A healthy Australia

The Australian Institute of Health and Welfare’s (AIHW) biennial flagship report card of Australians’ health has been launched by the Hon. Mark Butler, Minister for Health and Aged Care.

‘The last time we released an Australia’s health report, it was mid-2022 and Australia was in the middle of the Omicron wave of the pandemic,’ AIHW Deputy Chief Executive Officer Matthew James said. ‘Now, in mid-2024, it’s a good time to look back over the last few years and consider where we stand.

‘Australia’s health 2024 does just this, considering where Australia’s health and health system stand now, and what ongoing and future health challenges remain for us as a nation.’

Australia’s health 2024 shows that Australia’s life expectancy at birth is fourth highest among 38 Organisation for Economic Co-operation and Development (OECD) countries, after Japan, Korea and Switzerland. A boy and a girl born in 2020–2022 can expect to live on average 81.2 years and 85.3 years respectively – an increase of over 40% since the start of the 20th century.

For the first time since the mid-1990s, however, life expectancy in Australia decreased in 2020–2022 – by 0.1 years for males and females from 2019–2021 to 2020–2022. This is likely due to the increase in deaths seen in 2022, of which close to half were due to COVID-19. Greater declines in life expectancy were seen in the United States (from 78.9 in 2019 to 76.4 in 2021) and the United Kingdom (from 81.3 in 2019 to 80.4 in 2020).

‘Even though life expectancy in Australia decreased in 2020–2022, it was still higher than it was in 2017–2019, prior to the pandemic, by 0.3 years for males and females,’ Mr James said.

‘COVID-19 became the third leading cause of death in Australia in 2022, marking the first time in over 50 years that an infectious disease has been in the top 5 causes of death.’

As life expectancy has increased over time, so too has the number of years, on average, Australians spend in full health. Between 2003 and 2023, males gained a total of 2.2 years in full health (from 69.4 to 71.6 years) and females gained a total 0.8 years in full health (from 72.8 to 73.6 years). There has also been, however, an increase in the number of years on average Australians spend in ill-health (from 8.7 to 9.7 years for males and from 10.2 to 11.5 years for females) contributing to demands on the health system and other services.

The ABS has developed estimates of excess mortality that provide an indication of how many additional deaths have occurred since the beginning of the pandemic that would not have occurred without the pandemic. From the start of the pandemic to December 2023, there was a net total of 13,259 excess deaths in Australia. However, the pattern of excess mortality was different by year. In 2020 there were 1,854 less deaths than expected. In 2021, 2022 and 2023 there were more deaths than expected, with 369 in 2021, 11,558 in 2022 and 3,186 in 2023 (based on deaths above and below usual variation).

‘Burden of disease’ is used to measure the impact of diseases and injuries at a population level. It combines the years of healthy life lost due to living with ill health (non-fatal burden) with the years of life lost due to dying prematurely (fatal burden). In 2023, it was estimated that Australians lost 5.6 million years of healthy life due to either ill-health (54% of total burden) or dying prematurely (46% of the total burden). There was, however, an 11% decline in total burden (after adjusting for population ageing) between 2003 and 2023. This was driven by a 27% decrease in the rate of fatal burden, while the non-fatal burden rate increased by 6.3%.

In 2023, the leading causes of total burden among males were coronary heart disease, back pain and problems and suicide and self-inflicted injuries. Among females, the leading causes were dementia followed by anxiety disorders and back pain and problems.

Chronic Conditions

Australia’s health 2024 also highlights how with greater life expectancy comes a greater burden of chronic conditions on the Australian population.

Around 3 in 5 Australians were estimated to live with at least one long-term health condition, and 2 in 5 with two or more such conditions, in 2022. Chronic conditions contributed to between 89 and 92 per cent of all deaths each year in Australia from 2002–2022.

‘Chronic conditions present a key challenge for individuals, governments and society as a whole,’ Mr James said. ‘For example, with an ageing and growing population, AIHW predicts that the number of Australians with dementia will more than double by 2058 to 849,300 – 533,800 women and 315,500 men.

‘The age-standardised coronary heart disease death rate has been declining since its peak in the late 1960s (428 per 100,000 population in 1968) and fell by more than 80% between 1980 and 2022 (from 297 to 52 deaths per 100,000 population), although it is still the leading single cause of death in Australia. There was a slight increase in the age-standardised death rate between 2021 and 2022, but the rate in 2022 was lower than in 2019 (55 deaths per 100,000 population).’

Cancer is a major cause of illness in Australia. In 2023, on average over 450 cases were diagnosed each day.

Consistent with Australia’s ageing and growing population, between 2000 and 2023 the number of new cancer cases increased by 88% and deaths from cancer increased by 41%. Adjusted for age, however, the rate at which new cancer cases were diagnosed increased by 8%, while the rate at which people died due to cancer decreased by 25%. From 2000 to 2023, the cancer death rate fell for all 10-year age groups up to the age of 84. For example, the rate at which people aged 45–54 died from cancer fell by 36%.

‘Seven in 10 (71%) people survived at least 5 years after a cancer diagnosis during 2015–2019, an improvement from 5 in 10 (53%) in 1990–1994,’ Mr James said. ‘Since the National Cervical Screening Program was introduced in 1991, the age-standardised death rate for cervical cancer has halved.’

Risk Factors

Australia’s health 2024 reveals a decline in some behaviours and risk factors which negatively impact our health. Tobacco use – which causes more deaths than any other behavioural risk factor – continues to drop. 8.3% of people aged 14 and over smoked daily in 2022–‍2023, compared with 12.2% in 2016. The proportion of people aged 14 and over drinking alcohol in ways that put their health at risk has fallen too, from 39% in 2004 to 31% in 2022–23.

‘More people are also physically active, with fewer not meeting physical activity guidelines compared with 5 years ago,’ Mr James said. ‘37% of adults aged 18–64 did not meet the physical activity guideline in 2022, a decrease from 51% in 2017–18.’

In 2022, 2 in 3 (66%) Australian adults aged 18 and over were living with overweight or obesity; similar to the rate in 2017–18 (67%). Looking over a longer time period, the proportion of adults living with overweight or obesity has increased (from 56% in 1995).

While tobacco smoking continues trending down, Australia’s health 2024 shows vaping has become more common.

‘In 2022–2023, for people aged 14 and over, 3.5% were using e-cigarettes daily – up from 0.5% in 2016,’ Mr James said. ‘People aged 18–24 were the age group most likely to use e-cigarettes daily (9.3%) in 2022–2023. For the same year and age group, 5.9% smoke tobacco daily’.

‘In 2022–2023, females aged 18–24 were more likely to use e-cigarettes daily compared with males – 10.3% of females and 8.5% of males.’

In 2022, 94% of adults did not meet the Australian Dietary Guidelines for daily serves of vegetables – stable since 2007–08. There has been an increase in the proportion of adults not meeting the daily fruit recommendation: 56% of adults did not meet the guideline for daily serves of fruit in 2022, compared with 49% in 2017–18.

Mental Health

Australia’s health 2024 also shows the increasing burden of mental health on Australians’ health – especially younger Australians.

In 2020–2022, an estimated 8.5 million Australians (43% of the population) aged 16–85 had experienced a mental disorder at some time in their life while 4.3 million people aged 16–85 (22% of the population) had experienced a mental disorder in the last 12 months.

While the overall proportion of people with a mental disorder in the last 12 months was similar in 2007, there was a notable increase among young people. In 2020–2022, 39% of 16–24-year-olds had a mental illness in the last 12 months. Last time a comparable measure was collected in 2007, it was 26%. This change is almost entirely driven by an increased prevalence among females in this age group (46% in 2020–2022 – up from 30% in 2007).

In 2022–23, 10% of the population accessed 13.2 million Medicare-subsidised mental health-specific services (an increase from 8% in 2013–14). People aged 18–24 were most likely to receive services (16% of people aged 18–24 years) with females of this age (22%) accessing services at a higher rate than males (11%).

First Nations

There have been improvements in the health of Australia’s Aboriginal and Torres Strait Islander population, but significant challenges remain.

Death rates among First Nations people have been falling in most age groups over the past 10 years. There has not been any improvement, however, in infant and child death rates over this time.

Cancers are the most common group of diseases causing deaths among First Nations people, overtaking cardiovascular diseases as the most common group in recent years. Between 2006 and 2022, the age-standardised death rate for cardiovascular disease among First Nations people in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined fell by 22%, from 323 to 252 per 100,000, while the cancer death rate rose by 31%, from 205 to 269 per 100,000.

Australia’s Health System

In 2021–22, Australia spent an estimated $241.3 billion on health goods and services, an average of $9,365 per person. In real terms (adjusted for inflation), this was an increase of 6.0% ($13.7 billion) or $484 per person (in 2021–22 dollars) from 2020–21 and larger than the average yearly growth rate over the decade to 2021–22 (3.4%).

In 2022, there were almost 689,000 health care professionals actively working in their registered professions (as registered with the Australian Health Practitioner Regulation Agency), an increase of 37% (184,000 professionals) since 2013. This was faster than the growth in the total number of people who were employed over the same period (21%).

In 2022–23, 86% of Australians had at least one Medicare-subsidised GP attendance. GP attendance rates have been steadily increasing since 2005, with a one-time peak (7.4 attendances per person) in 2021 due to increased demand for GP attendances related to COVID-19 vaccine suitability assessment and telehealth.

COVID-19

During the pandemic, some health services were suspended, access restricted or changed, while health service workers faced additional burdens. Australia’s health 2024 shows that rates of hospitalisations and elective surgeries from public wait lists were impacted by the pandemic, remaining lower each year from 2019–20 to 2022–23 than 2018–19 (prior to the pandemic).

These activities were particularly affected in 2019–20 and 2021–22. There were 12.1 million hospitalisations in 2022–23, at a rate of 415.2 hospitalisations per 1,000 population – a decrease from 421.7 per 1,000 population in 2018–19. The numbers of hospitalisations for admitted patients in public and private hospitals were generally increasing each year before the COVID-19 pandemic.

Hospitalisation rates have remained lower than the pre-pandemic level (2018–19) in each year to 2022–23, with the largest falls observed in both 2019–20 and 2021–22, coinciding with elective surgery restrictions and workforce disruptions during the COVID-19 pandemic.

Admissions for elective surgeries from public hospital waiting lists, which were generally increasing each year before the COVID-19 pandemic, were heavily affected by disruptions to hospital services in 2019–20 and subsequent years. In 2022–23, for patients admitted from a public hospital elective surgery waiting list, 50% of patients were admitted for elective surgery within 49 days of being placed on the waiting list, an increase from 40 days in 2021–22 and 41 days in 2018–19.

‘The number and rate of admissions for elective surgeries from public hospital waiting lists in 2022–23, while higher than 2019–20 and 2021–22, were still lower than in the years preceding the pandemic (2016–17 to 2018–19),’ Mr James said.

Total numbers of Medicare Benefits Schedule (MBS)-subsidised services (such as GP attendances, pathology services and specialist attendances) and the number of services per person were generally increasing prior to 2021, but the pandemic saw higher than previous increases in 2021 and 2022.

There were large increases in GP attendances and pathology services in 2021 and 2022, driven by GP assessment of suitability for a COVID-19 vaccination and by PCR testing, respectively. These did not continue into 2023, with the use of MBS-subsidised services in 2023 returning to pre-pandemic levels. MBS-subsidised telehealth attendances have, however, shown no signs of reverting back to pre-pandemic levels of use. In 2023, each Australian, on average, received 1.26 telehealth attendances (a total of 33.7 million attendances) compared with 0.01 telehealth attendances each in the pre-pandemic years 2017–2019 (ranging from 176,800 to 275,400 total attendances each year).

‘There were missed or delayed cancer screenings early in the pandemic, while immunisation coverage rates for 5-year-olds declined slightly in 2022 to 94.3% after reaching the national target of 95% in 2021,’ Mr James said. ’The slight falls in coverage rates between 2021 and 2022 for 1- and 5-year-olds may reflect the impact of COVID-19 on routine childhood vaccination.’