Cardiovascular diseases (CVD) are considered to be one of the most significant contributors towards morbidity and mortality across the globe, especially in developed and developing nations. According to the World Health Organization, CVD is the number 1 cause of death with an estimated mortality of 17.9 million people (as of 2016), representing 31% of all deaths due to diseases and 85% of these deaths have been due to stroke or heart attacks. The CVD includes a wide range of conditions caused by disorders of the heart and its blood vessels (who.int, 2018). According to the Australian Bureau of Statistics, Ischemic heart disease is the main cause of mortality in Australia which caused 19,777 deaths (as of 2015) or 12.4% of the total number of deaths that year (159,052) (abs.gov.au, 2017). This information shows the significance of CVD to public health (Roth et al., 2017). Reports show that in the NSW area, the number of hospitalization due to CVD have reduced in the last 20 years, however still continues to be the most common cause of death, contributing to 35% of the mortality rate in the region and is responsible of 3/4th of all death for individuals above 75 years and there were 4,763 hospitalizations between 2010 and 2011 due to cardiac diseases and 1962 for strokes (swslhd.health.nsw.gov.au, 2013).
The aim of this report is to present a strategic health service plan (HSP) that can help to reduce the burden of the disease and minimize the rates of morbidity and mortality caused due to CVD and thus help to improve the wellbeing and health of the Australian people. The report will outline the impact of CVD on public health and different recommendations that can be suggested in order to improve the condition.
Policy and Planning Framework
The Framework for the Strategic Health Plan for Cardiovascular diseases aims to improve understanding the health risks for cardiovascular diseases as well as its risk factors, and help the people to understand strategies to minimize the risks of the disease through behavioral modifications. The aim of the framework is to reduce the burden of the disease through better awareness (Eggbeer et al., 2015).
Determinants of health
Several determinants of health can be attributed to cardiovascular diseases, which help to increase the risks of the disease and reduce the overall health and wellbeing of people. These determinants include social determinants such as socioeconomic position (SEP), race, ethnicity, access to care, language and culture and residential environment (Braveman & Gottlieb, 2014).
Burden of disease for selected population
The risks of cardiovascular disease have been found to be higher among Aboriginal and Torres Strait islanders compared to the non indigenous Australians. According to the Australian Institute of Health and Welfare, 38% of Indigenous Adults in Australia have risks for CVD and diabetes compared to non indigenous Australians (26%) (aihw.gov.au, 2015).
Morbidity and Mortality data
According to the Australian Heart Foundations, individuals from Aboriginal and Torres Strait Island communities had a 70% higher risk of mortality due to CVD. Also, the incidence of CVD has also increased from 10.5% (as of 2001) to 12.0% (as of 2013) showing an increase in the diagnosis for the condition among the Indigenous population (heartfoundation.org.au, 2018).
Analysis of relevant literature has revealed several important health needs that need to be addressed by the Health Service Plan (HSP) which have been discussed next:
Improving awareness of the impact of CVD on overall Health and wellbeing:
By improving the awareness about the impacts of CVD among the public, an effective health seeking behavior can be developed which can help in an earlier diagnosis of the condition and support healthy lifestyle among individuals at high risk. Understanding how CVD can impact the long term health of the individuals can further help to know why such knowledge is important to improve the wellbeing of people (World Health Organization, 2017; Loucks et al., 2015).
Improving awareness of strategies that can be used to reduce the risks of CVD
Apart from improving the awareness about the impact of CVD on health and wellbeing, the main aim is to improve knowledge about strategies that can be used by the people to reduce the risks through behavioral modifications such as increasing exercise, and diet, reduction or cessation of unhealthy behaviors such as smoking, drinking alcohol and consuming unhealthy diet (Shay et al., 2015).
Improving Access to care among individuals at high risk:
The HSP also aims to improve access to care for individuals at high risks for CVD, such as Indigenous Australians as well as individuals diagnosed with hypertension, obesity and type 2 diabetes (Record et al., 2015).
Relevant Facilities:
The relevant facilities that can be involved in the HSP include primary healthcare clinics, diagnostic clinics, hospitals and referral clinics. These facilities are primarily involved in the initial diagnosis of cardiovascular diseases among patients. The facilities and services related to patient education is also involved which can help in the process of health education among the patients (Mossialos et al., 2016).
Services:
The various services that can be involved to reduce the risks of CVD among the target population include: Emergency Health Services, Health Education Services, Lifestyle Consultation Services, Primary Care Giver and Social Care Services.
Role Delineation Levels:
The standard services which are involved in role delineation for the HSP includes endocrinology, gastroenterology, general and cute medicine, geriatric medicine, haematology, immunology, palliative care, rehabilitation medicine, general surgery as well as Aboriginal Health Services.
Models of Care:
The HSP focuses on a Community based model and self management support systems for health improvement using a patient centric, timely and efficient, evidence based and coordinated plan for reducing the risks of CVD in the target population. The plan aims to increase the awareness about CVD, its risk factors and strategies that can be used to reduce the risks of the disease (Record et al., 2015).
The number of hospitalizations for Cardiovascular Diseases in South Western Sydney Local health District has seen significant fluctuations over the years with an slight reduction in hospitalizations over the last couple of years, according to the report by NSW Government as shown in the graph below:
CVD Hospitalizations in South Western Sydney LHD (source: healthstats.nsw.gov.au, 2018)
Similarly, there also has been a decline in the number of hospitalizations for CVD among elderly individuals, as shown in the graph below:
CVD hospitalizations for people based on age groups (source: healthstats.nsw.gov.au, 2018)
The above graph shows that there has been some decrease in the number of hospitalizations and diagnosis of CVD among Australians in NSW in the recent few years. However, the hospitalizations for CVD still continue to be a biggest contributor of hospital admissions, causing approximately 576,000 hospitalizations as of 2016/2017 and there has been an increase in the rate of CVD by 2.2%, according to the Australian Heart Foundation (heartfoundation.org.au, 2018b). This clearly shows that CVD still continues to be significant factors that affect the health and wellbeing of people especially in South Western Sydney region.
Data on hospital separations for specific cardiovascular diseases have also shows significant changes since 2000. According to Australian Heart Foundation, these trends shows an overall improvement in care for CVD and a reduction in hospital stays, especially for Angina Pectoris among both men and boys as well as women and girls. Such trends can be well understood from the graphs below:
Trends in hospital separations for specific cardiovascular causes for men and boys (1999-2000 to 2012-2013). (source: heartfoundation.org.au, 2018c)
Trends in hospital separations for specific cardiovascular causes for women and girls (1999-2000 to 2012-2013). (source: heartfoundation.org.au, 2018c).
The primary catchment profiles that can be used to collect data regarding the patient can include data from general surgery wards, orthopedics, obstetrics and gastroenterology. Within the LHD levels, the catchment can involve all healthcare services that can be accessed by the people for the assessment and diagnosis of CVD and its related co morbidities and risk factors. Healthcare organizations located within the South Western Sydney would provide an ideal catchment for important information on this regard. Additionally, community outreaches and community care centers that works towards the Indigenous communities can also provide excellent clinical data related to CVD among the indigenous people (heartfoundation.org.au, 2018c).
The reverse catchment profile can include data related to CVD diagnosis among the non indigenous people, which can be used to compare and contrast the health data and understand if any health gap exists in the context of CVD between indigenous and non indigenous Australians.
Analysis of the current situation clearly showed that the number of hospitalizations caused due to CVD is still significant in the South Western Sydney LHD area. Even though there has been some reduction in the incidence of CVD over the last few years, it still continues to be one of the most significant contributors of morbidity and mortality among Australians, especially among the Aboriginal and Torres Strait Islander people, who has higher risks of CVD compared to the non indigenous Australians (abs.gov.au, 2017).
Considering the higher prevalence of CVD among the Indigenous Australians, it is vital that the health risks and the burden of disease in these communities be reduced at the soonest. Hence the primary strategy is to develop the wellbeing of these communities by supporting better care and reduction of the risk factors of CVD among Indigenous Australians.
The health priorities of the HSP is to develop awareness of the adverse impact of CVD on the health and wellbeing of people, as well as understanding how the risks for CVD can be lowered through behavioral modifications such as change in diet, increasing physical activities and reducing harmful behavior such as smoking and drinking alcohol (aihw.gov.au, 2015).
Various services can be used to reduce the burden of CVD on the target population, such as:
Health Education: This strategy can help to increase awareness about health conditions such as CVD and how it impacts the health and wellbeing, as well as the different risk factors such as obesity, diabetes and hypertension that can increase risks of CVD.
Healthy Diet Programs: This can be used to improve understanding of diet choices that can help to maintain a healthy cardiovascular system and avoid food which can adversely affect cardiovascular health.
Physical Activity Programs: This is another important strategy that can help the people to understand exercise routines that can minimize the risks of CVD or its related co morbid conditions such as Obesity, Diabetes and Hypertension.
Addiction Services: These services can help the people to avoid and give up unhealthy behavior such as smoking and drinking alcohol, which can increase risks of CVD and related conditions (heartfoundation.org.au, 2018)
The main goals of the health service plan are to reduce the impact of CVD among Indigenous Australians and thus improve the health and wellbeing of the people. The goal can be further differentiated into smaller goals such as:
|
Goals/ Objectives |
Strategies |
Resources |
|
1. Increasing awareness of the impacts of CVD among the target population |
Healthcare education, |
Online resources, scientific journals, books, newspapers, broadcast media, health workshops, referrals |
|
2. Increasing the awareness of the strategies that can be used to reduce the impact of CVD |
Healthcare education, |
General Physicians, referrals. Workshops and media |
|
3. Improving access to care among the Indigenous Australian Communities |
Setting up additional care centers to support individuals diagnosed of CVD, improving early detection of CVD through outreach clinics |
Primary care physicians, mobile clinics, referral services, outpatient services |
|
4. Reducing the overall number of hospitalizations due to CVD among the target population |
Improving the cardiovascular health of the people |
General Physicians, referrals. Workshops and media |
Some of the key recommendations that can be provided for the Health Service Planning are:
Conclusion
An overview of the prevalence of CVD in Australia shows that even though there has been some decline in the incidence of CVD in the past, it still continues to be a significant cause of hospitalization, morbidity and mortality among Australians. The problem has been found to be even more significant in case of Indigenous Australians. The Health Service Plan aims to reduce the burden of the disease for CVD in the South Western Sydney area. The plan have outlined the necessity of improving awareness of the health risks of CVD and strategies to reduce CVD risks as an important strategy to reduce the burden of the disease along with strategies such as improving accessibility of care, which can help to reduce the incidence of CVD in the target population.
References:
Abs.gov.au. (2017). Causes of Death, Australia, 2015. Retrieved from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2015~Main%20Features~Ischaemic%20Heart%20Disease~10001
Aihw.gov.au. (2015). Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: Aboriginal and Torres Strait Islander people, Table of contents – Australian Institute of Health and Welfare. Retrieved from https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/indigenous-australians/contents/table-of-contents
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Eggbeer, B., Hauser, M., & Johnson, S. (2015). Organizing for the’second curve’combining health plans and provider systems: the changing healthcare environment offers strategic advantages to provider systems that own health plans, but such integration requires significant preparation. Healthcare Financial Management, 69(1), 62-67.
Healthstats.nsw.gov.au. (2018). HealthStats NSW Cardiovascular disease hospitalisations by disease type and Local Health District, trends. Retrieved from https://www.healthstats.nsw.gov.au/Indicator/cvd_typehos/cvd_typehos_lhn_trend
Heartfoundation.org.au. (2018)a. Cardiovascular risk profile of Aboriginal and Torres Strait Islander peoples. Retrieved from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-risk-profile-of-aboriginal-and-torres-strait-islander-peoples
Heartfoundation.org.au. (2018)b. Cardiovascular disease fact sheet. Retrieved from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-disease-fact-sheet
Heartfoundation.org.au. (2018)c. Australian heart disease statistics 2015. Retrieved from https://www.heartfoundation.org.au/images/uploads/publications/RES-115-Aust_heart_disease_statstics_2015_WEB.PDF
Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J. A., & Fulwiler, C. (2015). Mindfulness and cardiovascular disease risk: state of the evidence, plausible mechanisms, and theoretical framework. Current cardiology reports, 17(12), 112.
Mossialos, E., Wenzl, M., Osborn, R., & Sarnak, D. (2016). 2015 international profiles of health care systems. Canadian Agency for Drugs and Technologies in Health.
Record, N. B., Onion, D. K., Prior, R. E., Dixon, D. C., Record, S. S., Fowler, F. L., … & Pearson, T. A. (2015). Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010. Jama, 313(2), 147-155.
Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S. F., Abyu, G., … & Alla, F. (2017). Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. Journal of the American College of Cardiology, 23715.
Shay, C. M., Gooding, H. S., Murillo, R., & Foraker, R. (2015). Understanding and improving cardiovascular health: an update on the American Heart Association’s concept of cardiovascular health. Progress in cardiovascular diseases, 58(1), 41-49.
Swslhd.health.nsw.gov.au. (2013). South Western Sydney Local Health District Strategic & Healthcare Services Plan Strategic Priorities in Health Care Delivery to 2021- Leading care, healthier communities- South Western Sydney Local Health District. Retrieved from https://www.swslhd.health.nsw.gov.au/pdfs/SWSLHD_Strategic_Priorities_to_2021.pdf
Who.int. (2018). Cardiovascular diseases (CVDs). Retrieved from https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
World Health Organization. (2017). Noncommunicable diseases: progress monitor 2017.
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