Australia is generally a healthy nation compared with similar countries, but there is room for improvement, according to the Australian Institute of Health and Welfare’s (AIHW) two-yearly health report card, Australia’s health 2022, released today.
The report provides a holistic view of the health of Australians, and explores topical health issues including factors that influence our health, mental health, and changes to mortality over the past century.
Australians are living longer, but suffer chronic and age-related illnesses, and two-thirds of Australians are fat, leading to preventable diseases. Heart disease remains the biggest killer for both men and women. Poorer Australians and those with disabilities have worse health.
The report also examines how the pandemic changed the health of Australians.
COVID-19 worsened Australians’ life satisfaction and stress, which have yet to return to pre-pandemic levels. Poorer Australians, those born overseas, and Aboriginal and Torres Strait Islander people were more likely to die from COVID-19 than other Australians.
“Today’s report comes at an important time as Australians continue to experience the effects of the COVID-19 pandemic,” said Matthew James, the AIHW’s Deputy Chief Executive Officer.
“In 2022, no health issue stands above, or has had as wide-reaching impacts on our population and health system, with these affects to be felt for many years to come.”
The AIHW publishes Australia’s health every two years, and Australia’s welfare in alternate years.
Doing well, but room for improvement
Australians are living longer – life expectancy at birth was 83.0 years in 2020, the sixth highest among the 38 OECD (Organisation for Economic Co-operation and Development) countries.
Males born in 2018–2020 can expect to live 81.2 years and females 85.3 years, up from 55.2 and 58.8 years, respectively, for those born in 1901–1910.
Over the last 100 years, Mr James said, the age-standardised death rate from infectious diseases (such as tuberculosis, polio, and diphtheria) has declined by 98 per cent, due to childhood immunisation and disease control measures.
In the first decade of the 20th century, one in 10 children died before their fifth birthday (26 per cent of all deaths, compared with 0.7 per cent in 2020), primarily from infectious diseases.
But today’s longer living population now experiences higher rates of chronic and age-related conditions, such as dementia, Mr. James said.
For example, older Australians use a higher proportion of hospital and other health services, and 54 per cent of all subsidised medicines were dispensed to people aged 65 and over.
Despite the number of Australians experiencing chronic health conditions, Mr James said there were marked improvements in many areas of health, including cancer survival, infant mortality, and deaths from coronary heart disease.
In 2020–21, almost half (47 per cent, or 11.6 million) of Australians have one or more common chronic health conditions (including diabetes, cancer, mental and behavioural conditions, and chronic kidney disease).
Headline statistics from the 2021 Census released last week included data on long-term health conditions, such as mental health, arthritis, and diabetes, for the first time. Further analysis will inform local health policy and health service planning.
More than one-third (38 per cent) of Australia’s ‘disease burden’ is due to preventable risk factors, such as smoking, excessive alcohol consumption, and not getting enough exercise.
Our expanding waistlines are a notable example: two in three adults (67 per cent) are either overweight or obese, while carrying excess weight is responsible for 8.4 per cent of our total disease burden.
The coronary heart disease death rate steadily increased throughout the first half of the 20th century, but has fallen by 89 per cent since 1968 (from 428 deaths per 100,000 to 49 per 100,000 in 2020). Coronary heart disease remains the leading single cause of death for males, and the second leading for females.
Seven in 10 (70 per cent) people survived at least five years after a cancer diagnosis during 2014–2018 – an improvement from about five in 10 (52 per cent) in 1989–1993.
However, some population groups are more likely to be healthy than others.
Generally, the higher a person’s socioeconomic position, the better their health. If all Australians had experienced the same disease burden as people living in the highest socioeconomic areas in 2018, the total burden could have been reduced by one-fifth (21 per cent).
In May 2021, almost three in 10 adults with disability self-reported their physical health as excellent or very good, compared with 55 per cent of adults without disability.
The AIHW aims to improve the evidence base that supports improved health and wellbeing for all Australians, Mr James said. Australia’s health 2022 describes insights gleaned from the first large-scale study in Australia to analyse health service costs in the last year of a person’s life.
Although just 0.7 per cent of the Australian population die each year, 8 per cent of the health expenditure in scope was for people in their final year of life. The outlay for hospitalisations was 39 times as high for people in their last year of life compared with those not in their last year.
Changes in the health of Australians during the COVID-19 period
“Since the emergence of COVID-19 in Australia, there has been extraordinary public interest in the health of Australians, including the efforts made and measures put in place to protect our collective health,” Mr James said.
The pandemic has affected, or could affect, the health of Australians in numerous ways.
Throughout 2020 and most of 2021, Australia fared better than most countries – but while Australia has world-leading vaccination rates for two doses, millions of Australians who contracted COVID-19 have been acutely ill, and some still suffer long-COVID.
Longer-term health effects remain unknown, Mr James said, and these population health impacts must be monitored.
According to ANUPoll surveys, since April 2020, fluctuations in Australian adults’ psychological distress and life satisfaction have tracked developments throughout the pandemic, including the introduction and easing of restrictions to limit the spread of COVID-19.
- Life satisfaction in the ACT has declined since the pandemic (September 2021)
For people aged 18 to 44, average levels of psychological distress were higher in 2020, 2021, and 2022 (up to April) than they were before the pandemic, especially for those aged 18–24. However, those aged 45 and above experienced either little change or improvements in their level of psychological distress.
Average life satisfaction for Australians fell substantially during the early stages of the pandemic (from 6.9 out of 10 in January 2020 to 6.5 in April 2020). By January 2021, the average level of life satisfaction had returned to pre-pandemic levels, and this remained the case in April 2021. However, in August 2021, life satisfaction was back to the to the same level as April 2020. As of April 2022, life satisfaction is yet to return to pre-pandemic levels.
At the onset of the pandemic, there were concerns that any economic downturn could increase the number of suicides in Australia. However, data from suicide registers shows that, despite a rise in the use of mental health services and an increase in psychological distress, COVID-19 has not been associated with a rise in suspected deaths by suicide, Mr. James said.
One way to understand the impact of the COVID-19 pandemic is to measure excess mortality: the difference between the actual number of deaths compared with the expected number based on previous trends. This measure includes both COVID-19 and non-COVID-19 deaths, reflecting both the direct and indirect impact of the pandemic.
Death rates were decreasing before the onset of the pandemic, and this trend continued in 2020 and 2021. There were 205 fewer deaths than expected in 2020, and 94 more deaths than expected in 2021.
However, there were 3,105 more deaths than expected in January and February 2022.
For deaths registered by 30 April, those living in the lowest socioeconomic area were nearly three times as likely to die from COVID-19 than those in the highest socioeconomic area, and people born overseas 2.5 times more likely to die from COVID-19 than people born in Australia. Of those born overseas, the death rate was highest for people born in North Africa and the Middle East.
Aboriginal and Torres Strait Islander people faced rates of severe disease from COVID-19 (ICU admission and/or death) seven times higher than the Australian population overall.
The AIHW will investigate the medium and longer-term health effects and health system use among all population groups, Mr. James said.
The AIHW will establish a national COVID-19 linked data set that will bring together COVID-19 cases collected in state and territory notification systems and health data sets, including deaths, hospitals, aged care, immunisation, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data.
This will be used for research into the health effects of COVID-19, health service planning, monitoring and evaluation, and health policy development both nationally and in the states and territories.
