HSC Core 1:HEALTH

PRIORITIES IN AUSTRALIA

Focus Question:

How are priority issues for Australia’s health

identified?

Topic 1: Measuring Health Status

• Health Status refers to the general pattern of health of a population over a period of time.

• The health status of the Australian population is considered high and continues to improve.

• Improved health status is evident by: an increasingly high life expectancy declining death rates reduced rates of infant mortality greater access to health care.

Health Status of Australians

STATS

Role of EpidemiologyTo create an accurate and comprehensive picture of the health status of Australians, a range of information needs to be accessed. We measure health status through the process of epidemiology.

• Epidemiology is the study of disease in groups or populations through the collection of data and information, to identify patterns and causes.

• Epidemiology is used by governments and health-related organisations to: obtain a picture of the health status of a population identify the patterns of health and disease analyse how health services and facilities are being used.

• Sources of information include: surveys records from hospitals, PSB, RTA etc. data from Medicare and GPs public and private health claims.

• Epidemiology considers the patterns of disease in terms of:

prevalence (the number of cases of disease in a population at a specific time) incidence (the number of new cases of disease occurring in a population)

distribution (the extent)

apparent causes (determinants and indicators).

Limitations of Epidemiology

• do not always show the significant variations in the health status among population subgroups • might not accurately indicate quality of life in terms of people’s level of distress, impairment, disability or handicap. • cannot provide the whole health picture. • fail to explain ‘why’ health inequities persist• do not account for health determinants

Epidemiology at Work —an example by Claire HallidayAfter working for a number of years in the area of Aboriginal health policy and planning, Scott Winch, 35, felt the need to improve his knowledge and research skills — with the view towards the development of health strategies and policies. So, in February last year, Scott commenced a master of applied epidemiology at Australian National University . . . There are four main components to the program. Winch first undertook data analysis on the burden of gastroenteritis amongst Aboriginal infants in East Arnhem and presented this work at the Australasian Epidemiological Association conference last year.Then he began an investigation into an infectious disease outbreak: a study on the mechanisms of the spread of equine influenza in south-east Queensland. ‘You are also required to do an evaluation of a surveillance system as well as an epidemiological study. I recently presented the findings from my social epidemiology study into protective and risk factors for commencing and ceasing petrol sniffing at the Population Health Congress.’

Winch says his course provides ‘an excellent opportunity to broaden my knowledge in this area’ and he plans to continue his studies at the university. ‘Next year I’m planning on commencing a PhD in social epidemiology modelling,’ he says. ‘Hopefully I’ll be involved in some capacity in state or federal Aboriginal health policy.’Source: Sydney Morning Herald, 6 September 2008

Read the snapshot ‘Epidemiology at work — an example’ and, working individually or in small groups, answer the following questions.1. Identify the investigations that Scott Winch has undertaken as part of his masters degree.2. Explain what the implications might be of such epidemiological studies for the health of indigenous Australians.3. Who do you think might use the information obtained in these studies and for what purposes?

CASE STUDY

Measures of Epidemiology

Lesson 3

Measures of Epidemiology

Analysing data in a table1. Using the data for number of deaths in table 1.1, rank the six most common causes of death.2. What proportion of total deaths related to diseases of the heart and blood vessels?3. Draw a bar graph to show the standardised death rates for the seven most common causes of death.4. Identify the causes of death related to:(a) the highest median age (b) the lowest median age.

Mortality

In Australia overall, the main causes of death are • cardiovascular (heartand blood vessel)• cancers• respiratory diseases. For some of the leading causes of death, such as heart disease, strokes and some types of cancer, the death rates are falling.

Trends in causes of deathThe 46 626 Australians who died of cardiovascular disease made up around one-third (34 per cent) of all deaths in 2007, but heart attacks have dropped from22 per cent of all deaths in 1998 to 16 per cent in 2007, while deaths from dementia and Alzheimer’s have more than doubled from 2.6 per cent to 5.3 per cent of all deaths, according to statistics released today by the Australian Bureau of Statistics (ABS). Over the same time, deaths from cancer have increased by 13 per cent but still represent nearly one-third (29 per cent) of all deaths.

Of the 40 287 deaths from cancer in 2007, lungcancer was the most prevalent cause of death with 7623 Australians dying of the disease in 2007; prostate cancer in men caused 2938 deaths, while breast cancer in women caused 2680. The top three leading causes of death have remained unchanged for the last 10 years — heart disease (1), stroke (2) and lung cancer (3). In this same period, deaths due to dementia and Alzheimer’s have gone from the seventh leading cause of death to the fourth.

More details are available in Causes of Death, Australia (cat. no. 3303.0) . . .Source: Australian Bureau of Statistics, media release, 18 March 2009.

CASE STUDY

1. Read the snapshot on trends in causes of death and identify the causes of death that have:(a) Increased (b) decreased (c) stayed the same.2. What was the leading cause of death in 2007 in Australia?3. Of all the deaths from cancer in 2007, identify the type that was the most prevalent cause of death.4. Suggest some possible reasons for the decline in the number of heart attacks causing death.

Mortality

Examine the graph in figure 1.4 and write half a page describing the trends you can identify.

Mortality

1. From the data in table 1.2, describe the trend in the death rate for respiratory diseases for:

(a) males (b) females. Suggest reasons for your findings.2. Identify two causes of death that show:(a) a significant decrease in the death rate for males(b) a relatively stable death rate for females.3. In groups, discuss what data such as that in table 1.2 can tell us about the health status of Australians.

Death rates for males and females

An objective and often easily determined measure of health status, data on mortality can be used to compare health status across groups and between years.

Mortality

Infant Mortality

Infant Mortality

The decline in the infant mortality rate over recent decades can be attributed to:• improved medical diagnosis and treatment of illness• improved public sanitation• health education• improved support services for parents and newborn babies and children.

Figure 1.7: An Aboriginal health worker checks on an infant at a Northern Territory health clinic while his mother looks on. The infant mortality rate for indigenous Australians is significantly higher than the rate for non-indigenous Australians.

Congenital malformation: A physical defect present in a baby at birth, irrespective of whether the defect is caused by a genetic factor or by prenatal events that are not genetic. In a malformation, the development of a structure is arrested, delayed, or misdirected early in embryonic life and the effect is permanent. Congenital malformations can involve many different organs including the brain, heart, lungs, liver, bones, and intestinal tract. These defects can occur for many reasons including inherited (genetic) conditions, toxic exposure of the fetus (for example, to alcohol), birth injury and, in many cases, for unknown reasons. All parents are at risk of having a baby with a birth defect, regardless of age, race, income or residence.

Infant Mortality

Morbidity

MorbidityLesson 3

• hospital use (the cause and number of admissions to hospital). These statistics provide some measure of the rates of illness (acute rather than chronic) and accidents in the community. The causes of hospital use indicate the major reasons for our ill health as a nation. They also provideuseful information about the pattern of more serious diseases, such as cancer and stroke, which require medical treatment. However, they do not describe less serious illness and ill health that remain untreated. Hospitalisation statistics have limitations as indicators of morbidity as they do not distinguish between re-admissions for the same condition and conditions that require further care. Rather, they treat each episode of inpatient care as a new case.

Inpatient care is the care ofpatients whose condition requireshospitalisation.

• doctor visits and Medicare statistics. Medicare statistics(services claimed on Medicare) indicate the reasons fordoctor visits and the number of visits. They can alsoprovide the number of days absent from work as aresult of sickness. However, this information does notalways include visits to doctors for checkups (eitheryearly health checks or checks for the purpose of pregnancyor contraception) or for advice and counselling.As with hospital use statistics, doctor visits by femalesmay not always reflect ill health; for example, the statisticscount visitations for pregnancy and childbirth.

Medicare is Australia’s publicfunded universal health-caresystem, ensuring all Australians have access to free or low-cost medical, optometric and hospital care.

Morbidity

• health surveys and reports. National health and other surveys can provide a range of key health indicators and bring together an extensive range of health information. Often, health surveys depend on self-reporting, so individual perceptions of health and illness affect the information gathered to varying degrees.

• disability and handicap. The incidence of disease or accident can lead to impairment, disability and handicap. A person incurring injury in an accident, for example, could be impaired. The resulting abnormal function or loss of physical or mental capacities could cause disability by disturbing the individual’s normal activity or performance. Disability can be in terms of self-care, mobility, verbal communication, schooling and/or employment. A handicap is a perceived social disadvantage that results from the impairment or disability.

Morbidity

Some of the healthiest people on EarthBy Mark MetherellThe latest report on Australia’s health illustrates how well we are overcoming what were once intractable and often lethal diseases and how many of the diseases on the rise are largely self-inflicted. The rates of heart attacks and strokes continue tofall. We are more likely to survive cancer, and the incidence of asthma has declined. The bad news is that with 7.4 million people overweight, the prevalence of lifestyle-related conditions such as diabetes and endstage kidney disease continues to climb rapidly. Sexually transmitted diseases have continued to rise in the past decade. The most frequently reported, chlamydia, afflicted 238 people per 100 000 people, up fourfold in a decade. Mental and behavioural problems such as anxiety and depression have steadily risen in prevalence, and according to the latest available comparisons, for 2003, rate after coronary heart disease as the second heaviest burden of illness and injury. Australians live longer than people in any other nation, bar Japan, with a life expectancy of 81.4 years. However, it comes at a cost, with health spending 45 per cent more in real terms than a decade ago, says the 600-page Australia’s Health 2008, produced by the Australian Institute of Health and Welfare. The Institute says Australia is one of the healthiest nations, taking great strides in many health areas, but

there are groups whose health lags behind, particularlyindigenous people. There remains great scope for health improvements through tackling ‘lifestyle’ health risk factors. Obesity rates remain stuck in the worst third in the world, with an estimated 7.4 million adults overweight or obese in 2004–05. Type 2 diabetes ranks as the third biggest diseaseburden, and the death rate from diabetes has drifted lower in the 18 years to 2005, compared with other developed countries. More than 11 000 die from conditions linked to diabetes each year. The federal Minister for Health, Nicola Roxon, said the report showed Australia was performing well but there were ‘worrying things’, including the nine per cent decline in general practitioners in the eight years to 2005 and inequities in health outcomes between different socioeconomic groups, the Institute says. Its director, Dr Penny Allbon, said that in rank order the best health outcomes resulted from reductions in tobacco smoking, high blood pressure, overweight/obesity, physical inactivity, high blood cholesterol and excessive alcohol consumption. The report shows that despite the big improvement in coronary heart disease treatments, it still contributes most of any single condition, about 10 per cent, to the overall burden of disease. But there are disturbing signs that in ‘sleeper’ lifestyle problems such as obesity, which contributes to the rapid rise of diabetes, Australia lags behind other Western nations’ progress.Source: Sydney Morning Herald, 25 June 2008.

Morbidity CASE STUDY

Australia’s health — issues and trendsRead the snapshot ‘Some of the healthiest people on Earth’ (page 14), thenanswer the following questions.1. Describe the falling trends outlined in the article.2. Describe the rising trends outlined in the article.3. How does the life expectancy of Australians compare with that of other nations?4. Identify the problems with Australia’s health that are mentioned in the article. Inwhat ways can Australia’s health be improved?

Life Expectancy

Life Expectancy

Life Expectancy

Australia spent $121.4 billion on health

in 2009–10.

Accounting for 9.4% of GDP (Gross Domestic Product-GDP = total spending

on all goods and services in the economy)

This averaged out to $5,479 per person.

What are we spending?

Identifying Priority Health IssuesHow are priority issues for Australia's Health determined?

Topic 2: Identifying priority health issues

In order to improve Australia’s health, governments and health authorities prioritise particular health issues, based generally on: how much they contribute to the burden of illness

in the community their potential for reducing this burden.These priority issues include: the health inequities experienced by certain groups

within our society our growing and ageing population the high levels of chronic disease and other health

problems evident in our society.

In determining the disease burden on the community and its potential to be reduced, health authorities need to consider a number of factors.

1. Social Justice

Social justice refers to value system that promotes fairness, equity and a just share of the benefits of society.

Social justiceExamine the poster in figure 1.13. Discuss how the ‘Close the Gap’ campaign:(a) aims to address social justice inequities(b) is focusing on a health priority issue to improve Australia’s health.

Homework – what is the Pharmaceutical Benefits Scheme(PBS) and the Medicare Safety Net?

2. Priority population groupsIs important because it allows health authorities to: determine the health disadvantages of

groups within the population better understand the social determinants

of health identify the prevalence of disease and

injury in specific groups determine the needs of groups in relation

to the principles of social justice.

2. Priority population groups (cont)

The following groups have been identified as suffering health inequities: Aboriginal and Torres Strait Islanders Socioeconomically disadvantaged people People in remote and rural areas Overseas born people The elderly People with disabilities

Some strategies designed to raise the health status of priority population groups include:

funding the Royal Flying Doctor Service (RFDS), which provides aeromedical emergency health services and community health clinics to remote sites; in 2006–07 there were 242 547 patient contacts with the RFDS

implementing incentive programs for medical practitioners and dentists to practise in rural and remote areas; these areas have proportionally half the supply of medical practitioners and dentists of major cities

allocating 17 per cent more funding for Indigenous health services than for non-Indigenous services

developing the NSW Multicultural Health Communication Service, which aims to ensure that culturally and linguistically diverse communities have access to high-quality health information in a language they understand.

3. Prevalence of condition

4. Potential for prevention and early intervention

There is strong justification for prioritising the allocation of resources to prevent and manage the health problems that cause the greatest overall disability and/or premature death in the population (referred to as the burden of disease or disease burden). These include:• Cancer• diabetes• cardiovascular

disease• musculoskeletal

conditions• mental health

problems

• neurological disorders

• Injury• oral health

problems• respiratory

disease• infectious

disease

CASE STUDY

BreastScreen and early interventionRead the snapshot ‘BreastScreen Australia program still yielding results’, then answer the following questions.1. Describe the trend for breast cancer mortality rates between 1990 and 2005.2. How often is breast screening recommended?3. Explain how breast screening acts as an early intervention program to reduce the prevalence of breast cancer in Australia.

5. Costs of the Individual and Community

CASE STUDY

Read the snapshot ‘Cardiovascular diseases are Australia’s costliest’, then answer the following questions.1. What was the direct health-care expenditure on cardiovascular diseases in 2004–05?2. Was the cost of treating and managing cardiovascular diseases higher in males or in females?3. On which age group in the population is health-care spending highest?

The changing face of Australia…

Syllabus

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