transition to practice - queensland health · the upstream or population health approach to...

Transitionto Practice

Population HealthWorkbook

Population Health Version1 (2014) A Primary Health Care Approach

TN4100 Population Health

Name

Community

Site

Position

Date Completed

Population Health Version1 (2014) A Primary Health Care Approach 2

Table of Contents

TN4100 Population Health - Introduction 4TN4100 Pre-Session Survey 6OR3301-1 Defining Population Health 7TN4101-1 Learning Activity 11TN4101-2 Priority Groups 12TN4101-2 Learning Activity 17TN4102-1 Mental Health 18TN4102-1 Learning Activity 22TN4102-2 Alcohol, Tobacco and Other Drugs 24TN4102-2 Learning Activity 29TN4100 Theory to Practice 30TN4100 Quiz 33TN4101-1 Learning Activity Feedback 36TN4101-2 Learning Activity Feedback 37TN4102-1 Learning Activity Feedback 38TN4102-2 Learning Activity Feedback 39TN4100 Theory to Practice 40TN4100 Quiz Feedback 43TN4100 Post-Session Survey 46TN4100 References 47

Population Health Version1 (2014) A Primary Health Care Approach4

TN4100 Population Health - Introduction

Introduction

The study of population health is focused on understanding health and disease in community, and on improving health and well-being through priority health approaches addressing the disparities in health status between social groups.

There are a number of population subgroups who do not enjoy the same level of health as the general population and identified as priority population groups. These groups include Aboriginal and Torres Strait Islander populations and people living in rural and remote areas.

Population health supports the provision of population approaches to diseases which, in Australia, have been identified based on their morbidity, premature mortality, disability and cost to health services. Social and emotional wellbeing is an essential component of population health and must be considered when monitoring and managing the health of vulnerable populations.

This course introduces the concept of and describes the various approaches to population health. It also discusses social and emotional wellbeing including mental health and the effects misuse of alcohol, tobacco and other drugs has on the overall health of the population.

On completion of this session participants will be able to:

• Define and discuss the population health approach to practice• Identify the population health priorities in Australia including:

» Priority population groups » Priority age groups » Disease priorities

• Define social and emotional wellbeing• Identify and discuss factors contributing to poor social and emotional well-being• Discuss the impacts of poor social and emotional well-being on the health of the population• Define and discuss mental health and its impact on the health of the population• Discuss the impact of substance misuse on the health of the population

Topics

Topic 1 identifies the national population health priority groups and discusses examples of some programs which have been developed in response to these priority areas. It also describes the upstream, mid-stream and down-stream approaches of population health programs

Topic two defines social and emotional wellbeing and its effects on the health of the population. This includes a definition and discussion of mental health and the impacts alcohol, tobacco and other drugs has on the health of the population.


Pre-Session Survey

Before you commence, we ask you to complete a quick survey to identify current knowledge base. This will provide a baseline you can refer to once you have completed this topic.

Learning Activities

Each module includes a non-graded learning activity and an ungraded Theory to Practice is included in this course. These activities must be completed before proceeding to the next module.

Quiz

Once you have completed the modules in this topic, you are asked to complete a graded interactive quiz.

Post Session Survey

When you have completed this session, we ask you to complete another quick survey to determine if we have met your learning needs.

Certificate

The final section is the completion of a personalised certificate which provides evidence of your training. If you complete this course using the manual only, you will need to email it to [email protected]. Your certificate will be issued on receipt of the completed manual.

Included on this is the average time the session takes which can be used for professional development points.


TN4100 Pre-Session Survey

Before you commence this session we ask you to take a few moments to complete the pre-session survey for this topic. This will give us some indication what your learning needs might be.

At the end of this session we will also ask you to complete another survey to see how well we have met your needs.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I am able to define and discuss the population health approach to care

I can identify the population health priorities in Australia

I am able to define social and emotional wellbeing

I can identify and discuss factors contributing to poor social and emotional wellbeingI can discuss the impacts of poor social and emotional wellbeing on the health of the populationI can define and discuss mental health/illness and its impact on the health of the populationI can discuss the impact of substance misuse on the health of the population

Stro

ngly

Agr

ee

Agr

ee

Neu

tral

Dis

agre

e

Stro

ngly

Dis

agre

e


OR3301-1 Defining Population Health

Learning Objectives

On completion of this module participants will be able to

• Discuss upstream, midstream and downstream approaches to health• Define public health, population health, health promotion and primary health care• Discuss the population health approach to practice• Define acute and chronic models of care

Approaches

• There are three main approaches to health service provision• The upstream approach has a population or public health focus which prevents illness from occurring

in the first place• The midstream approach focuses on the lifestyle and behaviour of an individual and includes health

promotion and prevention using a behaviourist approach• The downstream approach is dealing one on one with an individual who is sick or injured using the

biomedical approach to care

Upstream Approach

The Upstream or population health approach to services focuses on entire population by eradicating the source of the problem.

Examples of this approach include:

• Government policy – that affects the whole population• Public health measures to eradicate sources of the problem such as communicable diseases and• Socio environment factors which focus on how environmental issues including unemployment, poor

infrastructure, income and stress affect the health of the population


Public Health

The public health approach is the original upstream approach.

It became popular early last century with its initial focus being on eradicating diseases such as small pox and tuberculosis which was killing large numbers of the population.

Public health included the implementation of environmental improvements such as sanitation and water supply which directly impacted on the spread of deadly communicable diseases.

The focus was on preventing disease in the entire population, rather than treatment of individuals, and included a reactive response to disease manifestation.

The public health approach also includes non-infectious diseases including injury and chronic disease prevention and responding to environmental issues that impact on health.

Public health is discussed in further detail in the Transition course – TN 4400 – Public Health.

Population Health

Population health is a more modern approach which overlaps with public health, however it is less about communicable disease control and more about population strategies.

It is an organised approach to promoting and preventing illness, injury, disability, morbidity and early mortality which targets specific at risk populations rather than individuals.

Its focus is on the upstream issues of the entire and specific population groups and emphasises health promotion and disease prevention strategies at the population level.

Population health responds to the underlying social, economic, biological, environmental, genetic, and cultural determinants of health rather than on reactive or curative care. Population Health Programs

Current population health programs include:

• Disease prevention » Smoking cessation » National Drug Strategy

• Promotion of wellness » Environmental health programs » Healthy weight and Nutrition Programs

• Protection of population groups » Childhood immunisation program » Population specific screening


Population Health in Practice

Rural and remote and primary health care service providers are dealing with high levels of risk factors, chronic disease, morbidity and early mortality.

It is important for this type of service to focus on prevention and early intervention to reduce the need to provide reactive care.

For example:

A population health approach to cardiovascular disease would be to review the rates of disease in the population and factors contributing to the development of the disease including the population’s access to an affordable healthy food supply, their ability to engage in physical activity, smoking rates of the population, over all stress levels and so on.

A biomedical approach would look at the risk factors of the individual including diet, exercise, smoking, family history and so on.

Models of Care

Although the population focus to chronic disease is the ideal approach, clients may still require individualised care.

It is preferable that this care is provided using a “chronic” rather than “acute” approach.

The chronic approach focuses on prevention and early detection through • Screening, • The management of risk factors such as poor nutrition, smoking and physical activity • Self-management of diagnosed conditions.

The acute approach is on diagnosis and immediate, usually short term treatment which • Does little to assist in the prevention and ongoing management of chronic disease • In turn impacts on the overall health of the population.

Health Promotion

Health promotion enables individuals to increase control over their own health.

It promotes equity of service provision, supports access to information, encourages the building of healthy public policy and strengthens community action.

Health promotion requires involvement of all sectors of the community and encourages individual and community ownership of health services.

Health promotion is discussed in greater detail in the course TN4300.


Primary Health Care

Primary health care utilises a social approach to health. It supports the notion that everyone has the right to affordable, accessible and appropriate health services.

Primary health care adopts a social justice perspective to health care based on the principle that access to quality health care is a fundamental human right.

Focuses on holistic approach and acknowledges and responds to the social determinants of health.

Primary health care is discussed in greater detail in the PaRROT Introduction to Concepts - Primary Health Care course


TN4101-1 Learning Activity

1. What is the difference between the public health and population health approaches to care

Answers


TN4101-2 Priority Groups

Learning Objectives

On completion of this module learners will be able to:

• Identify the population health priorities in Australia including: » Priority population groups » Priority age groups » Disease priorities

• Discuss the benefits of the population health approach

Population Health

The study of population health is focused on understanding health and disease in community, and on improving health and well-being through priority health approaches addressing the disparities in health status between social groups.

There are a number of population subgroups who do not enjoy the same level of health as the general population and identified as priority population groups.

Aboriginal and Torres Strait Islander Australians

The available evidence suggests that Aboriginal and Torres Strait Islander Australians continue to suffer a greater burden of ill health than the rest of the population.

Overall, Aboriginal and Torres Strait Islander Australians die at younger ages compared to other Australians and experience: • Lower levels of access to health services than the general population, • Greater hospitilisation rates than non-Aboriginal and Torres Strait Islander people for most diseases

and conditions• Disability and reduced quality of life due to ill health,

Aboriginal and Torres Strait Islander Australians also suffer a higher burden of emotional distress and possible mental illness than that experienced by the wider community.


Aboriginal and Torres Strait Islander Health

Population health programs focusing on Aboriginal and Torres Strait Islander Health includes:

• Improving access which focuses on the provision of programs in communities and supports access to services outside of the community

• Alcohol, tobacco and other drug services which incorporate the provision of culturally safe programs for the population

• Health risk factors which includes universal screening of Aboriginal and Torres Strait Islander peoples from birth to death.

» The adult and child health check programs are examples of this• Chronic disease prevention, screening and management using a primary health care approach and the

provision of community controlled services• Mental health which includes the provision of culturally safe and appropriate social and emotional

well-being programs• Social indicators of health which ensures a holistic approach to Aboriginal and Torres Strait Islander

Health including infrastructure, education, employment and socio-economic factors.• Maternal and child Health which is supported by the Close the Gap program which focuses on

decreasing the gap in mortality and morbidity rates in the Aboriginal and Torres Strait Islander population

» This program focuses very much on the improving outcomes by ensuring the provision of comprehensive pregnancy, peri-natal, infant and child health.

Rural and Remote

People living in rural areas tend to have a shorter livespan and higher levels of illness and disease risk factors than those in major cities.

It is also true that, on average, people living in rural Australia do not always have the same opportunities for good health as those living in major cities.

For example, residents of more inaccessible areas of Australia are generally disadvantaged in their access to goods and services, educational and employment opportunities and income.

In contrast, rural & remote Australians generally have higher levels of social cohesiveness, for example, higher rates of participation in volunteer work and feelings of safety in their community.


Socio-economic Disadvantage

A number of studies have shown that there is an association between socio-economic disadvantage and health.

The mechanisms by which socio-economic status influence health status are complex and varied.

Also the association between socio-economic status and health is not always straightforward; it is confounded by many factors.

It is often hypothesised that a number of inter-related factors including education, place of residence, health beliefs and behaviour, occupation, income, access to health services and the environment in which people live determine the socio-economic disadvantage and health.

Males

Overall the health of Australian Males is poorer than that of Australian Females

• Males are less inclined to access health services• Males life expectancy is 3-4 years less than that of females• 1 in 2 males have experienced violence• 1 in 2 males have had sexual difficulties

Developing programs that are specifically targeted at males and provided in a manner that is appropriate and acceptable to them is an important population health issue.

Mothers and Babies

The perinatal period is crucial for the foundation for a healthy life for mothers and babies.

A population health approach to mothers and babies includes:

• Perinatal and infant health which monitors growth and development and nutrition including breastfeeding and child specific nutritional requirements

• Pregnancy health which incorporates antenatal and post natal care and safe birthing


Child Health

The importance of the early years of childhood is well established. Experiences early in life affect lifelong health and wellbeing.

A population health approach to early childhood includes:

• Early childhood development which incorporates child hood growth and development, nutrition, physical activity programs (See PD3100 – Child Health Check and PD3300 Growing Strong and Well)

• Child protection, which includes identifying, assessing and managing suspected child abuse and neglect (More information can be found in PD3110 – Child Health Check – Child Safety)

• Early learning and care which impacts on a child’s overall lifelong health• Disease Prevention, in particular childhood immunisation programs

Young People

Youth is a crucial period for establishing positive health and social behaviours.

It is a time when young people are undergoing rapid emotional, physical and intellectual changes, and when they begin the transition from childhood to adolescence to independent adulthood.

Timely, accurate and comprehensive programs focusing on the health and wellbeing of young people is therefore essential for ensuring lifelong health for Australia’s youth.

The health and wellbeing of Australia’s young people is also central to the health, social inclusion and productivity agendas of the Australian Government.

Other Australians

Good health not only helps older Australians to enjoy a good quality of life and to participate fully in the community, but also helps to reduce their demands for health and aged care services.

This is important as Australia’s population ages over coming decades. For this reason, improving older people’s health is a national priority in Australia.

One area of special interest is the adoption of a healthy lifestyle at older ages because its benefits include preventing disease and functional decline, and promoting a longer life and a better quality of life.


Disease Priorities

The diseases that also require a population health approach include:

• Arthritis and musculoskeletal conditions which result in considerable disability in older adults • Asthma and other respiratory conditions which cause high morbidity and place pressure on acute

health services• Cancer has a major impact on the community in terms of morbidity, mortality and health costs,

» Many cancers including lung, skin, bowel, prostate, lymphoma, breast and cervical cancer are preventable,

» And if detected early are treatable with the population health approach being on the adoption of healthy behaviours and accessing screening services.

• Cardiovascular disease is the largest cause of preventable, premature death in Australia and places a large burden on the health system in terms of costs and acute care.

• Diabetes Mellitus is emerging as a major health problem, associated with lifestyle behaviours, which causes considerable morbidity and premature mortality

» Diabetes is a contributing factor to several other chronic diseases including renal disease, stroke, and other cardio-vascular diseases

• Injury is a principal cause of death in people under 45, a leading cause of mortality, morbidity and permanent disability and a major cost to the health system

• Mental health is a leading cause of the non-fatal burden of disease and is associated with increased exposure to risk factors which lead to poorer physical health

• Obesity rates in Australia are among the highest in the world and can cause a range of health problems which adds to the burden of disease in the country.

Summary

Population health recognises the range of social, economic, physical and environmental factors that contribute to health.

It identifies the interrelated conditions and factors that influence the health of populations over the life course and focuses on improving the health status of the population.

Action is directed at the health of an entire population, or sub-population, rather than individuals and assists is reducing inequalities in health status between population groups.

The outcomes or benefits of a population health approach, extends beyond improved population health outcomes to include a sustainable and integrated health system, increased national growth and productivity, and strengthened social cohesion and community engagement.

Source: Australian Institute of Health and Welfare http://www.aihw.gov.au/home/

http://www.aihw.gov.au/home/



1. List the population health priority age groups.

Answers

2. List the priority population groups

Answers

3. List the population health priority diseases

Answers


TN4102-1 Mental Health

Learning Objectives

On completion of this module participants will:

• Define social and emotional wellbeing • Discuss the relationship between social and emotional wellbeing and mental and physical health• Discuss the prevalence of poor mental health in the population• Discuss the role of health services in managing population based social and emotional wellbeing

Definition

Aboriginal and Torres Strait Islander peoples describe their mental health as having a foundation of ‘social and emotional wellbeing’ originating in a network of relationships that includes between the individual and their community traditional lands, family and kin, ancestors and the spiritual dimension of existence.

Life is understood in holistic terms: with the health of individuals and communities evident not simply by the absence of disease but linked to their ‘control over their physical environment, of dignity, of community self-esteem, and of justice’.

Respect for Aboriginal and Torres Strait Islander rights is fundamental to social and emotional wellbeing: racism and discrimination are associated with both physical and mental health impacts.

Social and emotional wellbeing can be thought of as a protective factor and a source of resilience against the challenges of life, including those that impact on the mental health of children.

Risks

Issues of social and emotional well being covers a broad range of problems including:

• Unresolved grief and loss• Trauma and abuse• Violence• Substance misuse• Chronic health issues• Child development issues• Social issues and their effect on individuals• Family dysfunction• Racism• Discrimination

A person who feels socially and emotionally well is better able to cope with the pressures of life and will be more resilient than those who are not as socially or emotionally well.


Mental Health

Social and Emotional Wellbeing is not simply the absence of mental illness but the ability of individuals and groups to interact in ways which promote a sense of well being, optimal development and use of cognitive, affective and relational abilities to achieve individual and collective goals.

The World Health Organisation defines mental health as a state of emotional and social well being in which an individual realises his or her own abilities, they can cope with the normal stresses of life, can work productively or fruitfully and are able to contribute to their community.

National Health Priority Areas Report on Mental Health

Mental health problems and poor mental health refer to the spectrum of cognitive, emotional and behavioural disorders that interfere with the lives and productivity of people at school, at work and at home, and impact upon their interpersonal relationships.

The spectrum covers cognitive impairment and disabilities, phobias, panic attacks, drug-related harm, anxiety, post-traumatic stress disorder (PTSD), personality disorder, depressive disorders, schizophrenia and psychoses.

A diverse range of social, environmental, biological and psychological factors can impact on an individual’s mental health.

In turn, people can develop symptoms and behaviours that are distressing to themselves or others, and interfere with their social functioning and capacity to negotiate daily life.

These symptoms and behaviours may require community based treatment, rehabilitation or acute hospital based care.

Prevalence

Mental health is an emerging health priority in Australia . The National Survey of Mental Health and Wellbeing conducted by the Australian Bureau of Statistics in 2007 found:

• The symptoms of poor mental health were experienced by 20% of the population aged between 16 and 24, while 45% reported a lifetime of poor mental health.

• Women were more likely than men to have experienced symptoms of a poor mental health (22% of women compared to 18% of men).

• Women were more likely than men to report the symptoms of anxiety disorders (18% of women compared to 11% of men) and report affective disorders, such as depression (7% of women compared with 5% of men).

• Men were more than twice as likely to report substance use disorders (7% of men compared with 3% of women).

• Young men reported the highest rate of substance use disorder, (16% for men aged 16-24).• Young people were much more likely to report poor mental health (26%) and there was a steady

reduction in this rate with increasing age.


Population Groups

The Burdekin report identified a range of population groups that may be at increased risk for mental health problems in Australia (Human Rights and Equal Opportunity Commission 1993).

Population groups considered at high risk to develop mental health problems or with special mental health issues are:

• Children and adolescents• Older Australians (particularly those in residential care)• Aboriginal and Torres Strait Islander peoples• Rural and remote area populations• People from culturally and linguistically diverse backgrounds.

Homeless people, women, people with dual and multiple disabilities, and forensic patients and prisoners are also reported to be at increased risk for mental health problems.

Aboriginal peoples and Torres Strait Islanders

Mental health has been identified only recently as a priority by Aboriginal peoples and Torres Strait Islander people. • This is because stigma, cultural misunderstanding, involuntary confinement, and a failure of

past mental health policies and approaches have led many Aboriginal and Torres Strait Islander communities to be hesitant about discussing mental health issues in the public arena.

• While there are no current national statistics available, local investigations have shown that loss, separation and traumatic experiences for Aboriginal peoples contribute significantly to psychosocial morbidity.

• These factors correlate strongly with the presence of depressive symptoms and disorders.• Trauma, grief and loss for Aboriginal peoples and Torres Strait Islanders have had an impact on

physical as well as mental health.• Studies show that these risk factors are key variables contributing to the high levels of psychiatric

disorder found in Aboriginal and Torres Strait Islander communities, in particular to a very high frequency of depression (Swan & Raphael 1995).

• The high rates of incarceration and entry into the criminal and juvenile justice system for Aboriginal peoples and Torres Strait Islanders are also risk factors.


Rural and Remote Populations

The health of populations living in rural and remote areas of Australia is worse than that of those living in capital cities and other metropolitan areas.

However, limited national information on the prevalence of mental health problems and disorders among people living in rural and remote areas makes it difficult to quantify these differences.

There are lower levels of reported stress among females living in rural and remote areas although the number of stressful life events experienced by females are similar to those in other areas.

Strong et al (1998a) have recently compared death rates for suicide and self inflicted injury in Australia using the rural, remote and metropolitan area (RRMA) classification.

They have found the rates to be significantly higher among males from ‘large rural centres’ and ‘other remote areas’ when compared with those living in ‘capital cities’.

In contrast with males, death rates for suicide and self-inflicted injury were the highest among females living in metropolitan areas and the lowest among those living in remote areas.

Health Service Role

A population health approach to mental health means that health services need to integrate mental health into holistic service provision.

This will ensure physical and mental health status and outcomes of care are inseparable from the social, emotional, physical and spiritual components of life.

Mental Health needs to be an integral part of any health service to slow the increasing burden of poor mental health in the population.



1. What population groups in your community have been identified as requiring and receive services which focus on social and emotional well-being?

Answer

Answers will depend on what happens in your individual community.


2. Which of the following provide services in your community

Tick Choice


Local mental health team

Medical officer

Visiting specialist team

Guidance counsellor

Life support officer

Elder

Pastor or priest

None

Please list any other services that may not be included above


TN4102-2 Alcohol, Tobacco and Other Drugs

Learning Objectives

On completion of this module learners will be able to:

• Identify the most commonly used substances in Australia• Discuss the prevalence of substance use in Australia• Discuss the impacts of substance use on the health of the population

Morbidity and Mortality

Diseases that are caused by the use of alcohol, tobacco and other drugs (ATODs) are responsible for high morbidity and mortality rates globally.

Preventing risky behaviour and promoting healthy choices can produce positive health outcomes, not just during childhood and adulthood.

Tobacco-related diseases lead to premature deaths and can cause years of disease and disability.

In 2003 15,512 deaths were directly attributed to tobacco use.

One half of all people who regularly smoke will die from smoking related diseases, half in middle age and half in their senior years.

Drinking small amounts of alcohol can be a pleasant social activity for many people. Drinking small quantities of alcohol can reduce the risk of heart disease.

However, as the amount of alcohol we drink and the number of times we drink alcohol increases, then so do the health risks.

In 2003 1,084 deaths were directly attribute to alcohol use.

Mortality and morbidity from illicit drug use is lower than that of tobacco and alcohol with 967 deaths directly attributed to illicit substance use in 2003.


Financial Costs

Substance misuse in Australia not only impacts on the health of the population, it also has major financial effects.

In 2004-2005 the cost of substance for the Australian population was substantial.

This includes costs associated with lost hours and other workforce impacts, health care and crimes.

• Alcohol – 10.8 million dollars – 35.1% overall• Tobacco – 12 million dollars – 39% overall• Illicit substances – 6.9 million dollars – 22.4% overall• Combined alcohol and illicit – 1 million dollars 3.4%

Collins and Lapsley 2008

Substances that may be used

Drug use is not just the consumption of illicit drugs (amphetamines, cannabis etc.) and alcohol, it could also include:

• Products containing alcohol and not just alcoholic beverages • Tobacco products • Inhalants which includes paint, glue, deodorant, hair spray and nail polish • Over the counter and prescription medications which include pain killers, cough medicine, sedatives,

stimulants and • Performance enhancers especially steroids

Several of these are readily available and their sale and possession is not restricted by law.


Alcohol

Alcohol is the most common substance used, however it is a depressant and in low quantities alcohol causes people to do things they wouldn’t normally do.

In high doses it can cause unconsciousness and death.

People who have overindulged with alcohol are more likely to take risks such as swimming, driving, unsafe or unwanted sex.

Binge drinking is classified as 7 standard drinks for males and 5 standard drinks for females. It includes: • Drinking with the intent of getting drunk • Occasional and irregular bouts of heavy drinking • Normally being a responsible drinker, but often overindulging

Binge drinking is of concern because it increases the chance of falling, drowning, having an accident and being the initiator or recipient of violence.

Long term binge drinking can result in alcohol addiction and liver and brain damage.

Just over 10% of Australians aged 14 and over drank at levels that increased their risk of alcohol related harm. At least 26.8 % drank at levels that increased their risk of alcohol-related harm in the short-term at least monthly.

The most common age group for drinking at risky levels is 20 to 29 –with males in the age group being much more likely to binge drink than females in the age group.

Alcohol is a socially accepted and legal substance however considerable damage can be done to a young developing body and brain.

The earlier drinking it starts the bigger the risk of alcohol related problems as an adult. Being drunk increases the chances of victimisation, aggression and self-harm.

Drinking in pregnancy can cause harm to the developing foetus, with Foetal Alcohol Spectrum Disorder being one of the main causes of intellectual disability in children.


Tobacco

People who start smoking tobacco young are more likely to smoke heavily, become more dependent on nicotine, and be at more risk of illnesses and death.

Tobacco is the largest single preventable cause of death and disease in the world.

Heart attack, stroke and lung cancer are the three diseases that cause the most deaths in Australia, and they can all be directly attributed to smoking tobacco.

In 2004-05 around one in 10 adults who were daily smokers or ex-smokers, began tobacco before the age of 13 and 68%.

Of all smokers including ex-smokers had begun tobacco before the age of 18.

Over the last 10 years there has been slight decline in the percentage of male and female smokers.

However there has been no change in the tobacco rates for the Aboriginal and Torres Strait Islander population.

51% of Aboriginal and Torres Strait Islander males and 49% of Aboriginal and Torres Strait Islander females smoke compared to 24% of non-Aboriginal and Torres Strait Islander males and 18% of non-Aboriginal and Torres Strait Islander females.

Cannabis

Cannabis is the most common drug used by 15-24 year olds in Australia, with 18% of young Australians having tried it.

It is a depressant that causes mild changes in mood, lack of motivation, anxiety and depression.

Cannabis use is linked to developing psychosis and schizophrenia and people with schizophrenia who smoke cannabis have more symptoms than those with schizophrenia alone.

Medications

The misuse of medications is common in adults and older children.

Analgesics are the most commonly abused substance amongst adolescents, with the use of aspirin especially high.

Tranquilisers are also commonly used for reasons other than medical.

Steroids, whilst not broadly used, in the general population can be used to improve sporting ability, increase muscle size or improve appearance.

The use of steroids can have some serious and lasting health implications, particularly if used in high doses. Cough mixtures have also been misused.


Other Illicit Drugs

The prevalence of illicit drug use, as recorded in the 2004 NDS Survey, in Australia is:

• Methamphetamines (meth, speed, uppers, crystal meth); 9.1% • MDMA (ecstasy, Adam, essence); 7.5%• Hallucinogens (acid, LSD, mushrooms); 7.5%• Cocaine (crack, coke, snow, blow, nose candy);4.7 %• Heroin (smack, junk, black tar, big H); 1.4%



1. Which of the following best describes the problems with substance abuse in your community?

Tick Choice

Extreme

Major

Moderate

Minimal

None

2. What interventions are in place in your community to help deal with issues with substance use?

Answers


TN4100 Theory to Practice Take a few moments to think about the services provided in your community.

1. Under the headings of upstream, midstream and downstream, list the programs provided.

Upstream Midstream Downstream

2. Which population groups have been identified as priorities in your community?

Answer


3. Why have these groups been identified as priorities?

Answer

4. What if any issues are having an impact on the social and emotional wellbeing of members of your community?

Answers


5. What, if any, impact is substance misuse having on the population of your community?

Answers


TN4100 Quiz 1. Match the population approach to care with its definition

1. Upstream 2. Midstream 3. Downstream

Approach Definition

Health promotion and prevention

Biomedical approach

Population or public health approach

2. Which of the following population groups are deemed a national population health priority?

Tick Choice

Males

Females

Aboriginal and Torres Strait Islanders

Children

Adults


3. Which of the following diseases are considered a national population health priority?

Tick

Arthritis

Liver disease

Injury prevention

Mental health

Skin disease

4. Which of the following statements are true?

Tick Choice

Binge drinking can result in long term health problems

Tobacco smoking rates in Aboriginal and Torres Strait Islanders is decreasing

Alcohol misuse has the greatest overall financial cost for substances in Australia

Alcohol is the most commonly misused substance

Substance misuse results in considerable financial costs to the population


5. Poor social and emotional wellbeing can manifest into physical ill health

Tick Choice

True

False


TN4101-1 Learning Activity Feedback

1. What is the difference between the public health and population health approaches to care

Answers

Public Health:

The public health approach is the original upstream approach. Initial focus was on eradicating diseases such as small pox and tuberculosis Public health included the implementation of environmental improvements such as sanitation and water supply which directly impacted on the spread of deadly communicable diseases. The focus was on preventing disease in the entire population, rather than treatment of individuals, and included a reactive response to disease manifestation.The current public health approach includes non-infectious diseases including injury and chronic disease prevention and responding to environmental issues that impact on health.

Population Health:

Population health is less about communicable disease control and more about population strategies.It is an organised approach to promoting and preventing illness, injury, disability, morbidity and early mortality which targets specific at risk populations rather than individuals. Its focus is on the upstream issues of the entire and specific population groups and emphasises health promotion and disease prevention strategies at the population level.Population health responds to the underlying social, economic, biological, environmental, genetic, and cultural determinants of health rather than on reactive or curative care.



1. List the population health priority age groups.

Answers

Mothers and Babies

Children

Young people

Older people

2. List the priority population groups

Answers

Aboriginal and Torres Strait Islander peoples

Rural and Remote communities

Socio-economically disadvantaged populations

Males

3. List the population health priority diseases

Answers

Arthritis and musculoskeletal conditions Diabetes Mellitus

Asthma Injury prevention and control

Cancer Mental Health

Cardiovascular health Obesity



1. What population groups in your community have been identified as requiring and receive services which focus on social and emotional well-being?

Answer


Children and adolescentsOlder AustraliansAboriginal and Torres Strait IslandersPeople from culturally diverse backgroundsWomenHomeless or displaced persons Men New mothers or fathersLower socio-economic demographicsMigrants Unemployed Infants (peri-natal and infant mental health programs)



1. Which of the following best describes the problems with substance abuse in your community? There is no correct answer to this question.

Tick Choice

Extreme

Major

Moderate

Minimal

None

2. What interventions are in place in your community to help deal with issues with substance use?

Answers will depend on individual communities. Some possible programs are

Answers

ATODS services provided by health providersDetoxification programsCommunity based support programs e.g. Alcoholics anonymous; Church groupsReturn to Homeland initiativesATODS education and safe use promotionNeedle and syringe exchange programsInhalant use intervention and prevention programsYouth support services


TN4100 Theory to Practice Take a few moments to think about the services provided in your community.

Responses will depend on the individual community, but some examples are:

1. Under the headings of upstream, midstream and downstream, list the programs provided.

Upstream Midstream Downstream

Smoking cessation Animal control Immunisation programs

Substance use and control Mosquito control Child health screening

Sun protection programs Healthy schools Adult health screening

Breast checks Healthy weight STI specific screening

STI prevention – condom use Community cooking Breast screening

2. Which population groups have been identified as priorities in your community?

Answer

A number of communities have:

Maternal and child health programsMen’s health programsHealthy agingYouth health programsWomen’s health programsMental Health programs


3. Why have these groups been identified as priorities?

Answer

Priority groups are usually identified based on the national data as well as local health indicators. They may also be chosen based on local community concern or if there are a number of presentations e.g. inhalant use in youth, hungry children in school, large numbers of children with infected sores etc.Community action groups may also identify concerns and ask local health providers to respond to issues they are aware of.

4. What if any issues are having an impact on the social and emotional wellbeing of members of your community?

Answers

This will depend on your community but may include

Unresolved grief and lossTrauma and abuseViolenceSubstance misusePhysical health problemsChild development issuesSocial issuesFamily dysfunctionDiscriminationRacism


5. What, if any, impact is substance misuse having on the population of your community?

Answers

This will depend on your community but may include

High levels of violenceHigh levels of accidents including those which result in deathRisky activity included unintended, unwanted or unsafe sexual activityMental health issuesChronic diseasePoor attendance at schoolPoor attendance at workFinancial problems including an inability to pay for food, clothing and shelterFoetal Alcohol Spectrum DisorderFamily dysfunctionNone


TN4100 Quiz Feedback 1. Match the population approach to care with its definition

1. Upstream 2. Midstream 3. Downstream

Approach Definition

Midstream Health promotion and prevention

Downstream Biomedical approach

Upstream Population or public health approach

2. Which of the following population groups are deemed a national population health priority?

Tick Choice

Males

Females

Aboriginal and Torres Strait Islanders

Children

Adults


3. Which of the following diseases are considered a national population health priority?

Tick

Arthritis

Liver disease

Injury prevention

Mental health

Skin disease

4. Which of the following statements are true?

Tick Choice

Binge drinking can result in long term health problems

Tobacco smoking rates in Aboriginal and Torres Strait Islanders is decreasing

Alcohol misuse has the greatest overall financial cost for substances in Australia

Alcohol is the most commonly misused substance

Substance misuse results in considerable financial costs to the population


5. Poor social and emotional wellbeing can manifest into physical ill health

Tick Choice

True

False


TN4100 - Post-Session Survey

Now that you have completed this session we ask you to take a few moments to complete the post-session survey for this topic. This will give us some indication about how well we have met your learning needs. Once submitted you will be eligible to receive your certificate.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I am able to define and discuss the population health approach to care

I can identify the population health priorities in Australia

I am able to define social and emotional wellbeing

I can identify and discuss factors contributing to poor social and emotional wellbeingI can discuss the impacts of poor social and emotional wellbeing on the health of the populationI can define and discuss mental health/illness and its impact on the health of the populationI can discuss the impact of substance misuse on the health of the population

What, if anything could have been added to this session?

Stro

ngly

Agr

ee

Agr

ee

Neu

tral

Dis

agre

e

Stro

ngly

Dis

agre

e


TN4100 References

Australian Institute of Health and Welfare http://www.aihw.gov.au/home/

Australian Institute of Health and Welfare (AIHW) (2008). The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. Australian Bureau of Statistics, Australian Government. http://www.aihw.gov.au/publications/ihw/hwaatsip08/hwaatsip08.pdf

Australian Government (2011). “National Drugs Campaign” Retrieved 1/3/2011, 2011. http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/home-1

Collins, D.J. and Lapsley, H.M. and University of New South Wales (2008) The costs of tobacco, alcohol and illicit drug abuse to Australian Society in 2004-2005. Commonwealth of Australia

Dade-Smith, J. (2007). Australia’s Rural and Remote Health: a social justice perspective (2nd ed.). Croydon: Tertiary Press.

Holland, C., Dudgeon, P. and Milroy, H. (2013) The Mental Health and Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander Peoples, Families and Communities – Supplementary Paper to A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention.

Nofasard (2014). “What is Fetal Alcohol Spectrum Disorder (FASD)?”. Retrieved 13/5/2014, from http://www.nofasard.org/

Queensland Health and the Royal Flying Doctor Service (Queensland Section) (2010), Chronic Disease Guidelines. 3rd ed.Cairns. University of Queensland, Queensland Health. (2009). Protocols for the delivery of social and emotional wellbeing and mental health services in Indigenous communities. Guidelines for health workers, clinicians, consumers and carers. Cooperative Research Centre for Aboriginal Health.

White V and Hayman J (2006). Australian secondary school students’ use of alcohol in 2005. The Cancer Council Victoria.

White V and Hayman J (2006). Australian secondary school student’s use of over the counter and illicit substances in 2005. The Cancer Council Victoria.

http://www.aihw.gov.au/publications/ihw/hwaatsip08/hwaatsip08.pdf

http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/home-1

http://www.nofasard.org/

transition to practice - queensland health · the upstream or population health approach to...

Documents