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1

Leading causes of disease in the 1900s and why

Infectious diseases
Cardiovascular disease
Cancer
Respiratory diseases
Injury and poisoning

Improvements in sanitation, public health (vaccination development and delivery), and medical treatments, such as antibiotics, led to dramatic declines in deaths from infectious diseases during the 20th century.

2

How has public health changed since 1900 and why

Improvements in sanitation, public health (vaccination development and delivery), and medical treatments, such as antibiotics, led to dramatic declines in deaths from infectious diseases during the 20th century.

- Control of infectious disease
- Better hygiene
- Improved nutrition
- Improved sanitation
- Better understanding of dehydration

3

What is public health

The organised response by society (governments) to protect and promote health and wellbeing, and to prevent illness and injury.

4

What is "old" public health

Government actions that focussed on changing the physical environment to prevent the spread of disease, such as providing safe water, sanitation and sewerage disposal, improved nutrition, improved housing conditions and better work conditions.

5

Biomedical model and examples

The biomedical model of health focuses on the physical or biological aspects of disease and illness. It is a medical model of care practiced by doctors and health professionals and is associated with the diagnosis, cure and treatment of disease.

E.g. x-rays, scans, blood tests, surgery, ultrasound etc.

- 'Bandaid' or quick fix approach
- aims to return the patient to pre-illness health
- relies on medical practitioners and technology
- focuses on the individual

6

Improvements in technology as a result of the biomedical model of health

- Stethoscope in 1910 (measure blood pressure)
- New X-ray techniques.
- Heart-lung bypass machine
- Hypertension medication
- Coronary angioplasty and stent
- Cholesterol medication
- Pacemaker

7

Social model of health

An approach that recognises improvements in health and wellbeing can only be achieved by directing effort towards addressing the physical, sociocultural and political environments of health that have an impact on individuals and population groups

8

AREAS

Addresses the broader determinants/factors of health:
- focus on more than the behavioural factors
- social, economic, and environmental determinants

Involves intersectoral collaboration:
- government and non-government groups working together to address barriers and improve health outcomes for all

Acts to reduce social inequity:
- reduce the barriers that may prevent people from experiencing good health such as income, race, gender
- aim to 'level the playing field'

Acts to enable access to healthcare:
- address the social and environmental barriers that may restrict someone's ability to access healthcare, such as location, income.

Empowers individuals and communities:
- give people the knowledge and skills needed to allow them to participate in the decisions that positively impact their health

9

Difference in the old and new (social model) models of health

Biomedical model:
Individual focus
Focus on cure
Not all conditions can be treated

Social model:
Population focus
Focus on prevention
Not all conditions can be prevented

10

Health promotion

The process of enabling people to increase control over, and to improve, their health

11

Ottawa Charter

An approach to health developed by the World Health Organisation that aims to reduce inequalities in health. It reflects the social model of health and provides five action areas that can be used as a basis for improving health status, all of which are centred around three strategies for health promotion which are enabling, mediating and advocacy.

12

Bad Cats Smell Dead Rats

B

Build healthy public policy:
Refers to decisions (laws, policies) made by government and organisations that affect health
Laws and policies that make it easier to practice good health
E.g. removing the goods and services tax (GST) on unprocessed foods (which are healthier options than processed foods) and increasing the tax on certain alcoholic drinks.

13

Bad Cats Smell Dead Rats

C

Create supportive environments: about making it easier for people to make healthy choices by providing a physical and social environment that promotes health rather than detracts from it.

E.g.
- councils installing shade cloths over playgrounds
- bike paths and walking tracks
- the Quitline online service
- Kids Help Line counselling
- Red Frogs at Schoolies

14

Bad Cats Smell Dead Rats

S

Strengthen community action: refers to involving many different groups within the community to work towards a common goal of improving health.
This works to build links between individuals and communities to encourage communities to be involved in the development of health promotion campaigns and feel a sense of ownership

E.g. Local Men's Shed programs

15

Bad Cats Smell Dead Rats

D

Develop personal skills: is about providing people with the skills they need to be able to take control of their health and make healthy choices.
This priority area is about education, specifically the development of health-related knowledge.

E.g. The big issue

16

Bad Cats Smell Dead Rats

R

Reorienting health services: is about shifting the health system the health system towards prevention, as opposed to focusing on cure.

A doctor's waiting room often has preventative messages on their wall, such as reducing tobacco smoking or preventative measures for type 2 diabetes

17

Social model of health strengths and limitations

Strengths:
- Aimed at a population level; therefore, more cost-effective
- Encourages good health through disease-prevention
- Health messages can be passed down to future generations
- Can be targeted to vulnerable population groups

Limitations:
- Health messages may be ignored
- Not all conditions can be prevented (for example, genetic conditions)
- Doesn't assist those who are already sick

18

The biomedical model of health strength and limitations

Strengths:
- Life expectancy extended and quality of life improved
- Leads to significant advances in medical technology and research
- Most people and conditions can be treated and 'cured'.

Limitations:
- The 'fix-it' approach doesn't promote good health
- Relies on costly medical technology and practitioners
- Not all conditions can be treated or cured

19

Relationship between biomedical model and social models of health

The social model of health considers preventative measures, whereas the biomedical model considers only diagnosis, cure and treatment of disease. This results in the social model of health placing less of a burden on the Australian healthcare system

20

Social model of health principles - obesity prevention

Addresses the broader health determinants:
- make affordable access to culturally appropriate healthy foods
- ensuring affordable access to recreational facilities to encourage physical activity, such as well-lit walking tracks

Acts to reduce social inequities:
- health-promotion campaigns such as LiveLighter free access to resources, such as the 12 week meal and activity planner, to allow all members of the community to be able to access these resource, and can be downloaded in different languages

Empowers individuals and communities:
- workplaces running health cooking demonstrations to develop employee skills on preparing healthy lunches
- nutrition education programs in primary and secondary schools

Acts to enable access to healthcare:
- provision of bariatric services e.g. lap-band surgery, in public hospitals via Medicare

Involves intersectorial collaboration:
- Federal government working alongside Heart Foundation and Cancer Council to implement the LiveLighter program

21

Examples of medical technologies in treating cardiovascular disease

Pharmaceuticals:
- blood pressure medication
- blood thinners
- cholesterol lowering medication

Surgeries:
- bypass surgeries
- pacemaker
- stenting

Other medical interventions:
- defibrillator

22

Medicare

A universal health insurance scheme as it is available to all Australian residents, regardless of income, location and culture.

23

PBS (Pharmaceutical Benefits Scheme)

A federal government initiative that aims to make essential medicines available through subsidising a range of prescription medications at affordable prices for Australian citizens

24

PBS advantages

- They subsidise the prices of medications to make it affordable for Australians
- Available for over 5000 medications
- Providing access to essential medication
- Enables access to medications from local pharmacies
- Includes PBS Safety Net and the RPBS to further protect people from the high cost of medication
- Available to all citizens despite age
- Provides additional support to those with concession cards by having lower co-payments.

25

PBS disadvantages

- Doesn't subsidise every medication
- Available for over 5000 medications
- Dispensing fees
- Providing access to essential medication
- Significant financial burden it places on the Australian Government
- Enables access to medications from local pharmacies
- The co-payment of $38.80 that still needs to be paid by most Australians

26

PBS
Equity, Sustainability, Access

Funding
- Essential medicines; including those subsidised through the PBS
Sustainability
- Only certain medications are subsidised, otherwise, it’s too costly

Access
- Subsided medication; through the PBS, including further concessions for low-income earners, removes the income barrier

Equity
- PBS Safety Net, the government is trying to ensure financial costs areas ‘fair’ as possible Full price [$38.80] or concession rate [$6.30] - those low income, pensioners or seniors
- The PBS Safety Net is in place to assist those people who have a reliance on prescription medication and protect them from significant financial costs

27

Medicare
Who can access it and what it covers

Who can access it:
- all Australian permanent residents

What's covered:
- GP visits
- Treatment and accommodations as a public patient in a public hospital
- Eyes tests
- X-rays
- Pathology tests (blood tests)

28

How is Medicare funded

Medicare funding:
- General taxation: additional costs
- Medicare levy: additional 2% of their tax
- Medicare levy surcharge: additional 1-1.5% tax on top for high income earners

29

Advantages and Disadvantages of Medicare

Advantages:
- available to all Australian citizens
- basic health tests and treatments are provided at little or no cost
- reciprocal arrangements with other countries allow Australian citizens to access subsidised/free health care in other countries
- allows patients to choose their own doctor for out-of-hospital services

Disadvantages:
- waiting lists for many non-emergency treatments
- doesn't cover many common alternative treatments such as massage
- may not cover all costs of doctors and specialist fees if charged more than the scheduled fee
- does not allow patients to choose their doctor for in-hospital treatments

30

Medicare
Sustainability, Access, Equity

Sustainability:
- The Medicare levy increased from 1.5 to 2 per cent in July 2014 to assist in providing the necessary funds to maintain Australia’s health system and introduce the National Disability Insurance Scheme.

Access:
- It covers the cost of healthcare in public hospitals, making it more accessible for Australians

Equity:
- Medicare promotes equity by providing hospital care to all Australians, regardless of their ability to pay.
- The Medicare funding also reflects equity as it is based on a percentage of an individual’s income, so those who earn more, pay more
- Safety net and concession pricing schedules make financial costs as fair as possible