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Australian Journal of Pharmacy : March 2005
economics health economics Pharmacy Guild of Australia, director, health economics, Dr Michael Tatchell Australians becoming healthier T HE health status of Australians ‘is improving substantially’. This is the conclusion of a recent report on the per- formance of the health sector, under- taken by the National Health Perfor- mance Committee for the Australian Health Ministers’ Conference.1 This committee, formed in 1999, is responsi- ble for the development and mainte- nance of a national health performance framework, the support of benchmark- ing for health system improvement, and the provision of information on national health system performance. Their report (the second to be pub- lished) assesses the performance of Aus- tralia’s health system with reference to three sets of measures—changes in health status and outcomes, trends in various determinants of health, and trends in cer- tain health performance variables. It makes interesting reading. Health status and outcomes The report shows that Australians are not only living longer, but are healthier as well. Our life expectancy is among the highest in the world—we are third among OECD(Organisation for Economic Coop- eration and Development) countries with a life expectancy at birth in 2001 of 80 years. In 1970 we ranked sixteenth. Longer life expectancy is reflected in lower mor- tality—Australia’s mortality rate has fallen 50 per cent since 1970; and the decline is not slowing. The fall has, in fact, been most rapid in the past few years. Falling mortality from heart disease has been a major contributor. This has been due to a combination of a fall in the inci- dence of heart attacks and better survival after heart attack. Declining death rates from cancer and stroke have also con- tributed to the continuing fall in mortality rates. Regrettably, there remains a huge dif- ference in mortality rates and life expectancy between Aboriginal and Tor- res Strait Islander people (ATSI) and non- indigenous Australians. ATSI people have a life expectancy 20 years less than non- indigenous Australians. They have higher rates of infant mortality and much higher mortality rates in adulthood, particularly between the ages of 45 and 65 years. Determinants of health Determinants of health can have either positive or negative effects on health. Pro- tective factors include water fluoridation, fruit and vegetable intake and physical activity, while hazardous trends encom- pass such things as obesity, alcohol con- sumption and smoking, and insufficient physical activity. Disturbing trends identified in the report include: • higher incidence of obesity—in 2001, 58 per cent of adult males and 42 per cent of adult females were overweight or obese. This was much higher than in 1995. • increasing inactivity—in 2000, 54 per cent of Australians were insufficiently active to achieve a health benefit. This was more than in 1997. • alcohol consumption—in 2001, 13 per cent of males and 4 per cent of females reported risky levels of drinking. This was higher than in 1995. On the positive side, the report shows the prevalence of high blood pressure continues to drop, and tobacco use con- tinues to decline. High blood pressure now affects 21 per cent of adult males and 16 per cent of adult females—this is half the rates of 20 years ago. Daily smoking has fallen from 33 per cent of males 14 years and older in 1985 to 21 per cent in 2001, and from 26 per cent to 18 per cent for females. Health system performance Several performance measures are pre- sented in the report, all of which suggest improvements in the effectiveness of our health system over time. These include: 200 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 Conclusion This excellent report card on Australia’s health status and health system perfor- mance is most useful for those seeking to identify trends and patterns. Reports of this nature are invaluable for decision makers and health administrators—they help to identify areas of challenge and need and to inform resource allocation decisions. The picture that emerges is of a health system that is performing well, but that could do better in some areas. The life expectancy of Australians and their health status continue to improve, driven to a large extent by the various preven- tive and treatment activities of the health system. Further improvements can be achieved through attention to the determinants of disease such as obesity, smoking and lack of exercise. As well, there is much scope for earlier and better interventions for many chronic conditions, and for better treatment of cancer, heart disease and mental illness aimed at improving survival and reducing dependency. 1. National Report on Health Sector Performance Indicators 2003, a Report to the Australian Health Minister’s Conference, National Health Perfor- mance Committee, Australian Institute of Health and Welfare, November 2004. • reduction in the proportion of injecting drug users who reported sharing a nee- dle or syringe; • increased participation by women in breast cancer screening; • continued improvement in childhood immunisation rates; • continued decline in fatality rates from coronary heart disease; • improved five-year relative survival rates for several types of cancer; and • significant decline in the proportion of young smokers reporting they had personally purchased their own ciga- rettes.