Identifying priority health issues

Social justice principles

Social justice principles relate to eliminating inequity in health, promoting inclusiveness of diversity and establishing supportive environments for all Australians.

“Equity means that resources are allocated in accordance with the needs of individuals and populations with the desired goal of equality of outcomes.”[2] This means that some groups within Australia receiving more funding and are often identified as priority groups in Australia. This is because they have poorer health outcomes than other Australians. ATSI are an example of a people group who require additional funding and resources in order to improve health outcomes.

Diversity refers to the differences that exist between individuals and people groups. We are a diverse and multicultural country and as such we require a number of measures to be in place to ensure people within our diverse country have access to health care and achieves good health outcomes. A good example is providing health information in multiple languages and having interpreters in hospitals provides all people with opportunities to access health.

Supportive environments  are environments where “people live, work and play that protect people from threats to health and that increase their ability to make health-promoting choices.”[3] The government looks to create supportive environments for all people and works to determine if those who live in some environments might have poorer health outcomes. Rural and remote people are an example of people whose environment is not as supportive as other environments.

The social justice principles seek to recognise and address both the health outcomes, such as: incidence and prevalence of disease, and death rates, and the factors that influence health, such as: socioeconomic status, environment, and cultural factors.

We need to recognise and address inequities in health. These inequities encompass both differences in the incidence and prevalence of sickness and death, and inequalities in the social, economic, political and cultural factors that influence health. Our health status is relatively good compared with that of other countries, however we can always make improvement in some areas. For example the high incidence of diabetes in the indigenous population and the high incidence of injury in the 15–24 years age group are significant inequities in health.

By applying the principles of social justice in our identification of health priorities, we can determine the impact these principles have on reducing health inequities and improving the health of the nation. For example the provision of equal access to resources, health services, education and information may reduce the incidence of diabetes in the indigenous population.

Priority population groups

Australia is a diverse and multicultural society. Multiculturalism is the coexistence of groups in a society representing different cultural and linguistic backgrounds. We have a population groups who have significantly different health and these inequities reflect our diverse population. The identification of priority population subgroups with inequitable health status is important for determining health priority issues.

It allows health authorities to:

• determine the health disadvantages of groups within the population • better understand the social determinants of health • identify the prevalence of disease and injury in specific groups • determine the needs of groups in relation to the principles of social justice.

Epidemiological information reveals that:

• indigenous populations have much higher death rates from heart disease, injury, respiratory diseases and diabetes

• people from a low socioeconomic background have a higher incidence of disease risk factors such as high blood pressure, high cholesterol levels, smoking and lower use of preventative health services

• people living in rural or isolated locations have higher death rates and a higher incidence of heart disease and injury, compared with people who reside in metropolitan areas

• men are at much greater risk than women of developing a number of diseases (including heart disease and lung cancer). These are only a few examples of subgroups that have specific health issues.

Prevalence of a condition

Prevalence is “the number or proportion (of cases, instances, and so forth) in a population at a given time. In relation to cancer, prevalence refers to the number of people alive who had been diagnosed with cancer.”[1] This is different to incidence, which refers to the number of new cases diagnosed in a specific time period.

The prevalence of a condition is used to determine the number of people affected by the health issue. The higher the prevalence the greater the health issue, which may then be identified as a priority health issue in Australia.

There are many current conditions that are high in prevalence and have become priority health issues.  These include:

• Cardiovascular disease – has been a priority health issue for a long time in Australia and will continue to be long into our future.

• Cancers – have been a growing priority in Australia, although the decreased smoking rate is helping.

• Dementia and Alzheimer’s disease – affect many Australians today, particularly the elderly.

• Diabetes – is not only prevalent in Australia, but has an increasing incidence, making it a very high priority issue for Australia’s health.

• Cerebrovascular disease – like cardiovascular disease continues to be a major health issue and has similar underlying causes as cardiovascular disease. From <https://www.pdhpe.net

High prevalence rates of a disease indicate the health and economic burden that the disease or condition places on the community. Statistics reveal, for example, that cardiovascular disease is the leading cause of preventable death in Australia.

Potential for prevention and early intervention

The majority of diseases and illnesses suffered by Australians result from poor lifestyle behaviours. As such, to improve health status we can encourage individuals to change their poor behaviours, but it's not this simple. It is hard to change individual behaviours because often they reflect the environmental situation in which the individual lives. Prevention of illness, such as protecting the skin from sun damage and potential melanoma, can improve health outcomes for individuals.

Socioeconomic status, access to information and health services, employment status, housing, support networks and environmental infrastructure (such as roads, water supply, sewerage and power grids) are increasingly being viewed as the determinants of health inequities across the population. For change to occur we must address both individual behaviours and environmental determinants.

Most of the chronic diseases, injuries and mental health problems have social and individual determinants that can be modified, so prevention and early intervention may lead to improved health status. In relation to health priorities in Australia, the more potential for prevention and early intervention the more likely the health issue will be made a priority. This is particularly the case if the condition has both potential for prevention and potential for early intervention.

Costs to the individual and community

Disease and illness can place a great economic and health burden on the individual, which can lead to financial loss, loss of productivity, diminished quality of life and emotional stress. The cost of treatment, medication and rehabilitation may be more than the individual can afford. Further, injury and disease may affect the individual’s ability to be productive, and often the need to stop work during treatment and rehabilitation reduces the individual’s ability to earn and thus to maintain their quality of life. The emotional stress and social upheaval that often result from illness and injury are another burden. It is difficult to estimate the pain and suffering that an individual experiences as a result of illness and injury, but it is a significant factor. In addition, illness, disease and premature death all place an economic burden on the community.

The impact of disease in economic terms can provide some estimate of the cost to the community. This cost can be useful for health authorities when they are prioritising health issues and determining health interventions. Illness results in both direct and indirect costs.

• Direct costs include the money spent on diagnosing, treating and caring for the sick, plus the money spent on prevention. These costs can be estimated from the expenses of medical services, hospital admissions, pharmaceutical prescriptions, prevention initiatives, research, screening and education, for example.

• Indirect costs are the value of the output lost when people become too ill to work or die prematurely (for example, the cost of forgone earnings, absenteeism and the retraining of replacement workers). OUTCOMES 2, 2020