Australia’s life expectancy is up, but healthy years are a different story

Australians have added six years to their life expectancy since 1990 – a world-leading increase – but some measurements paint a less rosy picture of the nation’s health.

The data is the subject of a major feature in the respected British Medical journal The Lancet.

Overall, the data shows life expectancy in Australia improved from 77 years in 1990 to 83 in 2019.

Although heart disease and stroke remain the nation’s biggest killers, both have seen major reductions in deaths since 1990 – down 68% and 58% respectively.

In its analysis of data published in the 2019 Global Burden of Disease Study, the research also found:

• 90% of people die from non-communicable diseases.
• Lung cancers remain the third biggest killers, though substantial reductions have been recorded since 1990.
• Alzheimer’s and other dementias are now the fourth most frequent causes of death.
• Chronic kidney disease, pancreatic cancer, falls, leukaemia and liver cancer now kill more people than they did 30 years ago.

The biggest improvement has been the big drop in the number of road fatalities, which in 1990 was the seventh leading cause of death in Australia. There had been a 63% reduction in the number of deaths per 100,000 people (15.5 to 5.7) by 2019; now ranking it as the 17^th most frequent cause of death.

The data also explored the non-fatal disease burden in the population.

These, says the study’s lead author Dr Shariful Islam from Deakin University’s Institute for Physical Activity and Nutrition, add to the burden on Australia’s economy both in financial and productivity terms.

“These might not cause a lot of death, but they’re definitely causing a lot of disability-adjusted life years,” Islam says.

The nation ranks better than similar countries for the non-fatal disease burden from diabetes and non-fatal stroke. Conversely, its relative ranking has worsened for drug use, anxiety and depressive disorders.

Risk factors that diminish the years of healthy life a person might experience like these have seen big jumps over the last 30 years.

“It also causes a lot of economic issues, because when a person has musculoskeletal or low back pain, or especially anxiety or depression, they will often be absent from work, they will be less productive – this costs money.”

Two-speed health improvements

The data also shows the burden of disease is inequitably spread across the nation.

People from lower socioeconomic backgrounds were found to have a higher risk of death-causing disease, and account for larger proportions of smokers and those with obesity. Aboriginal and Torres Strait Islander peoples are disproportionately represented in these groups.

High blood pressure remains the leading risk factor for mortality, though it accounts for nearly half as many deaths in 2019 (as a proportion of the total) than it did 30 years prior.

And while body mass index (BMI) has been shelved in recent years as an individual health indicator in favour of metrics like waist measurements, at a population level, it remains a top-three mortality risk factor.

That, says Islam, is because those with high BMI likely carry other major risk factors.

“With High BMI you’ll often [also] see high blood pressure, high blood glucose, often sedentary lifestyles,” he says.

Islam and his colleagues highlight universal healthcare programs like Medicare, regulatory and broader healthcare systems as the strengths driving the overall positive outcomes in life expectancy.

But they argue the nation’s performance in delivering preventative and supportive treatment for non-fatal conditions, and promoting healthy lifestyles to its ageing population will be important to continue a sustained trajectory.

This view is supported by a comment by University of Sydney-affiliated public health experts Michelle Dickson, Cheryl Jones, Terry Slevin, and Jaime Miranda. While they say the study highlights Australia as a “public health exemplar”, they highlight the deficiencies bridging the health gap for Aboriginal and Torres Strait Islander peoples and those from lower socioeconomic backgrounds as an important public responsibility.

“Australia has a world-class health care and public health system that has been conducive to major population gains, at least in life expectancy,” they write. “Yet, work remains to be done to marry such gains with strategies and policies to prevent or reduce disease burden during the entire lifecourse, and to reduce inequalities. This will be essential to sustain this world-class health system and to promote healthier societies.”