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1370.0 - Measures of Australia's Progress, 2004  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 21/04/2004   
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Contents >> The measures >> Health

Key points

Life expectancy at birth

Graph - Life expectancy at birth


The relationship of health to progressPeople hope to have a long life, free from pain, illness or disability. Good health for all brings social and economic benefits to individuals, their families and the wider community.

About the headline indicator and its limitations: Life expectancy at birthLife expectancy at birth is a measure of how long someone born in a particular year might expect to live if mortality patterns for that year remained unchanged over their lifetime. Life expectancy at birth is one of the most widely used indicators of population health. It focuses on the length of life rather than its quality, but it usefully summarises the health of the population.

Health: Other indicators of progressThe proportion of people surviving to ages 25, 50 and 75; infant mortality rates; burden of disease; avoidable deaths; incidence of heart attacks and all cancers.

Some differences within AustraliaAlthough Australians are now among the longest-lived people in the world, substantial differences remain among certain parts of the population; Indigenous Australians in particular have much lower life expectancy than other Australians.

Links to other dimensionsImprovements in health may assist progress in other areas and vice versa. See also the commentaries National income, The human environment, Work, and Financial hardship.


Progress and the headline indicator

People hope to have a long life, free from pain, illness or disability. Good health for all brings social and economic benefits to individuals, their families and the wider community.

An indicator describing how long Australians live while simultaneously taking into account the full burden of illness and disability, would be a desirable summary measure of progress. But although such indicators have been developed they are not available as a time series (discussed later in this commentary). Life expectancy at birth is one of the most widely used indicators of population health. It focuses on length of life rather than its quality, but it usefully summarises the health of the population.

Australian life expectancy improved during the past ten years. A boy born in 2001 could expect to live to be over 77, while a girl could expect to reach nearly 83 - increases since 1991 of three and two years respectively.

A longer term view

Increases in life expectancy occurred over most of the twentieth century, and resulted in an increase of 20 years of life for both men and women. Much of the improvement in the first part of the century was because of a decline in deaths from infectious diseases. This was associated with improvements in living conditions, such as cleaner water, better sewerage systems and improved housing, coupled with rising incomes and improved public health care, including initiatives like mass immunisation.1 These changes were particularly beneficial to infants, women who were pregnant or in childbirth, and older people; official statistics show that rapid declines in deaths among infants were the main reason that life expectancy increased in the first half of the century.2 Increases in life expectancy slowed in the middle of the twentieth century, and then plateaued in the 1960s, largely because of increases in cardiovascular disease.1

Substantial improvements in the life expectancy of older people have been a feature of the second half of the twentieth century, particularly since the 1970s. Between 1982 and 2001, life expectancy at age 70 increased by about three years for men and two and a half years for women. Life expectancy at birth over the same period increased by six years for men and just over four years for women.

Progress has been associated with a decline in deaths from chronic diseases, such as heart disease, cancer and strokes (these have replaced infectious diseases as the main causes of death). Greater attention to living healthier lifestyles, continued improvements in living standards, together with ongoing medical advances, including improvement in illness prevention, screening and diagnosis and treatment, have supported this transition.


Life expectancy at birth: longer term view

Graph - Life expectancy at birth: longer term view

Proportion of people surviving to age 25

Graph - Proportion of people surviving to age 25

Proportion of people surviving to age 50

Graph - Proportion of people surviving to age 50
Proportion of people surviving to age 75

Graph - Proportion of people surviving to age 75


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 25, 50 and 75 increased dramatically.

At the start of the last century, 81% of men and 83% of women lived to be 25 years old. By 2001 these figures stood at 98% and 99% respectively. Over the same period the proportion of people surviving to age 50 increased from 66% and 70% to 94% and 97%, for men and women 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 75. In 1901 less than 25% of men and 33% of women reached their seventy-fifth birthday. By 2001 these figures stood at 67% and 80% respectively. Improvement was relatively steady over the period, except during the 1960s when the increase in some conditions, including heart disease, was enough to offset any improvements in survival rates, particularly among men older than 50.1 Since the early 1970s, the gap between men and women has closed steadily (down from over 21 percentage points in 1970 to about 12 in 2001).

Some differences within Australia

Despite continued improvement in the population's health, there are significant disparities between different groups.

Life expectancy at birth varied between the states and territories. In 2001 it was highest in the ACT for both men (79.2 years) and women (83.3 years) and lowest in the NT for both men (71.3 years) and women (76.7 years).

Men and Women

Women tend to live longer than men, and this is reflected in the differences in life expectancy throughout the twentieth century. But in recent years life expectancy at birth for men increased more quickly than for women, although a girl born in 2001 could still expect to live more than five years longer than a boy. There are a number of reasons why women live longer than men.

In 2002 death rates were higher for men than for women in all age groups. Women are thought to have a possible genetic advantage which makes them more resistant to a range of conditions.3

The remaining differences are attributed to different behavioural, lifestyle and working patterns of men and women. Women, for example, are less likely to be overweight or to smoke.4 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.

International comparisons
The World Health Organisation ranks Australian life expectancy among the highest in the world.5 Total life expectancy (men and women combined) in Australia is 80.4 years, close to Switzerland, San Marino and Sweden. It falls below Japan (81.9 years), and Monaco (81.2 years), but is above countries such as Canada (79.8 years),France and Italy (both 79.7 years), New Zealand (78.9 years), the United Kingdom (78.2 years) and the United States of America (77.3 years).

Aboriginal and Torres Strait Islander Peoples

The health of many Aboriginal and Torres Strait Islander people is poor. It is difficult to assess national trends in Indigenous life expectancy because many of the historical data are of poor quality.6 What is known is that Indigenous Australians do not live as long, and that the difference is marked.

Information on Indigenous death rates in 1999-2001 are available for people living in Queensland, Western Australia, South Australia and the Northern Territory combined. Their death rates were higher than for the total population in all age groups. The largest differences were between men and women aged 35-54 (where Indigenous deaths rates were about five times higher than those of all people). In all other age groups, other than those older than 75, the Indigenous death rate was at least double that of the total population.7

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 are more likely to smoke;4 and while several studies have shown that they are less likely to drink alcohol than other Australians, those who do are likely to consume it at hazardous levels.7 The Indigenous 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.7

Indigenous infant mortality (in Queensland, Western Australia, South Australia and the Northern Territory combined) was higher than the total infant mortality rate between 1999-2001. Indigenous infant mortality was estimated at between 16 deaths per thousand births. This is 2.6 times the rate among the total population (six deaths per 1,000 live births)7, and is similar to the level experienced by the non-Indigenous population in the mid-1970s.

Older people

ABS population projections indicate that the proportion of the population aged 65 years or more will rise. This has prompted concerns about future health care costs.

Older people are much more likely to experience ill health and disability. In 2002 just over 4% of 18-24 year-olds reported a core activity limitation, compared to nearly 36% of people aged 75 or more.8

And while Australians are living longer than ever before, there are concerns about whether the general health of older people (whether or not they are afflicted by disabilities or chronic illnesses associated with ageing) is also improving. Recent evidence is not conclusive, but it appears the length of time both men and women are living without a disability is not increasing, even though life expectancies for both are increasing.9

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).10 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.

More recent data from the World Health Organisation (WHO) quantifies the non-fatal burden of disease.5 The WHO estimates healthy life expectancy in Australia was about 71.6 years in 2001, and that a boy born in 2001 can expect to spend seven years in his life with a disease or disability, while a girl can expect to spend over nine years.



BURDEN OF DISEASE(a), AUSTRALIA - 1996

Years of
life lost
Years of
life with
disability
Disability
adjusted
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.11


Infant mortality rate per 1,000 births

Graph - Infant mortality rate per 1,000 births



Infant mortality
The decline in infant mortality was 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 2002 this figure was around five babies per thousand, a reduction of 29% since 1992, when 7 babies per 1,000 died. In 2002, 36% of all infant deaths occurred within the first day of birth with a further 32% occurring before the baby reached four weeks.

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.

Factors influencing change

Historical studies of health improvement, as well as comparisons of health between developing and developed countries, provide ample evidence that many factors have helped to improve health. In developed countries, improvements in nutrition, sanitation, water supplies, hygiene, and living and working conditions, brought major improvements in health and life expectancy, particularly before the 1950s. Advances in medical technology have also been important, especially in the past 50 years. These advances have been supported by further improvements in lifestyle such as better diet.

There is a good deal of debate about whether life expectancy will continue to increase, and there are two opposing schools of thought. Some analysts believe that there is a biological limit to an average life of around 85 years which has nearly been reached; others believe that life expectancy will continue to increase as a result of further medical advances and better lifestyles.1 There is no doubt that there is more room for improvement among some groups of the population than among others.


LEADING CAUSES OF DEATH - 2002

Males
Females
Male to female
rate(a)
rate(a)
ratio

Malignant neoplasms (cancers)
241
150
1.6
Ischaemic heart disease
170
98
2
Cerebrovascular diseases (e.g. strokes)
64
60
1.1
Chronic lower respiratory diseases
44
23
1.9
Accidents
34
16
2

(a) Standardised death rate per 100,000 population.
Source: Deaths, Australia, 2003, cat. no. 3302.0.

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 1992 and 2002, death rates from cancer declined by 13% for men and over 6% for women, and death rates from heart disease declined by over 40% for men and women.

Medical experts classify deaths as avoidable and unavoidable. A potentially avoidable death is one that, theoretically, could have been avoided given current understanding of causation, and available disease prevention and health care.

One example of this is colorectal cancer, which is potentially avoidable by:

  • primary prevention (through diet and exercise)
  • secondary prevention (through early detection)
  • tertiary prevention (through effective surgery, chemotherapy and radiotherapy).

Conversely an example of a death which is not potentially avoidable is one from dementia, where no substantial gains are available through either primary, secondary or tertiary prevention with current medical technology.12

Between 1991 and 2001 the overall death rate decreased by 16% for the general population. Most of the fall was in potentially avoidable deaths, which declined by one-third (the unavoidable death rate fell by 11%). Men had a higher rate of potentially avoidable mortality than women, reflecting their higher rates of heart disease, and higher rates of death from injuries and accidents (mainly motor vehicle accidents and suicide).

Avoidable Deaths(a)

Graph - Avoidable Deaths(a)


Incidence and treatment of cancer and heart diseases

In 2002 cancers were the leading cause of death accounting for 28% of all deaths. Heart diseases were the second leading cause of death, contributing nearly 26% of all deaths.13 Death rates from cancer and heart disease depend in part on prevention which reduces the incidence of these diseases, and in part on how successful their treatment is.

Between 1990 and 2000 the incidence rate for all cancers (other than non-melanoma skin cancers) among men and women rose by an average of 0.5%. Over the same period, death rates from cancers fell by about 1% for both sexes.14

A significant proportion of the rise in the female incidence rate can be attributed to increases in reported breast cancer which in turn is linked to better detection of cancers by breast screening programs. Lung cancer among women is also still increasing. The rise and then fall in the male cancer rate over the period is linked to the rise and fall in reported prostate cancer.14

From 1982-1986 to 1992-1997 the percentage of cancer patients surviving 5 years or longer increased from 44% to 57% for men, and 55% to 63% for women.14

Incidence rates for all cancers(a)

Graph - Incidence rates for all cancers(a)


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 age 65 from causes attributable to alcohol and tobacco. But the number of illicit drug deaths increased by one-third over the period.

Smoking is recognised as the single most preventable cause of death in Australia. The proportion of adults who smoked stood at 24% in 2001, down from 25% in 1995 and 28% in 1989.15 A similar proportion of men in most age groups smoked in both 1995 and 2001, but there was a 5% decline among men aged 65-74. Between 1995 and 2001, changes in the proportion of women who smoked varied by age group: from four percentage points lower for those aged 18-24 to four percentage points higher for those aged 35-44.15 Smoking is more common among Aboriginal and Torres Strait Islander peoples:49% of them were daily smokers compared with 22% of non-Indigenous Australians.16

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.11 In the 2001 National Health Survey, about 70% of people reported exercising for recreation, sport or fitness in the previous two weeks. The survey also asked about the frequency, type and duration of exercise to assess people’s overall level of exercise. About two-thirds of men and three-quarters of women were assessed as having a low level of exercise or being sedentary. Results from surveys in 1989 and 1995 suggest that relatively more people are exercising now, although the rise is small: the proportions recording a sedentary response fell from 37% in 1989-90 to 32% in 2001.15

Being overweight is closely related to lack of exercise and diet. And being overweight or obese increases the risk of suffering from a range of conditions, including coronary heart disease, type 2 diabetes and some cancers. In 1996 problems associated with being overweight or obese accounted for 4% of the total burden of disease in Australia.11 Between 1989 and 2001 the proportions of overweight and obese Australian adults in capital cities and urban areas increased from 32% to 42% for women and from 46% to 58% for men.15 In 2001, 61% of Aboriginal and Torres Strait Islander peoples were overweight or obese, compared with 48% of non-Indigenous Australians.16

Adequate levels of fruit and vegetable consumption is associated with a reduced risk of coronary heart disease, stroke and several major cancers. The National Health Medical Research Council recommends that adults eat at least two serves of fruit and five serves of vegetables each day.17 Overall, almost half (47%) of Australians aged 12 and over reported a daily fruit and vegetable intake of one serve or less, and 70% reported an intake of three serves or less. People were more likely to eat inadequate amounts of vegetables rather than fruit. And inadequate intakes were more common among men than women, and among 18-24 year-olds than other age groups.18

Many people’s lifestyles involve a combination of health risk factors. In 2001, only 11% of men and 13% of women reported none of the four risk factors: smoking, high alcohol consumption, overweight/obese and low exercise levels.15

Incidence rates for heart attacks (a)

Graph - Incidence rates for heart attacks (a)


Between 1993-94 and 2000-01 the incidence of heart attacks fell by 22% for men and 23% for women. The reduction in the rate of first ever heart attacks is attributed to reduced risk factors among Australians, such as smoking, high blood pressure and poor nutrition.

The reduction in the rate of heart attacks for those who have already had one is attributed to better treatment of heart disease, be it changes to health behaviour, pharmaceutical treatment or surgery. Over the same period the proportion of heart attacks that lead to death declined from 35% to 30%.

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.19 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).

In 2001 the ABS National Health Survey included questions - the K10 questions - covering people’s feelings of distress (anxiety, depression and worry) over the preceding four weeks. Questions were also asked in the 1997 Survey of Mental Health and Wellbeing.

In 1997, a little over 8% of adults reported a high or very high level of psychological distress. In 2001, the figure stood at a little under 13%. The 2001 survey found that more women (15%) than men (10%) reported a high or very high level of psychological distress. More than 60% of those reporting very high distress levels were women. The rates varied with age among women, with the highest proportion of women reporting high or very high stress aged 18-24 (22%). The rate declined with age thereafter. The proportion of men reporting high or very high levels of distress remained at around 10% up to age 64 and then declined in older age groups.

Links to other dimensions of progress

Improvements in health may assist progress in other areas and vice versa.

For instance, a healthy population stimulates economic growth: with fewer sick people to care for, more money is available for other things. While a larger pool of healthy people means a greater supply of labour for the workforce. Australian business benefits too from a healthy workforce taking fewer days off sick. Conversely the growth of the economy can help to provide funds, either to governments or individuals, to pay for better prevention programs, hospitals and health care, and to maintain suitable sanitation and housing services. Moreover, the health industry is a very significant employer and health spending accounted for about 28% of total government expenditure, and over 5% of household expenditure in 2003.20.500.

Various types of economic activity also affect human health. The burning of fossil fuels, for example, is linked to types of air pollution and a variety of health concerns. The changing make-up of the Australian economy is having an effect too: a shift to more office-based work with proportionally fewer people employed in more dangerous occupations like mining has helped,21 along with other factors, to reduce the incidence of fatal accidents at work, although more sedentary occupations have some adverse health effects.

A substantial body of evidence shows that lower socioeconomic status and less education contributes to poorer health. Likewise, poor health, particularly in childhood, can impair education and thus affect socioeconomic position in later life.22

See also the commentaries National income, The human environment, Work, and Financial hardship.

Endnotes

1 Mathers, C. and Douglas, B. 1997, 'Measuring Progress: is life getting better', in Measuring Progress, CSIRO Publishing, Melbourne.

2 Australian Bureau of Statistics 1995, 'Life expectancy trends', in Australian Social Trends 1995, cat. no. 4102.0, ABS, Canberra.

3 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.

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

5 World Health Organisation, 2003, The World Health report 2003, WHO, Geneva.

6 Previously published ABS experimental estimates of Indigenous life expectancy need to be interpreted with caution when used as measures of Indigenous mortality. While the life expectancy estimates may have been appropriate in the mid-1990s for the purposes of producing experimental Indigenous population estimates and projections, over precise analysis of those life expectancy estimates per se should be avoided. Both the methodologies that may be used in future in the construction of Indigenous life tables, and the more recent data available for use in their construction, are currently under review. Revised estimates are likely to confirm that Indigenous Australians do not generally live as long as the rest of the population, and that the differential remains significant.

7 Australian Bureau of Statistics and Australian Institute of Health and Welfare 2003, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, cat. no. 4704.0, ABS, Canberra.

8 Australian Bureau of Statistics 2003, General Social Survey, Summary of Results, 2002, cat. no. 4159.0, ABS, Canberra.

9 Australian Bureau of Statistics 2003, 'Health - National Summary Tables', in Australian Social Trends 2003, cat. no. 4102.0, ABS, Canberra.

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

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

12 New Zealand Ministry of Health 1999, Our Health, Our Future - Hauora Pakari, Koiora Roa - The Health of New Zealanders, Ministry of Health, Wellington

13 Australian Bureau of Statistics 2003, Deaths, Australia, 2002, cat. no. 3302.0, ABS, Canberra.

14 Australian Institute of Health and Welfare (AIHW) & Australasian Association of Cancer Registries (AACR) 2003, Cancer in Australia 2000, AIHW cat. no. 23. AIHW, Canberra.

15 Australian Bureau of Statistics 2002, National Health Survey, 2001, cat. no. 4364.0, ABS, Canberra.

16 Australian Bureau of Statistics 2002, National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001, cat. no. 4715.0, ABS, Canberra.

17 National Health and Medical Research Council 2003, Dietary Guidelines for Australian Adults, NHMRC, Commonwealth of Australia, Canberra.

18 Australian Bureau of Statistics 2004, National Health Risk Factors, Australia, 2001, cat. no. 4812.0, ABS, Canberra.

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

20 Australian Bureau of Statistics 2003, Australian System of National Accounts 2002-03, cat. no. 5204.0, ABS, Canberra.

21 National Occupation Health and Safety Commission 1994, Work-related Traumatic Fatalities in Australia 1989-92, NOHSC, Canberra.

22 Mathers, C. 1994, Health Differentials among adult Australians aged 25-64 years, AIHW: Health Monitoring Series No. 1, AGPS, Canberra.

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