© goodacre, slattery, upton 2007 changes in approaches to healthcare over time the biomedical...

© Goodacre, Slattery, Upton 2007

Changes in approaches to healthcare over time

• The biomedical approach to health involves the diagnosis and treatment of illness. It relies heavily on medical science and has lead to the development of new and sophisticated medical technologies (such as new drugs, organ transplants and diagnostic procedures).

• The preventative approach to health began in the early 1900s and was widely accepted by the 1960s. It acknowledges the fact that lifestyle behaviours contribute to ill health and focuses on preventing illness from occuring or returning. It considers all components of health and promotes healthy lifestyles.


Changes in approaches to healthcare over time

• The knowledge that social and environmental factors have a significant influence on health lead to a new model in health in the 1970s known as the social model of health. The social model of health is designed to work in conjunction with the biomedical and preventative approaches to health and is based on an understanding that in order for improvements in health to occur, basic needs must first be met.

• Ottawa Charter for health promotion – WHO, WHEN, WHY, WHAT and HOW?


Ottawa Charter

• Who was it developed by and when was it written?It was written in 1986 by the World Health Organization.

• Why was it written?It was written to outline action to achieve health for all by the year 2000 and beyond.

• What is it?A document (or charter) that outlines five areas for action: build health public policy; create supportive environments; strengthen community action; develop personal skills; and reorient health services.

• How is it used?It is used to develop strategies to promote health.


Ottawa Charter in action

Use the Ottawa Charter to develop a strategy to reduce

the number of injuries among children around the

home

Reorient health

services

Create supportive

environ-ments

Strengthen community

action

Developpersonal

skills

Buildhealthy publicpolicy

Ottawa Charter for

healthpromotion


The structure of the Australian healthcare system

• Role of the Commonwealth Government:To manage Medicare through HIC, financial support to government and non-government organisations, manage national health programs, health policy and legislation, regulate private health insurance, quarantine, food standards through FSANZ, international responsibilities in healthcare through AUSaid.

• Role of state and territory governments:To manage the public hospital system, mental health services, dental health services, health promotion and prevention activities through VicHealth, community health centres, ambulance services and the provision of prevention and early detection programs.

• Medicare – WHO, WHEN, WHAT, WHY and HOW?


Medicare• Who is responsible and when was it established?

It was established by the Commonwealth Government in 1984.

• What is it? It is a universal healthcare system that provides medical care to patients via their GP or hospital for little or no cost.

• Why was it established?It was established to improve access to healthcare for all Australians and provide access to adequate healthcare at little or no cost to all Australians in need of treatment, regardless of age or income.

• How is it used?It is funded by the Commonwealth Government, partly through a 1.5% Medicare levy paid by most taxpayers.


What are the advantages and disadvantages of

the Medicare system?

• Advantages: Treatment is available for little or no cost and all Australians have access to Medicare regardless of age or income.

• Disadvantages: Long waiting lists for some hospital services and it doesn’t cover all health services.


The National Health Priority Areas (NHPAs)

• Who were they developed by and when were they introduced?The NHPAs is a combined initiative between the Commonwealth and state and territory governments and was initially developed in 1994.

• What is it? The NHPAs is Australia’s response to the WHO’s Health for All by the Year 2000 strategy. It currently identifies seven priority areas:

1. Cardiovascular health2. Cancer control3. Injury prevention and control4. Mental health5. Diabetes mellitus6. Asthma7. Arthritis and musculoskeletal conditions


• Why were they introduced and why was each NHPA selected?They were established to increase public awareness and understanding and to focus on health policy in regard to these illnesses.

The illnesses were each chosen as they contribute significantly to disease burden and healthcare costs. Additionally, they are conditions where significant gains in the health of Australians can be made through treatment, prevention and management.


• How is it used?

Identify one initiative per NHPA:

NHPA Initiatives

Cardiovascular health

Cancer control

Injury prevention and control

Mental health

Diabetes mellitus

Asthma

Muscoloskeletal and athritis conditions


Factors affecting the provision, selection and purchase of food

People are influenced by a range of factors when making decisions regarding the provision, selection and purchase of food. In order to make effective changes to intake, individuals need to combine knowledge and research with other factors, such as preference to make informed choices that can be enjoyed.

Give examples of each of the four factors and explain how each factor can impact on the provision, selection and purchase of food.

Environ-mental

Social

Economic

Behavioural

Factors Influencing

the provisionpurchase and

selectionof food


Factors influencing the provision, selection and purchase of food

Factor and example Influence on the provision, selection and purchase

Behavioual

Economic

Social

Environmental


Factor and example Influence on provision, selection and purchase

Behavioual(e.g. lifestyle, taste preferences, physiology, habits)

Personal preference for foods will influence what is purchases at the supermarket or restaurant and lifestyle (choices about work, leisure and exercise) can influence when and where people eat, which can impact on food selection.

Economic(e.g. income, marketing, cost of food, food industry)

Income/socioeconomic status has a strong connection with food choice. Those from lower socioeconomic groups tend to purchase foods higher in fat, salt and sugar. Marketing may influence selection at point of sale leading to the selection of more high energy foods.

Social(e.g. family, culture, friends, gender, education, body image, age)

Family is the strongest influence on food choice as it teaches us many food habits and provide most meals. Culture will also have a strong influence on the behaviours and traditions that relate to food choice and the types of food individuals find acceptable.

Environmental(e.g. politics, food laws, natural environment, geographic location)

Where people live can impact on the provision of food, as not all food is available in all areas. Climate, floods, drought, etc. are also examples of environmental factors that can influence the provision of food. Government taxes (GST) have influenced the cost of fresh versus processed foods, which often influence the foods people purchase or at least the price they pay. Governments influence food selection by regulating the price, safety and labelling of food.


The role of governments in promoting healthy eating

The role of the government is to respond to immediate

health issues, and to develop policy and guidelines that will

address future considerations.

Three government initiatives include:• The Australian Guide to Healthy Eating • Eat Well Australia – a public health nutrition strategy • Dietary Guidelines – across the lifespan


The Australian Guide to Healthy Eating• Who was it developed by and when was it developed?

It was developed by Children’s Health and Development Foundation of the Women’s and Children’s Hospital (South Australia), and the Faculty of Health and Behavioural Sciences at Deakin University (Victoria) in 1995–1998.

• What is it?Based on the RDIs and the Dietary Guidelines, the guide is presented in a diagram that includes illustrations of a range of multicultural sample foods divided into five groups based on nutrient content. Additional information contained in the guide discusses the five food groups, serve sizes, nutritional requirements, sample serves and information based on needs for different population groups.

• Why was it introduced? To improve the knowledge and skills base necessary for Australians to select a healthier diet.


Eat Well Australia – a public health nutrition strategy

• Who was it developed by and when was it developed?SIGNAL (Strategic Inter-Governmental Nutrition Alliance) in conjunction with key stakeholders from government, non-government and industry organisations in1999–2000.

• What is it?It includes two public health and nutrition strategies: one aimed at the whole Australian population and one aimed at Indigenous Australians. It provides a framework for industry, government, non-government and community sectors to work together for the prevention and management of diet-related diseases.

• There are five key priorities of EWA:1. Preventing overweight and obesity

2. Increasing the consumption of fruit and vegetables

3. Promoting optimal nutrition for women, children and infants

4. Improving nutrition for vulnerable groups, including rural and isolated populations, low-income groups and Indigenous Australians

5. Addressing structural barriers to safe and healthy food


• Why was it developed?To take a national approach to public health nutrition to gain greater consistency and organisation of government policy and strategy development across Australia. Also to improve nutrition in Australia, and reduce diet-related illness and early death.


Dietary Guidelines• Who were they developed by?

The National Health and Medical Research Council (NHMRC)

• When were they developed?In 1992 and revised in 2003.

• What are they?There are two sets of guidelines that offer nutritional advice to target specific groups in the community. Based on current nutrition knowledge, they provide advice to Australians about healthy food choices to reduce the risk of developing diet-related diseases.

How many guidelines can you list from each of the two sets of guidelines?


The role of non-government organisations

• Non-government organisations provide advice and information to improve eating habits and services to improve healthy eating.

• Some NGOs have a vested interest in changing dietary patterns such as the Australian Dairy Corporation.

• Other NGOs receive government funding, which means that their policies must be in line with those of the government.


Nutrition Australia• Nutrition Australia is a non-government organisation that works

closely with the state and Commonwealth governments. It is Australia’s primary community nutrition education body and responds to local needs and opportunities for nutrition education and health promotion.

• The Healthy Eating Pyramid has been the trademark of Nutrition Australia for over 20 years. It is used by educators, health workers and the general public, and is a simple model for people to use as a first step to adequate nutrition.