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The NHPAs initiative is a collaborative approach to dealing with a range of conditions which account for 70% of the burden of disease and a high financial burden in Australia. It is overseen by the National Health Priority Action Council, which was established as a sub-committee of the Australian Health Ministers' Advisory Council (AHMAC) in June 2000, and comprises representatives of the Australian Government, each of the states and territories, a representative of Aboriginal and Torres Strait Islander peoples and a representative for consumer issues.
At present, seven NHPAs have been endorsed by the Australian Health Ministers' Conference covering cardiovascular health, cancer control, injury prevention and control, diabetes mellitus, mental health, asthma, and arthritis and musculoskeletal conditions. A range of program initiatives has been established aimed at improving health outcomes in these areas. More information on NHPAs, can be obtained from the Australian Government Department of Health and Ageing web site and other relevant web sites, the addresses of which are at the end of this chapter.
Table 9.8 shows health expenditure on the seven NHPA conditions. In total, expenditure on NHPAs in 2000-01 accounted for $21.4b, that is 44% of allocated recurrent expenditure or 35% of total health expenditure for the year. Hospital expenditure accounted for 50.6% of all expenditure on NHPAs (AIHW 2004b).
Cardiovascular disease, also known as 'circulatory disease', comprises all diseases and conditions involving the heart and blood vessels including high blood pressure, heart disease, stroke, and peripheral vascular diseases. Although the death rates from cardiovascular disease have notably decreased over the last three decades, it is still the leading cause of death in Australia (AIHW 2002). Total health expenditure attributable to cardiovascular disease is $5.4b, which accounts for 11% of allocated recurrent health system expenditure in 2000-01 (AIHW 2004b). Because its health and economic burden exceeds any other group of diseases, and because of its potential for prevention, cardiovascular disease was established as one of the original priority areas in 1996.
The 2001 NHS indicated that around 3.2 million Australians (17%) reported having a circulatory system condition as a long-term condition (having lasted or being expected to last six months or more). The most common cardiovascular condition reported was hypertension (high blood pressure) which affected 10% of the population.
The prevalence of long-term circulatory system conditions increases with age. For people aged 55 years and over, the prevalence of all circulatory system conditions is 48%. The prevalence of hypertensive disease is 34%, and ischaemic heart disease (also called coronary heart disease) is 5.8%. The prevalence of cerebrovascular disease (stroke) is 2.2%.
In 2002 over 38% (50,294) of all deaths were due to diseases of the circulatory system. Ischaemic heart disease accounted for 19.5% of all deaths, and cerebrovascular diseases a further 9.4% (table 9.4). Between 1992 and 2002, age-standardised death rates for diseases of the circulatory system declined by 36% for males (from 465 to 297 per 100,000 population), and 35% for females (from 322 to 209 per 100,000 population). In the same period age-standardised death rates for persons declined from 386 to 249 per 100,000 population (graph 9.9).
Despite declines in mortality rates in the past 30 years, cardiovascular disease (or diseases of the circulatory system) remains one of the leading causes of death in Australia in 2002, accounting for 50,294 or 38% of all deaths.
Arthritis and other musculoskeletal diseases
In July 2002, AHMAC announced arthritis and musculoskeletal conditions as a new (seventh) NHPA in recognition of the major burden these diseases place on the community. Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. Although they are not immediately life threatening and have low associated mortality, they have substantial influence on the quality of life and impose a heavy economic burden on the community. Total health expenditure attributable to musculoskeletal diseases is $4.7b, which accounts for 9.6% of allocated recurrent health system expenditure in 2000-01 (AIHW 2004b).
Osteoarthritis is one of the most common types of arthritis and affects the cartilage in the joints. Cartilage cushions the ends of bones where bones meet to form a joint. In osteoarthritis this cartilage degenerates. Osteoarthritis is most commonly found in the knees, neck, lower back, hip and fingers.
Rheumatoid arthritis is the most common form of inflammatory arthritis. Inflammatory arthritis is characterised by joint swelling and destruction. In rheumatoid arthritis the immune system attacks the tissues lining the joints. As a result of this attack, inflammation occurs causing pain, heat and swelling. The disease can also cause inflammation of connective tissue, blood vessels and organs.
Osteoporosis (porous bones) is a disease where bone density and structural quality deteriorate, leading to an increased risk of fracture. The most common sites of fracture are the bones of the spine, the hip and the wrist. However other bones are commonly affected, including the shoulder, ribs and the pelvis.
The 2001 NHS shows over 2.5 million Australians (14%) had some form of arthritis and over 299,000 Australians (1.6%) had osteoporosis. The prevalence is greater in females at nearly all ages. The overall prevalence of arthritis is 16% for females compared with 11% for males, while the prevalence of osteoporosis is 3.0% for females and 0.6% for males. The prevalence of arthritis and osteoporosis was increasingly higher for older age groups in 2001 (graph 9.10). For people aged 65 years and over, the prevalence of arthritis was 47% and the prevalence of osteoporosis was 8.0%.
Injuries and deaths due to external causes
Injury and poisoning are broad terms that encompass the adverse effects on the human body that may result from events. These events may be accidental, such as falls, vehicle accidents and exposure to chemicals, or intentional such as suicide attempts and assaults by other people. Such events, and the factors involved in them, are collectively known as 'external causes of injury and poisoning', and are a significant source of preventable illness, disability and premature death in Australia.
Males and females, and people in different age groups, experience different levels and types of risk from injury events (risk in this sense refers to both the probability of an injury event occurring and the severity of the injuries that may result).
Respondents to the 2001 NHS were asked about events in the four weeks prior to interview that resulted in an injury for which they had sought medical treatment or taken some other action. Injuries data from the survey are presented in graph 9.11 and highlight differences in the reporting of injury events among males and females of different age groups.
During the 1990s, the number of people dying as a result of injury from traffic accidents decreased. However, traffic accidents remain a serious source of preventable death, injury and disability. Results from the 2001 NHS indicate 3 in 1,000 people experienced a recent injury as a result of a vehicle accident. Inexperienced road users are an acknowledged risk group in terms of the potential for death or injury from vehicle accidents (Australian Transport Council 2001). Results from the 2001 NHS showed people aged 15-34 years experienced a higher rate of recent injury from vehicle accidents compared with people aged 35 years and over (graph 9.12).
External causes were responsible for 7,820 deaths (5.8% of all deaths) registered in 2002 (table 9.13). Since 1992 there has been a 11% decrease in the standardised death rate for deaths from external causes of injury and poisoning. This decrease has been influenced largely by the decline in deaths from motor vehicle accidents. In 2002, intentional self-harm and transport accidents accounted for 54% of all injuries reported for deaths due to external causes. There were 2,320 deaths attributed to intentional self harm (suicide) in 2002, accounting for 30% of the total deaths from external causes. Transport accidents accounted for 24% of total registered deaths in 2002 due to external causes.
Most people in Australia enjoy good mental health. However, in 2001, approximately 1.8 million people (9.6% of the population) reported having a long-term mental or behavioural problem that had lasted, or was expected to last, for six months or more. Mental illness is not a major direct cause of death, but it is associated with a proportion of deaths due to suicide and some other conditions, and can lead to chronic disability. For males, substance use disorders (from alcohol or other drugs) accounted for 33% of the mental health burden, while for females affective disorders such as depression accounted for 39% of the mental health burden (AIHW 1999). Together, mental disorders accounted for 6.1% of allocated recurrent health system expenditure.
In the 2001 NHS, information on long-term mental and behavioural problems was collected from all respondents. A long-term condition was defined as one which the respondent regarded as having lasted or was expecting to last six months or more. Respondents in the survey were not specifically asked if they had been diagnosed with any mental disorders, so the information they provided could be based on self-diagnosis rather than diagnosis by a health professional.
In 2001, 9.6% of the Australian population reported that they had a long-term mental or behavioural problem. Proportionally more females (11%) than males (8.5%) reported these problems. The most commonly reported problems for adults (aged 18 years and over) were classified into two groups: anxiety related problems and mood (affective) problems such as depression and bipolar disorder; each were reported by approximately 4% of all males and 7% of all females. In addition, around 1% of the population reported that they had a mental and behavioural disorder due to substance use (graph 9.14).
The child and adolescent component of the 1998 National Survey of Mental Health and Wellbeing studied 4,500 children and young people from metropolitan and rural areas across Australia. The results show 14% of children and young people (aged 4-17 years) had mental health problems. The specific problems most frequently identified by parents were somatic complaints (chronic physical complaints without known cause or medically verified basis) and delinquent behaviour, with 7% of children and adolescents scoring in the clinical range on each scale. The next most frequently identified problems were attention problems (6%) and aggressive behaviour (5%) (graph 9.15).
Cancer is a disease caused by abnormal cells which grow in an uncontrolled way and invade and spread to other parts of the body. Cancer can develop from most types of cells in different parts of the body, and each cancer has its own pattern of growth and spread. Some cancers remain in the body for years without showing any symptoms. Others can grow, invade and spread rapidly, and are fatal in a short period of time. Cancer is a major cause of death in Australia and accounted for 5.6% of allocated recurrent health system expenditure in 2000-01.
In the 2001 NHS, an estimated 261,300 Australians (1.4%) reported they currently had a malignant neoplasm.
The AIHW cancer registry data shows there were 85,231 registered new cancer cases in 2000. The most common registrable cancers are the combination of cancers of the colon and rectum (12,405), breast cancer (11,400), prostate cancer (10,512), melanoma (8,531) and lung cancer (8,060). Together they accounted for 60% of all registrable new cancer cases in that year. Cancer occurs more commonly in males than females. At the incidence rates prevailing in 2000, it would be expected that 1 in 3 men and 1 in 4 women would be diagnosed with a malignant cancer before the age of 75 years (AIHW 2003a).
In 2002 malignant neoplasms (cancer) accounted for 37,215 deaths (excluding deaths from non-melanocytic skin cancer), or 28% of all deaths registered (table 9.16). Of these, there were 20,771 male deaths and 16,444 female deaths. Overall, cancer of the trachea, bronchus and lung was the leading cause of cancer deaths, accounting for 20% of all cancer deaths. There were some differences in cancer death rates between males and females. Among males, the leading causes of cancer deaths were cancer of the trachea, bronchus and lung (23% of all male cancer deaths), prostate cancer (14%) and colon cancer (8%). Among females the leading causes of cancer deaths were breast cancer (16% of all female cancer deaths), cancer of the trachea, bronchus and lung (15%) and colon cancer (10%). Apart from age groups between 30 and 54 years, age-specific death rates for cancer increased markedly with age, and were generally greater for males than for females.
Mortality is influenced by the number of new cases of cancer (incidence) and the length of time lived after the initial diagnosis of cancer is made (survival). Relative survival is a measure that takes into consideration the crude survival (time between diagnosis and death) in the cancer population, and the corresponding expected survival in the general population. Expressed as a percentage, it is the cancer population that survives a specific number of years after the diagnosis divided by the general population that survives the same number of years.
In the general population during 1992-97, the expected proportion of males aged 60-69 years who survive for the next five years was 91%. The observed survival rate during 1992-97 after five years for males diagnosed with lung cancer at age 60-69 years is 11%. The five-year relative survival proportion for males diagnosed with lung cancer at age 60-69 years is the ratio of these two percentages, that is 12% (AIHW 2001).
By convention, the proportion of people surviving is measured at one, five and ten years after diagnosis. The periods reflect different stages of management during the life of a person diagnosed. For instance, the proportion of people surviving after one year can be a measure of the success of the interventions on the immediately detectable cancer, whereas five-year and ten-year measurements are strong indicators for remission or cure.
During 1992-97 the five-year relative survival proportions for all cancers for females (63%) were higher than those for males (57%) (table 9.16). Australian five-year relative survival proportions for all cancers was ranked second behind the United States of America for both males and females when compared with other Western countries for which relative survival data are available.
The article Cancer trends examines incidence of cancer, cancer mortality and relative survival ratios of persons with cancer, since the early-1980s.
Diabetes is a long-term condition characterised by high blood glucose (a type of sugar) level, which results from either the body producing little or no insulin, or the body not using the insulin properly (insulin resistance). Insulin is a hormone produced by the pancreas that helps the body cells use glucose.
There are three major types of diabetes mellitus. Type 1 diabetes is marked by extremely low levels of insulin. Type 2 diabetes is marked by reduced levels of insulin, or the inability of the body to use insulin properly. Gestational diabetes (which occurs in about 4-6% of pregnancies of women, who have not been previously diagnosed with diabetes) is not usually long-term. However, for women diagnosed with gestational diabetes, there is an increased risk of developing Type 2 diabetes later in life (AIHW 2003b).
Diabetes is a costly disease, associated with substantial morbidity and mortality, primarily from cardiovascular complications, eye and kidney diseases, and limb amputations. Total health expenditure attributable to diabetes was greater than $0.8b in 2000-01, accounting for 1.7% of allocated recurrent health system expenditure.
Results from the 2001 NHS indicate over half a million Australians (around 3%) reported having diabetes as a long-term condition. Results from the three successive National Health Surveys show diabetes is a growing health problem in Australia. The prevalence of diabetes has risen from 1.2% in 1989-90 to 2.0% in 1995, and to 2.9% in 2001.
People born in some overseas regions have a higher prevalence of diabetes than people born in Australia. This difference may be largely due to a combination of genetic, biological, behavioural and environmental risk factors. In 2001, men born in the Middle East and North Africa were 3.6 times as likely to report having diabetes as Australian-born men; women born in Southern and Eastern Europe and Central Asia were 1.5 times as likely to report diabetes as Australian-born women (AIHW 2004d).
In 2002 diabetes mellitus was the underlying cause of death in 3,329 deaths, 2.5% of all deaths registered. Of these, 1,771 deaths were males and 1,558 females. The age-standardised death rate due to diabetes was 16.6 per 100,000 persons (21 for males and 13 for females per 100,000 persons). Since 1992 there has been a 1.8% increase in the standardised death rate for deaths from diabetes.
In addition, there were a further 11,467 deaths where diabetes was listed as an associated cause. When diabetes was recorded as the underlying cause, conditions listed as associated causes included coronary heart disease (50% of cases), stroke (22%) and renal failure (15%) (AIHW 2004d).
Asthma is a chronic inflammatory disorder of the lung's air passages which makes them narrow in response to various triggers. This leads to episodes of shortness of breath and wheezing. Asthma can begin at all ages, including the very young. The disease can start as a mild chronic cough and lead to mild or severe wheezing, and sometimes even to respiratory arrest.
Although asthma has low associated mortality, people with asthma can experience reduced quality of life and require a range of health services, from general practitioner care to emergency department visits or hospital in-patient care. It is one of the most frequent reasons for hospitalisation among children aged 0-14 years (AIHW 2004d).
The management of asthma is an important public health issue because of the personal burden it places on those with asthma, often with onset in childhood, and the financial burden it places on the health system. In 2000-01 asthma accounted for $0.6b, which represented 1.2% of allocated recurrent health expenditure. Also, different from other NHPA conditions, the greatest cost of asthma is in pharmaceuticals.
The prevalence of asthma in Australia is one of the highest in the world (AIHW 2003c), with more than two million Australians (12%) reporting the disease in 2001. Asthma is more prevalent in young people than older age groups. For people under 25 years of age, the prevalence of asthma is 15%. Up to 14 years of age, asthma was more common among males than among females. In older age groups, however, asthma was more common among females than among males.
Asthma was identified as the underlying cause of 0.3% of deaths registered in Australia in 2002 (158 males and 239 females). The most recent peak in asthma deaths occurred in 1989, and standardised death rates for asthma have been declining since then (graph 9.17). Most asthma deaths occur in older age groups.
The article Living with asthma examines rates of asthma in 2001 and associated outcomes such as hospitalisation and the use of asthma medication.