” Generally, Australians can expect to enjoy long and relatively healthy lives, however, there are disparities across some population groups.
Often, people living in rural and remote and/or lower socioeconomic areas, people with disability, and Aboriginal and Torres Strait Islander people experience higher rates of illness, hospitalisation and death than other Australians.
For example, people living in remote and very remote areas are 1.2 times as likely to have diabetes as people in major cities; people living in the lowest socioeconomic areas are twice as likely to have diabetes as people in highest socioeconomic area; and Indigenous Australians are 2.9 times as likely to have diabetes as non-Indigenous Australians.
There have been some improvements in the health of Indigenous Australians in recent years, including a fall in the Indigenous death rate across all age groups—except for those aged 75 and over—between 2008 and 2018 and rates of ear disease among Indigenous children are decreasing.’
Aboriginal and Torres Strait Islander people and communities COVID-19 see below
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Life expectancy, chronic conditions, social determinants of health and the COVID-19 pandemic are some of the issues under the spotlight in the latest two-yearly report card on the health of Australians.
Australian Institute of Health and Welfare (AIHW) Chair Mrs Louise Markus today launched Australia’s Health 2020
AIHW Deputy CEO Mr. Matthew James said the report had come at an important time.
‘More than any other event in recent history, the pandemic has led Australians to focus on our health, the health of our families and communities, and demonstrated the importance of the health system,’ Mr. James said.
Doing well but room for improvement
Australians are living longer—life expectancy for males born in 2016–2018 was 80.7 years and 84.9 years for females, this is up from 55.2 and 58.8 years, respectively, for those born in 1901–1910. Australian males had the ninth highest and Australian females had the seventh highest life expectancy at birth among the 36 OECD (Organisation for Economic Co-operation and Development) countries in 2018.
An estimated 11.6% of Australian adults (aged 18+) were daily smokers in 2019—a decrease from 12.8% in 2016, and 25% in 1991. Similarly, the number of homes with children where someone smoked in the home has fallen over time—from 19.7% in 2001 to 2.8% in 2016, and 2.1% in 2019.
The coronary heart disease death rate has fallen 82% since 1980 but it is still our leading single cause of death. About 7 in 10 (69%) people survived at least 5 years after a cancer diagnosis during 2012–2016––an improvement from about 5 in 10 (51%) people during 1987–1991.
‘Unfortunately, Australia has the fifth highest rate of obesity out of the 23 OECD countries for which data is available. In 2017–18, around two-thirds (67%) of adults and one-quarter (25%) of children and adolescents were overweight or obese,’ Mr. James said.
‘Almost half (47%, or more than 11 million people) of Australians have a chronic condition such as heart disease, cancer, stroke, diabetes, arthritis, asthma or a mental health condition. Many—but not all—chronic conditions are largely preventable by addressing risk factors such as tobacco smoking, high blood pressure and high blood cholesterol, insufficient physical activity, poor diet and nutrition and overweight and obesity.’
The health system
On an average day, Australians make 430,000 visits to general practitioners, fill 830,000 prescriptions under the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme and there are 32,000 hospitalisations.
Over the past 2 decades, the health sector in Australia has grown faster than the rest of the economy, as well as the population.
‘In the 20-year period to 2017–18, total health expenditure in Australia increased from $77.5 billion to $185.4 billion in real terms, and spending per person increased from $4,200 to $7,490,’ Mr. James said.
‘As a proportion of Gross Domestic Product (GDP), health expenditure increased from 7.6% in 1997–98 to a peak of 10.3% in 2015–16. It has since declined to 10% in 2017–18.’
Governments funded about two-thirds (68%) of health spending in 2017–18, with funds primarily raised through tax revenue. As a proportion of tax revenue, health spending by governments represented 24% in 2017–18, a decline from 26% in 2016–17 (reflecting strong revenue growth in 2017–18).
Over the past 5 years, the proportion of health spending funded by individuals declined and in both 2016–17 and 2017–18, personal spending on health reflected less than 0.4% of individual wealth, the lowest proportion since 2000–01.
Between 2014–15 and 2018–19, the total number of hospitalisations in Australia increased by an average of 3.3%—faster than the average population growth of 1.6% over the same period.
Data to be released by the AIHW later this year will give an indication of how the COVID-19 pandemic, including the temporary suspension of elective surgery during April 2020, affected surgical and emergency department waiting times for 2019–20.
Looking back on the first 4 months of COVID-19 in Australia
The report includes new analysis to try to fill the gaps in our understanding of COVID-19. It contains data on the first 4 months of COVID-19 in Australia, covering the period from 25 January 2020 (when the first Australian cases were confirmed) to the end of May.
The data demonstrates COVID-19’s potential to seriously affect not just those who are elderly or in very poor health, but also people who may not have been considered to be at the highest risk.
‘One way of understanding a disease’s death toll is in terms of how many years of life it cost the victim, based on their expected lifespan. For example, if a young, healthy person dies, they have probably lost many more years of life compared with an elderly person,’ Mr. James said.
‘There is perception that the majority of COVID-19 deaths are among people who did not have a long expected lifespan prior to developing the disease. However, the Australians who died lost more years of their expected lifespan on average than those who died of our 3 leading causes of death: coronary heart disease, dementia and stroke.’
Mr. James said that Australian governments and the Australian community have responded well to this crisis so far and, as a result, it appears at this point that we may have avoided some of the large adverse impacts that have been seen in some other countries.
‘However, it is important to remember that COVID-19 continues to pose a threat to the community and to the health system—as seen by the current situation in Victoria—and has broadly affected the lives of Australians in other ways, particularly regarding employment.’
While the data in this report largely predates the pandemic, its impacts on both the health system and people’s physical and mental health will be the subject of analysis for several years.
The importance of data to our health
Data have been central to the COVID-19 response because governments have needed immediate and accurate information to make swift, evidence-based decisions.
In addition to seconding staff to the Department of Health to assist with responding to the COVID-19 crisis, the AIHW compiled data on the use of hospital, mental health, and homelessness services and data from various crisis help lines.
‘While the long-term health effects of COVID-19 are largely unknown at present, health data—in particular, linked data—will be critical to understanding its impact on health, society and the economy,’ Mr James said.
‘We expect the demand for ‘near real-time’ data will increase as a result of COVID-19 and the AIHW’s future planning will consider our capacity to deliver information more quickly, while maintaining quality and accuracy.’
In partnership with the Australian National University (ANU), the AIHW worked to add a range of questions to the Life in Australia panel survey to explore the impact of COVID-19 on mental health, housing, alcohol consumption and service use.
The most recent report focuses on mental health and relationships, and is available at https://csrm.cass.anu.edu.au/research/publications/covid-19
Aboriginal and Torres Strait Islander people and communities
There have been substantial improvements in Aboriginal and Torres Strait Islander health over the past 30 years, with decreases in cardiovascular death rates and infant mortality, and increases in life expectancy and in the number of people accessing preventive or health monitoring services (such as health checks, chronic disease management plans, and antenatal care) (AHMAC 2017).
However, Indigenous Australians as a group still experience poorer health outcomes compared withnon-Indigenous Australians.
The reasons for this disparity are complex, and key among these is the impact of colonisation and separation from Country on the wellbeing of Indigenous Australians (Osborne et al. 2013). It is also well recognised that disparities in upstream factors—the social determinants of health—result in differences in risks, exposures, access to services and in outcomes throughout life.
One social determinants having a substantial impact on Indigenous health is housing conditions.
This article considers common factors underlying a number of diseases prevalent in the Indigenous Australian population, particularly those in remote areas, but less commonly or even rarely seen among non-Indigenous Australians: chronic kidney disease, rheumatic heart disease, and certain eye and ear diseases. Bringing together the available information, and highlighting data gaps, can help us to
draw out critical issues and to identify potential points of intervention that would produce benefits across multiple areas. Given that many of the social determinants, including housing, lie outside of the health system, the efforts of a range of systems, government departments and other organisations will be needed to support and drive interventions. Establishing agreed indicators across the main domains of interest, and regularly monitoring these, can also help to ensure that all parties, both within and outside the health system, are able to gauge progress and to make sure their efforts are having the desired impact.
Social determinants of health and Indigenous Australians
The World Health Organization (WHO) describes social determinants of health as ‘the structural determinants and conditions of daily life’—that is, the conditions of work or leisure; people’s homes, communities and environments; and their access to education and health care (WHO CSDH 2008). People’s opportunities and circumstances are shaped by the distribution of power, income, goods and services, which are in turn affected by policy choices, and are a major component of health inequities between and within countries.
Commonly recognised social determinants of health include housing, education, employment, income, and social networks and connections. For Indigenous Australians and other Indigenous peoples across the world, cultural factors—including connection with land and waters, identity, and language, as well as the ongoing effects of dispossession, marginalisation, racism, and discrimination—also play a key role in influencing health outcomes (Figure 4.1).
Other important social determinants affecting health outcomes include:
- health literacy (the ability to obtain, read, understand and use health-related information to make appropriate health decisions), and
- availability of health resources (the funds, equipment, facilities, personnel and other items such as medicines and medical supplies) needed to provide health
The social determinants of health act through complex and multidirectional pathways, and underlie a broad range of poor health and welfare outcomes. A combination of factors may act at the community and the individual level to influence health.
For example, an individual’s level of education and household income may influence their food choices, while the area in which they live may affect the availability and cost of various foods.
Other articles in this report and the Australia’s health 2020 snapshots (for example, ‘Social determinants of health’ https://www.aihw.gov.au/reports/australias-health/ social-determinants-of-health and ‘Social determinants and Indigenous health’ https://www.aihw.gov.au/reports/australias-health/social-determinants-and- indigenous-health) detail the range of social determinants and how they relate to health; their impact throughout life; and their contribution to the gap in health outcomes between Indigenous and non-Indigenous Australians. This article examines key health conditions disproportionately impacting Indigenous Australians, which are affected by housing conditions and access to services.
Two of the critical factors connecting housing conditions to health are the impact of overcrowding and the state of domestic health hardware. ‘Health hardware’ refers to the physical equipment needed to support good health. This includes safe electrical systems; access to water; working taps, showers, and sinks with plugs; toilets; waste and wastewater removal systems; and facilities needed for the safe storage and preparation of food.
If any of these facilities are unavailable, not working, or inadequate to support the number of residents, illness or injury can occur. Also implicit in this is that local infrastructure should minimise environmental health risks, by providing access to safe drinking water, and by supporting sanitation and waste management services.
Aboriginal and Torres Strait Islander people and communities COVID-19
Aboriginal and Torres Strait Islander people and their communities are at high risk of COVID-19 outbreaks and severe outcomes for a number of reasons.
They are a mobile population and remote communities have frequent visitors (including fly-in fly-out health care workers), increasing the chances of disease importation. They often have reduced access to health services either due to physical distance for those in remote areas or due to other barriers related to institutional racism, and mistrust of mainstream health services (CDNA 2020b). In addition, Indigenous Australians experience a burden of disease 2.3 times the rate of non-Indigenous Australians, with 64% of the burden due to chronic diseases such as diabetes and CHD (AIHW 2016).
Overcrowding in homes and lack of infrastructure to support personal hygiene in remote areas can promote disease transmission and make physical distancing and efforts to self-quarantine challenging.
To protect remote communities from COVID-19, governments working in collaboration with Aboriginal and Torres Strait Islander organisations and communities began restricting the movement of people in and out of remote areas and began setting up respiratory clinics to support Indigenous Australians (Hunt & Wyatt 2020). The National Management Plan for Aboriginal and Torres Strait Islander Peoples has been developed by the Aboriginal and Torres Strait Islander Advisory Group on COVID-19 and endorsed by the Australian Health Protection Principal Committee, and was released on 30 March 2020.
As of 24 May, less than 1% of notified cases had been reported in Indigenous Australians (59 cases; with 95% Indigenous identification completeness for notified cases), who represent 3.3% of the Australian population. Ten per cent of these cases were acquired in Outer Regional areas, and none in Remote or Very Remote areas; 47% were acquired overseas (COVID-19 NIRST 2020d).
While the number of cases in Australian Indigenous communities has been low, there have been outbreaks in Indigenous populations in Brazil and in Navajo Native Americans in the USA (SBS 2020, The Guardian 2020).