Alison Barrett writes:
Health and social inequities are among some of the key areas of concern for the health of Australians highlighted in the August edition of The Lancet Public Health.
In particular, Aboriginal and Torres Strait Islander people, females and people with lower education attainment are experiencing disproportionate health outcomes and burden of disease, according to two studies in the series with a focus on the health of Australians.
Additional areas of concern are increasing rates in falls, drug use and anxiety disorders in the Australian general population between 1990 and 2019, according to findings from one of the studies in the series.
As well as identifying areas of concern, the edition highlights gains in population health, specifically regarding the increased life expectancy and length of working life of Australians (noting that studies published in the series are based on data collected prior to the pandemic).
The series acknowledges discrimination and harmful historic policies as risk factors for the disease burden in Aboriginal and Torres Strait Islander people, as well as highlighting the opportunity the Voice to Parliament offers in addressing health inequalities.
An editorial by the journal noted Australia’s opportunity to establish a constitutionally enshrined Voice of Aboriginal and Torres Strait Islander peoples, an independent and permanent advisory body that will have the ability to speak out and advise the Australian Parliament and Government on matters that affect the lives of First Nations peoples.
“We welcome the Public Health Association Australia, the Australian Academy of Health and Medical Sciences, and the Australian Medical Association supporting the constitutional amendment for Aboriginal and Torres Strait Islander peoples to be heard to tackle health inequalities,” the editorial said.
In a related commentary, public health experts called for Aboriginal and Torres Strait Islander people to be made visible in metrics used for policy making and monitoring, as well as the process of determining what metrics are used to guide policy.
“Australia cannot and should not embark on further prioritisation areas for action without inputs from the Aboriginal and Torres Strait Islander Australian population,” wrote Associate Professor Michelle Dickson, Professor Cheryl Jones, Terry Slevin and Professor J Jaime Miranda.
Notably, no article in the series delved into the impacts of climate change or housing insecurity, both critical determinants of health. One article briefly discussed the commercial determinants of health in relation to the high burden of non-communicable diseases.
Australia’s burden of disease
“Key challenges for Australia will be to keep an ageing population healthy, provide adequate resources to promote healthy lifestyles and manage non-communicable diseases,” according to Dr Shariful Islam and colleagues in their analysis for the Global Burden of Disease Study 2019.
While mortality related to non-communicable diseases decreased in the 1990-2019 study period, NCDs account for 90.9 percent of total deaths in Australia, followed by injuries (5.7%) and communicable, maternal, neonatal and nutritional diseases (3.3%).
Ischaemic heart disease was consistently the leading cause of death between 1990 and 2019, followed by stroke and then tracheal, bronchus and lung cancer.
The study also found that the leading risk factors for burden of disease were high BMI, smoking, high blood pressure, high fasting glucose and drug use.
Potentially a reflection of strong public health policies and education campaigns, road injuries declined by 54 percent during the study period.
The study authors noted that limitations in the methodology meant they were unable to present jurisdiction-level data or results by different population groups that would have been “beneficial in terms of understanding disparities and directing appropriate resources to those most in need”.
The authors discussed the influence of social, cultural and commercial influences on non-communicable disease-related deaths and disabilities.
Health impacts from youth justice system
Queensland adolescents with a history of contact with the youth justice system have a higher risk of death from non-communicable diseases compared to age- and sex- matched peers in the general population, according to another study in The Lancet series.
The risk increased for youth whose first contact with the justice system occurred before age 14, highlighting the importance of raising the minimum age of criminal responsibility.
Rates of NCD-related deaths for Indigenous people with a history of contact with the youth justice system are twice as high as for people in the general Australian population, the study also found.
The study showed that deaths by cardiovascular disease and digestive conditions were the most common.
“Because justice system contact commonly co-occurs with many other sources of social exclusion, such as homelessness and inadequate engagement with support services, incarceration during adolescence should be implemented only when a community-based order is not feasible, and for the shortest time possible,” the authors wrote.
Working life expectancy
Average years working has increased in Australia since 2001, regardless of gender or level of education, according to another study in the series.
However, the study – which investigated the healthy working life expectancy at 50 years by gender and level of education – found that men and people with higher education worked approximately two years longer in good health than women and people with lower levels of education.
Additionally, women and people with lower educational attainment experienced a decline in healthy non-working years.
As Australia’s population and workforce ages, strategies to achieve longer healthier working lives are required, according to the authors.
“There is a role for targeted health promotion, which must focus on addressing life-course social determinants,” they wrote.
The August edition of The Lancet Public Health can be read in full here.
Read Nature editorial here
See Croakey’s archive of articles on commercial determinants of health.