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Australian Journal of Pharmacy : October 2006
economics Australia’s health improves health economics Pharmacy Guild of Australia, director, health economics, Dr Michael Tatchell ‘A USTRALIANS generally enjoy very good health and Australia’s international ranking for numerous aspects of health is high and better than a decade or so ago.’ This is the principle conclusion of the latest Biennial Report1 of the Australian Institute of Health and Welfare (AIHW). Not all the news is good but, on balance and by international yardsticks, our health is good and improving. How do we compare? In the 18 years since Australia’s Health was first published, our ranking among com- parable countries has improved on most measures: • life expectancy at birth (83 years for females and 78 years for males) now places us among the top five nations in the world; • marked improvements in ranking are evident for our mortality rates from coronary heart disease, stroke, lung cancer and transport accidents; • our rates of smoking continue to fall, ranking us in the ‘best third’ of OECD countries on this measure; and • we also score well, and have improved rankings on self-rated health, dental health, various mortality measures and lower alcohol consumption. On the downside, our ranking has fallen in the past two decades on measures of mortality from suicide, diabetes and respiratory diseases, and for infant mor- tality. Our ranking for obesity has not changed—we are among the ‘worst third’ group of OECDcountries on this measure. Risk factors The health of Australians is determined by a wide range of factors including bio- medical, genetic, behavioural, socioeco- nomic and environmental. In recent years much of the focus has been on the behavioural determinants as this is an area where change can confer substantial benefits. Obvious examples are tobacco smoking, physical activity, alcohol consumption, use of illicit drugs, diet and body weight. The Institute’s report card (for the year 2004) on these risk factors is mixed: • Tobacco smoking continues to decline with prevalence for males and females falling by 7.3 and 5.5 per cent in the past 10 years. Some 3.9 million Aus- tralians (17.4 per cent of people aged 14 years and older) smoked daily. • About half of all adults did not under- take leisure-time physical activity at lev- els recommended for health benefits, and females reported less leisure-time physical activity than males. • About four out of five drank alcohol, and one in 10 did so daily. About one in 12 drank at levels that risked short and long-term harm. • In the past 10 years, those aged 14 years or older using illicit drugs (about one in seven) during the previous 12 month decreased. • Large sections of the population are not consuming adequate quantities of fruit and vegetables. • An estimated 2.5 million adults were obese (one in five males and one in six females) and a further 4.9 million were overweight but not obese. The preva- lence of obesity and overweight has increased markedly in past two decades. Use of medications In 2004 some 233 million prescriptions were dispensed, $1.7bn was spent on OTC medicines, and a further $0.8bn was spent on complementary medicines. Taken together, more than 14 per cent of our total health spend was spent on medicines of one form or another. The Report also refers to the results of the 2004/05 BEACH survey of general practice which shows that doctors pre- scribed medicines at a rate of 83 per 100 74 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 OCTOBER 2006 Child health With so much focus on our ageing popu- lation, a welcome feature of this Report is a special section on child health. While our children are generally very healthy, it is clear that their ongoing health will be affected by a growing prevalence of over- weight and obesity. Children are also experiencing rising levels of diabetes, and large numbers are affected by asthma and mental health problems. It will be interesting to follow these trends in years to come through future editions of Australia’s Health and to assess the effectiveness of initiatives to tackle these challenges to the health of young Australians. Conclusion Australia’s Health 2006 is an essential refer- ence document for anyone with an inter- est in health. As the Institute’s director states in the Report’s preface: ‘it is a rich reference source with a wealth of infor- mation about the health status of our fel- low Australians and the health services they receive’. 1. Australia’s Health 2006, 10th Biennial Report of the Australian Institute of Health and Welfare, Canberra, May 2006. ¦ patient encounters—marginally less than the 84.3 per 100 reported in the 2000/01 BEACH survey. Antibiotics were the most commonly prescribed drug group (20.9 per cent of all prescriptions), followed by cardiovascular medicines (15.5 per cent), central nervous system and psychological medications (21.1 per cent), muscu- loskeletal medicines (6.9 per cent) and res- piratory medicines (6.5 per cent). The sur- vey also found that doctors made nearly 10 million recommendations for OTC medicines, chiefly for paracetamol and ibuprofen, and directly supplied nearly eight million medicines to patients, mainly vaccines.