Australia's burden of disease

16 October 2019

Mid this year the Australian Institute of Health and Welfare released its report on the burden of disease in Australia for the calendar year 2015. This report provided a sobering assessment of the impact of illness and death, and shows that Australia's population experienced the equivalent of 4.8 million lost years of life from illness, injury and premature death. The report calculated this using three measures of illness: the years of life lost, the years of life disability and the disability adjusted life years. The report showed that a massive 38 per cent of the disease burden experienced by Australians was preventable, and it very much could have been avoided by addressing risk factors such as tobacco use, being overweight or obese and dietary risk. The largest causes of lost years include heart disease, back pain, lung cancer, non-cancer related lung diseases and dementia. Mental ill-health is also very much a heavy burden.

Lung cancer caused an overall greater burden compared to other cancers, yet we know it receives less than five per cent of cancer research funding. The government has failed, to date, in bringing forward disease management plans to address the lung cancer issue and provide an integrated, community based approach. Non cigarette related lung cancer is increasing even though smoking rates are declining. It affects both sexes equally and has very much a poor prognosis. Yet there is minimal funding being applied to research into the causes and treatment of such cancers.

Age-related rates for years lost have improved only in groups aged above 80. Despite all our health expenditure, we have still not really shifted the number of lost years for anyone under 79. Australians living in remote and very remote parts of Australia bear 1.4 times higher loss of years due to disease and death compared to their major city counterparts. Why is it that in 2019 we're still unable to provide equitable health services for our remote and very remote populations?

The standards of health care and the poor outcomes in our Indigenous population are a stain on our national character. A shameful example of this is the catastrophic rates of rheumatic heart disease in the Northern Territory. We know that, in the four years to 2017, fully 1,700 of the 1,800 cases of rheumatic heart disease have occurred in our Indigenous population. Rheumatic heart disease is a disease of poverty and overcrowding, which allows infections such as strep A to take hold. The NT has the highest rate of severe overcrowding, with over 40 per cent of Indigenous Australians living in severely overcrowded households. The damaging effects of rheumatic heart disease on the heart valves of Indigenous children aged five to 15 means that, once diagnosed, they need monthly injections of painful antibiotics given intramuscularly until they are adults. Later they require complex heart surgery, because their heart function was compromised. It also means they have a life expectancy of only 40, which is less than half the Australian average.

This is very much a public health problem caused by overcrowding, poor sanitation and a lack of access to good medical care. The number of lost years amongst the poorest 20 per cent of Australia's population was 1.5 times that of the wealthiest. This means that fully one-third of the lost years of productive life could have been avoided if the poorest had the same health outcomes as the wealthiest. Can we call ourselves an egalitarian society when the socioeconomic class you were born into is such a major determinant of the likelihood of living a healthy and productive life?

The government needs to be aggressive in tackling our disease burden and unrelenting in its efforts to address preventable risk factors such as disease caused by alcohol and tobacco. To that end, why are we still waiting for the government to finalise the National Alcohol Strategy 2018-2026? We need to commit to ensuring that all Australians, including those living in rural and remote areas and our Indigenous populations, have access to quality, affordable health care and health advice to enable them to live full lives and continue to contribute to our community.

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