Medicare - Cambridge University Press

Changes in approaches to healthcare
over time
• The biomedical approach to health involves the diagnosis and
treatment of illness. It relies heavily on medical science and has lead
to the development of new and sophisticated medical technologies
(such as new drugs, organ transplants and diagnostic procedures).
• The preventative approach to health began in the early 1900s and
was widely accepted by the 1960s. It acknowledges the fact that
lifestyle behaviours contribute to ill health and focuses on preventing
illness from occuring or returning. It considers all components of
health and promotes healthy lifestyles.
© Goodacre, Slattery, Upton 2007
Changes in approaches to healthcare
over time
• The knowledge that social and environmental factors have a
significant influence on health lead to a new model in health in the
1970s known as the social model of health. The social model of
health is designed to work in conjunction with the biomedical and
preventative approaches to health and is based on an
understanding that in order for improvements in health to occur,
basic needs must first be met.
• Ottawa Charter for health promotion – WHO, WHEN, WHY, WHAT
and HOW?
© Goodacre, Slattery, Upton 2007
Ottawa Charter
• Who was it developed by and when was it written?
It was written in 1986 by the World Health Organization.
• Why was it written?
It was written to outline action to achieve health for all by the year
2000 and beyond.
• What is it?
A document (or charter) that outlines five areas for action: build
health public policy; create supportive environments; strengthen
community action; develop personal skills; and reorient health
• How is it used?
It is used to develop strategies to promote health.
© Goodacre, Slattery, Upton 2007
Ottawa Charter in action
Use the Ottawa Charter to
develop a strategy to reduce
the number of injuries
among children around the
© Goodacre, Slattery, Upton 2007
Charter for
The structure of the Australian
healthcare system
• Role of the Commonwealth Government:
To manage Medicare through HIC, financial support to government
and non-government organisations, manage national health
programs, health policy and legislation, regulate private health
insurance, quarantine, food standards through FSANZ, international
responsibilities in healthcare through AUSaid.
• Role of state and territory governments:
To manage the public hospital system, mental health services,
dental health services, health promotion and prevention activities
through VicHealth, community health centres, ambulance services
and the provision of prevention and early detection programs.
• Medicare – WHO, WHEN, WHAT, WHY and HOW?
© Goodacre, Slattery, Upton 2007
• Who is responsible and when was it established?
It was established by the Commonwealth Government in 1984.
• What is it?
It is a universal healthcare system that provides medical care to
patients via their GP or hospital for little or no cost.
• Why was it established?
It was established to improve access to healthcare for all Australians
and provide access to adequate healthcare at little or no cost to all
Australians in need of treatment, regardless of age or income.
• How is it used?
It is funded by the Commonwealth Government, partly through a
1.5% Medicare levy paid by most taxpayers.
© Goodacre, Slattery, Upton 2007
What are the advantages and disadvantages of
the Medicare system?
• Advantages: Treatment is available for little or
no cost and all Australians have access to
Medicare regardless of age or income.
• Disadvantages: Long waiting lists for some
hospital services and it doesn’t cover all health
© Goodacre, Slattery, Upton 2007
The National Health Priority Areas (NHPAs)
Who were they developed by and when were they introduced?
The NHPAs is a combined initiative between the Commonwealth and state
and territory governments and was initially developed in 1994.
What is it?
The NHPAs is Australia’s response to the WHO’s Health for All by the Year
2000 strategy. It currently identifies seven priority areas:
Cardiovascular health
Cancer control
Injury prevention and control
Mental health
Diabetes mellitus
Arthritis and musculoskeletal conditions
© Goodacre, Slattery, Upton 2007
• Why were they introduced and why was each NHPA
They were established to increase public awareness and
understanding and to focus on health policy in regard to these
The illnesses were each chosen as they contribute significantly to
disease burden and healthcare costs. Additionally, they are
conditions where significant gains in the health of Australians can be
made through treatment, prevention and management.
© Goodacre, Slattery, Upton 2007
• How is it used?
Identify one initiative per NHPA:
Cardiovascular health
Cancer control
Injury prevention and control
Mental health
Diabetes mellitus
Muscoloskeletal and athritis conditions
© Goodacre, Slattery, Upton 2007
Factors affecting the provision,
selection and purchase of food
People are influenced by a range of
factors when making decisions regarding
the provision, selection and purchase of
In order to make effective changes to
intake, individuals need to combine
knowledge and research with other
factors, such as preference to make
informed choices that can be enjoyed.
Give examples of each of the four factors
and explain how each factor can impact
on the provision, selection and purchase
of food.
© Goodacre, Slattery, Upton 2007
the provision
purchase and
of food
Factors influencing the provision,
selection and purchase of food
Factor and example
© Goodacre, Slattery, Upton 2007
Influence on the provision, selection
and purchase
Factor and example
Influence on provision, selection and purchase
(e.g. lifestyle, taste preferences,
physiology, habits)
Personal preference for foods will influence what is purchases at the
supermarket or restaurant and lifestyle (choices about work, leisure and
exercise) can influence when and where people eat, which can impact
on food selection.
(e.g. income, marketing, cost of food,
food industry)
Income/socioeconomic status has a strong connection with food choice.
Those from lower socioeconomic groups tend to purchase foods higher
in fat, salt and sugar. Marketing may influence selection at point of sale
leading to the selection of more high energy foods.
(e.g. family, culture, friends, gender,
Family is the strongest influence on food choice as it teaches us many
food habits and provide most meals. Culture will also have a strong
influence on the behaviours and traditions that relate to food choice and
the types of food individuals find acceptable.
education, body image, age)
(e.g. politics, food laws, natural
environment, geographic location)
© Goodacre, Slattery, Upton 2007
Where people live can impact on the provision of food, as not all food is
available in all areas. Climate, floods, drought, etc. are also examples of
environmental factors that can influence the provision of food.
Government taxes (GST) have influenced the cost of fresh versus
processed foods, which often influence the foods people purchase or at
least the price they pay. Governments influence food selection by
regulating the price, safety and labelling of food.
The role of governments in promoting
healthy eating
The role of the government is to respond to immediate
health issues, and to develop policy and guidelines that will
address future considerations.
Three government initiatives include:
• The Australian Guide to Healthy Eating
• Eat Well Australia – a public health nutrition strategy
• Dietary Guidelines – across the lifespan
© Goodacre, Slattery, Upton 2007
The Australian Guide to Healthy Eating
• Who was it developed by and when was it developed?
It was developed by Children’s Health and Development Foundation of the
Women’s and Children’s Hospital (South Australia), and the Faculty of
Health and Behavioural Sciences at Deakin University (Victoria) in 1995–
• What is it?
Based on the RDIs and the Dietary Guidelines, the guide is
presented in a diagram that includes illustrations of a range
of multicultural sample foods divided into five groups based
on nutrient content. Additional information contained in the guide discusses
the five food groups, serve sizes, nutritional requirements, sample serves
and information based on needs for different population groups.
• Why was it introduced?
To improve the knowledge and skills base necessary for Australians to
select a healthier diet.
© Goodacre, Slattery, Upton 2007
Eat Well Australia – a public health
nutrition strategy
Who was it developed by and when was it developed?
SIGNAL (Strategic Inter-Governmental Nutrition Alliance) in conjunction with key
stakeholders from government, non-government and industry organisations in
What is it?
It includes two public health and nutrition strategies: one aimed at the whole
Australian population and one aimed at Indigenous Australians. It provides a
framework for industry, government, non-government and community sectors to work
together for the prevention and management of diet-related diseases.
There are five key priorities of EWA:
Preventing overweight and obesity
Increasing the consumption of fruit and vegetables
Promoting optimal nutrition for women, children and infants
Improving nutrition for vulnerable groups, including rural and isolated populations, low-income groups and
Indigenous Australians
Addressing structural barriers to safe and healthy food
© Goodacre, Slattery, Upton 2007
• Why was it developed?
To take a national approach to public health nutrition to gain greater
consistency and organisation of government policy and strategy
development across Australia. Also to improve nutrition in Australia,
and reduce diet-related illness and early death.
© Goodacre, Slattery, Upton 2007
Dietary Guidelines
• Who were they developed by?
The National Health and Medical Research Council (NHMRC)
• When were they developed?
In 1992 and revised in 2003.
• What are they?
There are two sets of guidelines that offer nutritional advice to target
specific groups in the community. Based on current nutrition
knowledge, they provide advice to Australians about healthy food
choices to reduce the risk of developing diet-related diseases.
How many guidelines can you list from each of the two sets of
© Goodacre, Slattery, Upton 2007
The role of non-government organisations
• Non-government organisations provide advice and
information to improve eating habits and services to
improve healthy eating.
• Some NGOs have a vested interest in changing dietary
patterns such as the Australian Dairy Corporation.
• Other NGOs receive government funding, which means
that their policies must be in line with those of the
© Goodacre, Slattery, Upton 2007
Nutrition Australia
• Nutrition Australia is a non-government organisation that works
closely with the state and Commonwealth governments. It is
Australia’s primary community nutrition education body and
responds to local needs and opportunities for nutrition education and
health promotion.
• The Healthy Eating Pyramid has been the trademark of Nutrition
Australia for over 20 years. It is used by educators, health workers
and the general public, and is a simple model for people to use as a
first step to adequate nutrition.
© Goodacre, Slattery, Upton 2007