Health system delivers, but lifestyle investment needed

By world standards Australians are living long lives, health risks are being actively tackled, and access to high quality health services is very good and generally improving, according to the Australian Institute of Health and Welfare's two-yearly report card on the nation's health.

Australia's Health 2002 shows that these results are being delivered by a complex health system employing 640,000 people, and accounting for around $54 billion a year in health services (8.5% of GDP).

Death rates from heart attacks and stroke have fallen by over two-thirds over the last 30 years, and cancer 5-year survival rates have improved. As a result life expectancy continues to increase (now 82.1 years for females, 76.6 years for males). There are also fewer people smoking overall, improved levels of immunisation, and a fall in the prevalence of high blood pressure.

Despite many great health gains for Australians, the health status of the Indigenous population remains poor. Health expenditure in this area has risen, but large service gaps remain.

Cardiovascular disease and cancer remain the biggest killers of Australians, with major tolls on the health system also being exacted by diabetes, mental health disorders and respiratory diseases such as asthma, and chronic obstructive pulmonary disease.

The extent of severe or profound disability in Australia has remained relatively stable over the last 10 years.

But much of the burden of ill-health to individuals and society as a whole can be reduced through attention to a few lifestyle factors, such as smoking, poor nutrition, excessive alcohol consumption, and inadequate physical activity-in other words, the public health message of prevention being better than cure

'It's like investing now in order to enjoy an asset later', says AIHW Director Dr Richard Madden. 'But there is a double pay-off in that not only might you enjoy better health, there will be a reduction in future demand on the nation's health services-a win-win with Australia's population ageing as it is.'

AIHW Medical Adviser Dr Paul Magnus says there is plenty of scope for improvement.

'For example, 50% of adults have high cholesterol levels, and this hasn't improved for the past 20 years. The major culprit is a diet too high in saturated fats.

'Diabetes is now a major disease for older people, with much of it probably due to increasing prevalence of overweight and obesity.

'Overweight and obesity affect about 65% of men, 45% of women, and 1 in every 5 children.

'We have to remember that diabetes, overweight and high cholesterol levels often occur together with high blood pressure-in fact 70% of diabetes sufferers aged over 25 also have high blood pressure. High blood pressure is the most common reason for consultation with a GP and a leading risk factor for cardiovascular disease.'

According to Dr Madden, catering for future health services demand is a difficult and complex task.

'Our future population structure can be projected with some confidence, but with health service use it is not so easy because it is driven by a complex mix of social, economic, and technical factors.

'Financial incentives will affect demand for services and the take-up of new technology. Investments today in public health, including screening and immunisation, will lower demand into the future.

'On the supply side, too few health professionals or poor allocating of these professionals will eventually push up costs.

'In this regard the fall in undergraduate nursing enrolments has to be viewed with some concern. It was the only one of the major health occupations to record an overall fall in enrolments in 2000 compared to 1995.

'There are many policy levers in health, and resources are always limited. Making the right choices at the right time requires good data and information, and we hope that Australia's Health 2002 goes some way towards providing this.

'Policy-makers, service providers, consumers and interested citizens are all invited to read and consult this publication-either in its printed version (available in Government Info Shops and through the Australian Bureau of Statistics), or free on our website ('



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