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

ii - Act early and throughout life (131)

|TOC|next page

‘A life-course perspective is essential for the prevention and control of non-communicable diseases. This approach starts with maternal health and prenatal nutrition, pregnancy outcomes, exclusive breastfeeding for six months, and child and adolescent health; reaches children at schools, adults at worksites and other settings, and the elderly; and encourages a healthy diet and regular physical activity from youth into old age.’[31]

The life course of individuals is shaped by their experiences in the earliest years of their life. The early childhood period has a profound impact on all aspects of development, and establishes the foundations of an individual’s future development. Early childhood experiences may place children on health and developmental pathways that are costly and difficult to change. Therefore, children necessarily form the cornerstone of any prevention agenda.

Research indicates that:
‘virtually every aspect of early human development, from the brain’s evolving circuitry to the child’s capacity for empathy, is affected by the environments and experiences that are encountered, in a cumulative fashion, beginning in the prenatal period and extending throughout the early childhood years’.[32]

In short, what happens to children at the earliest age has direct, identifiable outcomes in areas such as their health, life expectancy, the extent to which they rely on the economic and social support of the community and their capacity to contribute productively to their society. Children with poorer health do significantly less well in school, complete fewer years of education, and have significantly poorer health as well as lower earnings as adults.[33]

Investments in children’s health make significant differences not only to their health outcomes but also to a broad range of social, demographic and economic factors. There is strong evidence to show that investments that improve children’s health lead to higher cognitive development and school attainment, increased propensity for parents to invest in children, reduced cost of medical care and increased participation of parents in the labour market; all of which are associated with improved economic performance and stronger economic growth as well as reduced inequality in societies studied.[33]

‘…from conception, the early years of a child’s life influence health outcomes and life opportunities; an equitable start for all Australian children offers the best life chances for health and wellbeing in later years’ (Quote from submission)

The literature shows that ‘making greater investment in children’s health results in better educated and more productive adults, sets in motion favourable demographic changes, and shows that safeguarding health during childhood is more important than at any other age because poor health during children’s early years is likely to permanently impaired them over the course of their life’.[33]

The significance of these findings is reinforced by epidemiological evidence that adult disease can be linked to factors as early in the life course as foetal nutrition. Babies born with low birth weight, especially small for gestation age, are at increased risk of hypertension, dyslipidaemia, insulin resistance, type 2 diabetes, ischemic heart disease and breast or prostate cancer in adult life.[34-37]

The impact of poor nutrition during pregnancy (as indicated by low birth weight) can be compounded by ongoing poor nutrition and poor early childhood circumstances.[38] Studies have found that poor early childhood circumstances, including low income and family discord, interfere with healthy development
Top of Page

For example:
The Adverse Childhood Experiences (ACE) Study[41] is a major US research study that compares current adult health status to childhood experiences decades earlier. The findings are important medically, socially, and economically.

‘The ACE Study reveals a powerful relation between emotional experiences as children and adult emotional health, physical health, and major causes of mortality in the United States. Moreover, the time factors in the study make it clear that time does not heal some of the adverse experiences common in the childhoods of a large population of middle-aged, middle-class Americans. One doesn’t “just get over” some things.’[41]and lead to increased risks of onset of asthma, hypertension, diabetes, coronary heart disease and stroke or heart attack in adults, as well as significantly increased risk of poor mental health.[39] This same combination of conditions interferes with cognitive development and health capital in childhood, reduces educational attainment, and leads to worse labour market and health outcomes in adulthood.[40]


While it is true that Australia, like the United Kingdom and the United States, is a wealthy country with generally good social services, recent UNICEF figures indicate that we have little reason for complacency and much yet to do. UNICEF recently established benchmarks for OECD countries in infant mortality, birth weight and immunisation. Australia was below the benchmark in each of these three areas (see Figure 1.7 below).

Figure 1.8:

Australia’s Performance Against UNICEF Benchmarks For Early Childhood Health

	Benchmark	Australia	Number of OECD countries which exceed / below benchmark
Infant mortality	< 4 per 1000 live births	5 per 1000 live births	10/15
Low birthweight	< 6% below 2500 g	6.4% below 2500 g	8/17
Immunisation 12-23 months	Average rate 95%	Average rate 92.7%	10/15

Source: Adapted from UNICEF, (2008) ‘The child care transition, Innocenti Report Card 8’. UNICEF Innocenti Centre, Florence.

While research has demonstrated that children’s life courses can be significantly disrupted by poor early childhood experiences, it is also demonstrated that high-quality preventative programs can substantially change this life course. Although no single program has been identified as a ‘magic bullet’, there is substantial evidence that by acting early governments are in a position to ameliorate the effects of poor quality environments and intervene in the intergenerational transmission of disadvantage.

In summarising this research,[42] the National Scientific Council on the Developing Child has identified a number of core principles, which they have labelled ‘effectiveness factors’. The first of these identifies that access to basic medical care for pregnant women and children can help prevent threats to healthy development as well as provide early diagnosis and appropriate management as problems emerge. Evidence supporting this factor includes the positive effects of adequate prenatal and early childhood nutrition on healthy brain development, and the developmental benefits for very young children when parental problems such as maternal depression are identified and treated effectively.

Similarly, there is extensive research to indicate that children’s participation in quality early childhood programs can make a substantial difference to cognitive and social outcomes. Longitudinal studies in the United States, following significantly disadvantaged families, have demonstrated substantial differences in wellbeing, income, social participation and adjustment between adults who experienced high-quality early childhood programs compared to those who did not.[43]

Taken as a whole, the extensive research on early childhood gives Australia an excellent platform from which to reform and further develop its service systems for children and their families.
Top of Page

The Taskforce considers that the keys to effective prevention during pregnancy and the early years of life, whether associated with obesity, tobacco, alcohol or other health and social require risks, are:

• Early identification of family risk and need, starting in the antenatal period.
• Response to need in pregnancy, early years and through parent support.
• Monitoring of child health, development and wellbeing.
• Service redevelopment and workforce training to meet family and childhood needs.

Australia has a patchwork of existing early childhood and family support services which reflect the legacies of previous policies and earlier understandings about how children grow and develop. Governments have recognised the importance of supporting families to ‘get the early years right’. Work is under way through COAG to enhance service quality and delivery in early childhood settings. All governments recently endorsed the National Child Protection Framework, and COAG is currently addressing early childhood more broadly through development of a National Early Childhood Development Strategy, due for release in July 2009. In its December 2008 Interim Report, the NHHRC placed strong emphasis on approaching health systems reform from a life-course perspective (with a focus on early years) and the Maternity Services Review[44] provides a number of key recommendations to improve care and support for women during the antenatal period.

‘the importance of prevention for children, young people, their families and the broader community is now recognised and reflected in various policy initiatives around Australia’ (Quote from submission)

Australia has a clear opportunity to build on these initiatives and to create a service system which focuses on the health, learning and development of young children and which supports their families to provide the best possible environment to ensure their health and wellbeing. The Platforms program provides one example of a multi-strategy approach to such a service system.


Example: the platforms program: ccch melbourne[45]

• Community engagement and planning
• Raising awareness of early child development through dissemination of research
• Multi-disciplinary training for professionals who work with children and their families
• Early identification of need through the development of a national tool and systematic application of checks at 18 months and three years of age
• Provision of evidence-based information for parents
• Evidence-based information accessible to communities, providing choices for interventions in a variety of settings
• Collection of population data at community, state and national levels to inform sound policy decisions
• A national monitoring and evaluation strategy to measure progress

Top of Page

Keeping older Australians healthy

‘Approach preventative health policy through a framework of a commitment to active ageing and the promotion of healthy lifestyles and interventions that enable older Australians to age well and in place’ (Quote from submission)

Population ageing is a common characteristic of many developed countries, including Australia, and is due mainly to a combination of decreasing fertility rates and increased life expectancy,[46] much of which is due to past successes in prevention. Australian men and women currently aged 65 can expect to live to 83 and 86 years, respectively.[2]

Life expectancy trends are anticipated to continue, with current population projections indicating that by 2036 the proportion of the Australian population aged over 65 years will have increased from 13% (2.7 million people) in 2006 to 24% or 6.3 million people.[47] This is also likely to result in changes to the profile of older Australians over the next 30 years and increase the degree of heterogeneity within this group. These include:

• Rapid increases in the number of Australians aged over 85 years (333,000 in 2006 rising to 1.1 million in 2036) and 100 years and over (just under 5000 rising to more than 25,000)[47]
• A shift in gender distribution, due to the life expectancy of Australian men improving at a faster rate than that of Australian women[47]
• By 2011 one in five older Australians aged over 70 will be from culturally and linguistically diverse backgrounds[48]
• An increase in the number of older Australians still actively engaged in the workforce[49]
• Almost half of women and a third of men aged 65 years will enter permanent residential care at some time in their remaining lives[50]

The anticipated changes to the number and profile of older Australians have the potential to significantly impact on the quality of life outcomes for this population group, presenting challenges to both government and the community.[51][52] Whilst some sections of the older population will maintain their health and activity levels well into their later years, others will face considerable problems related to their health and quality of life.

The increased prevalence of chronic disease as individuals age is one such consideration, with older members of the population likely to have more than one chronic health condition (51% of people aged 60+ years) as compared to younger individuals (12% of people aged 59 years and under).[53] Many conditions common in older age are associated with behavioural and biomedical risk factors such as obesity, alcohol misuse and tobacco consumption that can be modified to prevent the onset of chronic disease and consequently improve the quality of health outcomes through ‘healthy ageing’.[54]

Healthy ageing is ‘the process of optimising opportunities for physical, social and mental health to enable older people to take an active part in society without discrimination and to enjoy an independent and good quality of life’.[55]

While the potential scope for policy and action is diverse, efforts to tackle and improve healthy ageing have four key areas:[56]

• Improved integration in the economy and community
• Better lifestyles
• Adapting health systems to the needs of the elderly
• Attacking the underlying social and environmental factors affecting healthy ageing

Whilst all of these areas are important in ensuring healthy ageing is supported, the encouragement of better lifestyles amongst the older population has the largest potential for improving the health of the elderly.[56] There is a strong reliance on prevention, as it is never too early or too late to promote health.[57] Action to address obesity, alcohol misuse and tobacco consumption is vital in achieving good health outcomes.[53]
Top of Page

Healthy weight

Current trends in overweight and obesity have had a substantial impact on Australia’s ageing population. The prevalence of obesity among Australians approaching retirement is between 25% and 30%. Those aged in their 50s and 60s have experienced weight increases as they age, and the current cohort of older Australians are estimated to be six to seven kilograms heavier than 20 years ago.[58] Factors contributing to this increase in obesity in older Australians are physical activity levels, nutrition and diet.

Exercise is considered the ‘best preventive medicine for old age’.[56] Evidence suggests that the impacts from a wide range of physical health and mental health conditions and dependency in old age can be reduced or minimised through regular physical activity of moderate intensity.[59] The inherent challenge is how to encourage the uptake and maintenance of physical activity amongst the older population, especially for those who have not been active over their lifetime or who have experienced a change in their level of mobility or living arrangements.[56]

A balanced diet and adequate nutrition is also vital in ensuring good health outcomes in the elderly. The diets of older Australians must be sufficient to provide their minimum nutrient requirements, which should include sufficient levels of fruit and vegetables and lower rates of fat and salt.[47] However, changes in food consumption patterns can affect the intake of food and health outcomes of the older population.[56] For example, a growing reliance on pre-packaged and processed foods could result in the risk of older Australians becoming overweight or obese, along with other health-related problems. However, a decline in food consumption associated with increasing age due to disability, the secondary effects of medication or bad eating habits as a result of social isolation could lead to malnutrition and risk of under-weight.

Tobacco

As in the general population, giving up smoking improves the health outcomes of older Australians. The decrease in smoking among adults over the last 20 years was initially apparent amongst older Australians. This was mainly due to a greater prevalence of smoking cessation and the greater mortality of smokers as compared to non-smokers within this population group.[47]

The relationship between continued smoking as people age and the increased risks of illness and premature death are well documented.[56] However, in keeping with the notion of it being ‘never too early and never too late to promote health’, even older smokers who quit between the ages of 65 and 70 can substantially reduce their excess risk of premature death.[55]

Risky alcohol consumption

In 2004–05, 8.1% of the Australian population aged 65 years and over consumed alcohol at risky levels for long-term harm.[47] Whilst the overall prevalence is lower in older populations, alcohol misuse disorders are common and can be associated with health issues such as some cancers, cirrhosis of the liver, cognitive problems, negative interactions with medications and falls.[55]
Top of Page
With alcohol playing an important role in Australian social life, there is expanded opportunity for consumption of alcohol in retirement and older age.[47] Combined with a general decrease in alcohol tolerance with age, this may result in further potential for risky consumption.

Achieving healthy ageing

‘Health promotion activities and equal access of older persons to preventative healthcare and services throughout life is the cornerstone of healthy ageing’ (Quote from submission)

Whilst the point has been made that encouraging older people to adopt healthier lifestyles has the largest potential for improving the health of the elderly, behaviour modification alone will not be enough to ensure the best health outcomes for older Australians. To be successful, healthy ageing must incorporate strategies and policies that target the individual, communities, the healthcare system and other services, and government needs to provide the necessary responsibility and infrastructure to encourage the active participation and engagement of older members of the population.[48][53]

|TOC|next page