National report card examines COVID-19 and other health issues in Australia

Note: Most information in this media release is for time periods before the 2019-20 summer bushfires and the COVID–19 pandemic.

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 in a video message.

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.

All is not equal 

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,’  Mr. James said.

‘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.’

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

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