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PDHPE – YEAR 12
Core 1: Health Priorities in Australia
Focus Question 1: How are priority issues for Australia’s Health identified?

MEASURING HEALTH STATUS

Epidemiology
☞ Is the study of the patterns and causes of health and disease in populations, and
how to apply this study to improve health.

☞ Epidemiology uses statistics that consist of births, deaths, disease incidence and
prevalence, contact with health – providers, hospital use, injury incidence,
work days lost and money spent on health care.

Role of epidemiology
Epidemiology uses health statistics to determine the health status of a population, if
health is improving or worsening and which group has health issues. This helps the
government develop policies and allocate funds to prepare for health improvement.
Example; Australia’s growing population has been identified as a significant priority issue. Epidemiology shows that Australia’s population is
both growing and getting older because of underlying factors such as immigration, rising birth rates and increased life expectancy. As a result of
this it is evident that an increase of health services and facilities will be needed in the immediate and long-term future, and the majority of these
facilities will need to be specifically allocated to support the health of older age groups.

What can epidemiology tell us?

☞ The diseases that are killing people and making them sick
☞ The current trends in relation to sickness
☞ Where the government should allocate funds
☞ What should be the priorities

Who uses these measures?

Department of health and ageing, Australian Institute of Health and Welfare, NSW Health department, Hospitals, Doctors, Pharmaceutical
companies, Australian government, NSW government and Local government.

Example; 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.

Do they measure everything about health status?

Epidemiology does have some limitations though. When identifying health status and statistics, using epidemiology leaves out the contributing
factors of that disease or sickness. For example; People who had heart diseased were recorded, and that affected the populations health status
but, it doesn’t identify the cause of the disease whether it was caused by genetics, smoking, sedentary lifestyle, diet etc.

MEASURING HEALTH STATUS

Measures of Epidemiology
☞ The major measures used to determine the health of a population are:
Mortality
the number of deaths from a given cause in a specific population within a certain time frame.

Infant Mortality
the number of deaths that occur in the first year of life per 1000 births.

Morbidity
the rates and trends of a disease, illness and injury in a specific population.

Life Expectancy
This is the average number of years a person of a given age and gender can expect to live.
☞ The indicators used are;
Prevalence Incidence
Is the number of current cases of a specific illness or disease Is the number of new cases of a disease or illness in a set
time period.
Current trends
Males Trend Females Trend
1 Coronary heart disease Down Dementia and Alzheimer disease Up
2 Lung cancer Down Coronary heart disease Down
3 Dementia and Alzheimer disease Up Cerebrovascular disease (stroke) Down
4 Cerebrovascular disease (stroke) Down Lung cancer Up
(slightly)
5 Chronic obstructive pulmonary disorder Up Chronic obstructive pulmonary disorder (COPD) Up
(COPD) (slightly) (slightly)
6 Prostate cancer Down Breast cancer Down
(slightly) (slightly)

IDENTIFYING PRIORITY HEALTH ISSUES

It is important to create health priorities to guarantee that resources are allocated to the most important health needs and are delivered in the most
efficient ways. In addition to this we need to predict likely health trends and issues for the future, basically getting the most ‘bang for our buck’.
Successfully identifying priority health issues relies on epidemiology, political factors and personal and community attitudes.
The Australian Government uses a set of criteria when making decisions about how to address health problems, a health issue that meets most of the
criteria will be made a priority, the criteria:
☞ Social justice principles
☞ Priority population groups
☞ Prevalence of condition
☞ Potential for prevention and early intervention
☞ Costs to the individual and community

Social Justice Principles

The principles of social justice are equity, diversity and supportive environments. Using social justice principles enables the government to focus
on acknowledging diversity within the community and working to ensure equity so that all Australians have the opportunity to be healthy.

Priority population groups

There are particular priority population groups that are achieving significantly poorer health outcomes compared to the rest of Australia. These
populations can be cultural such as Aboriginal and Torres Strait Islanders, who have health statistics that match developing worlds. They can also be
environmental such as rural and remote living people, who have limited access to health care facilities and services.

Prevalence of condition
The prevalence of a condition is used to determine the number of people affected by the health issue. The higher the prevalence the greater the health
issue, which may then be identified as a priority health issue in Australia.

Potential for prevention and early intervention

As a priority issue is identified, it is vital that there is potential for prevention and early intervention that will make treatment more successful. The
easier it is to prevent a disease the more likely a health promotion will have an impact on the burden of the disease and reduce its incidence.

Costs to the individual and community

In the identification of priority health issues, the costs to the individual and community of the health issue must be examined. Costs to the individual
and community come in various forms, such as: expenses, time, independence, and connection with other issues, such as mental health issues

WHEN STUDYING REANSWER QUESTIONS IN WORK BOOK. USE SEXY. Use past hsc papers too

Why is it important to prioritise issues for health?

Because it, ensures that resources and funds are being allocated to the correct groups and areas and is being used in the most efficient way. In
addition to being able to anticipate future health trends and issues by prioritising, as well as using the social justice principles equity, diversity and
supportive environments as they play a critical role in influencing the identification and management of Australia’s health priorities.

Describe the role of social justice determining health priority issues.

The use of social justice principles when determining health priority issues is crucial as it enables the government to focus on acknowledging
diversity within communities to ensure equity to all Australians, so that they have and equal chance to be healthy as it is their right.

How can social justice contribute to improved health for all Australians?
The social justice principles are equity, diversity and supportive environments. Using social justice principles enables the government to focus on
acknowledging diversity within the community and working to ensure equity so that all Australians have the opportunity to be healthy. Health issues
where social justice principles are not achieved are identified as a priority health issue. For example; CVD is more common among ATSI and Rural
and Remote communities. Meaning that these groups both experience health inequities, and so social justice principles are not being met. Thus
leading to CVD being identified as a priority health issue. Social justice can then be used for other health issues in order to improve health for all
Australians.
Core 1: Health priorities in Australia
Focus Question 2: What are the priority issues for improving Australia’s health.

GROUPS EXPERIENCING HEALTH INEQUITIES

These groups are more likely to have shorter lives, higher levels of risk factors that contribute to preventable disease and injury, and a lower use of
preventative health services. These groups usually have fewer resources, a reduced capacity to be healthy and less power to make healthy choices.

ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES (ATSI)

ATSI peoples generally have significantly worse health than Australians. They typically
die at much younger ages and are more likely to experience disability and reduced quality
of life. Indigenous Australians are socioeconomically disadvantaged than other
Australians. On average, they have lower incomes, higher rates of unemployment, lower
education fulfilment, and more overcrowded households.

The nature and extent of the health inequities

3.3% or 787000 people identify as being Aboriginal or Torres Strait Islander origin. The
age profile of the Indigenous population is significantly younger than the total Australian
population. This is due to both higher fertility rates and earlier mortality among
Indigenous people.

Life expectancy is significantly lower among Indigenous Australians than Non-Indigenous

Australians,10.6 years lower for males and 9.5 years for females. The average life
expectancy for indigenous males is 69 years compared with other Australian males at 79,
in addition the average life expectancy for Indigenous females is 73 compared with 83 for
other Australian females.

ATSI peoples have higher rates of infant mortality, 2.1 times higher than other Australians. But the rates are improving. Reasons for the gap:
☞ Rarer antenatal visits
☞ More likely to smoke while pregnant
☞ Pre-existing diabetes can affect pregnancy, 3x higher among Indigenous women than non-indigenous women
☞ Gestational diabetes was twice as common

Statistics, rates and trends among ATSI people and morbidity:

☞ More likely to be obese
☞ More likely to smoke
☞ Less likely to eat enough fruit and vegetables
☞ Higher rates of Diabetes, CVD, Mental health issues, self-harm, injuries

The sociocultural, socioeconomic and environmental determinants

REANSWER QUESTIONS IN WORK BOOK.
Explain how sociocultural determinants have contributed to Aboriginal and Torres Strait Islander peoples health status.
☞ The sociocultural determinants that affect health relate to society and culture. The sociocultural determinants being; family, peers, religion,
culture and media. After past history of discrimination and violence ATSI people have felt a sense of disconnection, this affects the initiative to
go and access health services. For example; Due to the long-lasting effect of traumatic history among ATSI people and non-indigenous , this
has reduced the likeliness of ATSI peoples accessing health services as they may not be comfortable with a Non-Indigenous person due to
cultural barriers as well as fear of judgement/discrimination.
Explain how socioeconomic determinants have contributed to Aboriginal and Torres Strait Islander people’s health status
☞ The socioeconomic determinants that determine health include: employment, education, and income. Socioeconomic refers to society
related economic factors. Aboriginal and Torres Strait Islander’s health status can be affected by the following attributes as our society and
lifestyle is based on our economic position. For example; On average and ATSI individual is more likely to not complete or go on to
further education, and with lack of education they’re disadvantaged in finding a high paying job and are less employable. Leading to the
fact that they will have a lower income which can affect future lifestyle such as a smaller household which can be overcrowded leading to
bad hygiene and mental health issues as well as being more inclined to buy low-nutrient food due to low cost. This causes health issues
such as obesity, diabetes and CVD.

Explain how environmental determinants have contributed to ATSI people’s health status
☞ Environmental determinants include geographical location and access to health services and technology. ATSI people on average live in
houses that are overcrowded and that do not satisfy the basic Australian standards for shelter, safe drinking water and adequate waste
disposal. As well as having higher rates of homelessness, and are more likely to live in rural or remote locations because of their culture.
These factors of the environmental determinants affect the health status of ATSI people. For example; Many Indigenous people live in
overcrowded dwellings and poor-quality housing which does not have satisfactory waste disposal this can lead to disease and sickness
contributing to poor physical health. As well as the occupants in the housing are associated with having mental health issues.
The roles of individuals, communities and governments in addressing the health inequities.
Individuals
The role of individuals is to engage in healthy behaviours themselves and to raise awareness of the health inequalities faced by ATSI people. An
individual’s ability to minimise their risky health behaviours to increase their protective behaviours or promote good health in others is influenced by
a variety of factors; these include age, family history, community support, education, role modelling, access to health services and socioeconomic
status.

Community
The role of communities is to have input into the development and delivery of programs and facilities that cater to the specific needs of communities.
Indigenous Australian’s do not access primary health care services to the extent they should, due to lack of availability of services, transport and
distance to services, cost and language or cultural barriers. Aboriginal Community Controlled Health Services (ACCHSs) and Aboriginal Medical
Services (AMSs) are primary healthcare services initiated and operated by the local Aboriginal community to deliver holistic, comprehensive and
culturally appropriate healthcare to the community that controls it. The nature of the services provided varies from one community to another, though
generally they include clinical care, health education, promotion, screening, immunisation and counselling.

Governments
The role of governments is to develop policy and allocate funding to address ATSI health issues. The high level of health risk factors among
Indigenous Australians suggest that policies need to deal with the risk factors in their own right as well as tackling the social conditions that promote
them and cause ill health and premature death. The Council of Australian Governments targets provide a means of monitoring progress in improving
both the social determinants of health and the overall health status of ATSI peoples.

PEOPLE IN RURAL AND REMOTE AREAS

Some characteristics of Australians that live in rural and remote areas are
that they live large distances away from major cities and services, and
are generally not as healthy as their city counterparts. Some reasons for
generally poorer health, lower economic advantages (lower education,
income, and employment), greater levels of smoking and alcohol abuse,
less access to health service and staff, and hazards of road accidents of
long distances.

26% of people in rural communities are Indigenous. The health

disadvantages of rural Australia, on average, are not as bad as ATSI
people.

The nature and extent of the health inequities

On average people who live in regional and remote areas have a shorter
life expectancy.

Statistics on Mortality that people in rural and remote face:

- The death rate for people who live rural are 2.5 times higher than those who are living outside capital cities
- Higher suicide rates (mainly among male farmers) and motor vehicle accidents
- CVD and COPD death rates are higher

Statistics on Morbidity that people in rural and remote face:

- Lip, head and neck cancers and melanoma rates are high due to smoking, alcohol and sun exposure
- Higher rates of mental health issues
- Poorer dental health due to lack of access to dentists
- Increased hospitalisations
- Less health literacy
- More likely to eat more vegetables and to use less drugs
- Higher rates of daily smoking, risky alcohol consumption, sedentary lifestyle and overweight and obesity
- Higher rates of CVD, diabetes, asthma and arthritis
-
The sociocultural, socioeconomic and environmental determinants
WHEN STUDYING REDO QUESTIONS
Explain (cause and effect) how socioeconomic determinants have contributed to People in rural and remote area’s health status
S ( c )– People living in rural and remote communities have lower rates of education due to reasons such as access and demands of family businesses.
E ( e ) – This contributes to health inequities as they are likely to have lower levels of health literacy, which means they may be unaware of
preventative strategies for diseases
X - (e.g. healthy eating to prevent CVD, signs and symptoms of diabetes, early prevention for melanoma. They also have lower levels of employment
which can lead to mental health issues and substance misuse (alcohol) and lower levels of income. Lower levels of income contribute to lower access
to some medical services (e.g dentists) and less access to healthy foods (fruit and vegetables), leading to higher rates of diseases such as CVD.

Explain (cause and effect) how environmental determinants have contributed to People in rural and remote area’s health status
S ( c ) – People living in rural and remote communities are restricted from accessing health services due to being situated in isolated locations.
E ( e) – Contributing to health inequities as they increase the risk of being injured or killed to drive long distance to access these health services,
meaning that it is less likely for people in rural and remote communities to travel for these services causing an increased chance of being unable to
prevent health issues
X - (melanoma, dental problems, CVD and Diabetes). Having to travel long distances for not only health services but social events increases the
likelihood of not attending leaving the individual to feel isolated and alone causing mental health issues (depression and social anxiety)

Explain (cause and effect) how sociocultural determinants have contributed to People in rural and remote area’s health status

S ( c ) – The stereotype of people living in rural and remote communities is that you are tough, independent and don’t share your problems, This
leads to people being less likely to access support (e.g talking to friends, family, health services) and is a contributing factor in the higher rates of
mental health and suicide in these communities. This stereotype also contributes to lower levels of access to preventative screening for health issues
(e.g. skin checks for melanoma, health checks for CVD).
Other sociocultural issues – drinking at the pub to socialise – higher rates of drinking alcohol to harmful levels - CVD

The roles of individuals, communities and governments in addressing the health inequities.
Refer to book – page 34, 35

CARDIOVASCULAR DISEASE
Cardiovascular disease includes all the diseases and conditions of the heart and blood vessels. Despite the health achievements made, cardiovascular
disease is still a major cause of death.

The nature of the problem

Disease Definition Key features (trends)

Coronary Heart Disease (ischaemic heart
disease) (CHD)
Cerebrovascular Disease (stroke)
Heart Failure
Peripheral vascular disease
Heart Attack: when a blood vessel supplying CHD is the most common cause of
the heart is completely blocked, damaging the cardiovascular disease
heart Death rates and incidence are declining
Angina: Chronic condition, short bursts of More likely to occur in males
chest pain happen due to blood supply to the
heart is temporarily blocked
Any disorder of a blood vessel supplying the Death rates are declining
brain, when vessel is blocked losing brain Kills more women than men
function
When heart functions less effectively in Death rates are declining
pumping blood around the body common Death rates higher with women
causes – heart attack, high blood pressure or Prevalence significantly higher in females
damaged heart valves
Affects arteries, arterioles and capillaries of Smokers have significantly higher rates
the bodys extremities, mostly legs and feet.
Furthest away from heart needs more blood
when walking or running this can be restricted
due to atherosclerosis

Hypertension – is high blood pressure (systolic) long-term medical condition in which the blood pressure in the arteries is persistently elevated

Atherosclerosis is the underlying cause of most of these conditions

- Is the build-up of fatty and/or fibrous material on the interior walls of arteries. This build-up hinders the flow of blood to the body’s tissues
and also acts to increase blood pressure.
Development of atherosclerosis may happen in any artery in the body, it is the greatest threat to an individual’s health when it is present in arteries
in the brain, the eyes or legs, or the heart. High blood pressure, smoking and a fatty diet accelerate the development of atherosclerosis.

Arteriosclerosis (hardening of arteries)

 - Is a degenerative disease that affects most people to some extent as part of the process of ageing. Begins in childhood. A form of
atherosclerosis develops as fatty deposits build up and arteries become harder and less elastic.
Extent of the problem (trends)
Mortality
- Coronary Heart Disease remains the largest single cause of death in Australia
- CHD is more likely to occur in men
- Stroke is the second-most common cause of CVD death
- More females die from stroke
- Death rates and incidence rates are declining for CHD
- Death rates are declining for Stroke
Morbidity
- Cancer is the major disease group causing the greatest burden (costs) in Australia, followed by cardiovascular disease.
- In terms of diseases, heart disease causes the greatest burden
- CHD burden has reduced by 32%
- 3.3% of the adult population, 1 in 6 adults aged 75 and over had CHD
- CHD deaths have fallen
- Prevalence of CHD was twice as high for males than females
- CHD was 2.0-3.1 times higher among ATSI peoples
- Over 1/3 of people who had a stroke had a resulting disability
- Stroke is 1.5 to 2.3 times higher among ATSI peoples
- Hospitalisation rates for stroke were 1.3 times higher in remote or very remote areas compared to major cities
Reduction in mortality and morbidity due to
Improvements in medical and surgical treatment e.g. better emergency care and early identification of risk
Increasing use of antithrombotic (blood thinner?) and blood pressure and blood cholesterol-lowering drugs and cardiac procedures that restore
blood flow to the heart by removing or bypassing blockages.
Reductions in risk factors, such as smoking, high blood cholesterol and high blood pressure, have also contributed to these declines

REANSWER QUESTIONS WHEN STUDYIING

Risk factors and protective factors
Outline the non-modifiable risk factors for CVD
- Non-Modifiable risk factors are factors that cannot be controlled or modified. In developing cardiovascular disease there are multiple non-
modifiable factors that increase the development that increase the development and the risk of CVD, such as; genetics, gender, and age. For
example; If an individual has a family history of cardiovascular disease they are more likely to develop CVD.
Outline the modifiable risk factors for CVD

- Modifiable risk factors are factors that can be reduced or eliminated by lifestyle changes or medical treatment. In developing cardiovascular
disease there are multiple factors that an individual can change to decrease the chance of cardiovascular disease, such as; smoking, high
blood-fat levels, high blood pressure, obesity and physical inactivity. For example; If an individual stops heavy smoking it decreases the
risk of heart attack and stroke by double.

Analyse protective factors for CVD and good health

- Protective factors are the opposite of risk factors as they help lower an individuals chance of developing heart disease. In partaking in
protective behaviours it lowers the risk of CVD by doing things such as; maintaining healthy blood pressure and blood cholesterol, quitting
smoking, enjoy healthy eating, visiting doctor regularly and being physically active. For example; Going to the doctor regularly and
checking blood pressure and cholesterol levels increases chances of early identification of CVD, as well as ways the individual can help
themselves

The sociocultural, socioeconomic and environmental determinants

Sociocultural
The sociocultural determinants of cardiovascular disease include: family, media, peers, religion and culture. Genetics play an important role in many
chronic diseases and cardiovascular disease is no exception. In addition to the genetic inherited, growing up in a family that is overweight or obese,
eats foods high in sugar and saturated fats or lives a sedentary lifestyle leads to children who grow up to live a similar lifestyle and make similar
choices concerning these risk factors. Peers can also influence people to make poor health choices, such as pressure to smoke, which can lead to
increases in cardiovascular disease.

Socioeconomic
Socioeconomic determinants of cardiovascular disease include employment, income and education. Education, especially health literacy and
knowledge influences lifestyle choices. Higher levels of education help produce lower incidence of cardiovascular disease. Education also enables
choice of employment. Cardiovascular disease has higher rates in blue collar employment, such as trades and labour. This is often linked with other
lifestyle choices often associated with these forms of employment such as higher rates of smoking and drinking as well as higher saturated fat diets.
Lower income levels result in fewer health-related choices as many incur cost to the individual, such as joining a gym, or buying lean meats rather
than regular meat.

Environmental
The environmental determinants of cardiovascular disease are geographical location, and access to health services and technology. People living in
rural areas have higher rates of death from cardiovascular disease. This could be because the speed of medical treatment for heart attacks or a stroke
greatly affects the results. People who access medical treatment swiftly have less chance of disability or death resulting from their stroke or heart
attack. Access to technology also impacts survival rates, but also is used in medical checks to test for atherosclerosis, angina and other cardiovascular
diseases.

Groups at risk

 ATSI, who have 2.6 times as many heart attacks as other Australians over 25 and are 1.7 times as likely to have a stroke.
 People with low socioeconomic status, who have a 40% higher death rate from cardiovascular disease and higher rates of stroke.
 Rural and remote people, who have a higher burden form stroke compared with people in major cities.
 The elderly, who represent 15% of those who have coronary heart disease and account for 70% of people who had a stroke.
 Smokers have much higher rates of cardiovascular diseases, and men, who have more cardiovascular disease than their female counterparts