Section 5: Other helpful Information
This section contains detailed information on some of the topics that are mentioned in earlier sections. It is background information which will help you understand the topics in a bit more detail.
Topics include:
•	an introduction to health promotion
•	some chronic diseases
•	lifestyle factors 
An introduction to health promotion 
The aim of health promotion in your role as a Healthy Lifestyle Worker is to assist people to make positive lifestyle choices for their health.
You can use health promotion methods for different stages of health to:
•	prevent people developing chronic diseases
•	encourage people to be checked/screened for chronic diseases 
•	assist in lifestyle management for people with chronic diseases
For example, health promotion activities for type 2 diabetes - one of the most common chronic diseases among Indigenous people - could include:
•	raising awareness of the condition
•	encouraging people to be screened for type 2 diabetes
•	encouraging healthy nutrition and exercise
These activities would help people manage the condition, reduce their risk of developing complications, and improve the quality of their lives.
What is health? 
Health has been defined by the World Health Organization as ‘a state of complete physical, mental, emotional and social wellbeing and not merely the absence of disease or infirmity’. To reach a state of complete physical, mental and social wellbeing, people must be able to identify and realise goals, to satisfy needs, and to change or cope with the environment. 
Health for Indigenous people includes everything that is important in their lives, including land, environment, physical body, community relationships and law. Health is the social, emotional and cultural wellbeing of the whole community and the concept is linked to the sense of being Indigenous. These aspects are included in the Indigenous definition that was initially developed more than 30 years ago by the National Aboriginal Health Strategy Working Party:
‘Aboriginal health means not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being thereby bringing about the total wellbeing of their community. It is a whole of life view and includes the cyclical concept of life-death-life.’	
There are many factors that influence health and wellbeing, often referred to as the ‘determinants of health’. These determinants generally refer to environmental, social, economic, behavioural and biological factors.
These factors include:
•	level of education
•	opportunities for employment 
•	income
•	social support networks
•	personal safety
•	genetic factors
•	clean water and air
•	adequate housing
•	nutrition 
•	level of physical activity
•	access to health services
•	finances.
What is health promotion? 
A major international meeting of health promotion in Ottawa, Canada defined health promotion as ‘the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions’ (this is included in the Ottawa Charter for Health Promotion).
Enjoyment of the highest possible standard of health is recognised as one of the rights of every human being. Health promotion is based on this human right; it offers a positive and inclusive concept of health, including mental and spiritual wellbeing, as a determinant of a person’s quality of life.
Health promotion actions include strengthening the skills and capabilities of individuals, and actions directed towards changing social, environmental, political and economic conditions to positively change their impact on population and individual health. 
The Ottawa Charter identifies three approaches to creating improvements in health:
•	advocating for health (by addressing political, economic, social, cultural, environmental, behavioural and biological factors) to create the essential conditions for health
•	developing and maintaining supportive environments, access to information, life skills and opportunities for healthy choices to enable people to take control over their own health in order to achieve their fullest potential
•	facilitating coordinated action between governments, health and other social and economic sectors, non-government and voluntary organisations, local authorities, industry and the media to pursue optimal health for individuals and communities. 
Strategies and planning in health promotion refer to these action areas:
•	building healthy public policy 
•	creating supportive environments
•	strengthening community action
•	developing personal knowledge and skills
•	reorienting health services
•	moving into the future.
The National Strategic Framework for Aboriginal and Torres Strait Islander Health identifies the following key principles for improving health and wellbeing in Indigenous communities: 
•	community control
•	holistic and culturally appropriate approaches
•	partnerships and shared responsibility
•	localised decision-making
•	community capacity building
•	coordination of service delivery
•	transparency and accountability.
In 2002, key state and territory representatives working in Aboriginal and Torres Strait Islander health promotion and population health met in Sydney and developed the Principles for better practice in Aboriginal health promotion. These are shown below.
Principles for better practice in Aboriginal health promotion
1.	Aboriginal health promotion should acknowledge Aboriginal cultural influences and the historical, social and cultural context of communities.
2.	Aboriginal health promotion practice should be based on available evidence.
3.	Effective Aboriginal health promotion practice means building the capacities of the community, government, service systems, organisations and the workforce, ensuring equitable resource allocation (flexible purchaser provider arrangements), cultural security and respect in the workplace.
4.	Aboriginal health promotion should ensure ongoing community involvement and consultation.
5.	The practical application of Aboriginal self-determination principles is fundamental in all Aboriginal health promotion planning.
6.	Aboriginal health promotion adheres to the holistic definition of health and acknowledges that primary health care in Aboriginal communities incorporates Aboriginal health promotion.
7.	The establishment of effective partnerships is required to address many of the determinants of health.
8.	Aboriginal health promotion programs should aim to be sustainable and transferable.
9.	Aboriginal health promotion should demonstrate transparency of operations and accountability.	

Source: NSW Health (2002) 

About chronic diseases and lifestyle factors 
The following pages will provide you with some background information on the main chronic diseases and main lifestyle factors that will be the focus of your work. The three main chronic diseases are diabetes, cardiovascular disease and kidney disease; all are largely preventable. 
Unhealthy eating, lack of physical activity, smoking and drinking alcohol (known collectively as ‘lifestyle factors’) are some of the risk factors that can be changed to reduce the risk of chronic diseases and reduce their effect among people who have already been diagnosed with them.

Diabetes 
What is diabetes? 
Diabetes occurs when the body does not produce enough insulin, a hormone that carries sugar (glucose) from the blood to the cells where it is turned into energy. Without insulin, the sugar stays in the blood, and the person feels tired and lacks energy.
Diabetes is indicated by a level of blood sugar outside the normal range of 4 to 8 millimoles per litre. Further tests are used to make a diagnosis.
How do people get diabetes? 
People may get diabetes because they have one or more risk factors. Not everyone who has risk factors will get diabetes, but having risk factors increases a person’s chances of getting the disease.
There are risk factors that can be changed and those that cannot (see lists below). And there are contributing factors, such as poverty, which can be changed, but not easily.
Risk factors that can be changed:
•	consuming too much unhealthy, processed food that is high in sugar and fat, including sugary drinks
•	getting little or no physical activity
•	having high blood pressure
•	being overweight
•	drinking alcohol heavily
•	smoking.
Risk factors that cannot be changed:
•	a family history of diabetes
•	older age.
What are the different types of diabetes? 
Type 1 diabetes is usually first found in children and young people. It occurs when the pancreas, a small organ near the stomach, cannot produce insulin any longer. This means that insulin has to be injected into the body several times a day.
Type 2 diabetes is usually found in people aged over 35, particularly those aged over 40 years. It occurs when the pancreas does not produce enough insulin, or something prevents the insulin from doing its job. This type of diabetes is most often caused by risk factors that could be avoided by adopting a healthier lifestyle. Some people can have this type of diabetes without knowing it, but it will still make them sick and shorten their lives, so the sooner it is diagnosed the better.
Gestational diabetes happens in some pregnant women and generally disappears after the birth. It is usually diagnosed with a blood test. Indigenous women should have this test at 12 weeks and between 26 and 28 weeks of pregnancy.
What are the symptoms of diabetes? 
Signs that a person has diabetes include:
•	sores, boils and ulcers that do not heal
•	urinating a lot
•	feeling more thirsty and hungry than usual
•	feeling tired and weak
•	having blurry vision
•	getting leg cramps and itching.
If a person has poorly controlled diabetes for a long time it can damage their body. When diabetes is well controlled, a person can live a healthy long life.
What are the consequences of diabetes? 
Having diabetes can lead to serious health problems such as:
•	heart attack
•	stroke
•	loss of feeling in nerves
•	poor circulation
•	feet problems
•	feeling weak in muscles
•	stomach problems
•	sexual problems
•	incontinence
•	damage to kidneys
•	damage to eyes
•	amputation of toes, feet, legs, hands or arms.
Babies born to women who have gestational diabetes are more likely to develop diabetes and cardiovascular disease when they grow up.
What can be done to prevent diabetes? 
Not all types of diabetes can be prevented, but lifestyle changes will improve a person’s health and make it less likely that they will get diabetes. 
Prevention of diabetes:
•	be physically active
•	eat healthy foods, particularly foods low in fat and sugar, and drink less sugary drinks
•	control weight and pay attention to waist circumference
•	limit alcohol use
•	stop smoking.
How is diabetes managed? 
There is no cure for diabetes, but it can be controlled. The following are ways of managing diabetes and improving health:
•	lose weight
•	eat healthy, unprocessed foods
•	check blood sugar levels regularly
•	do regular physical activity
•	quit smoking
•	drink less alcohol
•	take medicines (if prescribed by a doctor)
•	have good personal hygiene (to reduce the risk of infections).
People with diabetes should visit the health clinic for a health assessment including:
•	eyesight checks
•	feet checks
•	kidney checks
•	blood pressure checks
•	skin checks
•	blood glucose level checks.
Can someone have too little blood sugar? 
Yes, a condition known as hypoglycaemia (also called a ‘hypo’) may occur when someone has too little sugar in their blood (in medical terms, below 4 millimoles per litre). This can happen when the person does not take the right amount of medicine for diabetes. It can also happen when the person skips meals, exercises too much or drinks too much alcohol. Generally, only people with type 1 diabetes are at risk.
Signs of hypoglycaemia are:
•	unclear thinking
•	dizziness
•	headaches
•	blurred vision
•	faster heartbeat
•	sweatiness
•	shakes
•	hunger.

Cardiovascular disease
What is cardiovascular disease? 
Cardiovascular disease (CVD) is when the heart and blood vessels that carry blood around the body are damaged. The blood carries oxygen and nutrients to the cells and removes carbon dioxide and other waste that is produced by cells. The heart pumps blood around the body, and blood is carried back to the heart via the lungs. In this way, a healthy cardiovascular system makes sure that oxygen and nutrients find their way to each part of the human body.
Because the cardiovascular system is a complex system reaching all parts of the body, there are a number of cardiovascular diseases, including coronary heart disease, stroke, hypertension and rheumatic heart disease.
How do people get CVD? 
People get CVD because they have one or more risk factors. Not everyone who has risk factors will get CVD, but most people with CVD have several risk factors.
There are risk factors that can be changed and those that cannot (see lists below). And there are contributing factors, such as poverty, which can be changed, but not easily.
Risk factors that can be changed:
•	eating unhealthy food, high in sugar and fat
•	little or no physical activity
•	smoking
•	drinking alcohol heavily
•	high blood pressure
•	high blood cholesterol 
•	being overweight or obese
•	having diabetes
•	having kidney disease.
Risk factors that cannot be changed:
•	gender - men are at greater risk of CVD than women
•	age, particularly being over 45 years old
•	family history of CVD
•	having had a CVD event.
What are the main types of CVD? 
Coronary heart disease (CHD - also known as ischaemic heart disease) is caused by damage to the arteries that supply oxygen-rich blood to the heart muscle. If the damage is severe enough, it can result in a heart attack, which damages the heart muscle.
CHD is often a result of a build-up of hard, fatty substances in the arteries. 
In view of its major impact on Indigenous populations, CHD will be discussed in more detail below.
Hypertension means high blood pressure, which can cause damage to the body. Normal blood pressure is usually expressed as 120/80. A person is said to have high blood pressure if they have a reading of 140/90 or more. The main risk factors for hypertension are not doing enough exercise, being overweight or obese, stress, and eating lots of salt.
Stroke occurs when blood flow to a part of the brain is reduced or stops. This is usually caused by a blocked or burst blood vessel. As a result of a stroke, a part of the brain may die and no longer work properly. Sometimes, a stroke leads to a long-lasting disability, including inability to move an arm or leg, and problems with talking.
Rheumatic heart disease occurs as a result of damage to the heart valves and heart muscle following a bout of acute rheumatic fever. The fever itself is a reaction to bacteria infecting the throat, and affects some children living in rural and remote Australia. Poor personal hygiene, poor living conditions and malnutrition are added risk factors for developing rheumatic heart disease.
Coronary Heart Disease
What are the consequences of CHD? 
The most serious consequence of CHD is a heart attack, which can be fatal (lead to death). Even heart attacks that are not fatal can lead to serious health problems, including: 
•	headaches
•	shortness of breath
•	dizziness
•	numbness
•	weakness
•	blackouts
•	permanent disability
•	coma.
People can be at either low risk or high risk of experiencing a cardiovascular event, such as a heart attack.
People at low risk:
•	have some risk factors, such as mild hypertension and/or slightly elevated levels of cholesterol.
People at high risk:
•	have had a CVD event
•	have diabetes
•	have vascular disease
•	have kidney disease.
What are the symptoms of a heart attack? 
Chest pain or discomfort is the most common symptom of a heart attack, but some people don’t experience chest pain at all, and others experience only mild chest pain or discomfort. Pain, pressure or heaviness may also be felt in shoulders, arms (particularly the left arm), neck, jaw and back.
Some people feel generally unwell or ‘not quite right’. They may also be nauseous, dizzy, have a ‘cold sweat’ or be short-of-breath. 
Heart attacks need urgent medical action, at a hospital if at all possible.
The Heart Foundation warns that the symptoms of heart attack aren’t always ‘what you think’. They suggest that if a person thinks they’re having a heart attack, they should call triple zero (000) - ‘The operator will work out if you need an ambulance. And if it’s a false alarm, well, that’s the best thing that could happen.’
What can be done to prevent CHD? 
Some risk factors cannot be changed, so not all CHD can be prevented.
People can change most risk factors, however, and improve their health. 
Prevention of CHD:
•	quit smoking
•	be physically active
•	eat healthy foods, such as vegetables, fruit and fish
•	control weight
•	limit alcohol consumption to two standard drinks a day
•	reduce stress.
How is CHD managed? 
•	by taking medicines prescribed by a doctor
•	by adopting the same lifestyle factors that help prevention of CHD (above)
•	by having surgery (such as bypass surgery) to improve the flow of blood to heart muscle.
A person experiencing a heart attack or stroke needs some strategies to be put in place to ensure a better quality of life.
These strategies, known as cardiac rehabilitation include:
•	health education
•	counselling
•	changes in behaviour.

Kidney disease 
What is kidney disease? 
Kidney disease affects the urinary system, which is made up of the kidneys, urinary tract and bladder. The kidneys and other parts of the urinary system filter and discard blood-borne waste and excess fluid from the human body.
How do people get kidney disease? 
People get kidney disease because they have one or more risk factors. Not everyone who has risk factors will get kidney disease, but most people with kidney disease have several risk factors.
There are risk factors that can be changed and those that cannot (see lists below). And there are contributing factors, such as poverty, which can be changed, but not easily.
Risk factors that can be changed:
•	being overweight or obese
•	being pregnant many times
•	eating food that is high in fat and low in dietary fibre too often
•	drinking alcohol heavily
•	smoking
•	not being physically active.
Risk factors that cannot be changed:
•	gender - some kidney diseases are more common in women, others in men
•	age - some diseases are more common in older people, others in children 
•	family history
•	other existing health conditions, such as diabetes, heart disease or lung disease
•	low birthweight and childhood malnutrition
•	humid weather conditions
•	high blood pressure, and high blood glucose and lipid levels (for end-stage renal disease).
What are the different types of kidney disease? 
There are a number of different diseases affecting the kidneys, urinary tract and bladder, including urinary tract infection. Of particular concern is chronic (long-standing) kidney disease, which generally results from the impact of another long-term health condition, such as diabetes (diabetic nephropathy), high blood pressure (hypertensive renal disease) and direct damage to kidney cells (glomerular disease). Chronic kidney disease can also occur after recurrent urinary tract infection, which is more common for women than men.
Chronic kidney disease is the progressive loss of kidney function over months or years. As noted above, this is generally the result of long-term damage from another health condition.
End-stage kidney disease (also known as end-stage renal disease) is the most serious form of chronic kidney disease. It occurs when the kidneys are no longer able to function at a level needed for daily life. Medical help (including dialysis) is necessary to treat end-stage kidney disease. End-stage kidney disease can occur in young people, but it is more common in older people.
What are the symptoms of kidney disease? 
Each kind of kidney disease has its own symptoms. 
Symptoms for urinary tract infection include:
•	urinating more often than usual
•	a burning sensation when urinating
•	pain in the lower belly.
The symptoms of chronic kidney disease, including end-stage renal disease, can be quite varied, but common ones include:
•	need to urinate frequently, particularly at night 
•	feeling generally unwell or tired most of the time
•	swelling of the legs and puffiness around the eyes (fluid retention)
•	having dry skin and general itching
•	headaches
•	unexpected weight loss
•	loss of appetite
•	often feeling like vomiting.
What are the consequences of kidney disease? 
Possible consequences of a urinary tract infection are:
•	reduced kidney function
•	developing chronic kidney disease.
Possible consequences of chronic kidney disease are:
•	reduced kidney function
•	increased blood pressure
•	joint or chest pain (due to inflammation around the heart)
•	anaemia (low iron levels in the blood)
•	bleeding (due to poor blood clotting)
•	high blood sugar
•	muscle cramping
•	bone pain and fractures
•	decreased sexual interest
•	end-stage renal failure
•	permanent disability
•	death.

What can be done to prevent kidney disease? 
The following lifestyle changes can help prevent kidney disease:
•	getting regular physical activity
•	eating healthy foods, such as vegetables, fruit and fish
•	keeping homes clean
•	limiting alcohol use
•	quitting smoking
•	drinking lots of clean water
•	keeping stress levels low.
How is kidney disease managed? 
The management of most chronic kidney disease usually involves a combination of treatment for the underlying conditions and for the specific consequences of chronic kidney disease. For example, urinary tract infections are usually managed with antibiotics.
End-stage kidney disease requires medical intervention to prevent death. Current treatment options include regular dialysis to mechanically filter the blood and maintain the functions usually performed by kidneys. Kidney transplantation is another treatment option in some circumstances.
Some Indigenous people with end-stage renal disease are at high risk of withdrawing from treatment because of:
•	living away from homelands
•	loss of social support
•	despair with the discomfort and reliance on dialysis
•	complex treatment plans
•	difficulties coping with a long-term disability.
Withdrawal from treatment is a huge worry because this usually leads to death. 

Nutrition 
Healthy eating is a vital part of good health. Nutrition is the process in which the food we eat brings nourishment to our body.
What is good nutrition? 
With good nutrition the body receives a balance of nutrients from a variety of foods. A balanced diet can help with:
•	maintaining a healthy weight
•	maintaining energy levels
•	sleep
•	a healthy heart
•	healthy bones
•	reducing the risk of some diseases.
Why is good nutrition important? 
Good nutrition is important for physical wellbeing and social and emotional health.
Nutrients play an important role in the body processes of:
•	digestion
•	breathing
•	growth and repair of body tissue
•	heart function
•	prevention of disease.
Good nutrition requires a healthy diet made up of a combination of the different nutrients. 
What is poor nutrition? 
Poor nutrition can mean either: 
•	under-nutrition - the body receives too few nutrients and/or less energy than it needs
•	over-nutrition - the body receives too many nutrients and/or more energy than it needs.
Why is poor nutrition harmful? 
Under-nutrition  in pregnant women and infants will increase the chance of developing chronic diseases later in life. It can also lead to slower physical growth and brain development in children. Underweight children are at increased risk of death from infectious illnesses such as diarrhoea and pneumonia. In adults, under-nutrition can lead to serious illnesses over time.
Over-nutrition  can lead to overweight and obesity. It is caused by eating too many foods with high levels of sugar and saturated fats and by not being physically active. Being overweight is a risk factor for long-term health conditions such as diabetes, arthritis and some cancers. It is also associated with other risk factors such as high blood pressure and high cholesterol which can lead to heart disease.
Poor nutrition and lack of physical activity are major risk factors for the development of:
•	heart disease
•	stroke
•	type 2 diabetes
•	kidney disease
•	high blood pressure (hypertension)
•	obesity
•	some forms of cancer
•	osteoporosis (fragile bones).
Poor nutrition can also lead to:
•	reduced immunity against infectious diseases
•	problems with physical and mental development
•	reduced ability to work, study and learn.
Risk factors for poor nutrition 
There are several risk factors for poor nutrition: 
•	lack of knowledge about healthy eating and/or skills to be able to prepare healthy meals
•	environment - poor access to cooking facilities and food storage
•	cost - fresh, healthy food often costs more than processed, packaged food
•	access - in remote and regional areas of Australia, fresh food can be very expensive. Local stores often do not stock enough or a variety of fresh and healthy food
•	eating a lot of convenience foods that are high in salt, fat and sugar.
Nutrients in food 
There are six categories of nutrients:
•	proteins
•	fats
•	carbohydrates
•	vitamins
•	minerals
•	water.
People need nutrients in different quantities, depending on:
•	age
•	sex
•	height
•	weight
•	physical activity levels
•	rate of growth.
Food groups 
Foods are grouped according to the main types of nutrients they contain. There are five food groups:
•	vegetables and legumes
•	fruit
•	breads, cereals and wholegrains
•	milk, yogurt and cheese
•	meats, fish, poultry, eggs and nuts.
No single food or food group can supply all the nutrients a person needs, so nutrition experts recommend we eat daily servings from each of the five food groups.
Nutrition guidelines 
The Dietary guidelines for all Australians is a guide to food, nutrition and health, produced by the National Health and Medical Research Council. 
No guideline is more important than any other. The guidelines are:
•	enjoy a wide variety of nutritious food
•	prevent weight gain: be physically active and eat according to your energy needs
•	care for your food: prepare and store it properly
•	encourage and support breastfeeding. 
There are two extra guidelines for Indigenous Australians:
•	choose store foods that are most like traditional foods
•	enjoy traditional bush foods wherever possible.
The Dietary guidelines for all Australians is included in the Healthy Lifestyle Workers Resource Pack.

Physical activity
Physical activity - or body movement and exercise - is an important part of a healthy lifestyle. It includes structured exercise and sport, as well as daily activities like walking or gardening.
Physical activity is classed as low, moderate or high, depending on the level of energy.
Low level activities include:
•	walking slowly
•	doing household chores
•	gardening.
Moderate level activities include:
•	fast walking
•	dancing
•	bike riding.
High level activities include:
•	running
•	swimming laps
•	playing a sport such as football or netball.
Ways of being physically active 
Being physically active does not mean a person has to be involved in organised sport. There are many ways of being physically active as part of everyday life:
•	walking to work or school
•	being involved in cultural, spiritual or ceremonial activities
•	collecting bush tucker
•	bush walking
•	swimming and fishing
•	riding a bike
•	gardening
•	cleaning the house
•	being involved in community activities.
Why is physical activity important? 
Regular physical activity can help to maintain a healthy lifestyle and reduce the risk of chronic diseases such as:
•	cardiovascular disease
•	stroke
•	type 2 diabetes
•	some cancers.
Other benefits of regular physical activity include:
•	keeping bones and joints healthy
•	keeping muscles healthy
•	assisting in weight control
•	reducing depression
•	improving the quality of life
•	keeping the brain active and healthy
•	reducing the risk of dementia.
What are the risks of inactivity? 
When a person does not do enough physical activity, their rate of metabolism (the rate at which chemical processes occur within the body) slows down and their bodies do not require as much energy (food). If people eat more food than their body needs they are at risk of becoming overweight or obese.
Being overweight or obese is associated with a range of conditions, such as:
•	high blood pressure
•	sleep apnoea (breathing temporarily stopping during sleep, leading to lack of sleep)
•	osteoarthritis
•	psychological disorders.
Overweight and obesity are also risk factors for some chronic diseases including:
•	coronary heart disease
•	heart failure
•	stroke
•	type 2 diabetes
•	some metabolic diseases.
Why don’t people exercise enough? 
There are many reasons people may not exercise enough, including:
•	lack of time
•	existing illness
•	negative attitudes towards physical activity
•	limited access and/or limited transport options to sporting facilities 
•	cost of participation in sports.
Physical activity guidelines 
Children 
It is recommended that children aged between 5 and 18 years participate in both moderate and high levels of activity for at least 60 minutes a day, every day.
Children aged 5-12 years are active in spurts throughout the day, and they will often get enough exercise just through active play. 
Children should be encouraged to join in activities which they find fun, and are varied, so as to keep their bodies challenged.
Television, computer games and other electronic equipment should not be used for more than two hours a day.
Adults 
Adults are recommended to do at least 30 minutes of moderate physical activity every day, to improve their health and reduce the risk of chronic diseases.
The Physical activity guidelines for Australians is included in the Healthy Lifestyle Workers Resource Pack.

Alcohol 
Alcohol is one of the most widely used drugs in the world. It is used and accepted in many societies, but excessive levels of alcohol consumption result in both short-term and long-term poor health. 
Alcohol slows down the central nervous system and the brain, affecting concentration and coordination. It also slows down how quickly a person reacts to unexpected situations. Alcohol is absorbed very quickly into the bloodstream, affecting organs and cells throughout the body. The most immediate and noticeable effects are on the brain.
People who drink heavily place themselves at an increased risk of chronic ill health and early death. Long-term heavy drinking can have serious social and financial effects.
Why do people drink alcohol? 
There are many reasons people choose to drink alcohol including to:
•	experiment
•	socialise with friends and family
•	celebrate a special occasion
•	have fun
•	reduce boredom
•	relax and escape from troubles
•	feel less depressed.
What are the effects of alcohol? 
Alcohol use has many short-term and long-term health effects.
Short-term physical effects of alcohol use include problems with movement, coordination and judgment.
Short-term physical effects of high levels of alcohol use include confusion, blurred vision and poor muscle control, followed by a hangover the following day. Hangovers usually include headaches, dehydration, nausea, vomiting and/or tremors.
Long-term effects of high levels of alcohol use include:
•	liver disease
•	heart disorders
•	high blood pressure
•	anaemia
•	social and emotional issues
•	several types of cancer
•	inflammation of the pancreas
•	development problems in babies for pregnant women
•	brain damage
•	gallstones
•	stomach problems.
Chronic kidney disease, cardiovascular disease and type 2 diabetes are the chronic diseases strongly associated with high levels of alcohol use.
When a pregnant woman drinks alcohol, it can also permanently harm the unborn baby. For more information see the section below on alcohol and pregnancy.
What factors influence alcohol absorption? 
People may experience different effects of alcohol to varying degrees, and at different points in time. 
The speed of the absorption of alcohol depends on:
•	type and amount of alcohol consumed; for example, spirits contain more pure alcohol and affect the body more quickly
•	the environment - such as location, company and activity
•	gender - women usually absorb alcohol more quickly than men
•	body size - people with smaller bodies are affected more
•	age - young people and the elderly can be more affected than others
•	food intake slows down alcohol absorption.
There are ways to encourage low-risk drinking:
•	eating food before and during drinking
•	spacing drinks over time
•	drinking non-alcoholic beverages, such as water, between alcoholic drinks
•	keeping track of the number of drinks.
When is alcohol use a problem? 
There are ways to enjoy alcohol responsibly. For some people, however, alcohol use can become a problem. The following list of impacts may help identify if someone has an alcohol problem:
•	having a hangover in the mornings
•	thinking about alcohol, or the next drink, during the day
•	needing to drink more alcohol to get the same effect 
•	drinking more than planned
•	feeling on edge
•	skipping studies or work
•	having problems with people from home, school or work.
Alcohol guidelines 
The Australian alcohol guidelines, developed by the National Health and Medical Research Council, aim to reduce the risks of alcohol-related injury and disease. As already mentioned, alcohol affects different people in different ways, so there is no amount of alcohol that is safe for everyone, but these guidelines recommend upper limits of ‘standard drinks’:
•	drink no more than 2 standard drinks a day
•	drink no more than 4 standard drinks per occasion to reduce risk of injury.
The guidelines also state that:
•	for women who are pregnant or planning a pregnancy, not drinking is the safest option
•	for women who are breastfeeding not drinking is the safest option.
What is a ‘standard drink’?
A standard drink contains 10 grams of alcohol. Different alcoholic drinks have different percentages of alcohol, so the amount of beverage in a standard drink varies. For example:
•	285mls of heavy (full strength) beer contains one standard drink
•	100mls of red wine contains one standard drink
•	one nip of many spirits (such as whisky) contains one standard drink.
Note: These are only an approximate number of standard drinks. The label on the beverage container shows how many standard drinks it contains. 	

The Australian alcohol guidelines recommend that children under 15 years of age should not drink alcohol and that young people aged between 15 and 17 years should delay starting to drink for as long as possible. The safest option for pregnant and breastfeeding women is not to drink alcohol.
The Australian alcohol guidelines is included in the Healthy Lifestyle Workers Resource Pack.
Alcohol and pregnancy
When a pregnant woman drinks alcohol, it can permanently harm the unborn baby.
There is no known safe level of alcohol consumption during pregnancy and there is no period during the pregnancy when drinking alcohol is safe. That is why the Australian alcohol guidelines recommend that pregnant women do not drink alcohol.
Foetal Alcohol Spectrum Disorders (FASD) are a range of disorders that are caused by being exposed to alcohol in the womb. These disorders are associated with a range of physical, behavioural and memory problems, some of which may not become apparent until a child reaches primary school.
Being exposed to alcohol in the womb can mean that a person may have permanent disabilities, may have mental health issues, may not do well at school, may find it hard to get or keep a job, and may have a high level of contact with the criminal justice system.
More information is available at 
www.nofasard.org 

Smoking 
Tobacco is a drug used by many people throughout the world. In Australia, tobacco is usually smoked in the form of cigarettes. Cigarettes are often sold in packets containing 20-50 cigarettes, and can be bought from many places such as local stores, supermarkets and petrol stations. 
Tobacco contains a highly addictive drug called nicotine which affects the brain of a smoker. It can calm down a person if they are upset, or lift a person’s mood if they are feeling depressed. After a period of time the body gets used to the nicotine, and the smoker may find they need to smoke more cigarettes to get the same effect. The longer a person smokes, the more the body becomes used to the drug.
Tobacco smoke contains thousands of chemicals that come from the tobacco, the cigarette papers and other chemicals added to the cigarettes when they are made. These include tar, pesticides, metals and gasses.
Why do people smoke? 
There are many reasons people choose to smoke tobacco:
•	to experiment
•	to socialise
•	to join in with friends, family or colleagues who smoke
•	to control weight (as nicotine reduces the appetite)
•	to reduce stress
•	to relax and forget troubles
•	habit
•	to satisfy the ongoing nicotine cravings once addicted.
What are the effects of smoking? 
Tobacco causes more drug-related deaths and ill-health in Indigenous Australians than all other drugs combined.
Long-term smoking can have serious social and financial effects on individuals and populations. 
Long-term smoking is associated with chronic health problems, including:
•	respiratory problems
•	heart disease
•	stroke
•	lung, mouth and throat cancer
•	diseases of the blood vessels
•	high blood pressure
•	eye conditions (macular degeneration and blindness)
•	dental health problems.
The risk of developing these health conditions is made worse if a person has other risk factors such as drinking alcohol, being overweight, having poor nutrition, or using other drugs.
Smoking and pregnancy 
If people smoke while pregnant they can be at greater risk of:
•	ectopic pregnancy (the baby grows outside the womb)
•	miscarriage
•	early labour
•	still-born babies
•	reduced breast milk production.
The unborn baby can experience:
•	low oxygen supply
•	problems with growth and development
•	increased risk of cleft lip and palate
•	increased heart rate and disruption of breathing.
Once born, the baby can have an increased risk of:
•	low birth weight
•	sudden infant death syndrome (SIDS)
•	decreased lung function
•	asthma
•	immune system problems.
Passive smoking 
Passive smoking is when a non-smoker breathes in the smoke from a person smoking nearby. People who experience passive smoking on a regular basis are at increased risk of developing lung cancer and other smoking-related illnesses.
Is there a safe level of smoking? 
There is no safe level of tobacco smoking. People who choose to smoke will always be damaging their health. They may also be risking the health of those people around them through passive smoking.
Benefits of quitting smoking  
When people quit smoking they may improve their life expectancy and reduce their chances of developing respiratory problems, lung cancer and heart disease. Other benefits can include:
•	improved sense of taste
•	improved sense of smell
•	breathing becomes easier and therefore exercise becomes easier.
How hard is it to quit smoking? 
Because nicotine is highly addictive, it can be difficult for anyone to quit smoking. Sometimes people quit for a short period of time, but then resume smoking. It may take several attempts before a person is able to quit for good.
Barriers to quitting smoking may be:
•	cravings (the urge to smoke)
•	withdrawal (mental and physical symptoms)
•	increased hunger and weight gain
•	family relationships (feeling disconnected and not part of the group)
•	lack of support.
When a person is trying to quit smoking, there are certain triggers which may make this more difficult:
•	having a drink (alcohol or coffee)
•	driving a car
•	finishing a meal
•	on waking up
•	having other people smoking nearby
•	feeling sad, stressed, bored or relaxed
•	socialising with friends and family.
These events may make it easier to quit smoking:
•	pregnancy (including a smoker’s partner being pregnant)
•	a serious health problem (for example, a heart attack)
•	the banning of smoking in public places, such as in pubs and at work 
•	an increase in the price of cigarettes.