Evolution of Evolution of Public Health Public Health and Health and Health

CareCare

Defining Public HealthDefining Public Health

Public health is used to describe the public Public health is used to describe the public system for health care and, particularly, people system for health care and, particularly, people are often referring to public hospitals when are often referring to public hospitals when they talk about public health.they talk about public health.

Public Health – the actions taken by a society Public Health – the actions taken by a society to ensure the survival of populations by to ensure the survival of populations by protecting and promoting people’s health.protecting and promoting people’s health.

Defining Health CareDefining Health Care

Health Care is about the treatment and Health Care is about the treatment and management of disease and illness. management of disease and illness.

Health care is provided by a wide range Health care is provided by a wide range of practitioners in either the public or of practitioners in either the public or private sectorprivate sector

Public / Private SectorPublic / Private Sector

The public sector is available to The public sector is available to everybody, providing a full range of everybody, providing a full range of hospital and medical services, including hospital and medical services, including subsidized pharmaceutical drugs. subsidized pharmaceutical drugs.

Private Sector is available to people with Private Sector is available to people with private health insurance private health insurance

Early Nineteenth CenturyEarly Nineteenth Century

1885 the death rate from tuberculosis 1885 the death rate from tuberculosis was 173 per 100 000.was 173 per 100 000.

TB was a common course of death TB was a common course of death Rates begin to decline in response to Rates begin to decline in response to

improved economic conditions and improved economic conditions and improved public health measures – improved public health measures – especially in relation to damp housing especially in relation to damp housing and overcrowding.and overcrowding.

Australia experienced s severe economic Australia experienced s severe economic depression. Jobs were scarce and depression. Jobs were scarce and unemployment was high.unemployment was high.

Poverty was widespread and people Poverty was widespread and people found it difficult to buy food, or pay for found it difficult to buy food, or pay for health care.health care.

Life Expectancy at birth was 47.2yrs for Life Expectancy at birth was 47.2yrs for males and 50.8yrs for femalesmales and 50.8yrs for females

This was because of the Accidents This was because of the Accidents related to horse-drawn transport, related to horse-drawn transport, drowning and industrial injuries also drowning and industrial injuries also caused high rates of premature death.caused high rates of premature death.

Infant Mortality rates – statistics were not Infant Mortality rates – statistics were not routinely kept in every city during the routinely kept in every city during the nineteenth century.nineteenth century.

Quarantine – Early colonial Australia – Quarantine – Early colonial Australia – very important to governments to ensure very important to governments to ensure that populations did not die from that populations did not die from epidemics – plague, typhus, cholera and epidemics – plague, typhus, cholera and small pox.small pox.

Activity 3.2Activity 3.2

Public Health legislation - 1854 – Public Health legislation - 1854 – Victorian Health Act – looked at water, Victorian Health Act – looked at water, sanitation, housing, infectious disease sanitation, housing, infectious disease and pollution – What improvements and pollution – What improvements needed to be doneneeded to be done

Booms in cities but they weren’t planned Booms in cities but they weren’t planned well. - issues of overcrowding, sub well. - issues of overcrowding, sub standard housing, no sanitation or standard housing, no sanitation or running water.running water.

As the years passed the Health Act was As the years passed the Health Act was strengthened with amendments.strengthened with amendments.

Related legislation that affected Public Related legislation that affected Public HealthHealth 1872 – The Education Act – required 1872 – The Education Act – required

children to attend school and marked the children to attend school and marked the end of child labour.end of child labour.

Disease transmittedDisease transmitted 1.1. Miasma – about bad air, because Miasma – about bad air, because

people make connections between the bad air people make connections between the bad air and disease and disease

2.2. Contagion – transmission was Contagion – transmission was thought to be from some form of direct contact thought to be from some form of direct contact between carries between carries

3 Era’s of Public Health 3 Era’s of Public Health

11stst 1890- 1950 – Infectious Diseases and 1890- 1950 – Infectious Diseases and development of the biomedical model of development of the biomedical model of healthhealth

22ndnd 1950-1990 – Chronic Diseases and 1950-1990 – Chronic Diseases and the development of preventative health the development of preventative health carecare

33rdrd 1990’s – Present Health for all 1990’s – Present Health for all

Biomedical era of public Biomedical era of public healthhealth

Despite hostile environments in which Despite hostile environments in which most people lived, there were exciting most people lived, there were exciting scientific developments taking place in scientific developments taking place in Britain and Europe.Britain and Europe.

1868 – microscope was invented1868 – microscope was invented 1895 – X-rays were invented1895 – X-rays were invented

Development of HospitalsDevelopment of Hospitals

1850’s, rudimentary hospitals has been 1850’s, rudimentary hospitals has been built in the cities and major townsbuilt in the cities and major towns

Hospitals were supported by religious Hospitals were supported by religious organisations and donations in the organisations and donations in the beginning, rather then governmentbeginning, rather then government

Early hospitals were quite dangerous Early hospitals were quite dangerous places, contributing to the spread of places, contributing to the spread of disease.disease.

Little knowledge about how to treat Little knowledge about how to treat disease but medicine was gradually disease but medicine was gradually becoming saferbecoming safer

Anyone could say they were a Doctor.Anyone could say they were a Doctor. Generally sick people got better if they Generally sick people got better if they

avoided medical helpavoided medical help Second half of the nineteenth century is Second half of the nineteenth century is

referred to the ‘great sanitary revolution’.referred to the ‘great sanitary revolution’. Read interest box 3.1Read interest box 3.1 REVIEW – 1-9 page 120REVIEW – 1-9 page 120

Health was viewed as the absence of Health was viewed as the absence of disease and doctors and hospitals were disease and doctors and hospitals were viewed with increasing importance and viewed with increasing importance and become a dominant feature of the way in become a dominant feature of the way in which we view and delivered health care.which we view and delivered health care.

Increase demand for hospitals and Increase demand for hospitals and medical caremedical care

Treatment now involved skilled diagnosis Treatment now involved skilled diagnosis and intervention to either prevent further and intervention to either prevent further infection, to repair, reconstruct or remove infection, to repair, reconstruct or remove diseased areas of the body.diseased areas of the body.

Changes in roles in health care with Changes in roles in health care with focus on diagnosis, specialization, focus on diagnosis, specialization, lengthy training, increase of new types of lengthy training, increase of new types of technology and saw hospitals become technology and saw hospitals become the focus of medicinethe focus of medicine

Act 3.5/ 3.7/3.8Act 3.5/ 3.7/3.8 REVIEW pg 128 Q1-9REVIEW pg 128 Q1-9

Preventative era of public Preventative era of public healthhealth

22ndnd Era of Public Health Care 1950-1990 Era of Public Health Care 1950-1990 LE around 67yrsLE around 67yrs More control of infectious diseases and better More control of infectious diseases and better

public health measures brought about a large public health measures brought about a large decline in the overall death ratesdecline in the overall death rates

Preventable death and disease from motor Preventable death and disease from motor vehicle accidents, CV disease, cancer and other vehicle accidents, CV disease, cancer and other chronic illness such as asthma and arthritis had chronic illness such as asthma and arthritis had started to become the leading causes of death started to become the leading causes of death and disability – LIFESTYLE DISEASE and disability – LIFESTYLE DISEASE

1970’s saw the introductions of 1970’s saw the introductions of preventable strategiespreventable strategies

LIFESTYLE diseases can be reduced by LIFESTYLE diseases can be reduced by individual behavior change. However, individual behavior change. However, leaving the responsibility for disease leaving the responsibility for disease prevention with the individual lead to prevention with the individual lead to “VICTIM BLAMING” attitude.“VICTIM BLAMING” attitude. A temptation to blame the individual if they A temptation to blame the individual if they

suffer from a disease because they did not suffer from a disease because they did not change their behavior. HOWEVER change their behavior. HOWEVER changing behavior is difficult and complex.changing behavior is difficult and complex.

3 Levels of Preventative3 Levels of Preventative PRIMARY – actions are targeted towards PRIMARY – actions are targeted towards

those who are healthy and aims to keep those who are healthy and aims to keep them healthy and prevent the onset of them healthy and prevent the onset of illness, disease or injury in the 1illness, disease or injury in the 1stst instance.instance.

E.gE.g Regular ExerciseRegular Exercise

Balanced dietBalanced diet

Not SmokingNot Smoking

Sun SmartSun Smart

SECONDARY – actions are directed SECONDARY – actions are directed towards those at risk of developing an towards those at risk of developing an illness or disease. It aims to identify risk illness or disease. It aims to identify risk factors, illness or disease at the earliest factors, illness or disease at the earliest possible stage through screening possible stage through screening programsprograms

E.gE.g Breast ScreenBreast Screen

Cholesterol Cholesterol and and Blood Blood PressurePressure

Pap SmearsPap Smears

TERTIARY – actions directed towards TERTIARY – actions directed towards people who have suffered a disease or people who have suffered a disease or illness and aims to rehabilitate and illness and aims to rehabilitate and prevent a recurrence. It also involves prevent a recurrence. It also involves management of an illness or disease to management of an illness or disease to ensure best quality of lifeensure best quality of life

E.gE.g Education Education ProgramsPrograms

WATCH Video – The development of WATCH Video – The development of Public Health in AustraliaPublic Health in Australia

Present Health for allPresent Health for all 33rdrd Era of Public Health Era of Public Health HEALTH FOR ALLHEALTH FOR ALL LE – 75-85yrsLE – 75-85yrs Change from infectious disease to Change from infectious disease to

lifestyle diseases and move towards lifestyle diseases and move towards individuals having the responsibility for individuals having the responsibility for their health their health

Recognises the limitations of this and Recognises the limitations of this and promotes a social model of health or a promotes a social model of health or a new public health approachnew public health approach

Many factors affect a person’s health Many factors affect a person’s health such as their working environment, socio such as their working environment, socio economic status, health knowledge, economic status, health knowledge, access to health care, quality of housing access to health care, quality of housing & access to transport. Many of these & access to transport. Many of these factors lie outside the control of the factors lie outside the control of the individual.individual.

The Ottawa CharterThe Ottawa Charter

For health promotion has had an For health promotion has had an important influence on the way we plan to important influence on the way we plan to deliver public health programs in deliver public health programs in Australia Australia

The five basic elements that the charter The five basic elements that the charter identified as important in improving identified as important in improving health and achieving health for all are:health and achieving health for all are:

1)1) Build Healthy Public Policy Build Healthy Public Policy (laws, rules and regulations that (laws, rules and regulations that help promote health)help promote health)

Decisions made at all levels of government and Decisions made at all levels of government and by organizations that contribute to the by organizations that contribute to the improvement of the health of individuals;improvement of the health of individuals;

Includes workplace and school policies and Includes workplace and school policies and areas concerned with recreation, welfare, areas concerned with recreation, welfare, housing and transport.housing and transport.

It may be in the form of legislation or taxation It may be in the form of legislation or taxation considerations, helping to make healthier considerations, helping to make healthier choices the easier ones.choices the easier ones.

Example – banning of smoking on public Example – banning of smoking on public transport, taxation subsidies on low alcohol transport, taxation subsidies on low alcohol beer and the compulsory wearing of hats at beer and the compulsory wearing of hats at school.school.

2) Create supportive 2) Create supportive environmentsenvironments Social and physical environmentsSocial and physical environments Health is improved if the environment where we Health is improved if the environment where we

live and work supports health and we get help and live and work supports health and we get help and support from others.support from others.

Health behaviour change is more achievable if we Health behaviour change is more achievable if we support each others effort and create a culture that support each others effort and create a culture that health promoting behaviours is normal.health promoting behaviours is normal.

Support groups, health services, media and Support groups, health services, media and families can all help provide supportive families can all help provide supportive environments. We must also protect the physical environments. We must also protect the physical environment and conserve our natural resources in environment and conserve our natural resources in order to maintain a healthy environment.order to maintain a healthy environment.

3) Strengthen community 3) Strengthen community actionaction

Communities working together – common Communities working together – common goals and consistent messagesgoals and consistent messages

All communities have a range of resources All communities have a range of resources which they can use and develop – combined which they can use and develop – combined action is likely to foster improved health action is likely to foster improved health outcomes through empowerment, ownership outcomes through empowerment, ownership and control.and control.

Examples of community resources that can Examples of community resources that can work effectively together are community health work effectively together are community health centres, doctors, schools, workplaces and local centres, doctors, schools, workplaces and local governments.governments.

4) Develop personal skills4) Develop personal skills

Educating people to have the Educating people to have the knowledge and skills needed to knowledge and skills needed to make healthy decisions. make healthy decisions.

These can be developed through These can be developed through schools, in the home, workplace, schools, in the home, workplace, community settings, professional community settings, professional organizations and the mediaorganizations and the media..

5) Reorient Health Services5) Reorient Health Services Prevention programs need to be developed Prevention programs need to be developed

and health care services must provide a and health care services must provide a balance between prevention and cure,balance between prevention and cure,

There needs to be a move away from an There needs to be a move away from an emphasis on the biomedical model of health to emphasis on the biomedical model of health to one that promotes health and prevents ill one that promotes health and prevents ill health.health.

Research and planning needs to occur and Research and planning needs to occur and target groups identified. Programs that are target groups identified. Programs that are developed need to be appropriate to the developed need to be appropriate to the particular target groups needs.particular target groups needs.

Health promotion initiatives need to be Health promotion initiatives need to be evaluated continually.evaluated continually.

Structure of the Structure of the Australian Health Care Australian Health Care SystemSystem

The role of governmentThe role of government All levels of government are involved in the All levels of government are involved in the

administration and provision of services in administration and provision of services in the Australian Health Care.the Australian Health Care.

3 levels 3 levels Federal Federal StateState Local Local

Federal Federal

Federal Government responsibilities for Federal Government responsibilities for health in Australia are varied but health in Australia are varied but concentrated mainly on policy and concentrated mainly on policy and funding.funding. Policies – Policies – National Health Priority AreasNational Health Priority Areas

Medicare Medicare AgreementsAgreements

Funding – collected by the Commonwealth Funding – collected by the Commonwealth government through TAXES. government through TAXES.

Public health programs – carefully Public health programs – carefully targeted to priority areas where early targeted to priority areas where early mortality from disease and illness can be mortality from disease and illness can be prevented.prevented.

Screening programs include:Screening programs include: Breast screen and cervical cancer (Pap Smear)Breast screen and cervical cancer (Pap Smear) Blood Sugar screening for diabetesBlood Sugar screening for diabetes Blood Pressure and cholesterol screening to Blood Pressure and cholesterol screening to

detect early heart diseasedetect early heart disease

Research Research New priority areas 2000 – 2003New priority areas 2000 – 2003

Mental health Mental health Oral healthOral health Ageing Ageing

STATESTATE While federal concentrates mainly on While federal concentrates mainly on

funding and policy, the state government funding and policy, the state government responsibilities lie with the provision of responsibilities lie with the provision of services and health promotion.services and health promotion.

Health Care Services Health Care Services Preventable ProgramsPreventable Programs Health Promotion Health Promotion

Activity 3.15Activity 3.15

MEDICARE MEDICARE Medicare provides universal health cover Medicare provides universal health cover

to all on the basis of need, not the ability to all on the basis of need, not the ability to pay.to pay.

Was introduced in 1975 as a Was introduced in 1975 as a Commonwealth Labor government Commonwealth Labor government initiative.initiative.

PRIVATE Health PRIVATE Health InsuranceInsurance

Many private insurance companies.Many private insurance companies. HBAHBA Australian Unity Australian Unity MedibankMedibank

Generally, private health insurance is Generally, private health insurance is taken out by the wealthy and better taken out by the wealthy and better educated. educated.

Pharmaceutical Benefits Pharmaceutical Benefits Scheme (PBS)Scheme (PBS)

A scheme that enables partial funding or A scheme that enables partial funding or subsidies for prescribed drugs.subsidies for prescribed drugs.

Australia’s get subsides for about 650 drugs.Australia’s get subsides for about 650 drugs. The cost of PBS has increased dramatically The cost of PBS has increased dramatically

and patient co-payments, brand premiums and and patient co-payments, brand premiums and other strategies have been used to transfer other strategies have been used to transfer some of the cost to the consumer.some of the cost to the consumer.

Source of Funding Source of Funding

Read pages 143 and summaries the Read pages 143 and summaries the information information

Values that underpin the Values that underpin the Australian health care Australian health care systemsystem

Values that underpin expenditure on Values that underpin expenditure on health service changes with successive health service changes with successive governments. The core values are as governments. The core values are as follows:follows:

Appropriateness:Appropriateness: The provision of appropriate The provision of appropriate services, particularly in terms on gender and services, particularly in terms on gender and culture.culture.

Access and EquityAccess and Equity Efficiency: Cost and BenefitsEfficiency: Cost and Benefits Effectiveness: Whether the program is effective Effectiveness: Whether the program is effective

in reducing early mortality. in reducing early mortality. Activity 3.17 & Looking Back Activity 3.17 & Looking Back