Before 1990 Infectious diseases were a major source of illness and impacted life expectancy. Now life expectancy has increased by 50% since 1990 and will put demand on Sydney’s health system. Currently we are ranked 32 on the World Health Organization ranking system and only have 2.7 public hospital beds per 1000 people.

1. HEALTH

2. WHAT YOU NEED TO KNOW ABOUT HEALTH IN SYDNEY 1. Types of Health Care Providers in NSW 2. History of Health in NSW 3. Availability of hospitals in NSW 4. The Good and Bad of our Health Care System 5. Australia’s Poor Rank in Health Care World Wide 6. Scenario: Typical Day in a NSW Hospital 7. Distribution of Funds 8. Future Plans and Challenges for Sydney’s Health

3. HEALTH CARE PROVIDERS IN NEW SOUTH WALES + AREA HEALTH SERVICES Metropolitan and Rural + PUBLIC HEALTH UNITS Survey public health within each area health service + PUBLIC HEALTH ORGANISATIONS Such as Ambulance Service & Cancer Institute +OTHER SERVICES AIDS Dementia & HIV Psychiatry Service, AusHealth and Education Centre Against Violence

4. HEALTH CARE PROVIDERS IN NEW SOUTH WALES + Spends 8.8% GDP per year on Average + The Australian healthcare system is mixed. Responsibilities for healthcare are divided between the federal and state governments, and both the public and the private sectors play a role. + Government programs underpin the key aspects of healthcare, Medicare which is funded out of general tax revenue, pays for hospital and medical services. Medicare covers all Australians, pays the entire cost of treatment in a public hospital, and reimburses for visits to doctors. + PBS Scheme, the government subsidizes prescriptions + Government pays about 70% of healthcare costs (approximately 47% from the federal and 23% from state governments); the remainder is paid by non-government sources, e.g., insurance and private pay. + Problems – Waiting periods for elective surgeries at public hospitals, access for rural, health status of indigenous.

5. HISTORY OF HEALTH CARE + Pre 1990 Infectious diseaseswere a major source of illness. They dramatically impacted life expectancy. Hospitals such as quarantine wards were isolated – Manly, Waterfall and Randwick TB cases decreased by 80-90% due to improvements in living conditions. + Hospitals started as a charitable organization that received small government grants + Public donations decreased and government tax donations increased hospitals were thought more as a public utility, this began the divide between public and private health. Public hospitals Act 1929 (NSW) regulated and funded health care!

6. HEALTH STATISTICSHOSPITALS IN NSW 230 Public Hospitals 174 private hospitals

7. HEALTH STATISTICSHOSPITALS IN NSW + Public Hospitals NSW 229 VIC 144 QLD 178 WA 93 SA 80 TAS 27 ACT 3 NT 5 + Population NSW 6.8 MIL VIC 5.2 MIL QLD 4.18 MIL WA 2.11 MIL SA 1.58 MIL TAS 493, 400 ACT 339, 800 NT 215, 000

8. HEALTH STATISTICSHOSPITALS IN NSW There are 2.7 public hospital beds per 1000 people In the most recent budget NSW proposes to spend around $1814 per person on health

9. THE CONDITION OF SYDNEY’S HEALTH SYSTEMWEIGHING UP THE GOOD AND BAD THE POSITIVES + Relatively inexpensive on a personal level with access for all + There aremany hospitalsand specialist hospitals available + Choices: public and private + Medicare + Green space is readily available THE NEGATIVES + Prioritization of private over public patients = long waiting periods + Huge amount of preventable healthproblems in Sydney. I.e.. Obesity. Costs the health system billions of dollars! + Health decreases in places with lower socio-economic status. E.g. Indigenous Australians + Difficult for new immigrant to access public health + Only 2% of NSW budget is spent on health research!! + Homeless and disadvantaged have limited access to the health system

10. WORLD HEALTH ORGANIZATION (WHO)Ranking of health systemsHealth expenditure as a share of GDP, OECD countries 2006 1. France 2. Italy 3. San Marino 4. Andorra 5. Malta 6. Singapore 7. Spain 8. Oman 9. Austria 10. Japan 11. Norway 12. Portugal 13. Monaco 14. Greece 15. Iceland 16. Luxembourg 17. Netherlands 18. United Kingdom 19. Ireland 20. Switzerland 11.3% 21. Belgium 22. Colombia 23. Sweden 24. Cyprus 25. Germany 10.6% 26. Saudi Arabia 27. United Arab Emirates 28. Israel 29. Morocco 30. Canada 10.0% 31. Finland 32. AUSTRALIA 8.8% 33. Chile 34. Denmark 35. Dominica 36. Costa Rica 37. United States of America 38. Slovenia 39. Cuba

11. + On this random day public hospital outpatient departments provided over 104,000 occasions of service. A DAY IN THE LIFE OF ONE NSW PUBLIC HOSPITAL15 756 Admissions 15 906 Discharges

12. A DAY IN THE LIFE OF ONE NSW PUBLIC HOSPITALTREATMENTS PROVIDED FOR PATIENTS

13. GOVERNMENT FUNDINGWHERE DOES THE MONEY FOR HEALTH CARE GO?

14. SYDNEY’S HEALTH SYSTEMLOOKING TO THE FUTURE + 2010 and 2025 Plan for NSW Health + The Government outlines 7 steps for future development of NSW Health. They that assume society will remain as it is today. + The 2025 Plan looks towards addressing emerging pressures such as the ageing population and cultural diversity. + It neglects the possible effects of climate change, the need for more public transport and the depletion of energy resources.

15. SYDNEY’S HEALTH SYSTEMPOPULATION AGEING + Caused by patterns of fertility and migration, changes in life expectancy + Proportion of the population over the age of 65 is likely to increase by 50% in the next 15-20 years + Population ageing is likely to increase the proportion of the population with disease and disability and will result in substantial increases in the demand for health services.

16. SYDNEY’S HEALTH SYSTEMPOPULATION AGEING + Changes in life expectancy Australians are now the second-longest-living people on earth with falling death rates for cancer, heart disease, stroke and injury, but the indigenous population continues to die earlier. Australians' life expectancy is bettered only by the Japanese at 82.2 years.

17. KEY FUTURE CHALLENGES FOR AUSTRALIAOBESITY AND OVERWEIGHT + Proportion of the population that is over weight has increased rapidly + People in the most disadvantaged socio-economic group experience double the rates of obesity!! + …. Obesity cost the government $5.8 billion in 2006!! That’s double what they pay for in Medicare!

18. KEY FUTURE CHALLENGES FOR AUSTRALIAOBESITY AND OVERWEIGHT

19. KEY FUTURE CHALLENGES FOR AUSTRALIATHE USUAL SUSPECTS: National Health Priority Areas + Asthma, cardiovascular disease, cancer, diabetes mellitus, injuries, mental health problems, arthritis and musculoskeletal problems + In a study to determine the prevalence of mental disorders among homeless people in inner Sydney the results revealed:

20. KEY FUTURE CHALLENGES FOR AUSTRALIATHE USUAL SUSPECTS: Burden of disease + Tobacco smoking, physical inactivity, high blood pressure, alcohol, poor nutrition and high blood cholesterol + Increasing urbanisation especially when there has been little attention paid to the preservation of pedestrian amenities, public safety, access to cheap fresh food, social cohesiveness and the potential for pollution – is associated with higher rates of obesity, asthma and depression. (Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)

21. KEY FUTURE CHALLENGES FOR AUSTRALIAHEALTH INEQUALITIES + Certain groups within Australia experience markedly worse health than the general population + Health gains have not been shared equally across the population Women do better than men Well-educated city dwellers do better than people living in the bush or less affluent suburbs Indigenous Australians live, on average, almost 20 years less than other Australians. (Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’) + Access to health services is becoming less equitable. Patients’ out-of-pocket costs have grown 50% in the past decade.

22. KEY FUTURE CHALLENGES FOR AUSTRALIAHEALTH INEQUALITIES + Death rates among indigenous males and females were at least twice as high, across all age groups, as those for non-indigenous males and females.

23. KEY FUTURE CHALLENGES FOR AUSTRALIA Global Health Challenges + Climate change will have a range of effects on health with increasing extreme weather events and global warming Increased congestion caused by high density damages health. Vehicle exhaust contains microparticles that kill 3 million people each year; the World Health Organization says. High density is also bad for mental health. A study of more than 4 million Swedes showed the rate for psychosis was 70% greater for dense areas, and there was a 16% greater risk of depression. The Australian Unity Wellbeing Index shows the happiest electorates are those with lower population densities. (Recsei, T. Jan 14 09. SMH ‘Rise of High-density living a new low for Sydney’)

24. KEY FUTURE CHALLENGES FOR AUSTRALIACLIMATE CHANGE Heat waves and Bushfires Tsunamis Floods Storm Surges More strain on emergency services during extreme weather events, aging population…

25. KEY FUTURE CHALLENGES FOR AUSTRALIATHE UNKOWN + Future health challenges are likely to be less predictable + Australia will need to build and maintain the capacity to respond appropriately to these challenges Since the beginning of the last century, there has been a dramatic decrease in the mortality rates of babies and children. But after decades of progress children’s health is under fresh threat from an array of modern conditions that impair their life expectancy and quality of life. In what is described as “modernity’s paradox” many Australian children are now not as healthy as were children of earlier generations. (Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)

26. KEY FUTURE CHALLENGES FOR AUSTRALIATHE UNKOWN + Future health challenges are likely to be less predictable + Australia will need to build and maintain the capacity to respond appropriately to these challenges Since the beginning of the last century, there has been a dramatic decrease in the mortality rates of babies and children. But after decades of progress children’s health is under fresh threat from an array of modern conditions that impair their life expectancy and quality of life. In what is described as “modernity’s paradox” many Australian children are now not as healthy as were children of earlier generations. (Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)