.

antenatal occurring before birth
attention deficit hyperactivity disorder (ADHD) a
condition characterised by a pattern of impulsiveness,
inattention and overactivity
autoimmune disease a disease characterised by
the immune system attacking and destroying healthy
body cells
cephalocaudal development development that occurs
from the head downwards
child mortality deaths that occur between the first
birthday and 14 years of age
colostrum a concentrated form of breast milk that is also
rich in antibodies. Colostrum is produced for the first few
days after birth.
empathy the ability to see events from another person’s
point of view and to understand the emotions of others
infant mortality deaths that occur between birth and
the first birthday
meconium a dark, sticky, tar-like substance that is
excreted through the bowels shortly after birth. It includes
things ingested while in the uterus, such as mucous, bile
and water.
neonate describes an infant in the first 28 days
after birth
object permanence an awareness that objects continue
to exist even when they are out of sight
perinatal conditions conditions causing death in the
first 28 days of life (e.g. due to complications of the
placenta or umbilical cord, infections, birth injury, asphyxia
and problems relating to premature births)
proximodistal development development that occurs
from the core or centre of the body outwards (towards
the extremities)
The health and individual human development of Australia’s children • CHAPTER 8 231
8.1 Principles of individual human development
KEY CONCEPT Understanding the principles of individual human development
Development during the prenatal, infancy and childhood stages of the lifespan
establishes a base that will be built upon during youth and adulthood. As explored
in chapter 6, the prenatal stage is the fastest period of growth of all lifespan stages
and is characterised by the development of body systems that will allow the foetus
to survive outside its mother’s uterus after birth. Infancy and childhood are marked
by significant developmental milestones such as learning to walk, talk, read, write
and interact with others. Understanding the development that occurs during these
lifespan stages facilitates analysis of the effects that such development has on the
individual, both now and in the future.
Figure 8.2 Writing is an example
of a skill that, although achieved Development in humans, although occurring at different times and at different
in the young years, will be refined rates, has some similarities for all people. A number of principles govern the
over time as the individual builds on development that humans experience and many of these are particularly evident
those initial skills. in the infancy and childhood stages. Any example of development may display a
number of the five principles discussed in the following sections.
1. D
evelopment occurs in a predictable
and orderly way
Many aspects of development occur in predictable, orderly patterns. From
observing many individuals over long periods of time, experts can roughly predict
when certain milestones should occur. For example, most infants learn to walk at
9 to 15 months.
Many aspects of human development require other skills in order to occur. For
example, if a child is to put a sentence together, they need to be able to manipulate
their vocal chords, know the meanings of words and articulate the sentence so it
makes sense. If any of these prior skills are not present, then the child will not be
able to make a sentence that makes sense.
2. Development is continual
Development starts with conception and ends with death. All skills learnt and
milestones achieved between these two events form part of development. The
foundations laid in one stage (e.g. learning to write in early childhood) will be
built upon in the next (figure 8.2). The decline in body systems and memory
over time are also a part of this principle, indicating that humans never stop
developing.
3. T here are individual variations in the rate

and timing of development
Many factors influence development such as hormones, genetics, family interaction,
nutrition, physical activity levels and state of health. As a result, there will be
Figure 8.3 The rate and timing variations in when milestones are reached and how developed one person is
of development are different for compared to another person of the same age. These factors also influence how
all people.
quickly it takes a person to move through a developmental stage (figure 8.3).
4. Development follows predictable patterns

Growth and motor skill development follow patterns that are observable in
all people. The cephalocaudal and proximodistal patterns of development are
particularly evident during the prenatal, infant and childhood stages of the lifespan.

Case study
Spare the comparisons neighbour’s child can. Avoid comparing the two
as your child may not care about tennis anyway.
Comparing your kids with other children is a recipe What this means for you: help your child identify his or
for disaster. By Michael Grose. her own talents and interests. Recognise that his or her
Do you ever compare your child’s behaviour or progress strengths and interests may be completely different to
with other children of the same age? If so, you are those of his or her peers and siblings.
causing stress for yourself and your child. Comparing 3. Parents can have unrealistic expectations for their
your child with others is an ultimately useless activity. kids. We all have hopes and dreams for our kids,
But it’s hard to resist, as we tend to assess our but they may not be in line with their interests
progress in any area of life by checking out how we and talents.
compare with our peers. What this means for you: keep your expectations for
When you were a child in school you probably success in line with their abilities and interests. If
compared yourself to your schoolmates. Your teachers expectations are too high, kids will give up. If they are
may not have graded you, but you knew who the smart too low, they will usually meet them!
kids were and where you ranked in the pecking order. Parents should take pride in their children’s
Now that you have kids of your own, do you still performance at school, sport or leisure activities. You
keep an eye on your peers? Do you use the progress should also celebrate their achievements and milestones,
and behaviour of their kids as benchmarks to help you such as taking their first steps, scoring their first goal in
assess your own performance as well as your child’s a game or getting great marks at school.
progress? This is okay, as long as we don’t lose sight of However, you shouldn’t have too much personal
three important aspects. stake in your children’s success or in their milestones,
1. Kids develop at different rates. There are early as this close association makes it hard to separate
developers, slow bloomers and steady-as-you- yourself from your kids. It also causes you to play the
go kids in every group, so comparing your ‘compare and compete game’. By comparing kids you
child’s results or performance can be completely can put pressure on yourself and them to perform for
unrealistic. the wrong reasons.
What this means for you: focus on your child’s And certainly, your self-esteem as a parent should
improvement and effort and use your child’s results as not be explicitly linked to your children’s behaviour or
the benchmark for his or her progress and development. developmental levels.
‘Your spelling is better today than it was a few days, ‘You are not your child’ is a challenging but essential
weeks or months ago.’ parental concept to live by. Doing so takes real maturity
2. Kids have different talents, interests and strengths. and altruism, but it is the absolute foundation of that
Okay, your eight-year-old may not be able to hit powerful thing known as unconditional love.
a tennis ball with Rafael Nadal, even though your Source: Sunday Herald Sun, 26 April 2009.
Case study review

1 Why is it not useful for parents to compare their children to other children?
2 How could a child’s interests influence how fast they develop?
3 How could performing ‘for the wrong reasons’ influence future development?
Cephalocaudal development
Cephalocaudal development refers to growth and development that occurs from
the head down. An infant will gain control over their neck muscles first, which
allows them to hold their head steady. Control over their shoulder muscles usually
follows, which allows them to roll over. Finally, control over the muscles in their
8.1 Principles of individual human development
torso allows them to sit. The size of the head of an infant in relation to the rest of
the body also illustrates this pattern of development (figure 8.4).
Figure 8.4 The cephalocaudal

pattern of development is shown
in the changing proportions of the
human body over time.
Proximodistal development
Proximodistal development occurs from the centre or core of the body in an
outward direction. An example is the way that the spine develops first in the uterus,
followed by the extremities and finally the fingers and toes (figure 8.5). In motor
development, an infant reaches for a toy by using shoulder and torso rotation in
order to move the hand closer to the object. In childhood, the elbow and wrist are
responsible for the main movements.
Developing head
Ear
Eye
Heart prominent Nose
Figure 8.5 The proximodistal Upper limb
Upper limb
pattern of development is evident
in these 32- and 52-day-old embryos. Tail
The spine is prominent but the buds Lower limb Umbilical cord
that will become the arms and legs Lower limb
are still underdeveloped.
5. D
evelopment proceeds from the simple to
the complex
Thought processes and motor skill development go from simple to complex. Once
the simple aspects have been attained, they can be built upon to make the skills
more complex. For example, infants think in a concrete way but, as they move
through the childhood and youth stages, abstract thought develops. A child usually
learns to crawl before walking and ultimately running.

1 Explain what each of the following principles refers 2 Consider the following developmental milestones
to and provide examples for each: and explain how three principles of development
(a) predictable and orderly development are evident in each one:
(b) continual development (a) learning to write
(c) variations in the rate and timing of development (b) learning to throw a ball
(d) the cephalocaudal and proximodistal patterns of (c) a baby learning to sit up.
development
(e) simple to complex development.

8.2 Development during infancy
KEY CONCEPT Understanding physical, social, emotional and intellectual

development during infancy
Infancy is the first stage of the lifespan after birth and lasts until the second
birthday. Newborns are relatively helpless (figure 8.6). They cannot feed, maintain
body warmth, or stay clean or hydrated without the assistance of others. With
interaction and adequate care, the infant will begin to show significant gains in all
areas of development. For the first 28 days after birth, the infant is referred to as
a neonate and undergoes significant changes or adaptations that help it to survive
outside the uterus.
Adaptations of the neonate Figure 8.6 The newborn is relatively

In the uterus, the foetus relies on its mother for the provision of oxygen, nutrients helpless and relies on parents/
caregivers for almost everything.
and warmth and for the excretion of wastes. After birth, the infant must adapt to
the outside environment and carry out many of these bodily functions itself,
although it is still heavily reliant on help from parents or other caregivers.
In the uterus, the lungs of the foetus are filled with fluid and play no part in
circulation. Instead of travelling to the lungs, the blood must travel to the placenta
to become oxygenated. The foetal heart has two shunts, called the foramen ovale,
that are like valves that allow blood to travel between the chambers of the heart
and cause the blood to be redirected from the lungs to the placenta. After birth,
the foramen ovale close over and allow the blood to travel to the lungs to become
oxygenated. Although the foetus may display a breathing-like motion in the uterus,
there is only amniotic fluid in its immediate environment. As a result, its lungs
are filled with fluid. Once outside the uterus, the infant will take its first breath,
usually within 10 seconds after birth. This prompts the bloodstream to absorb
the fluid from the lungs, so the lungs will fill with air for the first time. A special
substance (called pulmonary surfactant) allows the lungs to expand when inhaling
and prevents them from collapsing when exhaling. Breathing may be shallow and
irregular for minutes or hours before it becomes more rhythmic.
During prenatal development, the foetus receives its nutrients from the mother.
After birth, the infant has some nutrients stored but relies on regular feeding in
order to grow and develop properly. The mother’s breast tissue produces a substance
called colostrum for the first few days after birth and then
regular breastmilk after that. Colostrum is a concentrated
form of breastmilk that is also rich in antibodies, which
boosts the infant’s immune function. At birth, the excretory
organs — which include the kidneys, liver and bowel —
become functional and capable of eliminating waste
products. For the first few days after birth, meconium is
passed through the bowels rather than normal faeces.
Meconium is a dark, sticky, tar-like substance that includes
things ingested whilst in the uterus such as mucous, bile
and water. Unlike later faeces, meconium is a thick liquid
that does not have an odour.
The mother’s body temperature maintains the temperature
of the foetus. After birth, temperature must be regulated
in some other manner. Although they have fat stores that
assist with temperature regulation, newborn infants are not
Figure 8.7 The foetus relies on its
capable of regulating their body temperature and rely on mother for the provision of oxygen,
blankets, clothing, environmental heat and body heat from nutrients and warmth while in the
others in order to survive. uterus.
The APGAR test

APGAR is an acronym for Activity, Pulse, Grimace, Appearance and Respiration.
Generally the first test given to newborns, the APGAR test is used to assess the
infant’s adaptation to life outside the uterus. The test is usually administered twice,
at one minute and at five minutes after birth. Judgements are made on the five
aspects of the test and scores given accordingly (table 8.1).
An infant receiving a score of 7 or over one minute after birth is generally
considered to have adapted successfully to life outside the uterus. If the score is
below 7 or after five minutes has not reached 7 (or if there are other concerns),
medical attention may be required.
Table 8.1 The APGAR test is administered to newborns to assess their overall physical condition.
Score
APGAR sign 2 1 0
Activity (muscle tone) Active, spontaneous movement Arms and legs flexed with little No movement, ‘floppy’ tone
movement
Pulse (heart rate) Normal (above 100 beats per Below 100 beats per minute Absent (no pulse)
minute)
Grimace (responsiveness or ‘reflex Pulls away, sneezes or coughs with Facial movement only (grimace) Absent (no response to
irritability’) stimulation with stimulation stimulation)
Appearance (skin coloration) Normal colour all over (hands and Normal colour (but hands and feet Bluish-grey or pale all over
feet are pink) are bluish)
Respiration (rate and effort of Normal rate and effort, good cry Slow or irregular breathing, Absent (no breathing)
breathing) weak cry
Physically, the infancy stage is the second fastest period of
physical development in the lifespan, second only to the
prenatal stage. Birth weight doubles by six months and triples by
12 months. Body proportions also start to change, reflecting the
cephalocaudal pattern of development.
The senses continue to develop and, although vision is still
largely blurry, the infant will soon begin to recognise familiar
faces and sounds. Bones continue to ossify during infancy. By
the first year, the infant can support its own weight.
Reflexes that are present at birth (e.g. the grasping reflex)
are gradually replaced by controlled movements as motor skills
develop. A newborn infant does not have much control over its
body but will soon learn to lift its head and roll over. At around
six months, infants start crawling. By the age of one, many
infants can stand and walk. By age two, they can usually throw
and kick a large ball.
Social development
The family is the most significant influence on social development
at this stage of the lifespan. The infant is totally dependent on its
parents or other caregivers, and will learn certain social skills by
observing these people.
The infant begins to smile at around six weeks, and after
Figure 8.8 By their first year, many infants can support around six months the infant will begin to recognise facial
their own weight. expressions of others, such as a smile or a frown.

At around six months of age, the infant can
enjoy basic games such as peekaboo. As infants
develop, play forms an important part of social
develop ment. They enjoy games and become
increasingly responsive to them. Many social
skills are learnt about sharing and taking turns
through play. This may occur with siblings and
parents at home, and also with other children at
child-care or playgroups. Through experiences
such as these, the infant also begins to learn
culturally acceptable behaviours such as listening
to parents and not hitting others. Social roles are
also imitated such as pushing a pram with a doll
in it (figure 8.9).
As language develops (intellectual develop
ment), infants can interact better with those
Figure 8.9 Social roles are often
around them. They can generally speak a few words at around one year of age, learned by imitating others.
and understand many more. This allows parents to more easily guide the social
development of their infant.
Emotional development also revolves around the family at this stage of the lifespan.
One of the first signs of emotional development is when the hurt or distressed
infant can be comforted by its caregivers.
Emotional attachment is formed with the caregivers within months and this
helps the infant to feel secure, safe and loved. It also helps to build trust. The
emotional bond between caregivers and the infant may be so strong that the infant
may become distressed when held by a stranger or when a caregiver leaves the
room. Fear may be shown when confronted by unfamiliar things such as a clown
or a dog.
By eight months, the infant can express anger and happiness, and may become
frustrated if interrupted in their activities (e.g. when playing games). This expression
of frustration may result in tantrum-throwing in later months.
By 12 months, the infant becomes sensitive to approval from parents. It may
become upset or distressed if approval is not gained.
From the time of birth, all senses are working (although they become more acute
over time) and the baby is capable of learning. The senses are the means by which
the baby makes sense of the world around it. Many infants collect information
around them by putting objects into their mouth. This behaviour will often change
as the infant develops and starts to use its other senses.
Within months, the infant will recognise its name and will respond when called.
Over time, this word–object association progresses and the infant will begin to
recognise the names of favourite people, toys, other objects and basic colours.
Early infancy also signifies an emerging understanding of cause and effect. Infants
will begin to associate certain actions with particular outcomes. For example, if
they cry, they get attention. If they reach for someone, that person may pick them
up. If they kick their legs around, their caregivers might play with them.
The attention span of an infant is short and may last only a matter of seconds.
The infant may give extra attention to games and objects that it finds interesting,
but only for very short periods of time.
Figure 8.10 The level of intellectual

development experienced during
infancy contributes to the joy many
infants get out of playing peekaboo.
In early infancy, an object that is out of sight no longer exists in the mind of the
infant. So a toy that is placed in a cupboard no longer exists. As the infant develops
intellectually, it begins to understand that, although an object cannot be seen, it
still exists. This concept is known as object permanence.
By 18 months, the infant can imitate and pretend in play activities. By observing
others, the infant learns a lot about the world around it. Infants may imitate talking
on a phone or having a dinner party.
Language development is rapid during infancy. A three-month-old will make
speech-like sounds (‘goo’ and ‘gaa’), and will be able to say a couple of basic words
by the first birthday (‘dada’ or ‘mumma’). The development of language occurs
very quickly after this point. By the end of infancy the individual can say around
150–300 words, although there is still confusion in context and pronunciation.

1 When does the infancy stage of the lifespan begin 6 Using the concept of object permanence as the
and end? basis of your answer, discuss why infants may
2 (a) Briefly describe the APGAR test. particularly enjoy a game of peekaboo.
(b) Explain why the test would be administered 7 An infant scores 4 on the APGAR test one minute
twice after birth. after birth and then scores 8 five minutes after
3 (a) Describe the adaptations an infant must make birth. Discuss two adaptations of the neonate that
after birth. may have contributed to this increase in APGAR
(b) Which adaptations is the neonate particularly score.
dependent on others for? 8 (a) Brainstorm a list of factors that might affect the
4 Describe the pattern of growth during infancy. development of an infant.
5 List three characteristics for each type of (b) For each factor, identify the area of human
development during the infancy stage. development concerned and the way it could
impact on an infant’s growth.
9 Explain why the role of parents is particularly
influential during infancy.

8.3 Development during early childhood

development during early childhood
Early childhood lasts from the second birthday until six years of age, typically the
preschool years. Although not long in years, significant development occurs during
early childhood.
Early childhood is characterised by slow and steady growth. Although the rate of
growth is variable, height increases by around 6 centimetres per year and weight
by around 2.5 kilograms per year. Bones continue to lengthen and ossify during
early childhood, resulting in the increases in height experienced. Body proportions
change during early childhood, and the limbs and torso become more proportionate
to the head. Body-fat levels also decrease, giving the child a leaner body type.
Children may begin to lose baby teeth as the permanent teeth begin to develop.
While muscle development slows during early childhood, motor skill
development continues at a rapid rate. Gross motor skills increase and the walking
style becomes more fluid and refined. The child can climb stairs but will still
need to place both feet on each step until towards the end of early childhood.
Kicking, catching and throwing skills also develop, and the child might learn how
to skip. Coordination improves, allowing the child to pedal and steer a tricycle
(figure 8.11). Fine motor skills progress, and the child can learn to manipulate Figure 8.11 As children gain greater
control over their body, more complex
zippers on clothing, hold crayons, use scissors and even tie shoelaces. As a result of activities such as riding a tricycle
these activities, left- or right-handedness starts to appear in certain activities. become possible.
Social development
The family remains the primary social contact during childhood and is responsible
for many achievements in social development made by the child. The child will
begin participating in a wider range of family routines such as attending social
functions, eating at the table and helping with the shopping. Communication skills
and acceptable social behaviours increase as a result of these experiences.
The child may attend a playgroup, kindergarten or a child-care centre, and this
provides many opportunities to further develop social skills such as sharing and
taking turns. As the child becomes accustomed to spending short periods of time
away from the family, independence starts to develop. The child may start wanting
to do things for themselves such as dressing or washing, although they may not be
completely successful.
Behaviours such as eating with a knife and fork are established during early
childhood but they will be refined over time. Children at this age like to be
accepted by others and may behave in a way that brings attention to them. This
can include showing off or performing for family and friends.
Play is still an important aspect of social development, although it is more
advanced than in infancy (figure 8.12). Children may have a friend to play with Figure 8.12 Play takes many forms,
and is a great way of increasing social
and some will create an imaginary friend. Make-believe play might also be a part of
development.
the child’s playing patterns.
Emotional development continues to occur at a rather fast pace during early
childhood. The emotional development of a two-year-old is quite different from
that of a six-year-old. A child will begin to develop a sense of empathy and may
8.3 Development during early childhood
care for people who are crying or upset. Yet their way of dealing with emotions
is still in its early stages, and children may use physical violence to express their
frustration. This is particularly common with other children or siblings. Play often
gives children a way of expressing their feelings.
Figure 8.13 Children often show

pride in their achievements.
Children take pride in their achievements and may want to show them off to
everyone. As a result of enjoying positive feedback from others, they may become
jealous when another child receives attention.
Children begin to develop an identity that will continue to form for years to
come. They learn to see themselves as being separate from others, and begin to
associate certain things with themselves such as ownership of a toy.
Mood can change quickly during this stage as children often do not have the
skills required to control their feelings. As a result, they can switch from being
happy to being upset and then happy again in a very short period.
Learning new words and how to use language occurs fairly rapidly during this
stage and is a key part of the child’s intellectual development. By the age of five, a
child knows approximately 1500–2500 words.
As interest in the world around them increases, children begin to question many
aspects of their environment. They ask parents or caregivers ‘why?’ and like to
share their knowledge with others about colours, objects and animals.
As their attention span lengthens and knowledge of language increases, children
can remember and follow basic instructions such as getting a toy from the bedroom,
bringing it back to the lounge room and sitting in a designated place with it.
In the first years of early childhood, the child can classify objects based on one
aspect such as colour. For example, they can separate orange blocks from green
blocks, but find it more difficult to classify items according to multiple aspects
such as colour and size. These more complex skills develop over time.
Children in this lifespan stage may learn to write basic letters and read basic
books. They can also learn to count to 10 or 20, although this is often memorised

without really understanding the formation of numbers. Abstract thought
and prediction of the outcome of events is still difficult, and children are more
comfortable thinking about objects they have already encountered.
TEST your knowledge mother at home. Carolyn’s physical development

has been very slow and her mother is worried
1 When does the early childhood stage of the lifespan
because Carolyn is significantly smaller than other
begin and end?
children her age. In order to assist with her social
2 Describe the pattern of growth during the early
development, Carolyn’s mother takes her to a local
childhood stage.
playgroup once a week.
3 List three characteristics for each of the following
(a) Describe the physical development Carolyn
types of development during the early childhood
would be experiencing at this stage of her life.
stage:
(b) i. What is the average growth during this stage
(a) physical
of the lifespan?
(b) social
ii. Explain why it is important to use these
(c) emotional
figures as averages only.
(d) intellectual.
(c) Identify the factors that may affect Carolyn’s
social development.
(d) Explain ways that Carolyn’s slow physical
4 Carolyn is four years old and lives in rural Victoria development might affect other dimensions
with her mother, father and three older brothers. of her development both in the short and
Her father runs their farm and her mother is a long term.
stay-at-home mother. Her brothers all go to school
so, for most of the day, it is just Carolyn and her
8.4 Development during late childhood

development during late childhood
Late childhood starts at the sixth birthday and continues until 12 years of age.
During this time, the child will begin formal schooling while continuing to grow in
a similar fashion to that experienced in early childhood.
Physical development in late childhood is slow and steady, as it was in early
childhood. Bones and muscles continue to grow in length and width. Height
continues to increase by 5 to 6 centimetres per year, and weight increases by
around 3 kilograms per year. Both sexes have similar body shapes until the onset
of puberty, although males may be slightly larger. Body proportions continue
to change as the head grows more slowly in comparison to the torso, arms and
legs. A child in the late childhood stage has similar body proportions to an adult.
Figure 8.14 Losing teeth is a normal Permanent teeth continue to develop and, by the end of late childhood, most
part of childhood development. permanent teeth will be present (figure 8.14).
The child gains greater control over their body, and motor skills develop as a
result. As size and strength increase, children can perform more complex physical
tasks such as playing basketball or participating in gymnastics. They have also
had years to develop speed, agility and balance, and these skills are used in many
physical activities such as games and sport. More complex gross motor skills such
as skipping are also refined during this time. Fine motor skills are developed, and
a child at the beginning of late childhood can write basic sentences. Writing might
still be illegible at times. By the end of late childhood, writing becomes more legible
and the writing style may also be more established.
Social development
With the commencement of formal schooling, most children experience a
wide range of social situations during late childhood (figure 8.15). As a result,
relationships with others change and the child will generally have numerous social
contacts outside the family. Social skills such as sharing, communication and
conflict resolution are further developed by this increase in social interaction.
Relationships at school are formed but are generally
limited to members of the same sex. Skills such as
cooperation and sharing are further developed as a
result.
The child may still ‘show off’ in front of friends and
family in order to gain attention. Children in this lifespan
stage place increasing importance on being accepted by
others (e.g. parents, teachers and peers) and may modify
their behaviour in order to achieve approval.
Morals further develop during this time, and children
acquire a greater sense of right and wrong as well as a
better understanding of what is acceptable behaviour in
their society. As a result, children can generally make an
informed decision about right and wrong even in new
situations. In contrast, knowledge of right and wrong
in early childhood is largely limited to the instances of
Figure 8.15 School provides many right and wrong that have been taught by parents or
opportunities for social development. caregivers.

Emotional development continues during late childhood, allowing children to
control and recognise their emotions much better than they could in early childhood.
As children develop empathy, they begin to be able to identify emotions in others.
Having better control of their emotions allows children to better function in a
range of settings including school and at friends’ houses. Tantrums are generally not
a common occurrence in this lifespan stage. Children also become more skilled at
conveying emotions in words, and this may further increase control of their emotions.
Self-concept is largely established during this time although it will continue
to be modified throughout life. Children will have formed ideas about what they
are and are not good at (e.g. ‘I am a fast runner’ or ‘I am good at school’). As a
result of these feelings, a child may become self-conscious in situations where they
feel inadequate. This might occur around certain people, or in certain activities
(e.g. playing soccer) if they feel they are not good at them.
Much of a child’s intellectual development takes place at school. The brain continues
to develop during late childhood and intellectual skills develop considerably. At the
beginning of this stage, children can generally follow basic instructions and place
objects in a logical order (e.g. from big to small) or arrange them according to
numerical value. As they develop intellectually, the child can follow instructions
with multiple steps and classify items based on multiple criteria. Problem-solving
skills develop and the child begins to be able to focus on ideas rather than objects.
Knowledge of language increases, allowing the child to complete tasks such as
pluralising words most of the time. By the age of six, children know 2000–3000
words. By the end of late childhood, they might know over 10 000 words. Reading Figure 8.16 A lot of intellectual
skills also develop during this stage and, by the age of 12, the individual can read development occurs through formal
and make sense of age-appropriate books. education.
Children in late childhood generally have an increased interest in numbers and
can perform basic mathematical problems. They can also apply logic to equations
and understand that 3 × 6 will produce the same answer as 6 × 3.
Attention span increases and the child can sit quietly in class for longer periods
of time, but concentration will still lapse after a matter of minutes. Long-term
memory develops and the child can more accurately recall stories of things that
happened in the past.

1 When does the late childhood stage of the lifespan 4 With a partner, brainstorm how inadequate
begin and end? development in the prenatal, infant and early and
2 Describe the pattern of growth during the late late childhood stages of the lifespan could affect
childhood stage. future development.
3 List three characteristics for each of the following 5 Discuss how emotional development is different
types of development during the late childhood between those in early and late childhood.
stage: 6 Explain how intellectual development could affect
(a) physical social development during late childhood.
(b) social 7 Choose a game or toy commonly enjoyed by
(c) emotional children and discuss how it might promote each
(d) intellectual. type of development.
8 Create a game that may assist in the social
development of children in the late childhood stage
of the lifespan.
8.5 The health status of Australia’s children: mortality
KEY CONCEPT Understanding the health status of Australia’s

children — mortality
Australia’s children have the best health status in the country, and key health
indicators place their health among the best in the world. Improvements are
continually being made with regards to many health indicators and, as a result, most
Australian children in today’s society can expect to live in good health. Unfortunately,
there are some exceptions, particularly among indigenous Australians, those living
in remote areas and those of low socioeconomic backgrounds. Infants and children
in these groups experience higher mortality rates and greater risk of disease and
injury. Many statistics present average figures for all Australian children and, as
a result, may mask the challenges facing some groups within the country. When
examining statistics, it is important to remember that not everyone enjoys the good
health experienced by the majority.
Because many sources of health data group infants and children in their statistics,
infant and child health will generally be considered together.
Foetus and newborn affected by

All other causes maternal complications of
pregnancy
Other signs, symptoms 18% 12% Foetus and newborn affected by
and abnormal findings complications of placenta, cord
8% and membranes
3%
Sudden infant 6% Disorders of short gestation
7%
death syndrome (SIDS) and low birthweight
8%
Figure 8.17 Leading Congenital malformations 20% Perinatal conditions (46%)
causes of infant mortality, of the circulatory system
2008–2010 18% Congenital anomalies (26%)
Source: Australian Institute of Health Other perinatal
Signs, symptoms and abnormal
and Welfare, Making Progress: the conditions
health, development and wellbeing findings (10%)
of Australia’s children and young
Other congenital anomalies
people, 2008. Other causes (18%)
12
Infant deaths per 1000 live births
10 Boys Mortality
Girls
Infant mortality rates in Australia have fallen considerably
8 Children
over the past two decades (figure 8.18), but still account
6
for half of all deaths in those aged under 20. Although the
rate for all Australians is relatively low by international
4 standards, the figures mask higher infant mortality rates for
Indigenous Australians. In fact, for the last ten years, the
2 infant mortality rate for Indigenous Australians has been
around three times higher than the rest of the population.
0
As infants get closer to their first birthday, the risk of death
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
decreases. Particular causes of death in the first year of life

Year
are outlined in figure 8.17.
Most cases of infant mortality arise from problems
Figure 8.18 Infant mortality rates for
boys and girls over time
associated with the birth or pregnancy itself. As a result of
Source: Adapted from ABS data and Australian this, a majority of infant deaths occur in the period directly prior to or after birth.
Institute of Health and Welfare 2012, A picture
of Australia’s children 2012, cat. no. PHE 112,
As shown in figure 8.17, perinatal conditions and congenital abnormalities account
Canberra, pp. 13, 140. for around 75 per cent of all infant deaths.

Much of the decrease in infant mortality has been 300
due to reductions in deaths from sudden infant death Boys
Infant deaths per 100 000

250 Introduction of SIDS Girls
syndrome (SIDS). SIDS is the unexplained death of an education campaign Children
apparently healthy infant. It is only diagnosed when 200
other causes are ruled out. Although the exact causes of
live births
SIDS are unknown, there are a number of determinants 150
that increase the risk of SIDS for an infant. These
include being male (70 per cent of SIDS deaths are 100
usually males) or sleeping on the stomach. Figure 8.19
50
outlines the decline in deaths attributable to SIDS
over time. 0
Child mortality rates refer to deaths occurring in
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
children between the ages of 1 and 14. Child mortality
rates have also decreased in recent decades. Awareness Year
of illness and advances in medicine and technology have Figure 8.19 Infant deaths from SIDS, 1986–2010.
been largely responsible for these decreases. Mortality Source: Adapted from ABS data and Australian Institute of Health and Welfare 2012,
A picture of Australia’s children 2012, cat. no. PHE 112, Canberra, p. 14.
rates decrease as children get older, as shown in table 8.2.
Although overall rates have decreased, child mortality rates for Indigenous, rural
and remote, and low socioeconomic backgrounds remain higher than the rest of
the population.
The majority of causes of mortality for children are termed ‘injuries’ (which
includes poisoning), and are accidental in nature (figure 8.20). Injuries account for Table 8.2 Mortality rates of those
more deaths in childhood than any other cause. Injuries include falls, drowning, aged 1–12 years
suffocation, poisoning, transport accidents and burns. According to the Australian Death rate
Institute of Health and Welfare in 2008–10, males were 60 per cent more Age (per 100 000 population)
likely than females to be hospitalised for injuries and Indigenous children were
1–4 years 19
50 per cent more likely to be hospitalised than other children.
5–12 years 10
Inadequate supervision can increase the risk of injury among children, but
they are also more likely to sustain injuries than older people due to their level of Source: Based on data from Australian Institute
of Health and Welfare 2012, A picture of
development. Australia’s children 2012, cat. no. PHE 112,
Because children are not as developed intellectually, they may lack knowledge of Canberra, p. 14.
how to avoid injuries. Burns, drowning, bike accidents and falls may all occur at
higher rates in children due to lower levels of
A child’s physical development can also
increase their risk of certain injuries:
• The size of an infant’s head in relation 1–4
to their body makes it difficult for them
to support the weight of their head. This
Age group (years)
can prevent them from lifting their head

out of water and increase the risk of
5–9
drowning.
Injuries
• Underdeveloped motor skills can also
contribute to injuries such as bike All cancer
accidents and falls, as children may be Diseases of the nervous system
more likely to trip over when running. Congenital anomalies
10–14
• Bones in children are not completely Circulatory conditions
developed and may therefore fracture All other causes
more easily than the bones of an adult.
0 5 10 15 20 25
The risk of most cancers increases with
Deaths per 100 000 children
age, but cancer remains a leading cause of
death for children. Cancer is characterised Figure 8.20 Leading causes of mortality among children aged 1–14 years,
2008–2010 (per 100 000 population)
by an uncontrolled growth of abnormal Source: Australian Institute of Health and Welfare 2012, A picture of Australia’s children 2012,
cells that, over time, can prevent normal cat. no. PHE 112, Canberra, p. 15.
8.5 The health status of Australia’s children: mortality
body cells from carrying out their functions. Cancers found in children are often
different in type and their response to treatment compared to cancers found in
adults. Leukaemia and brain cancers are the most common cancers in children.
Although incidence rates have remained constant, mortality rates due to cancer
have decreased in children as a result of advancements in medical technology and
treatment options. Table 8.3 outlines the changes in cancer deaths and mortality
rates in children.
Table 8.3 Cancer deaths among children aged 0–14 years, 1997–2010
Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number 140 154 122 106 118 124 102 114 96 90 90 84 74 116
Deaths per 100 000 3.6 3.9 3.1 2.7 3.0 3.1 2.5 2.8 2.4 2.2 2.2 2.0 1.8 2.7
children
Source: Australian Institute of Health and Welfare 2012, A picture of Australia’s children 2012, cat. no. PHE 112, Canberra, p. 22.
Diseases of the nervous system are the third leading cause of childhood mortality.
These conditions include a range of diseases that affect the brain, spinal cord and
nerves. Examples include meningitis; cerebral palsy; swelling of the brain; and
malformed brain, skull and spinal cord.
TEST your knowledge (b) Explain the changes in cancer mortality rates
over time and suggest possible reasons for this
1 (a) Using figure 8.18, identify two trends in infant
change.
mortality over time.
(b) What reasons can you think of that would APPLY your knowledge
account for these trends (give specific
examples)? 8 Write a press release describing the health of
2 (a) What is the leading category for cause of death Australia’s children. In your article, include:
in infants according to figure 8.17? (a) the overall level of health of children
(b) What causes of death are included in this (b) mortality rates
category? (c) leading causes of death. eBook plus
3 (a) Describe how the mortality rates for children 9 Use the SIDS and Kids weblink in
have changed over time. your eBookPLUS to find the link for this question.
(b) What factors could explain this trend? Produce an informative brochure for new parents
4 (a) Using table 8.2, compare the mortality rates for about the SIDS and Kids ‘Safe Sleeping’ and ‘Tummy
1–4 year olds and 5–12 year olds. Time’ education campaigns. In your brochure, be
(b) Suggest reasons for this difference. sure to include:
5 According to figure 8.20, what are the leading (a) ways to reduce SIDS and why each of these
causes of death for: measures are important including:
(a) i. 1–4 year olds? • guidelines as to how babies should be placed
ii. 5–9 year olds? to sleep
(b) What factors could account for differences • mattress and cot requirements
between age groups? (b) what ‘tummy time’ refers to
6 Outline two causes that contribute to the relatively (c) why tummy time is important
high rates of injury deaths among children. (d) considerations for tummy time.
7 (a) Graph the cancer mortality rates among children
from 1997 to 2010.

8.6 The health status of Australia’s children: morbidity
KEY CONCEPT Understanding the health status of Australia’s

children — morbidity
Morbidity
Although child mortality rates have decreased over time, there are many
chronic conditions that impact on the health and human development of children.
In the following section, various causes of both infant and child morbidity are
examined.
Birth weight is a good indicator of the health of newborns. Those born with Table 8.4 Percentage of low birth
a low birth weight are more likely to experience ill-health and even premature weight babies by Indigenous status,
2010.
death. This is largely due to the underdevelopment of organs and the immune
system, making infants with a low birth weight more susceptible to infections, Low birth
other diseases and organ malfunction. weight
A number of factors contribute to low birth weight, including exposure to Indigenous (%) 12.0
teratogens, the mother’s age (being under 20 or over 40 increases the chances of Non-Indigenous (%) 6.0
low birth weight) and access to antenatal care. Although overall rates of low birth Rate ratio 2.0
weight are relatively low in Australia, Indigenous mothers are about twice as likely
Source: AIHW, Australian mothers and babies,
to give birth to a low birth-weight baby compared with non-Indigenous mothers, 2010. cat. no. PER 57. P. 72.
as shown in table 8.4.
Many chronic conditions have become more common in childhood over recent
decades. According to the AIHW in 2012, 37 per cent of those aged 1–14 had a
long term or chronic condition. The most frequently reported chronic conditions
among children are shown in figure 8.21.
Asthma
Hayfever and allergic rhinitis
Allergy (undefined)
Long-term condition
Short sighted/myopia
Long sighted/hyperopia
Chronic sinusitis
Dermatitis and eczema
Behavioural and emotional problems
Anxiety-related problems
Problems of psychological development
0 2 4 6 8 10 12
Percentage
Note: Long-term condition is defined here as a condition that has lasted, or is expected to last, 6 months or more.
Figure 8.21 Most frequently reported chronic conditions

Source: Australian Institute of Health and Welfare, A picture of Australia’s children 2012, cat. no. PHE 167, Canberra, p. 17.
As children get older, they are more able to communicate their problems. Thus
a child might have suffered from poor eyesight for years but would not have been
able to tell anyone until they learnt to speak. This contributes to the increase in
chronic conditions as children get older.
Asthma, obesity, diabetes and mental health problems all contribute considerably
to the burden of disease among children.
25 Asthma
Boys
Girls Australia has one of the highest asthma rates in
20 Children the world (figure 8.22). While the exact causes
are not known, a number of factors contribute to
its onset. These include:
15 • maternal smoking
Percent
• exposure to tobacco smoke

• air pollution and exposure to other pollutants.
10
Asthma is characterised by a narrowing of the
airways that results in wheezing, coughing and
5 difficulty breathing. Although asthma does not
cause many deaths in children, it is the most
commonly reported chronic condition and one
0 of the major reasons for hospitalisation among
0–4 5–9 10–14
Age group (years)
children.
Figure 8.22 Parent-reported asthma
rates in children aged 0–14 years
Source: Australian Institute of Health and
Obesity
Welfare, A picture of Australia’s children 2012, Rates of overweight and obesity among Australian children have doubled in recent
years. Around one-quarter of all Australian children are now overweight or obese
(AIHW, 2012). This increase contributes to the development of other chronic
conditions in children such as asthma and type 2 diabetes. Children who are
overweight or obese are also more likely to be overweight or obese in adulthood,
which puts them at further risk of health complications.
Diabetes
The rates of both type 1 and type 2 diabetes have increased in children over
time, although type 1 cases still account for around 90 per cent of total diabetes
cases among children. Both type 1 and type 2 diabetes
30
are characterised by an inability of the body to effectively
transport glucose into the cells to be used for energy. As
Incidence per 100 000 children
25
a result, glucose stays in the bloodstream, which can lead
20 to serious health problems such as kidney damage, heart
disease, poor circulation and premature death.
15 Type 1 diabetes is generally diagnosed by the age of
15 and is a significant contributor to burden of disease
10 among children. Type 1 diabetes is an autoimmune disease
characterised by the destruction of the cells in the pancreas
5 that produce insulin. Insulin is the hormone responsible for
transporting glucose into cells, so a lack of insulin results in
0 high blood-glucose levels. As those with type 1 diabetes do
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year not produce insulin, it must be administered by injections
Figure 8.23 The incidence of type 1
or an insulin pump. Insulin is given when blood-glucose
diabetes (0–14 year olds) per 100 000 levels rise in order to allow glucose to be used by the cells.
population The incidence of type 1 diabetes in children increased from 19 to 24 new cases
Source: Australian Institute of Health and per 100 000 population between 2000 and 2004. The incidence rate has been
Welfare, A picture of Australia’s children 2012,
cat. no. PHE 167, Canberra, p. 19. fairly stable since 2004 (figure 8.23).
While previously considered an older person’s disease, type 2 diabetes is
becoming more common among Australian children, mostly as a result of increasing
rates of obesity. Indigenous and Pacific Islander children, those who live in rural
and remote areas, and those who live in socioeconomic disadvantage, are most
likely to develop the condition. While the effect of type 2 diabetes is similar to
that of type 1 diabetes, the causes are quite different. Those with type 2 diabetes

experience insulin resistance. Insulin resistance is characterised by an inability
of the body to use the insulin that is produced. Lifestyle changes to dietary and
exercise patterns can often reduce the effects of diabetes. For others, medication
and/or insulin may be required.
Mental health problems

Mental health problems (sometimes referred to as psychological, emotional and
behavioural disorders) are also a large contributor to the burden of disease in
childhood, and the rates increase as children get older. Indigenous people, those in
rural and remote areas, and those from low socioeconomic backgrounds experience
higher rates of mental health problems than the rest of the population. According to
the National Aboriginal and Torres Strait Islander Health Survey (ABS, 2006), around
13 per cent of Indigenous children experienced a mental or behavioural disorder
compared to 8 per cent of the rest of the population. Access to health care is essential
for the prevention, diagnosis and treatment of mental health problems, and these
population groups generally have lower levels of access to affordable, appropriate
care. This contributes to the higher rates of mental health problems experienced.
The impact of mental health problems will often depend on the type of condition
experienced. Three common mental health issues among children include attention
deficit hyperactivity disorder (ADHD), conduct disorders and depressive disorders.
The rates of these conditions are shown in figure 8.24.
25
ADHD
Conduct disorder
20
Depressive disorder
15
Per cent
10
5 Figure 8.24 Percentage of children

aged 6–12 years with selected
0 psychological disorders, 1998
6–12 6–12 Source: Based on data from Australian Institute of
Health and Welfare 2005, A picture of Australia’s
Boys Girls children, AIHW cat. no. PHE 58, Canberra, p. 26.
ADHD is characterised by hyperactivity and an inability to maintain attention

on a task. Some children with ADHD will only display a few signs and may not
experience the same burden that other children with the condition face.
Conduct disorders can be characterised by aggression, defiance, destruction of
property and deceitfulness. These disorders can impact on all areas of health and
development. The child may not experience success at school, which can lead to
feelings of low self-esteem.
Depressive disorders are characterised by prolonged periods of unexplained
sadness. Although everyone experiences sadness at different times in their lives,
depressive disorders are characterised by extremes in low mood that are often
accompanied by low self-esteem and a lack of interest in normally enjoyable
activities. Sleeping and eating patterns may be disrupted, which can impact on
other areas of health.
Dental health
Despite steady improvement from the 1970s onwards, dental health has been
declining in children since the mid-1990s (figure 8.25).
2.5
Mean number of decayed, missing or filled teeth
6 year olds
12 year olds
2.0
1.5
1.0
0.5
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003-04 2005 2006 2007
Year
Figure 8.25 Mean number of
decayed, missing or filled teeth Poor dental health has a number of implications for health and development.
Source: Mejia GC, Amarasena N, Ha DH, Roberts-
Thomson KF & Ellershaw AC 2012. Child Dental Bacteria can travel from the mouth to the lungs and contribute to lung infections
Health Survey Australia 2007: 30-year trends in and other respiratory problems. Bacteria found in plaque may also increase the
child oral health. Dental statistics and research
series no. 60. Cat. no. DEN 217. Canberra: AIHW. risk of heart disease and stroke, although this research is still continuing. Children
with poor dental health may experience decreased self esteem, especially if their
appearance is affected. School absences are common, as treatment is administered
or infections take hold. This can impact on social health and intellectual
development in particular. Physical development can be further hindered if the
bones that support teeth are also affected.
Hospitalisations
Hospitalisations among children are quite high due to asthma, mental and
behavioural disorders, and diabetes. Hospitalisations for these conditions are
500
Hospitalisations (per 100 000 population)
Asthma
450
Mental and behavioural disorders
400 Diabetes
350
300
250
200
150
Figure 8.26 Hospitalisations among
children aged 5–12 years from asthma, 100
mental and behavioural disorders and 50
diabetes
Source: Australian Institute of Health and Welfare 0
2008, Making progress: the health, development 1998–99 1999–00 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07
and wellbeing of Australia’s children and young
people, cat. no. PHE 104, Canberra, p. 23. Year
Although injuries contribute significantly to the burden of disease for children,

hospitalisation rates are lower than for asthma, mental and behavioural disorders
and diabetes. This is shown in figure 8.27.

18
Hospitalisations (per 100 000 population)
16
14
12
10 Accidental poisoning
Burns and scalds
8 Accidental drowning
4
Figure 8.27 Hospitalisations among
2 children aged 5–12 years from
accidental causes
0 Source: Australian Institute of Health and Welfare
1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07 2008, Making progress: the health, development
and wellbeing of Australia’s children and young
Year people, cat. no. PHE 104, Canberra p. 22.
Chronic conditions can impact on all areas of health and development. The child
may miss out on experiences due to extended periods away from school and, as a
result, may not develop as they otherwise would have. They may develop low self-
esteem and be marginalised by their peers. The impact on the sufferer will largely
depend on the severity of the condition. Some conditions, such as mild asthma,
may be easily managed and not interfere too much with normal functioning.
However, a condition such as type 2 diabetes may result in significant lifestyle
changes and management techniques that may interfere with normal life. Reducing
the rate of these conditions is important to limit the negative impacts on the health
and individual human development of children.
TEST your knowledge 6 (a) What factors could lead to poor dental health?
(b) Outline three possible impacts of poor dental
1 (a) Briefly explain why low birth weight babies are
health in children.
more likely to experience ill-health than those of
normal body weight.
(b) List three factors that increase the chance of
having a low birth weight baby. 7 Using figure 8.22, identify one difference in the
2 (a) Identify the most frequently reported chronic rates of asthma experienced by males and females.
condition according to figure 8.21. 8 Brainstorm reasons why birth weight would be a
(b) Approximately what percentage of children good indicator of a newborn baby’s health.
suffer from this condition? 9 Suggest reasons that may account for Indigenous
3 (a) Briefly describe the changes in the incidence women having higher rates of low birth weight
of type 1 diabetes over time according to babies.
figure 8.23. 10 Why do you think Australia has a high asthma rate
(b) Suggest reasons for this change. compared to other countries?
4 Explain the term ‘insulin resistance’. 11 Explain how asthma could affect physical, social and
5 Explain the difference between attention deficit mental health.
hyperactivity disorder (ADHD), conduct disorders
and depressive disorders.
of Australia’s children
KEY SKILL Describe the characteristics of development

from birth to late childhood
The key requirement for this key skill is to be able to describe the development
that occurs from birth until the 12th birthday. An understanding of the four types
of development (physical, social, emotional and intellectual) and the changes that
occur during the stages of infancy and early and late childhood is essential.
❶ The type of development is identified Consider the following example, which is a discussion of the development that
and all four dimensions are covered.
would be taking place for Juni, a six-year-old who is attending primary school.
❷ Juni’s lifespan stage is childhood. Physical development:❶
However, as a particular age is At Juni’s stage of the lifespan, growth would be slow and steady. Fine and gross
specified, discussion focuses on motor skills would continue to develop.❷
children around this age (within
one or two years). Reference to the Her running style would become more fluid and she may now be able to skip.
milestones for an 11-year-old would Juni may be able to write a legible sentence by this stage.❸
not be relevant, even though an Social development:
11-year-old would be placed within
the same lifespan stage. As she is attending school, Juni would associate with more people outside the
home and would refine social skills such as communication and cooperation. She
❸ Examples of physical development may show off in front of friends and family to gain attention.❹
Emotional development:
❹ Examples of social development Juni may be able to identify basic emotions in others and has greater control over
her own emotions, and tantrums are less common.❺
❺ Examples of emotional development Intellectual development:
Juni will be able to follow basic instructions and may be able to order objects from
❻ Examples of intellectual development big to small.❻

1 Milan is two years old and an only child. He has just started attending child-care
twice a week.
(a) Identify three physical changes that Milan will experience in the next five years.
(b) Explain how attending child-care may affect Milan’s social development.
KEY SKILL Interpret data on the health status of

Australia’s children
This key skill requires the analysis of data related to the health of children. Data
can be presented in a number of ways. To revisit this skill, refer to the key skills
section of chapter 2 (pages 66–7) and follow the steps outlined there. A knowledge
of the basic issues concerning the health status of children will be beneficial in
applying this key skill.
90
80
Hospital separations per
70
100 000 children
60
50
40
30
Boys
20
Girls
10 Children
Figure 8.28 Diabetes hospital 0
separations for children aged
2000–01
2001–02
2002–03
2003–04
2004–05
2005–06
2006–07
2007–08
2008–09
2009–10
2010–11
0–14 years, 2000–01 to 2010–11

Source: Australian Institute of Health and
Welfare, A picture of Australia’s children 2012,
cat. no. PHE 167, Canberra, p. 20. Year

Analyse the data in figure 8.28 and use it to draw conclusions about the
❼ In 2003–04, the rates were very
health status of Australia’s children. In describing the trends evident in this similar. Including the qualifier
graph, the following three statements can be made. However, there are important ‘generally’ takes this factor into
considerations to be taken into account. account.
• Girls generally❼ have higher rates of hospitalisations due to diabetes❽ than
boys. ❽ It is important to clearly state the
trend that is being identified.
• Rates for hospitalisations have increased from around 58 per 100 000 female
children in 2000–01 to around 75 per 100 000❾ female children in 2006–07. ❾ This information might also be
• The rates of hospitalisations due to diabetes have increased for both males and presented in a different way. For
females between 2000–01 and 2006–07.❿ example: ‘Female hospitalisations due
to diabetes have increased by around
17 per 100 000 children.’ A similar
Key skills exam practice trend focusing on ‘males’ or ‘all

children’ could also be used.
2 Study figure 8.29 and answer the questions that follow.

❿ Reference is made to the span of
years over which the trend occurred.
300 Try to avoid making statements like
Mortality rates per 100 000
0–4 years ‘hospitalisations have increased’,

250 5–9 years as this indicates that the trend is
9–14 years currently occurring when the data do
200 not support this.
150
100
50
Figure 8.29 Mortality rates over
0
time, per 100 000 for selected age
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007 groups
Source: Adapted from AIHW, National mortality
Year database.
(a) Identify two trends in the mortality rates as shown in figure 8.29.
2 marks
(b) Use your knowledge of children’s health status to list three causes of death that are
common in the 0–4 age group.
3 marks
(c) Discuss how causes of mortality change between infancy and childhood.
4 marks
CHAPTER 8 review
Chapter summary
• Development occurs according to a number of principles: it is predictable and
Interactivities:
orderly, it is continual, there is individual variation in its rate and timing, it follows the
Chapter 8 crossword
cephalocaudal and proximodistal laws, and it moves from simple to complex. Many
Searchlight ID: int-2903 achievements in development will display more than one of these principles.
Chapter 8 definitions • Infancy is a rapid period of growth. All areas of development occur quickly during
Searchlight ID: int-2904 this stage and the family is a significant influence on health and individual human
development.
• Physical development during early and late childhood is described as being slow and
steady.
• Gradual increases in height and weight are accompanied by increases in bone strength.
• As the child grows and gains strength, their motor development progresses and the
child becomes capable of more complex motor skills.
• Social development is facilitated by play and interaction with family members. Children
often imitate the actions of older people as a way of learning social skills and roles.
• By the end of early childhood, the child is usually toilet-trained and can use a knife
and fork.
• The child gains an increasing sense of self during the childhood years and may become
self-conscious in certain circumstances.
• Intellectual development continues to progress and, as the child ages, language skills
become increasingly complex.
• By the end of childhood, the child can read, write and complete basic mathematical
problems.
• Thought patterns begin to change and, by the end of late childhood, the child starts to
think in an abstract way.
• Overall, Australian children experience excellent health but some groups, especially
Indigenous, those in rural and remote areas, and those from low socioeconomic
backgrounds, fare far worse than the majority of the population.
• Death rates and life expectancy are continually improving for Australian children.
• The main causes of death in this age group are perinatal conditions for infants and
injuries for children.
• Asthma is the most commonly reported condition for children.
TEST your knowledge 4 Phil and Amanda have just had their first baby and
have no idea what to expect in terms of their baby’s
1 Brainstorm a list of factors that have contributed
development. Create a timeline that shows them
to lower death rates and higher life expectancy
what they can expect in the four types of
throughout all the stages of childhood.
development over the next 12 years. You can use
APPLY your knowledge the Development timeline weblink in your
eBookPLUS to find a timeline to
2 How can the family positively or negatively affect use as a resource for this
the development of a child? question.
3 List three milestones of development that require
prior skills in order to be achieved (list the prior skills
as well).

CHAPTER 9

of Australia’s children
are important to Australia’s children as they significantly
influence health status and physical, social, emotional and
intellectual development. How effectively the body functions,
the lifestyle choices made by parents and children, the physical
environment in which children live and their social environment,
can have an effect on the health and individual human
development of Australia’s children. Social determinants such
as the capacity of parents to cope with the responsibilities
associated with supporting and caring for a family, including
being informed about and accessing the range of services
available within the community, are important for promoting
the health and individual human development of children.
Key knowledge
2.4 determinants of the health and individual human development of
Australia’s children, including at least one from each of the following:
• biological, such as genetics, birth weight and body weight
(pages 260–9)
• behavioural, such as eating habits, level of physical activity, oral
hygiene, breastfeeding and vaccination (pages 270–83)
• physical environment, such as tobacco smoke in the home, housing
environment, fluoridation of water and access to recreational
facilities (pages 284–91)
• social, such as parental education, parenting practices, media
and access to healthcare (pages 292–301).
2.5 determinants that act as risk and/or protective factors in relation to
one health issue such as asthma, falls and injuries, food allergies,
juvenile arthritis or type 1 diabetes (online)
2.6 government, community and personal strategies and programs
designed to promote the health and human individual development
of children (online)
Key SKILLS
and their impact on children using relevant examples. FIGURE 9.1 A range of determinants
• describe a specific health issue facing Australia’s children and draw affect the health and individual
human development of Australia’s
informed conclusions about personal, community and government
children.
strategies and programs to optimise child health and development

autoimmune response when the immune system
attacks and destroys healthy body tissues
carrier a person who has inherited a genetic trait or
condition but does not display the trait or symptoms. They
are able to pass the gene onto their children, who may or
may not display the trait or symptoms.
chromosomes strands of DNA that contain genetic
information
congenital malformations defects or damage to the
developing foetus
endocrine system the system in the body that regulates
the production and release of hormones (through the
glands)
genes the blueprint of the body that controls growth,
development and how the body functions
gingivitis early stage of gum disease characterised by
bleeding, redness and swelling of gums
hormone a chemical in the body that causes a change in
the functioning of a specific tissue or organ
multicausal refers to a range of factors that together
determine and influence health
periodontitis advanced stage of gum disease resulting
in bleeding, swelling, receding gums, bad breath, a bad
taste in the mouth and loose teeth
protective factors influences that help guard against
ill-health
risk factors influences that increase the likelihood of
ill-health
sex-linked chromosome genetic material that
determines the sex of the developing baby
vaccination the administration of a micro-organism of a
disease to bring about an immune response
The determinants of health and individual human development of Australia’s children • CHAPTER 9 257
9.1 T he determinants of health and individual
human development
KEY CONCEPT The range of determinants of health and individual human

development impacting on children
The childhood stage of the lifespan is a time when the foundations for later health
and individual human development are established. It is during this time that
children learn skills, knowledge and behaviours through their interaction with
others and their environment that will help determine their current and future
health status. Australian children generally enjoy good health, as indicated by the
declining rates of morbidity and mortality from preventable conditions. Although
the overall health status of children is positive, there are areas of concern that need
to be addressed. Australian children are experiencing higher rates of overweight
and obesity, insufficient physical activity, poor eating habits, mental health issues,
and long-term health conditions such as asthma and type 1 diabetes.
A child’s level of health has a significant impact on physical, social, emotional and
intellectual development. In order to promote their optimal development, a child
needs to have an appropriate level of physical, social and mental health. Each child is
Figure 9.2 Foundations for later born with a genetically determined developmental potential. Whether or not a child
health and individual human achieves their potential depends on their health status. For instance, a child who has
development are formed during
a heart condition can be limited in the amount of physical activity they can undertake.
childhood.
As a result, the child’s bone density and muscle growth may be impaired, which might
limit the development of motor skills. The child may be physically unable to participate
in sporting activities or may not be selected by their
peers to be a part of games. Consequently, the child
Impact on physical
development
may not be able to engage in team activities, thereby
Limited opportunities for reducing the opportunities for social interaction in
the development of sporting situations and the capacity for developing
motor skills, bone density social skills. Feeling rejected from team activities, or
and muscle
feeling isolated from peers due to the inability to
participate in physical activity, may cause the child to
lack self-confidence and have low self-esteem. This can
adversely affect emotional development. Having
Impact on social
Physical activity development
a heart condition may require the child to be
is limited/unable Limited opportunities for hospitalised or result in extended absence from school,
to participate in interaction with peers thereby reducing the opportunities for developing
team activities and the development of intellectual skills (see figure 9.3).
social skills
The factors that impact on the health and individual
human development of individuals and populations
are referred to as ‘determinants’. In most instances,
it is not just one factor that influences health and
Impact on emotional
development
individual development but a combination of factors.
Child with a Child feels isolated, In this sense, health is seen to be multicausal. The
heart condition resulting in lack of determinants of health and individual human
confidence and low development can have positive or negative effects.
self-esteem
Certain behavioural or lifestyle influences — such
as eating habits or lack of physical activity — that
increase the likelihood of ill-health in children are
known as ‘risk factors’. Other behavioural or lifestyle
Impact on intellectual
development
influences — such as breastfeeding and childhood
Extended vaccinations — that reduce the likelihood of ill-health
Limited opportunities
absence from
school
for intellectual in children are commonly termed ‘protective factors’.
development
Figure 9.3 Examples of the impacts of ill-health on the
individual human development of a child

There are determinants of health and individual human development that have
an impact on the individual at each stage of the lifespan. Figure 9.4 highlights
some of the determinants that are particularly relevant to the childhood stage of
the lifespan. While you do not have to study all of these examples, this chapter
provides an overview of how each one influences the health and individual human
development of children.
Biological Physical environment

Genetics Tobacco smoking in the home
Birth weight Housing environment
Body weight Fluoridation of water
Behavioural Social
Eating habits Parental education
Level of physical activity Parenting practices
Oral hygiene Media
Breastfeeding Access to services e.g. health care
Vaccination
Figure 9.4 Determinants of health and individual human development of Australia’s children

1 The health status of Australian children is relatively 5 Outline three examples of the determinants of health
positive but there are areas of concern that need to and individual human development that can have a
be addressed. What are these health concerns? positive impact on children (protective factors).
2 Why is the childhood stage of the lifespan 6 Outline three examples of the determinants of health
considered to be particularly important in and individual human development that can have a
determining health status in the later stages of the negative impact on children (negative factors).
lifespan? 7 Explain how obesity may affect the individual
3 Explain the meaning of the term ‘determinants of human development of a child.
health and individual human development’. 8 Choose one health condition affecting children
4 Explain the interrelationship between health and and explain how the determinants of health and
individual human development by referring to an individual human development impact on this
example that is relevant during childhood. condition.
9.2 Biological determinants: genetics
KEY CONCEPT The influence of genetic factors on the health and individual
human development of children
Biological determinants refer to those genetic and physiological factors that affect
health and individual human development. They relate to the functioning of the
body and include factors such as genetics, body weight and birth weight. Biological
factors do not act in isolation, and are influenced by other determinants such as
environmental factors and health behaviours.
Genetics
In chapter 6, you learnt about the role of conception in determining the genetic
make-up of the unborn child. The genes that a child inherits from their biological
parents have a significant impact on the child’s health and individual human
development. Genes are the blueprint of the body because they control growth,
development and how the body functions.
A child’s genetic make-up determines:
• the rate and timing of physical development as a result of the excretion of
hormones from the glands of the endocrine system
• whether the child is male or female
• the development of genetic conditions such as Duchenne muscular dystrophy
• predisposition to diseases such as cardiovascular disease.
Genes are part of the chromosomes, which are long strands of deoxyribonucleic
acid (DNA) that contain genetic information and are found in the nucleus of
human cells (figure 9.5). Each human cell — except blood cells, which have
Figure 9.5 Our genetic make-up no nucleus — contains 46 chromosomes in 23 pairs. Of these chromosomes,
is determined by the combination 22 pairs are referred to as ‘autosomes’ and one pair is called the ‘sex-linked’
of genes that occur at the point of chromosome because it determines the sex of the individual. Our genetic make-up
conception. These genes are carried
on the DNA in our body cells.
is determined by the combination of genes that occur at the point of conception.
Fifty per cent of an individual’s genes are passed down from the biological father
and 50 per cent from the biological mother. It is this combination of genes that
determines the physical characteristics of the individual (e.g. facial features,
sexual characteristics and eye colour) as well as genetic conditions and genetic
predisposition to disease.
Sex-linked chromosomes
Figure 9.6 The sex of a As explained earlier, each human egg and each human sperm contains one set
child is genetically of 23 chromosomes, made up of 22 autosomes and one sex-linked chromosome.
determined. Each cell in the female body contains two ‘X’ sex-
linked chromosomes, but each cell in the male body
contains one ‘X’ and one ‘Y’ sex-linked chromosome.
Because every female egg contains one set of
chromosomes, every egg will have only the ‘X’ sex-
linked chromosome. In contrast, each male sperm
can have either an ‘X’ sex-linked chromosome or a ‘Y’
Sperm carries either an All female eggs sex-linked chromosome.
‘X’ chromosome or a contain an
This explains why the gender of a developing baby
‘Y’ chromosome. ‘X’ chromosome.
is determined by the sperm. If an ‘X’ sperm fertilises
an ‘X’ egg, then the result is a female baby. If a ‘Y’
‘X’ sperm fertilises an ‘X’ egg Female baby
sperm fertilises an ‘X’ egg, then the result is a male
‘Y’ sperm fertilises an ‘X’ egg Male baby baby (figure 9.6).

Some genetic conditions are carried When the father has When the mother carries the
on the ‘X’ chromosome. There are few Duchenne muscular dystrophy (DMD) Duchenne muscular dystrophy (DMD)
and the mother is unaffected gene and the father is unaffected
genetic conditions related to genes on
Father Mother Father Mother
the ‘Y’ chromosome. One normal copy
of a gene on the ‘X’ chromosome is
usually sufficient for normal function.
Women (‘XX’ chromosomes) who may
have a defective copy of a gene on one XY XX XY XX
of the two ‘X’ chromosomes are
protected by the normal gene on the XY XX XY XX XY XX XY XX
second ‘X’ chromosome. Conditions
such as colour blindness are much
more prevalent among men (‘XY’
chromosomes) as colour blindness is
carried on the ‘X’ chromosome, of None of the sons will There is a 50% chance at each birth
which men have only one copy. have DMD. that a son will have DMD.
Therefore, men do not have the All the daughters will carry There is a 50% chance at each birth that
the DMD gene. a daughter will carry the DMD gene.
protective factor of a second
chromosome carrying a normal gene.
Duchenne muscular dystrophy (DMD) is another example of a genetic condition Figure 9.7 Duchenne muscular
where the gene is carried on the ‘X’ chromosome. Individuals with DMD do not dystrophy is a genetic condition that is
carried on the ‘X’ chromosome.
make the dystrophin protein in their muscles. DMD is a rapidly progressive
form of muscular dystrophy that occurs primarily in males. The symptoms of
the condition include delayed motor milestones (including sitting and standing
independently), progressive muscle weakness, particularly of the legs and pelvic
muscles, and skeletal deformities which contribute to breathing difficulties.
Cardiomyopathy (enlarged heart) occurs in almost all cases. Few individuals
with DMD live beyond their 30s, with breathing difficulties and cardiomyopathy
being common causes of death. DMD affects approximately 1 in 3500 male births
globally.
As males have only one copy of the ‘X’ chromosome, a DMD gene mutation
will result in them having Duchenne muscular dystrophy. As females have two
copies of the ‘X’ chromosome, if one copy has the DMD gene mutation, then
females have a second ‘X’ chromosome to produce the dystrophin protein. In this
situation, females do not have Duchenne muscular dystrophy but are carriers of
the condition. Females who carry the changed copy of the gene have a 50 per cent
chance of passing it on to each of their children. If a male with DMD were to have
children, all his daughters would be carriers of the condition and none of his sons
would be affected (refer figure 9.7).
The role of hormones

Hormones are the chemical messengers within the body that transport a
signal from one cell to another to bring about certain changes in the body.
Hormones are secreted into the bloodstream by the glands of the endocrine
system (figure 9.8). These glands include the thyroid gland, parathyroid glands,
adrenal gland, pituitary gland, pineal gland, pancreas, testes and ovaries. Each
gland releases hormones that act on specific target sites within the body to bring
about physical changes. The rate and timing of hormone secretion is genetically
determined. During childhood, the actions of hormones affect the amount of
growth that occurs.
The hormones that regulate growth and physical development during childhood
are shown in table 9.1.
Table 9.1 Hormones that regulate growth and physical development during childhood
Hormone Site of secretion Effect on physical development
Growth hormone Pituitary gland Stimulates protein synthesis required for growth of
soft tissue (e.g. muscle) and hard tissue (e.g. bone)
Thyroid-stimulating Pituitary gland Stimulates the thyroid gland to secrete thyroxine
hormone
Thyroxine Thyroid gland Sets the rate at which the metabolism of food into
energy takes place. Energy is required for growth.
Calcitonin Thyroid gland Increases the rate of calcium deposition in bones
Parathyroid hormone Parathyroid glands Regulates the amount of calcium and phosphorus
(located behind the in the bones and blood. Calcium and phosphorus
thyroid gland) are required for strengthening bones.
Insulin Pancreas Stimulates the cells to convert glucose to energy.
Energy is required for growth.
Pineal gland Most children grow to a height similar to that of their parents. How each
child grows is dependent on the genes that determine the rate of secretion
Pituitary of hormones from the glands of the endocrine system. The pituitary
gland gland secretes growth hormone, which affects the bone development
and height of a child. In conjunction with this, the pituitary gland also
releases thyroid-stimulating hormone that prompts the thyroid to secrete
thyroxine. Thyroxine plays an important role in metabolising food
Parathyroid Thyroid
into energy. This energy is also required for bone development and the
glands gland increasing height of the child.
Genetic conditions
Thymus
A range of genetic conditions can be inherited from parents. An example
of this is cystic fibrosis, which is the most common life-threatening genetic
disorder among light-skinned people. This condition results in the secretion
of a thick mucus that affects the lungs, pancreas, liver and reproductive
system. In the lungs, the mucus clogs small air passages and traps bacteria.
This causes repeated bouts of infection, and the blockages can result in
Adrenal irreversible damage to the lungs. In the pancreas, the mucus blocks the
glands passage of the enzyme that is required for digestion in the intestines. This
can cause vitamin deficiencies, malnutrition and/or severe constipation.
Pancreas Thickened secretions in the reproductive system can result in obstructions
that can affect the development and function of the sexual organs. A child
suffering from cystic fibrosis will have a shortened life expectancy.
People with cystic fibrosis experience a range of symptoms including:
• persistent coughing that requires enormous physical effort
• breathing difficulties
Ovary
(in females)
• a lack of energy resulting in limited capacity for physical activity
• a frequent need to go to the toilet
Testis • muscle cramping or weakness
(in males)
• poor appetite.
In Australia, one in 25 people carry the cystic fibrosis gene without
showing any symptoms of the condition. If a male and a female who are
both carriers of the gene have a child together, their chance of having a
Figure 9.8 Hormones are secreted child with cystic fibrosis is one in four. They have a two-in-four chance
by glands that make up the endocrine of having a child who will not have the condition but will carry the gene,
system. and a one-in-four chance of having a child who will neither have the gene
nor be a carrier.

Genetic predisposition to disease
A number of conditions that
affect the health and individual
will arise due to a genetic
predisposition. Although the
exact cause of some of these
conditions is unknown, a child
may have a genetic susceptibility
to a particular illness. That is, if
the mother, the father or both
parents have the condition, then
this significantly increases the
possibility that their child will
also develop the condition. Type
1 diabetes and asthma are two
childhood conditions that have
a genetic predisposition. Figure 9.9 Children with type 1
Type 1 diabetes, also referred to as ‘insulin-dependent diabetes mellitus’ or diabetes need to regularly check their
‘juvenile diabetes’, can occur at any age. However, it is more common in people blood-glucose levels.
under 30. In fact, it is one of the most common childhood diseases in developed
countries such as Australia.
Type 1 diabetes is a chronic condition that affects the body’s ability to
maintain blood glucose levels. Blood glucose levels are regulated in the body
by insulin, a hormone that is secreted by the pancreas. The role of insulin is to
stimulate the cells of the body to convert glucose molecules to energy. Insulin
also enables excess glucose to be stored in the liver as glycogen, which can then
be used for energy when needed. For people with type 1 diabetes, the body’s
own immune system attacks the insulin-producing cells in the pancreas. As a
result of this autoimmune response, the pancreas is no longer able to produce
insulin and so the glucose accumulates in the bloodstream. When there is
insufficient insulin and the glucose levels in the bloodstream remain high for
several hours, the body starts to break down fat for energy. Ketones are produced
as by-products of fat being broken down. These can be toxic to the body
and, if left untreated, can lead to a life-threatening condition called diabetic
ketoacidosis (DKA).
In order to regulate blood glucose levels, people with type 1 diabetes must
regularly monitor their blood glucose and receive regular doses of insulin by
injection or an insulin pump. Insulin pumps are worn on the body and release
controlled doses of insulin into the bloodstream. Physical activity and diet are also
key factors in the management of type 1 diabetes. It is important for children with
type 1 diabetes to consume a regular and consistent amount of foods containing
carbohydrates. In particular, carbohydrates with a low glycaemic index should
be chosen. Before children with type 1 diabetes engage in physical activity, they
should consume an extra carbohydrate snack. If the exercise session continues over
a prolonged period of time, then a carbohydrate snack may be required during the
activity as well.
Blood glucose levels can be monitored by taking a small sample of blood via a
pinprick of the finger and testing it on a blood glucose meter (figure 9.9). Diabetics
who take too high a dose of insulin may experience low blood glucose levels,
which can have serious health consequences. Ideally, blood glucose levels should
range between 3.5 and 8 millimoles per litre, or mmol/L. Table 9.2 lists the health
effects of both high and low blood glucose levels.
Table 9.2 The impact of high and low blood glucose levels on health
Effects of high blood glucose levels Effects of low blood glucose levels
Excessive thirst Weakness, trembling, shaking
Loss of appetite Headache
Dehydration Light-headedness, dizziness
Weight loss Sweating
Abdominal pain Hunger
Vomiting Tingling around the lips
Frequent urination Racing heartbeat
Blurred vision Lack of concentration
Increased risk of infections Loss of coordination
Kidney damage Confusion
Eye damage Slurred speech
Nerve damage to feet and other parts of Loss of consciousness
the body
Heart disease Fitting
Circulation problems in the legs
Stroke
Impotence
Coma
There is no single gene that causes type 1 diabetes but there are inherited
factors that may increase the likelihood of a child developing the condition.
Certain environmental triggers have also been identified as increasing the risk of
developing type 1 diabetes. In particular, viruses such as rubella may damage the
insulin-producing cells of the pancreas. Research into the impact of dietary factors
has also shown that certain proteins found in cow’s milk may trigger the onset of
type 1 diabetes.
Asthma is another common childhood condition experienced by 14 to 16 per
cent of Australian children. Asthma affects the small air passages (bronchi) of the
lungs. When exposed to certain triggers (e.g. cigarette smoke and air pollution),
the lining of the air passages becomes inflamed and swollen, and extra mucus is
produced. The muscles of the airways also tighten (bronchoconstriction),
resulting in a narrowing of the airways that makes it difficult for the child to
breathe.
Figure 9.10 Approximately 14 to

16 per cent of Australian children are
affected by asthma.

The symptoms of asthma include:
• a dry, irritating cough
• shortness of breath
• tightness of the chest
• wheezing.
The most common triggers for asthma are:
• colds
• changes in weather
• cigarette smoke
• dust and dust mites
• pollen
• some animals
• exercise
• pollution
• certain medications (e.g. aspirin)
• certain chemicals and strong smells (e.g. from cleaning products)
• emotional factors (e.g. stress)
• some foods and food preservatives.
With the appropriate treatment and management of asthma, almost all children
will be able to participate in physical activity and lead active lives. Two main types
of medication are used for asthma:
• relievers — quick-acting and used during an asthma attack to open the airways
• preventers — slow-acting and used to prevent attacks from occurring.
Although the exact causes of asthma are not clear, a family history of asthma,
eczema or hay fever can increase the likelihood of a child developing the condition.
TEST your knowledge 5 Explain how cystic fibrosis might affect health and
1 What determines the genetic make-up of an
6 Explain how type 1 diabetes affects health.
individual? Explain.
7 Explain how asthma affects health.
2 With reference to sex-linked chromosomes, explain
8 What factors may increase the likelihood of an
how sex is determined.
individual developing asthma?
3 Explain the role of the following hormones in the
growth and physical development of children:
(a) growth hormone
(b) thyroid-stimulating hormone 9 What are the differences between a genetically
(c) thyroxine inherited condition and a genetic predisposition?
(d) calcitonin 10 Outline the determinants of health and individual
(e) parathyroid hormone development that affect asthma.
(f) insulin. 11 ‘Genetics play the most significant role in the health
4 What are the chances of a mother and father who and individual human development of children.’
are carriers of cystic fibrosis having a child with the Discuss.
condition?
9.3
Biological determinants: birth weight and body weight
KEY CONCEPT The influence of birth weight and body weight on the health
and individual human development of children
Birth weight
Birth weight can determine the health status of individuals as they develop into
children and then adults. Babies are classed as ‘low birth weight’ if they weigh less
than 2500 grams at birth. Low birth-weight babies can be further classified as ‘very
low birth weight’ if they weigh 1000–1500 grams, and as ‘extremely low birth
weight’ if they are below 1000 grams (table 9.3). Very low and extremely low birth
weights occur in infants who are born very prematurely.
Figure 9.11 Birth weight can be a
Table 9.3 Classification of birth weight
predictor of future health status.
Low birth weight Very low birth weight Extremely low birth weight
Below 2500 grams Between 1000 and 1500 grams Below 1000 grams
Weight-for-age percentiles: Girls, birth to 36 months Regular measurements of an infant’s weight,

kg kg height and head circumference over the time span
18
from birth to 36 months assist in determining their
97th 18
health and individual human development. These
95th
17 17 measurements are placed on a percentile chart in
90th order to determine the rate of increase in weight,
16 16 height and head circumference in comparison to
15 75th 15
the measurements of a large number of infants
of the same age and sex. Percentile charts give a
14 50th 14 visual representation of how a baby is progressing
over time.
13 25th 13 Percentile charts are marked with curved lines
12 10th 12 that represent different percentiles. Charts have
5th been developed for the three measurements of
3rd
11 11 weight, height and head circumference. If a baby
is in the 10th percentile for weight, it means that
10 10
90 per cent of babies of the same age are heavier
9 9 than he or she is, and 10 per cent of babies weigh
less. A baby in the 90th percentile for weight
8 8 is heavier than 90 per cent of other babies and
10 per cent of babies weigh more. In both
7 7
instances, the babies — although very different
6 6 in size and at different ends of the percentile
range — are within the normal range.
5 5 Figure 9.12 shows the weight-for-age percentile
chart for girls, aged from birth to 36 months. An
4 4
‘average’ baby would be in or close to the 50th
3 3 percentile. However, some babies are genetically
small and may be in the lowest percentile. It is
2 2 important that regular measurements are taken
kg kg to ensure that the baby is continuing to increase
Birth 3 6 9 12 15 18 21 24 27 30 33 36 in height, weight and head circumference.
Age (months) Measurements that remain the same over time,
decrease (e.g. weight) or do not increase at the
Figure 9.12 Weight-for-age
expected rate may indicate that there are possible problems with the baby. Regular
percentiles: Girls, birth to 36 months
Source: ‘Individual growth charts’, Centers for
checks by a maternal and child health nurse or a general practitioner are important
Disease Control and Prevention, www.cdc.gov. for monitoring the health and individual human development of the baby.

Of approximately 18 000 live born infants in 2006, 6.4 per cent weighed
less than 2500 grams, 1.1 per cent weighed less than 1500 grams and 5.3 per
cent weighed between 1500 and 2499 grams. (AIHW, 2009). Babies with a very
low birth weight, or an extremely low birth weight, have a greater risk of dying
prematurely or developing a range of conditions and developmental problems.
Table 9.4 outlines the health and development effects of a baby having a very low
birth weight or an extremely low birth weight.
Table 9.4 The impact on health and individual human development of very low or extremely low birth weight
Impact of very low or extremely low birth weight:
On health On individual human development
• Reduced lung function • Reduced muscle bulk

• Increased risk of bronchiolitis (an inflammation of the small airways in • Reduced coordination
the lungs) • Poor sucking and swallowing reflexes
• Decreased exercise capacity • Greater likelihood of impaired growth and motor skill development
• Feeding difficulties leading to lack of nutritional intake • Greater likelihood of impaired learning capabilities
• Increased risk of bradycardia (a slowing of the heart rate) • Damage to the retina of the eye resulting in sight difficulties
• Apnoea (a short-term suspension of breathing) including blindness
• Jaundice (yellowing of the skin due to the immature liver being unable • Increased risk of cerebral palsy
to process the compound bilirubin, which is found in the blood) • Increased risk of deafness
• Increased probability of a lengthy hospital stay following birth
• Increased risk of asthma during childhood
Body weight
The body weight of a child is determined by behavioural factors
(e.g. eating patterns and level of physical activity), the physical
environment (e.g. access to recreational facilities), the social
environment (e.g. the eating habits of family), as well as the genes
that are inherited from the biological parents. Research has shown
that genetics play a role in regulating body weight. For example,
children of parents with lower resting metabolic rates have a
greater chance of gaining weight. Overweight and obesity have a
significant impact on the health and individual human development
of children.
Figure 9.13 The genes that a child
How is children’s body weight measured? inherits are one factor that has an
impact on body weight.
Body weight is measured using the body mass index (BMI), which is an index of
weight relative to height. It is calculated by dividing a person’s weight in kilograms
by their height in metres squared.
BMI = weight (kg)/height (m2)
For example, the BMI calculation for a boy who weighs 25 kilograms and has a
height of 1.25 metres would be:
BMI = 25/(1.25)2
BMI = 16
The BMI calculation is useful for adults because they have stopped growing and
any increases in BMI are usually caused by increases in body fat. For children,
however, the BMI calculation on its own is not appropriate because children are
still growing and the proportion of body fat will change. To make the BMI relevant
to children, it needs to be compared against the BMI-for-age and gender percentile
charts. These percentile charts provide an indication of a child’s BMI relative to
children of the same age and sex.
9.3 Biological determinants: birth weight and body weight
The categories and percentiles for BMI-for-age are shown in table 9.5.
Table 9.5 BMI-for-age weight status categories and corresponding percentiles
Weight status category Percentile range
Underweight Less than the 5th percentile
Healthy weight 5th percentile to less than the 85th percentile
Overweight 85th percentile to less than the 95th percentile
Obese Equal to or greater than the 95th percentile
Source: ‘About BMI for children and teens’, Centers for Disease Control and Prevention, www.cdc.gov.
The chart in figure 9.14 shows how BMI can be measured relative to children of
the same age and sex. In this example, different BMI calculations for a 10-year-old
boy are marked on the chart.
Body mass index-for-age percentiles: Boys, 2 to 21 years
BMI BMI
34 34
A 10-year-old boy with a BMI of 23
would be in the obese category
32 (95th percentile or greater). 32
95th percentile
30 30
90th percentile
28 A 10-year-old boy with a 28
BMI of 21 would be in the 85th percentile
overweight category (85th
26 to less than 95th percentile). 26
75th percentile
24 24
50th percentile
22 22
25th percentile
20 20 10th percentile
5th percentile
18 18
16 16
A 10-year-old boy with

14 A 10-year-old boy with a a BMI of 13 would be in 14
BMI of 18 would be in the the underweight category
Figure 9.14 An example healthy weight category (less than 5th percentile).
of how sample BMI 12 (5th percentile to less than 12
calculations would be 85th percentile).
interpreted for a 10-year-
kg/m2 kg/m2
old boy
Source: ‘About BMI for children and 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
teens’, Centers for Disease Control
and Prevention, www.cdc.gov. Age (years)

The impact of obesity on the health and individual
Overweight and obesity can be caused by a genetically low metabolic rate, lack
of physical activity, a dietary intake consisting of a large proportion of saturated
fats and simple carbohydrates, or the overconsumption of carbohydrates, fats and
protein. Social factors (such as the types of food eaten due to a child’s culture),
as well as environmental factors (such as access to recreational facilities), also
impact on the development of obesity in childhood. Childhood obesity rates
have increased significantly over the past two decades. The 2007–08 National eLesson:
Consequences of childhood
Health Survey results indicate that 24.9 per cent of children aged 5–17 years are
obesity
overweight or obese.
Childhood obesity has serious short-term consequences for the health and
individual human development of children. Obesity during childhood significantly
increases the risk of illness and premature death in adulthood. Table 9.6 outlines the
short- and long-term consequences to health and individual human development
of childhood obesity.
Table 9.6 Consequences of childhood obesity on health and individual human development
Short-term consequences Long-term consequences
Health Health
• Physical discomfort • Twice the risk of developing cardiovascular disease (high blood
• Bone and joint problems pressure, angina, heart attack) in adulthood
• Asthma or shortness of breath during exercise • Three times the risk of developing type 2 diabetes in adulthood
• Heat intolerance • Increased risk of premature death
• Tiredness/lethargy • Poor self-esteem can lead to an increased tendency to smoke
• High blood pressure and drink alcohol, resulting in health conditions such as lung
• Abnormal cholesterol levels cancer, cardiovascular disease and cirrhosis of the liver
• Interrupted sleep due to breathing difficulties (obstructive sleep apnoea)
• Social and psychological distress
• Low self-esteem
Individual human development (short- and long-term)
• Decreased memory due to lack of sleep • Poor self-image

• Reduced learning performance • Limited social skill development
• Reduced motor skill development due to lack of physical activity
Source: Adapted from ‘Childhood obesity’, www.mydr.com.au.

1 Explain the weight classifications for low birth 5 Outline five health and/or developmental concerns
weight, very low birth weight and extremely low that may occur as a result of very low or extremely
birth weight. low birth weight.
2 What percentage of babies born in 2006 were 6 Describe four likely consequences of obesity on the
classified as: health of a child.
(a) low birth weight? 7 Describe four likely consequences of obesity on the
(b) very low birth weight? individual human development of a child.
(c) extremely low birth weight? 8 Use the BMI for age — Girls weblink in your
3 (a) How is BMI calculated? eBookPLUS to find the link for this question.
(b) Why is it important to use BMI-for-age and For an 11-year-old girl, identify the BMIs that eBook plus
gender percentile charts when determining the would place her in the 10th, 25th and
body weight of children? 75th percentiles.
4 Explain the relationship between the physical
environment and biological, social and behavioural
factors in the development of obesity.
9.4 Behavioural determinants: breastfeeding
KEY CONCEPT The impact of breastfeeding on the health and individual human
development of children
Breastfeeding
The benefits of breastfeeding to the health and
individual human development of the developing
child are well documented (table 9.7). In the first
few days following birth, the breasts produce a
fluid called colostrum, which contains antibodies
required to resist infection from conditions such as
acute diarrhoea, lower respiratory tract infections
and ear infections. Within a few days, the colostrum
changes to mature milk. Breastmilk contains all of
the nutrients required by the baby for the first six
months of life. Breastmilk can supply more than half
of the nutrients required by the child between 6 and
12 months of age, and up to a third of the nutrients
needed between one and two years of age. Mature
breastmilk contains the right amount of fat, sugar,
water and protein to promote the growth of the
baby. The World Health Organization recommends
exclusive breastfeeding for the first six months, with
the introduction of complementary foods beginning
at six months of age. Apart from the nutritional
value, breastfeeding is also hygienic, convenient and
inexpensive. For most babies, breastmilk is easier to
digest than formula.
Breastfeeding also promotes the social and
Figure 9.15 It is recommended that emotional attachment between mother and child. The secretion of the maternal
infants are breastfed for at least the
first six months of life.
hormones prolactin and oxytocin encourages the development of a maternal bond
with the child. Oxytocin plays a role in counteracting stress, which allows both
mother and baby to feel comfortable and relaxed.
Table 9.7 Benefits of breastfeeding for the health and individual human development of
children
Benefits of breastfeeding for individual

Benefits of breastfeeding to health human development
Reduced risk of SIDS Fatty acids within breastmilk contribute to

Reduced incidence and duration of diarrhoeal brain development, thereby reducing the risk of
disease learning difficulties in childhood
Reduced risk of juvenile diabetes in later life Optimal development of eyesight
Reduced risk of heart disease in later life Optimal development of the jaw and mouth
Reduction in allergies Optimal speech development
Reduced likelihood of childhood obesity Promotes intelligence
Reduced risk of respiratory illnesses
Reduced risk of middle ear infections
Source: Adapted from Australian Breastfeeding Association, www.breastfeeding.asn.au.
Although breastmilk is the best option for babies, artificial formula contains the
required nutrients and is readily available. Some mothers may choose to bottle
feed purely because they do not feel comfortable breastfeeding. For some mothers,

breastfeeding may not be an option or needs to be stopped due to the following
reasons:
• The baby may refuse to suck at the breast.
• The baby may be unable to breastfeed because of an illness or a congenital
malformation that makes it difficult for the child to suck (e.g. cleft palate).
• The mother has an illness that prevents her from breastfeeding.
• The mother has mastitis. This is an inflammation or infection in the breast
commonly caused by a cracked nipple, blocked milk duct or injury to the breast.
• The breastmilk may be in low supply and not adequate for the baby.
While infant formula has been developed to contain nutrients similar to those
found in breastmilk, it does not contain valuable antibodies like breastmilk. As
bottle-fed babies do not have the antibodies to protect them from harmful germs or
infections, it is important that bottles and other equipment are carefully sterilised
in order to reduce the risk of contaminating the formula and possibly infecting
the baby.

1 Outline the benefits of breastfeeding to the baby. 4 Outline the advantages and disadvantages of
2 What is colostrum and why is it important for breastfeeding and bottle feeding.
the health and individual human development of 5 Develop a wiki for new mothers outlining the
children? importance of breastfeeding for the health
3 Outline the possible reasons why a mother may and individual human development of
bottle feed her baby. their baby.
9.5 Behavioural determinants: vaccination
KEY CONCEPT The importance of vaccination in promoting the health and

individual human development of children
Vaccination
Many infectious diseases can have significant effects on the health and individual
human development of children. These diseases are caused by bacteria or viruses.
Bacteria may enter the body via:
• open wounds
• consumption of contaminated food or water
• close contact with an infected person or with the faeces of an infected person
• breathing in the exhaled droplets of an infected person
• touching surfaces contaminated with bacteria such as taps or toilets.
Viruses are spread from one person to another via:
• coughing
• sneezing
• exposure to an infected person’s vomit
• transfer of bodily fluids including blood, breastmilk, saliva, vaginal fluids and
semen.
Vaccines have been developed to help protect children against a range of
infectious diseases. Each vaccine contains either a weakened or dead micro-
organism of a disease so that the body will develop antibodies against that
particular disease. This immune response means that when the body comes
in contact with a particular infectious micro-organism, it is able to fight and
overcome the organism. By vaccinating against specific diseases, the individual is
able to resist those diseases if exposed to them.
Vaccinating from an early age helps protect children from a range of illnesses,
some of which may be life threatening. In the first months of life, a baby gains its
protection from infectious diseases via antibodies that have passed from the mother
during pregnancy and through breastfeeding. Vaccinations become important
when these antibodies are no longer effective and the child is at risk of infection.
Immunisation is the process of providing vaccinations. Immunisation not only
protects the child but also protects the community from the spread of disease.
Table 9.8 outlines vaccine-preventable diseases and their impact on health and
Figure 9.16 Vaccination is important

for protecting children against a
range of infectious diseases.

Table 9.8 Vaccine-preventable diseases and their impact on health and/or individual human development
Impact on health and/or individual

Disease Method of transmission human development
Diphtheria Bacteria spread by respiratory droplets 1 in 15 patients will die

Fever
Severe inflammation of the nose, throat and windpipe
Breathing difficulties
Swallowing difficulties
Nerve paralysis
Heart failure
Hepatitis B Virus spread via blood, sexual contact or 1 in 4 will develop cirrhosis of the liver or liver cancer
from mother to baby at birth
Haemophilus Bacteria spread via respiratory droplets Stiff neck, severe headache, convulsions/seizures, drowsiness, loss of consciousness,
Influenzae difficulty breathing
type B (Hib) Meningitis (infection of the membranes that surround the brain and spinal cord)
Epiglottitis (infection of the epiglottis, which is the flap at the top of the windpipe)
Pneumonia
Septicaemia (infection in the bloodstream)
Osteomyelitis (infection of the bone)
Measles Virus spread via respiratory droplets Fever, cough, rash, respiratory infections, diarrhoea and vomiting
1 in 15 with measles will develop pneumonia
1 in 1000 with measles will develop encephalitis, with 10 per cent dying and 40
per cent having permanent brain damage
Meningococcal Bacteria spread via respiratory droplets Septicaemia

Meningitis
1 in 10 patients will die
1 in 30 will have severe scarring of the skin or loss of limbs
1 in 30 will have severe brain damage
Mumps Bacteria spread via saliva Swollen neck and salivary glands, fever, weight loss
1 in 200 will develop encephalitis
Inflammation of other organs of the body (e.g. reproductive organs, heart, brain,
pancreas, liver, thyroid)
Occasionally causes infertility and/or deafness
Pertussis Bacteria spread via respiratory droplets Bleeding, apnoea (temporary cessation of breathing while sleeping), pneumonia,
(whooping inflammation of the brain, convulsions and coma, permanent brain damage, death
cough)
Pneumococcal Bacteria spread via respiratory droplets Septicaemia

Meningitis: 1 in 10 patients with meningitis will die
Poliomyelitis Virus spread via faeces and saliva Vomiting, fever, headache, paralysis
1 in 20 hospitalised patients will die
1 in 2 patients who survive will be permanently paralysed
Rotavirus Virus spread via person-to-person contact Cough, runny nose, vomiting, diarrhoea, fever, dehydration, drowsiness, shock
(e.g. touching contaminated hands,
faeces, vomit or saliva; consumption of
contaminated food or water)
Rubella Virus spread via respiratory droplets Fever, rash, swollen glands
Malformations in babies of infected pregnant women
1 in 3000 will develop thrombocytopenia (bruising or bleeding)
1 in 6000 will develop inflammation of the brain
9 in 10 babies infected in the 10 weeks following conception (first trimester) will
have a major congenital abnormality
(continued)
9.5 Behavioural determinants: vaccination
Table 9.8 (Continued)
Impact on health and/or individual

Disease Method of transmission human development
Tetanus Bacteria (that live in soil, dust and Muscle spasms, inability to open the mouth, swallowing and breathing difficulties,
manure) enter the body through a break convulsions, abnormal heart rhythm, suffocation, respiratory failure, high or low
in the skin blood pressure
Heart attack
3 in 100 will die
Chickenpox Highly contagious virus Fever and rash
(varicella) Spread via respiratory droplets 3 in 100 000 patients will die
1 in 100 000 patients will develop encephalitis
Source: Adapted from Better Health Channel (www.betterhealth.vic.gov.au) and Immunise Australia (www.immunise.health.gov.au).
In Australia, the government provides free vaccines to children under the

National Immunisation Program. The routine schedule of vaccines for children in
Victoria is listed in table 9.9.
Table 9.9 National immunisation program schedule for Victoria, 2013
Age Diseases
Birth • Hepatitis B
• Diphtheria, tetanus, pertussis, hepatitis B,
poliomyelitis, Haemophilus influenzae type b
• Pneumococcal
2 months • Rotavirus
• Pneumococcal
• Pneumococcal
• Measles, mumps, rubella
• Haemophilus influenzae type b
12 months • Meningococcal C
• Measles, mumps, rubella
18 months • Chickenpox (varicella)
• Diphtheria, tetanus, pertussis, poliomyelitis
4 years • Measles, mumps, rubella
• Hepatitis B
• Chickenpox (varicella)
12–13 years • Human papillomavirus
10 –17 years • Diphtheria, tetanus, pertussis
on-immune women planning pregnancy
N • Measles/mumps/rubella
or shortly after delivery
Source: Department of Health 2013, National Immunisation Program Schedule, www.health.vic.gov.au.
The Australian government monitors the immunisation rates of children. It is

important for the majority of children to be immunised in order to ensure ‘herd’
immunity. Herd immunity means that if the vast majority of the community is
immunised, then those who are not immunised are unlikely to contract vaccine-
preventable diseases as there is no one to pass them on. In order to maintain herd
immunity, vaccine coverage needs to exceed 90 per cent of the population. In
2012, 91.6 per cent of children aged 12–15 months, 92.6 per cent of children aged
24–27 months and 91.9 per cent of children aged 60–63 months had completed
a full course of immunisation for their age. There are many reasons why parents
choose not to vaccinate their children against diseases. Some of these include:

• Complacency due to lack of experience of childhood illness. As the vast majority
of people have not experienced vaccine-preventable childhood diseases, the
possible effects of the conditions may be underestimated. Also, people may
believe that childhood diseases have been eliminated from Australia. As a result,
some parents may not consider vaccination as being important for the health
and individual human development of their children. High vaccination rates
within a country prevent diseases from re-emerging.
• Concerns regarding reduced immunity in the child as a result of vaccination. Vaccines
do not reduce a child’s immunity. The vaccines contain dead or weakened
versions of the disease that do not cause a full immune response.
• Religious reasons. Some religious groups have concerns about the ingredients
in vaccines. For example, gelatine is added to some vaccines to protect them
from changes in temperature that may affect the quality of the vaccine. Gelatine
is usually made from animals such as pigs. As a result, some members of the
Islamic or Jewish faiths may object to vaccination on the grounds that the
vaccines contain pork products.
• Concerns regarding the safety of the vaccines. Every vaccine used in Australia has
been tested for safety and effectiveness. Ongoing monitoring and evaluation
of vaccinations ensures their continued safety and effectiveness. The risks
of complications from childhood diseases are far greater than the risks
associated with immunisation. For instance, the risk of contracting encephalitis
(inflammation of the brain) from the measles, mumps, rubella (MMR) vaccine
is thought to be one in a million immunisations. In comparison, the risk of
encephalitis as a result of contracting measles is estimated as one in 200, with
a 10 per cent risk of death and a 40 per cent risk of permanent brain damage.
• Concerns that vaccinations can cause other disorders such as autism and diabetes and
increase the risk of SIDS. These concerns have been investigated and dismissed by
researchers.
• The belief that vaccinations do not work. It is true that some people will still
contract a disease even if they have been vaccinated against it. However, effective
vaccinations rates are relatively high. For instance, complete immunity occurs in
95 per cent of people vaccinated against polio and measles and 84 per cent in
people vaccinated against diphtheria.
When enrolling a child in primary school, parents are required to present their
child’s immunisation status certificate. This certificate lists the diseases the child
has been immunised against. Children who are not immunised are still allowed to
attend school. However, if there is a reported case of one of the diseases routinely
vaccinated against, then the unvaccinated children will be sent home until the risk
of infection passes.

1 In what ways can bacteria enter the body? 8 As a community health nurse, you are required
2 Outline the ways in which viruses can be spread. to write an article in a local newspaper trying to
3 Explain what vaccines are and how they protect the convince parents to ensure that their children are
body from infections. immunised. In your article, address some of the
4 Why is it important to vaccinate children during infancy? reasons why parents may choose not to immunise
5 List the diseases that children in Australia can be their children.
vaccinated against.
6 Explain why it is important to have at least 90 per
cent of the population vaccinated.
7 Explain two reasons why parents may choose not to
vaccinate their children.
9.6 ehavioural determinants: eating habits and level of
B
physical activity
KEY CONCEPT The impact of eating habits and levels of physical activity on the
health and individual human development of children
The eating habits of children and the amount of physical activity they are involved
in are largely determined by their parents. Eating habits are learnt early in life and
have a significant impact on health and individual human development during
childhood and in the later stages of the lifespan.
In order to promote optimal health and individual human development in
children, it is important to instil healthy food habits and encourage children to
participate in regular physical activity.
Figure 9.17 The eating habits of

children are largely determined by
their parents.
Eating habits
Healthy eating habits need to be established early in life. The nutrients needed and
the stage at which different foods can be introduced into the child’s diet will vary
according to the age group.
From birth to 6 months of age

From the time of birth, the infant is reliant on their parents for nutrition. For the
first six months of life, the nutrients required for growth and individual human
development are supplied either from breastmilk or from infant formula. Infants
usually increase in length by 50 per cent and weight by 300 per cent between birth
and one year of age.
From 6 months to 12 months of age

Solid foods should be introduced into the child’s diet at six months of age.
The baby needs protein, iron and a range of other nutrients from solid food to
supplement the nutrients that are received from breastmilk and/or infant formula.
Starting on solid foods also assists with the development of the teeth and jaw. The
child experiences different tastes and textures during this time, and it is important

that the food given to the child contains the required nutrients to promote health
and individual human development. While solid foods are being introduced into
the diet, the baby should continue to be breastfed or be given formula until at least
12 months of age.
The types of foods introduced initially should be pureed and smooth, such as:
• infant rice cereal mixed with breastmilk or formula
• mashed potato, pumpkin or carrot
• mashed fruit such as bananas
• cooked and mashed apples and pears.
As the child gets used to eating solid foods, more coarsely mashed foods can be
introduced, such as:
• minced red meat and chicken
• cereals such as rice, couscous and pasta.
Cow’s milk can start being added to cereal or food such as custard but should
not be introduced as the main drink until 12 months of age. Salt, other seasonings
and sweeteners (e.g. sugar) should be avoided so that the child does not acquire a
taste for them as they grow and develop.
Good nutrition and eating habits in children can be promoted by:
• Encouraging a wide variety of nutritious foods. All nutritious foods contain nutrients
that are important for the health and individual human development of children.
Therefore it is important for children to consume a wide variety of foods to
ensure the intake of the required nutrients.
• Introducing reduced-fat dairy products from two years of age. Reducing the amount
of fat in a child’s diet will reduce the risk of overweight and obesity.
• Offering mostly wholegrain breads and cereals, vegetables and fruits. Complex
carbohydrates in breads and cereals are required for energy and the dietary fibre
in breads, cereals, vegetables and fruits help to remove wastes from the body.
• Limiting the intake of oil, margarine and butter. Overconsumption of fats can
contribute to childhood overweight and obesity.
• Providing the child with fresh fruits and vegetables instead of processed snack foods.
Snack foods tend to be high in saturated fat and trans fats, simple carbohydrates
(sugars) and sodium (salt).
• Only occasionally offering treats such as cakes, chips and
takeaway foods.
• Limiting sweet drinks such as juices, cordials and softdrinks.
These are high in sugar and overconsumption can
contribute to childhood overweight and obesity.
Although all nutrients are important for the health
and individual human development of the child, it
is important for parents to pay particular attention
to including foods that contain the nutrients listed in
table 9.10.
Ensuring the consumption of breakfast is an
important consideration in the eating habits of children.
Eating breakfast gives children energy to get through
the day. It provides a significant proportion of the
day’s total nutrient intake and replenishes the body’s
supply of glucose. Without breakfast, a child may have
difficulty concentrating and learning, and may be left
with reduced energy levels for daily activities. Research
indicates that children who skip breakfast tend to weigh
Figure 9.18 The consumption of
more than those who consume breakfast daily. This may be due to the fact that nutritious foods is important for
hungry children tend to eat more high-fat, high-sugar foods during the day to the health and individual human
alleviate hunger as a result of skipping breakfast. development of children.
9.6 Behavioural determinants: eating habits and level of physical activity
Table 9.10 Important nutrients during childhood
Nutrient Examples of food sources Impact on health and/or individual human development
Carbohydrates Breads, cereals, rice, pasta, legumes, potatoes Production of energy required for growth and physical activity
Fats Monounsaturated — canola oil, olive oil, peanut oil and nuts Production of energy required for growth and physical activity
such as cashews, hazelnuts, peanuts and almonds Protection of organs
Polyunsaturated — fish and other seafood, polyunsaturated Regulation of body temperature
margarines, vegetable oils such as safflower, sunflower, corn
oils, nuts such as walnuts, brazil nuts and seeds Transportation of fat-soluble vitamins A, D, E and K
Note: Saturated fats (found in biscuits, pastries, full-fat dairy
products) and trans fats (found in baked products such as
pies, pastries, cakes and biscuits) should be limited in the diet
Protein Red meat, chicken, fish, beans, lentils, dairy products, seeds Growth and repair of all body cells
and nuts, soy products, wheat Development of brain cells, muscle, hormones, antibodies,
enzymes, hair and nails
Calcium Dairy products, sardines, fortified cereals Strong bones and teeth
Phosphorus Dairy products, red meat, fish, nuts, legumes, whole grains Strong bones and teeth
Iron Red meat, poultry, fish, green leafy vegetables, dried beans, Required for haemoglobin, which transports oxygen in
lentils, chickpeas, eggs, nuts the blood
Brain development
Vitamin A Liver, fish-liver oil, egg yolks, dairy products, darkly-coloured Required for night vision
orange or green vegetables (such as carrots, sweet potatoes Bone growth
and pumpkin), orange fruits (such as cantaloupe, apricots
and mangoes) Development of the immune system to fight infections
Growth and maintenance of skin
Development of the lining of the respiratory, urinary and
intestinal tracts to protect against harmful bacteria
Vitamin B1 Liver, yeast products, rice, wholemeal products, peanuts, Development of the nervous system, muscles and the heart
pork, milk Release of energy from carbohydrates
Assists with digestion
Vitamin B2 Milk, liver, yeast, cheese, green leafy vegetables, fish Promotes growth including skin, nails and hair
Eyesight
Metabolism of carbohydrate, fat and protein for energy
Vitamin B3 Red meat, poultry, fish, milk, wholegrain breads and Metabolism of carbohydrates and fat
cereals, nuts Tissue growth
Maintenance of healthy skin
Assists in the functioning of the nervous and digestive systems
Vitamin B6 Fish, bananas, chicken, pork, whole grains, dried beans Manufacture of red blood cells
Nerve growth
Vitamin B12 Liver, red meat, cheese, eggs Maintenance of nerve cells
Production of red blood cells
Metabolism of fat and protein
Folate Green leafy vegetables, poultry, eggs, cereals, citrus fruits Production of red blood cells
and legumes, fortified cereals
Vitamin C Citrus fruits, kiwi fruit, berries, tomatoes, cauliflower, Promotes the functioning of the immune system to protect
potatoes, green leafy vegetables, capsicum against viruses and bacteria
Wound healing
Promotes bowel activity
Promotes the lifespan of the cell
Prevents scurvy (characterised by fatigue, nausea, fever,
bleeding gums, slow-healing wounds, scaly and dry skin).
Vitamin D Cod-liver oil, sardines, salmon, tuna, full-fat milk products Strong bones and teeth
Note: The main source of vitamin D is sunlight
Source: Adapted from ‘Vitamins’, Raising Children Network, www.raisingchildren.net.au.

Eating habits of children and the Australian
Dietary Guidelines
In 2013, the National Health and Medical Research Council launched the revised
Australian Dietary Guidelines. These Guidelines provide advice about the amounts
and kinds of foods that people need to eat for health and wellbeing. Extensive
research and scientific evidence were used in the development of the Guidelines.
While the Guidelines are relevant to the general healthy population, specific
reference is made to children and adolescents.
AUSTRALIAN DIETARY GUIDELINES

GUIDELINE 1
To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks
to meet your energy needs.
• Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically
active every day and their growth should be checked regularly.
• Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.
GUIDELINE 2
Enjoy a wide variety of nutritious foods from these five food groups every day:
• Plenty of vegetables of different types and colours, and legumes/beans
• Fruit
• Grain (cereal) foods. mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles,
polenta, couscous, oats, quinoa and barley
• Lean meats and poultry, fish. eggs, tofu, nuts and seeds, and legumes/beans
• Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat
And drink plenty of water.
GUIDELINE 3
Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
a. Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers,
pizza, fried foods, potato chips, crisps and other savoury snacks.
• Replace high fat foods which contain predominately saturated fats such as butter, cream, cooking margarine, coconut
and palm oil with foods which contain predominately polyunsaturated and monounsaturated fats such as oils, spreads,
nut butters/pastes and avocado.
• Low fat diets are not suitable for children under the age of 2 years.
b. Limit intake of foods and drinks containing added salt
• Read labels to choose lower sodium options
among similar foods.
• Do not add salt to foods in cooking or at the table.
c. Limit intake of foods and drinks containing added
sugars such as confectionary, sugar-sweetened soft
drinks and cordials, fruit drinks, vitamin waters,
energy and sports drinks.
d. If you choose to drink alcohol, limit intake. For
women who are pregnant, planning a pregnancy
or breastfeeding, not drinking alcohol is the safest
option.
GUIDELINE 4
Encourage, support and promote breastfeeding.
GUIDELINE 5 Figure 9.19 The Australian Dietary Guidelines make specific reference

Care for your food; prepare and store it safely. to children.
Source: National Health and Medical Research Council, Australian Dietary Guidelines Summary, 2013, page 5.
9.6 Behavioural determinants: eating habits and level of physical activity
As parents are the ones who often choose and purchase the foods that are consumed
in children’s diets, it is important that they have the information required to ensure
that their children are consuming the right amount of the required nutrients and
not overconsuming nutrients such as saturated fat, simple carbohydrates and
sodium as these can contribute to the development of illness/disease such as obesity,
cardiovascular disease and type 2 diabetes.
Most Australian children require more:
• vegetables and fruit, particularly green, orange and red vegetables, leafy
vegetables and legumes/beans
• grain foods, particularly wholegrain cereals
• reduced fat milk, yoghurt and cheese (reduced fat milks are not suitable for
children under the age of two years as their main milk drink)
• water rather than soft drinks, energy drinks, sports drinks and sweetened fruit
juices.
Most Australian children need to consume less:
• meat pies, sausage rolls and hot chips
• potato chips, savoury snacks, biscuits and crackers
• processed meats
• cakes, muffins, sweet biscuits and muesli bars
• confectionery and chocolate
• ice-cream and desserts
• cream and butter
• jam and honey
• soft drink, cordial, sports drinks, energy drinks.
Level of physical activity

The National Physical Activity Guidelines outline the minimum levels of physical
activity required in order to gain a health benefit. For children between the ages of
5 and 12, it is recommended that they participate in at least 60 minutes of moderate
to vigorous intensity exercise daily. Examples of moderate activities include brisk
walking, bike riding or any form of active play. More vigorous activities include
those that increase heart and breathing rates such as football, netball, ballet, running
and swimming. The guidelines also recommend that children do not spend more
than two hours a day on activities using electronic media such as computer games,
TV or the internet.
Regular physical activity has a range of benefits for the health and individual
human development of children as outlined below.
• Benefits of physical activity to the health of children:
–– improves cardiovascular fitness
–– develops and maintains flexibility
–– helps with relaxation
–– improves self-esteem
–– provides opportunities to make friends
–– helps achieve and maintain a healthy weight.
• Benefits of physical activity to the individual human development of children:
–– builds strong bones and muscles
–– promotes growth
–– improves balance and motor skills
–– improves posture
–– develops sensory systems such as sight and hearing
–– develops social skills (e.g. leadership, communication and teamwork)
–– increases knowledge (e.g. learning the rules of games).

Consuming nutritious foods and participating in regular physical activity reduces
the risk of childhood overweight and obesity. By balancing the energy intake from
food consumption with the energy expended through physical activity, healthy
body weight can be maintained. Therefore, food consumption and levels of physical
activity must not be viewed separately but considered together in relation to their
impact on the health and individual human development of children.
Figure 9.20 Regular exercise

is important for the health and
individual human development of
children.
TEST your knowledge 5 Why is it important for children to consume

breakfast daily?
1 Why is it important to develop healthy eating
6 What are the benefits of physical activity for each
patterns early in life?
dimension of health and the different types of
2 Explain the relationship between food intake and
physical activity in maintaining body weight. individual human development of children?
3 Outline the importance of the following nutrients
to the health and individual human development of
children: 7 Taking into account the nutrient content of a
(a) complex carbohydrates range of foods, provide an outline of a daily diet
(b) protein that you would recommend for a three-year-
(c) fats old child. Justify the foods you would include in
(d) iron the diet.
(e) calcium 8 Prepare a brochure for mothers outlining the
(f) B-group vitamins (Vitamins B1, B2, B3, B6, B12). types of foods that are recommended for children.
4 In order to optimise the health and individual Include a range of physical activities that would be
human development of children, what types of appropriate for children, and an explanation of the
foods should be consumed? What types of foods importance of balancing food intake with physical
should be avoided? Outline the reasons why. activity.
9.7 Behavioural determinants: oral hygiene
KEY CONCEPT The impact of oral hygiene on the health and individual human
Oral hygiene
Oral hygiene is the practice of keeping the mouth clean in order to
prevent bad breath and maintain healthy gums and teeth. Dental
decay is the most common disease that affects teeth. Plaque is a
sticky film that forms on teeth. It contains bacteria that change
sugars into acids, resulting in cavities (i.e. caries, or holes) in the
teeth (figure 9.22). A build-up of plaque on the teeth can also lead
to gum disease — initially gingivitis which, if left untreated, can
progress to periodontitis. Gingivitis is the early stage of gum disease
where plaque builds up and becomes hard mainly on the area where
the gum line meets the tooth. Symptoms of gingivitis are bleeding,
redness and swelling of the gum. Periodontitis is advanced gum
disease in which the edge of the gum that meets the tooth becomes
weakened, allowing bacteria to penetrate beneath the gum line.
This causes an inflammation in the structures below the gum line,
affecting the root of the tooth, the bone and the fibres that connect
the tooth to the bone. If left untreated, the eroded bone causes
space between the gum and teeth. Periodontitis results in bleeding,
swelling, receding gums, bad breath, a bad taste in the mouth and
loose teeth. The teeth can fall out if the condition is not treated.
Oral hygiene during early childhood is vital for ensuring the
health of teeth and gums and teaches children the daily routines
required to ensure optimal dental health. Cavities can occur in
children as young as six months of age if the appropriate dental care
is not followed. Baby teeth have a thinner enamel coating that can
result in decay being able to penetrate to the middle of the tooth.
Figure 9.21 Good oral hygiene helps This can be extremely painful and, if left untreated, can result in a
to prevent dental decay and gum
disease.
pus-filled abscess. The abscess can damage the permanent teeth that
are developing underneath the baby teeth. As baby teeth guide the
permanent teeth into position, losing them early as a result of decay
can result in reduced spaces between the teeth and thus the child
may require orthodontic care later in life. Poor oral hygiene
and decayed teeth can affect the individual human
development of children by interfering with speech
development and the shaping of the jaw.
Dental decay during childhood may present as the
following:
• a dull white band along the gum line as a result of plaque
build-up. The bacteria in plaque convert sugar to acids
that dissolve minerals in the tooth enamel. If left untreated,
this can result in cavities.
• a yellow, brown or black ring around the teeth. This is the
beginning of cavities.
• teeth that appear as brownish-black stumps. This is the
advanced stage of cavities.
When dental decay and cavities become severe and painful,
Figure 9.22 Plaque that builds up on they can interfere with the daily life of the child. The pain
teeth can cause cavities. may be so severe that it may prevent the child from going to

school. If the child is unable to chew or eat because of the pain, then they may lose
weight or develop nutritional deficiencies. Dental decay and the unnecessary loss
of teeth can impact significantly on the self-esteem of children, which may cause
them to withdraw from social activities due to feeling self-conscious about how
they look.
Promoting oral hygiene

The inappropriate use of feeding bottles can cause dental cavities. Infants should
not be encouraged to use the bottle as a dummy once asleep, or be given fruit
juices or sweet drinks in a bottle. Breastfeeding significantly reduces the risk of
dental cavities. If a child is to be bottle fed, the following should be done:
• Remove the bottle once the child has had enough.
• If the child uses the bottle for comfort, use cooled, boiled water instead.
• Encourage the use of a feeding cup when the child is developmentally ready.
• Encourage the child to drink water instead of fruit juices and sweet drinks.
Tooth brushing should start as soon as the first tooth appears. Initially, a soft cloth
can be used to wipe the front and back of each tooth. A soft toothbrush should be
introduced as soon as the child can cope with it, usually around 12 months of age.
Low-fluoride toothpaste can be used at approximately 18 months of age. Fluoridated
water helps to protect against dental cavities because fluoride reduces the amount of
acid produced in the mouth as well as helping to repair any damage to the teeth
before it progresses. It is recommended that a child have two dental checks before
the age of three and a half to ensure early detection of any dental problems. Beyond
the age of three and a half, the recommendation is six-monthly visits to the dentist.
The application of dental sealants by the dentist can help prevent tooth decay.
Sealants are clear or white plastic coatings that bond to the surface of the teeth and
block the small grooves, thereby reducing the risk of dental decay.
The consumption of a healthy diet with minimal sugary substances also helps to
prevent cavities and ensures good oral hygiene.

1 What is oral hygiene and why is it important for 5 Develop a one-page handout outlining the
the health and individual human development of importance of ensuring good oral hygiene in
children? children.
2 What is plaque, and how does it increase the risk of 6 Develop a health promotion media advertisement
dental cavities? that focuses on good oral hygiene for primary
3 Outline the difference between gingivitis and school students.
periodontitis.
4 How can dental decay be prevented in children?
9.8 hysical environment determinants: tobacco smoke in
P
the home
KEY CONCEPT The impact of tobacco smoke in the home on the health and
The physical environment refers to the surroundings in which a child lives and the
accessibility to resources such as housing, water, health services and recreational
facilities. It also refers to the environmental conditions in which a child lives that
impact on health and individual human development. For example, an asthma
sufferer who lives in an area that has a high degree of air pollution may have a
greater frequency of asthma attacks compared to an asthma sufferer who lives in
an area with lower pollution levels. There are many factors within the physical
environment that impact on the health and individual human development of
children including tobacco smoke in the home, housing environment, fluoridation
of water and access to recreational facilities.

Tobacco contains approximately 4000 different chemical substances, with at least
250 of these being found in second-hand smoke. The smoke that is exhaled from
a smoker or is emitted from the tip of a burning cigarette is called environmental
tobacco smoke. Passive smoking, which is the inhaling of environmental tobacco
smoke, is particularly dangerous for children because their lungs are still developing.
Environmental tobacco smoke exposes non-smokers to most of the same toxic
gases, chemicals and fine particles that smokers inhale directly when they smoke
tobacco. In the unfiltered smoke that comes from the tip of a burning cigarette, the
particles can be finer and more concentrated, which means they can be inhaled
deeper into the lungs and stay longer in the body of the passive smoker compared
to the person who is smoking.
For children who live in a home where one or more people smoke, their health
and individual human development may be affected in the following ways:
• increased risk of asthma and other serious chest infections such as bronchitis,
bronchiolitis and pneumonia
• greater likelihood of symptoms such as coughing, phlegm, wheezing and
breathlessness
• slower lung growth
• increased risk of meningococcal disease
• reduced immunity
• increased risk of middle-ear infection (otitis media), which may lead to hearing
loss
• increased risk of SIDS in the first year of life
• a tendency to be shorter than average at all ages
• a tendency to be absent from school more often
• lower level of lung function during childhood (decreased capacity to breathe
deeply).
Passive smoking has also been linked to the development of childhood cancers
such as leukaemia, brain cancer and lymphoma.
Environmental tobacco smoke can affect the unborn child if a mother smokes
or is exposed to environmental tobacco smoke during pregnancy. The harmful
substances in the tobacco smoke can be transported to the unborn child via
the mother’s blood stream. Exposure to environmental tobacco smoke during
pregnancy can lead to miscarriage, low birth weight and Sudden Infant Death
Syndrome (SIDS). Research has indicated that the babies of mothers who smoke
during pregnancy and after birth have more lung disease during the first year of life
and have double the risk of serious airway infections.

It is estimated that children of parents who smoke inhale approximately the
same amount of nicotine as they would if they actively smoked 60–150 cigarettes
a year. Children who are exposed to environmental tobacco smoke are 40 per cent
more likely to suffer from asthma symptoms as compared to children who are not
exposed to environmental tobacco smoke. Approximately 8 per cent of childhood
asthma in Australia is attributable to passive smoking.
TEST your knowledge 4 What percentage of childhood asthma can be

attributed to passive smoking?
1 Why is passive smoking particularly dangerous to
children?
2 Explain the impact that exposure to tobacco smoke
in the home can have on the health and individual 5 Develop a health promotion poster, commercial
human development of children. or blog outlining the risks of tobacco smoke in
3 Outline the impact that exposure to tobacco smoke the home to the health and individual human
in the home can have on the unborn child. development of children.
9.9 hysical environment determinants: housing
P
environment and fluoridation of water
KEY CONCEPT The impact of the housing environment and fluoridation of water
on the health and individual human development of children
Housing environment
Housing environment plays a significant role in the health and individual human
development of children. Ideally, a house provides shelter and a clean place in
which to live, and protects children from the outside environment, including any
physical dangers. However, some families are required to live in substandard or
overcrowded dwellings due to low income. This can put family members at greater
risk of poor health.
Overcrowding puts increased stress on water supplies (bathroom, kitchen
and laundry) and sewerage disposal systems, and forces people to live in close
proximity in the home environment. All these factors can result in the spread of
infectious diseases such as meningococcal, meningitis, septicaemia, tuberculosis,
rheumatic fever, respiratory conditions and skin infections.
Figure 9.23 Overcrowded living
conditions can have a significant
Prolonged periods of ill-health can impact on the health and individual human
impact on the health and individual development of children (figure 9.24). A child who is ill is less likely to be engaged
human development of children. in physical activity, so motor skills may not develop according to the child’s
potential. The child may not be able to socialise with other children, thereby
affecting the capacity to develop social skills. This also reduces the opportunities
for the child to develop emotionally through interaction with others. Continued
absence from school may hamper the intellectual development of the child.
Intellectual development may also be affected by the overcrowded living conditions
as the child may not have the space to concentrate on schoolwork.
Child less likely to Continued absence

participate in physical Overcrowding from school
activity Prolonged Limited opportunities
Limited opportunities ill-health for intellectual
for motor skill from infectious development
development diseases
Child less likely to

Figure 9.24 The impact of socialise with other children
overcrowding on the health and Limited opportunities for emotional
individual human development of and social skill development
children
Homelessness has significant impacts on the health and individual human

development of children, as children who are homeless are at greater risk of ill-
health. Homelessness has been linked to increased rates of gastroenteritis and a
range of respiratory conditions such as bronchitis and asthma.
Homeless children are at a greater risk of physical and sexual assault, as well as
having insufficient and unhealthy food, and inadequate shelter. All of these factors
can impact on the health and individual human development of the child. For
instance, children who are physically or sexually abused may experience irreparable
damage to their body. An example of this might be damage to the growth plate
in bones, which affects bone growth. Such abuse may have a negative emotional
effect, hampering the child’s capacity to trust others and form relationships. The
child may also lose interest in school, thereby affecting intellectual development.

Safety in the home
Approximately 260 children die and 58 000 are hospitalised every year due to
unintentional injury in Australia. This means that more Australian children die
of injury than die of cancer, asthma and infectious diseases combined. Ensuring
safety within the home is vital for promoting the health and individual human
development of children. According to Kidsafe, most injuries in children under
6 years of age occur at home.
Some of the major concerns within the home environment are:
• drowning in the backyard swimming pool, garden water features, baths or nappy
buckets
• access to cleaning products, medicines, chemicals and plants in the home that
can cause poisoning
• falls from change tables, strollers, bunk beds and playground equipment such as
slides, monkey bars and cubby houses
• tripping over toys and tools left lying around
• falls from verandas or stairs, or out of windows
• burns and scalds
• choking
• dog bites.
How safe are our homes? 4 Child resistant catches fitted to cupboards where dangers
Serious injuries to children under 6 years of age occur in the like medicines, cleaners, matches and lighters are stored.
place you’d think they would be safest — their own home. Why?
Try checking your home against the following list of home Young children are curious and don’t understand danger.
safety features: Telling them ‘not to touch’ is not enough to keep them safe.
1 Pools (and spas) that are fully fenced, with well Dangerous products and cleaning products need to be stored
maintained, self-closing gates. away safely.
Why? 5 Install smoke alarms, test them regularly and change the
Young children drown quickly and silently. Around 33 children battery once a year.
under five drown each year in Australia in unfenced pools or Why?
pools with poorly maintained fences or gates. House fires continue to claim Australian lives every year. The
2 Hot water from bathroom taps set at a delivery correct smoke alarms correctly positioned provide a warning
temperature of 50 ºC. that may be critical to survival.
Why? 6 Play areas fenced off from the street and the driveway.
Hot water burns like fire. Many Australian homes have hot Why?
water coming from their taps at temperatures that can burn a Cars and kids don’t mix. Young children have no fear of cars
child’s skin in one second. and are not easily seen by drivers. Every month a toddler is
3 Barriers such as gates on stairs, window latches and killed after being reversed over in a driveway.
fireguards in place to keep children from hazards. Kidsafe estimates that if these six features were in place in
Why? all Australian homes, they would help prevent more than half
Falls down stairs, off furniture and out of windows are of all home injury deaths among children under six and spare
common and because young children are ‘top heavy’, head thousands of children from disability from preventable injuries.
injuries can often occur. Source: www.kidsafe.com.au.
Fluoridation of water
Fluoride is a natural mineral found in food, water, plants and toothpaste. The
fluoridation of water involves adding fluoride to a public water supply to reduce
tooth decay in the population. It is a safe and effective way of reducing the risk
of tooth decay in people of all ages. Tooth decay occurs when acid is produced by
bacteria in the mouth. Fluoride reduces the amount of acid that is produced and
can also repair the damage to teeth before it progresses and becomes permanent.
In fluoridated areas of Victoria, six-year-old children experience 36 per cent less
decay in their baby teeth than those in areas without access to fluoridated water,
according to the Victorian government. Likewise, 12-year-old children living in
9.9 Physical environment determinants: housing environment and fluoridation of water
areas with ready access to fluoridated water have 22 per cent less decay in their
permanent teeth compared to those living in non-fluoridated areas.
The vast majority of the Australian population has access to fluoridated water.
By 2008, every capital city in Australia (except Brisbane) had implemented water
fluoridation. Table 9.11 outlines the percentage of the population with access to
fluoridated water according to state/territory. Melbourne has had fluoride added to
drinking water for over 30 years. In Queensland, water fluoridation started being
phased in from December 2008, however in 2012 the Queensland Government
changed laws that required larger communities to add fluoride to their water
supplies. As a result, councils were given the right to decide if fluoride should be
added to water.
Table 9.11 Populations with access to fluoridated drinking

water, 2010
State/territory Per cent of population
NSW 94
Vic. 90
Qld 80
WA 92
SA 90
Tas. 83
ACT 100.0
NT 70
Source: Australian Institute of Health and Welfare 2012, Australia’s
health 2012, cat. no. AUS 156, Canberra, p. 145.
Figure 9.25 Fluoride in drinking

water is a safe and effective way of Fluoridated water has numerous benefits for the health and individual human
reducing the risk of tooth decay. development of children as it:
• protects against tooth decay
• repairs weak spots on the surface of the tooth, thereby preventing cavities
• reduces the amount of money spent on dental treatment, which can then be
used for other health-promoting resources such as nutritious food
• reduces the time away from school for dental treatment
• reduces the pain associated with dental decay.
The consumption of fluoridated water, along with good nutrition and appropriate
oral hygiene, helps protect children’s teeth by reducing the risk of dental decay and
subsequent tooth loss. Children’s first teeth play an important role in the digestion
of food and in reserving spaces for the second, permanent teeth. If a child has
missing teeth, especially those at the front of the mouth, they may experience
difficulties with speech development. Healthy teeth create a healthy smile, which
help children feel good about how they look to others.
In spite of the well-documented evidence that fluoride promotes the health and
development of teeth, there are a number of myths associated with fluoride that
has resulted in people not wanting fluoridated water. Some of these myths include:
• Myth: Fluoride causes cancer.
• Fact: Cancer rates in Australia generally are no higher than in Queensland,
where fluoridated water was only made available to parts of the state in 2008.
• Myth: Fluoride causes allergies.
• Fact: Fluoride is found naturally in most foods and water, and no connection
has been shown between fluoridation and allergies.
• Myth: Fluoride causes arthritis.
• Fact: The incidence of arthritis does not differ between fluoridated and non-
fluoridated areas.

• Myth: Water fluoridation is banned in Europe.
• Fact: No country has banned water fluoridation. The large number
of water sources in Europe makes fluoridation impractical.
• Myth: Fluoride causes bone fractures.
• Fact: All Australian capital cities (except Brisbane) have been
fluoridated for decades and have not shown any increase in bone
fractures.
• Myth: Water fluoridation is bad for babies.
• Fact: Water fluoridation has been endorsed by the World Health
Organization and the Australian Medical Association, and no
known health risks to babies have been detected.
• Myth: Water fluoridation causes excessive dental fluorosis (white
marks on the teeth).
• Fact: A slight increase has been seen in dental fluorosis levels but
it is usually barely detectable. Fluorosis does no real damage to
teeth — unlike tooth decay, which can be painful, unsightly and
expensive to repair. Figure 9.26 There are many myths
about the dangers of fluoridated
water, but it is well documented that
fluoride promotes the health and
development of teeth.

1 Explain the relationship between overcrowded 6 Research information regarding the impact of
housing and ill-health. homelessness and complete the following: As an
2 How does homelessness impact on the health and advocate of human rights, write a letter to the
individual human development of children? government outlining the issues associated with
3 What are the benefits of fluoridating water? poor housing/homelessness and the health and
4 How long has Melbourne been fluoridating its individual human development of children. Provide
water supply for? suggestions about how the government could
5 Explain three myths associated with fluoridated address these issues.
water and why they have been discarded. 7 As a local government official, you are required to
write an article for the local newspaper outlining
the importance of fluoridating water for the health
Include possible reasons why people do not want
their water fluoridated and provide a persuasive
argument for fluoridating water.
9.10 hysical environment determinants: access to
P
recreational facilities
KEY CONCEPT The benefits of providing access to recreational facilities for the
health and individual human development of children

Access to recreational facilities has a significant impact on the health and individual
human development of children. Recreational facilities that are easily accessible for
families with children greatly increase the likelihood of regular physical activity
being undertaken. Participating in regular physical activity has enormous benefits
for the child. Children who are active will generally:
• have stronger muscles and bones
• have greater cardiovascular endurance
• be less likely to be overweight
• have a decreased risk of developing type 2 diabetes
• have a happier disposition and develop positive relationships with others
• have better sleep patterns
• be more capable of handling physical and emotional challenges
• be able to cope more effectively with stress and anxiety
• have higher levels of self-esteem
• have improved concentration.
The promotion of active play provides children with the opportunity to engage
in physical activity that is vital for establishing healthy behaviours. Active play is
basically physical activity with regular bursts of moderate to vigorous pace, such as
playing in a playground where children run from one piece of equipment to
another. Structured play is organised and involves rules, time limits and special
equipment. Examples of structured play include play group, gym classes and
swimming lessons. Unstructured play is often spontaneous and less restricted, such
as allowing a child to play freely in a playground.
The international guidelines for the daily amount of play for different ages are:
• toddlers — at least 30 minutes of structured physical activity and at least one
hour of unstructured physical activity
• pre-schoolers — at least 60 minutes of structured physical activity and at least
one hour of unstructured physical activity
• children (aged 5–12) — at least 60 minutes of moderate
to vigorous physical activity. The activity does not have
to occur in one session but can be accumulated in short
bursts throughout the day.
In the 12 months to April 2009, 63 per cent of children
aged 5–14 years participated in organised sport or dancing
according to the Australian Bureau of Statistics. The 2007
Australian National Children’s Nutrition and Physical
Activity Survey found that 74 per cent of children aged
9–14 years met the National Physical Activity Guidelines
for moderate to vigorous physical activity.
The state government department, Sport and Recreation
Victoria, is responsible for allocating funds for the
development of recreational facilities. The government
recognises the importance of providing facilities at a local
community level in promoting healthy lifestyles for all
Australians, both in urban and rural communities. As a
result of this funding, local communities are able to offer
Figure 9.27 Undertaking regular physical activity has enormous a range of facilities from sporting grounds and stadiums to
health and development benefits for children. parks and playgrounds.

Case study
Casey Fields a sports venue The kids’ fishing day also attracts 1000 young people
each year.
for everyone Casey Fields is also the venue for the annual Access
for All Abilities Sports carnival, catering for up to
By Nadja Poljo
300 children and adults with a disability.
Casey Fields has hosted a raft of memorable events and It has proven to be a vital sporting facility providing
activities since its opening in February 2006. opportunities from both a participatory and spectator
In March 2007, the first AFL NAB Challenge Match perspective.
attracted more than 10 000 people who came to watch The development of the regional playground, village
Essendon versus Hawthorn. green, fishing lake and walking paths now ensure it
The development of the Casey Campus has seen also offers a broad range of leisure opportunities for
the site play host to a number of events involving the residents.
Melbourne Football Club, including interclub practice Future plans for the fields include the development of
matches and regular training sessions, attracting up to the Casey Fields Soccer Centre of Excellence featuring
4000 people. four synthetic pitches and a pavilion with a capacity of
Last year, it played host to Premier Cricket finals 3000.
for the first time, featuring the Casey South Melbourne Plans are also well under way for a social club near
Cricket Club. the entrance and a pavilion to service the existing rugby
One of the most memorable moments at the fields league fields.
was the Dandenong and District Junior Football League Source: Berwick Leader, 23 February 2011.
finals last year, featuring 21 grand finals and attracting
more than 12 000 spectators.
Case study review

1 List the different types of activities that occur at Casey Fields. Which activities are
particularly relevant to children?
2 Explain how the recreational facilities outlined in the article can promote the
health and individual human development of children within the City of Casey.
3 Casey Fields ‘has proven to be a vital sporting facility providing opportunities
from both a participatory and spectator perspective’. What are the benefits to the
health and individual human development of children of being a ‘spectator’?

1 Outline five benefits of physical activity to children. 5 Research information regarding the importance of
2 What are the guidelines on the amount of physical physical activity for children, and develop a poster
activity for toddlers, preschoolers and children? encouraging parents to involve their children in
3 What percentage of children aged 9–14 met the recreational and sporting activities. Refer to the
National Physical Activity Guidelines in 2007? importance of physical activity for the health and
4 Who is responsible for the funding of community individual human development of children.
recreational facilities? 6 Investigate the recreational facilities available in your
local community. Create an information brochure
outlining the facilities available, types of activities
offered and the benefits of physical activity to
the health and individual human development of
children.
9.11 S ocial environment (family) determinants: parental
education
KEY CONCEPT The impact of parental education on the health and individual
The social environment refers to the social factors children are exposed to that
affect their health and individual human development. Social factors within families
are an important influence on the health and individual human development of
children, and include parental education and parenting practices. Social factors
that influence the health and individual human development of children may also
lie outside the family, such as the media and access to health care.
Parental education
A person’s level of education is a key determinant of their
employment, which is in turn directly linked to their
level of income. In general, higher levels of education
increase opportunities for higher-paid employment and
therefore a higher socioeconomic status.
Parental education refers to both the formal level
of education that is achieved by parents (e.g. through
tertiary qualifications) and the level of knowledge that
may be attained through more informal means (e.g. by
reading newspapers or watching television).
Education enables parents to gain the knowledge
and skills needed to promote the health and individual
human development of their children. Higher levels of
education provide parents with a greater understanding
Figure 9.28 Parental education is of health, particularly of health risks and protective factors. Therefore parents with
a key determinant of employment higher levels of education will tend to have a greater understanding of the factors
status and income. that impact on the health and individual human development of children (e.g.
nutrition, physical activity and vaccination). This is particularly true for mothers,
who are traditionally the caregivers of the family.
Formal qualifications provide opportunities for better employment and higher
income, which enable individuals to have a healthier lifestyle and greater access
to health-promoting resources such as nutritious foods and health care. This has a
significant effect on children because parents are responsible for the provision of
resources that are necessary for health and individual human development.
Parental employment status and occupation

Parental employment status has a significant impact on the health and individual
human development of children. Between 1997 and 2007, the proportion of
Australian families with dependent children (aged 0–24) that had at least one
parent employed increased from 82 per cent to 94 per cent, and for one-parent
families, employment rose from 47 per cent to 59 per cent. Children who
do not have a parent in paid employment may be living in a stressful home
environment due to financial strain. This may cause hostility and tension
between parents and children, which may result in the children feeling unloved
and unsupported, thereby impacting negatively on their social and emotional
development. Long-term unemployment (12 months or more) is linked to
increased rates of depression, which may affect a parent’s capacity to meet the
needs of the child. Children in this situation may be at risk of ill-health, including
mental health problems. Lower educational attainment is often seen in children
from low-income backgrounds.

The type of occupation in which a parent is employed
can also affect the family household.
Higher levels of education provide
adults with greater choices in their
occupation. This increases the
likelihood that they will be
employed in positions they find
stimulating and rewarding. Their
family environment is more likely
to be harmonious and supportive
as a result, and this has a positive
impact on the health and individual
human development of children.
The level of income of parents
is dependent on their employment
status and occupation. The income
level of parents can determine
the economic security of families,
which can have a significant impact
on the health and individual
human development of children. Figure 9.29 Occupation affects the
According to the Australian Institute of Health and Welfare (AIHW) report Australia’s level of income, which in turn can
health 2008, those on higher incomes generally have higher levels of health and live influence the health and individual
longer than those people with a lower income. human development of children.
Economic hardship that may arise from unemployment or low income can have a
debilitating effect on children. Low income can negatively affect a child’s nutrition,
access to medical care, the safety of their environment, the level of stress in the
home, and the quality and stability of care.
Socioeconomic status refers to the social status of an individual or family, and
depends on the level of education, occupation and income of family members.
The 2004–05 National Health Survey (NHS) found that people from lower
socioeconomic backgrounds were ‘more likely to smoke, be overweight and/or
obese, and have fewer or no daily serves of fruit’. Because parents are role models for
children and are a significant influence in shaping their health-related behaviours,
there is an increased risk of children from lower socioeconomic status backgrounds
adopting the negative health behaviours of their parents.

1 Explain the relationship between education and 4 Explain how low income can affect a child in
the health and individual human development of terms of:
children. (a) level of nutrition
2 How can the long-term unemployment of one or (b) access to medical care
both parents impact on the health and individual (c) the safety of the environment
human development of a child? (d) the level of stress in the home
3 Explain the importance of parents as role models (e) the quality and stability of care.
in the promotion of health and individual human
development.
9.12 S ocial environment (family) determinants:
parenting practices
KEY CONCEPT The impact of parenting practices on the health and individual
Parenting practices
Parenting practices refer to the way in which the parents or guardians interact with
their child and how they model behaviour. It incorporates the type of discipline
that is used and the way in which the parent/guardian responds to the child in
different situations. Parents and guardians have an enormous impact on the social
development of children, particularly in the following areas:
• teaching respect for others
• developing effective means of communication
• learning values
• learning appropriate behaviours
• learning how to cooperate effectively with others
• being empathetic towards others.
Parents/guardians of children tend to adopt a particular parenting style, and this
can have an impact on the health and individual human development of the child.
The four main types of parenting styles are:
• Authoritarian parenting style. Authoritarian parents/guardians
tend to use direct parenting styles with an overemphasis on
discipline and little or no opportunity for decision making by
the child. Authoritarian parents/guardians can be intimidating,
with an expectation of obedience and respect. Expectations are
not explained but simply demanded of the child, and the parent/
guardian will become angry and forceful if the expectations are not
met. Authoritarian parents/guardians may feel threatened by the
emerging independence and individuality in the child. Research
has shown that children who have been raised by authoritarian
parents/guardians tend to be more withdrawn, anxious and
discontented, with lower self-esteem and less trust in others.
• Authoritative parenting style. Authoritative parents/guardians
tend to provide fair discipline while also catering for the self-
esteem needs of the child. They have high but not unrealistic
expectations, and effectively communicate these to the child.
Good behaviour is rewarded with positive encouragement
and reinforcements. Authoritative parents set limits and
implement fair disciplinary measures if these are breached. They
acknowledge and respond to a child’s individuality and support
the child’s developing independence. Children who have had
an authoritative upbringing tend to be more self-reliant, self-
Figure 9.30 Parenting practices refer controlled and happy. They usually have a wide social network
to the way in which parents interact of friends, perform better in school and have higher self-esteem.
with their children. • Permissive parenting style. Permissive parents/guardians tend to overemphasise
the self-esteem needs of the child and fail to discipline the child when required.
They have very little or no expectations of the child and will usually ignore
obnoxious behaviour. Permissive parents give in to their child’s demands, thereby
reinforcing the demanding and inconsiderate aspect of the child. They do not set
rules or limitations, and their love and support of the child is unconditional.
Children who have been raised in a permissive environment tend to be more
immature, demanding and dependent. They may have social issues arising from
a tendency to blame others for their problems.

• Uninvolved parenting style. Uninvolved parents/guardians tend to be neglectful,
unresponsive and uncommunicative. They make sure that their children’s basic
survival needs are met but they remain emotionally detached from their children
and the whole parenting experience. As a result of this style of parenting,
children may have issues with cognition, attachment and the development of
emotional and social skills.
High
restrictive punitive promotion
strict
negotiation of boundaries
parenting
autocratic parent-centred independence
explanation
Behavioural control; demandingness

adherence expectation assertive balanced
to rules of supportive parenting
non-negotiable obedience discussion
Acceptance, responsiveness, supportiveness
Low High
lack of support child lack of boundaries
few demands no controls in charge indulged no demands
lack of expectation
lack of distant lack of over-involved
encouragement warmth spoilt
lack of
neglectful no direction
emotional withdrawal control
Low
Figure 9.31 The four styles of parenting
Some children may live in situations where the

parents/guardians use abuse as a part of their parenting
practices. Children who are subjected to regular acts of
abuse by their parents/guardians are at greater risk of
emotional and behavioural problems when compared
to other children.
There are four categories of abuse:
• physical — when the parent/guardian hurts their
child by hitting, slapping, shoving, pushing, biting,
kicking or burning
• verbal — when the parent/guardian yells mean and
hurtful things at their child, scaring or threatening
them
• sexual — when the child is touched in a sexual way
or forced to have sex
• neglect — when the parent/guardian hurts the child
by not providing care, food, clean items, safety,
clothing, love and support. Figure 9.32 Verbal abuse is a form of family violence.
9.12 Social environment (family) determinants: parenting practices
The effects on children exposed to abuse can be short and long term. Short-term
effects include the child:
• blaming themselves for the situation
• having sleeping difficulties
• regressing to earlier stages of development such as bedwetting and thumb
sucking
• being anxious or fearful
• displaying aggressive or anti-social behaviour
• isolating themselves from people
• not attending social or school events
• becoming a victim or perpetrator of bullying
• being cruel to animals
• suffering from stress-related illnesses such as headaches and stomach cramps
• displaying speech problems such as stuttering
• misusing drugs and alcohol.
The long-term effects of exposure to abuse may result in the child growing up to
be an abusive person from learning to solve problems through the use of violence.
From witnessing the violent behaviours of their adult role models, children may
grow up to behave in destructive ways in their own adult relationships.
Drug and alcohol dependence in parents/guardians may leave them unable to
appropriately care for their children, who may be hurt or neglected as a result of
the addiction. For parents/guardians in this situation, the need for drugs or alcohol
may take priority over looking after their children’s needs. Children growing up
with parents/guardians with a drug and/or alcohol dependency may:
• lack the essential nutrients required for growth and development
• have difficulties at school
• encounter learning problems
• develop emotional problems due to stress or anxiety
• lack trust in adults
• be at increased risk of mental illness or suicide in later life
• be at increased risk of substance abuse.

1 (a) What are the four main parenting styles? 5 Explain how each parenting style (authoritarian,
(b) Explain how each parenting style can impact on authoritative, permissive and uninvolved) would
the health and individual human development of approach the following case studies:
a child. (a) Lachlan is eleven years old. His parents have
2 Outline the four categories of abuse. recently found out that he has not been handing
3 List the possible short-term effects on the health of in his homework.
a child as a result of exposure to violence. (b) Maria is eight years old. She constantly argues
4 What are the possible effects of a parent’s or with her younger brother and sister.
guardian’s drug dependence on a child’s health and (c) Benjamin is five years old. He refuses to pay
individual human development? attention to his mother and ignores her
instructions.
(d) Melanie is six years old and refuses to eat any
fruit or vegetables. Her diet consists of chicken
nuggets, chips and pasta.

9.13 Social environment (community) determinants: media
KEY CONCEPT The impact of media on the health and individual human
Media
The media — television, print media, radio, videos/DVDs and the internet —
are a part of children’s daily lives. As a result, they are exposed to messages and
information that may impact positively or negatively on their health and individual
human development. Young Media Australia is a national community organisation
that is committed to the promotion of the healthy development of Australian
children. Table 9.12 outlines some of the key themes within the media identified
by Young Media Australia. The way in which the media portray these themes can
have positive and negative effects on children.
Table 9.12 Positive and negative effects of the media on children’s health and individual human development
Key theme Impacts on the health and individual human development of children
Needing to feel that the world is a Positive: Positive programs can show children elements of their world in a safe and non-threatening way.
safe place and that people can be Negative: Violent and scary programs can undermine children’s sense of safety and security.
trusted
Needing autonomy and connection — Positive: Appropriate programs can show children a world where people help and support each other
it is important for children to do a while maintaining their own independence.
range of tasks independently while Negative: In some programs, autonomy is commonly equated with violence and hurting others, and may
learning to participate more in be connected with helplessness and victimisation. It does not enable children to understand that they can
relationships with others be both independent and connected to others.
Feeling a sense of empowerment and Positive: Appropriate programs can make children feel that they can make a positive difference in the
efficacy — children need to develop a world.
sense that they can affect their world Negative: Programs fail to assist children in developing a sense of empowerment. In many children’s
and believe that they are competent program, characters display empowerment and efficacy by using weapons and violence.
and capable people
Developing a gender identity — Positive: Programs that show both male and female characters assist children in developing gender
identifying what it means to be a boy identity.
or a girl and that both sexes can do a Negative: Many programs stereotype males as muscle bound characters and females as sweet, kind and
range of things sexy. This gives children a restricted understanding of what it means to be a boy or a girl.
Understanding how people are alike Positive: Programs can show children a diverse range of people and how to respect and learn from each
and different other.
Negative: Some programs promote suspicion, intolerance and even violence against those who are
different, which does not encourage children to appreciate and respect the differences among people.
Developing a sense of morality and Positive: Appropriate programs can show cooperation, getting along with others and treating people with
social responsibility respect, encouraging children to imitate these behaviours.
Negative: Inappropriate programs can show children that violence can be justified in resolving conflict.
Children learn that people are either ‘all good’ or ‘all bad’.
Needing meaningful play Positive: Appropriate programs can promote imaginative play.
Negative: Too much television or time on the computer reduces the time available for physical play.
Source: Adapted from ‘Effects of media from a child development perspective’, Young Media.
Impact of food advertising

Advertisements for certain products — breakfast cereals, snacks, softdrinks and fast
foods — are often targeted at children. These types of foods are high in saturated
fats, simple carbohydrates and sodium, and can contribute to the development of
overweight and obesity.
9.13 Social environment (community) determinants: media
Childhood overweight and obesity are linked to numerous health risks including:
Social and mental health: overweight and obesity can lead to social isolation and
discrimination, poor self-esteem, depression, learning difficulties and limited social
skills.
Physical risks in childhood: back pain, flat feet, slipped growth plates in the
hips, knock knees (where the knees touch), fatty liver, type 2 diabetes, menstrual
problems, asthma and obstructive sleep apnoea (pauses in breathing due to an
obstruction of the open airway).
Physical risks in adulthood: type 2 diabetes, cardiovascular disease, stroke,
hypertension, some cancers such as colorectal cancer, musculoskeletal disorders
and gall bladder disease. Overweight and obesity can result in a reduced life
expectancy.
Dental health: The consumption of high sugar foods and acidic soft drinks is the
biggest risk factor for dental erosion and dental caries in children and adolescents.
Bone health: Children who consume soft drink rather than milk may have low
bone density due to inadequate calcium intake.
The childhood obesity rate in Australia is one of the highest in the world; in 2012,
the proportion of overweight and obese children (aged 5–17) was 25.3 per cent.
The Coalition on Food Advertising to Children (CFAC) — which includes
Australian community groups and organisations such as Cancer Council Australia
and the Australian Medical Association — estimates that Australian children (aged 5
to 12 years) watch an average 23 hours of television per week; up to four hours
are made up of advertisements which equates to 208 hours per year. More than
three-quarters of food advertisements shown during children’s TV viewing time
promote foods low in nutritional quality such as chocolate, confectionary, fast food
and sweetened breakfast cereal. Food advertisers on television use techniques such
as prizes, catchy jingles, animation and celebrities to attract children’s attention
and create a desire to want the product. Children are susceptible to television
advertising and will pester their parents to purchase the advertised products.

1 Explain three negative impacts the media can have 5 Select a one hour television timeslot and take
on the health and individual human development of note of the food advertisements shown during
children. this time. Record the types of foods that are being
2 Explain three positive impacts the media can have marketed and their target audience. How many
on the health and individual human development of advertisements market unhealthy foods to children?
children. What is the possible impact of this advertising on
3 What is social support? the health and individual human development
4 Explain the impact of food advertising on the health of children?

9.14 S ocial environment (community) determinants: access
to health care
KEY CONCEPT The importance of health care in promoting the health and

Access to health care during the prenatal and childhood stages of the lifespan
is vital for the health and individual human development of children. Through
the provision of easily accessible health care services, parents are able to monitor
growth, check the health status of their child and treat illnesses/conditions in their
earliest stage to maximise recovery and promote health and individual human
development.
Access to general practitioners, obstetricians and gynaecologists is important
during the prenatal stage of development. During pregnancy, the health of the
mother and the development of the unborn child need to be monitored carefully.
Many conditions that can occur in the mother may also have an impact on the
health and individual human development of the unborn child. If left untreated,
such conditions can have serious implications for both mother and baby. Table 9.13
outlines some of the conditions that may impact on the developing foetus.
Table 9.13 Some conditions that may affect the health and individual human development of
the unborn baby
Impact on health and individual Figure 9.33 Access to health care

Condition Explanation human development is vital for ensuring the health and
Pre-eclampsia High blood pressure, protein in the Premature birth children.
urine and fluid retention in the mother Reduction in blood flow to the baby,
restricting growth
Low birth weight
Death of the unborn baby
Placenta praevia Placenta becomes implanted at the Foetal distress from lack of oxygen
bottom of the uterus, covering the Low birth weight
cervix and preventing the baby from
being born vaginally. During pregnancy Premature birth
the placenta can separate from the wall
of the uterus, resulting in bleeding.
Gestational Form of diabetes in which pregnancy Baby can grow larger than expected
diabetes blocks the action of insulin Baby may have problems with low
blood glucose levels when born
Breathing difficulties
Source: Adapted from ‘Health problems in pregnancy’, Children, Youth and Women’s Health Services, www.cyh.com.
Neonatal intensive care units

Access to health services is an important consideration in the birth of a child, in
order to have medical professionals readily available in case of complications and
to ensure that the baby is carefully monitored and cared for. During the birth,
a caesarean section (in which the baby is delivered through an incision in the
mother’s abdomen) may be required if there are difficulties in delivering the baby
or if the baby is in foetal distress and not receiving enough oxygen. Newborn
Figure 9.34 Babies who require
babies requiring specialist care are placed in a neonatal intensive care unit, which specialist care following birth are
specialises in the care of ill or premature babies (figure 9.34). Approximately placed in a neonatal intensive-care
8 per cent of births in Australia are premature (born before 37 weeks gestation). unit.
9.14 Social environment (community) determinants: access to health care
Complications that may affect a premature baby include:

• lung disease — resulting in breathing difficulties
• feeding difficulties — due to the inability of the infant to suck
• temperature control difficulties — due to immature development of the
temperature control centre in the brain
• apnoea — breathing stops for short periods because the respiratory control
centre in the brain is not fully developed
• bradycardia — slowing of the heart rate
• jaundice — yellowing of the skin due to the liver being too immature to process
bilirubin, a compound that builds up in the bloodstream if not processed by
the liver.
Maternal and child health service

Once a child is born, the mother is referred to the maternal and child health
service. Qualified nurses employed by the maternal and child health service offer
support, information and opportunities to discuss concerns related to the health
and individual human development of children. Maternal and child health centres
are located within the community and offer the following:
• provision of information, support and
Height-for-age percentiles: Boys, birth to 36 months advice on a range of topics including
cm cm
parenting, child health, development and
learning, child behaviour, maternal health,
105 105 child safety, immunisation, nutrition,
97th
95th breastfeeding and family planning
100 90th 100 • appointments at specific developmental
75th stages in the early years for thorough health
50th and development checks
95 95
25th • home visits in the first few days following
10th birth or when circumstances require
90 5th 90
3rd • assistance with contacting other specialist
services such as early parenting centres
85 85
• parent groups where individuals can meet
other parents in the local area and discuss the
80 80 role of parenting and the needs of the child
• intensive support for those experiencing
75 75 difficulties.
By accessing the maternal and child
70 70 health service, parents can identify issues
and possible problems so that steps can be
65 65 taken to address them early in life. Regular
assessments evaluate the child’s health and
60 60 individual human development at particular
stages and enable any issues to be dealt with
55 55 promptly. These assessments include:
• regular checks of weight, height and head
50 50
circumference to determine the amount of
growth. These measurements are plotted
onto percentile charts to determine the
45 45
child’s rate of growth in comparison to
cm cm other children (figure 9.35).
• checks of motor skill development
Birth 3 6 9 12 15 18 21 24 27 30 33 36
• screening of hearing and eyesight
Age (months)
• observation of play
Figure 9.35 Height-for-age percentiles: Boys, birth to 36 months • physical examination (e.g. heart rate,
Source: ‘Individual growth charts’, Centers for Disease Control and Prevention, www.cdc.gov. breathing).

Primary School Nursing Program
In order to promote the health and individual human development of primary school
children, the Victorian Government’s Department of Human Services offers a free Sections 9.15 onwards
universal health-care service to all Victorian Primary and English Language Centre containing Key Knowledge 2.5
Schools through the Primary School Nursing Program. Full-time registered nurses and Key Knowledge 2.6
provide a service to 1750 state, Catholic and independent schools across Victoria. can be found online in your
The Primary School Nursing Program (PSNP) is a free service offered by the eBookPLUS.
Department of Education and Early Childhood Development to all children
attending primary schools and English Language Centres throughout Victoria. The
aim of the program is to provide all Victorian children with the opportunity to
have a health assessment, to link children, families and school communities to
services available in their local community, and to provide information and advice
that promotes health and individual human development.
Throughout the year, school nurses visit schools and English Language Centres
to provide children with the opportunity to have a health assessment. All children
are offered a health assessment in their first year of school through a School Entrant
Health Questionnaire, which contains a range of questions regarding health history,
wellbeing and family circumstances. The questionnaire also provides opportunities
for parents/cares to express any concerns that they may have about their child.
Further assessment may be undertaken at the request of the parents/carers, such
as a vision or hearing test. The completed questionnaire provides important
information about a child’s health and individual human development so that the
nurse can make an effective health assessment. If there are concerns, a child may
need to be referred to another health professional or agency. Throughout primary
schooling, parents can request for a health assessment to be completed for their
child.
Primary school nurses also provide health information and advice about healthy
behaviours and link children and their families to community-based health and
wellbeing services.
The health goals and targets of the Primary School Nursing Program are to:
• reduce the frequency of preventable premature mortality
• reduce the impact of disability occurrence and normalise the life of those with
a disability
• reduce the impact of vaccine-preventable diseases
• reduce the impact of conditions occurring in adulthood that have their origins in
childhood and adolescence (e.g. obesity)
• enhance family and social functioning.

1 Explain why it is important to access health services 5 Explain how the Primary School Nursing Program
during pregnancy. can promote the health and individual human
2 Explain the role of the maternal and child health development of children.
service. 6 Create an advertising brochure/television commercial
3 What types of assessment are made of the outlining the importance of the Primary School
developing child by the maternal and child health Nursing Program to the health and individual human
nurse? Why are these assessments important? development of children.
4 Explain the purpose of the Primary School Nursing
Program.
development of Australia’s children

individual human development and their impact on
children, using relevant examples
In order to demonstrate this skill, a thorough understanding of the determinants
of health and individual human development and how they relate to children is
essential. The ability to use relevant examples to demonstrate this understanding
is expected. When outlining the determinants of health and individual human
development, it is important to remember the following:
• There is a significantly large range of factors that affect the health and individual
human development of a population. It is important to select those factors that
are listed in the study design (i.e. biological, behavioural, physical environment
and social) as these are considered to be the most relevant.
• Focus on factors relevant to the childhood stage of the lifespan and ensure
that the discussion makes reference to how the selected factor impacts on
children.
• In order to clearly demonstrate an understanding of the impact of a selected
determinant of health on the health and individual human development of
children, it is important to first outline what the factor is.
• The determinants of health and individual human development help to explain or
predict trends in health. When outlining the impact of a selected determinant, it
is important to explain the way in which it impacts on the health and individual
human development of children.
• Where possible, use relevant statistics to outline the impact that the selected
determinant has on the health and individual human development of children.
Consider the following article, which discusses a behavioural determinant of
health and individual human development: tobacco smoke in the home.
Passive smoke: Kids’ health at risk

Karyn and Richard Shine wish to make a personal plea to Aussie parents who smoke.
‘Please don’t smoke near your kids.❶ It’s not fair. You have taken up the habit, but
❶ Highlights exposure to tobacco your children haven’t.
smoke as an important determinant ‘If you light up near them, they breathe the smoke as well. You’re putting their
of health and individual human health at risk because you choose to do something unhealthy — even deadly.’
development of children Before you think Karyn and Richard must be staunch anti-smokers lecturing about
their nicotine-free lives, read on…
❷ Information regarding the possible Karyn, 39, and Richard, 33, from Glenmore Park at the foot of the Blue Mountains
impact of passive smoking on the
health of children
in New South Wales, are both smokers. Richard began smoking when he joined the
RAAF at 18. Karyn started at 13 and has lost count of the number of times she has
tried to quit unsuccessfully — even through her three pregnancies.
➌ Recognition of the importance of
preventing exposure to passive ‘I tried to stop while I was pregnant, but I just couldn’t quit — though I did cut
smoking right back to only a couple a day,’ she explains.
‘Our two boys have infantile asthma,❷ and I’ll always wonder whether that was
caused by me smoking while pregnant. I know loads of non-smoking parents have
asthmatic kids — but at least they know they couldn’t have caused it. I will never
know for sure.’
Their children — Alec, three, Ronan, two, and Hayley, one — are the couple’s pride
and joy, and that’s why the Shines have made a solemn promise. They won’t let their
smoke go anywhere near the kids.
‘Our entire house and car are smoke-free zones,’ Karyn explains. ‘As soon as Alec
was born, we made this rule. Why should he have to put up with something he didn’t
choose? Even when outside, we don’t smoke near the kids.❸
‘It’s such an invasive habit. Although you’re doing it, the smoke drifts. People who
don’t want to smoke shouldn’t have to breathe it because someone else does.’
302
UNIT 2 • Individual human development and health issues
The Shine family has agreed to speak out to promote the Car and Home: Smoke
Free Zone campaign, a joint initiative of NSW Health, the Cancer Council NSW, the
National Heart Foundation (NSW), Asthma NSW and SIDS NSW.
‘People need to know how dangerous it is to smoke around their kids,’ Karyn says.
‘Passive smoking is dangerous.
‘It’s bad enough that I might be digging my own grave, but we don’t want to be ❹ Recognition of the possible impact of
passive smoking on premature death
digging our children’s graves as well.’❹
The risks of passive smoking: ❺ Information regarding the harmful

— There are 4000 chemicals in passive smoke, including carbon monoxide, ammonia, chemicals in tobacco smoke that can
affect children
cadmium, arsenic, butane, acetone, DDT and hydrogen cyanide.❺
— The National Drug Strategy Network survey estimates that between 1998 and
1999, 224 Australians died as a direct result of passive smoking. Of these, 103 ❻ Outlines the impact on children of
passive smoking, which often occurs
were under the age of 15.❻ in the home of smoking parents
— Approximately 16 320 cases of lower respiratory illness are diagnosed in Australia
each year among children aged 18 months or less.❼
❼ Statistical data that highlight the
Source: Woman’s Day, 15 June 2010. © ninemsn Pty Ltd. impact of passive smoking on infants
Consider the following information on a genetic determinant of health and

individual human development: low birth weight.
• Infants who are born with low birth weight are at greater risk of poor health,
disability and death than other infants.
• In 2006, 6.4 per cent of live born infants in Australia were of low birth weight
(weighing less than 2500 grams). This proportion was twice as high among babies
of Indigenous mothers.
• 1.1 per cent weighed less than 1500 grams (very low birth weight, including
extremely low birth weight).
• 5.3 per cent weighed between 1500 and 2499 grams.
Source: Australian Institute of Health and Welfare 2009, A picture of Australia’s children 2009,
Very low 1.1% (<1500 grams)

and extremely low (<1000 grams)
Low
6.4% 5.3% (1500–2499 grams)
Normal
93.6%
Figure 9.36 Proportion of infants by birth weight category, 2006

Source: Australian Institute of Health and Welfare 2009, A picture of Australia’s children 2009, cat. no. PHE 112, Canberra, p. 73.

1 Referring to figure 9.36, outline the percentage of infants born with normal birth
weight, low birth weight and very low birth weight.
2 What are the weight classifications for normal birth weight, low birth weight and
very low birth weight?
3 Explain the possible impact of low birth weight and very low birth weight on the
health and individual human development of infants/children.
4 Many of the risk factors for low birth weight babies can be reduced by appropriate
interventions. Outline the advice that could be provided to a first-time mother to
increase the likelihood of an infant being born normal birth weight.
Key skills The determinants of health and individual human development of Australia’s children

Australia’s children and draw informed conclusions about
personal, community and government strategies and
programs to optimise child health and development
This key skill can be found online in your eBookPLUS.

5 Francesca is 15 years of age and lives with her mother, father and two younger
brothers. Her father works full time while her mother stays at home to look after the
children and complete household chores. Francesca’s father is extremely strict with the
children and does not allow them to have their friends over to the house. The children
have a very strict routine of homework and daily chores, and are not allowed to attend
social gatherings at friends’ houses. The children are quite frightened of their father
and have learnt not to question his instructions or decisions. If the children disobey him,
they might be smacked or sent to their room for an indefinite amount of time.
(a) What type of parenting style is being exhibited by the father?
1 marks
(b) What impact could this parenting style have on the physical, social, emotional and
intellectual development of the children?
8 marks
304
CHAPTER 9 review
Chapter summary
• The factors that impact on the health of individuals and populations are referred to as
the determinants of health and individual human development.
• The determinants of health and individual human development include: biological
factors, health behaviours, physical environment and social.
• The determinants of health and individual human development can be multicausal.
• Although the overall health status of children is positive, Australian children are
experiencing higher rates of overweight and obesity, insufficient physical activity, poor
eating habits, mental health issues, and long-term health conditions such as asthma
and type 1 diabetes.
• Biological factors refer to those genetic and physiological factors that impact on health
• Biological factors relate to the functioning of the body and include body weight and
birth weight.
• Biological factors do not act in isolation, and are affected by environmental factors and
health behaviours.
• The genes that an individual inherits from their biological parents have a significant
impact on health and individual human development.
• Genes are the blueprint of the body because they control growth, development and
how the body functions.
• Humans have 46 chromosomes which make up 23 pairs; 22 pairs are referred to as
autosomes and one pair is called ‘sex-linked’ as it determines the sex of the individual.
• Some genetic conditions such as Duchenne muscular dystrophy are carried on the ‘X’
chromosome.
• Our genetic make-up is determined by the combination of genes that occur at the
point of conception.
• It is the combination of genes that will determine the physical characteristics of the
individual (e.g. facial features, sexual characteristics and eye colour) as well as genetic
conditions and genetic predisposition to disease.
• Hormones regulate growth and physical development during childhood.
• Some childhood conditions occur as a result of genetic susceptibility (e.g. asthma and
type 1 diabetes).
• Babies are considered to be low birth weight if they weigh less than 2500 grams at
birth. Low birth-weight babies can be further classified into ‘very low birth weight’ if
they weigh between 1000–1500 grams and ‘extremely low birth weight’ if they are
below 1000 grams.
• Babies that are born very low birth weight or extremely low birth weight are at greater
risk of premature death and a range of conditions and developmental problems.
• BMI-for-age and gender percentile charts are used for assessing the relative body
weight of children.
• Overweight and obesity can be caused by a genetically low metabolic rate.
• The lifestyles of children and the decisions they make in terms of health are largely
dependent on the lifestyles of the parents and the knowledge, attitudes and beliefs
that they pass on to their children.
• Eating habits and physical activity patterns of children are largely determined by the parents.
• It is recommended that children participate in 60 minutes of moderate to vigorous
exercise per day.
• Tobacco smoke in the home is particularly dangerous for children because their lungs
are still developing.
• Breastmilk contains all of the nutrients required by the infant for at least the first six
months of life, and the colostrum that the baby receives in the first few days following
birth contains antibodies required to resist infection.
Chapter 9 review
• Artificial formula contains the required nutrients for the developing baby, but it does
not contain antibodies.
• Vaccines contain either a weakened or dead micro-organism of a particular disease so
that the body will develop antibodies against that disease.
• Vaccinating from an early age helps protect children from a range of illnesses, some of
which may be life threatening.
• Dental decay is the most common disease that affects teeth.
• The first stage of gum disease is gingivitis and the later stage is periodontitis.
• Oral hygiene during early childhood is vital for ensuring health of the teeth and gums
and teaches children the daily routines required to maintain optimal dental health.
• The physical environment refers to the surroundings in which one lives and the
accessibility to resources such as food and water. It also refers to conditions in which an
individual lives that impact on health and individual human development.
• Families that are required to live in substandard or overcrowded dwellings are at greater
risk of poor health.
• Half of all deaths and three out of four injuries in the 0–5 age group occur at home.
• Fluoridation of water involves the addition of fluoride to a public water supply to
reduce tooth decay in the population.
• Fluoride reduces the amount of acid that is produced and can also repair the damage
to teeth before it progresses and becomes permanent.
• Recreational facilities that are easily accessible for families with children greatly increase
the likelihood of regular physical activity. Undertaking regular physical activity has
enormous benefits for the health and individual human development of children.
• The social environment includes factors such as parental education, parenting practices,
media and access to health care.
• Education provides opportunities for better employment and higher income, which
enable individuals to have a healthier lifestyle through greater access to health-
promoting resources such as nutritious foods and health care.
• Parenting practices refer to the way in which the parents or guardians interact with
eBook plus their child and the way in which they model behaviour.
• There are four main parenting styles: authoritarian, authoritative, permissive and uninvolved.
Interactivities:
• Violence and alcohol and drug misuse within the family can have detrimental effects on
Chapter 9 crossword
the developing child.
• As a result of the media, children are exposed to messages and information that may
Chapter 9 definitions impact positively or negatively on their health and individual human development.
• Maternal and child health services support families in caring for their child.
• Through the provision of easily accessible health-care services, parents are able to
monitor growth, check the health status of their child and treat illnesses/conditions in
their earliest stage to maximise recovery and health.
• The Primary School Nursing Program is a free universal health-care service offered to all
Victorian Primary and English Language Centre schools.

1 Outline the following determinants of health 2 Develop a brochure/web page to provide advice
and individual human development in relation to to parents on ways to improve their children’s
children and provide an example of each type. health and individual human development. In your
• Biological brochure/web page, refer to factors associated with
• Behavioural each of the determinants of health and individual
• Physical environment human development.
• Social

1.1
CHAPTER 8
Chapter 10
The health
Global andand
health individual human
development
human of Australia’s adults
development
Reaching adulthood — the longest stage of the human
lifespan — is a significant milestone for an individual.
A number of physiological changes mark the entry and journey
through adulthood, and the level of health is a significant
factor. However, it is the social and emotional development
of an individual that shapes the experiences and progress
through this period. Understanding the complexities of this
stage of the lifespan can make the transition through each
stage easier.
KEY KNOWLEDGE
3.1 the different classifications of the stages of adulthood (pages 310,
318, 322)
3.2 characteristics of physical development during adulthood, including
the physiological changes associated with ageing (pages 310–11,
318, 322–3)
3.3 the social, emotional and intellectual development associated with
the stages of adulthood and ageing (pages 311–17, 319–21, 323–6)
3.4 the health status of Australia’s adults, including the similarities and
differences between adult males and females (pages 327–31).
KEY SKILLS
• describe the stages of adulthood and ageing
• describe the characteristics of development during adulthood
• interpret data on the health status of Australia’s adults.
Figure 10.1 Three stages of

adulthood: early, middle and late

adulthood a stage of the human lifespan that starts at
19 and ends at death. It can be divided into early, middle
and late adulthood.
early adulthood the period of life between 19 and
40 years of age
emotional development the capacity to express
feelings and emotions and the ability to understand and
control moods and feelings
health status the level of health of an individual,
community or group
intellectual development the development of
processes in the brain such as thought, knowledge and
memory
in-vitro fertilisation (IVF) is a process by which egg
cells are fertilised by sperm outside the body, in vitro. IVF
is a major treatment in infertility when other methods of
assisted reproductive technology have failed.
late adulthood the final stage of the lifespan; the period
from 65 years of age until death
middle adulthood the period of life between 40 and
65 years of age
physiological changes changes that occur to the
physical and biomedical functions of the human body
social development the increasing complexity of
behaviour patterns used in relationship with other people
(VCAA study design)
spouse a partner in marriage, a husband or a wife
The health and individual human development of Australia’s adults • CHAPTER 10 309
10.1 Early adulthood: physical and social development
KEY CONCEPT Characteristics of physical and social development during early

adulthood, including the physiological changes associated with ageing
Adulthood is the longest stage of the human lifespan, starting at 19 years of age
(the end of the youth stage) and ending at death. The first stage, early adulthood,
ends around 40 years of age, but it is a difficult stage to generalise about because
every person’s journey is unique. The impact of biological, behavioural and
environmental determinants can have a significant effect on the ageing process.
Cells continue to divide
for the replacement,
repair and maintenance
of body tissue.
Sensory
Reflexes of organs are
the nervous at their
system are sharpest.
at their
peak.
Reproductive
function of Figure 10.2 The physical changes from boy to man
women has
an impact on Early adulthood is usually defined as the period between 19 and 40 years of
the physical
changes.
age. Although there are always individual differences, this stage of the lifespan is a
time when physical growth is completed and development of the muscles, internal
organs and body systems should be at their peak condition.
Peak bone Physical changes that occur to the functioning and appearance of the human body
mass is
achieved. as it ages are known as physiological changes (figure 10.3). These include the
following:
• Maximum adult height is reached. Young adults finish growing and their height
remains constant throughout early adulthood.
• Cells continue to divide for the replacement, repair and maintenance of body
Muscular
tissue, rather than for growth.
strength • Peak bone mass is achieved. Normal ageing is accompanied by the loss of bone
reaches its tissue throughout the body. Loss of bone density begins in the late 30s, so it is
peak.
important for adults to maintain their bone density through diet and physical
activity.
• Sensory organs are at their sharpest (ears, eyes, nose, mouth, skin).
Maximum • Muscular strength reaches its peak.
adult height • Reflexes of the nervous system are at their peak.
is reached.
• Women’s reproductive function has an impact on the changes experienced during
Figure 10.3 Physiological changes this stage. It is usually in early adulthood that women go through childbearing,
during early adulthood and their bodies will change physically to carry out this function.
310
Most people in early adulthood see themselves as being at their peak in terms
of health, lifestyle, sex life and physical condition. Estimates from the 2007–08
National Health Survey show that almost two-thirds (64 per cent) of 24–34 year
olds rated their health as excellent or very good, and this proportion declined as
age increased (Australia’s health 2010).
Social development
The process of socialisation begins at birth and continues until death. Social
development refers to learning the skills, knowledge, values and behaviours that
are appropriate to interact with others (figure 10.4). Social development during
adulthood includes acquiring new roles, responsibilities and expectations, both
within the family (e.g. as parents and grandparents) and outside it (e.g. at university
and in the work environment).
Figure 10.4 Learning how to interact

with work colleagues is a component
of young people’s social development.
Gaining independence and developing identity become the main focus during
early adulthood. This could include:
• career development. In developing their independence, young adults are faced
with many decisions. Starting a career is seen as important for both males
and females and will often include completing their secondary education and
possibly continuing on to further study. Being part of a new environment requires
individuals to adapt to new roles and the expectations linked to those roles.
Whether they are entering a tertiary institution or moving straight into a job,
individuals will form new relationships with other students, lecturers, tutors,
work colleagues and employers. Good communication skills and the ability to
work well with others are critical requirements for a successful work life.
• selecting a life partner. Finding a permanent partner and being involved in an
intimate relationship is a common goal for most young adults. The establishment
of a stable long-term relationship is linked to a range of positive attitudes such as
confidence and acceptance. Intimacy requires an individual to sacrifice some of
their independence for another person. Taking on the role of spouse or partner
requires many social skills, and having good role models improves the chances
of success in a relationship.
• getting married or learning to live with a partner. Getting married and establishing
a family is often delayed when young adults choose to focus on career
development. According to the Australian Bureau of Statistics (ABS), there has
been a trend towards getting married at a later age. The median age for first
marriages has increased, from 28 years in 1998 to 29.7 years in 2011 for men
and from 24 years to 28 years for women. Choosing to get married at an older
age means that individuals may have developed their social skills and have a
better understanding of how to behave in a relationship.
ABS marriage data for 2011 also confirms a forty-year trend for more couples
to cohabitate (live together) prior to entering a registered marriage. In 1975, only
16 per cent of couples cohabitated prior to marriage, increasing to 27 per cent in
1983, while 78.2 per cent of couples cohabitated in 2011. This trend to cohabitate
allows a couple to establish their relationship and develop the necessary skills that
are the key to a successful partnership. These skills include good communication
Figure 10.5 Although many people
are marrying at a later age and
(e.g. taking the time to listen to each other’s point of view); the ability to be flexible,
some are choosing not to marry at adaptable, trustworthy, empathetic, honest and accepting; and a willingness to
all, marriage remains a significant make compromises.
milestone for most people. • managing a home. Many young adults are staying in the family home longer
and delaying living independently, thus also delaying this aspect of their
social development. Moving out of the family home and living independently
(whether in a share house, cohabitating with a partner or living alone) is
another developmental milestone of early adulthood. The individual takes on
responsibilities such as paying bills, rent or a mortgage; maintaining a clean
living environment; establishing the expectations of each member of the
household; developing relationships with neighbours and learning to be part of
a community.
• starting a family. Starting a family is also an important developmental milestone
for most individuals. The role of a parent is linked to many societal and legal
expectations including registering the birth; providing a name for the child;
and the giving of appropriate care, love and support. The decision to take on
the role of parenthood is also influenced by society and technology. Individuals
have many choices, including the choice of whether or not to have children.
Contraception allows couples to plan their decision to conceive, while in-vitro
fertilisation (IVF) technology gives couples who may have remained childless
the chance to have children. These technological developments have allowed
couples the freedom to make choices and develop their independence.
Figure 10.6 Becoming a parent is an

important developmental milestone
during early adulthood.

Case study
Not quite grown up She’s not alone. Jeffrey Jensen Arnett, a psychology
professor at Clark University in Massachusetts, USA,
Is Generation Y’s reluctance to rush through the is leading the movement to view the 20s as a distinct
rites of passage from adolescence to adulthood a life stage, one that has developed in response to cultural
sign of self-indulgence or a sensible response to an change, not simply the lazy indecisiveness of an oft-
increasingly complex world? By Sarina Lewis. maligned generation. To support his argument, Arnett
As the daughter of Bryan Brown and Rachel Ward, points to the need for more education to survive in an
23-year-old Matilda Brown is the progeny of the information-based economy; the lack of entry-level
closest thing Australia has to entertainment royalty and jobs even after all that schooling; the fact that young
is a second-generation ‘face to watch’. After starring people feel less haste to marry because of the wider
in the award-winning short film Martha’s New Coat at acceptance of premarital sex, cohabitation and birth
age 15, Brown has gone on to appear in the TV shows control; and that young women also feel less rushed to
Underbelly, Offspring, My Place and Rake as well as have babies thanks to access to assisted reproductive
writing, directing and starring in this year’s Tropfest technology.
finalist How God Works. ‘I think you have to be open Just as adolescence has a particular psychological
in this industry,’ Brown says of her forays into acting, profile, Arnett says, so does emerging adulthood:
directing and writing. ‘Even life is kind of like that — identity exploration, instability, self-focus, feeling
you never know where you’re going and that’s the nice ‘in-between’ and a rather poetic characteristic he calls
thing about it.’ ‘a sense of possibilities’. A few of these, especially
Brown’s is a particularly revealing comment, and identity exploration, are also part of adolescence, but
one that some sociologists suggest is representative of a take on new depth and urgency in the 20s. The stakes
generation of 20-somethings challenging what has until are higher — people are approaching the age when
now been the ‘natural progression’ from adolescence options tend to close off and lifelong commitments
to adulthood. The five traditional milestones that mark must be made. Arnett calls it ‘the age 30 deadline’.
this transition to adulthood — completing school, The whole idea of milestones, of course, is
leaving home, becoming financially independent, something of an anachronism; they imply a lock-step
getting married and having a child — are being delayed march towards adulthood that is rare these days. Kids
by more and more members of Gen Y. don’t shuffle along in unison on the road to maturity —
It’s a topic that pops up everywhere, from newspaper they slouch towards adulthood at an uneven pace. Some
articles reporting changing statistics on the age of home never achieve all five milestones, including those who
leavers to sociology papers detailing the characteristics are single or childless by choice, or unable to marry
of today’s ‘boomerang kids’ as they ricochet back and because they’re gay. Others reach the milestones
forth between the parental home and independence. completely out of order, advancing professionally
And even when not spelled out, the often negative, before committing to a monogamous relationship,
judgmental nature of the commentary is clear. having children young and marrying later, leaving
For Brown and others like her, however, the notion school to go to work and returning to school long after
of deferring some of the traditional rites of passage in becoming financially secure.
favour of a more fluid approach to life in their third Certainly that is where Brown feels herself placed.
decade is far from troublesome. ‘I like the idea of being Having returned to the parental home in Sydney
free and not having to worry about settling down just following five years spent studying and living in
yet,’ she says, adding that this does not mean neglecting Melbourne, the rising star confesses that while she has
social responsibility: like her mother, Brown spends her career on track, she sees no issue in her decisions
time working as a mentor with disadvantaged youth in to delay the hunt for a long-term partner and remain in
the Big Brothers Big Sisters program. ‘I think there is the family home. Nor does she view her lifestyle choice
plenty of time for thinking about things like marriage as irresponsible.
and mortgages and I don’t know why I should be at this ‘I guess if adulthood means being married and having
time in my life.’ kids I’m clearly not there yet,’ she admits. ‘But I think
(continued)
in order to do all that stuff you need to be an adult long ‘I think there are a lot of complexities in the world
before you take on those responsibilities, otherwise today that definitely didn’t exist in the past,’ adds
you’re going to throw yourself into the deep end when Hollonds. ‘There are decisions about whether or not
you’re not ready. So I guess I’m just taking things one we’ll live together, whether or not we’ll get married.
step at a time, which feels good.’ Will we have children? When will we have children?
As a life decision, it seems eminently sensible, and Who will stay home with the children?
Relationships Australia NSW CEO Anne Hollonds ‘You might say that’s a really positive thing — we’ve
can certainly see the logic. ‘I think there are enormous got all these choices available to us. And it is a positive
advantages,’ she says of the delay in settling down and thing in many ways, but the downside is we have to be
the trend towards bouncing back to the family home. able to make ethical decisions and wise decisions, often
And many people clearly agree: figures from the in very complex circumstances. And you don’t get that
Australian Bureau of Statistics show that, after leaving ability overnight. You don’t get that just because you
home for the first time, 46 per cent of people return at turn 21.’
least once before turning 35. Source: Extract from Sydney Morning Herald, 12 November 2010.
Case study review

1 Identify the five traditional milestones for the transition from adolescent to
adulthood that have been identified by sociologists.
2 Explain what is meant by the term ‘the age 30 deadline’.
3 (a) What is Relationships Australia NSW CEO Anne Hollonds’s opinion of the
delay in settling down?
(b) What is your opinion? Do you agree or disagree with Anne Hollonds? Justify
your response.
4 (a) What experiences does Matilda Brown identify with being ‘grown up’?
(b) How do these experiences impact on the social, emotional and intellectual
development of an individual?
5 Use the Not quite grown up weblink in your eBookPLUS to
access the full article and answer the following questions.
(a) What trends are identified with the divorce and marriage rates?
(b) Outline possible reasons for the trends noted.

1 List the main physiological changes that occur 6 In what two ways can bone density can be
during early adulthood. maintained?
2 Loss of bone density is a normal part of the ageing 7 Damian, 22 years old, has just finished his electrical
process. At what age does it begin? apprenticeship and is planning to leave his parents’
3 Define social development. home and move in with his girlfriend.
4 (a) Identify the main developmental milestones that (a) Describe the predicted physical development of
have a significant impact on social development a male in Damian’s stage of the lifespan.
during early adulthood. (b) Identify examples in the case study that might
(b) Select one of the developmental milestones have impacted on Damian’s social development.
identified in part (a) and explain how it impacts (c) Select one of the examples from part (b)
on social development during early adulthood. and explain how it might have
5 The Australian Bureau of Statistics data suggest that affected Damian’s social
the age for first marriage is getting later. development.
(a) How has the median age for men and women 8 Use the Ageing narcissist weblink in your
changed since 1998? eBookPLUS to find the link to this question.
(b) Suggest how this may impact on the social Identify the physical changes are taking place as
development of young adults. each day passes.

10.2 E arly adulthood: emotional and intellectual
development
KEY CONCEPT Characteristics of emotional and intellectual development

associated with early adulthood
Emotional development is the capacity to express feelings and
emotions and the ability to understand and control moods
and feelings (figure 10.7). It is closely linked to self-concept,
the way an individual views themselves.
As previously outlined, the most significant changes that
occur in early adulthood include:
• career development
• selecting a life partner
• getting married or learning to live with a partner
• managing a home
• starting a family.
The ability to cope with these changes will depend on the
emotional development of the individual. The availability of
good role models at work, at home and in the community will
help to foster an individual’s self-concept, thus impacting their
Young adults still living at home need to adapt to the
changing nature of family relationships. In some cases,
the way parents treat their children when they reach early
adulthood will not change even though their children may Figure 10.7 Expressing emotions
be financially independent. Parents not only provide role is a key component of emotional
development.
models for their adult children, they also need to provide the
necessary support and encouragement to allow their children
to successfully develop into well-adjusted young adults.
Forming and maintaining relationships, in particular intimate relationships, in
early adulthood will affect the development of self-concept. Failed relationships or
lack of support and encouragement from family, work or the community can lead
to poor self-concept, impacting emotional development.
Good emotional development is the ability to understand and control the
emotions, and to respond well to the changes taking place around and within
the individual. This is not always easy but it is important for emotional growth.
Formulating an identity and developing a sense of self are key components of
early adulthood. Establishing a career and learning new roles and expectations will
impact on employment status, job satisfaction, financial security and self-concept.
Intellectual development involves an increase in knowledge and the ability to think
and reason. The foundations of intellectual development are formed during the
early stages of the lifespan, when language skills are developed, knowledge gained,
memory skills formed and the ability to understand and reason are developed. All
these skills are further developed during early adulthood. Attending university or
training programs usually involves learning the skills and acquiring the knowledge
for their chosen career or job, thus improving their intellectual development. In
the work environment, new employees will be inducted into the workplace and
taught the necessary skills and information essential to carrying out their tasks.
This requires intellectual development for success.
10.2 Early adulthood: emotional and intellectual development
Case study
Half of young people unable below this level. Three in four of those surveyed scored
below level 3 in at least one area, while more than one
to read well, Australian in three people, 36 per cent, were below in all four
Bureau of Statistics report areas. Only one in four people scored at level 3 or
above in all areas.
finds Among teenagers aged 15 to 19 years, the proportion
with literacy skills in levels 4 and 5 fell from 14.1 per
By Justine Ferrari, education writer.
cent to 9.3 per cent.
Literacy skills among high school students and school While not statistically significant, the drop represents
leavers have dropped over the past 10 years, with about more than 43 000 people.
one in two 15–24 year olds now unable to read at an The ABS says small improvements in literacy have
adequate level. occurred in the 10 years, with a slight but significant
The Australian Bureau of Statistics’ annual report decline of 3 percentage points in the proportion of
on social trends shows the proportion of people aged people with the lowest level of literacy skills. This was
between 15 and 24 with a level of literacy required to partially offset by a 2 percentage-point increase in the
function in society has fallen 3.7 percentage points. In proportion with literacy skills at levels 2 and 3.
1996, almost three in five, 59.1 per cent, could read at The survey also assessed document literacy, which
least at an adequate level compared with 55.4 per cent measured the ability to locate and use information in
in 2006. such formats as job applications, payroll forms and
The fall was most dramatic for teenagers who have bus timetables, and in 2006 measured numeracy and
better literacy skills, with the proportion of teenagers problem-solving skills for the first time.
in the top two levels falling five points in the 10-year About 47 per cent of people had document literacy
period. The only other age group to have a fall in literacy below an adequate level and 53 per cent had inadequate
skills was 35–44 year olds, with a 1.3 percentage point numeracy skills.
drop to 60.7 per cent having an adequate or better level. The social trends report also looks at educational
Literacy levels remained stable or rose in all other age trends and found the large jump in 25–64 year olds with
groups, with the biggest difference among 55–64 year non-school qualifications is not evenly spread across the
olds. In 2006, 45 per cent had adequate or better levels nation. While the proportion attaining qualifications after
of literacy compared with 35 per cent in 1996. school rose from 44 per cent to 57 per cent in major cities
The figures, from the ABS Adult Literacy and Life between 1996 and 2006, it rose only 6 percentage points
Skills Survey, relate to prose literacy, defined as the in very remote areas. The report says the difference is
ability to understand and use information in narrative partly due to the greater proportion of indigenous people
texts, including newspapers, magazines and brochures. living in very remote areas.
The results were ranked in five levels, with level 1 But the proportion of indigenous students aged 15
the lowest and level 3 considered ‘the minimum level to 19 years participating in education continued to rise,
required to meet the increasingly complex demands of from 43 per cent to 51 per cent.
a knowledge society’. The biggest change was among those living in very
The report says about half of all Australians between remote communities, with a 27 per cent rise in those
the ages of 15 and 74 years had literacy skills below undertaking education, to 28 per cent in 2006.
level 3, with 46 per cent having prose literacy skills Source: The Australian, 24 July 2008.
Case study review

1 How do poor literacy skills impact on achieving at school?
2 How would poor literacy schools affect a person learning a new job?
3 Would a person with poor literacy skills succeed in their career? What aspects of
their work would be hampered by this lack of skills?
4 Is there anything an adult can do to overcome this problem? Are there social
issues involved in this solution? What are they and how are they overcome?

The roles acquired by an individual as they move through early adulthood further
add to their experiences and provide them with knowledge and understanding.
How an individual deals with this information is considered part of emotional
development, but acquiring the knowledge and meaning is linked to intellectual
development.
An adult’s ability to reason, solve problems and strategise are all important
components of intellectual development. It is experience gained over time that
leads to a better understanding of the world around us.

1 Define emotional development. 5 The following is a profile from an internet dating
2 Using an example relevant to early adulthood, site:
explain how emotional and social development are Hi, I am a happy, good-natured person who enjoys
interrelated. all the good things life has to offer, especially good
3 Define intellectual development and give an friends, good conversation, good coffee, good food
example that is relevant to young adults. and good health. I enjoy travelling, keeping fit and
4 Using the table below, describe four characteristics golf, but all these things would be sweeter and
of physical, social, emotional and intellectual more enjoyable if they were shared with someone
development for the lifespan stage of early special. I am looking for someone who has a good
adulthood. sense of humour, and is friendly, warm, caring,
honest, loyal, trustworthy, independent, empathetic
Characteristics of development in early and most of all enjoys life.
adulthood (a) Suggest reasons why many adults are keen to
Physical find a partner.
(b) The ability to develop good relationships is a key
aspect of social development. Identify the skills
required to form good relationships.
Social (c) Explain how finding a life partner could impact
on an individual’s emotional development.
6 Find the employment section of a newspaper or an
employment website.
Emotional (a) Select two careers and identify the main
characteristics that you would need to be
successful in these careers.
Intellectual (b) Using the letters I and E, mark each selected
characteristic as being linked to intellectual or
(c) Share your ideas with the class.
10.3 Middle adulthood
KEY CONCEPT Characteristics of physical, social, emotional and intellectual

development associated with middle adulthood
Middle adulthood is the period from 40 to 65 years of age. The changes in physical
development are continuous and vary greatly between individuals, but a gradual
decline in many physiological functions may be evident from the age of 30.
Generally, in middle adulthood the following physical changes are expected
(figure 10.8):
• Bone density is lost. Bone loss, which can begin in the late 30s, accelerates in
the 50s. This will have an impact on the strength and mobility of an individual.
• The metabolic rate decreases and fat deposits accumulate. Weight gain can be
partly linked to changes in the metabolic rate, which tends to slow down in this
phase, and reduced levels of exercise, which lower the overall energy needs of an
individual. Unfortunately, many adults do not reduce their food intake to match
the lowered energy needs and gain weight as a result.
• The number of active cells decreases, leading to decreased need for energy.
• The cardiovascular system goes through significant structural changes as it
ages. The combination of the changes to the heart and the circulatory system
(described below) result in a gradual decrease in a person’s ability to cope with
physical exertion, especially aerobic exercise.
• The heart muscle stiffens from tissue changes. By the late 40s and early 50s, the
healthy muscle tissue is replaced by connective tissue, which causes thickening
and stiffening of the heart muscle and valves. These changes reduce the amount
Men experience a slight
decrease in sperm and Bone density Metabolic rate decreases, Heart muscle and valves
testosterone production decreases leading to weight gain thicken and stiffen
Women experience Walls of the arteries Number of active cells Sense of hearing
menopause harden decreases declines
Eyesight starts to Wrinkles begin to Hair starts to thin and

deteriorate appear turn grey
Figure 10.8 The physiological

changes of middle adulthood

of muscle tissue available to contract the heart and the remaining muscles need
to work harder. The amount of blood that the heart can pump declines from
5 litres per minute at age 20 to about 3.5 litres per minute by the age of 70.
• The circulatory system becomes less efficient. The walls of the arteries harden as
a result of calcification of the arterial walls and the replacement of elastic fibres
with less-elastic fibres.
• Sense of hearing declines. This occurs gradually at first but accelerates after the
age of 40. The speed at which hearing is lost can be linked to environmental
factors such as exposure to constant loud noise. Many work environments
provide protective gear for the ears to reduce the impact of prolonged exposure
to noise. This may explain why men generally experience greater hearing loss
than women as they age. This decline in hearing can have quite an impact on
effective communication and therefore social development.
• Eyesight starts to deteriorate. At about the age of 40, the structure of the eye
changes in a way that results in less light passing through the eye. Consequently
the individual requires more light to complete tasks such as reading. The eyes
also become slower to adapt to changes in light that occur when moving from a
well-lit area to a dark area (e.g. at a cinema).
• Wrinkles start to appear due to loss of skin elasticity. Skin wrinkling is one of the
first outward signs of ageing. The process is quite complex and involves the skin
getting thinner and becoming more fragile. Collagen fibres in the middle layer
lose their flexibility, making the skin less able to regain shape after it has been
pinched. The layer of fat under the surface of the skin, which helps to keep the
skin smooth, also starts to diminish.
• Greying of hair occurs due to loss of pigmentation. Hair can also start to thin in
both men and women.
• Women experience menopause as they move from the reproductive to the
non-reproductive phase of their life. Menopause occurs when the ovaries cease
releasing eggs. The changes begin in the late 40s as the menstrual cycle begins
to become irregular, and is usually complete by the age of 50 to 55. The time of
transition is known as perimenopause. A variety of physical and psychological
symptoms may accompany perimenopause and menopause. These include the
gradual loss and eventual cessation of monthly periods accompanied by decreases
in oestrogen and progesterone levels, changes in the reproductive organs, changes
in sexual functioning, hot flushes, night sweats, headaches, mood changes,
difficulty concentrating, vaginal dryness and general aches and pains. The range
and type of symptoms experienced will vary from woman to woman.
• Males experience a slight decease in the production of sperm and testosterone.
Men do not experience the complete loss of the ability to have children, but
sperm production declines by approximately 30 per cent between the ages of
20 and 60. Sperm quality also declines, although a man at 80 is still capable of
fathering a child.
Social development
Some aspects of social development that traditionally occurred in early adulthood
are increasingly becoming part of middle adulthood due to the delay in selecting
a life partner or getting married, setting up and managing a home and starting
a family.
Learning how to relate to a spouse/partner and developing a successful
relationship is a major aspect of social development in early and middle adulthood.
The increase in divorce rates over the past years has generated a rise in single-parent Figure 10.9 Middle adulthood is a
households, second marriages and de facto relationships. Some adults become time when many people begin to take
grandparents and provide child-care for their grandchildren in this stage, while on the new role of grandparent.
10.3 Middle adulthood
others their age are still engaged in parenting their own children and preparing
them to become responsible and happy adults.
The range of possible lifestyles during this stage of the lifespan is endless. Adults
will develop socially from their career achievements, meaningful relationships
with their partner and other significant friendships, commitments that they have
to various community or social groups (e.g. school, church, sporting groups)
and enjoyable interactions with others. These interactions with family, work
and community allow adults to develop their communication skills and make a
valuable contribution to the improvement of their environment. Establishing, and
maintaining an economic standard of living is an important aspect of adulthood
and drives many decisions relating to work/career, housing and other material
possessions. As children leave home, life priorities often change and relationships
with family and friends are redefined.
Middle adulthood is ideally characterised by self-confidence and an acceptance by
the person of who they are and what they want to achieve (figure 10.10). By this
stage, an individual will have already experienced many successes and failures. The
way they coped with these situations will have shaped their emotional development,
and future experiences will continue to affect this. Interactions with family, work
and community can influence self-concept. Factors such as an
unsuccessful relationship, job dissatisfaction and difficulty coping
with the demands of parenthood can have an impact on the emotional
development of an individual and affect their health status.
Adults need to cope with many challenges during this stage
of their lives. They may face the possibility of unemployment or
retrenchment and the significant impact it could have on their
family. Males in particular feel the pressure to provide for their
family, although as women increasingly take on the role of main
breadwinner they begin to face the same pressures. Adults who
develop enjoyable leisure activities are better able to cope with the
pressures of work and family, and are more likely to lead a healthy
lifestyle.
Figure 10.10 Middle adulthood is Accepting, and adjusting to the physiological changes associated
often characterised by self-confidence. with ageing can be challenging. The community expectation to look younger and
somehow slow down the ageing process is having an impact on many adults’ social
and emotional development. Advancements in medical technology have seen the
development of cosmetic surgery and a surge in its use, while a variety of creams,
potions and lotions all promise the fountain of youth (figure 10.11).
As discussed earlier, intellectual development involves the increased ability to think
and reason and the development of knowledge and skills. Research suggests that
the rate of decline in our ability to think and reason is fairly gentle. During middle
adulthood, knowledge is still being gained and the capacity to store knowledge and
further build permanent memories is limitless. The ability to process information
and solve problems will generally improve during this stage of the lifespan. Life
experiences and maturity often give older people more wisdom than the young.
The onset of mental deterioration can be delayed if adults keep their minds active
as long as possible. Leisure activities like Sudoku and crosswords can help achieve
Figure 10.11 Community
this. Playing certain computer games like ‘Dr. Kawashima’s Brain Training™: How
expectations to look younger create a Old Is Your Brain?’ by Nintendo can also allow adults to improve their response
large market for anti-ageing products. times and thinking skills (figure 10.12).

Figure 10.12 Playing computer
games can help keep the mind
The Brain Age Check will challenge you The speed and accuracy of your response will active by processing information and
with three randomly chosen activities. determine your score, called ‘DS brain age’. reacting as quickly as possible.
TEST your knowledge (d) Identify the suggestions given to reduce the risk
factors of a variety of health problems.
1 Explain how changes in an individual’s metabolic rate
(e) Reducing the onset of dementia has become a
can be linked to weight gain in middle adulthood.
focus for many individuals. What activities have
2 What impact do the changes to the cardiovascular
been recommended?
system have on an adult’s ability to be physically
active? APPLY your knowledge
3 Both eyesight and hearing gradually decline as an 11 Read the following case study and answer the
individual ages. Outline how these physiological questions:
changes may impact on the daily lives of individuals Domenica and Mario are both 44 years old and
in the middle-adulthood stage of the lifespan. have been happily married for 16 years. They have
4 What is menopause? two children, Matthew aged 14 and Chiara aged
5 Outline the main physical changes that take place 10. Domenica works casually for a department
during menopause. store and enjoys the interaction with a variety of
6 Suggest how the physical changes during people, including her work colleagues. Mario works
menopause can affect a female’s social and for a large company as their head of IT. He has just
emotional development. been promoted to manager of his department.
7 Females experience menopause, but do males Mario has worked hard to gain this promotion and
go through any changes in their reproductive is both excited and anxious about this new role
functioning? Explain. and how it will affect him and his family. On the
8 Define intellectual development and provide three weekends both Domenica and Mario are busy trying
examples relating to middle adulthood that illustrate to coordinate and cater to everyone’s needs. Chiara
the definition. plays netball on Saturday mornings and Matthew
9 Use The time of our lives: plays football on Sundays.
episode 1 eLesson in your (a) Identify the main aspects of social development
eBookPLUS to the find the link for this question. for Mario and Domenica’s stage of adulthood.
Watch the video and answer the following (b) Identify the main aspects of emotional
questions. development for Mario and Domenica’s stage
(a) Why do we age? of adulthood.
(b) How does the brain change as it ages and what (c) Identify the main aspects of intellectual
are the consequences of these changes? development for Mario and Domenica’s stage
(c) Identify and explain the factors that may slow of adulthood.
down the ageing process. (d) Predict possible changes in Mario and Domenica’s
10 Use the Ageing disgracefully weblink in your lives over the next ten years that may have an
eBookPLUS to find the link for this question. impact on their social development.
Read the article ‘Ageing disgracefully — get real’ 12 Use the Brain training weblink in your
and answer the following questions. eBookPLUS to find the link for this
(a) Explain what Adele Horin meant by the question.
statement ‘we all get the old age we deserve’. (a) Complete the online brain-training test.
(b) How much longer can women expect to live if (b) You may wish to conduct a survey of two adults,
they reach the age of 60? one male and one female. (They should be the
(c) Apart from genetics, what other same chronological age.) Provide them with
factors can determine how long the same online test and compare their results.
we live? Share your findings with the class.
10.4 Late adulthood
KEY CONCEPT Characteristics of physical, social, emotional and intellectual

development associated with late adulthood, including the physiological
changes associated with ageing
Late adulthood, the final stage of the lifespan, is the period from 65 years of age
until death. During this stage the efficiency and working of the body systems
continue to decline, and the physiological changes of older adulthood become
more visible. Australia’s current life expectancy is 79.3 years for males and 83.9 years
for females, so many adults could spend 18 years or more in late adulthood.
Factors such as genetics, quality of diet, level of physical activity and other lifestyle
choices will determine the impact and speed of the changes associated with ageing.
Physiological changes of late adulthood include the following (figure 10.13):
• Body systems experience a continued and gradual weakening and decline.
• The senses experience a continued decline. Eyesight, hearing, taste, smell and
touch all become less acute.
Aerobic capacity since early Rate of cell replacement
adulthood drops by up to slows down and in some Bone density continues
70 per cent by age 65 cases stops to decline
Muscle tone decreases, together Proportion of fat on the

Spine starts to compact, with muscular strength, ability body increases and body
decreasing height and endurance shape changes
Gums recede and teeth Eyelids thicken and Hair continues to lose
deteriorate and start eye sockets appear more pigmentation (go grey)
to fall out hollow and thin
Skin thins and continues to For men, the prostate gland

Facial hair starts to lose elasticity as more wrinkles enlarges, becomes stiffer and
appear on women and age spots appear may obstruct the urinary tract
Figure 10.13 The physiological

changes of late adulthood

• By the age of 65, the average adult has experienced a 60 to 70 per cent decline
in aerobic capacity since early adulthood. Maintaining fitness throughout
adulthood could reduce this decline to as little as 20 to 25 per cent.
• Physical appearance continues to change, including height, weight and shape:
–– The spine starts to compact, causing older adults to lose height.
–– The proportion of fat on the body increases and muscle tone
decreases, thus changing the shape and appearance of the body.
–– Weight can vary from weight gain to weight loss depending on
individual circumstances such as level of activity, level of health
and the impact of certain physical changes on the adult’s ability to
eat and enjoy food. These changes include a decline in the senses
of taste and smell and the quality of the adult’s teeth.
• Rate of cell replacement slows down and some cells stop being
replaced altogether. Healing times after an injury slow.
• Bone density continues to decline. Once the process begins, women
tend to lose bone density more rapidly than men. The gender
difference can be linked to women having less bone mass than men
in early adulthood, and the depletion of oestrogen after menopause
(which accelerates the process of bone loss). As bones lose mass,
they become hollow inside, turning more porous and becoming more
susceptible to breakage.
• Muscular strength, ability and endurance decline (impacting on motor
skills and reflexes) (figure 10.14).
• Teeth deteriorate and gums recede. Eventually tooth loss occurs .
• Eyelids thicken and eye sockets appear more hollow.
• Hair continues to lose pigmentation (go grey) and thin.
• Facial hair grows on women.
• Skin continues to lose elasticity, creating more wrinkles. It becomes
thinner and age spots appear.
Figure 10.14 Body systems decline and
• For men, the prostate gland enlarges and becomes stiffer, and may physiological changes become more visible during
obstruct the urinary tract. late adulthood.
Social development
In late adulthood, social development could be stimulated by retirement. This
major life event is an exciting culmination of a lifetime of work. Retirement can
also impact negatively and contribute to loss of social contact. Many decisions and
adjustments need to be made — coping with a reduced income, deciding what to
do with the extra time, re-establishing the relationship with their partner (if they
have one), and redefining household roles to ensure harmony. Many adults enjoy
this new-found freedom and spend their time on home improvements, travelling,
sporting interests established earlier or just started, community activities and
volunteering. Physical changes during late adulthood can also have a significant
impact on an individual’s social development. If their mobility is limited, it could
lead to isolation and reduced contact with friends. The loss of a spouse could also
affect an individual’s motivation to interact socially. How individuals spend their
time in late adulthood is dependent on many factors including level of health,
financial status and connectedness to family and friends.
Coping with the many changes associated with ageing is a challenging time during
late adulthood. The transition from work to retirement is a significant social change
(as discussed earlier) and the impact on emotional development can be enormous.
10.4 Late adulthood
For many, coping with the change in routine, feelings of boredom, loneliness and
loss requires a difficult adjustment. Adults who plan and prepare for retirement,
including taking into account their financial situation, find it easier to make the
transition.
Adjusting to decreasing physical strength and health can create challenges. For
many, being unable to do the things they used to do and in the way they always
did them can cause frustration and anxiety. Dealing with the death of a spouse can
be a very emotional time, as the grieving person must learn to cope with life alone
and adjust to a new lifestyle. Although this could happen at any time, it is most
likely to occur in late adulthood (figure 10.15).
The care and support of family and friends is an important part of
dealing with the stresses during this stage. An individual with a limited
support system may face further challenges related to loneliness and
isolation — major concerns for many older adults.
During late adulthood, gains can still be made in intellectual development
through life experiences, but there is a decline in information processing
abilities. Most intellectual abilities will start to decline slowly from about
70 years of age. The rate of decline is affected by biological, behavioural
and social deterinants unique to the individual (see chapter 11). Research
also suggests that the decline in intellectual ability — knowledge,
memory and reaction times — will be affected by the physiological
changes associated with ageing such as decline in eyesight and hearing.
These changes can impact on the ability of the brain to receive the correct
information and then respond appropriately and within a certain time.
The ‘use it or lose it’ motto is apt: practice may not only preserve existing
skills, but also revive supposedly lost or declining skills.
There are many activities that older adults can engage in that may assist
in maintaining or improving their intellectual development. Examples
include participating in bingo games, playing cards, volunteering as
a guide for various historical centres like an art gallery or museum,
or joining adult education classes to learn a new language or skill
(figure 10.16).
Figure 10.15 Dealing with death can
be a difficult transition in any person’s
life.
Figure 10.16 Activities like card

games can help individuals in late
adulthood maintain their intellectual
development.

Case study
Baby boomers to fill the gaps

in life-stage wasteland
By Bernard Salt
I have always thought that the segments of the life
cycle were unfair.
Life begins with infancy, which lasts for a year. Then
there’s toddlers who run amok between one and three
years. Then there’s the preschool, the primary school
and the secondary school stages that take the life cycle
to 17.
Superimposed on these bands are definitions such as
Figure 10.17 Individuals in the active retirement life stage
pre- and post-puberty which roughly equate to before are interested in wellness, wellbeing, travel and staying
and after the age of 12. And then there’s the teenage connected with family.
years, which by definition stretch between 13 and 19.
There’s even a time in life when newspapers refer to Well, I say enough’s enough. I may not be in the
young males as ‘youths’ who seem to inhabit the over-55s space, but I want to ensure that when I do
15-to-17 space. cross the line I’m not lumped in with, you know, old
And this age classification excludes exotic tribes people.
such as hoodlums, hooligans and louts who, often in Look at the marketing of banks and insurance
the company of youths, mill about the late teenage companies: they have special products with special
years. I’m not sure why, but there appear to be fewer marketing for the over-55s. Their logic seems to be,
life-stage tags for young women than for young men. ‘now that you’re old, we’ve got some cool stuff’.
Perhaps men are more aggressively tribal. In the coming decade, I think baby boomers will
Beyond the late teens lie young adulthood, the reposition the over-55 market. No longer will this be
newlywed and the young-parent phases in life. I could a wasteland inhabited by the old and the decrepit but
get all statistical on you here, but these micro phases instead we will see a finer focus. Consider some of the
generally extend from 20 to the early 30s. life stages that boomers are likely to forge in the last
The late 20s and early 30s are known as the 30 years of life.
‘household formation’ stage in the life cycle whereas • Portfolio Lifestyle (55–64): There are 2.5 million
the 40s are often referred to as ‘mature family’. And Australians in this life stage now; this number is
then the concept of naming a group of years for a stage expected to rise by 18 per cent over the coming
in the life cycle mysteriously stops. decade. The portfolio lifestyle stage is a new con-
Occasionally ‘mature family’ is extended to 54, cept invented by baby boomers as a precursor to
but anything thereafter is known collectively as the retirement. In this stage, boomers partly work and
over-55s. The only life forms to carve out separate partly focus on lifestyle. They resign and come back
existences beyond 55 are the grey nomads and the to work as a consultant, a contractor, a mentor or,
retirees. ultimate boomer fantasy, a non-executive director.
Now this is what I find unfair. Life expectancy Ahhh, directors’ fees for doing not that much. You
extends to the mid-80s, which means that all of life’s do realise that public company boards are set to
last 30 years are barely distinguishable. explode with boomers all scrambling for a seat.
No one under 50 cares about the personal growth that • Active Retirement (65–74): There are 1.6 million
might take place between 65 and 70. To young people, Australians in the active retirement stage of life at
this half-decade swishes about within a bigger grab-bag the moment, but by 2020 this number will be 47 per
of old age. And yet in the under 40 space every few cent higher. Active retirees are interested in wellness,
years is tagged and admired. wellbeing, travel (includes grey nomads), connecting
(continued)
10.4 Late adulthood
with adult children (using new technology) and • Frail (85-plus): There are 401 000 people aged
sharing time with grandchildren. Active retirees 85-plus in Australia now; by 2020, this number is
pursue clubs, volunteering opportunities and spiri expected to be 547 000. By this stage in life, many
tual growth. people are utterly alone in the sense that few friends
• Going Solo (75–84): There are 994 000 people in survive. Life partners are also unlikely to survive in
this age group now; by 2020, this number will rise tandem: typically, one outlasts the other. Social cir-
by 33 per cent. Most Australians die in this decade, cles and physical mobility close ranks. The 85-plus-
which means there will be a shift from older couple year-old is largely, if not entirely, reliant upon family
households to older single households. and institutional support.
Going solo is fine and dandy at 25; at 80 it’s a There are 30 years of life beyond 55 that are
different story. A wider circle of friends evaporate or, now available to many Australians. At the moment
more properly, die off by this stage. Work contacts have this space is a wasteland, but over the next decade I
long since withered. What is left is a tight circle based have no doubt it will blossom and yield a number of
around children and young adult grandchildren. interesting submarkets. These submarkets might not get
The challenge in this stage of the life cycle is as microscopic as the stages that mark childhood, but
maintaining solo living, which requires an involved surely there’s a need to realise that not everyone over
extended family and broader community support. the age of 55 is the same.
Source: The Australian, 25 November 2010.
Case study review

1 Describe how Bernard Salt identifies the following age groups:
(a) the late 20s to early 30s
(b) the 40s
(c) the over-55s (last 30 years of life).
2 With life expectancy increasing to over 80 years, much more time is spent in the
late adulthood stage of the lifespan.
(a) What suggestions have been made to redefine some of the subgroups within
this stage of adulthood?
(b) Identify the current and projected statistics for each of these groups.
(c) Identify the key characteristics suggested for each group and categorise them
as physical, social, emotional or intellectual development by placing a P, I, E or
S next to each one.
TEST your knowledge for this question. Watch the video and answer the
following questions.
1 Describe the characteristics of physical, social,
(a) Outline the factors that are linked to the speed
emotional and intellectual development in late
at which an individual ages.
adulthood.
(b) As an individual ages, their ability to cope with
2 Select three of the physiological changes of late
the physical, social and emotional changes can
adulthood. Identify the main factors that may
be challenged.
contribute to variations in the impact and speed of
i. Create a list of suggestions for the actions
these changes on an individual.
that people can take to successfully adjust to
the ageing process.
ii. Investigate community resources that may be
3 Use The time of our lives: available to assist in the successful adjustment
episode 2 eLesson in your into old age.
eBookPLUS to the find the link

10.5 The health status of Australia’s adults
KEY CONCEPT The health status of Australia’s adults, including similarities and
differences between adult males and females
The age group of 25–64 years represents 54 per cent of the population. It includes
both early and middle adulthood, a stage of the lifespan where many changes are
taking place and where health issues are likely to emerge.
For adults aged 65 and over, good health is a precious asset that allows them
to enjoy a good quality of life, stay independent and participate fully in the
community. The Australian population is getting older and as a result the demand
for health-care services continues to increase. On a national level the improvement
of the health of older Australians is now a priority.
The health behaviours of individuals
in the first 25 years of their lives will 95
0 (birth) 1 15 25 45 65 85
set the foundation for their future.
90
Generally, people in this age group
Life expectancy (years)
experience good health, but maintaining 85

good health as an individual ages is a
challenge because getting older is itself 80
a risk factor for ill health.
Health status is the level of health of 75
an individual, community or group.
70
According to the Australian Institute of
Health and Welfare (AIHW), the life 0
expectancy of Australians has increased Males Females
by more than six years over the past For the Aboriginal and Torres Strait Islander population in 2005–2007, life expectancy was estimated to be 11.5 years
lower than of the non-Indigenous population for males (67.2 years compared with 75.7) and 9.7 years lower for
decade. Life expectancy changes over females (72.9 years compared with 82.6).
the course of a person’s life, due to Figure 10.18 Life expectancy at
changing patterns of mortality. Also if a person is able to survive to a certain age, different ages, by sex, 2008–2010
their chance of reaching older age increases (refer to figure 10.18). Males at age 65 Source: ABS 2011.
are now expected to live to about 83.9 years and females to about 86.8 years.
Females have a higher life expectancy than males at all stages of the lifespan,
however they tend to spend more years in poor health (refer to figure 10.19). It is
important to examine the patterns of health behaviours to improve the health
status of the current population and prepare for the health needs of the future
generations.
25
With a severe or With disability but no severe Free of disability
profound core or profound core activity
20 activity limitation limitation
5.6
3.5 5.5
15 3.0
Years
6.5
7.0 5.6
10 6.0
5 9.7
8.2 8.7
7.1
Figure 10.19 Expected years of life
0 at age 65, 1998 and 2009
1998 2009 1998 2009
Source: Australian Institute of Health and Welfare,
Men Women Australia’s Health 2012 – in brief, p. 7.
Burden of disease
The impact of conditions causing illness, impairment, injury or premature death —
known as ‘burden of disease’ — is estimated by the AIHW using the DALY (disability
adjusted life years, discussed in chapter 2). According to the Australian Institute
of Health and Welfare (AIHW) report Australia’s health 2010, the conditions that
cause the most burden to people aged 25–34 years are anxiety and depression
for both males and females. This accounts for 12 per cent and 27 per cent of all
DALYs for males and females respectively. Suicide, self-inflicted injuries, substance
use disorders and road traffic accidents also featured highly in the 25–34 year age
group for males, while migraine, schizophrenia and infertility were included in the
top five for the 25–34 year age group for females.
In contrast, chronic diseases and cancer were the main causes of burden of
disease in the 55–64 year age group. Coronary heart disease was the largest single
contributor for males in this age group, while breast cancer caused the greatest
burden for females. Vision changes, hearing loss, type 2 diabetes and lung cancer
were also included in the top five conditions, causing disease burden for both sexes
Figure 10.20 Having blood pressure aged 55–64 years. As the population ages, the possibility of having to cope with
checked regularly and treated if
necessary reduces the risk of stroke.
more than one chronic condition increases. The clinical management of this is
linked with increased health care costs and a poorer quality of life. The term
comorbidity is often used to describe more than one illness, health condition or
disorder experienced by a person at the same time. Figure 10.21 shows the
percentage of males and females who have more than one chronic condition. For
males and females, arthritis and high blood pressure was the most common
combination of conditions (see table 10.1).
25
One Two Three Four or more
20
Figure 10.21 Number of selected 15

Per cent
self-reported chronic conditions, by

sex, 2007–08
Note: Chronic conditions are self-reported and
10
comprise asthma, Type 2 diabetes, ischaemic
heart disease, cerebrovascular disease, arthritis,
osteoporosis, COPD, depression and high blood 5
pressure.
Source: Australian Institute of Health and Welfare, 0
Australia’s Health 2012, p. 354. Males Females
Table 10.1 Top three combinations of selected chronic conditions reported, 2007–08
Males Females
Chronic conditions (‘000) Per cent Chronic conditions (‘000) Per cent
High blood pressure 125.4 1.2 High blood pressure and 237.4 2.3
and arthritis arthritis
High blood pressure 59.8 0.6 Osteoporosis and 120.3 1.2
and Type 2 diabetes arthritis
Depression and arthritis 55.8 0.5 Depression and arthritis 101.8 1.0
Note: Chronic conditions are self-reported and include asthma, Type 2 diabetes, ischaemic heart disease,
cerebrovascular disease, arthritis, osteoporosis, COPD, depression and high blood pressure.
eLesson: Among older Australians aged 65 years and over, the two leading causes of death
Prevalence of conditions for both males and females were coronary heart disease and cerebrovascular
Searchlight ID: eles-1039 diseases (stroke). Dementia and Alzheimer’s disease also featured prominently as
the third most common cause of death for older females and the sixth for older

males. It is projected that the number of Australians being diagnosed with dementia
will increase from 298 000 in 2011 (see table 10.2) to 400 000 by 2020, and to
reach 900 000 by 2050.
Table 10.2 Estimated number of people with dementia, by age and sex, 2011
Per cent Number(a)
Age Males Females Persons Males Females Persons
Under 65 11.1 6.1 8.0 12,600 11,300 23,900

65–74 22.3 15.6 18.1 25,200 28,900 54,100
75–84 35.2 31.1 32.7 39,800 57,500 97,400
85+ 31.5 47.1 41.1 35,600 87,500 122,600
Total: 65+ 88.9 93.9 92.0 100,700 173,400 274,100
Total 100.0 100.0 100.0 113,300 184,700 298,000
(a) Numbers may not sum to the total due to rounding.

Source: Australian Institute of Health and Welfare, Dementia in Australia, 2012, cat. no. AGE70, Canberra, p. 25.
These diseases are strongly age-related, and because the life expectancy of
females is longer than that of males, there are larger numbers of females than males
in the older age groups. Females are therefore more likely than males to develop
these diseases and die from them.
Lung cancer and colon and rectum cancer are also prominent for both sexes;
while prostate cancer and breast cancer were prominent sex-specific causes of
death (table 10.4).
Mortality
Deaths occurring during early and middle adulthood are seen as premature given
that life expectancy has increased. Referring to table 10.4, the leading cause of
death for both men and women in 2009 was coronary heart disease. Lung cancer
was ranked number two for men and number four for women and stroke was
ranked three for men and second for women. These diseases can be easily affected
by lifestyle and behavioural factors, as can a number of the other conditions listed
in the top ten causes of death. These factors include physical inactivity, insufficient
consumption of fruit and vegetables, a diet high in saturated fats, and smoking and
alcohol consumption, to name just a few.
Table 10.3 Leading causes(a)(b) of death by sex and age group, 2007
Males Females
Age group Cause of % of Cause of % of

(years) death Deaths deaths death Deaths deaths
25–34 Suicide 300 22.3 Suicide 73 12.5
Land transport 206 15.3 Land transport 45 7.7
accidents accidents
Accidental 128 9.5 Accidental 27 4.6
poisoning poisoning
35–44 Suicide 319 15.0 Breast cancer 167 13.6
Coronary heart 204 9.6 Suicide 85 6.9
disease
Land transport 148 7.0 Lung cancer 47 3.8
accidents
(continued )
Table 10.3 (continued )
Males Females
Age group Cause of Deaths % of Cause of % of

(years) death deaths death Deaths deaths
45–54 Coronary heart 644 15.1 Breast cancer 376 14.3
disease
Lung cancer 271 6.4 Lung cancer 222 8.5
Suicide 270 6.3 Coronary heart 123 4.7
disease
Colorectal 123 4.7
cancer
55–64 Coronary heart 1 296 16.2 Breast cancer 581 12.0
disease
Colorectal 388 4.9 Coronary heart 308 6.4
cancer disease
Total 25–64 Coronary heart 2 182 13.9 Breast cancer 1 144 12.4
disease
Lung cancer 1 187 7.6 Lung cancer 815 8.8
Suicide 1 069 6.8 Coronary heart 480 5.2
disease
(a) Based on commonly accepted ICD-10 groupings.
(b) The category ‘Event of undetermined intent’ ranks in the leading causes of death for males and females 25–34
and 35–44 years. However, these deaths were excluded from the tabulation as they are subject to a revision
process by the ABS upon further information from the coroner.
Source: Australian Institute of Health and Welfare 2010, Australia’s health 2010, cat. no. AUS 122, Canberra, p. 318.
Table 10.4 Leading causes of death, by sex, 2009

Males Females
% of all male % of all female

Rank Cause of death Number of deaths deaths Cause of death Number of deaths deaths
1 Coronary heart disease 12,047 16.7 Coronary heart 10,476 15.3
disease
2 Lung cancer 4,761 6.6 Stroke 6,706 9.8
3 Stroke 4,514 6.2 Dementia and 5,491 8.0
Alzheimer’s disease
4 Chronic lower 3,209 4.4 Lung cancer 3,025 4.4
respiratory diseases
5 Prostate cancer 3,111 4.3 Breast cancer 2,772 4.1
6 Dementia and 2,786 3.9 Chronic lower 2,769 4.0
Alzheimer’s disease respiratory diseases
7 Colon and rectum 2,253 3.1 Diabetes 2,050 3.0
cancer
8 Blood and lymph cancer 2,175 3.0 Heart failure 1,884 2.8
(including leukaemia)
9 Diabetes 2,120 2.9 Diseases of the 1,818 2.7
kidney and urinary
system
10 Suicide 1,631 2.3 Colon and rectum 1,812 2.6
cancer
Total 10 leading 38,607 53.4 Total 10 leading 38,803 56.7
Total all causes 72,320 Total all causes 68,440
Source: Australian Institute of Health and Welfare, Australia’s Health 2012, p. 93.

Case study
Losing your self don’t even realise it,” says Mandy, who has scaled back
her private psychology practice to support her husband.
Alzheimer’s is not just an old person’s disease — some “We have our dark times about this,” she continues,
sufferers begin to experience symptoms in their 40s. “where we notice the reality, when you notice something
Miriam Cosic explores a world where logic fails and new that he can’t do. That’s the bit that scares me and
memories fade, but where there is still time to appre- I’m sure it scares Garry.”
ciate life. Alzheimer’s is the most common form of dementia —
“This narrative is us,” neurologist Oliver Sacks some 260,000 Australians are estimated to have the
wrote. Who you are right now is the sum total of what disease, a figure that some experts predict will quadruple
you’ve done and thought: your childhood and school in 20 years. While it is generally thought of as an old
days, your career, your marriage, your children, your person’s disease, 10 per cent of sufferers get it while
friends, your likes and dislikes, your skills, what you’re still young (by medical criteria, that means under age
hopeless at, your moral code. 65). There are several forms of early-onset dementia —
So imagine if that narrative starts to unravel, if black Alzheimer’s is just one — and while most sufferers are in
holes appear in your happiest memories, your most their 40s, 50s or early 60s, dementia can strike as early as
intimate thoughts, your accumulated knowledge, even the 20s or 30s, often due to head injury or AIDS, or as a
your most basic skills, so that you no longer know how
side-effect of acute disease (one recent case was a teenager
the bread in your hand relates to the shiny appliance
who got it as a dreadful aftermath of encephalitis).
with the slots in front of you. And imagine how
Noel Hackett was diagnosed with Alzheimer’s six years
traumatic this process of unravelling would be if you’re
ago, at the age of 59, after a year of small but mounting
in the prime of life, have just met the love of your life
bafflements. He was working in a government counselling
and are paying off a mortgage.
service for the long-term unemployed, half of whom were
Garry Lovell, 50, knew in his late 30s that he had
homeless. He knew something was seriously wrong when
the gene that could lead to early-onset Alzheimer’s.
he couldn’t get his head around a new computer system.
His mother had got it at 51, and he nursed her until
Small failures of memory had caught him out before, but
her death 10 years later. Tormented by not knowing his
likely fate, he sought testing for the gene in 2001, very this was like a brick wall. Sometimes his younger clients,
early in his relationship with his partner Mandy. “I said weaned on screen-based technology, would help him out,
to her, ‘Look, it’s a horrible thing and it’s okay if you cover for him, while they were in his office.
don’t want to go out with me any more,’” he says. “But “I lost my sense of purpose and my sense of being
she said, ‘I’m never going to do that.’” capable,” he says, “I used to go to meetings and I’d be
That must be true love. “It is,” he replies seriously. thinking, ‘I hope no one asks me a question about that.’ ”
“We love each other a lot.” He worried for a while, talked it over with his wife,
In 2010, changes in Garry’s short-term memory put thought it might be stress and reduced his working
the couple on alert. Just before Christmas, his annual hours. On his first Friday off, in October 2007, he
test confirmed he had the disease. The gene had been went to see his doctor, an old friend. Hackett was one
expressed: he was 46, his wife was 39. A partner of the fortunate ones: some people with younger-onset
in a Melbourne landscaping business that planted dementia struggle for years to find out what’s wrong.
indigenous trees, Garry soon had to quit his job. Hackett’s doctor was onto it straight away and sent
While he misses his job, he still enjoys gardening. him for a battery of tests, including those designed to
He’s a champion dishwasher stacker, Mandy says, preclude other possibilities that can cause dementia-
though he has trouble remembering where things go like symptoms, such as vitamin B deficiency or a
afterwards. He still helps in the kitchen — chopping brain tumour. His doctor referred him to a neurologist,
vegetables, for example — and safety is not an issue. warning that it might be Alzheimer’s, but it took
But the logistics of cooking, such as juggling timing, another year before that was confirmed. Hackett’s wife,
are too hard. “We rely on our memories so much, we Jenny Fitzpatrick, says: “It was a very long year, 2008.”
(continued)
The final diagnosis felt like a “whack to the back of dissected the brain of a dead dementia patient and
the head”, Hackett says. “I could see a very dark, long described the build up of amyloid proteins into plaques
road.” and the growth of neurofibrillary tangles. Since then
His concentration as he talks is palpable, as if he’s our understanding has come a long way. Scientists can
feeling his way from sentence to sentence, like walking plot brain-cell death, brain lesions and atrophy, and
in the dark, avoiding a steep drop. know that they lead to memory loss, disorientation
Hackett and Fitzpatrick, a teacher who stopped and hallucinations, and that eventually the brain will
work to care for her husband, live in a suburban flat in forget to direct basic bodily functions, such as chewing,
Sydney. They are fun to be with, all gentle banter and breathing and expelling waste.
laughter. Conversation is halting, however, and Hackett We once thought what we called senility was just
often trails off mid-sentence. He likes to laugh so much a stage of being; now we know that Alzheimer’s is
it is difficult to know when he is parodying himself and a terminal illness. We can see the affected areas on
when he has actually lost his train of thought. But away MRIs. We can test for a faulty gene in the cases that are
from the presence of outsiders, when they stop putting genetic, but we still don’t know exactly why it happens
their best face on, there have been terrible moments of or how to prevent or cure it. Younger-onset dementia is
sadness and grief. the more inexorable condition: usually genetic and so
Earlier in his life, Hackett was a priest. Now his both heritable and transmissible. Late-onset is a yet to
faith comes and goes. Sometimes, when he feels low, be properly defined combination of genes, environment
life just seems “bloody crappy”, he says. Other times, and general health.
like when he sits on his balcony on a balmy day and That dementia comes in more than 100 forms, each
listens to the birds sing, the world expands. “I think the with its own causes, presents problems for both diagnosis
big picture is immeasurable,” he says, adding that he and research. At the top of the list are: Alzheimer’s
doesn’t try to conjure God. “And I don’t chase grace,” disease, which accounts for more than 50 per cent
he continues. “I don’t chase God to give me another of cases; vascular dementia, which relates to general
year. I don’t think like that at all.” vascular health; fronto-temporal lobar degeneration (most
Adrienne Withall, co-leader of Inspired, a research commonly seen in young-onset dementia), which causes
collaboration between the University of NSW, the behavioural problems including disinhibition; dementia
University of Sydney and several major hospitals, caused by head injuries, including sporting injuries (being
says that behavioural problems are more common in punch-drunk, for instance); and alcohol-related dementia.
younger-onset Alzheimer’s sufferers. Parents can appear Withall shudders when she thinks of young people’s
apathetic to their children, as though they don’t love lifestyles choices. “I look at some of the drugs around at
them. “People think if a person’s apathetic and just the moment, like ice, and I think it’s going to be really
sitting in a chair, it’s not too much of a problem. But it terrifying. Someone in the Inspired study is working with
is for children who don’t understand why their parent drug and alcohol services to see who this population is
suddenly doesn’t seem to care about them. And the other and how we are going to manage them later on.”
parent often has to work two jobs to keep up the family Keeping the mind active seems to delay onset, which
finances and they become a bit more absent, too.” is why those hoping to age gracefully are busy solving
Withall mentions an Australian woman in her 30s crosswords and Sudoku, and learning new languages.
who was diagnosed with Alzheimer’s, a single mother “We now know you can live with a degree of brain
with two young sons, both special-needs children. She is atrophy or tissue loss or amyloid load, and it’s variable as
racing against the clock to raise her children as well as to how it affects people,” says David Ames, a Melbourne
she can and ensure that they are provided for before the University professor who specialises in Alzheimer’s. “So
illness claims her. At least she was given time to prepare. you see people who have got significant brain atrophy
Diagnosis for younger-onset patients can take years. When on a scan, who are still performing quite well. And you
a 45-year-old comes in complaining of memory loss and see, particularly in young-onset cases, people who don’t
strange behaviour, Alzheimer’s is the last thing most GPs look as though they’ve got much brain atrophy at all and
think of. Work or marital stress, depression or menopause yet they’ve got cognitive difficulties.”
are what immediately come to mind, and antidepressants More highly educated people seem to deteriorate
or hormone replacement therapy prescribed. more slowly and have more brain damage by the
Alzheimer’s disease was first identified in 1906, time they notice a decline in their faculties. A New
when a German neurosurgeon, Alois Alzheimer, York professor of clinical neuropsychology, Yaakov

Stern, developed the “cognitive reserve” hypothesis. Even if it doesn’t strike us personally, Alzheimer’s
“If you’ve had the opportunity to be well-educated, will cast its shadow on many of us.
you have more connections to damage, and you can “I’ve come to the realisation that when we talk about
cope with more injury to your brain before it becomes dementia to other groups, we’re actually talking about
apparent,” says Ames. In other words, the more cells ourselves,” says John Watkins of Alzheimer’s Australia.
and connections your brain has made, the more it can “Because if you’re a woman, and you live to 95, one
afford to lose. in two women will have dementia. So it’s something
Researchers have isolated various gene abnormalities that’s going to impact many of us.”
that can cause Alzheimer’s, but they don’t yet know Garry Lovell is making the best of what life has dealt
what to do with the information. “I’ve been saying for him. He says he still enjoys his friends’ company, though
20 years there will be a cure in five, and we still don’t conversation in large groups is impossible. He plays a bit
have it,” says Henry Brodaty, professor of ageing and of golf and has taken up tennis. “I’m just trying to live
mental health at the University of NSW. Billions of it up and not worry about what might happen,” Garry
dollars are being pumped into clinical, epidemiological says. “If you kept thinking about it and think, ‘Why me?’,
and drug research because the eventual pay-off will you’re going to miss out on the next two years.”
be astronomical. “It’s huge money,” Brodaty says,
estimating that a cure could be worth $20 billion a year. Source: Good Weekend, Sydney Morning Herald, 2 March 2013.
Case study review

1 What is Alzheimer’s disease?
2 (a) How many Australians are estimated to have Alzheimer’s disease?
(b) How is this expected to change in the next 20 years?
3 Identify some of the causes suggested for the early onset of dementia.
4 Identify two illnesses that produce dementia-like symptoms.
5 Describe how Alzheimer’s disease was first identified.
6 Dementia comes in many forms. List and explain some examples.
7 ‘Highly educated people seem to deteriorate more slowly and have more brain
damage by the time they notice the decline.’ What reason is suggested for this
observation?
TEST your knowledge (b) What is the most common type?

(c) Who has dementia?
1 Referring to figure 10.18, explain why life
expectancy increases as age increases. APPLY your knowledge
2 Both males and females are living longer; however
they are not necessarily in good health. Using the 6 Refer to table 10.3 to answer the following
data from figure 10.19, suggest how poor health questions.
status may impact on an individual’s life. (a) Compare and contrast the leading causes of
3 What is meant by the term comorbidity? death for males and females in each of the age
(a) How does it impact on the cost of health care in brackets.
Australia? (b) What conclusions can be drawn about the
(b) What are the most common disease health status of males compared to females?
combinations? 7 Refer to table 10.4 to answer the following
4 Referring to table 10.2, identify two trends in the questions.
estimated prevalence of dementia. (a) Identify any differences in the leading causes of
5 Use the Dementia weblink in your death for males compared to females.
eBook PLUS to find the link for (b) Draw detailed conclusions about the health
this question. status of males compared to females.
(a) What is dementia?
Key SKILLS The health and individual human development of
Australia’s adults
KEY SKILL Interpret data on the health status of

Australia’s adults
The ability to interpret data is a vital skill in the study of health and individual
human development. Data can be presented in a variety of forms (notably in tables
and figures). It is important to have an understanding of what information is being
presented and to learn how to interpret the information.
• The first step is to note the title of the data. This provides an indication of the
type of information being presented.
• In the case of a table, identify the column headings and any subheadings that
❶ The table is numbered. The title might be included.
consists of a brief description of the • In the case of a figure (e.g. a line graph or bar graph), identify the horizontal and
content and the date.
vertical axis labels.
❷ The two major column headings are • Pay attention to any notes about the data that might be included at the bottom
‘Cause of death’ and ‘Age group’. of the table or figure.
‘Age group’ has a further level of
heading that includes spans of years. • Note the units of measurement that are being used in the data.
• Once the data have been carefully observed, it is possible to identify trends
❸ Note that the final rows present the and patterns; for example, a trend might be the decline in rates of smoking in
total for the combined age group.
They present the key data (i.e. the developed countries since the 1980s.
top three causes of death). Further consideration of data may generate a range of questions, such as:
❹ Note these important subheadings (a) What factors may have led to this trend or pattern?
(Males and Females). It would be easy (b) What are some possible implications of this data? (Health data highlights
to misunderstand the significance areas of need and allows governments to focus their planning and use of
of the data if these headings were
missed.
resources.)
(c) Has the data supported popular thinking or provided new or unexpected
❺ The note explains the significance of insights?
the (a) (b).
Below is table 10.3, featured in the previous section.
➎ ❶
Table 10.3 Leading causes(a)(b) of death by sex and age group, 2007
Males❹ Females❹
Age group (years)➋ Cause of death➋ Deaths % of deaths Cause of death Deaths % of deaths
25–34 Suicide 300 22.3 Suicide 73 12.5
Land transport accidents 206 15.3 Land transport accidents 45 7.7
Accidental poisoning 128 9.5 Accidental poisoning 27 4.6
35–44 Suicide 319 15.0 Breast cancer 167 13.6
Coronary heart disease 204 9.6 Suicide 85 6.9
Land transport accidents 148 7.0 Lung cancer 47 3.8
45–54 Coronary heart disease 644 15.1 Breast cancer 376 14.3
Suicide 270 6.3 Coronary heart disease 123 4.7
Colorectal cancer 123 4.7
55–64 Coronary heart disease 1 296 16.2 Breast cancer 581 12.0
Colorectal cancer 388 4.9 Coronary heart disease 308 6.4
Total 25–64 ➌ Coronary heart disease 2 182 13.9 Breast cancer 1 144 12.4
Lung cancer 1 187 7.6 Lung cancer 815 8.8
Suicide 1 069 6.8 Coronary heart disease 480 5.2
(a) Based on commonly accepted ICD-10 groupings.

(b) The category ‘Event of undetermined intent’ ranks in the leading causes of death for males and females 25–34 and 35–44 years. However, these deaths were
excluded from the tabulation as they are subject to a revision process by the ABS upon further information from the coroner.➎

The following trends and patterns can be identified from table 10.3:
• Suicide is the leading cause of death for both males and females in the 25–34
age group.
• Coronary heart disease is the leading cause of death for all male age categories
except the 25–34 age group and the 35–44 age group.
• Breast cancer is the leading cause of death for females in all age groups except
for the 25–34 age group.

1 Define burden of disease.
2 Refer to table 10.3. List the top cause of death for each age group for:
(a) males
(b) females.
3 Dementia and Alzheimer’s disease are a more common cause of death for females.
Provide a possible reason for this trend.
4 Use the Government fights battle of the bulge weblink in your
eBookPLUS to find the link for this question.
(a) What is the main aim of extending the ‘Measure Up’ campaign?
(b) Identify some of the sustainable actions that are being recommended for
Australians to improve their overall health.
(c) What are the long-term objectives of the ‘Measure Up’ campaign?
CHAPTER 10 review
Chapter summary
• Adulthood is the longest stage of the lifespan and can be divided into three stages:
Interactivities: early (19–40 years), middle (40–65 years) and late (65+ years) adulthood.
Chapter 10 crossword
• Early adulthood is when the body should be at its peak physical condition.
• Middle and late adulthood bring a steady decline in many physiological functions.
• Biological, behavioural and environmental (physical and social) determinants can have a
major impact on the progress through the adulthood stage of the lifespan.
• The social development of adults is reliant on the quality of interactions an adult has
with the people around them including family, partner, work, leisure and community.
• The ability to cope with the multitude of changes that occur in adulthood is an
important part of emotional development.
• The ability to think, reason, and effectively use memory skills is part of intellectual
development.
• Health status refers to the level of health of an individual, community or group.
• The life expectancy of Australian adults has increased by six years over the past decade
for both men and women. Males at 65 years are now expected to live to about 83.9
years and females to about 86.8 years.
• Australian adults generally experience good health.
• The main causes of mortality are coronary heart disease for men and breast cancer for
women.
A POEM ON AGEING
When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was wrongly assumed that she had
nothing left of any value. But later, when the nurses were going through her meagre possessions, they found this poem. Its
quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.
Look closer At forty, my young sons have grown and are gone,
What do you see, nurses, what do you see? But my man’s beside me to see I don’t mourn.
What are you thinking when you’re looking at me?
A crabby old woman, not very wise, At fifty once more, babies play ‘round my knee,
Uncertain of habit, with faraway eyes? Again we know children, my loved ones and me.
Who dribbles her food and makes no reply Dark days are upon me, my husband is dead;
When you say in a loud voice, ‘I do wish you’d try!’ I look at the future, I shudder with dread.
Who seems not to notice the things that you do, and For my young are all rearing young of their own,
Forever is losing a stocking or shoe … And I think of the years and the love that I’ve known.
Who, resisting or not, lets you do as you will, I’m now an old woman … and nature is cruel;
With bathing and feeding, the long day to fill … ’Tis jest to make old age look like a fool.
Is that what you’re thinking? The body, it crumbles, grace and vigour depart,
Is that what you see? There is now a stone where I once had a heart.
Then open your eyes, nurse; you’re not looking at me.
But inside this old carcass a young girl still dwells,
I’ll tell you who I am as I sit here so still, And now and again, my battered heart swells.
As I do at your bidding, as I eat at your will.
I’m a small child of ten … with a father and mother, I remember the joys, I remember the pain,
Brothers and sisters, who love one another. And I’m loving and living life over again.
A young girl of sixteen, with wings on her feet, I think of the years … all too few, gone too fast,
Dreaming that soon now a lover she’ll meet. And accept the stark fact that nothing can last.
A bride soon at twenty — my heart gives a leap, So open your eyes, people, open and see,
Remembering the vows that I promised to keep. Not a crabby old woman; look closer … see ME!!
At twenty-five now, I have young of my own, By Phyllis McCormack
Who need me to guide and a secure happy home.
A woman of thirty, my young now grown fast,
Bound to each other with ties that should last.
Remember this poem when you next meet an old person who you might brush aside without looking at the young soul within.
We will one day be there, too.

TEST your knowledge 4 Research current media, songs and poems that are
related to adulthood and ageing and select one.
1 For each phase of adulthood, list two significant
(a) Analyse the images of ageing that they are
examples of physical, social, emotional and
representing. Are they accurate? Explain, using
intellectual development. You might like to
examples to support your response.
complete a table similar to the one shown below.
(b) Share your findings with the class.
Development/
5 Read the following case study and answer the
stage Physical Social Emotional Intellectual following questions:
Grace is a 68-year-old grandmother of two. She
Early adulthood 1. 1. 1. 1.
lives alone after the death of her husband four years
2. 2. 2. 2. ago. Grace tries to keep busy. She baby-sits her
grandchildren, enjoys baking and feels good when
2 (a) i. Identify examples from A poem on ageing she can help her two daughters cope with their busy
of changes that occur in each stage of lives. On three days a week she attends the local
adulthood. gym for the ‘Live longer, live stronger’ program.
ii. For each change identified, discuss the impact Her strength and physical endurance have improved
on the social, emotional and intellectual significantly since she started six months ago. After
development of an individual. the class, the participants (all over the age of 60)
(b) Explain how the ‘old woman’ is feeling. sit and have a drink together and socialise. Grace
(c) Provide two reasons why old age is perceived in has participated in group activities with the class,
a negative way. including a ‘Christmas in July’ lunch and a trip to
(d) Does reading this poem affect your perception the local market. Grace has made some wonderful
of ageing? Explain. friendships and looks forward to these sessions.
(a) Analyse Grace’s activities and identify the
APPLY your knowledge different types of development (physical, social
3 Listen to the song ‘When I’m 64’ by the Beatles. emotional and intellectual) that each provide.
(a) Is the perception of ageing in this song mainly (b) What other community resources are available
positive or negative? Use examples from the for older adults to help keep them actively
song to support your response. involved after their retirement?
(b) What changes could you recommend to make the (c) Identify the main causes of mortality for females
song more representative of a 64-year-old today? in Grace’s stage of adulthood.
CHAPTER 11

of Australia’s adults
have an impact across all stages of the lifespan and are just
as important during adulthood as they are at other stages.
During childhood and youth, factors that impact on the
individual determine their current and future health status. For
adults, particularly older adults who experience the highest
rates of morbidity and mortality, the determinants of health
and individual human development play a key role in their
health status as well as their ability to maintain or enhance
individual human development. These determinants include
biological, behavioural and social factors, as well as the
physical environment. While it is not necessary to study all
of the determinants outlined in this chapter, a range has
been presented for you so that you can select one from each
category.
KEY KNOWLEDGE
3.5 determinants of health and individual human development of
Australia’s adults, including at least one from each of the following:
–– biological, such as genetics, body weight, blood pressure and blood
cholesterol (pages 340–54)
–– behavioural, such as sun protection, smoking, physical activity, food
intake, alcohol and drug use and sexual practices (pages 355–75)
–– physical environment, such as housing, workplace safety,
neighbourhood safety and access to healthcare (pages 376–86)
–– social, such as media, level of education, employment status and
income, the workplace, community belonging; that is, voluntary
work and social connections, living arrangements, social support,
family and work–life balance (pages 387–403).
KEY SKILL
and their impact on adults, using relevant examples.
Figure 11.1 The determinants

of health and individual human
development play a key role in the
health status of adults.

atherosclerosis narrowing of the arteries due to a build-
up of fatty deposits or ‘plaques’ that reduce blood flow
bowel cancer growth of malignant cells in the bowel
cerebrovascular disease a group of brain conditions
related to a disease of blood vessels supplying the brain
colonoscopy medical procedure to examine the large
bowel with a small camera
coronary heart disease conditions affecting the arteries
that supply the heart muscle
diastolic blood pressure a measure of the minimum
pressure in the arteries when the heart muscle relaxes
between heart contractions
endometriosis growth of the tissue that normally lines
the uterus in sites outside of the uterus such as the ovaries
familial hypercholesterolaemia a genetic condition in
which affected members of a family have high levels of
LDL cholesterol in their blood
genetic predisposition an inherited genetic pattern that
makes an individual susceptible to disease
high-density lipoprotein (HDL) cholesterol that
protects against heart disease
housing stress an anxious state that occurs when the
cost of housing (either rental or mortgage) is relatively
high in relation to household income
hypertension high blood pressure
infertility the inability to conceive a child while having
unprotected sexual intercourse for at least 12 months
low-density lipoprotein (LDL) cholesterol that increases
the risk of heart disease by forming plaques on arterial
walls
macular degeneration loss of vision in the centre of the
visual field due to retina damage
male impotency inability to develop or maintain an
erection of the penis
mammography screening X-ray of the breast tissue to
detect abnormal growths
myocardial infarction blockage in one or more of the
coronary arteries that stops blood flow to an area of the
heart muscle, resulting in damage to the heart or death
occupational overuse syndrome (OOS) a condition,
resulting from repetitive movements, that can affect the
tendons and muscles of joints
polyps abnormal growths within the bowel
psychoactive effects the altering of mental processes
such as mood, cognition, emotions and behaviour
social capital the level of cooperation, trust and
goodwill between people, organisations, levels of
government and in neighbourhoods
social support the connections that an adult has with
individuals and groups
sphygmomanometer instrument that measures blood
pressure
standard drink the volume of a particular beverage that
contains 10 grams of alcohol
stroke a condition resulting from a lack of blood flow
to an area of the brain due to a blockage or rupture of
a blood vessel
systolic blood pressure the maximum pressure exerted
on the arteries when the heart muscle contracts to pump
blood
thrombosis a blood clot that forms within a vein or
artery
transient ischaemic attack a ‘mini stroke’ that tends to
last only a few minutes and not more than 24 hours
KEY CONCEPT The influence of genetics on the health and individual human
development of adults
Biological determinants refer to those genetic and physiological factors that affect
eBook plus
health and individual human development. They relate to the functioning of the
body and include a range of biomedical factors such as cholesterol levels, blood
eLesson:
pressure and body weight. Obesity, raised blood pressure and high cholesterol
Predicting Alzheimer’s
levels can be indicators of ill-health, particularly in the adult population.
Genetics
The combination of genes that is inherited from the biological parents at the time
of conception can have a significant impact on health and individual human
development during the adulthood stage of the lifespan. The genes that are inherited
not only determine physical characteristics such as height, eye colour and body
shape, they also determine the rate and timing of development, genetic conditions
and predisposition to disease that may not become apparent until adulthood.
Rate and timing of development

In chapter 9, you learnt about the role of the endocrine system in releasing
hormones that impact on the rate and timing of development during the childhood
stage of the lifespan. During adulthood, hormones continue to have an impact on
the health and individual human development of the individual.
The genes a female inherits have a significant impact on the timing of menopause.
Those who have a family history of early onset of menopause are more likely to
experience early menopause themselves. Menopause is the final menstrual cycle
in a woman’s life and marks the end of the reproductive years. Most women reach
menopause between the ages of 45 and 55, with the average being 50 years of age.
The menstrual cycle ceases as a result of the ovaries no longer releasing eggs (ova)
and the female hormones oestrogen and progesterone. A decrease in the female
hormones after menopause may lead to the thinning of the bones (osteoporosis)
and an increased risk of bone fractures, as well as an increase in the risk of heart
attack, heart disease, high blood pressure and stroke.
As males age, they usually experience a decline in their testosterone levels.
Testosterone is a hormone produced by the testes. Unlike menopause, where
females experience a sudden reduction in the levels of hormones, the reduction
in testosterone in males is less and more gradual. The decline in testosterone
levels may not affect some males at all. Those who are affected by the decline
in testosterone may experience a lack of energy, fatigue, poor concentration or
memory, mood changes, low sex drive, or loss of muscle strength.
Genetic conditions impacting on adults

Genetic conditions occur as a result of an altered or faulty gene or set of genes.
Some genetic conditions appear from the time of birth, but other genetic conditions
may not present until adulthood. Two examples of genetic conditions that impact
on adults are Alzheimer’s disease and Huntington’s disease.
Alzheimer’s disease is a progressive condition that impairs the functioning of the
brain in areas such as memory, thinking and personality. The condition eventually
Figure 11.2 Genetic conditions causes death. There are two types of Alzheimer’s disease: sporadic Alzheimer’s
such as Alzheimer’s disease affect
health and individual human
which has no known cause, and familial Alzheimer’s which is caused by a genetic
development and usually become mutation. Alzheimer’s affects one in 25 Australians over the age of 60. There is no
apparent in adulthood. cure for Alzheimer’s, nor is there any way to prevent the onset of the disease.

Tables 11.1 and 11.2 summarise how Alzheimer’s disease impacts on the health
and individual human development of adults with the disease.
Table 11.1 Impact of Alzheimer’s disease on the health of those affected
Type of health affected Impacts
Physical • Inability to look after oneself resulting in lack of hygiene, which increases the risk of ill-health such as skin infections
and diarrhoea
• Memory lapses resulting in the individual forgetting to take medication, which could lead to a faster deterioration
in physical health
• Malnutrition due to forgetting to eat at regular times
• In the late stages, becoming bedridden and needing full-time care
• Poor judgement puts the individual at risk of physical harm when driving a car
• Disorientation to time and place, resulting in the individual getting lost and being susceptible to dangers in their
environment such as road traffic.
Social • Lack of ability to maintain relations with other people, resulting in poor social health
• Deterioration of social skills impacts on the individual’s capacity to interact with others
• Inability to hold a conversation with others, which impacts on the relationships with loved ones
Mental • Memory lapses
• Depression
• Apparent loss of enthusiasm for previously enjoyed activities
Table 11.2 Impact of Alzheimer’s disease on the individual human development of those affected
Type of development affected Impacts
Physical • Damage occurs to brain cells and there is a build-up of protein called ‘plaques’ in the brain
• Loss of motor skills
Social • Loss of social skills such as the ability to hold a conversation
• Loss of speech
• Personality changes
Emotional • Inability to control emotions
• Inability to adequately express emotions
Intellectual • Long-term memory loss
• Forgetting simple words or using the wrong words
• Confusion and difficulty making decisions
Huntington’s disease is a neurological condition caused by a defective gene.

Each child of a parent with the Huntington’s gene has a 50 per cent chance of
developing the disease. Huntington’s disease causes the death of cells in certain
areas of the brain, resulting in a gradual loss of intellectual, physical and emotional
capacities. Symptoms of the disease do not usually appear until middle adulthood.
Table 11.3 summarises the ways in which Huntington’s disease impacts on the
individual human development of an adult.
Table 11.3 Impact of Huntington’s disease on individual human development
Physical Social Emotional Intellectual
• Mild twitching of fingers and toes • Inappropriate social • Loss of ability to • Short-term memory loss
• Lack of coordination behaviour due to the loss of control emotions • Difficulties in concentrating
emotions such as shame and resulting in mood and making plans
• Walking difficulties embarrassment that usually swings, apathy and
• Jerky movements of the arms or legs (chorea) help to ensure appropriate aggression • Inability to block out
social behaviours distractions
• Speech and swallowing difficulties due to lack
of control of the muscles of the face, throat • Difficulties with • Loss of task sequencing
and tongue communication
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 341
One-third of people with Huntington’s disease experience depression. Problems

with speech, communication and inappropriate social behaviours may cause
people to avoid someone with Huntington’s disease. Due to swallowing difficulties,
an adult with Huntington’s disease may find eating difficult and may lose weight
as a result. Changes in the ability to think may result in the consumption of foods
that lack the nutrients required for maintaining or promoting health. In the later
stages of the disease, the adult may not be able to chew and swallow effectively,
resulting in the need to be tube fed to ensure that nutritional needs are being met.
Genetic predisposition to disease

Some adults are at greater risk of developing particular diseases due to inheriting an
altered gene. Inheriting these altered genes does not guarantee that the individual
will develop the condition but genetic predisposition can be a significant risk factor
in the development of diseases such as type 2 diabetes and particular cancers.
Type 2 diabetes
Normally, blood glucose levels are regulated by insulin, a hormone that is secreted
by the pancreas. Insulin enables the body’s cells to metabolise glucose for energy. In
Figure 11.3 Individuals with an adult with type 2 diabetes, the pancreas makes insufficient insulin or the cells of
Huntington’s disease may suffer
from depression, short-term memory
the body do not respond to it. As a result, there is an increase in the blood glucose
loss and an inability to control their levels and this can impact on health.
emotions. Symptoms of type 2 diabetes include:
• extreme tiredness • blurred vision
• excessive thirst • increased risk of infections.
If left untreated, the condition can cause long-term damage to the kidneys, eyes,
nerves and heart. Type 2 diabetes is most common after 40 years of age but can
appear earlier.
Although lifestyle factors such as poor diet, smoking and lack of physical activity
significantly increase the risk of developing type 2 diabetes, another risk factor is
genetics. According to the Better Health Channel, adults aged 35 years and over
who are Aboriginal or Torres Strait Islanders, Pacific Islanders, from the Indian
subcontinent or of Chinese origin, are at greater risk. Adults aged 45 years and
over who have had a first-degree relative (e.g. parent) with type 2 diabetes are also
at greater risk of developing the condition.
Cancer
Non-cancerous cells in the body grow and multiply in an orderly way. Changed
genes can result in cells behaving abnormally and growing into a cancerous tumour.
Cancers that have a genetic predisposition include breast, ovarian, bowel and skin
(melanoma) cancers.
Breast cancer
Breast cancer begins in the milk ducts or milk lobules (figure 11.4). Most breast
cancers are found when they become invasive. This means that they have grown
outside of the milk ducts or lobules and spread into other breast tissue or other
parts of the body. The following are possible signs of breast cancer:
• a thickening of the breast tissue
• a lump
• discharge from the nipple
• an inverted nipple
• dimpling of the skin
• change in shape of the breast or nipple
• a painful area in the breast.

Breast cancer affects one in eleven women in Australia.
The breast Ducts and lobules
Ribs
Muscle
Fatty tissue
Connective tissue
Nipple
Normal duct
Duct opening
Figure 11.4 Breast cancer begins in

the milk ducts or milk lobules.
Source: Reproduced with permission by Cancer
Council Victoria. Illustration by Con Stamatis.
Ovarian cancer
Ovaries are the oval-shaped glands that are part of the female reproductive system.
They release an egg (ovum) every month as part of the menstrual cycle. Ovaries also
secrete the female sex hormones, oestrogen and progesterone. For some women the
ovaries become the site of an uncontrolled growth of cells, or cancer. Symptoms of
ovarian cancer include:
• bloating or a feeling of pressure in the abdomen
• change in bowel habits
• indigestion
• unusual vaginal bleeding
• pain, particularly during sex
• swollen abdomen.
Advanced ovarian cancer that has spread to other parts of the body may cause
loss of appetite, sickness, constipation, tiredness, breathlessness and more extensive
swelling of the abdomen.
Skin cancer
Skin type and colour are genetically determined. The melanocytes of the skin
produce melanin, which gives skin its colour. Fair-skinned individuals have less
melanin and are at greater risk of skin cancer from sun exposure. Although darker-
skinned people naturally have more protection from harmful UV radiation, they
can still be at risk of skin damage and skin cancer.
The epidermis (outer layer of the skin) contains three types of cells: squamous
cells, basal cells and melanocytes. Skin cancer is named according to the cells
that are affected: squamous cell carcinoma, basal cell carcinoma and melanoma.
Melanoma is the most serious skin cancer. If detected early, most melanomas can
be cured. If left untreated, melanoma can spread to other parts of the body and
may not be curable.
Approximately 75 per cent of skin cancers are basal cell carcinomas and 5 per cent
are melanomas. Two out of three Australians will develop skin cancer at some stage
in their lifetime. Melanoma is the third most common cancer for Victorian women
and fourth most common cancer for Victorian men. In 2010, 2256 Victorians were
diagnosed with melanoma.
Bowel cancer
Bowel cancer usually affects the colon or rectum (figure 11.5). The colon is the
main part of the large bowel and the rectum is the last section of the large bowel
that opens to the outside at the anus. Faeces collect in the rectum before being
expelled from the body through the anus. Cancer usually starts in the lining of the
bowel. If left untreated, the cancer will spread into the walls of the bowel and then
to the lymph nodes, liver or lungs. Bowel cancer is diagnosed in more than 3400
Victorians each year and usually affects people over 50 years of age.
Symptoms of bowel cancer include:
• blood or mucus in the faeces
• constant tiredness
• unexpected change in bowel habit
• weakness
• bloating and/or cramping
of the abdomen
• pale complexion.
Stomach
Large bowel/ Pancreas

intestine
includes colon
and rectum
Small
bowel/
intestine
Anus
Figure 11.5 Bowel cancer usually
affects the colon or rectum.
TEST your knowledge 4 Outline the effects that type 2 diabetes has on the
health of the adult.
1 (a) Describe Alzheimer’s disease.
(b) Explain the impact that Alzheimer’s disease
has on the health and individual human
development of an adult. 5 Research and outline five strategies that family
2 (a) Describe Huntington’s disease. members can use to maximise the health and
(b) Explain the impact that Huntington’s disease individual human development of a person with
has on the health and individual human Alzheimer’s disease.
development of an adult. 6 Describe the difference between a genetic condition
3 Outline the types of cancer that have a genetic and a genetic predisposition.
predisposition.

11.2 Biological determinants: body weight
KEY CONCEPT The impact of body weight on the health and individual human
Body weight
The body weight of adults is largely determined by the combination of genes that
are inherited from the biological parents as well as lifestyle and behaviours such as
physical activity levels and food habits. Concerns regarding body weight tend to
focus on overweight and obesity due to the increasing rate of both conditions over
the past 20 to 30 years. Figure 11.6 demonstrates the proportion of people who
were overweight or obese in 2011–12. According to the 2011–12 National Health
Survey, 28.3 per cent of persons 18 years and over were obese, 35 per cent were
overweight, 35.2 per cent were normal weight and 1.5 per cent were underweight.
It is estimated that at the current rate of increase, overweight and obesity will affect
75 per cent of the Australian population by 2020.
90
80 Males
Females
70
60
Percentage
50
40
30
20
10 Figure 11.6 Proportion of persons
0 who are overweight or obese, 2011–12
18–24 25–34 35–44 45–54 55–64 65–74 75+ Note: Based on Body Mass Index for persons whose
height and weight were measured.
Age group (years) Source: ABS, Australian Health Survey: First Results.
Figure 11.7 Rates of obesity

and overweight have increased
significantly in the past three decades.
11.2 Biological determinants: body weight
Measuring body weight

Overweight and obesity are determined by the body mass index (BMI), which is
calculated by dividing an adult’s weight in kilograms by their height in metres
squared. For example, the BMI for an adult male with a weight of 110 kilograms
and a height of 1.86 metres would be calculated as follows:
BMI = weight (kg)/height (m)2
= 110/(1.86)2
= 110/3.46
= 31.8
A BMI of 31.8 for an adult male would place him in the obese class 1 classification.
Table 11.4 outlines the classification of adults according to BMI, and the risk of
further disease according to BMI classification.
Table 11.4 Classification of adults according to BMI
Classification BMI (kg/m2) Risk of further disease
Underweight >18.5 Low

Normal range 18.5–24.9 Average
Overweight >25
Pre-obese 25.0–29.9 Increased
Obese class 1 30.0–34.9 Moderate
Obese class 2 35.0–39.9 Severe
Obese class 3 >40.0 Very severe
Together with the BMI, the distribution of excess body fat can determine the level
of risk to health and individual human development. Excess fat around the waist is
associated with a greater risk of health-related conditions — such as coronary heart
disease, stroke and type 2 diabetes — compared to excess fat that is distributed around
the buttocks and thighs (the ‘pear’ shaped body). As can be seen from table 11.4,
increasing BMI correlates with an increased risk of ill-health. Overweight and obesity
significantly increase the risk of illnesses and conditions such as type 2 diabetes,
cardiovascular disease, high blood pressure, sleep apnoea, osteoarthritis, certain
cancers (breast, endometrial, cervical and bowel) and psychological disorders. In
terms of social and mental health, overweight and obesity can lead to discrimination,
poor self-esteem, body shape dissatisfaction, disordered eating (e.g. binge eating),
isolation and depression.
Maintaining a healthy body mass index (BMI)

In order to promote the health and individual human development of adults, it is
important that the body mass index is kept within the normal range. To maintain
a stable weight, the energy intake through food consumption needs to equal the
energy used through bodily functions and physical activity. If more energy is used
than is consumed, weight loss will occur. If more energy is consumed than is used,
weight gain will occur.
For those adults who have a BMI in the overweight or obese categories and
would like to lose weight, thereby reducing their BMI, there are a number of factors
that need to be considered. These include the following:
• A wide variety of foods from all food groups should be consumed to ensure
that the individual has the required intake of nutrients to promote health and
individual human development. Foods should be included from the breads and
cereals, fruit, vegetables, dairy and meat, fish and legumes groups.

• The overconsumption of nutrients that supply energy (carbohydrates, fats and
protein) should be avoided as excess energy that is not utilised will contribute
to weight gain.
• The closer the food is to its natural state, the more likely it is to contain the
required nutrients. Processed foods often have limited nutritional value and may
be high in fat, particularly saturated and trans fats, sugar and/or salt. Extra, or
‘sometimes’ foods such as biscuits, chips and chocolates should be limited in an
individual’s daily food intake.
• Trim excess fat from meat or purchase trim cuts of meat. Avoid, where pos
sible, processed meats such as salami or sausages, as these are often high in
saturated fat.
• Consume low-fat varieties of particular foods such as cheese, milk and yoghurt
where possible.
• Limit or avoid the consumption of alcohol, as it is energy dense (29 kilojoules
per gram) and may contribute to weight gain.
• Avoid making changes to dietary intake that are not sustainable. For example,
low-carbohydrate diets may result in weight loss initially; however, some of this
weight loss comes from a reduction in muscle mass. As muscles burn energy,
a reduction in muscle mass results in a decrease in the amount of kilojoules
being used on a daily basis. When the individual resumes the consumption of
carbohydrates, weight gain is likely to occur.
• Food should be consumed at regular intervals throughout the day to reduce the
feeling of hunger. When meals are missed, the individual may have an intense
feeling of hunger. This may cause them to overeat at their next meal.
• Regular physical activity is important for maintaining the balance between energy
consumption and energy expenditure, thereby reducing the risk of weight gain.
The importance of exercise for health is recognised in the National Physical
Activity Guidelines for Adults (Department of Health and Aging, 2005). These
guidelines outline the four steps for improving health:
1. Think of movement as an opportunity, not an inconvenience.
2. Be active every day in as many ways as you can.
3. Put together at least 30 minutes of moderate intensity physical activity on most,
preferably all, days. (Moderate intensity activity is exercise that causes a slight,
but noticeable, increase in heart rate and breathing rate, e.g. brisk walking.)
4. If you can, enjoy some regular, vigorous activity for extra health and fitness.
(Vigorous activity is exercise that causes you to ‘huff and puff’.)
TEST your knowledge 7 Use figure 11.6 to answer the following questions.
(a) Explain the relationship between age and the
1 Outline the factors that contribute to overweight
prevalence of overweight and obesity.
and obesity in adults.
(b) Explain the relationship between gender and the
2 In 2011–2012, what percentage of the adult
prevalence of overweight and obesity.
population was overweight or obese?
8 Use the Effects of obesity weblink in your
3 What is the prediction regarding future rates of
eBookPLUS to the find the link for this question.
overweight and obesity?
Develop a website to provide advice for adults
4 Outline BMI, including how it is calculated.
regarding the importance of maintaining a healthy
5 List the conditions associated with overweight and
BMI. Include information about ways to maintain
obesity.
a healthy BMI, and provide an explanation of the
APPLY your knowledge impact of overweight and obesity on the health and
individual human development of adults.
6 Calculate the BMI for an adult female who is
65 kilograms and has a height of 1.62 metres.
What BMI classification would this person be?
11.3 Biological determinants: blood pressure
KEY CONCEPT The impact of blood pressure on the health and individual
human development of adults
Blood pressure
Blood pressure measures the force of the blood on the walls of the arteries and
is recorded as systolic and diastolic measurements. Systolic blood pressure is
the maximum pressure exerted on the arteries when the heart muscle contracts
to pump blood. Diastolic blood pressure measures the minimum pressure in the
arteries when the heart muscle relaxes between heart contractions. Blood pressure
is measured in millimetres of mercury (mm Hg) using an instrument called a
sphygmomanometer. Blood pressure is written as a number figure of systolic/
diastolic, with the systolic measurement being the higher one (e.g. 120/80mm Hg).
Blood pressure can increase with exercise or exertion. Elevated blood pressure is
Figure 11.8 Blood pressure measures
the force of the blood on the walls of
a concern when the pressure remains high while at rest because this might indicate
the arteries. the heart is being overworked and the arteries have increased stress on the arterial
walls. This can accelerate the depositing of fatty plaques on the arterial walls, a
condition called atherosclerosis (figure 11.11). Atherosclerosis contributes to other
illnesses such as coronary heart disease and stroke.
Although there is no ‘ideal’ blood pressure, the following measurements provide
a guide:
• normal blood pressure: less than 120/80 mmHg
• normal–high blood pressure: between 120/80 and 140/90 mmHg
• high blood pressure: equal to or more than 140/90 mmHg
• very high blood pressure: equal to or more than 180/110 mmHg.
High blood pressure, or hypertension, is a major risk factor for coronary heart
disease, stroke, heart failure and kidney failure. Genetic factors — along with
obesity, lack of physical activity, poor nutritional intake including high salt intake
and heavy alcohol consumption — are also significant risk factors.
Hypertension is a common disorder of the circulatory system, with one in seven
Australian adults being affected. The condition is more common with age due to
the arteries becoming more rigid. Figure 11.9 shows the proportion of adults with
high blood pressure with increasing age in 2011–2012.
60
Males
Females
50
40
Percentage
30
20
10
Figure 11.9 Proportion of persons

with high blood pressure, 2011–12 0
Note: High blood pressure considered to be 18–24 25–34 35–44 45–54 55–64 64–74 75+
140/90 mmHg or more
Age group (years)
Source: ABS, Australian Health Survey: First Results

Coronary heart disease
The risk of having coronary heart disease increases after the age of 45 in men and
55 in women. Coronary heart disease is a condition characterised by a narrowing
of the coronary arteries, which are the blood vessels that supply the heart muscle
with blood. This narrowing of the arteries can occur as a result of atherosclerosis
(see figure 11.11). As an individual ages, the risk of atherosclerosis increases.
Heart Normal
coronary
artery
Artery with
atherosclerosis
Artery with Figure 11.10 High blood pressure

atherosclerosis and obesity are risk factors for
blocked by a coronary heart disease.
blood clot
Figure 11.11 Atherosclerosis is the build-up of fatty deposits on the arterial walls resulting
in a narrowing of the arteries.
Atherosclerosis can result in angina, which is characterised by temporary chest

pain or discomfort, particularly during physical activity, cold temperatures or
extremes of emotion. Angina occurs from a decreased oxygen supply due to the
narrowing of the coronary arteries and may be a warning sign of an impending
heart attack. It is treated with medications called nitrates, which ease the pain of
an angina attack. These medications can be taken as an aerosol spray or as a tablet
dissolved under the tongue. Other medications include those to reduce the risk
of blood clots, lower blood pressure and decrease cholesterol levels. If the pain
persists for more than 10 minutes or is more severe than usual, medical attention
needs to be sought immediately. The symptoms of angina include:
• pain or discomfort in the middle of the chest
• breathlessness and sweating
• a feeling of tightness or pressure in the chest
• radiating pain to the neck, jaw and left arm, or both arms
• possible radiating pain in the upper back and shoulders.
If the fatty deposits build up and block one of the coronary arteries, then the
blood supply to a specific area of the heart is stopped. When this occurs, the lack of
blood supply permanently damages the area of heart muscle that the artery would
normally supply. How much damage occurs to the heart depends on the size of
the area to which the blood supply is blocked. In severe cases, the blockage can
result in myocardial infarction, which is more commonly known as a heart attack.
A heart attack can cause permanent damage to the heart muscle and in severe cases
the heart can stop functioning (cardiac arrest), resulting in death.
The warning signs of a heart attack include:
• chest pain and discomfort in the middle of the chest. Pain may begin slowly or
come on suddenly and cannot be relieved by angina medication.
• pain that spreads to the neck, throat, jaw, shoulders, back, either or both arms,
wrists and hands.
• difficulty breathing, nausea and vomiting, sweating or a feeling of dizziness.
• collapse.
Sometimes there is no chest pain. Instead, there is a feeling of discomfort in the

upper body (e.g. heaviness of arms) and a choking feeling in the throat.
High blood pressure is one of the many risk factors for coronary heart
disease. Other determinants of health and individual human development work
in conjunction with biological determinants to significantly increase the risk of
developing coronary heart disease. These are shown in figure 11.12.
Biological factors Behavioural factors

Overweight and obesity Tobacco smoking
Diabetes Diet high in saturated fat, salt
Increasing age and sugar
Family history of heart Diet low in fibre, fruit and
disease vegetables
Depression Lack of physical activity
Coronary heart
disease
Social factors
Lack of sport and recreational
Depression and social isolation
facilities
Limited income to purchase
Lack of access to health care
nutritious foods
Lack of access to nutritious
Lack of nutrition education
foods
Figure 11.12 Some of the factors that increase the risk of developing coronary heart disease
Stroke
High blood pressure is a significant risk factor for stroke, also referred to as
cerebrovascular disease. Stroke is the most common cause of death in Australia.
Approximately 60 000 strokes occur every year, with the vast majority occurring in
adults over the age of 65 years.
High blood pressure puts unnecessary strain on the vessels of the circulatory
system, including those that transport blood to the brain. During a stroke, blood
flow is interrupted to an area of the brain. This may be caused by a blood clot
blocking the artery or a blood vessel breaking. As a result of this lack of blood
supply, the brain cells in the affected area may die. Images of the brain, taken by
magnetic resonance imaging (MRI), are used to detect a stroke (figure 11.13).
The effects depend on the size and location of the stroke. Some people may have
minor effects that they can recover from (e.g. loss of balance) while a more serious
stroke can result in paralysis on one side of the body or even leave the individual
in a coma. A severe stroke can result in death.
A transient ischaemic attack is a ‘mini stroke’ that can be a warning sign for a
more severe stroke. The symptoms can be the same as a more severe stroke but they
tend to disappear in a few minutes and do not last beyond 24 hours. This type of
attack can appear days, weeks or months before a full stroke occurs, and needs to be
treated immediately because the longer a stroke remains untreated, the greater the
degree of brain damage. The signs of stroke and transient ischaemic attack include:
• sudden blurred or decreased vision in one or both eyes
• numbness, weakness or paralysis of the face
Figure 11.13 An image of the brain • difficulty speaking
produced by magnetic resonance • loss of balance
imaging (MRI) enables stroke to be
diagnosed. This image shows where
• dizziness
the damage to the brain cells has • swallowing difficulties
occurred. • severe headache.

Some of the risk factors for stroke — age, gender and family history — cannot
be controlled but there are others that can be addressed to reduce the risk of
stroke. Some of the factors contributing to an increased risk of stroke are shown in
figure 11.14.
Behavioural factors
Biological factors
Tobacco smoking
High blood pressure
Diet high in saturated fat, salt
Diabetes
and sugar
High cholesterol levels
Overconsumption of alcohol
Overweight and obesity
Lack of physical activity
Stroke
Physical environment Social factors

Lack of sport and recreational Limited income to purchase
facilities nutritious foods
Lack of access to health care Low socioeconomic background
Lack of access to nutritional Limited education about
foods reducing the risk of stroke
Figure 11.14 Some of the factors contributing to an increased risk of stroke
Kidney failure
One in seven adults in Australia has some sign or symptom of kidney disease and
one in 35 have serious kidney disease.
The kidneys play a very important role in the body (figure 11.15). They filter the
blood and remove waste products as well as control the level of fluid in the body.
High blood pressure greatly increases the risk of kidney failure because the increased
pressure within the arteries can damage the vessels that supply the kidneys. The
very small vessels are usually the first to be affected and, if left untreated, can lead
to kidney disease. Initially, there may not be any signs or symptoms of disease. As
the condition progresses, the signs and symptoms include:
• more frequent urination
• greater volume of urine being passed
• foaming urine
• oedema, or swelling, around the feet, ankles, legs, abdomen and eyes
• pain in the back, under the ribs
• pain or a burning sensation when passing urine.
If kidney disease is not treated, and the risk factors contributing to the disease
are not addressed, then the kidneys may begin to fail due to a build-up of waste
products and extra fluid in the blood. When the kidneys begin to fail, the following
may occur:
• inability to concentrate
• tiredness
• loss of appetite
• nausea and vomiting
• breathlessness.
Apart from high blood pressure, the following

significantly increase the risk of developing kidney
disease:
• type 1 and type 2 diabetes
• obesity
• being over the age of 50 years
• family history of kidney disease
• tobacco smoking
• being of Aboriginal or Torres Strait Islander descent.
Treating high blood pressure

A range of medications is available to decrease high blood
pressure and thereby reduce the risk of coronary heart
disease, stroke and kidney failure. Medications such
as ACE inhibitors and beta blockers assist in lowering
blood pressure but must also be considered in relation
to lifestyle changes. Eating a healthy diet, drinking the
required amount of water daily and restricting alcohol
intake, maintaining a regular program of physical activity,
keeping within the healthy range for body mass index
and avoiding stress will also lower the risk of high blood
Right adrenal pressure. In particular, the diet should consist of plenty
gland of fruit and vegetables, legumes and whole grains such as
Left adrenal
gland bread, pasta, noodles and rice. Reducing salt intake can
help control high blood pressure or assist in preventing
Right kidney Left kidney high blood pressure altogether. Choosing foods low in
salt, avoiding processed and takeaway foods, and not
adding salt to meals will assist in reducing salt intake,
thereby reducing the risk of high blood pressure.
Bladder
Figure 11.15 The kidneys filter blood, remove waste products

and control the level of fluid in the body.
TEST your knowledge 7 Explain the relationship between high blood

pressure and stroke.
1 What is high blood pressure?
8 Explain how high blood pressure can increase
2 How is blood pressure measured?
the risk of kidney failure.
3 What is the difference between systolic and
diastolic pressure?
4 What proportion of Australian adults are affected
by high blood pressure? 9 Complete a one-page handout of advice that you
5 Why does high blood pressure become more would give to an adult who might be at risk of high
common with increasing age? blood pressure. Consider the importance of a range
6 High blood pressure is one risk factor for coronary of determinants in the development of diseases or
heart disease. Outline other determinants of health illnesses associated with high blood pressure.
and individual human development that increase
the risk of coronary heart disease.

11.4 Biological determinants: blood cholesterol
KEY CONCEPT The impact of blood cholesterol on the health and individual
Blood cholesterol
Cholesterol is a type of fat that has a range of functions within the human body.
It produces hormones, assists with digestion through the production of bile
acids and is an essential component of cell membranes. Cholesterol is found in
higher concentrations in the brain and nervous system. It occurs in two forms:
high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). HDL
cholesterol is referred to as the ‘good’ cholesterol as it can help unclog arteries
by removing excess LDLs out of the cells. LDL cholesterol, on the other hand, is
referred to as ‘bad’ cholesterol because it can cause fatty substances to build up on
the arterial walls and block the blood vessels. High levels of HDLs can be a positive
sign for health as long as they are accompanied by low levels of LDLs. Figure 11.16 When saturated fat
(such as found in doughnuts) is
Although it is required for the effective functioning of the body, cholesterol
consumed, the cholesterol that is not
becomes a health concern when there is too much of it in the blood. High blood- processed by the liver is returned to
cholesterol levels, particularly LDLs, are one of the three main risk factors for heart the bloodstream.
disease (the other two are tobacco smoking and high blood pressure). The liver is
where the processing of cholesterol occurs. When saturated fats are consumed, the
cholesterol that is not processed by the liver is returned to the bloodstream. If there
is too much LDL cholesterol in the blood, it can build up into fatty deposits on
the arterial walls. This build-up of fatty deposits causes a narrowing of the arteries
(atherosclerosis), which may eventually become blocked and cause a heart attack
or stroke. The safe level of cholesterol is thought to be no higher than 5.5 mmol/
litre of blood. Age is one of the risk factors for high blood cholesterol as shown in
figure 11.17, which highlights the proportion of Australian adults with high blood
cholesterol in 1999–2000.
80
Males
70 Females
60
50
Per cent
40
30
20 Figure 11.17 Proportion of

Australian adults with high blood
10
cholesterol, 1999–2000
Source: Australian Institute of Health and Welfare
0 2008, Australia’s health 2008, cat. no. AUS 99,
25–34 35– 44 45–54 55–64 65–74 75+ Canberra, p. 157.
Age group Note: These data are the most recent national
estimates of measured blood cholesterol, as
Note: High blood cholesterol is a total cholesterol level of 5.5 mmol/L or more. recognised in AIHW, Australia’s health 2012.
Cholesterol levels can be reduced through lifestyle modifications, including

reducing alcohol intake, not smoking, exercising regularly, controlling weight
and consuming a healthy diet. Dietary modifications are particularly important.
Saturated fats increase blood-cholesterol levels whereas monounsaturated and
polyunsaturated fats tend to lower blood-cholesterol levels. Therefore, a reduction
in saturated fats may help reduce blood-cholesterol levels.
11.4 Biological determinants: blood cholesterol
Examples of food sources of the different types of fats:

• saturated fats: fatty cuts of meat, full-cream milk, cheese, butter, cream, baked
products such as biscuits and pastries, deep-fried foods, coconut and palm oil
eLesson:
• monounsaturated fats: margarine spreads made with canola and olive oil, olive,
Dr Norman Swan’s cholesterol
check
canola and peanut oils, avocado and hazelnuts, cashews and almonds
• polyunsaturated fats: fish, seafood, polyunsaturated margarines, vegetable oils,
walnuts, brazil nuts and seeds.
Polyunsaturated fats are sources of omega-3 and omega-6 fatty acids. Omega-3
fatty acids, particularly the ones found in fish, have been found to have health
benefits including:
• reducing high blood pressure
• reducing the risk of coronary heart disease
• improving blood vessel elasticity
• maintaining the heart rhythm
• thinning the blood, thereby reducing the possibility of clotting, and the risk of
heart attacks, stroke and thrombosis
• building a strong immune system.
Trans fatty acids can be damaging as they raise LDL levels and lower HDL levels.
Trans fatty acids are found in natural products such as milk, cheese, beef and lamb,
but the amounts are too small to be a health concern. The trans fatty acids that need
to be reduced or avoided are the ones that are manufactured in table margarines
and solid spreads used to make baked products such as pies, pastries and cakes.
To reduce cholesterol levels or decrease the risk of developing high cholesterol
levels, the following actions need to be considered:
• Limit foods high in saturated fats such as processed meats, full-fat dairy products,
Figure 11.18 Eating a well-balanced takeaway foods, deep-fried foods and cakes, biscuits and pastries.
diet is important for reducing blood- • Consume a wide variety of fresh fruit, vegetables and wholegrain foods each day.
cholesterol levels. • Choose low-fat varieties such as low- or reduced-fat milk, yoghurt and cheese.
• Choose lean meats or trim fat from meat.
• Consume fish a couple of times a week.
• Use polyunsaturated margarines instead of butter.
• Consume nuts, legumes and seeds.
• Limit cheese and ice-cream to no more than two serves a week.
• Use salad dressings and mayonnaise made from oils such as canola and olive oils.
• Limit cholesterol-rich foods such as egg yolks and offal (liver, kidney, brains).
High cholesterol levels can be an inherited condition. Familial hyper
cholesterolaemia is passed on by the genes inherited from parents. It is a condition
that affects one in every 300 Australians and is responsible for up to 10 per cent
of heart disease that occurs before the age of 55. There is no cure for familial
hypercholesterolaemia but treatment with medication and lifestyle modifications
can reduce the risk of coronary heart disease.

1 Explain the difference between HDL cholesterol and 6 Explain the interrelationship between genetics
LDL cholesterol. and lifestyle in the development of high blood-
2 How can cholesterol levels be controlled? cholesterol levels.
3 What types of foods should be consumed in order 7 Develop a one-day dietary intake for an adult that
to reduce high cholesterol levels? reduces LDL cholesterol. Justify the reasons for
4 What types of foods should be avoided in order to selecting particular foods.
reduce high cholesterol levels? 8 Develop a brochure for adults outlining the
5 What is familial hypercholesterolaemia? importance of lifestyle changes to reduce the risk of
developing high cholesterol. Justify the advice you
have provided.

11.5 ehavioural determinants: sun protection
B
and smoking
KEY CONCEPT The impact of sun protection and smoking on the health
and individual human development of adults
Health-related behaviours have a significant impact on the health and individual human
development across the lifespan. The behaviours relevant to adults include smoking,
physical activity, food consumption, alcohol and drug use and sexual practices.
Many different factors can contribute to a person’s attitudes and lifestyle practices
such as social networks (parents, family, peers), education level, socioeconomic
status, environment, advertising, health campaigns, genetic predisposition, access
to resources, and government policies. Changing health-related behaviours can
sometimes take a long time.
Sun protection
When adults are outdoors,
the ultraviolet (UV)
radiation from the sun can
penetrate unprotected skin
and cause damage. Sunburn
occurs as a reaction to
exposure to UV radiation.
Chemicals are released from
the top layers of the skin,
causing the blood vessels
to expand and release fluids
that generate inflammation,
redness and pain. Severe
cases of sunburn can
result in all or some of the
following:
• blistering
• headaches
• nausea
• vomiting
• dizziness
• severe pain.
In Australia, the risk of
developing skin cancer from
too much sun exposure Figure 11.19 Sun protection is
needs to be balanced with the need to maintain adequate vitamin D levels. The UV important to block damaging UV rays.
from sunlight is required for the formation of vitamin D in the skin. Vitamin D can
also be found in relatively small amounts in some foods (e.g. oily fish, eggs, liver,
margarine and some dairy products fortified with vitamin D) but their contribution
to the overall daily requirement is minimal. Vitamin D is important to adults as it
helps the body to absorb calcium through the small intestine. Calcium is required
for maintaining the strength of bones and teeth, and the functioning of muscles and
nerves.
The majority of Australians have sufficient exposure to sunlight through
their daily activities to receive enough vitamin D, although some sections of
the population are more likely to be at risk of Vitamin D deficiency (e.g. the
elderly confined to nursing homes). The required length of exposure to sunlight
depends on UV radiation levels, which are higher during the warmer months
11.5 Behavioural determinants: sun protection and smoking
and in the northern parts of Australia. Figure 11.20 shows the amount of time
required in the sun in Australia’s capital cities to produce sufficient amounts of
vitamin D.
The UV index is an international standard measurement of the strength of the
UV radiation from the sun in a specific location at a particular time. When the
UV index reads 3 or above, sun protection is necessary because there is a much
greater risk of damage occurring to the eyes and skin. Skin cancer can develop
when the cells of the skin are damaged, causing them to grow abnormally. Each
time the skin is exposed to UV radiation, changes occur in the structure and
function of the skin cells and permanent damage can occur. Every exposure to
UV radiation can increase the risk of skin cancer. All skin types can be damaged
as a result of exposure to UV radiation, even those who have skin types that are
less likely to burn.
June–July Summer All year

2–3 hours per week A few minutes on most days A few minutes on most days
Darwin
Brisbane
Perth Sydney
Adelaide Canberra
Figure 11.20 How much sun is May–August Summer Melbourne

enough? 2–3 hours per week A few minutes on most days Hobart
Source: SunSmart and Cancer Council Victoria.
There are three types of skin cancer: basal cell carcinoma, squamous cell
carcinoma and melanoma. The types of skin cancer are named after the skin cell
in which the cancer develops. Basal cell carcinoma and squamous cell carcinoma
are referred to as common or non-melanoma skin cancers. The most dangerous
form of skin cancer is melanoma. If left untreated it can spread to other parts of the
body and, eventually, result in death.
Australia has one of the highest rates of skin cancer in the world, with over
440 000 Australians being treated for skin cancer each year. Two in three Australians
will be diagnosed with skin cancer by the age of 70. The most commonly diagnosed
cancer for young adults between 2003 and 2007 was melanoma.
Apart from skin cancer, lack of sun protection and exposure to UV radiation
can result in eye damage such as photoconjunctivitis, macular degeneration and
cataracts, and premature ageing.
The factors that increase the risk of skin cancer are:
• family history of skin cancer
• having a large number of moles on the skin
• skin type that is sensitive to UV radiation and burns easily
• a history (childhood, adolescent and/or adulthood) of severe sunburn
• spending a lot of time outdoors without appropriate sun protection
• actively tanning or using sunbeds, sunlamps and solariums
• having a job that requires work to be completed outdoors.

The Cancer Council is responsible for the SunSmart campaign, an internationally
recognised skin cancer prevention program. This program recommends sun protection
measures to be used when the UV Index reaches 3 or above. SunSmart even has a free
smartphone app that allows users to check when the UV will be above this level.
Recommended sun protection measures include:
• slip on sun-protective clothing to cover as much skin as possible
• slop on SPF30+ sunscreen — this should be broad spectrum and water-resistant,
applied 20 minutes before going outdoors and reapplied every two hours
• slap on a hat to protect the face, head, neck and ears (e.g. wide-brimmed or
bucket-style)
• seek shade wherever possible
• slide on sunglasses, making sure they are a wraparound style that covers as much
of the eye area as possible and meet the Australian standard (AS1067).
Smoking
Tobacco smoking has an enormous impact on the morbidity and mortality rates of
adults in Australia. It is the single most preventable cause of ill-health and death
in the Australian population. It is estimated that tobacco smoking contributes
7.8 per cent of the burden of disease in Australia; approximately 10 per cent of the
total burden of disease in males and 6 per cent in females.
Tobacco smoking is a major risk factor for a range of illnesses including cancer,
hypertension, heart disease and stroke. Approximately one-fifth of all cancer deaths
in Australia can be attributed to smoking.
Cigarette smoke contains over 4000 chemicals. When a person smokes, these Figure 11.21 Smoking is a major risk
chemicals are inhaled and pass through the alveoli of the lungs and into the factor for cancers of the mouth.
bloodstream to the rest of the body. Tar, radioactive compounds, hydrogen cyanide
and carbon monoxide are just a few of the poisonous substances found in tobacco
smoke.
The nicotine in cigarettes is what causes addiction in smokers. It is a naturally
occurring substance found in the tobacco plant. When inhaled as tobacco smoke,
nicotine raises the heart rate and increases blood pressure.
The short term effects of smoking include:
• dizziness
• hand tremors
• coldness in the extremities (hands and feet)
• irritation of the eyes and nose
• increased incidence of colds and coughs
• bronchitis
• increased acid in the stomach leading to ulcers
• reduced appetite
• reduced sense of smell and taste
• bad breath
• reduced physical endurance
• increased effect of irritants on allergies
• increased risk of lung infections
• increased risk of miscarriage in pregnant women who smoke.
Source: www.givingupsmoking.info.
The most common form of cancer caused by smoking is lung cancer. However,
smoking also contributes to cancer of many other areas of the body including the
tongue, mouth, throat, nose, oesophagus, pancreas, stomach, bladder, kidney, cervix
and bone marrow.
Smoking increases the risk of cardiovascular disease due to an increase in the rate
of fatty substances being deposited on the arterial walls, resulting in the narrowing
11.5 Behavioural determinants: sun protection and smoking
of the arteries. As a result, blood flow is reduced to the cardiac muscle of the
heart. Permanent damage occurs to an area of the heart when the build-up of fatty
substances blocks the artery or arteries supplying that area. The damage to the
peripheral arteries of the body can result in reduced blood flow to the extremities,
leading to blood clots, infection, gangrene and possibly amputation. For people
under 65 years, the risk of dying from heart disease is three times greater for a
smoker compared to a non-smoker, and 70 per cent greater for a smoker over
65 years. A smoker has about twice the risk of suffering from a stroke than a
non-smoker.
The 2011–12 National Health Survey collected information about people’s use of
tobacco. From this survey it was found that 2.8 million Australians aged 18 years
and over smoked daily (16.3 per cent). This has been a decrease from 22.4 per cent
in 2001 and 18.9 per cent in 2007–08 (see figure 11.22).
40
2001
2007–08
30 2011–12
Percentage
20
10
0
18–24 25–34 35–44 45–54 55–64 65–74 75+
Age group (years)
Figure 11.22 Proportion of persons who were current daily smokers, 2001, 2007–08 and
2011–12
Source: ABS, Australian Health Survey: First Results
Quitting smoking has immediate and long-term health benefits for adults:
• after 12 hours — most nicotine is out of the bloodstream
• within 24 hours — carbon monoxide blood levels have largely dropped, heart
rate slows, tremors lessen, skin temperature warms
• within a month — the immune system begins to recover
• within three months — symptoms such as cough, mucus and wheeze decrease,
and blood flow to the hands and feet improves
• after six months — stress levels are usually lower than when smoking and the
lungs are working much better
• after 12 months — the increased risk of heart disease due to smoking is halved
• after 15 years — the risk of heart disease and stroke becomes almost the same as
an adult who has never smoked.
Quit Victoria
Since the establishment of Quit Victoria in 1985 by the Minister of Health and
the Cancer Council, there has been a gradual decline in smoking rates in Victoria.
Similarly, national smoking rates have also declined as shown in figure 11.22.
Quit Victoria is ‘dedicated to eliminating the pain, illness and suffering caused by
tobacco smoke’.
Quit Victoria’s health promotion campaign is a multi-pronged approach aiming
to prevent people from taking up smoking in the first place while also encouraging

those who are smokers to quit. Some of the services offered by Quit Victoria
include:
• media and television advertising highlighting the harmful effects of smoking and
the importance of quitting
• the Quitline, which is a confidential telephone counselling service that provides
information, support and advice for quitting
• Quit courses to assist those trying to quit
• Quit packs that provide information and strategies for quitting
• Quit Coach, a free interactive website that provides advice for quitting
• information regarding the use of quitting medications and services.
TEST your knowledge 7 According to the 2011–12 National Health Survey,

what percentage of the population smoked in
1 Outline the impact that sunburn may have on an
2011–12?
adult’s health.
2 Explain the link between exposure to the sun during
childhood and developing melanoma in adulthood.
3 Outline the UV index and explain its relevance to 8 Imagine that you are a health promotion officer at a
the prevention of sunburn. local council. Create a brochure, web page or blog
4 Why is some exposure to UV radiation important for that highlights the risks associated with poor sun
the health and individual human development of behaviours, as well as recognising the importance
adults? of vitamin D to the health and individual human
5 Use the Quit weblink in your development of adults.
eBookPLUS to the find the link 9 Develop a brochure aimed at encouraging adults to
for this question. List the diseases quit smoking, making sure you include the benefits
for which tobacco smoking is a risk factor. of quitting.
6 Explain how smoking increases the risk of 10 (a) Refer to figure 11.22 and explain two trends
cardiovascular disease. shown in the graph.
(b) Explain the role that Quit may have played in
bringing about these trends.
11.6 Behavioural determinants: physical activity
KEY CONCEPT The impact of physical activity on the health and individual
Physical activity
The benefits of physical activity to the health and individual human development
of adults have been well documented. Physical activity reduces the risk of
developing a range of illnesses, some of which may be life threatening, and helps
ageing adults to maintain or develop the strength and stamina that enables them to
live independently.
The 2011–12 National Health Survey found that the overall level of physical
activity for Australians aged 15 years and over was low. In the week prior to
interview, 66.9 per cent of Australians were either sedentary or had low levels
Figure 11.23 The benefits of physical
of exercise (35.4 per cent were sedentary and 31.5 per cent had low levels of
activity to adults have been well exercise). Males tended to be generally more active than females (see figure 11.24).
documented. The National Physical Activity Guidelines for Australians outline the minimum
levels of physical activity required to gain a health benefit. One of these guidelines
recommends that adults be involved in at least 30 minutes of moderate-intensity
physical activity on most (preferably all) days. Research has shown that doing 30
minutes of moderate-intensity physical activities a day on most days can have
a positive effect on health, such as blood pressure, cholesterol levels and body
weight. The activity does not have to be done in one continuous block of time
but can occur in shorter amounts throughout the day. Regular and more vigorous
exercise has the additional benefit of protecting against heart disease. Vigorous
exercise is activity that makes the individual ‘huff and puff’. In technical terms,
vigorous exercise occurs when the heart is beating at 70–85 per cent of maximum
heart rate. Maximum heart rate is determined by subtracting an individual’s age
from 220.
50
Males
Females
40
30
Percentage
20
10
Figure 11.24 Level of exercise
undertaken for fitness, recreation or
sport in the last week, persons aged
0
15 years and over, 2011–12.
Source: ABS, Australian Health Survey: First Results.
Sedentary Low Moderate High
Benefits of physical activity to health and individual

human development
Regular moderate–high intensity activity has many health benefits for an adult, as

BENEFITS TO HEALTH
• Improves cardiovascular fitness
• Reduces the risk of cardiovascular disease
• Reduces the risk of type 2 diabetes
• Reduces the risk of premature death
• Reduces the risk of high blood pressure
• Helps reduce blood pressure for those
adults who already have high blood
pressure
• Reduces the risk of colon cancer
• Reduces depression
• Reduces anxiety
• Helps control weight
• Promotes mental wellbeing
• Assists in controlling joint swelling and pain
associated with arthritis
• Reduces the risk of osteoporosis
BENEFITS TO INDIVIDUAL HUMAN

DEVELOPMENT
• Maintains the density of bones
• Promotes muscle strength and joint
mobility
• Enables older adults to maintain motor
control and therefore the ability to live
independently
Figure 11.25 Benefits of moderate–high intensity physical activity on the health and
individual human development of adults
In 2011–12, 35.1 per cent of Australians were classified as overweight and

28.3 per cent as obese. This is a total of 63.4 per cent of Australians aged 18 years
and over who were overweight or obese.
Overweight and obesity occur as a result of poor nutrition, with an
overconsumption of energy dense foods, and a lack of physical activity. In order
to maintain body weight, the total energy intake from food must be equal to the
amount of energy that is expended through day-to-day activities, including physical
activity. If energy intake exceeds the amount of energy that is used on a day-to-day
basis, then weight gain will occur. If this energy imbalance is maintained for an
extended period of time, then the result may be overweight and obesity. Therefore it
is important for adults to eat a well-balanced diet and engage in the recommended
minimum of 30 minutes of moderate-intensity physical activity on most days.
Physical activity has many benefits to the health of adults. Regular physical
activity helps to improve glucose metabolism, reduce body fat and lowers blood
pressure, thereby reducing the risk of cardiovascular disease and type 2 diabetes.
For adults who have already developed these diseases, regular physical activity
can help in reducing their effects. Physical activity — particularly weight-bearing
exercise such as brisk walking and jogging — helps to maintain the density of
bones, thereby reducing the risk of osteoporosis. It also assists in maintaining the
strength of muscles. Research has shown that physically active people tend to have
better mental health, with more positive self-concept and self-esteem.
According to the Cancer Council Australia, doing little or no physical activity
has also been associated with a higher risk of developing certain types of cancer —
in particular, colon cancer and breast cancer. Being physically active reduces body
weight, another factor that influences the risk of developing cancer.
11.6 Behavioural determinants: physical activity
An inadequate level of physical activity is one of many health risk factors that
contribute to the increased risk of disease (see table 11.5).
Table 11.5 Selected health risk factors, people aged 25–64 years, 2007–08 (per cent)
Risk factors Males Females Total
Daily smokers 23.8 19.3 21.6
Risky or high-risk alcohol 16.3 11.5 13.9

consumption(a)
Sedentary exercise level(b) 34.4 34.4 34.4
Overweight or obese(c) 70.8 56.1 63.6
Insufficient fruit intake(d) 56.8 44.4 50.5
Insufficient vegetable intake(e) 93.5 89.7 91.6
High blood pressure 9.3 9.0 9.2
High blood cholesterol 7.3 5.5 6.4
(a) In a 1-week period.

(b) People undertaking no exercise or a very low level of exercise in the 2 weeks prior to the survey.
(c) Body mass index greater than or equal to 25, calculated from measured height and weight.
(d) An insufficient fruit intake is considered to be one or less serves of fruit per day.
(e) An insufficient vegetable intake is considered to be four or less serves of vegetables per day.
Source: Australian Institute of Health and Welfare 2010, Australia’s health 2010, cat. no. AUS 122,
Canberra, p. 319.
TEST your knowledge brisk walk. Twice a week, Michael attends the
gym during his lunch break and participates in
1 What is the recommended amount of physical
an aerobics class for 45 minutes. Most Saturday
activity for an adult?
2 What proportion of the population did not engage afternoons, Michael plays 18 holes of golf with a
in the recommended amount of physical activity in group of friends.
2011–12? (a) Classify the types of activities Michael is involved
3 Outline five benefits of physical activity to the health in as:
and individual human development of adults. i. low intensity
4 Explain the relationship between energy intake/ ii. moderate intensity
expenditure and body weight. iii. vigorous.
(b) Is Michael participating in the recommended
APPLY your knowledge amount of physical activity? Explain.
5 Develop a weekly physical activity program for (c) What changes would you suggest to improve
a mother of two children who works full time. Michael’s level and/or type of physical activity?
Consider the times of the day during which physical (d) What health benefits will Michael gain from
activity can occur and the type and intensity of the participating in the recommended levels of
exercise. physical activity?
6 Michael is a 42-year-old male who works in the city. 7 Using table 11.5, explain the relationship between
He catches the train to work every day and walks sedentary levels of exercise and other risk factors in
from the station to his office, which is a 10-minute the development of illness/disease.

11.7 Behavioural determinants: food intake
KEY CONCEPT The impact of food intake on the health and individual human
Food intake
Food contains a range of nutrients that are important for the health and
individual human development of adults. All nutrients are required across
all stages of the lifespan but the required quantities vary according to age,
gender, metabolism and lifestyle. Growth has ceased by the adulthood
stage of the lifespan. As a result, nutrients for the maintenance of body
tissue rather than growth become more important.
There are six categories of nutrients:
• carbohydrates • minerals • vitamins
• protein • fats/lipids • water.
Figure 11.26 To ensure that the required

Carbohydrates nutrients are consumed, adults should aim to eat
Complex
Simple a diet consisting of a wide variety of foods.
(including fibre)
High GI Low GI
Sugar Bread
Honey Cereals
Softdrink Pasta
Confectionery Rice Figure 11.27 Classification of
carbohydrates
Carbohydrates, fats and protein are referred to as

macronutrients because they are required in relatively large
amounts. Vitamins and minerals are micronutrients because
they are required in relatively smaller amounts.
• Carbohydrates. These are the
body’s preferred source of Fats
energy. They are classified
further into simple and complex
carbohydrates (figure 11.27).
Simple carbohydrates are
absorbed quickly into the
bloodstream and include Unsaturated Saturated
Saturated Trans
foods such as sugar, honey
and confectionery. Simple
carbohydrates are classified
as high glycaemic index (GI).
Complex carbohydrates such as
breads and cereals take longer
Monounsaturated Polyunsaturated
to break down and so provide
a more sustained source of
energy. Fibre is largely a complex
carbohydrate that is found in
foods such as oat bran, nuts,
seeds and wholegrain foods.
Complex carbohydrates take Omega-3 Omega-6
longer to be absorbed into the
bloodstream and are classified as
low-medium GI. Figure 11.28 Classification of fats
11.7 Behavioural determinants: food intake
• Fats. Along with carbohydrates, fats are a primary source of energy for the
body. Fats also play a role in protecting internal organs and maintaining
body temperature. There are four types of fats: saturated, monounsaturated,
polyunsaturated and trans fats (figure 11.28). Polyunsaturated fats can be
divided into omega-3 and omega-6 fatty acids.
• Protein. Protein is required for the growth, maintenance and repair of body
cells and the manufacturing of hormones, enzymes and antibodies. It is also a
secondary source of energy.
• Vitamins. These occur as two types: fat-soluble and water-soluble. Fat-soluble
vitamins are vitamins A, D, E and K. They are stored in body tissues and may
become toxic to the body if over consumed. Water-soluble vitamins include
vitamin C and the B-group vitamins. They are not stored in the body and any
excess intake is excreted in the urine.
• Minerals. These include calcium, iron, potassium and iodine. These are all
required for the effective functioning of the body.
• Water. Water is required for the functioning of every cell in the body. It also
regulates body temperature, acts as a lubricant for joints and assists in the
removal of waste from the body.
Certain nutrients act as a risk or protective factor for specific diet-related diseases
(table 11.6). A risk factor increases the likelihood of a disease occurring whereas a
protective factor helps guard against the development of a disease.
Table 11.6 Nutrients as risk or protective factors for diet-related diseases
Risk or
protective Relevant
Nutrient Function(s) Food source factor disease
Calcium • Strengthens bones Dairy products, Protective • Osteoporosis

and teeth leafy green
• Regulates muscle vegetables, soy and
function tofu, sardines and
• Assists blood clotting salmon, brazil nuts,
• Transmits messages almonds, sesame
along the nervous seeds, calcium
system fortified foods
Fibre • Provides the bulk to Cereals and Protective • Bowel cancer
assist in the removal wholegrain foods, • Cardiovascular
of waste from fruit, vegetables, disease
the body via the lentils, nuts, seeds
intestinal tract
Folate • Required for growth Asparagus, spinach, Protective • Folate-
and formation of red brussel sprouts, deficiency
and white blood cells oranges, bananas, anaemia
• Synthesises DNA strawberries, • Neural tube
legumes, fortified defects such as
cereals, liver, spina bifida
poultry, eggs
Iron • An important Red meat, egg Protective • Iron-deficiency
component of yolks, legumes and anaemia
haemoglobin in the nuts, leafy green
blood; haemoglobin vegetables, fortified
is required for the cereals
transportation of
oxygen to the cells of
the body
Polyunsaturated • Assist the normal Atlantic salmon, Protective • Cardiovascular
fats development of the mackerel, tuna, disease
foetal brain trevally, sardines,
• Lower blood canola and soy oils
pressure and blood and canola-based
triglycerides margarines

Risk or
protective Relevant
Nutrient Function(s) Food source factor disease
Saturated fats • Concentrated source Fatty cuts of meat, Risk • Obesity
and trans fats of energy, providing full-fat milk, cheese, • Cardiovascular
37 kilojoules butter and cream, disease
per gram commercially baked • Stroke
• Provides insulation products, deep- • Type 2 diabetes
and protection for fried foods, coconut
internal organs and palm oil
through fat stored
on the body
Simple • Provide energy Table sugar, Risk • Dental caries
carbohydrates (16 kilojoules confectionery, • Type 2 diabetes
(high GI) per gram) softdrinks, • Obesity
chocolate, cakes
and biscuits, honey
and jam
Sodium • Maintains water Table salt, processed Risk • Hypertension
balance in the body foods, takeaway • Cardiovascular
• Required for muscle and fast foods, disease
contraction potato crisps,
processed meats,
canned vegetables,
instant pastas and
soups, white bread,
sauces
Overconsumption of foods is contributing to the obesity epidemic in Australia.

In general, individuals are consuming more kilojoules than are required to meet
energy needs, resulting in the excess being stored as adipose tissue (fat) on the
body. Overweight and obesity increase the risk of diseases such as cardiovascular
disease, some cancers, stroke and type 2 diabetes.
TEST your knowledge 7 For what diseases are the following nutrients a
risk factor and what are the food sources of these
1 List the six categories of nutrients.
nutrients?
2 Explain the difference between simple (high GI)
(a) Saturated fats and trans fats
carbohydrates and complex (low GI) carbohydrates.
(b) Simple carbohydrates
3 What are the functions of protein?
(c) Sodium
4 What are the four types of fat?
8 Why is the overconsumption of food a health
5 Why should saturated fat and trans fat be reduced
concern?
in an adult’s diet?
9 Why is the lack of fruit and vegetable consumption
6 What diseases do the following nutrients protect
in the Australian population a concern?
against and what are the food sources of these
nutrients?
(a) Calcium
(b) Folate 10 Develop one page of advice for an adult to reduce
(c) Fibre the risk of diet-related conditions. In your advice,
(d) Iron consider the types of food that should be consumed
(e) Polyunsaturated fats or avoided, based on the nutrient content of the
food. Explain how consuming a nutritious diet
can promote the health and individual human
development of an adult.
11.8 Behavioural determinants: alcohol use
KEY CONCEPT The impact of alcohol use on the health and individual human
Alcohol use
Alcohol is the most widely used and accepted recreational drug in Australia.
However, the overconsumption of alcohol is a major risk factor for a range of
diseases and illness or injury-related deaths. Alcohol is second only to tobacco as a
preventable cause of drug-related death and hospitalisation in Australia (NHMRC,
2009). In 2011–12, the National Health Survey found that 29.1 per cent of males
and 10.1 per cent of females aged over 18 years exceeded the lifetime risk guidelines
of drinking no more than two standard drinks on any day. It is generally accepted,
however, that a very moderate intake of alcohol (around half a standard drink per
day) may contain health benefits for older people. Red wine, in particular, is
considered to be beneficial in reducing the risk of cardiovascular disease due to the
Figure 11.29 Alcohol is the most anti-oxidants it contains. However, health authorities do not go so far as to
widely used and accepted recreational recommend that non-drinkers should start consuming alcohol for their health.
drug in Australia.
Information gathered from the 2010 National Drug Strategy Household Survey
indicated that 47 per cent of Australians aged over 14 years of age drank alcohol,
at least one a week. In 2010, 20 per cent of Australians aged 14 and over reported
drinking alcohol at levels for lifetime harm. Males were 2.6 times as likely as
females to consume alcohol at risky levels (20 per cent for males; 11 per cent for
females) and people aged 18–29 were more likely than any other age group to
drink alcohol in risky quantities (AIHW).
A ‘standard drink’ is the measure used to determine the approximate amount of
alcohol consumed. One standard drink contains 10 grams of alcohol and equals:
• 285 mL (one pot) of regular strength beer (alcohol content of 4.9 per cent)
• 375 mL of mid-strength beer (alcohol content of 3.5 per cent)
• 100 mL (one small glass) of table wine (alcohol content of 12 per cent)
• 30 mL of spirits plus mixer (alcohol content of 40 per cent).
100
Males
Females
80
Percentage
60
40
20
0
(a) (b)
Daily Weekly Less than Ex- Never Abstainer Low risk Risky
weekly drinker
Drinking status Lifetime risk
(a) On average, had no more than 2 standard drinks per day.
(b) On average, had more than 2 standard drinks per day.
Figure 11.30 Alcohol drinking status and lifetime risk status, by sex, people aged
14 or older, 2010
Source: AIHW, Australia’s Health 2012, p. 226.

In 2009, the National Health and Medical Research Council released The
Australian Alcohol Guidelines to Reduce Health Risks from Drinking Alcohol.
There are four guidelines, two of which are relevant to the health of adults:
Guideline 1: Reducing the risk of alcohol-related harm over a lifetime
Drinking no more than 2 standard drinks on any
day reduces the lifetime risk of harm from alcohol-
Eyes (cataracts, drusen, age-related
related disease or injury. macular degeneration)
Guideline 2: Reducing the risk of injury on a Brain (anxiety,
depression, sleep
single occasion of drinking
disorders)
Drinking no more than 4 standard drinks on a
Cardiovascular
single occasion reduces the risk of alcohol-related
system (high blood Mouth,
injury arising from that occasion. pressure/LDL oesophagus,
The overconsumption of alcohol can seriously cholesterol, heart throat (cancer)
impact on the health and individual human attack, stroke)
development of adults (figure 11.31). Some of these
Liver (cirrhosis,
effects include: infection, Breast
• Liver. Overconsumption of alcohol is one of the blood (cancer)
most common causes of cirrhosis of the liver. clotting)
Liver cells are progressively replaced by scar Stomach
(cancer)
tissue, leading to an increased risk of infection and Pancreas
problems with blood clotting. The liver is unable (severe pain,
to perform vital functions, such as metabolism, inflammation Torso
cancer) (malnutrition
production of proteins and filtering of drugs and overweight,
toxins. It can eventually lead to death. obesity)
• Cardiovascular system. Overconsumption of
alcohol can elevate blood pressure and LDL
cholesterol, and increases the risk of heart attack Uterus
(infertility, other
and stroke. gynaecological
• Bowel and pancreas. Alcohol can affect the normal disorders)
secretions in the bowel and irritate the bowel Bowel
(diarrhoea,
lining, resulting in diarrhoea and inflammation. cancer)
The pancreas may become inflamed and cause
severe pain.
• Cancer. Alcohol is linked to an increase in cancer
risk. It is known to cause cancers of the mouth, Genitals
Hands
throat and oesophagus. It is also a risk factor for (male
(tremors)
cancers of the stomach, breast, liver, pancreas and impotence)
bowel. Figure 11.31 Areas of the body
• Mental health. For many adults, small amounts of alcohol can provide stress relief that are affected by the sustained
but the sustained consumption of alcohol can lead to dependence and increased overconsumption of alcohol
anxiety levels. For adults who are prone to mental illnesses such as depression,
alcohol can increase the frequency and severity of these conditions. This can
impact the individual’s capacity to interact with others, thereby affecting social
and emotional development.
• Sexual problems. Alcohol can increase sexual health problems such as male
impotency. This may impact on an adult’s capacity to maintain a relationship
with a partner.
• Eye disease. Alcohol consumption can increase the risk of eye conditions such as
cataracts, drusen (the accumulation of extracellular material in the eye) and age-
related macular degeneration.
• Alcohol dependence. Adults with a dependence on alcohol will place priority on
drinking over behaviours that would normally be considered important, such
as food consumption and personal hygiene. They might experience tremors and
anxiety if they cease drinking for a few hours. Alcohol dependence may cause
11.8 Behavioural determinants: alcohol use
social problems such as domestic violence. It may also affect an adult’s ability to
manage family and work relationships, thereby impacting social development.
• Sleep disorders. Initially alcohol can induce sleep, but it eventually reduces the
quality of sleep and may worsen sleep disorders.
• Malnutrition. Alcohol displaces important nutrients from the body. As a result,
nutrients are not available for the maintenance and repair of body tissues.
Alcohol is high in kilojoules and increases energy intake, which may contribute
to overweight and obesity if the energy is not expended.
• Breast cancer and gynaecological problems. Women who drink alcohol are at
greater risk of breast cancer and gynaecological problems such as infertility and
an irregular menstrual cycle.
• Brain impairment. Alcohol consumption can lead to memory loss, difficulties
with learning new information, confusion and hallucinations, thereby affecting
Alcohol consumption is associated with a higher risk of accidents and injury in a
range of settings including motor vehicle and bicycle accidents, accidents involving
pedestrians, falls, fires, drowning, sport and recreational injuries, alcohol poisoning,
overdose, suffocation, choking on vomit, assault, violence and intentional self-
harm. More adults die from alcohol-related road accidents and injuries than from
alcohol-related cancers, cardiovascular disease and alcohol dependence combined.

1 What represents a ‘standard’ drink? 5 Develop a health promotion campaign that aims
2 What is the recommended daily limit of standard to reduce the levels of alcohol consumption within
drinks for adults? the adult population. Consider the factors that
3 What are the two Australian Alcohol Guidelines influence the drinking behaviours of adults and the
to Reduce Health Risks from Drinking Alcohol that impact that alcohol has on the health and individual
are relevant to the health and individual human human development of adults.
development of adults? 6 Referring to figure 11.30, compare alcohol drinking
4 List five impacts on the health and individual status and life time risk status between males and
human development of adults as a result of the females.
overconsumption of alcohol.

11.9 Behavioural determinants: drug use
KEY CONCEPT The impact of drug use on the health and individual human
Drug use
A drug is any substance that produces a psychoactive effect. The National Drug
Strategy defines a drug as including tobacco, alcohol, pharmaceutical medications
and illicit substances such as heroin and ‘ecstasy’. Illicit drug use is a major risk
factor for ill-health and death associated with HIV/AIDS, hepatitis C, low birth
weight, malnutrition, poisoning, mental illness, self-inflicted injury and overdoses.
Drug use may arise from an inability to cope with adult responsibilities. Like
alcohol, drug use generally — not just the use of illicit drugs — is a major risk
factor for many diseases in adults. It is also associated with injury, accidents,
disability, violence, crime and suicide, and social and family problems.
According to the 2010 National Drug and Household Survey, the proportion of
people aged 14 and over who had used an illicit drug in the previous 12 months
had increased from 13.4 per cent in 2007 to 14.7 per cent in 2010. Cannabis is the
most commonly used illicit drug in Australia, with 35.4 per cent of Australians
aged over 14 years of age reporting using cannabis at some time (see figure 11.33).
The use of cannabis can result in acute effects including the impairment of motor
skills, reaction time and the ability to perform skilled activities, as well as decreased
memory and learning abilities — thus impacting on an individual’s physical and
intellectual development. Mental health can also be affected, as cannabis causes
changes in the user’s moods, affects how they think and perceive the environment,
and causes decreased motivation in areas such as study, work or concentration. Figure 11.32 Drug use is a major risk
35.4 factor for poor health outcomes in
Marijuana/cannabis
10.3 adults.
Ecstasy 10.3
3.0
(c)
Meth/amphetamine 7.0
2.1
Cocaine 7.3
2.1 Lifetime use(b)
Hallucinogens 8.8
1.4 Recent use(a)
Inhalants 3.8
0.6
Heroin 1.4
Drug type
0.2
Ketamine 1.4
0.2
GHB 0.8
0.1
Injectable drugs 1.8
0.4
(c)
Pain-killers/analgesics 4.8
3.0
(c)
Tranquillisers/sleeping pills 3.2
1.5
(c)
Steroids 0.4
0.1
(c)
Methadone or Buprenorphine 0.4
0.2
Other opiates/opioids 1.0
0.4
0 5 10 15 20 25 30 35 40
Per cent
Figure 11.33 Recent and lifetime
(a) Used in the previous 12 months.
illicit drug use, people aged 14 years
(b) Used at least once in lifetime. or older, by illicit drug used, 2010
(c) For non-medical purposes. Source: AIHW, 2010 National Drug Strategy
Household Survey report. Drug statistics series
no. 25. Cat. no. PHE 145. Canberra: AIHW. p. 86.
Younger adults are more likely to use illicit substances (e.g. ‘ecstasy’, marijuana)
whereas older adults are more likely to abuse prescription and over-the-counter
medications.
The use of drugs (e.g. anabolic steroids) to improve athletic performance is
increasing and the risks of using anabolic steroids are well documented. From the
case study on the next page, it can be seen that some adults are prepared to take
illegal risks to achieve the perceived benefits of some drugs.
The potential side effects of anabolic steroid use

Males:
• hair loss
• severe acne
• jaundice (yellowing of eyes or skin)
• psychiatric problems — aggressive behaviour (‘roid rage’), mood swings, delusions
• abnormal heart rhythms, high blood pressure, blood clots, heart attack
• diabetes
• breast development
• high cholesterol
• liver cancer and liver failure
• shrunken testicles, decreased sperm count
• increased risk of prostate cancer
Females:
• jaundice (yellowing of eyes or skin)
• psychiatric problems — aggressive behaviour (‘roid rage’), mood swings, delusions
• breast shrinkage
• development of facial and body hair
• severe acne
• deepening of the voice
• abnormal heart rhythms, high blood pressure, blood clots, heart attack
• diabetes
• can harm the baby if taken during pregnancy
• high cholesterol
• liver cancer and liver failure
• problems with periods
• enlarged clitoris
Normal aspects of ageing have a significant influence on drug use as adults age.
The way in which medications are absorbed, distributed, metabolised and cleared
from the body is affected by age-related changes in organ systems and illness. Even
when medications are taken as prescribed, age-related changes and disease can
increase the risk of side effects.
The rapid development of new medications to treat a variety of diseases, relieve
pain and improve quality of life has led to the increased use of prescribed and over-
the-counter medications. With increasing age, adults are more likely to have more
than one medical condition for which they have been prescribed medications. This
could pose a problem as different medications may interact and create side effects
that affect the functioning of the other medications.
The use of drugs can impact on health in the following ways:
• Damage to body organs. Heavy drug use can affect the liver, brain, lungs, throat
and stomach.
• Infectious diseases. Sharing needles from injecting drugs is a major risk for
contracting blood-borne diseases such as hepatitis B or C and HIV/AIDS.
• Injuries and accidents. Drug-related injuries can be linked to fights and falls,
Figure 11.34 A urine sample ready as well as accidents that occur while operating machinery at work or driving
for drug testing vehicles.

• Depression. It is common to feel low after using some drugs (including alcohol).
This could be due to the drug itself or to something that happened while using
the drug. It is unclear whether alcohol use contributes to depression or is a
symptom of it.
• Stress. Some adults use certain drugs to help them relax. However, changing the
way the body and mind work with drugs is a form of stress in itself, and users
can experience tension, anxiety, paranoia and other feelings that only add to the
feelings of stress.
• Relationship problems. Family breakdown and conflict between friends and
partners are more common with drug use.
Credible information on drugs (through various forms of media), early treatment
of complications, and drug treatment centres are important aspects of dealing with
some of the issues listed above. Increasing individual awareness and attempting to
change drug-taking attitudes and behaviours is of vital importance.
Case study
Men risk health for a boost … Human growth hormone is secreted naturally by
the brain’s pituitary gland and promotes growth during
of youth childhood and adolescence by stimulating production
of an insulin-like growth factor in the liver.
The illicit trade in human growth hormone has moved
Levels of HGH deplete as the body ages. The
to expensive anti-ageing clinics. Cameron Houston
and Jill Stark investigate the boom. By Cameron synthetic form of the hormone — which is not on the
Houston and Jill Stark. pharmaceutical benefits scheme — is injected daily and
costs $125 to $200 a week with a private prescription.
Middle-aged men are increasingly injecting human Doctors can prescribe the drug ‘off-label’ —
growth hormone in a bid to fight old age, spending up outside the purpose approved by the Therapeutic
to $15 000 a year on a drug they believe is the fountain Goods Administration — if they deem it ‘medically
of youth. appropriate’.
Government guidelines state it should only be Human growth hormone builds muscle mass and
prescribed to children with growth disorders and adults helps to reduce fat. Some anti-ageing doctors claim the
with severe hormone deficiencies. drug also reduces wrinkles, improves skin appearance
But a Sunday Age investigation has found many anti- and lowers cholesterol.
ageing clinics in Melbourne’s wealthier suburbs are Endocrinologists, who are specialists in hormones
flouting regulations by prescribing to people as young and glands, say the claims are not backed by scientific
as 35 who want to look good, stay fit and boost their evidence, and have hit out at ‘unscrupulous’ doctors
sex lives. prescribing the drug for non-medical reasons.
Most are men who use human growth hormone They say that for people with a normally functioning
(HGH) to improve fitness and energy levels, but leading pituitary gland, growth hormone treatment is potentially
specialists claim it can have serious side effects. dangerous even in small doses. Ken Ho, chair of
Black-market sales are also booming, with a former endocrinology at St Vincent’s Hospital in Sydney, said
dealer claiming $5000 worth of the drug can fetch up misuse could increase the risk of cancer and elongate
to $50 000 on the street. Possession is illegal without a the jaw.
prescription and importation is prohibited. Professor Ho said the medical properties of HGH
The dealer said some people were getting the were being exploited by anti-ageing clinics.
hormone for personal use from anti-ageing clinics then ‘They are trying to sell an expectation that if you’re
selling it for profit. 55 and you no longer have the body of a 21-year-old,
(continued)
then you can reclaim former glories by taking these … Use of the drug has divided the sector. Joe
drugs. There are claims about improved sex life, which Kosterich, head of the Australasian Institute of
are completely unfounded … They are trying to tell Antiageing Medicine, said the definition of growth
you that ageing is an insidious disease, but there is no hormone deficiency was a ‘grey area’.
hormone that can stop ageing.’ ‘Generally speaking, most adults are not going to be
Dr Martin Hill, of Life Sense clinic in Windsor, is deficient in human growth hormone, so there is going
known to prescribe and supply HGH to men as young to be some usage that does skirt close to the legal
as 35, after conducting blood tests and a prostate boundary,’ he said.
examination. He is believed to have told patients in … The Australian Medical Association is concerned
consultations that he personally used it and the only that vulnerable people who will pay anything to stay
side effect was the cost. young are being exploited. But investigations into the
A prominent endocrinologist said he had seen a prescribing habits of individual doctors are often only
number of Dr Hill’s patients, who had been given an launched after a patient makes a complaint. With the
‘incredible mixture of medications’. One woman was long-term effects of HGH still unknown, it is difficult
allegedly given five different hormone treatments by for regulatory bodies to intervene.
Dr Hill and was being sued by an insurance company Victorian Health Services Commissioner Beth
over a $100 000 debt. Wilson, who fields consumers’ medical complaints,
In a letter in response to questions from The Sunday said the anti-ageing industry often exaggerated benefits
Age, Dr Hill’s lawyer wrote: ‘Dr Hill’s management of and played down risks: ‘It’s really scary how people’s
his patients is supported by substantial scientific and fear of their own body image and ageing has been
medical research and literature.’ manipulated by the industry.
… Delaying the march of time is big business — ‘But the claims of the anti-ageing industry are
in the US the anti-ageing sector is expected to rake doomed to failure because the last time anyone looked at
in $US106 billion ($A139 billion) this year, rising to the statistics for human mortality, it was 100 per cent.’
more than $US115 billion by 2010. The AustralAsian Source: Extract from The Age, 10 May 2009.
Academy of Anti-Ageing Medicine describes it as the
‘fastest-growing medical speciality in the world’.
Case study review

1 What is the main reason for the use of human growth hormone?
2 What do endocrinologists see as the potential risk of using HGH to the health of
an individual?
3 Describe the benefits that are outlined for using this drug.
4 Do all health professionals agree about the benefits? Outline the main differences
of opinion.
5 Trying to reverse or stop the ageing process has become a multi-billion dollar
industry. Describe the impact on the social and emotional development of an
individual wanting to fight old age.

1 What is a drug? 4 Write a response to the following: ‘Drug use is less
2 How does drug use/misuse vary during adulthood? risky during adulthood than during the youth stage
3 Identify four drugs (illicit, prescription or non- of the lifespan’. In your response, consider the types
prescription) used by adults and explain the impact of drugs that adults use and their possible effects
that those drugs have on the physical, social and on health and individual human development.
mental health of an individual.

11.10 Behavioural determinants: sexual practices
KEY CONCEPT The impact of sexual practices on the health and individual
Sexual practices
Sexual practices refer to the ways in which individuals experience and
express their sexuality. Decisions made about sexual practices during
adulthood are a continuation of the decisions and experiences made
during youth, especially those made during early adulthood when
selecting or attracting a partner is a major developmental milestone.
Other important issues related to sexual practices include unprotected
sex, sexually transmissible infections, pregnancy and fertility/infertility,
and reproductive function and dysfunction.
Men and women continue to have a satisfactory pattern of sexual
functioning throughout middle and late adulthood. As in the earlier
stages of the lifespan, adults might need information to help them make
informed decisions about their sexual behaviours and contraception
methods appropriate to their needs.
Unprotected sex
Almost all sexually active Australians say they have had unprotected
sex, and yet more than half say they have never had a test for a sexually
transmissible infection (STI). According to the national clinic adviser for
Marie Stopes International (a non-profit sexual and reproductive health-
care provider), the majority of safe sex campaigns are targeted at youth;
however, research shows that 35–40 year olds are just as exposed to
unsafe sex practices. STIs and unplanned pregnancies are key health
issues that affect many Australians. Research shows that during early and
middle adulthood (18–24 year olds and 35–40 year olds respectively),
Figure 11.35 A couple express their
individuals were less likely to be proactive with their health care and sexuality in dance.
have an STI check. Women are more likely than men to have an STI check up after
having unprotected sex; however, overall as many as six out of ten adults do not
follow up with an STI check after unprotected sex.
Sexually transmissible infections

In 2011, chlamydia was the most frequently reported sexually transmitted infection
in Australia, with 79 833 new notifications in people aged 15 years and over. This
represents 435 cases per 100 000 population and is nearly seven times the rate
of gonorrhoea notifications. This rate has almost tripled over the past decade (see
figure 11.36)
Health messages regarding sexually transmissible infections (STIs) are usually
aimed at youth but adults are not immune to infection and need to follow safe
sex practices to minimise the risks. The decisions they make can have an impact
on their health and individual human development. Cancer of the cervix, for
example, can be linked to the sexually transmitted herpes 2 virus and the human
papillomavirus (HPV) and untreated chlamydia can lead to pelvic inflammatory
disease and infertility. As with many other health behaviours and diseases, the full
effect on the life of an individual and family may not be realised until middle
adulthood. Adults of all ages need accurate information about sexual health,
including developmental changes, STIs and related treatment strategies to promote
satisfying and responsible health behaviours.
11.10 Behavioural determinants: sexual practices
2,400
2,200
2,000 Males
Females
1,800
1,600
1,400
Rate
1,200
1,000
800
600
400
200
0
15–19 25–29 35–39 45–49 55–59 65+
20–24 30–34 40–44 50–54 60–64
Figure 11.36 Chlamydia notifications by age, 2011(a)

Note: (a) Per 100,000 population aged 15 years and over
Source: Australian Bureau of Statistics; National Notifiable Disease Surveillance System.
Pregnancy: fertility/infertility
Unintended pregnancy can be an issue not only for youth, but also for adults.
Research indicates that unintended pregnancies are often the result of contraceptive
failure. Whatever the cause, unintended pregnancy is associated with increased
infant mortality and morbidity, parental neglect, child and partner abuse, and
emotional deprivation.
Reproductive problems can become a major concern in early adulthood,
especially in relation to infertility. Infertility is the inability to conceive a child while
having unprotected sexual intercourse for at least 12 months. It is known that
men and women suffer from infertility at about the same rate. Sometimes multiple
Figure 11.37 An ovum and sperm —
will it be fertilised?
factors are involved in one or both partners.
Women can be infertile from disorders such as hormone imbalances, blocked
fallopian tubes, endometriosis, or abnormalities of the reproductive organs. Men
can experience infertility if they have problems with the number and shape of their
sperm, produce antibodies against their own sperm or have blocked spermatic
cords. In some cases, the exact cause of infertility cannot be found.
Proper diagnosis of infertility will help in selecting an appropriate treatment plan
that maximises the chance of becoming pregnant.
Infertility statistics
• One in six couples is infertile.
• In 40 per cent of cases the problem rests with the male, in 40 per cent with the
female, in 10 per cent with both partners, and in a further 10 per cent of cases
the cause is unknown.
• Fertility problems affect one in three women over 35.
• One in 25 males has a low sperm count and one in 35 is sterile.
• For healthy couples in their 20s having regular unprotected sex, the chance of
becoming pregnant each month is 25 per cent.

• Birth rates from a single cycle of IVF using the woman’s own eggs are
approximately 30–40 per cent for women aged 34 and younger. This decreases
steadily after age 35 as the ageing of the egg supply significantly impacts on the
chances of having a baby through IVF.
• Approximately 3 per cent of births in Australia involve the use of assisted
reproductive technologies such as IVF.
Reproductive function/dysfunction
As mentioned in chapter 10, physiological changes in the reproductive systems of
both men and women throughout adulthood result in changes in sexual function.
After menopause, many women enjoy sex more, especially because the risk of
becoming pregnant is no longer a concern.
Although men and women frequently enjoy satisfactory sexual relationships
throughout middle adulthood, men are more vulnerable to experiencing sexual
dysfunction than women. Advancements in medical technologies have made
available a range of products (e.g. Viagra) that allow men to continue to function
sexually into older age. Currently there is no data to suggest that men or women
Figure 11.38 Adults’ sexual
lose interest in sexual activity as they age. Although the need to express sexuality behaviour does not have to fade
continues, older adults are susceptible to many disabling medical conditions — with age.
cardiovascular conditions, arthritis, normal changes associated with ageing, and
medication side effects — that can make the expression of sexuality difficult. In
both males and females, reduced availability of sex hormones results in less rapid
and less extreme responses to sexual arousal. Touch is an overt expression of
closeness and an integral part of sexuality, and older adults still feel the human
need to touch and be touched.
TEST your knowledge 6 What are the issues relating to sexual practices
across each stage of adulthood?
1 Define sexual practices.
2 What are STIs?
3 What is the definition of infertility?
4 Outline possible causes of infertility in both males 7 ‘Unintended pregnancies can be an issue, not
and females. only for youth, but also for adults’. Discuss the
5 What percentage of births in Australia involved the impact that pregnancy can have on the health and
use of assisted reproductive technologies? individual human development of adults.
11.11 hysical environment determinants: housing and
P
workplace safety
KEY CONCEPT The impact of housing and workplace safety on the health and
individual human development of adults
The physical environment impacts on the health and individual human development
at all stages of the lifespan. For instance, access to clean water and sanitation is just
as important during the adulthood stage of the lifespan as it is during the infancy,
childhood and youth stages. Employment becomes a priority during adulthood, so
the physical environment in which adults work can impact significantly on health
and individual human development. Other factors within the physical environment
that have an impact on the health and individual human development of adults are
housing, neighbourhood safety and access to health care.
Housing
Housing plays a significant role in the health and individual human development of
adults. A house provides shelter and protects adults from the outside environment,
including any physical dangers. The majority of Australian adults live in their
own homes that they either own outright (33 per cent) or are paying off (36 per
cent). Rentals account for approximately 28 per cent of households, with the two
biggest groups being private rentals (24 per cent) and public/government rentals
(4 per cent).
Housing stress
Having suitable housing is a priority for the vast majority of adults. For many
Australian adults, housing stress has a significant impact on health and individual
human development, not only for themselves but also for their family members.
Housing stress occurs when the cost of housing (either rental or
mortgage) is high in relation to household income. It is generally
accepted that housing stress occurs when at least one-third of
family income is required to meet rent or mortgage payments.
Lack of affordable housing is a concern for many households.
Affordable housing is adequate, appropriate and secure housing
that is available at a cost that does not cause financial stress. Those
adults who pay a high proportion of their income to meet their
housing needs may experience financial stress. This leaves them
with less income to meet day-to-day needs such as basic services
(electricity, gas and water), nutrition, health care and clothing.
Figure 11.39 Housing provides Financial stress has a greater impact on lower-income households
shelter and protects residents from because they have little money to meet basic needs. According to the Australian
the outside environment. Bureau of Statistics, in 2007–2008, lower-income earners with a mortgage spent
27 per cent of their gross weekly income on housing costs, compared to all owners
with a mortgage who spent 18 per cent of their gross weekly income on housing
costs. These figures were similar for lower-income earners who were renting
privately as compared to all other private renters.
The constant stress of not having enough money to cover rent or mortgage
payments and other necessities of life can contribute to health problems. These
include:
• migraine or tension headaches
• insomnia or other sleep disorders
• anxiety, anger and irritability
• memory lapses

• shoulder, neck or back pain
• chronic fatigue
• heart palpitations
• skin conditions
• heartburn
• diarrhoea or constipation
• dizziness
• shortness of breath
• heart problems
• chronic pain.
Financial stress from housing affordability problems can result in
adults going without meals or not consuming foods that meet their
nutritional requirements. Over the long term, this can contribute to
a range of diet-related conditions such as osteoporosis, cardiovascular disease and Figure 11.40 Housing and financial
type 2 diabetes. The lack of income to pay for health care may result in these stress can contribute to a range of
conditions being left untreated. health problems.
Financial stress may also place a strain on relationships with family and
friends. As a result, the adult may feel isolated and have reduced opportunities
for socialisation. For married couples, financial stress linked to difficulties with
meeting house repayments or rental costs may cause divorce. For those who are
renting, frequent moves in order to find affordable rental housing may make it
difficult for the adult to maintain friendships and develop a sense of belonging
within a community. This will have a significant impact on an adult’s capacity to
develop relationships with other people, thereby impacting on social development.
As an adult’s emotional development is dependent on their interaction with others,
emotional development may also be hindered due to financial stress. The health
issues arising as a result of financial stress may affect the adult’s ability to focus
on learning new information and/or skills, thereby impacting their intellectual
development.
Homelessness
High levels of debt or the inability to meet rental payments has resulted in a
significant number of adults becoming homeless. According to the ABS, 0.5 per cent
of the Australian population were homeless on Census night in 2011.
Homelessness is having nowhere stable, safe and affordable to live. Homeless
adults living on the street may be vulnerable to violence, including sexual abuse
and rape. Being a victim of violence, or being exposed
to violent situations, may result in post-traumatic stress
disorder.
Homeless adults find it difficult to maintain healthy
eating habits. Lack of nutrients may result in reduced
immunity and loss of bone density and muscle mass.
Inadequate nutrition, poor living conditions and lack of
hygiene increase the risk of infectious diseases such as
meningococcal, meningitis, septicaemia, tuberculosis,
rheumatic fever, respiratory conditions and skin infections.
Adults who do not have a place to live and feel a lack of
control over their lives may suffer from depression, stress
and anxiety. This may result in increased drug, tobacco
and alcohol use, which is directly linked to illnesses such
as cancer, cardiovascular disease, type 2 diabetes and
various mental health conditions. Figure 11.41 The inability to afford
Prolonged ill-health can impact on the adult’s capacity to engage in physical housing is one of the reasons for
activities. As a result, bone and muscle strength may not be maintained or homelessness.
11.11 Physical environment determinants: housing and workplace safety
developed and a decline in motor skills and coordination may occur. Ill-health will
also affect the homeless adult’s ability to engage with other people, thereby limiting
opportunities to use and maintain social skills and to emotionally connect with
others. As a result, the adults may feel isolated from others, which may contribute
to the development of depression.
Workplace safety
More time is spent in the work environment in the adulthood stage of the lifespan
than in the youth stage. This means there is a greater risk of workplace injuries
and illnesses during adulthood if effective preventative measures are not in place.
In the 12 months to June 2010, 5.3 per cent of the 12 million people
who had worked during that time experienced a work-related injury,
with males having higher rates of injury than females. This equates
to approximately 650 000 people and an injury rate of 53 per
1000 employed people. Males tend to have higher rates of injury
than females because there are more men in the workforce and they
tend to be employed in higher-risk occupations (e.g. construction). In
2009–10, the injury rate for males was 55 per 1000 employed men
compared with a female rate of 51 per 1000 employed women.
Injury rates also vary according to age. Young workers are more
likely to sustain a work-related injury than an older worker. This
may be attributed to lack of experience, limited training and lack of
awareness of safety in the workplace.
The type of occupation has a significant impact on the risk of injury
or illness in the workplace. The occupations with the highest rates of
injury in 2009–10 were labourers, machinery operators and drivers,
community and personal service workers, and technicians and trades
workers. The higher rate of injuries in these occupations can be
attributed to the physical nature of these jobs. Professional people
Figure 11.42 Males tend to have
higher rates of workplace injury than
(science, building, engineering, business and information, health and education)
females. had the lowest rate of injuries. Figure 11.43 illustrates the rate (per thousand
employees) of work-related injury or illness according to occupation groups.
Managers
Professionals
Technicians and trades workers
Community and personal service workers
Clerical and administrative workers
Sales workers
Machinery operators and drivers
Labourers
0 20 40 60 80 100 120
Figure 11.43 Work-related injury or Per 1000 employed peoplea
illness rate by occupation groups
Source: Australian Bureau of Statistics 2010,
(a) Number of people who, in the last 12 months, experienced a work-related injury or illness
Work-related injuries, Australia, 2009–10, while working in an occupation group per 1000 people employed in that occupation
cat. no. 6324.0, p. 5. group during the reference week.
While office jobs have a relatively low risk of injury, conditions related to overuse
of technology are becoming more common. For instance, having to sit for hours in
front of a computer may lead to back and neck pain, headaches, muscle and joint
pain of the upper limbs, and eyestrain from having to look at the monitor for

extended periods of time (figure 11.44). Occupational overuse syndrome
(OOS) is a condition caused by repetitive movements that can affect the
tendons and muscles of the hands, wrists, elbows, shoulders, back and
neck. It can result in pain, muscle weakness, swelling, numbness and
restricted joint movement.
In 2009–10, the most commonly reported injuries were sprains or
strains of joints and muscles; these accounted for 30 per cent of workplace
injuries. This was followed by chronic joint or muscle conditions
(18 per cent of workplace injuries) and cuts or open wounds (16 per cent
of workplace injuries), the majority of which were suffered by adults.
The type of workplace injuries experienced depends on the industry Figure 11.44 Overuse of computers has resulted
or occupation (table 11.7). in an increase in injuries in the workplace.
Table 11.7 Common workplace injuries by industry/occupation

Industry/occupation Most frequently reported injuries (% contribution to total injuries for that industry/occupation)
Agriculture Back — muscle stress/strain from heavy lifting of feed, produce and animals (29%)
Shoulder — muscle stress/strain from heavy lifting of boxes, freight or pallets. Traumatic joint/muscle injury or strain from
heavy lifting (13%)
Ambulance service Back — muscle stress/strain from heavy lifting (patients) (44%)
Children’s services Back — strain from lifting, carrying and moving children, toys, furniture and equipment (36%)
Construction — Hand and fingers — wounds, lacerations or amputations from nail guns, protruding nails or sawing/cutting timber (21%)
carpenters
Construction — Back — muscle stress/strain from pulling cables or lifting materials or equipment (18%)
electricians Hands and fingers — wounds/lacerations from tools slipping or cutting (17%)
Knee — traumatic joint/muscle injury or strain from slipping/tripping on uneven surfaces, kneeling or falling from ladders,
down stairs or through roof/floor (13%)
Construction — Back — muscle stress/strain from lifting equipment or materials, or from bending (22%)
labourers Hands and fingers — wounds/lacerations from being caught or crushed in equipment or materials (11%)
Knee — traumatic joint/muscle injury or strain from slipping on wet/uneven surfaces, falling from heights, tripping down
steps/ladders or kneeling for long periods (11%)
Education sector Psychological stress — work-related stress, increased work pressure, bullying, harassment (19%)
Back — muscle stress/strain from lifting, assisting students, bending down, moving furniture or boxes, falling off chairs or
down stairs, slipping on wet floors or tripping over objects (18%)
Knee — muscle stress/strain from slipping on wet floors, tripping on uneven ground or from kneeling. Traumatic joint/muscle
injury or strain from slipping on wet floors, tripping on uneven ground, kneeling or falling during physical activity (10%)
Office workers Psychological stress — stress or anxiety from work pressure, traumatic events, bullying, harassment (20%)
Back — muscle strains from lifting and general manual handling of equipment such as computers, boxes or files (17%)
Source: Based on data from ‘Injury hotspots (statistics and solutions)’, Worksafe Victoria, www.worksafe.vic.gov.au.
Research indicates that shift work is a risk factor for work-related injuries. The
work-related injury rate for shift workers was twice that of non-shift workers in
2005–06.
eLesson:
Apart from the injuries or illnesses that may be sustained from the workplace,
WorkSafe
there is also the risk of workplace fatalities. In spite of the recommendations
and expectations of a safe working environment, people still die every year
from preventable causes. From July 2011 to June 2012, there were 102 notified
workplace fatalities across Australia. The most common causes of fatalities were
vehicle accidents, being hit by falling objects, being hit by moving objects, and falls
from height (Safe Work Australia, 2012).
The effects of workplace injury may be short or long term and can have significant
impacts on the health and individual human development of adults. Short-term
injuries/conditions, such as cuts and abrasions, will allow an adult to return to work
relatively quickly. Other injuries/conditions, such as fractures and stress-related
conditions, generally require a longer period of time away from work. In some
instances, the worker may be so severely injured that they are unable to return to
work or may not be able to return to the same position they previously held.
11.11 Physical environment determinants: housing and workplace safety
Workplace injury can result in the adult being in pain, and the potential
permanent scarring or impairment may cause significant misery to the individual.
Certain injuries, such as back injuries, may make it difficult for an adult to carry
out normal everyday tasks, such as going to the toilet. Being unable to look after
oneself and relying on the support of family and friends may impact on the affected
adult’s mental health. An adult who is unable to attend work may begin to feel
worthless and worry about the future, not only for themselves, but also for their
family members. The stress and anxiety associated with a long-term workplace
injury may lead to a variety of mental health conditions such as post-traumatic
stress disorder and depression. Some injured adults may become dependent on
prescription drugs, alcohol or other non-prescription drugs.
In terms of emotional development, the adult may be in chronic pain and find
it difficult to control their emotions. This may impact on the adult’s capacity to
maintain relationships with others, thereby impacting their social development. On
the other hand, the reliance on family and friends may result in greater bonds
being formed, which will enhance the social health and development of the adult.
The impacts on physical health can vary according to the severity of the injury.
The injured adult may be unable to participate in regular physical activity and, as
a result, fitness levels may decline. Lack of regular physical activity can impact on
physical development, such as a decrease in muscle mass and bone strength (Legal
Compensation Helpline, 2011).
Worksafe Victoria
Worksafe Victoria is a state government agency that manages Victoria’s workplace
safety system. Its responsibilities include:
• helping avoid workplace injuries from occurring
• enforcing Victoria’s occupational health and safety laws
• providing reasonably priced workplace-injury insurance for employers
• helping injured workers back into the workforce.
Worksafe Victoria provides a range of benefits to injured workers, regardless of
who was at fault. Benefits include weekly financial support, ambulance transport
expenses, medical and hospital treatment, attendant care and home help, and lump
sum payments.
One of the key messages from Worksafe Victoria is the prevention of workplace
injury. An extensive television and radio campaign aims to disseminate information
and raise awareness regarding safety in the workplace.

1 Explain the effects that financial stress can have on the 9 Write a letter to the editor of a newspaper outlining
health and individual human development of adults. the impact of high mortgage repayments and
2 Explain the impact that homelessness can have on the housing rent on the health and individual human
health and individual human development of adults. development of adults. In your letter, consider the
3 What was the workplace injury rate in 2009–10? numbers of people made homeless by financial
4 What were the most commonly reported workplace stress.
injuries in 2009–10? 10 Referring to table 11.7, which type of injury occurs
5 Explain occupational overuse syndrome. How can it most frequently in the listed industrial occupations?
be prevented? For each industry/occupation, outline the reasons
6 Why would shift work be a risk factor for work- why this type of injury would be occurring most
related injury? frequently.
7 Explain the possible impact on health and individual
human development of a long-term work-related
injury.
8 What are four responsibilities of Worksafe Victoria?

11.12 hysical environment determinants: neighbourhood
P
safety and access to health care
KEY CONCEPT The impact of neighbourhood safety and access to health care
on the health and individual human development of adults
Neighbourhood safety
All people need to feel safe in their homes and when out in the streets. In
2008–2009, more than four million adults, or 26 per cent of those aged 18 years
and over, reported feeling unsafe alone at home, walking alone at night in their
neighbourhood, or taking public transport at night alone (Australian Social Trends,
June 2010). Figure 11.46 indicates that during 2008–09 the vast majority of
Australians felt safe in their home alone.
After dark
During the day
Unsafe or very unsafe
Neither safe nor unsafe
Safe or very safe
Figure 11.45 Neighbourhood Watch

promotes neighbourhood safety.
Never home alone
0 20 40 60 80 100
Proportion (%)
Figure 11.46 Feelings of safety at home alone

Source: Australian Bureau of Statistics 2010, Crime victimisation, Australia, 2008–09, cat. no. 4530.0.
Crime rates
In 2011–12, it was estimated that:
• 2.9 per cent of households were victims of at least one break-in at their home,
garage or shed
• 7.5 per cent of households were victims of at least one incident of malicious
property damage
• 0.7 per cent of households had at least one motor vehicle stolen
• 0.4 per cent of persons over 15 years of age were victims of at least one robbery
• 3.0 per cent of persons over 15 years of age were victims of at least one assault.
Victims of crime may experience a range of impacts on health and individual
human development including:
• feelings of emptiness • fear or anxiety
• nightmares or insomnia • exhaustion
• sadness • depression
• guilt or shame • anger or irritability
• grief or loss • feelings of loss of privacy or control
• panic or confusion • helplessness or feeling deserted
• physical symptoms of illness.
11.1 2 Physical environment determinants: neighbourhood safety and access to health care
Apart from the physical impact of crime, fear for personal safety can restrict the
adult’s participation in social occasions and reduce their trust in the community.
As a result, an adult may lose interest in their daily activities and be less likely to
access local community services and recreational facilities (e.g. parks), which can
reduce their fitness levels and impact on the maintenance and/or development of
bone mass and muscle tissue. Restricted involvement in the community limits the
social contact that the adult has with others, which may contribute to feelings of
sadness, possibly leading to depression. Depression can affect the adult’s capacity
to control their emotions, and decrease their interest in situations or activities that
promote the development of intellectual skills. In contrast, adults who have a sense
of safety within their neighbourhood are more likely to be involved in community
activities, thereby promoting their health and individual human development.
Case study
Stonnington’s crime rate A ‘significant’ number of assaults still occurred in

and around Stonnington’s bars and pubs, he said, and
plummets more resources would be sent to these ‘hot spots’.
Rises in drug offences (up 23.9 per cent) were
By Liam Ryan
significantly higher than in many other police districts.
Residents being more mindful about safety has led to a But Inspector White said this indicated more arrests
dramatic drop in associated crimes, says Stonnington’s through focused police action rather than more drug use.
top cop. Table 11.8 Victoria Police’s crime statistics in Stonnington
Inspector Adrian White praised (per 100 000 population)
community efforts after the release of
General crime Apr 08–Mar 09 Apr 09–Mar 10 Per cent change
Victoria Police’s latest crime figures.
Crime against the person 939.2 870.7 –7.3
He was ‘extremely happy’ with the
Crime against property 8016.1 7280.8 –9.2
annual results, including a reported 42.6
per cent drop in robberies and 27.6 per Drug offences 362.4 449.0 +23.9
cent fall in home burglaries. Other crime 658.5 794.1 +20.6
The statistics compare rates of Total crime 9976.2 9394.6 –5.8
crime across Stonnington per 100 000 Specific crimes Apr 08–Mar 09 Apr 09–Mar 10 Per cent change
population from April 2008 to March Robbery 138.8 79.7 –42.6
2009 with the same period in 2009–2010. Assaults 688.1 685.1 –0.4
‘The message is starting to get out Property damage 1002.5 965.6 –3.7
there and people are locking their Burglary: residential 852.4 617.5 –27.6
houses,’ Inspector White said. The Burglary: other 518.6 445.0 –14.2
reality of unreasonable risk-taking, such
Theft from motor vehicles 1899.9 1555.8 –18.1
as short cuts through dark alleys, was
Theft of motor vehicles 357.3 274.4 –23.2
also starting to sink in.
Traffic statistics Jan 08–Dec 08 Jan 09–Dec 09 Per cent change
Assault statistics had dropped only
marginally, but this was promising as Fatalities 3.1 0.0 –100.0
assault rates were generally on the rise Serious injuries 151.1 109.0 –27.9
across Melbourne, he said. Source: Stonnington Leader, 15 June 2010.
Case study review

1 What factors have contributed to the decreasing crime rates in the city of
Stonnington?
2 What impact will decreasing crime rates have on the health and individual human
development of the adults within the city of Stonnington?

Access to health care 80
Females
Males
Health care focuses on promoting the health of the Australian
population through the provision of a range of health 60
services. As morbidity and mortality rates increase with age,
Per cent
it is important for adults to have access to appropriate health 40
services for the purpose of preventing disease, screening for
disease or treating illness. The range of health services that are
20
available to Australian adults has contributed to the increase
in life expectancy over the past two decades, as diseases are
detected earlier and treatments have continued to improve. As 0
can be seen from figure 11.47, there has been a significant 1997 2007
increase in the survival rate following a heart attack, which Year
may be partly attributed to the increased capacity of health Figure 11.47 Survival rate for heart
services to diagnose and treat a heart attack. attacks in the 40–90 age range
There are numerous different types of health-care services available to improve Source: Australian Institute of Health and Welfare
2010, Australia’s health 2010, cat. no. AUS 122,
the health and individual human development of adults including BreastScreen Canberra, p. 487.
Australia, the National Bowel Cancer Screening Program and community health
services.
BreastScreen Australia
BreastScreen Australia is a breast cancer screening program that operates in over
500 locations throughout Australia. Breast cancer is a major risk for women —
more women die from this type of cancer than any other form. On average, seven
women die from breast cancer every day in Australia. Detecting breast cancer early
increases the chance of surviving the disease.
Mammography screening takes a low-dose X-ray of the breasts to detect any
changes in breast tissue (figure 11.48). The aim is to detect abnormal growths so
that the individual can be treated before the cancer progresses. Mammograms can
detect small tumours that may not be felt by hand.
Figure 11.48 Mammography
screening detects changes in breast
tissue.
Women over 40 years of age are eligible for free mammography screening but
screening recruitment strategies focus on the 50–69 year age group. This is because
over 75 per cent of breast cancers occur in women 50 years and over. Also, breast
tissue in younger women is more dense and can show up as a white area on X-rays,
making it easy to be mistaken for breast cancer (which also appears as a white area
on X-rays). The lifetime risk of women developing breast cancer is one in eight.
Women in the 50–60 year age group who have previously had a mammography
screening are sent a reminder for their next mammogram, which ideally should be
conducted every two years.
Mammography screening is used for two purposes: detection and diagnosis. It
can detect breast cancers in apparently healthy women, and can also be used to
determine if a breast abnormality is a sign of breast cancer. Changes to breasts
include:
• a lump or lumpiness of the tissue
• change in shape or appearance of the breast such as dimpling or redness
• an area that feels ‘different’ from the rest of the breast tissue
• a discharge from the nipple
• a change in the shape or appearance of the nipple, such as inversion
• breast pain.
When a change in the breast is noticed, mammography screening is used in the
initial phase of diagnosing whether or not it is a possible breast cancer. Following
a mammogram, the results are sent to the individual within 28 days. Less than
1 per cent of women who are screened actually have breast cancer. For those who
are diagnosed with breast cancer, the options are to be referred to a clinic specialising
in breast cancer treatment or to return to their general practitioner who will then
refer them on to a specialist.
Early detection significantly increases a woman’s chance of survival. In 2008,
BreastScreen Australia detected 4289 invasive breast cancers. Mortality has declined
from 66.7 deaths per 100 000 women aged 50–69 in 1989 to 47.0 deaths per
100 000 women aged 50–69 in 2007.
National Bowel Cancer Screening

Program
The bowel is part of the digestive system. Its main functions are
to finish digesting food by absorbing water and nutrients, and to
assist in the removal of waste products. There are three parts to
the bowel:
• small bowel — absorbs nutrients from food that has been
broken down
• colon — absorbs water
• rectum — stores waste products before they are expelled from
the body through the anus.
The colon and rectum form the large bowel (or large intestine).
This is where bowel cancer usually occurs. Cancer of the small
bowel (small intestine) is quite rare.
Figure 11.49 Bowel cancer is a
Bowel cancer is a cancerous growth or growths that occur on the inside of the
cancerous growth that occurs on the
inside of the colon or rectum. colon or rectum. These growths are referred to as polyps. They can look like small
spots on the lining of the bowel or they can appear as growths that extend from
the lining like cherries on stalks. Not all polyps are cancerous but removing any
detected polyps significantly reduces the risk of bowel cancer.
Bowel cancer is the most common internal cancer and accounted for 9.3 per cent
of all cancer deaths in Australia in 2010, the vast majority of whom were adults.
If detected early, bowel cancer can be successfully treated. Unfortunately, only

40 per cent of bowel cancers are detected early. In recognition of the importance
of screening for bowel cancer, the Federal Government funded the National
Bowel Cancer Screening Program, which offers testing to people aged 60 to 70
years of age between 2012 and 2015. In 2017–18, the program will be expanded
to all Australians aged between 50 and 74 years. These ages were selected for
two reasons:
1. The risk of developing bowel cancer increases significantly from 50 years of age.
2. In order to effectively phase in the program, it was necessary to ensure that the
appropriate health services, such as colonoscopy services, were able to meet the
demands for their services.
People who are eligible to participate in the screening program are sent an
invitation through the mail to complete a simple test at home. This test is called a
faecal occult blood test (FOBT). It requires an individual to take a sample of their
faeces and send it to a pathology laboratory for testing. A positive FOBT means
that blood has been detected in the faeces, which could be a possible sign of bowel
cancer. Individuals with a positive FOBT are informed and advised to discuss the
results with their doctor, who will usually refer them for a colonoscopy.
Completing an FOBT every two years can reduce the risk of dying from bowel
cancer by up to a third.
Community health services

Government-funded community health services are provided in each state and
territory in Australia. A diverse range of services is offered, and they are either
managed by the state/local government or by local health/community organisations.
Community health services involve a multidisciplinary team of health-care
professionals who aim to meet the health needs of a community, with some
programs focusing particularly on adults. Community health centres have been
developed in many local councils but services may also be offered in other settings
such as the council offices, schools and in client’s homes. The community health
services provided by the state and territory governments include:
• maternal and child community health services such as antenatal and postnatal
parenting support services
• women’s health services that provide services
and health promotion programs for females
across a range of female specific issues such as
reproductive health concerns
• men’s health programs, including promotional
and educational programs
• community rehabilitation programs, including
case management, prosthetic services and
home modification.
Health promotion programs, including
educational programs, aim to prevent the onset
of illness. An example of this type of program is
nutrition classes that assist adults in developing
the skills to prepare nutritious meals, thereby
reducing the risk of diet-related diseases such as
cardiovascular disease. The classes also encourage
adults to consume a nutritious diet.
Figure 11.50 Community health
centres offer a range of programs
designed to improve the health and
adults.
Case study
Community Kitchens — operate within a variety of community-based settings

and people from many different walks of life attend.
Peninsula Health Benefits
Community Health Potential benefits for participants include positive
changes in:
What are Community Kitchens?
• social skills — communication and interpersonal
The Australian Community Kitchens Model was skills
initially developed by Peninsula Health based on the • teamwork and leadership skills — working with
Canadian Community Kitchens concept. It offers a others, taking a leadership role
flexible approach to promote healthy eating, skill devel- • budgeting and shopping skills — writing a shopping
opment and social support networks within the local list, putting money aside, buying in bulk or on sale
community. • cooking skills — learning new recipes and cooking
A Community Kitchen involves a group of like- techniques
minded individuals coming together on a regular basis to • motivation to plan meals and cook at home
socialise and cook before enjoying delicious, affordable • healthy food choices — reduced intake of takeaway/
and nutritious meals with new friends. Many Kitchens fast food and increased intake of fruit and vegetables
buy and cook in bulk to allow the production of many • access to food — increased availability of food,
meals at low cost. Participants can then take meals increased variety
home to enjoy on subsequent days. The participants • literacy and numeracy
have ownership over their Kitchen and direct how they • confidence and self-esteem.
would like their Kitchen to run. Community Kitchens Source: Community Kitchens, www.communitykitchens.org.au.
Case study review

1 What are the aims of the Community Kitchens?
2 How can Community Kitchens promote the health of those involved? In your
answer, consider all components of health.
3 In what ways do Community Kitchens promote the individual human
development of those involved? In your answer, consider all types of
development.
TEST your knowledge 9 What percentage of all cancer deaths in Australia

are due to bowel cancer?
1 Explain the impact of crime on the health and
10 Why is bowel cancer screening limited to those in
the 50–74 age group?
2 How many women die per day as a result of
11 What is the FOBT and how is it implemented?
breast cancer?
12 What are the benefits of community health
3 What age group does BreastScreen Australia target?
services?
4 What is mammography screening?
5 What is the lifetime risk of women developing
breast cancer?
6 What sort of changes to the breasts can be 13 Develop a brochure that outlines the benefits of
indicative of breast cancer? a selected health-care service to the health and
7 What percentage of women who are screened individual human development of adults.
actually have breast cancer? 14 Explain how access to health care promotes the
8 What is bowel cancer? health and individual human development of adults.

11.13 S ocial determinants: the media, level of education,
employment status and income
KEY CONCEPT The impact of the media, level of education, employment status
and income on the health and individual human development of adults
In the adulthood stage of the lifespan, the social determinants include factors such
as the media, living arrangements, level of education, employment status and
income, community belonging, social support, family and work–life balance. It
is during the adulthood stage of the lifespan that individuals take on the role of
parenting and employment becomes a significant factor in adults’ lives. The level
of education that a person achieves often determines their type of employment
and therefore their level of income. Level of income is a predictor for health status
because those on higher incomes tend to have better health than those on lower
incomes. As working life takes on greater significance in adulthood, so does the
capacity to maintain work–life balance. Many families experience changes to
their living arrangements that can impact on the health and individual human
development of all family members.
The media
The media has a huge impact on how adults see the world — on
their socialisation, development, opinions, values and knowledge.
Many of the effects of the media are obvious but others are so subtle
that adults do not even realise that they have been influenced.
The media takes many forms. It includes the internet, newspapers,
magazines, television, radio, books, video games, CDs and tapes,
billboards, posters, text messages, movies and videos. All forms of
media have the potential to influence the actions, beliefs, values,
opinions and ideas of adults. Figure 11.51 Our world is filled with information
and images that provide us with knowledge and
The impact of the media entertainment.
The effects of the media on the health and individual human development of adults
are listed below.
• The internet is a powerful form of media and adults can often spend hours in
front of a computer each day, socialising, reading, playing games and creating
content. The internet now provides many ways for people to access other forms of
media, such as newspapers, radio, movies and music. All these pursuits can have a
positive effect on individual human development by enhancing intellectual skills
and providing opportunities for meeting and communicating with new people.
• Unlike other forms of media, the internet allows adults to easily and cheaply
create content and become producers of media rather than just being consumers.
Profiles on social networking sites have allowed people to make connections and
form relationships, improving their social and mental health. On the internet
people can create blogs, twitter, upload videos and audios and interact in
exciting and creative ways.
• The internet is not a controlled environment so there is a lot of freedom.
However, this also means that it contains unedited or unreliable information,
alternative and possibly dangerous views, abusive content and opportunities for
predators to access people they can abuse. These drawbacks can detrimentally
affect mental health if precautions are not taken.
• The internet allows adults to self-diagnose health problems. This can be positive
if it encourages people to see a doctor for a symptom they might otherwise have
dismissed, but it can be dangerous when advice that contravenes mainstream
medical practice is provided by people without any medical training. It is
11.1 3 Social determinants: the media, level of education, employment status and income
important that adults seek reputable medical advice if there are concerns about
health.
• The media has allowed health messages to reach a great proportion of the
public. Most health promotion strategies incorporate some form of media
campaign. Also, studies have shown that if information about a particular health
issue is embedded into a television drama, awareness and understanding of that
health issue in the community improves significantly. This has great potential
for targeting various groups in the community who watch particular television
shows. Messages about infectious diseases, cancer, diabetes management,
sexually transmissible infections, mental health issues and access to health
care can all be successfully embedded into storylines and provide viewers with
valuable information. Health improves when people are provided with reliable
information in an easy-to-understand format.
• Newspapers provide information on a daily basis and allow individuals to keep
up with local community, national or world news for work or entertainment.
Newspapers are privately run and owners may have their own viewpoints that
they wish to get across to readers. Regular features such as crosswords and
other thinking games and quizzes may help keep the mind active and improve
intellectual development. Social health and development may be improved when
workmates share and discuss information they have read in the newspaper.
• Magazines are another form of media that can have an impact on health and
individual human development. They range from informative and factual,
to glamour and fashion magazines. Reading magazines can be a form of
entertainment for most adults. Some magazines, however, can set up unrealistic
goals of how people ‘should’ be and can influence how individuals view
themselves. This impacts on their self esteem and self-concept.
• Listening to the radio can also affect an individual’s health and individual
human development. Music can affect an adult’s mood and thus impact on
their emotional development and mental health. Listening to talkback radio can
keep an individual informed of the opinions of a community and allow them to
share their opinion with someone who is willing to listen. This form of media
is particularly important in influencing the social and mental health of those in
middle and later adulthood.
Level of education, employment status and income

Higher education improves people’s living standards because it is associated with
higher paid employment, which gives people the income needed to pay for resources
that assist in promoting health and individual human development. Education also
provides individuals with the skills and knowledge required for maintaining a
healthy lifestyle and for gaining access to the appropriate health services.
In Australia, the proportion of the population aged 15–64 years with a degree
qualification increased from 14.3 per cent in 1998 to 21.9 per cent in 2008. More
than half of this age group had some post-school qualification in 2008 (table 11.9).
Table 11.9 Highest post-school qualification of persons aged 15–64, 1998–2008 (per cent)
Qualification 1998 2000 2002 2004 2006 2008
Bachelor 14.3 15.7 17.8 18.9 20.6 21.9

Diploma or 27.6 28.1 29.8 31.3 30.8 30.8
certificate
None 58.1 56.2 51.8 49.1 47.6 46.1
Note: Totals may not add to 100 per cent because the level of highest non-school qualification of some persons
could not be determined.

Socioeconomic status (SES) is a measure of an adult’s or a family’s economic and
social position within society relative to others. It is usually based on education,
occupation and income. When categorising socioeconomic status, it is typically
divided into three levels: high, middle and low.
Adults from a high socioeconomic background tend to have the most resources,
opportunities and power to make decisions compared to adults from a low
socioeconomic background. Adults with higher incomes tend to have better health
and live longer than those with lower incomes. Studies have shown that adults from
a socioeconomically disadvantaged background tend to have reduced life expectancy,
premature mortality, increased disease incidence and prevalence, increased biological
and behavioural risk factors for ill-health, and lower overall health.
Adults from low socioeconomic backgrounds are more likely to smoke, eat less
fruit and vegetables, exercise less and be at greater risk of overweight and obesity.
They are also at greater risk of type 2 diabetes, cardiovascular diseases, arthritis,
mental health issues and respiratory conditions such as asthma (table 11.10).
Table 11.10 Prevalence of selected health measures by socioeconomic status, 2007–08 (per cent)
Characteristics Highest SES:5 4 3 2 Lowest SES:1
Health risk factors

Daily smoking 11.1 15.1 18.8 21.1 28.6
Sedentary exercise level 24.9 31.0 38.1 38.8 45.4
Risky or high-risk alcohol 12.7 12.6 13.3 13.6 10.1
consumption
Overweight to obese 37.9 41.2 42.7 42.2 42.5
Health condition
Depression 3.5 3.3 3.5 4.0 4.4
Diabetes (Type 2) 2.9 3.7 4.1 4.3 6.2
Chronic respiratory disease 2.2 2.7 2.8 3.1 3.3
Cardiovascular disease 17.3 17.1 21.0 22.2 23.8
Severe/profound disability 2.9 4.1 4.6 5.3 6.1
Notes
1. Data are based on persons aged 15 years and over, except smoking and alcohol consumption (18 years and
over).
2. Data are age-standardised to the 2001 Australian population.
Source: AIHW, Australia’s Health 2010, p. 254.
Adults from low socioeconomic backgrounds visit the doctor and hospital
outpatient and accident and emergency departments more frequently than
adults from higher socioeconomic backgrounds, but they are less likely to access
preventative health services. Socioeconomically disadvantaged adults are more likely
to die sooner after serious illness than adults who are socioeconomically advantaged.
Adults who are educated tend to have a higher level of health literacy. Health
literacy involves knowing what is good quality advice in regards to health, how
and where to seek further health-related information when required, and how to
translate relevant information into action. An adult with a higher level of health
literacy will find it easier to manage their health. Low levels of health literacy means
an adult will not be able to manage their health as effectively. The 2006 Adult
Literacy and Life Skills Survey, conducted by the Australian Bureau of Statistics,
found that people living in higher socioeconomic status areas were more likely
to have a higher level of health literacy than those in lower socioeconomic areas
(figure 11.52). Approximately 26 per cent of people from the lowest socioeconomic
areas had an adequate level of health literacy or above, compared with 55 per cent of
people from households in the highest socioeconomic areas (Australia’s health 2010).
11.1 3 Social determinants: the media, level of education, employment status and income
100
High
80 Adequate
Low
Very low
60
Per cent
40
20
Figure 11.52 Level of health literacy 0

and socioeconomic status 1 2 3 4 5
Source: Australian Institute of Health and Welfare Lowest Highest
2010, Australia’s health 2010, cat. no. AUS 122,
Canberra, p. 81. Socioeconomic status
Unemployment has a significant impact on health status as lack of income limits

people’s capacity to access health resources and services. Not being employed may
create stress and anxiety for adults and reduce their capacity to financially support
other members of their family or engage in social activities with family and friends,
thereby impacting on social and mental health.
There is a relationship between type of occupation and health and individual
human development. Poorer health, greater levels of disability and higher mortality
tends to occur in adults employed in low-skilled manual labour compared to
those in managerial/professional occupations. Adults who work in low-skilled
labouring jobs are at greater risk of physical hazards that may result in injuries,
thereby impacting on physical health. The injury may restrict the individual from
being involved in daily activities, resulting in a decline in physical strength and a
reduction in bone mass. These types of jobs may also impact on an adult’s mental
health as they tend to have less input into decision-making processes and therefore
less control over their jobs. This may cause the adult to resent those in authority,
thus impacting on social health.
TEST your knowledge 10 Discuss how the provision of education can

contribute to improving the health and individual
1 List the different forms of media.
human development of adults from low
2 Give one example of how the media influences the
socioeconomic status backgrounds.
health and individual human development of adults.
11 Why are socioeconomically disadvantaged
3 What is the relationship between higher education
individuals more likely to die sooner after serious
and health?
illness than those who are socioeconomically
4 In 2008, what proportion of people in the 15–65
advantaged?
age group had a post-school qualification?
12 Refer to table 11.10 to answer the following
5 Explain what is meant by ‘socioeconomic status’.
questions.
6 Outline the health risk factors for people from low
(a) Which health condition is most prevalent in the
socioeconomic backgrounds.
highest socioeconomic status group?
7 In what ways can unemployment impact on the
(b) Which risk factors are more prevalent in the
health status of individuals?
lowest socioeconomic status group?
8 Explain the relationship between occupation
(c) Explain the relationship between the health risk
and health.
factors and the health conditions for the lowest
APPLY your knowledge socioeconomic status group.
9 Explain the relationship between education,

occupation, income and health.

11.14 S ocial determinants: the workplace and
community belonging
KEY CONCEPT The impact of the workplace and a sense of community

belonging on the health and individual human development of adults
The workplace
The workplace in which an adult is employed is an important social determinant of
health. The working relationship that an adult has with colleagues has a significant
impact on their health and individual human development.
One of the issues that can have a negative effect on adults is conflict. Workplace
conflict can arise for a variety of reasons. It may occur when people’s ideas, decisions
or actions are not readily accepted by all employees, or when people simply do not
get along on a personal level. Conflict related to the implementation of new ideas
and decisions can be productive because it generates worthwhile discussion and
debate that may assist the business in making positive changes or improving work
practices. However, a clash of personalities can make the workplace an unpleasant
environment. Conflict with bosses can make it very difficult for the employee and
Figure 11.53 The workplace can be a
lead to work-related stress. According to a report completed by Safe Work Australia source of considerable stress.
in 2012, depression costs Australian employers approximately $8 billion per year
as a result of absence due to sickness and presenteeism, with $693 million of this
figure due to job strain and bullying. Presenteeism is the loss of productivity that
results from employees coming to work but, as a consequence of illness or other
conditions, not functioning at full capacity. Absenteeism occurs when employees
do not come to work at all (Safework Australia).
Many other factors in the workplace may cause work-related stress including:
• long working hours
• heavy workloads
• changes within the organisation
• tight deadlines
• lack of job security
• boredom
• harassment/bullying
• discrimination
• lack of autonomy and being over-supervised.
Work-related stress affects the health of an adult in a variety of ways including:
• depression
• anxiety
• feelings of being overwhelmed and unable to cope
• sleeping difficulties
• fatigue
• headaches
• gastrointestinal upsets such as diarrhoea or constipation
Conditions such as depression can result in the adult not consuming an
adequate dietary intake. This can impact significantly on their individual human
development because a lack of nutrients required for the maintenance of body
tissues can result in more rapid deterioration. For example, a lack of calcium in the
form of dairy products means that the calcium that is being leached from bones is
not replaced. This increases the risk of osteoporosis. Feeling depressed may also
result in the adult not being involved in social activities or disengaging from others.
As an adult’s social and emotional development is dependent on relationships with
others, not interacting with family, friends or work colleagues means that the adult
11.1 4 Social determinants: the workplace and community belonging
does not have the opportunities for maintaining or further developing social skills
or the capacity to understand and control emotions, which in turn impacts their
social and emotional development.
Case study
Overwork, mental stress The Safe Work Australia study revealed that when
‘body stressing’ and ‘mental stress’ are combined,
costs $30 billion they make up half of the cost of job-related injury and
illness.
The cost of workplace illness among managers
and administrators was $9.6 billion a year, injuries to
labourers $7.9 billion and to tradespeople, $10.6 billion.
The report showed the cost of workplace death and
injury was now worth about 5 per cent of Australia’s
total economic output.
The report coincides with labour force statistics that
showed Australians were working millions of hours
more since the GFC.
While the data did not draw a direct link between
longer hours and illness and injury, the Safe Work
FIGURE 11.54 Overworked and stressed employees
cost Australia $30 billion a year, and the total bill report said: ‘Over one-third of the total number of
of workplace injuries, sickness and fatalities is more cases and total economic cost are associated with body
than $60 billion. stressing or manual-handling cases.
OVERWORK and stress costs Australia more than ‘Mechanisms more associated with disease, such
$30 billion a year, half the total workplace injury bill. as sound and pressure, biological factors and mental
Physical and psychological stress has outstripped stress, have a higher unit cost than those associated
other forms of injury and illness and the long-term with injuries (such as falls and trips).
cost in lost productivity and compensation is worn by ‘While mental stress cases comprise 4 per cent of the
workers and the community. cases, they contribute 9 per cent of the total cost.’
A comprehensive study of workplace fatalities, Research by talent management firm SHL found just
injuries and illness put the cost at $60.6 billion a year. 29 per cent of workers with a good manager take days
The report found that, while the number of workplace off when they are not sick, compared with 35 per cent
fatalities fell in 2009–10 during the global financial crisis who rate their manager’s performance as below par.
to a record low of 216, signs were increasing again. One-third of employees say having too much
This week, Workplace Relations Minister Bill responsibility or ‘burnout’ is a reason for them to take
Shorten will announce a campaign to encourage sick leave when they are not ill. It topped the list of
workers to speak up about safety, and call for annual reasons to take a sick day.
reporting to Parliament. Source: The Advertiser, 13 March 2012.
Case study review

1 What is the difference between physical and psychological stress?
2 Why would workers with a good manager be less likely to take days off sick
when compared to workers with a manager whose performance is below par?
3 Explain how overwork and mental stress impact on the health and individual
human development of adults.

When adults belong to a group, such as one that is often found within a
workplace, they are likely to derive a sense of identity, at least in part, from that
group. An adult’s self-concept may be formed from the groups they are associated
with in the workplace. For those adults who feel a sense of belonging within the
workplace, a positive self-concept is more likely to develop, thereby promoting
social and mental health.
Community belonging
The degree of connectedness or belonging that an adult feels to their community
is determined by their level of engagement in community-based activities. These
activities enable adults to interact with other people from a diverse range of
backgrounds. Some of the activities may be done purely for the benefits they bring
to the individual (e.g. playing in a sporting team), whereas others may be done
for the benefits that they bring to others (e.g. a human rights group). Many adults
develop a sense of community belonging through becoming volunteers.
Social connections
The term ‘social capital’ is often used in relation to community belonging as it
refers to the connections between groups and individuals within society. Social
capital includes the level of cooperation, trust and goodwill that is formed between
people, organisations, neighbourhoods and levels of government. Social capital is
important for developing a sense of community wellbeing. Communities that have
limited social capital may exhibit the following:
• lack of support and networks for family, friends or community
• lack of participation in paid work or volunteering
• lack of involvement in local or broader decision making in the community.
Figure 11.55 Volunteering for community groups provides adults with a sense of community
belonging through making a positive contribution to society.
Research has shown that people who feel a sense of community belonging have
better self-reported health. A 2008 Canadian study, ‘Community belonging and
self-perceived health’, found that almost two-thirds of people who felt a strong or
11.1 4 Social determinants: the workplace and community belonging
somewhat strong sense of community belonging reported excellent or very good

general health. In comparison, only 51 per cent of respondents with a weak sense
of belonging viewed their general health positively.
Involvement in community activities and opportunities for developing a sense of
belonging may impact positively on the individual human development of adults.
A strong sense of community belonging can promote self-esteem and provide
opportunities for the development of social skills. Involvement in groups or clubs
that promote physical activity has the benefit of promoting physical development or
the maintenance of the physical components of the body. Intellectually, interacting
with others enables the adult to gain new knowledge and develop new skills.
Volunteering
Volunteering is an important aspect in the lives of many adults. In 2010, 38 per cent
of women and 34 per cent of men aged over 18 years were volunteers. Adult males
aged 55–64 years and adult females aged 35–44 and 45–54 years in 2010 were
most likely to volunteer (see figure 11.56)
50
Males
Females
40
30
Per cent
20
10
0
18–24 25–34 35–44 45–54 55–64 65–74 75–84 85+
Age group (years)
Figure 11.56 Volunteering rate, by age and sex, 2010

Source: Australian Bureau of Statistics
Volunteering has significant benefits for the health and individual human
development of adults. Research has established a strong link between volunteering
and health. Those who volunteer have lower mortality rates, greater functional
ability, lower rates of depression and longer life expectancy than those who do not
volunteer. In particular, volunteering tends to provide greater health benefits to
adults over the age of 60 than to younger volunteers. Volunteering has a positive
impact on the social and mental health of an adult as it provides opportunities for
developing a sense of purpose and accomplishment and enables social networks
to be developed. For adults with chronic or serious illness, volunteering has
significant health benefits. Reductions in pain intensity and decreased levels of
disability were seen in adults who began to serve as volunteers for others suffering
from chronic pain.
These health benefits have a positive influence on the individual human
development of an adult. Having greater functional ability means that the older
adult is more likely to participate in physical activity, thereby maintaining (or
slowing the deterioration of ) body tissues such as muscles and bones. Participation
in regular physical activity also assists in the maintenance of motor skills. Through
interacting with others, the adult is able to maintain or further develop the capacity
to socialise with people from a diverse range of backgrounds. For some volunteers,
situations may arise in which they are required to extend themselves beyond

their comfort zone and learn new skills that enable them to interact effectively
with others (e.g. volunteering to help migrants from a non-English speaking
background). Volunteering also provides opportunities for keeping the mind active.
This increases knowledge and promotes the maintenance and/or development of
intellectual skills.
TEST your knowledge for a selected organisation. In your advertisement,

include the benefits that volunteering provides for
1 What are the factors that contribute to workplace
stress? the health and individual human development of
2 Why is ‘social capital’ important for the health and adults.
individual human development of adults? 5 In what ways can the workplace improve the health
3 What benefits does volunteering provide for the and individual human development of adults?
health and individual human development of 6 Why would volunteering provide greater health
adults? benefits to adults over the age of 60 years than
to younger volunteers?
APPLY your knowledge 7 Referring to figure 11.56, explain possible reasons
4 Research the benefits of volunteering and write an for the increase/decrease in the volunteering rate
advertisement encouraging people to volunteer across the lifespan stages.
11.15 S ocial determinants: living arrangements and
social support
KEY CONCEPT The impact of living arrangements and social support on the
health and individual human development of adults
Living arrangements
Living arrangements refer not only to the type of accommodation that an adult lives
in but also to the number of people living together and the relationships between
them. The living arrangements of adults depend on family composition and lifespan
stage. For instance, young adults may still live at home with their parents because
high costs — of accommodation and/or university — combined with a limited
income may make living with their parents more financially attractive. Their parents
may be prepared to financially support them if they remain at home, and not having
to pay for rent and other essentials can leave young adults with
greater disposable income to spend on the things they enjoy.
Approximately 665,000 people aged 25 years or over lived with
one or both parents in 2009–10 (AIHW, 2011).
Living with parents can have both positive and negative effects
on the health and individual human development of young
adults. For instance, young adults living at home are more
likely to eat nutritious food prepared by their parents rather
than buying convenient or packaged meals that are high in
saturated fat, salt and sugar. As a result, their risk of developing
diet-related diseases is decreased while the consumption of the
required nutrients promotes the growth and maintenance of
the body’s tissues. However, living at home may create a sense
of dependence on their parents, which reduces opportunities
for them to develop the skills required to live as independent
adults.
For the parents, having adult children living at home can
increase financial stress due to the cost of providing for their
needs. Having to care for adult children may impact on the
mental health of parents if there is conflict with the children.
On the other hand, the emotional support that some parents
may gain from having their adult children at home can enhance
the parents’ social and mental health and individual human
development.
Research indicates that living arrangements can have a
significant impact on the mortality rates of adults. Being single
is associated with higher mortality than being married or living
in a de facto relationship. Living with a partner may have a
protective effect for many reasons, including having greater
disposable income for material resources (e.g. to buy safer cars),
Figure 11.57 There are a range of living the social support provided by a partner and the positive impact
arrangements available to adults in the late that partners may have on health behaviours (e.g. physical
adulthood stage of the lifespan.
activity levels).
Living arrangements during late adulthood

As adults age, decisions need to be made about living arrangements. For those in
the late adulthood stage of the lifespan, where they live is often dependent on their
level of health. For many elderly people, living in the comfort of their own home is
important for them but ill-health may impact on their ability to live independently.
Table 11.11 outlines some of the living arrangements available to the aged.
396
Table 11.11 Living arrangements available to elderly people
Living arrangement Explanation Benefits to health and individual human development
Staying at home with For some elderly people, staying at home Enables the elderly person to remain in an environment in which they feel
the assistance of requires extra assistance. ‘Home help’ or local comfortable and familiar. Additional services can assist in meeting the
community services community services can assist with housework, hygiene, health, nutritional, physical activity, social and emotional needs
meals, personal care and social outings. of the elderly person.
High-level care This caters for elderly people who require The health of the elderly person is monitored and appropriate treatments
homes 24-hour nursing care due to immobility or and care are provided.
conditions such as dementia.
Low-level care homes This caters for elderly people who may require Enables the elderly person to maintain some independence while being
some assistance with tasks such as dressing, provided with assistance to perform tasks they find difficult. Staff can monitor
eating and bathing, cleaning, laundry and day-to-day activities such as the taking of medications, physical activity and
meals. nutrition. Provides opportunities for social interaction with others.
Independent living Residential communities that offer a range of Enables the elderly person to live independently in a community of people
units (retirement services for independent elderly people. of similar ages. Socialisation and social support are important aspects of
villages) this type of living arrangement. Organised activities provide the elderly
person with opportunities for physical activity, social interaction and the
development of skills and knowledge.
Social support
Social support refers to the connections that an adult has
with individuals and groups, including family, friends, work
colleagues and other members of their community. These
individuals and groups make up the social network of the
person and provide support in a variety of forms such as the
provision of information, practical assistance and emotional and
financial help.
A study conducted in 2010 found that 97 per cent of
Australians aged 18 or over reported having face-to-face contact
with family and friends outside of the household in the previous
week (ABS, 2010). Table 11.12 shows the sources of support
during times of crisis for adults aged 18 years and over. This data indicates that Figure 11.58 The relationships
adults are more likely to seek help from informal sources such as family members that an adult has with others has
and friends rather than formal support services such as a psychologist. an impact on health and individual
human development.
Table 11.12 Sources of support in times of crisis, by age and sex
Proportion (%) of age Proportion (%) of sex
Sources of support 18–24 25–34 35–44 45–54 55–64 65–74 75–84 85 years All
In times of crisis (a) years years years years years years years or over Males Females persons
Friend 77.9 71.1 66.5 64.9 59.1 52.7 34.4 31.1 64.3 63.3 63.8
Neighbour 17.6 17.0 29.7 34.3 32.1 31.2 30.4 34.8 26.8 27.6 27.2
Family member 76.8 80.5 81.3 76.0 79.8 80.0 86.0 73.4 77.9 80.9 79.4
Work colleague 23.3 27.0 23.4 24.3 18.1 *3.1 np np 21.4 18.3 19.8
Community, charity or 7.4 7.6 11.1 11.3 11.5 11.2 *6.6 *6.9 8.5 10.9 9.8
religious organisation
Local council or other *3.3 3.7 5.5 5.9 6.6 5.7 *4.1 **5.0 4.6 5.5 5.1
government services
Health, legal or 5.2 8.0 9.3 9.6 9.1 8.6 5.3 **12.5 7.4 9.2 8.3
financial professional
Other sources *1.2 *0.4 *0.8 *0.9 *0.4 **0.2 np np 0.9 *0.3 0.6
(a) Categories are not mutually exclusive.
* estimate has a relative standard error of 25% to 50% and should be used with caution.
** estimate has a standard error greater than 50% and is considered too unreliable for general use.
np not available for publication but included in totals where applicable, unless otherwise indicated.
Source: Australian Bureau of Statistics.
11.1 5 Social determinants: living arrangements and social support
There is a significant link between social support and health, particularly in

terms of mental health. For adults, social support is important during worrying
times or times of stress. Prolonged stress and tension can result in aches and pain
such as headaches, migraine and backaches. By discussing the issues with family
and friends, an adult may reduce the associated tension or be offered advice on
how to reduce the stress in their lives.
Social support is recognised as a protective factor for mental health issues such
as depression and anxiety. In particular, good interpersonal relationships, family
cohesion and social connectedness with friends are important for maintaining
positive mental health.
As adults age, social support may decline due to a variety of reasons including:
• the loss of a spouse
• children leaving home
• health problems/disability that prevents interaction with others
• a decline in energy that reduces the capacity to be involved with others
• a lack of motivation.
This decline in social support can have a significant impact on the health and
individual human development of adults. For instance, the loss of a spouse who
is a main source of support is most likely to cause feelings of grief, which may
result in depression. Major depression causes adults to experience deep sadness
and difficulty in functioning. It may also impair their ability to perform daily tasks
such as the preparation of meals. As a result, the nutritional needs of the adult may
not be met, resulting in weight loss and deterioration of body tissues. Depression
often results in the avoidance of social situations and this reduces opportunities for
social interaction and the maintenance of social skills. Adults with depression are
less likely to be engaged in intellectual pursuits such as reading, which impacts on
their acquisition of knowledge and intellectual development.
On the other hand, an adult who has a supportive network of family and friends
is more likely to experience better health and individual human development. This
social support is more likely to have a positive impact on the mental health of the
adult, so they are more likely to consume the required nutrients, exercise, socialise,
participate in physical activity and engage in intellectual activities.
TEST your knowledge 6 Mary is 75 years old and still lives in the family
home. Her children have noticed that she is
1 Explain what is meant by the term ‘living
becoming forgetful and they are concerned about
arrangements’.
her ability to care for herself. Physically, Mary is able
2 What are some of the reasons for the lower
to move around with relative ease but she has had a
mortality rates of adults living with a partner?
couple of minor falls that have resulted in significant
3 Outline the benefits of the four types of living
bruising. Mary’s children worry about her capacity
arrangements for the aged.
to look after herself.
4 Define the term ‘social support’. What are the
(a) Outline the possible living arrangements
benefits to the adult of social support?
available to Mary at her stage of the lifespan.
APPLY your knowledge (b) Select a living arrangement that is appropriate
for Mary and justify your choice based on the
5 Write a response based on the following statement: information provided.
‘The connections that an adult has with others
are important for promoting health and individual
human development.’

11.16 Social determinants: family and work–life balance
KEY CONCEPT The impact of family and work–life balance on the health
Family
Family compositions over the last few decades have changed significantly and this
has resulted in a variety of living arrangements for families. It has also caused
much debate over the definition of a family. According to the Australian Bureau of
Statistics (ABS), ‘A family is two or more persons, one of whom is at least 15 years
of age, who are related by blood, marriage (registered or de facto), adoption, step
or fostering, and who are usually resident in the same household’.
Contemporary society is made up of a range of family types. The ABS has
categorised families into the following:
Table 11.13 Types of families

Family type Explanation
Figure 11.59 Family compositions
Couple family Two people, both aged 15 years and over, who are married to each other
have changed significantly over the
or living in a de facto relationship with each other
last few decades.
Couple family with A couple family (as defined above) who have children (regardless of age)
children usually resident in the family
Couple family without A couple family with no children usually resident in the family (i.e. includes
children families where children have left home)
One-parent family A parent with no resident partner (married or de facto), with at least one
child (regardless of age) usually resident in the family
Step family A couple family containing at least one child who is the stepchild of either
parent, and no children who are the natural children of both parents
Blended family A couple family containing both natural and stepchildren (i.e. at least one
child is the natural child of both parents, and one child is the step-child of
either parent)
Many factors have contributed to changes in family compositions, including:

• Divorce. The introduction of the Divorce Law Act in 1975 meant that it became
easier for married couples to divorce. In 2011, 48 935 divorces were granted
in Australia. Of these divorces, 48.3 per cent involved children. Divorce has
resulted in increases in single-parent families and in step and blended families as
individuals with children meet and develop new relationships with each other.
Divorce Careers
Increasing costs
Contraception
of living
Factors
impacting on
family
composition
Figure 11.60 Factors impacting on family composition
11.1 6 Social determinants: family and work–life balance
• Careers. As increasing numbers of women are employed in higher paid positions,

many are choosing to focus on their careers and consequently not having
children.
• Contraception. The availability of the contraceptive pill has resulted in women
being able to decide whether or not to have children, when to have children and
how many children to have. As gaining a post-school qualification has become
more desirable, more women are postponing having children. Consequently, a
greater proportion of women have remained childless into their 30s and 40s.
• Increasing costs of living. As the costs of living increase, more children are delaying
leaving home, preferring to be supported by their parents. This has also resulted
in people choosing to delay parenthood or deciding not to have children at all.
There are many advantages and disadvantages associated with each family
type that need to be considered according to individual family circumstances. An
appropriate example might be a couple family with children where the parents
are constantly in conflict. The financial support that may come from both parents
working or from one parent financially supporting the family is an advantage.
However, the constant conflict and arguments are a disadvantage that may lead to
mental health issues for individuals within the family.
The composition of families can have a positive and/or negative impact on health
Figure 11.61 A couple family with
and individual human development. For instance, a couple family with children
children may have the financial
resources to purchase nutritious food may be financially secure, enabling them to access resources such as nutritious
and practise an active lifestyle. food and health care. This reduces the risk of diet-related conditions and impacts
positively on the physical health and development of all family members. The
loving relationships that develop between the parents and the children will promote
the social and mental health and individual human development of the adults
within the family. Adults who feel connected to their family are more likely to
experience positive mental health and will therefore be more inclined to pursue
activities that promote their intellectual development.
Another example might be a single parent who has the responsibility of raising
children who may face significant financial pressure. Limited income affects the food
selection of adults because cheaper foods are more readily available, and tend to be
higher in saturated fats, salt and sugar — significant factors in the development of
diet-related diseases/conditions such as obesity, cardiovascular disease, colorectal
cancer and type 2 diabetes. Having to care for children may limit the time available
for the single parent to participate in physical activity. Poor nutritional intake and
lack of physical activity can reduce muscle mass and bone density and increase
the risk of overweight and obesity. The single parent may experience considerable
stress from the effort of meeting the financial, emotional and social needs of the
children. The opportunities for social occasions may be limited by lack of finances
to pay for such activities as well as the limited time available due to being the sole
caregiver of the family. This can impact on the maintenance or development of
social skills for the adult. This type of family situation may also reduce the chances
Figure 11.62 Children of single of pursuing further education or even partaking in activities that informally
parents who make junk food readily
available may be at higher risk of
promote the attainment of knowledge and the development of intellectual skills.
diet-related diseases.
Work–life balance
Work–life balance refers to the working conditions of parents/guardians being
conducive to ensuring that the social and emotional needs of all family members
are being met as well as enabling adults to pursue their own recreational/leisure
activities. For many Australian parents/guardians, the amount of hours they are
required to work impacts significantly on their capacity to effectively balance the
needs of their families with their work commitments. Approximately 15 per cent
of employed persons worked more than 50 hours per week in 2010 (ABS, 2010).
400
Figure 11.63 Work–life balance is important for the health and individual human
development of adults.
The inability to effectively balance work and family life impacts on the health
and individual human development of adults. Work-related stress can occur for
a range of reasons. One of these reasons is pressure from the demands of the job
in terms of amount of hours worked or level of responsibility. Extended working
hours impacts significantly on the individual’s capacity to meet the needs of their
family and to pursue recreational/leisure activities. Symptoms of work-related
stress include:
• depression
• anxiety
• feelings of not being able to cope eLesson:
The misery of long hours
• reduced work performance
• sleeping difficulties
• reduced ability to concentrate
• fatigue
• headaches
• gastrointestinal problems such as diarrhoea
• increased aggression.
Work-related stress can result in a deterioration of personal relationships and, in
the long term, can increase the risk of cardiovascular disease.
Over the past two decades there has been a significant increase in the number
of hours worked by full-time employees, and more children are growing up in
families in which both parents work. Another factor that is contributing to the
difficulty of achieving work–life balance is the fact that people are spending more
time commuting to work. Information and communication technology allows
work to intrude on family life via mobile phones and email. The Relationships
Indicator Survey conducted by Relationships Australia in 2008 found that at least
50 per cent of respondents had indicated work pressure and a lack of time to
spend with their partner as key factors that could impact negatively upon partner
relationships.
11.1 6 Social determinants: family and work–life balance
Many adults are in the situation of simultaneously caring for children and
ageing parents. This may cause increased stress as they take on the additional
responsibilities of ensuring that the health and individual human development
Weblink: needs of their parents are being met. Nutrition, physical activity, social interaction,
Australians unhappy with
health care, housing and transport are examples of factors that need to be
work–life balance?
considered when caring for ageing parents.
Case study
Five ways to balance work 2. Plan meals ahead
and life Planning weekly family meals ahead of time and

cooking at the beginning of the week can be useful
One in five Australian women is unhappy with their when time permits. Another tip is to prepare a weekly
current work–life balance situation. If this is you, here plan of recipes that you can turn around quickly on a
are five ways to turn that around. week night, says Jodie Benveniste, psychologist and
New research shows that nearly one in five Australian director of Parent Wellbeing. ‘[Try to] find really quick
women works 10 or more hours each week than their and easy meals you can make in under half an hour,’
job requires. And the extra time in the office is taking she notes.
its toll on their wellbeing. Fifty per cent of working And don’t feel guilty if you occasionally dial up
women struggle to balance the demands of work and for dinner during the week. As long as children are
family life, according to results from the Community eating mostly healthy meals through the week, ‘it’s ok
and Public Sector Union’s annual What Women Want to serve baked beans on toast or takeaway once in a
survey. Of the 9000 participants, the majority aged while,’ Benveniste says.
between 25–54 years, 20 per cent admitted they were
unhappy with their current work–life balance situation. 3. Remember your passions
With more work comes less time to exercise too. The Whether you have your own business or are climbing
Australian Bureau of Statistics reported that women the corporate ladder, as a working mum it’s important
who work from 16–34 hours per week were more likely to keep your goals in sight. Or as James puts it: ‘Some-
to adopt a sedentary lifestyle than those who worked thing that creates meaning and purpose in your life.’
less hours. She explains women who sacrifice their passions when
Here are a few ways to maintain balance for your they become mums can be in for a shock when their
own health and happiness. little ones grow up. ‘It can become difficult when kids
gain their independence and move away,’ she says.
1. Make an exercise plan And remember why you love what you do — it’s
Making time to exercise is crucial to balance a busy the ultimate confidence booster. ‘It’s important for
mind, says Kate James, a work–life balance expert working mums to recognise the value that they get out
and director of The Change Project. ‘If we want to of working and what that contributes to themselves and
be good mums, good partners and good workers, then their lives,’ Benveniste says.
that begins with taking care of our own wellbeing,’ she
notes. To stay on track, James advises following an 4. Time for the family
exercise plan that is ‘realistic’. ‘It is better to choose When you arrive home, instead of rushing to get dinner
an activity that you naturally enjoy,’ she says. ‘For ready, take some time to check in with your family.
a lot of people, a walk is a good starting point. Take James urges working mums to be mindful of having
your walking shoes to work and walk for 30 minutes at this time together, away from distractions and listen in
lunch time.’ to what’s happening in their world. ‘Talk about what
Or try to leave the office during your lunch break for was good about their day without the distractions of
a walk around the block, a run or to take a yoga class. television,’ James says.

This is also a good time to teach children This might be as simple as asking your partner to
responsibility and get them involved in domestic duties take the kids out for an afternoon, while you read
such as setting the table for the family meal. a book, or go out and watch a movie with a friend.
‘A few great friends who are supportive and fun to be
5. Make time for you with can offer a reprieve from work and family life,’
It is difficult to be a good support to your family if Benveniste says.
you’re not scheduling in your own downtime ‘You Source: www.bodyandsoul.com.au.
can’t look after other people very well unless you are
looking after yourself,’ says Benveniste.
Case study review

Explain how each of the five ways to balance work and life promotes the health
and individual human development of women.
TEST your knowledge and often works late in the evening and on
weekends. Maria works one day a week in the
1 What is the ABS definition of ‘family’?
local supermarket and tends to spend a lot of
2 What factors have impacted on the changing
time driving the children to their sports and music
composition of families?
lessons, as well as their part-time jobs.
3 Outline the advantages and disadvantages of each (a) What type of family is represented in this
type of family. case study?
4 Explain what is meant by ‘work–life balance’. (b) In what ways can this particular family
5 What are the symptoms of work-related stress? composition impact on the health and individual
human development of George and Maria?
APPLY your knowledge (c) Explain the possible impacts that George’s
6 George and Maria are both in their mid-40s and working life may have on his and Maria’s health
have been married for 15 years. They have two and individual human development.
teenage children, Sarah and Michael, who both 7 Choose one family type and explain how it can
attend the local secondary college. George is impact on the health and individual human
a successful businessman for a large company development of family members.
development of Australia’s adults

individual human development and their impact on adults,
using relevant examples
In order to demonstrate this skill, a thorough understanding of the determinants of
health and individual human development and how they relate to Australian adults
is essential. The ability to use relevant examples to demonstrate this understanding
is expected. When outlining the determinants of health, it is important to remember
the following:
• There is a significantly large range of determinants that impact on the health and
individual human development of a population. Select those determinants that
are listed in the study design because these are considered to be the most relevant.
• Focus on determinants that are relevant to the adulthood stage of the lifespan
and ensure that the discussion makes reference to how the selected determinant
impacts on adults.
• In order to clearly demonstrate an understanding of the impact of a selected
determinant on the health and individual human development of adults, it is
important to first outline what the determinant is.
• The determinants of health and individual human development help to explain
or predict trends in health. When outlining the impact of a selected determinant,
explain the way in which it impacts on the physical, social and mental health of
the individual. When referring to the effects on individual human development, it
is important to also consider the possible impact on each type of development —
physical, social, emotional and intellectual.
• Where possible, use relevant statistics that outline the impact of the selected
❶ This is one of the factors listed in determinant on the health and individual human development of an adult.
the study design as a behavioural In the following example, the role played by physical activity as a behavioural
determinant of health and individual
human development. determinant of health and individual human development is explained.
Physical activity❶ is considered to be an important behavioural determinant
➋ It is important to outline what in promoting the health and individual human development of adults. Physical
physical activity is.
activity involves body movement or exercise that may vary in intensity (e.g.
❸ It is important to include information walking, swimming, cycling and competitive sport).❷
relevant to the chosen factor. In this
instance, the level of physical activity The National Physical Activity Guidelines for Australians give the minimum
required is important in determining levels of physical activity required for good health. It is recommended that adults
the health benefits to the adult. do at least 30 minutes of moderate-intensity physical activity on most, preferably
❹ Better sleeping patterns means that all, days.➌ Examples of moderate-intensity activity include a brisk walk or cycling.
the adult is more alert and able to Short sessions of different activities of 10–15 minutes can be combined for a total
concentrate, thereby enhancing the of 30 minutes or more. Regular, more vigorous exercise that makes the adult ‘huff
capacity to develop intellectual skills.
and puff’ will have further health and fitness benefits.
❺ Highlights the impact on physical The benefits of regular physical activity to the health and individual human
health.
development of adults have been well documented and include: improved long-
❻ Highlights the impact on physical term health, reduced risk of heart attack, better weight management, lower blood
development. cholesterol and blood pressure, better sleeping patterns,➍ ➎ stronger bones and
❼ Highlights the impact on mental muscles,❻ promotion of feelings of happiness and being relaxed,❼ improved social
health. relationships and the development of social skills❽ and improved confidence and
❽ Highlights the impact on social health self-concept.❾
and development. According to the Get Moving Tasmania program, regular moderate physical
activity can reduce the risk of a coronary event such as heart attack by up to
❾ Highlights the impact on emotional 40 per cent, while regular, more vigorous exercise can reduce the risk by up to
development.
50 per cent. The risk of stroke can be reduced by up to 30 per cent with regular
❿ Include relevant statistical data that moderate levels of physical activity.❿
highlights the impact of physical
activity on the health and individual In the following example, the impact of alcohol consumption as a behavioural
human development of adults. determinant of health and individual human development is explained.

Alcohol impacts on the health and individual human development of adults. It is

often related to social issues such as domestic violence, assault and unemployment,
as well as being linked to a range of physical health concerns. When consumed,
alcohol is metabolised in the liver; however, the liver can metabolise only a small
amount of alcohol at a time. Alcohol that is not metabolised is circulated around
the body via the circulatory system. It can have a toxic effect on the central nervous
system and cause changes to an adult’s metabolism, heart function and blood
supply. The absorption of thiamine (an important nutrient for brain function), may
be affected by the consumption of alcohol, and wastage of brain cells may occur
due to the dehydrating effects of alcohol.
In order to address the many alcohol-related health issues, the National Health
and Medical Research Council has developed the Australian Alcohol Guidelines
to Reduce Health Risks from Alcohol (2009), which recommends ‘that both
women and men drink no more than two standard drinks a day over their lifetime
if they want to reduce their risk of being harmed by an alcohol-related injury or
disease’.
High levels of alcohol consumption increase the risk of a range of conditions
such as heart and vascular diseases, cirrhosis of the liver, and some cancers. One of
the many conditions that may occur as a result of the overconsumption of alcohol
is alcohol-related brain impairment (ARBI). More than 2500 Australians are treated
for ARBI every year and it is estimated that over two million Australians are at risk
of ARBI due to their level of alcohol consumption. The effects of ARBI can range
from mild to very severe, and may include changes in cognition (the ability to
think and reason), difficulties with movement and coordination, and a range of
medical and neurological disorders.

1 What does the acronym ARBI stand for?
2 How many people are treated for ARBI annually in Australia?
3 Approximately how many Australians are at risk of ARBI?
4 Alcohol consumption is one of the many behavioural determinants of health and
individual human development. Outline three more behavioural determinants.
5 Outline the effects that the overconsumption of alcohol can have on the health
and individual human development of an adult.

6 Refer to table 11.14 to answer some of the following questions.
Table 11.14 Problems most commonly managed at GP encounters, people aged

25–64, 2008–09
Males Females
Per 100 Per 100

Problem encounters Problem encounters
Hypertension 10.2 Hypertension 7.1

Lipid (cholesterol) disorders 5.6 Depression 6.9
Acute upper respiratory 4.9 Female genital check up 5.7
infection
Diabetes 5.0 Acute upper respiratory infection 5.1
Depression 4.8 Lipid (cholesterol) disorders 3.6
Key skills The determinants of health and individual human development of Australia’s adults
(a) Outline one determinant of the health and individual human development
that might account for the difference between male and female rates of
hypertension.
2 marks
(b) Explain how cholesterol levels contribute to stroke.
1 mark
(c) Explain how two behavioural determinants of health and individual human
development contribute to one of the conditions listed in the table.
2 marks
(d) Explain, with reference to specific nutrients, the role of nutrition as a risk factor for
coronary heart disease.
2 marks
7 Refer to table 11.15 to help answer the following questions.
Table 11.15 Selected health risk and protective factors, people aged 25–64 years, 2007–08
Risk and protective factor Males % Females % Total %
Daily smokers 23.8 19.3 21.6

Risky or high risk alcohol consumption(a) 16.3 11.5 13.9
Sedentary exercise(b) 34.4 34.4 34.4
Overweight or obese(c) 70.8 56.1 63.6
Insufficient fruit intake(d) 56.8 44.4 50.5
Insufficient vegetable intake(e) 93.5 89.7 91.6
High blood pressure 9.3 9.0 9.2
High blood cholesterol 7.3 5.5 6.4
(a) In a 1-week period.
(b) People undertaking no exercise or a very low level of exercise in the 2 weeks prior to the survey.
(c) Body mass index greater than or equal to 25, calculated from measured height and weight.
(d) An insufficient fruit intake is considered to be one or less serves of fruit per day.
(e) An insufficient vegetable intake is considered to be four or less serves of vegetables per day.

(a) Explain the relationship between food intake, exercise and overweight/obesity.
2 marks
(b) Select five risk factors from the table and describe one disease related to each risk
factor.
5 marks
(c) Provide two reasons why it is important for the health and individual human
development of an adult to enjoy a wide variety of nutritious foods.
2 marks
8 ‘Many studies show that people or groups who are socially and economically
disadvantaged have reduced life expectancy, premature mortality, increased
disease incidence and prevalence, increased biological and behavioural risk factors
for ill-health, and lower overall health status’ (Australian Institute of Health and
Welfare 2008, Australia’s health 2008, cat. no. AUS 99, Canberra, p. 65).
(a) Explain the term ‘socioeconomic status’.
1 mark
(b) Explain the relationship between education, employment and income.
3 marks
(c) Explain one behavioural and one biological determinant of health and individual
human development that puts individuals from lower socioeconomic status
backgrounds at greater risk of ill-health.
2 marks
(d) Explain two diseases/conditions that individuals from lower socioeconomic status
backgrounds are at greater risk of developing.
2 marks
CHAPTER 11 review
Chapter summary
• Biological factors refer to those genetic and physiological factors that impact on health
• Two examples of genetic conditions that impact on adults are Alzheimer’s disease and
Huntington’s disease.
• Genetic predisposition can be a significant risk factor in the development of diseases
such as cancer and type 2 diabetes.
• The body weight of adults is largely determined by the combination of genes that are
inherited from the biological parents as well as lifestyle and behaviours such as physical
activity levels and food intake.
• Overweight and obesity significantly increase the risk of a range of illnesses and
conditions, such as type 2 diabetes, cardiovascular disease and stroke.
• Blood pressure measures the force of the blood on the walls of the arteries and is
recorded as systolic and diastolic measurements.
• High blood pressure is a major risk factor for coronary heart disease, stroke, heart
failure and kidney failure.
• High blood pressure becomes more common with age due to the arteries becoming
more rigid.
• Coronary heart disease is characterised by a narrowing of the coronary arteries that
supply the heart muscle with blood.
• Atherosclerosis is the build-up of fatty deposits or ‘plaque’ on the arterial walls.
• There are many risk factors for coronary heart disease including genetics and
health behaviours such as tobacco smoking, poor dietary intake and lack of
physical activity.
• During a stroke, blood flow is interrupted to an area of the brain. This may be due to a
blood clot blocking the artery or a blood vessel breaking.
• A transient ischaemic attack is a ‘mini stroke’ that can be a warning sign for a more
severe stroke.
• Some of the risk factors of stroke — such as age, gender and family history — cannot
be controlled. However, there are risk factors that can be addressed to reduce the risk
of stroke. These include smoking, dietary intake, cholesterol levels, blood pressure,
alcohol consumption and body weight.
• Cholesterol is a type of fat that has a range of functions within the human body. It
produces hormones, assists with digestion through the production of bile acids, and is
an essential component of cell membranes.
• Low-density lipoprotein (LDL) cholesterol is referred to as ‘bad’ cholesterol as it
contributes to atherosclerosis.
• High-density lipoprotein cholesterol (HDL) is referred to as ‘good’ cholesterol because it
can help unclog arteries.
• Polyunsaturated fats are sources of omega-3 and omega-6 fatty acids.
• Trans fatty acids can raise the level of LDL cholesterol.
• High cholesterol levels can also be an inherited condition.
• In Australia, the risk of skin cancer as a result of too much sun exposure needs to be
balanced with the need to maintain adequate vitamin D levels.
• There are three types of skin cancer: squamous cell carcinoma, basal cell carcinoma and
melanoma. Melanoma is the most dangerous form of skin cancer.
• Tobacco smoking is the single most preventable cause of ill-health and death in the
Australian population.
• Tobacco smoking is a major risk factor for a range of illnesses including cancer,
cardiovascular disease and stroke.
• The most common form of cancer that is caused by smoking is lung cancer.

• The risk of dying from coronary heart disease is 70 per cent greater for a smoker than
for a non-smoker.
• Since the establishment of Quit Victoria in 1985, there has been a gradual decline in
smoking rates in Victoria.
• The National Physical Activity Guidelines recommends that adults be involved in at least
30 minutes of moderate-intensity physical activity on most (preferably all) days.
• By the adulthood stage of the lifespan, growth has ceased and, as a result, nutrients for
the maintenance of body tissue rather than growth become more important.
• Certain nutrients can act as a risk or protective factor for specific diet-related diseases.
A risk factor increases the likelihood of a disease occurring whereas a protective factor
helps guard against the development of a disease.
• One of the main issues related to dietary intake in the Australian population is an
inadequate consumption of fruit and vegetables.
• Red wine is considered to have benefit for some people in reducing the risk of
cardiovascular disease due to the anti-oxidants that it contains.
• One standard drink contains 10 grams of alcohol.
• A safe level of drinking for adults is no more than two standard drinks per day.
• Drug use may arise from an inability to cope with adult responsibilities.
• Older adults are more likely to abuse prescription medications rather than illicit
drugs.
• Decisions made about sexual practices during adulthood are a continuation of decisions
and experiences made during youth.
• Housing stress occurs when the cost of housing (either rental or mortgage) is high in
relation to household income.
• High levels of debt or the inability to meet rental payments have resulted in a significant
number of adults becoming homeless.
• During the adulthood stage of the lifespan, more time is spent in the work
environment, which means that there is a greater risk of workplace injuries and
illnesses.
• While office jobs have a relatively low risk of injury, conditions related to overuse of
technology are becoming more common.
• Shift work is a risk factor for work-related injury.
• Fears for personal safety within neighbourhoods can restrict adults’ participation in
social occasions and reduce their trust in the community.
• Mammography screening involves taking a low dose X-ray of the breasts to detect any
changes in the breast tissue.
• Bowel cancer is a cancerous growth or growths that occur on the inside of the colon or
rectum.
• If detected early, bowel cancer can be successfully treated, but only 40 per cent of
bowel cancers are detected early.
• Community health services offer a range of programs that aim to prevent ill-health.
• All forms of media have the potential to influence the actions, beliefs, values, opinions
and ideas of adults.
• Those from a high socioeconomic background tend to have the most resources,
opportunities and power to make decisions compared with those from a low
socioeconomic background.
• Unemployment has a significant impact on health status as it limits people’s capacity
to access health resources and services, and it can have an effect on mental and social
health.
• Poorer health, greater levels of disability and higher mortality tends to occur in people
employed in low-skilled manual labour compared with those in managerial/professional
occupations.
Chapter 11 review
• The degree of connectedness or belonging that an adult feels to their community is

determined by their level of engagement in community-based activities.
• Social capital refers to the connections between groups and individuals within society.
Interactivities:
• Those who volunteer have lower mortality rates, greater functional ability, lower rates
Chapter 11 crossword
of depression and longer life expectancy than those who do not volunteer.
• Social support refers to the connections that an adult has with individuals and groups,
including family, friends, work colleagues and other members of their community.
• Socioeconomically disadvantaged individuals are more likely to die sooner after serious
illness than those who are socioeconomically advantaged.
• According to the ABS, ‘A family is two or more persons, one of whom is at least
15 years of age, who are related by blood, marriage (registered or de facto), adoption,
step or fostering, and who are usually resident in the same household’.
• There are many factors that have contributed to changes in family compositions and
therefore living arrangements including divorce, careers, contraception and increased
living expenses.
• Work–life balance relates to the working conditions of parents/guardians being
conducive to ensuring that the social and emotional needs of all family members are
being met as well as enabling adults to pursue their own recreational/leisure activities.
• For many Australian parents/guardians, the amount of hours they are required to work
impacts significantly on their capacity to effectively balance the needs of their families
with their work commitments.
• Work-related stress can result in a deterioration of personal relationships and, in the
long term, can increase the risk of cardiovascular disease.
• More young adults are choosing to live longer with their parents.
• Being single is associated with higher mortality than being married or in a de facto
relationship.

1 Outline the following determinants of health and 2 Develop a brochure/web page that advises adults
individual human development in relation to adults on ways of improving health. In your brochure/web
and provide an example of each type: page, make sure you refer to factors associated with
(a) biological each of the determinants of health and individual
(b) behavioural human development.
(c) physical environment
(d) social.

CHAPTER 12
Health issues facing

Australian adults
Although the health status of adults in Australia is generally
good, there are some health issues that impact significantly
on burden of disease. Obesity, cardiovascular disease,
cancer, type 2 diabetes and mental illness are examples
of common health issues facing adults. Understanding
these issues and the corresponding determinants of health
allows personal, community and government strategies and
programs to be implemented to promote the health and
KEY KNOWLEDGE
3.6 determinants that act as risk and/or protective factors in relation
to one health issue such as cardiovascular disease, cancer, type 2
diabetes, obesity or mental illness (pages 414–30)
3.7 government, community and personal strategies and programs
adults (pages 431–9).
KEY SKILLS
• describe a specific health issue facing Australia’s adults and draw
informed conclusions about personal, community and government
strategies and programs to optimise adult health and development.
Figure 12.1 Participating in

physical activity throughout
adulthood can promote the health
and development of adults and
assist in preventing a range of
health issues including obesity,
cardiovascular disease, type 2
diabetes, some cancers and mental
illness.

atherosclerosis a condition where the blood vessels
become hardened and/or narrowed, thereby restricting
blood flow
mammography (mammogram) a breast scan used to
detect breast cancer
metastasise the process whereby cancerous cells spread
to other organs or tissues in the body
tumour a cluster of abnormal cells
Health issues facing Australian adults • CHAPTER 12 413

12.1 eterminants that act as risk and/or protective
D
factors in relation to obesity

protective factors in relation to obesity
The biological, behavioural, physical environment and social determinants play a

vital role in the health outcomes of adults in Australia. A range of health issues
contribute significantly to burden of disease during adulthood (figure 12.2) and are
the product of a combination of these determinants.
By understanding these health issues and the determinants that act as risk and/
or protective factors for them, a range of personal, community and government
strategies and programs can be implemented to optimise the health and individual
human development of adults in Australia.
Obesity
Mental Cardiovascular
Illness disease
Health issues
affecting
adults
Type 2
Cancer
diabetes
Figure 12.2 Some of the range of health issues affecting adults
Health issue: obesity

Obesity relates to having excess body weight in the form of fat. In adults,
obesity is measured using waist circumference or the body mass index (BMI).
A waist circumference of over 89 cm for females and 102 cm for males
indicates obesity and an increased risk of conditions such as cardiovascular
disease and type 2 diabetes. A BMI is a weight-to-height ratio and is calculated
using the following formula:
Weight (kg)
Height (m)2
A score of 30 or over indicates obesity. BMI does not take body type
into account and should be used with caution when making assessments of
Figure 12.3 Waist circumference is individuals. It is more useful when analysing statistics relating to population
increasingly being used to measure obesity. groups.

Obesity has a range of impacts on the health of adults, including an increased
risk of cardiovascular disease, some cancers, type 2 diabetes and mental illness.
Why is obesity a health issue for adults?

Obesity is a significant health issue for adults in Australia as rates have increased
significantly over the past 25 years and continue to increase (see figure 12.4). In
2007-08, 25 per cent of Australian adults were classified as obese. Obesity is a risk
factor for many illnesses, including those that can lead to premature death, and
contributes significantly to burden of disease as a result.
80
70
60
50
Males
Per cent
40 Females
30
20
10
Figure 12.4 Proportion of adults
(aged 18 and over) who were
0
overweight or obese, 1995 to 2011–12
1995 1997 1999 2001 2003 2005 2007 2009 2011–12
Source: ABS, Australian Health Survey, First Results,
Year 2011–12, p. 25.
Determinants acting as risk and/or protective

factors in relation to obesity
Biological
Obesity is itself a biological determinant or risk factor for other
conditions such as cardiovascular disease, some cancers and type 2
diabetes. Biological risk factors for obesity include:
• Age. As metabolism slows down with age, it becomes more
difficult to maintain weight.
• Genetics. Some people may have a genetic predisposition for
overweight or obesity.
• Basal Metabolic Rate (BMR). A lower BMR results in less energy
being used and can therefore contribute to obesity.
Behavioural
Behavioural factors that increase the risk of obesity include:
• Lack of physical activity. Less energy is expended or burned in
those who are not physically active, which increases the risk of
weight gain.
• Alcohol consumption. Alcohol contains kilojoules and therefore
energy, which means it can increase the chances of an individual
gaining weight (figure 12.5).
• Food intake. Foods containing large amounts of fat and simple
carbohydrates such as sugar contribute significant kilojoules to
the body. Over time, if this energy is not expended then weight Figure 12.5 Alcohol consumption is
gain can occur. a significant risk factor for obesity.

12.1 Determinants that act as risk and/or protective factors in relation to obesity
The physical environment can contribute to obesity in a number of ways as a
result of:
• Access to recreation facilities. If individuals do not have access to recreation
facilities such as cycling and walking paths, they may not have the same
opportunities for physical activity as others. This can increase body weight and
contribute to obesity.
• The work environment. A work environment that does not foster incidental
exercise can increase the risk of obesity. For example, a work environment that
has car parking next to the entrance, no stairs and a small office space can reduce
the level of incidental physical activity and contribute to weight gain.
Social
Some of the social determinants that have a relationship with obesity include:
• Education. Those with lower levels of education are more likely to be obese.
This could be a result of lower levels of knowledge relating to the importance of
physical activity and food intake.
• Occupation. People who are active as part of their job expend more energy in
their day than people who work in more passive occupations or spend prolonged
periods sitting.
• Income. People who can’t afford or can’t access a healthy food supply may rely
on processed food, which tends to be higher in fat and sugar and lower in fibre,
therefore adding kilojoules to the diet.
TEST your knowledge 6 Use the Obesity link in your

eBookPLUS to find the link to this
1 (a) Briefly explain obesity.
question.
(b) Explain two ways in which obesity is measured.
(a) What percentage of Australians are
(c) Outline the limitation of the body mass index in
obese, but don’t believe they are?
assessing obesity.
(b) How can obesity impact on social and mental
2 Explain why obesity is a health issue for adults.
health?
APPLY your knowledge (c) Which factor is identified as contributing to
obesity?
3 (a) Outline the trends evident in figure 12.4. 7 Use the Tackling obesity link in
(b) Discuss possible reasons for the trends your eBookPLUS to find the link
identified in part (a). to this question.
4 Prepare a poster that could be used to educate (a) What health risks occur as a result of obesity?
adults about the risks of obesity and the (b) Explain how social determinants can impact on
determinants that can protect against/contribute obesity.
to it. (c) Discuss how fast food chains can assist in
5 Explain three ways in which obesity could impact on reducing the risk of obesity.
the health and/or individual human development (d) Discuss the role that governments can play in
of adults. addressing the obesity issue in Australia.

D
factors in relation to cardiovascular disease

protective factors in relation to cardiovascular disease
Cardiovascular disease relates to all diseases of the heart and blood vessels.
Examples include hypertension (sometimes referred to as high blood pressure),
coronary heart disease, stroke, heart failure and peripheral vascular disease (which
affects the extremities, particularly the legs and feet).
Cardiovascular disease is characterised by an inability of the heart to pump
blood effectively to all tissues in the body. The cause may be in the heart itself, or
the blood vessels carrying the blood. Without an adequate blood supply, cells and
tissues cannot function normally and may die. If blood vessels become completely
blocked, major organs including the brain and heart may be permanently damaged,
which may lead to death. Even if blood flow is restored, permanent damage may
have already occurred.
Stroke
Coronary heart disease

Heart attack
Hypertension (can cause

kidney failure)
Peripheral vascular
disease
Figure 12.6 The common sites for

cardiovascular disease
Atherosclerosis is the underlying condition in most forms of cardiovascular

disease. Atherosclerosis is a condition where the blood vessels become hardened
and/or narrowed, thereby restricting blood flow. Atherosclerosis is caused by a
build-up of plaque on the walls of blood vessels, which narrows the passages that
the blood has to pass through. The plaque is made up of cholesterol, other fatty

12.2 Determinants that act as risk and/or protective factors in relation to cardiovascular disease
substances, human tissue and calcium. Cholesterol is a waxy substance and acts
like glue to hold the other materials against the artery wall. Over time, the plaque
becomes thicker, which results in an overall narrowing of the artery. This restricts
blood flow, and therefore oxygen supply, to various parts of the body (depending
on where the build-up is occurring, see figure 12.7). This puts strain on the heart
and the organs or muscles that the blood is being pumped to.
Normal Artery
artery with
plaque
Normal Restricted
blood flow blood flow
Figure 12.7 Atherosclerosis blocks

blood vessels and therefore restricts
blood flow.
Why is cardiovascular disease a health issue

for adults?
Although mortality rates for cardiovascular disease have decreased in recent
decades, it is still the most common cause of death among adults in Australia and
the second largest contributor to overall burden of disease. Cardiovascular disease
is also one of the most common conditions experienced by adults and becomes
more common with age (see figure 12.8).
30
28 Males
26 Females
24
22
20
18
Per cent
16
14
12
10
8
6
Figure 12.8 Proportion of 4
persons with cardiovascular 2
disease, 2011–12 0
Source: ABS, Australian Health 15–24 25–34 35–44 45–54 55–64 65–74 75+
Survey, First Results, 2011–12,
p. 20.
Age group (years)

factors in relation to cardiovascular disease
Biological
A range of biological determinants can increase the chances of developing
cardiovascular disease. Examples include:
• Body weight. Increased body weight usually places greater strain on the heart.
There is also an increased risk of high levels of cholesterol in the blood and a
higher risk of hypertension.
418
• High blood pressure, which is an indicator that the heart is already working
harder to pump the blood, and can increase the risk of heart attack and stroke
• High blood cholesterol, which increases the risk of plaque building up on artery
walls (atherosclerosis), making it harder for the blood to get through
• Genetic predisposition. Having family members (particularly in the immediate
family) with cardiovascular disease increases the individual’s risk of cardiovascular
disease.
• Being male. Men carry more fat around the abdomen, which places them at
increased risk of cardiovascular disease.
• Advancing age. Metabolism slows as people age, making weight management
more difficult. The heart also loses its efficiency with age, contributing to
cardiovascular disease.
Behavioural
Behavioural determinants that play a role in the development of cardiovascular
disease include:
• Physical activity. Lack of physical activity means less energy is used and this
increases the risk of weight gain, a risk factor for cardiovascular disease. Regular
physical activity also acts to exercise the heart muscle and maintain the flexibility
of the blood vessels. As a result, being physically inactive can speed up the
hardening process and contribute to cardiovascular disease.
• Food intake. Food intake is one of the most significant factors in the development
of cardiovascular disease. Food intake can contribute to cardiovascular disease in
numerous ways. For example:
–– foods that contain saturated or trans fat increase the levels of low density
lipoprotein (LDL) cholesterol, the ‘bad cholesterol’. LDL cholesterol can stick
to the blood vessel walls and contribute to atherosclerosis and cardiovascular
disease.
–– a diet low in fibre can increase cholesterol levels in the body and contribute to
overeating. If an individual overeats over a period of time, the risk of weight
gain and cardiovascular disease increase.
• Smoking. Smoking tobacco and other drugs speeds up the process of atherosclerosis
and therefore contributes to cardiovascular disease. Smoking increases the risk of
cardiovascular disease by up to six times that of a non-smoker.
• Alcohol use. Alcohol contributes extra kilojoules to the diet and can lead to
obesity and cardiovascular disease.
Factors within the physical environment can act to increase or decrease the risk of
cardiovascular disease. Examples include:
• Access to recreation facilities. Being able to access recreation facilities such as
walking and cycling paths, parks, beaches and gymnasiums can increase the
ability to exercise. With adequate exercise, the risk of obesity and cardiovascular
disease decrease.
• Proximity to health care. Being able to readily access health care may lead to
issues such as hypertension being diagnosed and interventions put in place to
reduce the risk of cardiovascular disease.
• Exposure to environmental tobacco smoke. Being exposed to environmental
tobacco smoke can contribute to atherosclerosis and increase the risk of
Social
A range of social determinants play a role in the development of cardiovascular
disease. Examples include:
• Education. Those who are adequately educated with regards to food intake,
the dangers of smoking and the benefits of regular physical activity are more

12.2 Determinants that act as risk and/or protective factors in relation to cardiovascular disease
likely to adopt healthy behaviours and are at a decreased risk of weight gain and
• Income. Those with low incomes may not be able to afford nutritious foods which
can increase the dependence on processed foods that may be high in fat. This
can increase energy intake and contribute to obesity and cardiovascular disease.
• Work. If an individual is experiencing workplace stress, they are more likely to
experience hypertension which increases the risk of cardiovascular disease.
• Occupation. Occupations where individuals spend extended periods of time
sitting, such as office work, can reduce levels of physical activity and contribute
to obesity and cardiovascular disease.
TEST your knowledge 7 Design a poster that could be used to educate

adults about cardiovascular disease and ways that
1 Explain cardiovascular disease.
individuals can reduce their risk of these conditions.
2 Describe atherosclerosis.
8 Research one of the following:
3 Why is cardiovascular disease an issue for adults in
• hypertension
Australia?
• coronary heart disease
4 Discuss the determinants of health that may
• stroke
increase or decrease the risk of cardiovascular
• heart failure
disease among adults.
• peripheral vascular disease.
APPLY your knowledge Prepare a fact sheet that includes:
(a) a description of the condition
5 Using the determinants of health as the basis of (b) relevant statistics (use Australian data)
your response, explain reasons that may account for (c) factors that work to increase or decrease the risk
males experiencing higher rates of cardiovascular of the condition.
disease than females.
6 Explain how an individual’s occupation could increase
or decrease the risk of cardiovascular disease.

D
factors in relation to cancer

protective factors in relation to cancer
Cancer is a disease characterised by the uncontrolled growth of abnormal cells

(figure 12.9). The human body produces millions of new cells per second to
replace those that have died or are no longer functioning correctly. This is a
normal part of life and is required to ensure that all organs and systems function
normally. If abnormal cells are created, they are usually destroyed by the immune
system. In some cases, these cells either aren’t recognised as being abnormal, or
the immune system cannot kill them. As a result, they may grow and divide
and form a cluster of abnormal cells called a tumour. Untreated, the cancerous
cells may invade nearby tissue and prevent normal cells from carrying out their
functions. They may also metastasise, and spread to other parts of the body.
The type of cancer experienced depends on the site of the initial tumour. The
breast, prostate, lung and skin are common sites for cancer in Australia.
Why is cancer a health issue for adults?

Figure 12.9 A computer-generated
Cancer is a significant health issue for adults as it is the leading cause of image of a cancer cell. They can divide
premature death in Australia. Cancer is also the greatest contributor to overall quickly and move, which makes them
burden of disease and injury in Australia. a serious threat to normal cells.
In 2011–12, there were 326 600 persons who had cancer, or around 1.5 per cent
of the Australian population.
The prevalence of cancer increased with age, with the highest rate for males and
females being in those aged 75 and over — 11.1 per cent and 4.4 per cent
respectively (see figure 12.10).
14
Males
12 Females
10
8
Per cent
2
0 with cancer, 2011–12
0–14 15–24 25–34 35–44 45–54 55–64 65–74 75+ Source: ABS, Australian Health Survey, First
Age group (years) Results, 2011-12, p.18.

factors in relation to cancer
Cancer has been linked to a number of risk and protective factors. Understanding
these factors can assist in reducing the risk of developing cancer by guiding
individual, community and government groups in implementing relevant programs
and strategies.

12.3 Determinants that act as risk and/or protective factors in relation to cancer
Biological
• Obesity. The exact link between obesity and cancer is not completely
understood but those with excessive body weight experience higher
rates of certain cancers, including breast cancer and colorectal
cancer.
• Age. Advancing age is a risk factor for many types of cancer
including prostate, breast and colorectal cancer.
• Genetic predisposition. Some people are more likely to develop
cancer than others. The genetic influence seems to be particularly
important for certain cancers, such as breast cancer and prostate
cancer.
Behavioural
Behavioural factors that play a role in the development of cancer
include:
• Tobacco smoking. Tobacco smoke contains thousands of
chemicals and many of these have been shown to cause cancer
(see figure 12.12). Tobacco smoking can contribute to cancer
in almost all parts of the body especially the lung, mouth and
oesophagus.
• Alcohol consumption. Alcohol can contribute to certain cancers,
such as breast cancer.
• A low fibre diet may increase the chances of colorectal cancer. Fruit and
vegetables are rich in nutrients, which may also play a protective
role in colorectal cancer.
Figure 12.11 Sun protection • Sun protection. Exposure to sunlight and UV radiation increases the
measures such as using sunscreen can
reduce the risk of skin cancer.
chances of developing skin cancer. Adults who do not practise sun
safety are at an increased risk (figure 12.11).
Aspects of the physical environment that play a role in cancer
include:
• Environmental tobacco smoke. Second-hand smoke can have
similar effects as smoking tobacco and increases the risk of many
types of cancer (figure 12.12).
• Workplace safety. Individuals who spend prolonged time outdoors as
a part of their job may have increased exposure to UV radiation and
an increased risk of skin cancer. Exposure to hazardous substances
in the workplace can also increase the risk of cancers such as lung
cancer.
• Access to health care. Access to health care does not prevent the
development of cancer. However, the rate of successfully treating
cancers is higher if they are detected early (see case study).
Social determinants
Education and income both have an indirect relationship with cancer.
Those with lower levels of education relating to tobacco use, the
importance of maintaining a healthy body weight and consuming fruit
and vegetables are at an increased risk of developing some types of
cancer. Those on low incomes may not be able to afford nutritious
Figure 12.12 Individuals exposed
foods and may rely on processed foods that are high in fat. This can
to environmental tobacco smoke increase body weight and the risk of developing breast and colorectal
experience an increased risk of cancer. cancer.

Case study
Smokers scan call Cancer Council Victoria said 13 per cent of people
with lung cancer survived five years.
Health experts are calling for screening of smokers for ‘Unfortunately, the survival rates haven’t dramatically
lung cancer, much the same way women are screened improved because many lung cancer patients still
for breast cancer. present with advanced disease,’ Prof Ball said.
They want Australia to investigate the health and ‘It is already incurable.’
economic benefits of screening smokers for lung He said the challenge was to detect the disease at an
cancer, our biggest cancer killer. earlier stage through screening.
Five Victorians die from lung cancer a day. Prof Ball said screening with chest x-rays had been
Investigations are underway to see if screening
found to be ineffective.
current and former smokers can cut the toll.
But CAT scanning in people who had been smokers
Chairman of the Peter MacCallum Cancer Centre’s
showed there was ‘a survival benefit if patients are
Lung Service, Prof David Ball, said the key to better
survival rates for lung cancer was earlier detection. regularly screened’.
Prof Ball said a North American study, which ‘But we do not know how relevant the US results are
investigated CAT scan screening of smokers for lung to the Australian population,’ Prof Ball added.
cancer, revealed a reduction in deaths. He said screening might be beneficial but that, if it
‘The question is how much does that cost and how was, the next question was whether such a screening
many patients would have to be screened to produce program was affordable.
benefits in, say, one individual?’ he asked. Source: Sunday Herald Sun, 19 February 2012.
Case study review

1 Explain why survival rates for lung cancer have not improved in recent years.
2 Besides the location of health services, what other factors may limit access to
scans for smokers?
3 Up to 30 per cent of lung cancer cases occur in non-smokers. Discuss the factors
that may contribute to lung cancer in non-smokers.
TEST your knowledge 5 Make a short video that could be used to educate
adults with regards to cancer and determinants that
1 Explain cancer.
act as risk and/or protective factors.
2 Discuss why cancer is a health issue for adults
6 Use the Cancer link in your eBookPLUS to find the
in Australia.
link to this question.
APPLY your knowledge Watch the animation on cancer.
(a) Explain what a tumour is.
3 Explain the trends evident in figure 12.10. (b) How do the cancerous cells obtain oxygen and
4 Explain how access to health care can promote the nutrients?
health of adults with cancer. (c) What is the metastatic stage?

D
factors in relation to type 2 diabetes

protective factors in relation to type 2 diabetes
4. Glucose can’t
2. Glucose enters
Type 2 diabetes is a disease characterised
enter the body by an inability of the body to utilise
the bloodstream.
effectively.
blood glucose for energy.
Glucose is the most basic form
of carbohydrate and is released into
the blood stream after eating foods
containing carbohydrate. As blood
glucose levels rise, a hormone called
insulin is released by the pancreas to
assist cells in absorbing the glucose.
Glucose molecules are then used for
energy which assists the cells in carrying
3. The pancreas
produces enough out their normal functions.
insulin, but it can’t 1. Food is converted For those with type 2 diabetes, either
be used effectively. to glucose in the too little insulin is produced, or the
5. Glucose levels in stomach.
the bloodstream insulin that is produced is ineffective.
increase. If type 2 diabetes is unmanaged, the
glucose remains in the blood stream and
is then filtered out through the kidneys.
Pancreas Stomach Over time, this can lead to long-term
problems including kidney disease,
Figure 12.13 Diabetes occurs when
the glucose in the blood cannot be cardiovascular disease, limb amputations, damage to the retina in the eyes and
effectively transported into the cells. premature death.
Why is type 2 diabetes a health issue

for adults?
As obesity rates have increased in Australia over the past 25 years, so too have the
rates of type 2 diabetes making it a common disease among adults in Australia
(figure 12.14). Type 2 diabetes is one of the leading causes of mortality and
morbidity among Australian adults and is predicted to become the leading cause of
overall disease burden by 2023.
20
18 Males
Females
16
14
12
Per cent
10
8
6
4
2
with type 2 diabetes, 2011–12 0
15–24 25–34 35–44 45–54 55–64 65–74 75+
Source: ABS, Australian Health Survey, First
results, 2011–12, p.19. Age group (years)

factors in relation to type 2 diabetes
Biological
Being overweight is the greatest risk factor for type 2 diabetes. The exact relationship
is unknown, but there are a number of possibilities.
• Fat cells may be more resistant to insulin than muscle cells. This means that
someone who is overweight is naturally more resistant to the effects of insulin
and therefore high amounts of glucose remain in the bloodstream.
• People who are overweight have put a strain on their pancreas as it has tried to
produce enough insulin to metabolise blood glucose. After a period of time, the
insulin-producing cells in the pancreas become inefficient.
• High levels of fat in the body may destroy insulin-producing cells in the pancreas,
resulting in a lower level of insulin available for glucose metabolism.
Genetics also play a part in the development of type 2 diabetes. Those who have
a family history of the condition are at an increased risk.
Behavioural
Behaviours that increase the risk of developing obesity also increase the risk of
type 2 diabetes. Examples include:
• Physical inactivity. Being physically inactive can contribute to weight gain and
increase the risk of type 2 diabetes.
• Alcohol consumption. Alcohol contains a large amount of energy, especially
mixed drinks and beer. These drinks can contribute to obesity which a risk
factor for type 2 diabetes.
• Food intake. An energy dense or high fat diet can contribute to weight gain and
type 2 diabetes.
• Tobacco smoking. Smokers are more likely to develop type 2 diabetes. Some
research suggests that smoking itself contributes to an increased risk of type 2
diabetes or it may be that smokers are more likely to be sedentary and overweight.
As obesity is a risk factor for type 2 diabetes, aspects of the physical environment that
increase the risk of obesity also increase the risk of type 2 diabetes. These include:
• Access to recreation facilities. If recreation facilities such as sporting ovals and
walking paths are not accessible, individuals may not get the required amount of
physical activity, which can increase body weight and contribute to obesity and
type 2 diabetes.
• Work environment. A work environment that does not promote incidental
physical activity can increase the risk of obesity. A work environment that has
car parking next to the entrance, no stairs and a small office space can reduce the
level of incidental physical activity and contribute to obesity and type 2 diabetes.
Social determinants
Social determinants of health that can increase the risk of type 2 diabetes include:
• Income. People with low incomes may be more likely to eat energy-dense,
processed foods that can increase the risk of obesity and contribute to type 2
diabetes.
• Education. People with lower levels of education have higher rates of obesity
and higher rates of type 2 diabetes.
• Occupation. People in managerial and other sedentary occupations may be more
at risk of obesity and type 2 diabetes.

12.4 Determinants that act as risk and/or protective factors in relation to type 2 diabetes
Case study
Ignorant on dangers of Australians were more willing to modify their diet

than exercise to improve health, with 62 per cent
diabetes saying they would eat more fruit and vegetables and
57 per cent would reduce their consumption of fat.
Australians are dangerously ignorant of the dangers
However, only 38 per cent would exercise regularly
of type 2 diabetes, despite rates of the chronic disease
and 25 per cent would reduce alcohol intake.
tipped to triple by the year 2031.
Lyell McEwin Hospital head of diabetes and
An Australian Medicines Industry report, out today,
endocrinology services Dr Elaine Pretorius said the
surveyed 5000 Australians aged 32–66 about their
report’s findings were ‘extremely worrying’.
opinions on health and disease.
‘There is a belief that obesity “won’t happen to me”
It found 90 per cent of those surveyed did not
and I think people believe that being overweight is not
consider the condition to be a major health concern.
an issue, and diabetes is not an issue when it clearly has
The report also found 42 per cent of respondents did
significant consequences,’ she said.
not exercise regularly — a risk factor for obesity and
Complications of type 2 diabetes include heart attack,
type 2 diabetes.
stroke, kidney failure, blindness and amputations.
‘There is a clear disconnect between our views
Dr Pretorius said the report found cancer was the
on health, particularly in relation to weight and
most feared disease among Australians, but few people
the implications of that in regard to serious and
were aware that obesity was a risk factor for certain
potentially life-threatening disease,’ industry spokesman
types of cancer.
Dr Brendan Shaw said.
‘The biggest gift we can give our children as parents
He said while Australians were aware of the
is to make healthy eating changes and regular exercise
messages of healthy eating and exercise, the long-term
part of their lives,’ she said.
consequences of obesity were not well understood in
‘Otherwise, trying to change those habits suddenly at
the community.
the age of 60 is going to be very hard.’
‘A staggering 65 per cent of all cardiovascular deaths
Source: The Advertiser, 11 March 2013.
occur in people with diabetes or pre-diabetes.’
Every day, about 280 Australians develop diabetes,
the report says.
Case study review

1 (a) Lack of understanding surrounding diabetes is an example of which
determinant of health?
(b) Discuss how this could be addressed in Australia.
2 Explain why type 2 diabetes is a major health concern in Australia.
3 (a) Which behavioural determinant were Australians most willing to modify to
improve their health?
(b) Would modifying this determinant eliminate the risk of developing type 2
diabetes? Explain.
4 Explain why trying to change habits at 60 is ‘very hard’.

1 Explain type 2 diabetes. 4 Make a short video that could be used to educate
2 Outline the complications that can occur if type 2 adults about the prevention of type 2 diabetes.
diabetes is unmanaged. 5 Use the Type 2 diabetes weblink in your
3 Discuss why type 2 diabetes is a health issue for eBookPLUS to find the link for this question.
adults in Australia. (a) What symptoms did Margot have
related to her condition?
(b) How does Margot manage her condition?
(c) Explain why Roger’s diagnosis is important
information for Margot’s doctor.

D
factors in relation to mental illness
KEY CONCEPT Understanding the determinants that act as risk

and/or protective factors in relation to mental illness
Mental illness is a broad term for a group of conditions. These conditions can be
short or long term, and there is no way of knowing who will be affected by them. It
is thought that chemical imbalance in the brain can alter the way a person perceives
his or her world and contribute to mental illnesses. The two most common types
of mental illness are anxiety disorders and depression.
Anxiety disorders
Anxiety relates to worry or fear and is a normal part of life. When in danger, anxiety
causes physical responses that assist in dealing with these situations. Anxiety
disorders, however, relate to irrational and ongoing fear or worry that interferes
with normal life. These thought patterns contribute to physical symptoms such as
panic attack, where the individual may experience shortness of breath, dizziness,
rapid heartbeat, choking or nausea.
Specific anxiety disorders include:
• Generalised anxiety disorder — anxiety associated with common issues such as
family, friends, work, health or money
• Social phobias — fear of social situations
• Specific phobias — fear of a specific object or situation; for example, a fear
of enclosed spaces, animals or spiders. In all cases, the fear is irrational and
interferes with normal life (see figure 12.15).
• Panic disorders — frequent and debilitating panic attacks
• Obsessive compulsive disorder — recurring unwanted thoughts (obsession) and
feeling compelled to perform behavioural or mental rituals (compulsion), such
as excessive handwashing
• Post traumatic stress disorder — can occur after an individual is exposed to a
traumatic event. Feelings of grief and sadness are common after traumatic events,
but this condition is characterised by severe, ongoing reactions that interfere
with normal life. Thoughts and images of the event may be more distressing
than the original event itself, and can lead to the individual avoiding reminders
of the trauma, including places and situations.
Figure 12.15 Phobias are a type of

anxiety that can result in the sufferer
avoiding certain situations.

12.5 Determinants that act as risk and/or protective factors in relation to mental illness
Depression
Everyone feels sad from time to time, but depression is
a condition characterised by ongoing feelings of extreme
sadness that can last weeks, months or years. It is a
serious illness that interferes with normal activities such
as school, work and leisure. Symptoms of depression
can include:
• feeling sad or depressed
• loss of interest in normal activities
• sleeping problems
• constant feelings of tiredness
• loss of appetite or weight
• difficulty concentrating
• feelings of restlessness, worthlessness or guilt.
Figure 12.16 Depression is more
than just being sad. It can be ongoing
and interfere with normal activities. Why is mental illness a health issue
for adults?
Mental illnesses are very common among adults in Australia. In 2012, around
13 per cent of Australian adults were currently experiencing a mental illness
(figure 12.17).
16
14
12
10 Males
Per cent
Females
8
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Figure 12.17 Proportion of persons with a mental illness, 2001 to 2011–12
Source: ABS, Australian Health Survey, First results, 2011–12, p. 21.
The 2007 National Survey of Mental Health and Wellbeing estimated that 20 per
cent of Australians aged 16–85 experienced one or more of the common mental
illnesses in the previous 12 months. While not experiencing a mental illness in the
previous 12 months, an additional 25 per cent had experienced one at some stage
in their lives. In total, 45 per cent of Australians had experienced a mental illness
(AIHW, 2012).
Although mental illness is not a leading cause of death among adults, it
contributes significantly to morbidity in Australia. Mental illnesses can impact on
all aspects of life, including the ability to work, socialise, sleep, exercise, eat and
relax.

factors in relation to mental illness
Biological
Some biological determinants that increase the risk of mental illness include:
• Obesity. Links have been established between mental illness and obesity (AIHW,
1998). Although no definitive relationship has been established, obesity could
develop if the person is eating in response to depressive symptoms, or depression
could develop as a result of low self-esteem due to obesity.
• Genetic predisposition. People with mental illness in the family are more likely
to develop mental illness at some stage in their lives.
• Having an underactive thyroid gland can contribute to depression and there
is evidence to suggest that those who have experienced a heart attack, stroke,
cancer or diabetes have an increased risk.
• Stress and grief can also place a person at greater risk.
Behavioural determinants
Some behavioural determinants related to mental illness
include:
• Tobacco use. Smokers are more likely to have mental health
problems (AIHW, 1998). Although the exact reason for this
is unknown, it has been suggested that people experiencing
mental health problems in their youth may be more likely
to take up smoking.
• Alcohol misuse. Although there is a relationship between
problem drinking and mental health (with problem
drinkers more likely to have mental health issues and vice
versa), the causal factor (mental illness or drinking) has not
been established. Alcohol is a depressant and some studies
suggest that people with depressive symptoms are more
likely to develop alcohol misuse and dependence in their
younger years.
• Drug use. People abusing drugs have higher rates of mental
illness. Many substances alter the chemical make-up in the
brain, which can trigger a range of mental illnesses. There
is a relationship between mental illness and marijuana use,
although the cause of this relationship is not understood.
• Physical activity. Physical activity releases hormone-type
chemicals called endorphins that relieve stress and assist
in maintaining optimal mental health. People who exercise
may therefore be at a decreased risk of developing mental
illness (figure 12.18).
Aspects of the physical environment that are related to mental
illness include:
• Housing. Living in overcrowded housing conditions can
Figure 12.18 Regular physical
increase the risk of psychological distress. activity can reduce the risk of
• Neighbourhood safety. Living in an area that is not considered safe may heighten developing a mental illness.
feelings of anxiety.
• Access to health care. Medical intervention can assist in treating mental illnesses.
If the individual cannot access health care due to geographical barriers, mental
illnesses may go untreated for an extended period of time.

12.5 Determinants that act as risk and/or protective factors in relation to mental illness
Social
Some social determinants that relate to mental illness include:
• Education and income. People with low education and incomes have higher
rates of mental illness. This could be attributed to a range of associated factors
such as higher rates of obesity, higher rates of smoking and drug misuse.
• Occupation. Work-related stress can add to depressive symptoms.
• Unemployment. Long-term unemployment has a relationship with mental
illness. Those who are unemployed may experience prolonged feelings of stress
and anxiety as a result of not being able to provide for themselves and/or their
family.
• A history of abuse or neglect during childhood increases the risk of mental
illness.
TEST your knowledge 7 Use the Anxiety weblink in your

1 Describe mental illness.
question.
2 Discuss the difference between anxiety and
(a) Why is a small amount of anxiety useful?
depression.
(b) What are the three types of anxiety identified?
3 What is the difference between feeling sad and
Explain each one.
having depression?
(c) Explain the ‘fight or flight’ response.
4 Explain why mental illness is a health issue for
(d) How can panic attacks impact on social health?
adults.
8 Use the Depression weblink in your
5 Explain how physical activity can reduce the risk of
mental illness.
question.
APPLY your knowledge (a) Explain why the term ‘depression’ may be
misleading.
6 Lisa is 16 and both her mother and father have (b) What does the ‘spectrum’ of depression mean?
experienced depression. Provide advice to Lisa as (c) What are some of the common symptoms of
to how she can reduce her risk of developing this depression?
condition. (d) What secondary problems can be associated
with depression?
(e) Briefly explain bipolar disorder.

12.6 overnment strategies and programs to promote
G
health and individual human development of adults
KEY CONCEPT Understanding government strategies and programs designed

to promote health and individual human development of adults.
A range of government, community and personal strategies and programs have

been designed to promote the health and development of adults in Australia.
These programs and strategies aim to reduce the burden of disease associated
with health issues and to assist adults in living long, healthy lives. Understanding
these programs and strategies can assist adults in accessing resources for optimal
health and development and making health choices throughout their lives.
Government strategies and programs

The three levels of government in Australia, federal, state and local, all play a role in
promoting the health and individual human development of adults. In this section,
examples of the strategies implemented by each level of government will be explored.
Federal Government
The Federal Government implements a range of strategies and programs to
promote the health and individual human development of adults in Australia.
Examples include the National Physical Activity Guidelines and Australian Dietary
Guidelines, the Shape Up Australia program and BreastScreen Australia.
The National Physical Activity Guidelines
The National Physical Activity Guidelines for Australians were developed to assist
individuals in meeting the amount of physical activity required to achieve health
benefits. Guidelines targeting different lifespan stages were developed, including
adults and older Australians. Recommendations as to the amount of physical
activity required and ways to incorporate physical activity into everyday life form
the basis of the guidelines.
Physical activity is important in reducing the burden of disease associated with
many conditions such as obesity, cardiovascular disease, type 2 diabetes, mental
illness and osteoporosis.
Physical activity guidelines for adults

There are four steps for better health for Make a habit of walking or cycling
Australian adults. instead of using the car, or do things
Together, steps 1–3 recommend the yourself instead of using labour-saving
minimum amount of physical activity you machines.
need to do to enhance your health. They Step 3 — Put together at least
are not intended for high-level fitness, 30 minutes of moderate-intensity
sports training or weight loss. To achieve physical activity on most, preferably
best results, try to carry out all three all, days.
steps and combine an active lifestyle You can accumulate your 30 minutes
with healthy eating. (or more) throughout the day by
Step 4 is for those who are able, and combining a few shorter sessions
wish, to achieve greater health and of activity of around 10 to 15 minutes
fitness benefits. each.
Step 1 — Think of movement as an Step 4 — If you can, also enjoy
opportunity, not an inconvenience. some regular, vigorous activity for
Where any form of movement of extra health and fitness.
the body is seen as an opportunity for This step does not replace
improving health, not as a time-wasting steps 1–3. Rather it adds an extra
inconvenience. level for those who are able, and wish,
Step 2 — Be active every day in as to achieve greater health and fitness
many ways as you can. benefits.

12.6 G
overnment strategies and programs to promote health and individual human
Physical activity recommendations for older Australians

It’s never too late to start becoming 1. Older people should do some form
physically active, and to feel the of physical activity, no matter what
associated benefits. ‘Too old’ or ‘too their age, weight, health problems or
frail’ are not of themselves reasons abilities.
for an older person not to undertake 2. Older people should be active every
physical activity. Most physical activities day in as many ways as possible, doing
can be adjusted to accommodate older a range of physical activities that
people with a range of abilities and incorporate fitness, strength, balance
health problems, including those living in and flexibility.
residential care facilities. 3. Older people should accumulate at
Many improved health and wellbeing least 30 minutes of moderate intensity
outcomes have been shown to occur physical activity on most, preferably
with regular physical activity. These all, days.
include helping to: 4. Older people who have stopped
• maintain or improve physical function physical activity, or who are starting a
and independent living new physical activity, should start at
❛ ….people should • improve social interactions and quality a level that is easily manageable and
of life, and reduce depression gradually build up the recommended
do some form of • build and maintain healthy bones, amount, type and frequency of
physical activity, muscles and joints, reducing the risk
of injuries from falls
activity.
5. Older people who continue to
no matter what • reduce the risk of heart disease, enjoy a lifetime of vigorous physical
stroke, high blood pressure, type 2 activity should carry on doing so in
their age, weight, diabetes and some cancers. a manner suited to their capability
health problems or There are five physical activity
recommendations for older
into later life, provided recommended
safety procedures and guidelines are
abilities. ❜ Australians. adhered to.
The Australian Dietary Guidelines

The Australian Dietary Guidelines were released in 2013 to assist Australians
in consuming a healthy diet and reduce the burden of disease associated with
cardiovascular disease, obesity, some cancers and type 2 diabetes.
The guidelines include information relating to the different food groups and
the number of serves that should be consumed from each food group to promote
optimal health. Specific advice for adults and older Australians are included in the
guidelines in order to assist in promoting the health of these lifespan stages.
The Australian Dietary Guidelines that relate to adults are:
Guideline 1: • Grain (cereal) foods, mostly

To achieve and maintain a healthy wholegrain and/or high cereal fibre
weight, be physically active and choose varieties, such as breads, cereals, rice,
amounts of nutritious food and drinks to pasta, noodles, polenta, couscous,
meet your energy needs. oats, quinoa and barley
Older people should eat nutritious • Lean meats and poultry, fish, eggs,
foods and keep physically active to help tofu, nuts and seeds, and legumes/
maintain muscle strength and a healthy beans
weight. • Milk, yoghurt, cheese and/or their
Guideline 2: alternatives, mostly reduced fat And
Enjoy a wide variety of nutritious foods drink plenty of water.
from these five food groups every day. Guideline 3:
• Plenty of vegetables of different types Limit intake of foods containing
and colours, and legumes/beans saturated fat, added salt, added sugars
• Fruit and alcohol.

a. Limit intake of foods high in saturated • Do not add salt to foods in
fat such as many biscuits, cakes, cooking or at the table.
pastries, pies, processed meats, c. Limit intake of foods and
commercial burgers, pizza, fried foods, drinks containing added sugars
potato chips, crisps and other savoury such as confectionery, sugar-
snacks. sweetened soft drinks and
• Replace high fat foods cordials, fruit drinks, vitamin
which contain predominately waters, and energy and sports
saturated fats such as butter, drinks.
cream, cooking margarine, d. If you choose to drink alcohol,
and coconut and palm oil limit intake. For women who are
with foods which contain pregnant, planning a pregnancy or
predominately polyunsaturated breastfeeding, not drinking alcohol
and monounsaturated fats such is the safest option.
as oils, spreads, nut butters/pastes Guideline 4:
and avocado. Encourage, support and promote
b. Limit intake of foods and drinks breastfeeding.
containing added salt. Guideline 5:
• Read labels to choose lower sodium Care for your food; prepare and store it
options among similar foods. safely.
Shape Up Australia
Shape Up Australia is an initiative that aims to prevent obesity and its associated
conditions such as cardiovascular disease and type 2 diabetes. It works by
endorsing information, products and services that are aligned with the national
dietary and physical activity guidelines. Service providers and producers can apply
to use the Shape Up logo in their marketing activities so consumers can easily
identify products and services that are proven to assist individuals in maintaining
a healthy body weight. Consumers can then be assured that the information or
goods they are accessing reflect the latest research on healthy behaviours.
BreastScreen Australia
BreastScreen Australia is a free
mammography service jointly
funded by the federal and
state governments. BreastScreen
Australia offers free mammograms
for women aged 50–69 (although
those aged 40–49 and 70+ can
also attend for scans). Seventy-
five per cent of breast cancer
cases are in women over 50 years
of age and 50 per cent occur in
those aged 50–69. As age is a
significant risk factor for breast
cancer, the target age group of
50–69 was selected. Since its
creation in 1991, BreastScreen has
performed millions of scans (over
1.7 million in 2009–10 alone).
Early detection greatly improves Figure 12.19 BreastScreen provides
the survival rates of those suffering from breast cancer and has improved the health free mammograms, which can assist in
of thousands of adult females in Australia. the early detection of breast cancer.

12.6 G
State and territory

government
Each state and territory government
creates legislation (sometimes
referred to as ‘laws’) to promote
the health and development of
their citizens, including adults.
In addition to legislation, each
state and territory government
implement strategies and programs
to promote health among their
population. In Victoria, examples
include the Victorian Healthy Eating
Enterprise and programs funded by
VicHealth.
Legislation
State and territory governments
Figure 12.20 Implementing and implement a range of laws that aim
enforcing speed limits are an example to promote health and development of adults, including laws relating to:
of a state government strategy • Driving. Laws relating to speed limits, speed cameras, seatbelt laws, probationary
that aims to reduce the risk of road drivers (P-plate drivers), drink driving laws and car safety standards.
trauma.
• Smoking. Laws may prevent individuals from smoking in certain public spaces. This
reduces exposure to environmental tobacco smoke and promotes physical health.
• Gambling. Gambling laws may restrict the amount that can be withdrawn from
automatic teller machines (ATMs) at gambling venues to assist individuals with
controlling their gambling.
Victorian Healthy Eating Enterprise

The Victorian Healthy Eating Enterprise (VHEE) is a state government initiative
that works to support the prevention of diet-related diseases in Victoria. The VHEE
encompasses a range of initiatives being undertaken by the Victorian Government
in partnership with local government, business, industry, health professionals and
communities guided by a shared vision to improve the health and wellbeing of
Victorians through healthy food consumption.
Examples of initiatives undertaken as a part of the VHEE:
• The Healthy Food Charter — intended as a tool for use by anyone interested
in making healthy food choices easy and promoting healthy food. In particular,
it is intended as a guide to all those working in partnership with the Victorian
Government to improve the health of Victorians through food intake.
• The Victorian Healthy Eating Advisory Service — provides healthy eating and
nutrition advice to hospitals and workplaces.
• Victorian Healthy Food Basket — a survey to monitor the cost and accessibility
of a healthy and unhealthy shopping basket of food across local government
areas in Victoria. This study is the largest of its kind conducted in Victoria and
will contribute greatly to health promotion planning and the understanding of
what impacts on Victorians’ ability to consume a healthy diet.
• Jamie’s Ministry of Food Victoria — to deliver healthy cooking courses,
demonstrations and events in prevention areas through a fixed centre and a
mobile kitchen. As part of this, a range of Victorian chefs will act as role models
to promote healthy eating.
• Health Champions — local community members who will promote good
nutrition through their networks.

VicHealth
VicHealth is Victoria’s health promotion foundation that aims to promote the
health of all Victorians. With this aim in mind, they have devised an Action
Agenda, designed to improve health across the state over the next decade.
The main areas on which the Agenda focuses are:
• promoting healthy eating
• encouraging regular physical activity
• preventing tobacco smoking
• preventing harm caused by alcohol
• improving mental wellbeing
VicHealth aims to achieve these goals through:
• funding activity related to the promotion of good health, safety or the prevention
and early detection of disease
• increasing awareness of programs for promoting good health through the
sponsorship of sports, the arts and popular culture
• encouraging healthy lifestyles and participation in healthy pursuits
• funding research and development in support of these activities.
Figure 12.21 The VicHealth logo
Local government
Local governments implement a range of strategies and programs to promote the
health and development of adults including:
• providing access to recreation facilities such as walking and cycling paths, parks,
gardens and public swimming pools
• implementing community health plans that aim to address the needs of the
local community and promote healthy lifestyles by encouraging healthy eating,
exercise and social interaction
• the provision of aged care services including home assistance relating to
household chores, personal hygiene, shopping and delivered meals services (see
below).
Delivered meals service

Local governments throughout Victoria offer a ‘delivered meals service’ (sometime
known as Meals on Wheels). This service provides home-delivered meals to
residents who, because of frailty, disability or ill health, are unable to prepare their
own meals. Meals are delivered either chilled for reheating at a later time or hot for
immediate consumption. A variety of meals are provided, including special dietary
meals such as diabetic, vegetarian and reduced fat.
Meals are delivered by volunteers who also monitor the health and wellbeing
of clients and report any concerns back to the office for follow up. The service is
available to frail older people and people with disabilities.
A fee is charged for a meal and varies according to income. Those unable to meet
the associated costs are eligible for free or subsidised meals.
The delivered meals service promotes the health and development of adults by
assisting individuals in meeting their nutritional requirements.

12.6 G
Figure 12.22 Local governments provide a delivered meals service which assists in promoting
the health and development of many adults in Australia.
TEST your knowledge 5 Discuss how each of the Dietary Guidelines

could promote the health and individual human
1 Explain two programs or strategies developed by
each level of government to promote the health
6 Research your own local government and
and individual human development of adults in
produce a fact file outlining the ways that they
Australia.
work to promote the health and individual human
APPLY your knowledge development of adults.
7 Find the VicHealth weblink in your
2 (a) What is a mammogram? eBookPLUS to find the link to this question.
(b) Explain how free mammograms could promote (a) How many people are overweight in Australia?
the health and/or individual human development (b) How can prolonged sitting impact on the health
of adults in Australia. of adults?
3 (a) Identify and explain the differences between the (c) Which population groups are most at risk of
National Physical Activity Guidelines for adults prolonged sitting?
and those for older Australians. (d) How can prolonged sitting be reduced in the
(b) Explain how maintaining physical activity workplace?
into adulthood could promote health and/or (e) Devise a poster that educates workers
individual human development. about ways to reduce the risk of prolonged
4 Select one state or territory strategy or program sitting.
and explain how it may promote the health and

12.7 S trategies and programs designed to promote health
KEY CONCEPT Understanding community and personal strategies and programs

designed to promote health and individual human development of adults.
Community strategies and programs

Many community strategies and programs designed to promote the health and
development of adults are implemented by non-government organisations.
Examples of these programs include the ‘Life! Taking Action on Diabetes’ program
and the Heart Foundation Tick.
Life! Taking Action on Diabetes

The ‘Life! Taking Action on Diabetes’ program supports individuals to take control
of their life, by providing a course addressing healthy behaviours to reduce their
risk of type 2 diabetes and cardiovascular disease. Funded by the Victorian
Government and implemented by Diabetes Australia — Victoria, the Life! program
is offered to Victorian adults aged over 45 who are at risk of developing type 2
diabetes. Individuals can be referred by their doctor or can enrol themselves by
calling the Life! helpline on 13 RISK (13 7475). The six-month course includes six Figure 12.23 The logo of the Life!
face-to-face sessions that address: program
• the importance of good nutrition and regular physical activity
• risk factors for type 2 diabetes, heart disease and stroke and their link to
lifestyle
• goal setting to assist in the adoption and maintenance of lifestyle changes
• linkages to local programs and services to adopt lifestyle changes.
For those who are unable to attend face-to-face sessions, a telephone coaching
service is available so individuals can access the course from their home.
The program is free for many eligible participants including:
• patients on a Concession or Health Care Card
• patients on low to medium incomes
• anyone referred through WorkHealth.
For others, a $50 co-payment may be required.
The Heart Foundation Tick logo

The Heart Foundation Tick is a program that aims to assist consumers in
purchasing healthier food products that may assist in maintaining a healthy
weight and reducing the risk of cardiovascular disease. Food producers can
Figure 12.24 The Heart Foundation
apply to display the Tick logo on their products. Producers of many different
Tick logo
types of food can apply to use the Tick.
Adults can identify healthier alternatives by looking for the Tick logo on food Tick TM used under licence
packaging. Tick approved products are healthier because they are lower in saturated
fat, sodium (salt) and kilojoules (energy), and higher in fibre, calcium, wholegrains
and vegetables compared to other similar products.
Personal strategies
Many of the personal strategies that can promote the health and individual human
development of adults relate to addressing the determinants that individuals have
some control over. Examples of personal strategies for adults in Australia include:
• Physical activity. Regular exercise assists in maintaining healthy body weight
which can reduce the risk of obesity and its associated conditions including
cardiovascular disease, type 2 diabetes and some cancers.

12.7 S trategies and programs designed to promote health and individual human
• Food intake. By consuming a healthy food intake, adults receive the nutrients
they need to supply energy, maintain hard and soft tissues and reduce the risk of
diet related diseases including cardiovascular disease and type 2 diabetes.
• Being socially active. Maintaining social networks and volunteering act to
promote social health and development by providing opportunities for social
interaction (figure 12.25). Self-esteem can also be enhanced by participating in
the life of the community.
Figure 12.25 Maintaining regular social interaction can promote health and development
throughout adulthood.
• Accessing health care. Regular health checks ensure that problems can be
identified early and relevant interventions put in place. Examples include treating
high blood pressure and making dietary changes if blood cholesterol is high.
• Using sun protection. Using sunscreen and covering exposed skin can reduce
the risk of skin cancer. Adults must also ensure they get some sun exposure to
receive adequate levels of vitamin D.
• Not smoking. Tobacco smoke is one of the leading causes of illness and premature
death in Australia. By not smoking and ensuring exposure to environmental
tobacco smoke is reduced, the risks are decreased.
• Drinking alcohol in moderation. If adults choose to drink alcohol, they can
choose to do so in moderation. This decreases the risk of health concerns such
as injuries and weight gain. Drinking in moderation also reduces the risk of
relationship breakdown and mental illness associated with excessive drinking.
• Not using drugs. Not using drugs can reduce the risk of mental illness and
promote physical and social health. Adults are more able to concentrate on daily
tasks and participate in health-promoting behaviours such as being socially
active, exercising and consuming a healthy food intake.
• Practicing safe sex. If adults are sexually active, practising safe sex can assist in
preventing sexually transmissible infections (STIs). Using condoms and having
regular health checks can assist in decreasing the spread of such diseases.
• Maintaining a safe housing environment. Eliminating hazards in the home
by clearing walkways, installing hand rails if required, maintaining heating
and cooling systems, regularly cleaning and maintaining adequate ventilation,
reduces the risk of injury and disease.

• Improving education. By accessing information relating to healthy lifestyles
through formal courses, the internet, friends, books and health professionals,
adults may be better informed to make necessary changes to improve their
health and development. Education is also mentally stimulating and can promote
mental health and intellectual development.
• Maintaining an adequate family and work–life balance. This assists adults to
relax and enjoy leisure time with loved ones. Stress levels may be reduced and
relationships enhanced as a result.
Figure 12.26 By accessing information, adults can improve their levels of education and
promote their health and development.
TEST your knowledge 5 Discuss the personal strategies that could be

employed to reduce the risk of any one of the
1 (a) Briefly explain the ‘Life! Taking Action on
following among adults:
Diabetes’ strategy.
(a) obesity
(b) Identify the determinant/s of health targeted by
(b) cardiovascular disease
this strategy.
(c) cancer
2 (a) Briefly explain the Heart Foundation Tick. (d) type 2 diabetes
(b) Identify the determinant/s of health targeted by (e) mental illness.
this strategy. 6 Create a multimedia presentation that aims to
educate adults about personal strategies that can be
APPLY your knowledge used to promote their health and individual human
3 Discuss how the ‘Life! Taking Action on Diabetes’ development.
strategy could promote the health of adults in 7 (a) Find five websites where adults could access
Australia. information to improve their health and
4 Discuss how the Heart Foundation Tick could development-related knowledge.
promote the health of adults in Australia. (b) Which determinants are addressed on each site?

KEY SKILLS Health issues facing adults

Australia’s adults and draw informed conclusions about
personal, community and government strategies and
programs to optimise adult health and development
The first part of this key skill is to develop an understanding of one health issue
facing Australia’s adults. In order to be able to adequately describe the issue, a
number of aspects about it should be known, including:
• the name of the issue
• what the issue actually is
• why it is considered a health issue for adults
• the biological, behavioural, physical environment and social determinants that
act as risk and/or protective factors for the selected issue.
A summary table can be useful in collating this information.
In following example, obesity as a health issue facing adults is described:
Obesity relates to carrying excess body weight in the form of fat. It is measured
using the body mass index (BMI) or waist circumference. BMI is a weight-to-
height ratio and is calculated by dividing body weight (in kilograms) by height in
metres squared. A score of 30 or over indicates obesity in adults. For waist
❶ The issue is identified and key aspects circumference, a measurement of over 89 cm for females and 102 cm for males
of it described. indicates obesity.❶
Obesity is considered a health issue in Australia as it is largely preventable yet
the rates of obesity have increased significantly over the past 25 years. Obesity is a
risk factor for many other conditions including cardiovascular disease and type 2
❷ The reasons for obesity being diabetes, and contributes significantly to the burden of disease in Australia.❷
considered a health issue are A range of risk factors exist for obesity. Examples include:
discussed.
Biological — a genetic predisposition can increase the risk of weight gain and
obesity.
Behavioural — eating energy-dense foods and not exercising can mean that more
food is stored as fat and can contribute to obesity.
Physical environment — if adults cannot access recreation facilities, they may
not be able to exercise frequently which can contribute to obesity.
Social — those with low incomes may not be able to afford nutritious foods,
which can mean they rely on processed foods that are energy dense. This can
❸ A range of factors that act to increase contribute to obesity.❸
the risk of obesity are outlined. The second part of this key skill is the ability to draw informed conclusions
about personal, community and government strategies and programs that are
implemented to optimise adult health and development.
In order to be able to draw conclusions about the program or strategy, a number
of aspects relating to it must be known, including:
• the name of the strategy or program
• whether the program is implemented at a government, community or individual
level
• the aims of the program
• the aspects of health and/or development being addressed
• the determinants of health and development that are the focus of the strategy or
program
• the advantages and/or disadvantages of the strategy or program
• the actual or perceived effectiveness of the program.
❹ The program is named and the type
of program is identified. In this case, In the following example, the Heart Foundation Tick is discussed and conclusions
it is a community program. about it are drawn.
The Heart Foundation Tick is a community strategy❹ that aims to reduce the
❺ The aim of the program is stated. prevalence of obesity and cardiovascular disease in Australia.❺

Food producers can apply to display the Tick logo on their food products if they
can show that their item is a healthier alternative than other similar products. This
may be in relation to lower levels of fat or sodium, or higher levels of fibre or
calcium.❻ ❻ An explanation of how the program
Adults can then identify foods that have been granted permission to display the works is provided.
tick to assist them in making healthier food choices.
If adults choose foods that display the Tick logo, they may be more able to
maintain their body weight. Adequate body weight can also reduce the risk of
cardiovascular disease. Mental health can also be improved by increasing self-
esteem. Human development could be impacted as adults may have more energy
to participate in physical activity, which enhances motor skills development, and
socialise with friends, which can assist in developing social skills such as
communication.❼ ❼ The program is linked to various
The Heart Foundation Tick is a beneficial program as it does not require aspects of health and human
development for adults.
consumers to have nutritional knowledge, but as not all food producers apply to
display the Tick, some healthy alternatives may be ignored as a result. This can
affect the ability of adults to consume a balanced food intake.❽ ❽ Conclusions about the program’s
effectiveness are drawn.

1 Describe a key issue facing adults in Australia. In your answer, make sure you
include:
(a) the name of the issue
(b) what the issue actually is
(c) why it is considered a health issue for adults
(d) the biological, behavioural, physical environment and social determinants that
act as risk and/or protective factors for the selected issue.
2 Explain a program or strategy implemented by a government and explain how it
may impact on adult health and/or development.
3 Identify personal strategies that may reduce the risk of one health issue facing
adults in Australia.
4 For a community strategy, discuss the likely effectiveness in promoting adults’
health and/or development.

CHAPTER 12 review
Chapter summary
• A range of health issues affect adults, including obesity, cardiovascular disease, cancer,
Interactivities:
type 2 diabetes and mental illness. The biological, behavioural, physical environment
Chapter 12 Crossword
and social determinants all play a role in these issues.
• Obesity relates to carrying excess body weight in the form of fat and is measured using
Chapter 12 Definitions the body mass index or waist circumference.
• Obesity increases the risk of cardiovascular disease, some cancers, type 2 diabetes and
mental illness.
• Obesity rates have increased significantly in Australia over the past 25 years.
• Determinants that can increase the risk of obesity include:
–– biological — advancing age, genetic predisposition and a low basal metabolic rate
–– behavioural — physical inactivity, alcohol consumption and food intake
–– physical environment — lack of access to recreation facilities and a work environment
that promotes a sedentary lifestyle
–– social — low levels of education, sedentary occupations and low income.
• Cardiovascular disease relates to conditions affecting the heart and blood vessels.
• Atherosclerosis is the underlying cause of cardiovascular disease.
• Cardiovascular disease is the leading cause of death in Australia.
• Determinants that can increase the risk of cardiovascular disease include:
–– biological — overweight/obesity, high blood pressure, high blood cholesterol, genetic
predisposition, being male and advancing age
–– behavioural — physical inactivity, food intake, tobacco smoking and alcohol
consumption
–– physical environment — lack of access to recreation facilities, lack of access to health
care and exposure to environmental tobacco smoke
–– social — low levels of education and income, workplace stress and occupation.
• Cancer is a condition characterised by the uncontrolled growth of abnormal cells.
• Cancer is the leading cause of premature death in Australia and is the leading
contributor to burden of disease.
• Determinants that can increase the risk or impact of cancer include:
–– biological — overweight/obesity, advancing age and genetic predisposition
–– behavioural — tobacco smoking, alcohol consumption, food intake and UV
exposure
–– physical environment — exposure to environmental tobacco smoke, exposure to
chemicals in the workplace and access to health care
–– social — low levels of education and income.
• Type 2 diabetes is characterised by an inability of the body to metabolise glucose.
• Type 2 diabetes is a leading cause of death and rates are increasing in Australia.
• Determinants that can increase the risk of type 2 diabetes include:
–– biological — overweight/obesity and genetic predisposition
–– behavioural — physical inactivity, alcohol consumption, food intake and tobacco
smoking
–– physical environment — lack of access to recreation facilities and a work environment
that promotes a sedentary lifestyle
–– social — low levels of education and income, and occupation.
• Mental illness is a term that encompasses a range of conditions.
• Anxiety and depression are the two most common forms of mental illness.
• Mental illness affects up to 45 per cent of Australians at some stage in their life and
contributes significantly to burden of disease.

• Determinants that can increase the risk of mental illness include:
–– biological — overweight/obesity and genetic predisposition
–– behavioural — tobacco smoking, alcohol consumption, drug use and physical
inactivity
–– physical environment — overcrowded housing, unsafe neighbourhoods and lack of
access to health care
–– social — low levels of education and income, stressful occupation and
unemployment.
• Government, community and personal strategies and programs are designed to
promote health and human development among adults.
• Government strategies include:
–– federal — National Physical Activity Guidelines, Australian Dietary Guidelines, Shape
Up Australia and BreastScreen Australia
–– state/territory — legislation, Victorian Healthy Eating Enterprise and VicHealth funded
projects
–– local — providing recreation facilities, implementing community health plans,
provision of aged care services and delivered meals services.
• Community strategies include ‘Life! Taking Action on Diabetes’ and the Heart
Foundation Tick.
• Personal strategies relate to addressing determinants that are modifiable. Examples
include not smoking, exercising regularly, accessing health care and maintaining
friendships.

1 Draw up a table that summarises the major 2 Design a program or strategy that could be
contributors to burden of disease for adults and implemented to address a health issue of your
the corresponding determinants that act as risk or choice. Make sure you include:
protective factors, as well as at least one example (a) the name of the program
of a government, community and personal strategy (b) who will implement it (government, community,
that be implemented to promote health. individuals)
(c) the aspects of adults’ health and/or
development that it is designed to address
(d) which determinants of health it addresses
(e) how it addresses the determinants of health.

1.1
Index Understanding health
A work-related stress 391–2 B

abstract thought 3, 16 workplace conflict 391 B-group vitamins 86–7
acne 60 workplace safety 378–80 baby boomers 325–6
adolescence alcohol consumption basal metabolic rate (BMR)
ending of 7 in adulthood 366–8 73, 88
meaning of term 6 alcohol abuse 46 behavioural determinants
adolescent growth spurt 3, 19 binge drinking 139, 142, 145 adult health and development
adult mortality 329–30 during pregnancy 202–3 355–75
adulthood impact on health 119–20 for anxiety and depression 156
definition 309 standard drinks 366 for cancer 422
stage of 310 in youth 119–20 for cardiovascular disease 419
adults and youth health 142–5 child health and development
access to health care 383–6 allied health services 139, 161 270–83
alcohol use 366–8 Alzheimer’s disease 331–3, 340–1 definition 111, 112
behavioural determinants of amniotic fluid 175, 181 for foetal alcohol syndrome 216
health 355–75 anabolic steroids 370 for gestational diabetes 217
biological determinants of anaemia 73, 82, 83–4 for low birth weight 214
health 340–54 anorexia 82 for mental illness 429
blood cholesterol 353–4 antenatal health care, access to for obesity 415
blood pressure 348–52 207, 247 prenatal health and
body weight 345–7 antepartum deaths 175, 183 development 199–205
burden of disease 328–9 anxiety for spina bifida 212
cancer 421 and health 154 for type 2 diabetes 425
cardiovascular disease 418 impact on human youth health and development 115
connection to community 393–5 development 155 Better Health Channel 221
drug use 369–72 nature of 153 Better Health Commission (BHC),
education level 388 risk and/or protective factors definition of health 40–1
family 399–400 155–7 beyond babyblues 221–2
food intake 363–5 anxiety disorders 427 beyondblue 158, 221–2
genetics 340–4 APGAR test 236 binge drinking 139, 142
health status 327–33 asthma, in children 248, 264–5 biological determinants
housing 376–8 atherosclerosis 111, 119, 339, 348, adult health and development
impact of media on health 387–8 349, 413, 417 340–54
living arrangements 396–7 attention deficit hyperactivity disorder for anxiety and depression 156
media influence on health 387–8 (ADHD) 231, 249 for cancer 422
mental illness 428 Australian Action on Pre-eclampsia for cardiovascular disease
neighbourhood safety 381–2 (AAPEC) 222 418–19
obesity 415 Australian Dietary Guidelines child health and development
physical activity 360–2 for adults 432–3 260–9
physical environment applying 101–3 definition 3, 22
determinants 376–86 and eating habits of children for gestational diabetes 217
sexual practices 373–5 279–80 for low birth weight 215
smoking 357–9 purpose and content 99, 432–3 for mental illness 429
social determinants of health Australian Guide to Healthy Eating for obesity 415
387–403 applying 101–3 prenatal health and
social support 397–8 food selection model 99–101 development 194–8
socioeconomic status 388–90 authoritarian parenting style 294 for spina bifida 213
sun protection 355–7 authoritative parenting style 294 for type 2 diabetes 425
type 2 diabetes 424 autoimmune disease 231, 248 youth health and development
work–life balance 400–3 autoimmune response 257, 263 58–61
Index 445
birth defects see congenital biological determinants of crime rates 381–2
abnormalities health 260–9 cystic fibrosis 195, 262
birth weight 214–16, 247, 266–7 birth weight 266–7
blastocysts 175, 179 body weight 267–9 D
blood cholesterol 353–4 chronic conditions 247 delivered meals service 435–6
blood pressure 348–52 dental health 249–50 dental caries 73, 96
blood production 89–91 determinants of health and dental health, children 249–50
body mass index (BMI) 3, 25–6, development 258–9 depression
267–8, 346–7 diabetes 248–9 during and after pregnancy 186
body systems 10 eating habits 276–80 impact on health 154
body weight health care access 299–301 impact on human development 155
adults 345–7 health status 244–51 nature of 153, 428
as biological determinant 24–7 hospitalisations 250–1 risk and/or protective factors 155–7
in childhood 267–9 housing environment 286–7 determinants of health
and hormones 59 media influences on health for children 258–9
measuring 3, 25–6, 267–8, 346 297–8 definition 3, 22, 111
in youth 60–1 mental health problems 249 key categories 112
bowel cancer 339, 344, 384–5 morbidity 247–51 see also risk/protective factors!!risk/
breast cancer 342–3 mortality 244–6 protective factors
breastfeeding 270–1 obesity 248, 269 development see individual human
BreastScreen Australia 383–4, 433 oral hygiene 282–3 development
burden of disease 39, 55–6, 328–9 physical activity 280–1 developmental milestones 5, 17,
physical environment 284–91 193, 201
C recreational facilities for 290–1 diabetes
calcium 80–2, 201 social environment 292–301 in children 248–9
cancer stage of 5–6 gestational diabetes 185–6, 217–18
as adult health issue 421 tobacco smoke in the home 284–5 type 1 59, 263–4
nature of 342 cholesterol 73, 78 type 2 59, 342, 424–6
risk and/or protective factors 421–3 chromosomal abnormalities 197 types 59
carbohydrates 74–5 chromosomes 193, 194, 257, 260 diastolic blood pressure 339, 348
cardiovascular disease civic participation 131 diet see food selection models
as a health issue 418 co-enzymes 73, 89 disability adjusted life years
risk and/or protective factors collagen 73, 86 (DALYs) 39, 55–6
417–20 colonoscopy 339, 385 discretionary foods 73, 101
carriers 193, 195, 257, 262 colostrum 231, 235 Down syndrome 39, 58, 184, 197
cartilage 73, 80 colour blindness 196 drowning 141
Casey Fields 291 community, sense of 393–4 drug use
cell differentiation 73, 85, 175, 179 community health services 385–6 in adulthood 369–72
cell membranes 73, 76 community participation 131, 393–5 during pregnancy 203–4
cellular respiration 73, 89 complementary health services illicit drugs 117, 139
cephalocaudal development 231, 232, 139, 161 impact of 117–18
233–4 complexity 3, 10 in youth 117–18
cerebrovascular disease 339, 350 concrete thought 3, 16 drugs, definition 369
child abuse 295–6 congenital abnormalities 175, 183, Duchenne muscular dystrophy
child morbidity 247–51 231, 244 (DMD) 261
child mortality 231, 245–6 congenital malformations 257, 271
children connective tissue 73, 86 E
asthma 248, 264–5 coronary heart disease 339, 348, early adulthood
behavioural determinants of 349–50 definition 309, 310
health 270–83 cortisol 59–60 emotional development 315
446 Index
intellectual development fats and prenatal health and
315–17 categories 77 development 194
physical development 310–11 monounsaturated fats 78 and youth health and
social development 311–14 as nutrients 76–8 development 58–9
early childhood polyunsaturated fats 78 germinal stage of prenatal
development 239–41 saturated fats 78 development 179
emotional development 239–40 trans fats 78 gestational diabetes 185–6, 217–18
intellectual development 240–1 Federal Government gingivitis 257, 282
physical development 239 adult health promotion strategies glandular fever, possible impacts on
social development 239 and programs 431–3 health and development 62
stage of 5 prenatal health promotion 219–20 glycaemic index (GI) 37, 95
eating habits, in childhood 276–80 feral children 12–13 gross motor skills 3, 10, 19
ectopic pregnancies 187 fertilisation
education definition 3, 4 H
access to 132 in-vitro fertilisation (IVF) 177–8, haemoglobin 73, 82
of parents 209, 292–3 309, 312 haemophilia 39, 58, 193, 195, 196
embryonic stage of prenatal process of 176–8 haemorrhages 175, 184
development 179–80 fibre 75 hard tissues 73, 74, 93
embryos 3, 10 fine motor skills 3, 10, 19 ‘Having a baby in Victoria’
emotional development fluoridation of water 287–9 website 220
aspects 14 foetal alcohol syndrome 193, 202, health
definition 3, 14, 309, 315 216–18 defining 39, 40–1
in early adulthood 315 foetal stage of prenatal dimensions of 41–4
in early childhood 239–40 development 180–1 interrelationships between
impact of anxiety and folate (folic acid) 86–7, 183, 200 dimensions 45–6
depression 155 food, energy content 89 interrelationships with individual
in infancy 237 food advertising, impact on human development 62–3
in late adulthood 323–4 children 297–8 optimal health 45
in middle adulthood 320 food intake, in adulthood 363–5 health care services
in youth 29 food selection models 99–104 access to 210–11, 299–301, 383–6
empathy 231, 239 fortified food 73, 81 rights and responsibilities of
endocrine system 193, 194, 257, 260 friendships, developing and users 161–3
endometriosis 339, 374 maintaining 121–2 health indicators 39, 48
endometrium 175, 179 health professionals, seeking help
energy G from 122–3
content of selected foods 89 general practitioners (GPs) 161 health promotion
measurement 88 Generation Y 313–14 community strategies and
nutrients required for production genes 193, 194, 257, 260 programs 158–9, 221–2, 437
of 88–9, 90 genetic conditions 58, 195–6, 262–5, government strategies and
requirements for individuals 89 340–2 programs 158–9, 219–21, 431–3
environmental tobacco smoke genetic potential 3, 22 personal strategies 160, 223, 437–9
(ETS) 124 genetic predispositions 39, 59, 263–5, health status
339, 342–4 adults 327–33
F genetics children 244–51
faecal occult blood test (FOBT) and adult health and definition 39, 48, 309
339, 385 development 340–4 measuring 48
familial hypercholesterolaemia as biological determinant of health pregnant women 184–7
339, 354 and development 22–3 unborn babies 182–4
family cohesion 111, 128–9 and child health and of youth 49
family composition 399–400 development 260–5 Healthy Living Pyramid 103–4
Index 447
Healthy Living Pyramid for Lacto-ovo individual human development J
Vegetarians 104 continual nature 232 jaundice 175, 186
Healthy Mothers, Healthy Babies definition 3
program 221 dimensions of 9 K
Heart Foundation Tick logo 437 in early childhood 239–41 kidney failure 351–2
high-density lipoproteins (HDLs) from simple to complex 234 kilojoules (kJ) 73, 88
339, 353 impact of anxiety and Klinefelter syndrome 197
homelessness 377–8 depression 155
hormonal changes in infancy 235–8 L
as biological determinants of health interrelationships between late adulthood
and development 23–4 dimensions 16–17 definition 309, 322
in puberty 23–4 interrelationships with health emotional development 323–4
and youth health 59–60 62–3 intellectual development 324
hormones in late childhood 242–3 living arrangements 396
definition 3, 193, 257 predictable orderly patterns 232 physical development 322–3
and endocrine system 194, 260 principles 232–4 social development 323
role in childhood 261–2 variations 232, 233 stage of 8, 325–6
role during pregnancy 194 infancy late childhood
role in puberty 19, 23–4 development 235–8 development 242–3
hospital care, mental health emotional development 237 intellectual development 243
problems 161 intellectual development 237–8 physical development 242
hospitalisations, children 250–1 physical development 236 social development 242
housing environment social development 236–7 stage of 5
adult health and development stage of 5 lethargy 39, 63
376–8 infant morbidity 247–51 life expectancy 39, 49
child health and development infant mortality 231, 244–6 Life! Taking Action on Diabetes
286–7 infertility 339, 373, 374–5 program 437
youth health and development infirmity 39, 40 Listeria monocytogenes 193, 201
124–5 influenza 62 literacy skills 316
housing stress 339, 376–7 inherited conditions 193, 195, 262 living arrangements 396–7
human growth hormone (HGH) injury 141–2 local government
371–2 insulin 59 adult health promotion 435–6
human lifespan intellectual development maternal and child health
childhood 5–6 aspects 16 centres 221
early adulthood 7 definition 3, 16, 309, 315 low birth weight 214–16,
infancy 5 in early adulthood 315–17 216, 247
late adulthood 8 in early childhood 240–1 low-density lipoproteins (LDLs)
middle adulthood 8 impact of anxiety and 339, 353
prenatal stage 4 depression 155 lung cancer 423
stages of 4–8 in infancy 237–8
youth 6 in late adulthood 324 M
Huntington’s disease 341–2 in late childhood 243 macronutrients 73, 74, 77
hypertension 339, 348 in middle adulthood 320–1 macular degeneration 339, 367
in youth 29–30 Malaya, Oxana 12–13
I intracytoplasmic sperm injection male impotency 339, 367
identity 15 175, 178 mammography screening 339, 383–4,
illicit drugs 139, 145–6 in-vitro fertilisation (IVF) 177–8, 413, 433
Immunise Australia program 220 309, 312 mandatory fortification of
implantation 175, 179 iodine 200 food 175, 184, 220
incidence (morbidity data) 39, 53–4 iron 82–4, 200–1 marriage 312
448 Index
maternal and child health centres micronutrients 73, 74 protein 75–6
221, 300 middle adulthood provision of energy 88–9
Maternal and Child Health Line definition 309, 318 required during youth 74
220–1 emotional development 320 vitamin A 85
maternal health, in rural and remote intellectual development vitamin C 86
communities 208 320–1 vitamin D 85–6
maternal morbidity 185–7 physical development water 80
maternal mortality 184–5 318–19 nutritional imbalance
maternal nutrition 193, 194, social development long-term consequences
199–201 319–20 96–8
Meals on Wheels 435–6 stage of 8 short-term consequences
meconium 231, 235 monounsaturated fats 78 95–6
media influences morbidity 39, 53–5
on adult health and mortality 39, 50–1 O
development 387–8 morula 175, 179 obesity
on child health and motor skills 9–10, 19 in adults 415
development 297–8 multicausal factors 257, 258 in children 248, 269
on youth health and muscular dystrophy 39, 58 as health issue 414–15
development 129–31 myocardial infaction 339, 349 risk and/or protective factors
Medicare 160–1, 219 414–16
melanoma 115, 344 N in youth 96–7, 140
menopause 340 National Bowel Cancer Screening object permanence 231, 238
mental health Program 384–5 occupational overuse syndrome
children 249 National Perinatal Depression (OOS) 339, 379
definition 39, 43 Initiative 220 optimal health 45
during and after pregnancy 186 National Physical Activity oral hygiene
impact of anxiety and Guidelines 280, 431–2 in childhood 282–3
depression 154 neighbourhood safety 381–2 promotion 283
indicators 44 neonatal intensive care units osteoporosis 73, 81, 82
issues 150 299–300 ova 176
mental health care services neonates ovarian cancer 343
available to youth 160–1 adaptations 235–6 overweight 96–7, 140
rights and responsibilities of definition 231, 235
users 161–3 neural tube defects 183–4, P
mental health policies 159 193, 200 parental education 209, 292–3
mental health promotion non-melanoma skin cancers 115 parental employment status 292–3
government and community nutrient dense foods 3, 24 parental income 209
strategies/programs 158–9 nutrients parenting practices 294–6
personal strategies 160 B-group vitamins 86–7 parents, socioeconomic status 129
mental health specialists 161 blood production 89–91 passive smoking 206–7
mental illness calcium 80–2 peak bone mass 73, 81, 82
definition 44 carbohydrates 74–5 perinatal conditions 231, 244
incidence, prevalence and during childhood 278 perinatal mortality 182
trends 150–3 fats 76–8 periodontitis 257, 282
risk and/or protective factors fibre 75 permissive parenting style 294
427–30 formation of hard tissue 93 personality 59
stigma attached 158 formation of soft tissue 91–2 physical activity
metabolism 3, 23, 249 functions and interrelationships in adulthood 360–2
metastasise (cancer) 111, 115, 88–93 in childhood 280–1
413, 421 iron 82–4 in youth 116–17
Index 449
physical development placenta 175, 179, 181 R
decline of body systems 10 Polycystic Ovarian Syndrome recreational facilities, access to 126–7,
definition 3, 9 (PCOS) 60 290–1
in early adulthood 310–11 polyps 339, 384 regeneration 175, 176
in early childhood 239 polyunsaturated fats 78 reproductive function/dysfunction 375
growth and development of body pre-eclampsia 186–7, 222 resilience 43, 111, 122
systems 10 pregnancy risk and/or protective factors
impact of anxiety and alcohol consumption 202–3 for anxiety and depression 155–7
depression 155 impact of drug use 203–4 for cancer 421–3
in infancy 236 smoking during 201–2 for cardiovascular disease 417–20
in late adulthood 322–3 unintended pregnancy 374 for foetal alcohol syndrome 216–18
in late childhood 242 Pregnancy, Birth and Baby for gestational diabetes 217–18
in middle adulthood 318–19 Service 220 for low birth weight 214–16
motor skills 9–10 pregnant women, health for mental illness 427–30
in youth 19–21 status 184–7 for obesity 414–16
physical environment prenatal development for spina bifida 212–13
access to recreational facilities embryonic stage 179–80 for type 2 diabetes 424–6
126–7 foetal stage 180–1 risk factors, definition 257, 258
and adult health and germinal stage 179 rites of passage 3, 28
development 376–86 stages 179
and anxiety and depression 156 prenatal health care, access to 207, S
and cancer 422 210–11 safety
and cardiovascular disease 419 prenatal health promotion in the home 287
and child health and community programs and of neighbourhood 381–2
development 284–91 strategies 221–2 in workplace 378–80
and foetal alcohol syndrome 218 government programs and SANE Australia 158
and gestational diabetes 217 strategies 219–21 saturated fats 78
housing environment 124–5 personal programs and secondary sex characteristics 3, 20–1
impact on health and strategies 223 sedentariness 111, 116
development 111, 112, 124 prenatal morbidity 183–4 self-esteem 44
and low birth weight 215–16 prenatal stage sex-linked chromosomes 193, 194,
and mental illness 429 biological determinants on health 195–6, 257, 260–1
and obesity 416 and development 194–8 sexual practices
prenatal health and of lifespan 4 in adulthood 373–5
development 206–8 prevalence (morbidity data) 39, 53–4 reproductive function/
and spina bifida 213 Primary School Nursing Program 301 dysfunction 375
tobacco smoke in home 124, primary sex characteristics unprotected sex 373
206–7, 284–5 3, 20, 21 in youth 120–1
and type 2 diabetes 425 protective factors sexually transmissible infections
work environment 125–6 definition 257, 258 (STIs) 111, 121, 139, 146–8,
and youth health and see also risk and/or protective factors 373–4
development 124–7 protein 75–6 Shape Up Australia 433
physical health proximodistal development 231, 232, skin cancer 111, 115, 343–4
definition 39, 41 234 smoking see tobacco smoking
impact of anxiety and psychoactive effects 339, 369 social capital 339, 393
depression 154 psychotic state 139, 150 social connections 393–4
indicators 41–3 puberty 3, 5, 7 social development
physiological changes aspects 11
definition 309 Q definition 3, 11, 309, 311
in early adulthood 310 Quit Victoria 358–9 in early adulthood 311–14
450 Index
in early childhood 239 stigma 139, 158 vitamin A 85
impact of anxiety and stress, and cortisol 59–60 vitamin B1 86
depression 155 stroke 339, 350–1 vitamin B2 86
in infancy 236 substance use 117, 145–6 vitamin B3 86
in late adulthood 323 sudden infant death syndrome vitamin B9 86–7
in late childhood 242 (SIDS) 193, 245, 257 vitamin B12 87
in middle adulthood 319–20 sun protection vitamin C 86
in youth 28 in adulthood 355–7 vitamin D 85–6
social environment determinants in youth 115–16 volunteering 131, 394–5
for adult health and systolic blood pressure 339, 348
development 387–403 W
for anxiety and depression 156–7 T water
for cancer 422 teratogens 175, 180 fluoridation 287–9
for cardiovascular disease 419–20 testosterone 60, 340 importance for survival 80
definition 111 thrombosis 339, 354 weight issues 140
for foetal alcohol syndrome 218 tobacco smoking work environment 125–6
impact on health and in adults 357–9 work–life balance 400–3
development 113, 128 during pregnancy 201–2 work-related stress 391–2
for mental illness 430 environmental tobacco smoke workplace conflict 391
for obesity 416 (ETS) 124 workplace safety 378–80
prenatal health and health impact 118–19, 142 Worksafe Victoria 380
development 209–11 and lung cancer 423 World Health Organization (WHO),
for spina bifida 213 passive smoking 124, 206–7, 284–5 definition of health 40
for type 2 diabetes 425 quitting 358–9
and youth health and in youth 118–19 X
development 128–32 trans fats 78 XYY syndrome 197
social health transient ischaemic attacks 339, 350
definition 39, 43 transport accidents 141 y
impact of anxiety and trends 51 years lost due to disability (YLDs) 39,
depression 154 triple X syndrome 197 53, 54–5
indicators 43 trisomies 13 and 18 197 years of life lost (YLL) 39, 51
social support 339, 397–8 tumours 413, 421 You2 initiative 222
socioeconomic status (SES) Turner syndrome 39, 58, 197 youth 6
and adult health 388–90 body weight 60–1
definition 111 U definition 3
parental income 209 ultrasound 175, 181 emotional development 29
of parents 129 unborn babies, health status 182–4 genetics 58–9
as social determinant 114 underweight 26–7, 140 hormonal changes 59–60
soft tissues 73, 74, 91–2 uninvolved parenting style 295 impact of biological determinants on
sperm 176 health 58–61
sphygmomanometers 339, 348 V intellectual development
spina bifida vaccination 193, 194, 204–5, 257, 29–30
nature of condition 212–13 272–5 physical development 19–21
risk and/or protective factors vegans 73, 87 self-assessed health status 49
213–15 VicHealth 435 social development 28
spouses 309, 311 Victorian Government, prenatal health Youthbeyondblue 158
standard drinks 339, 366 promotion 220–1
state and territory governments, health Victorian Healthy Eating Enterprise Z
promotion 434 (VHEE) 434 zygotes 175, 176
Index 451

Health and Human Development 1&amp;2

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KEY CONCEPTS in VCE

HEALTH & HUMAN

First edition published 2010

Second edition published 2012

Typeset in 10.5/12 pt Berkeley LT

The moral rights of the authors have been asserted.

National Library of Australia

Author: Beaumont, Andrew.

Reproduction and communication for educational purposes

Reproduction and communication for other purposes

Cover and internal design image: © mikeledray/Shutterstock

Illustrated by various artists and Wiley Composition Services

Typeset in India by diacriTech

Unit 1 The health and development of Australia’s youth 1

CHAPTER 2 The health of Australia’s youth 38

CHAPTER 3 Nutrition during youth 72

CHAPTER 4 T he determinants of health and individual human

Unit 2 Individual human development and health issues 173

CHAPTER 7 The determinants of health and individual human

CHAPTER 8 The health and individual human development

CHAPTER 9 The determinants of health and individual human

CHAPTER 10 The health and individual human development

CHAPTER 11 The determinants of health and individual human

Next generation teaching and learning

This book features eBookPLUS:

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AREA OF STUDY OUTCOME

The individual human development

Figure 1.1 Development becomes

2 UNIT 1 • The health and development of Australia’s youth

The individual human development of Australia’s youth • CHAPTER 1 3

KEY CONCEPT Understanding the stages of the human lifespan

Figure 1.2 Stages of the human Youth

4 UNIT 1 • The health and development of Australia’s youth

Figure 1.3 The prenatal stage begins

The individual human development of Australia’s youth • CHAPTER 1 5

Figure 1.5 Friends play an influential

6 UNIT 1 • The health and development of Australia’s youth

Case study review

The individual human development of Australia’s youth • CHAPTER 1 7

TEST your knowledge APPLY your knowledge

8 UNIT 1 • The health and development of Australia’s youth

KEY CONCEPT Understanding the characteristics of the physical dimension of

Individual human development encompasses the changes that people experience

associated with physical development are summarised in figure 1.9.

Figure 1.8 The four dimensions

Fine motor skills Gross motor skills

The individual human development of Australia’s youth • CHAPTER 1 9

Motor skills can be classified as either fine or gross:

Growth and development of body systems

Decline of body systems

TEST your knowledge APPLY your knowledge

10 UNIT 1 • The health and development of Australia’s youth

KEY CONCEPT Understanding the characteristics of the social dimension of

While the physical aspect of development is often

Social development Relationship

The individual human development of Australia’s youth • CHAPTER 1 11

12 UNIT 1 • The health and development of Australia’s youth

Case study review

TEST your knowledge APPLY your knowledge

The individual human development of Australia’s youth • CHAPTER 1 13

KEY CONCEPT Understanding the characteristics of the emotional and

• appropriate expression of feelings — how individuals show their emotions in

14 UNIT 1 • The health and development of Australia’s youth

Health and Human Development 1&2

Health and Human Development 1&2

CHAPTER 2 The health of Australia’s youth 38

CHAPTER 3 Nutrition during youth 72

CHAPTER 4 T he determinants of health and individual human

Unit 2 Individual human development and health issues 173

CHAPTER 7 The determinants of health and individual human

CHAPTER 8 The health and individual human development

CHAPTER 9 The determinants of health and individual human

CHAPTER 10 The health and individual human development

CHAPTER 11 The determinants of health and individual human