Cancer has a significant impact on individuals, families and the health care system. Despite a decline in cancer mortality and an increase in survival over time, one in two Australians will develop cancer and one in five will die from it before the age of 85.
National Health Priority Areas
Australia’s National Health Priority Areas are diseases and conditions that contribute significantly to the burden of illness, and the resulting high social and financial costs imposed on regional, rural and remote communities.
The targeted diseases and conditions were chosen because with appropriate and focused attention, significant gains in the health of the rural population can be achieved.
Arthritis and Musculoskeletal Disease
Arthritis and Musculoskeletal Disease are conditions in which inflammation of the joints cause pain, stiffness, disability and deformity. It also includes other joint problems and disorders of the bones, muscles and their attachments. The symptoms often have a significant impact on everyday life.
Arthritis, often referred to as a single disease, is an umbrella term for more than 100 medical conditions that affect the musculoskeletal system, specifically joints where two or more bones meet. It is possible to have more than one type of arthritis.
Arthritis is the second leading cause of disability and the most common cause of chronic pain in Australia; it is the most prevalent long-term health condition.
- In 2012, 15% of Australians (around 3.3 million people) had arthritis. More than half of people with arthritis had osteoarthritis, 13% had rheumatoid arthritis, and 37% had an unspecified type of arthritis.
- $5.7 billion was spent on arthritis and other musculoskeletal conditions in 2008–09. Of this, $1.6 million was spent on osteoarthritis, $1.2 million on back problems, $355 million on rheumatoid arthritis and $305 million on osteoporosis.
Osteoarthritis (OA) is a degenerative condition that mostly affects the hands, spine and joints such as hips, knees and ankles, and usually gets worse over time. It is the predominant condition leading to knee and hip replacement surgery in Australia.
Overall, OA is poorly managed in Australia. Two thirds of people with OA report that they are faring badly with their condition and 57% do not receive appropriate care according to current guidelines. Most GPs report dissatisfaction with the care they're able to provide to people with OA due to the limited effectiveness of current treatment options. Management is compromised by the fact that little is known about the causes of OA, and there is no confirmed cure or intervention to slow its progression.
Rheumatoid arthritis is an autoimmune disease where the body’s immune system attacks its own tissues. Rheumatoid arthritis can affect anyone at any age, and may cause significant pain and disability. Among more than 100 types of arthritis, rheumatoid arthritis is the most severe, and the second most common after osteoarthritis.
There has been little change in prevalence over the past 10 years. It is difficult to evaluate the full impact of this condition due to the limited national statistics available.
- 2% of Australians (approximately 445,000 people) reported having rheumatoid arthritis in 2012.
- 5 out of 8 people with rheumatoid arthritis are women (2.4% of women compared to 1.5% of men).
Asthma is a chronic lung disease affecting people of all ages. It can be controlled, but not cured. The prevalence of asthma is significantly higher in people living in inner regional areas, compared with those in major cities or outer regional and remote areas.
1 in 10 children and adults (2.3 million people) suffer from asthma.
Asthma death rates in Australia are high compared with other countries. Many deaths due to asthma are potentially preventable and can usually be managed through effective treatment. Deaths from asthma are higher in:
- People living in remote areas of Australia compared to major cities
- Indigenous Australians
- People residing in areas of greatest socioeconomic disadvantage.
In 2012, asthma interfered with daily living of a sizeable proportion (34%) of people with the condition. $655 million was spent on asthma in 2008–09: this represents 0.9% of all direct health expenditure on diseases.
Women aged 75 years and over are almost three times more likely to die from asthma compared to their male counterparts.
The most commonly reported cancers for 2012 were:
- Prostate cancer
- Bowel cancer
- Breast cancer
- Melanoma of the skin
- Lung cancer.
Grouped together, these five cancers are estimated to account for more than 60% of all cancers in 2012.
In 2004–08, cancer was significantly higher in inner regional areas (504 per 100,000 population) than in major cities (480), outer regional (495) and remote and very remote (474) areas.
There were 42,844 deaths due to cancer in 2010. Of these deaths, 24,328 were male and 18,516 female.
The five most common causes of death from cancer in 2010 were lung (8,099), bowel (3,982), prostate (3,235), breast (2,864) and pancreas (2,434).
Referred to under the broader terms heart disease or cardiovascular disease (CVD), this group of conditions encompass a range of circulatory conditions including ischaemic heart diseases, cerebrovascular diseases, oedema, heart failure, and diseases of the arteries, arterioles and capillaries.
Heart disease remains one of the leading causes of death worldwide, and therefore an emphasis has been placed around preventing its onset through modifying risk factors such as healthy eating, exercise and avoidance of smoking.
Cardiovascular disease – primarily heart attack, stroke and vascular disease – is a major cause of premature death and disability. Moreover it is the most expensive disease in Australia, costing about 12% of total healthcare costs, or $7.6 billion a year.
It is largely preventable as many of its risk factors are modifiable: including smoking, high blood pressure, high cholesterol, physical inactivity, poor nutrition and obesity. Australians living in rural and remote areas experience more CVD risk factors, higher rates of CVD-related hospitalisation and are more likely to die of CVD than those in metropolitan areas. The further a person lives from a metropolitan centre, the greater their risk of hospitalisation and death from cardiovascular disease.
There is no reliable national and jurisdictional data on the number of new cases of CVD each year. If Australians living in rural and remote areas had the same death rates as urban Australians, there would have been 3,632 fewer deaths due to cardiovascular disease (16.5 per cent fewer) in rural areas in 2009–2011.
- In 2012, an estimated 585,900 Australians had cardiovascular disease, with the condition being more common in men than women and among those aged 70 and over.
- One in four people living in regional and rural areas have CVD compared with one in five in metropolitan areas.
- CVD has a 40% higher death rate in remote areas than in major cities.
- Rates of heart attack events in Indigenous adults aged 25 and over were 2.6 times higher than in other Australians in 2011.
Dementia, most commonly associated with older age, is not a single specific disease. It is an umbrella term associated with more than 100 diseases that are characterised by the impairment of brain functions, including language, memory, perception, personality and cognitive skills.
The most common types of dementia are Alzheimer disease, vascular dementia, dementia with Lewy bodies, and fronto-temporal dementia (which includes Pick disease).
Emerging evidence suggests that a number of lifestyle and health factors may influence the risk of developing dementia. Relatively few of these factors however have yet to be definitively established, with most considered either probable determinants or inconclusive.
Studies also indicate that a number of other modifiable factors may increase the risk of dementia, including:
- Mid-life hypertension
- Excessive alcohol consumption
- Head injury
There is no data available on whether the prevalence of dementia varies geographically across Australia. On average, 27 people die from dementia every day.
- In 2014, it was estimated 332,000 people had dementia, of whom 62% were women.
- Among Australians aged 65 and over, almost 1 in 10 (9%), have dementia and among those aged 85 and over, 3 in 10 (30%) have dementia.
- The number of Australians with dementia is projected to reach almost 400,000 by 2020, and around 900,000 by 2050.
Read more about Garvan's research into Alzheimer's disease.
Diabetes is a chronic condition marked by high levels of glucose in the blood. It is caused either by the inability to produce insulin (a hormone produced by the pancreas to control glucose levels), or by the body not being able to use insulin effectively, or both.
If left undiagnosed or poorly managed, diabetes can lead to cardiovascular disease, stroke, kidney failure, limb amputations or blindness.
The main types of diabetes are:
- Type 1 diabetes – an autoimmune disease that usually has an onset in childhood or early adulthood but can be diagnosed at any age
- Type 2 diabetes – largely preventable, usually associated with lifestyle factors and with a later onset
- Gestational diabetes – when higher than normal blood glucose is diagnosed in pregnancy.
Among people with diabetes, cardiovascular disease has an earlier onset, and is more resistant to treatment and therapies. Individuals have a higher rate of mortality as a result of their first cardiovascular event and poorer outcomes in the months and years after. It significantly affects the health of many Australians and can result in a range of complications, including serious damage to the nerves and blood vessels.
In 2012, almost 1 million people aged two years and over had some type of diabetes:
- Around 119,000 people (or 11.9% of those with diabetes) had type 1 diabetes, and
- Around 848,000 people (or 84.9% of those with diabetes) had type 2 diabetes.
Currently, there is no national data collection on new cases of diagnosed type 2 diabetes each year. Symptoms are often absent in the early stages of diabetes, so people can go undiagnosed for a long time. In addition, there can be problems with misdiagnosis and misreporting of diabetes type. There is a lack of good information on diabetes in Indigenous people and Australians from different ethnic backgrounds. In 2004–05, after adjusting for differences in age structure, approximately 12% of Indigenous Australians reported diabetes/high sugar levels compared with 4% of non-Indigenous Australians.
- Diabetes was the sixth leading cause of death in Australia in 2011, contributing to 10% of all deaths.
- In around 4,200 deaths, diabetes was the underlying cause and in a further 10,900 it was an associated cause of death.
- Three in five of people with diabetes also have cardiovascular disease.
- Diabetes in pregnancy is common, affecting around about 1 in 20 pregnancies.
Mental illness is any clinically diagnosable disorder that significantly interferes with an individual’s cognitive, emotional or social abilities. The terms ‘mental illness’ and ‘mental disorder’ are both used to describe a wide spectrum of mental health and behavioural disorders, which can vary in both severity and duration.
The most prevalent mental illnesses are depression, anxiety and substance use disorders. Less prevalent, and often more severe illnesses include schizophrenia, schizoaffective disorder and bipolar disorder.
Depression, anxiety and sleep disturbance were the three mental health problems most frequently managed by GPs in 2013. These three problems accounted for 60% of all mental health-related issues managed.
Rates of mental illness do not vary much across the country. People in regional, rural and remote Australia face unique circumstances that shape mental health and wellbeing. For example, Medicare expenditure per person is much lower in rural and remote areas.
As remoteness increases, communities are increasingly affected by environmental extremes (such as flood, fire or drought) and economic variability. Tragically, suicide rates are also higher in rural and remote areas:
- The rate of suicide among men aged 15-29 who live outside major cities is twice as high. Farmers are twice as likely to die by suicide as the general employed public.
- The rate of suicide among young Aboriginal and Torres Strait Islander people (aged 15-24) is five times higher than that for non-Indigenous people.
- An estimated 20% of adults, including about 960,000 people living in regional, rural and remote areas, have experienced a mental disorder in the previous 12 months.
About 45% of Australian adults, or 7.3 million people, will experience a mental disorder sometime in their lifetime. This includes more than 2 million regional, rural and remote Australians.
Osteoporosis and osteopenia
Osteoporosis is a condition of the musculoskeletal system in which a person’s bones become fragile and brittle, leading to an increased risk of fractures. Fractures can lead to chronic pain, disability and loss of independence. Osteopenia is a condition when bone mineral density is lower than normal but not low enough to be classified as osteoporosis. Older people and post-menopausal women are at greater risk of having these conditions.
Risk factors associated with osteoporosis include:
- increasing age
- being female and a family history of the condition
- low vitamin D levels and low intake of calcium
- low body weight, smoking, excess alcohol consumption, and physical inactivity,
- long-term corticosteroid use and a reduced oestrogen level.
Five times more women compared with men aged 50 or over have osteoporosis or osteopenia—15.1% of women and 3.3% of men.
$306 million of the total direct expenditure allocated to arthritis and other musculoskeletal diseases was attributed to osteoporosis in 2008–09.
Nearly 1 in 10 Australians aged 50 and over (approximately 652,500 people) have osteoporosis or osteopenia.
Back pain and problems
Back problems are a range of conditions related to the bones, joints, connective tissue, muscles and nerves of the back. These conditions are a significant cause of disability and lost productivity. The chronic and widespread nature of back problems often leads to poorer quality of life, psychological distress, bodily pain and disability. Overall, people aged 18 and over with back problems are 2.6 times as likely to report very high levels of psychological distress (6.9%) than those without the condition (2.7%).
1 in 7 Australians (or 3 million people) reported back problems in 2012 .
In 2012 the prevalence of back problems was higher in inner regional (15.7%) and outer regional and remote (15.2%) areas compared to major cities (12.3%).
In 2008–09, $1.2 billion, or 1.8% of selected disease allocated health care expenditure, was attributed to back problems.
Overweight and obesity
Over half of Australians are trying to lose weight. Only 30% of Australians who are obese (based on their BMI) described their weight status as obese. Furthermore, only one in three obese people are concerned about their weight.
It is estimated that by 2025, the number of Australians considered overweight or obese will increase to more than 70%, with approximately one third of the adult population classified as obese.
Being overweight or obese increases a person’s risk of developing cardiovascular disease, high blood pressure and/or type 2 diabetes. Being Australian born, having English as the main language spoken at home and being employed also significantly increases the likelihood of being overweight/obese.
63% of adults are now overweight or obese, with 28% classified as obese.
People living in inner regional, outer regional and remote areas of Australia are more likely to be overweight or obesethan people living in major cities.
Australia’s rate of obesity (28% of the population aged 15 and over) is the fourth highest among 34 OECD countries, behind the United States (37%), Mexico (30%) and Hungary (29%).