Aceh.b-cdn.net



HSC PDHPE Task 1 – Health Priorities in AustraliaDiabetesPart One:The nature of the problemDiabetes mellitus is a chronic disease where there is too much glucose (sugar) in the blood. It is caused by the improper functioning of the pancreas, the organ that produces insulin. Insulin is required as it allows the glucose in the blood to enter the cells of the body to be used for energy. Hence with no working insulin, the blood sugar levels will remain high. Diabetes is when the body produces no or not enough insulin or when the insulin produced does not work effectively. Managing diabetes can be difficult, requiring regular monitoring and being able to maintain balanced blood sugar levels. If there is insufficient sugar in the blood, it is known as hypoglycaemia (low blood sugar levels), too much sugar is hyperglycaemia (high blood sugar levels). There are three types of diabetes:Type 1 – is an autoimmune condition, where the body destroys its own insulin producing cells in the pancreas, the body therefore does not produce insulin, causing diabetes. This type is usually detected in children, and will require lifelong injections of artificial insulin, as well as a healthy eating plan, monitoring blood sugar levels and regular physical activity.Type 2 – most common type of diabetes, common in people over forty, however can occur in overweight teenagers. It is where not enough insulin is produced and/or the insulin does not work effectively, also known as insulin resistance. It is usually treated with lifestyle modifications, monitoring blood levels, medication, and sometimes injections may be needed. Gestational – diabetes that is temporary during pregnancy, when hormones produced during pregnancy can stop the insulin from working properly. This can be dangerous to the baby and potential risk of developing type two diabetes later on in life, in the mother. Diabetes can often lead to ill health, disability and premature death and well as having a psychologically impact of dealing with the disease. Over time high blood glucose levels can cause blood vessel damage which can lead to kidney disease, loss of vision, nerve damage/disease in the lower limbs, it can also increase the risk of heart attack, stroke, coronary heart disease and peripheral vascular disease, atherosclerosis.Extent of the problem (trends)Diabetes is on the rise and is becoming a major health issue in Australia. It can be hard to determine the extent of diabetes as there is an estimated large number of cases that remain undiagnosed. Type1 – affects about 10-15% of people with diabetes as a chronic diseaseType 2 – affects 85-90% of people with diabetes as a chronic diseaseGestational diabetes occurs in about 1 in 20 pregnant women-29083028892500Morbidity – Over 800,000 or about 4% of Australians reported having diabetes in the 2007-08 (National Health Survey). Diabetes is three times more common than 20years ago.-42564052796540Fig. 1: Trends in Prevalence of diabetes (AIHW 2010)00Fig. 1: Trends in Prevalence of diabetes (AIHW 2010)Prevalence (Fig. 1) – has risen from 1.3% of the Australian population diagnosed with diabetes in 1990 to 2.4% in 1995 to 4% in 07-08(ABS-National Health Survey). This rise is mostly due to the increase in type 2 diabetes, but there has also been a rise in those suffering with type 1. In all age groups males suffer higher rates of the disease than females, male’s rate 5%, females 3 %( ABS2009). Prevalence increases with age, rates are especially high in those ages 65+. Some groups have much higher prevalence of diabetes, this is explained in more detail later.Some of the increasing rates of prevalence could reflect the improvements in diagnosis and awareness, and better survival. However it should also be noted that many people, especially those with type 2 diabetes can go undiagnosed.Aboriginal and Torres Strait Islanders have very high rates in type 2 diabetes, up to one third of people in indigenous communities have diabetes. They are three times more likely to develop diabetes, rising to five times more likely in the 45-54 age group. (explained further later)198628097917000Mortality (Fig. 2) – even with the increase in incidence and prevalence the mortality rates have remained reasonably unchanged. Diabetes is the 8th leading specific cause of death for both males and females accounting for 1,923 deaths or 2.7% of all deaths in males, and 1,887, or 2.8%of deaths in females. Diabetes is also a contributing cause of death in about 10% of all deaths for both males and females. The trends in death rates of diabetes as the underlying cause increased from 15.8 to 16.5 per 100,000 between 1980 and 2007. (AIHW National Mortality Database 2010). Death rates for males increased by 21%, but decreased by 8% for females between 1980 and 2007. The death rates increase with age, 87% of deaths with diabetes as the underlying cause where in those aged 65years or older (AIHW2010). Diabetes death rates are 6.6times higher in Aboriginal and Torres Strait Islander People. 2703195362585Fig. 2: Trends in deaths from diabetes (AIHW 2010)00Fig. 2: Trends in deaths from diabetes (AIHW 2010)Incidence – there has been a 30% increase in the incidence of type 1 diabetes in children from 2000 – 2007 (Australia’s health 2010). Recent reports show that approximately 275people are diagnosed with diabetes every day, almost all of which are type 2, with more than 100,000 new cases per year. Rate of incidence is similar for both males and females. Between 2000-2007 the incidence of gestational diabetes increased by 30%, however the rising trend for gestational diabetes did not continue in 2007-08.Although type 2 diabetes is most common in those aged over 45, in recent years there has been a rise in those developing it at a much younger age, there have been cases where teenagers have been diagnosed with type 2 diabetes. This is linked to lifestyle factors with higher rates of obese/overweight teenagers and less physical activity (more under risks and determinants).People with diabetes have a reduced life expectancy, and many will also experience other health problems, often with the eyes, kidneys, nerves and arteries, it is a major factor associated to blindness, kidney failure and amputations.Risk factors and protective behavioursThe risk factors differ by type of diabetes.Type 1Much of the cause for type 1 diabetes is not known, currently the biggest known factor is the family history. Recent research shows that there may be link to genetic factors and viral infections contracted in the early years of life, it is believed to be caused by biological interactions and/or environmental agents exposed to with those genetically predisposed. There is also a possible link with children who were introduced to cow’s milk earlier and breast feed for a shorter time. This type is unrelated to lifestyle and currently cannot be prevented.Risk FactorsProtective Behaviours Non – modifiable Family history – those who have family members with type 1 diabetes may have the gene and are therefore at a risk of developing the diseaseBe aware of family historyRegular check upsMonitor Maintain healthy weight rangePractice health lifestyle behaviours; diet, physical activity Type 2Type 2 diabetes is estimated to be preventable in 60% of cases, and many other delayed in onset.Risk FactorsProtective Behaviours Non – modifiable Age – most cases develop in middle or older age, especially over 50-65Gender - death rates are higher in males, more males have poorer lifestyles and are less likely to monitor their health than femalesFamily history – genetic predisposition, greater risk with one or more family members with diabetesEthnic background - genetic predisposition, higher prevalence in some groupsAboriginal or Torres Strait Islanders, Pacific Islander, Indian subcontinent, Chinese cultural background has increased riskHigh blood levels of triglycerides(type of fat molecule)Low birth weightHaving had heart disease or a heart attackHaving impaired glucose toleranceHaving polycystic ovarian syndrome (women)Having had gestational diabetes (women)Given birth to a child over 4.5kg (women)Check family history, be aware and looking out to signs and symptomsRegular check upsSpeak with a doctor and assess your risk – talk about your risk factorsHave a blood test – if one or more risk factors are presentSeek advice, support and further informationMaintain a healthy lifestyle, especially important if in high risk groupsModifiableStrong link to lifestyle.Being overweight or obese, carrying fat around your middlePhysical inactivity, little or no regular exerciseUnhealthy dietHigh intake of saturated fats and refined sugarHigh alcohol consumption, regular consumption of excessive alcoholHigh blood pressureHigh cholesterol in bloodSmoking Healthy lifestyleMaintain healthy weight rangeRegular physical activity- follow recommended guidelines, aim for at least 30minutes of moderate activity on most if not all days, and if possible regular vigorous exercise eat well balanced diet, with a variety of nutritious food, with plenty of whole grain breads, cereals, vegetables and fruitsLimit intake of saturated fat and refined sugar, and moderate salt intakeConsume little or no alcoholManage blood pressure and cholesterol levelsNot smokingEncourage and support breast feedingbe aware and looking out to signs and symptoms, with regular check upsSpeak with a doctor and assess your risk – talk about your risk factorsHave a blood test – if one or more risk factors are presentSeek advice, support and further information from health services or professionalsRisk increases when more than one of the above factors occur together, e.g. being over 55 and overweight, with a family history results in a great risk. Gestational Diabetessimilar to risk of type two, with females at higher risk if they are obese and/or over 30 years when pregnantThe sociocultural, socioeconomic and environmental determinantsThe increase in type 2 diabetes is closely linked to social factors.Sociocultural – cultural background can have a significant impact on risk for diabetes, such as Aboriginal or Torres Strait Islanders are three times more likely to develop diabetes, than other Australians. This may be linked to the risk factors and other issues, such as these groups have poorer socioeconomic factors as discussed below. The social acceptance of consumption of alcohol, has led to a lot more excessive and regular consumption of alcohol, a common risk factor of diabetes. Ethnic and cultural origins can influence a person’s health status, some races have higher rates of diabetes, and certain cultures can increase the risk of developing diabetes with certain traditional foods been high in fatty diets, such as some European diets/foods, especially in Australia where many have adopted some cooking styles such as using excessive butter and salt. There are the added language barrier to those born overseas who often find it difficult to comprehend the health issues, and seek the available health services and further information.Gender can also impact a person’s health, and diabetes. About 50% of Australian males are overweight and when problems or symptoms of diabetes arise they are more likely to ignore them than females, males are also less likely to monitor their health regularly and treat problems. This could account for the small difference in prevalence and mortality between males and females.Age also impacts diabetes, as explained above, and with an ageing population more problems are expected in the future. -44577068326000Family and friends can play a major role in health and diabetes, especially in younger age groups. Our social peers greatly influence our lifestyle and behaviours, such as our diets, attitudes towards health, and exercise and the value we place on our health. Type two diabetes is largely a lifestyle disease thus our family and friends can positively (e.g. importance placed on regular exercise) or negatively (e.g. habits of drinking and smoking) impact our chances of developing the disease. -51530252105025Fig. 3: Prevalence by Socioeconomic status (AIHW 2010)Shows those with lower socioeconomic status participate at higher rates in risk factor for diabetes, and have higher rates of disease.00Fig. 3: Prevalence by Socioeconomic status (AIHW 2010)Shows those with lower socioeconomic status participate at higher rates in risk factor for diabetes, and have higher rates of disease.Socioeconomic – socioeconomic factors can greatly influence a person’s susceptibility to developing diabetes, such as their socio economic status, education levels, employment status, occupation, and income. Those people who are socioeconomically disadvantaged are more likely to consume an unhealthy diet with high levels of saturated fats, consume large amount of alcohol, smoke, be in an unhealthy weight range, and participate in little or no physical activity as shown in fig.3. These are all risk factors, as explained above that can contribute to diabetes. People with low socioeconomic status are also likely to show more than one risk factor associated with diabetes, greatly increasing the chance of developing diabetes. The levels of education also have a substantial influence on prevalence of this condition. Type two diabetes is largely preventable, and therefore it is vital for awareness and education of the risk factors and the protective behaviours that should be practiced to reduce the chance of developing diabetes. Those with lower levels of education often have higher levels of preventable diabetes, those less educated about their health are less able to make informed decisions about their health choices, e.g. they find it difficult to read and understand food labels. Education and income levels are also important in the management once diabetes has developed. It is vital to monitor and treat diabetes correctly, this becomes easier with higher levels of educations and the income to support the treatment. Employment – some jobs, especially those with long or inconsistent work hours have an effect on eating habits. Sometimes leads to not enough time to prepare regular healthy meals, encouraging consumptions of fast food, which is often high in saturated fat, sugar and salt. If meals are skipped this can affect the blood glucose levels, which are important to maintain balanced for those with diabetes. For many of these reasons those with poor socioeconomic status also often have higher death rates. Environmental - Geographical location, depending on where someone lives can affect their access to health services and technology, as well as level of education, employment and available facilities for recreation. People in rural and remote areas have higher prevalence of diabetes, are more common to be overweight, and consume alcohol regularly. They find it harder to undertake protective behaviours such as not as much opportunity to take part in physical activity, with not as many facilities as in other areas, and it can be more difficult to have regular check-ups. Another contribution that has caused a rise of diabetes is the ageing and growing population, as the population ages and get bigger there is a rapid growth of diabetes being seen in age groups 45 and over, increasing the burden of diabetes on the Australian population. Groups at risk Type 1 – family history, most common developed at a young age.Type 2 – closely related to those with many poor lifestyle choicesOver 55 yearsFamily history of type 2Overweight/obese (having a Body Mass Index of over 25) – excess body fat places greater demand on the insulin, those who carry fat around the waist, (waist measurement, increased risk women more than 80cm, men more than 94cm, greatly increased risk women: 88cm, men 102cm(WHO & National Health and Medical Research Council figures))High fatty diets, high intakes of saturated fats, refined sugarRegular consumption of alcoholLittle or no physical activity – which results in weight gain, insulin produced ineffectiveAboriginal or Torres Strait Islanders Women who had gestational diabetesSome population groups are at a higher risk of diabetes: (per cent of population group with diabetes, general Australian population is 4%)Australians born overseas – 4.2%Lowest fifth socioeconomic disadvantaged – 5.9%Rural and remote areas – 4.1%Aboriginal and Torres Strait Islanders – 11%Gestational (women who are pregnant) – similar for type 2 diabetes, but mainly:Women who are overweightWho are pregnant and aged over 30Polycystic ovarian syndrome Part Two:High levels of preventable chronic disease, injury and mental health had been identified as a priority issue for improving Australia’s health. This is justified and explained below.Social justice principlesSocial justice aims to eliminate or reduce the inequities in a population, by establishing supportive environments and encouraging inclusiveness of diversity. Social justice principles related to health are: Equity: the fair allocation and distribution of resources and fundsaccess: the availability of health services, education and informationparticipation: the involvement and empowerment of people in the community in decisions and planning for healthrights: having equitable opportunities for allPreventable chronic disease, injury and mental health are frequently overrepresented among certain population groups. This is often due to these groups not experiencing the same levels of social justice. These groups are disadvantaged and must see equity of funds and resources to begin an improvement in their health status. Equity, in a way requires the allocation of funds and resources to be biased towards the disadvantaged, to ensure that they will then get the support needed. These groups experience similar issues in regard to access to health services and technology and rights. Much of these preventable diseases are more common in certain areas because of their limited availability to services and information. They must therefore receive equitable opportunities to improve current poor rates of chronic disease, injury and mental health, and which will also increase the individual’s involvement in their own health decisions. Cardiovascular disease: mortality rates are higher in remote and rural locations. This may be due to the inequity present in the education, awareness programs. The knowledge and skills are not known to reduce the burden of this disease, in conjunction with the limited access to health services, to provide support when required.Cancer: the mortality rates are higher, and there is more loss of quality and quantity of life in those people who have limited access. Because of their limited access to health services and technology, cancer cannot be detected as early as in other people who are able to access the facilities. Once detected, if the cancer is more established, further intense treatment may be needed, and this may be very far away and not be able to be accessed, especially for those living in rural and remote locations.Injury: some people are not able to have an input into the health decisions and planning that affects them. For example there are areas which are prone to traffic hazards and accidents. Large numbers of people are often not heard or able to participate in the decisions made that will affect their levels of injury, such as helping to determine a suitable speed limit, safe crossings and other road issues.Priority population groupsThis is closely related to the social justice principles. Certain population groups are greatly affected by some causes, more than the general population, and therefore are identified as priority population groups.-35433077406500As mentioned above chronic disease, injury and mental health issues are often overrepresented in certain population groups, and this has become a priority area. If these areas are seen as an area to be addressed and are, there is more a chance that these issues can be prevented. This will help to reduce the rates and impact of these problems on these groups and the Australian population as a whole. -43529252319020Fig. 4: Ratio of Indigenous to non-indigenous deaths (AIHW 2010)00Fig. 4: Ratio of Indigenous to non-indigenous deaths (AIHW 2010)Aboriginal and Torres Strait Islander people are part of the priority population groups, with very high rates present in cardiovascular disease, certain cancers, diabetes, respiratory disease, injury and mental health problems. This shows a major priority group present in high levels of many preventable chronic disease and other issues, as shown in fig.4. Therefore if this group is regarded as a priority to improve its health status it will greatly improve their poor rates of prevalence and mortality, as well as helping to lower these rates for the disease as a whole. Because of these high rates, the chronic diseases place a long term burden on these people that must be addressed immediately.It is similar with those people who are socioeconomically disadvantaged, especially in cardiovascular disease and diabetes. They represent a large proportion of those with the disease and hence are a priority group. Issues within this group must be addressed and this will help to reduce the burden of preventable chronic diseases. Prevalence of conditionEpidemiology data enables us to determine the number of cases of a certain disease or illness in a population at a specific time, the prevalence. Those diseases with high prevalence are regarded as a priority health issue. Preventable chronic disease, injury and mental health problems are very prevalent conditions. The current trends show that the prevalence and incidence of the condition is rising, and along with an ageing and growing population can lead to much greater problems in the future. Hence this is a regarded as a priority health issue. Cardiovascular disease: is most prevalent in terms of morbidity and mortality, it is the leading cause of death in Australia, in 2004 it accounted for 35% of deaths, with over 47 500 deaths. Cancer: accounted for 28% of Australian deaths in 2004. Cancer has been and remains in 2010 the leading cause of the burden of disease and injury in Australia. By the age of 75 it is estimated that 1 in 3 males and 1 in 4 females will have cancer.Diabetes: 4% of all Australians have diabetes, and the trends indicate that this rate is rapidly rising and must be addressed. Diabetes is also linked to many other health problems, such as cardiovascular and renal disease.Respiratory disease: prevalence in some respiratory conditions is decreasing, possibly due to the decline in smoking because of health promotion and awareness. This is an example of how making an issue a priority issue can begin to help numbers decline. However there is a high prevalence of asthma especially among children. Injury: it is the greatest cause of death in the first half of life, and will often cause long-term and serious disabilities, it is estimated to contribute to 6.5% of the burden of disease. Mental health problems and illness: it is estimated that 1 in 5 Australians will experience a mental illness in some stage of their life. Young adults (18-24years) have the highest prevalence of a mental disorder (27%). Mental health accounts for 13% of the burden of disease (Australia’s health 2008)As shown above these issues are very prevalent and affect a very large proportion of the population. Because they will have such a significant impact and burden on the population, thus making it a national health priority area has aims of substantially reducing this burden. Potential for prevention and early interventionWhen a disease is largely preventable, or when early detection and intervention will dramatically reduce the burden of that disease, it can be identified as a priority health issue. Many issues are related to modifiable lifestyle behaviours, and therefore if addressed can be easily prevented. Other diseases will have high rates of recovery if detected and treated early, thus reducing the burden of the disease. However it is often difficult to change many behaviours and attitudes as they reflect environmental, social, cultural and political determinants. Cardiovascular disease and diabetes are now becoming an increasing problem and are largely caused due to lifestyle behaviours. These behaviours are modifiable and with a change can lead to the prevention of diseases. For example about 60% of type 2 diabetes can be prevented and many more cases delayed in onset. Even with a limited amount of funding, it is worth it to be allocated to these areas as a priority issue as there is very high potential to prevent the majority of these diseases. Cancer is similar in that there is potential for prevention with modifications to lifestyle. In recent years technology has greatly improved the detection and knowledge of cancers. If cancer is detected and treated early there is a much higher survival rate with little loss to normal or quality of life. Injuries account for 6.5% of burden of disease and are the main cause of premature death that contributes to the most potential for life lost than any other cause. The majority of injuries are preventable, such as with falls in the elderly, transport, workplace and other accidents. Because of all this, injury prevention and control was declared a health priority. Cancer, cardiovascular disease, diabetes, respiratory disease and mental health issues will have a reduced burden of disease and will benefit greatly from early intervention and therefore must be classified as a national health priority area. Many of the above diseases are interrelated such as diabetes and cardiovascular disease, so by making it a priority to prevent one it will have a positive impact on the other areas. Costs to the individual and communityChronic disease can place a great burden on the individual and to the community, having an economic impact, loss of productivity, a reduction in the quality of life, and great emotional stress. The costs can be direct; hospital and medical expenses, treatment, pharmaceuticals, money spent on research, prevention programs and education, or indirect; which are those cost that are not directly related to the health system, such as burden on carers, family, lost quality and quantity of life, lost productivity, absenteeism. Chronic diseases, injuries and mental health problems contribute to a substantial cost to the individual and the community. They place a significant cost on money and resources, which then places a further burden on all areas of society. Treatment can be very expensive to the individual, and suffering from a disease can leave a person with long term side effects such as a disability, and experience a reduced quality of life. This all also evokes a lot of emotional stress on the individual and those around them, leading to mental health issues as a result. It can also result in loss of income and greatly impact family and carers. These problems place a great burden on government health expenditure e.g.:Cardiovascular disease - $5.9 billionCancer - $3.8 billionDiabetes - $1.2 billionRespiratory disease - $3.3 billionInjuries - $3.4 billionMental disorders - $4.1 billion The costs are not just financial but can affect the wider community, with more people suffering from a disease can impact the numbers in the workforce, retraining, demand for carers, and demand on health services. Diabetes: according to the Diabcost report, the cost to an individual suffering type 2 diabetes is $4025 per year. This helps to manage their disease and to improve their quality of life. As mentioned above the cost is not just financial but with diabetes a person’s whole lifestyle must be modified, from diet to exercise. This can be stressful and place great pressure on the individual and those around them. It can also lead to restricted participation in the workforce and the community.Cardiovascular disease: has very expensive direct health care expenditure, it accounted for 11.2% of the government health care systems expenditure in 2004-05, with $5.9 billion, much higher than other chronic disease. Conditions related to cardiovascular disease are very common and many people will pay a cost due to this disease.Cancer: $3.8 billion of government expenditure went towards cancer, $ 800 million of which was to preventing, managing and treating in a year, and $200 million on cancer through GP’s and health services. Cancer has long term effects and treatment can be very expensive to the individual, it is estimated that 1.7 years of average household income is needed to treat a person with cancer. Suffering from cancer often also restricts people from participating in the workforce, and a loss of income and independence to the individual. As discussed above it has been justified and explained through the examination of reasons and factors including the social justice principles, priority population groups, prevalence of condition, potential for prevention and early intervention, and the costs to the individual and community, why preventable chronic disease, injuries and mental health problems has be identified has a priority issue for improving Australia’s health. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download