The thirteenth report on Australia's health was released by the Australian Institute of Health and Welfare (AIHW) on 21 June 2012. The AIHW describes Australia's Health 2012
as 'the most comprehensive and authoritative source of national information on health in Australia', and many would not disagree. Produced biennially since 1988, the report has grown both in size and stature as a reliable report card on the status of the country's health and the services and resources that deliver and support it. A companion In brief
publication was also released.
Drawing on the resources of the AIHW, the ABS and other key statistical sources, Australia's Health 2012 contains the latest information on major causes of ill health, health service use and health spending, risk factors such as tobacco, obesity and alcohol, health and medical research, palliative care, blood, organ and tissue donation. While it reveals some good news, Australia's Health 2012
also presents evidence of some negative trends, and also highlights some gaps in our knowledge.
On the good news front, Australians continue to enjoy one of the world's longest life expectancies, sixth amongst developed countries. Fewer Australians smoke on a daily basis (15%), and our mortality rates from cardiovascular disease (CVD) and cancer have dropped. Over the last two decades the death rate from cancer fell 23% for males and 17% for females; and the death rate from CVD has fallen a staggering 78% since 1968. Overall, a majority of Australians (85%) rate their health as excellent/very good or good, compared to 15% who rate it as fair or poor.
On the bad news front, the health status of indigenous Australians remains poorer than for non-indigenous Australians. Indigenous Australians have lower life expectancy (12 years less for males and 10 less for females), higher rates of daily smoking (2.2 times higher), 3 times the rate of ear disease among children, lower rates of breast cancer screening (36% compared to 55%), 3 times the rate of diabetes, 6 times the rate of end-stage kidney disease, poorer oral health and they represent 93% of all cases of rheumatic heart disease.
There are other negatives, particularly around risk factors for chronic diseases like diabetes. Australians are getting fatter—25% of adults and 8% of children are obese. We are becoming more sedentary with 60% of adults doing insufficient exercise; and eating less healthily, with only 50% of adults eating enough fruit and less than 1 in 10 eating enough vegetables. The consequence of these poor health behaviours has seen our rate of diabetes more than double over the last decade.
At the same time, the cost of health is growing well above inflation. As a nation we now spend over $121 billion a year on health care. Most of this expenditure comes from governments (70%), but increasingly individuals are bearing a greater cost burden (17.5%), particularly for dental care ($4.7 billion) and medications ($7.7 billion). As a share of total health spending, our out of pocket expenditure is high compared to other developed countries (18.2% compared to 15.8%). Meanwhile, private health insurance covers nearly 46% of the population and funds 12% of health costs.
While the report paints probably the most detailed picture ever of our health status and use of health services, some of the picture is still fuzzy or unclear, due to a lack of information. The report itself highlights some of the significant gaps in our current knowledge. These include a lack of knowledge around health services delivered in primary care settings, a lack of quality indicators for health performance reporting (eg public dental waiting lists), gaps in maternity care data, few measures of socioeconomic status, a lack of survey data from residential aged care facilities, data gaps for hospitals and elective surgery, insufficiently detailed data on our health workforce and data deficiencies and gaps for indigenous Australians.
There remain many challenges for our health system and to retain our reputation as one of the healthiest countries. Not least among these is how to build a sustainable, high quality health system that is both equitable and efficient, while faced with an ageing population, a rising tide of chronic disease, innovative but sometimes costly medical advances, an ageing health workforce and increasingly complex funding and regulatory arrangements. The value of this report and others like it is in helping us better understand these challenges and where we might best direct our efforts.