Reducing the burden of death and disability in Australia
BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY
Good news is rare enough – so let’s celebrate. Here’s a report showing that the health of Australians is improving!
Between 2003 and 2015, the all-up impact of illness decreased by 11 per cent and premature deaths by 20 per cent. Big gains were observed in rates that combined death and disability from heart disease and from stroke. Here’s how we know.
The Australian Institute of Health and Welfare (AIHW) is charged with the responsibility of collecting and analysing health-relevant information from surveys and statistics across the country. It has recently published a report on what it calls the ‘burden of illness’ – a composite measure of the effect of early death and (generally) later suffering. They write:
Burden of disease analysis combines living with poor health (the non-fatal burden of disease) with dying prematurely (fatal burden). Fatal and non-fatal burden combined is referred to as total burden. Burden of disease is recognised as the best method to measure the impact of different diseases or injuries in a population.
And the burden is, for most Australians, getting lighter.
Because studies of the burden of disease depend so heavily upon data and analytics, it takes time to collect all the essential information from multiple sources and then to analyse and package it. The report refers to how things were in 2015. Listing all the doctors and public health experts and others who contributed their wisdom to the interpretation of the data takes six pages.
But this four-year lag is compensated for because the report provides information about trends between 2003 and 2011 and between 2011 and 2015: what’s happening to life expectancy and how long men and women might expect to live their lives free of disability. For men, the ‘adjusted’ life expectancy (without the burden of illness) is 71.5 years, and for women 74.4 years – for people born in 2015. The report states that while:
the life expectancy of those in the highest and lowest socioeconomic groups increased (or stayed the same) in 2015 compared to 2011, the disability-free life expectancy increased in the highest group but decreased in the lowest group.
The report also states: “The five top disease groups causing the most burden in 2015 were cancer, cardiovascular diseases, musculoskeletal conditions, mental and substance use disorders, and injuries; together, these accounted for around two-thirds (65 per cent) of the total burden.”
The total burden was split evenly between premature deaths and disability.
The report draws another encouraging fact to our attention – there is room for improvement. Although prevention is extremely difficult for most non-infectious diseases, there is evidence that, by using a comprehensive, all-weapons-blazing approach to tobacco, we have done ourselves a heap of good. What we have learned and developed there should guide the planning of our response to other preventive challenges.
At present, obesity is the hardest condition to prevent. Perhaps a magical medication will come to our rescue as has happened with hypertension and with HIV. Note, in passing, that transmission of the virus can be almost completely halted when HIV-positive people are treated optimally.
In the meantime, if the political and individual will were there, action could be taken to alter our food and fitness environment. But that is a big ask.
At a recent Melbourne conference on prevention, Federal Health Minister Greg Hunt, via a video message, encouraged those present to think creatively and widely about prevention. He used the example of new medications for conditions such as cystic fibrosis to demonstrate the power of innovative thinking. This is part of an appropriate response.
It needs the support of political commitment – as we saw with tobacco – to tackle vested interests in food manufacture and retailing – to re-set community opportunities to choose food wisely and easily. We should overcome the shocking social class differences in obesity rates which reflect variations in purchasing opportunity and responses to advertising and packaging.
The report gives encouragement to all of us who wonder occasionally whether or not we doctors are actually making a difference. Prevention rarely provides the short-term rewards we receive from clinical care. But take heart from the gains achieved in the long term; for example, in treating hypertension and the slow but steady decline in stroke deaths and disability. Of course, improved acute stroke treatment is also making a big contribution.
Let’s hope that, when the next burden of illness study is published, we can celebrate even further achievements.
Published: 12 Jul 2019