HHD is waaaaaaaaaaay easier if you have a pretty solid general idea of what it's all about, before starting. So this summary should give you a quick and understandable overview, not clogged up by definitions or details
Unit 3 Area of Study 1: Understanding Australia’s healthHealth and health statusclick here
Firstly: what is health? Just not being sick, not having a disease? It involves complete physical, mental and social wellbeing.
‘Health status’ is an individual/population’s overall level of health, and you learn different ways to measure this level of health (‘health status indicators’):
• burden of disease: a way to measure the impact of diseases; it's the gap between how health is now, and how we'd like it to be
• disability-adjusted life years (DALYs): it's a unit that measures burden of disease (like height is measured in metres). 1 DALY = 1 year of healthy life lost, due to death or sickness
• life expectancy: how many more years a person is likely to live
• health-adjusted life expectancy: how many more healthy years a person is likely to live
• mortality: the number of deaths from a condition
• under-five mortality rate: the number of kids that die before they're 5 (per 1000)
• morbidity: levels of sickness in an individual or population
• incidence: number of new cases of a disease diagnosed over a time period
• prevalence: the number people with a disease in a population right now
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Obviously, different countries or groups have different levels of health. Overall, poor people (lower socio-economic status), people living in the country (rural/remote), and Aborigines (Indigenous Australians) have a lower health status. Men and women also tend to have worse health for different diseases.
But WHY are there these differences? If we can figure this out, then we can improve everyone’s level of health by fixing up the things that increase risk of certain diseases and lower the health status of certain groups. These things are called “determinants”, things which make you more or less likely to get diseases and thus determine / decide / impact our health.
There are four main groups of determinants:
• biological: stuff to do with the body, like genetics, body weight or blood pressure
• behavioural: what you do, like diet or exercise
• social: your experiences and expectations of the society round you, like social exclusion, your income, or a binge drinking culture
• physical environment: the place you live and work in, like housing, or your house being too far from a doctor
Here’s an example for why males die more of different types of conditions from females.
• Biological: obviously, a guy will get prostate cancer more than girls and won’t get cervical cancer, because their bodies are different.
• Behavioural: males are more likely to drag race and die in car crashes.
• Social: guys are expected to be “strong” (macho image) and thus are less likely to admit to being sick and go to a doctor than a girl, so it’s more likely any diseases won’t get treated early and will get worse.
• Physical environment: males are more likely to work in physically dangerous places, like factories or building sites, so they’re more likely to be injured or breathe in nasty fumes.
Or, Indigenous Australians have higher rates of diabetes THAN OTHER AUSTRALIANS, because:
• Biological: genetically, they may have a condition called “Syndrome X”, which makes them more likely to get diabetes.
• Behavioural: overall, they tend to eat worse diets – fewer vegetables and more junk food so they get fat and have diabetes.
• Social: on average they have lower income and thus can’t afford to buy fruit and veg, and instead they may buy cheaper fast foods, they get obese and have diabetes.
• Physical environment: they’re more likely to live in rural areas and thus can’t access fresh fruit and veg, instead they get packaged foods.
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Some diseases/conditions are really big in Australia – like cancer, heart (cardiovascular) disease, depression. These cost us so much as individuals and a country – they’re expensive, lower our health status, and cause us a lot of sadness and pain. So we really have to deal with them!
To do this, the Government has chosen the nine biggest groups of conditions that challenge Australia, and called them the National Health Priority Areas. This means that they’re the diseases or issues that the government, health professionals, media and community will focus most on.
The National Health Priority Areas are:
• cardiovascular health (e.g. heart attack, stroke)
• cancer control
• arthritis and musculoskeletal conditions (e.g. arthritis, osteoporosis)
• obesity
• diabetes mellitus
• injury prevention and control (e.g. falls, drowning, suicide, road accidents)
• dementia
• mental health (e.g. depression, bipolar, schizophrenia, anxiety/eating disorders)
• asthma
For these, you have to learn:
• what each disease actually is!
• reasons why they were chosen - the impact they have on Australia, so you can see just how important it is to reduce them
• this involves learning the COSTS, both to the person with the disease and those around them or the country:
--> monetary costs (e.g. cost of diagnosing/treating the disease like medication, GP or chemo --> direct cost; not being able to work and earn money because you're sick --> indirect cost
--> intangible costs, those not related to money, e.g. suffering from the disease or losing a family member/friend
• risk determinants (biological, behavioural, social and physical environment again) – once we know the risks we can avoid them.
• one program that someone’s developed to reduce the impact of these diseases. The program may try to prevent the disease by teaching about the risk factors and encouraging people to change their behaviour; or it may try to keep people healthier once they’ve already got a disease. These programs are the KEY! They're the way we improve our health status and reduce the costs of these diseases.
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On a bit of a side note, you then learn about specific nutrients, what food you get them from, and their function and impact on health:
• protein
• carbohydrates
• fibre
• water
• monounsaturated fat
• polyunsaturated fat
• saturated fat
• trans fat
• calcium
• phosphorus
• vitamin D
• sodium
Tying it in, you learn about how nutrition impacts a few of the conditions covered in the NHPAs. If you eat too much or too little certain of these nutrients, then you are more likely to get the diseases!
• cardiovascular disease
• obesity
• colorectal cancer
• osteoporosis
• type 2 diabetes
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So, we know that we have a real issue with some conditions, and somehow we have to figure out a way to reduce their impact so we’ll be healthy happy people!
There are two main ways we’ve got to learn, and see which way is best.
You could wait till people get sick then get the doctors to come and fix them up. (This way’s called the biomedical model of health). Often medication, doctors and surgery do work to improve our health status. But this costs a LOT and unfortunately doesn’t always work; sometimes we die before they figure out how to fix us. Wouldn’t it be better if we never got sick in the first place??
[Of course that’s impossible]. But we CAN try and help people can control and improve their OWN health. This is called health promotion, ‘the process of enabling people to increase control over, and improve, their health’.
To do that, we have to make healthier choices easier for them, by changing the environment around them and teaching them skills so they can improve their own health. The aim is to make it easier for them to have positive determinants than negative determinants.
Summing up with an example: Lots of people are getting type 2 diabetes which can lead to kidney failure, gangrene, blindness and more. How do we fix this?
1. Biomedical: send them to the doctor once they’ve got it, who’ll give them insulin monitoring equipment, do kidney surgery, chop off their gangrenous legs, etc.
2. By health promotion: BEFORE they ever get the disease, teach them yummy low fat vegetable recipes, make soft drinks more expensive and vegetables cheaper, give them a free pass to the gym... etc., so they’re less likely to get fat and get diabetes.
Within the health promotion section, there are two models: the social model and the Ottawa Charter of Health Promotion. They are each made up of five ways/principles/action areas – their main key points that help promote health - which you have to learn word-for-word.
Social model: focuses on addressing social, economic and environmental determinants of health
a) involve intersectorial collaboration: get everyone (govt, businesses, media...) not just health pros to work together to improve health
b) enable access to healthcare: let everyone access healthcare (make it cheap, close and in the right language)
c) act to reduce social inequities: everyone's got to be able to access resources for health, so that ALL can improve their health (remember, disadvantaged groups had lower health status?)
d) empower individuals and the community: give people the skills/resources to change their own health
e) address broader determinants of health beyond the individual: don’t just look at genetics or behaviour; fix up people’s finances, social situations and the environment round them too, as they also impact health.
Ottawa Charter of health promotion:
a) Build healthy public policy: make rules that make it easier to make healthy choices (tax cigarettes so it’s harder to smoke; schools make kids wear hats to reduce skin cancer risk).
b) Create supportive environments: support people through safer/healthier environments (mums support groups, shade areas in playgrounds)
c) Strengthen community action: get the community to work together for health
d) Develop personal skills: teach people healthy skills (how to cook nutritious foods or check for skin cancer) so they can improve their own health
e) Reorient health services: get patients involved in their healthcare; don't just rely on the doctor.
VicHealth
Victoria’s main health promotion group (based on social model of health). Mainly, it funds and supports programs that aim to promote health.
You’ll have to learn its mission, and priorities (the main areas it targets). In SACs and the exam, you’ll probably be given a case study with one of the programs VicHealth’s funded. Then you might have to pick out its mission and priorities in the program, and how it shows the social model or Ottawa Charter (e.g. does it develop personal skills, or reduce social inequities?)
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One of the most applicable bits of the course to our lives is how Australia’s healthcare system – an example of the biomedical model of health – works.
You learn the healthcare jobs of the Federal, State and Local governments, and the values that underpin the healthcare system – its aims, goals and how it tries to deliver care.
Medicare and PBS
Then there’s Medicare. This is Australia’s healthcare system which provides us all healthcare free or very cheap, so everyone can access it regardless of income or age. It’s funded by taxes, and covers GP visits, public hospital treatment and accommodation, some tests like x-rays, and optometrist eye tests – which we get (almost) FREE!
The Pharmaceutical Benefits Scheme is similar, but it subsidises essential medicines rather than doctors’ treatment.
Private Health Insurance
But providing everything free costs way too much for the Government, so for some less essential services (physio, OT, ambulance, private hospitals, cosmetic surgery, dental...) you have to pay the whole lot.
Unless you pay a monthly premium to a private health insurance fund. After taking out insurance, you get all these extra health services much cheaper. While this is great, to both you and everyone else – you have access to more services, less waiting time, there’s less burden on the public system, and you get more choices of doctors and hospitals – still it costs more and not everyone can afford it.
The Govt really wants more people to take this out, as it means they’ll use the public system less so it’ll cost them less. So they’ve made an Incentives Scheme to encourage people to take out PHI:
• Govt provides a rebate to help cover premium costs
• there’s extra tax for people without PHI
• it’s cheaper per year if you take it out before 30 than after 30 (this one’s a bit confusing...)
click here
This next section ties in with the nutrition part earlier in the course; you will have learnt what nutrients/foods it's important to eat and which to avoid, which is important to improve Australia's health. So you learn about ways the Govt promotes healthy eating. The Govt can’t MAKE you eat healthy; it just tries to help you by teaching you about healthier choices, through these ways:
Nutrition SurveysThe Govt gets data from surveys asking people about their food intake. From this they know what people are eating too much or not enough of. Once they find this out, they can:
• make nutrition promotion programs, or help NGOs make nutrition education programs, that target people’s biggest nutrition issues
• make new rules, like what foods to tax more or less or mandatory fortification
• find out dietary trends
• revise national health targets
Australian Guide to Healthy Eating (AGHE)This is a big pie graph cut into five sections showing five food groups: fruit, vegies, grains/breads, meats, and dairy. Each section is a different size, based on how much of your diet it should be from that group, and is filled up with pictures/examples (e.g. chicken breasts, fish, prawns and lentils in the meats/protein category). It also shows, out of the pie, foods for ‘only sometimes and in small amounts’ (alcohol, soft drinks, oils, cakes, burgers...), and a glass of water to encourage drinking plenty of water. Print it out (
http://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55i_australian_guide_to_healthy_eating.pdf) and stick it on your wall!
The Dietary Guidelines for Australian AdultsThis is a booklet from the Govt with lots of info about what to eat and what not to eat, with guidelines on serve sizes etc. It has five main guidelines you’ll have to learn, one of which is directly related to the AGHE.
Nutrition AustraliaFinally, this non-govt organisation also promotes healthy eating as it provides:
• nutrition research
• nutrition publications
• nutrition info on website
• nutrition seminars
• healthy living pyramid (pyramid showing three levels of foods: ‘eat most’, ‘eat moderately’, and ‘eat in small amounts’, teaching you what you should and shouldn’t eat)
• holds national nutrition weeks
This unit revolves round HEALTH, HUMAN DEVELOPMENT and SUSTAINABILITY. You must know what these all mean!
Developed vs. developingclick here
Firstly, we split countries into two types: developED and developING. DevelopED countries have past tense – they’ve already achieved human development; they still have some to go, but basically they’re already relatively rich and healthy. DevelopING countries are present continuous tense – they’re on the way, but still have a long way to go. Basically for this course, we assume they’re poor and sick. We focus more on developing countries, because we’ve already looked at a developed country (Australia) in Unit 3, and besides, Australia doesn’t need nearly as much help as developing countries do.
So a developed country is:
• rich (high gross national income, GNI) – this comes from a good economy, with lots of trade, exporting, agriculture and mining
• healthy (high life expectancy, low death rates)
• well educated and immunised
Just assume that a developing country is the opposite.
Another way of dividing them up is into mortality (death) strata from strata A to strata E, based on child and adult mortality rates. Countries in strata A have the lowest mortality rates (most developed) and those in E have the highest mortality rates (least developed).
click here
This definition is huge. But it’s the underpinning force of this course: this is what we are trying to achieve for everyone in the world, basically the chance to do whatever we want, to be happy and achieve our best with nothing to stop us.
Human development is:
Creating an environment in which people can
• develop to their full potential
• lead productive and creative lives in accord with their needs and interests.
It is about
• expanding people’s choices
• enhancing capabilities (the range of things people can be and do)
• having access to knowledge, health and a decent standard of living
• participating in the life of their community and decisions affecting their lives.
It’s impossible to measure this! It’s a totally personal thing. But obviously people living in some countries have better human development than others. So the UN made the Human Development Index, a way of measuring and ranking countries’ levels of development, on a scale from 0.000 to 1.000. Countries with good health (high life expectancy), thorough education (based on the years of schooling), and high standard of living (high gross national income) will have a high HDI number. (P.S. Australia second-tops the world!)
click here
We want to meet our own needs, now, so we can be healthy and happy. But sometimes we can do that at the expense of the future, like cutting down all the trees. Our aim to be sustainable: to meet the needs of the present, without compromising the ability of future generations to meet their own needs (they’ve got to be able to be healthy and happy too).
Developed countries often implement programs to try and improve developing countries’ health and development. It would be useless to put in programs if, once those who started the program leave, it collapses. The aim is not just to help countries in the present, but help them to be sustainable – basically giving them the shove down the hill which they couldn’t do themselves. It’d be kinda sad if you pushed a child down a slide and as soon as you stopped pushing the child suddenly stopped...
Some sorts of programs are more likely to be sustainable and keep on going even without support. There are three elements that make a program more likely to be sustainable.
• equity: it must help those most in need (e.g. rural groups, women)
• affordability: no use doing something that can’t be funded by the developing community! They have to be able to keep on paying for it long term. Education is a great way – ‘give a man a fish, and he’ll be hungry tomorrow (and not able to pay for another), ‘teach a man to fish and he’ll never grow hungry’. Often all they need is skills – which are one-off, cheap things!
• appropriateness:
o it can’t go against social customs or they won’t accept it
o involve local community members! they understand the community’s needs and will help you do it the most culturally appropriate ways
o they’ve got to be able to understand – don’t give illiterate groups a PhD on choleric transmission to read to teach about hygiene, show them through pictures, drama and music to wash their hands!
click here
Developing countries have worse health status than Australia. Why the difference? This is like the determinants of health, on a global scale. Once you know what lower health status in developing countries, you can fix it! You learn about 7 factors that are different in developing countries from Australia, and how this leads to their worse health status.
Whether accurate or not, just make assumptions about what goes on in developing countries and Australia!
Income
Australia’s rich. Developing countries are poor, so their govts can’t afford education, healthcare or safe water and sanitation systems.
Individuals in developing countries are poor too, so they can’t afford:
• healthcare => high maternal and child mortality
• sanitation => waterborne diseases, e.g. cholera
• good housing
• education => cycle of poverty, few choices and capabilities
• adequate nutrition => malnutrition, illness, child mortality
Gender equality
In Aus, men and women have the same rights, opportunities and wages.
In developing countries, women have:
• less access to education/employment
• early marriage and childbirth: a girl’s body isn’t fully developed; young girls giving birth may have fistulas (a hole torn between the vagina and rectum/bladder, so they’ll leak urine or faeces) or may die, raising maternal mortality rates
• violence and prostitution
• unpaid domestic duties => poverty
So they can’t live productive, creative lives in accord with their needs and interests, expand their capabilities and choices, develop to their full potential, or participate in decisions affecting their lives and the lives of their communities.
Peace/political stability
Australia has peace and thus stable trading, healthcare and education systems.
Conflict due to political instability in developing countries causes:
• destruction of wells/hospitals/schools
• crop destruction => poverty, hunger
• money spent on weapons rather than healthcare/education
• injury (bombing etc)
Education
Most Australians are educated; many in developing countries aren’t.
Education provides people:
• more employment opportunities
• higher income
• the ability to understand any health-related information, so they can learn ways to promote their health (like cooking nutritious foods, hygiene) and what to avoid to keep healthy
Educated girls marry later, have fewer kids and look after them better and send them to school.
Access to healthcare
Australians can access healthcare, those in developing countries may not be able to access:
• immunisation, so they’re more likely to get sick and die from measles, TB, polio, rubella....
• midwives, so women and babies are more likely to die
• medicines
• treatment of common diseases
Overall, they don’t have access to treatment so they’re more likely to die than Australians.
Global marketing (of alcohol, tobacco and fast/processed foods)
Global marketing is basically selling products all over the world. It means that in Australia, lots of rules have been made – cigarettes are taxed, you can’t smoke in shops etc., so the tobacco companies don’t sell as much. So they’re selling more and more in developing countries.
So in developing countries people have more access to and consume more alcohol, tobacco and fast foods; so they’ll have more conditions that are consequences of using too much of these products. Also, because they’re poor, by spending money on these they may not be able to afford nutritious food and become malnourished.
Physical environments
Safe water/sanitation: Aus has great access, many developing countries don’t. Unsafe drinking water/not going to the toilet safely helps diseases to spread – cholera, diarrhoea, hookworm etc.
Shelter: poor housing in developing countries can cause poor access to safe water, sanitation, cooking, and lead to disease spread.
Climate change: due to extreme weather conditions (floods, cyclones, drought), crops and buildings can be destroyed leading to poverty, malnutrition and lack of access to healthcare/education. Floods can contaminate water => disease spread. Australia has resources to cope with disasters, developing countries don’t.
click here
This is like the NHPAs (national health priority areas) on a global scale: the UN countries have gathered together and decided on the biggest issues that really need fixing worldwide, and set goals for the impact they're going to try and have by 2030.The issues include:
• poverty
• hunger
• poor health, high mortality rates and spread of diseases like HIV, malaria and TB
• lack of education
• gender inequality
• not enough access to clean water and sanitation
• poor economic growth
• loss of environmental resources
• wars and lack of social justice
So they made 17 SDGs, each with specific targets - however, you only have to learn eight of them! For each goal, you have to learn:
• its name
• a description of what it's trying to achieve
• reasons why it’s important
• how it impacts on global health and sustainable human development
click here
Now we know what we want to achieve: lifting up developing countries, making all those factors positive, achieving health, human development and sustainability, and meeting the SDGS!
This section is about HOW people all over the world are achieving GLOBAL HEALTH and SUSTAINABLE HUMAN DEVELOPMENT. Like for the NHPAs, you learn lots of programs run by lots of different groups:
- the United Nations (UN)
- the World Health Organisation (WHO)
- Australian aid
- NGOs
- and more...!
and then the impact they all have on GH and SHD.
Global health is... well, what it sounds like. Health, worldwide; it’s not about individuals or countries, but achieving good, equal health all over the world – even for the most developing of countries. The ideal dream!
We found that what we really need to achieve is health, human development and sustainability – but that takes too long to say! So we mix them all up, and get sustainable human development. If we can achieve health, it makes it easier for people to have human development (they can go to school/work, expand capabilities and choices, participate in their community/lives...), which then means they’re likely to pass it on, leading to sustainability. You see, we can’t achieve them separately, because they interrelate and impact each other.
The longest exam question is a 6-mark question asking about how any program/factor influences sustainable human development; as part of this you have to show how health, human development and sustainability interact/impact each other.
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Multilateral: lots of countries and groups pool money in a big global group, like the UN or World Bank, and they then take money from the pool and use it wherever they want. That way any huge project that no one country is rich enough to carry out can be implemented, and you can address worldwide issues and make worldwide rules. e.g. to stop ebola spread all the countries have to work together, it has to be global.
Bilateral: bi = 2, this is one government giving aid directly to another country, like Australia to East Timor. Usually a developed country chooses to give a helping hand to a nearby country.
Emergency/humanitarian aid: when there’s an emergency or disaster – earthquake, flood, tsunami, war – other countries help out the people in very serious immediate need, giving them food, water, shelter, whatever they can’t access in the emergency situation. This rescues them (otherwise they might die/get very sick) so they have the chance to be healthy and rebuild their community later.
NGO aid: where non-government, generally not-for-profit volunteer and often quite small groups give aid. They normally work directly with villages or communities to implement specific, small and targeted programs. While they’re not necessarily big, they have a lot of impact as they can directly address the needs of communities.
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This is the world’s biggest health organisation (guess why it’s called the World Health Organisation?), which provides lots of information and research, tries to stop stuff like Ebola spreading, and tries to achieve all the health-related MDGs.
You have to learn WHO's six leadership priorities (mnemonic: UNSHIT)
- universal health coverage
- non-communicable diseases
- social, economic and environmental determinants
- health-related MDGs
- increasing access to medical products
- the international health regulations
and then how these points lead to GH and SHD.
click here
WHO is global; let’s look at how Australia gives its aid. The Department of Foreign Affairs and Trade (DFAT) is in charge of Australia giving aid – of all types, but especially bilateral aid, directly from Australia to other countries.
You have to learn the six priorities DFAT focuses on (IGA BEE):
- infrastructure, trade facilitation and international competitiveness
- gender equality and empowering women and girls
- aggriculture, fisheries and water
- building resilience: humanitarian assistance, disaster risk reduction and social protection
- effective governance: policies, institutions and functioning economies
- education and health
and again, how these priorities could lead to GH and SHD.
click here
The UN has four main big roles which help promote GH and SHD.
Promoting world peace and security: by mediating in conflicts and trying to stop conflict from happening, the UN promotes peace: thus less injury, less crop/infrastructure destruction and so on.
Social and economic development: the UN does heaps to promote development, like gender equality, better education, more people employed etc.
Human rights: the UN made a convention of Human Rights, which lists lots of rights we all have (education, work, food, religious freedom, democracy etc.). This makes people more aware of what they have a right to, and helps people have more access to education, work, food etc.
Humanitarian assistance: the UN delivers very large-scale aid in emergencies.
click here
Then you have to learn specific programs which aim to improve levels of
- literacy/education
- food security (having access to enough safe food)
- HIV/AIDS
- malaria
- immunisation
- safe water
- sanitation
in developing countries.
These are some of the biggest barriers to GH and SHD that developing countries face; so if we put in programs to fix them up, then we’ll improve GH and SHD.
For each issue you have to learn the following about one program:
- why they’re being implemented – why do they matter so much? what’s the huge impact of the issue anyway? (most of this you know from the SDGs and 7 factors that impact health status of developing countries)
- how the program is implemented, i.e. what it actually is and does. Learn specifics.
- who’s running the program – and is it multilateral, bilateral, NGO aid?
- how the program will promote GH and SHD (again, this is drawing from SDG and 7 factors knowledge; by the exam you should be able to make this up at the drop of a hat...)
Questions could ask you either to outline a program that has been implemented (a real program), or one that could be implemented (you get to make one up!)
With that – we're finished! I promise you, that while all that content can sometimes seem daunting, you have chosen the right subject! Throughout the year as you learn about Australia and finally how we can work together to get the whole world out of the cycle of poverty and sickness, you will find this a truly rewarding subject. Have fun studying and I hope you all get the scores you deserve!
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