Australia: the healthiest country by 2020
National Preventative Health Strategy - Overview
The need for urgent, comprehensive, prioritised and sustained action; What will be different because of the Strategy?
The need for urgent, comprehensive, prioritised and sustained action
In assessing the urgent reasons for action, the formidable current and predicted personal, financial and service burdens arising from obesity, tobacco and the harmful use of alcohol are presented.
The burdens associated with obesity, tobacco and the harmful use of alcohol
Obesity, tobacco and alcohol feature in the top seven preventable risk factors that influence the burden of disease, with over 7% of the total burden being attributed to each of obesity and smoking, and more than 3% attributed to the harmful effects of alcohol. Along with a range of other risk factors, and accounting for their interactions, approximately 32% of Australia’s total burden of disease can be attributed to modifiable risk factors.
The prevalence of overweight and obesity in Australia has been steadily increasing over the past 30 years. In only 15 years, from 1990 to 2005, the number of overweight and obese Australian adults increased by 2.8 million.
Recent national data on the prevalence of overweight and obesity among children, available from the National Children’s Nutrition and Physical Activity Survey 2007, indicated 17% of 2–16-year-olds were overweight and 6% obese.
Further examination by the National Heart Foundation of this survey data compared with data from previous studies clearly shows a disturbing upward trend in overweight and obesity rates in children over the last 20 years. Figure 1 shows the prevalence of overweight and obesity in Australian children aged 7–15 years in 1985, 1995 and 2007. As illustrated, the prevalence in overweight and obesity in boys in this age group has risen from 11% in 1985 to 20% in 1995 and almost 24% in 2007. For girls in the same age group the prevalence of overweight and obesity has increased from 12% in 1985 to 21% in 1995 to almost 27% in 2007.
Recent trends predict that the life expectancy for Australian children alive today will fall two years by the time they are 20 years old, representing life expectancy levels seen for males in 2001 and for females in 1997.
It is unacceptable that we as a nation are leaving this legacy to our children and grandchildren.
If these health threats are left unchecked, our health systems will find it increasingly difficult to cope. For example:
In total, the overall cost to the healthcare system associated with these three risk factors is in the order of almost $6 billion per year, while lost productivity is estimated to be almost $13 billion.[9, 10]
- The expected growth in the prevalence of obesity is the major reason for projections that, by 2023, type 2 diabetes will become the leading cause of disease burden for males and the second leading cause for females. If this occurs, annual healthcare costs for type 2 diabetes will increase from $1.3 billion in 2002/03 to $8 billion by 2032.
- Around half of the 2.9 million Australian adults who currently smoke on a daily basis and who continue to smoke for a prolonged period will die early; half will die in middle age. Smoking-related illness costs up to $5.7 billion per year in lost productivity.
- In 2004–05 the harmful consumption of alcohol resulted in huge costs to the community. They include costs attributable to crime ($1.6 billion), health effects ($1.9 billion), productivity loss in the workplace ($3.5 billion), loss of productivity in the home ($1.5 billion) and road trauma ($2.2 billion).
Our focus on obesity, tobacco and alcohol is also due to other important factors:
- Indigenous Australians suffer a starkly lower life expectancy than non-Indigenous Australians. The burden of disease attributable to obesity, tobacco and the harmful consumption of alcohol makes up a significant part of this gap.
- A large part of the differences in health status between advantaged and disadvantaged Australians, and between city dwellers and rural and remote Australians, can be attributed to obesity, tobacco and alcohol.
- The need to intervene early is becoming more evident as we better understand the relationship between growth and development during foetal and infant life, and health in later years. Poor nutrition, cigarette smoking and alcohol use during pregnancy can result in long-term adverse health effects. Early life events play a powerful role in influencing later susceptibility to chronic conditions such as obesity, cardiovascular disease and type 2 diabetes, as well as a range of negative social and economic outcomes.
New knowledge is constantly coming to light in each of these areas, and many new studies have emerged since the Taskforce’s Discussion Paper was released in October 2008:
- 2009 Organisation for Economic Co-operation and Development (OECD) report predicts that there will be continued significant rises in overweight and obesity levels over the next decade in Australia across all age groups to around two-thirds of the population.
- Recent studies show that tax on tobacco is highly supported and likely to disproportionately benefit lower SES smokers.(12)
- Three major reviews just published have shown that:
- Alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol.
- There is a causal link between exposure to alcohol commercials and role models on acute alcohol consumption.
- Among young people who had previously not drunk alcohol, ownership of alcohol branded merchandise is independently associated with susceptibility to, and initiation of, drinking and binge drinking.
- An Australian study published in 2009 has questioned whether there is in fact any safe level of alcohol use for those aged under 18.
What will be different because of the Strategy?
If we implement the tobacco strategy, approximately one million fewer Australians will smoke, and the premature deaths of almost 300,000 Australians now living will be prevented between now and 2020 from just the four main diseases caused by smoking.(50) We will also see significant decreases in Indigenous smoking.
If we reach the targets for alcohol, the proportion of Australians who drink at short-term risky/high-risk levels will drop from 20% to 14%, and the proportion of Australians who drink at long-term risky/high-risk levels will drop from 10% to 7%. This will prevent the premature deaths of over 7200 Australians and prevent some 94,000 fewer person-years of life being lost. The impact on morbidity would approximate to 330,000 fewer hospitalisations and 1.5 million fewer bed days at a cost saving of nearly $2 billion to the national health sector by 2020.
If current upward trends in overweight and obesity continue, there will be approximately 1.75 million deaths at ages 20+ years and 10.3 million years of life lost at ages 20–74 years caused by overweight and obesity in Australia from 2011 to 2050. Each Australian aged 20–74 years who dies from obesity between 2011 and 2050 will lose, on average, 12 years of life before the age of 75 years. If we just stabilise obesity at current levels, we can prevent the premature death of a half a million people between now and 2050.
A new national capacity will be developed. This begins with the capacity to effectively monitor, evaluate and build evidence. The COAG National Prevention Partnership has already committed to a National Prevention Agency (NPA), which will facilitate a national prevention research infrastructure to answer the fundamental research questions about what works best.
The NPA will also provide resources and advice for national, state and local policies, generate new partnerships for workplace, community and school interventions, assist in the development of the prevention workforce, and coordinate and implement a national approach to social marketing.