KEY KNOWLEDGE:1.1 definitions of physical, social and mental dimensions of health and health status;KEY SKILL:define key health terms Advice • Students should be able to recall these definitions • Can I define health status? Physical health? Social health? Mental health? • Do I know examples of each of these dimensions? • Physical activity and healthy eating are NOT examples of physical health- these are determinants of health. ‘Many students identified determinants of health instead of dimensions of health’ -2010 Assessment Report
Definitions of Health WHO definition of health; ‘A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.’ Definition of Health Status An individual’s or population’s overall level of health, taking into account various factors such a life expectancy, amount of disability, and levels of disease risk factors.
Physical Health • relates to the efficient functioning of the body and its systems, including the physical capacity to perform tasks, and physical fitness. • Characteristics/aspects • Maintain ideal body weight • Blood cholesterol levels • Blood pressure levels • Fatigue and exhaustion • Absence of presence of illness • Energy levels • Functioning of the systems
Social Health • means being able to interact with others and participate in the community, in both an independent and a cooperative way. • Characteristics/aspects • Communicating positively with others • Mixing and working cooperatively with others • Developing friendships • Contributing to the needs of the community • Behaving in a socially acceptable manner
Mental Health • refers to a state of wellbeing in which individuals realise their own abilities, cope with the normal stresses of life, can work productively and are able to make a contribution to their community. They relate to a person’s state of mind, including their emotions and feelings and their thought processes. • Characteristics/aspects • being aware of your feelings • being yourself • coping with stress • possessing positive self-esteem • accepting responsibility and reality • possessing the feeling of success and accomplishment
Exam Question Identify and then explain one dimension of health. ________________________________________________________________________________________________________________________________________________________________________________________ 2 marks (VCAA- HHD exam 2010) Many students identified determinants of health instead of dimensions of health and were not awarded any marks.
KEY KNOWLEDGE:1.2 different measures of health status of Australians, including the meaning of burden of disease, health adjusted life expectancy and DALY’s, life expectancy, under-five mortality rate, mortality, morbidity, incidence, prevalence; Advice • Do I know all of these health measures? • Do I remember to put in the figures such as ‘per 1000 live births’, ‘per 100,000’ etc • Do I know if they measurements should be low or high to be considered good? • Am I able to read a graph/data and apply these terms? • Have I learnt the definition from the VCAA glossary. • Expect to use these in graph analysis- important to check all details to ensure answer is correct based on type of measure. ‘Many students could not define life expectancy’ -2009 Assessment Report ‘ Providing the calculation for DALY’s is not enough. Must have definition also.’- 2009 Assessement report. ‘Many students could not define prevalence’ -2010 Assessment Report
DALY’s: 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. 1 DALY = 1 year of healthy life lost Burden of Disease: 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. Burden of disease is measured in a unit called DALY Life expectancy: An indication of how long a person can expect to live if death rates do not change. Health Adjusted Life Expectancy: a measure of the burden of disease based on life expectancy at birth, including an adjustment for times of ill health; the number of years of full health that a person can expect to live., based on current rates of ill health and mortality. Mortality: How many deaths occurred in a population in a given period of time for a specific cases all causes
Under 5 mortality rate: the number of deaths of children under five years of age per 1000 live births Infant Mortality Rate– refers to the risk of an infant dying between birth and one year of age in a given year per 1000 live birth Under-5 Mortality Rate (U5MR): refers to the number of deaths children under five years of age per 1000 live births Maternal Mortality Ratio:refers to the number of women dying from pregnancy-related causes per 100,000 live births Morbidity: ill health in an individuals and the levels of ill health in a population group. Incidence: the number of new cases of an illness occurring during a given period. Prevalence: the number or proportion of cases of a particular disease or condition present in a population at a given time.
Exam Questions Injury has a major impact on the health of Australians. It affects Australians of all ages. It is the greatest cause of death in the first half of life and leaves many with serious disability. In 2003 injuries accounted for 7.5% of Disability Adjusted Life Years (DALYs). Define the term Disability Adjusted Life Years (DALYs). ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2 marks (VCAA HHD exam 2009) AVERAGE: 1/2 marks For students to be awarded two marks they needed to included both an understanding of YLD and YLL in their answer. If not the formula was given, DALY=YLD + YLL, then only one mark was awarded.
Exam Questions Briefly outline two indicators that are used to measure the health status of populations. • ____________________________________________________________________________________________________________________________________________________________________________________ • ____________________________________________________________________________________________________________________________________________________________________________________ 4 marks AVERAGE: 1/4 marks Students do not know recall definitions- easy marks to gain
Exam Questions Jeanette has been diagnosed with the early symptoms of Diabetes Mellitus Type II. She lives in the City of Moonee Valley and has been asked by the health promotion Council to be involved in the ‘Life’ program. Diabetes Australia Vic. Has been ranked the City of Moonee Valley 57th in Victoria for the number of cases of Diabetes Mellitus. Although not considered a ‘hot spot’ it has had an increase of 94% in the prevalence of Diabetes in its population. Define prevalence. ___________________________________________________________________________________________________________________________________________________________________________ 1 mark AVERAGE: .5/1 mark Many students did not answer this question
Exam Question Outline the difference between mortality and morbidity as measurements of health status. _____________________________________________________________________________________________________________________________________________ 2 mark Many students confused these two terms.
KEY KNOWLEDGE:1.3 health status of Australians compared with populations in other developed countries.KEY SKILL:use and interpret data to compare the health status of Australia’s population with that of other developed countries Advice • Students will need to analyse data about the health status of Australia’s population and that of other developed countries • Do I roughly know how the health status’s compare without data? • Do I know how to set out a question that involves comparing developed countries and using data? • Have I gone down the list of data and worked out if high is good or high is bad? • Are all indicators relating to health status or are some relating to other factors? • When making a comparison do I: • Use data (can put this in brackets after your statement if needed) • Use data in the correct way? E.g add on 1,000 live births etc • Set the question out clearly and use dot points? • Make reference to approx. 2-3 other countries • Make enough points to gain full marks? • Refer to how the countries rank e.g ranked second behind ________? Yet to be on an exam (since 2010)
Comparing Health Status: Aus vsDev’d • Read question- are you comparing, evaluating, agreeing/disagreeing with a statement etc. Choose the direction of your answer. • SET OUT: • Address question- e.g Australia does not have the best health status when compared to other developed countries however has a better health status than countries such as UK, USA and at times Sweden. • Health indicator (list): • Life Expectancy: Australia has a Life expectancy of (data) compared to Japan (data), UK (data), USA (data), and Sweden (data). • Health indicator (list): • U5MR (per 1000 live births). Australia has a U5MR of _______. This is better than _______ (data), ________ (data) and _________ (data). _________ (data) however has a lower U5MR than that of Australia. • Look at marking allocation to see how many health status indicators you should be referring too. • Be careful e.g LE data should be high to be considered good. U5MR data should be low to be considered good. • Draw on your graph arrows to help reduce errors.
KEY KNOWLEDGE:1.5 The role of determinants of health, including the physical environment, biological, behavioural and social determinants of health in explaining variations in health status;KEY SKILL:use the determinants of health to explain differences in the health status of Australians and between population groups VCAA- Genetic predisposition/family history was often used to explain diabetes or obesity; however, this was incorrect. ‘Students need to give appropriate examples and name the specific determinant. Many students mixed dimensions with determinants; these are two different concepts’ -2010 Assessment Report
Advice • Determinant questions involve explaining ‘how’ the determinant acts as a risk factor or protective factor for a condition. • You will be required to use determinants to explain why some population groups experience better health and other population groups experience poorer levels of health. • Determinants MUST be linked to conditions. • An impact can be POSITIVE and NEGATIVE. • EG: Biological factors such as blood pressure can have a negative impact on health as high blood pressure places extra demand on the heart and can increase the risk of heart attack. • Do I know the four categories and examples that are included in each grouping? • The study design has changed to having 4 categories of determinants (Biological, Behavioural, Social environment and Physical environment). Be aware that some past exams (post 2013) will be incorrect at times. • Do I list the determinant category and then provide a specific determinant at the very beginning of my answer? • Should I be using determinants? Or is it dimensions of health?
Determinants of Health When to use the category: (biological, behavioural, physical environment, social environment) • Select one of these population groups. Identify two determinants of cardiovascular health and explain how each of these determinants could contribute to higher rates of cardiovascular disease for this population group. • Feedback: Many students did not gain marks for their answers. Many did not name the determinant as listed in the study design and instead listed a factor. When to use a specific determinant: • Use two other examples of determinants of health to explain why Indigenous Australians have.... TO BE SAFE: List the Category and then the specific determinant. E.g Biological: body weight. Behavioural: Dietary intake.
Exam Question • Identify TWO determinants of health that may contribute to variations in the health status of males and females and describe one example of how it could bring about each of these variations. (4 marks) ___________________________________________________________________________________________________________________________ • - Determinant – Specific example- • explanation a how determinants impacts on health/ health status • Make sure you have made reference to the two groups you are comparing Social – Access to Health Care Males are less likely than females to access health care. Many men believe that it is not manly and see going to the doctors as ‘weak’. This results in many preventable conditions occurring in higher rates among males such as cardiovascular disease and cancers as tests such as blood pressure and skin checks do not occur.
Exam Question Select one of the examples given in part a. (behavioural or social determinant) and explain how it might contribute to variations in health status between those living in rural and remote areas and those living in major cities. _________________________________________________________________________________________________________________________________ 2 marks Many students provided a general overview of the difference in the determinant for those living in rural and remote communities, rather than linking the determinant to poorer health status.
Exam Question Identify one biological determinant and explain how it might contribute to the differences in deaths per 100 000 between the population groups with the highest and lowest socio-economic status. ________________________________________________________________________________________________________________________________________________________________________ 2 marks AVERAGE: 0.7/2 Students who were able to identify a relevant biological determinant were able to answer this question well; however many students did not provide a biological determinant.
1.4 variations in the health status of population groups in Australia, including males and females, higher and lower socio-economic status groups, rural and remote populations and indigenous populations;KEY SKILLuse and interpret data to compare the health status of selected population groups within Australia Advice • Students should be able to recall a couple of key differences in health • Students should have practice at linking population groups to determinants • Identify and discuss differences in health status between population groups • Use the determinants of health to explain differences in the health status of Australians and between population groups • Analyse data relating to health status between population groups in Australia
Am I able to link each of the differences to a determinant and explain why there are variations? • Do I use words such as “more likely to” “less likely to” “experience higher levels of” • Do I use data from graphs and tables when given to me to support my explanations? • Am I making a comparison to both sides/both populations e.g Indigenous Australians are most likely to………….. compared to Non Indigenous Australians. • Do I list the determinant category, then the specific determinant when I set out my question? When given a graph for comparing population groups, comparing health etc. do you: • Read all information about the graph/table including the label and notes? • Have I look at the units/measurements • Have I looked at the information and worked out what it is? E.g. are they giving you determinants? Health status measurements? Health? Or are they mixing it up? VCAA- It was important for students to explain the variations between Indigenous and Non-Indigenous Australians, not simply describe the impact on Indigenous Australians. Many students did not use the information given in the stimulus material; for example, life expectancy differences, rates for diabetes mellitus, rates of hospitalisations and mortality rates.
RELATIONSHIP QUESTIONS COMPARE/VARIATIONS QUESTIONS=Spot the difference • Comparing BOTH sides • Looking for VARIATION between the two pictures. • THIS IS THE SAME FOR POPULATION GROUPS = two things = something that brings them together = can be good or bad relationship = need to find what the ‘bond’ is you are trying to explain from within the question
They keep telling us..... Many students ignored the stimulus materials in Section B, Questions 3bii. and 7b. or did not use the given data to answer the question adequately. Students are reminded that a good answer addresses the question, provides the necessary detail in a concise way, answers all parts of the question and uses relevant data where required. Will come in lots of different forms: • Graph • Table • Paragraph USE IT OR LOSE IT!
DETERMINANTS OF HEALTH BIOLOGICAL • Overweight/obesity • Hypertension • Impaired glucose regulation • Low birth weight BEHAVIOURAL • Higher rates of smoking, alcohol and drug misuse • Lower levels of physical activity • High fat diet • High rates of unsafe sexual practices • Lower immunisation rates SOCIAL • Low socioeconomic status • Social exclusion • Higher rates of food insecurity • Cultural barriers to accessing health care PHYSICAL ENVIRONMENT • Poor quality housing • Overcrowded housing • Lack of geographical access to health care and recreation facilities • Poor infrastructure in some remote areas, such as poor quality roads, and poor quality water supply and sanitation facilities
DETERMINANTS OF HEALTH BIOLOGICAL • Higher rates of overweight • Higher rates of hypertension • Genetics (sex, hormones and fat deposition) • Higher blood cholesterol levels BEHAVIOURAL • More males smoke • Males eat less healthy diets • Males are less likely to visit doctors • Males are not as likely to take notice of health promotion messages • Males take more risks SOCIAL • Males often experience pronounced impacts of unemployment • Males often have higher socioeconomic status (especially in single parent households) • Gender roles and representations can have negative impacts on males • Peer pressure may be more likely to negatively affect male behavior PHYSICAL ENVIRONMENT • Workplace environments, including: – exposure to building sites, farms, mines, – outdoor work – increased time on roads heavy machinery, tools and hazardous substances
DETERMINANTS OF HEALTH BIOLOGICAL • Higher obesity rates • Higher rates of hypertension • Higher glucose intolerance levels • Higher rates of lower birth weight babies BEHAVIOURAL • More likely to smoke, including during pregnancy • Lower levels of physical activity • Less likely to consume fruit and vegetables • Less likely to breastfeed SOCIAL • More likely to be unemployed • Lower education levels, including health literacy • Higher rates of social exclusion • More likely to experience food insecurity • Less likely to access preventive health services • Lower levels of private health insurance PHYSICAL ENVIRONMENT • Greater exposure to fast food outlets • More likely to live in poor quality housing • More likely to work in dangerous working environments • Higher rates of exposure to environmental tobacco smoke • More likely to live in neighbourhoods with more violence
DETERMINANTS OF HEALTH BIOLOGICAL • Higher rates of obesity • Higher rates of low birth weight babies • Higher rates of hypertension • Higher rates of high blood cholesterol BEHAVIOURAL • More likely to smoke tobacco • More likely to drink alcohol at risky levels • Lower levels of physical activity SOCIAL • Lower socioeconomic status • Higher unemployment • Higher rates of social isolation • Higher rates of food insecurity • Less access to health services PHYSICAL ENVIRONMENT • Poorer road quality • Poorly lit roads • Greater distances to drive • Fewer public transport services • Reduced proximity to health care services such as GPs and hospitals • Reduced proximity to recreation facilities, supermarkets and employment • Harsh climates • Greater susceptibility to the effects of climate change • Reduced access to fluoridated water • More dangerous working environments
No per 100,000= NO MARKS • No data= LOSE MARKS • asking for relationship= DO NOT EXPLAIN! VCAA 2011 Question Exam Health status varies within population groups in Australia. The graph below shows premature death rates for the 15-64 year age group according to socioeconomic status (SES). • Identify two factors that contribute to socioeconomic status. • __________________________________________________________________________________ • __________________________________________________________________________________ • 2 marks • b. From the data in the graph, describe a conclusion that can be drawn about the relationship between socioeconomic status and rates of premature death. • ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ • 2 marks
c. Name one determinant of health (other than socioeconomic status). • ________________________________________________________ • 1 mark • Explain how this determinant may impact on the rates of premature death for the lowest socioeconomic population group in Australia. • ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ • 2 marks
USE THIS DATA IN YOUR ANSWER. IT GIVES YOU THE VARIATIONS SO REFER TO THEM! Indigenous males and females in Australia have significantly poorer health than their non-Indigenous counterparts. For example • The estimated life expectancy for Indigenous males is approximately 12 years less than that of non-Indigenous males • The estimated life expectancy for Indigenous females is approximately 10 years less than that of non-Indigenous females • The Indigenous rate for diabetes mellitus area six times higher than non-Indigenous Australians • Indigenous rates of hospitialisation and mortality are around twice the rate of non-Indigenous Australians • Per person expenditure on health for Indigenous Australians was almost $6000 per person in 2006-2007, while for non-Indigenous Australians the spending was approximately $4500 per person. • Explain how one social determinant of health may impact on the variations in health status between Indigenous and non-Indigenous Australians. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2 marks b. Use two other examples of determinants of health to explain why Indigenous Australians have significantly poorer health status than non-Indigenous Australians. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4 marks It was important for students to explain the variations between Indigenous and non-Indigenous Australians, not simply describe the impact on Indigenous Australians. Many students did not sure the information given in the stimulus material; for example; life expectancy differences, rates for diabetes mellitus, rates of hospitalisation and mortality rates. Examples of social determinants could also be used as long as students used a different example from that in Question 1a.
1.6 the NHPA’s including;- key features, determinants that act as risk factors and reasons for selection of each NHPA- direct, indirect and intangible costs to individuals and communities of NHPAs- one health promotion program relevant to each NHPA;KEY SKILLexplain and justify one health promotion program that addresses each NHPA Advice • Students need to be able to explain and justify one health promotion program per NHPA • Students should be able to accurately recall all NHPA’s, the features of each condition, reasons for NHPA’s (which are all similar) • Students should be able to identify appropriate costs • Students need to have practice at identifying these costs relating to all NHPA’s • Must know the conditions that are listed under the NHPA’s and not just the NHPA categories. • When looking at the NHPA programs practice writing detailed summaries of the program in a small amount of space. This means you need to be concise. Always address – name, aim, overview and strategies… Unless the question states otherwise. VCAA- Fundraising activities were not considered to be health programs unless they were linked to an awareness of the cancer; for example, pink ribbon, blue ribbon and fun runs are usually focused on raising money for research or support programs. ‘ Students need to use the correct name of a National Health Priority Area (NHPA). Many students gave cardiovascular disease in their response. This was incorrect.’ – 2010 VCAA
Introduction to NHPA’s • The NHPAs are diseases or conditions that have been selected by the Commonwealth Government as key focus areas for improvement • Aims at involving all key stakeholders (Government and Non-government organizations and private sectors) to work together to reduce the burden of disease associated with these conditions • NHPAs are selected as a result of one or more of the following; • Contribute significantly to the burden of disease • Potential for significant improvements in health to be made (largely preventable conditions) • Potential to reduce health inequalities between population groups • Cost of treating the condition or disease is substantial • Potential for a range of strategies to be implemented that can improve health in these areas
Direct Costs • Direct associated with diagnosing, treating or preventing the disease or condition. • Costs include anything associated with developing and implementing health promotion strategies as well as diagnosis and treatment of the condition • Generally have a dollar cost To the individual • Are costs that are paid for by the ill person or their family • EG. Ambulance transport, blood test, dental xrays, doctors or specialist fees not covered by Medicare, pharmaceuticals To the community • Costs associated with implementing health promotion strategies and diagnosing and treating the condition, but which are paid for by the community. • EG. Medicare, PBS, costs associated with implementing health promotion programs
Indirect costs • Costs not directly related to the diagnosis or treatment of the disease, but occur as a result of the person having the disease. • Financial costs are able to be calculated for some of these costs To the individual • Include; • Loss of income if they can’t work • Paying for a cleaner to do home duties • Transport costs if the person is no longer able to drive • Paying someone to mow the lawns after bypass surgery To the community • Include; • Lost productivity – businesses may lose employees, which decreases volume or products produced • Social security payments – disability benefits • Lost taxation revenue
Intangible costs • Hard to identify and measure • May include pain and suffering (eg. How do you measure the cost of low self-esteem) To the individual • Include; • Pain and suffering • Stress • Loss of self-esteem • Loss of participation in social activities To the community • Include; • Loss of participation in social activities • Emotional impact
HEALTH PROMOTION VCAA Definition: ‘the process of enabling people to increase control over, and to improve, their health’.
NHPA Programs WHEN DESCRIBING A PROGRAM YOU MUST BE ABLE TO INCLUDE: Name: Organisation Description:
VCAA 2011 EXAM QUESTION Use two of the five priority areas (Ottawa Charter) and describe how they could be used to reduce death rates from any one of the NHPA cancers. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4 marks AVERAGE: 1.8/4