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Copyrighted Material i i i “c01HowArePriorityIssuesForAustraliasHealthIdentified” — 2018/6/12 — 3:24 — page 3—#1 i TOPIC 1 How are priority issues for Australia’s health identified? OVERVIEW 1.1 Measuring health status 1.2 Identifying priority health issues 1.3 Topic review OUTCOMES In this topic students will: • describe the nature and justify the choice of Australia’s health priorities (H1) • analyse and explain the health status of Australians in terms of current trends and groups most at risk (H2) • critically analyse key issues affecting the health of Australians and propose ways of working towards better health for all (H15) • devise methods of gathering, interpreting and communicating information about health and physical activity concepts. (H16) COPYRIGHTED MATERIAL TOPIC 1 How are priority issues for Australia’s health identified? 3 i i i i i i i “c01HowArePriorityIssuesForAustraliasHealthIdentified” — 2018/6/12 — 3:24 — page 4—#2 i Australians enjoy relatively high levels of health compared to many other nations. Statistics revealed in figure 1.1 show that we have a relatively long life expectancy, declining death rates and reasonable accessto health care. FIGURE 1.1 Australia at a glance 80.3 2012–14 A boy born between 2012 In 2015, 76% of people and 2014 can expect to live aged 15–64 held a Year 47.2 1890 to 80.3 years and a girl 12 or non-school qualication 84.4 years (ABS 2015a). at Certicate II level or above 84.4 2012–14 This compares with 47.2 (ABS 2015b) and 50.8 years, respectively, 50.8 1890 in 1890 (ABS 2014a). In 2014: In 2014, labour force participation rate for Australians aged 15–64 was 76% (ABS 2015e) Our estimated population in 3.0% of Australians were 2016 is 24.4 million, Aboriginal and Torres Strait of which: Islander — 714 000 people Almost 1 in 3 (30%) (ABS 2014b) employed people aged 15–64 worked part-time (ABS 2015e) 28% were born overseas — 4.6 million 6.6 million people (ABS 2015f) are aged 0–14 In 2013–14: 3.1 million are aged 15–24 71% lived in Major cities — 3.6 million 16.6 million people 31% of households are aged 25–34 owned their own homes outright 3.3 million are aged 35–44 18% lived in Inner regional areas — 4.3 million people 3.2 million are aged 45–54 36% had a mortgage 2.8 million 8.9% lived in Outer regional are aged 55–64 areas — 2.1 million people 3.7 million are aged 65 or older 26% were renting from (ABS 2013) 1.4% lived in Remote areas — a private landlord 324 000 people 4.0% were renting from a 0.9% lived in Very remote state or territory housing areas — 208 000 people (ABS 2015g) authority (ABS 2015d) Source: Australian Institute of Health and Welfare It would seem we are a healthy population and we benefit from Australia’s generally high standards of health care and the wide range of available health services. However, there are many health concerns that the federal, state and local governments identify as health priority issues to be addressed in order to achieve better health for all Australians. Health priority issues are those health issues that are of greatest concern to governments and support organisations due to the effect they have on the overall health of Australians and the burden of health on the economy. For example: • certain groups in society are more at risk of health problems than others • some diseases and other health problems are more prevalent than others • changes in the structure of our population affect the types of health service that people require. 4 HSC CORE 1 Health priorities in Australia i i i i i i i “c01HowArePriorityIssuesForAustraliasHealthIdentified” — 2018/6/12 — 3:24 — page 5—#3 i Core 1 Question 1 Topic 1 Concept 1 Health status of Australians Summary screen and practice questions eLesson: Health trends in Australia (eles-2922) 1.1 Measuring health status To identify health priority issues within a population it is necessary to understand the health status of that population and its subgroups. The health status of a nation is the pattern of health of the population in general over a period of time. To create an accurate and comprehensive picture of the health status of Australians, a range of information needs to be accessed. We measure health status through the process of data and information collection known as epidemiology, which is the study of disease in groups or populations. 1.1.1 Role of epidemiology FIGURE 1.2 Data for epidemiological Epidemiology is used by governments and health-related studies are gathered from many sources, organisations to obtain a picture of the health status of a pop- including the information collected by doctors and other health professionals, ulation, to identify the patterns of health and disease, and health surveys by government departments analyse how health services and facilities are being used. and health-related organisations, and the Epidemiology considers the patterns of disease in terms of: register of births and deaths. • prevalence (the number of cases of disease in a population at a specific time) • incidence (the number of new cases of disease occurring in a population) • distribution (the extent) • apparent causes (determinants and indicators). Observations and statistics help researchers and health authorities to: • describe and compare the patterns of health of groups, communities and populations • identify health needs and allocate health-care resources accordingly • evaluate health behaviours and strategies to control and prevent disease • identify and promote behaviours that can improve the health status of the overall population, such as eating less fat and more fibre. The data collected through the epidemiological process focus on quantifiable and direct measures of ill health (orthe lack of good health), such as patterns of illness, injury and death, rather than on the positive qualities of health and well-being. Figure 1.3 shows the wide variety of sources used to collect data for epidemiological studies. Epidemiology commonly uses statistics on: • births • deaths TOPIC 1 How are priority issues for Australia’s health identified? 5 i i i i i i i “c01HowArePriorityIssuesForAustraliasHealthIdentified” — 2018/6/12 — 3:24 — page 6—#4 i • disease incidence • disease prevalence • contact with health-care providers • hospital use (treatment received in hospitals for medical problems) • injury incidence • work days lost • money spent on health care. FIGURE 1.3 The epidemiological process revealing Australia’s health status Health status (groups, communities, populations, nation) Collection bodies (Examples of) National Health Australian National Injury NSW Roads Department Workplace National Heart and Medical Bureau of Surveillance and Maritime of Health Safety Australia Foundation Research Council Statistics Unit Service Collection, observation, analysis, reporting, dissemination, comparisons Information/statistics Vital statistics Population surveys Surveillance Health outcomes • Life expectancy • Baselines • Database • Changes — declines, • Disease incidence and prevalence • Indicators • Monitoring increases in rates • Hospital utilisation • Self-reporting • Reporting • Procedures • Cost of health care • Monitoring • Interventions • Morbidity • Mortality Limitations of epidemiology Epidemiology has proved to be an effective approach to measuring health status, but it has some limitations. For example, epidemiological statistics: • do not always show the significant variations in the health status among population subgroups (for example, between Aboriginal and non-Aboriginal Australians) • might not accurately indicate quality of life in terms of people’s level of distress, impairment (loss or abnormality of body structure or of a physiological or psychological function), disability or handicap. Statistics tell us little about the degree and impact of illness. • cannot provide the whole health picture. Data on some areas, such as mental health, are incomplete or non-existent. • fail to explain ‘why’ health inequities persist • do not account for health determinants — the social, economic, environmental and cultural factors that shape health. Epidemiology emphasises controlled measurement based on disease and associated risk factors, with limited consideration of other contributing factors to health. Statistics also have limitations due to: • the varying reliability of data • the numerous sources of information 6 HSC CORE 1 Health priorities in Australia i i i i i i i “c01HowArePriorityIssuesForAustraliasHealthIdentified” — 2018/6/12 — 3:24 — page 7—#5 i • imprecise methods of data collection • whether surveys use standard instruments, definitions and classifications. Instruments are methods or devices for recording, measuring or controlling. For example, the National Health Survey conducted by the Australian Bureau of Statistics collects data through surveying one adult and one child from each sample dwelling to gain a picture of the health status of Australians. This type of data collection gives fairly reliable data on illnesses such as asthma and colds, but unreliable data on illnesses such as cancer. To achieve an accurate picture of the health status of Australians, data would also need to be collected from places such as hospitals and nursing homes using strict privacy guidelines. Broadening the framework of epidemiology Despite its limitations, epidemiology provides valuable scientific information about disease and associated risk factors. It has been useful in providing a basis for investigating issues such as the impact of social, cultural and economic factors that support health or cause disease. Recently, health authorities have acknowledged the need to adopt a measurement approach that focuses on the health of populations more than the diseases of individuals. To address inequities in health we must go beyond the disease and its risk factors to the environmental and social frameworks in which individuals live. The epidemiological measurement process must incorporate a social perspective to identify and combat the leading causes of sickness and death in Australia, and to reduce inequities in health. The higher rates of morbidity and mortality in rural and remote populations, for example, are directly related to the social and environmental context of these communities.
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