HBS107 T1 2019: Health Plan Report: Victorian Public Health Plan
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This report provides a comprehensive analysis of the Victorian Public Health and Wellbeing Plan 2015-2019, focusing on the priority area of 'tobacco free living' and its impact on Aboriginal Victorians. The report begins with an introduction to the plan, outlining its key targets and objectives, particularly in relation to improving the health of indigenous populations. It then delves into the priority area of tobacco free living, highlighting the disproportionately high smoking rates among Aboriginal Victorians. Three critical social determinants of health—poor socioeconomic status, environmental tobacco exposure, and genetic factors—are examined in detail, revealing their influence on smoking behaviors and health outcomes within this population group. The report concludes by summarizing the plan's goals and the effectiveness of addressing these determinants to achieve optimal health for all Victorians, emphasizing the importance of addressing health inequities through strategic interventions. It references various studies and data sources to support its findings and recommendations.
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Introduction and summary of the health plan:
The report will discuss about the Victorian public health and well being plan 2015-
2019. The report will start with a description on the overview of the plan, the key targets of
the plan and the methods by which it will improve the health of specific Victorians like the
indigenous people (Victoria State Government 2018). The next section will provide details
regarding the priority areas of ‘Tobacco free living’ and the at risk group of older indigenous
people who might be experience poor health outcomes because of tobacco smoking. Three
social determinants of health namely poor socioeconomic status, environmental tobacco
exposure and genetic factors will then be critically and discussed in relation to the priority
area of ‘tobacco free living’.
Description of the plan and the determinants of health:
The main aim of Victorian public health and well being plan 2015-2019 is to achieve
the vision of a Victoria that is free from the burden of preventable disease and injury. The
plan aims to ensure that all Victorians achieve the highest standards of health and well being
at all age. To achieve the above mentioned vision, the plan focuses on the key priority areas
of active living and healthy eating, tobacco free living, decrease harmful drug and alcohol
consumption, promoting mental health, preventing violence and injury and improving sexual
and reproductive health. The target group that is of focus for the Victorian health plan
includes the group with least resources called the Aboriginal Victorians (Victoria State
Government 2018).
The health plan aims to promote health and well being for Aboriginal Victorians
throughout the life course by addressing social determinants of health and risk and protective
factors needed for health and well being. The determinants of health includes socioeconomic,
physical environmental factors and individual behaviours and characteristics of people that
combine together to affect the health of community. This implies that type of lifestyle,
housing, income and education level, social relationship, environments and genetics
significantly influence health and access to health care services (World Health Organization
2019). Hence, the plan also acknowledge that evaluating data related to health status and
health determinants of Victorians can help to achieve the key objectives of the plan. As the
plan identified Victorian Aboriginals to be suffering from health equities, it aims to improve
health status of this group by focusing on inequalities and the determinants that contribute to
Introduction and summary of the health plan:
The report will discuss about the Victorian public health and well being plan 2015-
2019. The report will start with a description on the overview of the plan, the key targets of
the plan and the methods by which it will improve the health of specific Victorians like the
indigenous people (Victoria State Government 2018). The next section will provide details
regarding the priority areas of ‘Tobacco free living’ and the at risk group of older indigenous
people who might be experience poor health outcomes because of tobacco smoking. Three
social determinants of health namely poor socioeconomic status, environmental tobacco
exposure and genetic factors will then be critically and discussed in relation to the priority
area of ‘tobacco free living’.
Description of the plan and the determinants of health:
The main aim of Victorian public health and well being plan 2015-2019 is to achieve
the vision of a Victoria that is free from the burden of preventable disease and injury. The
plan aims to ensure that all Victorians achieve the highest standards of health and well being
at all age. To achieve the above mentioned vision, the plan focuses on the key priority areas
of active living and healthy eating, tobacco free living, decrease harmful drug and alcohol
consumption, promoting mental health, preventing violence and injury and improving sexual
and reproductive health. The target group that is of focus for the Victorian health plan
includes the group with least resources called the Aboriginal Victorians (Victoria State
Government 2018).
The health plan aims to promote health and well being for Aboriginal Victorians
throughout the life course by addressing social determinants of health and risk and protective
factors needed for health and well being. The determinants of health includes socioeconomic,
physical environmental factors and individual behaviours and characteristics of people that
combine together to affect the health of community. This implies that type of lifestyle,
housing, income and education level, social relationship, environments and genetics
significantly influence health and access to health care services (World Health Organization
2019). Hence, the plan also acknowledge that evaluating data related to health status and
health determinants of Victorians can help to achieve the key objectives of the plan. As the
plan identified Victorian Aboriginals to be suffering from health equities, it aims to improve
health status of this group by focusing on inequalities and the determinants that contribute to
2STUDENT ID: NAME:
health inequalities and using whole of system approach to promote health and well being for
the group (Victoria State Government 2018). Newman et al. (2015) justifies that social
determinants of health inequities consists of three layers of influence such as socioeconomic
context, daily living condition and individual factors. These three factors interact with each
other to create inequities. Hence, the Victoria’s health plan focus on addressing determinants
of health that lead to health inequity is significant. The effectiveness of this plan will be
evaluated by the decrease in disparities related to health outcome and health access for
Aboriginal Victorians and assessment of improvement in health status after the delivery of
key strategies.
Description of one priority area and one at risk group:
The priority area of ‘Tobacco free living’ will be discussed in this section with a focus
on at risk group of adults aboriginal Victorians. This priority area focuses on developing a
Victoria which is tobacco free. Although the smoking rate is declining, however the aim of
this priority area is to further reduce smoking rate, implement smoking cessation support at
the community level, target smoking cessation measures for Aboriginal Victorians and
implement legislative measures to curb tobacco reform (Victoria State Government 2018).
The main rationale for choosing ‘tobacco free living’ as a priority includes disproportionate
improvement in smoking rate in Victoria because of high smoking rate among Aboriginal
people compared to non indigenous Victorians. The survey by Department of Health (2013)
has revealed that Aboriginal people with low income or unemployment, low level of
education and thus experiencing psychological distress are mostly involved in smoking on a
daily basis. As smoking contributes to 8.5% of Australia’s burden of disease and 41% of
aboriginal people smoke daily, this priority is considered relevant to promote health equity in
relation to smoking and reduce the risk of other disease associated with smoking such
cardiovascular diseases, lung cancer and respiratory disease like COPD.
Most recent statistics also show that rate of current smokers among indigenous
Australian was 45% in 2014 to 2015 and those living in remote areas are more likely to
smoke compared to those living in other areas (pmc.gov.au 2015). Evidence suggests that
smoking is the leading cause of premature disease and mortality among indigenous
Australians. Although the rate of smoking is declining, however compared to non indigenous
Australians, the rate of smoking is still three times higher for indigenous Australians
(Chamberlain et al. 2017). Hence, the strategy of legislation based reform and tobacco control
health inequalities and using whole of system approach to promote health and well being for
the group (Victoria State Government 2018). Newman et al. (2015) justifies that social
determinants of health inequities consists of three layers of influence such as socioeconomic
context, daily living condition and individual factors. These three factors interact with each
other to create inequities. Hence, the Victoria’s health plan focus on addressing determinants
of health that lead to health inequity is significant. The effectiveness of this plan will be
evaluated by the decrease in disparities related to health outcome and health access for
Aboriginal Victorians and assessment of improvement in health status after the delivery of
key strategies.
Description of one priority area and one at risk group:
The priority area of ‘Tobacco free living’ will be discussed in this section with a focus
on at risk group of adults aboriginal Victorians. This priority area focuses on developing a
Victoria which is tobacco free. Although the smoking rate is declining, however the aim of
this priority area is to further reduce smoking rate, implement smoking cessation support at
the community level, target smoking cessation measures for Aboriginal Victorians and
implement legislative measures to curb tobacco reform (Victoria State Government 2018).
The main rationale for choosing ‘tobacco free living’ as a priority includes disproportionate
improvement in smoking rate in Victoria because of high smoking rate among Aboriginal
people compared to non indigenous Victorians. The survey by Department of Health (2013)
has revealed that Aboriginal people with low income or unemployment, low level of
education and thus experiencing psychological distress are mostly involved in smoking on a
daily basis. As smoking contributes to 8.5% of Australia’s burden of disease and 41% of
aboriginal people smoke daily, this priority is considered relevant to promote health equity in
relation to smoking and reduce the risk of other disease associated with smoking such
cardiovascular diseases, lung cancer and respiratory disease like COPD.
Most recent statistics also show that rate of current smokers among indigenous
Australian was 45% in 2014 to 2015 and those living in remote areas are more likely to
smoke compared to those living in other areas (pmc.gov.au 2015). Evidence suggests that
smoking is the leading cause of premature disease and mortality among indigenous
Australians. Although the rate of smoking is declining, however compared to non indigenous
Australians, the rate of smoking is still three times higher for indigenous Australians
(Chamberlain et al. 2017). Hence, the strategy of legislation based reform and tobacco control
3STUDENT ID: NAME:
support mentioned in the Victorian Health and Well being plan is likely to reduce the burden
of disease caused due to tobacco smoking.
Discussion of three relevant determinants of health:
The three determinants of health that influence tobacco smoking and risk of disease
among indigenous Victorians include poor socioeconomic condition (social determinant),
(biological determinants) and living in remotes areas (environmental determinants). These
three determinants are directly linked to this priority area and the target at risk group because
these three determinants influence smoking rate and risk of disease in the group. More details
regarding impact of each determinant on tobacco smoking rate in indigenous Victorians is
explained in details below.
Socioeconomic condition is a major social determinant that influence tobacco
smoking rate among indigenous Australians. The survey by Cancer Council Victoria (2018)
also show socioeconomic factors like unemployment and income related to smoking
behaviour among Aboriginal and Torres Strait Islander people. The Aboriginal group are
more likely to be in disadvantage because of poor educational attainment, employment and
income compared to non indigenous Australians. Indigenous Australians are mostly
employed in labour force and they have low weekly income. This contributes to increase in
mental illness like depression, psychological distress, depression and high rate of
hospitalization. Each of these factors is strongly linked with prevalence of smoking too.
Smoking is found to be prevalence in those who are unemployed or those who have low
income brackets (Cancer Council Victoria 2018). The evidence by Mittiga et al. (2016)
investigating about sociodemographic factors associated with smoking among indigenous
women suggest that smoking in pregnancy was found to be associated with socioeconomic
disadvantage and unemployment. Women who smoked were most likely to unemployed and
suffering from socioeconomic disadvantages. Hence, as the evidence indicates that
unemployment issues and socioeconomic disadvantage predicts increase in tobacco use
among aboriginal people, the tobacco free living strategy can work to address disadvantage in
this area.
The biological factors that may interact with smoking behaviour among indigenous
adults include genetics and cognitive processes. Twin and family studies have revealed the
impact of genetic influence on different patterns of smoking behaviour and cessation among
support mentioned in the Victorian Health and Well being plan is likely to reduce the burden
of disease caused due to tobacco smoking.
Discussion of three relevant determinants of health:
The three determinants of health that influence tobacco smoking and risk of disease
among indigenous Victorians include poor socioeconomic condition (social determinant),
(biological determinants) and living in remotes areas (environmental determinants). These
three determinants are directly linked to this priority area and the target at risk group because
these three determinants influence smoking rate and risk of disease in the group. More details
regarding impact of each determinant on tobacco smoking rate in indigenous Victorians is
explained in details below.
Socioeconomic condition is a major social determinant that influence tobacco
smoking rate among indigenous Australians. The survey by Cancer Council Victoria (2018)
also show socioeconomic factors like unemployment and income related to smoking
behaviour among Aboriginal and Torres Strait Islander people. The Aboriginal group are
more likely to be in disadvantage because of poor educational attainment, employment and
income compared to non indigenous Australians. Indigenous Australians are mostly
employed in labour force and they have low weekly income. This contributes to increase in
mental illness like depression, psychological distress, depression and high rate of
hospitalization. Each of these factors is strongly linked with prevalence of smoking too.
Smoking is found to be prevalence in those who are unemployed or those who have low
income brackets (Cancer Council Victoria 2018). The evidence by Mittiga et al. (2016)
investigating about sociodemographic factors associated with smoking among indigenous
women suggest that smoking in pregnancy was found to be associated with socioeconomic
disadvantage and unemployment. Women who smoked were most likely to unemployed and
suffering from socioeconomic disadvantages. Hence, as the evidence indicates that
unemployment issues and socioeconomic disadvantage predicts increase in tobacco use
among aboriginal people, the tobacco free living strategy can work to address disadvantage in
this area.
The biological factors that may interact with smoking behaviour among indigenous
adults include genetics and cognitive processes. Twin and family studies have revealed the
impact of genetic influence on different patterns of smoking behaviour and cessation among
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4STUDENT ID: NAME:
people. The studies have indicated that several genes impact deleterious behaviours and lead
to smoking related behaviours such as initiation, intensity and initiation. In all studies done
for risk factor of heavy smoking, set of SNPs located in the chromosome 15 cluster of
nicotinic receptor genes was found to be risk factor of smoking (Bierut and Cesarini 2015).
Although, no inequalities may exist in terms of biological mechanisms associated with
smoking related behaviour and mortality among indigenous and non indigenous Australians,
however inequality in relation to mortality may exist in different sub groups (Lovett, Thurber
and Maddox 2017). Genetic factors may also mediate the link between social factors and
smoking behaviour. For example, those with specific genetic risk for nicotine dependence
may be less affected by social context (Wood et al. 2019). Hence, evaluation of the smoking
related mortality specific to the indigenous people can give an idea regarding how risk of
smoking can be communicated to the target at risk population group.
Environmental determinants of smoking may include acceptability and availability of
tobacco products and exposure to second hand smoke in homes. The Victorian public health
and well being plan 2015-2019 mentions that one in every five Victorian children live in a
house with smoker and those living in disadvantaged areas are more likely to be exposed to
second smoke (Victoria State Government 2018). This form of tobacco exposure in children
contributes to smoking during adulthood too. Hence, second hand tobacco smoke or
environmental tobacco smoke can be significant cause of morbidity and mortality. Evidence
suggests that second hand smoke is associated with increase in lung cancer, heart disease and
increase in risk of respiratory disease in adults. It exacerbates symptoms of asthma in
children too (Australian Institute of Health and Welfare 201)8. Indigenous Australians are 1.9
times more likely to die from lung cancer compared to rest of the population because of the
high prevalence smoking in this group (Australian Institute of Health and Welfare 2013).
Therefore, this discussion makes it clear how environmental tobacco smoke can deteriorate
health and increase risk of cancer and heart disease in indigenous Australians. Hence, the
plan of addressing determinants that lead to inequity is considered effective.
Conclusion:
To conclude, the report gave a summary about the goal and aim of the The Victorian
public health and well being plan 2015-2019 and the effectiveness of the plan in achieving
the vision of optimal health for all Victorians. The discussion regarding the priority area of
tobacco free living for adults indigenous Victorian revealed that this group is
people. The studies have indicated that several genes impact deleterious behaviours and lead
to smoking related behaviours such as initiation, intensity and initiation. In all studies done
for risk factor of heavy smoking, set of SNPs located in the chromosome 15 cluster of
nicotinic receptor genes was found to be risk factor of smoking (Bierut and Cesarini 2015).
Although, no inequalities may exist in terms of biological mechanisms associated with
smoking related behaviour and mortality among indigenous and non indigenous Australians,
however inequality in relation to mortality may exist in different sub groups (Lovett, Thurber
and Maddox 2017). Genetic factors may also mediate the link between social factors and
smoking behaviour. For example, those with specific genetic risk for nicotine dependence
may be less affected by social context (Wood et al. 2019). Hence, evaluation of the smoking
related mortality specific to the indigenous people can give an idea regarding how risk of
smoking can be communicated to the target at risk population group.
Environmental determinants of smoking may include acceptability and availability of
tobacco products and exposure to second hand smoke in homes. The Victorian public health
and well being plan 2015-2019 mentions that one in every five Victorian children live in a
house with smoker and those living in disadvantaged areas are more likely to be exposed to
second smoke (Victoria State Government 2018). This form of tobacco exposure in children
contributes to smoking during adulthood too. Hence, second hand tobacco smoke or
environmental tobacco smoke can be significant cause of morbidity and mortality. Evidence
suggests that second hand smoke is associated with increase in lung cancer, heart disease and
increase in risk of respiratory disease in adults. It exacerbates symptoms of asthma in
children too (Australian Institute of Health and Welfare 201)8. Indigenous Australians are 1.9
times more likely to die from lung cancer compared to rest of the population because of the
high prevalence smoking in this group (Australian Institute of Health and Welfare 2013).
Therefore, this discussion makes it clear how environmental tobacco smoke can deteriorate
health and increase risk of cancer and heart disease in indigenous Australians. Hence, the
plan of addressing determinants that lead to inequity is considered effective.
Conclusion:
To conclude, the report gave a summary about the goal and aim of the The Victorian
public health and well being plan 2015-2019 and the effectiveness of the plan in achieving
the vision of optimal health for all Victorians. The discussion regarding the priority area of
tobacco free living for adults indigenous Victorian revealed that this group is
5STUDENT ID: NAME:
disproportionately affected by rate of tobacco smoking compared to other population. As the
plan focuses on addressing the factors that lead to health inequity, the discussion regarding
three determinants affecting the priority area gave idea regarding how poor socioeconomic
status, environmental tobacco smoke and genetic factors influence risk of disease and
mortality in indigenous Australians.
disproportionately affected by rate of tobacco smoking compared to other population. As the
plan focuses on addressing the factors that lead to health inequity, the discussion regarding
three determinants affecting the priority area gave idea regarding how poor socioeconomic
status, environmental tobacco smoke and genetic factors influence risk of disease and
mortality in indigenous Australians.
6STUDENT ID: NAME:
References:
Australian Institute of Health and Welfare 2013. Cancer in Aboriginal and Torres Strait
Islander peoples of Australia: an overview. Retrieved from:
https://www.aihw.gov.au/reports/cancer/cancer-in-indigenous-australians-overview/
contents/summary
Australian Institute of Health and Welfare 2018. Aboriginal and Torres Strait Islander
Health Performance Framework (HPF) report. Retrieved from:
https://www.aihw.gov.au/reports/indigenous-health-welfare/health-performance-framework/
contents/tier-2-determinants-of-health/2-03-environmental-tobacco-smoke
Bierut, L., & Cesarini, D. (2015). How Genetic and Other Biological Factors Interact with
Smoking Decisions. Big data, 3(3), 198–202. doi:10.1089/big.2015.0013
Cancer Council Victoria 2018. Prevalence of tobacco use among Aboriginal peoples and
Torres Strait Islander. Retrieved from: https://www.tobaccoinaustralia.org.au/chapter-8-
aptsi/8-3-prevalence-of-tobacco-use-among-aboriginal-peo
Chamberlain, C., Perlen, S., Brennan, S., Rychetnik, L., Thomas, D., Maddox, R., Alam, N.,
Banks, E., Wilson, A. and Eades, S., 2017. Evidence for a comprehensive approach to
Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews
among Indigenous peoples. Systematic reviews, 6(1), p.135.
Department of Health 2013, Victorian secondary school students’ use of licit and illicit
substances in 2011: Results from the 2011 Australian Secondary Students’ Alcohol and
Druge (ASSAD) Survey, State Government of Victoria, Melbourne.
Lovett, R., Thurber, K.A. and Maddox, R., 2017. The Aboriginal and Torres Strait Islander
smoking epidemic: what stage are we at, and what does it mean. Public Health Res
Pract, 27(4), p.e2741733.
Mittiga, C., Ettridge, K., Martin, K., Tucker, G., Dubyna, R., Catcheside, B., Scheil, W. and
Maksimovic, L., 2016. Sociodemographic correlates of smoking in pregnancy and antenatal-
care attendance in Indigenous and non-Indigenous women in South Australia. Australian
journal of primary health, 22(5), pp.452-460.
References:
Australian Institute of Health and Welfare 2013. Cancer in Aboriginal and Torres Strait
Islander peoples of Australia: an overview. Retrieved from:
https://www.aihw.gov.au/reports/cancer/cancer-in-indigenous-australians-overview/
contents/summary
Australian Institute of Health and Welfare 2018. Aboriginal and Torres Strait Islander
Health Performance Framework (HPF) report. Retrieved from:
https://www.aihw.gov.au/reports/indigenous-health-welfare/health-performance-framework/
contents/tier-2-determinants-of-health/2-03-environmental-tobacco-smoke
Bierut, L., & Cesarini, D. (2015). How Genetic and Other Biological Factors Interact with
Smoking Decisions. Big data, 3(3), 198–202. doi:10.1089/big.2015.0013
Cancer Council Victoria 2018. Prevalence of tobacco use among Aboriginal peoples and
Torres Strait Islander. Retrieved from: https://www.tobaccoinaustralia.org.au/chapter-8-
aptsi/8-3-prevalence-of-tobacco-use-among-aboriginal-peo
Chamberlain, C., Perlen, S., Brennan, S., Rychetnik, L., Thomas, D., Maddox, R., Alam, N.,
Banks, E., Wilson, A. and Eades, S., 2017. Evidence for a comprehensive approach to
Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews
among Indigenous peoples. Systematic reviews, 6(1), p.135.
Department of Health 2013, Victorian secondary school students’ use of licit and illicit
substances in 2011: Results from the 2011 Australian Secondary Students’ Alcohol and
Druge (ASSAD) Survey, State Government of Victoria, Melbourne.
Lovett, R., Thurber, K.A. and Maddox, R., 2017. The Aboriginal and Torres Strait Islander
smoking epidemic: what stage are we at, and what does it mean. Public Health Res
Pract, 27(4), p.e2741733.
Mittiga, C., Ettridge, K., Martin, K., Tucker, G., Dubyna, R., Catcheside, B., Scheil, W. and
Maksimovic, L., 2016. Sociodemographic correlates of smoking in pregnancy and antenatal-
care attendance in Indigenous and non-Indigenous women in South Australia. Australian
journal of primary health, 22(5), pp.452-460.
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7STUDENT ID: NAME:
Newman, L., Baum, F., Javanparast, S., O'Rourke, K. and Carlon, L., 2015. Addressing
social determinants of health inequities through settings: a rapid review. Health Promotion
International, 30(suppl_2), pp.ii126-ii143.
pmc.gov.au 2015. ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2. Retrieved from:
https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/tier2/215.html
Victoria State Government 2018. Victorian public health and wellbeing plan 2015–2019.
Retrieved from: https://www2.health.vic.gov.au/about/health-strategies/public-health-
wellbeing-plan
Wood, L., Greenhalgh, EM., & Vittiglia, A. 2019. 5.3 Early Biological factors. In Scollo,
MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne:
Cancer Council Victoria; Available from: https://www.tobaccoinaustralia.org.au/chapter-5-
uptake/5-3-early-biological-factors
World Health Organization 2019. The determinants of health. Retrieved from:
https://www.who.int/hia/evidence/doh/en/\
Newman, L., Baum, F., Javanparast, S., O'Rourke, K. and Carlon, L., 2015. Addressing
social determinants of health inequities through settings: a rapid review. Health Promotion
International, 30(suppl_2), pp.ii126-ii143.
pmc.gov.au 2015. ABORIGINAL AND TORRES STRAIT ISLANDER
HEALTH PERFORMANCE FRAMEWORK 2. Retrieved from:
https://www.pmc.gov.au/sites/default/files/publications/indigenous/hpf-2017/tier2/215.html
Victoria State Government 2018. Victorian public health and wellbeing plan 2015–2019.
Retrieved from: https://www2.health.vic.gov.au/about/health-strategies/public-health-
wellbeing-plan
Wood, L., Greenhalgh, EM., & Vittiglia, A. 2019. 5.3 Early Biological factors. In Scollo,
MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne:
Cancer Council Victoria; Available from: https://www.tobaccoinaustralia.org.au/chapter-5-
uptake/5-3-early-biological-factors
World Health Organization 2019. The determinants of health. Retrieved from:
https://www.who.int/hia/evidence/doh/en/\
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