Priority issues for Australia’s health Core 1 Priority issues for Australia’s health

Health of indigenous people The most obvious contrast in health status is found between Aboriginal and Torres Strait Islander peoples, and non-indigenous people. Indigenous people are reported to have : Lower life expectancy Higher mortality Higher infant mortality Higher rates of diabetes Higher rates of elevated blood pressure Higher rates of injuries Higher rates of respiratory diseases Higher rates of cancer, endocrine and digestive disorders Higher hospitalisation rate

Health of indigenous people Life expectancy at birth, indigenous Australians, 1991 – 96 Persons Years Males Females Indigenous western Australia ¹ 53.7 58.9 Indigenous eastern Australia ² 59.2 63.6 Indigenous total 56.9 61.7 Total Australia 75.2 81.1 1 Western Australia, South Australia, Northern Territory 2 New South Wales, Queensland, Victoria, Tasmania, the Australian Capital Territory Source : Australian Institute of Health and Welfare 1998, Australia’s Health 1998, Canberra p.29

Socio-economically disadvantaged people Higher infant mortality Higher mortality rates Poor living conditions Unemployment Low levels of education High substance abuse

Australians born overseas Lower mortality rates Lower morbidity rates (except for mental health) Unemployment Racism Low wages /crime /exploitation Higher level of health: migration criteria, poor people find it difficult to migrate, less lifestyle disease risk factors Problem areas: migrant women, elderly, occupational health and safety, racism and cultural differences

People living in rural and isolated locations Higher mortality rates Lower life expectancy Low wages Poor access to health services Unemployment Major increase in suicide Disadvantages: life expectancy is less, death rates are 69% higher Greater: diabetes, homicide･Inequities/causes include: low socio-economic status, access to resources, occupational hazards

People with disabilities Disability: lack of ability to perform everyday functions/ activities 18% of people have one Higher rates in males than females Higher rates in rural areas Handicap: disadvantage resulting from impairment/disability that limits/prevents and everyday role. More severe. Inequities: social stigma and financial constraints

6 years greater life expectancy Gender specific conditions: breast and cervical cancer Lower rates in most diseases than men More vulnerable to domestic violence

Men 25% higher death rate Higher infant mortality rates Gender specific conditions: testicular and prostate cancer Causes: more risk taking behaviour, less use of medical services Youth: more suicide, drug dependency and MVA

Older people We have an aging population Medical problems: arthritis, hypertension Social problems: poor education and socio-economic status Have a greater demand for health services Higher mortality rates Higher morbidity rates

Cancer Why is cancer control a National Health Priority Area? Nature A group of diseases characterised by the uncontrolled growth and spread of abnormal cells Believed to be caused by damage to the genetic structure of a single cell Extent Causes 27% of all deaths in Australia Major types – lung, breast, colon, prostate, melanoma Risk factors Vary according to the cancer type. Some factors include family history, smoking, high-fat diet, exposure to cancer-causing agents Social determinants Lower socioeconomic status Lack of education Groups at risk Vary according to cancer type Most common groups include cigarette smokers, those exposed to health hazards, obese women, those over 50 years, family history

Cancer Glossary Cancer – a large group of diseases that are characterised by the uncontrolled growth and spread of abnormal cells. Tumour – is a swelling or enlargement caused by a clump of abnormal cells. Neoplasm – an abnormal mass of cells that force their way among healthy cells and interfere with their normal functioning.

Metastases – are secondary or new tumours that may begin some distance from the original malignant tumour. Carcinogens – cancer causing agents such as chemicals, pollutants, radiation, cigarette smoke, and alcohol Breast Cancer Breast Self Examination – (BSE) – a preventative action which detects changes or abnormalities in the breast. Mammographic Screening – is a process of using a special x-ray of glands, fat and blood vessels under the skin of the breast to identify any variations from the normal or healthy tissue.

Skin Cancer Basal Cell Carcinoma – a surface skin cancer that originates from the basal cells, which underlie the surface cells. It is the most common type of skin cancer. Squamous Cell Carcinoma – surface skin cancer that originates in the squamous or surface cells. It is the fastest growing form of skin cancer.

Injury Why is injury prevention and control a National Health Priority Area? Nature Major categories include transport-related accidents, suicide, falls, burns, scalds, industry-related injuries and interpersonal violence Extent Causes 6% of all deaths in Australia Leading cause of death in 1 – 44 age group Risk Factors road accidents : alcohol, lack of judgement, power, speeding, complacency childhood injuries : unsafe behaviours, lack of supervision Social determinants alcohol abuse susceptibility to risky behaviour Groups at risk varies according to injury type most common groups include children (burns and scalds), those who operate machinery in workplaces and older people (falls)

Injury Glossary Suicide – is an intended self-inflicted injury which is fatal. Parasuicide – is an attempted suicide that is not fatal and is often impulsive.

Mental Health Why is mental health a National Health Priority Area? Nature Ranges in severity from mental complaints and symptoms (eg depression) to mental illness (eg schizophrenia) Extent Estimated that 18% of Australians have experienced symptoms of mental disorder Mental disorder – highest among 18 – 24 age group Suicide is the leading cause of death in 15 – 24 age group Risk factors Depression, mental illness, drug abuse, stress, negative experiences For suicide : depression, mental and physical illness, social isolation Social determinants Unemployment and low income Lack of access to health care Groups at risk Those who suffer depression, disadvantaged groups

Diabetes Why is diabetes mellitus a National Health Priority Area? Nature A condition affecting the body’s ability to take glucose from the bloodstream and use for energy Two types – insulin dependent (type 1) and non-insulin dependent (type 2) Extent Approximately 700,000 Australians affected 85% of diabetics have type 2 diabetes Risk factors Type 2 diabetes – obesity, high blood pressure, age over 50, family history, inactivity, smoking, increasing age Social determinants Lack of sound nutritional practices Lack of access to health care Groups at risk Indigenous Australians Australians born overseas Elderly

Diabetes Glossary Diabetes Mellitus – a condition affecting the body’s ability to take glucose from the bloodstream to use it for energy. Insulin – is a hormone produced by the pancreas that helps glucose to enter the body cells and be used for energy.

Asthma Why is asthma a National Health Priority Area? Nature A chronic respiratory condition in which the narrowing of the airways causes difficulties in maintaining sufficient airflow in and out of the lungs. Unpredictable condition that can occur at any time. Extent Major cause of morbidity in Australia, and highest incidence in the world. Decrease in mortality. Risk factors Triggered by large number of factors Social determinants Socio-economic factors. Exposure to environmental pollutants Groups at risk Young children (Parents who smoke) People with allergies Hereditary

Nature Extent Risk Factors Social determinants Groups at Risk Why is arthritis and musculoskeletal conditions a National Health Priority Area? Nature Arthritis is a group of musculoskeletal conditions in which there is inflammation of the joints, causing pain, stiffness, disability and deformity Osteoarthritis - Osteoarthritis is one of the most common forms of arthritis. Rheumatoid arthritis - Rheumatoid arthritis is a chronic inflammatory disease that mainly affects the joints and is characterised by joint swelling and destruction. Osteoporosis - Osteoporosis meaning "porous bones" is a musculoskeletal disorder where the bone density thins and weakens, resulting in an increased risk of fracture. Extent Osteoarthritis was the seventh most frequently managed problem by general practioners in Australia in 2003-04 In the 2001 National Health Survey, 2.7% of females respondents reported having rheumatoid arthritis compared with 2.0% of males. The prevalence of rheumatoid arthritis increases sharply with age but is higher in females at nearly all ages. In the 2001 National Health Survey, 1.6% of respondents reported osteoporosis. The prevalence was 10.5% among females aged 65-74, increasing to 12.3% among female respondents aged 75 and above. In comparison, the prevalence of osteoporosis in males was much lower, at 1.2% and 1.5% in the two age groups respectively Risk Factors Hereditary Social determinants Gender Age Groups at Risk

Social determinants Social factors contribute to health inequities among population groups. The most important social determinants include : social and economic factors education employment ethnicity gender age location

Key Concepts Health Promotion Involves activities that are aimed at improving health and preventing illness Public Health A combination of science, medicine, practical skills and beliefs aimed at maintaining and improving the health of all people New Public Health All activities organised by society to protect people from disease and to promote good health Ottawa Charter A framework for health promotion

Trends in public health over the past decade Trends in Health Trends in public health over the past decade Improvements Mixed changes No change Worsening areas Overall mortality Stroke Heart disease Road safety Dental health Congenital abnormalities HIV/AIDS Diseases controlled by immunisation Colorectal cancer Level of improvements in lower socio- economic groups Lung cancer Cervical cancer Increased physical activity Indigenous health Breast cancer Premature deaths Social disparity Alcohol consumption Senile dementia Illicit drug use Prostate cancer Skin cancer Diabetes Youth suicide Obesity Sroiuce : G. Egger, R.Spark, J.Lawson and R.Donovan 1999, Health Promotion Strategies and Methods, Revised Edition, McGraw-Hill, Roseville NSW P.3