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Australian Institute of Health and Welfare 2020. Australia’s health 2020: data insights. Cat. no. AUS 231. Canberra: AIHW. doi:10.25816/5f05371c539f3
Australian Institute of Health and Welfare. (2020). Australia’s health 2020: data insights. Canberra: AIHW.
Australian Institute of Health and Welfare. Australia’s health 2020: data insights. AIHW, 2020.
Australian Institute of Health and Welfare. Australia’s health 2020: data insights. Canberra: AIHW; 2020.
Australian Institute of Health and Welfare 2020, Australia’s health 2020: data insights, AIHW, Canberra.
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Australia’s health 2020: data insights presents an overview of health data in Australia and explores selected health topics in 10 original articles.
Australia’s health 2020 is the 17th biennial health report of the Australian Institute of Health and Welfare. This edition has a new format and expanded product suite:
People’s health service and medication use can change in the 6 months before and after entry into permanent aged-care
Housing provides shelter and safety, and lack of available health hardware can lead to illness or injury
Suicide prevention requires a multi-sector approach with health and welfare related professionals and organisations
Health data are essential for supporting evidenced based decisions for better health outcomes for all Australians
Health is ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO 1946). It influences, and is influenced by, how we feel and how we interact with the world around us, and reflects the complex interactions of an individual’s genetics, lifestyle and environment. Generally, a person’s health depends on determinants (factors that influence health) and on interventions (actions taken to improve health, and the resources required for those interventions). These determinants can affect the health of individuals and communities.
Health outcomes and experiences of health are not the same for everyone. Income, education, conditions of employment and social support (often known as ‘social determinants’ of health) are known contributors to health inequalities between population groups.
Health systems play a crucial role in health and can help to reduce the burden that ill health places on the community. Australia’s health system is considered one of the best in the world, with many services funded and delivered by Australian, state and territory governments. Australia’s health system includes public and private hospitals; primary health care services (such as general practitioners and allied health services); and referred medical services (including many specialists).
In the past year, Australia has faced several major public health crises that have required large-scale government intervention—crises that have further highlighted how important health is to our quality of life and overall wellbeing.
The coronavirus disease (COVID-19) pandemic is a major health threat; it is highly infectious and has a higher death rate than many other infectious diseases. Since the World Health Organization (WHO) classified COVID-19 as a pandemic in March 2020, the Australian community has implemented many changes to reduce the spread of the disease. The health benefits of social distancing measures are clear, and have resulted in a slowed spread of infection and reduced pressure on health services, but the long-term impacts of the pandemic are not yet known.
In the aftermath of the 2019–20 bushfires, and for the ongoing management of COVID-19, governments and policymakers need accurate, relevant and timely data to develop and implement evidence-based policies. The articles in Australia’s health 2020: data insights illustrate how health data are crucial to improving the health of Australians and ensuring that health systems respond effectively to current and changing needs.
As a health and welfare statistical agency, the AIHW recognises that health data are crucially important for improving health for individuals and populations, as well as for monitoring trends and planning for future health needs. To understand health needs at individual and population levels, we need to be able to measure health status and to collect health data; to understand people’s interactions with multiple parts of the system—and with multiple systems—we also need to be able to link relevant data.
Australia’s health 2020: data insights examines issues related to health and health systems. It underscores both the importance of data, and of building the evidence base, in achieving long-term, sustainable improvements in health and health care for all Australians. It includes 10 chapters, which present focused discussions, analyses and evidence on current issues in health data and evidence.
This chapter provides an overview of what the health data landscape currently looks like, and key issues and challenges faced. Robust and consistent health data practices—in terms of the availability, collection, collation and analysis of health data—are important for the planning and delivery of appropriate health care and for assessing the health system as a whole.
We have opportunities to improve the ways in which data are collected, accessed and analysed to inform how we respond to many existing or emerging challenges—including the health impacts of the recent bushfires across Australia; the emergence of COVID-19; and existing issues such as the rate of suicide in Australia. Increased use of data linkage methods may provide opportunities to better understand and address these challenges. The article also discusses data gaps and limitations; developments in health data; the AIHW’s work; and the future of health data.
During crises, there is a strong need to obtain data as quickly as possible to allow for an informed, immediate response to manage the situation. Timely data, and innovative uses of data, has been vital in informing Australia’s response to the challenges posed by COVID-19. Chapter 2 is a point in time article that summarises what is known about the first 4 months of the epidemic in Australia. While we remain in the middle of an evolving situation, as at 7 June 2020, Australia had recorded 7,277 cases and 102 deaths. The chapter shows that, if Australia had experienced the same COVID-19 case and death rates as Canada, Sweden or the UK, it is estimated Australia would have had between 8 and 14 times the number of cases and around 5,000 to 14,000 extra deaths.
There are a number of potential indirect effects from changes within the health system and changes in wider society due to interventions put in place to manage the spread and impact of COVID-19. For example, the need for as many people to stay at home as possible to increase physical distancing meant that many people were isolated from family, friends and other support networks. The widespread interventions have a number of longer-term potential adverse health and welfare effects, although interventions can be put in place to reduce the risk of these. The large-scale loss of employment and the general economic downturn is a large challenge, and the longer-term effects will need to be monitored into the future.
Understanding the broad contextual factors that influence our health is important because our health is not immune to social and environmental influences. Chapter 3 looks at how health is affected by social and economic conditions of everyday life, such as family circumstances, housing, working conditions, livelihood and education. The connections between these social factors and health outcomes are complex and occur over many years. There is now a strong evidence base to help us understand the social determinants of health and the relationships between social determinants and biological mechanisms. In many cases, it is the social determinants that contribute to inequalities in health between population groups.
Despite substantial improvements in the health of Aboriginal and Torres Strait Islander people over the past 30 years, there are disparities in health outcomes between Indigenous Australians and non-Indigenous Australians. The reasons for these disparities are complex, and include the lasting impact of colonisation and separation from Country. Chapter 4 examines social determinants that have a substantial impact on Indigenous health. Diseases including chronic kidney disease, rheumatic heart disease, and certain eye and ear diseases, disproportionately affect Indigenous Australians. Some of the common factors underlying these health conditions are housing, living conditions and access to services. These diseases are preventable and treatable, and common in low- and middle-income countries—both linked to overcrowding, socioeconomic deprivation, and inadequate access to health hardware and health resources. Lack of access to health services also affects health outcomes for Indigenous Australians, as access to primary health care services is critical for timely management of acute and relatively minor illnesses such as infections.
Meeting these health challenges requires a multi-sectoral approach that addresses the basic needs of adequate housing and access to health services, including maintaining and fixing health hardware. Data about housing adequacy; service-access issues; and the incidence and prevalence of various health conditions; and evidence for what achieves improvement are key to reducing the disparities.
The concept of ‘equity’ in health is that, ideally, everyone should have a fair opportunity to attain their full health potential and that disadvantage should not prevent them from achieving this potential. Potentially preventable hospitalisation (PPH) statistics provide a useful measure for examining health equity. In Australia, and other countries, PPH data are used to assess timely, effective and appropriate primary health care. Chapter 5 shows that PPH conditions cost the hospital sector $4.5 billion in 2015–16.
PPH are influenced by many factors, including individual circumstances, patient characteristics and health-system factors. However, PPH statistics remain a valuable tool for exploring health disparities between different populations. Chapter 5 includes a case study on PPH for diabetes complications, exploring who is most at risk and comparing trends in PPH for specific groups within the Australian population. It also discusses the importance of exploring and understanding patient-care pathways that result in PPH, and the opportunities presented by data linkage for a more nuanced understanding of patient-care pathways that result in, and follow on from, PPH.
Data relating to health expenditure and funding are shaped both by health system activity and by health funding mechanisms. Australia’s health system is a complex mix of government and privately funded services delivered in a variety of settings. Chapter 6 provides an overview of the funding arrangements in place to fund Australia’s health system and provides some comparisons with other Organisation for Economic Co-operation and Development countries.
Moving into residential aged-care facilities can prompt a transition in the use of selected health services and medications. Chapter 7 explores people’s use of health services in the 6 months before and after entry into permanent residential aged care. Using original analysis, it provides insights into the nature of health-service use during this transition, which may help us to understand the context for change.
Access to care and services is influenced by the interactions aged-care services have with health care services; the availability of health care professionals in the local area; the workforce available within residential aged care; and prescribing practices within facilities. GPs play a central role in prescribing medicines for older people in residential aged care and access to medicines can be relatively straightforward.
Dementia is a major health issue in Australia, causing substantial illness, high levels of dependency, and death. The number of Australians living with dementia is estimated to be between 400,000 and 459,000 in 2020, but the exact number is unknown. It has also been a leading contributor to the burden of disease and injury, requiring $428 million in direct health expenditure in 2015–16.
Without a significant breakthrough in treatment, the number of people with dementia is expected to double by 2050, placing a greater demand on Australia’s health and aged-care systems. Chapter 8 examines current issues and gaps in Australia’s dementia data and how this affects our understanding of—and response to—dementia in Australia. It also looks at opportunities for data development to ensure Australia has sufficient data to inform dementia policy and service planning.
Monitoring dementia—and its impact on individuals and their carers and on Australia’s health and aged-care systems—is essential for the development of evidence-based health, aged-care and social policy and for associated service planning. However, there are currently gaps in the data limiting its ability to inform policy development and service planning. To address some of these gaps and data limitations, the Australian Government has committed to improve national dementia data assets and capabilities.
Suicide prevention in Australia is a complex area of policy, with governments, policymakers and service providers all having a role in reducing suicides and cases of intentional self-harm. The reasons for suicide are also complex and are different for each individual, and the prevalence, characteristics and methods of suicidal behaviour vary between different communities, demographic groups and over time. Effective suicide prevention thus requires a multi-sector approach, including health; education; employment; welfare and law-enforcement agencies; housing providers; and non-government organisations.
Chapter 9 provides an overview of the policy context for intentional self-harm and suicide monitoring and examines existing national sources of data currently used for this purpose. It discusses the limitations of these data sources, current data gaps and potential new sources of data that may strengthen the evidence base. It discusses that collection of timely data on suicide and intentional self-harm is essential to establish the extent of the problem; to highlight trends and emerging areas of concern; to identify vulnerable populations; and to underpin appropriate targeting of prevention strategies and research.
Life expectancy is often used as a key indicator of the health of a population and of overall progress in health and wellbeing over time. In Australia, life expectancy has increased substantially over many decades, and in 2018 it was 80.7 years for males and 84.9 years for females.
But what does our increasing life expectancy mean for individuals, and for the health system, in a country like Australia? Our longer lives have implications, not only for the quality of life of individuals, but also for health care planning, demand and need for health and welfare services, as well as health-system costs. Does living a longer life mean that people are also living healthier lives—or are we enduring poor health for longer at the end of our lives? Chapter 10 looks at this important distinction—between years lived in full or in ill health—in the years of life we have gained.
At a national level for people aged 65—while life expectancy continues to increase—the proportion of their lifetime spent in ill health has remained constant. However, this does not apply to all population groups. There is a clear gradient: life expectancy and years lived in full health increase as socioeconomic status increases.
WHO (World Health Organization) 1946. Preamble of the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946. New York: WHO.
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