What is osteoarthritis?
Osteoarthritis is a degenerative condition that mainly in the joints. Under normal conditions of the joints, a rubbery material called cartilage remains present at the end of the bones. This cartilage provides a smooth as well as a gliding surface to perform different motion and thereby behaves as a cushion between the bones (Cooper, Javaid and Arden 2014). However under the condition of osteoarthritis, the cartilage breaks down that result in pain as well as swelling and the various problems in moving the joints. Over time, the condition degenerates leading to the breaking of bones that result in growths called spurs. Often bits of bones and cartilage are found to break down and float in the joints resulting in an inflammatory process. Cytokines and enzymes gradually develop which leads to further deterioration of the situation. Ultimately, the cartilage gradually wears away leading to the rubbing of bones causing joint damage and more pain.
Osteoarthritis is one of the most important forms of arthritis in Australia. The Australian Bureau of Statistics 2014 to 2015 National Health survey has shown a striking rate of 2.1 million Australians suffering from the disease. This accounts for about 9% of the total population suffering from the disorder. Osteoarthritis is found to be more present in the females than in the males. After adjustment of age is done, it is found that the number of females account to about 10% which is much higher in comparison to the 6% males suffering from the disease (Jonsson et al. 2016). The prevalence of the diseases is mainly seen to increase with age. It has been found that the condition rises steeply when an individual attains the age of 45 and deteriorates further with age. However, the situation is mostly common in older, with relatively few younger people getting affected.
Social determinants are one of the most important focus points regarding discussing of the health condition of patients suffering from osteoarthritis. With the increase of the aging population in different western countries like in Australia, it has been clearly estimated that it will result in substantial economic costs for the healthcare systems. As more resources need to be allocated by the healthcare sectors to accommodate this rising number of osteoarthritis patients, the cost of healthcare will evitable increase. Hence this may act as a challenge for the many patients belonging from the low or middle socio-economic income families (Lankhorst et al. 2017). A large number of evidences are present which links the low socio-economic income of many Australian patients with that of poorer health outcomes for osteoarthritis. Some of the most common dimensions that have often acted as the contributor to the development of osteoarthritis are educational attainment, income and occupation, home ownership as well as social class.
Prevalence of osteoarthritis in Australia
Educational attainment has been found by researchers to be one of the leading factors resulting to poorer outcomes of osteoarthritis. In Australia, there is very few people who have not attended formal education and therefore researchers have mainly taken the education after the 12 years of the formal education as the main factor important to determine the reason of prevalence. Lower levels off educational attainment are often associated with increase in prevalence, morbidity as well as mortality of osteoarthritis (Luc, Grible and Pietrosimone 2014). Often the various kind of occupation that different individuals uptake also act as a determiner for the occurrence of osteoarthritis. Moreover low levels of income often lead to poorer health outcome due to compromised quantity of proper nutrition, lifestyle management options, housing, type of occupational hazards and many others. Hence, all these are seen to be the motor social determinants of health that lead to osteoarthritis.
Low economic class people with osteoarthritis are seen to suffer more and have poorer health outcomes in comparison to that of the affluent people. This inequality of healthcare service still acts a major laidback in the terms of humanity and the main aim of modern healthcare system. Health inequalities are actually governed by four important domains that need to be considered.
Health inequalities due to area based socioeconomic disadvantage is the primary one where it is seen that disadvantaged areas exhibit more death rates and sufferance than the advantages areas which are well supplied with health care sectors with modern technologies. It has yet been seen that the rural healthcare centers lack multidisciplinary team approach and also lacks modern technologies often required to treat osteoarthritis (Kiadaliri et al. 2017). Aboriginals as well as Torrent islanders often fail to attend any modern services as the regions lack modern amenities to get access to healthcare. Often coming to urban areas costs them much, making them to survive with the inhuman pain of osteoarthritis.
Health inequality is also associated to a larger extent with the poorer outcomes for osteoarthritis patients. This chronic disorder requires continuous maintenance and vigilance from the healthcare sectors with the use of modern technologies to relieve the pain of the patients. However, in order to get access to such treatment, a huge financial pressure is imposed on the patient and the family members. Therefore, low income families and old patients with lesser savings of life are found to suffer more often leading to inability to maintain this strenuous flow of finance and hence patients are unable to get proper health outcomes (Brennan et al. 2014). It is also seen that not only low SES people of urban areas, aboriginals and Torres Strait islanders are also seen to suffer due to their unstable financial condition. The rate of people suffering from osteoarthritis is extremely high and mortality with this disorder is quite common.
Growing pressure on healthcare centers
High level of education is associated with low levels of disorders and researchers suggest that high education level automatically results in proper income, correct nutrient intake, absence of harmful lifestyles, high financial stability and many others. The case is exactly opposite for the low education people who consume improper diet, lack disciplined lifestyle, improper housing as well as improper procedural knowledge to treat a disease symptom (Bartley 2016). Hence, their access to healthcare automatically gets limited in comparison to that of high education people who have made themselves affluent to derive healthcare benefits. In comparison, the low education people are not fortunate enough to access the healthcare hence becoming one of the greatest victims of health inequality.
Health inequality due to occupation is another factor that needs to be addressed by the modern nation of Australia. It has been seen that people with lower status occupations associate them with more of poorer outcomes of osteoarthritis than patients with higher status of occupation. Lower status occupations like patients working as labors, farmers, coalminers, carpet fitters, carpet and floor layering workers and similar others are more prone to the disorders. Individuals whose occupation involves lifting of heavy objects, kneeling and squatting and others are more prone to the disorders (Rodrigues et al. 2016). Again low status occupation besides being directly linked with occurrence of osteoarthritis is also indirectly associated with health disparities due to low education, low income and housing in disadvantaged areas. They are not being able to access the healthcare due to their low income and the preference of healthcare sectors over status of different patients which is indeed in human and cruel. This is mostly the scene in private healthcare centers. Hence, proper policy building is very necessary to bring the disadvantages people under the modern healthcare system and provide them with the best benefits.
The government has already initiated a number of med claims in order to provide financial security. However, they have yet not been able to handle the expenses of osteoarthritis for many poor people. Proper low cost packages both at public and private sector should be initiated. Moreover, rural healthcare centers need to be modernized along with higher fund from government to make treatments for rural disadvantaged people with minimal amount. Healthcare education should be strengthened within the 12 year formal studies only rather than strengthening it after the formal years in graduate courses. Low status occupation people should be provided with special health benefits schemes as their occupational hazards make them vulnerable to osteoarthritis (Tranter and Donohughe 2016).
Social determinants of osteoarthritis
Financial disparity will always remain as the main challenge that needs to be attended to overcome the health inequality. However, alternative approach can be initiated that will manly improve access to different forms of self management education. This can be achieved by community as well as clinical linkages which will in turn help in the promotion of early initiation of different types of early lifestyle modifications. This will be extremely helpful in reduction of pain. The government should develop different alternative methods as well as places for different types of free program delivery with encouragement of new types of collaborative practices (Harris et al. 2016). The governmental health system should ascertain adequate funding for the development of tools. These tools will be helpful in supporting efficient as well as effective adoption, use as well as maintenance of self management education programs in the community. This movement will help the lo SES people to maintain their health themselves reducing the effect of health disparity on them
The concerned authority should also initiate the concept of low impact, moderate intensity aerobic physical activity. This activity should also incorporate muscle strengthening exercises which would be promoted on a wider level as a method of public health intervention for adults suffering from osteoarthritis. A supportive environment should be implemented with the help of built-environment, land use as well as environmental supports (MacDougall et al. 2017). This will not take arguments of health disparity in the vicinity as the plan will help individual self management.
The existing policies and interventions which are produced to reduce the disorder related injuries should undergo promotion, implementation as well as enforcement. A widespread adoption of rules, policies and legislation and establishment of evidence based strategies as well as integration of injury prevention should be included in the already existing policy to make it more effective. Till date, a number of policy for advocacy for osteoarthritis had been published and therefore there is high urgency for the publish of the guidelines. The policy will rightly focus on the benefits that the low SES people will be able to achieve (Nelson et al. 2014). However, the benefits should be strictly monitored so that there remains no scope of misuse by the Australians.
The governmental departments for food and health will introduce new guidelines for the correct dietary intake that will reduce the occurrences of obesity which will in turn reduce the effect of osteoarthritis. Moreover, it should be such that both high socioeconomic people and low socioeconomic people can enjoy all the nutrients irrespective of their price. Governmental allowance for costly food at a lower price for the low SES people will help them to maintain their minimum requirement to prevent poorer outcomes on osteoarthritis (Rizol et al. 2013). Endorsement of quality diet as well as right calorie intake and providing provisions for such food material at a cheaper price is important to remove the inequality faced by different Australians.
Causes of health disparity
The entire policy has been based on the increasing prevalence of the disease of osteoarthritis as well as the different health inequality faced by different Australians when they seek for healthcare services from both private as well as public sectors. The entire discussion has thrown light about how different initiatives need to be taken by the government and also by the individual patients and their family members to overcome the health disparities and at the same time implement innovative idea that will help them to maintain their own health.
The health belief model is mainly followed in order to create the framework for the policy brief so that each and every important aspect get addressed. The first step included gathering of the information which was done by conducting a health need assessment as well as other efforts to determine which cohort is at a risk and the right population was targeted who are the older citizens. The next step included conveying the consequences of the health issues associated with the disorder and the risk factors associated with it. The entire issue of health disparity that mainly creates a concern has been discussed in details with clearly indicating how different classes of people are being affected. It has been discussed in clear and unambiguous pattern in order to develop the correct understanding of the situation. The third step incorporated communication with the target population discussing the recommendations and the collaborative approaches from the government, ordinary citizens, public and private healthcare centers and policy makers which will help in solving the present concern. The fourth step would include assistance in the proper identification of the barriers and effectively reducing them to bring the best action. A proper planning for removing the disparity has been discussed to indicate the issue and overcome the barriers. The last step includes demonstration of different action skills through skill development activities and at the same time providing support that will enhance self efficacy as well as likelihood for successful behavior changes (Harris et al. 2016). However, after implementation, proper monitoring committee should be incorporated in order to assure the success of the policy or to modify the policy if plans were not found to be effective.
References:
Bartley, M., 2016. Health inequality: an introduction to concepts, theories and methods. John Wiley & Sons.
Brennan, S.L., Lane, S.E., Lorimer, M., Buchbinder, R., Wluka, A.E., Page, R.S., Osborne, R.H., Pasco, J.A., Sanders, K.M., Cashman, K. and Ebeling, P.R., 2014. Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003–10: data from the Australian Orthopaedic Association National Joint Replacement Registry. BMC musculoskeletal disorders, 15(1), p.356.
Cooper, C., Javaid, M.K. and Arden, N., 2014. Epidemiology of osteoarthritis. In Atlas of Osteoarthritis (pp. 21-36). Springer Healthcare Ltd..
Harris, M.L., Dolja-Gore, X., Kendig, H. and Byles, J.E., 2016. First incident hospitalisation for Australian women aged 70 and beyond: A 10 year examination using competing risks. Archives of gerontology and geriatrics, 64, pp.29-37.
Jonsson, H., Olafsdottir, S., Sigurdardottir, S., Aspelund, T., Eiriksdottir, G., Sigurdsson, S., Harris, T.B., Launer, L. and Gudnason, V., 2016. Incidence and prevalence of total joint replacements due to osteoarthritis in the elderly: risk factors and factors associated with late life prevalence in the AGES-Reykjavik Study. BMC musculoskeletal disorders, 17(1), p.14.
Kiadaliri, A.A., Gerhardsson de Verdier, M., Turkiewicz, A., Lohmander, L.S. and Englund, M., 2017. Socioeconomic inequalities in knee pain, knee osteoarthritis, and health-related quality of life: a population-based cohort study in southern Sweden. Scandinavian journal of rheumatology, 46(2), pp.143-151.
Lankhorst, N.E., Damen, J., Oei, E.H., Verhaar, J.A.N., Kloppenburg, M., Bierma-Zeinstra, S.M.A. and van Middelkoop, M., 2017. Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis and cartilage, 25(5), pp.647-653.
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McDougall, C., Hurd, K. and Barnabe, C., 2017, April. Systematic review of rheumatic disease epidemiology in the indigenous populations of Canada, the United States, Australia, and New Zealand. In Seminars in arthritis and rheumatism (Vol. 46, No. 5, pp. 675-686). WB Saunders.
Nelson, A.E., Allen, K.D., Golightly, Y.M., Goode, A.P. and Jordan, J.M., 2014, June. A systematic review of recommendations and guidelines for the management of osteoarthritis: The Chronic Osteoarthritis Management Initiative of the US Bone and Joint Initiative. In Seminars in arthritis and rheumatism (Vol. 43, No. 6, pp. 701-712). WB Saunders.
Rizzoli, R., Boonen, S., Brandi, M.L., Bruyère, O., Cooper, C., Kanis, J.A., Kaufman, J.M., Ringe, J.D., Weryha, G. and Reginster, J.Y., 2013. Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Current medical research and opinion, 29(4), pp.305-313.
Rodriguez-Amado, J., Moreno-Montoya, J., Alvarez-Nemegyei, J., Goycochea-Robles, M.V., Sanin, L.H., Burgos-Vargas, R., Cardiel, M.H., Garza-Elizondo, M.A., Maradiaga, M. and Pelaez-Ballestas, I., 2016. The Social Gap Index and the prevalence of osteoarthritis in the community: a cross-sectional multilevel study in Mexico. Clinical rheumatology, 35(1), pp.175-182.
Tranter, B. and Donoghue, J., 2016. Housing tenure, body mass index and health in Australia. International Journal of Housing Policy, pp.1-20.
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