Measuring health status

Overall, the quality of health care in Australia is considered positive and there is a national drive to both maintain and improve the current level of physical and mental wellbeing of all Australians.

Demographically, Australia has a diverse, multicultural community with people of many ages, backgrounds, and ethnicities. These range from indigenous communities and Torres Strait Islanders, to second generation families and recent immigrants. Like many first world countries, Australia is also struggling to deal with the strain of an ageing population on the health care system.

Health professionals and medical scientists aren’t just investing money and time into finding cures for diseases and other medical conditions. They are also looking for opportunities and strategies to prevent illnesses from occurring in the first place.

There is a vast quantity of health information available in print and online. Because it is difficult to tailor this data to the unique qualities of an individual, health professionals often categorise and gather information about various health issues by demographic groups. For example, identifying health problems in specific age groups, genders or ethnicities.

This practice is called epidemiology and describes the process of examining a disease across demographic groups by collecting and analysing data to determine the pattern or cause of infection. This process is important as both governments and doctors can use these results to make strategic decisions about tackling and eliminating certain health problems.

Australia has a limited health budget, so the government must invest wisely in the content and delivery of campaigns designed to improve health. This might involve releasing information about new inoculations or changing attitudes and perceptions of modifiable behaviours such as smoking, which can lead to lung cancer, or drinking, which can lead to liver failure.

Measuring the quality of health and conducting statistical analyse of medical issues in Australia serves a critical role in maintaining and improving Australia’s overall health rating. Access to accurate and relevant medical information enables governments and health professionals to make informed decisions about which health issues need to be urgently addressed and allow them to prioritise certain health campaigns and target specific groups.

Roles of epidemiology

Epidemiology can be used to study disease and illness in specific, localised groups, or larger populations. When gathering data on a disease, epidemiologists examine four main areas:

– Prevalence (the number of cases)

– Incidence (the number of new cases)

– Distribution (the extent of disease/ infection)

– Possible causes (the possible determinants and indicators)

This data allows these specially trained medical professionals to identify patterns and to theorise and then prove cause and effect.

Measures of epidemiology

There are a number of additional measures, which epidemiologists may refer to when analysing a particular illness:

– Mortality: the number of deaths from a given cause in a specific population within a certain time frame

– Infant mortality: the number of deaths that occur in the first year of life per 1000 births

– Morbidity: the rates and trends of a disease, illness and injury in a specific population

– Life expectancy: the number of years an individual or group can be expected to live

What can epidemiology tell us?

By examining the data available it is possible to determine the seriousness and extent of particular health issues. For example, epidemiologists can determine where a disease originated from, the locales it has spread to and the specific demographic groups it is affecting. They can also attempt to identify whether there is a common determinant that causes, or correlates with, the health issue they are studying.

One other significant detail the data can provide is whether the health problem is modifiable. Obviously, the bigger the health issue, the greater the priority.

Who uses these measures?

Epidemiological data is used by a variety of people, agencies and groups to inform decision making processes and, consequently, improve the planning, implementation and effectiveness of any health initiatives or programs they introduce.

Some examples of agencies and groups that are interested in the data epidemiology provides are the:

Australian Department of Health: uses epidemiological data to ensure funds are allocated to the areas and health issues in Australia, which need it most.

Department of Education: utilises epidemiological data to inform students and young people about health issues relevant to their age and circumstances and put policies in place (e.g. no hat no play policy).

Hospitals: study epidemiological data to make informed decisions about which health issues to prioritise and which high risk areas of health to target.Specialists can also use the data to design health promotion strategies, to enforce good health practices.

Pharmaceutical companies: monitor epidemiological data to direct their investment into medical research and marketing, as well as determine which kinds of medications and experimental drugs are in demand.

Doctors: rely on the patterns identified by epidemiologists to inform the direction of their own research. They can also use the information to target patients who require urgent and essential health care or to promote and raise awareness of particular health problems.

Do they measure everything about health status?

Epidemiology does have some limitations. It doesn’t take into account the quality of life and the quality of life lost or the emotional suffering of patients and those around them. The data also cannot provide an explanation as to why people participate in risky behaviour, especially when they are aware of the consequences. Another factor that epidemiological data cannot provide data on is whether there are multiple determinants leading to particular health issues or just one.

Epidemiological studies provide important data, used by government agencies and health organisations, but the reliability of sources are sometimes questionable. The patterns and causes identified can only provide guidance, not a concrete plan for action.

Additionally, the epidemiologists only identify patterns of past behaviours and patterns. They can’t use the results to predict future developments and they don’t measure data relating to the implementation of health programs. Incidentally epidemiology can’t explain why some demographic groups respond differently to the same program or initiatives or how health funds can be distributed equally and efficiently.

Identifying priority health issues

In this section elements of the criteria used to identify priority issues are examined. This information is sourced from a variety of data and are used by government agencies to determine how to best spend their health budget and where to allocate any additional resources.

Social Justice Principles

Principles of social justice in health care focus on eliminating inequity in treatment and care. Organisations, groups and individuals who practice these principles promote inclusive programs, which provide health care and medical support to all people in Australia.

There is a significant difference between equality and equity. Some people think that health issues can be resolved by providing everyone with equal treatment. However, not all demographic groups have the same benefits, opportunities and advantages, so equal treatment will not necessarily result in equal results. Social Justice Principles seek to address this disparity and provide equitable health initiatives, which provide additional support to groups in need.

To summarise, an equal situation is one where everyone receives the same treatment, regardless of their circumstances. Social justice principles support a more equitable approach, which means disadvantaged individuals receive assistance respective to their needs to ensure that the treatment results in the same benefits for every patient.

Remember, not all groups experience the same advantages or have access to the same health care in Australia. Groups in rural, socio-economically disadvantaged or remote require more specialised services and care than their urban counterparts.

“Equity means that resources are allocated in accordance with the needs of individuals and populations with the desired goal of equality of outcomes.” This results in particular groups within Australia receiving more funding and being identified as priority groups in Australia 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. Australia is a very diverse multicultural country, which requires a number of measures to be in place to ensure each people group within our diversity has access to health care and achieves good health outcomes. Providing brochures in multiple languages and having interpreters in hospitals are examples of being inclusive of diversity.

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.” The government looks to create supportive environments for all people, but also looks at the environments of particular people groups to determine if these might be reasons for poorer health outcomes. Rural and remote people are an example of people whose environment is not as supportive as other environments.

Supportive environments

In health care, social justice principles create a supportive environment for patients. An example of a supportive environment is one where the social, political and environmental conditions help an individual or community achieve optimal health.

Supportive environments should also be participatory so that individuals, groups and communities can be involved in the decision making process, become responsible for improving their own health and help design effective programs to target health issues.

For example, discussions around the health of Aboriginal and Torres Strait Islanders should always involve members of these communities because they know the customs and attitudes of that group better than anyone else. For a health program to succeed, it needs to be tailored to the social values and behaviours of the target group. Participatory environments create the culture necessary to address and treat serious health issues.

Supportive environments should also ensure that laws protect the rights of humans to good physical health and adequate medical support. Part of this process involves facilitating access by removing the barriers, which stop people from having fair and equitable access to health care. They

For an environment to be supportive it also needs to recognising cultural, religious and other differences and promote equity by distributing resources in manner that enables all individuals and groups to achieve equal, healthy outcomes.

Priority population groups

Priority populations are groups of people who experience an abnormally high prevalence of a particular condition. In these situations government agencies must consider whether targeting the specific community will the improve the overall health of all group members.

For example, there are a number of groups who encounter an abnormally high prevalence of CVD. These groups include those from low socioeconomic backgrounds, rural areas and indigenous communities. A targeted health campaign, aimed at these communities has the potential to decrease the prevalence of CVD, which is a highly modifiable disease.

Prevalence of condition

Prevalence of condition refers to the number of cases of a disease present in a population at a specific time. If there is a high prevalence of a disease then there is a health burden on a group or community which is also likely to have an economic and emotional burden on this community also.

When looking at medical data, an epidemiologist must attempt to discover whether a disease is affecting a particular group of people, concentrated in a specific geographical area and if infection is on the increase.

Potential for prevention and early intervention

Many of the health issues which effect the Australian population are the result of poor lifestyle choices. For example, lung cancer can be caused by cigarette smoking and excessive drinking may lead to liver failure.

If these high risk lifestyle risks are identified then government agencies can implement relevant educational programs and promote healthy behaviours. Raising awareness can result in modified attitudes and perceptions which can lead to a healthier population and increased prevention of serious health issues.

Epidemiological data offers insight into Australia’s dynamic population and groups. this information can also help agencies and organisations understand, identify and even predict which lifestyle choices can have a negative effect on health. Campaigns can then be designed to facilitate early intervention and prevent the development of greater health problems.

Many illnesses and diseases in Australia are caused by the modifiable determinants of lifestyle choices (i.e. diet) and behaviours (i.e. exercise). Therefore investing in educational programs to promote healthy attitudes is essential, and can have a lasting impact federal budgets and the long term health and quality of life for people in Australia.

Early intervention and prevention of serious health issues also eases the financial burden, pain and suffering of individuals and their families and has the potential to save the government millions of dollars.

Costs to the individual and community

When considering the priority of a particular health issue, the government will consider the associated financial, societal and emotional costs to both the individual and the larger community. The term, “burden of disease”, is frequently used to describe the ‘expense’ of poor health.

It is possible to break down the burden of a disease by identifying the direct (financial) and indirect (social) costs.

Consider the following scenario: An individual develops cardiovascular disease and suffers a stroke.

The potential direct costs to the individual may include:

– hospital fees

– medications

– bills for medical opinions and consultation

The indirect costs to the individual are harder to measure and may include:

– persistent or debilitating pain

– loss of quality of life

– social exclusion

– mental exhaustion and depression

Potential direct costs to the community are:

– the funding needed for treatment

– cost of procedures and other tests covered by medicare

Potential indirect costs to the community are wide reaching and may include:

– the emotional and financial strain on friends and family

– the premature loss of a valued or influential member of the community

– impact on local business and industry due to loss of an employee

Groups experiencing health inequities

Aboriginal and Torres Strait Islander peoples

The nature and extent of the health inequities

Australia is considered one of the healthiest nations in the world, yet there is a large disparity between the life expectancy of Indigenous and non-Indigenous Australians. On average, Indigenous Australians are expected to live between 10 to 17 fewer years and the infant mortality rate of this community is almost 3 times higher than the national average.

The main causes of poor health in indigenous communities can be attributed to:

– mental health issues

– cancer

– respiratory disease

– diabetes

– circulatory diseases.

The sociocultural, socioeconomic and environmental determinants

So, why do these health inequities exist?

Since the arrival of the first fleet, there have been many circumstances which have lead to the current level of poor health for Indigenous Australians, including, but not limited to oppression, segregation, forced assimilation and poor integration.

Additionally, European settlers introduced a variety of diseases and infections to Australia and the indigenous population. These diseases had a devastating impact on many communities, as Indigenous Australian had no previous exposure to these illnesses, meaning that they had no immunity.

The current health inequities in Indigenous and Torres Strait Islander communities can be attributed to lower levels of education and higher rates of unemployment, resulting to lower income levels.

Another contributing factor is that a majority of indigenous Australians live in rural and remote areas where community members have poor access to health providers, low quality care facilities and preventative strategies, such as immunisation, a less consistently implemented.

Lower education levels often result in high risk lifestyle choices such as a unhealthy diet, inadequate exercise, poor drinking habits, smoking and, in some cases, illicit drug use, all of which are be detrimental to physical and mental health. This is attributed to a insufficient health awareness and a lower standard of education, both of which have lead to a poor understanding of the correlation between these behaviours and poor health.

In summary, there are three specific determinants which have led to the vast inequalities experienced by Indigenous Australians:

• SOCIOCULTURAL As a result of the first settlement and the consequent colonisation of Australia, the ATSI group has experienced loss of land, identity, culture and, for some, their self esteem and self worth.

• SOCIOECONOMIC Overall lower socioeconomic status, interrelating with lower levels of education – higher rates of unemployment – and lower income levels

• ENVIRONMENTAL Approximately, a quarter of Indigenous Australians live in rural and remote areas resulting in less access to health products, facilitates and services

The roles of individuals, communities and governments in addressing the health inequities

So, what can be done to eliminate these health inequities?

Individuals, communities along with federal and state governments all have a role to play in improving access to health care and the quality of life for all Aboriginal and Torres Strait Islander Groups.

Every ATSI individual needs to be, and feel, empowered to take responsibility for their health and make decisions that will improve their quality of life. This means that there needs to be drive to increase education and awareness of good health practices in indigenous communities. Long term objectives include increasing the quality of education, offering community support, recruiting elders to role model healthy behaviours and providing greater access to health services and facilities so that individuals have the opportunities and benefits afforded to other groups living in Australia.

The role of the community is to ensure that Indigenous Australians are aware of cultural and reconciliation programs offered locally. Local officials can work with tribal elders to empower Indigenous communities to become self-sufficient and autonomous when promoting services, raising awareness and breaking down the barriers to health care access.

The Government is responsible for overseeing the protection and implementation of Indigenous health care on a national scale. They are also responsible for creating initiatives such as Close the Gap; a preventative health service for Aboriginal and Torres Strait Islanders. Through the creation of this program and others like, government agencies demonstrate that they are aware of health within Indigenous communities and recognise that improving quality of life for ATIS groups is a priority. The NRL has also promoted and supported this initiative by creating the Indigenous all star game, which aims to raise awareness of indigenous health issues.

Socioeconomically disadvantaged people

Socioeconomic status refers to the status or position of an individual or group of people and is typically determined by:

– Where a person lives

– Their employment status

– Their household income

The nature and extent of the health inequities

People who have better access to healthcare services and resources are typically healthier than people who don’t have the same access, opportunities or financial stability. Consequently there is a correlation between individuals with a lower healthcare status and people who live in low SES areas.

People in low SES groups generally have a higher rates of mortality, morbidity and infant mortality. Additionally, individuals in this group have a lower life expectancy and are more likely to develop mental illness, asthma, diabetes and CVDs. There is also a link between low SES and poor educational levels and people with possess little to no knowledge of good health practices are more likely to engage in high risk behaviours and adopt and unhealthy lifestyle.

The sociocultural, socioeconomic and environmental determinants

Low SES and low health status are strongly connected. People who reside in lower SES areas tend to exhibit one or more of the following traits:

– An inactive lifestyle

– High risk behaviours

– Poor eating habits

– Poor access to, or disinterest in, healthcare services

– Dependency on government assistance

While low SES can lead to poor health, poor health can also lead to low SES. For instance, if a 40-year-old person suffers an injury or illness, it could impact their ability to perform their job requirements, leading to reassignment, a reduction of hours or dismissal. They may also require expensive medical products or procedures to treat their injury or illness.

The roles of individuals, communities and governments in addressing the health inequities

To improve the equity and overall health of people living in low SES areas individuals, communities and governments must take on certain responsibilities and commitments.

Individuals living in low SES circumstances must learn better health practices and pass these behaviours on to their children. These individuals must take responsibility for their dietary choices and exercise habits, to empower them to live healthier, better quality lives. The danger of high risk behaviours such as drinking, smoking and drug use should also be emphasised, long with the importance of life long learning and educational health.

The community should encourage the efforts of individuals by providing a range of government-funded, supportive initiatives. Childcare, community healthcare, primary care, education, employment training and migrant services are all examples of programs that can promote good health behaviours and alleviate the strain on low SES individuals.

The role of the government is to supply subsidies and funding to negate the high costs of health education and promotion. The government must recognise and respond to the inequalities people within this group, recognising that the costs associated with both bad heath and improving lifestyle behaviours may be prohibitive for individuals living in the low SES areas. Consequently, an array of government programs – public housing, pension cards, concession cards, Centrelink and Austudy – must be sustained and improved to relieve the pressure on low SES groups. Initiates like the Pharmaceutical Benefit Scheme and Medicare were created for this exact purpose; to decrease the gap between low and high SES groups by providing a service directed toward people who had most need for it.

People in rural and remote areas

The nature and extent of the health inequities

Occurrences of diabetes and depression are fairly even, between individuals who live in urban or rural areas, However, in comparison to city residents, individuals living in rural or remote areas are more likely to be diagnosed with cancer or suffer psychological distress and overall have a lower life expectancy. In fact, there is a clear correlation between life expectancy and geographical location. The further people live from the city, the lower their life expectancy is.

The sociocultural, socioeconomic and environmental determinants

There are a number of reasons for the inequities between urban and rural groups.

People living in rural and remote areas have fewer educational and employment opportunities, which can mean result in lower levels of income and limited access to services they need to stay healthy. As with ATSI individuals there are three key determinants which contribute to inequities in quality of life and health care

• SOCIOCULTURAL Many individuals living in rural or remote areas adopt an attitude of avoiding complaints. This “she’ll be right” mentality can have a serious impact on decision making with many people failing to seek medical assistance when they first fall sick, believing they’ll get better without treatment or intervention.

• SOCIOECONOMIC Individuals living in rural areas often depend on the growth of crops or care of livestock for income. As a result, seasonal weather can have a negative impact. For example, a drought may impede a farm’s crop growth and cause financial, emotional and mental hardship to the farmer.

• ENVIRONMENTAL Living remotely means that individuals have geographical barriers when it comes to accessing health products, facilities and services. For example, individuals are less likely to seek medical assistance for the examination of moles, lumps and other anomalies when travel times are extensive, infrastructure is poor and the process is “too much of an inconvenience”.

The roles of individuals, communities and governments in addressing the health inequities

Individuals need to take responsibility for improving education levels by finishing school, eating a healthy diet and exercising regularly. Rural residents must also maintain and improve their social and mental health by creating and maintaining positive relationships with people in their local towns and communities.

Communities need to do more to attract and retain health professionals in their communities. They must communicate and collaborate closely with government agencies and health departments to encourage qualified professionals to serve and support rural areas. If they can do this, they can create and improve the services available for people within the community.

The government must commit to providing funding and adequate facilities in remote communities with small populations. They must also design and implement initiatives to promote health education and reward health professionals for providing medical services in rural area. More programs like the Royal Flying Doctor, which aims to bridge the gap between city hospitals and people in rural and remote areas, are needed to improves the access to good quality health services.

Overseas-born people

The nature and extent of the health inequities

24 percent of the Australian population were born overseas and a majority suffer from inequities, including a lower level of health.

There are two primary reasons for this disparity. The first is that many migrants suffer from higher level psychological pain, especially those with no English language skills or individuals seeking refuge or asylum from politically or socially unstable nations. A second cause of poor health is that exposure to Australian lifestyle behaviours and risk factors often results in higher the rates of both morbidity and mortality in individuals who were born overseas.

The sociocultural, socioeconomic and environmental determinants

To understand why inequalities occur it’s important to consider the socioeconomic, sociocultural and environmental factors. In Australia migrants are exposed to dangerous risk factors such as CVD or other illnesses that they are unlikely to encounter in their birth country. Migration, especially asylum seeking, has also been associated with decreased opportunities for employment and education, resulting in lower income and socio-economic status.

The roles of individuals, communities and governments in addressing the health inequities

To address inequities amongst any group it’s important to consider how governments, communities and individuals can collaborate and take on specific roles to produce long-term, sustainable solutions.

Individuals must overcome their reluctance or hesitance to access and take advantage of the health related services available to them, such as translators. They should also learn to utilise the support offered by communities.

Communities must offer support and services to overseas-born people such as multi-language services as well as educational and training opportunities. Communities must also promote and maintain open and friendly relations with new migrants, encouraging them to seek assistance and utilise relevant services.

The government can employ cost-effective methods such as free transportation and language services to ensure better communication and access to healthcare services for migrants.

High levels of preventable chronic disease, injury and mental health problems

Cardiovascular disease (CVD)

The nature of the problem

Cardiovascular disease (CVD) is a serious condition, which is caused by the narrowing of blood vessels and arteries, affecting blood flow and the health of the heart. There are various types of CVD. For example:

– A Stroke (cerebrovascular disease) which is caused by blockages or blood clots forming in the blood vessels of the brain.

– Coronary (ischaemic) heart disease, which causes angina and heart attack.

– Peripheral Vascular Disease, which is caused by blockages or blood clots forming in the blood vessels of the patient’s limbs.

Coronary Heart Disease develops when fatty deposits build up along the inner lining (or wall) of the arteries. These fatty deposits comprise of blood clots, calcium and cholesterol, which can limit blood flow through the arteries and cause blockages, interrupting blood flow completely.

Atherosclerosis is an associated condition and occurs when the lining pf the arteries harden and blood vessels lose elasticity. People who suffer from this condition lose their ability to regulate blood flow throughout their body.

Cerebrovascular disease occurs when a blockage or blood clot forms in the blood vessels in the head, interrupting blood flow and cutting off the supply of oxygen to the brain. This is a serious condition which can result in permanent brain damage or death.

Hypertension, or high blood pressure, is a common and less dangerous respiratory condition.

Extent of the problem (trends)

CVD morality rates have declined steadily since the 1970s due to increased awareness, improved forms of treatment and better technology. However, it remains a leading cause of illness and fatalities in the Australia.

Risk factors and protective factors

There are two types of risk factors for any disease: non-modifiable factors, which are biological traits beyond the patient’s control, and modifiable factors, which are behaviours or habits the patient can change.

– Non-modifiable risk factors which can lead to CVD include:

– Age and Gender (specifically, females over 65 and males over 40)

– Ethnicity (i.e. ATSI)

– Family history

– Diabetes

Modifiable risk factors, which patients can address to reduce the chance of developing CVD include:

– Smoking

– High blood pressure

– Obesity (bad diet)

– Physical inactivity

– High stress levels

– High cholesterol levels

The Protective Factors :

Protective factors are behaviours or practices people can adopt to maintain good health and reduce the likelihood of conditions like CVD from occurring. Practicing a healthy diet (low in salt, fats and alcohol), exercising regularly, managing stress and attending regular check ups with a GP are all examples of protective factors.

The sociocultural, socioeconomic and environmental determinants

Socioeconomic factors are the combination of employment, education and social status, which impact and shape a person’s attitudes, experiences and lifestyle. For example, an individual with a a low-level of education and income is likely to be aware of health risks or be able to afford healthy food or medical services.

People who live in rural or remote areas, particular ATSIs, are more likely to develop CVD. Individuals in these location have less access to healthcare facilities and are often poorly educated, without a stable income. These factors can also lead to high risk behaviours, like smoking, and other health problems, like depression or anxiety.

Groups at risk

The people most at risk from CVD include those who:

– Smoke

– Are obese

– Eat poorly or overeat

– Have a family history of CVD

There are also several demographic groups with high rates of CVD including:

– Indigenous communities

– Migrants and refugees

– The socioeconomically disadvantaged

– Residents of remote/rural areas

Cancer

The nature of the problem

Cancer is caused by the development of abnormal cells within the body. These are classified by cell type. For example:

– Carcinoma: affects the epithelial tissue (skin or organ linings)

– Leukaemia: affects white blood cells

– Lymphomas – affects the lymph tissue (i.e.white blood cells, bone marrow etc.)

– Sarcomas – affects connective tissue like cartilage, bone and blood

Tumours occur when these abnormal cells multiply and create swelling. There are two classifications of tumours: malignant and benign. The abnormal cells in benign tumours are localised and unable to spread to other areas of the body and, therefore, are not considered cancerous. However, removal is still recommended as these growths can put pressure on or affect internal organs and tissue.

Malignant, or cancerous, tumours are compromised of unstable abnormal cells, which multiply and invade other parts of the body. Cancer cells, which break away from the key site can travel through body via the lymphatic and circulatory systems. This process, called metastasis, can result in the development of a secondary cancer in another area of the body.

Extent of the problem (trends) + risk factors and protective factors + groups at risk

Cancer is the second highest cause of death in Australia, and the mortality rate increases with age. The two most common types are prostate cancer (in men) and breast cancer (in women). The development of new vaccine has helped reduce occurrences of cervical cancer.

Despite the reduction of cancer-related deaths since the mid-1980s, there has been a steady rise of cancer rates in Australia.

Skin Cancer

Malignant melanomas, basal cell carcinoma and squamous cell carcinoma are all examples of different types skin cancer. The most aggressive of these is the malignant melanoma, which spreads aggressively through the entire body and damages the organs.

Skin Cancer – Risk factors

There are a variety of risk factors which can contribute to the development of abnormal or cancerous cells, resulting in skin cancer. For example:

• Prolonged, non-protected exposure to the sun

• Red hair, freckles and fair skin

• Risk-taking behaviour (especially in young males)

• Outdoor job

• Where a person lives

Skin Cancer – Groups at risk

There are certain groups who are more at risk at developing skin cancer than others including:

– Males

– People who work outside

– People with fair skin, red hair or freckles

– People who don’t wear protection for the sun

Skin Cancer – Protective factors

Wearing loose clothes, a hat and applying a high factor sunscreen whenever an individual goes outside, can substantially reduce these risks. It is also advisable for people in Australia to spend less time in the sun and get regular medical checkups if they work outdoors.

Breast Cancer

Breast cancer is the number one cause of death for women in Australia, which is why it’s so important to get regular screening for the disease.

Breast Cancer – Risk factors

Breast cancer rates are particularly high for women, although the condition can also affect men. Other factors which can increase the chances of developing breast cancer include:

– Family history of the disease

– Weight gain and/or obesity

– Age (40 years old and older)

– Mothers who don’t (or can’t) breast-feed

– Use of contraceptive pills

Breast Cancer – Groups at risk

Women are the primary group at risk of breast cancer, especially if they are over 40 and never had children.

Breast Cancer – Protective factors

Women who are over forty or have a family history of breast cancer should see their GP for regular checkups from their doctor. Individuals who fall into any of the high risk categories can also conduct regular breast exams at home. Maintaining a healthy weight can also reduce risk.

Lung Cancer

Lung Cancer – Risk factors

There are certain factors and behaviours which can increase the risk of developing lung cancer including:

• Active or passive smoking

• Carcinogen exposure (asbestos)

• Air pollution

Lung Cancer – Groups at risk

The main demographic groups at risk of lung cancer are:

– Smokers

– People who live with smokers

– People who work in an asbestos environment

Lung Cancer – Protective factors

There are a number of protective behaviours individuals can adopt to reduce the risk of developing lung cancer. The simplest positive change a person can make to their lifestyle is to stop, or never start, smoking and avoid areas where people smoke. Individuals should also limit their exposure to dangerous particles and wear protective gear, like face masks, when using harmful inhalants to prevent breathing them in.

The sociocultural, socioeconomic and environmental determinants

A low socioeconomic status can be a factor in the development of harmful conditions like lung cancer and people who live. People with low incomes and below average education are often afforded fewer employment opportunities, are less aware of healthy practices and can’t afford to regularly seek out medical services. They are also more likely to adopt high risk behaviours like smoking, poor eating habits or not using sunscreen.

Even when individuals in low SES areas are aware of the risks, they may not necessarily have the money available to purchase healthy food, high factor sunscreen or any other product or service, which can contribute to overall good health.

Other group at high risk of developing cancer are ATSIs and individuals who live in remote or rural areas. These groups also suffer from high rates of low employment and poor education. Other socioculturally factors, include barriers like language. People who can’t speak English may be reluctant to seek medical assistance. This may due to a lack of knowledge about the healthcare services and resources available or because they can’t communicate well enough to explain their heath issue or understand the solution.

Environmental factors, such as location, air/food/water quality and climate change, can also affect cancer rates and general health. Climate change in Australia has resulted in the depletion of the ozone layer and increasing UV exposure. Similarly, air pollution, typically caused by industry and heavy traffic, can increase the chance for lung cancer.

Diabetes

The nature of the problem

Diabetes affects the bodies ability to remove glucose from the bloodstream and use it for energy. This is caused by a malfunctioning of the pancreas, which can result in insufficient insulin levels. Insulin is the hormone responsible for the regulation of blood glucose.

There are three types of Diabetes:

• Type 1: typically presents early in life and is treated via a regular injection of insulin, as well as carefully monitored diet and exercise.

• Type 2: generally presents later in life and has been closely linked to poor diet andlack of exercise. Treated with medication.

• Gestational Diabetes: occurs during pregnancy and must be closely monitored.

Possible long term effects of diabetes include vision impairment and kidney disease. Research suggests that there is also a strong link between the development of CVD and diabetes.

Extent of the problem (trends)

Diabetes is the world’s fastest growing disease. The age it is being diagnosed is also Type 2 Diabetes is being diagnosed is decreasing, which may be due to the unhealthy lifestyles of families.

Risk factors and protective factors

The modifiable, or changeable, risk factors of Diabetes include:

– being overweight of obese

– having gestational diabetes

– having CVD

– high blood pressure

– poor diet

The non-modifiable, or fixed, risk factors include:

– being over 55 years old

– being over 35 and ATSI

– family history

Protective factors

Individuals can lower the risk of developing diabetes by maintaining a healthy weight and lifestyle, which involves regular exercise and good food. A low GI diet and small meals are recommended. Decreasing the consumption of alcohol can also improve health and decrease the chances of becoming diabetic.

The sociocultural, socioeconomic and environmental determinants

The socioeconomic determinants which can impact the rate of diabetes include low levels of education and employment. People who live in low SES, rural or remote areas, have less awareness of health promotion and prevention strategies due to lower levels of education. These individuals are also less likely to eat well or exercise regularly as they are poor in funds and time.

Australia’s ageing population is a major sociocultural determinant of the high rate of diabetes. The casual cultural attitudes towards drinking in Australia also negatively impact health. The long work hours and low salaries of many Australians have led to poor time management resulting in poor choices relating to diet and exercise.

People who live in rural or remote areas, including ATSI, have less access to medical services, which is significant environmental determinant. Increased levels of technology use, leading to sedentary behaviours and fast food advertising, which encourage unhealthy eating habits, are also an issue.

Groups at risk

Groups in Australia who are particularly at risk of diabetes include the elderly

and ATSI. There are also high rates of diabetes in rural, remote and low SES regions.

Respiratory disease

The nature of the problem

Asthma, emphysema, chronic bronchitis are common types of respiratory disease. These conditions affect the respiratory system and can negatively affect the everyday function of individuals. They also place a significant burden on the health care system.

Extent of the problem (trends)

Morbidity and mortality rates are decreasing in Australia, due to education and awareness, but millions of Australians still suffer from long term respiratory illnesses.

Risk factors and protective factors

Modifiable, or alterable, risk factors of respiratory disease include:

– Taking preventative medication for asthma or stress

– SmokingPassive smoking (especially in enclosed areas)

– Non-Modifiable (or fixed) risk factors include environmental changes in weather. For example, high pollen levels in spring.

Individuals can take protective measures to reduce the risk of contracting a respiratory illness. For example, raising awareness of triggers for asthma sufferers, increasing health education, and not smoking, are all effective ways to improve health and decrease risk.

The sociocultural, socioeconomic and environmental determinants

Individuals who live in low SES, rural or remote areas are more likely to contract respiratory diseases. People in the areas, along with ATSI, are more likely to smoke, contributing to poor health and reducing the amount of money available for preventative medicine and treatment. Smoking and passive smoking can also irritate asthma and affect the health of entire families.

Family history is also a sociocultural determinant of respiratory illness. Pollution, exposure to passive smoking and residing in remote areas, with no easy access emergency services, are all considered to be environmental determinants.

Groups at risk

The groups most at risk of respiratory problems are smokers and people who are exposed, without the proper protective masks, to harmful chemicals or gases in the workplace.

People aged 65 and over, ATSI and people who have a low SES are also more likely to develop respiratory diseases. Living in rural and remote areas can also increase the severity or harmfulness of respiratory conditions. People who are unable to conveniently access to emergency services have an increases chance of dying from typically non fatal conditions, like asthma attacks. Young children are particularly at risk as they have higher incidences of asthma.

Injury

The nature of the problem

An injury is any hurt, whether it’s intentional or not, which is occurs due to an internal or external factor. Falls, burns, vehicle accidents and drowning are all injuries. While most injuries are minor and easily treated, more serious damage can result in permanent disability or death.

Extent of the problem (trends)

Inn the last few years, injury mortality rates have dropped. The number of accidents have also dropped, perhaps due to advertising and awareness campaigns. However, the amount of injuries amongst the elderly has actually increased

Risk factors and protective factors

Risk factors

The most common risk factor relating to injury is age. The older a person is, the more at risk they are from injury, particularly falls. Babies and young children are also at high risk of drowning.

A person’s occupation can also increase the risk of injury. For example, truck drivers are more likely to experience a vehicular accident due to the size of their vehicle and the time they spend on the road.

Similarly, certain environmental factors carry an additional element of risk. Extreme weather, conditions, outdoor work and drug use (legal or illegal) can affect safety and a person’s ability to handle themselves.

Protective factors

Individuals can reduce the chances of injury happening by employing common sense, acting responsibly, reading warning labels and other safe behaviours. This is particularly important when in unknown or dangerous situations or scenarios.

The sociocultural, socioeconomic and environmental determinants

Socioeconomic status, which is determined by income, employment and education levels, is determinant of injury.

For example, a person with a low SES is more likely to not insure their vehicle or home, due to financial strain. Driving a vehicle they can’t afford to maintain or repair to ensure safe working order (motor, brakes, air bags etc.) increases the chances of accident and injury. Individuals with low incomes may also not have the funds to apply safety measures like cupboard locks, which keep children safe from injury.

People with low education levels are more likely to participate risk-taking behaviours due to lack of knowledge or care. For example, speeding, failing to use contraceptives or not using seat belts.

Environmental factors can also impact on the risk of injury. There is a higher chance for road accidents in remote or rural locations. Another example are the laws, which govern regulations for facilities like pools and Workplace Health and Safety.

Groups at risk

There are a number of groups who have particularly high rates of injury. Elderly individuals are prone to accidents and are more likely to have falls. Aboriginal and Torres Straight Islanders are more likely to be involved in a road accidents or inflict self harm and people who live in rural and remote areas are at risk from work place hazards

There are high rates of road accidents and suicide amongst males, while children face danger from drowning or be poison. Young Adults are more like to be involved in road accidents, be injured during sport and recreational activities or self-harm.

Mental health problems and illnesses

The nature of the problem

Mental health issues affects a person’s cognitive, emotional and social well-being. Some examples of mental health problems are:

• Anxiety

• Bipolar disease

• Depression

• Dementia

• Schizophrenia

Mental illness may last for a short period, but if a condition persists it may be diagnosed as chronic or a disorder.

Extent of the problem (trends)

Mental health issues can be attributed to a small amount of mortality rates. But, more and more cases of dementia are being diagnosed in the ageing population.

Risk factors and protective factors

Risk factors:

Mental health issues contribute to a low number of mortalities. However, there have been an increase in cases of dementia amongst the elderly population.

Some of the internal and external risk factors that contribute to mental illness include:

– Lack of attachment to parents/caregivers

– Cultural discrimination

– Victimisation due to social exclusion or bullying

– Violence within the home

– A single-parent family

– Academic failure

Protective factors

In order to reduce the chance of mental illness, a person needs a good support network and positive relationships. Involvement in a variety of activities, clear boundaries and a sense of purpose can help with mental health.

The sociocultural, socioeconomic and environmental determinants

The environment a person lives in can affect their ability to deal with problems that arise. Living conditions, education level and economy can all determine the mental state of an individual.

People need to learn strategies for how to handle social an emotional problems as they get older. Unemployment, grief and other stressful events can cause mental instability. With the right knowledge and education individuals can apply the coping skills needed to get through those times.

Although life expectancy is increasing, physical and mental health problems still affect millions of Australia.

For example, there is a rise in morbidity rates for arthritis, cancer, CVD, dementia and more. Australia’s ageing population will need to use the hospitals more often, putting pressure on an already strained health care system. As a result hospitals will need to hire more staff and upgrade their facilities to handle the increased burden. Government funding will need to increase to cover these costs and help address the shortage of caregivers and facilities.

Groups at risk

– ATSI

– Males

– People 25 to 40 years of age

A growing and ageing population

Like many first world nations, Australia is facing a series of challenges caused by the steady rise of life expectancy and an ageing population.

Specifically, Australia needs to develop long term strategies and solutions to deal with:

– The strain on the health care system as hospitals struggle to find the resources to treat the elderly, without impacting the services available for other patient.

– Staff shortages caused by the demands of the job and low salaries.

– The urgent need for upgraded facilities to handle the increased burden.

– Inadequate government funding as health costs rise.

– The increased demand for healthcare services, which has lead to a shortage of caregivers and facilities

– The rise in morbidity rates for arthritis, cancer, CVD, dementia and other diseases where age is a risk factor.

Healthy ageing

There are a multitude of benefits associated with ensuring the health of an ageing population. Elderly Australians who are healthy enjoy their retirement more, don’t have as many healthcare needs and are more likely to be active participants in their communities.

Healthy ageing has two components: the availability of health services and the behaviours of individuals. People who take a proactive and healthy stance in regards to their lifestyle increase the quality of their life as they get older. A healthy lifestyle includes social activities, physical exercise, eating a healthy diet, mental stimulation and regular medical checkups.

These kinds of practices decrease the likelihood of disease and illness and improve the overall well-being of individuals as they age. As a result, they are more likely to productive society members even after retirement.

A healthy elderly population can lessen the burden on the healthcare system by ensuring people are in a position to continue to actively participate and contribute to their communities.

The government can take of proactive inspire health ageing to. How older Australians are doing health-wise, is the representation of behaviours and attitudes from earlier years. It’s important a healthy lifestyle is instilled early on in life to make sure the ageing population stays healthy.

Increased population living with chronic disease and disability

A majority of the health problems elderly Australians experience are a result of poor lifestyle choices. Eating a diet high in fat, salts and sugars, drinking too much alcohol, smoking, failing to exercise regularly or neglecting mental health can all have a serious and detrimental impact on long term health, especially for those who are older.

Overall, however, the quality of life for all Australians has improved. Due to advances in technology and medical science more people are surviving serious conditions likes heart attacks and cancer. In the twenty-first century people are able to live longer, even when the suffer from chronic health conditions.

Demand for health services and workforce shortages

There is a direct correlation between the rising elderly population increasing strain on the healthcare industry in Australia. The issue of healthcare budgets is particularly pressing as healthcare providers struggle to maintain the staff numbers and high quality facilities needed to provide services for sick and ageing Australians, who need both short-term and long-term care.

Examples of the services affected by this increasing pressure include:

– Hospital admission

– Prescriptions

– Diagnostic equipment

– Transportation

– Palliative care

However, the government has come up with several potential working strategies to combat the problem:

– Expanding the job description of nurses

– Increasing the number of nurses in high demand areas

– Superannuation laws standardising employee contributions toward healthcare

– A means tested pension to be available upon retirement

Availability of carers and volunteers

The number of Australians, aged 85 and older, who need specialised care has doubled in the last few years. This ‘burden of care’ falls on one of both of the following groups:

– Family and/or friends

– Government organisations

Examples of the various groups and organisations, which provide elderly care and support are listed below.

Government Organisations

– PBS (Pharmaceutical Benefits Scheme)

– State-run hospitals

– Bulk billing

– Money for nursing homes

Community Groups

– Church groups

– Meals on wheels

– Community nurses

– Transport

There is strong evidence to suggest that the strain on health providers and caregivers will continue to rise as the need for specialised care for the elderly increases. Unfortunately, care workers receive low salaries and little societal respect, despite the demands of their job. More incentives, especially financial ones, are needed to ensure that existing carers can sustain their career and that more people are attracted to the industry.

Health care in Australia

The OECD is the Organisation for Economic Co-operation and Development. According to the Australian Institute of Health and Wellbeing, Australia has a respectably high OECD rating. To maintain this rating it is imperative that Australia’s health care system is maintained and developed to continue improvements to all areas of healthcare in Australia.

The purpose of the Australian health care system is to provide equitable service to ALL Australians via healthcare facilities and services which promote healthy living, diagnose and treat illness, provide rehabilitation, and palliative care for individuals who suffer from illness, injury or are unable to live independently.

Range and types of health facilities and services

Australian health facilities and services are categorised into 2 groups.

INSTITUTIONAL FACILITIES AND SERVICES –

Medial institutions are health services which provide beds and facilities for overnight care, for example, hospitals and nursing homes.

Hospitals provide targeted care for illness, disease or other chronic conditions. There are several types of hospitals which operate in Australia, including public, private and psychiatric.

Public Hospitals are funded by the federal government and provide free health services for all Australians.

Private Hospitals are owned and controlled by non-government bodies, such as individuals, companies and community organisations. Because patients must pay for services in Private Hospitals, they are not accessible to all Australians. However, many of the costs are typically reimbursed by private health insurance and, in some cases, medicare.

Psychiatric Hospitals may be public or private establishments. Due to an increase in awareness and acceptance of mental illness and it’s causes and treatments, there are now less psychiatric hospitals operating in Australia.

Healthcare for individuals with mental illnesses now focuses on the integration of hospital services and care within community settings., instead of institutionalised care.

The other form of institutionalised care available to Australian’s are Nursing Homes.

These provide long term care and services for individuals, like the elderly, patients with severe disabilities or chronic illness, who cannot independently look after themselves.

There are several types of nursing homes including; public, which are funded by the state governments, non-profit, which are usually operated by church and community groups, and private, which are typically run by various stakeholders as a profit-making businss.

NON-INSTITUTIONAL FACILITIES AND SERVICES –

Non-institutional health services are no-stay, which means that patients receive treatment and then leave.

Medical services are an example non-institutional care. There are a number of experts who provide medical services to Australians, including doctors, specialists and other healthcare professionals.

The most common medical practitioners in Australia are General Practitioners. This is because work in medical centres, private surgeries and hospitals, making them accessible to the majority of people. GPs can also offer prompt diagnosis and treatment for minor illness/disease, or ailments or refer the patient to a specialist who can provide care for specific illnesses. For example, a patient experiencing severe rashes and skin irritation may be referred to a dermatologist; a doctor who specialises in the health of the skin.

The next service we look at are Health-related services.

Health-related services provide types of improve healthcare, which improve the general wellbeing and quality of life of individuals.

Dentistry, physiotherapy, optometry, dietary consultation, counselling and occupational therapy are all examples of health-related services.

Pharmaceuticals are another type of health-related service. Shops and pharmacies serve people by dispensing prescriptions or over-the-counter medicines to individuals.

Responsibility for health facilities and services

There are five groups responsible with providing a range of health facilities and services in Australia

Federal Government

The Federal Government is the responsible for the development and implementation of national health policies. They receive and control taxpayer dollars and then distribute the budgeted funds to states, territories and local governments so they can manage their health expenditures.

Medicare and the Pharmaceutical Benefits Scheme are examples of federal government initiatives, along with selected national health and advocate selected programs.

State or Territory Government

State and territory governments receive their funds from the federal government. They use this budget to finance and manage various health and community services, including public hospitals, medical practitioners and family health services. These agencies also devise state health policies, regulate private hospitals and surgeries, and make immunisation programs easily accessible.

Local Government

Local governments must implement and support policies devised by state or territory governments. They are also responsible for regulating any environmental issues, including restaurant hygiene, safety standards, maintaining parks and recreational amenities, along with home care services.

Private sector

Health services in this sector are generally privately owned, funded and controlled by individuals, businesses, charities or religious organisations. However, in some instances, private organisations receive government funding (e.g. Cancer Council). They offer a variety of health services including private hospitals, private surgeries and alternative health services, like dental, optical, physiotherapy and occupational therapy.

Community Groups

Community groups may take on the responsibility of raising awareness for specific issues, promoting health and organising support services. Examples include Diabetes Australia and Alcoholics Anonymous.

Equity of access to health facilities and services

Healthcare systems across the world are working towards the same goal of ensuring that every individual has equal access to healthcare.

Equality in access of healthcare can be considered from two perspectives:

1. Horizontal Equity

Horizontal equity takes the position that when the needs of two individuals are comparable, the treatment provided should be equal.

Consider the Medicare, Australia’s national public health insurance; all residents of Australia are able to access basic healthcare equally. The Pharmaceutical Benefits Scheme, also known as PBS, is another initiative provided by the Australian government which ensure that prescription medicine will be available to all Australian, at affordable prices.

2. Vertical Equity

Vertical equity is needed when groups or individuals are in high need of healthcare but are unable or have less access to services and facilities. Aboriginal and Torres Strait individuals as well as migrants, and refugees, who experiencing language and cultural barriers, fall under this category.

Both horizontal equity and vertical equity are of vital component of a fair healthcare system. Implementing vertical equity can be a slow and challenging process. It can be difficult to prioritise or support groups when taking geography, cultural, social and linguistic issues into account. For some Aboriginal and Torres Strait Islanders, mainstream health facilities and services may not be easily accessible or culturally appropriate.

Australian governments must use vertical equity to specifically target their healthcare needs. Federal and state governments fund specific health facilities and services to ensure equal access of health for Aboriginal and Torres Strait Islanders. Services include treatment, management of chronic health illnesses, health promotion, transport, prevention strategies and help accessing other facilities and services.

Health care expenditure versus expenditure on early intervention and prevention

Health Expenditure

Health expenditure describes the allocation of funding and other economic resources for the provision and consumption of health services.

There are two types of expenditure:

1. Recurrent expenditures consist of regular ongoing costs (i.e. salaries, bandages)

2. Capital expenditures are infrequent costs (i.e. buildings, equipment)

Intervention and Prevention Expenditure

Organisations and governments have to work to ensure that health initiatives focus on prevention, promotion and protection, not just treatment.

Public services provides healthcare to groups of people, or the populace of a specific region, rather than focusing on individuals. These organisations also provide education about the types of behaviours and factors that cause illness and disease.

Public health initiatives include programs, events and campaigns, which are used in a variety of settings to spread and reinforce the positive messages about good health. Homes, schools, the work place, medical centres, hospitals and media are all examples of environments these initiatives can take place.

To be effective these initiatives must be delivered in a range of ways such as providing health education, advertising healthy lifestyles, controlling infection and exposure, and introducing tax increases on unhealthy choices.

Early intervention and preventative strategies can reduce the occurrence of diseases and illnesses. The success of these programs requires partnerships between federal, local, and territorial governments and other non-government organisations, such as the Heart Foundation and Cancer Council.

Educational programs at schools and initiatives which support health promotion and create awareness and prevent diseases, are highly effective. These methods are becoming increasingly accepted should be maintained.

There are a number of reasons to increase the budget for preventive and health promotional activities. They improve accessibility, education, quality of life and are cost-effective (low cost, high gains). They also utilise existing health structures, promote equitable services and empower people to become more self-responsible and proactive about their health.

The cost of preventive health is much less than the cost of treatment, however in some cases it take years for significant changes to morbidity and mortality rates to become apparent. Governments are often reluctant to invest more funds in preventive health as the benefits may not be apparent during their term in office and ‘poor results’ may lead to a loss in a election.

Instead governments often focus their efforts on short-term solutions where results and success can be quickly measured to use as political leverage when running for the next election.

Impact of emerging new treatments and technologies on health care, eg cost and access, benefits of early detection

Medical diagnostics and therapeutic procedures have improved dramatically due to advances in radiological scanning, biological therapeutics, surgical procedures, prostheses and other technological services. Due to these advances, the early detection and treatment of serious conditions is possible.

These new facilities and treatments can be expensive and have led to increased healthcare costs. The inclusion of these methods under subsidised healthcare, such as Medicare and the Pharmaceutical Benefits Scheme, have made it’s possible for most Australians to afford these new services.

If no subsidy was provided, the costs would be prohibitive for most of Australians, and inequity in the healthcare system would increase.

Cancer Screening

The Government of Australia has made provisions for screening of breast, bowel and cervical cancer with the intent of reducing mortality rate and morbidity through early detection and timely treatment of cancer.

These programs are free for particular groups who are considered high risk (due to age group and gender) and are encouraged to be screened regularly

The programs implemented are as follows:

• BreastScreen Australia: Mammography to screen for breast cancer

• National Cervical Screening Program: Test for cervical cancer using Pap smear method

• National Bowel Cancer Screening Program: Blood tests using faecal occult

Childhood Vaccinations

Vaccinations protect and immunise children against diseases such as whooping cough, tetanus, rubella, mumps, measles, diphtheria, polio, varicella (chicken pox), Hepatitis-B, meningococcal type C disease and rotavirus. Hepatitis A vaccinations are also given to children living in Aboriginal and Torres Strait communities as they rates of infection are particularly high.

Health insurance: Medicare and private

Advantages and disadvantages of Medicare and private health insurance

Medicare, was stablished in 1984, and is the primary healthcare system in Australia. The aim of Medicare is to provide all Australians with accessible, affordable and high quality healthcare. Since its introduction, all Australians contribute via tax payments, with the levy calculated based on the income of the individual. Approximately, at least 1.5% of an individual’s income must be contributed toward Medicare.

The federal government covers 85% of the scheduled medical costs in private hospitals and 75% of the costs incurred in public hospitals. Patients then pay the remainder of the costs, which is called the ‘gap’ payment. There is also a provision known as bulk billing, where healthcare providers receive 85% of the costs incurred, and patients don’t need to pat a gap fee.

Medicare provides all Australians with free treatment in public hospitals as well as free or subsidised treatment from various medical professionals including GPs, specialists and, in some instances, dentists and optometrists

Drawbacks of the Medicare policy include long waiting lists for surgery and the additional strain on hospitals. As a result, costs of healthcare rise and the State Government has to provide more funding. Under the Australian Medicare program, this payout is made only to patients who get treatment from eligible medical practitioners. Additionally, under the Medicare policy patients sometimes have to pay a service gap, making several treatments unaffordable to low income earners.

The payout for services is based on:

– where the treatment was given (in or out of hospital)

– if the treatment that is covered under Medicare

– the schedule of fees set by the negotiation between Department of Health and Ageing and professional bodies

Private Health Insurance is provided jointly by the Federal Government and other private entities. The policy cost has to be paid either on a monthly or an annual basis. The cover under private health insurance can be categorised into three types:

– Hospital Cover

– General Treatment Cover (ancillary/extras)

– Ambulance Cover

Some of the advantages of private health care insurance for both the patients and the government are the flexibility to opt for extra medical, ancillary, dental and optical covers and the fact that patients can choose from a wide range of public and private hospitals. Insured patients receive special benefits such as overseas cover and shorter waiting times for surgery. They also reduce the demand and strain on public facilities.

There are many specialist surgeries, which are primarily provided by the private division, meaning Australian citizens who lack private health insurance often have to wait for months before undergoing elective surgery under Medicare. This has led to increased inequity in the healthcare system as people who are able to afford better levels of healthcare receive medical attention quicker in than Medicare patients.

Private health insurance also has a major drawbacks including the fact that the premium paid for cover remains the same, regardless of whether the individual has used the service or not. Individuals who signup for private insurance also still have to pay their Medicare levy, adding to their overall healthcare costs. Additional insurance provides cover for various costs, including private hospital expenses, ancillary costs and aids like dental, physiotherapy, chiropractic, and ambulance services or even for aids, like glasses. However, patients may need to pay the ‘excess’ when using certain treatments. A higher excess translates to a lower premium, whilst a lower excess raises premium prices. The treatments requiring excess payments are dependent on the type of private cover the individual has.

The healthcare system in Australia is dependent on both public and private finances. Unfortunately, the equity of healthcare access is diminishing and patients spend more of healthcare than they did 10 years ago. Individuals living in regional and rural parts of Australia are less likely to be covered by private health insurance than their urban counterparts. This is primarily due to the lack of access to private in-patient facilities in remote regions

Increasing the amount of people covered by private health insurance, would the reduce government liability and spending, leaving more funds to put towards other initiatives.

When Medicare was established, there was a sudden drop in private health insurance, as the premium was high and people found public insurance to be more cost-effective. As a result there was a sudden pressure on the public health system, to provide care and support to people in need and an ageing population.

To counter these rising costs the government developed several, successful strategies to entice more individuals to purchase private health insurance.

30% Rebate by the Federal Government

To encourage people to purchase private health insurance and pay premiums for hospital and/or extras cover, the federal government provides a 30% rebate on the overall cost of insurance.

The rebate is available to the policy holder, even if the insurance covers others, such as their spouse and/or children (providing the spouse and/or children are eligible for Medicare).

The Medicare Levy Surcharge

• An extra 1% will be charged, along with the normal 1.5% charged for Medicare, for individuals who have an annual income more than the threshold amount and have not opted for private health insurance cover

To further promote private health insurance, the Government of Australia has introduced the following schemes:

Incentive Scheme

Individuals who earn over $75,000, or couples who earn over $150,000 per annum, do not have to pay a 1% surcharge if they opt for private health insurance. Individuals earning over $90,000 and couples earning over $180,000 have to pay an additional surcharge each year if they do not purchase private health insurance.

Lifetime Health Cover Scheme

Individuals aged above 30 are advised to opt for private health insurance. If people do not opt for a private health insurance by the age of 30, they will have to pay an extra surcharge of 2% each year when they do opt in. For example, when an individual reaches the age of 40, they would have to pay a surcharge of 20% additionally (10 years X 2%) towards the premium. That means if the premium usually costs $3000 – they will need to pay 20% on top, costing them $3600 per year for private health insurance for the rest of their life ($3000 x 120% = $3600)

Singles, couples and families must consider the risks when choosing or not choosing private health insurance, including:

– Paying a premium they may not use/need within that year

– Paying a premium and requiring treatment which could be easily, quickly and cheaply treated in the public sector

– Not buying private health insurance and requiring treatment for a medical condition that is costly and having to endure long waiting times

Some people, with little to no medical conditions, view private health insurance as a waste of money each year. Others view it as a safety net for future risks or serious conditions.

Complementary and alternative health care approaches

There are many healthcare services available to Australians, which compliment or are an alternative to the mainstream solutions available. In fact, over the years, general healthcare has incorporated a selection of alternative health services into it’s system.

There has been trend toward self-care in Australia, with individuals wanting more control over types of health products and services they use. This, along with the popular opinion that ‘natural’ implies healthier, has led to the to growth of natural therapies and other alternative treatments.

Patients suffering from chronic or incurable conditions are also more likely to seek out complimentary or alternative services in an attempt to find relief or a cure. In the age of the internet, finding information on these treatments has become simpler, and so more and more people are experimenting with healthcare services beyond the mainstream. There have also been some scientifically confirmed cases, which demonstrate the success of alternative treatment for some individuals who have sought treatment for serious conditions like HIV/AIDs and cancer.

There are a number of benefits to providing complementary or alternative products and services, including:

– Range and variety of services available

– Greater accessibility

– Relatively low cost

Alternative treatment are popular with many individuals because they typically involve natural methods or ingredients and are less likely to utilise synthetic chemicals or technology. Alternative methods of healthcare also employ a holistic approach to treatment and prevention, meaning they assess and provide care that targets the lifestyle and entire body of the individual, rather than a specific condition.

Reasons for growth of complementary and alternative health products and services

The World Health Organisation (WHO) has identified a variety of alternative practices as a reputable sources of health care, contributing to the growth and popularity of alternative medicine. There are several other factors, which have been instrumental to the rise of complementary and alternative health products and services.

The recognition by More Courses and Licensing has improved the credibility and reputation of alternative health providers. Consumer demand for more medical options, a growing awareness of alternative medicine an public concerns about the dangers of synthetic materials have also been a factor.

Alternative providers have responded with effective marketing strategies and a flexible approach, which is not restricted by the same regulations as other health services. Additionally, a number of Private Health Insurance programs now cover alternative treatments like Acupuncture.

As Australian society has become more multicultural and accepting, alternative treatments have also been introduced by migrants. Although mainstream medicine is more established, alternative and complimentary services have a high rate of effectiveness for some individuals.

Range of products and services available

There are a range of complementary and alternative products and services available throughout Australia. For example, most chemists now stock a broad range of herbal medicines and natural products like Fish oil, omega 3 and Glucosamine.

Individuals interested in alternative treatments also have access to the following services:

– Meditation

– Acupuncture

– Chiropractic

– Massage

– Naturopathy

– Aromatherapy

How to make informed consumer choices

There are advantages to using complementary or alternative products and services, but that does not mean they are without any risk.

A majority of individuals risk avoidable pain and injury they are not aware of the dangers. Finding reliable information can be challenging for people and as a result they don’t know what to look for before undertaking complementary and alternative medicines.

An example of a potential risk is relying on therapy or adopting a new diet on the advice of a naturopath with limited qualifications and experience.

There are laws, implemented by Australian federal and state governments, to protect consumer rights and safety from unsafe or unreliable medicinal practices. However, despite serious consequences, illegal practices still occur.

It is imperative for individuals to seek out reliable information and professional advice before using any complementary and alternative products and services so that they can make an informed decision. Specifically, people should attempt to find answers the following questions:

– What is the treatment?

– How it is implemented?

– Is it beneficial?

– Is it reliable?

– What are the chances of success?

– What are the qualifications held by the practitioner(s)?

– What is the practitioner’s accreditation, training and experience?

– How does this treatment compare to mainstream options?

– What is the cost?

– What are the side effects and/or potential risks?

– Is the service recommended by friends, family or medical professionals?

– Has the product been approved by the Australian Therapeutic Goods Association?

– Has the treatment been endorsed by trusted leaders, health experts, the World Health Organisation, or the Australian Federal Government?

Remember, consumers have the right to ask the provider for further information, report misleading or false advertising, and check that health providers uphold current government safety standards.

Health promotion based on the five action areas of the Ottawa Charter

The five action areas of the Ottawa charter are:

1 Developing Personal Skills

2 Reorienting Health Services

3 Strengthen Community Action

4 Creating Supportive Environments

5 Building Healthy Public Policy

Levels of responsibility for health promotion

Encouraging preventive attitudes from a young age can help reduce risk factors that lead to health issues. Implementing effective healthcare programs and practices requires collaboration between individuals, families, communities and the government. To improve awareness and behaviours these groups must work together to offer support, guidance and protection. Partnership development, bringing sectors together and using a variety of interventions to ensure this happens. The development of partnerships between organisations and sectors and the use of a variety of interventions can also contribute to the success of programs.

Government

The federal government has a responsibility to provide both coordination and leadership. Officials need encourage cities and states to work in conjunction with each other to create a strong foundation for health promotion.

On a federal level, the government must work with international agencies, like the World Health Organisation, to ensure that the general public, along with other important health related agencies, have the information and systems they need to produce the best health outcome possible.

Local and state governments should be responsible for providing and supporting preventive health services and promotion by:

– Highlighting health spending

– Meeting liability

– Establishing public policy of good health

– Setting public health goals

To meet these goals government agencies must work in conjunction with each other and with various other non-government agencies. They should also regularly communicate with the community and public, regarding the progress and implementation of various health programs, promotions and resources.

Local Government

The provision and support of effective health care by local governments is affected by limited funds and resources. However, local officials can work hard to create partnerships with community groups and other organisations to provide safe environments and relevant health services for the public. These programs should directly address the specific health needs of the community. For example, by targeting a particular illness affecting a large proportion of the community.

Private Sector

The private sector often struggles with the conflict between the drive to make profit and their social responsibilities to the community. Government regulations and community watchdogs can help keep private businesses accountability and encourage the sector to supply ethically sourced goods and accessible services. The private sector should also provide workers with fair and healthy working conditions.

Individuals

Each person must accept responsibility, and be held accountable, for their own health. Individuals need to seek out health information and advice so that they can make informed decisions about their wellbeing.

They can contribute to overall health of the community by seeking support from family and friends or offering to assist others. Participate in community events, created to promote and protect local health, can also help to raise awareness and improve attitudes to leading a healthy lifestyle.

The benefits of partnerships in health promotion, eg government sector, non- government agencies and the local community

The key to effective healthcare is an amalgamation of various factors. The most effective health solutions are developed by combining health promotion ingenuities with multi-strategy approaches to deal with targeted issues. Forming partnerships between various sectors and agencies can also diversify and improve healthcare programs.

Intersectoral collaboration

Intersectoral collaboration refers to the combined actions of agencies in and outside of the health sector. This type of cooperation can involve non-government agencies, government agencies or an amalgamation of both. Successful intersectoral collaboration requires the input of individuals and communities. Australians who are provided with a chance to contribute to decision making and asset with the design of healthcare initiatives are more likely to accept changes and participate in programs. The NSW Government supports public involvement in the health planning process as health promotion strategies and policies which have been built on foundation of collaboration with the affected community affected will achieve greater involvement and success when introduced.

Community Participation

Social capital is a resource which is created when an individual or community participates in promotional activities generating a collective sense of achievement. When neighbours come together, health professionals back community projects and the government improves the quality of environments and public spaces, social capital is created. Recent research has demonstrated that a high social capital can positively affect public health initiatives.

The majority of Australia’s health promotion campaigns provide people with perfect examples of how people, governments and cities can work together to generate a better health outcome for the population. These partnerships help better the population’s health rates and the effectiveness has been positively impacted by the Ottawa Charter’s five action areas.

When these action areas are included in a health promotion strategy design, they naturally result in a joint intersectoral approach capable of addressing a wide range of health factors and injustices on multiple levels.

How health promotion based on the Ottawa Charter promotes social justice

Social Justice

Social justice refers to a set of values relating to supporting equality by providing support to people who face disadvantage or discrimination in society.

Some basic principles of social justice include:

– Supportive environments

– Participation

– Rights

– Equity

– Access

– Diversity

The Ottawa Charter considers these principles when devising health promotion campaigns to support and protect people or groups who experience disadvantage. Social justice principles are enforced by “action areas” which uphold the same values.

Let’s see what this actually looks like in action:

Developing Personal Skills – Improving this area increases an individual’s ability to access health information and services, enabling them to make an informed health decision. It also provides equity by ensuring that that every student in Australia, from K -10, will have mandatory PDHPE lessons to teach health behaviours.

Reorienting Health Services – Provides greater access to health services for those who are disadvantaged (ATSI). These services support equity by providing quality health services for Aboriginal and Torres Strait Islander people.

Strengthen Community Action – Describes access at a community level to things like a Healthy School canteen, exercise groups or opportunities to participate in lobby groups which promote principles of diversity and equity in health.

Creating Supportive Environments – Improves the living conditions of individuals by increasing equity and improving access to health services and facilities. Local communities can create healthy environments by providing parks, facilities and other safe areas for individuals to enjoy and utilise.

Building Healthy Public Policy – The government is responsible for acknowledging diversity and equity and has created initiatives like medicare and PBS to ensure every individual has access to health care in Australia. The Government can also create supportive environments by promoting health campaigns, like ‘slip slop slap’, and introducing legislation, like no-smoking laws, to improve quality of life.

The Ottawa Charter in action

CLOSE THE GAP (2008)

The aim of this health promotion initiative was to close the health and life expectancy gap between indigenous and non indigenous Australians. There is currently a 17 year life expectancy gap between these two groups, which is devastating. There are serious concerns about the health inequities experienced by the indigenous population, the main causes being inadequate access to health services, low levels of education and overcrowded or poor living conditions.

Building Healthy Public Policy

A national Indigenous Representative Body has been established and targets have been set to show improvements in health equality. Funding has also been supplied to provide skilled labourers and workforces to counter the challenges of improving the quality of remote indigenous education and communities.

Create Supportive Environments

For health professionals to deliver quality care they need to be adequately trained and ideally indigenous, so that they understand they cultural and social challenges faced by the ATSI community. Extra teachers and educators have also been trained and sent to remote areas to improve levels of education.

In addition, training indigenous people to work in frontline services such as police can booster the profile and the relationship of indigenous people with local authorities.

Strengthening Community Action

The program makes sure that primary health services are delivered with cultural sensitivity. It also empowers Aboriginal and Torres Strait Islanders to become active members of the community and participate in the planning of health at a local and community level.

Developing Personal Skills

Improves the education levels and services available and provides indigenous mothers with access to early learning support services.

Reorienting Health Services

Investments have been made in primary health care to ensure that there is a balance between prevention, promotion and curative services. These services also promote access to health services which provide education to improve the quality of lifestyles choices.

SHAPE UP AUSTRALIA

This is a continuation of the Swap It – Don’t Stop It campaign,which was introduced by the Australian Government to address the increasing waistlines of Australians. This initiative aims to reduce the prevalence of lifestyle related diseases such as CVD by targeting the eating and exercise patterns of individuals and improving their quality.

Developing Personal Skills

The initiative encourages individuals to adopt positive behaviours for nutrition and exercise and promotes behavioural changes which will reduce the risk or poor health and serious illness. The program teaches people how to help themselves by swapping nutritionally poor foods for healthier options. This process is supported by online information as well as mandatory PDHPE lessons in schools, which raise awareness of the main health problems affecting society.

Examples of Developing Personal Skills: Healthy recipes are provided on the website along with advice on how to change bad behaviours. There are also exercise tips to empower each individual to find an activity that suits their lifestyle. Some examples include “Swap big for small” “Swap sitting for walking”. The strategies are also promoted through a mixture videos and advertising.

Creating Supportive Environments

The program aims to make the places we live, work and socialise the source and foundation of good health.

Examples of Creating Supportive Environments: Community based organisations have been invited to participate as partners with the initiatives. A “Swap it” app has also been developed as part of the program to make it easier to access information and advertisements have been created on social and print media as well as on television. On the website, people can access meal guides, shopping lists, and activity planners to help design and prepare a healthier lifestyle.

Strengthening Community Action

The idea is to empower individuals within the community to identify their own health priorities and then take action. There are a number of community groups/agencies who provide support for this initiative.

Examples of Strengthening Community Action: There are online forums available on the website where people can discuss and share their ideas with others who are on the same journey.

Re-orientating Health Services

The website serves as a centre point for promoting positive health behaviours and change within the community. The information provide health advice so that unhealthy behaviours can be prevented rather than modified at a later date.

Examples of Re-orientating Health Services: The government is investing in initiatives like this to prevent, rather than cure, the problems of heart disease, diabetes and obesity. The website educates individuals about the risks and factors associated with an unhealthy lifestyle.

Building Healthy Public Policy

The Federal Government identified that there was a need for new legislation and policy to improve the health of people in Australia.

Examples of Building Healthy Public Policy: The National Partnership Agreement Act 2010 led to the development of the Australian National Preventative Health Agency in 2011 while Shape Up Australia works with all levels of government to support a healthy lifestyle. This has been modelled to work in conjunction with mandatory PDHPE lessons and the implementation of the Healthy School Canteen initiative.