HEALTH

WHAT YOU NEED TO KNOW ABOUT HEALTH IN SYDNEY

1. Types of Health Care Providers in NSW2. History of Health in NSW3. Availability of hospitals in NSW4. The Good and Bad of our Health Care System5. Australia’s Poor Rank in Health Care World Wide6. Scenario: Typical Day in a NSW Hospital7. Distribution of Funds8. Future Plans and Challenges for Sydney’s Health

HEALTH CARE PROVIDERS IN NEW SOUTH WALES

+ AREA HEALTH SERVICES Metropolitan and Rural

+ PUBLIC HEALTH UNITS Survey public health within each area health service

+ PUBLIC HEALTH ORGANISATIONS Such as Ambulance Service & Cancer Institute

+OTHER SERVICESAIDS Dementia & HIV Psychiatry Service, AusHealth and Education Centre

Against Violence

HEALTH CARE PROVIDERS IN NEW SOUTH WALES

+ Spends 8.8% GDP per year on Average

+ The Australian healthcare system is mixed. Responsibilities for healthcare are divided between the federal and state governments, and both the public and the private sectors play a role.

+ Government programs underpin the key aspects of healthcare, Medicare which is funded out of general tax revenue, pays for hospital and medical services. Medicare covers all Australians, pays the entire cost of treatment in a public hospital, and reimburses for visits to doctors.

+ PBS Scheme, the government subsidizes prescriptions+ Government pays about 70% of healthcare costs (approximately 47% from

the federal and 23% from state governments); the remainder is paid by non-government sources, e.g., insurance and private pay.

+ Problems – Waiting periods for elective surgeries at public hospitals, access for rural, health status of indigenous.

HISTORY OF HEALTH CARE

+ Pre 1990 Infectious diseases were a major source of illness. They dramatically impacted life expectancy.

Hospitals such as quarantine wards were isolated – Manly, Waterfall and Randwick

TB cases decreased by 80-90% due to improvements in living conditions.

+ Hospitals started as a charitable organization that received small government grants

+ Public donations decreased and government tax donations increased hospitals were thought more as a public utility, this began the divide between public and private health.

Public hospitals Act 1929 (NSW) regulated and funded health care!

HEALTH STATISTICSHOSPITALS IN NSW

230 Public Hospitals 174 private hospitals

HEALTH STATISTICSHOSPITALS IN NSW

Number of Hospitals By State

NSWVICQLDW.AS.ATASA.C.TNT

Population per State

NSW

VIC

QLD

W.A

S.A

TAS

A.C.T

NT

+ Public HospitalsNSW 229VIC 144QLD 178WA 93SA 80TAS 27ACT 3NT 5

+ PopulationNSW 6.8 MILVIC 5.2 MILQLD 4.18 MILWA 2.11 MILSA 1.58 MILTAS 493, 400ACT 339, 800NT 215, 000

HEALTH STATISTICSHOSPITALS IN NSW

There are 2.7 public hospital beds per 1000 people

In the most recent budget NSW proposes to spend around $1814 per person on health

THE CONDITION OF SYDNEY’S HEALTH SYSTEMWEIGHING UP THE GOOD AND BAD

THE POSITIVES

+ Relatively inexpensive on a personal level with access for all

+ There are many hospitals and specialist hospitals available

+ Choices: public and private

+ Medicare

+ Green space is readily available

THE NEGATIVES

+ Prioritization of private over public patients = long waiting periods

+ Huge amount of preventable health problems in Sydney. I.e.. Obesity. Costs the health system billions of dollars!

+ Health decreases in places with lower socio-economic status. E.g. Indigenous Australians

+ Difficult for new immigrant to access public health

+ Only 2% of NSW budget is spent on health research!!

+ Homeless and disadvantaged have limited access to the health system

WORLD HEALTH ORGANIZATION (WHO)Ranking of health systems

Health expenditure as a share of GDP, OECD countries 2006

1. France 2. Italy 3. San Marino 4. Andorra 5. Malta 6. Singapore 7. Spain 8. Oman 9. Austria10. Japan11. Norway12. Portugal13. Monaco14. Greece15. Iceland16. Luxembourg17. Netherlands18. United Kingdom19. Ireland

20. Switzerland 11.3%21. Belgium22. Colombia23. Sweden24. Cyprus25. Germany 10.6%26. Saudi Arabia27. United Arab Emirates28. Israel29. Morocco30. Canada 10.0%31. Finland

32. AUSTRALIA 8.8%33. Chile34. Denmark35. Dominica36. Costa Rica37. United States of America38. Slovenia39. Cuba

A DAY IN THE LIFE OF ONE NSW PUBLIC HOSPITAL

15 756 Admissions 15 906 Discharges

+ On this random day public hospital outpatient departments provided over 104,000 occasions of service.

A DAY IN THE LIFE OF ONE NSW PUBLIC HOSPITALTREATMENTS PROVIDED FOR PATIENTS

Patient Treatment Numbers (1 Day)

Babies Born (614)Acute Heart Problem (944)Phenomenal (108)Asthma (86)Renal dialysis (2179)Emergency Surgery (630)Elective Surgery (2840)Hip/Knee Replacement (53)Died (164)Resuscitation (80)

GOVERNMENT FUNDINGWHERE DOES THE MONEY FOR HEALTH CARE GO?

Government Funding to Health Services

Public Hospitals 27%High level residential care 8%Dental Services 6%Pharmaceutical 14%Private Hospitals 8%Medical Services 18%Other Professional Services 4%Community and Public Health 5%

SYDNEY’S HEALTH SYSTEMLOOKING TO THE FUTURE

+ 2010 and 2025 Plan for NSW Health

+ The Government outlines 7 steps for future development of NSW Health. They that assume society will remain as it is today.

+ The 2025 Plan looks towards addressing emerging pressures such as the ageing population and cultural diversity.

+ It neglects the possible effects of climate change, the need for more public transport and the depletion of energy resources.

SYDNEY’S HEALTH SYSTEMPOPULATION AGEING

+ Caused by patterns of fertility and migration, changes in life expectancy

+ Proportion of the population over the age of 65 is likely to increase by 50% in the next 15-20 years

+ Population ageing is likely to increase the proportion of the population with disease and disability and will result in substantial increases in the demand for health services.

SYDNEY’S HEALTH SYSTEMPOPULATION AGEING

+ Changes in life expectancy Australians are now the second-longest-living people on earth with falling death rates for cancer, heart disease, stroke and injury, but the indigenous population continues to die earlier. Australians' life expectancy is bettered only by the Japanese at 82.2 years.

1909 Males 1909 Females 2009 Males 2009 Females 2009 Indigenous Australians

0

10

20

30

40

50

60

70

80

90

Life Expectancy in Australia 1909 & 2009

Series1

KEY FUTURE CHALLENGES FOR AUSTRALIAOBESITY AND OVERWEIGHT

+ Proportion of the population that is over weight has increased rapidly

+ People in the most disadvantaged socio-economic group experience

double the rates of obesity!!

+ …. Obesity cost the government $5.8 billion in 2006!! That’s double what they pay for in Medicare!

KEY FUTURE CHALLENGES FOR AUSTRALIAOBESITY AND OVERWEIGHT

Healthy weight range <50%

Overweight Men Women0%

10%

20%

30%

40%

50%

60%

Overweight/Obese Proportion of the Population

Series1

Proportion of Men/Women 55-59 Obese

Men 159 000Women 203 000

KEY FUTURE CHALLENGES FOR AUSTRALIATHE USUAL SUSPECTS: National Health Priority Areas

+ Asthma, cardiovascular disease, cancer, diabetes mellitus, injuries, mental health problems, arthritis and musculoskeletal problems

+ In a study to determine the prevalence of mental disorders among homeless people in inner Sydney the results revealed:

Men

Women

68% 70% 72% 74% 76% 78% 80% 82%

Sydney Homeless with at least 1 Mental Disorder

Series1

Men

Women

0% 10% 20% 30% 40% 50% 60%

Sydney Homeless with 2+ Mental Disorders

Series1

KEY FUTURE CHALLENGES FOR AUSTRALIATHE USUAL SUSPECTS: Burden of disease

+ Tobacco smoking, physical inactivity, high blood pressure, alcohol, poor nutrition and high blood cholesterol

+ Increasing urbanisation especially when there has been little attention paid to the preservation of pedestrian amenities, public safety, access to cheap fresh food, social cohesiveness and the potential for pollution – is associated with higher rates of obesity, asthma and depression.

(Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)

KEY FUTURE CHALLENGES FOR AUSTRALIAHEALTH INEQUALITIES

+ Certain groups within Australia experience markedly worse health than the general population

+ Health gains have not been shared equally across the population

Women do better than men Well-educated city dwellers do

better than people living in the bush or less affluent suburbs

Indigenous Australians live, on average, almost 20 years less than other

Australians. (Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)

+ Access to health services is becoming less equitable. Patients’ out-of-pocket costs have grown 50% in the past decade.

KEY FUTURE CHALLENGES FOR AUSTRALIAHEALTH INEQUALITIES

+ Death rates among indigenous males and females were at least twice as high, across all age groups, as those for non-indigenous males and females.

Life Expectancy Indigenous Vs. Non Indigenous

0102030405060708090

NonIndigenous

Male

NonIndigenousFemale

IndigenousMale

IndigenousFemale

Series1

KEY FUTURE CHALLENGES FOR AUSTRALIA

Global Health Challenges + Climate change will have a range of effects on

health with increasing extreme weather events and global warming

Increased congestion caused by high density damages health.

Vehicle exhaust contains microparticles that kill 3 million people each year; the World Health Organization says. High density is also bad for mental health.

A study of more than 4 million Swedes showed the rate for psychosis was 70% greater for dense areas, and there was a 16% greater risk of depression. The Australian Unity Wellbeing Index shows the happiest electorates are those with lower population densities. (Recsei, T. Jan 14 09. SMH ‘Rise of High-density living a new low for Sydney’)

KEY FUTURE CHALLENGES FOR AUSTRALIA CLIMATE CHANGE

Heat waves and Bushfires

Floods

Storm Surges

Tsunamis

More strain on emergency services during extreme weather events, aging population…

KEY FUTURE CHALLENGES FOR AUSTRALIATHE UNKOWN

+ Future health challenges are likely to be less predictable

+ Australia will need to build and maintain the capacity to respond appropriately to these challenges

Since the beginning of the last century, there has been a dramatic decrease in the

mortality rates of babies and children. But after decades of progress children’s health is under fresh threat from an array of modern conditions that impair their life expectancy and quality of life. In what is described as “modernity’s paradox” many Australian children are now not as healthy as were children of earlier generations.

(Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)

KEY FUTURE CHALLENGES FOR AUSTRALIATHE UNKOWN

+ Future health challenges are likely to be less predictable

+ Australia will need to build and maintain the capacity to respond appropriately to these challenges

Since the beginning of the last century, there has been a dramatic decrease in the

mortality rates of babies and children. But after decades of progress children’s health is under fresh threat from an array of modern conditions that impair their life expectancy and quality of life. In what is described as “modernity’s paradox” many Australian children are now not as healthy as were children of earlier generations.

(Armstrong, B.K et alI, ‘Challenges in health and health care for Australia’)