Key messages

  • Australians are living longer than ever before, but chronic conditions continue to have a considerable impact – 91% of the non-fatal burden of disease is related to them.
  • There are many challenges in living with chronic conditions – some expected, such as the demand on Australia’s health-care system and the impact of climate change, and some unexpected, such as the COVID-19 pandemic.
  • To cope with the growing burden of chronic conditions, it will be critical to continue to focus on prevention and health promotion, and to harness data to identify inequalities and monitor progress.


Over the last century, Australia has made great improvements in health. Advances in infectious disease control, disease screening, diagnosis and treatment have dramatically reduced mortality rates and improved the quality of life for many people living with chronic disease.

Today, Australians are living longer than ever before, with children born in 2023 expected to live into their 80s (AIHW 2023a). However, just over one-tenth of their lives will be spent with ill health, and the burden of chronic conditions remains high. Around 6 in 10 Australians are estimated to live with a long-term health condition (AIHW 2024a).

Chronic conditions thus present a key challenge for individuals, governments and society as a whole. The causes are varied and complex. A person’s health and wellbeing are affected not only by individual characteristics and behaviours, such as genetics and lifestyle, but also by the world around them and their opportunities throughout life (Box CC.1).

The impact of chronic conditions is widespread. Individuals with chronic conditions often have complex health needs and require services from all levels of the health system. Living with or caring for someone with a chronic condition can also affect a person’s social and economic circumstances, creating additional barriers to earning an income, participating in education, and/or socially engaging in communities. Australia’s ageing population presents an additional challenge through the increased demand for services to care for and support people living with chronic conditions.

From the vantage point of almost a quarter of the way through the 21st century, this article explores how Australia is living with chronic conditions. It considers some of the challenges Australia may face in the future, namely:

  • the demands on the health system
  • the risks of communicable disease outbreaks, such as COVID-19
  • the increasing impact of climate change and commercial determinants of health.

The article also highlights the value of prevention and early detection, and the importance of data in identifying inequalities and monitoring progress to improve the lives of all Australians.

Box CC.1: What are chronic conditions?

Also referred to as chronic diseases, non-communicable diseases or long-term health conditions, chronic conditions are generally characterised by their long-lasting and persistent effects. Chronic conditions are not usually immediately life threatening but tend to develop gradually, becoming more common with age. Once present, they often persist throughout a person’s life and require long-term management. 

In comparison, infectious diseases are caused by infectious agents (bacteria, viruses, parasites and fungi and their toxic products) and often cause acute or short-term illness. Many infectious diseases are also communicable diseases, meaning they can be passed from one person or animal to another. In some cases, infectious diseases can lead to longer term illness, or may be considered chronic conditions. 

For example, HIV is an infectious disease; however, it can be treated as a chronic condition in Australia, given the availability of effective medicine. For more information on infectious disease in Australia, see Infectious and communicable diseases.

The changing story of Australia’s health

‘The nature of disease changes with the nature of societies.’

Egger 2017

The health of Australians today is considerably different from what it was a century ago. While people born today are expected to live, on average, into their 80s, those born in the early 1900s were expected to live to around age 55 (AIHW 2022b). The 20th century saw improvements to living conditions, infection control, and advancements in medicine that led to overall lower death rates and longer life expectancy at all ages.

From infectious diseases to chronic conditions

Until the 1930s, infectious and parasitic diseases caused at least 10% of all deaths each year, with death rates from these diseases being highest among the very young and very old (Jain 1994). Infectious disease control measures and childhood immunisation led to substantial declines in mortality from tuberculosis, polio, diphtheria, tetanus, whooping cough, measles, mumps and rubella. Between 1907 and 2020, deaths from infectious diseases fell by 98% – from 320 per 100,000 deaths to 6.9 per 100,000, after accounting for differences in age structure (known as ‘age-standardised rates’; see glossary) (Figure CC.1). As a result, Australia experienced a health transition from more infectious diseases to more chronic conditions (Beaglehole and Bonita 1997).

The rise and fall of cardiovascular disease deaths

In the early part of the 20th century, cardiovascular disease was the fourth most common cause of death in Australia after pneumonia, tuberculosis and diarrhoeal disease, and was more common than cancer (Cumpston 1989). As fewer people died from infectious diseases, deaths from cardiovascular diseases increased rapidly, aligning with an ageing population structure (ABS 2002). By the mid-20th century, cardiovascular diseases accounted for more than half of all deaths, not only in Australia but also in most of the industrialised nations (Braunwald 1997).

After rising for several decades to a peak in 1968, deaths from cardiovascular disease dropped considerably over time – a decline of 85%, from 830 per 100,000 deaths in 1968 to 125 per 100,000 in 2022, after accounting for differences in age structure. This large fall represents a public health success. It can be attributed to both prevention and treatment; namely, a combination of:

  • reductions in risk factor levels
  • improvements in detection and secondary prevention
  • advances in treatment and care (AIHW 2022b).

Changing mortality due to other chronic conditions

As Australians are living longer, other chronic conditions have appeared among the leading causes of death. Crude mortality rates (‘crude rates’; see glossary) from cancer have steadily increased over the last 50 years, although age-standardised rates – generally steady between 1970 and 2000 – have since fallen. This may be due, in part, to the ageing of the Australian population and to an increase in the average age at death due to cancer over this period. Increased and earlier detection through cancer screening has likely also played a role for certain cancers. For example, cervical cancer mortality has halved since the National Cervical Screening Program was introduced in 1991 (AIHW 2023i). - read more in ‘Story from the data - Cervical cancer prevention, screening, and the path to elimination'

Dementia has also emerged as a leading cause of death, accounting for 9.0% of all deaths in 2022 (AIHW 2024b). Overall, chronic conditions contributed to 90% of all deaths in 2022 (AIHW 2024a).

Resurgence in infectious disease deaths due to COVID-19

Deaths due to infectious diseases remained low until the COVID-19 pandemic, which saw COVID-19 become the third leading cause of death in 2022. This was the first time in over 50 years that an infectious disease has been in the top 5 leading causes of death in Australia – since 1970, in fact, when influenza and pneumonia were the fifth leading causes (ABS 2023a).

Figure CC.1: While overall mortality has fallen dramatically, leading causes of death have shifted from infectious disease to chronic conditions

Age-standardised mortality rates (per 100,000 population), by selected broad cause of death, 1907–2022
This figure shows that between 1907 and 2022, age-standardised all-cause mortality rates fell 73% (2,054 to 548 deaths per 100,000 population).


  1. Age-standardised to the 2001 Australian Standard Population.
  2. Changes in mortality rates are also influenced by data improvements and changes to coding practices over time.
  3. Data on deaths from dementia and Alzheimer’s were not available before 1979 due to coding practices. Coding changes and variations in certification practices have likely resulted in an increase in deaths coded to dementia and Alzheimer’s since around 2006.

Source: AIHW 2024b.

Australians are living longer, but still with ill health

On average, Australians are now living longer than ever before, with life expectancy at birth reaching 81.3 years for males and 85.1 for females born in 2023 (AIHW 2023a). As well as living longer, Australians are, on average, spending more years lived in full health – also referred to as the health-adjusted life expectancy (HALE). Between 2003 and 2023, males gained 3.2 years in life expectancy and 2.2 years in HALE. The corresponding gains for females were 2.1 years in life expectancy and 0.8 year in HALE.

Despite these gains, the average time spent in ill health also increased by 1.0 year for males and 1.3 years for females, resulting in little change in the proportion of life spent in full health in recent decades (AIHW 2023a).

Burden of disease

The impact of living with disease and injury on the population as a whole can be further explored through the burden of disease. Burden of disease is a measure that combines the years of healthy life lost from living with illness and injury (non-fatal burden, or years lived with disability) with years lost to dying prematurely (fatal burden, or years of life lost) to estimate total health loss (total burden, or disability-adjusted life years, or DALY).

In 2023, Australians lost an estimated 5.6 million years of healthy life in total disease burden (AIHW 2023a). Over the last 20 years, although there was a 27% fall in the rate of fatal burden, the rate of non-fatal burden rose by 6.3%, after adjusting for population ageing (AIHW 2023a).

Majority of burden of disease due to chronic conditions

Chronic conditions make up an overwhelming proportion of the burden of disease – 91% of non-fatal burden and 78% of fatal burden in 2023. This proportion has remained stable over time, but population growth and ageing have led to an increase in the burden overall.

  • The years lived with disability due to chronic conditions rose from 1.6 million in 2003 to 2.5 million in 2023 (Figure CC.2a). In the same period, the years of life lost due to chronic conditions rose from 1.7 million to 1.9 million (Figure CC.2b).
  • By disease group, cancer remains the leading cause of premature death in Australia, contributing to one-third (33%) of the fatal burden in 2023 (AIHW 2023a). This is followed by cardiovascular disease, though the proportion of fatal burden due to cardiovascular disease has fallen over time – from 27% of fatal burden in 2003 to 19% in 2023.
  • The leading causes of ill health between 2003 and 2023 were mental and substance use disorders (26% of the non-fatal disease burden in 2023), followed by musculoskeletal disorders (23%) (AIHW 2023a).

Figure CC.2a: An overwhelming majority of Australia’s non-fatal burden of disease is due to chronic conditions

Non-fatal burden of disease, by broad disease category, 2003 to 2023

This figure shows that chronic conditions accounted for between 90–91% non-fatal burden of disease between 2003 and 2023. 

Source: AIHW analysis of the Australian Burden of Disease Study Database 2023.

Figure CC.2b: A large proportion of Australia’s fatal burden of disease is due to chronic conditions

Fatal burden of disease, by broad disease category, 2003 to 2023

This figure shows that chronic conditions accounted for between 78–81% of fatal burden of disease between 2003 and 2023. 

Source: AIHW analysis of the Australian Burden of Disease Study Database 2023.

Many Australians are living with multiple conditions

Many people experience multimorbidity; that is, they have 2 or more chronic conditions at the same time. The Australian Bureau of Statistics’s (ABS’s) National Health Survey presents self-reported data on 10 selected chronic conditions that are common, that pose significant health problems, and that have been a focus of ongoing public health surveillance (ABS 2023b):

  • arthritis
  • asthma
  • back problems
  • cancer
  • chronic obstructive pulmonary disease
  • diabetes mellitus
  • heart, stroke and vascular disease
  • kidney disease
  • mental and behavioural conditions
  • osteoporosis.

In 2022, the National Health Survey estimated that more than 1 in 5 Australians were living with multimorbidity, based on these selected chronic conditions. Of the population with at least one of these conditions, 44% were estimated to experience multimorbidity. However, the prevalence of multimorbidity varies considerably by the type of chronic condition – 87% of people with chronic obstructive pulmonary disease (COPD) and 85% of people with cardiovascular disease experience multimorbidity.

The prevalence of multimorbidity has gradually increased in recent years, even after adjusting for changes in the population age structure over time (Figure CC.3). The proportion of the population with multimorbidity has also increased at a greater rate than the proportion with one chronic condition only – up 33% from 2007–08, compared with an 18% increase for a single condition.

For more information, see Multimorbidity.

Figure CC.3: The proportion of Australians living with 2 or more chronic conditions is growing

Crude proportion (per cent) of Australians living with selected chronic conditions, 2007–08 to 2022

This figure shows that the proportion of people living without any selected chronic conditions decreased by 14%, from 58% in 2007–08 to 50% in 2022.

Chronic conditions represent a complex interplay of one’s individual health and environment

The factors that influence a person’s health and wellbeing, including their likelihood of developing chronic conditions, are varied and complex. These factors, known as determinants of health, may be either a risk or protective to a person’s health. Strengthening those determinants that are protective and minimising those that are a risk can:

  • reduce the risk of developing a chronic condition
  • ease symptoms for those already living with chronic conditions
  • improve a person’s quality of life overall.

At the highest level, health determinants include broad features of society, such as social cohesion and inclusion, commercial practices and environmental factors. These interact with and influence mid-stream factors, such as socioeconomic characteristics, health behaviours, working conditions, psychosocial and safety factors, and downstream biological factors, such as body weight, blood glucose and blood pressure – which have the most direct impact on health. Not only can all of these factors influence health, but also a person’s health can influence health determinants, such as through the ability to earn income or access social support.

While positive health behaviours can contribute to good health, individuals have little to no control over many determinants of health: 

  • Age, sex and genetics all influence health and one’s predisposition to chronic conditions.
  • People living with chronic conditions may be at greater risk of adverse effects during extreme weather events, which are increasing in frequency, intensity and duration due to climate change. These adverse effects may occur directly (such as the impact of bushfire smoke on people with respiratory conditions) or indirectly (through reduced access to medication, treatment and preventive health screening).
  • Broader aspects of society also play a role; for example:
    • cultural acceptance of alcohol and binge drinking
    • proximity to commercial outlets for tobacco, alcohol and discretionary foods
    • advertising of these products (Livingston 2011; Livingston et al. 2023; Schultz et al. 2021).

For more information on health determinants and how they affect health, see What are determinants of health?.

Modifiable risk factors

In 2018, up to 38% of the total burden of disease in Australia was estimated to be preventable by reducing exposure to 40 risk factors (such as tobacco use, overweight and obesity, dietary risks, and high blood pressure) (AIHW 2021a).

In recent decades, some improvements have been made in areas such as insufficient physical activity, and harmful alcohol consumption (Figure CC.4). However, the proportion of adults living with overweight and obesity continues to rise, driven largely by a rise in the proportion of adults living with obesity, which is the higher risk category. New risk factors also emerge over time.

While the proportion of the population who smoke daily is steadily declining, the proportion currently using e‑cigarettes has increased from 1.2% in 2016 to 7.0% in 2022–2023 (AIHW 2024e).

These trends are similar even after accounting for differences in the age structure of the population over time.

Figure CC.4: Insufficient physical activity, daily smoking and risky alcohol consumption decreasing, while overweight and obesity increasing

Trends in selected risk factors, 2001 to 2022

This figure shows that between 2011–12 and 2022, the proportion of adults living with uncontrolled high blood pressure remained stable at 21–23%.

All is not equitable: some people experience avoidable differences in health outcomes

While many factors are monitored individually, it is important to take a holistic view to properly understand the role of health determinants.

The Australian population is diverse, and the story of chronic conditions is not the same for all. There is a close relationship between people’s health and the circumstances in which they grow, live, work, play and age. A complex interaction between the circumstances of certain groups of Australians and the health determinants outlined in the previous section can contribute to avoidable differences in risk factor prevalence and health outcomes.

The amount of burden attributable to the 40 selected risk factors was higher for all risk factors as the level of socioeconomic disadvantage increased. The greatest relative difference in burden rate was for tobacco use (people living in areas of most disadvantage had 3.0 times the age-standardised rate of people living in areas of least disadvantage), followed by intimate partner violence and high blood plasma glucose (both 2.5 times) (AIHW 2021a). In terms of disease burden:

  • The burden of disease among First Nations people is 2.3 times that of other Australians (Figure CC.5).
  • People living in rural and remote areas and people living in the lowest socioeconomic areas also often experience higher rates of disease burden than other Australians.

These factors can build on each other, resulting in even greater inequality. For instance, First Nations people living in Remote areas experience a greater disease burden than First Nations people living in Major cities (AIHW 2022a).

These results illustrate the interconnectedness of health behaviours and determinants, both upstream and downstream, and how focusing on social determinants of health can improve health outcomes.

Figure CC.5: First Nations people, people living in Remote and very remote areas and people living in lower socioeconomic areas experience greater disease burden than their counterparts

Variation in burden of disease rates by population group, 2018
This figure shows that patterns were similar for fatal burden and non-fatal burden.

DALY = disability-adjusted life years; YLD = years lived with disability; YLL = years of life lost

Note: Rates are age standardised to the 2001 Australian population.

Sources: AIHW 2021a, 2022a.

Barriers to equitable health outcomes

Barriers to achieving equitable health outcomes may include difficulties in accessing services due to work or carer obligations, physical distance, affordability, and having insufficient knowledge to confidently navigate the health system. Many of these barriers are interlinked with the determinants of health.

  • People from culturally and linguistically diverse backgrounds often face interconnected health and social disadvantages and greater challenges when navigating the health‑care system (AIHW 2023e).
  • For First Nations people, cultural identity, family and kinship, Country and caring for Country, knowledge and beliefs, language, participation in cultural activities and access to traditional lands are key determinants of health and wellbeing, and a lack of culturally appropriate care is a barrier to seeking health care.
  • People with disability, older people and people in prisons also face unique barriers to achieving good health.

For more information, see the following AIHW web articles or reports:

More chronic conditions means more use of health services

Not all chronic conditions are preventable. Even with prevention efforts and favourable determinants, many Australians will eventually be diagnosed with a chronic condition. Given this, the focus must shift to how to best manage chronic conditions and optimise quality of life.

Primary care

Australia’s health system provides care for people with chronic conditions through a complex mix of health professionals and service providers. Primary care is often a person’s first contact with the health system and plays a key role in preventing, detecting, diagnosing and managing chronic conditions. Primary health care providers often refer individuals to specialist services that provide expert care for particular body systems or conditions, and to diagnostic services such as radiology and imaging. 

Despite the lack of comprehensive national primary care data, the available data show that chronic conditions make up a substantial proportion of general practice activity:

  • In 2022–23, 60% of people (10.2 million) who visited a general practitioner (GP) in the last 12 months had a long-term health condition (ABS 2023c).
  • In 2022–23, almost 1 in 6 (16%; 4.1 million) Australians claimed a Chronic Disease Management service – that is, a set of Medicare items available to people with chronic or terminal illness to help organise their care and manage complex care needs across multiple health-care providers (AIHW 2024d).

Overall, Australians are seeing a GP more often. The use of Medicare-subsidised GP services per person is increasing – both in total volume and in the average number of visits per person (Figure CC.6), even after accounting for the ageing population (Box CC.2; AIHW 2023h). The peak of service use in 2021 can be attributed to attendances to assess suitability for the COVID-19 vaccine and the increased availability of telehealth services during this period; however, the GP attendance rate has been steadily increasing since the early 2000s (AIHW 2023h). 

The use of GP Enhanced Primary Care services – a range of services, many of which are aimed at preventing, diagnosing or managing chronic conditions – is also increasing. Part of this growth can be attributed to new Medicare items being introduced, thereby increasing the number of services available. Still, the increasing uptake of these services demonstrates a need for this care, and illustrates the growing volume of care being provided for more complex health needs, including chronic conditions, in the general practice setting.

Box CC.2: Australia’s changing population

Understanding the changing nature of the Australian population is key to understanding the story of chronic conditions in this country. 

Over the last 50 years, it has doubled, from 13.1 million in 1971 to 26.2 million in 2022 (ABS 2021a). Before the turn of the century, much of this growth was due to natural increase – births minus deaths. From 2005–06, overseas migration was the main driver of growth – until the COVID-19 pandemic when international border restrictions in 2020–21 saw the first net outflow of migrants since World War II. By 2034, Australia’s population is projected to reach 30.9 million (AIHW 2024g).

Declining fertility and lower mortality mean the Australian population is ageing. While the arrival of younger overseas migrants has offset this in part, the median age of the population has increased by more than 10 years in the last 5 decades, from 27.5 in 1971 to 38.3 in 2023. With age being a common and unavoidable risk factor for many chronic conditions, a population who are older and living longer will continue to create pressures for treating and managing ill health in Australia.

For further information on Australia’s population, see Profile of Australia’s population.

Figure CC.6: Increase in average yearly GP visits per person and in use of services related to detecting and treating chronic conditions

Age-standardised patterns in GP services, 2000 to 2022

This figure shows that between 2000 and 2022, the GP attendance rate (average services per person) was highest in 2021 and lowest in 2003 and 2004. 

New models of primary care

A lot of work is being done on new models of care in general practice to promote continuity of care and provide more accessible services. 

For example, from 1 October 2023, a new model in primary care began called MyMedicare. This model enables a patient to voluntarily identify a general practice and practitioner as their regular care team; it aims to encourage continuity of care to improve health outcomes (Department of Health and Aged Care 2023a). 

New Medicare Benefits Schedule (MBS) items and incentive payments have been linked to MyMedicare registration progressively from November 2023 to help practices provide care that responds to patient needs. There are potential opportunities to draw on the nurse and allied health workforces to support the medical workforce in managing patients with chronic conditions and in encouraging access to multidisciplinary teams to keep patients well – and out of hospital. 

As at 10 April 2024, around 1.0 million patients and 5,800 practices had registered for MyMedicare (Department of Health and Aged Care, personal communication, 17 April 2024). This represents around 3.9% of Australians and 91% of general practices.

Hospital care

Hospitals are another integral part of Australia’s health system, providing advanced and complex care. At the end of a person’s hospital stay, information is collected on the reason chiefly responsible for the hospitalisation (known as the principal diagnosis, see glossary), as well as other conditions determined to affect patient care (known as additional diagnoses, see glossary). Based on a list of over 100 chronic conditions from the Australian Burden of Disease study (ABDS), analysis of the principal and additional diagnosis data estimated that chronic conditions are associated with:

  • more than half (55%) of all hospitalisations 
  • nearly three-quarters (74%) of all bed days – the time spent in hospital receiving care. 

In 2021–22, 6.4 million hospitalisations were related to chronic conditions; 4.0 million of these (63%) had a chronic condition as the principal diagnosis. After accounting for differences in the population age structure over time, the rate of chronic condition hospitalisations in the last decade has slightly increased, mirroring the trend seen for all hospitalisations (Figure CC.7).

Emergency department care

Emergency departments (EDs) treat acute and urgent illnesses and injuries, and have a key role in managing patients with chronic conditions. At the end of an ED visit, information is collated on the main reason for attendance (principal diagnosis) as well as up to 2 coexisting conditions or complaints (additional diagnoses). 

Between 2018–19 and 2022–23, around 1 in 6 (16%) ED presentations were associated with chronic conditions each year (based on a list of over 100 conditions from the ABDS). These presentations include, for example, the acute and life-threatening episodes of chronic conditions such as heart attacks and strokes, as well as illness or injury caused or exacerbated by a chronic condition. 

It is likely, however, that the true proportion of ED presentations related to chronic conditions is much higher, as patients may present only with symptoms and require further testing to receive a diagnosis. Pain in the throat and chest, and abdominal and pelvic pain were the 2 most common reasons for seeking care in an ED in 2022–23; together, they represented 9.6% of total presentations and possibly included patients with undiagnosed cardiovascular disease, respiratory disease or gastrointestinal disorders (AIHW 2023g). 

Figure CC.7: There has been a gradual increase in hospitalisations for chronic conditions over time

Patterns in hospitalisations, 2012–13 to 2021–22

This figure shows that between 2012–13 and 2021–22, the hospitalisation rate for chronic conditions was highest in 2018-19 and lowest in 2012–13. 

What does the future hold for chronic conditions in Australia?

This question is difficult to answer. Studying the history of chronic conditions and patterns in the data helps to identify trends and best practices for enhancing the health of Australians. However, this only gives us some understanding, as new challenges can emerge rapidly and unpredictably.

Expectations of Australia’s health-care system are high

Australia’s health-care system (both primary care and hospital systems) continues to provide high-quality treatment, care and support to people living with chronic conditions, with a high cost to the economy. Expectations to keep people well, and participating in work, education and communities are high.

A strong health-care workforce is key

Australia’s health-care workforce is expected to respond to emerging health issues quickly, and this sees it operating under increasing pressures to achieve positive outcomes for the individual patient and the health-care system. While overall health workforce numbers are trending in the right direction, its accessibility depends very much on the distribution of its members in areas where they are most needed (AIHW 2022c).

Coordinated care across multiple providers and systems

As the proportion of people living with 2 or more chronic conditions continues to rise, so, too, does the need for services from multiple providers, across multiple systems, including health, aged care, disability, education and social services. Evidence suggests that people with multiple conditions benefit from coordinated care to improve health and wellbeing, and that this results in a better individual experience of the health system (Australian Health Ministers’ Advisory Council 2017).

Poorer experiences for some

The system sometimes works well; however, not all patients have the same health-care experience. Poorer experiences and outcomes are reported for some of Australia’s priority population groups, such as First Nations people, people living in rural and remote Australia, people with disability, and culturally and linguistically diverse Australians (Khatri and Assefa 2022). This is of particular concern given the higher rates of chronic disease burden experienced by these population groups (see the section earlier in this article headed ‘All is not equitable: some people experience avoidable differences in health outcomes’).

Future challenges

Looking ahead, chronic conditions such as mental illness (particularly depression and anxiety), dementia and chronic liver disease (see Box CC.3) are emerging as some of the fastest growing chronic conditions. This is while the level of more ‘familiar’ chronic conditions, such as type 2 diabetes, cardiovascular disease, arthritis and asthma, remains high. It is expected in the future that more Australians will have multiple chronic conditions, due to the common risk factors and disease pathways that chronic conditions share.

Box CC.3: An ‘unseen’ chronic condition: non-alcohol fatty liver disease

Chronic liver disease was the ninth leading cause of fatal burden in Australia in 2023 and, when combined with liver cancer, was the fifth leading cause of fatal burden (AIHW 2023a). Non-alcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease worldwide (Wong et al. 2023), and the number of people living with this condition has increased markedly in Australia over the past 2 decades (Clayton-Chubb and Roberts 2023). A recent study in regional Victoria estimated the prevalence of NAFLD to be almost 40% (Vaz et al. 2023) and showed that it had increased significantly over the last 15 years, particularly for women.

The prevalence of NAFLD has been shown to increase parallel to the prevalence of obesity, which, in turn, has been closely linked to unhealthy environments contributing to unhealthy diets and insufficient physical activity (see Figure CC.4 for Australia’s trend in obesity). A study in Australia has projected the prevalence of NAFLD to increase by 25% between 2019 and 2030 (Adams et al. 2020).

As survival rates improve for other diseases, such as cardiovascular disease, diabetes and cancer, previously ‘hidden’ chronic conditions like NAFLD are becoming more visible. It therefore remains important to monitor these emerging diseases, to enable health policy to evolve, and the health system to respond in a timely manner. 

Ongoing impact of COVID-19

The COVID-19 pandemic illustrated that there are challenges that could threaten the ability of Australians and the health-care system to cope with the future burden of chronic conditions.

During the COVID-19 pandemic, a range of public health interventions were put in place to help contain the spread of the virus that causes COVID-19. While governments and public health officials tried to balance the benefits of these interventions with the potential harm they caused, some unintended consequences were observed, including:  

  • worsening wellbeing across a range of indicators, including life satisfaction, psychological distress and loneliness – especially among young people, people with low education, and people with low income (Biddle et al. 2022)
  • delays to seeking primary care, with almost 10% of people aged 15 and over reporting having delayed or missed needed health care from a GP due to COVID-19 (ABS 2021b)
  • interruption of non-urgent elective surgery in various jurisdictions at different times during the pandemic because of disruptions to the delivery of hospital services due to rising COVID-19 case numbers and hospitalisations (AIHW 2021c)
  • disruption of national cancer screening programs, with fewer screenings for BreastScreen and the National Bowel Cancer Screening Program (AIHW 2023c, 2023d) and likely also fewer screenings for the National Cervical Screening Program (AIHW 2023i).


Long COVID or post-acute COVID-19 is a new chronic condition that has emerged since the start of the COVID-19 pandemic in 2019; it is estimated to affect between 5–10% of COVID-19 cases. Long COVID refers to the long-term symptoms that some people experience after they have had a COVID-19 infection (Department of Health and Aged Care 2024). Common symptoms can include fatigue, cough, breathlessness, joint or muscle pain, chest pain, change in sense of taste or smell, anxiety and/or low mood (Health Direct 2023). Several studies have reported increased health-care use and costs as well as patient reports of limitations on their daily activities and a reduced quality of life (AIHW 2022d).

Climate change

Climate change is an example of a current challenge that is predicted to have increasing negative impacts on people living with chronic conditions and on people at risk of developing chronic conditions in Australia. People living with physical and mental chronic conditions are particularly vulnerable to the effects of extreme weather events, natural disasters and poor air quality.

As a consequence of climate change, the intensity and frequency of heatwaves and drought – and the number of days with fire weather conditions – have increased and are projected to continue increasing (BOM and CSIRO 2020). The health impacts of these events are also likely to increase (Beggs et al. 2019; WHO 2018) and disproportionately affect priority populations, such as people with chronic conditions, First Nations people, and people living in rural and remote Australia. Excessive heat can exacerbate existing health conditions, such as heart disease, diabetes, kidney disease and mental and behavioural conditions (AMA 2015).

In December 2023, the Australian Government launched Australia’s first National Health and Climate Strategy (Department of Health and Aged Care 2023b). The strategy outlines the government’s vision for ‘healthy, climate-resilient communities, and a sustainable, high-quality, net zero health system,’ and identifies whole-of-government actions over 5 years to achieve this.

Ageing population

The Australian population continues to experience increased life expectancy; it is also an ageing population. With age a common and unavoidable risk factor for many chronic conditions, more pressure will be placed on the health-care and aged-care systems to manage and treat people living with chronic conditions. Already, there is pressure to improve the connection between these 2 systems to ensure that the complex needs of older people living with chronic conditions can be met. 

In 2020–21, there were 19,600 hospitalisations for older people waiting for residential aged care (Productivity Commission 2023). Almost 1 in 10 (9.8%) of these ‘aged care type’ patients waited 35 days or longer in hospital, suggesting that barriers are preventing the smooth transition of patients between hospital and aged care. 

Also, given the complex interaction between determinants and disease, some people are more likely than others to develop more chronic conditions as they age, making them more vulnerable.

Role of health promotion and prevention

To cope with the growing burden of chronic conditions, prevention and promoting health across the life-course for all Australians must be a priority in the conversation.

The National Preventive Health Strategy 2021–2030 (Department of Health 2021) provides a platform for an overarching, long-term approach to prevention in Australia. To achieve its aims and assess progress being made into the future, the strategy requires:

  • long-term investment
  • implementation of preventive health actions
  • continual monitoring of targets. 

In the second half of 2024, the AIHW will be releasing a report monitoring the targets and aims outlined in the strategy. 

Australia – a global leader in some areas

Australia has already been a global leader in some aspects of prevention – namely, for tobacco control and the pathway to cervical cancer elimination (see the section later in this article headed ‘Story from the data - Cervical cancer: prevention, screening, and the path to elimination’). It is also known to have one of the most robust and comprehensive immunisation systems in the world (AIHW 2022b). It shares these success stories with the rest of the world but the question remains: what will the next success story be in preventing chronic conditions? 

Australia will need to ensure it retains an appropriate focus on preventing new and/or emerging risks. For example:

  • e-cigarettes – to counter the increased marketing and use of these in recent years, particularly among young people, Australian governments are implementing a range of new regulatory and non-regulatory measures (for more information on recent trends in vaping, see Electronic cigarette use (vaping) in Australia in 2022–2023)
  • obesity – long-standing challenges remain in halting the growing number of people living with obesity (which is linked to many chronic conditions, including type 2 diabetes, coronary heart disease and dementia) without increasing weight stigma.

Increasing importance of data and monitoring of chronic conditions

To understand where the burden of chronic conditions is heading in Australia, we need to continue to use the rich data at our disposal to create information that can be used to guide Australia’s health and other social systems towards a future where all Australians can live healthier and longer lives. 

There is a growing volume of information generated by the health system, but how best to harness that information is an ongoing challenge. Opportunities exist to improve the management and dissemination this information, with the support of technical advancements, ensuring it is accessible, timely, relevant, accurate and actionable to:

It is vital that we continue to monitor chronic conditions across the disease spectrum, including health determinants and prevention, disease prevalence and multimorbidity, health service use and outcomes. The AIHW’s Australian Centre for Monitoring Population Health is one such vehicle for monitoring, which brings together the latest data and information on the health of Australians. We need to continue to do this across all priority population groups and in a way that will identify emerging threats, issues and success stories so that Australia’s health system can be flexible and adapt to whatever the future may hold.

Box CC.4: Stories from the data

Monitoring of chronic conditions as a whole is integral to understanding the health of Australians at a broad level. However, as is seen in mortality trends across the 20th and 21st centuries (Figure CC.1), marked differences exist in trends for individual conditions. These are underpinned by etiological differences, and result in wide variation in the population groups affected, the type and level of care needed, and the opportunities for public health intervention.
This article includes 2 examples which show how the targeted collection and analysis of robust data can reveal the story of chronic conditions, and provide a compass to guide future health policy and care: 


Further reading

Related topic summaries