Escolar Documentos
Profissional Documentos
Cultura Documentos
UNITS 1 & 2
KEY CONCEPTS in VCE
HEALTH & HUMAN
DEVELOPMENT THIRD EDITION
UNITS 1 & 2
Andrew BEAUMONT
Lee-Anne MARSH
Agatha PANETTA
Series editor:
Meredith FETTLING
Third edition published 2014 by
John Wiley & Sons Australia, Ltd
42 McDougall Street, Milton, Qld 4064
© Andrew Beaumont, Lee-Anne Marsh, Agatha Panetta, Meredith Fettling 2010, 2012, 2014
Printed in China by
Printplus Limited
10 9 8 7 6 5 4 3
This textbook contains images of indigenous people who are, or may be, deceased. The publisher
appreciates that this inclusion may distress some indigenous communities. These images have been
included so that the young multicultural audience for this book can better appreciate specific aspects of
indigenous history and experience.
It is recommended that teachers should first preview resources on Aboriginal topics in relation to their
suitability for the class level or situation. It is also suggested that Aboriginal parents or community members
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down by the Department of Education should be followed.
CONTENTS
About eBookPLUS ix
Acknowledgements x
vi
Contents
9.3 Biological determinants: birth weight and body weight 266
9.4 Behavioural determinants: breastfeeding 270
9.5 Behavioural determinants: vaccination 272
9.6 Behavioural determinants: eating habits and level of physical activity 276
9.7 Behavioural determinants: oral hygiene 282
9.8 Physical environment determinants: tobacco smoke in the home 284
9.9 Physical environment determinants: housing environment and
fluoridation of water 286
9.10
Physical environment determinants: access to recreational facilities 290
9.11
Social environment (family) determinants: parental education 292
9.12
Social environment (family) determinants: parenting practices 294
Sections 9.15 onwards
9.13
Social environment (community) determinants: media 297
containing Key
9.14
Social environment (community) determinants: access to
Knowledge 2.5 and Key
health care 299
Knowledge 2.6 can be
KEY SKILLS The determinants of health and individual human found online in your
development of Australia’s children 302 eBookPLUS.
Chapter 9 review 305
Contents vii
CHAPTER 12 Health issues facing Australian adults 412
12.1 Determinants that act as risk and/or protective factors in relation
to obesity 414
12.2 Determinants that act as risk and/or protective factors
in relation to cardiovascular disease 417
12.3 Determinants that act as risk and/or protective factors in relation
to cancer 421
12.4 Determinants that act as risk and/or protective factors
in relation to type 2 diabetes 424
12.5 Determinants that act as risk and/or protective factors
in relation to mental illness 427
12.6 Government strategies and programs to promote health
and individual human development of adults 431
12.7 Strategies and programs designed to promote health
and individual human development of adults 437
KEY SKILLS Health issues facing adults 440
Chapter 12 review 442
Index 445
viii Contents
About eBookPLUS
Various data throughout the chapters have been sourced Chris Rogers, 280 (top)/© Miodrag Gajic, 295/Tomaz Levstek,
from the Australian Institute of Health and Welfare (AIHW). 324 (top), 355/© Lisa Kyle Young, 363/Anne Clark, 374 (bottom)/
The authors and publisher would also like to thank the cre8tive_studios, 384/Sebastian Kaulitzki, 387/narvikk • John
following copyright holders, organisations and individuals Wiley & Sons Australia: pages 80/Taken by Kari-Ann Tapp, 376/
Photo by Coo-ee Picture Library, 379 (top)/Taken by Kari-Ann
for their assistance and for permission to reproduce
Tapp • John Wiley & Sons, Inc.: page 234 (left and right)/
copyright material in this book. Figure 29.14 (c and e) from Principles of Anatomy & Physiology
by Tortora & Grabowski, 10th edition, © 2003, John Wiley &
Images: Sons, Inc. • Mission Australia: page 128 (bottom)/Extract
• Alamy Limited: pages 7/© Eliane SULLE, 174–5/© Frans Lanting from Mission Australia’s Youth Survey 2012, available at http://
Studio, 436/© David Hoffman Photo Library • Australian Bureau www.mayouthsurvey.com.au • National Health and Medical
of Statistics: pages 215 (centre), 345 (top), 348 (bottom), 358, Research Council: page 99 • National Heart Foundation: page
360 (bottom), 374 (top)/Australian Bureau of Statistics; National 437 (bottom) • © Newspix: pages 286/Renee Nowytarger, 385/
Notifiable Disease Surveillance System, 378 (top and bottom), 381 Joanna Fincham, 434/Ben Swinnerton • PhotoAlto: page 150
(left), 394, 415 (top), 418 (bottom), 421 (bottom), 424 (bottom), (bottom)/©Patrick Sheándell O’Carroll • © Photodisc: pages 61,
428 (bottom) • AAPEC — Australian Action on Pre-Eclampsia: 74 (top), 85, 86 (top), 155 (bottom), 270, 299 (bottom and
page 222 (bottom) • Australian Institute of Health and Welfare: top), 319, 360 (top), 370, 399 • Royal Life Saving Society: page
pages 182, 184 (top), 209, 245 (bottom), 245 (top), 247, 248 141 (bottom) • Shutterstock: pages 2–3/NotarYES, 5 (bottom)/
(top and bottom), 252, 327 (top and bottom), 328 (bottom), Peter Bernik, 5 (top)/timquom, 10 (bottom)/Rido, 14 (top)/
366 (bottom); 49, 67 (top), 118 (bottom), 120, 125 (bottom), Inna Astakhova, 16/Diego Cervo, 28/Pressmaster, 38–9/YanLev,
141 (top), 144 (middle), 146 (bottom), 147, 164, 165, 166, 167 40/© Jorge Salcedo, 2009, 42/Andresr, 43 (top)/© AVANA, 2009,
(top)/Graphs taken from Young Australians: their health and wellbeing 44 (bottom)/Stuart Jenner, 45 (bottom)/Charles T. Bennett, 48/
2011; 125 (top)/Graph taken from Young Australians: their health and Ahturner, 53/Alexander Raths, 72–73/Monkey Business Images, 74
wellbeing 2007; 244 (top), 250 (bottom), 251/Graphs taken from (bottom)/andreasnikolas, 75 (top)/Elena Schweitzer, 78 (bottom)/
Making Progress: the health, development and wellbeing of Australia’s Elenadesign, 78 (middle)/Eugene Sergeev, 78 (top)/isak55, 83/
children and young people 2008; 303/Graph taken from A Picture of © Sebastian Kaulitzki, 2009, 86 (bottom)/Jeka, 96/© Sandra Voogt
Australia’s Children 2009; 353 (bottom)/Graph taken from Australia’s 2011, 110–11/auremar, 113/Solovyova Lyudmyla, 119/Monkey
Health 2008; 369 (bottom)/Graph taken from 2010 National Drug Business Images, 122 (bottom)/Iakov Filimonov, 122 (top)/
Strategy Household Survey Report; 383 (top), 390/Graphs taken Monkey Business Images, 128 (top)/Monkey Business Images,
from Australia’s Health 2010. Reproduced with permission from 131 (bottom right)/Lev Kropotov, 132/l i g h t p o e t, 142 (top)/
Australian Institute of Health and Welfare • © Banana Stock: evgenymate, 148/© Shevelev Vladimir, 153/Sylvie Bouchard,
pages 239 (bottom), 242 (bottom), 290 • Better Health Channel: 154/© Tracy Whiteside, 155 (top)/bikeriderlondon, 156/Andresr,
page 221/Reproduced with permission from Better Health 162/© Lisa F. Young, 2009, 184 (bottom)/Denis Kuvaev, 192–3/
Channel, Department of Health, Victoria • beyondblue: pages 158 Janna Golovacheva, 199/holbox, 200 (bottom)/Vasaleks, 201/
(bottom), 222 (top)/Reproduced with permission of beyondblue Valua Vitaly, 206/Zurijeta, 214 (bottom)/Karl J Blessing, 219/
• Cancer Council Victoria: pages 343/Illustration by Con Stamatis, Monkey Business Images, 220 (top)/Maurizio Milanesio, 230–1/
356/Reproduced with permission of Cancer Council Victoria stefanolunardi, 232 (top)/Marina Dyakonova, 235 (bottom)/
• © Centers for Disease Control and Prevention (CDC): pages 25, Hannes Eichinger, 235 (top)/Andrey_Kuzmin, 236/Alexey
26 (top), 212 (right), 266 (bottom), 268, 300 • Copyright Losevich, 237/Denis Omelchenko, 239 (top)/VikaRayu, 240/Tom
Clearance Center: page 212 (left)/Reprinted by permission from Wang, 242 (top)/jean Schweitzer, 243/Oksana Kuzmina, 256–7/
Macmillan Publishers Ltd • ©Diabetes Australia: page 437 (top) BestPhotoStudio, 258/YanLev, 260 (top)/© aquatic creature,
• © Digital Vision: pages 6, 112 (bottom), 138–9, 328 (top), 349 2009, 266 (top)/Santibhavank P, 267/Vibe Images, 272/Dmitry
(right), 366 (top) • © Fairfax Syndications (Photos): page 393/ Naumov, 276/Monkey Business Images, 277/Maryna Pleshkun,
Joe Armao • © Getty Images: pages 46/Fuse, 58/Science Photo 280 (bottom)/© Monkey Business Images, 2009, 282 (bottom)/
Library, 75 (bottom)/STEVE GSCHMEISSNER, 86 (middle)/Science © Hirlesteanu Constantin-Ciprian, 2009, 282 (top)/gorillaimages,
Photo Library, 115 (bottom)/Jodi Jacobson, 200 (top)/Southern 288/© Eric Cote, 2009, 289/Konstantin Chagin, 292/Monkey
Illinois University, 213/Anne Ackermann, 214 (top)/UIG via Getty Business Images, 293/wavebreakmedia, 294/Iakov Filimonov,
Images, 217/BSIP/UIG, 238/Dorling Kindersley, 350 (bottom)/ 308–9/© Dana E. Fry, 310 (right)/© Yuri Arcurs, 2009, 311/
© Living Art Enterprises/Photo Researchers, 357/Science Photo Deklofenak, 312 (bottom)/© Mikhail Tchkheidze, 2011, 312 (top)/
Library, 383 (bottom)/Ben Edwards, 433/Vicky Kasala Productions taro911 Photographer, 315/Ariwasabi, 320 (bottom)/kuleczka,
• Haemophilia Foundation: page 196/© Haemophilia Foundation 320 (top)/michaeljung, 323/Cheryl E. Davis, 324 (bottom)/
Australia (HFA) 2013 www.haemophilia.org.au • Healthdirect Diego Cervo, 325/Darren Baker, 338–9/Kzenon, 340/© Jack
Australia: page 220 (bottom) • © iStockphoto: pages 8/pollypic, Cronkhite, 2009, 342/© Alexander Raths, 345 (bottom)/© Jakub
10 (top)/Pascal Genest, 11 (bottom)/Paperboat, 17 (bottom)/ Cejpek, 2009, 348 (top)/Andrey_Popov, 353 (top)/Berents, 354/
Anetta Romanenko, 17 (top)/walkerphotography, 29/asiseeit, 30 Yuganov Konstantin, 369 (top)/Shcherbakov Ilya, 373/© vgstudio,
(top)/Chris Schmidt, 115 (top)/Shane White, 118 (top)/ranplett, 2009, 375/Pressmaster, 377 (top)/wavebreakmedia, 381 (right)/
126 (bottom)/Devon Stephens, 126 (top)/Carrie Bottomley, 140/ © Johanna Goodyear, 2009, 391/mast3r, 392/mast3r, 396/
rrocio, 160/Galina Barskaya, 178/© ktsimage, 232 (bottom)/ © Yuri Arcurs, 397/© amrita, 2009, 400 (bottom)/Ivonne Wierink,
© Sveta Kashkina, 263/© Ruslan Anatolevich Kuzmenkov, 264/ 400 (top)/© Deklofenak, 401/Monkey Business Images, 412–13/
x
Acknowledgements
Robert Kneschke, 414/grynold, 415 (bottom)/MarFot, 421 (top)/ Fields a sports venue for everyone’ by Nadja Poljo, Berwick
Lightspring, 422 (bottom)/Romanchuck Dimitry, 422 (top)/Daniel Leader, 23/02/11 © News Limited. This work has been licensed
Rajszczak, 427/ARENA Creative, 428 (top)/luxorphoto, 429/ by Copyright Agency; 302–3/‘Passive smoke: Kids’ health at risk’,
bikeriderlondon, 438/Blend Images, 439/Monkey Business Images Woman’s Day, 15 June 2010 © ninemsn Pty Ltd; 313–14/‘Not
• SANE Australia: page 158 (top)/Reproduced with permission quite grown up’ by Sarina Lewis, The Sydney Morning Herald
from SANE Australia www.sane.org • Susan Astley, Professor, 12 November 2010. © Fairfax Media; 316/‘Half of young people
PhD, University of Washington: page 216 • Transport Accident unable to read well, Australian Bureau of Statistics report finds’
Commission, Victoria: page 167 (bottom) • VicHealth: page 435 by Justine Ferrari, The Australian, 24 July 2008 © News Limited;
325–26/‘Baby boomers to fill the gaps in life-stage wasteland’ by
Text: Bernard Salt, The Australian, 25 November 2010 © News Limited;
• Australian Bureau of Statistics: pages 49, 397 • ABC: pages 147–8/ 331–3/‘Losing your self’ by Miriam Cosic, The Sydney Morning
‘Youth chlamydia rate on the rise’ by Michael Turtle, first published Herald, 2 March 2013 © Fairfax Media; 371–2/From ‘Men risk
by ABC Online, 8 October 2007. Reproduced by permission of health for a boost of youth’ by Jill Stark and Cameron Houston,
the Australian Broadcasting Corporation and ABC Online. © 2007 The Sunday Age, 10 May 2009 © Fairfax Media; 382/‘Stonnington’s
ABC. All rights reserved. • Australian Institute of Health and crime rate plummets’ by Liam Ryan, Stonnington Leader, 15 June
Welfare: pages 115 (table 4.1)/Table taken from Young Australians: 2010 © News Limited; 392/‘Overwork, mental stress costs $30
their health and wellbeing 2011; 117 (table 4.4), 119 (table 4.5)/ billion’ by Simon Benson, The Advertiser, 13 March 2012 © News
Tables taken from 2007 National Drug Strategy Household Survey Limited; 402–3/‘Five ways to balance work and life; by Lakshmi
(first results); 144 (table 5.2), 151 (table 5.6)/Tables taken from Sing, body+soul (online) © News Limited; 423/‘Push for cancer
Young Australians: their health and wellbeing 2007; 144 (table 5.3), screening of smokers’ by Robyn Riley, Sunday Herald Sun,
288 (table 9.11), 328 (table 10.1), 329 (table 10.2), 330 19 February 2012 © News Limited; 426/‘Australians ignorant on
(table 10.4)/Tables based on Australian Institute of Health and dangers of type 2 diabetes to their health’ by Jordanna Schriever,
Welfare material; 146 (tables 5.4 and 5.5)/Tables taken from 2010 The Advertiser, 11 March 2013 © News Limited • Centers for
National Drug Strategy Household Survey report; 246 (table 8.3)/ Disease Control and Prevention: page 268 • Department of Health
Table taken from A picture of Australia’s children 2009; 329–30 and Ageing: pages 431–2/From the Department of Health and
(table 10.3), 361 (table 11.5), 388 (table 11.9), 389 (table 11.10), Ageing webpage ‘Physical Activity’, used by permission of the
405 (table 11.14), 406 (table 11.15)/Tables taken from Australia’s Australian Government • Department of Health Victoria: page 274
Health 2010 • Better Health Channel: page 88/Table created • Kidsafe QLD Inc.: page 287 • Mission Australia: page 131/Extract
with data sourced from Better Health Channel, 205/Reproduced from National Survey of Young Australians 2010: Key and emerging
with permission from Better Health Channel, Department of Issues, available at www.mayouthsurvey.com.au • National Rural
Health, Victoria • beyondblue: page 46/‘Confronting the issue’ Health Alliance: page 208/media release, 11 May 2012 • National
by Leonie Young (beyondblue) and Chris Tanti (headspace), Health and Medical Research Council: page 279/The Australian
published in Moorabbin/Glen Eira Standard, 21 November 2007. Dietary Guidelines • Telegraph Media Group: pages 12–13/
Reproduced with permission from beyondblue and headspace ‘Cry of an Enfant Sauvage’ by Elizabeth Grice, 17 July 2006,
• Community Kitchens: page 386/Reproduced from www. The Daily Telegraph • Tribune Media Services: page 7/‘Bedtimes
communitykitchens.org.au with permission from Peninsula Health, could pinpoint the end of adolescence’ by Andy Coghlan, New
Victoria • Copyright Agency Limited: page 82/‘Strong bones key Scientist, 8 January 2005 © 2005 Reed Business Information —
to health’ by Angela Thompson, Illawarra Mercury, 2 August 2008 UK • Victorian Curriculum and Assessment Authority: All
© Fairfax Media; 113/‘Fit dads mean healthy kids — study’ by chapter openers, pages 3, 39, 309/VCAA Study Design: Health
Vikki Campion, The Daily Telegraph, 18 August 2008 © News and Human Development 2010–2013/All Victorian Curriculum
Limited; 126–7/‘Whitehorse gymnasts left high and dry’ by and Assessment Authority (VCAA) material is copyright and is
Gareth Trickey, Herald Sun, 3 October 2008 © News Limited; reproduced with permission. For more information, go to www.
145/‘Bingeing women take risks’ by Mario Xuereb, The Sunday Age, vcaa.vic.edu.au The VCAA does not endorse and is not associated
7 September 2008 © Fairfax Media; 152/‘Mental illness ravaging with this product.
nation’s youth’ by Jill Stark, The Age, 3 April 2009 © Fairfax Media;
159/‘Fewer people receiving mental health treatment’ by Adam
Cresswell, The Australian, 24 October 2008 © News Limited;
Every effort has been made to trace the ownership of
203/‘Please don’t do what I did, pleads mother who drank’ by copyright material. Information that will enable the
Renee Switzer, The Age, 22 April 2007 © Fairfax Media; 233/‘Spare publisher to rectify any error or omission in subsequent
the comparisons’ by Michael Grose, published in ‘Body & Soul’, reprints will be welcome. In such cases, please contact the
Sunday Herald Sun, 26 April 2009 © News Limited; 291/‘Casey Permission Section of John Wiley & Sons Australia, Ltd.
Acknowledgements xi
1.1 Understanding health Unit 1
THE HEALTH AND
DEVELOPMENT OF
AUSTRALIA’S YOUTH
Key skills
• define health and individual human development
• describe characteristics of, and interrelationships between, the
different types of individual human development during the lifespan
stage of youth
• explain the biological determinants of health and development and
discuss the impact on the development of youth.
An understanding of the human lifespan and the various stages within it allows
analysis and discussion of health and individual human development that occurs
for people at different times throughout their lives.
The human lifespan can be broken up into different stages (figure 1.2), although
different cultures and societies have different ways of defining the stages. One thing
that all groups agree on is that the human lifespan starts at conception and ends
at death. In Australian society, as in most Western societies, there are a number of
stages that humans go through as they get older.
Late
adulthood Prenatal
Middle
adulthood
Infancy
Early
childhood
Late
childhood
Early
adulthood
Prenatal
The prenatal stage begins when a sperm penetrates an egg (figure 1.3) in a process
known as fertilisation, to form one complete cell, called a zygote. The prenatal
stage continues until birth and is characterised by the development of the body’s
organs and structures, and substantial growth. The unborn baby goes from being
a single cell (smaller than a quarter of a millimetre across) to consisting of more
than 200 billion cells at birth and weighing around 3.5 kilograms on average. This
process takes 40 weeks to complete. In terms of rate of growth, the prenatal stage
is by far the fastest growth period of all the human lifespan stages. It is also one of
the most uncertain in terms of making it all the way through the pregnancy and
the process of birth.
Infancy
As with most lifespan stages, there is debate about when infancy finishes. Everyone
accepts that it starts at birth, but when does the infant become a child? Historically,
infancy was considered to continue until the onset of speech. However, because
infants can vary greatly in the time at which they start speaking, many organisations
and professionals in this field have adopted the view that this stage ends with the
second birthday (approximately). Therefore we will also use the second birthday as
signifying the end of the infancy period.
Infancy is a period of rapid growth with many changes. A newborn baby is
obviously very different from a two year old. By the time an infant turns two, they
have developed their motor skills and can walk, use simple words, identify people
who are familiar to them, play social games — and throw tantrums when they do
not get what they want.
Many of the developmental milestones that the infant achieves will have some
sort of bearing on how they develop in later years. This concept will be explored in
more detail in later chapters.
Childhood
Like infancy, the start and end of the childhood stage is a difficult thing to define.
Most people say that it ends at the onset of puberty. As the age of the onset of
puberty shows great variation among individuals, this study uses the 12th birthday
to signify the end of childhood.
The development that occurs in childhood is substantial, so it is worthwhile
considering this lifespan as being divided into early childhood and late childhood.
Early childhood
Early childhood starts at the end of infancy and continues until the sixth birthday.
This stage is characterised by slow and steady growth, and the accomplishment of
many new skills. The child learns social skills that will allow them to interact with
other people. They will make friends, be able to eat with adults at the table and Figure 1.4 Learning to ride a bike is
become toilet trained. a milestone for most children.
Late childhood
Late childhood starts at the sixth birthday and ends at age 12. Like early childhood,
late childhood is characterised by slow and steady growth. There are many physical,
social, emotional and intellectual changes that occur as the child moves through
this stage. These include refining reading and writing skills, developing long-term
memory, understanding gender stereotypes and refining motor skills.
Youth
The youth stage of the lifespan has steadily lengthened over the past 100 years.
This has resulted from puberty starting earlier, and young people taking longer to
gain independence and reach maturity in other aspects of their lives. As a result,
the youth stage of the lifespan is perhaps the hardest to define. We will assume
that youth starts at 12 years of age and continues until 18, although this may vary
depending on the research used. The youth stage is characterised by rapid growth,
increased independence and sexual maturity.
This stage of the lifespan is concerned with moving from childhood to adulthood.
Youth must undergo vast physical changes in order to achieve sexual maturity, and
therefore the ability to reproduce. Youth will also undergo significant social, emotional
and intellectual changes as they become accustomed to greater independence, more
complex relationships and the development of life goals (figure 1.5).
The end of youth is characterised by a level of maturity in the physical, social,
emotional and intellectual changes that have been occurring.
The terms ‘adolescent’ and ‘adult’ come from different forms aspect of the transition between childhood and adulthood.
of the Latin word adolescere, meaning ‘to grow up’. For Young people now spend more time reaching maturity in
adolescent and adult, it means ‘growing up’ and ‘grown up’ other areas such as tertiary study, finding a career, living
respectively. with their parents and gaining financial independence.
The term ‘adolescence’ has generally come to mean the As a result, the term ‘youth’ is now more commonly used
period between the onset of puberty and the cessation of to describe the stage between childhood and adulthood
growth (i.e. physical maturity). As society has changed over because it encompasses all the changes experienced during
the years, the physical changes are seen as being only one this transition, not simply the physical changes.
Case study
Bedtimes could pinpoint the Women reach this peak at 19.5 years old on average,
and men at 20.9 years. After that, individuals gradually
end of adolescence return to earlier and earlier sleeping patterns, until
things go haywire in old age.
Andy Coghlan
Roenneberg, thinks that the peak in lateness is
The end of puberty, or sexual maturation, is well the first plausible biological marker for the end of
defined. It is the point when bones stop growing. But adolescence.
for adolescence, the transition from childhood to adult- If it is a physiological effect, forcing teenagers to get
hood, there is no clear endpoint. to school for, say, 8 am, could be a mistake, Roenneberg
‘I don’t know of any markers for it,’ says Till says. They probably take nothing in for the first two
Roenneberg of the Centre for Chronobiology at the lessons because they are still in biological ‘sleep time’,
University of Munich in Germany. ‘Everyone talks and end up with a horrendous sleep deficit by the
about it but no one knows when adolescence ends. It weekend.
is seen as a mixed bag of physical, psychological and
Source: Edited extract from New Scientist, 8 January 2005.
sociological factors.’
© 2005 Reed Business Information — UK. All rights reserved.
[The study of 25 000 individuals of all ages] reveals
Distributed by Tribune Media Services.
a distinct peak of night-owlishness at around age 20.
Middle adulthood
Middle adulthood begins at 40 and continues until the age of 65. The events
that occur during this period vary from culture to culture and from individual to
individual.
Some of the more common characteristics of this lifespan stage include stability
in work and relationships, the further development of identity including the
maturation of values and beliefs, financial security, physical signs of ageing and,
for women, menopause. During this stage, an individual’s children may gain
independence and leave home, giving the parent a new sense of freedom. Sometimes
this can also create a sense of loss or loneliness, often referred to as ‘empty nest
syndrome’. Many individuals in the middle adulthood stage will experience the
joy of becoming grandparents for the first time, although this can occur in late
adulthood as well.
Late adulthood
Late adulthood, the final stage of the lifespan, occurs from the age of 65 until death.
Figure 1.7 Late adulthood is often This period is characterised by a change in lifestyle arising from retirement and
characterised by increased leisure financial security (for most). It can include greater participation in voluntary work
time. and in leisure activities such as golf and bowls (figure 1.7). Many older people may
also have to endure the grief associated with the death of friends or a spouse.
As health begins to decline significantly, older people tend to reflect on their lives
and achievements. This may provide a sense of satisfaction or regret, depending on
how they assess the choices they have made in their lives.
Physical development
Intellectual Social
Physical development refers to the changes that occur to the body and its systems.
It includes external changes that you can see, such as changes in height, and
internal changes you cannot see, such as the increasing size of the heart. Physical
development includes growth as well as motor skill development. Various aspects Emotional
Nervous
system
Respiratory
Decline of system
Growth Increases in complexity body systems
e.g. people get e.g. structures within Motor skill Circulatory
e.g. wrinkling of the skin,
bigger until the the brain become development system
reduced functioning of
end of puberty more complex the respiratory system Digestive
system
System
Reproductive
Motor skills Organ system
Muscular
Motor skills refer to the control of system
the muscles in the body. Imagine
Tissue
a newborn baby. It has very
underdeveloped motor skills
Skeletal
(e.g. uncoordinated limbs). As system
Cell
the infant gets older, motor skills
will develop and movements
will gradually become more Figure 1.10 Physical development of
controlled and deliberate. the body, from a cell to the whole body
Case study
Gone to the dogs: the girl case — neglect on this scale was too shameful to
acknowledge — even though it has been of huge and
who ran with the pack continuing interest to psychologists who believe feral
children can help resolve the nature–nurture debate.
Elizabeth Grice
What is known about ‘the Dog Girl’ has been passed
She bounds along on all fours through long grass, down orally, through doctors and carers. ‘She was like
panting with her tongue hanging out. When she reaches a small animal. She walked on all fours. She ate like a
the tap she paws at the ground, drinks noisily with her dog,’ is about as scientific as it gets.
jaws wide open and lets the water cascade over her head. Last month, British child psychologist Lyn Fry,
Up to this point, you think the young woman could an expert on feral children, went to Ukraine with a
be acting — but the moment she shakes her head Channel Four film crew to meet Miss Malaya, who now
and neck free of droplets, exactly like a dog when it lives in a home for the mentally disabled. Five years
emerges from a swim, you get a creepy sense that this after a Discovery Channel program about her, they
is something beyond imitation. Then she barks. wanted to see if she had integrated into society. Ms Fry
The furious sound she makes is not like a human wanted to find out how far the girl was still damaged —
being pretending to be a dog. It is a proper, chilling, and to see a reunion with her father.
canine-like burst of aggression and it is coming from ‘I expected someone much less human,’ says Ms Fry,
the mouth of a young woman dressed in T-shirt and the first non-Ukrainian expert to meet Oxana. ‘I’d heard
shorts. stories that she could fly off the handle, that she was
This is 23-year-old Oxana Malaya reverting to very uncooperative, that she was socially inept, but she
behaviour she learnt as a young child when she was did everything I asked of her.
brought up by a pack of dogs on a rundown farm near ‘Her language is odd. She speaks flatly as though it’s
the village of Novaya Blagoveschenka in Ukraine. an order. There is no cadence or rhythm or music to
When she showed her boyfriend what she once was and her speech, no inflection or tone. But she has a sense
what she could still do — the barking, the whining, the of humour. She likes to be the centre of attention, to
four-footed running — he took fright. It was a party make people laugh. Showing off is quite a surprising
trick that went too far and the relationship ended. skill when you consider her background. In the film,
Miss Malaya is a feral child, one of only about 100 Miss Malaya looks uncoordinated and tomboyish.
known in the world. The story goes that, when she was When she walks, you notice her strange stomping
three, her indifferent, alcoholic parents left her outside gait and swinging shoulders, the intermittent squint
one night and she crawled into a hovel where they kept and misshapen teeth. Like a dog with a bone, her first
dogs. No one came to look for her or even seemed to instinct is to hide anything she is given.
notice she was gone, so she stayed where there was She is only 1.52 metres tall but when she fools
warmth and food — raw meat and scraps — forgetting about with her friends, pushing and shoving, there is a
what it was to be human, losing what toddler’s language palpable air of menace and brute strength. The oddest
she had and learning to survive as a member of thing is how little attention she pays to her pet mongrel.
the pack. ‘Sometimes, she pushed it away,’ says Ms Fry. ‘She
A shameful five years later, a neighbour reported a was much more orientated to people.’
child living with animals. When she was found, at the After a series of cognitive tests, Ms Fry concluded
age of eight in 1991, Oxana could hardly speak and ran that Miss Malaya had the mental capacity of a six-
around on all fours barking. year-old and a dangerously low boredom threshold. She
Though she must have seen humans at a distance, can count but not add up. She cannot read or spell her
and seems occasionally to have entered the family name correctly. She has learning difficulties, but she
house like a stray, they were no longer her species. is not autistic, as children brought up by animals are
Judging from the complete lack of documentation sometimes assumed to be.
about her physical and psychological state when Experts agree that unless a child learns to speak by
found, the authorities were not keen to record her the age of five, the brain misses its chance to acquire
Emotional development
Emotional development refers to developing
the full range of emotions, and learning
appropriate ways of dealing with and expressing
these emotions. Good emotional development
encourages positive self-esteem. Some specific
examples of emotional development are
summarised in figure 1.16 and are explained in
more detail below:
• self-concept — how individuals see themselves.
They may have different views about different
aspects of themselves, such as their academic
ability, social skills and physical capabilities.
Self-concept also influences the formation of
an individual’s identity (see page 15).
• awareness of emotions — how individuals
identify which emotions they are feeling. As
people experience a range of emotions, they
become better at identifying those emotions.
Love and jealousy are emotions that can be
confusing when experienced for the first time.
• management of emotions — how individuals
control their emotions in different situations.
Figure 1.15 Throwing tantrums is a characteristic that most children Desire, guilt and jealousy are common
overcome as they develop emotionally. emotions that people want to control. For
example, instead of getting upset at not being
selected for the soccer team, a person can
direct this energy into training harder in order
to have a better chance of selection next time.
Management of emotions
Self-concept
The ability to control
Relates to how someone
emotions in an
sees themselves
appropriate manner
Emotional
development Expression of emotions
Awareness of emotions
The ability to express
The ability to recognise Radio
emotions in an
the emotions experienced
Figure 1.16 Aspects of emotional appropriate way
development
Intellectual development
Intellectual development refers both to the processes that occur within the brain
and to the increasing complexity of the brain. Aspects of intellectual development
are summarised in figure 1.17 and are explained in more detail below.
• knowledge — this becomes more complex as people develop intellectually. The
longer a person has been developing intellectually, the more opportunities they
have to gain knowledge.
• language — knowledge of language and the way it can be used develops
continually over the human lifespan.
• memory — retaining information and being able recall it. Memory abilities change
throughout the lifespan and can decline in the latter parts of adulthood. Using this
section of the brain can help to promote a good memory into late adulthood.
• abstract thought — being able to think about concepts and ideas rather than
just the physical objects you can see (concrete thought).
• creativity and imagination — thinking in new ways. Both creativity and
imagination can be developed by exposure to many different experiences
including books, music and other people.
• problem solving — finding a way from the current state to the desired goal
Figure 1.18 Intellectual development
is rapid during the early years but it
when no clear path exists. Problem solving is one of the most complex of all
continues throughout the lifespan. thinking processes. Examples include trying to fit a number of commitments
into a given timeframe, figuring out what has caused a computer to crash or
calculating how much weight a new (as yet unbuilt) bridge can hold. Trial and
error is an important part of problem solving.
• attention — focusing on one aspect of the environment while ignoring others.
Attention is an important aspect of intellectual development as it assists in the
learning of new material. Young children can focus their attention for shorter
periods of time than older children. Attention can be developed by attaching an
intrinsic (or internal) reward, such as attaching satisfaction to completing a task.
The more a person enjoys the matter requiring attention, the longer they can
focus their attention on it.
Knowledge
Attention Language
Intellectual
development
Problem
Memory
solving
Youth is a time of rapid development. Although the physical changes that occur
during this stage are often the most well known, significant changes also take place
in the social, emotional and intellectual dimensions of development. The average
youth will end this lifespan stage by being physically capable of reproduction;
being seen as an adult in the eyes of the law; finishing compulsory education; being
legally allowed to drink alcohol, drive, vote and join the army; and making many
other decisions for themselves. We will explore the individual human development
that occurs during youth in each of the four dimensions of development, beginning
with physical development.
Growth
The adolescent growth spurt is one of the most easily 25
recognisable signs of puberty. During the growth spurt, the Boys
individual will grow at the fastest rate since infancy (figure 1.22). Girls
According to the Go For Your Life initiative (www.goforyourlife. 20
Height gain (cm/year)
• Penis begins
• Breasts grow
to lengthen
• Hips widen in proportion to waist • Muscles grow,
• First period (menarche) shoulders
broaden
• Sperm
production
starts
• Ovulation and menstruation begin • Acne begins
• Voice changes
• Pe
• Breasts grow
to
• Hips widen in proportion to waist •M
• First period (menarche) sh
br
• Sp
pr
st
• Ovulation and menstruation begin • Ac
Secondary sex characteristics arise from changes that occur to both males and
females but are not directly related to reproduction and are not present at birth.
Examples of secondary sex characteristics for males and females are shown in blue
in figure 1.24.
There is wide variation in the timing of when puberty begins, although girls
generally start before boys. Girls commonly reach puberty between the ages of
8 and 13, and boys between the ages of 10 and 15. The average ages at which
selected events associated with puberty occur are outlined in figure 1.23. These
Adulthood Adulthood
During During
puberty puberty
Before Before
puberty puberty
Key:
Primary sex characteristics
Secondary sex characteristics
Figure 1.24 The primary sex characteristics that develop for males and females
during puberty
TEST your knowledge 5 (a) Looking at figure 1.22, outline two differences
in the growth spurt as experienced by males and
1 Using examples, explain:
females.
(a) primary sex characteristics
(b) What leads to these differences?
(b) secondary sex characteristics.
6 Use the Puberty weblink in your eBookPLUS to find
2 During which lifespan stage are the primary sex
the link for this question.
characteristics first created?
(a) Research one of the hotspots for either males
3 Using figure 1.24 as a guide, draw a Venn diagram
or females. (Be sure to look at the animation for
summarising the changes that males and females
each hotspot in the bottom right-hand corner.)
undergo during puberty.
(b) Present your findings to the class or in small
APPLY your knowledge groups.
7 Prepare an educational guide or poster for
4 Use figure 1.23 to answer the following questions. prepubescent children outlining the changes that
(a) At what age span does the growth spurt begin occur during puberty.
for males and females?
(b) Identify two of the differences between males
and females as shown in the graph.
(c) Which milestone shows the greatest variation
for females?
Hormonal changes
Hormones are an example of a biological determinant
and are responsible for the process of puberty.
Hormones are chemicals that are released by special
parts of the body called glands. The series of glands Blood vessel
Hormone
in the body make up the endocrine system. There are
numerous glands in the body and some of the main Target cell
ones are shown in figure 1.28. Hormones play an Not a target cell
important role in bringing about changes in physical Receptor
Gland
development during youth. When hormones are
released from the glands, they are transported through
the bloodstream and circulate around the body.
Certain cells around the body are sensitive to different
hormones and will react when the particular hormones
are present in the blood (see figure 1.27). Figure 1.27 Hormones act on specific
Different hormones act on different parts of the cells and bring about many of the
physical changes associated with
body and are essential for many aspects of life such as
puberty.
metabolism, growth, cell death, the menstrual cycle in
women and puberty in youths. Hormones are the trigger for puberty and will play
a role in the physical state of both females and males for life.
Hormone changes during youth are caused by many factors including genetics
and body weight. It is the release of hormones that triggers puberty and results in
the changes in physical development that occur during this stage. The different
proportions of hormones released in males and females contribute to the different
changes that occur between the sexes.
Hormones also influence when and how quickly an individual develops, and
there is great variation in the rate of development. This is partly why some
individuals start puberty at eight and others may not start until 16. The duration
of puberty also varies greatly and can last from two to eight years. Generally
speaking, the earlier an individual starts puberty, the faster they move through it
(although this has no bearing on final height). Rate and timing of development can
affect other aspects, such as motor skill development. Early puberty contributes to
increased strength and endurance, which can contribute to greater participation in
activities that promote motor skill development. Social development can also be
affected by early puberty. Those who start puberty early might be expected to act in
a more mature manner because they look older than their actual age. They may also
socialise with youth who are older and this can also affect their social development.
During puberty, growth hormone is released at around double the amount
that was present during childhood. This leads to a faster rate of growth than was
experienced during childhood. The amount of growth hormone released may
influence final height. Growth hormone is also responsible for other aspects of
growth that take place during the youth stage, including an increase in muscle mass
and an increase in the size of the organs. These changes improve the functioning of
the body and contribute to the peak physical development that is usually reached
in early adulthood.
Ovaries Testes
The thyroid gland produces the hormone thyroxine, which regulates the rate of metabolism in the body.
This hormone is essential to regulate the energy produced by the body, for the development of the
nervous system and muscles, and for the growth of long bones. These functions are particularly relevant
during youth as the individual undergoes significant development in these areas.
Figure 1.28 The glands and hormones responsible for the changes experienced during puberty
Body weight
Maintaining a healthy body weight is beneficial for development during youth.
Body weight that does not fall within the healthy range can have a number of
effects on youth development. Genetics play a role in body weight, as does food
intake. When people do not have a balanced food intake, many nutrients required
for optimal development and health are absent from the diet or not present in the
right amounts. This is the result of not eating enough nutrient dense food.
Body weight can affect individual human development in many ways. Young
people who are either underweight or overweight/obese may not be eating enough
of the foods that provide adequate nutrition. This can mean that optimal physical
development is not achieved during puberty. The individual may not be as tall as they
should be, or may not develop optimal bone density. They might not participate in
sporting events, which could have a negative effect on their motor skill development.
28 28
26 26
24 24
22 22
20 20
18 18
16 16
14 14
12 12
28 28
26 26
24 24
22 22
20 20
18 18
16 16
14 14
12 12
The rates of overweight and obesity for young Australians in 2010–11 are shown
in figure 1.31. These rates have steadily increased over the past 25 years.
80
Underweight Normal Overweight (but not obese)
Obese Overweight/Obese
70
60
50
40
30
20
10
• Focus on the future increases. This may guide intellectual development — for
example, students wanting to study science might develop an interest in learning
about scientific principles and choose science courses at school.
• Thinking becomes more informed. Youths can distinguish between fact and
opinion and may challenge views put to them by others, including adults.
• More complex concepts are learned at school. As a result, youths may develop
an understanding of how they learn best (e.g. visual versus aural learners).
Some research suggests that the frontal lobe (a part of the brain) is not fully
developed until the end of puberty — possibly not until the 20s. The state of the
brain during these years may make youths favour immediate rewards and disregard
long-term consequences. It is thought that this aspect of brain development may
account for why youth are more likely to take risks than children or adults.
Figure 1.34 Towards the end of youth, individuals generally start to shift their attention to
learning things associated with their interests and possible career paths.
KEY SKILL Define individual human development ❶ The definition does not have to be
exactly the same as the textbook
It is essential to be able to define individual human development. A definition definition, but it must convey the
should include reference to the four dimensions of development (physical, social, same concept.
emotional and intellectual).
In the example below, the term ‘individual human development’ is defined. ❷ Examples assist in demonstrating
understanding.
Individual human development refers to the changes that humans experience
from conception until death.❶ Individual human development (sometimes simply
❸ The four areas of development
referred to as ‘development’) includes the predictable, orderly changes that occur should be mentioned.
and can be physical (such as growth and motor skill development),❷ social (such as
communication skills), emotional (such as learning to control and effectively express
emotions) and intellectual (such as changes in thought patterns).❸
development. Tan’s ovaries will produce more oestrogen, which will be responsible
for many of the changes that occur in the coming years.❺ ❺ Remember that not all physical
changes can be seen. Some occur
Tan will begin to develop breasts, although this process takes some years to inside the body such as the changes
complete. She will start to grow pubic hair, underarm hair and leg hair. Her voice in hormone production.
will deepen and she will undergo❻ a growth spurt that will see her add around
16 centimetres to her height and 16 kilograms in weight. At the end of puberty, ❻ Provide a range of changes that
her bones will have finished developing and her height will not increase much occur. Make sure that primary and
secondary sexual characteristics are
more. As a result of the growth spurt, Tan’s body proportions will change and covered.
fat will be deposited around her hips. Her hips will also widen, preparing her
body for reproduction. Tan’s menstrual cycle will begin. This marks the beginning ❼ Use key terms where appropriate.
of her ability to reproduce. Her primary sexual characteristics❼ will also develop
as her body prepares itself for reproduction (e.g. the enlarging of her vagina
and uterus).
A key requirement of this skill is to develop the ability to predict possible
outcomes for an individual, in all dimensions of development, in a particular
scenario or set of circumstances. Having a detailed knowledge of the four
dimensions of development is the first step in achieving this.
In this scenario (or case study), Ben is 16 and has just left school to begin a
plumbing apprenticeship. A discussion of how Ben’s development might be affected
by his leaving school and beginning full-time employment is presented below.
❽ If the question does not specify,
Ben’s development might be affected in the four key dimensions: physical, social, ensure that all dimensions of
emotional and intellectual.❽ development are covered.
Physical: He may miss out on playing sports at school, and this could affect his
motor development. He may learn new manual skills in the workplace that may
enhance his motor development.
Social: He will learn to communicate effectively with a range of people in a
professional manner.
Table 1.1 A summary table for analysing the impact on development of the biological
determinants
Physical
Social
Emotional
Intellectual
20
15
10
Figure 1.36 Average
rate of growth
0 for male youths
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 compared with
Age (years) James’ growth rate
5 List three aspects of physical, social, emotional and intellectual development that
occur during youth.
(2 marks)
(b) Identify two differences in the physical development that occurs at their stage of the
lifespan.
(2 marks)
(c) Identify two hormones that contribute to the physical development being
experienced by Fabio and/or Mandie and explain the role they play in physical
development.
(6 marks)
(Adapted from the VCAA exam paper, 2005, Q. 4)
Chapter summary
• The human lifespan begins at conception and ends at death. Each stage has
characteristics common to most people.
• The start and finish of some lifespan stages has been debated over the years, and
different groups and organisations may define the lifespan stages differently. For the
sake of this course, the lifespan stages, and the start and end of each stage, are:
–– prenatal: fertilisation until birth
–– infancy: birth to 2nd birthday
–– early childhood: 2 years of age to 6th birthday
–– late childhood: 6 years of age to 12th birthday
–– youth: 12 years of age to 18th birthday
–– early adulthood: 18 years of age to 40th birthday
–– middle adulthood: 40 years of age to 65th birthday
–– late adulthood: 65 years of age until death.
• Development refers to the orderly, predictable and sequential changes that occur
in individuals from conception to death. Development occurs in the physical, social,
emotional and intellectual dimensions.
• Some milestones may represent more than one dimension of development. Learning
to use a knife and fork is an example of both physical development (manipulating the
muscles to hold and move the knife and fork adequately) and social development (the
socially expected way to eat most meals).
• Physical development involves internal aspects (development and growth of body
systems and organs) and external aspects (motor skill development and growth). It
includes the decline in body systems.
• Youth is considered a period of rapid growth.
• The physical changes that occur during puberty can be classified as either primary or
secondary sex characteristics.
• The development experienced throughout life is determined by a broad range of factors
called determinants. Interactivities:
• Biological determinants relate to the state and functioning of the body and include Chapter 1 crossword
genetics, hormones and body weight. Biological determinants play a significant role Searchlight ID: Int-2889
in the physical development experienced by individuals in the youth stage of the Chapter 1 definitions
lifespan. Searchlight ID: Int-2890
• Genetics contribute to many aspects of development including height, the timing of the
onset of puberty, sex and physical appearance.
• Hormonal changes are largely responsible for the physical changes that occur during
puberty and can affect the onset and rate of physical development during youth. Growth
hormone is responsible for many of the changes that occur in height at this time.
• The rate of overweight and obesity has increased over time and impacts on the onset
of puberty for youth.
• Body mass is often measured using the body mass index (BMI). For adults, BMI scores
are judged according to set values. For youths, however, BMI classifications are based
on percentile charts because youths are undergoing rapid growth and experiencing
changes in body proportions.
• Social development refers to the social skills, behaviours, capabilities and roles that
people learn through interacting with others.
• Youth is a time of rapid social development. Values and beliefs are formed in this stage
and youths interact with a wider range of people, including increased interactions with
those of the opposite sex.
• The peer group is an important influence on social development as it contributes to the
development of behaviours and communication skills.
• Emotional development refers to the way that people deal with and express the
emotions they experience. It includes self-concept.
• Individuals experience a wider range of emotions during youth and learn to recognise
and deal with them more appropriately.
• Identity is an important aspect of social and emotional development and relates to the
unique personality and way that an individual defines him/herself.
• Intellectual development refers to the processes occurring in the brain and includes
knowledge, language, memory and problem solving.
• The brain continues to develop during youth and contributes to more developed
thinking and reasoning skills.
• Youths often become more focused on knowledge related to possible career paths.
• The four dimensions of development are interrelated and all affect each other.
The health of
Australia’s youth
WHY IS THIS IMPORTANT?
The health of Australia’s youth is generally good, and
improvements are continually being made in most areas.
An understanding of the concept of health is important if the
health of our young people is to be adequately analysed
and evaluated. Areas for possible improvement can then
be identified and current interventions can be evaluated.
Predictions can also be made about the health impacts of
current trends and issues. Understanding the role biological
determinants play is also useful in explaining specific health
concerns facing young people.
KEY KNOWLEDGE
1.3 definitions of health and the limitations of these definitions
(pages 40–1)
1.4 characteristics of, and interrelationships between, physical, social and
mental dimensions of health (pages 41–7)
1.5 measurements of health status, including life expectancy, incidence,
prevalence, trends, morbidity, mortality, disability adjusted life years
(DALYs) and burden of disease (pages 48–57)
1.6 the health status of Australia’s youth (pages 48–57)
1.7 biological determinants of health and individual human development
of Australia’s youth, including genetics, body weight and hormonal
changes (pages 58–61)
1.8 the interrelationships between health and individual human
development during the lifespan stage of youth (pages 62–3, 68–9).
KEY SKILLS
• define health
• explain the limitations of definitions of health
• describe the characteristics of, and interrelationships between, the
dimensions of health
• explain health status measurement terms
• interpret and analyse data on the health status of Australia’s youth
using appropriate measurements
• explain the biological determinants of health and development and
discuss the impact on the health of youth
• explain the interrelationships between health and human development Figure 2.1 The health of Australia’s
during the lifespan stage of youth. youth is generally good.
38 UNIT 1
4 • The
Global
health
health
andand
development
human development
of Australia’s youth
KEY TERM DEFINITIONS
burden of disease a measure of the impact of diseases
and injuries; specifically it measures the gap between
current health status and an ideal situation where
everyone lives to an old age free of disease and disability.
Burden of disease is measured in a unit called the DALY
(VCAA).
disability adjusted life year (DALY) a measure of
burden of disease. One DALY equals one year of healthy
life lost due to premature death and time lived with
illness, disease or injury (VCAA).
Down syndrome a genetic condition characterised by
having three chromosomes on the 21st pair instead of
two. Individuals exhibit distinct facial features, reduced
muscle mass and impaired intelligence.
genetic predisposition an inherited tendency to
exhibit certain traits (e.g. being tall) or to develop certain
conditions (e.g. cancer) based on genetic make-up
haemophilia an inherited condition characterised by an
inability of the blood to clot
health ‘a state of complete physical, mental and social
wellbeing and not merely the absence of disease or
infirmity’ (WHO,1946)
health indicators standard statistics that are used to
measure and compare health status, e.g. life expectancy,
mortality rates, morbidity rates
health status ‘an individual’s or a population’s overall
health, taking into account various aspects such as life
expectancy, amount of disability and levels of disease risk
factors’ (AIHW, 2008)
incidence refers to the number (or rate) of new cases of
a disease/condition in a population during a given period
infirmity a state of being weak, especially from old age
lethargic tired; lacking energy or mental awareness
life expectancy an indication of how long a person can
expect to live if the current death rates remain unchanged
mental health ‘State of wellbeing in which the
individual realises his or her own abilities, can cope with
the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her
community.’ (WHO, 2009)
morbidity refers to ill-health in an individual or levels of
ill-health in a population
mortality refers to deaths in the population
muscular dystrophy an inherited condition
characterised by progressive muscle wasting
physical health relates to the efficient functioning of the
body and its systems, and includes the physical capacity to
perform tasks and physical fitness (VCAA)
prevalence the number or proportion of cases of a
particular disease or condition present in a population at a
given time (AIHW, 2008)
social health being able to interact with others and
participate in the community in both an independent and
cooperative way
Turner syndrome a genetic condition characterised
by having only one full chromosome on the 23rd pair.
Sufferers are females of small stature who cannot
reproduce.
years lost due to disability (YLD) a measure of how
many ‘healthy’ years of life are lost due to illness, injury or
disability
years of life lost (YLL) a measure of how many years of
expected life are lost due to premature death
KEY CONCEPT Understanding the definitions of health and their limitations, and
the interrelationships between physical, social and mental health
With this in mind, the definition of health becomes more inclusive and more
achievable. The focus on ‘personal resources’ and ‘physical capacities’ means that
health is dependent on an individual’s own situation, and a person can be
considered healthy even if they do not have ‘complete’ wellbeing in the areas of
physical, social and mental health.
You will notice that the fourth word of the original WHO definition of health
is ‘state’. This is a key word for understanding the concept: health is a ‘state’ and,
as a result, is also dynamic. This means that it is
always changing (although the levels of change
may not always be obvious). Health can be
optimal one moment, and then events such as
accidents, illness, relationship breakdown and
stressful incidents can change the state of health
very quickly. Health can also improve quickly. A
person with a migraine who is experiencing poor
health can rest and possibly take medication
that will return their health to an optimal level.
In 1986, the Better Health Commission (BHC)
described health in the following way:
’Good health implies the achievement of a
dynamic balance between individuals or groups
and their environment. To the individual, good
Figure 2.2 Would this man be considered healthy using the WHO definition? health means improved quality of life, less
This definition is more inclusive than the original 1946 definition and builds
further on the capabilities of the individual. The individual’s environment is also
mentioned in this definition, and the environment exerts a huge influence on health.
Physical health
Physical health refers to the current condition of the body and its systems. Most
aspects of physical health can be readily measured or observed (see figure 2.3).
Physical
fitness
Functioning
of body Body weight
systems
Aspects of Blood
Energy levels
physical health cholesterol
Feelings of
Blood
physical
pressure
wellbeing
Levels of
illness
• blood cholesterol levels. Excessive blood cholesterol can increase the risk of
cardiovascular disease (sometimes called ‘heart disease’). Elevated blood cholesterol
levels may indicate that the intake of saturated and trans fats is excessive.
• blood pressure levels. Blood pressure refers to the force that blood places on the
walls of the blood vessels as the heart beats. High blood pressure indicates that
the blood vessels are not in optimal shape and the heart is working too hard.
High blood pressure is often a symptom of cardiovascular disease and can occur
as a result of a range of factors such as food intake, genetics and other diseases.
• the absence or presence of illness. A person who is physically healthy will have
an immune system that is functioning adequately and is capable of resisting
infection and disease.
Aspects of physical health that cannot typically be measured include:
• feelings of physical wellbeing. The way a person feels physically can be an
indicator of physical health. Being free from pain, tightness and discomfort are
some examples that might indicate feelings of physical wellbeing.
• energy levels. Physical health includes having enough energy to adequately carry
out daily tasks that might include school activities, socialising and a part-time
job. Lack of energy usually means that the individual’s body systems are not
functioning adequately. This could be the result of many factors including food
intake, exercise levels, illness and stress levels.
• functioning of the body’s systems. Physical health is ultimately reliant on the
functioning of the body’s systems. If the systems are functioning adequately,
the person will usually display other characteristics of physical health (such as
physical fitness; normal levels of blood pressure, blood cholesterol and energy;
freedom from disease; feelings of wellbeing).
Social health
Interacting with other people is an important
aspect of human nature (figure 2.5). Social
health refers to these interactions and their
quality. Someone who is experiencing a good
level of social health typically has a good
network of friends and a supportive and
understanding family, with all their social
needs met.
Like all dimensions of health, social health is
dynamic and can change quickly. An individual
can have a network of friends and a supportive
family until they move away from home.
Suddenly those interactions become more
difficult, and their social health can suffer.
Figure 2.5 Interaction with friends
is an important aspect of social health
and can affect mental health.
Friendship
networks
Aspects of
social health
Relationships
Social needs
with family
met
members
Figure 2.6 The indicators of social
health
Mental health
Mental health refers to a ‘state of wellbeing in which the individual realises his or her
own abilities, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her community’ (WHO, 2009).
This includes thoughts and the impact that a person’s feelings have on themselves.
Positive mental health might include managing day-to-day activities with low levels
of stress, being able to lead an independent life and being resilient in the event of
misfortune.
If a person is feeling particularly stressed, then the mental aspect of their health
may be compromised (figure 2.8). This area of health also includes levels of self-
esteem and confidence.
Self-esteem refers to how people feel about themselves. Having positive self-
esteem means that people feel good about themselves. Self-esteem influences
behaviour, as those with positive self-esteem are more likely to speak their mind
and act independently and responsibly.
Self
esteem
Aspects
Thought
of mental Confidence
patterns
health
Levels of
stress
44
UNIT 1 • The health and development of Australia’s youth
The interrelationships between the dimensions
of health Optimal
health
The three dimensions of health are interrelated; that is, they all affect each
other (figure 2.9). Although they will not all be affected in the same way Physical
or to the same degree, a change in one will usually have some effect on the health
other two. For this reason, all three dimensions of health need attention in
order to achieve optimal health (see box).
Exactly how do the dimensions of health affect each other? Consider a Mental Social
youth who has suffered a broken leg (physical health) and is recovering in health health
hospital (figure 2.10). While in hospital and during the recovery phase, their
health could be affected in numerous ways:
• physical health Figure 2.9 The three dimensions of
–– may not be able to exercise, so health are interrelated.
fitness levels reduce
–– could gain weight as physical
activity levels decrease OPTIMAL HEALTH
–– immune and other body systems Optimal health refers to the
may be affected by the food given in highest level of health an
individual can realistically
hospital (this could have positive or
attain. Everyone is born with
negative effects on health, depending a different genetic potential
on what the diet was like before) and is influenced by different
• social health environments. As a result, every
–– might make new friends in hospital individual’s level of optimal
–– could socialise with doctors and health will be different.
nurses
–– may get a lot of visits from family
members they would not normally
see
–– will not be able to socialise with
friends at school and during leisure
time
• mental health
–– might be happy or sad to miss out
on school
–– may be depressed about missing
out on socialising with friends and
family
–– could experience feelings of
loneliness
–– may feel like they are a burden on
their family.
Not all of the effects on health are
negative. Sometimes a negative event can
produce positive effects on one or more
of the dimensions of health. You may
also have noticed that there is a range
of effects on the various dimensions of
health. It is impossible to state exactly
how an individual’s health will be affected
by a particular event because everyone
is unique and each situation is different. Figure 2.10 This youth’s social and
We can, however, predict possible effects mental health may be affected by his
on health. physical health.
It is also important to note that the effect on health will not always have a
physical cause. For example, a relationship break-up (non-physical cause) can lead
to a loss of appetite (physical health). If the newly single individual used to spend
a lot of time with their partner’s friends, they may now have to find a new group of
friends (social health). The person may experience a loss of confidence and doubt
their own worth (mental health).
The following case study looks at the effect of excessive alcohol use on mental
health.
Case study
50
40
30
20
10
0
Male Female Male Female Male Female
15–17 years 18–24 years Total 15–24 years
Figure 2.14 Self-assessed health status of young people aged 15–24 years, 2007–08
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE
140, Canberra, p. 16.
Life expectancy
Life expectancy is one of the most common methods used to measure health
status. It gives an indication of how long a person can expect to live if the current
death rates stay the same. (Unless stated otherwise, the numbers refer to a person
born today.) Table 2.1 shows life expectancy data for people of different ages in Table 2.2 Life expectancy for
Australia. Australia’s youth and early adults at
different ages
Table 2.1 Life expectancy at different ages, 1901–10 and 2009–11 Age Males Females
140
Males
120 Females
Death rates per 100 000
100
80
60
40
20
0
0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39
Age
Figure 2.15 Death rates for infants, children, youths and early adults, 2009
Source: Adapted from AIHW and ABS data.
Youth has among the lowest death rates of all lifespan stages (figure 2.15). This
is because they have survived childhood, where factors associated with childbirth
and genetic abnormalities cause many deaths, and their bodies have generally not
had enough time to develop lifestyle conditions such as cardiovascular disease
and cancer. Deaths from accidental causes such as car accidents and drowning
contribute significantly during the youth stage. Such causes are classified as
‘injuries’. Specifically, injuries include:
• road accidents
• suicide
• drowning
• fires
• falls.
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
stages of the lifespan. Yet
Year when we see the trend data,
it shows that the rates have
Figure 2.16 Death rates for Australians aged 15–19, 1970–2009 actually decreased significantly
Source: Adapted from AIHW data. compared to years gone by (see
figure 2.16).
Years of life lost (YLL) due to premature death is another way of measuring and
comparing mortality. If a person dies from a given condition 30 years before the
predicted life expectancy for their age, then they have contributed 30 YLLs to that
particular cause of death. For example, if a 20-year-old female dies in a car crash,
and life expectancy for females that age is 84, then 64 years have been added to
the YLLs for injuries.
The YLLs that were caused by a range of conditions among young Australians
are shown in figure 2.17.
For Australia’s youth, road traffic accidents are the leading cause of years
of life lost, and injury-related deaths account for the top three causes of YLLs.
Cancer is the leading non-injury related cause of death, followed by nervous
system and sense disorders that include epilepsy and muscular dystrophy. Note
that ‘other causes’ is not considered to be a leading cause of death because it
encompasses a range of conditions, each of which on its own contributes very
few YLLs.
Respiratory diseases
(including asthma)
Drowning
Cardiovascular disease
Congenital abnormalities
Endocrine and metabolic Males 10–14
disorders Males 15–19
Nervous system/
sense disorders Females 10–14
Other causes
Females 15–19
Cancer
Other injuries
Suicide
TEST your knowledge 7 (a) Describe the trend in death rates as shown in
figure 2.16.
1 What percentage of 15–24 year olds assessed
(b) What factors may have led to this trend?
their health as excellent or very good in 2007–08,
8 What are the top three causes of death for males
according to figure 2.14?
and females?
2 Using table 2.1, explain how life expectancy
9 (a) State what the acronym ‘YLL’ stands for and
changed from 1901–10 and 2009–11 for:
explain what it means.
(a) males at birth
(b) Outline how YLLs are calculated.
(b) females at birth.
10 (a) Which sex contributes more YLLs to the burden
3 (a) Using table 2.2, explain what happens to life
of disease according to figure 2.17?
expectancy as individuals move through youth
(b) Suggest reasons for this.
and into the early adulthood stage of the
lifespan.
APPLY your knowledge
(b) Suggest reasons that account for this change.
4 What is mortality? 11 Discuss why death rates might be a more useful
5 Examine table 2.3 and answer the following statistic than the total number of deaths.
questions: 12 Examine table 2.3 and complete the following:
(a) Which age group has the greatest male:female (a) Graph the male:female mortality ratio across the
ratio for mortality? lifespan as shown in table 2.3.
(b) What does this number (ratio) mean? (b) Describe the pattern with regard to male:female
(c) Discuss reasons that may account for the ratio mortality rates across the lifespan.
identified in part (a).
6 (a) According to figure 2.15, how do death rates
change for 10–14 year olds compared with
15–19 year olds?
(b) Suggest reasons for this change.
Morbidity
Not all conditions end in death, so it is useful to examine
the effect that non-fatal conditions have on a population
(figure 2.18). This is where morbidity data is useful.
Morbidity refers to ill-health — including disease, injury
and disability — in an individual, and the level of ill-health
in a population. So the morbidity rate refers to the rate of
ill-health in a population in a given period of time.
There are two ways of considering morbidity:
• the number of people reporting a condition (often
represented as a percentage of a population, or the
incidence and prevalence rates)
• the years lost due to disability (YLDs), where one YLD is
equal to one ‘healthy’ year of life lost. Figure 2.18 Many conditions do not
By using two methods, it is possible to examine which conditions are the most end in death but still affect youth
common and which conditions have the biggest impact on health. health and development.
Males Females
As can be seen from table 2.4, the incidence rate for migraine was 12 for every
1000 males in the 10–14 age bracket. In 2003, there were approximately 706 500
males in this age group. To calculate the total number of new cases, multiply the
rate per 1000 by 706.5 (as there are 706.5 groups of 1000 in 706 500) to get the
total number of new cases in 2003:
706.5 × 12 = 8478.
So in 2003 there were approximately 8478 new cases of migraine among males
in the 10–14 year age group.
The prevalence, or total cases, of selected conditions are shown in table 2.5.
Table 2.5 Prevalence of selected conditions, 2003
Males Females
YLDs
Years lost due to disability (YLDs) is a measure of the impact of morbidity on a
group or population. YLLs and YLDs are equal in value, in that one YLL and one
YLD are each equal to one healthy year of life lost.
It would be difficult to compare the effect of asthma on an individual with
the effect of losing a leg in a car crash. They are very different conditions
and would impact on an individual in different ways. In order to address this
issue, the World Health Organization has given the most common conditions
a disability weight, which is an indication of the severity of the condition and
2% 1%
2% 1% 2% 1%
8% 3% 1%
7%
9%
13%
9%
59%
10% 58%
14%
Mental disorders
Other Mental disorders
Injuries Other
Nervous system and sense Chronic respiratory diseases
organ disorders Nervous system and sense
Chronic respiratory diseases organ disorders
Communicable diseases, maternal Communicable diseases, maternal
and neonatal conditions and neonatal conditions
Cardiovascular disease Injuries
Nutritional deficiencies Cardiovascular disease
Endocrine and metabolic disorders Nutritional deficiencies
Figure 2.19 Proportion of YLDs Figure 2.20 Proportion of YLDs attributed
attributed to selected causes, males to selected causes, females aged 10–19,
aged 10–19, 2003 2003
Source: Adapted from AIHW data. Source: Adapted from AIHW data.
Burden of disease
Burden of disease is a health indicator that combines mortality data with morbidity
data so that conditions that contribute differently to death and illness can be
compared. For example, cancer causes a lot of death and illness while a chronic, or
long-term, condition such as asthma causes a lot of illness but much less death. In
the past, it was hard to compare these two conditions and decide where valuable
funding should go. Burden of disease data was created to help overcome this
problem.
Burden of disease is measured in disability adjusted life years (or DALYs,
pronounced ‘dally’), where 1 DALY is equal to one year of ‘healthy’ life lost due to
premature death or living with a disability/illness. Using DALYs, it is possible to
compare the impact of different conditions equally — those that cause death, those
that cause disability and illness, and those that cause both (table 2.6). So a person
who has lived a healthy life — but dies suddenly 30 years earlier than the current
life expectancy of their age — has contributed 30 DALYs. In contrast, a person who
is still alive but has spent their last 10 years at only ‘half health’ has contributed
five DALYs.
Table 2.6 Ten leading causes of burden of disease and injury for 10–19 year olds
in Australia, 2013
Condition DALYs % of total DALYs
DALYs are calculated by adding YLLs (years of life lost) and YLDs (years lost due
to disability), as shown in figure 2.21.
Diabetes mellitus
Acute respiratory infections
Musculoskeletal diseases
Table 2.7 Leading specific causes of Cardiovascular disease
burden of disease and injury (DALYs) Cancers
for 10–19 year olds, 2003 YLLs
Skin diseases
YLDs
Condition DALYs Nervous system and sense organ disorders
Anxiety and depression 51 100 Chronic respiratory disease
Asthma 15 583 Injuries
Road traffic accidents 8 106 Mental disorders
Migraine 6 517
0 10 20 30 40 50 60 70 80
Substance use disorders 6 274 DALYs (000s)
Schizophrenia 5 145
Figure 2.22 Burden (YLL, YLD and total DALYs) for the top 10 causes of DALYs for
Eating disorders 4 522 10–19 year olds, 2003
Suicide and Source: Adapted from AIHW data.
self-inflicted injuries 3 850
Anorexia nervosa 2 312
Up to this point, the broad categories of burden of disease for youth have been
Bulimia nervosa 2 211
examined. In table 2.7, specific causes of burden of disease for all youth (male and
Source: Adapted from AIHW data. female) are presented.
As well as affecting their development, genetics, hormones and body weight also
contribute to the health experienced by young people.
Genetics
Genetics have been explored in chapter 1 in relation to their impact on development
during youth, but they also play a role in health outcomes. Although genetics play
a significant role in determining the health of youth, it is worth remembering that
there are other factors that also play a role. For instance, a person with genes that
increase the likelihood of being overweight might exercise and eat healthy foods
and thereby maintain an ideal body weight.
Genetics determine the body structures that males and females have, which
dictates some forms of illnesses experienced by the different sexes. For example,
females do not have testicles and therefore cannot develop testicular cancer. For
males however, testicular cancer is one of the most common forms of cancer
among youth. Unlike females, males do not have a cervix and are therefore not at
risk of cervical cancer.
Genetic conditions are conditions caused by an abnormality in the genes. Such
conditions often occur at conception if there is an abnormality when the sperm
and egg fuse together. These conditions are referred to as genetic abnormalities
(or anomalies) and examples include Down syndrome (figure 2.23) and Turner
syndrome. Sometimes the genes for certain genetic conditions may already be
present in the mother or father and can be passed on to the children. These
conditions are called inherited conditions and examples include haemophilia and
muscular dystrophy. All genetic conditions can impact on the health of youth. The
condition may make the youth unable to participate in certain activities due to the
risk of injury or to be more susceptible to illness.
However high and prolonged levels of cortisol in the blood stream can contribute
to prolonged stress and impact on mental health. If cortisol levels remain high for a
period of time, it can contribute to a range of health conditions including reduced
immune system function which can increase the risk of infections and disease.
Hormones are responsible for sperm production in males and regulation of the
menstrual cycle in females. The regular fluctuations of hormones in females can
contribute to other aspects of health such as mood changes and abdominal pain.
Testosterone in males is thought to have an influence on their higher rates of risk-
taking and ultimately injury.
Polycystic Ovarian Syndrome, or PCOS, is a condition that occurs in females
with a hormonal imbalance. Too much insulin or testosterone or both is often
the cause of PCOS. PCOS is thought to affect 12 to 18 per cent of female youth.
Females who experience PCOS may also experience:
• Irregular menstrual cycles — menstruation may be less or more frequent due to
less frequent ovulation
• Amenorrhoea — some women with PCOS do not menstruate, in some cases for
many years
• Excessive hair growth and acne — possibly due to increased testosterone
• Mood changes — including anxiety and depression
• Obesity.
Medical assistance should be sought if an individual suspects PCOS, as a range
of treatment options are available.
As testosterone levels increase in both males and females during puberty,
oil glands in the skin of the face, neck, back, shoulders and chest grow bigger
and secrete more oil. Bacteria on the skin and blocked pores can result in acne,
which consists of mild to severe outbreaks of blackheads, pimples and cysts.
Acne is common among male and female youth although males often experience
more severe outbreaks and females may experience outbreaks at different times,
according to the hormonal activity of their menstrual cycle. Acne may lead to
scarring and can impact on mental health if self-esteem is affected. A range of
treatment options exist for youth experiencing acne and medical assistance should
be sought in severe cases.
Changes in hormone levels also contribute to increased perspiration (or sweating)
in youth. Although perspiration has no smell, it provides a breeding ground for
bacteria who feed off it. Acids are produced by the bacteria which contribute to
increased rates of body odour among youth. Body odour can impact on the social
and mental health of the youth if the condition goes untreated.
Increased levels of human growth hormone contribute to the increases in growth
experienced during puberty. This growth increases the size of body systems and
tissues including the cardiovascular, respiratory and musculoskeletal systems.
These changes generally increase endurance and strength which are aspects of
fitness (physical health).
Body weight
Maintaining a healthy body weight is beneficial for health. Body weight that does
not fall within the healthy range can have a number of effects on youth health.
Body mass index (BMI) is often used to make judgements on underweight, normal
weight, overweight and obesity. See page 25 for an explanation of BMI.
Genetics and hormones play a role in body weight, as do a range of other factors
such as food intake and levels of physical activity.
Being underweight can have a range of effects on the health of an individual if
they lack the nutrients required for optimal health. Physical health can be affected
in a number of ways including a weakened immune system, increasing the risk of
contracting diseases such as influenza. Anaemia may also occur if the nutrients
Health and development have a direct relationship with each other (figure 2.25). If
health is optimal, then development will generally be optimal as well. Conversely, if
either health or development is not optimal, it will generally affect the other in a
Development negative way.
Youth is a time of significant change and both health and development can be
impacted in a number of individual by these changes. The following examples
outline some impacts on health and individual human development that could
Health occur as a result of the interrelationships that exist between these two concepts.
A youth who is not experiencing good physical health may also experience lower
levels of social and mental health. Consider a youth who is suffering from influenza
(physical health). They may have to stay home, so they cannot socialise with their
Figure 2.25 Health and development friends (social health) and may also feel frustrated and upset about having to stay
have a direct relationship. at home (mental health). If they lose their appetite, they may not get the nutrients
they require from their diet, and this could affect the development of their
bones and muscles (physical development). The lack of social interaction could
affect the development of their communication skills (social development), and
missing school could mean they miss
learning key concepts (intellectual
Intellectual development). Their self-concept
Absence from school could could decrease as a result of missing
mean missing out on
learning key concepts out on various experiences and feeling
that they are no longer seen as a key
Emotional
part of their normal activities and
Self-concept could decrease groups (emotional development).
as a result of missing out on Conversely, consider a youth who
various experiences and not is experiencing good social health.
feeling part of a group
Possible impacts They will generally feel good about
on development themselves (positive self-esteem, which
Social
Lack of social interaction could
is mental health) and might be better
affect development of able to concentrate at school (impacting
communication skills on intellectual development) and take
the time to look after themselves
Physical physically (impacting on physical
A person May lose appetite and not get health).
suffering from nutrients
Radiorequired from diet,
influenza affecting development of
Similarly, a youth who has optimal
(physical health) bones and muscles intellectual development might be
better informed about what foods they
should eat. Their choice of diet could
Social affect their immune system (physical
May have to stay home, so
would not be able to socialise health) and the growth of their body
with friends systems (physical development). They
Possible impacts might not be anxious about their
on health grades at school and may therefore
Mental have positive mental health.
May feel frustrated and upset Examples of the possible effects
about having to stay home
on the health and development of a
youth suffering from glandular fever
Figure 2.26 Possible impacts on health and development as a result of suffering are summarised in table 2.8. It is
from influenza difficult to say exactly how health
Physical health The immune system may be weakened while the infection is fought, making the person more susceptible to
secondary infections. They may also be continually lethargic and generally feel unwell.
Social health They may be forced to take weeks off school and so will miss out on opportunities to socialise with friends.
However, they may get a lot of visitors, which could lead to interactions with people they would not normally
socialise with (e.g. aunts and uncles, family friends).
Mental health They may feel depressed at being bedridden and missing out on leisure activities such as sport, music and
socialising with friends.
Physical development Motor skills may be affected as the person misses out on opportunities for physical activity. Diet may be restricted,
so inadequate nutrients might be ingested with effects on various body systems (e.g. blood production).
Social development Social development might be halted as the person may not be socialising with anyone outside their family.
Conversely, they may develop some skills in communicating with older people (if extended family members visit,
as suggested in the ‘social health’ section of this table).
Emotional development They may experience sorrow and despair as a result of being indoors for an extended period of time. However,
they may learn how to effectively deal with these emotions by talking about their experiences to parents or
siblings.
Intellectual development They may miss out on extended periods of school time, thereby affecting the skills normally practised and learnt
at school. Their ability to concentrate may be minimised by lethargy.
TEST your knowledge Table 2.9 A summary table for analysing possible
effects on health and development
1 Explain the relationship between health and
development. Use examples in your explanation. Area of health/
development Possible impact
APPLY your knowledge Physical health
2 Sally, a year 9 student, is an only child who has Social health Has few friends at her new
always had good social health. She has always school. Spends her free time
been popular at school and had a wide network of at home with her mum and
friends, both male and female. That was until last dad when they are home.
month, when her dad was offered a promotion that Mental health
required her family to move to Germany almost Physical development
immediately. Sally is now attending a new school,
but language barriers and being the ‘new kid’ have Social development
prevented her from making many friends at this Emotional development
stage. Consequently, her social health has suffered.
Intellectual development
She has become rather withdrawn and just wants to
go back to her old school in Australia. 3 (a) Write your own case study about a person
Copy and complete table 2.9, listing the possible experiencing positive or negative health or
effects on Sally’s health and development of her development.
family’s move to Germany. (One has been done for (b) Get a partner to complete a table (like table 2.9)
you as an example.) outlining the possible effects on the other
areas of health and development, based on the
information in your case study.
4 How might the physical development that occurs
during the youth stage of the lifespan affect the
social and emotional development that individuals
experience?
120
100
Rate per 100 000
Males
80 Females
60
40
20
0
Figure 2.27 Injury death rate over
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
time for males and females
Source: GRIM books, AIHW, accessed 9 July 2009. Year
Using data provided in figure 2.27, a response to the task ‘Describe two trends
in the injury death rates as experienced by males and females’ might include the
following points.
• Death rates for males and females both decreased between 1980 and 2007.⓯
• Males experienced higher death rates due to injuries between 1980 and 2007. ⓯ Use information from the graph, such
as dates, to substantiate your answer.
• The death rate for males decreased more than the death rate for females due to
injuries between 1980 and 2007. The male death rate decreased by around 45 per ⓰ Using figures from the graph shows
100 000⓰ (approximately 95 per 100 000 in 1980 down to 50 per 100 000 in an ability to interpret the data and
2007). The death rate for females decreased by around 10 per 100 000 (down draw conclusions from it.
from around 30 per 100 000 in 1980 to around 20 per 100 000 in 2007).
3500 Females
3000
young people
2500
2000
1500
Figure 2.28 The rate
1000 of injury and poisoning
hospital separations for
500
young people aged 12–24,
0 2008–09
12–14 years 15–19 years 20–24 years Source: AIHW 2011, Young
Australians: their health and
Age group wellbeing 2011, p. 35.
(a) i. What was the approximate hospital separation rate for injuries and poisoning for males aged 15–17 in 2008–09?
ii. What was the approximate hospital separation rate for injuries and poisoning for females aged 15–17 in 2008–09?
(b) According to figure 2.28, what trend is evident in regard to the hospital separation rate for injuries and poisoning for
males as they age?
0 Figure 2.29 shows death rates for young people from 1980 to 2007.
1
Deaths per 100 000 young people
140
Male
120 Female
100 Persons
80
60
40 Figure 2.29 Death
rates for young
20 people aged 12–24,
1980–2007
0
Source: Adapted from
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 AIHW data.
Physical
Social
Mental
Consider the following example where the impact of hormonal changes on the
⓱ Specific hormones are identified and health of youth is discussed.
knowledge of their role in youth is
outlined. Human Growth Hormone is responsible for increasing the rate of growth
experienced during youth. Testosterone⓱ is responsible for increasing muscle mass
⓲ The dimension of health is identified. in males. Increased size and strength increases the ability of youth to exercise for
extended periods of time and also increases strength. As a result, fitness can
increase (physical health⓲). Increased fitness may enhance self-esteem which is an
aspect of mental health. Increased self-esteem may contribute to increased
⓳ Possible impacts on mental and social participation in social activities which enhances social health.⓳
health are identified.
dimensions of health and areas of development are addressed. Another aspect of this
skill is being able to explain how individual human development can impact on health
and vice versa. Discussing hypothetical case studies with a partner, or completing
tables like the one in table 2.9 (see page 63), can help with developing this skill.
Consider the following example:
Sarah is in year 11 and has just been diagnosed with leukaemia. She will spend
the next two months undergoing chemotherapy and as a result will miss a lot of
school.
A possible approach to a discussion of how Sarah’s condition may impact on her
development follows.
Sarah’s condition could impact on her development in the following ways: ⓴ Make reference to the type of
development being explained.
Physical development:⓴
She will miss out on school and sport, which may impact on her motor skill
development. While she is undergoing treatment, she may have a diminished An aspect of physical development
appetite, which may mean her bones do not develop to their full potential.
Social development:
As Sarah will be missing out on social activities, she may miss out on opportunities
to refine communication skills. She will have to communicate with health
An aspect of social development
professionals, however, and this may enhance her communication skills. She may
learn valuable relationship skills as a result of not getting to see her friends daily,
gaining an appreciation of their important role in her daily life. An aspect of emotional development
Emotional development:
Sarah will experience a range of emotions that most likely she will not have
experienced before. She may learn how to deal with and express these emotions An aspect of intellectual development
effectively.
Intellectual development:
All four dimensions of development
Sarah may learn skills to assist in improving her health. Knowledge relating to are covered. The discussion maintains
diet and exercise is an example of these skills. a focus on development.
4 marks
(b) Refer back to Anissah’s story on page 65 to complete the following question.
Suggest one way that each aspect of Anissah’s physical, social and mental
development could be affected by not getting into the school band.
3 marks
Chapter summary
• Health can be defined in a number of ways, but it is always seen as a state that can
change from day to day.
• Health has been defined in a number of ways and most definitions have their
advantages and disadvantages. The most common definition of health comes from the
World Health Organization (1946) and is:
‘a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity. ’
Blood pressure
Cholesterol Presence or
levels absence of disease
Physical
health Functioning of
Fitness
body systems
Health
Mental Social
State of
health health
Self-esteem relationships
with family
Figure 2.30 A summary of the dimensions of health and examples that relate to each one
• All three areas of health influence each other, and people may experience different
levels of health in all three dimensions at any one time.
• Health status is an overall statement of the level of health being experienced by an
individual, group or population.
• Australia’s youth generally experience excellent health status.
• Life expectancy, mortality, morbidity and burden of disease measures are all used to
assess health status.
• Life expectancy is how long a person can expect to live if current mortality rates
continue unchanged.
• For a male born in 2009, the life expectancy was 79 years and for a female it was
84 years.
• Life expectancy and death rates are continually improving for Australia’s youth.
Key skills
• explain the functions of major nutrients for the development of hard
tissue, soft tissue, blood tissue and energy during youth
• explain the possible consequences of nutritional imbalance in a youth’s
diet on short- and long-term health and individual human development
• explain how food models can be used as a tool to promote health.
When we eat, the foods are broken down in the process of digestion to release the
nutrients. These nutrients are then used by the body for many functions related
to health and development including the production of energy and blood and the
development of hard and soft tissues.
Some foods have more nutrients in them than others, and some have nutrients
that other foods may not have at all. The best way to maintain a balanced diet is
to eat a wide variety or many different types of foods (figure 3.2). There are six
categories of nutrients that are needed for optimal health and individual human
development.
They are:
• carbohydrates (including fibre)
• protein
• fats
• vitamins
• minerals
• water.
Carbohydrates, protein and fats are needed by the body in large amounts and are
Figure 3.2 Eating a range of foods often called macronutrients, while vitamins and minerals are called micronutrients
is the best way to ensure adequate because they are only needed in very small quantities. Regardless of the quantity
nutrition.
needed by the body, each nutrient has a different role to play and all are important
for health and individual development.
Carbohydrates
Interactivity: The main function of carbohydrates is to provide fuel for energy. As youth are growing
Time Out: ‘Food sources at a rapid rate, a lot of energy is required for metabolism and growth. Glucose is
of nutrients’ the preferred fuel for energy in the human body and carbohydrates are rich in
Searchlight ID: int-1423 glucose, and as a result should provide the majority of an individual’s energy needs.
Carbohydrates allow an individual to maintain high activity levels, which can
provide opportunities to develop motor skills and also the energy to concentrate at
school and therefore develop intellectually.
Carbohydrates are broken down and the glucose
molecules are absorbed into the bloodstream, from
where they are taken into the cells and stored, ready
for use. In terms of energy production, one gram of
carbohydrates will produce 16 kJ of energy.
Glucose (and therefore carbohydrates) that is not
used by the body is stored as adipose (or fat) tissue.
If a person eats too much carbohydrate, they can
gain weight because this increases the amount of
glucose stored as fat. This process can be reversed
if glucose is needed by the body.
Most carbohydrates are found in foods of plant
origin. Common examples are potatoes, rice, pasta,
most breakfast cereals and fruit (figure 3.3).
However, carbohydrates are also found in sugar
and foods containing added sugar such as soft
drinks, cordial, lollies and chocolate. These foods
contain few other nutrients besides carbohydrates
Figure 3.3 Pasta is a good source of so are not considered to be good food sources of
carbohydrates. this nutrient.
Protein
Protein has two main functions in the body. Its main function
(and probably the most important for youth development)
is to build, maintain and repair body cells. This includes
the cells required to build soft tissues such as muscles and
organs, hard tissue such as bone and the production of blood
tissue (figure 3.5). The second function of protein is to act as
a fuel for producing energy. If a person does not have enough
glucose (from carbohydrates) to use for energy production,
protein can be used as a secondary source of energy. In
times of starvation, muscle and other body cells may be
broken down so the protein contained within them can be
used for energy. Protein yields about 17 kJ per gram when
being used for energy. If eaten in excess, protein is stored
as adipose or fat tissue and can contribute to obesity in the
long term.
Protein is made up of smaller building blocks called amino
acids. There are 20 different types of amino acids that
humans need to function properly. Eleven of these, called Figure 3.5 Protein is a key component of all body tissues, like
the non-essential amino acids, can be synthesised (or made) these muscle fibres.
in the body from other amino acids. The other nine, called essential
Protein content of selected foods amino acids, cannot be synthesised in the body and must therefore be
of animal origin (g of protein consumed (figure 3.8). To ensure that all amino acids are being
per 100 g of food item)
consumed regularly, protein from a range of different sources should be
Beef eaten. Many people get much of their protein requirements from meat,
Pork which is often rich in essential amino acids. Vegetarians must ensure
Tuna they consume a large variety of non-meat protein sources to ensure that
Chicken (thigh)
Salmon
their nutritional needs are being met. These foods include nuts, beans,
Cheddar cheese lentils and tofu.
Lamb Some food sources are termed ‘complete proteins’ because they
Chicken breast contain all the essential amino acids in the quantities required for
Egg individual human development. They are usually found in vast amounts
Milk
in animal products (figure 3.6). Some proteins can also be found in
0 10 20 30 40 many foods of plant origin (figure 3.7). These are usually incomplete
g per 100 g proteins and need to be eaten with other protein sources to ensure that
Figure 3.6 The protein content of selected all required amino acids are consumed.
foods of animal origin
Figure 3.8 Proteins can be classified as essential and non-essential amino acids.
Fats
Fats (sometimes referred to as lipids) play a number of roles in youth health and
individual human development. Although fats are often associated with negative
effects on the body, they are required for adequate health and development
throughout the lifespan and are an essential part of a balanced food intake.
Like carbohydrates, the main function of fats is to act as a fuel for energy. Fats
are a richer source of energy than carbohydrates and protein, yielding 37 kJ per
gram. This is why foods packed with fat but little else are referred to as ‘energy
dense’ foods. How much fat to include in the diet should be determined by the
amount of energy required by the individual. Balance is the key here. Remember
that most of an individual’s energy should come from carbohydrates.
Fats are required for a number of other processes including the development and
maintenance of cell membranes. Cell membranes form an important component of
body cells and therefore blood and soft tissues. They are responsible for maintaining
the structure of cells and allowing the transport of nutrients, gases and waste into
Fats (lipids)
Omega-3 Omega-6
Protein 20%
Lipids 25%
Carbohydrates 55%
Monounsaturated
10%
Polyunsaturated
5%
Saturated 9%
Trans fats 1%
Figure 3.10 Macronutrients (with a breakdown of lipids), and the average percentage of
total energy intake each should make up (approximate values only)
Monounsaturated and
polyunsaturated fat
Monounsaturated and polyunsaturated fats are considered
the ‘good fats’. They carry out the necessary functions of
fats and also have some health benefits. The greatest health
and development gains for youth can be achieved by
replacing saturated and trans fats with monounsaturated
and polyunsaturated fats. This can help reduce the risk
of diet-related diseases later in life, such as heart disease.
Monounsaturated fats are liquid at room temperature
and begin to solidify if placed in the refrigerator. Foods
rich in monounsaturated fats include olive oil, avocado,
canola oil, nuts, and peanut butter. Because all fats contain
37 kJ of energy per gram, all will lead to weight gain and
the associated effects on health if eaten in excess.
Figure 3.11 Nuts are a great source There are two main categories of polyunsaturated fats:
of the ‘good’ fats.
omega-3 and omega-6. Polyunsaturated fats are generally
liquid at room temperature and when refrigerated. Food
sources for these fats include:
• omega-3 — fish (particularly oily fish such as mackerel,
trout, sardines, tuna and salmon), canola and soy oils,
and canola-based margarines
•
omega-6 — mainly nuts, seeds and oil made from
corn, safflower and soy.
Many people in Western countries consume too many
omega-6 fats which, like all fats, can increase the risk
of obesity and associated conditions including heart
disease.
Function
Functions
Fibre
Carbohydrates
Food sources
Food sources
Figure 3.14 Concept map summarising the functions and food sources of
carbohydrates (including fibre)
Water
Although it has no nutritional value, water is the most important nutrient for
human survival. Water makes up around 55 to 75 per cent of body mass and is
needed for numerous functions within the body, including:
• as a medium for all chemical reactions required to provide energy and produce
soft tissue
• as a key component of many cells, tissues and systems
• as a key component of blood.
Being adequately hydrated allows chemical reactions in the body to occur
effectively, which is important for periods of rapid development such as the youth
stage of the lifespan. Sufficient water intake allows the body’s systems to function
adequately and the body as a whole to function properly. This means an individual
can effectively go about their day-to-day activities. Water intake can also assist in
weight maintenance as it helps to reduce hunger while contributing no kilojoules
or energy. When dehydrated, a person will often lack alertness and the ability to
concentrate. They may not have the energy to participate in physical activities,
which can impact on motor skill development. They may not be able to concentrate
at school, which can directly impact on intellectual development.
All foods have some water content (figure 3.15) and contribute to total water
intake, as do fluids such as milk. Water should also be consumed in its pure form
(i.e. from the tap or in bottled form) to meet hydration needs. Although they
contain a large percentage of water, softdrinks and sports drinks often contain high
amounts of sugar and other additives, so their consumption should be limited.
Figure 3.15 Foods such as fruits and vegetables have a high water content,
but water should also be consumed in its pure form.
Calcium
Calcium is one of the key nutrients required for the building of bone and other
hard tissues (such as teeth and cartilage) and is therefore extremely important
during periods of rapid growth such as during youth.
Men
Women
Bone mass
20 40 60 80 100
Figure 3.16 Changes in bone mass
Age (in years) with age
Case study
Strong bones key to health Illawarra, is telling her daughter’s story in the hope
it will help arrest a worrying trend towards poor
By Angela Thompson nutrition among a body image-conscious generation of
When Tracy Spark’s daughter shed 15 kilograms in adolescent girls.
four months her mother knew something was drasti- According to Wollongong nutritionist Anita
cally wrong. Needham, those who fail to achieve peak bone
The teenager’s school results had gone downhill mass during adolescence are more likely to develop
because she couldn’t concentrate, her hair had begun to osteoporosis.
fall out and she was icy to touch. ‘While we’re young it’s good to stockpile the calcium
The physical effects of anorexia were shocking, but we get from dairy products so that you offset the effect
it was only when routine blood tests were carried out of ageing on bone loss and therefore you reduce the
during treatment that Ms Spark learnt the full horror risk of osteoporosis,’ she said.
of what was happening to her daughter, then 14, on the ‘Unfortunately many people exclude dairy foods
inside. when trying to lose weight, and in doing so miss out
Tests showed the girl’s bones were being leached on valuable sources of calcium and other essential
of calcium to feed a body deprived of the essential nutrients.’
mineral. ‘Recent clinical studies show that including three
‘At a time when she should have been laying down
dairy serves in a weight-reducing diet may in fact result
calcium in her bones for later on, her body was actually
in more weight and body fat loss,’ she said.
taking calcium out of her bones to survive,’ Ms Spark
At the Sparks household, it was a lesson learnt the
said.
‘I work in the field and I was lost. I assumed eating hard way.
disorders were an issue when you became skeletal. ‘She does focus on eating healthily now,’ Ms Sparks
I didn’t realise people get very ill a long time before said of her daughter, who did not want to be named.
they get to that stage.’ ‘I’m a big believer in your body knowing what it
On the eve of National Healthy Bones Week, Ms needs and she absolutely adores dairy food.’
Spark, now a nutrition coordinator for Healthy Cities Source: Illawarra Mercury, 2 August 2008.
Iron
Iron is an essential part of blood. As blood volume increases during youth, iron is
needed in greater quantities (figure 3.18).
Iron forms the ‘haem’ part of haemoglobin, which is the oxygen-carrying part of
blood. A person who does not get enough iron may develop anaemia, a condition
characterised by tiredness and weakness. Individuals with anaemia struggle to
generate enough energy to complete daily tasks such as school work, sport and
socialising.
Red meat is a rich source of iron but it often contains high levels of saturated
fat. As a result, leans cuts of meat should be chosen and iron should also be gained
Case study
(continued)
• blood loss — due to injury, surgery, cancer, stomach How is anaemia treated?
ulcers, heavy periods or giving blood frequently Treatment for anaemia depends on the severity and the
• rapid growth or times during which large amounts cause of the condition. In any case, the cause must be
of energy are required — such as puberty or while addressed in addition to treating the symptoms.
pregnant. Vitamin and mineral supplements may be required
in the case of dietary deficiency. Iron injections may
What are the symptoms of anaemia?
be required if iron levels are particularly low. Note
Depending on the severity, the symptoms of anaemia that iron supplements should be used only under the
can include: direction of a doctor. The human body does not excrete
• pale skin iron efficiently, which can contribute to iron poisoning
• tiredness if the dose is not monitored.
• weakness
• shortness of breath How can anaemia be prevented?
• blood pressure drops on standing up suddenly — Anaemia caused by deficiencies in dietary intake can
sometimes caused by blood loss, such as during a be prevented by making sure that certain foods are con-
heavy menstrual period sumed on a regular basis, including lean meats, nuts and
• headaches legumes, fruit and vegetables and dairy products. Those
• fast pulse who do not consume any animal products (known as
• irritability vegans) may have to increase their intake with fortified
• difficulty concentrating foods or vitamin and mineral supplements.
• cracks or redness of the tongue Anaemia caused by an underlying health condition
• appetite loss may not be able to be prevented as it is caused by a fault
• strange food cravings (including the desire to eat dirt in the cell-making process. Treatments are available to
or rice, a condition known as pica). relieve the symptoms in these cases.
Source: Adapted from www.betterhealth.vic.gov.au.
TEST your knowledge (a) Identify two trends evident in the graph.
(b) Use the graph to help you explain a possible
1 (a) List three functions of water.
difference in health outcomes between males
(b) Why would it be a good idea to replace most
and females in older age.
drinks with plain water?
2 Why is calcium required in the body?
3 (a) List three foods that contain high levels of
APPLY your knowledge
calcium. 7 Explain how being dehydrated could affect the four
(b) Even though spinach has a lot of calcium, it is dimensions of development in youth.
not considered the best food source of dietary 8 List the likely symptoms of not getting enough
calcium. Explain why this is so. calcium.
4 Describe the role of iron in the body. 9 Which other stages of the lifespan would require
5 Why is iron required in greater amounts during the higher rates of:
youth stage of the lifespan? (a) calcium?
6 Refer to figure 3.16. (b) iron?
Vitamin A
Vitamin A is required for cell division and is therefore an important aspect of any
growth that occurs in the body. There are many aspects of physical development Interactivity:
that involve growth during the youth stage of the lifespan, so requirements for Time Out: ‘Vitamins and folate’
vitamin A increase at this time. Skin, muscle, organ, bone and blood cells all divide Searchlight ID: int-1425
Vitamin D
The main role of vitamin D is in the absorption of calcium from the intestine
into the bloodstream. Lack of vitamin D can lead to low levels of calcium being
absorbed and bones becoming weak. Fish (e.g. tuna, salmon, mackerel, sardines
and herring) is the best source of food-based vitamin D. Fortified milk, breakfast
cereals and orange juice can also contain vitamin D, but it is important to check
the packaging.
Most Australians get enough vitamin D from exposure to sunlight (figure 3.20),
during which UV rays are converted to vitamin D in the skin. However, there is
growing evidence to suggest that some groups in Australia are deficient in vitamin D
because they rarely go out into the sun. Youth with dark skin or those who always
cover up when outdoors can become deficient in vitamin D. While moderate
exposure without any degree of sunburn is healthy, excessive exposure leading to
sunburn is a major risk factor for skin cancer and should always be avoided.
Vitamin C
Vitamin C is important for the structure of tissues within the body and is required
for building collagen. Collagen is a protein that is required for the formation of
skin, scar tissue, connective tissue, bone, tendons, ligaments, and blood vessels
(figure 3.21). In this role, vitamin C allows the other components of tissues to be
held together.
Vitamin C is important in promoting the absorption of iron and is therefore an
important nutrient in the production of blood.
Humans can neither make their own vitamin C in the body nor store it effectively
Figure 3.20 Most Australians get (as other animals can do). Therefore, a daily intake of vitamin C is important for
enough vitamin D from exposure to normal individual human development and functioning.
sunlight, but those with restricted Vitamin C is found in many fruits and vegetables including kiwi fruit, broccoli,
access to sunlight might be deficient. blackcurrants, oranges and strawberries. It is easily destroyed when exposed to
heat and air, so fresh fruit and vegetables provide the best source of vitamin C.
B-group vitamins
Vitamins B1, B2 and B3
The B-group vitamins include vitamins B1, B2 and B3 (also known
as thiamine, riboflavin and niacin respectively). These vitamins
are essential in the process of metabolising or converting the fuels
(carbohydrates, fats and protein) into energy.
A lack of these nutrients can lead to a lack of energy. As energy is
essential for growth, a lack of the B-group vitamins can contribute
to slowed growth of hard and soft tissues.
Rich sources of the B-group vitamins include Vegemite,
wholegrain cereals and breads, eggs, meats, fish, dark-green leafy
vegetables and milk. The B-group vitamins are very delicate and
Figure 3.21 Collagen is a key component easily destroyed through cooking and processing. Getting enough of
of these tendons. these vitamins from whole grains and unrefined sources is the best
way to ensure that the recommended intake is met.
Vitamin B12
Vitamin B12 is another B-group vitamin that is required for adequate development
during youth. Although it has a number of roles in the body, its main function
during the youth stage is for the formation of red blood cells. It works with folate in
this capacity, ensuring the red blood cells are not only the correct size but also the
correct shape to enable oxygen to be transported throughout the body. A deficiency
of vitamin B12 can increase the chance of becoming anaemic. Having this condition
can prevent youths from participating in normal activities and therefore have a
wide range of effects on their development.
Most foods of animal origin contain some vitamin B12 but particularly good
sources include meat, eggs and cheese. Because vitamin B12 is found only in food
sources of animal origin, vegans are at particular risk of being deficient in this
vitamin.
KEY CONCEPT The function of major nutrients for the development of hard
tissue, soft tissue, blood tissue and energy
Although all the key nutrients have their specific functions, they must work
together or interrelate to carry out four major processes in the body:
1. provision of energy
2. production of blood
3. formation of soft tissue
4. formation of hard tissue.
Each nutrient is like a piece of the puzzle, so although its role may be minor in
the process, without it, the process cannot be carried out effectively. The four major
processes and the nutrients required for each will be explored in more detail in the
following section.
Provision of energy
Energy is required in all cells so they can carry out their functions. Cells without
energy — like cells without oxygen — will die. As well as being needed for physical
activity, energy is essential to sustain life and keep body systems functioning
adequately. The amount of energy needed to sustain life (i.e. to keep the major
organs functioning) is known as the basal metabolic rate (BMR).
About 70 per cent of an individual’s total energy expenditure is devoted to BMR
requirements. The other 30 per cent is needed for physical activity and digestion.
A number of factors influence BMR. They include:
• age — BMR generally decreases with age, mainly due to lower muscle mass.
The effect of ageing decreases BMR by about 2 per cent per decade after the
age of 20.
• growth — individuals undergoing growth (such as in youth) require more energy
to build tissues and increase blood volume.
• body size — larger people have a higher BMR as they have more cells which in
turn require more energy to maintain their function.
• body type — muscle requires a higher BMR than fat as muscle cells are more
active and therefore require more energy to maintain their function.
• dieting — can cause the body to conserve energy. This lowers the BMR.
• sex — males tend to have a higher BMR. The higher muscle mass in most males
contributes to this difference.
Table 3.1 The energy used in selected • environmental temperature — the body has to work harder to maintain
activities (kJ per kg per hour) temperature in hot or cold environments, therefore raising the BMR.
Energy
In Australia, energy is measured in kilojoules (kJ). A kilojoule contains one
Activity (kJ/kg/h) thousand joules. The exact meaning of a joule is quite technical but some examples
of how much energy is used in specific activities will help put it into perspective.
Sitting quietly 1.7
The approximate amount of energy used in certain activities is shown in table 3.1.
Writing 1.7
As the energy required for physical activity only makes up a fraction of a person’s
Standing relaxed 2.1 total energy requirement, it is useful to look at total energy requirements. The
Driving a car 3.8 approximate total energy requirement per day (kJ) based on an individual with
Vacuuming 11.3 moderate physical activity levels is shown in table 3.2.
Walking rapidly 14.2 The amount of energy contained in food is also measured in kilojoules. This
Running 29.3
makes it easier to compare energy intake with energy output. The amount of energy
contained in certain foods is shown in table 3.3. If more energy is consumed than
Swimming (4 km/hour) 33.0
is needed for metabolism, digestion or physical activity, it is stored as fat and
Rowing in a race 67.0 contributes to weight gain. If more energy is used than is consumed, the individual
Source: Better Health Channel, www.
will lose weight. In either case, health and individual human development are
betterhealth.vic.gov.au. affected.
Blood needs to be produced on a constant basis and even more so Domino’s Supreme Deep Pan Pizza 835
(1 slice)
when growth is occurring at a rapid rate. As youths are in a period
of rapid growth, their need for the nutrients required for blood McDonald’s Big Mac 2060
production increase significantly. Blood is made up of three main Hungry Jack’s Whopper Cheese 3184
components: KFC nuggets (6 pieces) 1090
• plasma — makes up approximately 55 per cent of blood and Subway (six inch sub, roasted chicken) 1240
contains clotting material and transports nutrients, gases, Drinks
hormones and waste
Cola softdrink (375 mL) 655
• red blood cells — make up around 44 per cent of blood and
contain haemoglobin, which carries oxygen, carbon dioxide and Apple juice (125 mL) 210
Carbohydrates,
lipids and protein
Are the fuel for
energy
B-group vitamins
Allow the release
of energy
Iron
Forms a part of
haemoglobin, essential
for carrying oxygen
around the body
Water
Transports the
B-group vitamins and
is also required for
chemical reactions
to take place
around 33 per cent of the weight of red blood cells and is responsible for carrying
oxygen around the body.
Vitamin C plays a number of roles in blood formation. It helps in the absorption
of iron from plant sources, making more iron available for haemoglobin production.
It is also important in the formation of healthy blood cells. Red blood cells live
for only 100 to 120 days and therefore require constant regeneration. The human
body produces around two million new red blood cells per second. In order for this
volume of red blood cells to be produced, cell division must occur at a rapid rate.
Vitamin A is essential for cell division and is therefore required for this process.
When a cell divides, the DNA must be replicated so each cell has a complete
set of DNA. Although a mature red blood cell does not contain DNA (as it has
no nucleus), immature blood cells do contain DNA. Folate and vitamin B12 are
required for DNA synthesis and so are vital for red blood cell development. Water
is the main component of blood plasma and many of the chemical reactions that
produce the components of blood need water.
The nutrients required for the production of blood are outlined in figure 3.24.
Lipids
Required for the
formation
of cell membranes
Plasma
55%
Vitamin A
Required for cell division
Red
blood cells
44%
Iron
Required for ‘haem’
part of haemoglobin
production
White
blood cells
1%
Protein
Main building material
Folate
Promotes cell
division and tissue
growth
Vitamin C
Forms connective tissue
Muscles
Lipids
Maintains and develops
cell membranes
Organs Tendons
Vitamin A
Required for cell division
Water
Medium for chemical Ligaments Skin
reactions and present in
soft tissue cells
Figure 3.25 The nutrients required
for soft tissue formation
Protein
Main building material
Vitamin C
Forms connective tissue
Vitamin A
Required for cell division
Calcium
Hardening material of
hard tissues
Vitamin D
Required for the absorption
of calcium
Youth is the third-fastest period of growth in the lifespan. During the adolescent
growth spurt, the average female youth can expect to grow 16 centimetres in height
and gain 16 kilograms in weight, and the average male youth can expect to grow
20 centimetres and put on 20 kilograms in weight. For this physical development
to occur, all of the nutrients required for the four processes — soft and hard tissue
formation and the production of energy and blood — must be eaten in appropriate
proportions. When nutrient intake is balanced, appropriate levels of nutrients
are available to carry out these processes effectively and the development of youth
is optimised.
The importance of food intake during youth is not limited to ensuring that
optimal individual human development occurs. Balanced nutrient intake also plays
a significant impact in promoting the health of youth.
If the nutritional intake of youth is not balanced and nutrients are not consumed
in appropriate proportions, the risk of a range of consequences for health and
individual human development increases. These consequences can occur as a result
of the over- or under-consumption of specific nutrients and can occur in both the
short and long term.
Short-term consequences
The consumption of a variety of nutrients is required regularly to carry out various
processes including the production of energy. If these nutrients are not present, or
are in incorrect proportions, these processes may not occur effectively.
Carbohydrates are broken down and the glucose molecules that result are
absorbed into the bloodstream, from where they are taken into the cells and stored,
ready for use. The amount of glucose contained within carbohydrate-rich foods,
and how much such foods affect the levels of blood glucose, is
measured using a system called the glycaemic index (GI). The High GI
Blood glucose level
glycaemic index rates foods from 1 to 100 based on how quickly Low Gl
they cause blood-glucose levels to rise. Foods that cause blood
glucose to increase sharply are called high GI (with a score of
more than 70) while those that have a more sustained impact on
blood glucose are called low GI (with a score less than 55). Those
in-between these numbers are termed medium GI. Eating foods
with a low GI rating gives a more sustained energy release and can
therefore assist in carrying out the biological processes required 0 1 2 3
during the day. In contrast, high GI foods give a quick rush of Time after meal (hours)
glucose that then drops off just as quickly (figure 3.27). As blood
glucose levels decrease, hunger increases. As a result, high GI Figure 3.27 The effect on blood glucose of high and low
GI foods
foods can contribute to overeating.
In addition to carbohydrates, B-group vitamins and iron also contribute to the
production of energy. If these nutrients are not consumed on a regular basis, energy
levels may decrease, impacting physical health. Reduced energy levels also impact
on an individual in many ways such as not having the energy to:
• socialise — which impacts social health
• exercise — affecting fitness, an aspect of physical health
• concentrate at school — affecting intellectual development.
Fibre is a type of carbohydrate made up of the indigestible parts of plant matter.
Fibre assists in regulating bowel movements and providing feelings of fullness.
Adequate fibre intake can reduce the risk of constipation and overeating in the
short term. Fibre also reduces the absorption of glucose and cholesterol into the
blood stream. This acts to decrease blood glucose and blood cholesterol levels in
the short term.
Water is essential for the optimal functioning of body systems throughout the
lifespan. Dehydration can affect many processes within the body and contribute
to a range of short-term impacts as a result. Common symptoms of dehydration
include thirst, dry mouth, headaches, decreased blood pressure, dizziness, fainting,
tiredness and constipation. In the most severe cases, dehydration can lead to
unconsciousness and death.
Long-term consequences
As well as contributing to short-term consequences, nutrient imbalance is associated
with many long-term consequences impacting on health and development,
including dental caries; underweight, overweight and obesity; chronic conditions
such as cardiovascular disease, colorectal cancer and osteoporosis; slowed growth;
anaemia; and increased risk of infection.
Sugars are a type of carbohydrate found naturally in some foods such as fruit
and honey, and added to many processed foods such as cakes and soft drinks.
As well as providing a fuel for energy production, sugars provide a food source
for bacteria in the mouth. These bacteria produce acids which can contribute to
dental decay and the development of dental caries. Dental caries can impact mental
health as a result of reduced self-esteem if the individual’s appearance is altered.
Intellectual development may also be affected if the individual misses school as
a result of ongoing treatment. If left untreated, diseases such as periodontitis can
occur. Periodontitis is a condition characterised by inflammation and infection of
the tissues that support the teeth. In the long term, periodontitis can lead to the
loosening and loss of teeth.
Although required as a fuel for energy production, if eaten in excess,
carbohydrates, fats and protein are stored as adipose (fat) tissue. Over time, this can
lead to weight gain, overweight and/or obesity. The most immediate consequences
of overweight and obesity in youth are social discrimination (associated with poor
self-esteem and depression), negative body image and eating disorders. Overweight
youth are more likely to develop sleep apnoea, have a reduced ability to exercise,
30
Obese
Overweight
25
20
Per cent
15
10
0
1985 1995 2007* 1985 1995 2007*
Males Females
* Figures are for 9–16 years
Figure 3.29 Prevalence of overweight and obesity among males and females aged
7–15 years, 1985, 1995 and 2007
Source: Adapted from Australian Institute of Health and Welfare 2004, Risk factor monitoring, a rising epidemic: obesity in
Australian children and adolescents and Australian National Children’s Nutrition and Physical Activity Survey 2007.
bone mass is not reached until early adulthood, bone density increases significantly
during youth. Calcium, phosphorus and vitamin D are all essential nutrients for
this process. If intake is deficient in these nutrients, weakened bones may be the
result. In many cases, this will develop into osteoporosis later in life.
Soft tissues are constantly repaired and replaced, and nutritional balance is
needed to ensure the nutrients required to carry out this process are present in
appropriate levels. Protein, vitamin C, vitamin A, folate, fats and water are all
required for the growth and repair of soft tissues. Without adequate amounts of
these nutrients, muscles and organs may not develop to their full potential.
As blood cells are produced constantly, adequate intake of the nutrients required
to make blood, such as iron, folate and vitamin B12, are required to ensure the
amount of blood produced meets the needs of the growing youth. Vitamin C is also
important as it assists with iron absorption. If these nutrients are under-consumed,
anaemia can occur. Anaemia is characterised by an inability of the blood to carry
adequate oxygen around the body. Symptoms of anaemia include tiredness and
weakness, so the youth might no longer be able to participate in daily activities.
Anaemia may affect development by creating:
• an inability to participate in the weight-bearing activities that are needed to
increase bone density, which can result in reduced bone mass
• an inability to participate in physical activity, which can impair motor skill
development
• insufficient energy to have a part-time job, which can affect social development
such as learning the role of an employee
• constant feelings of tiredness, which may generate a range of negative emotions
such as helplessness and isolation.
As well as providing energy and aiding in the formation of hard tissue, soft tissue
and blood, nutrients are required to keep all bodily systems functioning correctly.
The immune system, for example, requires a nutritional balance to function
effectively. Protein and vitamin A are key nutrients in immune system function. If a
person is deficient in protein or vitamin A, their immune system may not function
correctly, increasing the risk of disease or infection.
To assist youth in consuming a balanced diet and reducing the risk of short- and
long-term consequences associated with nutritional imbalance, a number of food
selection models have been produced. Food selection models are tools that help
youth to select foods that will meet their nutritional needs, without consuming
too many energy dense foods. Examples include the Australian Guide to Healthy
Eating and the Healthy Living Pyramid.
Table 3.4 Australian Dietary Guidelines recommended serves from the five food groups for 12–18 year olds
Note: Additional amounts of the Five Food Groups or unsaturated spreads and oils or discretionary food choices are needed only by people who are taller or more active to
meet additional energy requirements.
Unsaturated
spreads and Fats play an important part in many processes such as the development of cell
Age (years) oils per day membranes, fuel for energy production and regulation of cholesterol. Unsaturated
Boys 12–13 1½ fats are the healthiest options and should be included in the food intake of
14–18 2
youth. The Australian Dietary Guidelines recommend the following amounts of
unsaturated fats for youth.
Girls 12–13 1½
Food items counting as ‘one serve’ of unsaturated fats are shown below:
14–18 2
Unsaturated spreads and 10 g polyunsaturated spread
Pregnant (up 2 oils per day
to 18 years) 10 g monounsaturated spread
Breastfeeding 2 7 g polyunsaturated oil,
10 g tree nuts, peanuts or nut pastes/butters
(up to 18 years) e.g. olive or canola oil
100
UNIT 1 • The health and development of Australia’s youth
Discretionary foods are food and drinks not necessary to provide the
nutrients the body needs, but which add variety. However, many of these are
high in saturated fats, sugars, salt and/or alcohol, and are therefore described as
energy dense. The Australian Guide to Healthy Eating and the Australian Dietary
Guidelines encourage youth to consume these foods only sometimes, and in small
amounts.
With the information provided by the Australian Guide to Healthy Eating
Healthy Eating Pyramid and the Australian Dietary Guidelines, it is possible to
evaluate the daily food intake of an individual.
1 banana
These foods can be broken down into their parts in order to classify them into
the five food groups. Creating a table like table 3.8 can be useful for doing this.
Refer to table 3.5 to see how many serves are present in each food item. For
example, the bowl of wheat cereal with milk would contribute two serves to the
‘grain’ group and one serve to the ‘milk’ group. Including a column for unsaturated
fats and discretionary food items is important as, even though these foods are
not considered a food group, they can have significant impacts on health. The
breakdown for Scott’s 24-hour food intake is shown in table 3.8.
Instead of having to write each food in the table (as was done in table 3.8),
ticks or marks can be placed under each food group as you go through each item
consumed (as shown in table 3.9).
Table 3.8 Scott’s food consumption, broken down into the five food groups
1 salad from orange wheat flake cereal small can of tuna full-cream milk from margarine soft drink
roll juice cereal from toast
2 mashed orange wheat flake cereal roast meat cheese slices from margarine vanilla slice
potato juice toast from toast
3 peas banana toast roast meat (1/2 serve) yoghurt margarine chocolate
from bread topping
4 carrots apple toast full-cream milk from margarine
milkshake from bread
5 pineapple roll from lunch full-cream milk from
juice milkshake
6 pineapple roll from lunch full-cream milk from
juice milkshake
7 fruit pasta
salad
8 pasta
9 pasta
10 bread from dinner
11 bread from dinner
Total
4 7 11 2½ 6 4 3
serves
Table 3.9
In order to do this accurately, you need to know how much of each food group
was in each item. If no amounts are given, you can base your judgements on what
an average serve might be (but some accuracy will be sacrificed). You may be able
to do this more accurately for foods that you have eaten yourself.
Once the number of serves from each group has been estimated, they can be
compared with the recommendations for someone of Scott’s age (males, 14–18,
from table 3.4).
Table 3.10 Scott’s intake compared to the recommended intake
Males
5½ 2 7 2½ 3½ 2 ‘Limit intake’
14–18
Scott’s
4 7 11 2½ 6 4 3
intake
Although Scott’s diet is varied, he may be consuming too many of some food
groups. Some specific observations include:
• he ate adequate amounts from the meat group
• he consumed only 4 serves of vegetables and should be consuming 5½
Salt is a rich source of sodium, and although sodium is an essential nutrient, many
Due to the release of the Australians consume excess amounts, which can contribute to hypertension.
Australian Dietary Guidelines
in 2013, the Healthy Living The Healthy Eating Pyramid for Lacto–ovo Vegetarians
Pyramid is being updated. To The Healthy Eating Pyramid for Lacto–ovo Vegetarians is similar to the Healthy
check the progress of this Living pyramid but contains only meat-free foods. The major difference between
update, check the Healthy these two pyramids is in the ‘eat moderately’ layer. This layer contains dairy
Living Pyramid products and tofu in the lacto–ovo vegetarian pyramid. Tofu contains relatively
weblink in your high levels of protein and iron, and is a good substitute for meat.
eBookPLUS. The Health Living Pyramid and Healthy Eating Pyramid for Lacto–ovo
Vegetarians provide youth with a simple visual tool that promotes healthy food
intake. However, serving sizes and provisions for composite foods, such as pizza or
casserole, are not included, which may make following the model difficult.
TEST your knowledge (c) i. Of which food groups did Dallas consume the
optimal amount?
1 Explain what is meant by a ‘food selection model’.
ii. Explain how consuming an optimal amount of
2 Identify two food selection models that can be used
these foods might promote Dallas’ health.
by youth to promote health and individual human
(d) i. Which food groups did Dallas not consume
development.
enough of?
ii. Explain how not consuming enough of these
APPLY your knowledge foods might affect Dallas’ health.
3 Explain the difference between the Australian Guide (e) i. Of which food groups did Dallas consume too
to Healthy Eating and the Healthy Living Pyramid. much?
4 (a) Identify the five food groups identified in the ii. Explain how consuming too much of these
Australian Guide to Healthy Eating. foods might affect Dallas’ health.
(b) Identify the key nutrients provided by each group. (f) Why might it be more accurate to assess food
(c) Explain how these nutrients can impact on youth intake over three days instead of only one?
health and development. (g) Explain the changes Dallas could make to her
5 Outline the short- and long-term consequences that diet to more closely reflect the recommendations
may occur for Scott if he continues consuming the of the Australian Guide to Healthy Eating and
foods shown in table 3.7 on a daily basis. the Australian Dietary Guidelines.
6 Consider the following food intake of Dallas, a 7 Record your own food and drink intake over a
13-year-old female. 24-hour period.
Breakfast: (a) Estimate the number of serves consumed from
2 pieces of toast with 10 g of monounsaturated each food group using a similar method to that
margarine outlined in table 3.8.
1 cup of orange juice (b) Prepare an analysis of your intake. Be sure to
Snack: include the following:
1 small carton of yoghurt (200 g) i. Identify food groups where intake was
3 tablespoons of sultanas adequate.
Lunch: ii. Identify food groups where consumption was
A toasted sandwich (2 pieces of bread, 2 slices of deficient.
cheese, 10 g of monounsaturated margarine) iii. Identify food groups where consumption was
1 can of soft drink excessive.
Snack: iv. Discuss the possible short- and long-term
1 banana consequences of your diet if it continued over
1 glass of water time.
Dinner: v. Suggest changes that could be made to
½ cup of cooked rice with 65 g of cooked beef, minimise the risk of any short- or long-term
1 cup of cooked vegetables and 7 g of olive oil consequences identified in part iv.
1 cup of fruit salad (c) i. Discuss any difficulties you had in classifying
(a) Complete a table similar to table 3.8 for Dallas’ each food item.
food intake. ii. Explain how these challenges could be
(b) Compare Dallas’ intake to the guidelines given overcome.
in tables 3.4 to 3.6.
In the following example, the nutrients required to produce bone (a hard tissue)
and the role each plays are outlined:
Protein❶: the main building material for hard tissue. Protein binds with vitamin C
❶ The nutrient is named.
to produce the collagen matrix, the outline for hard tissues.❷
Vitamin C: binds with protein to form the collagen matrix.
Vitamin A: assists in the division of the new cells needed by both the collagen ❷ The function of the nutrient
matrix and the hardening materials. is outlined and its role in the
Calcium and phosphorus: bind together to form calcium phosphate, the hard development of hard tissue is
identified.
ening material for bones.
Vitamin D: assists in the absorption of calcium in the small intestine. A lack of
❸ The roles of a range of nutrients
this vitamin can result in weak bones.❸ required for hard tissue development
are discussed.
fuel for energy) could make an individual feel tired (physical health). Feeling tired
can have other implications for health and development, such as not wanting to
go to school (intellectual development and social health could be affected by this).
Long-term consequences can occur in all areas of health and development, as
a result of nutritional imbalance over an extended period of time. The role the
nutrients play in these consequences must be understood. A summary table can
be useful for brainstorming the possible short- and long-term consequences of
nutrient imbalance.
Possible short- and long-term
consequences of under- Possible short- and long-term
Nutrient consumption consequences of over-consumption
Consider the following example, which discusses the possible short- and long-
term consequences on the health and development of youth who consume a diet
high in fibre.
Fibre assists in the removal of waste products in the digestive tract and promotes
regular bowel movements. In the short term❹, this can prevent constipation
❹ Short-term consequences are
addressed. (physical health). If an individual is not constipated, they may be able to concentrate
better at school, which can enhance intellectual development.❺
❺ Possible consequences for Fibre is made up of the indigestible parts of plant matter. As a result, fibre
development are included. provides feelings of fullness without adding excess kilojoules. In the short term,
this can prevent overeating. In the long term❻, this can assist with weight
❻ Long-term consequences are also management and prevent the risk of overweight and obesity. Decreased risk of
included.
obesity can enhance self-esteem (mental health). Individuals of optimal body
❼ Consequences on different areas weight may be more able to exercise and promote fitness (physical health) and
of health and development are motor skill development (physical development). Fibre has also been shown to
explored. decrease the risk of colorectal cancer in the long term (physical health).❼
from takeaway outlets on his way home from football training. Simon is unsure
whether he is consuming all the foods he should be to provide the nutrients he
needs to maintain optimal health and development’. To discuss a possible solution
to Simon’s eating challenges, one approach might be to identify a food selection
model, describe it, and then discuss how it could be used to assist Simon in
consuming a healthy food intake.
An initiative established to promote healthy eating is the Australian Guide to
Healthy Eating.❽ The Australian Guide to Healthy Eating is a food selection model
❽ The initiative is identified.
devised by the Federal Government. It is comprised of a poster that breaks the five
food groups into the proportions in which they should be consumed on a daily
basis.
The largest section of the graph, and therefore the food group that should be
consumed in the greatest proportion, is the grain group. This includes food items
such as cereals, breads and rice. Around a third of all foods should come from this
group.
The next section is the vegetables and legumes/beans group. Around a third of
all foods should come from this group.
The third group is the lean meats and poultry, fish and eggs. Around one-seventh
of all foods should come from this group.
The fruit group and dairy products such as milk, yoghurt and cheese are the
final two food groups. Each of these should account for around one-eighth of all
foods consumed.
The guide recommends drinking plenty of water, using only small amounts of
healthy fats such as canola and olive oils, and limiting discretionary foods such as
those containing alcohol or high levels of saturated fat, salt and/or sugar.❾
❾ The food selection model is explained
The Australian Guide to Healthy Eating can assist Simon in adopting a healthy in greater detail.
diet, but some of his circumstances may reduce his ability to follow it closely. The
guide is in graphical form, which might make it easier for Simon to understand it
and make changes to his diet.❿ The Australian Guide to Healthy Eating does not
❿ Key aspects of the Australian Guide
include serving sizes, which might make it hard for Simon to consume adequate to Healthy Eating are included. It is
amounts from each food group.⓫ He would have to consult the Australian Dietary important to avoid being too general
Guidelines to access this information. As Simon purchases a lot of his foods, he and to provide examples specific to
Simon where possible.
will have to learn to break composite foods down into their parts so he can classify
them into one of the five food groups. He may be able to do this by keeping a food ⓫ Aspects of the model that may limit
diary of all the food and drink he consumes. He can then take some time to practise Simon’s ability to follow it are also
breaking these items down to their primary components. If Simon gains an discussed.
understanding of the components of different items available from the canteen and
takeaway outlets, he may be able to choose foods that more closely reflect the ⓬ Ways of increasing Simon’s
understanding of the model and so
proportions outlined in the guide.⓬ improve his diet.
Chapter summary
• There are six categories of nutrients required for optimal health and individual human
development; carbohydrates, protein, fats, water, vitamins and minerals.
• Youth require a balance of the six categories of nutrients in order to maintain optimal
Interactivities: health and individual human development.
Chapter 3 crossword
• The main function of carbohydrates is as an energy source.
Searchlight ID: int-2895
• Fibre is a type of carbohydrate that is indigestible. It has numerous health benefits, such
Chapter 3 definitions as reducing hunger, and decreasing cholesterol and glucose absorption. This can assist
Searchlight ID: int-2896 in weight maintenance. Fibre also acts to clean the digestive system and reduce the
chance of colorectal cancer later in life.
• Protein is required for the growth, maintenance and repair of body cells and structures.
It can also be used as an energy source.
• The main function of fats is as a fuel for energy production. They are also a key
component of cell membranes.
• Monounsaturated and polyunsaturated fats are a better choice than saturated and trans
fats because the latter contribute to high levels of LDL cholesterol.
• Water is required for many body processes, including functioning as a medium
for all chemical reactions in the body and forming an important part of blood and
soft tissues.
• Calcium is an important component of hard tissues and is required to achieve optimal
peak bone mass.
• Iron is required for haemoglobin in blood and a deficiency can lead to anaemia.
• Vitamin A is required for cell division and cell differentiation.
• Vitamin D is required in order for calcium to be absorbed in the small intestine and
therefore assists in building hard tissue.
• Vitamin C is required for collagen production and assists with the absorption
of iron.
• The B-group vitamins are required to release energy from carbohydrate, protein
and fat.
• The key nutrients interact to produce energy, blood, hard tissue and soft tissue.
• If energy intake and expenditure are not roughly the same, weight gain or loss will
result.
• Nutrient imbalance can result in a range of short- and long-term consequences for
youth.
• Short-term consequences include lack of energy, a spike in blood glucose levels,
overeating and constipation.
• Long-term consequences include dental caries, periodontitis, overweight and obesity,
type 2 diabetes, cardiovascular disease, sleep apnoea, arthritis, osteoporosis, colorectal
cancer, anaemia and increased risk of infection.
• The short- and long-term consequences can impact on all areas of the health and
development of the individual.
• Food selection models can be used as tools to assist youth in preventing nutritional
imbalance.
• The Australian Guide to Healthy Eating presents the five food groups in the proportions
in which they should be consumed.
• The Healthy Living Pyramid contains three layers relating to the foods that individuals
should ‘consume most’, ‘consume moderately’, and ‘eat in small amounts’.
Key Skill
• explain the determinants of health and individual human development
and analyse their impact on youth using relevant examples.
There are many factors that influence the health and individual human development
of youth. These factors act together to determine health and development and
hence are termed the ‘determinants of health and development’, sometimes
shortened to the ‘ determinants of health’.
There are four determinants
of health and individual human
development (see figure 4.2)
Behavioural Physical
determinants environment
Biological determinants have a
significant impact on the health
and development of youth and
were explored in detail in chapters
1 and 2. In this section, we will
Biological Social
explore three other determinants
determinants environment that relate to the decisions young
people make and the physical
and social environments in which
they live.
The three determinants to be
Determinants explored in this chapter are:
of health and
development
• behavioural determinants
• physical environment
• social environment.
Physical environment
The physical environment encompasses the physical things that make up the
environment such as air and water, and available facilities such as housing,
recreation and health care. Aspects of the physical environment can directly impact
on health by affecting the body’s systems. Air and water quality can make people
sick or promote good health (figure 4.3). Unhygienic or unsafe housing can spread
disease and contribute to injuries. Mental health can be compromised if individuals
do not have their own space within their physical environment. Social health
is influenced by those who share the physical environment with an individual.
For example, those who share a house, go to the same school or work with the
individual, will impact on the person’s social health by providing opportunities for
interaction and the formation of relationships.
Figure 4.3 Environmental Individual human development can also be affected by the physical environment.
pollution is an aspect of the physical The opportunities provided for physical activity in the environment, for example,
environment that affects health. will influence motor skill development and social development.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 113
4.1 Determinants of health and individual human development during youth: four categories
Social environment
The social environment refers to the ‘social situation’ in which people live. This
includes the people with whom an individual associates, the decisions that are
made on behalf of the community (e.g. policies and laws), and the position of
an individual compared to others in the society (based on factors including
income and occupation). These factors influence the opportunities available to an
individual and are related to the level of health and individual human development
experienced by that person.
The family provides an important part of our social environment. For young
people especially, the family is generally the main social contact and provider of
many resources such as shelter, food, clothing, emotional support and educational
eBook plus opportunities. Family cohesion and the socioeconomic status (SES) of parents are
examples of social factors that are influenced by the family.
Interactivity: Most individuals live in a community. The quality of the relationships within
Time Out: ‘Determinants the community and the services available in the community can affect health and
of health’ development. Examples of social factors influenced by the community include
Searchlight ID: int-1422 media, access to resources which enable community participation in areas such as
sport, recreation, arts and faith-based activities, and access to education.
TEST your knowledge (b) Justify your choices and discuss your responses
with other students.
1 (a) Explain the three determinants of health and
3 (a) Make a list of the determinants that have an
development addressed in this section.
impact on your health and development.
(b) Give one example for each.
(b) Rank them in order from ‘most influential’ to
‘least influential’.
APPLY your knowledge
(c) Discuss your list in small groups.
2 (a) Which group of determinants do you think 4 ‘The social environment often leads to the health
would have the greatest impact on the health behaviours that people engage in’. Write a response
and development of: (either agreeing or disagreeing) to this statement
i. a five-month-old baby in Sydney? using examples to support your point of view.
ii. a 16-year-old mother in Ethiopia?
iii. a 45-year-old unemployed person in
Melbourne?
iv. a 70-year-old retired grandparent in remote
Western Australia?
During childhood, a lot of the health behaviours that people engage in are based
on the decisions made for them either by law and policy makers, or by their family. eLesson:
As individuals enter the youth stage, they start to take more responsibility for the The dangers of a deadly tan
choices they make. The choices made during this stage can have short- and long- Searchlight ID: eles-0222
Sun protection
Australia’s climate is among the harshest in the world
and skin cancer is the most commonly diagnosed cancer.
Sunburn is one of the biggest risk factors for skin cancer
(figure 4.5). Skin cancers can be categorised into two
groups: melanoma and non-melanoma skin cancers.
Non-melanoma skin cancers are the most commonly
diagnosed skin cancers and comprise approximately
95 per cent of all skin cancers. Such cancers are generally
easily removed but can lead to complications if left
undiagnosed and untreated for extended periods of time.
Melanoma skin cancer, on the other hand, is an aggressive
form of skin cancer that can metastasise and cause death
if not treated.
The amount of UV radiation that a person is exposed to
during childhood and youth is one of the most detrimental
risk factors for skin cancer. People with fair skin that burns
easily, those with freckles and/or moles and those with a Figure 4.5 Sunburn should be avoided because it is one of the
biggest risk factors for skin cancer.
family history of skin cancer are also at an increased risk.
Although skin cancer becomes more common in later life,
young people are still at great risk. In fact, according to the Australian Institute of
Health and Welfare in 2011, skin cancer was the most commonly diagnosed cancer
among people aged 12–24, accounting for around 30 per cent of all newly
diagnosed cancers. A key reason for this is that youths are less likely to engage in
sun protection behaviours than adults (table 4.1).
Table 4.1 Sun protection behaviours during peak UV periods among young people aged
12–24 years, 2003–04 and 2006–07 (per cent)
2003–04 2006–07
Sun protection behaviours 12–17 years 18–24 years 12–17 years 18–24 years
Head wear (hat, cap or visor) 38 37 29 33
15+ sunscreen 37 36 37 33
3/4 length or long top 11 11 9 12
3/4 length or long leg-cover 37 37 30 37
Stayed mostly in the shade 19 26 20 22
Wore sunglasses 23 52 24 47
Figure 4.6 Surgery is commonly
Sunburnt 25 22 24 19 required to remove skin cancer, and
it often causes scarring because the
Note: Multiple responses were permitted therefore the total responses exceed 100 per cent.
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. surrounding tissue is usually removed
PHE 140, Canberra, p. 72. as well.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 115
4.2 Determinants of health and individual human development during youth: behavioural
While overexposure to UV rays can cause skin cancer, insufficient exposure can
also be detrimental. Exposure to UV rays triggers the production of vitamin D in
the skin. This nutrient is required to assist in the absorption of calcium, which
is turn is needed for the development of bones. Lack of UV exposure can lead
to a deficiency in vitamin D and therefore a lower than optimal bone mass. This
increases the chances of fractures and osteoporosis in later life. However, a lack of
sun exposure is not a significant problem for youth in Australia.
Physical activity
According to a study carried out by the Cancer Council and the National Heart
Foundation of Australia in 2009–10, 15.4 per cent of those in secondary school
years 8 to 11 participated in levels of physical activity recommended by the
national guidelines to obtain a health benefit (table 4.2). However, many young
people were sedentary.
Physical activity is an important part of a healthy, balanced lifestyle. Patterns
established in youth can carry through to adulthood and increase the likelihood
of maintaining an ideal weight. Other short- and long-term benefits of physical
activity include the prevention of:
• cardiovascular disease — being obese is a risk factor for cardiovascular disease.
Exercise can assist in maintaining an optimal body weight and maintaining
cardiovascular health.
• high blood pressure — overweight and obesity are risk factors for high blood
pressure. Maintaining a healthy body weight through exercise can help to reduce
this risk.
• some forms of cancer — exercise can enhance immune function and improve
the body’s response to cancerous growths.
Table 4.2 Proportion of students meeting physical activity recommendations over the past
week by sex and year level
Year Level
Many forms of physical activity (e.g. tennis, golf and soccer) promote social
interaction, which is an aspect of social health. Youth may also be exposed to
different social groups and learn different social skills, which is an area of social
development.
Physical activity can have a positive impact on mental health. Exercise has been
shown to relieve stress and anxiety. As well as providing an outlet for excess energy,
physical activity releases hormones in the body that can promote feelings of well-
being and therefore positive mental health.
Physical activity can also affect individual human development:
• Exercise (particularly weight-bearing exercise) assists in strengthening bones and
increasing bone density, which promotes physical development.
Substance use
Youth is often a stage of the lifespan where people experiment with different push
over? substances. The reasons for this are related to youths experimenting with Table 4.3 Mean age of initiation of
aspects of their identity and to the brain development that makes youths more lifetime drug use, Australia, 2010
likely to take risks. Some of substances most commonly experimented with by
Substance Age first tried
youth are summarised in tables 4.3 and 4.4.
Many of these substances can lead to health issues in the short and long term. Tobacco 16
Effects could include hospitalisation, accidents, conflict with friends and family, Alcohol 17
financial difficulties, legal issues, organ damage, mental illness and various forms Illicits
of cancer. Marijuana 18.5
Source: Adapted from Australian Institute of Health and Welfare 2008, 2007 National drug strategy household
survey: first results, Drug Statistics Series number 20, cat. no. PHE 98, Canberra, p. 27.
• blood-borne diseases (when injected) — needles can transfer diseases from one
person to another. Hepatitis C and HIV are two diseases that can be spread by
sharing needles.
• violence — the behaviour of people using drugs can be altered. This can make
them more prone to violent acts that can result in physical injuries.
• malnutrition — adequate food intake is often not a priority to those suffering
from a drug addiction. Drug use may also interfere with appetite and further
contribute to malnutrition. In addition, some substances can affect the retention
of different chemicals in the body. For instance, some painkillers can reduce the
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 117
4.2 Determinants of health and individual human development during youth: behavioural
retention of vitamins and minerals. All these can weaken the immune system
eBook plus
and make youth more susceptible to infection and disease.
• cardiovascular disease — some illicit substances can significantly increase heart
eLesson: rate and blood pressure, which can contribute to cardiovascular disease in youth
Ice addiction
• certain cancers — the risk of most cancers is increased when substances are
Searchlight ID: eles-0223
smoked
• drug overdose resulting in disability/death — body systems can shut down if the
body has an adverse reaction to the substance.
As well as the effects on physical health, substance use can have an impact on
the social and mental health of youths. For example, the risk of developing mental
illnesses is higher for drug users. Many illicit drugs can cause hallucinations and
an altered perception of reality, and can change the chemical make-up of the brain.
The chemical changes occurring in the brain can act as a trigger for a range of
mental illnesses such as depression, anxiety and psychosis. If drug use leads to
mental illness, the risk of suicide may also be increased.
If an individual experiments with drugs, the effects can extend to their circle of
friends. Some friends might disapprove and distance themselves. If other friends
Figure 4.7 Experimental drug use are similarly experimenting with drugs, the individual might spend more time with
can lead to a range of other health this group of people. Either way, drug use will generally affect social health.
issues.
Long-term substance use can have a range of effects on individual human
development. The person may not be able to hold down a job or participate in
full-time study. This can affect social development, as they do not learn the social
skills associated with full-time employment or tertiary education. The individual
might also find it hard to maintain a relationship in which valuable social skills
such as communication and sharing are further developed. It can also have an
impact on intellectual development, as the knowledge that could have been gained
may never be learned. Drug use can leave people with insufficient money to pay
for social experiences such as holidays or to attend gatherings such as weddings,
which could further impact on social development.
Because the mental health of an individual might be affected by substance use,
emotional development does not have a secure foundation on which to build. If a
person is using drugs to escape their problems, they will not get the opportunity to
deal with their issues and mature emotionally.
According to the Australian Institute of Health and Welfare, many factors can
put young people at risk of drug use. They include:
• maternal drug use during pregnancy
• early behavioural problems
25
• emotional problems and early exposure to drugs
Males
• peer antisocial behaviour
20 Females
• poor parental control and supervision
• poor family bonding
15 • drug use among family members
Per cent
0 Tobacco
1998 2001 2004 2007 The percentage of young Australians who smoke has decreased
Year significantly over the past decade (figure 4.8), although around
13 per cent continue to smoke. Tobacco has many effects on youth
Figure 4.8 Daily smoking rates among young people health in the short and long term. In the short term, tobacco smoking
aged 14–24 years, by sex, 1998–2007
Source: Australian Institute of Health and Welfare 2011, Young Australians:
increases heart rate and blood pressure. The immune system can also
their health and wellbeing 2011, cat. no. PHE 140, Canberra, p. 75. be adversely affected, increasing the risk of developing an infection.
118
UNIT 1 • The health and development of Australia’s youth
Smoking is less acceptable than it was in the past, and laws have been passed
that prohibit smoking in many public spaces. This means that youths must leave
venues to smoke. Continually leaving a social activity to smoke could affect social
experiences for young people. The financial costs associated with tobacco smoking
could leave less money available for other activities such as socialising with friends.
People with depressive symptoms are more likely to smoke, although it is not clear
if smoking contributes to depression or vice versa. There is also evidence that tobacco
use has a relationship with the use of other drugs such as alcohol and marijuana.
The longer a youth smokes, the more likely they are to develop long-term
conditions including:
• cardiovascular disease — tobacco smoking increases the rate of atherosclerosis
in the body and therefore increases the risk of cardiovascular disease
• many forms of cancer — tobacco smoke can facilitate the development of
cancerous cells in many parts of the body, including the lungs and breasts
• respiratory conditions such as emphysema.
As fitness levels decrease, the young smoker may be less inclined to participate
in sporting activities. This could affect all areas of development including
motor skills and social development. It could also make the youth less likely to
participate in sporting activities in later life, which could lead to an increased risk
of cardiovascular disease and cancers.
Alcohol use
Alcohol is the most common social drug used in Australia. Table 4.5 shows the rate
of alcohol consumption across age groups.
Table 4.5 Alcohol consumption of people aged 12 years or older at risk of short-term harm,
by age and sex, 2010 (per cent)
(a) For males, the consumption of 7 or more standard drinks on any one day. For females, the consumption of 5 or
more standard drinks on any one day.
(b) At least monthly but not as often as weekly
(c) At least yearly but not as often as monthly
(d) Has not consumed alcohol in the past 12 months
Source: Adapted from Australian Institute of Health and Welfare 2011, 2010 National drug strategy household
survey: supplementary tables.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 119
4.2 Determinants of health and individual human development during youth: behavioural
and other short-term effects on youth health each year. In fact, according to the
Australian Institute of Health and Welfare’s 2010 National drug strategy household
survey, youths often experience one or more negative short-term effects associated
with binge drinking. Examples of these include:
• violence
• accidents such as drowning
• unsafe sexual practices
• unconsciousness
• vomiting.
Excessive alcohol consumption may begin in youth and continue into adulthood.
The long-term effects associated with alcohol consumption include:
• cardiovascular diseases
• type 2 diabetes
• certain types of cancer
• mental illness.
Youth might socialise with other young people who drink and, while under the
influence of alcohol, could behave in a way they regret. Their mental health may
suffer as a result of feelings of regret and guilt.
The individual human development of youth can also be significantly affected
by alcohol consumption. Alcohol can reduce the absorption of nutrients, which
can contribute to malnutrition. If the essential nutrients required for physical
development are not present, then body systems such as the skeletal and muscular
system may not develop optimally.
Socialising regularly under the influence of alcohol could prevent the individual
from developing social skills while sober, and they might begin to rely on alcohol
to make friends or socialise effectively. Their self-concept could be affected by
alcohol consumption, especially if they had negative experiences while drinking.
Excessive alcohol consumption can lead to lethargy (tiredness), which can
reduce concentration levels and ultimately performance at school, which can affect
intellectual development. Alcohol can also affect brain function and therefore
intellectual development.
Sexual practices
Sexual development is a significant milestone occurring in the youth stage of the
lifespan. Some people start experimenting with sexual behaviour at this point in
their lives (figure 4.10). Being involved in a sexual relationship may affect the
people that an individual associates with, especially if their friends are not sexually
active. The person may attach feelings of love to the sexual relationship, which
can impact on mental health and emotional development. It may also increase the
feelings of sadness and loss should the relationship end.
70
Males
60 Females
Persons
50
Per cent
40
30
20
Figure 4.10 Proportion of students
in years 10 and 12 who have ever had 10
sexual intercourse, 2002 and 2008
0
Source: Australian Institute of Health and Welfare
2011, Young Australians: their health and wellbeing
Year 10 Year 12 Year 10 Year 12
2011, cat. no. PHE 140, Canberra, p. 81. 2002 2008
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 121
4.2 Determinants of health and individual human development during youth: behavioural
TEST your knowledge started to feel a burning sensation and has seen
some redness around her vagina. She has become
1 Why is skin cancer more common later in life when
worried and suspects that her boyfriend has recently
adults exercise more sun protection behaviours than
had other sexual partners and has given her an STI.
youths?
Kate is too embarrassed to talk to her friends and is
2 (a) Identify two trends evident in table 4.2.
(b) Discuss reasons that may account for the trends avoiding going to the doctor.
identified in part (a). (a) Identify ways that Kate’s physical, social,
3 (a) Which sex is more likely to exercise overall? emotional and intellectual development could
(b) Why do you think this is the case? have been affected by her sexual experience.
(b) What advice would you give Kate if she
APPLY your knowledge approached you asking for help?
(c) Suggest ways that Kate could have decreased
4 Brainstorm a list of the short- and long-term effects
her chances of contracting an STI.
of substance abuse.
(d) Brainstorm reasons why Kate might not be
5 How could substance abuse lead to conflict in
willing to visit a health professional.
relationships?
6 What is the average age at which lifetime smokers (e) Suggest a strategy that could be introduced
start smoking? to combat STI infection rates for people of
7 Tobacco has been referred to as the ‘gateway’ drug, Kate’s age.
meaning it often leads to experimentation with 2 Select one of the behavioural determinants covered
1
other drugs. Explain why tobacco may lead to other in this chapter and draw up a table to show
drugs. how it might affect all aspects of the health and
8 Do you think that most people who have tried illicit development of youth.
drugs also have a history of alcohol use? Explain 13 Use the Sexual health weblink in your eBookPLUS
your response. to find the link for this question.
9 (a) In what ways can weekly drinking be more of a (a) i. Click on the ‘sexual practices’ icon down the
concern than daily drinking? bottom.
(b) What associated effects can this type of drinking ii. Click on ‘STI’.
have on health? iii. Research three STIs and produce a fact file on
10 (a) Discuss how risky alcohol consumption patterns each one. Discuss these conditions in small
change as youth get older, according to table 4.5. groups.
(b) Outline possible reasons for these changes. (b) i. Click on the ‘home’ icon down the bottom of
(c) Discuss how these changes could impact the page.
on youth health and individual human ii. Place the cursor over the ‘true stories’ icon
development. and select ‘pregnant’.
11 Kate is in year 12 and has a boyfriend two years iii. Watch the slide show.
older than her. Two weeks ago, she decided to have iv. Discuss how this event could impact on this
sex with him for the first time. She was a virgin and girl’s development.
had wanted to wait until she was in a committed v. Brainstorm ways that the girl’s health may be
relationship before having sex. A few days ago, she affected by this incident.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 123
4.3 eterminants of health and individual human
D
development during youth: physical environment
Physical environment
The physical environment encompasses many factors that have a direct impact
on health and individual human development such as air quality, the housing
and work environments, and access to facilities for recreation and health care.
Aspects of the physical environment are often out of the individual’s control but
their relationship with health and individual human development makes them
significant determinants in the lives of youth.
Housing environment
Youth generally spend a lot of time at home, and the housing environment can
affect their health and individual human development.
Some of the physical aspects of the housing environment that can affect health
and development include:
• indoor pollutants. Dust and tobacco smoke, for example, can cause asthma and
other respiratory conditions.
• drinking water quality. Inadequate water quality can lead to infections or
dehydration.
• warmth. People living in dwellings that are damp, cold or mouldy are at greater
risk of respiratory conditions, meningococcal infection and asthma.
60
15–19 years
50 20 –24 years
40
Per cent
30
20
Work environment
Many youths will take on a part-time job for the first time during this stage or
will leave school to commence full-time employment (figure 4.15). Work allows
the individual to earn their own income and develop skills relating to all areas of
development. In the work environment, the young person may learn skills such
as cooking, cleaning, cooperation, and responsibility. But there are often risks
associated with the workplace as well.
Occupational health and safety laws in Australia are designed to ensure that
employers provide a safe environment for all of their employees, including youth.
These laws relate to physical space as well as machinery, training and supervision.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 125
4.3 Determinants of health and individual human development during youth: physical environment
Case study
Whitehorse gymnasts left The school is yet to complete its plans for the former
town hall.
high and dry Whitehorse Gymnastics Club vice-president Alison
Dunn said the council had done little to help move the
By Gareth Trickey
club’s members.
More than 500 gymnasts will be evicted from their ‘In 30 years we’ve never had to ask for any help, and
training centre after a council failed to pitch in for a now we are asking for some help,’ she said.
new lease or a training centre. The club approached Whitehorse Council three
The Whitehorse Gymnastics Club has called Wal weeks ago with a plan to move to another building.
Wicking Hall, in Blackburn South, home for the past The proposal was dashed after the club failed
10 years. But Orchard Grove Primary School, which to persuade Whitehorse councillors of the value of
owns Wal Wicking Hall, terminated the lease in June. moving.
TEST your knowledge that is considered less than adequate and much
less than adequate in terms of the number of
1 How can environmental tobacco smoke affect the
bedrooms?
health and development of young people in the:
(b) Why might this scenario be particularly difficult
(a) short term?
for youth?
(b) long term?
(c) How could inadequate housing lead to poor
2 List three aspects of the housing environment
health? (Remember that health is not just
that can affect health and individual human
physical.)
development. 8 Use the Young Workers weblink in your
3 Outline some benefits to your health that have eBookPLUS to find the link for this question, eBook plus
occurred as a result of participating in recreational and use the fact sheets to answer the
activities (make sure you cover the three areas of following questions.
health). (a) What rights do young workers have in the
4 (a) Using the data in figure 4.15, estimate the workplace?
proportion of males and females aged 15–24 (b) Discuss the options for youth if they are unsure
who have some form of job. about completing a task at work.
(b) Discuss the impact that having a job can have on (c) Explain how the work environment can impact
youth health and development. the health and individual human development of
youth.
APPLY your knowledge 9 (a) Make a list of recreational activities (within
5 Suggest reasons why indoor tobacco smoke has a 15-minute walk of home) that you could
decreased in recent years. participate in.
6 Why would young people whose parents smoke be (b) How often do you use these facilities?
more likely to take up the habit themselves? (c) Are there any facilities not located in your area
7 (a) According to figure 4.14, approximately what that you would use if they were closer?
percentage of 15–24 year olds live in housing (d) Compare your list with a classmate.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 127
4.4 eterminants of health and individual human
D
development during youth: social environment
Social environment
Social determinants of health and individual human development affect youth in
numerous ways. Some of these social factors are related to the influence of the
family and others are related to the wider community in which youth live.
Youths rely on their families for many aspects of their lives. Parents,
siblings and extended family members guide young people through their
childhood and youth, when development is occurring at a rapid rate.
Physical, social, emotional and intellectual development are all influenced by
family members. The health behaviours (e.g. food intake and exercise) that
young people partake in are also influenced by family members (figure 4.18).
The wider community such as schools, sporting groups and social/
cultural groups play an important role in influencing the health and
individual development of youth. They provide opportunities for young
people to be involved in the community in which they live, which can
promote health. Social determinants within the community include the
media, community and civic participation and access to education. Each of
these determinants will be explored in more detail.
Figure 4.18 The family is an
important determinant of health and Family cohesion
development. Family cohesion refers to the closeness or bonds within a family. The ability of
families to get along is an indicator of family cohesion and data relating to this
measure are shown in figure 4.19. According to the Australian Institute of Health
and Welfare, family cohesion, or lack thereof, is a risk factor for youth health
and individual human development. It is difficult to say whether lack of family
cohesion leads to poor health and development outcomes or vice versa. Issues such
as substance abuse, mental illness and suicide may be the result of poor family
cohesion or may in fact lead to it.
If the family is close, then social health may be reliant on the family. If the family
is not close, then friends may play this role. The family may also provide a resource
for young people. They can discuss their problems and seek advice. This could
increase the level of mental health experienced.
Individual human development is also influenced by the family. A family that
regularly socialises and communicates could assist in the development of social
skills and the emotional development of youth. Intellectual development could
also be improved by gaining new knowledge from family members such as parents
and grandparents.
35 32.9
31.031.2 Females %
30 29.0
Males %
25
21.120.1
Per cent
20
15 12.3
10.4
10
6.7
Figure 4.19 The ability of families to 5.4
5
get along according to young people
aged 15–19, 2012 0
Source: Mission Australia youth survey 2012. Excellent Very good Good Fair Poor
45
Child 10 –14 years
40 Dependent student
15 –24 years
35
30
Per cent
25
20
15
10
5
Figure 4.20 Young people in families
0 where no parent is employed, 2006–07
Couple parent Lone-parent All families Source: Adapted from ABS data.
Media
The media influences many of the decisions youth make (figure 4.21). By eBook plus
influencing social trends — from food items to clothing, music and recreational
activities — the media has a pronounced impact on the health and development eLessons:
of youth. In recent decades the use of media (particularly electronic and social Influence of global events
media) has increased significantly. This exposes young people to many forms of Searchlight ID: eles-1041
information.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 129
4.4 D
eterminants of health and individual human development during youth:
social environment
44
Education Travel Culture Social Small screen recreation
Hours of sedentary activity/week
40
36
32
28
24
20
16
12
8
4
0
Year 6 boys Year 6 girls Year 8 boys Year 8 girls Year 10 boys Year 10 girls
130
UNIT 1 • The health and development of Australia’s youth
90
Males
80 Females
Persons
70
60
Per cent
50
40
30
20
10
0
School day Weekend
Figure 4.23 Proportion of secondary school students exceeding the national guidelines for
small screen recreation, on school days and weekends, 2009–10
Source: Adapted from Cancer Council Victoria 2011, ‘Prevalence of Meeting Recommendations for Small Screen Recreation in
Australian Secondary Students’, National Secondary Students’ Diet and Activity (NaSSDA) survey 2009–10.
Table 4.6 Percentage of young people aged 15 to 19 years involved in selected activities, 2012
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 131
4.4 D
eterminants of health and individual human development during youth:
social environment
Access to education
Education is one of the key defining aspects of youth. Education in schools and
higher education institutions such as universities and TAFEs provides opportunities
for youth to develop knowledge and skills that will prepare them for work in later
years and enhances their social, emotional and intellectual development.
The resources available in each school will also influence the type of education
received by youth. Having access to multimedia and information technology
resources can increase their opportunities.
Education is also linked with better health outcomes (figure 4.25). Those with
higher levels of education report lower levels of illness and better mental health
than those with lower levels of education. Education can promote awareness of
healthy behaviours such as not smoking tobacco and maintaining adequate levels
of physical activity. Those with higher levels of education are also more likely to
secure jobs with better pay and prestige, which can lead to lower levels of stress
and more income to pay for things like private health insurance and an adequate
food supply.
Figure 4.25 Education has a relationship with health outcomes, but not all youths have
access to it.
132
UNIT 1 • The health and development of Australia’s youth
TEST your knowledge 10 Using figure 4.21, brainstorm how each form
of media might impact on health and individual
1 Explain what is meant by family cohesion.
human development in both positive and negative
2 List the three components that make up SES.
ways. (A table might be useful for this.)
3 Why is it important to look at the SES of parents
11 Brainstorm a list of social factors in the
when estimating the effect that SES has on youth?
community that affect your health and individual
4 List three ways that media could affect the health
human development. Compare your list with
and/or individual human development of youth.
someone else’s.
5 Identify two trends from figure 4.23.
12 (a) Design a survey that could be used to gauge
6 Outline factors that might prevent youths from
people’s participation in community and civic
accessing education.
activities. Make sure your questions allow data
collection about:
APPLY your knowledge • the nature of the activities
7 (a) What percentage of males and females aged • how often people participate
15–19 rated their family’s ability to get along as • the perceived health benefits of participation.
fair or poor? (b) Use the survey to collect data on youth
(b) Explain how their family’s fair or poor ability participation and collate the results.
to get along could impact on the health and (c) Draw conclusions about community and civic
individual human development of youth. participation in your school.
8 What effect might caring for a parent have on the 13 Select one form of social media and design a
health and development of a young person? pamphlet that could be used to educate youth about
9 Discuss the ways that having no parent in paid the positive and negative aspects of its use.
employment could affect the health and individual 14 Explain how education could promote health and
human development of youth. individual human development among youth.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 133
KEY SKILLS The determinants of health and individual human
development ofinAustralia’s
Key skills Variations youth
health within Australia
Table 4.7 A summary table for analysing the impact on health and individual human
development of the determinants
Determinant: Media
Physical
Social
Mental
Area of development
Physical
Social
Emotional
Intellectual
3 marks
(b) Select one of these and explain how they may affect Danny’s health and development.
4 marks
(c) Discuss ways that Danny’s illness may impact on his:
i. social health
ii. social development.
4 marks
(d) Explain how Danny’s family situation may impact on his recovery from his illness.
3 marks
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 135
CHAPTER 4 review
Chapter summary
• The level of health and development experienced throughout life is determined by a
broad range of factors called determinants.
• Behavioural determinants and the physical and social environment all combine to affect
youth health and development.
• Behavioural determinants include the behaviours that people engage in that have an
impact on health and development, including smoking and exercise.
• A lot of the behaviours that youths engage in can have long-term consequences.
Habits that are established during this stage are important for future health and
development.
• Lack of sun protection remains an issue for Australian youth although awareness of its
importance has increased in recent years.
• Levels of physical activity are not as high as they should be and contribute to a range of
health and developmental problems.
• Tobacco, alcohol and substance use is often first tried during the youth stage and can
lead to lifelong health problems.
• Chlamydia rates have more than doubled in recent years. Infections among youths and
early adults are largely responsible for this increase.
• A number of skills are required to develop and maintain friendships.
• Mutual and respectful friendships can be a great support for youth as they develop.
• Health professionals are a valuable resource in terms of maintaining optimal health and
development yet many youth are reluctant to seek help from them.
• The physical environment includes air and water quality and pollution. The physical
environment in Australia generally promotes good health.
• Housing issues such as unsafe housing and overcrowding can contribute to injuries and
mental health issues.
• Many youth start employment during this stage of the lifespan, and the work
environment can present many challenges and opportunities for health and
development.
• Indoor tobacco smoke can cause detrimental health outcomes for young people such as
respiratory problems.
• Having access to recreational facilities can promote physical activity and social
interaction, which be beneficial to health and development.
• The social environment refers to the people in the environment and the impact
they have on our health. Social factors can be related to family or the wider community.
• The family is an important component of the social environment that influences
many aspects of health and development such as schooling and the formation
eBook plus of values.
Interactivities: • The media is extremely influential with regards to the recreation pursuits youth
participate in and the information that is made available to them.
Chapter 4 crossword
Searchlight ID: int-2893
• Community participation such as volunteering can build links between the individual
and society, which can enhance health and development.
Chapter 4 definitions
• Levels of education are related to levels of health but some youths are unable to access
Searchlight ID: int-2894
education, particularly higher education.
The determinants of health and individual human development of Australia’s youth • CHAPTER 4 137
CHAPTER
Chapter 5
8
Key Skills
• analyse data to draw informed conclusions about the range of health
issues facing Australia’s youth
• describe a specific health issue facing Australia’s youth
• gather information on a selected health issue related to youth using a
range of sources such as primary data, print and electronic material
• analyse information on a selected youth health issue and draw
informed conclusions about personal, community and government FIGURE 5.1 The health of Australia’s
strategies and programs to optimise youth health and development youth is excellent, but there are
a number of issues that require
• identify the range of health care services available to youth and discuss attention.
their rights and responsibilities in accessing and using these services.
Weight issues
Underweight, overweight and obesity all impact significantly on youth health and
development.
In 2007, around 5 per cent of those aged 14 to 16 were considered to be
underweight. Underweight can indicate that the nutrients required for optimal health
and development are not present. The effects of being underweight can include:
• Greater risk of infection and disease, as a result of a weakened immune system.
• An inability to concentrate at school due to low levels of energy (physical health)
thereby impacting intellectual development.
• Delayed puberty. Low body weight can contribute to delayed puberty and when
it does commence, developmental processes such as increases in bone and
muscle mass may not be achieved.
The percentage of overweight and obese children and youth has more than
doubled over the past two decades and continues to increase. The Obesity Society
in 2008 estimated the current levels of overweight and obesity among Australian
youths to be around one in four. Obesity in youth can have lifelong implications and
contribute to many leading causes of death among adults, such as cardiovascular
disease, some cancers and type 2 diabetes. If the youth carries the extra weight into
adulthood, the risk of developing these conditions continues to increase. In the
short term, youth can suffer from psychological distress, cardiovascular disease and
type 2 diabetes. The increased prevalence of overweight/obesity among youth is
due to the combination of changes to food intake and the development of sedentary
lifestyles. The National Physical Activity Guidelines recommend that young people
participate in at least 60 minutes of moderate to vigorous physical activity every
Figure 5.2 Overweight and day. Examples of moderate exercise include medium-paced cycling, swimming and
obesity are increasing among young brisk walking. Examples of vigorous exercise include jogging and basketball.
Australians.
Table 5.1 Percentages of young Australians engaging in different levels of activity, 2008
Males Females
Table 5.1 shows the activity levels of young people. Those classified as sedentary
or low (engaging in no exercise to little exercise respectively) were considered to be
getting not enough physical activity.
ch
ur
ks
ol
er
n
t
oo
ow
po
a
th
ba
bo
c
a
re
Ro
Be
ag
kn
ar
St
g
pa
/L
in
/H
Un
k/
/S
am
m
e
an
ub
re
im
/D
ce
r/C
ht
Sw
ke
O
t
ve
Ba
La
Ri
Figure 5.4 Drowning deaths of young people aged 15 to 24 by location, five-year average,
2011–12.
Source: Royal Life Saving Society Australia, National drowning report, 2012.
Tobacco smoking
Youth is a critical time in the development of tobacco
addiction, and those who do not smoke during youth are less
likely to smoke later in life. Smoking increases the chances
of premature death and a range of conditions including
cancer, cardiovascular disease and respiratory illness. Even
though AIHW figures show that smoking rates steadily
declined between 1991 and 2007, tobacco use is the single
most preventable cause of ill-health and death in Australia,
contributing an estimated 7.8 per cent of the total burden
of disease. This equates to more drug-related hospitalisations
and deaths than alcohol and illicit drug use combined.
According to the AIHW’s 2007 National drug strategy
Figure 5.5 Lifetime smokers household survey, males had their first full cigarette at age 15.2 years on average
generally start smoking during youth.
and females at 16.5 years (figure 5.5). Rates of smoking among young people are
shown in figure 5.6.
Percentage of population
25
20 Males
Females
15
10
0
15–17 18–24
Age group
Figure 5.6 Proportion of current smokers by age and sex, 2011–12
Source: ABS, Australian health survey: first results, 2011–12.
Alcohol use
Youth is a stage when many people experiment with alcohol consumption. In
moderation, alcohol consumption causes few health problems. However, excessive
alcohol intake — such as binge drinking — during youth is associated with higher
rates of injury deaths and violence, can impact on brain development, and increases
the risk of alcohol-related problems later in life.
The AIHW in 2008 estimated that harm from alcohol was the cause of 3.8 per cent
of the burden of disease for males and 0.7 per cent for females, ranking it sixth in
terms of causes of burden of disease.
Youth under the age of 18 are recommended not to consume any alcohol as their
bodies and brains are experiencing rapid development. For youth aged 18, in order
to reduce the risk associated with alcohol consumption, the Department of Health
and Ageing recommends not consuming more than:
• two standard drinks on any day (to reduce lifetime risk)
• four standard drinks on any day (to reduce short-term risks).
It also states that:
• Drinkers under the age of 15 years are much more likely than older drinkers to
undertake risky or antisocial behaviour connected with their drinking.
• Risky behaviour is more likely among drinkers aged 15 to 17 years than older
drinkers. If drinking does occur in this age group, it should be at a low-risk level
and in a safe environment supervised by adults.
eLesson:
Teenage alcohol
Searchlight ID: eles-0226
MID LIGHT
BEER BEER BEER
MID LIGHT
BEER BEER BEER
1.5 1 0.8
375 mL 375 mL 375 mL
Full strength beer Mid strength beer Light beer
4.9% alc/vol 3.5% alc/vol 2.7% alc /vol
Spirits
Pre-mix
Spirits
1.5 1.2 1 22 1
375 mL 300 mL 30 mL 700 mL 30 mL
Pre-mix spirits Pre-mix spirits Spirit nip Bottle of spirits Spirit shot
5% alc/vol 5% alc/vol 40% alc/vol 40% alc/vol 40% alc/vol
Table 5.2 Alcohol consumption associated with harm among people over 18 years
Alcohol consumption
associated with harm Short-term harm Long-term harm
Males 7 to 10 standard drinks on 11 or more standard drinks 29 to 42 standard drinks 43 or more standard drinks
any one day on any one day per week per week
Females 5 to 6 standard drinks on 7 or more standard drinks 15 to 28 standard drinks 29 or more standard drinks
any one day on any one day per week per week
Source: Australian Institute of Health and Welfare 2007, Young Australians: their health and wellbeing 2007, cat. no. PHE 87, Canberra, p. 83.
100
Abstained/low risk
90
Risky/high risk
80
70
60
Per cent
50
40
30
20
10
0
12–17 years 18–24 years 12–17 years 18–24 years
Short-term harm Long-term harm
Figure 5.8 Proportion of young people who drink at risky or high-risk levels for short- or
long-term harm, 2007
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE 87,
Canberra.
As most youth are not of legal drinking age, the environment in which they
drink can promote or discourage excessive alcohol consumption. The places where
youth consume alcohol are detailed in table 5.3.
Table 5.3 Usual place of alcohol consumption by age group, 2010
Bingeing women ‘take risks’ ‘Binge drinking results in a decreased ability to make
clear decisions and can enable individuals to engage in
By Mario Xuereb behaviours that they would not if sober,’ said Geetanjali
Chander, an assistant professor at Johns Hopkins.
Women who binge drink are far more likely to
‘Regardless of why they choose to drink, many people
catch sexually transmitted diseases and agree to
do not perceive the potential risk or harm that may result
risky sex acts they would otherwise avoid, warns a new from binge drinking,’ Professor Chander said.
study. The director of the Centre for Adolescent Heath at
Those who drank more than five alcoholic drinks in Melbourne’s Royal Children’s Hospital, Susan Sawyer,
one session were most at risk, according to researchers said the results were not surprising.
at Johns Hopkins University in the US. ‘This reinforces the need to think seriously about not
Binge drinking increases the risk of women just youth patterns of alcohol consumption, but adult
contracting gonorrhoea and participating in sex acts — patterns of drinking,’ she said.
such as anal sex — to which they would not usually A report into young Victorians’ sex lives by the
consent, the study found. centre, Family Planning Victoria and the Royal
The study, to be published in the journal Alcoholism: Women’s Hospital said 25 per cent of sexually active
Clinical & Experimental Research, monitored patients students reported they were drunk or high during their
of a sexually transmitted diseases clinic over 13 most recent sexual encounter.
months. They interviewed 671 people being treated for Professor Sawyer said that over recent years women
STDs, most of whom were heterosexual. were tending to drink more than previous generations.
Women binge drinkers were five times more likely to ‘Of equal concern is that we know when young
contract gonorrhoea than other women. They were also people are extremely drunk they are at much greater
three times more likely to have anal sex, and twice as risk of sexual assault and other behaviours that normally
likely to have several partners compared with teetotal they’d view as regrettable,’ she said.
women. Source: Sunday Age, 7 September 2008.
substances during youth are more likely to develop substance abuse issues later in
life, which further increases the risk of health conditions.
Some of the common substances used during youth include marijuana,
amphetamines (including ecstasy and crystal meth), cocaine and heroin.
The reasons for trying drugs are complex. Like most risk-taking behaviours, drug
use arises from a combination of factors. Reasons for trying illicit drugs are shown
in table 5.4, and the rates of drug use among young people are shown in table 5.5.
Table 5.4 Factors influencing first use of any illicit drug, lifetime users aged 14 years or older,
by sex, 2010
Source: Australian Institute of Health and Welfare 2011. 2010 National drug strategy household survey report. Drug
statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 87.
STI Prevention
Youth is often a time of sexual exploration (figure 5.9), and this can have both
short- and long-term effects on young people. If youth participate in unsafe sex,
they may expose themselves to a range of sexually transmissible infections (STIs).
70 STIs are passed from one person to another through sexual contact.
Males
60 Females
This includes oral, genital and anal sex.
Persons Many STIs, such as chlamydia and syphilis, can have long-term
50 effects on health and development if not treated. Treatment is often
40 not sought as the condition may not have obvious symptoms. Other
Per cent
1000
young people
800
600
400
200
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Figure 5.10 Chlamydia notification rates among young people aged 12 to 24 years, 1998–2008
Source: Australian Institute of Health and Welfare 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE 140,
Canberra, p. 52.
Case study
(continued)
KEY CONCEPT Understanding the key features of one health issue relevant to
Australia’s youth — a description of anxiety and depression and the incidence,
prevalence and changes over time (trends) of mental illness
4.0 Males
Females
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Figure 5.14 Deaths from mental and behavioural disorders for young people aged 15–19 by
sex, 1997–2007
Source: Adapted from AIHW data.
Mental disorders contribute more to the burden of disease for youth than any
other condition. Of the conditions included under the ‘mental disorders’ umbrella,
anxiety and depression are the two most common among both male and female
Australian youth and will therefore form the focus of the exploration of this issue
(table 5.6).
Table 5.6 Burden (YLL, YLD and DALYs) of major disease groups for 15–24 year olds, 2003
DALYs % of DALYs % of
Rank Males (000) DALYs Females (000) DALYs
Source: Australian Institute of Health and Welfare 2007, Young Australians: their health and wellbeing 2007,
cat. no. PHE 87, Canberra, p. 21.
Case study
What is depression?
Everyone feels sad from time to time, but depression is more
than this. Depression is a debilitating condition in which the
feelings of sadness or worthlessness continue for an extended
period of time. It is usually more severe than just ‘feeling
down’. A person suffering from depression may withdraw
from their normal activities, suffer from sleep disturbances
Figure 5.15 Stressful experiences
and experience a decreased or increased appetite which can such as bullying can be a risk factor
impact on health and individual human development. for anxiety and depression.
TEST your knowledge 9 Using books and the internet, conduct research to
find information relating to an issue of your choice.
1 (a) Explain what the term ‘mental illness’ means.
Arrange this information into paragraphs and
(b) What does the term ‘mental health problems’
diagrams to produce an explanation of what the
refer to?
issue is.
(c) Outline the difference between these terms.
10 Use the Young Australians weblink in your
2 (a) What is a psychotic episode?
eBookPLUS to find the link for this question.
(b) Why would these be considered more severe
(a) Search this and other websites and
than other mental illnesses?
documents for incidence, prevalence and
3 According to table 5.6, what percentage of DALYs
trend data* relating to a health issue of your
are attributable to anxiety and depression for males
choice. Make sure your data relates to Australian
and females respectively?
youth.
4 (a) According to headspace, what percentage of
(b) What challenges were you presented with
young people do not seek help when they are
when searching for data? Brainstorm ways
feeling mentally unwell?
these hallenges could be eliminated or
(b) Suggest reasons for this.
decreased.
5 Explain the difference between anxiety and
(c) What other websites did you use to find
depression.
information, and what factors did you use to
make judgements on the authenticity of the data?
APPLY your knowledge (d) i. Suggest three other sources of information
6 Would the statistics in table 5.6 be completely where data regarding this issue could be
accurate? Explain. gathered.
7 (a) Which causes in table 5.6 have a relationship ii. If possible, access these sources and add
with mental illness? any extra information to your previous
(b) What percentage of DALYs do they contribute research.
*Note that if no trend data is presented, you can try searching older
for males and females respectively?
releases of Young Australians: their health and wellbeing to collect
8 (a) Describe one trend from figure 5.14. older data. These figures can then be compared to current statistics to
(b) Suggest reasons for this trend. determine any trends.
KEY CONCEPT Understanding the key features of one health issue relevant to
Australia’s youth — the impact of anxiety and depression on all dimensions of
health and individual human development and the determinants of health that
act as risk and/or protective factors for anxiety and depression
Anxiety and depression can have a range of effects on health and individual human
development, depending on the severity being experienced. The determinants
of health and development that act as risk and protective factors for anxiety and
depression can also vary considerably from person to person. The effects of anxiety
and depression, as well as determinants that act as protective and risk factors, will
be explored in this section.
Physical health
• Self-harm — people suffering from depression may be prone to hurting
themselves or to attempt suicide. Taking pills and cutting oneself are two
common forms of self-harm with direct effects on physical health.
• Lack of sleep — individuals experiencing depression may have disturbed sleep
patterns. The body might not be adequately rested and they may therefore be
unable to cope with day-to-day tasks.
• Lack of physical activity — a person who withdraws from regular activities
might not get enough physical activity. This can mean that the body is not in an
optimal state.
• Substance and alcohol abuse — people experiencing anxiety and depression are
more likely to abuse drugs and alcohol, which can affect the body’s systems.
Social health
• Social isolation — many individuals suffering
from anxiety and depression will remove
themselves from social interactions. This
may impact on the friendship network of
the individual and magnify the effects of the
condition.
• Strained family relationships — family
life may be interrupted during depressive
episodes. Family bonds might become weaker
as a result.
Mental health
• Poorer quality of life — people suffering from
anxiety or depression often back away from
the things in life that used to make them
happy. This can lead to a lower quality of life
Figure 5.16 Individuals suffering
and a continuing cycle of negative thoughts
from anxiety and depression may that can contribute to an increased risk of
isolate themselves from others. suicide and self-harm.
Physical development
• Impaired development from lack of nutrition — youth is a stage of rapid growth,
so nutrition is very important. If the youth suffers from a loss of appetite, they
may not get adequate nutrients to meet the requirements for growth.
• A lack of physical activity may impact on bone density and growth as weight-
bearing exercise is important for strong bones.
Social development
• Forgone social experiences — important experiences such
as associating with members of the opposite sex and rites
of passage such as school formals assist in developing the
young person’s social skills (figure 5.17). If they miss out
on these experiences, their social skills may not develop as
well as they could have.
Emotional development
• Impacts on self-esteem and confidence — people suffering
from ongoing anxiety or depression are less likely to
be employed than those who do not suffer from one of
these conditions. Employment can promote feelings of
satisfaction and can lead to a more positive self-concept. Figure 5.17 Youths with mental
Unemployment can have the opposite effect. illness may miss out on important
social events, and this loss can affect
their health and development.
Intellectual development
• Higher school dropout rates — according to the Australian Institute of Health
and Welfare, youth suffering from mental illness are less likely to finish
secondary school than those without a mental illness. Many important skills that
are normally learned at school may not be attained.
• Lack of concentration at school — a student in poor mental health may not
concentrate as much at school. They may also not complete homework tasks,
and this can affect intellectual development.
Biological
• Genetic factors — those with a family history of mental illness are more likely to
develop a mental illness themselves.
• Prenatal brain damage — damage caused during the prenatal period from injury
or teratogens (agents that can cause birth defects) can raise the risk of anxiety
and depression.
• Body weight — those who are overweight and/or obese are more likely to
develop anxiety and depression.
Behavioural
• Substance use — use of illicit drugs is linked to depression.
• Food intake — adequate nutrition acts to keep the body and mind in optimal
condition, which may help protect individuals from anxiety and depression.
• Physical activity — physical activity has been shown to reduce feelings of stress,
depression and anxiety (figure 5.18).
Physical environment
• Access to recreational facilities — youth without access to recreational facilities
may not have many opportunities for physical activity and/or the opportunity to
participate in activities that they value. This can lead to increased rates of anxiety
and depression.
• Work environment — an unsafe work environment can increase the risk of
injury among youth and, as a result, can be a source of anxiety.
Social environment
• Family situation — a supportive family life, free from conflict and abuse, is a
protective factor for anxiety and depression (figure 5.19).
• Early life experiences — negative experiences early in life are a risk factor for
mental illness.
• Socioeconomic situation — those in a lower socioeconomic situation are more
likely to develop anxiety or depression.
• Conflict between parents — this can lead to an unstable family situation, which
is a risk factor for anxiety and depression.
TEST your knowledge (b) Is it possible that Mike has a mental illness?
Discuss.
1 List five risk factors for anxiety and depression.
(c) Explain how Mike’s current situation may affect
2 List five protective factors for anxiety and
his health and individual human development.
depression.
(d) Suggest ways that Mike could improve his
mental health.
APPLY your knowledge
8 On your own or with a partner, select an issue
3 Select one effect that anxiety or depression can affecting youth (your teacher may also decide to
have on any area of health and discuss how this choose one issue for the class to consider).
could flow on to the other areas of health and (a) Use a concept map or summary table to
individual human development. brainstorm:
4 Select one effect that anxiety or depression can i. the possible impacts of this issue on all
have on any area of individual human development dimensions of health and individual human
and discuss how this could flow on to the other development
areas of health and individual human development. ii. the determinants of health and development
5 Why is it difficult to say whether the risk factor that may contribute to the selected issue.
leads to anxiety and depression, or vice versa? (b) Which determinant do you think has the
6 Why would it nearly always be a combination of greatest influence? Justify your choice and
factors that lead to anxiety or depression? discuss your responses with the rest of
7 Mike is 18 and has been experimenting with drugs the class.
and alcohol for the past three years. In the past 9 Use the Mental health case studies weblink
few months he has been feeling depressed and has in your eBookPLUS to find the link for this
lost his usual enthusiasm for life. As a result, he has question.
dropped out of his TAFE course and quit his part- (a) Read through some personal accounts of young
time job. Mike now relies on financial government people with mental health issues.
assistance but this has not been enough to support (b) Discuss these in small groups and identify ways
his lifestyle. At the moment he spends most of his that each individual’s health and development
days sitting around the house that he shares with has been or may be affected by their situation.
three friends, who are also alcohol and drug users. (c) Summarise the advice that has been provided by
(a) Identify the determinants of health and others to assist these individuals.
individual human development that may be (d) Brainstorm other ways that these individuals
affecting Mike. could improve their mental health.
KEY CONCEPT Understanding the key features of one health issue relevant
to Australia’s youth — government, community and personal strategies or
programs designed to promote the health and development of youth, health
care services available to youth and the rights and responsibilities of youth in
accessing and using relevant services
Both anxiety and depression have been the subject of numerous strategies that aim
to improve the health and individual human development of those experiencing
these conditions.
Australia’s health system also provides opportunities for youth to seek care
relating to their mental health and there are a range of rights and responsibilities
that apply to youth accessing these services.
Fewer people receiving such services, and that those missing out, men and
young people, were seeing little improvement in their
mental health treatment treatment.
‘We were shocked in 1997 to find that only 38 per
By Adam Cresswell, health editor
cent had access to services in the past year,’ Professor
A smaller proportion of people with a chronic Hickie said.
mental health condition is getting treatment now ‘Once that became clear, it became a goal to increase
than 10 years ago — a finding that has shocked access to care. If we were shocked in 1997, we are
experts and called into question the effectiveness staggered now. We should never have gone for 10 years
of the $1.8 billion poured into the neglected sector without knowing whether all the money we were
since 2006. spending was having any effect.’
National figures published by the Australian Bureau Professor Hickie called for new and innovative
of Statistics yesterday show that of the 3.2 million policies, such as delivering more mental health
people who had a mental health disorder in the previous care through community services, and better use of
12 months, only 35 per cent obtained treatment communications technologies and private providers.
services — less than the 38 per cent reported in the The study, conducted between August and December
previous survey in 1997. last year, indicated no reduction in the need for mental
And 2.1 million Australians recorded in the latest health treatment. It found 45 per cent of Australians
survey as having had a mental problem in the previous would experience a mental health problem at some
year did not use the health services, but felt they had stage in their lives, and that 20 per cent had a mental
missed out. problem in the past year.
The figures, contained in the latest National Survey Among people aged 16–24, the rate was more than
of Mental Health and Wellbeing, have prompted calls a quarter.
for a rethink of mental health policies. Mental Health Council of Australia chief David
Brain and Mind Research Institute executive Crosbie said the figures were deplorable.
director Ian Hickie, a long-standing advocate of ‘When you think it’s no better than it was 10 years
reform in mental health services, said many experts ago, and with all the investment and the rejigging of the
had expected the access figure to rise to at least 50 per existing system and the talk about reform, you have to
cent after the huge cash injections of recent years, wonder if it reaches real people in real communities,’
including the $1.8 billion package pledged by John he said.
Howard in 2006 and subsequent announcements by ‘As well as supporting the current system, we
most states. need a lot more new and different services, and
But Professor Hickie said that instead the report community-based services. The bottom line is we
showed Australia had been tipping ‘new money into are just not reaching people with a mental health
old services’ such as GP consultations. This meant disorder.’
the people benefiting the most, middle-aged women,
were the same people who had always most used Source: The Australian, 24 October 2008.
Medicare
Medicare is Australia’s universal health-insurance scheme. Established in 1984, it
gives all Australian citizens, permanent residents and people from countries with
a reciprocal agreement access to health care that is subsidised by the government.
Countries with a reciprocal agreement include New Zealand, the United Kingdom,
the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Malta and Norway.
As a result of this agreement, Australian citizens can also access subsidised health
care in those countries if they require treatment while abroad.
Youth aged 15 and over are able to apply for their own Medicare card. A
Medicare card can be used for:
• making a Medicare claim for a paid or unpaid doctor’s account
• visiting a doctor who bulk bills
• getting treatment as a public patient in a public hospital
• filling a Pharmaceutical Benefits Scheme prescription at a pharmacy
Youth enrolled in Medicare can receive subsidised treatment for a range of health
services including:
• doctors’ consultations (including specialists) and associated treatments
• tests and examinations by doctors
• x-rays and pathology tests
• eye tests performed by optometrists
• free treatment in public hospitals
• subsidised treatment in private hospitals.
Medicare covers most ‘clinically necessary’ hospital and doctors’ fees. Any
cosmetic or elective procedures are generally not covered. Other services not covered
Hospital care
Hospital emergency departments also play a significant role in treating mental
health issues and, in addition to GP consultations, can be the initial point of
contact with the health system for youth. A 2004 Victorian study of emergency
department presentations found that emergency departments were used as an
initial point of care for those seeking mental health-related services for the first
time, as well as an alternative point of care for people seeking after-hours mental
health care (Victorian Government Department of Human Services, 2006). In
2008–09, around 7 per cent of all hospital separations for those aged 12–24 were
related to mental health (AIHW, 2011). Almost two-thirds of the mental health-
related emergency department occasions of service were resolved without the need
for admission or referral. Most of the remaining mental health-related occasions of
service were admitted to hospital.
• The right to a second opinion. Regardless of the illness, all patients have the right
to a second opinion or to be dealt with by a different worker without fear of
victimisation.
• The right to use public health services. Most people residing in Australia have the
right to use Medicare, which can provide treatment free of charge. Those aged
15 and over are entitled to their own Medicare card.
• The right to help develop a treatment plan. Individuals have the right to assist in the
development of a treatment plan that suits them (figure 5.23).
• The right to refuse treatment. A person can usually refuse treatment. However, in
extreme cases, where the individual with a mental illness is a risk to themselves
or the community, they may be held against their will in a psychiatric hospital.
In these cases, the person does not have the right to leave that care but can
appeal against their detention.
• The right to complain about treatment. If the youth feels that their treatment has
not been satisfactory, they can lodge a complaint through the Health Services
Commissioner (www.health.vic.gov.au/hsc).
• The right to have a family member or friend present during consultations. Some
people feel more comfortable with a friend or relative present, and health
workers should respect this right.
• The right to be treated with respect and dignity. All human beings have certain
rights, including the right to dignity and respect. If a person feels that they
have not been treated with dignity and respect, a complaint can be made. In
addition to the range of rights, users of health care services also have a number
of responsibilities that include:
• The responsibility to give accurate accounts of medical history, and behavioural factors.
Health workers cannot decide on the best treatment options if they have only
half the story. It is therefore in the patient’s best interests to be completely honest.
Health workers are there to help, not to judge.
• The responsibility to keep appointments. Appointments can be difficult to get for
certain services. Every time someone fails to keep an appointment, another
person effectively misses out on care.
80
12–14 years
70 15–19 years
Deaths per 100 000 young people
20–24 years
60
50
40
30
20
10
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Figure 5.24 Injury and poisoning death rates for young people aged 12–24 years, 1997–2007
Source: Australian Institute of Health and Welfare, Young Australians: their health and wellbeing, 2011.
Overall, mortality rates due to injury and poisoning have decreased over time.❶
❶ A general statement is made relating
to the trend evident in the graph. Rates for those aged 15–19 decreased from around 45 deaths per 100 000 people
in 1997 to around 25 per 100 000 in 2007.❷ During the same period, mortality
❷ Data are used to support the general rates due to injury and poisoning decreased for those aged 20–24 from around
statement. 65 deaths per 100 000❸ to around 35 per 100 000. The mortality rates for those
aged 12–14 remained fairly stable over time at around 10 per 100 000. The graph
❸ Correct units are used. shows that those aged 12–14 are the least likely to die from injury and poisoning
compared to those aged 15–19 and those aged 20–24. Those aged 20–24 are most
❹ Conclusions are drawn. likely to die from injuries and poisoning of the three age groups.❹
0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Figure 5.25 Accidental poisoning death rates for young people aged 12–24 years,
1987–2007
Source: AIHW, Young Australians: their health and wellbeing, 2011.
1 Analyse the data relating to accidental poisoning death rates over time for males
and females and draw a conclusion about the differences between the two
groups.
2 Use the Young Australians weblink in your eBookPLUS to find the eBook plus
link for this question.
(a) Find data relating to an issue of your choice.
(b) Analyse the data and draw a conclusion relating to your selected health issue.
Suicide
Undetermined intent
Accidental poisoning
Assault Male
Female
Exposure to other factors
Accidental falls
Accidental drowning
Injuries contribute more to mortality for youth in Australia than any other cause,
⓫ A range of sources are used.
with land transport accidents the single greatest cause of injuries, followed by
suicide (AIHW, Young Australians: their health and wellbeing, 2011).⓫ As shown in
⓬ Information relating to hospitalisation
figure 5.26, males experience a greater percentage of injury deaths than females. rates is presented. Note that no
Hospitalisation analysis of the information is required
Rates of hospitalisation due to injuries are shown in figure 5.27.⓬ These for this key skill.
data show that males and females in the 15–19 age group are more likely to be
hospitalised due to injuries compared to those aged 12–14 and 20–24. In all age ⓭ Differences and similarities between
males and females are identified.
groups, males are more likely to be hospitalised than females.⓭,⓮
⓮ Students should state what the data
show rather than merely including a
graph.
4,000
Males
Hospital separations per 100 000 young people
3,500 Females
3,000
2,500
2,000
1,500
1,000
500
0
12–14 15–19 20–24
Age group (years)
Figure 5.27 Injury hospital separation rates for young people 2008–09⓯ ⓯ Information is presented in a range of
Source: AIHW, Young Australians: their health and wellbeing, 2011, p. 35. ways.
3 marks
7 Select one of the issues identified in question 6 and describe it briefly.
Issue selected _____________ Description __________________________________________
4 marks
For instance, males aged 12–14 experienced a hospitalisation rate of around 2500
⓲ Statements relating to injuries among
hospitalisations per 100 000 people, compared to around 900 hospitalisations per Australian youth are made, with
100 000 people for females.⓲ data from the graph used to provide
Those aged 15–19 were significantly more likely to be hospitalised than those statistical evidence.
aged 12–14. For example, rates for males aged 12–14 were around 2500 per 100 000
compared to rates of around 3500 per 100 000 people for males aged 15–19.⓳ ⓳ Trends relating to hospitalisations
are identified based on the data
Land transport accidents were the most common cause of injury death among presented.
Australian youth in 2007. Around 35 per cent of all injury deaths were due to land
transport accidents, with males accounting for around three-quarters of all land
transport deaths.
The TAC’s ‘Everybody Hurts’ campaign utilises media (including social media) to
⓴ Elements of TAC’s ‘Everybody Hurts’
reach its audience. Young people are often engaged in social media so may be more campaign are discussed.
likely to be exposed to its message. Everybody Hurts aims to educate people by
accessing their social media profiles and making personalised messages relating to Possible limitations of the campaign
the impact of injuries sustained on roads.⓴ are identified.
Not all young people at risk of road injuries access social media and not all will
be exposed to the ‘Everybody Hurts’ message. Youth is a time of risk taking for A conclusion is drawn and points
some individuals and even if they are exposed to the Everybody Hurts campaign, made to support the conclusion.
they may not respond to the message within it.
Overall, the Everybody Hurts campaign is effective as it targets speed, which The likely impact of the campaign is
outlined.
is a major cause of land transport accidents, the major cause of injury death
among young people. The campaign acts to reach young people via media that
they engage in, particularly social media. This may encourage youth to think
twice about risk taking on the road and may decrease the rate of injury death
among youth.
• Rehabilitation services
A range of services available to youth
are identified. • Allied health professionals such as physiotherapists
Youth have a number of rights and responsibilities when accessing health
A range of rights relating to accessing services, including:
health care services (including • Those aged 15 and over have a right to obtain their own Medicare card and use
Medicare) are discussed. Medicare-funded services. This allows youth to make their own appointments
for consultations and treatments.
A range of responsibilities are • Youth have a right to choose their own general practitioner (GP). Medicare
discussed.
subsidises the cost of GPs’ services regardless of which GP the individual
accesses.
• Youth have a right to have their privacy protected. Consultation and treatment
plans are not discussed with other people. This includes parents, provided the
youth is considered to be mature.
• Youth have a responsibility to be honest with their health care professional with
regards to their medical history and relevant behavioural factors so the most
appropriate type of care can be provided.
• Youth have a responsibility to keep all medical appointments. This assists the
health care system in treating as many people as possible.
Chapter summary
• Overweight and obesity rates have increased in recent decades and this is a risk factor
for a range of other health concerns such as psychological distress, cardiovascular Interactivities:
disease and type 2 diabetes. Increased consumption of energy-dense foods and a Chapter 5 crossword
decrease in physical activity levels have contributed to this issue. Searchlight ID: int-2897
• Injuries are the leading cause of death for youth and are higher for males. Chapter 5 definitions
• Youth is a stage of experimentation, but tobacco, alcohol and drug use can have far- Searchlight ID: int-2898
reaching implications.
• Tobacco smoking rates have decreased over time, but smoking still poses a risk to
the health of many individuals. The youth stage of the lifespan is when most lifelong
smokers develop their habit.
• Binge drinking increases the risks associated with alcohol consumption.
• Rates of STIs have increased over time, especially chlamydia infection.
• Anxiety and depression cause the largest burden of disease among Australian
youth.
• There are a number of other mental illnesses that affect young people such as bipolar
disorder, schizophrenia, eating disorders and substance use disorders.
• Mental illnesses affect the health and development of youth in many different ways.
• Up to 70 per cent of youth with a mental illness do not seek help.
• The rates of mental illness have been fairly stable over the 10 years to 2007.
• The death rates for mental and behavioural disorders decreased significantly in the
years to 2004.
• Biological, behavioural, environmental and social determinants can either protect a
person against, or put them at risk of, developing a mental illness.
• A number of strategies have been implemented to address the issue of mental illness in
Australian society, including SANE Australia and Youthbeyondblue.
• Personal strategies such as relaxation and communication can protect individuals from
mental illness.
• A range of health care services are available to youth, many of which are fully or
partially funded by Medicare.
• Medicare is Australia’s universal health insurance scheme.
• Services covered by Medicare include general practitioners, specialist services and
hospital treatment.
• Young people have rights when accessing mental health services including the
right to:
–– privacy
–– a second opinion
–– use public health services
–– help develop a treatment plan
–– refuse treatment
–– have a person present with them
–– be treated with respect and dignity.
• The responsibilities associated with using these services include the responsibility to:
–– give the health worker accurate health information
–– keep appointments
–– tell medical staff if they are not going to follow treatment plans
–– work with medical staff to optimise treatment
–– treat others with respect and dignity
–– respect the privacy of others.
KEY SKILLS
• describe the characteristics of physical development from conception
to birth
• interpret data on the health status of pregnant women and
unborn babies
The start of human life is dependent upon the genetic material provided by each
parent. In order to gain an understanding of the prenatal stage of development, we
will first explore fertilisation and the cells required for this process to occur.
Fertilisation
Fertilisation (sometimes referred to as conception) occurs when a sperm penetrates
an ovum and the genetic materials fuse together to make a single cell called a
zygote. The zygote contains 23 chromosomes from the sperm and 23 chromosomes
from the ova. The individual resulting from this single fertilised cell will therefore
display some characteristics of each of their parents and many combinations of
the two (figure 6.2). Body cells split in different ways each time a sperm or egg is
created, resulting in the vast variation typically seen among siblings.
46 46
chromosomes chromosomes
46 46 46 46
chromosomes chromosomes chromosomes chromosomes
Figure 6.2 When sperm and ova form, normal body cells split to contain half the genetic
material of a normal cell.
Fallopian tubes
Uterus
Uterine wall
Ovum Ovary
2 Sperm swimming through
uterus and tubes
3 Fertilisation of
ovum by sperm Cervix
Vagina 1 Sperm deposited in
vagina during sex
Figure 6.3 Fertilisation takes place in one of the fallopian tubes and the complete cell
moves into the uterus, where it implants in the lining of the uterus.
In-vitro fertilisation
Around one in five couples experience fertility problems and rely on other methods
to carry out the process of fertilisation. One of the most common techniques used
to assist with fertilisation is called in-vitro fertilisation. In-vitro fertilisation involves
extracting ova from the woman’s ovaries and mixing them with sperm outside
the woman’s body, often in a petri dish. If a zygote is created in this way, it can
be implanted in the woman’s uterus using a long, hollow needle, or frozen to be
implanted in the future (see figure 6.4).
Step one — Injection of Step two — Extraction of ova Step three — fertilisation Step four — incubation Step five — implantation
hormones
Fallopian Ovary Ova are
tube Uterus extracted
Ova
Sperm
Cervix
Vagina
Hormones are Ova are extracted Sperm and ova are The zygote is incubated The zygote is placed in the
injected to promote from the ovary. mixed in a petri dish at 37 degrees for around uterus using a flexible tube.
the maturation of to allow fertilisation 2 days (until the zygote
multiple ova. to occur. consists of around 8 cells).
Figure 6.4 The steps involved in the in-vitro fertilisation process
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 177
6.1 Fertilisation
TEST your knowledge (c) Which chromosome must the sperm have
to create:
1 When does sperm production begin in males?
i. a girl?
2 When are ova formed?
ii. a boy?
3 Where is an ova fertilised for most couples?
(d) How long does an egg survive after ovulation?
4 Explain why babies show traits of both parents.
(e) Why is it important for millions of sperm to be
5 Use a flow chart to outline the process of
released?
fertilisation.
(f) How does the egg ensure that only one sperm
6 Use a flow chart to outline the process involved in
penetrates it?
in-vitro fertilisation.
(g) Why is it important that only one sperm enters
7 Explain why twins are more common with in-vitro
the egg?
fertilisation.
(h) What is a fertilised ovum called?
(i) Explain how the fertilised egg ends up with half
APPLY your knowledge
the mother’s chromosomes and half the father’s.
8 Why would it be important for both the mother 0 Use the IVF weblink in your eBookPLUS
1
and father to maintain good health leading up to find the link for this question. eBook plus
to pregnancy? (a) For how long does the menstrual
9 Use the Fertilisation weblink in cycle last?
your eBookPLUS to find the link eBook plus
(b) When is the egg released?
for this question. (c) How are the eggs drawn from the ovary?
(a) What is the entrance to the uterus called? (d) How is the embryo transferred back into
(b) Where are the chromosomes located in sperm? the mother?
Embryonic
(3–8 weeks)
Figure 6.6 Stages of prenatal
development
Germinal stage
The germinal stage starts at fertilisation and ends with implantation.
Implantation begins around day five and ends around days 10–12. When
fertilised, the newly formed cell (zygote) travels down one of the fallopian tubes
while constantly dividing. Around three to four days after fertilisation, when there
are about 16 cells, the zygote takes on a spherical shape and is now known as
a morula. At around five days after fertilisation, when it is made up of around
64 cells, the morula transforms to include an outer cell mass, an inner cell mass
and a hollow, fluid-filled centre called the blastocyst cavity. At this stage, the
morula is known as a blastocyst. The inner cell mass of the blastocyst will become
the embryo and the outer cell mass will eventually become the placenta.
When it reaches the uterus, the blastocyst implants itself in the endometrium.
At this point, it becomes known as an ‘embryo’.
Embryonic stage
The embryonic stage starts at implantation and ends at the eighth week. This
stage is characterised by cell differentiation. This is when the cells start taking on
specialised roles such as heart cells, skin cells and bone cells.
This stage is perhaps the most critical for human development. Most internal
and external organs and systems are formed during this stage, and the brain and
spinal cord are almost complete by the end of it (although they will grow in size
and increase in complexity for years to come).
While the embryo is only around 2 centimetres in length by the end of this
stage, many of the internal organs and systems have begun to form. These include
the circulatory system, the stomach and kidneys, lungs, the nervous system and
the digestive system. Although sex is determined at conception, the internal sex
organs begin to form during the embryonic stage but will not be complete for
another eight weeks.
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 179
6.2 Prenatal development
The limbs start out as buds emerging from the torso and continue to grow
and develop during this stage. Fingers and toes also begin to form by the end of
the embryonic stage. By the eighth week, the embryo becomes distinctly human
looking, although the head and neck still account for around half the embryo’s
total length and the brain makes up almost half of its body weight.
Because major organs and systems are formed during this time, the embryo is
very sensitive to environmental influences. Teratogens such as tobacco, alcohol
and medication are particularly influential during this stage of development.
At the eighth week, the embryo has begun to form every major organ and system,
and many are close to completion. In fact, 90 per cent of the structures found in
an adult human can be found in an eight-week-old embryo. The remainder of the
prenatal stage is characterised by rapid growth and the maturing of these organs.
Foetal stage
The foetal stage starts at the ninth week of pregnancy and continues until birth at
around 40 weeks (figure 6.7). During this stage the unborn baby is referred to as
a ‘foetus’. The foetus measures only a few centimetres in length at the beginning of
this stage and about 50 centimetres by the end. Although this stage is characterised
by rapid growth, many other developmental milestones occur as well.
Embryo Foetus 16 20 24 28 32 36 40
at 8 weeks at 12 weeks
Figure 6.7 The growth pattern of the foetus
All organs and systems formed in the embryonic stage — including the lungs,
digestive system, liver and kidneys — mature and are functioning in the early
stages of foetal development.
The placenta is fully developed and functioning at 14 weeks. It is a disc-shaped
temporary organ, largely made up of blood vessels that facilitate the exchange of
substances between mother and foetus. The placenta acts like a kidney, lung and
digestive system for the foetus by supplying the foetus with oxygen, nutrients and
immune support, and removing wastes such as urine and carbon dioxide. It is
connected to the foetus by the umbilical cord, which is made up of two arteries
and one vein. The umbilical vein supplies the foetus with nutrient-rich oxygenated
blood from the placenta, and the umbilical arteries return deoxygenated and
nutrient-depleted blood to the placenta. The placenta is also connected to the
uterus of the mother, and her blood forms pools in the placenta. The blood
vessels of the umbilical cord complete a ‘U-turn’ while passing through pools of
the mother’s blood in the placenta. This allows the exchange of nutrients, oxygen
and wastes through the thin walls of the placenta without the foetal blood coming
into direct contact with the blood of the mother (see figure 6.8). The placenta also
produces hormones, such as progesterone, that assist in maintaining pregnancy.
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 181
6.3 The health status of Australia’s pregnant women
and unborn babies
More than a quarter of a million babies are born in Australia each year. The health
of pregnant women is vital to ensure that these babies develop optimally and are
in the best possible health throughout the pregnancy and when born. Babies born
healthy are more likely to experience good health throughout their life. Pregnant
women and unborn babies in Australia generally experience a high level of health,
although there are some exceptions to this. Examining the health of pregnant
women and their unborn babies helps identify where improvements to health may
be possible.
Perinatal mortality
Perinatal mortality relates to the death of babies before birth (over 20 weeks
gestation) and up to 28 days after birth. In 2009, the perinatal mortality rate was
estimated to be 9.2 perinatal deaths for every 1000 births. Perinatal death rates
vary for different population groups in Australia. In 2009, the perinatal death
rate per 1000 total births ranged from 8.6 for babies of mothers aged 25–29 to
14.2 for babies of mothers aged 40 or older. The perinatal death rate for babies
of teenage mothers was 12.8 per 1000 births. Babies born to Aboriginal or Torres
Strait Islander mothers had a perinatal mortality rate twice that of babies born to
non-Indigenous mothers.
Improvements in perinatal mortality rates have been made over the past 30 years,
with rates now around a quarter of those reported in the 1970s. Rates are now
lower in Australia than other comparable developed countries (figure 6.9).
20
United Kingdom
United States
Number per 1000 births
15 New Zealand
Canada
Australia
10
0
1978 2005
Year
Note: Data are based on the WHO definition of perinatal mortality, which includes deaths of at least
1000 grams birthweight, or 28 weeks gestation (if birthweight is unavailable), and neonatal
deaths of up to 7 completed days after birth. This differs slightly from the definition used in
Australia for the National Perinatal Data Collection, which includes all deaths of at least 400g
birthweight or at least 20 weeks gestation, and includes neonatal deaths within the first 28 days.
Figure 6.9 Perinatal mortality trends, Australia and other selected countries, 1978–2005
Source: Australian Institute of Health and Welfare, Australia’s health 2012, page 63.
35%
26%
Other causes
Congenital abormalities
Spontaneous preterm births
Figure 6.10 Causes of perinatal
Unexplained antepartum deaths mortality, per cent of total, 2009
Source: Adapted from Li Z, Zeki R, Hilder L &
Sullivan EA, 2012. Australia’s mothers and babies
2010. Perinatal statistics series no. 27. Cat. no.
16% PER 57. Canberra: AIHW National Perinatal
23% Epidemiology and Statistics Unit.
Prenatal morbidity
Many causes of morbidity among unborn babies go undiagnosed until after birth.
As a result, data are not available relating to many aspects of health status in the
prenatal stage. Conditions that may be diagnosed in unborn babies include neural
tube defects and Down syndrome.
Neural tube defects
The neural tube is a casing that encloses the brain and spinal cord
during the embryonic stage of development. The edges of the neural
tube fuse together in around the third week of pregnancy. Neural tube
defects (NTDs) are a group of conditions that occur when the neural
tube does not fuse completely. The part of the neural tube that does
not fuse will determine the type of defect experienced (see figure 6.11).
These conditions can lead to morbidity and mortality in unborn babies,
depending on their location and severity.
There is strong evidence that adequate folate intake can reduce the
risk of NTDs in unborn babies. The neural tube fuses early during the
pregnancy and many women may not know they are pregnant at this Spina bifida Anencephaly Encephalocele
point in time. As a result, women who may become pregnant should Figure 6.11 The area of the neural
ensure that adequate amounts of folate are being consumed prior to tube affected will determine the type
fertilisation where possible. of neural tube defect experienced.
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 183
6.3 The health status of Australia’s pregnant women and unborn babies
Based on data from the three Australian states that fully monitor NTDs (Victoria,
South Australia and Western Australia), there has been a small decline in the overall
prevalence of NTDs per 10 000 births between 1998 and 2008 (figure 6.12). The
introduction of mandatory fortification for all commercially baked bread (except
organic bread) is thought to be largely responsible for this decrease.
15
12
6
Figure 6.12 Overall prevalence of
neural tube defects in Victoria, South
Australia and Western Australia, 3
1998–2008.
Source: Australian Institute of Health and Welfare, 0
Australia’s health 2012, page 62. 1998 1999 2000 2000 2002 2003 2004 2005 2006 2007 2008
Year
Down syndrome
Down syndrome is a condition caused by a chromosomal abnormality. For people
with Down syndrome, there are three chromosomes on the twenty-first pair instead
of the usual two (see figure 2.23, page 58). This extra chromosome
produces a number of symptoms common to many people with this
condition, including:
• Eyes — nearly all people with Down syndrome have a slight upward
slant of the eyes.
• Face — this is often rounded and tends to have a flat profile.
• Stature — babies with Down syndrome are usually smaller and
weigh less at birth than others. Children tend to grow more slowly
and are commonly smaller than other children their age. Adults with
Down syndrome are commonly smaller than the general population.
• Slowed intellectual development — those with Down syndrome
will reach the same milestones as other babies, but may take longer
Figure 6.13 This little girl displays to achieve them.
the facial features typical of Down Besides slowed intellectual development and the physical characteristics,
syndrome. individuals with Down syndrome are no different to others in the population.
Down syndrome is the most common chromosomal abnormality in Australia
and between 45 and 60 babies are born with Down syndrome every year.
Maternal morbidity
Vast changes occur in a woman’s body during pregnancy, and a range of conditions
can develop as a result. Common conditions during pregnancy include gestational
diabetes, mental health issues, pre-eclampsia and ectopic pregnancy.
Gestational diabetes
Gestational diabetes is a form of diabetes that can occur during pregnancy in
women who have not previously been diagnosed with diabetes. Like all forms
of diabetes, gestational diabetes is characterised by high blood glucose levels.
Gestational diabetes usually goes away after pregnancy but can return during
subsequent pregnancies.
High blood
glucose levels
in mother
Gestational diabetes occurs in around 5 per cent of all pregnancies and is more
common in older women and those who are obese. This condition can impact on
women in numerous ways including:
• high blood pressure
• pre-term labour
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 185
6.3 The health status of Australia’s pregnant women and unborn babies
Mental health
Maternal mental health issues such as depression have been traditionally associated
with the period after birth, but research now suggests depression is a significant
cause of ill health among pregnant women. According to the Australian Institute
of Health and Welfare, around 8.9 per cent of Australian women experience
depression during pregnancy. This figure increases to 15.7 per cent in the period
after birth (AIHW, 2012). Although mental health problems during pregnancy can
often be treated, in some cases they can contribute to self-harm and increased risk
of maternal mortality.
Pre-eclampsia
Pre-eclampsia is a disorder of pregnancy characterised by hypertension, protein in the
urine and fluid retention (also known as oedema) leading to swollen hands, feet and
face. Pre-eclampsia is the most common pregnancy disorder in Australia, affecting
between 5 and 10 per cent of all pregnant women. One to two per cent of cases are
severe enough to threaten the lives of both the mother and her unborn child.
Protein in the urine
Oedema
Pre-eclampsia generally occurs in the latter stages of pregnancy and often displays
no symptoms. As a result, regular medical check-ups throughout pregnancy are
recommended.
The only cure for this condition is the delivery of the baby. Pre-eclampsia
accounts for one in five inductions and one in six Caesarean sections in Australia.
The reasons for the development of pre-eclampsia are not known, but genetic
factors and the placenta seem to play significant roles. For reasons unknown, pre-
eclampsia tends to be more common in first-time mothers than those experiencing
subsequent pregnancies. The mother’s blood pressure usually returns to normal
after the baby and placenta are delivered.
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 187
KEY SKILLS Determinants of prenatal health and development
9
8
7
6
5
4
3
2
1
0
5
5
97
97
98
98
98
99
99
99
99
00
00
1
2
3–
6–
9–
2–
5–
8–
1–
4–
7–
0–
3–
7
0
19
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19
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19
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19
20
20
Figure 6.17 Maternal mortality rate, per 100 000 women giving birth
In the following example, the data in figure 6.17 are analysed and conclusions
❸ Rates have decreased overall, but
drawn about the health status of Australia’s pregnant women. there were some increases. Including
In describing the trends evident in this graph, the following three statements can the qualifier ‘generally’ takes this into
be made. However, there are important considerations to be taken into account. account.
• Generally,❸ maternal mortality rates decreased between 1973–75 and 2003–05.❹
• Maternal mortality rates were around 8.2 deaths per 100 000 women giving ❹ Reference is made to the span of
years over which the trend occurred.
birth in 1973–75 compared to around 3.8 per 100 000 women giving birth in Try to avoid making statements such
2003–05.❺ as ‘maternal mortality rates have
decreased’, as this indicates that the
• There were three periods of time when maternal mortality rates increased. trend is currently occurring when the
These increases were relatively minor, with the exception of the period between data do not support this.
1991–93 and 1994–96 when rates increased from around 3.5 to 6 deaths per
100 000 women giving birth.❻ ❺ Data from the graph are used and
the correct units and time periods
identified.
14
12
10
0
Younger than 20–24 25–29 30–34 35–39 40 and over
20
Age of mother
Figure 6.18 Perinatal mortality rate per 1000 births
Health and individual human development during the prenatal stage of the lifespan • CHAPTER 6 189
CHAPTER 6 review
Chapter summary
eBook plus • Sex cells such as sperm and ova hold genetic material from each parent.
• Fertilisation is the process whereby the genetic material of the sperm and ovum fuse
Interactivities: together to make a complete cell called a zygote. This process usually occurs in the
Chapter 6 Crossword fallopian tube.
Searchlight ID: int-2899 • In-vitro fertilisation can be used when fertilisation cannot occur naturally. In IVF,
fertilisation occurs outside the mother’s body and the embryo is placed in the uterus in
Chapter 6 Definitions
the hope that implantation will occur.
Searchlight ID: int-2900
• Intracytoplasmic sperm injection involves injecting a single sperm into an ovum. This
procedure can be used when the sperm cannot fertilise the ovum naturally.
• Fertilisation marks the beginning of the prenatal stage of the lifespan.
• The prenatal stage can be divided into the germinal, embryonic and foetal stages.
• Growth during the prenatal stage is the fastest of all lifespan stages.
• Teratogens can have a large impact on the developing baby.
• The germinal stage is characterised by rapid cell division.
• The embryonic stage is characterised by organ development.
• The foetal stage is characterised by rapid growth.
• The placenta is an organ that facilitates the transfer of nutrients, liquids and gases from
mother to baby.
• Most mothers and their unborn babies experience good health in Australia, although a
number of health concerns do occur.
• Perinatal mortality rates relate to deaths that occur in babies from 20 weeks gestation
up to 28 days after birth.
• Perinatal mortality rates are comparatively low in Australia, although some population
groups experience higher rates that the national average. Younger mothers, older
mothers and Indigenous mothers all experience higher perinatal mortality rates than the
average.
• The main causes of perinatal mortality are congenital abnormalities, spontaneous
preterm birth and unexplained antepartum death.
• Neural tube defects and Down syndrome are two conditions that are often diagnosed
during pregnancy.
• Maternal mortality rates relate to deaths of pregnant women. Maternal mortality rates
are low in Australia.
• Causes of maternal morbidity include gestational diabetes, mental health issues, pre-
eclampsia and ectopic pregnancy.
The prenatal stage of the lifespan is when the foundations are laid for later life.
Optimal health and development during this stage is important to help promote
optimal heath and development throughout the lifespan.
The health and individual human development of unborn babies are influenced
by a range of factors including:
• biological influences such as genetics
• behavioural factors, such as maternal nutrition prior to and during pregnancy,
parental smoking, alcohol and drug use during pregnancy, and vaccination
• physical environment, such as tobacco smoke in the home and access to
health care
• social factors, such as parental education, parental income, parental health and
disability, and access to health care.
Understanding the determinants that influence the health and development
experienced during the prenatal stage allows personal, community and government
strategies to be implemented to optimise the health and development of unborn
babies in Australia.
Biological determinants
Genetics
An unborn baby begins life as a single cell containing the genetic information
passed down from the mother and father. This information dictates much of the
individual human development that occurs throughout the prenatal stage and
throughout life.
In chapter 6, you learnt how, at fertilisation, the genetic make-up of the unborn
child is determined. The genes that a child inherits from their biological parents
have a significant impact on the child’s health and individual human development.
Genes are the blueprint of the body because they control growth, development and
how the body functions. An unborn baby’s genetic make-up determines:
• the rate and timing of development in the uterus as a result of the excretion of
hormones from the glands of the endocrine system
• whether the unborn baby is male or female
• the development of genetic conditions such as haemophilia
• the development of chromosomal abnormalities including Down syndrome.
Genes are part of the chromosomes, which are long strands of deoxyribonucleic
acid (DNA) that contain genetic information and are found in the nucleus of human
cells. Each human cell — except blood cells, which have no nucleus — contains
46 chromosomes in 23 pairs. Of the 23 pairs, one pair is called the ‘sex-linked’
chromosome because it determines the sex of the individual. Our genetic make-up
is determined by the combination of genes that occur at the point of fertilisation.
Fifty per cent of an individual’s genes are passed down from the biological father
and 50 per cent from the biological mother. It is this combination of genes that
determines the physical characteristics of the individual (e.g. facial features, sexual
characteristics and eye colour), as well as genetic conditions and chromosomal
abnormalities.
Mother Father
Carrier Carrier
(no symptoms) (no symptoms)
Each child inherits one copy of the gene from
the mother and one copy from the father.
Possible combinations:
This individual has only one cystic Normal Carrier Carrier Affected This individual has two defective
fibrosis gene so will not have the genes and will therefore have
condition, but will be a carrier. cystic fibrosis.
Chromosome with normal gene
Although cystic fibrosis can be detected in the prenatal stage, it is often not
diagnosed until the baby is born. This condition results in the secretion of a thick
mucus that affects the lungs, pancreas, liver and reproductive system. In the lungs,
the mucus clogs small air passages and traps bacteria. This causes repeated bouts of
infection, and the blockages can result in irreversible damage to the lungs.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 195
7.1 D
eterminants of health and individual development during the prenatal
stage of the lifespan: biological
When the father has haemophilia and When the mother carries the altered gene
the mother is unaffected causing haemophilia and the father is unaffected
Father Mother Father Mother
XY XX XY XX
XY XY XX XX XY XY XX XX
None of the sons will have haemophilia. There is a 50% chance at each birth that a son will have haemophilia.
All of the daughters will carry the gene. There is a 50% chance at each birth that a daughter will carry the gene.
Some might have symptoms. Some might have symptoms.
© Haemophilia Foundation Australia (HFA) 2013 www.haemophilia.org.au
Figure 7.4 Haemophilia is a genetic condition that is carried on the ‘X’ chromosome.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 197
7.1 D
eterminants of health and individual development during the prenatal
stage of the lifespan: biological
Maternal nutrition
For women of child-bearing age, ensuring a healthy balanced diet prior to becoming
pregnant is important for preparing the body for the demands of carrying a baby. A
woman’s nutritional status during pregnancy is dependent on the nutritional reserves
that are built up in her body prior to conception. Women who have nutritional
deficiencies prior to conceiving a child are likely to have these deficiencies during
pregnancy, particularly as the body faces additional nutritional demands because
of the growing baby. It is particularly important that women consume the required
amount of folate, iron and calcium prior to and during pregnancy.
Ensuring good nutrition prior to conception is also important because the
ongoing development of the foetus is dependent on the health of the embryo.
Upon implantation, the embryo divides into two types of cells — those that
form the foetus and those that form the placenta. In undernourished women, a
greater proportion of cells are likely to form the placenta rather than the foetus,
which means the foetus will be relatively small when it begins its growth, and its
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 199
7.2 D
eterminants of health and individual development during the prenatal stage
of the lifespan: behavioural
development in the uterus will be restricted. There is an increased risk that the
baby will be low birth weight when born.
Iodine
Iodine is a mineral that is required in greater amounts during pregnancy
to promote optimal brain and nervous system development. If iodine
is deficient during pregnancy, the consequences can be serious and
include stunted growth and intellectual disability.
Countries that have a sufficient iodine concentration in the
soil generally get enough iodine from crops grown on the land.
In countries that do not have enough iodine in the soil (such as
Australia), iodine is added to other food items. In Australia, most
iodine comes from iodised salt and bread fortified with iodised salt,
but is also present in fish, seaweed, eggs, cow’s milk and strawberries.
Australians are reducing their intake of salt as a result of the
increasing rates of cardiovascular disease, so people are now at
an increased risk of iodine deficiency and need to ensure their
requirements are being met by other dietary sources, especially
Figure 7.7 Pregnant women during pregnancy. In Australia, recent studies conducted in Victoria and New
need to choose a wide variety South Wales indicate mild-to-moderate iodine deficiency in all groups.
of foods in order to meet the
nutritional requirements of
their baby. Iron
Iron is a mineral that is required in greater amounts during pregnancy due to the
increased demand for oxygen for the developing foetus as well as the increased
energy needs of the mother. During pregnancy, there is an increase in blood volume
to cater for the developing baby as well as the enlarging reproductive organs of
the mother. Iron is needed for haemoglobin, a component of blood that carries
oxygen around the body. Good sources of iron include red meat, fortified cereals,
Calcium
Calcium is required for the strengthening of bones and teeth. During pregnancy,
calcium is required to meet the needs of the developing foetus as well as ensuring
the maintenance of bone mass for the mother. Good food sources of calcium
include dairy products such as milk, cheese and yogurt. If a pregnant woman
does not consume the required amount of calcium-rich foods, the calcium that the
developing baby needs will be leached (or taken) from the mother’s bones. This
could lead to osteoporosis in later life.
To ensure that the dietary needs of the mother and baby are met, pregnant
women should choose from a wide variety of foods. These include:
• plenty of fruits and vegetables
• plenty of wholegrain breads and cereals
• moderate amounts of low-fat dairy foods and lean meats, chicken and fish
• small amounts of foods high in fat, sugar and salt
• dried beans and lentils, and nuts and seeds.
Some foods contain the bacteria Listeria monocytogenes, which increase the risk
of miscarriage, stillbirth or premature labour. For this reason, pregnant women
should avoid the following foods:
• soft-serve ice-cream
• unpasteurised foods and soft cheeses such as camembert and ricotta
• pre-cooked or prepared cold foods such as quiches, delicatessen meats, salad
from buffets
• raw seafood such as oysters and smoked seafood such as salmon.
Foods that contain high levels of mercury can put the baby at risk of delayed
development in the early years. The effects may not be noticed until the child
fails to reach developmental milestones at the expected age. It may also result
in difficulties with memory, language and attention span. Women need to be
selective about the type of fish they consume during pregnancy, as some fish have
significantly higher levels of mercury than others. Shark, swordfish, barramundi,
gemfish, orange roughy and southern bluefin tuna should all be avoided.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 201
7.2 D
eterminants of health and individual development during the prenatal stage
of the lifespan: behavioural
Table 7.1 Women who gave birth, by tobacco smoking status during pregnancy and state and
territory, 2010
Did not smoke 88.7 86.3 81.8 83.7 81.1 76.2 88.4 67.8 85.2
Total 100 100 100 100 100 100 100 100 100
Source: Adapted from Australian Institute of Health and Welfare, Australia’s mothers and babies 2010.
Source: Adapted from ‘Foetal alcohol syndrome’, Better Health Channel, www.betterhealth.vic.gov.au.
Case study
Please don’t do what I did, ‘I went to so many doctors who didn’t want to listen,
wouldn’t give me any information or referrals.’
pleads mother who drank She decided to attend a conference on FAS in
Canada and met a doctor who was able to diagnose
By Renee Switzer
her boys using their background information and from
Elizabeth Russell lives with the guilt that she ruined viewing their facial features on a photograph. ‘I felt
her sons’ lives after drinking during her pregnancies. absolutely distraught. I felt guilty that I had risked my
But now she is trying to prevent other women from son’s (health) and I had more or less ruined his life.’
unknowingly doing the same. Ms Russell said she had ‘absolutely no idea’ about the
Ms Russell is a recovering alcoholic who in 2001 risks of drinking alcohol while pregnant.
found that her addiction had physically harmed her two ‘I stopped smoking and I took vitamins and had no
sons. Her elder son, 26, was diagnosed with ‘alcohol idea that alcohol could cause any damage. In fact, my
exposed neurodevelopmental disorder’ and the younger doctor basically said to me alcohol wasn’t a problem’.
son, 22, has full foetal alcohol syndrome (FAS). Since her sons have been diagnosed Ms Russell has
People with these conditions are born with birth written two books on her family’s experience with FAS
defects that can involve brain damage, as well as as well as others’ experiences. She is now fighting to
facial abnormalities. As adults they can experience have national alcohol guidelines changed to advise
developmental delays, learning difficulties and women to avoid all alcohol while pregnant. ‘From
behavioural problems. personal experience with friends of mine, doctors are
But for Ms Russell, it wasn’t until her boys were still saying it’s OK to drink when you’re pregnant.
older, and she had seen a number of doctors, that their Abstinence is by far the best and I’ll fight to the end
conditions were diagnosed. about that because abstinence says it’s crucial, whereas
‘My youngest son was getting into a lot of trouble (the current guidelines) are sort of nonchalant, it’s not
from 13 years on and before that he had some strange really going to matter and, boy, it matters.’
behaviours. But when he was working he started using Ms Russell is also lobbying to have diagnostic clinics
drugs, alcohol, going out in the middle of the night. I just set up in major cities around the country so that alcohol
didn’t know what was going on with him,’ she said. ‘He’d related conditions can be identified.
been diagnosed with ADHD so I did some research on ‘There’s nobody who is able to diagnose properly in
that and then found out foetal alcohol syndrome existed.’ Australia. There are about 70 clinics in Canada and not
Ms Russell went to her doctor, who she says, asked one in Australia.’
her why she would put herself through such trauma. Source: The Age, 22 April 2007.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 203
7.2 D
eterminants of health and individual development during the prenatal stage
of the lifespan: behavioural
Vaccination
Vaccination plays an important role in reducing the spread of many conditions
in Australia. Even though over 90 per cent of the population are up to date with
their vaccinations, most vaccine preventable diseases still occur in Australia. The
prenatal stage of development is particularly susceptible to many of the effects of
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 205
7.3 eterminants of health and individual development during
D
the prenatal stage of the lifespan: physical environment
Aspects of a pregnant woman’s physical surroundings can impact on the health and
development of her unborn baby. Factors within the physical environment that
can impact on the unborn baby include tobacco smoke in the home and access to
health care.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 207
7.3 D
eterminants of health and individual development during the prenatal stage of
the lifespan: physical environment
Case study
TEST your knowledge 6 Suggest two ways in which prenatal health care
could promote the health and/or individual human
1 What is the difference between mainstream and
development of an unborn baby.
sidestream tobacco smoke?
7 Discuss two reasons why those who do not have
2 Explain why second-hand smoke can be particularly
health services near their homes may not access
damaging when indoors.
health care.
3 Discuss how tobacco smoke in the home can impact
8 Use the Environmental tobacco smoke weblink in
on the health and development of the unborn baby.
your eBookPLUS to find the link to this activity.
4 Outline the purpose of prenatal health care.
Watch the advertisement on environmental
tobacco smoke during pregnancy. Create eBook plus
APPLY your knowledge
another advertisement that educates about
5 Design a poster that could be used to educate the dangers of tobacco smoke in the home
people of the dangers of tobacco smoke in the during pregnancy.
home during pregnancy.
Once fertilisation has occurred, unborn babies rely on their mother to achieve
optimal health and development during the prenatal stage. The society in which
the mother lives and the social factors that impact on her life, will also contribute
significantly to the health and development of her unborn baby. Social factors
include parental education, parental income, parental health and disability, and
access to health care.
Parental education
The parents’ level of education can impact the developing baby in a number of ways.
Knowledge of health behaviours (also known as ‘health literacy’) can increase the
probability of parents caring for themselves in ways that promote the health and
development of their unborn baby. Accessing health care, consuming nutritious
food, being vaccinated, not smoking, avoiding teratogens such as alcohol and drugs,
and preventing illness are more likely to occur in those who are educated about the
benefits of maintaining optimal health during pregnancy. These behaviours promote
optimal health and individual human development in the unborn baby and reduce
the risk of conditions such as preterm birth, low birth weight and birth defects.
Parental education also increases employment opportunities and the ability to
generate an adequate income.
Parental income
Parental income is often related to the education of parents. Educated parents are
more likely to have a higher paying job and are more able to access a range of
health-promoting resources during the prenatal stage of the lifespan. Income can
improve the ability of parents to provide resources such as prenatal health care
and adequate nutrition which can enhance
2500 7
outcomes for the unborn baby by promoting Cases
optimal growth, health and development. Rate 6
Having an adequate income may also assist 2000
in decreasing stress levels as parents may be 5
more comfortable knowing they can provide
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 209
7.4 D
eterminants of health and individual development during the prenatal stage
of the lifespan: social
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 211
7.5 eterminants that act as risk and/or protective factors
D
in relation to one health issue
Neural crest
cell
Spina bifida
Spina bifida is a condition that occurs when the neural
tube (see figure 7.12) in the embryo fails to close properly
Day 24 The neural tube is (see figure 7.13).
formed The effects of spina bifida will vary from case to case,
1 depending on the number of nerves exposed and damaged.
2 In some cases, symptoms will be minor but in more
severe cases, the individual may be paralysed and require
3 assistance to carry out daily tasks such as feeding, washing
and toileting.
Neural tube
Figure 7.13 Spina bifida occurs when the neural tube fails to close properly during the
prenatal stage. As a result, the nerves of the spinal cord protrude out of the back instead
of running down the middle of the spinal cord. The nerves become damaged, leading to
moderate to severe disabilities.
Behavioural
The use of saunas and spas exposes the pregnant woman to a
hot environment and increases body temperature. Excess heat
during early pregnancy has been shown to increase the risk of
spina bifida (see figure 7.14).
Folate is a nutrient (also known as Vitamin B6) that is essential
for normal cell division and the production of new cells. Folate
is particularly important during periods of rapid growth, as
occurs during the prenatal stage. Folate has been shown to be a
significant protective factor in the development of spina bifida.
The neural tube closes early in the pregnancy, often before
the woman knows she is pregnant. As a result, all women of
childbearing age where pregnancy is possible should ensure
they consume adequate amounts of folate.
Physical environment
Exposure to excessive heat early in pregnancy may increase the
risk of spina bifida. If the physical environment is excessively
hot, the risk may be increased.
Exposure to agents such as solvents, pesticides and x-ray
radiation may increase the risk of spina bifida, although the
exact link is unknown.
The prevalence of spina bifida increases with remoteness of Figure 7.14 The use of spas during
residence. The exact reason for this trend is not known but it may be linked to reduced pregnancy can increase the risk of
access to health care and differences in food availability in rural and remote areas. spina bifida.
Social
Maternal fever raises body temperature and may increase the risk of spina bifida as Table 7.5 Prevalence of spina bifida
a result. Women who experience illness that increases body temperature may be at based on place of usual residence
an increased risk of having a baby with a neural tube defect. Prevalence of
In 2009, the Australian Government introduced mandatory fortification of bread Place of usual spina bifida (per
with folate. This aims to decrease the prevalence of neural tube defects as folate residence 10 000 births)
intake is increased. Major cities 5.5
Accessing health care prior to pregnancy can increase parental knowledge of Rural 6.5
folate intake and other precautionary measures such as avoiding hot environments.
Remote 11.1
This may reduce the risk of spina bifida.
Those with adequate education surrounding maternal nutrition and pregnancy Source: Adapted from Macaldowie A & Hilder L
2011. Neural tube defects in Australia: prevalence
may ensure folate intake is adequate prior to conception. This can decrease the risk before mandatory folic acid fortification. Cat. no.
of spina bifida in the unborn baby. PER 53. Canberra: AIHW.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 213
7.5 Determinants that act as risk and/or protective factors in relation to one health issue
In later life, low birth weight can contribute to high blood pressure, type 2
diabetes and cardiovascular disease.
Low birth weight can be classified according to three categories as shown in
figure 7.17. As birth weight decreases, the risk of health and development problems
increases. Those classified as having ‘extremely low birth weight’ have a higher risk
of complications compared to those classified as having a ‘very low’ or ‘low’ birth
weight.
There are many factors or determinants that can contribute to low birth weight.
These can be biological, behavioural, physical environment and social determinants.
Biological
Babies born under 37 weeks gestation have an increased rate of low birth weight.
Less time spent in the uterus means less time to grow and develop, especially in
the foetal stage, when the rate of growth increases significantly.
Maternal age also has a relationship with birth weight. Young mothers (especially
those under 15 years of age) and older mothers (those over 45 years of age) have
higher rates of low birth weight babies (see figure 7.18).
9
8
Percentage
5
15–19(a) 20–24 25–29 30–34 35–39 40 and over Figure 7.18 Prevalence of low birth
weight by age of mother
Age group (years)
Source: Australian Institute of Health and Welfare,
(a) Includes liveborn babies born to women aged less than 15 years. 2007 National Perinatal Data Collection.
Babies born to parents who are of small stature or were of low birth weight
themselves may have an increased risk of being born with low weight. Genetics
appear to play a part in this relationship.
Behavioural
Maternal food intake is vital for supplying the unborn baby with the nutrients
required for optimal development. An inadequate supply of nutrients can lead to
underdevelopment of the foetus.
Smoking, excessive alcohol consumption and drug use during pregnancy
contribute to higher rates of low birth weight.
Physical environment
Environmental tobacco smoke can have similar effects on the unborn baby as maternal
smoking. Exposure to tobacco smoke increases the risk of a low birth weight baby.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 215
7.5 Determinants that act as risk and/or protective factors in relation to one health issue
Women in remote areas may have fewer health services in the areas in which
they live. This can decrease access to health care which can mean that slowed
growth is not detected and goes untreated, contributing to low birth weight.
Social
Parental health is a key factor contributing to birth weight. Illness of the mother
during pregnancy can increase the risk of having a low birth weight baby. Infections
in the uterus can lead to early labour, while other infections, such as chickenpox
and rubella, can cause slowed growth.
Parental education and income influence the behaviours of the mother during
pregnancy. Those with the knowledge and the means to access resources such as a
nutritious food intake may reduce the risk of having a low birth weight baby.
Prenatal health care includes constant monitoring of the baby’s growth and
development. If the foetus is experiencing slowed growth, interventions such as
dietary change can be put in place to reduce the risk of low birth weight.
Gestational diabetes
Gestational diabetes is characterised by high blood glucose levels. It occurs in
around 5 per cent of all pregnancies and can impact on women in a number of
ways, including:
• high blood pressure
• pre-term labour
• longer hospital stay than mothers without gestational diabetes
• increased risk of developing type 2 diabetes
• increased risk of cardiovascular disease.
Gestational diabetes also increases the risk of many adverse outcomes for the
developing baby including higher than normal birth weight, respiratory conditions
and jaundice.
There are numerous factors that can either decrease or increase the risk of
developing gestational diabetes.
Biological
Women who have a genetic predisposition to type 2 diabetes are at a higher risk of
developing gestational diabetes during pregnancy.
Advancing age has been noted as a risk factor for gestational diabetes. The
proportion increased with age from 4.1 per cent for women aged under 35 to
7.3 per cent for women aged 35–39 and 10.3 per cent for women aged 40 or over
(AIHW, 2010).
Body weight is one of the major factors in determining the risk of gestational
diabetes. Overweight and obesity at the time of fertilisation significantly increase
the risk factors for the development of gestational diabetes. Ensuring body weight is
within the normal range before pregnancy occurs can reduce the risk of developing
gestational diabetes.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 217
7.5 Determinants that act as risk and/or protective factors in relation to one health issue
Behavioural
Food and alcohol intake prior to and during pregnancy can impact body weight.
Although gaining weight is a normal and required aspect of pregnancy, those who
consume an energy-dense diet and consume alcohol are at greater risk of becoming
overweight or obese, which increases the risk of gestational diabetes.
Physical activity acts to burn off excess energy. Sedentary lifestyles, on the other
hand, can contribute to weight gain and gestational diabetes.
Physical environment
Women who live in areas where health care is accessible may be able to receive
health education prior to pregnancy occurring. They may be provided with
strategies to assist them in losing excess body weight prior to becoming pregnant.
Social
Parental education is a key factor in preventing the onset of gestational diabetes.
Those who are educated are more likely to understand the risk factors for gestational
diabetes and act to reduce their risk of developing this condition.
Having adequate income can assist in affording resources such as health care and
nutritious foods, which can, in turn, assist with weight management and decrease
the risk of gestational diabetes.
Cultural factors can prevent some people from accessing health care. Indigenous
Australians for example, are less likely to access health care during pregnancy,
which can contribute to the higher rates of gestational diabetes experienced. Body
weight also plays a role in this difference, but access to health care could provide
knowledge about the risks associated with development of gestational diabetes.
Use the Gestational diabetes weblink in your eBookPLUS to watch a video
about this condition.
As explored in the last section, there are a number of issues that can impact on
the health and individual human development of pregnant women and their
unborn babies. In response to these and other issues, a number of programs and
strategies have been designed to reduce the risk of negative outcomes and promote
the health and development of mothers and babies during the prenatal stage of
the lifespan. These programs and strategies exist at a government, community and
personal level.
Federal government
Medicare is Australia’s universal health insurance scheme that provides free or
subsidised treatment for all Australians through the public health system. Pregnant
women can access a range of Medicare-funded health services throughout their
pregnancy, including free treatment in public hospitals. By making health care
more affordable, Medicare increases accessibility to prenatal health care which can
assist with early detection of issues during pregnancy and medical intervention
when required. Medicare also assists in providing professional health workers such
as nurses, midwives, doctors and obstetricians to assist with the birthing procedure
at no charge to the patient.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 219
7.6 Strategies and programs designed to promote prenatal health and individual development
Victorian Government
The Victorian Government has established the ‘Having a baby in Victoria’ website
that aims to educate pregnant women and those planning pregnancy. It contains
links to health services, dietary advice, general pregnancy information and
information about the availability of support services.
The Maternal and Child Health Line is a Victorian Government service that is
staffed by qualified maternal and child health nurses who provide callers with
Local government
Maternal and child health centres are located in every local government area in
Victoria, which are jointly funded by state and local governments and usually
managed by local government. The centres are staffed by highly qualified maternal
and child health nurses, with support from a range of other health professionals.
Pregnant women can seek advice relating to their pregnancy and receive prenatal
health care at these centres.
beyond babyblues
beyondblue is an independent, not-for-profit organisation working to increase
awareness and understanding of depression and anxiety in Australia, and to reduce
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 221
7.6 Strategies and programs designed to promote prenatal health and individual development
You2
The You2 initiative was developed by Diabetes Australia with the aim of preventing
gestational diabetes and supporting those with the condition. The You2 website
provides practical advice relating to healthy eating, exercise and prenatal health
care. The online blog allows women with gestational diabetes to share their stories
and provide support to others with the condition.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 223
KEY SKILLS The determinants of health and individual human
development during the prenatal stage
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 225
Key skills The determinants of health and individual human development during
the prenatal stage
Chapter summary
• A range of determinants of health and individual human development impact on
eBook plus
both pregnant women and their unborn babies during the prenatal stage of the
lifespan.
Interactivities:
• Biological determinants are factors affecting the body that impact health and individual
Chapter 7 Crossword
human development and include genetics.
Searchlight ID: int-2901
• Genetics determine numerous aspects of health and development during the
Chapter 7 Definitions
prenatal stage including the sex of the baby, genetic conditions and chromosomal
abnormalities. Searchlight ID: int-2902
• The behavioural determinants that impact on prenatal health and development are
related to the behaviours and choices of the parents both before and during pregnancy.
Examples include maternal nutrition prior to and during pregnancy, parental smoking,
alcohol and drug use during pregnancy, and vaccination.
• Adequate nutrition is important in ensuring that the nutrients required for optimal
health and individual human development of the unborn baby are present. Deficiency
of specific nutrients such as folate and iodine can contribute to health concerns such as
spina bifida and intellectual disability.
• Parental smoking causes toxic substances to cross the placenta. This increases the risk
of birth defects and perinatal mortality.
• Alcohol use during pregnancy can lead to foetal alcohol syndrome. Foetal alcohol
syndrome increases the risk of premature birth, heart defects, behavioural problems and
a range of physical characteristics.
• A range of drugs can impact on the unborn baby including prescription and illegal
drugs, and caffeine. Side effects include low birth weight, increased risk of miscarriage
and delayed growth.
• Vaccination is important prior to pregnancy to reduce the risk of infection and disease
in the mother. The unborn baby is particularly susceptible to the impacts of diseases
such as influenza that can result in birth defects and miscarriage.
• The physical environment relates to the physical surroundings in which people live,
work and play. Examples include tobacco smoke in the home and access to health care.
• Tobacco smoke in the home can cause chemicals in tobacco smoke to cross the
placenta and impact the unborn baby in numerous ways, including spontaneous
abortion, prematurity and birth defects.
• Where people live impacts on their ability to access health care. Those in rural and
remote areas, in particular, may not be able to access local health services. Lack of
access to health care can contribute to adverse health and development outcomes as
conditions may not be diagnosed and treated.
• Social determinants relate to aspects of society and the social environment that impact
on health and development. Examples relevant to the prenatal stage of the lifespan
include parental education, parental income, parental health and disability, and access
to health care.
• Parental education influences the behaviours of parents during the prenatal stage
of development including accessing health care, nutrition, tobacco use and alcohol
consumption. It also impacts on the income of the parents.
• Parental income influences the ability of parents to access health-promoting goods and
services during the prenatal stage, such as nutritious food and health care.
• Optimal parental health during pregnancy assists in promoting the health and
development of the unborn baby. Ill health and disability, on the other hand, can limit
the ability of the parents to provide all the necessary resources for their unborn baby.
Infectious diseases can interfere with normal development if they cross the placenta
and infect the baby.
• Social factors such as income, education and culture can limit the ability of individuals
to access health care during the prenatal stage of the lifespan.
The determinants of health and individual human development during the prenatal stage • CHAPTER 7 227
Chapter 7 review
• A range of health issues are a concern during the prenatal stage of the lifespan,
including spina bifida, low birth weight, foetal alcohol syndrome and gestational
diabetes.
• Spina bifida occurs when the neural tube fails to close properly. Genetic conditions,
maternal age, folate deficiency, exposure to excessive heat, parental illness and
education all play a role in the development of spina bifida.
• Low birth weight is classified as a baby under 2500 grams at birth. Premature birth,
maternal age, genetics, maternal nutrition, tobacco and alcohol use, tobacco in the
home, access to health care, parental health and parental education and income all play
a role in low birth weight.
• Foetal alcohol syndrome is characterised by developmental issues such as intellectual
disability, low birth weight and changes in the facial features of the baby. Alcohol use,
parental education, maternal health and access to health care play a role in foetal
alcohol syndrome.
• Gestational diabetes is characterised by an inability to transport glucose from the blood
stream into the cells. It can contribute to high birth weight in the baby and increased
risk of type 2 diabetes in the mother. Risk factors include overweight and obesity,
advancing age, genetic predisposition, food intake, alcohol consumption, physical
inactivity, lack of access to health care, and low levels of parental education and
income.
• A range of government, community and personal strategies and programs have been
implemented to promote prenatal health and development.
• Government initiatives include Medicare, mandatory fortification laws, the Pregnancy,
Birth and Baby Service, Immunise Australia, The National Perinatal Depression Initiative,
the Having a Baby in Victoria Program, the Maternal and Child Health Line, Better
Health Channel, the Healthy Mothers, Health Babies program, and Maternal and Child
Health Services.
• Community initiatives include Beyond Babyblues, the You2 program and Australian
Action on Pre-eclampsia.
• Personal strategies include accessing health care, maintaining adequate nutrition, not
smoking or consuming alcohol, increasing education, avoiding teratogens and being
vaccinated.
TEST your knowledge 2 Select one health issue and complete the following
table:
1 Discuss the possible impacts on health and
Issue Description Determinants that act as risk or
individual human development during the protective factors
prenatal stage of the lifespan in relation to one: Biological Behavioural Physical Social
environment
(a) biological determinant
3 Select one government, community and personal
(b) behavioural determinant
strategy and/or program and explain how it can
(c) physical environment determinant optimise health and individual development during
(d) social determinant. the prenatal stage of the lifespan.
The health
Global andand
health individual human
development
human of Australia’s children
development
WHY IS THIS IMPORTANT?
Development that occurs during the infancy and childhood
stages builds on the foundations laid down in the prenatal
stage and plays a significant role in the development that will
occur across the rest of the lifespan. Maintaining adequate
health is a key factor in achieving optimal development and
vice versa.
Having an understanding of the health and development
that occurs during these stages of the lifespan allows informed
decisions to be made for the promotion of optimal wellbeing
among children.
KEY KNOWLEDGE
2.1 physical, social, emotional and intellectual development from birth to
late childhood (pages 235–43)
2.2 the principles of individual human development (pages 232–4)
2.3 the health status of Australia’s children (pages 244–51).
KEY SKILLS
• describe the characteristics of individual human development from birth
to late childhood
• interpret data on the health status of Australia’s children.
The health and individual human development of Australia’s children • CHAPTER 8 231
8.1 Principles of individual human development
Development during the prenatal, infancy and childhood stages of the lifespan
establishes a base that will be built upon during youth and adulthood. As explored
in chapter 6, the prenatal stage is the fastest period of growth of all lifespan stages
and is characterised by the development of body systems that will allow the foetus
to survive outside its mother’s uterus after birth. Infancy and childhood are marked
by significant developmental milestones such as learning to walk, talk, read, write
and interact with others. Understanding the development that occurs during these
lifespan stages facilitates analysis of the effects that such development has on the
individual, both now and in the future.
Figure 8.2 Writing is an example
of a skill that, although achieved Development in humans, although occurring at different times and at different
in the young years, will be refined rates, has some similarities for all people. A number of principles govern the
over time as the individual builds on development that humans experience and many of these are particularly evident
those initial skills. in the infancy and childhood stages. Any example of development may display a
number of the five principles discussed in the following sections.
1. D
evelopment occurs in a predictable
and orderly way
Many aspects of development occur in predictable, orderly patterns. From
observing many individuals over long periods of time, experts can roughly predict
when certain milestones should occur. For example, most infants learn to walk at
9 to 15 months.
Many aspects of human development require other skills in order to occur. For
example, if a child is to put a sentence together, they need to be able to manipulate
their vocal chords, know the meanings of words and articulate the sentence so it
makes sense. If any of these prior skills are not present, then the child will not be
able to make a sentence that makes sense.
2. Development is continual
Development starts with conception and ends with death. All skills learnt and
milestones achieved between these two events form part of development. The
foundations laid in one stage (e.g. learning to write in early childhood) will be
built upon in the next (figure 8.2). The decline in body systems and memory
over time are also a part of this principle, indicating that humans never stop
developing.
Spare the comparisons neighbour’s child can. Avoid comparing the two
as your child may not care about tennis anyway.
Comparing your kids with other children is a recipe What this means for you: help your child identify his or
for disaster. By Michael Grose. her own talents and interests. Recognise that his or her
Do you ever compare your child’s behaviour or progress strengths and interests may be completely different to
with other children of the same age? If so, you are those of his or her peers and siblings.
causing stress for yourself and your child. Comparing 3. Parents can have unrealistic expectations for their
your child with others is an ultimately useless activity. kids. We all have hopes and dreams for our kids,
But it’s hard to resist, as we tend to assess our but they may not be in line with their interests
progress in any area of life by checking out how we and talents.
compare with our peers. What this means for you: keep your expectations for
When you were a child in school you probably success in line with their abilities and interests. If
compared yourself to your schoolmates. Your teachers expectations are too high, kids will give up. If they are
may not have graded you, but you knew who the smart too low, they will usually meet them!
kids were and where you ranked in the pecking order. Parents should take pride in their children’s
Now that you have kids of your own, do you still performance at school, sport or leisure activities. You
keep an eye on your peers? Do you use the progress should also celebrate their achievements and milestones,
and behaviour of their kids as benchmarks to help you such as taking their first steps, scoring their first goal in
assess your own performance as well as your child’s a game or getting great marks at school.
progress? This is okay, as long as we don’t lose sight of However, you shouldn’t have too much personal
three important aspects. stake in your children’s success or in their milestones,
1. Kids develop at different rates. There are early as this close association makes it hard to separate
developers, slow bloomers and steady-as-you- yourself from your kids. It also causes you to play the
go kids in every group, so comparing your ‘compare and compete game’. By comparing kids you
child’s results or performance can be completely can put pressure on yourself and them to perform for
unrealistic. the wrong reasons.
What this means for you: focus on your child’s And certainly, your self-esteem as a parent should
improvement and effort and use your child’s results as not be explicitly linked to your children’s behaviour or
the benchmark for his or her progress and development. developmental levels.
‘Your spelling is better today than it was a few days, ‘You are not your child’ is a challenging but essential
weeks or months ago.’ parental concept to live by. Doing so takes real maturity
2. Kids have different talents, interests and strengths. and altruism, but it is the absolute foundation of that
Okay, your eight-year-old may not be able to hit powerful thing known as unconditional love.
a tennis ball with Rafael Nadal, even though your Source: Sunday Herald Sun, 26 April 2009.
Cephalocaudal development
Cephalocaudal development refers to growth and development that occurs from
the head down. An infant will gain control over their neck muscles first, which
allows them to hold their head steady. Control over their shoulder muscles usually
follows, which allows them to roll over. Finally, control over the muscles in their
The health and individual human development of Australia’s children • CHAPTER 8 233
8.1 Principles of individual human development
torso allows them to sit. The size of the head of an infant in relation to the rest of
the body also illustrates this pattern of development (figure 8.4).
Proximodistal development
Proximodistal development occurs from the centre or core of the body in an
outward direction. An example is the way that the spine develops first in the uterus,
followed by the extremities and finally the fingers and toes (figure 8.5). In motor
development, an infant reaches for a toy by using shoulder and torso rotation in
order to move the hand closer to the object. In childhood, the elbow and wrist are
responsible for the main movements.
Developing head
Ear
Eye
Heart prominent Nose
Figure 8.5 The proximodistal Upper limb
Upper limb
pattern of development is evident
in these 32- and 52-day-old embryos. Tail
The spine is prominent but the buds Lower limb Umbilical cord
that will become the arms and legs Lower limb
are still underdeveloped.
5. D
evelopment proceeds from the simple to
the complex
Thought processes and motor skill development go from simple to complex. Once
the simple aspects have been attained, they can be built upon to make the skills
more complex. For example, infants think in a concrete way but, as they move
through the childhood and youth stages, abstract thought develops. A child usually
learns to crawl before walking and ultimately running.
Infancy is the first stage of the lifespan after birth and lasts until the second
birthday. Newborns are relatively helpless (figure 8.6). They cannot feed, maintain
body warmth, or stay clean or hydrated without the assistance of others. With
interaction and adequate care, the infant will begin to show significant gains in all
areas of development. For the first 28 days after birth, the infant is referred to as
a neonate and undergoes significant changes or adaptations that help it to survive
outside the uterus.
The health and individual human development of Australia’s children • CHAPTER 8 235
8.2 Development during infancy
Score
APGAR sign 2 1 0
Activity (muscle tone) Active, spontaneous movement Arms and legs flexed with little No movement, ‘floppy’ tone
movement
Pulse (heart rate) Normal (above 100 beats per Below 100 beats per minute Absent (no pulse)
minute)
Grimace (responsiveness or ‘reflex Pulls away, sneezes or coughs with Facial movement only (grimace) Absent (no response to
irritability’) stimulation with stimulation stimulation)
Appearance (skin coloration) Normal colour all over (hands and Normal colour (but hands and feet Bluish-grey or pale all over
feet are pink) are bluish)
Respiration (rate and effort of Normal rate and effort, good cry Slow or irregular breathing, Absent (no breathing)
breathing) weak cry
Physical development
Physically, the infancy stage is the second fastest period of
physical development in the lifespan, second only to the
prenatal stage. Birth weight doubles by six months and triples by
12 months. Body proportions also start to change, reflecting the
cephalocaudal pattern of development.
The senses continue to develop and, although vision is still
largely blurry, the infant will soon begin to recognise familiar
faces and sounds. Bones continue to ossify during infancy. By
the first year, the infant can support its own weight.
Reflexes that are present at birth (e.g. the grasping reflex)
are gradually replaced by controlled movements as motor skills
develop. A newborn infant does not have much control over its
body but will soon learn to lift its head and roll over. At around
six months, infants start crawling. By the age of one, many
infants can stand and walk. By age two, they can usually throw
and kick a large ball.
Social development
The family is the most significant influence on social development
at this stage of the lifespan. The infant is totally dependent on its
parents or other caregivers, and will learn certain social skills by
observing these people.
The infant begins to smile at around six weeks, and after
Figure 8.8 By their first year, many infants can support around six months the infant will begin to recognise facial
their own weight. expressions of others, such as a smile or a frown.
Emotional development
Emotional development also revolves around the family at this stage of the lifespan.
One of the first signs of emotional development is when the hurt or distressed
infant can be comforted by its caregivers.
Emotional attachment is formed with the caregivers within months and this
helps the infant to feel secure, safe and loved. It also helps to build trust. The
emotional bond between caregivers and the infant may be so strong that the infant
may become distressed when held by a stranger or when a caregiver leaves the
room. Fear may be shown when confronted by unfamiliar things such as a clown
or a dog.
By eight months, the infant can express anger and happiness, and may become
frustrated if interrupted in their activities (e.g. when playing games). This expression
of frustration may result in tantrum-throwing in later months.
By 12 months, the infant becomes sensitive to approval from parents. It may
become upset or distressed if approval is not gained.
Intellectual development
From the time of birth, all senses are working (although they become more acute
over time) and the baby is capable of learning. The senses are the means by which
the baby makes sense of the world around it. Many infants collect information
around them by putting objects into their mouth. This behaviour will often change
as the infant develops and starts to use its other senses.
Within months, the infant will recognise its name and will respond when called.
Over time, this word–object association progresses and the infant will begin to
recognise the names of favourite people, toys, other objects and basic colours.
Early infancy also signifies an emerging understanding of cause and effect. Infants
will begin to associate certain actions with particular outcomes. For example, if
they cry, they get attention. If they reach for someone, that person may pick them
up. If they kick their legs around, their caregivers might play with them.
The attention span of an infant is short and may last only a matter of seconds.
The infant may give extra attention to games and objects that it finds interesting,
but only for very short periods of time.
The health and individual human development of Australia’s children • CHAPTER 8 237
8.2 Development during infancy
In early infancy, an object that is out of sight no longer exists in the mind of the
infant. So a toy that is placed in a cupboard no longer exists. As the infant develops
intellectually, it begins to understand that, although an object cannot be seen, it
still exists. This concept is known as object permanence.
By 18 months, the infant can imitate and pretend in play activities. By observing
others, the infant learns a lot about the world around it. Infants may imitate talking
on a phone or having a dinner party.
Language development is rapid during infancy. A three-month-old will make
speech-like sounds (‘goo’ and ‘gaa’), and will be able to say a couple of basic words
by the first birthday (‘dada’ or ‘mumma’). The development of language occurs
very quickly after this point. By the end of infancy the individual can say around
150–300 words, although there is still confusion in context and pronunciation.
Early childhood lasts from the second birthday until six years of age, typically the
preschool years. Although not long in years, significant development occurs during
early childhood.
Physical development
Early childhood is characterised by slow and steady growth. Although the rate of
growth is variable, height increases by around 6 centimetres per year and weight
by around 2.5 kilograms per year. Bones continue to lengthen and ossify during
early childhood, resulting in the increases in height experienced. Body proportions
change during early childhood, and the limbs and torso become more proportionate
to the head. Body-fat levels also decrease, giving the child a leaner body type.
Children may begin to lose baby teeth as the permanent teeth begin to develop.
While muscle development slows during early childhood, motor skill
development continues at a rapid rate. Gross motor skills increase and the walking
style becomes more fluid and refined. The child can climb stairs but will still
need to place both feet on each step until towards the end of early childhood.
Kicking, catching and throwing skills also develop, and the child might learn how
to skip. Coordination improves, allowing the child to pedal and steer a tricycle
(figure 8.11). Fine motor skills progress, and the child can learn to manipulate Figure 8.11 As children gain greater
control over their body, more complex
zippers on clothing, hold crayons, use scissors and even tie shoelaces. As a result of activities such as riding a tricycle
these activities, left- or right-handedness starts to appear in certain activities. become possible.
Social development
The family remains the primary social contact during childhood and is responsible
for many achievements in social development made by the child. The child will
begin participating in a wider range of family routines such as attending social
functions, eating at the table and helping with the shopping. Communication skills
and acceptable social behaviours increase as a result of these experiences.
The child may attend a playgroup, kindergarten or a child-care centre, and this
provides many opportunities to further develop social skills such as sharing and
taking turns. As the child becomes accustomed to spending short periods of time
away from the family, independence starts to develop. The child may start wanting
to do things for themselves such as dressing or washing, although they may not be
completely successful.
Behaviours such as eating with a knife and fork are established during early
childhood but they will be refined over time. Children at this age like to be
accepted by others and may behave in a way that brings attention to them. This
can include showing off or performing for family and friends.
Play is still an important aspect of social development, although it is more
advanced than in infancy (figure 8.12). Children may have a friend to play with Figure 8.12 Play takes many forms,
and is a great way of increasing social
and some will create an imaginary friend. Make-believe play might also be a part of
development.
the child’s playing patterns.
Emotional development
Emotional development continues to occur at a rather fast pace during early
childhood. The emotional development of a two-year-old is quite different from
that of a six-year-old. A child will begin to develop a sense of empathy and may
The health and individual human development of Australia’s children • CHAPTER 8 239
8.3 Development during early childhood
care for people who are crying or upset. Yet their way of dealing with emotions
is still in its early stages, and children may use physical violence to express their
frustration. This is particularly common with other children or siblings. Play often
gives children a way of expressing their feelings.
Children take pride in their achievements and may want to show them off to
everyone. As a result of enjoying positive feedback from others, they may become
jealous when another child receives attention.
Children begin to develop an identity that will continue to form for years to
come. They learn to see themselves as being separate from others, and begin to
associate certain things with themselves such as ownership of a toy.
Mood can change quickly during this stage as children often do not have the
skills required to control their feelings. As a result, they can switch from being
happy to being upset and then happy again in a very short period.
Intellectual development
Learning new words and how to use language occurs fairly rapidly during this
stage and is a key part of the child’s intellectual development. By the age of five, a
child knows approximately 1500–2500 words.
As interest in the world around them increases, children begin to question many
aspects of their environment. They ask parents or caregivers ‘why?’ and like to
share their knowledge with others about colours, objects and animals.
As their attention span lengthens and knowledge of language increases, children
can remember and follow basic instructions such as getting a toy from the bedroom,
bringing it back to the lounge room and sitting in a designated place with it.
In the first years of early childhood, the child can classify objects based on one
aspect such as colour. For example, they can separate orange blocks from green
blocks, but find it more difficult to classify items according to multiple aspects
such as colour and size. These more complex skills develop over time.
Children in this lifespan stage may learn to write basic letters and read basic
books. They can also learn to count to 10 or 20, although this is often memorised
The health and individual human development of Australia’s children • CHAPTER 8 241
8.4 Development during late childhood
Late childhood starts at the sixth birthday and continues until 12 years of age.
During this time, the child will begin formal schooling while continuing to grow in
a similar fashion to that experienced in early childhood.
Physical development
Physical development in late childhood is slow and steady, as it was in early
childhood. Bones and muscles continue to grow in length and width. Height
continues to increase by 5 to 6 centimetres per year, and weight increases by
around 3 kilograms per year. Both sexes have similar body shapes until the onset
of puberty, although males may be slightly larger. Body proportions continue
to change as the head grows more slowly in comparison to the torso, arms and
legs. A child in the late childhood stage has similar body proportions to an adult.
Figure 8.14 Losing teeth is a normal Permanent teeth continue to develop and, by the end of late childhood, most
part of childhood development. permanent teeth will be present (figure 8.14).
The child gains greater control over their body, and motor skills develop as a
result. As size and strength increase, children can perform more complex physical
tasks such as playing basketball or participating in gymnastics. They have also
had years to develop speed, agility and balance, and these skills are used in many
physical activities such as games and sport. More complex gross motor skills such
as skipping are also refined during this time. Fine motor skills are developed, and
a child at the beginning of late childhood can write basic sentences. Writing might
still be illegible at times. By the end of late childhood, writing becomes more legible
and the writing style may also be more established.
Social development
With the commencement of formal schooling, most children experience a
wide range of social situations during late childhood (figure 8.15). As a result,
relationships with others change and the child will generally have numerous social
contacts outside the family. Social skills such as sharing, communication and
conflict resolution are further developed by this increase in social interaction.
Relationships at school are formed but are generally
limited to members of the same sex. Skills such as
cooperation and sharing are further developed as a
result.
The child may still ‘show off’ in front of friends and
family in order to gain attention. Children in this lifespan
stage place increasing importance on being accepted by
others (e.g. parents, teachers and peers) and may modify
their behaviour in order to achieve approval.
Morals further develop during this time, and children
acquire a greater sense of right and wrong as well as a
better understanding of what is acceptable behaviour in
their society. As a result, children can generally make an
informed decision about right and wrong even in new
situations. In contrast, knowledge of right and wrong
in early childhood is largely limited to the instances of
Figure 8.15 School provides many right and wrong that have been taught by parents or
opportunities for social development. caregivers.
Intellectual development
Much of a child’s intellectual development takes place at school. The brain continues
to develop during late childhood and intellectual skills develop considerably. At the
beginning of this stage, children can generally follow basic instructions and place
objects in a logical order (e.g. from big to small) or arrange them according to
numerical value. As they develop intellectually, the child can follow instructions
with multiple steps and classify items based on multiple criteria. Problem-solving
skills develop and the child begins to be able to focus on ideas rather than objects.
Knowledge of language increases, allowing the child to complete tasks such as
pluralising words most of the time. By the age of six, children know 2000–3000
words. By the end of late childhood, they might know over 10 000 words. Reading Figure 8.16 A lot of intellectual
skills also develop during this stage and, by the age of 12, the individual can read development occurs through formal
and make sense of age-appropriate books. education.
Children in late childhood generally have an increased interest in numbers and
can perform basic mathematical problems. They can also apply logic to equations
and understand that 3 × 6 will produce the same answer as 6 × 3.
Attention span increases and the child can sit quietly in class for longer periods
of time, but concentration will still lapse after a matter of minutes. Long-term
memory develops and the child can more accurately recall stories of things that
happened in the past.
The health and individual human development of Australia’s children • CHAPTER 8 243
8.5 The health status of Australia’s children: mortality
Australia’s children have the best health status in the country, and key health
indicators place their health among the best in the world. Improvements are
continually being made with regards to many health indicators and, as a result, most
Australian children in today’s society can expect to live in good health. Unfortunately,
there are some exceptions, particularly among indigenous Australians, those living
in remote areas and those of low socioeconomic backgrounds. Infants and children
in these groups experience higher mortality rates and greater risk of disease and
injury. Many statistics present average figures for all Australian children and, as
a result, may mask the challenges facing some groups within the country. When
examining statistics, it is important to remember that not everyone enjoys the good
health experienced by the majority.
Because many sources of health data group infants and children in their statistics,
infant and child health will generally be considered together.
8%
Figure 8.17 Leading Congenital malformations 20% Perinatal conditions (46%)
causes of infant mortality, of the circulatory system
2008–2010 18% Congenital anomalies (26%)
Source: Australian Institute of Health Other perinatal
Signs, symptoms and abnormal
and Welfare, Making Progress: the conditions
health, development and wellbeing findings (10%)
of Australia’s children and young
Other congenital anomalies
people, 2008. Other causes (18%)
12
Infant deaths per 1000 live births
10 Boys Mortality
Girls
Infant mortality rates in Australia have fallen considerably
8 Children
over the past two decades (figure 8.18), but still account
6
for half of all deaths in those aged under 20. Although the
rate for all Australians is relatively low by international
4 standards, the figures mask higher infant mortality rates for
Indigenous Australians. In fact, for the last ten years, the
2 infant mortality rate for Indigenous Australians has been
around three times higher than the rest of the population.
0
As infants get closer to their first birthday, the risk of death
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
live births
SIDS are unknown, there are a number of determinants 150
that increase the risk of SIDS for an infant. These
include being male (70 per cent of SIDS deaths are 100
usually males) or sleeping on the stomach. Figure 8.19
50
outlines the decline in deaths attributable to SIDS
over time. 0
Child mortality rates refer to deaths occurring in
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
children between the ages of 1 and 14. Child mortality
rates have also decreased in recent decades. Awareness Year
of illness and advances in medicine and technology have Figure 8.19 Infant deaths from SIDS, 1986–2010.
been largely responsible for these decreases. Mortality Source: Adapted from ABS data and Australian Institute of Health and Welfare 2012,
A picture of Australia’s children 2012, cat. no. PHE 112, Canberra, p. 14.
rates decrease as children get older, as shown in table 8.2.
Although overall rates have decreased, child mortality rates for Indigenous, rural
and remote, and low socioeconomic backgrounds remain higher than the rest of
the population.
The majority of causes of mortality for children are termed ‘injuries’ (which
includes poisoning), and are accidental in nature (figure 8.20). Injuries account for Table 8.2 Mortality rates of those
more deaths in childhood than any other cause. Injuries include falls, drowning, aged 1–12 years
suffocation, poisoning, transport accidents and burns. According to the Australian Death rate
Institute of Health and Welfare in 2008–10, males were 60 per cent more Age (per 100 000 population)
likely than females to be hospitalised for injuries and Indigenous children were
1–4 years 19
50 per cent more likely to be hospitalised than other children.
5–12 years 10
Inadequate supervision can increase the risk of injury among children, but
they are also more likely to sustain injuries than older people due to their level of Source: Based on data from Australian Institute
of Health and Welfare 2012, A picture of
development. Australia’s children 2012, cat. no. PHE 112,
Because children are not as developed intellectually, they may lack knowledge of Canberra, p. 14.
how to avoid injuries. Burns, drowning, bike accidents and falls may all occur at
higher rates in children due to lower levels of
intellectual development.
A child’s physical development can also
increase their risk of certain injuries:
• The size of an infant’s head in relation 1–4
to their body makes it difficult for them
to support the weight of their head. This
Age group (years)
The health and individual human development of Australia’s children • CHAPTER 8 245
8.5 The health status of Australia’s children: mortality
body cells from carrying out their functions. Cancers found in children are often
different in type and their response to treatment compared to cancers found in
adults. Leukaemia and brain cancers are the most common cancers in children.
Although incidence rates have remained constant, mortality rates due to cancer
have decreased in children as a result of advancements in medical technology and
treatment options. Table 8.3 outlines the changes in cancer deaths and mortality
rates in children.
Table 8.3 Cancer deaths among children aged 0–14 years, 1997–2010
Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number 140 154 122 106 118 124 102 114 96 90 90 84 74 116
Deaths per 100 000 3.6 3.9 3.1 2.7 3.0 3.1 2.5 2.8 2.4 2.2 2.2 2.0 1.8 2.7
children
Source: Australian Institute of Health and Welfare 2012, A picture of Australia’s children 2012, cat. no. PHE 112, Canberra, p. 22.
Diseases of the nervous system are the third leading cause of childhood mortality.
These conditions include a range of diseases that affect the brain, spinal cord and
nerves. Examples include meningitis; cerebral palsy; swelling of the brain; and
malformed brain, skull and spinal cord.
TEST your knowledge (b) Explain the changes in cancer mortality rates
over time and suggest possible reasons for this
1 (a) Using figure 8.18, identify two trends in infant
change.
mortality over time.
(b) What reasons can you think of that would APPLY your knowledge
account for these trends (give specific
examples)? 8 Write a press release describing the health of
2 (a) What is the leading category for cause of death Australia’s children. In your article, include:
in infants according to figure 8.17? (a) the overall level of health of children
(b) What causes of death are included in this (b) mortality rates
category? (c) leading causes of death. eBook plus
3 (a) Describe how the mortality rates for children 9 Use the SIDS and Kids weblink in
have changed over time. your eBookPLUS to find the link for this question.
(b) What factors could explain this trend? Produce an informative brochure for new parents
4 (a) Using table 8.2, compare the mortality rates for about the SIDS and Kids ‘Safe Sleeping’ and ‘Tummy
1–4 year olds and 5–12 year olds. Time’ education campaigns. In your brochure, be
(b) Suggest reasons for this difference. sure to include:
5 According to figure 8.20, what are the leading (a) ways to reduce SIDS and why each of these
causes of death for: measures are important including:
(a) i. 1–4 year olds? • guidelines as to how babies should be placed
ii. 5–9 year olds? to sleep
(b) What factors could account for differences • mattress and cot requirements
between age groups? (b) what ‘tummy time’ refers to
6 Outline two causes that contribute to the relatively (c) why tummy time is important
high rates of injury deaths among children. (d) considerations for tummy time.
7 (a) Graph the cancer mortality rates among children
from 1997 to 2010.
Morbidity
Although child mortality rates have decreased over time, there are many
chronic conditions that impact on the health and human development of children.
In the following section, various causes of both infant and child morbidity are
examined.
Birth weight is a good indicator of the health of newborns. Those born with Table 8.4 Percentage of low birth
a low birth weight are more likely to experience ill-health and even premature weight babies by Indigenous status,
2010.
death. This is largely due to the underdevelopment of organs and the immune
system, making infants with a low birth weight more susceptible to infections, Low birth
other diseases and organ malfunction. weight
A number of factors contribute to low birth weight, including exposure to Indigenous (%) 12.0
teratogens, the mother’s age (being under 20 or over 40 increases the chances of Non-Indigenous (%) 6.0
low birth weight) and access to antenatal care. Although overall rates of low birth Rate ratio 2.0
weight are relatively low in Australia, Indigenous mothers are about twice as likely
Source: AIHW, Australian mothers and babies,
to give birth to a low birth-weight baby compared with non-Indigenous mothers, 2010. cat. no. PER 57. P. 72.
as shown in table 8.4.
Many chronic conditions have become more common in childhood over recent
decades. According to the AIHW in 2012, 37 per cent of those aged 1–14 had a
long term or chronic condition. The most frequently reported chronic conditions
among children are shown in figure 8.21.
Asthma
Allergy (undefined)
Long-term condition
Short sighted/myopia
Long sighted/hyperopia
Chronic sinusitis
Anxiety-related problems
0 2 4 6 8 10 12
Percentage
Note: Long-term condition is defined here as a condition that has lasted, or is expected to last, 6 months or more.
As children get older, they are more able to communicate their problems. Thus
a child might have suffered from poor eyesight for years but would not have been
able to tell anyone until they learnt to speak. This contributes to the increase in
chronic conditions as children get older.
Asthma, obesity, diabetes and mental health problems all contribute considerably
to the burden of disease among children.
The health and individual human development of Australia’s children • CHAPTER 8 247
8.6 The health status of Australia’s children: morbidity
25 Asthma
Boys
Girls Australia has one of the highest asthma rates in
20 Children the world (figure 8.22). While the exact causes
are not known, a number of factors contribute to
its onset. These include:
15 • maternal smoking
Percent
Diabetes
The rates of both type 1 and type 2 diabetes have increased in children over
time, although type 1 cases still account for around 90 per cent of total diabetes
cases among children. Both type 1 and type 2 diabetes
30
are characterised by an inability of the body to effectively
transport glucose into the cells to be used for energy. As
Incidence per 100 000 children
25
a result, glucose stays in the bloodstream, which can lead
20 to serious health problems such as kidney damage, heart
disease, poor circulation and premature death.
15 Type 1 diabetes is generally diagnosed by the age of
15 and is a significant contributor to burden of disease
10 among children. Type 1 diabetes is an autoimmune disease
characterised by the destruction of the cells in the pancreas
5 that produce insulin. Insulin is the hormone responsible for
transporting glucose into cells, so a lack of insulin results in
0 high blood-glucose levels. As those with type 1 diabetes do
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year not produce insulin, it must be administered by injections
Figure 8.23 The incidence of type 1
or an insulin pump. Insulin is given when blood-glucose
diabetes (0–14 year olds) per 100 000 levels rise in order to allow glucose to be used by the cells.
population The incidence of type 1 diabetes in children increased from 19 to 24 new cases
Source: Australian Institute of Health and per 100 000 population between 2000 and 2004. The incidence rate has been
Welfare, A picture of Australia’s children 2012,
cat. no. PHE 167, Canberra, p. 19. fairly stable since 2004 (figure 8.23).
While previously considered an older person’s disease, type 2 diabetes is
becoming more common among Australian children, mostly as a result of increasing
rates of obesity. Indigenous and Pacific Islander children, those who live in rural
and remote areas, and those who live in socioeconomic disadvantage, are most
likely to develop the condition. While the effect of type 2 diabetes is similar to
that of type 1 diabetes, the causes are quite different. Those with type 2 diabetes
25
ADHD
Conduct disorder
20
Depressive disorder
15
Per cent
10
Dental health
Despite steady improvement from the 1970s onwards, dental health has been
declining in children since the mid-1990s (figure 8.25).
The health and individual human development of Australia’s children • CHAPTER 8 249
8.6 The health status of Australia’s children: morbidity
2.5
Mean number of decayed, missing or filled teeth
6 year olds
12 year olds
2.0
1.5
1.0
0.5
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003-04 2005 2006 2007
Year
Figure 8.25 Mean number of
decayed, missing or filled teeth Poor dental health has a number of implications for health and development.
Source: Mejia GC, Amarasena N, Ha DH, Roberts-
Thomson KF & Ellershaw AC 2012. Child Dental Bacteria can travel from the mouth to the lungs and contribute to lung infections
Health Survey Australia 2007: 30-year trends in and other respiratory problems. Bacteria found in plaque may also increase the
child oral health. Dental statistics and research
series no. 60. Cat. no. DEN 217. Canberra: AIHW. risk of heart disease and stroke, although this research is still continuing. Children
with poor dental health may experience decreased self esteem, especially if their
appearance is affected. School absences are common, as treatment is administered
or infections take hold. This can impact on social health and intellectual
development in particular. Physical development can be further hindered if the
bones that support teeth are also affected.
Hospitalisations
Hospitalisations among children are quite high due to asthma, mental and
behavioural disorders, and diabetes. Hospitalisations for these conditions are
shown in figure 8.26.
500
Hospitalisations (per 100 000 population)
Asthma
450
Mental and behavioural disorders
400 Diabetes
350
300
250
200
150
Figure 8.26 Hospitalisations among
children aged 5–12 years from asthma, 100
mental and behavioural disorders and 50
diabetes
Source: Australian Institute of Health and Welfare 0
2008, Making progress: the health, development 1998–99 1999–00 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07
and wellbeing of Australia’s children and young
people, cat. no. PHE 104, Canberra, p. 23. Year
16
14
12
10 Accidental poisoning
Burns and scalds
8 Accidental drowning
4
Figure 8.27 Hospitalisations among
2 children aged 5–12 years from
accidental causes
0 Source: Australian Institute of Health and Welfare
1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07 2008, Making progress: the health, development
and wellbeing of Australia’s children and young
Year people, cat. no. PHE 104, Canberra p. 22.
Chronic conditions can impact on all areas of health and development. The child
may miss out on experiences due to extended periods away from school and, as a
result, may not develop as they otherwise would have. They may develop low self-
esteem and be marginalised by their peers. The impact on the sufferer will largely
depend on the severity of the condition. Some conditions, such as mild asthma,
may be easily managed and not interfere too much with normal functioning.
However, a condition such as type 2 diabetes may result in significant lifestyle
changes and management techniques that may interfere with normal life. Reducing
the rate of these conditions is important to limit the negative impacts on the health
and individual human development of children.
TEST your knowledge 6 (a) What factors could lead to poor dental health?
(b) Outline three possible impacts of poor dental
1 (a) Briefly explain why low birth weight babies are
health in children.
more likely to experience ill-health than those of
normal body weight.
APPLY your knowledge
(b) List three factors that increase the chance of
having a low birth weight baby. 7 Using figure 8.22, identify one difference in the
2 (a) Identify the most frequently reported chronic rates of asthma experienced by males and females.
condition according to figure 8.21. 8 Brainstorm reasons why birth weight would be a
(b) Approximately what percentage of children good indicator of a newborn baby’s health.
suffer from this condition? 9 Suggest reasons that may account for Indigenous
3 (a) Briefly describe the changes in the incidence women having higher rates of low birth weight
of type 1 diabetes over time according to babies.
figure 8.23. 10 Why do you think Australia has a high asthma rate
(b) Suggest reasons for this change. compared to other countries?
4 Explain the term ‘insulin resistance’. 11 Explain how asthma could affect physical, social and
5 Explain the difference between attention deficit mental health.
hyperactivity disorder (ADHD), conduct disorders
and depressive disorders.
The health and individual human development of Australia’s children • CHAPTER 8 251
KEY SKILLS The health and individual human development
of Australia’s children
70
100 000 children
60
50
40
30
Boys
20
Girls
10 Children
Figure 8.28 Diabetes hospital 0
separations for children aged
2000–01
2001–02
2002–03
2003–04
2004–05
2005–06
2006–07
2007–08
2008–09
2009–10
2010–11
Analyse the data in figure 8.28 and use it to draw conclusions about the
❼ In 2003–04, the rates were very
health status of Australia’s children. In describing the trends evident in this similar. Including the qualifier
graph, the following three statements can be made. However, there are important ‘generally’ takes this factor into
considerations to be taken into account. account.
• Girls generally❼ have higher rates of hospitalisations due to diabetes❽ than
boys. ❽ It is important to clearly state the
trend that is being identified.
• Rates for hospitalisations have increased from around 58 per 100 000 female
children in 2000–01 to around 75 per 100 000❾ female children in 2006–07. ❾ This information might also be
• The rates of hospitalisations due to diabetes have increased for both males and presented in a different way. For
females between 2000–01 and 2006–07.❿ example: ‘Female hospitalisations due
to diabetes have increased by around
17 per 100 000 children.’ A similar
100
50
Figure 8.29 Mortality rates over
0
time, per 100 000 for selected age
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007 groups
Source: Adapted from AIHW, National mortality
Year database.
(a) Identify two trends in the mortality rates as shown in figure 8.29.
2 marks
(b) Use your knowledge of children’s health status to list three causes of death that are
common in the 0–4 age group.
3 marks
(c) Discuss how causes of mortality change between infancy and childhood.
4 marks
The health and individual human development of Australia’s children • CHAPTER 8 253
CHAPTER 8 review
Chapter summary
• Development occurs according to a number of principles: it is predictable and
Interactivities:
orderly, it is continual, there is individual variation in its rate and timing, it follows the
Chapter 8 crossword
cephalocaudal and proximodistal laws, and it moves from simple to complex. Many
Searchlight ID: int-2903 achievements in development will display more than one of these principles.
Chapter 8 definitions • Infancy is a rapid period of growth. All areas of development occur quickly during
Searchlight ID: int-2904 this stage and the family is a significant influence on health and individual human
development.
• Physical development during early and late childhood is described as being slow and
steady.
• Gradual increases in height and weight are accompanied by increases in bone strength.
• As the child grows and gains strength, their motor development progresses and the
child becomes capable of more complex motor skills.
• Social development is facilitated by play and interaction with family members. Children
often imitate the actions of older people as a way of learning social skills and roles.
• By the end of early childhood, the child is usually toilet-trained and can use a knife
and fork.
• The child gains an increasing sense of self during the childhood years and may become
self-conscious in certain circumstances.
• Intellectual development continues to progress and, as the child ages, language skills
become increasingly complex.
• By the end of childhood, the child can read, write and complete basic mathematical
problems.
• Thought patterns begin to change and, by the end of late childhood, the child starts to
think in an abstract way.
• Overall, Australian children experience excellent health but some groups, especially
Indigenous, those in rural and remote areas, and those from low socioeconomic
backgrounds, fare far worse than the majority of the population.
• Death rates and life expectancy are continually improving for Australian children.
• The main causes of death in this age group are perinatal conditions for infants and
injuries for children.
• Asthma is the most commonly reported condition for children.
TEST your knowledge 4 Phil and Amanda have just had their first baby and
have no idea what to expect in terms of their baby’s
1 Brainstorm a list of factors that have contributed
development. Create a timeline that shows them
to lower death rates and higher life expectancy
what they can expect in the four types of
throughout all the stages of childhood.
development over the next 12 years. You can use
APPLY your knowledge the Development timeline weblink in your
eBookPLUS to find a timeline to
2 How can the family positively or negatively affect use as a resource for this
the development of a child? question.
3 List three milestones of development that require
prior skills in order to be achieved (list the prior skills
as well).
Key SKILLS
• explain the determinants of health and individual human development
and their impact on children using relevant examples. FIGURE 9.1 A range of determinants
• describe a specific health issue facing Australia’s children and draw affect the health and individual
human development of Australia’s
informed conclusions about personal, community and government
children.
strategies and programs to optimise child health and development
The determinants of health and individual human development of Australia’s children • CHAPTER 9 257
9.1 T he determinants of health and individual
human development
The childhood stage of the lifespan is a time when the foundations for later health
and individual human development are established. It is during this time that
children learn skills, knowledge and behaviours through their interaction with
others and their environment that will help determine their current and future
health status. Australian children generally enjoy good health, as indicated by the
declining rates of morbidity and mortality from preventable conditions. Although
the overall health status of children is positive, there are areas of concern that need
to be addressed. Australian children are experiencing higher rates of overweight
and obesity, insufficient physical activity, poor eating habits, mental health issues,
and long-term health conditions such as asthma and type 1 diabetes.
A child’s level of health has a significant impact on physical, social, emotional and
intellectual development. In order to promote their optimal development, a child
needs to have an appropriate level of physical, social and mental health. Each child is
Figure 9.2 Foundations for later born with a genetically determined developmental potential. Whether or not a child
health and individual human achieves their potential depends on their health status. For instance, a child who has
development are formed during
a heart condition can be limited in the amount of physical activity they can undertake.
childhood.
As a result, the child’s bone density and muscle growth may be impaired, which might
limit the development of motor skills. The child may be physically unable to participate
in sporting activities or may not be selected by their
peers to be a part of games. Consequently, the child
Impact on physical
development
may not be able to engage in team activities, thereby
Limited opportunities for reducing the opportunities for social interaction in
the development of sporting situations and the capacity for developing
motor skills, bone density social skills. Feeling rejected from team activities, or
and muscle
feeling isolated from peers due to the inability to
participate in physical activity, may cause the child to
lack self-confidence and have low self-esteem. This can
adversely affect emotional development. Having
Impact on social
Physical activity development
a heart condition may require the child to be
is limited/unable Limited opportunities for hospitalised or result in extended absence from school,
to participate in interaction with peers thereby reducing the opportunities for developing
team activities and the development of intellectual skills (see figure 9.3).
social skills
The factors that impact on the health and individual
human development of individuals and populations
are referred to as ‘determinants’. In most instances,
it is not just one factor that influences health and
Impact on emotional
development
individual development but a combination of factors.
Child with a Child feels isolated, In this sense, health is seen to be multicausal. The
heart condition resulting in lack of determinants of health and individual human
confidence and low development can have positive or negative effects.
self-esteem
Certain behavioural or lifestyle influences — such
as eating habits or lack of physical activity — that
increase the likelihood of ill-health in children are
known as ‘risk factors’. Other behavioural or lifestyle
Impact on intellectual
development
influences — such as breastfeeding and childhood
Extended vaccinations — that reduce the likelihood of ill-health
Limited opportunities
absence from
school
for intellectual in children are commonly termed ‘protective factors’.
development
Figure 9.3 Examples of the impacts of ill-health on the
individual human development of a child
Behavioural Social
Eating habits Parental education
Level of physical activity Parenting practices
Oral hygiene Media
Breastfeeding Access to services e.g. health care
Vaccination
Figure 9.4 Determinants of health and individual human development of Australia’s children
The determinants of health and individual human development of Australia’s children • CHAPTER 9 259
9.2 Biological determinants: genetics
KEY CONCEPT The influence of genetic factors on the health and individual
human development of children
Biological determinants refer to those genetic and physiological factors that affect
health and individual human development. They relate to the functioning of the
body and include factors such as genetics, body weight and birth weight. Biological
factors do not act in isolation, and are influenced by other determinants such as
environmental factors and health behaviours.
Genetics
In chapter 6, you learnt about the role of conception in determining the genetic
make-up of the unborn child. The genes that a child inherits from their biological
parents have a significant impact on the child’s health and individual human
development. Genes are the blueprint of the body because they control growth,
development and how the body functions.
A child’s genetic make-up determines:
• the rate and timing of physical development as a result of the excretion of
hormones from the glands of the endocrine system
• whether the child is male or female
• the development of genetic conditions such as Duchenne muscular dystrophy
• predisposition to diseases such as cardiovascular disease.
Genes are part of the chromosomes, which are long strands of deoxyribonucleic
acid (DNA) that contain genetic information and are found in the nucleus of
human cells (figure 9.5). Each human cell — except blood cells, which have
Figure 9.5 Our genetic make-up no nucleus — contains 46 chromosomes in 23 pairs. Of these chromosomes,
is determined by the combination 22 pairs are referred to as ‘autosomes’ and one pair is called the ‘sex-linked’
of genes that occur at the point of chromosome because it determines the sex of the individual. Our genetic make-up
conception. These genes are carried
on the DNA in our body cells.
is determined by the combination of genes that occur at the point of conception.
Fifty per cent of an individual’s genes are passed down from the biological father
and 50 per cent from the biological mother. It is this combination of genes that
determines the physical characteristics of the individual (e.g. facial features,
sexual characteristics and eye colour) as well as genetic conditions and genetic
predisposition to disease.
Sex-linked chromosomes
Figure 9.6 The sex of a As explained earlier, each human egg and each human sperm contains one set
child is genetically of 23 chromosomes, made up of 22 autosomes and one sex-linked chromosome.
determined. Each cell in the female body contains two ‘X’ sex-
linked chromosomes, but each cell in the male body
contains one ‘X’ and one ‘Y’ sex-linked chromosome.
Because every female egg contains one set of
chromosomes, every egg will have only the ‘X’ sex-
linked chromosome. In contrast, each male sperm
can have either an ‘X’ sex-linked chromosome or a ‘Y’
Sperm carries either an All female eggs sex-linked chromosome.
‘X’ chromosome or a contain an
This explains why the gender of a developing baby
‘Y’ chromosome. ‘X’ chromosome.
is determined by the sperm. If an ‘X’ sperm fertilises
an ‘X’ egg, then the result is a female baby. If a ‘Y’
‘X’ sperm fertilises an ‘X’ egg Female baby
sperm fertilises an ‘X’ egg, then the result is a male
‘Y’ sperm fertilises an ‘X’ egg Male baby baby (figure 9.6).
The determinants of health and individual human development of Australia’s children • CHAPTER 9 261
9.2 Biological determinants: genetics
Table 9.1 Hormones that regulate growth and physical development during childhood
Hormone Site of secretion Effect on physical development
Growth hormone Pituitary gland Stimulates protein synthesis required for growth of
soft tissue (e.g. muscle) and hard tissue (e.g. bone)
Thyroid-stimulating Pituitary gland Stimulates the thyroid gland to secrete thyroxine
hormone
Thyroxine Thyroid gland Sets the rate at which the metabolism of food into
energy takes place. Energy is required for growth.
Calcitonin Thyroid gland Increases the rate of calcium deposition in bones
Parathyroid hormone Parathyroid glands Regulates the amount of calcium and phosphorus
(located behind the in the bones and blood. Calcium and phosphorus
thyroid gland) are required for strengthening bones.
Insulin Pancreas Stimulates the cells to convert glucose to energy.
Energy is required for growth.
Pineal gland Most children grow to a height similar to that of their parents. How each
child grows is dependent on the genes that determine the rate of secretion
Pituitary of hormones from the glands of the endocrine system. The pituitary
gland gland secretes growth hormone, which affects the bone development
and height of a child. In conjunction with this, the pituitary gland also
releases thyroid-stimulating hormone that prompts the thyroid to secrete
thyroxine. Thyroxine plays an important role in metabolising food
Parathyroid Thyroid
into energy. This energy is also required for bone development and the
glands gland increasing height of the child.
Genetic conditions
Thymus
A range of genetic conditions can be inherited from parents. An example
of this is cystic fibrosis, which is the most common life-threatening genetic
disorder among light-skinned people. This condition results in the secretion
of a thick mucus that affects the lungs, pancreas, liver and reproductive
system. In the lungs, the mucus clogs small air passages and traps bacteria.
This causes repeated bouts of infection, and the blockages can result in
Adrenal irreversible damage to the lungs. In the pancreas, the mucus blocks the
glands passage of the enzyme that is required for digestion in the intestines. This
can cause vitamin deficiencies, malnutrition and/or severe constipation.
Pancreas Thickened secretions in the reproductive system can result in obstructions
that can affect the development and function of the sexual organs. A child
suffering from cystic fibrosis will have a shortened life expectancy.
People with cystic fibrosis experience a range of symptoms including:
• persistent coughing that requires enormous physical effort
• breathing difficulties
Ovary
(in females)
• a lack of energy resulting in limited capacity for physical activity
• a frequent need to go to the toilet
Testis • muscle cramping or weakness
(in males)
• poor appetite.
In Australia, one in 25 people carry the cystic fibrosis gene without
showing any symptoms of the condition. If a male and a female who are
both carriers of the gene have a child together, their chance of having a
Figure 9.8 Hormones are secreted child with cystic fibrosis is one in four. They have a two-in-four chance
by glands that make up the endocrine of having a child who will not have the condition but will carry the gene,
system. and a one-in-four chance of having a child who will neither have the gene
nor be a carrier.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 263
9.2 Biological determinants: genetics
Table 9.2 The impact of high and low blood glucose levels on health
Effects of high blood glucose levels Effects of low blood glucose levels
Excessive thirst Weakness, trembling, shaking
Loss of appetite Headache
Dehydration Light-headedness, dizziness
Weight loss Sweating
Abdominal pain Hunger
Vomiting Tingling around the lips
Frequent urination Racing heartbeat
Blurred vision Lack of concentration
Increased risk of infections Loss of coordination
Kidney damage Confusion
Eye damage Slurred speech
Nerve damage to feet and other parts of Loss of consciousness
the body
Heart disease Fitting
Circulation problems in the legs
Stroke
Impotence
Coma
There is no single gene that causes type 1 diabetes but there are inherited
factors that may increase the likelihood of a child developing the condition.
Certain environmental triggers have also been identified as increasing the risk of
developing type 1 diabetes. In particular, viruses such as rubella may damage the
insulin-producing cells of the pancreas. Research into the impact of dietary factors
has also shown that certain proteins found in cow’s milk may trigger the onset of
type 1 diabetes.
Asthma is another common childhood condition experienced by 14 to 16 per
cent of Australian children. Asthma affects the small air passages (bronchi) of the
lungs. When exposed to certain triggers (e.g. cigarette smoke and air pollution),
the lining of the air passages becomes inflamed and swollen, and extra mucus is
produced. The muscles of the airways also tighten (bronchoconstriction),
resulting in a narrowing of the airways that makes it difficult for the child to
breathe.
TEST your knowledge 5 Explain how cystic fibrosis might affect health and
individual human development.
1 What determines the genetic make-up of an
6 Explain how type 1 diabetes affects health.
individual? Explain.
7 Explain how asthma affects health.
2 With reference to sex-linked chromosomes, explain
8 What factors may increase the likelihood of an
how sex is determined.
individual developing asthma?
3 Explain the role of the following hormones in the
growth and physical development of children:
APPLY your knowledge
(a) growth hormone
(b) thyroid-stimulating hormone 9 What are the differences between a genetically
(c) thyroxine inherited condition and a genetic predisposition?
(d) calcitonin 10 Outline the determinants of health and individual
(e) parathyroid hormone development that affect asthma.
(f) insulin. 11 ‘Genetics play the most significant role in the health
4 What are the chances of a mother and father who and individual human development of children.’
are carriers of cystic fibrosis having a child with the Discuss.
condition?
The determinants of health and individual human development of Australia’s children • CHAPTER 9 265
9.3
Biological determinants: birth weight and body weight
KEY CONCEPT The influence of birth weight and body weight on the health
and individual human development of children
Birth weight
Birth weight can determine the health status of individuals as they develop into
children and then adults. Babies are classed as ‘low birth weight’ if they weigh less
than 2500 grams at birth. Low birth-weight babies can be further classified as ‘very
low birth weight’ if they weigh 1000–1500 grams, and as ‘extremely low birth
weight’ if they are below 1000 grams (table 9.3). Very low and extremely low birth
weights occur in infants who are born very prematurely.
Figure 9.11 Birth weight can be a
Table 9.3 Classification of birth weight
predictor of future health status.
Low birth weight Very low birth weight Extremely low birth weight
Below 2500 grams Between 1000 and 1500 grams Below 1000 grams
Table 9.4 The impact on health and individual human development of very low or extremely low birth weight
Body weight
The body weight of a child is determined by behavioural factors
(e.g. eating patterns and level of physical activity), the physical
environment (e.g. access to recreational facilities), the social
environment (e.g. the eating habits of family), as well as the genes
that are inherited from the biological parents. Research has shown
that genetics play a role in regulating body weight. For example,
children of parents with lower resting metabolic rates have a
greater chance of gaining weight. Overweight and obesity have a
significant impact on the health and individual human development
of children.
Figure 9.13 The genes that a child
How is children’s body weight measured? inherits are one factor that has an
impact on body weight.
Body weight is measured using the body mass index (BMI), which is an index of
weight relative to height. It is calculated by dividing a person’s weight in kilograms
by their height in metres squared.
BMI = weight (kg)/height (m2)
For example, the BMI calculation for a boy who weighs 25 kilograms and has a
height of 1.25 metres would be:
BMI = 25/(1.25)2
BMI = 16
The BMI calculation is useful for adults because they have stopped growing and
any increases in BMI are usually caused by increases in body fat. For children,
however, the BMI calculation on its own is not appropriate because children are
still growing and the proportion of body fat will change. To make the BMI relevant
to children, it needs to be compared against the BMI-for-age and gender percentile
charts. These percentile charts provide an indication of a child’s BMI relative to
children of the same age and sex.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 267
9.3 Biological determinants: birth weight and body weight
The categories and percentiles for BMI-for-age are shown in table 9.5.
Source: ‘About BMI for children and teens’, Centers for Disease Control and Prevention, www.cdc.gov.
The chart in figure 9.14 shows how BMI can be measured relative to children of
the same age and sex. In this example, different BMI calculations for a 10-year-old
boy are marked on the chart.
Body mass index-for-age percentiles: Boys, 2 to 21 years
BMI BMI
34 34
A 10-year-old boy with a BMI of 23
would be in the obese category
32 (95th percentile or greater). 32
95th percentile
30 30
90th percentile
28 A 10-year-old boy with a 28
BMI of 21 would be in the 85th percentile
overweight category (85th
26 to less than 95th percentile). 26
75th percentile
24 24
50th percentile
22 22
25th percentile
20 20 10th percentile
5th percentile
18 18
16 16
Table 9.6 Consequences of childhood obesity on health and individual human development
Health Health
• Physical discomfort • Twice the risk of developing cardiovascular disease (high blood
• Bone and joint problems pressure, angina, heart attack) in adulthood
• Asthma or shortness of breath during exercise • Three times the risk of developing type 2 diabetes in adulthood
• Heat intolerance • Increased risk of premature death
• Tiredness/lethargy • Poor self-esteem can lead to an increased tendency to smoke
• High blood pressure and drink alcohol, resulting in health conditions such as lung
• Abnormal cholesterol levels cancer, cardiovascular disease and cirrhosis of the liver
• Interrupted sleep due to breathing difficulties (obstructive sleep apnoea)
• Social and psychological distress
• Low self-esteem
The determinants of health and individual human development of Australia’s children • CHAPTER 9 269
9.4 Behavioural determinants: breastfeeding
KEY CONCEPT The impact of breastfeeding on the health and individual human
development of children
Breastfeeding
The benefits of breastfeeding to the health and
individual human development of the developing
child are well documented (table 9.7). In the first
few days following birth, the breasts produce a
fluid called colostrum, which contains antibodies
required to resist infection from conditions such as
acute diarrhoea, lower respiratory tract infections
and ear infections. Within a few days, the colostrum
changes to mature milk. Breastmilk contains all of
the nutrients required by the baby for the first six
months of life. Breastmilk can supply more than half
of the nutrients required by the child between 6 and
12 months of age, and up to a third of the nutrients
needed between one and two years of age. Mature
breastmilk contains the right amount of fat, sugar,
water and protein to promote the growth of the
baby. The World Health Organization recommends
exclusive breastfeeding for the first six months, with
the introduction of complementary foods beginning
at six months of age. Apart from the nutritional
value, breastfeeding is also hygienic, convenient and
inexpensive. For most babies, breastmilk is easier to
digest than formula.
Breastfeeding also promotes the social and
Figure 9.15 It is recommended that emotional attachment between mother and child. The secretion of the maternal
infants are breastfed for at least the
first six months of life.
hormones prolactin and oxytocin encourages the development of a maternal bond
with the child. Oxytocin plays a role in counteracting stress, which allows both
mother and baby to feel comfortable and relaxed.
Table 9.7 Benefits of breastfeeding for the health and individual human development of
children
Although breastmilk is the best option for babies, artificial formula contains the
required nutrients and is readily available. Some mothers may choose to bottle
feed purely because they do not feel comfortable breastfeeding. For some mothers,
The determinants of health and individual human development of Australia’s children • CHAPTER 9 271
9.5 Behavioural determinants: vaccination
Vaccination
Many infectious diseases can have significant effects on the health and individual
human development of children. These diseases are caused by bacteria or viruses.
Bacteria may enter the body via:
• open wounds
• consumption of contaminated food or water
• close contact with an infected person or with the faeces of an infected person
• breathing in the exhaled droplets of an infected person
• touching surfaces contaminated with bacteria such as taps or toilets.
Viruses are spread from one person to another via:
• coughing
• sneezing
• exposure to an infected person’s vomit
• transfer of bodily fluids including blood, breastmilk, saliva, vaginal fluids and
semen.
Vaccines have been developed to help protect children against a range of
infectious diseases. Each vaccine contains either a weakened or dead micro-
organism of a disease so that the body will develop antibodies against that
particular disease. This immune response means that when the body comes
in contact with a particular infectious micro-organism, it is able to fight and
overcome the organism. By vaccinating against specific diseases, the individual is
able to resist those diseases if exposed to them.
Vaccinating from an early age helps protect children from a range of illnesses,
some of which may be life threatening. In the first months of life, a baby gains its
protection from infectious diseases via antibodies that have passed from the mother
during pregnancy and through breastfeeding. Vaccinations become important
when these antibodies are no longer effective and the child is at risk of infection.
Immunisation is the process of providing vaccinations. Immunisation not only
protects the child but also protects the community from the spread of disease.
Table 9.8 outlines vaccine-preventable diseases and their impact on health and
individual human development.
Hepatitis B Virus spread via blood, sexual contact or 1 in 4 will develop cirrhosis of the liver or liver cancer
from mother to baby at birth
Haemophilus Bacteria spread via respiratory droplets Stiff neck, severe headache, convulsions/seizures, drowsiness, loss of consciousness,
Influenzae difficulty breathing
type B (Hib) Meningitis (infection of the membranes that surround the brain and spinal cord)
Epiglottitis (infection of the epiglottis, which is the flap at the top of the windpipe)
Pneumonia
Septicaemia (infection in the bloodstream)
Osteomyelitis (infection of the bone)
Measles Virus spread via respiratory droplets Fever, cough, rash, respiratory infections, diarrhoea and vomiting
1 in 15 with measles will develop pneumonia
1 in 1000 with measles will develop encephalitis, with 10 per cent dying and 40
per cent having permanent brain damage
Mumps Bacteria spread via saliva Swollen neck and salivary glands, fever, weight loss
1 in 200 will develop encephalitis
Inflammation of other organs of the body (e.g. reproductive organs, heart, brain,
pancreas, liver, thyroid)
Occasionally causes infertility and/or deafness
Pertussis Bacteria spread via respiratory droplets Bleeding, apnoea (temporary cessation of breathing while sleeping), pneumonia,
(whooping inflammation of the brain, convulsions and coma, permanent brain damage, death
cough)
Poliomyelitis Virus spread via faeces and saliva Vomiting, fever, headache, paralysis
1 in 20 hospitalised patients will die
1 in 2 patients who survive will be permanently paralysed
Rotavirus Virus spread via person-to-person contact Cough, runny nose, vomiting, diarrhoea, fever, dehydration, drowsiness, shock
(e.g. touching contaminated hands,
faeces, vomit or saliva; consumption of
contaminated food or water)
Rubella Virus spread via respiratory droplets Fever, rash, swollen glands
Malformations in babies of infected pregnant women
1 in 3000 will develop thrombocytopenia (bruising or bleeding)
1 in 6000 will develop inflammation of the brain
9 in 10 babies infected in the 10 weeks following conception (first trimester) will
have a major congenital abnormality
(continued)
The determinants of health and individual human development of Australia’s children • CHAPTER 9 273
9.5 Behavioural determinants: vaccination
Source: Adapted from Better Health Channel (www.betterhealth.vic.gov.au) and Immunise Australia (www.immunise.health.gov.au).
The determinants of health and individual human development of Australia’s children • CHAPTER 9 275
9.6 ehavioural determinants: eating habits and level of
B
physical activity
KEY CONCEPT The impact of eating habits and levels of physical activity on the
health and individual human development of children
The eating habits of children and the amount of physical activity they are involved
in are largely determined by their parents. Eating habits are learnt early in life and
have a significant impact on health and individual human development during
childhood and in the later stages of the lifespan.
In order to promote optimal health and individual human development in
children, it is important to instil healthy food habits and encourage children to
participate in regular physical activity.
Eating habits
Healthy eating habits need to be established early in life. The nutrients needed and
the stage at which different foods can be introduced into the child’s diet will vary
according to the age group.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 277
9.6 Behavioural determinants: eating habits and level of physical activity
Nutrient Examples of food sources Impact on health and/or individual human development
Carbohydrates Breads, cereals, rice, pasta, legumes, potatoes Production of energy required for growth and physical activity
Fats Monounsaturated — canola oil, olive oil, peanut oil and nuts Production of energy required for growth and physical activity
such as cashews, hazelnuts, peanuts and almonds Protection of organs
Polyunsaturated — fish and other seafood, polyunsaturated Regulation of body temperature
margarines, vegetable oils such as safflower, sunflower, corn
oils, nuts such as walnuts, brazil nuts and seeds Transportation of fat-soluble vitamins A, D, E and K
Note: Saturated fats (found in biscuits, pastries, full-fat dairy
products) and trans fats (found in baked products such as
pies, pastries, cakes and biscuits) should be limited in the diet
Protein Red meat, chicken, fish, beans, lentils, dairy products, seeds Growth and repair of all body cells
and nuts, soy products, wheat Development of brain cells, muscle, hormones, antibodies,
enzymes, hair and nails
Calcium Dairy products, sardines, fortified cereals Strong bones and teeth
Phosphorus Dairy products, red meat, fish, nuts, legumes, whole grains Strong bones and teeth
Iron Red meat, poultry, fish, green leafy vegetables, dried beans, Required for haemoglobin, which transports oxygen in
lentils, chickpeas, eggs, nuts the blood
Brain development
Vitamin A Liver, fish-liver oil, egg yolks, dairy products, darkly-coloured Required for night vision
orange or green vegetables (such as carrots, sweet potatoes Bone growth
and pumpkin), orange fruits (such as cantaloupe, apricots
and mangoes) Development of the immune system to fight infections
Growth and maintenance of skin
Development of the lining of the respiratory, urinary and
intestinal tracts to protect against harmful bacteria
Vitamin B1 Liver, yeast products, rice, wholemeal products, peanuts, Development of the nervous system, muscles and the heart
pork, milk Release of energy from carbohydrates
Assists with digestion
Vitamin B2 Milk, liver, yeast, cheese, green leafy vegetables, fish Promotes growth including skin, nails and hair
Eyesight
Metabolism of carbohydrate, fat and protein for energy
Vitamin B3 Red meat, poultry, fish, milk, wholegrain breads and Metabolism of carbohydrates and fat
cereals, nuts Tissue growth
Maintenance of healthy skin
Assists in the functioning of the nervous and digestive systems
Vitamin B6 Fish, bananas, chicken, pork, whole grains, dried beans Manufacture of red blood cells
Nerve growth
Vitamin B12 Liver, red meat, cheese, eggs Maintenance of nerve cells
Production of red blood cells
Metabolism of fat and protein
Folate Green leafy vegetables, poultry, eggs, cereals, citrus fruits Production of red blood cells
and legumes, fortified cereals
Vitamin C Citrus fruits, kiwi fruit, berries, tomatoes, cauliflower, Promotes the functioning of the immune system to protect
potatoes, green leafy vegetables, capsicum against viruses and bacteria
Wound healing
Promotes bowel activity
Promotes the lifespan of the cell
Prevents scurvy (characterised by fatigue, nausea, fever,
bleeding gums, slow-healing wounds, scaly and dry skin).
Vitamin D Cod-liver oil, sardines, salmon, tuna, full-fat milk products Strong bones and teeth
Note: The main source of vitamin D is sunlight
GUIDELINE 2
Enjoy a wide variety of nutritious foods from these five food groups every day:
• Plenty of vegetables of different types and colours, and legumes/beans
• Fruit
• Grain (cereal) foods. mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles,
polenta, couscous, oats, quinoa and barley
• Lean meats and poultry, fish. eggs, tofu, nuts and seeds, and legumes/beans
• Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat
And drink plenty of water.
GUIDELINE 3
Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
a. Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers,
pizza, fried foods, potato chips, crisps and other savoury snacks.
• Replace high fat foods which contain predominately saturated fats such as butter, cream, cooking margarine, coconut
and palm oil with foods which contain predominately polyunsaturated and monounsaturated fats such as oils, spreads,
nut butters/pastes and avocado.
• Low fat diets are not suitable for children under the age of 2 years.
b. Limit intake of foods and drinks containing added salt
• Read labels to choose lower sodium options
among similar foods.
• Do not add salt to foods in cooking or at the table.
c. Limit intake of foods and drinks containing added
sugars such as confectionary, sugar-sweetened soft
drinks and cordials, fruit drinks, vitamin waters,
energy and sports drinks.
d. If you choose to drink alcohol, limit intake. For
women who are pregnant, planning a pregnancy
or breastfeeding, not drinking alcohol is the safest
option.
GUIDELINE 4
Encourage, support and promote breastfeeding.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 279
9.6 Behavioural determinants: eating habits and level of physical activity
As parents are the ones who often choose and purchase the foods that are consumed
in children’s diets, it is important that they have the information required to ensure
that their children are consuming the right amount of the required nutrients and
not overconsuming nutrients such as saturated fat, simple carbohydrates and
sodium as these can contribute to the development of illness/disease such as obesity,
cardiovascular disease and type 2 diabetes.
Most Australian children require more:
• vegetables and fruit, particularly green, orange and red vegetables, leafy
vegetables and legumes/beans
• grain foods, particularly wholegrain cereals
• reduced fat milk, yoghurt and cheese (reduced fat milks are not suitable for
children under the age of two years as their main milk drink)
• water rather than soft drinks, energy drinks, sports drinks and sweetened fruit
juices.
Most Australian children need to consume less:
• meat pies, sausage rolls and hot chips
• potato chips, savoury snacks, biscuits and crackers
• processed meats
• cakes, muffins, sweet biscuits and muesli bars
• confectionery and chocolate
• ice-cream and desserts
• cream and butter
• jam and honey
• soft drink, cordial, sports drinks, energy drinks.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 281
9.7 Behavioural determinants: oral hygiene
KEY CONCEPT The impact of oral hygiene on the health and individual human
development of children
Oral hygiene
Oral hygiene is the practice of keeping the mouth clean in order to
prevent bad breath and maintain healthy gums and teeth. Dental
decay is the most common disease that affects teeth. Plaque is a
sticky film that forms on teeth. It contains bacteria that change
sugars into acids, resulting in cavities (i.e. caries, or holes) in the
teeth (figure 9.22). A build-up of plaque on the teeth can also lead
to gum disease — initially gingivitis which, if left untreated, can
progress to periodontitis. Gingivitis is the early stage of gum disease
where plaque builds up and becomes hard mainly on the area where
the gum line meets the tooth. Symptoms of gingivitis are bleeding,
redness and swelling of the gum. Periodontitis is advanced gum
disease in which the edge of the gum that meets the tooth becomes
weakened, allowing bacteria to penetrate beneath the gum line.
This causes an inflammation in the structures below the gum line,
affecting the root of the tooth, the bone and the fibres that connect
the tooth to the bone. If left untreated, the eroded bone causes
space between the gum and teeth. Periodontitis results in bleeding,
swelling, receding gums, bad breath, a bad taste in the mouth and
loose teeth. The teeth can fall out if the condition is not treated.
Oral hygiene during early childhood is vital for ensuring the
health of teeth and gums and teaches children the daily routines
required to ensure optimal dental health. Cavities can occur in
children as young as six months of age if the appropriate dental care
is not followed. Baby teeth have a thinner enamel coating that can
result in decay being able to penetrate to the middle of the tooth.
Figure 9.21 Good oral hygiene helps This can be extremely painful and, if left untreated, can result in a
to prevent dental decay and gum
disease.
pus-filled abscess. The abscess can damage the permanent teeth that
are developing underneath the baby teeth. As baby teeth guide the
permanent teeth into position, losing them early as a result of decay
can result in reduced spaces between the teeth and thus the child
may require orthodontic care later in life. Poor oral hygiene
and decayed teeth can affect the individual human
development of children by interfering with speech
development and the shaping of the jaw.
Dental decay during childhood may present as the
following:
• a dull white band along the gum line as a result of plaque
build-up. The bacteria in plaque convert sugar to acids
that dissolve minerals in the tooth enamel. If left untreated,
this can result in cavities.
• a yellow, brown or black ring around the teeth. This is the
beginning of cavities.
• teeth that appear as brownish-black stumps. This is the
advanced stage of cavities.
When dental decay and cavities become severe and painful,
Figure 9.22 Plaque that builds up on they can interfere with the daily life of the child. The pain
teeth can cause cavities. may be so severe that it may prevent the child from going to
The determinants of health and individual human development of Australia’s children • CHAPTER 9 283
9.8 hysical environment determinants: tobacco smoke in
P
the home
KEY CONCEPT The impact of tobacco smoke in the home on the health and
individual human development of children
The physical environment refers to the surroundings in which a child lives and the
accessibility to resources such as housing, water, health services and recreational
facilities. It also refers to the environmental conditions in which a child lives that
impact on health and individual human development. For example, an asthma
sufferer who lives in an area that has a high degree of air pollution may have a
greater frequency of asthma attacks compared to an asthma sufferer who lives in
an area with lower pollution levels. There are many factors within the physical
environment that impact on the health and individual human development of
children including tobacco smoke in the home, housing environment, fluoridation
of water and access to recreational facilities.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 285
9.9 hysical environment determinants: housing
P
environment and fluoridation of water
KEY CONCEPT The impact of the housing environment and fluoridation of water
on the health and individual human development of children
Housing environment
Housing environment plays a significant role in the health and individual human
development of children. Ideally, a house provides shelter and a clean place in
which to live, and protects children from the outside environment, including any
physical dangers. However, some families are required to live in substandard or
overcrowded dwellings due to low income. This can put family members at greater
risk of poor health.
Overcrowding puts increased stress on water supplies (bathroom, kitchen
and laundry) and sewerage disposal systems, and forces people to live in close
proximity in the home environment. All these factors can result in the spread of
infectious diseases such as meningococcal, meningitis, septicaemia, tuberculosis,
rheumatic fever, respiratory conditions and skin infections.
Figure 9.23 Overcrowded living
conditions can have a significant
Prolonged periods of ill-health can impact on the health and individual human
impact on the health and individual development of children (figure 9.24). A child who is ill is less likely to be engaged
human development of children. in physical activity, so motor skills may not develop according to the child’s
potential. The child may not be able to socialise with other children, thereby
affecting the capacity to develop social skills. This also reduces the opportunities
for the child to develop emotionally through interaction with others. Continued
absence from school may hamper the intellectual development of the child.
Intellectual development may also be affected by the overcrowded living conditions
as the child may not have the space to concentrate on schoolwork.
How safe are our homes? 4 Child resistant catches fitted to cupboards where dangers
Serious injuries to children under 6 years of age occur in the like medicines, cleaners, matches and lighters are stored.
place you’d think they would be safest — their own home. Why?
Try checking your home against the following list of home Young children are curious and don’t understand danger.
safety features: Telling them ‘not to touch’ is not enough to keep them safe.
1 Pools (and spas) that are fully fenced, with well Dangerous products and cleaning products need to be stored
maintained, self-closing gates. away safely.
Why? 5 Install smoke alarms, test them regularly and change the
Young children drown quickly and silently. Around 33 children battery once a year.
under five drown each year in Australia in unfenced pools or Why?
pools with poorly maintained fences or gates. House fires continue to claim Australian lives every year. The
2 Hot water from bathroom taps set at a delivery correct smoke alarms correctly positioned provide a warning
temperature of 50 ºC. that may be critical to survival.
Why? 6 Play areas fenced off from the street and the driveway.
Hot water burns like fire. Many Australian homes have hot Why?
water coming from their taps at temperatures that can burn a Cars and kids don’t mix. Young children have no fear of cars
child’s skin in one second. and are not easily seen by drivers. Every month a toddler is
3 Barriers such as gates on stairs, window latches and killed after being reversed over in a driveway.
fireguards in place to keep children from hazards. Kidsafe estimates that if these six features were in place in
Why? all Australian homes, they would help prevent more than half
Falls down stairs, off furniture and out of windows are of all home injury deaths among children under six and spare
common and because young children are ‘top heavy’, head thousands of children from disability from preventable injuries.
injuries can often occur. Source: www.kidsafe.com.au.
Fluoridation of water
Fluoride is a natural mineral found in food, water, plants and toothpaste. The
fluoridation of water involves adding fluoride to a public water supply to reduce
tooth decay in the population. It is a safe and effective way of reducing the risk
of tooth decay in people of all ages. Tooth decay occurs when acid is produced by
bacteria in the mouth. Fluoride reduces the amount of acid that is produced and
can also repair the damage to teeth before it progresses and becomes permanent.
In fluoridated areas of Victoria, six-year-old children experience 36 per cent less
decay in their baby teeth than those in areas without access to fluoridated water,
according to the Victorian government. Likewise, 12-year-old children living in
The determinants of health and individual human development of Australia’s children • CHAPTER 9 287
9.9 Physical environment determinants: housing environment and fluoridation of water
areas with ready access to fluoridated water have 22 per cent less decay in their
permanent teeth compared to those living in non-fluoridated areas.
The vast majority of the Australian population has access to fluoridated water.
By 2008, every capital city in Australia (except Brisbane) had implemented water
fluoridation. Table 9.11 outlines the percentage of the population with access to
fluoridated water according to state/territory. Melbourne has had fluoride added to
drinking water for over 30 years. In Queensland, water fluoridation started being
phased in from December 2008, however in 2012 the Queensland Government
changed laws that required larger communities to add fluoride to their water
supplies. As a result, councils were given the right to decide if fluoride should be
added to water.
NSW 94
Vic. 90
Qld 80
WA 92
SA 90
Tas. 83
ACT 100.0
NT 70
Source: Australian Institute of Health and Welfare 2012, Australia’s
health 2012, cat. no. AUS 156, Canberra, p. 145.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 289
9.10 hysical environment determinants: access to
P
recreational facilities
KEY CONCEPT The benefits of providing access to recreational facilities for the
health and individual human development of children
Casey Fields a sports venue The kids’ fishing day also attracts 1000 young people
each year.
for everyone Casey Fields is also the venue for the annual Access
for All Abilities Sports carnival, catering for up to
By Nadja Poljo
300 children and adults with a disability.
Casey Fields has hosted a raft of memorable events and It has proven to be a vital sporting facility providing
activities since its opening in February 2006. opportunities from both a participatory and spectator
In March 2007, the first AFL NAB Challenge Match perspective.
attracted more than 10 000 people who came to watch The development of the regional playground, village
Essendon versus Hawthorn. green, fishing lake and walking paths now ensure it
The development of the Casey Campus has seen also offers a broad range of leisure opportunities for
the site play host to a number of events involving the residents.
Melbourne Football Club, including interclub practice Future plans for the fields include the development of
matches and regular training sessions, attracting up to the Casey Fields Soccer Centre of Excellence featuring
4000 people. four synthetic pitches and a pavilion with a capacity of
Last year, it played host to Premier Cricket finals 3000.
for the first time, featuring the Casey South Melbourne Plans are also well under way for a social club near
Cricket Club. the entrance and a pavilion to service the existing rugby
One of the most memorable moments at the fields league fields.
was the Dandenong and District Junior Football League Source: Berwick Leader, 23 February 2011.
finals last year, featuring 21 grand finals and attracting
more than 12 000 spectators.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 291
9.11 S ocial environment (family) determinants: parental
education
KEY CONCEPT The impact of parental education on the health and individual
human development of children
The social environment refers to the social factors children are exposed to that
affect their health and individual human development. Social factors within families
are an important influence on the health and individual human development of
children, and include parental education and parenting practices. Social factors
that influence the health and individual human development of children may also
lie outside the family, such as the media and access to health care.
Parental education
A person’s level of education is a key determinant of their
employment, which is in turn directly linked to their
level of income. In general, higher levels of education
increase opportunities for higher-paid employment and
therefore a higher socioeconomic status.
Parental education refers to both the formal level
of education that is achieved by parents (e.g. through
tertiary qualifications) and the level of knowledge that
may be attained through more informal means (e.g. by
reading newspapers or watching television).
Education enables parents to gain the knowledge
and skills needed to promote the health and individual
human development of their children. Higher levels of
education provide parents with a greater understanding
Figure 9.28 Parental education is of health, particularly of health risks and protective factors. Therefore parents with
a key determinant of employment higher levels of education will tend to have a greater understanding of the factors
status and income. that impact on the health and individual human development of children (e.g.
nutrition, physical activity and vaccination). This is particularly true for mothers,
who are traditionally the caregivers of the family.
Formal qualifications provide opportunities for better employment and higher
income, which enable individuals to have a healthier lifestyle and greater access
to health-promoting resources such as nutritious foods and health care. This has a
significant effect on children because parents are responsible for the provision of
resources that are necessary for health and individual human development.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 293
9.12 S ocial environment (family) determinants:
parenting practices
KEY CONCEPT The impact of parenting practices on the health and individual
human development of children
Parenting practices
Parenting practices refer to the way in which the parents or guardians interact with
their child and how they model behaviour. It incorporates the type of discipline
that is used and the way in which the parent/guardian responds to the child in
different situations. Parents and guardians have an enormous impact on the social
development of children, particularly in the following areas:
• teaching respect for others
• developing effective means of communication
• learning values
• learning appropriate behaviours
• learning how to cooperate effectively with others
• being empathetic towards others.
Parents/guardians of children tend to adopt a particular parenting style, and this
can have an impact on the health and individual human development of the child.
The four main types of parenting styles are:
• Authoritarian parenting style. Authoritarian parents/guardians
tend to use direct parenting styles with an overemphasis on
discipline and little or no opportunity for decision making by
the child. Authoritarian parents/guardians can be intimidating,
with an expectation of obedience and respect. Expectations are
not explained but simply demanded of the child, and the parent/
guardian will become angry and forceful if the expectations are not
met. Authoritarian parents/guardians may feel threatened by the
emerging independence and individuality in the child. Research
has shown that children who have been raised by authoritarian
parents/guardians tend to be more withdrawn, anxious and
discontented, with lower self-esteem and less trust in others.
• Authoritative parenting style. Authoritative parents/guardians
tend to provide fair discipline while also catering for the self-
esteem needs of the child. They have high but not unrealistic
expectations, and effectively communicate these to the child.
Good behaviour is rewarded with positive encouragement
and reinforcements. Authoritative parents set limits and
implement fair disciplinary measures if these are breached. They
acknowledge and respond to a child’s individuality and support
the child’s developing independence. Children who have had
an authoritative upbringing tend to be more self-reliant, self-
Figure 9.30 Parenting practices refer controlled and happy. They usually have a wide social network
to the way in which parents interact of friends, perform better in school and have higher self-esteem.
with their children. • Permissive parenting style. Permissive parents/guardians tend to overemphasise
the self-esteem needs of the child and fail to discipline the child when required.
They have very little or no expectations of the child and will usually ignore
obnoxious behaviour. Permissive parents give in to their child’s demands, thereby
reinforcing the demanding and inconsiderate aspect of the child. They do not set
rules or limitations, and their love and support of the child is unconditional.
Children who have been raised in a permissive environment tend to be more
immature, demanding and dependent. They may have social issues arising from
a tendency to blame others for their problems.
High
restrictive punitive promotion
strict
negotiation of boundaries
parenting
autocratic parent-centred independence
explanation
lack of expectation
lack of distant lack of over-involved
encouragement warmth spoilt
lack of
neglectful no direction
emotional withdrawal control
Low
The determinants of health and individual human development of Australia’s children • CHAPTER 9 295
9.12 Social environment (family) determinants: parenting practices
The effects on children exposed to abuse can be short and long term. Short-term
effects include the child:
• blaming themselves for the situation
• having sleeping difficulties
• regressing to earlier stages of development such as bedwetting and thumb
sucking
• being anxious or fearful
• displaying aggressive or anti-social behaviour
• isolating themselves from people
• not attending social or school events
• becoming a victim or perpetrator of bullying
• being cruel to animals
• suffering from stress-related illnesses such as headaches and stomach cramps
• displaying speech problems such as stuttering
• misusing drugs and alcohol.
The long-term effects of exposure to abuse may result in the child growing up to
be an abusive person from learning to solve problems through the use of violence.
From witnessing the violent behaviours of their adult role models, children may
grow up to behave in destructive ways in their own adult relationships.
Drug and alcohol dependence in parents/guardians may leave them unable to
appropriately care for their children, who may be hurt or neglected as a result of
the addiction. For parents/guardians in this situation, the need for drugs or alcohol
may take priority over looking after their children’s needs. Children growing up
with parents/guardians with a drug and/or alcohol dependency may:
• lack the essential nutrients required for growth and development
• have difficulties at school
• encounter learning problems
• develop emotional problems due to stress or anxiety
• lack trust in adults
• be at increased risk of mental illness or suicide in later life
• be at increased risk of substance abuse.
KEY CONCEPT The impact of media on the health and individual human
development of children
Media
The media — television, print media, radio, videos/DVDs and the internet —
are a part of children’s daily lives. As a result, they are exposed to messages and
information that may impact positively or negatively on their health and individual
human development. Young Media Australia is a national community organisation
that is committed to the promotion of the healthy development of Australian
children. Table 9.12 outlines some of the key themes within the media identified
by Young Media Australia. The way in which the media portray these themes can
have positive and negative effects on children.
Table 9.12 Positive and negative effects of the media on children’s health and individual human development
Key theme Impacts on the health and individual human development of children
Needing to feel that the world is a Positive: Positive programs can show children elements of their world in a safe and non-threatening way.
safe place and that people can be Negative: Violent and scary programs can undermine children’s sense of safety and security.
trusted
Needing autonomy and connection — Positive: Appropriate programs can show children a world where people help and support each other
it is important for children to do a while maintaining their own independence.
range of tasks independently while Negative: In some programs, autonomy is commonly equated with violence and hurting others, and may
learning to participate more in be connected with helplessness and victimisation. It does not enable children to understand that they can
relationships with others be both independent and connected to others.
Feeling a sense of empowerment and Positive: Appropriate programs can make children feel that they can make a positive difference in the
efficacy — children need to develop a world.
sense that they can affect their world Negative: Programs fail to assist children in developing a sense of empowerment. In many children’s
and believe that they are competent program, characters display empowerment and efficacy by using weapons and violence.
and capable people
Developing a gender identity — Positive: Programs that show both male and female characters assist children in developing gender
identifying what it means to be a boy identity.
or a girl and that both sexes can do a Negative: Many programs stereotype males as muscle bound characters and females as sweet, kind and
range of things sexy. This gives children a restricted understanding of what it means to be a boy or a girl.
Understanding how people are alike Positive: Programs can show children a diverse range of people and how to respect and learn from each
and different other.
Negative: Some programs promote suspicion, intolerance and even violence against those who are
different, which does not encourage children to appreciate and respect the differences among people.
Developing a sense of morality and Positive: Appropriate programs can show cooperation, getting along with others and treating people with
social responsibility respect, encouraging children to imitate these behaviours.
Negative: Inappropriate programs can show children that violence can be justified in resolving conflict.
Children learn that people are either ‘all good’ or ‘all bad’.
Needing meaningful play Positive: Appropriate programs can promote imaginative play.
Negative: Too much television or time on the computer reduces the time available for physical play.
Source: Adapted from ‘Effects of media from a child development perspective’, Young Media.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 297
9.13 Social environment (community) determinants: media
Childhood overweight and obesity are linked to numerous health risks including:
Social and mental health: overweight and obesity can lead to social isolation and
discrimination, poor self-esteem, depression, learning difficulties and limited social
skills.
Physical risks in childhood: back pain, flat feet, slipped growth plates in the
hips, knock knees (where the knees touch), fatty liver, type 2 diabetes, menstrual
problems, asthma and obstructive sleep apnoea (pauses in breathing due to an
obstruction of the open airway).
Physical risks in adulthood: type 2 diabetes, cardiovascular disease, stroke,
hypertension, some cancers such as colorectal cancer, musculoskeletal disorders
and gall bladder disease. Overweight and obesity can result in a reduced life
expectancy.
Dental health: The consumption of high sugar foods and acidic soft drinks is the
biggest risk factor for dental erosion and dental caries in children and adolescents.
Bone health: Children who consume soft drink rather than milk may have low
bone density due to inadequate calcium intake.
The childhood obesity rate in Australia is one of the highest in the world; in 2012,
the proportion of overweight and obese children (aged 5–17) was 25.3 per cent.
The Coalition on Food Advertising to Children (CFAC) — which includes
Australian community groups and organisations such as Cancer Council Australia
and the Australian Medical Association — estimates that Australian children (aged 5
to 12 years) watch an average 23 hours of television per week; up to four hours
are made up of advertisements which equates to 208 hours per year. More than
three-quarters of food advertisements shown during children’s TV viewing time
promote foods low in nutritional quality such as chocolate, confectionary, fast food
and sweetened breakfast cereal. Food advertisers on television use techniques such
as prizes, catchy jingles, animation and celebrities to attract children’s attention
and create a desire to want the product. Children are susceptible to television
advertising and will pester their parents to purchase the advertised products.
KEY CONCEPT The importance of health care in promoting the health and
individual human development of children
Table 9.13 Some conditions that may affect the health and individual human development of
the unborn baby
Placenta praevia Placenta becomes implanted at the Foetal distress from lack of oxygen
bottom of the uterus, covering the Low birth weight
cervix and preventing the baby from
being born vaginally. During pregnancy Premature birth
the placenta can separate from the wall
of the uterus, resulting in bleeding.
Gestational Form of diabetes in which pregnancy Baby can grow larger than expected
diabetes blocks the action of insulin Baby may have problems with low
blood glucose levels when born
Breathing difficulties
Source: Adapted from ‘Health problems in pregnancy’, Children, Youth and Women’s Health Services, www.cyh.com.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 299
9.14 Social environment (community) determinants: access to health care
The determinants of health and individual human development of Australia’s children • CHAPTER 9 301
KEY SKILLS The determinants of health and individual human
development of Australia’s children
302
UNIT 2 • Individual human development and health issues
1.1 Understanding health
The Shine family has agreed to speak out to promote the Car and Home: Smoke
Free Zone campaign, a joint initiative of NSW Health, the Cancer Council NSW, the
National Heart Foundation (NSW), Asthma NSW and SIDS NSW.
‘People need to know how dangerous it is to smoke around their kids,’ Karyn says.
‘Passive smoking is dangerous.
‘It’s bad enough that I might be digging my own grave, but we don’t want to be ❹ Recognition of the possible impact of
passive smoking on premature death
digging our children’s graves as well.’❹
• Infants who are born with low birth weight are at greater risk of poor health,
disability and death than other infants.
• In 2006, 6.4 per cent of live born infants in Australia were of low birth weight
(weighing less than 2500 grams). This proportion was twice as high among babies
of Indigenous mothers.
• 1.1 per cent weighed less than 1500 grams (very low birth weight, including
extremely low birth weight).
• 5.3 per cent weighed between 1500 and 2499 grams.
Source: Australian Institute of Health and Welfare 2009, A picture of Australia’s children 2009,
cat. no. PHE 112, Canberra, p. 72.
Low
6.4% 5.3% (1500–2499 grams)
Normal
93.6%
The determinants of health and individual human development of Australia’s children • CHAPTER 9 303
Key skills The determinants of health and individual human development of Australia’s children
1 marks
(b) What impact could this parenting style have on the physical, social, emotional and
intellectual development of the children?
8 marks
304
UNIT 2 • Individual human development and health issues
CHAPTER 9 review
Chapter summary
• The factors that impact on the health of individuals and populations are referred to as
the determinants of health and individual human development.
• The determinants of health and individual human development include: biological
factors, health behaviours, physical environment and social.
• The determinants of health and individual human development can be multicausal.
• Although the overall health status of children is positive, Australian children are
experiencing higher rates of overweight and obesity, insufficient physical activity, poor
eating habits, mental health issues, and long-term health conditions such as asthma
and type 1 diabetes.
• Biological factors refer to those genetic and physiological factors that impact on health
and individual human development.
• Biological factors relate to the functioning of the body and include body weight and
birth weight.
• Biological factors do not act in isolation, and are affected by environmental factors and
health behaviours.
• The genes that an individual inherits from their biological parents have a significant
impact on health and individual human development.
• Genes are the blueprint of the body because they control growth, development and
how the body functions.
• Humans have 46 chromosomes which make up 23 pairs; 22 pairs are referred to as
autosomes and one pair is called ‘sex-linked’ as it determines the sex of the individual.
• Some genetic conditions such as Duchenne muscular dystrophy are carried on the ‘X’
chromosome.
• Our genetic make-up is determined by the combination of genes that occur at the
point of conception.
• It is the combination of genes that will determine the physical characteristics of the
individual (e.g. facial features, sexual characteristics and eye colour) as well as genetic
conditions and genetic predisposition to disease.
• Hormones regulate growth and physical development during childhood.
• Some childhood conditions occur as a result of genetic susceptibility (e.g. asthma and
type 1 diabetes).
• Babies are considered to be low birth weight if they weigh less than 2500 grams at
birth. Low birth-weight babies can be further classified into ‘very low birth weight’ if
they weigh between 1000–1500 grams and ‘extremely low birth weight’ if they are
below 1000 grams.
• Babies that are born very low birth weight or extremely low birth weight are at greater
risk of premature death and a range of conditions and developmental problems.
• BMI-for-age and gender percentile charts are used for assessing the relative body
weight of children.
• Overweight and obesity can be caused by a genetically low metabolic rate.
• The lifestyles of children and the decisions they make in terms of health are largely
dependent on the lifestyles of the parents and the knowledge, attitudes and beliefs
that they pass on to their children.
• Eating habits and physical activity patterns of children are largely determined by the parents.
• It is recommended that children participate in 60 minutes of moderate to vigorous
exercise per day.
• Tobacco smoke in the home is particularly dangerous for children because their lungs
are still developing.
• Breastmilk contains all of the nutrients required by the infant for at least the first six
months of life, and the colostrum that the baby receives in the first few days following
birth contains antibodies required to resist infection.
The determinants of health and individual human development of Australia’s children • CHAPTER 9 305
Chapter 9 review
• Artificial formula contains the required nutrients for the developing baby, but it does
not contain antibodies.
• Vaccines contain either a weakened or dead micro-organism of a particular disease so
that the body will develop antibodies against that disease.
• Vaccinating from an early age helps protect children from a range of illnesses, some of
which may be life threatening.
• Dental decay is the most common disease that affects teeth.
• The first stage of gum disease is gingivitis and the later stage is periodontitis.
• Oral hygiene during early childhood is vital for ensuring health of the teeth and gums
and teaches children the daily routines required to maintain optimal dental health.
• The physical environment refers to the surroundings in which one lives and the
accessibility to resources such as food and water. It also refers to conditions in which an
individual lives that impact on health and individual human development.
• Families that are required to live in substandard or overcrowded dwellings are at greater
risk of poor health.
• Half of all deaths and three out of four injuries in the 0–5 age group occur at home.
• Fluoridation of water involves the addition of fluoride to a public water supply to
reduce tooth decay in the population.
• Fluoride reduces the amount of acid that is produced and can also repair the damage
to teeth before it progresses and becomes permanent.
• Recreational facilities that are easily accessible for families with children greatly increase
the likelihood of regular physical activity. Undertaking regular physical activity has
enormous benefits for the health and individual human development of children.
• The social environment includes factors such as parental education, parenting practices,
media and access to health care.
• Education provides opportunities for better employment and higher income, which
enable individuals to have a healthier lifestyle through greater access to health-
promoting resources such as nutritious foods and health care.
• Parenting practices refer to the way in which the parents or guardians interact with
eBook plus their child and the way in which they model behaviour.
• There are four main parenting styles: authoritarian, authoritative, permissive and uninvolved.
Interactivities:
• Violence and alcohol and drug misuse within the family can have detrimental effects on
Chapter 9 crossword
the developing child.
Searchlight ID: Int-2905
• As a result of the media, children are exposed to messages and information that may
Chapter 9 definitions impact positively or negatively on their health and individual human development.
Searchlight ID: Int-2906
• Maternal and child health services support families in caring for their child.
• Through the provision of easily accessible health-care services, parents are able to
monitor growth, check the health status of their child and treat illnesses/conditions in
their earliest stage to maximise recovery and health.
• The Primary School Nursing Program is a free universal health-care service offered to all
Victorian Primary and English Language Centre schools.
The health
Global andand
health individual human
development
human of Australia’s adults
development
WHY IS THIS IMPORTANT?
Reaching adulthood — the longest stage of the human
lifespan — is a significant milestone for an individual.
A number of physiological changes mark the entry and journey
through adulthood, and the level of health is a significant
factor. However, it is the social and emotional development
of an individual that shapes the experiences and progress
through this period. Understanding the complexities of this
stage of the lifespan can make the transition through each
stage easier.
KEY KNOWLEDGE
3.1 the different classifications of the stages of adulthood (pages 310,
318, 322)
3.2 characteristics of physical development during adulthood, including
the physiological changes associated with ageing (pages 310–11,
318, 322–3)
3.3 the social, emotional and intellectual development associated with
the stages of adulthood and ageing (pages 311–17, 319–21, 323–6)
3.4 the health status of Australia’s adults, including the similarities and
differences between adult males and females (pages 327–31).
KEY SKILLS
• describe the stages of adulthood and ageing
• describe the characteristics of development during adulthood
• interpret data on the health status of Australia’s adults.
The health and individual human development of Australia’s adults • CHAPTER 10 309
10.1 Early adulthood: physical and social development
Adulthood is the longest stage of the human lifespan, starting at 19 years of age
(the end of the youth stage) and ending at death. The first stage, early adulthood,
ends around 40 years of age, but it is a difficult stage to generalise about because
every person’s journey is unique. The impact of biological, behavioural and
environmental determinants can have a significant effect on the ageing process.
Cells continue to divide
for the replacement,
repair and maintenance
of body tissue.
Sensory
Reflexes of organs are
the nervous at their
system are sharpest.
at their
peak.
Reproductive
function of Figure 10.2 The physical changes from boy to man
women has
an impact on Early adulthood is usually defined as the period between 19 and 40 years of
the physical
changes.
age. Although there are always individual differences, this stage of the lifespan is a
time when physical growth is completed and development of the muscles, internal
organs and body systems should be at their peak condition.
Physical development
Peak bone Physical changes that occur to the functioning and appearance of the human body
mass is
achieved. as it ages are known as physiological changes (figure 10.3). These include the
following:
• Maximum adult height is reached. Young adults finish growing and their height
remains constant throughout early adulthood.
• Cells continue to divide for the replacement, repair and maintenance of body
Muscular
tissue, rather than for growth.
strength • Peak bone mass is achieved. Normal ageing is accompanied by the loss of bone
reaches its tissue throughout the body. Loss of bone density begins in the late 30s, so it is
peak.
important for adults to maintain their bone density through diet and physical
activity.
• Sensory organs are at their sharpest (ears, eyes, nose, mouth, skin).
Maximum • Muscular strength reaches its peak.
adult height • Reflexes of the nervous system are at their peak.
is reached.
• Women’s reproductive function has an impact on the changes experienced during
Figure 10.3 Physiological changes this stage. It is usually in early adulthood that women go through childbearing,
during early adulthood and their bodies will change physically to carry out this function.
310
UNIT 2 • Individual human development and health issues
Most people in early adulthood see themselves as being at their peak in terms
of health, lifestyle, sex life and physical condition. Estimates from the 2007–08
National Health Survey show that almost two-thirds (64 per cent) of 24–34 year
olds rated their health as excellent or very good, and this proportion declined as
age increased (Australia’s health 2010).
Social development
The process of socialisation begins at birth and continues until death. Social
development refers to learning the skills, knowledge, values and behaviours that
are appropriate to interact with others (figure 10.4). Social development during
adulthood includes acquiring new roles, responsibilities and expectations, both
within the family (e.g. as parents and grandparents) and outside it (e.g. at university
and in the work environment).
Gaining independence and developing identity become the main focus during
early adulthood. This could include:
• career development. In developing their independence, young adults are faced
with many decisions. Starting a career is seen as important for both males
and females and will often include completing their secondary education and
possibly continuing on to further study. Being part of a new environment requires
individuals to adapt to new roles and the expectations linked to those roles.
Whether they are entering a tertiary institution or moving straight into a job,
individuals will form new relationships with other students, lecturers, tutors,
work colleagues and employers. Good communication skills and the ability to
work well with others are critical requirements for a successful work life.
• selecting a life partner. Finding a permanent partner and being involved in an
intimate relationship is a common goal for most young adults. The establishment
of a stable long-term relationship is linked to a range of positive attitudes such as
confidence and acceptance. Intimacy requires an individual to sacrifice some of
their independence for another person. Taking on the role of spouse or partner
requires many social skills, and having good role models improves the chances
of success in a relationship.
The health and individual human development of Australia’s adults • CHAPTER 10 311
10.1 Early adulthood: physical and social development
• getting married or learning to live with a partner. Getting married and establishing
a family is often delayed when young adults choose to focus on career
development. According to the Australian Bureau of Statistics (ABS), there has
been a trend towards getting married at a later age. The median age for first
marriages has increased, from 28 years in 1998 to 29.7 years in 2011 for men
and from 24 years to 28 years for women. Choosing to get married at an older
age means that individuals may have developed their social skills and have a
better understanding of how to behave in a relationship.
ABS marriage data for 2011 also confirms a forty-year trend for more couples
to cohabitate (live together) prior to entering a registered marriage. In 1975, only
16 per cent of couples cohabitated prior to marriage, increasing to 27 per cent in
1983, while 78.2 per cent of couples cohabitated in 2011. This trend to cohabitate
allows a couple to establish their relationship and develop the necessary skills that
are the key to a successful partnership. These skills include good communication
Figure 10.5 Although many people
are marrying at a later age and
(e.g. taking the time to listen to each other’s point of view); the ability to be flexible,
some are choosing not to marry at adaptable, trustworthy, empathetic, honest and accepting; and a willingness to
all, marriage remains a significant make compromises.
milestone for most people. • managing a home. Many young adults are staying in the family home longer
and delaying living independently, thus also delaying this aspect of their
social development. Moving out of the family home and living independently
(whether in a share house, cohabitating with a partner or living alone) is
another developmental milestone of early adulthood. The individual takes on
responsibilities such as paying bills, rent or a mortgage; maintaining a clean
living environment; establishing the expectations of each member of the
household; developing relationships with neighbours and learning to be part of
a community.
• starting a family. Starting a family is also an important developmental milestone
for most individuals. The role of a parent is linked to many societal and legal
expectations including registering the birth; providing a name for the child;
and the giving of appropriate care, love and support. The decision to take on
the role of parenthood is also influenced by society and technology. Individuals
have many choices, including the choice of whether or not to have children.
Contraception allows couples to plan their decision to conceive, while in-vitro
fertilisation (IVF) technology gives couples who may have remained childless
the chance to have children. These technological developments have allowed
couples the freedom to make choices and develop their independence.
Not quite grown up She’s not alone. Jeffrey Jensen Arnett, a psychology
professor at Clark University in Massachusetts, USA,
Is Generation Y’s reluctance to rush through the is leading the movement to view the 20s as a distinct
rites of passage from adolescence to adulthood a life stage, one that has developed in response to cultural
sign of self-indulgence or a sensible response to an change, not simply the lazy indecisiveness of an oft-
increasingly complex world? By Sarina Lewis. maligned generation. To support his argument, Arnett
As the daughter of Bryan Brown and Rachel Ward, points to the need for more education to survive in an
23-year-old Matilda Brown is the progeny of the information-based economy; the lack of entry-level
closest thing Australia has to entertainment royalty and jobs even after all that schooling; the fact that young
is a second-generation ‘face to watch’. After starring people feel less haste to marry because of the wider
in the award-winning short film Martha’s New Coat at acceptance of premarital sex, cohabitation and birth
age 15, Brown has gone on to appear in the TV shows control; and that young women also feel less rushed to
Underbelly, Offspring, My Place and Rake as well as have babies thanks to access to assisted reproductive
writing, directing and starring in this year’s Tropfest technology.
finalist How God Works. ‘I think you have to be open Just as adolescence has a particular psychological
in this industry,’ Brown says of her forays into acting, profile, Arnett says, so does emerging adulthood:
directing and writing. ‘Even life is kind of like that — identity exploration, instability, self-focus, feeling
you never know where you’re going and that’s the nice ‘in-between’ and a rather poetic characteristic he calls
thing about it.’ ‘a sense of possibilities’. A few of these, especially
Brown’s is a particularly revealing comment, and identity exploration, are also part of adolescence, but
one that some sociologists suggest is representative of a take on new depth and urgency in the 20s. The stakes
generation of 20-somethings challenging what has until are higher — people are approaching the age when
now been the ‘natural progression’ from adolescence options tend to close off and lifelong commitments
to adulthood. The five traditional milestones that mark must be made. Arnett calls it ‘the age 30 deadline’.
this transition to adulthood — completing school, The whole idea of milestones, of course, is
leaving home, becoming financially independent, something of an anachronism; they imply a lock-step
getting married and having a child — are being delayed march towards adulthood that is rare these days. Kids
by more and more members of Gen Y. don’t shuffle along in unison on the road to maturity —
It’s a topic that pops up everywhere, from newspaper they slouch towards adulthood at an uneven pace. Some
articles reporting changing statistics on the age of home never achieve all five milestones, including those who
leavers to sociology papers detailing the characteristics are single or childless by choice, or unable to marry
of today’s ‘boomerang kids’ as they ricochet back and because they’re gay. Others reach the milestones
forth between the parental home and independence. completely out of order, advancing professionally
And even when not spelled out, the often negative, before committing to a monogamous relationship,
judgmental nature of the commentary is clear. having children young and marrying later, leaving
For Brown and others like her, however, the notion school to go to work and returning to school long after
of deferring some of the traditional rites of passage in becoming financially secure.
favour of a more fluid approach to life in their third Certainly that is where Brown feels herself placed.
decade is far from troublesome. ‘I like the idea of being Having returned to the parental home in Sydney
free and not having to worry about settling down just following five years spent studying and living in
yet,’ she says, adding that this does not mean neglecting Melbourne, the rising star confesses that while she has
social responsibility: like her mother, Brown spends her career on track, she sees no issue in her decisions
time working as a mentor with disadvantaged youth in to delay the hunt for a long-term partner and remain in
the Big Brothers Big Sisters program. ‘I think there is the family home. Nor does she view her lifestyle choice
plenty of time for thinking about things like marriage as irresponsible.
and mortgages and I don’t know why I should be at this ‘I guess if adulthood means being married and having
time in my life.’ kids I’m clearly not there yet,’ she admits. ‘But I think
(continued)
The health and individual human development of Australia’s adults • CHAPTER 10 313
10.1 Early adulthood: physical and social development
in order to do all that stuff you need to be an adult long ‘I think there are a lot of complexities in the world
before you take on those responsibilities, otherwise today that definitely didn’t exist in the past,’ adds
you’re going to throw yourself into the deep end when Hollonds. ‘There are decisions about whether or not
you’re not ready. So I guess I’m just taking things one we’ll live together, whether or not we’ll get married.
step at a time, which feels good.’ Will we have children? When will we have children?
As a life decision, it seems eminently sensible, and Who will stay home with the children?
Relationships Australia NSW CEO Anne Hollonds ‘You might say that’s a really positive thing — we’ve
can certainly see the logic. ‘I think there are enormous got all these choices available to us. And it is a positive
advantages,’ she says of the delay in settling down and thing in many ways, but the downside is we have to be
the trend towards bouncing back to the family home. able to make ethical decisions and wise decisions, often
And many people clearly agree: figures from the in very complex circumstances. And you don’t get that
Australian Bureau of Statistics show that, after leaving ability overnight. You don’t get that just because you
home for the first time, 46 per cent of people return at turn 21.’
least once before turning 35. Source: Extract from Sydney Morning Herald, 12 November 2010.
Emotional development
Emotional development is the capacity to express feelings and
emotions and the ability to understand and control moods
and feelings (figure 10.7). It is closely linked to self-concept,
the way an individual views themselves.
As previously outlined, the most significant changes that
occur in early adulthood include:
• career development
• selecting a life partner
• getting married or learning to live with a partner
• managing a home
• starting a family.
The ability to cope with these changes will depend on the
emotional development of the individual. The availability of
good role models at work, at home and in the community will
help to foster an individual’s self-concept, thus impacting their
emotional development.
Young adults still living at home need to adapt to the
changing nature of family relationships. In some cases,
the way parents treat their children when they reach early
adulthood will not change even though their children may Figure 10.7 Expressing emotions
be financially independent. Parents not only provide role is a key component of emotional
development.
models for their adult children, they also need to provide the
necessary support and encouragement to allow their children
to successfully develop into well-adjusted young adults.
Forming and maintaining relationships, in particular intimate relationships, in
early adulthood will affect the development of self-concept. Failed relationships or
lack of support and encouragement from family, work or the community can lead
to poor self-concept, impacting emotional development.
Good emotional development is the ability to understand and control the
emotions, and to respond well to the changes taking place around and within
the individual. This is not always easy but it is important for emotional growth.
Formulating an identity and developing a sense of self are key components of
early adulthood. Establishing a career and learning new roles and expectations will
impact on employment status, job satisfaction, financial security and self-concept.
Intellectual development
Intellectual development involves an increase in knowledge and the ability to think
and reason. The foundations of intellectual development are formed during the
early stages of the lifespan, when language skills are developed, knowledge gained,
memory skills formed and the ability to understand and reason are developed. All
these skills are further developed during early adulthood. Attending university or
training programs usually involves learning the skills and acquiring the knowledge
for their chosen career or job, thus improving their intellectual development. In
the work environment, new employees will be inducted into the workplace and
taught the necessary skills and information essential to carrying out their tasks.
This requires intellectual development for success.
The health and individual human development of Australia’s adults • CHAPTER 10 315
10.2 Early adulthood: emotional and intellectual development
Case study
Half of young people unable below this level. Three in four of those surveyed scored
below level 3 in at least one area, while more than one
to read well, Australian in three people, 36 per cent, were below in all four
Bureau of Statistics report areas. Only one in four people scored at level 3 or
above in all areas.
finds Among teenagers aged 15 to 19 years, the proportion
with literacy skills in levels 4 and 5 fell from 14.1 per
By Justine Ferrari, education writer.
cent to 9.3 per cent.
Literacy skills among high school students and school While not statistically significant, the drop represents
leavers have dropped over the past 10 years, with about more than 43 000 people.
one in two 15–24 year olds now unable to read at an The ABS says small improvements in literacy have
adequate level. occurred in the 10 years, with a slight but significant
The Australian Bureau of Statistics’ annual report decline of 3 percentage points in the proportion of
on social trends shows the proportion of people aged people with the lowest level of literacy skills. This was
between 15 and 24 with a level of literacy required to partially offset by a 2 percentage-point increase in the
function in society has fallen 3.7 percentage points. In proportion with literacy skills at levels 2 and 3.
1996, almost three in five, 59.1 per cent, could read at The survey also assessed document literacy, which
least at an adequate level compared with 55.4 per cent measured the ability to locate and use information in
in 2006. such formats as job applications, payroll forms and
The fall was most dramatic for teenagers who have bus timetables, and in 2006 measured numeracy and
better literacy skills, with the proportion of teenagers problem-solving skills for the first time.
in the top two levels falling five points in the 10-year About 47 per cent of people had document literacy
period. The only other age group to have a fall in literacy below an adequate level and 53 per cent had inadequate
skills was 35–44 year olds, with a 1.3 percentage point numeracy skills.
drop to 60.7 per cent having an adequate or better level. The social trends report also looks at educational
Literacy levels remained stable or rose in all other age trends and found the large jump in 25–64 year olds with
groups, with the biggest difference among 55–64 year non-school qualifications is not evenly spread across the
olds. In 2006, 45 per cent had adequate or better levels nation. While the proportion attaining qualifications after
of literacy compared with 35 per cent in 1996. school rose from 44 per cent to 57 per cent in major cities
The figures, from the ABS Adult Literacy and Life between 1996 and 2006, it rose only 6 percentage points
Skills Survey, relate to prose literacy, defined as the in very remote areas. The report says the difference is
ability to understand and use information in narrative partly due to the greater proportion of indigenous people
texts, including newspapers, magazines and brochures. living in very remote areas.
The results were ranked in five levels, with level 1 But the proportion of indigenous students aged 15
the lowest and level 3 considered ‘the minimum level to 19 years participating in education continued to rise,
required to meet the increasingly complex demands of from 43 per cent to 51 per cent.
a knowledge society’. The biggest change was among those living in very
The report says about half of all Australians between remote communities, with a 27 per cent rise in those
the ages of 15 and 74 years had literacy skills below undertaking education, to 28 per cent in 2006.
level 3, with 46 per cent having prose literacy skills Source: The Australian, 24 July 2008.
The health and individual human development of Australia’s adults • CHAPTER 10 317
10.3 Middle adulthood
Physical development
Middle adulthood is the period from 40 to 65 years of age. The changes in physical
development are continuous and vary greatly between individuals, but a gradual
decline in many physiological functions may be evident from the age of 30.
Generally, in middle adulthood the following physical changes are expected
(figure 10.8):
• Bone density is lost. Bone loss, which can begin in the late 30s, accelerates in
the 50s. This will have an impact on the strength and mobility of an individual.
• The metabolic rate decreases and fat deposits accumulate. Weight gain can be
partly linked to changes in the metabolic rate, which tends to slow down in this
phase, and reduced levels of exercise, which lower the overall energy needs of an
individual. Unfortunately, many adults do not reduce their food intake to match
the lowered energy needs and gain weight as a result.
• The number of active cells decreases, leading to decreased need for energy.
• The cardiovascular system goes through significant structural changes as it
ages. The combination of the changes to the heart and the circulatory system
(described below) result in a gradual decrease in a person’s ability to cope with
physical exertion, especially aerobic exercise.
• The heart muscle stiffens from tissue changes. By the late 40s and early 50s, the
healthy muscle tissue is replaced by connective tissue, which causes thickening
and stiffening of the heart muscle and valves. These changes reduce the amount
Men experience a slight
decrease in sperm and Bone density Metabolic rate decreases, Heart muscle and valves
testosterone production decreases leading to weight gain thicken and stiffen
Women experience Walls of the arteries Number of active cells Sense of hearing
menopause harden decreases declines
Social development
Some aspects of social development that traditionally occurred in early adulthood
are increasingly becoming part of middle adulthood due to the delay in selecting
a life partner or getting married, setting up and managing a home and starting
a family.
Learning how to relate to a spouse/partner and developing a successful
relationship is a major aspect of social development in early and middle adulthood.
The increase in divorce rates over the past years has generated a rise in single-parent Figure 10.9 Middle adulthood is a
households, second marriages and de facto relationships. Some adults become time when many people begin to take
grandparents and provide child-care for their grandchildren in this stage, while on the new role of grandparent.
The health and individual human development of Australia’s adults • CHAPTER 10 319
10.3 Middle adulthood
others their age are still engaged in parenting their own children and preparing
them to become responsible and happy adults.
The range of possible lifestyles during this stage of the lifespan is endless. Adults
will develop socially from their career achievements, meaningful relationships
with their partner and other significant friendships, commitments that they have
to various community or social groups (e.g. school, church, sporting groups)
and enjoyable interactions with others. These interactions with family, work
and community allow adults to develop their communication skills and make a
valuable contribution to the improvement of their environment. Establishing, and
maintaining an economic standard of living is an important aspect of adulthood
and drives many decisions relating to work/career, housing and other material
possessions. As children leave home, life priorities often change and relationships
with family and friends are redefined.
Emotional development
Middle adulthood is ideally characterised by self-confidence and an acceptance by
the person of who they are and what they want to achieve (figure 10.10). By this
stage, an individual will have already experienced many successes and failures. The
way they coped with these situations will have shaped their emotional development,
and future experiences will continue to affect this. Interactions with family, work
and community can influence self-concept. Factors such as an
unsuccessful relationship, job dissatisfaction and difficulty coping
with the demands of parenthood can have an impact on the emotional
development of an individual and affect their health status.
Adults need to cope with many challenges during this stage
of their lives. They may face the possibility of unemployment or
retrenchment and the significant impact it could have on their
family. Males in particular feel the pressure to provide for their
family, although as women increasingly take on the role of main
breadwinner they begin to face the same pressures. Adults who
develop enjoyable leisure activities are better able to cope with the
pressures of work and family, and are more likely to lead a healthy
lifestyle.
Figure 10.10 Middle adulthood is Accepting, and adjusting to the physiological changes associated
often characterised by self-confidence. with ageing can be challenging. The community expectation to look younger and
somehow slow down the ageing process is having an impact on many adults’ social
and emotional development. Advancements in medical technology have seen the
development of cosmetic surgery and a surge in its use, while a variety of creams,
potions and lotions all promise the fountain of youth (figure 10.11).
Intellectual development
As discussed earlier, intellectual development involves the increased ability to think
and reason and the development of knowledge and skills. Research suggests that
the rate of decline in our ability to think and reason is fairly gentle. During middle
adulthood, knowledge is still being gained and the capacity to store knowledge and
further build permanent memories is limitless. The ability to process information
and solve problems will generally improve during this stage of the lifespan. Life
experiences and maturity often give older people more wisdom than the young.
The onset of mental deterioration can be delayed if adults keep their minds active
as long as possible. Leisure activities like Sudoku and crosswords can help achieve
Figure 10.11 Community
this. Playing certain computer games like ‘Dr. Kawashima’s Brain Training™: How
expectations to look younger create a Old Is Your Brain?’ by Nintendo can also allow adults to improve their response
large market for anti-ageing products. times and thinking skills (figure 10.12).
TEST your knowledge (d) Identify the suggestions given to reduce the risk
factors of a variety of health problems.
1 Explain how changes in an individual’s metabolic rate
(e) Reducing the onset of dementia has become a
can be linked to weight gain in middle adulthood.
focus for many individuals. What activities have
2 What impact do the changes to the cardiovascular
been recommended?
system have on an adult’s ability to be physically
active? APPLY your knowledge
3 Both eyesight and hearing gradually decline as an 11 Read the following case study and answer the
individual ages. Outline how these physiological questions:
changes may impact on the daily lives of individuals Domenica and Mario are both 44 years old and
in the middle-adulthood stage of the lifespan. have been happily married for 16 years. They have
4 What is menopause? two children, Matthew aged 14 and Chiara aged
5 Outline the main physical changes that take place 10. Domenica works casually for a department
during menopause. store and enjoys the interaction with a variety of
6 Suggest how the physical changes during people, including her work colleagues. Mario works
menopause can affect a female’s social and for a large company as their head of IT. He has just
emotional development. been promoted to manager of his department.
7 Females experience menopause, but do males Mario has worked hard to gain this promotion and
go through any changes in their reproductive is both excited and anxious about this new role
functioning? Explain. and how it will affect him and his family. On the
8 Define intellectual development and provide three weekends both Domenica and Mario are busy trying
examples relating to middle adulthood that illustrate to coordinate and cater to everyone’s needs. Chiara
the definition. plays netball on Saturday mornings and Matthew
9 Use The time of our lives: plays football on Sundays.
episode 1 eLesson in your (a) Identify the main aspects of social development
eBookPLUS to the find the link for this question. for Mario and Domenica’s stage of adulthood.
Watch the video and answer the following (b) Identify the main aspects of emotional
questions. development for Mario and Domenica’s stage
(a) Why do we age? of adulthood.
(b) How does the brain change as it ages and what (c) Identify the main aspects of intellectual
are the consequences of these changes? development for Mario and Domenica’s stage
(c) Identify and explain the factors that may slow of adulthood.
down the ageing process. (d) Predict possible changes in Mario and Domenica’s
10 Use the Ageing disgracefully weblink in your lives over the next ten years that may have an
eBookPLUS to find the link for this question. impact on their social development.
Read the article ‘Ageing disgracefully — get real’ 12 Use the Brain training weblink in your
and answer the following questions. eBookPLUS to find the link for this
(a) Explain what Adele Horin meant by the question.
statement ‘we all get the old age we deserve’. (a) Complete the online brain-training test.
(b) How much longer can women expect to live if (b) You may wish to conduct a survey of two adults,
they reach the age of 60? one male and one female. (They should be the
(c) Apart from genetics, what other same chronological age.) Provide them with
factors can determine how long the same online test and compare their results.
we live? Share your findings with the class.
The health and individual human development of Australia’s adults • CHAPTER 10 321
10.4 Late adulthood
Physical development
Late adulthood, the final stage of the lifespan, is the period from 65 years of age
until death. During this stage the efficiency and working of the body systems
continue to decline, and the physiological changes of older adulthood become
more visible. Australia’s current life expectancy is 79.3 years for males and 83.9 years
for females, so many adults could spend 18 years or more in late adulthood.
Factors such as genetics, quality of diet, level of physical activity and other lifestyle
choices will determine the impact and speed of the changes associated with ageing.
Physiological changes of late adulthood include the following (figure 10.13):
• Body systems experience a continued and gradual weakening and decline.
• The senses experience a continued decline. Eyesight, hearing, taste, smell and
touch all become less acute.
Aerobic capacity since early Rate of cell replacement
adulthood drops by up to slows down and in some Bone density continues
70 per cent by age 65 cases stops to decline
Gums recede and teeth Eyelids thicken and Hair continues to lose
deteriorate and start eye sockets appear more pigmentation (go grey)
to fall out hollow and thin
Social development
In late adulthood, social development could be stimulated by retirement. This
major life event is an exciting culmination of a lifetime of work. Retirement can
also impact negatively and contribute to loss of social contact. Many decisions and
adjustments need to be made — coping with a reduced income, deciding what to
do with the extra time, re-establishing the relationship with their partner (if they
have one), and redefining household roles to ensure harmony. Many adults enjoy
this new-found freedom and spend their time on home improvements, travelling,
sporting interests established earlier or just started, community activities and
volunteering. Physical changes during late adulthood can also have a significant
impact on an individual’s social development. If their mobility is limited, it could
lead to isolation and reduced contact with friends. The loss of a spouse could also
affect an individual’s motivation to interact socially. How individuals spend their
time in late adulthood is dependent on many factors including level of health,
financial status and connectedness to family and friends.
Emotional development
Coping with the many changes associated with ageing is a challenging time during
late adulthood. The transition from work to retirement is a significant social change
(as discussed earlier) and the impact on emotional development can be enormous.
The health and individual human development of Australia’s adults • CHAPTER 10 323
10.4 Late adulthood
For many, coping with the change in routine, feelings of boredom, loneliness and
loss requires a difficult adjustment. Adults who plan and prepare for retirement,
including taking into account their financial situation, find it easier to make the
transition.
Adjusting to decreasing physical strength and health can create challenges. For
many, being unable to do the things they used to do and in the way they always
did them can cause frustration and anxiety. Dealing with the death of a spouse can
be a very emotional time, as the grieving person must learn to cope with life alone
and adjust to a new lifestyle. Although this could happen at any time, it is most
likely to occur in late adulthood (figure 10.15).
The care and support of family and friends is an important part of
dealing with the stresses during this stage. An individual with a limited
support system may face further challenges related to loneliness and
isolation — major concerns for many older adults.
Intellectual development
During late adulthood, gains can still be made in intellectual development
through life experiences, but there is a decline in information processing
abilities. Most intellectual abilities will start to decline slowly from about
70 years of age. The rate of decline is affected by biological, behavioural
and social deterinants unique to the individual (see chapter 11). Research
also suggests that the decline in intellectual ability — knowledge,
memory and reaction times — will be affected by the physiological
changes associated with ageing such as decline in eyesight and hearing.
These changes can impact on the ability of the brain to receive the correct
information and then respond appropriately and within a certain time.
The ‘use it or lose it’ motto is apt: practice may not only preserve existing
skills, but also revive supposedly lost or declining skills.
There are many activities that older adults can engage in that may assist
in maintaining or improving their intellectual development. Examples
include participating in bingo games, playing cards, volunteering as
a guide for various historical centres like an art gallery or museum,
or joining adult education classes to learn a new language or skill
(figure 10.16).
Figure 10.15 Dealing with death can
be a difficult transition in any person’s
life.
(continued)
The health and individual human development of Australia’s adults • CHAPTER 10 325
10.4 Late adulthood
with adult children (using new technology) and • Frail (85-plus): There are 401 000 people aged
sharing time with grandchildren. Active retirees 85-plus in Australia now; by 2020, this number is
pursue clubs, volunteering opportunities and spiri expected to be 547 000. By this stage in life, many
tual growth. people are utterly alone in the sense that few friends
• Going Solo (75–84): There are 994 000 people in survive. Life partners are also unlikely to survive in
this age group now; by 2020, this number will rise tandem: typically, one outlasts the other. Social cir-
by 33 per cent. Most Australians die in this decade, cles and physical mobility close ranks. The 85-plus-
which means there will be a shift from older couple year-old is largely, if not entirely, reliant upon family
households to older single households. and institutional support.
Going solo is fine and dandy at 25; at 80 it’s a There are 30 years of life beyond 55 that are
different story. A wider circle of friends evaporate or, now available to many Australians. At the moment
more properly, die off by this stage. Work contacts have this space is a wasteland, but over the next decade I
long since withered. What is left is a tight circle based have no doubt it will blossom and yield a number of
around children and young adult grandchildren. interesting submarkets. These submarkets might not get
The challenge in this stage of the life cycle is as microscopic as the stages that mark childhood, but
maintaining solo living, which requires an involved surely there’s a need to realise that not everyone over
extended family and broader community support. the age of 55 is the same.
Source: The Australian, 25 November 2010.
TEST your knowledge for this question. Watch the video and answer the
following questions.
1 Describe the characteristics of physical, social,
(a) Outline the factors that are linked to the speed
emotional and intellectual development in late
at which an individual ages.
adulthood.
(b) As an individual ages, their ability to cope with
2 Select three of the physiological changes of late
the physical, social and emotional changes can
adulthood. Identify the main factors that may
be challenged.
contribute to variations in the impact and speed of
i. Create a list of suggestions for the actions
these changes on an individual.
that people can take to successfully adjust to
the ageing process.
APPLY your knowledge
ii. Investigate community resources that may be
3 Use The time of our lives: available to assist in the successful adjustment
episode 2 eLesson in your into old age.
eBookPLUS to the find the link
KEY CONCEPT The health status of Australia’s adults, including similarities and
differences between adult males and females
The age group of 25–64 years represents 54 per cent of the population. It includes
both early and middle adulthood, a stage of the lifespan where many changes are
taking place and where health issues are likely to emerge.
For adults aged 65 and over, good health is a precious asset that allows them
to enjoy a good quality of life, stay independent and participate fully in the
community. The Australian population is getting older and as a result the demand
for health-care services continues to increase. On a national level the improvement
of the health of older Australians is now a priority.
The health behaviours of individuals
in the first 25 years of their lives will 95
0 (birth) 1 15 25 45 65 85
set the foundation for their future.
90
Generally, people in this age group
Life expectancy (years)
25
With a severe or With disability but no severe Free of disability
profound core or profound core activity
20 activity limitation limitation
5.6
3.5 5.5
15 3.0
Years
6.5
7.0 5.6
10 6.0
5 9.7
8.2 8.7
7.1
Figure 10.19 Expected years of life
0 at age 65, 1998 and 2009
1998 2009 1998 2009
Source: Australian Institute of Health and Welfare,
Men Women Australia’s Health 2012 – in brief, p. 7.
The health and individual human development of Australia’s adults • CHAPTER 10 327
10.5 The health status of Australia’s adults
Burden of disease
The impact of conditions causing illness, impairment, injury or premature death —
known as ‘burden of disease’ — is estimated by the AIHW using the DALY (disability
adjusted life years, discussed in chapter 2). According to the Australian Institute
of Health and Welfare (AIHW) report Australia’s health 2010, the conditions that
cause the most burden to people aged 25–34 years are anxiety and depression
for both males and females. This accounts for 12 per cent and 27 per cent of all
DALYs for males and females respectively. Suicide, self-inflicted injuries, substance
use disorders and road traffic accidents also featured highly in the 25–34 year age
group for males, while migraine, schizophrenia and infertility were included in the
top five for the 25–34 year age group for females.
In contrast, chronic diseases and cancer were the main causes of burden of
disease in the 55–64 year age group. Coronary heart disease was the largest single
contributor for males in this age group, while breast cancer caused the greatest
burden for females. Vision changes, hearing loss, type 2 diabetes and lung cancer
were also included in the top five conditions, causing disease burden for both sexes
Figure 10.20 Having blood pressure aged 55–64 years. As the population ages, the possibility of having to cope with
checked regularly and treated if
necessary reduces the risk of stroke.
more than one chronic condition increases. The clinical management of this is
linked with increased health care costs and a poorer quality of life. The term
comorbidity is often used to describe more than one illness, health condition or
disorder experienced by a person at the same time. Figure 10.21 shows the
percentage of males and females who have more than one chronic condition. For
males and females, arthritis and high blood pressure was the most common
combination of conditions (see table 10.1).
25
One Two Three Four or more
20
Table 10.1 Top three combinations of selected chronic conditions reported, 2007–08
Males Females
Chronic conditions (‘000) Per cent Chronic conditions (‘000) Per cent
High blood pressure 125.4 1.2 High blood pressure and 237.4 2.3
and arthritis arthritis
High blood pressure 59.8 0.6 Osteoporosis and 120.3 1.2
and Type 2 diabetes arthritis
Depression and arthritis 55.8 0.5 Depression and arthritis 101.8 1.0
Note: Chronic conditions are self-reported and include asthma, Type 2 diabetes, ischaemic heart disease,
cerebrovascular disease, arthritis, osteoporosis, COPD, depression and high blood pressure.
eLesson: Among older Australians aged 65 years and over, the two leading causes of death
Prevalence of conditions for both males and females were coronary heart disease and cerebrovascular
Searchlight ID: eles-1039 diseases (stroke). Dementia and Alzheimer’s disease also featured prominently as
the third most common cause of death for older females and the sixth for older
Table 10.2 Estimated number of people with dementia, by age and sex, 2011
Per cent Number(a)
These diseases are strongly age-related, and because the life expectancy of
females is longer than that of males, there are larger numbers of females than males
in the older age groups. Females are therefore more likely than males to develop
these diseases and die from them.
Lung cancer and colon and rectum cancer are also prominent for both sexes;
while prostate cancer and breast cancer were prominent sex-specific causes of
death (table 10.4).
Mortality
Deaths occurring during early and middle adulthood are seen as premature given
that life expectancy has increased. Referring to table 10.4, the leading cause of
death for both men and women in 2009 was coronary heart disease. Lung cancer
was ranked number two for men and number four for women and stroke was
ranked three for men and second for women. These diseases can be easily affected
by lifestyle and behavioural factors, as can a number of the other conditions listed
in the top ten causes of death. These factors include physical inactivity, insufficient
consumption of fruit and vegetables, a diet high in saturated fats, and smoking and
alcohol consumption, to name just a few.
Table 10.3 Leading causes(a)(b) of death by sex and age group, 2007
Males Females
The health and individual human development of Australia’s adults • CHAPTER 10 329
10.5 The health status of Australia’s adults
Males Females
Source: Australian Institute of Health and Welfare, Australia’s Health 2012, p. 93.
Losing your self don’t even realise it,” says Mandy, who has scaled back
her private psychology practice to support her husband.
Alzheimer’s is not just an old person’s disease — some “We have our dark times about this,” she continues,
sufferers begin to experience symptoms in their 40s. “where we notice the reality, when you notice something
Miriam Cosic explores a world where logic fails and new that he can’t do. That’s the bit that scares me and
memories fade, but where there is still time to appre- I’m sure it scares Garry.”
ciate life. Alzheimer’s is the most common form of dementia —
“This narrative is us,” neurologist Oliver Sacks some 260,000 Australians are estimated to have the
wrote. Who you are right now is the sum total of what disease, a figure that some experts predict will quadruple
you’ve done and thought: your childhood and school in 20 years. While it is generally thought of as an old
days, your career, your marriage, your children, your person’s disease, 10 per cent of sufferers get it while
friends, your likes and dislikes, your skills, what you’re still young (by medical criteria, that means under age
hopeless at, your moral code. 65). There are several forms of early-onset dementia —
So imagine if that narrative starts to unravel, if black Alzheimer’s is just one — and while most sufferers are in
holes appear in your happiest memories, your most their 40s, 50s or early 60s, dementia can strike as early as
intimate thoughts, your accumulated knowledge, even the 20s or 30s, often due to head injury or AIDS, or as a
your most basic skills, so that you no longer know how
side-effect of acute disease (one recent case was a teenager
the bread in your hand relates to the shiny appliance
who got it as a dreadful aftermath of encephalitis).
with the slots in front of you. And imagine how
Noel Hackett was diagnosed with Alzheimer’s six years
traumatic this process of unravelling would be if you’re
ago, at the age of 59, after a year of small but mounting
in the prime of life, have just met the love of your life
bafflements. He was working in a government counselling
and are paying off a mortgage.
service for the long-term unemployed, half of whom were
Garry Lovell, 50, knew in his late 30s that he had
homeless. He knew something was seriously wrong when
the gene that could lead to early-onset Alzheimer’s.
he couldn’t get his head around a new computer system.
His mother had got it at 51, and he nursed her until
Small failures of memory had caught him out before, but
her death 10 years later. Tormented by not knowing his
likely fate, he sought testing for the gene in 2001, very this was like a brick wall. Sometimes his younger clients,
early in his relationship with his partner Mandy. “I said weaned on screen-based technology, would help him out,
to her, ‘Look, it’s a horrible thing and it’s okay if you cover for him, while they were in his office.
don’t want to go out with me any more,’” he says. “But “I lost my sense of purpose and my sense of being
she said, ‘I’m never going to do that.’” capable,” he says, “I used to go to meetings and I’d be
That must be true love. “It is,” he replies seriously. thinking, ‘I hope no one asks me a question about that.’ ”
“We love each other a lot.” He worried for a while, talked it over with his wife,
In 2010, changes in Garry’s short-term memory put thought it might be stress and reduced his working
the couple on alert. Just before Christmas, his annual hours. On his first Friday off, in October 2007, he
test confirmed he had the disease. The gene had been went to see his doctor, an old friend. Hackett was one
expressed: he was 46, his wife was 39. A partner of the fortunate ones: some people with younger-onset
in a Melbourne landscaping business that planted dementia struggle for years to find out what’s wrong.
indigenous trees, Garry soon had to quit his job. Hackett’s doctor was onto it straight away and sent
While he misses his job, he still enjoys gardening. him for a battery of tests, including those designed to
He’s a champion dishwasher stacker, Mandy says, preclude other possibilities that can cause dementia-
though he has trouble remembering where things go like symptoms, such as vitamin B deficiency or a
afterwards. He still helps in the kitchen — chopping brain tumour. His doctor referred him to a neurologist,
vegetables, for example — and safety is not an issue. warning that it might be Alzheimer’s, but it took
But the logistics of cooking, such as juggling timing, another year before that was confirmed. Hackett’s wife,
are too hard. “We rely on our memories so much, we Jenny Fitzpatrick, says: “It was a very long year, 2008.”
(continued)
The health and individual human development of Australia’s adults • CHAPTER 10 331
10.5 The health status of Australia’s adults
The final diagnosis felt like a “whack to the back of dissected the brain of a dead dementia patient and
the head”, Hackett says. “I could see a very dark, long described the build up of amyloid proteins into plaques
road.” and the growth of neurofibrillary tangles. Since then
His concentration as he talks is palpable, as if he’s our understanding has come a long way. Scientists can
feeling his way from sentence to sentence, like walking plot brain-cell death, brain lesions and atrophy, and
in the dark, avoiding a steep drop. know that they lead to memory loss, disorientation
Hackett and Fitzpatrick, a teacher who stopped and hallucinations, and that eventually the brain will
work to care for her husband, live in a suburban flat in forget to direct basic bodily functions, such as chewing,
Sydney. They are fun to be with, all gentle banter and breathing and expelling waste.
laughter. Conversation is halting, however, and Hackett We once thought what we called senility was just
often trails off mid-sentence. He likes to laugh so much a stage of being; now we know that Alzheimer’s is
it is difficult to know when he is parodying himself and a terminal illness. We can see the affected areas on
when he has actually lost his train of thought. But away MRIs. We can test for a faulty gene in the cases that are
from the presence of outsiders, when they stop putting genetic, but we still don’t know exactly why it happens
their best face on, there have been terrible moments of or how to prevent or cure it. Younger-onset dementia is
sadness and grief. the more inexorable condition: usually genetic and so
Earlier in his life, Hackett was a priest. Now his both heritable and transmissible. Late-onset is a yet to
faith comes and goes. Sometimes, when he feels low, be properly defined combination of genes, environment
life just seems “bloody crappy”, he says. Other times, and general health.
like when he sits on his balcony on a balmy day and That dementia comes in more than 100 forms, each
listens to the birds sing, the world expands. “I think the with its own causes, presents problems for both diagnosis
big picture is immeasurable,” he says, adding that he and research. At the top of the list are: Alzheimer’s
doesn’t try to conjure God. “And I don’t chase grace,” disease, which accounts for more than 50 per cent
he continues. “I don’t chase God to give me another of cases; vascular dementia, which relates to general
year. I don’t think like that at all.” vascular health; fronto-temporal lobar degeneration (most
Adrienne Withall, co-leader of Inspired, a research commonly seen in young-onset dementia), which causes
collaboration between the University of NSW, the behavioural problems including disinhibition; dementia
University of Sydney and several major hospitals, caused by head injuries, including sporting injuries (being
says that behavioural problems are more common in punch-drunk, for instance); and alcohol-related dementia.
younger-onset Alzheimer’s sufferers. Parents can appear Withall shudders when she thinks of young people’s
apathetic to their children, as though they don’t love lifestyles choices. “I look at some of the drugs around at
them. “People think if a person’s apathetic and just the moment, like ice, and I think it’s going to be really
sitting in a chair, it’s not too much of a problem. But it terrifying. Someone in the Inspired study is working with
is for children who don’t understand why their parent drug and alcohol services to see who this population is
suddenly doesn’t seem to care about them. And the other and how we are going to manage them later on.”
parent often has to work two jobs to keep up the family Keeping the mind active seems to delay onset, which
finances and they become a bit more absent, too.” is why those hoping to age gracefully are busy solving
Withall mentions an Australian woman in her 30s crosswords and Sudoku, and learning new languages.
who was diagnosed with Alzheimer’s, a single mother “We now know you can live with a degree of brain
with two young sons, both special-needs children. She is atrophy or tissue loss or amyloid load, and it’s variable as
racing against the clock to raise her children as well as to how it affects people,” says David Ames, a Melbourne
she can and ensure that they are provided for before the University professor who specialises in Alzheimer’s. “So
illness claims her. At least she was given time to prepare. you see people who have got significant brain atrophy
Diagnosis for younger-onset patients can take years. When on a scan, who are still performing quite well. And you
a 45-year-old comes in complaining of memory loss and see, particularly in young-onset cases, people who don’t
strange behaviour, Alzheimer’s is the last thing most GPs look as though they’ve got much brain atrophy at all and
think of. Work or marital stress, depression or menopause yet they’ve got cognitive difficulties.”
are what immediately come to mind, and antidepressants More highly educated people seem to deteriorate
or hormone replacement therapy prescribed. more slowly and have more brain damage by the
Alzheimer’s disease was first identified in 1906, time they notice a decline in their faculties. A New
when a German neurosurgeon, Alois Alzheimer, York professor of clinical neuropsychology, Yaakov
The health and individual human development of Australia’s adults • CHAPTER 10 333
Key SKILLS The health and individual human development of
Australia’s adults
Age group (years)➋ Cause of death➋ Deaths % of deaths Cause of death Deaths % of deaths
25–34 Suicide 300 22.3 Suicide 73 12.5
Land transport accidents 206 15.3 Land transport accidents 45 7.7
Accidental poisoning 128 9.5 Accidental poisoning 27 4.6
35–44 Suicide 319 15.0 Breast cancer 167 13.6
Coronary heart disease 204 9.6 Suicide 85 6.9
Land transport accidents 148 7.0 Lung cancer 47 3.8
45–54 Coronary heart disease 644 15.1 Breast cancer 376 14.3
Lung cancer 271 6.4 Lung cancer 222 8.5
Suicide 270 6.3 Coronary heart disease 123 4.7
Colorectal cancer 123 4.7
55–64 Coronary heart disease 1 296 16.2 Breast cancer 581 12.0
Lung cancer 858 10.7 Lung cancer 538 11.1
Colorectal cancer 388 4.9 Coronary heart disease 308 6.4
Total 25–64 ➌ Coronary heart disease 2 182 13.9 Breast cancer 1 144 12.4
Lung cancer 1 187 7.6 Lung cancer 815 8.8
Suicide 1 069 6.8 Coronary heart disease 480 5.2
The following trends and patterns can be identified from table 10.3:
• Suicide is the leading cause of death for both males and females in the 25–34
age group.
• Coronary heart disease is the leading cause of death for all male age categories
except the 25–34 age group and the 35–44 age group.
• Breast cancer is the leading cause of death for females in all age groups except
for the 25–34 age group.
The health and individual human development of Australia’s adults • CHAPTER 10 335
CHAPTER 10 review
Chapter summary
• Adulthood is the longest stage of the lifespan and can be divided into three stages:
Interactivities: early (19–40 years), middle (40–65 years) and late (65+ years) adulthood.
Chapter 10 crossword
• Early adulthood is when the body should be at its peak physical condition.
Searchlight ID: Int-2907
• Middle and late adulthood bring a steady decline in many physiological functions.
Chapter 10 definitions
Searchlight ID: Int-2908
• Biological, behavioural and environmental (physical and social) determinants can have a
major impact on the progress through the adulthood stage of the lifespan.
• The social development of adults is reliant on the quality of interactions an adult has
with the people around them including family, partner, work, leisure and community.
• The ability to cope with the multitude of changes that occur in adulthood is an
important part of emotional development.
• The ability to think, reason, and effectively use memory skills is part of intellectual
development.
• Health status refers to the level of health of an individual, community or group.
• The life expectancy of Australian adults has increased by six years over the past decade
for both men and women. Males at 65 years are now expected to live to about 83.9
years and females to about 86.8 years.
• Australian adults generally experience good health.
• The main causes of mortality are coronary heart disease for men and breast cancer for
women.
A POEM ON AGEING
When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was wrongly assumed that she had
nothing left of any value. But later, when the nurses were going through her meagre possessions, they found this poem. Its
quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.
Look closer At forty, my young sons have grown and are gone,
What do you see, nurses, what do you see? But my man’s beside me to see I don’t mourn.
What are you thinking when you’re looking at me?
A crabby old woman, not very wise, At fifty once more, babies play ‘round my knee,
Uncertain of habit, with faraway eyes? Again we know children, my loved ones and me.
Who dribbles her food and makes no reply Dark days are upon me, my husband is dead;
When you say in a loud voice, ‘I do wish you’d try!’ I look at the future, I shudder with dread.
Who seems not to notice the things that you do, and For my young are all rearing young of their own,
Forever is losing a stocking or shoe … And I think of the years and the love that I’ve known.
Who, resisting or not, lets you do as you will, I’m now an old woman … and nature is cruel;
With bathing and feeding, the long day to fill … ’Tis jest to make old age look like a fool.
Is that what you’re thinking? The body, it crumbles, grace and vigour depart,
Is that what you see? There is now a stone where I once had a heart.
Then open your eyes, nurse; you’re not looking at me.
But inside this old carcass a young girl still dwells,
I’ll tell you who I am as I sit here so still, And now and again, my battered heart swells.
As I do at your bidding, as I eat at your will.
I’m a small child of ten … with a father and mother, I remember the joys, I remember the pain,
Brothers and sisters, who love one another. And I’m loving and living life over again.
A young girl of sixteen, with wings on her feet, I think of the years … all too few, gone too fast,
Dreaming that soon now a lover she’ll meet. And accept the stark fact that nothing can last.
A bride soon at twenty — my heart gives a leap, So open your eyes, people, open and see,
Remembering the vows that I promised to keep. Not a crabby old woman; look closer … see ME!!
At twenty-five now, I have young of my own, By Phyllis McCormack
Who need me to guide and a secure happy home.
A woman of thirty, my young now grown fast,
Bound to each other with ties that should last.
Remember this poem when you next meet an old person who you might brush aside without looking at the young soul within.
We will one day be there, too.
The health and individual human development of Australia’s adults • CHAPTER 10 337
CHAPTER 11
KEY SKILL
• explain the determinants of health and individual human development
and their impact on adults, using relevant examples.
KEY CONCEPT The influence of genetics on the health and individual human
development of adults
Biological determinants refer to those genetic and physiological factors that affect
eBook plus
health and individual human development. They relate to the functioning of the
body and include a range of biomedical factors such as cholesterol levels, blood
eLesson:
pressure and body weight. Obesity, raised blood pressure and high cholesterol
Predicting Alzheimer’s
levels can be indicators of ill-health, particularly in the adult population.
Searchlight ID: eles-0228
Genetics
The combination of genes that is inherited from the biological parents at the time
of conception can have a significant impact on health and individual human
development during the adulthood stage of the lifespan. The genes that are inherited
not only determine physical characteristics such as height, eye colour and body
shape, they also determine the rate and timing of development, genetic conditions
and predisposition to disease that may not become apparent until adulthood.
Physical • Inability to look after oneself resulting in lack of hygiene, which increases the risk of ill-health such as skin infections
and diarrhoea
• Memory lapses resulting in the individual forgetting to take medication, which could lead to a faster deterioration
in physical health
• Malnutrition due to forgetting to eat at regular times
• In the late stages, becoming bedridden and needing full-time care
• Poor judgement puts the individual at risk of physical harm when driving a car
• Disorientation to time and place, resulting in the individual getting lost and being susceptible to dangers in their
environment such as road traffic.
Social • Lack of ability to maintain relations with other people, resulting in poor social health
• Deterioration of social skills impacts on the individual’s capacity to interact with others
• Inability to hold a conversation with others, which impacts on the relationships with loved ones
Mental • Memory lapses
• Depression
• Apparent loss of enthusiasm for previously enjoyed activities
Table 11.2 Impact of Alzheimer’s disease on the individual human development of those affected
Physical • Damage occurs to brain cells and there is a build-up of protein called ‘plaques’ in the brain
• Loss of motor skills
Social • Loss of social skills such as the ability to hold a conversation
• Loss of speech
• Personality changes
Emotional • Inability to control emotions
• Inability to adequately express emotions
Intellectual • Long-term memory loss
• Forgetting simple words or using the wrong words
• Confusion and difficulty making decisions
• Mild twitching of fingers and toes • Inappropriate social • Loss of ability to • Short-term memory loss
• Lack of coordination behaviour due to the loss of control emotions • Difficulties in concentrating
emotions such as shame and resulting in mood and making plans
• Walking difficulties embarrassment that usually swings, apathy and
• Jerky movements of the arms or legs (chorea) help to ensure appropriate aggression • Inability to block out
social behaviours distractions
• Speech and swallowing difficulties due to lack
of control of the muscles of the face, throat • Difficulties with • Loss of task sequencing
and tongue communication
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 341
11.1 Biological determinants: genetics
Type 2 diabetes
Normally, blood glucose levels are regulated by insulin, a hormone that is secreted
by the pancreas. Insulin enables the body’s cells to metabolise glucose for energy. In
Figure 11.3 Individuals with an adult with type 2 diabetes, the pancreas makes insufficient insulin or the cells of
Huntington’s disease may suffer
from depression, short-term memory
the body do not respond to it. As a result, there is an increase in the blood glucose
loss and an inability to control their levels and this can impact on health.
emotions. Symptoms of type 2 diabetes include:
• extreme tiredness • blurred vision
• excessive thirst • increased risk of infections.
If left untreated, the condition can cause long-term damage to the kidneys, eyes,
nerves and heart. Type 2 diabetes is most common after 40 years of age but can
appear earlier.
Although lifestyle factors such as poor diet, smoking and lack of physical activity
significantly increase the risk of developing type 2 diabetes, another risk factor is
genetics. According to the Better Health Channel, adults aged 35 years and over
who are Aboriginal or Torres Strait Islanders, Pacific Islanders, from the Indian
subcontinent or of Chinese origin, are at greater risk. Adults aged 45 years and
over who have had a first-degree relative (e.g. parent) with type 2 diabetes are also
at greater risk of developing the condition.
Cancer
Non-cancerous cells in the body grow and multiply in an orderly way. Changed
genes can result in cells behaving abnormally and growing into a cancerous tumour.
Cancers that have a genetic predisposition include breast, ovarian, bowel and skin
(melanoma) cancers.
Breast cancer
Breast cancer begins in the milk ducts or milk lobules (figure 11.4). Most breast
cancers are found when they become invasive. This means that they have grown
outside of the milk ducts or lobules and spread into other breast tissue or other
parts of the body. The following are possible signs of breast cancer:
• a thickening of the breast tissue
• a lump
• discharge from the nipple
• an inverted nipple
• dimpling of the skin
• change in shape of the breast or nipple
• a painful area in the breast.
Muscle
Fatty tissue
Connective tissue
Nipple
Normal duct
Duct opening
Ovarian cancer
Ovaries are the oval-shaped glands that are part of the female reproductive system.
They release an egg (ovum) every month as part of the menstrual cycle. Ovaries also
secrete the female sex hormones, oestrogen and progesterone. For some women the
ovaries become the site of an uncontrolled growth of cells, or cancer. Symptoms of
ovarian cancer include:
• bloating or a feeling of pressure in the abdomen
• change in bowel habits
• indigestion
• unusual vaginal bleeding
• pain, particularly during sex
• swollen abdomen.
Advanced ovarian cancer that has spread to other parts of the body may cause
loss of appetite, sickness, constipation, tiredness, breathlessness and more extensive
swelling of the abdomen.
Skin cancer
Skin type and colour are genetically determined. The melanocytes of the skin
produce melanin, which gives skin its colour. Fair-skinned individuals have less
melanin and are at greater risk of skin cancer from sun exposure. Although darker-
skinned people naturally have more protection from harmful UV radiation, they
can still be at risk of skin damage and skin cancer.
The epidermis (outer layer of the skin) contains three types of cells: squamous
cells, basal cells and melanocytes. Skin cancer is named according to the cells
that are affected: squamous cell carcinoma, basal cell carcinoma and melanoma.
Melanoma is the most serious skin cancer. If detected early, most melanomas can
be cured. If left untreated, melanoma can spread to other parts of the body and
may not be curable.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 343
11.1 Biological determinants: genetics
Approximately 75 per cent of skin cancers are basal cell carcinomas and 5 per cent
are melanomas. Two out of three Australians will develop skin cancer at some stage
in their lifetime. Melanoma is the third most common cancer for Victorian women
and fourth most common cancer for Victorian men. In 2010, 2256 Victorians were
diagnosed with melanoma.
Bowel cancer
Bowel cancer usually affects the colon or rectum (figure 11.5). The colon is the
main part of the large bowel and the rectum is the last section of the large bowel
that opens to the outside at the anus. Faeces collect in the rectum before being
expelled from the body through the anus. Cancer usually starts in the lining of the
bowel. If left untreated, the cancer will spread into the walls of the bowel and then
to the lymph nodes, liver or lungs. Bowel cancer is diagnosed in more than 3400
Victorians each year and usually affects people over 50 years of age.
Symptoms of bowel cancer include:
• blood or mucus in the faeces
• constant tiredness
• unexpected change in bowel habit
• weakness
• bloating and/or cramping
of the abdomen
• pale complexion.
Stomach
Small
bowel/
intestine
Anus
Figure 11.5 Bowel cancer usually
affects the colon or rectum.
TEST your knowledge 4 Outline the effects that type 2 diabetes has on the
health of the adult.
1 (a) Describe Alzheimer’s disease.
(b) Explain the impact that Alzheimer’s disease
APPLY your knowledge
has on the health and individual human
development of an adult. 5 Research and outline five strategies that family
2 (a) Describe Huntington’s disease. members can use to maximise the health and
(b) Explain the impact that Huntington’s disease individual human development of a person with
has on the health and individual human Alzheimer’s disease.
development of an adult. 6 Describe the difference between a genetic condition
3 Outline the types of cancer that have a genetic and a genetic predisposition.
predisposition.
KEY CONCEPT The impact of body weight on the health and individual human
development of adults
Body weight
The body weight of adults is largely determined by the combination of genes that
are inherited from the biological parents as well as lifestyle and behaviours such as
physical activity levels and food habits. Concerns regarding body weight tend to
focus on overweight and obesity due to the increasing rate of both conditions over
the past 20 to 30 years. Figure 11.6 demonstrates the proportion of people who
were overweight or obese in 2011–12. According to the 2011–12 National Health
Survey, 28.3 per cent of persons 18 years and over were obese, 35 per cent were
overweight, 35.2 per cent were normal weight and 1.5 per cent were underweight.
It is estimated that at the current rate of increase, overweight and obesity will affect
75 per cent of the Australian population by 2020.
90
80 Males
Females
70
60
Percentage
50
40
30
20
10 Figure 11.6 Proportion of persons
0 who are overweight or obese, 2011–12
18–24 25–34 35–44 45–54 55–64 65–74 75+ Note: Based on Body Mass Index for persons whose
height and weight were measured.
Age group (years) Source: ABS, Australian Health Survey: First Results.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 345
11.2 Biological determinants: body weight
Together with the BMI, the distribution of excess body fat can determine the level
of risk to health and individual human development. Excess fat around the waist is
associated with a greater risk of health-related conditions — such as coronary heart
disease, stroke and type 2 diabetes — compared to excess fat that is distributed around
the buttocks and thighs (the ‘pear’ shaped body). As can be seen from table 11.4,
increasing BMI correlates with an increased risk of ill-health. Overweight and obesity
significantly increase the risk of illnesses and conditions such as type 2 diabetes,
cardiovascular disease, high blood pressure, sleep apnoea, osteoarthritis, certain
cancers (breast, endometrial, cervical and bowel) and psychological disorders. In
terms of social and mental health, overweight and obesity can lead to discrimination,
poor self-esteem, body shape dissatisfaction, disordered eating (e.g. binge eating),
isolation and depression.
TEST your knowledge 7 Use figure 11.6 to answer the following questions.
(a) Explain the relationship between age and the
1 Outline the factors that contribute to overweight
prevalence of overweight and obesity.
and obesity in adults.
(b) Explain the relationship between gender and the
2 In 2011–2012, what percentage of the adult
prevalence of overweight and obesity.
population was overweight or obese?
8 Use the Effects of obesity weblink in your
3 What is the prediction regarding future rates of
eBookPLUS to the find the link for this question.
overweight and obesity?
Develop a website to provide advice for adults
4 Outline BMI, including how it is calculated.
regarding the importance of maintaining a healthy
5 List the conditions associated with overweight and
BMI. Include information about ways to maintain
obesity.
a healthy BMI, and provide an explanation of the
APPLY your knowledge impact of overweight and obesity on the health and
individual human development of adults.
6 Calculate the BMI for an adult female who is
65 kilograms and has a height of 1.62 metres.
What BMI classification would this person be?
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 347
11.3 Biological determinants: blood pressure
KEY CONCEPT The impact of blood pressure on the health and individual
human development of adults
Blood pressure
Blood pressure measures the force of the blood on the walls of the arteries and
is recorded as systolic and diastolic measurements. Systolic blood pressure is
the maximum pressure exerted on the arteries when the heart muscle contracts
to pump blood. Diastolic blood pressure measures the minimum pressure in the
arteries when the heart muscle relaxes between heart contractions. Blood pressure
is measured in millimetres of mercury (mm Hg) using an instrument called a
sphygmomanometer. Blood pressure is written as a number figure of systolic/
diastolic, with the systolic measurement being the higher one (e.g. 120/80mm Hg).
Blood pressure can increase with exercise or exertion. Elevated blood pressure is
Figure 11.8 Blood pressure measures
the force of the blood on the walls of
a concern when the pressure remains high while at rest because this might indicate
the arteries. the heart is being overworked and the arteries have increased stress on the arterial
walls. This can accelerate the depositing of fatty plaques on the arterial walls, a
condition called atherosclerosis (figure 11.11). Atherosclerosis contributes to other
illnesses such as coronary heart disease and stroke.
Although there is no ‘ideal’ blood pressure, the following measurements provide
a guide:
• normal blood pressure: less than 120/80 mmHg
• normal–high blood pressure: between 120/80 and 140/90 mmHg
• high blood pressure: equal to or more than 140/90 mmHg
• very high blood pressure: equal to or more than 180/110 mmHg.
High blood pressure, or hypertension, is a major risk factor for coronary heart
disease, stroke, heart failure and kidney failure. Genetic factors — along with
obesity, lack of physical activity, poor nutritional intake including high salt intake
and heavy alcohol consumption — are also significant risk factors.
Hypertension is a common disorder of the circulatory system, with one in seven
Australian adults being affected. The condition is more common with age due to
the arteries becoming more rigid. Figure 11.9 shows the proportion of adults with
high blood pressure with increasing age in 2011–2012.
60
Males
Females
50
40
Percentage
30
20
10
Heart Normal
coronary
artery
Artery with
atherosclerosis
Figure 11.11 Atherosclerosis is the build-up of fatty deposits on the arterial walls resulting
in a narrowing of the arteries.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 349
11.3 Biological determinants: blood pressure
Coronary heart
disease
Physical environment
Social factors
Lack of sport and recreational
Depression and social isolation
facilities
Limited income to purchase
Lack of access to health care
nutritious foods
Lack of access to nutritious
Lack of nutrition education
foods
Figure 11.12 Some of the factors that increase the risk of developing coronary heart disease
Stroke
High blood pressure is a significant risk factor for stroke, also referred to as
cerebrovascular disease. Stroke is the most common cause of death in Australia.
Approximately 60 000 strokes occur every year, with the vast majority occurring in
adults over the age of 65 years.
High blood pressure puts unnecessary strain on the vessels of the circulatory
system, including those that transport blood to the brain. During a stroke, blood
flow is interrupted to an area of the brain. This may be caused by a blood clot
blocking the artery or a blood vessel breaking. As a result of this lack of blood
supply, the brain cells in the affected area may die. Images of the brain, taken by
magnetic resonance imaging (MRI), are used to detect a stroke (figure 11.13).
The effects depend on the size and location of the stroke. Some people may have
minor effects that they can recover from (e.g. loss of balance) while a more serious
stroke can result in paralysis on one side of the body or even leave the individual
in a coma. A severe stroke can result in death.
A transient ischaemic attack is a ‘mini stroke’ that can be a warning sign for a
more severe stroke. The symptoms can be the same as a more severe stroke but they
tend to disappear in a few minutes and do not last beyond 24 hours. This type of
attack can appear days, weeks or months before a full stroke occurs, and needs to be
treated immediately because the longer a stroke remains untreated, the greater the
degree of brain damage. The signs of stroke and transient ischaemic attack include:
• sudden blurred or decreased vision in one or both eyes
• numbness, weakness or paralysis of the face
Figure 11.13 An image of the brain • difficulty speaking
produced by magnetic resonance • loss of balance
imaging (MRI) enables stroke to be
diagnosed. This image shows where
• dizziness
the damage to the brain cells has • swallowing difficulties
occurred. • severe headache.
Behavioural factors
Biological factors
Tobacco smoking
High blood pressure
Diet high in saturated fat, salt
Diabetes
and sugar
High cholesterol levels
Overconsumption of alcohol
Overweight and obesity
Lack of physical activity
Stroke
Kidney failure
One in seven adults in Australia has some sign or symptom of kidney disease and
one in 35 have serious kidney disease.
The kidneys play a very important role in the body (figure 11.15). They filter the
blood and remove waste products as well as control the level of fluid in the body.
High blood pressure greatly increases the risk of kidney failure because the increased
pressure within the arteries can damage the vessels that supply the kidneys. The
very small vessels are usually the first to be affected and, if left untreated, can lead
to kidney disease. Initially, there may not be any signs or symptoms of disease. As
the condition progresses, the signs and symptoms include:
• more frequent urination
• greater volume of urine being passed
• foaming urine
• oedema, or swelling, around the feet, ankles, legs, abdomen and eyes
• pain in the back, under the ribs
• pain or a burning sensation when passing urine.
If kidney disease is not treated, and the risk factors contributing to the disease
are not addressed, then the kidneys may begin to fail due to a build-up of waste
products and extra fluid in the blood. When the kidneys begin to fail, the following
may occur:
• inability to concentrate
• tiredness
• loss of appetite
• nausea and vomiting
• breathlessness.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 351
11.3 Biological determinants: blood pressure
KEY CONCEPT The impact of blood cholesterol on the health and individual
human development of adults
Blood cholesterol
Cholesterol is a type of fat that has a range of functions within the human body.
It produces hormones, assists with digestion through the production of bile
acids and is an essential component of cell membranes. Cholesterol is found in
higher concentrations in the brain and nervous system. It occurs in two forms:
high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). HDL
cholesterol is referred to as the ‘good’ cholesterol as it can help unclog arteries
by removing excess LDLs out of the cells. LDL cholesterol, on the other hand, is
referred to as ‘bad’ cholesterol because it can cause fatty substances to build up on
the arterial walls and block the blood vessels. High levels of HDLs can be a positive
sign for health as long as they are accompanied by low levels of LDLs. Figure 11.16 When saturated fat
(such as found in doughnuts) is
Although it is required for the effective functioning of the body, cholesterol
consumed, the cholesterol that is not
becomes a health concern when there is too much of it in the blood. High blood- processed by the liver is returned to
cholesterol levels, particularly LDLs, are one of the three main risk factors for heart the bloodstream.
disease (the other two are tobacco smoking and high blood pressure). The liver is
where the processing of cholesterol occurs. When saturated fats are consumed, the
cholesterol that is not processed by the liver is returned to the bloodstream. If there
is too much LDL cholesterol in the blood, it can build up into fatty deposits on
the arterial walls. This build-up of fatty deposits causes a narrowing of the arteries
(atherosclerosis), which may eventually become blocked and cause a heart attack
or stroke. The safe level of cholesterol is thought to be no higher than 5.5 mmol/
litre of blood. Age is one of the risk factors for high blood cholesterol as shown in
figure 11.17, which highlights the proportion of Australian adults with high blood
cholesterol in 1999–2000.
80
Males
70 Females
60
50
Per cent
40
30
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 353
11.4 Biological determinants: blood cholesterol
KEY CONCEPT The impact of sun protection and smoking on the health
and individual human development of adults
Health-related behaviours have a significant impact on the health and individual human
development across the lifespan. The behaviours relevant to adults include smoking,
physical activity, food consumption, alcohol and drug use and sexual practices.
Many different factors can contribute to a person’s attitudes and lifestyle practices
such as social networks (parents, family, peers), education level, socioeconomic
status, environment, advertising, health campaigns, genetic predisposition, access
to resources, and government policies. Changing health-related behaviours can
sometimes take a long time.
Sun protection
When adults are outdoors,
the ultraviolet (UV)
radiation from the sun can
penetrate unprotected skin
and cause damage. Sunburn
occurs as a reaction to
exposure to UV radiation.
Chemicals are released from
the top layers of the skin,
causing the blood vessels
to expand and release fluids
that generate inflammation,
redness and pain. Severe
cases of sunburn can
result in all or some of the
following:
• blistering
• headaches
• nausea
• vomiting
• dizziness
• severe pain.
In Australia, the risk of
developing skin cancer from
too much sun exposure Figure 11.19 Sun protection is
needs to be balanced with the need to maintain adequate vitamin D levels. The UV important to block damaging UV rays.
from sunlight is required for the formation of vitamin D in the skin. Vitamin D can
also be found in relatively small amounts in some foods (e.g. oily fish, eggs, liver,
margarine and some dairy products fortified with vitamin D) but their contribution
to the overall daily requirement is minimal. Vitamin D is important to adults as it
helps the body to absorb calcium through the small intestine. Calcium is required
for maintaining the strength of bones and teeth, and the functioning of muscles and
nerves.
The majority of Australians have sufficient exposure to sunlight through
their daily activities to receive enough vitamin D, although some sections of
the population are more likely to be at risk of Vitamin D deficiency (e.g. the
elderly confined to nursing homes). The required length of exposure to sunlight
depends on UV radiation levels, which are higher during the warmer months
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 355
11.5 Behavioural determinants: sun protection and smoking
and in the northern parts of Australia. Figure 11.20 shows the amount of time
required in the sun in Australia’s capital cities to produce sufficient amounts of
vitamin D.
The UV index is an international standard measurement of the strength of the
UV radiation from the sun in a specific location at a particular time. When the
UV index reads 3 or above, sun protection is necessary because there is a much
greater risk of damage occurring to the eyes and skin. Skin cancer can develop
when the cells of the skin are damaged, causing them to grow abnormally. Each
time the skin is exposed to UV radiation, changes occur in the structure and
function of the skin cells and permanent damage can occur. Every exposure to
UV radiation can increase the risk of skin cancer. All skin types can be damaged
as a result of exposure to UV radiation, even those who have skin types that are
less likely to burn.
Darwin
Brisbane
Perth Sydney
Adelaide Canberra
There are three types of skin cancer: basal cell carcinoma, squamous cell
carcinoma and melanoma. The types of skin cancer are named after the skin cell
in which the cancer develops. Basal cell carcinoma and squamous cell carcinoma
are referred to as common or non-melanoma skin cancers. The most dangerous
form of skin cancer is melanoma. If left untreated it can spread to other parts of the
body and, eventually, result in death.
Australia has one of the highest rates of skin cancer in the world, with over
440 000 Australians being treated for skin cancer each year. Two in three Australians
will be diagnosed with skin cancer by the age of 70. The most commonly diagnosed
cancer for young adults between 2003 and 2007 was melanoma.
Apart from skin cancer, lack of sun protection and exposure to UV radiation
can result in eye damage such as photoconjunctivitis, macular degeneration and
cataracts, and premature ageing.
The factors that increase the risk of skin cancer are:
• family history of skin cancer
• having a large number of moles on the skin
• skin type that is sensitive to UV radiation and burns easily
• a history (childhood, adolescent and/or adulthood) of severe sunburn
• spending a lot of time outdoors without appropriate sun protection
• actively tanning or using sunbeds, sunlamps and solariums
• having a job that requires work to be completed outdoors.
Smoking
Tobacco smoking has an enormous impact on the morbidity and mortality rates of
adults in Australia. It is the single most preventable cause of ill-health and death
in the Australian population. It is estimated that tobacco smoking contributes
7.8 per cent of the burden of disease in Australia; approximately 10 per cent of the
total burden of disease in males and 6 per cent in females.
Tobacco smoking is a major risk factor for a range of illnesses including cancer,
hypertension, heart disease and stroke. Approximately one-fifth of all cancer deaths
in Australia can be attributed to smoking.
Cigarette smoke contains over 4000 chemicals. When a person smokes, these Figure 11.21 Smoking is a major risk
chemicals are inhaled and pass through the alveoli of the lungs and into the factor for cancers of the mouth.
bloodstream to the rest of the body. Tar, radioactive compounds, hydrogen cyanide
and carbon monoxide are just a few of the poisonous substances found in tobacco
smoke.
The nicotine in cigarettes is what causes addiction in smokers. It is a naturally
occurring substance found in the tobacco plant. When inhaled as tobacco smoke,
nicotine raises the heart rate and increases blood pressure.
The short term effects of smoking include:
• dizziness
• hand tremors
• coldness in the extremities (hands and feet)
• irritation of the eyes and nose
• increased incidence of colds and coughs
• bronchitis
• increased acid in the stomach leading to ulcers
• reduced appetite
• reduced sense of smell and taste
• bad breath
• reduced physical endurance
• increased effect of irritants on allergies
• increased risk of lung infections
• increased risk of miscarriage in pregnant women who smoke.
Source: www.givingupsmoking.info.
The most common form of cancer caused by smoking is lung cancer. However,
smoking also contributes to cancer of many other areas of the body including the
tongue, mouth, throat, nose, oesophagus, pancreas, stomach, bladder, kidney, cervix
and bone marrow.
Smoking increases the risk of cardiovascular disease due to an increase in the rate
of fatty substances being deposited on the arterial walls, resulting in the narrowing
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 357
11.5 Behavioural determinants: sun protection and smoking
of the arteries. As a result, blood flow is reduced to the cardiac muscle of the
heart. Permanent damage occurs to an area of the heart when the build-up of fatty
substances blocks the artery or arteries supplying that area. The damage to the
peripheral arteries of the body can result in reduced blood flow to the extremities,
leading to blood clots, infection, gangrene and possibly amputation. For people
under 65 years, the risk of dying from heart disease is three times greater for a
smoker compared to a non-smoker, and 70 per cent greater for a smoker over
65 years. A smoker has about twice the risk of suffering from a stroke than a
non-smoker.
The 2011–12 National Health Survey collected information about people’s use of
tobacco. From this survey it was found that 2.8 million Australians aged 18 years
and over smoked daily (16.3 per cent). This has been a decrease from 22.4 per cent
in 2001 and 18.9 per cent in 2007–08 (see figure 11.22).
40
2001
2007–08
30 2011–12
Percentage
20
10
0
18–24 25–34 35–44 45–54 55–64 65–74 75+
Age group (years)
Figure 11.22 Proportion of persons who were current daily smokers, 2001, 2007–08 and
2011–12
Source: ABS, Australian Health Survey: First Results
Quitting smoking has immediate and long-term health benefits for adults:
• after 12 hours — most nicotine is out of the bloodstream
• within 24 hours — carbon monoxide blood levels have largely dropped, heart
rate slows, tremors lessen, skin temperature warms
• within a month — the immune system begins to recover
• within three months — symptoms such as cough, mucus and wheeze decrease,
and blood flow to the hands and feet improves
• after six months — stress levels are usually lower than when smoking and the
lungs are working much better
• after 12 months — the increased risk of heart disease due to smoking is halved
• after 15 years — the risk of heart disease and stroke becomes almost the same as
an adult who has never smoked.
Quit Victoria
Since the establishment of Quit Victoria in 1985 by the Minister of Health and
the Cancer Council, there has been a gradual decline in smoking rates in Victoria.
Similarly, national smoking rates have also declined as shown in figure 11.22.
Quit Victoria is ‘dedicated to eliminating the pain, illness and suffering caused by
tobacco smoke’.
Quit Victoria’s health promotion campaign is a multi-pronged approach aiming
to prevent people from taking up smoking in the first place while also encouraging
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 359
11.6 Behavioural determinants: physical activity
KEY CONCEPT The impact of physical activity on the health and individual
human development of adults
Physical activity
The benefits of physical activity to the health and individual human development
of adults have been well documented. Physical activity reduces the risk of
developing a range of illnesses, some of which may be life threatening, and helps
ageing adults to maintain or develop the strength and stamina that enables them to
live independently.
The 2011–12 National Health Survey found that the overall level of physical
activity for Australians aged 15 years and over was low. In the week prior to
interview, 66.9 per cent of Australians were either sedentary or had low levels
Figure 11.23 The benefits of physical
of exercise (35.4 per cent were sedentary and 31.5 per cent had low levels of
activity to adults have been well exercise). Males tended to be generally more active than females (see figure 11.24).
documented. The National Physical Activity Guidelines for Australians outline the minimum
levels of physical activity required to gain a health benefit. One of these guidelines
recommends that adults be involved in at least 30 minutes of moderate-intensity
physical activity on most (preferably all) days. Research has shown that doing 30
minutes of moderate-intensity physical activities a day on most days can have
a positive effect on health, such as blood pressure, cholesterol levels and body
weight. The activity does not have to be done in one continuous block of time
but can occur in shorter amounts throughout the day. Regular and more vigorous
exercise has the additional benefit of protecting against heart disease. Vigorous
exercise is activity that makes the individual ‘huff and puff’. In technical terms,
vigorous exercise occurs when the heart is beating at 70–85 per cent of maximum
heart rate. Maximum heart rate is determined by subtracting an individual’s age
from 220.
50
Males
Females
40
30
Percentage
20
10
Figure 11.24 Level of exercise
undertaken for fitness, recreation or
sport in the last week, persons aged
0
15 years and over, 2011–12.
Source: ABS, Australian Health Survey: First Results.
Sedentary Low Moderate High
Figure 11.25 Benefits of moderate–high intensity physical activity on the health and
individual human development of adults
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 361
11.6 Behavioural determinants: physical activity
An inadequate level of physical activity is one of many health risk factors that
contribute to the increased risk of disease (see table 11.5).
Table 11.5 Selected health risk factors, people aged 25–64 years, 2007–08 (per cent)
Source: Australian Institute of Health and Welfare 2010, Australia’s health 2010, cat. no. AUS 122,
Canberra, p. 319.
TEST your knowledge brisk walk. Twice a week, Michael attends the
gym during his lunch break and participates in
1 What is the recommended amount of physical
an aerobics class for 45 minutes. Most Saturday
activity for an adult?
2 What proportion of the population did not engage afternoons, Michael plays 18 holes of golf with a
in the recommended amount of physical activity in group of friends.
2011–12? (a) Classify the types of activities Michael is involved
3 Outline five benefits of physical activity to the health in as:
and individual human development of adults. i. low intensity
4 Explain the relationship between energy intake/ ii. moderate intensity
expenditure and body weight. iii. vigorous.
(b) Is Michael participating in the recommended
APPLY your knowledge amount of physical activity? Explain.
5 Develop a weekly physical activity program for (c) What changes would you suggest to improve
a mother of two children who works full time. Michael’s level and/or type of physical activity?
Consider the times of the day during which physical (d) What health benefits will Michael gain from
activity can occur and the type and intensity of the participating in the recommended levels of
exercise. physical activity?
6 Michael is a 42-year-old male who works in the city. 7 Using table 11.5, explain the relationship between
He catches the train to work every day and walks sedentary levels of exercise and other risk factors in
from the station to his office, which is a 10-minute the development of illness/disease.
KEY CONCEPT The impact of food intake on the health and individual human
development of adults
Food intake
Food contains a range of nutrients that are important for the health and
individual human development of adults. All nutrients are required across
all stages of the lifespan but the required quantities vary according to age,
gender, metabolism and lifestyle. Growth has ceased by the adulthood
stage of the lifespan. As a result, nutrients for the maintenance of body
tissue rather than growth become more important.
There are six categories of nutrients:
• carbohydrates • minerals • vitamins
• protein • fats/lipids • water.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 363
11.7 Behavioural determinants: food intake
• Fats. Along with carbohydrates, fats are a primary source of energy for the
body. Fats also play a role in protecting internal organs and maintaining
body temperature. There are four types of fats: saturated, monounsaturated,
polyunsaturated and trans fats (figure 11.28). Polyunsaturated fats can be
divided into omega-3 and omega-6 fatty acids.
• Protein. Protein is required for the growth, maintenance and repair of body
cells and the manufacturing of hormones, enzymes and antibodies. It is also a
secondary source of energy.
• Vitamins. These occur as two types: fat-soluble and water-soluble. Fat-soluble
vitamins are vitamins A, D, E and K. They are stored in body tissues and may
become toxic to the body if over consumed. Water-soluble vitamins include
vitamin C and the B-group vitamins. They are not stored in the body and any
excess intake is excreted in the urine.
• Minerals. These include calcium, iron, potassium and iodine. These are all
required for the effective functioning of the body.
• Water. Water is required for the functioning of every cell in the body. It also
regulates body temperature, acts as a lubricant for joints and assists in the
removal of waste from the body.
Certain nutrients act as a risk or protective factor for specific diet-related diseases
(table 11.6). A risk factor increases the likelihood of a disease occurring whereas a
protective factor helps guard against the development of a disease.
Table 11.6 Nutrients as risk or protective factors for diet-related diseases
Risk or
protective Relevant
Nutrient Function(s) Food source factor disease
TEST your knowledge 7 For what diseases are the following nutrients a
risk factor and what are the food sources of these
1 List the six categories of nutrients.
nutrients?
2 Explain the difference between simple (high GI)
(a) Saturated fats and trans fats
carbohydrates and complex (low GI) carbohydrates.
(b) Simple carbohydrates
3 What are the functions of protein?
(c) Sodium
4 What are the four types of fat?
8 Why is the overconsumption of food a health
5 Why should saturated fat and trans fat be reduced
concern?
in an adult’s diet?
9 Why is the lack of fruit and vegetable consumption
6 What diseases do the following nutrients protect
in the Australian population a concern?
against and what are the food sources of these
nutrients?
APPLY your knowledge
(a) Calcium
(b) Folate 10 Develop one page of advice for an adult to reduce
(c) Fibre the risk of diet-related conditions. In your advice,
(d) Iron consider the types of food that should be consumed
(e) Polyunsaturated fats or avoided, based on the nutrient content of the
food. Explain how consuming a nutritious diet
can promote the health and individual human
development of an adult.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 365
11.8 Behavioural determinants: alcohol use
KEY CONCEPT The impact of alcohol use on the health and individual human
development of adults
Alcohol use
Alcohol is the most widely used and accepted recreational drug in Australia.
However, the overconsumption of alcohol is a major risk factor for a range of
diseases and illness or injury-related deaths. Alcohol is second only to tobacco as a
preventable cause of drug-related death and hospitalisation in Australia (NHMRC,
2009). In 2011–12, the National Health Survey found that 29.1 per cent of males
and 10.1 per cent of females aged over 18 years exceeded the lifetime risk guidelines
of drinking no more than two standard drinks on any day. It is generally accepted,
however, that a very moderate intake of alcohol (around half a standard drink per
day) may contain health benefits for older people. Red wine, in particular, is
considered to be beneficial in reducing the risk of cardiovascular disease due to the
Figure 11.29 Alcohol is the most anti-oxidants it contains. However, health authorities do not go so far as to
widely used and accepted recreational recommend that non-drinkers should start consuming alcohol for their health.
drug in Australia.
Information gathered from the 2010 National Drug Strategy Household Survey
indicated that 47 per cent of Australians aged over 14 years of age drank alcohol,
at least one a week. In 2010, 20 per cent of Australians aged 14 and over reported
drinking alcohol at levels for lifetime harm. Males were 2.6 times as likely as
females to consume alcohol at risky levels (20 per cent for males; 11 per cent for
females) and people aged 18–29 were more likely than any other age group to
drink alcohol in risky quantities (AIHW).
A ‘standard drink’ is the measure used to determine the approximate amount of
alcohol consumed. One standard drink contains 10 grams of alcohol and equals:
• 285 mL (one pot) of regular strength beer (alcohol content of 4.9 per cent)
• 375 mL of mid-strength beer (alcohol content of 3.5 per cent)
• 100 mL (one small glass) of table wine (alcohol content of 12 per cent)
• 30 mL of spirits plus mixer (alcohol content of 40 per cent).
100
Males
Females
80
Percentage
60
40
20
0
(a) (b)
Daily Weekly Less than Ex- Never Abstainer Low risk Risky
weekly drinker
Drinking status Lifetime risk
(a) On average, had no more than 2 standard drinks per day.
(b) On average, had more than 2 standard drinks per day.
Figure 11.30 Alcohol drinking status and lifetime risk status, by sex, people aged
14 or older, 2010
Source: AIHW, Australia’s Health 2012, p. 226.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 367
11.8 Behavioural determinants: alcohol use
social problems such as domestic violence. It may also affect an adult’s ability to
manage family and work relationships, thereby impacting social development.
• Sleep disorders. Initially alcohol can induce sleep, but it eventually reduces the
quality of sleep and may worsen sleep disorders.
• Malnutrition. Alcohol displaces important nutrients from the body. As a result,
nutrients are not available for the maintenance and repair of body tissues.
Alcohol is high in kilojoules and increases energy intake, which may contribute
to overweight and obesity if the energy is not expended.
• Breast cancer and gynaecological problems. Women who drink alcohol are at
greater risk of breast cancer and gynaecological problems such as infertility and
an irregular menstrual cycle.
• Brain impairment. Alcohol consumption can lead to memory loss, difficulties
with learning new information, confusion and hallucinations, thereby affecting
intellectual development.
Alcohol consumption is associated with a higher risk of accidents and injury in a
range of settings including motor vehicle and bicycle accidents, accidents involving
pedestrians, falls, fires, drowning, sport and recreational injuries, alcohol poisoning,
overdose, suffocation, choking on vomit, assault, violence and intentional self-
harm. More adults die from alcohol-related road accidents and injuries than from
alcohol-related cancers, cardiovascular disease and alcohol dependence combined.
KEY CONCEPT The impact of drug use on the health and individual human
development of adults
Drug use
A drug is any substance that produces a psychoactive effect. The National Drug
Strategy defines a drug as including tobacco, alcohol, pharmaceutical medications
and illicit substances such as heroin and ‘ecstasy’. Illicit drug use is a major risk
factor for ill-health and death associated with HIV/AIDS, hepatitis C, low birth
weight, malnutrition, poisoning, mental illness, self-inflicted injury and overdoses.
Drug use may arise from an inability to cope with adult responsibilities. Like
alcohol, drug use generally — not just the use of illicit drugs — is a major risk
factor for many diseases in adults. It is also associated with injury, accidents,
disability, violence, crime and suicide, and social and family problems.
According to the 2010 National Drug and Household Survey, the proportion of
people aged 14 and over who had used an illicit drug in the previous 12 months
had increased from 13.4 per cent in 2007 to 14.7 per cent in 2010. Cannabis is the
most commonly used illicit drug in Australia, with 35.4 per cent of Australians
aged over 14 years of age reporting using cannabis at some time (see figure 11.33).
The use of cannabis can result in acute effects including the impairment of motor
skills, reaction time and the ability to perform skilled activities, as well as decreased
memory and learning abilities — thus impacting on an individual’s physical and
intellectual development. Mental health can also be affected, as cannabis causes
changes in the user’s moods, affects how they think and perceive the environment,
and causes decreased motivation in areas such as study, work or concentration. Figure 11.32 Drug use is a major risk
35.4 factor for poor health outcomes in
Marijuana/cannabis
10.3 adults.
Ecstasy 10.3
3.0
(c)
Meth/amphetamine 7.0
2.1
Cocaine 7.3
2.1 Lifetime use(b)
Hallucinogens 8.8
1.4 Recent use(a)
Inhalants 3.8
0.6
Heroin 1.4
Drug type
0.2
Ketamine 1.4
0.2
GHB 0.8
0.1
Injectable drugs 1.8
0.4
(c)
Pain-killers/analgesics 4.8
3.0
(c)
Tranquillisers/sleeping pills 3.2
1.5
(c)
Steroids 0.4
0.1
(c)
Methadone or Buprenorphine 0.4
0.2
Other opiates/opioids 1.0
0.4
0 5 10 15 20 25 30 35 40
Per cent
Figure 11.33 Recent and lifetime
(a) Used in the previous 12 months.
illicit drug use, people aged 14 years
(b) Used at least once in lifetime. or older, by illicit drug used, 2010
(c) For non-medical purposes. Source: AIHW, 2010 National Drug Strategy
Household Survey report. Drug statistics series
no. 25. Cat. no. PHE 145. Canberra: AIHW. p. 86.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 369
11.9 Behavioural determinants: drug use
Younger adults are more likely to use illicit substances (e.g. ‘ecstasy’, marijuana)
whereas older adults are more likely to abuse prescription and over-the-counter
medications.
The use of drugs (e.g. anabolic steroids) to improve athletic performance is
increasing and the risks of using anabolic steroids are well documented. From the
case study on the next page, it can be seen that some adults are prepared to take
illegal risks to achieve the perceived benefits of some drugs.
Normal aspects of ageing have a significant influence on drug use as adults age.
The way in which medications are absorbed, distributed, metabolised and cleared
from the body is affected by age-related changes in organ systems and illness. Even
when medications are taken as prescribed, age-related changes and disease can
increase the risk of side effects.
The rapid development of new medications to treat a variety of diseases, relieve
pain and improve quality of life has led to the increased use of prescribed and over-
the-counter medications. With increasing age, adults are more likely to have more
than one medical condition for which they have been prescribed medications. This
could pose a problem as different medications may interact and create side effects
that affect the functioning of the other medications.
The use of drugs can impact on health in the following ways:
• Damage to body organs. Heavy drug use can affect the liver, brain, lungs, throat
and stomach.
• Infectious diseases. Sharing needles from injecting drugs is a major risk for
contracting blood-borne diseases such as hepatitis B or C and HIV/AIDS.
• Injuries and accidents. Drug-related injuries can be linked to fights and falls,
Figure 11.34 A urine sample ready as well as accidents that occur while operating machinery at work or driving
for drug testing vehicles.
Case study
Men risk health for a boost … Human growth hormone is secreted naturally by
the brain’s pituitary gland and promotes growth during
of youth childhood and adolescence by stimulating production
of an insulin-like growth factor in the liver.
The illicit trade in human growth hormone has moved
Levels of HGH deplete as the body ages. The
to expensive anti-ageing clinics. Cameron Houston
and Jill Stark investigate the boom. By Cameron synthetic form of the hormone — which is not on the
Houston and Jill Stark. pharmaceutical benefits scheme — is injected daily and
costs $125 to $200 a week with a private prescription.
Middle-aged men are increasingly injecting human Doctors can prescribe the drug ‘off-label’ —
growth hormone in a bid to fight old age, spending up outside the purpose approved by the Therapeutic
to $15 000 a year on a drug they believe is the fountain Goods Administration — if they deem it ‘medically
of youth. appropriate’.
Government guidelines state it should only be Human growth hormone builds muscle mass and
prescribed to children with growth disorders and adults helps to reduce fat. Some anti-ageing doctors claim the
with severe hormone deficiencies. drug also reduces wrinkles, improves skin appearance
But a Sunday Age investigation has found many anti- and lowers cholesterol.
ageing clinics in Melbourne’s wealthier suburbs are Endocrinologists, who are specialists in hormones
flouting regulations by prescribing to people as young and glands, say the claims are not backed by scientific
as 35 who want to look good, stay fit and boost their evidence, and have hit out at ‘unscrupulous’ doctors
sex lives. prescribing the drug for non-medical reasons.
Most are men who use human growth hormone They say that for people with a normally functioning
(HGH) to improve fitness and energy levels, but leading pituitary gland, growth hormone treatment is potentially
specialists claim it can have serious side effects. dangerous even in small doses. Ken Ho, chair of
Black-market sales are also booming, with a former endocrinology at St Vincent’s Hospital in Sydney, said
dealer claiming $5000 worth of the drug can fetch up misuse could increase the risk of cancer and elongate
to $50 000 on the street. Possession is illegal without a the jaw.
prescription and importation is prohibited. Professor Ho said the medical properties of HGH
The dealer said some people were getting the were being exploited by anti-ageing clinics.
hormone for personal use from anti-ageing clinics then ‘They are trying to sell an expectation that if you’re
selling it for profit. 55 and you no longer have the body of a 21-year-old,
(continued)
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 371
11.9 Behavioural determinants: drug use
then you can reclaim former glories by taking these … Use of the drug has divided the sector. Joe
drugs. There are claims about improved sex life, which Kosterich, head of the Australasian Institute of
are completely unfounded … They are trying to tell Antiageing Medicine, said the definition of growth
you that ageing is an insidious disease, but there is no hormone deficiency was a ‘grey area’.
hormone that can stop ageing.’ ‘Generally speaking, most adults are not going to be
Dr Martin Hill, of Life Sense clinic in Windsor, is deficient in human growth hormone, so there is going
known to prescribe and supply HGH to men as young to be some usage that does skirt close to the legal
as 35, after conducting blood tests and a prostate boundary,’ he said.
examination. He is believed to have told patients in … The Australian Medical Association is concerned
consultations that he personally used it and the only that vulnerable people who will pay anything to stay
side effect was the cost. young are being exploited. But investigations into the
A prominent endocrinologist said he had seen a prescribing habits of individual doctors are often only
number of Dr Hill’s patients, who had been given an launched after a patient makes a complaint. With the
‘incredible mixture of medications’. One woman was long-term effects of HGH still unknown, it is difficult
allegedly given five different hormone treatments by for regulatory bodies to intervene.
Dr Hill and was being sued by an insurance company Victorian Health Services Commissioner Beth
over a $100 000 debt. Wilson, who fields consumers’ medical complaints,
In a letter in response to questions from The Sunday said the anti-ageing industry often exaggerated benefits
Age, Dr Hill’s lawyer wrote: ‘Dr Hill’s management of and played down risks: ‘It’s really scary how people’s
his patients is supported by substantial scientific and fear of their own body image and ageing has been
medical research and literature.’ manipulated by the industry.
… Delaying the march of time is big business — ‘But the claims of the anti-ageing industry are
in the US the anti-ageing sector is expected to rake doomed to failure because the last time anyone looked at
in $US106 billion ($A139 billion) this year, rising to the statistics for human mortality, it was 100 per cent.’
more than $US115 billion by 2010. The AustralAsian Source: Extract from The Age, 10 May 2009.
Academy of Anti-Ageing Medicine describes it as the
‘fastest-growing medical speciality in the world’.
KEY CONCEPT The impact of sexual practices on the health and individual
human development of adults
Sexual practices
Sexual practices refer to the ways in which individuals experience and
express their sexuality. Decisions made about sexual practices during
adulthood are a continuation of the decisions and experiences made
during youth, especially those made during early adulthood when
selecting or attracting a partner is a major developmental milestone.
Other important issues related to sexual practices include unprotected
sex, sexually transmissible infections, pregnancy and fertility/infertility,
and reproductive function and dysfunction.
Men and women continue to have a satisfactory pattern of sexual
functioning throughout middle and late adulthood. As in the earlier
stages of the lifespan, adults might need information to help them make
informed decisions about their sexual behaviours and contraception
methods appropriate to their needs.
Unprotected sex
Almost all sexually active Australians say they have had unprotected
sex, and yet more than half say they have never had a test for a sexually
transmissible infection (STI). According to the national clinic adviser for
Marie Stopes International (a non-profit sexual and reproductive health-
care provider), the majority of safe sex campaigns are targeted at youth;
however, research shows that 35–40 year olds are just as exposed to
unsafe sex practices. STIs and unplanned pregnancies are key health
issues that affect many Australians. Research shows that during early and
middle adulthood (18–24 year olds and 35–40 year olds respectively),
Figure 11.35 A couple express their
individuals were less likely to be proactive with their health care and sexuality in dance.
have an STI check. Women are more likely than men to have an STI check up after
having unprotected sex; however, overall as many as six out of ten adults do not
follow up with an STI check after unprotected sex.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 373
11.10 Behavioural determinants: sexual practices
2,400
2,200
2,000 Males
Females
1,800
1,600
1,400
Rate
1,200
1,000
800
600
400
200
0
15–19 25–29 35–39 45–49 55–59 65+
20–24 30–34 40–44 50–54 60–64
Pregnancy: fertility/infertility
Unintended pregnancy can be an issue not only for youth, but also for adults.
Research indicates that unintended pregnancies are often the result of contraceptive
failure. Whatever the cause, unintended pregnancy is associated with increased
infant mortality and morbidity, parental neglect, child and partner abuse, and
emotional deprivation.
Reproductive problems can become a major concern in early adulthood,
especially in relation to infertility. Infertility is the inability to conceive a child while
having unprotected sexual intercourse for at least 12 months. It is known that
men and women suffer from infertility at about the same rate. Sometimes multiple
Figure 11.37 An ovum and sperm —
will it be fertilised?
factors are involved in one or both partners.
Women can be infertile from disorders such as hormone imbalances, blocked
fallopian tubes, endometriosis, or abnormalities of the reproductive organs. Men
can experience infertility if they have problems with the number and shape of their
sperm, produce antibodies against their own sperm or have blocked spermatic
cords. In some cases, the exact cause of infertility cannot be found.
Proper diagnosis of infertility will help in selecting an appropriate treatment plan
that maximises the chance of becoming pregnant.
Infertility statistics
• One in six couples is infertile.
• In 40 per cent of cases the problem rests with the male, in 40 per cent with the
female, in 10 per cent with both partners, and in a further 10 per cent of cases
the cause is unknown.
• Fertility problems affect one in three women over 35.
• One in 25 males has a low sperm count and one in 35 is sterile.
• For healthy couples in their 20s having regular unprotected sex, the chance of
becoming pregnant each month is 25 per cent.
Reproductive function/dysfunction
As mentioned in chapter 10, physiological changes in the reproductive systems of
both men and women throughout adulthood result in changes in sexual function.
After menopause, many women enjoy sex more, especially because the risk of
becoming pregnant is no longer a concern.
Although men and women frequently enjoy satisfactory sexual relationships
throughout middle adulthood, men are more vulnerable to experiencing sexual
dysfunction than women. Advancements in medical technologies have made
available a range of products (e.g. Viagra) that allow men to continue to function
sexually into older age. Currently there is no data to suggest that men or women
Figure 11.38 Adults’ sexual
lose interest in sexual activity as they age. Although the need to express sexuality behaviour does not have to fade
continues, older adults are susceptible to many disabling medical conditions — with age.
cardiovascular conditions, arthritis, normal changes associated with ageing, and
medication side effects — that can make the expression of sexuality difficult. In
both males and females, reduced availability of sex hormones results in less rapid
and less extreme responses to sexual arousal. Touch is an overt expression of
closeness and an integral part of sexuality, and older adults still feel the human
need to touch and be touched.
TEST your knowledge 6 What are the issues relating to sexual practices
across each stage of adulthood?
1 Define sexual practices.
2 What are STIs?
3 What is the definition of infertility?
APPLY your knowledge
4 Outline possible causes of infertility in both males 7 ‘Unintended pregnancies can be an issue, not
and females. only for youth, but also for adults’. Discuss the
5 What percentage of births in Australia involved the impact that pregnancy can have on the health and
use of assisted reproductive technologies? individual human development of adults.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 375
11.11 hysical environment determinants: housing and
P
workplace safety
KEY CONCEPT The impact of housing and workplace safety on the health and
individual human development of adults
The physical environment impacts on the health and individual human development
at all stages of the lifespan. For instance, access to clean water and sanitation is just
as important during the adulthood stage of the lifespan as it is during the infancy,
childhood and youth stages. Employment becomes a priority during adulthood, so
the physical environment in which adults work can impact significantly on health
and individual human development. Other factors within the physical environment
that have an impact on the health and individual human development of adults are
housing, neighbourhood safety and access to health care.
Housing
Housing plays a significant role in the health and individual human development of
adults. A house provides shelter and protects adults from the outside environment,
including any physical dangers. The majority of Australian adults live in their
own homes that they either own outright (33 per cent) or are paying off (36 per
cent). Rentals account for approximately 28 per cent of households, with the two
biggest groups being private rentals (24 per cent) and public/government rentals
(4 per cent).
Housing stress
Having suitable housing is a priority for the vast majority of adults. For many
Australian adults, housing stress has a significant impact on health and individual
human development, not only for themselves but also for their family members.
Housing stress occurs when the cost of housing (either rental or
mortgage) is high in relation to household income. It is generally
accepted that housing stress occurs when at least one-third of
family income is required to meet rent or mortgage payments.
Lack of affordable housing is a concern for many households.
Affordable housing is adequate, appropriate and secure housing
that is available at a cost that does not cause financial stress. Those
adults who pay a high proportion of their income to meet their
housing needs may experience financial stress. This leaves them
with less income to meet day-to-day needs such as basic services
(electricity, gas and water), nutrition, health care and clothing.
Figure 11.39 Housing provides Financial stress has a greater impact on lower-income households
shelter and protects residents from because they have little money to meet basic needs. According to the Australian
the outside environment. Bureau of Statistics, in 2007–2008, lower-income earners with a mortgage spent
27 per cent of their gross weekly income on housing costs, compared to all owners
with a mortgage who spent 18 per cent of their gross weekly income on housing
costs. These figures were similar for lower-income earners who were renting
privately as compared to all other private renters.
The constant stress of not having enough money to cover rent or mortgage
payments and other necessities of life can contribute to health problems. These
include:
• migraine or tension headaches
• insomnia or other sleep disorders
• anxiety, anger and irritability
• memory lapses
Homelessness
High levels of debt or the inability to meet rental payments has resulted in a
significant number of adults becoming homeless. According to the ABS, 0.5 per cent
of the Australian population were homeless on Census night in 2011.
Homelessness is having nowhere stable, safe and affordable to live. Homeless
adults living on the street may be vulnerable to violence, including sexual abuse
and rape. Being a victim of violence, or being exposed
to violent situations, may result in post-traumatic stress
disorder.
Homeless adults find it difficult to maintain healthy
eating habits. Lack of nutrients may result in reduced
immunity and loss of bone density and muscle mass.
Inadequate nutrition, poor living conditions and lack of
hygiene increase the risk of infectious diseases such as
meningococcal, meningitis, septicaemia, tuberculosis,
rheumatic fever, respiratory conditions and skin infections.
Adults who do not have a place to live and feel a lack of
control over their lives may suffer from depression, stress
and anxiety. This may result in increased drug, tobacco
and alcohol use, which is directly linked to illnesses such
as cancer, cardiovascular disease, type 2 diabetes and
various mental health conditions. Figure 11.41 The inability to afford
Prolonged ill-health can impact on the adult’s capacity to engage in physical housing is one of the reasons for
activities. As a result, bone and muscle strength may not be maintained or homelessness.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 377
11.11 Physical environment determinants: housing and workplace safety
developed and a decline in motor skills and coordination may occur. Ill-health will
also affect the homeless adult’s ability to engage with other people, thereby limiting
opportunities to use and maintain social skills and to emotionally connect with
others. As a result, the adults may feel isolated from others, which may contribute
to the development of depression.
Workplace safety
More time is spent in the work environment in the adulthood stage of the lifespan
than in the youth stage. This means there is a greater risk of workplace injuries
and illnesses during adulthood if effective preventative measures are not in place.
In the 12 months to June 2010, 5.3 per cent of the 12 million people
who had worked during that time experienced a work-related injury,
with males having higher rates of injury than females. This equates
to approximately 650 000 people and an injury rate of 53 per
1000 employed people. Males tend to have higher rates of injury
than females because there are more men in the workforce and they
tend to be employed in higher-risk occupations (e.g. construction). In
2009–10, the injury rate for males was 55 per 1000 employed men
compared with a female rate of 51 per 1000 employed women.
Injury rates also vary according to age. Young workers are more
likely to sustain a work-related injury than an older worker. This
may be attributed to lack of experience, limited training and lack of
awareness of safety in the workplace.
The type of occupation has a significant impact on the risk of injury
or illness in the workplace. The occupations with the highest rates of
injury in 2009–10 were labourers, machinery operators and drivers,
community and personal service workers, and technicians and trades
workers. The higher rate of injuries in these occupations can be
attributed to the physical nature of these jobs. Professional people
Figure 11.42 Males tend to have
higher rates of workplace injury than
(science, building, engineering, business and information, health and education)
females. had the lowest rate of injuries. Figure 11.43 illustrates the rate (per thousand
employees) of work-related injury or illness according to occupation groups.
Managers
Professionals
Technicians and trades workers
Community and personal service workers
Clerical and administrative workers
Sales workers
Machinery operators and drivers
Labourers
0 20 40 60 80 100 120
Figure 11.43 Work-related injury or Per 1000 employed peoplea
illness rate by occupation groups
Source: Australian Bureau of Statistics 2010,
(a) Number of people who, in the last 12 months, experienced a work-related injury or illness
Work-related injuries, Australia, 2009–10, while working in an occupation group per 1000 people employed in that occupation
cat. no. 6324.0, p. 5. group during the reference week.
While office jobs have a relatively low risk of injury, conditions related to overuse
of technology are becoming more common. For instance, having to sit for hours in
front of a computer may lead to back and neck pain, headaches, muscle and joint
pain of the upper limbs, and eyestrain from having to look at the monitor for
Agriculture Back — muscle stress/strain from heavy lifting of feed, produce and animals (29%)
Shoulder — muscle stress/strain from heavy lifting of boxes, freight or pallets. Traumatic joint/muscle injury or strain from
heavy lifting (13%)
Ambulance service Back — muscle stress/strain from heavy lifting (patients) (44%)
Children’s services Back — strain from lifting, carrying and moving children, toys, furniture and equipment (36%)
Construction — Hand and fingers — wounds, lacerations or amputations from nail guns, protruding nails or sawing/cutting timber (21%)
carpenters
Construction — Back — muscle stress/strain from pulling cables or lifting materials or equipment (18%)
electricians Hands and fingers — wounds/lacerations from tools slipping or cutting (17%)
Knee — traumatic joint/muscle injury or strain from slipping/tripping on uneven surfaces, kneeling or falling from ladders,
down stairs or through roof/floor (13%)
Construction — Back — muscle stress/strain from lifting equipment or materials, or from bending (22%)
labourers Hands and fingers — wounds/lacerations from being caught or crushed in equipment or materials (11%)
Knee — traumatic joint/muscle injury or strain from slipping on wet/uneven surfaces, falling from heights, tripping down
steps/ladders or kneeling for long periods (11%)
Education sector Psychological stress — work-related stress, increased work pressure, bullying, harassment (19%)
Back — muscle stress/strain from lifting, assisting students, bending down, moving furniture or boxes, falling off chairs or
down stairs, slipping on wet floors or tripping over objects (18%)
Knee — muscle stress/strain from slipping on wet floors, tripping on uneven ground or from kneeling. Traumatic joint/muscle
injury or strain from slipping on wet floors, tripping on uneven ground, kneeling or falling during physical activity (10%)
Office workers Psychological stress — stress or anxiety from work pressure, traumatic events, bullying, harassment (20%)
Back — muscle strains from lifting and general manual handling of equipment such as computers, boxes or files (17%)
Source: Based on data from ‘Injury hotspots (statistics and solutions)’, Worksafe Victoria, www.worksafe.vic.gov.au.
Research indicates that shift work is a risk factor for work-related injuries. The
work-related injury rate for shift workers was twice that of non-shift workers in
2005–06.
eLesson:
Apart from the injuries or illnesses that may be sustained from the workplace,
WorkSafe
there is also the risk of workplace fatalities. In spite of the recommendations
Searchlight ID: eles-1034
and expectations of a safe working environment, people still die every year
from preventable causes. From July 2011 to June 2012, there were 102 notified
workplace fatalities across Australia. The most common causes of fatalities were
vehicle accidents, being hit by falling objects, being hit by moving objects, and falls
from height (Safe Work Australia, 2012).
The effects of workplace injury may be short or long term and can have significant
impacts on the health and individual human development of adults. Short-term
injuries/conditions, such as cuts and abrasions, will allow an adult to return to work
relatively quickly. Other injuries/conditions, such as fractures and stress-related
conditions, generally require a longer period of time away from work. In some
instances, the worker may be so severely injured that they are unable to return to
work or may not be able to return to the same position they previously held.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 379
11.11 Physical environment determinants: housing and workplace safety
Workplace injury can result in the adult being in pain, and the potential
permanent scarring or impairment may cause significant misery to the individual.
Certain injuries, such as back injuries, may make it difficult for an adult to carry
out normal everyday tasks, such as going to the toilet. Being unable to look after
oneself and relying on the support of family and friends may impact on the affected
adult’s mental health. An adult who is unable to attend work may begin to feel
worthless and worry about the future, not only for themselves, but also for their
family members. The stress and anxiety associated with a long-term workplace
injury may lead to a variety of mental health conditions such as post-traumatic
stress disorder and depression. Some injured adults may become dependent on
prescription drugs, alcohol or other non-prescription drugs.
In terms of emotional development, the adult may be in chronic pain and find
it difficult to control their emotions. This may impact on the adult’s capacity to
maintain relationships with others, thereby impacting their social development. On
the other hand, the reliance on family and friends may result in greater bonds
being formed, which will enhance the social health and development of the adult.
The impacts on physical health can vary according to the severity of the injury.
The injured adult may be unable to participate in regular physical activity and, as
a result, fitness levels may decline. Lack of regular physical activity can impact on
physical development, such as a decrease in muscle mass and bone strength (Legal
Compensation Helpline, 2011).
Worksafe Victoria
Worksafe Victoria is a state government agency that manages Victoria’s workplace
safety system. Its responsibilities include:
• helping avoid workplace injuries from occurring
• enforcing Victoria’s occupational health and safety laws
• providing reasonably priced workplace-injury insurance for employers
• helping injured workers back into the workforce.
Worksafe Victoria provides a range of benefits to injured workers, regardless of
who was at fault. Benefits include weekly financial support, ambulance transport
expenses, medical and hospital treatment, attendant care and home help, and lump
sum payments.
One of the key messages from Worksafe Victoria is the prevention of workplace
injury. An extensive television and radio campaign aims to disseminate information
and raise awareness regarding safety in the workplace.
KEY CONCEPT The impact of neighbourhood safety and access to health care
on the health and individual human development of adults
Neighbourhood safety
All people need to feel safe in their homes and when out in the streets. In
2008–2009, more than four million adults, or 26 per cent of those aged 18 years
and over, reported feeling unsafe alone at home, walking alone at night in their
neighbourhood, or taking public transport at night alone (Australian Social Trends,
June 2010). Figure 11.46 indicates that during 2008–09 the vast majority of
Australians felt safe in their home alone.
After dark
During the day
Unsafe or very unsafe
0 20 40 60 80 100
Proportion (%)
Crime rates
In 2011–12, it was estimated that:
• 2.9 per cent of households were victims of at least one break-in at their home,
garage or shed
• 7.5 per cent of households were victims of at least one incident of malicious
property damage
• 0.7 per cent of households had at least one motor vehicle stolen
• 0.4 per cent of persons over 15 years of age were victims of at least one robbery
• 3.0 per cent of persons over 15 years of age were victims of at least one assault.
Victims of crime may experience a range of impacts on health and individual
human development including:
• feelings of emptiness • fear or anxiety
• nightmares or insomnia • exhaustion
• sadness • depression
• guilt or shame • anger or irritability
• grief or loss • feelings of loss of privacy or control
• panic or confusion • helplessness or feeling deserted
• physical symptoms of illness.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 381
11.1 2 Physical environment determinants: neighbourhood safety and access to health care
Apart from the physical impact of crime, fear for personal safety can restrict the
adult’s participation in social occasions and reduce their trust in the community.
As a result, an adult may lose interest in their daily activities and be less likely to
access local community services and recreational facilities (e.g. parks), which can
reduce their fitness levels and impact on the maintenance and/or development of
bone mass and muscle tissue. Restricted involvement in the community limits the
social contact that the adult has with others, which may contribute to feelings of
sadness, possibly leading to depression. Depression can affect the adult’s capacity
to control their emotions, and decrease their interest in situations or activities that
promote the development of intellectual skills. In contrast, adults who have a sense
of safety within their neighbourhood are more likely to be involved in community
activities, thereby promoting their health and individual human development.
Case study
Per cent
it is important for adults to have access to appropriate health 40
services for the purpose of preventing disease, screening for
disease or treating illness. The range of health services that are
20
available to Australian adults has contributed to the increase
in life expectancy over the past two decades, as diseases are
detected earlier and treatments have continued to improve. As 0
can be seen from figure 11.47, there has been a significant 1997 2007
increase in the survival rate following a heart attack, which Year
may be partly attributed to the increased capacity of health Figure 11.47 Survival rate for heart
services to diagnose and treat a heart attack. attacks in the 40–90 age range
There are numerous different types of health-care services available to improve Source: Australian Institute of Health and Welfare
2010, Australia’s health 2010, cat. no. AUS 122,
the health and individual human development of adults including BreastScreen Canberra, p. 487.
Australia, the National Bowel Cancer Screening Program and community health
services.
BreastScreen Australia
BreastScreen Australia is a breast cancer screening program that operates in over
500 locations throughout Australia. Breast cancer is a major risk for women —
more women die from this type of cancer than any other form. On average, seven
women die from breast cancer every day in Australia. Detecting breast cancer early
increases the chance of surviving the disease.
Mammography screening takes a low-dose X-ray of the breasts to detect any
changes in breast tissue (figure 11.48). The aim is to detect abnormal growths so
that the individual can be treated before the cancer progresses. Mammograms can
detect small tumours that may not be felt by hand.
Figure 11.48 Mammography
screening detects changes in breast
tissue.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 383
11.1 2 Physical environment determinants: neighbourhood safety and access to health care
Women over 40 years of age are eligible for free mammography screening but
screening recruitment strategies focus on the 50–69 year age group. This is because
over 75 per cent of breast cancers occur in women 50 years and over. Also, breast
tissue in younger women is more dense and can show up as a white area on X-rays,
making it easy to be mistaken for breast cancer (which also appears as a white area
on X-rays). The lifetime risk of women developing breast cancer is one in eight.
Women in the 50–60 year age group who have previously had a mammography
screening are sent a reminder for their next mammogram, which ideally should be
conducted every two years.
Mammography screening is used for two purposes: detection and diagnosis. It
can detect breast cancers in apparently healthy women, and can also be used to
determine if a breast abnormality is a sign of breast cancer. Changes to breasts
include:
• a lump or lumpiness of the tissue
• change in shape or appearance of the breast such as dimpling or redness
• an area that feels ‘different’ from the rest of the breast tissue
• a discharge from the nipple
• a change in the shape or appearance of the nipple, such as inversion
• breast pain.
When a change in the breast is noticed, mammography screening is used in the
initial phase of diagnosing whether or not it is a possible breast cancer. Following
a mammogram, the results are sent to the individual within 28 days. Less than
1 per cent of women who are screened actually have breast cancer. For those who
are diagnosed with breast cancer, the options are to be referred to a clinic specialising
in breast cancer treatment or to return to their general practitioner who will then
refer them on to a specialist.
Early detection significantly increases a woman’s chance of survival. In 2008,
BreastScreen Australia detected 4289 invasive breast cancers. Mortality has declined
from 66.7 deaths per 100 000 women aged 50–69 in 1989 to 47.0 deaths per
100 000 women aged 50–69 in 2007.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 385
11.1 2 Physical environment determinants: neighbourhood safety and access to health care
Case study
KEY CONCEPT The impact of the media, level of education, employment status
and income on the health and individual human development of adults
In the adulthood stage of the lifespan, the social determinants include factors such
as the media, living arrangements, level of education, employment status and
income, community belonging, social support, family and work–life balance. It
is during the adulthood stage of the lifespan that individuals take on the role of
parenting and employment becomes a significant factor in adults’ lives. The level
of education that a person achieves often determines their type of employment
and therefore their level of income. Level of income is a predictor for health status
because those on higher incomes tend to have better health than those on lower
incomes. As working life takes on greater significance in adulthood, so does the
capacity to maintain work–life balance. Many families experience changes to
their living arrangements that can impact on the health and individual human
development of all family members.
The media
The media has a huge impact on how adults see the world — on
their socialisation, development, opinions, values and knowledge.
Many of the effects of the media are obvious but others are so subtle
that adults do not even realise that they have been influenced.
The media takes many forms. It includes the internet, newspapers,
magazines, television, radio, books, video games, CDs and tapes,
billboards, posters, text messages, movies and videos. All forms of
media have the potential to influence the actions, beliefs, values,
opinions and ideas of adults. Figure 11.51 Our world is filled with information
and images that provide us with knowledge and
The impact of the media entertainment.
The effects of the media on the health and individual human development of adults
are listed below.
• The internet is a powerful form of media and adults can often spend hours in
front of a computer each day, socialising, reading, playing games and creating
content. The internet now provides many ways for people to access other forms of
media, such as newspapers, radio, movies and music. All these pursuits can have a
positive effect on individual human development by enhancing intellectual skills
and providing opportunities for meeting and communicating with new people.
• Unlike other forms of media, the internet allows adults to easily and cheaply
create content and become producers of media rather than just being consumers.
Profiles on social networking sites have allowed people to make connections and
form relationships, improving their social and mental health. On the internet
people can create blogs, twitter, upload videos and audios and interact in
exciting and creative ways.
• The internet is not a controlled environment so there is a lot of freedom.
However, this also means that it contains unedited or unreliable information,
alternative and possibly dangerous views, abusive content and opportunities for
predators to access people they can abuse. These drawbacks can detrimentally
affect mental health if precautions are not taken.
• The internet allows adults to self-diagnose health problems. This can be positive
if it encourages people to see a doctor for a symptom they might otherwise have
dismissed, but it can be dangerous when advice that contravenes mainstream
medical practice is provided by people without any medical training. It is
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 387
11.1 3 Social determinants: the media, level of education, employment status and income
important that adults seek reputable medical advice if there are concerns about
health.
• The media has allowed health messages to reach a great proportion of the
public. Most health promotion strategies incorporate some form of media
campaign. Also, studies have shown that if information about a particular health
issue is embedded into a television drama, awareness and understanding of that
health issue in the community improves significantly. This has great potential
for targeting various groups in the community who watch particular television
shows. Messages about infectious diseases, cancer, diabetes management,
sexually transmissible infections, mental health issues and access to health
care can all be successfully embedded into storylines and provide viewers with
valuable information. Health improves when people are provided with reliable
information in an easy-to-understand format.
• Newspapers provide information on a daily basis and allow individuals to keep
up with local community, national or world news for work or entertainment.
Newspapers are privately run and owners may have their own viewpoints that
they wish to get across to readers. Regular features such as crosswords and
other thinking games and quizzes may help keep the mind active and improve
intellectual development. Social health and development may be improved when
workmates share and discuss information they have read in the newspaper.
• Magazines are another form of media that can have an impact on health and
individual human development. They range from informative and factual,
to glamour and fashion magazines. Reading magazines can be a form of
entertainment for most adults. Some magazines, however, can set up unrealistic
goals of how people ‘should’ be and can influence how individuals view
themselves. This impacts on their self esteem and self-concept.
• Listening to the radio can also affect an individual’s health and individual
human development. Music can affect an adult’s mood and thus impact on
their emotional development and mental health. Listening to talkback radio can
keep an individual informed of the opinions of a community and allow them to
share their opinion with someone who is willing to listen. This form of media
is particularly important in influencing the social and mental health of those in
middle and later adulthood.
Table 11.9 Highest post-school qualification of persons aged 15–64, 1998–2008 (per cent)
Qualification 1998 2000 2002 2004 2006 2008
Table 11.10 Prevalence of selected health measures by socioeconomic status, 2007–08 (per cent)
Characteristics Highest SES:5 4 3 2 Lowest SES:1
Adults from low socioeconomic backgrounds visit the doctor and hospital
outpatient and accident and emergency departments more frequently than
adults from higher socioeconomic backgrounds, but they are less likely to access
preventative health services. Socioeconomically disadvantaged adults are more likely
to die sooner after serious illness than adults who are socioeconomically advantaged.
Adults who are educated tend to have a higher level of health literacy. Health
literacy involves knowing what is good quality advice in regards to health, how
and where to seek further health-related information when required, and how to
translate relevant information into action. An adult with a higher level of health
literacy will find it easier to manage their health. Low levels of health literacy means
an adult will not be able to manage their health as effectively. The 2006 Adult
Literacy and Life Skills Survey, conducted by the Australian Bureau of Statistics,
found that people living in higher socioeconomic status areas were more likely
to have a higher level of health literacy than those in lower socioeconomic areas
(figure 11.52). Approximately 26 per cent of people from the lowest socioeconomic
areas had an adequate level of health literacy or above, compared with 55 per cent of
people from households in the highest socioeconomic areas (Australia’s health 2010).
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 389
11.1 3 Social determinants: the media, level of education, employment status and income
100
High
80 Adequate
Low
Very low
60
Per cent
40
20
The workplace
The workplace in which an adult is employed is an important social determinant of
health. The working relationship that an adult has with colleagues has a significant
impact on their health and individual human development.
One of the issues that can have a negative effect on adults is conflict. Workplace
conflict can arise for a variety of reasons. It may occur when people’s ideas, decisions
or actions are not readily accepted by all employees, or when people simply do not
get along on a personal level. Conflict related to the implementation of new ideas
and decisions can be productive because it generates worthwhile discussion and
debate that may assist the business in making positive changes or improving work
practices. However, a clash of personalities can make the workplace an unpleasant
environment. Conflict with bosses can make it very difficult for the employee and
Figure 11.53 The workplace can be a
lead to work-related stress. According to a report completed by Safe Work Australia source of considerable stress.
in 2012, depression costs Australian employers approximately $8 billion per year
as a result of absence due to sickness and presenteeism, with $693 million of this
figure due to job strain and bullying. Presenteeism is the loss of productivity that
results from employees coming to work but, as a consequence of illness or other
conditions, not functioning at full capacity. Absenteeism occurs when employees
do not come to work at all (Safework Australia).
Many other factors in the workplace may cause work-related stress including:
• long working hours
• heavy workloads
• changes within the organisation
• tight deadlines
• lack of job security
• boredom
• harassment/bullying
• discrimination
• lack of autonomy and being over-supervised.
Work-related stress affects the health of an adult in a variety of ways including:
• depression
• anxiety
• feelings of being overwhelmed and unable to cope
• sleeping difficulties
• fatigue
• headaches
• heart palpitations
• gastrointestinal upsets such as diarrhoea or constipation
• increased risk of cardiovascular disease.
Conditions such as depression can result in the adult not consuming an
adequate dietary intake. This can impact significantly on their individual human
development because a lack of nutrients required for the maintenance of body
tissues can result in more rapid deterioration. For example, a lack of calcium in the
form of dairy products means that the calcium that is being leached from bones is
not replaced. This increases the risk of osteoporosis. Feeling depressed may also
result in the adult not being involved in social activities or disengaging from others.
As an adult’s social and emotional development is dependent on relationships with
others, not interacting with family, friends or work colleagues means that the adult
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 391
11.1 4 Social determinants: the workplace and community belonging
does not have the opportunities for maintaining or further developing social skills
or the capacity to understand and control emotions, which in turn impacts their
social and emotional development.
Case study
Overwork, mental stress The Safe Work Australia study revealed that when
‘body stressing’ and ‘mental stress’ are combined,
costs $30 billion they make up half of the cost of job-related injury and
illness.
The cost of workplace illness among managers
and administrators was $9.6 billion a year, injuries to
labourers $7.9 billion and to tradespeople, $10.6 billion.
The report showed the cost of workplace death and
injury was now worth about 5 per cent of Australia’s
total economic output.
The report coincides with labour force statistics that
showed Australians were working millions of hours
more since the GFC.
While the data did not draw a direct link between
longer hours and illness and injury, the Safe Work
FIGURE 11.54 Overworked and stressed employees
cost Australia $30 billion a year, and the total bill report said: ‘Over one-third of the total number of
of workplace injuries, sickness and fatalities is more cases and total economic cost are associated with body
than $60 billion. stressing or manual-handling cases.
OVERWORK and stress costs Australia more than ‘Mechanisms more associated with disease, such
$30 billion a year, half the total workplace injury bill. as sound and pressure, biological factors and mental
Physical and psychological stress has outstripped stress, have a higher unit cost than those associated
other forms of injury and illness and the long-term with injuries (such as falls and trips).
cost in lost productivity and compensation is worn by ‘While mental stress cases comprise 4 per cent of the
workers and the community. cases, they contribute 9 per cent of the total cost.’
A comprehensive study of workplace fatalities, Research by talent management firm SHL found just
injuries and illness put the cost at $60.6 billion a year. 29 per cent of workers with a good manager take days
The report found that, while the number of workplace off when they are not sick, compared with 35 per cent
fatalities fell in 2009–10 during the global financial crisis who rate their manager’s performance as below par.
to a record low of 216, signs were increasing again. One-third of employees say having too much
This week, Workplace Relations Minister Bill responsibility or ‘burnout’ is a reason for them to take
Shorten will announce a campaign to encourage sick leave when they are not ill. It topped the list of
workers to speak up about safety, and call for annual reasons to take a sick day.
reporting to Parliament. Source: The Advertiser, 13 March 2012.
Community belonging
The degree of connectedness or belonging that an adult feels to their community
is determined by their level of engagement in community-based activities. These
activities enable adults to interact with other people from a diverse range of
backgrounds. Some of the activities may be done purely for the benefits they bring
to the individual (e.g. playing in a sporting team), whereas others may be done
for the benefits that they bring to others (e.g. a human rights group). Many adults
develop a sense of community belonging through becoming volunteers.
Social connections
The term ‘social capital’ is often used in relation to community belonging as it
refers to the connections between groups and individuals within society. Social
capital includes the level of cooperation, trust and goodwill that is formed between
people, organisations, neighbourhoods and levels of government. Social capital is
important for developing a sense of community wellbeing. Communities that have
limited social capital may exhibit the following:
• lack of support and networks for family, friends or community
• lack of participation in paid work or volunteering
• lack of involvement in local or broader decision making in the community.
Figure 11.55 Volunteering for community groups provides adults with a sense of community
belonging through making a positive contribution to society.
Research has shown that people who feel a sense of community belonging have
better self-reported health. A 2008 Canadian study, ‘Community belonging and
self-perceived health’, found that almost two-thirds of people who felt a strong or
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 393
11.1 4 Social determinants: the workplace and community belonging
Volunteering
Volunteering is an important aspect in the lives of many adults. In 2010, 38 per cent
of women and 34 per cent of men aged over 18 years were volunteers. Adult males
aged 55–64 years and adult females aged 35–44 and 45–54 years in 2010 were
most likely to volunteer (see figure 11.56)
50
Males
Females
40
30
Per cent
20
10
0
18–24 25–34 35–44 45–54 55–64 65–74 75–84 85+
Age group (years)
Volunteering has significant benefits for the health and individual human
development of adults. Research has established a strong link between volunteering
and health. Those who volunteer have lower mortality rates, greater functional
ability, lower rates of depression and longer life expectancy than those who do not
volunteer. In particular, volunteering tends to provide greater health benefits to
adults over the age of 60 than to younger volunteers. Volunteering has a positive
impact on the social and mental health of an adult as it provides opportunities for
developing a sense of purpose and accomplishment and enables social networks
to be developed. For adults with chronic or serious illness, volunteering has
significant health benefits. Reductions in pain intensity and decreased levels of
disability were seen in adults who began to serve as volunteers for others suffering
from chronic pain.
These health benefits have a positive influence on the individual human
development of an adult. Having greater functional ability means that the older
adult is more likely to participate in physical activity, thereby maintaining (or
slowing the deterioration of ) body tissues such as muscles and bones. Participation
in regular physical activity also assists in the maintenance of motor skills. Through
interacting with others, the adult is able to maintain or further develop the capacity
to socialise with people from a diverse range of backgrounds. For some volunteers,
situations may arise in which they are required to extend themselves beyond
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 395
11.15 S ocial determinants: living arrangements and
social support
KEY CONCEPT The impact of living arrangements and social support on the
health and individual human development of adults
Living arrangements
Living arrangements refer not only to the type of accommodation that an adult lives
in but also to the number of people living together and the relationships between
them. The living arrangements of adults depend on family composition and lifespan
stage. For instance, young adults may still live at home with their parents because
high costs — of accommodation and/or university — combined with a limited
income may make living with their parents more financially attractive. Their parents
may be prepared to financially support them if they remain at home, and not having
to pay for rent and other essentials can leave young adults with
greater disposable income to spend on the things they enjoy.
Approximately 665,000 people aged 25 years or over lived with
one or both parents in 2009–10 (AIHW, 2011).
Living with parents can have both positive and negative effects
on the health and individual human development of young
adults. For instance, young adults living at home are more
likely to eat nutritious food prepared by their parents rather
than buying convenient or packaged meals that are high in
saturated fat, salt and sugar. As a result, their risk of developing
diet-related diseases is decreased while the consumption of the
required nutrients promotes the growth and maintenance of
the body’s tissues. However, living at home may create a sense
of dependence on their parents, which reduces opportunities
for them to develop the skills required to live as independent
adults.
For the parents, having adult children living at home can
increase financial stress due to the cost of providing for their
needs. Having to care for adult children may impact on the
mental health of parents if there is conflict with the children.
On the other hand, the emotional support that some parents
may gain from having their adult children at home can enhance
the parents’ social and mental health and individual human
development.
Research indicates that living arrangements can have a
significant impact on the mortality rates of adults. Being single
is associated with higher mortality than being married or living
in a de facto relationship. Living with a partner may have a
protective effect for many reasons, including having greater
disposable income for material resources (e.g. to buy safer cars),
Figure 11.57 There are a range of living the social support provided by a partner and the positive impact
arrangements available to adults in the late that partners may have on health behaviours (e.g. physical
adulthood stage of the lifespan.
activity levels).
396
UNIT 2 • Individual human development and health issues
Table 11.11 Living arrangements available to elderly people
Living arrangement Explanation Benefits to health and individual human development
Staying at home with For some elderly people, staying at home Enables the elderly person to remain in an environment in which they feel
the assistance of requires extra assistance. ‘Home help’ or local comfortable and familiar. Additional services can assist in meeting the
community services community services can assist with housework, hygiene, health, nutritional, physical activity, social and emotional needs
meals, personal care and social outings. of the elderly person.
High-level care This caters for elderly people who require The health of the elderly person is monitored and appropriate treatments
homes 24-hour nursing care due to immobility or and care are provided.
conditions such as dementia.
Low-level care homes This caters for elderly people who may require Enables the elderly person to maintain some independence while being
some assistance with tasks such as dressing, provided with assistance to perform tasks they find difficult. Staff can monitor
eating and bathing, cleaning, laundry and day-to-day activities such as the taking of medications, physical activity and
meals. nutrition. Provides opportunities for social interaction with others.
Independent living Residential communities that offer a range of Enables the elderly person to live independently in a community of people
units (retirement services for independent elderly people. of similar ages. Socialisation and social support are important aspects of
villages) this type of living arrangement. Organised activities provide the elderly
person with opportunities for physical activity, social interaction and the
development of skills and knowledge.
Social support
Social support refers to the connections that an adult has
with individuals and groups, including family, friends, work
colleagues and other members of their community. These
individuals and groups make up the social network of the
person and provide support in a variety of forms such as the
provision of information, practical assistance and emotional and
financial help.
A study conducted in 2010 found that 97 per cent of
Australians aged 18 or over reported having face-to-face contact
with family and friends outside of the household in the previous
week (ABS, 2010). Table 11.12 shows the sources of support
during times of crisis for adults aged 18 years and over. This data indicates that Figure 11.58 The relationships
adults are more likely to seek help from informal sources such as family members that an adult has with others has
and friends rather than formal support services such as a psychologist. an impact on health and individual
human development.
Table 11.12 Sources of support in times of crisis, by age and sex
Proportion (%) of age Proportion (%) of sex
Sources of support 18–24 25–34 35–44 45–54 55–64 65–74 75–84 85 years All
In times of crisis (a) years years years years years years years or over Males Females persons
Friend 77.9 71.1 66.5 64.9 59.1 52.7 34.4 31.1 64.3 63.3 63.8
Neighbour 17.6 17.0 29.7 34.3 32.1 31.2 30.4 34.8 26.8 27.6 27.2
Family member 76.8 80.5 81.3 76.0 79.8 80.0 86.0 73.4 77.9 80.9 79.4
Work colleague 23.3 27.0 23.4 24.3 18.1 *3.1 np np 21.4 18.3 19.8
Community, charity or 7.4 7.6 11.1 11.3 11.5 11.2 *6.6 *6.9 8.5 10.9 9.8
religious organisation
Local council or other *3.3 3.7 5.5 5.9 6.6 5.7 *4.1 **5.0 4.6 5.5 5.1
government services
Health, legal or 5.2 8.0 9.3 9.6 9.1 8.6 5.3 **12.5 7.4 9.2 8.3
financial professional
Other sources *1.2 *0.4 *0.8 *0.9 *0.4 **0.2 np np 0.9 *0.3 0.6
(a) Categories are not mutually exclusive.
* estimate has a relative standard error of 25% to 50% and should be used with caution.
** estimate has a standard error greater than 50% and is considered too unreliable for general use.
np not available for publication but included in totals where applicable, unless otherwise indicated.
Source: Australian Bureau of Statistics.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 397
11.1 5 Social determinants: living arrangements and social support
TEST your knowledge 6 Mary is 75 years old and still lives in the family
home. Her children have noticed that she is
1 Explain what is meant by the term ‘living
becoming forgetful and they are concerned about
arrangements’.
her ability to care for herself. Physically, Mary is able
2 What are some of the reasons for the lower
to move around with relative ease but she has had a
mortality rates of adults living with a partner?
couple of minor falls that have resulted in significant
3 Outline the benefits of the four types of living
bruising. Mary’s children worry about her capacity
arrangements for the aged.
to look after herself.
4 Define the term ‘social support’. What are the
(a) Outline the possible living arrangements
benefits to the adult of social support?
available to Mary at her stage of the lifespan.
APPLY your knowledge (b) Select a living arrangement that is appropriate
for Mary and justify your choice based on the
5 Write a response based on the following statement: information provided.
‘The connections that an adult has with others
are important for promoting health and individual
human development.’
KEY CONCEPT The impact of family and work–life balance on the health
and individual human development of adults
Family
Family compositions over the last few decades have changed significantly and this
has resulted in a variety of living arrangements for families. It has also caused
much debate over the definition of a family. According to the Australian Bureau of
Statistics (ABS), ‘A family is two or more persons, one of whom is at least 15 years
of age, who are related by blood, marriage (registered or de facto), adoption, step
or fostering, and who are usually resident in the same household’.
Contemporary society is made up of a range of family types. The ABS has
categorised families into the following:
Divorce Careers
Increasing costs
Contraception
of living
Factors
impacting on
family
composition
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 399
11.1 6 Social determinants: family and work–life balance
400
UNIT 2 • Individual human development and health issues
Figure 11.63 Work–life balance is important for the health and individual human
development of adults.
The inability to effectively balance work and family life impacts on the health
and individual human development of adults. Work-related stress can occur for
a range of reasons. One of these reasons is pressure from the demands of the job
in terms of amount of hours worked or level of responsibility. Extended working
hours impacts significantly on the individual’s capacity to meet the needs of their
family and to pursue recreational/leisure activities. Symptoms of work-related
stress include:
• depression
• anxiety
• feelings of not being able to cope eLesson:
The misery of long hours
• reduced work performance
Searchlight ID: eles-0229
• sleeping difficulties
• reduced ability to concentrate
• fatigue
• headaches
• heart palpitations
• gastrointestinal problems such as diarrhoea
• increased aggression.
Work-related stress can result in a deterioration of personal relationships and, in
the long term, can increase the risk of cardiovascular disease.
Over the past two decades there has been a significant increase in the number
of hours worked by full-time employees, and more children are growing up in
families in which both parents work. Another factor that is contributing to the
difficulty of achieving work–life balance is the fact that people are spending more
time commuting to work. Information and communication technology allows
work to intrude on family life via mobile phones and email. The Relationships
Indicator Survey conducted by Relationships Australia in 2008 found that at least
50 per cent of respondents had indicated work pressure and a lack of time to
spend with their partner as key factors that could impact negatively upon partner
relationships.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 401
11.1 6 Social determinants: family and work–life balance
Many adults are in the situation of simultaneously caring for children and
ageing parents. This may cause increased stress as they take on the additional
responsibilities of ensuring that the health and individual human development
Weblink: needs of their parents are being met. Nutrition, physical activity, social interaction,
Australians unhappy with
health care, housing and transport are examples of factors that need to be
work–life balance?
considered when caring for ageing parents.
Case study
TEST your knowledge and often works late in the evening and on
weekends. Maria works one day a week in the
1 What is the ABS definition of ‘family’?
local supermarket and tends to spend a lot of
2 What factors have impacted on the changing
time driving the children to their sports and music
composition of families?
lessons, as well as their part-time jobs.
3 Outline the advantages and disadvantages of each (a) What type of family is represented in this
type of family. case study?
4 Explain what is meant by ‘work–life balance’. (b) In what ways can this particular family
5 What are the symptoms of work-related stress? composition impact on the health and individual
human development of George and Maria?
APPLY your knowledge (c) Explain the possible impacts that George’s
6 George and Maria are both in their mid-40s and working life may have on his and Maria’s health
have been married for 15 years. They have two and individual human development.
teenage children, Sarah and Michael, who both 7 Choose one family type and explain how it can
attend the local secondary college. George is impact on the health and individual human
a successful businessman for a large company development of family members.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 403
KEY SKILLS The determinants of health and individual human
development of Australia’s adults
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 405
Key skills The determinants of health and individual human development of Australia’s adults
(a) Outline one determinant of the health and individual human development
that might account for the difference between male and female rates of
hypertension.
2 marks
(b) Explain how cholesterol levels contribute to stroke.
1 mark
(c) Explain how two behavioural determinants of health and individual human
development contribute to one of the conditions listed in the table.
2 marks
(d) Explain, with reference to specific nutrients, the role of nutrition as a risk factor for
coronary heart disease.
2 marks
7 Refer to table 11.15 to help answer the following questions.
Table 11.15 Selected health risk and protective factors, people aged 25–64 years, 2007–08
Risk and protective factor Males % Females % Total %
(a) Explain the relationship between food intake, exercise and overweight/obesity.
2 marks
(b) Select five risk factors from the table and describe one disease related to each risk
factor.
5 marks
(c) Provide two reasons why it is important for the health and individual human
development of an adult to enjoy a wide variety of nutritious foods.
2 marks
8 ‘Many studies show that people or groups who are socially and economically
disadvantaged have reduced life expectancy, premature mortality, increased
disease incidence and prevalence, increased biological and behavioural risk factors
for ill-health, and lower overall health status’ (Australian Institute of Health and
Welfare 2008, Australia’s health 2008, cat. no. AUS 99, Canberra, p. 65).
(a) Explain the term ‘socioeconomic status’.
1 mark
(b) Explain the relationship between education, employment and income.
3 marks
(c) Explain one behavioural and one biological determinant of health and individual
human development that puts individuals from lower socioeconomic status
backgrounds at greater risk of ill-health.
2 marks
(d) Explain two diseases/conditions that individuals from lower socioeconomic status
backgrounds are at greater risk of developing.
2 marks
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 407
CHAPTER 11 review
Chapter summary
• Biological factors refer to those genetic and physiological factors that impact on health
and individual human development.
• Two examples of genetic conditions that impact on adults are Alzheimer’s disease and
Huntington’s disease.
• Genetic predisposition can be a significant risk factor in the development of diseases
such as cancer and type 2 diabetes.
• The body weight of adults is largely determined by the combination of genes that are
inherited from the biological parents as well as lifestyle and behaviours such as physical
activity levels and food intake.
• Overweight and obesity significantly increase the risk of a range of illnesses and
conditions, such as type 2 diabetes, cardiovascular disease and stroke.
• Blood pressure measures the force of the blood on the walls of the arteries and is
recorded as systolic and diastolic measurements.
• High blood pressure is a major risk factor for coronary heart disease, stroke, heart
failure and kidney failure.
• High blood pressure becomes more common with age due to the arteries becoming
more rigid.
• Coronary heart disease is characterised by a narrowing of the coronary arteries that
supply the heart muscle with blood.
• Atherosclerosis is the build-up of fatty deposits or ‘plaque’ on the arterial walls.
• There are many risk factors for coronary heart disease including genetics and
health behaviours such as tobacco smoking, poor dietary intake and lack of
physical activity.
• During a stroke, blood flow is interrupted to an area of the brain. This may be due to a
blood clot blocking the artery or a blood vessel breaking.
• A transient ischaemic attack is a ‘mini stroke’ that can be a warning sign for a more
severe stroke.
• Some of the risk factors of stroke — such as age, gender and family history — cannot
be controlled. However, there are risk factors that can be addressed to reduce the risk
of stroke. These include smoking, dietary intake, cholesterol levels, blood pressure,
alcohol consumption and body weight.
• Cholesterol is a type of fat that has a range of functions within the human body. It
produces hormones, assists with digestion through the production of bile acids, and is
an essential component of cell membranes.
• Low-density lipoprotein (LDL) cholesterol is referred to as ‘bad’ cholesterol as it
contributes to atherosclerosis.
• High-density lipoprotein cholesterol (HDL) is referred to as ‘good’ cholesterol because it
can help unclog arteries.
• Polyunsaturated fats are sources of omega-3 and omega-6 fatty acids.
• Trans fatty acids can raise the level of LDL cholesterol.
• High cholesterol levels can also be an inherited condition.
• In Australia, the risk of skin cancer as a result of too much sun exposure needs to be
balanced with the need to maintain adequate vitamin D levels.
• There are three types of skin cancer: squamous cell carcinoma, basal cell carcinoma and
melanoma. Melanoma is the most dangerous form of skin cancer.
• Tobacco smoking is the single most preventable cause of ill-health and death in the
Australian population.
• Tobacco smoking is a major risk factor for a range of illnesses including cancer,
cardiovascular disease and stroke.
• The most common form of cancer that is caused by smoking is lung cancer.
The determinants of health and individual human development of Australia’s adults • CHAPTER 11 409
Chapter 11 review
KEY SKILLS
• describe a specific health issue facing Australia’s adults and draw
informed conclusions about personal, community and government
strategies and programs to optimise adult health and development.
Obesity
Mental Cardiovascular
Illness disease
Health issues
affecting
adults
Type 2
Cancer
diabetes
80
70
60
50
Males
Per cent
40 Females
30
20
10
Figure 12.4 Proportion of adults
(aged 18 and over) who were
0
overweight or obese, 1995 to 2011–12
1995 1997 1999 2001 2003 2005 2007 2009 2011–12
Source: ABS, Australian Health Survey, First Results,
Year 2011–12, p. 25.
Behavioural
Behavioural factors that increase the risk of obesity include:
• Lack of physical activity. Less energy is expended or burned in
those who are not physically active, which increases the risk of
weight gain.
• Alcohol consumption. Alcohol contains kilojoules and therefore
energy, which means it can increase the chances of an individual
gaining weight (figure 12.5).
• Food intake. Foods containing large amounts of fat and simple
carbohydrates such as sugar contribute significant kilojoules to
the body. Over time, if this energy is not expended then weight Figure 12.5 Alcohol consumption is
gain can occur. a significant risk factor for obesity.
Physical environment
The physical environment can contribute to obesity in a number of ways as a
result of:
• Access to recreation facilities. If individuals do not have access to recreation
facilities such as cycling and walking paths, they may not have the same
opportunities for physical activity as others. This can increase body weight and
contribute to obesity.
• The work environment. A work environment that does not foster incidental
exercise can increase the risk of obesity. For example, a work environment that
has car parking next to the entrance, no stairs and a small office space can reduce
the level of incidental physical activity and contribute to weight gain.
Social
Some of the social determinants that have a relationship with obesity include:
• Education. Those with lower levels of education are more likely to be obese.
This could be a result of lower levels of knowledge relating to the importance of
physical activity and food intake.
• Occupation. People who are active as part of their job expend more energy in
their day than people who work in more passive occupations or spend prolonged
periods sitting.
• Income. People who can’t afford or can’t access a healthy food supply may rely
on processed food, which tends to be higher in fat and sugar and lower in fibre,
therefore adding kilojoules to the diet.
Cardiovascular disease relates to all diseases of the heart and blood vessels.
Examples include hypertension (sometimes referred to as high blood pressure),
coronary heart disease, stroke, heart failure and peripheral vascular disease (which
affects the extremities, particularly the legs and feet).
Cardiovascular disease is characterised by an inability of the heart to pump
blood effectively to all tissues in the body. The cause may be in the heart itself, or
the blood vessels carrying the blood. Without an adequate blood supply, cells and
tissues cannot function normally and may die. If blood vessels become completely
blocked, major organs including the brain and heart may be permanently damaged,
which may lead to death. Even if blood flow is restored, permanent damage may
have already occurred.
Stroke
Peripheral vascular
disease
substances, human tissue and calcium. Cholesterol is a waxy substance and acts
like glue to hold the other materials against the artery wall. Over time, the plaque
becomes thicker, which results in an overall narrowing of the artery. This restricts
blood flow, and therefore oxygen supply, to various parts of the body (depending
on where the build-up is occurring, see figure 12.7). This puts strain on the heart
and the organs or muscles that the blood is being pumped to.
Normal Artery
artery with
plaque
Normal Restricted
blood flow blood flow
30
28 Males
26 Females
24
22
20
18
Per cent
16
14
12
10
8
6
Figure 12.8 Proportion of 4
persons with cardiovascular 2
disease, 2011–12 0
Source: ABS, Australian Health 15–24 25–34 35–44 45–54 55–64 65–74 75+
Survey, First Results, 2011–12,
p. 20.
Age group (years)
418
UNIT 2 • Individual human development and health issues
• High blood pressure, which is an indicator that the heart is already working
harder to pump the blood, and can increase the risk of heart attack and stroke
• High blood cholesterol, which increases the risk of plaque building up on artery
walls (atherosclerosis), making it harder for the blood to get through
• Genetic predisposition. Having family members (particularly in the immediate
family) with cardiovascular disease increases the individual’s risk of cardiovascular
disease.
• Being male. Men carry more fat around the abdomen, which places them at
increased risk of cardiovascular disease.
• Advancing age. Metabolism slows as people age, making weight management
more difficult. The heart also loses its efficiency with age, contributing to
cardiovascular disease.
Behavioural
Behavioural determinants that play a role in the development of cardiovascular
disease include:
• Physical activity. Lack of physical activity means less energy is used and this
increases the risk of weight gain, a risk factor for cardiovascular disease. Regular
physical activity also acts to exercise the heart muscle and maintain the flexibility
of the blood vessels. As a result, being physically inactive can speed up the
hardening process and contribute to cardiovascular disease.
• Food intake. Food intake is one of the most significant factors in the development
of cardiovascular disease. Food intake can contribute to cardiovascular disease in
numerous ways. For example:
–– foods that contain saturated or trans fat increase the levels of low density
lipoprotein (LDL) cholesterol, the ‘bad cholesterol’. LDL cholesterol can stick
to the blood vessel walls and contribute to atherosclerosis and cardiovascular
disease.
–– a diet low in fibre can increase cholesterol levels in the body and contribute to
overeating. If an individual overeats over a period of time, the risk of weight
gain and cardiovascular disease increase.
• Smoking. Smoking tobacco and other drugs speeds up the process of atherosclerosis
and therefore contributes to cardiovascular disease. Smoking increases the risk of
cardiovascular disease by up to six times that of a non-smoker.
• Alcohol use. Alcohol contributes extra kilojoules to the diet and can lead to
obesity and cardiovascular disease.
Physical environment
Factors within the physical environment can act to increase or decrease the risk of
cardiovascular disease. Examples include:
• Access to recreation facilities. Being able to access recreation facilities such as
walking and cycling paths, parks, beaches and gymnasiums can increase the
ability to exercise. With adequate exercise, the risk of obesity and cardiovascular
disease decrease.
• Proximity to health care. Being able to readily access health care may lead to
issues such as hypertension being diagnosed and interventions put in place to
reduce the risk of cardiovascular disease.
• Exposure to environmental tobacco smoke. Being exposed to environmental
tobacco smoke can contribute to atherosclerosis and increase the risk of
cardiovascular disease.
Social
A range of social determinants play a role in the development of cardiovascular
disease. Examples include:
• Education. Those who are adequately educated with regards to food intake,
the dangers of smoking and the benefits of regular physical activity are more
likely to adopt healthy behaviours and are at a decreased risk of weight gain and
cardiovascular disease.
• Income. Those with low incomes may not be able to afford nutritious foods which
can increase the dependence on processed foods that may be high in fat. This
can increase energy intake and contribute to obesity and cardiovascular disease.
• Work. If an individual is experiencing workplace stress, they are more likely to
experience hypertension which increases the risk of cardiovascular disease.
• Occupation. Occupations where individuals spend extended periods of time
sitting, such as office work, can reduce levels of physical activity and contribute
to obesity and cardiovascular disease.
14
Males
12 Females
10
8
Per cent
2
Figure 12.10 Proportion of persons
0 with cancer, 2011–12
0–14 15–24 25–34 35–44 45–54 55–64 65–74 75+ Source: ABS, Australian Health Survey, First
Age group (years) Results, 2011-12, p.18.
Biological
• Obesity. The exact link between obesity and cancer is not completely
understood but those with excessive body weight experience higher
rates of certain cancers, including breast cancer and colorectal
cancer.
• Age. Advancing age is a risk factor for many types of cancer
including prostate, breast and colorectal cancer.
• Genetic predisposition. Some people are more likely to develop
cancer than others. The genetic influence seems to be particularly
important for certain cancers, such as breast cancer and prostate
cancer.
Behavioural
Behavioural factors that play a role in the development of cancer
include:
• Tobacco smoking. Tobacco smoke contains thousands of
chemicals and many of these have been shown to cause cancer
(see figure 12.12). Tobacco smoking can contribute to cancer
in almost all parts of the body especially the lung, mouth and
oesophagus.
• Alcohol consumption. Alcohol can contribute to certain cancers,
such as breast cancer.
• A low fibre diet may increase the chances of colorectal cancer. Fruit and
vegetables are rich in nutrients, which may also play a protective
role in colorectal cancer.
Figure 12.11 Sun protection • Sun protection. Exposure to sunlight and UV radiation increases the
measures such as using sunscreen can
reduce the risk of skin cancer.
chances of developing skin cancer. Adults who do not practise sun
safety are at an increased risk (figure 12.11).
Physical environment
Aspects of the physical environment that play a role in cancer
include:
• Environmental tobacco smoke. Second-hand smoke can have
similar effects as smoking tobacco and increases the risk of many
types of cancer (figure 12.12).
• Workplace safety. Individuals who spend prolonged time outdoors as
a part of their job may have increased exposure to UV radiation and
an increased risk of skin cancer. Exposure to hazardous substances
in the workplace can also increase the risk of cancers such as lung
cancer.
• Access to health care. Access to health care does not prevent the
development of cancer. However, the rate of successfully treating
cancers is higher if they are detected early (see case study).
Social determinants
Education and income both have an indirect relationship with cancer.
Those with lower levels of education relating to tobacco use, the
importance of maintaining a healthy body weight and consuming fruit
and vegetables are at an increased risk of developing some types of
cancer. Those on low incomes may not be able to afford nutritious
Figure 12.12 Individuals exposed
foods and may rely on processed foods that are high in fat. This can
to environmental tobacco smoke increase body weight and the risk of developing breast and colorectal
experience an increased risk of cancer. cancer.
Smokers scan call Cancer Council Victoria said 13 per cent of people
with lung cancer survived five years.
Health experts are calling for screening of smokers for ‘Unfortunately, the survival rates haven’t dramatically
lung cancer, much the same way women are screened improved because many lung cancer patients still
for breast cancer. present with advanced disease,’ Prof Ball said.
They want Australia to investigate the health and ‘It is already incurable.’
economic benefits of screening smokers for lung He said the challenge was to detect the disease at an
cancer, our biggest cancer killer. earlier stage through screening.
Five Victorians die from lung cancer a day. Prof Ball said screening with chest x-rays had been
Investigations are underway to see if screening
found to be ineffective.
current and former smokers can cut the toll.
But CAT scanning in people who had been smokers
Chairman of the Peter MacCallum Cancer Centre’s
showed there was ‘a survival benefit if patients are
Lung Service, Prof David Ball, said the key to better
survival rates for lung cancer was earlier detection. regularly screened’.
Prof Ball said a North American study, which ‘But we do not know how relevant the US results are
investigated CAT scan screening of smokers for lung to the Australian population,’ Prof Ball added.
cancer, revealed a reduction in deaths. He said screening might be beneficial but that, if it
‘The question is how much does that cost and how was, the next question was whether such a screening
many patients would have to be screened to produce program was affordable.
benefits in, say, one individual?’ he asked. Source: Sunday Herald Sun, 19 February 2012.
TEST your knowledge 5 Make a short video that could be used to educate
adults with regards to cancer and determinants that
1 Explain cancer.
act as risk and/or protective factors.
2 Discuss why cancer is a health issue for adults
6 Use the Cancer link in your eBookPLUS to find the
in Australia.
link to this question.
APPLY your knowledge Watch the animation on cancer.
(a) Explain what a tumour is.
3 Explain the trends evident in figure 12.10. (b) How do the cancerous cells obtain oxygen and
4 Explain how access to health care can promote the nutrients?
health of adults with cancer. (c) What is the metastatic stage?
4. Glucose can’t
2. Glucose enters
Type 2 diabetes is a disease characterised
enter the body by an inability of the body to utilise
the bloodstream.
effectively.
blood glucose for energy.
Glucose is the most basic form
of carbohydrate and is released into
the blood stream after eating foods
containing carbohydrate. As blood
glucose levels rise, a hormone called
insulin is released by the pancreas to
assist cells in absorbing the glucose.
Glucose molecules are then used for
energy which assists the cells in carrying
3. The pancreas
produces enough out their normal functions.
insulin, but it can’t 1. Food is converted For those with type 2 diabetes, either
be used effectively. to glucose in the too little insulin is produced, or the
5. Glucose levels in stomach.
the bloodstream insulin that is produced is ineffective.
increase. If type 2 diabetes is unmanaged, the
glucose remains in the blood stream and
is then filtered out through the kidneys.
Pancreas Stomach Over time, this can lead to long-term
problems including kidney disease,
Figure 12.13 Diabetes occurs when
the glucose in the blood cannot be cardiovascular disease, limb amputations, damage to the retina in the eyes and
effectively transported into the cells. premature death.
20
18 Males
Females
16
14
12
Per cent
10
8
6
4
2
Figure 12.14 Proportion of persons
with type 2 diabetes, 2011–12 0
15–24 25–34 35–44 45–54 55–64 65–74 75+
Source: ABS, Australian Health Survey, First
results, 2011–12, p.19. Age group (years)
Behavioural
Behaviours that increase the risk of developing obesity also increase the risk of
type 2 diabetes. Examples include:
• Physical inactivity. Being physically inactive can contribute to weight gain and
increase the risk of type 2 diabetes.
• Alcohol consumption. Alcohol contains a large amount of energy, especially
mixed drinks and beer. These drinks can contribute to obesity which a risk
factor for type 2 diabetes.
• Food intake. An energy dense or high fat diet can contribute to weight gain and
type 2 diabetes.
• Tobacco smoking. Smokers are more likely to develop type 2 diabetes. Some
research suggests that smoking itself contributes to an increased risk of type 2
diabetes or it may be that smokers are more likely to be sedentary and overweight.
Physical environment
As obesity is a risk factor for type 2 diabetes, aspects of the physical environment that
increase the risk of obesity also increase the risk of type 2 diabetes. These include:
• Access to recreation facilities. If recreation facilities such as sporting ovals and
walking paths are not accessible, individuals may not get the required amount of
physical activity, which can increase body weight and contribute to obesity and
type 2 diabetes.
• Work environment. A work environment that does not promote incidental
physical activity can increase the risk of obesity. A work environment that has
car parking next to the entrance, no stairs and a small office space can reduce the
level of incidental physical activity and contribute to obesity and type 2 diabetes.
Social determinants
Social determinants of health that can increase the risk of type 2 diabetes include:
• Income. People with low incomes may be more likely to eat energy-dense,
processed foods that can increase the risk of obesity and contribute to type 2
diabetes.
• Education. People with lower levels of education have higher rates of obesity
and higher rates of type 2 diabetes.
• Occupation. People in managerial and other sedentary occupations may be more
at risk of obesity and type 2 diabetes.
Case study
Mental illness is a broad term for a group of conditions. These conditions can be
short or long term, and there is no way of knowing who will be affected by them. It
is thought that chemical imbalance in the brain can alter the way a person perceives
his or her world and contribute to mental illnesses. The two most common types
of mental illness are anxiety disorders and depression.
Anxiety disorders
Anxiety relates to worry or fear and is a normal part of life. When in danger, anxiety
causes physical responses that assist in dealing with these situations. Anxiety
disorders, however, relate to irrational and ongoing fear or worry that interferes
with normal life. These thought patterns contribute to physical symptoms such as
panic attack, where the individual may experience shortness of breath, dizziness,
rapid heartbeat, choking or nausea.
Specific anxiety disorders include:
• Generalised anxiety disorder — anxiety associated with common issues such as
family, friends, work, health or money
• Social phobias — fear of social situations
• Specific phobias — fear of a specific object or situation; for example, a fear
of enclosed spaces, animals or spiders. In all cases, the fear is irrational and
interferes with normal life (see figure 12.15).
• Panic disorders — frequent and debilitating panic attacks
• Obsessive compulsive disorder — recurring unwanted thoughts (obsession) and
feeling compelled to perform behavioural or mental rituals (compulsion), such
as excessive handwashing
• Post traumatic stress disorder — can occur after an individual is exposed to a
traumatic event. Feelings of grief and sadness are common after traumatic events,
but this condition is characterised by severe, ongoing reactions that interfere
with normal life. Thoughts and images of the event may be more distressing
than the original event itself, and can lead to the individual avoiding reminders
of the trauma, including places and situations.
Depression
Everyone feels sad from time to time, but depression is
a condition characterised by ongoing feelings of extreme
sadness that can last weeks, months or years. It is a
serious illness that interferes with normal activities such
as school, work and leisure. Symptoms of depression
can include:
• feeling sad or depressed
• loss of interest in normal activities
• sleeping problems
• constant feelings of tiredness
• loss of appetite or weight
• difficulty concentrating
• feelings of restlessness, worthlessness or guilt.
Figure 12.16 Depression is more
than just being sad. It can be ongoing
and interfere with normal activities. Why is mental illness a health issue
for adults?
Mental illnesses are very common among adults in Australia. In 2012, around
13 per cent of Australian adults were currently experiencing a mental illness
(figure 12.17).
16
14
12
10 Males
Per cent
Females
8
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Figure 12.17 Proportion of persons with a mental illness, 2001 to 2011–12
Source: ABS, Australian Health Survey, First results, 2011–12, p. 21.
The 2007 National Survey of Mental Health and Wellbeing estimated that 20 per
cent of Australians aged 16–85 experienced one or more of the common mental
illnesses in the previous 12 months. While not experiencing a mental illness in the
previous 12 months, an additional 25 per cent had experienced one at some stage
in their lives. In total, 45 per cent of Australians had experienced a mental illness
(AIHW, 2012).
Although mental illness is not a leading cause of death among adults, it
contributes significantly to morbidity in Australia. Mental illnesses can impact on
all aspects of life, including the ability to work, socialise, sleep, exercise, eat and
relax.
Behavioural determinants
Some behavioural determinants related to mental illness
include:
• Tobacco use. Smokers are more likely to have mental health
problems (AIHW, 1998). Although the exact reason for this
is unknown, it has been suggested that people experiencing
mental health problems in their youth may be more likely
to take up smoking.
• Alcohol misuse. Although there is a relationship between
problem drinking and mental health (with problem
drinkers more likely to have mental health issues and vice
versa), the causal factor (mental illness or drinking) has not
been established. Alcohol is a depressant and some studies
suggest that people with depressive symptoms are more
likely to develop alcohol misuse and dependence in their
younger years.
• Drug use. People abusing drugs have higher rates of mental
illness. Many substances alter the chemical make-up in the
brain, which can trigger a range of mental illnesses. There
is a relationship between mental illness and marijuana use,
although the cause of this relationship is not understood.
• Physical activity. Physical activity releases hormone-type
chemicals called endorphins that relieve stress and assist
in maintaining optimal mental health. People who exercise
may therefore be at a decreased risk of developing mental
illness (figure 12.18).
Physical environment
Aspects of the physical environment that are related to mental
illness include:
• Housing. Living in overcrowded housing conditions can
Figure 12.18 Regular physical
increase the risk of psychological distress. activity can reduce the risk of
• Neighbourhood safety. Living in an area that is not considered safe may heighten developing a mental illness.
feelings of anxiety.
• Access to health care. Medical intervention can assist in treating mental illnesses.
If the individual cannot access health care due to geographical barriers, mental
illnesses may go untreated for an extended period of time.
Social
Some social determinants that relate to mental illness include:
• Education and income. People with low education and incomes have higher
rates of mental illness. This could be attributed to a range of associated factors
such as higher rates of obesity, higher rates of smoking and drug misuse.
• Occupation. Work-related stress can add to depressive symptoms.
• Unemployment. Long-term unemployment has a relationship with mental
illness. Those who are unemployed may experience prolonged feelings of stress
and anxiety as a result of not being able to provide for themselves and/or their
family.
• A history of abuse or neglect during childhood increases the risk of mental
illness.
Federal Government
The Federal Government implements a range of strategies and programs to
promote the health and individual human development of adults in Australia.
Examples include the National Physical Activity Guidelines and Australian Dietary
Guidelines, the Shape Up Australia program and BreastScreen Australia.
The National Physical Activity Guidelines
The National Physical Activity Guidelines for Australians were developed to assist
individuals in meeting the amount of physical activity required to achieve health
benefits. Guidelines targeting different lifespan stages were developed, including
adults and older Australians. Recommendations as to the amount of physical
activity required and ways to incorporate physical activity into everyday life form
the basis of the guidelines.
Physical activity is important in reducing the burden of disease associated with
many conditions such as obesity, cardiovascular disease, type 2 diabetes, mental
illness and osteoporosis.
Shape Up Australia
Shape Up Australia is an initiative that aims to prevent obesity and its associated
conditions such as cardiovascular disease and type 2 diabetes. It works by
endorsing information, products and services that are aligned with the national
dietary and physical activity guidelines. Service providers and producers can apply
to use the Shape Up logo in their marketing activities so consumers can easily
identify products and services that are proven to assist individuals in maintaining
a healthy body weight. Consumers can then be assured that the information or
goods they are accessing reflect the latest research on healthy behaviours.
BreastScreen Australia
BreastScreen Australia is a free
mammography service jointly
funded by the federal and
state governments. BreastScreen
Australia offers free mammograms
for women aged 50–69 (although
those aged 40–49 and 70+ can
also attend for scans). Seventy-
five per cent of breast cancer
cases are in women over 50 years
of age and 50 per cent occur in
those aged 50–69. As age is a
significant risk factor for breast
cancer, the target age group of
50–69 was selected. Since its
creation in 1991, BreastScreen has
performed millions of scans (over
1.7 million in 2009–10 alone).
Early detection greatly improves Figure 12.19 BreastScreen provides
the survival rates of those suffering from breast cancer and has improved the health free mammograms, which can assist in
of thousands of adult females in Australia. the early detection of breast cancer.
Legislation
State and territory governments
Figure 12.20 Implementing and implement a range of laws that aim
enforcing speed limits are an example to promote health and development of adults, including laws relating to:
of a state government strategy • Driving. Laws relating to speed limits, speed cameras, seatbelt laws, probationary
that aims to reduce the risk of road drivers (P-plate drivers), drink driving laws and car safety standards.
trauma.
• Smoking. Laws may prevent individuals from smoking in certain public spaces. This
reduces exposure to environmental tobacco smoke and promotes physical health.
• Gambling. Gambling laws may restrict the amount that can be withdrawn from
automatic teller machines (ATMs) at gambling venues to assist individuals with
controlling their gambling.
Local government
Local governments implement a range of strategies and programs to promote the
health and development of adults including:
• providing access to recreation facilities such as walking and cycling paths, parks,
gardens and public swimming pools
• implementing community health plans that aim to address the needs of the
local community and promote healthy lifestyles by encouraging healthy eating,
exercise and social interaction
• the provision of aged care services including home assistance relating to
household chores, personal hygiene, shopping and delivered meals services (see
below).
Figure 12.22 Local governments provide a delivered meals service which assists in promoting
the health and development of many adults in Australia.
Personal strategies
Many of the personal strategies that can promote the health and individual human
development of adults relate to addressing the determinants that individuals have
some control over. Examples of personal strategies for adults in Australia include:
• Physical activity. Regular exercise assists in maintaining healthy body weight
which can reduce the risk of obesity and its associated conditions including
cardiovascular disease, type 2 diabetes and some cancers.
• Food intake. By consuming a healthy food intake, adults receive the nutrients
they need to supply energy, maintain hard and soft tissues and reduce the risk of
diet related diseases including cardiovascular disease and type 2 diabetes.
• Being socially active. Maintaining social networks and volunteering act to
promote social health and development by providing opportunities for social
interaction (figure 12.25). Self-esteem can also be enhanced by participating in
the life of the community.
Figure 12.25 Maintaining regular social interaction can promote health and development
throughout adulthood.
• Accessing health care. Regular health checks ensure that problems can be
identified early and relevant interventions put in place. Examples include treating
high blood pressure and making dietary changes if blood cholesterol is high.
• Using sun protection. Using sunscreen and covering exposed skin can reduce
the risk of skin cancer. Adults must also ensure they get some sun exposure to
receive adequate levels of vitamin D.
• Not smoking. Tobacco smoke is one of the leading causes of illness and premature
death in Australia. By not smoking and ensuring exposure to environmental
tobacco smoke is reduced, the risks are decreased.
• Drinking alcohol in moderation. If adults choose to drink alcohol, they can
choose to do so in moderation. This decreases the risk of health concerns such
as injuries and weight gain. Drinking in moderation also reduces the risk of
relationship breakdown and mental illness associated with excessive drinking.
• Not using drugs. Not using drugs can reduce the risk of mental illness and
promote physical and social health. Adults are more able to concentrate on daily
tasks and participate in health-promoting behaviours such as being socially
active, exercising and consuming a healthy food intake.
• Practicing safe sex. If adults are sexually active, practising safe sex can assist in
preventing sexually transmissible infections (STIs). Using condoms and having
regular health checks can assist in decreasing the spread of such diseases.
• Maintaining a safe housing environment. Eliminating hazards in the home
by clearing walkways, installing hand rails if required, maintaining heating
and cooling systems, regularly cleaning and maintaining adequate ventilation,
reduces the risk of injury and disease.
Figure 12.26 By accessing information, adults can improve their levels of education and
promote their health and development.
Food producers can apply to display the Tick logo on their food products if they
can show that their item is a healthier alternative than other similar products. This
may be in relation to lower levels of fat or sodium, or higher levels of fibre or
calcium.❻ ❻ An explanation of how the program
Adults can then identify foods that have been granted permission to display the works is provided.
tick to assist them in making healthier food choices.
If adults choose foods that display the Tick logo, they may be more able to
maintain their body weight. Adequate body weight can also reduce the risk of
cardiovascular disease. Mental health can also be improved by increasing self-
esteem. Human development could be impacted as adults may have more energy
to participate in physical activity, which enhances motor skills development, and
socialise with friends, which can assist in developing social skills such as
communication.❼ ❼ The program is linked to various
The Heart Foundation Tick is a beneficial program as it does not require aspects of health and human
development for adults.
consumers to have nutritional knowledge, but as not all food producers apply to
display the Tick, some healthy alternatives may be ignored as a result. This can
affect the ability of adults to consume a balanced food intake.❽ ❽ Conclusions about the program’s
effectiveness are drawn.
Chapter summary
• A range of health issues affect adults, including obesity, cardiovascular disease, cancer,
Interactivities:
type 2 diabetes and mental illness. The biological, behavioural, physical environment
Chapter 12 Crossword
and social determinants all play a role in these issues.
Searchlight ID: int-2911
• Obesity relates to carrying excess body weight in the form of fat and is measured using
Chapter 12 Definitions the body mass index or waist circumference.
Searchlight ID: int-2912
• Obesity increases the risk of cardiovascular disease, some cancers, type 2 diabetes and
mental illness.
• Obesity rates have increased significantly in Australia over the past 25 years.
• Determinants that can increase the risk of obesity include:
–– biological — advancing age, genetic predisposition and a low basal metabolic rate
–– behavioural — physical inactivity, alcohol consumption and food intake
–– physical environment — lack of access to recreation facilities and a work environment
that promotes a sedentary lifestyle
–– social — low levels of education, sedentary occupations and low income.
• Cardiovascular disease relates to conditions affecting the heart and blood vessels.
• Atherosclerosis is the underlying cause of cardiovascular disease.
• Cardiovascular disease is the leading cause of death in Australia.
• Determinants that can increase the risk of cardiovascular disease include:
–– biological — overweight/obesity, high blood pressure, high blood cholesterol, genetic
predisposition, being male and advancing age
–– behavioural — physical inactivity, food intake, tobacco smoking and alcohol
consumption
–– physical environment — lack of access to recreation facilities, lack of access to health
care and exposure to environmental tobacco smoke
–– social — low levels of education and income, workplace stress and occupation.
• Cancer is a condition characterised by the uncontrolled growth of abnormal cells.
• Cancer is the leading cause of premature death in Australia and is the leading
contributor to burden of disease.
• Determinants that can increase the risk or impact of cancer include:
–– biological — overweight/obesity, advancing age and genetic predisposition
–– behavioural — tobacco smoking, alcohol consumption, food intake and UV
exposure
–– physical environment — exposure to environmental tobacco smoke, exposure to
chemicals in the workplace and access to health care
–– social — low levels of education and income.
• Type 2 diabetes is characterised by an inability of the body to metabolise glucose.
• Type 2 diabetes is a leading cause of death and rates are increasing in Australia.
• Determinants that can increase the risk of type 2 diabetes include:
–– biological — overweight/obesity and genetic predisposition
–– behavioural — physical inactivity, alcohol consumption, food intake and tobacco
smoking
–– physical environment — lack of access to recreation facilities and a work environment
that promotes a sedentary lifestyle
–– social — low levels of education and income, and occupation.
• Mental illness is a term that encompasses a range of conditions.
• Anxiety and depression are the two most common forms of mental illness.
• Mental illness affects up to 45 per cent of Australians at some stage in their life and
contributes significantly to burden of disease.
Index 445
birth defects see congenital biological determinants of crime rates 381–2
abnormalities health 260–9 cystic fibrosis 195, 262
birth weight 214–16, 247, 266–7 birth weight 266–7
blastocysts 175, 179 body weight 267–9 D
blood cholesterol 353–4 chronic conditions 247 delivered meals service 435–6
blood pressure 348–52 dental health 249–50 dental caries 73, 96
blood production 89–91 determinants of health and dental health, children 249–50
body mass index (BMI) 3, 25–6, development 258–9 depression
267–8, 346–7 diabetes 248–9 during and after pregnancy 186
body systems 10 eating habits 276–80 impact on health 154
body weight health care access 299–301 impact on human development 155
adults 345–7 health status 244–51 nature of 153, 428
as biological determinant 24–7 hospitalisations 250–1 risk and/or protective factors 155–7
in childhood 267–9 housing environment 286–7 determinants of health
and hormones 59 media influences on health for children 258–9
measuring 3, 25–6, 267–8, 346 297–8 definition 3, 22, 111
in youth 60–1 mental health problems 249 key categories 112
bowel cancer 339, 344, 384–5 morbidity 247–51 see also risk/protective factors!!risk/
breast cancer 342–3 mortality 244–6 protective factors
breastfeeding 270–1 obesity 248, 269 development see individual human
BreastScreen Australia 383–4, 433 oral hygiene 282–3 development
burden of disease 39, 55–6, 328–9 physical activity 280–1 developmental milestones 5, 17,
physical environment 284–91 193, 201
C recreational facilities for 290–1 diabetes
calcium 80–2, 201 social environment 292–301 in children 248–9
cancer stage of 5–6 gestational diabetes 185–6, 217–18
as adult health issue 421 tobacco smoke in the home 284–5 type 1 59, 263–4
nature of 342 cholesterol 73, 78 type 2 59, 342, 424–6
risk and/or protective factors 421–3 chromosomal abnormalities 197 types 59
carbohydrates 74–5 chromosomes 193, 194, 257, 260 diastolic blood pressure 339, 348
cardiovascular disease civic participation 131 diet see food selection models
as a health issue 418 co-enzymes 73, 89 disability adjusted life years
risk and/or protective factors collagen 73, 86 (DALYs) 39, 55–6
417–20 colonoscopy 339, 385 discretionary foods 73, 101
carriers 193, 195, 257, 262 colostrum 231, 235 Down syndrome 39, 58, 184, 197
cartilage 73, 80 colour blindness 196 drowning 141
Casey Fields 291 community, sense of 393–4 drug use
cell differentiation 73, 85, 175, 179 community health services 385–6 in adulthood 369–72
cell membranes 73, 76 community participation 131, 393–5 during pregnancy 203–4
cellular respiration 73, 89 complementary health services illicit drugs 117, 139
cephalocaudal development 231, 232, 139, 161 impact of 117–18
233–4 complexity 3, 10 in youth 117–18
cerebrovascular disease 339, 350 concrete thought 3, 16 drugs, definition 369
child abuse 295–6 congenital abnormalities 175, 183, Duchenne muscular dystrophy
child morbidity 247–51 231, 244 (DMD) 261
child mortality 231, 245–6 congenital malformations 257, 271
children connective tissue 73, 86 E
asthma 248, 264–5 coronary heart disease 339, 348, early adulthood
behavioural determinants of 349–50 definition 309, 310
health 270–83 cortisol 59–60 emotional development 315
446 Index
intellectual development fats and prenatal health and
315–17 categories 77 development 194
physical development 310–11 monounsaturated fats 78 and youth health and
social development 311–14 as nutrients 76–8 development 58–9
early childhood polyunsaturated fats 78 germinal stage of prenatal
development 239–41 saturated fats 78 development 179
emotional development 239–40 trans fats 78 gestational diabetes 185–6, 217–18
intellectual development 240–1 Federal Government gingivitis 257, 282
physical development 239 adult health promotion strategies glandular fever, possible impacts on
social development 239 and programs 431–3 health and development 62
stage of 5 prenatal health promotion 219–20 glycaemic index (GI) 37, 95
eating habits, in childhood 276–80 feral children 12–13 gross motor skills 3, 10, 19
ectopic pregnancies 187 fertilisation
education definition 3, 4 H
access to 132 in-vitro fertilisation (IVF) 177–8, haemoglobin 73, 82
of parents 209, 292–3 309, 312 haemophilia 39, 58, 193, 195, 196
embryonic stage of prenatal process of 176–8 haemorrhages 175, 184
development 179–80 fibre 75 hard tissues 73, 74, 93
embryos 3, 10 fine motor skills 3, 10, 19 ‘Having a baby in Victoria’
emotional development fluoridation of water 287–9 website 220
aspects 14 foetal alcohol syndrome 193, 202, health
definition 3, 14, 309, 315 216–18 defining 39, 40–1
in early adulthood 315 foetal stage of prenatal dimensions of 41–4
in early childhood 239–40 development 180–1 interrelationships between
impact of anxiety and folate (folic acid) 86–7, 183, 200 dimensions 45–6
depression 155 food, energy content 89 interrelationships with individual
in infancy 237 food advertising, impact on human development 62–3
in late adulthood 323–4 children 297–8 optimal health 45
in middle adulthood 320 food intake, in adulthood 363–5 health care services
in youth 29 food selection models 99–104 access to 210–11, 299–301, 383–6
empathy 231, 239 fortified food 73, 81 rights and responsibilities of
endocrine system 193, 194, 257, 260 friendships, developing and users 161–3
endometriosis 339, 374 maintaining 121–2 health indicators 39, 48
endometrium 175, 179 health professionals, seeking help
energy G from 122–3
content of selected foods 89 general practitioners (GPs) 161 health promotion
measurement 88 Generation Y 313–14 community strategies and
nutrients required for production genes 193, 194, 257, 260 programs 158–9, 221–2, 437
of 88–9, 90 genetic conditions 58, 195–6, 262–5, government strategies and
requirements for individuals 89 340–2 programs 158–9, 219–21, 431–3
environmental tobacco smoke genetic potential 3, 22 personal strategies 160, 223, 437–9
(ETS) 124 genetic predispositions 39, 59, 263–5, health status
339, 342–4 adults 327–33
F genetics children 244–51
faecal occult blood test (FOBT) and adult health and definition 39, 48, 309
339, 385 development 340–4 measuring 48
familial hypercholesterolaemia as biological determinant of health pregnant women 184–7
339, 354 and development 22–3 unborn babies 182–4
family cohesion 111, 128–9 and child health and of youth 49
family composition 399–400 development 260–5 Healthy Living Pyramid 103–4
Index 447
Healthy Living Pyramid for Lacto-ovo individual human development J
Vegetarians 104 continual nature 232 jaundice 175, 186
Healthy Mothers, Healthy Babies definition 3
program 221 dimensions of 9 K
Heart Foundation Tick logo 437 in early childhood 239–41 kidney failure 351–2
high-density lipoproteins (HDLs) from simple to complex 234 kilojoules (kJ) 73, 88
339, 353 impact of anxiety and Klinefelter syndrome 197
homelessness 377–8 depression 155
hormonal changes in infancy 235–8 L
as biological determinants of health interrelationships between late adulthood
and development 23–4 dimensions 16–17 definition 309, 322
in puberty 23–4 interrelationships with health emotional development 323–4
and youth health 59–60 62–3 intellectual development 324
hormones in late childhood 242–3 living arrangements 396
definition 3, 193, 257 predictable orderly patterns 232 physical development 322–3
and endocrine system 194, 260 principles 232–4 social development 323
role in childhood 261–2 variations 232, 233 stage of 8, 325–6
role during pregnancy 194 infancy late childhood
role in puberty 19, 23–4 development 235–8 development 242–3
hospital care, mental health emotional development 237 intellectual development 243
problems 161 intellectual development 237–8 physical development 242
hospitalisations, children 250–1 physical development 236 social development 242
housing environment social development 236–7 stage of 5
adult health and development stage of 5 lethargy 39, 63
376–8 infant morbidity 247–51 life expectancy 39, 49
child health and development infant mortality 231, 244–6 Life! Taking Action on Diabetes
286–7 infertility 339, 373, 374–5 program 437
youth health and development infirmity 39, 40 Listeria monocytogenes 193, 201
124–5 influenza 62 literacy skills 316
housing stress 339, 376–7 inherited conditions 193, 195, 262 living arrangements 396–7
human growth hormone (HGH) injury 141–2 local government
371–2 insulin 59 adult health promotion 435–6
human lifespan intellectual development maternal and child health
childhood 5–6 aspects 16 centres 221
early adulthood 7 definition 3, 16, 309, 315 low birth weight 214–16,
infancy 5 in early adulthood 315–17 216, 247
late adulthood 8 in early childhood 240–1 low-density lipoproteins (LDLs)
middle adulthood 8 impact of anxiety and 339, 353
prenatal stage 4 depression 155 lung cancer 423
stages of 4–8 in infancy 237–8
youth 6 in late adulthood 324 M
Huntington’s disease 341–2 in late childhood 243 macronutrients 73, 74, 77
hypertension 339, 348 in middle adulthood 320–1 macular degeneration 339, 367
in youth 29–30 Malaya, Oxana 12–13
I intracytoplasmic sperm injection male impotency 339, 367
identity 15 175, 178 mammography screening 339, 383–4,
illicit drugs 139, 145–6 in-vitro fertilisation (IVF) 177–8, 413, 433
Immunise Australia program 220 309, 312 mandatory fortification of
implantation 175, 179 iodine 200 food 175, 184, 220
incidence (morbidity data) 39, 53–4 iron 82–4, 200–1 marriage 312
448 Index
maternal and child health centres micronutrients 73, 74 protein 75–6
221, 300 middle adulthood provision of energy 88–9
Maternal and Child Health Line definition 309, 318 required during youth 74
220–1 emotional development 320 vitamin A 85
maternal health, in rural and remote intellectual development vitamin C 86
communities 208 320–1 vitamin D 85–6
maternal morbidity 185–7 physical development water 80
maternal mortality 184–5 318–19 nutritional imbalance
maternal nutrition 193, 194, social development long-term consequences
199–201 319–20 96–8
Meals on Wheels 435–6 stage of 8 short-term consequences
meconium 231, 235 monounsaturated fats 78 95–6
media influences morbidity 39, 53–5
on adult health and mortality 39, 50–1 O
development 387–8 morula 175, 179 obesity
on child health and motor skills 9–10, 19 in adults 415
development 297–8 multicausal factors 257, 258 in children 248, 269
on youth health and muscular dystrophy 39, 58 as health issue 414–15
development 129–31 myocardial infaction 339, 349 risk and/or protective factors
Medicare 160–1, 219 414–16
melanoma 115, 344 N in youth 96–7, 140
menopause 340 National Bowel Cancer Screening object permanence 231, 238
mental health Program 384–5 occupational overuse syndrome
children 249 National Perinatal Depression (OOS) 339, 379
definition 39, 43 Initiative 220 optimal health 45
during and after pregnancy 186 National Physical Activity oral hygiene
impact of anxiety and Guidelines 280, 431–2 in childhood 282–3
depression 154 neighbourhood safety 381–2 promotion 283
indicators 44 neonatal intensive care units osteoporosis 73, 81, 82
issues 150 299–300 ova 176
mental health care services neonates ovarian cancer 343
available to youth 160–1 adaptations 235–6 overweight 96–7, 140
rights and responsibilities of definition 231, 235
users 161–3 neural tube defects 183–4, P
mental health policies 159 193, 200 parental education 209, 292–3
mental health promotion non-melanoma skin cancers 115 parental employment status 292–3
government and community nutrient dense foods 3, 24 parental income 209
strategies/programs 158–9 nutrients parenting practices 294–6
personal strategies 160 B-group vitamins 86–7 parents, socioeconomic status 129
mental health specialists 161 blood production 89–91 passive smoking 206–7
mental illness calcium 80–2 peak bone mass 73, 81, 82
definition 44 carbohydrates 74–5 perinatal conditions 231, 244
incidence, prevalence and during childhood 278 perinatal mortality 182
trends 150–3 fats 76–8 periodontitis 257, 282
risk and/or protective factors fibre 75 permissive parenting style 294
427–30 formation of hard tissue 93 personality 59
stigma attached 158 formation of soft tissue 91–2 physical activity
metabolism 3, 23, 249 functions and interrelationships in adulthood 360–2
metastasise (cancer) 111, 115, 88–93 in childhood 280–1
413, 421 iron 82–4 in youth 116–17
Index 449
physical development placenta 175, 179, 181 R
decline of body systems 10 Polycystic Ovarian Syndrome recreational facilities, access to 126–7,
definition 3, 9 (PCOS) 60 290–1
in early adulthood 310–11 polyps 339, 384 regeneration 175, 176
in early childhood 239 polyunsaturated fats 78 reproductive function/dysfunction 375
growth and development of body pre-eclampsia 186–7, 222 resilience 43, 111, 122
systems 10 pregnancy risk and/or protective factors
impact of anxiety and alcohol consumption 202–3 for anxiety and depression 155–7
depression 155 impact of drug use 203–4 for cancer 421–3
in infancy 236 smoking during 201–2 for cardiovascular disease 417–20
in late adulthood 322–3 unintended pregnancy 374 for foetal alcohol syndrome 216–18
in late childhood 242 Pregnancy, Birth and Baby for gestational diabetes 217–18
in middle adulthood 318–19 Service 220 for low birth weight 214–16
motor skills 9–10 pregnant women, health for mental illness 427–30
in youth 19–21 status 184–7 for obesity 414–16
physical environment prenatal development for spina bifida 212–13
access to recreational facilities embryonic stage 179–80 for type 2 diabetes 424–6
126–7 foetal stage 180–1 risk factors, definition 257, 258
and adult health and germinal stage 179 rites of passage 3, 28
development 376–86 stages 179
and anxiety and depression 156 prenatal health care, access to 207, S
and cancer 422 210–11 safety
and cardiovascular disease 419 prenatal health promotion in the home 287
and child health and community programs and of neighbourhood 381–2
development 284–91 strategies 221–2 in workplace 378–80
and foetal alcohol syndrome 218 government programs and SANE Australia 158
and gestational diabetes 217 strategies 219–21 saturated fats 78
housing environment 124–5 personal programs and secondary sex characteristics 3, 20–1
impact on health and strategies 223 sedentariness 111, 116
development 111, 112, 124 prenatal morbidity 183–4 self-esteem 44
and low birth weight 215–16 prenatal stage sex-linked chromosomes 193, 194,
and mental illness 429 biological determinants on health 195–6, 257, 260–1
and obesity 416 and development 194–8 sexual practices
prenatal health and of lifespan 4 in adulthood 373–5
development 206–8 prevalence (morbidity data) 39, 53–4 reproductive function/
and spina bifida 213 Primary School Nursing Program 301 dysfunction 375
tobacco smoke in home 124, primary sex characteristics unprotected sex 373
206–7, 284–5 3, 20, 21 in youth 120–1
and type 2 diabetes 425 protective factors sexually transmissible infections
work environment 125–6 definition 257, 258 (STIs) 111, 121, 139, 146–8,
and youth health and see also risk and/or protective factors 373–4
development 124–7 protein 75–6 Shape Up Australia 433
physical health proximodistal development 231, 232, skin cancer 111, 115, 343–4
definition 39, 41 234 smoking see tobacco smoking
impact of anxiety and psychoactive effects 339, 369 social capital 339, 393
depression 154 psychotic state 139, 150 social connections 393–4
indicators 41–3 puberty 3, 5, 7 social development
physiological changes aspects 11
definition 309 Q definition 3, 11, 309, 311
in early adulthood 310 Quit Victoria 358–9 in early adulthood 311–14
450 Index
in early childhood 239 stigma 139, 158 vitamin A 85
impact of anxiety and stress, and cortisol 59–60 vitamin B1 86
depression 155 stroke 339, 350–1 vitamin B2 86
in infancy 236 substance use 117, 145–6 vitamin B3 86
in late adulthood 323 sudden infant death syndrome vitamin B9 86–7
in late childhood 242 (SIDS) 193, 245, 257 vitamin B12 87
in middle adulthood 319–20 sun protection vitamin C 86
in youth 28 in adulthood 355–7 vitamin D 85–6
social environment determinants in youth 115–16 volunteering 131, 394–5
for adult health and systolic blood pressure 339, 348
development 387–403 W
for anxiety and depression 156–7 T water
for cancer 422 teratogens 175, 180 fluoridation 287–9
for cardiovascular disease 419–20 testosterone 60, 340 importance for survival 80
definition 111 thrombosis 339, 354 weight issues 140
for foetal alcohol syndrome 218 tobacco smoking work environment 125–6
impact on health and in adults 357–9 work–life balance 400–3
development 113, 128 during pregnancy 201–2 work-related stress 391–2
for mental illness 430 environmental tobacco smoke workplace conflict 391
for obesity 416 (ETS) 124 workplace safety 378–80
prenatal health and health impact 118–19, 142 Worksafe Victoria 380
development 209–11 and lung cancer 423 World Health Organization (WHO),
for spina bifida 213 passive smoking 124, 206–7, 284–5 definition of health 40
for type 2 diabetes 425 quitting 358–9
and youth health and in youth 118–19 X
development 128–32 trans fats 78 XYY syndrome 197
social health transient ischaemic attacks 339, 350
definition 39, 43 transport accidents 141 y
impact of anxiety and trends 51 years lost due to disability (YLDs) 39,
depression 154 triple X syndrome 197 53, 54–5
indicators 43 trisomies 13 and 18 197 years of life lost (YLL) 39, 51
social support 339, 397–8 tumours 413, 421 You2 initiative 222
socioeconomic status (SES) Turner syndrome 39, 58, 197 youth 6
and adult health 388–90 body weight 60–1
definition 111 U definition 3
parental income 209 ultrasound 175, 181 emotional development 29
of parents 129 unborn babies, health status 182–4 genetics 58–9
as social determinant 114 underweight 26–7, 140 hormonal changes 59–60
soft tissues 73, 74, 91–2 uninvolved parenting style 295 impact of biological determinants on
sperm 176 health 58–61
sphygmomanometers 339, 348 V intellectual development
spina bifida vaccination 193, 194, 204–5, 257, 29–30
nature of condition 212–13 272–5 physical development 19–21
risk and/or protective factors vegans 73, 87 self-assessed health status 49
213–15 VicHealth 435 social development 28
spouses 309, 311 Victorian Government, prenatal health Youthbeyondblue 158
standard drinks 339, 366 promotion 220–1
state and territory governments, health Victorian Healthy Eating Enterprise Z
promotion 434 (VHEE) 434 zygotes 175, 176
Index 451