Closing the gap in a generation: health equity through action on the social determinants of health. The Australian Burden of Disease Study 2018 estimated disease burden in Australia due to high blood pressure which was defined as systolic blood pressure greater than 115mmHg. Risk factors may include high blood pressure, dyslipidaemia, impaired fasting glucose and overweight and obesity as outlined in the National Preventive Health Strategy 20212030 (Department of Health 2021). The residential environment has an impact on health equity through its influence on local resources, behaviour and safety. The NDS also continues to support and develop essential partnerships between the law enforcement, health and non-government sectors, communities, and all levels of government (MCDS 2011). In 20092011, a baby born in a region where only 10% of the subregions were in the lowest socioeconomic group could, on average, expect to live to 83 years, whereas a baby born in a region where 70% of the subregions were in the lowest socioeconomic group could expect to live to 79 years. Canberra: NHMRC. Australian Institute of Health and Welfare. These consist of smaller subregions based on ABS Statistical Areas Level 1 (SA1), which were classified using the ABS Index of Relative Socio-economic Disadvantage. This chapter also looks at illicit drug use, which contributes to substantial illness, disease and many deaths in Australia. Some data used to report on these aspects are self-reported and may be prone to under-reporting; exploring ways to obtain additional measured data could eliminate some of this bias. This strong link occurs not just with higher levels of income but with a wide range of characteristics that denote a person's socioeconomic position, including educational attainment, employment and occupation. This was highest in people aged 75 and over (96%) (AIHW analysis of ABS 2014; AIHW 2015). Overall, Indigenous adults were 1.2 times as likely to be either overweight or obese as non-Indigenous adults (72% compared with 63%). Almost half of adults aged 1864 (45%) were inactive or insufficiently active for health benefits in 201415, with rates higher among women (47%) than men (42%) (ABS 2015). While use of drugs such as cannabis, ecstasy and methamphetamines has generally declined since 2004, the proportion of people using cocaine has been increasing since 2004. The effects of individual biomedical risk factors on a person's health can also be amplified when other behavioural or biomedical risk factors are present. Safe, affordable and secure housing is associated with better health, which in turn impacts on people's participation in work, education and the community. The social gradient effects can start from birth and persist throughout life, through adulthood and into old age, often extending to the next generation. 31. Sydney: National Drug and Alcohol Research Centre, University of New South Wales. Longitudinal research into factors associated with overweight and obesity, such as changing patterns of health, nutritional status, vulnerable populations and education could provide further public health benefits for Australians. AUS 180. Drug and Alcohol Review 27(3):27785. Eighty-nine per cent of people with measured dyslipidaemia (7.6 million people) were not using lipid-modifying medication. no. ABS (Australian Bureau of Statistics) 2013. Determinants of health are factors that influence how likely we are to stay healthy or to become ill or injured. There were falls in the reported use of ecstasy (from 3.0% to 2.5%), heroin (from 0.2% to 0.1%) and gamma hydroxybutyrate (GHB). [1] : 24, 26 The biomedical model contrasts with sociological theories of care, [1] : 1 and is generally associated with poorer . Social exclusion can damage relationships, and increase the risk of disability, illness and social isolation. For example, in 201112, 77% of people with diabetes and 59% of people with chronic kidney disease had high blood pressure. The social gradient also extends to types of health care coverage (Figure 4.1.5). NHPA (National Health Performance Authority) 2013. AIHW 2015b. 85% of Indigenous children aged 214, and 97% of Indigenous adults aged 15 and over, had inadequate daily fruit and/or vegetable intake, 22% of Indigenous children aged 214, and 58% of Indigenous adults aged 15 and over, did not eat the daily intake of fruit (2 serves), recommended in the 2013 National Health and Medical Research Council guidelines. People with high blood pressure may be able to control their condition with lifestyle changes that reduce these risk factors, or they may require medication. Certain groups within the population are more likely to use drugs and to experience drug-related harms, with some population groups in the 2013 NDSHS far more likely to report having used methamphetamines recently than the general population. ABS cat. 2013; Carey et al. This was largely influenced by an increase in young people aged 1217 abstaining, from 64% in 2010 to 71% in 2013. Australian Drug Trends Series No. A systematic review. Previous studies have shown the importance of social determinants in understanding and addressing the health gap between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians (Booth & Carroll 2008; DSI Consulting 2009; Marmot 2011; Zhao et al. ABS 2014a. PER 72. Australian secondary school students' use of tobacco, alcohol, and over-the counter and illicit substances in 2011. In 201213, 54% of Indigenous Australians aged 15 and over drank at levels placing them at risk of harmmore than four standard drinks on a single occasion at least once in the past 12 months. 2014). Obesity, which is also a biomedical risk factor, is discussed in Overweight and obesity. The Australian illicit drug guide: every person's guide to illicit drugstheir use, effects and history, treatment options and legal penalties. Marmot M 2010. Use of battery-operated electronic cigarettes (e-cigarettes) is more common among younger smokers and was highest for smokers aged 1824 (27%) in the last 12 months and declined with age (to 5.3% of smokers aged 70 and over). Cardiovascular disease, diabetes and chronic kidney disease: Australian facts: prevalence and incidence. Data on the different forms of amphetamines, and methamphetamine specifically, are not separately available in the AODTS NMDS due to the nature of the classification structure used in this collection. Australian Institute of Health and Welfare 2023. Between 2010 and 2013, the proportion of people who drank at levels placing them at lifetime risk of harm (more than two standard drinks per day on average) fell from 20% to 18%. While national data are available, they have not been available at a regional level since 1997. Melbourne: Black Inc. Coghlan S & Godsmid S 2015. Additionally, disease and ill health can be both products of, and contribute to, social exclusion. The prevalence of major behavioural and biomedical health risk factors is generally higher for Aboriginal and Torres Strait Islander Australians than for other Australians. Australia's health 2016 [Internet]. Wilkinson R & Marmot M (eds) 2003. ), the number of treatment episodes for amphetamines increased from around 10,000 in 200910 to 28,900 in 201314 (AIHW 2014b). In Australia in 2011, it was estimated that 80% of lung cancer burden and 75% of chronic obstructive pulmonary disease burden were attributable to tobacco smoking. 84% of Indigenous children aged 214, and 95% of Indigenous adults aged 15 and over, did not eat the daily recommended intake of vegetables (56 serves). no. Canberra: AIHW. Economic status and health in childhood: the origins of the gradient. Child social exclusion and health outcomes: a study of small areas across Australia. 1 in 4 (25%) had abnormal or high total cholesterol levels, and a similar proportion also had high triglyceride levels. A person's health is also influenced by biomedical factors and health behaviours that are part of their individual lifestyle and genetic make-up. People in low economic resource households spend proportionally less on medical and health care than other households (3.0% and 5.1% of weekly equivalised expenditure, respectively, in 200910) (ABS 2012). Biomedical risk factors are bodily states that have an impact on a persons risk of disease. DSI Consulting Pty Ltd & Benham D 2009. Many of the key drivers of health reside in our everyday living and working conditionsthe circumstances in which we grow, live, work and age. Indicators of socioeconomic position. Creating change in government to address the social determinants of health: how can efforts be improved? For example, in 2014-15, 23% of Australian adults had high blood pressure, which is a risk factor for stroke, coronary heart disease, heart failure and chronic kidney disease. According to the 2013 National Drug Strategy Household Survey (NDSHS), around 2.9 million people in Australia aged 14 and over were estimated to have used illicit drugs in the previous 12 months, and 8 million were estimated to have done so in their lifetime (AIHW 2014b). Additional longitudinal data would also enable improved monitoring of gaps and gradients in health inequalities. Collins D & Lapsley H 2008. In 201112, most adults who were overweight or obese were also inactive or insufficiently active, and/or had inadequate fruit and vegetable consumption (Figure 4.4.2). Australia's health 2014. As with previous iterations of the NDSHS, the AIHW has established a Technical Advisory Group to provide advice on the survey design and content for the 2016 survey. 1996). Kawachi I, Subramanian SV & Almeida-Filho N 2002. Social determinants of health act through complex and multidirectional pathways. Substantial changes to smoking patterns have occurred since 2004 and more recent data on these costs would enhance evaluations of policy effectiveness. The National Drug Strategy 20102015. Australian Drug Trend Series No. According to WHO, the social conditions in which people are born, live and work is the single most important determinant of good health or ill health. After adjusting for differences in age structure, Indigenous adults aged 18 and over were 1.6 times as likely to be obese as non-Indigenous adults43% compared with 27% (Figure 4.8.2); but less likely (0.8 times) to be overweight than non-Indigenous adults (30% compared with 35%). Canberra: AHMAC. Canberra: Department of Health and Ageing. In New South Wales and Victoria, data from a study comparing pathology testing in general practices showed that non-acute respiratory illness pathology testing decreased during the first and second waves of COVID-19 in 2020 (Imai et al. 'Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines', Australian and New Zealand Journal of Public Health vol. Cardiovascular, diabetes and chronic kidney disease series no. In Australia, changes in the use of methamphetamine have been one area of increasing concern among the community (seeBox 4.5.1). Improving biomedical risk factors can prevent disease, delay disease progression, and improve treatment outcomes, and have the potential to enhance the health of the population. We'd love to know any feedback that you have about the AIHW website, its contents or reports. One example of this relationship is the difference in behavioural risk factors associated with employment status. Behavioural risks include smoking, poor nutrition, physical inactivity and excessive alcohol consumption. World drug report 2015. Australia's health 2014. Between 2010 and 2013: Data from the Illicit Drug Reporting System (IDRS) indicates that this trend in increased frequency of crystal use has also been observed among the population of people who inject drugs, and it has continued past 2013. TheNational Drug Strategy Household Survey detailed report: 2013can be downloaded for free. WHO 2013b. Based on self-reported data from the 202021 NHS, an estimated 28,100 adults (or 0.1%) reported that they had high glucose levels measured in their blood or urine (ABS 2022). There are a variety of settings in which people receive treatment for alcohol and other drug-related issues that are not in scope for the AODTS NMDS. Since 2009, the global market for amphetamine-type stimulants (ATSseeBox 4.5.4) has increased substantially. According to the 2013 NDSHS, there was no change in the overall use of any illicit drug between 2010 and 2013 (15% of people reporting they had used at least 1 of 17 illicit drugs). Closing the gap in a generation: health equity through action on the social determinants of health: final report of the Commission on Social Determinants of Health. Two key reports quantify the efforts of such agencies: theIllicit drug data report,produced by the ACC, and theWorld drug report,produced by the United Nations Office on Drug Crime. The reportAustralia's mothers and babies 2013has more detailed data on low birthweight babies and other outcomes for Indigenous and non-Indigenous babies. Canberra: AIHW. 6th edition. Levels of physical activity are related to being overweight or obese: The NATSIHMS results show that, among Indigenous adults in 201213: After adjusting for differences in the age structure (Figure 4.8.2): Data on the behavioural and biomedical health risk factors among Indigenous Australians were enhanced through the additional components of the 201213 AATSIHS, such as the Health Measures Survey and the Nutrition and Physical Activity Survey. It looks at how our body works through a medical lens and has many different aspects such as genetics, nutrition, physical activity, mental health, and more. Evidence on the close relationship between living and working conditions and health outcomes has led to a renewed appreciation of how human health is sensitive to the social environment. For example, a high blood cholesterol level (biomedical) may be the result of a diet high in saturated fats (behavioural). Cat. Implicit value judgements in the measurement of health inequalities. Cat. The concepts and principles of equity and health. That is the focus of this snapshot in the context of Indigenous health outcomes. The others were all holistic. no. Mortality inequalities in Australia 20092011. In 201112, 3.1% of adults or 416,000 Australians had IFG. support families, communities and frontline workers. IHME (Institute for Health Metrics and Evaluation) 2014. Cat. Cat. Average weights increased by 4.4kg for both men and women. Canberra: AIHW. As this was not possible during lockdown periods, there were lower response rates than previous NHS cycles, which impacted sample representativeness for some sub-populations. IGCD (Intergovernmental Committee on Drugs) 2013. There has been a shift in the distribution of body mass index (BMI), with fewer people in the 'normal' or 'overweight' category and more people in the 'obese' category (Figure 4.4.1). no. Economic Letters 99(3):60406. For example: Sources:2004 to 2013 National Drug Strategy Household Surveys; 200304 to 201314 Alcohol and Other Drug Treatment Services National Minimum Data Set. Apparent consumption of alcohol, Australia, 201314. The biomedical model is the dominant model of mental health care in Australia, explaining mental illness as arising from physical causes, and treating it through physical interventions. no. Some health inequalities are attributable to external factors and to conditions that are outside the control of the individuals concerned. A data portal with dynamic and interactive data is also being developed. ABS 2015. Campbell A 2001. Current medical models assume that all illness is secondary to disease. Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 201213. Geneva: WHO. The framework includes community and socioeconomic factors that relate to income, health literacy and educational attainment (see 'Chapter 7.1 Indicators of Australia's health'). 1. Note:Impaired fasting glucose is defined as a fasting plasma glucose level ranging from 6.1 mmol/L to less than 7.0 mmol/L. Across all key determinants, evaluation of programs and interventions to identify successes in reducing inequalities is important. Cardiovascular disease, diabetes and chronic kidney diseaseAustralian facts: risk factors. Measuring health inequalities. Background document to WHOstrategy paper for Europe. Available from: https://www.aihw.gov.au/reports/australias-health/australias-health-2016, Australian Institute of Health and Welfare (AIHW) 2016, Australia's health 2016, viewed 1 May 2023, https://www.aihw.gov.au/reports/australias-health/australias-health-2016, Get citations as an Endnote file: Canberra: AIHW. Marmot review final report. IHW 167. 4364.0.55.007. Over the 5 years to 201314, alcohol has consistently been the drug-related principal diagnosis with the highest number of hospital separations, increasing from 61,000 to nearly 66,000 hospitalisations in that time (from about 280 to 282 hospitalisations per 100,000) (AIHW analysis of the National Hospital Morbidity Database). ABS 2015. For example, there is no regular data collection on smoking prevalence among many groups that face multiple levels of disadvantage, such as people experiencing homelessness; people living with a mental illness; culturally and linguistically diverse populations; and the drug treatment population. The Australian Burden of Disease Study 2018 estimated disease burden in Australia due to high cholesterol levels defined as LDL cholesterol between 0.71.3mmol/L., The Australian Burden of Disease Study 2018 estimated disease burden in Australia due to high cholesterol levels defined as LDL cholesterol greater than 1.3mmol/L., Australian Institute of Health and Welfare 2023. 2021). The increase from 2009 is primarily attributable to the growing amount of methamphetamine seized, which increased from 31 tonnes in 2009 to 80 tonnes in 2013. People living in the lowest socioeconomic areas generally have lower life expectancies (Figure 4.1.3). This page focuses on 3 biomedical risk factors: high blood pressure, dyslipidaemia and impaired fasting glucose which have been directly linked to specific health outcomes such as cardiovascular disease, including coronary heart disease and stroke, chronic kidney disease and diabetes. In 201920, hypertension was the most commonly reported chronic condition at general practice encounters, and dyslipidaemia was the third most commonly reported chronic condition (NPS MedicineWise 2021). more than 1 in 4 (26%) Australians had been a victim of an alcohol-related incident; verbal abuse was the most common incident reported (22%), although this proportion was lower than the 24% in 2010. ABS cat. The combination of overweight or obesity, poor dietary intake and/or insufficient physical activity further increases the risk of chronic disease. Note:Socioeconomic groups are based on the area of residence using the ABS Index of Relative Socio-economic Disadvantage. In 201112, 63% of adults or 8.5 million Australians had dyslipidaemia. Illicit drug use is associated with many risks of harm to the user and to their family and friends. National Health Survey: first results, Australia, 201415. Roxburgh A & Burns L 2015. 66. Canberra: Australian Institute of Family Studies. Report prepared for: Tobacco Control Taskforce, Australian Government Department of Health. Cardiovascular, diabetes and chronic kidney disease series no. Annual Review of Economics, Annual Reviews 6(1):689733. It is estimated that illicit drug use costs the Australian economy $8.2 billion annually through crime, productivity losses and health care costs (Collins & Lapsley 2008). Oxford: Oxford University Press. Population Health Metrics 11:19. no. Social capital. Over the last 5 years, the total number of arrests for ATS increasedaccounting for 16% of illicit drug arrests in 200910 (12% were for consumers; 4.6% for providers) and 23% (18% for consumers; 5.6% for providers) in 201314 (Figure 4.5.4). Mackenbach JP 2015. Department of Health (2021) National Preventive Health Strategy 20212030, Biomedical, page 18, Department of Health, Australian Government, accessed 4 March 2022. Policies and strategies to promote social equity in health. The American Economic Review 92(5):130844. While there was no increase in methamphetamine use in 2013, there was a change in the main form of methamphetamines used, with crystal replacing powder as the preferred form of the drug. 4364.0.55.001. Review of social determinants and the health divide in the WHO European Region. The development of one risk factor can lead to the occurrence of another, or they may have shared causes. In 201415, an estimated 11.2 million adults (63%) were overweight or obese6.3 million (35%) were overweight and 4.9 million (28%) were obese. A person had dyslipidaemia if they had one or more of the following: total cholesterol greater than or equal to 5.5 mmol/L, LDL cholesterol greater than or equal to 3.5 mmol/L, HDL cholesterol less than 1.0 mmol/L in men or less than 1.3 mmol/L in women, triglycerides greater than or equal to 2mmol/L, or were taking lipid-modifying medication (ABS 2013). no. The socioeconomic gradient in health status also occurs because rates of risky health behaviours are usually higher among individuals in low socioeconomic positions. For more information on overweight and obesity, nutrition and physical activity, refer toOverweight and obesityandFood and nutrition.