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Unpacking the latest report card on Australia’s health, with calls for action on the wider determinants

Introduction by Croakey: The Australian Institute of Health and Welfare’s (AIHW) biennial report card of Australians’ health was launched today, with the headline verdict that overall health “continues to fare well” compared with similar countries despite significant impacts from the COVID-19 pandemic and the ongoing burden of chronic conditions.

As the ABC reported, the AIHW notes that for the first time since the mid-1990s, life expectancy in Australia decreased – by 0.1 years for males and females from 2019–2021 to 2020–2022.

“This is likely due to the increase in deaths seen in 2022, of which close to half were due to COVID-19,” the AIHW said, though pointing to greater declines in life expectancy seen in the United States (from 78.9 in 2019 to 76.4 in 2021) and the United Kingdom (from 81.3 in 2019 to 80.4 in 2020).

Responding to the report, the Australian Medical Association (AMA) emphasised the longer-term trend – that boys and girls born in Australia today can expect to live 81.2 years and 85.3 years respectively, up about 40 percent since the start of the 20th century. Australia’s life expectancy is the fourth best among OECD countries.

However, AMA president Professor Steve Robson said that, while there are many positives to take from the report, there are also “red flags and warnings” for government, particularly with the burdens of chronic disease and mental illness on the rise.

“We must treat health spending as an investment, rather than a cost. Placing a greater focus on preventive health, mental health and increasing support for general practice would help Australians live healthier lives and would save taxpayer dollars in the long run by reducing pressure on the health system,” Robson said, also calling for immediate action from governments to address the “public hospital logjam crisis”.

His comments came as the Federal Health Minister Mark Butler announced that bulk-billing rates continued to rise since the Government tripled the bulk-billing incentive, with May monthly data approaching “almost a million additional free visits” to GPs – or more than 915,000, according to media reports.

In the article below, health policy analyst Charles Maskell-Knight digs into the AIHW report, looking at its findings on family and sexual violence, risk factors and First Nations peoples’ health.

The health system cannot deal with the causes of many health concerns, he writes, as improving diet and physical activity requires action across education, town planning, food standards, access to fresh and affordable food, mental health support, taxation policy and other commercial determinants of health.

See also this visual report on the AIHW findings, from Adrian Esterman, Professor of Biostatistics and Epidemiology at the University of South Australia, and The Conversation.


Charles Maskell-Knight writes:

The AIHW released Australia’s Health 2024  today, the 19th biennial edition of the report.

As well as the main document, the Institute also released:

How to make sense of this abundance of data?

Australia’s Health 2024: in brief may be the best place to start, even though the title is something of an oxymoron, given the document has 110 pages.

And given the interest of many Croakey readers in determinants of health and First Nations peoples’ health, this article will focus on those topics.

Risk factors

After signposts to AIHW work on the built environment and health, natural environment and health and social determinants of health, chapter 2 of Australia’s Health 2024: in brief deals with other factors.

The first is family, domestic and sexual violence. Of the 20,100 hospitalisations in 2021-22 due to assault, almost a third were due to family and domestic violence, and “in 2018, intimate partner violence contributed to 1.4 percent of the total burden of disease and injury among Australian women”.

There is some good news – the rate of domestic homicide has more than halved between 1989-90 and 2022-23, “with the female victimisation rate falling from 0.90 to 0.34 per 100,000 females, and the male victimisation rate falling from 0.59 to 0.29 per 100,000 males”.

Presumably restrictions on gun ownership have played a part in this decline.

Looking at other risk factors, almost a third of the burden of disease in 2018 was due to the combined impact of tobacco use, overweight and obesity, dietary risks, high blood pressure, and alcohol use.

As is widely reported, Australia has largely won the battle against smoking, with overall rates steadily trending down, and rates among 18-24 year olds dropping from 24 percent in 2001 to just under six percent in 2022-23. However, we are losing the fight against vaping, with rates among the same age cohort increasing over ten-fold from 0.8 percent in 2016 to 9.3 percent last year.

Between 2004 and 2022-23 there has been a steady decline in the proportion of people drinking alcohol in a risky way (more than ten standard drinks a week, or more than four standard drinks in a day) from about 30 percent of the population aged over-14 years to 25 percent (ten drinks a week) and 24 percent (four drinks in a day). Over the same period the proportion of abstainers (people who haven’t had a standard drink in over a year) has increased to 23 percent.

However, the proportion of the over-14 population consuming illicit drugs is increasing. In 2007, 13 percent had used an illicit drug in the last year, but by 2022-23 this had increased to 18 percent. The most common drugs used were cannabis (11 percent) and cocaine (4.5 percent). Half of people who had used cannabis were using it monthly, and 18 percent reported daily use.

Over a million people (5.3 percent) also reported using pharmaceutical drugs for a non-medical purpose.

Australians’ adherence to dietary guidelines about fruit and vegetable consumption has never been good, and between 2017-18 and 2022 adherence fell for some cohorts of children and adolescents. The proportion of adults who did not meet the guideline for fruit consumption increased from 49 percent to 56 percent over the same period.

Adult consumption of vegetables has been static since 2007-08, with an amazing 94 percent failing to meet the guideline.

On a more positive note, adherence to guidelines for physical activity is improving. In 2017-18 just over half of adults aged 18-64 did not meet the guideline, but that had dropped to 37 percent in 2022. For people aged 65 and over, 72 percent were not meeting the guideline in 2017-18, and that had dropped to 57 percent in 2022.

Perhaps the COVID-19 lockdowns encouraged people to get out and exercise when they could, and those habits have stuck?

However, despite these improvements in physical activity, we are still an overweight nation. In 2022, 66 percent of Australian adults were “living with overweight or obesity”, 34 percent overweight and 32 percent obese. This is virtually the same as 2017-18.

There has been a steady increase since 1995, when 56 percent of adults were living with overweight or obesity, driven mainly by an increase in obesity from 19 percent to 32 percent.

First Nations health

Chapter 4 of Australia’s Health 2024: in brief deals with First Nations peoples’ health and wellbeing, and notes that “there have been some notable improvements” in recent years – including a decrease in the age-standardised death rate for cardiovascular diseases, reduced rates of smoking (including during pregnancy), and improved attendance at antenatal care”.

However, the reduction between 2006 and 2022 in the age-standardised death rate for cardiovascular disease among First Nations people was largely offset by an increase in the death rate from cancer.

Many of the changes in risk factors for the non-Indigenous population are also apparent in the First Nations population: smoking rates and risky use of alcohol are declining, but overweight and obesity are increasing.

Almost a third of First Nations adults report ‘high or very high’ levels of psychological distress – and that was in 2018-19, before the impact of the COVID-19 pandemic and the failure of the Voice referendum.

Educational attainment and employment rates are increasing, but still lag the non-Indigenous population.

There have been some improvements in how the health system works for First Nations people, including an increase between 2012 and 2020 from 50 percent to 71 percent in the proportion of First Nations women who accessed antenatal care in their first trimester of pregnancy.

There has also been an increase from 255 to 309 per 10,000 population between 2011 and 2021 in the rate of First Nations people aged 15 and over who are employed in health-related occupations, over half of which was due to increased numbers of nurses and midwives.

However, the health gap – disparities in health outcomes between First Nations and non-Indigenous Australians – remains, and the gap is only closing very slowly.

The report says that “after accounting for the differences in the average age, sex, marital status, and regional factors (remoteness and state/territory of residence) between First Nations and non-Indigenous Australians, an adjusted, overall, health gap of 24 percentage points was estimated in 2017–2019. This represents a slight decline in the adjusted health gap since 2011–13 (a gap of 27 percentage points)”.

It concludes that a little over a third of the health gap was due to differences in the social determinants of health (mainly employment status and income), and a little under a third was due to differences in health risk factors. The remaining third is due to other factors such as differences in access to health services and discrimination.

As the Productivity Commission found earlier this year, improving how the health system works for First Nations people requires cultural change in governments to commit to sharing power with First Nations people, recognising the expertise of community controlled organisations, and accepting programs that they design and implement.

Australia has a long way to go to Close the Gap.

The policy agenda

Australian health ministers and others are prone to boast about our “world class health system”.

Australia’s Health serves as a regular reminder that the health system may be good, but it faces many challenges – and responses to these often lie outside the health system.

The health system is faced with dealing with the growth in overweight and obesity, but it cannot deal with the causes.

Improving diet and physical activity requires action across education, town planning, food standards, access to fresh and affordable food, mental health support, taxation policy and the commercial determinants of health.

Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021.  He worked as a senior adviser to the Aged Care Royal Commission in 2019-20.


See Croakey’s archive of articles on public health and population health

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