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Outcomes 2 Notes! (Almost all of of Core 1) (1 Viewer)

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Thurstenburg

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Chapter 1 Notes
The Role of Epidemiology
Epidemiology is the study of disease and illness through the process of data and information collection. Epidemiology can be useful in many different ways, it can:
· Help monitor the major causes of sickness and death, in order to identify and issues or inequalities between groups.
· Identify areas of need so that specific prevention and treatment can be targeted.
· Determine priority areas and the distribution of government funds.
· Monitoring the use of health care services.
· Evaluating the effectiveness of prevention and treatment programs.

Measures of Epidemiology
The measures of epidemiology in a community consist of mortality, infant mortality, morbidity and life expectancy.

Groups Experiencing Health Inequities
Aboriginal and Torres Straight Islanders have major inequities in their health status compared to non-indigenous people. They are more likely to die at a younger age and have a reduced quality of life. Indigenous people are reported to have:
· Lower life expectancy rates at birth for both males and females. 59 years for males and 65 for females.
· Higher mortality rates at all ages compared with non-indigenous people.
· Mortality from preventable causes. Death rates were 3 times than that of the non-indigenous population.
· High death rates from the circulatory system, injuries, respiratory disease, cancer, endocrine disorders and digestive disorders.

Current trends in the health status of Aboriginal and Torres Straight Islander people include:
· Decline in death rates from all causes in indigenous males
· Similar decline in indigenous females

Socioeconomically Disadvantaged Groups
The socioeconomic status of a person can be measured by income, education level, occupation or areas of socioeconomic disadvantage. In all age groups, male and female, people who have a lower socioeconomic status have higher mortality rates and higher levels of illness than people who are more affluent.
Studies in Australia have revealed that:
· Higher socioeconomic groups have a lower infant mortality rate
· Higher socioeconomic groups are better educated about their health
· A decline in heart disease rates is greater in higher socioeconomic groups.
· Smoking prevalence tends to fall as occupational status rises.
· People of low socioeconomic status appear to be less informed about health
· Lower socioeconomic groups make less use of preventative health services (immunizations, family planning, dental checkups and pap smears)
· People of low socioeconomic status are sick a more often and die younger

Australians Born Overseas
Australians born overseas generally have a better level of general health then those of the Australian-born population. There are some significant health inequities between our overseas-born Australians and the Australian-born populations, including:
· high rates of mortality from lung cancer for people from the United Kingdom and Ireland
· higher rates of diabetes and cervical cancer in the population groups of Asian origin
· markedly lower death rates for people born in China and Vietnam
· a much lower incidence of skin cancer in overseas-born Australians.

People living in rural and isolated locations
The health of people living in rural or isolated areas is poorer than that of people living in urban areas. Around 34% of Australians live in isolated or rural areas. People living in isolated or rural areas are more likely to:
· be smokers
· drink alcohol in hazardous quantities
· be overweight or obese
· be physically inactive
· have lower levels of education
· have poorer access to health services
· have risky occupations
· be at higher risk on the read due to longer travelling distances.



People with Disabilities
Disability is defined in terms of the lack of ability to perform everyday functions or activities. It refers to limitations in the physical and mental capabilities. In 2003 there were 3.9 million people in Australia with a disability, whether it was mental or physical.

Men and Women 25-64 years of age
This age group enjoys good levels of health and has one of the longest life expectancies in the world, when people’s age increases, so to does the mortality and morbidity rates.

Older People
Australians over the age of 65 years of age make up 13 % of the population. The high amount of disability within this age group puts a large financial burden on the health system.

Identifying Priority Areas
  • Social Justice Principals
o Participation
o Equity
o Access
o Rights
  • Prevalence of condition
  • Cost to the community
  • Cost to the individual
  • Potential for change.
  • Priority Population Groups

Chapter 2 – Priority Areas for Improving Health
Cardiovascular Disease (CVD)
CVD refers to damage or disease of the heart, arteries, veins and smaller blood vessels. CVD is one of Australia’s most financial costing causes of sickness and death.
· In 2004, roughly 36% of all deaths were caused by CVD.
· Males are more likely to get CVD than females.
· Indigenous people are twice as more likely to die from CVD than the non-indigenous population.
Cardiovascular Disease is a general term which covers all disease of the heart, these include:
· Coronary Heart Disease (poor supply to the muscular walls of the heart by its own blood supply)
· Stroke (the interruption of the supply of blood to the brain)
· Peripheral Vascular Disease (diseases of the arteries, arterioles and capillaries that affect the limbs)

Atherosclerosis – is the build up of fatty and/or fibrous material on the interior walls of arteries.

Atheroma – is a thickened area of fatty and fibrous deposits on the inside of surface of arteries, resulting in atherosclerosis.

Cholesterol – is a fatty substance contained in all animal cells.

Coronary Arteries – are the blood vessels that supply blood to the heart muscle.

Arteriosclerosis – is the hardening of the arteries whereby artery walls lose their elasticity.

Myocardial Infarction – is a heart attack that is usually due to the complete blockage of a coronary artery and results in the death of some heart tissue.

Coronary Thrombosis – is the formation of an obstructing clot within a coronary artery that is narrowed by atherosclerosis, possible leading to a heart attack.

Coronary Occlusion – is a heart attack (or myocardial infarction) caused by the sudden and complete blockage of blood and oxygen to the heart muscle, leaving the heart muscle damaged.

Symptoms of heart attack include:
· Sudden collapse or unconsciousness
· Shortness of breath, nausea, vomiting, excessive sweating
· Chronic pain, lasting for hours or days
· Acute pain, extending to the shoulders, neck, arms and jaw
· Pain felt as a burning sensation in the centre of the chest, between the shoulder blades or behind the breastbone.

Angina Pectoris – refers to chest pain that occurs when the heart has an insufficient supply of oxygenated blood
Stroke – occurs when there is a blockage of blood to the brain

Hypertension – refers to high blood pressure

Aneurysm – ballooning of the arterial wall due to thinning and weakening. It often results from constant high blood pressure and can lead to stroke.

Peripheral Vascular Disease – is the result of reduced blood flow to the legs and feet usually due to atherosclerosis.

Extent of CVD in Australia
Mortality
Accounted for 36% of all deaths among Australians in 2004. Coronary Heart Disease is the leading cause of death. 19.2% of deaths in males and 17.7% in females.

Morbidity
Over 1.4 million Australians have reported cases of being in one way or another disabled from CVD.

Risk Factors and Determinants of CVD
· Family history
· Gender
· Advancing Age
· Smoking
· Raised blood Fat levels
· High Blood Pressure
· Obesity and Overweight Conditions
· Abdominal Obesity
· Physical Inactivity

Modifiable Behaviors
· Smoking
· High-fat Diet
· High blood pressure
· Abdominal obesity
· Overweight condition or obesity
· High blood cholesterol
· Lack of physical activity
Groups Most at Risk
· Smokers
· People with family history
· People with high blood cholesterol levels
· People with high-fat diets
· People with hypertension
· People aged over 65 years
· Socioeconomically disadvantaged groups

Cancer
Cancer – refers to a large group of disease that are characterized by the uncontrolled growth and spread of abnormal cells.

A tumour – is a swelling or enlargement caused by a clump of abnormal cells.

A neoplasm – is an abnormal mass of cells that forces it way among the healthy cells and interferes with their normal functioning.

Metastases – are secondary or new tumours, which may develop some distance from the original malignant tumour.

Two different types of tumour:
· Benign – are not cancerous, they generally grow slowly, surrounded by a capsule that tends to control their spread. Removal is generally surgical, and they can cause some damage to tissue or organs by taking nutrients.
· Malignant – are cancerous, cause sickness and death by spreading to other parts of the body and starving surrounding tissues of necessary nutrients.

Carcinogens – are cancer-causing agents such as chemicals, pollutants, radiation, cigarette smoke and alcohol.

Extent of Cancer in Australia
Incidence
Out of all the major causes of death in Australia, Cancer is the only one increasing.
Main reasons include:
· The ageing population
· Better detection of cancer
· New diagnostic technology and screening programs
· Better reporting of cancer (which is mandatory by health care personnel)

Most frequent life threatening includes:
· Prostate cancer, colorectal cancer, lung cancer and melanoma (skin cancer) in men
· Breast cancer, colorectal cancer, lung cancer and melanoma in women
The current risk of being diagnosed with cancer in Australia at the age of 75 is 1 in 3 for men, and 1 in 4 for women.

Mortality
Cancer accounted for 28% of all deaths in Australia 2004 – 31.5% male and 25.9% female.
The major types of cancer were, lung, breast, colon, prostate and melanoma.
Cancer mortality rates could be reduced by changes to peoples lifestyles; not smoking, eating a balanced diet, increased knowledge and awareness of risk factors and symptoms, effective screening programs and earlier detection.

Risk Factors and Determinants of Cancer
List of major risk factors and determinants for most common cancers
1. Lung Cancer
· Tobacco smoking
· Occupational exposure to cancer-causing agents (carcinogens)
· Air pollution
2. Breast Cancer
· A family history or personal history of the disease
· A high-fat diet
· Early onset of menstruation
· Late menopause
· Obesity
· Benign breast disease
· Late age at first full-term pregnancy or childlessness
3. Colorectal Cancer
· High intake of fats
· Low intake of complex carbohydrates and dietary fibre
· Excessive alcohol consumption
· Obesity
4. Skin Cancer
· Fair skin that burns rather than tans
· Fair or red hair, blues eyes, combined with residence in high sun exposure areas
· A high number of hours of bright sunlight at place of residence
· Prolonged exposure to the sun, especially as a child and adolescent
· The number and type of moles on the skin
5. Prostate Cancer
· Family history
· A high-fat diet
6. Cervical Cancer
· An early age of first sexual intercourse
· Sexual intercourse with many partners
· A male partner who has had intercourse with a number of other female partners
· Viruses such as genital warts
Tobacco causes 30% of all cancer related deaths, diet 10-70%, sexual reproductive patters 7%, occupational factors cause 4% and alcohol 4%.

Groups at Risk of Developing Cancer
1. Lung Cancer
· Cigarette smokers
· People exposed to occupational or environmental hazards
· People working in blue-collar occupations
· Men and women aged over 50 years
2. Breast Cancer
· Women who have never given birth
· Obese women
· Women aged over 50 years
· Women who have a direct relative with breast cancer
· Women who do not practice self-examination
· Women who start menstruation at an early age
· Women who have late menopause
3. Colorectal Cancer
· Obese males and females
· People with high-fat diets, low-fibre diets
· Males age 50 years and over
4. Skin Cancer
· People in lower latitudes
· People with fair skin
· People with outdoor occupations
· People who spend too much time in the sun without protection such as hats and sunscreen
5. Prostate Cancer
· Males aged over 50 years
· Males who have a direct relative with prostate cancer
6. Cervical Cancer
· Women who have early first intercourse
· Women aged over 50 years
· Women who neglect screening via Pap smears
· Women who smoke

Injury
The consequences of injury can be short or long term:
· Loss of physical function, permanent disability or death
· Loss of productivity in the workplace
· Emotional trauma for both the individual and their family
· Reduced earning capacity
· The financial burden of medical and rehabilitation costs

The many different causes of injury in Australia include:
· Transport related injuries
· Suicide and self-inflicted injury
· Interpersonal violence
· Residential injuries as a result of falls, drownings, poisonings, burns and scalds
· Industry-related injuries
· Consumer product injuries sport and recreation-related injuries

The Extent of Injury in Australia
· Injury is one of the leading causes of all deaths in Australia, accounting for 6% of all deaths in 2004.
· Leading cause of death from peoples aged from 1-44 (47%)
· It is the main cause of premature deaths, accounting for more potential life lost under 65 years than any other cause.
· It is a major cause of hospital admissions
· Male mortality rate from injury is double that of females
· Death rates from unintentional injuries are declining, but those of intentional injuries (suicide) are increasing.

Mental health
Examples of mental health problems can include:
· Depression
· Schizophrenia
· Personality disorders
· Major depression
· Post traumatic stress disorder
Often a poor mental health at childhood may result in the development of a mental health disorder. This can lead to many poor health choices such as drug abuse, physical neglect, early pregnancy and alcohol abuse.

Extent of Mental Health in Australia
These statistics are result of the National Mental Health Strategy in 1997:
· An estimated 18 percent of Australian adults have experienced symptoms of mental disorder in the 12 months prior to the survey.
· One in five Australian adults will suffer a mental illness at some stage in their life
· Women were more likely than men to have had symptoms on anxiety disorders
· Men were more than twice as likely to have symptoms of substance use disorders
· Young adults aged 18-24 years had the highest prevalence of mental disorder, which could be related to high rates of substance abuse
· The prevalence of mental disorders decreased with age
· Women were more likely to have mood disorders
· About 2.1 million people said they suffered from a long term mental or behavioural problem. By age group, this represented:
Ø 6.7 per cent of children under 15 years
Ø 9.4 per cent aged 15-17 years
Ø 12.3 per cent aged 18-64 years
Ø 9.5 per cent aged 65 and over
· About 19 per cent of respondents aged over 18 years said they used medication for mental wellbeing. This was more common in females.

Suicide
Suicide – is an intended self inflicted injury that is fatal
Parasuicide – is an attempted suicide that is not fatal and is often impulsive


Overview of Australia’s suicide:
· Suicide is now the leading cause of fatal injury in Australia, 26% of all injury deaths in 2004
· Australia had the highest rate of youth suicide recorded in all industrialised countries
· Males living in rural areas have a significantly higher rate of suicide than those of urban youths
· The number of recorder suicides has shown a downward trend since 1997

Risk Factors and Determinants of Suicide
Reasons for suicide have been suggested:
· Depression
· Mental illness
· Physical illness
· Marginalisation of some groups
· Social isolation
Groups at risk include:
· People suffering chronic depression
· Elderly people
· People with a physical illness, particularly a terminal illness
· People who have made previous suicide attempts
· People who talk about ending their lives
· Teenagers particularly those for whom life seems worthless
· Young gay and lesbian people

Diabetes
Diabetes Mellitus – is a condition affecting the body’s ability to take glucose from the blood stream to use it for energy

Insulin – is a hormone produced by the pancreas that help glucose to enter the body cells and be used for energy

Diabetes is condition which affects the body’s ability to take glucose from the bloodstream and use it for energy.

Insulin-Dependent Diabetes Mellitus – Type 1
With this type of diabetes, the body produces little or no insulin at all. This can be controlled by the sufferer injecting an artificial supply of insulin. Symptoms of this type can include:
· Unusual thirst
· Excessive passing or urine
· Weight loss
· Weakness in muscles and joints
· Fatigue
The causes of diabetes are unknown; it is an autoimmune disease which may be triggered by a virus or environmental factors.

Non-Insulin-Dependent Diabetes – Type 2
In this type of diabetes, the insulin produced is either not effective or it is in such small amounts, or both. Treatment for this type of diabetes can be achieved through healthy eating, regular exercise and where required insulin injections.

Extent of Diabetes in Australia
These are the recent trends of Diabetes in Australia:
· The incidence of diabetes has risen significantly over the past 10 years. Around 669 600 Australians had medically diagnosed diabetes.
· Prevalence of diabetes increases with age
· Aboriginal and Torres Straight Islander people have one of the highest prevalence rates of type 2 diabetes in the world.
· People with diabetes experience reduced life expectancy
· Diabetes can contribute to CVD
· Major contributing factor to blindness, kidney failure and amputation
· 85% of people who have diabetes, have type 2 which is cause by poor lifestyle habits and poor health choices

Risk Factors and Determinants of Type 2 Diabetes
Non-Insulin dependent diabetes is associated with:
· Being over 45
· High blood pressure
· Being overweight
· Having a family history
· Being Aboriginal or Torres Straight Islander
· Having pacific island, Indian, or Chinese cultural background

Asthma
Asthma – a chronic disease of the respiratory system or airways
Symptoms of asthma:
· Wheezing
· Coughing
· Chest tightness
· Difficulty breathing
· Shortness of breath

Risk Factors and Determinants of Asthma
The causes of asthma are not known, however if you have a family history of asthma you are more likely to develop it. Asthma attacks can be triggered by:
· Colds and flu
· Tobacco smoke
· Inhaled allergens such as pollens, animal hair, dust mites
· Air pollution
· Strong odours and scents
· Cold air or changes in temperature
· Certain drugs such as aspirin
· Food preservatives, flavourings and colourings
· Exercise

Mortality Rates
Mortality rates of Asthma in Australia are characterised by:
· Comparatively low death rates compared with other diseases
· High death rates compared with international standards
· Deaths from asthma occur in all age groups
· The risk of dying from asthma increases with age
· The overall death rate from asthma has decreased significantly over the past 15 years.

Incidence of Asthma
In the 2004-05 National Health Survey there were 2 million reported cases of Asthma. Highest prevalence occurs in the 15-24 age groups.

Arthritis and Musculoskeletal Conditions
Arthritis – refers to a number of conditions that affect the joints of the body. It is part of a larger group of musculoskeletal conditions.

Osteoarthritis – is a condition of the musculoskeletal system in which the cartilage in the joint degenerates.

Symptoms of osteoarthritis include:
· Pain and stiffness in the joint
· Swelling of the joint
· Restricted movement
· Weakened muscles around the joint
· Joint deformity

Risk Factors and Determinants of Osteoarthritis
Risk factors of developing osteoarthritis include:
· Age – average age of onset is 45
· Gender – more common in females than males
· Obesity – being overweight puts more stress and pressure on joints
· Repetitive use of a joint – in some jobs, particular joints used repetitively, overworking the joint.

In 2004-05 there were 1.6 million Australians suffering from osteoarthritis.

Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease. It occurs when the immune system attacks the tissues lining the joints. It causes:
· Older people
· Women
· Some children can develop juvenile arthritis
In 2004-05 491 000 Australians were diagnosed with Rheumatoid arthritis. More than half of these people were women.

Osteoporosis
Osteoporosis – is a type of musculoskeletal condition in which there is deterioration in the bone structure. The bones become thin and weak, leading to an increased risk bone fracture.

Risk Factors and Determinants of Osteoporosis
· Women, particularly after menopause
· Older people

Social Determinants of Health
The social determinants of health include:
· Social and economic factors
· Education
· Employment
· Ethnicity
· Gender
· Age
· Location
Socioeconomic Status
A person’s socioeconomic status is a measure of their education level, occupational prestige and level of income. It is often closely linked with morbidity and mortality rates.
Australians with lower socioeconomic status:
· have higher death rates and higher levels of illness
· Make greater use of health services
· Make less use of preventative and screening services
· Are more likely to die from CVD
· Are likely to have more than one risk factor

Education
An estimated 1 million Australians have trouble carrying out everyday literacy tasks. Having knowledge does not ensure people will use it or know how to use it to make healthy choices. People also need to be able to:
· Use services appropriately
· Manage chronic conditions effectively
· Obtain relevant information
· Know where to obtain further information
· Interpret and receive health information wisely
· Receive support from the social, physical and economic environments in they live
· Access information that is culturally sensitive and in their own language
· Access social supports and health service under different health systems

Employment
Unemployment and low income are often contributors to low socioeconomic status. Unemployment is linked to a number of health concerns, such as:
· Lower levels of health
· Higher mortality and suicide rates amongst unemployed men
· Significant mental health problems
· Homelessness
· Lost of self-esteem and confidence
· Abuse of drugs
· Lack of choice about health
· A higher incidence of chronic illness in children and unemployed parents.

Ethnicity
Australia encourages immigration to those with a good level of health, as to not burden the health system. Non-Australian born people tend to have a better level of health then Australian born Australians because the food in their culture is a lot healthier and more nutritious than Australian born Australians.

Gender
Australian women tend to have higher levels of health than that of males. This can be seen here:
· Men have lower life expectancies
· After the first year of life, the death rate for males is 35% higher
· Over 50% of Australian males are overweight, compared with one-third of women
· Men are more likely to have heart disease or cancer
· Around twice as many men die of skin cancer
· Men have higher mortality rates from cancer
· Men are more likely to die or be seriously injured as a result of road accidents, falls, drowning, accidents at work or violence
· Men are more likely to die of alcohol abuse
· Males take more risks
· Men are more likely to ignore health problems, where as women will seek out advice and help about theirs problem

Age
The age of Australians is increasing due to better technology, better health services, falls in infectious diseases and improved awareness about health. The social effects of improved life expectancy include:
· Increases in the aged population
· Increases in the overall level of disability in the community
· Increased health care costs as survival rates improve
· Increased cancer incidence and death rates as fewer aged people die from other causes at an earlier young
· An increased need for health resources and services





Location
Depending on where a person lives, can result in it being harder for them to access certain or all medical services. This health inequity may be attributed to:
· Poor access to health services
· Lower socioeconomic status
· Higher unemployment levels
· Exposure to relatively harsher environment
· Sparse infrastructure
· The higher the risk of occupational hazards
· Possible frequent indulgence in risk-taking behaviours
· A poorer attitude to health promotion and self-care messages
Chapter 3 Core Notes
Approaches to Health Promotion
Public Health – is a combination of science, medicine, practical skills, and beliefs aimed at maintaining and improving the health of all people.

New Public Health – is a model that recognises the dual role of lifestyle and living conditions as determinants oh health status. It involves establishing programs policies and services that create environments that support health.

In the 1950’s to 1970’s the world realised that a persons lifestyle can have major impacts on their health. The emergence of lifestyle-related disease surpassed infectious disease as the main cause of death. This is when public health authorities began to focus on changing individuals’ behaviours to prevent and control disease and illness, thus reduction of medical costs to the individual and improved levels of health.

The Alma Ata Declaration (1978) had highlighted that an improvement of health inequalities nationally and internationally was needed. This was soon followed by The Ottawa Charter for Health Promotion (1986). This new approach was seen as the vehicle to all Australians achieving health.

What is Health Promotion?
Health Promotion – involves activities that are aimed at enabling people to increase control over their health, to improve their level of health and prevent illness.

Types of Health Promotion
Health promotion strategies can focus on individuals, select populations or the whole population. Examples of focus on individuals include:

1. Patient Education – This strategy is concerned with providing information to the patient about their health status, identification and reduction of risk factors and self-care procedures.
2. General Medical Practice – When visiting your GP or local doctor with an ailment of some sort, your doctor will have the opportunity to explain and provide information on ways in which to prevent illness and improve health.



Some examples of group health promotion strategies are shown below:

1. Schools – formal health education programs and environments that promote health (such as shade areas, a healthy canteen policy and student welfare strategies)
2. Workplaces – occupational health and safety committees to prevent work-related injury and illness; risk factor analysis and changes to the work environment (such as smoking bans on the worksite, improved canteen foods and stress counseling)

Another strategy for health promotion focuses on environments rather then people. Changing the physical environment, legislation and enforcement, changes to public policy, technical interventions and the use of incentives and disincentives.

Limitations of an Individual Lifestyle Approach
The individual lifestyle approach to better health has many limitations and is ineffective in a majority of cases:
· It does not account for the social context in which the individual lives, and pays little regard to the social, economical and environmental factors that impact on health
· It assumes that improved knowledge will improve the choices made by individuals
· It is based on premise that behaviour change is solely the responsibility of the individual
· It gives power to medical experts who decide what is best for the community
· It does not give individuals and communities a choice in the determination of health priorities.

The New public Health Approach
The new public health approach has developed over the past twenty years, and provides a much more holistic approach to health. The approach takes into account the environmental, social and economic factors which contribute to individual health status. The new approach places emphasis on establishing programs, policies and services that create opportunities to engage in healthy behaviour. The approach promotes the reorientation of health services towards primary health care. As such, it is based on the following principles:
· Disease prevention and health promotion
· Social justice
· Empowering individuals
· Community participation
· A holistic and positive view of health
The new public health approach advocates the cooperation of government, community and all health professionals in the promotion of better health for the whole population.

Characteristics of the New Public Health Approach
Empowerment of Individuals
The major difference between the new public health approach and the individual lifestyle approach is the way in which the individual gains power over their health status. The Individual approach assumed empowerment come with knowledge as an outcome of health education, whilst the new public health approach entails the cooperation of individuals with health professionals in actively addressing all aspects of health, and thus improving individual health status.

Community Participation
Community action is a strong focus of the new public health approach. Communities are empowered by actively involving themselves in decisions about their health priorities and problems, and so develop a sense of ownership and empowerment. Communities aren’t necessarily defined by geographical location; they can be due to race, socio economic status or profession. Policies are promoted in the new public health approach in order to involve communities in health policies.

As apart of the new public health approach, the following community sectors all play different parts:

Commonwealth Government (Federal)
· Planning and forming national health policies
· Giving direction to state health policy making, and influencing its delivery
· Allocating funding for health promotion, special projects and research
· Providing legislation to ensure the maintenance of health

State Governments
State governments are responsible for planning and implementing specific health-promotion and disease-prevention programs. Each state has a department of health which develops these ideas.


Local Governments
Local governments are given specific instructions to try and implement state-controlled programs at a community level, for example, ensuring that swimming pools are fenced.

Business and Industry
Manufacturing and marketing organizations have a responsibility to produce and promote the sale of health products and services. Involves such aspects as:
· Correct and informative labeling
· The promotion of health levels of food additives such as salt
· The production of non-polluting manufacturing wastes
· The provision of health workplaces
· Hygienic and high standards of food preparation
· The regulation of the chemical content in foodstuffs
· Honest advertising
· The provision of safe products, such as fire-retardant night clothes

Non-Government Organisations
Non-government groups are community based, they are run by community members and can be effective and very decisive about how they think best to solve certain problems. Consumer advocacy groups represent the broad interests of consumers and often have a role in dealing with specific health issues. This role can involve:
· Providing independent advice to health authorities and governments
· Giving information and research advice to consumers
· Offering emotional and physical support to groups
· Advocating legislative changes in health
· Promoting the involvement of the community in decision-making processes.

Intersectoral Action
Intersectoral action refers to the active partnership between the health sector and non-health sectors of government, such as housing, food production, urban development, local councils, education, roads and traffic, and social services. Together with non-government and community groups, Intersectoral groups support health orientated action, program development and policy, and address particular health issues.


I hope this helps some people!!!​
 
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