CQ1 – How are priority issues for Australia’s health identified? HSC PDHPE CQ1 – How are priority issues for Australia’s health identified?

How are priority issues for Australia’s health identified? Students learn about: Students learn to: identifying priority health issues social justice principles (D.E.S. + P.E.A.R.) priority population groups (The Elderly, A.T.S.I., S.E.D, People Born Overseas, Rural & Remote, People with a Disability) prevalence of condition potential for prevention and early intervention costs to the individual and community argue the case for why decisions are made about health priorities by considering questions such as: how do we identify priority issues for Australia’s health? what role do the principles of social justice play? why is it important to prioritise? 

2. identifying priority health issues Although Australia’s health status has improved over the years, many people still experience health conditions that are, to some degree, preventable. This is particularly so for groups such as Aboriginal and Torres Strait Islander peoples and the socio- economically disadvantaged. With a view to making significant progress in improving the health status of all Australians, the vision for national health information in the years ahead is to improve the health of populations.

The Commonwealth Government and all state and territory governments work together to provide some common direction in national health and reduce any existing inequities. At the National Health Summit held in 1993 the health ministers agreed that national goals and targets should be stated and form the basis of a national health policy. From this summit there is continued acknowledgement of the need to reorientate policies and programs towards health prevention and improvement, rather than simply curative measures and health care services.

The National Health Priority Areas (NHPA): The 9 NHPAs agreed by the Australian Health Ministers’ Advisory Council between 1996 and 2012 were: Cancer control (first set of conditions, 1996) Cardiovascular health (first set of conditions, 1996) Injury prevention and control (first set of conditions, 1996) Mental health (first set of conditions, 1996) Diabetes mellitus (added 1997) Asthma (added 1999) Arthritis and musculoskeletal conditions (added 2002) Obesity (added 2008) Dementia (added 2012)

The National Health Priority Areas (NHPA): The priority areas chosen provide a framework within which more specific goals and targets have been established. There are other significant health issues in Australia that could have been singled out for additional emphasis. This selection of priority areas was based on five specific criteria: principles of social justice priority population groups prevalence of condition potential for prevention and early intervention costs to individuals and the community.

social justice principles

social justice principles Social justice is about making sure that every Australian has choices about how they live and the ability to make those choices. For example, social justice refers to everyone being able to access an adequate water supply, cooking facilities and sanitation; nourish their children and send them to school where their education not only equips them for employment but also reinforces their knowledge and understanding of their cultural inheritance; and have an opportunity to secure employment and good health. That is, social justice is a life of choices and opportunity, free from discrimination.

social justice principles Everyone has the right to equal health opportunities. Social justice recognises the importance to support the marginalised, disadvantaged or under-represented groups of people in society. Social justice principles provide a framework or process to guide the equal division and distribution of policies and practices so all groups have equal opportunity to benefit depending on their needs. Social justice principles recognise the following: There are situations where identical rules, laws or policies applied to all groups may produce unequal results. Past and present disadvantage exists. Barriers exist in our systems that create discrimination.

social justice principles The principles of social justice are equity, diversity and supportive environments. This is applied by reducing inequality; encouraging participation; removing barriers; building stronger communities; providing education; and valuing and promoting the social, economic and cultural benefits of diversity.

social justice principles

social justice principles Diversity Diversity involves all community groups in planning and making decisions about health issues, as well as: recognising the cultural and social diversity of society and examining and evaluating diverse values, beliefs and attitudes recognising the contribution of social, cultural, economic and biological factors to individual values, attitudes and behaviours exploring different views about issues such as gender roles, physical activity, peer-group relationships, sexuality, cultural beliefs and what constitutes a healthy environment exploring conflicting values, morals and ethics for wellbeing when making decisions.

social justice principles Equity Equity involves making sure resources and funding are distributed fairly and without discrimination. Health equity means that all people have access to the health services and support they need at the time that they need it, and in a place that is easily accessible.

social justice principles supportive environments The principle of supportive environments refers to both the physical and social aspects of our surroundings. It encompasses where people live, their local community, their home, and where they work and play. It also refers to access to resources for living and opportunities for empowerment. Therefore, action to create supportive environments has many dimensions: physical, social, spiritual, economic and political.

social justice principles

social justice principles Other notions of social justice include: P.E.A.R. Participation (expanded opportunities for real participation in the decisions which govern their lives). Equity (overcoming unfairness caused by unequal access to economic resources and power) Access (greater equality of access to goods and services) Rights (equal effective legal, industrial and political rights)

priority population groups

priority population groups One of the criteria for selection as a priority issue was the potential to reduce inequities in health status. To achieve social justice for each issue, specific priority population groups were identified.

priority population groups These priority population groups are those that are shown by research to experience an unnecessarily high incidence of the condition. Some of the priority groups identified include: socio-economically disadvantaged people Aboriginal and Torres Strait Islander peoples people living in rural and remote areas the elderly people with disabilities and people who were born overseas.

prevalence of condition

prevalence of condition Another criterion for the selection of a priority issue was the current number of cases of the illness or condition. Epidemiology shows that cardiovascular disease, cancer, injury, mental health, diabetes and asthma contribute substantially to mortality and morbidity in Australia. The seven**** priority issues account for the large majority of deaths recorded every year in Australia, and also for a significant number of the recorded hospital episodes. **** currently 9 but only 7 are looked at

prevalence of condition Cardiovascular disease, although experiencing a decline, is the second leading cause of death in Australia. The number of people with cardiovascular disease may increase as the population ages. Source: AIHW National Mortality Database (Data source table).

prevalence of condition Cancer is the leading cause of death in Australia. The incidence of certain types of cancer is increasing. Advances in cancer diagnosis and treatment, and an ageing population, have led to increasing numbers of people surviving for longer periods after a diagnosis of cancer. Australian Institute of Health and Welfare, Cancer in Australia, An overview 2014, Cancer Series No.90, Cat. No. CAN 88, Canberra: AIHW, p. 17.C

prevalence of condition Diabetes is increasing significantly, and is known to affect over half a million Australians. The real figure is likely to be higher because many people with type-2 diabetes (adult-onset diabetes) remain undiagnosed. Apart from deaths directly due to diabetes, a much larger number of deaths also occur as a result of diseases that are complications of diabetes. Diabetes is thus the cause of a very large number of deaths, either directly or indirectly.

prevalence of condition Respiratory diseases, such as asthma, are a major cause of morbidity in Australia, with levels among the highest in the world. Asthma especially affects young children, and is one of the most common reasons for the hospitalisation of school-age children. Improved asthma management, asthma diagnosis at an earlier age and an increased awareness of treatment have resulted in a significant decrease in deaths related to asthma.

prevalence of condition Although injury mortality is declining, it is still responsible for substantial hospital admissions. Injury is the greatest cause of death in the first half of life and leaves many people with serious disability or long-term conditions.

prevalence of condition The prevalence of mental health problems in Australia has only recently been clearly understood. Someone might experience a mental illness only once, and then fully recover. For others, mental illness can recur throughout their lives. It is currently estimated that one in five individuals will be affected by a mental health problem at some point in their lives.

potential for prevention and early intervention

potential for prevention and early intervention The identification of priority issues is based on the potential for prevention and early prevention. The incidence of lifestyle-related conditions (such as cardiovascular disease, some forms of cancer and type-2 diabetes) can be reduced through behavioural change and environmental modifications. For health problems that are not lifestyle-related the potential for change is extremely limited and progress is more reliant on research and medical advances.

potential for prevention and early intervention For lifestyle-related conditions, in addition to research and medical advancements, education and awareness of risk factors can lead to behaviour change and a reduction in incidence. Such risk factors include smoking, sun exposure and drink driving. Environmental modifications can also contribute to a reduction in incidence; for example, shaded areas to reduce skin cancer, dual-lane highways to reduce road injury, and lean beef and low-fat milk to reduce heart disease.

potential for prevention and early intervention Prevention and early prevention in relation to these major conditions is more complicated than simply identifying the behaviour that contributes to their incidence. Health problems are social issues that are directly related to the society in which people live. Prevention for many people is limited and, in some cases, non-existent. To blame individuals for their behaviour ignores the social, economic, cultural and political forces at work in society.

costs to the individual and community

costs to the individual and community Cost of ill-health to the individual Another criterion for selection as a priority issue was the impact that the condition has on individual health and well-being. The impact on the physical, social and emotional health of people experiencing a condition will vary from individual to individual. Costs can be categorised as either direct or indirect. Direct costs are those that can be measured, usually through financial means; for example, cost of treatment, cost of replacement labour or lost working hours. Indirect costs are more difficult to measure. They include factors such as emotional trauma and relationship breakdown. There are millions of Australians whose quality of life is decreased as a result of experiencing cardiovascular disease, cancer, diabetes, respiratory disease, injury or mental health problems and illnesses.

costs to the individual and community The impact of these conditions on the individual’s physical health can vary from minor pain and discomfort to permanent disability or death. Dealing with minor physical health problems can be overcome in a short time with appropriate treatment and medication. More serious physical effects can remain for a long time, however, and, in some cases, are permanent. Examples of permanent physical effects are spinal cord injury from an accident, limb amputation caused by peripheral vascular disease, and mastectomy (breast removal) to remove a cancerous tumour. Permanent physical health problems that result from an illness or accident will, for many people, have effects that reach far beyond the physical.

costs to the individual and community As noted, it is more difficult to measure how illness or injury indirectly impacts on the social health of an individual. Serious illness or injury can result in: Social isolation—This isolation can be caused by an inability to continue employment or to participate in hobby or sporting groups. Long-term hospitalisation and lack of mobility—This might also isolate the individual and increase financial pressures, resulting in further limitations to social opportunities. Pressure on relationships and family structures—This can result from the short-term trauma of a serious health scare. If ongoing care and rehabilitation are required this might need to occur in the home, and thus place additional pressure on immediate family and close relatives and friends.

costs to the individual and community The emotional well-being of an individual can also be affected by serious illness or injury. A person diagnosed with a serious (possibly terminal) illness will experience a range of emotions that might extend into periods of extreme depression. A loss of self-esteem and purpose in life, a sense of hopelessness, personal reflections on questions such as ‘why me?’, and despair at possibly not being there for loved ones in the future—these are the types of thoughts that can contribute to an erratic state of mental health. The emotional trauma of injury from an accident can also be difficult to overcome as the victim might be young and, in most cases, the trauma unexpected.

costs to the individual and community Cost of ill-health to the community The cost of ill-health to the Australian community is enormous. As such, it was a criterion for the selection of priority issues. The annual economic cost alone related to the diagnosis, treatment and care of the sick is over $30 billion. This includes the costs of hospitalisation, medical treatments, pharmaceuticals, health insurance and illness prevention. The indirect costs of ill-health to the community are not included in the dollar figures. Indirect costs are difficult to measure and would obviously increase the financial impact even further. Indirect costs include loss of income and workplace productivity as a result of illness or premature death, travel costs of patients, and the costs of caring for an ill person at home.

costs to the individual and community Australia’s expenditure on health Over the past 20 years, Australia’s expenditure on health has been fairly constant. Measured in terms of Australia’s total wealth— known as gross domestic product (GDP)—expenditure on health has been about 8% each year for the last 20 years. It is feared that expenditure on health might have to increase significantly in future years, however, and recent statistics have detected a slight increase already. There are several factors indicating that Australia’s health system might come under financial pressure in the future. These include: an ageing population a more informed population increased use of Medicare advances in medical technology.

costs to the individual and community An ageing population Life expectancy at birth for the Australian population has increased by over 20 years since the beginning of the twentieth century. Whether this will cause a big increase in health costs is uncertain. The people who live longer might be healthier, and they might require less health care than older people do today. However, there is still concern that having an older population might place an extra burden on Australia’s health costs.

costs to the individual and community A more informed population Health promotion and illness-prevention messages have resulted in a population more informed about ill- health. This might result, in turn, in an increase in the use of health services, especially in relation to prevention. In the longer term, spending money on prevention and early detection of illness might decrease overall health costs. In the short term, however, having a more informed and health conscious population does tend to cause people to use more medical services than previously, and this puts immediate pressure on the health care budget.

costs to the individual and community Increased use of Medicare The ease and simplicity that Medicare has brought to health care has resulted in a steady increase in the use of doctors’ services, especially in urban areas where there are many doctors. As noted, this might result in longer- term benefits if conditions are detected earlier and prevented from developing into more serious (and expensive) problems. It places a burden on the health budget now, however, and in the immediate future. Even if there might be longer- term benefits, these are difficult to measure, and the immediate concern is that health costs are going up because of the increased number of consultations.

costs to the individual and community There is also concern that the ease and simplicity of Medicare might lead to some people seeing doctors for trivial matters. In addition, some doctors are guilty of ‘overservicing’; that is, deliberately seeing people more often than required, and providing medical services that are unnecessary and costly. The effect of Medicare on health costs is thus a complex matter. Overall, Medicare helps to keep down costs because the government does have some control over the fees charged for services. But overuse of doctors by some patients, and over- servicing of patients by some doctors are causes for concern in assessing health costs.

costs to the individual and community Advances in medical technology Improved technology has resulted in a wider range of treatments available. Many of these treatments utilise the latest expensive technology; for example, organ transplants, use of lasers, joint replacements, open-heart surgery. People obviously want the best possible treatment, but costs are increasing as a result.