PDHPE-HSC Online- Health Priorities in Australia

Health care in Australia Key Messages

##The Australian health care system is vital in maintaining and improving the health of all Australians. ##Government and non-government sectors work together to improve the provision of health care. Health care services are funded and provided by the public and private sectors. ##The health care system provides diagnosis, treatment, rehabilitation and health prevention and promotion campaigns. ##The Commonwealth's funding includes two national subsidy schemes - Medicare and the Pharmaceutical Benefits Scheme (PBS). ##Emerging new treatments and technologies can improve access to better health care and provide early detection for chronic disease, however, can be very costly. ##Medicare provides a base level of cover for all Australians. Individuals can choose to pay for private health insurance as well which increases cover for health care. ##Factors which impact on the health care system include a growing and ageing population, equity of access for certain population groups and high levels of preventative disease.

Cancer (skin, breast and lung) Key Messages

#Cancer refers to a large group of diseases characterised by uncontrolled growth and spread of abnormal body cells. ##The most common cancers in Australian females are breast cancer, melanoma of the skin, lung cancer and colorectal cancer. For males the most common cancers are prostate, colorectal, melanoma of the skin, and lung cancer. #Cancer is the second most common cause of morbidity and mortality. There has been a decreasing mortality trend despite the overall cancer incidence rate remaining virtually unchanged. #The major risk factors for cancer are specific to each type of cancer. Family history, smoking and exposure to UV rays play a large role in developing cancer. #Low socioeconomic status is a large determinant to the development of most forms of cancer as well as environmental factors. #The groups at risk for cancers are specific to each type of cancer.

'Efforts to control cancer involve primary prevention, early detection and therapy. The programs and tools for these activities vary with the type of cancer but mostly include a combination of all three'. Interpret what is meant by this statement giving examples.

(b) Primary prevention includes public health programs to reduce tobacco smoking, exposure to tobacco smoke and cancer-causing agents in the environment, and excessive exposure to ultra-violet radiation. Early detection improves survival and other outcomes. National screening programs for breast and cervical cancers in Australia have contributed to substantial declines in associated mortality during the last decade. The treatment of cancer includes surgery, radiotherapy, chemotherapy and counselling support services. Advances in each one of these areas are improving cancer outcomes.

1.Investigate volunteer organisations that are available to assist older people? For example Red Cross: Meals on wheels & Telecross (external website).

) Flexible Support Services Australia. (external website) New Hope. ACHA Program. (external website) Commonwealth Respite and Carelink Services (external website) Local Information Network for Community Services (external website) 2) Carers and volunteers play an important part in Australia's health care system, especially in rural areas. (Aged Care Australia, (external website)Australian Government Department of Health and Ageing

Identifying priority health issues

* Social justice principle * Priority population groups * Prevalence of condition * Potential for prevention and early intervention * Costs to the individual and the community.

Statistic: Diabetes

1 in 20 Australian adults (5%), about 917,000 people, had diabetes in 2011-12, based on self-reported and measured data 29,545 people started using insulin in 2013 to treat their diabetes. 900,000 hospitalisations—9% of all hospitalisations in 2013-14—where diabetes was the principal and/or additional diagnosis. 1 in 10 or 15,095 Australian deaths in 2012, recorded diabetes as an underlying or associated cause of death. 2 times as high diabetes death rates in the lowest socioeconomic group compared with the highest group

Availability of carers and volunteers

A carer is any person who provides assistance in a formal paid role or informal unpaid role to a person because of that person's age, illness or disability. The provision of unpaid care by family members is an important complement to formal services. Carers may be needed to assist with tasks of daily living, such as feeding, bathing, dressing, toileting, transferring or administering medications. On other circumstances, there may only be the need for assistance with transport, financial or emotional support. Older people living in households most commonly reported needing assistance with property maintenance and health care because of disability or age. Service providers that offer aged care in the community and through aged care homes include a mix of private and religious or charitable organisations, as well as state, territory and local government. The Australian Government has the major role in funding residential aged care services and aged care packages in the community. The bulk of home and community based services for older people are provided under the Home and Community care (HACC) program. The program includes home nursing services, delivered meals, home help and home maintenance services, transport and shopping assistance, allied health services, home and centre based respite care, and advice and assistance of various kinds.

The benefits of partnerships in health promotion, eg government sector, non-government agencies and the local community

A crucial feature of health promotion is the understanding that improving health is a shared responsibility. The success of the Ottawa Charter as a health promotion tool is increased if individuals, communities, government and non-government agencies work together in partnership toward achieving a common health goal. Integrated health promotion programs increase the chances of success of a program. It is important for individuals and communities to be included in the planning of all health promotion programs to ensure that their interests and needs are being addressed. This inclusiveness encourages participation which contributes to better health outcomes by empowering individuals and communities. Intersectoral action can be used to promote and achieve shared goals in a number of areas; for example policy, research, planning, practice and funding. It may be implemented through numerous activities, including advocacy, legislation, policy change, programs, community projects, consultative community meetings, surveys and the analysis of local health data. There is no doubt that intersectoral action for health works. One example of this is the National Mental Health Strategy which brings together federal government departments with state and territorial governments, community groups, professional associations and private sector organisations to develop an intersectoral response to addressing mental health issues.

What are the risk factors for breast cancer?

A risk factor is any factor that is associated with an increased chance of developing a particular health condition, such as breast cancer. There are different types of risk factors, some of which can be modified and some which cannot. It should be noted that having one or more risk factors does not mean a person will develop breast cancer. Many people have at least one risk factor but will never develop breast cancer, while others with breast cancer may have had no known risk factors. Even if a person with breast cancer has a risk factor, it is usually hard to know how much that risk factor contributed to the development of their disease. While the causes of breast cancer are not fully understood, there are a number of factors associated with the risk of developing the disease. Some of the risk factors for breast cancer include: • being a woman • increasing age • having a strong family history of breast cancer. • having a breast condition such as a personal history of breast cancer, DCIS or LCIS • a number of hormonal factors, child-bearing history, personal and lifestyle factors

What are the risk factors for melanoma?

A risk factor is any factor that is associated with an increased chance of developing a particular health condition, such as melanoma. There are different types of risk factors, some of which can be modified and some which cannot. It should be noted that having one or more risk factors does not mean a person will develop melanoma. Many people have at least one risk factor but will never develop melanoma, while others with melanoma may have had no known risk factors. Even if a person with melanoma has a risk factor, it is usually hard to know how much that risk factor contributed to the development of their disease. While the causes of melanoma are not fully understood, there are a number of factors associated with the risk of developing the disease. These factors include: •a history of melanoma or other skin cancer •having several large or many small moles (called naevae) on the skin (melanocytic naevi) •having a fair complexion, including light-coloured, blond or red, hair, light coloured eyes and/or fair skin that freckles easily •exposure to the sun and other sources of ultraviolet radiation such as sunbeds •a family history of melanoma

Variations among population groups STROKE

Aboriginal and Torres Strait Islander people were 1.7 times as likely to have had a stroke as non-Indigenous Australians. Further, hospitalisation rates for stroke among Indigenous Australians were twice as high as for other Australians and stroke death rates 1.5 times as high as for non-Indigenous Australians. People living in remote areas of Australia and in the lowest socioeconomic status (SES) groups also have a higher burden of stroke compared with people living in Major cities and in the highest SES groups.

Incidence and mortality: Non-Melanoma Cancer Skin Cancer

According to general practice and hospital data, non-melanoma skin cancer is the most commonly diagnosed cancer in Australia. There is no reporting of cases to cancer registries however, in 2008, an estimated 434,000 Australians were treated for non-melanoma skin cancers. In 2011 in Australia, there were 543 deaths from non-melanoma skin cancer.

Morbidity CANCER

According to the AIHW , in 2009 the risk for Australian males of being diagnosed with cancer before their 85th birthday was 1 in 2. The most common diagnoses were prostate (1 in 5 males), bowel (1 in 10), lung (1 in 13), and skin (1 in 14). The risk for Australian females of being diagnosed with cancer before their 85th birthday was 1 in 3. The most common diagnoses were breast (1 in 8 females), bowel (1 in 15), lung (1 in 22), and skin (1 in 23).

Growing and ageing population (points for consideration in your answer for the impact on the healthcare system)

Ageing of the Australian population will contribute to substantial pressure on government spending over the next 40 years. Around two-thirds of the projected increase in spending to 2049-50 is expected to be on health, reflecting pressures from ageing, along with increasing demand for health services and funding of new technologies. Growth in spending on age-related pensions and aged care also is significant, reflecting population ageing. Inevitably, the ageing of our population will lead to increased demand for care and support services for the elderly - both in the community and in residential care. This increasing demand means that under current policy settings, government expenditure on aged care could rise from the current 3% of total Australian Government revenues, to 9% by 2050. At the same time, there is expected to be fewer tax payers to fund care.

Why is the gathering of epidemiological information so important in improving the health of all Australians?*

Along with limited resources, the challenge to improve health for all Australians requires choices, priority setting and trade-offs between the health sector and other sectors. Significant decisions between focusing on prevention and treatment of chronic conditions and between improving health overall and reducing inequalities have implications for Australian health care services. Improving Australia's health can lead to improved education and employment which, in turn, can result in economic and social prosperity. Epidemiology provides a good starting point for discussion to improve health status for all Australians. It can identify key indicators of illness and hard evidence about various health conditions. It can provide indicators of key groups at risk and trends in the prevalence of diseases. It can provide good information on death rates and changes over time. Such information is valuable in identifying priority health issues to ensure the appropriate allocation of funds and resources to improve the health for all Australians.

life expectancy

An indication of how long a person can expect to live, depending on the age they have already reached. Technically, it is the number of years of life remaining to a person at a particular age if death rates do not change. The most commonly used measure is life expectancy at birth.

Prognosis: Melanoma Skin Cancer

An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. Five year survival for people diagnosed with melanoma is 91%, rising to 99% if the melanoma is detected before it has spread. If spread is within the region of the primary melanoma, the five year survival is 65%, dropping to 15% if the disease is widespread. For more information, contact Cancer Council 13 11 20 (cost of a local call). 1) Excluding non-melanoma skin cancer, which is the most commonly diagnosed cancer according to general practice and hospitals data, however there is no reporting of cases to cancer registries

Prognosis: Non-Melanoma Cancer Skin Cancer

An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. The majority of non-melanoma skin cancers are successfully treated

Prevalence of condition

Analysing statistics allows us to interpret the prevalence of a condition or disease. Prevalence means how common a condition is in the community. Morbidity statistics are reliable indicators of the prevalence of a condition. They can often highlight points of difference for the same condition, e.g. the mortality (death) rate for a disease/condition may be low but the morbidity rate quite high. Governments can then look at the reasons why (e.g. improved technology for detection and treatment) and further allocate resources. Hospital admissions and health surveys are two examples of how statistics are accumulated to give us a picture of the health status of a population

According the syllabus Groups experiencing health inequities

As part of the syllabus requirements, you are required to research and analyse Aboriginal and Torres Strait Islanders peoples and ONE other group experiencing health inequities (either: socioeconomically disadvantaged people, people in rural and remote areas, overseas-born people, the elderly, people with disabilities). To determine why these groups have been selected as experiencing health inequities, it is important to investigate each group in terms of: •the nature and extent of the health inequities •the sociocultural, socioeconomic and environmental determinants •the roles of individuals, communities and governments in addressing the health inequities

According to the syllabus which which conditions to you have to know? High levels of preventable and chronic disease, injury and mental health problems

As part of the syllabus requirements, you are required to research and analyse cardiovascular disease, cancer (skin, breast, and lung) and ONE other condition (either: diabetes, respiratory disease, injury or mental health problems and illnesses). To determine why these health conditions have been selected as priority issues, it is important to research and analyse each priority area in terms of: •the nature of the problem •the extent of the problem (trends) •risk factors and protective factors •the sociocultural, socioeconomic and environmental determinants •groups at risk

Range and types of health facilities and services

Australia has a complex and diverse range of health facilities and services. The Australian health system produces some of the best health outcomes for individuals compared to the rest of the world. Medical practitioners, nurses, other health professionals, hospitals, clinics, government and non-government agencies provide health services. We can classify the range of facilities and services into broad categories, e.g. public health services, primary care and community health care services, hospitals, specialised health services and goods. There is acknowledgement that some facilities and services may fit into more than one category. The first point of call for a person is usually their General Practitioner (also known as GP or doctor). GP's are in the primary care and community health care service category. There is growing concern about the Australian health care system's ability to cope with increasing demands. Some reasons for this include; lower numbers of people studying to be health professionals (e.g. nurses), the effects of an ageing population on the capabilities of the system, the high cost of health care and a lack of access for specific groups to some facilities and services.

Causes Skin Cancer

Australia has one of the highest rates of skin cancer in the world. Anyone can be at risk of developing skin cancer, though the risk increases as you get older. The majority of skin cancers in Australia are caused by exposure to UV radiation in sunlight. Sunburn •Sunburn causes 95% of melanomas, the most deadly form of skin cancer. •In Australia, almost 14% of adults, 24% of teenagers and 8% of children are sunburnt on an average summer weekend. Many people get sunburnt when they are taking part in water sports and activities at the beach or a pool, as well gardening or having a barbeque. •Sunburn is also common on cooler or overcast days as many people mistakenly believe UV radiation is not as strong. This is untrue - you can still be sunburnt when the temperature is cool. •Sun exposure that doesn't result in burning can still cause damage to skin cells and increase your risk of developing skin cancer. Evidence suggests that regular exposure to UV radiation year after year can also lead to skin cancer. Tanning •A tan is not a sign of good health or wellbeing, despite many Australians referring to a 'healthy tan'. Almost half of Australian adults still hold the misguided belief that a tan looks healthy. •Tanning is a sign that you have been exposed to enough UV radiation (from the sun or solarium) to damage your skin. This will eventually cause loss of elasticity (wrinkles), sagging, yellowish discolouration and even brown patches to appear on your skin. Worst of all, it increases your risk of skin cancer. •A tan will offer limited protection from sunburn, but usually no more than SPF4, depending on your skin type. It does not protect from DNA damage, which can lead to skin cancer. •Some people who use fake tans mistakenly believe that a tan will provide them with protection against UV radiation. As a result, they may not take sun protection measures, putting them at greater risk of skin cancer. More information about fake tans is available in Cancer Council's position statement on fake tans. Solariums •Solariums emit UVA and UVB radiation, both known causes of cancer. Cancer Council Australia does not recommend solarium use for cosmetic tanning under any circumstances.

Overseas-born people

Australia has one of the largest proportions of immigrant populations in the world, with an estimated 25% of the total population (5.5 million people) born overseas. Well over half of these were born in a non-English-speaking country. Migrants bring to Australia their own unique health profiles. Research has found that most migrants enjoy health that is at least as good as, if not better than, that of the Australian-born population. Immigrant populations often have lower death and hospitalisation rates, as well as lower rates of disability and lifestyle-related risk factors. Australian Institute of Health and Welfare: Singh & de Looper, 2002 This healthy migrant effect is believed to result from two main factors: •a self-selection process which includes people who are willing and economically able to migrate and excludes those who are sick or disabled •a government selection process which involves certain eligibility criteria based on health, education, language and job skills. There is evidence that the healthy migrant effect decreases the longer they live in Australia, i.e. the longer they live in Australia, the closer they align to health patterns of the whole population. Despite these advantages, certain health risk factors and diseases are more common among some country-of-birth groups in Australia, reflecting diverse socioeconomic, cultural and genetic influences such as: •significant psychological distress, especially related to war and conflict and/or the disruption of moving and leaving friends and family, has been observed among some migrant groups •people from non-English speaking backgrounds are less likely to report medical conditions they may be experiencing, may have difficulty access health services due to language barriers, less likely to immunise their children, less likely to exercise and more likely to be slightly overweight.

How are priority issues for Australia's health identified?

Australia is one of the healthiest countries in the world; however, Australia's population still experiences a range of health problems. The challenge for the Australian government is to allocate a limited amount of resources to address these health problems. This means that priorities need to be established. The Australian government has chosen to use a framework of priority health issues to achieve this. Epidemiology plays an important role, however issues such as social justice, potential for prevention and costs are also important.

A growing and ageing population Key Messages

Australia's population is growing and ageing. The ageing population is the consequence of sustained low fertility levels and increasing life expectancy at birth. ##With our ageing population, comes a number of health challenges to our community. An increase in people living with chronic diseases and disabilities, places a higher demand for health services and workforce shortages as well as the financial strain to provide these services. ##Government priority is to encourage healthy ageing so as to enable people to contribute for as long as possible and to reduce the burden on our health care system. ##It is projected that there will be little growth in the number of available carers, compared with the anticipated rise in demand for home-based support. This is likely to result in a shortage of carers in the future.

A growing and ageing population

Australia's population is projected to grow from around 22 million people currently to 35.9 million people in 2050. The ageing of the population will see the number of people aged 65 to 84 years more than double and the number of people 85 years and over more than quadruple. As a consequence, the proportion of the population of traditional working age and therefore the rate of labour force participation across the whole population is projected to decline. Australia's population is projected to grow from around 22 million people currently to 35.9 million people in 2050.The number of people of working age to support every person aged 65 years and over is projected to decline to 2.7 people by 2050 (compared with 5 people now). A direct consequence of declining death rates is that Australians in general enjoy one of the highest life expectancies in the world. Life expectancy at age 65 years increased only slightly between 1900 and 1970, but from 1970 on it has consistently improved. Improvements in life expectancy for persons aged 85 years have also occurred since the 1970s. Most of these gains in life expectancy among older Australians occurred during the latter three decades of the 20th century, when mortality from cardiovascular diseases (notably heart disease and stroke) fell rapidly.

People in rural and remote areas

Australia's rural and remote regions reflect the variety of Australian life. Despite this variation and the perceived health advantages of living in rural areas (clean air, less traffic, more relaxed lifestyle), those who live in rural and remote areas generally have poorer health than their major city counterparts, reflected in higher levels of mortality, disease and health risk factors. There is evidence to suggest medical services in rural and remote Australia are not as accessible as in metropolitan areas and people in these areas are exposed to different health risks. In contrast, rural Australians generally have higher levels of social cohesiveness, for example, higher rates of participation in volunteer work and feelings of safety in their community Defining 'rural and remote' is challenging because of the diversity of these areas. In summary, it usually reflects all those areas outside major cities. Indigenous Australians are important in any discussion about the health of people living in rural and remote areas. Although they make up 2.5% of the total Australian population, Aboriginal and Torres Strait Islander peoples constitute 24% of the population in remote or very remote areas. The poor health status of the Indigenous population form a significant part of the health statistics of some rural and remote areas.

Prevention : Melanoma Skin Cancer

Avoid sunburn by minimising sun exposure when the SunSmart UV Alert exceeds 3 and especially in the middle of the day when UV levels are most intense. Seek shade, wear a hat that covers the head, neck and ears, wear sun protective clothing and close-fitting sunglasses, and wear an SPF30+ sunscreen. Avoid using solariums (tanning salons).

Prevention: Non-Melanoma Cancer Skin Cancer

Avoid sunburn by minimising sun exposure when the SunSmart UV Alert exceeds 3 and especially in the middle of the day when UV levels are most intense. Seek shade, wear a hat that covers the head, neck and ears, wear sun protective clothing and close-fitting sunglasses, and wear an SPF30+ sunscreen. Avoid using solariums (tanning salons).

Breast cancer

Breast cancer occurs when abnormal cells in the breast grow in an uncontrolled way Breasts are made up of lobules and ducts surrounded by fatty and connective tissue. Lobules produce breast milk and ducts carry milk to the nipple

Ottawa charter

Build Healthy Public Policy Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health. Create Supportive Environments Our societies are complex and interrelated. The overall guiding principle for the world, nations, regions and communities alike, is the need to encourage reciprocal maintenance - to take care of each other, our communities and our natural environment. Strengthen Community Actions Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities - their ownership and control of their own endeavours and destinies. Develop Personal Skills Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Reorient Health Services The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments. They must work together towards a health care system which contributes to the pursuit of health.

What are the priority issues for improving Australia's health?

By measuring health status and identifying the priority health issues for improving Australia's health, the Australian government has identified the following priority issues for improving Australia's health.

Cardiovascular disease (CVD) Key Messages

CVD is a term used to describe all conditions that affect the heart and blood vessels. ##The underlying cause of CVD is atherosclerosis. ##CVD continues to be one of the biggest health problems affecting Australian's. ##CVD remains the leading cause of death for Australians, however there is a decreasing mortality trend and morbidity trend. ##CVD is highly preventable. The major modifiable risk factors are lifestyle related such as tobacco smoking, high blood cholesterol, insufficient physical activity and poor nutrition. ##The groups at highest risk of developing CVD are Aboriginal and Torres Strait Islanders peoples, socio-economically disadvantaged people, the elderly and those born in Australia.

How has this changed since 1990? CVD

Cancer (ranked 2 in 1990) and musculoskeletal conditions (ranked 3 in 1990) replaced cardiovascular diseases as the leading contributors to the Australasian total disease burden in 2010.

Support Services Lung Cancer

Cancer Council 13 11 20 Information and Support is a confidential service where you can speak to a specialist cancer professional about anything to do with cancer, including: •emotional support if you or someone you care about has cancer •how to prevent cancer •questions about early detection •cancer diagnosis •how to cope with treatment and its side effects •practical support that is available to anyone affected by cancer •end of life issues.

Cancer (skin, breast and lung) The nature of the problem

Cancer is a disease of the body's cells. Normally, cells grow and reproduce in an orderly manner. Sometimes, though, abnormal cells will grow and be defective. These abnormal cells may then reproduce, sometimes at a very rapid rate, and spread (metastasise (external website) ) uncontrolled throughout the body. Cancer is the term used to describe about 100 different diseases including malignant tumours, leukaemia, Hodgkin's disease and non-Hodgkin's lymphoma Tumours are swellings or enlargement caused by a clump of abnormal cells. They can form and remain localised with no threat of spreading and are known as benign tumours. These can be treated surgically. However, if the tumour has the potential to spread uncontrolled throughout the surrounding normal cells and affect their functioning, it is known as a malignant tumour. These malignant cancer cells can often break off and enter the blood stream and lymphatic system and travel to other parts of the body, where they can cause new cancers to grow.

Mortality CANCER

Cancer is a major cause of death, accounting for about 3 of every 10 deaths registered in Australia in 2010. Over the last decade, improvements in early detection and treatment have resulted in improved survival and a clear decline in mortality for most cancers, despite the overall cancer incidence rate remaining virtually unchanged. This is due to the growing and ageing population as those aged over 65 years have the highest incidence and mortality for cancer.

Projected most common cancers diagnosed in 2015

Cancer type New cases 2015 % of all new cancers 2015 Prostate 17,250 24.7 (among males) Bowel 17,070 13.5 Breast 15,740 12.4 Melanoma 12,960 10.2 Lung 11,880 9.4

Cardiovascular disease (CVD) The nature of the problem

Cardiovascular disease (CVD) is a term used to describe all health conditions that affect the heart (cardio) and blood vessels (vascular system). The definition of 'cardiovascular diseases' differs between organisations. The terms cardiovascular disease, circulatory disease and heart, stroke and vascular diseases are often used interchangeably to convey the same meaning. Cardiovascular disease includes: •coronary heart disease (CHD) •cerebrovascular disease (stroke) •peripheral vascular disease.

Extent of the problem (trends): CVD

Cardiovascular disease has a major impact on the health status of Australians. It remains the leading cause of death for Australians and is a major cause of morbidity. Morbidity The cardiovascular disease burden increases markedly with age. Mortality Despite declines in mortality rates in the last 30 years, cardiovascular disease remains one of the leading causes of death in Australia.

Risk factors and protective factors CVD

Cardiovascular disease is highly preventable. The factors that increase a person's chance of getting cardiovascular disease are called risk factors. These risk factors can be modifiable or non-modifiable.

Stroke

Cerebrovascular disease (notably stroke) is the second most common underlying cause of death in Australia, accounting for 8% of all deaths in 2011. It is the third most common underlying cause of death for men and the second most common cause for women. It is also the second most common cause of cardiovascular disease death, after CHD. Stroke deaths increase greatly with age, with 82% of deaths occurring in people aged 75 or over in 2011. Stroke deaths have been falling for decades, with the stroke death rate falling by 67% between 1981 and 2011. Cardiovascular disease (which includes heart attack, angina, stroke and peripheral vascular disease) is the single most common group of diseases causing death in Australia

Cerebrovascular disease

Cerebrovascular disease refers to any disorder of the blood vessels supplying the brain. Most cases of cerebrovascular death are due to stroke. A stroke occurs when a blood vessel to the brain is suddenly blocked or bleeds. This may result in part of the brain dying because of the lack of blood, leading to a loss of brain function or impairment in a range of activities including movement, thinking and communication

How to make informed consumer choices

Complementary and alternative health care approaches have come under much scrutiny over recent years. In the past, complementary and alternative health care approaches were passed through generations of culture, often taking years to master. After becoming more popular in western culture, many remedies and therapists started appearing all over the place with no real qualifications or experience in delivery. Some actually compromised conventional medicine and interfered with treatment for serious conditions. Others have claimed impossible success or cures for incurable diseases which had serious implications for some people's ability to survive without conventional forms of medicine and treatment. This has led to the development of regulatory authorities and professional associations to ensure qualifications were obtained and regularly updated by providers and claims for success were substantiated. As these treatments move into an evidence based approach to health, more people will have the skills to research and understand who to believe. They will be able to make informed decisions about complementary and alternative health care approaches.

Complementary and alternative health care approaches

Complementary and alternative health care approaches have grown in popularity across the world. Australia tends to refer to them as complementary and alternative health care approaches. Traditional, natural or holistic health care are other terms that are used internationally. The Australian Government's Health Insite website's explanation of complementary and alternative health care approaches provides a good overview. Complementary therapies complement conventional medical treatment, while alternative therapies are those which offer alternatives to conventional diagnosis and therapies. Complementary medicine used together with conventional medicine is known as integrative medicine.

Complementary and alternative health care approaches: Key Messages

Complementary and alternative health care approaches have rapidly grown in popularity. ##The reasons for growth of complementary and alternative health care approaches are due to increased demand from consumers and recognition by governments of the benefits and cost subsidies through private health insurance. ##There is a diverse range of products and services that offer prevention and management for specific conditions and maintenance of health. ##Regulatory authorities and professional associations have been put in place to ensure the credibility of complementary and alternative health care approaches. ##There are still many skeptics of complementary and alternative health care approaches due to limited evidence of their success. ##Some complementary and alternative health care approaches can interfere with conventional medical management and treatment. It is important to inform medical practitioners if you are using other treatments. ##Individuals need the knowledge and skills to make informed decisions regarding their health and the use of complementary and alternative health care approaches.

Coronary heart disease

Coronary heart disease (CHD) (also known as ischaemic heart disease) was the leading underlying cause of death for both males and females in Australia in 2011, accounting for 15% of all deaths. Three-quarters of these were deaths in people aged 75 and over, and just 5% were deaths of people under the age of 55. CHD deaths (principally heart attacks and angina) have been trending downwards since the late 1960s, but for the 35-54 age group the falls decelerated from 6% a year between 1987 and 1998 to 3% a year between 1999 and 2011. For older age groups the falls accelerated in the second period compared with the first.

Coronary Heart Disease

Coronary heart disease (CHD) occurs when there is a blockage in the blood vessels that supply blood to the heart muscle. There are 2 major clinical forms of CHD: heart attack—an acute life-threatening event where the blood vessel is completely blocked, requiring prompt treatment; and angina—a chronic condition where there is a temporary deficiency in the blood supply. Although angina is less severe than a heart attack, people with the condition are at increased risk of heart attack or sudden cardiac death (see Glossary). CHD kills more people in Australia than any other disease. However, it is largely preventable, as many of its risk factors are modifiable, including: tobacco smoking, high blood pressure, high blood cholesterol, physical inactivity, poor nutrition and obesity

Coronary heart disease (CHD)

Coronary heart disease (CHD) or ischaemic heart disease is the most common type of cardiovascular disease. The two major forms of coronary heart disease are heart attack and angina. A heart attack is a life-threatening event that occurs when a blood vessel supplying the heart itself becomes suddenly blocked. This restricts blood flow to the muscles of the heart. It can cause severe damage the heart and its functions which can result in the loss of life (AIHW, Cardiovascular Health). Angina is a chronic condition which involves episodes of chest pain that occur periodically when the heart has a temporary deficiency in its blood supply. An individual experiences angina when one of the heart's arteries becomes significantly narrowed through the process of atherosclerosis and cannot meet an extra demand for blood flow, such as with strenuous exercise.

Life course risk factors CVD

Coronary heart disease and COPD are leading examples of strong links between several life course risk factors and processes and the later development of chronic disease (see Table 4.2). Many of these risk factors can interact with each other as well as with chronic disease development. For example, in-utero biological effects, combined with poor nutrition early in life, may affect how particular forms of fat are tolerated later in life. Early social disadvantage may interact with affluence in later life to increase coronary heart disease risk. Cholesterol, blood pressure and overweight measures at young ages often persist into adulthood, and can predict the later occurrence of coronary heart disease.

The sociocultural, socioeconomic and environmental determinants CANCER

Cultural background is a factor in cancer rates, as seen by, high rates of lung cancer amongst Aboriginal and Torres Strait Islander peoples. In the demographic mix, cancer incidence and mortality is highest in the 65 years and over age group, so the prospect of an aging population is cause for concern for future cancer trends. Prevailing values and attitudes also have an effect, particularly, in regards to modifiable risk factor behaviours. Education, employment status and occupation, and income and wealth are reflected in cancer data, which shows that people from socioeconomically disadvantaged backgrounds have notably higher rates of some cancers. Environment can often play a large role in the risk of developing cancer. This includes workplace influences, climate and UV exposure as well as exposure to tobacco smoke.

Additional Information STROKE

Currently, there are no comprehensive national data on the incidence of stroke (new cases) or treatment and care responses such as the time elapsed between the onset of stroke symptoms and emergency response, and the presentation to hospital. Nor are there national data on the uptake of best practice clinical guidelines or on medications given in acute care or at discharge

Additional Information: Diabetes

Currently, there is no national data collection on new cases of diagnosed type 2 diabetes each year. Symptoms are often absent in the early stages of diabetes, so people can go undiagnosed for a long time. In addition, there can be problems with misdiagnosis and misreporting of diabetes type. There is a lack of good information on diabetes in Aboriginal and Torres Strait Islander people and people from different ethnic backgrounds. Further monitoring and surveillance of diabetes is crucial for guiding preventive measures, determining clinical care and informing health policy and service planning.

mortality

Death

Diabetes death rates as underlying and/or associated cause, by age and sex, 2012

Deaths per 100,000 popualtion Age group (years) Males Females Persons <55 4 3 4 55-64 59 32 45 65-74 202 104 152 75-84 632 405 508 85+ 1,573 1,141 1,292

Trends in diabetes death rates as underlying cause, by sex, 1981-2012

Deaths per 100,000 population (a) Year Males Females Persons 1981 17 15 16 1982 17 13 15 1983 17 13 15 1984 19 14 16 1985 18 15 16 1986 18 14 16 1987 19 14 16 1988 17 14 15 1989 18 14 16 1990 18 14 16 1991 19 14 16 1992 19 15 16 1993 20 14 17 1994 21 15 18 1995 20 14 17 1996 22 15 18 1997 22 15 18 1998 20 14 16 1999 20 14 16 2000 21 13 16 2001 20 13 16 2002 21 13 17 2003 21 13 17 2004 22 14 17 2005 20 14 16 2006 20 14 17 2007 20 14 17 2008 22 15 18 2009 21 15 17 2010 19 13 16 2011 20 13 16 2012 19 13 16 (a) Age-standardised to the 2001 Australian population

Trends in diabetes death rates as underlying and/or associated cause, by sex, 1997-2012

Deaths per 100,000 population (a) Year Males Females Persons 1997 71 45 56 1998 69 43 54 1999 67 42 53 2000 69 43 54 2001 70 42 54 2002 75 45 58 2003 71 45 56 2004 72 45 57 2005 70 44 55 2006 73 47 58 2007 73 46 58 2008 78 49 62 2009 75 47 59 2010 73 46 58 2011 75 46 59 2012 72 45 57 (a) Age-standardised to the 2001 Australian population

Explain how the following factors impact on people's access to health facilities and services:

Decreasing supply of skilled health workers (e.g. doctors and nurses). The supply of qualified doctors, dentists, nurses and allied health professionals is not keeping pace with demand. Reasons for this include: fewer students commencing and completing undergraduate health courses compared to corresponding increase in demand; an ageing health workforce with an increasing proportion of clinicians reaching retirement, and health services having to compete for workers in a tightening general labour market; changing expectations of work including a desire for more flexible working hours and shorter working weeks. Provider shortages are also highlighted by the increased demand for health services associated with our rising standard of living and technological advances. The growing shortfall in health providers, and their greater concentration in larger population centres, is placing increasing pressure on existing staff and services, particularly in outer metropolitan, rural and remote areas. This in turn is affecting the availability of some health services. ◦The geographical size and nature of Australia. It is impossible to have a health facility or service in every town in Australia. More services are needed for population dense areas, stretching funding for health services in regional and rural areas. The health-care services provided in rural and remote areas can be influenced by factors such as larger geographic areas, smaller populations, fewer general and specialist medical professionals per population, and fewer services. Those who live in rural and remote areas generally have poorer health than their major city counterparts, reflected in their higher levels of mortality, disease and health risk factors. Mobile services such as Breastscreen Australia has allowed for increased access to services in regional and rural locations. Distance can be a major barrier for people needing health care. Time could be critical in emergency situations, resulting in delayed treatment and complications or fatalities for people in rural and isolated locations. ◦Long waiting lists for elective surgery for public hospital patients. Increased demand for elective surgery impacts more on people from low socio-economic status who cannot afford private health insurance. This has led to a greater reliance on the public health care system, resulting in longer waiting times. ◦Socio economic status (SES) Income has a significant impact on health, both at the level of individuals and societies. High incomes increase access to goods and services beneficial to health, such as health care, better food and housing, and preventive health measures. Those with the highest socioeconomic status are those who have the most resources, opportunities and power to make choices, whereas those with the lowest status have the least of these. People with a higher income generally enjoy better health and longer lives than people with a lower income (Marmot et al. 1984). The rich tend to be healthier than those in the middle, who are, in turn, healthier than the poor. ◦Cultural background Indigenous Australians experience significantly more ill health than other Australians, reflected in lower life expectancy higher rates of disability and reduced quality of life because of ill health. Data from a number of sources indicate that across a range of socioeconomic and health related indicators the Indigenous population is disadvantaged. Evidence suggests that gaps in access to primary health care and specialist services persist. For geographic, social and cultural reasons, mainstream services are not always accessible to, or are the most appropriate provider of health care for, Indigenous Australians. Australian governments recognise this and, given the relatively poor health status of Aboriginal and Torres Strait Islander peoples, provide specific health-care services to meet their needs. People from other cultural backgrounds may experience difficulty in accessing health facilities and services due to a number of reasons such as cultural beliefs about medical treatment or language difficulty due to English being their second language. For example, their willingness to seek more western medical solutions that are not part of their cultural beliefs may influence whether or not they seek help in the first place or their ability to understand the messages in English about early detection and obtain regular medical check-ups may limit their ability to access a medical professional. ◦A growing and ageing population Older people as a population group experience lower levels of income, higher rates or morbidity and disability resulting in greater reliance on the public health system, PBS and Medicare. Hospitalisation of older people generally results in longer stays therefore increasing costs, reducing the beds available for others and increasing waiting times for surgery, including elective surgeries. The government will need to provide access to high quality health and aged care facilities and services for the growing and ageing population. The rate of increase in the population, combined with inflating costs of new technologies and treatments will greatly increase Commonwealth and State health expenditure.

Diabetes: The nature of the problem

Diabetes (also called diabetes mellitus) is a hereditary or developmental disease caused by the improper functioning of the pancreas which secretes a hormone, insulin. This results in a disturbance in the sugar levels (glucose concentration) of the blood. There are three types of diabetes: •Type 1 diabetes (insulin-dependent diabetes) •Type 2 diabetes (non-insulin dependent diabetes) •Gestational diabetes is a temporary form of diabetes that occurs during pregnancy.

Deaths from diabetes

Diabetes contributed to 10% of all deaths in 2012, that is 15,095 deaths, according the AIHW National Mortality Database. In around 4,239 deaths diabetes was the underlying cause of death (28% of diabetes deaths) and in a further 10,856 it was an associated cause of death (72% of diabetes deaths). Diabetes is far more likely to be listed as an associated cause of death. This is because it is often not diabetes itself that leads directly to death but one of its complications that will be listed as the underlying cause of death on the death certificate. When diabetes is an associated cause of death, the conditions most commonly listed as underlying cause of death were coronary heart disease, cancer and stroke. Where diabetes was listed as an underlying or associated cause of death: •6% were due to type 1 diabetes (958 deaths) •50% were due to type 2 diabetes (7,474 deaths) •44% were due to unspecified diabetes (6,663 deaths)

Deaths from diabetes; Inequalities

Diabetes death rates increase with remoteness and socioeconomic disadvantage (Figure 3). In 2010-12, the diabetes death rate (as an underlying or associated cause) was: •twice as high in Remote and very remote areas compared with Major cities (108 compared with 53 per 100,000 population). The gap was greater for females than males―2.4 times as high in Remote and very remote areas as Major cities for females (100 compared with 42 per 100,000 population), and 1.7 times as high for males (116 compared with 68 per 100,000 population). •twice as high in the lowest socioeconomic group compared with the highest group—for males 96 compared with 48 per 100,000 population and for females 64 compared with 29 per 100,000

Diabetes

Diabetes is a chronic condition marked by high levels of glucose in the blood. It is caused either by the inability to produce insulin (a hormone produced by the pancreas to control blood glucose levels), or by the body not being able to use insulin effectively, or both. The main types of diabetes are: type 1 diabetes—a lifelong autoimmune disease that usually has onset in childhood but can be diagnosed at any age; type 2 diabetes—usually associated with lifestyle factors and largely preventable; and gestational diabetes—when higher-than-normal blood glucose is diagnosed in pregnancy Diabetes may progress to a range of health complications, including heart disease, kidney disease, blindness and lower limb amputation. For example, diabetes was the leading cause and accounted for 1 in 3 new cases of end-stage kidney disease requiring dialysis or transplantation, in 2011 While type 1 diabetes is believed to be caused by an interaction of genetic predisposition and environmental factors, type 2 diabetes is largely preventable by maintaining a healthy lifestyle. Modifiable risk factors for type 2 diabetes include physical inactivity, unhealthy diet, obesity, tobacco smoking, high blood pressure and high blood lipids

Diabetes: Key Messages

Diabetes is a disease caused by an imbalance in the secretion of insulin resulting in a disturbance in the sugar levels of the blood. ##There are three types of diabetes - type 1, type 2 and gestational. Type 2 is the most common. ##Incidence and prevalence of diabetes in increasing. Mortality rates are relatively unchanged. ##The risk factors for diabetes differ by type of diabetes. Age, family history and poor lifestyle choices such as poor diet and physical inactivity are the main risk factors. ##The main determinants for type 2 diabetes are linked to social factors, such as socio-economic status as well as cultural backgrounds, such as Aboriginal and Torres Strait Islander peoples. ##The groups at risk for diabetes are specific to each type of diabetes. Type 1 diabetes is primarily those who have a family history of the condition and type 2 also includes many poor lifestyle choices.

Diabetes

Diabetes mellitus is a major problem that significantly affects the health of Australians.

How is breast cancer diagnosed?

Diagnosis of breast cancer involves the triple test. This includes: • a clinical breast examination • imaging tests - which may include a mammogram or ultrasound • taking a sample of tissue (biopsy) from the breast for examination under a microscope. Other tests, such as blood tests or bone scans, may be done if symptoms suggest that breast cancer has spread outside the breast.Magnetic resonance imaging (MRI) may be suggested to assess extent of disease in some cases.

People with disabilities

Diseases and injuries can often impair how a person functions for a while, but many people do recover fully. For some people the effect can be long term because there is residual damage or the health condition becomes chronic. Alternatively, a person may have permanent damage or loss of function from birth. In these cases, the resulting disability may bring special needs for assistance in the person's daily life. Many Australians live with long-term health conditions. Most of these conditions are not major causes of death, but they are common causes of disability and reduced quality of life. One in five Australians lives with some degree of disability. Disability can be defined in the following categories: •severe or profound core activity limitation—where the individual sometimes or always needs help with at least one core activity: self-care, communication or mobility •moderate or mild core activity limitation, or schooling or employment restriction— where the individual does not need assistance but has difficulty performing a core activity (moderate); or has no difficulty performing a core activity but uses aids or equipment because of disability (mild), or has restriction in schooling or employment participation only •no specific core activity limitation, or schooling or employment restriction—where the individual is identified by the ABS Short Disability Module as having disability but without having specific limitations or restrictions. The large majority of disabilities are of a physical nature, including arthritis, respiratory diseases, circulatory diseases and musculoskeletal disorders. Sensory disorders (such as diseases of the ear and eye) are also common, as are mental disorders. Rates of disease and comorbidity (having 2 or more conditions at the same time) increase with the severity of disability. People with disabilities often experience inequities due to the socioeconomic circumstances they experience. These include factors such as a lack of access to employment opportunities and the need for ongoing health care. People with disability also encounter more difficulty accessing health services, have lower life expectancy and experience poorer health across a range of areas. How people experience and cope with disability is greatly affected by the opportunities and services provided for them. For example, people needing wheelchair access need a variety of support including access to the wheelchair or other technical aids, accessibility to buildings and public transport can limit access to health services, job opportunities and support and policies that support employment

Measuring health status

Epidemiology is the study of the frequency and distribution of a disease within a population and the attempt to identify the cause(s) of that disease. Collecting, verifying and analysing data about the incidence of disease in a given population gives researchers, health department officials and governments, indicators of the existence of health problems in a community. Some of the health indicators used to describe the health status of a population include mortality (death) rates, morbidity (illness) rates, life expectancy, and infant mortality rates. These indicators can also provide patterns of disease in terms of age, gender, ethnicity, socioeconomic status and educational opportunity. This level of data allows public health authorities to manage, evaluate and plan for health services to prevent, control and treat diseases and health problems (Australasian Epidemiological Association). Epidemiological information is used by health professionals and by the government to develop policies and health promotion strategies that promote the health of individuals in the community.

Health care expenditure versus expenditure on early intervention and prevention

Expenditure on health care versus expenditure on early intervention has always been a matter of contention for governments. Where should the money be spent to reap the greatest health rewards for the Australian population? Consider the following example for cardiovascular disease. Many people are suffering from some form of cardiovascular disease and it can be life threatening if not caught early enough. Medical treatment is needed. This costs the government a considerable amount of money. On the other hand, there are many preventative measures that can be put in place to help prevent cardiovascular disease from occurring, e.g. regular physical activity and a healthy diet or intervene early so the impact on the health care system is reduced. Governments currently invest money on increasing individual and community capacity to partake in preventative measures to reduce the amount of people experiencing CVD. The difficulty is determining what proportion of money is spent on health care or treatment compared to early intervention and prevention. All levels of government spend an enormous amount on health for Australians. In 2011-12, health expenditure in Australia was estimated at $140.2 billion, compared with $82.9 billion in 2001-02 and $132.6 billion in 2010-11 (AIHW Australia's Health 2014 (external website)). Almost 70% of total health expenditure during 2011-12 was funded by governments, with the Australian Government contributing 42.4% and state and territory governments 27.3%. The remaining 30.3% ($42.4 billion) was paid for by patients (17%), private health insurers (8%) and accident compensation schemes (5%). Health care expenditure is expected to increase remarkably in the next 40 years. With our growing and ageing population and the increased demand for health care, expenditure is projected to be over $250 billion by the year 2050. A major concern for government is how the current health care system will be able to cope in the future. Explore the future projections of Australia's health expenditure on page 51 from the Intergenerational report 2010. (external website) In recent years, there has been pressure to continue increasing expenditure on early intervention and prevention of chronic disease and conditions. Although federal, state and territory governments have increased the amount of expenditure in this area; there is much debate in the professional arena about the need to increase expenditure even more. The issue is how to allocate funds when evidence shows that prevention can save enormous amounts of money in the long run, however, in the meantime people need treatment for existing conditions. Prevention does not always see immediate change. It is a longer process and therefore is often seen as greater risk of investment for current governments. Research plays an important role in health. It allows for breakthroughs in technology for early detection, prevention (such as genetic analysis) along with improved treatment and cures. The downside of research is that it is very costly. Determining what percentage of expenditure should be allocated to research is another major consideration for government.

A group of factory workers is concerned over the methods for storing poisonous chemicals. There are over 20 different types of chemicals that are poorly labelled.*

For Example: Employees have the right to a safe working environment. The company should ensure that all chemicals are well marked and regularly checked to ensure leakages don't occur. All employees should be trained in accident and emergency procedures in case of accidents.

Small rural communities are experiencing significant difficulty in employing doctors and nurses. The local residents are concerned about the impact on health services.*

For example: All citizens have the right to equal access to health care no matter where they live. Local and state government departments should be actively pursuing medical staff through advertising and offering incentive schemes to attract people to work in the area.

A local hospital notices that women from a non-English speaking background are not taking advantage of free breast screening programs in their community. Currently, all advertising about the program is in English.*

For example: All people have the right to have access to information and health services. Therefore, pamphlets should be provided in different languages or promotion of the breast screening program could take place over the local ethnic radio or in community newspapers.

A local high school does not have wheelchair access to the art classrooms that are upstairs. As a result, disabled students cannot participate in art classes.*

For example: All students have the right to equal access to resources in a school. The school can have building modifications done such as a special purpose lift to the art rooms or the art rooms moved to a ground floor location.

Identify the respective priority population groups that are represented in the section.*

For example: Indigenous Australians, individuals from low socioeconomic status, rural and remote (outside major cities), Australians born overseas.

A local bowling club is closing down. The members of the club are concerned that they are losing the only social outlet in their community.*

For example: People need adequate social outlets to enhance social interaction. The local council will need to consult with the members affected by the closure to establish alternate social functions.

A local primary school is situated on a busy main road. The school community have complained to the local council about road safety issues and noise pollution*

For example: Students need to go to school in a safe environment with minimal distractions from learning. The local council and state government departments could modify the traffic flow outside the school with speed bumps, traffic lights, etc. Noise reduction modifications can be made to the school buildings and surroundings to ensure that all students are given the opportunity to learn in a comfortable environment.

Cardiovascular; expenditure

For expenditure that can be allocated to individual disease groups, the group with the highest spending nationally in 2008-09 was 'Cardiovascular disease' ($7.7 billion, or 10.4% of total disease expenditure) Allocated health expenditure in Australia, by disease group and area of expenditure, 2008-09: Approximately for cardiovascular: Hospital admitted patient services 4500 ,million Out-of-hospital ,medical expenses 6,000 million Prescription pharmaceuticals 8,000 million

Outline the development of diabetes (how it occurs in the body) and describe the three types of diabetes. What are the effects of diabetes on the body?

For glucose to enter the cells and be used for energy, insulin must be available. Therefore diabetes occurs when the body does not make insulin (Type 1 diabetes) or when the insulin that is made is not working properly (Type 2 diabetes). There are three types of diabetes: •Type 1 diabetes (insulin - dependent diabetes) affects 10-15% of people with diabetes. It usually occurs in people under the age of 30, but can happen at any age. It is an autoimmune condition, meaning the body's immune system turns on its own tissue; in diabetes, it is the insulin producing cells that are destroyed. •Type 2 diabetes (Non-insulin dependent diabetes).The majority of people with diabetes have type 2 diabetes. This type of diabetes usually occurs in people over 30 years of age but it may occur in overweight teenagers and children with a family history of diabetes. Diabetes often runs in the family and can be triggered by aspects of lifestyle such as overweight and inactivity. Initially insulin is still produced by the pancreas, but is less effective than normal. This is called insulin resistance and is an inherited characteristic made worse by carrying extra body fat or being inactive. •Gestational diabetes is a temporary form of diabetes that occurs during pregnancy, when certain hormones stop insulin from working properly. It occurs in approximately 1 in 20 pregnant women, and is usually detected during a routine screening test, which is performed at 26-28 weeks of pregnancy. Over time, high blood glucose levels may damage blood vessels and nerves. These complications of diabetes can cause damage to eyes, nerves and kidneys and increase the risk of heart attack, stroke, impotence and foot problems. This damage can happen before an individual knows they have diabetes and the diabetes remains undetected for a long time.

Evaluate the effectiveness of using epidemiology to define the health status of a population *

For instance: Epidemiology plays a vital role in accurately assessing the health of a given population. The data generated from epidemiology allows public health officials to identify and monitor existing and emerging health issues that exist within a population. The identification of priority health issues enables governments to allocate sufficient funding to meet the specific health care needs of the community. The health information generated through epidemiology is fundamental in enabling the development of effective health promotion strategies that target health inequities and increase health for all Australians. Epidemiology however does have some limitations with regards to identifying the health status of a population. ◦The primary focus on identifying disease and physical ill health does not identify factors or areas where Australia's experience excellent health. ◦Epidemiology does not identify or explain how causal or contributing factors influence health statistics. ◦Chronic health conditions may take years to develop before presenting and therefore may be unidentifiable amongst populations. ◦Statistics gathered through epidemiology on the incidence of mental health often rely on individual reporting and therefore can be misleading. ◦It is difficult to measure the quality of social health indicators amongst a population.

1.Outline the range and types of health facilities and services provided in the Australian health care system.

General Practice: 2800: Molong Medical Practice Molong Health One General Practice 76 Prince Street Medical Anson Medical Centre Orange Skin Cancer Clinic Colour City Medical Practice The Professional Centre of Acupuncture & Medicine Apple City Family Medicine Medical Practice - Dr Ridge Dr Holmes & Dr Fuller Rooms Central West Skin Cancer Clinic Medical Practice - Dr Howe ORANGE DAY SURGERY CENTRE Dr Graham Blom - Psychiatry Orange Family Medical Practice The Wellness House Orange Orange Aboriginal Health Service - Murundhu dharaa Orange Aboriginal Medical Service Western NSW LHD Mental Health Information and Support Line Western NSW Local Health District Pharmacy: Molong Pharmacy North Orange Discount Drugs Hogan's Pharmacy Oze Pharmacy - Orange Peter Smith Chemmart Orange City Centre Amcal Pharmacy Blooms The Chemist - Orange McCarthy's Pharmacy Chemist Warehouse - Orange Bestbuy Pharmacy - Orange Emergency Department : Molong Health Service Orange Health Service Blayney District Hospital Canowindra Soldiers Memorial Hospital Bathurst Base Hospital Wellington Health Service Mudgee Health Service Parkes District Hospital Peak Hill Health Service Cowra District Hospital Hospital: Molong Health Service ORANGE DAY SURGERY CENTRE Dudley Private Hospital Orange Health Service Other services: Audiology General Dental Occupational Therapy Optometry Physiotherapy Podiatry Psychology

The elderly

Good health is a crucial factor for older Australians enabling them to enjoy a good quality of life, stay independent and participate fully in the community. Good health among older Australians helps to moderate demand for health and aged care services, which is important as Australia's population ages over coming decades. In response to population ageing, Australia has made the improvement of older people's health a national research priority. The evidence shows that today's older Australians are living longer and healthier lives than previous generations. In 1901, older people made up 4.0% of Australia's population. Between 1971 and 2011, the proportion of Australia's population aged 65 years and over increased to 14%. For those aged 85 years and over it more than tripled, from 0.5% to 1.8%. In 2011, women aged 65 years and over formed 15% of the total population of women, while older men constituted a smaller proportion of all men, 13%. It is estimated that these increasing trends will continue. Evidence also reveals that as people are living longer, there is more time spent living with a disability in the later years of their life. This makes them less mobile and they will need more access to health care. The 2011-12 Australian Health Survey (AHS) shows that, among older Australians living in households, the most common long-term health conditions (excluding short- and long-sightedness) are: •arthritis (affecting 49% of those aged 65 and over) •hypertensive disease (38%) •hearing loss (complete or partial) (35%) Just over 1 in 5 older people (22%) reported having heart, stroke and vascular diseases, 15% had diabetes, and 7% had cancer. Age-related vision problems that are likely to be disabling include cataracts (affecting 10% of those aged 65 and over), glaucoma (3%), macular degeneration (5%) and blindness (2%).

Healthy ageing

Good health not only helps older Australians to enjoy a good quality of life and to participate fully in the community, but also helps to reduce their demands for health and aged care services. This is important as Australia's population ages over coming decades. For this reason, improving older people's health is a national research priority in Australia (DIISR 2009). One area of special interest is the adoption of a healthy lifestyle at older ages. Health across the life stages because its benefits include preventing disease and functional decline, and promoting a longer life and a better quality of life (WHO 2002). Healthy ageing refers to activities and behaviours which aim to reduce the risk of illness and disease, and increase physical, emotional and mental health during the ageing process (Peak Performance HSC PDHPE. Buchanan et al. 2009. Macmillan Education Australia.). It is concerned with the quality of life, not just the years of life, enjoyed by an individual. Evidence shows that today's older Australians are living longer and, in several respects, healthier lives than previous generations. According to the 2007-08 National Health Survey, the majority of older Australians consider themselves to be in excellent, very good or good health, although the proportion of older females reporting fair or poor health increases with age. Thus, many older people have a positive view of their health even though older age may be generally associated with increasing levels of disability and illness.

Groups at risk Diabetes

Groups at risk of type 1 diabetes are primarily those who have a family history of the condition. Groups most at risk of type 2 diabetes include: •those over 55 years •those with a family history of adult- onset diabetes •people who are overweight •those with high intakes of saturated fat and refined sugar •people who frequently consume alcohol •those who engage in little or no exercise •people from an Aboriginal or Torres Strait Islander background, or from Pacific Island, the Indian subcontinent or a Chinese cultural background. •women who have had gestational diabetes, or have had polycystic diabetes.

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Health promotion based on the five action areas of the Ottawa Charter Key Messages

Health Promotion is a broad practice, which includes actions directed at strengthening skills and capabilities of individuals and changing social, environmental and economic conditions. ##Effective health promotion requires a multi-faceted approach and is not just the responsibility of the health sector. ##The public health approach acknowledges that effective health promotion requires intersectoral involvement. ##The Ottawa Charter is at the core of good health promotion. It promotes social justice, increases the likelihood of positive health outcomes and has proven to be very successful. ##The five action areas of the Ottawa Charter: build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills, and re-orient health services; have provided the framework for many successful health promotion initiatives

Build Healthy Public Policy

Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health. Health promotion policy combines diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change. It is coordinated action that leads to health, income and social policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments. Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice for policy makers as well.

How common is melanoma skin cancer?

In 2011, there were 11,570 new cases of melanoma skin cancer diagnosed in Australia (6,734 males and 4,835 females).a In 2015, it is estimated that 12,960 new cases of melanoma skin cancer will be diagnosed in Australia (7,640 males and 5,320 females).b In 2011, the age-standardised incidence rate was 48 cases per 100,000 persons (59 for males and 39 for females).d In 2015, it is estimated that that the age-standardised incidence rate will be 49 cases per 100,000 persons (60 for males and 39 for females). Melanoma skin cancer was the 4th most commonly diagnosed cancer in Australia in 2011. It is estimated that it will remain the 4th most commonly diagnosed cancer in 2015. In 2015, it is estimated that the risk of an individual being diagnosed with melanoma skin cancer by their 85th birthday will be 1 in 18 (1 in 14 males and 1 in 23 females). In 2015, it is expected the incidence of melanoma skin cancer will generally increase with age

Health promotion based on the five action areas of the Ottawa Charter

Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being. for Health Promotion to achieve ‘Health for All by the year 2000 and beyond'. This conference was primarily a response to growing expectations for a new public health movement around the world and has remained the core of good health promotion. The Ottawa Charter identifies three basic strategies for health promotion. These are advocacy for health to create the essential conditions for health; enabling all people toachieve their full health potential; and mediating between the different interests in society inthe pursuit of health. These strategies are supported by five priority action areas •build healthy public policy •create supportive environments for health •strengthen community action for health •develop personal skills, and •re-orient health services.

Develop Personal Skills

Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves.

Strengthen Community Actions

Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities - their ownership and control of their own endeavours and destinies. Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation in and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support.

Priority population groups

High levels of preventable chronic disease, injury and mental health problems have been identified as one of the priority health issues for Australians. Within each of these health areas, certain groups in our population have been identified as at increased risk of developing these diseases or health conditions. By identifying at risk population groups, government health care expenditure and health promotion initiatives can be directed towards these groups to attempt to reduce the prevalence of the disease.

Deaths CHD

I n 2011, there were 21,500 deaths with CHD recorded as the underlying cause of death. CHD contributed to 15% of all deaths in Australia and almost 1 in 2 cardiovascular disease deaths. t C HD death rates have fallen by 73% over the last 3 decades; however, the rate of decline has varied over time and across age groups. For some age groups, CHD death rates continue to fall at accelerated rates (such as for those aged 70 and over), while for others, such as the 55-69 age group, there has been a levelling-off or plateauing over the last 5 years

What impact do the principles of social justice have on identifying priority population groups? *

If statistics indicate that certain groups in the community are significantly worse off than the rest of the population then it is cause for concern. If these groups are the most disadvantaged and we know social determinants impact on disease rates then governments have a responsibility to try and minimise the inequity. The principles of social justice aim at decreasing or eliminating inequity, promoting inclusiveness and diversity and establishing environments that are supportive to others. All individuals should have an equal chance at experiencing better health.

Staging: Melanoma Skin Cancer

If the excised lesion is thick, a biopsy of the first draining lymph node (sentinel node) is performed. The most important feature of a melanoma in predicting its outcome is its thickness (stage 0 is less than 0.1mm, stage I less than 2mm, stage II greater than 2mm, stage III spread to lymph nodes and stage IV distant spread). The presence of ulceration also predicts a poor outcome. If distant spread is suspected, CT scans of the chest, abdomen and pelvis are performed. The blood test LDH can sometimes be useful to assess metastatic disease.

How common is breast cancer?

In 2011, there were 14,568 new cases of breast cancer diagnosed in Australia (103 males and 14,465 females).a In 2015, it is estimated that 15,740 new cases of breast cancer will be diagnosed in Australia (145 males and 15,600 females).b In 2011, the age-standardised incidence rate was 60 cases per 100,000 persons (0.9 for males and 116 for females).d In 2015, it is estimated that that the age-standardised incidence rate will be 59 cases per 100,000 persons (1.1 for males and 115 for females). Breast cancer was the third most commonly diagnosed cancer in Australia in 2011. It is estimated that it will remain the third most commonly diagnosed cancer in 2015. In 2015, it is estimated that the risk of an individual being diagnosed with breast cancer by their 85th birthday will be 1 in 16 (1 in 719 males and 1 in 8 females). In 2015, it is expected the incidence of breast cancer will increase with age until age group 65-69. It will then decrease for age group 70-79 before increasing for individuals aged 80+ (see figure below).

Cancer support organisations Breast cancer

In addition, State and Territory Cancer Councils provide general information about cancer as well as information on local resources and relevant support groups. The Cancer Council Helpline can be accessed from anywhere in Australia by calling 13 11 20 for the cost of a local call. Click here for a list of Cancer Councils and other cancer support organisations or go to Breast Cancer Network Australia http://www.bcna.org.au/

Costs to the individual and the community

Ill health impacts across all aspects of a person's life. Loss of life, quality of life and the financial burden to a family, are examples of the detrimental effect of developing a chronic health condition. Many people, who suffer from serious illness, may need to be hospitalised for lengthy periods of time. This may prevent them from maintaining employment status and consequently place a financial strain on their families. It is important to remember that the cost of ill health to individuals and communities is not simply the direct financial costs. It includes the indirect financial, physical, social, emotional and mental costs as well. The burden of an acute or chronic health condition on the social and emotional health of an individual or family is extremely difficult to measure and fully comprehend. According to the Australian Institute of Health and Welfare (AIHW), health expenditure has also grown faster than the broader economy. Reasons for this are varied. Life expectancy has increased by 20 years since the beginning of the twentieth century and is continually increasing for the Australian population. This means that more money will be required to fund health care to care for the increased number of elderly living longer lives. As survival rates from chronic illnesses such as cancer improve, the increased burden of this older population living longer will inevitably result in Australians contributing more towards the expenditure of health care costs in Australia. Increasing use of Medicare also places extra emphasis on Australia's health system and expenditure. Improved technological advances that provide Australians with more effective methods of treatment do come at a great expense, and yet are essential in providing individuals with the best possible treatment.

Reasons for growth of complementary and alternative health products and services

In 2002, the World Health Organisation acknowledged that complementary and alternative health products and services were increasing in popularity and released a strategy to assist countries to regulate traditional or complementary/alternative medicine to make its use safer, more accessible to their populations and sustainable. The main reason for the growth of complementary and alternative health products and services is due to increased societal demand. NSW Health estimated that close to 60% of Australians access some form of complementary health care (NSW Health, accessed 2010 (external website)). This may be due to the increased levels of chronic and preventable diseases and conditions, concerns about the side effects of conventional medicine or dissatisfaction with conventional medicine. Therapies such as massage and acupuncture are widely known for their relief of chronic pain. They may complement more conventional treatments. In Australia, people who have extras cover through their private health insurer can receive subsidies for their use of certain complementary and alternative health care services such as registered massage or acupuncture providers. This has contributed to increased use of complementary and alternative health services as people are able to receive treatment at a reduced price. The effect of rebates for their use implies that the Australian health care system recognises registered providers as creditable within the Australian health care system. The increased demand for complementary and alternative health care has increased employment in the area which has also increased demand for training courses. There has been significant growth in this sector of the health industry.

How common is stroke?

In 2009, an estimated 375,800 Australians (205,800 males and 170,000 females) had had a stroke at some time in their lives. Most (70%) were aged 65 or over. The rate of stroke events has fallen by 25% over the last decade (from an age-standardised rate of 186 to 140 per 100,000 population between 1997 and 2009). But the total number of Australians experiencing a stroke rose by 6% over the same period, reflecting the ageing of the population. In 2009, over one-third (35%) of Australians who experienced a stroke had a resulting disability; this was an improvement from 1998 when the rate was 45%.

Deaths from diabetes; Aboriginal and Torres Strait Islander people

In 2009-2011, diabetes was the underlying or associated cause of death for 1,129 Aboriginal and Torres Strait Islander people in the 5 jurisdictions with adequate identification of Indigenous status. One-third of these deaths (343) had diabetes as an underlying cause of death. Diabetes death rates (underlying or associated cause) were 3 times as high among Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. The gap between Indigenous and non-Indigenous Australians was greater for females than males―3.8 times as high for females (185 compared with 49 per 100,000 population) and 2.7 times as high for males (202 compared with 74 per 100,000 population).

Incidence and mortality: Melanoma Skin Cancer

In 2010, 11,405 new cases of melanoma were diagnosed in Australia, accounting for nearly one in ten cancer diagnoses. Melanoma is more commonly diagnosed in men than women. The risk of being diagnosed with melanoma by age 85 is 1 in 14 for men compared to 1 in 24 for women. In Australia in 2011, there were 1544 deaths due to melanoma. Melanoma is the sixth most common cause of cancer death in Australian men and tenth most common in Australian women.

How common is lung cancer?

In 2011, there were 10,511 new cases of lung cancer diagnosed in Australia (6,409 males and 4,102 females).a In 2015, it is estimated that 11,880 new cases of lung cancer will be diagnosed in Australia (6,990 males and 4,890 females).b In 2011, the age-standardised incidence rate was 43 cases per 100,000 persons (56 for males and 31 for females).d In 2015, it is estimated that that the age-standardised incidence rate will be 43 cases per 100,000 persons (54 for males and 33 for females). Lung cancer was the 5th most commonly diagnosed cancer in Australia in 2011. It is estimated that it will remain the 5th most commonly diagnosed cancer in 2015. In 2015, it is estimated that the risk of an individual being diagnosed with lung cancer by their 85th birthday will be 1 in 17 (1 in 13 males and 1 in 22 females). In 2015, it is expected the incidence of lung cancer is expected to generally increase with age

A growing and ageing population

In Australia life expectancy is continually increasing. This section explores the impact a growing and ageing population has on the health care system, workforce, carers and volunteer organisations

Deaths STOKE

In 2011, there were 8,800 deaths with stroke recorded as the underlying cause of death, accounting for 6% of all deaths in Australia (1 in 5 cardiovascular disease deaths; see Glossary and Chapter 3 'Multiple causes of death in Australia' for 'cause of death' definitions). OVer the last 3 decades, stroke death rates have fallen by almost 70% (from an age-standardised rate of 103 to 33 deaths per 100,000 population between 1979 and 2011) (Figure 4.10). Death rates were similar for males and females (age-standardised rate of 33 compared with 32 deaths per 100,000 population respectively); but more females than males die from stroke (5,400 stroke deaths for females in 2011 compared with 3,500 deaths for males). This largely reflects that there are more older women than men

Health care CHD

In 2011-12 there were 153,700 hospitalisations for CHD (an age-standardised rate of 615 per 100,000 population), a 28% decline from 1993-94 when the age-standardised rate was 859 per 100,000. t T he downward trend in CHD hospitalisations was similar for men and women (27% and 31%, respectively), although men are hospitalised at much higher rates than women.

Diabetes :Extent of the problem (trends) Morbidity

In 2011-12 there were about 1 million Australians with diabetes .The proportion of people with diagnosed diabetes increased with age. Of these around 12% of those with diabetes had Type 1 diabetes, and around or 85% of those with diabetes had Type 2 diabetes. Diabetes increases with age. In 2011-12, approximately 95% of people with diabetes were aged 35 years or more and 50% were aged 65 years or more .

Health Care STROKE

In 2011-12, there were 36,800 hospitalisations for acute care of stroke and 27,400 hospitalisations for rehabilitation care for stroke. The average length of stay in acute hospital care for stroke was 9 days, and in rehabilitation care 14 days. Over the last decade, hospitalisation rates for stroke fell by 17% (from an age-standardised rate of 174 to 145 per 100,000 population between 1998-99 and 2011-12). Stroke units significantly improve health outcomes of stroke patients. Between 2007 and 2011, the number of stroke units in public hospitals increased from 54 to 74 and the proportion of patients receiving stroke unit care increased from 50% to 60%. In 2009, informal carers played an important role in care of stroke survivors. Of the estimated 75,000 primary carers who provided assistance to people with stroke and resulting disability, more than half spent 40 hours or more per week in their caring role.

Deaths from diabetes; Age and sex

In 2012, diabetes death rates (as underlying or associated cause): •increased with age, with rates 3 times as high in those aged 85 and over (1,573 and 1,141 per 100,000 for males and females) compared with those 75-84 years (632 and 405 per 100,000 for males and females). •were 1.6 times as high for males than females overall, and higher for males across all age groups (Figure 2).

Deaths from melanoma skin cancer

In 2012, there were 1,515 deaths from melanoma skin cancer in Australia (1,039 males and 476 females). In 2015, it is estimated that this will increase to 1,675 deaths (1,160 males and 515 females).c In 2012, the age-standardised mortality rate was 5.9 deaths per 100,000 persons (9.0 for males and 3.4 for females).d In 2015, it is estimated that the age-standardised mortality rate will be 6.1 deaths per 100,000 persons (9.2 for males and 3.5 for females). In 2012, melanoma skin cancer accounted for the 8th highest number of deaths from cancer in Australia. It is estimated that it will become the 9th most common cause of death from cancer in 2015. In 2015, it is estimated that the risk of an individual dying from melanoma skin cancer by their 85th birthday will be 1 in 123 (1 in 80 for males and 1 in 233 for females).

Deaths from breast cancer

In 2012, there were 2,819 deaths from breast cancer in Australia (24 males and 2,795 females). In 2015, it is estimated that this will increase to 3,065 deaths (25 males and 3,040 females).c In 2012, the age-standardised mortality rate was 11 deaths per 100,000 persons (0.2 for males and 21 for females).d In 2015, it is estimated that the age-standardised mortality rate will be 11 deaths per 100,000 persons (0.2 for males and 21 for females). In 2012, breast cancer accounted for the 4th highest number of deaths from cancer in Australia. It is estimated that it will remain the 4th most common cause of death from cancer in 2015. In 2015, it is estimated that the risk of an individual dying from breast cancer by their 85th birthday will be 1 in 74 (1 in 3,664 males and 1 in 39 females).

Deaths from lung cancer

In 2012, there were 8,137 deaths from lung cancer in Australia (4,882 males and 3,255 females). In 2015, it is estimated that this will increase to 8,790 deaths (5,190 males and 3,600 females).c In 2012, the age standardised mortality rate was 32 deaths per 100,000 persons (42 per 100,000 males and 24 per 100,000 females).d In 2015, it is estimated that the age standardised mortality rate will be 32 per 100,000 persons (41 per 100,000 males and 24 per 100,000 females). In 2012, lung cancer accounted for the highest number of deaths from cancer in Australia. It is estimated that it will remain the most common cause of death from cancer in 2015. In 2015, it is estimated that the risk of an individual dying from lung cancer by their 85th birthday will be 1 in 22 (1 in 17 for males and 1 in 29 for females).

Aboriginal and Torres Strait Islander people, hospitalisations

In 2012-13, Indigenous males and females were 1.7 times as likely as Other Australian males and females to be hospitalised for type 1 diabetes as the principal and/or additional diagnosis (416 compared with 241 per 100,000 for males and 422 compared with 240 per 100,000 for females).

Inequalities for diabetes hospitalisations

In 2012-13, the hospitalisation rate for type 1 diabetes (as principal and/or additional diagnosis) was greater in Inner regional and Outer regional areas (290 and 255 per 100,000 population) compared with Major cities and Remote and very remote areas (206 and 182 per 100,000 population; Figure 3). Hospitalisation rates for type 1 diabetes increase with level of socioeconomic disadvantage (Figure 3). In 2012-13, the hospitalisation rate for type 1 diabetes (principal and/or additional diagnosis) was 1.7 times as high in the lowest socioeconomic (SES) group (based on area of usual residence) compared with the highest SES group (273 compared with 165 per 100,000 population).

Type 2 diabetes hospitalisations

In 2013-14, there were around 820,000 hospitalisations with type 2 diabetes recorded as the principal and/or additional diagnosis—26,900 as a principal diagnosis and 795,000 as additional diagnosis. Of those where type 2 diabetes was recorded as a principal and/or additional diagnosis: •most (87%) hospitalisations occurred in those 55 years and over, with rates highest in men aged 85 and over (25,923 per 100,000 population) and women aged 75-84 (17,244 per 100,000 population) (Figure 4). •male rates were overall higher (1.4 times as high) than female rates.

Range of products and services available

In complementary and alternative health care, the range of products and services is very diverse. Products are often referred to as medicines whereas services are often referred to as therapies. Some are a combination of both. Complementary and alternative medicines can include herbal, vitamin, mineral, homoeopathic, nutritional and other supplements. Therapies include herbal medicine, Chinese medicine, chiropractic, naturopathy, osteopathy, acupuncture, homoeopathy, reflexology, aromatherapy, Alexander technique, Bach and other flower remedies, massage, hypnotherapy, shiatsu, ayurvedic medicine, nutritional medicine, yoga, anthroposophical medicine, spiritual healing, iridology, kinesiology, meditation and others.

Outline some of the inequities each group experiences with regards to health status. *

In general, individuals from low socioeconomic status live shorter lives and have higher rates of illness, disability and death than those relatively advantaged. There are also links between low socioeconomic status and risky behaviours which negatively impact on health, e.g. smoking, lack of physical activity, alcohol consumption and high levels of overweight and obesity. Aboriginal and Torres Strait Islander peoples (Indigenous Australians) experience significantly higher levels of ill health compared to other Australians. They are more likely to be from low socioeconomic backgrounds which increases inequities experienced. The death rate is almost twice the rate for Australia as a whole. Aboriginal and Torres Strait Islander people are about three times as likely to have Type 2 diabetes, have significantly higher rates of serious and fatal injuries (motor vehicle crashes are the main cause of injury death) and are twice as likely to have high or very high levels of distress than other Australians.

Screening: Melanoma Skin Cancer

Individuals at high risk of melanoma (see risk factors below) should be taught to check their skin for irregular or changing lesions, and have annual checks by a dermatologist.

breast cancer: Prevention, detection and potential for change

It is important to know exactly what your breast looks and feel like. By completing regular breast self examinations you get to know your breast and therefore can detect any abnormalities. Regular mammograms can detect breast cancer early and therefore save lives with early treatment. Mammograms are not reliable for women under 40 due to their breasts being denser. As prevention and education programs improve it is expected that incidence and mortality rates will start to decline.

REMEMBER:

It is important to remember many cancers can be detected in the early stages, which makes them easier to treat. It is important to have regular checkups from your GP if and when you notice anything unusual. Know what is 'normal' for your body. There are many risk factors that are avoidable and if avoided will reduce the incidence of most forms of cancer.

What is lung cancer?

Lung cancer is a malignant tumour in the tissue of one or both of the lungs. A primary cancer starts in the lungs, while a secondary or metastatic cancer starts somewhere else in the body and spreads to the lungs.

What is lung cancer?

Lung cancer is a malignant tumour in the tissue of one or both of the lungs. A primary cancer starts in the lungs, while a secondary or metastatic cancer starts somewhere else in the body and spreads to the lungs.

Deaths from diabetes; Trends

Over the last few decades trends in diabetes death rates have remained relatively stable, both where diabetes is an underlying cause of death and where it is underlying or associated cause of death: •Diabetes was an underlying cause of death in around 2,800 deaths per year between 1982 and 2012, equating to 17 to 19 deaths per 100,000 population for males and 13 to 15 per 100,000 population for females (see Data table). •Diabetes was an underlying or associated cause of death in around 13,000 deaths per year between 1997 and 2012, equating to 71 to 72 per 100,000 population for males and around 45 per 100,000 population for females (Figure 1).

Statistics: Breast Cancer

Projected* number of new cases of breast cancer diagnosed in 2015 15,740 = Male 145 males + Female 15,600 females Projected % of all new cancer cases diagnosed in 2015 2.4% Projected number of deaths from breast cancer in 2015 3,065 = Male PG 25 males + Female 3,040 females Projected % of all deaths from cancer in 2015 6.6%

Socioeconomically disadvantaged people

Many studies show that people or groups who are socially and economically disadvantaged have reduced life expectancy, premature mortality, increased disease incidence and prevalence, increased biological and behavioural risk factors for ill health, and lower overall health status. The link between socio-economic status (SES) and health begins at birth and continues through life, but the strength of the relationship varies at different life stages. Because economic and social inequalities go hand in hand, their combined impact can result in limited opportunities and life chances for those who experience them. Those with the highest socioeconomic status tend to be those who have the most resources, opportunities and power to make choices, whereas those with the lowest status have less of these. This forms a 'social gradient', with overall health and wellbeing tending to improve with each step up the socioeconomic ladder. Thus, people with a higher income generally enjoy better health and longer lives than people with a lower income. The rich tend to be healthier than those in the middle, who are, in turn, healthier than the poor. Some factors that can lead to SES effects on health include: •access to high-quality health care •individual factors such as smoking, exercise, nutrition, stress and depression •environmental factors such as pollution, housing and overcrowding •social environments such as neighbourhoods, work, interpersonal support or conflict, and violence and discrimination. Results from the 2007-08 National Health Survey (NHS) indicate that people with lower socioeconomic status are more likely to smoke, exercise less and be overweight and/or obese. These are risk factors for a number of long-term health conditions such as respiratory diseases, lung cancer and cardiovascular diseases Among the long-term health conditions explored in the 2007-08 NHS, those reported most often by people experiencing disadvantage were cardiovascular disease, diabetes, depression and respiratory diseases (including asthma). The survey also found that those who were socioeconomically disadvantaged reported more visits to doctors and hospital outpatient and accident and emergency services, but were less likely to use preventive health services, such as dental services.

How equitable is the access and support for all sections of the community to Medicare and Private health Insurance?

Medicare is Australia's universal health care system to provide eligible Australian residents with affordable, accessible and high quality health care. All Australians contribute to the costs of health care through the Medicare Levy, which is collected from all income earners who earn above a set minimum amount in Australia. The Medicare Levy is implemented according to a person's ability to pay, reducing costs for low income earners compared to high income earners. Medicare is accessible and affordable for all residents. Medicare reduces costs associated with health care, through subsidised treatment by medical practitioners such as GP's. This increases an individual's access to these services and reduces the inequity associated with socioeconomic status. Health care is made more affordable through Medicare allowing all sectors of the population to access services more equally. The Pharmaceutical Benefits Scheme (PBS) provides all Australians with affordable access to prescription medicine. In addition, the Medicare and PBS safety nets provide families and individuals with financial assistance for high out of pocket costs for out of hospital Medicare Benefits Schedule (MBS) services and pharmaceuticals. Once an individual or family reach a safety net threshold pharmaceuticals, visiting a doctor or having tests may cost less. Many Australians choose to purchase private health insurance. This insurance increases an individual's access to services in private hospitals as well as services provided in public hospitals for private patients and associated medical services. Private health insurance also subsidises the costs of other services including alternative therapies such as massage, chiropractic and naturopathy. This type of health insurance can be expensive and is often not accessible to people of low socioeconomic status. The Australian Government has introduced a number of incentives to increase private health insurance membership. Through funding of the 30% Rebate and other key incentives to support people's choice to take up and retain private health insurance the government is trying to reduce the pressure and demand on the public health system.

Health insurance: Medicare and private

Medicare is a system that is partly funded by taxpayers, who pay what is known as a Medicare levy as part of their tax. Under the levy, taxpayers pay a percentage of their taxable income for dedicated use by the health system thus providing access for all Australians. The government sets fee levels for services and provides rebates to customers based on these prices, e.g. GP visit, public hospital visit. For a GP visit, regardless of what fee is charged by the medical practitioner, every Australian is covered for 85% of the scheduled fee. The rest of the fee is often referred to as 'the gap' which is paid by the patient. Some GP's allow bulk billing to take place which means they claim the minimum pay from Medicare itself and patients do not have to pay a gap. Under Medicare, people can choose to be treated as public patients in public hospitals free of charge. Individuals can choose to use only Medicare or combine Medicare with private health insurance to increase their cover. Private health insurance is available for people who wish to be covered for private hospital fees or ancillary services such as ambulance cover, physiotherapy and optical appliances (e.g. glasses, contact lenses etc). There are different levels of cover, e.g. the more you pay, the more cover you receive. The Australian government provides an incentive to Australians who choose to take up private health insurance by providing a 30% rebate. The rebate increases for older people, e.g. 35% for people aged 65-69 years and 40% for people aged 70 years and over.

Melanoma

Melanoma is the fourth most common cancer diagnosed in Australia1, which along with New Zealand has the world's highest incidence rate for melanoma.

Causes: Melanoma Skin Cancer

Melanoma risk increases with exposure to UV radiation, particularly with episodes of sunburn (especially during childhood). Melanoma risk is increased for people who have: •increased numbers of unusual moles (dysplastic naevi) •depressed immune systems •a family history of melanoma in a first degree relative •fair skin, a tendency to burn rather than tan, freckles, light eye colour, light or red hair colour •had a previous melanoma or non-melanoma skin cancer.

Cancer (skin, breast and lung) Extent of the problem (trends)

Morbidity and mortality

Diabetes :Extent of the problem (trends) Mortality

Mortality rates are relatively unchanged for diabetes. The death rates for diabetes increases with age. Males were more likely to die from diabetes as any cause fo death than females. Diabetes was the sixth leading cause of death in Australia in 2011, contributing to 10% of all deaths

Aboriginal and Torres Strait Islander peoples

No greater contrast can be found in health status in Australia than that between Aboriginal and Torres Strait Islander peoples and the rest of the Australian population. Aboriginal and Torres Strait Islander peoples experience significantly more ill health than other Australians. They typically die at much younger ages and are more likely to experience disability and reduced quality of life because of ill health. Although there have been improvements in the mortality rates of Indigenous Australians in recent years, available data suggest that the relative gap in overall mortality rates between Indigenous and non-Indigenous Australians is widening. Indigenous children aged 0-4 years died at more than twice the rate of non-Indigenous children •Indigenous Australians tend to die earlier than non-Indigenous Australians and their death rates are almost twice those of non-Indigenous Australians. •Indigenous boys born between 2010 and 2012 can expect to live to 69.1 years and Indigenous girls to 73.7 years compared with 79.7 for non-Indigenous boys and 83.1 for non-Indigenous girls. •Indigenous Australians had higher death rates than non-Indigenous Australians across all age groups during 2007-2011. In the 35-44 age group, Indigenous people died at about 5 times the rate of non-Indigenous people. •Between 2007 and 2011, Indigenous Australians were most likely to die from circulatory conditions (26% of all Indigenous deaths), cancer (19%) and external causes such as suicides, falls, transport accidents and assaults (15%). •The largest gap in death rates between Indigenous and non-Indigenous Australians was in circulatory disease deaths (22% of the gap) followed by endocrine, metabolic and nutritional disorders (particularly diabetes) (14% of the gap). •Indigenous Australians were 5 times as likely as non-Indigenous Australians to die from endocrine, nutritional and metabolic conditions (such as diabetes), and 3 times as likely to die of digestive conditions. •Indigenous children aged 0-4 died at more than twice the rate of non-Indigenous children in 2012. Indigenous child death rates fell by 30% from 2001 to 2012 compared with 22% for non-Indigenous children. •Indigenous Australians were at least twice as likely as non-Indigenous Australians to rate their health as fair or poor, and almost half as likely to rate their health as excellent or very good.

Risk Factors: Breast Cancer

Non- modifiable •gender - a small percentage of males do suffer from breast cancer •family history •personal history •early onset of menstruation •late menopause Modifiable •obesity •high fat diet •late maternal age (over 40years) at time of first full-term pregnancy or childlessness

Risk Factors:Lung Cancer

Non-Modifiable •gender •age •family history Modifiable •smoking - smokers are up to 20 times more likely to develop lung cancer •exposure to carcinogenic chemicals, for example asbestos and lead. •air pollution

Risk Factors: Skin Cancer

Non-Modifiable •fair skin - freckles; skin that burns easily; skin that doesn't tan easily •fair or red hair and blue eyes •the number and types of moles on the skin •have a personal or family history of melanoma •are older •have had a previous non-melanoma skin cancer (NMSC) Modifiable •exposure to the sun's ultraviolet rays (UVR)- particularly between 11am and 3pm (and between 10am and 2pm daylight saving) - especially as a child or adolescent •have repeated exposure to UVR over their lifetime, including solariums •have episodes of severe sunburn •geographic location in a high sunlight longitude

Treatment: Non-Melanoma Cancer Skin Cancer

Non-melanoma skin cancers are almost always removed. In more advanced skin cancers, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells have been taken. Most common skin cancers (basal and squamous cell carcinomas) can be treated with ointments or radiation therapy. They can also be removed with surgery (usually under a local anaesthetic), cryotherapy (using liquid nitrogen to rapidly freeze the cancer off), curettage (scraping) or cautery (burning).

Non - melanoma cancer

Non-melanoma skin cancers are the most common cancers in Australia, however most are not life-threatening. The two main types are basal cell carcinoma and squamous cell carcinoma. A third group of lesions called keratinocyte dysplasias includes solar keratosis, Bowenoid keratosis and squamous cell carcinoma in-situ (Bowen's disease). These are not invasive cancers, however may require treatment as some may develop into non-melanoma skin cancers.

What role do the principles of social justice play in determining the potential for prevention and early intervention as a priority health issue?

Not everyone has access to the factors which can aid prevention or early detection of lifestyle diseases or conditions. The principles of social justice allow marginalised groups or under represented population groups to be represented and catered for when there are increases in certain conditions. This is a priority health issue because everyone should have equal access to better health. Sometimes, factors that can help prevent or intervene early can provide inequality to certain groups of people. The principles of social justice attempt to eliminate inequality in health and establish supportive environments for all Australians. For instance, a regular mammogram can help screen for breast cancer. If the mammogram technology was only in city areas then rural and remote people would have less access to early detection for breast cancer. As a result, there are many mobile breast cancer screening units to travel through rural and remote areas giving more equal access to breast screening procedures and hopefully helping the early detection of breast cancer. Survival rates markedly improve for people who detect breast cancer early.

Symptoms and diagnosis: Melanoma Skin Cancer

Often melanoma has no symptoms, however it can be associated with changes that relate to 'ABCDE' - Asymmetry, irregular Border, uneven Colour, Diameter (usually over 6mm), Evolving (changing and growing). Other symptoms include dark areas under nails or on membranes lining the mouth, vagina or anus. Diagnosis is by biopsy to remove the whole lesion.

Create Supportive Environments

Our societies are complex and interrelated. Health cannot be separated from other goals. The inextricable links between people and their environment constitutes the basis for a socioecological approach to health. The overall guiding principle for the world, nations, regions and communities alike, is the need to encourage reciprocal maintenance - to take care of each other, our communities and our natural environment. The conservation of natural resources throughout the world should be emphasized as a global responsibility. Changing patterns of life, work and leisure have a significant impact on health. Work and leisure should be a source of health for people. The way society organizes work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable. Systematic assessment of the health impact of a rapidly changing environment - particularly in areas of technology, work, energy production and urbanization - is essential and must be followed by action to ensure positive benefit to the health of the public. The protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy.

Samuel is a 30 year old father of three who has worked most of his life as a carpenter. Recently Samuel was diagnosed with a melanoma skin cancer. He has had surgery to remove the skin cancer and is now undergoing chemotherapy to stop the growth and reproduction of the melanoma

Outline the physical, social, emotional/mental and financial costs to Samuel during this period of treatment. Note that these answers are not exhaustive, they do demonstrate the link between the variety of costs to the individual and community and why this is an important factor in identifying priority health issues. Physical Samuel may experience fatigue, nausea, bowel problems (diarrhoea), mouth ulcers and infections during his chemotherapy treatment. Such physical limitations as fatigue could restrict his movement and prevent Samuel from completing many daily chores as well as affect ability to work as a carpenter. The community could suffer by not having work Samuel was contracted to do finished. His workmates may have to complete more work to cover him which is physically demanding. Social Due to his depressed immune system as a result of chemotherapy, Samuel needs to maintain isolation as much as possible to prevent any infection from occurring in his body. This may prevent him from seeing family members and friends who may display symptoms of common illnesses such as colds and coughs. Samuel may also experience the loss or thinning of his hair throughout the chemotherapy process. In some social situations, Samuel may feel embarrassment at the sudden loss of his hair. This could discourage him from attending social functions throughout receiving chemotherapy. Samuel's friends may feel shut out and any community activities he was involved in may have one less person to help organise. Emotional/Mental The uncertainty surrounding Samuel's short-term and long-term health could place considerable strain and pressure on his mental state. The prospect of being unable to watch his children grow up could fill Samuel with sadness and despair. The financial strain caused by his inability to complete regular paid work could result in significant stress and anxiety. Furthermore, Samuel may experience loss of self worth due to the change in his employment circumstances which could result in decreased self-esteem. He may need to access professional support to cope with the emotional and mental demands. Family and friends could feel helpless which increases their stress levels. Financial The physical side-effects Samuel may experience during chemotherapy will most probably prevent him from completing his normal duties at work. On top of the medical expenses Samuel may incur (depending on private health insurance); Samuel could have significant worry about the means to support his young family. Without paid employment, Samuel would have to rely on welfare payments which may have been significantly less than his normal wage. Increased access to support services for Samuel and his family and friends could result in more demand for a variety of community resources.

Explain what the saying 'prevention is better than a cure' means to an individual and community.

Overall, preventing a disease or condition is much better than having the disease or condition, going through treatment, emotional effects, work implications, lifestyle modifications and cost to the individual and community. For example, consider a person who has just been treated for a heart attack. They have had a major operation and spent several weeks in hospital. ◦emotional - the individual, family and friends will be devastated. ◦work - the individual will not be able to work for a period of time and may affect their future work involvement, affecting their income. The employer will be out of an experienced worker and need train a new person for maybe a short period of time taking considerable amount of time. Productivity at work may be reduced for a period of time. ◦economic cost - the individual will have medical bills for treatment and rehabilitation and a potential lack of income. The cost to the community includes medical treatment, insurance and temporary staffing. ◦future impact on lifestyle - depending on severity of heart attack, exercise, access to support services, education about prevention which needs to be provided by the community. Prevention strategies, such as lifestyle modifications (eating healthy, regular exercise, no smoking), access to regular check-ups and early detection facilities, were in place for individuals who are in high risk groups due to a family history or age appropriate, policy and regulations, e.g. no smoking in cars around children, education about prevention and early detection/intervention through health promotion would benefit the individual and community.

Finding support Breast cancer

People often feel overwhelmed, scared, anxious and upset after a diagnosis of cancer. These are all normal feelings. Having practical and emotional support during and after diagnosis and treatment for cancer is very important. Support may be available from family and friends, health professionals or special support services. More information about finding support can be found on this website: Living with cancer. This information deals with some of the challenges experienced by people affected by cancer. It includes information about managing some of the longer term side effects of treatment, how people close to you might feel after a diagnosis of cancer, and where to find practical and emotional support.

Why do people use complementary and alternative health products and services?

People use complementary and alternative health products and services for a variety of reasons such as: •for pain relief of chronic conditions •enhance wellbeing •improve body functioning •to complement treatment of other conditions •belief in the benefits (personal and cultural) •stress relief •cost subsidies from private health insurance •it aligns with their view of holistic health •lack of success with conventional medicine •concern about side effects of conventional medicine. One population group that has increased in use of complementary and alternative health care are the elderly. As our population ages, more chronic conditions require some form of treatment. More people are turning to complementary and alternative health care to help manage conditions such as arthritis, joint stiffness and overall wellbeing to improve their quality of life. Seeking help other than conventional medicine eases the burden on the Australian health care system.

The sociocultural, socioeconomic and environmental determinants CVD

People with a low socioeconomic status (SES) are more likely to develop CVD. Although reductions have been seen in CVD statistics, unfortunately these reductions are not as well documented amongst people with a low SES. People with a low SES tend to have limited health choices related to income such as using exercise facilities and purchasing fresh fruit and vegetables. They also show greater incidence of more risky behaviours such as smoking, lack of physical activity and poor nutrition. People with low education levels are more at risk of developing CVD as poor education is linked to poor health choices and less knowledge about how to access and use health services. Cultural background and factors have an influence on whether an individual may develop a CVD. Some population groups have higher rates and a predisposition to developing CVD such as Indigenous Australian's, compared to low rates amongst people from Asian populations. An individual's values and attitudes impact greatly on behaviours. Attitudes to smoking, for example, have become increasingly negative which has contributed to reducing the rates of smoking. Community support, health promotion and legislation have also played an important role. There are variations in the incidence of CVD between people who live in metropolitan areas and those who live in rural or remote areas. This can be linked to a lack of access to health information, health services and technology, as well as higher levels of smoking and obesity. The Indigenous populations in these areas also contribute to the statistics as they tend to consult elders in regards to health issues rather than accessing conventional western health care.

Peripheral vascular disease

Peripheral vascular disease refers to diseases of arteries outside the heart and brain. It occurs when fatty deposits (atheromas) build up along the inner walls of the arteries and affect blood circulation, mainly in the arteries leading to the legs and feet. The walls of the arteries tend to lose their elasticity resulting in increased pressure on the heart and vascular system. It ranges from asymptomatic disease, through pain on walking, to pain at rest and limb-threatening reduced blood supply that can lead to amputation.

Statistics: Lung Cancer

Projected* number of new cases of lung cancer diagnosed in 2015 11,880 = Male 6,990 males + Female 4,890 females Projected % of all new cancer cases diagnosed in 2015 9.4% Projected number of deaths from lung cancer in 2015 8,790 = Male 5,190 males + Female 3,600 females Projected % of all deaths from cancer in 2015 18.9%

Statistic: Skin Cancer (Melanoma)

Projected* number of new cases of melanoma skin cancer diagnosed in 2015 12,960 = Male 7,640 males + Female 5,320 females Projected % of all new cancer cases diagnosed in 2015 10.2% Projected number of deaths from melanoma skin cancer in 2015 1,675 = Male 1,160 males + Female 515 females Projected % of all deaths from cancer in 2015 3.6%

Prevention Skin Cancer

Protect your skin •For best protection, we recommend a combination of sun protection measures: ◦Slip on some sun-protective clothing - that covers as much skin as possible ◦Slop on broad spectrum, water resistant SPF30+ sunscreen. Put it on 20 minutes before you go outdoors and every two hours afterwards. Sunscreen should never be used to extend the time you spend in the sun. ◦Slap on a hat - that protects your face, head, neck and ears ◦Seek shade ◦Slide on some sunglasses - make sure they meet Australian Standards •Be extra cautious in the middle of the day when UV levels are most intense. •For further information please read our position statements on eye protection. SunSmart UV alert •The SunSmart UV Alert is reported in the weather section of daily newspapers and on the Bureau of Meteorology website. •Issued by the Bureau when they forecast a UV Index for the day of three or above, the SunSmart UV Alert identifies the times during the day when sun protection will be needed. Applying sunscreen •Apply sunscreen liberally - at least a teaspoon for each limb, front and back of the body and half a teaspoon for the face, neck and ears. Most people don't apply enough sunscreen resulting in only 50-80% of the protection stated on the product. Sun protection and babies ◦Evidence suggests that childhood sun exposure contributes significantly to your lifetime risk of skin cancer. Cancer Council Australia recommends keeping babies out of the sun as much as possible for the first 12 months. ◦Where this is not possible, parents and carers should minimise exposure by: 1.Planning the day's activities outside the middle of the day when UV levels are most intense. 2.Cover as much skin as possible with loose fitting clothes and wraps made from closely woven fabrics. 3.Choosing a hat that protects the baby's face, neck and ears. 4.Make use of available shade or create shade for the pram, stroller or play area. The material should cast a dark shadow. The baby will still need to be protected from scattered and reflected UV radiation. 5.Keep an eye on the baby's clothing, hat and shade to ensure they continue to be well-protected. 6.Apply a broad spectrum, water resistant sunscreen to small areas of the skin that cannot be protected by clothing, such as the face, ears, neck and hands, remembering to reapply the sunscreen every two hours or more often it is wiped or washed off. •There is no evidence that using sunscreen on babies is harmful, although some babies may develop minor skin irritation. Try sunscreen milks or creams for sensitive skin which are less likely to irritate the skin. As with all products, use of any sunscreen should cease if any unusual reaction occurs

Protective factors CVD

Protective factors are strategies that individuals can implement to reduce the risk of developing chronic diseases. Some protective factors linked to CVD are to quit smoking and avoid exposure to tobacco smoke, maintain healthy levels of blood pressure and blood cholesterol, consumption of a healthy diet, maintenance of a healthy weight, and be physically active. The Australian Government publishes guidelines and recommendations about physical activity and diet, informing the community about important health-promoting behaviours that can offer protection against cardiovascular disease. These include the Dietary Guidelines , Guide to Healthy Eating and the Physical Activity Guidelines

How can an individual know who to believe and make an informed decision when accessing a complementary or alternative health care product or service?

Purpose - Decide on what you want to achieve from a product or service. Research - Research the type of product or service that would suit your needs. Include internet searches for professional associations, background research on the type of product or service, narrow down a few options. Questions worth considering include: •What are the benefits? •Is this safe? Are there side effects or risks I should know about? Qualifications/credentials - Once you have decided on a few alternatives, always check a product or services credentials or qualifications with a regulatory authority and professional association. Questions that could be asked include: •Where did you do your training? •How long was your training course? •How long have you been practising? •Are you a member of a professional association? •How do you keep up to date with advances in your area? If it is a product, find out who endorses it and any other background to its credentials as to whether it works. Gather other opinions - Ask your medical practitioner about the product or service, use the internet to research forums on the product or service, talk to people who have used it. Discuss - It is important to talk to the service provider or product seller to see whether it is the right option for you. Questions worth asking include: •What would I expect from my first therapy session? •Is this a complementary or alternative health care option? •Why should this type of therapy be the first choice of therapy? •What is the cost? •How long should I take the therapy and how will I know it is working? Evaluate - This should be done before you commence any treatment and it should also be ongoing throughout the treatment should you decide to continue. Always inform your medical practitioner if you are complementing their treatment or using alternatives to their advice.

morbidity

Refers to ill health in an individual and to levels of ill health in a population or group.

Impact of emerging new treatments and technologies on health care, e.g. cost and access, benefits of early detection

Research has provided many benefits in the discovery of new treatments and technologies used in health care. New treatments and technologies can improve health outcomes to individuals which, in turn, reduces the burden on the health care system. In the end, less people will require complicated health care. The more complicated the health care, the higher the cost. The types of benefits that are achievable through emerging new treatments and technologies include: •early detection •early treatment •less side effects impacting on individuals lives due to improved treatment •improved functionality of service, e.g. treat more patients and less follow up needed. Some examples of new treatments and technologies that have improved the burden on Australia's health care system include cervical cancer screening, STI testing, mammogram technology for breast cancer detection, ultrasound and MRI scanning technology and more recently, genetic testing for a variety of cancers. Some barriers to the widespread use of emerging new treatments and technologies are included below. •High cost of new technologies/treatments - new technology and treatments are often costly to research and develop. •Time - introduction of new techniques and technologies must be done with the assurance of safety and minimal side effects for the short and long term. Quality assurance takes time to ensure safe procedures and effects on individuals. •Australia's geographical size - when introduced, new treatment and technologies are often placed in major city areas first, limiting access to certain groups, e.g. rural & remote communities. •Ethical - ethical practices play a major role in research. For example, consider the cloning debate for organs. •Equity of access - people with money tend to be able to receive new, better treatment and technologies which increases the gap in health outcomes between the advantaged and disadvantaged. •Increasing and ageing population - more people equals more health problems which need to be treated. The growing and ageing population impacts more as older people tend to require more health care. The government must allocate funds to the health care system to care for more people requiring access to health care. Health promotion campaigns have proved to be very successful. These have raised awareness in people to be able to perform self detection and seek early help for a variety of conditions. Using new treatments and technologies can have a significant positive impact on the health care system. Governments need to make decisions as to where to place funding and in what percentages. Ill people need treatment and money needs to be put into research to develop new treatments and emerging technologies. It is a challenging balancing act.

Responsibility for health facilities and services

Responsibility for health facilities and services consists of two parts. The first part is the responsibility for funding. Health care services are funded and provided by the public and private sectors. The Australian government provides over 40 per cent of the total health funding, and is the major source of public funds. State and territory and local governments fund around around one third. The Commonwealth's funding includes two national subsidy schemes - Medicare and the Pharmaceutical Benefits Scheme (PBS). These schemes cover all Australians and subsidise their payments for medical services and for a high proportion of prescription medicines bought from pharmacies. The Commonwealth and State Governments also jointly fund public hospital services so they are provided free of charge to patients. Between them, these three funding provisions aim to give all Australians, regardless of their personal circumstances, access to adequate health care at an affordable cost. The Commonwealth's funding includes two national subsidy schemes - Medicare and the Pharmaceutical Benefits Scheme (PBS). These schemes cover all Australians and subsidise their payments for medical services and for a high proportion of prescription medicines bought from pharmacies. The Commonwealth and State Governments also jointly fund public hospital services so they are provided free of charge to patients. Between them, these three funding provisions aim to give all Australians, regardless of their personal circumstances, access to adequate health care at an affordable cost. The second part of responsibility relates to the functioning of health facilities and services, i.e. who governs and controls them. In a system so complex, it varies between government, non-government and private organisations.

Risk factors and protective factors

Risk factors can be divided into two categories, those that can be modified and those that cannot be modified. The risk factors vary according to the type of cancer.

Risk factors and protective factors: Diabetes

Risk factors for diabetes differ by type of diabetes. Type 1 - The exact cause of type 1 diabetes is not known, but family history appears to be a factor. There is also a possible link to genetic factors and viral infections contracted while young. Onset of Type 1 diabetes is unrelated to lifestyle and currently cannot be prevented, although maintaining a healthy lifestyle is very important in managing this condition. Type 2 - This is sometimes referred to as adult-onset diabetes, as age is a risk, with most cases developing in middle or older age. Genetic predisposition is shown by family history and ethnic background. Having had gestational diabetes when pregnant, or having had polycystic ovarian syndrome are also risk factors that affect females. Being from an Aboriginal or Torres Strait Islander background or from a Pacific Island, the Indian subcontinent or a Chinese cultural background also puts a person at increased risk. Unlike type 1diabetes, type 2 has strong links to lifestyle. It is related to overweight/obesity, physical inactivity and an unhealthy diet. It is also related to high blood pressure, the intake of too much saturated fat and refined sugar, and high alcohol consumption. It is estimated that up to 60% of type 2 diabetes can be prevented, and even more cases delayed. People in the above categories are encouraged to undertake a healthy lifestyle. That is, eat a well balanced diet, limit the intake of saturated fat and refined sugar, consume little or no alcohol, maintain a healthy weight range and regularly participate in physical activity. Managing blood pressure and cholesterol levels as well as not smoking assists in the prevention of diabetes.

Prevention CHD

Significant reductions in CHD deaths can be attributed to improvements in medical and surgical treatment. These include better emergency care and early identification of risk, the increasing use of antithrombotic and blood pressure- and blood cholesterol-lowering drugs, and cardiac procedures that restore blood flow to the heart by removing or bypassing blockages. Reductions in risk factors, such as tobacco smoking, high blood cholesterol and high blood pressure, have also contributed to these declines.

Skin cancer

Skin cancer occurs when skin cells are damaged, for example, by overexposure to ultraviolet (UV) radiation from the sun. Every year, in Australia: •skin cancers account for around 80% of all newly diagnosed cancers •between 95 and 99% of skin cancers are caused by exposure to the sun •GPs have over 1 million patient consultations per year for skin cancer •the incidence of skin cancer is one of the highest in the world, two to three times the rates in Canada, the US and the UK. There are three main types of skin cancer: •melanoma - the most dangerous form of skin cancer •basal cell carcinoma* •squamous cell carcinoma* *Both basal cell carcinoma and squamous cell carcinoma are known as non-melanoma skin cancer.

Causes: Non-Melanoma Cancer Skin Cancer

Skin cancer occurs when skin cells are damaged, for example, by overexposure to ultraviolet (UV) radiation from the sun. Between 95% and 99% of skin cancers in Australia are caused by exposure to the sun. The risk of skin cancer is increased for people who have: •increased numbers of unusual moles (dysplastic naevi) •fair skin, a tendency to burn rather than tan, freckles, light eye colour, light or red hair colour •had a previous skin cancer.

Treatment Skin Cancer

Skin cancers are almost always removed. In more advanced skin cancers, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells have been taken out. Common skin cancers can be treated with ointments or radiation therapy. They can also be removed with surgery (usually under a local anaesthetic), cryotherapy (using liquid nitrogen to rapidly freeze the cancer off), curettage (scraping) or cautery (burning).

Smoking CVD

Smoking habits acquired in adolescence or early adulthood greatly increase the risk for cardiovascular diseases and COPD in adulthood and old age—along with cancers and many other chronic diseases. The age of quitting smoking is also important and a major influence in reducing later COPD, coronary heart disease, and other chronic disease risk.

lung cancer: Prevention, detection and potential for change

Smoking is the main risk factor for lung cancer. Smokers and workers exposed to asbestos, nickel and arsenic have a higher risk of developing lung cancer. Secondhand smoke also has a higher link to lung cancer. Prevention of exposure to these areas lowers the risk of developing lung cancer. Lung cancer is very hard to detect at an early stage. There is potential for change if individuals can continue to quit smoking.

Social determinant CVD

Social determinants of health, experienced at different life stages, can also influence the development of chronic diseases, through their effect on biological processes (Lynch & Davey Smith 2005). Low birthweight babies, for example, are more likely to come from less affluent backgrounds, and low birthweight is associated with increased rates of cardiovascular disease and diabetes later in life

Social justice principles

Social justice means that the rights of all people in our community are considered in a fair and equitable manner. While equal opportunity targets everyone in the community, social justice targets the marginalised and disadvantaged groups of people in our society. Public policies should ensure that all people have equal access to health care services. People living in isolated communities should have the same access to clean water and sanitation as a person living in an urban area. People of a low socioeconomic background should receive the same quality health services that a person in a higher socioeconomic income receives. Information designed to educate the community must be provided in languages that the community can understand. A focus on social justice aims to social justice is to reduce the level of health inequalities in Australia. The four principles of social justice are equity, access, participation and rights. Social justice is what faces you in the morning. It is awakening in a house with an adequate water supply, cooking facilities and sanitation. It is the ability to nourish your children and send them to a school where their education not only equips them for employment, but reinforces their knowledge and understanding of their cultural inheritance. It is the prospect of genuine employment and good health: a life of choices and opportunity, free from discrimination. Social Justice Commissioner, Australian Museum, 1993. "Equity in health is not about eliminating all health differences so that everyone has the same level of health, but rather to reduce or eliminate those which result from factors which are considered to be both avoidable and unfair. Equity is therefore concerned with creating equal opportunities for health and with bringing health differentials down to the lowest levels possible."

Stoke

Stroke occurs when an artery supplying blood to the brain either suddenly becomes blocked (ischaemic stroke) or begins to bleed (haemorrhagic stroke). This may result in part of the brain dying, leading to sudden impairment that can affect a range of functions. Stroke often causes paralysis of parts of the body normally controlled by the area of the brain affected by the stroke, or speech problems and other symptoms such as difficulties with swallowing, vision and thinking. In many but not all cases stroke is preventable because many of its risk factors are modifiable, such as high blood pressure, physical inactivity, abdominal obesity and tobacco smoking

Treatment: Melanoma Skin Cancer

Surgery can be curative for thin melanomas and requires that the melanoma be removed with at least 1-2cm of normal skin around it. If the draining lymph nodes are involved they are removed. For thick melanomas some cancer centres offer high dose interferon after surgery, however many offer clinical trials of vaccines because there is no routine therapy mandated. Surgery should be the mainstay of treating relapsed melanoma if it is possible to remove all of the disease. For widespread disease, chemotherapy is borderline effective and drugs such as dacarbazine can palliate symptoms, as can biologicals like interferon or interleukin 2. Radiotherapy may palliate local symptoms

Symptoms and diagnosis: Non-Melanoma Cancer Skin Cancer

Symptoms of non-melanoma skin cancers include: •any crusty, non-healing sores •small lumps that are red, pale or pearly in colour •new spots, freckles or any moles changing in colour, thickness or shape over a period of weeks to months (especially those dark brown to black, red or blue-black in colour). Diagnosis is by biopsy (removal of a small sample of tissue for examination under a microscope).

Levels of responsibility for health promotion

The balance between personal and community responsibility for health is often discussed in public forums. The Ottawa Charter recognises that all levels of the community can support and promote better health The Ottawa Charter aims to develop partnerships and support networks, resulting in governments recognising that health promotion is most successful if individuals, groups, governments and other organisations take a shared responsibility and joint action to improve health outcomes for Australians. The public health approach acknowledges that effective health promotion requires intersectoral involvement. It also emphasises the importance of creating an environment that is fully supportive of positive health behaviours and actively involves the community.

Equity of access to health facilities and services

The Australian health care system aims to provide fair and equal access to all Australians. The Australian Government provides subsidies and discounts through the Medicare system and the Pharmaceutical Benefits Scheme (PBS). These two functions have improved access to health facilities and services for most Australians by subsidising the cost of accessing a health service. Unfortunately, due to a variety of factors, there are still some groups of people that have limited access to certain health facilities and services. The groups experiencing health inequity are often those affected by limited access to health facilities and services. There are a variety of factors that compound the challenge of access to health services, some of these unique to certain regions of Australia. Examples include: the decreasing supply of skilled health workers, e.g. doctors and nurses; the geographical size and nature of Australia; long waiting lists for elective surgery in public hospitals; increased numbers of people suffering from chronic disease; and a growing and ageing population. A number of initiatives have been put in place to address more localised or specific health inequities. Some of these include: •The Royal Flying Doctor Service •The Aboriginal and Torres Strait Islander peoples community controlled health services •Regional Health Services.

What role do health care facilities play in achieving better health for all Australians?

The Australian health care system consists of a wide variety of facilities and services. They mainly focus on diagnosis, treatment, rehabilitation and care for people who are sick or injured. These are often referred to as the primary health care components of the health system. Increasingly, there is recognition of the importance of prevention and health promotion. There is ongoing political debate about funding and allocation of resources to primary and preventative health care. To explore some of the factors relating to the nature of the health care system, funding and alternative health care approaches, click on the appropriate heading listed below.

Demand for health services and workforce shortages

The Australian health system is complex, with many types of service providers and a variety of funding and regulatory mechanisms. Those who provide services include a range of medical practitioners, other health professionals, hospitals, clinics, and other government and non-government agencies. Older people are much higher users of hospitals than their younger counterparts. As age increases, so does the average length of stay. On discharge from the hospital, older people are more likely than younger people to enter residential aged care or die. This is particularly the case for injury-related hospitalisations.

Explore the BreastScreen Australia (external website) cancer prevention strategy. How equitable is the access and support for all sections of the community?

The BreastScreen Australia program aims at reducing mortality and morbidity from breast cancer by actively recruiting and screening females without symptoms in the target age group 50-69 years. Services are available throughout Australia providing free 2 yearly mammographic screening and follow-up of any suspicious breast areas identified. Women aged 40-49 and over 70 years of age can access the service too. Since it began, in 1991, it has been quite successful, however, in 2004-2005, there were a few differences across geographic regions and groups. Higher participation rates in the inner regional, outer regional and remote areas were observed. This may be due to the use of mobile Breastscreen services in these areas. Participation rates in very remote areas and major cities areas were significantly lower than the national rate. The strategy seems quite equitable to females in the targeted age group and provides extensive follow up support for those attending the program.

What are the priority issues for improving Australia's health? High levels of preventable and chronic disease, injury and mental health problems

The National Health Priority Areas (NHPAs) are diseases and conditions that Australian governments have chosen for focused attention because they contribute significantly to the burden of illness and injury in the Australian community. The National Health Priority Areas include: •Cancer control (1996) •Cardiovascular disease (1996) •Injury prevention and control (1996) •Mental Health (1996) •Diabetes (1997) •Asthmas (1999) •Arthristis and musculoskeletal conditions (2002) •Obesity (2008) •Dementia (2012) These priority areas impose major costs on society in terms of health system use, reduced quality of life and days off work (because of illness or to care for people who are ill). Despite diseases and injuries remaining significant problems, the situation is improving on many fronts. The increase in the number of people with certain diseases such as diabetes and mental health issues however, is cause for concern. It is possible to identify risk factors for these diseases and illnesses, the determinants of health and ways that behaviours can be modified to reduce the impact of such conditions. If government agencies and health authorities give priority to reducing the high prevalence of such diseases and illnesses, the overall health status of Australians is likely to improve.

Increased population living with chronic disease and disability

The ageing population and greater longevity of individuals are leading to growing numbers of people, especially at older ages, with a disability and severe or profound core activity limitation. Coronary heart disease and cerebrovascular disease are the two leading causes of death and the major causes of disability among older Australians. The top ten causes of disease burden in Australia are chronic diseases. The prevalence of chronic disease increases with age. In 2004-5, more than 90% of coronary heart disease and osteoporosis, and over 80% of diabetes and arthritis, were reported for people aged 45 years and over. In 2003, the Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers (SDAC) one in five people in Australia had a reported disability with the rate being very similar for males and females. Disability was defined as any limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities. Examples range from hearing loss which requires the use of a hearing aid, to difficulty dressing due to arthritis, to advanced dementia requiring constant help and supervision. In 2003, just over half of the population aged 60 years and over had a reported disability (51%) and 19% had a profound or severe core-activity limitation. Of all people aged 60 years and over, less than half (41%) reported needing assistance, because of disability or old age, to manage health conditions or cope with everyday activities. However, people aged 85 years and over reported a much higher need for assistance than those aged 60-69 years (84% compared with 26%).

Variations among population groups CHD

The burden of CHD is greater in Aboriginal and Torres Strait Islander people than in other Australians—rates of heart attack events in adults aged 25 and over were 2.6 times as high in 2011. CHD death rates are also higher for Indigenous adults compared with other Australian adults (2.0 and 1.6 times as high for men and women, respectively, in 2009-2010). CHD death rates were 1.4 times as high for adults living in the lowest socioeconomic status (SES) groups compared with the highest SES groups in 2007

Identifying priority health issues

The determination of priorities for health spending can be very challenging. Different people in the community will take different perspectives. The Australian government has determined that along with epidemiology, the following considerations are important. This means that it is not simply morbidity and mortality rates that determine Australia's health priority issues. There are a range of factors that need to be considered. For example, groups who are identified as experiencing significant health issues such as Aboriginal and Torres Strait Islander peoples need significant support and resources to address any health inequities that exist.

As part of the syllabus requirements, you are required to critically analyse the importance of the five action areas of the Ottawa Charter through a study of TWO health promotion initiatives related to Australia's health priorities.

The following questions may help assist you to develop your understanding of the priority action areas. •Which of the five action areas are of greater significance for the priority issue? •How do the five action areas interact for the priority issue? Building healthy public Policy •Identify public policy developments that address priority issues •What impact do these public policies have on health (reducing the priority issue)? Creating supportive Environments •What community services exist to support/prevent people suffering from the priority issues? •Has there been environment modification to reduce the burden of disease? •What are some of the factors that influence these priority issues/population groups, for e.g. socio-cultural, physical, political, and economic? Reorienting Health services •What health services are available for people suffering from this priority issue? •Â Are these services aimed at prevention, cure or promotion of the issue? •Is access to these services equitable for all? What restricts access? What can be done to improve access? Developing personal Skills •What personal skills are needed to improve health behaviours that contribute to this priority issue? •What behaviour modifications are needed to improve health? •Where can reliable/accurate information be found? •Are there support services that can assist in developing positive health behaviours? Strengthening Community action •What motivates people to take action and work towards improving the burden of disease? •What initiatives have been developed to address priority issues? •Are these initiatives addressed by a sole agency or an intersectoral approach?

Groups at risk CVD

The groups at highest risk of developing cardiovascular disease are Aboriginal and Torres Strait Islanders peoples, socio-economically disadvantaged people, the elderly and those born in Australia. Within these broader groups are the more specific groups at risk, e.g. smokers, people with a family history of CVD, people who are overweight or obese, have a high fat diet, high cholesterol, high blood pressure, and 'blue-collar' workers (labourers and tradespeople).

Health care in Australia

The health care system includes a wide range of facilities and services delivered through institutions (e.g. hospitals, nursing homes) and non-institutions (e.g. doctors, dentists). These facilities and services are provided by local, state and federal governments as well as private individuals, businesses and organisations.

Health care in Australia

The health of all Australians is an important issue for government. People need to be healthy to live long, productive and fulfilling lives. The Australian health care system is vital in achieving a healthy nation. Its role is to provide facilities and services that meet the needs of all Australians. Facilities and services range from being government owned, funded and delivered, to being provided by private practitioners and organisations on a fee-for-service based system (or somewhere in between). The Australian health system is complex, with many different providers of services, and a range of funding and regulatory mechanisms. It promotes an intersectoral approach where government and non-governmental organisations (public and private sectors) work together at all levels to improve the provision of health care. Australia's health care system provides diagnosis, treatment, rehabilitation and health prevention and promotion campaigns. More recognition is being given to health promotion as an essential element in enabling people to increase control over, and to improve, their health. Explore the following links to develop a deeper understanding of Australia's health care system. Focus on investigating issues of access and adequacy in relation to social justice principles.

Groups experiencing health inequities

The health status of Australian's has improved over the last century. It is in line with several other developed countries. Australia has one of the highest life expectancies in the world, although, life expectancy in Australia is not uniform across all population subgroups.

Gestational diabetes hospitalisations

There were 37,279 hospitalisations with gestational diabetes recorded as the principal or additional diagnosis in 2013-14―8% as principal diagnosis and 92% as additional diagnosis. Women aged 30-34 had the highest hospitalisation rate for gestational diabetes (1,558 per 100,000 population), with the majority (82%) of gestational diabetes hospitalisations occurring between the ages 25 and 39 (Figure 6).

Risk factors CVD

The high prevalence of tobacco smoking, overweight and obesity, poor nutrition and diabetes among Indigenous Australians increases their risk of CVD. The presence of multiple cardiovascular risk factors is also very common in adult Indigenous Australians, with 53% of those surveyed in the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reporting three or four risk factors. Indigenous Australians are also likely to experience other factors recognised as important contributors to the development of CVD. These include environmental and socioeconomic risk factors, such as poor housing, low income and poverty; and psychosocial stressors, such as the death of a family member or close friend, serious illness or disability and inability to get a job.

Determinants: Lung Cancer

The incidence of lung cancer is decreasing in males, reflecting a decrease in the smoking rate over the past two decades. In females, the incidence of lung cancer has increased, and smoking levels in young females remain high. The changing role of females in the workplace might be a cause for this increase in lung cancer. Females are becoming more prevalent in a range of occupations that were previously the domain of males, and with these more 'high powered' positions often comes higher stress levels, or the projection of an image of being 'in control', of which smoking may be a factor. The media may also have a negative influence through the promotion of a link between smoking and weight control. Improved education and effective health promotion strategies have contributed to this behavioural change, as has society's changing attitude to smoking. Tobacco smoking is seen as less socially acceptable and the subsequent reduction in smoking rates can have a positive impact on lung cancer. People are more aware of passive smoking and less tolerant of other people's smoking, especially in public areas and the workplace. Improved workplace safety codes and equipment have also resulted in reduced exposure to carcinogenic substances (e.g. asbestos) in the workplace, such as mines. Low socioeconomic status often is associated with lower levels of education, and therefore an increased likelihood of employment in occupations that involve exposure to dangerous chemicals and pollutants. They tend to have higher rates of smoking which places them at further risk of developing lung cancer.

Determinants: Breast Cancer

The increased incidence of breast cancer in females can, in part, be linked to changes in family structure and the changing role of women in society. The average age at marriage is now later, as is the average age of a female's first pregnancy. This delay is a response to greater financial demands placed upon young families, and the desire of females to focus on establishing a career before having a family. The result has been more females experiencing their first full-term pregnancy after the age of 40 years, and thus increasing their risk of breast cancer.

The sociocultural, socioeconomic and environmental determinants Diabetes

The increased incidence of non-insulin dependent diabetes, type 2, is linked to social factors, such as socio-economic status. Education, employment status and occupation, income and wealth impact on the prevalence of diabetes. In Australia, socio-economically disadvantaged people are less likely to engage in physical activity, are more likely to consume large amounts of alcohol, are more likely to be obese, and, are more likely to have diets high in saturated fats. These are all risk factors for diabetes. In terms of cultural background, significantly higher rates of type 2 diabetes are found amongst Aboriginal and Torres Strait peoples, who are almost three times more likely to have diabetes than other Australians. This may be due to health risk factors discussed above as well as issues of lack of access to education and medical care. An ageing population has also contributed to an increased incidence of type 2 diabetes. As the Australian population ages, the most rapid growth in diabetes will occur in the age group of 45 years and over. Another contributing factor is the social acceptance of alcohol. Dangerous levels of alcohol consumption contributes to many health and social issues and has been identified as a significant risk factor for type 2 diabetes.

Determinants: Skin Cancer

The increasing incidence of skin cancer may be the result of improved education relating to detection. Education and media health promotion strategies have alerted the community to the importance of detecting skin anomalies early, and reporting for medical advice. This increased education and awareness has resulted in common, less-harmful skin cancers being recorded and treated more frequently than in the past. On the negative side, the media are sometimes guilty of promoting tanned skin as being desirable and thereby encouraging people to expose themselves to dangerous ultraviolet rays. Australian society has for many decades regarded a suntan as 'healthy' and attractive. Changing attitudes about sun tanning has had a positive impact on skin cancer rates, as it is now less fashionable to aspire to the traditional image of the 'bronzed Aussie'. Exposure to the sun in the workplace, and in recreational and school activities, is of concern with respect to rates of skin cancer. People of low socio-economic status more commonly have lower levels of education, and therefore are more likely to be employed in occupations that involve exposure to UV radiation.

What contributes most to burden of disease in Australasia? ( Australia and the Asian pacific) CVD

The largest contributors to the total burden were cancer (16%), musculoskeletal disorders (15%), cardiovascular diseases (14%) and mental and behavioural disorders (13%). t Cancer contributed 33% and cardiovascular diseases 26% of the fatal burden in 2010.

Groups experiencing health inequities

The population of a nation can be divided into specific groups when interpreting current health trends. This makes it easier to see if there is an unequal distribution of some illnesses and conditions within each group. Some have shorter lives, higher levels of risk factors that contribute to preventable disease and injury, and a lower level of access and/or use of health services. Although there may be many groups experiencing health inequity, the following groups have been identified as having special concerns in relation to their health. The consequences of having fewer resources, less power to make healthy lifestyle choices and a reduced capacity to be healthy all impact on their ability to achieve better health.

Type 1 diabetes hospitalisations

There were around 53,500 hospitalisations with type 1 diabetes recorded as the principal and/or additional diagnosis in 2013-14—13,360 as principal diagnosis and 40,148 as additional diagnosis. Of those with a principal diagnosis of type 1 diabetes: •rates were similar among males and females (58 and 60 per 100,000 population) •young people aged 10-19 had the highest rates of hospitalisation, with rates then declining and remaining relatively stable at older ages (Figure 2). Hospitalisation rates for type 1 diabetes showed a different age pattern when recorded as an additional diagnosis rather than a principal diagnosis. When recorded as an additional diagnosis, rates increased steadily up to age 79 and then declined (Data table).

The lungs Lung cancer

The lungs are the main organs for breathing, and make up part of what is called the respiratory system. The respiratory system also includes the nose, mouth, windpipe (trachea) and airways to each lung. The airways to each lung consist of large airways (bronchi) and small airways (bronchioles). When you breathe in (inhale), air goes into the nose or mouth, down the trachea and into the bronchi and bronchioles. At the end of the bronchioles, tiny air sacs called alveoli, pass oxygen into the blood and collect the waste gas (carbon dioxide). Carbon dioxide is released back into the atmosphere - and removed from the body - as you breathe out (exhale). The lungs look like two large, spongy cones. Each lung is made up of sections called lobes - the left lung has two lobes and the right lung has three. The lungs rest on the diaphragm, which is a wide, thin muscle that helps with breathing. A number of structures lie in the space between the lungs (the mediastinum), including: •the heart and large blood vessels •the windpipe (trachea), the tube that carries air into lungs •the oesophagus (the tube that carries food from the mouth to the stomach) •lymph nodes that collect lymph fluid and foreign matter from the lungs. The lungs are covered by two layers of a thin sheet of tissue called the pleura, which is about as thick as plastic cling wrap. Its inner layer (the visceral layer) is attached to the lungs and its outer layer (the parietal layer) lines the chest wall and diaphragm. Between the two layers is the pleural cavity (also called pleural space), which normally contains a small volume of fluid. This fluid allows the two layers of pleura to slide against each other so your lungs move smoothly against the chest wall as you breathe

Lung cancer symptoms

The main symptoms of lung cancer are: •a new dry cough or change in a chronic cough •chest pain or breathlessness •repeated bouts of pneumonia or bronchitis •coughing or spitting up blood. A person may have also experienced symptoms such as fatigue, weight loss, hoarseness or wheezing, difficulty swallowing, and abdominal or joint pain. Lung cancer symptoms can be vague and the disease is often discovered when it is advanced (spread to other parts of the body). Having any one of these symptoms does not necessarily mean that you have cancer. Some of these symptoms may be caused by other conditions or from the side effects of smoking. Talk to your doctor to have your symptoms checked. Sometimes, there are no symptoms and the cancer is detected during routine tests (often an x-ray or CT scan) for other conditions. If so, the cancer is more likely to be in an early stage of development (confined to the lungs).

The nature of the problem: CVD

The main underlying causal mechanism in cardiovascular disease (CVD) is the formation of plaque which occurs as a result of atherosclerosis. Atherosclerosis is a long term process where there is a build up of fat, cholesterol and other substances in the inner lining of the arteries. It is most serious when it leads to a reduced or blocked blood supply to the heart (causing angina or heart attack) or to the brain (causing a stroke). Cardiovascular disease continues to be one of the biggest health problems requiring attention in Australia.

infant mortality rate:

The number of deaths among children aged under 1 year in a given period, per 1,000 live births in the same period.

Mortality: Breast Cancer

The number of deaths from breast cancer increased from 1,435 in 1968 to 2,819 in 2012. Over the same period, the age-standardised mortality rate decreased from 17 deaths per 100,000 persons in 1968 to 11 deaths per 100,000 in 2012.

Mortality

The number of deaths from lung cancer increased from 2,883 in 1968 to 8,137 in 2012. Over the same period, the age standardised mortality rate increased from 32 deaths per 100,000 persons in 1968 to a high of 43 per 100,000 in 1989 before decreasing back 32 per 100,000 persons in 2012.

Mortality: Skin Cancer

The number of deaths from melanoma skin cancer increased from 315 in 1968 to 1,515 in 2012. Over the same period, the age-standardised mortality rate increased from 3.3 deaths per 100,000 persons in 1968 to 5.9 deaths per 100,000 in 2012.

Incidence: Breast Cancer

The number of new cases of breast cancer diagnosed increased from 5,368 in 1982 to 14,568 in 2011. Over the same period, the age-standardised incidence rate increased from 44 per 100,000 persons in 1982 to 60 per 100,000 persons in 2011.

Incidence Lung Cancer

The number of new cases of lung cancer diagnosed increased from 5,949 in 1982 to 10,511 in 2011. Over the same period, the age-standardised incidence rate decreased from 47 cases per 100,000 persons in 1982 to 43 per 100,000 persons in 2011.

Incidence Skin cancer

The number of new cases of melanoma skin cancer diagnosed increased from 3,534 in 1982 to 11,570 in 2011. Over the same period, the age-standardised incidence rate increased from 27 cases per 100,000 persons in 1982 to 48 per 100,000 persons in 2011.

2.Outline the impact of a growing and ageing population on carers and volunteer organisations.

The paid workforce is complemented by large numbers of informal carers who are ageing along with the rest of the population. Growth in the informal workforce is projected to be less than the anticipated increase in demand for home-based support, potentially resulting in a gap that will need to be filled. However, people over the age of 60 today are more healthier and more active than their counterparts in previous generations, and also have access to a health system which can now routinely offer "new for old" replacement of many worn body parts. This points to the possibility of a growing cohort of fit retirees who might be interested in spending some of their time as carers or volunteers. The next 2 decades will see increased demand for informal care in the working age population and in the very old population. The continued motivation of families to care for their own is a crucial factor in whether future needs will be met. Historically, this care has been met by women. Higher female labour force participation and lower rates of lifetime partnership are often cited as factors that may reduce the overall availability of informal care.

melanoma: Prevention, detection and potential for change

There is great potential in reducing melanoma. The quicker you spot the change, the easier it is to deal with. In fact, over 90% of melanoma can be cured when treated in its early stages. The best way to prevent melanoma is to plan to be indoors or under cover between 11 and 3 (daylight savings) or 10 and 2 (standard time), cover up with a broad brimmed hat, shirt, sunscreen and sunglasses.

How health promotion based on the Ottawa Charter promotes the social justice

The principles of social justice - equity, diversity and supportive environments - are an essential part of effective health promotion. The Ottawa Charter promotes social justice as it is designed to provide access to health opportunities for all members of a community and aims to reduce the level of health inequalities in Australia. Social justice means that the rights of all people in our community are considered in a fair and equitable manner. While equal opportunity targets everyone in the community, social justice targets the marginalised and disadvantaged groups of people in our society. In a socially just community public policies should ensure that all people have equal access to health care services, for example the Medicare system in Australia. People living in isolated communities should have the same access to clean water and sanitation as a person living in an urban area. People of a low socioeconomic background should receive the same quality health services that a person in a higher socioeconomic income receives. Information designed to educate the community must be provided in languages that the community can understand. The Ottawa Charter incorporates three basic health promotion strategies: to enable, mediate, and advocate which are needed and applied to all health promotion action areas.

Reorient Health Services

The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments. They must work together towards a health care system which contributes to the pursuit of health. The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components. Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person.

Symptoms and diagnosis Skin Cancer

The sooner a skin cancer is identified and treated, the better your chance of avoiding surgery or, in the case of a serious melanoma or other skin cancer, potential disfigurement or even death. It is also a good idea to talk to your doctor about your level of risk and for advice on early detection. Become familiar with the look of your skin, so you pick up any changes that might suggest a skin cancer. Look for: •any crusty, non-healing sores •small lumps that are red, pale or pearly in colour •new spots, freckles or any moles changing in colour, thickness or shape over a period of weeks to months (especially those dark brown to black, red or blue-black in colour). If you notice any changes consult your doctor.Your doctor may perform a biopsy (remove a small sample of tissue for examination under a microscope) or refer you to a specialist if he/she suspects a skin cancer. More information about early detection is available in Cancer Council's position statement on screening and early detection of skin cancer. You can also explore our section on how to check your skin for signs of skin cancer.

What are the symptoms of breast cancer?

The symptoms of breast cancer depend on where the tumour is in the breast, the size of the tumour and how quickly it is growing. Breast changes that may indicate breast cancer include: • a new lump or lumpiness, especially if it's only in one breast • a change in the size or shape of the breast • a change to the nipple, such as crusting, ulcer, redness or inversion • a nipple discharge that occurs without squeezing • a change in the skin of the breast such as redness or dimpling • an unusual pain that doesn't go away. There are a number of conditions that may cause these symptoms, not just breast cancer. If any of these symptoms are experienced, it is important that they are discussed with a doctor.

Outline factors that may influence an individual not being able to achieve healthy ageing.

There are a number of factors influencing healthy ageing including income, adequate and safe housing, a physical environment that facilitates independence and mobility, and personal health behaviours. Some risk factors have a cumulative effect over the life course and risk behaviours in middle age can lead to poorer health in late life.

Potential for prevention and early intervention

There are many behaviours that can influence the incidence and prevalence of diseases and conditions. These are often related to lifestyle behaviours, e.g. smoking, lack of physical activity and a diet high in fat and salt increase a person's risk of cardiovascular disease. By making lifestyle changes such as eating a healthy diet, regularly exercising, limiting alcohol intake and refraining from smoking, many lifestyle related conditions can be prevented. For example, cardiovascular disease has some very highly preventable risk factors including smoking and lack of physical activity. An individual could modify their lifestyle by stopping smoking and taking up regular exercise in order to decrease the risk of developing cardiovascular disease. For many Australians, behaviour change is difficult to achieve. There are many social and environmental factors that influence behaviour, e.g. access to mammograms for people from isolated areas. Making decisions about the allocation of resources for health issues is a complex one. Changing behavioural, social and environmental determinants provides great potential for decreasing the burden of poor health on the individual and society. It is through prevention and early intervention where some diseases and conditions, if detected in the early stages, can be treated successfully. Examples where early detection and intervention have been successful in reducing mortality rates include breast and skin cancer

Benefits of partnerships

There are many benefits from adopting, supporting and sustaining an intersectoral action approach to health promotion, including: •pooling of resources, knowledge and expertise •access to resources and skills needed to understand and solve complex issues which sometimes a single sector cannot achieve alone •greater capacity to tackle and resolve complex health and social problems that individual sectors have been unable to achieve by themselves •development of networks, that allow partners to address current problems more effectively and position them to respond better to future issues •implementation of a range of health, social service, criminal justice and housing services •reductions in duplication of effort among different partners and sectors •improved population health and well-being •reduced demand for health care and social services in future. •increased public awareness •networks of partners who continue to work together •better health outcomes for individuals.

There are many benefits of adopting a healthy lifestyle, even at an older age, to individuals as well as the nation. Identify benefits for the individual as well as the community.

There are many benefits of adopting a healthy lifestyle, even at an older age, to individuals as well as the nation. They include the prevention of disease and functional decline, extended longevity and enhanced quality of life. The healthier an individual, the less economic and medical burden that person places on governments and the health care system. Healthy ageing will result in: ◦fewer healthcare needs ◦less chronic disease and disability ◦less pressure placed on the national health budget and health care system ◦individuals who are less likely to leave the workforce for health reasons ◦individuals who are more likely to enjoy retirement ◦individuals who are able to contribute more to their own communities.

Additional information CHD

There are no reliable national and jurisdictional data on the number of new cases of CHD each year. Consequently, proxy measures have been developed that combine hospital and mortality data to estimate new cases of heart attack (including unstable angina, also known as 'acute coronary syndrome'). More data on the care pathways of patients with CHD as they move through the health system, and on the medicines prescribed in the various settings, could lead to better identification of any gaps in health care, and to potentially better care overall.

What are the different types of breast cancer?

There are several different types of breast cancer. • Ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) are non-invasive breast cancers that are confined to the ducts or lobules of the breast. • Invasive ductal or lobular carcinoma is an invasive breast cancer that starts in the ducts or lobules of the breast and can spread into the breast tissue. Invasive breast cancer may be confined to the breast and lymph nodes in the armpit (early breast cancer) or may have spread outside the breast to other parts of the body (secondary breast cancer). • Paget's disease of the nipple is a rare form of breast cancer that affects the nipple and the area around the nipple (the areola) and is commonly associated with an invasive cancer elsewhere in the breast. • Inflammatory breast cancer is a rare form of invasive breast cancer that affects the lymphatic vessels in the skin of the breast, causing the breast to become red and inflamed

Types of lung cancer

There are several types of lung cancer, which are classified according to the type of cells affected. Cancers are named for the way the cells appear when viewed under a microscope. Non-small cell lung cancer (NSCLC) - Makes up over 60% of lung cancers. NSCLC is classified as: •squamous cell carcinoma (it mainly affects the cells that line the tubes into the lungs (bronchi) •adenocarcinoma (affecting smaller airways) •large cell carcinoma (large round cells under the microscope). Other less common subtypes also exist. Small cell lung cancer (SCLC) - Makes up about 12% of lung cancers. SCLC tends to start in the middle of the lungs, and it usually spreads more quickly than NSCLC. Types include: •small cell carcinoma •mixed small cell/large cell carcinoma. Less common lung cancers - Other less common cancers can form in the thoracic (or chest) area. These are known as thoracic cancers and include thymomas, mediastinal tumours and chest wall tumours. Mesothelioma - A rare type of cancer that affects the covering of the lung (the pleura). It is almost always caused by exposure to asbestos. It is very different to lung cancer. Call Cancer Council 13 11 20 for information about mesothelioma.

Outline the services provided by the following health solutions and the groups they hope to increase access to health facilities and services

There are some innovative solutions to health issues arising out of Australia's unique history and needs. Outline the services provided by the following health solutions and the groups they aim to enable access to health facilities and services. ◦The Royal Flying Doctor Service (RFDS) provides aeromedical emergency health services, primary and community health care clinics at remote sites (for example, routine health checks and advice, immunisation, child health care, and dental, eye and ear clinics), telehealth consultations via radio, telephone or videoconference, pharmaceutical supplies at remote sites and transfers of patients between hospitals. This service increases the access to health facilities and emergency care for people living in rural and isolated areas. Aeromedical emergency and health care services are provided 24-hours-a-day, 365-days-a-year to people who live, work or travel in Australia's remote areas. ◦The Aboriginal and Torres Strait Islander peoples community controlled health services aim to meet the special needs of Indigenous Australians. Indigenous-specific health services are important providers of comprehensive primary health care. These services have funding provided by the Australian Government, state and territory governments, or both. The state and territory governments provide community based Indigenous primary health-care services and offer many types of care, including management of acute and chronic health conditions, preventive health measures (such as immunisation and screening), health promotion activities, transport services and assistance in accessing other appropriate community and health services. Due to the local input from the Aboriginal community, these services are having success. A small number of services provide specific programs only, such as health promotion and counselling. (Department of health and ageing, 2008) ◦Through regional health services, community identified priorities for health services in rural and remote areas are met through a flexible mix of Commonwealth and State funded services. Regional health services work with regional and rural communities to identify local priorities and develop and support integrated services to address these priorities. A wide range of services can be supported under the Regional Health Services program, including community health care, child health services, substance misuse and abuse counselling, mental health services and aged care. The Regional Health Services Program improves access to an increased range of services and programs for regional and rural communities. It enhances the skills of local health professionals, and encourages doctors and other health professionals into small communities.

Screening: Non-Melanoma Cancer Skin Cancer

There is no organised screening program for skin cancer. People should be aware of their skin and see a doctor if there are any significant changes, such as changes in shape, colour or size of a pigmented lesion or a new lesion.

All diabetes hospitalisations

There were over 900,000 hospitalisations where diabetes was recorded as the principal and/or additional diagnosis in 2013-14, according to the AIHW National Hospital Morbidity Database. This represents 9% of all hospitalisations in Australia. In 2013-14 there were: •44,573 hospitalisations with diabetes as a principal diagnosis (the diagnosis largely responsible for hospitalisation). •884,337 hospitalisations with diabetes as an additional diagnosis (a coexisting condition with the principal diagnosis or a condition arising during hospitalisation that affects patient management). Overall diabetes is far more likely to be recorded as an additional diagnosis than a principal diagnosis―especially for type 2 diabetes. However, type 1 diabetes is more likely to be recorded as principal diagnosis.

Complementary and alternative health care approaches

These refer to treatments and services that fall outside of those practiced by the majority of medical practitioners. Consumers have been turning to alternative health care services and products for treatment and prevention of many health conditions.

Treatment options Breast cancer

Treatment and care of people with cancer is usually provided by a team of health professionals - called a multidisciplinary team. Treatment for breast cancer depends on the stage and type of the disease, the severity of symptoms and the person's general health. Treatment usually involves surgery to remove part or all of the affected breast, and removal of one or more lymph nodes from the armpit. Breast reconstruction may be available for women who have the whole breast removed (mastectomy). Radiotherapy, chemotherapy, hormonal therapies, and/or targeted therapies, may also be used. Research is ongoing to find new ways to diagnose and treat different types of cancer. Some people may be offered the option of participation in a clinical trial to test new ways of treating breast cancer.

Incidence and mortality Skin cancer

Two in three Australians will be diagnosed with skin cancer by the time they are 70. Over the past decades, the incidence of skin cancer has risen in Australia. From 1982 to 2010 melanoma diagnoses increased by around 60%. From 1998 to 2007, GP consultations to treat non-melanoma skin cancer increased by 14%, to reach 950,000 visits each year. Non-melanoma skin cancer is the most common type of skin cancer. This type of skin cancer is more common in men, with almost double the incidence compared to women. Over 434,000 people are treated for one or more non-melanoma skin cancers in Australia each year. Excluding non-melanoma skin cancer, melanoma is the third most common cancer in both Australian women and men, and the most common cancer in Australians aged 15-44 years. In 2011, 11,570 people in Australia were diagnosed with melanoma. In 2012, 2,036 people died from skin cancer in Australia. The majority of these deaths were due to melanoma, with 1,515 deaths from melanoma that year, compared with 521 deaths from non-melanoma skin cancers. The five-year relative survival rate for melanoma is 90% for Australian men and 94% for Australian women.

Describing chronic disease: CVD cardiovascular conditions (such as coronary heart disease and stroke)

Typically, chronic diseases are long-lasting, and have persistent effects. They can result from complex causes, which can include a number of different health risk factors. They are a leading cause of disability, and have major impacts on health and welfare services (AIHW 2010). Many people have more than 1 chronic illness or condition at the same time. Chronic diseases can range from mild conditions such as short- or long-sightedness, dental decay and minor hearing loss, to debilitating arthritis and low back pain, and to life-threatening heart disease and cancers. These conditions may never be cured completely, so there is generally a need for long-term management. Once present, chronic diseases often persist throughout life, although they are not always the cause of death.

Staging: Non-Melanoma Cancer Skin Cancer

Usually a biopsy is sufficient to determine the stage of a non-melanoma skin cancer. In cases of squamous cell carcinoma, lymph nodes may be examined to see if the cancer has spread. The staging system used is the TNM system, which describes the stage of the cancer from stage I to stage IV.

Remedial massage therapy: Involves the manipulation of soft tissue in the body. This action helps to break up fibrous tissue and loosen stiff joints.

What is it used for? Encourage relaxation, soothe muscles, relief tension pain, aid in healing of some injuries.

Aromatherapy: Aromatic essential oils made from plants and flowers are blended for each individuals needs. Different oils are used for different solutions, e.g. lavender for relaxation. They may be used as a topical application, massage, inhalation or water immersion.

What is it used for? Enhance wellbeing, stress relief, enhance healing process.

Naturopathy: Based on treating the whole person and not just the affected area. Uses natural approaches such as diet, herbs, lifestyle advice, hydrotherapy, soft tissue manipulation and homeopathy.

What is it used for? Maintain health and wellbeing, Common disorders treated include, fatigue, digestive complaints, mood disorders and depression, allergy and fertility problems.

Chinese herbal medicine: Based around the theory that the body is a dynamic energy system. Traditional Chinese herbs have been used for centuries because of their healing power. They have also influenced more modern types of medicine. It includes herbal therapy, acupuncture, dietary therapy and exercises in breathing and movement.

What is it used for? Maintain or restore harmony in the body and balance the two types of energy (Yin and Yang)

Acupuncture: Small needles are inserted into various points in the body to stimulate nerve impulses. It is based on traditional Chinese practice where energy (qi) is channelled around the body using the needles.

What is it used for? Pain relief, improve organ function, stress relief.

Causes of lung cancer

While the causes of lung cancer are not fully understood, there are a number of risk factors associated with developing the disease. These factors include: Age - Lung cancer is most commonly diagnosed in people aged 60 years and older. Family history - Having family members who have been diagnosed with lung cancer increases your risk. Personal history - The risk of developing lung cancer is increased if you have been previously diagnosed with lung diseases such as lung fibrosis, chronic bronchitis, emphysema, and pulmonary tuberculosis. Tobacco smoking - About one in 10 smokers develop lung cancer. Studies from a number of countries suggest that a life-long smoker has between a 10 and 20% risk of developing lung cancer. However, compared with non- smokers, smokers are more than 10 times more likely to develop lung cancer. In Australia about 90% of lung cancer cases in males, and 65% in females, are estimated to be a result of tobacco smoking. The risk of lung cancer among smokers is strongly related to the length of time and the number of cigarettes a person has smoked. Passive smoking - Breathing in someone else's tobacco smoke (passive or secondhand smoking) can cause lung cancer. Non-smokers who have been frequently exposed to secondhand smoke are 20-30% more likely to develop lung cancer than non-smokers who have not been exposed. People who have never smoked and have not been around secondhand smoke have about a 0.5% risk of developing lung cancer. Exposure to asbestos - Although the use of asbestos has been banned nationally since 2003, it may still be in some older buildings. People who are exposed to asbestos have a greater risk of developing cancer. Some people are exposed to asbestos at work or during home renovations. People who have been exposed to asbestos and are, or have been, a smoker are at even greater risk. Exposure to other elements - Contact with the processing of steel, nickel, chrome and coal gas may be a risk factor. Exposure to radiation and other air pollution, such as diesel fumes, also increases the risk of lung cancer. If you are concerned about your risk factors, talk to your doctor. If you are a smoker If you need help quitting, call Quitline on 13 78 48. Smoking is addictive and this is the main reason people continue to smoke even though many may be concerned about the risks or have tried to quit. Your doctors understand this and will consider it when caring for you. They shouldn't regard you negatively because you are (or were) a smoker.

What were the biggest risk factors for Australasia? CVD

While these risk factors are known to be associated with many diseases, the main conditions affected by these risk factors were cancer, cardiovascular diseases, and diabetes, urogenital, blood and endocrine diseases combined.

Risk factors CVD

Whilst cardiovascular disease is the most common cause of death in Australia, it is also highly preventable. The factors that make the occurrence of a disease more likely are called risk factors. These risk factors can be modifiable or non-modifiable. Non-modifiable risk factors for CVD are age (risk increases with age), heredity (people with a family history of CVD are more likely to develop a CVD) and gender (males are more at risk of CVD). Modifiable risk factors for CVD are tobacco smoking, high blood pressure, high blood cholesterol, insufficient physical activity or sedentary lifestyle, overweight and obesity, poor nutrition and diabetes. A high intake of alcohol also increases the risk of stroke (Australia's health 2008, 2008, p.182). Smoking is the largest modifiable risk factor. Smokers are up to five times more likely to develop CVD than non-smokers. Blood pressure (hypertension) is one of the most common causes of heart disease as it can overload the heart and blood vessels. A diet high in saturated fat can raise blood cholesterol levels and generally, the higher the blood cholesterol level, the higher the risk of heart disease. People who are overweight or obese are at an increased risk of heart disease. This is due to the extra burden placed on the heart and lungs, and the link between obesity and increased blood fats and high blood pressure. Abdominal obesity (waist-to-hip ratio) is often a good indicator of an individual's risk of developing CVD. People who do not engage in regular physical activity can have a less efficient circulatory system and a tendency to put on weight. The contraceptive pill, poor nutrition, alcohol and diabetes have also been identified as increasing the risk by influencing other risk factors indirectly.

a.Analyse use of general practitioner's (GPs) by older people

a.Older Australians use the services of GPs more often than younger people. Approximately 25% of these attendances were older patients. For older Australians the average number of visits was 8.6 per person in 2005-06 compared with about 4.0 per person for people aged under 65. Although rates of use increased with age and were highest for people aged 85 years and over, visits in this oldest age group represented less than 4% of all visits to the GP. For each age group, older women were more likely than older men to use the services of a GP.

1.According to The burden of disease and injury in Australia 2003 (Begg et al. 2007), in 2003, Australia racked up 2.6 million years of lost 'healthy life' due to disease and injury. a.What is meant by the term DALY (disability-adjusted life year)? b.Analyse DALY and disability trends for older people and identify the chronic diseases and disabilities that affect this age group.

a.There are many benefits of adopting a healthy lifestyle, even at an older age, to individuals as well as the nation. They include the prevention of disease and functional decline, extended longevity and enhanced quality of life. The healthier an individual, the less economic and medical burden that person places on governments and the health care system. Healthy ageing will result in: ◦fewer healthcare needs ◦less chronic disease and disability ◦less pressure placed on the national health budget and health care system ◦individuals who are less likely to leave the workforce for health reasons ◦individuals who are more likely to enjoy retirement ◦individuals who are able to contribute more to their own communities. b.There are a number of factors influencing healthy ageing including income, adequate and safe housing, a physical environment that facilitates independence and mobility, and personal health behaviours. Some risk factors have a cumulative effect over the life course and risk behaviours in middle age can lead to poorer health in late life.

b.Outline the main problems for people aged over 65 managed by GPs.

b.The top five problems managed by GPs for both older men and women are hypertension, immunisation, diabetes, osteoarthritis and lipid disorders. Diseases of the cardiovascular system, skin, and musculoskeletal (osteoarthritis, back complaint) and respiratory systems are also relatively common problems. Many of the most common problems managed in older Australians are chronic in nature and are largely preventable—problems such as hypertension, heart disease, some forms of diabetes and osteoarthritis. Australia's National Chronic Disease Strategy provides national direction for improving chronic disease prevention and care across Australia. One of its key directions is to encourage primary health care, particularly general practice, to engage in early intervention, through appropriate screening and identification of risk factors, and support for self-management.

c.Assess the length of stay in hospitals for older people.

c.Not only does the rate of separation from hospital increase with age, so too does the average number of days per stay. In 2004-05, patients aged 65 years and over accounted for 11.4 million patient days, or 48% of all patient days. The number of days that a patient stays in hospital is a function of patient clinical factors, for example the conditions being treated, type of treatment received, patient response to treatment and functional status. Other factors relating to individual circumstances include living arrangement and availability of support at home following discharge; and health system factors, e.g. hospital discharge planning arrangements and the availability and settings for receipt of care other than acute care, such as rehabilitation care and geriatric management and evaluation.

g.Predict the effect on an ageing population on health expenditure.

g.It is estimated that total health expenditure (including residential aged care - high care) will increase by 127% over the three decades from 2003-2033. This takes into account the predicted favourable trends in the disease rates of cardiovascular disease, chronic obstructive pulmonary disease, cancers, injuries and other diseases. Ageing ($29 billion) and normal overall population growth ($28 billion) are the main causes for the overall increase projected for the period. Residential aged care expenditure is expected to show the greatest growth (242% increase) because of the ageing population. Pharmaceutical expenditure has the next highest projected growth. (Draft Support Document, PDHPE Stage 6. 2009. BOS.)

d.What are Community Aged Care Packages (CACPs)? Outline the incidence of these in Australian communities since their inception. Who utilises these most?

d.Community Aged Care Packages (CACPs) are funded by the Australian Government and began in 1992 as an alternative to low-level residential aged care. It provides home-based care to frail or disabled older people living in the community following an Aged Care Assessment Team (ACAT) assessment and recommendation. A CACP provides a package of assistance managed by a care coordinator, who manages the complex care needs of the recipients and arranges provision of the following types of assistance: personal care, domestic assistance, social support, assistance with meal preparation and other food services, respite care, rehabilitation support, home maintenance, delivered meals, linen services and transport. The CACP program has grown rapidly since its inception, from 235 packages in 1992 to 35,383 at 30 June 2006. At 30 June 2006, a large proportion of CACP recipients were aged 85 and over (38%), with 3% aged 95 and over. Around 6% of package recipients were younger than 65, and less than 1% of recipients were under the age of 50. Female recipients predominated in all age groups, varying from 59% of all recipients under age 50, to 74% of all recipients aged 85 years and over. Over 59% of all package recipients were women aged 75 years and over.

e.What is Residential Aged Care? Who utilises these facilities most?

e.Permanent residential aged care provides accommodation and care services to people who are no longer able to support themselves or be supported by others in their own homes. Government makes a substantial financial contribution to residential aged care. Rates of use of residential aged care increase with age. At all ages there has been a decrease in usage rates between 2000 and 2006 which is particularly marked among the older groups. To some extent this reflects the growing availability and use of community care options by people who are assessed as eligible for residential aged care. (Older Australians at a glance, 4th Edition. 2007. AIHW. p.138)

f.What is Palliative Care? Discuss the use of Palliative Care by older people.

f.Palliative care is the specialised care of people who are terminally ill. The care adopts a holistic approach that emphasises quality of life and the relief of suffering. Care may be provided by specialist and non-specialist providers. In 2005-06, there were 25,741 palliative care separations from Australian hospitals for admitted patients who received care in a specific hospice or palliative care unit within a hospital, according to a palliative care program, or where the principal clinical intent was deemed to be palliative. The average length of stay for these separations was 12.4 days and 79% were from public hospitals. Fifty-five per cent of all palliative care separations were for males and 71% were for patients aged 65 years and over. Seventy-three per cent of palliative care separations had a principal diagnosis of cancer. (Australia's health 2008. 2008. AIHW. p.380)

How common is coronary heart disease?

t I n 2011-12, an estimated 585,900 Australians had CHD, with the condition being more common in men (3.3%) than women (2.0%) and among those aged 70 and over (15% compared with 2.2% for those aged 25-69) (ABS 2013). t I n 2011, an estimated 69,900 people aged 25 and over had a heart attack. There has been a 20% fall in heart attack rates over the last 5 years (age-standardised rate of 427 per 100,000 people in 2011 compared with 534 in 2007) (see Chapter 9 'Indicators of Australia's health' for more information).

Variations among population groups: Diabetes

•Aboriginal and Torres Strait Islander people were over three times as likely as non-Indigenous Australians to have diabetes, in particular type 2 diabetes (ABS 2013b). •People in the lowest socioeconomic status (SES) groups were more likely to have diabetes compared with people in the highest SES groups. •People living outside Major cities were more likely to have diabetes compared with people living in Major cities (ABS 2013c).

Lung cancer statistics

•About 11,270 people (59% males, 41% females) were diagnosed with lung cancer in Australia in 2012 •It is the fifth most common cancer in Australia •It is most commonly diagnosed in people aged 60 years and older.

Health care: Diabetes

•Diabetes was the principal diagnosis for around 40,000 hospitalisations in 2010-11, and was an additional diagnosis for a further 180,000 hospitalisations. Together, these represented 2.5% of all hospitalisations in 2010-11. •In 2012, almost 8.2 million prescriptions were dispensed for diabetes medicines: 11% for insulin and 89% for other blood glucose-lowering medications, with about half of these being for metformin. •Between 1992 and 2012, the annual number of prescriptions filled for metformin rose by an average of 8% a year; for other blood glucose-lowering medications the annual rise was 7%, and for insulin it was 5%. •In 2011, about 53,500 people began using insulin to treat their diabetes. •In 2011, there were 10,510 insulin pump users in Australia—representing 10% of people with type 1 diabetes. Almost half of all insulin pump users were aged under 25.

Deaths: Diabetes

•Diabetes was the sixth leading cause of death in Australia in 2011, contributing to 10% of all deaths. In around 4,200 deaths diabetes was the underlying cause and in a further 10,900 it was an associated cause of death

Questions: Ottawa Charter

•How does health promotion affect health status? •What impact does health promotion have on the priority issues? •What impact does health promotion have on health care in Australia

Questions Diabetes

•Justify why diabetes is a health priority issue? •Which groups experiencing health inequities are more susceptible to diabetes? •What role do health care facilities and services play in preventing and treating diabetes? •Identify a health promotion campaign that aims to prevent diabetes and analyse how it addresses the five action areas of the Ottawa Charter. •Make a judgement on how effective the health promotion campaign is.

How common is diabetes?

•There are an estimated 1 million people aged 2 or over with diagnosed diabetes in Australia. However, this is likely to be an underestimate—for every 4 adults with diagnosed diabetes, there is estimated to be 1 with undiagnosed diabetes (ABS 2013a). •Of all people with diabetes, around 85% have type 2 diabetes and 12% have type 1 diabetes (ABS 2013a). In addition, gestational diabetes affects about 1 in 20 pregnancies each year. •Diabetes is becoming more common—the rate of self-reported diabetes more than doubled, from 1.5% to 4.2% of Australians, between 1989-90 and 2011-12. •In 2011-12, diabetes was more common in men (6%) than women (4%) and was more common in older age groups—affecting 15% of those aged 65-74 compared with 5% for those aged 45-54 (ABS 2013a). •In 2011, there were around 2,400 new cases of type 1 diabetes, with half of these being among people aged 18 or under. Rates of type 1 diabetes remained stable over 2000-2011, with age-standardised rates of around 10 to 12 new cases per 100,000 population per year. •In 2011-12, there were around 49,800 new cases of diagnosed type 2 diabetes among people 10 and over, based on preliminary findings. Despite nearly all cases (92%) occurring in those aged 40 and over, there were around 430 new cases among children and young people aged 10-24—even though type 2 diabetes is generally regarded as a disease of adulthood.

Questions : Aging populations

•Why do elderly people experience health inequities? •Identify priority issues for older Australian's. •Assess the impact of an ageing population on health care facilities and services. •Identify a health promotion campaign that is aimed at ageing populations and analyse how it addresses the five action areas of the Ottawa Charter. •Make a judgement on how effective the health promotion campaign is

QUESTIONS

•Why is CVD a health priority issue? •Which groups experiencing health inequities are more susceptible to CVD? •What role do health care facilities and services play in preventing and treating CVD? •Identify a health promotion campaign that aims to prevent CVD and analyse how it addresses the five action areas of the Ottawa Charter. •Make a judgement on how effective the health promotion campaign is.

Questions

•Why is cancer a health priority issue? •Which groups experiencing health inequities are more susceptible to cancer? •What role do health care facilities and services play in preventing and treating cancer? •Identify a health promotion campaign that aims to prevent cancer and analyse how it addresses the five action areas of the Ottawa Charter. •Make a judgement on how effective the health promotion campaign is.

Protective Factor: Lung Cancer

•avoid exposure to tobacco smoke •avoid exposure to hazardous materials such as asbestos

Protective Factor: Skin Cancer

•avoid sunlight •reduce exposure to the sun by wearing a hat, sunscreen, protective clothing and sunglasses •monitoring skin changes and having regular check ups

Protective Factor: Breast Cancer

•consumption of a diet high in fruits and vegetables, and low in fat •practising self-examination •regular mammograms if over the age of 50 years •familiarity with family history

Private health insurance: Disadvantages

◦Can be expensive and not affordable for people of low SES ◦Premiums are the same for all regardless of whether they use it or not on top of being charged the Medicare Levy ◦Premiums do not cover all expenses, therefore individuals may still need to pay for the gap amount

Private health insurance: Advantages

◦Choice of hospital services ◦Health cover while overseas ◦Private rooms in hospital where available ◦Subsidised ancillary cover e.g. physiotherapy, chiropractic care ◦Shorter waiting lists for surgery ◦Decreased demand on public facilities ◦Peace of mind

Medicare: Disadvantages

◦Long waiting lists for elective surgery ◦Additional costs and further strain on hospitals ◦Additional costs to state governments ◦Patients are still required to pay the gap amount ◦Limitations to the level of choice available e.g. choice of doctor in a hospital

Medicare: Advantages

◦Provides access to free treatment as a public patient in public hospital ◦Subsidised treatment by medical practitioners e.g. GP's ◦Increases equity and access to services for people of low SES ◦Broad range of high quality health care provided including emergency health care ◦Availability of bulk billing