Health Priorities in Australia

How are priority issues for Australia’s health identified?

Measuring health status

Epidemiology is the study of patterns and causes of health and disease in the population, and how to apply this study to improve health.

It commonly uses statistics on births, deaths, disease incidence and prevalence.

Through the collection of data epidemiology studies can identify specific factors relating to health. Epidemiologists collect data by:

• Counting the cases of disease or injury
• Identifying affected groups
• Calculating the rates of disease or injury within that group
• Comparing those rates to other populations
• Drawing conclusions to determine whether a problem exists

With access to accurate and current data, epidemiology can answer questions such as:

• How healthy is the population and is health improving/declining?

• Which groups enjoy better or worse health than others

• How can current trends in health status help prepare for the future?

• What are the key health issues we need to plan and prioritise (treatment v prevention in terms of GDP)

  Data collected by Epidemiology is used by many agencies such as:

• The Department of Health and Ageing

• Pharmaceutical companies

• Doctors

  Epidemiology is a quantitative science, while health is a multifaceted concept based largely on human behaviour. Aspects of health such as wellbeing, emotional cost, quality of life and social determinants are not easily measured using the statistical tools in epidemiology. Despite it being useful, it has shortcomings. Things that are difficult to measure using epidemiology include

• Reasons people engage is risk taking behaviour

• How to balance government expenditure on preventive and treatment services.

  The major measures used to determine the health of a population are:

• Mortality (death rate, usually in a year)

• Infant Mortality (annual number of deaths of children under 1 year old per 1000)

• Life Expectancy (average number of years people of different ages/genders are expected to live)

• Morbidity (data that provides information about the level of disease in specific populations. Made up of **Prevalence **and Incidence)

• Prevalence (number or proportion of people with a disease in a population at a given point in time (e.g. 20 000 people in Australia are infected with HIV)

• Incidence (number or proportion of new cases arising in a population within a given period, usually a year e.g. 800 new diagnoses of HIV/ year)

Based on these measures Australia’s health shows consistent improvements for most groups on most measures over the past century.

Trends

Life Expectancy

• Male 80 (up)

• Female 84 (up)

• Indigenous Male 69

• Indigenous Female 74

Infant Mortality

• 3.4/1000 (down)

• Indigenous 6/1000

Identifying Priority Health Issues

Establishing health priorities is critical to ensure that our resources address our most important health needs, and are allocated in the most efficient way. We also need to anticipate likely health trends for the future and plan for addressing them.

A key challenge is to ensure the research that underpins strategic decision making about the allocation of health resources is valid and reliable. This relies heavily on epidemiology, political factors and attitudes. This is put into effect through these principles:

• Social Justice Principles

• Priority **Population **Groups

• **Prevalence **of Conditions

• Potential for Prevention/early intervention

• Cost to individuals and communities

  A health issue that meets most of these criteria will become a priority, ensuring it will be the target of greater allocation of resources and spending.

Social Justice Principles

These principles play a role in the identification and subsequent management of health priorities.

The principles are:

• equity

• diversity

• supportive environments

  By implementing policies and actions based on these principles, we can focus and acknowledge diversity within the community, and work to ensure equity.

Social Justice Principles seek to recognise and address both health outcomes e.g. influence and prevalence as well as factors influencing health e.g. environments

Equity

Resources are allocated in accordance with the needs of individuals and populations with the goals of equality. This results groups receiving more funding and being identified as priority groups e.g. ATSI

Diversity

Differences that exist between people and individual groups. Australia is diverse and multicultural which means several measures must be in place to ensure each group has access to healthcare and achieves good health.

Supportive Environments

Environments where people live, work and play, makes people have health promoting choices.

An example of Social justice principles in Australia is Medicare. It forms the cornerstone of the public health system and is based on the belief all Australians regardless of personal circumstances should have access to adequate healthcare at affordable or no cost.

It provides essential medical care at an affordable or no cost, so that socioeconomic factors should not restrict a person’s capacity to receive appropriate treatment.

The Pharmaceutical Benefit Scheme (PBS)

Subsidises the cost of selective drug treatments deemed to be lifesaving or adding dramatically to the quality of life. E.g. some cancer treatments.

Note pensioners receive even bigger subsidies

The Medicare Safety Net

$111.60, is a threshold set to assist people, especially socioeconomically disadvantaged, with paying for treatment.

It also assists people with ongoing medical issues/costs

Federal Government Initiative

Priority Population Groups

Criterion for how to best spend money and distribute health resources on priority population groups should be considered by asking questions such as:

• does a specific group within the population suffer higher prevalence of the condition

• can this health issues be improved by targeting a specific population group

Groups include:

• ATSI
• Socioeconomically Disadvantaged
• Rural and Remote
• The Elderly
• People Born Overseas
• People with Disabilities

There are priority population groups that are achieving significantly poorer health outcomes compared to the rest of Australia. Epidemiology allows the government to identify priority groups that need extra resources allocated.

Prevalence of Condition

Criterion for how to best spend money on prevalence of conditions should be based on

• Does it affect many people?

• Is there evidence the extent of the problem is increasing?

Prevalence is the number or proportion in a population at a given time. (refers to the number of people with disease/injury).

It is used to determine the number of people affected by a health issue. The higher the prevalence the greater the issue, which may then be identified as a priority health issue.

Conditions that are high in prevalence and have become a priority health issue include:

• CVD
• Cancer
• Dementia and Alzheimer’s
• Diabetes

Potential for prevention and early intervention

Is this health problem the result of risk factors or determinants that can be changed or modified?

Can harm caused by the condition be reduced by earlier detection and intervention?

Can the impact of the condition be predicted and reduced by understanding changes in the population?

The prevalence of chronic lifestyle diseases in Australia is largely the result of health damaging behaviours. The capacity to change these and many other modifiable risk factors provides great potential for improving health. Because chronic lifestyle diseases develop over many years, improved technical capacity to identify them has greatly increased potential for improving health outcomes.

Cost to the individual and community

Disease and illness can place a great economic and health burden on the individual, and can be measured in terms of financial loss, loss of productivity, diminished quality of life and emotional stress.

Injury and disease may also affect the individual’s ability to be productive and often need to stop work during treatment.

• Direct costs are money spent on diagnosing, treating, caring etc.

• Indirect Costs are the value of outputs lost when individuals become too ill to work.

• Both costs to the community and individual have direct and indirect costs.

Individual:

• Indirect – wellbeing (social and physical health may decrease)

• Direct - medicine, doctor etc

Community

• Indirect – loss of expertise/empty positions at jobs

• Direct – sick leave, replacement

What are the priority issues for improving Australia’s Health?

Groups Experiencing Health Inequities

Australia’s health is generally very good and continues to improve. However, this is not necessarily true for all population groups within Australia. Some groups that experience significantly lower levels of health have been identified.

These groups require extra health resources and funding that aims to help close the gap in health outcomes between these groups and the rest of the Australian population. They include:

• ATSI
• Low SES
• Rural and Remote
• Elderly
• Disabled
• ESL

ATSI

ATSI people experience the largest health gap in Australia. They have higher death rates in each age group. Whilst this is improving they still suffer majorly from the main diseases and illnesses. Overall ATSI people have an extensive gap in health outcomes compared to other Australians. These include:

• Higher CVD
• Higher cancer
• Higher infant mortality
• Lower life expectancy
• Higher endocrine diseases
• Increased mental health issues and suicide

These figures can be attributed to sociocultural, socioeconomic and environmental determinants.

The determinants interact with each other to produce the gap in health outcomes.

Sociocultural determinants for ATSI include spirituality, family and peers. Almost 2/3 of ATSI people identified with a clan or tribal language. Another barrier within ATSI culture is the disempowerment they feel because of many years of oppression and discrimination from non-indigenous society.

Socioeconomic determinants include lower education, employment and income.

• Less than 65% of working age ATSI people were in the labour force as of 2008.

• ATSI households were 2.5 times more likely to be in the lowest income bracket and 4 times less likely to be in the high-income bracket.

• These poor socioeconomic factors lead to lower health education which in turn leads to increased rates of risk behaviours.

• In indigenous communities there is often poor nutrition, physical activity and lifestyle in general. ATSI living in remote areas have little or no access to fruit and vegetables.

Environmental determinants include:

• poor housing conditions, many ATSI people live in houses that are overcrowded and do not satisfy the basic Australian standards for shelter

• exposure to violence, a study showed that indigenous exposure to violence was twice that of any other Australians.

Roles of Individuals, communities and Governments in addressing the health inequities:

• Individuals are empowered by their own choices regarding protective behaviours and risk behaviours. An individual can undertake a more hands-on role in learning about and making choices which will result in better health for them.
• Communities and leaders of ATSI people are involved in the implementation of many closing the gap health services and programs.
• The Australian government introduced an $805 million Indigenous Chronic Disease Package. This aims to improve the way the health care system prevents and treats chronic diseases regarding ATSI people.

The Elderly

The elderly refers to people over the age of 65. In general Australia’s population is aging, therefore it is important to understand the health of the elderly. Chronic disease and levels of independence are of importance regarding the elderly.

Nature and extent

Elderly are mostly affected by chronic disease with 78% of elderly suffering from:

• Asthma
• Arthritis
• Dementia
• Musculoskeletal problems
• Other diseases such as CVD, cancer, CHD

• 93% of people suffering from dementia are elderly.

• The elderly also have the highest rate of injury related hospitalisations i.e. falls.

• The aging population of Australia is predicted to continue growing, which will increase the prevalence of these conditions and diseases.

Sociocultural, Socioeconomical and Environmental Determinants

Sociocultural determinants include peers, family media and mobility. Amongst the elderly family becomes very important for health and social activity. As they age, the elderly also begin to lose friends, reducing support networks.

Socioeconomically, the health of the elderly can be affected by their employment. As elderly reduce their workloads their support networks are once again reduced, which can affect their mental health. Retirement often brings a reduction in income which restricts the choice of health services.

Environmental determinants include access to health services and geographic location. Due to the increased morbidity of disease amongst this age group, access to health services is vital and can play a major role in their health. There is a reduced independence amongst the elderly which also can affect their access to health services.

Roles of Individuals, comm. Gov. in addressing the health inequities:

Elderly individuals can take responsibility for their own health by:

• Increasing exercise levels
• Being socially active
• Decreasing risk behaviours (quit smoking, good diet i.e. less carbs more calcium (for bones))

Communities:

• Meals on wheels
• GP home visits
• Home services i.e. cleaning mowing etch
• RSL

Government:

The Australian government’s focus in improving health for the elderly is preventing and reducing chronic disease. This includes promoting good health across the lifespan as many health conditions aren’t a result of ageing but lifestyle choices.

• “healthy ageing”
• Coordination of information amongst doctors etc.
• Legislation to regulate aged care facilities

High levels of preventable chronic disease, injury and mental health

CVD

Nature and extent:

CVD refers to all diseases of the circulatory system. Including CHD, myocardial arrhythmia and heart failure. The main cause of many of these diseases is atherosclerosis.

CHD includes heart diseases such as heart attacks and angina. A heart attack results from momentary blockage of the artery to a section of the heart muscle. However, a stroke is a temporary blockage of the blood vessels to the brain.

CVDs are the second leading cause of death in Australia. It is also the costliest disease.

However, the rate of strokes has fallen by 22%

Risk and Protective Factors:

Risk Factors include:

• hypertension

• physical inactivity

• obesity

• smoking

Protective:

• Regular physical activity
• Regular health checks
• Eating a balanced diet

SC, SE and EN. Determinants:

Sociocultural includes family, media, peers and culture. Genetics play an important role in chronic diseases. Family life as a child also has an impact on and lifestyle choices that children witness they are likely to follow.

Socioeconomic includes education, employment and income. Education is essential as knowledge of potential diseases and protective behaviours can enable an individual to make positive health choices. CVD also has higher rates in blue collared workers. Lower income levels may also result in fewer health related options.

Environmental include geographical location and access to health services and technology. These in turn affect the speed of treatment which can drastically affect individuals who may suffer from CVD.

Groups at risk:

• ATSI, 2.6 as many heart attacks
• Low SES, 40% higher death rate from CVD
• R and R, higher burden from stokes
• Elderly, represent 70% of stroke victims
• Smokers and males, higher rates of CVD

Arteriosclerosis – stiff and hardening of arteries, related to hypertension

Atherosclerosis – build-up of fats and cholesterol on an artery wall, eventually restricts blood flow.

Cancer

Nature

Cancer refers to cells that have become abnormal and begin to multiply rapidly and cannot be controlled by the body. Cancer cells invade surrounding tissue and can be deadly. The body helps minimise the impact by placing multiplying abnormal cells into sacs called tumours. Tumours can be benign (non-cancerous) or malignant (cancerous). Malignant tumours contain cells that grow out of control and can invade surrounding tissue. If cancer moves away from the original, or primary site, it is called metastasis, or secondary cancer.

Extent

Cancer (all types) is the leading cause of death in Australia. Survival rates are improving and death rates are declining, however the probability of being diagnosed with cancer before 85 is 1 in 2 for males and 1 in 3 for females.

Current trends in Australia are:

• Increased incidence

• Increased survival

• Increased prevalence

• Decreased death rate

  Increased incidence is mainly attributed to increased detection of prostate, bowel and breast.

Cancers with the highest mortality rates are lung, bowel, prostate, breast and pancreatic. However, the last 20 years mortality rates have fallen 17%.

Lung cancer incidence declining for men, however increasing for women

Melanoma incidence almost halved over last 30 years

Breast cancer incidence has risen, however mortality has steadily declined

Bowel cancer decreasing

##### Risk and Protective Factors

• Behavioural factors e.g. Smoking, alcohol, diet, obesity, physical inactivity
• Family history e.g. genetic susceptibility, reproductive/hormonal factors
• Occupational and environmental exposures e.g. asbestos
• Medical and Iatrogenic e.g. infections related to cancer

Protective

• Stop smoking

• Get screening
• Use protective behaviours
• Balanced diet
• Physical activity

Sociocultural, socioeconomic, environmental factors

Sociocultural includes family, culture, media, peers, religion.

Australian culture revolves around going to the beach in summer and getting tan, which can lead to cancer. Genetics inherited through family can also cause cancer.

Socioeconomic includes education, employment and income. People with lower education are more likely to smoke resulting in lung cancer.

Environmental includes access to health services and technology and geographical location. People living in rural and remote areas need to travel to major cities to seek treatment for cancers.

Groups at risk

• Elderly, 70% diagnosis and 80% of cancer deaths occur in the elderly
• Males, death rates higher than females
• ATSI, 10% more likely to be diagnosed
• Low SES, higher rates of all cancers
• R and R, higher mortality though incidence lower

Diabetes

Nature

Diabetes is a disease that relates to the body’s ability to control blood sugar levels using insulin. There are 3 main types:

• Type 1 (hereditary) where the body no longer produces insulin
• Type 2 (lifestyle) where the efficiency of insulin is lowered
• Gestational diabetes, which can occur in women during pregnancy

Diabetes can be the underlying cause of other chronic diseases.

Extent

There are a million people in Australia diagnosed with diabetes. Over the last 20 years, the rate has doubled to 4.2%.

92% of type 2 diabetes occurs in adulthood.

Morbidity is rising quite quickly, with mortality rising but less quickly.

Risk factors and protective behaviour

RF

• Genetics, obesity, imbalanced diet, physical inactivity, hypertension

PF

• Good management of blood sugar levels, regular physical activity, balanced diet, no smoking

SC, SE and Enviro. Determinants

Sociocultural includes family, peer’s media and religion. People with Chinese, Indian, pacific islander or ATSI backgrounds are more likely to be diagnosed with type 2 diabetes. Families that have poor diets and sedentary lifestyles are also more likely to raise children who will be diagnosed with diabetes.

SE

People with low SES have higher rates of smoking and alcohol consumption, physical inactivity and imbalanced diets, which contributes to type 2 diabetes.

ENV

People outside of major cities are more likely to be diagnosed with diabetes

Groups at risk

• ATSI, 3x more likely to have diabetes
• Men more than women
• People of low SES and outside major cities
• Elderly, 15% of people over 65 have diabetes

A growing and ageing population

Australia’s population is growing and ageing. This population is one of Australia’s health priorities, as a growing and ageing population brings an increase in disease burden and health care demand. This population is a product of increased life expectancy and decreased birth rates. Increasing survival rates for chronic disease means the elderly have greater prevalence of major diseases such as cancer, CVD, diabetes and musculoskeletal disorders.

As the population living with chronic disease and disability increases, the demand for health services also does.

Healthy Ageing

Healthy ageing is a process that includes various behaviours and choices that affect health such as; regular physical activity, good diet, regular family contact, social activities and resilience to life’s circumstances. The goal of healthy ageing is to enable elderly people to maintain their health into old age, which allows them to contribute to the workforce longer and engage in society better. This increases economic growth but also decreases the use of health services by the elderly. Healthy ageing involves people reducing their risk factors for disease and preventing the progression of disease. As the government seeks to promote healthy ageing it aims to:

• Prevent disease

• Reduce illness and illness periods

• Maintain economic contributions

• Maintain social participations

  Ultimately healthy ageing improves Quality of Life (QOL) and reduces Disability Adjusted Life Years (DALY).

Better health is associated with employment, thus healthy ageing can bring health gains and increase their work and community activity, therefore improving their wellbeing.

As Australia’s population continues to age, there is an increased population living with chronic disease and disability, as these are more prevalent in the elderly. Chronic disease is the greatest issue for Australia’s health.

Cancer, CVD, prevalence of chronic disease and disability all have rising survival rates.

The more common illnesses amongst the elderly include:

• 49% have arthritis
• 93% of dementia ridden people are elderly

Demands for health services and workforce shortages

• Increased demand for health services
• Increase in age = increase of health conditions/disability
• Increase in 85+ who suffer from cancer, dementia
• 65+ age group have higher levels of lifestyle disease
• Elderly visit health professionals frequently, 98% going a year
• 75% elderly use specialists

These all contribute to challenges on the health system and workforce

Health Service workforce

• People in aged care facilities up by 20%
• Elderly have higher rates of multiple diseases
• Ageing population requires adequate health services/workforce

Availability of Carers and Workers

Carers of the elderly:

• A carer is someone who aids in a formal paid or informal unpaid role for someone due to illness disease or disability.

Informal unpaid includes family/spouse and charities such as RSL

They undertake activities such as cooking, cleaning, administering medication etc.

There are currently 3 types of community care:

1. Community aged care packages: low level care, basic support
2. Extended aged care at home: higher level of care
3. Extended aged care at home (dementia): catering for complex needs regarding dementia

Often people with informal community care progress to formal community care before transferring into residential aged care.

Volunteers:

Volunteering is unpaid, wilful help given as time, service or skill

Formal groups include social groups e.g. sport/rec, civic participation groups e.g. RSL/lions

Volunteers often cook, do housework, visit, help shop

Volunteer organisations include Anglicare, nursing on wheels

Rates of volunteers increased from 1995 to 2010, but after rates fell from 36% to 31%

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

Health care in Australia

Range and type of healthcare facilities and services

Institutional

Public and Private hospitals – serve a variety of patients in a variety of ways, e.g. care, operations treatment elective procedures (non-emergency operations) etc. public financed by state and federal government, public by individuals and community groups. Equity of access in relation to public hospitals has been debated.

Nursing Homes – provide care and long-term nursing attention to those unable to look after themselves, e.g. elderly, chronically ill, people w/ dementia or disability. There are 3 types:

• Private charitable

• Private for profit
• State government

Psychiatric Hospitals – treats people with severe mental illness, recently moved away from institutional care to a system that integrates hospital services and care within community settings. Number of hospitals has fallen, however there has been a corresponding increase in community based residential services.

Non-Institutional

Medical services – includes doctors and specialists that provide different services. Includes GPs who work in medical centres, hospitals etc. the average consultations with GPs has increased over the past decade, which can be attributed to increased awareness of individual diseases and illness. Some Specialists include:

• Dermatologist, treats skin ailments

• Neurologist, treats nervous system diseases

• Pathologist, examines body tissue, blood and urine etc.

• Psychiatrist, specialises in mental illness

• Radiologist, specialist in bones and X-rays

  Health related services – includes ambulances, dentistry, occupational speech therapy, pharmacists, counselling etc.

Pharmaceuticals

Drugs are supplied through hospitals and doctors or over the counter in chemists. Over the counter sales account for 1/3 of all sales. Most prescription drugs sold are subsidised by the PBS.

Community Supports

A significant factor in the provision of an environment that is encouraging to positive health. These supports promote health, however are not recognised as part of the healthcare system. Includes the food industry which set regulations etc.

Responsibility for health facilities and services

Responsibility for most services lies with the state and federal governments. They:

• Administer public care
• Develops legislation and regulations
• Manage health services

Access to health care facilities and services

The health care system needs to have equity of access, meaning it is easily accessible when needed and distributed fairly. The nature of Australia’s population and landmass makes it difficult to do this.

People in rural and remote areas have limited access to services and facilities. To address this inequity, the government introduced programs such as the royal flying doctors.

ATSI also has less access to Dentists, GPs and hospitals. People with lower levels of education also have less access to facilities and services.

The biggest action taken by the government to address equity and access was the introduction of the PBS and MSN. This has greatly removed cost as a barrier.

Local Hospital Networks is another example. LHNs are groups of hospitals that link services within an area, which increases flexibility to respond to local needs.

Access to facilities and services is also about the health system’s ability to provide affordable and appropriate health care when required. It may be affected by issues such as:

• Shortages of qualified staff

• Lack of resources and funding

• Waiting lists

  An Individual’s ability to access services and facilities can be influenced by their:

• Knowledge

• SES

• Cultural and religious beliefs

• Location

• Language

Health Care expenditure vs early intervention and prevention expenditure

This seeks to compare treatment of disease and illness with prevention. To create an effective health care model, Australia must incorporate both.

Australia spends over $140 Billion on health care a year. P and EI can help reduce this cost. Since Australia’s leading causes of death are lifestyle related, the argument is that prevention will be more cost effective than treatment.

Prevention refers to activities and approaches aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing a disorder or reducing disability. Major prevention activities include good hygiene, safe environments and sanitation. Prevention programs include school medical and dental programs, immunisation programs, antismoking campaigns and HIV/AIDS programs.

Currently there is a focus on the increase in Chronic disease, so prevention in Australia aims to improve lifestyle related factors. This aims to decrease smoking, increase exercise, decrease alcohol and drug consumption and promote a balanced diet.

In doing this Australia has recognised the importance of the determinants of health, and seeks to create an environment promoting good health.

Some health promotion campaigns include:

• Slip slop slap
• Every cigarette is doing you damage

Before interventions are undertaken, they should demonstrate value for money with economic evaluations. Cost effectiveness compares estimated cost with potential for health improvement, however this evaluation is difficult to make over time, which can make decisions hard to make. An example of this is discussion about taxing food with poor nutrition.

The Who have a list of policies they suggest being implemented in primary care settings in all countries. They include: reducing the impact of tobacco smoke, restricting advertising for smoking, reducing salt intake, promoting awareness of good diet, etc.

Impact of emerging new treatments and technologies on health care

Early detection and subsequently early intervention is a significant contributor to improving health status. Advancements have been made in the field of medical imaging which greatly enhance the capacity to detect health issues. X-ray, MRI and arthroscopic surgery all enable earlier detection which results in better health. However, they all have associated costs. The development of drugs to treat HIV was a highly expensive process. The drugs themselves were quite expensive, but were critical to people with HIV. As a result, they were placed on the PBS which increased their availability to the everyday Australian. Treatments and technologies are also less available in rural areas. This results in the need for people in RR areas to move to more populated areas if requiring more advanced treatment.

Health Insurance

Medicare

Medicare in Australia has improved health and reduced inequities. It provides health cover for all Australians, and covers the costs incurred by a patient in hospital and a large portion of the cost for primary healthcare.

It is funded through the tax system and the Medicare levy, which is 2% of a person’s taxable income. There is also a Medicare levy surcharge for people earning over $90 000 per year.

Medicare covers free hospital care, and free or subsidised treatment via GPs or specialists. Under Medicare, the patient has little choice of care provider.

Medicare doesn’t cover most ancillary care providers, other than allied health and dental care provided through the allied health initiative.

The amount of benefits provided by Medicare is determined by the Medicare Benefit Scheme (MBS), to be fair to both the patient and doctor.

Some doctors often charge above the MBS fee, the difference being known as “the gap”. However, some doctors accept the MBS as full payment, and are “bulk billed” by Medicare for their services.

Medicare Safety Net:

To protect people who require many medical services, the government established the Medicare Safety Net (MSN). Once a person has paid gap amounts that reach a total, any future payments are covered by Medicare for the rest of the calendar year.

PBS: The scheme subsidises most prescription medicine. The aim is to allow all individuals, regardless of SES, access to necessary medication/prescriptions. Concession card holders get a further subsidy. Once an individual has paid a set amount, they receive prescriptions free of charge for the rest of the calendar year.

Private Health Insurance:

Many people choose to supplement Medicare with private health insurance. Its benefits include not paying the Medicare levy surcharge, and often has private health insurance rebates. It aims to decrease government expenditure and increase personal contributions to health care. They benefit those of higher SES, but also provide greater funds to the socioeconomically disadvantaged. It provides the patient with choice of:

• Specialist
• GP
• Care provider within hospital system

It also covers some ancillary costs, allows faster access to elective surgeries, etc.

Medicare:

Advantages

• Broad range of high quality healthcare
• Affordable or no cost
• Bulk billing

Disadvantages:

• Ancillary benefits not or partially covered

• Waiting lists for elective surgeries
• Limitations in choice

Private health insurance:

Advantages

• Ancillary benefits may be covered
• Choice of doctor, private ward, no waiting lists etc.

Disadvantages:

• Costly
• Premiums must be paid
• Premiums don’t always cover all expenses (the gap)

Complementary and Alternative health care approaches

These are a group of diverse medical and health care systems, practices and products that are not part of conventional medicine. Complementary treatments can be used with western medicine, while alternative treatments are used instead.

The popularity of alternative therapy is growing because there is acceptance building within the community.

Also, because complementary therapies are not necessarily designed to replace orthodox medicine, they are often used in conjunction. Can include:

• Acupuncture
• osteotherapy
• Herbal medicines

However Western medicine practitioners state there is little evidence of benefits.

Another reason for growth is an increase in trained personnel due to courses being provided in universities.

Also, the development of regulatory bodies and associations has increased the credibility of these professions.

Also, the growth of multiculturalism in Australia has also increased complementary and alternative practices.

People are also beginning to show a greater interest because it is designed to prevent illness from occurring.

Complementary and alternative products include:

• Natural medicine (herbs)
• Supplementation (vitamins and minerals)
• Physiological treatment (acupuncture)
• Energy based treatments (crystals)

Osteopath focuses on musculoskeletal issues to help the body function properly. They use joint manipulation and massages.

A naturopath uses natural medicine and natural products to strengthen the immune system and accelerate the healing process. They focus on diets or provide nutritional supplements and herbal medicines.

Despite the acceptance there are still “dodgy” treatments that consumers must be aware of. They sometimes promise quick cures on a money back guarantee. When determining legitimacy, look for qualifications and regulations. This is readily available on government websites.it is vital individuals put thought and time into choosing a natural therapist. The person should have reasonable qualifications for their field and should be registered with an appropriate body.

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

Responsibility of health:

• Lies with individuals, communities and governments, when they work in partnerships it ensures effective improvements in health outcomes. This integration of health promotion creates optimal conditions for achieving health promotion goals.

Governments, communities and individuals are all enabled to improve their health. This means they are encouraged to actively participate, which contributes to better health outcomes.

Empowering gives people and communities the support needed to identify problems and work together in creating solutions.

Health Promotions based on Ottawa Charter and Social Justice: Health promotions aim to reduce the inequities in health status, ensuring equal opportunities and resources for health.

Ottawa Charter and Social justice:

National Tobacco Strategy 2004-09

Increasing excise and customs duty on tobacco products – Building healthy public policy

D: self help material - allows smokers access to info

C: regulation of promotion - people aren’t exposed to messages that glorify smoking

S: ensure ATSI organizations are represented on expert decision-making committees – ensures key stakeholders are represented ensuring various cultural considerations are considered

R: quitting services and treatment – ensures smokers are supported by trained medical staff when trying to quit

B: regulating place of sale – ensures retailers will not sell to minors and people will not be reminded they need tobacco as it won’t be on display

National Action Plan on Mental Health 2006-11

D: expanding early intervention services for youths – ensures young people will be provided with info

C: funding statewide 24hr helplines – people will have access to counselors

S: training aboriginal mental health first aid instructors – will identify people in ATSI communities at risk and allow appropriate action to take place

R: mental health content in tertiary curriculum – more health workers will be trained in supporting mental illness

B: better access to psych through Medicare – less of financial burden in seeking care