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3.4 Are we getting healthier?
Australians have one of the longest life expectancies in the world, but does this mean we are healthier
than our parents or grandparents?
The concept of what it is to be ‘healthy’ encompasses more than just how many years a person
lives—for example, it could also include consideration of how many of those years are spent in good
health or with disability or chronic illness.
While a baby born today can expect to live about 30 more years than a baby born in the late 1800s, he
or she will face a set of different health challenges, largely driven by lifestyle factors not encountered
by previous generations.
Extra ‘healthy’ years
A boy born in 1881–1890 had a life expectancy of 47.2 years and a baby girl 50.8 years. Today, a baby
boy can expect to live to 79.9 and a baby girl to 84.3 (see Chapter 3 ‘Life expectancy’).
Importantly, we are not just living longer, but have more years living free of disability. A baby boy born
in 2012 could expect to live 62.4 years free of disability and 17.5 years with some form of disability.
This compares with a baby boy born in 1998 who could expect to live 58 years free of disability and
17.9 years with some form of disability. A baby girl born in 2012 could expect to live 64.5 years free
of disability and 19.8 years with some form of disability. This compares with a baby girl born in 1998
who could expect to live 62.1 years free of disability and 19.4 years with some form of disability
(AIHW forthcoming) (see Chapter 6 ‘Ageing and the health system’).
Box 3.2
Age-standardisation
‘Age-standardised’ refers to removing, statistically, the influence of differing age structures when
comparing populations. See Glossary for more information.
There has been a long and continuing decline in death rates in Australia. Between 1907 and 2012, the
age-standardised death rate fell by more than 70%, from 2,054 to 550 deaths per 100,000 population
(ABS 2013d; AIHW 2013c) (see Figure 3.4).
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0
500
1,000
1,500
2,000
2,500
Female
Male
20121907
Deaths per 100,000 population
Year
The rate of potentially avoidable deaths (deaths among people younger than 75 that are potentially
avoidable within the present health-care system) has also been in decline.
Potentially avoidable deaths are divided into potentially preventable deaths (those amenable to
screening and primary prevention, such as immunisation) and deaths from potentially treatable
conditions (those amenable to therapeutic interventions). Preventable death rates fell by 36%
between 1997 and 2010 (from 142 to 91 deaths per 100,000) and rates of deaths from treatable
conditions fell by 41% between 1997 and 2010 (from 97 to 57 deaths per 100,000) (see Chapter 9
‘Indicators of Australia’s health’).
We’re dying of different things than in the past
In 1900, people could mainly expect to die from pneumonia, influenza, tuberculosis, gastrointestinal
infections, heart disease and strokes (Jones et al. 2012).
In 2011, the top 5 causes of death in Australia for males were coronary heart disease, followed by lung
cancer, cerebrovascular disease (including stroke), prostate cancer and chronic lower respiratory disease.
For females, the top 5 causes were coronary heart disease, cerebrovascular disease, dementia and
Alzheimer disease, lung cancer and breast cancer (see Chapter 3 ‘Leading causes of death in Australia’).
Figure 3.4
Sources: ABS 2013d; AIHW 2013c.
Age-standardised death rates, by sex, 1907–2012
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LEWhy the change and what does it mean for our health status?Since the 1900s, sanitation and housing have improved and vaccines have been developed to help
our fight against infectious diseases. In many parts of the world, diseases that killed our ancestors
no longer prove fatal; however, while we have capitalised on medical advances and technological
innovations to treat and prevent these diseases, new threats have emerged.
Changing lifestyles
We are now dealing with different causes of illness than past generations. Compared with previous
generations, life for many of us today is increasingly inactive.
In the early 20th century, people ate fewer processed foods, walked more, did more manual labour,
lived with fewer labour-saving appliances and gadgets, and spent less time in front of televisions and
other screens.
According to the latest ABS Australian Health Survey (AHS), in 2011–12 adults spent an average of just
over 30 minutes a day doing physical activity. When measured against the National Physical Activity
Guidelines for adults ‘to do at least 30 minutes of moderate intensity physical activity on most days’,
only 43% met the ‘sufficiently active’ threshold (ABS 2013c).
Children and teenagers aged 5–17 spent 1.5 hours a day doing physical activity and more than 2 hours
a day in screen-based activity (watching TV, DVDs or playing electronic games). Moreover, physical
activity fell as children got older (ABS 2013c).
As we are discovering, lifestyle factors such as this can have a profound effect on our health and
increase our likelihood of being ill with chronic disease.
Today, nearly two-thirds of Australian adults are overweight or obese (63%), an increase from 56.3% in 1995
and 61.2% in 2007–08 (ABS 2013c). There are an estimated 1 million people aged 2 and over with diagnosed
diabetes in Australia. However, this is likely to be an underestimate—for every 4 adults with diagnosed
diabetes, there is estimated to be 1 with undiagnosed diabetes (AIHW 2013d) (See Chapter 4 ‘Diabetes’).
As well as not getting enough exercise and carrying too much weight, many of us do not eat sufficient
fruit and vegetables and some of us smoke tobacco or consume alcohol at risky levels.
In 2011–12, less than half of Australian adults (48.5%) reported that they usually ate the recommended
2 serves of fruit per day and only 8% that they ate the recommended 5 or more serves of vegetables
per day. Overall, only 5.5% of Australian adults ate the recommended daily intake of both fruit and
vegetables (ABS 2013c).
These self-reported findings were similar to those from the 2007–08 National Health Survey where 9%
of people aged 15 and over did not usually consume sufficient serves of vegetables and about half
(49%) did not usually consume sufficient serves of fruit (AIHW 2012)
Older Australians (aged 65 and over) in both surveys were more likely to meet the guidelines than
younger Australians.
Smoking rates in Australia are still falling, continuing a long-term downtrend trend over the past 50
years. In 1964, 43% of Australian adults smoked (OECD 2013), but by 2010 this rate had dropped to
16%. Moreover, fewer younger people are now taking up smoking. In 2001, about one-quarter of
18- to 24-year-olds smoked daily—by 2010, this had fallen to 16% (see Chapter 5 ‘Tobacco smoking’).
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Results from the 2010 National Drug Strategy Household Survey showed that while daily drinking
declined between 2007 (8.1%) and 2010 (7.2%), 1 in 5 people drank at a level that put them at risk of
harm over their lifetime. The rate of people drinking at a level that put them at risk of harm over their
lifetime has remained stable since 2001 (see Chapter 5 ‘Alcohol risk and harm’).
These behaviours put us at an increased risk for a range of chronic diseases, including heart disease,
stroke and cancer (see Table 3.3 and Chapter 4 ‘Chronic disease—Australia’s biggest health challenge’).
Table 3.3: Relationship between selected chronic conditions and risk factors
Behavioural Biomedical
Conditions
Tobacco
smoking
Physical
inactivity
Risky alcohol
consumption Poor diet Obesity Hypertension(a)
High
blood
fats
Ischaemic
heart
disease
     
Stroke       
Type 2
diabetes
    
Kidney
disease
    
Arthritis (b) (c) (c)
Osteoporosis    
Lung cancer 
Colorectal
cancer
   
Chronic
obstructive
pulmonary
disease

Asthma 
Depression   
Oral health   
(a) High blood pressure.
(b) Relates to rheumatoid arthritis.
(c) Relates to osteoarthritis.
Note: The relationships shown above relate to the causation (development) of the chronic diseases. They do not to reflect
the determinant’s role (effect) on management of the chronic disease.
Source: AIHW 2012 adapted from AIHW 2008.
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LEStress of everyday life
Today’s generation faces emotional, mental and physical stressors that are fuelled by living in a
fast-moving, ever-changing world.
Stress has been associated with a range of illnesses, from headaches and sleep disorders to
autoimmune diseases and heart problems (mindhealthconnect 2012). Stress can be triggered by a
multitude of causes, from running late for an appointment to a life-changing event such as the death
of a family member or partner. Common everyday stressors include job insecurity, financial worries
and relationship difficulties.
While a British review of research into the health benefits of work found that, in general, work
improved physical and mental health and wellbeing (Waddell & Burton 2006), work stress has been
shown to increase the risk of developing mood and anxiety disorders, coronary heart disease and
metabolic syndrome, which can be a precursor to type 2 diabetes, stroke and heart disease
(Chandola et al. 2006; Marmot et al. 1997; Rosengren et al. 2004; Szeto & Dobson 2013) (see Chapter 6
‘The health of our working age population’).
Indigenous health
Indigenous Australians experience poorer health and have worse health outcomes than other
Australians. They have a burden of disease 2–3 times greater than the general Australian population,
and are more likely to die at younger ages, experience disability and report their health as fair or poor
(see Chapter 7 ‘How healthy are Indigenous Australians?’).
The gap in the health of Indigenous and non-Indigenous Australians is best illustrated by differences
in life expectancy. Life expectancy at birth for Indigenous Australians in 2010–2012 was 73.7 years for
females and 69.1 years for males, compared with 83.1 and 79.7 years for non-Indigenous females and
males respectively (ABS 2013e) (see Chapter 7 ‘Indigenous life expectancy and death rates’). These
differences in health start at birth and continue throughout life. Babies born to Indigenous mothers
are more likely to be of low birthweight than babies born to non-Indigenous mothers and Indigenous
children die at more than twice the rate of non-Indigenous children. Between 2008 and 2012, 203
out of 100,000 Indigenous children aged 0–4 died compared with 91 out of 100,000 non-Indigenous
children. Indigenous adults of all ages also died at a higher rate than non-Indigenous Australians
(AIHW 2013a; SCRGSP forthcoming) (See Chapter 7 ‘Indigenous life expectancy and death rates’).
Despite this continuing health gap, there have been improvements in recent years. Overall mortality
for Indigenous Australians fell by 19% from 1991 to 2011, and Indigenous infant mortality rates fell by
62% from 2001 to 2012 (AIHW 2013a).
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While mortality rates for chronic diseases were much higher for Indigenous Australians (over 5 times
the rate of non-Indigenous Australians for diabetes and twice the rate for circulatory diseases in
2007–11), deaths due to circulatory disease fell by 41% and deaths due to respiratory disease fell by
39% from 1997 to 2010 (AIHW 2013a). However, in the same period, there was a large increase (96%) in
incidence rates of treated end-stage renal disease among Indigenous Australians (currently 7 times the
rate for non-Indigenous Australians) and Indigenous Australians were twice as likely to be hospitalised
for mental and behavioural disorders, and injury and poisoning, as non-Indigenous Australians
between July 2010 and June 2012 (see Chapter 7 ‘How healthy are Indigenous Australians?’).
Living with ill health
In the 19th and early 20th centuries, many people who became acutely ill died quickly. And, as outlined
earlier, today many of these acute illnesses have been replaced by chronic, non-communicable illnesses
that now cause most of the disease burden—in 2011, 90% of all Australian deaths were caused by a
chronic disease (see Chapter 4 ‘Chronic disease—Australia’s biggest health challenge’).
Typically, chronic conditions are long-lasting, have persistent effects, and can range from conditions
such as short- or long-sightedness to debilitating arthritis and low back pain, to life-threatening heart
disease and cancers. Once present, chronic conditions often persist throughout life—which means
that although Australians are now living longer, many people live with some type of ill health for many
years, with a need for long-term management.
ABS Australian Health Survey data for 2011–12 indicate that about 3.3 million Australians (14.8% of
the population) have arthritis, 2.3 million (10.2%) have asthma, 1 million have heart disease (5%) and
1 million have diabetes (5%) (ABS 2013b; 2013c).
Living with chronic illness
Living with a chronic illness can affect many aspects of a person’s life. For example, people with
asthma rate their health as worse than people without the condition, with most of the impact on their
physical functioning and social and work life (ACAM 2011).
And while people who control their asthma with medication and a management plan can lead a
normal life (National Asthma Council Australia 2013), most people with asthma do not have a written
action plan, and poor asthma control (frequent symptoms and asthma exacerbations) is a common
problem in both adults and children (ACAM 2011).
The burden of chronic conditions extends far beyond personal costs and results in a significant
national economic burden. Estimates based on allocated health care expenditure indicate that the 4
most expensive disease groups are chronic—cardiovascular diseases, oral health, mental disorders,
and musculoskeletal—incurring direct health-care costs of $32 billion, or 43% of all allocated health
expenditure in 2008–09 (see Chapter 4 ‘Chronic disease—Australia’s biggest health challenge’).
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LENew health responses
Although Australians now face the challenges of rises in non-communicable diseases which have a
long latency period and are more frequent with ageing (Hetzel 2001), we also have new answers to
those challenges. Today we have access to an increasingly innovative and sophisticated health system
providing care and treatment regimens that were not available in the past. Cancer is one such example.
Cancer is the second leading cause of death in Australia (after cardiovascular disease) but despite a
rise in new cases diagnosed, the mortality rate has fallen and people are living longer after diagnosis.
Why? Detection and treatment have improved markedly in recent years, and national screening
programs have been established for breast, bowel and cervical cancer (see Chapter 4 ‘Cancer in
Australia’). So, while more people are being diagnosed with cancer, more people are surviving due to
early detection (which is associated with more successful treatment, generally) and better treatment
technology and delivery.
Inequalities
Presenting a broad picture of health status to some extent masks that there are clear inequalities in
health for many Australians, particularly Indigenous Australians (as described earlier), people living in
rural and remote areas, and the socioeconomically disadvantaged.
People living outside Australia’s major cities have worse outcomes on leading indicators of health and
access to care. They have higher rates of obesity, smoking and risky alcohol consumption, their rates
of potentially preventable hospitalisations are also higher and they are less likely to gain timely access
to aged care (COAG Reform Council 2013). The COAG Reform Council report, Healthcare 2011–12:
comparing outcomes by remoteness, also found that people living outside major cities were more likely
to defer access to dental services and general practitioners due to cost and were more likely to wait
longer than 1 year for access to public dental services.
It has been suggested that socioeconomic factors have the largest impact on health, accounting
for up to 40% of all influences compared with health behaviours (30%), clinical care (20%) and the
physical environment (10%) (The British Academy 2014).
The World Health Organization’s Commission on Social Determinants of Health concluded that social
inequalities in health arise because of inequalities in the conditions of daily life and the fundamental
drivers that give rise to them: inequities in power, money and resources (Commission on Social
Determinants of Health 2008).
The WHO describes a ‘social gradient in health’ which shows that, in general, the lower an individual’s
socioeconomic position the worse their health. Where people are in the social hierarchy affects
the conditions in which they grow, learn, live, work and age, their vulnerability to ill health and the
consequences of ill health (WHO 2014).
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LESo, are we healthier?
The change in the patterns and causes of illness and deaths in Australia and many other countries has
been described as the ‘health transition’ from a pattern of high mortality from infectious diseases to
one of lower overall mortality from non-communicable disease and injury (Hetzel 2001).
It could be argued that we are both healthier and unhealthier in different ways compared with
the past, and that we have, perhaps, more control of our health. Today there are medications and
treatments that were not available to our predecessors—medical technologies such as minimally
invasive surgery and devices such as pacemakers and hip replacements offer not just more treatment
options, but in some cases treatments that were previously not available at all.
Emerging technologies such as telehealth enable people to monitor chronic conditions such as diabetes
and hypertension in their own homes, with the support of health professionals (see Chapter 2 ‘Australia’s
health system’). Avenues such as online health forums and websites provide better access to health
information, making it easier to take more personal responsibility for our own health management.
How do we rate our own health?
According to the Australian Health Survey, in 2011–12 more than half (55.1%) of all Australians aged 15
and over considered themselves to be in ‘excellent’ or ‘very good’ health, and another 30.3% in ‘good’
health. Just over 1 in 10 (10.7%) rated their health as ‘fair’, and 4.0% as ‘poor’. These ratings are slightly
better than those recorded in 1995 when 54.3% rated their health as ‘excellent’ or ‘very good’, 28.3% as
‘good’, 13% as ‘fair’ and 4.2% as ‘poor’ (ABS 2006; 2013c).
Older Australians generally rated themselves as having poorer health than younger people. People
aged 75–84, and 85 and over, recorded the highest proportions of ‘fair’ health (21.6% and 23.3%
respectively) and ’poor’ health (9.7% and 14.2%). About 35% of people aged 75–84 rated their health
as ‘excellent’ or ‘very good’, and a further 33% as ‘good’. About 30% of those aged 85 and over rated
their health as ‘excellent’ or ‘very good’ and 32% as ‘good’ (ABS 2013c).
In comparison with figures given earlier for all Australians, only 39% of Indigenous Australians rated their
health as ‘excellent’ or ‘very good’, 36% as ‘good’, 18% as ‘fair’ and 7% as ‘poor’ in 2012–13 (ABS 2013a).
Where do I go for more information?
Detailed information on Australians’ health and wellbeing, including on leading causes of ill health and
risk factors, is available at the AIHW website. Detailed information on the ABS Australian Health Survey
is available at www.abs.gov.au.
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