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4102.0 - Australian Social Trends, 1997  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 19/06/1997   
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Contents >> Health >> Health Status: Protecting the health of our children

Health Status: Protecting the health of our children

A variety of health actions can be taken to protect the health of our children. In 1995, 19% of children had recently consulted a doctor, 53% had had both sight and hearing checks and most were immunised against polio, measles and mumps.

By world standards, most Australian children enjoy good health. Medicare and other government services have made health care more accessible and affordable for most Australians. Also, many childhood diseases can now be successfully treated or prevented.

The health of children is influenced by a wide range of social, cultural, physical and economic factors. Children are particularly vulnerable because they are dependent on their families, communities and governments to ensure that their health needs are met.

Health initiatives of communities and governments to protect the health of our children include education on the benefits of breastfeeding, good nutrition and hygiene and by assisting in the provision of adequate housing. Other initiatives include minimising negative environmental influences such as reducing environmental lead levels and providing guidelines to reduce sun exposure among children.

Health actions taken by carers also influence the health of our children. These include the use of preventive services such as dental and immunisation services, and providing or obtaining appropriate treatment when a child is ill.

Despite overall improvements in child health, significant inequalities still exist. The health status of Indigenous children1, and children from other economically disadvantaged backgrounds remain far below that of the general Australian population2.

Children from low socio-economic backgrounds, compared with children from higher socio-economic backgrounds, are the major users of medical services such as hospitals and doctors. Conversely, they are the lowest users of preventive services such as dentists and immunisation clinics3.


Child health

In this review children are people aged less than 15 years.

Infants are children aged less than one year.

Recent health actions refer to activities such as visiting a doctor, taking medication (vitamins, minerals, herbal, natural, prescribed or other medication) in the two weeks prior to interview.

Health screening refers to testing of sight and hearing, consultations with dental professionals and visits to baby health clinics.


Health actions
In 1995, 61% of children had undertaken a recent health action. The most common type of health action was the use of medication (51%). The next most common type of health action was consulting a doctor (19%). The likelihood of having taken a recent health action was similar for boys and girls.

Children aged 0-4 were more likely to have taken a recent health action than children aged 5-14 (64% compared to 60%). The specific types of health actions taken also varied by age. While the occurrence was very low, children aged 0-4 were three times more likely to have stayed in hospital as an inpatient, compared to those aged 5-14 (1.2% compared to 0.4%). 29% of children aged 0-4 consulted a doctor, compared to 16% of those aged 5-9 and 12% of those aged 10-14.

RECENT HEALTH ACTIONS TAKEN(a), 1995p

Age group (years)

0-4
5-9
10-14
Total
%
%
%
%

No health action taken
35.7
40.1
40.3
38.7
Health action taken(b)
64.3
59.9
59.7
61.3
    Hospital inpatient
1.2
0.3
0.4
0.6
    Visited casualty/outpatients
2.7
1.8
1.9
2.1
    Doctor consulted
29.0
16.1
11.5
18.9
    Dentist consulted
1.2
7.8
10.6
6.5
    Used medication(c)
53.9
49.5
48.6
50.7
Total children
100.0
100.0
100.0
100.0

(a) Health actions taken in the two weeks prior to the survey interview.
(b) Components do not add to total because children may have undertaken more than one type of health action.
(c) Includes vitamins, minerals, herbal, natural, prescribed or other medication.

Source: 1995 National Health Survey: First Results (cat. no. 4392.0 and unpublished data).


Immunisation
Immunisation programs for children are recognised as an effective public health intervention. Because of mass immunisation programs, infectious diseases such as diphtheria, whooping cough and polio are no longer major causes of death and disability in Australia.

Immunisation schedules are periodically reviewed and updated by the National Health and Medical Research Council to provide better protection to individuals and the community. For example, between 1989-90 and 1995 three major changes were made. The DTP vaccination (diphtheria, tetanus, whooping cough) replaced the CDT vaccination (combined diphtheria tetanus) for children prior to school entry. Also, a combined measles, mumps and rubella vaccination and vaccination for Haemophilus influenzae type b (Hib) were introduced.

In statistical terms changes to the schedule impact on the measured rate of children fully immunised. Additions to the schedule tend to lower this rate. Care therefore needs to be taken in examining falls in immunisation rates over time to determine whether the fall represents a real decline as opposed to a decline resulting from a change in the schedule.

Between 1989-90 and 1995 the proportion of children aged three months to six years who were fully immunised against all diseases appeared to fall from 54% to 33%. However, if changes to the previous Standard Childhood Vaccination Schedule were taken into account, the actual fall (down to 52%) would have been relatively small.

Notwithstanding, a recent decline in the level of immunisation against some diseases appears to have contributed to increases in the incidence of disease. This is most evident for whooping cough. Between 1989-90 and 1995 the number of reported cases of whooping cough increased by over 3,000. In the same period the proportion of children immunised against whooping cough fell from 73% to 60%. However adjusting for changes to the previous Standard Childhood Vaccination Schedule for whooping cough increases the 1995 immunisation rate to 67%. This implies a real decline of whooping cough immunisation rates of six percentage points.

Of children aged three months to six years, 65% had received at least one, but not all of the required doses for the diseases listed on the current Standard Childhood Vaccination Schedule and 0.4% had not received any immunisation doses for any of the diseases.

Most children were fully immunised against measles (92%), mumps (90%) and polio (83%). But only 50% of children were immunised against Hib. Hib immunisation levels were low possibly because the vaccine was only introduced to the Standard Childhood Vaccination Schedule in 1993.

The proportion of children who were fully immunised differed between the States and Territories. Children in the Australian Capital Territory were most likely to be fully immunised (48%) followed by those in Western Australia (42%). Tasmania had the lowest proportion of fully-immunised children (27%).

Girls were slightly more likely to be fully immunised than boys (34% compared to 32%). This is because a higher proportion of girls were immunised against rubella (80% compared to 71%), reflecting the perception that the rubella vaccine is required only for girls.

The proportion of children who were fully immunised varied according to a range of socio-economic factors. Children in couple families were more likely to be fully immunised than those in one-parent families. For example, 85% of children from couple families were fully immunised against polio, compared to 69% from one-parent families. Also, children from families who usually speak English at home were more likely to be fully immunised than those who speak a language other than English. In addition, children from low-income families were less likely to be fully immunised than children from high-income families (see Australian Social Trends 1994, Children's immunisation).
CASES OF NOTIFIABLE DISEASES REPORTED

1985
1990(a)
1995
Disease
no.
no.
no.

Rubella
n.a.
620
4,380
Whooping cough
587
862
4,297
Measles
n.a.
880
1,324
Mumps
n.a.
n.a.
153
Hib
n.a.
549
74
Tetanus
11
6
7
Diphtheria
17
7
0
Polio
0
0
0

(a) Cases of Hib and rubella refer to 1991.

Source: Department of Health and Family Services, Communicable Diseases Intelligence.

IMMUNISATION STATUS(a) OF CHILDREN AGED THREE MONTHS TO SIX YEARS, APRIL 1995

Disease

Immunisation status
Diphtheria/ tetanus
Whooping cough
Polio
Measles(b)
Mumps(b)
Rubella(b)
Hib
Total
%
%
%
%
%
%
%
%

Fully immunised(c)
68.6
59.9
82.6
91.6
89.6
75.5
50.2
33.1
Partially Immunised(d)
24.2
31.7
10.1
* *
* *
* *
5.5
65.4
Not immunised
1.2
2.2
1.6
6.2
7.6
19.7
31.4
0.4
Not known
6.0
6.2
5.8
2.2
2.9
4.8
13.0
1.0
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0

(a) Based on the current Standard Childhood Vaccination Schedule.
(b) Children aged one year or less were excluded from estimates for measles, mumps and rubella.
(c) Fully immunised refers to the proportion of children receiving all of the required doses for that disease.
(d) Partially immunised refers to the proportion of children receiving at least one but not all of the required doses for that disease.

Source: Children's Immunisation Survey (unpublished data).


Health screening
Child health screening such as testing of sight and hearing, dental consultations and visits to baby health clinics enables preventive measures to be taken to stop or slow further development of a problem.

In 1995, 63% of children had had their sight tested and 66% their hearing tested at some stage in their life. Just over half (53%) had had both sight and hearing tests.

The proportions of girls and boys tested for sight and hearing were much the same. Among children aged 2-14, 75% had had a dental consultation.

Among children aged 0-3 years, 89% had visited a baby health clinic at least once. A slightly higher proportion of girls than boys had visited a baby health clinic (90% compared to 88%). The largest proportions of children who had visited a baby health clinic were in Victoria and the Northern Territory (both 97%) and the lowest proportion was reported in Queensland (73%).

TYPE OF HEALTH SCREENING, CHILDREN AGED 0-14, APRIL 1995

Age group (years)

0-1
2-4
5-9
10-14
Total
Total
Type of health screening
%
%
%
%
%
'000

Has had sight and hearing tests
28.4
33.7
63.1
63.1
52.6
2,023.0
Sight tests only
4.9
4.7
9.1
16.2
10.0
385.1
Hearing tests only
17.3
22.6
12.0
7.5
13.3
512.7
Has visited a dental professional(a)
n.a.
22.5
85.1
96.6
75.0
2,501.7

(a) Excludes children aged under two years.

Source: Children's Health Screening (cat. no. 4337.0).


Breastfeeding
Breastfeeding has major health advantages for children. It provides immunological, developmental and psychological benefits as well as providing children with a food high in nutritional content. Breast milk provides all the nutritional needs of a full-term infant for the first 4-6 months of life and remains an important food for the first 12 months. Because of these benefits, the National Health and Medical Research Council (NHMRC) set national targets recommending that 90% of infants aged up to two months should be breastfed4.

Breastfeeding patterns have changed among generations of mothers. While there is some evidence to suggest that most newborns were breastfed before the 1940s5, this level declined to about 40-50% in the early 1970s6. Since then the levels have increased.

In 1995, 78% of children aged one had been breastfed for two weeks or more, 68% had been breastfed for at least two months and 47% had been breastfed for at least six months.

How long a mother decides to breastfeed varies according to a range of factors. For example, the length of time a mother breastfeeds increases as the mother's level of education increases. Married mothers tend to breastfeed for longer periods than those who are not currently married. In addition, Indigenous mothers and older mothers tend to breastfeed their children for longer periods than non-Indigenous mothers and younger mothers.6

WHETHER CHILDREN AGED ONE YEAR WERE BREASTFED, 1995p

Children
Whether breastfed
%

Were never breastfed
12.4
Were breastfed
87.6
    Less than one week
1.9
    Two weeks or more
77.7
    Two months or more
68.1
    Six months or more
47.1
    One year or more
15.3
    Unknown duration
2.3
'000
Total
264.8

Source: 1995 National Health Survey (unpublished data).


Blood lead levels
Over the past 20 years there has been increasing community awareness about the quality of the environment and its effect on children's health. In particular, attention has focused on the effects of lead on the mental development of children aged under four years. Young children tend to have the highest blood lead levels of any age group.

Lead in petrol is a significant source of environmental lead, but deteriorating lead-based paint is considered the most dangerous source of lead exposure. Other possible sources of lead in the environment are lead in the solder of canned acidic foods, lead released from lead smelters and passively-inhaled cigarette smoke.

Government initiatives to reduce lead levels in the environment include the use of unleaded petrol in Australian vehicles purchased since 1986 and a reduction in the levels of lead in paint. Lead levels in paint have decreased from 50% prior to the 1950s, to a current level of 0.25%. This limit will be reduced to 0.1% in December 1997.

The National Health and Medical Research Council (NHMRC) in 1993, set the national target level of blood lead concentration to less than 0.49 Ámol/L (micromole per litre). They also made the reporting of levels greater than 0.72 Ámol/L notifiable to State and Territory health authorities7.

The National Survey of Lead in Children was conducted in 1995 of children aged 1-4 years. This survey found that 7% (75,500) of the children surveyed had blood lead levels greater than the target set by the NHMRC.
2% (17,500) had blood levels greater than 0.72 Ámol/L and were thus notifiable.

The mean blood lead level was higher among younger children and decreased with age. 10% of one year olds had blood lead levels of 0.49 Ámol/L or greater compared to 3% of children aged four. There was no difference between the mean blood lead levels of girls and boys.

The mean blood lead level was higher among Indigenous children aged 1-4 than other Australian children aged 1-4 (0.36 Ámol/L compared to 0.28 Ámol/L).

The lowest mean blood lead levels among children aged 1-4 were from the Australian Capital Territory (0.22 Ámol/L). This finding may, in part, be explained by the fact that many of the children in the survey lived in houses constructed after the 1970s, when paint lead concentrations were lower. However there may be other factors such as the general absence of heavy industries. The highest mean blood lead levels were from the Northern Territory (0.32 Ámol/L) and South Australia (0.30 Ámol/L).

PERCENTAGE OF CHILDREN AGED 1-4 WITH BLOOD LEAD LEVELS OF 0.49 Ámol/L OR GREATER, 1995


Source: Australian Institute of Health and Welfare, Lead in Australian children, 1996.


Sun protection
Sun exposure is a leading cause of skin damage and a major risk factor for skin cancer. Behaviours such as avoiding sun exposure in the middle of the day or using protective clothing and effective sunscreens reduce the risk of skin damage. Government and other organisations have introduced guidelines to reduce sun exposure among children. For example, many schools have introduced hats as a compulsory part of their school uniform.

In 1995, 87% of children had undertaken sun-protection measures in the month prior to interview. The most common sun-protection measure was wearing a hat (80%). This was followed by using sunscreen (64%) and wearing protective clothing (49%).

The type of sun-protection measure undertaken varied according to age. Younger children were more likely than older children to wear protective clothing, and to avoid the sun, while older children were more likely to wear sunglasses. Children aged 5-9 were most likely to take sun-protection measures (91%).

The use of sun-protection measures differed between the States and Territories. In 1995, 97% of those living in Queensland and 95% of children living in the Northern Territory used a sun-protection measure compared to 74% of those in Victoria and 83% of those in South Australia. Moreover, children living in warmer climates, such as Queensland and the Northern Territory, were more likely to use sun-protection measures all year round than children living in other States.

SUN PROTECTION MEASURES, 1995p

Age group (years)

0-4
5-9
10-14
Total
Measures(a)
%
%
%
%

No measures taken
15.6
9.5
13.3
12.8
Measures taken(b)
84.4
90.5
86.7
87.2
    Hat
76.0
87.0
76.1
79.7
    Sunscreen
61.0
67.0
63.2
63.7
    Protective clothing
52.6
51.5
44.1
49.4
    Sunglasses
16.6
20.0
23.3
19.9
    Umbrella
7.1
3.8
2.5
4.5
    Sun avoided
34.6
23.1
17.0
24.9
    Other
1.6
0.7
0.3
0.8
'000
'000
'000
'000
Total children
1,297
1,289
1,287
3,873

(a) Measures taken in the month prior to the survey interview.
(b) Components do not add to the total because more than one type of sun protection measure may have been taken.

Source: 1995 National Health Survey (unpublished data).


Endnotes
1 Australian Bureau of Statistics and Australian Institute of Health and Welfare 1997, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, cat. no. 4704.0, ABS, Canberra.

2 Australian Institute of Health and Welfare 1995, Health Differentials among Australian Children, Health Monitoring Series No. 3, AGPS, Canberra.

3 National Health Strategy, Department of Health Housing and Community Services 1992, Enough to Make You Sick: How Income and Environment Affect Health, Research Paper No. 1, National Health Strategy Unit, Melbourne.

4 National Health and Medical Research Council 1995, Dietary Guidelines for Children and Adolescents, AGPS, Canberra.

5 Lund-Adams, M. and Heywood, P. 1995, Breastfeeding in Australia, Nutrition Program, University of Queensland, Brisbane.

6 Australian Bureau of Statistics 1996, Breastfeeding in Australia, cat. no. 4394.0, ABS, Canberra.

7 National Health and Medical Research Council 1993, Report on Revision of the Australian Guidelines for Lead in Blood and Lead in Ambient Air, AGPS, Canberra.


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