HHD Units 1+2 Textbook

Key Concepts in VCE
Health & human

development
Units 1 & 2
fourth EDITION
Key ConCepts in vCe
HealtH & Human

development
fourth EDItIoN
Units 1 & 2
Andrew BEAUMOnt
Meredith FEttLinG
Fourth edition published 2016 by

John Wiley & Sons Australia, Ltd
42 McDougall Street, Milton, Qld 4064
First edition published 2010
Second edition published 2012
Third edition published 2014
Typeset in 10.5/12 pt ITC Berkeley Oldstyle Std
Andrew Beaumont, Lee-Anne Marsh, Agatha Panetta, Meredith Fettling 2010, 2012
John Wiley & Sons Australia, Ltd 2014, 2016
The moral rights of the authors have been asserted.
National Library of Australia
Cataloguing-in-publication data
Creator:
Beaumont, Andrew, author.
Title: Key concepts in VCE health & human development units 1 & 2/ Andrew Beaumont;
Meredith Fettling.
Edition:
Fourth edition.
ISBN:
978 0 7303 2223 8 (set)

978 0 7303 2769 1 (paperback)

978 0 7303 2218 4 (eBook)

978 0 7303 2460 7(studyON)
Notes:
Includes index.
Target Audience: For secondary school age.
Subjects:
Public healthAustraliaTextbooks.
HealthTextbooks.

Victorian Certificate of Education examinationStudy guides.
Other Creators/
Contributors: Fettling, Meredith.
Dewey Number: 613
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Contents
About eBookPLUS and studyON
Acknowledgements
Unit 1 The health and development

of Australias youth
Chapter 1 The individual human development of
Australias youth
1.1 The human lifespan: an overview
1.2 Exploring individual human development: physical
ix
x
1
2
4
9
1.3 Individual human development during youth: physical
12
1.4 Exploring individual human development: social
17
1.5 Exploring individual human development: emotional
21
1.6 Exploring individual human development during youth: intellectual
25
1.7 Exploring the interrelationships between the areas of

individual human development
28
1.8 The impact of biological determinants on youth development

30
KEY SKILLS The individual human development of
Australias youth37
Chapter 1 review41
Chapter 2 The health of Australias youth44

2.1 What is health?
46
2.2 The health status of Australias youth
54
2.3 The health status of Australias youth: morbidity and burden of disease
60
2.4 The impact of biological determinants on youth health
65
2.5 Understanding the interrelationships between health and individual

human development during youth
70
Key SKILLS The health of Australias youth72
Chapter 2 review78
Chapter 3 Nutrition during youth80

3.1 Introduction to the nutrients required during youth: carbohydrates,
protein and fats
82
3.2 Introduction to the nutrients required during youth: water, calcium and iron
89
3.3 Introduction to the nutrients required during youth: vitamins A, B, C and D
94
3.4 The interrelationship of major nutrients
98
3.5 Consequences of nutritional imbalance
105
3.6 Food selection models as tools to promote healthy eating during youth
109
Key SKILLS Nutrition during youth117
Chapter 3 review120
Chapter 4 The determinants of health and individual human

development of Australias youth122
4.1 Determinants of health and individual human development during
youth: four categories
124

youth: behavioural
127

youth: physical environment
136
Contents v

youth: social environment
140
KEY SKILLS The determinants of health and individual
human development of Australias youth148
Chapter 4 review150
Chapter 5 Health issues facing Australias youth152

5.1 Health issues facing Australias youth
154
5.2 A health issue in focus: anxiety and depression, part 1
165
169

174
KEY SKILLS Health issues facing Australias youth180
Chapter 5 review187
Unit 2 Individual human development and

health issues
189
Chapter 6 Health and individual human development during the

prenatal stage of the lifespan190
6.1 Fertilisation192
6.2 Prenatal development
195
6.3 The health status of Australias pregnant women and unborn babies
201
KEY SKILLS Health and individual human development during
the prenatal stage of the lifespan208
Chapter 6 review210

development during the prenatal stage212
7.1 Determinants of health and individual development during the
prenatal stage of the lifespan: biological
214

prenatal stage of the lifespan: behavioural
219

prenatal stage of the lifespan: physical environment
227

prenatal stage of the lifespan: social
231
7.5 Determinants that act as risk and/or protective factors in relation

to one health issue
234
7.6 Strategies and programs designed to promote prenatal health and

individual development
242
KEY SKILLS The determinants of health and individual human
development during the prenatal stage247
Chapter 7 review250
viContents
Chapter 8 The health and individual human development of

Australias children252
8.1 Principles of individual human development
254
8.2 Development during infancy
258
8.3 Development during early childhood
262
8.4 Development during late childhood
265
8.5 The health status of Australias children: mortality
268
8.6 The health status of Australias children: morbidity

272
KEY SKILLS The health and individual human development of
Australias children278
Chapter 8 review280

development of Australias children282
the childhood stage of the lifespan: biological
284
9.2 Determinants of health and individual human development of children:

behavioural293
9.3 Determinants of health and individual human development of children:
physical environment
306
9.4 Determinants of health and individual human development of

children: social
312
9.5 Determinants that act as risk and/or protective factors for asthma
320
9.6 Determinants that act as risk and/or protective factors for falls
and injuries
323
9.7 Determinants that act as risk and/or protective factors for food allergies
326
9.8 Determinants that act as risk and/or protective factors for juvenile
arthritis328
9.9 Determinants that act as risk and/or protective factors in relation to
type 1 diabetes
331
9.10 Government strategies and programs designed to promote the health

and individual human development of children
334
9.11 Community and personal strategies and programs designed to promote

the health and individual human development of children
341
KEY SKILLS The determinants of health and
individual human development of Australias children344
Chapter 9 review349
Chapter 10 The health and individual human development of

Australias adults354
10.1 Early adulthood: physical, social, emotional and intellectual development
356
10.2 Middle adulthood: physical, social, emotional and intellectual development
360
10.3 Late adulthood: physical, social, emotional and intellectual development
364
10.4 The health status of Australias adults

369
KEY SKILLS The health and individual human development of
Australias adults377
Chapter 10 review379

development of Australias adults382
11.1 Biological determinants: genetics, body weight, blood pressure and
blood cholesterol
384
11.2 Behavioural determinants: sun protection and tobacco smoking
392
11.3 Behavioural determinants: physical activity
396
11.4 Behavioural determinants: food intake
398
Contents vii
11.5 Behavioural determinants: alcohol use
402
11.6 Behavioural determinants: drug use
406
11.7 Behavioural determinants: sexual practices
409
11.8 Physical environment determinants: housing and workplace safety
412
11.9 Physical environment determinants: neighbourhood safety and access

to health care
416
11.10 Social determinants: the media, level of education, employment status

and income
421
11.11 Social determinants: the workplace and community belonging
425
11.12 Social determinants: living arrangements and social support
429
11.13 Social determinants: family and worklife balance

432
KEY SKILLS The determinants of health and individual human
development of Australias adults436
Chapter 12 Health issues facing Australian adults444

to obesity
446

cardiovascular disease
449

to cancer
453

type 2 diabetes
456

mental illness
459
12.6 Government strategies and programs to promote health and individual

human development of adults
463
12.7 Strategies and programs designed to promote health and individual

469
KEY SKILLS Health issues facing Australian adults472
Index476
viiiContents
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AAPEC: 245 AIHW: 75, 130, 137, 155, 155; 161/Young
Australians: their health and wellbeing 2011, Fig. 17.1, p. 81,
Australian Institute of Health and Welfare; 180, 181, 183, 201,
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Pty Ltd: 23/Heide Benser; 468/Paul Doyle Andrew Beaumont:
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could pinpoint the end of adolescence by Andy Coghlan 200501-08 Vic Roads: 338 VCE Health and Human Development
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Acknowledgements xi
Chapter ????
The determinants of health and

of Australias youth
Unit 1
THE HEALTH AND DEVELOPMENT

OF AUSTRALIAS YOUTH
AREA OF STUDY
1 Understanding youth
health and human
development
Outcome
Describe the dimensions of, and the interrelationships within and between, youth
health and individual human development, and analyse the health status of
Australias youth using appropriate measurements.
2 Youth issues
Describe and explain the factors that have an impact on the health and individual
human development of Australias youth, outline health issues relevant to
Australias youth and, in relation to a specific health issue, analyse strategies or
programs that have an impact on youth health and development.
CHAPtEr 1
The individual human

development of Australias
youth
WHY iS tHiS iMPOrtAnt?
Individual human development is a constant process
that starts with conception and ends with death. The
youth stage of the lifespan is one of great change and
significant development. Having an understanding of the
development that occurs during this stage can provide an
insight into the triumphs and challenges experienced by
many youths.
KEy KNOWLEDGE
1.1 definitions of physical, social, emotional and intellectual development
(pages 411, 17, 212, 256, 41)
1.2 characteristics of, and interrelationships between, physical, social,
emotional and intellectual development during the lifespan stage of
youth (pages 929, 41)
1.7 biological determinants of individual human development of
Australias youth including genetics, body weight and hormonal
changes (pages 306, 412).
KEy SKILLS
define individual human development (pages 11, 37, 39, 42)
describe characteristics of, and interrelationships between, the
differenttypes of individual human development during the lifespan
stage ofyouth (pages 11, 16, 19, 20, 23, 24, 27, 29, 36, 3740)
explain the biological determinants of health and development
anddiscuss the impact on the development of youth (pages 36,
3840,42).
FigUrE 1.1 Development

becomes more obvious as people
age.
Unit 1 The health and development of Australias youth
KEY TERM DEFINITIONS

abstract thought a complex thought process where ideas are the focus rather than
tangible objects
adolescent growth spurt a period of rapid physical growth experienced during puberty
biological determinants factors relating to the body that affect health (e.g. genetics,
hormones, body weight)
body mass index (BMI) a measure of body mass to height, used to ascertain overweight
and obesity levels
complexity the quality of being intricate or complex
concrete thought a simple thought process that centres on objects and the physical
environment
determinants of health factors that raise or lower the level of health in a population or
individual. Determinants of health help to explain or predict trends in health and why some
groups have better or worse health than others (AIHW, 2006).
developmental milestone a significant skill or event occurring in a persons life: for
example, learning to walk, getting a job or having children
ejaculation the process whereby semen is ejected from a males penis
embryo a developing human from around the second week of pregnancy until the end of
the eighth week
emotional development the development of the full range of emotions and the optimal
way of dealing with and expressing them
fertilisation the point in time when the sperm fertilises the egg, the genetic material fuses
and development begins
fine motor skills the manipulation and coordination of small muscle groups such as those
in the hands
genetic potential the genetic capabilities and limitations of an individuals genetic make-up
gross motor skills the manipulation and coordination of large muscle groups such as
those in the arms and legs
hormone a chemical messenger that results in changes in the body
individual human development the series of orderly, predictable changes that occur
from conception until death. Development can be physical, social, emotional or intellectual.
intellectual development the development of processes in the brain such as thought,
knowledge and memory
menarch the first occurrence of menstruation in females
menstruation the discharge of blood and other tissue from the uterus that marks the
beginning of the menstrual cycle
metabolism the sum of all chemical reactions in the body. It allows body structures to
carry out their functions.
nutrient dense describes foods that contain a large amount of nutrients such as vitamins
and minerals
period see menstruation.
physical development changes to the body and its systems. These can be changes in size
(i.e. growth), complexity (e.g. the increase in complexity of the nervous system) and motor
skills (e.g. learning to walk).
primary sex characteristics body parts that are directly involved in reproduction and form
what are commonly referred to as genitals and organs of reproduction
puberty biological changes that occur during youth and prepare the individual for sexual
reproduction
rite of passage a cultural event or ceremony that signifies an achievement in a persons
development
secondary sex characteristics traits arising from changes in both males and females at
puberty. They are neither directly related to reproduction nor present at birth.
semen a substance containing sperm and fluids that is released from the penis during
ejaculation
social development the increasing complexity of behaviour patterns used in relationships
with other people (VCAA)
sperm a component of semen. Sperm are the male sex cells required for reproduction.
spermarche relating to the first ejaculation in males
youth 12 to 18 years of age; however, it should be acknowledged that classifications for
the stage of youth can differ across agencies (VCAA)
1.1
The human lifespan: an overview
KEY CONCEPT Understanding the stages of the human lifespan
An understanding of the human lifespan and the various stages within it allows
analysis and discussion of health and individual human development that occurs
for people at different times throughout their lives.
The human lifespan can be broken up into different stages (figure 1.2), although
different cultures and societies have different ways of defining the stages. One thing
that all groups agree on is that the human lifespan starts at conception and ends
at death. In Australian society, as in most Western societies, there are a number of
stages that humans go through as they get older.
Late
adulthood
Prenatal
Middle
adulthood
Infancy
Early
childhood
Late
childhood
Early
adulthood
Youth
Figure 1.2 Stages of the human

lifespan
Prenatal
The prenatal stage begins when a sperm penetrates an egg (figure 1.3) in a process
known as fertilisation, to form one complete cell, called a zygote. The prenatal
stage continues until birth and is characterised by the development of the bodys
organs and structures, and substantial growth. The unborn baby goes from being
a single cell (smaller than a quarter of a millimetre across) to consisting of more
than 200 billion cells at birth and weighing around 3.5 kilograms on average. This
process takes about 38 weeks to complete. In terms of rate of growth, the prenatal
stage is by far the fastest growth period of all the human lifespan stages. It is also
one of the most uncertain in terms of making it all the way through the pregnancy
and the process of birth.
4UNIT 1 The health and development of Australias youth
The term infant comes

from the Latin infans, which
translates to without speech or
unable to speak.
Figure 1.3 The prenatal stage

begins when one sperm penetrates
the egg.
Infancy
As with most lifespan stages, there is debate about when infancy finishes. Everyone
accepts that it starts at birth, but when does the infant become a child? Historically,
infancy was considered to continue until the onset of speech. However, because
infants can vary greatly in the time at which they start speaking, many organisations
and professionals in this field have adopted the view that this stage ends with the
second birthday (approximately). Therefore we will also use the second birthday as
signifying the end of the infancy period.
Infancy is a period of rapid growth with many changes. A newborn baby is
obviously very different from a two year old. By the time an infant turns two, they
have developed their motor skills and can walk, use simple words, identify people
who are familiar to them, play social games and throw tantrums when they do
not get what they want.
Many of the developmental milestones that the infant achieves will have some
sort of bearing on how they develop in later years. This concept will be explored in
more detail in later chapters.
Childhood
Like infancy, the start and end of the childhood stage is a difficult thing to define.
Most people say that it ends at the onset of puberty. As the age of the onset of
puberty shows great variation among individuals, this study uses the 12th birthday
to signify the end of childhood.
The development that occurs in childhood is substantial, so it is worthwhile
considering this lifespan stage as being divided into early childhood and late
childhood.
Early childhood
Early childhood starts at the end of infancy and continues until the sixth birthday.
This stage is characterised by slow and steady growth, and the accomplishment of
many new skills. The child learns social skills that will allow them to interact with
other people. They will make friends, be able to eat with adults at the table and
become toilet trained.
Figure 1.4 Learning to ride a bike is

a milestone for most children.
The individual human development of Australias youth CHAPTER 1 5
Late childhood
Late childhood starts at the sixth birthday and ends at age 12. Like early childhood,
late childhood is characterised by slow and steady growth. There are many physical,
social, emotional and intellectual changes that occur as the child moves through
this stage. These include refining reading and writing skills, developing long-term
memory, understanding gender stereotypes and refining motor skills.
Youth
The youth stage of the lifespan has steadily lengthened over the past 100 years.
This has resulted from puberty starting earlier, and young people taking longer to
gain independence and reach maturity in other aspects of their lives. As a result,
the youth stage of the lifespan is perhaps the hardest to define. We will assume
that youth starts at 12 years of age and continues until 18, although this may vary
depending on the research used. The youth stage is characterised by rapid growth,
increased independence and sexual maturity.
This stage of the lifespan is concerned with moving from childhood to adulthood.
Youth must undergo vast physical changes in order to achieve sexual maturity, and
therefore the ability to reproduce. Youth will also undergo significant social, emotional
and intellectual changes as they become accustomed to greater independence, more
complex relationships and the development of life goals (figure 1.5).
The end of youth is characterised by a level of maturity in the physical, social,
emotional and intellectual changes that have been occurring.
Figure 1.5 Friends play an

influential role in development during
youth.
The terms adolescent and adult come from different forms

of the Latin word adolescere, meaning to grow up. For
adolescent and adult, it means growing up and grown up
respectively.
The term adolescence has generally come to mean the
period between the onset of puberty and the cessation of
growth (i.e. physical maturity). As society has changed over
the years, the physical changes are seen as being only one
aspect of the transition between childhood and adulthood.

Young people now spend more time reaching maturity in
other areas such as tertiary study, finding a career, living
with their parents and gaining financial independence.
As a result, the term youth is now more commonly used
to describethe stage between childhood and adulthood
because it encompasses all the changes experienced during
this transition, not simply the physical changes.
Early adulthood
Early adulthood begins on the 18th birthday and ends on the 40th birthday.
Physically, this stage is characterised by the body reaching its physical peak around
2530 followed by a steady decline in body systems thereafter. Some growth
may continue at the beginning of early adulthood, but all stages of adulthood are
essentially periods of maintenance and repair as opposed to the periods of growth
experienced in the earlier lifespan stages.
People in this age group often decide on a career and may become quite career
focused. Young adults may also choose their life partner, get married and/or have
children. These events lead to many physical, social, emotional and intellectual
changes.
Case study
Bedtimes could pinpoint the

end of adolescence
Andy Coghlan
The end of puberty, or sexual maturation, is well
defined. It is the point when bones stop growing.
But for adolescence, the transition from childhood to
adulthood, there is no clear endpoint.
I dont know of any markers for it, says Till
Roenneberg of the Centre for Chronobiology at the
University of Munich in Germany. Everyone talks
about it but no one knows when adolescence ends. It
is seen as a mixed bag of physical, psychological and
sociological factors.
[The study of 25000 individuals of all ages] reveals
a distinct peak of night-owlishness at around age 20.
Women reach this peak at 19.5 years old on average,

and men at 20.9 years. After that, individuals gradually
return to earlier and earlier sleeping patterns, until
things go haywire in old age.
Roenneberg, thinks that the peak in lateness is
the first plausible biological marker for the end of
adolescence.
If it is a physiological effect, forcing teenagers
to get to school for, say, 8 am, could be a mistake,
Roenneberg says. They probably take nothing in for
the first two lessons because they are still in biological
sleep time, and end up with a horrendous sleep deficit
by the weekend.
Source: Edited extract from New Scientist, 8 January 2005.
2005 Reed Business Information UK. All rights reserved.
Distributed by Tribune Media Services.
Case study review

1 What aspect of sleeping patterns may signify the end of adolescence
(youth) according to the study?
2 Discuss why starting school at 8 am could be a mistake for adolescents.
3 (a) Create a survey that could be used to find out about the sleeping
patterns of youths and young adults. Some questions to consider are:
What time do you go to bed?
What time do you wake in the morning?
Do you sleep during the day as well? If so, for how many hours?
Do you get sleepy during the day?
How do your sleeping patterns change on the weekend compared
to Monday to Friday? What about your holiday sleeping patterns?
Figure 1.6 Sleeping is important to most
adolescents.
(b) Hand the surveys out to people in the youth stage (your class could
be a good place to start) and to those in their 20s and 30s.
(c) Collate and present the results (graphs and tables are useful for this). Be sure to include the total number of hours
of sleep for each person and the average for each age group.
(d) Did you find any patterns or trends in the results?
(e) Did they support the findings of the study in Europe?
Middle adulthood
Middle adulthood begins at 40 and continues until the 65th birthday. The events
that occur during this period vary from culture to culture and from individual to
individual.
Some of the more common characteristics of this lifespan stage include stability
in work and relationships, the further development of identity including the
maturation of values and beliefs, financial security, physical signs of ageing and,
for women, menopause. During this stage, an individuals children may gain
independence and leave home, giving the parent a new sense of freedom. Sometimes
this can also create a sense of loss or loneliness, often referred to as empty nest
syndrome. Many individuals in the middle adulthood stage will experience the
joy of becoming grandparents for the first time, although this can occur in late
adulthood as well.
Late adulthood
Figure 1.7 Late adulthood is often
characterised by increased leisure
time.
Late adulthood, the final stage of the lifespan, occurs from the age of 65 until death.
This period is characterised by a change in lifestyle arising from retirement and
financial security (for most). It can include greater participation in voluntary work
and in leisure activities such as golf and bowls (figure 1.7). Many older people may
also have to endure the grief associated with the death of friends or a spouse.
As health begins to decline significantly, older people tend to reflect on their lives
and achievements. This may provide a sense of satisfaction or regret, depending on
how they assess the choices they have made in their lives.
TEST your knowledge
APPLY your knowledge
1 (a) When does the human lifespan start?

(b) When does it finish?
2 (a) What are the stages of the human lifespan?
(b) When does each stage start and finish?
(c) i. Which lifespan stage is the longest?
ii. Would this be the same for everyone?
Explain.
(d) Why are the starting and end points of some
lifespan stages difficult to classify?
3 Discuss the difference between youth and puberty.
4 Why is it difficult to pinpoint the end of youth?
5 (a) Why has the period of youth been getting
longer over the past 100 years?
(b) How many of these reasons relate to the
physical changes that occur during youth? What
aspects of life do they relate to?
6 What developmental milestones are used to signify
independence?
7 Why might other cultures define stages of the

lifespan differently?
8 (a) How might the experiences of youth in Australia
differ from the experiences of youth in a country
like Ethiopia in Africa?
(b) Are there any experiences you think are
common to youth across the world?
9 (a) Brainstorm factors that may affect the age at
which a person reaches their physical peak.
(b) How could someone prolong their peak physical
condition?
10 Work individually or with a partner to identify key
words you would use to explain each lifespan stage.
(a) What sort of words did you come up with for
each stage?
(b) Were the words used for each lifespan stage
positive or negative?
(c) Where do you think these ideas come from?
(d) Would they be the same if someone from
another culture played this game? Why?
11 Design a concept map that summarises three
aspects for each lifespan stage that you think
help define the stage. Images from newspapers,
magazines and/or the internet can be used for this
activity.
1.2
Exploring individual human development: physical
KEY COnCEPt Understanding the characteristics of the physical area

of individual human development
Individual human development encompasses the changes that people experience
from conception until death. Development is often characterised by milestones that
are predictable and occur in a sequential order. Going through puberty, learning
to walk or learning the skills required to interact with others are examples of
milestones associated with individual human development.
In this course, we will examine four types or areas of individual human
development (figure 1.8). All four types are interrelated and therefore affect each
other. We will explore these relationships in more detail later. In the coming
sections, we will explore each type of development and the common characteristics
of each type among youth.
Interactivity
Time Out: Development
Searchlight ID: Int-1429
Physical development
Physical development refers to the changes that occur to the body and its systems.
It includes external changes that you can see, such as changes in height, and
internal changes you cannot see, such as the increasing size of the heart. Physical
development includes growth as well as motor skill development. Various aspects
associated with physical development are summarised in figure 1.9.
Physical
development
Physical
Intellectual
Social
Emotional
Growth
e.g. people get
bigger until the
end of puberty
FigUrE 1.9 Aspects of

physical development
Changes to body systems

e.g. the increase in complexity
of the brain, changes to sex
organ function during puberty,
and the decline of body systems
Motor skill
development
Fine motor skills

e.g. writing, cutting with
scissors, tying shoelaces
FigUrE 1.8 The four areas

ofindividual human development
Gross motor skills

e.g. running, throwing
a ball, riding a bike
Growth of body systems

From early in the uterus, the embryo begins to develop the cells that will become the
vital organs and systems required to sustain life in the outside world (figure 1.10).
The changes in size that take place in these organs and systems are important parts
of physical development. Examples of systems in the body include the circulatory
system and the immune system.
Growth refers to organs and systems getting bigger in size. It is an important
aspect of physical development. Much growth occurs during puberty, which is why
youth is considered a rapid growth period along with the prenatal and infancy
Unit 1
AOS 1
Topic 1
Concept 1
Physical
development
youth
Concept summary
and practice
questions
The individual human development of Australias youth CHAPtEr 1
1.2 Exploring individual human development: physical
System
Nervous
system
Organ
Respiratory
system
Tissue
Circulatory
system
Digestive
system
Muscular
system
Reproductive
system
Cell
stages (figure 1.11). Childhood is characterised by slow and steady growth, while
the three adulthood stages are predominantly periods of maintenance. Even though
growth stops at the end of puberty, individuals keep on developing physically for
the rest of their lives. The decline in body systems that people experience in later
lifespan stages is also part of physical development.
Skeletal
system
FigUrE 1.10 Physical development

of thebody, from a cell to the whole
body
FigUrE 1.11 Humans experience their fastest rate of

growth while in the womb.
FigUrE 1.12 By the age of 70, many

signs of ageing are evident.
10
As well as getting bigger, tissues and systems also change in structure and function.
Such changes include an increase in complexity and the decline in function that
occurs as a normal part of ageing.
Examples of increases in the complexity of body systems include:
the replacement of baby teeth with permanent teeth during childhood
the hardening of bones until early adulthood (in addition to the growth of
bones)
the change in the way sex organs function during youth
the development of the immune system that occurs throughout life.
These changes are part of the processes that assist individuals in reaching
their physical peak. This physical peak usually occurs in the early 20s to
early 30s. After this point, most of the systems such as the muscular system,
the circulatory system and the skeletal system generally decline at a rate
of about 0.5 to 2 per cent per year. This decline is a normal part of physical
development. Most of the decline takes place over a long period of time. In
fact, people might not realise they have changed until they look back at old
photographs of themselves.
Like all aspects of development, ageing happens to everyone. Most of the changes
are predictable, but there will be individual variations in when they occur. This is
due to a number of factors, including:
differences in rate and timing of development. Due to genetic and hormonal
differences, some individuals will start the ageing process at a younger age than
others, and some will age at a faster rate.
behaviours. Not smoking, eating a balanced diet and exercising can slow the rate
of ageing.
Motor skills
Motor skills refer to the control of the muscles in the body. Imagine a newborn
baby. It has very underdeveloped motor skills (e.g. uncoordinated limbs). As the
infant gets older, motor skills will develop and movements will gradually become
more controlled and deliberate.
Motor skills can be classified as either fine or gross:
gross motor skills refer to movements that involve large muscle groups such as
walking, throwing, skipping and kicking
fine motor skills involve control over the smaller muscle groups such as those
used for writing, tying shoelaces, cutting with scissors and manipulating the
mouth to speak.
TEST your knowledge
1 Explain what is meant by individual human

development.
2 Using examples, define physical development.
3 (a) What does increase in complexity mean?
(b) List one example of a body part that increases
incomplexity.
4 Explain the difference between growth and
development of body systems.
5 Even though the ageing process begins in the
20sor 30s, why is it often not evident until much
later in life?
6 Use the Infancy links in

the Resources section of your
eBookPLUS to find the weblink
and questions for this activity.
7 Draw a line graph showing the rate of growth
across the lifespan. Place the lifespan stages
onthehorizontal axis and the rate of growth
(nogrowth, slow, medium and fast) on the
verticalaxis.
1.3
Individual human development during youth: physical
KEY CONCEPT Understanding the physical development that occurs

duringyouth
Youth is a time of rapid development. The average youth will end this lifespan
stage by being physically capable of reproduction; being seen as an adult in
the eyes of the law; finishing compulsory education; being legally allowed to
drink alcohol, drive, vote and join the army; and making many other decisions
for themselves. We will explore the individual human development that occurs
during youth in each of the four areas of development, beginning with physical
development.
Physical development during youth

The youth stage of the lifespan is a time of rapid physical development that
commences at puberty. Puberty is triggered by hormones released in the pituitary
gland (in the brain) and causes many changes in the body including an increase in
the rate of growth, a refinement of gross and fine motor skills, and the development
of primary and secondary sex characteristics.
Growth
25
Boys
Girls
Height gain (cm/year)
20
15
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age (years)
Figure 1.13 The rate of growth across the lifespan
The adolescent growth spurt is one of the most easily

recognisable signs of puberty. During the growth spurt,
the individual will grow at the fastest rate since infancy
(figure 1.13). According to the Go For Your Life initiative
(www.goforyourlife.vic.gov.au), on average a girl will gain
16 centimetres in height and 16 kilograms in weight,
while boys will gain an extra 20 centimetres in height and
20 kilograms in weight. The growth spurt happens at different
times for females and males, with girls generally experiencing
their growth spurt between the ages of 10 and 13, and boys
between 12 and 15. The growth spurt usually lasts for two to
three years.
As well as changes in height, youth experience changes in
body composition. In males, increases in muscle mass and the
broadening of the shoulders in relation to the waist result in a
more triangular body shape. For females, the hips widen and
the fat to muscle ratio increases. Most fat is deposited in the
mid-section, including the thighs and hips, resulting in the
hourglass figure seen in many adult females.
Fine and gross motor skills

During the adolescent growth spurt, arms and legs lengthen and body proportions
change. As these changes occur, different body parts may grow at different rates.
As a result, some youth may experience periods of time when arms and legs
are disproportionate to the rest of the body. This can contribute to some youth
experiencing difficulty controlling their limbs in a coordinated manner, in the way
they were able to during childhood.
As the body continues to mature, the individual will gain more control over it.
By the end of puberty, however, the arms and legs are proportionate to the rest of
the body. The extra strength and endurance gained during puberty increase the
ability to carry out many motor skills in adulthood.

In addition to the growth experienced during youth, a number of body systems
change in structure and/or function. Bones continue to build strength, the structure
of the brain increases in complexity, and sex organs change in the way they function.
Bones are first developed during the prenatal stage of the lifespan but do not
reach their maximum density or strength until adulthood. Youth is an important
time for building bone density and ensuring that bones are as strong as possible
for adulthood.
Structures in the brain continue to increase in complexity throughout youth. New
skills and experiences provide opportunities for different structures of the brain
to change in complexity, and this impacts on brain function. The results of these
changes relate to intellectual development and will be explored in more detail later.
One of the most noticeable changes that occur to body systems in youth are the
changes to the reproductive system, which includes the sex organs and the way
they function. These changes can be classified into two categories: primary and
secondary sex characteristics.
Primary sex characteristics are those parts of the body that are directly involved
in reproduction. During puberty, changes occur to the organs of reproduction
commonly referred to as the genitals. Although present at birth, these organs only
develop and become fully functional during puberty. The primary sex characteristics
that develop for males and females during puberty are shown in red in figure 1.14.
Secondary sex characteristics arise from changes that occur to both males and
females but are not directly related to reproduction and are not present at birth.
Examples of secondary sex characteristics for males and females are shown in blue
in figure 1.14.
During
puberty
Adulthood
Adulthood
During
puberty
Before
puberty
Before
puberty
Skin becomes oily
Skin becomes oily
Body hair develops including

underarm and pubic hair
Facial hair appears

Voice lowers
Increased fat to muscle ratio

Shoulders broaden
Breasts develop
Increased stature
Hips widen
Increased muscle mass
Body hair develops including pubic,
underarm, chest and arm hair
First ovulation
Penis enlarges
First menstruation
First ejaculation
The ovaries, uterus, vagina,

labia and clitoris enlarge in size
Testes grow and start

producing sperm
FigUrE 1.14 The primary sex characteristics that develop for males and females
duringpuberty
Key:
Primary sex characteristics
Secondary sex characteristics
13

There is wide variation in the timing of when puberty begins, although girls
generally start before boys. Girls commonly reach puberty between the ages of
8 and 13, and boys between the ages of 10 and 15. The average ages at which
selected events associated with puberty occur are outlined in figure 1.15. These
changes and the timing and rate at which they are occur are largely due to biological
determinants, in particular genetics, hormonal changes and body weight.
Boys
9
Age in years
10
11
12
13
14
15
16
17
18
Hormone production triggers puberty

Growth spurt
begins
Testes and
scrotum grow
Hair appears
on genitals
and under
arms
Penis begins
to lengthen
Muscles grow,
shoulders
broaden
Sperm
production
starts
Acne begins
Voice changes
Facial and chest hair appears
Physical maturity reached
Girls
8
Age in years
9
10
11
12
13
14
15
16
17
18
19
Hormone production triggers

puberty
Growth spurt begins
Hair begins to appear on genitals and under
arms
Breast buds appear
Acne begins
Breasts grow
Hips widen in proportion to waist
First period (menarche)
Ovulation and menstruation begin
Physical maturity reached
Figure 1.15 The timing of puberty

Source: Adapted from www.bibalex.org.
Sexual maturity
As youth move through the process of puberty, most will become physically capable
of reproduction. In order for reproduction to be possible, sperm production in
males and the menstrual cycle in females must begin.
Sperm production
The male reproductive system consists of internal and external organs
that are responsible for semen production and ejaculation. The internal
reproductive organs are the testicles (or testes), epididymis, vas deferens,
prostate and urethra; and the external reproductive organs are penis and
scrotum (figure 1.16). During puberty, these organs grow and sperm is
produced. The onset of sperm production is often marked by spermarche
(or first ejaculation). This often occurs as a nocturnal emission (also referred
to as a wet dream) or direct stimulation (most commonly as a result of
masturbation). Sperm are the male sex cells that are required for reproduction.
Once sperm are produced, males are capable of reproduction. If not ejaculated,
sperm will eventually die and are absorbed back into the body so a build-up does
not occur.
Unit 1
AOS 1
Topic 1
Growth and
development
Concept summary
and practice
questions
Concept 2
4. Seminal vesicles produce a glucose-rich

fluid that mixes with sperm to provide a
source of energy to help the sperm move.
This seminal fluid makes up most of the
volume of a mans semen.
3. Vas deferens a tube about

30 cm long that connects the
epididymis to the ejaculatory
duct in the prostate gland.
Sperm can be stored here
ready for ejaculation.
2. Epididymis 6 metres of small

tubes that are coiled behind each
testicle. Immature sperm are
released from the testicle into the
tubes and spend the next two
weeks travelling the length of the
epididymis as they mature.
5. Prostate gland a walnut-sized gland

producing a liquid that mixes with the seminal
fluid and sperm to help provide energy and
keep the sperm alive
6. Penis the external organ used for sexual
intercourse
Urethra a tube in the penis that transports
semen out of the mans body during ejaculation
1. Testes/testicles create up to 1500 sperm each second. The

sperm mature here for about 50 days before being released into
the epididymis.
Scrotum a pouch-like sac that houses the testicles and assists in
controlling the temperature of the testes. Testes work best when
slightly cooler than body temperature. Muscles in the scrotum
draw the testes closer to the body when extra warmth is required
and move them further away for cooling.
Figure 1.16 The male reproductive system begins to function during puberty.
The menstrual cycle

The menstrual cycle refers to the process required to develop an ovum (or egg) and
signals the ability to reproduce in females (figure 1.17). The first menstrual cycle
begins with a process called menarche which relates to the first menstruation (or
period) a female experiences. Most girls will experience erratic menstrual cycles
for the first couple of years after menarche before the cycle settles and becomes
more regular and predictable. Once this occurs, the menstrual cycle will usually
last from 24 to 30 days.
1. Ovaries ova (or eggs) are

present in the ovaries from birth.
They do not mature until puberty
and so do not contribute to
reproduction until then.
2. Fallopian tubes after menarche, the ovaries
will mature and release (usually) one ovum
into the fallopian tubes each menstrual cycle
until menopause, when the menstrual cycle stops.
5. Vagina menstrual blood and tissue will be

shed through the vagina. This process takes
around 36 days.
3. Uterus as the ovum is maturing, the wall of the

uterus (the endometrium) thickens with blood and
nutrients to provide a place for an egg to develop
should it be fertilised by a sperm.
4. Cervix the endometrium will shed through

the cervix if the ovum is not fertilised, leading
to menstruation.
Figure 1.17 The menstrual cycle generally signifies the ability of females to reproduce.
TEST your knowledge
1 Using examples, explain:

(a) primary sex characteristics
(b) secondary sex characteristics.
2 During which lifespan stage are the primary sex
characteristics first created?
3 Using figure 1.14 as a guide, draw a Venn diagram
summarising the changes that males and females
undergo during puberty.
4 Explain what is meant by:
(a) spermarche
(b) menstruation
(c) menarche
(d) menstrual cycle.
5 Use figure 1.15 to answer the following questions.

(a) At what age span does the growth spurt begin
for males and females?
(b) Identify two of the differences between males
and females as shown in the graph.
(c) Which milestone shows the greatest variation
for females?
6 (a) Looking at figure 1.13, outline two differences
in the growth spurt as experienced by males and
females.
(b) What leads to these differences?
7 Research the menstrual cycle and prepare a timeline
showing when different events occur.
8 Use the Puberty links in the
Resources section of your
9 Prepare an educational guide or poster for
prepubescent children outlining the changes that
occur during puberty.
16
UNIT 1 The health and development of Australias youth
1.4
Exploring individual human development: social
KEY COnCEPt Understanding the characteristics of the social area of

individual human development and the social development that occurs
during youth
While the physical aspect of development is
often the most easily recognisable, there are
significant social changes that also occur as
individuals move through the lifespan.
Social development
Behaviours
e.g. being
considerate
Relationship
skills
e.g. conflict
resolution and
open
communication
Social roles
e.g. son/daughter,
People from different cultures are raised with
employee, friend
different values and skills relating to how they
are expected to interact with others. A newborn
child knows very little about how to interact with
Social
others; it must learn the appropriate social skills
development
and behaviours. Social development refers to the
social skills and behaviours that are learnt from
a young age. Examples of social development are
summarised in figure 1.18 and include:
Communication
Values and beliefs
behaviours learning what is appropriate
skills
e.g. valuing honesty
e.g. written and
behaviour in a range of situations and
or compassion
oral
how individuals behave around others
towards those less
communication
fortunate
(figure 1.19). Being a good listener and being
generous are two examples of behaviours that
people may learn.
social roles and expectations Humans spend a lot of their time in different groups FigUrE 1.18 Aspects of social
development
and will often have distinct roles within those groups. Examples include the role
of employee, friend, son/daughter, coach and team-mate. Each role will generally
have a set of behaviours, skills and expectations associated with it. Gender roles are
another example of social roles and relate to behaviours that are culturally acceptable
for males and females. Although many of these roles and expectations have broken
down over the past decades, some cultures still have distinct roles for males and
females. These roles are learnt from a very young age and shape many aspects of the
wider society. Examples of traditional social roles related to gender include:
males working and females staying at home to look after the children
men mowing lawns and women cooking
girls playing with dolls while boys play with trucks
men and women dressing differently (e.g. women wearing skirts and men
wearing trousers).
values and beliefs determining what is important to an individual. Throughout
life, many people will stand up for what they believe in, and knowing what
they believe in is the first step in this aspect of development. Values and beliefs
assist in the development of an identity (see page 23) and are formed through
interactions with family, friends, wider society and the media.
communication skills being able to effectively communicate with different
groups of people. This is an important aspect of development and continues
to be built upon over the years. For example, talking to an elderly grandparent
requires different skills than talking to a brother, sister or school friend.
FigUrE 1.19 Learning behaviours,
relationships knowing how to behave in a relationship and what is expected. such as table manners and using
This will be continually refined over time. It often requires establishing mutual cutlery, are important aspects of social
respect and taking the time to listen to each others point of view.
development in Australia.
17
Case study
Gone to the dogs: the girl

who ran with the pack
Elizabeth Grice
She bounds along on all fours through long grass,
panting with her tongue hanging out. When she reaches
the tap she paws at the ground, drinks noisily with her
jaws wide open and lets the water cascade over her
head.
Up to this point, you think the young woman could
be acting but the moment she shakes her head
and neck free of droplets, exactly like a dog when it
emerges from a swim, you get a creepy sense that this
is something beyond imitation. Then she barks.
The furious sound she makes is not like a human
being pretending to be a dog. It is a proper, chilling,
canine-like burst of aggression and it is coming from
the mouth of a young woman dressed in T-shirt and
shorts.
This is 23-year-old Oxana Malaya reverting to
behaviour she learnt as a young child when she
was brought up by a pack of dogs on a rundown
farm near the village of Novaya Blagoveschenka in
Ukraine. When she showed her boyfriend what she
once was and what she could still do the barking,
the whining, the four-footed running he took
fright. It was a party trick that went too far and the
relationship ended.
Miss Malaya is a feral child, one of only about 100
known in the world. The story goes that, when she was
three, her indifferent, alcoholic parents left her outside
one night and she crawled into a hovel where they kept
dogs. No one came to look for her or even seemed to
notice she was gone, so she stayed where there was
warmth and food raw meat and scraps forgetting
what it was to be human, losing what toddlers language
she had and learning to survive as a member of
thepack.
A shameful five years later, a neighbour reported a
child living with animals. When she was found, at the
age of eight in 1991, Oxana could hardly speak and ran
around on all fours barking.
Though she must have seen humans at a distance,
and seems occasionally to have entered the family
house like a stray, they were no longer her species.
Judging from the complete lack of documentation
about her physical and psychological state when
found, the authorities were not keen to record her

case neglect on this scale was too shameful to
acknowledge even though it has been of huge and
continuing interest to psychologists who believe feral
children can help resolve the naturenurture debate.
What is known about the Dog Girl has been passed
down orally, through doctors and carers. She was like
a small animal. She walked on all fours. She ate like a
dog, is about as scientific as it gets.
Last month, British child psychologist Lyn Fry,
an expert on feral children, went to Ukraine with a
Channel Four film crew to meet Miss Malaya, who now
lives in a home for the mentally disabled. Five years
after a Discovery Channel program about her, they
wanted to see if she had integrated into society. Ms Fry
wanted to find out how far the girl was still damaged
and to see a reunion with her father.
I expected someone much less human, says Ms Fry,
the first non-Ukrainian expert to meet Oxana. Id heard
stories that she could fly off the handle, that she was
very uncooperative, that she was socially inept, but she
did everything I asked of her.
Her language is odd. She speaks flatly as though its
an order. There is no cadence or rhythm or music to
her speech, no inflection or tone. But she has a sense
of humour. She likes to be the centre of attention, to
make people laugh. Showing off is quite a surprising
skill when you consider her background. In the film,
Miss Malaya looks uncoordinated and tomboyish.
When she walks, you notice her strange stomping
gait and swinging shoulders, the intermittent squint
and misshapen teeth. Like a dog with a bone, her first
instinct is to hide anything she is given.
She is only 1.52 metres tall but when she fools
about with her friends, pushing and shoving, there is a
palpable air of menace and brute strength. The oddest
thing is how little attention she pays to her pet mongrel.
Sometimes, she pushed it away, says Ms Fry. She
was much more orientated to people.
After a series of cognitive tests, Ms Fry concluded
that Miss Malaya had the mental capacity of a sixyear-old and a dangerously low boredom threshold. She
can count but not add up. She cannot read or spell her
name correctly. She has learning difficulties, but she
is not autistic, as children brought up by animals are
sometimes assumed to be.
Experts agree that unless a child learns to speak by
the age of five, the brain misses its chance to acquire
language, a defining characteristic of being human.

Miss Malaya was able to learn to talk again because she
had some childish speech before she was abandoned. At
an orphanage school, they taught her to walk upright, to
eat with her hands and, crucially, to talk.
Through an interpreter, Miss Malaya tells Ms Fry
that her mother and father completely forgot about
me. They argued and shouted. Her mother would hit
her and she would pee herself in terror. She says she
still goes off by herself into the woods when she is
upset. Although she knows it is socially unacceptable to
bark, she certainly can.
Miss Malaya seems to be happy looking after cows at
the Baraboy Clinics insalubrious farm, outside Odessa.
It was dirty, terribly rundown and primitive, says Ms

Fry, but in Ukrainian terms, very desirable. Her carers
are good people with the best interests of their charges
at heart, though there is no therapy as such. Oxana is
doing things she is good at.
It was here that the reunion with her father was
staged a few weeks ago.
In the film, they stand awkwardly apart and it is ages
before anyone speaks. Miss Malaya breaks the silence.
Hello, she says. I have come, replies her father. The
exchange is moving in its halting formality. I thank
you that you have come. I wanted you to see me milk
the cows.
Source: The Age, 19 July 2006.
Case study review

1 Explain how Miss Malayas social development has been affected by her early life
experiences.
2 Discuss how Miss Malayas physical development has been/may be affected
byher experiences.
3 Discuss why Miss Malaya may have forgotten how to talk but remembers how
to bark.
4 Using examples from the article, explain why development that occurs in
earlylife is important.
Social development during youth

Even though considerable physical changes occur during youth, the social
changes can be just as intense. Youth generally move from being essentially
dependent on parents, to being largely independent. They learn how to act among
different groups, and change the way they behave according to the situation. The
types of interactions that occur also change as youth are given greater freedom
and treated more like adults. As a result, their communication skills are further
developed.
As individuals socialise with a broader social group during this stage, they are
often exposed to new beliefs and values. These may relate to religion, politics,
global issues such as the economy, and social justice issues such as discrimination
and racism. As a result of this exposure, youths will generally start to form their
own beliefs and values, and these can influence with whom they continue to
socialise. This is an important aspect of social development.
In forming their own values and beliefs and struggling to become independent,
youths often learn that they are responsible for their own actions, decisions and
consequences. As a result, individuals in this stage often question more things,
and this can contribute to conflict with their parents or other caregivers. Up until
this point, parents often make most of the decisions for their child. During youth,
relationships with parents are often reorganised in such a way that both the child
and parent have a say in decision making. As a result of this struggle (and the
other changes that youths experience, such as identity formation, social changes
and puberty), youths may disagree with parents more often, which can lead to
escalating conflict. However, most young people emerge from this stage with a
deeper understanding of their parents and vice versa.
Figure 1.20 Socialising helps youth

learn vital social roles.
Unit 1
AOS 1
Topic 1
Concept 4
Social
development
youth
Concept summary
and practice
questions
The peer group is extremely influential at this stage. Many of the social experiences
that youths encounter are due to their peer group. The group may influence their
choice of clothing, style of music, the types of activities they participate in and the
formation of their identity. As individuals strive for their own independence, they
may spend a majority of their free time with their peers, possibly experimenting
with different behaviours within the peer group. Some of these behaviours may be
considered risky such as smoking cigarettes and experimenting with alcohol.
Individuals often communicate in a number of different ways and the use of the
internet, mobile phones and social media can significantly influence how youth
communicate with friends, develop values and beliefs, and learn about the world.
The nature of relationships changes during this time as many peer groups start
to include members of the opposite sex. This can further develop communication
skills and provide youth with opportunities to experience new types of relationships.
Many individuals will experience their first intimate relationship with another
person during this stage, and some will experience their first sexual relationship.
New skills, such as conflict resolution and compromise, are learned and/or
developed as a result of these relationships. Towards the end of the youth stage, the
individual will usually have developed a clearer sexual identity and may be looking
for a serious relationship.
Culture and family also play a significant role in the social development of
youths. Some cultures have particular rites of passage linked to this stage. Youths
may be allowed to stay home alone for the first time when parents go out, learn to
drive, get a job, make their own transport arrangements to and from school and
social engagements, go out on a date, or consider future career paths.
TEST your knowledge
1 Using examples relevant to youth, explain social

development.
2 What is meant by social roles? Provide three
examples.
3 Explain why conflict with parents often occurs as
youth form their own values and beliefs, and gain
independence.
4 Make a list of the aspects of social development
that can be influenced by the peer group.
5 (a) Make a list of all the people or groups from

which we learn social skills.
(b) Which of these do you think has had the
greatest influence on your own social
development? Explain.
6 Make a list of social skills that are generally learned
from the family.
7 Would learning to use a knife and fork be a part of
social development in all cultures? Explain.
8 In small groups, find or write lyrics to a song that
depicts an aspect of social development during
youth.
1.5
Exploring individual human development:

emotional
KEY COnCEPt Understanding the characteristics of the emotional area

of individual human development and the emotional development that
occurs during youth
Emotional development
Emotional development refers to developing the full range of emotions, and
learning appropriate ways of dealing with and expressing these emotions. Some
specific examples of emotional development are summarised in figure 1.21 and are
explained in more detail below:
Management of emotions
The ability to control
emotions in an
appropriate manner
Self-concept
Relates to how someone
sees themselves
Awareness of emotions
The ability to recognise
the emotions experienced
Emotional
development
Expression of emotions
The ability to express
emotions in an
appropriate way
FigUrE 1.21 Aspects of emotional development
self-concept how individuals see themselves. They

may have different views about different aspects of
themselves, such as their academic ability, social skills
and physical capabilities. Self-concept also influences
the formation of an individuals identity (see page 23).
awareness of emotions how individuals identify
which emotions they are feeling. The first emotionsthat
can be recognised by infants include joy, anger,sadness
and fear. As children begin to develop a sense of self,
they experience more complex emotions like shyness,
surprise, embarrassment, shame, guilt and pride. As
children develop emotionally, they begin to identify
different emotions and learn appropriate ways of
responding to them. This is a process that continues
through youth and into adulthood.
management of emotions how individuals control
their emotions in different situations. As individuals
develop emotionally, they become more equipped at
dealing with emotions in an appropriate manner. Desire,
guilt and jealousy are common emotions that people
want to control. Learning to accept the things they
cannot change and focusing energy on the things they
can change is a significant achievement in this area of
development. For example, instead of being upset at not
being selected for the soccer team, a person can direct
this energy into training harder in order to have a better
chance of selection next time. It takes time to develop
appropriate ways of responding to the way a person feels.
FigUrE 1.22 Throwing tantrums is a characteristic that most

children overcome as they develop emotionally.
21

appropriate expression of feelings how individuals show their emotions in
an appropriate way. This skill develops over time, and those who are more
developed emotionally are more able to control the way in which they express
their feelings. This is why toddlers, rather than adults, are more likely to throw
temper tantrums when they do not get their way (figure 1.22).
during youth
As with social and physical development, the emotional changes that occur
during youth are significant. As a result of all the changes that youth go
through, the way they view themselves and how they deal with these feelings
may also change.
At the beginning of the youth stage, the individual may become preoccupied
with what others think of them and feel that others are judging them. This is often
the result of the physical changes being experienced. As they move through the
youth stage, self-concept develops and the individual becomes more comfortable
with themselves. As a result, they generally become less concerned with what
others think and more concerned with who they are as a person.
In the early stages of youth, individuals might be very self-conscious and
begin asking themselves, Am I normal? As a result of these feelings, youth
might explore strategies, such as consulting with friends, in order to deal with
these emotions effectively. This helps to shape how individuals see themselves
(self-concept).
Youths also start to look less childlike and more mature, so people begin to treat
them differently. Young people need time to adjust to this change.
The release of hormones during youth can bring about extremes in mood
that can cause conflict with others, often parents and other family members.
Consequently, youth may experience negative emotions such as isolation, rejection
and loneliness.
As the body matures, the mind changes as well, and youth might
seek emotional independence. For example, they might try to solve
their own problems instead of consulting parents. This may lead
to feelings of satisfaction if they succeed or despair if they fail.
Experiencing these emotions can encourage the individual to take
more responsibility for their actions and provide ways to accept
emotions both positive and negative that occur as a result of
this responsibility (e.g. guilt, remorse, happiness, fulfilment).
As the nature of relationships changes, youth may also seek
intimacy and affection within those relationships. They might
experience emotions such as love and lust (figure 1.23).
Towards the end of the youth stage, the individual will have
been exposed to a range of emotions and will generally be
able to recognise them accurately when they arise. Most youth
Figure 1.23 Some youths will experience the emotions
will also have an understanding of the appropriate ways of
associated with a relationship for the first time.
expressing those emotions. Most older youth will be able to
adequately express their feelings in words, and this helps to regulate their
emotions.
As youths explore different values and settle on their beliefs, they may have
deeper feelings of who they are as people. This influences their emotional
development and sense of identity. If they are satisfied with the person they have
become, they may emerge from the youth stage with a great sense of pride and
achievement not experienced previously.
Case study: Identify

Identity is the establishment of a unique personality
and encompasses aspects of both social and emotional
development. It refers to how an individual defines
him/herself, and is based on the values and beliefs of
that individual. There are various aspects of identity
including physical, sexual, political, religious and
ethnic identity and the different aspects may develop
at different times. Although an identity will generally
be firmly formed by the later stages of youth, aspects of
it will be modified throughout life.
In early youth, identity is often based on parental
expectations and occurs without exploring alternatives.
As youths develop, they may begin to question this
identity and actively experiment with alternatives in an
attempt to find an identity that suits them. During this
process, the individual may change hobbies quickly,
explore various possibilities for future careers, and
sample different clothing and hair styles, musical
genres and friendship groups.
As abstract thought develops, many youths will
explore their spirituality. Spirituality is an aspect of
identity that means different things to different people.
Some of the more common associations include:
searching for meaning in life
finding ones place in the world, where the greater

good of the universe and those in it is important
seeing oneself as a small part of a bigger universe
acknowledging forces both inside and outside
individuals that are separate from the physical and
mental functioning of living things.
Religion is an organised form of spirituality that is
based on culturally and historically based guidelines (or
doctrine). As part of their search for spirituality, some
people will explore religions or turn away from the
religion in which they were raised.
Many factors contribute to identity formation. They
include:
culture/ethnicity
parents
siblings
friends
school
society.
Once an identity has been committed to, people feel
more comfortable about themselves. This can contribute
to increased self-esteem and also help to guide their
moral decisions.
Case study review

1 What is meant by the term identity?
2 What factors could cause someone to change aspects of their identity later in life?
3 Explain the difference between spirituality and religion.
4 (a) Answer this question 10 times: Who am I?
(b) i. Rank your answers according to how well they define who you are,
where 1 is the answer that best defines you and 10 is the answer that
least defines you.
ii. For what reasons did you choose the answer you ranked as 1?
(c) Next to each answer, write down who you think influenced this aspect of
yourself the most.
(d) i. Which influence featured the most times?
ii. Do you think this influence is the biggest determinant of identity? Explain.
eLesson
Clarifying self-identity and self-worth
Searchlight ID: eles-1043
Unit 1
AOS 1
Topic 1
Concept 5
Emotional
development
youth
Concept summary
and practice
questions
FIGURE 1.24 Identity is often found through friendship groups.
TEST your knowledge
1 Using examples, explain emotional development.

2 Discuss three ways in which youth develop
emotionally.
3 Explain what is meant by emotional independence.
4 Explain what is meant by self-concept.
5 Brainstorm emotions that may be experienced for

the first time during youth.
6 Explain how developing emotionally can impact on
relationships with others.
7 Discuss ways in which youth may express or respond
to the following emotions compared to a child:
(a) happiness
(b) anger
(c) jealousy
(d) disappointment.
8 Discuss the difference between social development
and emotional development.
9 Explain how social development and emotional
development may impact on each other.
10 Explain why individuals in early youth might be
preoccupied with what other people think of them.
1.6
Exploring individual human development

during youth: intellectual
KEY COnCEPt Understanding the characteristics of the intellectual

area of individual human development and the intellectual
development that occurs during youth
intellectual development
Intellectual development refers both to the processes that occur within the brain
and to the increasing complexity of the brain. Aspects of intellectual development

are summarised in figure 1.26 and are explained in more detail below:
Knowledge
Attention
Language
Intellectual
development
Problem
solving
Memory
Creativity
and
imagination
Thought patterns
(abstract versus
concrete)
FigUrE 1.25 Intellectual

development is rapid during the early
years but it continues throughout the
lifespan.
FigUrE 1.26 Aspects of intellectual development
knowledge this becomes more complex as people develop intellectually. The

longer a person has been developing intellectually, the more opportunities they
have to gain knowledge.
language knowledge of language and the way it can be used develops
continually over the human lifespan.
memory retaining information and being able recall it. Memory abilities
change throughout the lifespan and can decline in the latter parts of adulthood.
Using this section of the brain can help to promote a good memory into late
adulthood.
abstract thought being able to think about concepts and ideas rather than
just the physical objects you can see (concrete thought)
creativity and imagination thinking in new ways. Both creativity and
imagination can be developed by exposure to many different experiences
including books, music and other people.
problem solving finding a way from the current state to the desired goal
when no clear path exists. Problem solving is one of the most complex of all
thinking processes. Examples include trying to fit a number of commitments
into a given timeframe, figuring out what has caused a computer to crash or
calculating how much weight a new (as yet unbuilt) bridge can hold. Trial and
error is an important part of problem solving.
25
1.6 E xploring individual human development during youth: intellectual
Unit 1
AOS 1
Topic 1
Concept 6
Intellectual
development
youth
Concept summary
and practice
questions
attention focusing on one aspect of the environment while ignoring others.

Attention is an important aspect of intellectual development as it assists in the
learning of new material. Young children can focus their attention for shorter
periods of time than older children. Attention can be developed by attaching an
intrinsic (or internal) reward, such as attaching satisfaction to completing a task.
The more a person enjoys the matter requiring attention, the longer they can
focus their attention on it.
Many aspects of intellectual development occur in the younger years, but
intellectual development continues throughout the lifespan as people learn skills
associated with pursuing careers, raising children, becoming grandparents or
taking up hobbies.
Intellectual development
during youth
During youth, physiological changes occur in the brain and in the way that the
young person perceives problems. These changes result in significant advances in
intellectual development. Youth begin to see grey areas in problems when they
would have seen only black and white in the past. During this stage, the brain
structures mature and abstract thought develops, as opposed to the concrete
thought relied upon in childhood. Information can be processed more efficiently,
and groups of concepts that were viewed individually might now be linked together
and viewed as an interrelated whole.
Examples of intellectual development during this stage
include the following.
Reasoning skills increase. As youth are presented with
problems, they start to apply related knowledge to the
problems in order to make educated guesses. In contrast,
most children can see only concrete solutions.
The ability to create hypothetical solutions and evaluate the
best options develops. This comes from previous experiences
and from applying old knowledge to new situations.
Focus on the future increases (figure 1.27). This may guide
intellectual development for example, students wanting
to study science might develop an interest in learning
about scientific principles and choose science courses at
school.
Thinking becomes more informed. Youths can distinguish
between fact and opinion and may challenge views put to
them by others, including adults.
More complex concepts are learned at school. As a result,
youths may develop an understanding of how they learn
best (e.g. visual versus aural learners).
Some research suggests that the frontal lobe (a part of the
brain) is not fully developed until the end of puberty
possibly not until the 20s. The state of the brain during
these years may make youths favour immediate rewards and
disregard long-term consequences. It is thought that this
aspect of brain development may account for why youth are
more likely to take risks than children or adults.
Figure 1.27 Towards the end of youth, individuals generally
start to shift their attention to learning things associated with their
interests and possible career paths.
TEST your knowledge
1 Using examples, explain what is meant by

intellectual development.
2 Outline three aspects of intellectual development
relevant to youth.
3 (a) Discuss the difference between concrete and
abstract thought.
(b) List one example of thought that illustrates:
i. concrete thought
ii. abstract thought.
4 Classify the following as examples of physical,
social, emotional or intellectual development:
(a) The changes to sex organs that occur during
puberty
(b) Learning to use a graphing calculator
(c) Deciding to join a religious group
(d) Pattern baldness that occurs in many males
(e) A musician writing a song for the first time
(f) Finding a way to fix a banging door
(g) A person perceiving themselves as intelligent
(h) A person deciding that they value honesty more
than not hurting someone elses feelings
(i) Developing the skills required to discuss issues
with parents
(j) Increase in the complexity of the skeletal system
in a developing foetus
(k) Using words to express emotions
(l) Developing beliefs relating to ethical issues such
as abortion
(m) Changes in height that occur during childhood
(n) Moving in with a partner
(o) Selecting a career path.
5 Draw pictures/collect magazine photos and create

a collage representing examples of the type of
development that might occur in each lifespan
stage. Ensure that the four areas of development
are addressed.
6 (a) Find lyrics to a song that focuses on an area of
development.
(b) Print the lyrics and share them in small groups.
(c) Discuss what the lyrics are saying about
development.
7 When I was a boy of 14, my father was so ignorant
I could hardly stand to have the old man around.
But when I got to be 21, I was astonished at how
much he had learnt in seven years. What do you
think this quote (by American author Mark Twain) is
trying to say?
8 (a) How many triangles are shown in figure 1.28?
(b) Compare your answers with other students.
(c) Do you think a child would be able to answer
this problem? Why?
(d) Think of another example of a brain teaser/
problem that children and youths might answer
differently.
Figure 1.28 Triangle problem
9 Use the Child-safe toys links in the

Resources section of your eBookPLUS to
find the weblink and questions for this activity.
1.7
Exploring the interrelationships between the

areas of individual human development
KEY COnCEPt Understanding the interrelationships between physical,

social, emotional and intellectual development
Classifying developmental
milestones
FigUrE 1.29 Learning to talk

encompasses aspects of physical, social
and intellectual development.
Developmental milestones refer to the changes and achievements that occur

throughout the lifespan. Examples include learning to walk and talk, completing
basic mathematics problems, getting married, having children, choosing a career,
finishing high school and experiencing love. Some of these milestones are easily
classified into one of the four areas of development. For example, learningtowalk
is an aspect of physical development. But what about learning to talk (figure 1.29)?
Muscles must be manipulated to make coherent sounds (physical development)
and words must be learnt (intellectual development). Obviously, speech allows the
individual to communicate (social development). Examples such as these can be
classified into any one or all of these three areas.
There are many other examples of milestones that do not fit neatly into one of
the four areas. Therefore when classifying a developmental milestone, you should
justify why you have chosen a particular area for that milestone.
interrelationships between physical,

social, emotional and intellectual
development
While the four areas of development have their own definitions and characteristics,
none of them occurs in isolation. All four areas influence each other, and so are said
to be interrelated. That is, a change in one will produce a change in the others. There
is no limit to which any single aspect of development can influence another and the
nature of the interrelationships will depend on the individual in question. Figure 1.30
and the paragraphs that follow outline some possible impacts on the different areas
of development based on different
scenarios.
Early puberty may mean that
A persons social skills (social
the individual is more interested
development)
can
influence
in the opposite sex. This can
the
social
group
with
which
lead to an intimate relationship
they associate. This in turn can
and experiencing emotions
such as love and jealousy.
affect social habits such as food
consumption (e.g. eating at
food courts). Food consumption
Social development
has a direct impact on physical
Early puberty may mean that
development, as the foods eaten
Physical
Early puberty can
they socialise with older
development
contribute to the development of
contribute
to
sporting
people. This can impact social
Early onset of
success in young males,
the bodys systems such as
experiences. These experiences
puberty
which could lead to learning
can shape aspects
bones, muscles and organs
of sports strategies.
like behaviours.
(physical
development).
An
individuals ability to socialise and
FigUrE 1.30 The possible impacts
communicate may assist with expressing their emotions adequately (emotional
on social, emotional and intellectual
development). Being a good listener (social development) might mean that the
development for a youth who starts
individual learns from others, such as parents and grandparents (intellectual
puberty (physical development) earlier
than his/her peers
development).
28
Being able to adequately deal with emotions (emotional

development) such as disappointment might influence
whether they are prepared to take risks, such as trying
out for a sports team at school. Taking such risks can
ultimately enhance motor skill development, for example,
if they make the team (physical development). Being able
to effectively express emotions can contribute to more
meaningful friendships which can assist in developing
communication
skills
and
behaviours
(social
development). Valuing intrinsic rewards such as
satisfaction and achievement (emotional development)
can contribute to a person applying themselves at school
and therefore developing knowledge (intellectual
development).
Youths with higher intellectual development may have a greater knowledge
of the benefits of nutrition and exercise, and may therefore have more advanced
motor skills and greater development of bones, muscles and organs (physical
development). Those with high levels of intellectual development may associate
with people of similar intellect. The peer group in turn influences the development
of behaviours and communication skills (social development). Youths who succeed
academically may receive praise from their parents, which can contribute to feelings
of pride (emotional development).
Figure 1.31 Early physical

development (as experienced by the
boy in the middle) can influence other
aspects of development.
Unit 1
AOS 1
Topic 1
Concept 7
Interrelationship
between types
of development
Concept summary
and practice
questions
TEST your knowledge
1 Explain what is meant by interrelationships.

2 What is meant by the term developmental
milestone?
3 Identify three developmental milestones often
associated with youth. Would these be common for
all youth across the world? Explain.
4 Discuss why it can be difficult to classify some
developmental milestones into one of the four areas
of development.
5 Select two of the following developmental

milestones and complete a diagram similar to that
in figure 1.30 for each one:
Learning to do gymnastics (physical development)
Leaving school in year 11 to start an
apprenticeship (social development)
Passing a drivers licence test and getting a car
(social development)
Learning to play a musical instrument (intellectual
development)
Being in love for the first time (emotional
development).
Remember that the selected milestone should be in
the centre of the diagram with the possible effects
on the other three areas of development coming
out from it.
6 Write a play or create a comic strip outlining
how physical, social, emotional and intellectual
development can interrelate.
1.8
The impact of biological determinants

on youth development
KEY COnCEPt Understanding the impact of biological determinants

on the development of youth
Determinants of health and

development: an introduction
Hormonal
changes
Biological
determinants
Genetics
Body
weight
FigUrE 1.32 Biological determinants

of health
There are many factors that influence the health and individual
human development of youth. Some of these are genetic and out of
the individuals control, some are choices that people make, and some
form part of the society and environment in which the individual lives.
These factors act together to determine health and individual human
development and hence are termed the determinants of health and
development, sometimes shortened to the determinants of health.
The biological determinants are concerned with the bodys cells,
tissues, organs and systems, and how they function. They include
genetics, hormonal changes and body weight (see figure 1.32). Due to
the many physical changes that occur during youth and the impact
these changes have on social, emotional and intellectual development
biological factors are particularly significant. As a result, some of these
will be investigated as the development and health of youth are explored.
The behavioural, physical environment and social determinants also
play a significant role in the health and individual human development
of youth and will be explored specifically in chapter 4.
Genetics
Sections of DNA are called genes and control
many aspects of health and development.
Each nucleus contains 23 pairs of
chromosomes. One chromosome
in each pair is from the mother and
the other is from the father.
The nucleus contains the genetic

material for the human body,
the chromosomes.
The chromosomes
contain strands of DNA.
FigUrE 1.33 The nucleus of the cell

contains the genetic material needed
for life.
30
The term genetics refers to the

biological information that is passed
down from parents to children at
the time of conception. Most cells in
the human body contain this genetic
blueprint, which contributes to many
aspects of health and individual human
development for youth.
Most cells contain a nucleus
(figure 1.33). The nucleus controls
the functions of the cell including the
reproduction of cells and the timing of
development. Within the nucleus there
are structures called chromosomes. The
chromosomes contain links of DNA
called genes. Although genetics have a
significant impact on individual human
development during youth, it should be
remembered that other factors also play
large roles.
Physical appearance is also largely
determined by genetics. A person has
genetic potential in many aspects of
their physical appearance (e.g. height,
weight, skin colour, freckles, hair and
eye colour, muscle mass and facial
features). Remember that other determinants also play a part, and they can be just
as influential as genetics. For example, a person who has the genetic potential to be
tall might not consume sufficient nutrition and so could end up shorter than the
maximum height possible according to their genetic potential.
Genetics determine sex, which has a large impact on the different physical
characteristics of males and females such as genitals and reproductive systems.
Genetics also influence the types and amounts of hormones that are released
during puberty and therefore influence the physical changes that occur during
youth. While genetics influence the timing of the release of these hormones, it is
the hormones themselves that cause the changes associated with puberty.
Hormonal changes
Hormones are an example of a biological determinant and
are responsible for the process of puberty. Hormones are
chemicals that are released by special parts of the body
Blood vessel
Hormone
called glands. The series of glands in the body make
Target cell
up the endocrine system. There are numerous glands
Not a target cell
in the body and some of the main ones are shown in
Receptor
figure 1.35. Hormones play an important role in bringing
Gland
about changes in physical development during youth.
When hormones are released from the glands, they are
transported through the bloodstream and circulate around
the body. Certain cells around the body are sensitive
to different hormones and will react when the particular
FigUrE 1.34 Hormones act on
hormones are present in the blood (see figure 1.34).
specific cells and bring about many of
Different hormones act on different parts of the body and are essential for many the physical changes associated with
aspects of life such as metabolism, growth, cell death, the menstrual cycle in puberty.
women and puberty in youths. Hormones are the trigger for puberty and will play
a role in the physical state of both females and males for life.
Hormone changes during youth are caused by many factors including genetics
and body weight. It is the release of hormones that triggers puberty and results in
the changes in physical development that occur during this stage. The different
proportions of hormones released in males and females contribute to the different
changes that occur between the sexes.
Hormones also influence when and how quickly an individual develops, and
there is great variation in the rate of development. This is partly why some
individualsstart puberty at eight and others may not start until 16. The duration
of puberty also varies greatly and can last from two to eight years. Generally
speaking, the earlier an individual starts puberty, the faster they move through it
(although this has no bearing on final height). Rate and timing of development can
affect other aspects, such as motor skill development. Early puberty contributes to
increased strength and endurance, which can contribute to greater participation in
activities that promote motor skill development. Social development can also be
affected by early puberty. Those who start puberty early might be expected to act in
a more mature manner because they look older than their actual age. They may also
socialise with youth who are older and this can also affect their social development.
During puberty, growth hormone is released at around double the amount
that was present during childhood. This leads to a faster rate of growth than was
experienced during childhood. The amount of growth hormone released may
influence final height. Growth hormone is also responsible for other aspects of
growth that take place during the youth stage, including an increase in muscle mass
and an increase in the size of the organs. These changes improve the functioning of
the body and contribute to the peak physical development that is usually reached
in early adulthood.
31
1. The hormone that starts puberty is gonadotropin-releasing hormone (GnRH). GnRH is

released from the hypothalamus and triggers the pituitary gland to release two more hormones,
luteinising hormone (LH) and follicle-stimulating hormone (FSH).
2. LH and FSH
are released
from the
pituitary gland.
2. LH and FSH
are released
from the
pituitary gland.
Hypothalamus
Pituitary gland
Thyroid gland
3. LH and FSH
acton the
testes and
cause them
to produce
and release
testosterone.
3. LH and FSH
acton the
ovaries and
stimulate the
production
and release of
oestrogen.
Ovaries
Testes
The thyroid gland produces the hormone thyroxine, which regulates the rate of metabolism in the body.
This hormone is essential to regulate the energy produced by the body, for the development of the
nervous system and muscles, and for the growth of long bones. These functions are particularly relevant
during youth as the individual undergoes significant development in these areas.
4. Although found in both sexes,

oestrogen is present in higher amounts
in females. It is responsible for the
development of the female reproductive
organs including the uterus and vagina.
Oestrogen also increases fat deposits,
promotes breast development and plays
a role in regulating the menstrual cycle.
Growth hormone is released

from the pituitary gland
in greater amounts during
puberty, increasing the rate
of growth and leading to the
growth spurt in youth.
4. Although found in both sexes, testosterone

is present in higher amounts in males. It is
responsible for the development of the male
reproductive organs including the penis,
prostate gland and scrotum. Testosterone also
produces muscle development, voice changes
and facial hair sprouting experienced by males
during puberty.
Figure 1.35 The glands and hormones responsible for the changes experienced during puberty
Body weight
Unit 1
AOS 1
Topic 1
Concept 3
Determinant
overview
Concept summary
and practice
questions
Maintaining a healthy body weight is beneficial for development during youth.

Body weight that does not fall within the healthy range can have a number of
effects on youth development. Genetics play a role in body weight, as does food
intake. When people do not have a balanced food intake, many nutrients required
for optimal development and health are absent from the diet or not present in the
right amounts. This is the result of not eating enough nutrient dense food.
Body weight can affect individual human development in many ways. Young
people who are either underweight or overweight/obese may not be eating enough
of the foods that provide adequate nutrition. This can mean that optimal physical
development is not achieved during puberty. The individual may not be as tall as they
should be, or may not develop optimal bone density. They might not participate in
sporting events, which could have a negative effect on their motor skill development.
As with all effects on an individual, the impact of body weight on social,

emotional and intellectual development will vary, but some examples could include:
missing out on social experiences can affect communication skills
coping strategies may be developed to deal with feelings of loneliness and affect
emotional development
being victimised at school can affect concentration levels and impact on
Generally, body weight is measured using the body mass index (BMI). The BMI is
calculated using the following formula:
Weight (kg)
BMI =
Height (m)2
So for someone who is 170 centimetres and weighs 68 kilograms:
68 (kg)
BMI =
1.7 (m)2
68
=
2.89
= 23.5
For adults, the BMI score is compared to set figures to determine if a person is
underweight, a healthy weight, overweight or obese (although waist circumference
is increasingly being used as an indicator of health risks associated with excess body
weight). This cannot be used for youth because they are growing and their body
proportions and fat levels change as they grow. Therefore the BMI-for-age charts
must be used (figures 1.36 and 1.37). They compare youth to other individuals of
the same age and sex, and give a more accurate indicator of overweight or obesity
than the adult charts.
BMI
32
BMI
32
30
30
28
28
26
26
24
24
22
22
20
20
18
18
16
16
14
14
12
12
kg/m2
kg/m2
2
9 10 11 12 13 14 15 16 17 18 19 20 21
Age (years)
Obese
At risk of obesity
Normal weight
Figure 1.36 BMI chart for boys

aged220 years
Source: Adapted from US Centers for Disease
Control and Prevention, www.cdc.gov.

BMI
32
BMI
32
Figure 1.37 BMI chart for girls

aged220 years
30
30
28
28
26
26
24
24
22
22
20
20
18
18
16
16
14
14
12
12
Obese
At risk of obesity
Normal weight
kg/m2
kg/m2
2
Source: Adapted from US Centers for Disease

Control and Prevention, www.cdc.gov.
9 10 11 12 13 14 15 16 17 18 19 20 21
Age (years)
The rates of overweight and obesity for young Australians in 201112 are shown
in figure 1.38. These rates have steadily increased over the past 25 years.
80
70
Underweight
Obese
Normal
Overweight (but not obese)

Overweight/Obese
60
50
40
30
20
10
Figure 1.38 Rates of overweight/
obesity in Australian teenagers,
201112
1215
1617
Although overweight and obesity are well-publicised issues for youth,underweight

poses a significant challenge for many, particularly females. The media play a
significant role in attitudes towards underweight, in that being thin is often related
to beauty in popular culture. Females are at significantly higher risk of being
underweight. In cases of underweight, the onset of puberty is often delayed. Current
research indicates that individuals must reach a certain weight before puberty will
begin as nutrient and fat stores must be sufficient to support the development
that will occur. The average age at which puberty begins has decreased in recent
decades and some researchers believe this is due to increasing rates of overweight
and obesity.
The rate of physical development may also be slowed in underweight youth
as the nutrients required for building new tissues are not present in the diet in
the right amounts. This can be particularly detrimental to building optimal bone
density.
Case study
Puberty at 7: why girls are

maturing early
Christina Larmer
A landmark US study shows the number of girls
reaching puberty by the age of seven has doubled
during the past 10 years. Research figures published
in the medical journal Pediatrics found that of the
1239 girls studied, between 10 and 23 per cent had
breast development by seven a condition known as
precociouspuberty.
While these figures arent yet reflected in Australia,
those on the frontline say it is cause for concern.
Certainly the age of puberty is dropping throughout
the Western world, says Dr Louise Farrell, an
obstetrician and gynaecologist, and vice president of
The Royal Australian and New Zealand College of
Obstetricians and Gynaecologists (RANZCOG). Now
its not uncommon for girls to have breast development
and puberty at primary school, whereas it was less
common previously.
The most obvious reason is the rise inbodyweight.
In Elizabethan times, when girls were smaller, many
didnt reach puberty until their late teens. Since then,
improvements in nutrition and health have seen the
average age drop gradually to about 12. Generally,
women wont menstruate under a certain weight, Dr
Farrell says. There is no doubt that increasing obesity
orbodymass index (BMI) is contributing.
Various international studies also point the finger at
environmental toxins, family breakdown and exposure
to artificial light, all of which are increasing in
Australia.
Precocious puberty has serious health implications,

leaving girls at greater risk for asthma, depression and
breast and reproductive cancers in adulthood. Theyre
also more likely to engage in risky behaviour such as
underage sex and substance abuse.
A seven-year-old girl isnt equipped emotionally
to have the body of a young woman, says Denise
Greenaway, psychologist and body image educator
with MirrorMirror.com.au. Were dealing with very
young, vulnerable, impressionable children who
arent at the same emotional, psychological level as
theirbodies.
The sudden development of breasts can
trigger body image issues and lead to confusion at
school and in the community, says Dr Farrell: Once a
girl develops physical changes she might not appreciate
that she can be the object of unwanted sexual attention
and older males may not appreciate how young she is.
Greenaway says parents need to be sensitive to
how their daughter is feeling without dismissing it or
inflaming it further. For parents to pour out all of their
anxiety, pain and grief at seeing the loss of their little
one doesnt help, she says.
Make sure your child understands whats happening
to herbody. If she wants to talk about sex, drugs and
alcohol make it a listening opportunity to see what she
knows, rather than burden her with information she
may not be ready for emotionally, Greenaway says.
And remember, your priority is to protect her. Speak
to her teachers, sports groups, friends and family about
the need for greater privacy and understanding: She
may look older but shes still a little girl at heart and
little girls can hopefully still be climbing trees, riding
horses and looking daggy.
(continued)
Heres what international studies have shown.

Bodyweight: Girls who are obese at the age of three
may be more likely to experience early puberty by
the age of 10.Bodyweightsignals the brain to start
reproducing.
Stepdads: Girls living with stepfathers are almost
twice as likely to enter early puberty as those who
live with their biological dad, due to the presence of
unrelated male pheromones.
Family instability: On average, girls from broken
homes start puberty four months earlier than those
whose parents are together. Instability, stress

and the absence of the biological father may all be
triggers.
Medical disorders: Brain changes, genetic problems
and hormone-releasing tumours can all bring on
earlypuberty.
Environmental toxins: Certain chemicals, some
natural, others man-made, can affect normal
hormonal development.
Source: Sunday Herald Sun, 15 May 2011.
Case study review

1 What is meant by precocious puberty?
2 What is the most obvious reason for precocious puberty according to the
article?
3 Identify the health risks associated with precocious puberty.
4 Explain why the level of emotional development of young girls is an issue if they
go through puberty early.
5 Explain how precocious puberty can impact on intellectual development.
6 Outline other factors that are believed to contribute to precocious puberty.
TEST your knowledge
1 Outline what is meant by biological determinants

of health and development.
2 Using genetics as the basis of your discussion,
outline why people often look like a combination of
both their parents.
3 Explain how each of the following can impact
on the development of youth (remember that
development is not just physical).
(a) Genetics
(b) Hormonal changes
(c) Body weight
4 Prepare a summary table for the hormones and be
sure to include:
(a) the name of the hormone
(b) the gland that secretes it
(c) the role it plays in physical development during
puberty.
5 Draw a flow chart that shows how the hormones
act on the body for both males and females.
6 (a) What is BMI?
(b) How is it calculated?
(c) Explain why the BMI of youths is compared to
percentile charts rather than the set values used
for adults.
7 (a) Calculate the BMI and determine the weight

range (according to figures 1.36 and 1.37) for
each of the following:
i. a 10-year-old boy who is 140 centimetres tall
and weighs 47 kilograms
ii. an 18-year-old female who is 175 centimetres
tall and weighs 52 kilograms.
(b) i. A 15-year-old boy with the same height and
weight as the 10-year-old boy would fall into
which weight category?
ii. Why is there a difference between the two?
8 Use the Genetics links in the
9 Use the BMI links in the
Key skills The individual human development of Australias youth

KEY SKILL Define individual human development
It is essential to be able to define individual human development. A definition
should include reference to the four areas of development (physical, social,
emotional and intellectual).
In the example below, the term individual human development is defined.
Individual human development refers to the changes that humans experience
from conception until death. Individual human development (sometimes simply
referred to as development) includes the predictable, orderly changes
that occur and can be physical (such as growth and motor skill development),
social (such as communication skills), emotional (such as learning to control and
effectively express emotions) and intellectual (such as changes in thought
patterns).
The definition does not have to be

exactly the same as the textbook
definition, but it must convey the
same concept.
Examples assist in demonstrating

understanding.
The four areas of development

should be mentioned.
KEY SKILL Describe characteristics of, and

interrelationships between, the different types of
individual human development during the lifespan
stage of youth
Youth is a time of rapid development, and the common aspects of development
should be known. In addition to the physical changes that occur, the social,
emotional and intellectual changes are also significant. Some questions will focus
on one area of development and others will be more open. Be sure to read the
question carefully to determine the main focus or requirement.
In the following scenario or case study, Tan is in grade six and she has just
started puberty. The following response outlines the physical changes that Tan will
experience as she moves through puberty.
Tan can expect to go through many physical changes during this stage of
development. Tans ovaries will produce more oestrogen, which will be responsible
for many of the changes that occur in the coming years.
Tan will begin to develop breasts, although this process takes some years to
complete. She will start to grow pubic hair, underarm hair and leg hair. Her voice
will deepen and she will undergo a growth spurt that will see her add around
16 centimetres to her height and 16 kilograms in weight. At the end of puberty,
her bones will have finished developing and her height will not increase much
more. As a result of the growth spurt, Tans body proportions will change and
fat will be deposited around her hips. Her hips will also widen, preparing her
body for reproduction. Tans menstrual cycle will begin. This marks the beginning
of her ability to reproduce. Her primary sexual characteristics will also develop
as her body prepares itself for reproduction (e.g. the enlarging of her vagina
anduterus).
A key requirement of this skill is to develop the ability to predict possible
outcomes for an individual, in all areas of development, in a particular scenario or
set of circumstances. Having a detailed knowledge of the four areas of development
is the first step in achieving this.
In this scenario (or case study), Ben is 16 and has just left school to begin a
plumbing apprenticeship. A discussion of how Bens development might be affected
by his leaving school and beginning full-time employment is presented below.
Bens development might be affected in the four key areas: physical, social,
emotional and intellectual.
Physical: He may miss out on playing sports at school, and this could affect his
motor development. He may learn new manual skills in the workplace that may
enhance his motor development.
Keep your answer focused on

females.
Remember that not all physical
changes can be seen. Some occur

inside the body such as the changes
in hormone production.
Provide a range of changes that
occur. Make sure that primary and

secondary sexual characteristics are
covered.
Use key terms where appropriate.
If the question does not specify,
ensure that all areas of development

are covered.
Not all outcomes will be entirely
positive or entirely negative. Try to

achieve a balance.
Social: He will learn to communicate effectively with a range of people in a

professional manner.
Emotional: His identity may change as he begins to see himself differently as he
gains more skills and responsibilities.
Intellectual: Ben will miss out on the traditional academic concepts
learned at school; however, he will learn a new set of skills associated with his
trade.
KEY SKILL Explain the biological determinants of

health and development and discuss the impact on
the development of youth
In order to complete this key skill, knowledge of the biological determinants of
health and development is important. As well as being able to explain the biological
determinants of health and development, the ability to predict the likely effect of
these determinants on the individual human development of youth is also required.
You may also be required to use the biological determinants to explain possible
reasons for differences in the development between individuals. Remember that
the focus of this key skill is on youth and any discussion should be about this
particular age group.
Completing a summary table (such as table 1.1) can provide practice in
predicting likely effects of biological determinants on youth development.
Table 1.1 A summary table for analysing the impact on development of the biological
determinants
Determinant: Body weight
Area of development
Possible impact on youth
Physical
Social
Emotional
Intellectual
As the task is to identify and
discuss the determinants, the first

step is to identify the determinant.
Then discuss how it may have led
to the differences in health and
development.
Ensure the link between the
determinant and the aspect of health

or development is clearly established.
Consider the following example:

Trent and Mai-Lin are both 13 years old and are in year 7 at the same school.
Although it would be expected that Mai-Lin would have started puberty earlier
than Trent, this is not the case. Trent started puberty 18 months ago which is
relatively early for a male, whereas Mai-Lin has not yet started puberty. Mai-Lin is
slightly underweight with a BMI of 14, whereas Trent has a BMI of 27, which for a
male of his age puts him in the obese category.
To identify biological determinants of health and development, and discuss how
they might influence the differences in development experienced by Trent and
Mai-Lin, a response might be as follows.
Genetics: Even though females, on average, start puberty earlier than males,
Trents genes may be responsible for his earlier start to puberty.
Body weight: Body weight is linked to the onset of puberty and the fact that
Mai-Lin is underweight could have contributed to her delayed onset of puberty.
Trent on the other hand, is classified as obese which may have contributed to his
relatively early onset of puberty.
PRACTISE the key skills

1 Define individual human development.
2 Glenn is 14. He has just moved away from the family home to attend boarding school.
(a) Glenn is in which lifespan stage?
(b) Discuss ways that attending boarding school could impact on Glenns
physical, social, emotional and intellectual development.
3 Jacob and Zoe have both just started puberty. Discuss the role that hormones
play in the development that each will experience over the coming years.
4 The graph in figure 1.39 shows the rate of growth for James compared to the
average male youth.
(a) Discuss how James rate of growth differs from that of the average male.
(b) Using biological determinants as the basis of your answer, discuss possible
reasons for this difference.
(c) Discuss how James physical development may have affected his social and
emotional development.
30
James
Average
Height gain (cm/year)
25
20
15
10
5
Figure 1.39
Average rate of
growth for male
0
youths compared
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
with James growth
Age (years)
rate
5 List three aspects of physical, social, emotional and intellectual development that
occur during youth.
Key skills exam practice

6 Fabio and Mandie are both 14 and attend the same school. They are active individuals
who started puberty in the past 18 months.
(a) Identify two similarities in the physical development that occurs at their stage of the
lifespan.
(2 marks)

(b) Identify two differences in the physical development that occurs at their stage of the
lifespan.
(2 marks)
(c) Identify two hormones that contribute to the physical development being
experienced by Fabio and/or Mandie and explain the role they play in physical
development.
(6 marks)
(Adapted from the VCAA exam paper, 2005, Q. 4)
40
CHAPTER 1 review
Chapter summary
The human lifespan begins at conception and ends at death. Each stage has
characteristics common to most people.
The start and finish of some lifespan stages has been debated over the years, and
different groups and organisations may define the lifespan stages differently. For the
sake of this course, the lifespan stages, and the start and end of each stage, are:
Interactivities
Chapter 1 crossword
Searchlight ID: int-6527
Chapter 1 definitions
prenatal: fertilisation until birth

infancy: birth to 2nd birthday
early childhood: 2 years of age to 6th birthday
late childhood: 6 years of age to 12th birthday
youth: 12 years of age to 18th birthday
early adulthood: 18 years of age to 40th birthday
Unit 1
middle adulthood: 40 years of age to 65th birthday
AOS 1
late adulthood: 65 years of age until death.

Development refers to the orderly, predictable and sequential changes that occur
in individuals from conception to death. Development occurs in the physical, social,
emotional and intellectual areas.
Physical development involves internal aspects (development and growth of body
systems and organs) and external aspects (motor skill development and growth). It
includes the decline in body systems.
The individual
human
development of
Australias youth
Sit Topic test
Youth is considered a period of rapid growth.

The physical changes that occur during puberty can be classified as either primary or
secondary sex characteristics.
Social development refers to the social skills, behaviours, capabilities and roles that
people learn through interacting with others.
Youth is a time of rapid social development. Values and beliefs are formed in this stage
and youths interact with a wider range of people, including increased interactions with
those of the opposite sex.
The peer group is an important influence on social development as it contributes to the
development of behaviours and communication skills.
Emotional development refers to the way that people identify, deal with, and express
the emotions they experience.
Self-concept is an important aspect of emotional development and relates to the way
that an individual sees him/herself.
Individuals experience a wider range of emotions during youth and learn to recognise
and deal with them more appropriately.
Intellectual development refers to the processes occurring in the brain and includes
knowledge, language, memory and problem solving.
The brain continues to develop during youth and contributes to more developed
thinking and reasoning skills.
Youths often become more focused on knowledge related to possible career paths.
Some milestones may represent more than one area of development. Learning to use a
knife and fork is an example of both physical development (manipulating the muscles
to hold and move the knife and fork adequately) and social development (the socially
expected way to eat most meals).
The four areas of development are interrelated and all affect each other.
The development experienced throughout life is determined by a broad range of factors
called determinants.
Biological determinants relate to the state and functioning of the body and include
genetics, hormones and body weight. Biological determinants play a significant role in
the physical development experienced by individuals in the youth stage of the lifespan.
CHAPTER 1 review
Genetics contribute to many aspects of development including height, the timing of the
onset of puberty, sex and physical appearance.
Hormonal changes are largely responsible for the physical changes that occur during
puberty and can affect the onset and rate of physical development during youth.
Growth hormone is responsible for many of the changes that occur in height at this
time.
The rate of overweight and obesity has increased over time and impacts on the onset
of puberty for youth.
Body mass is often measured using the body mass index (BMI). For adults, BMI scores
are judged according to set values. For youths, however, BMI classifications are based
on percentile charts because youths are undergoing rapid growth and experiencing
changes in body proportions.
TEST your knowledge
1 Define individual human development.

2 Draw a concept map outlining the four areas
of development. For each area, include five
characteristics that occur throughout the lifespan.
3 Explain why puberty is no longer used to signify the
start of the youth stage of the human lifespan.
4 Make a list of physical, social, emotional and

intellectual characteristics that occur for people of
your age.
5 Write a newspaper article titled The long and
winding road youth of today.
6 Youth really lasts from age 12 until age 25.
Working in groups, debate this statement.
42
CHAPTEr 2
The health of
Australias youth
WHY IS THIS IMPOrTANT?
The health of Australias youth is generally good, and
improvements are continually being made in most areas.
An understanding of the concept of health is important
if the health of our young people is to be adequately
analysed and evaluated. Areas for possible improvement
can then be identified and current interventions can be
evaluated. Predictions can also be made about the health
impacts of current trends and issues. Understanding
the role biological determinants play is also useful in
explaining specific health concerns facing young people.
KEY KNOWLEDGE
1.3 definitions of health and the limitations of these definitions
(pages467, 78)
1.4 characteristics of, and interrelationships between, physical, social and
mental dimensions of health (pages4753, 78)
1.5 measurements of health status, including life expectancy, incidence,
prevalence, trends, morbidity, mortality, disability adjusted life years
(DALYs) and burden of disease (pages5464, 78)
1.6 the health status of Australias youth (pages5464, 789)
1.7 biological determinants of health and individual human development
of Australias youth, including genetics, body weight and hormonal
changes (pages659, 79)
1.8 the interrelationships between health and individual human
development during the lifespan stage of youth (pages513, 701, 79).
KEY SKILLS
define health (pages 53, 72, 79)
explain the limitations of definitions of health (pages 53, 72)
describe the characteristics of, and interrelationships between, the
dimensions of health (pages 53, 72, 73, 79)
explain health status measurement terms (pages 5864, 734, 79)
interpret and analyse data on the health status of Australias youth
using appropriate measurements (pages 589, 64, 745)
explain the biological determinants of health and development and
discuss the impact on the health of youth (pages 69, 76, 79)
explain the interrelationships between health and human
development during the lifespan stage of youth (pages 71, 767, 79).
44
FIgUrE 2.1 The health of

Australias youth is generally good.

burden of disease a measure of the impact of diseases and
injuries; specifically it measures the gap between current health
status and an ideal situation where everyone lives to an old age
free of disease and disability. Burden of disease is measured in a
unit called the DALY (VCAA).
disability adjusted life year (DALY) a measure of burden of
disease. One DALY equals one year of healthy life lost due to
premature death and time lived with illness, disease or injury
(VCAA).
Down syndrome a genetic condition characterised by having
three chromosomes on the 21st pair instead of two. Individuals
exhibit distinct facial features, reduced muscle mass and
impaired intelligence.
genetic predisposition an inherited tendency to exhibit
certain traits (e.g. being tall) or to develop certain conditions (e.g.
cancer) based on genetic make-up
haemophilia an inherited condition characterised by an
inability of the blood to clot
health a state of complete physical, mental and social
wellbeing and not merely the absence of disease or infirmity
(WHO,1946)
health indicators standard statistics that are used to measure
and compare health status, e.g. life expectancy, mortality rates,
morbidity rates
health status an individuals or a populations overall health,
taking into account various aspects such as life expectancy,
amount of disability and levels of disease risk factors (AIHW,
2008)
incidence refers to the number (or rate) of new cases of a
disease/condition in a population during a given period
infirmity a state of being weak, especially from old age
lethargic tired; lacking energy or mental awareness
life expectancy an indication of how long a person can expect
to live; it is the number of years of life remaining to a person at a
particular age if death rates do not change (AIHW, 2008)
mental health State of wellbeing in which the individual
realises his or her own abilities, can cope with the normal
stresses of life, can work productively and fruitfully, and is able
to make a contribution to his or her community. (WHO, 2009)
morbidity refers to ill-health in an individual and the levels of
ill-health in a population or group (AIHW, 2008)
mortality refers to deaths in the population
muscular dystrophy an inherited condition characterised by
progressive muscle wasting
physical health relates to the efficient functioning of the
body and its systems, and includes the physical capacity to
perform tasks and physical fitness (VCAA)
prevalence the number or proportion of cases of a particular
disease or condition present in a population at a given time
(AIHW, 2008)
social health being able to interact with others and
participate in the community in both an independent and
cooperative way
Turner syndrome a genetic condition characterised by having
only one full chromosome on the 23rd pair. Sufferers are
females of small stature who cannot reproduce.
years lost due to disability (YLD) a measure of how many
healthy years of life are lost due to illness, injury or disability
years of life lost (YLL) a measure of how many years of
expected life are lost due to premature death
2.1
What is health?
KEY CONCEPT Understanding the definitions of health and their

limitations, and the interrelationships between physical, social and
mental health
Understanding the concept of health is important for gaining an accurate
knowledge of the level of health experienced in Australia. This understanding
allows areas for improvement to be identified and targeted. A deep understanding
of health will also allow for predictions to be made about the likely effect that
introduced strategies and actions will have on the health of individuals.
Defining health
There has been ongoing debate about the meaning of health since the first
commonly accepted definition was released by the World Health Organization
(WHO) in 1946:
health is a state of complete physical, mental and social wellbeing and not merely
the absence of disease or infirmity.
Although this is a broad definition, it is the one used by health professionals

to define health. It was the first definition to consider health as being more than
justthe physical aspect, and recognises the other types or dimensions of health
social and mental. The use of such a broad definition to make a judgement about
whether a person is healthy or not can be difficult (figure 2.2). Although it moves
beyond disease and infirmity, it does not give everyone the opportunity to be
considered healthy. For example, trying to achieve complete wellbeing in even one
of the dimensions of health identified is very difficult. Therefore it has been argued
that this definition makes good health unattainable for most people.
In 1986, the WHO clarified the definition by saying that health is:
a resource for everyday life, not the objective of living. Health is a positive concept
emphasising social and personal resources, as well as physical capacities.
Figure 2.2 Would this man be

considered healthy using the WHO
definition?
With this in mind, the definition of health becomes more inclusive and more
achievable. The focus on personal resources and physical capacities means
that health is dependent on an individuals own situation, and a person can be
considered healthy even if they do not have complete wellbeing in the dimensions
of physical, social and mental health.
You will notice that the fourth word of the original WHO definition of health
is state. This is a key word for understanding the concept: health is a state and,
as a result, is also dynamic. This means that it is always
changing (although the levels of change may not always
be obvious). Health can be optimal one moment, and then
events such as accidents, illness, relationship breakdown
and stressful incidents can change the state of health very
quickly. Health can also improve quickly. A person with
a migraine who is experiencing poor health can rest and
possibly take medication that will return their health to an
optimal level.
In 1986, the Better Health Commission (BHC) described
health in the following way:
Good health implies the achievement of a dynamic balance
between individuals or groups and their environment. To
the individual, good health means improved quality of life,
less sickness and disability, a happier personal, family, and
46
social existence, and the opportunity to make choices in work and recreation. To the
community, good health means a higher standard of living, greater participation in
making and implementing community health policies, and reduced health-care costs.
This definition is more inclusive than the original 1946 definition and builds
further on the capabilities of the individual. The individuals environment is also
mentioned in this definition, and the environment exerts a huge influence on health.
The physical, social and mental dimensions

of health
Unit 1
AOS 1
Topic 2
Definition of
health
Concept summary
and practice
questions
Concept 1
When people talk about health, they are often talking about physical health, or
rather, physical ill-health. Although some information or data is available relating
to social and mental health, physical ill-health is generally easier to measure and
has become the main focus of many health statistics. Although the physical aspect
of health is very important, it is not the only one that needs to be considered. As
stated in the WHO definition, health encompasses the social and mental state of
the individual as well as the physical state, and there is an increasing understanding
of the importance of these other dimensions of health.
Physical health
Physical health relates to the efficient functioning of the body and its systems, and
includes the physical capacity to perform tasks and physical fitness. Most aspects
of physical health can be readily measured or observed (see figure 2.3).
Physical
fitness
Functioning
of body
systems
Energy levels
Body weight
Aspects of
physical health
Feelings of
physical
wellbeing
Blood
cholesterol
Blood
pressure
Levels of
illness
FIgUrE 2.3 The indicators of
physicalhealth
Physical health can be measured using indicators such as:

physical fitness. Physical fitness means being able to complete activities such as
daily chores, exercise and incidental physical activity such as walking or riding
to school without exhaustion or extreme fatigue (figure 2.4).
The health of Australias youth CHAPTEr 2
47
2.1 What is health?
Figure 2.4 Fitness is an aspect of

physical health.
Unit 1
AOS 1
Topic 2
Concept 2
Physical
health
Concept summary
and practice
questions
weight measurements in relation to height. A person who is physically healthy

hasa weight that is appropriate for their heightand is not carrying excess weight.
blood cholesterol levels. Excessive blood cholesterol can increase the risk
of cardiovascular disease (sometimes called heart disease). Elevated blood
cholesterol levels may indicate that the intake of saturated and trans fats is
excessive.
blood pressure levels. Blood pressure refers to the force thatblood places on the
walls of the blood vessels as the heart beats. High blood pressure indicates that
the blood vessels are not in optimal shape and the heart is working too hard.
High blood pressure is often a symptom of cardiovascular disease and can occur
as a result of a range of factors such as food intake, genetics and other diseases.
the absence or presence of illness. A person who is physically healthy will have
an immune system that is functioning adequately and is capable of resisting
infection and disease.
Aspects of physical health that cannot typically be measured include:
feelings of physical wellbeing. The way a person feels physically can be an
indicator of physical health. Being free from pain, tightness and discomfort are
some examples that might indicate feelings of physical wellbeing.
energy levels. Physical health includes having enough energy to adequately carry
out daily tasks that might include school activities, socialising and a part-time
job. Lack of energy usually means that the individuals body systems are not
functioning adequately. This could be the result of many factors including food
intake, exercise levels, illness and stress levels.
functioning of the bodys systems. Physical health is ultimately reliant on the
functioning of the bodys systems. If the systems are functioning adequately,
the person will usually display other characteristics of physical health (such as
physical fitness; normal levels of blood pressure, blood cholesterol and energy;
freedom from disease; feelings of wellbeing).
There are many factors that can influence physical health such as food intake,
sleep patterns, exercise levels and genetics. Although these factors contribute to
the level of health experienced, it is the physical state that they result in such
as a healthy immune system or an ideal body weight that is considered to be a
physical aspect of health.
48
Social health
Interacting with other people is an important aspect of human
nature (figure 2.5). Social health relates to being able to interact
with others and participate in the community in both an
independent and cooperative way. Someone who is experiencing
a good level of social health typically has a good network of
friends and a supportive and understanding family, with all their
social needs met (figure 2.6).
Like all dimensions of health, social healthis dynamic and can
change quickly. An individual can have a network of friends and
a supportive family until they move away from home. Suddenly
those interactions become more difficult, and their social health
can suffer. This individual may then make friends at their new
school or work, which can restore their social health.
FIgUrE 2.5 Interaction with friends

is an important aspect of social health
and can affect mental health.
Friendship
networks
Being part
of a group
or team
Social needs
met
Aspects of
social health
Unit 1
AOS 1
Topic 2
Social health
Concept summary
and practice
questions
Concept 3
State of
relationship
with
school/
workmates
Relationships
with family
members
FIgUrE 2.6 The indicators of social
health
Mental health
Mental health refers to a state of wellbeing in which the individual realises his or
her own abilities, can cope with the normal stresses of life, can work productively
and fruitfully, and is able to make a contribution to his or her community (WHO,
2009). This includes thoughts and the impact that a persons feelings have on
themselves. Positive mental health might include managing day-to-day activities
with low levels of stress, being able to lead an independent life and having positive
thought patterns (figure 2.7).
If a person is feeling particularly stressed, then the mental aspect of their health
may be compromised (figure 2.8). This dimension of health also includes levels of
self-esteem and confidence.
Self-esteem refers to how people feel about themselves. Having positive selfesteem means that people feel good about themselves. Self-esteem influences
behaviour, as those with positive self-esteem are more likely to speak their mind
and act independently and responsibly.
49
2.1 What is health?

Confidence relates to believing in ones own worth and ability to succeed. Having
confidence can help people accept challenges, such as volunteering to give a speech,
and increase their chances of success because they are not concentrating on failure.
Individuals may have different levels of confidence in different aspects of their lives.
Although it is based on past experiences, confidence can change rapidly as a result
of factors such as ones personal appearance or comments made by others.
Unit 1
AOS 1
Topic 2
Mental
health
Concept summary
and practice
questions
Self
esteem
Concept 4
Thought
patterns
Confidence
Aspects of
mental health
Feelings
Levels of
stress
FIgUrE 2.7 The indicators of mental

health
Interactivity:
Time Out: Dimensions ofhealth
It should be noted that mental health is not the opposite of mental illness.
Mental illness refers to certain mental disorders, whereas mental health is broad
and will vary for an individual from day to day. Mental health can be affected by
life events such as breaking up with a partner, experiencing a death in the family or
being dropped from a sports team.
FIgUrE 2.8 Stress can be a

detrimental aspect of mental health.
50
Case study
Conflict
Tom is a year 11 student who enjoys playing football
and socialising with friends in his spare time. He has
a parttime job that allows him to earn enough money
to fund his social life and to save money for a car. In
the past few months, Tom has been trying to convince
his parents to allow him to leave school and get a job
as an apprentice plumber. Toms parents have been
trying to persuade him to finish year 11 and then try

to get an apprenticeship. This issue has caused a lot of
conflict within the household. Tom has been feeling
stressed about being at home and is therefore avoiding
the house as much as possible. In the past week, he
has been sleeping at a friends house and has not been
doing the things that he normally does, including going
to his job and playing football.
Case study review

1 How has Toms health been affected by the conflict with his parents?
2 Suggest examples from the case study that represent each of the three
dimensions of health (physical, social and mental).
3 Suggest ways that Tom could return his health to an optimal state.
The interrelationships between the

dimensions of health
The three dimensions of health are interrelated; that is, they all affect each other
(figure 2.9). Although they will not all be affected in the same way or to the same
degree, a change in one will usually have some effect on the other two. For this
reason, all three dimensions of health need attention in order to achieve optimal
health (see box).
Optimal
health
Physical
health
Mental
health
OPTIMAL HEALTH
Optimal health refers to the
highest level of health an
individual can realistically
attain. Everyone is born with
a different genetic potential
and is influenced by different
environments. As a result, every
individuals level of optimal
health will be different.
Social
health
FIgUrE 2.9 The three dimensions of health are interrelated.
Exactly how do the dimensions of health affect each other? It is impossible

to state exactly how an individuals health will be affected by a particular event
because everyone is unique and each situation is different. We can, however,
predict possible effects on health. Consider a youth who has suffered a broken leg
(physical health) and is recovering in hospital (figure 2.10). While in hospital and
during the recovery phase, their health could be affected in numerous ways:
physical health
may not be able to exercise, so fitness levels reduce
could gain weight as physical activity levels decrease
Unit 1
AOS 1
Topic 2
Concept 5
Interrelationship
between the
dimensions of
health
Concept summary
and practice
questions
51
2.1 What is health?

immune and other body systems may be affected by the food given in hospital
(this could have positive or negative effects on health, depending on what the
diet was like before)
social health
might make new friends in hospital
could socialise and interact with doctors and nurses
may get a lot of visits from family members they would not normally see
will not be able to socialise and interact with friends at school and during
leisure time
mental health
might be happy or sad to miss out on school
may be depressed about missing out on socialising with friends and family
could experience feelings of loneliness
may feel like they are a burden on their family.
Not all of the effects on health are negative. Sometimes a negative event can
produce positive effects on one or more of the dimensions of health. You may also
have noticed that there is a range of effects on the various dimensions of health.
It is also important to note that the effect on health will not always have a
physical cause. For example, a relationship break-up (non-physical cause) can lead
to a loss of appetite (physical health). If the newly single individual used to spend
a lot of time with their partners friends, they may now have to find a new group of
friends (social health). The person may experience a loss of confidence and doubt
their own worth (mental health).
The following case study looks at the effect of excessive alcohol use on mental
health.
Figure 2.10 This youths social and

mental health may be affected by her
physical health.
Case study
Confronting the issue

By Chris Tanti (headspace) and Leonie Young
(beyondblue)
headspace, the National Youth Mental Health Foun
dation, and beyondblue: the national depression initiative, welcome the Brumby Governments commitment
to addressing the spiralling alcohol abuse, particularly
with young people.
We agree with the Premier that alcohol is one of the
biggest social issues facing Victoria, and it is one of the
biggest threats to young Victorians.
However, it is not just the rise in hospital emergency
department admissions for alcohol use that needs to be
acknowledged when dealing with this issue.
Figure 2.11 Excessive alcohol use can have negative

effects on the physical, social and mental dimensions
ofhealth.
Too often we think of drug and alcohol use in

isolation and the mental health concerns in respect to
this use are neglected.
We urge the Alcohol Action Taskforce to take
a holistic approach and focus on mental health,
particularly depression and anxiety, as a precursor to
alcohol use in our young people.
The relationship with pre-existing depression and other
mental health issues is one of the strongest predictors of
young people taking up and continuing alcohol use at the
alarming rate indicated by Premier Brumby.
We can no longer afford to ignore the social, physical

and mental health implications of alcohol use among
our young people.
Nor can we continue to ignore the rise in depression,
anxiety and other mental health conditions and their
relationship with substance use.
Parents and the community have the opportunity
to take the lead in reducing alcohol consumption and
educate young people on the dangers of alcohol use.
Source: Moorabbin/Glen Eira Standard, 21 November 2007.
Case study review

1 (a) How could excessive alcohol use affect the physical, social and mental health
of young people?
(b) Are all of the effects negative?
2 (a) What does it mean when mental illness is described as a precursor to
alcohol use?
(b) Brainstorm a list of other factors that may increase/decrease the risk of
participating in dangerous alcohol consumption.
TEST your knowledge

1 What is the WHO definition of health?
2 (a) What does it mean when health is said to be
dynamic?
(b) List examples that show the dynamic nature of
health.
3 What is meant by the term optimal health?
4 (a) Which dimension of health is usually the focus
of health statistics?
(b) Suggest reasons that might account for this.
(c) When we talk about health, why is it often
ill-health that we are actually talking
about?
5 What are the three dimensions of health? List two
examples of factors that relate to each.

6 Suggest some limitations of the 1946 WHO
definition of health.
7 Would you be considered healthy at this point in
your life according to the original WHO definition?
Why?
8 Discuss the similarities and differences in the two

definitions of health presented. Which definition do
you prefer? Explain.
9 Devise your own definition of health that you
thinkis appropriate. Share your definition with
theclass.
10 (a) Brainstorm factors that may affect physical
health.
(b) Suggest ways that physical health could be
optimised.
11 (a) Brainstorm factors that may affect social health.
(b) Suggest ways that social health could be
optimised.
12 (a) Brainstorm factors that may affect mental
health.
(b) Suggest ways that mental health could be
optimised.
13 Give two examples of how the three dimensions of
health can affect each other or interrelate.
14 Look at figure 2.8 and suggest ways that this
persons physical and social health could be affected
by her current state of mental health.
The health of Australias youth CHAPTER 2 53
2.2
The health status of Australias youth
KEY CONCEPT Understanding measurements of health status and

the health status of Australias youth: self-assessed health status, life
expectancy and mortality
What is health status?

An understanding of health status and the statistics that indicate health status
allows informed judgements to be made about the health of various groups.
Health professionals often refer to an individuals or groups health status, which
is the level of health being experienced by an individual or a population after taking
into account factors such as life expectancy, disability rates and risk of disease. It is
useful to think of health status as a continuum (figure 2.12). An individuals place
on the continuum is a product of the three dimensions of health.
Severe
ill-health
Neutral (no discernible

illness or wellness)
Optimal
health
Figure 2.12 Health status can be thought of as a continuum.
As already mentioned, health is a dynamic state it is continually changing.

Usually these changes in health status are fairly minor; for example, developing
a cold may slightly affect physical, social and mental health for a short period of
time. Major changes in health status do occur but are less common; for example, if
someone experiences the death of a loved one, their mental health might take some
time to recover.
Measuring health status

Unit 1
AOS 1
Topic 3
Concept 1
Measurement of
health status
Concept summary
and practice
questions
Measuring health status is useful for a number of purposes. First, it allows judgements
to be made about the health of individuals, groups or populations. With this
information, government and non-government organisations can take action to
improve health in areas that need it. Second, it allows trends to be identified in health
status over time. This can provide valuable feedback on actions that have already been
implemented. Such information can further guide interventions aimed at improving
health. There are a number of ways of measuring health status and these measures
are collectively known as health indicators. Each health indicator provides specific
information relating to the health status experienced. By examining a range of health
indicators, a more complete assessment of health status can be made. Common health
indicators include self-assessed health status, life expectancy, mortality, morbidity and
burden of disease. Each of these will be explored in the coming sections.
It can take some time for health statistics to become public often around
three years before data can be accurately collated and released. Some statistics are
released only every two years (biannually) or less often. As a result, some statistics
quoted in this book may date back to the mid 2000s, yet they represent the most
recent statistics available. Generally speaking, the rates and ratios derived from
statistics change slowly over time, so even older statistics are relevant to what is
happening today. Further, many statistics are available only for set age groups
(often 1224). When these statistics are used, it is important to remember that
they include a proportion of those in the early adulthood stage.
Australia is one of the healthiest countries in the world and Australias
youth (those aged 1218) are among the healthiest individuals in the country
(figure2.13). There have been constant improvements over time in most aspects of
health. In order to adequately assess the health of Australias youth, it is important
to understand the methods used for reporting health status.
The self-assessed health status of

Australias youth
Self-assessed health status is based on an individuals own perception of their
health. People are asked to rate their level of health and wellbeing. Responses
range from excellent, very good, good, fair and poor. Young Australians generally
rate their own health positively. Figure 2.14 shows the self-assessed health status of
young Australians at selected ages.
100
Excellent or very good

Good
Fair or poor
90
80
Per cent
70
60
Figure 2.13 The youth stage of the
lifespan is generally characterised by
good health.
50
40
30
20
10
0
Male
Female
Male
1517 years
Female
1824 years
Figure 2.14 Self-assessed health status of young people aged 1524 years, 201112
Source: Adapted from ABS, Australian health survey: updated results, 201112.
Life expectancy
Life expectancy is one of the most common methods used to measure health status.
It gives an indication of how long a person can expect to live if the current death rates
stay the same. (Unless stated otherwise, the numbers refer to a person born in the years
provided.) Table 2.1 shows life expectancy data for people of different ages in Australia.
Table 2.1 Life expectancy at different ages, 190110 and 201113
Age
Males
Females
190110
201113
190110
201113
Birth
55.2
80.1
58.8
84.3
30
66.5
81.0
69.3
85.0
65
76.3
84.2
77.9
87.0
85
87.7
91.1
89.2
92.2
Source: Adapted from AIHW and ABS data.
According to the Australian Bureau of Statistics (2014), the life expectancy of a

child born in 2013 was 80.1 years for a male and 84.3 years for a female. Compare
this to a life expectancy of 55.2 years for males and 58.8 years for females born
between 1901 and 1910 (table 2.1). This represents an increase in life expectancy
of more than 25 years in the past century. The life expectancy of Australians is
constantly improving while death rates are decreasing.
The life expectancy for Australias youth reflects the high figures experienced by
all age groups in this country. According to table 2.2, a male aged 12 could expect
Table 2.2 Life expectancy for

Australias youth and early adults at
different ages
Age
Males
Females
12
80.5
84.7
13
80.5
84.7
14
80.5
84.7
15
80.5
84.7
16
80.5
84.7
17
80.6
84.8
18
80.6
84.8
19
80.6
84.8
20
80.7
84.8
21
80.7
84.8
22
80.7
84.8
23
80.8
84.9
24
80.8
84.9
25
80.8
84.9
Source: Adapted from ABS, Life Tables,

Australia, 201113, ABS cat. no.
3302.0.55.001.

to live to 80.5 years and a male aged 21 could expect to live to 80.7 years. As life
expectancy is based on averages, it increases as people get older. Some individuals
will not survive infancy or childhood, and this brings the average down for life
expectancy at birth. Once an individual survives these stages, the likelihood that
they will live beyond the life expectancy at birth increases.
Mortality
Table 2.3 Mortality rates by age group and sex, 2011

Males
04
99.8
Females
Persons
83.9
92.0
Male : female ratio

1.2
59
11.7
9.5
10.6
1.2
1014
10.3
8.7
9.5
1.2
1519
41.5
23.6
32.8
1.8
2024
63.3
27.9
46.0
2.3
2529
74.2
30.2
52.5
2.5
3034
92.0
41.6
66.9
2.2
3539
113.4
64.2
88.6
1.8
4044
147.8
91.6
119.5
1.6
4549
224.4
143.1
183.4
1.6
5054
336.3
214.7
274.9
1.6
5559
526.5
305.8
415.2
1.7
6064
813.3
470.7
641.5
1.7
6569
1257.6
743.5
999.0
1.7
7074
2118.4
1329.5
1716.8
1.6
7579
3772.3
2250.5
2954.8
1.7
8084
6793.2
4488.3
5477.5
1.5
15334.0
12997.0
13802.3
1.2
85+
Source: Adapted from AIHW data.
Mortality refers to deaths in a

population. The mortality rate is
therefore an indication of how many
deaths occurred in a population in a
given period of time for a specific cause/
all causes. Mortality rates are usually
presented per 100000 population in a
12-month period. Some mortality rates
are shown in table 2.3.
A mortality rate of 23.6 per 100000
means that, on average, 23.6 females
in every 100000 died in 2011 in this
age group. According to the ABS, there
were 706860 females in this age group
in 2011, which equals 167 deaths.
The male:female ratio means that
in 2011 an average of 1.8 males died
in this age group for every female that
died in this age group.
Youth has among the lowest
mortality rates of all lifespan stages,
second only to childhood mortality
rates (figure2.15).
Death rates per 100 000
140
Males
Females
120
100
80
60
40
20
0
04
59
1014
1519
2024
Age
2529
3034
3539
Figure 2.15 Death rates for infants, children, youths and early adults, 2011
Source: Adapted from AIHW and ABS data.
Mortality rates have also decreased significantly over time among youth
(figure 2.16). In 1970, mortality rates were around 150 per 100
000 people
aged 1519 and around 35 per 100000 people aged 1014. These figures had
decreased in 2011 to around 40 deaths per 100000 and 10 deaths per 100000 for
those aged 1519 and 1014 respectively. Advances in technology, education and
medical treatment were largely responsible for these decreases.
Death rates per 100 000
180
TRENDS
1014
1519
160
140
120
100
80
60
40
20
2012
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
0
Year
Figure 2.16 Death rates for Australians aged 1014 and 1519, 19702011
A trend is a general movement

or pattern. Sometimes trend
data is valuable because it tells
us what has been happening to
the data over a period of time.
For example, the death rate
for those aged 1519 in 2011
was 41 per 100000. This figure
may seem high considering that
youth is one of the healthiest
stages of the lifespan. Yet
when we see the trend data,
it shows that the rates have
actually decreased significantly
compared to years gone by (see
figure 2.16).
Death rates are low during youth because they have survived childhood, where
factors associated with childbirth and genetic abnormalities cause many deaths,
and lifestyle factors such as food intake, alcohol consumption and physical activity
levels have generally not had time to impact on the body to the point of causing
premature death.
The leading contributors to death among youth are shown in figure 2.17.
Injuries and poisoning
Cancers
Diseases of the nervous system
Cardiovascular diseases
All other causes
Males
1014
1519
Females
1014
1519
10
15
20
25
30
35
40
45
Deaths per 100 000

FIGURE 2.17 Mortality rates due to selected causes for those aged 1019 according to sex, 2011
Source: Adapted from AIHW, GRIM (general record of incidence of mortality) books, 2015.
Deaths from accidental causes such as car accidents and drowning contribute
significantly during the youth stage. Such causes are classified as injuries.
Specifically, injuries include road accidents, intentional self-harm, poisoning,
drowning and violence.
Although the mortality rate associated with cancer is relatively low among youth
compared to other lifespan stages, it is still the second leading cause of mortality
among youth. Cancer is characterised by the uncontrolled growth of abnormal
cells. These cells can interfere with healthy cells and prevent them from carrying
out their normal functions.
Unit 1
AOS 1
Topic 3
Concept 2
Mortality in
youth
Concept summary
and practice
questions
Among youth, the most common cancers include:

melanoma cancer of the melanocytes, a type of skin cell
Hodgkin lymphoma a form of blood cancer
testicular cancer cancer of the testicles, therefore affecting only males.
Diseases of the nervous system were the third most common cause of death
among youth. The nervous system is made up of the brain, spinal cord and nerves.
Diseases affecting these structures in youth include:
cerebral palsy a condition caused by damage to the brain that occurs either
during pregnancy or shortly after birth
epilepsy a brain condition characterised by recurrent seizures
muscular dystrophy a range of related conditions that cause progressive
weakness and loss of muscle mass.
Cardiovascular disease refers to diseases of the heart and blood vessels. This
cause of death is not common in young people, and when cardiovascular-related
deaths do occur in youth they usually arise from heart defects and genetic
conditions.
Years of life lost (YLL) due to premature death is another way of measuring and
comparing mortality. If a person dies from a given condition 30 years before the
predicted life expectancy for their age, then they have contributed 30 YLLs to that
particular cause of death. For example, if a 14-year-old female dies in a car crash,
and life expectancy for females that age is 84, then 70 years have been added to
the YLLs for injuries.
The YLLs that were caused by a range of conditions among young Australians
are shown in figure 2.18.
For Australias youth, road traffic accidents are the leading specific cause of years
of life lost, and injury-related deaths account for the top three specific causes of
YLLs. Cancer is the leading non-injury related cause of death, followed by nervous
system and sense disorders that include epilepsy and muscular dystrophy. Note
that other causes is not considered to be a leading cause of death because it
encompasses a range of conditions, each of which on its own contributes very
fewYLLs.
Respiratory diseases
(including asthma)
Drowning
Cardiovascular disease
Congenital abnormalities
Males 1014
Males 1519
Females 1014
Females 1519
Endocrine and metabolic

disorders
Nervous system/
sense disorders
Other causes
Cancer
Other injuries
Suicide
Road traffic accidents
1000
2000
3000
4000
5000
6000
7000
Years of life lost (YLLs)

Figure 2.18 Years of life lost (YLLs) for selected conditions by sex and age group
8000
TEST your knowledge

1 What percentage of 1524 year olds assessed
their health as excellent or very good in 201112,
according to figure 2.14?
2 Using table 2.1, explain how life expectancy
changed from 190110 and 201113 for:
(a) males at birth
(b) females at birth.
3 (a) Using table 2.2, explain what happens to life
expectancy as individuals move through youth
and into the early adulthood stage of the
lifespan.
(b) Suggest reasons that account for this change.
4 What is mortality?
5 Examine table 2.3 and answer the following
questions:
(a) Which age group has the greatest male:female
ratio for mortality?
(b) What does this number (ratio) mean?
(c) Discuss reasons that may account for the ratio
identified in part (a).
6 (a) According to figure 2.15, how do death rates
change for 1014 year olds compared with
1519 year olds?
(b) Suggest reasons for this change.
7 (a) Describe the trend in death rates as shown in

figure 2.16.
(b) What factors may have led to this trend?
8 (a) What are the top three broad causes of death
for males and females according to figure2.17?
(b) For each broad cause of death identified in
part(a), list the specific diseases or conditions
that are most likely to have caused these deaths.
9 (a) Explain how mortality rates change for those
aged 1519 compared to those aged 1014 as
shown in figure2.17.
(b) Discuss possible reasons for these changes.
10 (a) State what the acronym YLL stands for and
explain what it means.
(b) Outline how YLLs are calculated.
11 (a) Which sex contributes more YLLs according to
figure 2.18?
(b) Suggest reasons for this.

12 Discuss why death rates might be a more useful
statistic than the total number of deaths.
13 Examine table 2.3 and complete the following:
(a) Graph the male:female mortality ratio across the
lifespan as shown in table 2.3.
(b) Describe the pattern with regard to male:female
mortality rates across the lifespan.
2.3
he health status of Australias youth:

T
morbidity and burden of disease
Understanding measurements of health status and the health status of

Australias youth: morbidity and burden of disease
Morbidity
Not all conditions end in death, so it is useful to examine the effect that non-fatal
conditions have on a population (figure 2.19). This is where morbidity data is
useful. Morbidity refers to ill-health including disease, injury and disability
in an individual, and the level of ill-health in a population. So the morbidity rate
refers to the rate of ill-health in a population in a given period of time.
There are two ways of considering morbidity:
the number of people reporting a condition (often represented as a percentage of
a population, or the incidence and prevalence rates)
the years lost due to disability (YLDs), where one YLD is equal to one healthy
year of life lost due to time lived with illness, injury or disability.
By using two methods, it is possible to examine which conditions are the most
common and which conditions have the biggest impact on health.
Incidence and prevalence
Figure 2.19 Many conditions do

not end in death but still affect youth
health and development.
Incidence and prevalence are two measures used to present morbidity data.
Incidence refers to the number of new cases of a condition in a given period of
time (usually 12 months) and prevalence refers to the total number of cases of a
condition at a given time. Both incidence and prevalence data can be shown as the
total number or the rate (often per 1000 or per 100000 population).
Incidence data is useful for identifying which conditions are increasing in
diagnosis and which ones are decreasing. This can assist the government and
health organisations in allocating resources and taking action to improve the health
status of Australias youth.
Table 2.4 shows the incidence rates (per 1000) for selected age groups and
conditions in 2003.
Table 2.4 Incidence rates for selected conditions, per 1000 population, 2003
Males
Females
1014
1519
1014
1519
1691.0
1590.2
1544.6
2070.3
Diarrhoeal diseases
704.5
704.5
861.1
861.1
Back pain
100.8
18.8
0.7
233.2
Dental caries
250.0
269.5
250.0
269.6
9.2
11.3
11.3
15.3
Migraine
12.0
9.2
20.5
23.2
Asthma
7.5
1.0
8.7
6.0
Falls
9.4
7.7
3.8
1.6
Acne
4.7
6.2
1.8
5.7
Upper respiratory tract infections
Anxiety and depression
As can be seen from table 2.4, the incidence rate for migraine was 12 for
every 1000 males in the 1014 age bracket. In 2003, there were approximately
706500males in this age group. To calculate the total number of new cases,multiply
the rate per 1000 by 706.5 (as there are 706.5 groups of 1000 in 706500) to get
the total number of new cases in 2003:
706.5 12 = 8478.
So in 2003 there were approximately 8478 new cases of migraine among males
in the 1014 year age group.
The prevalence, or total cases, of selected conditions are shown in table 2.5.
Table 2.5 Prevalence of selected conditions, 2003
Males
Females
1014
1519
1014
1519
Asthma
88076
63203
59095
58346
17796
47328
23195
56735
Migraine
16990
23053
14813
33522
Attention deficit hyperactivity

disorder
36369
15270
14487
5704
Dental caries
13105
13956
12464
13347
5737
4528
19024
15933
Eczema
32864
435
Acne
Alcohol dependence
5629
12090
2128
8102
Back pain
3181
4639
2198
5427
Interactivity:
Time Out: Patterns of morbidity
and mortality
Statistics on prevalence can be useful for comparing the number of individuals

suffering from certain conditions during a specified period of time. As with
incidence, information about prevalence can assist with allocating resources
andplanning for the future. It also ensures that trends can be identified over time
so that the health system can adapt to cater for the changing needs of Australias
youth.
The rate of each condition can be calculated if the approximate population is
known. First, divide the population number by 1000 (or 100000 if you want to
display the rate per 100000).
For example, in 2003 there were approximately 671900 females in the 1014
age group:
671900 1000 = 671.9.
In other words, there were 671.9 groups of 1000.

To calculate the rate, divide the number of individuals suffering from the
condition by 671.9. For asthma (table 2.5), there were 59095 females in this age
group suffering from asthma:
59095 671.9 = 87.9 cases per 1000 females in this age group.
YLDs
Years lost due to disability (YLDs) is a measure of the impact of morbidity on a
group or population. YLLs and YLDs are equal in value, in that one YLL and one
YLD are each equal to one healthy year of life lost.
It would be difficult to compare the effect of asthma on an individual with
the effect of losing a leg in a car crash. They are very different conditions
and would impact on an individual in different ways. In order to address this
issue, the World Health Organization has given the most common conditions
a disability weight, which is an indication of the severity of the condition and
how much it interferes with normal life. The disability weights are incorporated
into the YLD formula, so all YLDs are relative and different conditions can be
compared.
The graphs below show the breakdown of YLDs for males (figure 2.20) and
females (figure 2.21) in 2003. While YLLs are generally male-dominated, YLDs
were slightly higher for females in 2003 (57 616 for males and 67 840 for females).
Females experience higher rates of YLDs for most conditions, with injuries being a
notable exception.
2%
2%
8%
1%
1%
2%
3%
7%
1%
1%
9%
13%
9%
10%
59%
58%
Mental disorders
Other
Injuries
Nervous system and sense
organ disorders
Chronic respiratory diseases
Communicable diseases, maternal
and neonatal conditions
Nutritional deficiencies
Endocrine and metabolic disorders
14%
Mental disorders
Other
Chronic respiratory diseases
Nervous system and sense
organ disorders
Communicable diseases, maternal
and neonatal conditions
Injuries
Nutritional deficiencies
FIgUrE 2.20 Proportion of YLDs

attributed to selected causes, males
aged 1019, 2003
FIgUrE 2.21 Proportion of YLDs

attributed to selected causes, females
aged 1019, 2003
burden of disease
Unit 1
AOS 1
Topic 3
Concept 3
62
Health status
terms
Concept summary
and practice
questions
Burden of disease is a health indicator that combines mortality data with morbidity
data so that conditions that contribute differently to death and illness can be
compared. For example, cancer causes a lot of death and illness while a chronic, or
long-term, condition such as asthma causes a lot of illness but much less death. In
the past, it was hard to compare these two conditions and decide where valuable
funding should go. Burden of disease data was created to help overcome this
problem.
Burden of disease is measured in disability adjusted life years (or DALYs,
pronounced dally), where 1 DALY is equal to one year of healthy life lost due to
premature death or the equivalent time lost due to living with a disability/illness.
Using DALYs, it is possible to compare the impact of different conditions equally
those that cause death, those that cause disability and illness, and those that cause
both (table 2.6). So a person who has lived a healthy life but dies suddenly
30 years earlier than the current life expectancy of their age has contributed
30DALYs. In contrast, a person who is still alive but has spent their last 10 years
at only half health has contributed five DALYs.
TAbLE 2.6 Ten leading causes of burden of disease and injury for 1019 year olds
in Australia, 2013
Condition
DALYs
% of total DALYs
Mental disorders
73 415
49.6
Injuries
21 014
14.2
Chronic respiratory disease
14 084
9.5
Nervous system and sense organ disorders
11 701
7.9
Skin diseases
3 815
2.6
Cancers
2 931
2.0
2 837
1.9
Musculoskeletal diseases
2 238
1.5
Acute respiratory infections
1 813
1.2
Diabetes mellitus
1 528
1.0
DALYs are calculated by adding YLLs (years of life lost) and YLDs (years lost due
to disability), as shown in figure 2.22.
YLDs
YLLs
DALYs
FIgUrE 2.22 The equation for
DALYs
Australias youth experience a significantly greater number of YLDs than YLLs.

According to data from the Australian Institute of Health and Welfare, in 2003
those aged between 10 and 19 had 125 446 YLDs compared to 22 498 YLLs,
giving a total of 147 944 DALYs. The top 10 causes of DALYs (with a breakdown of
YLLs and YLDs) for this age group is shown in figure 2.23.
Diabetes mellitus
Acute respiratory infections
Musculoskeletal diseases
TAbLE 2.7 Leading specific causes of

burden of disease and injury (DALYs)
for 1019 year olds, 2003
Cancers
YLLs
YLDs
Skin diseases
Nervous system and sense organ disorders
Chronic respiratory disease
Injuries
Mental disorders
0
10
20
30
40
50
60
70
80
DALYs (000s)
FIgUrE 2.23 Burden (YLL, YLD and total DALYs) for the top 10 causes of DALYs for
1019 year olds, 2003
Up to this point, the broad categories of burden of disease for youth have been
examined. In table 2.7, specific causes of burden of disease for all youth (male and
female) are presented.
Condition
DALYs
51 100
Asthma
15 583
8 106
Migraine
6 517
Substance use disorders
6 274
Schizophrenia
5 145
Eating disorders
4 522
Suicide and
self-inflicted injuries
3 850
Anorexia nervosa
2 312
Bulimia nervosa
2 211
63
TEST your knowledge
1 (a) What is meant by the term morbidity?

(b) Explain why it is useful to examine morbidity
data in addition to mortality data.
2 (a) State what the acronym YLD stands for and
explain what it means.
(b) What are the top three causes of YLDs for young
Australians according to figure 2.23?
3 (a) Which sex contributes more YLDs to the burden
of disease?
4 (a) What is a DALY?
(b) What is the benefit of using DALYs instead of
morbidity or mortality data?
5 Using data to support your response, write a

paragraph discussing the health status of Australian
youth.
6 If the incidence for a condition drops to 0 per
100000 population, does this also mean the
prevalence will be 0? Explain.
7 (a) Which three conditions lead to the most burden
of disease as shown in table 2.6?
(b) For each of the three conditions, explain
whether you think most DALYs would be
attributable to mortality or morbidity.
8 Explain how anxiety and depression can be the
leading burden of disease (DALYs) for young
Australians when these conditions cause relatively
few deaths.
9 Why might it be useful to look at the total number
of people suffering from a condition as well as YLDs
contributed by each condition?
64
2.4
The impact of biological determinants on youth health
KEY CONCEPT Understanding the impact of biological determinants

on the health of youth
As well as affecting their individual human development, genetics, hormones and
body weight also contribute to the health experienced by young people.
Genetics
Genetics have been explored in chapter 1 in relation to their impact on development
during youth, but they also play a role in health outcomes. Although genetics play
a significant role in determining the health of youth, it is worth remembering that
there are other factors that also play a role. For instance, a person with genes that
increase the likelihood of being overweight might exercise and eat healthy foods
and thereby maintain a healthy body weight.
Genetics determine sex, which influences the body structures that males and
females have, and dictates some forms of illnesses experienced by the different
sexes. For example, females do not have testicles and therefore cannot develop
testicular cancer. For males, however, testicular cancer is one of the most common
forms of cancer among youth. Unlike females, males do not have a cervix and are
therefore not at risk of cervical cancer.
Genetic conditions are conditions caused by an abnormality in the genes. Such
conditions often occur at conception if there is an abnormality when the sperm
and egg fuse together. These conditions are referred to as genetic abnormalities (or
anomalies) and examples include Down syndrome (figure 2.24) and Turner syndrome.
Unit 1
AOS 1
Topic 4
Genetics
Concept summary
and practice
questions
Concept 1
Figure 2.24 Down syndrome

occurs as a result of having three
chromosomes, instead of two, on the
21st pair.
Sometimes the genes for certain genetic conditions may already be present in the
mother or father and can be passed on to the children. These conditions are called
inherited conditions and examples include haemophilia and muscular dystrophy.
All genetic conditions can impact on the health of youth (table2.8). The condition
may make the youth unable to participate in certain activities due to the risk of
injury or to be more susceptible to illness.

TABLE 2.8 Common genetic conditions affecting youth
Condition
eLesson:
Teen brain
Explanation
Common symptoms
Down
syndrome
Down syndrome (also known as

Trisomy 21) is a genetic condition in
which the person has an extra copy
of chromosome 21. This additional
chromosome results in a number
of physical and developmental
characteristics and some level of
intellectual disability.
Slight upward slant of eyes

Round face and flat facial features
Low birth weight, small stature
and slow rate of growth
Language and speech problems
Turner
syndrome
Turner syndrome is a random genetic

disorder that affects females. The
main characteristics include short
stature and infertility. A female usually
has two X chromosomes. However, in
females with Turner syndrome, one
of these chromosomes is missing or
abnormal.
S hort stature (average adult

height is 143cm)
Infertility due to underdeveloped
ovaries
Congenital heart defects in about
50percent of affected women
Spatial awareness issues (e.g.
trouble with sense of direction)
Absence of menstruation
(amenorrhoea)
Hearing problems
Haemophilia
Haemophilia is a rare blood disorder

caused by an inherited gene. People
with haemophilia lack one of the
essential blood-clotting factors. It is
mainly a male disorder because the
haemophilia gene is carried on the
X chromosome. (For a girl to get
haemophilia she must inherit defects
on both X chromosomes, making it
much rarer among females.) People
with haemophilia need special first
aid for injured muscles or joints.
Haemophilia can be mild, moderate

or severe, according to the level of
clotting factor deficiency. The lack
of clotting factor means that people
with haemophilia tend to bleed
internally into joints and muscles.
This can lead to chronic pain and
arthritis. When someone with
haemophilia experiences a bleed, a
blood transfusion is often provided
to replace the missing blood clotting
factor.
Muscular
dystrophy
Muscular dystrophy is the name given

to a group of disorders that cause
progressive and irreversible weakness
and wasting of the muscles.
Muscle wasting is the most common

symptom of muscular dystrophy. It
can contribute to:
falls
inability to walk
restricted breathing.
Individuals can also have a genetic predisposition to certain diseases and

conditions. One person may be more likely to develop cancer and another
may be more likely to have asthma. However, other determinants (including
behavioural and environmental) may also play a key role. Therefore, a person
who is predisposed to cancer may not develop it due to their behavioural and
environmental determinants. Many leading causes of mortality and morbidity for
youth have a genetic predisposition, including cancer, depression and anxiety,
respiratory conditions such as asthma, and endocrine conditions such as diabetes.
Genetics contribute to personality. Personality in turn contributes to many
aspects of health including the likelihood of taking risks. This can influence the risk
of sustaining injuries from risk-taking behaviours. Personality may also influence
sociability which can impact on social health.
As you saw previously, genetics also influence the timing and rate of hormone
release during youth and this may contribute to health outcomes. Some studies
suggest that females who start puberty early may be at increased risk of breast
cancer in later life. In males, early onset of puberty may be associated with
increased strength and sporting prowess, which may enhance other aspects of
health for these individuals (e.g. mental or social health). Those who develop early
may socialise with older people, and some studies suggest that they are more likely
to experiment with drugs and alcohol at an early age which can also impact on
health by increasing the risk of injuries.
Hormonal changes
Hormones are the chemical messengers that contribute to many of the
changes that occur during youth and also have numerous impacts on
health. Quite often, an imbalance of hormones or impaired response to
hormones is responsible for these impacts. A combination of genetics,
stress and environmental factors are thought to be responsible for most
hormonal imbalances and impaired hormonal responses.
Insulin is the hormone responsible for controlling blood glucose levels.
If insulin is not produced or the bodys cells are resistant to it, diabetes
may occur. Diabetes is a condition characterised by an inability to control
blood glucose levels. The three types of diabetes are type 1, type 2 and
gestational diabetes, all of which can affect youth. Type 1 diabetes is
often first diagnosed in childhood or youth and is characterised by an
inability of the body to produce insulin. Insulin must be administered
regularly to control blood glucose levels (figure 2.25). In 2011, 695
people aged 1019 were diagnosed with type 1 diabetes in Australia
and more than 9000 people in the same age group were living with the
condition (National Diabetes Services Scheme, 2015). In the past, type 2
diabetes was considered an older persons disease, but rates among youth
have increased in the past decade. Type 2 diabetes is characterised by
insufficient amounts of insulin being produced or an inability of the body
to utilise the insulin that is produced. Type 2 diabetes is closely related to
obesity and behavioural factors such as levels of physical activity and food
intake. Gestational diabetes can occur during pregnancy, and pregnant youth may
therefore be affected by it. Gestational diabetes usually disappears after the baby is
born; however, those experiencing this condition are more likely to be diagnosed
with type 2 diabetes later in life. If left untreated, diabetes can contribute to a
range of health concerns including cardiovascular disease, kidney disease, limb
amputations, blindness and premature death.
A range of hormones contribute to the regulation of body weight. Leptin, for
example, is a hormone that plays a role in regulating the amount of fat that is
stored in the body. Ghrelin is a hormone that influences appetite and promotes
feelings of hunger. An imbalance of or resistance to these hormones can increase
the risk of underweight, overweight or obesity in youth.
Cortisol is often referred to as the stress hormone and plays a number of roles
in the body. In small amounts, cortisol can assist youth in dealing with stressful
situations by providing a short burst of energy and decreasing feelings of pain.
However high and prolonged levels of cortisol in the bloodstream can contribute to
prolonged stress and impact on mental health. If cortisol levels remain high for a
period of time, it can contribute to a range of health conditions including reduced
immune system function which can increase the risk of infections and disease.
Hormones are responsible for sperm production in males and regulation of the
menstrual cycle in females. The regular fluctuations of hormones in females can
contribute to other aspects of health such as mood changes and abdominal pain.
Testosterone in males is thought to have an influence on their higher rates of risktaking and, ultimately, injury.
Polycystic Ovarian Syndrome, or PCOS, is a condition that occurs in females
with a hormonal imbalance. Too much insulin or testosterone or both is often
the cause of PCOS. PCOS is thought to affect 12 to 18 per cent of female youth.
Females who experience PCOS may also experience:
Irregular menstrual cycles menstruation may be less or more frequent due to
less frequent ovulation
Amenorrhoea some women with PCOS do not menstruate, in some cases for
many years
Figure 2.25 People with type 1

diabetes must administer insulin
regularly to control their blood
glucose levels.
Unit 1
AOS 1
Topic 4
Hormonal
changes
Concept summary
and practice
questions
Concept 2
Figure 2.26 Hormones contribute

to acne among many youth.
Excessive hair growth and acne possibly due to increased testosterone

(figure2.26)
Mood changes including anxiety and depression
Obesity.
Medical assistance should be sought if an individual
suspects PCOS, as a range of treatment options are available.
As testosterone levels increase in both males and females
during puberty, oil glands in the skin of the face, neck,
back, shoulders and chest grow bigger and secrete more oil.
Bacteria on the skin and blocked pores can result in acne,
which consists of mild to severe outbreaks of blackheads,
pimples and cysts. Acne is common among male and female
youth although males often experience more severe outbreaks
and females may experience outbreaks at different times,
according to the hormonal activity of their menstrual cycle.
Acne may lead to scarring and can impact on mental health if
self-esteem is affected. A range of treatment options exist for
youth experiencing acne and medical assistance should be
sought in severe cases.
Changes in hormone levels also contribute to increased
perspiration (or sweating) in youth. Although perspiration
has no smell, it provides a breeding ground for bacteria who
feed off it. Acids are produced by the bacteria which contribute to increased rates
of body odour among youth. Body odour can impact on the social and mental
health of the youth if the condition goes untreated.
Increased levels of human growth hormone contribute to the increases in growth
experienced during puberty. This growth increases the size of body systems and
tissues including the cardiovascular, respiratory and musculoskeletal systems.
These changes generally increase endurance and strength which are aspects of
fitness (physical health).
Body weight
Maintaining a healthy body weight is beneficial for health. Body weight that does
not fall within the healthy range can have a number of effects on youth health.
Body mass index (BMI) is often used to make judgements on underweight, normal
weight, overweight and obesity. See page 33 for an explanation of BMI.
Figure 2.27 Maintaining an ideal

body weight can have many health
benefits for youth.
Genetics and hormones play a role in body weight, as do a range of other factors
such as food intake and levels of physical activity.
Being underweight can have a range of effects on the health of an individual if
they lack the nutrients required for optimal health. Physical health can be affected
in a number of ways including a weakened immune system, increasing the risk
of contracting diseases such as influenza. Anaemia may also occur if the nutrients
required for blood production are not present, leading to feelings of lethargy. If the
youth lacks energy, they may not be able to participate in their regular activities,
and this can impact on social and mental health. Physical fitness may also be
reduced as it becomes increasingly difficult to exercise. In the long term, the risk of
osteoporosis increases if the nutrients required for building bone mass are deficient.
Overweight and obesity rates have increased significantly among youth in recent
years, to around 25 per cent of youth in 201112, and also have a range of impacts
on health. In the short term, the risk of developing a range of conditions, including
asthma and cardiovascular conditions, increases with increased body weight.
As well as having an impact on physical health, overweight and obesity could
have many associated effects on social and mental health. The exact impact would
depend on the individual in question but could include:
Social marginalisation those who are overweight or obese might be excluded
from certain activities by others. They might not be invited to parties or asked
to join sporting teams. The individual might also be victimised by their peers,
which could have a negative impact on mental health.
Self-esteem issues those who are overweight or obese might feel negative
about their body, which can influence other areas of their life such as social
participation.
Many of the effects of being overweight or obese occur in the long term. Youths
who are overweight or obese have a higher chance of becoming obese adults and
therefore developing one or more of the following conditions in the future:
Cardiovascular disease a high-fat diet contributes to a build-up of plaque on
the artery walls, increasing the chance of heart attack and/or stroke.
Some cancers it is thought that high-fat, low fibre diets can increase the risk
of colorectal cancer.
Respiratory problems excess weight can put pressure on the lungs, making
breathing more difficult.
Arthritis excess weight places extra pressure on joints, which can increase the
rate at which cartilage is worn down.
TEST your knowledge

1 What is the difference between a genetic
abnormality and an inherited condition?
2 Outline three ways in which hormones can impact
on the health of youth.

3 Do all youths have the same risk of skin cancer?
Explain, making reference to genetics.
4 Bill is 12 years old and has a BMI of 26.
(a) In which category (underweight, normal weight,
overweight or obese) does this place Bill? (You
will need to refer to the BMI chart on page 33.)
(b) What might the short- and long-term health
implications be for Bill if he maintains this BMI?
Unit 1
AOS 1
Topic 4
Body weight
Concept summary
and practice
questions
Concept 3
5 Sarah is 16 and has a BMI of 15.

(a) In which category (underweight, normal weight,
overweight or obese) does this place Sarah?
(You will need to refer to the BMI chart on
page34.)
(b) What might the short- and long-term health
implications be for Sarah if she maintains this
BMI?
6 Select one genetic disease and research information
about it. Include a description of the condition, how
common it is and how it can impact on health.
7 Explain how being underweight may impact on the
social health of an individual.
8 Explain how being obese could impact on the
mental health of an individual.
2.5
Understanding the interrelationships between health

and individual human development during youth
KEY CONCEPT Understanding the interrelationships between health

and individual human development
Health and individual human development have a direct relationship with each
other (figure 2.28). If health is optimal, then development will generally be optimal
as well. Conversely, if either health or development is not optimal, it will generally
affect the other in a negative way.
Development
Youth is a time of significant change and both health and development can be
impacted in a number of ways by these changes. The following examples outline
some impacts on health and individual human development that could occur as a
Health
result of the interrelationships that exist between these two concepts.
A youth who is not experiencing good physical health may also experience lower
levels of social and mental health. Consider a youth who is suffering from influenza
(physical health; figure 2.29). They may have to stay home, so they cannot socialise
with their friends (social health) and may also feel frustrated and upset about
FIgUrE 2.28 Health and
having to stay at home (mental health). If they lose their appetite, they may not get
development have a direct
the nutrients they require from their diet, and this could affect the development
relationship.
of their bones and muscles (physical development). The lack of social interaction
could affect the development of their communication skills (social development),
and missing school could mean they
miss learning key concepts (intellectual
Intellectual
development). Their self-concept
Absence from school could
could decrease as a result of missing
mean missing out on
learning key concepts
out on various experiences and feeling
that they are no longer seen as a key
part of their normal activities and
Emotional
Self-concept could decrease
groups (emotional development).
as a result of missing out on
Conversely, consider a youth who
various experiences and not
is
experiencing good social health.
feeling part of a group
Possible impacts
They will generally feel good about
on development
themselves
(positive
self-esteem,
Social
which is mental health) and might
Lack of social interaction could
affect development of
be better able to concentrate at
communication skills
school (impacting on intellectual
development) and take the time
Physical
to look after themselves physically
A person
May lose appetite and not get
(impacting on physical health).
suffering from
nutrients
Radiorequired from diet,
Similarly, a youth who has optimal
influenza
affecting development of
(physical health)
intellectual development might be
bones and muscles
better informed about what foods they
should eat. Their choice of diet could
Social
affect their immune system (physical
May have to stay home, so
health) and the growth of their body
would not be able to socialise
systems (physical development). They
with friends
Possible impacts
might not be anxious about their
on health
grades at school and may therefore
Mental
have positive mental health.
May feel frustrated and upset
Examples of the possible effects
about having to stay home
on the health and development of a
youth suffering from glandular fever
are summarised in table 2.9. It is
FIgUrE 2.29 Possible impacts on health and development as a result of suffering
frominfluenza
difficult to say exactly how health
70
and development will affect each other in every instance because every person is
different, and effects on health and development will produce different outcomes
for each individual. Note that not all of these examples are negative.
Table 2.9 Possible effects on the health and development of a youth suffering from glandular fever
Aspect of health/development
Possible impact
Physical health
The immune system may be weakened while the infection is fought, making the person more susceptible to
secondary infections. They may also be continually lethargic and generally feel unwell.
Social health
They may be forced to take weeks off school and so will miss out on opportunities to socialise with friends.
However, they may get a lot of visitors, which could lead to interactions with people they would not normally
socialise with (e.g. aunts and uncles, family friends).
Mental health
They may feel depressed at being bedridden and missing out on leisure activities such as sport, music and
socialising with friends.
Motor skills may be affected as the person misses out on opportunities for physical activity. Diet may be
restricted, so inadequate nutrients might be ingested with effects on various body systems (e.g. blood
production).
Social development
Social development might be halted as the person may not be socialising with anyone outside their family.
Conversely, they may develop some skills in communicating with older people (if extended family members
visit, as suggested in the social health section of this table).
They may experience sorrow and despair as a result of being indoors for an extended period of time.
However, they may learn how to effectively deal with these emotions by talking about their experiences to
parents or siblings.
They may miss out on extended periods of school time, thereby affecting the skills normally practised and
learnt at school. Their ability to concentrate may be minimised by lethargy.
TEST your knowledge

1 Explain the relationship between health and
individual human development. Use examples in
your explanation.

2 Sally, a year 9 student, is an only child who has
always had good social health. She has always
been popular at school and had a wide network of
friends, both male and female. That was until last
month, when her dad was offered a promotion that
required her family to move to Germany almost
immediately. Sally is now attending a new school,
but language barriers and being the new kid have
prevented her from making many friends at this
stage. Consequently, her social health has suffered.
She has become rather withdrawn and just wants to
go back to her old school in Australia.
Copy and complete table 2.10, listing the possible
effects on Sallys health and individual human
development of her familys move to Germany. (One
has been done for you as an example.)
Table 2.10 A summary table for analysing possible

effects on health and development
Aspect of health/
development
Possible impact
Physical health
Social health
Has few friends at her new

school. Spends her free time
at home with her mum and
dad when they are home.
Mental health
Social development
3 (a) Write your own case study about a person

experiencing positive or negative health or
development.
(b) Get a partner to complete a table (like table2.10)
outlining the possible effects on the other
dimensions of health and areas of development,
based on the information in your case study.
4 How might the physical development that occurs
during the youth stage of the lifespan affect the
social and emotional development that individuals
experience?
KEY SKILLS The health of Australias youth

KEY SKILL Define health and explain the limitations
of the definitions of health
Stating the definition provides a good

point of reference for the remainder
of the discussion.
It is worth memorising the WHO

definition of health.
Provide a reference if using the WHO

definition.
Make references to specific words
that limit the scope of the definition.
Use examples to substantiate claims.

Suggesting another definition that
accounts for the limitations of the
original definition can be useful.
As these two skills are closely related, they are explained together. To provide an
adequate definition of health, knowledge of a range of definitions is beneficial.
Although the WHO definition is acceptable, there may be occasions on which it
is necessary either to expand on this definition or discuss the limitations of it.
Being familiar with the Better Health Commission definition and understanding
the differences between it and the WHO definition should ensure a sound
understanding of the concept of health and why it can be difficult to define.
One approach to a discussion of the possible limitations of the WHOs definition
of health might be as follows.
The World Health Organization defines health as a state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity
(WHO, 1946).
This definition is very broad and makes no reference to the circumstances that
individuals may experience. For example, a person with asthma would not be
considered to have complete physical wellbeing and could not be considered
healthy according to this definition. This is despite the fact that many asthmatics
manage their condition effectively, have excellent physical fitness and excel in
sports. Likewise, a person who suffers from depression may manage their
condition well, have a broad network of friends and maintain optimal mental
health. To say that health refers to the best possible state of physical, social and
mental functioning a person can realistically attain might be a better definition as
everyone has the opportunity to be considered healthy.

The first commonly accepted definition of health was devised by the World Health
Organization (WHO) in 1946. Since that time, there has been wide debate about
defining health.
1 What is the WHO definition of health?
2 Suggest two limitations of this definition.
3 Suggest and then justify a definition for health that might be more appropriate.
KEY SKILL Describe the characteristics of, and

interrelationships between, the dimensions of health
In order to master this key skill, it is important to be able to explain each dimension
of health (physical, social and mental), and to be able to identify examples that
relate to each. A useful approach is to practise identifying the dimensions of health
in case studies or in examples drawn from personal experience.
When describing the interrelationships between the dimensions of health, it
might be necessary to describe the possible effects on health in a scenario or context
that is totally unfamiliar. Again, practising identifying possible effects on health
can be beneficial. Start by thinking of something (a set of circumstances such as
relationship breakdown, illness or stress) that could affect one of the dimensions
and then brainstorm ways that the dimensions of health could be affected by it.
When doing this, remember that all three dimensions of health will be affected
including the dimension where the initial effect occurred. For example, a condition
such as rheumatoid arthritis (which relates to physical health) will lead to other
impacts on physical health (such as reduced fitness) as well as impacting on social
and mental health.
An explanation of social health might be as follows:

Social health refers to being able to interact with others and participate in the
community in both an independent and cooperative way. Someone with optimal
social health, for instance, might have their social needs met by an understanding
family and a supportive network of friends.
In the following scenario, Josie has just broken up with her boyfriend of six
months and is feeling upset and anxious. During the course of the relationship
Josie had begun to associate with her boyfriends friends. She now feels that she
has neglected her own friends and that it may be difficult to re-establish links with
them.
The following response explains how Josies breakup may have affected her
health.
As Josie is feeling upset and anxious, she may not be eating properly and
exercising. This may impact on her fitness levels and her body weight, which is an
aspect of physical health. She is upset and anxious, which is an aspect of mental
health; and her friendship circle has been thrown into turmoil, which is social
health.
Social health is explained.
Use examples to add substance to

your explanation.
If the question doesnt specify, cover

all three dimensions of health.
Link the example to the dimension of

health.
Social and mental health are also

covered.

4 Read the case study below, Anissahs story, and answer the questions that follow.
Anissah is in year 10 at school. She loves school and is involved in many
extracurricular activities, including the annual drama production, the netball team
and the school band. She has played clarinet in the school band since year 7 and
has many friends who also play in the band. Last week, Anissah tried out for this
years band but missed out on a place as she had not had time to practise the
prescribed piece in the weeks leading up to auditions. She has felt devastated by
not getting into the band and has not wanted to attend school at all. Her mother
has let her stay home for a few days while she tries to deal with this experience.
Anissah has also withdrawn from her other usual activities as she tries to accept
not being a part of the band for this year.
(a) Health relates to three different dimensions. List the three dimensions and
briefly explain what is meant by each one.
(b) Suggest ways that not getting into the school band could impact on the three
dimensions of health in Anissahs case.
KEY SKILL Explain health status measurement terms

When explaining health status, try to avoid using the term health status. Using the
term health status, without supporting explanation and examples, will not clarify
this concept for someone who is unfamiliar with it. It is important to remember
that health status is related to overall wellbeing (physical, social and mental), not
just those aspects that can be measured. Although the physical aspect of health
is often the focus of data, the social and mental aspects of health are equally as
important when explaining health status. It is important to have knowledge of the
key health measurement terms, including life expectancy, incidence, prevalence,
trends, morbidity, mortality, disability adjusted life years (DALYs) and burden of
disease. As well as being able to define these terms, it is important to know what
they mean when data is presented about them.
Consider the following explanation of the term DALYs.
DALYs are Disability Adjusted Life Years and are the unit of measurement of
burden of disease. One DALY is equal to one year of healthy life lost through
premature death, disability, illness or injury. DALYs are calculated by adding Years
of Life Lost (due to premature death) to Years Lost due to Disability (i.e. YLL +
YLD).
There are a number of important
aspects of this explanation, the most

important of which is what DALYs
actually measure.
The inclusion of the word healthy
is a critical aspect of the definition.

Without it, the meaning would be
quite different.
Including the formula for calculating

DALYs demonstrates detailed
understanding of the term.
Key skills The health of Australias youth

5 Explain what is meant by the term health status.
6 The current life expectancy in Australia is around 82 (both sexes combined).
(a) Define the term life expectancy.
(b) Morbidity is another measure used to provide information about health status.
Explain what is meant by morbidity.
7 What does a life expectancy tell us about the level of morbidity being experienced?
KEY SKILL Interpret and analyse data on the

health status of Australias youth using appropriate
measurements
This key skill relates to the interpretation and analysis of data. Data concerning
health status are presented using a range of different measurements and an
understanding of the measures commonly used will assist in developing this skill.
Measures used to present data relating to health status include:
life expectancy
incidence
prevalence
morbidity
mortality
disability adjusted life years (DALYs)
burden of disease (i.e. YLL and YLD).
To become proficient at data analysis, it is necessary to be able to interpret
data available in the form of graphs, tables and charts. A range of activities in this
chapter provides the opportunity to practise this skill. The following steps offer a
systematic approach to interpreting graphs and tables:
1. Read the title of the graph or table the title usually gives an indication about
what information is presented in the graph. It may be located at the top of the
graph or next to the figure number.
2. Read the horizontal and vertical axes (for a bar graph) and look at the units (e.g.
is it %, year, number, rate, proportion, $, etc.).
3. Look at the key if there is one this helps identify various elements of the data.
4. Read any notes that relate to the data there may be additional written information
at the bottom of the graph explaining various elements of the graph. An element
of the data that may not make sense may become clear after reading these notes.
5. Look for trends, similarities and differences between the data. This will enable a
better understanding of the data that the graph is actually presenting.
Figure 2.30 describes the injury death rate over time for males and females.
120
Rate per 100 000
100
Figure 2.30 Injury death rate over

time for males and females
Males
Females
80
60
40
20
0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Source: GRIM books, AIHW, accessed 9 July 2009.
Year
Using data provided in figure 2.30, a response to the task Describe two trends
in the injury death rates as experienced by males and females might include the
following points.
Death rates for males and females both decreased between 1980 and 2007.
Males experienced higher death rates due to injuries between 1980 and 2007.
The death rate for males decreased more than the death rate for females due to
injuries between 1980 and 2007. The male death rate decreased by around
45 per 100000 (approximately 95 per 100000 in 1980 down to 50 per
100000 in 2007). The death rate for females decreased by around 10 per
100000 (down from around 30 per 100000 in 1980 to around 20 per 100000
in 2007).
Use information from the graph, such
as dates, to substantiate your answer.
Using figures from the graph shows

an ability to interpret the data and
draw conclusions from it.

8 Outline three steps that should be taken when interpreting data from a graph.
9 Figure 2.31 shows the rate of injury and poisoning hospital separations for young people aged 1224, in 200809.
Hospital separations per 100 000
young people
4000
3500
Males
Females
3000
2500
2000
1500
1000
Figure 2.31 The rate of

injury and poisoning hospital
separations for young people
aged 1224, 200809
500
0
1214 years
1519 years
Age group
2024 years
Source: AIHW 2011, Young

Australians: their health and wellbeing
2011, p. 35.
(a) i. What was the approximate hospital separation rate for injuries and poisoning for males aged 1519 in 200809?
ii. What was the approximate hospital separation rate for injuries and poisoning for females aged 1519 in 200809?
(b) According to figure 2.31, what trend is evident in regard to the hospital separation rate for injuries and poisoning for
males as they age?
0 Figure 2.32 shows death rates for young people from 1980 to 2007.
1
Deaths per 100 000 young people
140
120
100
Male
Female
Persons
80
60
Figure 2.32 Death
rates for young
people aged 1224,
19802007
40
20
0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Source: Adapted from

AIHW data.
(a) Identify two trends in death rates as shown in figure 2.32.

(b) Besides death rates, outline three differences in health status between male and female youth.
Key skills The health of Australias youth
KEY SKILL Explain the biological determinants of

health and development and discuss the impact on
the health ofyouth
As well as impacting on youth development, biological determinants including
genetics, hormonal changes and body weight impact on youth health. As well as
being able to explain the biological determinants of health, the ability to predict
the possible effect of these determinants on the health of youth is also required.
You may also be required to use the biological determinants to explain possible
reasons for differences in the health experienced between individuals. Remember
that the focus of this key skill is on youth and any discussion should be about this
particular age group.
Completing a summary table (like table 2.11) can provide practice in predicting
likely effects of biological determinants on youth health.
Table 2.11 A summary table for analysing the impact on health and development of the
determinants
Determinant: Hormonal changes
Dimension of health
Physical
Social
Mental
Specific hormones are identified and

knowledge of their role in youth is
outlined.
The dimension of health is identified.

Possible impacts on mental and social
health are identified.
Consider the following example where the impact of hormonal changes on the
health of youth is discussed.
Human Growth Hormone is responsible for increasing the rate of growth
experienced during youth. Testosterone is responsible for increasing muscle mass
in males. Increased size and strength increases the ability of youth to exercise for
extended periods of time and also increases strength. As a result, fitness can
increase (physical health). Increased fitness may enhance self-esteem which is an
aspect of mental health. Increased self-esteem may contribute to increased
participation in social activities which enhances social health.

1 Explain how insulin can impact on the health of youth.
1
12 Discuss how hormones can impact on the body weight of youth.
13 Explain how an increase in body weight could impact on the health of youth.
14 Explain possible impacts on health for a youth who is underweight.
KEY SKILL Explain the interrelationships between

health and human development during the lifespan
stage of youth
The prerequisite for this key skill is to have a thorough knowledge of concepts
of health and development. They are very different concepts and students often
make the mistake of using these terms interchangeably. To help clarify these
concepts, a useful approach is first to try explaining the difference between health
and individual human development; then, try classifying examples as being related
either to health or development.
Once accustomed to this approach, practise identifying the possible effects on
youth health and development as a result of a selected event or condition. Ensure
76
all dimensions of health and areas of development are addressed. Another aspect of
this skill is being able to explain how individual human development can impact
on health and vice versa. Discussing hypothetical case studies with a partner, or
completing tables like table 2.11 (see page 76), can help with developing this skill.
Sarah is in year 11 and has just been diagnosed with leukaemia. She will spend
the next two months undergoing chemotherapy and, as a result, will miss a lot of
school.
A possible approach to a discussion of how Sarahs condition may impact on her
development follows.
Sarahs condition could impact on her development in the following ways:
Physical development:
She will miss out on school and sport, which may impact on her motor skill
development. While she is undergoing treatment, she may have a diminished
appetite, which may mean her bones do not develop to their full potential.
Social development:
As Sarah will be missing out on social activities, she may miss out on opportunities
to refine communication skills. She will have to communicate with health
professionals, however, and this may enhance her communication skills. She may
learn valuable relationship skills as a result of not getting to see her friends daily,
gaining an appreciation of their important role in her daily life.
Emotional development:
Sarah will experience a range of emotions that most likely she will not have
experienced before. She may learn how to deal with and express these emotions
effectively.
Intellectual development:
Sarah may learn skills to assist in improving her health. Knowledge relating to
diet and exercise is an example of these skills.
Make reference to the type of
development being explained.
An aspect of physical development
An aspect of social development

An aspect of emotional development
An aspect of intellectual development
All four areas of development are
covered. The discussion maintains a

focus on development.

5 Briefly outline the relationship between health and development.
1
16 Lindy is in year 12 and has just quit her job at the local supermarket to focus on her
VCE. As a result, she will not have money to spend on activities that she has enjoyed
in the past such as going out with friends, shopping and her gym membership.
Explain how quitting her job may impact on the health and individual human
development of Lindy.

17 Puberty is a time of significant change for youth and this can have a range of impacts
on health and development.
(a) Discuss how puberty could impact on the mental health and emotional
development of youths.
4 marks
(b) Refer back to Anissahs story on page 73 to complete the following question.
Suggest one way that each aspect of Anissahs physical, social and mental
development could be affected by not getting into the school band.
3 marks
CHAPTER 2 review
Chapter summary
Health can be defined in a number of ways, but it is always seen as a state that can
change from day to day.
Interactivities:
Chapter 2 crossword
Most definitions have their advantages and disadvantages. The most common definition
of health comes from the World Health Organization (1946) and is:
a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity.
Presence or
absence of disease
Blood pressure
Cholesterol
levels
Feelings of
physical wellbeing
Body weight
Fitness
Feelings
Energy levels
Physical
health
Functioning of
body systems
Health
Being part of a
group or team
Network of friends
Confidence
Self-esteem
Social
health
Mental
health
Levels of stress
Thought patterns
State of
relationships with
school/work mates
State of
relationships
with family
Social needs met
FIgUrE 2.33 A summary of the dimensions of health and examples that relate to each one
All three dimensions of health influence each other, and people may experience
different levels of health in all three dimensions at any one time.
Unit 1
AOS 1
The health of
Australias
youth
Health status is an individuals or a populations overall health, taking into account

various aspects such as life expectancy, amount of disability and levels of disease risk
factors (AIHW, 2008).
Australias youth generally experience excellent health status.
Sit Topic test
Life expectancy, mortality, morbidity and burden of disease measures are all used to
assess health status.
Life expectancy is an indication of how long a person can expect to live; it is the
number of years of life remaining to a person at a particular age if death rates do not
change (AIHW, 2008).
For a male born in 2013, the life expectancy was 80 years and for a female it was
84years.
78
Life expectancy and death rates are continually improving for Australias youth.
Mortality refers to deaths in a population. The mortality rates for Australias youth are
among the lowest when compared to other lifespan stages.
Morbidity can be measured using YLDs, incidence and prevalence.
DALYs are used to measure burden of disease and are calculated by adding YLLs
andYLDs.
Males are more likely to experience premature mortality than females.
Females generally experience slightly more YLDs than males.
Injuries contribute most to YLLs. Within the injury category, road traffic accidents
cause the most deaths for youth.
Mental health disorders contribute most to the overall burden of disease for youth.
Biological determinants relate to the state and functioning of the body and include
genetics, hormones and body weight.
Genetics contribute to many aspects affecting health such as sex, genetic predisposition
to disease, and genetic and inherited conditions.
Hormone levels change significantly during youth. Impacts of these changes can include
acne, body odour, polycystic ovarian syndrome and increased fitness levels. Hormonal
imbalance can also impact on youth and can contribute to overweight and obesity,
diabetes and decreased immune function.
The rate of overweight and obesity has increased over time and now poses a
considerable health risk for youth including an increased risk of conditions such as
cardiovascular disease, type 2 diabetes and mental health issues.
Underweight is also a significant issue for youth and can contribute to low levels of
energy and an increased risk of osteoporosis later in life.
Health and development are also interrelated and will affect each other throughout the
lifespan. Optimal health will generally result in optimal development and vice versa.
TEST your knowledge
1 Define:
(a) health (according to the World Health
Organization)
(b) life expectancy
(c) mortality
(d) morbidity
(e) burden of disease.
2 Explain, using examples, what is meant by:
(a) physical health
(b) social health
(c) mental health.
3 Use a Venn diagram to show the similarities and
differences between health and development.
4 Why can defining health be difficult?

5 Explain two ways in which being overweight can
impact the health of youth.
6 (a) Discuss examples of how development can
affect health during the youth stage of the
lifespan.
(b) Discuss examples of how health can affect
development during the youth stage of the
lifespan.
CHAPTEr 3
Nutrition
during youth
Nutrition is one of the most important factors affecting
the health and individual human development of
Australias youth. It is a significant risk factor for health
issues such as underweight, overweight and obesity.
Nutrition also has a direct relationship to aspects of
individual human development such as bone and organ
development. It can also affect development indirectly
by, for example, providing energy that allows the youth
to concentrate at school, thereby promoting intellectual
development. In recent decades, the nutritional status of
Australias youth has declined and is contributing to health
and developmental issues. To develop a deep knowledge
of these issues, it is important to learn about the nutrients,
the roles they play in optimising health and development,
and the short- and long-term consequences of nutritional
imbalance. A range of food selection models exist to assist
youth in food selection. Understanding these models
can assist youth in achieving a balanced nutrient intake
and in achieving optimal health and individual human
development.
KEY KNOWLEDGE
2.1 the function of major nutrients for the development of hard tissue,
soft tissue, blood tissue and energy (pages 82104)
2.2 the consequence of nutritional imbalance in a youths diet on
short- andlong-term health and individual human development
(pages 1058)
2.3 food selection models as tools to promote healthy eating during
youth (pages 10916).
KEY SKILLS
explain the functions of major nutrients for the development of hard
tissue, soft tissue, blood tissue and energy during youth (pages 88,
93, 97, 104, 117, 121)
explain the possible consequences of nutritional imbalance in a
youths diet on short- and long-term health and individual human
development (pages 108, 118, 121)
explain how food models can be used as a tool to promote health
(pages 11516, 119, 121).
80
FIgUrE 3.1 As youths gain

independence, their food choices
become particularly important for
future health and development.
KEY TErM DEFINITIONS

anaemia a condition characterised by a reduced ability of the
body to deliver enough oxygen to the cells due to a lack of
healthy red blood cells
basal metabolic rate (BMR) the amount of energy required to
sustain basic functioning of the human body
bone matrix the structure of bone that allows calcium and
phosphorus to be deposited, therefore making the tissue hard.
The bone matrix consists mainly of collagen.
cartilage connective tissue that protects and cushions the
joints, and provides structure and support to various body tissues
cell differentiation the process in which body cells take on
their specialised function (e.g. as skin cells or muscle cells)
cell membrane the outer layer of a cell that provides structural
support for the cell and allows nutrients, gases and waste into
and out of the cell
cellular respiration the process whereby oxygen and fuel are
converted into energy
cholesterol a type of fat required for optimal functioning of
the body that in excess can lead to a range of health concerns
including the blocking of arteries (atherosclerosis). Can be bad
low-density lipoprotein (LDL) or good high-density lipoprotein
(HDL).
co-enzyme usually a vitamin or mineral that binds with protein
to allow chemical reactions such as metabolism to occur
collagen fibrous protein found in connective tissue that is
the main component of cartilage, ligaments, tendons, bone
and skin
connective tissue tissue that is involved in the structure and
support of body cells and systems
dental caries decay of teeth caused by a breakdown in the
tissues that make up the tooth
discretionary foods includes foods and drinks not necessary to
provide the nutrients the body needs, but that may add variety.
However, many of these are high in saturated fats, sugars, salt
and/or alcohol, and are therefore described as energy dense.
fortified having a nutrient artificially added to increase
nutritional value
glycaemic index (GI) a scale from 0 to 100 indicating the
effect on blood glucose of foods containing carbohydrates
haemoglobin a component of blood, largely consisting of iron
and protein, that transports oxygen throughout the body
hard tissue tissues in the body that form hard substances such
as bones, teeth and cartilage
kilojoule (kJ) a unit for measuring energy intake or expenditure
macronutrients nutrients that are required in large amounts
(protein, carbohydrates and fats)
micronutrients nutrients that are required in small amounts
(vitamins and minerals)
ossification the process whereby bones are hardened by laying
down the minerals calcium and phosphorus
osteoporosis a condition characterised by a reduction in bone
mass that makes bones more likely to break and fracture
peak bone mass the maximum bone mass (i.e. density and
strength) reached in early adulthood
soft tissue organs and tissues in the body that connect,
support or surround other structures. They include skin, muscles,
tendons, ligaments, collagen and organs.
vegan a type of vegetarianism that excludes foods of animal
origin including eggs and dairy
3.1
Introduction to the nutrients required during

youth: carbohydrates, protein and fats
KEY CONCEPT Understanding the major nutrients required

during youth
When we eat, the foods are broken down in the process of digestion to release the
nutrients. These nutrients are then used by the body for many functions related
to health and development including the production of energy and blood and the
development of hard and soft tissues.
Figure 3.2 Eating a range of foods is the best way to ensure adequate nutrition.
Some foods have more nutrients in them than others, and some have nutrients
that other foods may not have at all. The best way to maintain a balanced diet is to eat
a wide variety or many different types of foods (figure3.2). There are six categories
of nutrients that are needed for optimal health and individual human development.
They are:
carbohydrates (including fibre)
protein
fats
vitamins
minerals
water.
Carbohydrates, protein and fats are needed by the body in large amounts and are
often called macronutrients, while vitamins and minerals are called micronutrients
because they are needed in only very small quantities. Regardless of the quantity
needed by the body, each nutrient has a different role to play and all are important
for health and individual development.
Carbohydrates
The main function of carbohydrates is to provide fuel for energy. As youth are growing
at a rapid rate, a lot of energy is required for metabolism and growth. Glucose is
the preferred fuel for energy in the human body and carbohydrates are rich in
glucose. As a result they should provide the majority of an individuals energy
needs. Carbohydrates allow an individual to maintain

high activity levels, which can provide opportunities to
develop motor skills and also the energy to concentrate
at school and therefore develop intellectually.
Carbohydrates are broken down and the glucose
molecules are absorbed into the bloodstream, from
where they are taken into the cells and stored, ready
for use. In terms of energy production, one gram of
carbohydrates will produce about 16 kJ ofenergy.
Glucose (and therefore carbohydrates) that is not
used by the body is stored as adipose (or fat) tissue.
If a person eats too much carbohydrate, they can gain
weight because this increases the amount of glucose
stored as fat. This process can be reversed if glucose is
needed by the body.
Most carbohydrates are found in foods of plant origin. Common examples
are vegetables (including potatoes), rice, pasta, most breakfast cereals and fruit
(figure3.3).
However, carbohydrates are also found in sugar and foods containing added
sugar such as soft drinks, cordial, lollies and chocolate. These foods contain few
other nutrients besides carbohydrates so are not considered to be good food
sources of this nutrient.
FIgUrE 3.3 Pasta is a good source of

carbohydrates.
Fibre
Fibre is a type of carbohydrate that is required for the optimal health and individual
human development of youth. Found in all foods of plant origin, fibre does not
get absorbed by the body. Rather, it travels through the digestive system, acting
like a cleaner as it moves. The benefits of fibre in the diet are numerous foryouth:
Fibre acts to reduce the amount of glucose that is absorbed by the digestive
system, thereby reducing the energy provided by the foods eaten. It also providesa feeling of fullness (satiety), so decreases the amount of energy consumed
from other foods. Both of these characteristics of fibre assist
in weight maintenance.
Fibre reduces the amount of cholesterol that is absorbed
by the body, which reduces the risk of cardiovascular
disease later in life.
Foods containing fibre are generally high in a range of
vitamins and minerals, which improves overall nutrient
intake. This is particularly important for youth as their
nutritional requirements increase due to the growth they
experience.
Fibre absorbs water, which adds bulk to the faeces. This
assists in regular bowel movements, which decreases the
chances of becoming constipated.
According to the National Health and Medical Research
Council, youths should be consuming around 2228 grams
of fibre per day. Examples of foods that contain fibre are:
3/4 cup bran flake cereal (4.5 grams of fibre)
two slices wholemeal bread (4.5 grams of fibre)
one apple and one orange (5.5 grams of fibre)
two cups mixed raw vegetables (10 grams of fibre)
1/4 cup baked beans (3 grams of fibre).
As fibre absorbs water, increased fibre intake should be
accompanied by increased water consumption.
FIgUrE 3.4 Grains and seeds are an

excellent source of fibre.
Nutrition during youth CHAPTEr 3
83
3.1 Introduction to the nutrients required during youth: carbohydrates, protein and fats
Protein
Protein has two main functions in the body. Its main function (and probably the
most important for youth development) is to build, maintain and repair body cells.
This includes the cells required to build soft tissues such as muscles and organs,
hard tissue such as bone and the production of blood tissue (figure 3.5). The second
function of protein is to act as a fuel for producing
energy. If a person does not have enough glucose
(from carbohydrates) to use for energy production,
protein can be used as a secondary source of energy.
In times of starvation, muscle and other body cells
may be broken down so the protein contained within
them can be used for energy. Protein yields about
17kJ pergram when beingused forenergy. If eaten in
excess, protein may be stored asadipose or fat tissue
and can contribute to obesity in the long term.
Protein is made up of smaller building blocks
called amino acids. There are 20 different types of
amino acids that humans need to function properly.
Eleven of these, called the non-essential amino acids,
can be synthesised (or made) in the body from other
amino acids. The other nine, called essential amino
acids, cannot be synthesised in the body and must
therefore be consumed (figure 3.6). To ensure that
all amino acids are being consumed regularly, protein
FIgUrE 3.5 Protein is a key component of all body tissues, like these
from a range of different sources should be eaten.
muscle fibres.
Many people get much of their protein requirements
from meat, which is often rich in essential amino acids. Vegetarians must ensure
they consume a large variety of non-meat protein sources to ensure that their
nutritional needs are being met. These foods include nuts, beans, lentils and tofu.
Some food sources are termed complete proteins because they contain all the
essential amino acids in the quantities required for individual human development.
They are usually found in vast amounts in animal products (figure 3.7). Some
proteins can also be found in many foods of plant origin (figure 3.8). These are
usually incomplete proteins and need to be eaten with other protein sources to
ensure that all required amino acids are consumed.
Protein
Essential amino
acids
FIgUrE 3.6 Proteins can be classified

as essential and non-essential amino
acids.
84
Complete proteins
Contain all essential
amino acids
Incomplete proteins
Do not contain all
essential amino acids
Non-essential
amino acids
Can be made in the

body from essential
amino acids
Protein content of selected foods

of animal origin (g of protein
per 100 g of food item)
Protein content of selected foods

of plant origin (g of protein
per 100 g of food item)
Beef
Pork
Tuna
Chicken (thigh)
Salmon
Cheddar cheese
Lamb
Chicken breast
Egg
Milk
Pumpkin seeds
Peanut butter
Almonds
Pistachios
Tofu
Oats
Cashews
Hazelnuts
Lentils
Wheat bread
0
10
20
30
g per 100 g
40
10
20
30
40
g per 100 g
FIgUrE 3.7 The protein content of selected

foods of animal origin
FIgUrE 3.8 The protein content of selected

foods of plant origin
Fats
Fats (sometimes referred to as lipids) play a number of roles in youth health and
individual human development. Although fats are often associated with negative
effects on the body, they are required for adequate health and development
throughout the lifespan and are an essential part of a balanced food intake.
Like carbohydrates, the main function of fats is to act as a fuel for energy. Fats
are a richer source of energy than carbohydrates and protein, yielding about
37 kJ per gram. This is why foods packed with fat but little else are referred to as
energy dense foods. How much fat to include in the diet should be determined
by the amount of energy required by the individual. Balance is the key here.
Remember that most of an individuals energy should come from carbohydrates.
Fats are required for a number of other processes including the development and
maintenance of cell membranes. Cell membranes form an important component of
body cells and therefore blood and soft tissues. They are responsible for maintaining
the structure of cells and allowing the transport of nutrients, gases and waste into
and out of cells. Fats are a key component of the cell membrane and are required
throughout life for adequate cell function.
Fats are an important part of a balanced diet for youths, but there are different
types of fats and some are healthier than others (see figure 3.9). Some fats can
actually lead to poor health and should be kept to a minimum in the diet.
Fats (lipids)
Monounsaturated
Omega-3
Polyunsaturated
Saturated
Omega-6
Trans
FIgUrE 3.9 There are four

different categories of fats.
85
Based on their chemical make-up, fats can be classified into four broad categories:
monounsaturated, polyunsaturated, saturated and trans fats. Total fat intake should
account for around 25 per cent of the total energy requirement (with carbohydrates
and protein making up the other 75 per cent). Of this 25 per cent, the majority should
come from monounsaturated fats. Approximate recommended percentages of total
energy intake from the different types of macronutrients are shown in figure3.10.
Protein 20%
Carbohydrates 55%
Fats 25%
Monounsaturated
10%
Polyunsaturated
5%
Saturated 9%
Trans fats 1%
FIgUrE 3.10 Macronutrients (with a breakdown of fats), and the average percentage of
total energy intake each should make up (approximate values only)
Monounsaturated and polyunsaturatedfat

Monounsaturated and polyunsaturated fats are considered the good fats. They
carry out the necessary functions of fats and also have some health benefits such
as reducing levels of cholesterol and promoting the health of the heart and blood
vessels. The greatest health and development gains for youth can be achieved by
replacing saturated and trans fats with monounsaturated and polyunsaturated fats.
This can help reduce the risk of diet-related diseases later in life, such as heart
disease. Because all fats contain about 37kJ of energy per gram, the total fat intake
should not increase because all types will lead to weight gain and the associated
effects on health if eaten in excess.
FIgUrE 3.11 Nuts are a great source

of the good fats.
86
Monounsaturated fats are liquid at room temperature and begin to solidify if

placed in the refrigerator. Foods rich in monounsaturated fats include olive oil,
avocado, canola oil and canola-based margarine, nuts such as peanuts, hazelnuts,
cashews and almonds, peanut butter and other nut butters.
There are two main categories of polyunsaturated fats: omega-3 and omega-6.
Polyunsaturated fats are generally liquid at room temperature and when refrigerated.
Food sources for these fats include:
omega-3 fish (particularly oily fish such as mackerel, trout, sardines, tuna
and salmon), canola and soy oils, and canola-based margarines
omega-6 mainly nuts such as walnuts and Brazil nuts, seeds and oil made
from corn, safflower and soy.
Many Western people consume too many omega-6 fats which, like all fats, can
increase the risk ofobesity and associated conditions including heart disease.
Saturated and trans fats

Saturated and trans fats are sometimes known as bad fats
because they increase cholesterol levels in the blood and
can therefore contribute to heart disease in the long term.
Although consuming saturated and trans fats will satisfy
the energy and other requirements provided by other types
of fats, they should be replaced by monounsaturated and
polyunsaturated fats where possible.
Saturated fats are generally found in foods of animal origin
(figure 3.12) and are often solid at room temperature. You
can see saturated fat in fatty cuts of meat as the marbling
throughout the meat or the fat that forms along the ends
of cuts of red meat. Other foods containing high levels of
saturated fat include full-cream milk, cream and cheese,
some fried takeaway food, and most commercially baked
goods such as pastries and biscuits.
Although small amounts of trans fats are found naturally in certain foods, most
trans fats are created when liquid oil is converted into solid fat by a process
called hydrogenation. For this reason, they are generally found in processed
foods such as pies, pastries and cakes (figure3.13). Margarines and solid spreads
made for cooking are sometimes high in trans fats, as are the products made
from them.
Figure 3.12 Fats that come from

animals and are solid at room
temperature are normally saturated.
This pork fat is one example.
Interactivity:
Time Out: Which fat?
Figure 3.13 Trans fats are often

present in baked goods such as
doughnuts, biscuits and cakes.
Nutrition during youth CHAPTER 3 87
TEST your knowledge
1 What are the six categories of nutrients?

2 List the main function of carbohydrates.
3 How much energy does one gram of carbohydrate
produce?
4 Outline the main functions of fibre.
5 Does fibre contribute to energy intake? Explain.
6 (a) What is the main function of protein?
(b) How can protein enhance the physical
development of youth?
7 (a) Is fat required in the diet? Explain.
(b) Which fats are considered the good fats? Why?
(c) Which fats are considered the bad fats? Why?
8 Explain why overall fat intake should be limited.
9 (a) What percentage of energy should come from
each of the macronutrients?
(b) Explain why most of our energy needs should
come from carbohydrates instead of fats and
protein.
10 Explain how eating insufficient carbohydrates could

affect the physical, social, emotional and intellectual
development of youth.
11 Discuss the possible short- and long-term effects on
a youth who does not consume adequate amounts
of fibre.
12 Using mind mapping software, or by copying
figure 3.14, complete a mind map summarising
information relating to the functions and food
sources of carbohydrates, including fibre.
13 Create a table that summarises the health and
individual human development impacts of
carbohydrates (including fibre), protein and fat.
Function
Functions
Fibre
Carbohydrates
Food sources
Food sources
FIgUrE 3.14 Concept map summarising the functions and food sources of carbohydrates
(including fibre)
88
3.2
Introduction to the nutrients required

during youth: water, calcium and iron
KEY CONCEPT Understanding the major nutrients required

during youth
Water
Although it has no nutritional value, water is the most important nutrient for
human survival. Water makes up around 55 to 75 per cent of body mass and is
needed for numerous functions within the body, including:
as a medium for all chemical reactions required to provide energy and produce
soft tissue
as a key component of many cells, tissues and systems
as a key component of blood.
Being adequately hydrated allows chemical reactions in the body to occur
effectively, which is important for periods of rapid development such as the
youth stage of the lifespan. Sufficient water intake allows the bodys systems to
function adequately and the body as a whole to function properly. This means an
individual can effectively go about their day-to-day activities. Water intake can
also assist in weight maintenance as it helps to reduce hunger while contributing
no kilojoules or energy. When dehydrated, a person may not have the energy to
participate in physical activities, which can impact on motor skill development.
They may not be able to concentrate at school, which can directly impact on
All foods have some water content (figure 3.15) and contribute to total water
intake, as do fluids such as milk. Water should also be consumed in its pure state
(i.e. from the tap or in bottled form) to meet hydration needs. Although they
contain a large percentage of water, soft drinks and sports drinks often contain high
amounts of sugar and other additives, so their consumption should be limited.
Figure 3.15 Foods such as fruits and

vegetables have a high water content,
but water should also be consumed in
its pure form.
Calcium
Bone mass
Calcium is one of the key nutrients required for the building of bone and other
hard tissues (such as teeth and cartilage) and is therefore extremely important
during periods of rapid growth such as during youth.
The youth stage signifies the greatest increase in bone density and contributes
significantly to achieving optimal peak bone mass. It is therefore vital that youth
get enough calcium during these years to build as much bone density as possible.
The greater the bone density during this stage, the less chance the individual will
have of developing osteoporosis later in life (figure 3.16).
Calcium is found in most dairy products (figure 3.17). Milk, cheese and yogurt
are all rich sources of calcium. Other sources include sardines and salmon (with
bones), green leafy vegetables (broccoli, spinach), fortified soy milk, tofu made
with calcium sulfate and fortified
Men
orange juice.
Women
Oxalic acid is present in
spinach and binds to the calcium
molecules, preventing all of the
calcium from being absorbed.
In fact, if oxalic acid is present
when calcium is eaten, only 5per
cent of the available calcium may
be absorbed. For this reason, it
is important to obtain calcium
from other sources as well, such
20
40
60
80
100
as dairy (which does not contain
Age (in years)
oxalic acid).
Figure 3.16 Changes in bone mass

with age
Interactivity:
Time Out: Food sources ofnutrients
Figure 3.17 Dairy products such as milk are a rich source of calcium and help to build peak
bone mass.
90
Case study
Strong bones key to health

By Angela Thompson
When Tracy Sparks daughter shed 15 kilograms in four
months her mother knew something was drastically
wrong.
The teenagers school results had gone downhill
because she couldnt concentrate, her hair had begun to
fall out and she was icy to touch.
The physical effects of anorexia were shocking, but
it was only when routine blood tests were carried out
during treatment that Ms Spark learnt the full horror
of what was happening to her daughter, then 14, on the
inside.
Tests showed the girls bones were being leached
of calcium to feed a body deprived of the essential
mineral.
At a time when she should have been laying down
calcium in her bones for later on, her body was actually
taking calcium out of her bones to survive, Ms Spark
said.
I work in the field and I was lost. I assumed eating
disorders were an issue when you became skeletal.
I didnt realise people get very ill a long time before
they get to that stage.
On the eve of National Healthy Bones Week,
Ms Spark, now a nutrition coordinator for Healthy
Cities Illawarra, is telling her daughters story in the

hope it will help arrest a worrying trend towards poor
nutrition among a body image-conscious generation of
adolescent girls.
According to Wollongong nutritionist Anita
Needham, those who fail to achieve peak bone
mass during adolescence are more likely to develop
osteoporosis.
While were young its good to stockpile the calcium
we get from dairy products so that you offset the effect
of ageing on bone loss and therefore you reduce the
risk of osteoporosis, she said.
Unfortunately many people exclude dairy foods
when trying to lose weight, and in doing so miss out
on valuable sources of calcium and other essential
nutrients.
Recent clinical studies show that including three
dairy serves in a weight-reducing diet may in fact result
in more weight and body fat loss, she said.
At the Sparks household, it was a lesson learnt the
hard way.
She does focus on eating healthily now, Ms Sparks
said of her daughter, who did not want to be named.
Im a big believer in your body knowing what it
needs and she absolutely adores dairy food.
Source: Illawarra Mercury, 2 August 2008.
Case study review

1 How was the development of Ms Sparks daughter affected by not consuming
enough calcium?
2 Why do a lot of people cut dairy products out of their diet?
3 Although osteoporosis does not usually occur during youth, explain why getting
adequate calcium in the diet is very important during this stage of the lifespan.
Iron
Iron is an essential part of blood. As blood volume increases during
youth, iron is needed in greater quantities (figure 3.18).
Iron forms the haem part of haemoglobin, which is the oxygencarrying part of blood. A person who does not get enough iron
may develop anaemia, a condition characterised by tiredness and
weakness. Individuals with anaemia struggle to generate enough
energy to complete daily tasks such as school work, sport and
socialising.
Red meat is a rich source of iron but it often contains high
levels of saturated fat. As a result, leans cuts of meat should be
chosen and iron should also be gained from other sources. A
balanced, varied diet is the best way to get adequate amounts of
iron.
Figure 3.18 As blood volume increases during the

youth stage of the lifespan, iron is required in higher
amounts to make red blood cells.
Foods providing iron include:
lean red meat
turkey and chicken
fish, particularly oily fish (e.g. mackerel, sardines and pilchards), fresh, frozen
or canned
eggs
nuts (including peanut butter) and seeds
brown rice
tofu
bread, especially wholemeal or brown bread
leafy green vegetables, especially curly kale, watercress and broccoli.
Iron from meat is usually absorbed best, although vegetarians can still get enough
iron if they eat a variety of foods. Vitamin C changes the chemical make-up of
iron from non-meat sources and increases the amount absorbed. Vitamin C should
therefore be eaten if iron absorption needs to be maximised.
Case study
A close up on anaemia
Anaemia is a condition characterised by a deficiency in
the number or quality of red blood cells.
Red blood cells are responsible for transporting
oxygen to cells around the body to allow them to carry
out their normal functions. One of the components
of red blood cells is a protein called haemoglobin.
Each red blood cell contains a haemoglobin molecule
and it is this molecule that gives red blood cells their
red colour. When transported to the lungs, oxygen
molecules attach themselves to the haemoglobin and
are carried through the network of blood vessels until
they are absorbed by a cell.
Anaemia occurs when there is a reduced level of red
blood cells or haemoglobin in the blood.
In those with anaemia, the heart pumps harder in
an attempt to ensure adequate levels of oxygen are
delivered to the cells. During exercise, meeting the
demands of the cells becomes increasingly difficult and
the individual can become exhausted.
Anaemia isnt a disease itself, but the result of a
malfunction somewhere in the body. Females are
particularly susceptible to anaemia, with some estimates
suggesting that around one in five menstruating females
and half of all pregnant females are anaemic. Youth
experiencing puberty are also at an increased risk as
blood volume increases, which increases the demand
for red blood cells and haemoglobin.
How are blood cells produced?
Blood cells are constantly being produced in the
bone marrow, at a rate of millions per second. Bone
marrow is a spongy tissue in the cavities of bones that

is responsible for generating the key components of
blood, including red blood cells. Bone marrow requires
certain nutrients, including iron, folate and vitamin
B12, to be able to create red blood cells.
In Australia, iron deficiency is one of the most
common causes of anaemia. If there is not enough iron
in the diet, the body will use stored supplies from the
liver. Once this reserve is used up, the bone marrow
will not be able to make enough haemoglobin and
anaemia may result.
What causes anaemia?
Anaemia can have many causes, and although
commonly associated with a deficiency in iron, folate
and/or vitamin B12, anaemia can also occur as the
result of:
malabsorption this occurs when the nutrients
that are consumed are not able to be used. It can be
caused by conditions such as coeliac disease.
inherited disorders some blood disorders such as
thalassaemia and sickle cell disease can be inherited
from parents and can lead to anaemia
chronic conditions conditions such as
rheumatoid arthritis and tuberculosis can contribute
to anaemia
bone marrow conditions such as cancer or
infection
blood loss due to injury, surgery, cancer, stomach
ulcers, heavy periods or giving blood frequently
rapid growth or times during which large amounts
of energy are required such as puberty or while
pregnant.
What are the symptoms of anaemia?

Depending on the severity, the symptoms of anaemia
can include:
pale skin
tiredness
weakness
shortness of breath
blood pressure drops on standing up suddenly
sometimes caused by blood loss, such as during a
heavy menstrual period
headaches
fast pulse
irritability
difficulty concentrating
cracks or redness of the tongue
appetite loss
strange food cravings (including the desire to eat dirt
or rice, a condition known as pica).
How is anaemia treated?
Treatment for anaemia depends on the severity and the
cause of the condition. In any case, the cause must be
addressed in addition to treating the symptoms.
Vitamin and mineral supplements may be required

in the case of dietary deficiency. Iron injections may
be required if iron levels are particularly low. Note
that iron supplements should be used only under the
direction of a doctor. The human body does not excrete
iron efficiently, which can contribute to iron poisoning
if the dose is not monitored.
How can anaemia be prevented?
Anaemia caused by deficiencies in dietary intake can
be prevented by making sure that certain foods are
consumed on a regular basis, including lean meats, nuts
and legumes, fruit and vegetables and dairy products.
Those who do not consume any animal products (known
as vegans) may have to increase their intake with
fortified foods or vitamin and mineral supplements.
Anaemia caused by an underlying health condition
may not be able to be prevented as it is caused by a fault
in the cell-making process. Treatments are available to
relieve the symptoms in these cases.
Source: Adapted from www.betterhealth.vic.gov.au.
Case study review

1 Briefly explain anaemia.
2 Discuss haemoglobin and the role it plays in the body.
3 How might someone know if they are anaemic?
4 Research the blood disorders that can cause anaemia and prepare a brief
summary of each.
5 Explain how anaemia could impact on the health and development of youth.
6 Discuss why female youth are more susceptible to anaemia than male youth.
7 Discuss why youth is a higher risk lifespan stage for anaemia than adulthood.
TEST your knowledge

1 (a) List three functions of water.
(b) Why would it be a good idea to replace most
drinks with plain water?
2 Why is calcium required in the body?
3 (a) List three foods that contain high levels of
calcium.
(b) Even though spinach has a lot of calcium, it is
not considered the best food source of dietary
calcium. Explain why this is so.
4 Describe the role of iron in the body.
5 Why is iron required in greater amounts during the
youth stage of the lifespan?
6 Refer to figure 3.16.
(a) Identify two trends evident in the graph.
(b) Use the graph to help you explain a possible

difference in health outcomes between males
and females in older age.

7 Explain how being dehydrated could affect the four
areas of development in youth.
8 List the likely symptoms of not getting enough
calcium.
9 Which other stages of the lifespan would require
higher rates of:
(a) calcium
(b) iron?
3.3
Introduction to the nutrients required

during youth: vitamins A, B, C and D
KEY CONCEPT Understanding the major nutrients required during youth
Vitamin A
Interactivity:
Time Out: Vitamins and folate
Vitamin A is required for cell division and is therefore an important aspect of any
growth that occurs in the body. There are many aspects of physical development
that involve growth during the youth stage of the lifespan, so requirements for
vitamin A increase at this time. Skin, muscle, organ, bone and blood cells all divide
rapidly during youth and therefore require vitamin A.
Vitamin A also plays a role in cell differentiation. Due to the rapid speed of
growth during youth, cell differentiation occurs at a rapid rate and contributes to
the increased need for this vitamin. Vitamin A has also been shown to promote the
development of bones.
Vitamin A assists with the development of immune system function by promoting
mucus development in the lungs and airways. This lining of mucus is a defence
mechanism against bacteria and viruses. Vitamin A also helps in the development
of antibodies required to fight infection.
The best sources of Vitamin A can be found in red, yellow and orange coloured
fruits and vegetables including raw carrots, sweet potatoes, squash, spinach and
rockmelon (figure3.19).
Figure 3.19 Yellow, orange and redfruit and vegetables are good sources of vitamin A.
Vitamin D
The main role of vitamin D is in the absorption of calcium from the intestine
into the bloodstream. Lack of vitamin D can lead to low levels of calcium being
absorbed and bones becoming weak.
Figure 3.20 Most Australians get enough vitamin D from exposure to sunlight, but those
with restricted access to sunlight might be deficient.
Most Australians get enough vitamin D from exposure to sunlight (figure 3.20),
during which UV rays are converted to vitamin D in the skin. However, there
is growing evidence to suggest that some groups in Australia are deficient in
vitamin D because they rarely go out into the sun. Youth with dark skin or
those who always cover up when outdoors can become deficient in vitamin D.
While moderate exposure without any degree of sunburn is healthy, excessive
exposure leading to sunburn is a major risk factor for skin cancer and should
always be avoided.
In terms of food sources, fish (particularly tuna, salmon, mackerel, sardines
and herring) is the best source of vitamin D. Small amounts can also be found
in beef liver, cheese and egg yolks. Some brands of milk, breakfast cereals
and orange juice are fortified with vitamin D, but it is important to check the
packaging.
Vitamin C
Vitamin C is important for the structure of tissues within the body and is required
for building collagen. Collagen is a protein that is required for the formation of
skin, scar tissue, connective tissue, bone, tendons, ligaments, and blood vessels
(figure 3.21). In this role, vitamin C allows the other components of tissues to be
held together.
Vitamin C is important in promoting the absorption of iron and is therefore an
important nutrient in the production of blood.
Humans can neither make their own vitamin C in the body nor store it effectively
(as other animals can do). Therefore, a daily intake of vitamin C is important for
normal individual human development and functioning.
Vitamin C is found in many fruits and vegetables including kiwi fruit, broccoli,
blackcurrants, citrus fruits such as oranges, and strawberries. It is easily destroyed
when exposed to heat and air, so fresh fruit and vegetables provide the best source
of vitamin C.
Figure 3.21 Collagen is a key

component of these tendons.
3.3 Introduction to the nutrients required during youth: vitamins A, B, C and D
B-group vitamins
Vitamins B1, B2 and B3
The B-group vitamins include vitamins B1, B2 and B3 (also known as thiamine,
riboflavin and niacin respectively). These vitamins are essential in the process of
metabolising or converting the fuels (carbohydrates, fats and protein) into energy.
A lack of these nutrients can lead to a lack of energy. As energy is essential for
growth, a lack of the B-group vitamins can contribute to slowed growth of hard
and soft tissues.
Rich sources of the B-group vitamins include Vegemite (figure 3.22), wholegrain
cereals and breads, eggs, meats, fish, dark-green leafy vegetables and milk. The
B-group vitamins are very delicate and easily destroyed through cooking and
processing. Getting enough of these vitamins from whole grains and unrefined
sources is the best way to ensure that the recommended intake is met.
Figure 3.22 Vegemite is one of
the worlds richest sources of B-group
vitamins.
Folate (vitamin B9)
Folate is a B-group vitamin that is essential for growth and development. It plays
an important role in DNA synthesis and is therefore required for cells to duplicate
in periods of growth. (It also occurs in periods of maintenance, but not to the same
degree.)
Folate also plays a role in the development of red blood cells, and a deficiency
in folate can lead to anaemia. Note that anaemia can be caused by a deficiency in
iron (called iron-deficiency anaemia) or in folate (called folate-deficiency anaemia).
Anaemia is characterised by tiredness, so the youth might no longer participate in
daily activities. This in turn can affect all types of individual human development
(figure 3.23).
Folate is found in green leafy vegetables, citrus fruits, poultry and eggs. Many
cereals, breads and fruit juices are fortified with folate. The form of folate added to
foods is a synthetic form of folate known as folic acid.
Figure 3.23 A lack of folate can lead to folate-deficiency anaemia and therefore tiredness.
This can have numerous effects on the development of youth.
Vitamin B12
Vitamin B12 is another B-group vitamin that is required for adequate development
during youth. Although it has a number of roles in the body, its main function
during the youth stage is for the formation of red blood cells. It works with folate in
this capacity, ensuring the red blood cells are not only the correct size but also the
correct shape to enable oxygen to be transported throughout the body. A deficiency
of vitamin B12 can increase the chance of becoming anaemic. Having this condition
can prevent youths from participating in normal activities and therefore have a
wide range of effects on their health and development.
Most foods of animal origin contain some vitamin B12 but particularly good
sources include meat, eggs and cheese (figure 3.24). Because vitamin B12 is found
only in food sources of animal origin, vegans are at particular risk of being deficient
in this vitamin.
Unit 1
AOS 2
Topic 1
Nutrient
overview
Concept summary
and practice
questions
Concept 1
Figure 3.24 Foods from animal sources are good sources of vitamin B12.
TEST your knowledge
1 (a) What is cell differentiation?

(b) Explain the difference between cell
differentiation and cell division.
2 What is the main role of vitamin D in the body?
3 Why are vegans at particular risk of vitamin B12
deficiency?
4 Explain the role of the following nutrients and
why each is important for youth health and/or
development:
(a) vitamin A
(b) vitamin C
(c) folate
(d) vitamins B1, B2 and B3.
5 Describe the effects on development of youth who

are deficient in:
(a) vitamin A
(b) vitamin D
(c) vitamin C
(d) B-group vitamins.
6 Create a mind map that summarises the function
and food sources of the vitamins covered in this
chapter.
3.4
The interrelationship of major nutrients
KEY CONCEPT The function of major nutrients for the development of

hard tissue, soft tissue, blood tissue and energy
Although all the key nutrients have their specific functions, they must work
together or interrelate to carry out four major processes in the body:
1. provision of energy
2. production of blood
3. formation of soft tissue
4. formation of hard tissue.
Each nutrient is like a piece of the puzzle, so although its role may be minor in
the process, without it, the process cannot be carried out effectively. The four major
processes and the nutrients required for each will be explored in more detail in the
following section.
Provision of energy
Unit 1
AOS 2
Topic 1
Energy
nutrients
Concept summary
and practice
questions
Concept 4
Table 3.1 The energy used in

selected activities (kJ per kg per hour)
Activity
Energy
(kJ/kg/h)
Sitting quietly
1.7
Writing
1.7
Standing relaxed
2.1
Driving a car
3.8
Vacuuming
11.3
Walking rapidly
14.2
Running
29.3
Swimming (4 km/hour)
33.0
Rowing in a race
67.0
Source: Better Health Channel,

www.betterhealth.vic.gov.au.
Energy is required in all cells so they can carry out their functions. Cells without
energy like cells without oxygen will die. As well as being needed for physical
activity, energy is essential to sustain life and keep body systems functioning
adequately. The amount of energy needed to sustain life (i.e. to keep the major
organs functioning) is known as the basal metabolic rate (BMR).
About 70 per cent of an individuals total energy expenditure is devoted to
BMR requirements such as temperature control and cell replacement. The other
30 per cent is needed for physical activity and digestion.
A number of factors influence BMR. They include:
age BMR generally decreases with age, mainly due to lower muscle mass.
The effect of ageing decreases BMR by about 2 per cent per decade after the
ageof 20.
growth individuals undergoing growth (such as in youth) require more energy
to build tissues and increase blood volume.
body size larger people have a higher BMR as they have more cells which in
turn require more energy to maintain their function.
body type muscle requires a higher BMR than fat as muscle cells are more
active and therefore require more energy to maintain their function.
dieting can cause the body to conserve energy. This lowers the BMR.
sex males tend to have a higher BMR. The higher muscle mass in most males
contributes to this difference.
environmental temperature the body has to work harder to maintain
temperature in hot or cold environments, therefore raising the BMR.
In Australia, energy is measured in kilojoules (kJ). A kilojoule contains one
thousand joules. The exact meaning of a joule is quite technical but some examples
of how much energy is used in specific activities will help put it into perspective.
The approximate amount of energy used in certain activities is shown in table 3.1.
As the energy required for physical activity makes up only a fraction of a persons
total energy requirement, it is useful to look at total energy requirements. The
approximate total energy requirement per day (kJ) based on an individual with
moderate physical activity levels is shown in table 3.2.
The amount of energy contained in food is also measured in kilojoules. This
makes it easier to compare energy intake with energy output. The amount of energy
contained in certain foods is shown in table 3.3. If more energy is consumed than is
needed for metabolism, digestion or physical activity, it is stored as fat and contributes
to weight gain. If more energy is used than is consumed, the individual will lose
weight. In either case, health and individual human development are affected.
Table 3.2 Average energy requirements for individuals of selected ages, by sex and based
on moderate physical activity levels
Males
Females
Age
Energy requirement
Age
Energy requirement
13
11200
13
10000
14
11900
14
10300
15
12600
15
10600
16
13200
16
10700
17
13700
17
10800
18
14000
18
10900
Source: Adapted from www.nhmrc.gov.au.
Table 3.3 The approximate energy content of selected foods

Food
Approximate
kilojoules
Approximate
kilojoules
Food
White bread (1 slice)
290
Banana (1 medium)
390
Wholemeal bread (1 slice)
270
Popcorn (air-popped, no oil, 1 cup)
115
Egg (boiled)
330
Ice-cream (vanilla, 1 scoop)
375
Egg (fried)
417
Snickers Bar (1 bar)
1175
Skim milk (250 mL)
380
Potato chips (50 g)
990
Yoplait Creamy Original Yoghurt (175 g)
745
Pasta (1 cup, cooked)
Butter (1 tsp)
120
French fries (small serve, 100 g)
1510
1500
Roast beef (lean, 150 g)
1070
1 sausage roll
Hamburger mince (1 patty)
1050
Dominos Supreme Deep Pan Pizza (1slice)
830
835
Chicken breast (no skin, roasted without fat, 100 g)
605
McDonalds Big Mac
2060
Chicken breast (with skin, roasted without fat, 100 g)
920
Hungry Jacks Whopper Cheese
3184
960
KFC nuggets (6 pieces)
1090
Subway (six inch sub, roasted chicken)
1240
1 medium T-bone steak (trimmed offat)

Sausages (pork, grilled)
Lettuce (1 cup)
1015
20
Drinks
Broccoli (1/2 cup)
115
Cola soft drink (375 mL)
655
Carrot (1 medium)
170
Apple juice (125 mL)
210
Potatoes (boiled, 100 g)
340
Orange juice (250 mL)
335
Apple (1 medium)
230
Water (250 mL)
The provision of energy involves two groups of nutrients those nutrients

required for fuel (the sources of energy), and those nutrients that enable the fuel to
be converted or changed into energy.
As discussed earlier in this chapter, carbohydrates, fats and protein are the fuel
or sources of energy. These fuels are broken down into simpler forms and then
transported to the cells for immediate use or stored in various sites around the
body (e.g. the liver and fat cells). The nutrients needed for energy production to
occur are shown in figure 3.25 (page 100).
Thiamine, riboflavin and niacin (the B-group vitamins) form co-enzymes that
bind to other substances and convert the fuels into forms that can be used by the
cells. The B-group vitamins are transported to the cells by water, and many of the
chemical reactions that occur in producing energy take place in water.
Oxygen is required in the process of energy production. It is transported to the
cells by haemoglobin, which is largely made up of iron and protein. The process
whereby energy is released and used by the body is known as cellular respiration.
Carbohydrates,
fats and protein
are the fuel for
energy
B-group vitamins
allow the release
of energy
Iron
forms a part of
haemoglobin, essential
for carrying oxygen
around the body
FIgUrE 3.25 The nutrients required

for energy production
Water
transports the
B-group vitamins and
is also required for
chemical reactions
to take place
Blood production
Unit 1
AOS 2
Topic 1
Concept 5
100
Blood nutrients
Concept summary
and practice
questions
Blood needs to be produced on a constant basis and even more so when growth is
occurring at a rapid rate. As youths are in a period of rapid growth, their need for
the nutrients required for blood production increase significantly. Blood is made up
of three main components:
plasma makes up approximately 55 per cent of blood and contains clotting
material and transports nutrients, gases, hormones and waste
red blood cells make up around 44 per cent of blood and contain haemoglobin,
which carries oxygen, carbon dioxide and other gases
white blood cells make up around 1 per cent of blood and are important for
fighting disease and infection.
Blood cells are made in the bone marrow, which is a spongy tissue found inside
the large bones of the legs, hip, spine and skull.
Protein forms a major part of all three components of blood. In the case of red
blood cells, iron binds with protein to form haemoglobin. Haemoglobin makes up
around 33 per cent of the weight of red blood cells and is responsible for carrying
oxygen around the body.
Vitamin C plays a number of roles in blood formation. It helps in the absorption
of iron from plant sources, making more iron available for haemoglobin production.
It is also important in the formation of healthy blood cells. Red blood cells
live for only 100 to 120 days and therefore require constant regeneration. The
human body produces around two million new red blood cells per second. In
order for this volume of red blood cells to be produced, cell division must occur
at a rapid rate. Vitamin A is essential for cell division and is therefore required for
this process.
When a cell divides, the DNA must be replicated so each cell has a complete
set of DNA. Although a mature red blood cell does not contain DNA (as it has
no nucleus), immature blood cells do contain DNA. Folate and vitamin B12 are
required for DNA synthesis and so are vital for red blood cell development. Water
is the main component of blood plasma and many of the chemical reactions that
produce the components of blood need water.
The nutrients required for the production of blood are outlined in figure 3.26.
Vitamin C
Assists in
iron absorption
Protein
Main building material
for blood components
and also forms the globin
part of haemoglobin
Fats
Required for the
formation
of cell membranes
Plasma
55%
Vitamin A
Required for cell division
Red
blood cells
44%
Iron
Required for haem
part of haemoglobin
production
White
blood cells
1%
B6, folate and B12
Required for DNA
synthesis and red blood
cell formation
Water
The main component
of blood
FIgUrE 3.26 The components of

blood and the nutrients required for
blood production
Formation of soft tissue

Soft tissue includes skin, muscles, tendons, ligaments, collagen and organs. They
are categorised as soft tissue because they are soft compared to the other tissues
that make up the human body (hard tissue).
101

The development of soft tissue needs many nutrients for maintenance throughout
the lifespan but, when the size of the soft tissue expands during times of growth,greater
amounts of nutrients are needed. These nutrients are summarised in figure 3.27.
Protein is the main building material for soft tissue, as it is for all body cells. Protein
is broken down into amino acids through the process of digestion and thenrebuilt
into protein required by the body. This process requires the nutrient folate.
Vitamin C plays an important role in the process of soft tissue development by
providing collagen. Collagen is like glue for the bodys cells and tissues, holding
them together and giving them structure.
Fats are required for the maintenance and development of cell membranes,
which are the outer layer of all human cells. When soft tissues grow, more cells are
created, thus increasing the need for fats.
Vitamin A is required for cell division. It is therefore required for the generation
of new soft tissue cells.
Unit 1
AOS 2
Topic 1
Soft tissue
nutrients
Concept summary
and practice
questions
Folate
Promotes cell
division and tissue
growth
Concept 3
Protein
Vitamin C
Forms connective tissue
Fats
Maintain and develop
cell membranes
Vitamin A
Water
Medium for chemical
reactions and present in
soft tissue cells
FIgUrE 3.27 The nutrients required for soft tissue formation
102
Muscles
Organs
Tendons
Ligaments
Skin
Formation of hard tissue

Hard tissue includes bones, teeth and cartilage, which contain minerals and
vitamins. Hard tissue can break if it is not strong enough.
The body cannot store all of the nutrients needed to make hard tissue, so these
nutrients are required throughout the lifespan. They are needed in greater amounts
during periods of growth such as during youth. The nutrients required for hard
tissue development are summarised in figure3.28.
FIgUrE 3.28 The nutrients required
for hard tissue formation
Protein
Vitamin C
Forms connective tissue
Unit 1
AOS 2
Topic 1
Hard tissue
nutrients
Concept summary
and practice
questions
Concept 2
Vitamin A
Calcium
Works with phosphorus (another
mineral) to produce the hardening
material for hard tissues
Vitamin D
Required for the absorption
of calcium
Bones
Teeth
Cartilage
Protein, vitamin C and vitamin A play similar roles in hard tissue development
as they do in soft tissue development.
Protein is the main building material for hard tissue development and, with
vitamin C, forms collagen, which is the main component of the bone matrix
(sometimes referred to as the collagen matrix). The bone matrix is like a framework
for the bone structure. On its own, the bone matrix is spongy and would not
support the weight of a person, but it provides the shape of the bone and allows
the hardening agents to provide the structure with strength.
Once the bone matrix has formed, calcium and phosphorus bind together to
form calcium phosphorus, the hardening agent for the bone matrix. Crystals of
calcium phosphate attach to the matrix, making the tissue strong and hard. This
process is known as ossification. Ossification is much like dipping a sponge into a
bucket of plaster. The once-soft sponge maintains its shape but becomes very hard
as the plaster dries. The matrix is like the sponge and the calcium phosphate is like
the plaster. They are both needed for adequate bone formation (figure 3.29).
Vitamin D assists the absorption of calcium in the small intestine. A lack of this
vitamin can result in weak bones.
Calcium
phosphate
Bone
matrix
FIgUrE 3.29 The bone matrix

provides the form of the bone and
calcium phosphate provides the
strength.
103
Case study
Energy
The 24-hour intake of food and drink for Chris, a
17-year-old male, is shown below.
2 fried eggs on white toast with 2 tsp of butter
175 g yogurt
250 mL orange juice
1 sausage roll
500 mL water
1 Big Mac
1 small serving French fries
375 mL cola
1 apple
300 mL water
2 slices of leftover pizza
1 medium T-bone steak
200 g potatoes
1 carrot
1 banana
250 mL apple juice
2 scoops of vanilla ice-cream
Case study review

1 Using table 3.3, calculate the total energy intake for Chris.
2 Chris weighs 70 kilograms, has a BMR of around 7200 kJ/day and uses around
1200 kJ/day for digestion. Using table 3.1, calculate the extra energy that Chris
will expend by engaging in each of the activities below in one day. You will need
to multiply the amount of energy the activity uses (in kJ/kilogram/hour) by Chriss
weight (in kg) by the amount of time he performed the activity (in hours). An
Excel spreadsheet can be used to do this.
(a) Writing at school and at home for a combined total of four hours
(b) Running around at football training for one hour
(c) Sitting at home quietly for a total of fivehours
(d) Walking rapidly to and from school for a total of 30 minutes
(e) Taking a one-hour driving lesson
3 Calculate the total energy requirement for Chris for this day.
4 Calculate the energy balance for Chris during this day (subtract the energy used
from the energy consumed).
5 (a) If 37000 kJ result in around one kilogram of excess weight, calculate
how much weight Chris would lose/add if he maintained this intake and
expenditure of energy for a fullyear.
(b) Discuss how this weight gain/loss might affect Chriss health and development.
TEST your knowledge

1 (a) Which nutrients are required for more than one
process in the body?
(b) Do they play the same role in all processes?
2 (a) Design a silly sentence or acronym to remember
the nutrients required for energy provision, blood
production and hard and soft tissue formation.
(b) Share your response with other students and
decide on the best ones.

3 Which lifespan stages would require higher
amounts of the nutrients needed for each of the
following processes? Explain each answer.
(a) Energy provision

(b) Blood production
(c) Soft tissue formation
(d) Hard tissue formation
4 In small groups, select one of the processes (hard
tissue, soft tissue, energy or blood production) and
design a poster, multimedia presentation or video
that could be used to educate youth about the
nutrients required for the process andexamplesof
foods that may supply these nutrients.
5 Use the Bone mass links in the
104
3.5
Consequences of nutritional imbalance
KEY CONCEPT Understanding the consequence of nutritional

imbalance in a youths diet on short- and long-term health and
Youth is the third-fastest period of growth in the lifespan. During the adolescent
growth spurt, the average female youth can expect to grow 16 centimetres in height
and gain 16 kilograms in weight, and the average male youth can expect to grow
20centimetres and put on 20 kilograms in weight. For this physical development
to occur, all of the nutrients required for the four processes soft and hard tissue
formation and the production of energy and blood must be eaten in appropriate
proportions. When nutrient intake is balanced (figure 3.30), appropriate levels of
nutrients areavailable to carry out these processes effectively and thedevelopment
of youth isoptimised.
FIgUrE 3.30 A balanced diet doesnt

mean eating the same amount of
everything.
The importance of food intake during youth is not limited to ensuring that
optimal individual human development occurs. Balanced nutrient intake also plays
a significant impact in promoting the health of youth.
If the nutritional intake of youth is not balanced and nutrients are not consumed
in appropriate proportions, the risk of a range of consequences for health and
individual human development increases. These consequences can occur as a result
of the over- or under-consumption of specific nutrients and can occur in both the
short and longterm.
Short-term consequences
The consumption of a variety of nutrients is required regularly to carry out various
processes including the production of energy. If these nutrients are not present, or
are in incorrect proportions, these processes may not occur effectively.
Carbohydrates are broken down and the glucose molecules that result are
absorbed into the bloodstream, from where they are taken into the cells and stored,
ready for use. The amount of glucose contained within carbohydrate-rich foods,
and how much such foods affect the levels of blood glucose, is measured using a
system called the glycaemic index (GI). The glycaemic index rates foods from 1 to
100 based on how quickly they cause blood-glucose levels to rise. Foods that cause
blood glucose to increase sharply are called high GI (with a score of more than 70)
while those that have a more sustained impact on blood glucose are called low GI
Unit 1
AOS 2
Topic 2
Short-term
consequences
Concept summary
and practice
questions
Concept 1
105
Blood glucose level
(with a score less than 55). Those in-between these numbers are
termed medium GI. Eating foods with a low GI rating gives a more
sustained energy release and can therefore assist in carrying out the
biological processes required during the day. In contrast, high GI
foods give a quick rush of glucose that then drops off just as quickly
(figure 3.31). As blood glucose levels decrease, hunger increases. As
a result, high GI foods can contribute to overeating.
In addition to carbohydrates, B-group vitamins and iron also
contribute to the production of energy. If these nutrients are not
0
1
2
3
consumed on a regular basis, energy levels may decrease, impacting
Time after meal (hours)
physical health. Reduced energy levels also impact on an individual
in many ways such as not having the energy to:
Figure 3.31 The effect on blood
socialise which impacts social health
glucose of high and low GI foods
exercise affecting fitness, an aspect of physical health
concentrate at school affecting intellectual development.
Fibre is a type of carbohydrate made up of the indigestible parts of plant matter.
Fibre assists in regulating bowel movements and providing feelings of fullness.
Adequate fibre intake can reduce the risk of constipation and overeating in the
short term. Fibre also reduces the absorption of glucose and cholesterol into the
bloodstream. This acts to decrease blood glucose and blood cholesterol levels in
the short term.
Water is essential for the optimal functioning of body systems throughout the
lifespan. Dehydration can affect many processes within the body and contribute
to a range of short-term impacts as a result. Common symptoms of dehydration
include thirst, dry mouth, headaches, decreased blood pressure, dizziness, fainting,
tiredness and constipation. In the most severe cases, dehydration can lead to
unconsciousness and death.
Figure 3.32 Foods like cakes,

biscuits and donuts have a high GI
that gives a quick rush of glucose.
High GI
Low Gl
Long-term consequences
As well as contributing to short-term consequences, nutrient imbalance is associated
with many long-term consequences impacting on health and development,
including dental caries; underweight, overweight and obesity; chronic conditions
such as cardiovascular disease, colorectal cancer and osteoporosis; slowed growth;
anaemia; and increased risk of infection.
Sugars are a type of carbohydrate found naturally in some foods such as fruit
and honey, and added to many processed foods such as cakes and soft drinks.
As well as providing a fuel for energy production, sugars provide a food source
for bacteria in the mouth. These bacteria produce acids which can contribute to
dental decay and the development of dental caries. Dental caries can impact mental
health as a result of reduced self-esteem if the individuals appearance is altered.
Intellectual development may also be affected if the individual misses school as
a result of ongoing treatment. If left untreated, diseases such as periodontitis can
occur. Periodontitis is a condition characterised by inflammation and infection of
the tissues that support the teeth. In the long term, periodontitis can lead to the
loosening and loss of teeth.
Although required as a fuel for energy production, if eaten in excess,
carbohydrates, fats and protein are stored as adipose (fat) tissue. Over time, this can
lead to weight gain, overweight and/or obesity. The most immediate consequences
of overweight and obesity in youth are social discrimination (associated with poor
self-esteem and depression), negative body image and eating disorders. Overweight
youth are more likely to develop sleep apnoea, have a reduced ability to exercise,
and show early signs of metabolic consequences, such as hypertension, high blood
glucose and high blood cholesterol.
106
Overweight and obesity rates have been steadily increasing for youth over time
(see figure 3.33). Overweight youth are more likely to be overweight or obese as
adults, which increases the risk of a range of conditions including type 2 diabetes,
cardiovascular disease, some cancers and arthritis.
30
Obese
Overweight
25
Per cent
20
15
10
0
1985
1995
Males
201112
1985
1995
Females
201112
* Figures are for 1217 years

Figure 3.33 Prevalence of overweight and obesity among males and females aged
715 years, 1985, 1995 and 201112
Source: Adapted from Australian Institute of Health and Welfare 2004, Risk factor monitoring, a rising epidemic: obesity in
Australian children and adolescents and ABS, Australian health survey: updated results, 201112.
When consumed in excess, protein can reduce the ability of the body to absorb
calcium. This can contribute to reduced bone density and osteoporosis later in life.
Fibre provides feelings of fullness without contributing significantly to energy
intake. As a result, adequate fibre intake can assist with weight management in the
long term. It also assists with regulating bowel movements and has been linked to
lower rates of colorectal cancer in the long term.
Saturated and trans fat increase the process of atherosclerosis by increasing
levels of low density lipoprotein (LDL) in the blood. Low density lipoprotein is
a type of cholesterol that can stick to the walls of blood vessels which causes the
blood vessels to narrow. This process can eventually restrict blood flow or stop it
completely. Atherosclerosis is the underlying cause of many types of cardiovascular
disease, including heart attack and stroke. Monounsaturated and polyunsaturated
fats work to reduce levels of LDL cholesterol in the blood and can therefore assist in
reducing the risk of cardiovascular disease in the long term. Like all fats, however,
over-consumption can contribute to obesity and its associated effects.
Although overweight and obesity are significant issues for youth, underweight
is also a concern. Underweight often indicates undernourishment in which the
nutrients required for optimal health and development are not present.
Severe undernourishment, as occurs in many individuals with an eating disorder,
can contribute to long-term developmental problems. Growth may be slowed as
the nutrients required for hard tissue formation are not present. Although peak
bone mass is not reached until early adulthood, bone density increases significantly
during youth. Calcium, phosphorus and vitamin D are all essential nutrients for
Unit 1
AOS 2
Topic 2
Concept 2
Long-term
consequences
Concept summary
and practice
questions
this process. If intake is deficient in these nutrients, weakened bones may be the
result. In many cases, this will develop into osteoporosis later in life.
Soft tissues are constantly repaired and replaced, and nutritional balance is
needed to ensure the nutrients required to carry out this process are present in
appropriate levels. Protein, vitamin C, vitamin A, folate, fats and water are all
required for the growth and repair of soft tissues. Without adequate amounts of
these nutrients, muscles and organs may not develop to their full potential.
As blood cells are produced constantly, adequate intake of the nutrients required
to make blood, such as iron, folate and vitamin B12, are required to ensure the
amount of blood produced meets the needs of the growing youth. Vitamin C is also
important as it assists with iron absorption. If these nutrients are under-consumed,
anaemia can occur. Anaemia is characterised by an inability of the blood to carry
adequate oxygen around the body. Symptoms of anaemia include tiredness and
weakness, so the youth might no longer be able to participate in daily activities.
Anaemia may affect development by creating:
an inability to participate in the weight-bearing activities that are needed to
increase bone density, which can result in reduced bone mass
an inability to participate in physical activity, which can impair motor skill
development
insufficient energy to have a part-time job, which can affect social development
such as learning the role of an employee
constant feelings of tiredness, which may generate a range of negative emotions
such as helplessness and isolation.
As well as providing energy and aiding in the formation of hard tissue, soft tissue
and blood, nutrients are required to keep all bodily systems functioning correctly.
The immune system, for example, requires a nutritional balance to function
effectively. Protein and vitamin A are key nutrients in immune system function. If a
person is deficient in protein or vitamin A, their immune system may not function
correctly, increasing the risk of disease or infection.
TEST your knowledge
1 (a) Explain the glycaemic index.

(b) Outline the consequences that a high GI diet can
have on the health of youth.
2 (a) Discuss how nutritional imbalance may
contribute to low energy levels.
(b) Explain three ways in which this could impact on
youth health and/or development.
3 Outline the role that fibre can play in optimising
health in the short term.
4 (a) Explain how nutritional imbalance may contribute
to dental health problems among youth.
(b) Discuss how dental caries could impact on
youth:
i. health
ii. individual human development.
5 Explain anaemia.
6 Explain how carbohydrate, protein and fat intake

can contribute to obesity.
7 Discuss how youth could reduce the risk of
developing osteoporosis in later life.
8 Explain how being underweight could impact on
youth health and development.
9 Discuss how anaemia could impact on youth health
and development.
10 Design a poster or short video outlining the
possible short- and long-term effects of nutritional
imbalance among youth.
108
3.6
Food selection models as tools to promote

healthy eating during youth
KEY CONCEPT Understanding food selection models as tools to

promote healthy eating during youth
To assist youth in consuming a balanced diet and reducing the risk of short- and
long-term consequences associated with nutritional imbalance, a number of food
selection models have been produced. Food selection models are tools that help
youth to select foods that will meet their nutritional needs, without consuming
too many energy dense foods. Examples include the Australian Guide to Healthy
Eating and the Healthy Eating Pyramid.
The Australian Dietary Guidelines

and the Australian Guide to
Healthy Eating
The Australian Dietary Guidelines and the Australian Guide to Healthy Eating
are federal government initiatives that provide nutrition advice with the aim of
reducing the short- and long-term consequences associated with nutritional
imbalance.
The guidelines are targeted towards health professionals, including dietitians,
nutritionists, general practitioners (GPs), nurses, educators, government policy
makers, the food industry and other interested parties. Guidelines 2 and 3 provide
advice on which foods should be consumed regularly and which ones should be
consumed in moderation.
GUIDELINE 2
Enjoy a wide variety of nutritious foods from these five groups every day:
Plenty of vegetables, including different types and colours, and legumes/beans
Fruit
Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles,
polenta, couscous, oats, quinoa and barley
Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat
And drink plenty of water.
GUIDELINE 3
Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
a. Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers,
pizza, fried foods, potato chips, crisps and other savoury snacks.
Replace high fat foods which contain predominantly saturated fats such as butter, cream, cooking margarine, coconut
and palm oil with foods which contain predominantly polyunsaturated and monounsaturated fats such as oils, spreads,
nut butters/pastes and avocado.
b. Limit intake of foods and drinks containing added salt.
Read labels to choose lower sodium options among similar foods.
Do not add salt to foods in cooking or at the table.
c. Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials,
fruit drinks, vitamin waters, energy and sports drinks.
d. If you choose to drink alcohol, limit intake.
Serving numbers and sizes from each of the five food groups and healthy fats and
oils are included in the Australian Dietary Guidelines to assist youth in planning
their daily food intake (table 3.4).
Table 3.4 Australian Dietary Guidelines recommended serves from the five food groups for 1218 year olds
Recommended number of serves per day
Fruit
Grain (cereal) foods per day,

mostly wholegrain and/or
high cereal fibre varieties
Males
1213
1418
5
5
2
2
6
7
2
2
3
3
Females
1213
1418
5
5
2
2
5
7
2
2
3
3
Pregnant (up to
18 years)
Breastfeeding
(up to 18 years)
Age (years)
Vegetables
and legumes/
beans
Lean meats, poultry, fish,

eggs, tofu, nuts and seeds,
and legumes/beans
Milk, yoghurt, cheese

and/or alternatives
mostly reduced fat
Note: Additional amounts of the Five Food Groups or unsaturated spreads and oils or discretionary food choices are needed only by people who are taller or more active to
meet additional energy requirements.
Fats play an important part in many processes such as the development of cell
membranes, fuel for energy production and regulation of cholesterol. Unsaturated
fats are the healthiest options and should be included in the food intake of youth.
The amount of unsaturated fats recommended by the guidelines for youth are
shown in table 3.5.
Information is also included in the guidelines to provide youth with examples of
foods that make up a single serve of each food group (table 3.6).
Table 3.5 Australian Dietary
Guidelines recommended fat intake
for youth
Age (years)
Boys
Girls
Unsaturated
spreads and
oils per day
1213
1418
1213
1418
Pregnant (up
to 18 years)
Breastfeeding
(up to 18 years)
Table 3.6 Examples of single serves

Vegetables and
legumes/beans
75 g ( cup) cooked green or Brassica or cruciferous vegetables

75 g ( cup) cooked orange vegetables
75 g ( cup) cooked dried or canned beans, chickpeas or lentils, no added salt
75 g (1 cup) raw green leafy vegetables
75 g starchy vegetables (e.g. medium potato, or equivalent of sweet potato,
taro, sweet corn or cassava)
75 g other vegetables, e.g. 1 medium tomato
Fruit
150 g (1 piece) of medium-sized fruit, e.g. apple, banana, orange, pear

150 g (2 pieces) of small fruit, e.g. apricots, kiwi fruit, plums
150 g (1 cup)
diced, cooked or
canned fruit
125 mL ( cup) 100% fruit juice
Grain (cereal)
foods per
day, mostly
wholegrain and/
or high cereal
fibre varieties
1 slice of bread or a medium roll or flat bread (40 g)
30 g dried fruit, e.g. 4 dried apricot halves, 1 tablespoons of sultanas
cup cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur
or quinoa (75120 g)
cup cooked porridge (120 g), 2/3 cup wheat cereal flakes (30 g) or cup
muesli (30 g)
3 crispbreads (35 g)
1 crumpet (60 g) or 1 small English muffin or scone (35 g)
cup flour (30 g)
Lean meats,
poultry, fish,
eggs, tofu, nuts
and seeds, and
legumes/beans
65 g cooked lean red meats (e.g. beef, lamb, pork, venison or kangaroo) or cup
of lean mince, 2 small chops, 2 slices of roast meat (about 90100 g raw weight)
80 g cooked poultry (about 100 g raw weight) e.g. chicken, turkey
100 g cooked fish fillet (about 115 g raw weight) or 1 small can of fish, no
added salt, not in brine
2 large eggs (120 g)
1 cup (150 g) cooked dried beans, lentils, chickpeas, split peas, or canned beans
170 g tofu
30 g nuts or seeds or nut/seed paste, no added salt*
110
Milk, yoghurt,
cheese and/
or alternatives,
mostly reduced
fat
1 cup (250 mL) milk fresh, UHT long life or reconstituted powdered
1/2 cup (120 mL) evaporated unsweetened milk
3/4 cup (200 g) yoghurt
40 g (2 slices or 4 x 3 x 2 cm piece) hard cheese, e.g. cheddar
1/2 cup (120 g) ricotta cheese
1 cup (250 mL) soy, rice or other cereal drink with at least 100 mg of added
calcium per 100 mL
Unsaturated
spreads and oils
per day
10 g polyunsaturated spread
10 g monounsaturated spread
10 g tree nuts, peanuts or nut pastes/butters
7 g polyunsaturated oil, e.g. olive or canola oil
The Australian Guide to Healthy Eating is a food selection model that provides a
visual representation of guidelines 2 and 3 from the Australian Dietary Guidelines.
Presented in poster form (see figure 3.34), the main section of the Australian
Guide to Healthy Eating is a pie chart that shows the proportions of foods that
should be consumed from each of the five food groups according to Australian
Dietary Guideline number 2 vegetables, fruit, grain, lean meats (or alternatives),
and milk, yoghurt and cheese products.
Grain foods such as bread, cereal, rice and pasta should
account for around 3035 per cent of total daily food intake.
These foods are high in carbohydrates, which provide fuel for
energy production, and high in fibre, which assists with weight
management and maintains digestive health.
Vegetables and legumes/beans are the second biggest section
and should account for around 30percent of daily food intake.
These foods include fresh, frozen and tinned vegetables, legumes
such as lentils and chickpeas, and beans such as kidney beans.
These foods are high in vitamins and minerals, which assist in
promoting optimal health and development among youth. They
are also high in fibre and low in energy, which can assist with
weight management.
Meats and meat alternatives should account for around
15percent of total food intake. These foods provide much of the
protein that is required for the development of hard tissues, soft
tissue, energy and blood. They also contain iron and vitamin B12,
which are required for the production of red blood cells.
Although fruit contains many of the vitamins and minerals
required for optimal health, it can also contain high amounts
of high GI carbohydrates that can contribute to weight gain if
not used for energy. As a result, fruit should make up around
1012percent of total food intake.
Milk and other dairy products should also account for around
1012 per cent of total food intake. These foods are rich in
calcium and are required for optimal bone development.
The Australian Guide to Healthy Eating recommends that
people consume plenty of water, represented in the poster by a glass being filled
from a tap. Water is required for many body processes but does not contribute any
energy and so can assist in maintaining healthy body weight.
The healthier fats are shown in the bottom left corner of the Australian Guide
to Healthy Eating poster and include foods such as margarine and canola spray.
These foods contain monounsaturated and/or polyunsaturated fats and can assist
in reducing the risk of cardiovascular disease.
Figure 3.34 The Australian Guide

to Healthy Eating
Guideline 3 provides advice relating to discretionary foods. These foods are
shown in the bottom right corner of the Australian Guide to Healthy Eating
poster and consumers are advised to use these foods only sometimes and in small
amounts. They are not necessary to provide the nutrients the body needs, but
may add variety. Many of these foods are high in saturated fats, sugars, salt and/
or alcohol, and are therefore described as energy dense. Examples of discretionary
foods include pies and other pastries, cakes, processed meats, soft and sports
drinks, cordial, alcohol, potato chips, chocolate and biscuits.
With the information provided by the Australian Dietary Guidelines and the
Australian Guide to Healthy Eating, it is possible to evaluate the daily food intake
of an individual.
Applying the Australian Dietary

Guidelines and the Australian Guide
to Healthy Eating
Unit 1
AOS 2
Topic 2
Concept 3
Australian
Guide to
Healthy
Eating and
the Australian
Dietary
Guidelines
Concept summary
and practice
questions
If the food and drinks consumed in a 24-hour period are recorded, it is possible
to evaluate that particular days intake against the recommended number of
serves within the Australian Dietary Guidelines. This information can then give
some indication as to the adequacy of both the amount of food consumed and
the proportion of different food groups consumed. It is important to remember
that individual differences exist and the foods eaten in a 24-hour period do not
necessarily reflect overall dietary patterns. The following foods were consumed by
Scott, a 16-year old male, in a 24-hour period:
Table 3.7 Scotts food consumption for one day
Breakfast
Morning tea
Lunch
Afternoon tea
Bowl of wheat
flake cereal (60 g)
with full-cream
milk (1 cup).
Dinner
cup of
yoghurt
1 medium
roll with
salad (75 g
total)
Cooked pasta
dish (1 cups
ofcooked pasta)
3 slices of roast meat

75 g mashed potato
2 slices of bread with
monounsaturated
margarine(20 g total)
75 g of cooked peas
75 g of cooked carrots
2 slices of
toast with
monounsaturated
margarine (20 g),
and 2 slices of
cheese
Small can of
tuna
1 vanilla
slice
Milkshake
(3cups of full
cream milk,
chocolate
topping)
Fruit salad (150 g)
250 mL freshly
squeezed orange
juice
1 can of soft
drink
Water
1 apple
250 mL pineapple juice
1 banana
These foods can be broken down into their parts in order to classify them into
the five food groups. Creating a table like table 3.8 can be useful for doing this.
Refer to table 3.6 to see how many serves are present in each food item. For
example, the bowl of wheat cereal with milk would contribute two serves to the
grain group and one serve to the milk group. Including a column for unsaturated
fats and discretionary food items is important as, even though these foods are
not considered a food group, they can have significant impacts on health. The
breakdown for Scotts 24-hour food intake is shown in table 3.8.
Instead of having to write each food in the table (as was done in table 3.8),
ticks or marks can be placed under each food group as you go through each item
consumed (as shown in table 3.9).
Table 3.8 Scotts food consumption, broken down into the five food groups, unsaturated fats and discretionary foods
Vegetables
and
legume/
beans
Fruit
Grain (cereal) foods

perday, mostly
wholegrain and/
or high cereal fibre
varieties
Lean meats, poultry,

fish, eggs, tofu,
nuts and seeds, and
legumes/beans
Milk, yoghurt,
cheese and/or
alternatives, mostly
reduced fat
Unsaturated
spreads and
oils
Discretionary
foods
salad from
roll
orange
juice
wheat flake cereal
small can of tuna
full-cream milk from

cereal
margarine
from toast
soft drink
mashed
potato
orange
juice
wheat flake cereal
roast meat
cheese slices from

toast
margarine
from toast
vanilla slice
peas
banana
toast
roast meat (1/2 serve)
yoghurt
margarine
from bread
chocolate
topping
carrots
apple
toast

milkshake
margarine
from bread
pineapple roll from lunch

juice

milkshake
pineapple roll from lunch

juice

milkshake
fruit
salad
pasta
pasta
pasta
10
bread from dinner
11
bread from dinner
Total
serves
11
Unsaturated
spreads and
oils
Discretionary
foods
Table 3.9 Scotts food consumption, broken down into serves

Vegetables
and legume/
beans
Fruit

perday, mostly wholegrain
and/or high cereal fibre
varieties

fish, eggs, tofu,
nuts and seeds, and
legumes/beans
Milk, yoghurt, cheese

and/or alternatives,
mostly reduced fat
In order to do this accurately, you need to know how much of each food group
was in each item. If no amounts are given, you can base your judgements on what
an average serve might be (but some accuracy will be sacrificed). You may be able
to do this more accurately for foods that you have eaten yourself.
Once the number of serves from each group has been estimated, they can be
compared with the recommendations for someone of Scotts age (males, 1418,
from table 3.4).
Table 3.10 Scotts intake compared to the recommended intake from the Australian Dietary Guidelines
Vegetables
and
legume/
beans
Fruit

perday, mostly
wholegrain and/or high
cereal fibre varieties

fish, eggs, tofu,
nuts and seeds, and
legumes/beans
Milk, yoghurt,
cheese and/or
alternatives, mostly
reduced fat
Unsaturated
spreads and
oils
Discretionary
foods
Males
1418
Limit intake
Scotts
intake
11
Although Scotts diet is varied, he may be consuming too many of some food
groups. Some specific observations include:
he ate adequate amounts from the meat group
he consumed only 4 serves of vegetables and should be consuming 5
he consumed 7 serves of fruit and should be consuming 2 serves
he consumed 11 serves from the grain group, which is 4 serves above the
recommended amount
he consumed 6 serves of dairy foods instead of the recommended 3 serves
he consumed more unsaturated fats than recommended for someone his age
he may be consuming too many discretionary foods.
Some advice regarding Scotts diet could include:
ensure that the amount of foods from the meat group is not decreased
increase the amount of vegetables consumed
reduce the amount of fruit being consumed even though fruit contains many
important nutrients, it also has a relatively high amount of natural sugar, which
adds to the total kilojoules
drink water instead of fruit juice in the
morning and with dinner
replace soft drink with a glass of water
replace the vanilla slice at lunch with
carrot and celery sticks
replace the discretionary food items with
healthier alternatives.
The Healthy Eating

Pyramid
FIgUrE 3.35 The Healthy Eating Pyramid

The Australian Nutrition Foundation Inc.
114
The Healthy Eating Pyramid was developed

by Nutrition Australia, a non-government
organisation.
Based on the Australian Dietary Guidelines,
the pyramid represents foods from the five basic
food groups and arranges them into four levels,
indicating the proportion of different types of
food that should be consumed (see figure 3.35).
The Healthy Eating Pyramid promotes
youth health and development by encouraging
food variety and a diet based on minimally
processed foods from the five food groups,
healthy fats, limited salt and added sugar, and
sufficient water.
The foundation layers (the bottom two layers)
contain food of plant origin: vegetables and
legumes, fruits and grains. These foods should
make up the majority of an individuals daily
food intake. These foods are nutrient dense and
assist in providing youth with optimal amounts
of carbohydrates, fibre, vitamins and minerals.
The middle layer includes the milk, yoghurt,
cheese (and alternatives) food group, which
primarily provides calcium; and the lean meat,
poultry, fish, eggs, nuts, seeds and legumes food
group, which provides protein and a unique mix
of other nutrients.
The top layer presents foods that contain monounsaturated and polyunsaturated
fats, which youth should consume in small amounts to support heart health and
brain function. Health benefits can occur when consumers choose foods that
contain these healthier fats instead of foods that contain saturated fats and trans
fats.
The pyramid encourages individuals to drink water because it provides the best
source of hydration for the body without adding extra sugar and therefore energy
to the diet.
It also recommends that salt intake and added sugar should be limited. Salt is
a rich source of sodium, which is an essential nutrient, but the average Australian
already consumes too much salt and added sugar, and this is linked to increased
risk of diseases such as heart disease, type 2 diabetes and some cancers.
The Healthy Eating Pyramid provides youth with a simple visual tool that
promotes healthy food intake. However, serving sizes and provisions for composite
foods (such as pizza or casserole) are not included, and this may make following
the model difficult.
Unit 1
AOS 2
Topic 2
The Healthy
Eating Pyramid
Concept summary
and practice
questions
Concept 4
Case study
Food intake
Consider the following food intake of Dallas, a
13-year-old female.
Breakfast:
2 pieces of toast with 10 g of monounsaturated
margarine
1 cup of orange juice
Snack:
1 small carton of yoghurt (200 g)
3 tablespoons of sultanas
Lunch:
A toasted sandwich (2 pieces of bread, 2 slices of
cheese, 10 g of monounsaturated margarine)
1 can of soft drink
Snack:
1 banana
1 glass of water
Dinner:
cup of cooked rice with 65 g of cooked beef, 1cup
of cooked vegetables and 7 g of olive oil
1 cup of fruit salad
Case study review

1 Complete a table similar to table 3.8 for Dallas food intake.
2 Compare Dallas intake to the guidelines given in tables 3.4 to 3.6.
3 (a) Of which food groups did Dallas consume the optimal amount?
(b) Explain how consuming an optimal amount of these foods might promote
Dallas health.
4 (a) Which food groups did Dallas not consume enough of?
(b) Explain how not consuming enough of these foods might affect Dallas health.
5 (a) Of which food groups did Dallas consume too much?
(b) Explain how consuming too much of these foods might affect Dallas health.
6 Why might it be more accurate to assess food intake over three days instead of
only one?
7 Explain the changes Dallas could make to her diet to more closely reflect the
recommendations of the Australian Guide to Healthy Eating and the Australian
Dietary Guidelines.
TEST your knowledge

1 Explain what is meant by a food selection model.
2 Identify two food selection models that can be used
by youth to promote health and individual human
development.

3 Explain the similarities and differences between the
Australian Guide to Healthy Eating and the Healthy
Eating Pyramid.
4 (a) Identify the five food groups identified in the
Australian Guide to Healthy Eating.
(b) Identify the key nutrients provided by each group.
(c) Explain how these nutrients can impact on youth
health and development.
5 Outline the short- and long-term consequences that
may occur for Scott if he continues consuming the
foods shown in table 3.7 on a daily basis.
6 Describe how one of the food selection models
discussed in this chapter could promote healthy
eating among youth.
7 Explain how the Australian Guide to Healthy Eating
could reduce the short- or long-term consequences
of nutritional imbalance among youth.
8 Record your own food and drink intake over a

24-hour period.
(a) Estimate the number of serves consumed from
each food group using a similar method to that
outlined in table 3.8.
(b) Prepare an analysis of your intake. Be sure to
include the following:
i. Identify food groups where intake was
adequate.
ii. Identify food groups where consumption was
deficient.
iii. Identify food groups where consumption was
excessive.
iv. Discuss the possible short- and long-term
consequences of your diet if it continued over
time.
v. Suggest changes that could be made to
minimise the risk of any short- or long-term
consequences identified in part iv.
(c) i. Discuss any difficulties you had in classifying
each food item.
ii. Explain how these challenges could be
overcome.
KEY SKILLS Nutrition during youth

KEY SKILL Explain the functions of major nutrients
for the production of hard tissue, soft tissue, blood
tissue and energy during youth
This key skill requires knowledge of the nutrients needed to carry out different
functions in the body, namely the development of hard and soft tissue, blood
production and the provision of energy. As well as knowing which nutrients are
required for these processes, knowledge of the role each one plays is essential.
Visual tools such as concept maps, flow charts and equation diagrams can be used
to consolidate this information. The following example relates to the production of
energy:
Carbohydrates,
fats and
protein
provide the
fuel for energy
B-group
vitamins
allow the
release of
energy
Iron forms
a part of
haemoglobin,
essential for
carrying oxygen
around
the body
Water
transports the
B-group vitamins
and is also required
for chemical
reactions to
take place
Energy
production
FIgUrE 3.36 How energy is produced in the body
In the following example, the nutrients required to produce bone (a hard tissue)
and the role each plays are outlined:
Protein: the main building material for hard tissue. Protein binds with vitaminC
to produce the collagen matrix, the outline for hard tissues.
Vitamin C: binds with protein to form the collagen matrix.
Vitamin A: assists in the division of the new cells needed by both the collagen
matrix and the hardening materials.
Calcium and phosphorus: bind together to form calcium phosphate, the hardening
material for bones.
Vitamin D: assists in the absorption of calcium in the small intestine. A lack of
this vitamin can result in weak bones.
The nutrient is named.
The function of the nutrient

is outlined and its role in the
development of hard tissue is
identified.
The roles of a range of nutrients

required for hard tissue development
are discussed.
PrACTISE the key skills

1 Devise a summary diagram outlining the roles of the major nutrients required for
soft tissue production.
2 Discuss the roles of the nutrients required for blood production.
KEY SKILL Explain the possible consequences of

nutritional imbalance in a youths diet on short- and
long-term health and individual human development
Each nutrient has a role to play in the body, but both under- and over-consumption
of nutrients can contribute to a range of short- and long-term consequences for
youth. It is important to understand the effect that too little, or too much, of
each nutrient can have on the body. By understanding the role of the nutrients,
predictions can be made about the likely consequences on health and development.
Most of the short-term effects will be on physical health and development; it will
then be possible to predict the potential impact of these effects on the other aspects
of health and development. For example, insufficient carbohydrates (which are a
117
Key skills Nutrition during youth

fuel for energy) could make an individual feel tired (physical health). Feeling tired
can have other implications for health and development, such as not wanting to
go to school (intellectual development and social health could be affected by this).
Long-term consequences can occur in all types of health and development, as
a result of nutritional imbalance over an extended period of time. The role the
nutrients play in these consequences must be understood. A summary table can
be useful for brainstorming the possible short- and long-term consequences of
nutrient imbalance.
Nutrient
Short-term consequences are

addressed.
Possible consequences for
development are included.
Long-term consequences are also

included.
Consequences on different types

of health and development are
explored.
Possible short- and long-term

consequences of underconsumption
Possible short- and long-term

consequences of over-consumption
Consider the following example, which discusses the possible short- and longterm consequences on the health and development of youth who consume a diet
high in fibre.
Fibre assists in the removal of waste products in the digestive tract and promotes
regular bowel movements. In the short term, this can prevent constipation
(physical health). If an individual is not constipated, they may be able to concentrate
better at school, which can enhance intellectual development.
Fibre is made up of the indigestible parts of plant matter. As a result, fibre
provides feelings of fullness without adding excess kilojoules. In the short term, this
can prevent overeating. In the long term, this can assist with weight management
and prevent the risk of overweight and obesity. Decreased risk of obesity can
enhance self-esteem (mental health). Individuals of optimal body weight may
be more able to exercise and promote fitness (physical health) and motor skill
development (physical development). Fibre has also been shown to decrease the
risk of colorectal cancer in the long term (physical health).

3 Explain the possible short-term consequences of a high-GI diet on youth health
and development.
4 Explain the possible long-term consequences of a low-GI diet on youth health
and development.
5 Explain the possible short- and long-term consequences on health and
development for a youth consuming low levels of:
(a) iron
(b) calcium.
KEY SKILL Explain how food models can be used as

a tool to promote health
In order to become proficient in this skill, knowledge of different food selection
models is necessary. The Australian Guide to Healthy Eating and the Healthy
Eating Pyramid are two food selection models that can be used by youth as tools
to promote health. Understanding how they can be used is an important aspect of
this skill. Using these tools to analyse and plan food intake can assist in developing
a deeper understanding of each model.
A typical scenario in which food selection models could be used to assist in
promoting the health of youth is explored in the following case study. Simon is a
16 year old who enjoys playing football. He recently made the representative side
in his region and is now committed to training three nights a week and playing
every Sunday. He also trains in the gym at school twice a week. He has been
purchasing his lunch from the school canteen most days of the week and buys food
from takeaway outlets on his way home from football training. Simon is unsure
whether he is consuming all the foods he should be to provide the nutrients he
needs to maintain optimal health and development. To discuss a possible solution
to Simons eating challenges, one approach might be to identify a food selection
model, describe it, and then discuss how it could be used to assist Simon in
consuming a healthy food intake.
An initiative established to promote healthy eating is the Australian Guide to
Healthy Eating. The Australian Guide to Healthy Eating is a food selection model
devised by the federal government. It is comprised of a poster that breaks the five
food groups into the proportions in which they should be consumed on a daily
basis.
The largest section of the graph, and therefore the food group that should be
consumed in the greatest proportion, is the grain group. This includes food items
such as cereals, breads and rice. Around a third of all foods should come from this
group.
The next section is the vegetables and legumes/beans group. Around a third of
all foods should come from this group.
The third group is the lean meats and poultry, fish and eggs. Around one-seventh
of all foods should come from this group.
The fruit group and dairy products such as milk, yoghurt and cheese are the
final two food groups. Each of these should account for around one-eighth of all
foods consumed.
The guide recommends drinking plenty of water, using only small amounts of
healthy fats such as canola and olive oils, and limiting discretionary foods such as
those containing alcohol or high levels of saturated fat, salt and/or sugar.
The Australian Guide to Healthy Eating can assist Simon in adopting a healthy
diet, but some of his circumstances may reduce his ability to follow it closely. The
guide is in graphical form, which might make it easier for Simon to understand it
and make changes to his diet. The Australian Guide to Healthy Eating does not
include serving sizes, which might make it hard for Simon to consume adequate
amounts from each food group. He would have to consult the Australian Dietary
Guidelines to access this information. As Simon purchases a lot of his foods, he
will have to learn to break composite foods down into their parts so he can classify
them into one of the five food groups. He may be able to do this by keeping a
food diary of all the food and drink he consumes. He can then take some time to
practise breaking these items down to their primary components. If Simon gains
an understanding of the components of different items available from the canteen
and takeaway outlets, he may be able to choose foods that more closely reflect the
proportions outlined in the guide.
The food selection model is

identified.
The food selection model is explained

in greater detail.
Key aspects of the Australian Guide
to Healthy Eating are included. It is

important to avoid being too general
and to provide examples specific to
Simon where possible.
Aspects of the model that may limit

Simons ability to follow it are also
discussed.
Ways of increasing Simons
understanding of the model and so

improve his diet.

6 Identify two similarities between the Australian Guide to Healthy Eating and the
Healthy Eating Pyramid.
7 Obesity rates among youth in Australia have been steadily increasing over the
past 20 years. Explain how the Healthy Eating Pyramid could be used to assist
individuals in reducing their energy intake.
8 Jackie is 14 and has just become a vegetarian. Identify one food selection
model and explain how it could assist Jackie in consuming foods that will
provide her with the nutrients she needs to maintain optimal health and human
development.
CHAPTER 3 review
Chapter summary
There are six categories of nutrients required for optimal health and individual human
development; carbohydrates, protein, fats, water, vitamins and minerals.
Interactivities:
Chapter 3 crossword
Youth require a balance of the six categories of nutrients in order to maintain optimal
health and individual human development.
Fibre is a type of carbohydrate that is indigestible. It has numerous health benefits, such
as reducing hunger, and decreasing cholesterol and glucose absorption. This can assist
in weight maintenance. Fibre also acts to clean the digestive system and reduce the
chance of colorectal cancer later in life.
The main function of carbohydrates is as an energy source.
Protein is required for the growth, maintenance and repair of body cells and structures.
It can also be used as an energy source.
Unit 1
Nutrition
during youth
AOS 1
The main function of fats is as a fuel for energy production. They are also a key
component of cell membranes.
Monounsaturated and polyunsaturated fats are a better choice than saturated and trans
fats because the latter increase the risk of cardiovascular disease.
Sit Topic test
Water is required for many body processes, including functioning as a medium

for allchemical reactions in the body and forming an important part of blood and
softtissues.
Calcium is an important component of hard tissues and is required to achieve optimal
peak bone mass.
Iron is required for haemoglobin in blood and a deficiency can lead to anaemia.
Vitamin A is required for cell division and cell differentiation.
Vitamin D is required in order for calcium to be absorbed in the small intestine and
therefore assists in building hard tissue.
Vitamin C is required for collagen production and assists with the absorption of iron.
The B-group vitamins are required to release energy from carbohydrate, protein and fat.
The key nutrients interact to produce energy, blood, hard tissue and soft tissue.
If energy intake and expenditure are not roughly the same, weight gain or loss will
result.
Nutrient imbalance can result in a range of short- and long-term consequences for
youth.
Short-term consequences include lack of energy, a spike in blood glucose levels,
overeating and constipation.
Long-term consequences include dental caries, periodontitis, overweight and obesity,
type 2 diabetes, cardiovascular disease, sleep apnoea, arthritis, osteoporosis, colorectal
cancer, anaemia and increased risk of infection.
The short- and long-term consequences can impact on all aspects of the health and
development of the individual.
Food selection models can be used as tools to assist youth in preventing nutritional
imbalance.
The Australian Guide to Healthy Eating presents the five food groups in the proportions
in which they should be consumed.
The Healthy Eating Pyramid contains four layers relating to the proportions of different
foods that should be consumed.
TEST your knowledge

1 What is the difference between macronutrients and
micronutrients?
2 Draw up a table similar to the one below and
complete it for each key nutrient.
Nutrient
Function/s
Food sources

3 Prepare a booklet that outlines the considerations
for youth food intake, with a focus on providing the
nutrients required for the production of hard tissue,
soft tissue, energy and blood.
4 Comment on the likely short- and long-term
consequences that may occur if youth consume too
much/too little of the key nutrients.
5 Play a game of nutrient celebrity head. Three

players are selected and assigned a nutrient each
(the nutrient can be written above their head if they
sit with their back to the whiteboard) but are not
told which nutrient they have. They then take turns
at asking questions. Each time the answer to the
question is no, they lose their turn and the next
player asks a question. Play continues until a correct
guess is made. Incorrect guesses are counted as a
no and the player loses their turn.
6 (a) Conduct a survey of current nutritional intake
and trends in your school.
(b) Collate the results and comment on the
nutritional adequacy of the sample groups diet.
(c) What are the possible short- and long-term
consequences if these trends continue?
(d) Use a food selection model to suggest changes
that the students could make to improve their diet.
CHAPTER 4

ofAustralias youth
WHY iS THiS iMPORTANT?
The youth stage of the lifespan is one of great change. In
general, the health and individual human development of
Australias youth is good although there are some areas
that could be improved. Understanding the factors that
influence health and development during this stage is
vital for ensuring that young people live the fullest lives
possible and achieve optimal health and individual human
development.
KEY KNOWLEDGE
2.4 determinants of the health and individual human development of
Australias youth (pages 1246), including at least one from each of
the following:
behavioural, such as sun protection, level of physical activity,
food intake, substance use, sexual practices, skills in developing
and maintaining friendships and seeking help from health
professionals (pages 12735)
physical environment, such as tobacco smoke in the home,
housing environment, work environment, access to recreational
facilities (pages 1369)
social environment: family and community, such as family
cohesion, socioeconomic status of parents, media, community
and civic participation (sport, recreation, arts and faith-based
activities) and access to education (pages 1407).
KEY SKILL
explain the determinants of health and individual human
development and analyse their impact on youth using relevant
examples (pages 135, 139, 1469, 151).
FiguRE 4.1 The youth stage of

the lifespan is one of vast change.
122
uNiT 1 The health and development of Australias youth

atherosclerosis the build-up of plaque on blood
vessel walls, making it harder for blood to get through
behavioural determinants the actions or patterns
of living of an individual or group that affect health
(e.g. smoking, sexual activity, participation in physical
activity, eating practices)
determinants of health factors that raise or lower
the level of health in a population or individual.
Determinants of health help to explain or predict
trends in health and why some groups have better or
worse health than others (AIHW, 2006). Determinants
can be classified in many ways such as biological,
behavioural and those relating to the physical and
social environment.
family cohesion the closeness or bonds between
family members
metastasise when cancer cells spread from the
primary site to other areas of the body
physical environment the physical surroundings
in which we live, work and play. The physical
environment includes water and air, workplaces,
housing, roads, nature, schools, recreation settings and
exposure to hazards.
resilience refers to an individuals ability to face and
cope with stressful and difficult situations, and to
recover after misfortune
sedentary undertaking no or very low levels of
physical activity
sexually transmissible infections (STIs) a range of
conditions that are generally transmitted sexually from
one person to another
skin cancer uncontrolled cell growth in one of the
layers of the skin
social determinants aspects of society and the social
environment that impact on health, such as poverty,
early life experiences, social networks and support
socioeconomic status (SES) a measure of an
individuals or familys economic and social position
within society relative to others, usually based on
education, occupation and income
4.1
Determinants of health and individual human

development during youth: four categories
KEY CONCEPT Understanding the determinants of the health and

developmentof Australias youth
There are many factors that influence the health and individual human development
of youth. These factors act together to determine health and development and hence
are termed the determinants of health and development, sometimes shortened to
the determinants of health.
There are four determinants of health and individual human development (see
figure 4.2) Biological determinants have a significant impact on the health and
development of youth and were explored in detail in chapters 1 and 2. In this
section, we will explore three other determinants that relate to the decisions young
people make and the physical and social environments in which theylive.
The three determinants to be explored in this chapter are:
behavioural determinants
social environment.
Behavioural
determinants
Physical
environment
Biological
determinants
Social
environment
Determinants
of health and
development
FiguRE 4.2 All four categories of the determinants of health combine to produce an
individuals health status and development.
Behavioural determinants
Behavioural determinants focus on the decisions people make and how they choose
to lead their lives. Nutrition and food intake is a significant behavioural factor and
was explored in detail in chapter 3. Other examples of behavioural determinants
include using sun protection, participating in physical activity, the use of various
substances, skills in developing and maintaining friendships and seeking help from
health professionals.
124
Physical environment
The physical environment encompasses the physical things that make up the
environment such as air and water, and available facilities such as housing,
recreation and health care. Aspects of the physical environment can directly impact
on health by affecting the bodys systems. Air and water quality can make people
sick or promote good health (figure4.3). Unhygienic or unsafe housing can spread
disease and contribute to injuries. Mental health can be compromised if individuals
do not have their own space within their physical environment. Social health
is influenced by those who share the physical environment with an individual.
For example, those who share a house, go to the same school or work with the
individual, will impact on the persons social health by providing opportunities for
interaction and the formation of relationships.
Figure 4.3 Environmental

pollution is an aspect of the physical
environment that affects health.
Individual human development can also be affected by the physical environment.

The opportunities provided for physical activity in the environment, for example,
will influence motor skill development and social development.
Social environment
The social environment refers to the aspects of society and the social environment
that impact on health. This includes the people with whom an individual
associates, the decisions that are made on behalf of the community (e.g. policies
and laws), and the position of an individual compared to others in the society
(based on factors including income and occupation). These factors influence the
opportunities available to an individual and are related to the level of health and
individual human development experienced by that person.
The family provides an important part of our social environment. For young
people especially, the family is generally the main social contact and provider of
many resources such as shelter, food, clothing, emotional support and educational
opportunities. Family cohesion and the socioeconomic status (SES) of parents are
examples of social factors that are influenced by the family.
Most individuals live in a community. The quality of the relationships within
the community and the services available in the community can affect health and
development. Examples of social factors influenced by the community include
media, community and civic participation, and access to education.
Unit 1
AOS 2
Topic 3
Concept 1
Behavioural
determinants
youth
Concept summary
and practice
questions
Interactivity:
Time Out: Determinants ofhealth
The determinants of health and individual human development ofAustralias youth CHAPTER 4 125
4.1 Determinants of health and individual human development during youth: four categories
Case study
Lifestyles of the rich and

anxious
By Rachel Browne
The young and rich are seeking help for anxiety and
depression at twice the rate of their poorer peers,
according to recent research.
Australian mental health experts say the disorders
are endemic among the young, especially the affluent.
Their observations follow Columbia University research
that found depression and anxiety occur at twice the
national US average in the children of families with an
annual income of more than $170000.
Lina Ricciardelli, associate professor of psychology
at Deakin University, said high status can be a risk
factor in anxiety and depression.
These families should be the happiest families in
the universe, shouldnt they? she said. The old adage
that money doesnt buy you happiness is true. In fact, it
might even buy you a few problems.
The US research found affluent children showed
high rates of alcohol and drug abuse, eating disorders
and criminal activity such as stealing from their parents
or peers.
A theory behind the rate of anxiety and depression

is the pressure high achieving parents put on their
children.
Director of psychological services at the Black Dog
Institute, Vijaya Manicavasagar, said the phenomenon
was endemic in the developed world.
If the parents are focused on outcomes, then the
kids are going to feel that their needs arent being met,
she said. Some kids could withdraw into their shell
and become depressed or anxious. Other kids would
rebel against it.
The chief executive of youth mental health group
Generation Next, Ramesh Manocha, said wealthy
families were often headed by parents who were
consumed by their jobs.
Affluent young people have access to alcohol, more
access to illicit drugs and more time and knowledge
about how to misuse the resources available to them.
A survey of 15000 people aged 14 to 19 released by
Mission Australia last week found one of their biggest
concerns was performing poorly in school and limiting
future prospects.
Source: Sun-Herald, 12 August 2013.
Case study review

1 Coming from a wealthy family is an example of which determinant?
2 Which behaviours are children from wealthy families more likely to take part in?
3 Outline the reasons that are said to contribute to higher rates of anxiety and
depression among children from wealthy families.
TEST your knowledge

1 (a) Explain the three determinants of health and
development addressed in this section.
(b) Give one example for each.

2 (a) Which group of determinants do you think
would have the greatest impact on the health
and development of:

i. a five-month-old baby in Sydney?
ii. a 16-year-old mother in Ethiopia?
iii. a 45-year-old unemployed person in
Melbourne?
iv. a 70-year-old retired grandparent in remote

Western Australia?
(b) Justify your choices and discuss your responses
with other students.
3 (a) Make a list of the determinants that have an
impact on your health and development.
(b) Rank them in order from most influential to
least influential.
(c) Discuss your list in small groups.
4 The social environment often leads to the health
behaviours that people engage in. Write a response
(either agreeing or disagreeing) to this statement
using examples to support your point of view.
126
4.2

development during youth: behavioural
KEY CONCEPT Understanding the behavioural determinants of the

health anddevelopment of Australias youth
During childhood, a lot of the health behaviours that people engage in are based
on the decisions made for them either by law and policy makers, or by their family.
As individuals enter the youth stage, they start to take more responsibility for the
choices they make. The choices made during this stage can have short- and longterm consequences for the individual.
eLesson:
The dangers of a deadly tan
Sun protection
Australias climate is among the harshest in the world and skin cancer is the most
commonly diagnosed cancer. Sunburn is one of the biggest risk factors for skin
cancer (figure 4.4). Skin cancers can be categorised into two groups: melanoma
and non-melanoma skin cancers.
Non-melanoma skin cancers are the most commonly diagnosed skin cancers and
comprise approximately 95percent of all skin cancers. Such cancers are generally
easily removed but can lead to complications if left undiagnosed and untreated
for extended periods of time. Melanoma skin cancer, on the other hand, is an
aggressive form of skin cancer that can metastasise and cause death if not treated.
The amount of UV radiation that a person is exposed to during childhood and
youth is one of the most detrimental risk factors for skin cancer. People with fair
skin that burns easily, those with freckles and/or moles and those with a family
history of skin cancer are also at an increased risk. Although skin cancer becomes
more common in laterlife, young people are still at great risk. In fact, according to
the Australian Institute of Health and Welfare in 2011, skin cancer was the most
commonly diagnosed cancer among people aged 1224, accounting for around
30per cent of all newly diagnosed cancers. A key reason for this is that youths are
less likely to engage in sun protection behaviours than adults (table4.1).
Sun protection behaviours describe any actions that individuals take to avoid
over-exposure to UV radiation. These include:
using sunscreen with a high protection factor
staying in the shade
wearing long trousers and long-sleeved shirts
wearing sunglasses.
Table 4.1 Sun protection behaviours during peak UV periods among young people aged
1224 years, 200304 and 200607 (per cent)
200304
Sun protection behaviours
1217 years
1217 years
Unit 1
AOS 2
Topic 3
Sun protection
Concept summary
and practice
questions
Concept 2
200607
1824 years
Figure 4.4 Sunburn should be

avoided because it is one of the
biggest risk factors for skin cancer.
1824 years
Head wear (hat, cap or visor)
38
37
29
33
15+ sunscreen
37
36
37
33
3/4 length or long top
11
11
12
3/4 length or long leg-cover
37
37
30
37
Stayed mostly in the shade
19
26
20
22
Wore sunglasses
23
52
24
47
Sunburnt
25
22
24
19
Note: Multiple responses were permitted; therefore, the total responses exceed 100 per cent.
Source: AIHW 2011, Young Australians: their health and wellbeing 2011, cat. no. PHE 140, Canberra, p. 72.
4.2 Determinants of health and individual human development during youth: behavioural
Figure 4.5 Surgery is commonly required to remove skin cancer,

and it often causes scarring because the surrounding tissue is usually
removed as well.
By using such sun protection methods, individuals can

reduce the damage caused to skin cells as a result of
exposure to UV radiation and thereby reduce their risk
of developing skin cancer.
While overexposure to UV rays can cause skin
cancer, insufficient exposure can also be detrimental.
Exposure to UV rays triggers the production of
vitaminD in the skin. This nutrient is required to assist
in the absorption of calcium, which in turn is needed
for the development of bones. Lack of UV exposure can
lead to a deficiency in vitamin D and therefore a lower
than optimal bone mass. This increases the chances of
fractures and osteoporosis in later life. However, a lack
of sun exposure is not a significant problem for youth
in Australia.
Physical activity
Unit 1
AOS 2
Topic 3
Concept 3
Physical activity
Concept summary
and practice
questions
According to a study carried out by the Australian Bureau of Statistics in 201112,

8.2 per cent of those aged 1217 participated in levels of physical activity
recommended by the national guidelinestoobtain a health benefit. However, many
young people were sedentary.
Physical activity is an important part of a healthy, balanced lifestyle. Patterns
established in youth can carry through to adulthood and increase the likelihood
of maintaining an ideal weight. Other short- and long-term benefits of physical
activity include the prevention of:
cardiovascular disease being obese is a risk factor for cardiovascular disease.
Exercise can assist in maintaining an optimal body weight and maintaining
cardiovascular health.
high blood pressure overweight and obesity are risk factors for high blood
pressure. Maintaining a healthy body weight through exercise can help to reduce
this risk.
some forms of cancer exercise can enhance immune function and improve
the bodys response to cancerous growths.
For health benefits to occur, the federal government recommends that youth
engage in at least 60 minutes daily of moderate-to-vigorous intensity physical
activity. Table 4.2 shows the average number of days that youth met this requirement
in a seven-day period in 201112.
TABLE 4.2 Average number of days that youth (by age group) met the federal government
recommendation for physical activity in a seven day period (percent of youth), 201112
Males
1517
1214
1517
3.4
12.4
7.1
24.9
12 days
22.3
29.2
33.8
30.8
34 days
25.2
29.5
27.6
29.1
56 days
36.5
22.8
22.9
9.0
7 days
12.5
5.4
8.6
6.2
Total(a)
100.0
100.0
100.0
100.0
None
Per cent
Females
1214
(a)
Numbers may not sum to the total due to rounding.

Source: Adapted from ABS, Australian health survey: physical activity, 201112.
Many forms of physical activity (e.g. tennis, golf and soccer) promote social
interaction, which is an aspect of social health. Youth may also be exposed to
128
different social groups and learn different social skills, which is an area of social
development.
Physical activity can have a positive impact on mental health. Exercise has been
shown to relieve stress and anxiety. As well as providing an outlet for excess energy,
physical activity releases hormones in the body that can promote feelings of wellbeing and therefore positive mental health.
Physical activity can also affect individual human development:
Exercise (particularly weight-bearing exercise) assists in strengthening bones and
increasing bone density, which promotes physical development.
Individuals participating in physical activity may learn new games and strategies
associated with different sports, promoting intellectual development.
Concepts such as sharing and taking turns can be reinforced by cooperative
exercises such as team sports, which promote social development.
Substance use
Youth is often a stage of the lifespan where people experiment with different
substances. The reasons for this are related to youths experimenting with aspects
of their identity and to the brain development that makes youths more likely to
take risks. The substances most commonly experimented with by youth are drugs,
tobacco and alcohol (table 4.3).
Many of these substances can lead to health issues in the short and long term.
Effects could include hospitalisation, accidents, conflict with friends and family,
financial difficulties, legal issues, organ damage, mental illness and various forms
of cancer.
Drug use
According to the Australian Institute of Health and Welfare (2014), illicit drug use
includes:
using illegal drugs
using substances as inhalants (e.g. glue and petrol)
using prescription medicine for non-medical purposes.
Recent illicit drug use (in the previous 12 months) of selected substances among
youth is shown in table 4.4.
Illicit drug use during youth has been linked to many physical health problems,
such as:
blood-borne diseases (when injected) needles can transfer diseases from one
person to another. Hepatitis C and HIV are two diseases that can be spread by
sharing needles.
violence the behaviour of people using drugs can be altered. This can make
them more prone to violent acts that can result in physical injuries.
malnutrition adequate food intake is often not a priority to those suffering
from a drug addiction. Drug use may also interfere with appetite and further
contribute to malnutrition. In addition, some substances can affect the retention
of different chemicals in the body. For instance, some painkillers can reduce the
retention of vitamins and minerals. All these can weaken the immune system
and make youth more susceptible to infection and disease.
cardiovascular disease some illicit substances can significantly increase
heart rate and blood pressure, which can contribute to cardiovascular disease
in youth
certain cancers the risk of most cancers is increased when substances are
smoked
drug overdose resulting in disability/death body systems can shut down if the
body has an adverse reaction to the substance.
Table 4.3 Average age of initiation

of lifetime drug use, Australia, 2013
Substance
Age first tried
Tobacco
15.9
Alcohol
15.7
Illicits
Marijuana
16.7
Painkillers/analgesics
15.0
Meth/amphetamine
18.6
Cocaine
19.2
Hallucinogens
18.5
Inhalants
16.9
Ecstasy
18.2
Heroin
16.9
Source: Adapted from AIHW 2014, National

drug strategy household survey: detailed report
2013.
TABLE 4.4 Recent use of illicit drugs

(last 12 months): proportion of the
population aged 1419 years, 2013
(per cent)
Males
Females
Marijuana
Substance
17.3
12.0
Painkillers/
analgesics
4.4
3.7
Meth/
amphetamine
2.3
1.6
Cocaine
1.1
1.1
Ecstasy
3.1
2.8
20.6
14.5
Used any
illicit drug
Source: Adapted from AIHW 2014, National

drug strategy household survey detailed report
2013, supplementary tables.
eLesson:
Ice addiction
Per cent
As well as the effects on physical health, substance use can have an impact on
the social and mental health of youths. For example, the risk of developing mental
illnesses is higher for drug users. Many illicit drugs can cause hallucinations and
an altered perception of reality, and can change the chemical make-up of the brain.
The chemical changes occurring in the brain can act as a trigger for a range of
mental illnesses such as depression, anxiety and psychosis. If drug use leads to
mental illness, the risk of suicide may also be increased.
If an individual experiments with drugs, the effects can extend to their circle of
friends. Some friends might disapprove and distance themselves. If other friends
are similarly experimenting with drugs, the individual might spend more time with
this group of people. Either way, drug use will generally affect social health.
Long-term substance use can have a range of effects on individual human
development. The person may not be able to hold down a job or participate in
full-time study. This can affect social development, as they do not learn the social
skills associated with full-time employment or tertiary education. The individual
might also find it hard to maintain a relationship in which valuable social skills
such as communication and sharing are further developed. It can also have an
impact on intellectual development, as the knowledge that could have been gained
may never be learned. Drug use can leave people with insufficient money to pay
Figure 4.6 Experimental drug use
for social experiences such as holidays or to attend gatherings such as weddings,
can lead to a range of other health
which could further impact on social development.
issues.
Because the mental health of an individual might be affected by substance use,
emotional development does not have a secure foundation on which to build. If a
person is using drugs to escape their problems, they will not get the opportunity to
deal with their issues and mature emotionally.
25
According to the Australian Institute of
Males
Health and Welfare, many factors can put
Females
young people at risk of drug use. They
20
include:
maternal drug use during pregnancy
15
early behavioural problems
emotional problems and early exposure to
10
drugs

peer antisocial behaviour
5
poor parental control and supervision
poor family bonding
0
drug use among family members
1998
2001
2004
2007
2010
2013
poor connection with family, school and
Year
community
Figure 4.7 Daily smoking rates among young people aged 1424 years, by sex,
academic failure
19982013
low self-esteem
Note: 200713 is a six-year period as data for 2010 was not available.
leaving school early.
Source: Based on AIHW, National drug strategy household survey, various years.
Tobacco
The percentage of young Australians who smoke has decreased significantly over the
past decade (figure 4.7), although around 8per cent continue to smoke. Tobacco
has many effects on youth health in the short and long term. In the short term,
tobacco smoking increases heart rate and blood pressure. The immune system can
also be adversely affected, increasing the risk of developing an infection.
Smoking is less acceptable than it was in the past, and laws have been passed
that prohibit smoking in many public spaces. This means that youths must leave
venues to smoke. Continually leaving a social activity to smoke could affect social
experiences for young people. The financial costs associated with tobacco smoking
could leave less money available for other activities such as socialising with friends.
130
People with depressive symptoms are more likely to smoke, although it is not
clear if smoking contributes to depression or vice versa. There is also evidence
that tobacco use has a relationship with the use of other drugs such as alcohol and
marijuana.
The longer a youth smokes, the more likely they are to develop long-term
conditions including:
cardiovascular disease tobacco smoking increases the rate of atherosclerosis
in the body and therefore increases the risk of cardiovascular disease
many forms of cancer tobacco smoke can facilitate the development of
cancerous cells in many parts of the body, including the lungs and breasts
respiratory conditions such as emphysema.
As fitness levels decrease, the young smoker may be less inclined to participate
in sporting activities. This could affect all areas of development including physical
development, especially motor skills, and social development. It could also make
the youth less likely to participate in sporting activities in later life, which could
lead to an increased risk of cardiovascular disease and cancers.
Alcohol use
Alcohol is the most common social drug used in Australia. Table 4.5 shows the
alcohol consumption status across age groups.
TABLE 4.5 Alcohol consumption status of people aged 1217, by age and sex, 2013 (per cent)
Males
1215
Weekly
Less than weekly
Ex-drinker(a)
Never a full serve of alcohol
(a)
Females
1617
1215
1617
0.7
11.3
0.5
6.0
15.8
43.0
13.4
50.0
3.5
4.6
1.4
3.7
80.0
41.1
84.7
40.2
Consumed at least a full serve of alcohol, but not in the previous 12 months.
Source: AIHW 2014, National drug strategy household survey detailed report 2013, supplementary tables.
The National Health and Medical Research Council (NHMRC) is a federal

government body that developed guidelines relating to young people and alcohol:
The NHMRCs guidelines state that for children and young people under 18 years of
age, not drinking is the safest option.
Dangerous behaviour is more likely among young people when they drink
compared to older drinkers. Young people are more likely to drink more and take
risks.
The brain is still developing during the teenage years and drinking alcohol during
this time may damage the brain and lead to health complications later in life.
The earlier a child is introduced to alcohol the more likely they are to develop
problems with it later in life. Young people should therefore delay their first drink
for as long as possible. (Australian Drug Foundation, 2015).
In small amounts, alcohol may pose minimal risks to health. Excessive alcohol
intake, however, puts individuals at an elevated risk of many causes of morbidity
and mortality. Experimentation with alcohol often starts during youth (figure 4.8)
when the individual may not have the knowledge, experience or supervision to
moderate their drinking. As a result, binge drinking is the major concern associated
with alcohol consumption by youth. Binge drinking results in many hospitalisations
and other short-term effects on youth health each year. In fact, according to the
Australian Institute of Health and Welfares 2010 National drug strategy household
Figure 4.8 Many youths experiment

with alcohol.
survey, youths often experience one or more negative short-term effects associated
with binge drinking. Examples of these include:
violence
accidents such as drowning
unsafe sexual practices
unconsciousness
vomiting.
Excessive alcohol consumption may begin in youth and continue into adulthood.
The long-term effects associated with alcohol consumption include:
weight gain and obesity alcohol is energy dense and often contributes to
weight gain. If alcohol consumption results in obesity, this increases the risk of
developing a range of related conditions including cardiovascular disease, type 2
diabetes and some cancers.
cancer according to the Cancer Council, alcohol use increases the risk of cancers
of the mouth, pharynx, larynx, oesophagus, bowel (in men) and breast (in women)
mental illness alcohol consumption can contribute to long-term mental health
problems and has been linked to increased rates of anxiety and depression.
Youth might socialise with other young people who drink and, while under the
influence of alcohol, could behave in a way they regret. Their mental health may
suffer as a result of feelings of regret and guilt.
The individual human development of youth can also be significantly affected
by alcohol consumption. Alcohol can reduce the absorption of nutrients, which
can contribute to malnutrition. If the essential nutrients required for physical
development are not present, then body systems such as the skeletal and muscular
system may not develop optimally.
Socialising regularly under the influence of alcohol could prevent the individual
from developing social skills while sober, and they might begin to rely on alcohol
to make friends or socialise effectively. Their self-concept could be affected by
alcohol consumption, especially if they have negative experiences while drinking.
Regular alcohol consumption during youth impacts on brain development and
can contribute to problems with verbal skills. This can interfere with the way in
which youth communicate and therefore affect social development.
Excessive alcohol consumption can lead to lethargy (tiredness), which can
reduce concentration levels and ultimately performance at school, thereby affecting
intellectual development. Alcohol can also affect brain function and impair brain
development. This can contribute to memory problems and reduced capacity for
problem solving, similarly affecting intellectual development.
Sexual practices
Sexual development is a significant milestone occurring in the youth stage of the
lifespan. Some people start experimenting with sexual behaviour at this point in
their lives (figure 4.9). Being involved in a sexual relationship may affect the people
that an individual associates with, especially if their friends are not sexually active.
The person may attach feelings of love to the sexual relationship, which can impact
on mental health and emotional development. It may also increase the feelings of
sadness and loss should the relationship end.
The sexual practices that young people undertake can have long-term
consequences. Teenage pregnancy and sexually transmissible infections (STIs) are
two examples. The more sexual activity that a person engages in, the greater their
chance of contracting an STI or conceiving a baby.
STIs are passed from one person to another through sexual contact. This
includes oral, genital and anal sex. The rates of many STIs increased between 2002
and 2012. This includes HIV/AIDS, chlamydia and gonorrhoea. According to the
Australian Bureau of Statistics (2012), more than half of all STI notifications in
2011 were for young people.
70
Males
Females
Persons
60
Per cent
50
40
30
Figure 4.9 Proportion of students

in years 10 and 12 who have ever had
sexual intercourse, 2002 and 2013
20
10
0
Year 10
Year 12
2002
Year 10
Year 12
2013
Source: Smith et al. 2009, Secondary students and

sexual health 2008; and Mitchell et al. 2014, 5th
National survey of Australian secondary students
and sexual health 2013; Australian Research Centre
in Sex, Health and Society, La Trobe University,
Melbourne.
STIs have a range of effects on health. Diseases such as HIV and herpes have no
cure and stay in the body for life. Although treatments are available for HIV, the
virus slowly destroys the immune system and can lead to an increase in infections
such as pneumonia and premature death. Genital herpes is the same virus that
causes cold sores and can cause recurrent blisters on or around the genitals.
All STIs can have long-term consequences ranging from fever and infertility to
death, but (other than HIV and herpes) they can be cured with antibiotics or other
medication. Some STIs have few or no symptoms in some people, so they can go
undiagnosed for a long period of time, increasing the impact of the infection on
the person.
Social health could be affected by a person contracting an STI. If it is contracted
within a relationship, the relationship could break down.
STIs can affect mental health by contributing to stress and anxiety. The individual
might feel embarrassed and uncomfortable about having to discuss sexual issues
with their doctor and then inform previous sexual partners. They could also feel
anxious about their condition and may experience feelings of denial.
The impact of contracting an STI on individual human development would
depend on the type of STI contracted, the amount of time the person suffers from
it and the personality of the individual concerned. Self-esteem could suffer from
contracting an STI, but the person could also learn to deal with the emotions they
experience as a result of the STI (e.g. anger, fear, remorse) or develop assertiveness
by confronting the person who infected them.
Skills in developing and maintaining

friendships
As already discussed, the peer group is increasingly influential during youth. Young
people rely on each other more heavily as they move through this stage of the lifespan.
The skills required for developing and maintaining friendships begin to develop
early in the lifespan and are refined further during youth. Common skills required
to develop and maintain meaningful friendships include:
Being trustworthy being able to keep secrets and maintaining trust

Accepting others mistakes not judging people based on past mistakes
promotes acceptance

Sharing and compromising sharing possessions, ideas, goals, space and
interests promotes deep friendships. Compromising is essential in order to
maintain friendships.
Unit 1
AOS 2
Topic 3
Concept 4
Skills in
developing and
maintaining
friendships
Concept summary
and practice
questions
Figure 4.10 Friends can be a great

support during youth.

Listening active listening is important in maintaining adequate levels of
communication.
Commitment friends are committed to each other and dedicate time to spend
with one another when possible.
Being supportive one of the key benefits of friendship is to provide each other
with support in times of need. Youth is a time of vast change and friends can
support each other through these events.
Participating in conversations real friends value each others opinions and
want to hear what the other has to say.
Providing compliments providing positive feedback to others is required for
the promotion of self-esteem and shows others that their friends care.
Being honest although compliments are important, friends are often in a
position to be honest with each other when advice is sought. Respect should
always be maintained when offering advice.
Using these skills in interactions with others is influential in developing
and maintaining meaningful relationships. Developing mutual and respectful
friendships during youth can provide a valuable resource for all individuals
involved (figure4.10).
Having mutual and respectful friendships means that the individual is valued
for who they are. This allows youth to express their feelings without being
judged, to discuss concerns about the present and future and to share experiences
with those they trust. Friendships give an alternative to the family from which
youth can seek advice and gain support during times of crisis. Friends can also
guide each other through the sometimes difficult period of youth and assist in
building resilience.
Developing and maintaining a friendship requires effort from all the individuals
involved. As a result, friendships can dissolve if the effort is not made. Friendships
during youth can influence many aspects of health and development. Friends may:
influence other behaviours that youth participate in such as exercise, substance
use and risk-taking activities. All of these can affect physical health and
development.
encourage social development by engaging the youth in a range of social
activities. These may assist in building communication skills and social roles.
encourage and support each other. This promotes mental health.
lead the youth to experience strong bonds with individuals outside the family,
promoting emotional development.
Seeking help from health professionals
Figure 4.11 Health professionals

can help youths in numerous ways,
including giving advice.
As medical technology and knowledge have advanced over the past century, many
conditions have become curable and/or preventable. Health professionals can
help youths in numerous ways, particularly in providing treatment and advice
about optimising health and individual human development (figure 4.11). Health
professionals can:
give advice about nutrition, which can promote physical health and individual
human development
provide immunisation against conditions such as meningococcal infection,
which can enhance physical health
give advice on stress and anxiety management (an aspect of mental health)
correct eye disorders, which can promote intellectual development.
Parents often make choices for children in deciding when to seek help from
health professionals, but during youth the responsibility falls on the individual
to make the decision to seek help when issues arise. Youth may be intimidated
at the thought of visiting a health professional or may feel they have to manage
134
issues themselves. Confidentiality is another major concern of many youth. They

may not want their parents to know the nature of their medical conditions and
may fear that the health professionals will discuss these issues with their parents.
Youth are eligible to obtain their own Medicare card and can therefore visit doctors
by themselves, which ensures confidentiality. However, maintaining open lines
of communication with parents is an important part of maintaining all aspects of
health and individual human development. As a result of failing to access health
care, any health and development issues and concerns may go unaddressed. Such
issues can lead to physical complications and increase feelings of stress and anxiety.
According to the Australian Psychological Society, the following patterns with
regards to youth accessing professional help have been noted:
Young people are more likely to seek help from friends than from health
professionals.
Males are less likely to seek help for mental health problems than females, and
this can contribute to higher suicide rates among males.
Youths do not access health services at the same rates as people in other lifespan
stages.
TEST your knowledge

1 Identify four types of sun protection behaviours.
2 Why is skin cancer more common later in life when
adults exercise more sun protection behaviours than
youths?
3 (a) Identify two trends evident in table 4.2.
(b) Discuss reasons that may account for the trends
identified in part (a).
4 (a) Which sex is more likely to meet the
recommended amount of physical activity for
those aged 1214 overall?
(b) Why do you think this is the case?

5 Explain what is meant by illicit drug use.
6 Outline the skills required to develop and maintain
friendships.
7 Brainstorm a list of the short- and long-term effects
of substance abuse.
8 How could substance abuse lead to conflict in
relationships?
9 What is the average age at which lifetime smokers
start smoking?
10 Tobacco has been referred to as the gateway drug,
meaning it often leads to experimentation with
other drugs. Explain why tobacco may lead to other
drugs.
11 Do you think that most people who have tried illicit
drugs also have a history of alcohol use? Explain
your response.
12 (a) In what ways can weekly drinking be more of a
concern than daily drinking?
(b) What associated effects can this type of drinking
have on health?
13 (a) Discuss how alcohol consumption patterns
change as youth get older, according to table 4.5.
Unit 1
AOS 2
Topic 3
Concept 5
Seeking help
from health
professionals
Concept summary
and practice
questions
(b) Outline possible reasons for these changes.

(c) Discuss how these changes could impact
on youth health and individual human
development.
14 Kate is in year 12 and has a boyfriend two years
older than her. Two weeks ago, she decided to have
sex with him for the first time. She was a virgin and
had wanted to wait until she was in a committed
relationship before having sex. A few days ago, she
started to feel a burning sensation and has seen
some redness around her vagina. She has become
worried and suspects that her boyfriend has recently
had other sexual partners and has given her an STI.
Kate is too embarrassed to talk to her friends and is
avoiding going to the doctor.
(a) Identify ways that Kates physical, social,
emotional and intellectual development could
have been affected by her sexual experience.
(b) What advice would you give Kate if she
approached you asking for help?
(c) Suggest ways that Kate could have decreased
her chances of contracting an STI.
(d) Brainstorm reasons why Kate might not be
willing to visit a health professional.
(e) Suggest a strategy that could be introduced
tocombat STI infection rates for people of
Katesage.
15 Select one of the behavioural determinants covered
in this chapter and draw up a table to show
how it might affect all aspects of the health and
development of youth.
16 Use the Sexual health links in the
Resources section of your eBookPLUS
to find the weblink and questions for
this activity.
4.3

development during youth: physical environment
KEY CONCEPT Understanding the physical environmental

determinants of thehealth and development of Australias youth
The physical environment encompasses many factors that have a direct impact
on health and individual human development such as air quality, the housing
and work environments, and access to facilities for recreation and health care.
Aspects of the physical environment are often out of the individuals control but
their relationship with health and individual human development makes them
significant determinants in the lives of youth.
Tobacco smoke in the home

When a non-smoker is exposed to environmental tobacco smoke (ETS), they
are exposed to more than 4000 different types of chemicals. The impact of ETS
on youth health and individual human development can be significant. ETS can
prevent lungs functioning at their optimal level, which could have an adverse
effect on physical activity and therefore motor development. Young people exposed
to ETS are also more likely to suffer from asthma and other breathing problems.
Exposure to ETS leaves people more likely to become sick and increases their risk of
developing heart disease by 25 to 30 per cent and lung cancer by 20to 30 per cent.
Young people in households with a smoker are more likely to take up smoking
themselves, and this can have long-term effects on their health and individual human
development. The household smoking status of young people in 2013 is shownin
figure 4.12. According to the ABS National Health Survey (NHS), between 1995
and 2013 the proportion of Australian households with dependent children where
household members smoked inside decreased from 31per cent to around 4 per cent.
70
60
Per cent
50
40
30
20
10
Figure 4.12 Household smoking
status of young people aged 15 years
and under, 2013
Source: AIHW 2014, National drug strategy
household survey 2013, supplementary tables.
0
No one at home regularly
smokes
Smokes inside the home
Only smokes outside the

home
Household smoking status
Housing environment
Youth generally spend a lot of time at home, and the housing environment can
affect their health and individual human development.
Some of the physical aspects of the housing environment that can affect health
and development include:
indoor pollutants. Dust and tobacco smoke, for example, can cause asthma and
other respiratory conditions. This may reduce the individuals capacity for
physical activity which in turn can affect fitness (physical health) and motor skill
development (physical development).
Kitchen facilities. Youth is a time of rapid physical development and specific
nutrients are required to optimise the development of many structures such as
hard and soft tissues. If kitchen facilities are inadequate, it may impact on the
individuals ability to consume adequate levels of nutrients.
drinking water quality. Inadequate water quality can lead to infections or
dehydration. This can affect concentration and intellectual development.
warmth. People living in dwellings that are damp, cold or mouldy are at greater
risk of respiratory conditions, meningococcal infection and asthma.
the number of bedrooms (figure 4.13). Cramped living conditions can lead to stress
and other mental health issues. It may also mean that the young person cannot
find a quiet place to study, and this can impact on intellectual development. It
may not be possible for an individual to entertain friends at their house, thereby
affecting social health and development.
safety of the housing. An unsafe housing environment can increase the risk of falls,
electrocution and other injuries.
Research published by the Australian Housing Urban Research Institute suggests
that overcrowded houses are associated with a greater risk of infectious disease and
poor mental health. As young people are usually dependent on others, they may
have little control over the number of people who share their living environment.
60
1519 years
20 24 years
50
Per cent
40
30
20
10
0
Much less than
adequate
Less than
adequate
Adequate
More than
adequate
Much more than

adequate
Self-reported adequacy of the number of bedrooms
Figure 4.13 Self-reported adequacy

of the number of bedrooms in
households of young people aged
1524 years, 2001
Source: AIHW 2007, Young Australians: their health
and wellbeing 2007, cat. no. PHE 87, Canberra,
p. 136.
Work environment
Many youths will take on a part-time job for the first time during this stage or
will leave school to commence full-time employment (table 4.6). Work allows
the individual to earn their own income and develop skills relating to all areas of
development. In the work environment, the young person may learn skills such as
cooking, cleaning, cooperation and responsibility, and gain knowledge relating to
their job. But there are often risks associated with the workplace as well.
TABLE 4.6 Participation in employment among those aged 1519 years, 2014
National
%
Female
%
Male
%
Employed full-time
1.2
1.0
1.4
Employed part-time
35.9
37.6
33.3
Not in paid employment, looking for work
35.4
32.9
39.3
Not in paid employment, NOT looking for work
27.5
28.5
26.0
Note: Part-time is considered to be less than 35 hours per week and full-time is 35 hours or more.
Source: Mission Australia, Youth survey 2014, p.13.
4.3 Determinants of health and individual human development during youth: physical environment
Figure 4.14 The work environment

can present youths with many
opportunities and risks.
Occupational health and safety laws in Australia are designed to ensure that
employers provide a safe environment for all of their employees, including youth.
These laws relate to physical space as well as machinery, training and supervision.
They are intended to promote the health and individual human development of
those working in Australia.
The physical space in which a youth works can impact on their health and
development. Working outdoors for instance can leave them exposed to UV
radiation and other elements such as heat and cold, all of which can affect physical
health. The tools and instruments that young people use at work can lead to
injuries such as strains and cuts. Youths may be required to stack shelves, which
can increase strength but also the likelihood of back injury.
Many youths work in fast-food outlets or other commercial kitchens. Facilities
within these environments pose particular risks to youths including:
burns from hot water, deep fryers, ovens and other appliances
falls and injury caused by slippery floors
cuts and lacerations from sharp objects.
Unpleasant or unfavourable working conditions can also influence mental health
by affecting self-esteem and contributing to feelings of depression.
The distance of the workplace in relation to the home can also provide
opportunities and risks for health and individual human development. Riding or
walking to work can increase the level of physical health and promote physical
development, but traffic conditions might increase the risk of injury.
Access to recreational facilities

Unit 1
AOS 2
Topic 3
Concept 6
Physical
environment
youth
Concept summary
and practice
questions
Opportunities for physical activity are affected by the facilities available to people
(figure 4.15). As many youth do not drive, the distance from home to a venue will
influence whether or not they become involved in activities that interest them.
Recreational facilities (e.g. sporting grounds, parks, beaches, natural environments
and social clubs) provide young people with opportunities for social interaction and
to optimise social health. By being able to be physically active, youth can maintain
a healthy body weight and promote fitness levels which improves physical health.
Physical activity acts to reduce stress and promote feelings of wellbeing, which
enhances mental health.
Figure 4.15 Access to recreational

facilities such as surf beaches affects
the activities in which people
participate.
Having access to recreational facilities also promotes individual human

development. Regular weight-bearing activity assists in building bone density and
enhances physical development. Motor skills are also developed through regular
physical activity. If participating with others, social skills and self-concept are
promoted and knowledge of different activities can also occur.
TEST your knowledge

1 How can environmental tobacco smoke affect
the health and development of young people in the:
(a) short term?
(b) long term?
2 List three aspects of the housing environment
that can affect health and individual human
development.
3 Outline some benefits to your health that have
occurred as a result of participating in recreational
activities (make sure you cover the three dimensions
of health).
4 (a) According to table 4.6, what proportion of
males and females aged 1519 have some form
of job?
(b) Discuss the impact that having a job can have on

5 Suggest reasons why indoor tobacco smoke has
decreased in recent years.
6 Why would young people whose parents smoke be
more likely to take up the habit themselves?
7 (a) According to figure 4.13, approximately what

percentage of 1524 year olds live in housing
that is considered less than adequate and much
less than adequate in terms of the number of
bedrooms?
(b) Why might this scenario be particularly difficult
for youth?
(c) How could inadequate housing lead to poor
health? (Remember that health is not just
physical.)
8 (a) Make a list of recreational activities (within a
15-minute walk) that you could participate in.
(b) How often do you participate in these
activities?
(c) Are there any facilities not located in your areas
that you would use if they were closer?
(d) Explain how having access to recreational
facilities can promote individual human
development among youth.
(e) Compare your answers with a partner.
9 Use the Young Workers links in the
find the weblink and questions for this
activity.
4.4

development during youth: social environment
KEY CONCEPT Understanding the social environmental determinants

of the health and development of Australias youth
Social environment
Social determinants of health and individual human development affect youth in
Figure 4.16 The family is an

important determinant of health and
development.
numerous ways. Some of these social factors are related to the influence of the
family and others are related to the wider community in which youth live.
Youths rely on their families for many aspects of their
lives. Parents, siblings and extended family members guide
young people through their childhood and youth, when
development is occurring at a rapid rate. Physical, social,
emotional and intellectual development are all influenced by
family members. The health behaviours (e.g. food intake and
exercise) that young people partake in are also influenced by
family members (figure 4.16).
The wider community such as schools, sporting groups and
social/cultural groups play an important role in influencing
the health and individual development of youth. They
provide opportunities for young people to be involved in the
community in which they live, which can promote health. Social determinants
within the community include the media, community and civic participation and
access to education. Each of these determinants will be explored in more detail.
Family cohesion
Family cohesion refers to the closeness or bonds within a family. The ability of
families to get along is an indicator of family cohesion and data relating to this
measure are shown in figure 4.17.
According to the national youth survey published by Mission Australia in 2014,
73.4 per cent of people aged 1519 ranked family relationships as one of the most
valuable things in their lives. Friendships with those other than family members
came first at 75.9 per cent.
35
Females %
Males %
30
Per cent
25
20
15
10
Figure 4.17 The ability of families
to get along according to young
people aged 1519, 2014
Source: Mission Australia, youth survey 2014, p. 19.
5
0
Excellent
Very good
Good
Fair
Poor
According to the Australian Institute of Health and Welfare, family cohesion, or

lack thereof, is a risk factor for youth health and individual human development.
It is difficult to say whether lack of family cohesion leads to poor health and
development outcomes or vice versa. Issues such as substance abuse, mental illness
and suicide may be the result of poor family cohesion or may in fact lead to it.
If the family is close, then social health may be reliant on the family. If the family
is not close, then friends may play this role. The family may also provide a resource
for young people. They can discuss their problems and seek advice. This could
increase the level of mental health experienced.
Individual human development is also influenced by the family. A family that
regularly socialises and communicates could assist in the development of social
skills and the emotional development of youth. Intellectual development could
also be improved by gaining new knowledge from family members such as parents
and grandparents.
Socioeconomic status of parents

Socioeconomic status (SES) includes three key areas: education, occupation and
income. The relationship between socioeconomic status and health is undeniable.
People from higher SES groups have lower mortality and morbidity rates and
display lower rates of risk factors.
In terms of the effects that socioeconomic status has on youth health and
development, it is important to also look at the socioeconomic status of the
youths parents. For youth living under their parents roof and undertaking fulltime education, the socioeconomic status of parents is directly related to the
socioeconomic status of youth. It is therefore generally the socioeconomic status
of parents that influences the health and individual human development of youth.
Unemployment among parents (figure 4.18) can have long-term effects on the
development, educational outcomes and employment prospects of young people.
Families without an employed parent generally have low incomes and therefore
live in lower economic circumstances with less economic stability. Long-term
unemployment can lead to high levels of stress, family conflict and social isolation,
which can in turn have an impact on the health and individual human development
of the youth. Alow income could also mean that money is not available to spend
on resources that can promote health and development adequate food, social
experiences (e.g. dining out or going to a concert), or the purchase of computers,
internet access, musical instruments/lessons, adequate housing or new clothing.
eLessons:
Revising roles within relationships
Influence of family and peers
45
Child 10 14 years
Dependent student
15 24 years
40
35
Per cent
30
25
20
15
10
Figure 4.18 Young people in
families where no parent is employed,
200910
5
0
Couple parent
Lone-parent
All families
Source: Adapted from ABS data.
Lack of education can lead to unemployment or low-paid employment.

Low-paying jobs can have effects that are similar to unemployment but are not as
severe.
Media
The media influences many of the decisions youth make (figure 4.19). By
influencing social trends from food items to clothing, music and recreational
activities the media has a pronounced impact on the health and development
eLesson:
Influence of global events
4.4 Determinants of health and individual human development during youth: social environment
of youth. In recent decades the use of media (particularly electronic and social
media) has increased significantly. This exposes young people to many forms of
information.
Exposure to many forms of media can have negative
or positive influences on health and development. Media
can be a valuable education tool. Access to the internet
Television
and television can promote learning and intellectual
development if the material being viewed is age
appropriate and relevant. On the other hand, many youth
spend hours at a time on activities such as browsing the
Internet
Radio
internet, engaging in social media, watching television
and playing video games (collectively called small screen
recreation). These forms of media expose youth to a range
of subjects and themes that can have a detrimental impact
on their health and development. The violence and explicit
Media
Video
Music
language and images often presented in the media may
games
influence the way youths communicate or behave around
others, which affects social development. Stereotypes that
portray certain groups of people in a negative light (e.g.
FiguRE 4.19 Common forms of media that influence youth
men being violent) are often displayed in the media. As
values are being formed during youth, the internet and television can be extremely
influential.
Advertising is prominent in most forms of media and can influence the behaviour
of youth in their choices of food, non-alcoholic drinks and alcohol. This can have
both long and short-term impacts on health and development.
Youth who spend a lot of time engaged in small screen and social media may
spend less time exercising, socialising and studying. As a result, physical health
may be affected by weight gain, social skills may not be learned and knowledge
development may be limited. The Australian governments physical activity
recommendations for children and young people state that no more than two
hours should be spent on small screen recreation on any one day. The average
number of days that youth met this requirements over a seven-day period is shown
in figure4.20.
100
None
12 days
34 days
56 days
7 days
90
80
Per cent
70
60
50
40
30
20
10
0
1214
1517
1214
Males
1517
Females
FiguRE 4.20 Average number of days that youth met the recommendations for small screen
activities over a seven-day period, 201112
Source: Based on data from ABS, Australian health survey: physical activity, 201112.
142
Average amount of time spent per day (minutes)
The amount of time spent on different types of small screen activities is shown
in figure4.21.
200
180
1214
1517
160
140
120
100
80
60
40
20
0
Watching TV,
DVDs or videos
Playing
electronic games
Using the
internet/
computer for
non-homework
purposes
(excluding game)
Using the
internet/
computer for
homework
purposes
Average time spent on sedentary screen-based activity per day
Per week day
Per weekend day
Per day
Average time spent on sedentary screen-based activity
FIGURE 4.21 Average number of minutes spent on various small screen activities, 201112
Source: Based on data from ABS, Australian health survey: physical activity, 201112
Social media sites such as Facebook, Twitter and Tumblr allow youth to interact
online. This can assist with developing and maintaining friendships and enhance
social and mental health by facilitating online interaction and promoting selfesteem. It can also have negative effects on social and mental health by being
used as a platform to bully, harass or exclude others. Social media may reduce
face-to-face interaction among youth, which can contribute to reduced social and
emotional development by limiting the experiences youth have.
Case study
The net result: an irritable,

addicted child gamer
By Sarah Whyte
ADDICTION to the internet has moved a step closer to
being classified as a mental illness with the inclusion of
internet use disorder in a worldwide psychiatric manual.
The move has been welcomed by Australian
psychology professionals in response to a wave of
always-on technology engulfing children.
The Sunday Age has spoken to parents of children as

young as seven who are aggressive, irritable and hostile
when deprived of their iPads or laptops.
Psychologists say video game and internet addictions
share the characteristics of other addictions, including
emotional shutdown, lack of concentration and
withdrawal symptoms if the gadgets are removed.
Other fallout can include devastating impacts for
children and families as social interaction and even
food are neglected in favour of the virtual worlds the
children inhabit.
(continued)
The rule book for the psychiatric profession, known

as the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), will include internet use disorder
as a condition recommended for further study in its
revised edition in May next year.
The inclusion acknowledges risks posed by overuse
of seemingly benign technologies, classifying internet
use disorder alongside other mental disorders that need
further research before becoming a recognised mental
illness that can be formally diagnosed.
Australian experts contributed to the Australian
Psychological Societys submission to the international
manual, supporting the inclusion of an addiction
focused on internet gaming.
But they have called for a broader diagnosis of
internet-use addiction, allowing proper treatment of
children obsessed by other technologies such as sexting
and a proliferation of devices such as iPads, tablets and
Nintendo DS.
Professor Mike Kyrios, of Swinburne University of
Technology, one of the authors of the APS submission
and a clinical psychologist with more than 15 years
experience, is formally pushing for the revised manual
to broaden internet use disorder beyond gaming
addictions.
Professor Kyrios, the director of the Brain and
Psychological Sciences Research Centre, says more
research would allow health professionals to diagnose
children with addictive behaviours from technology
overuse and treat them appropriately, including
strategies to change their obsessive over-reliance on
being connected.
With kids, gaming is an obvious issue. But overall,
technology use could be a potential problem, he said.
Kara Wright was so concerned her 12-year-old son,
Jack, had an internet addiction she banned him from
using the laptop over his school holidays.
After playing the computer game Minecraft for an
hour on his laptop, Jack would become frustrated,
angry and often cry, she said. It is only when he is

using technology that those emotions emerge, said Ms
Wright, who lives at Caloundra in Queensland. It had
a huge impact on the family.
Ms Wright said Jack was first introduced to
technology when he was seven.
Her first attempt to tackle the problem was to limit
Jacks use to an hour. When that didnt work, she
enforced a full ban.
He has demonstrated he can cope without it, she
said. Ill introduce it slowly if he can demonstrate
responsibility for his time limits.
In January, Emil Hodzic, a psychologist with seven
years experience, established a video game addiction
treatment clinic in Sydneys CBD, because of what he
saw as growing demand from frustrated parents and
damaged children.
He said he was seeing clients as young as 12 addicted
to the internet and video games.
The most typical sign of addiction is anything that
looks like withdrawal symptoms, he said. So any
expression of distress, frustration, irritability when they
dont get to play.
Mr Hodzic said about 70 per cent of the people
he treated were children and teenagers, with many
showing addiction symptoms closely related to anxiety
and depression.
A lot of kids I have coming into the clinic have
difficulty in being able to tolerate distress without
zoning out via the internet or via the games, he said.
But psychiatrist Professor Rhoshel Lenroot, the chair
of child psychiatry at the University of New South
Wales, said it was still too early to be able to see how
detrimental technology overuse could be for children.
I think [it] can be dangerous in not learning how
to pay attention in a focused way, but in balance there
is nothing wrong with technology, Professor Lenroot
said.
Source: Sunday Age, 30 September 2012.
Case study review

1 Identify the term used in the article to describe addiction to the internet.
2 (a) What characteristics do video game and internet addictions share with other
addictions?
(b) Explain how these characteristics could impact on health and/or individual
human development.
3 Explain how neglecting social interaction and food could impact on the health of
individuals.
4 Explain how internet addiction could impact on the physical health and
intellectual human development of youth.
5 Discuss reasons that may account for 70percent of the people being treated in
Mr Hodzics clinic being children and teenagers.
Community and civic participation

Being involved in community groups gives young people a social network and can
generate a sense of achievement and worth (figure 4.22).
Figure 4.22 Volunteering can

provide a connection with society.
Although relatively few young people volunteer compared to people in other

lifespan stages (table 4.7), many youth are involved in sport, recreation, arts and
faith-based activities. This gives them a chance to mix with like-minded people,
which promotes social health and is a source of relaxation and stress relief, which
promotes mental health.
Table 4.7 Percentage of young people aged 15 to 19 years involved in selected activities, 2014
National 2014 %
Female %
Male %
74.1
72.6
76.4
Sports (as a participant)

Sports (as a spectator)
67.6
64.6
72.5
Volunteer work
53.4
58.8
44.8
Arts/cultural/music activities
53.0
61.4
39.5
Student leadership activities
41.9
46.6
34.3
Youth groups and clubs
32.4
32.6
31.9
Religious groups or activities
29.3
30.9
26.8
Environmental groups or activities
23.7
25.6
20.8
8.5
8.5
8.4
Political groups or organisations
Note: Items are listed in order of national importance and the top three activities for each group are shown in bold text.
Source: Mission Australia, youth survey 2014, p. 121.
Self-concept is a key area of emotional development that can be significantly

enhanced by volunteering or being involved in other community activities.
Bycontributing to the community in which they live, young people can derive a
sense of pride and pleasure, enhancing self-esteem.
Access to education
Education is one of the key defining aspects of youth. Education in schools and
higher education institutions such as universities and TAFEs provides opportunities
for youth to develop knowledge and skills that will prepare them for work in later
years and enhances their social, emotional and intellectual development.
The resources available in each school will also influence the type of education
received by youth. Having access to multimedia and information technology
resources can increase their opportunities.
Education is also linked with better health outcomes (figure 4.23). Those with
higher levels of education report lower levels of illness and better mental health
than those with lower levels of education. Education can promote awareness of
healthy behaviours such as not smoking tobacco and maintaining adequate levels
of physical activity. Those with higher levels of education are also more likely to
secure jobs with better pay and prestige, which can lead to lower levels of stress
and more income to pay for things like private health insurance and an adequate
food supply.
Unit 1
AOS 2
Topic 3
Social
environment
Concept summary
and practice
questions
Concept 7
Figure 4.23 Education has a

relationship with health outcomes,
but not all youths have access to it.
A number of factors can contribute to youth not accessing education services.

They include:
geographical barriers those in rural and remote areas of Australia may find it
difficult to get to a school because it could be hundreds of kilometres away.
social/cultural factors some parents may not place importance on formal
schooling. As a result, children may be home-schooled or may receive little or
no formal education.
socioeconomic reasons some individuals may not be able to meet the
costs associated with education (particularly tertiary education), and this may
influence their decision on whether to continue with formal study.
TEST your knowledge
1 Explain what is meant by family cohesion.

2 List the three components that make up SES.
3 Why is it important to look at the SES of parents
when estimating the effect that SES has on youth?
4 List three ways that media could affect the health
and/or individual human development of youth.
5 Identify two trends from figure 4.20.
6 Outline factors that might prevent youths from
accessing education.
7 (a) What percentage of males and females aged

1519 rated their familys ability to get along as
fair or poor?
(b) Explain how their familys fair or poor ability
to get along could impact on the health
and individual human development of youth.
8 What effect might caring for a parent have on the
health and development of a young person?
9 Youth generally rely on their families for many

things. Discuss two ways that your family impacts
on your own health and individual human
development.
10 Discuss the ways that having no parent in paid
employment could affect the health and individual
human development of youth.
11 Using figure 4.19, brainstorm how each form
of media might impact on health and individual
human development in both positive and negative
ways. (A table might be useful for this.)
12 (a) How many minutes per day on average were
spent on the following small screen activities for
1214 year olds according to figure 4.21?
i. Watching TV, DVDs or videos
ii. Using the internet/computer for
non-homework purposes
iii. Using the internet/computer for homework
purposes
(b) Explain how each small screen activity in part(a)
could impact on health or individual human
development.
13 Brainstorm a list of social factors in the

community that affect your health and individual
human development. Compare your list with
someoneelses.
14 (a) Design a survey that could be used to gauge
peoples participation in community and civic
activities. Make sure your questions allow data
collection about:
the nature of the activities
how often people participate
the perceived health benefits of participation.
(b) Use the survey to collect data on youth
participation and collate the results.
(c) Draw conclusions about community and civic
participation in your school.
15 Select one form of social media and design a
pamphlet that could be used to educate youth about
the positive and negative aspects of its use.
16 Explain how education could promote health and
individual human development among youth.

human development of Australias youth
KEY SKILL Explain the determinants of health and
individual human development and analyse their
impact on youth using relevant examples
In order to complete this key skill, a knowledge of the determinants of health
and development is important. As well as being able to explain each of the three
determinants addressed in this chapter (behavioural, physical environment and
social environment), the ability to predict the likely effect of at least one factor
or example from each determinant is also required. Remember that the focus of
this key skill is on youth and any discussion should be about this particular age
group.
Completing a summary table (like table 4.8) can provide practice in predicting
likely effects.
Table 4.8 A summary table for analysing the impact on health and individual human
development of the determinants
Determinant: Media
Dimension of health
Physical
Social
Mental
Area of development
Physical
Social
Emotional
Intellectual
Note that a choice is given in this
scenario and links can be made to

health and/or individual human
development.
As the task is to identify and discuss
the determinants, the first step is

to identify the determinant. Then
discuss how it may have contributed
to aspects of Ralphs health and/or
individual human development.
Identifying the aspect of health and/
or development can assist in ensuring

a clear link has been made.

Ralph is 15 years old and in year 10 at school. He has well developed motor
skills and excels in football and cricket. Earlier this year, Ralph sustained an injury
during a cricket match and could not play sport for four months. His body
weightincreased during that time and his BMI now places him in the overweight
category.
To identify two determinants of health and development, and discuss how each
might influence the health and/or individual development experienced by Ralph,
a response might be as follows.
Behavioural physical activity: Ralph had to take four months off sport after his
injury, which may have decreased his overall levels of physical activity. If Ralph is
not getting as much physical activity as he did in the past, this may be contributing
to his increase in body weight, which is an aspect of physical health.
Physical environment access to recreational facilities: If Ralph lives relatively close
to recreational facilities such as ovals and sporting clubs, this may have influenced
his ability to become involved in a range of sports and activities. By being able
to play a range of sports, Ralphs motor skills may have been enhanced (physical
development).

1 (a) Explain what is meant by the term determinants of health and development.
(b) List the three categories of determinants of health addressed in this chapter
and explain (using examples) what is meant by each one.
2 Natalie is in year 11 at a school in Melbourne. She lives with her mother and
brother and has a good network of friends. Natalies mother has recently become
unemployed and is currently looking for work. Her mother is a smoker and smokes
in their house. Although Natalie plays netball with her school friends at the local
sports centre once a week, she has started to put on weight in recent months and
this has taken her above her healthy body weight. In recent weeks, Natalie has been
going out with her friends and experimenting with alcohol and smoking cigarettes.
(a) Identify four examples of determinants of health and development for Natalie.
(b) Explain their possible impact on her health and development.

3 Danny is 15 and left school around the same time he was kicked out of home by his
stepfather. He has been spending his time with a group of older people on the streets and
they have introduced him to drugs. One night, Danny was out with his friends and he
decided to try ecstasy. After two hours, he began hallucinating and started thinking that his
friends were out to get him. He could not control his thoughts and by the next day was in
a psychiatric hospital diagnosed with drug-induced psychosis (where perception of reality
is altered and people see, hear, smell and touch things that are not there). Psychosis can be
treated but many individuals will experience further episodes of psychosis in the future.
(a) Identify three examples of determinants of health and development for Danny.
3 marks
(b) Select one of these and explain how they may affect Dannys health and
development.
4 marks
(c) Discuss ways that Dannys illness may impact on his:
i. social health
ii. social development.
4 marks
(d) Explain how Dannys family situation may impact on his recovery from his illness.
3 marks
Chapter 4 review
Chapter summary
The level of health and development experienced throughout life is determined by a
broad range of factors called determinants.
Interactivities:
Chapter 4 crossword
Behavioural, the physical environment and social determinants all combine to affect
Behavioural determinants include the behaviours that people engage in that have an
impact on health and development, including smoking and exercise.
A lot of the behaviours that youths engage in can have long-term consequences.
Habitsthat are established during this stage are important for future health and
development.
Lack of sun protection remains an issue for Australian youth although awareness of its
importance has increased in recent years.
Unit 1
AOS 1
Sit Topic test
The
determinants
of health and
individual
human
development of
Australias
youth
Levels of physical activity are not as high as they should be and contribute to a range of
health and developmental problems.
Tobacco, alcohol and substance use is often first tried during the youth stage and can
lead to lifelong health problems.
The rates of many STIs have increased significantly in recent years. Infections among
youths and early adults are largely responsible for this increase.
A number of skills are required to develop and maintain friendships.
Mutual and respectful friendships can be a great support for youth as they develop.
Health professionals are a valuable resource in terms of maintaining optimal health and
development yet many youth are reluctant to seek help from them.
The physical environment includes air and water quality and pollution. The physical
environment in Australia generally promotes good health.
Housing issues such as unsafe housing and overcrowding can contribute to injuries and
mental health issues.
Many youth start employment during this stage of the lifespan, and the work
environment can present many challenges and opportunities for health and
development.
Indoor tobacco smoke can cause detrimental health outcomes for young people such as
respiratory problems.
Having access to recreational facilities can promote physical activity and social
interaction, which can be beneficial to health and development.
The social environment refers to the people in the environment and the impact
theyhave on our health. Social factors can be related to family or the wider
community.
The family is an important component of the social environment that influences
manyaspects of health and development such as schooling and the formation
ofvalues.
Family cohesion relates to the familys ability to get along and impacts significantly on
the health and individual human development of youth.
Socioeconomic status relates to a persons position relative to others in society based
on income, education and occupation. The socioeconomic status of parents affects the
resources, knowledge and behaviours that parents pass on to youth.
The media is extremely influential with regards to the recreation pursuits youth
participate in and the information that is made available to them.
Community participation such as volunteering can build links between the individual
and society, which can enhance health and development.
Levels of education are related to levels of health but some youths are unable to access
education, particularly higher education.
Test your knowledge

1 Explain what is meant by determinants of health.

2 For each of the determinants of health and
development, list one example and discuss how it
can influence the health and development of youth.
3 Brainstorm how the determinants of health and
development might differ for someone living in
remote Australia (the outback) compared with
someone living in a city. Explain the possible
consequences these differences may have on health
and development.
4 Select an aspect of health that could be improved

for young people and design a strategy that the
government could introduce to address the issue.
5 Choose five of the following and suggest ways they
might influence social development during youth:
peers, parents, siblings, school, workplace, music,
media, and sporting teams.
CHAPTEr 5
Health issues facing

Australiasyouth
Although the health of Australias youth is very good, a number
of preventable health issues continue to affect the health and
individual human development of many young people. You will
be required to investigate one of these issues in depth. A brief
overview of a range of topics is included, and after reviewing
the outline of issues, you will be able to work with your teacher
to select an issue to research in greater detail. A comprehensive
look at mental health is also included to provide you with an
idea of the depth required in your research and report.
KEY KNOWLEDGE
2.5 health issues facing Australias youth such as mental health, weight issues
(including obesity), injury (including injury and death from drowning), tobacco
smoking, alcohol use, illicit substance use and STI prevention (pages 15463)
2.6 the key features of one health issue for Australias youth (pages1658),
including:
its impact on all dimensions of health and individual human
development (pages 16971)
its incidence, prevalence and changes over time (trends) (pages 1656)
determinants of health that act as risk and/or protective factors
(pages1712)
government, community and personal strategies or programs designed to
promote health and individual human development of youth (pages1745)
the range of health care services available to youth and their rights
and responsibilities in accessing and using relevant services (including
Medicare) (pages 1759).
KEY SKILLS
analyse data to draw informed conclusions about the range of health issues
facing Australias youth (pages 168, 17980)
describe a specific health issue facing Australias youth (pages 168, 1812)
gather information on a selected health issue related to youth using a range of
sources such as primary data, print and electronic material (pages 168, 1834)
analyse information on a selected youth health issue and draw informed
conclusions about personal, community and government strategies and
programs to optimise youth health and development (pages 176, 177, 179,
1845)
identify the range of health care services available to youth and discuss their
rights and responsibilities in accessing and using these services (pages 179,
1856).
152
FIgUrE 5.1 The health of

Australias youth is excellent,
but there are a number of
issues that require attention.

allied health services health services provided by
health professionals that are distinct from doctors,
nurses and dentists. These services exist in conjunction
with clinical health professionals and include
physiotherapists, speech therapists and occupational
therapists.
binge drinking consuming seven or more standard
drinks for males or five or more standard drinks for
females in one sitting
complementary health services (also referred to
as alternative medicine); health services that operate
outside the boundaries of modern medicine (e.g.
naturopathy, acupuncture and chiropractic services)
illicit drugs illegal substances, or legal drugs used in
an illegal manner
psychotic a state in which the individual experiences a
loss or distortion of reality
sexually transmissible infections (STIs) a range of
conditions that are generally transmitted sexually from
one person to another
stigma a negative stereotype
5.1
Health issues facing Australias youth
KEY CONCEPT Understanding health issues facing Australias youth

weight issues (including obesity), injury (including injury and death
from drowning), tobacco smoking, alcohol use, illicit substance use and
STI prevention
Unit 1
AOS 2
Topic 4
Concept 1
Weight issues
including
obesity
Concept summary
and practice
questions
As explored in chapter 1, the health of Australias youth is generally good. If further

improvements to health in this area are to be made, however, the current issues
facing Australias youth must be explored. There are numerous issues that can
be improved by either behaviour change or early intervention. Your task will be
to explore one of these issues and produce a detailed report. Some of the issues
you can research will be briefly outlined in the coming section. These outlines are
not intended to provide you with a detailed explanation, but rather, just enough
information for you to make a decision as to which issue you want to learn more
about.
Weight issues
Underweight, overweight and obesity all impact significantly on youth health and
development.
In 201112, around 5 per cent of those aged 12 to 17 were considered to be
underweight. Underweight can indicate that the nutrients required for optimal
health and development are not present. The effects of being underweight can
include:
Greater risk of infection and disease, as a result of a weakened immune system.
An inability to concentrate at school due to low levels of energy (physical health)
thereby impacting intellectual development.
Delayed puberty. Low body weight can contribute to delayed puberty and when
it does commence, developmental processes such as increases in bone and
muscle mass may not be achieved.
The percentage of overweight and obese children and
youth has more than doubled over the past two decades
and continues to increase. The Australian Bureau of
Statistics in 2014 estimated the current levels of overweight
and obesity among Australian youths to be around one
in four. Obesity in youth can have lifelong implications
and contribute to many leading causes of death among
adults, such as cardiovascular disease, some cancers and
type 2 diabetes. If the youth carries the extra weight
into adulthood, the risk of developing these conditions
continues to increase. In the short term, youth can suffer
from psychological distress, sleeping problems and low
levels of energy. Long-term risks include cardiovascular
disease, type 2 diabetes, arthritis and some cancers. The
increased prevalence of overweight/obesity among youth is
due to the combination of changes to food intake and the
development of sedentary lifestyles. Guidelines released
by the federal government recommend that young people
participate in at least 60 minutes of moderate to vigorous
physical activity every day. Examples of moderate exercise
include medium-paced cycling, swimming and brisk
walking. Examples of vigorous exercise include jogging
Figure 5.2 Overweight and obesity are increasing
and basketball.
among young Australians.
Table 5.1 shows the activity levels of young people. Those classified as sedentary
or low (engaging in no exercise to little exercise respectively) were considered to be
getting not enough physical activity.
Table 5.1 Percentages of young Australians engaging in different levels of activity, by age, 2008
Males
Unit 1
AOS 2
Topic 4
Females
1517
1824
1517
1824
Moderate to high
49.0
41.3
34.7
26.2
Low
31.0
31.6
40.0
42.7
Sedentary
19.8
27.2
25.2
31.1
Weight issue
programs
Concept summary
and practice
questions
Concept 2
Source: Adapted from ABS, National Health Survey, 200708.
Injury
Injury is an umbrella term that refers to a range of causes of mortality and morbidity,
including traffic accidents, suicide, poisoning, drowning and near drowning. All
injuries are considered to be preventable, which can add to the impact that they
have on individuals. Although death rates from injury have decreased significantly
over the past 20 years, it is still the leading cause of death for youth in Australia
(AIHW, 2011).
Transport accidents (largely motor vehicle accidents) were the most common
cause of injury death for both males and females in 2007 (see figure 5.3). According
to the Australian Institute of Health and Welfare:
young men are significantly more likely than the rest of the population,
including young women, to be killed or injured in a motor vehicle accident.
In 2012, young males accounted for three-quarters of road transport accident
deaths involving young people, with death rates over twice as high among
males as females (13 and 5 per 100000 respectively). In 2012, almost
half (47 per cent) of 1524 year olds killed in a vehicle accident were the
driver; around 28percent were passengers. The rest were motorcycle riders
(13percent), pedestrians (9percent) or cyclists (0.7percent).
Young people differ from the general population in that their fatal vehicle
accidents occur more often at weekends or at night. Age and inexperience
separately or combined are associated with the higher death rate as well as
risky driving behaviour, including speeding, driving when fatigued, and driving
under the influence of alcohol or drugs (AIHW, Australias health 2014, p.232).
Land transport accidents
Suicide
Unit 1
Undetermined intent
AOS 2
Accidental poisoning
Male
Female
Assault
Topic 4
Injury
Concept summary
and practice
questions
Concept 5
Exposure to other factors

Accidental falls
Accidental drowning
Other
0
5
10 15 20 25 30 35
Per cent of external cause of death
40
Figure 5.3 Injury and poisoning deaths among young people aged 15 to 24, by external
cause of injury, 2007
Source: AIHW 2011, Young Australians: their health and wellbeing 2011.
Health issues facing Australiasyouth CHAPTER 5 155

Injuries not resulting in death can lead to disability and various lifelong
conditions, which also have the potential to significantly impact the health and
individual human development of youth and their families.
The youth stage of the lifespan has specific relationships with both the type
and rate of injuries experienced. Rates of injury are significantly higher than in
most other lifespan stages, largely due to the stage of development that youth are
experiencing. Developing independence increases the opportunity for decision
making, which can, in turn, increase risk-taking behaviour. Brain development,
substance use, the peer group, the media and other social pressures can play a role
in the high rates of injuries experienced among youth.
Drowning and near drowning are a significant contributor to injury among youth.
In 2012, there were 45 drowning deaths among those aged 15 to 24. Of those,
89per cent were male (Royal Life Saving Society Australia, National Drowning Report,
2012).
Drowning can occur in a range of locations. The sites of drowning death for
youth in 201314, compared to the 10-year average, are shown in figure 5.4.
16
10-year average
201314
14
12
10
8
6
4
2
er
th
po
g
m
Sw
im
re
e
r/C
Ri
ve
ol
s
ck
in
St
k/
/H
an
ce
O
Ro
m
re
a
bo
ar
ag
/L
am
La
ke
/D
b/
tu
th
Ba
ur
n
oo
ac
Be
Sp
ba
th
Figure 5.4 Drowning deaths of young people aged 15 to 24 by location, 10-year average,
201314.
Source: Royal Life Saving Society Australia, National drowning report 2014, p. 12.
Percentage of population
Risk-taking behaviours, including alcohol consumption, are particularly

significant during youth and have a strong relationship with drowning injury
and death. In 201112, alcohol played a major factor in drowning deaths in
the 15 to 19 years age group, with 20 per cent of all cases known to involve
alcohol.
Tobacco smoking
25
20
Males
Females
15
10
5
0
1824
1217
Age group
Figure 5.5 Proportion of daily smokers by age and sex, 2013

Source: AIHW 2014, National drug strategy household survey 2013.
Youth is a critical time in the development of tobacco addiction,

and those who do not smoke during youth are less likely to
smoke later in life. Smoking increases the chances of premature
death and a range of conditions including cancer, cardiovascular
disease and respiratory illness. Even though AIHW figures
show that smoking rates steadily declined between 1991 and
2014, tobacco use is the single most preventable cause of
ill-health and death in Australia, contributing an estimated
7.8 per cent of the total burden of disease. This equates to
more drug-related hospitalisations and deaths than alcohol and
illicit drug use combined.
Rates of smoking among young people are shown in figure 5.5. According to
the AIHWs 2013 National drug strategy household survey, males had their first full
cigarette at age 16years on average and females at 15.7 years (figure5.6).
Unit 1
AOS 2
Topic 4
Tobacco
smoking
Concept summary
and practice
questions
Concept 6
Unit 1
AOS 2
Topic 4
Smoking
programs
Concept summary
and practice
questions
Concept 7
Figure 5.6 Lifetime smokers generally start smoking during youth.
Alcohol use
Youth is a stage when many people experiment with alcohol consumption. In
moderation, alcohol consumption causes few health problems. However, excessive
alcohol intake such as binge drinking during youth is associated with higher
rates of injury deaths and violence, can impact on brain development, and increases
the risk of alcohol-related problems later in life.
The AIHW in 2010 estimated that harm from alcohol was the cause of
5.5 per cent of the burden of disease for males and 2.4 per cent for females.
Youth under the age of 18 are recommended not to consume any alcohol as their
bodies and brains are experiencing rapid development. Youth who do consume
alcohol may increase their risk of ill-health on the occasion they drink (called
single occasion risk) due to injuries, alcohol poisoning and sexually transmissible
infections. Alcohol consumption by youth also increases their lifetime risk of
developing conditions including cardiovascular disease, type 2 diabetes, some
cancers and liver disease. For youth aged 18, in order to reduce the risk associated
with alcohol consumption, the Department of Health and Ageing recommends not
consuming more than:
two standard drinks on any day (to reduce lifetime risk)
four standard drinks on any day (to reduce short-term risks).
It also states that:
Drinkers under the age of 15 years are much more likely than older drinkers to
undertake risky or antisocial behaviour connected with their drinking.
Risky behaviour is more likely among drinkers aged 15 to 17 years than older
drinkers. If drinking does occur in this age group, it should be at a low-risk level
and in a safe environment supervised by adults.
Unit 1
AOS 2
Topic 5
Alcohol use
Concept summary
and practice
questions
Concept 3
Standard drink guide

eLesson:
Teenage alcohol
1.1
1.6
285 mL 425 mL
Full strength beer
4.9% alc /vol
BEER
MID
BEER
FIgUrE 5.7 Common examples of

alcoholic drinks and the number of
standard drinks contained in each
Source: Adapted from The Australian standard
drink, www.alcohol.gov.au.
Pre-mix
1.5
375 mL
Pre-mix spirits
5% alc/vol
1.2
300 mL
Pre-mix spirits
5% alc/vol
1
60 mL
Sherry glass
20% alc/vol
MID
BEER
LIGHT
BEER
1
375 mL
Mid strength beer
3.5% alc /vol
Spirits
1.5
375 mL
Full strength beer
4.9% alc/vol
0.6
0.9
285 mL 425 mL
Light beer
2.7% alc /vol
LIGHT
BEER
0.8
375 mL
Light beer
2.7% alc /vol
Spirits
BEER
0.8
1.2
285 mL 425 mL
Mid strength beer
3.5% alc /vol
1
30 mL
Spirit nip
40% alc/vol
1.5
170 mL
Average serve of
sparkling wine/
champagne
11.5% alc/vol
22
700 mL
Bottle of spirits
40% alc/vol
1.5
150 mL
Average serve
of wine
12.5% alc/vol
1
30 mL
Spirit shot
40% alc/vol
7.5
750 mL
Bottle of wine
12.5% alc/vol
Standard drink information is printed on all prepacked alcohol containers

(figure 5.7). Table 5.2 shows how many standard drinks are harmful to people
over 18years of age. This information is supposed to act as a guide only, because
everyone is different. The way that the body breaks alcohol down depends on
body weight, metabolic rates, food consumed and gender. The proportion of young
people who drink to risky levels is shown in figure 5.8.
158
Table 5.2 Alcohol consumption associated with harm among people over 18 years
Alcohol consumption
associated with harm
Short-term harm
Long-term harm
Risky
High-risk
Risky
High-risk
Males
7 to 10 standard drinks on
any one day
11 or more standard drinks

on any one day
29 to 42 standard drinks
per week

per week
Females
5 to 6 standard drinks on
any one day

on any one day
15 to 28 standard drinks
per week

per week
Source: AIHW 2007, Young Australians: their health and wellbeing 2007, cat.no.PHE 87, Canberra, p. 83.
80
1217 year olds
1824 year olds
70
Per cent
60
50
40
30
20
10
0
Abstainers (a)
Single occasion risky

drinkers (b)
Lifetime risky
drinkers (c)
Figure 5.8 Proportion of young

people who drink at single occasion
risk and lifetime risk, 2013
(a) Not consumed alcohol in the previous 12 months.

(b) Had more than 4 standard drinks at least once a month.
Source: AIHW 2014, National drug strategy

household survey 2013, supplementary tables.
(c) On average, had more than 2 standard drinks per day.
As most youth are not of legal drinking age, the environment in which they
drink can promote or discourage excessive alcohol consumption. The places where
youth consume alcohol are detailed in table 5.3.
Table 5.3 Usual place of alcohol consumption by age group, 2010
Age group (years)
Place
1215
1617
1819
2029
In my home
35.1
36.1
50.7
70.9
At friends house
37.1
49.2
58.7
56.9
At private parties
59.2
72.4
61.1
50.6
At licensed premises
1.1
7.7
71.2
62.9
At restaurants/cafes
2.5
4.8
35.9
46.2
At workplace
At raves/dance parties
In public places
In a car
At school/TAFE/university, etc.
Somewhere else
0.9
4.6
5.9
8.6
16.9
28.8
15.4
12.9
9.6
8.2
6.2
1.4
5.2
6.8
4.4
0.7
0.6
5.9
3.2
16.0
7.3
5.1
3.4
Unit 1
AOS 2
Topic 5
Alcohol use
programs
Concept summary
and practice
questions
Concept 4
Notes
1. Base is recent drinkers.
2. Respondents could select more than one response.
Source: Adapted from AIHW 2011, 2010 National drug strategy household survey: detailed findings, p. 84.
Case study
Alcohol putting teens at

sex risk
By Kate Hagan; Caroline Zielinski
TEENAGERS who drink alcohol to excess are much
more likely to engage in risky sexual behaviour, including
having multiple partners andsexthey later regret.
A study of more than 500 year 11 students in Victoria,
whose average age was 17, found half had consumed
five or more drinks on a single occasion in the previous
two weeks and 44 per cent reported having sex in the
past year.
The study, published in The Australian and New
Zealand Journal of Public Health, found students who
drank alcohol excessively were more than twice as
likely to be sexually active.
Students who reported binge drinking were three
times as likely to have had three or more sexual partners
in the past year. Compulsive drinkers, who said they
were unable to stop, were four times as likely to have
hadsexthey later regretted.
Lead author Paul Agius, of the Burnet Institute,
said the links between excessive drinking and risky
sexual behaviour occurred even in students with strong
ties to school and family, which might have shown a
protective effect.
He said 34 per cent of sexually active students

hadsexwithout a condom at their last sexual encounter,
but excessive drinking was not associated with failing
to use a condom.
Hopefully what this says is that condom use is
becoming more of a normative behaviour for young
people and can withstand instances where they may
have lost control, for example from drinking too much,
he said.
Mr Agius said it was nonetheless concerning that
high numbers of young people continued to engage in
unprotectedsex.
The study found 19 per cent of sexually active
students had three or more sexual partners in the past
year, and 28 per cent had sex they later regretted due
toalcoholuse which, according to the studys authors,
may indicate a sexual encounter contextualised
by sexual coercion, poor communication about
expectations of the encounter or sexual inexperience
and unpreparedness forsex.
Youth Support and Advocacy Service spokesman
Peter Wearne said increased binge drinking among
young women was adding to their risk of unwanted and
unsafe sexual encounters. The best way to help young
people understand therisksof heavy drinking is through
education, information and empowerment, he said.
Source: The Age, 2 June 2013.
Case study review

1 Discuss the relationship between alcohol consumption and sexual behaviours as
outlined in the article.
2 Explain how regretting sexual encounters could impact on the health of youth.
3 Design a poster that could be used to educate youth about the risks associated
with alcohol consumption and risky or unwanted sexual encounters.
Illicit substance use

eLesson:
Marijuana madness
Youth is a common time to experiment with drugs and other substances. Ifmisused,
these substances can lead to a range of short- and long-term effects on health and
individual human development. Although the impacts will depend on the type of
drug, how it is taken and the duration of use, some common impacts include social
isolation, mental illness, poor academic performance, unemployment, increased
rate of criminal behaviour and family breakdown. Those who experiment with
substances during youth are more likely to develop substance abuseissues later in
life, which further increases the risk of health conditions.
Some of the common substances used during youth include marijuana,
amphetamines (including ecstasy and crystal meth), cocaine and heroin.
160
The reasons for trying drugs are complex. Like most risk-taking behaviours, drug
use arises from a combination of factors. Reasons for trying illicit drugs are shown
in table 5.4, and the rates of drug use among young people are shown in table 5.5.
Unit 1
Table 5.4 Factors influencing first use of any illicit drug, lifetime users aged 14 years or
older, by sex, 2010
Males %
Females %
Persons %
Factor
2010
2010
2010
Curiosity
78.8
79.3
79.0
Peer pressure
47.6
50.2
48.8
To do something exciting
20.3
19.7
20.0
To enhance an experience
12.6
13.0
12.8
To take a risk
8.8
9.1
8.9
To feel better
5.5
6.6
5.9
Family, relationship, work or school

problems
4.6
5.9
5.2
Dont know/cant say
2.8
2.1
2.5
Traumatic experience
2.1
4.0
2.9
To lose weight
0.5
1.5
1.0
Other
2.7
1.8
2.3
AOS 2
Topic 5
Illicit substance
abuse
Concept summary
and practice
questions
Concept 1
Unit 1
AOS 2
Topic 5
Illicit substance
abuse programs
Concept summary
and practice
questions
Concept 2
Notes
1. Base is those who had used an illicit drug in their lifetime.
2. Respondents could select more than one response.
Source: Australian Institute of Health and Welfare 2011. 2010 National drug strategy household survey report. Drug
statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 169.
Table 5.5 Illicit drug use by age, 2010

Period
1417
1819
2029
In lifetime
18.7
37.0
51.3
In the last 12 months
14.5
25.1
27.5
In the last month
6.0
16.1
14.9
In the last week
2.3
9.8
9.0
Source: Australian Institute of Health and Welfare 2011. 2010 National drug strategy household survey report. Drug
statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 87.
STI Prevention
70
60
50
Per cent
Youth is often a time of sexual exploration (figure 5.9), and this can
have both short- and long-term effects on young people. If youth
participate in unsafe sex, they may expose themselves to a range of
sexually transmissible infections (STIs). STIs are passed from one
person to another through sexual contact. This includes oral, genital
and anal sex.
Many STIs, such as chlamydia and syphilis, can have long-term
effects on health and development if not treated. Treatment is often
not sought as the condition may not have obvious symptoms. Other
STIs, such as herpes and human immunodeficiency virus (HIV),
are incurable and can impact on health throughout the rest of the
individuals life.
According to the AIHW (2011), youth may be at an increased risk
of STIs due to a lack knowledge about these conditions, inconsistency
with condom use, and lack of communication and negotiation skills
which can make using condoms difficult.
Males
Females
Persons
40
30
20
10
0
Year 10
Year 12
2002
Year 10
Year 12
2013
Figure 5.9 Proportion of students in Year 10 and 12

who have ever had sexual intercourse, 2002and2013
Source: Smith et al. 2009, Secondary students and sexual health 2008;
and Mitchell et al. 2014, 5th National survey of Australian secondary
students and sexual health 2013; Australian Research Centre in Sex,
Health and Society, La Trobe University, Melbourne.
Unit 1
AOS 2
Topic 5
STI prevention
Concept summary
and practice
questions
As many youths have not committed to a long-term partner, there is potential for
STIs to spread at high rates in these age groups. Chlamydia, for example, is particularly
common among youth, with 81percent of the 82707 new cases in Australia in 2012
being diagnosed among 1519 year olds. Although rates have decreased in recent
years, there is still significant room for improvement (see figure5.10).
2500
Notifications per 100 000 young people
Concept 5
2000
Males
Females
Persons
1500
1000
500
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Year
Figure 5.10 Chlamydia notification rates among young people aged 15 to 19 years, 19982014
Source: Based on data from National Notifiable Diseases Surveillance System, http://www9.health.gov.au/cda/source/rpt_5_sel.cfm.
The prevention of STIs is important to promote the health and individual

human development of youth in Australia. Avoiding sexual contact is the safest
way to prevent contracting an STI. For those who are sexually active, using a
condom during sexual contact can reduce the risk of contracting an STI. In 2013,
41 percent of sexually active students did not use a condom at their most recent
sexual encounter (Australian Research Centre in Sex, Health and Society, 2014).
Case study
Chlamydia epidemic may

cause rise in infertility
among young Australians,
experts warn
By Kerry Brewster
Health experts are warning that an epidemic of
chlamydia may herald a wave of infertility among
young Australians.
Last year, nearly 83000 Australians under age 24
tested positive for the common sexually transmitted
infection.
Alarmingly, a high rate of chlamydia has been found
in girls aged as young as 12.
Professor David Wilson from the Kirby Institute says

the figures are the top of the iceberg.
We know that there are many more Australians out
there who are undiagnosed, he said.
We know that because weve gone out and tested
people in rural, remote and urban settings in every
state and territory, and weve found one in 20 young
Australians have chlamydia.
We estimate about 500000 young Australians have
chlamydia right now.
Doctors say if chlamydia in any young person is not
detected, then there is a significant risk of infertility
and complications down the track.
To start with its often asymptomatic. Theyre not
aware of it, Professor Wilson said.
But down the line whats often likely to occur is

that they might get pelvic inflammatory disease, thats
effectively pain in the pelvic region. Following that,
what it can lead to is infertility.
So, many young women are likely to want to get
pregnant in the future, and they might be precluded
from doing that because they had chlamydia in the past.
Professor Wilsons research colleague Carol el-Hayek
has analysed data from five states over three years.
She found 13 per cent of 12- to 15-year-old girls
tested for sexually transmitted infections carried
chlamydia.
Twelve to 15-year-olds are sexually active. The fact
that theyre testing for STIs or that doctors are testing
them for STIs means that they are practising sex, and
theyre probably practising unsafe sex, she said.
Safe sex message falls off the radar
Professor Wilson says there has been a substantial trend
towards people having sex at a younger age.
I think our main messaging through schools, but

more importantly through the home, through parents,
and then through friends, the social media and other
educational messages are not getting through most
appropriately, he said.
Dr Anna McNulty from the Sydney Sexual Health
Centre says chlamydia is easy to detect, easy to test for
and easy to treat.
I would encourage all young people who are
sexually active to either see their GP or find a service;
Google sexual health and find their closest service and
seek some testing, she said.
One of Sydneys biggest fertility clinics, Sydney
IVF, says the safe sex message has fallen from the
public radar.
The clinic says it is expecting fallopian tube-related
infertility to steadily increase over the next few years as
a result of increased chlamydia infections.
Source: ABC News, 24 October 2013, www.abc.net.au.
Case study review

1 According to Dr McNulty, chlamydia is easy to detect, easy to test for and easy to
treat. If this is the case, suggest reasons that might account for so many young
Australians having the condition.
2 Outline the possible long-term impacts of chlamydia infection.
3 Research chlamydia and film a short commercial that could be used to educate
youth about this condition.
TEST your knowledge

1 Explain why each of the following are a
significant health issue for youth:
(a) weight issues
(b) injury
(c) tobacco smoking
(d) alcohol use
(e) illicit substance use
(f) STI prevention.
2 Use a concept map to brainstorm the
possible impacts of obesity on the health
and individual human development of youth.
Be sure to address all dimensions of health
and individual human development in your
answer.
3 Why might overweight or obese people be more
susceptible to psychological distress?
4 (a) Explain how physical activity levels change as

people get older according to table 5.1.
(b) Discuss factors that may contribute to these
patterns.
5 Suggest two ways that injuries among youth could
impact on the health and/or individual human
development of their family.
6 (a) What percentage of young people drink in their
own home?
(b) Does this mean that parents are supporting their
childs drinking? Explain.
7 (a) Identify two changes in the patterns of where
people drink as they move from the youth stage
to the early adulthood stage of the lifespan.
(b) Discuss possible reasons for these changes and
share your results in small groups.
8 What were the main reasons for individuals trying
illicit drugs?

9 Devise a strategy that could be implemented to
reduce the rates of overweight and obesity in
school-aged children.
10 Design a poster that could be used to reduce the
risk of injury among youth.
11 What factors have led to the decrease in smoking
rates since 1991?
12 Do you agree with parents allowing youth to drink
alcohol? Explain your response.
13 (a) Are youth more likely to be at risk of shortor long-term effects on their health from
consuming alcohol?
(b) Why would this be the case?
14 (a) Create a list of consequences that would be
considered short-term effects of heavy drinking.
(b) Create a list of consequences that would be
considered long-term effects of heavy drinking.
15 Why might alcohol consumption cause more
disability adjusted life years (DALYs) for males
compared to females?
16 Brainstorm a list of determinants that could

decrease the risk of tobacco smoking, alcohol use or
illicit substance use.
17 Devise a strategy that could be used to reduce
tobacco, alcohol or drug use among youth.
18 What factors could account for the high rates of
chlamydia among youth?
19 What determinants of health and development
could increase the risk of youth contracting an STI?
20 Brainstorm ways that contracting an STI could impact
on the health and development of a young person.
21 Research one of the following STIs and produce a
poster that could assist in educating youth about
the condition:
chlamydia
herpes
HIV.
22 Use the Ask 500 links in the
164
5.2
A health issue in focus: anxiety and depression, part 1
KEY CONCEPT Understanding the key features of one health issue

relevant to Australias youth a description of anxiety and depression
and the incidence, prevalence and changes over time (trends) of
mental illness
Mental health and, in particular, anxiety and
depression, have been selected as a focus issue for
this chapter. This section presents a detailed look
at the issue and contains similar information that
should be evident in your own research task.
Mental health issues
Anxiety
Attention
deficit
hyperactivity
disorder
(ADHD)
Eating
disorders
Mental health issues affect a large number of

Australians over the course of their lives, and many
of these issues have their origins in the youth stage
of the lifespan.
Mental
The term mental illness is an umbrella term that
illnesses/
disorders
encompasses a number of conditions, including
anxiety and depression. These conditions can
affect the way a person thinks, acts and feels.
Such conditions are also referred to as mental
Bipolar
Schizophrenia
disorders (figure 5.11). These disorders have a
disorder
set of symptoms that can be used to diagnose and
subsequently treat the condition.
Mental health problems, on the other hand, have
a negative impact on mental health and may occur
Depression
as a result of life stresses. These are often temporary
and disappear with time. Mental health problems
are generally not as severe as mental disorders and
do not usually get medically diagnosed.
FIgUrE 5.11 Common mental
There are a range of mental illnesses, and the
illnesses/disorders
signs and symptoms vary both in their nature and severity depending on the type
experienced. Some mental illnesses do not greatly interfere with daily life and can
be effectively treated. On the other hand, some can be quite severe, such as
psychotic mental illnesses. During a psychotic episode, the individual loses touch
with reality and may see, hear, smell or taste things that are not there.
The rates of mental illness are high among youth and contribute significantly to
the overall burden of disease in this age group.
The incidence, prevalence

and trends of mental illness
among youth
According to the Australian Bureau of Statistics, in 201112 around
13percent of people aged 1524 were currently experiencing a mental
illness. A study by Mission Australia indicated that around one in five
youth aged 1519 had symptoms of a mental illness in 2014. Up to
70 per cent of young people do not seek help when they are feeling
mentally unwell (headspace.com.au), so the rates of people suffering
from a diagnosable mental illnesses may be higher than reported.
FIgUrE 5.12 Around one in four people will be

affected by mental illness.
Health issues facing Australiasyouth CHAPTEr 5
165

There have been some fluctuations in the rates of mental illness over time but the
AIHW found that the overall rates of mental illness have remained fairly constant
in the 10 years to 2007 (Making progress: the health, development and wellbeing of
Australias children and young people, 2008).
Deaths of young people from mental disorders have steadily decreased from 1997
to 2012 (figure 5.13). Many of these deaths are due to substance use disorders, and
a reduced availability of heroin during this period was largely responsible for the
decline.
Figure 5.13 Deaths from mental

and behavioural disorders for young
people aged 1519 by sex, 19972012
4.5
Males
Females
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Mental disorders contribute more to the burden of disease for youth than any other
condition. Of the conditions included under the mental disorders umbrella, anxiety
and depression are the two most common among both male and female Australian
youth and will therefore form the focus of the exploration of this issue (table 5.6).
Table 5.6 Burden (YLL, YLD and DALYs) of major disease groups for 1524 year olds, 2003
Rank
Males
DALYs
(000)
% of
DALYs
Females
DALYs
(000)
% of
DALYs
29946
31.8
Anxiety and
depression
17868
17.4
Anxiety and
depression
10380
10.1
Asthma
6641
7.1
Schizophrenia
9795
9.6
Migraine
6217
6.6
Suicide and selfinflicted injuries
7320
7.1
Other genito-urinary
diseases
5676
6.0
Heroin or polydrug
dependence and
harmful use
5657
5.5
Schizophrenia
3754
4.0
Alcohol dependence
and harmful use
4848
4.7
Road traffic
accidents
3572
3.8
Migraine
3539
3.5
Personality disorders
2622
2.8
Cannabis dependence
and harmful use
3520
3.4
Bulimia nervosa
2576
2.7
Personality disorders
3130
3.1
Bipolar disorder
2450
2.6
10
Bipolar disorder
2672
2.6
Anorexia nervosa
2063
2.2
102476
100.0
93985
100.0
All causes
All causes
Source: AIHW 2007, Young Australians: their health and wellbeing 2007, cat.no.PHE 87, Canberra, p. 21.
What is anxiety?
Anxiety disorders cover a range of conditions including
phobias, panic disorder and generalised anxiety. Anxiety
disorders are characterised by an uneasy emotional state that
may be brought on by an actual or perceived threat to the
safety and wellbeing of the individual (figure 5.14). Everyone
experiences anxiety at one time or another, but if the anxiety
starts to interfere with a persons normal activities, an anxiety
disorder may be diagnosed. Anxiety disorders can be treated
in a range of ways including medication and therapy.
What is depression?
Everyone feels sad from time to time, but depression is more
than this. Depression is a debilitating condition in which the
feelings of sadness or worthlessness continue for an extended period of time. It is
usually more severe than just feeling down. A person suffering from depression
may withdraw from their normal activities, suffer from sleep disturbances and
experience a decreased or increased appetite which can impact on health and
Figure 5.14 Stressful experiences

such as bullying can be a risk factor
for anxiety and depression.
Case study
One in five young people

struggle with mental
illness but few seek help:
report
By medical reporter Sophie Scott and Sophie Quinn
One in five young Australians are dealing with a
serious mental illness but more than 60 per cent feel
uncomfortable seeking professional support, a new
report from Mission Australia and the Black Dog
Institute has found.
The research shows young people who are
experiencing the greatest distress are also the least
willing to seek information or support from counselling
services.
The confronting findings in this report illustrate
the significant challenges many of our young people
are facing when it comes to psychological distress and
mental health issues, Mission Australia chief executive
Catherine Yeomans said.
We know that many of our youth are struggling with
complex issues, and its impacting on their ability to
transition with confidence into adulthood.
The study found young women are almost twice as

likely to experience mental illness compared to young
men, and Aboriginal and Torres Strait Islander people
are also more likely to be affected.
However, when it comes to use of mental health
services, young men are least likely to seek professional
help, according to the report.
Almost 15
000 young Australians aged between
15 and 19 responded to the survey which asked
participants to answer questions about their experiences
of depression and anxiety in the past four weeks.
Respondents were asked about their level of concern
on 12 major issues including alcohol, drugs, bullying,
depression, discrimination, family conflict and suicide.
The results show that coping with stress, school
problems and body image are the primary issues of
concern for young Australians.
Young people prefer to seek help online
The survey findings show most young people felt
comfortable seeking support, information and advice
from the internet.
The authors call for further development of online
support programs, such as involving elements of
interactive gaming, and telephone hotline services.
(continued)
This comes after earlier revelations that increased

numbers of young people are reaching out to the Kids
Helpline, but as many as156000 calls went unanswered
in 2013.
The Mission Australia report said online support
offers greater accessibility for youth living in remote
or rural Australia, where stigma associated with
accessing mental health services can be worse than in
metropolitan areas.
This mode of delivery has a number of advantages
including low cost and en masse delivery, the reports
authors said.
The authors make a strong recommendation for
policy development focused on preventative measures.
Early intervention and prevention, stigma reduction
and mental health promotion are imperative, and it is
necessary for schools to take action and play a central

role, they said.
It is critical that there is early recognition and
support for students struggling with mental health
issues to assist them in remaining actively engaged and
participating in schools to the extent that they are able
to complete their education.
Ms Yeomans says early intervention is a key area.
We must invest in early intervention and support to
ensure vulnerable youth get the assistance they need
to work through these challenges and live happy and
healthy lives, she said.
If you or anyone you know is in need of crisis support
contact Lifeline Australia on 131114, Kids Helpline on
1800551800 or visit BeyondBlue.
Source: ABC News, 19 June 2014, www.abc.net.au.
Case study review

1 What proportion of young people are dealing with a serious mental illness
according to the article?
2 Discuss factors that may prevent young people from accessing professional
support.
3 Discuss reasons why youth may feel more comfortable accessing information
online.
4 Suggest reasons why it is important for schools to play a role in addressing
mental health issues.
TEST your knowledge
1 (a) Explain what the term mental illness

means.
(b) What does the term mental health problems
refer to?
(c) Outline the difference between these terms.
2 (a) What is a psychotic episode?
(b) Why would these be considered more severe
than other mental illnesses?
3 According to table 5.6, what percentage of DALYs
are attributable to anxiety and depression for males
and females respectively?
4 (a) According to headspace, what percentage of
young people do not seek help when they are
feeling mentally unwell?
5 Explain the difference between anxiety and
depression.
6 Would the statistics in table 5.6 be completely

accurate? Explain.
7 (a) Which causes in table 5.6 have a relationship
with mental illness?
(b) What percentage of DALYs do they contribute
for males and females respectively?
8 (a) Describe one trend from figure 5.13.
(b) Suggest reasons for this trend.
9 Using books and the internet, conduct research to
find information relating to an issue of your choice.
Arrange this information into paragraphs and
diagrams to produce an explanation of what the
issue is.
10 Use the Young Australians links
in the Resources section of your
5.3

relevant to Australias youth the impact of anxiety and depression
on all dimensions of health and individual human development and
the determinants of health that act as risk and/or protective factors for
anxiety and depression
Anxiety and depression can have a range of effects on health and individual human
development, depending on the severity being experienced. The determinants
of health and development that act as risk and protective factors for anxiety and
depression can also vary considerably from person to person. The effects of anxiety
and depression, as well as determinants that act as protective and risk factors, will
be explored in this section.
The impact of anxiety and

depression on health
Anxiety and depression can affect health in a number of ways, as outlined below.
Physical health
Self-harm people suffering from depression may be prone to hurting
themselves or to attempt suicide. Taking pills and cutting oneself are two
common forms of self-harm with direct effects on physical health.
Lack of sleep individuals experiencing depression may have disturbed sleep
patterns. The body might not be adequately rested and they may therefore be
unable to cope with day-to-day tasks.
Lack of physical activity a person who withdraws from regular activities
might not get enough physical activity. This can mean that the body is not in an
optimal state.
Substance and alcohol abuse people experiencing anxiety and depression are
more likely to abuse drugs and alcohol, which can affect the bodys systems.
Social health
Social isolation many individuals suffering from
anxiety and depression will remove themselves
from social interactions. This may impact on the
friendship network of the individual and magnify
the effects of the condition.
Strained family relationships family life may
be interrupted during depressive episodes.
Family bonds might become weaker as a result.
Mental health
Poorer quality of life people suffering from
anxiety or depression often back away from the
things in life that used to make them happy.
This can lead to a lower quality of life and a
continuing cycle of negative thoughts that can
contribute to an increased risk of suicide and
self-harm.
Figure 5.15 Individuals suffering from anxiety and depression may

isolate themselves from others.
The impact of anxiety and

depression on individual human
development
Anxiety and depression can also affect the four areas of individual human
development in the ways outlined below.
Impaired development from lack of nutrition youth is a stage of rapid growth,
so nutrition is very important. If the youth suffers from a loss of appetite, they
may not get adequate nutrients to meet the requirements for growth.
A lack of physical activity may impact on bone density and growth as weightbearing exercise is important for strong bones.
Social development
Forgone social experiences important experiences such as associating with
members of the opposite sex and rites of passage such as school formals assist
in developing the young persons social skills (figure 5.16). If they miss out on
these experiences, their social skills may not develop as well as they could have.
Figure 5.16 Youths with mental

illness may miss out on important
social events, and this loss can affect
their health and development.
Impacts on self-concept people suffering from ongoing anxiety or depression
are less likely to be employed than those who do not suffer from one of these
conditions. Employment can promote feelings of satisfaction and can lead to a
more positive self-concept. Unemployment can have the opposite effect.
Learning to deal with emotions people experiencing anxiety or depression
may develop mechanisms to assist in dealing with the associated emotions such
as sadness and despair.
170
Higher school dropout rates according to the Australian Institute of Health
and Welfare, youth suffering from mental illness are less likely to finish
secondary school than those without a mental illness. Many important skills that
are normally learned at school may not be attained.
Lack of concentration at school a student in poor mental health may not
concentrate as much at school. They may also not complete homework tasks,
and this can affect intellectual development.
Unit 1
AOS 2
Topic 4
Concept 3
Mental
illness
youth
Concept summary
and practice
questions
Determinants of health that act as

risk and/or protective factors
Anxiety and depression are often diagnosed for the first time in youth or early
adulthood. Research suggests that 75 per cent of mental health disorders begin
before the age of 25 years (www.headspace.org.au). In fact, the causes can reach
back into early childhood or even prenatally. While the exact causes of these
conditions are unknown, there are many determinants that can contribute to or
protect an individual from anxiety and depression, so it is most likely that these
conditions arise from a combination of factors.
Anxiety and depression can increase the chances of risky health behaviours such
as self-harm, social withdrawal and substance abuse. These in turn can intensify the
cycle of mental ill-health. Some specific determinants that act as risk and protective
factors include the following.
Biological
Genetic factors those with a family history of mental illness are more likely to
develop a mental illness themselves.
Prenatal brain damage damage caused during the prenatal period from injury
or teratogens (agents that can cause birth defects) can raise the risk of anxiety
and depression.
Body weight those who are overweight and/or obese are more likely to
develop anxiety and depression.
Behavioural
Substance use use of illicit drugs is linked to
depression.
Food intake adequate nutrition acts to keep
the body and mind in optimal condition, which
may help protect individuals from anxiety and
depression.
Physical activity physical activity has been
shown to reduce feelings of stress, depression and
anxiety (figure 5.17).
Access to recreational facilities youth without
access to recreational facilities may not have many
opportunities for physical activity and/or the
opportunity to participate in activities that they
value. This can lead to increased rates of anxiety
and depression.
Figure 5.17 Physical activity is a

protective factor for anxiety and
depression.

Work environment an unsafe work environment can increase the risk of
injury among youth and, as a result, can be a source of anxiety.
Inadequate housing housing that does not have enough bedrooms may be
overcrowded. Overcrowded housing often means that individuals cannot find
their own space and contributes to increased rates of anxiety and depression.
Social environment
Family situation a supportive family life, free from conflict and abuse, is a
protective factor for anxiety and depression (figure 5.18). Conflict between
family members, on the other hand (especially parents), can lead to an unstable
family situation, and this is a risk factor for anxiety and depression.
Early life experiences negative experiences early in life are a risk factor for
mental illness.
Socioeconomic situation those in a lower
socioeconomic situation are more likely to
develop anxiety or depression.
Failure to achieve academically those who
do not achieve academically are more likely
to have a mental illness such as anxiety or
depression. As with all risk factors, it is difficult
to say whether the mental illness contributes
to low academic achievement or vice versa.
Social networks those with good social
networks are less likely to develop a mental illness.
Social harmony social harmony is a
protective factor for mental illness.
Social isolation this is both a risk factor for,
and a consequence of, mental illness.
School environment bullying can increase
the chances of mental illness such as anxiety or
depression. A supportive school environment
Figure 5.18 A supportive family is a protective factor for anxiety and
can be a protective factor for mental illness.
depression.
Case study
Substance and alcohol abuse

Mike is 18 and has been experimenting with drugs
and alcohol for the past three years. In the past few
months he has been feeling depressed and has lost
his usual enthusiasm for life. As a result, he has
dropped out of his TAFE course and quit his parttime job. Mike now relies on financial government
assistance but this has not been enough to support
his lifestyle. At the moment he spends most of his
days sitting around the house that he shares with
three friends, who are also alcohol and drug users.
Case study review

1 Identify the determinants of health and individual human development that may
be affecting Mike.
2 Is it possible that Mike has a mental illness? Discuss.
3 Explain how Mikes current situation may affect his health and individual human
development.
4 Suggest ways that Mike could improve his mental health.
172
TEST your knowledge

1 List five risk factors for anxiety and depression.
2 List five protective factors for anxiety and
depression.

3 Select one effect that anxiety or depression can
have on any area of health and discuss how this
could flow on to the other areas of health and
4 Select one effect that anxiety or depression
can have on any area of individual human
development and discuss how this could flow on
to the other areas of health and individual human
development.
5 Why is it difficult to say whether the risk
factor leads to anxiety and depression, or vice
versa?
6 Why would it nearly always be a combination of
factors that lead to anxiety or depression?
7 On your own or with a partner, select an issue

affecting youth (your teacher may also decide to
choose one issue for the class to consider).
(a) Use a concept map or summary table to
brainstorm:
i. the possible impacts of this issue on all
dimensions of health and individual human
development
ii. the determinants of health and development
that may contribute to the selected issue.
(b) Which determinant do you think has the
greatest influence? Justify your choice and
discuss your responses with the rest of the class.
8 Use the Mental health case studies links
in the Resources section of your eBookPLUS
to find the weblink and questions for this
activity.
9 Use the Nutrition and mental health links
in the Resources section of your eBookPLUS
to find the weblink and questions for this
activity.
5.4

relevant to Australias youth government, community and personal
strategies or programs designed to promote the health and development
of youth, health care services available to youth and the rights and
responsibilities of youth in accessing and using relevant services
Both anxiety and depression have been the subject of numerous strategies that aim
to improve the health and individual human development of those experiencing
these conditions.
Australias health system also provides opportunities for youth to seek care
relating to their mental health and there are a range of rights and responsibilities
that apply to youth accessing these services.
Strategies and programs designed

to promote mental health
Mental illnesses such as anxiety and depression have been increasingly in the
public spotlight in recent years. Despite this, many young people suffering from
these conditions do not seek or receive help.
There are many government and community strategies and programs aimed at
reducing the rates of anxiety and depression, and improving the overall mental
health of Australians. Some are focused on youth in particular, while others are
aimed at the whole population. Some of these strategies and programs focus on the
stigma attached to mental illness while others aim to improve personal
skills, early detection and/or treatment.
Government and community

strategies/programs
SANE Australia
FIgUrE 5.19 SANE Australia is a

national charity working for a better
life for Australians affected by mental
illness.
website: www.sane.org
Helpline: 1800 18 SANE (7263)
SANE Australia is a national charity working for a better life for people
affected by mental illness, including anxiety and depression. Through
education and campaigning, SANE aims to assist those with mental illness
as well as their families. SANE provides a helpline for those dealing with
mental illness and educational resources such as books, DVDs and online resources
(figure 5.19).
SANE also acts to reduce the stigma associated with mental illness through
strategies such as Stigmawatch, where media that promote stigma associated
withmental illness are contacted with an explanation of the damage that can be done
by promoting such views. Stigmawatch also congratulates media for good coverage.
Youthbeyondblue
FIgUrE 5.20 The beyondblue logo
174
Youthbeyondblue is the youth arm of beyondblue and focuses on young people aged
12 to 25 years. Youthbeyondblue aims to raise awareness of depression and anxiety
by reassuring young people that its okay to talk about depression and anxiety, and
to get help when its needed.
Youthbeyondblue.com provides an informative website with information for
young people about depression and anxiety, and where to get help. Youthbeyondblue
also provides young people with an opportunity to share their experiences of
depression and anxiety, their ideas and thoughts, and general information about
getting help and getting better. In this forum, young people can also respond to
other peoples stories.
Personal strategies that promote

mentalhealth
As well as the government and community strategies and programs put in place to
combat anxiety and depression, there are a number of things that individuals can
do to promote their own mental wellbeing. They include:
Communicating with friends and family this is a very
effective way of promoting mental health (figure 5.21).
Effective communication means that individuals can
discuss their problems and solve issues before they become
seemingly unmanageable.
Seeking help from medical professionals this assists
in promoting mental health. Mental health problems can
therefore be professionally identified before they develop
into clinical anxiety or depression.
Taking time for relaxation enhances mental wellbeing
strategies such as undertaking hobbies, exercise and
meditation can all help with relaxation.
Strengthening the protective factors already mentioned is
obviously a key determinant in mental health promotion.
Mental health care services

available to youth
Figure 5.21 Talking to friends and

family can improve mental wellbeing.
As well as government, community and personal programs and strategies, youth

can access a range of health care services for both preventative and curative mental
health care. In Australia, mental health care services are provided in a number
of ways, including general practitioners, specialists such as psychologists and
psychiatrists, and hospital care. Many of these services are either fully or partially
funded through Medicare (see case study).
Case study
Medicare
Medicare is Australias universal health-insurance
scheme. Established in 1984, it gives all Australian
citizens, permanent residents and people from countries
with a reciprocal agreement access to health care
that is subsidised by the government. Countries with
a reciprocal agreement include New Zealand, the
United Kingdom, the Republic of Ireland, Sweden,
the Netherlands, Finland, Italy, Malta and Norway. As
a result of this agreement, Australian citizens can also
access subsidised health care in those countries if they

require treatment while abroad.
Youth aged 15 and over are able to apply for their
own Medicare card. A Medicare card can be used for:
making a Medicare claim for a paid or unpaid
doctors account
visiting a doctor who bulk bills
getting treatment as a public patient in a public
hospital
filling a Pharmaceutical Benefits Scheme prescription
at a pharmacy.
(continued)
Youth enrolled in Medicare can receive subsidised

treatment for a range of health services including:
doctors consultations (including specialists) and
associated treatments
tests and examinations by doctors
x-rays and pathology tests
eye tests performed by optometrists
free treatment in public hospitals
subsidised treatment in private hospitals.
Medicare covers most clinically necessary hospital
and doctors fees. Any cosmetic or elective procedures
are generally not covered. Other services not covered
by Medicare include dental examinations, home

nursing treatment and ambulance services. A number of
treatments that exist in addition to mainstream medicine
are also generally not covered by Medicare. Some of
these services are referred to as allied health services
and include physiotherapy, occupational therapy,
speech therapy, eye therapy, podiatry and psychology.
Complementary health services are also generally not
covered and include chiropractic services,acupuncture
andhypnotherapy. Allied and alternative health services
may be covered by Medicare in some cases, especially
if they are referred by a GP.
Case study review

1 (a) Explain Medicare.
(b) Discuss the range of health care services available to youth through
Medicare.
2 Use the Medicare Information links in the Resources section
of your eBookPLUS to find the weblink and questions for this
activity.
Unit 1
AOS 2
Topic 6
Medicare
Concept summary
and practice
questions
Concept 1
General practitioners and specialist

services
In relation to mental health, youth can access a range of health services. General
practitioners (GPs) are often the first contact youth have with the health system.
In 201213, around 12.3 per cent of all GP encounters were related to mental
health, which translates to around 16 million visits. GPs provide a range of services
including treating mental health issues and referring individuals to specialists.
Mental health specialists include psychologists, psychiatrists, mental health nurses,
occupational therapists, social workers and Aboriginal health workers. These
services are provided in a range of settings; for example, in hospital, consulting
rooms, home visits and over the phone. Each year, there are over 5 million
Medicare-subsidised mental health-related services provided by psychiatrists,
psychologists and other allied health professionals in addition to the services
provided by GPs.
Hospital care
Unit 1
AOS 2
Topic 4
Concept 4
Mental health
programs
Concept summary
and practice
questions
Hospital emergency departments also play a significant role in treating mental

health issues and, in addition to GP consultations, can be the initial point of contact
with the health system for youth. A Victorian study of emergency department
presentations found that emergency departments were used as an initial point
of care for those seeking mental health-related services for the first time, as well
as an alternative point of care for people seeking after-hours mental health care
(Victorian Government Department of Human Services, 2006). In 201213,
around 8.6 per cent of all hospital separations for those aged 1519 were related
to mental health (AIHW, 2015). Almost two-thirds of the mental health-related
emergency department occasions of service were resolved without the need for
admission or referral. Most of the remaining mental health-related occasions of
service were admitted to hospital.
Case study
Fewer people receiving

mental health treatment
By Adam Cresswell, health editor
A smaller proportion of people with a chronic
mental health condition is getting treatment now
than 10 years ago a finding that has shocked
experts and called into question the effectiveness
of the $1.8 billion poured into the neglected sector
since2006.
National figures published by the Australian Bureau
of Statistics yesterday show that of the 3.2 million
people who had a mental health disorder in the previous
12 months, only 35 per cent obtained treatment
services less than the 38 per cent reported in the
previous survey in 1997.
And 2.1 million Australians recorded in the latest
survey as having had a mental problem in the previous
year did not use the health services, but felt they had
missed out.
The figures, contained in the latest National Survey
of Mental Health and Wellbeing, have prompted calls
for a rethink of mental health policies.
Brain and Mind Research Institute executive
director Ian Hickie, a long-standing advocate of
reform in mental health services, said many experts
had expectedthe access figure to rise to at least 50per
cent after the huge cash injections of recent years,
including the $1.8 billion package pledged by John
Howard in 2006 and subsequent announcements by
most states.
But Professor Hickie said that instead the report
showed Australia had been tipping new money into
old services such as GP consultations. This meant
the people benefiting the most, middle-aged women,
were the same people who had always most used
such services, and that those missing out, men and

young people, were seeing little improvement in their
treatment.
We were shocked in 1997 to find that only 38 per
cent had access to services in the past year, Professor
Hickie said.
Once that became clear, it became a goal to increase
access to care. If we were shocked in 1997, we are
staggered now. We should never have gone for 10years
without knowing whether all the money we were
spending was having any effect.
Professor Hickie called for new and innovative
policies, such as delivering more mental health
care through community services, and better use of
communications technologies and private providers.
The study, conducted between August and December
last year, indicated no reduction in the need for mental
health treatment. It found 45 per cent of Australians
would experience a mental health problem at some
stage in their lives, and that 20 per cent had a mental
problem in the past year.
Among people aged 1624, the rate was more than
a quarter.
Mental Health Council of Australia chief David
Crosbie said the figures were deplorable.
When you think its no better than it was 10 years
ago, and with all the investment and the rejigging of the
existing system and the talk about reform, you have to
wonder if it reaches real people in real communities,
he said.
As well as supporting the current system, we
need a lot more new and different services, and
community-based services. The bottom line is we
are just not reaching people with a mental health
disorder.
Source: The Australian, 24 October 2008.
Case study review

1 (a) How has Australia poured new money into old services according
toProfessor Hickie?
(b) Who was most likely to benefit from this?
2 (a) What new and innovative policies does Professor Hickie call for?
(b) With a partner, select one of these suggestions and devise a plan for
implementing it.
Rights and responsibilities of youth

in using health services
There are a number of rights and responsibilities that youth have when accessing
health care services to promote health, including those services addressing anxiety
and depression. These rights and responsibilities are established to ensure that
Rights
Unit 1
the best possible outcomes are achieved for the individuals health. Many young
Concept summary
AOS 2
and practice
people are not aware of their rights, and this is a contributing factor for youth not
questions
accessing health services.
Topic 6
The rights and responsibilities of youth in accessing health care are outlined
Concept 2
below:
The right to privacy. Any information about an individual must be treated
confidentially. If the doctor deems a young person (under the age of 18) to be
mature, then parents do not have to be informed of consultations or treatment. If
the person is deemed not mature by the doctor, then parents may be informed.
In most cases, those aged 14 years or older demonstrate the maturity to make
their own decisions, but this will of course depend on the individual and the
nature of the consultation and/or treatment.
The right to a second opinion. Regardless of the illness, all patients have the right
to a second opinion or to be dealt with by a different worker without fear of
victimisation.
The right to use public health services. Most people residing in Australia have the
right to use Medicare, which can provide treatment free of charge. Those aged
15 and over are entitled to their own Medicare card.
The right to help develop a treatment plan. Individuals have the right to assist in the
development of a treatment plan that suits them (figure 5.22).
The right to refuse treatment. A person can usually refuse treatment. However, in
extreme cases, where the individual with a mental illness is a risk to themselves
or the community, they may be held against their will in a psychiatric hospital.
In these cases, the person does not have the right to leave that care but can
appeal against their detention.
The right to complain about treatment. If the youth feels that their treatment has
not been satisfactory, they can lodge a complaint through the Health Services
Commissioner (www.health.vic.gov.au/hsc).
The right to have a family member or friend
present during consultations. Some people feel
more comfortable with a friend or relative
present, and health workers should respect
this right.
The right to be treated with respect and dignity.
All human beings have certain rights,
including the right to dignity and respect. If
a person feels that they have not been treated
with dignity and respect, a complaint can be
made. In addition to the range of rights, users
of health care services also have a number of
responsibilities that include:
The responsibility to give accurate accounts of
medical history, and behavioural factors. Health
workers cannot decide on the best treatment
options if they have only half the story. It is
therefore in the patients best interests to be
completely honest. Health workers are there
Figure 5.22 Individuals can and should be involved in devising
to help, not to judge.
treatment plans.
178
The responsibility to keep appointments. Appointments can be difficult to get for

certain services. Every time someone fails to keep an appointment, another
person effectively misses out on care.
The responsibility to tell medical staff if they do not intend to follow treatment. If a
person does not agree with a treatment plan or intends to not follow it, they
should communicate this with their health worker so that a more appropriate
plan can be devised.
The responsibility to work with medical staff to make the most of the opportunities
available to improve their health. Medical professionals can provide opportunities
to improve health (e.g. by giving advice on how to alter behavioural factors), but
the responsibility to act on these opportunities lies with the patient.
The responsibility to treat others with respect and dignity. All humans have these
rights and are entitled to be treated in this manner.
The responsibility to respect the privacy of others. All people receiving and giving
care are entitled to their privacy.
TEST your knowledge

1 (a) What is SANE Australia?
(b) How does it promote health and individual
human development?
2 (a) What is Youthbeyondblue?
(b) How does it promote the health and individual
human development of those suffering from
mental illness?
3 Does a doctor have to report medical issues to the
parents of young patients? Explain.

4 Discuss why it would be beneficial for an individual
to assist in devising their treatment plan.
5 How could you improve your personal skills to assist
in the prevention of mental illness?
6 Discuss the characteristics a doctor would look for
in evaluating a young persons maturity.
7 Why is it important to consider getting a second
opinion for any serious condition?
Unit 1
AOS 2
Topic 6
Responsibilities
Concept summary
and practice
questions
Concept 3
8 (a) Which rights and responsibilities were you

not aware of with regards to accessing health
services?
(b) Would knowledge of these rights and
responsibilities change the way you feel about
accessing health services? Explain.
9 (a) Research government and non-government
strategies that are employed to address an issue
of your choice.
(b) Produce a summary on the strategy and include
the following information:

i. name of the organisation/level of government
ii. aims/goals of the organisation/strategy
iii. a description of how they attempt to achieve
their goals.
(c) How can you tell if the strategy is a government
or non-government initiative?
10 Brainstorm the personal strategies that may assist
youth in reducing the impact of a selected health
issue. Consider the determinants that increase the
risk of the issue when answering this question.
Key skills Health issues facing Australias youth

KEY SKILL Analyse data to draw informed
conclusions about the range of health issues facing
Australias youth
This key skill requires the ability to use information presented (in the form of
tables, graphs or case studies, for instance) and combine it with existing knowledge
about health and development in order to draw conclusions about issues facing
Australias youth.
Whenever using information presented, take time to understand what the
information is saying. If it is presented in graphical form, follow the steps presented
in the skills section at the end of chapter 2. If it is in written form, always re-read
the information carefully. It is easy to miss key information on a first reading.
In the following example, data about the patterns of injury and poisoning
mortality rates over time (figure 5.23) are analysed, trends identified and
conclusions drawn.
70
1014
1519
2024
60
50
40
30
20
10
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Figure 5.23 Injury and poisoning death rates for young people aged 1024 years, 19972011
Source: Adapted from AIHW, GRIM (general record of incidence of mortality) books, 2015.
A general statement is made relating

to the trend evident in the graph.
Data are used to support the general

statement.
Correct units are used.

Conclusions are drawn.
Overall, mortality rates due to injury and poisoning have decreased over time.
Rates for those aged 1519 decreased from around 43 deaths per 100000 people
in 1997 to around 22 per 100000 in 2011. During the same period, mortality
rates due to injury and poisoning decreased for those aged 2024 from around
60deaths per 100000 to around 33 per 100000. The mortality rates for those
aged 1014 remained fairly stable over time at around 58 per 100000. The graph
shows that those aged 1214 are the least likely to die from injury and poisoning
compared to those aged 1519 and those aged 2024. Those aged 2024 are most
likely to die from injuries and poisoning of the three age groups.

9
Males
Females
Persons
8
7
6
5
4
3
2
1
0
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Figure 5.24 Accidental poisoning death rates for young peopleaged1224years,

19872007
Source: AIHW 2011, Young Australians: their health and wellbeing 2011.
1 Analyse the data relating to accidental poisoning death rates over time for males
and females and draw a conclusion about the differences between the two
groups.
2 Use the Young Australians weblink in your eBookPLUS to find the
link for this question.
(a) Find data relating to an issue of your choice.
(b) Analyse the data and draw a conclusion relating to your selected health issue.
KEY SKILL Describe a specific health issue facing

Australias youth
To complete this key skill, you must describe in detail one health issue that faces
Australias youth. As the issue of mental health is explored in detail in this chapter
already, it may be useful to explore another issue to demonstrate this key skill.
Togive a comprehensive overview, in addition to being able to describe the issue,
it is important to provide any related information.
For example, to describe injuries, it is required to explain what they are, how
they affect the sufferer and their causes. The following is a description of injuries as
a health issue facing Australias youth.
Injury is a term that refers to the physical damage that can occur to the body as a
result of trauma. Examples of injuries affecting youth include drowning, car
crashes, suicide and poisoning. Mortality rates from injuries have declined in
recent years but they still remain the leading cause of death for youth in Australia.
During youth, males have significantly higher rates of injury deaths than females. As
well as mortality, injuries can result in lifelong disability and contribute significantly
to morbidity. When not fatal, injuries can require hospitalisation and ongoing
treatment, including rehabilitation. Behavioural determinants such as alcohol and
drug use, risk-taking behaviours and social determinants such as the influence of the
peer group can act to increase or decrease the risk of sustaining injuries.
The characterising features of injuries

are identified.
Examples related to youth are

identified.
The reason why injury is considered a
health issue is identified. In this case,

it is due to the high rates of mortality
and morbidity.
Determinants that can increase
or decrease the risk of injuries are

identified.

3 Identify and describe one issue for Australias youth that has become increasingly
significant in the past 20 years.
4 Identify and describe one issue for Australias youth that is more likely to lead to
ill health later in life.
KEY SKILL Gather information on a selected issue

related to youth health using a range of sources such
as primary data, print and electronic material
The source of the information is listed.
Information should be gathered from a range of sources and presented in a variety

of ways including discussions, tables, graphs, and other media such as podcasts.
Information should relate to different aspects of the issue and can include morbidity
(including prevalence and incidence where appropriate), the impact on mortality,
differences between males and females, the amount of money spent addressing the
issue, and strategies devised to address the issue. The data must relate to youth,
although other lifespan stages can be included when they are used as a basis of
comparison with youth.
It is important to record where information comes from, so a source can be
presented for each piece of data and can also be recorded in a bibliography.
In the following example, selected data relating to injuries are presented.
Injuries contribute more to mortality for youth in Australia than any other
cause, with land transport accidents the single greatest cause of injuries, followed
by suicide (AIHW, Young Australians: their health and wellbeing, 2011). As
shown in figure 5.25, males experience a greater percentage of injury deaths than
females.
Land transport accidents
Suicide
Undetermined intent
Male
Female
Assault
Exposure to other factors
Accidental falls
Accidental drowning
Figure 5.25 Injury and poisoning
deaths among young people aged
1524 years, by external cause of injury
Other
0
Source: AIHW National Mortality Database.
When relevant, the data source is

explained.
30
10
15
20
25
Per cent of external cause of death
35
40
In 2011, the Australian Institute of Health and Welfare collected information

relating to hospitalisations due to injuries for those aged 1519. It found that
there were 19351 cases of children aged 15 to 17 years hospitalised as a result of
an injury, representing 15 per cent of all hospitalised injury cases in youth. The
incidence rate of injury was 2244 cases per 100000 population (AIHW, Injury
research and statistics series, 2014).
Rates of hospitalisation due to injuries are shown in figure 5.26. These data
show that males and females in the 1519 age group are more likely to be
hospitalised due to injuries compared to those aged 1214 and 2024. In all age
groups, males are more likely to be hospitalised than females.,
A range of sources are used.

Information relating to hospitalisation
rates is presented. Note that no
analysis of the information is required
for this key skill.
Differences and similarities between

males and females are identified.
Hospital separations per 100 000 young people
4000
3500
Males
Females
Students should state what the data

show rather than merely including a
graph.
3000
2500
2000
1500
1000
500
0
1014
1519
Age group (years)
2024
Figure 5.26 Injury hospital separation rates for young people 201112
Source: AIHW, Injury research and statistics series no. 91, 2014.
Information is presented in a range of

ways.
Data on a range of indicators relating

In the 201112 financial year, injury expenditure was around $5.2 billion,
representing more than 6 per cent of total allocated health expenditure in that
year.
The TAC produce a range of initiatives including advertising campaigns, with
the aim of reducing the incidence and severity of injuries occurring as a result
of road accidents. The Everybody Hurts campaign is an example of this (see
figure5.27)
to the issue are presented (although

to cover an issue such as injuries
adequately, more data would be
required than presented in this
section).
Information relating to prevention,
treatment or care with regard to the

issue can be included.
Figure 5.27 An anti-speeding advertisement produced by the Transport Accident

Commission
The Everybody Hurts campaign is an advertising strategy aimed at encouraging

people to reduce their speed and therefore their risk of sustaining injuries
on Victorian roads. Everybody Hurts utilises social media such as Facebook to
personalise road safety messages. It also provides a website that contains clips of all
the different people who are affected by road trauma.

5 For an issue of your choice, collect information relating to:
(a) morbidity (including incidence and prevalence where appropriate), mortality
and burden of disease data
(b) differences between males and females
(c) the amount of money spent addressing the issue
(d) personal, community and/or government strategies or programs designed to
address the issue.

There are many issues facing Australias youth. If continual improvements to health status
are to be made, these issues must be addressed. Individuals, communities and governments
implement a range of strategies and programs in order to optimise health and development.
6 List three issues that impact on the health and development of Australias youth.
3 marks
7 Select one of the issues identified in question 6 and describe it briefly.
Issue selected
Description
4 marks
KEY SKILL Analyse information on a selected youth

health issue and draw informed conclusions about
personal, community and government strategies and
programs to optimise youth health and development
This key skill requires statements to be made about the information and data that
have been collected on a selected health issue.
To begin an analysis of the issue, examine the trends that have become evident
and the associated impact on youth health and development. In addition, analyse
a range of personal, community and government strategies or programs that
have been implemented to address the issue. Comment on their actual or possible
effectiveness. For this, a critical approach is required. For instance, there may be
financial constraints that prevent the strategy from being more effective than it is.
It is not expected that all comments will be positive. There will no doubt be room
for improvement evident in at least some of them.
In the following example, the data and information on injuries are analysed and
conclusions about the TACs Everybody hurts when you speed campaign are made.
Although the focus here is on a community program, this skill should also be
applicable to personal and government strategies and programs.
Injury rates are high among Australian youth, with males more likely to
experience injuries than females. Land transport accidents were the most common
cause of injury death among Australian youth. Around 35 per cent of all injury
deaths were due to land transport accidents, with males accounting for around
184
three-quarters of all land transport deaths. In 201112, males aged 1214 and
1519 were more than twice as likely to be hospitalised due to injuries compared
to females. For instance, males aged 1214 experienced a hospitalisation rate
of around 2000 hospitalisations per 100
000 people, compared to around
900hospitalisations per 100000 people for females.
Those aged 1519 were significantly more likely to be hospitalised than those
aged 1014. For example, rates for males aged 1014 were around 2000 per100000
compared to rates of around 3000 per 100000 people for males aged1519.
The TACs Everybody Hurts campaign utilises media (including social media) to
reach its audience. Young people are often engaged in social media so may be more
likely to be exposed to its message. Everybody Hurts aims to educate people by
accessing their social media profiles and making personalised messages relating to
the impact of injuries sustained on roads.
Not all young people at risk of road injuries access social media and not all will
be exposed to the Everybody Hurts message. Youth is a time of risk taking for
some individuals and even if they are exposed to the Everybody Hurts campaign,
they may not respond to the message within it.
Overall, the Everybody Hurts campaign is effective as it targets speed, which is a
major cause of land transport accidents, the major cause of injury death amongyoung
people. The campaign acts to reach young people via media that they engage in,
particularly social media. This may encourage youth to think twice about risk
taking on the road and may decrease the rate of injury death among youth.
Statements relating to injuries among

Australian youth are made, with
data from the graph used to provide
statistical evidence.
Trends relating to hospitalisations

are identified based on the data
presented.
Elements of TACs Everybody Hurts

campaign are discussed.
Possible limitations of the campaign

are identified.
A conclusion is drawn and points

made to support the conclusion.
The likely impact of the campaign is

outlined.

8 Analyse the information you collected for the previous key skill. In doing so,
ensure that you:
(a) make statements summarising the information collected
(b) identify trends
(c) discuss possible impacts on youth as a result of the information collected
(d) draw conclusions about a strategy or program designed to address the issue
(including the likely effectiveness of the strategy or program).
KEY SKILL Identify the range of health care services

available to youth and discuss their rights and
responsibilities in accessing and using these services
The first part of this key skill is identifying the range of health care services available
to youth. Discussion of these services is not necessary but an understanding of
them is essential to ensure that appropriate services are identified for the given
issue or situation. Medicare provides a range of health care services in Australia
and is a key concept for this key skill.
The second part of this skill requires a discussion of the rights and responsibilities
of youth in accessing these services.
In the following example, health care services relating to injuries are identified
and the rights and responsibilities relating to the use of them are discussed.
Health care services available to youth relating to injuries issues include:
Ambulance services
General practitioners
Emergency departments at public hospitals
Rehabilitation services
Allied health professionals such as physiotherapists
A range of services available to youth

are identified.
A range of rights relating to accessing

health care services (including
Medicare) are discussed.
A range of responsibilities are

discussed.
Youth have a number of rights and responsibilities when accessing health

services, including:
Those aged 15 and over have a right to obtain their own Medicare card and use
Medicare-funded services. This allows youth to make their own appointments
for consultations and treatments.
Youth have a right to choose their own general practitioner (GP). Medicare
subsidises the cost of GPs services regardless of which GP the individual
accesses.
Youth have a right to have their privacy protected. Consultation and treatment
plans are not discussed with other people. This includes parents, provided the
youth is considered to be mature.
Youth have a responsibility to be honest with their health care professional with
regards to their medical history and relevant behavioural factors so the most
appropriate type of care can be provided.
Youth have a responsibility to keep all medical appointments. This assists the
health care system in treating as many people as possible.

9 In relation to a health issue of your choice:
(a) Identify a range of health care services available for youth.
(b) Discuss the rights and responsibilities associated with using these services.
10 Design a poster aimed at educating youth as to the range of health care services
available relating to STI prevention.
CHAPTER 5 review
Chapter summary
Overweight and obesity rates have increased in recent decades and this is a risk factor
for a range of other health concerns such as psychological distress, cardiovascular
disease and type 2 diabetes. Increased consumption of energy-dense foods and a
decrease in physical activity levels have contributed to this issue.
Injuries are the leading cause of death for youth and are higher for males.
Interactivity:
Youth is a stage of experimentation, but tobacco, alcohol and drug use can have
far-reaching implications.
Tobacco smoking rates have decreased over time, but smoking still poses a risk to
the health of many individuals. The youth stage of the lifespan is when most lifelong
smokers develop their habit.
Binge drinking increases the risks associated with alcohol consumption.
Rates of STIs are relatively high among youth, especially chlamydia infection.
Unit 1
AOS 2
Health issues
facing Australias
youth
Anxiety and depression cause the largest burden of disease among Australian youth.
There are a number of other mental illnesses that affect young people such as bipolar
disorder, schizophrenia, eating disorders and substance use disorders.
Sit Topic test
Mental illnesses affect the health and development of youth in many different ways.
Up to 70 per cent of youth with a mental illness do not seek help.
The rates of mental illness have been fairly stable over the 10 years to 2007.
The death rates for mental and behavioural disorders decreased significantly over time.
Biological, behavioural, physical environment and social determinants can either protect
a person against, or put them at risk of, developing a mental illness.
A number of strategies have been implemented to address the issue of mental illness
in Australian society, including SANE Australias helpline and Stigmawatch and
Youthbeyondblue.
Personal strategies such as relaxation and communication can protect individuals from
mental illness.
A range of health care services are available to youth, many of which are fully or
partially funded by Medicare.
Medicare is Australias universal health insurance scheme.
Services covered by Medicare include general practitioners, specialist services and
hospital treatment.
Young people have rights when accessing mental health services including the right to:
privacy
refuse treatment
a second opinion
have a person present with them
use public health services
be treated with respect and dignity.
help develop a treatment plan

The responsibilities associated with using these services include the responsibility to:
give the health worker accurate
health information
work with medical staff to optimise

treatment
keep appointments
treat others with respect and dignity
tell medical staff if they are not

going to follow treatment plans
respect the privacy of others.
TEST your knowledge
1 What are the major health issues for Australias

youth in relation to: (a) morbidity? (b) mortality?
(c)overall burden of disease?
2 Select one health issue and explain the

determinants of health that together may influence
the decisions a person makes regarding this issue.
Individual
human development
and health issues
Unit 2
AREA OF STUDY
1 Prenatal health and
Outcome
Describe and explain factors that affect the health and individual human
development during the prenatal stage.
2 Child health and

Describe and explain factors that affect the health and individual human
development of Australias children.
3 Adult health and

Describe and explain the factors that affect the health and individual human
development of Australias adults.
CHAPtER 6
Health and individual human

development during the
prenatal stage of the lifespan
WHY iS tHiS iMPORtAnt?
The development that occurs during the prenatal stage
lays the foundations for development across the rest of
the lifespan. Maintaining adequate health prior to and
during pregnancy is a key factor in achieving optimal
health and development in the unborn baby. Having an
understanding of the health and development that occurs
during this stage of the lifespan allows informed decisions
to be made to ensure the promotion of optimal wellbeing
among pregnant women and unbornbabies.
KEY KNOWLEDGE
1.1 the process of fertilisation (pages 1924, 210)
1.2 physical development from conception to birth, including the features
of the germinal, embryonic and foetal stages (pages 195200, 210)
1.3 the health status of australias pregnant women and unborn babies
(pages 2017, 210).
KEY SKILLS
describe the characteristics of physical development from conception
tobirth (pages 194, 200, 208, 210)
interpret data on the health status of pregnant women and
unbornbabies (pages 207, 2089).
FigURE 6.1 The influences on

health and development are
already evident on this foetus.
190
Unit 2 Individual human development and health issues

amniotic fluid the fluid surrounding the embryo/
foetus that protects the unborn baby
antepartum relating to the period directly before
birth
blastocyst a cluster of cells in which some cell
differentiation has occurred
cell differentiation when cells take on specialised
roles
congenital abnormality sometimes called
congenital anomaly, a condition characterised by
malformed body parts (either external such as limbs or
internal such as organs) that is present at birth
endometrium the nutrient-rich lining on the uterine
wall in which the ovum (blastocyst) embeds or that is
expelled every month if pregnancy does not occur
haemorrhage excessive bleeding
implantation occurs when a cluster of cells that will
become an embryo attaches itself to the endometrium
intracytoplasmic sperm injection a process whereby
a single sperm is injected directly into an ovum
jaundice a condition that can affect newborn babies.
Symptoms may include a yellow tinge to the skin and
whites of eyes, drowsiness, feeding difficulties and
dark urine.
mandatory fortification a law that requires certain
nutrients to be added to specific foods during
production
morula a solid ball of cells created from a zygote
placenta an organ that allows the transfer of
nutrients, gases and wastes between mother and
foetus
regenerate regrow to replace damaged, old or dead
cells or tissue
teratogen anything in the environment of the embryo
that can cause defects in development. Examples
include tobacco smoke, alcohol, shellfish, prescription
medication and some diseases like measles.
ultrasound a tool that uses high-frequency
soundwaves to create a visual representation of
something that can usually not be seen. Ultrasound is
used to monitor foetal development.
zygote a full cell resulting from the fusion of a sperm
and an ovum
6.1
Fertilisation
KEY COnCEPt The process of fertilisation
The start of human life is dependent upon the genetic material provided by each
parent. In order to gain an understanding of the prenatal stage of development, we
will first explore fertilisation and the cells required for this process to occur.
Sperm and ova

Most cells in the human body contain a nucleus, which is like the brain of the
cell. It contains the genetic material or blueprints that allow human cells to keep
reproducing throughout the lifespan, although some types of cells regenerate more
than others.
Sperm and ova (singular ovum, sometimes referred to as an egg) are the names
given to the male and female sex cells respectively. Sperm production in males
starts during puberty and sperm form in the testes at a rapid rate (over 12 billion
per month). Ova form in the ovaries before the female is even born. Once born,
the female already has all the eggs that she will have for life. These eggs will mature
once puberty occurs.
When sperm and ova are created, they take a random half of the individuals
genetic material to essentially make half a cell. These two half-cells (one from each
parent) are able to join to make a complete cell called a zygote in a process called
fertilisation.
Fertilisation
Fertilisation (sometimes referred to as conception) occurs when a sperm penetrates
an ovum and the genetic materials fuse together to make a single cell called a
zygote. The zygote contains 23 chromosomes from the sperm and 23 chromosomes
from the ova. The individual resulting from this single fertilised cell will therefore
display some characteristics of each of their parents and many combinations of
the two (figure 6.2). Body cells split in different ways each time a sperm or egg is
created, resulting in the vast variation typically seen among siblings.
Fathers genetic information
Mothers genetic information
46
chromosomes
46
chromosomes
23 chromosomes
FigURE 6.2 When sperm and

ova form, normal body cells
split to contain half the genetic
material of a normal cell.
192
46
chromosomes
23 chromosomes
46
chromosomes
23 chromosomes
23 chromosomes
46
chromosomes
46
chromosomes
In most cases, fertilisation occurs in a females fallopian tubes (see figure 6.3).
During sexual intercourse, sperm is deposited in the vagina and swims towards
the fallopian tubes. If an ovum is present, any sperm that reach it will compete
to break through the eggs membrane. In order to do this, the sperm release an
enzyme that breaks down the outer barrier of the egg. Once a sperm has penetrated
the membrane, other sperm are blocked from entering by electrical impulses
released by the egg. If more than one sperm were to enter, the zygote would have
an incorrect amount of genetic information and would not survive.
Fallopian tubes
Uterus
Uterine wall
Ovum
Ovary
2 Sperm swimming through

uterus and tubes
3 Fertilisation of
ovum by sperm
Figure 6.3 Fertilisation takes place

in one of the fallopian tubes and the
complete cell moves into the uterus,
where it implants in the lining of the
uterus.
Cervix
1 Sperm deposited in
vagina during sex
Vagina
In-vitro fertilisation
Around one in five couples experience fertility problems and rely on other methods
to carry out the process of fertilisation. One of the most common techniques used
to assist with fertilisation is called in-vitro fertilisation (often referred to as IVF).
In-vitro fertilisation involves extracting ova from the womans ovaries and mixing
them with sperm outside the womans body, often in a petri dish. If a zygote is
created in this way, it can be implanted in the womans uterus using a long, hollow
needle, or frozen to be implanted in the future (see figure 6.4).
Step one Injection of
hormones
Step two Extraction of ova
Step three fertilisation
Step four incubation
Step five implantation
Ovary Ova are

Fallopian
extracted
Uterus
tube
Ova
Sperm
Cervix
Vagina
Hormones are
injected to promote
the maturation of
multiple ova.
Ova are extracted

from the ovary.
Sperm and ova are

mixed in a petri dish
to allow fertilisation
to occur.
The zygote is incubated

at 37 degrees for around
2 days (until the zygote
consists of around 8 cells).
The zygote is placed in the

uterus using a flexible tube.
Figure 6.4 The steps involved in the in-vitro fertilisation process
Health and individual human development during the prenatal stage of the lifespan CHAPTER 6 193
6.1 Fertilisation
Unit 2
AOS 1
Topic 1
The process of
fertilisation
Concept summary
and practice
questions
Concept 1
Often, multiple embryos will be implanted in the hope that at least one will
result in a full-term pregnancy. Only about one in five IVF treatments results in a
full-term pregnancy; the older the woman, the less the chance of success. Multiple
births occur in about one-quarter of those instances where IVF does succeed.
For a range of reasons, in some cases sperm do not reach the egg or cannot
penetrate the membrane of the egg. In these instances, a single sperm can be
directly injected into an ovum in a process called intracytoplasmic sperm injection
(see figure 6.5). The embryo can then be implanted into the endometrium in the
same manner as in-vitro fertilisation.
Figure 6.5 An intracytoplasmic

sperm injection involves injecting a
single sperm directly into an ovum.
The sperm and ova used in the process of in-vitro fertilisation may be obtained
from the man and woman seeking the pregnancy. At other times, the ova and/or
sperm are provided by known or anonymous donors. If the parents sex cells are
used, the child will have the same genetic mix as if conceived naturally. This will
not be the case if one or more donor cells are used.
TEST your knowledge
1 When does sperm production begin in males?

2 When are ova formed?
3 Where is an ova fertilised for most couples?
4 Explain why babies show traits of both parents.
5 Use a flow chart to outline the process of
fertilisation.
6 Use a flow chart to outline the process involved in
in-vitro fertilisation.
7 Explain why twins are more common with in-vitro
fertilisation.
8 Use the Fertilisation links in the

9 Use the IVF links in the Resources
section of your eBookPLUS to
find the weblink and questions
for this activity.
194UNIT 2 Individual human development and health issues
6.2
Prenatal development
KEY COnCEPt Physical development from conception to

birth, including the features of the germinal, embryonic and
foetal stages
Once fertilisation occurs, the prenatal stage
of development commences. Even though
the foundations of social, emotional and
Prenatal
stage
intellectual development start at this stage,
the physical aspect of development is the
most noticeable. Development during this
stage is the most rapid of all lifespan stages.
The prenatal stage is generally divided into
three stages: the germinal, embryonic and
foetal stages (refer to figure 6.6).
Germinal
Foetal
Embryonic
Different groups use different ways to
(02 weeks)
(940 weeks)
(38 weeks)
measure the stages of pregnancy. Many
organisations use the first day of the
mothers last menstrual period to signify the beginning of pregnancy, although FigURE 6.6 Stages of prenatal
fertilisation doesnt usually occur until around two weeks after this event. The development
average pregnancy will last 40 weeks after the start of the last menstrual period or
around 38 weeks from fertilisation. In this section, fertilisation is used to signify
the beginning of a pregnancy that results in 38 weeks of pregnancy.
germinal stage
The germinal stage starts at fertilisation and ends with implantation (figure 6.7).
Blastocyst cavity
Outer cell mass
The sperm penetrates
the ovum and
fertilisation occurs
Around 30 hours after

fertilisation, the cell
divides for the first time
Three days after

fertilisation, the morula
consists of 16 cells
Inner cell mass

Around 5 days after fertilisation,
the blastocyst consists of an inner
and outer cell mass
Endometrium
Inner cell mass
Blastocyst cavity
Outer cell mass
Cells of the blastocyst

implanting into the
endometrium
Endometrium
Around 7 days after fertilisation, the blastocyst

begins to implant into the endometrium
FigURE 6.7 The germinal stage of prenatal development sees the single-celled morula develop into a multi-celled
blastocyst. Once implantation is complete, the germinal stage concludes.
Health and individual human development during the prenatal stage of the lifespan CHAPtER 6
195
Unit 2
AOS 1
Topic 2
Germinal stage
Concept summary
and practice
questions
Concept 1
When fertilised, the newly formed cell (zygote) travels down one of the fallopian
tubes while constantly dividing. Around three to four days after fertilisation,
when there are about 16 cells, the zygote takes on a spherical shape and is now
known as a morula. At around five days after fertilisation, when it is made up of
around 64 cells, the morula transforms to include an outer cell mass, an inner
cell mass and a hollow, fluid-filled centre called the blastocyst cavity. At this stage,
the developing baby is called a blastocyst. The inner cell mass of the blastocyst
will become the embryo and the outer cell mass will eventually become the
placenta.
When it reaches the uterus, the blastocyst implants itself in the endometrium.
Once implantation occurs, the developing baby is referred to as an embryo.
A summary of the physical development that occurs during the germinal stage
is shown in table 6.1.
TABLE 6.1 Characteristics of development that occurs during the germinal stage
Stage of prenatal
development
Week of prenatal
development
Characteristics of development
Thirty hours after fertilisation, the cell divides for the first time. This process of cell division
will continue for life.
After three days, the zygote consists of 16 cells.
The zygote travels down the fallopian tube and into the uterus.
Around a week after fertilisation, and while smaller than a grain of rice, the blastocyst
begins to implant into the endometrium.
Germinal
Embryonic stage
Unit 2
AOS 1
Topic 2
Concept 2
Embryonic
stage
Concept summary
and practice
questions
The embryonic stage starts at implantation and ends at the eighth week (figure6.8).
This stage is characterised by cell differentiation. This is when the cells start taking
on specialised roles such as heart cells, skin cells and bone cells.
This stage is perhaps the most critical for human development. Most internal
and external organs and systems are formed during this stage, and the brain and
spinal cord are almost complete by the end of it (although they will grow in size
and increase in complexity for years to come).
While the embryo is only around 2 centimetres in length by the end of this
stage, many of the internal organs and systems have begun to form. These include
the circulatory system, the stomach and kidneys, lungs, the nervous system and
the digestive system. Although sex is determined at conception, the internal sex
organs begin to form during the embryonic stage but will not be complete for
another eight weeks.
The limbs start out as buds emerging from the torso and continue to grow
and develop during this stage. Fingers and toes also begin to form by the end of
the embryonic stage. By the eighth week, the embryo becomes distinctly human
looking, although the head and neck still account for around half the embryos
total length and the brain makes up almost half of its body weight.
Because major organs and systems are formed during this time, the embryo is
very sensitive to environmental influences. Teratogens such as tobacco, alcohol and
medication are particularly influential during this stage of development. Teratogens
are explored in more detail in chapter 7.
At the eighth week, the embryo has begun to form every major organ and
system, and many are close to completion. In fact, 90 per cent of the structures
found in an adult human can be found in an eight-week-old embryo. The
remainder of the prenatal stage is characterised by rapid growth and the maturing
of these organs. These developments are summarised in table 6.2 on page 198.
Week 3: Cells continue to divide rapidly and

start to take on specialised roles.
Liver and lungs
are formed from
the inner layer
Bones and heart are formed

from the middle layer
Skin and eyes are formed
from the outer layer
Week 4: The neural tube that will become the

brain and spinal cord is developing.
Week 8: Fingers and toes are

starting to form.
Eyelids are formed

but fused shut
Heart has
already formed
Week 7: Facial features are

becoming recognisable.
Week 5: The arms and legs

start to bud.
Shoulders, arms, hands

and fingers are forming
Week 6: The spinal cord looks like a tail and

the placenta is starting to form.
Legs, feet and toes

are forming
Skeleton is soft
but fully formed
Placenta carries
nutrients to the baby
FigURE 6.8 The embryonic stage of prenatal development
197
6.2 prenatal development

tABLE 6.2 Characteristics of development that occurs during the embryonic stage
Stage of prenatal
development
Week of prenatal
development
Implantation is complete and the developing baby is referred to as an embryo.

Cells continue to divide rapidly and start taking on specialised roles as the organs begin to
develop.
the tissues that will become the brain and spine (called the neural tube) start to develop.
around 3mm in length, the embryo secretes hormones to maintain the endometrium and to
prevent the mother from having a menstrual period.
Buds appear on each side of the embryo that will become the limbs. the heart begins to beat.
the placenta has begun to develop and attach to the endometrium so it will be able to access
oxygen and nutrients from the mothers bloodstream. It will be a number of weeks until it is
fully functional.
Brain cells are being generated at a rate of 100perminute.
the spinal cord looks like a tail and the head is large in relation to the rest of the body.
the embryo is approximately 1.3cmlong.
Blood cells are being made in the liver.

Facial features such as the eyes and mouth are forming.
tiny muscles have formed which allow the embryo to move.
the embryo is around 2.5cm in length.

Fingers and toes are starting to form.
the brain is now active.
Embryonic
Foetal stage
Unit 2
AOS 1
Topic 2
Foetal stage
Concept summary
and practice
questions
The foetal stage starts at the ninth week of pregnancy and continues until birth at
around 38 weeks (figure 6.9). During this stage the unborn baby is referred to as
a foetus. The foetus measures only a few centimetres in length at the beginning of
this stage and about 50 centimetres by the end. Although this stage is characterised
by rapid growth, many other developmental milestones occur as well (table 6.3).
Concept 3
Foetal growth from

8 to 40 weeks
Embryo
at 8 weeks
Foetus
at 12 weeks
16
20
24
28
32
36
38
FigURE 6.9 The growth pattern of the foetus
All organs and systems formed in the embryonic stage including the lungs,
digestive system, liver and kidneys mature and are functioning in the early
stages of foetal development.
The placenta is fully developed and functioning at 14 weeks. It is a disc-shaped
temporary organ, largely made up of blood vessels that facilitate the exchange of
substances between mother and foetus. The placenta acts like a kidney, lung and
digestive system for the foetus by supplying the foetus with oxygen, nutrients and
immune support, and removing wastes such as urine and carbon dioxide. It is
connected to the foetus by the umbilical cord, which is made up of two arteries
and one vein. The umbilical vein supplies the foetus with nutrient-rich oxygenated
blood from the placenta, and the umbilical arteries return deoxygenated and
198
nutrient-depleted blood to the placenta. The placenta is also

connected to the uterus of the mother, and her blood forms
pools in the placenta. The blood vessels of the umbilical
cord complete a U-turn while passing through pools of the
mothers blood in the placenta. This allows the exchange of
nutrients, oxygen and wastes through the thin walls of the
placenta without the foetal blood coming into direct contact
with the blood of the mother (see figure 6.10). The placenta
also produces hormones, such as progesterone, that assist in
maintaining pregnancy.
Sex organs start taking shape and, by around the 15th week,
the sex of the foetus may be identifiable by an ultrasound.
A female foetus will have produced millions of eggs but this
number will be reduced by the time she is born. The testes of a
male foetus will be producing testosterone.
Movement occurs in almost all parts of the foetal body and
becomes more noticeable as the foetus grows. Reflexes such as
sucking and grasping are highly responsive and will continue to
develop throughout this stage. The foetus displays a breathing
movement but its lungs are filled with amniotic fluid, not air.
Tooth buds form in the gums in the second half of the foetal
stage. The bones, which mainly consist of cartilage, also start
to harden or ossify around this time. This is a process that will
continue until the end of puberty.
The senses begin to function around 25 weeks after
fertilisation, and the foetus may respond to light, sound and
touch. These senses become more sensitive throughout the
remainder of the foetal stage.
Fat is deposited under the skin during the later weeks ofthe
foetal stage. This assists with temperature regulation after birth.
Mothers
blood
vessels
Placenta
Arteries
Umbilical
cord
Vein
FigURE 6.10 The placenta connects the foetus to the

uterine wall of the mother, providing the foetus with
nutrients and oxygen and removing its waste products.
tABLE 6.3 Characteristics of development that occurs during the foetal stage
Stage of prenatal
development
Week of prenatal
development
913
the developing baby is now known as a foetus.

all of the bodys organs are formed but not all are functioning at this point.
the foetus is around 7cm in length in week 11.
teeth are beginning to form in the gums.
eyelids are fused over the eyes.
1418

the tongue develops tastebuds.
ears are fully functioning and the foetus can hear muffled sounds from the outside world.
the sex of the foetus can be distinguished via an ultrasound.
1923

the foetus will swallow regularly but takes in only amniotic fluid.
the eyelids separate into upper and lower lids and the foetus can open and shut its eyes.
2428
the foetus is around 37cm long and weighs approximately 1kg.

the fingers and toes grow nails
the foetuss body has grown and it is now more in proportion with the size of the head
but will take until childhood to completely catch up.
2933
3438
the foetus assumes the head down position in preparation for birth.
the lungs develop at a rapid rate during this time.
the foetus is around 50cm in length.
Foetal
the foetus spends most of its time asleep.

eyebrows and eyelashes grow.
Fat is laid down under the skin to assist with adjusting to life outside the uterus.
the foetus moves in a strong and coordinated way.
199
TEST your knowledge

1 (a) What are the three stages of prenatal
development?
(b) When does each stage start and finish?
(c) What are the characteristics of physical
development that occur during each stage?
2 (a) What are teratogens?
(b) Make a list of teratogens.
(c) When do you think the unborn baby would be
most at risk from teratogens? Explain.
3 (a) What is the placenta?
(b) Do all women have a placenta? Explain.
4 (a) What is amniotic fluid?
(b) Why is it important for the developing
embryo/foetus?
5 Draw up a table with three columns and provide

examples that represent the key characteristics of
physical development in each of the three stages of
prenatal development.

6 Prenatal development would be impossible without
the placenta. Discuss this statement.
7 Use the Teratogens links in the
8 Use the Prenatal development
links in the Resources section of
your eBookPLUS to find the
weblink and questions for this activity.
6.3
The health status of Australias pregnant

women andunborn babies
KEY CONCEPT Understanding the health status of Australias pregnant

women and unborn babies
More than a quarter of a million babies are born in Australia each year. The health
of pregnant women is vital to ensure that these babies develop optimally and are
in the best possible health throughout the pregnancy and when born. Babies born
healthy are more likely to experience good health throughout their life. Pregnant
women and unborn babies in Australia generally experience a high level of health,
although there are some exceptions to this. Examining the health of pregnant
women and their unborn babies helps identify where improvements to health may
be possible.
The health status of unborn babies

Data relating to the health status of unborn babies is often combined with babies in
the first weeks of life. As a result, some figures relate to those in the prenatal and/
or infancy stage of the lifespan.
Foetal mortality
Foetal mortality relates to the death of babies over 20 weeks gestation or weighing
at least 400grams. In 2012, the foetal mortality rate was estimated to be 7.2deaths
for every 1000 births.
Foetal death rates vary for different population groups in Australia. In 2012, the
foetal death rate per 1000 total births ranged from 6.4 for babies of mothers aged
2529 to 12.6 for teenage mothers. The foetal death for babies of mothers aged
40 or older was 11.2. Babies of Aboriginal or Torres Strait Islander mothers had a
foetal mortality rate one and a half times that of babies of non-Indigenous mothers
(figure 6.11).
14
Deaths per 1000 births
12
10
8
6
4
2
0
Younger
than 20
2024
2529
3034
3539
40 and
over
Indigenous
Maternal age
NonIndigenous
Indigenous status
FIGURE 6.11 Foetal mortality rates for selected population groups, 2012
Source: Adapted from Hilder et al. 2014, Australias mothers and babies 2012, Perinatal statistics series no. 30,
cat. no. PER69, Canberra: AIHW.
6.3 The health status of Australias pregnant women andunborn babies

The main causes of foetal mortality are congenital abnormalities (or anomalies),
maternal conditions, spontaneous preterm birth and unexplained antepartum
death (seefigure 6.12).
30%
27%
Other causes
Congenital abnormalities
Unexplained antepartum deaths
Spontaneous preterm births
FIGURE 6.12 Causes of foetal

mortality, per cent of total, 2012
Source: Adapted from Hilder et al. 2014, Australias
mothers and babies 2012, Perinatal statistics series
no. 30, cat. no. PER69, Canberra: AIHW.
Maternal conditions
11%
20%
12%
Congenital abnormalities, sometimes referred to as birth defects, accounted

for 27.1 per cent of all foetal deaths. Congenital abnormalities often result from
missing or ill-formed body structures. They may have a genetic, infectious or
environmental origin, although in most cases it is difficult to identify their cause.
Unexplained antepartum death contributes 20.4 per cent of foetal deaths.
Unexplained antepartum deaths relate to babies who are born with no signs of life.
The causes of these deaths are unknown.
Spontaneous preterm births relate to births where labour begins without medical
intervention between the 20th and 37th weeks of pregnancy. The organs of babies
born prematurely are often not developed enough to function adequately outside the
uterus. Most babies born prematurely will survive, but spontaneous preterm births
still contribute to 11.7percent of all foetal deaths. The lungs are the last organs to
develop and respiratory problems contribute significantly to the deaths that do occur.
Maternal conditions relate to ill-health of the mother that contributes to the death
of the foetus. Examples include diabetes, cardiovascular disease and rubella (also
referred to as German measles). Maternal conditions also include mental health
problems that may result in a termination of medically uncomplicated pregnancies.
Prenatal morbidity
Many causes of morbidity among unborn babies go undiagnosed until after birth.
As a result, data are not available relating to many aspects of health status in the
prenatal stage. Conditions that may be diagnosed in unborn babies include neural
tube defects and Down syndrome.
Neural tube defects

The neural tube is a casing that encloses the brain and spinal cord during the
embryonic stage of development. The edges of the neural tube fuse together in
around the third week of pregnancy. Neural tube defects (NTDs) are a group
of conditions that occur when the neural tube does not fuse completely. These
conditions can lead to morbidity and mortality in unborn babies, depending on
their location and severity. The part of the neural tube that does not fuse will
determine the type of defect experienced (see figure 6.13):
Spina bifida occurs when the part of the neural tube that will form the spinal
cord fails to fuse. As a result, the bones that develop into the spine are unable
to form properly, leading to an opening in part of the spine through which the
spinal cord may protrude.
202
UNIT 2 Individual human development and health issues
Anencephaly occurs when the neural tube does not close at the
head, and the top part of the brain, skull and scalp are partially or
totally missing. These babies usually die at, or soon after, birth.
Encephalocele occurs when part of the brain and/or surrounding
membrane are pushed through an opening in the skull. This
condition is rarer than other neural tube defects and is usually
treatable with surgery provided other severe abnormalities are not
present and the defect is not too large.
There is strong evidence that adequate folate intake can reduce the
risk of NTDs in unborn babies. The neural tube fuses early during
the pregnancy and many women may not know they are pregnant at
this point in time. As a result, women who are planning to become
pregnant should ensure that adequate amounts of folate are being
Spina bifida
consumed prior to fertilisation where possible.
Based on data from the three Australian states that fully monitor
NTDs (Victoria, South Australia and Western Australia), there has been a small
decline in the overall prevalence of NTDs per 10000 births between 1998 and
2008 (figure 6.14). The introduction of mandatory fortification for all commercially
baked bread (except organic bread) in 2009 was expected to reduce the rate of
neural tube defects further but data relating to this was unavailable at the time of
writing.
Anencephaly
Encephalocele
Figure 6.13 The area of the neural

tube affected will determine the type
of neural tube defect experienced.
15
Per 10,000 births
12
9
6
3
0
1998
1999
2000
2000
2002
2003
Year
2004
2005
2006
2007
2008
Figure 6.14 Overall prevalence of

neural tube defects in Victoria, South
Australia and Western Australia,
19982008
Source: AIHW, Australias health 2012, p. 62.
Down syndrome
Down syndrome is a condition caused by a chromosomal abnormality. For people
with Down syndrome, there are three chromosomes on the twenty-first pair instead
of the usual two (see figure 2.24, page 65). This extra chromosome produces a
number of symptoms common to many people with this condition, including:
Eyes nearly all people with Down syndrome have a slight upward slant of
the eyes.
Face this is often rounded and tends to have a flat profile.
Stature babies with Down syndrome are usually smaller and weigh less at
birth than others. Children tend to grow more slowly and are commonly smaller
than other children their age. Adults with Down syndrome are commonly
smaller than the general population.
Slowed intellectual development those with Down syndrome will reach the
same milestones as other babies, but may take longer to achieve them.
Besides slowed intellectual development and the physical characteristics,
individuals with Down syndrome are no different to others in the population.
Down syndrome is the most common chromosomal abnormality in Australia
and between 45 and 60 babies are born with Down syndrome every year.
Figure 6.15 This little girl displays the facial features typical of Down syndrome.
The health status of

pregnant women
Maternal mortality
Maternal mortality relates to deaths among pregnant women where the cause of
death is attributed to the pregnancy itself. Pregnant women in Australia experience
low maternal mortality rates compared to most other countries, although there
is some variation among population groups within Australia. Between 2006 and
2010, maternal mortality rates for Aboriginal or Torres Strait Islander women were
more than three times as high as for other women. There were 16.4 deaths per
100000 women giving birth, versus 5.4 per 100000 for non-Indigenous women.
Causes of maternal mortality include cardiovascular conditions and haemorrhage
(excessive blood loss). In most cases, however, these conditions do not lead to
death and are managed with medical intervention.
Maternal morbidity
Although most women will not experience a diagnosed condition during pregnancy,
the vast changes occurring in a womans body during pregnancy can contribute to
the development of a range of conditions. The conditions that can affect pregnant
women include gestational diabetes, mental health problems, pre-eclampsia and
ectopic pregnancy.
Gestational diabetes
Gestational diabetes is a form of diabetes that can occur during pregnancy in
women who have not previously been diagnosed with diabetes. Like all forms of
diabetes, gestational diabetes is characterised by high blood glucose levels (see
figure 6.16). Gestational diabetes usually goes away after pregnancy but can return
during subsequent pregnancies.
204
Gestational diabetes occurs in around 5 per cent of all pregnancies and is more
common in older women and those who are obese. This condition can impact on
women in numerous ways including:
high blood pressure
preterm labour
longer hospital stay than mothers without gestational diabetes
increased risk of developing type 2 diabetes
increased risk of cardiovascular disease.
Gestational diabetes increases the risk of many adverse outcomes for the
developing baby including high birth weight, respiratory conditions and jaundice.
High blood
glucose levels
in mother
Brings extra glucose

to baby
Causes baby to put

on extra weight
Figure 6.16 Gestational diabetes
can contribute to high birth weight of
thebaby.
Mental health
Maternal mental health issues such as depression have been traditionally associated
with the period after birth, but research now suggests depression is a significant
cause of ill health among pregnant women. According to the Australian Institute
of Health and Welfare, around 8.9 per cent of Australian women experience
depression during pregnancy. This figure increases to 15.7 per cent in the period
after birth (AIHW, 2012). Although mental health problems during pregnancy can
often be treated, in some cases they can contribute to self-harm and increased risk
of maternal mortality.
Pre-eclampsia
Pre-eclampsia is a disorder of pregnancy characterised by hypertension, protein in
the urine and fluid retention (also known as oedema) leading to swollen hands, feet
and face (see figure 6.17). Pre-eclampsia is the most common pregnancy disorder
in Australia, affecting between 5 and 10 per cent of all pregnant women. One to
two per cent of cases are severe enough to threaten the lives of both the mother
and her unborn child.
Pre-eclampsia generally occurs in the latter stages of pregnancy and often displays
no symptoms. As a result, regular medical check-ups throughout pregnancy are
recommended.
The only cure for this condition is the delivery of the baby. Pre-eclampsia
accounts for one in five inductions and one in six Caesarean sections in Australia.
Protein in the urine

High blood pressure
Oedema
Figure 6.17 Common signs of pre-eclampsia. The signs of pre-eclampsia often

cannot be felt and regular health care is essential to make an early diagnosis of this
condition.
Unit 2
AOS 1
Topic 3
Concept 1
Pregnant
women
and unborn
babies
Concept summary
and practice
questions
The reasons for the development of pre-eclampsia are not known, but genetic
factors and the placenta seem to play significant roles. For reasons unknown, preeclampsia tends to be more common in first-time mothers than those experiencing
subsequent pregnancies. The mothers blood pressure usually returns to normal
after the baby and placenta are delivered.
In its most severe forms, it can cause problems in the kidneys, liver, brain and
blood. It is difficult to predict who will be affected, but certain women appear to be
more at risk than others, including:
Women experiencing their first pregnancy
Those with pre-existing high blood pressure or some other types of vascular
disease
Women with a family history of the condition
Diabetics
Women pregnant with multiple foetuses.
206
Ectopic pregnancy
An ectopic pregnancy occurs when, instead of implanting in
the uterus, the embryo implants elsewhere in the mothers
reproductive system. The fallopian tubes are the most common
site of implantation in ectopic pregnancies (see figure 6.18),
but implantation can occur in a range of other places including
the abdomen and cervix. In Australia, around five in every
1000 pregnancies are ectopic and, in most cases, the embryo
does not survive. The fallopian tubes are not large enough to
accommodate the growing embryo and the placenta cannot
access the nutrient-rich lining of the uterus. Symptoms can
include cramping, abdominal pain and vaginal bleeding. One
in five cases of ectopic pregnancy will cause the fallopian tube
to rupture and bleed excessively, which is a medical emergency
and needs immediate surgery.
Foetus
Fallopian
tube
Uterus
Figure 6.18 The fallopian tubes are the most common site
of implantation in ectopic pregnancies.
TEST Your Knowledge
APPLY Your Knowledge
1 Explain the following terms:

(a) foetal mortality
(b) maternal mortality.
2 Discuss the relationship between maternal age and
foetal mortality rates as shown in figure6.11.
3 Identify and describe the three main causes of foetal
mortality in Australia.
4 Explain why morbidity data relating to the prenatal
stage are not readily available.
5 (a) What is the neural tube?
(b) Explain each of the three types of neural tube
defect.
6 Explain why folate consumption is important prior
to fertilisation.
7 Explain how gestational diabetes can contribute to
high birthweight babies.
8 Explain the following:
(a) gestational diabetes
(b) pre-eclampsia
(c) ectopic pregnancy.
9 Explain how each of the following could impact on

the health of pregnant women:
(a) gestational diabetes
(b) pre-eclampsia
(c) prenatal depression
(d) ectopic pregnancy.
10 Create an information booklet or short video that
could be used to inform women of common health
conditions experienced during pregnancy.
11 Use the Pre-eclampsia links in the Resources
section of your eBookPLUS to find the
12 Use the Ectopic pregnancy links in the
activity.
KEY SKILLS Health and individual human development

during the prenatal stage of the lifespan
KEY SKILL Describe the characteristics of
development from conception to birth
The start and end points of the

embryonic stage are identified.
The major characteristic of the stage

is identified and examples provided
to illustrate understanding.
The key requirement for this key skill is to be able to describe the development that
occurs from conception until birth. An understanding of the process of fertilisation
and the physical changes that occur during the three stages of the prenatal stage of
the lifespan is essential.
Consider the following example, which is a discussion of the development that
would be taking place during the embryonic stage in the prenatal stage of the
lifespan:
The embryonic stage of prenatal development begins when the embryo implants
in the uterus and ends at the eighth week of pregnancy.
The embryonic stage is characterised by cell differentiation where the cells start
taking on specialised roles such as brain, bone, skin and muscle. Most organs and
systems are formed during the embryonic stage including the circulatory, nervous
and digestive systems.
Limbs, fingers and toes begin to develop and by the end of the embryonic stage
the embryo is distinctly human-looking, although it is only around 2cm long. The
head and neck make up half the length of the embryo.

1 Explain the process of fertilisation.
2 Lois is eight weeks pregnant. Describe the changes Lois unborn baby will go
through between now and the end of the pregnancy.
3 Outline the characteristics of the germinal stage of prenatal development.
KEY SKILL Interpret data on the health status of

pregnant women and unborn babies
Rates have decreased overall, but
there were some increases. Including

the qualifier generally takes this into
account.
Reference is made to the span of
years over which the trend occurred.

Try to avoid making statements such
as maternal mortality rates have
decreased, as this indicates that the
trend is currently occurring when the
data do not support this.
Data from the graph are used and

the correct units and time periods
identified.
Exceptions to the overall trend are
identified. In this case, increases

in maternal mortality rates are
identified and data used to illustrate
understanding.
This key skill requires the analysis of data related to the health of pregnant women
and unborn babies. Data can be presented in a number of ways. To revisit this
skill, refer to the key skills section of chapter 2 (pages 745) and follow the steps
outlined there. Knowledge of the basic issues concerning the health status of
pregnant women and unborn babies will be beneficial in applying this key skill.
In the following example, the data in figure 6.19 are analysed and conclusions
drawn about the health status of Australias pregnant women.
In describing the trends evident in this graph, the following three statements can
be made. However, there are important considerations to be taken into account.
Generally, maternal mortality rates decreased between 197375 and 200610.
Maternal mortality rates were around 12.7 deaths per 100000 women giving
birth in 197375 compared to around 7 per 100000 women giving birth in
200610.
There were four periods of time when maternal mortality rates increased. These
increases were relatively minor, with the exception of the period between
199193 and 199496 when rates increased from around 6 to 9 deaths per
100000 women giving birth.
13
12
11
10
9
8
7
6
5
4
3
2
1
0
01
5
2
06
20
20
03
00
2
00
9
2
20
00
99
6
97
19
99
3
99
94
19
0
1
91
99
19
7
98
1
88
19
4
98
19
85
1
1
19
82
98
8
97
79
19
1
76
19
19
73
97
Note: 20062010 is a five-year period; previously three-year reporting periods were used.
Figure 6.19 Maternal mortality

rate, per 100000 women giving birth
Source: Johnson et al. 2014, Maternal deaths in
Australia 20062010, Maternal deaths series no.4,
cat.no.PER61, Canberra:AIHW, p.14.

4 The following data show foetal mortality rates according to the weight of
thefoetus.
350
Deaths per 1000 births
300
250
200
150
100
50
0
Less than
1500
15002499
25002999
30003999
4000 and
over
Weight of foetus (grams)

FIGURE 6.20 Foetal mortality rate per 1000 births according to the weight of the
foetus
Source: Adapted from Hilder et al. 2014, Australias mothers and babies 2012, Perinatal statistics series no. 30,
cat. no. PER69, Canberra: AIHW.
(a) Describe the trend evident in the graph above.

(b) What conclusion can be drawn relating to weight of the foetus and foetal
mortality rates?
CHAPTER 6 review
Chapter summary
Sex cells such as sperm and ova hold genetic material from each parent.
Interactivities:
Chapter 6 Crossword
Chapter 6 Definitions
Fertilisation is the process whereby the genetic material of the sperm and ovum fuse
together to make a complete cell called a zygote. This process usually occurs in the
fallopian tube.
In-vitro fertilisation can be used when fertilisation cannot occur naturally. In IVF,
fertilisation occurs outside the mothers body and the embryo is placed in the uterus in
the hope that implantation will occur.
Intracytoplasmic sperm injection involves injecting a single sperm into an ovum. This
procedure can be used when the sperm cannot fertilise the ovum naturally.
Fertilisation marks the beginning of the prenatal stage of the lifespan.
The prenatal stage can be divided into the germinal, embryonic and foetal stages.
Unit 2
AOS 1
Sit Topic test
Health and
individual
human
development
during the
prenatal stage
of the lifespan
Growth during the prenatal stage is the fastest of all lifespan stages.
Teratogens can have a large impact on the developing baby.
The germinal stage is characterised by rapid cell division.
The embryonic stage is characterised by organ development.
The foetal stage is characterised by rapid growth.
The placenta is an organ that facilitates the transfer of nutrients, liquids and gases from
mother to baby.
Most mothers and their unborn babies experience good health in Australia, although a
number of health concerns do occur.
Foetal mortality rates relate to deaths that occur in unborn babies from 20 weeks
gestation or weighing at least 400 grams.
Foetal mortality rates are comparatively low in Australia, although some population
groups experience higher rates than the national average. Younger mothers, older
mothers and Indigenous mothers all experience higher foetal mortality rates than the
average.
The main causes of foetal mortality are congenital abnormalities, unexplained
antepartum deaths, spontaneous preterm birth and maternal conditions.
Neural tube defects and Down syndrome are two conditions that are often diagnosed
during pregnancy.
Maternal mortality rates relate to deaths of pregnant women. Maternal mortality rates
are low in Australia.
Causes of maternal morbidity include gestational diabetes, mental health issues,
pre-eclampsia and ectopic pregnancy.
TEST your knowledge
1 Explain the process of fertilisation.

2 Discuss one option for a couple experiencing
difficulties achieving pregnancy.
3 (a) Outline the major characteristics of the germinal,
embryonic and foetal stages of prenatal
development.
(b) Explain why the prenatal stage of development
is so important for future development.
4 Discuss two health concerns for pregnant women.
5 (a) Find a strategy that has been put in place to

address a major concern for the health and
development of pregnant women or unborn
babies and prepare a fact sheet about it.
(b) If you have time, present your findings to
yourclass.
CHAPTER 7

during the prenatal stage
WHY IS THIS IMPORTANT?
The determinants of health and individual human
development are important during the prenatal stage
because they significantly influence the health and
development of boththe pregnant woman and her
unborn baby. How effectivelythe body functions, the
lifestyle choices made by parents, the physical environment
in which parents live and social determinants such as the
education of parents can have an effect on health and
individual human development during the prenatal stage.
The determinants of health and development are vital
in understanding the range of health issues that can
impact on pregnant women and unborn babies, including
spina bifida, low birth weight, foetal alcohol syndrome
(or foetal alcohol spectrum disorder) and gestational
diabetes. Understanding how the determinants act as
risk and protective factors allows a range of government,
community and personal strategies and programs to be
implemented promoting health and development during
the prenatal stage of the lifespan.
KEY KNOWLEDGE
1.4 determinants that have an impact on health and individual human
development during the prenatal stage of the lifespan, including at
least one from each of the following:
biological, such as genetics (pages 21418, 250)
behavioural, such as maternal nutrition prior to and during
pregnancy, parental smoking, alcohol and drug use during
pregnancy, and vaccination (pages 21926, 250)
physical environment, such as tobacco smoke in the home and
access to health care (pages 22730, 250)
social, such as parental education, parental income, parental
health and disability and access to health care (pages 2435)
1.5 determinants that act as risk and/or protective factors in relation to
one health issue such as spina bifida, low birth weight, foetal alcohol
syndrome or gestational diabetes (pages 2313, 251)
1.6 government, community and personal strategies and programs
designed to promote health and individual human development of
pregnant women and unborn children (pages 2426, 251).
212
FIGURE 7.1 The prenatal stage is

the first stage of the lifespan and a
range of determinants contribute
to the health and individual human
development of pregnant women
and their unborn babies.
Key skills
explain the determinants of health and
individual human development and
their impact during the prenatal stage
of the lifespan using relevant examples
(pages218, 224, 226, 230, 233, 241,
2467, 251)
describe a specific health issue affecting
the prenatal stage of the lifespan and
draw informed conclusions about
personal, community and government
strategies and programs to optimise
prenatal health and development
(pages241, 246, 2489, 251).
antenatal occurring before birth
carrier a person who has inherited a genetic trait or
condition but does not display the trait or symptoms.
They are able to pass the gene on to their children,
who may or may not display the trait or symptoms.
chromosomes strands of DNA that contain genetic
information
developmental milestones physical, social,
emotional and intellectual developments that most
children achieve by specific ages
endocrine system the system in the body that
regulates the production and release of hormones
(through the glands)
foetal alcohol spectrum disorder describes a range
of features seen in babies who have been exposed to
alcohol during the prenatal stage
genes the blueprint of the body that controls growth,
development and how the body functions
haemophilia an inherited condition characterised
by an inability of the blood to clot. Both males and
females can carry the gene for haemophilia, but the
condition is usually present only in males.
hormone a chemical in the body that causes a change
in the functioning of a specific tissue or organ
inherited condition a condition that is passed down
from parents to children
Listeria monocytogenes bacteria that can increase
the risk of stillbirth, miscarriage and premature labour
in pregnant women
maternal nutrition the dietary intake of the mother
during pregnancy
sex-linked chromosome genetic material that
determines the sex of the developing baby
vaccination the administration of a micro-organism
of a disease to bring about an immune response
7.1
Determinants of health and individual development

during the prenatal stage of the lifespan: biological
KEY CONCEPT Understanding the biological determinants that have

an impact on health and individual human development during the
prenatal stage of thelifespan
The prenatal stage of the lifespan is when the foundations are laid for later life.
Optimal health and development during this stage is important to help promote
optimal heath and development throughout the lifespan.
The health and individual human development of unborn babies are influenced
by a range of factors including:
biological influences such as genetics
behavioural factors, such as maternal nutrition prior to and during pregnancy,
parental smoking, alcohol and drug use during pregnancy, and vaccination
behaviours
physical environment, such as tobacco smoke in the home and access to
healthcare
social factors, such as parental education, parental income, parental health and
disability, and access to health care.
Understanding the determinants that influence the health and development
experienced during the prenatal stage allows personal, community and government
strategies to be implemented to optimise the health and development of unborn
babies in Australia.
Biological determinants
Genetics
An unborn baby begins life as a single cell containing the genetic information
passed down from the mother and father. Fifty per cent of an individuals genes are
passed down from the biological father and 50 per cent from the biological mother.
This information dictates much of the individual human development that occurs
throughout the prenatal stage and throughout life.
In chapter 6, you learnt how, at fertilisation, the genetic make-up of the
unborn child is determined. The genes that a child inherits from their biological
parents have a significant impact on the childs health and individual human
development. Genes are the blueprint of the body because they control growth,
development and how the body functions. An unborn babys genetic make-up
determines:
the rate and timing of development in the uterus as a result of the excretion of
hormones from the glands of the endocrine system
whether the unborn baby is male or female
the development of genetic conditions such as haemophilia
the development of chromosomal abnormalities including Down syndrome.
Genes are part of the chromosomes, which are long strands of deoxyribonucleic
acid (DNA) that contain genetic information and are found in the nucleus of human
cells. Each human cell except blood cells, which have no nucleus contains
46 chromosomes in 23 pairs. Of the 23 pairs, one pair is called the sex-linked
chromosome because it determines the sex of the individual (figure 7.2). The
combination of genes contribute to the physical characteristics of the individual
(e.g. facial features, sexual characteristics and eye colour), as well as genetic
conditions and chromosomal abnormalities.
Genetic conditions
Sometimes the genes for certain
genetic conditions are already
present in the mother or father
and can be passed on to the
1
2
3
4
5
children. These conditions are
called inherited conditions and
examples include cystic fibrosis
and haemophilia.
Cystic fibrosis is the most
6
7
8
9
10
11
12
common life-threatening genetic
disorder among light-skinned
people. In Australia, 1 in 2500
babies are born with cystic
13
14
15
16
17
18
fibrosis. Whether or not an
unborn baby will have cystic
fibrosis is determined at the time
19
20
21
22
of fertilisation. An abnormality
X
Y
on the seventh chromosome
causes cystic fibrosis but, in FIGURE 7.2 The 23rd pair of chromosomes determine whether the individual is male or
order to develop the condition, female.
two defective chromosomes must
be inherited, one from each parent. Individuals with one defective gene will not
display the condition, but are considered to be carriers. If two carriers have a
child, they have a 25 per cent chance of producing a baby with cystic fibrosis and a
50 per cent chance of producing a child that is a carrier (seefigure 7.3).
Mother Father
Carrier
(no symptoms)
Carrier
(no symptoms)
Each child inherits one copy of the gene from

the mother and one copy from the father.
Possible combinations:
Cystic
fibrosis
gene
Normal gene cancels

out the effect of the
defective gene.
This individual has only one cystic

fibrosis gene so will not have the
condition, but will be a carrier.
Cystic
fibrosis
gene
Normal
Carrier
Carrier
Affected
Chromosome with normal gene
Cystic
fibrosis
gene
This individual has two defective

genes and will therefore have
cystic fibrosis.
Chromosome with cystic fibrosis gene
FIGURE 7.3 How the inherited condition cystic fibrosis is passed on
Although cystic fibrosis can be detected in the prenatal stage, it is often not
diagnosed until the baby is born. This condition results in the secretion of a thick
The determinants of health and individual human development during the prenatal stage CHAPTER 7
215
7.1 Determinants of health and individual development during the prenatal stage of the lifespan:
biological
mucus that affects the lungs, pancreas, liver and reproductive system. In the lungs,
the mucus clogs small air passages and traps bacteria. This causes repeated bouts
of infection, and the blockages can result in irreversible damage to the lungs.
Lung failure is the major cause of death for people with cystic fibrosis. From
birth, a person with cystic fibrosis undergoes constant medical treatments and
physiotherapy. Currently there is no cure for cystic fibrosis.
Sex-linked genetic conditions

As explained earlier, each human egg and each human sperm contain one set of
23 chromosomes, with the 23rd chromosome being the one that determines the
sex of the individual. Each cell in the female body contains two X sex-linked
chromosomes, but each cell in the male body contains one X and one Y sex-linked
chromosome. Because every female egg contains one set of chromosomes,
every egg will have only the X sex-linked chromosome. In contrast, each
male sperm can have either an X sex-linked chromosome or a Y sex-linked
chromosome.
This explains why the gender of a developing baby is determined by the sperm.
If an X sperm fertilises an X egg, then the result is a female baby. If a Y sperm
fertilises an X egg, then the result is a male baby (figure 7.4).
Sperm carries either an

X chromosome or a
Y chromosome.
All female eggs

contain an
X chromosome.
X sperm fertilises an X egg
Female baby
Y sperm fertilises an X egg
Male baby
FIGURE 7.4 The sex of a child is genetically determined.
Some genetic conditions are carried on the X chromosome and a few

genetic conditions are carried on the Y chromosome. One normal copy of a
gene on the X chromosome is usually sufficient for normal function. Females
(XXchromosomes) who may have a defective copy of a gene on one of the two
X chromosomes are protected by the normal gene on the second X chromosome.
Conditions such as colour blindness are much more prevalent among males
(XY chromosomes) as colour blindness is carried on the X chromosome, of which
males have only one copy. Therefore, males do not have the protective factor of a
second chromosome carrying a normal gene.
Haemophilia is another example of a genetic condition where the gene is carried
on the X chromosome (figure 7.5). Haemophilia is a rare condition that affects
approximately 2300 Australians, most of whom are males. It is passed on by
females who carry the haemophilia gene and by males who have the condition.
Individuals with haemophilia do not have one of the essential factors required to
form a blood clot. This means they are prone to bleeding, particularly internally.
Bleeding may occur as a result of injury or trauma or can occur spontaneously.
Treatment involves the injection of the missing blood-clotting factor. If the bleeding
is not stopped, it can result in pain and swelling. People with haemophilia may
suffer from arthritis, chronic pain and joint damage as a result of bleeding into
joints and muscles over a period of time.
216
Haemophilia Genetic Inheritance

or
= has an X chromosome with the haemophilia genetic alteration

or
= has an unaltered X chromosome
When the father has haemophilia and

the mother is unaffected
When the mother carries the altered gene

causing haemophilia and the father is unaffected
Father
Mother
Father
Mother
XY
XX
XY
XX
XY
XY
XX
XX
None of the sons will have haemophilia.

All of the daughters will carry the gene.
Some might have symptoms.
XY
XY
XX
XX
There is a 50% chance at each birth that a son will have haemophilia.
There is a 50% chance at each birth that a daughter will carry the gene.
Some might have symptoms.
Haemophilia Foundation Australia (HFA) 2013 www.haemophilia.org.au
FIGURE 7.5 Haemophilia is a genetic condition that is carried on the X chromosome.
Chromosomal abnormalities
Abnormalities during the creation of sperm and ova can cause a range of conditions
in the unborn baby. Most often, these conditions arise as a result of too many or
too few chromosomes.
A common chromosomal abnormality is trisomy, where there are three copies of
a specific chromosome instead of the usual two. In most cases, an embryo with a
trisomy will not survive. In these cases, the pregnant woman has a miscarriage. The
miscarriage often occurs in the early stages of pregnancy, often before the woman
realises she is pregnant.
The risk of trisomy abnormalities increase with the age of the mother. The
approximate risks are:
1 in 1300 at age 25
1 in 1000 at age 30
1 in 400 at age 35
1 in 100 at age 40
1 in 35 at age 45.
Other chromosomal abnormalities occur when part of a chromosome is missing,
duplicated or attached to the wrong part of the chromosome.
Common chromosomal abnormalities include:
Down syndrome Down syndrome (also known as Trisomy 21) occurs
when there are three copies of the 21st chromosome. One of the most common
chromosomal conditions, individuals with Down syndrome generally have an
intellectual disability and characteristic facial features.
Trisomies 13 and 18 These trisomies usually are more severe than Down
syndrome, but less common. Babies with either of these conditions often have
severe intellectual disabilities and physical birth defects. Most babies born with
these conditions die before their first birthday.
217
biological
Unit 2
AOS 1
Topic 4
Concept 1
Biological
determinants
prenatal
Concept summary
and practice
questions
Turner syndrome Turner syndrome affects girls who are missing all or part
of one of their X chromosomes. They are usually infertile and do not undergo
the normal changes associated with puberty. Turner syndrome can result in short
stature and cardiovascular and kidney problems.
Triple X syndrome Girls with this condition have an extra X chromosome.
Affected girls generally have no physical birth defects, experience normal puberty
and are fertile. Affected girls usually have normal intelligence, though many have
learning problems. As the effects of this condition are subtle, many of those
affected go undiagnosed.
Klinefelter syndrome This condition affects only boys and is characterised
by having two, and sometimes more, X chromosomes in addition to their
Y chromosome. Affected boys usually have normal intelligence, although may
have learning difficulties. As adults, they produce lower-than-normal amounts of
the male hormone testosterone and are infertile.
XYY syndrome This condition affects males, who have an extra Y chromosome.
XYY syndrome results in fertile males who generally have normal intelligence
although some experience learning, behavioural and/or speech problems. Some
with this condition are taller than normal. Like triple X females, many affected
males dont know they have a chromosomal abnormality.
TEST your knowledge
1 What determines the genetic make-up of an

individual? Explain.
2 Outline three aspects of health and/or development
during the prenatal stage that are influenced by
genetics.
3 With reference to sex-linked chromosomes, explain
how sex is determined.
4 What are the chances of a mother and father who
are carriers of cystic fibrosis having a child with the
condition? Explain why this is the case.
5 Explain why sex-linked conditions sometimes affect
only either males or females.
6 Explain the term trisomy.
7 Using examples, explain what the difference is

between a genetically inherited condition and a
chromosomal abnormality.
8 Genetics play the most significant role in the health
and individual human development of unborn
babies. Discuss.
9 Using the internet, research:
(a) ways that inherited and chromosomal conditions
can be tested for during the prenatal stage.
(b) what genetic testing relates to. How could this
information be used prior to pregnancy?
10 Use the Genetics during the
prenatal stage links in the
Resources section of your eBookPLUS to find the
7.2

during the prenatal stage of the lifespan: behavioural
KEY CONCEPT Understanding the behavioural determinants that have

an impact on health and individual human development during the
prenatal stage of the lifespan
The behavioural determinants that impact on prenatal health and development
are related to the behaviours and choices of the parents, both before and during
pregnancy. Examples include maternal nutrition status, parental smoking, alcohol
and drug use during pregnancy, and vaccination behaviours.
Maternal nutrition
Figure 7.6 Maternal nutrition is important for the health and individual human
development of the growing baby.
For women of child-bearing age, ensuring a healthy balanced diet prior to

becoming pregnant is important for preparing the body for the demands of
carrying a baby. A womans nutritional status during pregnancy is influenced by the
nutritional reserves that are built up in her body prior to conception. Women who
have nutritional deficiencies prior to conceiving a child are likely to have these
deficiencies during pregnancy, particularly as the body faces additional nutritional
demands because of the growing baby. Although a balanced intake of all nutrients
is required for optimal prenatal development, it is particularly important that
women consume the required amount of folate, iron and calcium prior to and
during pregnancy.
Ensuring good nutrition prior to conception is important because the ongoing
development of the foetus is dependent on the health of the embryo. Upon
implantation, the embryo divides into two types of cells those that form the
foetus and those that form the placenta. In undernourished women, a greater
proportion of cells are likely to form the placenta rather than the foetus, which
means the foetus will be relatively small when it begins its growth, and its
development in the uterus will be restricted. There is an increased risk that the
baby will be low birth weight when born.
The determinants of health and individual human development during the prenatal stage CHAPTER 7 219
behavioural
Folate (folic acid)
Figure 7.7 Lack of folate before

and during pregnancy can result in
neural tube defects that may cause
deformities of the spine.
Folate is a B-group vitamin that is required for the formation of red blood cells,
which transport oxygen around the body. It also assists with DNA synthesis, cell
growth and the development of the nervous system of the foetus. Adequate folate
consumption before and during pregnancy reduces the risk of neural tube defects
in the baby. Neural tube defects involve damage to the brain and spine, and to
the nerve tissue of the spinal cord. The vertebrae or skull may not close properly
during development, which results in the spinal cord or brain being exposed and
placed at risk of further damage.
Spina bifida is the most common neural tube defect and occurs when the spinal
nerves protrude through the gap in the unclosed vertebrae instead of growing
down the middle of the spinal column. Spina bifida may result in one or more of
the following symptoms:
walking difficulties, which may result in the inability to walk
reduced sensation in the legs and feet
increased risk of burns and pressure sores due to limited feeling
urinary and faecal incontinence
sexual dysfunction
deformities of the spine, commonly referred to as scoliosis (figure 7.7).
Good sources of folate include green leafy vegetables, poultry, eggs, cereals, citrus
fruits and legumes. In Australia, many cereal products including bread are fortified
with folate.
Iodine
Iodine is a mineral that is required in greater amounts during pregnancy to
promote optimal brain and nervous system development. If iodine is deficient
during pregnancy, the consequences can be serious and include stunted growth
and intellectual disability.
Countries that have a sufficient iodine concentration in the soil generally get
enough iodine from crops grown on the land. In countries that do not have enough
iodine in the soil (such as Australia), iodine is added to other food items. In
Australia, most iodine comes from iodised salt and bread fortified with iodised salt,
but is also present in fish, seaweed, eggs, cows milk and strawberries.
Australians are reducing their intake of salt as a result of the increasing rates of
cardiovascular disease, so people are now at an increased risk of iodine deficiency
and need to ensure their requirements are being met by other dietary sources,
especially during pregnancy. In Australia, recent studies conducted in Victoria and
New South Wales indicate mild-to-moderate iodine deficiency in all groups.
Iron
Figure 7.8 Pregnant women need

to choose a wide variety of foods
in order to meet the nutritional
requirements of their baby.
Iron is a mineral that is required in greater amounts during pregnancy due to the
increased demand for oxygen for the developing foetus as well as the increased
energy needs of the mother. During pregnancy, there is an increase in blood volume
to cater for the developing baby as well as the enlarging reproductive organs of
the mother. Iron is needed for haemoglobin, a component of blood that carries
oxygen around the body. Good sources of iron include red meat, fortified cereals,
egg yolks, legumes, nuts and green leafy vegetables. Vitamin C assists with the
uptake of iron from the small intestine. High-fibre diets, alcohol and tannic acid in
tea can interfere with iron absorption.
Lack of iron can lead to iron-deficiency anaemia, resulting in the body not having
enough iron to form haemoglobin. In pregnant women, iron-deficiency anaemia
can increase the risk of a premature birth and a low birth weight baby.
Calcium
Calcium is required for the strengthening of bones and teeth. During pregnancy,
calcium is required to meet the needs of the developing foetus as well as ensuring
the maintenance of bone mass for the mother. Good food sources of calcium
include dairy products such as milk, cheese and yogurt. If a pregnant woman
does not consume the required amount of calcium-rich foods, the calcium that the
developing baby needs will be leached (or taken) from the mothers bones. This
could lead to osteoporosis in later life.
Foods to avoid during pregnancy

Some foods contain the bacteria Listeria monocytogenes, which increase the risk
of miscarriage, stillbirth or premature labour. For this reason, pregnant women
should avoid the following foods:
soft-serve ice-cream
unpasteurised foods and soft cheeses such as camembert and ricotta
pre-cooked or prepared cold foods such as quiches, delicatessen meats, salad
from buffets
raw seafood such as oysters and smoked seafood such as salmon.
Foods that contain high levels of mercury can put the baby at risk of delayed
development in the early years. The effects may not be noticed until the child
fails to reach developmental milestones at the expected age. It may also result
in difficulties with memory, language and attention span. Women need to
be selective about the type of fish they consume during pregnancy, as some
fish have significantly higher levels of mercury than others. Shark, swordfish,
barramundi, gemfish, orange roughy and southern bluefin tuna should all be
avoided.
Parental smoking during pregnancy

Smoking during pregnancy is a significant risk factor for a number of conditions
for both the mother and her unborn baby. Tobacco smoke contains thousands
of chemicals, and acts to reduce oxygen flow to the placenta and exposes the
developing foetus to numerous toxins. Maternal smoking increases the risk of a
range of health and developmental conditions of the unborn baby including:
spontaneous abortion
ectopic pregnancy
prematurity
complications of the placenta
birth defects
lung function abnormalities
respiratory conditions
foetal mortality.
According to the Australian Institute of Health and Welfare (2012), there is
evidence that the more cigarettes a mother smokes, the higher the risk of poor
birth outcomes.
Maternal smoking rates are higher in some population groups including
Indigenous women, teenagers, single mothers and mothers with lower
socioeconomic status. According to a survey taken by the AIHW in 2012, almost
half of Aboriginal and Torres Strait Islander mothers reported smoking during
pregnancy (48.1 per cent), compared with 10.7 per cent of non-Indigenous women
who gave birth. Of all teenage mothers, 34.9 per cent reported smoking.
Maternal smoking rates have declined significantly over time (figure 7.10),
reflecting the decreasing rates of smoking in the community as a whole.
Figure 7.9 Tobacco or alcohol

use during pregnancy can harm the
developing baby.
behavioural
Per cent of pregnant women who smoked
20
FIGURE 7.10 Proportion (per cent)

of pregnant women who smoked,
by year
Small head
16
15
14
13
12
11
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year
Low nasal
bridge
Short
nose
Smooth
philtrum
17
2001
Small eye
openings
Flat
cheeks
18
10
Source: Adapted from AIHW, Australias mothers

and babies, various years.
Epicanthal
(skin) folds
19
Thin
upper lip
Underdeveloped jaw
Figure 7.11 Foetal alcohol spectrum

disorder is seen in the facial features
of affected children.
Alcohol use during pregnancy

Alcohol can cause problems for women even before pregnancy because it may
interfere with fertility. Therefore women who are trying to fall pregnant should
limit their consumption of alcohol or stop it altogether. The consumption of
alcohol during pregnancy can cause significant harm to the unborn child.
When alcohol is consumed by a pregnant woman, it crosses the placenta
from the mothers blood to the babys blood. This can result in foetal alcohol
spectrum disorder (figure 7.11). A foetus that is severely affected by foetal
alcohol spectrum disorder is at risk of dying before birth. The alcohol may
harm the development of the nervous system of the foetus, including the
brain. It may also narrow the blood vessels in the placenta and umbilical cord,
thereby restricting blood supply to the foetus. The impact of foetal alcohol
spectrum disorder on the health and individual human development of the
unborn child is described in table 7.1.
Table 7.1 Impact of alcohol consumption on the health and individual human development of the unborn child
Impact of alcohol consumption on
Impact of alcohol consumption on health

Increased risk of premature birth
Increased risk of stillbirth
Undernourishment of the growing baby due to alcohol blocking
the absorption of nutrients
Reduction in the amount of oxygen available to the baby due
to alcohol narrowing the blood vessels in the placenta and/or
umbilical cord resulting inthe restriction of blood supply
Low birth weight

Smaller head circumference (microcephaly)
Small eyes and epicanthal folds
Flattened face, including the bridge of the nose due to earlier than
normal cell changes in the babys face during development
Underdeveloped vertical ridges between the nose and upper lip
Smaller lower jaw
Heart defects
Restriction of movement of elbow and knees due to tightening of
ligaments, muscles, tendons and skin around the joints
Source: Adapted from Foetal alcohol syndrome, Better Health Channel, www.betterhealth.vic.gov.au.
Heavy consumption of alcohol, particularly in the first trimester (first three

months) of pregnancy, is considered to be particularly dangerous to the foetus.
The World Health Organization recommends that pregnant women consider not
consuming alcohol at all.
Case study
Pregnant pause on alcohol

By Fiona Baker
The advice from experts is clear: theres no safe level
of alcohol consumption in pregnancy. But that message
becomes impacted by a lot of human factors.
More and more is being understood about foetal
alcohol spectrum disorder (FASD), an umbrella term
for a range of physical, developmental and neurological
disabilities resulting from alcohol consumption in
pregnancy.
Health experts believe its far more widespread
than previously believed. In the US, FASD is the most
common cause of developmental delay and is estimated
to affect between 2 and 7percent of all births.
This isnt a condition thats only found in
disadvantaged pockets of the community, because
drinking isnt confined to socioeconomic groups,
explains Elizabeth Elliott, a professor of paediatrics
and child health at the University of Sydney.
What we do know is that women who dont drink
any alcohol during pregnancy face no risks of [this kind
of] damage to their foetus, she says.
Frequent, high intakes of alcohol, and particularly
binge drinking, increases the risk.
What we dont know is the risk to an individual
pregnancy. Each pregnancy is different and every
womans body responds differently to alcohol
consumption because of a range of factors such as age,
body composition, genetics and prior disease.
So, she strongly advises that expecting and trying-toconceive women apply the precautionary principle as
recommended in Australias national alcohol guidelines
that not drinking alcohol is the safest option.
However, thats where some of these human factors
come in.
Despite living in an age of highly accessible
contraception, almost 50 per cent of pregnancies
in Australia are unplanned. Add to that another
contemporary issue of the sharp increase in young
women binge drinking, and the message of having an
alcohol-free pregnancy becomes blurred.
A new study from Newcastle University has revealed
that eight in 10 expectant mums drink alcohol in
pregnancy 64 per cent higher than found in other
Australian studies.
This follows survey results released last year by

the Foundation for Alcohol Research and Education
which found that 47 per cent of Australian women
interviewed consumed alcohol while pregnant before
knowing theyd conceived and almost 20 per cent
drank alcohol after confirmation of their pregnancy.
The most comparable figures for how much mums are
drinking come from the US, where almost 1.5percent
of women reported binge drinking while pregnant.
Elliott understands the panic women can feel if they
continued drinking at high levels while unknowingly
pregnant: We know birth defects can result from
first trimester alcohol exposure although the foetus is
vulnerable throughout the pregnancy.
The best advice we can provide is that the woman
talks about her alcohol consumption with her health
provider. In most cases well be able to provide
reassurance that everything should be fine but if there
are concerns, at least we can be prepared for that.
Meanwhile, Elliotts advice for women who are
planning to get pregnant is stop drinking now.
She describes prevention as the only option. This
should involve public education strategies such as
labelling of alcoholic drinks.
Currently, labelling of the harms of alcohol in
pregnancy is voluntary, but Elliott would like to see it
mandated and enforced.
The impact of FASD on a family is devastating and
its more common than we think, she says. Strategies
which focus on prevention are vital.
A foetus is exposed to similar amounts of alcohol
as the mother because it crosses the placenta into the
babys bloodstream.
The National Organisation for Fetal Alcohol
Spectrum Disorders (NOFASD) says the physical,
developmental and/or neuro-behavioural characteristics
of the disorder may not be noticed until the child
reaches school age. Foetal alcohol syndrome is at
the most serious end of the spectrum, and is often
accompanied by characteristic facial features, such as a
smooth philtrum (indent between the lip and nose), thin
upper lip, upturned nose, flat nasal bridge and midface
and small head circumference.
Red flags of FASD include developmental delays,
learning difficulties, major organ damage and problems
with memory and social relationships.
Source: Sunday Herald Sun, 12 August 2013.
(continued)
behavioural
Case study review

1 Briefly explain foetal alcohol spectrum disorder (FASD).
2 Discuss the factors that influence whether a mother drinks alcohol during
pregnancy.
3 Design a poster to educate females about foetal alcohol spectrum disorder.
Drug use during pregnancy

Drug use during pregnancy may have a significant effect on the health and
individual human development of the foetus. Some medications or drugs will
cross the placenta and potentially harm the unborn child. Side effects may include
withdrawal symptoms, developmental delay, intellectual disability, birth defects,
premature birth and stillbirth. The types of drugs that may be harmful include:
medicines (e.g. some prescription drugs, over-the-counter medicines, herbal
remedies or nutrition supplements)
caffeine
illegal drugs (e.g. cannabis, heroin, cocaine, amphetamines)
other substances used as inhalants (e.g. glue or aerosols).
The potential for harm to the unborn child depends on a range of factors including:
the type of drug being consumed
how the drug is taken
the amount taken
how often it is taken
whether the drug is used alone or in combination with other drugs
the response of the baby to the drug
the gestational age of the unborn baby
the level of health of the mother.
Table 7.2 outlines the possible effects of drug use on the health and individual
human development of the unborn baby.
Table 7.2 Possible effects of drug use on the health and individual human development of
the unborn child
Possible impact on health and/or individual
humandevelopment
Type of drug
Over-the-counter and
prescription medications,
nutritional supplements
and herbal medicine
Birth defects may be caused by some antibiotics, anticonvulsant

medication (e.g. for the treatment of epilepsy), drugs that treat some
rheumatic conditions, some thyroid medications, some blood thinning
medications, and high doses of vitamin A. Medicines are given a risk
category by the Australian Drug Evaluation Committee according to
their safety during pregnancy.
Caffeine
Increased risk of miscarriage, premature birth and stillbirth if consumed

heavily
Illegal drugs
Cannabis increased risk of poor or delayed growth

Heroin increased risk of low birth weight, premature birth, foetal
distress, stillbirth, blood-borne viral diseases, infant drug withdrawal
after birth
Cocaine increased risk of miscarriage, poor or delayed growth, birth
defects (e.g. brain, heart, genitals, urinary system), stillbirth
Amphetamines increased risk of miscarriage, premature birth, birth
defects (e.g. smaller head size, eye problems, cleft palate, limb and
brain defects), increased heart rate, infant drug withdrawal after birth
Substances used as drugs,

e.g. inhalants
Increased risk of miscarriage, low birth weight, birth defects, sudden

infant death syndrome (SIDS)
Source: Adapted from Birth defects and drugs and Pregnancy and drugs, Better Health Channel,
www.betterhealth.vic.gov.au.
224
Case study
The thalidomide tragedy

In 1956 Melbourne hosted the Olympic Games,
television arrived in Australia, and the first child with
disability caused by the medicine thalidomide was
born to an employee of the German pharmaceutical
company, who had taken samples home to his wife.
Thalidomide
was
marketed as a wonder drug
an effective tranquilliser
and pain killer useful for
insomnia, coughs and
headaches and it helped
pregnant women with
morning sickness!
It was considered to be
safe: in contrast to older tranquillisers, an overdose did
not result in death, but simply an extra long sleep.
However, no studies had been conducted to investigate
the safety of thalidomide for the unborn child.
In 1961 a German paediatrician, Dr HR Wiedemann,
described an epidemic of babies being born with limb
malformations, but the cause of this epidemic was
unknown.
Linking birth defects to thalidomide
At the end of 1961, the Australian Dr William
McBride and the German Dr Widukind Lenz separately
worked out the likely cause and effect relationship
between thalidomide use in early pregnancy and birth
defects.
In recent months I have observed that the
incidence of multiple severe abnormalities in
babies delivered of women who were given the
drug thalidomide (Distival) during pregnancy,
as an anti-emetic (anti-vomiting) or as a sedative,
to be almost 20percent.
WG McBride, The Lancet, December 1961
Thalidomide was withdrawn in Australia, Germany

and the UK by the end of 1961. Eight months after the
withdrawal of thalidomide, babies stopped being born
with the characteristic limb defects.
About 40percent of babies damaged by the effects

of thalidomide died in their first year. But there are
adults alive today who are living with disabilities
caused by thalidomide.
Australian response to thalidomide tragedy
The thalidomide experience brought home to
Australians the message that medicines have risks as
well as benefits.
Never again was the wish of the Australian
community, but what was the appropriate response?
It was decided that an independent committee should
be set up to monitor the safety of new medicines as well
as medicines that were already available. To achieve this,
the Australian Government established the Australian
Drug Evaluation Committee (ADEC) in June 1963.
Government control does not absolve drug
manufacturers from the responsibility of
conducting adequate laboratory and clinical tests
to ensure, as far as this is possible, the safety of
drugs before they are offered to the public.
AJ Forbes, Minister for Health, 1967 (preface to the
Report of the Australian Drug Evaluation Committee
June 1963December 1966)
Source: Therapeutic Goods Administration, Fifty years
of independent expert advice on prescription medicines,
12February2014, www.tga.gov.au.
Case study review

1 What was the intended purpose of thalidomide?
2 What impact did thalidomide have on unborn babies?
behavioural
Vaccination behaviours
Unit 2
AOS 1
Topic 4
Concept 2
Behavioural
determinants
prenatal
Concept summary
and practice
questions
Vaccination plays an important role in reducing the spread of many conditions

in Australia. Even though over 90 per cent of the population are up to date with
their vaccinations, most vaccine-preventable diseases still occur in Australia. The
prenatal stage of development is particularly susceptible to many of the effects
of vaccine-preventable diseases. The greatest impact of these conditions is often
during the embryonic stage because major organs, including those of the nervous
system, are formed at this time. Specific diseases and their possible impact on the
unborn baby include:
rubella can cause defects in the brain, heart, eyes and ears of the baby. It also
increases the risk of miscarriage and stillbirth.
chickenpox can cause defects in the brain, eyes, skin and limbs of the baby
measles increases the risk of miscarriage, premature birth or stillbirth
mumps increases the risk of miscarriage
hepatitis B can be passed on to the baby during birth. The mother and baby
can also become carriers of hepatitis B (when they have been infected and the
virus has not been cleared from their body).
influenza increases the risk of miscarriage, premature birth or stillbirth, and
increases the risk of severe illness and death in the mother
whooping cough can cause pneumonia, seizures, conditions affecting the
brain and the death of a baby (Source: Better Health Channel, Department of
Health, Victoria).
A possible side effect of some vaccines is mild fever which can increase the risk
of developmental abnormalities in the developing baby. As a result, vaccinations
will generally not be given during pregnancy. The exception to this is the influenza
vaccine which is deemed safe for pregnant women and can decrease the risk of
developing fever as a result of the disease itself.
To reduce the risk of contracting one of the vaccine-preventable diseases, women
who are planning a pregnancy should ensure their vaccinations are up to date prior
to fertilisation. Once pregnant, women can also reduce their risk of contracting
disease by regular hand washing, avoiding international travel and avoiding close
contact with sick people.
TEST your knowledge

1 Explain the importance of folate, iodine, calcium
and iron to the developing baby and/or mother
during pregnancy.
2 Explain why nutrition is an important consideration
prior to pregnancy.
3 Outline three possible effects on the unborn baby of
maternal smoking.
4 Discuss the changes in rates of maternal smoking
over time illustrated in figure 7.10.
5 What is the recommended alcohol level for
pregnant women?
6 Explain the possible impact of alcohol consumption
on the developing baby during pregnancy.
7 Outline the effects of foetal alcohol spectrum
disorder on the health and individual human
development of unborn babies.
8 Why should pregnant women avoid foods
such as soft cheeses, shellfish and soft-serve
ice-cream?
9 Why should pregnant women avoid fish that

contain high levels of mercury?
10 The use of drugs can have a significant impact
on the health and individual human development
of the unborn child. What factors determine the
potential harm that can occur as a result of drug
use during pregnancy?
11 Explain the possible impacts of three vaccinepreventable diseases on the health and/or
development of the unborn baby.

12 You have been appointed as a maternal and child
health nurse. What advice would you give a firsttime mother about nutrition, tobacco, alcohol and
drug use, and vaccination?
13 Use the Foetal alcohol spectrum
disorder links in the Resources
section of your eBookPLUS to find
the weblink and questions for this activity.
7.3
eterminants of health and individual development during

D
the prenatal stage of the lifespan: physical environment
KEY CONCEPT Understanding the physical environment determinants

that have an impact on health and individual human development
during the prenatal stage of the lifespan
Aspects of a pregnant womans physical surroundings can impact on the health and
development of her unborn baby. Factors within the physical environment that
can impact on the unborn baby include tobacco smoke in the home and access to
health care.

Tobacco smoke in the home increases the risk of passive smoking among pregnant
women. Passive smoking means breathing in other peoples tobacco smoke. Exhaled
smoke is called exhaled mainstream smoke. The smoke drifting from a lit cigarette
is called sidestream smoke. The combination of mainstream and sidestream smoke
is called second-hand smoke or environmental tobacco smoke.
Tobacco smoke cools quickly which prevents it from rising. As smoke is
heavier than air, it tends to hang in mid-air rather than be dispersed into the
atmosphere. This increases the amount of second-hand smoke people breathe as it
is concentrated in the lower half of the room.
For pregnant women who live with one or more smokers, the home can be source of
exposure to second-hand smoke. Rates of tobacco smoke in the home have declined in
the last decade, reflecting the continuing decline in the prevalence of smoking as well
as an increase in smokers confining their smoking to outside the home environment.
In 2013, more than three-quarters (70 per cent) of Australians lived in homes where
no-one regularly smoked, and 26.2 per cent lived with one or more people who
smoked only outside the home. However, around 4 per cent of non-smokers were
exposed to smoke from another resident at home at least once a day (AIHW, 2014).
Data are not available regarding the rate of pregnant women who were exposed to
tobacco smoke in the home, but given the exposure rates applying to all non-smokers,
it is reasonable to assume that some pregnant women would be exposed.
Figure 7.12 Tobacco smoke in the

home can have similar impacts on the
unborn baby as maternal smoking.
Exposure to environmental tobacco smoke can contribute to the same health
and development effects as maternal smoking including:
spontaneous abortion
ectopic pregnancy
prematurity
complications of the placenta
birth defects
lung function abnormalities
respiratory conditions including asthma
foetal mortality.
Access to health care

Prenatal health care (also called antenatal care) is an important part of pregnancy
and there is a strong relationship between regular prenatal health care and positive
health outcomes for both mother and baby. The purpose of prenatal health care is
to monitor the health of the mother and baby, monitor growth of the baby, provide
health education and advice to the mother, identify any risks to the mother and
baby, and provide medical interventions if necessary.
FIGURE 7.13 Ultrasounds help monitor foetal development by using soundwaves to create
an image of the developing foetus.
The World Health Organization recommends pregnant women access prenatal

health care at least four times during their pregnancy to increase the likelihood of
receiving effective maternal health interventions.
During prenatal health checks, a number of tests and measures are often
taken, including body weight, an ultrasound, blood pressure, blood glucose and
foetal heart rate. These allow the health and individual human development of
the pregnant woman and unborn baby to be assessed. If issues are detected,
interventions can be put in place.
The birthing process is a time when medical intervention is often required
and, if adequate health care is not accessible, any complications arising can go
untreated and impact the health and individual human development of both
mother andbaby.
Geographical factors such as the location of relevant services can impact

on a womans ability to access prenatal health care. Many women in rural and
remote areas struggle to access health services during pregnancy due to the time
taken to reach them. As a result, the health of both mother and baby can be
compromised.
In 2013, two-thirds (62 per cent) of women attended at least one antenatal visit
before 14 weeks gestation, although 15 per cent of women did not receive antenatal
care until after 20 weeks. In 2009, about 80 per cent of women in major cities
and inner regional areas in New South Wales, South Australia and the Northern
Territory received antenatal care in the first 14 weeks of pregnancy, compared with
73.7 per cent of women residing in remote and 53.1 per cent of women in very
remote areas.
Stress in pregnancy can have a negative impact on both mother and baby.
A 2011 study indicates that women who have to travel for more than one hour
to accessantenatal care are nearly eight times as likely to experience moderate or
severe stress as mothers who have this care close to home (National Rural Health
Alliance, 2012). A 2010 survey of rural families found only 12 per cent of the
respondents feltthey had good access to maternity services (National Rural Health
Alliance, 2012).
Unit 2
AOS 1
Topic 4
Concept 3
Physical
environment
prenatal
Concept summary
and practice
questions
Case study
Spare a thought for rural

mums on Mothers Day
Every woman in Australia has the right to safe,
affordable maternity services as close to home as
possible. This is something most people would agree
with and something that is within the nations power
to deliver.
But in recent years more than half of Australias
small maternity units, many of them in rural areas,
have been closed. This Sunday, Mothers Day, is a
timely reminder of the importance of maternal and
child health. This is vital for mothers everywhere in
Australia, for their babies and children, and ultimately
for the health of the nation.
Over time, the number of procedural GPs in rural
areas has been falling, while the number of rural women
giving birth has been increasing. Also significant is
the fact that the prevalence of midwives decreases
with distance from capital cities, while the birth rate
increases. Money can be saved in the short term by
closing small rural maternity units, but this transfers

cash costs to families and also imposes costs on
mothers and babies through increased risk and family
dislocation. Stress in pregnancy has a detrimental effect
on mother and baby.
Mothers health is an important determinant of the
health and wellbeing of children and communities. So
this Sunday lets remember the mothers who live in
rural and remote areas of this country. They face the
challenges of distance, isolation, poorer health and
worse access to health services than women in the
cities and so often with their renowned fortitude and
resilience.
Some of the steps towards improved maternalhealth
in rural and remote Australia are spelled out in the
National Maternity Services Plan, 20102015,endorsed
by State, Territory and Commonwealth Governments.
The Plans goal is to maintain Australias standard of
safety and quality in maternity care and to improve
access to services and choice of models of care.
Source: National Rural Health Alliance, media release, 11 May 2012.
Case study review

1 Discuss how financial costs may increase for pregnant women who cannot access
health care locally.
2 Brainstorm possible reasons for increased levels of stress among pregnant women
who cannot access health care close to their homes.
Weblink:
Rural health
TEST your knowledge

1 What is the difference between mainstream and
sidestream tobacco smoke?
2 Explain why second-hand smoke can be particularly
damaging when indoors.
3 Discuss how tobacco smoke in the home can impact
on the health and development of the unborn baby.
4 Outline the purpose of prenatal health care.

5 Design a poster that could be used to educate
people of the dangers of tobacco smoke in the
home during pregnancy.
6 Suggest two ways in which prenatal health care
could promote the health and/or individual human
development of an unborn baby.
7 Discuss two reasons why those who do not have
health services near their homes may not access
health care.
8 In groups of three, allocate one of the following

tests to each student:
amniocentesis
ultrasound
chorionic villus sampling.
After researching the test, each student should
present a short explanation to the rest of the group.
Make sure to include:
(a) a description of the test
(b) how it is performed
(c) when it is performed
(d) issues/conditions it can detect.
9 Use the Environmental tobacco
smoke links in the Resources
section of your eBookPLUS to
find the weblink and questions
for this activity.
230
7.4

during the prenatal stage of the lifespan: social
KEY CONCEPT Understanding social determinants that have an impact

on health and individual human development during the prenatal stage
of the lifespan
Once fertilisation has occurred, unborn babies rely on their mother to achieve
optimal health and individual human development during the prenatal stage. The
society in which the mother lives and the social factors that impact on her life, will
also contribute significantly to the health and development of her unborn baby.
Social factors include parental education, parental income, parental health and
disability, and access to health care.
Parental education
The parents level of education can impact the developing baby in a number of ways.
Knowledge of health behaviours (also known as health literacy) can increase the
probability of parents caring for themselves in ways that promote the health and
development of their unborn baby. Accessing health care, consuming nutritious
food, being vaccinated, not smoking, avoiding teratogens such as alcohol and drugs,
and preventing illness are more likely to occur in those who are educated about the
benefits of maintaining optimal health during pregnancy. These behaviours promote
optimal health and individual human development in the unborn baby and reduce
the risk of conditions such as preterm birth, low birth weight and birth defects.
Parental education also increases employment opportunities and the ability to
generate an adequate income which can be used for resources such as adequate
nutrition and health care.
Parental income
2500
Number
Parental income is often related to the

6
2000
education of parents. Educated parents are
more likely to have a higher paying job and
5
are more able to access a range of health1500
promoting resources during the prenatal
4
stage of the lifespan. Income can improve the
ability of parents to provide resources such as
3
1000
prenatal health care and adequate nutrition
2
which can enhance outcomes for the unborn
baby by promoting optimal growth, health
500
1
and development. Having an adequate income
may also assist in decreasing stress levels as
0
0
parents may be more comfortable knowing
2
3
4
5
6
1
7
8
9
10
they can provide the necessary resources for
(Lowest)
(Highest)
their child.
Socioeconomic
status
Specific population groups are often more
likely to experience the effects of low income during pregnancy, including teenage Figure 7.14 Number and rate of
mothers, Indigenous Australians and those from low socioeconomic status groups. babies born with low birth weight
Socioeconomic status is a measure that combines the levels of education and according to socioeconomic status
income, and occupation status. Those with higher socioeconomic status have Source: AIHW, Australias health 2012, p.61.
higher paying jobs, higher levels of education and higher status occupations. These
components are often, but not always, interrelated so a person with a higher level of
education is more likely to get a higher paying job that has a high status within the
community. Socioeconomic status has a relationship with the number and rate of low
birth weight babies as shown in figure 7.14.
Per 100 live births
Cases
Rate
social
Parental health and disability

The level of health experienced by parents influences the health and individual
human development of developing babies in a number of ways. In some cases,
conditions experienced by the mother can directly impact on the development of
the baby. In other cases, parental illness or disability can impact on the unborn baby
indirectly by influencing the ability of parents to provide the resources necessary for
the optimal health and development of their unborn baby, such as earning an income.
Health concerns for pregnant women include:
Gestational diabetes. This condition occurs in around 5 per cent of pregnant women
and can impact the developing baby in a number of ways, including an increased
risk of higher than normal birth weight, respiratory conditions and jaundice.
Pre-eclampsia. High blood pressure during pregnancy causes the mothers blood
vessels to constrict. This results in reduced blood flow to the uterus which can
impact on the growth of the baby.
Stress. Stress during pregnancy releases hormones that may impact on the unborn
baby in a number of ways. Some research suggests that stress can contribute to
premature birth and may also impact brain development.
Infections. Most infections in pregnant women do not impact on the developing
baby in the majority of cases but some infections can. If this occurs, the impacts
can be significant. Vaccination prior to pregnancy can reduce the risk of many of
these conditions, as was explored on page 226.
Parents experiencing optimal health may be more able to provide the resources
required for optimal health and development of their unborn baby. Parental disability
and health conditions, on the other hand, may limit the ability of parents to adequately
care for themselves and their unborn baby. If a parent requires care as a result of their
illness or disability, this can further decrease the ability to provide resources for the
mother. Factors including employment, nutrition, health care, stress management
and exercise may become difficult if the health of the parents is not optimal.
Unit 2
AOS 1
Topic 4
Concept 4
Social
determinants
prenatal
Concept summary
and practice
questions
Although access to health care may be limited due to factors related to the physical
environment such as geographical location of resources, many social factors also
impact on access to health care. Education, cultural factors and income can all
enhance or limit the ability of pregnant women to access health care.
If parents have a sound understanding of the benefits of health care during
pregnancy, they may be more likely to access these resources. By accessing health
care throughout the pregnancy, the mothers and babys health and development
can be monitored and interventions put in place if necessary. Education is often
a key component of health care and the knowledge of parents with regards to
promoting optimal health and development of their unborn baby can be enhanced.
Cultural factors can contribute to some pregnant women not accessing
health care. Around 25 per cent of Australians were born overseas, reflecting
the multicultural nature of Australian society. Language barriers and differences
in beliefs about pregnancy and health care can contribute to some women not
accessing health care.
Indigenous mothers are less likely to access health care during pregnancy than nonIndigenous Australians. In 2010, of Indigenous mothers who gave birth at 32weeks
or more, 77.7 per cent had five or more visits, compared with 92 percent of nonIndigenous mothers. Indigenous Australians across the lifespan often record lower
rates of health care usage than their non-Indigenous counterparts. According to the
2008 National Aboriginal and Torres Strait Islander Social Survey, almost 30percent
of Indigenous people aged 15 and over experienced problems accessing services
232
and almost 10 per cent experienced problems accessing a doctor. Overall, 1.3 per
cent reported barriers to accessing services due to discrimination, and 2.3 percent
reported barriers due to services not being culturally appropriate (AIHW,2012).
Although many prenatal health services can be accessed free of charge for the
user through Medicare, other services require a patient co-payment. Those with
low incomes may not access health care during pregnancy as a result of the costs
involved. This may increase the risk of complications going untreated throughout
the prenatal stage.
TEST your knowledge

1 Explain two ways in which each of the following
may impact on the health and/or individual human
development of an unborn baby.
(a) parental education
(b) parental income
(c) parental health and disability
(d) access to health care
2 (a) Describe the trend relating to the rate of low birth
weight babies according to socioeconomic status,
as shown in figure 7.14.
(b) Discuss possible reasons for this trend.
3 Besides geographical location of resources, discuss

factors that may limit access to health care.

4 Social factors often influence the behaviours of
parents which, in turn, impact on the health and
development of unborn babies. Write a response to
this statement.
7.5
Determinants that act as risk and/or protective factors

in relation to one health issue
KEY CONCEPT Understanding the determinants that act as risk and/or

protective factors in relation to one health issue such as spina bifida,
low birth weight, foetal alcohol syndrome or gestational diabetes
Day 16
Neural plate
Neural
groove
Day 18
The sides of the plate

fold in
Day 22
The sides of the plate

fuse together
Spina bifida
Neural crest
cell
The neural tube is

formed
Day 24
As we have seen, there are a range of health issues that can

affect the mother and unborn baby during the prenatal
stage of the lifespan. Many determinants of health and
development play a role in decreasing or increasing the risk
of these issues occurring. An understanding of these issues
and the determinants that play a role in their development
is important in implementing personal, community and
government strategies to reduce the risk of negative outcomes
during pregnancy. Common issues include spina bifida, low
birth weight, foetal alcohol syndrome (also referred to as
foetal alcohol spectrum disorder) and gestational diabetes.
Spina bifida is a condition that occurs when the neural tube

(see figure 7.15) in the embryo fails to close properly (see
figure 7.16).
The effects of spina bifida will vary from case to case,
depending on the number of nerves exposed and damaged.
In some cases, symptoms will be minor but in more severe
cases, the individual may be paralysed and require assistance
to carry out daily tasks such as feeding, washing and toileting.
Neural tube
The neural tube is a cylindrical structure

that will house the brain and spinal
cord of the embryo. Before the tube is
formed, the outer cells of the embryo lay
flat to make a neural plate. From around
day 16 to 24 after fertilisation, the neural
plate folds in on itself and the sides fuse
together to form the neural tube.
Figure 7.15 How the neural tube
isformed
Source: Reprinted by permission from Macmillan
Publishers Ltd: The origin and development of
glial cells in peripheral nerves by Jessen & Mirsky,
Nature Reviews Neuroscience, Vol. 6, Iss. 9,
pp.671682, 2005.
Unit 2
AOS 1
Topic 5
Concept 1
Spina bifida
Concept summary
and practice
questions
Vertebra
Dura mater
Spinal cord
Spinal fluid
Figure 7.16 Spina bifida occurs when the neural tube fails to close properly during the
prenatal stage. As a result, the nerves of the spinal cord protrude out of the back instead
of running down the middle of the spinal cord. The nerves become damaged, leading to
moderate to severe disabilities.
234
Although the exact causes of spina bifida are not completely understood, there
appear to be a number of factors or determinants that can either increase or decrease
the risk of developing this condition. These factors will be explored in greater detail.
Biological
Certain genetic conditions can increase the risk of developing spina bifida, including
trisomy 13 and trisomy 18. Trisomy 13 is a condition in which there are three
copies of the 13th chromosome instead of the usual two. In Trisomy 18, there are
three copies of the 18th chromosome. These conditions are rare and contribute to
a range of development issues in addition to an increased risk of spina bifida.
There is a relationship between spina bifida and maternal age. The overall
prevalence of spina bifida is higher at the extremes of reproductive age; that is, among
women aged less than 20 years and women aged 35 years or more, than among
women aged 20 to 35 (see table 7.3). The exact cause of this relationship is not known.
Table 7.3 Prevalence of spina bifida

in babies, by age of mother
Age (years)
Prevalence
(per10000 births)
less than 20
8.3
2024
7.3
2529
6.3
3034
4.7
35 and over
7.5
Source: Adapted from Macaldowie A & HilderL

2011. Neural tube defects in Australia: prevalence
before mandatory folic acid fortification. Cat. no.
PER 53. Canberra: AIHW.
Behavioural
The use of saunas and spas exposes the pregnant woman to a hot environment and
increases body temperature. Excess heat during early pregnancy has been shown to
increase the risk of spina bifida (see figure 7.17).
Maternal nutrition can increase or decrease the risk of spina bifida. Folate is
a nutrient (also known as Vitamin B6) that is essential for normal cell division
and the production of new cells. Folate is particularly important during periods of
rapid growth, as occurs during the prenatal stage. Folate has been shown to be a
significant protective factor in the development of spina bifida.
The neural tube closes early in the pregnancy, often before the woman knows
she is pregnant. As a result, all women of childbearing age where pregnancy is
possible should ensure they consume adequate amounts of folate.
Exposure to excessive heat early in pregnancy may increase the risk of spina bifida.
If the physical environment is excessively hot, the risk may be increased. Having
access to saunas and spas may increase the chance of them being used, although
choosing to use these resources is a behavioural determinant (see above).
Exposure to agents such as solvents, pesticides and x-ray radiation may increase
the risk of spina bifida, although the exact link is unknown.
The prevalence of spina bifida increases with remoteness of residence (table 7.4).
The exact reason for this trend is not known but it may be linked to reduced access to
health care and differences in food availability in rural and remote areas.
Social
Maternal fever (parental health) raises body temperature and may increase the
risk of spina bifida as a result. Women who experience illness that increases body
temperature may be at an increased risk of having a baby with a neural tube defect.
In 2009, the Australian government introduced mandatory fortification of bread
with folate. This aims to decrease the prevalence of neural tube defects as folate
intake is increased.
Accessing health care prior to pregnancy can increase parental knowledge of
folate intake and other precautionary measures such as avoiding hot environments.
This may reduce the risk of spina bifida.
Those with adequate education surrounding maternal nutrition and pregnancy
may ensure folate intake is adequate prior to conception. This can decrease the risk
of spina bifida in the unborn baby.
Figure 7.17 The use of spas during

pregnancy can increase the risk of
spina bifida.
Table 7.4 Prevalence of spina bifida

based on place of usual residence
Place of usual
residence
Major cities
Rural
Remote
Prevalence of
spina bifida
(per10000 births)
5.5
6.5
11.1
Source: Adapted from Macaldowie A & Hilder L

2011. Neural tube defects in Australia: prevalence
before mandatory folic acid fortification. Cat. no.
PER 53. Canberra: AIHW.
7.5 Determinants that act as risk and/or protective factors in relation to one health issue
Low birth weight
Figure 7.18 Jaundice is

characterised by yellowing of the skin.
The birth weight of babies has a significant impact on health and individual
human development in both the short and long term. Adequate birth weight often
indicates that the bodys systems have developed optimally in the prenatal stage,
therefore decreasing the risk of health issues after birth. Low birth weight, on the
other hand, may indicate that the bodys systems are underdeveloped and the risk
of a range of health and development problems increases, including:
risk of infection as a result of an under-developed immune system
respiratory conditions, such as bronchitis
reduced lung function
feeding difficulties, leading to lack of nutritional intake
increased risk of bradycardia (a slowing of the heart rate)
apnoea (a short-term suspension of breathing)
jaundice the yellowing of the skin due to the immature liver being
unable to process the compound bilirubin, which is found in the blood (see
figure 7.18)
increased risk of asthma during childhood
poor sucking and swallowing reflexes
damage to the retina of the eye, resulting in sight difficulties including
blindness
increased risk of deafness
greater likelihood of impaired learning capabilities
greater likelihood of impaired growth and motor skill development.
Figure 7.19 Low birth weight can impact on a babys health and development in a number
of ways.
In later life, low birth weight can contribute to high blood pressure, type 2
diabetes and cardiovascular disease.
Low birth weight can be classified according to three categories as shown in
figure 7.20. As birth weight decreases, the risk of health and development problems
increases. Those classified as having extremely low birth weight have a higher risk
of complications compared to those classified as having a very low or low birth
weight.
Low birth weight

babies
Very low birth weight

between 1000
and 1500 grams
Low birth weight

below 2500 grams
Extremely low birth

weight below
1000 grams
FIGURE 7.20 The classification of low birth weight babies
There are many factors or determinants that can contribute to low birth weight.
These can be biological, behavioural, physical environment and social determinants.
Biological
Babies born under 35 weeks gestation have an increased rate of low birth weight.
Less time spent in the uterus means less time to grow and develop, especially in
the foetal stage, when the rate of growth increases significantly.
Maternal age also has a relationship with birth weight. Young mothers (especially
those under 15 years of age) and older mothers (those over 45 years of age) have
higher rates of low birth weight babies (see figure 7.21).
9
Percentage
5
1519(a)
2024
2529
3034
Age group (years)
3539
40 and over
(a) Includes liveborn babies born to women aged less than 15 years.
FIGURE 7.21 Prevalence of low birth weight by age of mother
Source: AIHW, 2007 National Perinatal Data Collection.
Babies born to parents who are of small stature or were of low birth weight
themselves may have an increased risk of being born with low weight. Genetics
appear to play a part in this relationship.
Behavioural
Maternal nutrition is vital for supplying the unborn baby with the nutrients
required for optimal development. An inadequate supply of nutrients can lead to
underdevelopment of the foetus.
Smoking, excessive alcohol consumption and drug use during pregnancy
contribute to higher rates of low birth weight.
237
Unit 2
AOS 1
Topic 5
Concept 2
Low birth
weight
Concept summary
and practice
questions
Environmental tobacco smoke can have similar effects on the unborn baby as maternal
smoking. Exposure to tobacco smoke increases the risk of a low birth weight baby.
Women in remote areas may have fewer health services in the areas in which
they live. This can decrease access to health care which can mean that slowed
growth is not detected and goes untreated, contributing to low birth weight.
Social
Parental health is a key factor contributing to birth weight. Illness of the mother
during pregnancy can increase the risk of having a low birth weight baby. Infections
in the uterus can lead to early labour, while other infections, such as chickenpox
and rubella, can cause slowed growth.
Parental education and income influence the behaviours of the mother during
pregnancy. Those with the knowledge and the means to access resources such as a
nutritious food intake may reduce the risk of having a low birth weight baby.
Prenatal health care includes constant monitoring of the babys growth and
development. If the foetus is experiencing slowed growth, interventions such as
dietary change can be put in place to reduce the risk of low birth weight.
Foetal alcohol syndrome (foetal

alcohol spectrum disorder)
The consumption of alcohol during pregnancy has been shown to impact the
health and individual human development of the unborn baby in many ways.
The severity of the impacts will depend on a range of factors including the
amount of alcohol consumed and the susceptibility of the foetus. Common effects
include:
harm to the development of the nervous system,
including the brain. Research shows that alcohol
can damage developing brain cells. Impaired brain
development in those experiencing foetal alcohol
syndrome (also called foetal alcohol spectrum disorder)
can impact on intellectual development and contribute
to behavioural problems throughout life.
under-nourishment of the growing baby. Alcohol can
impact on the absorption of nutrients leading to low
birth weight and under-developed organs.
triggering of changes in the development of the babys
face, resulting in the typical foetal alcohol syndrome
facial features (see figure 7.22).
Behavioural
Figure 7.22 Foetal alcohol syndrome results in

characteristicfeatures in the babysface.
The biggest factor associated with an increased risk of

foetal alcohol syndrome is the amount of alcohol consumed
and how often it is consumed throughout the pregnancy.
Frequent binge drinking is associated with especially high
risks.
The 2009 Australian alcohol guidelines recommend
that pregnant women abstain completely from alcohol
during pregnancy. In 2010, the majority of pregnant
women either reduced their alcohol consumption while
pregnant (48.7per cent) or abstained (48.9 per cent). The
proportion of pregnant women abstaining during pregnancy increased between

2007 and 2010 (40.0percent in 2007 to 48.9 per cent in 2010).
Although alcohol consumption is the greatest risk factor for foetal alcohol
syndrome, a range of factors can contribute to an increased risk. Those who live
far away from health services may have difficultly accessing health care and may
not receive the advice they need relating to the potential impacts of consuming
alcohol while pregnant, and this may increase their risk of consuming alcohol at
risky levels.
Unit 2
AOS 1
Topic 5
Foetal alcohol
syndrome
Concept summary
and practice
questions
Concept 3
Social
Those with lower levels of education may not fully understand the risks associated
with alcohol consumption during pregnancy. This may increase the likelihood of
the mother drinking to risky levels.
Individuals who experience poor mental health during pregnancy may be more
likely to consume alcohol in an attempt to numb feelings of sadness and despair.
The health and development of the foetus may be affected as a result.
Women who face financial, cultural or other social barriers to accessing health
care may not be able to discuss their alcohol consumption patterns with a health
professional. As a result, strategies may not be put in place to reduce alcohol
consumption if intake is considered to be at a risky level.
Women who access health care may discuss their alcohol consumption patterns
with a health professional. Strategies may then be put in place to reduce alcohol
consumption if intake is considered to be at a risky level.
Gestational diabetes is characterised by high blood glucose levels. It occurs in
around 5 per cent of all pregnancies and can impact on women in a number of
ways, including:
high blood pressure
preterm labour
longer hospital stay than mothers without gestational diabetes
increased risk of developing type 2 diabetes
Gestational diabetes also increases the risk of many adverse outcomes for the
developing baby including higher than normal birth weight, respiratory conditions
and jaundice.
There are numerous factors that can either decrease or increase the risk of
developing gestational diabetes.
Biological
Women who have a genetic predisposition to type 2 diabetes are at a higher risk of
developing gestational diabetes during pregnancy.
Maternal age has been noted as a risk factor for gestational diabetes. The
proportion increased with age from 4.1 per cent for women aged under 35 to
7.3per cent for women aged 3539 and 10.3 per cent for women aged 40 or over
(AIHW, 2010).
Body weight is one of the major factors in determining the risk of gestational
diabetes. Overweight and obesity at the time of fertilisation significantly increase
the risk factors for the development of gestational diabetes. Ensuring body weight is
within the normal range before pregnancy occurs can reduce the risk of developing
gestational diabetes.
Figure 7.23 Pregnant women

who are overweight or obese have
an increased risk of developing
Behavioural
Maternal nutrition can impact body weight. Although gaining weight is a normal
and required aspect of pregnancy, those who consume an energy-dense diet and
consume alcohol are at greater risk of becoming overweight or obese, which
increases the risk of gestational diabetes.
Physical activity acts to burn off excess energy. Sedentary lifestyles, on the other
hand, can contribute to weight gain and gestational diabetes.
Unit 2
AOS 1
Topic 5
Gestational
diabetes
Concept summary
and practice
questions
Concept 4
Women who live in areas where health care is accessible may be able to receive
health education prior to pregnancy occurring. They may be provided with
strategies to assist them in losing excess body weight prior to becoming pregnant.
Social
Weblink:
Parental education is a key factor in preventing the onset of gestational diabetes.

Those who are educated are more likely to understand the risk factors for gestational
diabetes and act to reduce their risk of developing this condition.
Having adequate income can assist in affording resources such as health care and
nutritious foods, which can, in turn, assist with weight management and decrease
the risk of gestational diabetes.
Cultural factors can prevent some people from accessing health care. Indigenous
Australians for example, are less likely to access health care during pregnancy,
which can contribute to the higher rates of gestational diabetes experienced. Body
weight also plays a role in this difference, but access to health care could provide
knowledge about the risks associated with development of gestational diabetes.
Use the Gestational diabetes weblink in the Resources section of your
eBookPLUS to watch a video about this condition.
TEST your knowledge

1 (a) Explain how the neural tube forms.
(b) Explain what is meant by a neural tube defect.
(c) Describe spina bifida.
(d) Explain why folate intake is important prior to
fertilisation in reducing the risk of spina bifida.
(e) Besides nutrition, discuss the determinants of
health and development that can increase the
risk of spina bifida.
2 (a) Identify what constitute low, very low and
extremely low birth weights.
(b) Outline the possible effects of low birth weight.
(c) Discuss the determinants of health and
individual human development that can increase
the risk of having a low birth weight baby.
3 (a) Describe foetal alcohol syndrome.

(b) Discuss the factors that may contribute to
alcohol consumption during pregnancy.
4 (a) Explain gestational diabetes.
(b) Discuss the effects of gestational
diabetes.
(c) Discuss the determinants of health and
individual human development that can increase
the risk of developing gestational diabetes.

5 Devise a poster, multimedia presentation or short
video that educates parents about the risk and
protective factors associated with a health issue of
your choice.
7.6
Strategies and programs designed to promote

prenatal health and individual development
KEY CONCEPT Understanding government, community and personal

strategies and programs designed to promote health and individual
human development of pregnant women and unborn children
As explored in the last section, there are a number of issues that can impact on
the health and individual human development of pregnant women and their
unborn babies. In response to these and other issues, a number of programs and
strategies have been designed to reduce the risk of negative outcomes and promote
the health and development of mothers and babies during the prenatal stage of
the lifespan. These programs and strategies exist at a government, community and
personal level.
Government programs and

strategies
All levels of government, federal, state/territory and local, implement strategies and
programs to promote the health and individual human development of pregnant
women and their unborn babies.
Federal government
Unit 2
AOS 1
Topic 6
Government
strategies
Concept summary
and practice
questions
Concept 1
Medicare is Australias universal health insurance scheme that provides free

or subsidised treatment for all Australians through the public health system.
Pregnant women can access a range of Medicare-funded health services
throughout their pregnancy, including free treatment in public hospitals. By
making health care more affordable, Medicare increases accessibility to prenatal
health care which can assist with early detection of issues during pregnancy
and medical intervention when required. Medicare also assists in providing
professional health workers such as nurses, midwives, doctors and obstetricians
to assist with the birthing procedure at no charge to the patient.
Figure 7.24 Medicare covers the

costs of many prenatal health services.
Food Standards Australia New Zealand is the federal government body

responsible for making laws relating to the food industry. In Australia, numerous
laws have been implemented in an attempt to increase the intake of nutrients
required for the optimal health and development of unborn babies. Iodine and
folate intake, specifically, have been shown to be deficient across the population
and deficiency of these nutrients can contribute to a range of birth defects during
pregnancy, including neural tube defects and impaired brain development.
Mandatory fortification laws require food manufacturers to add iodine and folate
to specific food products. Since 2009, all salt used in bread manufacturing
(except organic bread) must be iodised salt. Similarly, all bread products (except
organic bread) must contain added folate. Bread was selected as the subject of
mandatory fortification laws as most people consume bread on a regular basis
and regular consumption may decrease the risk of the defects associated with
deficiency of iodine and folate.
Figure 7.25 Most bread in Australia

is fortified with folate and iodine.
The federal government provides a free phone and online service for pregnant
women and new parents who have a baby up to 12 months of age. The
Pregnancy, Birth and Baby service provides information and advice on topics
such as maternal nutrition, breastfeeding, a babys development and sleeping
habits as well as directionto maternity-related services including specialist and
support services (figure 7.26).
Through the Immunise Australia program, the federal
government provides free influenza vaccines for all pregnant
women. Pregnant women are at high risk of severe consequences
of influenza infection. The Australian government aims to
provide greater protection against influenza for pregnant
women, by making influenza vaccine available, free of charge.
The National Perinatal Depression Initiative is a federal
government strategy developed in conjunction with all state and
territory governments. It aims to promote the mental health of
pregnant women, providing:
routine and universal screening for perinatal depression
follow up support and care for women assessed as being at
risk of or experiencing perinatal depression
workforce training and development for health professionals
research and data collection
national guidelines for screening for perinatal depression
community awareness.
Figure 7.26 The Pregnancy, Birth

and Baby service logo
7.6 Strategies and programs designed to promote prenatal health and individual development
Victorian Government
Figure 7.27 The Better Health

Channel logo
The Victorian Government provides a range of maternity services for Victorian

women. As well as running public hospitals (where many antenatal health care
encounters and births occur), the government has also established three tertiary
hospitals that provide state-wide maternity services for the most complex
pregnancies. Tertiary hospitals employ specialists with experience in dealing
with high-risk pregnancies.
The Maternal and Child Health Line is a Victorian Government service that is
staffed by qualified maternal and child health nurses who provide callers with
information, support and advice regarding child health, maternal and family
health, and parenting issues. This is a free service for all Victorians.
Established by the Victorian Government, the Better Health Channel provides
online health and medical information for the Victorian community. It contains
information to educate parents about issues relating to pregnancy and childbirth.
Fact sheets are available on topics such as:
folate during pregnancy
foetal alcohol syndrome
pregnancy and exercise
pre-eclampsia
gestational diabetes
ectopic pregnancy.
The Healthy Mothers, Healthy Babies program aims to promote prenatal health
of pregnant women and their unborn babies by addressing risk behaviours and
providing support during pregnancy.
The Healthy Mothers, Healthy Babies program targets pregnant women who
are unable to access prenatal care services or require additional support because
of their socioeconomic status, culturally and linguistically diverse background,
Aboriginal and Torres Strait Islander descent, age or residential distance to
services.
The program operates in the outer growth suburbs of Melbourne that have high
numbers of births, higher rates of relative socioeconomic disadvantage and lower
service accessibility.
The aim of the Healthy Mothers, Healthy Babies program is to improve the
health and wellbeing of mothers and babies by:
facilitating access to prenatal, postnatal and other health and human
services
supporting women throughout their pregnancy
delivering key health promotion messages that enable healthy behaviours in
pregnancy and beyond.
The Healthy Mothers, Healthy Babies program is not a clinical antenatal care
service but acts to complement existing services by linking women into services
early, providing additional support that is not available in current services, and
promoting a continuum of care for the woman by working with maternity and
maternal and child health services.
Local government
Maternal and child health centres are located in every local government area in
Victoria, which are jointly funded by state and local governments and usually
managed by local government. The centres are staffed by highly qualified maternal
and child health nurses, with support from a range of other health professionals.
Pregnant women can seek advice relating to their pregnancy and receive prenatal
health care at these centres.
244
Community programs and

strategies
Community programs and strategies are often developed by non-government
organisations and have a specific focus with regards to prenatal health and
development. beyondblues perinatal program, You2 Program and Australian Action
on Pre-eclampsia are examples of community programs and strategies.
beyondblues perinatal program

beyondblue is an independent, not-for-profit organisation working to increase
awareness and understanding of depression and anxiety in Australia, and to reduce
the associated stigma. Part of beyondblues work relates to maintaining positive
mental health during pregnancy and early parenthood. Through beyondblues
perinatal program, a range of resources are provided for health professionals,
women and their families including:
online training for health professionals
printed resources for health professionals
resources for expectant and new parents
the Just Speak Up website, which provides a forum for people to share their
experiences with antenatal and postnatal depression and anxiety
the Mind the Bump app, developed with Smiling Mind, a free mindfulness
meditation tool for new and expecting parents.
Unit 2
AOS 1
Topic 6
Community
strategies
Concept summary
and practice
questions
Concept 2
FIGURE 7.28 The beyondbluelogo
You2
The You2 initiative was developed by Diabetes Australia with the aim of preventing
gestational diabetes and supporting those with the condition. The You2 website
provides practical advice relating to healthy eating, exercise and prenatal health
care. The online blog allows women with gestational diabetes to share their stories
and provide support to others with the condition.
Australian Action on Pre-eclampsia (AAPEC)

Australian Action on Pre-eclampsia Inc. (AAPEC) is a Victorian association
set up to provide support and information to families who are experiencing or
have experienced pre-eclampsia. The organisation aims to educate the public
and health professionals about the prevalence and risks of pre-eclampsia, and
campaigns for greater awareness of this condition. AAPEC publishes regular
newsletters, provides brochures, organises educational seminars and workshops,
and raises funds to promote research into the prevention and early detection of
pre-eclampsia.
FIGURE 7.29 The AAPEC logo
245
7.6 Strategies and programs designed to promote prenatal health and individual development
Personal programs and strategies

Unit 2
AOS 1
Topic 6
Concept 3
Personal
strategies
prenatal
Concept summary
and practice
questions
Many of the personal strategies that individuals can employ during pregnancy relate
to addressing the factors that can be modified to optimise the health and individual
human development of themselves and their unborn babies. Examples include:
Maintaining healthy body weight can reduce the risk of gestational diabetes.
Ensuring nutrient intake is adequate leading up to pregnancy and taking
supplements if required, specifically folate and iodine supplements, can reduce
the risk of neural tube defects.
Having regular prenatal health checks assists in monitoring health and
implementing changes required to promote health and individual human
development.
Increasing education levels relating to pregnancy, including attending antenatal
classes, provides information and strategies relating to the birthing procedure.
Avoiding teratogens such as raw fish, soft cheeses, alcohol, drugs, x-rays and
tobacco can reduce the risk of conditions such as low birth weight.
Ensuring vaccinations are up to date prior to pregnancy reduces the risk of
infection and disease during pregnancy.
Reducing the risk of infection by avoiding contact with those who are ill and
maintaining adequate levels of hygiene.
Reducing stress levels can assist in maintaining optimal mental health.
TEST your knowledge
1 Identify three government strategies and/or

programs and explain how each can promote
pregnant women and/or their unborn babies.
2 (a) Briefly explain mandatory fortification.
(b) i. Which nutrients are the subject of mandatory
fortification laws?
ii. Discuss why these nutrients are a focus of
mandatory fortification laws.
3 (a) Identify the federal governments phone and
online help service.
(b) Discuss two ways in which this service may
promote health and development of pregnant
women and/or unborn babies.
4 (a) Explain the Healthy Mothers, Healthy Babies
program.
(b) Explain how the program works to promote
health and development of mothers and babies.
5 Discuss how local governments contribute to
improved health and individual human development
for pregnant women and unborn babies.
6 Use the Better Health Channel

weblink and questions for this
activity.
7 Use the beyondblue, You2
or the Australian Action on
Pre-eclampsia links in the
8 Use the Just Speak Up links in
9 Create a pamphlet that could be given out at
maternal health centres to assist in educating
pregnant women about personal strategies that
may promote their and their unborn babys health
and development.

human development during the prenatal stage
individual human development and their impact
during the prenatal stage of the lifespan using
relevant examples
In order to demonstrate this skill, a thorough understanding of the determinants
of health and individual human development and how they relate to the
prenatal stage of the lifespan is essential. The ability to use relevant examples to
demonstrate this understanding is expected. When outlining the determinants
of health and individual human development, it is important to remember the
following:
Understand at least one factor or example relating to each determinant, i.e. one
biological, behavioural, physical environment and social environment example.
Focus on factors that are relevant to the prenatal stage of the lifespan and ensure
that the discussion makes reference to how the selected factor impacts on health
and human development during this stage.
To clearly demonstrate an understanding of the impact of a selected determinant
of health on health and individual human development during the prenatal
stage, it is important to be able to outline what the factor is.
The determinants of health and individual human development help explain or
predict trends in health. When outlining the impact of a selected determinant,
explain the way in which it impacts on the health and individual human
development during the prenatal stage.
Consider the following example where the biological determinant of health and
individual human development is explained and one example is discussed with
regards to the possible impacts on health and human development during the
prenatal stage of the lifespan.
Biological determinants are factors relating to the body that impact on health
and human development.
Genetics are an example of a biological determinant that is particularly relevant
during the prenatal stage of the lifespan.
Genetics relate to the genetic information passed from parents to the unborn
baby at fertilisation. During the prenatal stage, genetics can impact on health in a
number of ways. Genetic conditions such as haemophilia can be passed down from
the unborn babys parents. Haemophilia is a sex-linked condition that is generally
carried by females and occurs in males. It is characterised by an inability of blood
to clot. Chromosomal abnormalities such as Down syndrome are also related to
genetics. Three copies of the 21st chromosome are present instead of two. Down
syndrome is characterised by intellectual disability.
Genetics also contribute to individual human development during the prenatal
stage. The sex of the unborn baby is determined by the 23rd pair of chromosomes.
An unborn baby with an XY pairing will be male and an unborn baby with XX
will be female. Sex determines the sex organs that will develop during the prenatal
stage.
An explanation of the biological

determinant is provided.
The example to be discussed is

identified.
A brief outline of genetics is included.
Genetics are linked to a number of

health outcomes.
Genetics are also linked to individual

human development.
KEY SKILLS The determinants of health and individual human development during the prenatal stage

1 (a) Explain the physical environment as a determinant of health and individual
human development.
(b) Identify one example of a physical environment determinant and explain
how it can impact on health and individual human development during the
prenatal stage of the lifespan.
2 Behavioural determinants relevant to the prenatal stage of the lifespan include
maternal nutrition prior to and during pregnancy, parental smoking, alcohol and
drug use during pregnancy, and vaccination behaviours.
Select one of these examples, and explain how it can impact on health and
individual human development during the prenatal stage of the lifespan.
KEY SKILL Describe a specific health issue affecting

the prenatal stage of the lifespan and draw informed
conclusions about personal, community and
government strategies and programs to optimise
prenatal health and development.
Characteristics of the issue are

described.
Possible impacts of the condition are

outlined.
Relevant determinants of health are

discussed.
Personal strategies are linked to

A community program is identified

and explained.
For this key skill, knowledge of one health issue relevant to the prenatal stage is
essential. Issues include spina bifida, low birth weight, foetal alcohol syndrome
(foetal alcohol spectrum disorder) and gestational diabetes. The first step of this
skill is to be able to describe the issue. The determinants of health and development
that increase or decrease the risk of the issue are an important aspect of the
description.
The second part of this skill relates to the personal, community and government
strategies and programs that aim to optimise health and development during the
prenatal stage. Knowledge of these strategies and programs is required and the
ability to draw informed conclusions relating to how they can optimise health and
development is necessary.
In the following example, gestational diabetes is described.
Gestational diabetes is characterised by an inability of the body to utilise glucose
effectively. Instead of being transported into the cells, glucose remains in the
bloodstream and is filtered out through the kidneys and eventually passed in the
urine. As a result of the excess blood glucose present, extra energy is provided
to the foetus, which can result in high birth weight. Mothers who are overweight
or obese (biological) have an increased risk of gestational diabetes. Food intake
and exercise prior to pregnancy (behavioural) impact body weight and also play
a role in the onset of this condition. Advancing age and a genetic predisposition
(biological) also increase the risk of gestational diabetes.
In the next example, strategies that can assist with optimising health and
development during the prenatal stage are discussed. In this instance, reducing the
risk and impacts of gestational diabetes are the focus.
Personal strategies, including maintaining healthy body weight before and during
pregnancy, can reduce the risk of gestational diabetes. Accessing expert advice on
behaviours such as food intake and exercise to assist in maintaining healthy body
weight is also beneficial in reducing the risk of gestational diabetes.
Community strategies such as the You2 program provide support for those with
gestational diabetes. The online blog allows sufferers to share their experiences of
gestational diabetes. Individuals can provide advice and support to each other to
assist with dealing with the impacts of this condition.
The Victorian Governments Healthy Mothers, Healthy Babies program provides

support to population groups at increased risk of health concerns during pregnancy,
including gestational diabetes. Vulnerable individuals are linked to health services
to ensure that education and health care are provided throughout the pregnancy to
reduce the risk of developing the condition. For those diagnosed with gestational
diabetes, blood glucose levels can be monitored and relevant interventions put in
place to reduce the impact of the condition.
A government strategy is discussed.

3 Issues affecting the prenatal stage of the lifespan include spina bifida, low birth
weight, foetal alcohol syndrome (foetal alcohol spectrum disorder) and gestational
diabetes.
(a) Select one of these issues and explain it briefly.
(b) Discuss the determinants of health and individual human development that
can decrease or increase the risk of this health issue.
4 A range of personal, community and government strategies exist to promote
health and individual human development during the prenatal stage of the
lifespan.
(a) Identify two personal strategies and explain how each can promote health
and individual human development during the prenatal stage of the lifespan.
(b) Discuss one community strategy that is designed to promote prenatal health
and individual human development.
(c) Discuss a range of government programs and/or strategies that aim to
promote health and individual human development during the prenatal stage
of the lifespan.
CHAPTER 7 review
Chapter summary
Interactivities:
Chapter 7 Crossword
A range of determinants of health and individual human development impact on

bothpregnant women and their unborn babies during the prenatal stage of the
lifespan.
Biological determinants are factors affecting the body that impact health and individual
human development and include genetics.
Genetics determine numerous aspects of health and development during the
prenatalstage including the sex of the baby, genetic conditions and chromosomal
abnormalities.
The behavioural determinants that impact on prenatal health and development are
related to the behaviours and choices of the parents both before and during pregnancy.
Examples include maternal nutrition prior to and during pregnancy, parental smoking,
alcohol and drug use during pregnancy, and vaccination behaviours.
Unit 2
AOS 1
Sit Topic test
The
determinants
of health and
individual
human
development
during the
prenatal stage
Adequate nutrition is important in ensuring that the nutrients required for optimal
health and individual human development of the unborn baby are present. Deficiency
of specific nutrients such as folate and iodine can contribute to health concerns such as
spina bifida and intellectual disability.
Parental smoking causes toxic substances to cross the placenta. This increases the risk
of birth defects and foetal mortality.
Alcohol use during pregnancy can lead to foetal alcohol syndrome. Foetal alcohol
syndrome, also known as foetal alcohol spectrum disorder, increases the risk of
premature birth, heart defects, behavioural problems and a range of physical
characteristics.
A range of drugs can impact on the unborn baby including prescription and illegal
drugs, and caffeine. Side effects include low birth weight, increased risk of miscarriage
and delayed growth.
Vaccination is important prior to pregnancy to reduce the risk of infection and disease
in the mother. The unborn baby is particularly susceptible to the impacts of diseases
such as influenza that can result in birth defects and miscarriage.
The physical environment relates to the physical surroundings in which people live,
work and play. Examples include tobacco smoke in the home and access to health care.
Tobacco smoke in the home can cause chemicals in tobacco smoke to cross the
placenta and impact the unborn baby in numerous ways, including spontaneous
abortion, prematurity and birth defects.
Where people live impacts on their ability to access health care. Those in rural and
remote areas, in particular, may not be able to access local health services. Lack of
access to health care can contribute to adverse health and development outcomes as
conditions may not be diagnosed and treated.
Social determinants relate to aspects of society and the social environment that impact
on health and development. Examples relevant to the prenatal stage of the lifespan
include parental education, parental income, parental health and disability, and access
to health care.
Parental education influences the behaviours of parents during the prenatal stage
of development including accessing health care, nutrition, tobacco use and alcohol
consumption. It also impacts on the income of the parents.
Parental income influences the ability of parents to access health-promoting goods and
services during the prenatal stage, such as nutritious food and health care.
Optimal parental health during pregnancy assists in promoting the health and
development of the unborn baby. Ill health and disability, on the other hand, can limit
the ability of the parents to provide all the necessary resources for their unborn baby.
Infectious diseases can interfere with normal development if they cross the placenta
and infect the baby.
Social factors such as income, education and culture can limit the ability of individuals
to access health care during the prenatal stage of the lifespan.
250
A range of health issues are a concern during the prenatal stage of the lifespan,
including spina bifida, low birth weight, foetal alcohol syndrome and gestational
diabetes.
Spina bifida occurs when the neural tube fails to close properly. Genetic conditions,
maternal age, folate deficiency, exposure to excessive heat, parental illness and
education all play a role in the development of spina bifida.
Low birth weight is classified as a baby under 2500 grams at birth. Premature birth,
maternal age, genetics, maternal nutrition, tobacco and alcohol use, tobacco in the
home, access to health care, parental health and parental education and income all play
a role in low birth weight.
Foetal alcohol syndrome is characterised by developmental issues such as intellectual
disability, low birth weight and changes in the facial features of the baby. Alcohol use,
parental education, maternal health and access to health care play a role in foetal
alcohol syndrome.
Gestational diabetes is characterised by an inability to transport glucose from the
bloodstream into the cells. It can contribute to high birth weight in the baby and
increased risk of type 2 diabetes in the mother. Risk factors include overweight and
obesity, advancing age, genetic predisposition, food intake, alcohol consumption,
physical inactivity, lack of access to health care, and low levels of parental education
and income.
A range of government, community and personal strategies and programs have been
implemented to promote prenatal health and development.
Government initiatives include Medicare, mandatory fortification laws, the Pregnancy,
Birth and Baby Service, Immunise Australia, the National Perinatal Depression Initiative,
the Maternal and Child Health Line, Better Health Channel, the Healthy Mothers,
Health Babies program, and Maternal and Child Health Services.
Community initiatives include beyondblue, the You2 program and Australian Action on
Pre-eclampsia.
Personal strategies include accessing health care, maintaining adequate nutrition, not
smoking or consuming alcohol, increasing education, avoiding teratogens and being
vaccinated.
TEST your knowledge

1 Discuss the possible impacts on health and
individualhuman development during the
prenatalstage of the lifespan in relation to one:
(a) biological determinant
(b) behavioural determinant
(c) physical environment determinant
(d) social determinant.
2 Select one health issue and complete the following

table:
Issue Description
Determinants that act as risk or

protective factors
Biological Behavioural
Physical
Social
environment
3 Select one government, community and personal

strategy and/or program and explain how it can
optimise health and individual development during
the prenatal stage of the lifespan.
CHAPTEr 8
The health and individual

human development of
Australias children
Development that occurs during the infancy and childhood
stages builds on the foundations laid down in the prenatal
stage and plays a significant role in the development
that will occur across the rest of the lifespan. Maintaining
adequate health is a key factor in achieving optimal
development and vice versa.
Having an understanding of the health and development
that occurs during these stages of the lifespan allows
informed decisions to be made for the promotion of
optimal wellbeing among children.
KEY KNOWLEDGE
2.1 physical, social, emotional and intellectual development from birth to
late childhood (pages 25867, 280)
2.2 the principles of individual human development (pages 2547, 280)
2.3 the health status of Australias children (pages 26877, 280).
KEY SKILLS
describe the characteristics of individual human development from
birth to late childhood (pages 257, 261, 264, 267, 278, 280)
interpret data on the health status of Australias children (pages 271,
2767, 2789).
FIgUrE 8.1 Childhood is a time

of significant individual human
development, influenced by a
rangeof factors.
252

attention deficit hyperactivity disorder (ADHD) a
condition characterised by a pattern of impulsiveness,
inattention and overactivity
autoimmune disease a disease characterised by
the immune system attacking and destroying healthy
bodycells
cephalocaudal development development that
occurs from the head downwards
child mortality deaths that occur between the first
birthday and 14 years of age
colostrum a concentrated form of breastmilk that is
also rich in antibodies. Colostrum is produced for the
first few days after birth.
empathy the ability to see events from another
persons point of view and to understand the emotions
of others
infant mortality deaths that occur between birth and
the first birthday
meconium a dark, sticky, tar-like substance that is
excreted through the bowels shortly after birth. It
includes things ingested while in the uterus, such as
mucous, bile and water.
neonate describes an infant in the first 28 days
afterbirth
object permanence an awareness that objects
continue to exist even when they are out of sight
perinatal conditions conditions causing death in
the first 28 days of life (e.g. due to complications of
the placenta or umbilical cord, infections, birth injury,
asphyxia and problems relating to premature births)
proximodistal development development that
occurs from the core or centre of the body outwards
(towards the extremities)
8.1
Principles of individual human development
KEY CONCEPT Understanding the principles of individual human

development
Figure 8.2 Writing is an example

ofa skill that, although achieved
inthe young years, will be refined
over time as the individual builds on
those initial skills.
Development during the prenatal, infancy and childhood stages of the lifespan
establishes a base that will be built upon during youth and adulthood. As explored
in chapter 6, the prenatal stage is the fastest period of growth of all lifespan stages
and is characterised by the development of body systems that will allow the foetus
to survive outside its mothers uterus after birth. Infancy and childhood are marked
by significant developmental milestones such as learning to walk, talk, read, write
and interact with others. Understanding the development that occurs during these
lifespan stages facilitates analysis of the effects that such development has on the
individual, both now and in the future.
Development in humans, although occurring at different times and at different
rates, has some similarities for all people. A number of principles govern the
development that humans experience and many of these are particularly evident
in the infancy and childhood stages. Any example of development may display a
number of the five principles discussed in the following sections.
1. Development occurs in a
predictable andorderly way
Many aspects of development occur in predictable, orderly patterns. From
observing many individuals over long periods of time, experts can roughly predict
when certain milestones should occur. For example, most infants learn to walk at
9 to 15 months.
Many aspects of human development require other skills in order to occur. For
example, if a child is to put a sentence together, they need to be able to manipulate
their vocal chords, know the meanings of words and articulate the sentence so it
makes sense. If any of these prior skills are not present, then the child will not be
able to make a sentence that makes sense.
2. Development is continual
Development starts with conception and ends with death. All skills learnt and
milestones achieved between these two events form part of development. The
foundations laid in one stage (e.g. learning to write in early childhood) will be built
upon in the next (figure 8.2). The decline in body systems and memory over time
are also a part of this principle, indicating that humans never stop developing.
3. T
here are individual variations
in the rate and timing of
development
Figure 8.3 The rate and timing
ofdevelopment are different for
allpeople.
Many factors influence development such as hormones, genetics, family interaction,

nutrition, physical activity levels and state of health. As a result, there will be
variations in when milestones are reached and how developed one person is
compared to another person of the same age. These factors also influence how
quickly it takes a person to move through a developmental stage (figure 8.3).
254
4. Development follows predictable

patterns
Growth and motor skill development follow patterns that are observable in
all people. The cephalocaudal and proximodistal patterns of development are
particularly evident during the prenatal, infant and childhood stages of the lifespan.
Cephalocaudal development
Cephalocaudal development refers to growth and development that occurs from
the head down. An infant will gain control over their neck muscles first, which
allows them to hold their head steady. Control over their shoulder muscles usually
follows, which allows them to roll over. Finally, control over the muscles in their
torso allows them to sit. The size of the head of an infant in relation to the rest of
the body also illustrates this pattern of development (figure 8.4).
Figure 8.4 The cephalocaudal pattern of development is shown in the changing

proportions of the human body over time.
Proximodistal development
Proximodistal development occurs from the centre or core of the body in an
outward direction. An example is the way that the spine develops first in the uterus,
followed by the extremities and finally the fingers and toes (figure 8.5). In motor
development, an infant reaches for a toy by using shoulder and torso rotation in
order to move the hand closer to the object. In childhood, the elbow and wrist are
responsible for the main movements.
Developing head
Heart prominent
Upper limb
Tail
Lower limb
Ear
Eye
Nose
Upper limb
Umbilical cord
Lower limb
Figure 8.5 The proximodistal patternof development is evident inthese 32- and 52-dayold embryos. The spine is prominent but the buds that will become the arms and legs are still
underdeveloped.
The health and individual human development of Australias children CHAPTER 8 255
8.1 Principles of individual human development
5. Development proceeds from the

simple to the complex
Thought processes and motor skill development go from simple to complex. Once
the simple aspects have been attained, they can be built upon to make the skills
more complex. For example, infants think in a concrete way but, as they move
through the childhood and youth stages, abstract thought develops. Another
example of this principle is that children usually learn to crawl before walking and
ultimately running.
Case study
Spare the comparisons

Comparing your kids with other children is a recipe
for disaster. By Michael Grose.
Do you ever compare your childs behaviour or p rogress
with other children of the same age? If so, you are
causing stress for yourself and your child. Comparing
your child with others is an ultimately useless activity.
But its hard to resist, as we tend to assess our
progress in any area of life by checking out how we
compare with our peers.
When you were a child in school you probably
compared yourself to your schoolmates. Your teachers
may not have graded you, but you knew who the
smart kids were and where you ranked in the pecking
order.
Now that you have kids of your own, do you still
keep an eye on your peers? Do you use the progress
and behaviour of their kids as benchmarks to help you
assess your own performance as well as your childs
progress? This is okay, as long as we dont lose sight of
three important aspects.
1. Kids develop at different rates. There are early
developers, slow bloomers and steady-as-yougo kids in every group, so comparing your
childs results or performance can be completely
unrealistic.
What this means for you: focus on your childs
improvement and effort and use your childs results as
the benchmark for his or her progress and development.
Your spelling is better today than it was a few days,
weeks or months ago.
2. Kids have different talents, interests and strengths.
Okay, your eight-year-old may not be able to
hit a tennis ball with Rafael Nadal, even though
your neighbours child can. Avoid comparing

the two as your child may not care about tennis
anyway.
What this means for you: help your child identify his or
her own talents and interests. Recognise that his or her
strengths and interests may be completely different to
those of his or her peers and siblings.
3. Parents can have unrealistic expectations for their
kids. We all have hopes and dreams for our kids,
but they may not be in line with their interests
and talents.
What this means for you: keep your expectations for
success in line with their abilities and interests. If
expectations are too high, kids will give up. If they are
too low, they will usually meet them!
Parents should take pride in their childrens
performance at school, sport or leisure activities.
You should also celebrate their achievements and
milestones, such as taking their first steps, scoring their
first goal in a game or getting great marks at school.
However, you shouldnt have too much personal
stake in your childrens success or in their milestones,
as this close association makes it hard to separate
yourself from your kids. It also causes you to play the
compare and compete game. By comparing kids you
can put pressure on yourself and them to perform for
the wrong reasons.
And certainly, your self-esteem as a parent should
not be explicitly linked to your childrens behaviour or
developmental levels.
You are not your child is a challenging but essential
parental concept to live by. Doing so takes real maturity
and altruism, but it is the absolute foundation of that
powerful thing known as unconditional love.
Source: Sunday Herald Sun, 26 April 2009.
Case study review

1 Why is it not useful for parents to compare their children to other children?
2 How could a childs interests influence how fast they develop?
3 How could performing for the wrong reasons influence future development?
TEST your knowledge
1 Explain what each of the following principles refers

to and provide examples for each:
(a) predictable and orderly development
(b) continual development
(c) variations in the rate and timing of development
(d) the cephalocaudal and proximodistal patterns of
development
(e) simple to complex development.
2 Consider the following developmental milestones

and explain how three principles of development
are evident in each one:
(a) learning to write
(b) learning to throw a ball
(c) a baby learning to sit up.
8.2
Development during infancy
KEY CONCEPT Understanding physical, social, emotional and

intellectual development during infancy
Infancy is the first stage of the lifespan after birth and lasts until the second
birthday. Newborns are relatively helpless (figure 8.6). They cannot feed, maintain
body warmth, or stay clean or hydrated without the assistance of others. With
interaction and adequate care, the infant will begin to show significant gains in all
areas of development. For the first 28 days after birth, the infant is referred to as
a neonate and undergoes significant changes or adaptations that help it to survive
outside the uterus.
Figure 8.6 The newborn is

relatively helpless and relies on
parents/caregivers for almost
everything.
Adaptations of the neonate

In the uterus, the foetus relies on its mother for the provision of oxygen, nutrients
and warmth and for the excretion of wastes. After birth, the infant must adapt
to the outside environment and carry out many of these bodily functions itself,
although it is still heavily reliant on help from parents or other caregivers.
In the uterus, the lungs of the foetus are filled with fluid and play no part in
circulation. Instead of travelling to the lungs, the blood must travel to the placenta
to become oxygenated. The foetal heart has two shunts, called the foramen ovale,
that are like valves that allow blood to travel between the chambers of the heart
and cause the blood to be redirected from the lungs to the placenta. After birth,
the foramen ovale close over and allow the blood to travel to the lungs to become
oxygenated. Although the foetus may display a breathing-like motion in the uterus,
there is only amniotic fluid in its immediate environment. As a result, its lungs
are filled with fluid. Once outside the uterus, the infant will take its first breath,
usually within 10 seconds after birth. This prompts the bloodstream to absorb
the fluid from the lungs, so the lungs will fill with air for the first time. A special
substance (called pulmonary surfactant) allows the lungs to expand when inhaling
and prevents them from collapsing when exhaling. Breathing may be shallow and
irregular for minutes or hours before it becomes more rhythmic.
During prenatal development, the foetus receives its nutrients from the mother.
After birth, the infant has some nutrients stored but relies on regular feeding in order
to grow and develop properly. The mothers breast tissue produces a substance called
colostrum for the first few days after birth and then regular breastmilk after that.
Colostrum is a concentrated form of breastmilk that is also rich in antibodies, which
boosts the infants immune function.
Figure 8.7 The foetus relies on its

mother for the provision of oxygen,
nutrients and warmth while in the
uterus.
258
At birth, the excretory organs which include the kidneys, liver and bowel
become functional and capable of eliminating waste products. For the first few
days after birth, meconium is passed through the bowels rather than normal faeces.
Meconium is a dark, sticky, tar-like substance that includes things ingested while in
the uterus such as mucous, bile and water. Unlike later faeces, meconium is a thick
liquid that does not have an odour.
The mothers body temperature maintains the temperature of the foetus. After
birth, temperature must be regulated in some other manner. Although they have
fat stores that assist with temperature regulation, newborn infants are not capable
of regulating their body temperature and rely on blankets, clothing, environmental
heat and body heat from others in order to survive.
The APGAR test

APGAR is an acronym for Activity, Pulse, Grimace, Appearance and Respiration.
Generally the first test given to newborns, the APGAR test is used to assess the
infants adaptation to life outside the uterus. The test is usually administered twice,
at one minute and at five minutes after birth. Judgements are made on the five
aspects of the test and scores given accordingly (table 8.1).
Table 8.1 The APGAR test is administered to newborns to assess their overall physical condition.
Score
APGAR sign
Activity (muscle tone)
Active, spontaneous movement
Arms and legs flexed with little

movement
No movement, floppy tone
Pulse (heart rate)
Normal (above 100 beats per

minute)
Below 100 beats per minute
Absent (no pulse)
Grimace (responsiveness or reflex

irritability)
Pulls away, sneezes or coughs with

stimulation
Facial movement only (grimace)

with stimulation
Absent (no response to

stimulation)
Appearance (skin coloration)
Normal colour all over (hands and

feet are pink)
Normal colour (but hands and feet

are bluish)
Bluish-grey or pale all over
Respiration (rate and effort of

breathing)
Normal rate and effort, good cry
Slow or irregular breathing,

weak cry
Absent (no breathing)
An infant receiving a score of 7 or over one minute after birth is generally

considered to have adapted successfully to life outside the uterus. If the score is
below 7 or after five minutes has not reached 7 (or if there are other concerns),
medical attention may be required.
Physically, the infancy stage is the second fastest period of physical development in
the lifespan, second only to the prenatal stage. Birth weight doubles by six months
and triples by 12 months. Body proportions also start to change, reflecting the
cephalocaudal pattern of development.
The senses continue to develop and, although vision is still largely blurry, the
infant will soon begin to recognise familiar faces and sounds. Bones continue to
ossify during infancy. By the first year, the infant can support its own weight.
Reflexes that are present at birth (e.g. the grasping reflex) are gradually replaced
by controlled movements as motor skills develop. A newborn infant does not
have much control over its body but will soon learn to lift its head and roll over.
At around six months, infants start crawling. By the age of one, many infants
can stand and walk (figure 8.8). By age two, they can usually throw and kick a
large ball.
Figure 8.8 By their first year, many

infants can support their own weight.
8.2 Development during infancy
Social development
The family is the most significant influence on social development at this stage of
the lifespan. The infant is totally dependent on its parents or other caregivers, and
will learn certain social skills by observing these people.
The infant begins to smile at around six weeks, and after around six months the
infant will begin to recognise facial expressions of others, such as a smile or a frown.
At around six months of age, the infant can enjoy basic games such as peekaboo.
As infants develop, play forms an important part of social development. They enjoy
games and become increasingly responsive to them. Many social skills are learnt
about sharing and taking turns through play. This may occur with siblings and
parents at home, and also with other children at child-care or playgroups. Through
experiences such as these, the infant also begins to learn culturally acceptable
behaviours such as listening to parents and not hitting others. Social roles like
parenting and employment are also imitated in ways such as pushing a pram with
a doll in it or dressing up as a firefighter (figure 8.9).
Figure 8.9 Social roles are often

learned by imitating others.
As language develops (intellectual development), infants can interact better with

those around them. They can generally speak a few words at around one year
of age, and understand many more. This allows parents to more easily guide the
social development of their infant.
Emotional development also revolves around the family at this stage of the lifespan.
One of the first signs of emotional development is when the hurt or distressed
infant can be comforted by its caregivers.
Emotional attachment is formed with the caregivers within months and this helps
the infant to feel secure, safe and loved. It also helps to build trust. The emotional
bond between caregivers and the infant may be so strong that the infant may become
distressed when held by a stranger or when a caregiver leaves the room.
Many things an infant experiences are encountered for the first time. As a result, it
may take time to develop appropriate responses to certain stimuli. For example, fear
may be shown when confronted by unfamiliar things such as a clown or a dog.
By eight months, the infant can express anger and happiness, and may become
frustrated if interrupted in their activities (e.g. when playing games). This expression
of frustration may result in tantrum-throwing in later months.
By 12 months, the infant becomes sensitive to approval from parents. It may
become upset or distressed if approval is not gained.
From the time of birth, all senses are working (although they become
more acute over time) and the baby is capable of learning. The senses
are the means by which the baby makes sense of the world around it.
Many infants collect information around them by putting objects into
their mouth. This behaviour will often change as the infant develops and
starts to use its other senses.
Within months, the infant will recognise its name and will respond
when called. Over time, this wordobject association progresses and the
infant will begin to recognise the names of favourite people, toys, other
objects and basic colours.
Early infancy also signifies an emerging understanding of cause and
effect. Infants will begin to associate certain actions with particular
outcomes. For example, if they cry, they get attention. If they reach for
someone, that person may pick them up. If they kick their legs around,
their caregivers might play with them.
The attention span of an infant is short and may last only a matter of
seconds. The infant may give extra attention to games and objects that it
finds interesting, but only for very short periods of time.
In early infancy, an object that is out of sight no longer exists in the mind of the
infant. So a toy that is placed in a cupboard no longer exists. As the infant develops
intellectually, it begins to understand that, although an object cannot be seen, it
still exists. This concept is known as object permanence (figure8.10).
By 18 months, the infant can imitate and pretend in play activities. By observing
others, the infant learns a lot about the world around it. Infants may imitate talking
on a phone or having a dinner party.
Language development is rapid during infancy. A three-month-old will make
speech-like sounds (goo and gaa), and will be able to say a couple of basic words
by the first birthday (dada or mumma). The development of language occurs
very quickly after this point. By the end of infancy the individual can say around
150300 words, although there is still confusion in context and pronunciation.
Figure 8.10 The level of intellectual

development experienced during
infancy contributes to the joy many
infants get out of playing peekaboo.
TEST your knowledge
1 When does the infancy stage of the lifespan begin

and end?
2 (a) Briefly describe the APGAR test.
(b) Explain why the test would be administered
twice after birth.
3 (a) Describe the adaptations an infant must make
after birth.
(b) Which adaptations is the neonate particularly
dependent on others for?
4 Describe the pattern of growth during infancy.
5 List three characteristics for each type of
development during the infancy stage.
6 Using the concept of object permanence as the

basis of your answer, discuss why infants may
particularly enjoy a game of peekaboo.
7 An infant scores 4 on the APGAR test one minute
after birth and then scores 8 five minutes after
birth. Discuss two adaptations of the neonate that
may have contributed to this increase in APGAR
score.
8 (a) Brainstorm a list of factors that might affect the
development of an infant.
(b) For each factor, identify the area of human
development concerned and the way it could
impact on an infants growth.
9 Explain why the role of parents is particularly
influential during infancy.
8.3
Development during early childhood

intellectual development during early childhood
Early childhood lasts from the second birthday until six years of age, typically the
preschool years. Although not long in years, significant development occurs during
early childhood.
Figure 8.11 As children gain

greater control over their body, more
complex activities such as riding a
tricycle become possible.
Early childhood is characterised by slow and steady growth. Although the rate of
growth is variable, height increases by around 6 centimetres per year and weight
by around 2.5 kilograms per year. Bones continue to lengthen and ossify during
early childhood, resulting in the increases in height experienced. Body proportions
change during early childhood, and the limbs and torso become more proportionate
to the head. Body-fat levels also decrease, giving the child a leaner body type.
Children may begin to lose baby teeth as the permanent teeth begin to develop.
While muscle development slows during early childhood, motor skill
development continues at a rapid rate. Gross motor skills increase and the walking
style becomes more fluid and refined. The child can climb stairs but will still
need to place both feet on each step until towards the end of early childhood.
Kicking, catching and throwing skills also develop, and the child might learn how
to skip. Coordination improves, allowing the child to pedal and steer a tricycle
(figure 8.11). Fine motor skills progress, and the child can learn to manipulate
zippers on clothing, hold crayons, use scissors and even tie shoelaces. As a result of
these activities, left- or right-handedness starts to appear in certain activities.
Social development
The family remains the primary social contact during childhood and is responsible
for many achievements in social development made by the child. The child will
begin participating in a wider range of family routines such as attending social
functions, eating at the table and helping with the shopping. Communication skills
and acceptable social behaviours increase as a result of these experiences.
The child may attend a
playgroup, kindergarten or a childcare centre, and this provides many
opportunities to further develop
social skills such as sharing and
taking turns (figure 8.12). As
the child becomes accustomed
to spending short periods of
time away from the family,
independence starts to develop.
The child may start wanting to
do things for themselves such as
dressing or washing, although they
may not be completely successful.
Figure 8.12 Play takes many forms,

and is a great way of increasing social
development.
Behaviours such as eating with a knife and fork are established during early
childhood but they will be refined over time. Children at this age like to be
accepted by others and may behave in a way that brings attention to them. This
can include showing off or performing for family and friends.
Play is still an important aspect of social development, although it is more
advanced than in infancy. Children may have a friend to play with and some will
create an imaginary friend. Make-believe play might also be a part of the childs
playing patterns.
Emotional development continues to occur at a rather fast pace during early
childhood. The emotional development of a two-year-old is quite different from
that of a six-year-old. A child will begin to develop a sense of empathy and may
care for people who are crying or upset. Yet their way of dealing with emotions
is still in its early stages, and children may use physical violence to express their
frustration. This is particularly common with other children or siblings. Play often
gives children a way of expressing their feelings.
Children take pride in their achievements (figure 8.13) and may want to show
them off to everyone. As a result of enjoying positive feedback from others, they
may become jealous when another child receives attention.
Figure 8.13 Children often show pride in their achievements.
Children begin to develop an identity that will continue to form for years to
come. They learn to see themselves as being separate from others, and begin to
associate certain things with themselves such as ownership of a toy.
Mood can change quickly during this stage as children often do not have the
skills required to control their feelings. As a result, they can switch from being
happy to being upset and then happy again in a very short period.
8.3 Development during early childhood
Learning new words and how to use language occurs fairly rapidly during this
stage and is a key part of the childs intellectual development. By the age of five, a
child knows approximately 15002500 words.
As interest in the world around them increases, children begin to question many
aspects of their environment. They ask parents or caregivers why? and like to
share their knowledge with others about colours, objects and animals.
As their attention span lengthens and knowledge of language increases, children
can remember and follow basic instructions such as getting a toy from the bedroom,
bringing it back to the lounge room and sitting in a designated place with it.
In the first years of early childhood, the child can classify objects based on one
aspect such as colour. For example, they can separate orange blocks from green
blocks, but find it more difficult to classify items according to multiple aspects
such as colour and size. These more complex skills develop over time.
Children in this lifespan stage may learn to write basic letters and read basic
books. They can also learn to count to 10 or 20, although this is often memorised
without really understanding the formation of numbers. Abstract thought
and prediction of the outcome of events is still difficult, and children are more
comfortable thinking about objects and situations they have already encountered.
TEST your knowledge
1 When does the early childhood stage of the lifespan

begin and end?
2 Describe the pattern of growth during the early
childhood stage.
3 List three characteristics for each of the following
types of development during the early childhood
stage:
(a) physical
(b) social
(c) emotional
(d) intellectual.
4 Carolyn is four years old and lives in rural Victoria

with her mother, father and three older brothers.
Her father runs their farm and her mother is a
stay-at-home mother. Her brothers all go to school
so, for most of the day, it is just Carolyn and her
mother at home. Carolyns physical development
has been very slow and her mother is worried
because Carolyn is significantly smaller than other
children her age. In order to assist with her social
development, Carolyns mother takes her to a local
playgroup once a week.
(a) Describe the physical development Carolyn
would be experiencing at this stage of her life.
(b) i. What is the average growth during this stage
of the lifespan?
ii. Explain why it is important to use these
figures as averages only.
(c) Identify the factors that may affect Carolyns
social development.
(d) Explain ways that Carolyns slow physical
development might affect other areas ofher
development both in the short and longterm.
264
8.4
Development during late childhood

intellectual development during late childhood
Late childhood starts at the sixth birthday and continues until 12 years of age.
During this time, the child will begin formal schooling while continuing to grow in
a similar fashion to that experienced in early childhood.
Physical development in late childhood is slow and steady, as it was in early
childhood. Bones and muscles continue to grow in length and width. Height
continues to increase by 5 to 6 centimetres per year, and weight increases by
around 3 kilograms per year. Both sexes have similar body shapes until the onset
of puberty, although males may be slightly larger. Body proportions continue
to change as the head grows more slowly in comparison to the torso, arms and
legs. A child in the late childhood stage has similar body proportions to an adult.
Permanent teeth continue to develop and, by the end of late childhood, most
permanent teeth will be present (figure 8.14).
The child gains greater control over their body, and motor skills develop as a
result. As size and strength increase, children can perform more complex physical
tasks such as playing basketball or participating in gymnastics. They have also
had years to develop speed, agility and balance, and these skills are used in many
physical activities such as games and sport. More complex gross motor skills such
as skipping are also refined during this time. Fine motor skills are developed, and a
child at the beginning of late childhood can write basic sentences, although writing
might still be illegible at times. By the end of late childhood, writing becomes more
legible and the writing style may also be more established.
Social development
Figure 8.14 Losing teeth is a normal

part of childhood development.
Unit 2
Physical
development
With the commencement of formal schooling, most children experience a
AOS 2
childhood
wide range of social situations during late childhood (figure 8.15). As a result,
Concept summary
Topic 2
relationships with others change and the child will generally have numerous social
and practice
contacts outside the family. Social skills such as sharing, communication and
Concept 1
questions
conflict resolution are further developed by this increase in social interaction.
Relationships at school are formed but are generally
limited to members of the same sex. Skills such as
cooperation and sharing are further developed as a result.
The child may still show off in front of friends and
family in order to gain attention. Children in this lifespan
stage place increasing importance on being accepted by
others (e.g. parents, teachers and peers) and may modify
their behaviour in order to achieve approval.
Morals further develop during this time, and children
acquire a greater sense of right and wrong as well as a
better understanding of what is acceptable behaviour in
their society. As a result, children can generally make an
informed decision about right and wrong even in new
situations. In contrast, knowledge of right and wrong
in early childhood is largely limited to the instances of
right and wrong that have been taught by parents or Figure 8.15 School provides many opportunities for social
development.
caregivers.
8.4 Development during late childhood
Unit 2
AOS 2
Topic 2
Concept 2
Unit 2
AOS 2
Topic 2
Concept 3
Unit 2
AOS 2
Topic 2
Concept 4
Social
development
childhood
Concept summary
and practice
questions
Emotional
development
childhood
Concept summary
and practice
questions
Intellectual
development
childhood
Concept summary
and practice
questions
Emotional development continues during late childhood, allowing children to

control and recognise their emotions much better than they could in early childhood.
As children develop empathy, they begin to be able to identify emotions in others.
Having better control of their emotions allows children to better function in a
range of settings including school and at friends houses. Tantrums are generally
not a common occurrence in this lifespan stage. Children also become more skilled
at conveying emotions in words, and this may further increase control of their
emotions.
Self-concept is largely established during this time although it will continue
to be modified throughout life. Children will have formed ideas about what they
are and are not good at (e.g. I am a fast runner or I am good at school). As a
result of these feelings, a child may become self-conscious in situations where they
feel inadequate. This might occur around certain people, or in certain activities
(e.g.playing soccer) if they feel they are not good at them.
Much of a childs intellectual development takes place at school (figure 8.16). The
brain continues to develop during late childhood and intellectual skills develop
considerably. At the beginning of this stage, children can generally follow basic
instructions and place objects in a logical order (e.g. from big to small) or arrange
them according to numerical value. As they develop intellectually, the child can
follow instructions with multiple steps and classify items based on multiple criteria.
Problem-solving skills develop and the child begins to be able to focus on ideas
rather than objects.
Knowledge of language increases, allowing the child to complete tasks such as
pluralising words most of the time. By the age of six, children know 20003000
words. By the end of late childhood, they might know over 10000 words. Reading
skills also develop during this stage and, by the age of 12, the individual can read
and make sense of age-appropriate books.
Figure 8.16 A lot of intellectual development occurs through formal education.
Children in late childhood generally have an increased interest in numbers and

can perform basic mathematical problems. They can also apply logic to equations
and understand that 3 6 will produce the same answer as 6 3.
Attention span increases and the child can sit quietly in class for longer periods
of time, but concentration will still lapse after a matter of minutes. Long-term
memory develops and the child can more accurately recall stories of things that
happened in the past.
TEST your knowledge
1 When does the late childhood stage of the lifespan

begin and end?
2 Describe the pattern of growth during the late
childhood stage.
3 List three characteristics for each of the following
types of development during the late childhood
stage:
(a) physical
(b) social
(c) emotional
(d) intellectual.
4 With a partner, brainstorm how inadequate

development in the prenatal, infant and early and
late childhood stages of the lifespan could affect
future development.
5 Discuss how emotional development is different
between those in early and late childhood.
6 Explain how intellectual development could affect
social development during late childhood.
7 Choose a game or toy commonly enjoyed by
children and discuss how it might promote each
type of development.
8 Create a game that may assist in the social
development of children in the late childhood stage
of the lifespan.
8.5
The health status of Australias children: mortality
KEY CONCEPT Understanding the health status of Australias

children mortality
Australias children have the best health status in the country, and key health
indicators place their health among the best in the world. Improvements are
continually being made with regards to many health indicators and, as a result,
most Australian children in todays society can expect to live in good health.
Unfortunately, there are some exceptions, particularly among Indigenous Australians,
those living in remote areas and those of low socioeconomic backgrounds. Infants
and children in these groups experience higher mortality rates and greater risk of
disease and injury. Many statistics present average figures for all Australian children
and, as a result, may mask the challenges facing some groups within the country.
When examining statistics, it is important to remember that not everyone enjoys
the good health experienced by the majority.
Because many sources of health data group infants and children in their statistics,
infant and child health will generally be considered together.
Mortality
Infant mortality rates in Australia have fallen considerably over the past two
12
Boys
Girls
Children
10
8
6
4
2
2013
2012
2011
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
0
1986
Infant deaths per 1000 live births
decades (figure 8.17), but still account for half of all deaths in those aged under
20. Although the rate for all Australians is relatively low by international standards,
the figures mask higher infant mortality rates for Indigenous Australians. In fact,
for the last ten years, the infant mortality rate for Indigenous Australians has been
around three times higher than the rest of the population. As infants get closer to
their first birthday, the risk of death decreases.
Year
Figure 8.17 Infant mortality rates for boys and girls over time
Source: Adapted from ABS data and AIHW 2012, A picture of Australias children 2012, cat. no. PHE 112, Canberra,
pp. 13, 140.
Most cases of infant mortality arise from problems associated with the birth or
pregnancy itself. As a result of this, a majority of infant deaths occur in the period
directly prior to or after birth. Particular causes of death in the first year of life are
outlined in figure 8.18; perinatal conditions and congenital abnormalities account
for around 75 per cent of all infant deaths.
268
Foetus and newborn affected by

maternal complications of
pregnancy
All other causes

Other signs, symptoms
and abnormal findings
Sudden infant
death syndrome (SIDS)
18%
8%
3%
Disorders of short gestation

and low birthweight
6%
7%
8%
Congenital malformations
of the circulatory system
Foetus and newborn affected by

complications of placenta, cord
and membranes
12%
20%
Perinatal conditions (46%)
18%
Congenital anomalies (26%)

Other perinatal
conditions
Signs, symptoms and abnormal

findings (10%)
Other congenital anomalies
Other causes (18%)

FIgUrE 8.18 Leading causes of infant mortality, 20082010
Source: AIHW, Making progress: the health, development and wellbeing ofAustralias children and young people, 2008.
Much of the decrease in infant mortality has been due to reductions in deaths
from sudden infant death syndrome (SIDS). SIDS is the unexplained death of an
apparently healthy infant. It is only diagnosed when other causes are ruled out.
Although the exact causes of SIDS are unknown, there are a number of determinants
that increase the risk of SIDS for an infant. These include being male (70 per cent
of SIDS deaths are usually males) or sleeping on the stomach. Figure 8.19 outlines
the decline in deaths attributable to SIDS overtime.
Infant deaths per 100 000

live births
300
Boys
Girls
Children
Introduction of SIDS
education campaign
250
200
150
100
50
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
Year
Child mortality rates refer to deaths occurring in children between the ages of 1
and 14. Child mortality rates have also decreased in recent decades. Awareness of
illness and advances in medicine and technology have been largely responsible for
these decreases. Mortality rates decrease as children get older, as shown in table8.2.
Although overall rates have decreased, child mortality rates for Indigenous, rural
and remote, and low socioeconomic backgrounds remain higher than the rest of
the population.
The majority of causes of mortality for children are termed injuries (which
includes poisoning), and are accidental in nature (figure 8.20). Injuries account for
more deaths in childhood than any other cause. Injuries include falls, drowning,
suffocation, poisoning, transport accidents and burns. According to the Australian
Institute of Health and Welfare in 200810, males were 60 per cent more likely
than females to be hospitalised for injuries and Indigenous children were 50 per
cent more likely to be hospitalised than other children.
FIgUrE 8.19 Infant deaths from

SIDS, 19862010
Source: Adapted from ABS data and AIHW
2012, Apicture of Australias children 2012,
cat. no. PHE 112, Canberra, p. 14.
TAbLE 8.2 Mortality rates of those

aged 112 years
Age
Death rate
(per 100 000 population)
14 years
19
512 years
10
Source: Based on data from AIHW 2012,

Apicture of Australias children 2012,
cat. no. PHE 112, Canberra, p. 14.
The health and individual human development of Australias children CHAPTEr 8
269
8.5 The health status of Australias children: mortality

Inadequate supervision can increase the risk of injury among children, but
they are also more likely to sustain injuries than older people due to their level of
development.
Because children are not as developed intellectually, they may lack knowledge of
how to avoid injuries. Burns, drowning, bike accidents and falls may all occur at
higher rates in children due to lower levels of intellectual development.
AOS 2
Topic 3
14
Child mortality
Concept summary
and practice
questions
Age group (years)
Unit 2
Concept 1
59
Injuries
All cancer
Diseases of the nervous system
Congenital anomalies
1014
Circulatory conditions
All other causes
0
15
10
Deaths per 100 000 children
20
25
Figure 8.20 Leading causes of mortality among children aged 114 years, 20082010 (per
100000 population)
Source: AIHW 2012, A picture of Australias children 2012, cat. no. PHE 112, Canberra, p. 15.
A childs physical development can also increase their risk of certain injuries:
The size of an infants head in relation totheir body makes it difficult for them
to support the weight of their head. This can prevent them from lifting their
head out of water and increase the risk of drowning.
Underdeveloped motor skills can also contribute to injuries such as
bike accidents and falls, as children may be more likely to trip over when
running.
Bones in children are not completely developed and may therefore fracture more
easily than the bones of an adult.
The risk of most cancers increases with age, but cancer remains a leading cause of
death for children. Cancer is characterised by an uncontrolled growth of abnormal
cells that, over time, can prevent healthy body cells from carrying out their normal
functions. Cancers found in children are often different in type and their response
to treatment compared to cancers found in adults. Leukaemia and brain cancers
are the most common cancers in children. Although incidence rates have remained
constant, mortality rates due to cancer have decreased in children as a result of
advancements in medical technology and treatment options. Table 8.3 outlines the
changes in cancer deaths and mortality rates in children.
Table 8.3 Cancer deaths among children aged 014 years, 19972010
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Number
140
154
122
106
118
124
102
114
96
90
90
84
74
116
Deaths per 100000

children
3.6
3.9
3.1
2.7
3.0
3.1
2.5
2.8
2.4
2.2
2.2
2.0
1.8
2.7
Source: AIHW 2012, A picture of Australias children 2012, cat. no. PHE 112, Canberra, p. 22.
Diseases of the nervous system are the third leading cause of childhood mortality.
These conditions include a range of diseases that affect the brain, spinal cord and
nerves. Examples include meningitis; cerebral palsy; swelling of the brain; and
malformed brain, skull and spinal cord.
TEST your knowledge

1 (a) Using figure 8.17, identify two trends in infant
mortality over time.
(b) What reasons can you think of that would
account for these trends (give specific
examples)?
2 (a) What is the leading category for cause of death
in infants according to figure 8.18?
(b) What causes of death are included in this
category?
3 (a) Describe how the mortality rates for children
have changed over time.
(b) What factors could explain this trend?
4 (a) Using table 8.2, compare the mortality rates for
14 year olds and 512 year olds.
(b) Suggest reasons for this difference.
5 According to figure 8.20, what are the leading
causes of death for:
(a) i. 14 year olds?
ii. 59 year olds?
(b) What factors could account for differences
between age groups?
6 Outline two causes that contribute to the relatively

high rates of injury deaths among children.
7 (a) Graph the cancer mortality rates among children
from 1997 to 2010.
(b) Explain the changes in cancer mortality rates
over time and suggest possible reasons for this
change.

8 Write a press release describing the health of
Australias children. In your article, include:
(a) the overall level of health of children
(b) mortality rates
(c) leading causes of death.
9 Use the SIDS and Kids links in the
activity.
8.6
The health status of Australias children: morbidity
KEY CONCEPT Understanding the health status of Australias

children morbidity
Morbidity
Table 8.4 Percentage of low birth

weight babies by Indigenous status,
2012
Low birth
weight
Indigenous (%)
11.8
Non-Indigenous (%)
6.0
Rate ratio
1.9
Source: AIHW, Australias mothers and babies

2012, cat. no. PER 69, p. 78.
Although child mortality rates have decreased over time, there are many
chronicconditions that impact on the health and human development of children.
In the following section, various causes of both infant and child morbidity are
examined.
Birth weight is a good indicator of the health of newborns. Those born with
a low birth weight are more likely to experience ill-health and even premature
death. This is largely due to the underdevelopment of organs and the immune
system, making infants with a low birth weight more susceptible to infections,
other diseases and organ malfunction.
A number of factors contribute to low birth weight, including exposure to
teratogens, the mothers age (being under 20 or over 40 increases the chances of
low birth weight) and access to antenatal care. Although overall rates of low birth
weight are relatively low in Australia, Indigenous mothers are about twice as likely
to give birth to a low birth weight baby compared with non-Indigenous mothers,
as shown in table 8.4.
Many chronic conditions have become more common in childhood over recent
decades. According to the AIHW in 2012, 37 per cent of those aged 114 had a
long term or chronic condition. The most frequently reported chronic conditions
among children are shown in figure 8.21.
Asthma
AOS 2
Topic 3
Concept 2
Child morbidity
Concept summary
and practice
questions
Hayfever and allergic rhinitis

Long-term condition
Unit 2
Allergy (undefined)
Short sighted/myopia
Long sighted/hyperopia
Chronic sinusitis
Dermatitis and eczema
Behavioural and emotional problems
Anxiety-related problems
Problems of psychological development
0
8
6
Percentage
10
12
Note: Long-term condition is defined here as a condition that has lasted, or is expected to last, 6 months or more.
Figure 8.21 Most frequently reported chronic conditions, 2012

Source: AIHW, A picture of Australias children 2012, cat. no. PHE 167, Canberra, p. 17.
As children get older, they are more able to communicate their problems. Thus
a child might have suffered from poor eyesight for years but would not have been
able to tell anyone until they learnt to speak. This contributes to the increase in
chronic conditions as children get older.
Asthma, obesity, diabetes and mental health problems all contribute considerably
to the burden of disease among children.
Asthma
25
Boys
Girls
Children
20
Per cent
Australia has one of the highest asthma rates in

the world (figure 8.22). While the exact causes are
not known, a number of factors contribute to its
onset. These include:
maternal smoking
exposure to tobacco smoke
air pollution and exposure to other pollutants.
Asthma is characterised by a narrowing of the
airways that results in wheezing, coughing and
difficulty breathing. Although asthma does not cause
many deaths in children, it is the most commonly
reported chronic condition and one of the major
reasons for hospitalisation among children.
15
10
Obesity
04
59
Age group (years)
Rates of overweight and obesity among Australian children have doubled in

recent years. Around one-quarter of all Australian children are now overweight or
obese (ABS, 2014). This increase contributes to the development of other chronic
conditions in children such as asthma and type 2 diabetes. Children who are
overweight or obese are also more likely to be overweight or obese in adulthood,
which puts them at further risk of health complications.
1014
Figure 8.22 Parent-reported

asthma rates in children aged
014years
Source: AIHW,A picture of Australias children
2012, cat.no. PHE 167, Canberra, p.18.
Diabetes
Incidence per 100 000 children
The rates of both type 1 and type 2 diabetes have increased in children over time,
although type 1 cases still account for around 90 per cent of total diabetes cases
among children. Both type 1 and type 2 diabetes are characterised by an inability
of the body to effectively transport glucose into the cells to be used for energy.
As a result, glucose stays in the bloodstream, which can lead to serious health
problems such as kidney damage, heart disease, poor circulation and premature
death.
Type 1 diabetes is generally diagnosed by the age of 15 and is a significant
contributor to burden of disease among children. Type 1 diabetes is an autoimmune
disease characterised by the destruction of the cells in the pancreas that produce
insulin. Insulin is the hormone responsible
30
for transporting glucose into cells, so a lack
of insulin results in high blood-glucose levels.
25
As those with type 1 diabetes do not produce
insulin, it must be administered by injections or
20
an insulin pump. Insulin is given when bloodglucose levels rise in order to allow glucose to be
15
used by the cells.
The incidence of type 1 diabetes in children
10
increased from 19 to 24 new cases per 100000
population between 2000 and 2004. The
5
incidence rate has been fairly stable since 2004
0
(figure 8.23).
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
While previously considered an older persons
Year
disease, type 2 diabetes is becoming more
Figure 8.23 The incidence of type 1 diabetes (014 year olds) per
common among Australian children, mostly as
100000population
a result of increasing rates of obesity. Indigenous
Source: Adapted from ABS data and AIHW,A picture of Australias children 2012, cat.no. PHE 167,
Canberra, p. 19.
and Pacific Islander children, those who live in

rural and remote areas, and those who live in socioeconomic disadvantage, are
most likely to develop the condition. While the effect of type 2 diabetes is similar
to that of type1 diabetes, the causes are quite different. Those with type 2 diabetes
experience insulin resistance. Insulin resistance is characterised by an inability
of the body to use the insulin that is produced. Lifestyle changes to dietary and
exercise patterns can often reduce the effects of diabetes. For others, medication
and/or insulin may be required.
Mental health problems

Mental health problems (sometimes referred to as psychological, emotional
and behavioural disorders) are also a large contributor to the burden of disease
in childhood, and the rates increase as children get older. Indigenous children,
those in rural and remote areas, and those from low socioeconomic backgrounds
experience higher rates of mental health problems than the rest of the population.
According to the National Aboriginal and Torres Strait Islander Health Survey
(ABS, 2006), around 13 per cent of Indigenous children experienced a mental or
behavioural disorder compared to 8 per cent of the rest of the population. Access
to health care is essential for the prevention, diagnosis and treatment of mental
health problems, and these population groups generally have lower levels of access
to affordable, appropriate care. This contributes to the higher rates of mental health
problems experienced.
The impact of mental health problems will often depend on the type of
condition experienced. Three common mental health issues among children
include conduct problems, emotional symptoms and hyperactivity. The proportion
of Victorian children at high or moderate risk of these issues in 2012 is shown in
figure 8.24.
16
14
Per cent
12
10
8
6
4
2
0
Conduct problems
Emotional symptoms
Hyperactivity
FIGURE 8.24 Percentage of Victorian children at high or moderate risk of selected mental
health issues, 2012
Source: Adapted from Victorian Department of Education, School Entrant Health Questionnaire (SEHQ),
www.education.vic.gov.au.
Conduct problems can be characterised by aggression, defiance, destruction of

property and deceitfulness. Oppositional defiant disorder (ODD) is a childhood
conduct problem characterised by constant disobedience and hostility. Around
onein10children under the age of 12years are thought to have ODD, with boys
outnumbering girls by two to one. Conduct problems can impact on all areas of
health and development. The child may not experience success at school, which
274
can lead to feelings of low self-esteem. Or other children may not want to interact
with the child, leading to poor social health and development.
Emotional symptoms refer to experiencing a high level of negative emotions,
such as sadness, fear and worries. Emotional symptoms can indicate an increased
risk of conditions such as depression and anxiety. Emotional symptoms can
contribute to low self-esteem and a lack of interest in normally enjoyable activities.
Sleeping and eating patterns may be disrupted, which can contribute to low energy
levels and thereby impact on all areas of health and development.
Hyperactivity relates to a range of behaviours, including restlessness,
impulsiveness and lack of concentration. An example of a common hyperactivity
disorder in Australia is attention deficit hyperactivity disorder (ADHD). ADHD
is characterised by hyperactivity and an inability to maintain attention on
a task. Some children with ADHD will display only a few signs and may not
experience the same burden that other children with the condition face. Intellectual
development may be affected if the child cannot concentrate on key concepts at
school.
Dental health
Despite steady improvement from the 1970s onwards, dental health has been
declining in children since the mid-1990s (figure 8.25).
6
Average number of affected teeth
Permanent teeth (at age 12)

Baby teeth (at age 6)
2010
2009
2008
2007
2006
2005
200304
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
FIGURE 8.25 Trends in decayed, missing or filled teeth in children, 19902010

Source: AIHW 2014, Oral health and dental care in Australia: key facts and figures trends 2014, cat. no. DEN 228, Canberra, p.2.
Poor dental health has a number of implications for health and development.
Bacteria can travel from the mouth to the lungs and contribute to lung infections
and other respiratory problems. Bacteria found in plaque may also increase the
risk of heart disease and stroke, although this research is still continuing. Children
with poor dental health may experience decreased self esteem, especially if their
appearance is affected. School absences are common, as treatment is administered
or infections take hold. This can impact on social health and intellectual
development in particular. Physical development can be further hindered if the
bones that support teeth are also affected.
Hospitalisations
Hospitalisation among children can have a range of impacts on the health and
development, especially if hospital stays are long.
Rates of hospitalisation due to asthma are higher in childhood than other lifespan
stages, although rates have decreased over time (figure 8.26). The average stay in
hospital as a result of asthma is 2.6 days for children.
Hospitalisation rate per 100 000 people
800
700
600
500
400
300
200
100
0
199899 199900 200001 200102 200203 200304 200405 200506 200607 200708 200809 200910 201011
Year
FIGURE 8.26 Hospitalisations among
children aged 014 years from asthma
Source: AIHW 2013, Asthma hospitalisations in
Australia 201011, cat. no. ACM 27, Canberra,
p. 11.
Injuries are another significant cause of hospitalisation for children. Among

the different types of injuries, falls contributed the most to the hospitalisation of
children (table 8.5). The amount of time spent in hospital as a result of injuries
depends on the severity of the injury sustained, and can vary from hours to months.
TABLE 8.5 Hospitalisations among children aged 114 years from selected injuries, 201112
Age group
14
Transport
67.2
Drowning and submersion
59
1014
133.1
237.2
13.0
2.0
2.0
112.6
11.9
10.7
Falls
678.2
700.5
626.4
Source: Pointer S 2014, Hospitalised injury in children and young people 201112, Injury research and statistics series
no. 91, cat. no. INJCAT 167, Canberra: AIHW, p.84.
Chronic conditions can impact on all areas of health and development. The
child may miss out on experiences due to extended periods away from school and,
as a result, may not develop as they otherwise would have. They may develop low
self-esteem and be marginalised by their peers.
The impact on the sufferer will largely depend on the severity of the condition.
Some conditions, such as mild asthma, may be easily managed and not interfere too
much with normal functioning. However, a serious injury may result in extended
periods of hospitalisation and significant rehabilitation after being discharged
from hospital, affecting many aspects of life. Reducing the rate of these conditions
is important to limit the negative impacts on the health and individual human
development of children.
276
TEST your knowledge
1 (a) Briefly explain why low birth weight babies are

more likely to experience ill-health than those of
normal body weight.
(b) List three factors that increase the chance of
having a low birth weight baby.
2 (a) Identify the most frequently reported chronic
condition according to figure 8.21.
(b) Approximately what percentage of children
suffer from this condition?
3 (a) Briefly describe the changes in the incidence
oftype 1 diabetes over time according to
figure 8.23.
(b) Suggest reasons for this change.
4 Explain the term insulin resistance.
5 (a) Explain the difference between conduct
problems, emotional symptoms and
hyperactivity.
(b) Explain how each issue identified in part (a)
could impact on health or individual human
development.
6 (a) What factors could lead to poor dental health?
(b) Outline three possible impacts of poor dental
health in children.
7 Using figure 8.22, identify one difference in

the rates of asthma experienced by males and
females.
8 Brainstorm reasons why birth weight would be a
good indicator of a newborn babys health.
9 Suggest reasons that may account for Indigenous
women having higher rates of low birth weight
babies.
10 Why do you think Australia has a high asthma rate
compared to other countries?
11 Explain how asthma could affect physical, social and
mental health of children.
12 Explain how asthma hospitalisation rates have
changed over time according to figure8.26.
13 (a) Discuss the differences in hospitalisation rates
for those aged 04 compared to those aged
1014 as a result of:
i. transport
ii. drowning and submersion
iii. accidental poisoning.
(b) Using table 8.5, discuss how changes in
individual human development may contribute
to the differences discussed in part (a).
KEY SKILLS The health and individualhumandevelopment

of Australias children
KEY SKILL Describe the characteristics of
development from birth to late childhood
The type of development is identified

and all four areas are covered.
Junis lifespan stage is childhood.
However, as a particular age is

specified, discussion focuses on
children around this age (within
one or two years). Reference to the
milestones for an 11-year-old would
not be relevant, even though an
11-year-old would be placed within
the same lifespan stage.
Examples of physical development

Examples of social development
Examples of emotional development
Examples of intellectual development
The key requirement for this key skill is to be able to describe the development
that occurs from birth until the 12th birthday. An understanding of the four types
of development (physical, social, emotional and intellectual) and the changes that
occur during the stages of infancy and early and late childhood is essential.
Consider the following example, which is a discussion of the development that
would be taking place for Juni, a six-year-old who is attending primary school.
Physical development:
At Junis stage of the lifespan, growth would be slow and steady. Fine and gross
motor skills would continue to develop.
Her running style would become more fluid and she may now be able to skip.
Juni may be able to write a legible sentence by this stage.
Social development:
As she is attending school, Juni would associate with more people outside the
home and would refine social skills such as communication and cooperation. She
may show off in front of friends and family to gain attention.
Emotional development:
Juni may be able to identify basic emotions in others and has greater control over
her own emotions, and tantrums are less common.
Intellectual development:
Juni will be able to follow basic instructions and may be able to order objects from
big to small.

1 Milan is two years old and an only child. He has just started attending child-care
twice a week.
(a) Identify three physical changes that Milan will experience in the next five years.
(b) Explain how attending child-care may affect Milans social development.

Australiaschildren
This key skill requires the analysis of data related to the health of children. Data
can be presented in a number of ways. To revisit this skill, refer to the key skills
section of chapter 2 (pages 745) and follow the steps outlined there. A knowledge
of the basic issues concerning the health status of children will be beneficial in
applying this key skill.
60
50
40
30
Boys
Girls
Children
20
10
Year
201011
200910
200809
200708
200607
200506
200405
200304
0
200203
Source: AIHW,A picture of Australias children

2012, cat.no. PHE 167, Canberra, p. 20.
70
200102
Figure 8.27 Diabetes hospital

separations for children aged
014years, 200001 to 201011
80
200001
Hospital separations per

100 000 children
90
Analyse the data in figure 8.27 and use it to draw conclusions about the
health status of Australias children. In describing the trends evident in this
graph, the following three statements can be made. However, there are important
considerations to be taken into account.
Girls generally have higher rates of hospitalisations due to diabetes than boys.
Rates for hospitalisations have increased from around 58 per 100000 female
children in 200001 to around 75 per 100000 female children in 201011.
The rates of hospitalisations due to diabetes have increased for both males and
females between 200001 and 201011.
In 200304, the rates were very

similar. Including the qualifier
generally takes this factor into
account.
It is important to clearly state the

trend that is being identified.
This information might also be
presented in a different way. For

example: Female hospitalisations due
to diabetes have increased by around
17 per 100000 children. A similar
trend focusing on males or all
children could also be used.

2 Study figure 8.28 and answer the questions that follow.
(a) Identify two trends in the mortality rates as shown in figure 8.28.
Reference is made to the span of
years over which the trend occurred.

Try to avoid making statements like
hospitalisations are increasing as this
indicates that the trend is currently
occurring when the data do not
support this.
2 marks
(b) Use your knowledge of childrens health status to list three causes of death that are
common in the 04 age group.
3 marks
(c) Discuss how causes of mortality change between infancy and childhood.
300
04 years
59 years
914 years
250
200
150
100
50
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
0
1985
Mortality rates per 100 000
4 marks
Year
Figure 8.28 Mortality rates over time, per 100000 for selected age groups
Source: Adapted from AIHW, National mortality database.
CHAPTER 8 review
Chapter summary
Interactivities:
Chapter 8 crossword
Development occurs according to a number of principles: it is predictable and

orderly, it is continual, there is individual variation in its rate and timing, it follows the
cephalocaudal and proximodistal laws, and it moves from simple to complex. Many
achievements in development will display more than one of these principles.
A neonate is the name given to a newborn from birth to 28 days.
There are several adaptations that must occur for the neonate to survive outside the
uterus. These include changes to respiration, circulation, nutrition, excretion and control
of body temperature.
The APGAR test is used to assess how well a newborn has adjusted to life outside the uterus.
Infancy is a rapid period of growth. Major milestones such as crawling and walking
occur during this stage.
Unit 2
AOS 2
Sit Topic test
The health
and individual
human
development of
Australias
children
The family is the most significant influence on social development during infancy.
Emotional attachment to a significant caregiver occurs during infancy.
Infants use their senses to learn. By the end of infancy, most infants can associate
names with people and objects. Language development is rapid during infancy.
Physical development during early and late childhood is described as being slow and steady.
Gradual increases in height and weight are accompanied by increases in bone strength.
As the child grows and gains strength, their motor development progresses and the
child becomes capable of more complex motor skills.
Social development is facilitated by play and interaction with family members. Children
often imitate the actions of older people as a way of learning social skills and roles.
By the end of early childhood, the child is usually toilet-trained and can use a knife
andfork.
The child gains an increasing sense of self during the childhood years and may become
self-conscious in certain circumstances.
Intellectual development continues to progress and, as the child ages, language skills
become increasingly complex.
By the end of childhood, the child can read, write and complete basic mathematical
problems.
Thought patterns begin to change and, by the end of late childhood, the child starts to
think in an abstract way.
Overall, Australian children experience excellent health but some groups, especially
Indigenous, those in rural and remote areas, and those from low socioeconomic
backgrounds, fare far worse than the majority of the population.
Death rates and life expectancy are continually improving for Australian children.
The main causes of death in this age group are perinatal conditions for infants and
injuries for children.
Asthma is the most commonly reported condition for children.
Hospitalisation rates for asthma and injuries are relatively high for children.
TEST your knowledge

1 Brainstorm a list of factors that have contributed
to lower death rates and higher life expectancy
throughout all the stages of childhood.

2 How can the family positively or negatively affect
the development of a child?
3 List three milestones of development that require

prior skills in order to be achieved (list the prior skills
as well).
4 Use the Development timeline
280
CHAPTEr 9

ofAustralias children
The determinants of health and individual human development
are important to Australias children as they significantly
influence health status and physical, social, emotional and
intellectual development. How effectively the body functions,
the lifestyle choices made by parents and children, the physical
environment in which children live and their social environment
can have an effect on the health and individual human
development of Australias children. Social determinants such
as the capacity of parents to cope with the responsibilities
associated with supporting and caring for a family, including
being informed about and accessing the range of services
available within the community, are important for promoting
the health and individual human development of children.
KEY KNOWLEDGE
2.4 determinants of the health and individual human development of
Australias children, including at least one from each of the following:
biological, such as genetics, birth weight and body weight (pages28492)
behavioural, such as eating habits, level of physical activity, oral
hygiene, breastfeeding and vaccination (pages 293305)
physical environment, such as tobacco smoke in the home, housing
environment, fluoridation of water and access to recreational facilities
(pages 30611)
social, such as parental education, parenting practices, media
andaccess to health care (pages 31219)
2.5 determinants that act as risk and/or protective factors in relation to one
health issue such as asthma, falls and injuries, food allergies, juvenile
arthritis or type 1 diabetes (pages 32033)
2.6 government, community and personal strategies and programs designed
to promote the health and human individual development of children
(pages33443).
KEY SKILLS
explain the determinants of health and individual human development and
their impact on children using relevant examples (pages 292, 305, 307, 311,
319, 322, 325, 327, 330, 333, 340, 343, 3445, 352)
describe a specific health issue facing Australias children and draw
informed conclusions about personal, community and government
strategies and programs to optimise child health and development
(pages322, 325, 327, 330, 333, 340, 343, 3467, 352).
282
FIGUrE 9.1 A range of

determinants affect the health and
individual human development of
Australias children.

autoimmune when the immune system attacks and
destroys healthy body tissues
carrier a person who has inherited a genetic trait or
condition but does not display the trait or symptoms.
They are able to pass the gene on to their children,
who may or may not display the trait or symptoms.
chronic obstructive pulmonary disease refers to
a number of conditions that restrict the airways and
therefore make breathing difficult
congenital malformations defects or damage to the
developing foetus
endocrine system the system in the body that
regulates the production and release of hormones
(through the glands)
genes the blueprint of the body that controls growth,
development and how the body functions
gingivitis early stage of gum disease characterised by
bleeding, redness and swelling of gums
hormone a chemical in the body that causes a change
in the functioning of a specific tissue or organ
meningococcal disease a potentially fatal infection
that occurs when meningococcal bacteria invade the
body, usually from the throat or nose
multicausal refers to a range of factors that together
determine and influence health
periodontitis advanced stage of gum disease
resulting in bleeding, swelling, receding gums, bad
breath, a bad taste in the mouth and loose teeth
protective factors influences that help guard against
ill-health
recessive describes a trait that must be contributed by
both parents in order to appear in the offspring
risk factors influences that increase the likelihood of
ill-health
9.1
Determinants of health and individual human development

during the childhood stage of the lifespan: biological
KEY CONCEPT Understanding the biological determinants of health

and individual human development of Australias children
Figure 9.2 Foundations for

later health and individual human
development are formed during
childhood.
Biological
Genetics
Birth weight
Body weight
Behavioural
Breastfeeding
Eating habits
Oral hygiene
Level of physical activity
Vaccination
The childhood stage of the lifespan is when the foundations for later
health and individual human development are established. Some
of the chronic diseases suffered in adulthood have risk factors that
originate during the infancy and childhood stages of the lifespan.
For example, the development of cardiovascular disease and chronic
obstructive pulmonary disease in adulthood are associated with infant
and childhood food intake, poor growth, low socioeconomic status,
quality of the housing environment and parental smoking.
As in all lifespan stages, some determinants have a positive effect
on health and individual human development and are referred to as
protective factors, while others have a negative effect and are known
as risk factors.
Understanding the determinants that impact childrens health and
individual human development allows us to understand why some children have
better health than others and to develop programs and policies to help prevent
disease and promote health and individual human development across the lifespan.
Figure 9.3 highlights some of the determinants that are particularly relevant to the
childhood stage of the lifespan.
In most instances, health and individual
human development is not affected by just
one factor but a combination of several (or
multicausal) factors. While you are required
Tobacco smoking in the home
Housing environment
to explore only one example from each
Fluoridation of water
determinant, the chapter provides an overview
of how each determinant can influence the
health and individual human development of
Social
children.
Parental education
Biological determinants refer to factors
Parenting practices
Media
relating to the body that impact on health and
individual human development such as genetics,
hormones, body weight and blood pressure.
Biological factors do not act in isolation and
are influenced by other determinants such as
environmental factors and health behaviours.
Genetics
Figure 9.3 Determinants of health
and individual human development of
Australias children
In chapter 6, you learnt about the role of

conception in determining the genetic make-up
of the unborn child. The genes that a child
inherits from their biological parents have a
significant impact on the childs health and individual human development. Genes
are the blueprint of the body because they control growth, development and how
the body functions.
A childs genetic make-up determines:
the rate and timing of physical development as a result of the production of
hormones from the glands of the endocrine system
whether the child is male or female (their sex)
284
the development of genetic conditions such as cystic fibrosis

predisposition to diseases such as asthma, food allergies and type I diabetes.
Rate and timing of physical development:

hormones
Hormones are the chemical messengers within the body that transport a signal
from one cell to another to bring about certain changes in the body. Hormones are
secreted into the bloodstream by the glands of the endocrine system (figure9.5).
The glands of most interest in childhood are the thyroid gland, parathyroid glands,
pituitary gland and the pancreas. Each gland releases hormones that act on specific
target sites within the body to bring about physical changes. The rate and timing of
hormone secretion is genetically determined. During childhood, the actions of
hormonesaffect the amount of growth that occurs.
Table 9.1 Hormones that regulate growth and physical development during childhood
Hormone
Site of secretion
Effect on physical development
Growth hormone
Pituitary gland
Stimulates protein synthesis required for growth of

soft tissue (e.g. muscle) and hard tissue (e.g. bone)
Thyroid-stimulating
hormone
Pituitary gland
Stimulates the thyroid gland to secrete thyroxine
Thyroxine
Thyroid gland
Sets the rate at which the metabolism of food into

energy takes place. Energy is required for growth.
Calcitonin
Thyroid gland
Increases the rate of calcium deposition in bones
Parathyroid hormone
Parathyroid glands
(located behind the
thyroid gland)
Regulates the amount of calcium and phosphorus

in the bones and blood. Calcium and phosphorus
are required for strengthening bones.
Insulin
Pancreas
Stimulates the cells to convert glucose to energy.

Energy is required for growth.
The hormones that regulate growth and physical development during

childhood are shown in table 9.1.
Most children grow to a height similar to that of their parents. How each
child grows is dependent on the genes that determine the rate of secretion
of hormones from the glands of the endocrine system. The pituitary
gland secretes growth hormone, which affects the bone development
and height of a child. In conjunction with this, the pituitary gland also
releases thyroid-stimulating hormone that prompts the thyroid to secrete
the hormone thyroxine. Thyroxine plays an important role in metabolising
food into energy. This energy is also required for bone development and
the increasing height of the child.
Hormones also determine the age of onset of puberty, which signals the
end of childhood. This age varies from one person to another.
Figure 9.4 Our genetic make-up

is determined by the combination
of genes that occur at the point of
conception to determine our genetic
potential.
Pituitary
gland
Parathyroid
glands
Thyroid
gland
Genetic conditions
As you saw in chapter 6, a range of genetic conditions that can affect
childrens health and individual human development can be inherited
from parents. One example that can have a significant impact during
childhood is cystic fibrosis. Cystic fibrosis is the most common lifethreatening recessive genetic condition affecting Australian children.
This condition results in the secretion of a thick mucus that affects the
lungs, pancreas, liver and reproductive system. In the lungs, the mucus
clogs small air passages and traps bacteria. This causes repeated bouts of
infection, and the blockages can result in irreversible damage to the lungs.
Pancreas
Figure 9.5 Hormones are secreted by glands

that make up the endocrine system. This shows
the glands most important in childhood.
The determinants of health and individual human development ofAustralias children CHAPTER 9 285
9.1 Determinants of health and individual human development during the childhood stage of the
lifespan: biological
In the pancreas, the mucus blocks the passage of the enzyme that is required for
digestion in the intestines. This can cause vitamin deficiencies, malnutrition and/or
severe constipation. Thickened secretions in the reproductive system can result in
obstructions that can affect the development and function of the sexual organs. A
child suffering from cystic fibrosis will have a shortened life expectancy, and from
birth will undergo constant medical treatment and physiotherapy.
Children with cystic fibrosis experience a range of symptoms including:
persistent coughing that requires enormous physical effort
breathing difficulties
a lack of energy resulting in limited capacity for physical activity
a frequent need to go to the toilet
muscle cramping or weakness
poor appetite.
In Australia, one in 25 people carry the cystic fibrosis gene without showing any
symptoms of the condition. If a male and a female who are both carriers of the
gene have a child together, their chance of having a child with cystic fibrosis is one
in four. They have a two-in-four chance of having a child who will not have the
condition but will carry the gene, and a one-in-four chance of having a child who
will neither have the gene nor be a carrier (figure 9.6).
Every newborn baby in Australia can undergo a simple blood test to screen for
cystic fibrosis.
Father is a carrier
of the gene for CF.
FIGUrE 9.6 How cystic fibrosis is

inherited
Child has CF.
Child is a carrier
of the gene for CF.
Mother is a carrier
of the gene for CF.
Child is a carrier
of the gene for CF.
Child does not have

CF or carry the gene for CF.
Genetic predisposition to disease

A number of conditions that affect the health and individual human development
of children will arise due to a genetic predisposition. A genetic predisposition is
an increased likelihood of developing a particular disease or illness based on a
persons genetic make-up. A genetic predisposition results from specific genetic
variations that are often inherited from a parent. These genetic changes contribute
to the development of a disease but do not directly cause it. Children can
therefore inherit an increased risk of suffering from a disease, but they may in
fact, not develop it due to the influence of other behavioural and environmental
286
determinants. Type 1 diabetes and asthma are two childhood conditions that have
a genetic predisposition.
Biological
Type 1 diabetes, also referred to as insulin-dependent diabetes mellitus or
Unit 2
determinants
juvenile diabetes, can occur at any age. However, it is more common in people
AOS 2
childhood
under 30. In fact, it is one of the most common childhood diseases in developed
Concept summary
Topic
4
countries such as Australia.
and practice
Type 1 diabetes is a chronic condition that affects the bodys ability to maintain
Concept 1
questions
blood glucose levels. Blood glucose levels are regulated in the body by insulin, a
hormone that is secreted by the pancreas. The role of insulin is to stimulate the
cells of the body to convert glucose molecules to energy. Insulin also enables
excess glucose to be stored in the liver as glycogen, which can then be used for
energy when needed. For people with type 1 diabetes, the pancreas is no longer
able to produce insulin and the glucose accumulates in the bloodstream. When
there is insufficient insulin and the glucose levels in the bloodstream remain high
for several hours, the condition can become life threatening.
People with type 1 diabetes must regularly monitor their blood glucose levels
and receive regular doses of insulin by injection or an insulin pump. Physical
activity and diet are also key factors in the management of type 1 diabetes. It is
important for children with type 1 diabetes to consume a regular and
consistent amount of foods containing carbohydrates, in particular,
carbohydrates with a low glycaemic index. Before children with type
1 diabetes engage in physical activity, they should consume an extra
carbohydrate snack. If the exercise session continues over a prolonged
period of time, then a carbohydrate snack may be required during the
activity as well.
Blood glucose levels can be monitored by taking a small sample of
blood via a pinprick of the finger and testing it on a blood glucose
meter (figure 9.7). Diabetics who take too high a dose of insulin may
experience low blood glucose levels, which can have serious health
consequences. Ideally, blood glucose levels should range between 3.5
Figure 9.7 Children with type 1 diabetes need to
and 8 millimoles per litre, or mmol/L. Table 9.2 lists the health effects regularly check their blood-glucose levels.
of both high and low blood glucose levels.
Table 9.2 The impact of high and low blood glucose levels on health
Effects of high blood glucose levels
Effects of low blood glucose levels
Excessive thirst
Weakness, trembling, shaking
Loss of appetite
Headache
Dehydration
Light-headedness, dizziness
Weight loss
Sweating
Abdominal pain
Hunger
Vomiting
Tingling around the lips
Frequent urination
Racing heartbeat
Blurred vision
Lack of concentration
Increased risk of infections
Loss of coordination
Kidney damage
Confusion
Eye damage
Slurred speech
Nerve damage to feet and other parts of thebody
Loss of consciousness
Heart disease
Fitting
Circulation problems in the legs

Stroke
Coma
Asthma is another common childhood condition that has a genetic predisposition.
Asthma affects the small air passages (bronchi) of the lungs. When exposed to
certain triggers (e.g. cigarette smoke and air pollution), the lining of the air passages
becomes inflamed and swollen, and extra mucus is produced. The muscles of the
airways also tighten (bronchoconstriction), resulting in a narrowing of the airways
that makes it difficult for the child to breathe.
The symptoms of asthma include:
a dry, irritating cough
shortness of breath
tightness of the chest
wheezing.
With the appropriate treatment and management of asthma, almost all children
will be able to participate in physical activity and lead active lives. Two main types
of medication are used for asthma:
relievers quick-acting and used during an asthma attack to open the airways
preventers slow-acting and used to prevent attacks from occurring.
Figure 9.8 Approximately 14 to

16 per cent of Australian children are
affected by asthma.
Birth weight
Birth weight is a key indicator of infant health and has a major influence on a
babys chance of survival and health status. Babies are classed as low birth weight
if they weigh less than 2500 grams at birth. Low birth-weight babies can be
further classified as very low birth weight ifthey weigh 10001500 grams, and as
extremely low birth weight if they are below 1000 grams (table 9.3). Very low and
extremely low birth weights occur in infants who are born very prematurely.
Figure 9.9 Birth weight can be a

predictor of future health status.
Table 9.3 Classification of birth weight
Low birth weight
Very low birth weight
Below 2500 grams
Between 1000 and 1500 grams
Extremely low birth weight

Below 1000 grams
Babies can be born with low birth weight because they are born prematurely, or
have experienced some disruption to their growth within the uterus.
In Australia in 2012, there were 19243 (6.2 per cent) of babies born with low
birth weight. There were 3071 (1 per cent) very low birth weight babies and 1299
(0.4 per cent) extremely low birth weight babies (AIHW, 2012). Babies with a very
low birth weight, or an extremely low birth weight, have a greater risk of dying
prematurely or developing a range of conditions and developmental problems.
Table 9.4 outlines the health and development effects of a baby having a very low
birth weight or an extremely low birth weight.
Table 9.4 The impact on health and individual human development of very low or
extremely low birth weight
Impact of very low or extremely low birth weight:
Unit 2
On health
On individual human development
AOS 2
Reduced lung function

Increased risk of bronchiolitis (an inflammation
of the small airways in the lungs)
Decreased exercise capacity
Feeding difficulties leading to lack of nutritional
intake
Increased risk of bradycardia (a slowing of the
heart rate)
Apnoea (a short-term suspension of breathing)
Jaundice (yellowing of the skin due to the
immature liver being unable to process the
compound bilirubin, which is found in the blood)
Increased probability of a lengthy hospital stay
following birth
Increased risk of asthma during childhood
Reduced muscle bulk

Reduced coordination
Poor sucking and swallowing reflexes
Greater likelihood of impaired growth and
motor skill development
Greater likelihood of impaired learning
capabilities
Damage to the retina of the eye resulting
in sight difficulties including blindness
Increased risk of cerebral palsy
Increased risk of deafness
Topic 4
Concept 1
Biological
determinants
childhood
Concept summary
and practice
questions
Body weight
The maintenance of a healthy body weight is important for the optimal health
and individual human development of children. Being underweight or overweight
during childhood can lead to many short- and long-term health problems that can
affect all aspects of individual human development.
Establishing whether children are of healthy weight, underweight or overweight
is more difficult than for adults where the common measure is the body mass
index or BMI. Children are still growing and they each grow at different times
and rates. To make the BMI relevant to children, it needs to be compared against
the BMI-for-age and gender percentile charts. These percentile charts provide an
indication of a childs BMI relative to children of the same age and sex.
Figure 9.10 The genes that a child

inherits are one factor that has an
impact on body weight.
TAblE 9.5 BMI-for-age weight status categories and corresponding
percentiles
The categories and percentiles for BMI-for-age

are shown in table 9.5.
The chart in figure 9.11 shows how BMI can be
Weight status category
Percentile range
measured relative to children of the same age and
Underweight
Less than the 5th percentile
sex. In this example, different BMI calculations for
Healthy weight
5th percentile to less than the 85th percentile
a 10-year-old boy are marked on the chart.
In 201112, findings from the Australian Health
Overweight
85th percentile to less than the 95th percentile
Survey found that an estimated 26 per cent of
Obese
Equal to or greater than the 95th percentile
children were either overweight (19 per cent) or
Source: About BMI for children and teens, Centers for Disease Control and Prevention,
obese (7 per cent). This is equivalent to around
www.cdc.gov.
716 000 Australian children aged 514. Over twothirds (69percent) of children had a healthy weight, with the remaining 5percent
being underweight. There was no significant difference between boys and girls, or
between age groups 59 years and 1014 years.
Body mass index-for-age percentiles: Boys, 2 to 21 years

BMI
BMI
34
34
A 10-year-old boy with a BMI of 23
would be in the obese category
(95th percentile or greater).
32
32
95th percentile
30
30
A 10-year-old boy with a

BMI of 21 would be in the
overweight category (85th
to less than 95th percentile).
28
26
28
26
90th percentile
85th percentile
75th percentile
24
24
50th percentile
22
22
25th percentile
20
20
18
18
16
16
14
FIGUrE 9.11 An example
of how sample BMI
calculations would be
interpreted for a 10-yearold boy
Source: About BMI for children and
teens, Centers for Disease Control
and Prevention, www.cdc.gov.
290
A 10-year-old boy with

a BMI of 13 would be in
the underweight category
(less than 5th percentile).
A 10-year-old boy with a

BMI of 18 would be in the
healthy weight category
(5th percentile to less than
85th percentile).
12
14
12
kg/m2
kg/m2
2
10 11 12 13 14 15 16 17 18 19 20 21
Age (years)
10th percentile
5th percentile
The impact of obesity on the health and

individual human development of children
Overweight and obesity can be caused by a genetically low metabolic rate, lack
of physical activity, a dietary intake consisting of a large proportion of saturated
fats and simple carbohydrates, or the overconsumption of carbohydrates, fats and
protein. Social factors (such as the types of food eaten due to a childs culture),
as well as environmental factors (such as access to recreational facilities), also
impact on the development of obesity in childhood. Childhood obesity rates
have increased significantly over the past two decades. The 200708 National
Health Survey results indicate that 24.9 per cent of children aged 517 years were
overweight or obese.
Childhood obesity has serious short-term consequences for the health and
individual human development of children. Obesity during childhood significantly
increases the risk of illness and premature death in adulthood. Table 9.6 outlines the
short- and long-term consequences to health and individual human development
of childhood obesity.
eLesson:
Consequences of childhood obesity
Table 9.6 Consequences of childhood obesity on health and individual human development
Short-term consequences
Long-term consequences
Health
Health
Physical discomfort
Bone and joint problems
Asthma or shortness of breath during
exercise
Heat intolerance
Tiredness/lethargy
High blood pressure
Abnormal cholesterol levels
Interrupted sleep due to breathing
difficulties (obstructive sleep apnoea)
Social and psychological distress as obese
children often experience discrimination,
bullying and teasing by their peers
Low self-esteem
Poor peer relationships
Twice the risk of developing cardiovascular

disease (high blood pressure, angina, heart
attack) in adulthood
Three times the risk of developing type 2
diabetes in adulthood
Increased risk of premature death
Poor self-esteem can lead to an increased
tendency to smoke and drink alcohol,
resulting in health conditions such as lung
cancer, cardiovascular disease and cirrhosis
of the liver
Unit 2
AOS 2
Topic 4
Concept 1
Biological
determinants
childhood
Concept summary
and practice
questions
Individual human development (short- and long-term)

Decreased memory due to lack of sleep
Reduced learning performance
Reduced motor skill development due to lack
of physical activity
Poor self-image
Limited social skill development
Source: Adapted from Childhood obesity, www.mydr.com.au.
Being underweight can also impact childrens health and individual human
development. Being underweight is not the same as being thin. There are many
reasons why a child might be underweight. They may not be consuming enough
food, be suffering from an underlying illness or stress, or have a lack of interest in
eating; or their body may be experiencing a sudden growth spurt.
Being underweight often indicates poor nutritional intake, which puts children
at risk of undernourishment. This can increase the risk of becoming ill as childrens
immune systems, which are designed to fight diseases and protect the body, are
weakened. Undernourished children are likely to feel weak or tired, and have trouble
focusing and concentrating. They are also less likely to be fit and active, increasing
their risk of diseases such as cardiovascular disease in the long term. They may also
be at risk of having stunted growth or a delay in the age of onset of puberty.
TEST your knowledge
1 Identify four ways in which genetics can influence a

childs health and individual human development.
2 Explain the role of the following hormones in the
growth and physical development of children:
(a) growth hormone
(b) thyroxine
(c) calcitonin
(d) insulin.
3 Explain how cystic fibrosis might affect the health
and individual human development of children.
4 Provide one example of a disease where there is a
genetic predisposition and explain how the disease
might impact the health and individual human
5 List the weight classifications for low birth weight,
very low birth weight and extremely low birth
weight.
6 What percentage of babies born in 2012 were
classified as:
(a) low birth weight?
(b) very low birth weight?
(c) extremely low birth weight?
7 Using information provided in table 9.4, further

classify health and individual human development
examples into physical, social and mental health
impacts; and physical, social, intellectual and
emotional development impacts.
8 Discuss four ways in which childhood obesity could
affect the health of children.
9 Use the BMI for age Girls links
in the Resources section of your
eBookPLUS to find the weblink and
questions for this activity.
10 What are the differences between a genetically
inherited condition and a genetic predisposition?
9.2

development of children: behavioural
KEY CONCEPT Understanding the behavioural determinants of health

and individual human development of Australias children
Behavioural determinants refer to the actions or patterns of living of an individual

or a group that impacts on health and individual human development. The
behavioural determinants that impact on children include a mothers decision to
breastfeed, eating habits, oral hygiene, level of physical activity and vaccination
status.
Breastfeeding
Table 9.7 Benefits of breastfeeding for the health and individual human development of
children
Reduced risk of SIDS

Reduced incidence and duration of diarrhoeal
disease
Reduced risk of juvenile diabetes in later life
Reduced risk of heart disease in later life
Reduction in allergies
Reduced likelihood of childhood obesity
Reduced risk of respiratory illnesses
Reduced risk of middle ear infections
AOS 2
Topic 4
Concept 2
Breastfeeding is the healthiest start for infants. The benefits of

breastfeeding to the health and individual human development
of the developing child are well documented (table 9.7). In the
first few days following birth, the breasts produce a fluid called
colostrum, which contains antibodies required to resist infection
from conditions such as acute diarrhoea, lower respiratory tract
infections and ear infections. Within a few days, the colostrum
changes to mature milk. Breastmilk contains all of the nutrients
required by the baby for the first six months of life. Breastmilk
can supply more than half of the nutrients required by the child
between 6 and 12 months of age, and up to a third of the nutrients
needed between one and two years of age. Mature breastmilk
contains the right amount of fat, sugar, water and protein to
promote the growth of the baby. The World Health Organization
recommends exclusive breastfeeding for the first six months,
with the introduction of complementary foods beginning at six
months of age. Apart from the nutritional value, breastfeeding
is also hygienic, convenient and inexpensive. For most babies,
breastmilk is easier to digest than formula.
Breastfeeding also promotes the social and emotional
attachment between mother and child. The secretion of the
maternal hormones prolactin and oxytocin encourages the
development of a maternal bond with the child. Oxytocin plays a
role in counteracting stress, which allows both mother and baby
to feel comfortable and relaxed.
Benefits of breastfeeding to health
Unit 2
Behavioural
determinants
childhood
Concept summary
and practice
questions
Figure 9.12 It is recommended that

infants are breastfed for at least the
first six months of life.
Benefits of breastfeeding for individual

human development
Fatty acids within breastmilk contribute to
brain development, thereby reducing the risk of
learning difficulties in childhood
Optimal development of eyesight
Optimal development of the jaw and mouth
Optimal speech development
Promotes intellectual development
Source: Adapted from Australian Breastfeeding Association, www.breastfeeding.asn.au.
9.2 Determinants of health and individual human development of children: behavioural

Although breastmilk is the best option for babies, artificial formula contains the
required nutrients and is readily available. Some mothers may choose to bottle
feed purely because they do not feel comfortable breastfeeding. For some mothers,
breastfeeding may not be an option because:
The baby may refuse to suck at the breast.
The baby may be unable to breastfeed because of an illness or a congenital
malformation that makes it difficult for the child to suck (e.g. cleft palate).
The mother has an illness that prevents her from breastfeeding.
The mother has mastitis. This is an inflammation or infection in the breast
commonly caused by a cracked nipple, blocked milk duct or injury to the breast.
The breastmilk may be in low supply and not adequate for the baby.
While infant formula has been developed to contain nutrients similar to those
found in breastmilk, it does not contain valuable antibodies like breastmilk. As
bottle-fed babies do not have the antibodies to protect them from harmful germs or
infections, it is important that bottles and other equipment are carefully sterilised
in order to reduce the risk of contaminating the formula and possibly infecting
thebaby.
Eating habits
The eating habits of children have a significant impact on health and individual
human development during infancy and childhood. Healthy eating habits need to
be established early in life. The Infant Feeding Guidelines and Australian Dietary
Guidelines provide advice on what represents healthy eating for children.
Figure 9.13 The eating habits of

children are largely determined by
their parents.
From birth until six months of age, breastfeeding or infant formula provides
all the nutrients an infant needs for growth and individual human development.
At around the age of six months, infants are physiologically and developmentally
ready for new foods, textures and modes of feeding. Their bodies now require
more nutrients than can be provided by breastmilk or formula.
A variety of foods are needed to meet the increased nutritional demands and
to help an infant accept a range of flavours, but the inclusion of iron-rich foods
294
is important. The texture of foods should be suitable to the infants stage of

development, progressing from a smooth puree to lumpy to normal textures across
the 612 month period. Appropriate foods to be introduced initially include:
infant rice cereal mixed with breastmilk or formula
mashed potato, pumpkin or carrot
mashed fruit such as bananas
cooked and mashed apples and pears.
As infants get used to eating solid foods, more lumpy foods can be introduced
such as:
minced red meat and chicken
cereals such as rice, couscous and pasta.
Breastfeeding or formula should be continued until 12 months of age. Cows
milk can start being added to cereal or food such as custard, but should not be
introduced as the main drink until 12 months of age. Avoid giving whole nuts and
similar hard foods to young children aged less than three years to reduce the risk
of choking. It is important that solid foods are provided without the addition of
sugar, honey or salt.
From 12 months of age and beyond, toddlers should be consuming family foods
according to the Australian Dietary Guidelines (figure9.15).
Good nutrition and eating habits in children can be promoted by:
Encouraging a wide variety of nutritious foods. All nutritious foods contain nutrients
that are important for the health and individual human development of children.
Therefore it is important for children to consume a wide variety of foods to
ensure the intake of the required nutrients.
Introducing reduced-fat dairy products from
two years of age. Reducing the amount of
fat in a childs diet will reduce the risk of
overweight and obesity.
Offering mostly wholegrain breads and
cereals, vegetables and fruits. Complex
carbohydrates in breads and cereals are
required for energy and the dietary fibre
in breads, cereals, vegetables and fruits
help to remove wastes from the body.
Limiting the intake of oil, margarine and
butter. Overconsumption of fats can
contribute to childhood overweight and
obesity.
Providing the child with fresh fruits and
vegetables instead of processed snack foods.
Snack foods tend to be high in saturated
fat and trans fats, simple carbohydrates
(sugars) and sodium (salt).
Only occasionally offering treats such as cakes, chips and takeaway foods.
Limiting sweet drinks such as juices, cordials and soft drinks. These are high in sugar
and overconsumption can contribute to childhood overweight and obesity.
The consumption of breakfast is an important consideration in the eating
habits of children. Eating breakfast gives children energy to get through the day
and provides a significant proportion of the days total nutrient intake. Without
breakfast, a child may have difficulty concentrating and learning, and may be left
with reduced energy levels for daily activities. Research indicates that children who
skip breakfast tend to weigh more than those who consume breakfast daily. This
may be due to the fact that hungry children tend to eat more high-fat, high-sugar
foods during the day to alleviate hunger as a result of skipping breakfast.
Figure 9.14 The consumption of

nutritious foods is important for
the health and individual human
Eating habits of children and the

Australian Dietary Guidelines
In 2013, the National Health and Medical Research Council launched the revised
Australian Dietary Guidelines. These Guidelines provide advice about the amounts
and kinds of foods that people need to eat for health and wellbeing. While the
Guidelines are relevant to the general healthy population, specific reference is made
to children and adolescents. The Guidelines also set out serving numbers and sizes
that should be consumed by children from each of the five food groups to promote
good health and individual human development (figure9.16).
What are the DIETARY GUIDELINES?

The Australian Dietary Guidelines provide up-to-date advice about the amount and kinds of foods that we need eat for health
and wellbeing. They are based on scientific evidence and research.
The Australian Dietary Guidelines of most relevance to children are included below:
GUIDELINE 1
To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your
energy needs.
Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically
active every day and their growth should be checked regularly.
GUIDELINE 2
Enjoy a wide variety of nutritious foods from these five food groups every day:
Plenty of vegetables of different types and colours, and legumes/beans
Fruit
Grain (cereal) foods, mostly wholegrain and/or high fibre cereal varieties, such as breads, cereals, rice, pasta, noodles,
Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the
age of 2 years)
GUIDELINE 3
Replace high fat foods which contain predominately saturated
fats such as butter, cream, cooking margarine, coconut
and palm oil with foods which contain predominately
polyunsaturated and monounsaturated fats such as oils,
spreads, nut butters/pastes and avocado.
Low fat diets are not suitable for children under the age of 2 years.
b. Limit intake of foods and drinks containing addedsalt.
Read labels to choose lower sodium options
among similar foods.
c. Limit intake of foods and drinks containing added sugars such
as confectionery, sugar-sweetened soft drinks and cordials, fruit
drinks, vitamin waters, energy and sports drinks.
GUIDELINE 4
Encourage, support and promote breastfeeding.
Figure 9.15 The Australian Dietary Guidelines make

specific reference to children.
GUIDELINE 5
Source: National Health and Medical Research Council 2013, Healthy

eating for children, www.nhmrc.gov.au.
Care for your food; prepare and store it safely.
SERVE SIZES
Serves per day

23
48
years
years
medium
cup
911
years
1213
years
1418
years
Boys
Girls
cup
cup
A standard serve of vegetables is about 75g (100350kJ) or:

cup
cup
1 cup
cup
medium
1 medium
cooked green or orange vegetables (for example, broccoli, spinach, carrots or pumpkin)
cooked, dried or canned beans, peas or lentils*
green leafy or raw salad vegetables
sweet corn
potato or other starchy vegetables (sweet potato, taro or cassava)
tomato
*preferably with no added salt
Vegetables and legumes/beans
Serves per day

23
48
years
years
medium
small
cup
911
years
1213
years
1418
years
Boys
Girls
A standard serve of fruit is about 150g (350kJ) or:

1 medium apple, banana, orange or pear
2 small apricots, kiwi fruits or plums
1 cup diced or canned fruit (with no added suger)
Or only occasionally:
125mL ( cup) fruit juice (with no added suger)
30g dried fruit (for example, 4 dried apricot halves, 1 tablespoons of sultanas)
Fruit
cup
cooked
slice
cup
cooked
cup
A standard serve (500kJ) is:

Serves per day
23
48
years
years
911
years
1213
years
1418
years
Boys
Girls
1 slice (40g)
medium (40g)
cup (75120g)
cup (120g)
cup (30g)
cup (30g)
3 (35g)
1 (60g)
1 small (35g)
bread
roll or flat bread
cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur or quinoa
cooked porridge
wheat cereal flakes
muesli
crispbreads
crumpet
English muffin or scone
Grain (cereal) foods, mostly wholegrain and/or high fibre cereal varieties
65g
100g
80g
large
cup

Serves per day
23
48
years
years
911
years
1213
years
1418
years
Boys
Girls
65g
80g
100g
2 large (120g)
1 cup (150g)
170g
30g
cooked lean meats such as beef, lamb, veal, pork, goat or kangaroo (about 90100g raw)*
cooked lean poultry such as chicken or turkey (100g raw)
cooked fish fillet (about 115g raw weight) or one small can of fish
eggs
cooked or canned legumes/beans such as lentils, chick peas or split peas (preferably with no
added salt)
tofu
nuts, seeds, peanut or almond butter or tahini or other nut or seed paste (no added salt)
*weekly limit of 455g
Serves per day

23
48
years
years
slices
cup
cup
cup

911
years
1213
years
1418
years
Boys
Girls
1 cup (250mL)
cup (125mL)
2 slices (40g)
cup (120g)
cup (200g)
1 cup (250mL)
fresh, UHT long life, reconstituted powdered milk or butter milk

evaporated milk
or 4 3 2cm cube (40g) of hard cheese, such as cheddar
ricotta cheese
yoghurt
soy, rice or other cereal drink with at least 100mg of added calcium per 100mL
Milk, yoghurt, cheese and/or alternatives, mostly reduced fat
FIGURE 9.16 Recommended serving sizes from the five food groups
Source: National Health and Medical Research Council 2013, Healthy eating for children, www.nhmrc.gov.au.

As parents are the ones who often choose and purchase the foods that are
consumed by children, it is important that they have the information required to
ensure that their children are consuming the right amount of the required nutrients
and not overconsuming nutrients such as saturated fat, simple carbohydrates
and sodium as these can contribute to the development of illness/disease such as
obesity, cardiovascular disease and type 2 diabetes.
Most Australian children require more:
vegetables and fruit, particularly green, orange and red vegetables, leafy
vegetables and legumes/beans
grain foods, particularly wholegrain cereals
reduced fat milk, yoghurt and cheese (reduced fat milks are not suitable for
children under the age of two years as their main milk drink)
water rather than soft drinks, energy drinks, sports drinks and sweetened fruit
juices.
Most Australian children need to consume less:
meat pies, sausage rolls and hot chips
potato chips, savoury snacks, biscuits and crackers
processed meats
cakes, muffins, sweet biscuits and muesli bars
confectionery and chocolate
ice-cream and desserts
cream and butter
jam and honey
soft drink, cordial, sports drinks, energy drinks.
Oral hygiene
Figure 9.17 Good oral hygiene

helps to prevent dental decay and
gum disease.
Oral hygiene is the practice of keeping the mouth clean in order to prevent bad
breath and maintain healthy gums and teeth. Dental decay is the most common
disease that affects teeth. Plaque is a sticky film that forms on teeth. It contains
bacteria that change sugars into acids, resulting in cavities (i.e. caries, or holes)
in the teeth (figure 9.18). A build-up of plaque on the teeth can also lead to gum
disease initially gingivitis which, if left untreated, can progress to periodontitis.
Gingivitis is the early stage of gum disease where plaque builds up and becomes hard
mainly on the area where the gum line meets the tooth. Symptoms of gingivitis are
bleeding, redness and swelling of the gum. Periodontitis is advanced gum disease
in which the edge of the gum that meets the tooth becomes
weakened, allowing bacteria to penetrate beneath the gum
line. This causes an inflammation in the structures below the
gum line, affecting the root of the tooth, the bone and the
fibres that connect the tooth to the bone. If left untreated,
the eroded bone causes space between the gum and teeth.
Periodontitis results in bleeding, swelling, receding gums,
bad breath, a bad taste in the mouth and loose teeth. The
teeth can fall out if the condition is not treated.
Oral hygiene during early childhood is vital for ensuring
the health of teeth and gums and teaches children the daily
routines required to ensure optimal dental health. Cavities
can occur in children as young as six months of age if the
appropriate dental care is not followed. Baby teeth have a
thinner enamel coating that can result in decay being able to
penetrate to the middle of the tooth. This can be extremely
painful and, if left untreated, can result in a pus-filled
abscess. The abscess can damage the permanent teeth that
298
are developing underneath the baby teeth.

As baby teeth guide the permanent teeth
into position, losing them early as a result
of decay can result in reduced spaces
between the teeth and thus the child may
require orthodontic care later in life. Poor
oral hygiene and decayed teeth can affect
the individual human development of
children by interfering with speech
development and the shaping of thejaw.
When dental decay and cavities become
severe and painful, they can interfere
with the daily life of the child and impact
health. The pain can be so severe that
it may prevent the child from going to
school. If the child is unable to chew or
eat because of the pain, then they may lose
weight or develop nutritional deficiencies.
Dental decay and the unnecessary loss
of teeth can impact significantly on the self-esteem of children, which may cause
them to withdraw from social activities due to feeling self-conscious about how
they look.
According to the Australian Institute of Health and Welfare (Australias health
2014), in 2010:
more than half of children aged 6 had experienced decay in their baby teeth
almost half of children aged 12 had experienced decay in their permanent teeth
the rate of hospitalisations for dental conditions that could have been prevented
was the highest for children aged 59.
Figure 9.18 Plaque that builds up

on teeth can cause cavities.
Promoting oral hygiene

The inappropriate use of feeding bottles can cause dental cavities. Infants should
not be given a bottle as a dummy once asleep, or be given fruit juices or sweet
drinks in a bottle. Breastfeeding significantly reduces the risk of dental cavities. If a
child is to be bottle fed, the following should be done:
Remove the bottle once the child has had enough.
If the child uses the bottle for comfort, use cooled, boiled water instead.
Encourage the use of a feeding cup when the child is developmentally ready.
Encourage the child to drink water instead of fruit juices and sweet drinks.
Tooth brushing should start as soon as the first tooth appears. Initially, a soft
cloth can be used to wipe the front and back of each tooth. A soft toothbrush
should be introduced as soon as the child can cope with it, usually around
12months of age. Low-fluoride toothpaste can be used at approximately 18months
of age. Fluoridated water helps to protect against dental cavities because fluoride
reduces the amount of acid produced in the mouth as well as helping to repair any
damage to the teeth before it progresses. It is recommended that a child have two
dental checks before the age of three and a half to ensure early detection of any
dental problems. Beyond the age of three and a half, the recommendation is sixmonthly visits to the dentist. The application of dental sealants by the dentist can
help prevent tooth decay. Sealants are clear or white plastic coatings that bond to
the surface of the teeth and block the small grooves, thereby reducing the risk of
dental decay.
The consumption of a healthy diet with minimal sugary substances also helps to
prevent cavities and ensures good oral hygiene.
Level of physical activity

It is important that children are physically active. Physical activity for children
includes both structured and unstructured free play.
Australias Physical Activity and Sedentary Behaviour Guidelines outline the
minimum levels of physical activity required in order to gain a health benefit. For
children between the ages of 5 and 12, it is recommended that they participate in
at least 60 minutes of moderate to vigorous intensity exercise daily. Examples of
moderate activities include brisk walking, bike riding or any form of active play.
More vigorous activities include those that increase heart and breathing rates such
as football, netball, ballet, running and swimming. The guidelines also recommend
that children do not spend more than two hours a day on activities using electronic
media such as computer games, TV or the internet. Toddlers and preschool children
should be physically active for at least three hours each day, spread throughout
the day.
According to the 201112 Australian Health Survey, 24 year olds spent an
average of 6hours and 12minutes per day engaged in physical activity, with just
under half (47 per cent) of the physical activity coming from outside activities.
Most 24 year olds (84 per cent) averaged three hours or more of physical
activity per day. However, just under three-quarters (72percent) of 24 year olds
were physically active for three hours or more per day on all seven days prior
to interview, meeting the physical activity recommendation. The average daily
duration of physical activity for this age group is shown in figure 9.19.
24
22
20
18
16
%
14
12
10
8
6
4
2
0
01
12
23
34
45
56
67
78
89
910
1011
1112
12+
Hours(c)
FIGURE 9.19 Children aged 24 years, average daily duration of physical activity,(a)(b) 201112
(a)
Average over seven days prior to interview.
(b)
Proportions do not add to 100percent, as includes children with time not known.
(c)
Category 01 includes 1 minute to 59 minutes, 12 includes 1 hour to 1 hour and 59 minutes, etc.
Source: ABS, Australian health survey: physical activity, 201112.
At the same time, 24 year olds spent almost one and a half hours (83minutes)
per day in the sedentary activities of watching TV/DVDs or playing electronic
games. While 43 per cent averaged no more than 60 minutes a day over the
reporting week, only one in four (26 per cent) met the screen-based activity
recommendation on all seven days prior to interview. The average daily duration of
sedentary screen-based activity for this age group is shown in figure 9.20.
50
45
40
35
%
30
25
20
15
10
5
0
01
12
23
34
45
56
6+
Hours(c)
FIGURE 9.20 Children aged 24 years, average daily duration of sedentary screen-based
activity,(a)(b) 201112
(a)
(b)
Proportions do not add to 100percent, as includes children with time not known.
(c)
Category 01 includes 1 minute to 1 hour, 12 includes 61 minutes to 2 hours, etc.
The results of the survey also found that children aged 24 who had at least
one item of screen-based equipment in their bedroom such as a TV, computer
or game console spent on average an extra 22 minutes per day engaged in
screen-based activities, and were twice as likely as those without screen equipment
in their bedrooms to have done more than the recommended 60minutes per day.
Children aged 58 spent an average two hours per day engaged in physical
activity and 1 hour 38 minutes engaged in screen-based activities. As the age of
children increased, the level of physical activity decreased and the time spent
engaged in screen-based activities increased. Children aged 911 spent an average
of 1 hour 35 minutes on physical activity and 1 hour 59 minutes engaged in
screen-based activities (figure 9.21).
140
Physical activity
Sedentary screen-based activity
120
Minutes
100
80
60
40
20
0
58
911
Age group (years)
FIGURE 9.21 Children 511 years, average minutes per day spent in physical activity and
sedentary screen-based activity,(a) 201112
(a)
Benefits of physical activity on the health

and individual human development of
children
Regular physical activity has a range of benefits for the health and individual
human development of children. These are outlined in table9.8.
TABLE 9.8 Benefits of regular physical activity for children
Benefits of physical activity for health
Figure 9.22 Regular exercise

is important for the health and
children.
Benefits of physical activity for individual

human development
Improves fitness, strength, flexibility and

coordination
Promotes growth
Helps with relaxation and reduces stress, anxiety

and depression
Improves balance and motor skills
Improves self-esteem
Improves posture
Provides opportunities to make friends
Develops sensory systems such as sight and

hearing
Helps achieve and maintain a healthy weight
Develops social skills (e.g. leadership,

communication, teamwork)
Builds strong bones and muscles
Increases knowledge (e.g. learning the rules of

games)
Encouraging children to be physically active during childhood establishes a good

routine that can stay with them throughout life. To encourage physical activity in
children, parents should make sure they expose children to lots of fun activities
and undertake different types of sport and physical activity themselves.
Vaccination
Parents and carers make decesions about whether or not to immunise their children.
There are two main reasons why parents should ensure their child is immunised:
1 Children are protected against a range of diseases that can have serious effects on
a childs health and individual human development and sometimes death.
2 When the majority of the community are immunised, infectious
diseases can no longer spread from one person to another, and
those who are not immunised are also protected. This is called herd
immunity and can also help to eliminate diseases altogether.
Each vaccine contains either a weakened or dead micro-organism
of a disease so that the body will develop antibodies against that
particular disease. This immune response means that when the body
comes in contact with a particular infectious micro-organism, it is able
to fight and overcome the organism. By vaccinating against specific
diseases, the individual is able to resist those diseases if exposed
tothem.
In the first months of life, a baby gains its protection from infectious
diseases via antibodies that have passed from the mother during
pregnancy and through breastfeeding. Vaccinations become important
whenthese antibodies are no longer effective and the child is at risk of
infection. Immunisation is the process of providing vaccinations.
Figure 9.23 Vaccination is important for protecting children against a range
of infectious diseases.
Table 9.9 outlines vaccine-preventable diseases and their impact on health and
Table 9.9 Vaccine-preventable diseases and their impact on health and/or individual human development
Disease
Method of transmission
Impact on health and/or individual

human development
Diphtheria
Bacteria spread by respiratory droplets
1 in 15 patients will die

Fever, severe inflammation of the nose, throat and windpipe causing breathing and
swallowing difficulties
Nerve paralysis and heart failure
Hepatitis B
Virus spread via blood, sexual contact or

from mother to baby at birth
1 in 4 will develop cirrhosis of the liver or liver cancer
Haemophilus
Influenzae
type B (Hib)
Bacteria spread via respiratory droplets
Stiff neck, severe headache, convulsions/seizures, drowsiness, loss of consciousness,

difficulty breathing
Meningitis (infection of the membranes that surround the brain and spinal cord)
Epiglottitis (infection of the epiglottis, which is the flap at the top of the windpipe)
Pneumonia
Septicaemia (infection in the bloodstream)
Osteomyelitis (infection of the bone)
Measles
Virus spread via respiratory droplets
Fever, cough, rash, respiratory infections, diarrhoea and vomiting

1 in 15 children with measles will develop pneumonia
1 in 1000 children with measles will develop encephalitis, with 10 per cent dying
and 40per cent having permanent brain damage
Meningococcal

Meningitis (infection of the membranes that surround the brain and spinal cord)
1 in 10 children will die, 1 in 30 will have severe scarring of the skin or loss of
limbs, 1 in 30 will have severe brain damage
Mumps
Virus spread via saliva
Swollen neck and salivary glands, fever, weight loss

1 in 200 children will develop encephalitis
Inflammation of other organs of the body (e.g. reproductive organs, heart, brain,
pancreas, liver, thyroid), occasionally causes infertility and/or deafness
Pertussis
(whooping
cough)
Uncontrolled coughing and vomiting

Bleeding, apnoea (temporary cessation of breathing while sleeping), pneumonia,
inflammation of the brain, convulsions and coma, permanent brain damage
1 in 200 children under 6 months of age will die
Pneumococcal

Meningitis: 1 in 10 children with meningitis will die
Poliomyelitis
(Polio)
Virus spread via faeces and saliva
Vomiting, fever, headache, paralysis

1 in 20 hospitalised children will die, 50% who survive will be permanently
paralysed
Rotavirus
Virus spread via faeces, and saliva
Gastroenteritis vomiting and diarrhoea, fever, dehydration
Rubella
Virus spread via respiratory droplets
Fever, rash, swollen glands, 1 in 3000 children will develop thrombocytopenia

(bruising or bleeding), 1 in 6000 will develop inflammation of the brain
Tetanus
Bacteria (that live in soil, dust and

manure) enter the body through a break
in the skin
Muscle spasms, inability to open the mouth, swallowing and breathing difficulties,
convulsions, abnormal heart rhythm, suffocation, respiratory failure, high or low
blood pressure, heart attack
3 in 100 children will die
Chickenpox
Highly contagious virus

Spread via respiratory droplets
Fever and rash, pneumonia, 3 in 100000 children will die and 1 in 100000 children
will develop encephalitis
Source: Adapted from Better Health Channel (www.betterhealth.vic.gov.au) and Immunise Australia (www.immunise.health.gov.au).

In Australia, the government provides free vaccines to children under the
National Immunisation Program. The routine schedule of vaccines for children is
listed in table 9.10.
Table 9.10 National immunisation program schedule for Australia, 2014
Age
Diseases
Birth
Hepatitis B
2 months
Diphtheria, tetanus, pertussis, hepatitis B,

poliomyelitis, Haemophilus influenzae type b
Pneumococcal
Rotavirus
4 months

Pneumococcal
Rotavirus
6 months

Pneumococcal
Rotavirus
12 months
Measles, mumps, rubella

Haemophilus influenzae type b
Meningococcal C
18 months

Chickenpox
4 years
Diphtheria, tetanus, pertussis, poliomyelitis

Source: Department of Human Services 2015, Your childs immunisation schedule, www.humanservices.gov.au.
While immunisation is not compulsory in Australia, it is highly recommended.

The Australian government monitors the immunisation rates of children. It is
important for the majority of children to be immunised in order to ensure herd
immunity. In order to maintain herd immunity, vaccine coverage needs to exceed
90percent of the population, and this has been achieved.
The government has also put in place a range of incentives to encourage all
parents to get their children vaccinated. These include:
Primary school enrolment. When enrolling a child in primary school, parents are
required to present their childs immunisation status certificate. This certificate
lists the diseases the child has been immunised against. Children who are not
immunised are still allowed to attend school. However, if there is a reported
case of one of the diseases routinely vaccinated against, then the unvaccinated
children will be sent home until the risk of infection passes.
Family assistance payments. To be eligible to receive the Family Tax Benefit Part
A supplement or day-care or child-care rebates, children need to be up to date
with immunisations or have received an exemption.
Sometimes parents choose not to vaccinate their children against diseases.
Reasons for doing this include:
Complacency due to lack of experience of childhood illness. Many adults have not
experienced vaccine-preventable childhood diseases, and may believe that
childhood diseases have been eliminated from Australia. As a result, some parents
may not consider vaccination as being important for the health and individual
human development of their children. However, high vaccination rates within a
country prevent diseases from re-emerging.
Concerns regarding reduced immunity in the child as a result of vaccination. Vaccines
do not reduce a childs immunity. The vaccines contain dead or weakened
versions of the disease that do not cause a full immune response.
Religious reasons. Some religious groups have concerns about the ingredients
in vaccines. For example, gelatine is added to some vaccines to protect them
from changes in temperature that may affect the quality of the vaccine. Gelatine
is usually made from animals such as pigs. As a result, some members of the
Islamic or Jewish faiths may object to vaccination on the grounds that the
vaccines contain pork products.
Concerns regarding the safety of the vaccines. Every vaccine used in Australia
has been tested for safety and effectiveness. The risks of complications from
childhood diseases are far greater than the risks associated with immunisation.
For instance, the risk of contracting encephalitis (inflammation of the brain)
from the measles, mumps, rubella (MMR) vaccine is thought to be one in a
million immunisations. In comparison, the risk of encephalitis as a result of
contracting measles is estimated as one in 200, with a 10 per cent risk of death
and a 40 per cent risk of permanent brain damage.
Concerns that vaccinations can cause other disorders such as autism and diabetes and
increase the risk of SIDS. These concerns have been investigated and dismissed by
researchers.
The belief that vaccinations do not work. It is true that some people will still
contract a disease even if they have been vaccinated against it. However, effective
vaccination rates are relatively high. For instance, complete immunity occurs in
95 per cent of people vaccinated against polio and measles and 84 per cent in
people vaccinated against diphtheria.
TEST your knowledge

1 Outline the benefits of breastfeeding to the baby.
2 What is colostrum and why is it important for
children?
3 Why is it important to develop healthy eating
patterns early in life?
4 Explain the relationship between food intake and
physical activity in maintaining body weight.
5 In order to optimise the health and individual
human development of children, what types of
foods should be consumed? What types of foods
should be avoided? Outline the reasons why.
6 Why is it important for children to consume
breakfast daily?
7 What are the benefits of physical activity for
each dimension of health and the different
types of individual human development of
children?
8 What is oral hygiene and why is it important for
children?
9 What is plaque, and how does it increase the risk of
dental cavities?
10 Outline the difference between gingivitis and
periodontitis.
11 How can dental decay be prevented in children?
12 Explain what vaccines are and how they protect the
body from infections.
13 Why is it important to vaccinate children during
infancy?
14 List the diseases that children in Australia can be
vaccinated against.
15 Explain why it is important to have at least 90 per

cent of the population vaccinated.
16 What are two examples of incentives that the
government have put in place to encourage
parents/carers to vaccinate their children?
17 Explain two reasons why parents/carers may choose
not to vaccinate their children.

18 Draw up a table to show the advantages and
disadvantages of both breastfeeding and bottle
feeding.
19 Using the Australian Dietary Guidelines and
recommended servings, provide an outline of a daily
diet that you would recommend for a three-year-old
child and a child aged 911. Justify the foods you
would include in thediet.
20 Develop a one-page handout outlining the
importance of ensuring good oral hygiene in
children.
21 Develop a health promotion media advertisement
that focuses on good oral hygiene for primary
school students.
22 As a community health nurse, you are required
to write an article in a local newspaper trying to
convince parents to ensure that their children are
immunised. In your article, address some of the
reasons why parents may choose not to immunise
their children.
23 What are the advantages of having a National
Immunisation Register and monitoring the
immunisation rates?
24 Parents/carers have the right to decide whether
they get their children immunised. Discuss.
9.3
eterminants of health and individual human

D
development of children: physical environment
KEY CONCEPT Understanding the physical environment determinants

that have an impact on the health and individual human development
of children
Unit 2
AOS 2
Topic 4
Concept 3
Physical
environment
childhood
Concept summary
and practice
questions
The physical environment refers to the surroundings in which a child lives and
plays. The physical environment includes accessibility to resources such as housing,
water, health services and recreational facilities. It also refers to the environmental
conditions in which a child lives that impact on health and individual human
development. For example, an asthma sufferer who lives in an area that has a high
degree of air pollution may have a greater frequency of asthma attacks compared to
an asthma sufferer who lives in an area with lower pollution levels. There are many
factors within the physical environment that impact on the health and individual
human development of children including tobacco smoke in the home, housing
environment, fluoridation of water and access to recreational facilities.

Tobacco contains approximately 4000 different chemical substances, with at least
250 of these being found in second-hand smoke. The smoke that is exhaled from
a smoker or is emitted from the tip of a burning cigarette is called environmental
tobacco smoke. Passive smoking, which is the inhaling of environmental tobacco
smoke, is particularly dangerous for children because their lungs are still
developing. Environmental tobacco smoke exposes non-smokers to most of the
same toxic gases, chemicals and fine particles that smokers inhale directly when
they smoke tobacco. In the unfiltered smoke that comes from the tip of a burning
cigarette, the particles can be finer and more concentrated, which means they can
be inhaled deeper into the lungs and stay longer in the body of the passive smoker
compared to the person who is smoking.
For children who live in a home where one or more people smoke, their health
and individual human development may be affected in the following ways:
increased risk of asthma and other serious chest infections such as bronchitis,
bronchiolitis and pneumonia
greater likelihood of symptoms such as coughing, phlegm, wheezing and
breathlessness
slower lung growth
increased risk of meningococcal disease
reduced immunity
increased risk of middle-ear infection (otitis media), which may lead to hearing
loss
increased risk of SIDS in the first year of life
a tendency to be shorter than average at all ages
a tendency to be absent from school more often
lower level of lung function during childhood (decreased capacity to breathe
deeply).
Passive smoking has also been linked to the development of childhood cancers
such as leukaemia, brain cancer and lymphoma.
It is estimated that children of parents who smoke inhale approximately the
same amount of nicotine as they would if they actively smoked 60150 cigarettes
a year. Children who are exposed to environmental tobacco smoke are 40 per cent
more likely to suffer from asthma symptoms as compared to children who are not
exposed to environmental tobacco smoke. Approximately 8 per cent of childhood
asthma in Australia is attributable to passive smoking.
306
Case study
Third-hand smoke residue

on walls, furniture and car
interiors more harmful
than previously thought
By Laura Chalmers
Stale cigarette smoke clinging to walls, furniture
and car interiors poses a greater risk to health than
previously believed.
The Cancer Council Queensland will today release
research showing third-hand smoke poses a serious
health threat to children and could cause cancer.
It says parents need to ensure their home is totally
smoke-free and any curtains, clothing, toys or floors
that could have been exposed to smoke need to be
cleaned.
Research shows many of the more than 4000
chemicals in second-hand smoke linger long after
cigarettes are put out, sticking to surfaces and damaging
human DNA in a way that can potentially cause cancer,
Cancer Council Queensland spokeswoman Katie Clift
said.
Chemicals from second-hand smoke stick to
curtains, dust, clothing, toys and floors and can
remain in a home as third-hand smoke on surfaces for
months after active smoking occurs.
Making your home totally smoke-free is the only

way to protect your family from the harmful effects of
second- and third-hand tobacco smoke, she said.
About 3000 Queenslanders will die from a tobaccorelated disease each year, with about 300 of the deaths
caused by second-hand smoke exposure young
children are at risk from third-hand smoke partly
because of their habit of putting their hands in their
months.
One ex-smoker, now a mother, Tracy Hatten, 34,
smoked for several years when she was younger and
said she had undergone a conversion and was now a
complete anti-smoker who was opposed to smoking
in public places.
She said she did everything she could to prevent
her children Callum, 6, and Evie, 3, from exposure to
second-hand or third-hand smoke.
I really dislike it, Ive even finally encouraged my
mum to give up smoking, she said.
Health Minister Lawrence Springborg this month
announced a ban on smoking at school gates or within
5m of hospitals.
The Cancer Council Queensland is pushing for the
Government to go further and introduce smoke-free
spaces across the state at locations such as bus stops,
taxi ranks and shopping centres.
Chief Health Officer Jeannette Young said about
15per cent of adult Queenslanders smoked regularly.
Source: Courier-Mail, 31 May 2014.
Case study review

1 What is meant by third-hand smoke?
2 What are the dangers of third-hand smoke to the health and individual human
development of children?
3 According to the article, why are young children at greater risk from the dangers
of third-hand smoke?
Housing environment
Housing environment plays a significant role in the health and individual human
development of children. Ideally, a house provides shelter and a clean place in
which to live, and protects children from the outside environment, including any
physical dangers. However, some families are required to live in substandard or
overcrowded dwellings due to low income. This can put family members at greater
risk of poor health.
Overcrowding puts increased stress on water supplies (bathroom, kitchen and
laundry) and sewerage disposal systems, and forces people to live in close proximity
9.3 Determinants of health and individual human development of children: physical environment
FIGUrE 9.24 Overcrowded living

conditions can have a significant
impact on the health and individual
human development of children.
in the home environment. All these factors can result in

the spread of infectious diseases such as meningococcal,
meningitis, septicaemia, tuberculosis, rheumatic fever,
respiratory conditions and skin infections.
Prolonged periods of ill-health can impact on the
health and individual human development of children
(figure 9.25). A child who is ill is less likely to be engaged
in physical activity, so motor skills may not develop
according to the childs potential. The child may not be
able to socialise with other children, thereby affecting
the capacity to develop social skills. This also reduces
the opportunities for the child to develop emotionally
through interaction with others. Continued absence
from school may hamper the intellectual development of
the child. Intellectual development may also be affected
by the overcrowded living conditions as the child may not have the space to
concentrate on schoolwork.
Homelessness has significant impacts on the health and individual human
development of children, as children who are homeless are at greater risk of illhealth. Homelessness has been linked to increased rates of gastroenteritis and a
range of respiratory conditions such as bronchitis and asthma.
Child less likely to

participate in physical
activity
Limited opportunities
for motor skill
development
FIGUrE 9.25 The impact of

overcrowding on the health and
children
Overcrowding
Prolonged
ill-health
from infectious
diseases
Continued absence
from school
Limited opportunities
for intellectual
development
Child less likely to

socialise with other children
Limited opportunities for emotional
and social skill development
Homeless children are at a greater risk of physical and sexual assault, as well as
having insufficient and unhealthy food, and inadequate shelter. All of these factors
can impact on the health and individual human development of the child. For
instance, children who are physically or sexually abused may experience irreparable
damage to their body. An example of this might be damage to the growth plate
in bones, which affects bone growth. Such abuse may have a negative emotional
effect, hampering the childs capacity to trust others and form relationships. The
child may also lose interest in school, thereby affecting intellectual development.
Safety in the home

Approximately 260 children die and 58 000 are hospitalised every year due to
unintentional injury in Australia. This means that more Australian children die
of injury than die of cancer, asthma and infectious diseases combined. Ensuring
safety within the home is vital for promoting the health and individual human
development of children. According to Kidsafe, most injuries in children under
6years of age occur at home.
308
Some of the major concerns within the home environment are:

drowning in the backyard swimming pool, garden water features, baths or nappy
buckets
access to cleaning products, medicines, chemicals and plants in the home that
can cause poisoning
falls from change tables, strollers, bunk beds and playground equipment such as
slides, monkey bars and cubby houses
tripping over toys and tools left lying around
falls from verandas or stairs, or out of windows
burns and scalds
choking
dog bites.
How safe are our homes?
Serious injuries to children under 6 years of age occur in the
place youd think they would be safest their own home.
Try checking your home against the following list of home
safety features:
1 Pools (and spas) that are fully fenced, with well
maintained, self-closing gates.
Why?
Young children drown quickly and silently. Around 33 children
under five drown each year in Australia in unfenced pools or
pools with poorly maintained fences or gates.
2 Hot water from bathroom taps set at a delivery
temperature of 50 C.
Why?
Hot water burns like fire. Many Australian homes have hot
water coming from their taps at temperatures that can burn a
childs skin in one second.
3 Barriers such as gates on stairs, window latches and
fireguards in place to keep children from hazards.
Why?
Falls down stairs, off furniture and out of windows are
common and because young children are top heavy, head
injuries can often occur.
4 Child resistant catches fitted to cupboards where dangers

like medicines, cleaners, matches and lighters are stored.
Why?
Young children are curious and dont understand danger.
Telling them not to touch is not enough to keep them safe.
Dangerous products and cleaning products need to be stored
away safely.
5 Install smoke alarms, test them regularly and change the
battery once a year.
Why?
House fires continue to claim Australian lives every year. The
correct smoke alarms correctly positioned provide a warning
that may be critical to survival.
6 Play areas fenced off from the street and the driveway.
Why?
Cars and kids dont mix. Young children have no fear of cars
and are not easily seen by drivers. Every month a toddler is
killed after being reversed over in a driveway.
Kidsafe estimates that if these six features were in place in
all Australian homes, they would help prevent more than half
of all home injury deaths among children under six and spare
thousands of children from disability from preventable injuries.
Source: www.kidsafe.com.au.
Fluoridation of water
Fluoride is a natural mineral found in food, water, plants and
toothpaste. The fluoridation of water involves adding fluoride to a
public water supply to reduce tooth decay in the population. It is a
safe and effective way of reducing the risk of tooth decay in people
of all ages. In fluoridated areas of Victoria, six-year-old children
experience 36 per cent less decay in their baby teeth than those in
areas without access to fluoridated water, according to the Victorian
government. Likewise, 12-year-old children living in areas with
ready access to fluoridated water have 22 per cent less decay in their
permanent teeth compared to those living in non-fluoridated areas.
More than 80 per cent of Australians have access to fluoridated water.
Fluoridated water has numerous benefits for the health and
individual human development of children as it:
protects against tooth decay
repairs weak spots on the surface of the tooth, thereby preventing cavities
Figure 9.26 Fluoride in drinking

water is a safe and effective way of
reducing the risk of tooth decay.
9.3 Determinants of health and individual human development of children: physical environment
reduces the amount of money spent on dental treatment, which can then be
used for other health-promoting resources such as nutritious food
reduces the time away from school for dental treatment
reduces the pain associated with dental decay.
The consumption of fluoridated water, along with good nutrition and appropriate
oral hygiene, helps protect childrens teeth by reducing the risk of dental decay and
subsequent tooth loss. Childrens first teeth play an important role in the digestion
of food and in reserving spaces for the second, permanent teeth. If a child has
missing teeth, especially those at the front of the mouth, they may experience
difficulties with speech development. Healthy teeth create a healthy smile, which
helps children feel good about how they look.

Access to recreational facilities has a significant impact on the health and individual
human development of children. Recreational facilities that are easily accessible for
families with children greatly increase the likelihood of regular physical activity
being undertaken. Participating in regular physical activity has enormous benefits
for the child. Children who are active will generally:
have stronger muscles and bones
have greater cardiovascular endurance
be less likely to be overweight
have a decreased risk of developing type 2 diabetes
have a happier disposition and develop positive relationships with others
have better sleep patterns
be more capable of handling physical and emotional challenges
be able to cope more effectively with stress and anxiety
have higher levels of self-esteem
have improved concentration.
Figure 9.27 Undertaking regular physical activity has enormous health and development
benefits for children.
The promotion of active play provides children with the opportunity to engage
in physical activity that is vital for establishing healthy behaviours. Active play is
basically physical activity with regular bursts of moderate to vigorous pace, such
as playing in a playground where children run from one piece of equipment to
another. Structured play is organised and involves rules, time limits and special
equipment. Examples of structured play include play group, gym classes and
swimming lessons. Unstructured play is often spontaneous and less restricted, such
as allowing a child to play freely in a playground.
Toddlers and preschool children should be physically active for at least three
hours each day, spread throughout the day.
Children aged 512 should undertake at least 60 minutes of moderate to
vigorous physical activity. The activity does not have to occur in one session but
can be accumulated in short bursts throughout the day.
Based on the 201112 National Nutrition and Physical Activity Survey,
only 23 per cent of children aged 514 years met the national physical activity
recommendations every day.
The state government department, Sport and Recreation Victoria, is responsible
for allocating funds for the development of recreational facilities. The government
recognises the importance of providing facilities at a local community level
in promoting healthy lifestyles for all Australians, both in urban and rural
communities. As a result of this funding, local communities are able to offer a
range of facilities from sporting grounds and stadiums to parks and playgrounds.
TEST your knowledge
1 Why is passive smoking particularly dangerous to

children?
2 Explain the impact that exposure to tobacco smoke
in the home can have on the health and individual
3 Explain the relationship between overcrowded
housing and ill-health.
4 How does homelessness impact on the health and
individual human development of children?
5 What are the benefits of fluoridating water?
6 Why is it important for governments to provide
funding for the development of recreational
facilities?
7 The government should ban smoking in the home.

Discuss.
8 Research information regarding the impact of
homelessness and complete the following: As an
advocate of human rights, write a letter to the
government outlining the issues associated with
poor housing/homelessness and the health and
individual human development of children. Provide
suggestions about how the government could
address these issues.
9 Select two examples from the How safe are
our homes? checklist and discuss how their
implementation would improve the health and
individual human development of children.
10 Investigate the recreational facilities available in your
local community. Create an information brochure
outlining the facilities available, types of activities
offered and the benefits of physical activity to
children.
9.4
eterminants of health and individual

D
human development of children: social
KEY CONCEPT The impact of social determinants on the health and

Unit 2
AOS 2
Topic 4
Concept 4
Social
determinants
childhood
Concept summary
and practice
questions
A range of social determinants impact on the health and individual human

development of children. Families play a crucial role in the lives of children,
providing them with physical, emotional and economic support. Children who are
raised in stimulating and nurturing environments have been shown to have better
outcomes throughout their lives. Parental education and parenting practices have
both been found to play an important role in influencing childrens health and
individual human development. Two other social factors that lie outside the family
that also influence childrens health and individual human development are the
media and access to health care.
Parental education
Figure 9.28 Parental education is

a key determinant of employment
status and income.
Parental education refers to both the formal level of

education that is achieved by parents (e.g. through
tertiary qualifications) and the level of knowledge that
may be attained through more informal means (e.g. by
reading newspapers or watching television).
Education enables parents to gain the knowledge
and skills needed to promote the health and individual
human development of their children. Higher levels of
education provide parents with a greater understanding
of health, particularly of health risks and protective
factors. Therefore parents with higher levels of
education will tend to have a greater understanding of
the factors that impact on the health and individual
human development of children (e.g. nutrition,
physical activity and vaccination). This is particularly true for mothers, who are
traditionally the caregivers of the family.
Formal qualifications provide opportunities for better employment and higher
income, which enable individuals to have a healthier lifestyle and greater access
to health-promoting resources such as nutritious foods and health care. This has a
significant effect on children because parents are responsible for the provision of
resources that are necessary for health and individual human development.
Parental employment status has a significant impact on the health and individual
human development of children. According to the Australian Bureau of Statistics,
11percent of families with dependent children had no one in the family who was
working (jobless families) in June 2012. Over one-third of one-parent families with
dependants were jobless compared to onein25 couple families with dependants.
There were 362000 children aged 014 years living in jobless one-parent families
in June 2012.
Children who do not have a parent in paid employment are more likely to be
living in a stressful home environment due to financial pressure. Low family income
can negatively affect the health, education and self-esteem of children. Children
living in families without adequate income are at a greater risk of poor health and
educational outcomes. Lack of family income can affect a childs food intake, access
to medical care, the safety of their environment, level of stress in the family, quality
and stability of their care, and provision of appropriate housing, heating and
clothing. Children from low-income families are more likely to suffer from poor
physical, mental and social health, and this can affect their individual human
development.
Higher levels of education provide adults with greater choices in their occupation.
This increases the likelihood that they will be employed in positions they find
stimulating and rewarding. Their
family environment is more likely
to be harmonious and supportive
as a result, and this has a positive
impact on the health and
of children.
Parenting
practices
Parenting practices refer to the
way in which the parents or
carers interact on a daily basis
with their child and how they
model behaviour. It incorporates
the type of discipline that is used
and the way in which the parent/
carer responds to the child in
different situations. Parents and
carers have an enormous impact Figure 9.29 Occupation affects the level of income, which in turn can influence the health
on the social development of and individual human development of children.
children, particularly in the
following areas:
teaching respect for others
developing effective means of communication
learning values
learning appropriate behaviours
learning how to cooperate effectively with others
being empathetic towards others.
Parents/carers of children tend to adopt a particular parenting
style, and this can have an impact on the health and individual
human development of the child. The four main types of parenting
styles are:
Authoritarian parenting style. Authoritarian parents/carers
tend to use direct parenting styles with an overemphasis on
discipline and little or no opportunity for decision making by
the child. Authoritarian parents/carers can be intimidating,
with an expectation of obedience and respect. Expectations
are not explained but simply demanded of the child, and the
parent/carer will become angry and forceful if the expectations
are not met. Authoritarian parents/carers may feel threatened
by the emerging independence and individuality in the child.
Research has shown that children who have been raised
by authoritarian parents/carers tend to be more withdrawn,
anxious and discontented, with lower self-esteem and less trust
in others.
Figure 9.30 Parenting practices
Authoritative parenting style. Authoritative parents/carers
refer to the way in which parents
tend to provide fair discipline while also catering for the
interact with their children.
9.4 Determinants of health and individual human development of children: social

self-esteem needs of the child. They have high but not unrealistic expectations,
and effectively communicate these to the child. Good behaviour is rewarded
with positive encouragement and reinforcements. Authoritative parents/carers
set limits and implement fair disciplinary measures if these are breached. They
acknowledge and respond to a childs individuality and support the childs
developing independence. Children who have had an authoritative upbringing
tend to be more self-reliant, self-controlled and happy. They usually have a wide
social network of friends, perform better in school and have higher self-esteem.
Permissive parenting style. Permissive parents/carers tend to overemphasise
the self-esteem needs of the child and fail to discipline the child when required.
They have very little or no expectations of the child and will usually ignore
obnoxious behaviour. Permissive parents/carers give in to their childs demands,
thereby reinforcing the demanding and inconsiderate aspect of the child.
They do not set rules or limitations, and their love and support of the child is
unconditional. Children who have been raised in a permissive environment tend
to be more immature, demanding and dependent. They may have social issues
arising from a tendency to blame others for their problems.
Uninvolved parenting style. Uninvolved parents/carers tend to be neglectful,
unresponsive and uncommunicative. They make sure that their childrens basic
survival needs are met but they remain emotionally detached from their children
and the whole parenting experience. As a result of this style of parenting,
children may have issues with cognition, attachment and the development of
emotional and social skills.
restrictive
autocratic
punitive
parent-centred
High
negotiation
explanation
expectation
of
obedience
Acceptance, responsiveness,
Low
lack of support
few demands
no controls
lack of
encouragement
distant
emotional withdrawal
lack of
warmth
neglectful
Behavioural control; demandingness
adherence
to rules
non-negotiable
strict
parenting
assertive
promotion
of
independence
supportive
boundaries
balanced
parenting
discussion
supportiveness
child
in charge
indulged
High
lack of boundaries
no demands
lack of expectation
over-involved
spoilt
lack of
no direction
control
Low
Figure 9.31 The four styles of parenting
Some children may live in situations where the parents/carers use abuse as a part
of their parenting practices. Children who are subjected to regular acts of
abuse by their parents/carers are at greater risk of emotional

and behavioural problems when compared to other
children.
There are four categories of abuse:
physical when the parent/carer hurts their child by
hitting, slapping, shoving, pushing, biting, kicking or
burning
verbal when the parent/carer yells mean and hurtful
things at their child, scaring or threatening them
sexual when the child is touched in a sexual way or
forced to have sex
neglect when the parent/carer hurts the child by not
providing care, food, clean items, safety, clothing, love
and support.
The effects on children exposed to abuse can be short Figure 9.32 Verbal abuse is a form of family violence.
and long term. Short-term effects include the child:
blaming themselves for the situation
having sleeping difficulties
regressing to earlier stages of development such as bedwetting and thumb sucking
being anxious or fearful
displaying aggressive or anti-social behaviour
isolating themselves from people
not attending social or school events
becoming a victim or perpetrator of bullying
being cruel to animals
suffering from stress-related illnesses such as headaches and stomach cramps
displaying speech problems such as stuttering
misusing drugs and alcohol.
The long-term effects of exposure to abuse may result in the child growing up to
be an abusive person from learning to solve problems through the use of violence.
From witnessing the violent behaviours of their adult role models, children may
grow up to behave in destructive ways in their own adult relationships.
Drug and alcohol dependence in parents/carers may leave them unable to
appropriately care for their children, who may be hurt or neglected as a result of
the addiction. For parents/carers in this situation, the need for drugs or alcohol
may take priority over looking after their childrens needs. Children growing up
with parents/carers with a drug and/or alcohol dependency may:
lack the essential nutrients required for growth and development
have difficulties at school
encounter learning problems
develop emotional problems due to stress or anxiety
lack trust in adults
be at increased risk of mental illness or suicide in later life
be at increased risk of substance abuse.
Media
The introduction of media technologies (TV, video, games, Internet, music, mobile
phones, tablets) and social media have brought about a change in the experience
of childhood in our society, and these new media can have a significant impact
on the health and individual human development of children. Media can have
both a positive and negative impact depending on the age of the child, the type
of media, whether or not the use of media is regulated by parents, and whether
parents choose to get involved when their child is using media technologies.
How media can benefit children

For children under two, there are no benefits from any media it is recommended
that parents avoid exposure to the media until children are at least two years of age.
For children aged 28,television programs should be chosen carefully, but movies
and computer games can promote individual human development and improve
social health. For younger children these benefits include:
development of literacy skills by learning letters of the alphabet through
childrens programs such as Play School and Sesame Street, or through educational
computer games
development of numeracy skills by learning how to count through programs
such as Sesame Street and Play School
learning social skills such as cooperation by watching television programs and
using computer games and websites, such asABCfor Kids,that show cooperative
and helping behaviour.
Forolder children, there are:
intellectual benefits such as developing problem-solving and critical thinking
skills through playing computer games, or developing morals by comparing
family values with those found in fiction and documentary content
educational benefits through the encouragement of reading after watching a
program or movie based on a book
creative benefits through the development of skills such as imagination, art and
modelling, music and media, by using software to create a picture, or being
inspired to make something by a television show
benefits to social health and development by joining online clubs designed for
children such as Club Penguin or Skoodle, which teach children strategies for
effectively and safely using social networking sites or playing computer games
with friends and family
cultural benefits from being exposed to diversity, especially ethnic diversity
that can foster a greater understanding of different cultures (adapted from
raisingchildren.net.au).
However, the media is not always a positive influence on childrens health
and individual human development. Parents are often challenged when deciding
which media is good for their children and which media could have a negative
influence. Parents are therefore encouraged to sit with their children, especially
young children, to decide whether the type of media being consumed is likely to
have a positive impact.
Children can often be exposed to violence through the media, which can
undermine their sense of safety and security as well as normalising violence as an
acceptable method of solving conflict.
Children will often see people in the media as role models. When these role
models display positive behaviour, the impact on health and individual human
development can be positive. However, poor role models can influence children to
behave inappropriately or encourage them to take unnecessary risks.
Children should also be monitored when using the internet to ensure they do
not accidently access websites that are inappropriate.
The use of media can have a negative impact if the amount of time being
spent by children is beyond what is recommended. Children aged 25 should not
spend more than one hour watching television or DVDs, or using the computer.
Children over five should not spend more than two hours per day in front of a
screen. Childrens media use should be balanced with creative play, sport, other
physical activity and music to promote optimal health and individual human
development.
Impact of food advertising

It has been estimated that Australian children (aged 5 to 12 years) watch an
average 23 hours of television per week; up to four hours are made up of
advertisements which equates to 208 hours per year. More than three-quarters of
food advertisements shown during childrens TV viewing time promote foods low
in nutritional quality such as chocolate, confectionary, fast food and sweetened
breakfast cereal. Food advertisers on television use techniques such as prizes,
catchy jingles, animation and celebrities to attract childrens attention and create a
desire to want the product. Children are susceptible to television advertising and
will pressure their parents to purchase the advertised products.
Media can also expose children to excessive food advertising. Advertisements
for certain products breakfast cereals, snacks, soft drinks and fast foods are
often targeted at children. These types of foods are high in saturated fats, simple
carbohydrates and sodium, and can contribute to the development of overweight
and obesity.
Childhood overweight and obesity are linked to numerous health risks including:
Social and mental health: overweight and obesity can lead to social isolation and
discrimination, poor self-esteem, depression, learning difficulties and limited social
skills.
Physical health risks in childhood: back pain, flat feet, slipped growth plates in the
hips, knock knees (where the knees touch), fatty liver, type 2 diabetes, menstrual
problems, asthma and obstructive sleep apnoea (pauses in breathing due to an
obstruction of the open airway).
Physical health risks in adulthood: type 2 diabetes, cardiovascular disease, stroke,
hypertension, some cancers such as colorectal cancer, musculoskeletal disorders
and gall bladder disease. Overweight and obesity can result in a reduced life
expectancy.
Dental health: The consumption of high sugar foods and acidic soft drinks
is the biggest risk factor for dental erosion and dental caries in children and
adolescents.
Bone health: Children who consume soft drink rather than milk may have low
bone density due to inadequate calcium intake.
The childhood obesity rate in Australia is one of the highest in the world; in 2012,
the proportion of overweight and obese children (aged 517) was 25.3percent.

Access to health care during childhood is vital for the health and individual human
development of children. Through the provision of easily accessible health care
services, parents are able to monitor their childs growth, check the health status of
their child and treat illnesses/conditions in their earliest stage to maximise recovery
and promote health and individual human development.
Access to health services is important in the birth of a child, in order to have
medical professionals readily available in case of complications and to ensure that
the baby is carefully monitored and cared for. During the birth, a caesarean section
(in which the baby is delivered through an incision in the mothers abdomen)
may be required if there are difficulties in delivering the baby or if the baby is
in foetal distress and not receiving enough oxygen. Newborn babies requiring
specialist care are placed in a neonatal intensive care unit, which specialises in
the care of ill or premature babies (figure 9.34). Approximately 8 per cent of
births in Australia are premature (born before 37 weeks gestation) and require
medical attention.
Figure 9.33 Access to health care

is vital for ensuring the health and
children.
Figure 9.34 Babies who require

specialist care following birth are
placed in a neonatal intensive-care unit.
Maternal and child health service
cm
105
100
95
90
85
80
75
70
65
60
55
50
45
cm
Birth
Once a child is born, the mother is referred to the maternal and child health service
where they are provided with support, information and opportunities to discuss
concerns related to the health and individual
Height-for-age percentiles: Boys, birth to 36 months
human development of children. Maternal
cm
and child health centres are located within the
community and offer the following:
105
97th
provision of information, support and advice
95th
on a range of topics including parenting,
90th 100
child health, development and learning,
75th
child behaviour, maternal health, child safety,
50th
95
immunisation, nutrition, breastfeeding and
25th
family planning
10th
5th
90

health and development checks
3rd
home visits in the first few days following
85
birth or when circumstances require
assistance with contacting other specialist
80
services such as early parenting centres
support for those experiencing difficulties.
By accessing the maternal and child health
75
service, parents can identify issues and
possible problems so that steps can be taken to
70
address them early in life. Regular assessments
evaluate the childs health and individual
65
human development at particular stages. These
assessments include:
60
regular checks of weight, height and head
circumference to determine the amount of
55
growth. These measurements are plotted onto
percentile charts to determine the childs rate
50
of growth in comparison to other children
(figure 9.35).
45
checks of motor skill development
screening of hearing and eyesight
cm
observation of play
6
9
12 15 18 21 24 27 30 33 36
physical examination (e.g. heart rate,
Age (months)
breathing).
Figure 9.35 Height-for-age

percentiles: Boys, birth to 36 months
Source: Individual growth charts, Centers for
Disease Control and Prevention, www.cdc.gov.
PERCENTILE CHARTS
Percentile charts have been developed for the three measurements of weight, height
and head circumference. If a baby or child lies on the 10th percentile for weight for
example, it means 90 per cent of children the same age are heavier than the child and
10 per cent of babies weigh less. In both examples, the children although different
in size are within the normal range for weight. An average child would be close to
the 50th percentile. Regular measurements show visually if the child is increasing in
height, weight and head circumference and is therefore developing as they should.
Primary School Nursing Program

In order to promote the health and individual human development of primary
school children, the Victorian Governments Department of Human Services offers
a free universal health-care service to all Victorian Primary and English Language
Centre Schools through the Primary School Nursing Program.
The aim of the program is to provide all Victorian children with the opportunity
to have a health assessment, to link children, families and school communities to
services available in their local community, and to provide information and advice
that promotes health and individual human development.
All children are offered a health assessment in their first year of school through a
School Entrant Health Questionnaire, which contains a range of questions regarding
health history, wellbeing and family circumstances. The questionnaire also provides
opportunities for parents/cares to express any concerns that they may have about their
child. Further assessment may be undertaken at the request of the parents/carers,
such as a vision or hearing test. The completed questionnaire provides important
information about a childs health and individual human development so that the
nurse can make an effective health assessment. If there are concerns, a child may
need to be referred to another health professional or agency. Throughout primary
schooling, parents can request a health assessment to be completed for their child.
Primary school nurses also provide health information and advice about healthy
behaviours and link children and their families to community-based health and
wellbeing services.
TEST your knowledge
1 Explain the relationship between parental education

and the health and individual human development
of children.
2 How can the long-term unemployment of one or
both parents impact on the health and individual
human development of a child?
3 (a) What are the four main parenting styles?
(b) Explain how each parenting style can impact on
a child.
4 Outline the four categories of abuse.
5 List the possible short-term effects on the health of
a child as a result of exposure to violence.
6 What are the possible effects of a parents or carers
drug dependence on a childs health and individual
human development?
7 Explain three negative impacts the media can have
on the health and individual human development of
children.
8 Explain three positive impacts the media can have
on the health and individual human development of
children.
9 What is social support?
10 Explain the impact of food advertising on the health
11 Explain why access to health care during pregnancy
is important for the health and individual human
development of infants.
12 Explain the role of the maternal and child health
service.
13 What types of assessment are made of the
developing child by the maternal and child health
nurse? Why are these assessments important?
14 Explain the Primary School Nursing Program.
15 Explain how low income can affect a child in terms of:

(a) level of nutrition
(b) access to medical care
(c) the safety of the environment
(d) the level of stress in the home
(e) the quality and stability of care.
16 Explain how each parenting style (authoritarian,
authoritative, permissive and uninvolved) would
approach the following case studies:
(a) Lachlan is eleven years old. His parents have
recently found out that he has not been handing
in his homework.
(b) Maria is eight years old. She constantly argues
with her younger brother and sister.
(c) Benjamin is five years old. He refuses to pay
attention to his mother and ignores her
instructions.
(d) Melanie is six years old and refuses to eat any
fruit or vegetables. Her diet consists of chicken
nuggets, chips and pasta.
17 Select a one hour television timeslot and take note
of the food advertisements shown during this time.
Record the types of foods that are being marketed
and their target audience. How many advertisements
marketed unhealthy foods to children? What is the
possible impact of this advertising on the health and
individual human development ofchildren?
18 Explain how the Primary School Nursing Program
can promote the health and individual human
19 Invite a maternal and child health nurse into the class
or visit a maternal and child health centre and develop
a poster or multimedia presentation that explains the
importance of the service in promoting the health and
9.5
Determinants that act as risk and/or

protective factors for asthma

protective factors in relation to asthma
There are a range of biological, behavioural, physical environment and social
determinants that impact significantly on the health of children in Australia. Arange
of health issues contribute significantly to the burden of disease during childhood
(figure 9.36) and are the product of a combination of these determinants.
By understanding these health issues and the determinants that act as risk and/
or protective factors for each, a range of personal, community and government
strategies and programs can be implemented to optimise the health and individual
human development of children in Australia.
Asthma
Type 1
diabetes
Falls and
injuries
Health issues
affecting
Australian
children
FIGUrE 9.36 Some of the health

issues that have a significant impact
on Australias children
Juvenile
arthritis
Food
allergies
Asthma
Asthma is a common inflammatory condition of the airways resulting in wheezing,
breathlessness and tightness of the chest. The lining of the airways become swollen
and inflamed, producing sticky mucus that causes a narrowing of the airways,
making it difficult for the child to breathe. Asthma cannot be cured; however,
with the appropriate preventive and relief medication, asthma can be controlled
effectively, enabling children to lead active, normal lives.
FIGUrE 9.37 Asthma is a significant

health issue for children.
320
Why is asthma a health issue for

children?
Asthma is one of the most common causes of hospital admissions and visits to
medical centres for children. It is the most frequently reported long-term chronic
condition with approximately 10 per cent of Australian children aged 014
having asthma (Australian Bureau of Statistics, 200708 National Health Survey).
Figure9.38 shows the prevalence of asthma among children aged 014 in 200708.
25
Boys
Girls
Children
Per cent
20
15
10
5
0
04
59
1014
Age group (years)
Figure 9.38 Prevalence of asthma

among children aged 014, 200708
Determinants acting as risk and/

or protective factors in relation to
asthma
While the underlying causes of asthma are still not well understood, the following
determinants may increase the risk of developing asthma or increase the risk of
having an asthma attack.
Biological
Biological determinants that impact on asthma in children include:
Genetics: having a parent with asthma, eczema or hay fever increases a childs
risk of developing asthma.
Body weight: being overweight or obese increases the risk of a child developing
asthma.
Sex: more boys have asthma than girls. This may be due to the fact that young
boys tend to have smaller lungs than young girls.
Respiratory infections: infants who have respiratory infections are up to
40percent more likely to develop asthma as children.
Behavioural
Behavioural factors that impact on asthma in children include:
Eating habits: approximately 2.5 per cent of people with asthma are affected by
food and drinks but food is not a common trigger for asthma. A myth is that
milk is a trigger for asthma; however, studies have not shown a link between the
consumption of milk and asthma.
Physical activity: exercise may trigger an asthma attack. Exercise-induced asthma
can usually be controlled with an appropriate warm-up and medications.
Breastfeeding: infants who are breastfed are less likely to suffer childhood asthma.
9.5 Determinants that act as risk and/or protective factors for asthma
The physical environment can impact on asthma in children in the following ways:
Tobacco smoke in the home: children who have a mother who smokes are four
times more likely to suffer from asthma.
Air pollution: both indoor and outdoor air pollution can make asthma symptoms
worse; however, it is not clear if pollution causes asthma.
Exposure to allergens: house dust mites, pollens, mould spores and animal hair
or fur can all be triggers for asthma.
Weather fluctuations: temperature changes and thunderstorms can bring about
asthma attacks in some children.
Unit 2
AOS 2
Topic 5
Risk factors
Concept summary
and practice
questions
Concept 1
Unit 2
AOS 2
Topic 5
Concept 2
Protective
factors
Concept summary
and practice
questions
Social
Some of the social determinants that have a relationship with childhood asthma
include:
Parental education: those with lower levels of education have higher rates
of smoking. Being exposed to tobacco smoke in the home increases the risk
of respiratory infections and possibly asthma during childhood. Smoking
during pregnancy can increase the risk of asthma during childhood. A lack of
understanding about asthma and its treatment may result in asthma being left
untreated, increasing the risk of mortality.
Socioeconomic status: higher rates of asthma are seen in lower socioeconomic
status population groups. A possible reason for this is increased exposure to the
environmental factors that impact on asthma in poor households. For example,
living in a household that contains mould may increase the risk of an asthma
attack.
TEST your knowledge

1 (a) Briefly explain asthma.
(b) What are the symptoms of asthma?
(c) What percentage of children had asthma in
200708?
2 Explain why asthma is a health issue for children.

3 Select two determinants of health and explain how
they impact on asthma.
4 Prepare a poster that could be used to educate

children about the risks of asthma and the
determinants that can protect against/contribute
toit.
5 Explain three ways in which asthma could impact on
the health and/or individual human development of
children.
6 Use the Asthma links in the Resources section of
activity.
322
9.6

protective factors for falls and injuries

protective factors in relation to falls and injuries
Falling is the most common cause of injury for children of all ages. The seriousness
of an injury is determined by the height from which the child has fallen, the surface
onto which the child falls and the objects or surfaces the child may hit as they fall.
Children are
MORE LIKELY to
be injured than
adults. Why?
Children have
softer and, for
their size, bigger
heads than adults.
Children dont always

know how to keep
themselves safe
they havent
learned yet.
Young children have

thinner skin than
adults, and their skin
can be easily hurt.
Children have small

arms, legs, hands,
feet and fingers that can
get caught in small
gaps and holes.
Children are
shorter than
adults, so they
are less likely
to be seen
(for example,
by drivers on
the road) and
see whats
going on.
FIGUrE 9.39 There are many reasons why children are more likely to be injured than adults.
Other injuries such as burns and scalds can occur as a result of fire,
hot surfaces and hot liquids. Hot liquids cause 2 out of 3 burns in young
children. Severe burns can actually result in the death of a child as their
skin is thinner than the skin of an adult.
Swallowing chemicals or poisons are also key reasons for children being
hospitalised. Children, particularly under the age of five, will naturally put
things in their mouth. Household chemicals such as cleaning products
and medicines are the most common cause of poisoning in children.
Other causes of injury and death in children include bicycle accidents,
road accidents, drowning and choking.
Why are falls and injuries a

health issue for children?
Approximately 260 children die and 58 000 are hospitalised as a result of
unintentional injury in Australia. The vast majority of these injuries and
deaths are preventable.
Falls and injuries are a health issue for children as unintentional falls
are the most common cause of injury hospitalisations for children aged
04, accounting for 42 per cent of the total for injury hospitalisations.
This is followed by injuries due to smoke inhalation, contact with fire,
heat and hot substances (8 per cent) and poisoning by drugs (6 per cent).
In the 514 age group, falls were the most common cause of injury
requiring hospitalisation (46 per cent), followed by transport accidents
(16percent).
FIGUrE 9.40 Bicycle riding is one of the causes

of injury in children.
The determinants of health and individual human development ofAustralias children CHAPTEr 9
323
9.6 Determinants that act as risk and/or protective factors for falls and injuries
Determinants acting as risk and/or

protective factors in relation to falls
and injuries
Biological
Unit 2
AOS 2
Topic 5
Risk factors
Concept summary
and practice
questions
Concept 1
A range of biological determinants can increase the risk of falls and injuries in
children:
Body proportion: children, particularly toddlers, have a large head size in
relation to their body. This is due to the cephalocaudal pattern of development.
As a result, they have a higher centre of gravity which makes them more likely
to fall over.
Height: being smaller in stature than adults, children are less likely to be seen by
vehicles on the road and are less able to see potential dangers.
Thinner skin: children tend to have thinner skin than adults which puts them at
greater risk of damaging their skin from an injury or fall.
Smaller body size: children have smaller fingers, hands, arms, toes, feet and legs
which can get caught in small gaps and holes, thereby increasing the risk of
injury.
Motor skill development: young children are more likely to drop things, trip and
fall as their motor skills are still developing.
Behavioural
Behavioural determinants that play a role in injuries and falls in children include:
Physical activity: children engage in play and physical activity which can
potentially result in falls and injuries. While playgrounds have been designed
to reduce the risk of falls and injuries, there is still a significant risk. Riding a
bicycle, scooter, skateboard or roller skates/blades can increase the risk of falls
and injuries.
Unit 2
AOS 2
Topic 5
Concept 2
Protective
factors
Concept summary
and practice
questions
Factors within the physical environment can act to increase or decrease the risk of
falls and injuries. Examples include:
Access to recreational facilities: many playgrounds have been designed to reduce
the risk of injury. For example, many have a rubberised surface which decreases
the risk of injury if a child falls. For older style playgrounds, these types of
surfaces do not exist which increases the risk of a child being injured.
Housing environment: many falls and injuries occur in the home. Tripping on
objects in the home, such as toys left lying around, can increase the risks of
falls. Leaving children unsupervised around hot surfaces and objects can result
in a child being burnt or scalded if they touch the surface or object. Leaving
medications and poisons in areas where children can gain access to them can
potentially result in severe internal injuries and possibly death.
Social
A range of social determinants play a role in the rate of falls and injuries experienced
by Australian children. Examples include:
Lack of knowledge leading to risk-taking behaviour: children do not always
have the knowledge regarding how to keep safe. As a result, they may engage in
behaviours that increase their risk of falls and injuries.
Natural inquisitiveness: children are naturally inquisitive and may become

injured when exploring their surroundings.
Peer pressure: some children may feel pressured by their peers to engage in risktaking behaviour, leading to falls and injuries. For example, completing a trick
on a skateboard or bike may result in a child falling and injuring themself.
Lack of supervision: parents, carers or supervisors may not maintain constant
supervision of a child in their care. As a result, a child may fall and become
injured in a situation that may have been prevented if the child had been
carefully supervised.
TEST your knowledge
1 Why are children at greater risk of falls and injuries

than adults?
2 Why are falls and injuries an issue for children in
Australia?
3 Discuss the determinants of health that may increase
or decrease the risk of falls and injuries in children.
4 Using the determinants of health as the basis of

your response, explain reasons that may account for
children having high rates of falls and injuries.
parents about the importance of ensuring the safety
of children in their home.
6 Access the Kidsafe links in the Resources section of
your eBookPLUS to find the weblink
9.7
eterminants that act as risk and/or

D
protective factors for food allergies

protective factors in relation to food allergies in children
Figure 9.41 Peanuts are one of many foods that susceptible

children can have an allergic reaction to.
Food allergies are an adverse immune response to a food

that has been eaten. In an attempt to protect the body, the
immune system produces antibodies to that particular
food. These antibodies trigger allergy cells in the body
(mast cells) to release chemicals into the bloodstream.
Once the body has made antibodies against a particular
food or foods, the body recognises the foods when they
are consumed, resulting in an allergic reaction. A range of
symptoms can occur including breathing difficulties,
stomach upsets, skin rashes and, in severe cases, death. In
children with severe allergies, a reaction can occur as a
result of touching or breathing in the particles of food.
A serious and potentially life threatening allergic
reaction is known as anaphylaxis. The symptoms of an
anaphylactic reaction include swelling of the airways,
serious breathing difficulties, a decrease in blood pressure,
loss of consciousness and possibly death. Children who
have an anaphylactic reaction are required to have an
injection of epinephrine (EpiPen) which will prevent the
reaction from becoming life threatening.
Children can be allergic to a wide range of foods but the
eight most common foods that cause allergic reactions are:
milk, eggs, peanuts, soy, wheat, tree nuts (such as walnuts
and cashews), fish and shellfish (such as prawns).
Why are food allergies a

health issue for children?
Figure 9.42 Skin rashes, such as hives, can occur as a result of a

food allergy.
Food allergies occur in approximately 1 in 20 children.

Over the past decade, hospital admissions as a result of
anaphylaxis have doubled in Australia. In the 04 age
group, admissions due to food allergies have increased
five-fold in the same period. Anaphylaxis is a severe
allergic reaction that can result in death.

food allergies
Food allergies and the management of them in children have been linked to a
number of risk and protective factors including the following.
Biological
Age: some food allergies in children are not severe and will disappear over time.
Genetic predisposition: children who have one family member with one or more
allergic diseases, including asthma and eczema, have a 20 to 40 per cent greater
326
risk of developing a food allergy. This increases to 50 to 80 per cent if there are
two or more family members with allergic conditions.
Sex: a higher proportion of male children tend to have food allergies compared
to female children.
Behavioural
Breastfeeding: exclusive breastfeeding in the first four to six months of a childs
life can protect against the development of food allergies in early childhood. If
a child is allergic to a particular food, then it is important for the breastfeeding
mother to avoid eating that food.
Early commencement of solid foods: starting a child on solid foods earlier than
recommended can increase the risk of developing food allergies in early childhood.
Accidental consumption of foods causing an allergic response: children with
food allergies may consume food that they are allergic to. Children must be
taught not to take food from other children and consume only food that has
been specifically prepared for them.
Availability of foods causing allergic responses: where children have access to
foods they are allergic to, there is an increased risk of an allergic response.
Social determinants
Unit 2
Education: education plays a key role in understanding the causes of food

allergies and how to prevent an allergic reaction. For a child with anaphylaxis,
education regarding how to effectively administer the EpiPen is important for
ensuring that the child is treated appropriately.
Family: the types of foods that are eaten within a family can reduce the risk of
a child with a food allergy having a reaction. It is the responsibility of family
members to ensure that a child is not at risk and appropriate supervision of a
child will assist in ensuring that they do not consume foods that could potentially
cause an allergic reaction.
Access to health care: children who experience a severe allergic reaction require
an injection of epinephrine in order to prevent the reaction from becoming life
threatening. Children who have an allergic reaction are required to be monitored
in a medical facility for at least four hours to ensure that they have effectively
recovered from the anaphylactic reaction.
TEST your knowledge

1 Explain how an allergy develops.
2 What are the top eight foods that can cause an
allergic reaction?
3 Explain why food allergies are a health issue for
children in Australia.
AOS 2
Topic 5
Risk factors
Concept summary
and practice
questions
Concept 1
Unit 2
AOS 2
Topic 5
Protective
factors
Concept summary
and practice
questions
Concept 2
5 Make a short video that could be used to educate

parents regarding the determinants that impact on
food allergies in children.
6 Use the Food allergy links in the Resources section
of your eBookPLUS to find the
activity.

4 Explain how access to health care can promote the
health of children with food allergies.
9.8

protective factors for juvenile arthritis

protective factors in relation to juvenile arthritis
Juvenile idiopathic
arthritis joint
Bone
overgrown
Inflamed
synovial
membrane
Excess
synovial
fluid
FIGUrE 9.43 The knee joint of a
child with juvenile arthritis
Thinning
cartilage
Juvenile arthritis is any form of autoimmune or inflammatory condition

that can occur in children under 16 years of age. The normal role of the
immune system is to fight infections; however, in a child with juvenile
arthritis, the immune system starts attacking the healthy tissues,
particularly the lining of the joint (synovial membranes). Synovial
membranes produce synovial fluid that lubricates and cushions the
connecting bones of the joint as well as providing nutrition to the cartilage
covering the ends of the bones. When the synovial membranes become
inflamed, more fluid is produced, resulting in the affected joints becoming
swollen, painful and stiff. The term arthritis means joint inflammation,
but juvenile arthritis can also affect the eyes, skin and gastrointestinal tract.
The symptoms typically include pain, joint swelling and stiffness, skin
rashes, anaemia, fever and inflammation in one or more joints. Juvenile
arthritis is also referred to as juvenile rheumatoid arthritis, juvenile
idiopathic arthritis, juvenile chronic arthritis and Stills disease.
Why is juvenile arthritis a health

issue for children?
Juvenile arthritis affects less than 1 per cent of children under the age of 16 in
Australia. Juvenile arthritis is not a particularly common condition of childhood,
but it does have significant impacts on health and individual human development.
It can cause damage to the joint cartilage that covers the ends of the bones as well
as the surrounding structures. This can result in joint weakness, instability and
deformities that can interfere in the childs ability to perform the most basic tasks
such as walking, eating and dressing. The pain, stiffness and fatigue associated with
juvenile arthritis may impact on their mental health and sense of wellbeing. A child
with juvenile arthritis may be unable to participate in certain physical and social
activities, resulting in a feeling of isolation.
Healthy joint
Synovitis
Bones
Fibrous
capsule
Synovial
membrane
FIGUrE 9.44 A comparison of a

healthy joint and an arthritic joint
328
Cartilage
Joint cavity
with synovial
fluid
Synovial
membrane
inflamed and
thickened
Bones and
cartilage
gradually
eroded
40
Girls
Children
Boys
30
20
10
0
20
09
9
0
08
20
20
07
7
06
0
20
05
5
20
04
4
20
03
3
20
0
02
20
0
01
20
0
00
20
Number per 100 000 population

(aged 015)
In the 10 years to 200910, the age-standardised hospitalisation rates for juvenile

arthritis increased significantly, from 8.8 per 100000 population in 200001 to
28.9 per 100000 in 200910 (see figure 9.45). The hospitalisation rate for girls
(39 per 100000 population) was more than double the hospitalisation rate for
boys (19 per 100000 population). The reasons for this difference are not clear.
Years
Figure 9.45 Rate of hospitalisation

for juvenile arthritis, 200001 to
200910

juvenile arthritis
Research into the determinants acting as risk and/or protective factors in relation
to juvenile arthritis have focused on genetics and environmental factors such as
exposure to viruses, bacterial infections, psychological stress and physical trauma.
The research has found genetic factors increase the susceptibility to juvenile
arthritis; however, research into the impact of environmental factors has been less
successful.
Biological
Biological factors related to juvenile arthritis include:
Genetics: current research indicates that there may be a genetic predisposition to
juvenile arthritis.
Age: some children may grow out of the condition as they age.
Sex: a greater number of girls are affected by juvenile arthritis than boys.
Behavioural
Although a link has not been established between particular behaviours and the
onset of juvenile arthritis, there are behaviours that can assist in managing the
condition, including:
Physical activity: regular physical activity will help maintain the mobility of
the joints. Over-exercising can also increase the pain associated with juvenile
arthritis. Exercising in water enables the child to complete non-weight bearing
exercise, which reduces the impact on the joints.
Eating habits: if children over-consume energy-dense nutrients then they are
at risk of becoming overweight/obese. Extra body weight increases the stress
on joints, particularly the knees, hips and back, which can increase the pain
associated with juvenile arthritis. (Note: there is no evidence that foods, toxins,
allergies or vitamin deficiencies are a cause of juvenile arthritis.)
9.8 Determinants that act as risk and/or protective factors for juvenile arthritis
Unit 2
AOS 2
Topic 5
Risk factors
Concept summary
and practice
questions
Concept 1
Access to recreation facilities: if recreation facilities such as walking paths and

swimming pools are not accessible, children with juvenile arthritis may not get
the required amount of physical movement necessary to maintain joint mobility.
Housing environment: ensuring safety in the home is important for reducing the
risk of injury for children with juvenile arthritis due to their inability to move
quickly and lack of balance as a result of inflamed joints.
Social determinants
Unit 2
AOS 2
Topic 5
Concept 2
Protective
factors
Concept summary
and practice
questions
Access to health care: in order to promote the health of children with juvenile
arthritis, it is important that they are able to access the relevant health care.
As there are different types of juvenile arthritis, the type of treatment will
vary according to individual circumstances. Children may require therapy to
strengthen muscles and keep the joints flexible in order to promote normal limb
development. Medications to control inflammation and prevent long-term joint
damage are also important for treating children with juvenile arthritis.
Parental education: being able to effectively manage and treat juvenile arthritis is
dependent on the parents/carers having the required knowledge to ensure that
the relevant courses of treatment/therapy are being followed.
TEST your knowledge
1 Explain juvenile arthritis.

2 What are the symptoms of juvenile arthritis?
3 What causes juvenile arthritis?
4 Outline the impact that juvenile arthritis has on
children.

parents about caring for children with juvenile
arthritis.
6 Use the Juvenile arthritis links in the Resources
section of your eBookPLUS to find the weblink and
9.9
eterminants that act as risk and/or protective

D
factors in relation to type 1 diabetes
KEY CONCEPT Determinants that act as risk and/or protective factors

in relation to type 1 diabetes
Type 1 diabetes is an autoimmune condition where the immune system attacks the
cells in the pancreas that are responsible for producing insulin. Insulin is required
for the bodys cells to convert glucose into energy. Without insulin, the glucose
remains in the bloodstream rather than being used by the cells to create energy.
In order to provide the energy that is required, the body burns other sources of
fuel such as stored fats. The burning of fat in the body results in the release of
by-products called ketones. When ketones are released in large amounts it can lead
to a potentially life-threatening condition called ketoacidosis.
The symptoms of type 1 diabetes include:
extreme thirst
frequent urination
weight loss
tiredness/fatigue
blurred vision
irritated skin, particularly around the genitals
nausea and vomiting.
It is important to monitor the blood glucose levels of children with type 1 diabetes
via a blood glucose monitor. This requires testing a very small amount of blood from
a pin prick on the finger. Affected children require up to four insulin injections every
day. Insulin can be administered via a syringe or an insulin pump which is carried
on the body and regularly administers insulin into the bloodstream. Children with
type 1 diabetes have to ensure they eat a well-balanced diet so blood glucose levels
remain stable. There is no cure for type 1 diabetes. It is a serious condition that
needs ongoing management to control and reduce the risk of complications.
Why is type 1 diabetes a health

issue for children?
Australia is ranked seventh in the world for prevalence of type 1 diabetes in children
aged 0 to 14 years of age and sixth for incidence. In 2008, more than 5700 children
had type1 diabetes in Australia. In 2011 there were 983 new cases of type1 diabetes
among children aged 014, representing 23per 100000 young people.
Figure 9.46 Monitoring blood

glucose levels is important in
managing type 1 diabetes in children.
9.9 Determinants that act as risk and/or protective factors in relation to type 1 diabetes
Children have a higher incidence rate of type 1 diabetes when compared to
other age groups, with the peak age of diagnosis occurring at 1014 (figure9.47).
Boys appear to have a slightly higher incidence than girls.
Unit 2
AOS 2
Topic 5
Risk factors
Concept summary
and practice
questions
Concept 1
25
20
15
10
5
10
1
4
15
-1
9
20
-2
4
25
-2
9
30
3
4
35
3
9
40
4
4
45
4
9
50
5
4
55
5
9
60
-6
4
65
6
9
70
7
4
75
7
9
80
8
4
85
+
4
59
Source: AIHW 2014, Incidence of insulin-treated

diabetes in Australia 20002011, cat. no. CVD 66,
Canberra.
Males
Females
30
Figure 9.47 Incidence rate of type1

diabetes, by age at first insulin use
and sex, 200009
Number per 100 000 population
35
Age at diagnosis (years)

type 1 diabetes
Biological
Genetic predisposition: children with type 1 diabetes in the family are more
likely to develop type 1 diabetes.
Age: the incidence of type 1 diabetes decreases with increasing age.
Unit 2
AOS 2
Topic 5
Concept 2
Protective
factors
Concept summary
and practice
questions
Although behavioural determinants do not increase the risk of type 1 diabetes, they
do impact on the management of the condition in the following ways:
Monitoring of blood glucose levels: in order to manage the condition, blood
glucose levels must be monitored to ensure they remain within the required
levels to maintain health.
Eating habits: to maintain stable blood glucose levels, children with type 1
diabetes must consume a well-balanced diet and eat regular meals. Meals should
be low in fat, particularly saturated fats, and based on high fibre carbohydrate
foods such as wholegrain breads and cereals, lentils, beans, vegetables and fruits.
Regularly taking insulin: insulin is the only way in which blood glucose levels
can be controlled in children with type 1 diabetes.
Physical activity: regular exercise is an important part of the management of
type 1 diabetes. It assists the insulin in working more efficiently and assists with
blood glucose control. Regular physical activity also maintains body weight.
Access to recreational facilities: regular physical activity is important for
controlling the blood glucose levels of children with type 1 diabetes. Having
access to facilities within the community that enable children to engage in
regular physical activity assists in ensuring that children with type 1 diabetes
undertake the required amount of physical activity.
Social
Access to health care: the effective management of type 1 diabetes requires
regular visits to health care facilities such as the local medical centre. If blood
glucose levels drop too low, a child is at risk of hypoglycaemia. Medical
treatment must be sought immediately, as the child may become unconscious
and begin convulsing. High blood glucose levels can result in hyperglycaemia.
The symptoms of hyperglycaemia include extreme thirst, frequent urination,
blurred vision, tiredness, infections and weight loss. In this situation, the child
must visit their doctor in order to assess their treatment and management plan.
Parental education: for children to effectively manage their type 1 diabetes, they
must have guidance from their parents/carers. Younger children may not understand
the importance of controlling blood glucose levels so it is important that the parents/
carers fully understand how to check blood glucose levels, the management of
type1 diabetes and the signs and symptoms of hypoglycaemia and hyperglycaemia.
Parenting practices: it is important for children to learn how to manage their
type 1 diabetes, including regularly checking their blood glucose, eating a wellbalanced diet and the importance of exercise. This is particularly important
as children become more independent and do not always have their parents/
carers with them. Parents/carers play a key role in teaching their children about
managing their type 1 diabetes.
Figure 9.48 Regular physical

activity can assist in managing type 1
diabetes.
TEST your knowledge
1 Describe type 1 diabetes.

2 What are the symptoms of type 1 diabetes?
3 Explain why type 1 diabetes is a health issue for
children.
4 What is the difference between hyperglycaemia and
hypoglycaemia?
5 Explain how physical activity can assist in the
management of type 1 diabetes.
6 Explain the determinants that are important in

assisting children in managing their type 1 diabetes.
7 Develop an information brochure for parents
that explains the steps required for the effective
management of type 1 diabetes.
8 Use the Type 1 diabetes links in the Resources
section of your eBookPLUS to find the weblink
9 Use the Type 1 diabetes study links in the
Resources section of your eBookPLUS to find
9.10
overnment strategies and programs

G
designed to promote the health and individual
human development of children
KEY CONCEPT Understanding government strategies and programs

children
A range of government, community and personal strategies and programs have
been designed to promote the health and individual human development of
As many of the conditions/diseases that impact on children are not preventable,
the strategies and programs focus on treating and managing the condition/disease.
In the case of preventable health concerns such as falls and injuries, the strategies
and programs focus on ways in which the health issue can be prevented. Ultimately,
the focus is on enabling children to live long and healthy lives. Understanding
the programs and strategies that focus on children can assist parents/carers in
maximising the health and individual human development of their children.
Government strategies and

programs
The three levels of government in Australia, federal, state and local, all play a role
in promoting the health and individual human development of children. In this
section, examples of the strategies implemented by each level of government will
be explored.
Federal government
The Federal government implements a range of strategies and programs for children
including Australias Physical Activity and Sedentary Behaviour Guidelines, the
Dietary Guidelines for Australians, National Diabetes Services Scheme, Asthma
Child and Adolescent Program, and National Immunisation Program.
Figure 9.49 Daily physical activity is important for the health and individual human
Australias Physical Activity and Sedentary

Behaviour Guidelines
There are five sets of guidelines as part of Australias Physical Activity and Sedentary
Behaviour Guidelines. The following two focus on children:
National Physical Activity Recommendations for Children 05 years Move
and play every day
Australias Physical Activity and Sedentary Behaviour Guidelines for Children
512 years.
The Guidelines recommend the amount of physical activity required daily
to promote health and individual human development of children while also
highlighting the importance of limiting the amount of time during which children
from 5 to 12 years of age are sedentary.
The benefits of daily physical activity for children include the following:
assists in achieving and maintaining a healthy weight
builds strong bones and muscles
improves balance, motor control and coordination
promotes the development of social skills
supports brain development
promotes self-confidence and independence.
As discussed earlier, regular physical activity is very important for children who
have type 1 diabetes or juvenile arthritis.
Figure 9.50 Long periods of sedentary behaviour can have a negative impact on the health and individual human
9.10 G
overnment strategies and programs designed to promote the health and individual human
development of children
Table 9.11 provides a summary of the physical activity recommendations for
children aged 05 and aged 512.
TABLE 9.11 Australias physical activity and sedentary behaviour guidelines for children aged
05 and aged 512
Recommendations for children aged 05
Move and play every day
Birth 1 year
For healthy development in infants, physical
activity particularly supervised floor-based
play in safe environments should be
encouraged from birth.
Toddlers (13 years) and preschoolers
(35years)
Should be physically active for at least three
hours, spread throughout the day
Children aged 25 years
Sitting and watching television and the use of
other electronic media (DVDs, computer and
other electronic games) should be limited to
less than one hour per day.
Children aged less than 2 years
Should not spend any time watching television
or using other electronic media (DVDs,
computer and other electronic games)
Recommendations for children aged 512

Physical activity
Children aged 512 years should accumulate
at least 60minutes of moderate to vigorous
intensity physical activity every day, which should
include a variety of aerobic activities and some
vigorous intensity activities.
On at least three days per week, children should
engage in activities that strengthen muscle and
bone.
Sedentary behaviour
Should minimise the time they spend being
sedentary every day by restricting the use of
electronic media for entertainment to no more
than two hours per day.
Break up long periods of sitting with periods of
physical activity.
Children from birth to 5 years

Infants, toddlers and preschoolers should not
be sedentary, restrained, or kept inactive,
for more than one hour at a time, with the
exception of sleeping.
Source: Adapted from Australian Department of Health, Australias physical activity and sedentary behaviour
guidelines, www.health.gov.au.
The National Diabetes Services Scheme (NDSS)

The National Diabetes Services Scheme (NDSS) is an initiative of the federal
government administered by Diabetes Australia Ltd. Through federal government
funding, Diabetes Australia is able to provide over one million Australians diagnosed
with diabetes, including children with type 1
diabetes, with practical assistance, information and
subsidised products through the NDSS.
This includes testing strips for checking blood
glucose levels, free insulin syringes and insulin
pump consumables (or supplies).
The federal government also funds the Type 1
Diabetes Insulin Pump Program which subsidises
up to 80 per cent of the price of a clinically
recommended insulin pump for children under
the age of 18 years with type 1 diabetes. An insulin
pump is a small computerised device that provides
a continuous amount of insulin to the individual
throughout the day or can be used to provide a
greater amount of insulin at particular times of the
day, such as during meal times. The pump is carried
on the individual and a tiny tube is connected to
Figure 9.51 The federal government subsidises up to 80 per cent of
the skin through which the insulin is delivered to
the price of a clinically recommended insulin pump for children under the
the body.
age of 18 years with type 1 diabetes.
Dietary Guidelines For Australians

The Australian Dietary Guidelines were released in 2013 to assist Australians in consuming a healthy diet and reduce the
burden of disease associated with cardiovascular disease, obesity, some cancers and type 2 diabetes.
The guidelines include information relating to the different food groups and the number of serves that should be consumed
from each food group to promote optimal health. Specific advice for children is contained within the guidelines.
The Australian Dietary Guidelines that relate to children are:
Guideline 1:
To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your
energy needs.
Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically
active every day and their growth should be checked regularly.
Guideline 2:
Enjoy a wide variety of nutritious foods from these five food groups every day.
Plenty of vegetables of different types and colours, and legumes/beans
Fruit
Grain (cereal) foods, mostly wholegrain and/or high fibre cereal varieties, such as breads, cereals, rice, pasta, noodles,
Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under two
years of age).
Guideline 3:
Replace high fat foods which contain predominately saturated fats such as butter, cream, cooking margarine, and
coconut and palm oil with foods which contain predominately polyunsaturated and monounsaturated fats such as oils,
spreads, nut butters/pastes and avocado.
Low fat diets are not suitable for children under two years of age.
b. Limit intake of foods and drinks containing added salt.
Read labels to choose lower sodium options among similar foods.
c. Limit intake of foods and drinks containing added sugars such as confectionery, sugar-sweetened soft drinks and cordials,
fruit drinks, vitamin waters, and energy and sports drinks.
Guideline 4:
Encourage, support and promote breastfeeding.
Guideline 5:
Care for your food; prepare and store it safely.
Advice is also offered regarding the intake of discretionary foods.
These are foods that are not a necessary or essential part of a childs
dietary intake. These foods are high in kilojoules, saturated fat,
sugars, salt or alcohol. Examples include cakes, biscuits, potato chips,
processed meats and sausages, meat pies and other pastries and
sugar-sweetened cordials, soft drinks and sports drinks.
It is also important to remember that children under the age of
three years are at an increased risk of choking on hard foods. Adults
should sit with young children whilst they eat and they should not be
given food such as popcorn, nuts, hard confectionery or potato chips.
Hard fruit and vegetables should be grated or cooked to make them
easier for the child to consume and all bones should be carefully
removed from meat and fish to prevent choking.
Figure 9.52 It is important for children to eat

sufficient nutritious food to grow and develop
normally.
Source: National Health and Medical Research Council, Healthy Eating for Children Poster.
9.10 G
Asthma Child and Adolescent Program

The Asthma Child and Adolescent Program (ACAP) isa nationally funded program
by the Commonwealth Department of Health. This program provides school and
preschool staff, parents and carers with access to free information regarding the
management of asthma in an education setting. Through this program, free one
hour asthma education sessions are made available to school and childrens services
staff throughout Victoria. Free asthma management information sessions are also
made available to school students, parents and carers.
National Immunisation Program

The federal government provides funding for the Immunise Australia Program
which implements the National Immunisation Program. This program currently
includes vaccines against 16 diseases. The federal government funding enables state
and territory governments to obtain vaccines listed on the National Immunisation
Program. Funds are also provided for Medicare Australia to implement the
Australian Childhood Immunisation Register which keeps a record of the
immunisation history of Australian children and adolescents.
State and territory government

State and territory governments create laws/legislation that assist in promoting
the health and individual human development of children. Health promotion
campaigns and programs are also developed and implemented by state and territory
governments which play an important role in promoting the health and individual
human development of children. In Victoria, examples include Child Protection
Services, Family Services, and the Maternal and Child Health Service.
Legislation
State and territory governments implement laws/legislation that aim to promote the
health and individual human development of children. Examples of these include:
Child protection: mandatory reporting legislation requires professionals such as
doctors, nurses, police and school teachers to report suspected child abuse.
Driving: laws relating to speed limits, speed cameras, seatbelts, probationary
drivers, drink driving laws and car safety standards are designed to protect all
people, including children. By law, the driver of a vehicle is responsible for
ensuring that all passengers are restrained correctly. The road rules in Victoria
require that a child aged:
under 6 months of age must travel in a rearward facing child restraint
6 months to under 4 years must travel in either a rearward facing or forward
facing child restraint
4 years to under 7 years must travel in a forward facing approved child
restraint with an inbuilt harness or a booster seat
7 years to under 16 years must travel in either a booster seat or an adult
seatbelt (VicRoads).
Smoking: laws prevent adults from smoking in motor vehicles with children
under the age of 18 years. It is illegal to sell or supply cigarettes to children
under the age of 18 years.
Figure 9.53 The driver of a motor
vehicle is legally responsible for
ensuring that children are restrained
correctly.
Victorian Child Protection Service

The Department of Human Services Victoria is a state government department that
provides a range of services designed to promote the health and individual human
development of children, families and young people. One of these services is the
Victorian Child Protection Service, which assists in ensuring the safety of children.
When adults caring for children do not provide the appropriate level of care or are
abusive towards the children, the child protection system takes action. The main
functions of the Victorian Child Protection Service are to:
investigate matters where it is alleged that a child is at risk of harm
refer children and families to services that assist in providing the ongoing safety
and wellbeing of children
take matters before the Childrens Court if the childs safety cannot be ensured
within the family
supervise children on legal orders granted by the Childrens Court
provide and fund accommodation services, specialist support services, and
adoption and permanent care to children and adolescents in need.
Family Services
Family Services is another important area within the Department of Human
Services Victoria that provides a range of services to assist families in caring for
their children, thereby promoting health and individual human development.
Family Services provides family and early parenting support to assist families
in developing an action plan in caring for the children. Early parenting services
support parents from pregnancy until the child is four years old. Specialist support,
counselling and advice services are available which may include education and
skills development programs. Services offered by Family Services include:
early parenting centres: provide experienced parenting support
day stay services: provide an intensive day program to support parents in the
early parenting phase
residential services: provide a centre-based intensive parenting program where
the parents stay at the centre for five days to build parenting skills
home-based services: skilled staff visit the parent/s in the home and work oneon-one with them in parenting skills and education
group services: incorporate group-based programs where the parent/s attends
sessions with other parents and children. These are designed to improve
relationships and interaction between the parents and the child.
Maternal and Child Health Service

The state and territory governments are also responsible for the provision of
maternal and child health Services. In Victoria, these services are the responsibility
of the Department of Education and Training and are often
operated by local councils. The Maternal and Child Health Service
supports families in the provision of parenting and the promotion
of health and individual human development of children. It is
through this service that families are provided with referrals to
other professionals and are linked with other families in the local
community. Parents have regular appointments from birth until
the child reaches school age. All appointments are provided free
of charge.
The Maternal and Child Health Service offers 10 key ages and
stages consultations for the parents and their child, including an
initial home visit and consultations at two, four and eight weeks;
four, eight, 12 and 18 months; and two and 3.5 years of age. At
each consultation, parents are able to discuss any concerns, discuss
their parenting experiences and learn how to improve their childs Figure 9.54 Family Services provide home-based
services that focus on parenting skills and education.
9.10 G
When a baby is born, its parents receive a book called My Health and Development
Record where a record can be kept of the childs health, growth, development and
immunisation. The book allows parents and maternal and child health staff to keep
details of the development of the child at each of the consultations.
Maternal and child health centres are located within local communities, enabling
parents to have easy access to the service.
Local government
Unit 2
AOS 2
Topic 6
Concept 1
Government
programs
Concept summary
and practice
questions
Local governments implement a range of strategies and programs to promote the

health and individual human development of children including:
providing access to recreation facilities such as walking and cycling paths, parks,
gardens and public swimming pools
implementing community health plans that aim to address the needs of the
local community and promote healthy lifestyles by encouraging healthy eating,
exercise and social interaction
the implementation of immunisation programs within the local community as
part of the National Immunisation Program
ensuring that communities have access to facilities and services that provide UV
protection
the provision of long day care which is a centre-based form of child-care service.
Long day care services provide all day or part-time care for children of working
families and the general community. Local councils may run these services. Long
day care services may also provide care for school children before and after
school and during school holidays.
maternal and child health services: locally based maternal and child health nurses
provide parents with support, information and access to professional advice
on a range of health-related concerns from child behaviour and nutrition to
breastfeeding and family planning. The service is jointly funded by the Victorian
government and local councils and is usually operated by local councils.
the provision of playgroups for infants, toddlers and preschoolers and their
parents or caregivers. Adults stay with their children at playgroup, which gives
them the chance to meet other people going through similar experiences while
also learning about the community, health and support services available within
the local community.
TEST your knowledge

1 Briefly explain two programs or strategies developed
by each level of government to promote the health
and individual human development of children in
Australia.

2 (a) Outline the two sets of physical activity and
sedentary behaviour guidelines that are specific
to children.
(b) What are the benefits of daily physical activity to
children?
(c) Why would recommendations also be made
regarding the sedentary behaviour of children?
3 Discuss how each of the dietary guidelines
could promote the health and individual human
4 (a) Outline the National Diabetes Services Scheme

(NDSS).
(b) Explain how the NDSS promotes the health and
5 Select two types of legislation relevant to promoting
children. Conduct research to answer the following:
(a) Who is responsible for enforcing the legislation?
(b) Explain how community members are made
aware of the legislation.
(c) How does the legislation aim to promote the
children?
6 Research your own local government and produce
a fact file/brochure outlining the ways that they
work to promote the health and individual human
9.11
ommunity and personal strategies and

C
programs designed to promote the health and
KEY CONCEPT Understanding community and personal strategies

and programs designed to promote the health and individual human
Community strategies and

programs
Many community strategies and programs designed to promote the health and
individual human development of children are implemented by non-government
organisations. Examples of these programs include the Diabetes Camps Victoria,
Kidsafe and Asthma Friendly Schools.
Diabetes Camps Victoria

Diabetes Camps Victoria (DCV) is a partnership of Diabetes Australia Victoria,
Monash Health and the Royal Childrens Hospital. Each year, DCV runs seven
camps for children aged four to 17 years with type 1 diabetes. The goal of the
camps is for young people to learn how to manage their diabetes in an environment
that is fun, safe and supportive while also promoting a culture of independence
through adventure. The camps promote peer support and positive role modelling
from other children and volunteers with diabetes through providing opportunities
to meet other young people and adults with type 1 diabetes.
Health professionals and volunteers attend the camps to supervise, educate and
provide information to the children in a relaxed setting. Children can increase their
skills and awareness in managing their condition.
Figure 9.55 Diabetes Camps Victoria provide opportunities for children with type 1
diabetes to connect with others with the condition.
9.11 Community and personal strategies and programs designed to promote the health and
Kidsafe
Figure 9.56 Kidsafe aims to prevent child deaths and

reduce the severity of unintentional injuries.
Kidsafe is a non-government, not-for-profit organisation

that aims to prevent child deaths from unintentional injury
and reduce the severity of injuries in children aged less than
15 years. Kidsafes mission is To make a safer world for
kids by leading the promotion of action to highlight and to
minimise the unacceptable level of risk and consequence of
injury to children in our adult-focused world.
Kidsafe takes responsibility for disseminating information
regarding ways in which to promote the safety of children.
Parents can download a range of information from the
Kidsafe website such as Safe sleeping for infants, A parents
guide to Kidsafe homes and A parents guide to Kidsafe
roads.
Kidsafe, along with Neuroscience Research Australia,
developed the National Guidelines for the Safe Restraint of
Children Travelling in Motor Vehicles which provide best
practice recommendations for keeping children safe when
travelling in motor vehicles.
Asthma Friendly Schools Program

Unit 2
AOS 2
Topic 6
Concept 2
Community
programs
Concept summary
and practice
questions
The Asthma Friendly Schools Program was developed by the Asthma Foundation
Victoria in 2001. The strategy aims to develop safe, healthy and inclusive school
environments for students with asthma. Asthma Friendly Schools adopts the
strategies designed to support the whole school community in understanding and
managing asthma.
To be recognised as an Asthma Friendly School, a school must meet the following
criteria:
1. The school has developed an asthma policy based on the recommendations and
advice provided by the Department of Education and Training.
2. At least 75 per cent of school staff have completed a minimum one hour asthma
training session provided by the Asthma Foundation of Victoria.
3. The school has a minimum of two asthma emergency kits that contain reliever
medication, two spacers, a record sheet and instructions for use.
4. Asthma action plans for each student with asthma are kept in a central location
and asthma first aid incidents are recorded, reviewed and reported to the
students parents/carers.
5. Asthma first aid posters are displayed around the school and asthma information
is included in the curriculum and is made available to parents.
6. Parents/carers are contacted when a student experiences asthma symptoms, uses
their asthma medication or has an asthma incident at school.
7. Students are encouraged to have prompt and easy access to their asthma
medication in order to self-manage their symptoms at school and on excursions.
8. Safe medication practices are implemented such as asthma medicine being
clearly labelled and stored in a cool location that is easily accessible.
9. Measures are taken to minimise the impact of potential asthma triggers such
as mowing outside of school hours, and ensuring that carpets, curtains and
airconditioning vents are cleaned regularly to minimise dust.
Personal strategies
Many of the personal strategies that can promote the health and individual human
development of children require both parents/carers and children to be aware of
the determinants that can have an impact.

Examples of personal strategies for children in
Australia include:
Physical activity: regular exercise assists in
maintaining healthy body weight, which
can reduce the risk of obesity. This reduces
the impact on joints, which can assist in
the management of juvenile arthritis.
Eating habits: by consuming a healthy food
intake, children receive the nutrients they
need for maintaining a healthy immune
system and promoting growth. For children
with type 1 diabetes, a well-balanced
diet assists with the management of their
condition.
Accessing health care: taking children
for regular health checks ensures that
their health can be monitored and any
health concerns can be addressed early.
Regular visits to the doctor are important Figure 9.57 One of the criteria
for being an Asthma Friendly School
for assisting children with managing is that children are encouraged to
conditions such as type 1 diabetes and have easy access to their asthma
medication.
juvenile arthritis.
Not smoking: tobacco smoke is a trigger
for asthma symptoms. By not smoking and ensuring exposure to environmental
tobacco smoke is reduced, the risk of having an asthma attack is reduced.
Maintaining a safe housing environment: eliminating hazards in the home by
clearing walkways, having secure locks on cupboards, storing chemicals and
cleaning products out of the reach of children, and having fencing around pools are
examples of ways in which the risk of injury and death can be reduced for children.
Improving education: by accessing information relating to conditions such as
juvenile arthritis, type 1 diabetes and asthma, parents and carers of children may
be better informed regarding ways to promote the health and individual human
TEST your knowledge

1 (a) Briefly explain the Diabetes Camps Victoria
program.
(b) Identify the determinant/s of health targeted by
this program.
2 (a) Briefly explain the role of Kidsafe.
Kidsafe.

3 Use the Kidsafe battery controlled links in the
weblink and questions for
this activity.
Unit 2
AOS 2
Topic 6
Concept 3
Personal
strategies
childhood
Concept summary
and practice
questions
4 Discuss how the Asthma Friendly Schools program

could promote the health of children in Australia.
5 Discuss the personal strategies that could be
employed to address one of the following conditions
that may impact on children:
(a) type 1 diabetes
(b) juvenile arthritis
(c) asthma
(d) falls and injuries
(e) food allergies.
6 Create a multimedia presentation that aims to
educate parents, carers and children about personal
strategies that can be used to promote the health

human development of Australias children
individual human development and their impact on
children, using relevant examples
In order to demonstrate this skill, a thorough understanding of the determinants
of health and individual human development and how they relate to children is
essential. The ability to use relevant examples to demonstrate this understanding
is expected. When outlining the determinants of health and individual human
development, it is important to remember the following:
There are many factors that affect the health and individual human development
of children and they are categorised as biological, behavioural, physical
environment and social.
It is important to select one factor from each category of determinant, be able to
describe what it is and how it impacts childrens health and all types of individual
human development.
Where possible, use relevant statistics to outline the impact that the selected
determinant has on the health and individual human development of children.
Consider the following article, which discusses a physical environment

determinant of health and individual human development: tobacco smoke in
the home.
Passive smoke: Kids health at risk
Highlights exposure to tobacco
smoke as an important determinant

of health and individual human
Information regarding the possible

impact of passive smoking on the
health of children
Recognition of the importance of

preventing exposure to passive
smoking
Karyn and Richard Shine wish to make a personal plea to Aussie parents who smoke.
Please dont smoke near your kids. Its not fair. You have taken up the habit, but
your children havent.
If you light up near them, they breathe the smoke as well. Youre putting their
health at risk because you choose to do something unhealthy even deadly.
Before you think Karyn and Richard must be staunch anti-smokers lecturing about
their nicotine-free lives, read on
Karyn, 39, and Richard, 33, from Glenmore Park at the foot of the Blue
Mountains in New South Wales, are both smokers. Richard began smoking
when he joined the RAAF at 18. Karyn started at 13 and has lost count of the
number of times she has tried to quit unsuccessfully even through her three
pregnancies.
I tried to stop while I was pregnant, but I just couldnt quit though I did cut
right back to only a couple a day, she explains.
Our two boys have infantile asthma, and Ill always wonder whether that was
caused by me smoking while pregnant. I know loads of non-smoking parents have
asthmatic kids but at least they know they couldnt have caused it. I will never
know for sure.
Their children Alec, three, Ronan, two, and Hayley, one are the couples pride
and joy, and thats why the Shines have made a solemn promise. They wont let their
smoke go anywhere near the kids.
Our entire house and car are smoke-free zones, Karyn explains. As soon as Alec
was born, we made this rule. Why should he have to put up with something he didnt
choose? Even when outside, we dont smoke near the kids.
Its such an invasive habit. Although youre doing it, the smoke drifts. People
who dont want to smoke shouldnt have to breathe it because someone
else does.
The Shine family has agreed to speak out to promote the Car and Home: Smoke
Free Zone campaign, a joint initiative of NSW Health, the Cancer Council NSW, the
National Heart Foundation (NSW), Asthma NSW and SIDS NSW.
People need to know how dangerous it is to smoke around their kids, Karyn says.
Passive smoking is dangerous.
344
Its bad enough that I might be digging my own grave, but we dont want to be
digging our childrens graves as well.
Recognition of the possible impact of

passive smoking on premature death
THE RISKS OF PASSIVE SMOKING:
There are 4000 chemicals in passive smoke, including carbon monoxide, ammonia,
cadmium, arsenic, butane, acetone, DDT and hydrogen cyanide.
The National Drug Strategy Network survey estimates that between 1998 and
1999, 224 Australians died as a direct result of passive smoking. Of these, 103
were under the age of 15.
Approximately 16 320 cases of lower respiratory illness are diagnosed in Australia
each year among children aged 18 months or less.
Information regarding the harmful

chemicals in tobacco smoke that can
affect children
Outlines the impact on children of

passive smoking, which often occurs
in the home of smoking parents
Statistical data that highlight the

impact of passive smoking on infants
Source: Womans Day, 15 June 2010. ninemsn Pty Ltd.
Consider the following information on a biological determinant of health and

individual human development: low birth weight.
Infants who are born with low birth weight are at greater risk of poor health,
disability and death than other infants.
In 2012, 6.2 per cent of live born infants in Australia were of low birth weight
(weighing less than 2500 grams). This proportion was twice as high among babies
of Indigenous mothers.
1 per cent weighed less than 1500 grams (very low birth weight, including
extremely low birth weight).
5.2 per cent weighed between 1500 and 2499 grams.
Source: AIHW, Australias mothers and babies 2012, cat. no. PER 69, Canberra, p. 74.
Very low 1% (<1500 grams)

and extremely low (<1000 grams)
Low
6.2%
5.2% (15002499 grams)
Normal
93.8%
FIGUrE 9.58 Proportion of infants by birth weight category, 2012

Source: AIHW, Australias mothers and babies 2012, cat. no. PER 69, Canberra, p. 74.
PrACTISE the key skills

1 Referring to figure 9.58, outline the percentage of infants born with normal birth
weight, low birth weight and very low birth weight.
2 What are the weight classifications for normal birth weight, low birth weight and
very low birth weight?
3 Explain the possible impact of low birth weight and very low birth weight on the
health and individual human development of infants/children.
4 Many of the risk factors for low birth weight babies can be reduced by appropriate
interventions. Outline the advice that could be provided to a first-time mother to
increase the likelihood of an infant being born normal birth weight.
The determinants of health and individual human development ofAustralias children CHAPTEr 9
345
KEY SKILLS The determinants of health and individual human development of Australias children

Australias children and draw informed conclusions
about personal, community and government
strategies and programs to optimise child health and
development
The issue is identified and key aspects

of it described.
The reasons for falls and injuries
being considered a health issue are

discussed.
Outlines the determinants that act as

risk and protective factors.
The first part of this key skill is to develop an understanding of one health issue
facing Australias children. In order to be able to adequately describe the issue, a
number of aspects about it should be known, including:
the name of the issue
what the issue actually is
why it is considered a health issue for children
the biological, behavioural, physical environment and social determinants that
act as risk and/or protective factors for the selected issue.
A summary table can be useful in collating this information.
In the following example, falls and injuries as a health issue impacting on
children is described:
Unintentional child injuries are a major public health issue in Australia. Most
can be prevented. Preventable injuries are higher amongst children compared with
other age groups (ABS 2007).
In 201112, 21019 children 04 years of age were admitted to hospital for
injury across Australia. This was second only to admissions to hospital for
respiratory conditions. Hospital isolation rates were higher for boys than girls.
Hospitalisation rates for falls and poisonings were higher for children living in
rural and remote communities, compared to children living in metropolitan areas
(1.5 times greater for falls and 1.9 times greater for poisoning) (AIHW 2014).
Children are at risk of injuries due to a combination of determinants.
Biological body proportion: due to the cephalocaudal principle of
development, a childs head is large in relation to their body. This contributes to a
higher centre of gravity and can increase the risk of falls.
Behavioural some activities have a greater risk of injury than others. For
example, bike riding is a much riskier activity than going for a walk. The types of
activities a child engages in will impact on their risk of injury.
Physical environment the type of physical environment a child lives and plays
in has a significant impact on their risk of falls and injuries. Checking a house for
hazards will greatly reduce the risk of falls and injuries.
Social the activities that a childs friends engages in greatly influences the
types of activities the child will be involved in. If a childs peer group tends to
engage in risk-taking behaviour that increases the risk of falls and injuries, then the
child is more likely to also engage in this type of behaviour.
The second part of this key skill is the ability to draw informed conclusions
about personal, community and government strategies and programs that are
implemented to optimise child health and individual human development.
In order to be able to draw conclusions about the program or strategy, a number
of aspects relating to it must be known, including:
the name of the strategy or program
whether the program is implemented at a government, community or individual
level
the aims of the program
the aspects of health and/or individual human development being addressed
the determinants of health and development that are the focus of the strategy or
program
the advantages and/or disadvantages of the strategy or program

the actual or perceived effectiveness of the program.
In the following example, Kidsafe home safety information sessions are discussed
and conclusions about the effectiveness of Kidsafe are drawn.
Kidsafe Victoria collaborates with other organisations to provide injury
prevention programs, media campaigns and educational resources. One of the
programs that Kidsafe offers is the home safety information session. These sessions
are presented to a wide range of groups including early childhood centres,
community organisations and parent groups. The sessions aim to provide
attendees with information regarding injury prevention in the home and to
encourage people to implement prevention strategies in community organisations
and homes.
Sessions contain information on common child injury topics such as:
burns and scalds
drownings and near drowning
falls
cuts and jamming fingers
poisonings
choking and suffocation
dog bites and pet safety
road safety.
Through educating parents, the safety of children can be promoted and
preventative strategies are more likely to be implemented to reduce child injuries
and fatalities. Children who are healthy and not suffering from injury are able to
participate fully in activities, including schooling and sporting activities. Engaging
in sporting activities will increase a childs physical fitness (physical health) while
also enhancing motor skill development (physical development). It is through
engaging with other children that social health will improve as skills such as
communication can be further developed (social development). Being able to fully
participate with friends will also have a positive impact on a childs self-esteem,
thereby promoting mental health. A child with positive self-esteem is more likely to
engage fully in school, which will promote the development of intellectual skills.
Since Kidsafes establishment in 1979, the number of children in Australia killed
by unintentional injury has been halved. This has been achieved through a range of
strategies including injury prevention programs, media campaigns and educational
resources which have led to increased awareness of child safety issues and injury
prevention throughout the community.
The program is named and the type
of program is identified. In this case,

it is a community program.
The aim of the program is stated.
An explanation of how the program

works is provided.
The program is linked to various
aspects of health and individual

Conclusions about the programs

effectiveness are drawn.

5 Describe a key health issue other than injuries facing children in Australia. In your
answer, make sure you include:
(a) the name of the health issue
(b) what the health issue actually is
(c) why it is considered a health issue for children (include relevant statistical
information)
(d) the biological, behavioural, physical environment and social determinants that
act as risk and/or protective factors for the selected health issue.
6 Explain a program or strategy implemented by a government and explain how it
may impact on the health and/or individual human development of children.
7 Identify personal strategies that may reduce the risk of one health issue facing
8 For a community strategy, discuss the likely effectiveness in promoting child health
and/or individual human development.
KEY SKILLS The determinants of health and individual human development of Australias children

9 Francesca is 15 years of age and lives with her mother, father and two younger
brothers. Her father works full time while her mother stays at home to look after the
children and complete household chores. Francescas father is extremely strict with the
children and does not allow them to have their friends over to the house. The children
have a very strict routine of homework and daily chores, and are not allowed to attend
social gatherings at friends houses. The children are quite frightened of their father
and have learnt not to question his instructions or decisions. If the children disobey him,
they might be smacked or sent to their room for an indefinite amount of time.
(a) What type of parenting style is being exhibited by the father?
1 mark
(b) What impact could this parenting style have on the individual human development
of the children?
8 marks
CHAPTER 9 review
Chapter summary
The childhood stage of the lifespan is when the foundations for later health and
individual human development are established.
The determinants of health and individual human development include: biological
factors, health behaviours, physical environment and social.
Some determinants have a positive effect (protective factors) and some have a negative
effect (risk factors) on health and individual human development.
The determinants of health and individual human development can be multicausal.
Interactivities:
Chapter 9 Crossword
Biological factors refer to those genetic and physiological factors that impact on health
Biological factors do not act in isolation, and are affected by environmental factors and
health behaviours.
The genes that an individual inherits from their biological parents have a significant
impact on health and individual human development.
Genes are the blueprint of the body because they control growth, development and
how the body functions.
Unit 2
AOS 2
Hormones regulate growth and physical development during childhood.

Some childhood conditions occur as a result of genetic predisposition (e.g. asthma and
type 1 diabetes).
The determinants
of health and
individual human
development of
Australias
children
Sit Topic test
Babies are considered to be low birth weight if they weigh less than 2500 grams at
birth. Low birth-weight babies can be further classified into very low birth weight if
they weigh between 10001500 grams and extremely low birth weight if they are
below 1000 grams.
Babies that are born very low birth weight or extremely low birth weight are at greater
risk of premature death and a range of conditions and developmental problems.
BMI-for-age and gender percentile charts are used for assessing the relative body
weight of children.
Overweight and obesity can be caused by a genetically low metabolic rate.
The lifestyles of children and the decisions they make in terms of health are largely
dependent on the lifestyles of the parents and the knowledge, attitudes and beliefs
that they pass on to their children.
Eating habits and physical activity patterns of children are largely determined by the
parents.
It is recommended that children participate in 60 minutes of moderate to vigorous
exercise per day.
Tobacco smoke in the home is particularly dangerous for children because their lungs
are still developing.
Breastmilk contains all of the nutrients required by the infant for at least the first six
months of life, and the colostrum that the baby receives in the first few days following
birth contains antibodies required to resist infection.
Infant formula contains the required nutrients for the developing baby, but it does not
contain antibodies.
Vaccines contain either a weakened or dead micro-organism of a particular disease so
that the body will develop antibodies against that disease.
Vaccinating from an early age helps protect children from a range of illnesses, some of
which may be life threatening.
Dental decay is the most common disease that affects teeth.
The first stage of gum disease is gingivitis and the later stage is periodontitis.
Oral hygiene during early childhood is vital for ensuring health of the teeth and gums
and teaches children the daily routines required to maintain optimal dental health.
CHAPTER 9 review
The physical environment refers to the surroundings in which one lives and the
accessibility of resources such as food and water. It also refers to conditions in which an
individual lives that impact on health and individual human development.
Families that are required to live in substandard or overcrowded dwellings are at greater
risk of poor health.
Fluoridation of water involves the addition of fluoride to a public water supply to
reduce tooth decay in the population.
Fluoride can help repair the damage to teeth before it progresses and becomes
permanent.
Recreational facilities that are easily accessible for families with children greatly increase
the likelihood of regular physical activity. Undertaking regular physical activity has
enormous benefits for the health and individual human development of children.
Social determinants include factors such as parental education, parenting practices,
media and access to health care.
Education provides opportunities for better employment and higher income, which
enable individuals to have a healthier lifestyle through greater access to healthpromoting resources such as nutritious foods and health care.
Parenting practices refer to the way in which the parents or carers interact with their
child and the way in which they model behaviour.
There are four main parenting styles: authoritarian, authoritative, permissive and
uninvolved.
Violence and alcohol and drug misuse within the family can have detrimental effects on
the developing child.
As a result of the media, children are exposed to messages and information that may
impact positively or negatively on their health and individual human development.
Maternal and child health services support families in caring for their child.
Through the provision of easily accessible health care services, parents are able to
monitor growth, check the health status of their child and treat illnesses/conditions in
their earliest stage to maximise recovery and health.
The Primary School Nursing Program is a free universal health care service offered to all
Victorian Primary and English Language Centre schools.
A range of health issues affect children, including asthma, falls and injuries, food
allergies, juvenile arthritis and type 1 diabetes. The biological, behavioural, physical
environment and social determinants all play a role in these issues.
Asthma is a common inflammatory condition of the airways resulting in wheezing,
breathlessness and tightness of the chest.
Asthma is one of the most common causes of hospital admissions and visits to medical
centres for children. It is the most frequently reported long-term chronic condition, with
approximately 10 per cent of Australian children aged 014 having asthma.
Determinants that impact on asthma include:
biological: genetics, obesity, sex, respiratory infections
behavioural: dietary intake, physical activity, breastfeeding
physical environment: tobacco smoke in the home, air pollution, exposure to
allergens
social: education, socioeconomic status.
Falling is the most common cause of injury for children of all ages.
Severe burns can result in the death of a child as their skin is thinner than the skin of
an adult.
Falls and injuries are a health issue for children as unintentional falls are the most
common cause of injury hospitalisations for children aged 04, accounting for
42percent of the total for injury hospitalisations, followed by smoke, fire, heat and
hot substances (8 per cent) and poisoning by drugs (6 per cent).
350
In the 514 age group, falls were the most common cause of injury requiring
hospitalisation (46 per cent), followed by transport accidents (16 per cent).
Determinants that impact on falls and injuries in children include:
biological: body proportions, height, having thinner skin than adults, smaller body size
behavioural: physical activity, risk-taking behaviour
physical environment: access to recreational facilities, housing environment
social: lack of knowledge leading to risk-taking behaviour, natural inquisitiveness,
peer pressure, lack of supervision.
Food allergies are an adverse immune response to a food that has been consumed by
an individual.
A serious and potentially life threatening allergic reaction is known as anaphylaxis.
Children can be allergic to a wide range of foods but the eight most common foods
that cause allergic reactions are: milk, eggs, peanuts, soy, wheat, tree nuts (such as
walnuts and cashews), fish and shellfish (such as prawns).
Food allergies occur in approximately 1 in 20 children. Over the past decade, hospital
admissions as a result of anaphylaxis have doubled in Australia.
Food allergies and their management have been linked to a number of determinants,
including:
biological: age, genetic predisposition, sex
behavioural: breastfeeding, early introduction of solid foods, accidental consumption
of foods causing allergic responses
physical environment: availability of food causing allergic responses
social: education, family and access to health care.
Juvenile arthritis is any form of autoimmune or inflammatory condition that can occur
in children under 16 years of age.
Juvenile arthritis affects less than 1 per cent of children under the age of 16 in
Australia.
Research has found genetic factors that increase the susceptibility to juvenile arthritis;
however, research into the impact of environmental factors has been less successful.
Determinants that impact on juvenile arthritis include:
biological: genetics, age, sex
behavioural: regular physical activity, eating habits
physical environment: access to recreation facilities, housing environment
social: access to health care, parental education.
Type 1 diabetes is an autoimmune condition where the immune system attacks the cells
in the pancreas that are responsible for producing insulin.
It is important to monitor the blood glucose levels of children with type 1 diabetes via a
blood glucose monitor.
There is no cure for type 1 diabetes so it is important that it is effectively managed by
treatment, nutrition and exercise.
Australia is ranked seventh in the world for prevalence of type 1 diabetes in children
aged 0 to 14 years of age and sixth for incidence.
The determinants that impact on type 1 diabetes include:
biological: genetic predisposition, age
behavioural: monitoring of blood glucose levels, eating habits, regularly taking
insulin, physical activity
physical environment: access to recreational facilities
social: access to health care, parental education, parenting practices.
Government, community and personal strategies and programs are designed to
promote health and individual human development of children.
CHAPTER 9 review
Government strategies include:
Federal: Australias Physical Activity and Sedentary Behaviour Guidelines, the Dietary
Guidelines for Australians, National Diabetes Services Scheme, Asthma Child and
Adolescent Program and National Immunisation Program.
state/territory: Child Protection Services, Family Services, Maternal and the Child
Health Service.
local: access to recreation facilities, community health plans, immunisation programs,
long day care, facilities and services that provide UV protection, maternal and child
health services, playgroups.
Community strategies include Diabetes Camps Victoria, Kidsafe and Asthma Friendly
Schools.
Personal strategies relate to addressing determinants that are modifiable. These include:
physical activity, dietary behaviours, accessing health care, not smoking, maintaining a
safe house environment and improving education.
TEST your knowledge
1 Outline the following determinants of health

and individual human development in relation to
children and provide an example of each type.
Biological
Behavioural
Social
2 Draw up a table that summarises the major
contributors to burden of disease for children and
the corresponding determinants that act as risk or
protective factors, as well as at least one example of
a government, community and personal strategy that
is implemented to promote health.
3 Develop a brochure/web page to provide advice

to parents on ways to improve their childrens
health and individual human development. In your
brochure/web page, refer to factors associated with
each of the determinants of health and individual
human development.
4 Design a program or strategy that could be
implemented to address a child health issue of your
choice. Make sure you include:
(a) the name of the program
(b) who will implement it (government, community,
individuals)
(c) the aspects of childrens health and/or
development that it is designed to address
(d) which determinants of health it addresses
(e) how it addresses the determinants of health.
352
CHAPTEr 10
The health and individual

human development of
Australias adults
Reaching adulthood the longest stage of the human
lifespan is a significant milestone for an individual.
A number of physiological changes mark the entry and
journey through adulthood, and the level of health is an
important factor. However, it is the social and emotional
development of an individual that shapes the experiences
and progress through this period. Understanding the
complexities of this stage of the lifespan can make the
transition through each stage easier.
KEy KNOWLEDGE
3.1 the different classifications of the stages of adulthood (pages 356,
360, 364)
3.2 characteristics of physical development during adulthood, including
the physiological changes associated with ageing (pages 3567,
3601, 3645)
3.3 the social, emotional and intellectual development associated with
the stages of adulthood and ageing (pages 3579, 3613, 3658)
3.4 the health status of Australias adults, including the similarities and
differences between adult males and females (pages 36976).
KEy SKILLS
describe the stages of adulthood and ageing (pages359, 363,
368, 380)
describe the characteristics of development during adulthood
(pages359, 363, 368, 380)
interpret data on the health status of Australias adults (pages 3768).
FIgUrE 10.1 Three stages of

adulthood: early, middle and late
354

adulthood a stage of the human lifespan that starts
at 19 and ends at death. It can be divided into early,
middle and late adulthood.
early adulthood the period of the lifespan between
19 and 40years of age
emotional development refers to developing the full
range of emotions and learning appropriate ways of
dealing with and expressing these emotions
health status an individuals or a populations overall
health, taking into account various aspects such as life
expectancy, amount of disability and levels of disease
risk factors
intellectual development the processes that occur
within and to the increasing complexity of the brain
in-vitro fertilisation (IVF) is a process by which egg
cells are fertilised by sperm outside the body, in vitro (in
a test tube). IVF is a major treatment in infertility when
other methods of assisted reproductive technology
have failed.
late adulthood the final stage of the lifespan; the
period from 65 years of age until death
middle adulthood the period of the lifespan
between 41 and 64 years of age
physiological changes changes that occur to the
physical and biomedical functions of the human body
social development the increasing complexity of
behaviour patterns used in relationship with other
people (VCAA study design)
spouse a partner in marriage, a husband or a wife
10.1
Early adulthood: physical, social, emotional

and intellectual development
KEY CONCEPT Characteristics of physical, social, emotional and

intellectual development during early adulthood, including the
physiological changes associated with ageing
Adulthood is the longest stage of the human lifespan, starting at 19 years of age (the
end of the youth stage) and ending at death. The first stage, early adulthood, ends
on your 41st birthday. The impact of biological, behavioural and environmental
determinants can have a huge impact on the ageing process.
Cells continue to divide
for the replacement,
repair and maintenance
of body tissue.
Sensory
organs are
at their
sharpest.
Reflexes of
the nervous
system are
at their
peak.
Reproductive
function of
women has
an impact on
the physical
changes.
Figure 10.2 The physical changes from girl to woman
Peak bone
mass is
achieved.
Muscular
strength
reaches its
peak.
Maximum
adult height
is reached.
Figure 10.3 Physiological changes

during early adulthood
Early adulthood is a time when physical growth is completed and development of

the muscles, internal organs and body systems should be at their peak condition.
Physical changes that occur to the functioning and appearance of the human
body as it ages are known as physiological changes (figure 10.3). These include
the following:
Maximum adult height is reached. Young adults finish growing and their height
remains constant throughout early adulthood.
Cells continue to divide for the replacement, repair and maintenance of body
tissue, rather than for growth.
Peak bone mass is achieved. Normal ageing is accompanied by the loss of bone
tissue throughout the body which begins in the late 30s.
Sensory organs are at their sharpest (ears, eyes, nose, mouth, skin).
Muscular strength reaches its peak.
Reflexes of the nervous system are at their peak.
Womens reproductive function has an impact on the changes experienced during
this stage. It is usually in early adulthood that women go through childbearing,
and their bodies will change physically to carry out this function.
Most people in early adulthood see themselves as being at their peak in terms
of health, lifestyle, sex life and physical condition. Estimates from the 200708
National Health Survey show that almost two-thirds (64 per cent) of 2434 year
olds rated their health as excellent or very good, and this proportion declined as age
increased (Australias health 2010). Since 200708 these figures have not changed.
Social development
Social development during adulthood includes acquiring new roles, responsibilities
and expectations, both within the family (e.g. as parents and grandparents) and
outside it (e.g. at university and in the work environment).
Unit 2
AOS 3
Topic 1
Understanding
adulthood
Concept summary
and practice
questions
Concept 1
Figure 10.4 Learning how to

interact with work colleagues is a
component of young peoples social
development.
Gaining independence and developing identity become the main focus of social
development during early adulthood. This could include:
career development. In developing their independence, young adults are faced
with many decisions. Starting a career is seen as important for both males and
females and will often include completing secondary education and possibly
continuing on to further study. Being part of a new environment requires
individuals to adapt to new roles and the expectations linked to those roles.
Whether they are entering a tertiary institution or moving straight into a job,
individuals will form new relationships with other students, lecturers, tutors,
work colleagues and employers. Good communication skills and the ability to
work well with others are critical requirements for a successful work life.
selecting a life partner. Finding a permanent partner and being involved in an
intimate relationship is a common goal for most young adults. The establishment
of a stable long-term relationship is linked to a range of positive attitudes such as
confidence and acceptance. Intimacy requires an individual to sacrifice some of
their independence for another person. Taking on the role of spouse or partner
requires many social skills, and having good role models improves the chances
of success in a relationship.
managing a home. More young adults are staying in the family home longer
and delaying living independently than in the past. Moving out of the family
home and living independently (whether in a share house, cohabitating with a
partner or living alone) is another developmental milestone of early adulthood.
The individual takes on responsibilities such as paying bills, rent or a mortgage;
maintaining a clean living environment; establishing the expectations of each
Figure 10.5 Selecting a life partner

and being involved in an intimate
relationship is a common milestone
during early adulthood.
The health and individual human development of Australias adults CHAPTER 10 357
10.1 Early adulthood: physical, social, emotional and intellectual development

member of the household; developing relationships with neighbours and
learning to be part of a community.
starting a family. Starting a family is also an important developmental milestone
for most individuals. The role of a parent is linked to many societal and legal
expectations including registering the birth; providing a name for the child;
and the giving of appropriate care, love and support. The decision to take on
the role of parenthood is also influenced by society and technology. Individuals
have many choices, including the choice of whether or not to have children.
Contraception allows couples to plan their decision to conceive, while in-vitro
fertilisation (IVF) technology gives couples who may have remained childless
the chance to have children. These technological developments have allowed
couples the freedom to make choices and develop their independence.
Emotional development is the development of a full range of emotions and learning
Figure 10.6 Becoming a parent

is an important developmental
milestone during early adulthood.
the appropriate ways of dealing with and expressing these emotions (figure 10.7).
It is closely linked to self-concept, the way an individual views themselves.
As previously outlined, the most significant changes that occur in early adulthood
include:
career development
selecting a life partner
managing a home
starting a family.
These changes will all impact on emotional development, and a young adults
ability to cope with these changes will also depend on their emotional development.
The availability of good role models at work, at home and in the community
will help to foster an individuals self-concept, thus impacting their emotional
development.
Young adults still living at home need to adapt to the changing nature of family
relationships. In some cases, the way parents treat their children when they reach
early adulthood will not change even though their children may be financially
independent. Parents not only provide role models for their adult children, they
also need to provide the necessary support and encouragement to allow their
children to successfully develop into well-adjusted young adults.
Forming and maintaining relationships, in particular intimate relationships, in
early adulthood will affect the development of self-concept. Failed relationships or
lack of support and encouragement from family, work or the community can lead
to poor self-concept, impacting emotional development.
Good emotional development is the ability to understand and control the
emotions, and to respond well to the changes taking place around and within the
individual. This is not always easy but it is important for emotional development.
Formulating an identity and developing a sense of self are key components of
early adulthood. Establishing a career and learning new roles and expectations will
impact on employment status, job satisfaction, financial security and self-concept.
Figure 10.7 Expressing emotions

is a key component of emotional
development.
Intellectual development involves an increase in knowledge and the ability to think

and reason. The foundations of intellectual development are formed during the
early stages of the lifespan, when language skills are developed, knowledge gained,
memory skills formed and the ability to understand and reason are developed. All
these skills are further developed during early adulthood. Attending university or
training programs usually involves learning the skills and acquiring the knowledge
358
for their chosen career or job, thus improving intellectual development. In the work
environment, new employees will be inducted into the workplace and taught the
necessary skills and information essential to carrying out their tasks, and improve
The roles acquired by an individual as they move through early adulthood further
add to their experiences and provide them with knowledge and understanding.
How an individual deals with this information is considered part of emotional
development, but acquiring the knowledge and meaning is linked to intellectual
development.
An adults ability to reason, solve problems and strategise are all important
components of intellectual development. It is experience gained over time that
leads to a better understanding of the world around us.
TEST your knowledge
1 List the main physiological changes that occur

2 Define social development.
3 (a) Identify the main developmental milestones that
have a significant impact on social development
(b) Select one of the developmental milestones
identified in part (a) and explain how it impacts
on social development during early adulthood.
4 Define emotional development.
5 Using an example relevant to early adulthood,
explain how emotional and social development are
interrelated.
6 Define intellectual development and give an
example that is relevant to young adults.
7 Using the table below, describe four characteristics
of physical, social, emotional and intellectual
development for the lifespan stage of early
adulthood.
8 Damian, 22 years old, has just finished his electrical

apprenticeship and is planning to leave his parents
home and move in with his girlfriend.
(a) Describe the predicted physical development of
a male in Damians stage of the lifespan.
(b) Identify examples in the case study that might
have impacted on Damians social development.
(c) Select one of the examples from part (b) and
explain how it might have affected Damians
social development.
9 Use the Ageing narcissist links in the
10 The following is a profile from an internet dating site:
Hi, I am a happy, good-natured person who enjoys
all the good things life has to offer, especially good
friends, good conversation, good coffee, good food
and good health. I enjoy travelling, keeping fit and
golf, but all these things would be sweeter and more
enjoyable if they were shared with someone special.
I am looking for someone who has a good sense of
humour, and is friendly, warm, caring, honest, loyal,
trustworthy, independent, empathetic and most of
all enjoys life.
(a) Suggest reasons why many adults are keen to
find a partner.
(b) The ability to develop good relationships is a key
aspect of social development. Identify the skills
required to form good relationships.
(c) Explain how finding a life partner could impact
on an individuals emotional development.
11 Find the employment section of a newspaper or an
employment website.
(a) Select two careers and identify the main
characteristics that you would need to be
successful in these careers.
(b) Using the letters I and E, mark each selected
characteristic as being linked to intellectual or
(c) Share your ideas with the class.
Characteristics of development in early

adulthood
Physical
Social
Emotional
Intellectual
10.2
Middle adulthood: physical, social, emotional


intellectual development associated with middle adulthood, including
the physiological changes associated with ageing
Middle adulthood is the period from 41 to 64 years of age. The changes in physical
development are continuous and vary greatly between individuals, but a gradual
decline in many physiological functions may be evident from the age of 30.
Generally, in middle adulthood the following physical changes are expected
(figure10.8):
Bone density is lost. Bone loss, which can begin in the late 30s, accelerates in the
50s especially for women after menopause. This will have an impact on the
strength and mobility of an individual.
The metabolic rate decreases and fat deposits accumulate. Weight gain can be
partly linked to changes in the metabolic rate, which tends to slow down in this
phase, and reduced levels of exercise, which lower the overall energy needs of an
individual. Unfortunately, many adults do not reduce their food intake to match
the lowered energy needs and gain weight as a result.
The number of active cells decreases, leading to decreased need for energy.
The cardiovascular system goes through significant structural changes as it
ages. The combination of the changes to the heart and the circulatory system
(described below) result in a gradual decrease in a persons ability to cope with
physical exertion, especially aerobic exercise.
Men experience a slight
decrease in sperm and
testosterone production
Bone density
decreases
Metabolic rate decreases,

leading to weight gain
Heart muscle and valves

thicken and stiffen
Women experience
menopause
Walls of the arteries

harden
Number of active cells

decreases
Sense of hearing
declines
Eyesight starts to
deteriorate
Wrinkles begin to
appear
Hair starts to thin and

turn grey
Figure 10.8 The physiological

changes of middle adulthood
360
The heart muscle stiffens from tissue changes. By the late 40s and early 50s, the
healthy muscle tissue is replaced by connective tissue, which causes thickening
and stiffening of the heart muscle and valves. These changes reduce the amount
of muscle tissue available to contract the heart and the remaining muscles need
to work harder. The amount of blood that the heart can pump declines from
5 litres per minute at age 20 to about 3.5 litres per minute by the age of 70.
The circulatory system becomes less efficient. The walls of the arteries harden as
a result of calcification of the arterial walls and the replacement of elastic fibres
with less-elastic fibres.
Sense of hearing declines. This occurs gradually at first but accelerates after the
age of 40. The speed at which hearing is lost can be linked to environmental
factors such as exposure to constant loud noise. Many work environments
provide protective gear for the ears to reduce the impact of prolonged exposure
to noise. This may explain why men generally experience greater hearing loss
than women as they age. This decline in hearing can have quite an impact on
effective communication and therefore social development.
Eyesight starts to deteriorate. At about the age of 40, the structure of the eye
changes in a way that results in less light passing through the eye. Consequently
the individual requires more light to complete tasks such as reading. The eyes
also become slower to adapt to changes in light that occur when moving from a
well-lit area to a dark area (e.g. at a cinema).
Wrinkles start to appear due to loss of skin elasticity. Skin wrinkling is one of the
first outward signs of ageing. The process is quite complex and involves the skin
getting thinner and becoming more fragile. Collagen fibres in the middle layer
lose their flexibility, making the skin less able to regain shape after it has been
pinched. The layer of fat under the surface of the skin, which helps to keep the
skin smooth, also starts to diminish.
Greying of hair occurs due to loss of pigmentation. Hair can also start to thin in
both men and women.
Women experience menopause as they move from the reproductive to the nonreproductive phase of their life. Menopause occurs when the ovaries cease releasing
eggs. The changes begin in the late 40s as the menstrual cycle begins to become
irregular, and is usually complete by the age of 50 to 55. The time of transition is
known as perimenopause. A variety of physical and psychological symptoms may
accompany perimenopause and menopause.
These include the gradual loss and eventual
cessation of monthly periods accompanied
by decreases in oestrogen and progesterone
levels, changes in the reproductive organs,
changes in sexual functioning, hot flushes,
night sweats, headaches, mood changes,
difficulty concentrating, vaginal dryness
and general aches and pains. The range and
type of symptoms experienced will vary
from woman to woman.
Males experience a slight decease in the
production of sperm and testosterone.
Men do not experience the complete loss
of the ability to have children, but sperm
production declines by approximately 30
per cent between the ages of 20 and 60.
Sperm quality also declines, although a
man at 80 is still capable of fathering a Figure 10.9 Middle adulthood is a time when many people begin to take on
child.
the new role of grandparent.
10.2 Middle adulthood: physical, social, emotional and intellectual development
Social development
Unit 2
AOS 3
Topic 2
Concept 3
Emotional
development
adulthood
Concept summary
and practice
questions
Some aspects of social development that traditionally occurred in early adulthood

are increasingly becoming part of middle adulthood due to the delay in selecting
a life partner or getting married, setting up and managing a home and starting
a family.
Learning how to relate to a spouse/partner and developing a successful
relationship is a major aspect of social development in early and middle adulthood.
The increase in divorce rates over the past years has generated a rise in singleparent households, second marriages and de facto relationships. Some adults
become grandparents and provide child-care for their grandchildren in this stage,
while others at this age are still engaged in parenting their own children and
preparing them to become responsible and happy adults.
The range of possible lifestyles during this stage of the lifespan is endless. Adults
will develop socially from their career achievements, meaningful relationships
with their partner and other significant friendships, commitments that they have
to various community or social groups (e.g. school, church, sporting groups)
and enjoyable interactions with others. These interactions with family, work
and community allow adults to develop their communication skills and make a
valuable contribution to the improvement of their social
environment. Establishing, and maintaining an economic
standard of living is an important aspect of adulthood
and drives many decisions relating to work/career,
housing and other material possessions. As children leave
home, life priorities often change and relationships with
family and friends are redefined.
Middle adulthood is ideally characterised by selfconfidence and an acceptance by the person of who they
are and what they want to achieve (figure 10.10). By
this stage, an individual will have already experienced
many successes and failures. The way they coped
with these situations will have shaped their emotional
Figure 10.10 Middle adulthood is often characterised by
development, and future experiences will continue to
self-confidence.
affect this. Interactions with family, work and community
can influence self-concept. Factors such as an unsuccessful relationship, job
dissatisfaction and difficulty coping with the demands of parenthood can have
an impact on the emotional development of an individual and affect their
healthstatus.
Adults need to cope with many challenges during this stage of their lives. They
may face the possibility of unemployment or retrenchment and the significant
impact it could have on their family. Males in particular feel the pressure to
provide for their family, although as women increasingly take on the role of main
breadwinner they begin to face the same pressures. Adults who develop enjoyable
leisure activities are better able to cope with the pressures of work and family, and
are more likely to lead a healthy lifestyle.
Accepting, and adjusting to the physiological changes associated with ageing can
be challenging. The community expectation to look younger and somehow slow
down the ageing process is having an impact on many adults social and emotional
development. Advancements in medical technology have seen the development of
Figure 10.11 Community
cosmetic surgery and a surge in its use, while a variety of creams, potions and
expectations to look younger create a
large market for anti-ageing products.
lotions all promise the fountain of youth (figure10.11).
As discussed earlier, intellectual development involves the increased ability to
think and reason and the development of knowledge and skills. Research suggests
that the rate of decline in our ability to think and reason is fairly gentle. During
middle adulthood, knowledge is still being gained and the capacity to store
knowledge and further build permanent memories is limitless. The ability to
process information and solve problems will generally improve during this stage
of the lifespan. Life experiences and maturity often give older people more wisdom
than the young.
TEST your knowledge
1 Explain how changes in an individuals metabolic rate

can be linked to weight gain in middle adulthood.
2 What impact do the changes to the cardiovascular
system have on an adults ability to be physically
active?
3 Both eyesight and hearing gradually decline as an
individual ages. Outline how these physiological
changes may impact on social and emotional
development in the middle-adulthood stage of the
lifespan.
4 What is menopause?
5 Outline the main physical changes that take place
during menopause.
6 Suggest how the physical changes during
menopause can affect a females social and
7 Females experience menopause, but do males
go through any changes in their reproductive
functioning? Explain.
8 Define intellectual development and provide three
examples relating to middle adulthood that illustrate
the definition.
9 Use The time of our lives:
episode 1 links in the
10 Use the Ageing disgracefully
activity.
11 Read the following case study and answer the

questions:
Domenica and Mario are both 44 years old and
have been happily married for 16 years. They have
two children, Matthew aged 14 and Chiara aged
10. Domenica works casually for a department
store and enjoys the interaction with a variety of
people, including her work colleagues. Mario works
for a large company as their head of IT. He has just
been promoted to manager of his department.
Mario has worked hard to gain this promotion and
is both excited and anxious about this new role
and how it will affect him and his family. On the
weekends both Domenica and Mario are busy trying
to coordinate and cater to everyones needs. Chiara
plays netball on Saturday mornings and Matthew
plays football on Sundays.
(a) Identify the main aspects of social development
for Mario and Domenicas stage of adulthood.
(b) Identify the main aspects of emotional
development for Mario and Domenicas stage
ofadulthood.
(c) Identify the main aspects of intellectual
development for Mario and Domenicas stage
ofadulthood.
(d) Predict possible changes in Mario and Domenicas
lives over the next ten years that may have an
impact on their social development.
12 Becoming a grandparent is a milestone for many
during middle adulthood.
(a) How might becoming a grandparent impact on
their individual human development?
(b) What positive contributions can grandparents
make to their families?
10.3
Late adulthood: physical, social, emotional


intellectual development associated with late adulthood, including the
physiological changes associated with ageing
Late adulthood, the final stage of the lifespan, is the period from 65 years of age
until death. During this stage the efficiency and working of the body systems
continue to decline, and the physiological changes of older adulthood become more
visible. In 2015, Australias life expectancy was 80.1 years for males and 84.3years
for females, so many adults could spend 18 years or more in late adulthood.
Factors such as genetics, quality of diet, level of physical activity and other lifestyle
choices will determine the impact and speed of the changes associated with ageing.
Physiological changes in late adulthood include the following (figure10.12):
Body systems experience a continued and gradual weakening and decline.
The senses experience a continued decline. Eyesight, hearing, taste, smell and
touch all become less acute.
Unit 2
AOS 3
Topic 2
Concept 1
Physical
development
adulthood
Concept summary
and practice
questions
Aerobic capacity since early

adulthood drops by up to
70 per cent by age 65
Rate of cell replacement

slows down and in some
cases stops
Bone density continues

to decline
Spine starts to compact,

decreasing height
Muscle tone decreases, together

with muscular strength, ability
and endurance
Proportion of fat on the

body increases and body
shape changes
Gums recede and teeth

deteriorate and start
to fall out
Eyelids thicken and

eye sockets appear more
hollow
Hair continues to lose

pigmentation (go grey)
and thin
Facial hair starts to

appear on women
Skin thins and continues to

lose elasticity as more wrinkles
and age spots appear
For men, the prostate gland

enlarges, becomes stiffer and
may obstruct the urinary tract
Figure 10.12 The physiological

changes of late adulthood
By the age of 65, the average adult has experienced a 60 to 70 per cent decline
in aerobic capacity since early adulthood. Maintaining fitness throughout
adulthood could reduce this decline to as little as 20 to 25 per cent.
Physical appearance continues to change, including height, weight and shape:
The spine starts to compact, causing older adults to lose height.
The proportion of fat on the body increases and muscle tone
decreases, thus changing the shape and appearance of the body.
Weight can vary from weight gain to weight loss depending on
individual circumstances such as level of activity, level of health
and the impact of certain physical changes on the adults ability to
eat and enjoy food. These changes include a decline in the senses of
taste and smell and the quality of the adults teeth.
Rate of cell replacement slows down and some cells stop being replaced
altogether. Healing times after an injury become slower.
Bone density continues to decline. Once the process begins, women tend
to lose bone density more rapidly than men. The gender difference can
be linked to women having less bone mass than men in early adulthood,
and the depletion of oestrogen after menopause (which accelerates the
process of bone loss). As bones lose mass, they become hollow inside,
turning more porous and becoming more susceptible to breakage.
Muscular strength, ability and endurance decline (impacting on motor
skills and reflexes) (figure 10.13).
Teeth deteriorate and gums recede.
Eyelids thicken and eye sockets appear more hollow.
Hair continues to lose pigmentation (go grey) and thin.
Facial hair grows on women.
Skin continues to lose elasticity, creating more wrinkles. It becomes
thinner and age spots appear.
For men, the prostate gland enlarges and becomes stiffer, and may Figure 10.13 Body systems decline and
physiological changes become more visible
obstruct the urinary tract.
during late adulthood.
Social development
In late adulthood, social development could be stimulated by retirement. This
major life event is an exciting culmination of a lifetime of work. Retirement can
also impact negatively and contribute to loss of social contact. Many decisions and
adjustments need to be made coping with a reduced income, deciding what to
do with the extra time, re-establishing the relationship with their partner (if they
have one), and redefining household roles to ensure harmony. Many adults enjoy
this new-found freedom and spend their time on home improvements, travelling,
sporting interests established earlier or just started, community activities and
volunteering. Physical changes during late adulthood can also have a significant
impact on an individuals social development. If their mobility is limited, it could
lead to isolation and reduced contact with friends. The loss of a spouse could also
affect an individuals motivation to interact socially. How individuals spend their
time in late adulthood is dependent on many factors including level of health,
financial status and connectedness to family and friends.
Unit 2
AOS 3
Topic 2
Concept 2
Social
development
adulthood
Concept summary
and practice
questions
Coping with the many changes associated with ageing is a challenging time during
late adulthood. The transition from work to retirement is a significant social change
(as discussed earlier) and the impact on emotional development can be enormous.
For many, coping with the change in routine, feelings of boredom, loneliness and

loss requires a difficult adjustment. Adults who plan and prepare for retirement,
including taking into account their financial situation, find it easier to make the
transition.
Adjusting to decreasing physical strength and health can create challenges. For
many, being unable to do the things they used to do and in the way they always
did them can cause frustration and anxiety. Dealing with the death of a spouse can
be a very emotional time, as the grieving person must learn to cope with life alone
and adjust to a new lifestyle. Although this could happen at any time, it is most
likely to occur in late adulthood (figure 10.14).
The care and support of family and friends is an important part of
dealing with the stresses during this stage. An individual with a limited
support system may face further challenges related to loneliness and
isolation major concerns for many older adults.
Figure 10.14 Dealing with death

can be a difficult transition in any
persons life.
Unit 2
AOS 3
Topic 2
Concept 4
During late adulthood, gains can still be made in intellectual development

through life experiences, but there is a decline in information processing
abilities. Most intellectual abilities will start to decline slowly from about
70 years of age. The rate of decline is affected by biological, behavioural
and social determinants unique to the individual (see chapter 11).
Research also suggests that the decline in intellectual ability knowledge,
memory and reaction times will be affected by the physiological
changes associated with ageing such as decline in eyesight and hearing.
These changes can impact on the ability of the brain to receive the correct
information and then respond appropriately and within a certain time.
The use it or lose it motto is apt: practice may not only preserve existing
skills, but also revive supposedly lost or declining skills.
There are many activities that older adults can engage in that may assist
in maintaining or improving their intellectual development. Examples
include participating in bingo games, playing cards, volunteering as
a guide for various historical centres like an art gallery or museum,
or joining adult education classes to learn a new language or skill
(figure 10.15).
Intellectual
development
adulthood
Concept summary
and practice
questions
Figure 10.15 Activities like card

games can help individuals in late
adulthood maintain their intellectual
development.
Case study
Baby boomers to fill the gaps

in life-stage wasteland
By Bernard Salt
I have always thought that the segments of the life
cycle were unfair.
Life begins with infancy, which lasts for a year. Then
theres toddlers who run amok between one and three
years. Then theres the preschool, the primary school and
the secondary school stages that take the life cycle to 17.
Superimposed on these bands are definitions such as
pre- and post-puberty which roughly equate to before
and after the age of 12. And then theres the teenage
years, which by definition stretch between 13 and 19.
Theres even a time in life when newspapers refer to
young males as youths who seem to inhabit the
15-to-17 space.
And this age classification excludes exotic tribes
such as hoodlums, hooligans and louts who, often in
the company of youths, mill about the late teenage
years. Im not sure why, but there appear to be fewer
life-stage tags for young women than for young men.
Perhaps men are more aggressively tribal.
Beyond the late teens lie young adulthood, the
newlywed and the young-parent phases in life. I could
get all statistical on you here, but these micro phases
generally extend from 20 to the early 30s.
The late 20s and early 30s are known as the
household formation stage in the life cycle whereas
the 40s are often referred to as mature family. And
then the concept of naming a group of years for a stage
in the life cycle mysteriously stops.
Occasionally mature family is extended to 54, but
anything thereafter is known collectively as the over-55s.
The only life forms to carve out separate existences
beyond 55 are the grey nomads and the retirees.
Now this is what I find unfair. Life expectancy
extends to the mid-80s, which means that all of lifes
last 30 years are barely distinguishable.
No one under 50 cares about the personal growth that
might take place between 65 and 70. To young people,
this half-decade swishes about within a bigger grab-bag
of old age. And yet in the under 40 space every few
years is tagged and admired.
Well, I say enoughs enough. I may not be in the
over-55s space, but I want to ensure that when I do cross
the line Im not lumped in with, you know, old people.
Figure 10.16 Individuals in the active retirement life

stage are interested in wellness, wellbeing, travel and
staying connected with family.
Look at the marketing of banks and insurance

companies: they have special products with special
marketing for the over-55s. Their logic seems to be,
now that youre old, weve got some cool stuff.
In the coming decade, I think baby boomers will
reposition the over-55 market. No longer will this be
a wasteland inhabited by the old and the decrepit but
instead we will see a finer focus. Consider some of the
life stages that boomers are likely to forge in the last
30 years of life.
Portfolio Lifestyle (5564): There are 2.5
million
Australians in this life stage now; this number is
expected to rise by 18 per cent over the coming
decade. The portfolio lifestyle stage is a new
concept invented by baby boomers as a precursor to
retirement. In this stage, boomers partly work and
partly focus on lifestyle. They resign and come back
to work as a consultant, a contractor, a mentor or,
ultimate boomer fantasy, a non-executive director.
Ahhh, directors fees for doing not that much. You
do realise that public company boards are set to
explode with boomers all scrambling for a seat.
Active Retirement (6574): There are 1.6 million
Australians in the active retirement stage of life at
the moment, but by 2020 this number will be 47 per
cent higher. Active retirees are interested in wellness,
wellbeing, travel (includes grey nomads), connecting
with adult children (using new technology) and
sharing time with grandchildren. Active retirees
pursue clubs, volunteering opportunities and spiritual
growth.
(continued)
Going Solo (7584): There are 994000 people in

this age group now; by 2020, this number will rise
by 33 per cent. Most Australians die in this decade,
which means there will be a shift from older couple
households to older single households.
Going solo is fine and dandy at 25; at 80 its a
different story. A wider circle of friends evaporate or,
more properly, die off by this stage. Work contacts have
long since withered. What is left is a tight circle based
around children and young adult grandchildren.
The challenge in this stage of the life cycle is
maintaining solo living, which requires an involved
extended family and broader community support.
Frail (85-plus): There are 401
000 people aged
85-plus in Australia now; by 2020, this number is
expected to be 547000. By this stage in life, many
people are utterly alone in the sense that few friends

survive. Life partners are also unlikely to survive
in tandem: typically, one outlasts the other. Social
circles and physical mobility close ranks. The
85-plus-year-old is largely, if not entirely, reliant
upon family and institutional support.
There are 30 years of life beyond 55 that are
now available to many Australians. At the moment
this space is a wasteland, but over the next decade I
have no doubt it will blossom and yield a number of
interesting submarkets. These submarkets might not get
as microscopic as the stages that mark childhood, but
surely theres a need to realise that not everyone over
the age of 55 is the same.
Source: The Australian, 25 November 2010.
Case study review

1 Describe how Bernard Salt identifies the following age groups:
(a) the late 20s to early 30s
(b) the 40s
(c) the over-55s (last 30 years of life).
2 With life expectancy increasing to over 80 years, much more time is spent in the
late adulthood stage of the lifespan.
(a) What suggestions have been made to redefine some of the subgroups within
this stage of adulthood?
(b) Identify the current and projected statistics for each of these groups.
(c) Identify the key characteristics suggested for each group and categorise them
as physical, social, emotional or intellectual development by placing a P, I, E or
S next to each one.
TEST your knowledge
1 Describe the characteristics of physical, social,

emotional and intellectual development in late
adulthood.
2 Use The time of our lives:

episode 2 links in the Resources
section of your eBookPLUS to find
10.4
The health status of Australias adults
KEY CONCEPT The health status of Australias adults, including

similarities and differences between adult males and females
Health status refers to the level of health of an individual, community or group. There
are many ways in which health status can be measured. One of the common ways is
life expectancy. According to the Australian Institute of Health and Welfare (AIHW),
overall life expectancy at birth has increased by 2.5 years for men and 1.7 years
for women over the last decade. However, life expectancy changes over the course
of a persons life due to changing patterns of mortality. Also, if a person reaches a
particular age, their chance of reaching older age increases (see figure10.17).
Life expectancy (years)
95
0 (birth)
15
25
45
65
85
90
85
80
75
70
0
Males
Females
F or the Aboriginal and Torres Strait Islander population in 201012, life expectancy was estimated to be 10.6 years
lower than that of the non-Indigenous population for males (69.1 years compared with 79.7) and 9.5 years lower for
females (73.7 years compared with 83.1).
Figure 10.17 Life expectancy at

different ages, by sex, 201113
Source: ABS 2014.
Males at age 65 are expected to live to 84.2 years and females to 87.1 years.
Females have a higher life expectancy than males at all stages of the lifespan, but
they tend to spend more years in poor health (see figure 10.18).
25
20
With a severe or
profound core
activity limitation
With disability but no severe

or profound core activity
limitation
3.7
Years
15
6.0
5
7.1
0
5.8
5.5
3.0
6.7
10
Free of disability
1998
Men
6.7
5.6
8.7
8.7
9.5
2012
1998
2012
Women
Figure 10.18 Expected years of life

at age 65, 1998 and 2012
Source: AIHW, Australias health 2014, p. 260.
Another method of determining health status is to ask people to rate their own
health at a given point in time. This is referred to as self-assessed health status, and
can provide a useful measure of the level of overall health of both an individual
and the broader population.
In relation to the health status of adults, in 201112 over half of all Australians
aged 19 years and over considered themselves to be in very good or excellent

health. Older Australians generally rated themselves as having poorer health than
younger people, with persons aged 7584years and 85years and over recording
the highest proportions of fair or poor health (31.4 per cent and 37.5 per cent
respectively). There were no differences in the way males and females assessed
their overall health (see figure 10.19).
50
Excellent
Very good
Good
Fair
Poor
40
30
20
10
0
1517
1824
2534
3544
4554
5564
6574
7584
Age group (years)

FIGURE 10.19 Persons aged 15 years
and over, self-assessed health status,
201112
Source: ABS, Australian health survey: updated
results, 201112.
85 years
and over
Health status of young adults

aged 1924
Obtaining specific data on the health status of young adults aged 1924 can be
difficult as it is commonly inclusive of the ages 1524. However, individuals in
early adulthood generally experience good health. According to the Australian
Institute of Health and Welfare, 69 per cent of young adults aged 2024 were
found to be very satisfied with their lives.
In 2011, new cases of diabetes in the 2024 year age group were estimated at
13per 100000 for type 1 and 15 per 100000 for type 2. During young adulthood,
the levels of psychological distress can be quite high, especially the levels of
depression and anxiety. In the ABS 201112 Australian Health Survey, an estimated
258100 (12 per cent) of young adults aged 1824 reported high or very high
levels of psychological distress.
Adults aged 1824 are exposed to a wide range of activities that carry a risk of
injury, including driving, employment, socialising with alcohol, and participation
in sport. Risk-taking behaviour in this age group (particularly among men) is
common, and hazard perception and decision-making skills are still developing.
As a result, the level of hospitalisation and death from injuries for young adults
of this age is high. In 2012 there were 52718 cases of young adults aged 18 to
24 hospitalised as a result of an injury. The injury rate for males is twice that
of females. Injuries are also the leading cause of death in this age group (AIHW,
Australias health 2014).
Health status of adults aged 2564

People in the age group 2564 years represent 53percent of the population. This
group includes both early and middle adulthood, and is a period of the lifespan
where many changes are taking place and where health issues are likely to emerge.
The health behaviours of individuals in the first 25 years of their lives will set
the foundation for their future. Maintaining good health as an individual ages is a
challenge because getting older is itself a risk factor for ill-health.
Given the diversity of health issues that arise in this age group, it is often
examined in two age brackets: 2544 and 4564. The health of Australians in this
stage of adulthood is important because it affects not only them, but their families,
workplaces and society in general.
According to the Australian Institute of Health and Welfare, the most common
chronic health conditions reported by adults aged 2544 in 201112 were
vision problems (with 25 per cent reporting being short-sighted and 12 per cent
being long-sighted), hay fever and allergic rhinitis (22 per cent), and back pain
(15percent). Some 12percent of adults in this age category suffered from mood
problems such as depression and 5percent suffered from anxiety.
While people aged 2544 suffered fewer long-term health conditions than older
age groups, many were putting themselves at a greater risk of developing these
conditions later in life through a range of health risk factors such as inadequate
vegetable consumption, lack of physical activity, risky levels of alcohol consumption,
and overweight and obesity.
In terms of mortality, people aged 2544 made up only 3.5percent of all deaths
in Australia in 2012 even though they represented 29 per cent of the Australian
population. Men were almost twice as likely to die as women. Deaths occurring
during early and middle adulthood are seen as premature given that life expectancy
is high. In 2011, suicide was the leading cause of death for both males and females
in this age group, with the rates for males being much higher than for females. This
was followed by accidental poisoning, coronary heart disease and car accidents for
males; compared with breast cancer, accidental poisoning and diseases of the liver
for women (table 10.1).
TABLE 10.1 Leading causes of death(a)(b) in people aged 2544, by sex, 2011(c)
Rank
Men
No.
Women
No.
Suicide
672
19.9
Suicide
199
11.0
406
12.0
Breast cancer
173
9.6
Coronary heart disease
243
7.2
103
5.7
Car accident
138
4.1
Diseases of the liver
63
3.5
118
3.5
Car accident
54
3.0
Other forms of heart
disease(d)
(a)
Based on ICD-10 groupings.

(b) Excludes the category Event of undetermined intent as these deaths are subject to a revision process by the ABS
upon further information from the coroner.
(c) Deaths registered in 2011 are based on the preliminary version of cause of death data and are subject to further
revision by the ABS.
(d) Includes diseases of the myocardium (heart muscle), endocardium (lining of the heart), heart valves and
pericardium (membrane covering the heart).
Source: AIHW, Australias health 2014, p.246.
For people aged 4564, chronic diseases are more common than in the earlier
stages of adulthood. In 201112, vision problems (affecting 90 per cent) and
back pain (affecting 20per cent) were commonly reported along with high blood
pressure (17 per cent) and osteoarthritis (15 per cent). About 14 per cent of the
4564 age group reported mood problems such as depression and 5 per cent
reported experiencing anxiety-related problems.

In relation to mortality, the influence of health risk factors start to emerge with
the major causes of death for men in 2011 being coronary heart disease, lung
cancer, suicide, diseases of the liver and bowel cancer, compared to breast cancer,
lung cancer, coronary heart disease, bowel cancer and chronic lower respiratory
diseases for women (table 10.2).
TABLE 10.2 Leading causes of death(a) in people aged 4564, by sex, 2011(b)
Rank
Men
No.
1968
15.5
Lung cancer
1174
9.3
Suicide
549
Diseases of the liver
541
Bowel cancer
463
Women
No.
Breast cancer
999
13.0
Lung cancer
818
10.6
4.3
457
5.9
4.3
Bowel cancer
348
4.5
3.7
Chronic lower respiratory diseases
306
4.0
(a)
ased on ICD-10 groupings.

B
(b) Deaths registered in 2011 are based on the preliminary version of cause of death data and are subject to further
revision by the ABS.
Health status of adults aged

65years and over
FIGURE 10.20 Having blood

pressure checked regularly and
treated if necessary reduces the risk
of stroke.
For adults aged 65 years and over, good health is a precious asset that allows them to
enjoy a good quality of life, stay independent and participate fully in the community.
The Australian population is getting older and the number of people aged over 65 is
increasing. As a result, the demand for health care services continues to increase. On
a national level, the improvement in the health of older Australians is a priority.
The prevalence of many health conditions is higher in
adults aged over 65, and it increases with age. According
to the Australian Institute of Health and Welfare, the most
common long-term health conditions (excluding short- and
long-sightedness) in this age group in 2012 were arthritis
(affecting 49 per cent), hypertensive disease (38 per cent)
and hearing loss (complete or partial; 35 per cent). About
22percent of older adults reported having heart, stroke and
vascular diseases, 15 per cent had diabetes, and 7 per cent
had cancer. Falls, which can result in breakages, are also
more common among older people, and the rate of falls and
injuries increases with age in both males and females.
As the population ages, the possibility of having to
cope with more than one chronic condition increases. The
management of this is linked with increased health care costs
and a poorer quality of life. The term comorbidity is often
used to describe more than one illness, health condition or disorder experienced
by a person at the same time. Older people are also more likely than younger
people to have multiple long-term health conditions. In 2009, around 49percent
of those aged 6574 had 5 or more long-term health conditions, increasing to
70percent of those aged 85 and over.
In terms of mortality, the two leading causes of death for both males and females
in this age group were coronary heart disease and stroke. Dementia and Alzheimers
disease was the third common cause of death for older females and the sixth for older
males. Lung cancer and colorectal cancer were also prominent, along with prostate
cancer for men and breast cancer for women. Age is a major risk factor for most of
these diseases and, given that life expectancy for females is longer than for males,
females are more likely than males to develop these diseases and die from them.
With increasing life expectancy, the prevalence of dementia is expected to rise. It is a
major health problem in Australia, with significant consequences for the health and
quality of life of sufferers as well as for their families and friends. Dementia is more
common in older people and is characterised by the impairment of brain functions,
including language, memory, perception, social awareness, reasoning and cognition.
Sufferers eventually become dependent on their care providers for all areas of their
daily living, and this places an economic burden on the community (table 10.3).
Unit 2
AOS 3
Topic 3
Concept 1
Similarities
and differences
between genders
Concept summary
and practice
questions
Table 10.3 Estimated number of people with dementia, by age and sex, 2011
Number(a)
Per cent
Females
Persons
Under 65
Age
11.1
6.1
8.0
12600
11300
23900
6574
22.3
15.6
18.1
25200
28900
54100
7584
35.2
31.1
32.7
39800
57500
97400
85+
31.5
47.1
41.1
35600
87500
122600
Total: 65+
88.9
93.9
92.0
100700
173400
274100
100.0
100.0
100.0
113300
184700
298000
Total
(a)
Males
Females
Persons
Males
Numbers may not sum to the total due to rounding.
Source: AIHW, Dementia in Australia, 2012, cat. no. AGE70, Canberra, p. 25.
Case study
Losing your self

Alzheimers is not just an old persons disease
some sufferers begin to experience symptoms in their
40s. Miriam Cosic explores a world where logic fails
and memories fade, but where there is still time to
appreciate life.
This narrative is us, neurologist Oliver Sacks
wrote. Who you are right now is the sum total of what
youve done and thought: your childhood and school
days, your career, your marriage, your children, your
friends, your likes and dislikes, your skills, what youre
hopeless at, your moral code.
So imagine if that narrative starts to unravel, if black
holes appear in your happiest memories, your most
intimate thoughts, your accumulated knowledge, even
your most basic skills, so that you no longer know how
the bread in your hand relates to the shiny appliance
with the slots in front of you. And imagine how
traumatic this process of unravelling would be if youre
in the prime of life, have just met the love of your life
and are paying off a mortgage.
Garry Lovell, 50, knew in his late 30s that he had
the gene that could lead to early-onset Alzheimers.
His mother had got it at 51, and he nursed her until
her death 10 years later. Tormented by not knowing his
likely fate, he sought testing for the gene in 2001, very

early in his relationship with his partner Mandy. I said
to her, Look, its a horrible thing and its okay if you
dont want to go out with me any more, he says. But
she said, Im never going to do that.
That must be true love. It is, he replies seriously.
We love each other a lot.
In 2010, changes in Garrys short-term memory put
the couple on alert. Just before Christmas, his annual
test confirmed he had the disease. The gene had been
expressed: he was 46, his wife was 39. A partner
in a Melbourne landscaping business that planted
indigenous trees, Garry soon had to quit his job.
While he misses his job, he still enjoys gardening.
Hes a champion dishwasher stacker, Mandy says,
though he has trouble remembering where things go
afterwards. He still helps in the kitchen chopping
vegetables, for example and safety is not an issue.
But the logistics of cooking, such as juggling timing,
are too hard. We rely on our memories so much, we
dont even realise it, says Mandy, who has scaled back
her private psychology practice to support her husband.
We have our dark times about this, she continues,
where we notice the reality, when you notice something
new that he cant do. Thats the bit that scares me and
Im sure it scares Garry.
(continued)
Alzheimers is the most common form of dementia

some 260
000 Australians are estimated to have the
disease, a figure that some experts predict will quadruple
in 20 years. While it is generally thought of as an old
persons disease, 10 per cent of sufferers get it while
still young (by medical criteria, that means under age
65). There are several forms of early-onset dementia
Alzheimers is just one and while most sufferers are in
their 40s, 50s or early 60s, dementia can strike as early as
the 20s or 30s, often due to head injury or AIDS, or as a
side-effect of acute disease (one recent case was a teenager
who got it as a dreadful aftermath of encephalitis).
Noel Hackett was diagnosed with Alzheimers six years
ago, at the age of 59, after a year of small but mounting
bafflements. He was working in a government counselling
service for the long-term unemployed, half of whom were
homeless. He knew something was seriously wrong when
he couldnt get his head around a new computer system.
Small failures of memory had caught him out before, but
this was like a brick wall. Sometimes his younger clients,
weaned on screen-based technology, would help him out,
cover for him, while they were in his office.
I lost my sense of purpose and my sense of being
capable, he says, I used to go to meetings and Id be
thinking, I hope no one asks me a question about that.
He worried for a while, talked it over with his wife,
thought it might be stress and reduced his working
hours. On his first Friday off, in October 2007, he
went to see his doctor, an old friend. Hackett was one
of the fortunate ones: some people with younger-onset
dementia struggle for years to find out whats wrong.
Hacketts doctor was onto it straight away and sent
him for a battery of tests, including those designed to
preclude other possibilities that can cause dementialike symptoms, such as vitamin B deficiency or a
brain tumour. His doctor referred him to a neurologist,
warning that it might be Alzheimers, but it took
another year before that was confirmed. Hacketts wife,
Jenny Fitzpatrick, says: It was a very long year, 2008.
The final diagnosis felt like a whack to the back of the
head, Hackett says. I could see a very dark, long road.
His concentration as he talks is palpable, as if hes
feeling his way from sentence to sentence, like walking
in the dark, avoiding a steep drop.
Hackett and Fitzpatrick, a teacher who stopped
work to care for her husband, live in a suburban flat in
Sydney. They are fun to be with, all gentle banter and
laughter. Conversation is halting, however, and Hackett
often trails off mid-sentence. He likes to laugh so much
it is difficult to know when he is parodying himself and
when he has actually lost his train of thought. But away
from the presence of outsiders, when they stop putting
their best face on, there have been terrible moments of

sadness and grief.
Earlier in his life, Hackett was a priest. Now his faith
comes and goes. Sometimes, when he feels low, life just
seems bloody crappy, he says. Other times, like when
he sits on his balcony on a balmy day and listens to the
birds sing, the world expands. I think the big picture
is immeasurable, he says, adding that he doesnt try to
conjure God. And I dont chase grace, he continues. I
dont chase God to give me another year. I dont think
like that at all.
Adrienne Withall, co-leader of Inspired, a research
collaboration between the University of NSW, the
University of Sydney and several major hospitals,
says that behavioural problems are more common in
younger-onset Alzheimers sufferers. Parents can appear
apathetic to their children, as though they dont love
them. People think if a persons apathetic and just
sitting in a chair, its not too much of a problem. But it
is for children who dont understand why their parent
suddenly doesnt seem to care about them. And the
other parent often has to work two jobs to keep up the
family finances and they become a bit more absent, too.
Withall mentions an Australian woman in her 30s
who was diagnosed with Alzheimers, a single mother
with two young sons, both special-needs children. She is
racing against the clock to raise her children as well as
she can and ensure that they are provided for before the
illness claims her. At least she was given time to prepare.
Diagnosis for younger-onset patients can take years. When
a 45-year-old comes in complaining of memory loss and
strange behaviour, Alzheimers is the last thing most GPs
think of. Work or marital stress, depression or menopause
are what immediately come to mind, and antidepressants
or hormone replacement therapy prescribed.
Alzheimers disease was first identified in 1906,
when a German neurosurgeon, Alois Alzheimer,
dissected the brain of a dead dementia patient and
described the build up of amyloid proteins into plaques
and the growth of neurofibrillary tangles. Since then
our understanding has come a long way. Scientists can
plot brain-cell death, brain lesions and atrophy, and
know that they lead to memory loss, disorientation
and hallucinations, and that eventually the brain will
forget to direct basic bodily functions, such as chewing,
breathing and expelling waste.
We once thought what we called senility was just
a stage of being; now we know that Alzheimers is
a terminal illness. We can see the affected areas on
MRIs. We can test for a faulty gene in the cases that are
genetic, but we still dont know exactly why it happens
or how to prevent or cure it. Younger-onset dementia is
374
the more inexorable condition: usually genetic and so

both heritable and transmissible. Late-onset is a yet to
be properly defined combination of genes, environment
and general health.
That dementia comes in more than 100 forms, each
with its own causes, presents problems for both diagnosis
and research. At the top of the list are: Alzheimers
disease, which accounts for more than 50 per cent
of cases; vascular dementia, which relates to general
vascular health; fronto-temporal lobar degeneration (most
commonly seen in young-onset dementia), which causes
behavioural problems including disinhibition; dementia
caused by head injuries, including sporting injuries (being
punch-drunk, for instance); and alcohol-related dementia.
Withall shudders when she thinks of young peoples
lifestyle choices. I look at some of the drugs around at
the moment, like ice, and I think its going to be really
terrifying. Someone in the Inspired study is working with
drug and alcohol services to see who this population is
and how we are going to manage them later on.
Keeping the mind active seems to delay onset, which
is why those hoping to age gracefully are busy solving
crosswords and Sudoku, and learning new languages.
We now know you can live with a degree of brain
atrophy or tissue loss or amyloid load, and its variable as
to how it affects people, says David Ames, a Melbourne
University professor who specialises in Alzheimers. So
you see people who have got significant brain atrophy
on a scan, who are still performing quite well. And you
see, particularly in young-onset cases, people who dont
look as though theyve got much brain atrophy at all and
yet theyve got cognitive difficulties.
More highly educated people seem to deteriorate
more slowly and have more brain damage by the time
they notice a decline in their faculties. A New York
professor of clinical neuropsychology, Yaakov Stern,

developed the cognitive reserve hypothesis. If youve
had the opportunity to be well-educated, you have
more connections to damage, and you can cope with
more injury to your brain before it becomes apparent,
says Ames. In other words, the more cells and connections
your brain has made, the more it can afford to lose.
Researchers have isolated various gene abnormalities
that can cause Alzheimers, but they dont yet know
what to do with the information. Ive been saying for
20 years there will be a cure in five, and we still dont
have it, says Henry Brodaty, professor of ageing and
mental health at the University of NSW. Billions of
dollars are being pumped into clinical, epidemiological
and drug research because the eventual pay-off will
be astronomical. Its huge money, Brodaty says,
estimating that a cure could be worth $20 billion a
year.
Even if it doesnt strike us personally, Alzheimers
will cast its shadow on many of us.
Ive come to the realisation that when we talk about
dementia to other groups, were actually talking about
ourselves, says John Watkins of Alzheimers Australia.
Because if youre a woman, and you live to 95, one
in two women will have dementia. So its something
thats going to impact many of us.
Garry Lovell is making the best of what life has dealt
him. He says he still enjoys his friends company, though
conversation in large groups is impossible. He plays a bit
of golf and has taken up tennis. Im just trying to live it
up and not worry about what might happen, Garry says.
If you kept thinking about it and think, Why me?,
youre going to miss out on the next two years.
Source: Good Weekend, Sydney Morning Herald, 2 March 2013.
Case study review

1 What is Alzheimers disease?
2 (a) How many Australians are estimated to have Alzheimers disease?
(b) How is this expected to change in the next 20 years?
3 Identify some of the causes suggested for the early onset of dementia.
4 Identify two illnesses that produce dementia-like symptoms.
5 Describe how Alzheimers disease was first identified.
6 Dementia comes in many forms. List and explain some examples.
7 Highly educated people seem to deteriorate more slowly and have more brain
damage by the time they notice the decline. What reason is suggested for this
observation?
TEST your knowledge
1 Referring to figure 10.17, explain why life

expectancy increases as age increases.
2 Both males and females are living longer; however
they are not necessarily in good health. Using
the data from figure 10.18, suggest how poor
health status may impact on individual human
development.
3 What is meant by the term comorbidity?
(a) How does it impact on the cost of health care in
Australia?
(b) What are the most common disease
combinations?
4 Use the Dementia links in the
5 (a) For adults aged 1924, what are three major

causes of morbidity, and what is the major cause
of mortality?
(b) For adults aged 2544, what are three major
causes of morbidity, and what is the major cause
of mortality? Do causes of mortality differ for
males and females in this age group?
(c) For adults aged 4564, what are three major
causes of morbidity? What is the major cause of
mortality for men and for women?
(d) For adults aged 65 and over, what are three
major causes of morbidity? What are the two
leading causes of mortality for males and
females?
376
Key SKILLS The health and individual human

development of Australias adults
Australiasadults
The ability to interpret data is a vital skill in the study of health and individual
human development. Data can be presented in a variety of forms (notably in tables
and figures). It is important to have an understanding of what information is being
presented and to learn how to interpret the information.
The first step is to note the title of the data. This provides an indication of the
type of information being presented.
In the case of a table, identify the column headings and any subheadings that
might be included.
In the case of a figure (e.g. a line graph or bar graph), identify the horizontal and
vertical axis labels.
Pay attention to any notes about the data that might be included at the bottom
of the table or figure.
Note the units of measurement that are being used in the data.
Once the data have been carefully observed, it is possible to identify trends
and patterns; for example, a trend might be the decline in rates of smoking in
developed countries since the 1980s.
Further consideration of data may generate a range of questions, such as:
(a) What factors may have led to this trend or pattern?
(b) What are some possible implications of this data? (Health data highlights
areas of need and allows governments to focus their planning and use of
resources.)
(c) Has the data supported popular thinking or provided new or unexpected
insights?
The title consists of a brief description

of what the data is referring to and
the date.
The major column headings tell you

the ranking of diseases from 110
and the specific cause of death.
Note these important subheadings
(Males and Females). It would be easy

to misunderstand the meaning of this
data if these headings were missed.
For each disease listed, these columns

enable a comparison of the ranking
between percentage of male deaths
and percentage of female deaths.
TABLE 10.4 Leading causes of death, by sex, 2011

Males
Rank
Cause of death
Females
% of deaths
15.6
Cause of death
% of deaths
13.7
Lung cancer
6.6
Cerebrovascular diseases
9.5
Cerebrovascular diseases
5.9
Dementia and Alzheimers disease
9.2
Chronic obstructive pulmonary disease
4.4
Lung cancer
4.4
Prostate cancer
4.4
Breast cancer
4.1
Dementia and Alzheimers disease
4.3
Chronic obstructive pulmonary disease
3.6
Colorectal cancer
Diabetes
2.8
Diabetes
2.9
Heart failure
2.8
Cancer ill defined
2.6
Colorectal cancer
2.6
10
Suicide
2.3
Cancer ill defined
2.5
Source: Adapted from AIHW, Australias health 2014, pp.723.
The following trends can be identified in the leading causes of death in 2011 for
males and females identified in table 10.4:
Coronary heart disease was the leading cause of death for both males and
females.
Lung cancer was the second most common cause of death in males and the
fourth in females.
Cerebrovascular disease was the second most common cause of death for females
and third for males.
KEY SKILLS The health and individual human development of Australias adults
Dementia and Alzheimers disease was the third leading cause of death in females
and sixth in males.
Suicide featured as the tenth leading cause of death in males but did not feature
in the top 10 leading causes of death in females.

1 Use the data in table 10.4 to identify two similarities and two differences in the
leading causes of death of males compared to females.
2 Dementia and Alzheimers disease are a more common cause of death for
females. Provide a possible reason for this trend.
CHAPTER 10 review
Chapter summary
Adulthood is the longest stage of the lifespan and can be divided into three stages:
early (1940 years), middle (4164 years) and late (65+ years) adulthood.
Early adulthood is when the body should be at its peak physical condition.
Middle and late adulthood bring a steady decline in many physiological functions.
Biological, behavioural and environmental (physical and social) determinants can have a
major impact on the progress through the adulthood stage of the lifespan.
The social development of adults is reliant on the quality of interactions an adult has
with the people around them including family, partner, work, leisure and community.
Interactivities:
Chapter 10 crossword
The ability to cope with the multitude of changes that occur in adulthood is an
important part of emotional development.
The ability to think, reason, and effectively use memory skills is part of intellectual
development.
Health status refers to an individuals or a populations overall health, taking into account
various aspects such as life expectancy, amount of disability and levels of disease risk factors.
Unit 2
AOS 3
The life expectancy of Australian adults has increased by two years over the past
decade for both men and women. Males at 65 years are now expected to live to about
84.2 years and females to about 87.1 years.
Australian adults generally experience good health.
The health and

individual human
development of
Australias adults
Sit Topic test
The main cause of mortality for both men and women is coronary heart disease.
A POEM ON AGEING
When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was wrongly assumed that she had
nothing left of any value. But later, when the nurses were going through her meagre possessions, they found this poem. Its
quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.
Look closer
What do you see, nurses, what do you see?
What are you thinking when youre looking at me?
A crabby old woman, not very wise,
Uncertain of habit, with faraway eyes?
At forty, my young sons have grown and are gone,

But my mans beside me to see I dont mourn.
Who dribbles her food and makes no reply

When you say in a loud voice, I do wish youd try!
Who seems not to notice the things that you do, and
Forever is losing a stocking or shoe
Dark days are upon me, my husband is dead;

I look at the future, I shudder with dread.
For my young are all rearing young of their own,
And I think of the years and the love that Ive known.
Who, resisting or not, lets you do as you will,

With bathing and feeding, the long day to fill
Is that what youre thinking?
Is that what you see?
Then open your eyes, nurse; youre not looking at me.
Im now an old woman and nature is cruel;

Tis jest to make old age look like a fool.
Ill tell you who I am as I sit here so still,

As I do at your bidding, as I eat at your will.
Im a small child of ten with a father and mother,
Brothers and sisters, who love one another.
At fifty once more, babies play round my knee,

Again we know children, my loved ones and me.
The body, it crumbles, grace and vigour depart,

There is now a stone where I once had a heart.
But inside this old carcass a young girl still dwells,
And now and again, my battered heart swells.
I remember the joys, I remember the pain,
And Im loving and living life over again.
A young girl of sixteen, with wings on her feet,

Dreaming that soon now a lover shell meet.
I think of the years all too few, gone too fast,

And accept the stark fact that nothing can last.
A bride soon at twenty my heart gives a leap,

Remembering the vows that I promised to keep.
So open your eyes, people, open and see,

Not a crabby old woman; look closer see ME!!
At twenty-five now, I have young of my own,

Who need me to guide and a secure happy home.
By Phyllis McCormack
A woman of thirty, my young now grown fast,

Bound to each other with ties that should last.
Remember this poem when you next meet an old person who you might brush aside without looking at the young soul within.
We will one day be there, too.
The health and individual human development of Australias adults CHAPTEr 10
379
CHAPTER 10 review
TEST your knowledge

1 For each stage of adulthood, list two significant
examples of physical, social, emotional and
intellectual development. You might like to
complete a table similar to the one shown below.
Development/
stage
Physical Social Emotional Intellectual
Early adulthood
1.
1.
1.
1.
2.
2.
2.
2.
2 (a) i. Identify examples from A poem on ageing

of changes that occur in each stage of
adulthood.
ii. For each change identified, discuss the impact
on the social, emotional and intellectual
development of an individual.
(b) Explain how the old woman is feeling.
(c) Provide two reasons why old age is perceived in
a negative way.
(d) Does reading this poem affect your perception
of ageing? Explain.

3 Listen to the song When Im 64 by the Beatles.
(a) Is the perception of ageing in this song mainly
positive or negative? Use examples from the
song to support your response.
(b) What changes could you recommend to make
the song more representative of a 64-year-old
today?
4 Research current media, songs and poems that are

related to adulthood and ageing and select one.
(a) Analyse the images of ageing that they are
representing. Are they accurate? Explain, using
examples to support your response.
(b) Share your findings with the class.
5 Read the following case study and answer the
questions:
Grace is a 68-year-old grandmother of two. She
lives alone after the death of her husband four years
ago. Grace tries to keep busy. She baby-sits her
grandchildren, enjoys baking and feels good when
she can help her two daughters cope with their busy
lives. On three days a week she attends the local
gymfor the Live longer, live stronger program.
Her strength and physical endurance have improved
significantly since she started six months ago. After
the class, the participants (all over the age of 60)
sit and have a drink together and socialise. Grace
has participated in group activities with the class,
including a Christmas in July lunch and a trip to
the local market. Grace has made some wonderful
friendships and looks forward to these sessions.
(a) Analyse Graces activities and identify the
different types of development (physical, social
emotional and intellectual) that each would
impact.
(b) What other community resources are available
for older adults to help keep them actively
involved after their retirement?
(c) Identify the main causes of mortality for females
in Graces stage of adulthood.
380
CHAPTEr 11

of Australias adults
The determinants of health and individual human
development have an impact across all stages of the
lifespan and are just as important during adulthood as
they are at other stages. During childhood and youth,
factors that impact on the individual determine their
current and future health status. For adults, particularly
older adults who experience the highest rates of morbidity
and mortality, the determinants of health and individual
human development play a key role in their health status
as well as their ability to maintain or enhance individual
human development. These determinants include
biological, behavioural and social factors, as well as the
physical environment. While it is not necessary to study all
of the determinants outlined in this chapter, a range has
been presented for you to select one from each category.
KEY KNOWLEDGE
3.5 determinants of health and individual human development of
Australias adults, including at least one from each of the following:
biological, such as genetics, body weight, blood pressure and
blood cholesterol (pages 38490)
behavioural, such as sun protection, smoking, physical activity,
food intake, alcohol and drug use and sexual practices
(pages392411)
physical environment, such as housing, workplace safety,
neighbourhood safety and access to health care (pages 41220)
social, such as media, level of education, employment status and
income, the workplace, community belonging; that is, voluntary
work and social connections, living arrangements, social support,
family and worklife balance (pages 42135).
KEY SKILL
explain the determinants of health and individual human
development and their impact on adults, using relevant examples
(pages 391, 395, 397, 401, 405, 408, 411, 415, 420, 424, 428, 431,
435, 4379, 442).
382
FIGUrE 11.1 The determinants

of health and individual human
development play a key role in the
health status of adults.

atherosclerosis narrowing of the arteries due to a
build-up of fatty deposits or plaques that reduce
blood flow
bowel cancer growth of malignant cells in the bowel.
Also known as colorectal cancer
colonoscopy medical procedure to examine the large
bowel with a small camera
coronary heart disease conditions affecting the
arteries that supply the heart muscle
diastolic blood pressure a measure of the minimum
pressure in the arteries when the heart muscle relaxes
between heart contractions
endometriosis growth of the tissue that normally
lines the uterus in sites outside of the uterus such as
the ovaries
genetic predisposition an inherited tendency to
exhibit certain traits (e.g. being tall) or to develop
certain conditions (e.g. cancer) based on genetic
make-up
high-density lipoprotein (HDL) cholesterol that
protects against heart disease
housing stress an anxious state that occurs when the
cost of housing (either rental or mortgage) is relatively
high in relation to household income
hypertension high blood pressure
infertility the inability to conceive a child while
having unprotected sexual intercourse for at least
12months
low-density lipoprotein (LDL) cholesterol that
increases the risk of heart disease by forming plaques
on arterial walls
macular degeneration loss of vision in the centre of
the visual field due to retina damage
male impotency inability to develop or maintain an
erection of the penis
mammography screening X-ray of the breast tissue
to detect abnormal growths
occupational overuse syndrome (OOS) a condition,
resulting from repetitive movements, that can affect
the tendons and muscles of joints
polyps abnormal growths within the bowel
psychoactive effects the altering of mental processes
such as mood, cognition, emotions and behaviour
social capital the level of cooperation, trust and
goodwill between people, organisations, levels of
government and in neighbourhoods
social support the connections that an adult has with
individuals and groups
sphygmomanometer instrument that measures
blood pressure
standard drink the volume of a particular beverage
that contains 10 grams of alcohol
stroke a condition resulting from a lack of blood flow
to an area of the brain due to a blockage or rupture of
ablood vessel
systolic blood pressure the maximum pressure
exerted on the arteries when the heart muscle
contracts to pump blood
11.1
Biological determinants: genetics, body weight,

blood pressure and blood cholesterol
KEY CONCEPT The influence of biological determinants on the health

and individual human development of adults
Unit 2
AOS 3
Topic 4
Concept 1
Biological
determinants
adulthood
Concept summary
and practice
questions
As we have seen in previous chapters, biological determinants relate to the

functioning of the body and include a range of factors such as cholesterol levels,
blood pressure and body weight. Obesity, raised blood pressure and high cholesterol
levels can be indicators of ill-health, particularly in the adult population.
Genetics
The combination of genes that is inherited from the biological parents at the
time of conception can have a significant impact on health and individual human
development during the adulthood stage of the lifespan. The genes that are
inherited not only determine physical characteristics such as height, eye colour
and body shape, they also determine the rate and timing of development, genetic
conditions and predisposition to disease that may not become apparent until
adulthood.
Rate and timing of development

In chapter 9, you learnt about the role of the endocrine system in releasing
hormones that impact on the rate and timing of development during the childhood
stage of the lifespan. During adulthood, hormones continue to have an impact on
The genes a female inherits have a significant impact on the timing of menopause.
Those who have a family history of early onset of menopause are more likely to
experience early menopause themselves. Menopause is the final menstrual cycle
in a womans life and marks the end of the reproductive years. Most women reach
menopause between the ages of 45 and 55, with the average being 51 years of age.
The menstrual cycle ceases as a result of the ovaries no longer releasing eggs (ova)
and the female hormones oestrogen and progesterone. A decrease in the female
hormones after menopause may lead to the thinning of the bones (osteoporosis)
and an increased risk of bone fractures, as well as an increase in the risk of heart
attack, heart disease, high blood pressure and stroke. The onset of menopause can
impact on a womans mental health, with some women experiencing mood changes,
mild depression and irritability. Having to adjust to the end of reproductive life can
also affect emotional development. However, some women find menopause a time
of freedom and one which brings about positive change.
As males age, they usually experience a decline in their testosterone levels.
Testosterone is a hormone produced by the testes. Unlike menopause, where
females experience a sudden reduction in the levels of hormones, the reduction
in testosterone in males is less and more gradual. The decline in testosterone
levels may not affect some males at all. Those who are affected by the decline
in testosterone may experience a lack of energy, fatigue, poor concentration or
memory, mood changes, low sex drive, or loss of muscle strength.
Figure 11.2 Genetic conditions

such as Alzheimers disease affect
healthand individual human
development and usually become
apparent in adulthood.
Genetic conditions impacting on adults

Genetic conditions occur as a result of an altered or faulty gene or set of genes.
Some genetic conditions appear from the time of birth, but other genetic conditions
may not present until adulthood. Two examples of genetic conditions that impact
on adults are Alzheimers disease and Huntingtons disease.
Alzheimers disease
Alzheimers disease is a progressive condition that impairs the functioning of the
brain in areas such as memory, thinking and personality. The condition eventually
causes death. There are two types of Alzheimers disease: sporadic Alzheimers
which has no known cause, and familial Alzheimers which is caused by a genetic
mutation. Alzheimers affects one in 25 Australians over the age of 60. There is no
cure for Alzheimers, nor is there any way to prevent the onset of the disease.
Tables 11.1 and 11.2 summarise how Alzheimers disease impacts on the health
and individual human development of adults with the disease.
eLesson:
Predicting Alzheimers
Table 11.1 Impact of Alzheimers disease on the health of those affected

Type of health affected
Impacts
Physical
Inability to look after oneself resulting in lack of hygiene, which

increases the risk of ill-health such as skin infections and diarrhoea
Memory lapses resulting in the individual forgetting to take medication,
which could lead to a faster deterioration in physical health
Malnutrition due to forgetting to eat at regular times
In the late stages, becoming bedridden and needing full-time care
Poor judgement puts the individual at risk of physical harm when
driving a car
Disorientation to time and place, resulting in the individual getting
lost and being susceptible to dangers in their environment such as
road traffic.
Social
Lack of ability to maintain relationships with other people, resulting

in poor social health
Deterioration of social skills impacts on the individuals capacity to
interact with others
Inability to hold a conversation with others, which impacts on the
relationships with loved ones
Mental
Memory lapses
Depression
Apparent loss of enthusiasm for previously enjoyed activities
Table 11.2 Impact of Alzheimers disease on the individual human development of those
affected
Type of development affected
Impacts
Physical
Damage occurs to brain cells and there is a build-up of

protein called plaques in the brain
Loss of motor skills
Social
Loss of social skills such as the ability to hold a conversation

Loss of speech, which makes it difficult to communicate
adequately with others
Personality changes
Emotional
Inability to control emotions

Inability to adequately express emotions
Intellectual
Long-term memory loss

Forgetting simple words or using the wrong words
Confusion and difficulty making decisions
Huntingtons disease
Huntingtons disease is a neurological condition caused by a defective gene. Each
child of a parent with the Huntingtons gene has a 50 per cent chance of developing
the disease. Huntingtons disease causes the death of cells in certain areas of the
brain, resulting in a gradual loss of intellectual, physical and emotional capacities.
Symptoms of the disease do not usually appear until middle adulthood.
The determinants of health and individual human development of Australias adults CHAPTER 11 385
11.1 Biological determinants: genetics, body weight, blood pressure and blood cholesterol
Table 11.3 summarises the ways in which Huntingtons disease impacts on the
individual human development of an adult.
Table 11.3 Impact of Huntingtons disease on individual human development
Physical
Mild twitching of fingers and toes
Lack of coordination
Walking difficulties
Jerky movements of the arms or legs
(chorea)
Speech and swallowing difficulties due
to lack of control of the muscles of the
face, throat and tongue
Figure 11.3 Individuals with

Huntingtons disease may suffer
from depression, short-term memory
loss and an inability to control their
emotions.
Social
Inappropriate social
behaviour due to the loss of
emotions such as shame and
embarrassment that usually
help to ensure appropriate
social behaviours
Difficulties with
communication
Emotional
Loss of ability to
control emotions
resulting in mood
swings, apathy and
aggression
Intellectual
Short-term memory loss
Difficulties in concentrating
and making plans
Inability to block out
distractions
Loss of task sequencing
One-third of people with Huntingtons disease experience depression. Problems

with speech, communication and inappropriate social behaviours may cause
people to avoid someone with Huntingtons disease. Due to swallowing difficulties,
an adult with Huntingtons disease may find eating difficult and may lose weight
as a result. Changes in the ability to think may result in the consumption of
foods that lack the nutrients required for maintaining or promoting health. In
the later stages of the disease, the adult may not be able to chew and swallow
effectively, resulting in the need to be tube fed to ensure that nutritional needs
are being met.
Genetic predisposition to disease

Some adults are at greater risk of developing particular diseases due to inheriting
an altered gene. Inheriting these altered genes does not guarantee that the
individual will develop the condition but genetic predisposition can be a
significant risk factor in the development of diseases such as type 2 diabetes and
some cancers.
Type 2 diabetes
Normally, blood glucose levels are regulated by insulin, a hormone that is secreted
by the pancreas. Insulin enables the bodys cells to metabolise glucose for energy. In
an adult with type 2 diabetes, the pancreas makes insufficient insulin or the cells of
the body do not respond to it. As a result, there is an increase in the blood glucose
levels and this can impact on health.
Symptoms of type 2 diabetes include:
extreme tiredness
excessive thirst
blurred vision
increased risk of infections.
If left untreated, the condition can cause long-term damage to the kidneys, eyes,
nerves and heart. Type 2 diabetes is most common after 40 years of age but can
appear earlier.
Although lifestyle factors such as poor diet, smoking and lack of physical activity
significantly increase the risk of developing type 2 diabetes, another risk factor is
genetics. According to the Better Health Channel, adults aged 35 years and over
who are Aboriginal or Torres Strait Islanders, Pacific Islanders, from the Indian
subcontinent or of Chinese origin, are at greater risk. Adults aged 45 years and
over who have had a first-degree relative (e.g. parent) with type 2 diabetes are also
at greater risk of developing the condition.
Cancer
Cancer is one of the most common causes of death in Australia and impacts
significantly on all aspects of health and individual human development. The
functioning of the organs and systems affected by cancer are seriously diminished
as cancer cells invade and damage the tissues and organs. This is commonly
associated with excessive pain. Sufferers can experience a range of emotions such as
anger, denial, shock, sadness, depression and helplessness. Socially, many sufferers
become isolated and lonely. Cancer does not only affect the sufferers but also their
families and friends.
Non-cancerous cells in the body grow and multiply in an orderly way. Changed
genes can result in cells behaving abnormally and growing into a cancerous
tumour. The location of the tumour determines the type of cancer. Cancers that
have a genetic predisposition include breast, bowel, stomach and prostate cancer.
Body weight
Percentage
The body weight of adults is largely determined by the combination of genes that
are inherited from the biological parents as well as lifestyle and behaviours such
as physical activity levels and food habits. Concerns regarding body weight tend
to focus on overweight and obesity due to the
90
increasing rate of both conditions over the
Males
80
past 20 to 30 years. Figure 11.4 demonstrates
Females
70
the proportion of people who were overweight
60
or obese in 201112. According to the
201112 National Health Survey, 28.3 per
50
cent of persons 18 years and over were obese,
40
35 per cent were overweight, 35.2 per cent
30
were normal weight and 1.5 per cent were
20
underweight. It is estimated that at the current
10
rate of increase, overweight and obesity will
affect 75 per cent of the Australian population
0
1824
2534
3544
4554
5564
6574
75+
by 2020.
Age group (years)
In 201112 more men were overweight or
obese than women (69.7 per cent compared
Figure 11.4 Proportion of persons
to 55.7 per cent).
who are overweight or obese, 201112
Note: Based on Body Mass Index for persons whose
height and weight were measured.
Source: ABS, Australian health survey: first results.
Figure 11.5 Rates of obesity

and overweight have increased
significantly in the past three decades.
Measuring body weight

Overweight and obesity are determined by the body mass index (BMI), which is
calculated by dividing an adults weight in kilograms by their height in metres
squared. For example, the BMI for an adult male with a weight of 110 kilograms
and a height of 1.86 metres would be calculated as follows:
BMI = weight (kg)/height (m)2
= 110/(1.86)2
= 110/3.46
= 31.8
A BMI of 31.8 for an adult male would place him in the obese class 1 classification.
Table 11.4 outlines the classification of adults according to BMI, and the risk of
further disease according to BMI classification.
Table 11.4 Classification of adults according to BMI
Classification
BMI (kg/m2)
Risk of further disease
Underweight
>18.5
Low
Normal range
18.524.9
Average
Overweight
>25
Pre-obese
25.029.9
Increased
Obese class 1
30.034.9
Moderate
Obese class 2
35.039.9
Severe
Obese class 3
>40.0
Very severe
As can be seen from table11.4, increasing BMI correlates with an increased risk
of ill-health. Overweight and obesity significantly increase the risk of illnesses and
conditions such as type 2 diabetes, cardiovascular disease, high blood pressure,
sleep apnoea, osteoarthritis, certain cancers (breast, endometrial, cervical and bowel)
and psychological disorders. In terms of social and mental health, overweight and
obesity can lead to discrimination, poor self-esteem, body shape dissatisfaction,
disordered eating (e.g. binge eating), isolation and depression.
Together with the BMI, the distribution of excess body fat can determine the level
of risk to health and individual human development. Excess fat around the waist is
associated with a greater risk of health-related conditions such as coronary heart
disease, stroke and type 2 diabetes compared to excess fat that is distributed around
the buttocks and thighs (the pear shaped body). A persons waist circumference is
sometimes considered to be a better predictor of health risk than BMI:
A waist circumference of 80centimetres or over for women indicates an increased
risk to health while a waist circumference of 88centimetres or more indicates a
significantly higher risk of developing obesity-related conditions.
For men, a waist circumference of 94centimetres or more indicates an increased
risk to health and a waist circumference of 102centimetres indicates a substantially
increased risk.
Blood pressure
Blood pressure measures the force of the blood on the walls of the arteries and
is recorded as systolic and diastolic measurements. Systolic blood pressure is
the maximum pressure exerted on the arteries when the heart muscle contracts
to pump blood. Diastolic blood pressure measures the minimum pressure in the
arteries when the heart muscle relaxes between heart contractions. Blood pressure
is measured in millimetres of mercury (mm Hg) using an instrument called a
sphygmomanometer. Blood pressure is written as a number figure of systolic/

diastolic, with the systolic measurement being the higher one (e.g. 120/80mmHg).
Blood pressure can increase with exercise or exertion. Elevated blood pressure is
a concern when the pressure remains high while at rest because this might indicate
the heart is being overworked and the arteries have increased stress on the arterial
walls. This can accelerate the depositing of fatty plaques on the arterial walls, a
condition called atherosclerosis. Atherosclerosis contributes to other illnesses such
as coronary heart disease and stroke.
Although there is no ideal blood pressure, the following measurements provide
a guide:
normal blood pressure: less than 120/80 mmHg
normalhigh blood pressure: between 120/80 and 140/90 mmHg
high blood pressure: equal to or more than 140/90 mmHg
very high blood pressure: equal to or more than 180/110 mmHg.
High blood pressure is known as hypertension and is a major risk factor for
coronary heart disease, stroke, heart failure and kidney failure. Genetic factors
along with obesity, lack of physical activity, poor nutritional intake including high
salt intake and heavy alcohol consumption are also significant risk factors.
One in seven Australian adults suffers from hypertension. The condition is more
common with age due to the arteries becoming more rigid, and it is more common
in males than females until the age of 64+, when a greater proportion of women
suffer from the disease. Figure 11.7 shows the proportion of adults with high blood
pressure with increasing age in 20112012.
60
Figure 11.6 High blood pressure

is a risk factor for coronary heart
disease, stroke, heart failure and
kidney failure.
Males
Females
50
Percentage
40
30
20
10
Figure 11.7 Proportion of persons
with high blood pressure, 201112
0
1824
2534
3544
4554
5564
6474
75+
Age group (years)
Note: High blood pressure is considered to be

140/90 mmHg or more.
Blood cholesterol
Cholesterol is a type of fat that has a range of functions within the human body. It
produces hormones, assists with digestion through the production of bile acids and
is an essential component of cell membranes. Cholesterol is found in higher
concentrations in the brain and nervous system. It occurs in two forms:
high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). HDL
cholesterol is referred to as the good cholesterol as it can help unclog arteries by
removing excess LDLs out of the cells. LDL cholesterol, on the other hand, is
referred to as bad cholesterol because it can cause fatty substances to build up on
Figure 11.8 When saturated fat

(such as found in doughnuts) is
consumed, the cholesterol that is not
processed by the liver is returned to
the bloodstream.
the arterial walls and block the blood vessels. High levels of HDLs can be a positive
sign for health as long as they are accompanied by low levels of LDLs.
Although it is required for the effective functioning of the body, cholesterol becomes
a health concern when there is too much of it in the blood. High blood-cholesterol
levels, particularly LDLs, are one of the three main risk factors for heart disease (the
other two are tobacco smoking and high blood pressure). The liver is where the
processing of cholesterol occurs. When saturated fats are consumed, the cholesterol
that is not processed by the liver is returned to the bloodstream. If there is too much
LDL cholesterol in the blood, it can build up into fatty deposits on the arterial walls.
This build-up of fatty deposits causes a narrowing of the arteries (atherosclerosis),
which may eventually become blocked and cause a heart attack or stroke. The safe
level of cholesterol is thought to be no higher than 5.5 mmol/litre of blood.
High blood cholesterol is often asymptomatic (has no symptom) so it can go
undetected for many years. In 201112, one in ten adults diagnosed were unaware
they had the condition.
In 20122013, high blood cholesterol levels were responsible for 6 per cent of
chronic health conditions managed by GPs and represented 3.3 per cent of all GP
visits.
The number of people with high blood cholesterol levels has decreased since
19992000. This could be due to improved detection and better management of the
disease. According to the Australian Institute of Health and Welfare, in 201112:
More than one in three people aged 25 and older had high blood cholesterol
(36percent) compared to 48percent in 19992000 (figure11.10).
About 5.6 million adults had high blood cholesterol. It was more common in
women than men (2.9 million women suffered from the condition compared to
2.7 million men).
One in three Australian adults (33 per cent) had high levels of LDL bad
cholesterol and 23 per cent had low levels of HDL good cholesterol a
combination that increases the risk of heart disease.
High blood cholesterol was most common among adults aged 5564 (48 per
cent), but 24percent of people aged 1824 also suffered from the condition.
60
FIGURE 11.9 Eating a well-balanced

diet is important for reducing bloodcholesterol levels.
50
Per cent
40
30
20
eLesson:
Dr Norman Swans cholesterol check
10
0
19992000
201112
Year
FIGURE 11.10 Proportion of people, aged 25 and older, with high blood cholesterol
19992000 and 201112
High blood cholesterol levels are more common among people living in rural and
remote communities, with 38 per cent from such communities being diagnosed
with the condition compared to 31percent in the city. High blood cholesterol is
also a health risk factor that contributes to the differences in health status between
the Indigenous and non-Indigenous community.
390
TEST your knowledge

1 Explain how the rate and timing of development
can impact on a womans health and individual
human development. Your response could be in the
form of a table similar to tables 11.1 and 11.2.
2 (a) Describe Alzheimers disease.
(b) Explain the impact that Alzheimers disease
has on the health and individual human
development of an adult.
3 (a) Describe Huntingtons disease.
(b) Explain the impact that Huntingtons disease
has on the health and individual human
development of an adult.
4 Outline the types of cancer that have a genetic
predisposition.
5 Explain how cancer can affect health and individual
human development.
6 Outline the effects that type 2 diabetes has on the
health of the adult.
7 Outline the factors that contribute to overweight
and obesity in adults.
8 In 201112, what percentage of the adult
population was overweight or obese?
9 What is the prediction regarding future rates of
overweight and obesity?
10 Outline BMI, including how it is calculated.
11 List the health conditions associated with
overweight and obesity.
12 What is high blood pressure?
13 How is blood pressure measured?
14 What is the difference between systolic and
diastolicpressure?
15 What proportion of Australian adults are affected

by high blood pressure or hypertension?
16 Why does high blood pressure become more
common with increasing age?
17 How does high blood pressure impact the health of
Australian adults?
18 Explain the difference between HDL cholesterol and
LDL cholesterol.
19 List the health conditions that are associated with
high levels of blood cholesterol.
20 Explain how blood cholesterol can contribute to
heart attack or stroke.

21 Research and outline five strategies that family
members can use to maximise the health and
individual human development of a person with
Alzheimers disease.
22 Describe the difference between a genetic condition
and a genetic predisposition.
23 Calculate the BMI for an adult female who is
65kilograms and has a height of 1.62 metres.
WhatBMI classification would this person be?
24 Use figure 11.4 to answer the following questions.
(a) Explain the relationship between age and the
prevalence of overweight and obesity.
(b) Explain the relationship between gender and the
prevalence of overweight and obesity.
25 Use the Effects of obesity links in the
activity.
11.2
Behavioural determinants: sun protection

and tobacco smoking
KEY CONCEPT The impact of sun protection and tobacco smoking on

the health andindividual human development of adults
Health-related behaviours have a major impact on the health and individual human
development of adults, particularly behaviours related to smoking, physical activity,
food consumption, alcohol and drug use, and sexual practices. Significant health
gains can be achieved by adults making changes to their behaviours. However,
this is often difficult because many of these behaviours start early in life and are
also affected by a range of factors such as social networks (parents, family, peers),
education level, socioeconomic status, environment, advertising, health campaigns,
genetic predisposition, access to resources, and government policies. Changing
health-related behaviours can sometimes take a long time.
Sun
protection
Sexual
practices
Smoking
Behavioural
determinants
affecting adults
Alcohol and
drug use
Physical
activity
Food
intake
FIGUrE 11.11 Behavioural determinants affecting adults
Sun protection
When adults are outdoors, the ultraviolet (UV) radiation from the sun can penetrate
unprotected skin and cause damage. Sunburn occurs as a reaction to exposure to
UV radiation. Chemicals are released from the top layers of the skin, causing the
blood vessels to expand and release fluids that generate inflammation, redness and
pain. Severe cases of sunburn can result in all or some of the following:
blistering
headaches
nausea
392
vomiting
dizziness
severe pain.
In Australia, the risk of developing skin cancer from too much sun exposure needs
to be balanced with the need to maintain adequate vitamin D levels. The UV from
sunlight is required for the formation of vitamin D in the skin. Vitamin D can also be
found in relatively small amounts in some foods (e.g. oily fish, eggs, liver, margarine
and some dairy products fortified with vitamin D) but their contribution to the overall
daily requirement is minimal. Vitamin D is important to adults as it helps the body to
absorb calcium through the small intestine. Calcium is required for maintaining the
strength of bones and teeth, and the functioning of muscles and nerves.
The majority of Australians have sufficient exposure to sunlight through their daily
activities to receive enough vitamin D, although older adults confined to nursing
homes can be at greater risk of vitamin D deficiency due to lack of UV exposure.
The UV index is an international standard measurement of the strength of the
UV radiation from the sun in a specific location at a particular time. When the
UV index reads 3 or above, sun protection is necessary because there is a much
greater risk of damage occurring to the eyes and skin. Skin cancer can develop
when the cells of the skin are damaged, causing them to grow abnormally. Each
time the skin is exposed to UV radiation, changes occur in the structure and
function of the skin cells and permanent damage can occur. Every exposure to
UV radiation can increase the risk of skin cancer. All skin types can be damaged
as a result of exposure to UV radiation, even those who have skin types that are
less likely to burn.
There are three types of skin cancer: basal cell carcinoma, squamous cell
carcinoma and melanoma. The types of skin cancer are named after the skin cell
in which the cancer develops. Basal cell carcinoma and squamous cell carcinoma
are referred to as common or non-melanoma skin cancers. They represent the most
common type of cancer in Australia, but are not life-threatening. However, in 2011
there were 543 deaths from non-melanoma skin cancer. The most dangerous form
of skin cancer is melanoma. If left untreated it can spread to other parts of the
body and, eventually, result in death. Melanoma is the fourth most common cancer
diagnosed in Australia.
Australia has one of the highest rates of skin cancer in the world, with over
440000 Australians being treated for skin cancer each year. Two in three Australians
will be diagnosed with skin cancer by the age of 70. In 2011, 1544 deaths in
Australia were due to melanoma. It is the sixth most common cause of cancer
deaths in Australian men and tenth most common in Australian women.
Apart from skin cancer, lack of sun protection and exposure to UV radiation
can result in eye damage such as photoconjunctivitis, macular degeneration and
cataracts, and premature ageing.
It is important for adults to follow the recommended sun-protection practices that
are relevant for every stage of the lifespan. These include:
slip on sun-protective clothing to cover as much skin as possible
slop on SPF50+ sunscreen this should be broad spectrum and water-resistant,
applied 20 minutes before going outdoors and reapplied every two hours
slap on a hat to protect the face, head, neck and ears (e.g. wide-brimmed or
bucket-style)
seek shade wherever possible
slide on sunglasses, making sure they are a wraparound style that covers asmuch
of the eye area as possible and meet the Australian standard (AS1067).
Using sun-protection behaviours can reduce the risk of skin cancer, a disease that
affects not only physical health and individual physical development but also has a
huge impact on emotional and social development and mental and social health.
Figure 11.12 Sun protection is

important to block damaging UV rays.
11.2 Behavioural determinants: sun protection and tobacco smoking

A cancer diagnosis can result in a range of emotions being experienced by the
sufferer and their family and friends. While everyone reacts differently, most will
experience enormous sadness, anxiety, anger and a sense of helplessness about the
future. This requires significant emotional adjustment. Relationships with family
and friends often change, and people can sometimes find it difficult to talk about
the illness. Many sufferers also experience a sense of loneliness and isolation.
However, cancer can be successfully treated if it is diagnosed early enough, and
sufferers and their families are encouraged to remain hopeful.
Tobacco smoking
Figure 11.13 Smoking is a major

risk factor for cancers of the mouth.
Tobacco smoking has an enormous impact on the morbidity and mortality rates of
adults in Australia. It is the single most preventable cause of ill-health and death
in the Australian population. It is estimated that tobacco smoking contributes
7.8percent of the burden of disease in Australia; approximately 10 per cent of the
total burden of disease in males and 6 per cent in females.
Tobacco smoking is a major risk factor for a range of illnesses including cancer,
hypertension, heart disease, stroke and emphysema. Approximately one-fifth of all
cancer deaths in Australia can be attributed to smoking.
The most common form of cancer caused by smoking is lung cancer. However,
smoking also contributes to cancer of many other areas of the body including the
tongue, mouth, throat, nose, oesophagus, pancreas, stomach, bladder, kidney,
cervix and bone marrow.
Smoking increases the risk of cardiovascular disease due to an increase in
the rate of fatty substances being deposited on the arterial walls, resulting in the
narrowing of the arteries. As a result, blood flow is reduced to the cardiac muscle
of the heart. Permanent damage occurs to an area of the heart when the build-up of
fatty substances blocks the artery or arteries supplying that area. The damage to the
peripheral arteries of the body can result in reduced blood flow to the extremities,
leading to blood clots, infection, gangrene and possibly amputation. For people
under 65 years, the risk of dying from heart disease is three times greater for a smoker
compared to a non-smoker, and 70 per cent greater for a smoker over 65 years. A
smoker has about twice the risk of suffering from a stroke than a non-smoker.
The nicotine in cigarettes is what causes addiction in smokers. It is a naturally
occurring substance found in the tobacco plant. When inhaled as tobacco smoke,
nicotine raises the heart rate and increases blood pressure. Smoking also has shortterm effects on health that include:
dizziness
hand tremors
coldness in the extremities (hands and feet)
irritation of the eyes and nose
increased incidence of colds and coughs
bronchitis
increased acid in the stomach leading to ulcers
reduced appetite
reduced sense of smell and taste
bad breath
reduced physical endurance
increased effect of irritants on allergies
increased risk of lung infections
increased risk of miscarriage in pregnant women who smoke.
Source: www.givingupsmoking.info.
The 201112 National Health Survey collected information about peoples

use of tobacco. From this survey it was found that 2.8 million Australians aged
394
18 years and over smoked daily (16.3 per cent). This has been a decrease from
22.4 per cent in 2001 and 18.9 per cent in 200708. Furthermore, the daily
smoking rates for people aged 1824 fell from 21percent in 2001 to 16percent
in 2010 (figure11.14).
30
2001
2004
2007
2010
25
Per cent
20
15
10
5
FIGURE 11.14 Adult daily smoking

rates, by age group, 2001 to 2010
0
1824
2534
3544
4554
5564
65+
Age group (years)
Source: AIHW analysis of 2001 to 2010 NDSHS data.

Quitting smoking has immediate and long-term health benefits for adults:
after 12 hours most nicotine is out of the bloodstream
within 24 hours carbon monoxide blood levels have largely dropped, heart
rate slows, tremors lessen, skin temperature warms
within a month the immune system begins to recover
within three months symptoms such as cough, mucus and wheeze decrease,
and blood flow to the hands and feet improves
after six months stress levels are usually lower than when smoking and the
lungs are working much better
after 12 months the increased risk of heart disease due to smoking is halved
after 15 years the risk of heart disease and stroke becomes almost the same as
an adult who has never smoked.
Unit 2
AOS 3
Topic 4
Concept 2
Behavioural
determinants
adulthood
Concept summary
and practice
questions
TEST your knowledge
1 Outline the impact that sunburn may have on an

adults health.
2 Outline the UV index and explain its relevance to
the prevention of sunburn.
3 Why is some exposure to UV radiation important for
adults?
4 Use the Quit links in the
5 Explain how smoking increases the risk of
cardiovascular disease.
6 According to the 201112 National Health Survey,
what percentage of the population smoked in
201112?
7 (a) Refer to figure 11.14 and explain two trends

shown in the graph.
(b) What factors might have accounted for this?
8 Imagine that you are a health promotion officer at a
local council. Create a brochure, web page or blog
that highlights the risks associated with poor sun
behaviours, as well as recognising the importance
of vitamin D to the health and individual human
development of adults.
9 Develop a brochure aimed at encouraging adults to
quit smoking, making sure you include the benefits
of quitting.
10 Explain how using sun-protection practices would
help promote the health and individual human
11 Apart from impacts on physical health, how might
tobacco smoking impact on social and mental health?
11.3
Behavioural determinants: physical activity
KEY CONCEPT The impact of physical activity on the health and

individual human development of adults
Physical activity
The benefits of physical activity to the health and individual human
development of adults are considerable. Physical activity reduces the
risk of chronic diseases such as heart disease, stroke and hypertension.
It also helps ageing adults maintain or develop the strength and stamina
that enables them to live independently. The benefits of physical activity
are shown in figure 11.16.
BENEFITS TO HEALTH
Figure 11.15 The benefits of
physical activity to adults have been
well documented.
Improves cardiovascular fitness

Reduces the risk of cardiovascular disease
Reduces the risk of type 2 diabetes
Reduces the risk of premature death
Reduces the risk of high blood pressure
Helps reduce blood pressure for those
adults who already have high blood
pressure
Reduces the risk of colon cancer
Reduces depression
Reduces anxiety
Helps control weight
Promotes mental wellbeing
Assists in controlling joint swelling and pain
associated with arthritis
Reduces the risk of osteoporosis
BENEFITS TO INDIVIDUAL HUMAN

DEVELOPMENT
Maintains the density of bones
Promotes muscle strength and joint
mobility
Enables older adults to maintain motor
control and therefore the ability to live
independently
Figure 11.16 Benefits of moderatehigh intensity physical activity on the health and
Physical activity helps to improve glucose metabolism, reduce body fat and lowers
blood pressure, thereby reducing the risk of cardiovascular disease and type 2
diabetes. For adults who have already developed these diseases, regular physical
activity can help in reducing their effects. Physical activity particularly weightbearing exercise such as brisk walking and jogging helps to maintain the density
of bones, thereby reducing the risk of osteoporosis. It also assists in maintaining the
strength of muscles. Research has shown that physically active people tend to have
better mental health, with more positive self-concept and self-esteem.
According to the Cancer Council Australia, doing little or no physical activity
has also been associated with a higher risk of developing certain types of cancer
in particular, colon cancer and breast cancer. Being physically active reduces body
weight, another factor that influences the risk of developing cancer.
The 201112 National Health Survey found that the overall level of physical
activity for Australians aged 15 years and over was low. In the week prior to
interview, 66.9 per cent of Australians were either sedentary or had low levels of
exercise (35.4percent were sedentary and 31.5percent had low levels of exercise).
Males tended to be generally more active than females (see figure11.17).
The recommended minimum level of physical activity for adults is 150minutes
per week of walking or other moderate or vigorous activity, with at least 30minutes
per day of activity. The activity does not have to be done in one continuous block
of time but can occur in shorter amounts throughout the day. Vigorous exercise
is activity that makes the individual huff and puff. In technical terms, vigorous
exercise occurs when the heart is beating at 7085percent of maximum heart rate.
50
Males
Females
Percentage
40
30
20
Unit 2
10
AOS 3
Topic 4
Concept 2
Sedentary
Low
Moderate
Behavioural
determinants
adulthood
Concept summary
and practice
questions
High
Figure 11.17 Level of exercise undertaken for fitness, recreation or sport in the last week,
persons aged 15 years and over, 201112
TEST your knowledge

1 What is the recommended amount of physical
activity for an adult?
2 What proportion of the population did not engage
in the recommended amount of physical activity in
201112?
3 Outline five benefits of physical activity to the health
and individual human development of adults.

4 Develop a weekly physical activity program for
a mother of two children who works full time.
Consider the times of the day during which physical
activity can occur and the type of exercise.
5 Michael is a 42-year-old male who works in the city.

He catches the train to work every day and walks
from the station to his office, which is a 10-minute
brisk walk. Twice a week, Michael attends the
gym during his lunch break and participates in
an aerobics class for 45 minutes. Most Saturday
afternoons, Michael plays 18 holes of golf with a
group of friends.
(a) Is Michael participating in the recommended
amount of physical activity? Explain.
(b) What changes would you suggest to improve
Michaels level and/or type of physical activity?
(c) What health benefits will Michael gain from
participating in the recommended levels of
physical activity?
11.4
Behavioural determinants: food intake
KEY CONCEPT The impact of food intake on the health and individual
Food intake
Food contains a range of nutrients that are important for the health and individual
human development of adults. All nutrients are required across all stages of the
lifespan but the required quantities vary according to age, gender, metabolism and
lifestyle. Growth has ceased by the adulthood stage of the lifespan. As a result,
nutrients for the maintenance of body tissue rather than growth become more
important.
Figure 11.18 To ensure that the required nutrients are consumed, adults should aim to eat
a diet consisting of a wide variety of foods.
There are six categories of nutrients:

carbohydrates
protein
minerals
fats/lipids
vitamins
water.
Carbohydrates, fats and protein are referred to as macronutrients because they
are required in relatively large amounts. Vitamins and minerals are micronutrients
because they are required in relatively smaller amounts.
Carbohydrates. The bodys preferred source of energy. They are classified into
simple and complex carbohydrates (figure 11.19). Simple carbohydrates are
absorbed quickly into the bloodstream and include foods such as sugar, honey
and confectionery. Simple carbohydrates are classified as high glycaemic index
(GI). Complex carbohydrates such as breads and cereals take longer to break
down and so provide a more sustained source of energy. Fibre is largely a
complex carbohydrate that is found in foods such as oat bran, nuts, seeds and
398
wholegrain foods. Complex carbohydrates take

longer to be absorbed into the bloodstream and are
classified as low-medium GI.
Carbohydrates
Fats. Along with carbohydrates, fats are a primary
Simple
source of energy for the body. Fats also play a role
High GI
in protecting internal organs and maintaining body
Sugar
temperature. There are four types of fats: saturated,
Honey
monounsaturated, polyunsaturated and trans fats
Soft drink
Confectionery
(figure 11.20). Polyunsaturated fats can be divided
into omega-3 and omega-6 fatty acids.
Protein. Protein is required for the growth,
FIGUrE 11.19
maintenance and repair of body cells and the manufacturing of hormones, carbohydrates
enzymes and antibodies. It is also a secondary source of energy.
Vitamins. These occur as two types: fat-soluble and water-soluble. Fat-soluble
vitamins are vitamins A, D, E and K. They are stored in body tissues and may
become toxic to the body if over consumed. Water-soluble vitamins include
vitamin C and the B-group vitamins. They are not stored in the body and any
excess intake is excreted in the urine.
Minerals. These include calcium, iron, potassium and iodine. These are all
required for the effective functioning of the body.
Water. Water is required for the functioning of every cell in the body. It also
regulates body temperature, acts as a lubricant for joints and assists in the
removal of waste from the body.
Certain nutrients act as a risk or protective factor for specific diet-related diseases
(table 11.5 that follows). A risk factor increases the likelihood of a disease occurring
whereas a protective factor helps guard against the development of a disease.
Complex
(including fibre)
Low GI
Bread
Cereals
Pasta
Rice
Classification of
Fats
Unsaturated
Monounsaturated
Saturated
Saturated
Trans
Polyunsaturated
Omega-3
Omega-6
FIGUrE 11.20 Classification of fats
The determinants of health and individual human development of Australias adults CHAPTEr 11
399
11.4 Behavioural determinants: food intake

Table 11.5 Nutrients as risk or protective factors for diet-related diseases
Nutrient
Function(s)
Food source
Risk or
protective
factor
Relevant
disease
Calcium
Strengthens bones
and teeth
Regulates muscle
function
Assists blood
clotting
Transmits messages
along the nervous
system
Dairy products,
leafy green
vegetables, soy and
tofu, sardines and
salmon, brazil nuts,
almonds, sesame
seeds, calcium
fortified foods
Protective
Osteoporosis
Fibre
Provides the bulk to

assist in the removal
of waste from
the body via the
intestinal tract
Cereals and
wholegrain foods,
fruit, vegetables,
lentils, nuts, seeds
Protective
Bowel cancer
Cardiovascular
disease
Folate
Required for growth

and formation of red
and white blood cells
Synthesises DNA
Asparagus,
spinach, brussels
sprouts, oranges,
bananas,
strawberries,
legumes, fortified
cereals, liver,
poultry, eggs
Protective
Folatedeficiency
anaemia
Neural tube
defects such as
spina bifida
Iron
An important
component of
haemoglobin in the
blood; haemoglobin
is required for the
transportation of
oxygen to the cells of
the body
Red meat, egg

yolks, legumes and
nuts, leafy green
vegetables, fortified
cereals
Protective
Iron-deficiency
anaemia
Polyunsaturated
fats
Assist the normal

development of the
foetal brain
Lower blood
pressure and blood
triglycerides
Atlantic salmon,
mackerel, tuna,
trevally, sardines,
canola and soy oils
and canola-based
margarines
Protective
Cardiovascular
disease
Saturated fats
and trans fats
Concentrated source
of energy, providing
37kilojoules
pergram
Provides insulation
and protection for
internal organs
through fat stored
on the body
Fatty cuts of meat,

full-fat milk, cheese,
butter and cream,
commercially baked
products, deepfried foods, coconut
and palm oil
Risk
Obesity
Cardiovascular
disease
Stroke
Type 2 diabetes
Simple
carbohydrates
(high GI)
Provide energy
(16kilojoules
pergram)
Table sugar,
confectionery,
soft drinks,
chocolate, cakes
and biscuits, honey
and jam
Risk
Dental caries
Type 2 diabetes
Obesity
Sodium
Maintains water
balance in the body
Required for muscle
contraction
Table salt, processed

foods, takeaway
and fast foods,
potato crisps,
processed meats,
canned vegetables,
instant pastas
and soups, white
bread, sauces
Risk
Hypertension
Cardiovascular
disease
In terms of food intake, the consumption of sufficient fruit and vegetables by

adults is important in promoting health and reducing the risks of developing
stomach cancer, colorectal cancer and cardiovascular disease. According to the
National Health and Medical Research Council, adults should consume two serves
of fruit and five serves of vegetables each day. In 201112, 92percent of Australian
adults did not eat five serves of vegetables daily, and 52percent did not eat two
serves of fruit daily.
Of concern was also the consumption of extras foods those foods high in
energy and low in nutrients. These foods make up 36percent of the energy intake
for adults, which is greater than the recommended one to three serves per day.
Overconsumption of these foods increases the risk of obesity and other health
problems such as type 2 diabetes, heart disease and cancer.
The Australian government has developed food selection tools such as the
Dietary Guidelines for Australians and the Australian Guide to Healthy Eating
which can be used by adults to guide healthy food choices.
TEST your knowledge

1 Explain the difference between simple (high GI)
carbohydrates and complex (low GI)
carbohydrates.
2 What are the four types of fat?
3 Why should saturated fat and trans fat be reduced
in an adultsdiet?
4 What diseases do the following nutrients protect
against and what are the food sources of these
nutrients?
(a) Calcium
(b) Folate
(c) Fibre
(d) Iron
(e) Polyunsaturated fats
Unit 2
AOS 3
Topic 4
Concept 2
Behavioural
determinants
adulthood
Concept summary
and practice
questions
5 For what diseases are the following nutrients a

risk factor and what are the food sources of these
nutrients?
(a) Saturated fats and trans fats
(b) Simple carbohydrates
(c) Sodium
6 Why is the overconsumption of extras food a
health concern?
7 Why is the lack of fruit and vegetable consumption
in the Australian population a concern?

8 Use the Australian Dietary Guidelines links
in the Resources section of your eBookPLUS to
11.5
Behavioural determinants: alcohol use
KEY CONCEPT The impact of alcohol use on the health and individual
Alcohol use
Alcohol is the most widely used and accepted recreational drug in Australia.
However, the overconsumption of alcohol is a major risk factor for a range of
diseases, illness and injury-related deaths. Alcohol is second only to tobacco as a
preventable cause of drug-related death and hospitalisation in Australia (NHMRC,
2009). The 2013 National Drug Strategy found that 26 per cent of males and
9.7per cent of females aged over 18 years drank more than the recommended daily
alcohol consumption of no more than two standard drinks. It is generally accepted,
however, that a very moderate intake of alcohol (around half a standard drink
per day) may contain health benefits for older people. Red wine, in particular, is
considered to be beneficial in reducing the risk of cardiovascular disease due to
the anti-oxidants it contains. However, health authorities do not go so far as to
recommend that non-drinkers should start consuming alcohol for their health.
ALCOHOL RISK
Figure 11.21 Alcohol is the most
widely used and accepted recreational
drug in Australia.
In 2009, the National Health and Medical Research Council released new Australian
guidelines to reduce health risks from drinking alcohol. For healthy men and women,
drinking no more than two standard drinks on any day reduces the lifetime risk of
harm from alcohol-related disease or injury, and drinking no more than four standard
drinks on a single occasion reduces the risk of alcohol-related injury arising from that
occasion.
Unit 2
AOS 3
Topic 4
Concept 2
Behavioural
determinants
adulthood
Concept summary
and practice
questions
Many adults consume alcohol responsibly; however, many consume alcohol at

a level that is considered to increase their risk of alcohol-related harm. According
to the 2013 National Drug Strategy Household Survey, the level of alcohol
consumption has declined since 2010. Further:
The number of people drinking at levels that placed them at risk of an alcoholrelated disease or injury fell by approximately 250000 (from 3.7million in 2010
to 3.5million in 2013).
Fewer people consumed five or more standard drinks on a single occasion at
least once a month, declining from 5.2million in 2010 to 5.0million in 2013.
More people were choosing not to drink alcohol, with the proportion increasing
from 19.9percent in 2010 to 22percent in 2013.
However, almost one in five people aged 14 or older consumed more than two
standard drinks per day on average, putting themselves at risk of an alcohol-related
illness. One in six (15.6percent) people aged 12 or older had consumed eleven
or more standard drinks on a single drinking occasion, which is well over the
recommended safe level of consumption. In 2013 almost half (49 per cent) of
drinkers took action to reduce their alcohol intake, with the main reason for doing
so being a concern for their health.
Alcohol consumption varied between males and females and across different age
groups:
Males are almost twice as likely (8.5percent) as females (4.6percent) to drink
daily.
The age group of 70 years and over was the most likely to drink daily. However,
people in this age group were the least likely to consume alcohol in risky
402
quantities, with only one in ten (9.3percent) consuming five or more standard
drinks on a single occasion in the past year.
People aged 1824 were more likely than any other age group to exceed the
single-occasion risk guidelines, although people in their 40s and 50s were most
likely to consume five or more standard drinks on a single drinking occasion
more regularly, with around 6percent doing so on most days or every day. In
comparison, people aged 1824 were most likely to exceed single-occasion risk
guidelines weekly or monthly (see figure11.22).
60
2001
2004
2007
2010
2013
50
Per cent
40
FIGURE 11.22 Proportion of people

exceeding the single occasion risk(a)
guidelines (at least monthly), people
aged 18 or older, by age, 2001 to 2013
(per cent)
30
20
10
(a)
ad more than four standard drinks on one

H
occasion.
Source: Online Table 4.8.
1824
2529
3039
4049
5059
6069
70+
Age group (years)
Source: Adapted from AIHW 2014, National drug

strategy household survey detailed report 2013,
p.40.
Excessive alcohol consumption is a major risk factor for a range of diseases

and conditions. It is associated with a higher risk of accidents and injury in
a variety of settings including motor vehicle and bicycle accidents, accidents
involving pedestrians, falls, fires, drowning, sport and recreational injuries,
alcohol poisoning, overdose, suffocation, choking on vomit, assault, violence and
intentional self-harm. More adults die from alcohol-related road accidents and
injuries than from alcohol-related cancers, cardiovascular disease and alcohol
dependence combined.
The impact on the health and individual human development of adults
(figure11.23) include:
Liver. Overconsumption of alcohol is one of the most common causes of cirrhosis
of the liver. Liver cells are progressively replaced by scar tissue, leading to an
increased risk of infection and problems with blood clotting. The liver is unable
to perform vital functions, such as metabolism, production of proteins and
filtering of drugs and toxins. It can eventually lead to death.
Cardiovascular system. Overconsumption of alcohol can elevate blood pressure
and LDL cholesterol, and increases the risk of heart attack and stroke.
Bowel and pancreas. Alcohol can affect the normal secretions in the bowel and
irritate the bowel lining, resulting in diarrhoea and inflammation. The pancreas
may become inflamed and cause severe pain.
Cancer. Alcohol is linked to an increase in cancer risk. It is known to cause
cancers of the mouth, throat and oesophagus. It is also a risk factor for cancers
of the stomach, breast, liver, pancreas and bowel.
Mental health. For many adults, small amounts of alcohol can provide stress relief
but the sustained consumption of alcohol can lead to dependence and increased
anxiety levels. For adults who are prone to mental illnesses such as depression,
alcohol can increase the frequency and severity of these conditions. This can
impact the individuals capacity to interact with others, thereby affecting social
and emotional development.
11.5 Behavioural determinants: alcohol use

Eyes (cataracts, drusen, age-related
macular degeneration)
Cardiovascular
system (high blood
pressure/LDL
cholesterol, heart
attack, stroke)
Liver (cirrhosis,
infection,
blood
clotting)
Pancreas
(severe pain,
inflammation
cancer)
Bowel
(diarrhoea,
cancer)
Genitals
(male
impotence)
Brain (anxiety,
depression, sleep
disorders)
Mouth,
oesophagus,
throat (cancer)
Breast
(cancer)
Stomach
(cancer)
Torso
(malnutrition
overweight,
obesity)
Uterus
(infertility, other
gynaecological
disorders)
Hands
(tremors)
Figure 11.23 Areas of the body

that are affected by the sustained
overconsumption of alcohol
Sexual problems. Alcohol can increase sexual health

problems such as male impotency. This may impact
on an adults capacity to maintain a relationship with
a partner.
Eye disease. Alcohol consumption can increase the
risk of eye conditions such as cataracts, drusen (the
accumulation of extracellular material in the eye)
and age-related macular degeneration.
Alcohol dependence. Adults with a dependence
on alcohol will place priority on drinking over
behaviours that would normally be considered
important, such as food consumption and personal
hygiene. They might experience tremors and anxiety
if they cease drinking for a few hours. Alcohol
dependence may cause social problems such as
domestic violence. It may also affect an adults ability
to manage family and work relationships, thereby
impacting social development.
Sleep disorders. Initially alcohol can induce sleep, but
it eventually reduces the quality of sleep and may
worsen sleep disorders.
Malnutrition. Alcohol displaces important nutrients
from the body. As a result, nutrients are not available
for the maintenance and repair of body tissues.
Alcohol is high in kilojoules and increases energy
intake, which may contribute to overweight and
obesity if the energy is not expended.
Breast cancer and gynaecological problems. Women
who drink alcohol are at greater risk of breast cancer
and gynaecological problems such as infertility and
an irregular menstrual cycle.
Brain impairment. Alcohol consumption can lead
to memory loss, difficulties with learning new
information, confusion and hallucinations, thereby
affecting intellectual development.
Case study
Alcohol study: Middle-aged

women drink more than
any age group, Queensland
researcher says
By Erika Rutledge and Elaine Ford
Middle-aged women drink more alcohol than any
other age group, according to a Queensland University
of Technology researcher who is now working to find
out why.
Student Hanna Watling says 13 per cent of women

aged 45 to 59 are drinking an average of more than two
glasses of wine at night, which could be placing them
at risk of serious illness.
Ms Watling says a new online survey aims to find
out why more middle-aged women are turning to the
bottle.
Were hoping to understand a bit more about whats
going on for this particular group of drinkers and why
it is they tend to turn to alcohol in this sort of way, she
said.
404
develop interventions that are tailored to their specific

needs and their specific circumstances.
Three drinks a day triples risk of
alcohol-related disease
FIGURE 11.24 The study suggests that for women in their

40s and 50s, drinking is not about getting drunk.
What were doing were launching this survey

and were asking for women who are between 45 and
59years old and who have been drinking at least once in
the past month to take part.
When we understand more about whats going on
for this particular group of drinkers we might be able to
Ms Watling says research has found when women

increased their drinking from two to three standard
drinks a day, they more than tripled their lifetime risk
of death from alcohol-related diseases.
Heavy drinking is more common among young
women in their late teens and 20s, but as they age,
women tend to abandon binge drinking for less heavy but
more frequent levels of alcohol consumption, she said.
However, Ms Watling says the study suggests that
for women in their 40s and 50s, drinking is not about
getting drunk.
Instead, its more that alcohol becomes a greater
part of everyday life as you age, for example having a
wine with dinner or in front of the TV, she said.
Alcohol also becomes a way of dealing with the
stresses of busy lives such as family worries, work
pressures or social commitments.
However, she says researchers are concerned those
women who drink moderately often may end up
consuming a larger volume of alcohol than those who
drink heavily but less frequently.
Source: ABC News, 5 June 2014, www.abc.net.au.
Case study review

1 What percentage of women aged 4559 were found to be drinking alcohol at a
level that could put their health at risk?
2 What happens to alcohol consumption patterns for women as they age?
3 What reasons are given for why women in their 40s and 50s are drinking alcohol?
TEST your knowledge
1 What has been the trend in alcohol consumption

between 201013?
2 How do the patterns of alcohol consumption vary
between males and females and across the different
ages of adulthood?
3 Which age group is more likely to exceed the
recommended safe level of drinking on a single
occasion?
4 What is the recommended daily limit of standard
drinks for adults?
5 List five impacts on the health and individual
human development of adults as a result of the
overconsumption of alcohol.
6 Develop a health promotion campaign that aims

to reduce the levels of alcohol consumption within
the adult population. Consider the factors that
influence the drinking behaviours of adults and the
impact that alcohol has on the health and individual
human development of adults.
7 Refer to figure 11.22 and identify three trends
evident in the graph.
11.6
Behavioural determinants: drug use
KEY CONCEPT The impact of drug use on the health and individual
Drug use
Figure 11.25 Drug use is a major

risk factor for poor health outcomes
in adults.
A drug is any substance that produces a psychoactive effect. The National Drug
Strategy defines a drug as including tobacco, alcohol, pharmaceutical medications
and illicit substances such as heroin and ecstasy. Illicit drug use is a major risk factor
for ill-health and death associated with HIV/AIDS, hepatitis C, low birth weight,
malnutrition, poisoning, mental illness, self-inflicted injury, overdoses and death.
Drug use may arise from an inability to cope with adult responsibilities. Like
alcohol, drug use generally not just the use of illicit drugs is a major risk
factor for many diseases in adults. It is associated with injury, accidents, disability,
violence, crime and suicide, and social and family problems.
According to the 2013 National Drug and Household Survey, the proportion of
people aged 14 and over who had used an illicit drug in the previous 12months
had increased from 14.7 per cent in 2010 to 15 per cent in 2013. Cannabis is the
most commonly used illicit drug in Australia, with 35 per cent of Australians aged
over 14 years of age reporting using cannabis at some time. The use of cannabis
can result in acute effects including the impairment of motor skills, reaction time
and the ability to perform skilled activities, as well as decreased memory and
learning abilities thus impacting on an individuals physical and intellectual
development. Mental health can also be affected, as cannabis causes changes in
the users moods, affects how they think and perceive the environment, and causes
decreased motivation in areas such as study, work or concentration.
While there was no change in the use of meth/amphetamine in 2013, there was
a change in the form of drug used. The use of ice (also known as crystal) more
than doubled, from 22percent to 50percent, between 2010 and 2013. Among
ice users there was also a doubling of daily and weekly use.
The recent use of selected illicit drugs across the different ages in adulthood can
be seen in figure 11.26. Those aged 2029 are more likely to have recently used
illicit drugs, while people aged 40+ tend to have the lowest rate of drug use.
In 2013, of the 2.7million people in Australia who had used an illicit drug in the
previous 12months, over 1.5million were male and over 1.1million were female
(with 100000 not accounted for), and 18.1percent of all males and 12.1percent
of all females in Australia had used an illicit drug in the previous 12 months.
30
2029
3039
40+
25
FIGURE 11.26 Recent use(a) of

illicit drugs, people aged 20 or older,
selected illicit drugs, 2013 (per cent).
(a)
In the last 12 months.
(b)
Illicit use of at least 1 of 17 illicit drugs in 2013.
(c)
For non-medical purposes.
Source: Online tables 5.8, 5.22, 6.4 and S6.3.

Source: Adapted from AIHW 2014, National drug
strategy household survey detailed report 2013,
p.54.
Per cent
20
15
10
5
0
Any illicit
drug(b)
Cannabis
Ecstasy
Cocaine
Drug type
Meth/
Synthetic Pharmaceutical
misuse(c)
amphetamines cannabis
Normal aspects of ageing have a significant influence on drug use as adults age.
The way in which medications are absorbed, distributed, metabolised and cleared
from the body is affected by age-related changes in organ systems and illness. Even
when medications are taken as prescribed, age-related changes and disease can
increase the risk of side effects.
The rapid development of new medications to treat a variety of diseases, relieve
pain and improve quality of life has led to the increased use of prescribed and overthe-counter medications. With increasing age, adults are more likely to have more
than one medical condition for which they have been prescribed medications. This
could pose a problem as different medications may interact and create side effects
that affect the functioning of the other medications.
The use of drugs can impact on health in the following ways:
Damage to body organs. Heavy drug use can affect the liver, brain, lungs, throat
and stomach.
Infectious diseases. Sharing needles from injecting drugs is a major risk for
contracting blood-borne diseases such as hepatitis B or C and HIV/AIDS.
Injuries and accidents. Drug-related injuries can be linked to fights and falls,
as well as accidents that occur while operating machinery at work or driving
vehicles.
Depression. It is common to feel low after using some drugs (including alcohol).
This could be due to the drug itself or to something that happened while using
the drug. It is unclear whether alcohol use contributes to depression or is a
symptom of it.
Stress. Some adults use certain drugs to help them relax. However, changing the
way the body and mind work with drugs is a form of stress in itself, and users
can experience tension, anxiety, paranoia and other feelings that only add to the
feelings of stress.
Relationship problems. Family breakdown and conflict between friends and
partners are more common with drug use.
Credible information on drugs (through various forms of media), early treatment
of complications, and drug treatment centres are important aspects of dealing with
some of the issues listed above. Increasing individual awareness and attempting to
change drug-taking attitudes and behaviours is of vital importance.
Figure 11.27 A urine sample ready

for drug testing
Unit 2
AOS 3
Topic 4
Concept 2
Behavioural
determinants
adulthood
Concept summary
and practice
questions
Case study
Psychosis fears after ice use

rises among injecting drug
users
By Harriet Alexander with Dan Harrison
Hospitals and drug clinics are bracing themselves
for more patients presenting with psychosis and
cardiovascular problems after a significant increase in
use of the drug ice.
The number of injecting drug users who used ice in
the last six months has increased from 55 per cent to
61 per cent in the last year, according to the National
Drug and Alcohol Research Centres annual survey

released on Monday.
Overall, methamphetamine use remained stable, but
there was a shift from snorting it as speed to smoking
or injecting in its crystal form, as ice.
Chief investigator Lucy Burns, of the University of
NSW, said the figures were concerning because ice was
more addictive than other forms of methamphetamine
and its use was associated with psychosis and violence.
Heroin remains the drug of choice for people
who inject drugs but ice is pretty up there too, Dr
Burns said. Theres been a move to the crystal use of
methamphetamine and of course thats the stronger form.
(continued)
11.6 Behavioural determinants: drug use
Injecting the drug also exposed people to a greater

risk of blood-borne viruses.
The proportion of injecting drug users who used ice
remained stable at 74percent in NSW, but it leapt from
55 per cent to 75 per cent in Victoria and also rose to
72percent in the ACT.
Use of the drug ice is growing faster among injecting
drug users in Victoria than in any other part of Australia.
Dr Burns said the increase was significant.
Ice is metabolised by the body more quickly than
other forms of methamphetamine, is more addictive
and its use is associated with drug-induced psychosis,
violence and erratic behaviour, she said. Injecting
ice also puts people at a number of other major risks,
including acquiring septicaemia, hepatitis C and HIV.
NSW injectors were using ice more than once a
week, while in Victoria they were using it fortnightly
and in the ACT they were taking it twice a week.
Among recreational drug users, the use of ice was
statistically stable, with about one in five people
reporting that they used the drug regularly nationally,
although it was as high as one in three in Victoria.
They were more likely to take methamphetamine in
powder form.
The clinical director of the drug and alcohol service
at St Vincents Hospital, Nadine Ezard, said the number
of people presenting at Sydney emergency departments
for methamphetamine-related problems had more than
tripled in the last five years.
Theyre using stronger forms and more often,
therefore were expecting to see more problems
associated with it because the presentations we see tend
to be dose related, Associate Professor Ezard said.
These included psychosis and cardiovascular

problems.
Last year, more than 20
000 people around
Australia received treatment for drug problems where
methamphetamine was the principal drug of concern.
Associate Professor Ezard said the residential
withdrawal service at St Vincents Hospital was
receiving proportionally fewer residents with opioid
and alcohol problems and proportionally more people
who used stimulants as the primary drug of concern.
The implications were broad, with people intoxicated
by crystal methamphetamine more likely to engage in
risky behaviour such as unprotected sex.
Demand had exploded in the stimulant treatment
program at St Vincents that was set up by NSW Health
in response to concerns about ice in 2006.
In January last year, there were 120 people on the
program.
There are now 200 on the program and 100 on the
waiting list and most of them are employed, unlike
the methadone clinic where just three per cent are
employed.
Its a different cohort to people on the opioid
treatment program, Associate Professor Ezard said.
We would like to intervene before people lose their
jobs.
The National Drug and Alcohol Centres survey of
ecstasy users had happier news, reporting that the use
of synthetic cannabis had halved among this group.
They were also less likely to buy psychoactive
substances online.
Source: ABC News, 19 October 2014, www.abc.net.au.
Case study review

1 What is meant by psychosis?
2 Why is the increasing use of ice as a form of methamphetamine considered to be
a problem?
3 In what ways is the bodys response to ice different to other forms of
methamphetamines? Why is this a concern?
4 How does the use of ice impact adult health and individual human development?
TEST your knowledge
1 What is a drug?
2 Which drug is the most commonly misused?
3 How does drug use/misuse vary during adulthood?
4 Identify four drugs (illicit, prescription or nonprescription) used by adults and explain the impact
that those drugs have on the physical, social and
mental health of an individual.
5 Write a response to the following: Drug use is less

risky during adulthood than during the youth stage
of the lifespan. In your response, consider the types
of drugs that adults use and their possible effects
on health and individual human development.
11.7
Behavioural determinants: sexual practices
KEY CONCEPT The impact of sexual practices on the health and

Sexual practices
Sexual practices refer to the ways in which individuals experience and express
their sexuality. Decisions made about sexual practices during adulthood are a
continuation of the decisions and experiences made during youth, especially
those made during early adulthood when selecting or attracting a partner is a
major developmental milestone. Other important issues related to sexual practices
include unprotected sex, sexually transmissible infections, pregnancy and fertility/
infertility, and reproductive function and dysfunction.
Unit 2
AOS 3
Topic 4
Concept 2
Behavioural
determinants
adulthood
Concept summary
and practice
questions
Unprotected sex
Almost all sexually active Australians say they have had unprotected sex, and yet
more than half say they have never had a test for a sexually transmissible infection
(STI). While many safe sex campaigns are targeted at youth, 3540 year old adults
are also exposed to unsafe sex practices. STIs and unplanned pregnancies are key
health issues that affect many Australians. Research shows that during early and
middle adulthood (1824 year olds and 3540 year olds respectively), individuals
are less likely to be proactive with their health care and have an STI check. Women
are more likely than men to have an STI check up after having unprotected sex;
however, overall as many as six out of ten adults do not follow up with an STI
check after unprotected sex.
Sexually transmissible infections

Chlamydia is one of the most frequently reported sexually transmitted infections
in Australia, and the rate of infection has almost tripled over the past decade (see
figure 11.28).
2400
2200
2000
Males
1800
Females
1600
Rate
1400
1200
1000
800
600
400
Figure 11.28 Chlamydia

notifications by age and sex, 2014(a)
200
Note: (a) Per 100000 population aged 15 years

and over
0
1519
2529
2024
3539
3034
4549
4044
5559
5054
6569
6064
Source: Australian government Department of

Health, National Notifiable Disease Surveillance
System.
11.7 Behavioural determinants: sexual practices

Health messages regarding sexually transmissible infections (STIs) are usually
aimed at youth but adults are not immune to infection and need to follow safe
sex practices to minimise the risks. The decisions they make can have an impact
on their health and individual human development. Cancer of the cervix, for
example, can be linked to the sexually transmitted herpes 2 virus and the human
papillomavirus (HPV) and untreated chlamydia can lead to pelvic inflammatory
disease and infertility. As with many other health behaviours and diseases, the full
effect on the life of an individual and family may not be realised until middle
adulthood. Adults of all ages need accurate information about sexual health,
including developmental changes, STIs and related treatment strategies to promote
satisfying and responsible health behaviours.
Pregnancy: fertility/infertility
Unintended pregnancy can be an issue not only for youth, but also for adults.
Research indicates that unintended pregnancies are often the result of contraceptive
failure. Whatever the cause, unintended pregnancy is associated with increased
infant mortality and morbidity, parental neglect, child and partner abuse, and
emotional deprivation.
Reproductive problems can become a major
concern in early adulthood, especially in relation
to infertility. Infertility is the inability to conceive a
child while having unprotected sexual intercourse
for at least 12 months. It is known that men and
women suffer from infertility at about the same
rate. Sometimes multiple factors are involved in
one or both partners.
Women can be infertile from disorders such
as hormone imbalances, blocked fallopian tubes,
endometriosis, or abnormalities of the reproductive
organs. Men can experience infertility if they have
problems with the number and shape of their
sperm, produce antibodies against their own sperm
or have blocked spermatic cords. In some cases,
the exact cause of infertility cannot be found.
Proper diagnosis of infertility will help in
selecting an appropriate treatment plan that
maximises the chance of becoming pregnant.
Figure 11.29 An ovum and
sperm will it be fertilised?
Infertility statistics
One in six couples is infertile.
In 40 per cent of cases the problem rests with the male, in 40 per cent with the
female, in 10 per cent with both partners, and in a further 10 per cent of cases
the cause is unknown.
Fertility problems affect one in three women over 35.
One in 25 males has a low sperm count and one in 35 is sterile.
For healthy couples in their 20s having regular unprotected sex, the chance of
becoming pregnant each month is 25 per cent.
Birth rates from a single cycle of IVF using the womans own eggs are
approximately 3040 per cent for women aged 34 and younger. This decreases
steadily after age 35 as the ageing of the egg supply significantly impacts on the
chances of having a baby through IVF.
Approximately 3 per cent of births in Australia involve the use of assisted
reproductive technologies such as IVF.
410
Reproductive function/dysfunction
As mentioned in chapter 10, physiological changes in the reproductive systems of
both men and women throughout adulthood result in changes in sexual function.
After menopause, many women enjoy sex more, especially because the risk of
becoming pregnant is no longer a concern.
Although men and women frequently enjoy satisfying sexual relationships
throughout middle adulthood, men are more vulnerable to experiencing sexual
dysfunction than women. Advancements in medical technologies have made
available a range of products (e.g. Viagra) that allow men to continue to function
sexually into older age. Currently there is no data to suggest that men or women
lose interest in sexual activity as they age. Although the need to express sexuality
continues, older adults are susceptible to many disabling medical conditions
cardiovascular conditions, arthritis, normal changes associated with ageing, and
medication side effects that can make the expression of sexuality difficult. In
both males and females, reduced levels of sex hormones result in less rapid and
less extreme responses to sexual arousal. Touch is an overt expression of closeness
and an integral part of sexuality, and older adults still feel the human need to touch
and be touched.
Figure 11.30 Adults sexual behaviour does not have to fade withage.
TEST your knowledge

1 Define sexual practices.
2 What are STIs?
3 What is the definition of infertility?
4 Outline possible causes of infertility in both males
and females.
5 What percentage of births in Australia involved the
use of assisted reproductive technologies?
6 What are the issues relating to sexual practices

across each stage of adulthood?

7 Unintended pregnancies can be an issue, not
only for youth, but also for adults. Discuss the
impact that pregnancy can have on the health and
individual human development of adults.
11.8
Physical environment determinants:

housing and workplace safety
KEY CONCEPT The impact of housing and workplace safety on the

health and individual human development of adults
Unit 2
AOS 3
Topic 4
Concept 3
Physical
environment
adulthood
Concept summary
and practice
questions
Many aspects of the physical environment impact on the health and individual
human development of adults. Employment becomes a priority during adulthood,
so the physical environment in which adults work can impact on health and
individual human development. Other factors within the physical environment
include housing, neighbourhood safety and access to health care.
Housing
A house provides shelter and protects adults from the outside environment,
including any physical dangers. The majority of Australian adults live in their
own homes that they either own outright (33 per cent) or are paying off (36 per
cent). Rentals account for approximately 28 per cent of households, with the two
biggest groups being private rentals (24 per cent) and public/government rentals
(4 per cent).
Housing stress
Figure 11.31 Housing provides

shelter and protects residents from
the outside environment.
Having suitable housing is a priority for most adults. However, for many Australian
adults, housing stress impacts on health and individual human development, not
only for themselves but also for their family members. Housing stress occurs when
the cost of housing (either rental or mortgage) is high in relation to household
income, and when at least one-third of family income is required to meet rent
or mortgage payments. This also contributes to financial stress, leaving adults
and families with less income to meet day-to-day needs such as basic services
(electricity, gas and water), nutrition, health care and clothing. Financial stress has
a greater impact on lower-income households because they have little money to
meet basic needs. Low-income families often have to spend nearly one-third of
their income on housing costs.
The constant stress of not having enough money to cover rent or mortgage
payments and other necessities of life can contribute to health problems
and affects all aspects of individual human development. The effects on health
include:
migraine or tension headaches
insomnia or other sleep disorders
anxiety, anger and irritability
memory lapses
shoulder, neck or back pain
chronic fatigue
heart palpitations
skin conditions
heartburn
diarrhoea or constipation
dizziness
shortness of breath
heart problems
chronic pain.
Financial stress from housing affordability problems can result in adults going
without meals or not consuming foods that meet their nutritional requirements.
Over the long term, this can contribute to a range of diet-related conditions such
as osteoporosis, cardiovascular disease and type 2 diabetes. The lack

of income to pay for health care may result in these conditions being
left untreated.
Financial stress may also place a strain on relationships with
family and friends. As a result, the adult may feel isolated and have
reduced opportunities for socialisation. For married couples, financial
stress linked to difficulties with meeting house repayments or rental
costs may cause divorce. For those who are renting, frequent moves
in order to find affordable rental housing may make it difficult for
the adult to maintain friendships and develop a sense of belonging
within a community. This will have a significant impact on an adults
capacity to develop relationships with other people, thereby impacting
on social development. As an adults emotional development is
dependent on their interaction with others, emotional development
may also be hindered due to financial stress. The health issues arising
as a result of financial stress may affect the adults ability to focus
on learning new information and/or skills, thereby impacting their
Figure 11.32 Housing and financial

stress can contribute to a range of
health problems.
Workplace safety
More time is spent in the work environment in the adulthood stage of the lifespan
than in the youth stage. This means there is a greater risk of workplace injuries
and illnesses during adulthood if effective preventative measures are not in place.
In the 12 months to June 2014, 4.3 per cent of the 12.5 million people who had
worked during that time experienced a work-related injury, with males having
higher rates of injury than females. This equates to approximately 531800 people
and an injury rate of 43 per 1000 employed people. Males tend to have higher
rates of injury than females because there are more men in the workforce and they
tend to be employed in higher-risk occupations (e.g. construction). In 201314,
the injury rate for males was 44 per 1000 employed men compared with a female
rate of 36per 1000 employed women.
Injury rates also vary according to
age. The highest work-related injury
and illness rate was in the 5054 year
age group with 52 per 1000 workers.
Adults over the age of 65 years
recorded the lowest rate with 25 per
1000 persons.
The type of occupation also affects
the risk of injury or illness in the
workplace. The occupations with the
highest rates of injury in 201314
were labourers, machinery operators
and drivers, community and personal
service workers, and technicians and
trades workers. The higher rate of
injuries in these occupations can be
attributed to the physical nature of
these jobs. Professional people (science,
building, engineering, business and
information, health and education)
had the lowest rate of injuries.
Figure 11.33 Males tend to have higher rates of workplace injury than females.
11.8 Physical environment determinants: housing and workplace safety

Figure 11.34 illustrates the rate (per thousand employees) of work-related injury
or illness according to occupation groups. Shift workers are also at greater risk of
work-related injury, representing almost one-third of all workers.
Managers
Professionals
Technicians and trades workers
Community and personal service workers
Clerical and administrative workers
Sales workers
Machinery operators and drivers
Labourers
0
Figure 11.34 Work-related injury or

illness rate by occupation groups
Source: ABS 2014, Work-related injuries, Australia,
201314.
20
40
60
80
100
Per 1000 employed people(a)
120
(a) Number of people who, in the last 12 months, experienced a work-related injury or illness while working in
an occupation group per 1000 people employed in that occupation group during the reference week.
While office jobs have a relatively low risk of injury, conditions related to overuse
of technology are becoming more common. For instance, having to sit for hours
in front of a computer may lead to back and neck pain, headaches, muscle and
joint pain of the upper limbs, and eyestrain from having to look at the monitor for
extended periods of time (figure 11.35). Occupational overuse syndrome (OOS)
is a condition caused by repetitive movements that can affect the tendons and
muscles of the hands, wrists, elbows, shoulders, back and neck. It can result in
pain, muscle weakness, swelling, numbness and restricted joint movement.
Figure 11.35 Overuse of computers has resulted in an increase in injuries in the workplace.
In 201314, the most commonly reported injuries were sprains or strains of

joints and muscles; these accounted for 33 per cent of workplace injuries. This was
followed by chronic joint or muscle conditions (21percent of workplace injuries)
and cuts or open wounds (14 per cent of workplace injuries).
414
Apart from the injuries or illnesses that may be sustained from the workplace,
there is also the risk of workplace deaths. In spite of the recommendations and
expectations of a safe working environment, people still die every year from
preventable causes. In 2014, there were 185 workplace fatalities across Australia.
The most common causes of fatalities were vehicle accidents, being hit by falling
objects, being hit by moving objects, and falls from height (Safe Work Australia,
2014).
The effects of workplace injury may be short or long term and can have
significant impacts on the health and individual human development of adults.
Short-term injuries/conditions, such as cuts and abrasions, will allow an adult to
return to work relatively quickly. Other injuries/conditions, such as fractures and
stress-related conditions, generally require a longer period of time away from work.
In some instances, the worker may be so severely injured that they are unable to
return to work or may not be able to return to the same position they previously
held.
Workplace injury can result in the adult being in pain, and the potential
permanent scarring or impairment may cause significant misery to the individual.
Certain injuries, such as back injuries, may make it difficult for an adult to carry
out normal everyday tasks, such as going to the toilet. Being unable to look after
oneself and relying on the support of family and friends may impact on the affected
adults mental health. An adult who is unable to attend work may begin to feel
worthless and worry about the future, not only for themselves, but also for their
family members. The stress and anxiety associated with a long-term workplace
injury may lead to a variety of mental health conditions such as post-traumatic
stress disorder and depression. Some injured adults may become dependent on
prescription drugs, alcohol or other non-prescription drugs.
In terms of emotional development, the adult may be in chronic pain and find
it difficult to control their emotions. This may impact on the adults capacity to
maintain relationships with others, thereby impacting their social development. On
the other hand, the reliance on family and friends may result in greater bonds
being formed, which will enhance the social health and development of the adult.
The impacts on physical health can vary according to the severity of the injury.
The injured adult may be unable to participate in regular physical activity and, as
a result, fitness levels may decline. Lack of regular physical activity can impact on
physical development, such as a decrease in muscle mass and bone strength.
TEST your knowledge

1 Explain the effects that financial stress can have on
adults.
2 What was the workplace injury rate in 201314?
3 What were the most commonly reported workplace
injuries in 201314?
4 Which stages of adulthood had the highest and
lowest rates of workplace injury?
5 Explain occupational overuse syndrome. How can it
be prevented?
eLesson:
WorkSafe
6 Why would shift work be a risk factor for workrelated injury?

7 Explain the possible impact on health and individual
human development of a long-term work-related
injury.

8 Write a letter to the editor of a newspaper outlining
the impact of high mortgage repayments and
housing rent on the health and individual human
11.9
Physical environment determinants: neighbourhood

safety and access to health care
KEY CONCEPT The impact of neighbourhood safety and access to

health care on the health and individual human development of adults
Neighbourhood safety
All people need to feel safe in their homes and when out in the streets. In 2008
2009, more than four million adults, or 26 per cent of those aged 18 years and
over, reported feeling unsafe alone at home, walking alone at night in their
neighbourhood, or taking public transport at night alone (Australian Social Trends,
June 2010). Figure 11.37 indicates that during 200809 the vast majority of
Australians felt safe in their home alone.
FIGUrE 11.36 Neighbourhood
Watch promotes neighbourhood
safety.
After dark
During the day
Unsafe or very unsafe
Neither safe nor unsafe
Safe or very safe
Never home alone
20
40
60
80
100
Proportion (%)
FIGUrE 11.37 Feelings of safety at home alone
Source: ABS 2010, Crime victimisation, Australia, 200809, cat. no. 4530.0.
Crimerates
In 201314, it was estimated that:
2.6 per cent of households were victims of at least one break-in at their home,
garage or shed
6.0 per cent of households were victims of at least one incident of malicious
property damage
0.6 per cent of households had at least one motor vehicle stolen
0.4 per cent of persons over 15 years of age were victims of at least one robbery
2.3 per cent of persons over 15 years of age were victims of at least one physical
assault.
Victims of crime may experience a range of impacts on health and individual
human development including:
feelings of emptiness
nightmares or insomnia
sadness
guilt or shame
grief or loss
panic or confusion
physical symptoms of illness.
416
fear or anxiety
exhaustion
depression
anger or irritability
feelings of loss of privacy or control
helplessness or feeling deserted.
Apart from the physical impact of crime, fear for personal safety can restrict the
adults participation in social occasions and reduce their trust in the community. As
a result, an adult may lose interest in their daily activities and be less likely to access
local community services and recreational facilities (e.g. parks), which can reduce their
fitness levels and impact on the maintenance and/or development of bone mass and
muscle tissue. Restricted involvement in the community limits the social contact that
the adult has with others, which may contribute to feelings of sadness, possibly leading
to depression. Depression can affect the adults capacity to control their emotions,
and decrease their interest in situations or activities that promote the development
of intellectual skills. In contrast, adults who have a sense of safety within their
neighbourhood are more likely to be involved in community activities, thereby
promoting their health and individual human development.
Per cent
Health care focuses on promoting the health of the Australian population through
the provision of a range of health services. As morbidity and mortality rates
increase with age, it is important for adults to have access to appropriate health
services for the purpose of preventing disease, screening for disease or treating
illness. The range of health services that are available to Australian adults has
contributed to the increase in life expectancy over the past two decades, as diseases
are detected earlier and treatments have continued to improve. As can be seen from
figure11.38, there has been a significant increase in the survival rate following a
heart attack, which may be partly attributed to the increased capacity of health
services to diagnose and treat a heart attack.
There are many health care services available to improve the health and
individual human development of adults including BreastScreen Australia, and the
National Bowel Cancer
80
Females
Screening Program.
Males
Not all Australians
60
have equal access to
health care. Those living
in rural and remote
40
communities, Indigenous
people and those from
20
low
socioeconomic
backgrounds are often
disadvantaged in relation
0
to accessing a range of
1997
2007
health care services.
Year
Figure 11.38 Survival rate for heart

attacks in the 4090 age range
Source: AIHW 2010, Australias health 2010,
cat. no. AUS 122, Canberra, p. 487.
BreastScreen Australia
BreastScreen Australia is a breast cancer screening program that operates in over
500 locations throughout Australia. Breast cancer is a major risk for women
more women die from this type of cancer than any other form. On average, seven
women die from breast cancer every day in Australia. Detecting breast cancer early
increases the chance of surviving the disease.
11.9 Physical environment determinants: neighbourhood safety and access to health care
Mammography screening takes a low-dose X-ray of the breasts to detect any
changes in breast tissue (figure 11.39). The aim is to detect abnormal growths so
that the individual can be treated before the cancer progresses. Mammograms can
detect small tumours that may not be felt by hand.
Figure 11.39 Mammography

screening detects changes in breast
tissue.
Women over 40 years of age are eligible for free mammography screening but
screening recruitment strategies focus on the 5069 year age group. This is because
over 75 per cent of breast cancers occur in women 50 years and over. Also, breast
tissue in younger women is more dense and can show up as a white area on X-rays,
making it easy to be mistaken for breast cancer (which also appears as a white area
on X-rays). The lifetime risk of women developing breast cancer is one in eight.
Women in the 5060 year age group who have previously had a mammography
screening are sent a reminder for their next mammogram, which ideally should be
conducted every two years.
Access to BreastScreen services is important as early detection significantly
increases a womans chance of survival. Accessing BreastScreen services varies
depending upon where women live. In 201112, women living in outer regional
areas had the highest BreastScreen participation rate (59 per cent) and women
living in very remote areas had the lowest participation rate (46 per cent).
Only 38 per cent of Indigenous women accessed BreastScreen services. Since
BreastScreens establishment in 1991, breast cancer deaths have fallen from 68 to
44 deaths per 1000 women.
National Bowel Cancer Screening

Program
Bowel cancer is a cancerous growth or growths that occur onthe inside
of the colon or rectum. These growths are referred to as polyps. They
Figure 11.40 Bowel cancer is a

cancerous growth that occurs on the
inside of the colon or rectum.
can look like small spots on the lining of the bowel or they can appear
as growths that extend from the lining like cherries on stalks. Not all
polyps are cancerous but removing any detected polyps significantly
reduces the risk of bowel cancer.
Bowel cancer is the second most common cancer diagnosed in
Australia. If detected early, bowel cancer can be successfully treated.
Unfortunately, only 40percent of bowel cancers are detected early.
In recognition of the importance of screening for bowel cancer,
the federal government funded the National Bowel Cancer Screening
Program. Under this program, men and women turning 50, 55, 60, 65,
418
70 and 74 are invited to screen for bowel cancer. They are sent a free screening kit
by mail. From 2015 the program has been further expanded, with more age groups
included. In 2016 Australians aged 64 and 72 years will be sent a free screening
kit, and in 2017 those aged 68, 58 and 54 years will also be included. By 2020,
people aged 52, 56, 62 and 66 will also be invited to be part of the program. It is
anticipated that by 2020, almost four million Australians will be invited to screen
each year under this program.
Access to these services varies according to geographical location. In 2012,
65 per cent of all participants in the National Bowel Cancer Screening Program
came from major cities. Those living in very remote areas had the lowest
participation rate. Access also varies according to socioeconomic status. Those of
lower socioeconomic status had lower participation rates.
People who are eligible to participate in the screening program are sent an
invitation through the mail to complete a simple test at home. This test is called
a faecal occult blood test (FOBT). It requires an individual to take a sample of
their faeces and send it to a pathology laboratory for testing. A positive FOBT
means that blood has been detected in the faeces, which could be a possible sign
of bowel cancer. Individuals with a positive FOBT are informed and advised to
discuss the results with their doctor, who will usually refer them for a colonoscopy.
Completing an FOBT every two years can reduce the risk of dying from bowel
cancer by up to a third.
Unit 2
AOS 3
Topic 4
Concept 3
Physical
environment
adulthood
Concept summary
and practice
questions
Case study
Rural residents need more

than a quick-fix approach to
mental health
By Martin Laverty
Field days and agricultural shows are big events in
country Australia. Farming families travel for hours
to see the latest in tractor technology, soil seeding, or
water conservation techniques. They mostly travel just
to meet others and have a chat.
In recent years, new exhibitors have established
themselves among the livestock and paddock
demonstrations also wanting to have a chat. These
exhibitors, such as the Royal Flying Doctor Service,
are providing mental health and wellbeing checks.
For some country residents, a mental health check
at a field day may be the only face-to-face mental
health care they encounter. The Council of Australian
Governments Reform Council data tells us only half
of remote area residents needing mental health care
actually receive it, when compared to people accessing
mental health care in cities.
One in five Australians in the past year encountered
a mental health condition of some type, according to
a June report of the Australian Institute of Health and

Welfare. Myth suggests a disproportionate number of
these one in five people live in rural and remote areas,
fuelling incorrect assumptions that the act of living in
a rural or remote area contributes to the risk of mental
illness.
Research does not show higher rates of mental
disorders in rural and remote areas, according to the
journal of the National Rural Health Alliance. The
alliances study found socioeconomic disadvantage,
poor access to mental health services, high-risk
occupations, exposure to environmental adversity, and
variation in community resources each contributed to
mental illness in rural and remote Australia, as opposed
to living in country Australia per se.
These determinants of mental health risk are no
different to risks that also exist in metropolitan areas.
The difference is that responding to these determinants
requires different city and country approaches; one size
does not fit all in the bush.
The evidence in country Australia is that mental
health care and prevention is simply not reaching as
many people as it needs to. Old-fashioned resourcing,
rather than how to apply that resource, is a key
problem.
(continued)
11.9 Physical environment determinants: neighbourhood safety and access to health care
The Australia and New Zealand Journal of Psychiatry

reports that rural and remote areas have fewer mental
health services, fewer qualified professionals, and a
narrower range of service options. The consequence is
that people in country areas are less likely to engage in
and complete mental health treatments than those who
live in the city. For some, the consequences are fatal.
The National Mental Health Commission is at
present finalising its review of Australias mental
health services. It will hand its report to the federal
government before months end. In proposing action
for rural and remote Australia, the commission should
focus on achieving citycountry parity in mental health
service utilisation, to in turn contribute to parity in
nationwide mental health outcomes.
Achieving citycountry parity will require new
resourcing for country services. Such parity does not
mean a mental health hospital in every country town.
It does not mean a psychologist in every remote
community. Parity does however require a universal
service obligation guarantee of appropriate remote area
access when mental health care treatment is needed,
using existing and trusted community organisations in
newly expanded prevention and treatment roles.
Future mental health care delivery into rural and
remote Australia should build on existing health and
community care access points, rather than trying to
build new services from scratch. Again, the Australian
Institute of Health and Welfare reported in June that
71percent of those seeking treatment for mental illness

consulted their doctor.
With consumers asking their doctor for mental health
care more than any other service provider, it is doctors
in rural areas who should ideally be supported through
the Mental Health Commissions recommendations
to take on, with proper support, expanded prevention,
diagnostic, care, and mental health treatment roles.
Proposing a greater role for doctors in mental
health care may be met by howls of protest from other
interests. The nursing, psychologist, and broader allied
health community working in country Australia also
deserve more support than they get.
Yet the scarcity and workload of health professionals
in country Australia means doctors, nurses,
psychologists, and allied health staff work in effective
collaborative teams in any case. Its to these teams that
new resourcing should be directed.
With expert evidence that there is insufficient access
to mental health care in rural and remote Australia, and
with this resulting in large numbers of bush residents
missing out on care and not completing treatment
plans, its clear the Mental Health Commission should
recommend that government expand mental health
service access in rural and remote Australia.
Martin Laverty is the Federation Chief Executive
Officer of the Royal Flying Doctor Service of Australia.
Source: The Age, 12 November 2014.
Case study review

1 How do the rates of mental health conditions of those living in rural and remote
Australia compare to those living in the major cities?
2 What factors were identified as contributing to mental illness in rural and remote
Australia?
3 What health care services do those living in rural and remote Australia lack?
4 How might the lack of health care services affect the health of those living in
rural and remote Australia?
5 Explain three recommendations from the article that you think should be
implemented to address the issue of mental illness.
TEST your knowledge

1 Why is it important for people to feel safe in their
community?
2 Explain the impact of crime on the health and
3 What is meant by access to health care?
4 How many women die per day as a result of
breastcancer?
5 What age group does BreastScreen Australia target?
6 What is mammography screening?
7 Why is bowel cancer screening limited to those in

the 5074 age group?
8 What is the FOBT and how is it implemented?

9 Explain how access to health care promotes the
health and individual human development of adults.
10 Explain the relationship between access to health
care in remote areas and the health status of these
people.
420
11.10
Social determinants: the media, level of

education, employment status and income
KEY CONCEPT The impact of the media, level of education,

employment status and income on the health and individual human
development of adults
In the adulthood stage of the lifespan, social determinants that affect health
and individual human development include factors such as the media, living
arrangements, level of education, employment status and income, community
belonging, social support, family and worklife balance. It is during the adulthood
stage of the lifespan that individuals take on the role of parenting, and employment
becomes a significant factor in adults lives. The level of education that a person
achieves often determines their type of employment and therefore their level of
income. Level of income is a predictor for health status because those on higher
incomes tend to have better health than those on lower incomes. As working life takes
on greater significance in adulthood, so does the importance of maintaining work
life balance. Many families also experience changes to their living arrangements that
can impact on the health and individual human development of all family members.
The media
The media impacts on how adults see the world on their socialisation,
development, opinions, values and knowledge.
Media takes many forms. It includes the internet, social media, newspapers,
magazines, television, radio, books, video games, CDs and tapes, billboards,
posters, text messages, movies and videos.
Figure 11.41 Our world is filled

with information and images that
provide us with knowledge and
entertainment.
The impact of the media

The effects of the media on the health and individual human development of adults
are listed below.
The internet
The internet is a powerful form of media and adults can often spend hours
in front of a computer each day, socialising, reading, playing games and
11.10 Social determinants: the media, level of education, employment status and income
creating content. The internet now provides many ways for people to access
other forms of media, such as newspapers, radio, movies and music. All
these pursuits can have a positive effect on individual human development
by enhancing intellectual skills and providing opportunities for meeting and
communicating with new people.
Unlike other forms of media, the internet allows adults to easily and cheaply
create content and become producers of media rather than just being
consumers. Profiles on social networking sites have allowed people to make
connections and form relationships, improving their social and mental health.
On the internet people can create blogs, twitter, upload videos and audios
and interact in exciting and creative ways.
The internet is not a controlled environment so there is a lot of freedom.
However, this also means that it contains unedited or unreliable information,
alternative and possibly dangerous views, abusive content and opportunities
for predators to access people they can abuse. These drawbacks can
detrimentally affect mental health if precautions are not taken.
The internet allows adults to self-diagnose health problems. This can be
positive if it encourages people to see a doctor for a symptom they might
otherwise have dismissed, but it can be dangerous when advice that
contravenes mainstream medical practice is provided by people without any
medical training. It is important that adults seek reputable medical advice if
there are concerns about health.
The media has allowed health messages to reach a great proportion of the
public. Most health promotion strategies incorporate some form of media
campaign. Also, studies have shown that if information about a particular health
issue is embedded into a television drama, awareness and understanding of that
health issue in the community improves significantly. This has great potential
for targeting various groups in the community who watch particular television
shows. Messages about infectious diseases, cancer, diabetes management,
sexually transmissible infections, mental health issues and access to health
care can all be successfully embedded into storylines and provide viewers with
valuable information. Health improves when people are provided with reliable
information in an easy-to-understand format.
Newspapers provide information on a daily basis and allow individuals to keep
up with local community, national or world news for work or entertainment.
Newspapers are privately run and owners may have their own viewpoints
that they wish to get across to readers. Regular features such as crosswords
and other thinking games and quizzes may help keep the mind active and
improve intellectual development. Social health and development may be
improved when workmates share and discuss information they have read in
the newspaper.
Magazines are another form of media that can have an impact on health and
individual human development. They range from informative and factual,
to glamour and fashion magazines. Reading magazines can be a form of
entertainment for most adults. Some magazines, however, can set up unrealistic
goals of how people should be and can influence how individuals view
themselves. This impacts on their self-esteem and self-concept.
Listening to the radio can also affect an individuals health and individual
human development. Music can affect an adults mood and thus impact on
their emotional development and mental health. Listening to talkback radio can
keep an individual informed of the opinions of a community and allow them to
share their opinion with someone who is willing to listen. This form of media
is particularly important in influencing the social and mental health of those in
middle and later adulthood.
422
Level of education, employment

status and income
Higher education improves peoples living standards because it is associated
with higher paid employment, which gives people the income needed to pay for
resources that assist in promoting health and individual human development.
Education also provides individuals with the skills and knowledge required for
maintaining a healthy lifestyle and for gaining access to the appropriate health
services.
In Australia the proportion of males and females aged 2064 with a non-school
qualification such a university degree, diploma or certificate has increased over time
for both males and females (see table 11.6). In 2014, 65.6percent of males and
63.6percent of females had a post-school qualification compared to 59.2percent
of males and 52.5 per cent of females in 2004. The proportion of females aged
2064 who have gained post-school qualifications has shown the greatest increase
over this time.
Socioeconomic status (SES) is a measure of an adults or a familys economic and
social position within society relative to others. It is usually based on education,
occupation and income. When categorising socioeconomic status, it is typically
divided into three levels: high, middle and low.
Adults from a high socioeconomic background tend to have the most resources,
opportunities and power to make decisions compared to adults from a low
socioeconomic background. Adults with higher incomes tend to have better
health and live longer than those with lower incomes. Studies have shown that
adults from a socioeconomically disadvantaged background tend to have reduced
life expectancy, premature mortality, increased disease incidence and prevalence,
increased biological and behavioural risk factors for ill-health, and lower overall
health.
Adults from low socioeconomic backgrounds are more likely to smoke, eat less
fruit and vegetables, exercise less and be at greater risk of overweight and obesity.
They are also at greater risk of type 2 diabetes, cardiovascular diseases, arthritis,
mental health issues and respiratory conditions such as asthma.
Adults from low socioeconomic backgrounds visit the doctor and hospital
outpatient and accident and emergency departments more frequently than
adults from higher socioeconomic backgrounds, but they are less likely to access
preventative health services. Socioeconomically disadvantaged adults are more likely
to die sooner after serious illness than adults who are socioeconomically advantaged.
Unemployment has a significant impact on health status as lack of income limits
peoples capacity to access health resources and services. Not being employed may
create stress and anxiety for adults and reduce their capacity to financially support
other members of their family or engage in social activities with family and friends,
thereby impacting on social and mental health.
There is a relationship between type of occupation and health and individual
human development. Poorer health, greater levels of disability and higher mortality
tends to occur in adults employed in low-skilled manual labour compared to
those in managerial/professional occupations. Adults who work in low-skilled
labouring jobs are at greater risk of physical hazards that may result in injuries,
thereby impacting on physical health. The injury may restrict the individual from
being involved in daily activities, resulting in a decline in physical strength and a
reduction in bone mass. These types of jobs may also impact on an adults mental
health as they tend to have less input into decision-making processes and therefore
less control over their jobs. This may cause the adult to resent those in authority,
thus impacting on social health.
TABLE 11.6 Non-school qualification,

persons aged 2064 (per cent),
200414
Male
Female
2004
59.2
52.5
2006
60.1
54.9
2008
61.1
57.4
2010
62.7
59.4
2012
65.4
63.0
2014
65.6
63.6
Source: Based on data from ABS 2014,

Education and work, Australia, cat. no. 6227.0.
11.10 Social determinants: the media, level of education, employment status and income
Adults who are educated tend to have a higher level of health literacy. Health
literacy involves knowing what is good quality advice in regards to health, how
and where to seek further health-related information when required, and how to
translate relevant information into action. An adult with a higher level of health
literacy will find it easier to manage their health. Low levels of health literacy means
an adult will not be able to manage their health as effectively. The 2006 Adult
Literacy and Life Skills Survey, conducted by the Australian Bureau of Statistics,
found that people living in higher socioeconomic status areas were more likely
to have a higher level of health literacy than those in lower socioeconomic areas
(figure11.42). Approximately 26 per cent of people from the lowest socioeconomic
areas had an adequate level of health literacy or above, compared with 55percent
of people from households in the highest socioeconomic areas.
100
High
Adequate
80
Unit 2
AOS 3
Topic 4
Concept 4
Per cent
Low
Social
determinants
adulthood
Concept summary
and practice
questions
Very low
60
40
20
0
1
Lowest
5
Highest
Socioeconomic status
Figure 11.42 Level of health literacy and socioeconomic status
Source: Australian Institute of Health and Welfare 2010, Australias health 2010, cat. no. AUS 122, Canberra, p. 81.
TEST your knowledge

1 List the different forms of media.
2 Give one example of how the media influences the
health and individual human development of adults.
3 What is the relationship between higher education
and health?
4 In 2014, what proportion of people aged 2064
had a non-school qualification?
5 Explain what is meant by socioeconomic status.
6 Outline the health risk factors for people from low
socioeconomic backgrounds.
7 In what ways can unemployment impact on the
health status of individuals?
8 Explain the relationship between occupation
andhealth.

9 Explain the relationship between education,
occupation, income and health.
10 Refer to table 11.6.

(a) Which sex has shown the greatest increase in
non-school qualifications between 200414?
(b) Provide two reasons that might explain this.
11 Discuss how the provision of education can
contribute to improving the health and individual
human development of adults from low
socioeconomic status backgrounds.
12 Why are socioeconomically disadvantaged
individuals more likely to die sooner after serious
illness than those who are socioeconomically
advantaged?
13 (a) Which health conditions are more prevalent in
the highest socioeconomic status group?
(b) Which risk factors are more prevalent in the
lowest socioeconomic status group?
(c) Explain the relationship between the health risk
factors and the health conditions for the low
socioeconomic status population groups.
11.11
Social determinants: the workplace and

community belonging
KEY CONCEPT The impact of the workplace and a sense of community

belonging on the health and individual human development of adults
The workplace
The workplace in which an adult is employed is an important social determinant of
health. The working relationship that an adult has with colleagues has a significant
impact on their health and individual human development.
One of the issues that can have a negative effect on adults is conflict. Workplace
conflict can arise for a variety of reasons. It may occur when peoples ideas, decisions
or actions are not readily accepted by all employees, or when people simply do not
get along on a personal level. Conflict related to the implementation of new ideas
and decisions can be productive because it generates worthwhile discussion and
debate that may assist the business in making positive changes or improving work
practices. However, a clash of personalities can make the workplace an unpleasant
environment. Conflict with bosses can make it very difficult for the employee and
lead to work-related stress. According to a report completed by Safe Work Australia
in 2012, depression costs Australian employers approximately $8 billion per year
as a result of absence due to sickness and presenteeism, with $693 million of this
figure due to job strain and bullying. Presenteeism is the loss of productivity that
results from employees coming to work but, as a consequence of illness or other
conditions, not functioning at full capacity. Absenteeism occurs when employees
do not come to work at all (Safe Work Australia).
Many other factors in the workplace may cause work-related stress including:
long working hours
heavy workloads
changes within the organisation
tight deadlines
lack of job security
boredom
harassment/bullying
discrimination
lack of autonomy and being over-supervised.
Work-related stress affects the health of an adult in a variety of ways including:
depression
anxiety
feelings of being overwhelmed and unable to cope
sleeping difficulties
fatigue
headaches
heart palpitations
gastrointestinal upsets such as diarrhoea or constipation
As an adults social and emotional development is dependent on relationships
with others, not interacting with family, friends or work colleagues means that the
adult does not have the opportunities for maintaining or further developing social
skills or the capacity to understand and control emotions, which in turn impacts
their social and emotional development.
When adults belong to a group, such as one that is often found within a
workplace, they are likely to derive a sense of identity, at least in part, from that
group. An adults self-concept may be formed from the groups they are associated
with in the workplace. For those adults who feel a sense of belonging within the
Unit 2
AOS 3
Topic 4
Concept 4
Social
determinants
adulthood
Concept summary
and practice
questions
Figure 11.43 The workplace can be

a source of considerable stress.

workplace, a positive self-concept is more likely to develop, thereby promoting
social and mental health.
Community belonging
The degree of connectedness or belonging that an adult feels to their community
is determined by their level of engagement in community-based activities. These
activities enable adults to interact with other people from a diverse range of
backgrounds. Some of the activities may be done purely for the benefits they bring
to the individual (e.g. playing in a sporting team), whereas others may be done
for the benefits that they bring to others (e.g. a human rights group). Many adults
develop a sense of community belonging through becoming volunteers.
Social connections
The term social capital is often used in relation to community belonging as it
refers to the connections between groups and individuals within society. Social
capital includes the level of cooperation, trust and goodwill that is formed between
people, organisations, neighbourhoods and levels of government. Social capital is
important for developing a sense of community wellbeing. Communities that have
limited social capital may exhibit the following:
lack of support and networks for family, friends or community
lack of participation in paid work or volunteering
lack of involvement in local or broader decision making in the community.
Figure 11.44 Volunteering for community groups provides adults with a sense of
community belonging through making a positive contribution to society.
Research has shown that people who feel a sense of community belonging have
better self-reported health. A 2008 Canadian study, Community belonging and
self-perceived health, found that almost two-thirds of people who felt a strong or
somewhat strong sense of community belonging reported excellent or very good
general health. In comparison, only 51 per cent of respondents with a weak sense
of belonging viewed their general health positively.
Involvement in community activities and opportunities for developing a sense of
belonging may impact positively on the individual human development of adults.
426
A strong sense of community belonging can promote self-esteem and provide

opportunities for the development of social skills. Involvement in groups or clubs
that promote physical activity has the benefit of promoting physical development or
the maintenance of the physical components of the body. Intellectually, interacting
with others enables the adult to gain new knowledge and develop new skills.
Volunteering
Volunteering can build a sense of community belonging and impact positively on
health and individual human development. In 2010, 38 per cent of women and
34 per cent of men aged over 18 years were volunteers. Adult males aged 5564
years and adult females aged 3544 and 4554 years in 2010 were most likely to
volunteer (see figure 11.45).
50
Males
Females
Per cent
40
30
20
10
0
1824
2534
3544
4554
5564
Age group (years)
6574
7584
85+
Figure 11.45 Volunteering rate, by age and sex, 2010

Source: ABS.
Volunteering has significant benefits for the health and individual human
development of adults. Research has established a strong link between volunteering
and health. Those who volunteer have lower mortality rates, greater functional
ability, lower rates of depression and longer life expectancy than those who do not
volunteer. In particular, volunteering tends to provide greater health benefits to
adults over the age of 60 than to younger volunteers. Volunteering has a positive
impact on the social and mental health of an adult as it provides opportunities for
developing a sense of purpose and accomplishment and enables social networks to
be developed. For adults with chronic or serious illness, volunteering has significant
health benefits. Reductions in pain intensity and decreased levels of disability were
seen in adults who began to serve as volunteers for others suffering from chronic
pain.
These health benefits have a positive influence on the individual human
development of an adult. Having greater functional ability means that the older
adult is more likely to participate in physical activity, thereby maintaining (or
slowing the deterioration of) body tissues such as muscles and bones. Participation
in regular physical activity also assists in the maintenance of motor skills. Through
interacting with others, the adult is able to maintain or further develop the capacity
to socialise with people from a diverse range of backgrounds. For some volunteers,
situations may arise in which they are required to extend themselves beyond
their comfort zone and learn new skills that enable them to interact effectively
with others (e.g. volunteering to help migrants from a non-English speaking
background). Volunteering also provides opportunities for keeping the mind active.
This increases knowledge and promotes the maintenance and/or development of
intellectual skills.
TEST your knowledge
1 What are the factors that contribute to workplace

stress?
2 Why is social capital important for the health and
individual human development of adults?
3 What benefits does volunteering provide for the
adults?
4 Research the benefits of volunteering and write an

advertisement encouraging people to volunteer
for a selected organisation. In your advertisement,
include the benefits that volunteering provides for
adults.
5 In what ways can the workplace improve the health
and individual human development of adults?
6 Why would volunteering provide greater health
benefits to adults over the age of 60 years than
toyounger volunteers?
7 Referring to figure 11.45, explain possible reasons
for the increase/decrease in the volunteering rate
across the lifespan stages.
11.12
Social determinants: living arrangements

and social support
KEY CONCEPT The impact of living arrangements and social support

on the health and individual human development of adults
Living arrangements
Living arrangements refer not only to the type
of accommodation that an adult lives in but also
to the number of people living together and the
relationships between them. The living arrangements
of adults depend on family composition and lifespan
stage. For instance, young adults may still live at
home with their parents because high costs of
accommodation and/or university combined
with a limited income may make living with their
parents more financially attractive. Their parents
may be prepared to financially support them if they
remain at home, and not having to pay for rent and
other essentials can leave young adults with greater
disposable income to spend on the things they enjoy.
Living with parents can have both positive and
negative effects on the health and individual human
development of young adults. For instance, young
adults living at home are more likely to eat nutritious food prepared by their
parents rather than buying convenient or packaged meals that are high in saturated
fat, salt and sugar. As a result, their risk of developing diet-related diseases is
decreased while the consumption of the required nutrients promotes the growth
and maintenance of the bodys tissues. However, living at home may create a sense
of dependence on their parents, which reduces opportunities forthem to develop
the skills required to live as independent adults.
For the parents, having adult children living at home can increase financial stress
due to the cost of providing for their needs. Having to care for adult children may
impact on the mental health of parents if there is conflict with the children. On
the other hand, the emotional support that some parents may gain from having
their adult children at home can enhance the parents social and mental health and
Research indicates that living arrangements can have a significant impact on
the mortality rates of adults. Being single is associated with higher mortality than
being married or living in a de facto relationship. Living with a partner may have a
protective effect for many reasons, including having greater disposable income for
material resources (e.g. to buy safer cars), the social support provided by a partner
and the positive impact that partners may have on health behaviours (e.g. physical
activity levels).
Figure 11.46 There are a range

of living arrangements available to
adults in the late adulthood stage of
the lifespan.
Living arrangements during late

adulthood
As adults age, decisions need to be made about living arrangements. For those in
the late adulthood stage of the lifespan, where they live is often dependent on their
level of health. For many elderly people, living in the comfort of their own home is
important for them but ill-health may impact on their ability to live independently.
Table 11.7 outlines some of the living arrangements available to the aged.
11.12 Social determinants: living arrangements and social support

Table 11.7 Living arrangements available to elderly people
Living arrangement
Explanation
Benefits to health and individual human development
Staying at home with

the assistance of
community services
For some elderly people, staying at home

requires extra assistance. Home help or local
community services can assist with housework,
meals, personal care and social outings.
Enables the elderly person to remain in an environment in which they feel

comfortable and familiar. Additional services can assist in meeting the
hygiene, health, nutritional, physical activity, social and emotional needs
of the elderly person.
High-level care
homes
This caters for elderly people who require

24-hour nursing care due to immobility or
conditions such as dementia.
The health of the elderly person is monitored and appropriate treatments

and care are provided.
Low-level care homes
This caters for elderly people who may require

some assistance with tasks such as dressing,
eating and bathing, cleaning, laundry and
meals.
Enables the elderly person to maintain some independence while being

provided with assistance to perform tasks they find difficult. Staff can monitor
day-to-day activities such as the taking of medications, physical activity and
nutrition. Provides opportunities for social interaction with others.
Independent living
units (retirement
villages)
Residential communities that offer a range of

services for independent elderly people.
Enables the elderly person to live independently in a community of people

of similar ages. Socialisation and social support are important aspects of
this type of living arrangement. Organised activities provide the elderly
person with opportunities for physical activity, social interaction and the
development of skills and knowledge.
Social support
Figure 11.47 The relationships that an adult has

with others has an impact on health and individual
human development.
Social support refers to the connections that an adult has with

individuals and groups, including family, friends, work colleagues and
other members of their community. These individuals and groups make
up the social network of the person and provide support in a variety
of forms such as the provision of information, practical assistance and
emotional and financial help.
A study conducted in 2010 found that 97 per cent of Australians
aged 18 or over reported having face-to-face contact with family and
friends outside of the household in the previous week (ABS, 2010).
Table 11.8 shows the sources of support during times of crisis for adults
aged 18 years and over. This data indicates that adults are more likely
to seek help from informal sources such as family members and friends
rather than formal support services such as a psychologist.
Table 11.8 Sources of support in times of crisis, by age and sex

Proportion (%) of age
Proportion (%) of sex
1824
years
2534
years
3544
years
4554
years
5564
years
6574
years
7584
years
85 years
or over
Males
Females
All
persons
Friend
77.9
71.1
66.5
64.9
59.1
52.7
34.4
31.1
64.3
63.3
63.8
Neighbour
17.6
17.0
29.7
34.3
32.1
31.2
30.4
34.8
26.8
27.6
27.2
Family member
76.8
80.5
81.3
76.0
79.8
80.0
86.0
73.4
77.9
80.9
79.4
Work colleague
23.3
27.0
23.4
24.3
18.1
*3.1
np
np
21.4
18.3
19.8
Community, charity or
religious organisation
7.4
7.6
11.1
11.3
11.5
11.2
*6.6
*6.9
8.5
10.9
9.8
Local council or other

government services
*3.3
3.7
5.5
5.9
6.6
5.7
*4.1
**5.0
4.6
5.5
5.1
Health, legal or
financial professional
5.2
8.0
9.3
9.6
9.1
8.6
5.3
**12.5
7.4
9.2
8.3
*1.2
*0.4
*0.8
*0.9
*0.4
**0.2
np
np
0.9
*0.3
0.6
Sources of support
In times of crisis (a)
Other sources
(a) Categories are not mutually exclusive.

* estimate has a relative standard error of 25% to 50% and should be used with caution.
** estimate has a standard error greater than 50% and is considered too unreliable for general use.
np not available for publication but included in totals where applicable, unless otherwise indicated.
Source: Australian Bureau of Statistics.
430
There is a significant link between social support and health, particularly in

terms of mental health. For adults, social support is important during worrying
times or times of stress. Prolonged stress and tension can result in aches and pain
such as headaches, migraine and backaches. By discussing the issues with family
and friends, an adult may reduce the associated tension or be offered advice on
how to reduce the stress in their lives.
Social support is recognised as a protective factor for mental health issues such
as depression and anxiety. In particular, good interpersonal relationships, family
cohesion and social connectedness with friends are important for maintaining
positive mental health.
As adults age, social support may decline due to a variety of reasons including:
the loss of a spouse
children leaving home
health problems/disability that prevents interaction with others
a decline in energy that reduces the capacity to be involved with others
a lack of motivation.
This decline in social support can have a significant impact on the health and
individual human development of adults. For instance, the loss of a spouse who
is a main source of support is most likely to cause feelings of grief, which may
result in depression. Major depression causes adults to experience deep sadness
and difficulty in functioning. It may also impair their ability to perform daily tasks
such as the preparation of meals. As a result, the nutritional needs of the adult may
not be met, resulting in weight loss and deterioration of body tissues. Depression
often results in the avoidance of social situations and this reduces opportunities for
social interaction and the maintenance of social skills. Adults with depression are
less likely to be engaged in intellectual pursuits such as reading, which impacts on
their acquisition of knowledge and intellectual development.
On the other hand, an adult who has a supportive network of family and friends
is more likely to experience better health and individual human development. This
social support is more likely to have a positive impact on the mental health of the
adult, so they are more likely to consume the required nutrients, exercise, socialise,
participate in physical activity and engage in intellectual activities.
TEST your knowledge

1 Explain what is meant by the term living
arrangements.
2 What are some of the reasons for the lower
mortality rates of adults living with a partner?
3 Outline the benefits of the four types of living
arrangements for the aged.
4 Define the term social support. What are the
benefits to the adult of social support?

5 Write a response based on the following statement:
The connections that an adult has with others
are important for promoting health and individual
human development.
Unit 2
AOS 3
Topic 4
Concept 4
Social
determinants
adulthood
Concept summary
and practice
questions
6 Mary is 75 years old and still lives in the family

home. Her children have noticed that she is
becoming forgetful and they are concerned about
her ability to care for herself. Physically, Mary is able
to move around with relative ease but she has had a
couple of minor falls that have resulted in significant
bruising. Marys children worry about her capacity
to look after herself.
(a) Outline the possible living arrangements
available to Mary at her stage of the lifespan.
(b) Select a living arrangement that is appropriate
for Mary and justify your choice based on the
information provided.
11.13
Social determinants: family and worklife balance
KEY CONCEPT The impact of family and worklife balance on the

health andindividual human development of adults
Family
Family compositions over the last few decades have changed significantly and this
has resulted in a variety of living arrangements for families. It has also caused
much debate over the definition of a family. According to the Australian Bureau of
Statistics (ABS), A family is two or more persons, one of whom is at least 15 years
of age, who are related by blood, marriage (registered or de facto), adoption, step
or fostering, and who are usually resident in the same household.
Contemporary society is made up of a range of family types. Table 11.9 shows
how the ABS has categorised families.
FIGUrE 11.48 Family compositions
have changed significantly over the
last few decades.
TAblE 11.9 Types of families

Family type
Explanation
Couple family
Two people, both aged 15 years and over, who are married to each other
or living in a de facto relationship with each other
Couple family with

children
A couple family (as defined above) who have children (regardless of age)
usually resident in the family
Couple family without

children
A couple family with no children usually resident in the family (i.e. includes
families where children have left home)
One-parent family
A parent with no resident partner (married or de facto), with at least one

child (regardless of age) usually resident in the family
Step family
A couple family containing at least one child who is the stepchild of either
parent, and no children who are the natural children of both parents
Blended family
A couple family containing both natural and stepchildren (i.e. at least one
child is the natural child of both parents, and one child is the step-child of
either parent)
Many factors have contributed to changes in family compositions, including:

Divorce. The introduction of the Divorce Law Act in 1975 meant that it became
easier for married couples to divorce. In 2013, 47 638 divorces were granted
in Australia. Of these divorces, 47.4 per cent involved children. Divorce has
resulted in increases in single-parent families and in step and blended families as
individuals with children meet and develop new relationships with each other.
Divorce
Careers
Contraception
Factors
impacting on
family
composition
FIGUrE 11.49 Factors impacting on family composition
432
Increasing costs
of living
Careers. As increasing numbers of women are employed in higher paid positions,

many are choosing to focus on their careers and consequently not having
children.
Contraception. The availability of the contraceptive pill has resulted in women
being able to decide whether or not to have children, when to have children and
how many children to have. As gaining a post-school qualification has become
more desirable, more women are postponing having children. Consequently, a
greater proportion of women have remained childless into their 30s and 40s.
Increasing costs of living. As the costs of living increase, more children are delaying
leaving home, preferring to be supported by their parents. This has also resulted
in people choosing to delay parenthood or deciding not to have children at all.
There are many advantages and disadvantages associated with each family
type that need to be considered according to individual family circumstances. An
appropriate example might be a couple family with children where the parents
are constantly in conflict. The financial support that may come from both parents
working or from one parent financially supporting the family is an advantage.
However, the constant conflict and arguments are a disadvantage that may lead to
mental health issues for individuals within the family.
The composition of families can have a positive and/or negative impact on health Figure 11.50 A couple family
and individual human development. For instance, a couple family with children with children may have the financial
may be financially secure, enabling them to access resources such as nutritious resources to purchase nutritious food
food and health care. This reduces the risk of diet-related conditions and impacts and practise an active lifestyle.
positively on the physical health and development of all family members. The
loving relationships that develop between the parents and the children will promote
the social and mental health and individual human development of the adults
within the family. Adults who feel connected to their family are more likely to
experience positive mental health and will therefore be more inclined to pursue
activities that promote their intellectual development.
Another example might be a single parent who has the responsibility of raising
children who may face significant financial pressure. Limited income affects the food
selection of adults because cheaper foods are more readily available, and tend to be
higher in saturated fats, salt and sugar significant factors in the development of
diet-related diseases/conditions such as obesity, cardiovascular disease, colorectal
cancer and type 2 diabetes. Having to care for children may limit the time available for
the single parent to participate in physical
activity. Poor nutritional intake and lack
of physical activity can reduce muscle
mass and bone density and increase the
risk of overweight and obesity. The single
parent may experience considerable stress
from the effort of meeting the financial,
emotional and social needs of the children.
The opportunities for social occasions may
be limited by lack of finances to pay for
such activities as well as the limited time
available due to being the sole caregiver
of the family. This can impact on the
maintenance or development of social
skills for the adult. This type of family
situation may also reduce the chances
of pursuing further education or even
partaking in activities that informally
promote the attainment of knowledge and Figure 11.51 Children of single parents who make junk food readily available may
the development of intellectual skills.
be at higher risk of diet-related diseases.
11.13 Social determinants: family and worklife balance
Worklife balance
Unit 2
AOS 3
Topic 4
Concept 4
Social
determinants
adulthood
Concept summary
and practice
questions
Worklife balance refers to the working conditions of parents/carers being

conducive to ensuring that the social and emotional needs of all family members
are being met as well as enabling adults to pursue their own recreational/leisure
activities. For many Australian parents/carers, the amount of hours they are
required to work impacts significantly on their capacity to effectively balance the
needs of their families with their work commitments. Approximately 15 per cent
of employed persons worked more than 50 hours per week in 2010 (ABS, 2010).
Figure 11.52 Worklife balance is important for the health and individual human
eLesson:
The misery of long hours
The inability to effectively balance work and family life impacts on the health
and individual human development of adults. Work-related stress can occur for
a range of reasons. One of these reasons is pressure from the demands of the job
in terms of amount of hours worked or level of responsibility. Extended working
hours impacts significantly on the individuals capacity to meet the needs of their
family and to pursue recreational/leisure activities. Symptoms of work-related
stress include:
depression
anxiety
feelings of not being able to cope
reduced work performance
sleeping difficulties
reduced ability to concentrate
fatigue
headaches
heart palpitations
gastrointestinal problems such as diarrhoea
increased aggression.
Work-related stress can result in a deterioration of personal relationships and, in
the long term, can increase the risk of cardiovascular disease.
Over the past two decades there has been a significant increase in the number
of hours worked by full-time employees, and more children are growing up in
families in which both parents work. Another factor that is contributing to the
difficulty of achieving worklife balance is the fact that people are spending more
time commuting to work. Information and communication technology allows
work to intrude on family life via mobile phones and email. The Relationships
Indicator Survey conducted by Relationships Australia in 2008 found that at least
50 per cent of respondents had indicated work pressure and a lack of time to
spend withtheir partner as key factors that could impact negatively upon partner
relationships.
Many adults are in the situation of simultaneously caring for children and
ageing parents. This may cause increased stress as they take on the additional
responsibilities of ensuring that the health and individual human development
needs of their parents are being met. Nutrition, physical activity, social interaction,
health care, housing and transport are examples of factors that need to be
considered when caring for ageing parents.
TEST your knowledge

1 What is the ABS definition of family?
2 What factors have impacted on the changing
composition of families?
3 Outline the advantages and disadvantages of each
type of family.
4 Explain what is meant by worklife balance.
5 What are the symptoms of work-related stress?

6 George and Maria are both in their mid-40s and
have been married for 15 years. They have two
teenage children, Sarah and Michael, who both
attend the local secondary college. George is
a successful businessman for a large company
and often works late in the evening and on
weekends. Maria works one day a week in the
Weblink:
Australians unhappy with worklife
balance?
local supermarket and tends to spend a lot of

time driving the children to their sports and music
lessons, as well as their part-time jobs.
(a) What type of family is represented in this
casestudy?
(b) In what ways can this particular family
composition impact on the health and individual
human development of George and Maria?
(c) Explain the possible impacts that Georges
working life may have on his and Marias health
7 Choose one family type and explain how it can
impact on the health and individual human
development of family members.
8 Use the Australians unhappy with worklife
balance links in the Resources section of
your eBookPLUS to find the weblink and

human development of Australias adults
individual human development and their impact on
adults, using relevant examples
This is one of the factors listed in
the study design as a behavioural

determinant of health and individual
human development.
It is important to outline what

physical activity is.
It is important to include information

relevant to the chosen factor. In this
instance, the level of physical activity
required is important in determining
the health benefits to the adult.
Better sleeping patterns means that
the adult is more alert and able to

concentrate, thereby enhancing the
capacity to develop intellectual skills.
Highlights the impact on physical

health.
Highlights the impact on physical

development.
Highlights the impact on mental

health.
Highlights the impact on social health

and development.
Highlights the impact on emotional

development.
Include relevant statistical data that
highlights the impact of physical

activity on the health and individual
human development of adults.
In order to demonstrate this skill, a thorough understanding of the determinants of

health and individual human development and how they relate to Australian adults
is essential. The ability to use relevant examples to demonstrate this understanding
is expected. When outlining the determinants of health, it is important to remember
the following:
There is a significantly large range of determinants that impact on the health
and individual human development of a population. Select those determinants
that are listed in the study design because these are considered to be the most
relevant.
Focus on determinants that are relevant to the adulthood stage of the lifespan
and ensure that the discussion makes reference to how the selected determinant
impacts on adults.
In order to clearly demonstrate an understanding of the impact of a selected
determinant on the health and individual human development of adults, it is
important to first outline what the determinant is.
The determinants of health and individual human development help to explain
or predict trends in health. When outlining the impact of a selected determinant,
explain the way in which it impacts on the physical, social and mental health of
the individual. When referring to the effects on individual human development, it
is important to also consider the possible impact on each type of development
physical, social, emotional and intellectual.
Where possible, use relevant statistics that outline the impact of the selected
determinant on the health and individual human development of an adult.
In the following example, the role played by physical activity as a behavioural
determinant of health and individual human development is explained.
Physical activity is considered to be an important behavioural determinant
in promoting the health and individual human development of adults. Physical
activity involves body movement or exercise that may vary in intensity (e.g.
walking, swimming, cycling and competitive sport).
Australias Physical Activity and Sedentary Behaviour Guidelines give the
minimum levels of physical activity required for good health. It is recommended
that adults do at least 30 minutes of moderate-intensity physical activity on most,
preferably all, days. Examples of moderate-intensity activity include a brisk walk
or cycling. Short sessions of different activities of 1015 minutes can be combined
for a total of 30 minutes or more. Regular, more vigorous exercise that makes the
adult huff and puff will have further health and fitness benefits.
The benefits of regular physical activity to the health and individual human
development of adults have been well documented and include: improved longterm health, reduced risk of heart attack, better weight management, lower blood
cholesterol and blood pressure, better sleeping patterns (physical health),
stronger bones and muscles (physical development), promotion of feelings of
happiness and being relaxed (mental health), improved social relationships and
the development of social skills (social development) and improved confidence
and self-concept (emotional development).
According to the Get Moving Tasmania program, regular moderate physical
activity can reduce the risk of a coronary event such as heart attack by up to
40 per cent, while regular, more vigorous exercise can reduce the risk by up to
50 per cent. The risk of stroke can be reduced by up to 30 per cent with regular
moderate levels of physical activity.
In the following example, the impact of alcohol consumption as a behavioural

determinant of health and individual human development is explained.
Alcohol impacts on the health and individual human development of adults. It is
often related to social issues such as domestic violence, assault and unemployment,
as well as being linked to a range of physical health concerns. When consumed,
alcohol is metabolised in the liver; however, the liver can metabolise only a small
amount of alcohol at a time. Alcohol that is not metabolised is circulated around
the body via the circulatory system. It can have a toxic effect on the central nervous
system and cause changes to an adults metabolism, heart function and blood
supply. The absorption of thiamine (an important nutrient for brain function), may
be affected by the consumption of alcohol, and wastage of brain cells may occur
due to the dehydrating effects of alcohol.
In order to address the many alcohol-related health issues, the National Health
and Medical Research Council has developed the Australian Alcohol Guidelines
to Reduce Health Risks from Alcohol (2009), which recommends that both
womenandmen drink no more than two standard drinks a day over their lifetime
if they want to reduce their risk of being harmed by an alcohol-related injury or
disease.
High levels of alcohol consumption increase the risk of a range of conditions
such as heart and vascular diseases, cirrhosis of the liver, and some cancers. One of
the many conditions that may occur as a result of the overconsumption of alcohol
is alcohol-related brain impairment (ARBI). More than 2500 Australians are treated
for ARBI every year and it is estimated that over two million Australians are at risk
of ARBI due to their level of alcohol consumption. The effects of ARBI can range
from mild to very severe, and may include changes in cognition (the ability to
think and reason), difficulties with movement and coordination, and a range of
medical and neurological disorders.

1 What does the acronym ARBI stand for?
2 How many people are treated for ARBI annually inAustralia?
3 Approximately how many Australians are at risk ofARBI?
4 Alcohol consumption is one of the many behavioural determinants of health and
individual human development. Outline three more behavioural determinants.
5 Outline the effects that the overconsumption of alcohol can have on the health
and individual human development of an adult.

6 Refer to table 11.10 to answer some of the following questions.
Table 11.10 Problems most commonly managed at GP encounters, people aged
2564, 200809
Males
Problem
Hypertension
Females
Per 100
encounters
10.2
Problem
Per 100
encounters
Hypertension
7.1
Lipid (cholesterol) disorders
5.6
Depression
6.9
Acute upper respiratory

infection
4.9
Female genital check up
5.7
Diabetes
5.0
Acute upper respiratory infection
5.1
Depression
4.8
Lipid (cholesterol) disorders
3.6
Source: AIHW 2010, Australias health 2010, cat. no. AUS 122, Canberra, p. 315.
KEY SKILLS The determinants of health and individual human development of Australias adults
(a) Outline one determinant of the health and individual human development
thatmight account for the difference between male and female rates of
hypertension.
2 marks
(b) Explain how cholesterol levels contribute to stroke.
1 mark
(c) Explain how two behavioural determinants of health and individual human
development contribute to one of the conditions listed in the table.
2 marks
(d) Explain, with reference to specific nutrients, the role of nutrition as a risk factor for
coronary heart disease.
2 marks
7 Refer to figure 11.53 to help answer the following questions.
Inadequate fruit and vegetable
consumption
Insufficient physical activity
Overweight and obesity
Daily smoking
Males
Females
Risky alcohol use (long-term)

FIGURE 11.53 Prevalence of selected
health risk factors in people aged
2544, by sex, 201112
Source: AIHW 2014, Australias health 2014 in
brief, p. 29
High blood pressure

0
20
40
60
Per cent
80
100
(a) Explain the relationship between food intake, exercise and overweight/obesity.
2 marks
(b) Select five risk factors from the table and describe one disease related to each risk
factor.
5 marks
(c) Provide two reasons why it is important for the health and individual human
development of an adult to enjoy a wide variety of nutritious foods.
2 marks
8 Many studies show that people or groups who are socially and economically
disadvantaged have reduced life expectancy, premature mortality, increased
diseaseincidence and prevalence, increased biological and behavioural risk factors
forill-health, and lower overall health status (AIHW2008, Australias health 2008,
cat. no. AUS 99, Canberra, p. 65).
(a) Explain the term socioeconomic status.
1 mark
(b) Explain the relationship between education, employment and income.
3 marks
(c) Explain one behavioural and one biological determinant of health and individual
human development that puts individuals from lower socioeconomic status
backgrounds at greater risk of ill-health.
2 marks
(d) Explain two diseases/conditions that individuals from lower socioeconomic status
backgrounds are at greater risk of developing.
2 marks
Chapter 11 review
Chapter summary
The biological determinants that impact adult health and individual human development
include genetics, body weight, blood pressure and blood cholesterol levels.
Interactivities:
Chapter 11 Crossword
Two examples of genetic conditions that impact on adult health and individual human
development are Alzheimers disease and Huntingtons disease.
Genetic predisposition can be a significant risk factor in the development of diseases
such as cancer and type 2 diabetes.
The body weight of adults is largely determined by the combination of genes that are
inherited from the biological parents as well as lifestyle and behaviours such as physical
activity levels and food intake.
Overweight and obesity significantly increase the risk of a range of illnesses and
conditions, such as type 2 diabetes, cardiovascular disease and stroke.
Unit 2
AOS 3
Sit Topic test
The
determinants
of health and
individual
human
development of
Australias
adults
Blood pressure measures the force of the blood on the walls of the arteries and is
recorded as systolic and diastolic measurements.
High blood pressure is a major risk factor for coronary heart disease, stroke, heart
failure and kidney failure.
High blood pressure becomes more common with age due to the arteries becoming
more rigid.
Cholesterol is a type of fat that has a range of functions within the human body. It
produces hormones, assists with digestion through the production of bile acids, and is
an essential component of cell membranes.
Low-density lipoprotein (LDL) cholesterol is referred to as bad cholesterol as it
contributes to atherosclerosis.
High-density lipoprotein cholesterol (HDL) is referred to as good cholesterol because it
can help unclog arteries.
A range of behavioural determinants impact on the health and individual human
In Australia, the risk of skin cancer as a result of too much sun exposure needs to be
balanced with the need to maintain adequate vitamin D levels.
There are three types of skin cancer: squamous cell carcinoma, basal cell carcinoma and
melanoma. Melanoma is the most dangerous form of skin cancer.
Tobacco smoking is the single most preventable cause of ill-health and death in the
Australian population.
Tobacco smoking is a major risk factor for a range of illnesses including cancer,
cardiovascular disease and stroke.
The most common form of cancer that is caused by smoking is lung cancer.
The risk of dying from coronary heart disease is 70 per cent greater for a smoker than
for a non-smoker.
It is recommended that adults be involved in at least 30 minutes of moderate-intensity
physical activity on most (preferably all) days.
The overall level of physical activity for Australian adults is below what is recommended.
Low levels of physical activity can lead to cardiovascular disease, type 2 diabetes,
obesity and poor mental health.
By the adulthood stage of the lifespan, growth has ceased and, as a result, nutrients for
the maintenance of body tissue rather than growth become more important.
Certain nutrients can act as a risk or protective factor for specific diet-related diseases.
A risk factor increases the likelihood of a disease occurring whereas a protective factor
helps guard against the development of a disease.
One of the main issues related to dietary intake in the Australian population is an
inadequate consumption of fruit and vegetables.
A safe level of drinking for adults is no more than two standard drinks per day.
The level of alcohol consumption among adults has decreased.
440
Excessive alcohol consumption is associated with many diseases, illnesses and injuries,
violence and drowning.
Drug use may arise from an inability to cope with adult responsibilities.
Cannabis is the most commonly used illicit drug and is associated with psychosis and
other mental health disorders.
The use of ice by young adults has increased, creating significant health problems.
Decisions made about sexual practices during adulthood are a continuation of decisions
and experiences made during youth.
Unprotected sex is associated with sexually transmitted infections, in particular
chlamydia, infertility and unwanted pregnancy.
Housing stress occurs when the cost of housing (either rental or mortgage) is high in
relation to household income.
During the adulthood stage of the lifespan, more time is spent in the work
environment, which means that there is a greater risk of workplace injuries and
illnesses.
While office jobs have a relatively low risk of injury, conditions related to overuse of
technology are becoming more common.
Shift work is a risk factor for work-related injury.
Fears for personal safety within neighbourhoods can restrict adults participation in
social occasions and reduce their trust in the community.
Not all Australians have equal access to health care, with people living in rural and
remote communities, those from low socioeconomic background and Indigenous
people being most disadvantaged.
Access to services such as BreastScreen and the National Bowel Cancer Screening
Program can improve health outcomes.
Mammography screening involves taking a low dose X-ray of the breasts to detect any
changes in the breast tissue.
Bowel cancer is a cancerous growth or growths that occur on the inside of the colon or
rectum.
If detected early, bowel cancer can be successfully treated, but only 40 per cent of
bowel cancers are detected early.
Bowel cancer screening is successful in the early detection of bowel cancer.
All forms of media have the potential to influence the actions, beliefs, values, opinions
and ideas of adults.
Those from a high socioeconomic background tend to have the most resources,
opportunities and power to make decisions compared with those from a low
socioeconomic background.
Unemployment has a significant impact on health status as it limits peoples capacity
to access health resources and services, and it can have an effect on mental and social
health.
Poorer health, greater levels of disability and higher mortality tends to occur in people
employed in low-skilled manual labour compared with those in managerial/professional
occupations.
The degree of connectedness or belonging that an adult feels to their community is
determined by their level of engagement in community-based activities.
Social capital refers to the connections between groups and individuals within society.
Those who volunteer have lower mortality rates, greater functional ability, lower rates
of depression and longer life expectancy than those who do not volunteer.
Social support refers to the connections that an adult has with individuals and
groups, including family, friends, work colleagues and other members of their
community.
Socioeconomically disadvantaged individuals are more likely to die sooner after serious
illness than those who are socioeconomically advantaged.
CHAPTER 11 review
A family is described as two or more persons, one of whom is at least 15years of age,
who are related by blood, marriage (registered or de facto), adoption, step or fostering,
and who are usually resident in the same household.
There are many factors that have contributed to changes in family compositions and
therefore living arrangements including divorce, careers, contraception and increased
living expenses.
Worklife balance relates to the working conditions of parents/carers being conducive
to ensuring that the social and emotional needs of all family members are being met as
well as enabling adults to pursue their own recreational/leisure activities.
For many Australian parents/carers, the amount of hours they are required to work
impacts significantly on their capacity to effectively balance the needs of their families
with their work commitments.
Work-related stress can result in a deterioration of personal relationships and, in the
long term, can increase the risk of cardiovascular disease.
More young adults are choosing to live longer with their parents.
Being single is associated with higher mortality than being married or in a de facto
relationship.
TEST your knowledge
1 Outline the following determinants of health and

individual human development in relation to adults
and provide an example of each type:
(a) biological
(b) behavioural
(c) physical environment
(d) social.
2 Develop a brochure/web page that advises adults

on ways of improving health. In your brochure/web
page, make sure you refer to factors associated with
each of the determinants of health and individual
human development.
442
CHAPTER 12
Health issues facing

Australian adults
WHY iS THiS iMPORTANT?
Although the health status of adults in Australia is
generally good, there are some health issues that impact
significantly on burden of disease. Obesity, cardiovascular
disease, cancer,type 2 diabetes and mental illness
are examples of common health issues facing adults.
Understanding these issues and the corresponding
determinants of health allows personal, community and
government strategies and programs to be implemented
to promote the health and development of adults.
KEY KNOWLEDGE
3.6 determinants that act as risk and/or protective factors in relation
to one health issue such as cardiovascular disease, cancer, type 2
diabetes, obesity or mental illness (pages 44662, 4745)
3.7 government, community and personal strategies and programs
adults (pages 46371, 4745).
KEY SKILLS
describe a specific health issue facing Australias adults and draw
informed conclusions about personal, community and government
strategies and programs to optimise adult health and development
(pages 448, 452, 455, 458, 462, 468, 471, 4723, 4745).
FiguRE 12.1 Participating in

physical activity throughout
adulthood can promote the health
and development of adults and
assist in preventing a range of
health issues including obesity,
cardiovascular disease, type 2
diabetes, some cancers and mental
illness.
444
uNiT 2 Individual human development and health issues

atherosclerosis a condition where the blood vessels
become hardened and/or narrowed, thereby restricting
blood flow
mammography (mammogram) a breast scan used
to detect breast cancer
metastasise the process whereby cancerous cells
spread to other organs or tissues in the body
tumour a cluster of abnormal cells
12.1

protective factors in relation to obesity

protective factors in relation to obesity
The biological, behavioural, physical environment and social determinants play a
vital role in the health outcomes of adults in Australia. A range of health issues
contribute significantly to burden of disease during adulthood (figure 12.2) and are
the product of a combination of these determinants.
By understanding these health issues and the determinants that act as risk and/
or protective factors for them, a range of personal, community and government
strategies and programs can be implemented to optimise the health and individual
human development of adults in Australia.
Obesity
Cardiovascular
disease
Mental
Illness
Health issues
affecting
adults
Type 2
diabetes
Cancer
FiguRE 12.2 Some of the range of health issues affecting adults
Health issue: obesity

Obesity relates to having excess body weight in the form of fat that can be
harmful to health. In adults, obesity is measured using waist circumference
or the body mass index (BMI). A waist circumference of over 89 cm for
females and 102 cm for males indicates obesity and an increased risk of
conditions such as cardiovascular disease and type 2 diabetes. BMI is a
weight-to-height ratio and is calculated using the following formula:
Weight (kg)
Height (m)2
FiguRE 12.3 Waist circumference is

increasingly being used to measure obesity.
446
A score of 30 or over indicates obesity. BMI does not take body type into
account and should be used with caution when making assessments of
individuals. It is more useful when analysing statistics relating to population
groups.
Obesity has a range of impacts on the health of adults, including an increased

risk of cardiovascular disease, some cancers, type 2 diabetes and mental illness.
Why is obesity a health issue for

adults?
Obesity is a significant health issue for adults in Australia as rates have increased
significantly over the past 25 years and continue to increase. Obesity is a risk factor
for many illnesses, including those that can lead to premature death, and contributes
significantly to burden of disease as a result. According to the ABS Australian Health
Survey (updated results, 2014), in 201112 around 27 per cent of adults were
classified as obese. Specifically, for those aged 18 and over in this period:
27.3per cent of males were obese
27.1percent of females were obese.
Although overweight and obesity are distinct conditions, they are related in
that an individual who is overweight is at greater risk of developing obesity than
a person with a healthy body weight. Rates of overweight and obesity are often
combined, but in Australia the rate of overweight is significantly higher than the
rate of obesity. The proportion of Australian adults who are overweight or obese
has increased over time (figure 12.4).
80
70
Per cent
60
50
Males
Females
40
30
20
10
0
1995
1997
1999
2001
2003
Year
2005
2007
2009
201112
Figure 12.4 Proportion of adults

(aged 18 and over) who were
overweight or obese, 1995 to 201112
Source: ABS, Australian health survey: first results,
201112, p. 25.

obesity
Biological
Body weight is itself a biological determinant and obesity is a risk factor for other
conditions such as cardiovascular disease, some cancers and type 2 diabetes.
Biological risk factors for obesity include:
Age. As metabolism slows down with age, it becomes more difficult to maintain
weight.
Genetics. Some people may have a genetic predisposition for overweight or obesity.
Basal Metabolic Rate (BMR). A lower BMR results in less energy being used and
can therefore contribute to obesity.
Health issues facing Australian adults CHAPTER 12 447
12.1 Determinants that act as risk and/or protective factors in relation to obesity
Behavioural
Behavioural factors that increase the risk of obesity include:
Lack of physical activity. Less energy is expended or burned in those who are not
physically active, which increases the risk of weight gain.
Alcohol consumption. Alcohol contains kilojoules and therefore energy, which
means it can increase the chances of an individual gaining weight (figure 12.5).
Dietary behaviours. Foods containing large amounts of fat and simple
carbohydrates such as sugar contribute significant kilojoules to the body. Over
time, if this energy is not expended then weight gain can occur.
Figure 12.5 Alcohol consumption is

a significant risk factor for obesity.
The physical environment can contribute to obesity in a number of ways as a

result of:
Access to recreation facilities. If individuals do not have access to recreation
facilities such as cycling and walking paths, they may not have the same
opportunities for physical activity as others. This can increase body weight and
contribute to obesity.
The work environment. A work environment that does not foster incidental
exercise can increase the risk of obesity. For example, a work environment that
has car parking next to the entrance, no stairs and a small office space can reduce
the level of incidental physical activity and contribute to weight gain.
Social
Unit 2
AOS 3
Topic 5
Concept 1
Obesity
Concept summary
and practice
questions
Some of the social determinants that have a relationship with obesity include:
Education. Those with lower levels of education are more likely to be obese.
This could be a result of lower levels of knowledge relating to the importance of
physical activity and food intake.
Occupation. People who are active as part of their job expend more energy in
their day than people who work in more passive occupations or spend prolonged
periods sitting.
Income. People who cant afford or cant access a healthy food supply may rely
on processed food, which tends to be higher in fat and sugar and lower in fibre,
therefore adding kilojoules to the diet.
TEST your knowledge

1 (a) Briefly explain obesity.
(b) Explain two ways in which obesity is measured.
(c) Outline the limitation of the body mass index in
assessing obesity.
2 Explain why obesity is a health issue for adults.

3 (a) Outline the trends evident in figure 12.4.
(b) Discuss possible reasons for the trends identified
in part (a).
4 Prepare a poster that could be used to educate adults
about the risks of obesity and the determinants that
can protect against/contribute toit.
5 Explain three ways in which obesity could impact on

the health and/or individual human development
ofadults.
6 Use the Obesity links in the
7 Use the Tackling obesity links in
448
12.2
Determinants that act as risk and/or protective

factors in relation to cardiovascular disease

protective factors in relation to cardiovascular disease
Health issue: cardiovascular disease

Cardiovascular disease relates to all diseases of the heart and blood vessels.
Examples include hypertension (sometimes referred to as high blood pressure),
coronary heart disease, stroke, heart failure and peripheral vascular disease (which
affects the extremities, particularly the legs and feet); see figure 12.6.
Cardiovascular disease is characterised by an inability of the heart to pump blood
effectively to all tissues in the body. The cause may be in the heart itself, or the blood
vessels carrying the blood. Without an adequate blood supply, cells and tissues cannot
function normally and may die. If blood vessels become completely blocked, major
organs including the brain and heart may be permanently damaged, which may lead to
death. Even if blood flow is restored, permanent damage may have already occurred.
Stroke

Heart attack
Hypertension (can cause
kidney failure)
Peripheral vascular
disease
FiguRE 12.6 The common sites for

Atherosclerosis is the underlying condition in most forms of cardiovascular

disease. Atherosclerosis is a condition where the blood vessels become hardened
and/or narrowed, thereby restricting blood flow. Atherosclerosis is caused by a
build-up of plaque on the walls of blood vessels, which narrows the passages that
the blood has to pass through. The plaque is made up of cholesterol, other fatty
substances, human tissue and calcium. Cholesterol is a waxy substance and acts
Health issues facing Australian adults CHAPTER 12
449
12.2 Determinants that act as risk and/or protective factors in relation to cardiovascular disease
like glue to hold the other materials against the artery wall. Over time, the plaque
becomes thicker, which results in an overall narrowing of the artery (figure 12.7).
This restricts blood flow, and therefore oxygen supply, to various parts of the body
(depending on where the build-up is occurring). This puts strain on the heart and
the organs or muscles that the blood is being pumped to.
Normal
artery
Artery
with
plaque
Restricted
blood flow
Normal
blood flow
FiguRE 12.7 Atherosclerosis blocks
blood vessels and therefore restricts
blood flow.
Why is cardiovascular disease a

health issue foradults?
Per cent
Although mortality rates for cardiovascular disease have decreased in recent

decades, it is still the most common cause of death among adults in Australia and
the second largest contributor to overall burden of disease. Cardiovascular disease
is also one of the most common conditions experienced by adults and becomes
more common with age (see figure 12.8).
FiguRE 12.8 Proportion

of persons with
cardiovascular disease,
201112
Source: ABS, Australian health
survey: first results, 201112, p. 20.
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
1524
Males
Females
2534
3544
4554
Age group (years)
5564
6574
75+

Biological
A range of biological determinants can increase the chances of developing
cardiovascular disease. Examples include:
Body weight. Increased body weight usually places greater strain on the heart.
There is also an increased risk of high levels of cholesterol in the blood and a
higher risk of hypertension.
450
Blood pressure. High blood pressure is an indicator that the heart is already
working harder to pump the blood, and can increase the risk of heart attack and
stroke.
Blood cholesterol. High blood cholesterol increases the risk of plaque building
up on artery walls (atherosclerosis), making it harder for the blood to get
through.
Genetic predisposition. Having family members (particularly in the immediate
family) with cardiovascular disease increases the individuals risk of cardiovascular
disease.
Being male. Men carry more fat around the abdomen, which places them at
increased risk of cardiovascular disease. This may occur due to hormonal
differences between males and females.
Advancing age. Metabolism slows as people age, making weight management
more difficult. The heart also loses its efficiency with age, contributing to
Behavioural
Behavioural determinants that play a role in the development of cardiovascular
disease include:
Physical activity. Lack of physical activity means less energy is used and this
increases the risk of weight gain, a risk factor for cardiovascular disease. Regular
physical activity also acts to exercise the heart muscle and maintain the flexibility
of the blood vessels. As a result, being physically inactive can speed up the
hardening process and contribute to cardiovascular disease.
Dietary behaviours. Food intake is one of the most significant factors in
the development of cardiovascular disease. Food intake can contribute to
cardiovascular disease in numerous ways. For example:
foods that contain saturated or trans fat increase the levels of low density
lipoprotein (LDL) cholesterol, the bad cholesterol. LDL cholesterol can stick
to the blood vessel walls and contribute to atherosclerosis and cardiovascular
disease.
a diet low in fibre can increase cholesterol levels in the body and contribute to
overeating. If an individual overeats over a period of time, the risk of weight
gain and cardiovascular disease increase.
Smoking. Smoking tobacco and other drugs speeds up the process of atherosclerosis
and therefore contributes to cardiovascular disease. Smoking increases the risk of
cardiovascular disease by up to six times that of a non-smoker.
Alcohol use. Alcohol contributes extra kilojoules to the diet and can lead to
obesity and cardiovascular disease.
Factors within the physical environment can act to increase or decrease the risk of
cardiovascular disease. Examples include:
Access to recreation facilities. Being able to access recreation facilities such as
walking and cycling paths, parks, beaches and gymnasiums can increase the
ability to exercise. With adequate exercise, the risk of obesity and cardiovascular
disease decrease.
Proximity to health care. Being able to readily access health care may lead to
issues such as hypertension being diagnosed and interventions put in place to
reduce the risk of cardiovascular disease.
Exposure to environmental tobacco smoke. Being exposed to environmental
tobacco smoke can contribute to atherosclerosis and increase the risk of
12.2 Determinants that act as risk and/or protective factors in relation to cardiovascular disease
Social
Unit 2
AOS 3
Topic 5
Concept 2
Cardiovascular
disease
Concept summary
and practice
questions
A range of social determinants play a role in the development of cardiovascular

disease. Examples include:
Education. Those who are adequately educated with regards to food intake,
the dangers of smoking and the benefits of regular physical activity are more
likely to adopt healthy behaviours and are at a decreased risk of weight gain and
Income. Those with low incomes may not be able to afford nutritious foods
which can increase the dependence on processed foods that may be high in fat.
This can increase energy intake and contribute to obesity and cardiovascular
disease.
Work. If an individual is experiencing workplace stress, they are more likely to
experience hypertension which increases the risk of cardiovascular disease.
Occupation. Occupations where individuals spend extended periods of time
sitting, such as office work, can reduce levels of physical activity and contribute
to obesity and cardiovascular disease.
TEST your knowledge

1 Explain cardiovascular disease.
2 Describe atherosclerosis.
3 Why is cardiovascular disease an issue for adults in
Australia?
4 Discuss the determinants of health that may
increase or decrease the risk of cardiovascular
disease among adults.

5 Using the determinants of health as the basis of
your response, explain reasons that may account for
males experiencing higher rates of cardiovascular
disease than females.
6 Explain how an individuals occupation could increase
or decrease the risk of cardiovascular disease.

adults about cardiovascular disease and ways that
individuals can reduce their risk of these conditions.
8 Research one of the following:
hypertension
coronary heart disease
stroke
heart failure
peripheral vascular disease.
Prepare a fact sheet that includes:
(a) a description of the condition
(b) relevant statistics (use Australian data)
(c) factors that work to increase or decrease the risk
of the condition.
452
12.3

protective factors in relation to cancer

protective factors in relation to cancer
Health issue: cancer

Cancer is a disease characterised by the uncontrolled growth
of abnormal cells (figure 12.9). The human body produces
millions of new cells per second to replace those that have
died or are no longer functioning correctly. This is a normal
part of life and is required to ensure that all organs and
systems function normally. If abnormal cells are created, they
are usually destroyed by the immune system. In some cases,
these cells either arent recognised as being abnormal, or the
immune system cannot kill them. As a result, they may grow
and divide and form a cluster of abnormal cells called a tumour.
Untreated, the cancerous cells may invade nearby tissue and
prevent normal cells from carrying out their functions. They
may also metastasise, and spread to other parts of the body.
The type of cancer experienced depends on the site of the initial tumour. The
breast, prostate, lung and skin are common sites for cancer in Australia.
Why is cancer a health issue for

adults?
Figure 12.9 A computer-generated

image of a cancer cell. They can divide
quickly and move, which makes them
a serious threat to normal cells.
Cancer is a significant health issue for adults as it is the leading cause of premature
death in Australia. Cancer is also the greatest contributor to overall burden of
disease and injury in Australia.
In 201112, there were 326600 persons who had cancer, or around 1.5percent
of the Australian population.
The prevalence of cancer increased with age, with the highest rate for males
and females being in those aged 75 and over 11.1 per cent and 4.4 per cent
respectively (see figure 12.10).
14
Males
Females
12
Per cent
10
8
6
4
2
0
014
1524
2534
3544
4554
5564
Age group (years)
6574
75+
Figure 12.10 Proportion of persons with cancer, 201112

Source: ABS, Australian health survey: first results, 201112, p.18.
12.3 Determinants that act as risk and/or protective factors in relation to cancer

cancer
Cancer has been linked to a number of risk and protective factors. Understanding
these factors can assist in reducing the risk of developing cancer by guiding
individual, community and government groups in implementing relevant programs
and strategies.
Biological
Body weight. The exact link between obesity and cancer is not completely
understood but those with excessive body weight experience higher rates of
certain cancers, including breast cancer and colorectal cancer.
Age. Advancing age is a risk factor for many types of cancer including prostate,
breast and colorectal cancer.
Genetic predisposition. Some people are more likely to develop cancer than
others. The genetic influence seems to be particularly important for certain
cancers, such as breast cancer and prostate cancer.
Behavioural
Figure 12.11 Sun protection

measures such as using sunscreen can
reduce the risk of skin cancer.
Behavioural factors that play a role in the development of cancer include:

Tobacco smoking. Tobacco smoke contains thousands of chemicals and many of
these have been shown to cause cancer (see figure12.12). Tobacco smoking can
contribute to cancer in almostall parts of the body especially the lung, mouth
and oesophagus.
Alcohol consumption. Alcohol can contribute to certain cancers, such as breast
cancer.
Dietary behaviour. A low fibre diet may increase the chances of colorectal cancer.
Fruit and vegetables are rich in nutrients, which may also play a protective role
in colorectal cancer.
Sun protection. Exposure to sunlight and UV radiation increases the chances of
developing skin cancer. Adults who do not practise sun safety are at an increased
risk (figure 12.11).
Figure 12.12 Individuals exposed

to environmental tobacco smoke
experience an increased risk of cancer.
Aspects of the physical environment that play a role in

cancer include:

Environmental
tobacco
smoke.
Second-hand
smoke can have similar effects as smoking tobacco
and increases the risk of many types of cancer
(figure12.12).
Workplace safety. Individuals who spend prolonged
time outdoors as a part of their job may have
increased exposure to UV radiation and an increased
risk of skin cancer. Exposure to hazardous substances
in the workplace can also increase the risk of cancers
such as lung cancer.
Access to health care. Access to health care does not
prevent the development of cancer. However, the rate
of successfully treating cancers is higher if they are
detected early (see case study).
Case study
Smokers scan call

Health experts are calling for screening of smokers for
lung cancer, much the same way women are screened
for breast cancer.
They want Australia to investigate the health and
economic benefits of screening smokers for lung
cancer, our biggest cancer killer.
Five Victorians die from lung cancer a day.
Investigations are underway to see if screening
current and former smokers can cut the toll.
Chairman of the Peter MacCallum Cancer Centres
Lung Service, Prof David Ball, said the key to better
survival rates for lung cancer was earlier detection.
Prof Ball said a North American study, which
investigated CAT scan screening of smokers for lung
cancer, revealed a reduction in deaths.
The question is how much does that cost and how
many patients would have to be screened to produce
benefits in, say, one individual? he asked.
Cancer Council Victoria said 13 per cent of people

with lung cancer survived five years.
Unfortunately, the survival rates havent dramatically
improved because many lung cancer patients still
present with advanced disease, Prof Ball said.
It is already incurable.
He said the challenge was to detect the disease at an
earlier stage through screening.
Prof Ball said screening with chest x-rays had been
found to be ineffective.
But CAT scanning in people who had been smokers
showed there was a survival benefit if patients are
regularly screened.
But we do not know how relevant the US results are
to the Australian population, Prof Ball added.
He said screening might be beneficial but that, if it
was, the next question was whether such a screening
program was affordable.
Source: Sunday Herald Sun, 19 February 2012.
Case study review

1 Explain why survival rates for lung cancer have not improved in recent years.
2 Besides the location of health services, what other factors may limit access to
scans for smokers?
3 Up to 30 per cent of lung cancer cases occur in non-smokers. Discuss the factors
that may contribute to lung cancer in non-smokers.
Social determinants
Education and income both have an indirect relationship with cancer. Those with
lower levels of education relating to tobacco use, the importance of maintaining a
healthy body weight and consuming fruit and vegetables are at an increased risk of
developing some types of cancer. Those on low incomes may not be able to afford
nutritious foods and may rely on processed foods that are high in fat. This can
increase body weight and the risk of developing breast and colorectal cancer.
TEST your knowledge

1 Explain cancer.
2 Discuss why cancer is a health issue for adults
inAustralia.

3 Explain the trends evident in figure 12.10.
Unit 2
AOS 3
Topic 5
Cancer
Concept summary
and practice
questions
Concept 3
4 Explain how access to health care can promote the

health of adults with cancer.
adults with regards to cancer and determinants that
act as risk and/or protective factors.
6 Use the Cancer links in the Resources
section of your eBookPLUS to find the
12.4

factors in relation to type 2 diabetes

protective factors in relation to type 2 diabetes
4. Glucose cant
enter the body
effectively.
Health issue:
type 2 diabetes
2. Glucose enters
the bloodstream.
Type 2 diabetes is a disease characterised

by an inability of the body to utilise
blood glucose for energy.
Glucose is the most basic form
of carbohydrate and is released into
the bloodstream after eating foods
containing carbohydrate. As blood
glucose levels rise, a hormone called
3. The pancreas
insulin is released by the pancreas to
produces enough
assist cells in absorbing the glucose.
insulin, but it cant
1. Food is converted
Glucose molecules are then used for
be used effectively.
to glucose in the
5. Glucose levels in
stomach.
energy which assists the cells in carrying
the bloodstream
out their normal functions.
increase.
For those with type 2 diabetes, either
too little insulin is produced, or the
insulin that is produced is ineffective
Pancreas
Stomach
(figure 12.13). If type 2 diabetes
FiguRE 12.13 Diabetes occurs when
is unmanaged, the glucose remains in the bloodstream and is then filtered out
the glucose in the blood cannot be
through the kidneys. Over time, this can lead to long-term problems including
effectively transported into the cells.
kidney disease, cardiovascular disease, limb amputations, damage to the retina in
the eyes and premature death.
Why is type 2 diabetes a health

issue foradults?
As obesity rates have increased in Australia over the past 25 years, so too have the
rates of type 2 diabetes making it a common disease among adults in Australia
(figure 12.14). Type 2 diabetes is one of the leading causes of mortality and
morbidity among Australian adults and is predicted to become the leading cause of
overall disease burden by 2023.
20
Males
Females
18
16
Per cent
14
12
10
8
6
4
FiguRE 12.14 Proportion of persons
with type 2 diabetes, 201112
Source: ABS, Australian health survey: first results,
201112, p.19.
456
2
0
1524
2534
3544
4554
5564
Age group (years)
6574
75+
Determinants acting as risk and/or

protective factors in relation to
type 2 diabetes
Biological
Body weight. Being overweight is the greatest risk factor for type 2 diabetes. The
exact relationship is unknown, but there are a number of possibilities:
Fat cells may be more resistant to insulin than muscle cells. This means that
someone who is overweight is naturally more resistant to the effects of insulin
and therefore high amounts of glucose remain in the bloodstream.
People who are overweight have put a strain on their pancreas as it has tried to
produce enough insulin to metabolise blood glucose. After a period of time, the
insulin-producing cells in the pancreas become inefficient.
High levels of fat in the body may destroy insulin-producing cells in the pancreas,
resulting in a lower level of insulin available for glucose metabolism.
Genetics also play a part in the development of type 2 diabetes. Those who have
a genetic predisposition to the condition are at an increased risk.
Behavioural
Behaviours that increase the risk of developing obesity also increase the risk of
type2 diabetes. Examples include:
Physical inactivity. Being physically inactive can contribute to weight gain and
increase the risk of type 2 diabetes.
Alcohol consumption. Alcohol contains a large amount of energy, especially
mixed drinks and beer. These drinks can contribute to obesity which is a risk
factor for type 2 diabetes.
Dietary behaviours. An energy dense or high fat diet can contribute to weight
gain and type 2 diabetes. A high fat diet also appears to increase the risk of
type2 diabetes in those who are not overweight or obese.
Tobacco smoking. Smokers are more likely to develop type 2 diabetes. Some
research suggests that smoking itself contributes to an increased risk of type 2
diabetes or it may be that smokers are more likely to be sedentary and overweight.
As obesity is a risk factor for type 2 diabetes, aspects of the physical environment that
increase the risk of obesity also increase the risk of type 2 diabetes. These include:
Access to recreation facilities. If recreation facilities such as sporting ovals and
walking paths are not accessible, individuals may not get the required amount of
physical activity, which can increase body weight and contribute to obesity and
type 2 diabetes.
Work environment. A work environment that does not promote incidental
physical activity can increase the risk of obesity. A work environment that has
car parking next to the entrance, no stairs and a small office space can reduce the
level of incidental physical activity and contribute to obesity and type 2 diabetes.
Social determinants
Unit 2
AOS 3
Topic 5
Social determinants of health that can increase the risk of type 2 diabetes include:
Income. People with low incomes may be more likely to eat energy-dense, processed
foods that can increase the risk of obesity and contribute to type 2 diabetes.
Education. People with lower levels of education have higher rates of obesity
and higher rates of type 2 diabetes.
Type 2 diabetes
Concept summary
and practice
questions
Concept 4
12.4 Determinants that act as risk and/or protective factors in relation to type 2 diabetes
Occupation. People in managerial and other sedentary occupations may be more
at risk of obesity and type 2 diabetes.
Case study
Ignorant on dangers of
diabetes
Australians are dangerously ignorant of the dangers
of type 2 diabetes, despite rates of the chronic disease
tipped to triple by the year 2031.
An Australian Medicines Industry report, out today,
surveyed 5000 Australians aged 3266 about their
opinions on health and disease.
It found 90 per cent of those surveyed did not
consider the condition to be a major health concern.
The report also found 42 per cent of respondents did
not exercise regularly a risk factor for obesity and
type 2 diabetes.
There is a clear disconnect between our views
on health, particularly in relation to weight and the
implications of that in regard to serious and potentially
life-threatening disease, industry spokesman Dr Brendan
Shaw said.
He said while Australians were aware of the
messages of healthy eating and exercise, the long-term
consequences of obesity were not well understood in
the community.
A staggering 65 per cent of all cardiovascular deaths
occur in people with diabetes or pre-diabetes.
Every day, about 280 Australians develop diabetes,
the report says.
Australians were more willing to modify their diet

than exercise to improve health, with 62 per cent
saying they would eat more fruit and vegetables and
57percent would reduce their consumption of fat.
However, only 38 per cent would exercise regularly
and 25 per cent would reduce alcohol intake.
Lyell McEwin Hospital head of diabetes and
endocrinology services Dr Elaine Pretorius said the
reports findings were extremely worrying.
There is a belief that obesity wont happen to me
and I think people believe that being overweight is not
an issue, and diabetes is not an issue when it clearly has
significant consequences, she said.
Complications of type 2 diabetes include heart attack,
stroke, kidney failure, blindness and amputations.
Dr Pretorius said the report found cancer was the
most feared disease among Australians, but few people
were aware that obesity was a risk factor for certain
types of cancer.
The biggest gift we can give our children as parents
is to make healthy eating changes and regular exercise
part of their lives, she said.
Otherwise, trying to change those habits suddenly at
the age of 60 is going to be very hard.
Source: The Advertiser, 11 March 2013.
Case study review

1 (a) Lack of understanding surrounding diabetes is an example of which
determinant of health?
(b) Discuss how this could be addressed in Australia.
2 Explain why type 2 diabetes is a major health concern in Australia.
3 (a) Which behavioural determinant were Australians most willing to modify to
improve their health?
(b) Would modifying this determinant eliminate the risk of developing type 2
diabetes? Explain.
4 Explain why trying to change habits at 60 is very hard.
TEST your knowledge
1 Explain type 2 diabetes.

2 Outline the complications that can occur if type 2
diabetes is unmanaged.
3 Discuss why type 2 diabetes is a health issue for
adults in Australia.

adults about the prevention of type 2 diabetes.
5 Use the Type 2 diabetes links in the
Resources section of your eBookPLUS
to find the weblink and questions for this activity.
12.5

factors in relation to mental illness

protective factors in relation to mental illness
Health issue: mental illness

Mental illness is a broad term for a group of conditions. These conditions can be
short or long term, and there is no way of knowing who will be affected by them. It
is thought that chemical imbalance in the brain can alter the way a person perceives
his or her world and contribute to mental illnesses. The two most common types
of mental illness are anxiety disorders and depression.
Anxiety disorders
Anxiety relates to worry or fear and is a normal part of life. When in danger, anxiety
causes physical responses that assist in dealing with these situations. Anxiety
disorders, however, relate to irrational and ongoing fear or worry that interferes
with normal life. These thought patterns contribute to physical symptoms such as
panic attack, where the individual may experience shortness of breath, dizziness,
rapid heartbeat, choking or nausea.
Specific anxiety disorders include:
Generalised anxiety disorder anxiety associated with common issues such as
family, friends, work, health or money
Social phobias fear of social situations
Specific phobias fear of a specific object or situation; for example, a fear
of enclosed spaces, animals or spiders. In all cases, the fear is irrational and
interferes with normal life (see figure 12.15).
Panic disorders frequent and debilitating panic attacks
Obsessive compulsive disorder recurring unwanted thoughts (obsession) and
feeling compelled to perform behavioural or mental rituals (compulsion), such
as excessive handwashing
Post traumatic stress disorder can occur after an individual is exposed to a
traumatic event. Feelings of grief and sadness are common after traumatic events,
but this condition is characterised by severe, ongoing reactions that interfere
with normal life. Thoughts and images of the event may be more distressing
than the original event itself, and can lead to the individual avoiding reminders
of the trauma, including places and situations.
Figure 12.15 Phobias are a type of

anxiety that can result in the sufferer
avoiding certain situations.
12.5 Determinants that act as risk and/or protective factors in relation to mental illness
Depression
Figure 12.16 Depression is more

than just being sad. It can be ongoing
and interfere with normal activities.
Everyone feels sad from time to time, but depression is

a condition characterised by ongoing feelings of extreme
sadness that can last weeks, months or years. It is a
serious illness that interferes with normal activities such
as school, work and leisure. Symptoms of depression can
include:
feeling sad or depressed
loss of interest in normal activities
sleeping problems
constant feelings of tiredness
loss of appetite or weight
difficulty concentrating
feelings of restlessness, worthlessness or guilt.
Why is mental illness a health issue

for adults?
Mental illnesses are very common among adults in Australia. In 2012, around
13 per cent of Australian adults were currently experiencing a mental illness
(figure12.17).
16
14
Per cent
12
10
Males
Females
8
6
4
2
0
2001
2002
2003
2004
2005
2006 2007
Year
2008
2009
2010
2011
2012
Figure 12.17 Proportion of persons with a mental illness, 2001 to 201112

Source: ABS, Australian health survey: first results, 201112, p. 21.
The 2007 National Survey of Mental Health and Wellbeing estimated that 20 per
cent of Australians aged 1685 experienced one or more of the common mental
illnesses in the previous 12 months. While not experiencing a mental illness in the
previous 12 months, an additional 25 per cent had experienced one at some stage
in their lives. In total, 45 per cent of Australians had experienced a mental illness
(AIHW, 2012).
Although mental illness is not a leading cause of death among adults, it
contributes significantly to morbidity in Australia. Mental illnesses can impact on
all aspects of life, including the ability to work, socialise, sleep, exercise, eat and
relax.

mental illness
Biological
Some biological determinants that increase the risk of mental illness include:
Body weight. Links have been established between mental illness and obesity
(AIHW, 1998). Although no definitive relationship has been established, obesity
could develop if the person is eating in response to depressive symptoms, or
depression could develop as a result of low self-esteem due to obesity.
Genetic predisposition. People with mental illness in the family are more likely
to develop mental illness at some stage in their lives.
Having an underactive thyroid gland can contribute to depression and there
is evidence to suggest that those who have experienced a heart attack, stroke,
cancer or diabetes have an increased risk.
Some behavioural determinants related to mental illness include:
Tobacco use. Smokers are more likely to have mental health
problems (AIHW, 1998). Although the exact reason for this
is unknown, it has been suggested that people experiencing
mental health problems in their youth may be more likely to
take up smoking.
Alcohol misuse. Although there is a relationship between
problem drinking and mental health (with problem drinkers
more likely to have mental health issues and vice versa),
the causal factor (mental illness or drinking) has not been
established. Alcohol is a depressant and some studies suggest
that people with depressive symptoms are more likely to
develop alcohol misuse and dependence in their younger
years.
Drug use. People abusing drugs have higher rates of mental
illness. Many substances alter the chemical make-up in the
brain, which can trigger a range of mental illnesses. There
is a relationship between mental illness and marijuana use,
although the cause of this relationship is not understood.
Physical activity. Physical activity releases hormone-type
chemicals called endorphins that relieve stress and assist in
maintaining optimal mental health. People who exercise may
therefore be at a decreased risk of developing mental illness
(figure 12.18).
Figure 12.18 Regular physical

activity can reduce the risk of
developing a mental illness.
Aspects of the physical environment that are related to mental illness include:
Housing. Living in overcrowded housing conditions can increase the risk of
psychological distress.
Neighbourhood safety. Living in an area that is not considered safe may heighten
feelings of anxiety.
Access to health care. Medical intervention can assist in treating mental illnesses.
If the individual cannot access health care due to geographical barriers, mental
illnesses may go untreated for an extended period of time.
12.5 Determinants that act as risk and/or protective factors in relation to mental illness
Social
Unit 2
AOS 3
Topic 5
Concept 5
Mental illness
adulthood
Concept summary
and practice
questions
Some social determinants that relate to mental illness include:

Education and income. People with low education and incomes have higher
rates of mental illness. This could be attributed to a range of associated factors
such as higher rates of obesity, higher rates of smoking and drug misuse.
Occupation. Work-related stress can add to depressive symptoms.
Unemployment. Long-term unemployment has a relationship with mental
illness. Those who are unemployed may experience prolonged feelings of stress
and anxiety as a result of not being able to provide for themselves and/or their
family.
A history of abuse or neglect during childhood increases the risk of mental
illness.
TEST your knowledge
1 Describe mental illness.

2 Discuss the difference between anxiety and
depression.
3 What is the difference between feeling sad and
having depression?
4 Explain why mental illness is a health issue for
adults.
5 Explain how physical activity can reduce the risk of
mental illness.
6 Lisa is 16 and both her mother and father have

experienced depression. Using your knowledge of
determinants that increase and decrease the risk of
mental illness, provide advice to Lisa as to how she
can reduce her risk of developing this condition.
7 Use the Anxiety links in the
8 Use the Depression links in the
462
12.6
Government strategies and programs to promote

health and individual human development of adults
KEY CONCEPT Understanding government strategies and

programs designed to promote health and individual human
A range of government, community and personal strategies and programs have
been designed to promote the health and development of adults in Australia.
These programs and strategies aim to reduce the burden of disease associated
with health issues and to assist adults in living long, healthy lives. Understanding
these programs and strategies can assist adults in accessing resources for optimal
health and development and making health choices throughout their lives.
Government strategies and

programs
The three levels of government in Australia, federal, state and local, all play a role
in promoting the health and individual human development of adults. In this
section, examples of the strategies implemented by each level of government will
be explored.
Federal government
The federal government implements a range of strategies and programs to promote
the health and individual human development of adults in Australia. Examples
include Australias Physical Activity and Sedentary Behaviour Guidelines for Adults,
Australian Dietary Guidelines and BreastScreen Australia.
Australias Physical Activity and Sedentary Behaviour

Guidelines
Australias Physical Activity and Sedentary Behaviour Guidelines were developed
to assist individuals in meeting the amount of physical activity required to achieve
health benefits and to reduce the associated health risks of sedentary behaviours.
Guidelines targeting different lifespan stages were developed, including adults and
older Australians. Recommendations as to the amount of physical activity required,
and ways to incorporate physical activity and reduce sedentary behaviour in
everyday life, form the basis of the guidelines.
Increasing physical activity and reducing sedentary behaviour are important in
reducing the burden of disease associated with many conditions such as obesity,
cardiovascular disease, type 2 diabetes and mental illness.
AUSTRALIAS PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR GUIDELINES

FOR ADULTS (1864 YEARS)
Being physically active and limiting
your sedentary behaviour every day
is essential for health and wellbeing.
These guidelines are for all adults aged
1864years, irrespective of cultural
background, gender or ability.
Physical activity guidelines

Doing any physical activity is better
than doing none. If you currently do
no physical activity, start by doing
some, and gradually build up to the
recommended amount.
12.6 Government strategies and programs to promote health and individual human development
of adults
Be active on most, preferably all, days

every week.
Accumulate 150 to 300minutes (2
to 5hours) of moderate intensity
physical activity or 75 to 150minutes
(1 to 2hours) of vigorous intensity
physical activity, or an equivalent
combination of both moderate and
vigorous activities, each week.
Do muscle strengthening activities on
at least 2days each week.
Sedentary behaviour guidelines
Minimise the amount of time spent in
prolonged sitting.
Break up long periods of sitting as
often as possible.
Physical activity recommendations
for older Australians (65 and over)
Being physically active and staying fit
and healthy will help you to get the
most out of life, whatever your age.
These recommendations are designed to
help older Australians achieve sufficient
physical activity for good health as they
age. They are mainly for people who
are not currently building 30minutes of
physical activity into their daily lives, and
are looking for ways they can do so.
Being physically active for 30minutes
every day is achievable and even a slight
increase in activity can make a difference

to your health and wellbeing.
There are five physical activity
recommendations for older Australians.
1. Older people should do some form
of physical activity, no matter what
their age, weight, health problems or
abilities.
2. Older people should be active every
day in as many ways as possible, doing
a range of physical activities that
incorporate fitness, strength, balance
and flexibility.
3. Older people should accumulate at
least 30 minutes of moderate intensity
physical activity on most, preferably
all, days.
4. Older people who have stopped
physical activity, or who are starting a
new physical activity, should start at
a level that is easily manageable and
gradually build up the recommended
amount, type and frequency of
activity.
5. Older people who continue to
enjoy a lifetime of vigorous physical
activity should carry on doing so in
a manner suited to their capability
into later life, provided recommended
safety procedures and guidelines are
adhered to.
The Australian Dietary Guidelines

The Australian Dietary Guidelines were released in 2013 to assist Australians
in consuming a healthy diet and reduce the burden of disease associated with
cardiovascular disease, obesity, some cancers and type 2 diabetes.
The guidelines include information relating to the different food groups and
the number of serves that should be consumed from each food group to promote
optimal health. Specific advice for adults and older Australians are included in the
guidelines in order to assist in promoting the health of these lifespan stages.
The Australian Dietary Guidelines that relate to adults are:
Guideline 1:
To achieve and maintain a healthy
weight, be physically active and choose
amounts of nutritious food and drinks to
meet your energy needs.
Older people should eat nutritious
foods and keep physically active to help
maintain muscle strength and a healthy
weight.
Guideline 2:
Enjoy a wide variety of nutritious
foods from these five food groups every
day.
Plenty of vegetables of different types

and colours, and legumes/beans
Fruit
Grain (cereal) foods, mostly
wholegrain and/or high fibre cereal
varieties, such as breads, cereals, rice,
pasta, noodles, polenta, couscous,
oats, quinoa and barley
Lean meats and poultry, fish, eggs, tofu,
nuts and seeds, and legumes/beans
Milk, yoghurt, cheese and/or their
alternatives, mostly reduced fat
Drink plenty of water.
Guideline 3:
Limit intake of foods containing
saturated fat, added salt, added sugars
and alcohol.
a. Limit intake of foods high in saturated
fat such as many biscuits, cakes,
pastries, pies, processed meats,
commercial burgers, pizza, fried foods,
potato chips, crisps and other savoury
snacks.
Replace high fat foods
which contain predominately
saturated fats such as butter,
cream, cookingmargarine,
and coconut and palm oil
with foods which contain
predominately polyunsaturated
and monounsaturated fats such
as oils, spreads, nut butters/pastes
and avocado.
b. Limit intake of foods and drinks
containing added salt.
Read labels to choose lower sodium

options among similar foods.
Do not add salt to foods in
cookingor at the table.
c. Limit intake of foods and
drinks containing added sugars
such asconfectionery, sugarsweetenedsoftdrinks and
cordials,fruit drinks,vitamin
waters,andenergyand sports
drinks.
d. If you choose to drink alcohol,
limit intake. For women who are
pregnant, planning a pregnancy or
breastfeeding, not drinking alcohol
isthe safest option.
Guideline 4:
Encourage, support and promote
breastfeeding.
Guideline 5:
Care for your food; prepare and storeit
safely.
Unit 2
AOS 3
Topic 6
Government
strategy
Concept summary
and practice
questions
Concept 1
BreastScreen Australia
BreastScreen Australia is a free mammography service jointly funded by the federal
and stategovernments. BreastScreen Australia offers free mammograms for women
aged 5074 (although those aged 4049 and 75+ can also attend for scans).
Seventy-five per cent of breast cancer cases are in women over 50 years of age and
over 50per cent occur in those aged 5074. As age is a significant risk factor for
breast cancer, the target age group of 5074 was selected. Since its creation in 1991,
BreastScreen has performed millions of scans (over 1.7 million in 201112 alone).
Early detection greatly improves the survival rates of those suffering from breast
cancer and has improved the health of thousands of adult females in Australia.
Figure 12.19 BreastScreen provides

free mammograms, which can assist in
the early detection of breast cancer.
of adults
State and territory government

Each state and territory government creates legislation (sometimes referred to as
laws) to promote the health and development of their citizens, including adults. In
addition to legislation, each state and territory government implements strategies
and programs to promote health among their population. In Victoria, examples
include the Victorian Healthy Eating Enterprise, the LiveLighter campaign and
programs funded by VicHealth.
Legislation
Figure 12.20 Implementing and enforcing speed limits are examples of

a state government strategy that aims to reduce the risk of road trauma.
State and territory governments implement a range of

laws that aim to promote health and development of
adults, including laws relating to:
Driving. Laws relating to speed limits, speed
cameras, seatbelt laws, probationary drivers (P-plate
drivers), drink driving laws and car safety standards.
Smoking. Laws may prevent individuals from
smoking in certain public spaces. This reduces
exposure to environmental tobacco smoke and
promotes physical health.
Gambling. Gambling laws may restrict the amount
that can be withdrawn from automatic teller
machines (ATMs) at gambling venues to assist
individuals with controlling their gambling.
Victorian Healthy Eating Enterprise

The Victorian Healthy Eating Enterprise (VHEE) is a state government initiative
that works to support the prevention of diet-related diseases in Victoria. The VHEE
encompasses a range of initiatives being undertaken by the Victorian Government
in partnership with local government, business, industry, health professionals and
communities guided by a shared vision to improve the health and wellbeing of
Victorians through healthy food consumption.
Examples of initiatives undertaken as a part of the VHEE:
The Healthy Food Charter intended as a tool for use by anyone interested
in making healthy food choices easy and promoting healthy food. In particular,
it is intended as a guide to all those working in partnership with the Victorian
Government to improve the health of Victorians through food intake.
The Victorian Healthy Eating Advisory Service provides healthy eating and
nutrition advice to hospitals and workplaces.
Victorian Healthy Food Basket a survey to monitor the cost and accessibility
of a healthy and unhealthy shopping basket of food across local government
areas in Victoria. This study is the largest of its kind conducted in Victoria and
will contribute greatly to health promotion planning and the understanding of
what impacts on Victorians ability to consume a healthy diet.
Jamies Ministry of Food Victoria to deliver healthy cooking courses,
demonstrations and events in prevention areas through a fixed centre and a
mobile kitchen. As part of this, a range of Victorian chefs will act as role models
to promote healthy eating.
Health Champions local community members who will promote good
nutrition through their networks.
LiveLighter campaign
The LiveLighter campaign aims to assist individuals in eating well, being physically
active and maintaining a healthy body weight. Beginning in Western Australia in
2012, the Victorian Government provided funding to extend the program to Victoria
in 2014. Implemented by the Heart Foundation and Cancer Council Victoria, the
program uses an advertising campaign, the 12-week meal and activity planner, and
the Am I at risk? tool to educate adults about the dangers of abdominal fat and
ways to reduce their risk of associated conditions such as cardiovascular disease
and type 2 diabetes.
The LiveLighter advertising campaign uses graphic images to educate individuals
about the danger of abdominal fat and then provides web-based resources to assist
consumers in modifying risk factors such as sedentary lifestyles and poor dietary
behaviours.
An online 12-week meal and activity planner assists adults in becoming more
active by providing tips for increasing levels of physical activity. The meal planner
provides recipes that work to improve dietary intake by promoting the consumption
of healthy foods such as fruits and vegetables (figure12.21).
The Am I at risk? tool on the website shows consumers how to take a waist
measurement and includes a body mass index calculator. Consumers can learn
about their personal level of risk for obesity related conditions and access resources
that will assist them in reducing their risk.
Figure 12.21 The LiveLighter

12-week meal and activity planner
encourages behaviour change, such as
consuming more vegetables.
VicHealth
VicHealth is Victorias health promotion foundation that aims to promote the health
of all Victorians. With this aim in mind, they have devised an Action Agenda,
designed to improve health across the state over the next decade.
The main areas on which the Agenda focuses are:
promoting healthy eating
encouraging regular physical activity
preventing tobacco smoking
preventing harm caused by alcohol
improving mental wellbeing.
VicHealth aims to achieve these goals through:
funding activity related to the promotion of good health, safety or the prevention
and early detection of disease
increasing awareness of programs for promoting good health through the
sponsorship of sports, the arts and popular culture
encouraging healthy lifestyles and participation in healthy pursuits
funding research and development in support of these activities.
Figure 12.22 The VicHealth logo
Local government
Local governments implement a range of strategies and programs to promote the
health and development of adults including:
providing access to recreation facilities such as walking and cycling paths, parks,
gardens and public swimming pools
implementing community health plans that aim to address the needs of the
local community and promote healthy lifestyles by encouraging healthy eating,
exercise and social interaction
the provision of aged care services including home assistance relating to household
chores, personal hygiene, shopping and delivered meals services.
of adults
Delivered meals service
Figure 12.23 Local governments

provide a delivered meals service
which assists in promoting the health
and development of many adults in
Australia.
Local governments throughout Victoria offer a

delivered meals service (sometimes known as Meals
on Wheels). This service provides home-delivered
meals to residents who, because of frailty, disability or
ill health, are unable to prepare their own meals. Meals
are delivered either chilled for reheating at a later time
or hot for immediate consumption. A variety of meals
are provided, including special dietary meals such as
diabetic, vegetarian and reduced fat.
Meals are delivered by volunteers who also monitor
the health and wellbeing of clients and report any
concerns back to the office for follow up. The service
is available to frail older people and people with
disabilities.
A fee is charged for a meal and varies according to income. Those unable to meet
the associated costs are eligible for free or subsidised meals.
The delivered meals service promotes the health and development of adults by
assisting individuals in meeting their nutritional requirements.
TEST your knowledge

1 Explain two programs or strategies developed by
each level of government to promote the health
and individual human development of adults in
Australia.

2 (a) What is a mammogram?
(b) Explain how free mammograms could promote
the health and/or individual human development
of adults in Australia.
3 (a) Identify and explain the differences between
Australias Physical Activity and Sedentary
Behaviour Guidelines for Adults and those for
older Australians.
(b) Explain how maintaining physical activity
into adulthood could promote health and/or
4 Select one state or territory strategy or program

and explain how it may promote the health and
5 Discuss how each of the Dietary Guidelines
couldpromote the health and individual human
6 Research your own local government and
produceafact file outlining the ways that they
work to promote the health and individual human
development ofadults.
7 Find the VicHealth links in the
12.7
Strategies and programs designed to promote health

and individual human development of adults
KEY CONCEPT Understanding community and personal strategies

and programs designed to promote health and individual human
Community strategies and programs

Many community strategies and programs designed to promote the health and
development of adults are implemented by non-government organisations.
Examples of these programs include the Life! Taking Action on Diabetes program
and the Heart Foundation Tick.
Unit 2
AOS 3
Topic 6
Life! Taking Action on Diabetes

The Life! Taking Action on Diabetes program supports individuals to take control
of their life, by providing a course addressing healthy behaviours to reduce their
risk of type 2 diabetes and cardiovascular disease. Funded by the Victorian
Government and implemented by Diabetes Australia Victoria, the Life! program
is offered to Victorian adults aged over 45 who are at risk of developing type 2
diabetes. Individuals can be referred by their doctor or can enrol themselves by
calling the Life! helpline on 13 RISK (13 7475). The six-month course includes six
face-to-face sessions that address:
the importance of good nutrition and regular physical activity
risk factors for type 2 diabetes, heart disease and stroke and their link to lifestyle
goal setting to assist in the adoption and maintenance of lifestyle changes
linkages to local programs and services to adopt lifestyle changes.
For those who are unable to attend face-to-face sessions, a telephone coaching
service is available so individuals can access the course from their home.
The program is free for many eligible participants including:
patients on a Concession or Health Care Card
patients on low to medium incomes
anyone referred through WorkHealth.
For others, a $50 co-payment may be required.
Community
strategy
Concept summary
and practice
questions
Concept 2
The Heart Foundation Tick

The Heart Foundation Tick is a program that aims to assist consumers in
purchasing healthier food products that may assist in maintaining a healthy
weight and reducing the risk of cardiovascular disease. Food producers can
apply to display the Tick logo on their products. Producers of many different
types of food can apply to use the Tick.
Adults can identify healthier alternatives by looking for the Tick logo on food
packaging. Tick approved products are healthier because they are lower in saturated
fat, sodium (salt) and kilojoules (energy), and higher in fibre, calcium, wholegrains
and vegetables compared to other similar products.
FiguRE 12.24 The Heart Foundation

Tick logo
Tick TM used under licence.
Personal strategies
Many of the personal strategies that can promote the health and individual human
development of adults relate to addressing the determinants that individuals have
some control over. Examples of personal strategies for adults in Australia include:
Physical activity. Regular exercise assists in maintaining healthy body weight
which can reduce the risk of obesity and its associated conditions including
cardiovascular disease, type 2 diabetes and some cancers.
Health issues facing Australian adults CHAPTER 12
469
12.7 Strategies and programs designed to promote health and individual human development of
adults
Dietary behaviours. By consuming a healthy food intake, adults receive the
nutrients they need to supply energy, maintain hard and soft tissues and reduce
the risk of diet-related diseases including cardiovascular disease and type 2
diabetes.
Being socially active. Maintaining social networks and volunteering act to
promote social health and development by providing opportunities for social
interaction (figure 12.25). Self-esteem can also be enhanced by participating in
the life of the community.
Figure 12.25 Maintaining regular social interaction can promote health and development
throughout adulthood.
Accessing health care. Regular health checks ensure that problems can be
identified early and relevant interventions put in place. Examples include treating
high blood pressure and making dietary changes if blood cholesterol is high.
Using sun protection. Using sunscreen and covering exposed skin can reduce
the risk of skin cancer. Adults must also ensure they get some sun exposure to
receive adequate levels of vitamin D.
Not smoking. Tobacco smoke is one of the leading causes of illness and premature
death in Australia. By not smoking and ensuring exposure to environmental
tobacco smoke is reduced, the risks are decreased.
Drinking alcohol in moderation. If adults choose to drink alcohol, they can
choose to do so in moderation. This decreases the risk of health concerns such
as injuries and weight gain. Drinking in moderation also reduces the risk of
relationship breakdown and mental illness associated with excessive drinking.
Not using drugs. Not using drugs can reduce the risk of mental illness and
promote physical and social health. Adults are more able to concentrate on daily
tasks and participate in health-promoting behaviours such as being socially
active, exercising and consuming a healthy food intake.
Practising safe sex. If adults are sexually active, practising safe sex can assist in
preventing sexually transmissible infections (STIs). Using condoms and having
regular health checks can assist in decreasing the spread of such diseases.
Maintaining a safe housing environment. Eliminating hazards in the home by
clearing walkways, installing hand rails if required, maintaining heating and
470
cooling systems, regularly cleaning and maintaining adequate ventilation,

reduces the risk of injury and disease.
Improving education. By accessing information relating to healthy lifestyles
through formal courses, the internet, friends, books and health professionals,
adults may be better informed to make necessary changes to improve their
health and development. Education is also mentally stimulating and can promote
mental health and intellectual development (figure 12.26).
Maintaining an adequate family and worklife balance. This assists adults to
relax and enjoy leisure time with loved ones. Stress levels may be reduced and
relationships enhanced as a result.
Unit 2
AOS 3
Topic 6
Concept 3
Personal
strategies
adulthood
Concept summary
and practice
questions
Figure 12.26 By accessing information, adults can improve their levels of education and
promote their health and development.
TEST your knowledge

1 (a) Briefly explain the Life! Taking Action on
Diabetes strategy.
this strategy.
2 (a) Briefly explain the Heart Foundation Tick.
this strategy.

3 Discuss how the Life! Taking Action on Diabetes
strategy could promote the health of adults in
Australia.
4 Discuss how the Heart Foundation Tick could
promote the health of adults in Australia.
5 Discuss the personal strategies that could be

employed to reduce the risk of any one of the
following among adults:
(a) obesity
(b) cardiovascular disease
(c) cancer
(d) type 2 diabetes
(e) mental illness.
6 Create a multimedia presentation that aims to
educate adults about personal strategies that can be
used to promote their health and individual human
development.
7 (a) Find five websites where adults could access
information to improve their health and
development-related knowledge.
(b) Which determinants are addressed on each site?
KEY SKILLS Health issues facing Australian adults

Australias adults and draw informed conclusions about
personal, community and government strategies and
programs to optimise adult health and development
The issue is identified and key aspects

of it described.
The reasons for obesity being

considered a health issue are
discussed.
A range of factors that act to increase

the risk of obesity are outlined.
The program is named and the type
of program is identified. In this case,

it is a community program.
The aim of the program is stated.
The first part of this key skill is to develop an understanding of one health issue
facing Australias adults. In order to be able to adequately describe the issue, a
number of aspects about it should be known, including:
the name of the issue
what the issue actually is
why it is considered a health issue for adults
the biological, behavioural, physical environment and social determinants that
A summary table can be useful in collating this information.
In the following example, obesity as a health issue facing adults is described:
Obesity relates to carrying excess body weight in the form of fat that can be
harmful to health. It is measured using the body mass index (BMI) or waist
circumference. BMI is a weight-to-height ratio and is calculated by dividing body
weight (in kilograms) by height in metres squared. A score of 30 or over indicates
obesity in adults. For waist circumference, a measurement of over 89 cm for
females and 102 cm for males indicates obesity.
Obesity is considered a health issue in Australia as it is largely preventable yet
the rates of obesity have increased significantly over the past 25 years. Obesity is a
risk factor for many other conditions including cardiovascular disease and type 2
diabetes, and contributes significantly to the burden of disease in Australia.
A range of risk factors exist for obesity. Examples include:
Biological a genetic predisposition can increase the risk of weight gain and
obesity.
Behavioural eating energy-dense foods and not exercising can mean that more
food is stored as fat and can contribute to obesity.
Physical environment if adults cannot access recreation facilities, they may
not be able to exercise frequently which can contribute to obesity.
Social those with low incomes may not be able to afford nutritious foods,
which can mean they rely on processed foods that are energy dense. This can
contribute to obesity.
The second part of this key skill is the ability to draw informed conclusions
about personal, community and government strategies and programs that are
implemented to optimise adult health and development.
In order to be able to draw conclusions about the program or strategy, a number
of aspects relating to it must be known, including:
the name of the strategy or program
whether the program is implemented at a government, community or individual
level
the aims of the program
the aspects of health and/or development being addressed
the determinants of health and development that are the focus of the strategy or
program
the advantages and/or disadvantages of the strategy or program
the actual or perceived effectiveness of the program.
In the following example, the Heart Foundation Tick is discussed and conclusions
about it are drawn.
The Heart Foundation Tick is a community strategy that aims to reduce the
prevalence of obesity and cardiovascular disease in Australia.
472
Food producers can apply to display the Tick logo on their food products if they
can show that their item is a healthier alternative than other similar products. This
may be in relation to lower levels of fat or sodium, or higher levels of fibre or
calcium.
Adults can then identify foods that have been granted permission to display the
tick to assist them in making healthier food choices.
If adults choose foods that display the Tick logo, they may be more able to
improve their physical health as they are able to maintain their body weight.
Adequate body weight can also reduce the risk of cardiovascular disease. Mental
health can also be improved by increasing self-esteem. Physical development could
be impacted as adults may have more energy to participate in physical activity,
which enhances motor skills development. Social development may be enhanced
as adults have the energy to socialise with friends, which can assist in developing
social skills such as communication.
The Heart Foundation Tick is a beneficial program as it does not require
consumers to have nutritional knowledge, but as not all food producers apply to
display the Tick, some healthy alternatives may be ignored as a result. This can
affect the ability of adults to consume a balanced food intake.
An explanation of how the program

works is provided.
The program is linked to various

aspects of health and human
development for adults.
Conclusions about the programs

effectiveness are drawn.

1 Describe a key issue facing adults in Australia. In your answer, make sure you
include:
(a) the name of the issue
(b) what the issue actually is
(c) why it is considered a health issue for adults
(d) the biological, behavioural, physical environment and social determinants that
2 Explain a program or strategy implemented by a government and explain how it
may impact on adult health and/or development.
3 Identify personal strategies that may reduce the risk of one health issue facing
adults in Australia.
4 For a community strategy, discuss the likely effectiveness in promoting adults
health and/or development.
CHAPTER 12 review
Chapter summary
Interactivity:
Chapter 12 Crossword
A range of health issues affect adults, including obesity, cardiovascular disease, cancer,
type 2 diabetes and mental illness. The biological, behavioural, physical environment
and social determinants all play a role in these issues.
Obesity relates to carrying excess body weight in the form of fat that can be harmful to
health and is measured using the body mass index or waist circumference.
Obesity increases the risk of cardiovascular disease, some cancers, type 2 diabetes and
mental illness.
Obesity rates have increased significantly in Australia over the past 25 years.
Determinants that can increase the risk of obesity include:
Unit 2
AOS 3
Health
issues facing
Australias
adults
biological advancing age, genetic predisposition and a low basal metabolic rate
behavioural physical inactivity, alcohol consumption and dietary behaviours
physical environment lack of access to recreation facilities and a work environment
that promotes a sedentary lifestyle
social low levels of education, sedentary occupations and low income.
Sit Topic test
Cardiovascular disease relates to conditions affecting the heart and blood vessels.
Atherosclerosis is the underlying cause of most forms of cardiovascular disease.
Cardiovascular disease is the leading cause of death in Australia.
Determinants that can increase the risk of cardiovascular disease include:
biological overweight/obesity, high blood pressure, high blood cholesterol, genetic
predisposition, being male and advancing age
behavioural physical inactivity, dietary behaviours, tobacco smoking and alcohol
consumption
physical environment lack of access to recreation facilities, lack of access to health
care and exposure to environmental tobacco smoke
social low levels of education and income, workplace stress and occupation.
Cancer is a condition characterised by the uncontrolled growth of abnormal cells.
Cancer is the leading cause of premature death in Australia and is the leading
contributor to burden of disease.
Determinants that can increase the risk or impact of cancer include:
biological body weight, advancing age and genetic predisposition
behavioural tobacco smoking, alcohol consumption, dietary behaviours and UV
exposure
physical environment exposure to environmental tobacco smoke, exposure to
chemicals in the workplace and access to health care
social low levels of education and income.
Type 2 diabetes is characterised by an inability of the body to metabolise glucose.
Type 2 diabetes is a leading cause of death and rates are increasing in Australia.
Determinants that can increase the risk of type 2 diabetes include:
biological body weight and genetic predisposition
behavioural physical inactivity, alcohol consumption, dietary behaviours and
tobacco smoking
physical environment lack of access to recreation facilities and a work environment
that promotes a sedentary lifestyle
social low levels of education and income, and occupation.
Mental illness is a term that encompasses a range of conditions.
Anxiety and depression are the two most common forms of mental illness.
Mental illness affects up to 45 per cent of Australians at some stage in their life and
contributes significantly to burden of disease.
Determinants that can increase the risk of mental illness include:

biological body weight and genetic predisposition
behavioural tobacco smoking, alcohol consumption, drug use and physical
inactivity
physical environment overcrowded housing, unsafe neighbourhoods and lack of
access to health care
social low levels of education and income, stressful occupation and
unemployment.
Government, community and personal strategies and programs are designed to
promote health and human development among adults.
Government strategies include:
federal Australias Physical Activity and Sedentary Behaviour Guidelines for Adults,
Australian Dietary Guidelines and BreastScreen Australia
state/territory legislation, Victorian Healthy Eating Enterprise, the LiveLighter
campaign and VicHealth funded projects
local providing recreation facilities, implementing community health plans,
provision of aged care services and delivered meals services.
Community strategies include Life! Taking Action on Diabetes and the Heart
Foundation Tick.
Personal strategies relate to addressing determinants that are modifiable. Examples
include not smoking, exercising regularly, accessing health care and maintaining
friendships.
TEST your knowledge
1 Draw up a table that summarises the major

contributors to burden of disease for adults and
the corresponding determinants that act as risk or
protective factors, as well as at least one example
of a government, community and personal strategy
that could be implemented to promote health.
2 Design a program or strategy that could be

implemented to address a health issue of your
choice. Make sure you include:
(a) the name of the program
(b) who will implement it (government, community,
individuals)
(c) the aspects of adults health and/or
development that it is designed to address
(d) which determinants of health it addresses
(e) how it addresses the determinants of health.
index
A
abstract thought 3, 25
acne68
adolescence
end of 7
definition6
and sleep 7
adolescent growth spurt 3, 12
adult mortality 371, 372
adulthood
definition355
stage of 356
adults
access to health care 41720
alcohol use 4025
behavioural determinants of
health3925
biological determinants of
health38490
blood cholesterol 38990
blood pressure 3889
bodyweight3878
cancer453
cardiovascular disease 450
connection to community 4267
drug use 4068
education, employment and
income4234
family4323
food intake 398401
genetics3847
health status 36975
housing41213
living arrangements 42930
media influence on health 4212
mental illness 460
neighbourhood safety 41617
obesity447
physical activity 3967
physical environment determinants
of health 41215
sexual practices 40911
smoking3945
social determinants of health
42135
social support 4301
sun protection 3924
type 2 diabetes 456
worklife balance 4345
work-related stress 4256
476Index
workplace conflict 425

workplace safety 41315
alcohol consumption
adults4025
alcohol abuse 523
binge drinking 153, 157
impact on health 1312
and injury 156
in pregnancy 2223
standard drinks 402
and substance use 172
women4045
youth 1312, 15760
allied health services 153, 176
Alzheimers disease 3735, 385
amniotic fluid 191, 196
anaemia 81, 91, 923
anorexia91
antenatal health care 2289
antepartum deaths 191, 202
anxiety
impact on human
development1701
nature of 167
prevalence among affluent
youth126
1712
anxiety disorders 459
APGAR test 259
asthma
in children 273, 288, 3201
nature of condition 320
risk and/or protective factors 3212
Asthma Child and Adolescent Program
(ACAP)338
Asthma Friendly Schools Program 342
atherosclerosis 123, 131, 383, 389,
445, 44950
attention deficit hyperactivity disorder
(ADHD) 253, 275
Australian Action on Pre-eclampsia
(AAPEC)245
Australian Dietary Guidelines 337,
401
for adults 4645
applying11214
and eating habits of children 2967
purpose and content 10910
Australian Guide to Healthy

Eating401
applying11214
food selection model 11112
Australias Physical Activity and
Sedentary Behaviour
Guidelines 300, 3356, 4634
authoritarian parenting style 313
authoritative parenting style 31314
autoimmune disease 253, 273, 328
autoimmune response 283
B
B-group vitamins 967
baby boomers 3678
basal metabolic rate (BMR) 81, 98
behavioural determinants
adult health and development 3925
anxiety and depression 171
asthma321
cancer454
child health and development
293305
definition 123, 124
falls and injuries 324
foetal alcohol syndrome 2389
food allergies 327
gestational diabetes 23940
juvenile arthritis 329
low birth weight 237
mental illness 461
obesity448
prenatal health and
development21926
spina bifida 2345
type 1 diabetes 3323
youth health and
development12735
Better Health Channel 244
Better Health Commission (BHC),
definition of health 467
beyondblue174
beyondblue perinatal program 245
binge drinking 153
biological determinants
adult health and development
38490
asthma321
cancer454
28491
definition 3, 30
food allergies 3267
mental illness 461
obesity447
prenatal health and
development21418
spina bifida 235
type 1 diabetes 332
type 2 diabetes 457
youth health and
development659
birth defects see congenital
abnormalities
birth weight 2368, 272, 2889
blastocysts 191, 196
blood cholesterol 38990
blood pressure 3889
blood production 1001
body mass index (BMI) 3, 334,
28990, 388
body systems
changes to 1011, 1314
growth of 910
body weight
adults3878
as biological determinant 325
in childhood 28991
and hormones 67
measuring 334, 28990, 388
in youth 689
bone matrix 81, 103
bowel cancer 383, 387, 41819
breast cancer 387
breastfeeding2934
BreastScreen Australia 41718, 465
burden of disease 45, 623
C
calcium 901, 103, 221
cancer
as adult health issue 453
genetic predisposition to 387

4545
carbohydrates 823, 3989
as health issue 450
4502
carriers 213, 215, 283, 286
cartilage 81, 90
cell differentiation 81, 94, 191, 196
cell membranes 81, 85
cellular respiration 81, 99
cephalocaudal development 253, 255
child abuse 31415
child morbidity 2726
child mortality 253, 26971
child protection 3389
childhood, determinants of health and
development284
children
asthma 273, 288, 3202
behavioural determinants of
health293305
biological determinants of
health28491
birth weight 2889
body weight 28990
chronic conditions 272
dental health 275
diabetes2734
eating habits 2948
health care access 31719
health status 26871
hospitalisations276
housing environment 3079
media influences on health
31517
mental health problems 2745
mortality26871
obesity291
oral hygiene 2989
physical activity 2801
physical environment 30612
recreational facilities for 31011
social environment 31219
stage of 56
tobacco smoke in the home
3067
vaccination3025
cholesterol81
chromosomal abnormalities 21718
chromosomes 213, 214
chronic obstructive pulmonary
disease 283, 284
civic participation 145
co-enzymes 81, 99
collagen 81, 95
colonoscopy 383, 419
colostrum 253, 258
colour blindness 215
community, sense of 4267
community participation 145, 4267
complementary health services 153,
176
complexity 3, 13
concrete thought 3, 26
congenital abnormalities 191, 202,
225, 268
congenital malformations 283, 294
connective tissue 81, 95
coronary heart disease 383, 389
cortisol67
crime rates 41617
cystic fibrosis 21516, 2856
D
delivered meals service 468
dementia373
dental caries 106
dental health, children 275
depression
during and after pregnancy 205
impact on human
development1701
nature of 167, 460
prevalence among affluent
youth1256
determinants of health
in childhood 284
definition 3, 30, 123
key categories 124
see also risk and/or protective factors
development see individual human
development
developmental milestones 221
classifying28
Index 477
diabetes
in children 2734, 3313
gestational diabetes 67, 2045,
23940
type 1 67, 287
type 2 67, 386, 4568
types67
Diabetes Camps Victoria (DCV) 341
diastolic blood pressure 383, 388
diet
childhood eating habits 2948
food intake in adulthood 398401
food selection models 11112
diet-related diseases 400
disability adjusted life years
(DALYs) 45, 623
discretionary foods 81, 112
Down syndrome 45, 65, 2034, 217
drowning 155, 156
drug use
in adulthood 4068
during pregnancy 2245
ice4078
illicit drugs 12930, 153, 4067
impact of 12930
over-the-counter drugs 407
prescription drugs 407
in youth 12930
drugs, psychoactive effects 406
E
early adulthood
definition 355, 356
emotional development 358
intellectual development 3589
physical development 3567
social development 3578
early childhood
development2624
stage of 5
eating habits, in childhood 2948
ectopic pregnancies 207
education
access to 1456
of parents 231, 31213
ejaculation 3, 15
478Index
embryonic stage of prenatal

development 195, 1968
embryos3
emotional development
aspects212
early adulthood 358
early childhood 263
impact of anxiety and
depression170
infancy260
late adulthood 3656
late childhood 266
middle adulthood 362
youth223
empathy 253, 263
endocrine system 213, 214, 283, 284
endometriosis 383, 410
endometrium 191, 196
energy
content of selected foods 99
measurement98
nutrients required for production
of989
requirements for individuals 99
environmental tobacco smoke
(ETS)136
F
falls and injuries
as child health issue 323
3245
family cohesion 123, 1401
family composition 4323
Family Services 339
fats
categories 85, 399
monounsaturated fats 867
as nutrients 857
polyunsaturated fats 867
saturated fats 88
trans fats 88
Federal Government
adult health promotion strategies
and programs 4635
child health promotion strategies
and programs 3348
prenatal health promotion 2423
feral children 1819
fertilisation
definition 3, 4
in-vitro fertilisation (IVF) 1934,
355, 358
process of 1924
fibre83
fine motor skills 3, 11, 12
fluoridation of water 30910
foetal alcohol syndrome 213, 222,
2389
foetal mortality 2012
foetal stage of prenatal
development1989
folate (folic acid) 96, 203, 220
food
energy content 99
see also diet
food advertising, impact on
children317
food allergies
food selection models 11112
fortified food 81, 90
friendships, developing and
maintaining1334
G
general practitioners (GPs) 176
genes 213, 214, 283, 284
genetic conditions 656, 21516,
2856, 3846
genetic potential 3, 30
genetic predispositions 45, 66, 2868,
383, 3867
genetics
and adult health and
development3847
as biological determinant of health
and development 301
and child health and
development2848
and prenatal health and
development214
and youth health and
development656
germinal stage of prenatal
development1956
gestational diabetes 67, 2045, 23940
gingivitis 283, 298
glandular fever, possible impacts on

health and development 701
glycaemic index (GI) 105
gross motor skills 3, 11, 12
H
haemoglobin 81, 91
haemophilia 45, 65, 213, 215,
21617
haemorrhages 191, 204
hard tissues 81, 82, 102
health
defining 45, 467
dimensions of 4752
interrelationships between
dimensions512
interrelationships with individual
human development 701
optimal health 51
health care services
access to 2323, 31719, 3836
rights and responsibilities of
users1789
health indicators 45, 54
health professionals, seeking help
from1345
health promotion
community strategies and
programs 1745, 245, 3413,
469
government strategies and
programs 1745, 2424,
33440, 4638
personal strategies 175, 246,
46971
targeting adults 46371
targeting children 33443
targeting prenatal health 2426
health status
adults36975
children26871
measuring545
pregnant women 2047
unborn babies 2014
youth55
Healthy Eating Pyramid 11415
Healthy Mothers, Healthy Babies
program244
Heart Foundation Tick logo 469
high-density lipoproteins (HDLs) 383,

38990
hormonal changes
as biological determinants of health
and development 312
in puberty 312
and youth health 678
hormones
and endocrine system 214, 284
role in childhood physical
development285
role during pregnancy 214
role in puberty 312
hospital care, mental health
problems176
hospitalisations, children 276
housing environment
41213
3079
youth health and
development1367
housing stress 383, 41213
human lifespan
childhood56
early adulthood 7
infancy5
late adulthood 8
middle adulthood 8
prenatal stage 4
stages of 48
youth6
Huntingtons disease 3856
hypertension 383, 389
I
ice (crystal methamphetamine) 4078
identity234
illicit drugs 153, 156, 1601, 4067
Immunise Australia program 243
implantation 191, 195
in-vitro fertilisation (IVF) 1934, 355,
358
incidence (morbidity data) 45, 601
continual nature 254
definition3
dimensions of 9
early childhood 23941

depression1701
infancy25861
interrelationships between
dimensions289
interrelationships with health 701
late childhood 2657
predictable orderly patterns 255
principles2546
variations 2545, 256
infancy
development25861
stage of 5
infant mortality 253, 2689
infertility 383, 409, 410
infirmity 45, 46
influenza70
inherited conditions 213, 215, 2856
injuries
youth1556
see also falls and injuries
insulin67
intellectual development
aspects256
early adulthood 3589
early childhood 264
depression171
infancy261
late adulthood 366
late childhood 2667
youth26
internet use disorder 1434
intracytoplasmic sperm injection 191,
194
iodine220
iron 913, 220
J
jaundice 191, 205
juvenile arthritis
Index 479
K
Kidsafe342
kilojoules (kJ) 81
Klinefelter syndrome 218
L
late adulthood
definition 355, 364
health status 3723
stage of 8
late childhood
development2657
stage of 5
lethargy45
life expectancy 45, 556, 269
Life! Taking Action on Diabetes
program469
Listeria monocytogenes 213, 221
LiveLighter campaign 4667
local government
adult health promotion 4678
child health strategies and
programs340
maternal and child health centres 244
low birth weight 2368, 272
low-density lipoproteins (LDLs) 383,
38990
lung cancer, scanning for 455
M
macronutrients 81, 82
macular degeneration 339, 383, 393
Malaya, Oxana 1819
male impotency 383
male reproductive system 15
mammograms465
mammography screening 383, 418,
445, 465
mandatory fortification of food 191,
203, 243
480Index
maternal and child health centres 244,

318
Maternal and Child Health Line
244
Maternal and Child Health
Service33940
maternal health, in rural and remote
communities229
maternal morbidity 2047
maternal mortality 204
maternal nutrition 193, 214, 21921
Meals on Wheels 468
meconium 253, 259
media influences
on adult health and development
4212
on child health and
development31517
on youth health and
development1414
Medicare 1756, 242
melanoma127
menarche3
meningococcal disease 283, 306
menopause384
menstrual cycle 1516
menstruation 3, 15
mental health
access to services in rural
areas41920
children2745
definition 45, 49
during and after pregnancy 205
depression169
indicators4950
issues165
mental health care services
available to youth 175, 177
rights and responsibilities of
users1789
mental health promotion
government and community
strategies/programs1745
personal strategies 175
mental health specialists 176
mental illness
definition50
incidence, prevalence and
trends1656

stigma attached 174
metabolism 3, 31, 249
metastasise (cancer) 123, 127, 445,
453
micronutrients 81, 82
middle adulthood
definition 355, 360
health status 3712
stage of 8
minerals399
monounsaturated fats 867
morbidity 45, 603
mortality 45, 568
morula 191, 196
motor skills 11
multicausal factors 283, 284
muscular dystrophy 45, 65
N
National Bowel Cancer Screening
Program41819
National Diabetes Services Scheme
(NDSS)336
National Immunisation Program 338
National Perinatal Depression
Initiative243
neighbourhood safety 41617
neonatal intensive care units 317
neonates
adaptations2589
definition 253, 258
neural tube defects 2023, 213, 220
non-melanoma skin cancers 127
nutrient dense foods 3, 32
nutrients
B-group vitamins 967
blood production 1001
calcium901
carbohydrates823
fats857
fibre83
formation of hard tissue 102
formation of soft tissue 1012
functions and interrelationships
98104
iron913
protein845
provision of energy 989
required during youth 82
as risk or protective factors for
diet-related diseases 400
vitamin A 94
vitamin C 95, 100
vitamin D 945
water89
nutritional imbalance
long-term consequences 1068
short-term consequences 1056
O
obesity
in adults 447
in children 291
as health issue 4467
4478
in youth 1067, 154
object permanence 253, 261
occupational overuse syndrome
(OOS) 383, 414
optimal health 51
oral hygiene
in childhood 2989
promotion299
ossification 81, 103
osteoporosis 81, 90
ova192
overweight 1067, 154
P
parental education 231, 31213
parental employment status 31213
parental health and disability 232
parental income 232
parenting practices 31315
parents, socioeconomic status 141
passive smoking 2278
peak bone mass 81, 90
perinatal conditions 253, 268
periodontitis 283, 298
permissive parenting style 314
physical activity
adulthood3967
childhood3002
youth1278
changes to body systems 1011
definition 3, 9
early childhood 262
growth and development of body
systems910
depression170
infancy259
late adulthood 3645
late childhood 265
motor skills 11
youth1216
physical environment determinants
access to recreational facilities
1389
41215
asthma322
cancer454
30612
food allergies 327
housing environment 1367
impact on health and
development 123, 1245,
136
mental illness 461
obesity448
prenatal health and
development2279
spina bifida 235
tobacco smoke in home 136,
2278, 3067
type 2 diabetes 457
work environment 1378
youth health and
development1369
physical health
definition 45, 47

depression169
indicators478
physiological changes
definition355
early adulthood 356
placenta 191, 196
Polycystic Ovarian Syndrome
(PCOS)678
polyps 383, 418
polyunsaturated fats 867
pre-eclampsia 206, 245
precocious puberty 35
pregnancy
alcohol consumption 2223
foods to avoid 221
impact of drug use 2245
smoking during 2212
unintended pregnancy 410
Pregnancy, Birth and Baby service 243
pregnant women, health status 2047
prenatal development
embryonic stage 1968
foetal stage 1989
germinal stage 1956
stages195
prenatal health care, access to 2289,
2323
prenatal health promotion
community programs and
strategies245
government programs and
strategies243
personal programs and
strategies246
prenatal morbidity 2024
prenatal stage
biological determinants on health
and development 21418
of lifespan 4
prescription drugs 407
prevalence (morbidity data) 45, 601
Primary School Nursing
Program31819
primary sex characteristics 3, 12
prostate cancer 387
protective factors 283, 284
see also risk and/or protective factors
protein 845, 103, 399
proximodistal development 253, 255
Index 481
psychoactive effects 383, 406

psychotic state 153, 165
puberty 3, 5, 7
age of 14, 356
in girls 356
precocious puberty 35
R
recessive traits 283, 285
recreational facilities, access to 1389,
31011
regeneration 191, 192
reproductive function/dysfunction 411
resilience 123, 134
asthma3212
cancer4545
food allergies 3267
mental illness 4612
obesity4478
spina bifida 2345
risk factors, definition 283, 284
rites of passage 3
rural mental health services 41920
S
safety
in the home 3089
of neighbourhood 41617
in workplace 41315
SANE Australia 174
saturated fats 88
secondary sex characteristics 3, 12
sedentariness 123, 127
self-esteem49
semen 3, 15
sex-linked chromosomes 21314,
21617
sex-linked genetic conditions
21617
sexual maturity 14
482Index
sexual practices
in adulthood 40911
reproductive function/
dysfunction411
unprotected sex 409
in youth 1323
sexually transmissible infections
(STIs) 123, 1323, 153, 1613,
40910
skin cancer 123, 1278, 387
smoking see tobacco smoking
social, children 31219
social capital 383, 426
social connections 4267
social development
aspects17
definition 3, 17, 355, 357
early childhood 2623
depression170
infancy260
late adulthood 365
late childhood 265
youth1920
social environment determinants
for adult health and
development42135
for anxiety and depression 172
and asthma 322
for cancer 455
for cardiovascular disease 452
definition123
and falls and injuries 3245
for foetal alcohol syndrome 239
food allergies 327
impact on health and
development 125, 140
for mental illness 461
for obesity 448
prenatal health and
development2313
for spina bifida 235
for type 1 diabetes 333
for type 2 diabetes 4578
and youth health and
development1406
social health
definition 45, 49
depression169
indicators49
social support 383, 4301
socioeconomic status (SES)
and adult health 4234
definition123
parental income 231
of parents 141
as social determinant 125
soft tissues 81, 82, 1012
sperm 3, 15, 192
sperm production 15
spermarche 3, 15
sphygmomanometers 383, 389
spina bifida
Sport and Recreation Victoria 311
spouses 355, 357
standard drinks 383, 402
state and territory governments, health
promotion 33840, 4667
stigma 153, 174
stress, and cortisol 67
stroke383
substance use 12930, 1601, 172
sudden infant death syndrome
(SIDS)269
sun protection
in adulthood 3924
in youth 1278
systolic blood pressure 383, 388
T
teratogens 191, 196
testosterone 67, 384
thalidomide225
tobacco smoking
adults3945
environmental tobacco smoke
(ETS)136
health impact 1301
legislation338
and lung cancer 455
passive smoking 136, 2278, 3067
in pregnancy 2212
quitting395
youth1301
and youth health 156
trans fats 88
transport accidents 155
trends57
Triple X syndrome 218
Trisomies 13 and 18 217
tumours 445, 453
Turner syndrome 45, 65, 218
type 1 diabetes 67, 287
as child health issue 2734, 3312
U
ultrasound 191, 196
unborn babies, health status 2014
underweight 345, 154
uninvolved parenting style 314
V
vaccination 213, 214, 226, 3025
vegans 81, 97
Victorian Child Protection
Service3389
Victorian Government, prenatal health

promotion244
Victorian Healthy Eating Enterprise
(VHEE)466
vitamin A 94, 101, 103
vitamin B196
vitamin B296
vitamin B396
vitamin B996
vitamin B1297
vitamin C 95, 100, 103
vitamin D 945, 103
vitamins399
volunteering 145, 427
W
water
fluoridation30910
importance for survival 89, 399
weight issues 1545
work environment 1378
worklife balance 4345
work-related stress 4256
workplace conflict 425
workplace safety 41315
World Health Organization (WHO),

definition of health 46
X
XYY syndrome 218
Y
years of life lost (YLL) 45, 58
years lost due to disability (YLDs) 45,
60, 612
You2 initiative 245
young adults, health status 370
youth6
body weight 689
definition3
genetics656
hormonal changes 678
impact of biological determinants on
health659
self-assessed health status 55
Youthbeyondblue1745
Z
zygotes 191, 192
Index 483

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HHD Units 1+2 Textbook

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Key Concepts in VCE

Health & human

Key ConCepts in vCe

HealtH & Human

Fourth edition published 2016 by

Unit 1 The health and development

1.3 Individual human development during youth: physical

1.4 Exploring individual human development: social

1.5 Exploring individual human development: emotional

1.6 Exploring individual human development during youth: intellectual

1.7 Exploring the interrelationships between the areas of

1.8 The impact of biological determinants on youth development

Chapter 2 The health of Australias youth44

2.2 The health status of Australias youth

2.4 The impact of biological determinants on youth health

2.5 Understanding the interrelationships between health and individual

Chapter 3 Nutrition during youth80

3.3 Introduction to the nutrients required during youth: vitamins A, B, C and D

3.4 The interrelationship of major nutrients

3.5 Consequences of nutritional imbalance

Chapter 4 The determinants of health and individual human

4.2 Determinants of health and individual human development during

4.3 Determinants of health and individual human development during

4.4 Determinants of health and individual human development during

Chapter 5 Health issues facing Australias youth152

5.2 A health issue in focus: anxiety and depression, part 1

5.3 A health issue in focus: anxiety and depression, part 2

5.4 A health issue in focus: anxiety and depression, part 3

Unit 2 Individual human development and

Chapter 6 Health and individual human development during the

Chapter 7 The determinants of health and individual human

7.2 Determinants of health and individual development during the

7.3 Determinants of health and individual development during the

7.4 Determinants of health and individual development during the

7.5 Determinants that act as risk and/or protective factors in relation

7.6 Strategies and programs designed to promote prenatal health and

Chapter 8 The health and individual human development of

8.2 Development during infancy

8.3 Development during early childhood

8.4 Development during late childhood

8.5 The health status of Australias children: mortality

8.6 The health status of Australias children: morbidity

Chapter 9 The determinants of health and individual human

9.2 Determinants of health and individual human development of children:

9.4 Determinants of health and individual human development of

9.10 Government strategies and programs designed to promote the health

9.11 Community and personal strategies and programs designed to promote

Chapter 10 The health and individual human development of

10.2 Middle adulthood: physical, social, emotional and intellectual development

10.3 Late adulthood: physical, social, emotional and intellectual development

10.4 The health status of Australias adults

Chapter 11 The determinants of health and individual human

11.2 Behavioural determinants: sun protection and tobacco smoking

11.3 Behavioural determinants: physical activity

11.4 Behavioural determinants: food intake

11.5 Behavioural determinants: alcohol use

11.6 Behavioural determinants: drug use

11.7 Behavioural determinants: sexual practices

11.8 Physical environment determinants: housing and workplace safety

11.9 Physical environment determinants: neighbourhood safety and access

11.10 Social determinants: the media, level of education, employment status

11.11 Social determinants: the workplace and community belonging

11.12 Social determinants: living arrangements and social support

1.3 Individual human development during youth: physical

1.4 Exploring individual human development: social

1.5 Exploring individual human development: emotional

1.6 Exploring individual human development during youth: intellectual

1.8 The impact of biological determinants on youth development

Chapter 2 The health of Australias youth44

2.2 The health status of Australias youth

2.4 The impact of biological determinants on youth health

Chapter 3 Nutrition during youth80

3.3 Introduction to the nutrients required during youth: vitamins A, B, C and D

3.4 The interrelationship of major nutrients

3.5 Consequences of nutritional imbalance

Chapter 5 Health issues facing Australias youth152

5.2 A health issue in focus: anxiety and depression, part 1

5.3 A health issue in focus: anxiety and depression, part 2

5.4 A health issue in focus: anxiety and depression, part 3

8.2 Development during infancy

8.3 Development during early childhood

8.4 Development during late childhood

8.5 The health status of Australias children: mortality

8.6 The health status of Australias children: morbidity

10.2 Middle adulthood: physical, social, emotional and intellectual development

10.3 Late adulthood: physical, social, emotional and intellectual development

10.4 The health status of Australias adults

11.2 Behavioural determinants: sun protection and tobacco smoking

11.3 Behavioural determinants: physical activity

11.4 Behavioural determinants: food intake

11.5 Behavioural determinants: alcohol use

11.6 Behavioural determinants: drug use

11.7 Behavioural determinants: sexual practices

11.8 Physical environment determinants: housing and workplace safety

11.11 Social determinants: the workplace and community belonging

11.12 Social determinants: living arrangements and social support

11.13 Social determinants: family and worklife balance

Chapter 12 Health issues facing Australian adults444