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Prevalence of Big Five Chronic Diseases

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Prevalence of Other Health Risks

Health risks

• Tobacco smoking offers the greatest scope for prevention, closely followed by high blood pressure and overweight/obesity.
• Australia's level of smoking continues to fall and is among the lowest for OECD countries.
• Illicit drug use in Australia is generally declining, including the use of methamphetamine (the drug group that includes "ice").
• The vaccination coverage of children is very high and continues to increase.
• Unsafe sexual practices continue, with generally increasing rates of sexually transmitted infections.
• About 7.4 million Australian adults were overweight in 2004-05, with over a third of those being obese (based on self reports).

Population groups

Mothers and babies

• Caesarean section rates increased from 18% in 1991 to 30% in 2005.
• Aboriginal and Torres Strait Islander babies are about twice as likely as other babies tobe low birth weight or pre-term.

Children and young people

• Death rates among children and young people more than halved in the two decades to 2005, largely because of fewer injury-related deaths.
• Close to 3 in 10 children and young people are overweight or obese.

People aged 25-64 years

• The most common causes of death among this group are coronary heart disease for males (16% of their deaths) and breast cancer for females (15%).
• Older people
• At age 65 years, Australian males can now expect to live to about 83 years and females to 86--about 6 years more than their counterparts a century ago.
• For older Australians, the most prominent health conditions in terms of death and hospitalisation are heart disease, stroke and cancer.

Socio-economically disadvantaged people

• Compared with those who have social and economic advantages, disadvantaged Australians are more likely to have shorter lives, higher levels of disease risk factors and lower use of preventive health services.

Aboriginal and Torres Strait Islander peoples

• Indigenous people are generally less healthy than other Australians, die at much younger ages, have more disability and a lower quality of life. Despite some improvements in Indigenous death rates, the overall gap between Indigenous and non-Indigenous rates appears to be widening. However, the gap in death rates between Indigenous infants and other Australian infants is narrowing.

People in rural and remote areas

• People living in rural and remote areas tend to have shorter lives and higher levels of illness and disease risk factors than those in urban areas.

Prisoners

• Prison inmates tend to have poor mental health and high levels of health risk behaviours, such as drug and alcohol use, smoking, and unsafe sexual practices.

Overseas-born people

• Most migrants enjoy health that is equal to or better than that of the Australian-born population--generally with lower rates of death, hospitalisation, disability and disease risk factors.xiv

Australian Defence Force members and veterans

• Death rates for Australian Defence Force members are lower than the general community's for overall mortality, cancer, cardiovascular disease, assault and suicide.
• Veterans tend to have poorer mental health than the general community, with the prevalence of mental health problems being closely related to the degree of combat exposure.

Population Health Improvement Initiatives

A widely used definition of public health in Australia is "the organised response by society to protect and promote health, and to prevent illness, injury and disability; the starting point for identifying public health issues, problems and priorities, and for designing and implementing interventions, is the population as a whole, or population subgroups" (NPHP 1998). The term "public health" is often used interchangeably with "population health" and "preventive health".

In essence, public health interventions focus on prevention, promotion and protection rather than on treatment; on populations rather than on individuals; and on the factors and behaviours that cause illness. Using a range of sources, the AIHW has estimated that around $1.5 billion was spent by governments on public health activities in Australia in 2005-06, representing 1.8% of total health expenditure.

Public health activities can take the form of programs, campaigns, or events. They draw on a very large range of methods such as health education, lifestyle advice, infection control, risk factor monitoring, and tax loadings to discourage unhealthy lifestyle choices. They also apply in multiple settings (such as schools, homes, workplaces, through the media, and via general practitioner consultations), and relate to a broad spectrum of health issues.

They are variously carried out by state, territory and local governments, the Australian Government, and other agencies such as anti-cancer councils and the Heart Foundation.

Cancer screening

For breast, cervical and bowel cancers, there are national population screening programs in Australia. Their goals are to reduce morbidity and mortality from these cancers through early-as-possible detection of cancer and pre-cancerous abnormalities and effective followup treatment. These programs are called BreastScreen Australia (using mammography for screening), the National Cervical Screening Program (using Pap tests) and the National Bowel Cancer Screening Program (using faecal occult blood tests). They provide screening services that are free to females in the target age group (for breast screening) and to males and females invited to participate in bowel screening, or they are covered by a Medicare rebate (for cervical screening).

BreastScreen Australia

The BreastScreen Australia program began in 1991 (Box 7.2). The proportion of females in the target age group 50-69 years who were screened under the BreastScreen Australia program in a 2-year period rose from 51.4% in 1996-1997 (the first period for which national data are available) to 56.9% in 2000-2001, before falling to 56.2% in 2004-2005.

National Cervical Screening Program

Cervical screening in Australia was standardised under the National Cervical Screening Program from 1995 (Box 7.3). The proportion of females in the target age group who were screened under the national program in a 2-year period changed little between the periods 1996-1997 and 2004-2005 (Table 7.3). There was a steady decline in participation among females aged under 40 years from 1998-1999 to 2004-2005 but improvement for older females in the 55-69 year age group. For example, participation fell from 68.7% in 1998-99 to 62.9% in 2004-05 for females aged 30-34 years but increased from 46.5% to 49.7% during the same period for females aged 65-69 years.

National Bowel Cancer Screening Program

The current phase of the National Bowel Cancer Screening Program began in August 2006, following the success of the Bowel Cancer Screening Pilot Program which was conducted earlier (Box 7.4). The proportion of people responding to an invitation to participate in the National Program in the first 12 months was 31.8% for those aged 55 years and 38.0% for those aged 65 years. The overall crude participation rate was 34.2%. Overall participation of people invited to participate in the Pilot Program cannot be estimated because of the late start of the Pilot Program in Victoria; however, crude participation rates for the Queensland region of Mackay were 70.0% for rescreening of Pilot participants and 19.2% for Pilot invitees. 312

The participation rates presented in Table 7.5 represent an underestimate of the true screening participation rate. This is because the rates were calculated based on all invitations sent up to 31 July 2007, but only people who had received the invitation and had time to respond by that date were counted as participants. This underestimation does not affect comparisons of rates for different groups, but it does mean that the absolute levels of participation are understated.

Childhood vaccinations

The National Immunisation Program Schedule in 2006-07 covered children's vaccinations for diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, Haemophilus influenzae type b (Hib), meningococcal type C disease, varicella (chickenpox), pneumococcal disease, hepatitis B, rotavirus and, for females aged 12 years and over, human papillomavirus (HPV). Additionally, for Aboriginal and Torres Strait Islander children living in high-risk areas, hepatitis A is covered.

In 2006-07, nearly 3.7 million immunisations were delivered to children nationally (Table 7.6). The vast majority of these were done in general practice, which was the dominant provider in the six states and the Australian Capital Territory (Table 7.6). In the Northern Territory most vaccinations were administered through community health centres, and in Victoria nearly half were through local government councils.

Adult vaccinations

For adults, influenza and pneumococcal vaccines are available free to all Australians aged 65 years and over, to Indigenous Australians aged 50 years and over, and to medically at-risk younger Indigenous Australians.

For those in the main target group who were vaccinated in 2006, over 98% received their influenza vaccination from a general practitioner (GP) or other doctor. However, for those aged under 65 years who were vaccinated, about four-fifths received their vaccination from a GP and 15% received it from someone at their place of work.

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