Indicator: Community Health

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Summary

The ACT community in general enjoys good health. Long-term trends towards longer life-expectancy, lower standardised death rates and lower infant mortality rates continued over the reporting period. However, there are inequalities in health between population groups within the ACT, with Indigenous people and those on low incomes experiencing disadvantage.

There was an increase in the proportion of overweight people in the ACT during the reporting period, accompanied by a decline in the proportion of people engaging in moderate to vigorous physical activity. Large sections of the population reported poor dietary behaviours.

In conjunction with projected demographic shifts in the population, these trends and patterns of behaviour may constrain future health outcomes if they remain unchecked.

What the results tell us about the ACT

In the ACT since 1971, life expectancy at birth has increased by about 10 years for males and seven years for females. In 2001, life expectancy at birth for ACT females (82.9 years) and ACT males (78.5 years) was slightly higher than national life expectancy (82.4 years for females and 77.0 years for males).

Infant mortality rates for the ACT have decreased by more than 50% in the last 10 years. This is thought to be largely the result of advances in medical technologies, new therapies and health promotion activities in the community.

The standardised death rate for ACT residents has declined dramatically over the last three decades, by more than 50% since 1971. Between 1997 and 2001, the standardised death rate declined from 6.0 deaths per 1000 population to 5.1 deaths per 1000 population.

Causes of death

About one in four deaths in the ACT, in 2000, was potentially avoidable, indicating the theoretical scope for health gain through disease prevention, early detection and treatment. Both cancer and cardiovascular disease were the leading causes of avoidable death, followed by external causes (accidents and injury) and respiratory disease.

Estimates derived from the 2001 National Health Survey indicate that the prevalence of national health priority conditions (cancer, cardiovascular disease, diabetes mellitus, asthma, mental illhealth, injury, and arthritis and musculoskeletal disorders) in the ACT is similar to national levels.

Cardiovascular disease

Cardiovascular disease is the leading cause of death in the ACT, accounting for 36% of deaths in 2001. Fifty per cent of these deaths were due to myocardial infarction (heart attack) and 23.5% were due to stroke. The ACT had the second highest percentage of premature deaths due to cardiovascular disease in Australia between 1997 and 2000.

Cancer

Cancer is the second leading cause of death in the ACT, accounting for 32% of deaths between 1996 and 2000. The most prevalent types are cancer of the trachea, bronchus and lung, colorectal cancer, prostate cancer in males and breast cancer in females.

Participation rates in the breast and cervical cancer screening programs are higher in the ACT than nationally. There is insufficient evidence to determine whether or not routine Prostate Specific Antigen blood test (PSA) testing prevents death from prostate cancer, and the Australian Cancer Council does not advocate routine PSA testing. There is currently no national screening program.

Health concerns in the ACT

Injury prevention and control was endorsed as a priority in 1986. Injuries caused 8.4% of deaths in the ACT in 2001. Most were among people aged 15–44 years, and male death rates were usually between two and three times higher than female.

Mental illness

The World Health Organization has predicted that, by the year 2020, depression will be the second largest mental health problem in the world. Depression is the most common mental health disorder reported in Australia, accounting for about 3.7% of the total burden of disease and injury in Australia in 1996. If the attributable suicides and self-inflicted injuries are included, depression accounts for about 5% of the total burden. Depression has been identified as the first national mental health priority area for action, followed by prevention of suicide, early detection and prevention of mental ill health.

The 1997 Mental Health Survey suggested that 21.1% of ACT residents had experienced a mental health disorder during the previous 12 months, compared with 17.7% nationally. The higher prevalence in the ACT was primarily due to a higher level of mental health disorder reported by ACT males.

Suicide accounted for 3.2% of deaths in the ACT in 2001, and although there was a greater number of suicides among males than females, more females were hospitalised for self-inflicted harm than males.

Diabetes

Survey results underestimate the true prevalence of diabetes in Australia, as it is thought that, for every person diagnosed with diabetes, there is another undiagnosed. In the ACT, 3.1% of the adult population (18 or older) had been diagnosed with diabetes for six months or more in 2001, compared with 2.9% nationally. Almost 5% of hospitalisations in the ACT in 2001–02 showed diabetes as the principal or associated diagnosis. The most common diagnoses associated with diabetes were cardiovascular disease, digestive disorders and cancer.

Asthma

Australia has one of the highest known rates of asthma in the world. The prevalence of the disease in the ACT has increased in recent years, although hospitalisations and mortality rates have declined over time. Current estimates are that about 16.5% of kindergarten children in the ACT have ‘current’ asthma and about 22.4% have had asthma at some stage. About 23% of kindergarten children with current asthma have an asthma management plan. There were 324 hospitalisations with a principal diagnosis of asthma in the ACT in 2001– 02. Seven hundred and twenty-two children (14 or younger) and 834 adults (15 or older) presented to emergency departments with asthma during that period.

Arthritis

The burden of disease from arthritis and musculoskeletal disorder is significant, primarily due to the reduced quality of life associated with chronic pain and disability. The 2001 National Health Survey suggested the ACT had a slightly lower prevalence of arthritis and rheumatism and slightly higher rates of back pain, osteoporosis and other musculoskeletal diseases, than national figures.

Communicable diseases

Although the burden of communicable disease has declined considerably, it remains a significant cause of ill health. In general, notifiable communicable disease rates and trends for the ACT are similar to national rates and trends. Campylobacter infection (an illness with diarrhoea, fever and vomiting as common symptoms) was the most commonly notified disease in the ACT in 2002, with 114 cases reported per 100,000 population.

The second most commonly reported disease was Chlamydia, followed by hepatitis C. Rates of genital Chlamydiainfection have risen steadily in recent years, from 26 cases per 100,000 population in 1996 to 147 per 100,000 population in 2002. A less invasive testing technique for Chlamydia(coupled with education campaigns) has contributed to the increase in notification rates in the ACT.

Food poisoning

Food safety is monitored in the ACT, and notified incidences of food poisoning are investigated. By far the most common causes of ill health from food in the ACT, during the reporting period, were infections due to campylobacter and salmonella.

Obesity

The ACT has a similar proportion of overweight and obese adults (18 or older) as nationally. However the level of excess weight in the population has increased in recent years, from 32% in 1995 to 42% in 2001. Although ACT physical activity levels are higher than those nationally, there has been a decline in levels of people doing the intense physical exercise needed to confer a health benefit.

Poor diet

The 2001 National Health Survey results indicate there are worrying levels of sub-optimal dietary behaviours among adults (12 or older) in the ACT, as in the rest of Australia. About 20.9% of adult ACT residents do not consume the recommended minimum daily quantity of vegetables, 46.8% do not consume the recommended minimum daily quantity of fruit, and 46.5% identify ‘whole milk’ as the ‘usual type’ of milk they consumed in 2001.

Smoking

Tobacco smoking is the single largest preventable cause of disease and premature death in Australia, and places the greatest burden of disease on the population. The proportion of smokers (14 or older) in the ACT has remained relatively stable in recent years. The 1998 and 2001 National Drug Strategy Household Surveys suggested that about 24% were smokers in 1998, and 22.5% were smokers in 2001. Estimates for Australia as a whole were similar (24% in 1998 and 23.1% in 2001). The Australian Secondary Students Alcohol and Drug Survey suggested there was a significant decrease, between 1999 and 2002, among ACT students (12–17 years) reporting that they had tried smoking. The figure fell from 52.4% of male students and 55.0% of female students in 1999, to 44.9% and 46.9% respectively in 2002.

Drinking

Alcohol consumption is associated with considerable morbidity and mortality in the community – alcohol-related harm accounts for about 4.9% of the total burden of disease and injury in Australia. The 2001 National Drug Strategy Household Survey suggested that 9.6% of the ACT population (14 or older) consumed alcohol daily, compared to 8.3% nationally. The survey also suggested women and young people in the ACT are more likely, than other groups, to engage in high-risk drinking practices.

Drug use

The prevalence of drug use in the ACT is similar to national levels with, for instance, 14% of ACT residents (14 or older) having used cannabis in 2001, compared with 13% nationally.

Health and social factors

Socio-economic status

Recent research suggests links between health and socioeconomic status (ACTCOSS, forthcoming; AIHW, 2002). People who are less educated, unemployed or on a low income report poorer health. People from lower socioeconomic groups are more likely to smoke, be overweight or obese and report lower levels of physical activity (AIHW, 2002). Research also suggests that reducing socioeconomic inequality leads to health benefits that are shared by all members of society (ACTCOSS, forthcoming).

These favourable average indicators should not mask the inequalities in social factors affecting health. The forthcoming ACTCOSS report, Sustaining the Social Relations of Healthin the ACT, sheds some light on the health status and social determinants of health for specific population groups in the ACT, but there is still limited accessible data in this area. More detailed and ongoing analysis and reporting of variation in health and social outcomes for specified population groups is needed.

Social indicators of ACT health

In general, social indicators affecting health are more favourable in the ACT than nationally. For instance, in 2001:

  • average weekly earnings were $778 in the ACT compared with $655 in Australia
  • 26% of ACT residents held a tertiary qualification compared with 13% nationally
  • the unemployment rate was 5% in the ACT compared with 7% in Australia
  • 94% of ACT households had access to a motor vehicle compared with 90% nationally (ACT Health, 2003).

Gender

Gender imbalances in health statistics in the ACT are similar to those nationally. Men have shorter life expectancy and higher mortality rates than women. ACT women however are more likely to suffer from a long-term health condition than ACT men. ACT men’s health appears better in comparison with men from other Australian jurisdictions than does ACT women’s health when compared with women from other Australian jurisdictions.

Sexuality

There are limited data on the influence of sexuality on health status. However, to the extent that the dominant culture continues to marginalise gay, lesbian and transgender people, these groups may experience violence, isolation, lowered self-esteem and associated health impacts.

Indigenous status

The 2000 Inquiry into Aboriginal and Torres Strait Islander Health in the ACT showed significant health inequalities persist in local Indigenous communities compared to the broader population. Mortality rates were significantly higher for Indigenous people (especially women) than for the total ACT population, and the average age at death (in 1997) was 56.5 for Indigenous people compared with 68.4 for all ACT deaths. Under-reporting of Indigenous peoples in health data and population counts, and the small size of the Indigenous population in the ACT, limit the scope and reliability of statistics. However, qualitative research also indicates inequalities between Indigenous and non-Indigenous ACT people in a number of health areas (ACT Health, forthcoming). The Chief Executive of the Winnunga Nimmityjah Aboriginal Health Service, Julie Tongs, identified chronic illness, diabetes, heart disease, kidney disease, mental illness, and drug and alcohol problems, as areas of concern for Indigenous people in the ACT. Her impression is that the gap is widening between Indigenous and non-Indigenous Canberrans.

Country of birth

A Social and Demographic Profile of Multicultural Canberra (ACT Government, 2003) reports that Canberrans born overseas generally experience less psychological distress and greater satisfaction with quality of life than do their counterparts living in other parts of Australia. Contrary to the national trend, these wellbeing indicators are more favourable for overseas-born than for Australian-born Canberrans. However, there is significant variation in the experiences of Canberra’s multicultural community. Migrants from English-speaking countries fare better than Australian-born people on a range of wellbeing measures, whereas more recent migrants from non–English-speaking backgrounds are more likely to experience disadvantage.

Income

Although there are limited data on the health status of people living on low incomes in the ACT, ACTCOSS research includes a project focusing on the experience of people accessing community services in the Civic area. Of these people, 70% live on less than $300 per week and 90% on less than $500 per week. Participants in the research generally reported poor health. Comparison with the Australian Bureau of Statistics (ABS) Health Survey for the ACT, while not statistically valid, suggests a marked difference between health levels of the disadvantaged and the average (see Table 1).

Health outcomes for different age groups and for people with disabilities and mental illness are also of interest from a social determinants of health perspective. Discussion of these specific groups is beyond the scope of this indicator.

Table 1: Self-reported health status for the total population and the ‘disadvantaged’
Health Status Total Population* Disadvantaged Sample**
Excellent/very good 54.2% 3.8%
Good 29.9% 30.8%
Poor/fair 15.9% 65.4%

*ABS National Health Survey ACT; **2001 ACTCOSS ‘disadvantaged’ sample

Data sources and references

ACT Council of Social Services (forthcoming), Sustaining the Social Relations of Health in the ACT: Draft Report , ACTCOSS, Canberra.

ACT Health 2003, ACT Chief Health Officer’s Report 2000–02 , ACT Health, Canberra.

Australian Institute of Health and Welfare 2002, Australia’s Health , AIHW, Canberra.

Standing Committee on Health and Community Care 2000, Inquiry into Aboriginal and Torres Strait Islander Health in the ACT, Legislative Assembly for the Australian Capital Territory, Canberra.

With funding from ACT Health, the ACT Council of Social Services (ACTCOSS) is currently researching the social determinants of health in the ACT. The forthcoming report, Sustaining the Social Relations of Health in the ACT , will provide a basis for understanding and addressing health (and other social) inequalities in the ACT. Information on ACTCOSS activities and publications is available at http://www.actcoss.org.au.

The ACT Chief Health Officer’s Report is tabled in the Legislative Assembly biennially in accordance with the Public Health ACT 1997. The 2000–02 report is available at http://www.health.act.gov.au.

Australia’s Health and Australia’s Wellbeing are headline publications of the Australian Institute of Health and Wellbeing (AIHW). They are produced biennially in alternate years. These and other AIHW publications are available at http://www.aihw.gov.au/publications/index.cfm.

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