Australia: the healthiest country by 2020
National Preventative Health Strategy – the roadmap for action

3.1 - The burden of disease – a focus on obesity, tobacco and alcohol

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Obesity, tobacco and alcohol feature in the top seven preventable risk factors that influence the burden of disease (see Figure 1.1 below), 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.[2]


    Figure 1.1:
    Keys to prevention: top seven selected risk factors and the burden of disease
    Figure 1.1: Keys to prevention: top seven selected risk factors and the burden of disease

    Source: AIHW (adapted from Australia’s Health 2008 Table 4.1)


While the prevalence of smoking is declining (though not enough), overweight and obesity and the harmful use of alcohol are escalating. The scale and pace of efforts in all these areas must be increased.

The prevalence of overweight and obesity in Australia has been steadily increasing over the past 30 years.

If the current trends continue unabated over the next 20 years, it is estimated that nearly three-quarters of the Australian population will be overweight or obese in 2025.(4)

In only 15 years, from 1990 to 2005, the number of overweight and obese Australian adults increased by 2.8 million. Almost a quarter of Australian children are overweight or obese, an increase from an estimated 5% in the 1960s. Nearly a third of children do not meet the national physical activity guidelines. Only one-fifth of 4–8-year-olds and 5% of 14–16-year-olds meet the dietary guidelines for vegetable intake.[3]
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Recent trends indicate 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.[4] This is not a legacy we should be leaving our children.

If these health threats are left unchecked, the impact on individuals and families, our healthcare systems, the economy and society more generally will be profound.
  • Type 2 diabetes is projected to become the leading cause of disease burden for males and the second leading cause for females by 2023, mainly due to the expected growth in the prevalence ofbesity. If this occurs, annual healthcare costs for type 2 diabetes will increase from $1.3 billion to $8 billion by 2032.[5]
  • Almost 2.9 million Australian adults smoke on a daily basis. Around half of these smokers who continue to smoke for a prolonged period will die early; half will die in middle age.[6]
  • The total quantifiable costs of smoking to the economy (including the costs associated with loss of life) were estimated at over $31 billion in 2004–05.[8]
  • There can be no cause for complacency while one-sixth of Australian adults smoke, thousands of children start smoking each year, and adult and young non-smokers alike are exposed to the dangers of passive smoking.
  • The most recent national survey of drug use estimates that one in four Australians drink at a level that puts them at risk of short-term harm at least once a month. Around 10% of Australians drink at risky levels of harm in the long term. However, among young adults aged 20–29 years, the prevalence of drinking at levels for long-term risk of harm is significantly higher (16%) than among other age groups.
  • The harmful consumption of alcohol causes problems for those who drink at risky levels and has repercussions across our society. Alcohol is involved in 62% of all police attendances, 73% of assaults, 77% of street offences, 40% of domestic violence incidents and 90% of late-night calls (10 pm to 2 am).[7]
  • The annual costs of harmful consumption of alcohol are huge. They consist of crime ($1.6 billion per annum), health ($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) in 2004–05.[8]
The cost to the healthcare system alone associated with these three risk factors is in the order of almost $6 billion per year, while lost productivity is estimated to cost almost $13 billion.[8, 9]

There are further and especially important reasons for urgent action in these areas:
  • 'Close the Gap': the burden of disease caused by obesity, tobacco and alcohol makes up a significant part of the life expectancy gap between Indigenous and non-Indigenous Australians. Similarly, a large part of the differences in health status between rich and poor Australians and between city dwellers and rural and remote Australians can be attributed to these risk factors.
  • Intervening early in life is important. A relationship exists 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 consequences. Early life events also play a powerful role in influencing later susceptibility to chronic conditions such as obesity, cardiovascular disease and type 2 diabetes.
Since the release of the Taskforce’s Discussion Paper, many new studies have emerged, and have been reflected in updated versions of the three Technical Reports on obesity, tobacco and alcohol. Important examples are described below:

For obesity:

The National Children’s Nutrition and Physical Activity Survey 2007 provides the most recent measurement of Australian data on the prevalence of overweight and obesity among children. Overall, this survey indicated 17% of 2–16-year-olds were overweight and 6% obese.[10]

Further examination by the National Heart Foundation[11] of this survey data, and data from previous studies, clearly shows a disturbing upward trend in overweight and obesity rates in children over the last 20 years.
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For children aged 7–15 years, levels of overweight and obesity have increased for both girls and boys. For girls, rates have risen from 12% in 1985 to 22% in 1995, reaching 26% in 2007. Similarly for boys, levels have increased from 11% in 1985 to 20% in 1995, rising to 24% in 2007. Figure 1.2 below shows the prevalence of overweight and obesity in Australian children aged 7–15 years, 1985–2007.

    Figure 1.2:
    Prevalence of overweight and obesity in Australian children aged 7–15 years, 1985–2007
    Figure 1.2: Prevalence of overweight and obesity in Australian children aged 7–15 years, 1985–2007

    * Data weighted for age, gender and region.
    Source: Roberts L, Letcher T, Gason A et al. 2009[11]


A 2009 Organisation for Economic Co-operation and Development (OECD) report further predicts that there will be continued significant rises in overweight and obesity levels in Australia over the next decade across all age groups to around two-thirds of the population.[12]
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For tobacco:

A vast range of reports have been published since the Taskforce released the Discussion Paper. Reports cover issues such as:
  • The consequences of active and passive smoking
  • The effectiveness of various tobacco control strategies and progress in the implementation of new tobacco control measures, both internationally and nationally
  • Guidelines developed and recently adopted to assist parties to the Framework Convention on Tobacco Control (FCTC) with the implementation of various articles of the treaty
  • The importance of packaging in communicating positive imagery about smoking and reinforcing false ideas about the relative harmfulness of various products
  • Recent studies show that tax on tobacco is highly supported and likely to disproportionately benefit lower SES smokers.(12)
  • Strong public support for a wide range of tobacco control measures

For alcohol:

Four major reviews published in 2009 have shown:
  • Alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol[14]
  • There is a causal link between exposure to alcohol commercials and role models on acute alcohol consumption[15]
  • 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[16]
  • An Australian study has questioned whether there is in fact any safe level of alcohol consumption for those aged under 18,[17] and the National Health and Medical Research Council (NHMRC) released its low-risk drinking guidelines in 2009

Broad trends

Other broad trends with a continuing impact on the health and wellbeing of Australians and on our health system include:
  • The ageing of the population has important implications for health services usage and labour force participation.
  • Increasing levels of disability, chronic illness and injury will continue to increase and challenge health services, workplaces, communities and families.
  • Increasing discrepancies in health status and outcomes for some population groups must be a high priority, particularly the needs of Indigenous communities, whose life expectancy at birth is around 17 years less than that of non-Indigenous Australians.
  • Other disadvantaged groups including rural and remote Australians, recent immigrants – especially refugees and those escaping conflict – those on limited incomes, people with disabilities and people with low levels of education.
  • Climate change and sustainability: this Strategy does not address climate change, but recognises it as an area of the utmost importance for health as well as the national and global community, requiring urgent action. There are also many areas where improving health is entirely compatible with increasing sustainability; for example, promoting walking and cycling as a means of transport.
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