PDH/PE

Personal Development, Health and Physical Education

Core 1:Health Priorities in Australia

Health priorities in Australia How are priority areas for Australia health identified?

Measuring health status

Health status is a term used to describe the state of health of an individual, the community or the population of a region of country, measured against an identifiable standard.

Role of epidemiology

Epidemiology is the study of the patterns and causes of health and disease in populations, and the applications of this study to improve health.

Historically referred to as the study of ‘epidemics’ of infectious disease.

The disadvantage of using epidemiology as a measure of health status is that the statistics do not tell us the quality of life of the

individual that is being represented.

Measures of epidemiology

Different measures of epidemiology are:

Mortality, or death rates and the causes and distribution of these deaths over the population by age, gender, population group, or geographical location.

Infant mortality or the rate of death of infants per number of live births.

Morbidity or the rates of illness and diseases, and their distribution.

Measures of epidemiology

Life expectancy or the number of years an individual or population group can expect to live after birth, according to gender or population group.

Statistics on the rates of death, sickness and disease are compiled by the Australian Bureau of Statistics ABS. This information is used by Commonwealth, state and community health departments and organisations to determine the distribution of funds for health care. Statistical data can be collected for various groups in the population as well as for the population as a whole.

What can epidemiology tell us? Through the collection of data, epidemiology studies can identify

specific factors relating to health.

The disadvantage of epidemiology is that statistics do not tell us the quality of life that the individual represented

Who uses these measures?

Epidemiological data and information about population health can be used by a variety of people agencies as evidence to improve their decision making, planning and implementation of health

programs and strategies.

Who uses these measures?

Department of health and Ageing use mortality, disease prevalence and cancer screening to inform the development of policies like the National Chronic Disease Strategy.

NSW Health use data on health status, health expenditure, equity, demographic changes, community expectations and health workforce shortages to identify challenges in its State Health Plan.

NSW Department of Education use data collected about sports injuries to develop safe guidelines for the implementation of sport in schools

Who uses these measures?

Hospitals use data about the application of health services, incidence of diseases and the health workforce to plan staff training and recruitment in order to meet community needs

Pharmaceutical companies use data about life expectancy, application of medicines and attitudes to health to develop and market pharmaceutical products

Doctors use data about health determinants, disease monitoring and groups at risk to inform decisions about preventive actions, diagnosis and prescription

Current trends - Mortality

Australia’s population has increased 11.8% from 1997 – 2006. Population of people aged 65 years and over has increased from 12.1% to 13%

The standardised death rate in 2006 of 6 deaths per 1000 in the standard population was the lowest on record, steady decline from 7.6 deaths per 1000 in 1997.

Males accounted for 51.3% of deaths in 2006, down from 52.4% 1997.

Females accounted for 48.7% of deaths in 2006, an increase from 47.6% in 1997.

Ratio of male deaths per 100 female deaths has decreased from 110 in 1997 to 105.2 in 2006.

Leading causes of deaths

For males, coronary heart disease CHD, lung cancer cerebrovascular disease STROKE caused 32.4% of deaths in 2005.

Other hearth diseases, prostate cancer and chronic obstructive pulmonary disorder COPD were the next most common causes.

For females, coronary heart disease, cerebrovascular and other heart diseases caused 32.5% of all deaths.

Leading causes of deaths

Dementia, breast and lung cancer were the next most common causes

Cardiovascular diseases CVD were the number one cause of death in 2005, totalling 35% of all deaths.

Females were 10% more likely to suffer from a CVD than males.

Death rates for coronary heart disease and stroke have declined consistently since 1960

Cancers

Cancer 30% of all deaths in Australia in 2005.

Lung, prostate and colorectal cancers were the leading causes of death for males

Lung, breast and colorectal cancers were the leading causes of death for females

Make deaths from cancer occurred at a rate of 1.3 for every female death

Diabetes

New diabetes cases are increasing however diabetes related deaths have declined slightly to 2.7% of all deaths in 2005

Diabetes was named as an associated cause in 6.4% of all deaths

Mental illness

Mental or behavioural disorders accounted for 2.7 deaths per 100,000 persons (excluding suicide and dementia) and had decreased significantly since the 1990’s

Females were more likely to suffer death as a result from mental or behavioural disorder while males were a result from psychoactive substance abuse

Injury

Suicides accounted for 1/5 deaths by injury in 2005

Motor accidents and falls each accounted for a quarter of all injury related deaths

Males were more likely to die from injury than females at a ratio of 1.7 male deaths for every female death

Falls were the only injury category that female death rates were higher than males death rates

Morbidity

Morbidity data describes sickness and illness within a population as opposed to mortality data that describes causes of death.

Illness and injury cause much suffering, disability, premature mortality and impose significant costs on society in terms of health system use and lost productivity in the workplace

Major causes of illness

Cancer at 19% is the leading cause of disease burden followed by cardiovascular disease at 18% then mental disorders at 13%

Heart attack rates are falling and survival from attacks is improvingDiabetes prevalence has doubled in the last 2 decades

Kidney disease has recorded an increase with cases of end-stage kidney disease tripling in the last 25 yearsHigh levels of preventable chronic disease, injury and mental health problems

Complete questions

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

All diseases involving the heartCoronary heart disease, stroke, vascular disease

Trends Leading cause of death in AustraliaDeath rates declining due to preventionStroke is leading cause of death for both males and females

High levels of preventable chronic disease, injury and mental health problems Positive lifestyle factors and improved disease management have

contributed to an annual decline in death rates since 1970

People aged over 65 are more likely to suffer from CVD

Risk factorsSmoking, physical inactivity, overweight or obesity, high fat diet, alcohol abuse, high blood pressure and cholesterol, poor nutrition and diabetes

Groups at riskOlder people, indigenous people, socioeconomically disadvantaged people and rural and remote Australians

Cancer

Cancer can arise in any organ or body tissue

Occurs when normal cell division in the body becomes uncontrolled and unstoppable. The cells then spread throughout the body producing malignancy

Skin cancer – MelanomaMost dangerous skin cancerSpreads throughout the body

TrendsAustralia has largest level of skin cancer in the worldRates are rising, more males affected than females

Cancer

Risk factorsExposure to suns rays, solariums and attitude “healthy tan”

Protective factors Reduce exposure to suns rays, wear protective clothing e.g. hat, long sleeve shirts and sunscreen, check skin regularly for changes in moles and freckles , take care with solarium use

Groups at riskChildren, adolescents, young adults, outdoor workers

Lung cancer

Is a malignancy in the lungs

TrendsIs the major cause of cancer deaths in Australia

Male deaths are higher

Female death rates have risen gradually

Risk factorsSmoking is the greatest factor, exposure to asbestos and chemicals

Lung cancer

Protective factors

Not smoking, quitting smoking, being aware of symptoms e.g. cough not getting better and early intervention to prevent children becoming future smokers

Groups at risk

Smokers, passive smokers, older people and indigenous people

Breast cancer

Cancer cells grow in the breast and spread to other parts of the body

Trends

Have the highest rates for women

Males are also diagnosed with breast cancer

Survival rates increasing due to early detection

Breast cancer

Risk factors

High fat diet, excess alcohol intake, hormone replacement therapy taken over 4 years, late pregnancy and menopause and family history

Protective factors

Self examination, screening programs and health promotion campaigns

Injury Is a large cause of health care costs

Leading cause of deaths among young people

Suicide has become a more common cause of death than transport related injury

Three and a half more males than females committed suicide in 200

Road injury deaths have declined since early 1970’s due to intervention strategies being introduced to improve road safety

Has a major but often preventable impact on Australia’s health

Major cause of death in first half of life

Many injured people left with series disability or long term conditions

Injury Largest male rates were from road crashes and interpersonal

violence

60+ year old females have higher injury rates due to falls causing injuries such as hip fractures as compared to males

Suicide is the most frequent cause of injury deaths among males overall

Decline in road deaths has slowed recently

From late 1990’s declines in drug-related deaths and suicides

Groups at riskYoung adult males, people in rural areas, children and Indigenous Australians

Injury Protective factors

National Injury Prevention and Safety Promotion Plan 2004-14, road safety laws and education, pool fencing, reduction of excess alcohol intake and use of illicit drugs

DiabetesIs a disorder of the body’s levels of insulin. Type I is insulin dependant and can be fatal if not treatedType II is non-insulin dependant, may be undetected for years, known as mature-onset diabetesGestational diabetes can occur during pregnancyLong term effects include blindness, kidney problems, lower limb amputations, heart attack, stroke and impotence

Injury

TrendsNumbers rising in Australia and across the worldType II once mainly affected older people, now becoming more common in childhood

Risk factorsObesity, physical inactivity and poor nutrition

Groups at riskIndigenous Australians, people over the age of 50 for type II, gestational diabetes for pregnant women

Respiratory disease - COPD Chronic obstructive pulmonary disease COPD is known as

emphysema or chronic bronchitis

Destruction of the lung tissue and narrowing of the air passages obstructs oxygen intake and gas exchange

Shortness of breath and coughing

Risk factorsSmoking is the major risk factor, environmental exposure to pollutants

Protective factors

Quitting smoking, not smoking, vaccination for influenza

Respiratory disease – Asthma Is an inflammatory disease of the air passages that makes them

become narrow causing wheezing, coughing and shortness of breath

TrendsDuring the 1980’s and 1990’s there was a world wide increaseRecent years trends has plateauedAustralia has high level compared to international standardsRecent decrease among children and young adults

Respiratory disease – Asthma Risk factors

Family history, allergic conditions, parental smoking, major respiratory infection during first 2 years of life, exposure to domestic allergens and triggers including pollen, dust, exercise, cold weather and chest or throat infections

Protective factorsLearning to manage the condition, avoiding known allergens and not smoking

Groups at riskAffects all age groups and ranges in severity, boys under 15 years but after teenage years females with asthma are more prevalent and females have had a significantly higher prevalence overall than males

Identifying priority health issues The Australia Government makes decisions on where to allocate

funding and address the health problems confronted by the nation.

This is achieved through considering:

Social justice principles - A set of values that recognises the impact of discrimination, past disadvantage, structural barriers to equality, as well as other social factors. It is concerned with reducing inequity by supporting the most disadvantaged people in society

Example – Medicare is designed to provide basic health care to all Australians regardless of religion, socioeconomic status, location or cultural background

Identifying priority health issues Priority population groups – Are those experiencing inequities

however which group has priority? Decided through community consultation, media attention, demands of lobby groups to parliament and epidemiology all play a part in the decision making process

Prevalence of the condition – Major causes of death and illness that are shown in statistics point to a need to prioritise

Potential for prevention and early intervention – The capacity to identify and change health damaging risk behaviours provides great potential for improving health outcomes through education and health promotion strategies

Identifying priority health issues Costs to individuals and communities – The costs imposed on

the community may include ‘direct’ costs that are borne by the health care system or ‘indirect’ costs that may be borne by the family or other sectors of the community

What are the priority issues for improving Australia’s health? Australia ranks as one of the healthiest nations in the world. We

have a high life expectancy, low mortality rate and an improving health status.

However this is not shared by all by all groups. Aboriginal and Torres Strait Islander people suffer extraordinarily poor health status. Other groups that also share health inequities and different health status include socioeconomically disadvantaged people, people in rural areas, overseas-born people, the elderly and people with disabilities.

Currently 75% of Indigenous Australians live in cities and regional areas while 25% live in remote areas.

What are the priority issues for improving Australia’s health? The life expectancy of a male Indigenous Australian in 2001 was 59

years. This was the same life expectancy of a non indigenous male in 1910

The life expectancy of a female Indigenous Australian in 2001 was 65 years. This was the same life expectancy of a non indigenous female in 1922

The gap between indigenous and non-indigenous life expectancy is approximately 22 years

Indigenous Australians mortality rates The mortality rates for Indigenous Australians continue to be

unacceptably high compared to other Australians

Between 2001 and 2005 the death rates for Indigenous males and females in most states were almost 3 times higher than non Indigenous males and females

The 5 leading causes of death wereDiseases of the circulatory system and cancers

Indigenous Australians mortality rates Endocrine, metabolic and nutritional disorders (including diabetes)

Respiratory diseases

Injuries (injuries caused by transport, assault, self-harm were responsible for deaths amongst young Indigenous males at 3 times the non-Indigenous rate

There are however positive trends occurring with the Indigenous rates decreasing significantly in Western Australia between 1991 and 2005

Throughout Australia the gap between Indigenous and non-Indigenous infant mortality rates has closed considerably since 1991

Indigenous Australians morbidity rates The burden of disease among Indigenous Australians represents

3.6% of all disability yet they represent only 2.5% of the total population

In 2004-2005 Indigenous adults were twice as likely as non-Indigenous Australians to report their health as fair or poor – 29% compared to 15% as well as twice as likely to report high levels of psychological distress compared to non-indigenous adults

Main Causes of poor health include mental disorders, circulatory diseases, diabetes, respiratory diseases, cancers, musculoskeletal conditions, eye and ear problems and kidney disease (markedly increased between 2001 and 2004-2005

Indigenous people were hospitalised at a rate 5 times higher than the rate of non-indigenous people and at a rate 14 times higher for care involving dialysis

Indigenous Australians morbidity rates Fewer Indigenous people suffer skin cancers and prostate cancers

Rates of asthma, back pain and hearing problems amongst Indigenous Australians have declined between 2001 and 2005

Sociocultural, socioeconomic and environmental determinants

Indigenous Australians experience significant socioeconomic and Sociocultural challenges.

Since European settlement, cultural divisions and conflicts, ill-advised or ineffective programs of integration, separation, education and welfare support have all contributed to the poor state of Indigenous health.

The most critical challenges for Indigenous Australians include Lower incomes – median income for Indigenous families in 2006

was approximately 55% of non-Indigenous families

Higher rates of unemployment – in 2006 the Indigenous unemployment rate was 16% The non-Indigenous rate was 5%

Lower educational attainment – the number of Indigenous people who completed Year 12 was approximately half of non-Indigenous people

Lower rates of home owner ship – the number of Indigenous families who either owned or were purchasing a home in 2006 was half the number of non-Indigenous families 34% compared to 69%

The social determinants discussed have contributed and influenced the exposure to the following risk factors

The most critical challenges for Indigenous Australians include Tobacco use – was the main contributor to the burden of disease

among Indigenous Australians. In 2004-2005 50% of the Indigenous population were smokers and smoking rates are double those of non-Indigenous Australians.

Alcohol consumption – In 2004 – 2005, 1 in 6 Indigenous Australians reported chronic levels of risky drinking and binge drink at twice the rate of other Australians

Illicit drug use – twice as many Indigenous Australians over 15 years (28%) reported illicit drug use.

Overweight and obesity – more than 50% of Indigenous Australians are over weight (similar to non-Indigenous rates)

The most critical challenges for Indigenous Australians include Poor nutrition – little difference between Indigenous and non-

Indigenous Australians however fresh fruit intake is slightly lower in rural communities

Physical inactivity – indigenous Australians in particular females were more likely to be sedentary or exercise at low levels

Exposure to violence – 2002 national Aboriginal and Torres Strait Islander Social Survey NATSISS reported Indigenous exposure to violence was twice the rate of non-Indigenous Australians which had doubled since 1994. Exposure was 3 times more likely in rural communities

Poor housing conditions – In 2004 overcrowding affected 1 in 4 Indigenous Australians

Positive news

Year 10 and beyond school retention rates increased between 1998 – 2007 and the difference between Indigenous and non-Indigenous retention rates decreased

Labour force participation increased from 52% to 54% between 2001 – 2006

Home ownership rates increased from 31% in 2001 to 34% in 2006

The unemployment rate decreased between 2001 - 2006 from 20% to 16% for Indigenous people aged 16 – 64 years

Between 2001 – 2006 the year 12 completion rate increased from 20% to 30%

Roles of individuals, communities and governments in addressing the health inequities Aboriginal health is a major problem for this nation. Given the poor

state of current health indicators, the current strategies and programs have had limited success.

Indigenous health status results from the interaction of multiple determinants and requires a multi-faced response from the health care system. Therefore a “intersectoral” approach based on partnerships between people and agencies at many levels from a variety of sectors is needed.

Government

There are 2 peak agencies which coordinate Indigenous health services at the federal government level with a 3rd peak body in NSW that overseas at a state level.

1. The Office of Aboriginal and Torres Straight Islander Health OATSIH– has been established within the Department of Health and Ageing to bring greater focus to the Australian Governments delivery of mainstream health services to Indigenous Australians.

Is responsible for administering and funding ATSI community controlled health and substance use services

OATSIH provides direct grants to around 245 organisations of which around 80% are ATSI community controlled or managed

Government

2 The National Aboriginal Community Controlled Health Organisation NACCHO – agency that works with the Department of Families, Housing, Community Services and Indigenous affairs.

Is the national Aboriginal health body representing Aboriginal Community Controlled Health Services throughout Australia

3. The Aboriginal Health and Medical Research Council of NSW AH&MRC – is the peak body for Aboriginal health in NSW.

Is comprised of over 60 Aboriginal Community Controlled Health Organisations throughout the state

Government

Provides services that include –

Health service delivery, supporting Aboriginal community health initiatives, development and delivery of Aboriginal Health Education, research in Aboriginal health data and policy development and

evaluation

Communities

OATSIH, NACCHO and AH&MRC aim to improve the access of primary health care services for Indigenous people through the principle of working in partnership with the Aboriginal and Torres Straight islander community controlled health sector

Communities

Aboriginal communities run hundreds of local health services providing services including clinical care, health education, promotion, screening, immunisation, counselling, men’s and women’s health, aged care, transport to medical appointments,

hearing health, sexual health, substance use and metal health.

Individuals

Individuals capacity to affect their own health (risk vs protective) is influenced by many factors including (discuss)

Programs such as The Healthy for Life H4L provides a strong focus for the education and support of Indigenous mothers and children and increasing the number of Aboriginal health workers in communities

Socioeconomically disadvantaged people Socioeconomic status SES describes the ‘position’ or ‘power’ of a

person or group in the community. In Australia, Socioeconomic Indexes for Areas SEIFA measure the average SES of people living in a local area e.g. within a postcode area, are used to produce an Index of Relative Socioeconomic Disadvantage IRSD

Socioeconomic disadvantage is the existence of limited material resources such as income

Reduced access to educational opportunities

Less safe working conditions

Lower employment status

Worse living conditions during childhood

Less access to services

Greater likelihood of racism or discrimination

The nature and extent of the health inequities Studies have identified a strong relationship between low economic

status and lower health status

Health status is better or worse according to where a group is positioned on the social ladder

People from areas of lower socioeconomic status are –

More likely to suffer from cardiovascular disease, diabetes, asthma, mental illness and arthritis

Lose more years of life dur to illnesses

Experience lower life expectancy as a result

The Sociocultural, socioeconomic and environmental determinants Inadequate income, single parent family structure or family

breakdown can all contribute to a low SES and as a result cause that individual to experience reduced access, limited resources, restricted educational opportunity and control over their life

Individuals from low SES are more likely to –

Daily smokers

Eat less than the recommended serving of fruit and vegetables

Be over weight or obese

Be sedentary or physically inactive

The Sociocultural, socioeconomic and environmental determinants Report higher levels of psychological stress

Visit a doctor or emergency clinic

Depend on government assistance

Avoid the use of preventative health services

The relationship between SES and health status is complex. Each can affect the other.

Discuss the ways that they can create a cycle

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

Federal and state governments recognise the cost of poor health among people and are committed to make improvements through funding and policy.

Medicare and the Pharmaceutical Benefits Scheme PBS are programs designed to address the needs of SES by providing lower cost health services and medications

Government

The State Health Plan is designed for government and non government services and the private sector to work together to bridge the health gap for people in New South Wales

State government responsibilities relate to service provision and prevention. The NSW Government has strategies in place the risk factors that SES are exposed to. The strategies relate to -

Government

Child health and wellbeing

Immunisation

Mental health

Obesity

Sexual health

Oral health

Chronic disease

Government

Urban planning

Tobacco

Drugs and alcohol

The State Health Plan reflects the NSW Governments priorities for the development of the public health system towards 2010 and beyond

Communities and individuals The success of the strategies is dependant on the services and

information being successfully delivered into the community

The prevention of disease and management of illness within communities is more important and relevant to changing needs

Community agencies that can provide assistance will improve the health outcomes of low SES people

People in rural and remote areas People who live in regional areas represent 29% of the Australian

population

People who live in remote areas represent 3% of the Australian population

These people represent higher levels of mortality, disease and health risk factors and experience –

Similar levels of diabetes, cerebrovascular disease (stroke), coronary heart disease, depression and anxiety

Slightly higher levels of cancer in rural areas but lower levels of cancer in remote areas

More likely to suffer acute or chronic injury

People in rural and remote areas Lower life expectancy, increasing with remoteness

Less likely to report very good health or excellent health

Were more likely to show high levels to very high levels of psychological distress amongst males

The Sociocultural, socioeconomic and environmental determinants People living in rural and remote areas have fewer educational and

employment opportunities, lower income and less access to goods and services and may even have less access to basic necessities like fresh fruit and vegetables

People living in rural and remote areas were more likely to –

Drink alcohol in risky quantities that would be harmful in the short term

The Sociocultural, socioeconomic and environmental determinants Be overweight or obese

Consume less low-fat or skim milk or to eat under the recommended 2 serves of fruit per day

Consume 4 or more serves of vegetables per day

Experience lower birth weights, particularly among teenage mothers

Government

The Rural Health Taskforce provides advice to the NSW Government about improving health services to people in rural areas of the state

Responsibilities identified in the State health Plan are –

Attract and retain more health professionals in rural and remote communities

Provide sustainable quality health services

Make health services more accessible for people in rural and remote areas

Government

Implement innovative models of service, staffing, networking, rural and remote health professional support, professional development and family support

The NSW Government runs programs such as the Medical Specialist Outreach Assistance Program which offers a range of scholarships and grants to support rural health professionals an din cooperation with the Australian Government runs the Multi Purpose Service MPS Program

Communities

Rural communities struggle to sustain adequate health and medical services for their residents and find it difficult to run services based on the same models established for services in the larger centres and cities

The MPS model is aimed at –

Establishing viable acute health, aged care and community services

Improving access to appropriate services

Increasing coordination, flexibility and innovative service delivery

Communities

In order to successfully run health services, rural communities must attract and retain properly trained staff

The Australian Rural Health Education Network ARHEN is a network of University Rural Health Departments committed to increasing retention of health professionals that are linked to rural placements for graduates. They also carry out research into the satisfaction rates of rural doctors and health workers

Overseas-born people

The Australian population comprises 24% of people born overseas

They are often people who can afford to emigrate and have lower levels of illness and disease

Within the total population of people born overseas there is a great diversity of group characteristics and health status

The nature and extent of the health inequities Many migrant residents born overseas especially in South-East Asia

enjoy lower rates of death than other Australians, however this effect has a tendency to reduce as length of residence increases and exposure to typically Australian lifestyle and risk factors become more prevalent

People born overseas

Suffer higher levels of psychological stress if they come from war zones, don’t speak English or have trouble in the resettling process

Have hospitalisation rates almost 20% lower than other Australians

Are hospitalised for the following diseases according to country of birth –

Tuberculosis – India, Vietnam, Philippines and China

People born overseas

Lung Cancer – United Kingdom and Ireland

Diabetes – Greece, India, Italy and Vietnam

Heart attack – India

Heart failure – Italy, Greece and Poland

Dialysis – Greece, Italy, Vietnam, Philippines, Croatia and India

Breast Cancer – women from England and Northern Ireland

The Sociocultural, socioeconomic and environmental determinants Migrants are often less exposed to harmful risk factors for

cardiovascular and other diseases such as overweight or obesity, physical inactivity and high risk alcohol consumption in their country of origin

The 2004-2005 National health Survey reported that there were higher levels of exposure to some risk factors for some groups –

Current daily smoking – Oceania (New Zealand, Papua New Guinea, Solomon Islands, Kiribati, Fiji and Antarctica).

The Sociocultural, socioeconomic and environmental determinants Sedentary or low exercise levels – Southern and Eastern Europe,

North Africa, the Middle East and South East Asia.

Varying body weights and heights showing they are likely to be overweight or obese than people born in Australia – Oceania and

Southern and Eastern Europe

Government

The main approach by governments to the health of people born overseas is to provide translation and language services to improve communication of health issues and access to health services among culturally and linguistically diverse CALD communities

The NSW Multicultural Health Communication Service MHCS works with health services to provide non English speakers with access to important health information

The NSW Government identifies the delivery of health services to CALD communities and refugees as one of its objectives.

Communities

The critical role of communities is to provide support for their members by advocating, promoting and engaging in the use and delivery of culturally appropriate health services

Training and educating of CALD community members to join and support the health care profession in the most enabling of all strategies

Communities

The capacity of CLAD communities to provide and support healthcare services is governed by the age of the community. The longer the community has been established, the greater the greater the capacity

Government and non government services work in partnership with

CLAD communities to provide a range of health care services

A growing and ageing population In 2007 Australia’s population reached 21,015042 growing appx

1.5% annually

In the period 1956 – 2006 the proportion of people aged up to 14 years grew by 46%

The proportion of people aged 65 and over grew more than 200%

The proportion of people aged 85 years and over grew 700%

This is depicting an ageing population

Older are much higher users of hospitals than younger people with over half of people in hospital at one time being over 65 years. This means that majority of hospital resources will be focused on older people

A growing and ageing population Appx 25% of all GP visits were made by older patients

The percentage of visits from people aged 75 years and older has increased significantly however the percentage of visits from people aged 65 – 75 years has only slightly increased

Most common reasons for GP visits – hypertension, immunisation, diabetes, osteoarthritis and health check ups

6% of people aged over 65 years live in residential and aged care facilities resulting in aged care services being delivered in the home

A growing and ageing population In 2006 appx 2.6% of people aged 65 years and over

and 22% of people aged 85 years had dementia

High percentage of people move into aged care facilities as a result from falls. Injury from falls is estimated to cost the NSW healthcare system over $1.2 billion. The “Stay on your Feet” program run in NSW reduced hospital admissions by 20% for people aged over 60 years

In 2006 35% of elderly people were born overseas with 61% of those were born in non English speaking countries

A growing and ageing population Older population taking the “sea change” moving to more costal

areas and away from cities when retiring. This change has a large impact on governments who need to address the health needs of retirees by redistribute appropriate services from the cities to rural centres. Problems then arise such as finding trained and qualified staff

Older Australians are increasingly being used to provide care. Grandparents provide 60% of child care for children equating to 20% of all children and represent a large source of primary care for partners or other older people with a disability or poor health

Healthy ageing

Healthy older Australians are –

Less likely to leave the workforce for health reasons

More likely to enjoy retirement

Contribute more to their own environment

Have fewer health care needs

Experience less chronic disease and disability

Place less pressure on the national health budget and health care system

Healthy ageing

Positive determents for maintenance of health include –

Sufficient income

Safe housing

Right conditions for achieving independence and mobility

Healthy ageing

Risk factors that contribute to the health status of older people

High blood cholesterol

Impaired glucose tolerance

High blood pressure

Obesity

Physical inactivity

Healthy ageing

Risky alcohol consumption

Smoking

Poor diet

Increased population living with chronic disease and disability

Healthy ageing

Most health problems experienced from older Australians are a result from the accumulated effects of poor lifestyle behaviours over many years

As the age of the suffer increases, so does the level of disability causing a greater increase on carers and healthcare

The National Chronic Disease Strategy targets conditions that place a huge burden on the healthcare system including –

Healthy ageing

Cardiovascular diseases

Cancers

Chronic lung disease

Obesity (major problem in NSW)

Injurious falls in older people

Diabetes (type 2)

Poor emotional and psychological wellbeing

Healthy ageing

These conditions are a result from modifiable risk factors including –

Tobacco smoking

Nutrition

Alcohol consumption

Physical activity

Stress – psychosocial risk factors

Healthy ageing

In response to the increased levels of chronic disease and disability the NSW Government has included a range of studies in its State Health Plan including –

Align NSW activities with the Australian Better Health Initiative

Develop and implement new community based models of care for older people and people with chronic disease

Expend programs to prevent and reduce the impact of chronic disease to improve survival rates and quality of life

Healthy ageing

Enhance services for early detection, prevention and management of chronic disease

Implement initiatives to address childhood and adult obesity (Fresh Tastes@School NSW Healthy School Canteen Strategy)

Strengthen the capacity of the public health system

Demand for health services and workforce shortages In 2005 – 2006 subsidies for aged care homes totalled appx $5.3

billion.

These providers include public, private, religious and charitable organisations

Older Australians prefer to live in their own home. They have access to a range of care packages including –

Home and Community Care HACC Programs e.g. home nursing services, delivered meals, home help, home maintenance services, transport and shopping assistance, allied health services home and centre based respite care

Demand for health services and workforce shortages The Extended Aged Care at Home EACH and EACH Dementia

programs

Community Aged Care Packages CACP

Aged care homes, high level, personal care is required, low level, only assistance is needed

Eligibility for any type of care is assessed through the Ages Care Assessment Team

A main challenge in meeting the health needs is for the government to train and mobilise enough qualified professionals to the areas affected.

What other staffing challenges would be faced?

Availability of carers and volunteers The number of Australians aged 85 years and over has doubled

over the past 20 years and is projected to 4.6% of the total population by 2036

The care is split up by 80% of family and 20% by organisations

As the aged population grows, so will the demand for carers, based off the current projections the demand may not be meet

What role do health care facilities and services play in achieving better health for all Australians? Health care in Australia

While Australia is a relatively healthy country in comparison to other nations, the healthcare system is still extremely important. Its role is to provide quality health facilities and services to meet the needs of all Australians.

Health services are organised, financed and delivered by both

public and private sources. Healthcare in Australia is dominated by medicine and is generally concerned with diagnosis, treatment, rehabilitation and care of people with illness and injury.

Range and types of health facilities and services Health facilities and services provided in Australia can be classified

in two areas.

Institutional facilities and services

Hospitals provide general and specialised healthcare.

Patients in hospitals are classified as public or private according to their choice of service. Public hospitals are operated and financed by the government, and the healthcare service is free of charge for patients.

Range and types of health facilities and services Private hospitals are owned and operated by individuals and

community groups. Service must be paid for by the patients, although Medicare and private health insurance refund most of the expense.

In Australia, hospital admissions have increased whilst length of stay has decreased.

Nursing homes provide care and long-term nursing attention for those who are unable to look after themselves, such as the

chronically ill, the elderly and people with disabilities.

Range and types of health facilities and services There are three types of nursing homes in operation throughout

Australia – private charitable (such as Anglicare), private for profit and state government.

The federal government funds the running of all nursing homes through taxes.

Psychiatric hospitals provide treatment for people with severe mental disorders.

They use a system of care that integrates hospital services and community settings.

Non-institutional facilities and services

Medical services

These are services provided by doctors, specialists and other health professionals. General practitioners are the most commonly used service, however consultation rates have increased. Medicare refunds patients’ payments for these services. Specialists such as obstetricians, dermatologists, orthopaedic surgeons, who have expertise in a particular field of medicine, are also used.

Health-related services

These include other services such as a dentistry, optometry, nursing, ambulance services and physiotherapy.

Pharmaceuticals

Drugs are supplied through prescription from doctors or hospitals (PBS) or over the counter from shops or pharmacies. Pharmaceutical Benefit Scheme (PBS) drugs are subsidised by the federal government for people with special needs.

Responsibility for health facilities and services The following groups are responsible for a range of health facilities

and services within Australia.

Federal government

The formation of national health policies is the responsibility of the federal government.

They control funds obtained through taxes and allocate these to state or local government health sectors.

The Australian Government operates assistance programs, such as Medicare and PBS; and coordinates approved national health programs, such as HIV/AIDS.

They also support special programs such as the National Heart Foundation and Royal Flying Doctor Service.

State or territory government The responsibility for providing funding for health and community

services, such as public hospitals, medical practitioners, and family health services lies with the state or territory. At this level, governments also regulate private hospitals and provide immunisation programs.

Local government

At a local level, governments are responsible for implementing state health policies and controlling local environmental issues such as maintenance of recreational facilities. They are also responsible for providing a range of personal, preventive and home care services such as waste disposal and Meals on Wheels.

Private sector

The private sector is responsible for providing a wide range of services, such as private hospitals and alternative health services including dental, physiotherapy and chiropractic services. These services are generally privately owned, funded and operated through business, charity or religious groups, such as Mayne Health. However, some private sector services receive government funding such as the NSW Cancer Council.

Community groups

On a community level, these groups are responsible for promoting health within a more concentrated or focused area of health, for example, the Asthma Foundation and Diabetes Australia.

Equity of access to health facilities and services The pursuit of equity of access to healthcare is a central objective of

many healthcare systems. There are two dimensions to equity of access to health facilities and services. The first is horizontal equity, which refers to equal treatment for comparable needs. One example is Medicare, the national health insurance system, which aims to provide the majority of Australians with equal access to basic healthcare.

Another example is the Pharmaceutical Benefits Scheme (PBS), where the service provided by the Australian Government ensures a range of necessary prescription medicines are made available at affordable prices to all Australian residents.

Equity of access to health facilities and services The second dimension of equity of access is referred to as vertical

equity.

This involves the priority treatment of those groups with increased health needs and reduced access to health facilities and services, such as Aboriginal and Torres Strait Islanders, and people of culturally and linguistically diverse backgrounds.

Horizontal and vertical equity are both essential aspects of a comprehensive health system, however governments and service providers find it easier to work on a horizontal level of equity as it is less complex and does not involve the issues associated with needing to prioritise population groups.

Equity of access to health facilities and services An example of a service addressing the vertically equitable need of

geographic disadvantage is the Royal Flying Doctor Service of Australia.

For geographic, social and cultural reasons, mainstream services are not always accessible to, or the most appropriate form of service for, Indigenous people.

Australian governments recognise this and apply the principles of vertical equity to provide specific healthcare services to meet their needs.

Specific Indigenous health services have funding provided at federal and state or territory government levels.

Equity of access to health facilities and services The Australian Government, through the Office for Aboriginal and

Torres Strait Islander Health (OATSIH), provides funding for a range of Indigenous-specific community-controlled primary healthcare services.

In 2005-2006, OATSIH funded 151 services to provide or facilitate access to primary healthcare for Aboriginal and Torres Strait Islander peoples. Overall, 58 of these services (39%) were in remote or very remote locations.

These services offer many types of care, including management of acute and chronic health conditions, preventative health measures, such as immunisation and screening, health promotion activities, transport services and assistance in accessing other appropriate community and health services.

Health care expenditure versus expenditure on early intervention and prevention

Health expenditure

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

There are two types of expenditure:

Recurrent expenditure – regular ongoing costs (salaries, bandages)

Capital expenditure – infrequent costs (buildings, equipment).

Health expenditure

In 2005-2006, government funding for health was $58,875 million (68% of the total health expenditure), with the Australian Government contributing $37,229 million (43%) and state, territory and local governments contributing $21,646 million (25%). The non-government sector – households, private health insurance and other non-government sources – funded the remaining $28,004 million (32%).

Recurrent expenditure on health for Indigenous people was estimated at $2304 million or nearly 3% of recurrent health expenditure for the entire population. This represents an average of $4718 per Indigenous person, 17% higher than the average of $4019 for other Australians (AIHW 2008).

Health expenditure

Seven broad disease groups accounted for an estimated $29,827 million, or 57% of the available health expenditure in Australia in 2004-2005. Cardiovascular disease was the most expensive disease group $5923 million or 11% of expenditure) and oral health was the second most expensive $5305 million or 10%.

Different illnesses have different patterns of expenditure by type of health service. Cardiovascular diseases, musculoskeletal diseases, cancers and other neoplasms and injuries accounted for a relatively high proportion of total expenditure on hospital admitted patient services.

Intervention and prevention expenditure The term ‘public health’ is also referred to as ‘preventative health’.

Public health interventions focus on prevention, promotion and protection rather than on treatment. It centres on populations rather than on individuals and on the factors and behaviours that cause illness.

Public health activities can be programs, campaigns or events. They draw on a large range of methods, such as health education, lifestyle advice, infection control, risk factor monitoring and tax increases to discourage unhealthy lifestyle choices. They also use multiple settings, such as schools, homes, work places, through the media and via general practitioner consultations.

Intervention and prevention expenditure Early intervention and prevention strategies are carried out by

federal, state or territory and local governments, as well as non-government agencies, such as the Cancer Council and the Heart Foundation.

In 2005-2006, governments in Australia spent a total of $1476 million on public health activities through the programs administered by their health departments.

This represented 1.8% of total recurrent expenditure on health. Expenditure on organised immunisation accounted for $318 million (22% of all government expenditure on public health activities) during 2005-2006 and was the largest single area of such expenditure.

Intervention and prevention expenditure Selected health promotion activities accounted for a further $250

million (17%) and communicable disease control activities cost $245 million (17%). Activities directed at preventing hazardous and harmful drug use accounted for $176 million (12%).

It’s been seen so far that healthcare expenditure in Australia far exceeds expenditure on prevention and support programs, are efficient and increasingly accepted and used.

Nevertheless, governments still have not yet fully acknowledged health promotion as a cost-effective method of reducing morbidity and mortality.

The new public health approach focuses on shifting away from medically dominated expenditure to health promotion expenditure.

Intervention and prevention expenditure The reasons for increasing funding and support for preventive and

promotional health include:

cost-effectiveness (human and non-human resources)

improvement to quality of life

improved access and education

maintenance of social equity

use of existing structures

reinforcement of individual responsibility for health (empowerment).

Intervention and prevention expenditure Unfortunately, even though preventive health is generally cheaper,

the benefits often take years to translate into a visible reduction in illness or death. Current governments could spend money now on programs that might be considered as risky political options if they are unsuccessful. Governments may feel pressure to choose an option where results are short term and can be used as leverage for winning the next election.

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

Intervention and prevention expenditure Much of the rise in healthcare costs can be attributed to advances in

medical technology. Diagnostic and therapeutic advances, such as new radiological scanners, biological therapeutics, surgical procedures and prostheses, come at a considerable cost. Listing these for subsidy through Medicare or the Pharmaceutical Benefits Scheme greatly increases their availability and use, and therefore the cost to the community. Failing to subsidise them inevitably raises questions about why new medical advances are not available to all Australians and generates political pressure. Treatments and technologies have emerged that address the essential needs of access and early detection. Two programs that have been effective in achieving this are cancer screening and childhood vaccinations.

Cancer screening

There are national population screening programs in Australia for breast, cervical and bowel cancers with aims to reduce morbidity and mortality from these cancers through early detection of cancer and pre-cancerous abnormalities and effective follow-up treatment.

These programs are:

Breast Screen Australia – using mammography for screening

National Cervical Screening Program – using Pap smear tests

National Bowel Cancer Screening Program – using faecal occult blood tests.

These programs provide screening services that are free to women in the target age group (for breast screening) and to men and women invited to participate in bowel screening, or if they are covered by a Medicare rebate (for cervical screening).

Childhood vaccinations

The National Immunisation Program Schedule covers children’s vaccinations for diphtheria, tetanus, whooping cough (pertussis), polio, measles, mumps, rubella, meningococcal type C disease, varicella (chickenpox), hepatitis B, rotavirus and, for females aged 12 years and over, human papillomavirus (HPV).

Additionally, for Aboriginal and Torres Strait Islander children living in high-risk areas, hepatitis A is covered. In 2006-2007, nearly 3.7 million immunisations were delivered to children nationally (AIHW 2008).

Medicare

Medicare is Australia’s universal healthcare system introduced in 1984 to provide eligible Australian residents with affordable, accessible and high quality healthcare.

Medicare provides access to free treatment as a public (Medicare) patient in a public hospital, and free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only).

Medicare

Medicare was established based on the understanding that all Australians should contribute to the cost of healthcare according to their ability to pay. It is funded through the Australian Government, progressive income tax and an income-related Medicare lvy. Nearly everybody (except for those on welfare or very low incomes) pays at least 1.5% of their earnings toward Medicare levy. It reimburses 85% of scheduled medical fees for services provided outside hospital and 75% of scheduled fees for services provided inside a public hospital. Individuals must pay the remaining 15%, commonly referred to as the ‘gap’. Bulk billing, which eliminates the ‘gap’ payment for patients, is also covered. This is where patients pay nothing and the medical professionals bill Medicare to receive 85% of the scheduled consultation fee back.

Medicare

The disadvantages to the individual and community in using Medicare include:

long waiting lists for surgery

additional costs and further strain for hospitals

additional costs to state government

patients may still be required to pay the ‘gap’ amount left over from the general practitioner’s fee and the amount paid by Medicare.

Medicare

Medicare Australia is responsible for ensuring that Medicare benefits are paid to eligible healthcare consumers for services provided by eligible medical practitioners; and for assessing and paying Medicare benefits for a range of medical services, whether provided in or out of hospital, based on a schedule of fees determined by Department of Health and Ageing in consultation with professional bodies.

For more information, go to the Medicare website:

www.medicareaustralia.gov.au/

Private health insurance

Private health insurance is funded through the federal government and private contributions. Private health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover. Contributions are usually paid monthly or annually.

The advantages to the individual and community for having private health insurance include:

an option to cover extra services such as medical, ancillary, dental and optical

patients have a choice of hospital service (public or private)

special benefits

Private health insurance

health cover while overseas

shorter waiting lists for surgery

decreased demand on public facilities.

Some areas of surgery are no performed predominantly in the private sector, and the 57% of Australians without private health insurance must wait, often for months, for elective surgery in the public system.

Private health insurance

This creates an equity challenge where access to care is based on ability to pay rather than need. Specialist surgical training remains concentrated in the public sector, where the caseload is diminishing.

One of the disadvantages of joining the private health insurance sector is that it is heavily regulated.

This means that premiums for private health insurance are the same for all, whether they use it or not. Also, Medicare must still be paid, which adds to the annual costs.

Private health insurance

Additional insurance covers private hospital expenses, ambulance services, ancillary expenses and aids, such as dental, physiotherapy and chiropractic; and options such as glasses. Patients may still be required to pay an ‘excess’, which is the first part of the cost before the insurance company will pay. A higher excess means a lower premium.

Access to health services is becoming less equitable. The out-of-pocket costs for patients have increased 50% in the past decade and for some this can present a sizeable barrier to needed care.

Private health insurance

Regional Australians have substantially lower levels of private health fund membership. In 2001, 50% of people living in capital cities were covered by private health insurance compared with 44% living outside capital cities. The main reason for the lower level of membership in regional areas is the limited availability of private in-patient facilities. Only 16% of hospitals located outside major cities are private facilities.

If more people joined private health insurance providers, it would decrease the costs to government, which in turn would allow funds to be redirected to other government priorities and initiatives.

The federal government 30% rebate An individual who pays hospital and/or ancillary private health fund

premiums to a registered health fund can get the federal government’s 30% reduction on the cost of private health insurance. It is the policy holder who is eligible for this rebate; even if it is a dependent child or spouse who is covered by the policy. However, the policy must cover people who are eligible for Medicare in order to be eligible for the rebate. The 30% rebate was not means tested up until 2009, so it had been paid regardless of individual or family income. During the 2009 federal budget, a decision was made to progressively reduce the rebate for people earning over the threshold amounts, phasing it out completely for people on high incomes.

The federal government 30% rebate The use of private health insurance initially decreased after the

introduction of Medicare because of large increases in premiums and general satisfaction with public insurance. This fall initially created pressures on the public health system, particularly in terms of funding. To facilitate the future expected increase of demands for an ageing population, the government has used several strategies to encourage people to invest in private health insurance. These strategies have led to increased levels of cover.

The Medicare levy surcharge The Medicare levy surcharge of an extra 1% - on top of the 1.5%

charged to all Australians – only applies to people who earn over the Medicare levy surcharge threshold and who choose not to have private hospital health insurance.

The federal government has used the following strategies to encourage people to take out private health insurance:

The Medicare levy surcharge Incentive scheme: As of 1 July 2010 individuals earning $75,000 or

over, or couples earning $150,000 or over, will not be required to pay the extra 1% Medicare levy if they take out private health insurance. At the same time, singles earning above $90,000 and families earning above $180,000 will be required to pay a higher surcharge if they choose not to take out private health insurance.

Lifetime health cover scheme From the age of 30 years, Australians are encouraged to take out

private health insurance. If they do not, then when or if they choose to take out private health insurance at a later time in their life, for example when they get older and may be at higher risk of illness, they are required to pay an extra 2% on top of the premium for every year after the age of 30. For example, a person who takes out insurance at age 50 would be required to add an extra 40% (20 years x 2%) onto the premium. Therefore, a $2,000 annual premium would now be charged at the penalty rate of $2,800 each year, for the remainder of the person’s life.

Lifetime health cover scheme The decision for many individuals and families is whether to save

the amount paid each year on private health insurance and hope that if something does occur medically, that it will cost less than the amount save. On the other side, if a major medical issue did arise and they were not covered, the out of pocket expenses could be large and the wait for treatment quite lengthy. For many people, they see private health insurance as a waste of money, while for others, private health insurance is taken out for peace of mind.

Complementary and alternative health care approaches What do you need to help you make informed decisions?

Australians have access to a range of services that either complement or are alternative to mainstream healthcare services. In the 2004-2005 National Health Survey, results indicated that in any two-week period, 1 in 28 Australians (700,000) consulted a complementary or alternative health professional: 1 in 23 females (500,000 and 1 in 37 males (300,000. About 1 in every 47 Australians (400,000) consulted a chiropractor, 100,000 consulted a naturopath and about 200,000 consulted an acupuncturist, herbalist, hypnotherapist or osteopath.

Complementary and alternative health care approaches Complementary and alternative health services have been

incorporated into the general healthcare system to a varying extent.

Acupuncture performed by a medical practitioner attracts a Medicare rebate, for which a total of 589,796 claims were made in 2006-2007, attracting benefits of $21.1 million (PHIAC 2007).

Reasons for growth of complementary and alternative health

Patients to be more proactive towards their own health, seek out different forms of self-care. In the process, many people have turned to natural traditional medicinal products and practices under the assumption that ‘natural means safe’.

Scientific studies of several therapies show that their use is effective, such as for HIV/AIDS and cancer patients.

Complementary and alternative health care approaches The advantages of complementary and alternative medicine include

diversity and flexibility

availability and affordability in many parts of the world

widespread acceptance in low and middle income countries

comparatively low cost

relatively low level of technological input.

Complementary and alternative health care approaches Reasons for use -

compatibility with a holistic view of health

acceptance by people with diverse cultural backgrounds and influences and traditional beliefs

desire to use natural products rather than synthetic ones and an

acceptance of their validity by the World Health Organization.

Range of products and services available

Some of the more common complementary and alternative products used are herbal medicines.

Complementary and alternative health care approaches These can be categorised as:

herbs – leaves, flowers, fruit, seed, stems, bark, roots or other plant parts

herbal materials – herbs, juices, oils, resins and dry powders of herbs

herbal preparations – extraction and purification.

Popular natural products used in Australia include fish oil/omega 3, which reduces the risk of heart disease; glucosamine for managing arthritis; and Echinacea, which is used to increase activity of the immune system.

Complementary and alternative health care approaches Some examples of complementary and alternative services -

Acupuncture – inserting needles into the skin at points where the flow of energy is thought to be blocked.

Aromatherapy – the use of oils extracted from plants to alleviate physical and psychological disorders such as sleep disorders, stress, and anxiety.

Chiropractic – based on the theory that disease and disorders are caused by a misalignment of the bones, especially in the spine, that obstructs nerve functions.

Homeopathy – a patient is given minute doses of natural substances that in larger doses would produce symptoms of the disease itself.

Complementary and alternative health care approaches Massage – rubbing or kneading the muscles, either for medical or

therapeutic purposes or simply as an aid to relaxation.

Meditation – the concentration of the mind on one thing, in order to aid mental or spiritual development and relaxation.

Naturopathy – founded on the belief that diet, mental state, exercise, breathing, and other natural factors are central to the origin and treatment of disease.

How to make informed consumer choices Though there are many benefits using different types

of complementary and alternative medicines, there are also associated risks. Despite widespread access to various treatments and therapies, people often do not have enough information on what to know or check when using complementary and alternative medicines in order to avoid unnecessary harm.

For example, the Chinese herb ‘ma huang’, which contains ephedrine and is used for breathing problems such as asthma, has caused heart attacks and strokes among some people using it as a dietary supplement.

How to make informed consumer choices Long term use of ‘kava kava’, which is used to relieve anxiety, can

cause serious liver damage. And the use of ‘ginkgo’, which stimulates peripheral circulation, can result in bleeding during a surgical procedure.

It is important to make informed decisions when choosing to use alternative healthcare. Before undertaking any service or product, people should research:

the nature of the product or service, its credibility, benefits and effectiveness

qualifications and experience of practitioners

recommendations from friends, community members and recognised experts or groups such as the World Health Organization

What actions are needed to address Australia’s health priorities? Health promotion based on the five action areas of the Ottawa

Charter

Levels of responsibility for health promotion

Health promotion is all about prevention. If, at an early stage, preventive attitudes can be developed and exposure to risk factors can be controlled the chances of achieving positive health outcomes are significantly improved.

This is difficult to put into practice and requires determined action by governments, communities, families and individuals to reduce risk and provide support and protection. There should be an emphasis on developing partnerships, combining the sectors and using a mixture of interventions.

Levels of responsibility for health promotion The federal government is responsible for providing leadership and

coordination. It is vital for top level of government to encourage the states and territories to work together to establish a strong health promotion infrastructure.

At a federal level, government should interact with international agencies such as the World Health Organization and provide the public and the relevant health-promoting agencies with information and systems for achieving the best health outcomes for the population.

Levels of responsibility for health promotion State and territory governments are responsible for delivering the

preventive health services that support health promotion, including prioritising health spending, establishing healthy public policy, meeting accountability and public health goals.

They need to work cooperatively with different ministries, other levels of government and non-government agencies, as well as communicating closely with communities and the public about health promotion initiatives and programs.

The private sector has a responsibility to contribute to the overall wellbeing of the population. This can be in conflict with other responsibilities to make profits. The private sector should also work to protect the environment, providing goods, services and working conditions that contribute to achieving healthy outcomes.

Levels of responsibility for health promotion Local communities have a responsibility to their citizens. With

limited resources, they need to develop partnerships to provide safe environments and relevant health services to meet public demand. Identifying the specific needs of local groups and addressing the critical determinants of health in the community are the most important tasks in achieving positive health outcomes in the population.

Individuals must take responsibility for their own health. They can only make informed health decisions if they actively seek accurate health information. Individuals can contribute to the health of the community by supporting their families and friends and by actively participating in community activities that are designed to promote and protect the health of the wider population.

One of the future directions of NSW Health is to ‘make prevention everybody’s business’.

Individuals

With appropriate support, take greater responsibility for our own health

Develop supportive, nurturing relationships which can help strengthen coping abilities.

Schools, community groups and non-government organisations Develop individuals’ knowledge, skills, capacity and motivation to

adopt and maintain a healthy lifestyle

Provide affordable and accessible opportunities for people to improve their physical and mental health in health-promoting environments

NSW public health system

Work with individuals, parents, communities, GPs, other health practitioners, childcare providers, schools, aged care facilities, other government and non-government agencies, the corporate sector and the media to implement evidence-based programs to reduce health risks, create health living environments and increase other health protective factors for people of all ages

Make a particular effort to close the health gap by helping those most in need and at highest risk of poor health

Emphasise early intervention as an effective means of preventing risk in the population, preventing disease or injury in those at risk, and preventing the progression of health conditions so as to minimise their impact

Health practitioners

Assist and support individuals, carers and families to take control of their health as far as possible

Regard every interaction with a health consumer and carer as a chance for prevention, early intervention and education

NSW, Australian and local governments Develop an investment strategy to increase the share of resources

spent on prevention and protection initiatives

Adopt a life course approach to the promotion of good health focusing on evidence-based measures which produce the greatest health gains, beginning with the prenatal period and infancy

Focus on developing health-promoting public policies which address underlying determinants of health

Industry and business

Develop products, services and marketing which encourage healthy choices and promote a culture of healthy living

Pursue healthy workplace initiatives (which can also increase employee job satisfaction and business productivity)

Media

Provide meaningful information on risks to health, reinforce messages about healthy behaviours, and be responsible in depicting unhealthy behaviours

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

Modern view of health acknowledges that health comes from interactions between a multitude of factors. As such, the most effective health solutions can be found when health promotion initiatives employ multi-strategy approaches to address targeted health problems.

This is best achieved when partnerships are developed between different agencies and sectors.

Media

‘Intersectoral collaboration’ is a term used to describe combined action taken between agencies from within the health sector and agencies from outside the health sector. It can occur between government agencies, non-government agencies or a combination of both.

Intersectoral collaboration also relies on the input of communities and individuals.

When Australians are given the opportunity to participate in decisions and planning relating to their own health they have been shown to be more accepting and trusting of those decisions.

Media

Health promotion policies and strategies based on contributions from the people whom they are most likely to affect will benefit from increased community involvement in the health promoting process.

The NSW Government support the notion that individuals should contribute to the health planning process. This is an important aspect of the collaborative process.

NSW Health produced a ‘Fit for the Future’ questionnaire to allow the people of New South Wales to have their say and contribute to the health planning process. Respondents were provided with opportunities to answer by phone, mail, online, fax or at a personal meeting.

Media

Participation in health promotion activities at a community or individual level produces a resource called ‘social capital’. It can be described as a collective sense of achievement. Social capital is being built when neighbours are brought together, health professionals support community projects or local governments improve the quality of public spaces and environments. It is an essential component in building healthy communities and has been linked in recent research to improved population health outcomes.

Individuals and carers should ‘participate as much as possible in decisions about their health care’ and ‘provide constructive feedback about experiences of the health system’, and that the NSW public health system should ‘provide timely reliable information to consumers and carers about available health services and treatment options, help them find their way through the health system, and respond to their feedback’.

Argue the benefits of health promotion based on Individuals, communities and governments working in partnership

The most successful health promotion campaigns in Australia provide us with outstanding examples of how individuals, communities and governments have worked in partnership to produce greatly improved health outcomes for the population.

Following are a few examples of successful partnerships and how they have worked to accomplish their achievements.

BreastScreen Australia

The BreastScreen Australia Program is a free screening program that aims to maximise the early detection of breast cancer. The program targets women aged 50-69 years as these are the years of higher risk from breast cancer and optimum benefit from screening. However, women of 40-49 years and over 70 years of age are also eligible to attend. The program operates in over 500 fixed, relocatable and mobile locations.

BreastScreen Australia

The state and territory governments have primary responsibility for the implementation of the program at their local level. The Australian Government provides overall coordination of policy formulation, national data collection, quality control, monitoring and evaluation, with the AIHW publishing an annual monitoring report.

Health departments and the Cancer Council in all states and territories advertise and promote ‘Breast screen’ services. General practitioners, as well as organisations and local community groups help promote the use of the service to women in the targeted group.

BreastScreen Australia

In NSW, the Cancer Institute provides ongoing scientific research, while local governments provide sites and access. As a result of these collaborative programs, breast cancer mortality has declined from 62 deaths per 100,000 women aged 50-69 years in 1996, to 52 deaths per 100,000 in 2005.

Cervical screening

The National Cervical Screen Program (NCSP) provides free Pap smear tests for all women aged 18-70 years. In combination with free pap smear tests a program of immunisation for young women and school-aged girls against the human papilloma virus (HPV) has also been initiated.

The Australian Government is responsible for the National Immunisation Framework. The NCSP is jointly funded by federal and state governments and coordinated by the Cancer Institute. General practitioners play an important primary role by

recommending regular Pap tests to their patients.

Cervical screening

This influences many patients in making the decision to have a regular Pap test. (Media agencies are also employed to design and deliver advertising campaigns to promote Pap testing).

Gynaecologists advise and assist the program in the development of evidence-based strategies that will facilitate effective clinical management of women. All results from laboratories are reported to service providers and the pap test register according to guidelines established by the NHMRC.

Cervical screening

Schools are involved as sites for education and the delivery of the HPV vaccine, while families, mothers in particular, support their daughters to use these preventative services as recommended.

Since the introduction of a national screening program in 1991, cancer of the cervix has dropped from the 8th to the 18th most common cancer among Australian women. The use of pap smear tests has reduced death rates from cervical cancer by 52% in the last decade. The introduction of the HPV vaccine will protect women from the strains of HPV that cause approximately 70% of all cervical cancer.

The five action areas of the Ottawa Charter Just as partnerships in health promotion improve health outcomes

for the population, its effectiveness is enhanced when it is based on the five action areas of the Ottawa Charter.

The following two statements from the Ottawa Charter give a better understanding about what the ‘action areas’ are designed to do.

When the five ‘action areas’ are incorporated in the design of a health promotion strategy they integrate quite naturally to produce a collaborative intersectoral approach that can address a wide range of health determinants and inequities on a variety of different levels.

The five action areas of the Ottawa Charter The ‘action areas’ that are applied to address heart disease might

include the following suite of responses in a multi-strategy approach:

Reorienting health services (RHS) – This could include strategies for screening programs to identify risk factors such as obesity and hypertension; free checkups for people in higher risk categories such as males over 45 years old; and training for doctors to identify high-risk patients.

The five action areas of the Ottawa Charter Developing personal skills (DPS) – This could include strategies for

courses in time management, yoga or other stress management techniques and PDHPE lessons that educate students about nutrition and exercise.

Creating supportive environments (CSE) – This could include strategies for smoke-free zones, workplaces that reduce exposure to tobacco smoke and programs such as ‘Quit’ that provide social support to smokers who are trying to give up.

Building healthy public policy (BHPP) – This could include strategies such as no GST applied to fresh fruit and vegetables or high taxes on tobacco and alcohol.

The five action areas of the Ottawa Charter Strengthening community action (SCA) – This could include

strategies such as healthy canteens in schools, breakfast exercise groups in local communities or community obesity forums.

Many of Australia’s most successful health promotion campaigns have applied the Ottawa Charter action areas, influencing many of the determinants that contribute to the problem and putting pressure on influential people and agencies to take action.

The Immunise Australia Program coordinated the Measles Immunisation Program in the late 1990s. The summarised case study below demonstrates how the action areas were applied to produce a highly effective national health promotion program.

How health promotion based on the Ottawa Charter promotes social justice Social justice has been described as a set of values concerned with

reducing inequity by supporting the most disadvantaged people in society. Social justice principles include participation, equity, access, rights, supportive environments and acknowledging diversity.

The Ottawa Charter addresses each of these values when it is used to design health promotion campaigns that support and protect people and groups who suffer disadvantage.

The ‘action areas’ relate in many ways to the principles of social justice and can clearly be applied to support these values.

Developing personal skills (DPS) This will improve a person’s ability to access information and

services and empower them to defend their rights. Individuals need to take responsibility for their own learning. This may entail formal or informal education. Parents can model healthy behaviours to help their children to develop health skills.

Individuals should maintain awareness of how they can conserve the environment and make it safe, including the home and the natural resources.

Developing personal skills (DPS) Communities should be conscious of local needs, supporting the

development of skills such as advocacy, communication and planning by providing courses and opportunities to their residents.

State governments should take the most responsibility for developing personal skills. Departments of Education and health promotion campaigns are typically managed at this level. Deciding what information is essential and how it should be communicated is a major responsibility of government.

Building healthy public policy (BHPP) This can acknowledge diversity and lead to the creation of

supportive environments. Individuals may not feel involved in the development of policy, but involvement in the political process and being active in community events that support a health cause or promote population health can be influential.

Communities need to be politically active by engaging in health promotion action. Organising events and mobilising local agencies is a vital responsibility for community groups with an interest in population health.

Building healthy public policy (BHPP) Governments are responsible for producing and enacting policy.

Of all the responsibilities involved, it is most important that governments listen to the public to ensure that the policies they develop meet public needs and expectations. Providing the opportunity to participate in policy development is essential. It is also important to enact policy in a way that it is financially and environmentally sustainable.

Strengthening community action (SCA) This can raise awareness of people’s rights, promote equity and

facilitate participation by community members.

Individuals can participate actively in local health promoting events and they can contact local representatives about health concerns. Communities are the focus of this action area, but really need the support of governments to develop partnerships that provide support and funding.

Governments can support community action by seeking community input and then empowering communities with direction, funding and support to create their own health solutions.

Creating supportive environments (CSE) This increases access, encourages participation and can improve

living conditions. Individuals can act responsibly to protect and enhance the quality of their homes, workplaces and natural environments.

Most behaviour that supports the environment is only effective due to the cumulative actions of many individuals.

Communities are the focus of healthy living. Leisure, work and neighbourhood settings should be safe, stimulating and enjoyable. Local communities, with the support of governments, are the primary guardians of such health promoting environments.

Reorienting health services (RHS) This improves access to health services and promotes equity by

supporting the disadvantaged. In this care of action there is a range of responsibilities at different levels.

Individuals need to take responsibility for knowing what services are available and developing the skills necessary to be able to access those services.

Communities have a range of responsibilities.

These include supporting local service providers and findings ways to attract people and services that best meet their needs. Sometimes incentives and flexibility are required, especially in remote or disadvantaged communities.

Reorienting health services (RHS) Local businesses can benefit their communities by accommodating

or encouraging other related services. For example, a local health service might be able to offer rental assistance for a pharmacist to move in.

Governments take responsibility for regulation, but must ensure that sufficient surveillance and evidence are available so that decisions about health services can be well informed and justifiable. The supply of health professionals, licensing of new services and distribution of resources should be based on clear evidence.