PUBLIC HEALTH AND HEALTH PROMOTION

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PUBLIC HEALTH 13

Public Health and Health Promotion

Table of Contents

1.0 Introduction 5

2.0 Type 2 Diabetes 5

2.1 Potential areas of action 7

3.0 Depression 8

3.1 Prevention, Promotion, and community education 9

4.0 Conclusion 10

References 11

List of Figures

Figure 1: Diabetes forecast in a span of 20 years 6

Figure 2: Trends of depression in Australia by gender 9

List of Tables

Table 1: Type 2 diabetes diagnosed in children in three Australian states 7

1.0 Introduction

Public health issues in Australia are taken seriously in response to a number of conditions and diseases that affect its population. While it costs the state a lot of money in maintaining a health population, health promotion is vital in changing and developing people’s lifestyles that influence environmental, economic and social conditions. This paper analyzes the public health and health promotion response to Type 2 Diabetes and Depression. It recognizes the need to assess and monitor health of communities and provide assurance to Australian communities on effective disease prevention and cost-effective care. Similarly, health promotion of the health issues seek to enhance personal skills, reorient health services and create supportive environments. In both conditions, this paper observes their trends, state-by-state comparison, affected and vulnerable groups, gender differences and remoteness.

2.0 Type 2 Diabetes

Type 2 diabetes arises when key body organs resist insulin as its production by the pancreas slows down. These organs are least likely to use glucose from the blood. While it is common and largely preventable, adolescents and young adults are increasingly getting diagnosed of type 2 diabetes. Approximately 935,000 Australians are living with this condition today based on measured and self-reported data (ABS, 2013). In 2011, diabetes accounted for 3 percent of all deaths with complications such as nerve disease, depression, stroke, blindness and heart attack (ABS, 2014). In 1996, Australian government recognized diabetes as a National Health Priority Area (NHPA) that requires urgent prevention and treatment. People with pre-diabetes in the range of 15-30 percent are more likely, within five years, to develop type 2 diabetes. Australia is using $1.7 billion per year to treat diabetes and another $14 billion on indirect costs (AIHW, 2013). Australia has developed a risk assessment tool for type 2 diabetes called AUSDRISK which helps patients and health professional to assess and manage type 2 diabetes in the next five years (AGDH, 2015). If this condition is poorly controlled or remains undetected, it poses a negative impact on the quality of life and life expectancy. However, lifestyle modification such as exercise and dietary changes can reduce type 2 diabetes risk by 59 percent (Tuomilehto et al. 2001).

Diabetes is a chronic disease that is growing rapidly in Australia with a carer or family member in support roles also living with diabetes. By 2017, diabetes will be the highest disease contributor alongside dementia. Australian Institute of Health and Welfare forecasted that the leading burden of disease by 2023 will be diabetes (see fig. 1 below).

PUBLIC HEALTH AND HEALTH PROMOTION

(Source: Diabetes Australia, 2013, p. 1)

Figure 1: Diabetes forecast in a span of 20 years

Type 2 diabetes is now prevalent among Torres Strait Islander and Aboriginal people of 15-54 years. According to the Australian Health Survey (2013), one in every five members of this minority group has diabetes. Young indigenous Australians aged 10-39 years were more likely (4 times) to be diabetic compared to non-indigenous Australians (Craig et al. 2007). Also, Australians aged 40-49 years are more vulnerable to type 2 diabetes with older Australians experiencing high disability rates associated with the disease. Worse still, diabetic people living in remote and rural communities find it difficult to manage the disease as they cannot access health services. They are at a higher risk of experiencing anxiety, depression and other mental health disorders. Compared to their male counterparts, Maple-Brown et al. (2010) observes that young females aged 10-29 years were at a higher risk of type 2 diabetes. However, the opposite was observed for females aged between 30-39 years where they had low risk compared to males.

Table 1: Type 2 diabetes diagnosed in children in three Australian states

PUBLIC HEALTH AND HEALTH PROMOTION 1

(Source: AIHW, 2011, p. 29)

From the table above, the data was obtained from Australian Pediatric Endocrine Group (APEG) and National Diabetes Services Scheme (NDSS). Insulin-treated diabetes varies by state among children aged 0-14 years. Cases of diabetes in children are higher in New South Wales compared to Western and South Australia. Moreover, AIHW (2011) found 104 percent of recorded cases by NDSS of insulin-treated cases in Western Australia while APEG recorded 69 percent of the cases.

In 2014, the Australian government established the National Diabetes Strategy Advisory Group to develop research, management, prevention and care of diabetes (ABS, 2014). It specifically developed the national diabetes strategy and sought to advice the government on how to manage diabetes. This strategy has a timeframe of five years from 2016 to 2020 and requires direct funding, collaboration across organizations, health sector and all levels of governments.

2.1 Potential areas of action

Type 2 diabetes requires a health promotion response through modification of risk factors. Fry et al (2010) agrees that reduction of health inequalities and involvement in health promotion of type 2 diabetes is in developing ‘upstream’ programs that are of benefit to the entire population. This is a primary prevention that promotes the environment and healthy behaviors throughout the life course. To start with, people should be encouraged to improve health eating, reduce sedentary behavior and increase levels of physical activity in communities, schools and workplaces. Second, social media and educational campaigns will help parents to understand the need for physical activity and balanced nutrition that reduces chances of obesity and overweight in children (Maple-Brown et al. 2010). Third, early detection and use of risk screening tools leads to better management of the disease. Fourth, Primary Health Networks (PHNs) can coordinate care alongside General Practitioners (GPs) in local health systems. Also, school education programs can help minority communities such as the Torres and Islander people as well as the Aborigines on the need for lifestyle changes, healthier choices and food security. Priority groups are linguistically and culturally diverse people, Australians living in remote and rural areas and older Australians. Lastly, the government should strengthen evidence-based practice and increase research funding streams.

3.0 Depression

Depression is one of the mental illnesses that affect families, individuals and the society at large. Common causes of depression include homelessness, reduced productivity, unemployment and poverty. Such people experience stigma, discrimination and isolation. According to the Mental Health and Wellbeing Survey of 2007, approximately 7.3 million (45 percent of the population) of those aged 16 and 85 years had mental condition related to substance abuse, anxiety or depression (ABS, 2007). In addition, about 14 percent of adolescents (14-17 years) and children (4-13 years) experience mental disorders (National Household Survey, 2013). Moreover, over $8 billion is spent annually on GPs, hospital based services and community or residential services in Australia. Hickie (2002) suggests that depression is a major public health issue in Australia that affects more than 800,000 people annually. In this case, less than a sixth receive evidence-based treatment while less than 40 percent are available for care. A substantial proportion of women (10 percent) is affected compared to men (4.8 percent) and is responsible for about 8 percent in disability loss (Clarke & Currie, 2009). Depression leads to early death, suicide and ischaemic heart disease. Depressive disorders pose complications during treatment due to low intervention, clinical presentation and rates of detection.

Early intervention and screening-led prevention is attractive especially in Australia. Minges et al observes that high-risk groups include Torres Strait Islander and Aboriginal populations, perinatal or pregnant women (2011, p.142). Torres Strait Islander and Aboriginal people are experiencing high levels of psychiatric disorders evidenced by high rates of incarceration to juvenile homes. Standardized psychiatric measure is advisable when a clinician suspects depression. The Australian government is using about $20 billion in treating mental illnesses which have far reaching impact on personal self-esteem, social participation and person’s income (AIHW, 2013). Each year, about 100,000 young Australians and a million adults live with depression (AIHW, 2010). One in six males and one in four females experience depression as one in every five people in the population is depressed.

Carr and Reid (1996) opine that depression is the most common mental problem among young Australians aged 12-25 years. By the age of 25 years, at least a third of young people will have experienced one or more mental illness (ABS, 2009). While depression is a risk factor for chronic illness, people with the latter are twice as more likely to suffer major depression than those who do not (DHFS, 1998). Some of the chronic illnesses include osteoporosis, arthritis, cancer, stroke, heart disease and asthma. The risk factors related to depression include treatment regimes, functional impairment, social isolation, difficulty swallowing, pain and worsening condition. Type of mood disturbance and severity especially with the feelings of being worthless, hopeless and guilt are likely to be experienced by depressed individuals.

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(Source: AIHW, 1998, p. 50)

Figure 2: Trends of depression in Australia by gender

From the figure above, about 12 percent of the young people were depressed and 6 percent of them have contemplated suicide. The reasons were lack of employment, substance abuse and confusion over their sexuality. Young people living in communities are less likely to experience depression compared to those living in residential aged care (McKendrick & Thorpe, 1994). Depression is a priority area among the minorities in Australia given the psychosocial morbidity is common after traumatic experiences, separation and loss. Mental health of people living in rural and remote communities is worse off compared to those living in capital cities and metropolitan areas. However, females in remote and rural areas have lower stress levels compared to men despite the similarity in the number of stressful life events (Kelly & Turner, 2009). Death rates among males in remote areas and large rural centers are higher than those living in capital cities.

3.1 Prevention, Promotion, and community education

The National Mental Health Plan was developed in 1998 to focus on mental health promotion on issues such as ‘world-class care’ and ‘healthy ageing’. The current support initiatives include Active Australia Initiative, Breast Cancer Program and National Women’s Health Program. For the Torres Islanders and Abogirinal communities, a Mental Health Action Plan was introduced (McKendrick & Thorpe, 1994). This was intended to respond to social and emotional wellbeing of this minority group by establishing regional centers that offer training and educational packages. In addition, Substance Misuse Program Funds were established to rehabilitate and treat remote and rural communities (AIHW, 2010). Parenting programs are provided in every Australian state to improve resilience and coping skills. For example, the Dumping Depression project was started in the coastal area of New South Wales while Gatehouse program is working in Victoria. Similarly, there is the Queensland School Nurse Program in Queensland and Child and Adolescent Mental Health Services in South Australia (DHFS, 1998). Western Australia has the Aussie Optimism program which is a depression prevention program for children living in rural areas aged 10-13 years. There is also the ACT Youth Suicide Prevention program and the Open Mind magazine for Tasmanian people.

These programs aim at providing short and long-term interventions as well as screening children between 5 and 15 years for depressive symptoms. Current public health responses to depression include; screening depression in elderly persons, providing support group for new parents who are at risk, and intervention and screening of postnatal depression (Clarke & Currie, 2009). It also provides screening for suicide risk and ideation among young people. Midwives are also being educated on postnatal depression and prophylaxis and the education of GPs on treatment and recognition of depression (DHFS, 1998). Opportunities and future direction is tied to the provision of information on help-seeking and de-stigmatizing depression. There is need for self-help groups that reduce depressive risk factors such as drug-related harm, family conflict and bereavement (Antrobus, 2010). Lifestyle changes such as social relationships and physical exercise can alleviate depressive symptoms.

4.0 Conclusion

The report establishes that type 2 diabetes requires a health promotion response while depression is a public health issue. While type 2 diabetes is affecting about 935,000 Australians, depression is linked to it and is a major cause of suicidal deaths in Australia. Type 2 diabetes and depression are raising healthcare costs by more than $30 billion annually, especially among women, Aborigines and Torres Islander people. Young people aged 10 – 39 years are quickly developing symptoms of type 2 diabetes as opposed to the typical believed elderly persons of over 55 years. New South Wales has the highest rates of type 2 diabetes while Western Australia has high rates of depression. To reduce the impact of type 2 diabetes, health promotion is necessary through change of lifestyle and nutrition. On the other hand, depression as a public health issue requires social support programs in every state to address social and psychological problems of children, minorities and unemployment.

Reference list

Australian Bureau of Statistics (ABS) 2007, National Survey of Mental Health and Wellbeing, Canberra.

https://mhaustralia.org/sites/default/files/imported/component/rsfiles/factsheets/statistics_on_mental_health.pdf.

Australian Bureau of Statistics (ABS) 2009, Australian Social Trends, Canberra. http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4102.0Main+Features30March%202009.

Australian Bureau of Statistics (ABS) 2013, Australian Health Survey: Biomedical results for chronic diseases, 2011–12. Canberra: ABS.

Australian Bureau of Statistics (ABS) 2014, Patient experiences in Australia: Summary of findings, 2013-14. ABS Cat. No. 4839.0. Canberra: ABS.

Australian Bureau of Statistics (ABS) 2014, Australian Health Survey: National Aboriginal and Torres Strait Islander Health Measures Survey 2012-13, Canberra: ABS.

Australian Government Department of Health (AGDH) 2015, Australian type 2 diabetes risk assessment tool (AUSDRISK). http://www.health.gov.au/preventionoftype2diabetes.

Australian Institute of Health and Welfare (AIHW) 2010, Australia’s health 2010, Australia’s health series no. 12, Cat. no. AUS 122, Canberra: AIHW.

Australian Institute of Health and Welfare (AIHW) 1998, National Health Priority Areas Report Mental health: A Report Focusing on Depression, Commonwealth of Australia. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459185.

Australian Institute of Health and Welfare (AIHW) 2011, Incidence of insulin treated diabetes in Australia 2000-2011, Canberra: AIHW.

Australian Institute of Health and Welfare (AIHW) 2013, Diabetes expenditure in Australia 2008- 09, Canberra: AIHW.

Antrobus, C 2010, Health promotion for chronic illness and depression, Continuing Professional Development. https://www.psa.org.au/download/Health%20promotion%20for%20chronic%20illness%20and%20depression.pdf.

Carr, VJ & Reid, ALA 1996, Seeking solutions for mental health problems in general practice, Medical Journal of Australia, vol. 162, pp. 435-436.

Clarke, DM & Currie, KC 2009, Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Medical Journal of Australia, vol. 190, no. 7, pp. 54-60.

Commonwealth Department of Health and Family Services (DHFS) 1998, National mental health report 1996, Fourth annual report, Changes in Australia’s mental health services under the National Mental Health Strategy 1995–96, DHFS, Canberra.

Craig, ME Wong, CH Alexander, J 2009, Delayed referral of new-onset type 1 diabetes increases the risk of diabetic ketoacidosis, Medical Journal of Australia, vol. 190, no. 4, pp. 219- 223.

Diabetes Australia 2013, Diabetes: The Silent Pandemic and its Impact on Australia (2013). Baker IDI Heart & Diabetes Institute. https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/e549bdb8-0f80-46f8-b827-35cb4f1b6cd2.pdf.

Fry, D Gleeson, S & Rissel, C 2010, Health promotion and secondary prevention: Response to Milat, O’Hara and Develin, Health Promotion Journal of Australia, vol. 21, no. 2, pp. 86- 91.

Hickie, IB 2002, Responding to the Australian experience of depression, Medical Journal of Australia, vol. 176, no. 10, pp. 61-72.

Kelly, BJ & Turner, J 2009, Depression in advanced physical illness: diagnostic and treatment issues. Medical Journal of Australia, vol. 190, no. 7, pp. 90-92.

Maple-Brown, LJ Sinha, AK Davis, EA 2010, Type 2 diabetes in Indigenous Australian children and adolescents. Journal of Pediatrics and Child Health, vol. 46, no. 9, pp. 487-490.

McKendrick, JH & Thorpe, M 1994, The Victorian Aboriginal Mental Health Network: Developing a model of mental health care for Aboriginal Communities, Australasian Psychiatry, vol. 2, no. 5, pp. 219-221.

Minges, KE Zimmet, PZ, Magliano, DJ 2011, Diabetes prevalence and determinants in Indigenous Australian populations: a systematic review, Diabetes Research and Clinical Practice, vol. 93, no. 3, pp. 139-149.

Tuomilehto, J Lindstom, J Eriksson, J 2001, Finnish Diabetes Prevention Study Group: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance, New England Journal of Medicine, vol. 344, pp. 1343-1350.