Our health report card is in—and here’s what we can learn

Australia is generally a healthy nation but there are some key areas where we could do better, according to the latest report from the Australian Institute of Health and Welfare (AIHW). The two-yearly report card, Australia’s health 2018, was launched today by the Hon. Greg Hunt MP, Minister for Health.

The report shows that Australia sits squarely in the best third of OECD countries when it comes to life expectancy, with girls born in 2016 likely to live 84.6 years, while boys can expect to live to 80.4 years.

Fewer of us are smoking or putting ourselves at risk from long-term alcohol use than in the past. More of our children have been immunised and we’re doing well in terms of preventing avoidable deaths.

At an individual level, we’re feeling the effects of these good results, with more than 4 in every 5 Australians grading their own health to be at least ‘good’—if not ‘very good’ or ‘excellent’.

But with a population that is living longer, we are now experiencing higher rates of chronic and age-related conditions. For example, we know that older Australians use a higher proportion of hospital and other health services and 75% of all PBS medicines were dispensed to people aged 50 and over. And with health spending continuing to rise—reaching $170 billion in 2015–16 and outstripping population growth—we see the important role our health system plays in both prevention and treatment.

Long-term health conditions are common—often underpinned by lifestyle factors

Half of Australians have a common chronic health condition, such as diabetes, heart disease, a mental illness, or cancer. Importantly, almost a quarter of us have two or more of these conditions, often making our experiences of health and healthcare particularly complex.

Many chronic health conditions share common preventable risk factors, such as smoking, excessive alcohol consumption, and not getting enough exercise—in fact, around one-third of our nation’s ‘disease burden’ is due to preventable risk factors.

Our expanding waistlines are a notable example: about 6 in 10 adults—or 63%—are either overweight or obese, while carrying too much weight is responsible for 7% of our total disease burden.

Over the past two decades, the proportion of Australians who have a healthy body weight fell, while the proportion who are obese increased. Over the same period, the proportion who are ‘severely obese’ nearly doubled.

AIHW CEO Barry Sandison said that when it comes to obesity, it is not just a case of poor diet or exercise habits. Rather, a range of factors—biological, behavioural, social and environmental—contribute to our likelihood of becoming obese, including the walkability of our cities, rising work hours and increasingly sedentary jobs, larger portion sizes and food advertising.

‘Understanding why someone may be obese—or in good or poor health generally—is complex and it’s important to look at the raft of factors across a person’s life that may be at play,’ he said.

Tackling the ‘why’ of poor health

Mr Sandison said that through data, we are able to better understand how a diverse array of social and other factors contribute to our health.

For example, the report shows a clear connection between socioeconomic position and health—compared with people living in Australia’s highest socioeconomic areas, those in the lowest group are almost 3 times as likely to smoke or have diabetes and twice as likely to die of potentially avoidable causes.

Those in the lowest group are also  more likely to have cost barriers preventing them from accessing health services—more than twice as likely to avoid seeing a dentist or filling a prescription due to the cost.

The impact of socioeconomic position on health can also be thought of in terms of disease burden, with those in the lowest socioeconomic group experiencing disease burden 1.5 times higher than those in the highest group.

Mr Sandison noted a similar pattern was seen among people living in remote areas, while certain groups—such as veterans—experience higher rates of mental health conditions such as depression. LGBTI Australians, people with a disability, prisoners and people of cultural and linguistically diverse backgrounds also experience specific health challenges.

As well as social factors, our natural environment is connected to our health and wellbeing—with air and water quality, exposure to extreme weather, and other events such as bushfires and drought all playing a role.

‘There is more to learn about the connections between health and the natural world—and in turn, the interplay between these and other risk factors,’ Mr Sandison said.

Employment and income key factors in improving Indigenous health

There have been some big improvements in the health of Australia’s Aboriginal and Torres Strait Islander population—but challenges remain.

Life expectancy for Indigenous Australians has improved over time and with higher education attainment closely associated with better health outcomes, rising year 12 completion rates among Indigenous Australians are a positive sign. There have also been reductions in smoking rates and alcohol use, as well as a significant  improvement in child death rates.

While the improvements seen in recent years are positive, the report shows that social factors are key to making further progress—social factors such as employment, education and income are responsible for about one-third of the health gap between Indigenous and non-Indigenous Australians. By comparison, health risk factors such as smoking and obesity account for one-fifth of the health gap.

The value of data and looking forward

Mr Sandison noted that in a digital age, there is enormous potential to fill data gaps through new sources of health information.

‘Health data is collected for a variety of reasons—in hospitals, at our GP and through the prescriptions we receive, while new sources of information are emerging, such as through the Australian Government’s My Health Record.’

Despite the breadth of health and welfare information available, there are gaps in our knowledge and opportunities to make better use of existing data.

By bringing together data, we can gain important insights into people’s pathways through the health system and experiences of their own health, such as the relationship between different chronic conditions and the services and treatments yielding the greatest improvements in health outcomes and quality of life.

‘With a structured, strategic approach to health information and leadership from agencies like the AIHW, Australia’s health data assets can be built and improved  to fill gaps in our knowledge and understanding—to drive better health outcomes for all Australians,’ Mr Sandison said.

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