Core 1

Identifying priority issues for Australia’s health

Measuring Health Status

• Health status is the pattern of health of a population over a period of time.

• Health Status is measured through a process of information and data collection, the study of which is called epidemiology.

• Agencies, for example the Australian Institute of Health and Welfare, use health information in epidemiology. The most important information collected relates to :- mortality- infant mortality- morbidity- life expectancy- use of health services

Measures of Epidemiology

Four indicators are commonly used.

Mortality refers to the number of deaths in a population from a particular cause and/or over a period of time.

Infant mortality refers to the number of infant deaths in the first year of life, per 1000 live births.

Morbidity is the incidence or level of illness or sickness in a given population.

Life expectancy refers to the average number of years of life remaining to a person at a particular age, based on current death rates.

What can Epidemiology Tell Us?

• Monitoring the major causes of sickness and death to identify any emerging issues or inequalities

• Identifying areas of need so prevention and treatment interventions can be targeted

• Determining priority areas for the allocation of government funding

• Monitoring the use of health care services and facilities

• Evaluating the effectiveness of any prevention and treatment programs

Who uses Epidemiology?

• Policy Developers at all levels of Government

• The manufacturers of health products

• The providers of health services

• Individual consumers

Do they measure everything about health status?

• No, Epidemiology is simply a study of the patterns of health not total health. It has been challenged as focusing mostly on the physical health issues.

• Doesn’t explain socio-cultural factors• Doesn’t take into account influencing factors like

social factors• Doesn’t show variations between population sub

groups• Doesn’t evaluate quality of life

Life Expectancy

• For both males and females has increased significantly over the past century

• most Australians can now expect to live for an average of 80yrs

Major causes of sickness and death

Assessment of the health statues of Australians must include reference to the leading causes of sickness and death.

Cause % of population

Disease of cardiovascular system 35%

Cancers 30%

Accident and injury 6%

Age Group

SIDS Aged less than 1

Motor vehicle accidents 1 – 14 years

Motor vehicle accidents 15 – 24 years

Suicide 25 – 44 years

Heart attack 45 – 54 years

Heart attack 55 – 64 years

Identifying priority health issuesTo improve the health status of

Australians, action needs to be taken across all areas of health, but particularly in areas causing concern. These are called priority issues and have been chosen for a number of reasons.

Reason for selection Epidemiology Political factors Personal Attitudes Community attitudes

Principles Of Social Justice

• Social Justice: value system which encourages equity, promotes interests of the disadvantaged Principles of social justice: equity, access, participation, rights

• To reduce health inequalities, governments have set in place:– All Australians regardless of financial status should have access

to a comprehensive range of health services– Health services should be of a consistently high standard across

Australia– There should be continuity of care across the health care

system, with appropriate referral to higher level services– Major causes of ill health and premature death should be

identified and addressed and plans to reduce them developed– Example Medicare

• Equity – the balanced distribution of resources to ensure fair health outcomes to all groups,, including the disadvantaged– Participation - the importance of communities and

individuals being fully involved in the planning and decision making associated with improving their own health

– Access – removing barriers to make sure all people regardless of circumstances are provided with satisfactory health services and information

– Rights – the laws that protect human rights should protect good health as one of the most fundamental rights of all

• Diversity – when cultural, religious and other differences are accepted

• Supportive environments – social, environmental and political conditions all have a profound effect on health and need to be included in the process of decision making and planning when improving the health of the population

Priority Population Groups

• Those experiencing inequalities as previously mentioned.

• But which group has priority? And who decides? Community consultation is one method, media attention, the demands of lobby groups to members of parliament and epidemiology all play a part.

• The distribution of money and resources should be considered– Does a specific group within a population suffer

higher prevalence of this condition– Can this health issue be improved by targeting a

specific population group?

• CVD - Aboriginal and Torres Strait Islanders, low socio-economic status, rural and remotes, family history, other specific groups

• Cancers - Aboriginal and Torres Strait Islanders, low socio-economic status, rural and remotes, family history, other specific groups

• Diabetes - Aboriginal and Torres Strait Islanders, low socio-economic status, rural and remotes, family history, other specific groups

• Injuries - Aboriginal and Torres Strait Islanders, low socio-economic status, rural and remotes, family history, other specific groups

• Asthma - Aboriginal and Torres Strait Islanders, low socio-economic status, rural and remotes, family history, other specific groups

• Mental Illness - Aboriginal and Torres Strait Islanders, low socio-economic status, rural and remotes, family history, other specific groups

Prevalence of Condition

• Does this health problem affect a large number of people within the population?

• Is there evidence that the extent of this health problem is increasing?

• Australian governments have established well-organised systems for reporting, collecting, measuring and monitoring the prevalence of health conditions throughout the country and the changes that are occurring in characteristics and structure of the population.

Potential for prevention and early intervention

Costs To Individuals

• Financial cost of treatment or medications or lost employment• Physical cost of lost mobility or functionality• Emotional suffering caused by chronic pain or depression• Social cost resulting from damaged relationships and family

suffering• The impact that the condition has on individual health and well-being.• Direct Costs:• Cost of treatment ･

– Cost of replacement labour ･– Lost working hours ･

• Indirect Costs– Emotional trauma– Relationship breakdown ･

• Health Costs– Physical

• Spinal cord injury from accident, breast removal, limb amputation

– Social• Social isolation - inability to continue employment, participate

in hobbies• Long term hospitalisation and lack of mobility isolate

individual & increase financial pressure, resulting in further limitations in social opportunities

• Pressure on Relationships and Family Structures-result from short term trauma of a serious health scare or rehabilitation, can place additional pressure on family and friends.

– Emotional• Loss of self esteem, depression• Emotional Trauma of injury may be difficult to overcome

Costs To Community

• Direct–Financial cost of providing hospital

and medical services• Indirect

–Cost of premature death, lost of productivity, insurance costs, support services

• Costs over $30 billion, 8% of GDP due to:– An aging population:

• Increase life expectancy means older population = increase in costs for elderly care (nursing homes, hospitals)

– More Informed Population• Health promotion and prevention = more informed

population. This leads to increased use of health services in relation to prevention, but will hopefully lead to decreased costs in the long run.

– Increased Use of Medicare• People see and use medical advice more often since

consultation is free through Medicare. ･– Advances In Medical Technology

• A wide range of treatments (heart, laser treatment, joint replacement) = people live longer, causing an aging population

Potential To Change

• Is this health problem the result of risk factors or determinants that can be changed or modified?

• Can the harm caused by this condition be reduced by earlier detection and intervention?

• Can the impact of this condition be predicted and reduced by understanding changes in the population?

• The prevalence of chronic lifestyle diseases in Australia is largely the result of health damaging behaviour such as smoking, physical inactivity, poor diet, and excessive alcohol consumption.

• The capacity to change these and other modifiable risk factors provides potential for improving health outcomes through education and health promotion strategies.

• Chronic lifestyle diseases develop over many years , improved technical capacity to identify them through screening programs and early intervention provides potential for improving health outcomes.

• The changing age structure and the diversity of the population also provides governments with increased potential to plan ahead for changing patterns of health.

• Individuals and communities have the potential to change their health outcomes if given appropriate help. For change to occur, we must address both individual behaviours and environmental determinant, therefore determinants can be modified– Behavioral Choices ･ Education– Awareness of risk factors such as smoking, sun

exposure, drink driving, speeding, work safety– Environmental Modifications

• Dual-lane highways, random breath testing, low fat meat and milk to reduce heart disease