HSC PDHPE

NOTES
CORE 1- HEALTH PRIORITIES IN
AUSTRALIA
CORE 2FACTORS AFFECTING
PERFORMANCE
BY ALAN VAN

HEALTH
PRIORITIES

IN
AUSTRALIA
HEALTH PRIORITIES IN AUSTRALIA
FOCUS QUESTION 1 HOW ARE PRIORITY AREAS FOR AUSTRALIAS
HEALTH IDENTIFIED?
MEASURING HEALTH STATUS
Prevalence refers to the number of cases of disease that exists in a
defined population at a point in time. Occurrence, commonness.
Incidence refers to the number of new cases of disease occurring in a
defined population over a period of time.
Role of epidemiology
Epidemiology considers the patterns of disease in terms of prevalence,
incidence, distribution and determinants. It describes and compares the
patterns of health groups, communities and populations.
Measures of epidemiology
Mortality (death rates): indicates how many people die in a particular
population, how they died and over what period. Expressed per 100 000.
Infant mortality: indicates the number of infant deaths in the first year of
life per 1000 live births
Morbidity (disease and sickness rates): examines the prevalence and
incidence of disease and sickness in a specific population
Life expectancy: indicates the number of years a person is expected to
live.
HEALTH STATUS OF AUSTRALIANS
Current trends
Life Expectancy Trends
As life expectancy increases so does our ageing population. Increased life
expectancy has led to an increase demand for health services that cater
for the elderly, increase in nursing homes and the need to provide care for
a growing number of dependant people.
Major Causes of Sickness and Illness

Diseases of the circulatory system were the leading causes of death for
both men and women in 2001, followed by cancer, injuries and then
respiratory diseases.
Groups experiencing inequities
Inequality is the unequal distribution of illness or conditions throughout
the population.
Inequity is injustice in regard to social, economic and cultural factors.
Examples: Income, education, access to heath services, location.
Aboriginal and Torres Strait Islander Peoples
Mortality from preventable causes is twelve to thirteen times higher than
Australia as a whole.
Higher mortality rates than the non-indigenous population for almost all
causes of death.
Infant mortality rate is two to four times higher than the national average.
Hospitalisation rates are two to five times higher than the total
population.
Socioeconomically Disadvantaged People
They are more likely to drink alcohol at harmful levels, smoke, become
obese, have raised blood pressure and have diseases such as
cardiovascular disease, respiratory diseases and cancers.
High levels of disease are associated with lower socioeconomic status
mainly due to the limitations of reduced access to services which provide
diagnosis and treatments, and the lack of education.
Australians Born Overseas
They often have lower mortality and hospitalisations rates, as well as
lower rates of disability and lifestyle related factors.
This is believed to result from: A self selection process which includes
people who are willing and economically able to migrate and a
government selection process that involves a certain eligibility criteria
based on health education, language and job skills.
As the time of residence in Australia lengthens, the more likely overseasborn Australians are to adopt the Australian lifestyle and hence death
rates increase for migrants and approach those of Australian born people.
People Living in Rural and Isolated Locations
The mortality rate for males and females who live in remote areas is 32%
higher than those who live in major Australian cities.
There is less access to health services and they are heavily affected by
environmental issues.
They tend to suffer from heart disease, injury, diabetes, suicide and the
effects of alcohol.
People with Disabilities
Disability is defined in terms of the lack of ability to perform everyday
functions or activities.
In 1993 a survey was conducted by the Australian Bureau of Statistics
which showed 18% of all Australians (approx. 3.2 million people) were
diagnosed with some kind of disability.

They also found the most common disabilities were musculoskeletal

(arthritis), hearing loss and mental disorders. Also that 4.1% of Australian
are classified as handicapped.
Women
The most frequently reported conditions for women aged 15 years and
over were diseases of the nervous system and sense organs, respiratory
conditions, arthritis and circulatory conditions.
Heart disease kills more women more than any other disease due to their
lifestyle and nutrition.
Women make much greater use of medical services.
Men
The most frequently reported conditions for men aged 15 years and over
were diseases of the nervous system, sense organs respiratory conditions
and circulatory conditions.
Men have a 25% higher death rate then women.
Men on average live for six years less than women.
Older People
The elderly do suffer from health inequities because they make up the
majority of the population and arent supported as they should be due to
lack of resources, time and effort.
The elderly earn less and can not pay for proper treatment. They may not
know about the symptoms of the disease and may not recognise that they
need treatment for it.
The elderly may suffer from cardiovascular disease, cancer, stroke and
diseases of the respiratory system. Their life expectancy is also
increasing.
IDENTIFYING PRIORITY NEEDS
The process of identifying priority areas seeks to focus attention on areas
believed to be the most significant in affecting the community and for
those areas that have potential for health gains.
Available funds have to be allocated according to the areas of highest
priority.
Social justice principles.
Social justice means that the rights of all people in our community are
dealt with fairly and equitable. Public policies should ensure that all
people have equal access to health care services. People living in isolated
communities should have the same access to clean water and sanitation
as a person living in an urban area. People of a low socioeconomic
background should receive the same quality health services that a person
in a higher socioeconomic income receives. Information designed to
educate the community must be provided in languages that the
community can understand.
Priority population groups.
The health priority areas established by the government include
cardiovascular disease, cancer, injury, mental health and diabetes. Within

each of these priority areas certain groups in our population have been
identified as at risk of developing these diseases. By identifying at
risk population groups, government health care expenditure can be
directed towards these groups to attempt to reduce the prevalence of the
disease.
Prevalence of condition.
Analysing statistics allows us to interpret the prevalence of a condition or
disease. (Prevalence-how common a condition is in the community).
Morbidity statistics are reliable indicators of the prevalence of a condition.
Hospital admissions and health surveys are two examples of how
statistics are accumulated to give us a picture of the health status of a
population.
Costs to community.
Health priorities for government are determined by a number of factors.
This includes the expense of illnesses. The six disease groups that
account for the most health expenditure in Australia are:
Digestive system diseases including dental services: 11.8% of total health
system costs.
Circulatory disorders: 11.7%
Musculoskeletal problems: 9.5%
Mental disorders: 8.4%
Injury: 8.3%
Respiratory diseases: 8.0%
Potential for change
All of the health priority areas that have been identified have the potential
to change the incidence and mortality of the particular disease and
condition. For instance cardiovascular disease has some very highly
preventable risk factors including smoking and lack of physical activity. An
individual could modify their lifestyle by stopping smoking and taking up
regular exercise in order to decrease the risk of developing cardiovascular
disease. Other diseases and conditions, if detected in the early stages,
can be treated successfully. Some conditions and diseases may in fact
start to increase as our population ages and our lifestyle becomes more
sedentary.
FOUCUS QUESTION 2: WHAT ARE THE PRIORITY AREAS FOR
IMPROVING AUSTRALIAS HEALTH?
PRIORITY AREA
Cardiovascular Disease (CVD)
Cardiovascular disease refers to damage to or disease of the heart,
arteries, veins and smaller blood vessels. Cardiovascular disease can be
attributed to a number of modifiable risk factors.
Nature: There are three major forms of cardiovascular disease:
Coronary heart disease, stroke and peripheral vascular disease

Atherosclerosis is the build-up of fatty and/or fibrous material on the

interior walls of arteries.
Arteriosclerosis is the hardening of the arteries whereby artery walls lose
their elasticity.
Extent of the Problem: Cardiovascular disease accounts for 42% of all
deaths among Australians-1996.
Coronary heart disease represents 26% of all deaths and 57% of all
cardiovascular disease deaths
Stroke accounts for 10% of all deaths.
Peripheral vascular disease accounts for 3% of all deaths.
The declining prevalence of cardiovascular disease is due to a reduction in
the levels of risk factors and improved medical care and treatment.
Risk Factors: Unmodifiable: A family history of the disease, gender,
advancing age. Modifiable: Smoking, raised blood fat levels, high blood
pressure, obesity, abdominal obesity, physical inactivity.
Groups at Risk: Tobacco smokers, people with a family history of the
disease, people with high blood pressure (hypertension), people who
consume a high fat diet, people over 65, males, blue collar workers
Cancer
Nature: Cancer refers to a large group of diseases that are characterised
by the uncontrollable growth and spread of abnormal cells. There are two
types of tumours benign and malignant.
Extent of the Problem: On average, one in three men and one in four
women will be affected by cancer in their life time.
Cancer is the only major cause of death in Australia which is increasing in
incidence in both sexes.
Cancer in males occurs more frequently then those in females, except in
young to middle aged women were the chances of cancer is three times
higher than men due to cancers of the cervix, breast, ovary and uterus.
Cancer accounted for 27% of all deaths in Australia in 1996.
The major types of cancer that account for deaths in Australia include:
Lung, breast, colon, prostate and melanoma.
Lung Cancer is the major cause of cancer death, accounting for 20% of all
cancer deaths. Lung cancer death rates have declined for men but have
increased for women, yet male rates are still three times those of women.
Lung cancer is largely preventable considering that smokers are ten times
more likely to develop lung cancer than non-smokers.
Breast Cancer affects on in fifteen women in Australia and is more
common in women ages over 40 years, as breast cancer accounts for
17.4% of all cancer deaths.
Skin Cancer is due to prolonged exposure to ultraviolet radiation.
Australias skin cancer rates are the highest in the world and its incidence
has quadrupled in the last two decades. It accounts for 2.9% of all cancer
deaths.
Colorectal Cancer is the cancer of the colon or rectum. It is the second
most common cause of cancer related death in Australia.
Prostate Cancer is the second most common cancer for men and appears
to be increasing.

Cervical Cancer is one of the most preventable cancers with regular pap
smears. It accounts for 2% of cancer deaths.
Risk Factors: Lung Cancer: Tobacco smoking, occupational exposure to
carcinogens, air pollution.
Breast Cancer: A family history of the disease, high fat diet, early onset
menstruation, late menopause, obesity.
Colorectal Cancer: High intake of fats, low intake of complex
carbohydrates and dietary fibre, excessive alcohol consumption, obesity.
Skin Cancer: Fair skin which burns rather than tans, prolonged exposure
to sun and ultraviolet rays, the number a types of moles on the skin.
Prostate Cancer: Family history, high fat diet.
Cervical Cancer: An early age of first sexual intercourse, sexual
intercourse with many partners, a male partner who has intercourse with
a number of other female partners, viruses such as genital warts.
Groups at Risk: Lung Cancer: Cigarette smokers, people exposed to
occupational or environmental hazards, people working in blue-collar
occupations, men and women aged over 50 years.
Breast Cancer: Women who have never given birth, obese women,
women aged over 50 years, women who have a direct relative with breast
cancer, women who do not practice self-examination, women who start
menstruating at an early age, women who have late menopause.
Colorectal Cancer: Obese males and females, people with high fat diets
and low fibre diets, males aged 50 years and over.
Skin Cancer: People in lower latitudes, people with fair skin, people in
outdoor occupations, people who spend time in the sun with out
sunscreen, hats etc.
Prostate Cancer: Males aged over 50 years, males who have a direct
relative with prostate cancer.
Cervical Cancer: Women who have early first intercourse, women aged
over 50 years, women who neglect screenings such as pap smears,
women who smoke
Mental Health
Nature: Poor mental health in childhood and adolescence may underpin a
lack of self care.
Drug abuse, physical neglect and early pregnancy are examples of poor
health choices which may result to mental disorders.
Extent of the Problem: An estimated 17.7% of Australian adults had
experienced the symptoms of a mental disorder.
Young adults aged 18-24 years had the highest prevalence of a mental
disorder.
Suicide is the leading cause of injury as it accounted for 32% of all injury
death in 1997.
Suicide is the leading cause of death for people aged 15-24 years in
Australia.
Australia had the highest rate of youth suicide recorded in industrialised
countries.
Rural males have higher rates of suicide compared to urban males.

Risk Factors: The risk factors of suicide include: depression, mental

illness, physical illness, social isolation.
The risk factors of depression include: mental illness, chemical changes
within the brain, drug and alcohol abuse, life stresses, high anxiety,
negative experiences.
Groups at Risk: The groups at risk of suicide include: people suffering
chronic depression, elderly people, teenagers, young gays and lesbians,
people with a physical illness.
Diabetes
Nature: Diabetes mellitus is a condition affecting the bodys ability to
produce glucose from the bloodstream and use it for energy.
The pancreas functions poorly and produces insufficient insulin and the
glucose can not enter the cells.
Insulin-dependant diabetes mellitus Type One is where the body
produces minimal insulin or none at all. They need to inject an artificial
supply of insulin.
Non-insulin-dependant diabetes Type Two is where the pancreas has the
ability to produce insulin but it the amount is insufficient or the inulin is
not effective.
Extent of the Problem: Nearly one in four Australian adults over the age of
25 has a type of diabetes.
The incidence of diabetes has risen significantly, approximately 26%.
Australia ranks ninth among 35 countries with a high prevalence in
diabetes.
Aboriginal and Torres Strait Islander people the highest prevalence rates
of type two diabetes.
Diabetics have a reduced life expectancy and diabetes can contribute to
coronary artery disease.
85% of diabetics have type two diabetes, which is related to lifestyle
factors.
Risk Factors: Type one diabetes is an autoimmune disease (when the
body starts attacking its own tissues), which may be triggered by a virus
or environmental factors.
The risk factors of type two diabetes include: Being 50 and having high
blood pressure, being 50 and overweight, being 50 and having one or
more family members with diabetes, being over 65, having had a heart
disease or heart attack, having had gestational diabetes
Groups at Risk: The elderly, those who have poor lifestyles, people who
are obese, Aboriginal, Torres Strait Islander, Pacific Islander people,
Chinese, Indian, those who have had polycystic ovary syndrome.
Injury
Nature: Those that are caused by any form of external violence. This
includes in juries and death suffered from MVAs and workplace accidents,
suicide, violence, drowning and poisoning.
Due to the nature of the problem, there is usually significant emotional
trauma associated.

Extent: Injuries caused by accidents, poisoning, suicide and violence are

the most common cause of death in Aust. They account for approx. 6%.
Highest rate occurs in the 15-24 yrs age bracket (71%).
The three main causes of death from injury are:
Suicide:
In the early 1990s, was the leading cause of injury death.
In 1996, suicide accounted for 36% of all injury deaths.
There has been an increase in suicide in young adults, particularly males.
MVAs:
Account for approx. 30% of all injury deaths.
There has been a consistent downward trend.
Child accidents:
Most common cause of death for children under 14 yrs involve, in order:
Transportation
Drowning
Poisoning
Falls
Burns/scalds
Trends are showing significant decreases
Risk factors: For the major causes of injury there are specific sets of risk
factors:
Suicide:
Increased breakdown in family structure.
Depression
Lack of access to quality counseling and treatment
Mental disorder
Inappropriate modeling
MVAs:
Speeding
Alcohol
Fatigue
No seat belt
Overcrowding
Driver inexperience
Environmental conditions.
Child Accidents:
Lack of supervision
Unsafe environment
The reduction in transport deaths can be attributed to:
Improved safety and training devices
Helmet legislation
Other cycling and pedestrian safety initiatives
Social determents
Youth suicide:
Lifestyle patterns => higher levels of depression
Seek independence => unemployment, homelessness, inability to
develop relationships, drugs
Lack of access to appropriate support
MVAs:

The media
Image of masculinity/rite of passage
Child accidents:
Parents in full-time employment
Unsupervised children
No safety implementations
Lack of parental education
Groups at risk The elderly (falls), Males 15-24 yrs, Drivers who
speed/drink, and drive, Young children, Workers in high-risk occupations
WHAT ROLE DOES HEALTH PROMOTION PLAY IN ACHIEVING
BETTER HEALTH FOR ALL AUSTRALIANS?
APPROACHES TO HEALTH PROMOTION
What is health promotion
Health Promotion involves activities that are aimed at improving health
and preventing illness. prevention is better than the cure
Public Health is a combination of science, medicine, practical skills and
beliefs aimed at maintaining and improving the health of all people.
New Public Health is the totality of activities organised by a society to
protect people from disease and not to promote their health. These
activities occur in all sectors in society and include policies which support
health.
The Ottawa Charter for Health Promotion is a framework for health
promotion which was made in 1986.
Health promotion recognises the social, economic, environmental, and
behavioural and lifestyle factors which contribute to the prevalent lifestyle
related diseases of today.
Health promotion involves: Physical support, Economic support,
Government legislation, Social support, and Educational support and
Government regulations. (PEGSEG)
Health promo can be targeted at 3 levels of prevention:
1 Primary (before disease)
2 Secondary (at the early sign of disease).
3 Tertiary (after disease sets in)
Shift from an individual lifestyle approach to health promotion to
the new public health approach
Individual Lifestyle Approach to Health Promotion is based on the principle
that the major causes of morbidity and mortality within Australia are
diseases resulting from poor lifestyle behaviour choices.
This approach takes a medical view, emphasising public illness rather
than public health.
It focuses on understanding the causes of illness rather than allocating
resources to reduce illness.

It emphasises the role of the individual in improving their health status,

assuming that a change in individual lifestyle behaviour will improve
health.
Therefore, health promotion programs under this approach are aimed at
changing the individual behaviour.
Its limitations include: its inability to recognise the social, economic and
environmental factors that have an impact on health, it assumes that
improved knowledge about health issues can change individual
behaviours, is assumes that all individuals are able to change their
behaviours and it is based on the idea that behaviour change is solely the
responsibility of the individual.
The new public health approach recognises the importance of all social
sectors influence on contributions to the health of the population.
It attempts to broaden our understanding of health by considering the
underlying environmental factors that influences our health and by
ensuring that social, physical and economic environments promote
health.
The most significant shift to a new public health approach to health
promotion was the World Health Organisations development of the
Ottawa Charter in 1986.
The charter provides structures and principles of the new public health
promotion such as: Disease prevention and health promotion, social
justice, community participation, a holistic and positive view of health.
CHARACTERISTICS OF THE NEW PUBLIC HEALTH APPROACH
Empowerment of the Individual
The social, economic and physical environments of some people
prevented them from changing their health behaviours which made the
old public health approach ineffective.
Individual empowerment refers to an individuals ability to make decisions
about having personal control over their health and lives.
Community Participation
Community participation in health promotion depends on community
empowerment which includes: the knowledge of local people to identify
local health issues, community partnerships with health professionals and
support for a public voice for the health of the local community.
The community sectors that contribute to the positive promotion of health
include: The Commonwealth Government, State governments, Local
governments, Business and industry, Non-government organisations and
Intersectional action.
Recognition of the Social Determinants of Health
The social determinants of health include: the distribution of income,
poverty and wealth, access to and conditions of work, living conditions
and environments access to health services and information, education,
housing and social support.
Policy change is needed for the inequities in income distribution and living
environments to improve health.

Role of individuals

Role of health
professionals

Role of
communities

INDIVIDUAL
LIFESTYLE
APPROACH
Own
responsibility
Listen to info
- Curative measures

- Very little

NEW PUBLIC
HEALTH APPROACH
- Participate in HP

Prevention and
cure
Inter-sectoral
collaboration
- Participate in HP

MAJOR HEALTH PROMOTION INITIATIVES

The Ottawa Charter for Health Promotion (1986) is an action plan for all
nations to undertake in the goal of achieving health for all by 2000.
Building a public health policy, Creating supportive environments,
Strengthening community action, Developing personal skills, Reorienting
health services.
The charter is significant because it gave direction to health promotion
through clear definitions, action plans and positive involvement.
The Fourth International Conference on Health Promotion was held in
Jakarta in 1997. It produced the Jakarta Declaration, which reaffirms the
principles of the Ottawa Charter and urges health promotion to build on
and expand partnerships for health with all sectors of the community.
The Jakarta Declaration promotes social responsibility for health, the
provision of supportive environments and a settings approach for the
promotion of health. It promotes social responsibility for health, increased
investments for health development in all sectors, consolidates and
expands partnerships for health, increases community capacity and
empowers the
individual, secures an infrastructure for health promotion.
Government responses
International level: Ottawa Charter 1986, Jakarta Declaration 1997
National level: Health for all Australians report 1988, National Better
Health Program 1989,
Goals and Targets for Australias Health in
2000 1993, Better Health Outcomes for All Australians 1994, National
Health Priorities Initiative 1995/1996, Australias Health 1998/2000
State level: NSW Health Corporate Plan 1998-2003, Breast Screen NSW,
Cervical Cancer etc.
Community Responses

Each area/region is required to develop a strategic plan for health

promotion and annually report on its implementation to the public health
division of NSW.
Area Health Services have their own initiatives which are relevant to their
community.
Jakarta Declaration:
The Jakarta Declaration resulted from the World Health Organisations
Fourth International Conference on Health Promotion. It offers a vision
and focus for health promotion into the 21st century. The declaration
reaffirms the Ottawa Charter, the importance of health promotion and the
five action areas set out in the Charter as being essential for success. It
also noted that comprehensive approaches that use combinations of the
five action areas are more effective
The Jakarta Declaration:

recognises that there are new challenges in relation to addressing

the determinants with poverty posing the greatest threat to health

recognises the importance of particular settings such as schools,

workplaces and cities for health promotion

stresses the need for new responses such as the creation of new
partnerships for health to address the emerging threats to health.

The five priorities for the Jakarta Declaration are:

1)promoting a social responsibility for health
2)increasing investments for health development
3)consolidating and expanding partnerships for health
4)increasing community capacity and empowering the individual
5)securing an infrastructure for health promotion.
Participants in this conference were all committed to sharing the
messages of the Jakarta Declaration with their governments, institutions
and communities, and putting the proposed actions into practice.
OTTAWA CHARTER (1986)
Based on 5 action areas:
Developing personal skills:

Health education in schools

Media campaigns
Quit smoking programs
Reorienting health services:
Increased funding to health research
Doctors working with child-care services to encourage immunization
Pharmacists working with community centers to encourage more
preventative strategies
Building healthy public policy:
Legislation restricting cigarette advertising
Smoke-free areas
Compulsory swimming pool fences
Strengthen community action:
Health-promoting schools
Lions club driver reviver stations
Self-help groups (AA)
Create supportive environments:
Greenhouse emission targets
Protection of forests
Elimination of CFCs
FOCUS QUESTION: WHAT ROLE DO HEALTH CARE FACILITIES AND
SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL
AUSTRALIANS?
NATURE OF HEALTH CARE IN AUSTRALIA
Health care facilities diagnose, treat and rehabilitate the ill and injured.
They have the important role of preventing and promoting health.
Role of health care
Australias health care involves a strong partnership between public
health initiatives and medical care. This aims to balance the need for both
prevention and treatment.
Health services are financed, organized and delivered by public and
private sources
Private practitioners (doctors, physios, etc) on a fee-for-service basis,
provide health services, while the government and private insurance
companies finance these services.
Health care in Australia is about clinical diagnosis, treatment and rehab.
There is an increasing focus on health education and promo.
Range and types of health care facilities and services
Institutional health care
Non-institutional health care

Public and private acute

care (general) hospitals
Public psychiatric hospitals
Nursing homes and hostels
Ambulance

Medical services (GPs,

pathology)

Dental

Pharmaceuticals

Admin and research

Other pro services (physio,
etc)
Access to Health Facilities and Services
Access to health facilities and services is about the health systems ability
to provide affordable and appropriate health care. It includes patient
waiting times in public hospitals for emergency care, outpatient services
and elective surgery.
Access also refers to equitable distribution of health facilities and services
to all sections of the Australian population.
The majority of Australians have access to fundamental medical care
through the national health insurance system Medicare. Unfortunately,
this health insurance system does not cover all health services, so some
health services are inaccessible to those who can not afford them.
An individuals ability to access services and facilities can also be
influenced by their knowledge of health information and the services
available to help them.
Responsibility for Health Care
The Commonwealth Government is mainly concerned with the formation
of national health policies and the control of health system financing
through the collection of taxes.
State and Territory Governments have the prime responsibility for
providing health and community services. Responsibilities include:
Hospital services, mental health programs, dental health services, etc.
Private Sector provides a range of services such as private hospitals,
dentists and alternative health services.
Local Government is mainly concerns environmental control and a range
of personal, preventative and home care services. They include
monitoring of sanitation and hygiene standards in food outlets, waste
disposal and immunisation.
Community Groups include the Asthma Foundation and Diabetes
Australia.
FUNDING OF HEALTH CARE IN AUSTRALIA
Health Insurance (Public and Private)
Medicare is a system of health insurance which is accessible to all
Australians. It reimburses a large amount of medical and hospital
expenses that individuals incur. Every Australian is covered for 85% of an
amount that is considered to be a scheduled fee.

Private health insurance is an extra insurance which allows people to

cover private hospitals and ancillary expenses. People with private
insurance have shorter waiting times for treatment, staying in hospitals
that they want, having their own choice of doctor in hospital, private
rooms in hospitals, ancillary benefits and insurance cover while overseas.
The Government also introduced a 30% rebate system for those who have
private health insurance.
Costs of Health Care to Consumers
Funding for health promotion and illness prevention has increased in
recent years. However, more than 90% of Australias health expenditure is
allocated to curative services.
Strategies that could be used to prevent illness and death in the
community include the education of school children about positive health
behaviours, better coordination among the various levels of Government,
restrictions on advertising, legislations and higher taxes on products such
as alcohol and tobacco. These strategies promote a higher level of
personal health and improved quality of life.
Strong arguments for increasing the funds of preventative health care
include: Cost effectiveness, improvement to quality of life, containment of
increasing costs, maintenance of social equity, use of existing structures
and the reinforcement of individual responsibility for health.
Health Care Expenditure versus Health Promotion Expenditure
Health care expenditure in Australia far exceeds expenditure on illness
prevention and health promotion.
An emphasis on medical treatments to cure illness dominates the
allocation of public health resources and spending.
The new public health model focuses on the social factors that lead to ill
health, which will hopefully lead a shift away from medical dominance to
the allocation of more funds to support health promotion strategies.
ALTERNATIVE HEALTH CARE APPROACHES
Reasons for Growth of Alternative Medicines and Health Care
Approaches
The World Health Organisations recognition of the usefulness of many
traditional medicines, the recognition that the majority of the worlds
population use traditional medicines, the effectiveness of the treatment
for people who found modern medicine as being ineffective, the desire of
many people to have natural or herbal medicines rather than synthetically
produced medicines and the holistic nature of alternative medicines.
Range of Services Available
Acupuncture

Aromatherapy

Chiropractic

Based on Chinese beliefs that proposes energy

(Chi) flows through the body via meridians
Through the insertion of fine needles into certain
points along meridians, it is believed health
benefits can results.
Used for pain relief and control of asthma and
arthritis
Used to treat stress and skin disorders
Involves special massage techniques using blends
of oils and the burning of incenses.
The benefits are claimed to be holistic.
o Relieves pain and improves health
o Involves spine manipulation
o The theory is that ailments are the result of
poorly aligned vertebrae.
o Chiropractors believe that because of the
nervous system, adjusting the spine can
improve health

Naturopathy
o Involves treating the whole person by harnessing natural
abilities of self-healing
o Adapts a variety of tailored therapies, such as:
Massage
Relaxation
Herbal medicine
Nutrition
o Aims to use natural resources in order to put the body in the
right state so that it can heal itself
How to Make Informed Consumer Choices
It is important to investigate the service offered and the credibility of the
practitioner.
Ask questions like: What are your qualifications? How much will the
treatment cost? Can I afford this? Do I really need this? Will it do what it
claims to do? Are there any risks?
To make an informed decision about health care you need education,
information, a range of options and confidence in your right to take
responsibility for your own health care.
FOCUS QUESTION: WHAT ACTIONS ARE NEEDED TO ADDRESS
AUSTRALIAS HEALTH PRIORITIES?
DEVELOPING PERSONAL SKILLS
Developing personal skills focuses on health promotion that supports
personal and social development of the individual. It aims at increasing

the education and knowledge of the individual in order for the individual
to have more control over their health and environment.
Modifying Personal Behaviours
Peoples values, attitudes and beliefs will influence whether they will use
the knowledge learned and change their health behaviours.
This requires the development of skills such as: Decision making,
communicating, assertiveness, time management, planning and problem
solving.
Gaining Access to Information and Support
To improve and maintain the health of all Australians, it is important to
find ways to provide equitable access to information and support services.
People who experience inequities in gaining access to information and
support include those who experience physical isolation, low
socioeconomic status, poor literacy skills, language/cultural barriers.
CREATING SUPPORTIVE ENVIRONMENTS
This action area focuses on the places people live, work and play and on
increasing peoples ability to make health-promoting choices.
It is concerned with our lifestyles and our social and physical
environments.
Identifying Personal Support Networks and Community Services
Having emotional, social or financial support from people who are close
can greatly influence the individuals ability to change.
Identifying Socio cultural, Physical, Political and Economic
Influences on Health
If health promotion is to be effective, it must address the social, cultural,
physical, political and economic factors that affect peoples lives.
STRENGTHENING COMMUNITY ACTION
The focus of this area is giving communities the chance to identify and
implement actions that address their health concerns.
The new public health approach advocates the active involvement of
communities, in partnership with health practitioners and government
authorities, in the promotion of health.
It encourages communities to identify health priorities specific to their
population and initiate action to help address these priorities.
Empowering communities to take action
The focus is on giving communities the chance to identify and implement
actions that address their health concerns.
Community empowerment involves:
Setting health priorities
Making decisions collaboratively
Planning strategies
Identifying and effectively using resources

Implementing and evaluating strategies

Community resources include:

Schools
Workplaces
Self-help groups
Local governments
Community health centers
Doctors
The media
Interest groups
REORIENTING HEALTH SERVICES
A refocusing on the well-being of the whole person compliments
traditional roles of diagnosis, treatment and rehabilitation.
This requires changes in the attitude and organisation of health services
and changes to professional education, training and research.
Identifying The Range of Services Available
There are a range of services available through the large number of
primary health-care services.
Examples: Clinical services, patient education, counselling, information
source, equitable access, hospitals, womens health centres, baby health
centres.
Gaining Access to Services
Access to health services depends on requirements of each service,
physical location, community awareness of its availability and the
affordability of the service.
Health care services are accessible to all Australians through the public
insurance scheme Medicare.
BUILDING HEALTHY PUBLIC POLICY
Public health policy is made at all levels of government and it includes
legislation, policies, taxation and organisational change.
Identifying The Impact of Policies on Health
The combination of compulsory health policy and legislation, policing or
monitoring of legislation, and increased community awareness through
media campaigns will ensure a positive impact on health.
Influencing Policy
It is important to gain community support in order to influence public
health policy through advocacy.
Deciding Where to Spend the Money

Funding needs to be allocated to health-promotion programs that target

the health priority areas, thereby improving health in these areas and
reducing expenditure on treatment and rehabilitation.
Applying the action areas to priorities

DEVELOPING
PERSONAL
SKILLS

CREATING
SUPPORTIVE
ENVIRONMEN
TS

LUNG CANCER
(SMOKING)
Mass media
campaigns
Strong
messages on
cigarette
labels
Quit
workshops
and materials
Smoke-free
zones
Media
coverage

STRENGTHEN
ING
COMMUNITY
ACTION

REORIENTING

HEALTH
SERVICES
BUILDING
HEALTHY
PUBLIC
POLICY

CARDIO-VASCULAR
DISEASE
Education
regarding risk
factors.
More
importance on
diet and
nutrition

Community
advocacy
Political action

H.P.
foundations
from tobacco
tax

Tobacco ad
bans
Price rises
Health
warnings on
packets
Age
restrictions

INJURIES (ROAD
INJURIES)
Driver education
License scheme
Reduction of risks
(BAC, seatbelts)
Speed, fatigue
campaigns

Specialised
gyms (Curves)
Walking/riding
tracks
Food changes
Free cholesterol
checks
Heart
Foundation

H.P. foundations
to promo P.A.
GPs educating
on lifestyle

Intersectional
action for the
promo of P.A.

Dual lanes
Speed zones
Driver Reviver
Airbags, road
design
Child restraints
School traffic
rules
Improved roads
Safe public
transport
Speed humps

Laws on
speeding, BAC,
seat belts
RBT units
Speed humps
Round-a-bouts
Black spot
warnings

FACTORS
AFFECTING
PERFORMAN
CE

HOW DOES TRAINING AFFECT PERFORMANCE?

Energy Systems

Alactacid system (ATP/PC)

Muscle contraction causes ATP to split and become ADP. Creatine
phosphate then breaks down and creates energy to drive free phosphate
back to ADP creating ATP again.
Source of Fuel: ATP found in body. Creatine phosphate found in meat and
fish
Efficiency of ATP production: efficient fuel source, however it doesnt last
long
Duration the system can operate: 2 seconds ATP + 15 seconds CP.
Generally 1-30 seconds worth of explosive movement
Cause of fatigue: lack of creatine phosphate
By-products of energy production: heat produced from energy
Process and rate of recovery: 2 minutes rest to replace CP levels
Lactic acid system
In the lactic acid system instead of using CP, the body uses stored glucose
in the muscles and liver caller glycogen. This process if called glycolysis
and no oxygen is required.
Source of Fuel: carbohydrates and glycogen in muscles and blood sugar
Efficiency of ATP production: readily in supply. 100g glycogen = 3 mol.
ATP glycolysis
Duration the system can operate: 30 seconds 3 minutes. It is the
dominant energy system
Cause of fatigue: lactic acid build up
By-products of energy production: lactic acid
Process and rate of recovery: lactic acid converted in liver to provide
energy. 20 minutes-2 hrs to break down lactic acid
Aerobic system
Source of Fuel: carbohydrates, fats and proteins
Efficiency of ATP production: extremely effective; 100g glycogen = 39
mol. ATP
Duration the system can operate: only limit is muscle fatigue. Starts at
about 2-3 minutes
Cause of fatigue: depletion of fuel; fats and carbohydrates.
By-products of energy production: carbon dioxide; respiration, water;
sweat.
Process and rate of recovery: depends on how much glycogen is used
Principles of Training
Progressive overload
Progressive overload implies that gains in fitness will occur only when the
training load is greater than normal and progressively increased as

improvements in fitness occur. The adaptations wont occur if the

resistance is either too small or too big.
Specificity
Specificity implies that the effects of a training program will be
specifically related to the manner in which the program is conducted. It
draws a close relationship between activities selected for training and
those utilised in a game or event. It implies that greatest gains will be
made when an activity in the training program resemble the movements
in the game or activity.
Reversibility
In the same way that the body responds to training by improving the level
of fitness, lack of training causes the opposites to occur. It is referred to
as the detraining effect.
Variety
Using the same drills and routines can become bored and unproductive.
Because of this the coach must continually strive to develop the required
attributes using different techniques to ensure that the athlete is
challenged not only by the activity but also by the initiative and
implementation.
Training thresholds
Thresholds generally refer to a specific point which, when passed, takes
the person to a new level. The lowest level we can work and have fitness
gains is the aerobic threshold. The highest is the anaerobic threshold.
[See diagram in book]
Warm-up/Cool down
Purpose of warm-up: reduce risk of injury, increase body temperature,
mentally prepare athlete, and stimulate cardiorespiratory system
Purpose of cool-down: Minimise muscle stiffness, disperse lactic acid,
build up and replenish energy stores
Types of Training
Aerobic
Aerobic training includes:
Continuous training
Fartlek training continuous + overload
Interval training eg. run 500m then have a 2
minute break
Circuit training different stations with different
activities
Aerobics dance, exercise lasting for 30 minutes
Strength

Strength programs can be divided up into three

categories:
Isotonic participants raise/lower or pull/push free
weights to contract/lengthen muscle fibres
Isometric participants develop strength by
applying a resistance and using exercises in which
muscle length doesnt change
Isokinetic participants use elaborate machines to
ensure that the resistance applied to the muscle
group is uniform throughout the full range of
movement
There are four types of strength:
Absolute strength is the maximum force that can
be generated by a muscle
Relative strength is the maximum strength that
can be generated by a muscle relative to ones
weight
Muscular endurance is the ability of a muscle
group or the whole body to withstand fatigue
Power is the ability to apply force at a rapid rate.
Power is required in explosive sports such as
jumping and sprinting and most team sports
Flexibility (static, ballistic, PNF)
Flexibility is affected by a number of factors including:
Age muscles shorten and tighten as we grow
older
Sex generally, females are more flexible than
males
Temperature increased atmospheric and boy
temperature both improve flexibility
Exercise people who are frequently involved in
exercise tend to be more flexible than more
sedentary people
Specificity flexibility is joint specific. The fact
that a person is flexible in the shoulder does not
automatically mean similar flexibility exists in
their hips.
A flexibility program is essential for:
Prevention of injury
Improved coordination between muscle groups
Muscular relaxation
Decreasing soreness and tightness following
exercise
An increased range of movements around joint,
maximizing performance potential
Preparing the athlete for training

HOW DOES THE BODY RESOND TO AEROBIC TRAINING?

The Basis of Aerobic Training
Pre-screening
Before beginning an exercise program it is essential that all subjects at
risk be pre-screened. Pre-screening is especially important for:
Males over 40yrs
Females over 50 yrs
Asthmatics
People who smoke, are obese or have high blood
pressure
People with a family history or heart conditions
Pre-screening is essential to:
Provide information that will be the basis of their
exercise prescription
Enable people to be aware of their limits
Provide information about general health status
Provide medical records that act as a benchmark
against which fitness improvements can be
assessed
An exercise prescription is like a doctors prescription, except that it will
relate directly to exercise. It will specify:
Frequency
Intensity
Time/Duration
Type
Application of the FITT principle
Frequency the amount of times a week you would participate in physical
activity. At least 3-4 days a week
Intensity how hard you train each time you participate in physical
activity; 70-85% of MHR.
Type the type of activity the person participate in; aerobic
supplemented by resistance.
Time how long each session is. It is recommended that for fitness
training a person trains for 20 minutes at high intensity, and for health
training a person trains for 30 minutes at a moderate intensity.

Immediate Physiological Response to Training

Heart rate
Immediately when a person begins to exercise their heart rate will
increase. For an untrained person their heart rate will increase at a faster

rate and will take longer for them to recover. An average persons resting
heart rate is approximately 80beats/min and their training zone is
between 130 and 170 beats/min.
Ventilation rate
Before exercise the ventilation rate will increase in anticipation of
exercise, it will then increase again during exercise as there is an increase
in oxygen consumption and carbon dioxide production. After exercise
breathing will remain rapid then slowly return to resting levels at 12
breaths/minute as oxygen stores are replenished.
Stroke volume
When exercise increases, the amount of blood that the heart discharges
increases considerably, stroke volume increases rapidly compared to
heart rate but levels off at the peak of moderate exercise, the more blood
being pumped around the body, the more oxygen that is available to the
body, resulting in a better performance.
Cardiac output
Cardiac output is the amount of blood pumped by the heart per minute. It
increase with exercise and is equal to heart rate times stroke volume
(CO=HR x SV). The working muscles demand for additional oxygen causes
blood flow to be redistributed around the body, resulting in the increased
need of blood.
Lactate levels
At rest the blood has a pH level of 7.4. However, as exercise intensity
increases, the pH level drops and acidification of muscles increases. The
lactic threshold is the point at which lactate levels rise above resting
levels and after a short period of time will force the athlete to reduce the
intensity of their training.
Physiological Adaptations in Response to Aerobic Training
Resting heart rate
Resting heart rate is the number of heart beats a minute when the body is
at rest. Trained athletes have lower resting heart rates than an untrained
athlete. This is due to the efficiency of the cardiovascular system and,
particularly, a higher stroke volume.
Stroke volume and cardiac output
Stroke volume is the amount of blood ejected by the left ventricle during
a contraction. A substantial increase is stroke volume is a long-term effect
of endurance training as more blood is able to enter the left ventricle in a
trained heart during diastole. Ventricles are enlarged by an increase in
blood volume. The enlarged ventricle causes contractions that are more
powerful, resulting in less blood remaining in the ventricles following
systole.

Cardiac output is the amount of blood ejected from the heart in one
minute. It increases in a trained athlete due to the increase in stroke
volume.
Oxygen uptake
Oxygen uptake is an athletes aerobic power which is their VO2 level. An
athletes max VO2 level is their maximum oxygen uptake by their
muscles. Oxygen uptake decreases by about 1% every year after the age
of 25, but aerobic training greatly influences this. Some increases in VO2
max can be due to an increased blood volume due to endurance training.
Lung capacity
Lung capacity is the amount of air the lungs can hold. Lung volumes and
capacity change little with training.
Vital capacity is the amount of air that can be expelled after a max
inspiration. This increases slightly due to training.
Residual volume is the amount of air that cannot be moved out of the
lungs and shows a slight decrease from training.
Tidal Volume is the amount of air breathed in and out during normal
respiration and in unchanged at rest, thought increases when at maximal
levels of exercises. This however is an immediate response rather than an
adaptation.
Hemoglobin level
Hemoglobin is the oxygen carrying agent in red blood cells. It increases
due to training to compensate in an increase in oxygen carrying capacity.
Training at high altitudes also aids in increasing haemoglobin levels.
General endurance programs increase haemoglobin levels from 800g1000g/100mL blood.
Blood pressure
The diastolic blood pressure remains almost unaffected by exercise;
however, the systolic pressure significantly rises. The overall effect on
blood pressure through exercise involves a lowering of blood pressure.

HOW CAN PSYCHOLOGY AFFECT PERFORMANCE?

Motivation
Motivation is an internal state, which activates, directs and sustains
behaviour towards achieving a goal.
Positive motivation occurs when the athlete performs because they have
received rewards for similar actions, and they realise that continuing to
perform as required will result in additional rewards.

Negative motivation can occur when an athlete may be inspired to

perform more from a fear of consequences of not performing than as a
result of motivated behaviour.
Intrinsic motivation is a self-propelling force that encourages athletes to
achieve because they have an interest in a task and enjoy the
movements. They are motivated by the need to be more competent
task orientation.
Extrinsic motivation arises from behaviours that result in some kind of
reward for the effort. It may be necessary to provide focus and lift
athletes to the levels they are capable of performing at. Sustained
motivation, however, relies more on internal factors.
Social, material and internal reinforcement
Social reinforcement emanates from coaches, other players and any
person who influences the athlete. It arises from social contact and
develops in an atmosphere of interaction, teamwork and co-operation. It
can be positive or negative.
Material reinforcement is conferred in the form of tangible items like
trophies. It can be positive or negative and is important while players are
in the developmental stages of learning games, but less important to
serious athletes.
Internal Reinforcement
Internal reinforcement is not visible like social or material. It is also called
covert or disguised reinforcement. It can result from any situation or
emerge from observation.
Anxiety is predominately a psychological process characterised by fear or
apprehension in anticipation of confronting a situation perceived to be
potentially threatening.
Trait anxiety refers to a general level of stress that is characteristic of
each individual. It varies according to how individuals have conditioned
themselves to respond to and manage stress. It is the athletes general
disposition to perceive a situation as threatening or non-threatening.
State anxiety is more specific. It refers to the emotional response of an
athlete to a particular situation. It refers to a heightened presence of
distress to a particular situation.
A state might be controlled by managing the situation.
A trait is controlled by the athlete.
Sources of stress
Stress is a non-specific response that the body makes to demands placed
upon it. Different types of stress include:

 Hyper-stress too much stress

Hypo-stress too little stress
Eustress good stress
Distress bad stress
Stress is very closely linked to state anxiety.
Optimum arousal
Arousal is the level of anxiety before or during performance. It is the
emotional, mental or physiological activation required to produce a
response. In terms of sport performance, it refers to the degree of energy
and release and the intensity of readiness in performers.
The inverted U hypothesis illustrates the connection between arousal and
performance. If, in A, performance may suffer due to lack of motivation,
disinterest, concentration and the inability to cope with distractions. B
shows a balance between level of motivation and ability to control
muscular tension, and is optimum arousal. If an individual is working in C,
their feelings would be characterised by anxiousness and
apprehensiveness resulting in poor performance. [See book for diagram]
Managing Anxiety

Concentration/attention skills
Mental rehearsal -has been shown to enhance not
only competition performance, but also the
acquisition and building of motor skills. A
commonly used technique in many forms of
physical activity, it involves the mental repetition
of a movement to increase the minds familiarity
with the desired motion. It relies upon the power
of imagery.
Visualisation
Relaxation
Goal-setting

HOW CAN NUTRITION AFFECT PERFORMANCE?

Balanced Diet

Is it adequate for performance needs?

Carbohydrates and fluids are the two most important considerations in a
balanced diet. Fluid is the bodys medium for cooling heated muscles and
ultimately preventing dehydration. It assists in temperature regulation by
transporting heart to outside the body. It is also important because it
prevents damage to organs, by diluting toxic waste, aiding oxygen
transport to cells, helping transport waste from the body, and helping
eliminate carbon dioxide.

The aim is to maximise glycogen and hydration levels. Glycogen levels

can be lowered by 55% as a result of sustained aerobic activity lasting
one hour and full depleted in a two hour session.
It is important to drink adequate fluid in the days preceding an event. This
will increase the bodys weight, particularly if glycogen has been
increased in the diet.
Supplementation
Supplement intake is routine for many competitors because it is believed
to improve athletic performance. However, a well-balanced diet can
provide all necessary vitamins and minerals.
Vitamins
Vitamins are required in only very small quantities in the body. They act
as catalysts that help the body use energy nutrients. They assist functions
as energy release, metabolic regulation and tissue building.
The body is unable to manufacture vitamins and food is the main source.
Some athletes are inclined to supplement even thought their normal diet
contains all the necessary vitamins.
The intake of excessive amounts of vitamins is not only unnecessary but
potentially dangerous. The body can store vitamins A and D which may
lead to muscle and joint pain. Overdoses of vitamin A can cause nausea,
loss of appetite, fatigue and skin dryness.
It is known that super-supplementation doesnt improve performance and
any need for supplementation is really a need to develop positive
nutritional habits.
Supplementation should not be a response to a desire for improved
performance, but rather arise out of special needs such as illness.
Minerals
Minerals belong to the group of micronutrients that are essential for the
body to function properly, but dont provide energy. Iron and calcium are
the two minerals that are commonly deficient in athletes and inadequate
supplies will affect performance.
Iron is found in hemoglobin in red blood cells. These cells collect and
transport oxygen. Diminished hemoglobin levels affect performance
because the muscles are deprived of oxygen.
Sports Anemia is a condition commonly associated with activity and is
most frequently experienced in the early stages of heavy training
programs and is characterised by lack of energy and fatigue. If training is
gradual, progressive and supported by a balanced diet, the condition
tends to subside. People most at risk of iron deficiency are:
Endurance athletes as a result of sweat loss
Females as a result of menstrual blood loss
Vegetarians as a result of a lack of red meat in
their diet
Adolescent males as a result of a growth spurt
Calcium deficiency is more specific to health. Calcium is vital for bone
structure. The quality of bone tissue deteriorates gradually from the age

of around the mid-twenties. Adequate calcium intake during childhood

and adolescence has a positive effect on bone quality during later life.
Athletes should look to dietary sources rather than supplements to gain
adequate calcium. People most at risk of calcium deficiency are:
Females as a result of an insufficient intake of
dairy
Females whose menstrual cycles have ceased,
leading to a loss of calcium from bone tissue
Carbohydrate loading
Carbohydrate loading involves furnishing the liver and muscles with extra
glycogen before an event because carbohydrates are lost readily through
activity. The process of exhausting muscles of glycogen makes them
increasingly hungry for it. In the glycogen-depleted state, muscles can
store more glycogen than normal.
Athletes involved in short-term, low-intensity activity do not need to
carbohydrate load. For endurance athletes, muscle saturation of glycogen
is best achieved through:
A balanced diet, focusing on food rich in
carbohydrates. Emphases should be on complex
carbohydrates.
Tapering of training in the week before
competition
Carbohydrate loading has the benefit of delaying the point at which the
muscles being repeatedly used run out of fuel. Different carbohydrates
affect energy levels in various ways. We now know that digestion rates
vary regardless of whether the food is labelled simple or complex.
Digestion rates are now expressed as a glycemic index. This ranks
carbohydrate-type food according to how they affect blood glucose levels.
Food that digests rapidly has a high glycemic index. Low glycemic foods
do not cause the large swings in blood sugar levels like high glycemic
food. The athlete can consume particular food according to when the
greatest benefit will be realised. High glycemic foods are most beneficial
as part of recovery, while low glycemic foods provide most benefit in the
pre-event phase.
Hydration
Principles of body temperature regulation
The bodys normal temperature is 37 deg. and it remains there because a
balance exists between the heat entering and leaving the body; heat gain
and heat loss.
Temperature Control
The hypothalamus is the bodys thermostat. It reacts when the bodys
temperature goes above or below its set point of 37.
Heat Balance Mechanism

Body temperature is kept within a small range despite large fluctuation in

atmospheric temperature. When the amount of heat produced is equal to
the amount of heat lost, the body is in a state of heat balance.
Heat Production
The body produces heat mainly through metabolic processes and
exercise.
Metabolism: major organs work continuously in performing their functions;
these tasks result in considerable heat production.
Exercise: skeletal muscle is able to produce heat rapidly, the more
vigorous the activity, the more heat that is able to be produced.
Heat Loss
Body heat is lost as a result of the following processes:
Radiation loss of heat in the form or infra-red
rays. Radiation accounts for 60% of heat loss.
Conduction transfer of heat from a boy to an
object through contact. Conduction accounts for
3% of heat loss.
Convection transfer of heat by a moving fluid
(body heating surrounding air). Convection
accounts for 12% of heat loss.
Evaporation sweating. It is only effective if the
sweat evaporates. Evaporation accounts for 12%
of heat loss.
Exercise and certain environmental conditions can
change the impact of these mechanisms.
Balancing Heat Production with Heat Loss
Circulating blood distributes heat within the body. By varying the quantity
of blood circulating just below the skin, the body can control the amount
of heat retained or lost. The body has two mechanisms that operate to
constrict or enhance the dissipation of heat: vasoconstriction and
vasodilation. The type of vessel affected is usually a small artery.
Vasoconstriction results in less blood and thus less heat circulating under
the skin. It operates whenever core temperature goes below the set point.
Its functioning accelerates if body temperate decreases rapidly, as is the
case with hypothermia.
Vasodilation increases blood flow from the body core to its surface. The
body uses vasodilation to cool itself down as the core temperature rises. It
is operating constantly if core temperature is above the set point but
ceases to function in cases of severe hyperthermia.
These mechanisms arent exclusively related to extreme changes of body
temperature. They operate reflexively during the day when our core
temperature can vary by 1 deg. and in response to movement changes
such as beginning vigorous exercise. They work together to direct blood
flow to where it is needed.
Guidelines for Fluid Replacement

57% of the total body weight of the average person is water. Exercise in
the heat can make it difficult for the body to maintain its heat balance.
Moisture loss through evaporation can range from 0.5L-4.2L/hour. The
body loses its main cooling aid through perspiration, causing progressive
rises in core temperature. The most important cooling mechanism during
physical activity is the evaporation of sweat.
Environmental warmth and humidity may limit the bodys ability to
dissipate heat. Humidity prevents evaporation. Exercise in times of high
temperature and humidity is to be avoided because it places the athlete
at greatest risk.
The role of water in temperature regulation is critical. Blood plasm is 90%
water. A reduction in water lowers plasma levels and causes blood
pressure to decrease. This results in less blood being available to the
muscles. Reduced plasma volume also affects the bodys circulatory
function because plasma is the medium for carrying red blood cells,
nutrients, carbon dioxide, waste and hormones around the body. The
production of water doesnt keep pace with fluid loss. The loss rate can
exceed the metabolic production rate by 10 times. Minimal fluid loss
affects endurance performance.
The amount of sweat depends upon:
Metabolic rate
Body size
Environmental temperature
Progressive water loss produces the following symptoms:
1% loss- thirst
5% loss- discomfort and decline in aerobic effort
10% loss-breakdown in coordination
20% loss- upper limit of dehydration before death
Sweating causes some loss of electrolytes, while continued profuse
sweating leads to dehydration.
Dehydration is characterized by:
Increase in pulse rate
Increase in core body temperature
Decrease in blood pressure
Decrease in water in the cells
Gradual decline in circulatory function.
Hydration and Heat Disorder Prevention
Hydration involves not only the supply of sufficient fluid, but also the
development of mechanisms to keep fluid loss to a minimum during
exercise. The following are the most important:
Hydrate before, during and after activity
Drink every 15-20 minutes while running
Drink water of low-carbohydrate concentration
sports drinks
Train properly and acclimatise to race conditions
Wear clothing that breathes

Avoid activity in times of high temperature and

high humidity
Avoid two consecutive days of competition or
training with high fluid loss
Avoid excess fat and any salt, alcohol or coffee
Do not run if suffering from a fever
Learn to recognise the symptoms of dehydration.

HOW DOES SKILL ACQUISITION AFFECT PERFORMANCE?

The Learning Process

A cyclic process
A skill is about achieving a goal while:
Maximising the achievement certainty
Maximising the physical and mental energy costs
of performance
Minimizing time
Learning a skill involves four main steps
1 Perceiving comes in the form of information called
cues. Data arrives at the brain via the senses.
Messages travel rapidly to the brain which
transcribes the data into a visual blueprint. Hence
the person develops the perception of what needs
to be done. (Input)
2 Deciding is when the brain interprets and codes
the details so they can be used in a meaningful
way. It needs to work out how to convert the cues
into an appropriate physical response. (Process)
3 Acting is the neuromuscular system guides the
person in making the desired movement. This is
called the output. (Output)
4 Feedback is the relationship between feedback
and the necessary action is important.

If the action is highly unsuccessful, then feedback

should suggest that the learner substitute or
replace the action
If the action is unsuccessful, then feedback should
suggest that the learner modify the action
If the action is successful, then feedback should
suggest the learner repeats the action

Characteristics of the Learner

Personality develops as a result of the individuals infinite social
interactions and learning experiences.
The manner in which personality blends with learning is often seen in an
athletes behaviour. Certain aspects of personality tend to be more
favourable with certain learning environments.
Heredity- Individuals are endowed with certain characteristics inherited
from their parents. These are unchangeable and will limit the dimensions
of their potential. The following important hereditary characteristics will
influence success of otherwise in specific athletic events:
The relative percentage of fast-twitch to slow-twitch fibres athletes with
a high percentage of fast-twitch fibres will be more suited to sprint and
explosive events
Somatotype the tendency towards ectomorphy,
mesomorphy or endomorphy determines an
individuals suitability for many activities
Gender higher levels or testosterone in males
give them the potential to make greater increases
in strength and power than females
Height differences in height provide
considerable physical and biomechanical
advantages to some players
Conceptual ability the ability to visualise a
movement and make it materialise is a significant
factor
Self-confidence is critical not only to improvements in skill acquisition, but
also to the performance of many tasks faced in everyday living. It
develops from experiencing success in learning situations.
Prior experience- If an individual earlier learnt a movement that is similar
to one being taught, they can accelerate the learning process. It is
commonly referred to as the transfer of learning.
Ability is seen in the way in which an individual is able to learn, process
and implement new skills. It incorporates a range of factors like sense,
acuity, perception, reaction time and intelligence.
The Learning Environment
The physical environment is the surrounding conditions under which a
skill is being performed. The physical environment can affect interest and

level of motivation. It may impose restrictions, like making it dangerous to

execute certain skills or limiting playing time.
Nature of skill

Open and Closed Skills

Open skills occur in an environment that is
unpredictable and frequently changing.
Closed skills occur in an environment that id
stable and predictable.
Gross Motor and Fine Motor Skills
Gross motor skills are commonly found in team
games and many competitive and recreational
activities like bushwalking and skiing. They
involve large muscle groups
Fine motor skills are found in activities that
require finesse and limited movement. The
execution of these movements requires precision
and exactness, controlled by the smaller muscle
groups.
Discrete, Serial and Continuous Skills
Skills can be classified as discrete, serial or
continuous according to where they begin and
end. Discrete skills have a distinct beginning and
end that can be identified.
Serial skills involve a sequence of smaller
movements that are assembled to form as skill.
Continuous skills have no distinct beginning or
end.
Self-paced and Externally-paced Skills
Pacing refers to the performers control over the
timing of skill execution. Self-paced skills are
movements for which the performer determines
the timing and speed of execution.
Externally-paced skills are movements for which
an external source controls the timing.

Practice method
Massed practice involves a continuous practice session, with the rest
intervals being shorter than practice intervals. It works best when
performers are:
Highly motivated
Fresh
Unable to attend a number of sessions
Distributed practice involves a number of broken practice sessions with
the intervals of rest being longer than the practice intervals. It works best
when:
Performer lacks interest

The task is difficult

Motivation is low
Task causes fatigue
Excessive work causes discomfort

Whole practice is applied when a skill is practiced in its entirety.

Part practice is when a skill is broken down into smaller components and
each is practiced separately.
Feedback has three functions:
To reinforce what is being performed successfully
To provide a basis for correcting performance
aspects that need improvement
To motivate the performer for continued effort and
improvement
Internal and External Feedback
Internal feedback is received through the bodys proprioceptive
mechanisms. This is made possible by the neuromuscular system sending
messages to the brain about how the movement is being performed.
External feedback is derived from outside sources during performance of
a skill. While it may vary in nature, its origin will be from outside the body.
Concurrent feedback is received during the performance of the skill by the
proprioceptive mechanism relaying it throughout the body.
Delayed feedback is received after the skill has been executed.
Knowledge of results is information about the outcome of a movement. It
suggests how successfully the skill was performed. It is always external.
Knowledge of performance is information about the pattern of the
movement during execution. It gives feedback on the quality of the
execution of the skill and may be external or internal.

Stages of Skill Acquisition

Cognitive
The fundamental requirement here is that the player gains an
understanding of the task required. Conceptualisation is essential for
good movement reproduction. If difficulty is experienced the skill could be
broken into smaller movements for practice.
Associative
The learner needs to repeat the movement to enhance the
synchronisation of their mind and muscles. Errors tend to be smaller and
less frequent here than in the cognitive stage. Practice will improve the

way the skill is performed and the learner will eventually experience some
success.
Autonomous
The autonomous stage is characterised by the ability to automatically
execute the skill. Execution of the movement is now properly sequenced
and performed instinctively. Most important feature of performers in the
autonomous stage is that they are able to attend to other cues while
giving little thought to how to perform the skill.
Rates of Skill Acquisition
Learning curves and plateaus illustrate the relationship between practice
and performance; they reveal how performance alters as a result of
practice.
The linear curve demonstrates that performance improves as practice
increases. This is due to:
High motivation
Positive coaching
Stimulating environment
Performers interest
Simplicity of skill
The Negatively Accelerated Curve-This curve shows that practice was
highly successful in the early stages, and then tapered off. It suggests
that learning has slowed and performance levelled. This is possibly due
to:
Physical fatigue
Loss of interest
Loss of motivation
Lack of physical condition
Other demands on the learner
Boredom
Limited ability of coach to assist
Use of substandard equipment
The Positively Accelerated Curve- This curve shows only small gains in the
early sessions, but significant improvement in the later stages. This could
reflect:
Increasing task complexity
Information overload
Learner gradually developing interest and
motivation
The S-Shaped Curve- This curve is a combination of positively and
negatively accelerated curves. Periods of rapid learning are interspersed
with periods of only gradual progress. Reasons for this include:

Mix of simple and complex tasks

Learners inability to focus for long periods
Learners need for constant motivation

The learning plateau involves observable levelling-off of the learning

curve to a point where it is virtually horizontal. It indicates little learning is
occurring. It can occur for a number of reasons, including:
Lack of practice
Declining interest
Lack of motivation
Injury
Time given to other sports
Poor grasp of skill fundamentals
Implications of rate of learning
Some skills are easy to acquire, while others remain difficult. Some
learners progress much faster than other. Solving small problems in the
initial stages could result in rapid learning of the rest of the skill.
Skilled Performers Vs. Unskilled Performers
Kinesthesis is an awareness of muscular effort during movement.
Inexperienced performers make mistakes because their muscle memory
isnt full developed, but highly skilled performers are especially alert to
movement area and are able to make corrections while executing the
movement.
Anticipation and timing- Skilled performers are better able to predict what
may happen in specific situations. This allows them added time in which
to respond. A skillful player can vary the pace of a movement to prevent
an opponent from anticipating an action.
Timing applies to skill execution and largely depends on temporal
patterning to do so. It can also apply to the performers ability to position
them to enable skill execution in the best possible manner.
Mental approach- Achievements of skilled players are attributable to both
physical effort and a highly trained mental approach. Skilled performers
can:
Recognise and respond to only relevant cues
Respond to multiple cues
Develop motor imagery or mental rehearsal
techniques
Develop high levels or internal motivation
Realise the importance of optimal arousal and use
it
Establish goals and feel a desire to achieve them
Use the benefits of experience to advantage

Anticipate what is going to happen

Skilled performers exhibit the ability to focus.

Consistency- Skilled performers show much more consistency than
unskilled performers. The skilled performer is able to perform the desired
movement repeatedly.
Objective Measurement of Skill- Measurement is the process of using
numeric information to assess a particular physical ability.
Where measurement is not part of the process of gathering information,
assessment of the performance tends to be subjective and less accurate.
The use of instruments such as measurement tape and stopwatches
makes data more credible by eliminating guesswork; it increases the
degree of objectivity. A completely objective observation occurs when
judges apply the same criteria to measure a performance and do not need
to interpret information. Observations can be made more objective by
using:
Check lists
Measurement systems
Established criteria
Rating scales
Skill related tests are tests designed to measure how well an individual is
able to execute a specific motor skill. To be recognised and accepted,
tests need to:
Have a set of procedures for people to follow
Use techniques that incorporate objective
measurement devices
Have an established set of norms or averages
Be a valid test
Validity and reliability of tests- Establishing validity is about determining
the strength of a relationship between a performance component and a
test designed to assess that component. The ranges of techniques
commonly used to enhance the validity of a test include:
Judgements about the test items
Using already validated but similar tests as an
indicator
Accuracy prediction
Ensuring test items contain the component being
validated
A test can be proved to be reliable if the same tester repeats the same
test on the same subject under the same conditions and equipment as
originally prescribed and gets similar results.
Judging the Quality of Performance- Adjudicators attempt to increase the
objectivity of assessment procedures by placing numeric values on a
movement component so it can be compared to other movements.

However, while highly objective procedures are used for judging most
activities, a degree of subjectivity exists in seeing and appreciating the
performance before transcribing it as a numerical value.
Characteristics of skilled performance
In a skilled performance, the player demonstrates the ability to:
Anticipate responses and react to them quickly
Coordinate movements
Time movements
Focus on tactics and strategies
Execute skills with ease
Adapt and modify movements
Perform consistently and at a high level
Gain the desired outcome from demonstrated
movements
Exhibit aesthetically pleasing actions
Reveal resourcefulness in having a range of
options
Make time to perform movements
Outcomes of skilled performance- A skilled performance has many
positive outcomes for the performer. The long-term outcomes may
include:
Financial remuneration
Increased self-confidence and self-esteem
The desire to improve skills
Improved ability to analyses and evaluate
performances
The ability to transfer proficiency
The ability to make an informed critical evaluation
of the performances of others
Increased Motivation
Negative outcomes may also result. These can include:
Increased media profile
High expectations to perform
Feelings of pressure to use performanceenhancing drugs
Personal criteria are the preconceived ideas or expectations that an
individual brings to judge a performance.
Prescribed criteria are established by a sports organisation or body, and
form the basis of assessment for competitions in that sport or activity. For
organized competitions, judges are usually supplied with prescribed
criteria well before the event.