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CORE 1: Health Priorities in AustraliaHow are priority issues for Australia’s health identified?Measuring Health StatusRole of Epidemiology: Epidemiology is the study of disease in groups or populations through the collection of data and information, to identify patterns and cause. It considers the prevalence (number of cases), incidence (new cases of disease), distribution (the extent) and apparent cause (determinants and indicators)Epidemiology can tell us:Identify health needs and allocate health-care resources accordinglyDescribe and compare patterns of health (in groups, communities and populations)Evaluate health behaviours and strategies to control and prevent diseaseIdentify and promote behaviours that can improve health status of the overall populationWho uses these measures?Australian Department of health: allocates funds to areas where Australia lacks healthDepartment of Education: informs students about health, puts policies in place e.g. no hat no play policy, also targets younger generation in areas where health is most needed to be promoted and approachedHospitals: so they can prioritise larger problems, targeting high risk areas of health. Specialists can also use health promotion strategies, to enforce good health.Pharmaceutical companies: so they know what kinds of medications and experimental drugs are in demand.Doctors: can see patterns which they can use towards research. Target patients where health care is needed most. Also: to promote that area of health.However epidemiology does not:Measure everything about health status as it does not indicate the quality of life in terms of peoples level of distress, impairment, disability, or handicap.Take into account: health determinants; the social economic, environmental and cultural factors that shape health.Provide the whole health picture: e.g. mental illness data is incomplete or non-existent. Doesn’t show variation in health between subgroups e.g. Indigenous in comparison with non-indigenous.Other measures:DALYS- Disability Adjusted Life years- refers to the number of years lost due to ill health, disability or early deathHALE-Health adjusted life expectancy- is an estimate of the number of healthy years (free from disability or disease) that a person born in a particular year can expect to live based on current trends in death and disease patterns.QALYS-Quality adjusted life years-is a measure of disease burden, including both the quantity and quality of life lived.Measures of Epidemiology Mortality: the number of deaths in a population from a particular cause and/or over a period of time. More older people (BABY BOOMERS) are dying Infant Mortality: the number of infant deaths in the first year of life, per 1000 live births. In Aust: gradual decrease. Was very high in 1920’s (WWII). Generally we have a high Infant mortality rate as the Aboriginal status brings our whole nations status down.Morbidity: is the incidence or level of illness, disease or injury in a given population. More people are diagnosed of cancer (raises awareness), Breast and Prostate cancer have an increase in incidence. Drop in Prostate cancer rates due to awareness and a push in the mid-90s by the media, to check up. Though this ceased, and rates started to incline (again) Life Expectancy: the length of time a person can expect to live. The average number of years of life remaining to a person at a particular age, based on current death rates. The life expectancy of females is higher than males. In 1907 we could live up to 57 in 2011 75+. Australian Life expectancy rates are high compared to the rest of the world.Identifying Priority Health IssuesSocial Justice Principles: aim to eliminate inequity in health; promote inclusiveness of diversity and establishing supportive environments for all Australians. The concept of social justice aims to narrow the gap in health status in subgroups. Aims to recognise: the impact of discrimination, past disadvantages, structural barriers to equality etc. Equity: there should be a balance and even distribution of resources, to ensure that all people, in particular those who are disadvantaged, get equal opportunity for health.Diversity: we need to ensure that cultural, religious and other differences within our population are accepted, and do not interfere in the opportunities for good health outcomes.Supportive environments: where we live may affect our health. It is important that social, environmental and political issues need to be considered in ensuring that the whole population has equal opportunities for health. What role do the principles of social justice play? The people feel included, important and recognised for the disadvantages faced allowing more participation of planning and decision making, when it comes to their own health.People feel empowered to make changes in health, and will be more successful in achieving better health. A greater access: as barriers have been removed that prevents people from accessing health services and information, barriers include: distance, sex, money etc. Priority Population groups: Some groups in society are more disadvantaged than others in terms of health. Epidemiology gives us evidence that this inequality exists. For example ATSI people and people living in rural and remote areas have higher rates of Cardiovascular disease than people with a family history who are prone to diabetes, cancer etc. Specific groups are also prone to injury and mental illness such as elderly people.Why is it important to prioritise?So that allocation of funds, assistance, and priority are given to the people who are most in need to create equality and make them important as we care for the health of all Australians, and want target those that are most in need of Australia’s funds and facilities.Prevalence of condition: The more prevalent the condition, the more funds are put into the certain disease. For example: Cardiovascular disease (35%) and cancer (30%) are most prevalent, meaning that the number of people that receive benefit to funding allocation would be high. If there is evidence that the prevalence of the disease is increasing, there would be further budgetary support, effort and priority put into combating the disease.Potential for prevention and early intervention:Decision makers consider where their limited funds will have the greatest impact. With an ageing population and the increasing cost of health care, it makes sense to give priority to those conditions with potential for prevention and successful intervention. “Prevention is better than cure”If the harm caused by the condition can be reduced by early detection and prevention and money spent will have an impact on the prevalence of the disease, then it is the way to go.As most of the leading causes of mortality and morbidity are a result of ‘health damaging’ behaviours, there is a great scope for prevention and early intervention. E.g. smoking, physical inactivity, excessive alcohol.Some examples of prevention and early intervention include:A study of family history (tracing health records)Breast screening (successful in intervening early before breast cancer has developed)Vaccinations are used to prevent the incidence of many diseases e.g. (influenza, cervical cancer) etc.Lung cancer prevention strategies (more focused on tobacco use) e.g. bans in clubs, pubs, schools, workplaces etc. (have been successful) Costs to the individual and community:Illness and premature deaths comes at a great cost to the individual and the community:Individual:Physical costs-such as loss of mobility or functionEmotional costs-such as depression, feelings of worthlessness caused by chronic painSocial costs- such as damaged relationships, family sufferingCommunity: costs can be DIRECT or INDIRECTDirect: costs to the community can be financial costs of providing hospital places, medical services, pharmaceuticals, funding for research.Indirect: costs can be loss of productivity, unemployment/and other benefits, support services, retraining programs, insurance costsWhat are the priority issues for improving Australia’s health?Groups experiencing health inequities:ATSI (Aboriginal and Torres Strait Islander Peoples) People living in rural and remote areasHigh levels of preventable and chronic disease, injury and mental healthCardiovascular disease (CVD)Cancer (skin, breast and lung)And ONE OTHER to study[Refer to hand-written summaries and Assignment!]A growing and ageing populationHealthy Ageing:Where Individuals maintain a better quality of life and good health while ageing. This involves both physical exercise and mental stimulation, being involved in social interactions regularly and having regular medical check-ups. This reduces the risk of illness and disease during the ageing process, so that individuals can be productive members of the community for longer.Good health among older Australians helps moderate demands for health and aged care services, which is important as Australia’s population is getting older each decade. (More people will become elderly and in need of medical support). Due to this Australia has made improving the health of older people a national research priority.E.g. meals on wheels (free, stress less of cooking allowing independent living) allowing a sense of empowerment, the pharmaceutical benefits scheme, Bulk billing, Gyms etc. Increased population living with chronic disease and disability:Australia’s ageing population and the greater longevity of individuals is leading to growing numbers of people, especially at older ages, with a disability and activity limitation. Evidence suggests most recent gain in life expectancy for individuals was spent with a disability in those extra years, much of that period with severe core activity limitation.This is because: medical technology and improvements in medical procedures have improved, therefore; for example people may survive a car crash, that wouldn’t have survived in the past (without the technology), but may have to live with a disability for longer. The future levels of chronic disease can be reduced if young people control risk factors: such as smoking, obesity, excessive drinking and physical inactivity. Demand for health services and workforce shortages:More stress on the healthcare system, and as more people are aged and retiring and dying, there is less people in the workforce, meaning more work/pressure. More of taxpayer’s money will help sustain older people’s life, not just superannuation. With more people ageing, there is more demand on health services, and as more people retire, there is more and more of a shortage in the workforce, if the younger generations don’t take their place. Government has tried to increase education (minimum leaving age) in order to increase education levels and numbers in the workplace. Availability of carers and volunteers: Due to the increased number of people in their older stages of life, there is an increased shortage of carers and volunteers. More carers are needed about 75 billion dollar per annum is needed for assistance. Less people in the workforce can also contribute, as it can be a paid/unpaid job. (e.g. nursing home). ................
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