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1370.0 - Measuring Australia's Progress, 2002  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 19/06/2002   
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Contents >> The supplementary commentaries >> Health: Looking more closely

The headline indicator discusses life expectancy. This supplementary commentary examines health in more detail. It begins by considering the changing proportion of the population that are surviving to ages 50 and 70. Causes of death and the health of Australia’s Indigenous people are examined, as is infant mortality. The overall burden of disease in Australia and people’s lifestyles are also discussed.



SURVIVAL RATES

As well as considering changes in life expectancy at birth, one can also consider changes in the proportions of people surviving to a certain age. Between 1898 to 1998, the changing proportion of the population surviving to the ages of 50 and 70 increased dramatically.

In the late 1890s only about 64% of men and 68% of women lived to be 50 years old. At the end of the 1990s these figures stood at 94% and 97% respectively. The difference between the sexes was evident throughout the period. Change was even more rapid when one considers the proportion of the population living to be 70. At the end of the nineteenth century only 34% of men and less than 43% of women reached their seventieth birthday. By the end of the 1990s these figures stood at 76% and 85% respectively. Improvement was relatively steady over the period, except during the 1960s when the increase in conditions such as lung cancer and heart disease was enough to offset any improvements in survival rates, particularly among men older than 50.(FOOTNOTE 1) Since the early 1970s, the gap between men and women has closed steadily (down from over 18 percentage points in 1970 to fewer than 10 in 1998).

In 2000 death rates were higher for men than for women in all age groups. Women are thought to have a genetic advantage which makes them more resistant to a range of conditions.(FOOTNOTE 2) The remaining differences are attributed to different behavioural and lifestyle patterns of men and women. Women, for example, are less likely to be overweight or to smoke (although the proportions of women smoking, particularly young women, are still increasing, whereas they have been declining for men for some years).(FOOTNOTE 3) Men are more often involved in hazardous occupations than women, while younger men in particular are more prone to risk-taking, and have higher death rates because of accidents.


Proportion of people surviving to age 50
Graph - Proportion of people surviving to age 50

Proportion of people surviving to age 70
Graph - Proportion of people surviving to age 70





CAUSES OF DEATH

Causes of death are, of course, strongly linked to a person's age. Among people aged 1-44, transport accidents and suicide were the leading causes of death, with death rates from these causes much higher for men than for women. Among people older than 44 years, cancer and heart disease were the leading causes of death, with men again more at risk than women from these conditions.

Advances in medical technology, public health measures, including earlier detection of some illnesses, and healthier lifestyles, have contributed to declines in death rates from most of the leading causes of death. Between 1990 and 2000, death rates from cancer declined by 11% for men and 9% for women, and from heart disease they declined by 40% for men and 39% for women.

LEADING CAUSES OF DEATH - 2000

Male to
female
Males
Females
ratio
Cause of death
rate(a)
rate(a)

Malignant neoplasms (cancers)
212
128
1.7
Ischaemic heart disease
150
84
2
Cerebrovascular diseases (e.g. strokes)
54
48
1.1
Chronic lower respiratory diseases
38
19
2.0
Accidents
35
16
2

(a) Standardised death rate per 100,000 population.
Source: Deaths Australia, 2000.(SEE FOOTNOTE 4)


INFANT MORTALITY

The decline in infant mortality has been one of the prime drivers in increased life expectancy during the twentieth century, particularly its first half. For every thousand babies born in 1901, over 100 would die before their first birthday. By 2000 this figure was around five babies per thousand. Infant mortality declined particularly quickly in the first half of the twentieth century (to around 28 deaths per 1,000 live births at the end of World War II). Clearly, the risk of death in the first year of life had a large impact on overall life expectancy: male life expectancy at birth in 1901-1910 was around 55 years, but was 60 years for those reaching their first birthday.

Infant mortality rate(a)
Graph - Infant mortality rate(a)



ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES

The commentary for the headline indicator described the 20 year gap between life expectancy of Australia’s Aboriginal and Torres Strait Islander peoples and that of the general population. Indigenous death rates in 2000 were more than double those of the non-Indigenous population.(SEE FOOTNOTE 4)

A number of factors help to explain why Indigenous Australians suffer poorer health than other Australians. In general, more Indigenous Australians experience disadvantages such as poor education, unemployment, and inadequate housing and infrastructure. Indigenous Australians also smoke more;(FOOTNOTE 3) and while many are less likely to drink alcohol that other Australians, those who do are likely to consume it at hazardous levels.(FOOTNOTE 5) Indigenous Australians have high rates of infectious disease, obesity, diabetes, heart disease, kidney disease and cancer. They also experience high rates of injury and death from accidents and violence.(SEE FOOTNOTE 4)

Indigenous infant mortality declined during the 1990s,(FOOTNOTE 3) as did infant mortality for the general population. The Indigenous rate, estimated at around 14 deaths per 1,000 live births in 2000,(SEE FOOTNOTE 4) is close to three times that of the general population (five deaths per 1,000 live births), and is similar to the level experienced by the non-Indigenous population in the mid 1970s.(FOOTNOTE 3)


THE BURDEN OF DISEASE

Summary measures that combine information on mortality, disability and other non-fatal health outcomes give a more complete view of the health of the population than life expectancy alone. The most comprehensive measure in Australia has been developed by the Australian Institute of Health and Welfare (AIHW) and is known as the Disability Adjusted Life Year (DALY). It is a measure that combines information about the years of healthy life lost due either to premature mortality (relative to a standard life expectancy) and to years lived with a disability (here disability means any departure from full health, and includes conditions that range from the common cold to quadriplegia).(FOOTNOTE 6)

The Australian burden of disease can be quantified by DALYs. In 1996 cardiovascular diseases and cancer were responsible for the loss of 547,000 and 478,000 years of healthy life, respectively. Over 85% of these years were lost due to premature mortality rather than time spent living with a disability. In contrast, almost 95% of the 338,000 years of healthy life lost to mental illness were due to years lived with a disability.


Burden of disease(a), Australia - 1996

Years of
Disability
Years of
life with
adjusted
life lost
disability
life years
Major disease group,
health condition or
injury
‘000
‘000
‘000

Cardiovascular
447
100
547
Cancer
400
79
478
Mental illness
18
320
338
Nervous system
48
177
225
Injury
152
58
210
Chronic respiratory
76
104
180
Musculoskeletal
7
82
89
Digestive
41
36
77
Diabetes
31
45
77

(a) For nine major disease groups, health conditions or injury.
Source: Australian Institute of Health and Welfare 1999, Burden of Disease and Injury in Australia.(FOOTNOTE 6)


LIFESTYLES AND HEALTH

People’s lifestyles can have a major impact on their health. In 1998 the use of tobacco, alcohol and other (illicit) drugs was estimated to have caused about 25% (7,000) of the deaths of Australians under 65 years old. Deaths related to alcohol (which include alcohol-related road injuries) accounted for over 2,000 of these deaths, smoking about 4,200 and illicit drug use almost 1,000 deaths. Over 5,600 of the 7,000 deaths were of men. In 1996, a similar number of people died before 65 from causes attributable to alcohol and tobacco. But the number of illicit drug deaths increased by a third over the period.

Smoking is recognised as the single most preventable cause of death in Australia. There was little change in the proportion of people who smoked regularly (every day or most days) from 1991 (23%) to 1998 (22%).(FOOTNOTE 7) However, the proportion of adults claiming never to have smoked rose from 23% to 34% over the period.

Exercise can benefit both physical and mental health. Physical inactivity is believed to be responsible for about 7% of the total burden of disease in Australia.(FOOTNOTE 6) The proportions of people undertaking sufficient physical activity (which AIHW defines as at least 150 minutes a week of walking, moderate activity or vigorous activity (weighted by two)) varied according to age and educational attainment in 1999. Only 50% of those aged 45-59 took sufficient exercise, compared to almost 69% of 18-29 year olds. Data for the period 1989-90 to 1995 suggest a small increase in the proportion of adults engaged in physical activity. (FOOTNOTE 3)

Being overweight is closely related to lack of exercise and diet. Between 1980 and 1995 the proportions of overweight and obese Australians aged 25-64 in capital cities and urban areas increased from 27% to 43% for women and 48% to 63% for men. In 1996 some 56% of Australians over the age of 18 were overweight or obese. In 1996 problems associated with being overweight or obese accounted for 4% of the total burden of disease in Australia.

Unless otherwise noted, all data are cited in The National Health Performance Framework Report.(FOOTNOTE 7)


MENTAL HEALTH

Although there is no time series to assess progress in the incidence of mental health, there are data from 1997 when the ABS conducted a survey of Australians' mental health, as part of the National Mental Health Strategy. (FOOTNOTE 8) The survey found that over 18% of all Australian adults had experienced a mental disorder during the preceding year.

The prevalence of mental disorder was similar for men and women, but there were differences in the types of disorder suffered: 12% of women and 7% of men had anxiety disorders, while 7% of women and 4% of men had affective disorders (which include depression). Some 11% of men and 4% of women had substance use disorders (such as drug or alcohol dependence).


DISABILITY-FREE LIFE EXPECTANCY

The data for burden of disease have been produced only for 1996. A simpler measure, which combines information on mortality and disability, is available over a long time period. This measure describes the average number of years for which a person might expect to live free from disability, and can be contrasted with the life expectancy measure to indicate the average years of life that a person could expect to live with a disability.

In 1988, disability-free life expectancy at birth was about 58 years for men and 63 years for women. Despite improvements in overall life expectancy over the following decade (by almost three years for men and two years for women, between 1988 and 1998) disability-free life expectancy at birth did not show any signs of improvement, remaining close to the levels recorded in 1988. It therefore appears that recent improvements in life expectancy have not been accompanied by similar improvements in reducing the burden of disability. This assessment is affected by a number of factors, including the increased identification of people with disabilities.(FOOTNOTE 3)


FOOTNOTES

1 Mathers, C. and Douglas, B. 1997, "Measuring Progress - is life getting better", in Measuring Progress (p.131), CSIRO Publishing, Melbourne.

2 Smith, D.W.E. and Warner, H.R. 1990, "Overview of biomedical perspectives: possible relationships between genes on the sex chromosomes and longevity", in Gender, Health and Longevity: a Multidisciplinary Perspective, (eds Ory, G.M. and Warner, H.R.), Springer Publishing, New York.

3 de Looper, M. and Bhatia, K. 2001, Australian Health Trends 2001, AIHW Cat. no. PHE 24, AIHW, Canberra.

4 Australian Bureau of Statistics 2001, Deaths Australia, 2000, Cat. no. 3302.0, ABS, Canberra.

5 Australian Bureau of Statistics and Australian Institute of Health and Welfare 1999, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander People, Cat. no. 4704.0, ABS, Canberra.

6 Mathers, C., Vos, T. and Stevenson, C. 1999, The burden of disease and injury in Australia, AIHW Cat. no. PHE 17, AIHW, Canberra.

7 National Health Performance Committee 2001, National Health Performance Framework Report, Queensland Health, Brisbane.

8 The Survey of Mental Health and Wellbeing of Adults 1997 was funded as part of the National Mental Health Strategy.

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