1.  Different measures of health status of Australians, including the meaning of burden of disease (BOD), health adjusted life expectancy (HALE) and disability adjusted life years (DALY’s), life expectancy (LE), under 5 mortality rate (U5MR),mortality, morbidity and incidence and prevalence. Area of study 1 dot point 2

2. Sources of data and statistics Outline the role of the following organisations: a. The Australian Bureau of statistics  Australia’s national statistical agency.  It concentrates on demographic and economic data.  Also produces a range of health related-statistical information.  The ABS gauges the health of Australia by measuring: mortality, morbidity, lifestyle factors, disability and the use of health services.  The ABS also administers National Health Surveys of the population at regular intervals.  ABS also completes specific surveys in a range of areas including Torres Straight Islander people, mental health and wellbeing and the prevalence of chronic diseases.  ABS website www.abs.gov.au provides vitals statistical information.www.abs.gov.au Click below for a short summary of Australia's demographics from ABS 2013> Population clock  http://www.abs.gov.au/videos/221-0114-001/ABS%20Snapshot%20June%202013.mp4 http://www.abs.gov.au/videos/221-0114-001/ABS%20Snapshot%20June%202013.mp4

3. The census http://www.youtube.com/watch?v=4MaHzKEPleQ&list=PL78D8EA9578904CF7 http://www.youtube.com/watch?v=qxm_VIKwRtI&list=PL78D8EA9578904CF7 http://www.youtube.com/watch?v=4MaHzKEPleQ&list=PL78D8EA9578904CF7 http://www.youtube.com/watch?v=qxm_VIKwRtI&list=PL78D8EA9578904CF7  Compulsory survey completed by the ABS.  Conducted every 5 years> next one is August 2016 ( Most recent one was 9 August 2011). What age will you be?  This survey is a basis for estimating the population- aims to accurately measure the number of people in different areas of Australia.  Information is collected about key characteristics e.g. how many people in households, what they do, how they live?  Assists with the distribution of government funding for infrastructure e.g. community services, facilities i.e. schools and roads.  This information is used by individuals and organisations in the public and private sector to make informed decisions on policy and planning issues that impact on the lives of Australians.

4. b. The Australian Institute of Health and Welfare.  Australia's national agency for health and welfare statistics and information.  Works closely with the ABS and was set up by the Australian Government. It is an independent statutory body managed by a board and is accountable to the government.  Conducts surveys.  Collects and analyses statistics and information on its own and with other organisations e.g. Universities and research centres.  Provides a range of products and services.  Produces publications about key health and welfare issues  Aims to improve health and wellbeing through better health and welfare information and statistics on a wide range of topics e.g. health and welfare expenditure, hospitals, disease and injury and mental health, ageing, homelessness, disability and child protection.  It produces publications about key health and welfare issu es> in addition to Australia's Health and Australia's Welfare (biennial report to the Australian Government) it produced over 100 reports and working papers each year focusing on the NHPA’s.  VIEW AIHW data- Australia’s Health & Australia’s Welfare.  https://www.aihw.gov.au/deaths/ https://www.aihw.gov.au/deaths/

5. c. The Victorian Government Health information website  This website is a gateway of information relating to the provision of health care services in Victoria.  Works in partnership with organisations, communities and individuals to make health a central part of individuals daily lives.  Website www.health.vic.gov.au.www.health.vic.gov.au  The pages in this website are developed and managed by the department of human services.  This site has information on the Victorian governments plans, funds and delivery of health, community and housing services.  DHS are involved in the functioning of the Better Health Channel. Better Health channel>  http://www.betterhealth.vic.gov.au/ http://www.betterhealth.vic.gov.au/

6. d. The Department of Human Services (DHS) Victoria.  Victoria’s largest government department which plans, funds and delivers health and housing services.  The Department of Human Services is responsible for the development of policy and provides access to social, health and other payments and services.  The DHS is Victoria’s largest government department. It is involved in community and housing services e.g. child protection, disability services, justice issues.  It develops and co-ordinates government policies to remove barriers, e.g. Funding of the Better Health Channel, family violence prevention and support programs ( men’s behaviour change programs.

7. International sources: e. The World Health Organisation:  The directing and co-ordinating authority for health within the United Nations System.  The WHO provides a wealth of information i.e. health data and statistics.  The WHO Statistical Data System ( WHOSIS) which provides national statistics for 70 core indicators on morbidity, mortality, risk factors, service coverage and health systems.  The WHO Global InfoBase Online which has data on chronic diseases and their risk factors for all WHO member states.  Regional statistics from the WHO regional offices. Statistics are published every year, WHO reports on global public health and key statistics> World Health Report, which combines an expert assessment of global health including statistics relating to all countries, with a focus on specific subjects.  Visit the WHO website look at country statistics or map gallery> http://www.who.int/countries/en/ http://www.who.int/countries/en/

8. Understanding some Key measures of health 2. Key measures are also known as indicators. They are often presented as statistics for: life expectancy (LE), health adjusted life expectancy (HALE), mortality, morbidity and burden of disease (BOD). They are used to measure and compare health status. 3a. Define health status. An individuals or populations overall health, taking into account various aspects such as life expectancy, amount of disability and levels of disease risk factors. AIHW, 2008 : VCAA It takes all dimensions of health into account. It can be thought of as a continuum. Severe illness neutral optimal

9. b. Life expectancy ‘ An indication of how long a person can expect to live, it is the number of years of life remaining to a person at a particular age if death rates do not change.’ (AIHW, 2008) VCAA c. Optimal health. The best level of health an individual can realistically attain. Optimal health varies from person to person as- everyone is born with different genetics and experiences different environments- therefore, everyone’s level of optimal health is different.

10. 4a. Health adjusted life expectancy (HALE).  A measure of burden of disease based on life expectancy at birth, but including an adjustment for time spent in poor health.  It is the number of years in full health that a person can expect to live, based on current rates of ill health and mortality. VCAA Male LE= 78.5 yrs Female LE 83 yrs - 7.7 yrs in an unhealthy state -8.1 yrs in an unhealthy state HALE 70.9 74.3

11. b. Why is HALE a more comprehensive health status indicator than that of life expectancy?  HALE is a more comprehensive health status indicator than LE as it comprises the component quality of life.  As life expectancy has risen in recent years ( due to medical technology, awareness of health promotion campaigns and disease prevention), greater attention has shifted to determining the number of healthy years that individuals can expect to live.  “Are people spending these extra years of life in good or poor health?”  The concept of “healthy life expectancy” acknowledges that it is not only increases in life expectancy that are important, what also matters is that people live longer lives in better health.  Life expectancy alone certainly do not fully reflect the health status of the population. These estimates provide no indication of the quality of life, only the quantity.

12. ci. Explain how the HALE is calculated  A common measure of this is health adjusted life expectancy or HALE. This is an estimate of the number of healthy years ( free from disability or disease) that a person born in a particular year, can expect to live, based on current trends in death and disease patterns.  The average number of years spent in unhealthy states is subtracted from the overall life expectancy, taking into account the relative severity of such states. i.e. it is expressed as an equation.

13. cii. HALE Calculation- HALE- Health Adjusted life expectancy = Life expectancy - Number of years living in unhealthy states d. What is HALE often simply referred to? “ Healthy life expectancy ”- The number of years not lived without reduced functioning (including mobility and operation of body systems) due to reduced health, therefore an indicator of quality of life.

14. 4ei. An example of how HALE is calculated: The average male born in 2011 can expect to live to 79.7 whilst a female born in 2011 can expect to live to 84.2 years of age. Whilst the HALE for males born in 2011 was 72.4 and for females it was 75 Australian male: born in 2011Australian female Could expect to lose an average 7.3 years of their life to disability and live 90.2 % of their life in good health. i.e. 79.7= LE in 2011 72.4 = HALE in 2011 ________ 7.3 years in disability Could expect to lose an average of 8.1 years of their life to disability and live 75 years in good health. i.e. 84.2= LE in 2011 75 = HALE in 2011 ________ 9.2 years in disability

15. HALE Calculation-2003 Male LE= 79.7 years Female LE = 84.2 years - 7.3 yrs in an unhealthy state -9.2 yrs in an unhealthy state HALE 72.4 HALE 75 HALE

16. Mortality a. Define the term i. mortality- number of deaths in a population caused by a particular disease, illness or other environmental factors. ii. Mortality rate- Some times referred to as a death rate. The number of deaths from a specific cause or all causes (usually per 100,000). iii. How is the mortality rate calculated? iv. Rewrite the hypothetical example outlined that is relevant to the mortality rates for cancer.

17. Mortality b. Explain how studying the trends in mortality can be of value?  Provides important feedback on the success of current intervention ( i.e. policies, strategies and campaigns.)  Can allow predictions to be made.  Can be used to guide policy making and planning.

18. 5c. Definitions and outline of some of the measures of mortality. Infant mortalityUnder 5 mortality rate (U5MR) Maternal mortality ratio Refers to the number of deaths that occur in the first year of life. It is reported by the actual number of deaths per 1,000 live births. The number of deaths of children under five years of age per 1,000 live births. (WHO< 2008) VCAA Maternal mortality refers to the number of deaths of women due to pregnancy or child birth- related complications.

19. Age standardisation  Age standardisation rates allow us to compare populations that have a different spread of ages.  E.g. Australia's population is ageing and as a result, we would expect more deaths than a country with a young population, as older people are more likely to die.  Age standardisation manipulates data to make age groups, of different populations relative-so that they can be compared more accurately.

20. 6.Trends in mortality a. List 2 different points outlining how trends in mortality have changed over time.  Developments have been made with regard to the economy, technology and education. As a result- many diseases that were common causes of death 100 years ago i.e. influenza and tuberculosis- cause few deaths.  As people live longer they are more likely to suffer from lifestyle related illnesses. Diseases such as CVD, cancers and diabetes have emerged as the leading causes of death in Australia.

21. Refer to table 1.2 Beaumont: bi. List the three leading causes of death for males and females. 6bii.List two similarities & differences from the data.

22. Study table 1.3 Leading causes of death, by age group, broad causes, 2007. 6cii.Comment on how leading causes of death change as people become older.

23. 6ciii Key trends in mortality Read over the information from Beaumont. Brainstorm possible reasons for these trends. 6civ. Read case study Beaumont p 17 and answer questions.

24. 7.Morbidity a. Morbidity Refers to ill health in an individual and to levels of illness in a population or group. (AIHW 2008) b. Morbidity rate- is a measure of how many people suffer from a particular condition during a given period of time. c. Morbidity data Includes levels of disease, illness, disability and injury. Statistics that include information/ data on the levels of disease, illness, disability and injury.

25. 8 ai. Incidence  The number of new cases of a particular condition during a specific time.  E.g. In 2005, 901 new cases of Type 1 diabetes in children aged under 15 years were recorded. Therefore, an annual incidence of 22.6 cases per 100,000 population => 1 in 4,000 of this age group- were recorded.  There has been an increase of Type 1 diabetes in Australia which is consistent with international trends.

26. 8ii. Outline how incidence is calculated.  Incidence rates are calculated by dividing the number of new cases of a disease occurring in a population during a specific time ( usually 12 months) period by the number of persons exposed to risk of developing the disease during that period of time.

27. bi. Prevalence The number or proportion of cases of a particular disease or condition present in a population at a given time. (AIHW, 2008) ii. How it prevalence calculated? Prevalence is calculated by dividing the number of cases of disease present in the population at a specified period of time by the number of persons at risk of having the disease at that specific time. The ratios used to calculate incidence and prevalence are then multiplied by 1000 or 100,000 to yield statistics that are more readily interpretable.

28. b. Illness A state of feeling unwell, although the term is often used synonymously with disease. c. Chronic diseases This is a term applied to a diverse group of diseases, such as heart disease. Persistent and long lasting and causing suffering, disability and premature death> cost to society and reduced quality of life. a. Disease Refers to a physical or mental disturbance involving symptoms such as pain or feeling unwell, dysfunction or tissue damage, specifically if these symptoms and signs form a recognisable clinical pattern. 9. Terms associated with morbidity

29. d. Hospital separations  Refers to episodes in hospital care that start with admission and end with transfer, discharge or death.

30. e. Injury  The term relates to the adverse effects on the human body that may result from a range of different events.  Injuries may be accidental, such as falls, poisoning, drowning's, sporting and workplace injuries and car crashes.  They may be intentional such as suicide or attempted suicide and violence. f. Trend A general change or movement in a particular direction. e.g. they may depict an increase or decrease in a health issue> Obesity

31. 8. Burden of disease and Disability Adjusted Life Years. (DALY)’s a. Define the term burden of disease- Burden of disease is a measure of the impact of disease and injuries. Specifically it measures the gap between current health status and an ideal situation where everyone lives to an old age free of disease and disability. BOD is measured in a unit called the DALY. VCAA b. The benefits of BOD as a health indicator More information can be gained from BOD. A more accurate picture of the extent of a disease and injury and its impact on health. A concept developed in the 1990’s by organisations such as WHO to describe death and loss of health due to disease, injuries and risk factors for all regions of the world. Commonly used measures of morbidity and mortality provide information about the health of the population but are inadequate in providing information required for developing informed health policies and for assessing the impact of limited functioning and ill health on every day life. Morbidity and mortality measures are difficult to use to obtain an unambiguous representation of the extent of disease and injury in the population. E.g. some chronic injuries and diseases may not cause fatalities but lead to long term debilitation. BOD assists in analysis of the consequences of disease and the burden it is having on the population.

32. 10ci. What is the unit measurement for burden of disease?  Disability Adjusted Life Year- DALY cii. What does one DALY equal? One DALY equals one year of healthy life lost due to premature death and time lived with illness, disease or injury. ciii. Define the Disability Adjusted Life Years Disability Adjusted Life Year (DALY)- A measure of burden of disease, one DALY equals one year of healthy life lost due to premature death and time lived with illness, disease or injury. VCAA

33. civ. Outline key points to describe the DALY’s use as a measurement of health status.  The use of Daly’s as a measure of health status allows the determination of how much illness or disease a exists in a population and the effects it is having on the populations quality of life.  It has specifically been developed in order to enable international comparative assessments in health to be made. This the BOD between different population groups and for different countries can be measured.  DALY’s are useful for comparing population groups and can be valuable about trends and where interventions are required.  DALY’s are used to gauge the contribution of various risk factors to the overall burden of disease experienced.  DALY’s are often calculated for a range of conditions and added to produce a grand total.  In 2010 it was estimated that 2.8 million years of healthy life were lost in Australia.  If 1,000 DALY’s were lost due to asthma > 1000 years of health life were lost as a result of premature death or by people suffering the condition, reducing their quality of life.

34. 10cv. How are DALY’S calculated? YLL + YLD = DALY’S YLLYLD Definition- The fatal component BOD of a population, defined as the years of life lost due to death. Fatal components of DALY’S Each YLL represents 1 year of life lost due to premature death YLL can be calculated for any condition The younger a person is when they die from a condition the greater the number of years of life lost will be added to the condition Definition- YLD refers to the non fatal components of BOD and is a measurement of the healthy years of life lost due to diseases and injuries. Non fatal component of the DALY’s A complex formula is used to calculate the YLD because conditions vary in severity e.g. Alzheimer's disease vs asthma. As the formula takes such considerations into account it is possible to make accurate comparisons. If a person suffers a condition for 10 years making them ½ unwell the YLD= 5 years YLL and YLD are equal in value, however, YLL> premature death whilst YLD is from illness, disease and disability. cvi. How do YLL and YLD differ?

35. DATA ANALYSIS Figure 1.23 Projected burden of disease (YLL, YLD & DALY’s of major disease groups, 2010.

36. DATA ANALYSIS