4160.0 - Measuring Wellbeing: Frameworks for Australian Social Statistics, 2001  
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 12/10/2001   
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Contents >> Chapter 4: Health >> Social issues

Social issues


Over the last century in Australia, there was a substantial increase in average life expectancy. In the first half of the century this was driven by a decline in infectious diseases which resulted in a significant drop in infant mortality. In the second half of the century, reductions in death rates occurred more in older age groups, mainly due to improved treatment for, and prevention of, heart disease and associated diseases. More people are now living into old age than ever before. However, many of these people are living with degenerative diseases such as heart disease and cancer, with non-fatal conditions such as arthritis, or with disabilities such as loss of hearing and sight. As medical treatments continue to improve, and the baby boomer cohort begins to reach older age groups, issues have emerged that concern the number of people living into old age with disability, and how their quality of life can be supported. Government and community goals have begun to shift toward supporting, not only long, but healthy lives. There is concern that pressures on the families and friends of elderly or disabled family members may increase in response to government initiatives aimed at maintaining people within their community as long as possible (see also Chapter 3 - Family and community.)


Although a greater proportion of people now live into old age, many premature deaths and, in particular, many preventable deaths, still occur. These deaths are often age related. For example, young men are more prone than any other group to die in motor vehicle accidents, by suicide or by accidental drug overdose. Young children are susceptible to accidental drownings or poisonings. The fact that these premature deaths still occur, and in some areas are increasing, is of concern to governments, communities and families alike.


Response to ill-health and injury has widened over the last few decades to include active promotion of positive health behaviours and intervention to prevent or delay the onset of disease or disability. This has been largely driven by acknowledgment of the connection between certain risk factors and disease. For example, discouraging smoking has long been a focus of health policy makers, while enhancing the protective factors and reducing risk factors for mental disorders are more recent policy developments. Prevention and promotion initiatives are not only aimed at behaviours with long term health implications, but can target behaviours that have more immediate health outcomes. For example, excessive alcohol consumption is linked to long term health conditions but can also be a more immediate catalyst in relation to mental health episodes, drug use and motor vehicle accidents. Health promotion and prevention initiatives are often complemented by, or implemented through, policy decisions taken in other portfolio areas. For example, campaigns aimed at preventing accidental drownings are supported by local government legislation for child-proof fencing around swimming pools, and health benefits flow from increased taxation on cigarettes.


In order to focus health promotion and prevention efforts, the Australian Health Ministers have identified six health conditions they consider need to be addressed as a high priority. These are referred to as National Health Priority Areas (NHPAs), and are:

  • cardiovascular disease;
  • cancer;
  • injury prevention;
  • mental health;
  • diabetes mellitus; and
  • asthma.

These areas have been specifically identified as they are all major causes of death and disability; and together account for the majority of the burden of disease in Australia. Several of these conditions, namely cardiovascular disease, diabetes and certain cancers, have modifiable risk factors in common (e.g. poor diet, smoking, physical inactivity). Hence, focus on the NHPAs has identified areas where health promotion activity might have the widest benefit. Associated issues revolve around the variation in prevalence of NHPA conditions across different population groups and regions, and the effectiveness of public health campaigns relating to the NHPAs.


There is an increasing body of evidence to suggest that socioeconomic conditions can influence health status. In recent years this has become a health issue rather than simply being a sociological phenomenon. Living in poor socioeconomic conditions is often associated with lifestyle behaviours known to undermine good health, which has led governments, researchers and community groups to attempt to address the wider socioeconomic determinants of health. There is seen to be an ongoing need to address fundamental questions such as whether health differentials are narrowing or widening between particular groups in the community and how social and economic factors influence these inequalities. While Australians generally enjoy a relatively high standard of living, some groups within Australia have fewer socioeconomic resources on which to draw in times of need. Not only does this jeopardise effective recovery from disease, but it has implications for the effectiveness of health prevention measures.


The broader Australian health system provides health care services in a range of settings as well as developing and supporting promotion and prevention activities. Consumers, services providers and governments are interested in the performance of the health system and, in particular, in the performance of health services. Levels of unmet need, factors determining service usage, and reasons alternatives may be preferred, are of interest. Of equal concern is the capacity of services to deliver help to those using them and the ability of health care services to deliver appropriate care which ensures patient safety. Providing or improving access to health services for all community groups - whether that be in terms of effective education, improved transport, disability access, through ensuring services are culturally appropriate or providing language assistance - is considered important in encouraging the use of services and improving their effectiveness. The potential for improved efficiency of, and public access to, health services arising from integrating and coordinating private, community, and government health care is a recent area of interest.


The substantial financial costs associated with supporting the health system, borne by individuals and the community, is an ongoing area of public concern. Of key interest is the sustainability of the health system over the long term, particularly as the population ages and new health problems arise. Another area of interest is how cost and effectiveness goals can be appropriately balanced. For instance, immunisation is a relatively inexpensive prevention measure, which reaches a high proportion of the population. Other health treatments can be more costly, and may benefit fewer people.

Debate often surrounds the appropriate allocation of responsibility for health costs. In other words, there is a question of how these should be shared among governments, communities, private organisations, and individuals. In the context of a changing private health insurance environment, there is interest in the characteristics of people who have private health insurance, and how and why these people differ from those who do not have health insurance. Private health insurance membership may not only affect the affordability of health care and health actions, but may influence use of health services, and may be seen as an effective medium through which healthy lifestyles can be promoted.


The effective implementation of safe and healthy work practices and conditions is of general concern. Health problems caused by conditions in the workplace impact on a number of groups. For example, injured or sick workers may suffer pain and disability from workplace related injuries or illnesses, and may lose income. Employers may face costs associated with lost working days, lowered productivity, and workers insurance liability. Surrounding families, businesses and communities can also be affected. The incidence of work-related injury and disease, effective preventative measures and appropriate compensation and insurance regulation are all related areas of interest.

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