PDH/PE
Personal Development, Health and Physical
Education
Core 1:Health Priorities in Australia
Health priorities in Australia

How are priority areas for Australia health identified?

Measuring health status
Health status is a term used to describe the state of health of an
individual, the community or the population of a region of country,
measured against an identifiable standard.
Role of epidemiology



Epidemiology is the study of the patterns and causes of health and
disease in populations, and the applications of this study to improve
health.
Historically referred to as the study of ‘epidemics’ of infectious
disease.
The disadvantage of using epidemiology as a measure of health
status is that the statistics do not tell us the quality of life of the
individual that is being represented.
Measures of epidemiology

Different measures of epidemiology are:
Mortality, or death rates and the causes and distribution of these
deaths over the population by age, gender, population group, or
geographical location.

Infant mortality or the rate of death of infants per number of live
births.

Morbidity or the rates of illness and diseases, and their distribution.
Measures of epidemiology

Life expectancy or the number of years an individual or population
group can expect to live after birth, according to gender or
population group.

Statistics on the rates of death, sickness and disease are compiled
by the Australian Bureau of Statistics ABS. This information is used
by Commonwealth, state and community health departments and
organisations to determine the distribution of funds for health care.
Statistical data can be collected for various groups in the population
as well as for the population as a whole.
What can epidemiology tell us?

Through the collection of data, epidemiology studies can identify
specific factors relating to health.

The disadvantage of epidemiology is that statistics do not tell us the
quality of life that the individual represented
Who uses these measures?

Epidemiological data and information about population health can
be used by a variety of people agencies as evidence to improve
their decision making, planning and implementation of health
programs and strategies.
Who uses these measures?

Department of health and Ageing use mortality, disease prevalence
and cancer screening to inform the development of policies like the
National Chronic Disease Strategy.

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.

NSW Department of Education use data collected about sports
injuries to develop safe guidelines for the implementation of sport in
schools
Who uses these measures?

Hospitals use data about the application of health services,
incidence of diseases and the health workforce to plan staff training
and recruitment in order to meet community needs

Pharmaceutical companies use data about life expectancy,
application of medicines and attitudes to health to develop and
market pharmaceutical products

Doctors use data about health determinants, disease monitoring and
groups at risk to inform decisions about preventive actions,
diagnosis and prescription
Current trends - Mortality

Australia’s population has increased 11.8% from 1997 – 2006.
Population of people aged 65 years and over has increased from
12.1% to 13%

The standardised death rate in 2006 of 6 deaths per 1000 in the
standard population was the lowest on record, steady decline from
7.6 deaths per 1000 in 1997.

Males accounted for 51.3% of deaths in 2006, down from 52.4%
1997.

Females accounted for 48.7% of deaths in 2006, an increase from
47.6% in 1997.

Ratio of male deaths per 100 female deaths has decreased from
110 in 1997 to 105.2 in 2006.
Leading causes of deaths

For males, coronary heart disease CHD, lung cancer
cerebrovascular disease STROKE caused 32.4% of deaths in 2005.

Other hearth diseases, prostate cancer and chronic obstructive
pulmonary disorder COPD were the next most common causes.

For females, coronary heart disease, cerebrovascular and other
heart diseases caused 32.5% of all deaths.
Leading causes of deaths

Dementia, breast and lung cancer were the next most common
causes

Cardiovascular diseases CVD were the number one cause of death
in 2005, totalling 35% of all deaths.

Females were 10% more likely to suffer from a CVD than males.

Death rates for coronary heart disease and stroke have declined
consistently since 1960
Cancers

Cancer 30% of all deaths in Australia in 2005.

Lung, prostate and colorectal cancers were the leading causes of
death for males

Lung, breast and colorectal cancers were the leading causes of
death for females

Make deaths from cancer occurred at a rate of 1.3 for every female
death
Diabetes

New diabetes cases are increasing however diabetes related deaths
have declined slightly to 2.7% of all deaths in 2005

Diabetes was named as an associated cause in 6.4% of all deaths
Mental illness

Mental or behavioural disorders accounted for 2.7 deaths per
100,000 persons (excluding suicide and dementia) and had
decreased significantly since the 1990’s

Females were more likely to suffer death as a result from mental or
behavioural disorder while males were a result from psychoactive
substance abuse
Injury

Suicides accounted for 1/5 deaths by injury in 2005

Motor accidents and falls each accounted for a quarter of all injury
related deaths

Males were more likely to die from injury than females at a ratio of
1.7 male deaths for every female death

Falls were the only injury category that female death rates were
higher than males death rates
Morbidity

Morbidity data describes sickness and illness within a population as
opposed to mortality data that describes causes of death.

Illness and injury cause much suffering, disability, premature
mortality and impose significant costs on society in terms of health
system use and lost productivity in the workplace
Major causes of illness

Cancer at 19% is the leading cause of disease burden followed by
cardiovascular disease at 18% then mental disorders at 13%

Heart attack rates are falling and survival from attacks is improving
Diabetes prevalence has doubled in the last 2 decades

Kidney disease has recorded an increase with cases of end-stage
kidney disease tripling in the last 25 years
High levels of preventable chronic disease, injury and mental health
problems

Complete questions
High levels of preventable chronic
disease, injury and mental health
problems

Cardiovascular disease CVD
All diseases involving the heart
Coronary heart disease, stroke, vascular disease

Trends
Leading cause of death in Australia
Death rates declining due to prevention
Stroke is leading cause of death for both males and females
High levels of preventable chronic
disease, injury and mental health
problems

Positive lifestyle factors and improved disease management have
contributed to an annual decline in death rates since 1970

People aged over 65 are more likely to suffer from CVD

Risk factors
Smoking, physical inactivity, overweight or obesity, high fat diet,
alcohol abuse, high blood pressure and cholesterol, poor nutrition
and diabetes

Groups at risk
Older people, indigenous people, socioeconomically disadvantaged
people and rural and remote Australians
Cancer

Cancer can arise in any organ or body tissue

Occurs when normal cell division in the body becomes uncontrolled
and unstoppable. The cells then spread throughout the body
producing malignancy


Skin cancer – Melanoma
Most dangerous skin cancer
Spreads throughout the body
Trends
Australia has largest level of skin cancer in the world
Rates are rising, more males affected than females
Cancer

Risk factors
Exposure to suns rays, solariums and attitude “healthy tan”

Protective factors
Reduce exposure to suns rays, wear protective clothing e.g. hat,
long sleeve shirts and sunscreen, check skin regularly for changes
in moles and freckles , take care with solarium use

Groups at risk
Children, adolescents, young adults, outdoor workers
Lung cancer

Is a malignancy in the lungs

Trends
Is the major cause of cancer deaths in Australia
Male deaths are higher
Female death rates have risen gradually

Risk factors
Smoking is the greatest factor, exposure to asbestos and chemicals
Lung cancer

Protective factors
Not smoking, quitting smoking, being aware of symptoms e.g. cough
not getting better and early intervention to prevent children
becoming future smokers

Groups at risk
Smokers, passive smokers, older people and indigenous people
Breast cancer

Cancer cells grow in the breast and spread to other parts of the
body

Trends
Have the highest rates for women
Males are also diagnosed with breast cancer
Survival rates increasing due to early detection
Breast cancer

Risk factors
High fat diet, excess alcohol intake, hormone replacement therapy
taken over 4 years, late pregnancy and menopause and family
history

Protective factors
Self examination, screening programs and health promotion
campaigns
Injury

Is a large cause of health care costs

Leading cause of deaths among young people

Suicide has become a more common cause of death than transport
related injury

Three and a half more males than females committed suicide in 200

Road injury deaths have declined since early 1970’s due to
intervention strategies being introduced to improve road safety

Has a major but often preventable impact on Australia’s health

Major cause of death in first half of life

Many injured people left with series disability or long term conditions
Injury

Largest male rates were from road crashes and interpersonal
violence

60+ year old females have higher injury rates due to falls causing
injuries such as hip fractures as compared to males

Suicide is the most frequent cause of injury deaths among males
overall

Decline in road deaths has slowed recently

From late 1990’s declines in drug-related deaths and suicides

Groups at risk
Young adult males, people in rural areas, children and Indigenous
Australians
Injury

Protective factors
National Injury Prevention and Safety Promotion Plan 2004-14, road
safety laws and education, pool fencing, reduction of excess alcohol
intake and use of illicit drugs

Diabetes
Is a disorder of the body’s levels of insulin.
Type I is insulin dependant and can be fatal if not treated
Type II is non-insulin dependant, may be undetected for years,
known as mature-onset diabetes
Gestational diabetes can occur during pregnancy
Long term effects include blindness, kidney problems, lower limb
amputations, heart attack, stroke and impotence
Injury

Trends
Numbers rising in Australia and across the world
Type II once mainly affected older people, now becoming more
common in childhood

Risk factors
Obesity, physical inactivity and poor nutrition

Groups at risk
Indigenous Australians, people over the age of 50 for type II,
gestational diabetes for pregnant women
Respiratory disease - COPD

Chronic obstructive pulmonary disease COPD is known as
emphysema or chronic bronchitis

Destruction of the lung tissue and narrowing of the air passages
obstructs oxygen intake and gas exchange

Shortness of breath and coughing

Risk factors
Smoking is the major risk factor, environmental exposure to
pollutants

Protective factors
Quitting smoking, not smoking, vaccination for influenza
Respiratory disease – Asthma

Is an inflammatory disease of the air passages that makes them
become narrow causing wheezing, coughing and shortness of
breath

Trends
During the 1980’s and 1990’s there was a world wide increase
Recent years trends has plateaued
Australia has high level compared to international standards
Recent decrease among children and young adults
Respiratory disease – Asthma

Risk factors
Family history, allergic conditions, parental smoking, major
respiratory infection during first 2 years of life, exposure to domestic
allergens and triggers including pollen, dust, exercise, cold weather
and chest or throat infections

Protective factors
Learning to manage the condition, avoiding known allergens and not
smoking

Groups at risk
Affects all age groups and ranges in severity, boys under 15 years
but after teenage years females with asthma are more prevalent and
females have had a significantly higher prevalence overall than
males
Identifying priority health issues

The Australia Government makes decisions on where to allocate
funding and address the health problems confronted by the nation.

This is achieved through considering:

Social justice principles - A set of values that recognises the
impact of discrimination, past disadvantage, structural barriers to
equality, as well as other social factors. It is concerned with reducing
inequity by supporting the most disadvantaged people in society

Example – Medicare is designed to provide basic health care to all
Australians regardless of religion, socioeconomic status, location or
cultural background
Identifying priority health issues



Priority population groups – Are those experiencing inequities
however which group has priority? Decided through community
consultation, media attention, demands of lobby groups to
parliament and epidemiology all play a part in the decision making
process
Prevalence of the condition – Major causes of death and illness
that are shown in statistics point to a need to prioritise
Potential for prevention and early intervention – The capacity to
identify and change health damaging risk behaviours provides great
potential for improving health outcomes through education and
health promotion strategies
Identifying priority health issues

Costs to individuals and communities – The costs imposed on
the community may include ‘direct’ costs that are borne by the
health care system or ‘indirect’ costs that may be borne by the family
or other sectors of the community
What are the priority issues for
improving Australia’s health?

Australia ranks as one of the healthiest nations in the world. We
have a high life expectancy, low mortality rate and an improving
health status.

However this is not shared by all by all groups. Aboriginal and Torres
Strait Islander people suffer extraordinarily poor health status. Other
groups that also share health inequities and different health status
include socioeconomically disadvantaged people, people in rural
areas, overseas-born people, the elderly and people with
disabilities.

Currently 75% of Indigenous Australians live in cities and regional
areas while 25% live in remote areas.
What are the priority issues for
improving Australia’s health?

The life expectancy of a male Indigenous Australian in 2001 was 59
years. This was the same life expectancy of a non indigenous male
in 1910

The life expectancy of a female Indigenous Australian in 2001 was
65 years. This was the same life expectancy of a non indigenous
female in 1922

The gap between indigenous and non-indigenous life expectancy is
approximately 22 years
Indigenous Australians mortality rates

The mortality rates for Indigenous Australians continue to be
unacceptably high compared to other Australians

Between 2001 and 2005 the death rates for Indigenous males and
females in most states were almost 3 times higher than non
Indigenous males and females

The 5 leading causes of death were
Diseases of the circulatory system and cancers
Indigenous Australians mortality rates

Endocrine, metabolic and nutritional disorders (including diabetes)

Respiratory diseases

Injuries (injuries caused by transport, assault, self-harm were
responsible for deaths amongst young Indigenous males at 3 times
the non-Indigenous rate

There are however positive trends occurring with the Indigenous
rates decreasing significantly in Western Australia between 1991
and 2005

Throughout Australia the gap between Indigenous and nonIndigenous infant mortality rates has closed considerably since 1991
Indigenous Australians morbidity rates

The burden of disease among Indigenous Australians represents
3.6% of all disability yet they represent only 2.5% of the total
population

In 2004-2005 Indigenous adults were twice as likely as nonIndigenous Australians to report their health as fair or poor – 29%
compared to 15% as well as twice as likely to report high levels of
psychological distress compared to non-indigenous adults

Main Causes of poor health include mental disorders, circulatory
diseases, diabetes, respiratory diseases, cancers, musculoskeletal
conditions, eye and ear problems and kidney disease (markedly
increased between 2001 and 2004-2005

Indigenous people were hospitalised at a rate 5 times higher than
the rate of non-indigenous people and at a rate 14 times higher for
care involving dialysis
Indigenous Australians morbidity rates

Fewer Indigenous people suffer skin cancers and prostate cancers

Rates of asthma, back pain and hearing problems amongst
Indigenous Australians have declined between 2001 and 2005

Sociocultural, socioeconomic and environmental determinants

Indigenous Australians experience significant socioeconomic and
Sociocultural challenges.

Since European settlement, cultural divisions and conflicts, illadvised or ineffective programs of integration, separation, education
and welfare support have all contributed to the poor state of
Indigenous health.
The most critical challenges for
Indigenous Australians include





Lower incomes – median income for Indigenous families in 2006
was approximately 55% of non-Indigenous families
Higher rates of unemployment – in 2006 the Indigenous
unemployment rate was 16% The non-Indigenous rate was 5%
Lower educational attainment – the number of Indigenous people
who completed Year 12 was approximately half of non-Indigenous
people
Lower rates of home owner ship – the number of Indigenous families
who either owned or were purchasing a home in 2006 was half the
number of non-Indigenous families 34% compared to 69%
The social determinants discussed have contributed and influenced
the exposure to the following risk factors
The most critical challenges for
Indigenous Australians include




Tobacco use – was the main contributor to the burden of disease
among Indigenous Australians. In 2004-2005 50% of the Indigenous
population were smokers and smoking rates are double those of
non-Indigenous Australians.
Alcohol consumption – In 2004 – 2005, 1 in 6 Indigenous
Australians reported chronic levels of risky drinking and binge drink
at twice the rate of other Australians
Illicit drug use – twice as many Indigenous Australians over 15 years
(28%) reported illicit drug use.
Overweight and obesity – more than 50% of Indigenous Australians
are over weight (similar to non-Indigenous rates)
The most critical challenges for
Indigenous Australians include


Poor nutrition – little difference between Indigenous and nonIndigenous Australians however fresh fruit intake is slightly lower in
rural communities
Physical inactivity – indigenous Australians in particular females
were more likely to be sedentary or exercise at low levels

Exposure to violence – 2002 national Aboriginal and Torres Strait
Islander Social Survey NATSISS reported Indigenous exposure to
violence was twice the rate of non-Indigenous Australians which had
doubled since 1994. Exposure was 3 times more likely in rural
communities

Poor housing conditions – In 2004 overcrowding affected 1 in 4
Indigenous Australians
Positive news

Year 10 and beyond school retention rates increased between 1998
– 2007 and the difference between Indigenous and non-Indigenous
retention rates decreased

Labour force participation increased from 52% to 54% between
2001 – 2006

Home ownership rates increased from 31% in 2001 to 34% in 2006

The unemployment rate decreased between 2001 - 2006 from 20%
to 16% for Indigenous people aged 16 – 64 years

Between 2001 – 2006 the year 12 completion rate increased from
20% to 30%
Roles of individuals, communities and
governments in addressing the health
inequities

Aboriginal health is a major problem for this nation. Given the poor
state of current health indicators, the current strategies and
programs have had limited success.

Indigenous health status results from the interaction of multiple
determinants and requires a multi-faced response from the health
care system. Therefore a “intersectoral” approach based on
partnerships between people and agencies at many levels from a
variety of sectors is needed.
Government

There are 2 peak agencies which coordinate Indigenous health
services at the federal government level with a 3rd peak body in
NSW that overseas at a state level.

1. The Office of Aboriginal and Torres Straight Islander Health
OATSIH– has been established within the Department of Health and
Ageing to bring greater focus to the Australian Governments delivery
of mainstream health services to Indigenous Australians.

Is responsible for administering and funding ATSI community
controlled health and substance use services

OATSIH provides direct grants to around 245 organisations of which
around 80% are ATSI community controlled or managed
Government

2 The National Aboriginal Community Controlled Health
Organisation NACCHO – agency that works with the Department of
Families, Housing, Community Services and Indigenous affairs.

Is the national Aboriginal health body representing Aboriginal
Community Controlled Health Services throughout Australia

3. The Aboriginal Health and Medical Research Council of NSW
AH&MRC – is the peak body for Aboriginal health in NSW.

Is comprised of over 60 Aboriginal Community Controlled Health
Organisations throughout the state
Government


Provides services that include –
Health service delivery, supporting Aboriginal community health
initiatives, development and delivery of Aboriginal Health Education,
research in Aboriginal health data and policy development and
evaluation
Communities

OATSIH, NACCHO and AH&MRC aim to improve the access of
primary health care services for Indigenous people through the
principle of working in partnership with the Aboriginal and Torres
Straight islander community controlled health sector
Communities

Aboriginal communities run hundreds of local health services
providing services including clinical care, health education,
promotion, screening, immunisation, counselling, men’s and
women’s health, aged care, transport to medical appointments,
hearing health, sexual health, substance use and metal health.
Individuals

Individuals capacity to affect their own health (risk vs protective) is
influenced by many factors including (discuss)

Programs such as The Healthy for Life H4L provides a strong focus
for the education and support of Indigenous mothers and children
and increasing the number of Aboriginal health workers in
communities
Socioeconomically disadvantaged
people

Socioeconomic status SES describes the ‘position’ or ‘power’ of a
person or group in the community. In Australia, Socioeconomic
Indexes for Areas SEIFA measure the average SES of people living
in a local area e.g. within a postcode area, are used to produce an
Index of Relative Socioeconomic Disadvantage IRSD
Socioeconomic disadvantage is the
existence of

limited material resources such as income

Reduced access to educational opportunities

Less safe working conditions

Lower employment status

Worse living conditions during childhood

Less access to services

Greater likelihood of racism or discrimination
The nature and extent of the health
inequities

Studies have identified a strong relationship between low economic
status and lower health status

Health status is better or worse according to where a group is
positioned on the social ladder

People from areas of lower socioeconomic status are –

More likely to suffer from cardiovascular disease, diabetes, asthma,
mental illness and arthritis

Lose more years of life dur to illnesses

Experience lower life expectancy as a result
The Sociocultural, socioeconomic and
environmental determinants

Inadequate income, single parent family structure or family
breakdown can all contribute to a low SES and as a result cause
that individual to experience reduced access, limited resources,
restricted educational opportunity and control over their life

Individuals from low SES are more likely to –

Daily smokers

Eat less than the recommended serving of fruit and vegetables

Be over weight or obese

Be sedentary or physically inactive
The Sociocultural, socioeconomic and
environmental determinants

Report higher levels of psychological stress

Visit a doctor or emergency clinic

Depend on government assistance

Avoid the use of preventative health services

The relationship between SES and health status is complex. Each
can affect the other.

Discuss the ways that they can create a cycle
The roles of individuals, communities,
and governments in addressing the
health inequities

Government

Federal and state governments recognise the cost of poor health
among people and are committed to make improvements through
funding and policy.

Medicare and the Pharmaceutical Benefits Scheme PBS are
programs designed to address the needs of SES by providing lower
cost health services and medications
Government

The State Health Plan is designed for government and non
government services and the private sector to work together to
bridge the health gap for people in New South Wales

State government responsibilities relate to service provision and
prevention. The NSW Government has strategies in place the risk
factors that SES are exposed to. The strategies relate to -
Government

Child health and wellbeing

Immunisation

Mental health

Obesity

Sexual health

Oral health

Chronic disease
Government

Urban planning

Tobacco

Drugs and alcohol

The State Health Plan reflects the NSW Governments priorities for
the development of the public health system towards 2010 and
beyond
Communities and individuals

The success of the strategies is dependant on the services and
information being successfully delivered into the community

The prevention of disease and management of illness within
communities is more important and relevant to changing needs

Community agencies that can provide assistance will improve the
health outcomes of low SES people
People in rural and remote areas

People who live in regional areas represent 29% of the Australian
population

People who live in remote areas represent 3% of the Australian
population

These people represent higher levels of mortality, disease and
health risk factors and experience –

Similar levels of diabetes, cerebrovascular disease (stroke),
coronary heart disease, depression and anxiety

Slightly higher levels of cancer in rural areas but lower levels of
cancer in remote areas

More likely to suffer acute or chronic injury
People in rural and remote areas

Lower life expectancy, increasing with remoteness

Less likely to report very good health or excellent health

Were more likely to show high levels to very high levels of
psychological distress amongst males
The Sociocultural, socioeconomic and
environmental determinants



People living in rural and remote areas have fewer educational and
employment opportunities, lower income and less access to goods
and services and may even have less access to basic necessities
like fresh fruit and vegetables
People living in rural and remote areas were more likely to –
Drink alcohol in risky quantities that would be harmful in the short
term
The Sociocultural, socioeconomic and
environmental determinants

Be overweight or obese

Consume less low-fat or skim milk or to eat under the recommended
2 serves of fruit per day

Consume 4 or more serves of vegetables per day

Experience lower birth weights, particularly among teenage mothers
Government


The Rural Health Taskforce provides advice to the NSW
Government about improving health services to people in rural areas
of the state
Responsibilities identified in the State health Plan are –

Attract and retain more health professionals in rural and remote
communities

Provide sustainable quality health services

Make health services more accessible for people in rural and remote
areas
Government

Implement innovative models of service, staffing, networking, rural
and remote health professional support, professional development
and family support

The NSW Government runs programs such as the Medical
Specialist Outreach Assistance Program which offers a range of
scholarships and grants to support rural health professionals an din
cooperation with the Australian Government runs the Multi Purpose
Service MPS Program
Communities

Rural communities struggle to sustain adequate health and medical
services for their residents and find it difficult to run services based
on the same models established for services in the larger centres
and cities

The MPS model is aimed at –

Establishing viable acute health, aged care and community services

Improving access to appropriate services

Increasing coordination, flexibility and innovative service delivery
Communities

In order to successfully run health services, rural communities must
attract and retain properly trained staff

The Australian Rural Health Education Network ARHEN is a network
of University Rural Health Departments committed to increasing
retention of health professionals that are linked to rural placements
for graduates. They also carry out research into the satisfaction
rates of rural doctors and health workers
Overseas-born people

The Australian population comprises 24% of people born overseas

They are often people who can afford to emigrate and have lower
levels of illness and disease

Within the total population of people born overseas there is a great
diversity of group characteristics and health status
The nature and extent of the health
inequities

Many migrant residents born overseas especially in South-East Asia
enjoy lower rates of death than other Australians, however this effect
has a tendency to reduce as length of residence increases and
exposure to typically Australian lifestyle and risk factors become
more prevalent
People born overseas

Suffer higher levels of psychological stress if they come from war
zones, don’t speak English or have trouble in the resettling process

Have hospitalisation rates almost 20% lower than other Australians

Are hospitalised for the following diseases according to country of
birth –

Tuberculosis – India, Vietnam, Philippines and China
People born overseas

Lung Cancer – United Kingdom and Ireland

Diabetes – Greece, India, Italy and Vietnam

Heart attack – India

Heart failure – Italy, Greece and Poland

Dialysis – Greece, Italy, Vietnam, Philippines, Croatia and India

Breast Cancer – women from England and Northern Ireland
The Sociocultural, socioeconomic and
environmental determinants

Migrants are often less exposed to harmful risk factors for
cardiovascular and other diseases such as overweight or obesity,
physical inactivity and high risk alcohol consumption in their country
of origin

The 2004-2005 National health Survey reported that there were
higher levels of exposure to some risk factors for some groups –

Current daily smoking – Oceania (New Zealand, Papua New
Guinea, Solomon Islands, Kiribati, Fiji and Antarctica).
The Sociocultural, socioeconomic and
environmental determinants


Sedentary or low exercise levels – Southern and Eastern Europe,
North Africa, the Middle East and South East Asia.
Varying body weights and heights showing they are likely to be
overweight or obese than people born in Australia – Oceania and
Southern and Eastern Europe
Government

The main approach by governments to the health of people born
overseas is to provide translation and language services to improve
communication of health issues and access to health services
among culturally and linguistically diverse CALD communities

The NSW Multicultural Health Communication Service MHCS works
with health services to provide non English speakers with access to
important health information

The NSW Government identifies the delivery of health services to
CALD communities and refugees as one of its objectives.
Communities

The critical role of communities is to provide support for their
members by advocating, promoting and engaging in the use and
delivery of culturally appropriate health services

Training and educating of CALD community members to join and
support the health care profession in the most enabling of all
strategies
Communities

The capacity of CLAD communities to provide and support
healthcare services is governed by the age of the community. The
longer the community has been established, the greater the greater
the capacity

Government and non government services work in partnership with
CLAD communities to provide a range of health care services
A growing and ageing population


In 2007 Australia’s population reached 21,015042 growing appx
1.5% annually
In the period 1956 – 2006 the proportion of people aged up to 14
years grew by 46%

The proportion of people aged 65 and over grew more than 200%

The proportion of people aged 85 years and over grew 700%

This is depicting an ageing population

Older are much higher users of hospitals than younger people with
over half of people in hospital at one time being over 65 years. This
means that majority of hospital resources will be focused on older
people
A growing and ageing population

Appx 25% of all GP visits were made by older patients

The percentage of visits from people aged 75 years and older has
increased significantly however the percentage of visits from people
aged 65 – 75 years has only slightly increased


Most common reasons for GP visits – hypertension, immunisation,
diabetes, osteoarthritis and health check ups
6% of people aged over 65 years live in residential and aged care
facilities resulting in aged care services being delivered in the home
A growing and ageing population

In 2006 appx 2.6% of people aged 65 years and over
and 22% of people aged 85 years had dementia

High percentage of people move into aged care
facilities as a result from falls. Injury from falls is
estimated to cost the NSW healthcare system over
$1.2 billion. The “Stay on your Feet” program run in
NSW reduced hospital admissions by 20% for people
aged over 60 years

In 2006 35% of elderly people were born overseas
with 61% of those were born in non English speaking
countries
A growing and ageing population


Older population taking the “sea change” moving to more costal
areas and away from cities when retiring. This change has a large
impact on governments who need to address the health needs of
retirees by redistribute appropriate services from the cities to rural
centres. Problems then arise such as finding trained and qualified
staff
Older Australians are increasingly being used to provide care.
Grandparents provide 60% of child care for children equating to 20%
of all children and represent a large source of primary care for
partners or other older people with a disability or poor health
Healthy ageing

Healthy older Australians are –

Less likely to leave the workforce for health reasons

More likely to enjoy retirement

Contribute more to their own environment

Have fewer health care needs

Experience less chronic disease and disability

Place less pressure on the national health budget and health care
system
Healthy ageing


Positive determents for maintenance of health include –
Sufficient income

Safe housing

Right conditions for achieving independence and mobility
Healthy ageing

Risk factors that contribute to the health status of older people

High blood cholesterol

Impaired glucose tolerance

High blood pressure

Obesity

Physical inactivity
Healthy ageing

Risky alcohol consumption

Smoking

Poor diet

Increased population living with chronic disease and disability
Healthy ageing

Most health problems experienced from older Australians are a
result from the accumulated effects of poor lifestyle behaviours over
many years

As the age of the suffer increases, so does the level of disability
causing a greater increase on carers and healthcare

The National Chronic Disease Strategy targets conditions that place
a huge burden on the healthcare system including –
Healthy ageing

Cardiovascular diseases

Cancers

Chronic lung disease

Obesity (major problem in NSW)

Injurious falls in older people

Diabetes (type 2)

Poor emotional and psychological wellbeing
Healthy ageing

These conditions are a result from modifiable risk factors including –

Tobacco smoking

Nutrition

Alcohol consumption

Physical activity

Stress – psychosocial risk factors
Healthy ageing

In response to the increased levels of chronic disease and disability
the NSW Government has included a range of studies in its State
Health Plan including –

Align NSW activities with the Australian Better Health Initiative

Develop and implement new community based models of care for
older people and people with chronic disease

Expend programs to prevent and reduce the impact of chronic
disease to improve survival rates and quality of life
Healthy ageing

Enhance services for early detection, prevention and
management of chronic disease

Implement initiatives to address childhood and adult
obesity (Fresh Tastes@School NSW Healthy School
Canteen Strategy)

Strengthen the capacity of the public health system
Demand for health services and workforce
shortages

In 2005 – 2006 subsidies for aged care homes totalled appx $5.3
billion.

These providers include public, private, religious and charitable
organisations

Older Australians prefer to live in their own home. They have access
to a range of care packages including –

Home and Community Care HACC Programs e.g. home nursing
services, delivered meals, home help, home maintenance services,
transport and shopping assistance, allied health services home and
centre based respite care
Demand for health services and workforce
shortages

The Extended Aged Care at Home EACH and EACH Dementia
programs

Community Aged Care Packages CACP

Aged care homes, high level, personal care is required, low level,
only assistance is needed

Eligibility for any type of care is assessed through the Ages Care
Assessment Team

A main challenge in meeting the health needs is for the government
to train and mobilise enough qualified professionals to the areas
affected.

What other staffing challenges would be faced?
Availability of carers and
volunteers

The number of Australians aged 85 years and over has doubled
over the past 20 years and is projected to 4.6% of the total
population by 2036

The care is split up by 80% of family and 20% by organisations

As the aged population grows, so will the demand for carers, based
off the current projections the demand may not be meet
What role do health care facilities and
services play in achieving better health
for all Australians?

Health care in Australia

While Australia is a relatively healthy country in comparison to other
nations, the healthcare system is still extremely important. Its role is
to provide quality health facilities and services to meet the needs of
all Australians.

Health services are organised, financed and delivered by both public
and private sources. Healthcare in Australia is dominated by
medicine and is generally concerned with diagnosis, treatment,
rehabilitation and care of people with illness and injury.
Range and types of health facilities
and services

Health facilities and services provided in Australia can be classified
in two areas.

Institutional facilities and services

Hospitals provide general and specialised healthcare.

Patients in hospitals are classified as public or private according to
their choice of service. Public hospitals are operated and financed
by the government, and the healthcare service is free of charge for
patients.
Range and types of health facilities
and services

Private hospitals are owned and operated by individuals and
community groups. Service must be paid for by the patients,
although Medicare and private health insurance refund most of the
expense.

In Australia, hospital admissions have increased whilst length of stay
has decreased.

Nursing homes provide care and long-term nursing attention for
those who are unable to look after themselves, such as the
chronically ill, the elderly and people with disabilities.
Range and types of health facilities
and services

There are three types of nursing homes in operation throughout
Australia – private charitable (such as Anglicare), private for profit
and state government.

The federal government funds the running of all nursing homes
through taxes.

Psychiatric hospitals provide treatment for people with severe
mental disorders.

They use a system of care that integrates hospital services and
community settings.

Non-institutional facilities and services
Medical services

These are services provided by doctors, specialists and other health
professionals. General practitioners are the most commonly used
service, however consultation rates have increased. Medicare
refunds patients’ payments for these services. Specialists such as
obstetricians, dermatologists, orthopaedic surgeons, who have
expertise in a particular field of medicine, are also used.
Health-related services

These include other services such as a dentistry, optometry, nursing,
ambulance services and physiotherapy.
Pharmaceuticals

Drugs are supplied through prescription from doctors or hospitals
(PBS) or over the counter from shops or pharmacies.
Pharmaceutical Benefit Scheme (PBS) drugs are subsidised by the
federal government for people with special needs.
Responsibility for health facilities and
services

The following groups are responsible for a range of health facilities
and services within Australia.
Federal government

The formation of national health policies is the responsibility of the
federal government.

They control funds obtained through taxes and allocate these to
state or local government health sectors.

The Australian Government operates assistance programs, such as
Medicare and PBS; and coordinates approved national health
programs, such as HIV/AIDS.

They also support special programs such as the National Heart
Foundation and Royal Flying Doctor Service.
State or territory government

The responsibility for providing funding for health and community
services, such as public hospitals, medical practitioners, and family
health services lies with the state or territory. At this level,
governments also regulate private hospitals and provide
immunisation programs.
Local government

At a local level, governments are responsible for implementing state
health policies and controlling local environmental issues such as
maintenance of recreational facilities. They are also responsible for
providing a range of personal, preventive and home care services
such as waste disposal and Meals on Wheels.
Private sector

The private sector is responsible for providing a wide range of
services, such as private hospitals and alternative health services
including dental, physiotherapy and chiropractic services. These
services are generally privately owned, funded and operated
through business, charity or religious groups, such as Mayne Health.
However, some private sector services receive government funding
such as the NSW Cancer Council.
Community groups

On a community level, these groups are responsible for promoting
health within a more concentrated or focused area of health, for
example, the Asthma Foundation and Diabetes Australia.
Equity of access to health facilities
and services

The pursuit of equity of access to healthcare is a central objective of
many healthcare systems. There are two dimensions to equity of
access to health facilities and services. The first is horizontal equity,
which refers to equal treatment for comparable needs. One example
is Medicare, the national health insurance system, which aims to
provide the majority of Australians with equal access to basic
healthcare.

Another example is the Pharmaceutical Benefits Scheme (PBS),
where the service provided by the Australian Government ensures a
range of necessary prescription medicines are made available at
affordable prices to all Australian residents.
Equity of access to health facilities
and services

The second dimension of equity of access is referred to as vertical
equity.

This involves the priority treatment of those groups with increased
health needs and reduced access to health facilities and services,
such as Aboriginal and Torres Strait Islanders, and people of
culturally and linguistically diverse backgrounds.

Horizontal and vertical equity are both essential aspects of a
comprehensive health system, however governments and service
providers find it easier to work on a horizontal level of equity as it is
less complex and does not involve the issues associated with
needing to prioritise population groups.
Equity of access to health facilities
and services

An example of a service addressing the vertically equitable need of
geographic disadvantage is the Royal Flying Doctor Service of
Australia.

For geographic, social and cultural reasons, mainstream services
are not always accessible to, or the most appropriate form of service
for, Indigenous people.

Australian governments recognise this and apply the principles of
vertical equity to provide specific healthcare services to meet their
needs.

Specific Indigenous health services have funding provided at federal
and state or territory government levels.
Equity of access to health facilities
and services

The Australian Government, through the Office for Aboriginal and
Torres Strait Islander Health (OATSIH), provides funding for a range
of Indigenous-specific community-controlled primary healthcare
services.

In 2005-2006, OATSIH funded 151 services to provide or facilitate
access to primary healthcare for Aboriginal and Torres Strait Islander
peoples. Overall, 58 of these services (39%) were in remote or very
remote locations.

These services offer many types of care, including management of
acute and chronic health conditions, preventative health measures,
such as immunisation and screening, health promotion activities,
transport services and assistance in accessing other appropriate
community and health services.

Health care expenditure versus expenditure on early intervention
and prevention
Health expenditure

Health expenditure is the allocation of funding and other economic
resources for the provision and consumption of health services.

There are two types of expenditure:

Recurrent expenditure – regular ongoing costs (salaries, bandages)

Capital expenditure – infrequent costs (buildings, equipment).
Health expenditure

In 2005-2006, government funding for health was $58,875 million
(68% of the total health expenditure), with the Australian
Government contributing $37,229 million (43%) and state, territory
and local governments contributing $21,646 million (25%). The nongovernment sector – households, private health insurance and other
non-government sources – funded the remaining $28,004 million
(32%).

Recurrent expenditure on health for Indigenous people was
estimated at $2304 million or nearly 3% of recurrent health
expenditure for the entire population. This represents an average of
$4718 per Indigenous person, 17% higher than the average of
$4019 for other Australians (AIHW 2008).
Health expenditure

Seven broad disease groups accounted for an estimated $29,827
million, or 57% of the available health expenditure in Australia in
2004-2005. Cardiovascular disease was the most expensive
disease group $5923 million or 11% of expenditure) and oral health
was the second most expensive $5305 million or 10%.

Different illnesses have different patterns of expenditure by type of
health service. Cardiovascular diseases, musculoskeletal diseases,
cancers and other neoplasms and injuries accounted for a relatively
high proportion of total expenditure on hospital admitted patient
services.
Intervention and prevention
expenditure


The term ‘public health’ is also referred to as ‘preventative health’.
Public health interventions focus on prevention, promotion and
protection rather than on treatment. It centres on populations rather
than on individuals and on the factors and behaviours that cause
illness.
Public health activities can be programs, campaigns or events. They
draw on a large range of methods, such as health education,
lifestyle advice, infection control, risk factor monitoring and tax
increases to discourage unhealthy lifestyle choices. They also use
multiple settings, such as schools, homes, work places, through the
media and via general practitioner consultations.
Intervention and prevention
expenditure

Early intervention and prevention strategies are carried out by
federal, state or territory and local governments, as well as nongovernment agencies, such as the Cancer Council and the Heart
Foundation.

In 2005-2006, governments in Australia spent a total of $1476
million on public health activities through the programs administered
by their health departments.

This represented 1.8% of total recurrent expenditure on health.
Expenditure on organised immunisation accounted for $318 million
(22% of all government expenditure on public health activities)
during 2005-2006 and was the largest single area of such
expenditure.
Intervention and prevention
expenditure


Selected health promotion activities accounted for a further $250
million (17%) and communicable disease control activities cost $245
million (17%). Activities directed at preventing hazardous and
harmful drug use accounted for $176 million (12%).
It’s been seen so far that healthcare expenditure in Australia far
exceeds expenditure on prevention and support programs, are
efficient and increasingly accepted and used.

Nevertheless, governments still have not yet fully acknowledged
health promotion as a cost-effective method of reducing morbidity
and mortality.

The new public health approach focuses on shifting away from
medically dominated expenditure to health promotion expenditure.
Intervention and prevention
expenditure

The reasons for increasing funding and support for preventive and
promotional health include:

cost-effectiveness (human and non-human resources)

improvement to quality of life

improved access and education

maintenance of social equity

use of existing structures

reinforcement of individual responsibility for health (empowerment).
Intervention and prevention
expenditure

Unfortunately, even though preventive health is generally cheaper,
the benefits often take years to translate into a visible reduction in
illness or death. Current governments could spend money now on
programs that might be considered as risky political options if they
are unsuccessful. Governments may feel pressure to choose an
option where results are short term and can be used as leverage for
winning the next election.

Impact of emerging new treatments and technologies on health care
eg cost and access, benefits of early detection
Intervention and prevention
expenditure

Much of the rise in healthcare costs can be attributed to advances in
medical technology. Diagnostic and therapeutic advances, such as
new radiological scanners, biological therapeutics, surgical
procedures and prostheses, come at a considerable cost. Listing
these for subsidy through Medicare or the Pharmaceutical Benefits
Scheme greatly increases their availability and use, and therefore
the cost to the community. Failing to subsidise them inevitably raises
questions about why new medical advances are not available to all
Australians and generates political pressure. Treatments and
technologies have emerged that address the essential needs of
access and early detection. Two programs that have been effective
in achieving this are cancer screening and childhood vaccinations.
Cancer screening

There are national population screening programs in Australia for
breast, cervical and bowel cancers with aims to reduce morbidity
and mortality from these cancers through early detection of cancer
and pre-cancerous abnormalities and effective follow-up treatment.

These programs are:

Breast Screen Australia – using mammography for screening

National Cervical Screening Program – using Pap smear tests


National Bowel Cancer Screening Program – using faecal occult
blood tests.
These programs provide screening services that are free to women
in the target age group (for breast screening) and to men and
women invited to participate in bowel screening, or if they are
covered by a Medicare rebate (for cervical screening).
Childhood vaccinations


The National Immunisation Program Schedule covers children’s
vaccinations for diphtheria, tetanus, whooping cough (pertussis),
polio, measles, mumps, rubella, meningococcal type C disease,
varicella (chickenpox), hepatitis B, rotavirus and, for females aged
12 years and over, human papillomavirus (HPV).
Additionally, for Aboriginal and Torres Strait Islander children living in
high-risk areas, hepatitis A is covered. In 2006-2007, nearly 3.7
million immunisations were delivered to children nationally (AIHW
2008).
Medicare


Medicare is Australia’s universal healthcare system introduced in
1984 to provide eligible Australian residents with affordable,
accessible and high quality healthcare.
Medicare provides access to free treatment as a public (Medicare)
patient in a public hospital, and free or subsidised treatment by
medical practitioners including general practitioners, specialists,
participating optometrists or dentists (for specified services only).
Medicare

Medicare was established based on the understanding that all
Australians should contribute to the cost of healthcare according to
their ability to pay. It is funded through the Australian Government,
progressive income tax and an income-related Medicare lvy. Nearly
everybody (except for those on welfare or very low incomes) pays at
least 1.5% of their earnings toward Medicare levy. It reimburses
85% of scheduled medical fees for services provided outside
hospital and 75% of scheduled fees for services provided inside a
public hospital. Individuals must pay the remaining 15%, commonly
referred to as the ‘gap’. Bulk billing, which eliminates the ‘gap’
payment for patients, is also covered. This is where patients pay
nothing and the medical professionals bill Medicare to receive 85%
of the scheduled consultation fee back.
Medicare

The disadvantages to the individual and community in using
Medicare include:

long waiting lists for surgery

additional costs and further strain for hospitals

additional costs to state government

patients may still be required to pay the ‘gap’ amount left over from
the general practitioner’s fee and the amount paid by Medicare.
Medicare

Medicare Australia is responsible for ensuring that Medicare benefits
are paid to eligible healthcare consumers for services provided by
eligible medical practitioners; and for assessing and paying
Medicare benefits for a range of medical services, whether provided
in or out of hospital, based on a schedule of fees determined by
Department of Health and Ageing in consultation with professional
bodies.

For more information, go to the Medicare website:

www.medicareaustralia.gov.au/
Private health insurance

Private health insurance is funded through the federal government
and private contributions. Private health insurance cover is generally
divided into hospital cover, general treatment cover (also known as
ancillary or extras cover) and ambulance cover. Contributions are
usually paid monthly or annually.

The advantages to the individual and community for having private
health insurance include:

an option to cover extra services such as medical, ancillary, dental
and optical

patients have a choice of hospital service (public or private)

special benefits
Private health insurance

health cover while overseas

shorter waiting lists for surgery

decreased demand on public facilities.

Some areas of surgery are no performed predominantly in the
private sector, and the 57% of Australians without private health
insurance must wait, often for months, for elective surgery in the
public system.
Private health insurance

This creates an equity challenge where access to care is based on
ability to pay rather than need. Specialist surgical training remains
concentrated in the public sector, where the caseload is diminishing.

One of the disadvantages of joining the private health insurance
sector is that it is heavily regulated.

This means that premiums for private health insurance are the same
for all, whether they use it or not. Also, Medicare must still be paid,
which adds to the annual costs.
Private health insurance

Additional insurance covers private hospital expenses, ambulance
services, ancillary expenses and aids, such as dental, physiotherapy
and chiropractic; and options such as glasses. Patients may still be
required to pay an ‘excess’, which is the first part of the cost before
the insurance company will pay. A higher excess means a lower
premium.

Access to health services is becoming less equitable. The out-ofpocket costs for patients have increased 50% in the past decade
and for some this can present a sizeable barrier to needed care.
Private health insurance

Regional Australians have substantially lower levels of private health
fund membership. In 2001, 50% of people living in capital cities were
covered by private health insurance compared with 44% living
outside capital cities. The main reason for the lower level of
membership in regional areas is the limited availability of private inpatient facilities. Only 16% of hospitals located outside major cities
are private facilities.

If more people joined private health insurance providers, it would
decrease the costs to government, which in turn would allow funds
to be redirected to other government priorities and initiatives.
The federal government 30% rebate

An individual who pays hospital and/or ancillary private health fund
premiums to a registered health fund can get the federal
government’s 30% reduction on the cost of private health insurance.
It is the policy holder who is eligible for this rebate; even if it is a
dependent child or spouse who is covered by the policy. However,
the policy must cover people who are eligible for Medicare in order
to be eligible for the rebate. The 30% rebate was not means tested
up until 2009, so it had been paid regardless of individual or family
income. During the 2009 federal budget, a decision was made to
progressively reduce the rebate for people earning over the
threshold amounts, phasing it out completely for people on high
incomes.
The federal government 30% rebate

The use of private health insurance initially decreased after the
introduction of Medicare because of large increases in premiums
and general satisfaction with public insurance. This fall initially
created pressures on the public health system, particularly in terms
of funding. To facilitate the future expected increase of demands for
an ageing population, the government has used several strategies to
encourage people to invest in private health insurance. These
strategies have led to increased levels of cover.
The Medicare levy surcharge

The Medicare levy surcharge of an extra 1% - on top of the 1.5%
charged to all Australians – only applies to people who earn over the
Medicare levy surcharge threshold and who choose not to have
private hospital health insurance.

The federal government has used the following strategies to
encourage people to take out private health insurance:
The Medicare levy surcharge

Incentive scheme: As of 1 July 2010 individuals earning $75,000 or
over, or couples earning $150,000 or over, will not be required to
pay the extra 1% Medicare levy if they take out private health
insurance. At the same time, singles earning above $90,000 and
families earning above $180,000 will be required to pay a higher
surcharge if they choose not to take out private health insurance.
Lifetime health cover scheme

From the age of 30 years, Australians are encouraged to take out
private health insurance. If they do not, then when or if they choose
to take out private health insurance at a later time in their life, for
example when they get older and may be at higher risk of illness,
they are required to pay an extra 2% on top of the premium for every
year after the age of 30. For example, a person who takes out
insurance at age 50 would be required to add an extra 40% (20
years x 2%) onto the premium. Therefore, a $2,000 annual premium
would now be charged at the penalty rate of $2,800 each year, for
the remainder of the person’s life.
Lifetime health cover scheme

The decision for many individuals and families is whether to save
the amount paid each year on private health insurance and hope
that if something does occur medically, that it will cost less than the
amount save. On the other side, if a major medical issue did arise
and they were not covered, the out of pocket expenses could be
large and the wait for treatment quite lengthy. For many people, they
see private health insurance as a waste of money, while for others,
private health insurance is taken out for peace of mind.
Complementary and alternative health
care approaches

What do you need to help you make informed decisions?

Australians have access to a range of services that either
complement or are alternative to mainstream healthcare services. In
the 2004-2005 National Health Survey, results indicated that in any
two-week period, 1 in 28 Australians (700,000) consulted a
complementary or alternative health professional: 1 in 23 females
(500,000 and 1 in 37 males (300,000. About 1 in every 47
Australians (400,000) consulted a chiropractor, 100,000 consulted a
naturopath and about 200,000 consulted an acupuncturist, herbalist,
hypnotherapist or osteopath.
Complementary and alternative health
care approaches

Complementary and alternative health services have been
incorporated into the general healthcare system to a varying extent.

Acupuncture performed by a medical practitioner attracts a Medicare
rebate, for which a total of 589,796 claims were made in 2006-2007,
attracting benefits of $21.1 million (PHIAC 2007).

Reasons for growth of complementary and alternative health

Patients to be more proactive towards their own health, seek out
different forms of self-care. In the process, many people have turned
to natural traditional medicinal products and practices under the
assumption that ‘natural means safe’.

Scientific studies of several therapies show that their use is
effective, such as for HIV/AIDS and cancer patients.
Complementary and alternative health
care approaches

The advantages of complementary and alternative medicine include

diversity and flexibility

availability and affordability in many parts of the world

widespread acceptance in low and middle income countries

comparatively low cost

relatively low level of technological input.
Complementary and alternative health
care approaches

Reasons for use -

compatibility with a holistic view of health

acceptance by people with diverse cultural backgrounds and
influences and traditional beliefs

desire to use natural products rather than synthetic ones and an

acceptance of their validity by the World Health Organization.

Range of products and services available

Some of the more common complementary and alternative products
used are herbal medicines.
Complementary and alternative health
care approaches





These can be categorised as:
herbs – leaves, flowers, fruit, seed, stems, bark, roots or other plant
parts
herbal materials – herbs, juices, oils, resins and dry powders of
herbs
herbal preparations – extraction and purification.
Popular natural products used in Australia include fish oil/omega 3,
which reduces the risk of heart disease; glucosamine for managing
arthritis; and Echinacea, which is used to increase activity of the
immune system.
Complementary and alternative health
care approaches





Some examples of complementary and alternative services Acupuncture – inserting needles into the skin at points where the
flow of energy is thought to be blocked.
Aromatherapy – the use of oils extracted from plants to alleviate
physical and psychological disorders such as sleep disorders,
stress, and anxiety.
Chiropractic – based on the theory that disease and disorders are
caused by a misalignment of the bones, especially in the spine, that
obstructs nerve functions.
Homeopathy – a patient is given minute doses of natural substances
that in larger doses would produce symptoms of the disease itself.
Complementary and alternative health
care approaches



Massage – rubbing or kneading the muscles, either for medical or
therapeutic purposes or simply as an aid to relaxation.
Meditation – the concentration of the mind on one thing, in order to
aid mental or spiritual development and relaxation.
Naturopathy – founded on the belief that diet, mental state, exercise,
breathing, and other natural factors are central to the origin and
treatment of disease.
How to make informed consumer
choices

Though there are many benefits using different types
of complementary and alternative medicines, there are
also associated risks. Despite widespread access to
various treatments and therapies, people often do not
have enough information on what to know or check
when using complementary and alternative medicines
in order to avoid unnecessary harm.

For example, the Chinese herb ‘ma huang’, which
contains ephedrine and is used for breathing problems
such as asthma, has caused heart attacks and strokes
among some people using it as a dietary supplement.
How to make informed consumer
choices

Long term use of ‘kava kava’, which is used to relieve anxiety, can
cause serious liver damage. And the use of ‘ginkgo’, which
stimulates peripheral circulation, can result in bleeding during a
surgical procedure.

It is important to make informed decisions when choosing to use
alternative healthcare. Before undertaking any service or product,
people should research:

the nature of the product or service, its credibility, benefits and
effectiveness

qualifications and experience of practitioners

recommendations from friends, community members and
recognised experts or groups such as the World Health Organization
What actions are needed to address
Australia’s health priorities?

Health promotion based on the five action areas of the Ottawa
Charter
Levels of responsibility for health promotion

Health promotion is all about prevention. If, at an early stage,
preventive attitudes can be developed and exposure to risk factors
can be controlled the chances of achieving positive health outcomes
are significantly improved.

This is difficult to put into practice and requires determined action by
governments, communities, families and individuals to reduce risk
and provide support and protection. There should be an emphasis
on developing partnerships, combining the sectors and using a
mixture of interventions.
Levels of responsibility for health
promotion

The federal government is responsible for providing leadership and
coordination. It is vital for top level of government to encourage the
states and territories to work together to establish a strong health
promotion infrastructure.

At a federal level, government should interact with international
agencies such as the World Health Organization and provide the
public and the relevant health-promoting agencies with information
and systems for achieving the best health outcomes for the
population.
Levels of responsibility for health
promotion

State and territory governments are responsible for delivering the
preventive health services that support health promotion, including
prioritising health spending, establishing healthy public policy,
meeting accountability and public health goals.

They need to work cooperatively with different ministries, other
levels of government and non-government agencies, as well as
communicating closely with communities and the public about health
promotion initiatives and programs.

The private sector has a responsibility to contribute to the overall
wellbeing of the population. This can be in conflict with other
responsibilities to make profits. The private sector should also work
to protect the environment, providing goods, services and working
conditions that contribute to achieving healthy outcomes.
Levels of responsibility for health
promotion

Local communities have a responsibility to their citizens. With limited
resources, they need to develop partnerships to provide safe
environments and relevant health services to meet public demand.
Identifying the specific needs of local groups and addressing the
critical determinants of health in the community are the most
important tasks in achieving positive health outcomes in the
population.

Individuals must take responsibility for their own health. They can
only make informed health decisions if they actively seek accurate
health information. Individuals can contribute to the health of the
community by supporting their families and friends and by actively
participating in community activities that are designed to promote
and protect the health of the wider population.

One of the future directions of NSW Health is to ‘make prevention
everybody’s business’.
Individuals

With appropriate support, take greater responsibility for our own
health

Develop supportive, nurturing relationships which can help
strengthen coping abilities.
Schools, community groups and nongovernment organisations


Develop individuals’ knowledge, skills, capacity and motivation to
adopt and maintain a healthy lifestyle
Provide affordable and accessible opportunities for people to
improve their physical and mental health in health-promoting
environments
NSW public health system

Work with individuals, parents, communities, GPs, other health
practitioners, childcare providers, schools, aged care facilities, other
government and non-government agencies, the corporate sector
and the media to implement evidence-based programs to reduce
health risks, create health living environments and increase other
health protective factors for people of all ages

Make a particular effort to close the health gap by helping those
most in need and at highest risk of poor health

Emphasise early intervention as an effective means of preventing
risk in the population, preventing disease or injury in those at risk,
and preventing the progression of health conditions so as to
minimise their impact
Health practitioners

Assist and support individuals, carers and families to take control of
their health as far as possible

Regard every interaction with a health consumer and carer as a
chance for prevention, early intervention and education
NSW, Australian and local
governments

Develop an investment strategy to increase the share of resources
spent on prevention and protection initiatives

Adopt a life course approach to the promotion of good health
focusing on evidence-based measures which produce the greatest
health gains, beginning with the prenatal period and infancy

Focus on developing health-promoting public policies which address
underlying determinants of health
Industry and business

Develop products, services and marketing which encourage healthy
choices and promote a culture of healthy living

Pursue healthy workplace initiatives (which can also increase
employee job satisfaction and business productivity)
Media

Provide meaningful information on risks to health, reinforce
messages about healthy behaviours, and be responsible in
depicting unhealthy behaviours

The benefits of partnerships in health promotion, eg government
sector, non-government agencies and the local community

Modern view of health acknowledges that health comes from
interactions between a multitude of factors. As such, the most
effective health solutions can be found when health promotion
initiatives employ multi-strategy approaches to address targeted
health problems.

This is best achieved when partnerships are developed between
different agencies and sectors.
Media

‘Intersectoral collaboration’ is a term used to describe combined
action taken between agencies from within the health sector and
agencies from outside the health sector. It can occur between
government agencies, non-government agencies or a combination
of both.

Intersectoral collaboration also relies on the input of communities
and individuals.

When Australians are given the opportunity to participate in
decisions and planning relating to their own health they have been
shown to be more accepting and trusting of those decisions.
Media

Health promotion policies and strategies based on contributions
from the people whom they are most likely to affect will benefit from
increased community involvement in the health promoting process.

The NSW Government support the notion that individuals should
contribute to the health planning process. This is an important
aspect of the collaborative process.

NSW Health produced a ‘Fit for the Future’ questionnaire to allow
the people of New South Wales to have their say and contribute to
the health planning process. Respondents were provided with
opportunities to answer by phone, mail, online, fax or at a personal
meeting.
Media


Participation in health promotion activities at a community or
individual level produces a resource called ‘social capital’. It can be
described as a collective sense of achievement. Social capital is
being built when neighbours are brought together, health
professionals support community projects or local governments
improve the quality of public spaces and environments. It is an
essential component in building healthy communities and has been
linked in recent research to improved population health outcomes.
Individuals and carers should ‘participate as much as possible in
decisions about their health care’ and ‘provide constructive feedback
about experiences of the health system’, and that the NSW public
health system should ‘provide timely reliable information to
consumers and carers about available health services and treatment
options, help them find their way through the health system, and
respond to their feedback’.
Argue the benefits of health promotion
based on

Individuals, communities and governments working in partnership

The most successful health promotion campaigns in Australia
provide us with outstanding examples of how individuals,
communities and governments have worked in partnership to
produce greatly improved health outcomes for the population.

Following are a few examples of successful partnerships and how
they have worked to accomplish their achievements.
BreastScreen Australia

The BreastScreen Australia Program is a free screening program
that aims to maximise the early detection of breast cancer. The
program targets women aged 50-69 years as these are the years of
higher risk from breast cancer and optimum benefit from screening.
However, women of 40-49 years and over 70 years of age are also
eligible to attend. The program operates in over 500 fixed,
relocatable and mobile locations.
BreastScreen Australia

The state and territory governments have primary responsibility for
the implementation of the program at their local level. The Australian
Government provides overall coordination of policy formulation,
national data collection, quality control, monitoring and evaluation,
with the AIHW publishing an annual monitoring report.

Health departments and the Cancer Council in all states and
territories advertise and promote ‘Breast screen’ services. General
practitioners, as well as organisations and local community groups
help promote the use of the service to women in the targeted group.
BreastScreen Australia

In NSW, the Cancer Institute provides ongoing scientific research,
while local governments provide sites and access. As a result of
these collaborative programs, breast cancer mortality has declined
from 62 deaths per 100,000 women aged 50-69 years in 1996, to 52
deaths per 100,000 in 2005.
Cervical screening

The National Cervical Screen Program (NCSP) provides free Pap
smear tests for all women aged 18-70 years. In combination with
free pap smear tests a program of immunisation for young women
and school-aged girls against the human papilloma virus (HPV) has
also been initiated.

The Australian Government is responsible for the National
Immunisation Framework. The NCSP is jointly funded by federal and
state governments and coordinated by the Cancer Institute. General
practitioners play an important primary role by recommending
regular Pap tests to their patients.
Cervical screening

This influences many patients in making the decision to have a
regular Pap test. (Media agencies are also employed to design and
deliver advertising campaigns to promote Pap testing).

Gynaecologists advise and assist the program in the development of
evidence-based strategies that will facilitate effective clinical
management of women. All results from laboratories are reported to
service providers and the pap test register according to guidelines
established by the NHMRC.
Cervical screening

Schools are involved as sites for education and the delivery of the
HPV vaccine, while families, mothers in particular, support their
daughters to use these preventative services as recommended.

Since the introduction of a national screening program in 1991,
cancer of the cervix has dropped from the 8th to the 18th most
common cancer among Australian women. The use of pap smear
tests has reduced death rates from cervical cancer by 52% in the
last decade. The introduction of the HPV vaccine will protect women
from the strains of HPV that cause approximately 70% of all cervical
cancer.
The five action areas of the Ottawa
Charter

Just as partnerships in health promotion improve health outcomes
for the population, its effectiveness is enhanced when it is based on
the five action areas of the Ottawa Charter.

The following two statements from the Ottawa Charter give a better
understanding about what the ‘action areas’ are designed to do.

When the five ‘action areas’ are incorporated in the design of a
health promotion strategy they integrate quite naturally to produce a
collaborative intersectoral approach that can address a wide range
of health determinants and inequities on a variety of different levels.
The five action areas of the Ottawa
Charter


The ‘action areas’ that are applied to address heart disease might
include the following suite of responses in a multi-strategy approach:
Reorienting health services (RHS) – This could include strategies for
screening programs to identify risk factors such as obesity and
hypertension; free checkups for people in higher risk categories
such as males over 45 years old; and training for doctors to identify
high-risk patients.
The five action areas of the Ottawa
Charter



Developing personal skills (DPS) – This could include strategies for
courses in time management, yoga or other stress management
techniques and PDHPE lessons that educate students about
nutrition and exercise.
Creating supportive environments (CSE) – This could include
strategies for smoke-free zones, workplaces that reduce exposure to
tobacco smoke and programs such as ‘Quit’ that provide social
support to smokers who are trying to give up.
Building healthy public policy (BHPP) – This could include strategies
such as no GST applied to fresh fruit and vegetables or high taxes
on tobacco and alcohol.
The five action areas of the Ottawa
Charter



Strengthening community action (SCA) – This could include
strategies such as healthy canteens in schools, breakfast exercise
groups in local communities or community obesity forums.
Many of Australia’s most successful health promotion campaigns
have applied the Ottawa Charter action areas, influencing many of
the determinants that contribute to the problem and putting pressure
on influential people and agencies to take action.
The Immunise Australia Program coordinated the Measles
Immunisation Program in the late 1990s. The summarised case
study below demonstrates how the action areas were applied to
produce a highly effective national health promotion program.
How health promotion based on the
Ottawa Charter promotes social justice

Social justice has been described as a set of values concerned with
reducing inequity by supporting the most disadvantaged people in
society. Social justice principles include participation, equity, access,
rights, supportive environments and acknowledging diversity.

The Ottawa Charter addresses each of these values when it is used
to design health promotion campaigns that support and protect
people and groups who suffer disadvantage.

The ‘action areas’ relate in many ways to the principles of social
justice and can clearly be applied to support these values.
Developing personal skills (DPS)


This will improve a person’s ability to access information and
services and empower them to defend their rights. Individuals need
to take responsibility for their own learning. This may entail formal or
informal education. Parents can model healthy behaviours to help
their children to develop health skills.
Individuals should maintain awareness of how they can conserve
the environment and make it safe, including the home and the
natural resources.
Developing personal skills (DPS)

Communities should be conscious of local needs, supporting the
development of skills such as advocacy, communication and
planning by providing courses and opportunities to their residents.

State governments should take the most responsibility for
developing personal skills. Departments of Education and health
promotion campaigns are typically managed at this level. Deciding
what information is essential and how it should be communicated is
a major responsibility of government.
Building healthy public policy (BHPP)

This can acknowledge diversity and lead to the creation of
supportive environments. Individuals may not feel involved in the
development of policy, but involvement in the political process and
being active in community events that support a health cause or
promote population health can be influential.

Communities need to be politically active by engaging in health
promotion action. Organising events and mobilising local agencies is
a vital responsibility for community groups with an interest in
population health.
Building healthy public policy (BHPP)

Governments are responsible for producing and enacting policy.

Of all the responsibilities involved, it is most important that
governments listen to the public to ensure that the policies they
develop meet public needs and expectations. Providing the
opportunity to participate in policy development is essential. It is also
important to enact policy in a way that it is financially and
environmentally sustainable.
Strengthening community action
(SCA)

This can raise awareness of people’s rights, promote equity and
facilitate participation by community members.

Individuals can participate actively in local health promoting events
and they can contact local representatives about health concerns.
Communities are the focus of this action area, but really need the
support of governments to develop partnerships that provide support
and funding.

Governments can support community action by seeking community
input and then empowering communities with direction, funding and
support to create their own health solutions.
Creating supportive environments
(CSE)

This increases access, encourages participation and can improve
living conditions. Individuals can act responsibly to protect and
enhance the quality of their homes, workplaces and natural
environments.

Most behaviour that supports the environment is only effective due
to the cumulative actions of many individuals.

Communities are the focus of healthy living. Leisure, work and
neighbourhood settings should be safe, stimulating and enjoyable.
Local communities, with the support of governments, are the primary
guardians of such health promoting environments.
Reorienting health services (RHS)

This improves access to health services and promotes equity by
supporting the disadvantaged. In this care of action there is a range
of responsibilities at different levels.

Individuals need to take responsibility for knowing what services are
available and developing the skills necessary to be able to access
those services.

Communities have a range of responsibilities.

These include supporting local service providers and findings ways
to attract people and services that best meet their needs.
Sometimes incentives and flexibility are required, especially in
remote or disadvantaged communities.
Reorienting health services (RHS)

Local businesses can benefit their communities by accommodating
or encouraging other related services. For example, a local health
service might be able to offer rental assistance for a pharmacist to
move in.

Governments take responsibility for regulation, but must ensure that
sufficient surveillance and evidence are available so that decisions
about health services can be well informed and justifiable. The
supply of health professionals, licensing of new services and
distribution of resources should be based on clear evidence.