Introduction Activity:

What are your thoughts about the general health of Australian's? 

Write a brief paragraph describing what you believe to be the current health status of Australian's

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. The common indicators of the health of a community include:

– Mortality: the number of deaths from a given cause in a specific population over a specific time period, usually a year.

     eg: 158 504 deaths were registered in 2016 in Australia, of which 81,867 were males and 76,637    were females.

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

     eg: the infant mortality rate in Australia has declined steadily over the past few decades. It was at a record low of 3.1 infant deaths per 1000 live births in 2016   

– Morbidity (sickness): the rates and trends of a disease, illness and injury in a specific population that do not cause death.

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

AIHW Report Summary Mortality and Morbidity 

AIHW Report Summary  

www.aihw.gov.au/reports/life-expectancy-deaths/deaths-in-australia/contents/summary 

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. 

Limitations of epidemiology

Epidemiology has proved to be an effective approach to measuring health status, but it has some limitations. For example, epidemiological statistics:

• do not always show the significant variations in the health status among population subgroups (for example, between Aboriginal and non-Aboriginal Australians)

• might not accurately indicate quality of life in terms of people’s level of distress, impairment (loss or abnormality of body structure or of a physiological or psychological function), disability or handicap. Statistics tell us little about the degree and impact of illness.

• cannot provide the whole health picture. Data on some areas, such as mental health, are incomplete or non-existent.

• fail to explain ‘why’ health inequities persist

• do not account for health determinants — the social, economic, environmental and cultural factors that shape health.

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.

Activity 3:

Describe three similarities and differences between the leading causes of death for males and females

Activity 4: Complete the table below for the leading causes of death 

Review Questions: 

The role of epidemiology

1. What is epidemiology?

2. What can epidemiology show?

3. Who uses epidemiological measures?

4. Does epidemiology measure everything about health status? Explain.

Past Paper Questions: 

1. Outline TWO indicators of morbidity. Include examples in your answer. 3 Marks

Social Justice Principles   (equity, diversity and supportive environments)

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.

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. 

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

Practice question with suggested content:

"Account for why Australians are living longer"

• Improvements since the 1970s have resulted from a reduction in death rates at all ages.

These can be attributed to:

• Lower infant mortality

• Declining death rates for CVD

• Declining overall death rates from cancer

• Fall in deaths from traffic accidents

• Increased medical knowledge and management of medical conditions

• If life expectancy increases so does our aging population

• This leads to an increase in demand for health services to cater for the elderly

• Increased need for nursing homes and aged care workers