Core1healthprioritiesinaust 140924005837-phpapp02

CORE 1 – Health Priorities in Aust.
Overview
• How are priority issues for Australia’s health
identified? (epidemiology, health issues)
• What are the priority issues for improving
Australia’s health? (ATSI, SES, CVD, Cancer, Ageing)
• What role do health care facilities and services
play in achieving better health for all Australians?
(medicare, alternative health care, insurance, public vs private)
• What actions are needed to address Australia’s
health priorities? (Ottawa Charter)

How are priority issues for
Australia’s health
identified?

Students learn about:
• measuring health status
-role of epidemiology
-measures of epidemiology (mortality, infant
mortality, morbidity, life expectancy)
• identifying priority health issues
-social justice principles
-priority population groups
-prevalence of condition
-potential for prevention and early
intervention
-costs to the individual and community
Students learn to:
• critique the use of epidemiology to role of
epidemiology describe health status by
considering questions such as:
-what can epidemiology tell us?
-who uses these measures?
-do they measure everything about health
status?
• use tables and graphs from health reports to
analyse current trends in life expectancy and
major causes of morbidity and mortality for the
general population and comparing males and
females
• argue the case for why decisions
are made about health priorities by
considering questions such as:
-how do we identify priority issues for
Australia’s health?
-what role do the principles of social justice
play?
- why is it important to prioritise?
SYLLABUS

How are priority issues for Australia’s
health identified?
Measuring health status:
•“Health is a state of complete physical, mental and social well-being and not
merely the absence of disease” (WHO, 1946)
•To develop a health proﬁle of a community or population, speciﬁc information is
gathered from various sources.
•A large proportion of this information is collated annually by government
organisations, such as the:
• Australian Bureau of Statistics (ABS)
http://www.abs.gov.au/ausstats/abs@.nsf/Products/E064ECE543403651CA2576F600122A30?opendocument
• Australian Institute of Health and Welfare
http://www.aihw.gov.au/publications/aus/ah10inbrief/ah10inbrief.pdf
• nongovernment agencies (such as the Cancer Council and the Heart
Foundation). http://www.cancer.org.au/home.htm, http://www.heartfoundation.org.au/Pages/default.aspx

How are priority issues for Australia’s
health identified?
Role of epidemiology :
•Information on the health of a nation is gathered in many areas, including life
expectancy, infant mortality rates, morbidity rates and use of health care services
(for example, hospital admissions and Medicare claims)
•The study of this information is known as epidemiology. Epidemiology provides
information on the distribution (or patterns) of disease, illness and injury and on
the likely causes (or determinants) within groups or populations.
•Epidemiology considers the patterns of disease in terms of:
• Prevalence: is the number of current cases of a speciﬁc illness or disease (for example,
20 000 people in Australia infected with HIV)
• Incidence: is the number of new cases of a disease or illness in a set time period (for
example, approximately 800 new diagnoses of HIV per year).
• Distribution
• Determinants
• It describes and compares the patterns of health groups, communities and
populations.

What can epidemiology tell us?

Who uses epidemiology?
• An example of how epidemiology has been applied is in the area of heart
disease. Epidemiology indicates that deaths from heart disease are decreasing,
especially in males aged over 45 years. This is an indication that previously
implemented management strategies have been effective.
• Although epidemiology can provide statistical information on the incidence,
trends and population groups most at risk of illness and disease, it fails to
explain the socio-cultural factors that contribute to negative health behaviours.
• More recently, epidemiology has been challenged regarding this shortcoming,
and has also been challenged as focusing primarily on physical health issues.
• Health promotion campaigns that are designed in response to the statistics
obtained through epidemiology alone, but which ignore social influences, can
be ineffective.
• For example, epidemiology identifies 17–25-year-old males as being at high risk
of injury from motor vehicle accidents, and it also identifies the risk factors that
contribute to these accidents; for example, speed and alcohol. But
epidemiology does not say why young males are more likely to engage in this
risk behaviour and what the influencing factors are.
• http://www.youtube.com/watch?v=c2nvAFOk7x0

• Activity:
• Epidemiological ﬁndings are often presented in the form of
statistical data. Discuss whether statistics always present the
full story.

Measures of epidemiology :

Current trends in Aust. Health

• Life expectancy and death
• Australia’s life expectancy at birth continues to rise and is
among the highest in the world—almost 84 years for females and
79 years for males.
• Death rates are falling for many of our major health problems
such as cancer, cardiovascular disease, chronic obstructive
pulmonary disease, asthma and injuries.
• Coronary heart disease causes the largest number of ‘lost years’
through death among males aged under 75 years, and breast
cancer causes the most among females.

• Diseases
• Cancer is Australia’s leading broad cause of disease burden (19% of
the total), followed by cardiovascular disease (16%) and mental
disorders (13%).
• The rate of heart attacks continues to fall, and survival from them
continues to improve.
• Around 1 in 5 Australians aged 16–85 years has a mental disorder
at some time in a 12-month period, including 1 in 4 of those aged 16–
24 years.
• The burden of Type 2 diabetes is increasing and it is expected to
become the leading cause of disease burden by 2023.
• The incidence of treated end-stage kidney disease is increasing,
with diabetes as the main cause.

• Health risks
• Risk factors contribute to over 30% of Australia’s total burden of death, disease and
disability.
• Tobacco smoking is the single most preventable cause of ill health and death in
Australia.
• However, Australia’s level of smoking continues to fall and is among the lowest for
OECD countries, with a daily smoking rate of about 1 in 6 adults in 2007.
• Three in 5 adults (61%) were either overweight or obese in 2007–08.
• One in 4 children (25%) aged 5–17 years were overweight or obese in 2007–08.
• Of Australians aged 15–74 years in 2006–2007, less than half (41%) had an adequate
or better level of health literacy.
• Rates of sexually transmissible infections continue to increase, particularly among
young people.
• Use of illicit drugs has generally declined in Australia, including the use of
methamphetamines (the drug group that includes ‘ice’).

Current trends in Aust. HealthCause of
sickness/Death
Overall
trend
Males Females
Incidence Mortality Incidence Mortality
CVD (all types) Incidence:
Mortality:
Cancer in
general
Incidence:
Mortality:
Lung cancer
Incidence:
Mortality:
Breast cancer
Incidence:
Mortality:
Melanoma
Incidence:
Mortality:
Diabetes Incidence:
Mortality:

Current trends in Aust. HealthCause of
sickness/Death Overall
trend
Males Females
Incidence Mortality Incidence Mortality
CVD (all types)
Incidence:
decreasing
Mortality:
Decreasing
decreasing decreasing decreasing decreasing
Cancer in
general
Incidence:
increasing
Mortality:
Decreasing
increasing decreasing increasing decreasing
Lung cancer Incidence:
decreasing
Mortality:
Decreasing
decreasing decreasing increasing increasing
Breast cancer Incidence:
increasing
Mortality:
Decreasing
increasing decreasing
Melanoma Incidence:
increasing
Mortality:
Increasing
increasing increasing increasing increasing
Diabetes
Incidence:
Increasing
Mortality:
Slight increase
increasing Slight increase increasing Slight increase

Current trends in Aust. HealthLife stages
• Mothers and babies
• The proportion of females having caesarean sections has continued to increase over the
latest decade, from 21% in 1998 to 31% in 2007.
• The perinatal death rate of babies born to Indigenous mothers in 2007 was twice that of
other babies.
• Children and young Australians
• Death rates among children and young people halved in the two decades to 2007, largely
due to fewer deaths from transport accidents.
• More children are being vaccinated against major preventable childhood diseases, with
91% (the target level) being fully vaccinated at 2 years of age.
• Land transport accidents and intentional self-harm accounted for 2 in every 5 deaths (42%)
among young Australians (aged 15–24 years) in 2007.
• People aged 25–64 years
• The main causes of death in this age group in 2007 were coronary heart disease for males
(14% of their deaths) and breast cancer for females (12%).
• Older Australians
• For older people, the main causes of death are heart disease, stroke and cancer.
• At age 65, Australian males can now expect to live a further 19 years to almost 84 years of
age, and females a further 22 years to almost 87.

Groups of special interest
• People with disability are more likely than others to have poor physical
and mental health, and higher rates of risk factors such as smoking and
overweight.
• Compared with those who have social and economic advantages,
disadvantaged Australians are more likely to have shorter lives.
• Indigenous people are generally less healthy than other Australians, die
at much younger ages, and have more disability and a lower quality of life.
• People living in rural and remote areas tend to have higher levels of
disease risk factors and illness than those in major cities.
• Compared with the general community, prisoners have significantly
worse health, with generally higher levels of diseases, mental illness and
illicit drug use than Australians overall.
• Most migrants enjoy health that is equal to or better than that of the
Australian-born population—often with lower rates of death, mental illness
and disease risk factors.
.

Identifying priority health issues:• Although Australia’s health status has improved over the years, many people still
experience health conditions that are, to some degree, preventable.
• This is particularly so for groups such as Aboriginal and Torres Strait Islander peoples
and the socio-economically disadvantaged.
• With a view to making significant progress in improving the health status of all
Australians, the vision for national health information in the years ahead is to improve
the health of populations.
• The priority areas are:
• cardiovascular health
• cancer control
• injury prevention and control
• mental health
• diabetes mellitus
• asthma
• arthritis and musculosketetal conditions
This selection of priority areas was based on five specific criteria:
• principles of social justice
• priority population groups
• prevalence of condition
• potential for prevention and early intervention
• costs to individuals and the community.

Social justice principles
• Social justice aims to decrease or remove inequity from a population. This would
mean that there is a health equality.
• Social justice is a life of choices and opportunity, free from discrimination
• Everyone has the right to equal health opportunities. Social justice recognises the
importance to support the marginalised, disadvantaged or under-represented
groups of people in society
• Equity involves making sure resources and funding are distributed fairly and
without discrimination. Health equity means that all people have access to the
health services and support they need at the time that they need it.
• Inequity refers to differences in health status due to living conditions. E.G poor
access to healthy food, living in violent community, stressful work, less recreational
facilities, lack of access to health care etc
• Examples:
• People living in isolated communities should have the same access to clean water
and sanitation as a person living in an urban area.
• People of a low socioeconomic background should receive the same quality health
services that a person in a higher socioeconomic income receives.
• Information designed to educate the community must be provided in languages
that the community can understand.

Social Justice Principles Review
• Define ‘social justice’. What role is played by the principles of social
justice?
• Explain why social justice is a fundamental component of health
programs.
• One of the principles of social justice is that ‘all Australians should
have access to a comprehensive range of health care services
regardless of financial status’:
a) Identify the government policies that have been implemented
to meet this principle.
b) Describe how effective these strategies have been.
• Identify the main differences between equality and equity

Priority Population Groups
• Priority health issues are identified when certain population groups are
MORE greatly affected by certain causes of illness and death then the rest
of the population.
• These priority population groups are those that are shown by research to
experience an unnecessarily high incidence of the condition.
• The priority groups identiﬁed are:
– socio-economically disadvantaged
– Aboriginal and Torres Strait Islanders
– People living in rural and remote areas
– Elderly
– People with disabilities
– People who were born overseas.
• ACTIVITY:
• Describe the criteria for identifying priority population groups.
• Discuss the purpose of singling out priority population groups. Are there any
groups that have been overlooked?

Prevalence of Condition
• Another criterion for the selection of a priority issue was the current number of
cases of the illness or condition
• The seven priority issues account for the large majority of deaths recorded every
year in Australia, and also for a signiﬁcant number of the recorded hospital
episodes, hence, are priority issues.
• Activity: Discuss the reasons for the importance of prioritising. Does this mean other
health issues might be neglected? What if the prevalence of another health condition
increases

Potential for Prevention and Early Intervention
• Priority health issues are identified when a disease is preventable or has the
potential for intervention
• Most of Australia’s major causes of illness and death are due to modifiable lifestyle
behaviours. These are known as Lifestyle diseases.
• For health problems that are not lifestyle-related the potential for change is
extremely limited and progress is more reliant on research and medical advances
• Education and awareness of risk factors can lead to behaviour change and a
reduction in incidence. Such risk factors include smoking, sun exposure and drink
driving.
• Environmental modiﬁcations can also contribute to a reduction in incidence; for
example, shaded areas to reduce skin cancer, dual-lane highways to reduce road
injury, and lean beef and low-fat milk to reduce heart disease.
• To simply blame individuals for their behaviour ignores the social, economic,
cultural and political forces at work in society.
• Activity: Explain why the ‘potential for prevention and early prevention’ was a
criterion in the identiﬁcation of priority issues

Costs of ill-health to the individual and community
• Cost of ill-health to the individual
• Costs can be categorised as either direct or indirect.
• Direct costs are those that can be measured, usually through financial means; for
example, cost of treatment, cost of replacement labour or lost working hours.
• Indirect costs are more difficult to measure. They include factors such as emotional
trauma and relationship breakdown.
• The impact of health conditions on the individual’s physical health can vary from
minor pain to permanent disability or death. Dealing with minor physical health
problems can be overcome in a short time with appropriate treatment and
medication.
• Examples of permanent physical effects are spinal cord injury from an accident,
limb amputation caused by peripheral vascular disease, and mastectomy (breast
removal) to remove a cancerous tumour.
• Permanent physical health problems that result from an illness or accident will, for
many people, have effects that reach far beyond the physical:
– Social isolation
– Long-term hospitalisation and lack of mobility
– Pressure on relationships and family structures
– Emotional Wellbeing – self esteem/depression etc

• Cost of ill-health to the Community
• The annual economic cost alone related to the diagnosis, treatment and care of
the sick is over $30 billion. This includes the costs of hospitalisation, medical
treatments, pharmaceuticals, health insurance and illness prevention.
• The indirect costs of ill-health to the community are not included in the dollar
ﬁgures. Indirect costs include loss of income and workplace productivity as a result
of illness or premature death, travel costs of patients, and the costs of caring for an
ill person at home.
• Australia’s expenditure on health
• Australia’s expenditure on health has been fairly constant. Measured in terms of
Australia’s total wealth—known as gross domestic product (GDP)—expenditure on
health has been about 8 per cent each year for the last 20 years
• There are several factors indicating that Australia’s health system might come
under ﬁnancial pressure in the future. These include:
• an ageing population
• a more informed population
• increased use of Medicare
• advances in medical technology

Cost of ill-health to the Community
• AGING Population
• Life expectancy at birth for the Australian population has increased by over 20
years since the beginning of the twentieth century.
• Whether this will cause a big increase in health costs is uncertain.
• The people who live longer might be healthier, and they might require less health
care than older people do today. However, there is still concern that having an
older population might place an extra burden on Australia’s health costs.
• They rely heavily on the health care system and health professionals

• A more informed population
• Health promotion and illness-prevention messages have resulted in a population
more informed about ill-health.
• This might result, in turn, in an increase in the use of health services, especially in
relation to prevention.
• In the longer term, spending money on prevention and early detection of illness
might decrease overall health costs.
• In the short term, however, having a more informed and health conscious
population does tend to cause people to use more medical services than
previously, and this puts immediate pressure on the health care budget.

• Increased use of Medicare
• The ease and simplicity that Medicare has brought to health care has resulted in a
steady increase in the use of doctors’ services, especially in urban areas where
there are many doctors.
• This might result in longer-term beneﬁts if conditions are detected earlier and
prevented from developing into more serious (and expensive) problems.
• There is also concern that the ease and simplicity of Medicare might lead to some
people seeing doctors for trivial matters
• The eﬀect of Medicare on health costs is thus a complex matter. Overall, Medicare
helps to keep down costs because the government does have some control over
the fees charged for services.

Advances in medical technology
• Improved technology has resulted in a wider range of treatments available.
• Many of these treatments utilise the latest expensive technology; for example,
organ transplants, use of lasers, joint replacements, open-heart surgery.
• People obviously want the best possible treatment, but costs are increasing as a
result
• Activity: Discuss how an illness or injury can have an impact on the social health of
an individual.
• Explain why it is diﬃcult to measure the social cost of ill-health.

How are priority issues identified Revision
1. Outline the measures of epidemiology
2. Describe the current trends in life expectancy and the major causes of
morbidity and mortality.
3. Outline the differences in health status by gender.
4. Describe how priority health issues are identified.
5. Analyse current trends in life expectancy and major causes of morbidity and
mortality for the general population.
6. Account for the differences in the health status of men and women in
Australia.
7. Justify why cardiovascular disease has been identified as a health priority
issue in Australia
8. Discuss why mortality, morbidity and life expectancy are important
indicators of health status.
9. Discuss why it is important for the Australian Government to prioritise health
issues when determining health policy
10. Discuss the limitations of using epidemiology to describe the current health
status of a population

What are the priority issues for
improving Australia's health?

Syllabus students learn about:
• groups experiencing health inequalities
-aboriginal and Torres strait islander peoples
-socioeconomically disadvantaged people
- people in rural and remote areas
-overseas - born people
- the elderly
-people with disabilities
• a growing and ageing population
-healthy ageing
-increased population living with chronic disease and disability
- demand for health services and workforce shortages
-availability of carers and volunteers
• high levels of preventable
chronic disease, injury and
mental health problems
-cardiovascular disease
(CVD)
-cancer (skin, breast, lung)
-diabetes
-respiratory disease
-injury
- mental health problems
and illnesses

Aboriginal and Torres strait islander peoples
The nature and extend of the health inequities
• No greater contrast in the extremes of health status can be found in Australia
than that between Aboriginal and Torres Strait Islander peoples and the rest
of the Australian population
• ATSI die at a much younger age and are more likely to experience disability
and reduced quality of life because of ill-health
• The life expectancy of Indigenous Australians is approximately 10 years less
than the overall Australian life expectancy
• The life expectancy at birth of a male is approximately 67 years and for a
female is approximately 73 years.
• Death rates for Aboriginal and Torres Strait Islander peoples are higher for
every speciﬁc major cause of death
• Infant mortality (estimated at two to three times higher than the overall
Australian ﬁgure) and higher mortality rates.

• The leading causes of death in the ATSI population are circulatory diseases, cancer,
diabetes and respiratory diseases.
• Indigenous females and males are, respectively, four and ﬁve times as likely to die
from avoidable causes.
• Indigenous people are ﬁve times as likely to die from heart attack
• Twice as likely to die from cancer
• 18 times as likely to die from diabetes
• Twice as likely to die from suicide.
• Indigenous Australians are more likely to die from transport accidents, intentional
self-harm and assault than other Australians. Injury rates are around three times
those of the total Australian population
• http://www.youtube.com/watch?v=vIuK_F80X08
• http://www.oxfam.org.au/explore/indigenous-australia/close-the-gap

• Trauma and grief related to the history of a new settlement invading Indigenous
communities, the impact of colonisation by Europeans, loss of land and culture,
high rates of premature mortality, high levels of Jail, family separations and
Aboriginal deaths in custody have been identiﬁed as underlying the great burden
among Indigenous people of ‘mental health problems’, which may lead to ‘mental
illness’.
• Diabetes is a major health problem among Indigenous people. Overall, diabetes is
around three-and-a-half times more common among Indigenous people than
among other Australians. Only around one-half of people with diabetes know they
have the condition.
• One in three Indigenous people have eye and/or sight problems, such as refractive
error (requiring glasses for correction), cataract (clouding of the lens), trachoma (a
bacterial infection that can lead to blindness if untreated)
• Nearly twice as many Indigenous six-year-olds as non Indigenous six-year-olds
have tooth decay.

Socio-cultural, socio-economic and
environmental determinants for ATSI

The roles of individuals, communities and governments in
addressing the health inequities
Government
• Government attempts to the health of ATSI by bring in new policy and reforms.
• Government agencies such as ‘The Aboriginal Health and Medical Research Council of NSW (AH&MRC)’
aim to improve the access of Indigenous people to primary health care services:
These combined services include:
•Ensure basic health standards are being met
•Supporting aboriginal community health initiatives
•Research in aboriginal health
•Policy development and evaluation
Community
• The nature of the services provided varies from one community to another, though
generally they include clinical care, health education, promotion, screening, immunisation
and counselling, as well as specific programs such as men's and women's health ,aged care,
transport to medical appointments, hearing health, sexual health, substance use and
mental health.
Individuals
• Educational services are needed to be built and increasing the number of aboriginal health
workers is needed to be done.
• Health services focus is on improving their knowledge and community skills.
•Empowering the individual to make wise decisions is ultimately the main aim

ATSI Revision
• Discuss why the financial resources devoted to improving
Indigenous health have so far had little impact.
• Apart from financial support, identify other strategies that have
been introduced to improve Indigenous health. Evaluate how
effective they have been.
• Propose alternative strategies that could be introduced to reduce
health inequities in the Indigenous population.

Socio-economically disadvantaged people
Nature and extent of inequalities
• A person’s socio-economic status is determined by several factors:
– Income
– Occupation
– Education
• Socio-economically disadvantaged people are those who, as a result of one or
more of these factors, experience significant financial limitations.
• Inequalities occur as a result of socioeconomic differences in material
resources, access to educational opportunities, safe working conditions,
effective services, living conditions in childhood, racism and discrimination
• Socio-economically disadvantaged people:
– have reduced life expectancy
– are more likely to die from cardiovascular disease
– respiratory disease and lung cancer
– have higher infant mortality
– have higher levels of blood pressure
– are more likely to smoke
– are more often generally sick.

Socio-economically disadvantaged people
Nature and extent of inequalities
• SES disadvantaged people are more likely to suffer from long-term health
conditions, such as diabetes, diseases of the circulatory system (which
include heart disease and stroke), arthritis, mental health problems and
respiratory diseases (including asthma)
• Socio-economically disadvantaged people are far less likely to engage in
preventative health behaviours, such as having ‘Pap’ smears and dental
check-ups.
• Unemployment is also a major issue because it is significantly higher than the
national rate. Unemployment can lead to a sense of helplessness, and is
therefore linked to social problems, including drug use, violence, vandalism
and crime. It a factor contributing to depression and suicide in young people.
• Department housing often experience higher levels of social problems. EG.
domestic violence, vandalism and family breakdown.
• Low income and education can reduce alternatives regarding employment,
housing and nutrition, and can generally affect the ability to raise standards
of living.
• Socio-economic disadvantage is considered to be the most important
indicator of poor health in Australia

environmental determinants for SES

The roles of individuals, communities and governments in
addressing the health inequities
Government
• Federal and state Government committed to making improvements in funding and
policies to reduce health inequities. Strategies by the government aim to improve the
access of SES people to better health.
These services include:
•Medicare
•Pharmaceutical Benefit Scheme (PBS)
•Immunisation programs
•Oral checkups
•Subsidised child care for low income families
Community
• The nature of the services provided varies from one community to another, though
generally they include clinical care, health education, promotion, screening, immunisation
and counselling, as well as specific programs such as men's and women's health ,aged care,
transport to medical appointments, hearing health, sexual health, substance use and
mental health.
Individuals
• Educational services are provided to individuals to help them help themselves.
• Health services focus is on improving their knowledge and community skills.
•Empowering the individual to make wise decisions is ultimately the main aim

FYI - People in rural and remote areas
Nature and extent of health inequities
• More likely to suffer acute and
chronic injury
• Experience lower life expectancy
• Reported less likely to have good
health
• More likely to have high levels of
psychological distress amongst
males
Sociocultural, socioeconomic and
environmental determinants
People living in rural and remote areas
were more likely to:
• Drink risky amounts of alcohol
• Be overweight/obese
• Ate less fruit
• Experience lower birth weight,
particularly among teenage
mothers
Roles of individuals, communities
and governments in addressing the
health inequities
Government
State health Plans are needed to:
•Attract and retain more health
professionals in rural and remote
communities
•Provide sustainable quality health
services
•Make health services more
accessible
Communities
In order to run health services, it is
essential that rural communities are
able to attract and retain properly
trained staff.

FYI - Overseas-born people
Nature and extent of health inequalities
• Suffer higher levels of psychological distress
( due to wars, or language problems)
• Hospital rates 20% lower than other
Australians
• Are hospitalised for diseases according to
country of birth, at greater levels than others.
E.g. heart attacks are more likely to happen to
people born in India whilst breast cancer is
more common for women from England and
Northern Ireland.
• Lower deaths than Australian – born people.
Sociocultural, socioeconomic and environmental
determinants
• Current daily smoking – Oceania
• Lower levels of exercise – North Africa and
Middle East
• Consume less fruit and veg than others
• Overweight and obese – Oceania and
southern and eastern Europe
Roles of individuals, communities and
governments
Government
The main approach by governments to
the health of people born overseas is
to provide translation and language
services to improve communication of
health issues and access to health
services among culturally and
linguistically diverse communities
(CALD).
Communities
The critical role of communities is to
provide support for their members by
advocating, promoting and engaging in
the use and delivery of culturally
appropriate health services. The
training and education of CALD
community and members to join and
support the healthcare profession is
the most enabling of all strategies.

Cardiovascular Disease (CVD)
• Its the disease of the heart and blood vessels. There are 3 main types of
CVD:
– Coronary heart disease
– Cerebrovascular disease (stroke)
– Peripheral vascular disease
• Despite the health achievements made, cardiovascular
disease is still the major cause of death in Australia.
• Coronary heart disease
• Coronary heart disease is the most common type of cardiovascular disease and
accounts for just over 20 per cent of all deaths. It occurs when the blood
supply to the heart is decreased by a narrowing (usually caused by
atherosclerosis) in one or more of the coronary arteries.
• If the blockage severely decreases blood ﬂow to the heart it can lead to a
condition called angina. Angina is chest pain that occurs as a result of cramping
of the heart muscle due to constricted arteries.
• In some cases the decrease in the blood supply can result in a more serious
sudden heart attack, which can be fatal.
• http://www.youtube.com/watch?v=n8P3n6GKBSY&feature=related

• Atherosclerosis- http://www.youtube.com/watch?v=fLonh7ZesKs
• Angina- http://www.youtube.com/watch?v=RXuPBaKzmfM
• Cerebrovascular disease (stroke)
• Cerebrovascular disease is a disease of the arteries of the brain. An
interruption (usually caused by atherosclerosis) of the blood supply to
the brain results in what is commonly known as a ‘stroke’.
• A stroke can also occur as a result of a blood vessel bursting in the
brain. The eﬀects that a stroke has on the person will depend on which
part of the brain has had its blood supply restricted.
• http://www.youtube.com/watch?v=6h7Frkj96yM&feature=fvw

• Peripheral vascular disease
• Peripheral vascular disease is a type of cardiovascular disease that
aﬀects the blood vessels in the limbs.
• Hardening of the arteries that interferes with blood supply to the
muscles and skin is known as arteriosclerosis.
• This disease has close links to smoking, and to diabetes and certain
other diseases. In extreme cases, this can result in gangrene and
possibly limb amputation.
• http://www.youtube.com/watch?v=I4jxjWIbWyg&feature=related
• Activity: Explain the effect atherosclerosis
would have on a persons blood pressure

Extent of and trends in CVD
• Leading cause of death in Australia (about 35% of all deaths)
• Second leading cause of burden of disease (cost, social, emotional costs etc)
following cancer
• Despite this being the leading cause of death, there has been a downward
trend for all cardiovascular disease
• The death rate increases sharply with age and causes the greatest number of
deaths among older people
• The decline in cardiovascular
disease can be attributed
to two main factors:
• Improved medical care (for
example, drugs to manage
blood pressure)
• A reduction in risk behaviour
that contributes to
cardiovascular disease (for
example, smoking)

Extent of and trends in CVD
• Males are more likely to die from CVD then females
• Death rates significantly increase with age. CVD accounts for
48% of all deaths over 85
• Lower SES are more likely to have CVD
• ATSI are twice as likely to have CVD, compared to non – ATSI
• People from rural areas are more likely to have CVD, then urban

Risk factors and protective factors
for cardiovascular disease
Risk factors
• Some risk factors for cardiovascular disease cannot be modiﬁed.
The non-modiﬁable risk factors for cardiovascular disease are:
– Age : The risk of cardiovascular disease increases as people age; this is often the
result of the slow progression of atherosclerosis.
– Heredity :People with a family history of cardiovascular disease are more prone to
developing the disease Themselves.
– Gender: Males are more at risk of coronary heart disease than are females.

Risk factors and protective factors for
cardiovascular disease
Risk factors
• Other risk factors for cardiovascular disease can be modified. The modifiable
risk factors for cardiovascular disease are:
– Smoking : Smokers are up to five times more likely to develop a cardiovascular disease than are
non-smokers. Chemicals contained in cigarette reduce oxygen-carrying capacity of the blood.
– High blood pressure—Blood pressure is one of the most common causes of heart disease; high
blood pressure is linked to a high-salt diet and being overweight
– High blood fats—High levels of cholesterol and triglycerides (types of lipids or ‘fats’) in the
blood significantly increase the chances of cardiovascular disease.
– Overweight and obesity—People who are overweight are at an increased risk of heart disease
because obesity is linked to high blood pressure and an increased level of blood fats.
– Lack of physical activity—People who do not engage in regular physical activity can have a less
efficient heart, higher levels of blood fats and a propensity to gain weight.
• other possible influences include poor nutrition, alcohol, the contraceptive ‘pill’
(especially coupled with smoking) and diabetes

Risk factors and protective factors for
cardiovascular disease
Protective Factors
• Protective factors are the opposite of risk factors in that they help lower a person’s
chances of developing heart disease.
– Maintain healthy levels of blood pressure and blood cholesterol—Regular blood pressure and
cholesterol checks will assist in early identiﬁcation and management of any factors associated with
heart disease.
– Quit smoking—Stopping smoking is the single most important action a person can take to reduce
his or her risk of cardiovascular disease.
– Enjoy healthy eating—Healthy eating means enjoying a variety of foods from diﬀerent food groups.
– Visit the doctor regularly—Regular visits to the doctor can assist in maintaining any early signs of
risk for cardiovascular disease. This includes assessing blood pressure, cholesterol, family history
and lifestyle factors. With this information, a doctor can provide individualised advice on the best
ways for the patient to lower his or her risk and lead a healthy-heart lifestyle.
– Be physically active—Regular, moderate-intensity physical activity is good for the heart. Engaging in
at least 30 minutes of physical activity can help lower blood pressure, lower blood cholesterol and
assist in maintaining a healthy weight range.
– Maintain a healthy weight—Being overweight and carrying too much weight around the waist are
risk factors for cardiovascular disease and diabetes. Therefore, maintaining a healthy body weight
by eating healthily and participating in regular physical activity will act as a protective factor to
cardiovascular disease.

CVD Personal Reflection
• Do you have a family history of CVD?
• Are you 55 or above? (hope not!)
• Are you male or female?
• Are you a present or past smoker?
• What level is your cholesterol?
• Are you at a healthy weight range?
• How high is your blood pressure?
• Are you regularly involved in physical activity?

environmental determinants of CVD
Social Determinant Effect on CVD
AGE • Risk increases with age
•Congenital heart disease is one of the leading causes of death in a
child’s first year of life
SEX •Females have a greater prevalence then males (why??)
•Males are more likely to die then females from CVD
SOCIO-ECONOMIC
STATUS
•Lower SES are more likely to get CVD
•Many behavioural risk factors for CVD are more prevalent among
people of lower SES (physical inactivity, obesity, hypertension)
•Low SES are likely to have 3 or more risk factors
•Low SES is linked to other social determinants such as poorer
education, poorer working conditions and poor living conditions
EDUCATION •Education leads to greater knowledge of risk factors
•Higher educated people are less likely to smoke, more likely to
engage in PA and eat healthier meals. All these decrease CVD.
EMPLOYMENT •Blue collar occupations have higher risk of CVD. This is linked to
higher levels of smoking and physical inactivity.
•Unemployment leads to lower SES

environmental determinants of CVD
Social Determinant Effect on CVD
GEOGRAPHIC
LOCATION
•Rural populations have higher death rates of CVD
•Larger proportion of rural are ATSI, who have higher rates of CVD
•Geographic location also impacts on other social determinants such
as: transport, communication, health services, employment, SES and
social isolation.
CULTURE •Migrants have lower CVD then Australian born
•Death rates increase though once migrant has lived in Australia for
10 or more yrs.
•Support networks are not so good
•Culture can cause barriers to health services (language differences)
ACCESS TO SERVICES •People who do not have easy access to health care die more from
CVD due to lack of diagnosis, prevention and treatment.
•Lack of access could be due to cost, distance, knowledge, language
or lack of facilities.
PHYSICAL
ENVIRONMENT
•Well designed neighbourhoods that provide recreational facilities,
good roads, street lights assist with PA
•Unsafe alcohol consumption can be controlled through the
regulation of alcohol outlets (bars, liquor shops and clubs)

• ACTIVITY:
• Create a postor illustrating the groups most at
risk of CVD. Use images from the internet,
magazines etc to build a profile.
• Put these poster up around the classroom
once completed

Game Show - CVD• This population is twice as likely to die from CVD in Australia
• ATSI
• TWO determinant affecting CVD rates... Give details
• AGE, SEX,SES,EDUCATION,EMPLOYMENT,GEOGRAPHIC LOCATION, CULTURE, ACCESS TO SERVICES, PHYSICAL
ENVIRONMENT
• Another name for High blood pressure
• Hypertension
• Death rates for CVD have _______________ over the past 30yrs
• Decreased
• PVD is poor blood supply to the _________
• Limbs
• Are males or females at greater risk of CVD?
• Males
• Most risk factors for CVD are ____________
• Preventable/modifiable
• A heart attack is usually the result of blockage of which arteries
• Coronary
• CVD accounts for nearly ___________ percent of all deaths in Australia
• 40
• Lack of blood supply to the brain is called a ________
• Stroke
• Another name for chest pains

Cancer (skin, lunch, breast)
• Cancer is the uncontrolled growth of abnormal body cells.
• Abnormal growth of cells leads to the build up of tissue masses called tumours
• Tumours can be benign (non-cancerous) or malignant (cancerous)
• Benign tumours do not spread, but malignant spread through bloodstream or the
lympth system (body defence system) to get to other parts of the body.
• They then form an new tumour (a secondary cancer) and begin invading the surrounding
cells again.
• There are various types of cancer. Some develop slowly; some quickly.
• Some have known causes; others are of unknown cause.
• Cancers are classiﬁed according to thearea of the body where they initially began:
– Carcinoma - cancer of epithelial cells (including skin, mouth, throat, breasts and lungs)
– Sarcoma —cancer of bone, muscle or connective tissue
– Leukaemia —cancer of the blood-forming organs
of the body
– Lymphoma —cancer of the infection-ﬁghting
organs of the body
• http://www.youtube.com/watch?v=LEpTTolebqo

Extent of and trends
in cancer
• Cancer is the 2nd
leading cause of death in Australia.
• Cancer currently accounts for about 30% of all male deaths and 25% of female
• The risk of being diagnosed with cancer before the age of 75 years is 1 in 3 for
males and 1 in 4 for females.
• The risk before age 85 years is higher, at 1 in 2 for males and 1 in 3 for females.
• Since the 1990s, cancer has replaced cardiovascular disease as the greatest
cause of years of life lost or fatal burden
• In the past 15 years the incidence rate of melanoma has increased more rapidly
than that of any other type of cancer
• Reasons for the increase in cancer incidence include:
– exposure to risk factors (for example, ultraviolet radiation)
– improvements in the quality of detection techniques (mammograms)
– more widespread use of personal detection (self-examination for breast cancer)
– people being less likely to die from other causes (for example, from coronary heart disease and
accidents)

Extent of and trends
in cancer
• Analyse the following slides from AIHW 2010 on cancer and make
notes regarding further trends and the extent of cancer

Comparison of incidence and Mortality

for cancer

for cancer
Skin cancer
• The major cause of skin cancer is exposure to the sun’s ultraviolet rays.
• The sun is at its most damaging between the hours of 11.00 am and 3.00 pm.
• Exposure to sunlight increases the chances of skin cancer later in life.
• Further risk factors include having fair skin (which readily burns) and having a large
number of moles. These are hereditary factors, which cannot be modiﬁed.
• Protective factors include slip/slop/slap/seek/slide (shirt/sunscreen/hat/shade/sunnies)
• http://www.youtube.com/watch?v=YzYHwzSE1VY
• http://www.youtube.com/watch?v=vaoSfy5-mp4

for cancer
• Breast cancer
• There are still many unanswered questions regarding the cause of breast cancer.
• The major risk factor that is unavoidable is, of course, gender.
• Family history of breast cancer increases the risk of developing the disease.
• Risk factors associated with lifestyle are believed to be obesity, and a late maternal
age (over 40 years) at the time of the ﬁrst full-term pregnancy.
• Regular self examination and checkups are recommended for all women past 25
years old, especially if a family history exists

for cancer
• Lung cancer
• The risk factors related to lung cancer that are unmodifiable are gender, age and
family history.
• Risk factors that can be modiﬁed include smoking and exposure to carcinogenic
chemicals; for example, asbestos and lead.
• People who are regular smokers are up to 20 times more likely to develop lung
cancer.
• It is never too late to give up smoking because the body has the capacity to repair
the damage done by smoking, and thus reduce the risk of lung cancer.
• http://www.youtube.com/watch?v=6NfMjaVOs6g&feature=related
• http://www.youtube.com/watch?v=D0mUHzmnN_4&feature=related
• http://www.youtube.com/watch?v=lEc-Rsv9pMc&feature=related

environmental determinants• Skin cancer
• The incidence of skin cancer is increasing as a result of improved education
relating to detection.
• Education and media health promotion strategies have alerted the community
to the importance of detecting skin anomalies early, and reporting for medical
advice.
• This increased education and awareness has resulted in common, less harmful
skin cancers being recorded and treated more frequently than in the past, thus
resulting in a higher rate of incidence.
• In Australia, society has for many decades regarded a suntan as ‘healthy’ and
attractive. There has been a shift in attitudes, however, and it is now less
fashionable to aspire to the traditional image of the ‘bronzed Aussie’ lifesaver.
• Exposure to the sun in the workplace, and in
recreational and school activities, is of concern with
respect to rates of skin cancer.

environmental determinants• Breast cancer
• The increased incidence of breast cancer in females can, in part, be linked to
changes in family structure and the changing role of women in society.
• The average age at marriage is now later, as is the average age of a female’s
first pregnancy.
• This delay is a response to greater financial demands placed on young families,
and the desire of females to focus on establishing a career before having a
family.
• The result has been more females experiencing their first full-term pregnancy
after the age of 40 years, and thus increasing their risk of breast cancer

environmental determinants• Lung cancer
• The incidence of lung cancer is decreasing in males, reflecting a decrease in the smoking rate over the
past two decades.
• Improved education and effective health promotion strategies have contributed to this behavioural
change, as has society’s changing attitude to smoking.
• People are more aware of passive smoking and less tolerant of other people’s smoking, especially in
public areas and the workplace.
• Improved workplace safety codes and equipment have also resulted in reduced exposure to
carcinogenic substances (for example, asbestos) in the workplace.
• People of low socio-economic status, however, are more likely to be employed in occupations that
involve exposure to dangerous materials, and involve high-risk tasks. These occupations include mining
and construction.
• In females, the incidence of lung cancer has increased, and smoking levels in young females remain
high.
• The changing role of females in the workplace might be a cause for this increase in lung cancer. Females
are challenging traditional gender roles and stereotypes, and are more active in a range of occupations
that previously were the domain of males. These occupations are, in most cases, more ‘high-powered’,
which can lead to higher stress levels.
• The media might also have a negative influence through the promotion of
high-profile, attractive females smoking, and in the promotion of a link between
smoking and weight control (which is, of course, important in relation to

Cancer Revision
1 Identify the three leading causes of:
a) cancer in males and females
b) cancer mortality in males and females.
2 The increase in cancer incidence has been partly attributed to improvements in
detection techniques.
a) Identify the steps that are available to individuals to detect cancers at the
earliest possible time.
b) Explain why some people do not take full advantage of available screening
services.
c) Propose how screening services could be further promoted and utilised.
3 a) There have been signiﬁcant increases in melanoma (a form of skin cancer)
over the last 15 years. Explain why this is so.
b) Describe the steps that have been taken to reduce the incidence of skin
cancer

Diabetes Mellitus
• The incidence of diabetes is on the rise in Australia and across the world.
• Recent increases in the number of people with diabetes have led to claims that it
has now risen to ‘epidemic’ proportions.
• Diabetes is a hereditary or developmental disease caused by the improper
functioning of the pancreas
• This results in a disturbance in the sugar levels (glucose concentration)of the
blood.
• If there is insuﬃcient sugar in the blood, the condition is known as hypoglycaemia.
• Too much sugar in the blood is known as hyperglycaemia.
• Type-1 (insulin dependent) diabetes is not a lifestyle disease.
• Type-2 diabetes results from a combination of genetic and environmental factors.
Although there is a strong genetic predisposition, the risk is greatly increased when
associated with lifestyle factors such as:
– high blood pressure
– overweight or obesity
– insuﬃcient physical activity
– poor diet

Diabetes Mellitus
• A person with diabetes has an increased risk of coronary heart disease and
atherosclerosis.
• Diabetes is also linked to kidney failure, nerve disease in the lower limbs and
blindness.
• Type 1 - http://www.youtube.com/watch?v=_OOWhuC_9Lw
• Type 2 - http://www.youtube.com/watch?v=nBJN7DH83HA&feature=related
• Gestational - http://www.youtube.com/watch?v=A-8de9LuVJQ

Extent of and trends in diabetes
• There has been a signiﬁcant increase in the number of people with diabetes in
Australia over the last 20 years, and it is now a major cause of morbidity and early
mortality.
• Where diabetes was the underlying cause of death, common conditions listed as
associated causes included coronary heart diseases, kidney-related diseases, stroke
and heart failure.
• There have not been major changes in the death rate from diabetes
• More than half (56 per cent) of the people with diabetes also have a disability.
• Diabetes is the eighth leading cause of disease and injury in Australia.
• Diabetes increases the risk of coronary heart disease and stroke and, when this
contribution is added, diabetes is then ranked fourth out of all diseases.
• It is projected that by 2023, type-2 diabetes will be the leading speciﬁc cause of
disease burden for males and the second for females.
• Australia has a relatively low prevalence of overall diabetes compared with other
countries, ranking the third lowest in 2006

Extent of and trends in diabetes

Risk factors and protective factors for diabetes
• Insulin-dependent diabetes (type 1)
• Insulin-dependent diabetes is more common in children and young adults, and
is caused by the failure of the pancreas to supply sufficient amounts of insulin
to convert glucose into energy.
• The cause of insulin dependent diabetes is not confirmed, but is possibly linked
to genetic factors and to viral infections contracted while young.
• It can also be caused by biological interactions and exposure to environmental
agents among genetically predisposed people.
• Type-1 diabetes is managed by artificially supplying the body with insulin
through regular injections

Risk factors and protective factors for diabetes
• Non-insulin-dependent diabetes (type 2)
• Age is a risk for type-2 diabetes and genetic predisposition is shown by family
history and ethnic background.
• Unlike type-1 diabetes, non-insulin-dependent diabetes has strong links to lifestyle.
• Type-2 diabetes occurs in adults, and is related to obesity, physical inactivity and
an unhealthy diet. It is related to high blood pressure, the intake of too much
saturated fat and reﬁ ned sugar, and high alcohol consumption.
• As such, it is controlled through strict dietary measures and weight reduction.
• The protective factors for diabetes include:
– regularly participating in physical activity
– eating a well-balanced diet
– consuming no or little alcohol
– limiting the intake of saturated fat and reﬁned sugar
– maintaining a healthy weight range.

Groups at risk of diabetes
• Groups at risk of type-2 diabetes are:
– those aged over 65 years
– those with a family history of adult onset diabetes
– people who are overweight those with high intakes of saturated fat and reﬁned sugar
– people who frequently consume alcohol
– those who engage in little or no exercise.
• ATSI peoples have markedly higher rates of diabetes (speciﬁcally type 2)
• Six per cent of the total Indigenous population has diabetes/high-sugar level.
• The prevalence of diabetes among Indigenous people is almost three times as
high as that of non-Indigenous Australians.
• There are also higher rates of diabetes among other sections of the Australian
community, namely those living in more remote areas, those with lower SES
and those born overseas.

Diabetes Revision
1 Deﬁne diabetes.
2 Describe the diﬀerences between type-1 diabetes and type-2 diabetes.
3 Diabetes is considered to be under-reported. Explain why this is so.
4 Discuss the links between the social acceptance of alcohol and the increase
in diabetes.

FYI - Injury
Nature of the problem
The term accidents and injuries is used by the
World Health Organization to classify deaths
resulting from external causes.
Extent of problems (trends)
• More than 1 in 20 Australians were hospitalised
as a result of injury between 2005-2006.
• Injuries cased by falls continue to grow in
prevalence as a result of an increase in the
ageing population
Risk factors
• Age and gender as well as a person occupation.
• Risks from vehicles are due to driver
experience, speed, alcohol, driver fatigue and
multiple passengers
Groups at risk
Indigenous people , rural and remote people ,
socioeconomically disadvantaged people,
prisoners, people born overseas, veterans
Sociocultural, socioeconomic and
environmental determinants
Example Media has promoted
increased independence of young
people through social networking,
technology and marketing.
Increased independence in an
affluent society can result in
increased access to motor
vehicles. In particular young males
with their characteristics and
sense of impunity, can impact on a
disproportionate number of traffic
accident deaths for this group

FYI Mental health problems and illnesses
Nature of the problem
Mental health disorders and mental illness are related conditions that affect the
emotional, cognitive behavioural and social wellbeing of the sufferer. Mental
health disorders are diagnosable illnesses that can include anxiety, depression
substance abuse disorders, dementia, bipolar disorder and schizophrenia.
Extent of the problem (trends)
• 2005 – mental or behavioural disorders accounted for 2.7 deaths per 100 000
persons
• 6.5% of Australians over 65 years suffer from dementia – two thirds o these are
females
• Dementia is increasing. This is a result of Australia's ageing population
Groups at risk
Indigenous people , rural and remote people , socioeconomically disadvantaged
people, prisoners, people born overseas aged 20 – 34 years and who have never
been married, veterans. 25-44 year old males.
Sociocultural, socio economic and environmental determinants
When their ability to cope is compromised by drugs and alcohol, racism, bullying,
negative thoughts, hereditary traits, social isolation and other factors the
likelihood of mental problems or disorders is increased.

A growing and ageing population

A growing and ageing population
• Australia has a growing and ageing population.
• Older Australians are people aged 65 years and over.
• This group makes up approximately 13 per cent of the population.
• The proportion of the population aged 65 years and over is projected to rise
by between 27 per cent and 30 per cent by 2051.
• The ageing of the population is caused by two factors.
• First, Australian families are, on average, having fewer children.
• The second factor contributing to the ageing population is that we are living
longer.
• With fewer babies being born, and more people living longer, it is inevitable
that the population will become progressively older.
• With the population ageing and people living longer, there are more people,
particularly those at older ages, who have a disability and are limited in their
ability to participate in physical activity
• There is thus added pressure on health care services.
• Health expenditure increases with age as the greatest costs increase in ones
last years of life.
•

Growing and ageing population
Healthy ageing
Healthy older Australians:
• Less likely to leave the workforce for health reasons
• Are more likely to enjoy retirement
• Contribute more to their own communities (volunteers)
• Have fewer healthcare needs
• Experience less chronic disease and disability
• Place less pressure on the national health budget and healthcare system
• Australian males aged 65 can expect to live to be 83.1 years, while 65-year-old
females have an expected life span of 86.4 years

Increased population living with chronic disease and disability

• As the age of the sufferer increases, so does the level of disability experienced:
– CVD
– Cancers
– Chronic lung disease
– Obesity
– Injurious falls
– Diabetes type 2
– Poor emotional and psychological wellbeing
• Coronary heart disease and cerebrovascular disease (particularly stroke) are the
two leading causes of death among older males and females
• Lung cancer is the third most common cause of death for older males and the fifth
for older females. Colorectal cancer is also high for both sexes, and prostate cancer
and breast cancer are two important sex-specific causes of death.
• Dementia and related disorders, such as Alzheimer’s disease, still cause many
deaths among older Australians. Diabetes is the main underlying cause of death.
• For those aged 85 years and over, influenza and pneumonia and kidney failure are
among the top causes.

• Some of the most commonly reported chronic conditions are:
– Vision and hearing problems
– Back pain and disc problems
– Hey fever and allergies
– Arthritis
• Largest increase in chronic disease has occurred in diabetes
• Chronic disease impacts on Australia’s burden of disease as it is determined by a a
combination of the effect of death AND disease
• ACTIVITY
• Explain how the concept of ‘healthy ageing’ differs from the good health practices
that are promoted for young people.
• There is an increasing amount of Australians living with chronic illness or disease.
Examine the effects this has for the health care system and its services.
• Discuss the roles that carers and volunteers can play in helping people manage
chronic disease and disability.

Demand for health services
http://news.theage.com.au/national/govt-ignoring-aged-care-crisis-20090106-7b3g.html
• During the last 25 years the Australian medical workforce has increased much
more rapidly than the population.
• Factors contributing to this include the growing and ageing of the population.
• The demand for health care increases with age, and medical workforces are
derived from the demand for health care.
• Those 55 years and older are the heaviest consumers of medical services.
• The rising national health expenditure is likely to be driven by factors:
– relative health price increases
– a growing population
– the ageing of the population
• When older people are discharged from hospital, they are less likely than younger
people to return to their usual residence, and more likely to enter aged care or die.
• Public health efforts can help preventable illness and disability as they age. EG.
Screening programs, immunisation programs.

Demand for health services
• Older people rely more heavily on the following health professionals:
– Doctors (GP’s)
– Dentists
– Specialists (bone, heart etc)
– Hospitals
– Pharmacies
– Disability support workers
– Counsellors
• All these contribute to the wellbeing of the aged population
• ACTIVITY
• Research at least 2 of these health professionals in depth

Workforce shortages
• A shortage in the health care system exists when the supply of workers can’t meet
the demand of health needed
• The demand for health care services will increase with the ageing population and
improved health technology (better detection and treatments)
• Reasons for shortages:
– Low numbers of health care professionals being training
– Health care professionals working fewer hrs per week
– Retirement of health care workers (more then are being trained)

Availability of carers and volunteers
• Most assistance to the elderly comes from family and friends
• Service providers that oﬀer aged care in the community and through aged care
homes include a mix of private and religious or charitable organisations, as well as
state, territory and local governments.
• Most older Australians prefer to stay in their own homes, so there are a number of
programs available to help with daily living activities that may have become harder
for these people to manage on their own. This is called community care
• The Home and Community Care (HACC) program aims to meet basic needs to
maintain a person’s independence at home and in the community. They include:
– Community nursing
– Domestic assistance
– Personal care
– Meals on Wheels
– Anglicare
– Home modiﬁcation and maintenance
– Transport and community-based respite care.

• For the older person who can no longer live at home because of ageing, illness or
disability, there are publicly funded places in aged care homes. This is called
‘residential aged care’
• High-level care provides nursing care when required, meals, laundry, cleaning and
personal care, while low-level care gives the person assistance with meals, laundry
and personal care.
• Older people can struggle with everyday events such as loosing drivers license,
mowing the lawn, doing the shopping, loss of a loved one, or even understanding
new technologies.
• The cost for family caring for the elderly may be:
– Financial – family loss of earnings to look after loved one, cost of treatments
– Social and Emotional – stress and less opportunity to care and look after own family
– National labour force – as more people look after elderly, less people can work, leading to less
taxation revenue and therefore increase of treatment costs.

What are the priority issues for improving
Australia’s health REVISION
• Providing Equity in health does not mean giving equal resources to all population
groups. Why?
• Not all population groups experience good health. Discuss.
• Identify the groups in Australia that experience health inequities.
• Outline the major health issues that have an impact on the health status of Australians
• Describe the leading causes of death in the ATSI population
• Discuss the risk factors and protective factors for health for each of the following:
a) Aboriginal and Torres Strait Islander peoples
b) socio-economically disadvantaged people
• Discuss how the changing nature of the lifestyle patterns of Australians has an impact
on the incidence of two major causes of sickness and death.
• Outline the major determinants that contribute to the incidence of two of the major
causes of sickness and death in Australia.
• Assess the impact that the health status of Australians has on the provision of health
care facilities and services
• Explain why the level of health of older people in Australia is diﬀerent from that of
other population groups in Australia
• Assess the impact of a growing and ageing population on health care in Australia

What role do health care facilities and services play in
achieving better health for all Australians?

Health care in Australia
• Because the major causes of sickness and death relate to lifestyle, the aim is to
improve quality of life through health promotion initiatives that establish
environments that enhance positive health behaviour.
• The role of health care is to achieve a delicate balance between resources for
prevention and resources for treatment.
• This changing emphasis towards prevention has been seen in numerous
national health campaigns. Examples include HIV/AIDS, breast cancer and
mental health.
• In summary, the role of health care is no longer simply curative.
• Instead, it is concerned with ensuring an improvement in the health of the
population as a whole through a combination of preventative strategies and
clinical medical care

Health care in AustraliaRange and types of health facilities and services
TYPE DESCRIPTION
Public Hospital Government owned, used for medical treatments, caters for
overnight stays. Medicare covers most payments
Private Hospital Individually and community owned, private insurance
required. Often has many additional benefits
Psychiatric Hospital Used for treatment of people suffering mental illness
Nursing Homes Long term care given to people who can’t look after
themselves. EG. The elderly/chronically ill
Medical Services Refers to GP’s and specialists EG cardiologist,
dermatologists,
Dental Services Services related to teeth and gum disorders
Pharmaceuticals Drugs and medicines. Most drugs are supplied through the
pharmaceutical benefits scheme (PBS). Also people can get
prescriptions from GP and Over The Counter drugs
Professional Services Other health services such as physiotherapists, chiropractor,
ambulance
Community Health Services Meals on wheels, baby health centres – community based

WHO DESCRIPTION
Commonwealth
Government
•Sets policy and legislation (PBS)
•Provides funding for health care
•Looks after war veterans and ATSI programs
State
Government
•Provides the ACTUAL health services. EG the hospitals
•Develops state programs. EG ATSI health in NT
•Controls health facilities and employment of staff
Local
Government
•Develops local health promotion campaigns. EG Healthy canteens
•Provision of community health services.
Private Sector •Provides private medical services and private hospitals
•Contributes to research. EG national heart foundation, cancer council,
diabetes Australia
•Business and companies provide health care facilities. EG workplace gyms
Communities •Provides community (often voluntary) services such as meals on wheels,
home nursing etc
Individual •Responsibility lies with individuals to make wise decisions regarding their
need for appropriate health care and effective screening behaviours
Responsibility for health care facilities and services

Equity of access to health facilities and services
• Access to health services and facilities is essential to health and well-being.
• The cornerstone of Australia’s health care system is Medicare. Medicare is designed to
allow simple and equitable access to all Australian citizens regardless of location and
socio-economic status.
• Supporting programs, such as the Medicare Safety Net (the amount of what ppl need to
pay is capped) and Pharmaceutical Benefits Scheme (government subsidising
medicines) , are also in place to promote equity of access.
• Although, in principle, equity of access is the intention, some individuals and groups
find it difficult to access appropriate health services and facilities.
• Medicare does not fully cover, or provide access to, a range of medical services that are
vital for maintaining good health. This places people of low SES at a disadvantage. EG
speech therapy and physiotherapy.
• Access to health services has also been hampered in recent years by overcrowding and
lack of bed availability in public hospitals.
• Access can also be difficult for people in rural or remote areas
• People from non-English speaking backgrounds and different cultures might also not
take full advantage of the services available to them.
• Actively involving these communities in the establishment and delivery of their health
services will result in more effective care and improved health choices.

• ACTIVITY
• Identify the ways in which the community takes responsibility for the individual
health problems
• Do you think that the community’s level of responsibility should be greater or
less? Justify you answer
• Outline the factors that influence access to health care facilities and services
A) Identify the health care services most relevant to you at this point in your life.
B) Are they easily accessible?
C) Is the quality of service adequate?

Health care expenditure versus early intervention and prevention expenditure

Health care in AustraliaHealth care expenditure versus early intervention and prevention expenditure

• The majority of health expenditure is on health goods and services, such as
medications and hospital care.
• A major matter of consideration for all levels of government is the delicate
balance of treatment versus early intervention and prevention.
• In recent times signiﬁcant steps have been taken in the area of health
promotion and illness prevention.
• Health promotion and prevention programs were supported by an increase in
funding during the 1990s.
• Despite this increase, more than 90 per cent of government health expenditure
is still allocated to curative services.
• With Australia’s leading causes of death and illness being lifestyle-related, the
argument that prevention will be more cost-eﬀective than cure has gained
considerable support.

• Prevention programs that have been implemented include:
– school medical and dental services
– immunisation programs
– the fluoridation of water supplies
– anti-smoking campaigns
– the National Campaign Against Drug Abuse
– the National Mental Health Strategy
– National HIV/AIDS Program.
• Despite the strength of the arguments supporting an increase in preventative
measures over curative, there seems little hope for a significant shift in
government expenditure in the short term.
• Governments are reluctant to cut back on funding to curative health services and
divert it towards preventative strategies.
• The reason for this is that the results, especially financial savings, are not seen in
the short term.
• For example, a large amount of expenditure dedicated to reducing the number of young
people who smoke or to limiting sun exposure will not be reflected in lower cancer rates—
and resultant financial savings—for 15–30 years. For a government currently in office, that
expenditure might be more beneficial politically if used to shorten hospital waiting lists or to

• DEBATE the following thoughts:
• Governments are reluctant to divert money from curative to preventative
measures because it might not win them votes at the ballot box. (For example,
closing a hospital or decreasing hospital bed numbers could be politically costly.)
What is your opinion of this?
• Are there other reasons for so much health expenditure being devoted to cure and
so little to prevention?

Health care in AustraliaImpact of emerging new treatments and technologies on health care
• Medical technology refers to the proceducers, equipment and processes by which
medical care is delivered.
• High tech medicine is often linked to high quality health care.
• Enhanced quality of health occurs when new technology produces better
diagnosis, quicker and more effective treatment.
• Technology may also produce new remedies or findings. EG.
– New cancer and heart disease drugs
– New vaccine developments – Gardasil for cervical cancer
– Keyhole surgery brings quicker recovery times
– Laser surgery is less invasive
– PET (positron emission tomography) allows detection of tumours that may now be found using MRI
or CT scans http://www.youtube.com/watch?v=J9pOTlC3IJg&feature=related
– Use of robots in surgery http://www.youtube.com/watch?v=k3gIa_w4GXQ
• Technology accounts for a large increase in health care costs
• Technology advances allow medical workers to diagnose and treat greater
numbers
• Screening improvements result in higher detection, therefore greater costs in care
• Technology increases peoples ability to survive illness and disease. This means they

Health care in AustraliaImpact of emerging new treatments and technologies on health care
• Vaccines like Gardasil (cervical cancer) has been recommended for all females
between 12-26. The government covered this cost of 3 injections at a price of $460
per person. This naturally raises the health care costs.
• Better screening and diagnosis means people are finding illness and disease more
effectively. This means that long term treatment should be shorter and therefore
less expensive.
• Technology advances have seen more day surgeries only. Lowering cost of
prolonged stays in hospital.
• Technology:
– Improves quality of life
– Faster return to productivity in the workforce
– Better emotional wellbeing for patient and carers
• The threat of legal action also puts pressure on medical workers to use latest tech.
• Equity considerations need to be made. Making it available to all is important.
Mobile breast screening is a good example
• People of lower SES are more likely not to have access to
latest technology

Health care in AustraliaHealth insurance: Medicare and private
• Medicare is health insurance that ensures all Australians have access to free or
low-cost medical, optometrical and hospital care. Australians are also free to
choose private health services.
• Medicare was introduced in Australia in 1984 as a national system of health care
funding.
• It is designed to protect people from the huge costs of sickness and injury by
providing free or subsidised medical care, and free hospital treatment in public
hospitals. All Australian residents are eligible for Medicare beneﬁts.
• Medicare is funded from general taxation revenue plus an additional contribution
known as the Medicare Levy.
• The Medicare Levy is 1.5 % of each taxpayer’s income, and people pay it in
addition to their ordinary income tax.
• Individuals and families on higher incomes may have to pay a 1 per cent surcharge
in addition to the Medicare Levy if they do not have private health insurance.
• The government introduced this change in the hope of encouraging more
ﬁnancially able people to take out private health cover, and thus ease the pressure
on the public health system

• http://www.youtube.com/watch?v=eqo9MAmyWQM - medicare and pharmaceutical benefits scheme
• http://www.youtube.com/watch?v=5cA2hihzmYA&feature=channel – private vs public health
• http://www.youtube.com/watch?v=ta9NjDBwetg&feature=channel Medicare levy surcharge
• ACTIVITY
• Outline the benefits of private health insurance
• Propose why some people choose not to take out private health insurance

Medicare does cover Medicare does not cover
• 85 per cent of the MBS fee for out-of-hospital services provided by registered
medical practitioners (for example, GPs, specialists, X-rays, pathology tests)
• Private patient hospital costs (other
than dental examinations and treatment)
• 75 per cent of the MBS fee for medical services provided in-hospital • General dental services
•The full cost of accommodation and treatment by hospital-appointed doctors
for public patients in recognised public hospitals
• Ambulance
• The full cost of X-rays and pathology tests for public patients • Home nursing
• 85 per cent of the cost of eye tests • Physiotherapy
• 75 per cent of in-hospital medical procedures performed by oral surgeons
(general dental services are covered by Medicare)
• Speech therapy
• Free out-patient services in some public hospitals • Chiropractic services
• Podiatry
• Psychology
• Acupuncture
• Glasses and contact lenses

• Pharmaceutical Beneﬁts Scheme
• The Pharmaceutical Beneﬁts Scheme (PBS) was introduced by the Commonwealth
Government in 1986.
• This scheme subsidises most prescription medicines bought at pharmacies in
Australia. The major aim of the PBS is to allow all individuals, regardless of socio-
economic status, access to necessary prescription medication.

Private Health Insurance

Complementary and alternative health care
approaches
• Reasons for growth of complementary and alternative health products and services
• Complementary and alternative health care approaches is a group of diverse
medical and health care systems, practices and products that are not generally
considered to be part of conventional medicine.
• Australians spend approximately $1 billion per year on alternative health care
• Complementary therapies are so-called because they are not necessarily
designed to replace orthodox medicine, but are an additional approach that can
be used alongside traditional treatments. Treatments such as acupuncture and
osteopathy, and the use of herbal medicines, are now far more common than
they once were
• Another reason for the growth in alternative medicines and health care
approaches has been the increase in the number of trained personnel as a result
of courses now being provided in some universities
• The popularity of alternative medicines and health care is also linked to a
reaction in the community against the use of conventional drug-based
medication, and a preference by some people for the holistic approach oﬀeredby
natural therapies where diet and lifestyle are discussed.

approaches
• Reasons for growth of complementary and alternative health products and services
• People are also starting to show a greater interest in natural health care because
it is designed to prevent illness occurring, whereas conventional medicine is
largely reactive.
• Another reason for the growth of alternative health care is that some private
insurers are now recognising natural therapies and placing them on their beneﬁts
list.
• ACTIVITY
• Explain why alternative medicines are called ‘complementary therapies’.
• Describe the factors that have contributed to the increased acceptance and
popularity of alternative medicines and approaches.
• Outline how a health consumer can ensure that an alternative approach is of
some value.
• Describe what recourse the consumer has if the
treatment is unsuccessful.

approaches• Range of products and services available
Type Description
Acupuncture Uses fine needles to stimulate change in the energy balance of body to restore health.
Can be used for pregnancy and stress also
http://www.youtube.com/watch?v=WzMUhD8hecU&feature=channel
Aromatherapy Uses oils from nature (plants, flowers) to stimulate or relax the body. Can also maintain
resistance from disease.
Chiropractic Manipulation of the spine to correct spinal displacements
http://www.youtube.com/watch?v=O5wB-iSUsYg&feature=related
Herbal Medicine Herbs are used following traditional customs as an alternative to pharmaceutical drugs.
Iridology Diagnoses the state of the body from examination of the iris (eye)
Naturopathy Based on the belief that the body can heal and maintain itself. Herbs, vitamins, and diet
are used to help the person take responsibility for their own health. Many terminal
cancer patients try this method. Can be used also for adhd treatment also.
Reflexology Reflexes in the feet and hands relate to most the body and can promote healing and
relaxation.
http://www.youtube.com/watch?v=DRtvN6VLw5s&feature=channel
Yoga Yoga has been found to reduce stress and lower blood pressure through a combination
of breathing exercises, physical postures and meditation.
Osteopathy Osteopathy involves manual deep-tissue massage and the manipulation of the spine,
joints and surrounding tissue to alleviate back pain, joint problems and muscular
disorders

approaches• How to make informed consumer choice
• Despite the increased acceptance of alternative health care approaches there are
still many treatment options promoted as cures or remedies that have been
designed by unscrupulous dealers attempting to take advantage of people
desperate to obtain relief from ailments
• It can be difficult to gain information regarding alternative health care.
• Many drug companies fund much of the medical research, therefore not much
research is dedicated to alternative medicine research as this could take away
some of their earning potential

WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY
IN
ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS REVISION
• Evaluate health care in Australia in relation to social justice principles.
• Describe the advantages and disadvantages of Medicare and private health
insurance.
• There is a range of health services and information available to the individual.
Justify the factors you would consider when deciding on the suitability of health
services and information.
• Propose the reasons for the growth of alternative health care approaches in
Australia.
• Describe how many sectors of the community share the responsibility for
health care in Australia
• Explain how a greater focus on health promotion and prevention could lead to
a decrease in health expenditure in the long term

Core 1
What actions are needed to
address Australia's health
priorities.

Students learn about :
• health promotion based on the five action areas
of the Ottawa Charter:
– levels of responsibility for health promotion
– the benefits of partnerships in health promotion, e.g.
government sector, non-government agencies and the
local community
– how health promotion based on the Ottawa Charter
promotes social justice
– the Ottawa Charter in action

Health promotion is the process of enabling
people to increase control over, and to improve,
their health. To reach a state of complete
physical, mental and social well-being, an
individual or group must be able to identify and
to realise aspirations, to satisfy needs, and to
change or cope with the environment. Health is
a positive concept emphasising social and
personal resources, as well as physical
capacities. Therefore, health promotion is not
just the responsibility of the health sector, but
goes beyond healthy lifestyles to well-being.
- WHO, 2010

Health Promotion
• http://www.youtube.com/watch?v=FZXVM_ad3No – irish mental health
• http://www.youtube.com/watch?v=AY5AILaXDdA&feature=fvw – get active
• http://www.youtube.com/watch?v=SfAxUpeVhCg – anti smoking
• http://www.youtube.com/watch?v=fnYu9X6b0XE – micro sleep
• http://www.youtube.com/watch?v=iCCt-Bo07oc – anti violence
• Health Promotion (HP) is a combination of science, medicine, practical skills
and beliefs aimed at maintaining and improving the health of all people.
• Just as important HP, recognises the importance of changing determinants:
– Social (drink driving is socially unacceptable)
– Economic (investing in health is important)
– Environmental (setting up speed zones, smoke free areas etc)
• Health promotion is not just the TV ad or billboard, rather, it involves research,
policy development and enforcement and education of the general public.

Health promotion based o the five action areas of the
Ottawa Charter:
• Levels of responsibility for health promotion
• Health promotion is not just the responsibility of the health sector but requires
a coordinated action by all governments as well as by health and other social
and economic sectors, non-government and voluntary organisations, local
authorities, industry and the media.
• The Ottawa Charter was developed in 1986 to build a global ‘all for health’
movement as a means to realise the right to health of all humans. The ﬁve
action areas of the Ottawa Charter are:
– developing personal skills
– creating supportive environments
– strengthening community action
– reorientating health services
– building healthy public policy.
– http://pdhpe12.pbworks.com/w/page/10661231/Ottawa-Charter-for-Health-Promotion-(1986)
• The charter aims to develop partnerships and support networks with public,
private, government, non-government and international organisations to
create and maintain actions to promote health

Ottawa Charter:
• Levels of responsibility for health promotion

Ottawa Charter:
• The benefits of partnerships in health promotion
• Effective health promotion must involve the cooperation of a variety of
government and non-government organisations.
• The public health approach acknowledges that effective health promotion
requires inter-sectoral involvement.
• It also emphasises the importance of creating an environment that is fully
supportive of positive health behaviours and actively involves the community.
• Inter-sectoral (governments, NGO, community groups, schools, businesses,
recreation groups etc) action about a health concern makes possible the
joining of all the knowledge available about the health concern
• It also allows for access to the resources and skills needed to understand and
solve complex issues where possible solutions lie outside the capacity and
responsibility of a single sector.
• Another benefit is the development of a stronger community network.

Ottawa Charter:
• The National Mental Health Strategy brought together federal government
departments with state and territorial governments, community groups,
professional associations and private sector organisations to develop an
intersectoral response to addressing mental health issues.
• Intersectoral action results in increased public awareness; implementation of a
range of health, social service, criminal justice and housing services; and
networks of partners who continue to work together
• There are significant potential benefits to be realised from adopting, supporting
and sustaining an intersectoral action approach, including:
• a greater capacity to tackle and resolve complex health and social problems that have eluded
individual sectors for decades, resulting in improved population health and well-being, and
reduced demand for health care and social services in future
• a pooling of resources, knowledge and expertise, and development of networks, that will allow
partners to address current problems more effectively and position them to respond better to
future issues
• reductions in duplication of effort among different partners and sectors
• new collaborative and inclusive ways of working together that will enable partners to contribute
to improvements in social cohesion, provide increased opportunities for sustainable human
development, and create a more dynamic and vibrant society.

Ottawa Charter:
• CASE STUDY

Health promotion based on the five action areas of the
Ottawa Charter:
• Activity
• In pairs, create a list of different sectors of the community that are involved in
health promotion. EG – Government puts in legislation like no smoking on public
transport etc. Analyse for:
• Road safety
• Skin Cancer
• Smoking is a major health concern in Australia. Conduct a review of health
promotion strategies designed to reduce smoking. Argue the beneﬁts that
partnerships have had on health promotion in relation to smoking.

Ottawa Charter:
• The 5 action areas of Ottawa Charter
• The action areas applied to address heart disease:
• Reorientating health services – This could include strategies for screening
programs to identify risk factors sch as obesity and hypertension. Free check ups
for people in high risk categories such as males over 45 and training for doctors
to identify high risk patients.
• Developments personal Skills – This could include strategies for courses in time
management, yoga or other stress management techniques and PDHPE lessons
that educate students about nutrition and exercise.
• Creating supportive environments – This could include strategies for smoke free
zones, workplaces that reduce exposure to tobacco smoke and programs such as
QUIT that provide social support to smokers who are trying to give up.
• Building healthy public policy – This could include strategies such as no GST
applied to fruit and vegetables and high taxes on cigarettes and alcohol.
• Strengthening community action – This could include strategies such as healthy
canteens in schools, breakfast exercise groups in local communities or
community obesity forums.

Ottawa Charter:
• The 5 action areas of Ottawa Charter
• The action areas applied to address Measles (Immunisation program):
• Reorientating health services – This could include strategies such as in 1997 the
minister for health announced a 7 point plan to raise vaccination rates. Doctors
were offered payments for each child they immunise.
• Developments personal Skills – This could include strategies such as media
campaigns with series of tv ads showing the distressing reality of whooping
cough and urging them to have their child vaccinated.
• Creating supportive environments – This could include strategies such as a
Maternity Immunisation Allowance was introduced in addition to the normal
maternity allowance. State governments were enlisted to require parents to
submit details of their childs immunisation history, when they enroll at school.
• Building healthy public policy – This could include strategies such as a new
national Australian Childhood Immunisation Register was set up to monitor
immunisation levels. They were rewarded when vaccinations rose
• Strengthening community action – This could include strategies such as financial
pressure being placed on parents to have their child immunised, especially when
they were in school or childcare.

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