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As health gaps widen in Australia, where are the lessons from #Prevention2019?

When the Australian Institute of Health and Welfare (AIHW) released the latest findings from the national burden of disease study recently, it resulted in optimistic headlines like ‘We’re not just living for longer – we’re staying healthier for longer, too’ and ‘Fewer Aussies dying prematurely: study’.

The AIHW press release announcing the study also had an encouraging headline, ‘Healthier population eases Australia’s disease burden’.

The release did not mention some worrying news from the Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 – that it documents an increase in the health gap between wealthier and poorer Australians (as judged by where they live).

One of the measures used in the report is called health-adjusted life expectancy or HALE, which reflects the average length of time a person can expect to live in full health. It was 71.5 years for males and 74.4 years for females born in 2015.

The HALE gap (the difference in HALE between the highest and lowest socioeconomic groups) was greater in 2015 than in 2011. For men, this gap was 2.6 years in 2011 compared with 3.6 years in 2015. For women, the gap doubled: from 1.3 years in 2011 to 2.7 years in 2015.

For men and women in the lowest socioeconomic group, the number of expected healthy years fell over time as did the percentage of healthy years – both signs of expansion of morbidity in the lowest socioeconomic group, the authors reported.

In 2015, the most advantaged socioeconomic group expected, at birth, to live more healthy years (75.7 for males and 77.6 for females) than those in the lowest socioeconomic group (68.3 for males and 71.8 for females).

Between 2011 and 2015, HALE at birth increased for the highest socioeconomic group (from 74.8 to 75.7 years for males and from 76.7 to 77.6 for females) but decreased for the lowest group (from 68.7 to 68.3 years for males and from 72.7 to 71.8 for females).

The report says the disparity in HALE between the highest and lowest socioeconomic groups is further emphasised by the percentage of life expectancy at age 65 that is expected as healthy years.

While this percentage increased over time for men and women in the highest socioeconomic group, it declined for those in the lowest group: from 77 percent for both men and women in 2011 to 75 percent for men and 74 percent for women in 2015.

Both the life expectancy and HALE gaps, at birth and at age 65, were larger (wider) in 2015 than in 2011; that is, there was greater disparity between the socioeconomic groups in 2015 than in 2011, the report says.

Burden of disparities

The report found that a 20 percent reduction in burden could be achieved if all Australians experienced the same rate of disease burden (DALY or disability-adjusted life years) as the most advantaged socioeconomic group.

Likewise, if the rate of burden experienced by all Australians was the same as in major cities, there would be a 4.3 percent reduction in burden.

In 2015, the five conditions causing the most burden were coronary heart disease, back pain and problems, chronic obstructive pulmonary disease (COPD), dementia and lung cancer.

Narrow focus

The report is documenting the health impacts of social and economic inequality, but retains a focus on narrowly defined risk factors, although it is the first time the study has estimated risk factors by socioeconomic group (as per the graph below).

The authors do acknowledge this, stating that: “Social factors (such as income/poverty, education and employment) play an important role in determining the health of a population, and they often have a strong association with health outcomes and health behaviours.”

They say:

Risk factors that were social determinants (such as income, employment and education) could not be included.

They have not been incorporated into burden of disease studies either here or internationally, and developing methods to do so was outside the scope of this study.

However, their importance is clear, and it is hoped that they could be included as risk factors in future burden of disease studies.”

Another obvious gap is the lack of attention to the health impacts of climate change in the report although internationally there are plans to include air pollution and climate change in burden of diseases analyses.

Timely challenge

The report’s findings, presented to the Public Health Prevention Conference in Melbourne recently, as per the tweets below, present a timely challenge to the health sector to engage much more actively in addressing the wider structural determinants of social and economic inequality.


From #Prevention2019

The tweets below report on some of the wider discussions at the Public Health Prevention Conference – with thanks to all #Prevention2019 tweeps.

Economics of Cancer Prevention

Mr Todd Harper, Chief Executive Officer, Cancer Council Victoria


The Economics of Prevention

Teresa Fels, Executive Director, Department of Treasury and Finance, Victoria


Sin taxes, politics and containing health care costs

Mr Peter Martin, Business and Economy Editor, The Conversation Australia


Public health logics of Indigenous ill health –preventable or pre-destined?

Associate Professor Chelsea Bond, Senior Research Fellow, University of Queensland

Many observers noted the omission of Chelsea Bond’s title ‘Associate Professor’ from the program slide listing participants in the plenary session, and saw this as an example of concerns raised in the recent IndigenousX article by Associate Professor Chelsea Bond, Dr Lisa Whop and Ali Drummond: The Blackfulla Test: 11 reasons that Indigenous health research grant/publication should be rejected.


Framing Health Promotion

Mark Chenery, Co-Director, Common Cause Australia

Sign up here.


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Acknowledgement