ACT State of the Environment 2007
Indicator: Community health
ACT residents enjoyed the longest life expectancy and the lowest death rates of all Australians during the reporting period. On the whole they believe they are mostly in good health. They have the lowest proportion of people smoking and higher than average participation in certain cancer screening programs.
However, there are some concerning health issues. The ACT continues to have the highest incidence of mental health disorders with around 20% of our population affected. We also have the highest proportion of people over 18 at risk from alcohol abuse.
We are struggling with healthy eating and exercising; only 10.3% of ACT adults consume the recommended serves of vegetables and just under half consume the recommended intake of fruit. While the ACT has a greater proportion of obese adults than the national average we also have a higher rate of people in the normal range (though this is still less than half our population).
Community health programs to address these key heath concerns should be encouraged and strengthened.
What the results tell us about the ACT
Life expectancy at birth in the ACT in 2005 was 84.0 years for females and 79.9 years for males (Table 1). This is an increase of 1.1 years for females and 1.4 years for men since 2001 and an increase of about 11 years for both since 1971. The ACT life expectancy at birth in 2005 continued to lead the national life expectancy (83.3 years for females and 78.5 years for males) by 0.7 years for females and 1.4 years for men.
Source: Australian Bureau of Statistics 2008, ABStract, Statistics News, Australian Capital Territory, 2007, cat. no. 1344.8.55.002, Australian Bureau of Statistics, Canberra,
Standardised death rates
Against a general trend of declining death rates, the standardised death rates for the ACT increased from 5.1 deaths per 1000 people in 2001 to 5.6 deaths per 1000 in 2005. At 5.6 deaths per 1000, the Territory's rate was still the lowest of Australia's jurisdictions, which averaged 6.0 per 1000 people in 2005 – the lowest national rate on record.
Death rates in the ACT have fallen by around 50% since 1971 and from 6.5 to 5.6 per 1000 from 1995 to 2005. The total number of deaths registered in the ACT increased from 1100 in 1995 to 1500 in 2005; as the population increases, so does the number of deaths. The median age at death increased by 5.2 years, from 73.3 years in 1995 to 78.5 years in 2005.
Infant mortality1 rates in the ACT increased to 5.98 deaths per 1000 live births in 2002–03 (Figure 1) against the trend of declining rates previously reported (OCE 2003). The infant mortality rate since then has been above the national average, declining only in the last two years of the reporting period to 4.70 deaths per 1000 live births in 2006–07 (Australian Bureau of Statistics 2007c), a rate just above the Australian average. Technological advances have enabled infant mortality to decrease significantly since the 1950s but rates have shown some volatility in the past decade. For the ACT, infant deaths in 2001–02 were 12, rising to between 23 and 25 from 2002 to 2007. The reasons for this are not known.
Source: Australian Bureau of Statistics 2007, Australian Demographic Statistics, cat. no. 3101.0, Australian Bureau of Statistics, Canberra
The number and proportion of ACT perinatal deaths2 increased from 5.6 per 1000 in 2002 to 11 per 1000 in 2004 and 10.4 per 1000 in 2005 (Table 2). The ACT recorded 46 perinatal deaths in 2004 and 55 in 2005 at rates higher than the national average. As in the case of infant mortality, perinatal mortality rates in the ACT fluctuate from year to year due to the small number of perinatal deaths each year.
|Number||Rate per 1000||Number||Rate per 1000|
Source: Australian Bureau of Statistics 2007, Causes of death, Australia, 2005, cat. no. 3303.0, Australian Bureau of Statistics, Canberra
Causes of hospitalisation and death
Heart disease, stroke and cancer continue to be the main causes of hospitalisation and death in the ACT and the primary source of potentially preventable deaths. Cardiovascular diseases (including heart disease and stroke) accounted for 12.9% of hospitalisation of ACT residents between 2004–05 and 2005–06, and 477 (32%) of deaths in 2005 (Table 3).
Cancer provided the next greatest health burden for the ACT making up 10.4% of the hospitalisations between 2004–05 and 2005–06, and 431 (29%) of deaths in 2005.
External causes or accidents accounted for 9.3% of hospitalisations (2004–05 to 2005–06) and 120 (8.1%) of deaths in 2005 and diseases of the respiratory system such as influenza and pneumonia, accounted for 95 deaths (6.4%) in 2005 (ACT Health 2004–05 to 2005–06; Australian Bureau of Statistics 2006b, 2007b).
|Male||Female||Total||Male||Female||Total||Male||Female||Total||% of deaths|
Source: Australian Bureau of Statistics 2007, Causes of death, Australia, 2005, cat. no. 3303.0, Australian Bureau of Statistics, Canberra
Cardiovascular disease, including heart disease and cerebrovascular disease (stroke), remains the leading cause of hospitalisation and death in the ACT, accounting for 480 (32.2%) of all deaths in 2005. Following advances in technology and treatment, health promotion and prevention measures, the prevalence of deaths from such disease dropped progressively from 36% in 2001 to 34.7% in 2003 and 32.6% in 2004, but now appears to be levelling out.
Australian Bureau of Statistics data show that heart disease remains a significant cause of premature death in the ACT even though the Territory has significantly lower standardised death rates from heart disease (0.8 per 1000 compared to 1.0–1.1 per 1000 nationally) and only half the standardised death rate from heart attacks (0.27 per 1000 compared to 0.5 to 0.58 per 1000). The ACT has the highest standardised death rate among Australian jurisdictions from diseases of arteries, arterioles and capillaries. Cardiovascular disease made up 12.9% of hospital separations for ACT residents in 2004–05 to 2005–06.
Estimates from the 2001 and 2004 National Health Surveys suggest the prevalence of cardiovascular disease among ACT residents rose from 17.4% (compared to 16.8% nationally) in 2001 to 18.9% (18.0% nationally) in 2004.3
Cancer (or neoplasm) accounted for 444 (30.0%) of all deaths in the ACT in 2005 and 10.4% of hospital separations in 2004–05 to 2005–06. While the rate of cancer deaths has dropped from 32% of all deaths between 1996 and 2000, cancer remains the second leading cause of death in the ACT.
Cancer of the trachea, bronchus and lung accounted for 34 ACT male deaths in 2005, and prostate cancer a further 33. Breast cancer (43 deaths) and trachea, bronchus and lung (28) were the most prevalent cancers causing death in ACT females. During 2000–04, 979 new cases of breast cancer accounted for 35.2%, and 53 new cases of cervical cancer accounted for 1.9%, of all new cases of cancer in females (ACT Health 2004–05 to 2005–06; Australian Bureau of Statistics 2007b).
The Territory's younger-than-average population still has the lowest standardised death rates from cancer generally (1.6 per 1000) and from lung cancer specifically (0.2 per 1000). However, malignant cancers are reported to affect 1.7% of the ACT population and other cancers a further 0.2%, in line with national averages.
ACT women are benefitting from a higher-than-national-average participation in breast and cervical cancer screening programs. ACT women have a higher rate of breast cancer detection (141.4 per 100,000) but the same rate of deaths as nationally (117.2 per 100,000). Cervical cancer detection of 6.4 per 100,000 and mortality rates in ACT women are in line with the national average (ACT Health 2007).
No national screening program has been established for prostate cancer. A key reason is that there is no firm evidence that routine Prostate Specific Antigen blood testing (Mackenzie et al. 2007) prevents death from prostate cancer, and the Australian Cancer Council does not advocate routine Prostate Specific Antigen testing.
Accident and injury
Accidents and injury caused 121 (8.1%) deaths in the ACT in 2005 and 9.3% of hospitalisations in 2004–05 to 2005–06. The death rate was lower than the 8.4% reported for the ACT in 2001 but significantly higher than the 86 (6%) deaths attributed to accidents, poisoning or violence in 2004. Male deaths in this category continue to be double those of females and, in 2005, was most evident in transport accidents (21 males, 8 females) and intentional self-harm (26 males, 9 females).
ACT death rates for accidents and injury are in line with those across most states but are significantly better than for the Northern Territory. As all these deaths are potentially preventable, the importance of injury prevention and control remains a priority.
While most Australian (and ACT) residents consider they are in good health (Australian Bureau of Statistics 2006a), data suggest there are a number of important areas of concern. For example:
- The ACT has the highest proportion (79.3%) of people in any jurisdiction reporting one or more long-term condition4 (national average of 76.7%).** Only 20.7% of the ACT population is estimated to be without a long-term condition.
- The ACT has the highest rate of long-term mental health conditions as well as eye, circulatory, respiratory and urinary system diseases.**
- The ACT has proportionally more (67.7%) residents 18 years and over with some risk from alcohol abuse than any other Australian jurisdiction (national average 62.4%).
- The ACT has increasing proportions of people who are overweight, obese or acquiring diabetes as a result of inadequate diet, insufficient exercise, drug and alcohol abuse (ACT Health 2007) and other factors. About half of all adults (aged 18–64 years) in the ACT in 2004 were estimated to be either overweight or obese (ACT Health 2007).
- Only 10.3% of ACT adults consumed the recommended number of serves of vegetables while about half (50.9%) did not eat enough fruit to meet dietary guidelines in 2004.
- Only 55.2% of all adults (aged 19 years or over) in the ACT were exercising enough to meet national guidelines (The Royal Australian College of General Practitioners, 2004). The National Health Survey 2004–05 (Australian Bureau of Statistics 2006a) suggested 23.6% of ACT adults (18 years and over) were sedentary or not exercising (compared to a national rate of 34%).
Community health programs aimed at these areas of concern should be encouraged and strengthened in order to reduce their impact on the health of Canberrans.
On the positive side, the ACT has:
- lower-than-average incidences of long-term blood, ear, digestive and musculoskeletal system diseases**
- close-to-average rates of cancer, nutritional/metabolic, nervous system, and heart disease
- lowest proportion of people smoking (17.6% compared to 23.2% national).
Poor or suboptimal dietary behaviour is increasing in the ACT amid an environment of pre-packaged, processed and fast food, aggressive marketing and time pressures.
The National Health Survey 2004–05 suggested that only 10.3% of adults (18 years and over) in the ACT eat at least the recommended five daily serves of vegetables while about half (49.1%) are eating less than the recommended two daily serves of fruit (Australian Bureau of Statistics 2006a).
|Overweight or obese||54.2||42.1||48.2||58.6||42.5||50.6|
Notes: a Consumption of four or fewer serves of vegetables; b Consumption of one or no serves of fruit
Source: AIHW 2006, Australia's Health, 2006, AIHW Canberra
The National Health Survey 2004–05 (Australian Bureau of Statistics 2006a) showed similar results, with the ACT faring worst of all Australian jurisdictions for vegetable consumption. Proportionally more ACT people eat less serves of vegetables than recommended and proportionally less eat the recommended number of serves or greater.9
Survey estimates suggest that in 2004 only one in 10 (10.3%) adults (aged 19 years or more) in the ACT consumed sufficient vegetables – the worst result nationally** – while about half did not eat enough fruit to meet dietary guidelines.
While the ACT had a higher proportion (76.4% compared to 65.9% nationally) of physically active adults (18 years and over) than in other states in 2004–05, insufficient exercise is a growing area of concern for community health and the environment.
A 2004 survey suggested only 55.2% of all adults (aged 19 years or more) in the ACT were exercising enough to meet national guidelines (The Royal Australian College of General Practitioners, 2004). The National Health Survey 2004–05 suggested 23.6% of ACT adults (18 years and over) were sedentary or not exercising at all. This compares favourably to national results where 34% of adults were sedentary or not exercising.
The Territory's level of participation in exercise at low, moderate and high levels, continues to be significantly better than the national average (Australian Bureau of Statistics 2006a). Exercise might be one factor keeping more adults out of the obese or overweight range (AIHW 2000), particularly in view of other lifestyle issues in the ACT.
The National Health Survey 2004–05 found that men were more likely to do moderate or vigorous exercise than women, while women were more likely to walk for exercise than men. Moderate and vigorous exercise was most common among younger age groups, while the highest proportions walking for exercise were recorded for the 55–64 and 65–74 year age groups (around 54%) (Australian Bureau of Statistics 2006a).
The ACT has a similar proportion (16.8%) of obese adults (18 years and over) to the national average (16.6%) and a lower-than-average proportion of otherwise overweight people (31.9% compared with 32.7% nationally). Less than half (41.6%) the ACT population is in a normal weight range and this is similar to all other states (the national average is 40.4%) (Australian Bureau of Statistics 2006a). Although these data are slightly different to AIHW (2006) data due to different reporting methods, the trends are consistent.
The proportion of overweight and obese people has risen progressively from 1995 to 2004–05 across most age ranges and jurisdictions (Australian Bureau of Statistics 2006a). Work, life and recreational pressures and behaviours are understood to be driving this weight gain through the combined effects of poor diet, alcohol consumption and lower levels of suitable physical exercise (ACT Health unpublished). As obesity is closely related to other diseases, such as diabetes and heart disease, these trends are a major concern for current and future community health and the environment.
Nationally, the proportion of adults classified as overweight or obese (when body mass index was calculated from reported height and weight) increased from 52% in 1995 to 62% in 2005 for men and 37% to 45% for women. While 37% of women assess themselves to be overweight, only 32% of men consider themselves overweight, in contrast to the 62% identified from body mass index calculations (Australian Bureau of Statistics 2006a). Obesity levels are greatest in the middle age groups from 45–65 years for men and 45–75 for women. Among women aged 18–24 years, 10% had a body mass index that would classify them as underweight.
Much of the rise in childhood obesity in the ACT is believed to be attributed to a reduction in exercise and an increase in poor diet, including consumption of highly processed, high sugar/carbohydrate, high artificial additives, low fibre foods (ACT Minister for Health 2007). Only 24% of children (aged 2–12 years) eat the recommended minimum daily serves of vegetables (ACT Minister for Health 2007).
The ACT Government is trying to address these issues through ACT Health nutrition initiatives such as the Eat well ACT nutrition plan, and material from the national 'Go for 2&5(r)' campaign to increase fruit and vegetable consumption. As well, the ACT Children's Plan and various ACT Health nutrition initiatives are encouraging children to combine active play with health eating (see Health services indicator).
Diabetes is among the fastest growing chronic diseases in the ACT and Australia. Diabetes Australia (ACT) reports that approximately 100 people in the ACT develop the disease every month (ACT Government 2007). Nationally, the incidence of long-term diabetes has increased from 2.9% in 2001 to 3.6% in 2004–05 (Australian Bureau of Statistics 2006a). In the same period the incidence of diabetes increased in the ACT from 3.1% to 3.2%.
A large proportion of diabetes cases are undiagnosed. Diabetes was estimated to affect 28,000 (8.6%) of the ACT population in 2006 (ACT Minister for Health 2006). The Australian Diabetes, Obesity and Lifestyle Study in 2000 found that 6.4% of the national population had impaired glucose metabolism and were at high risk of developing diabetes in the future.
Diabetes was the principal or associated diagnosis for approximately 5.2% of hospitalisations in the ACT in 2004–05 to 2005–06 compared with 5% in 2001–02. Diabetes mellitus was also listed as the underlying causes of 45 (3%) of deaths in the ACT in 2005.
Uncontrolled diabetes can lead to a number of serious health problems including heart and kidney disease, blindness, stroke, nerve damage, and blood flow problems. Australia-wide 20% of people with diabetes mellitus also reported having long-term heart, stroke or vascular disease. Of those reporting diabetes, 69% also reported having an overweight or obese body mass index and 78% had a no or low exercise level (Australian Bureau of Statistics 2006a).
Tobacco smoking remains the most obvious preventable cause of disease and premature death in Australia, in spite of recent success in reducing the rate of daily smoking across all age groups and, particularly among women.
The ACT is leading the way in reducing the proportion of adults (18 years and over) smoking daily (15.4%) or at all (17.6%) compared to other jurisdictions and the national average (21.3% – daily and 23.2% – all: Table 5; Australian Bureau of Statistics 2006a).
|Risky alcohol use||9||7.9|
|High risk alcohol use||5.3||5.6|
Source: Australian Bureau of Statistics 2006, National Health Survey 2004–05: summary of results, cat. no. 4364.0, Australian Bureau of Statistics, Canberra
The Territory's drop to 17.6% of adults (18 and over) smoking is significant as previous National Drug Strategy Household Survey results indicated that in 1998 24% of ACT adults (14 years and over) were smokers, and 22.5% smoked in 2001, in line with national rates (AIHW 2005).
Results from the 2005 ACT Secondary Student Alcohol and Drug Survey (Population Health Research Centre 2007) suggest that 8.6% of ACT students aged 12 to 17 are current smokers; a marked drop from 1996 when 20.4% of students reported being current smokers.
To move towards a smoke-free environment, the ACT Government introduced a ban on smoking in public places from 1 December 2006. Before that the ACT had a Smokefree Policy in indoor public areas and several outdoor spaces, and Smokefree School (Football) Clinics to promote sport, fair play, healthier lifestyle and not smoking (ACT Health website).
AIHW (2005) suggested daily smoking among adults dropped nationally from 19.5% in 2001 to 17.4% in 2004 – the lowest rate ever reported for Australia and among the lowest rate reported in the world. Importantly for future community health outcomes, about 32.8% of ACT adults (30.2% nationally) in 2004–05 classified themselves as ex-smokers who have quit smoking altogether (Australian Bureau of Statistics 2006a).
Alcohol consumption and impacts remain a significant concern for the ACT despite recent reductions in the proportion of adults (14 or older) drinking every day. The 2004 National Drug Strategy Household Survey indicated that the Territory's proportion of daily drinkers has reduced (down from 9.6% in 2001 to 9.1% in 2004) which is marginally above the national average (8.3% in 2001 to 8.9% in 2004; AIHW 2005).**
Perhaps more significant is the low proportion of ACT adults (18 years and over) with no risk from alcohol consumption (32.3%), which is lower than in any other jurisdiction (national average 37.6%; Australian Bureau of Statistics 2006a). Some 14.3% of ACT adults engaged in risky or high risk drinking in 2004–05 compared with 13.5% nationally, an increase from 11% in 2001 (these data exclude no risk and low risk behaviours). Such findings are consistent with an increase in recreational binge drinking in the ACT, as distinct from moderate drinking.
Alcohol-related harm accounts for about 5% of the total disease and injury burden in Australia and is associated with considerable morbidity and mortality. Alcohol continues to provide a gateway for many to use other addictive substances and illegal drugs, and to participate in high-risk and/or antisocial behaviours.
Women remain more likely to be at high risk of long-term harm though alcohol abuse, however, a lower proportion of ACT women were consuming alcohol daily in 2004 (10.1%) than in 2001 (11.6%).
National Drug Strategy Household Surveys suggest that the rate of illegal drug use among ACT people 14 years and older continued to be above the national average but decreased marginally from 18.1% in 2001 to 17.6% in 2004 (nationally 16.9% in 2001 to 15.3% in 2004; Table 6).
Notes: a Used in the past 12 months; b For non-medical purposes; c Non-maintenance; d In previous surveys including 2001 this included designer drugs; *Relative standard error greater than 50%
Source: AIHW 2002, 2001 National Drug Strategy Household Survey, Drug Statistics Series no. 11, AIHW, Canberra; AIHW 2005, 2004 National Drug Strategy Household Survey, Drug Statistics Series no. 13, AIHW, Canberra
Cannabis use among 14% of the population (same as 2001) remains a key health concern, particularly because of the potency of hybrid species and hydroponic plants and the established links with mental illness.
The rate of ecstasy use in the ACT was 4.8% of the population in 2001 and rose to 6% (almost double the national rate) in 2004. Methamphetamine use in the ACT in 2004 was reported among 4.3% of the population aged 14 years and over; higher than was reported nationally (3.2%) but lower than reported for the ACT in 2001.
The decrease in methamphetamine use appears to have been balanced by an increase in the use of crystal methamphetamine or 'ice'. A survey of 100 injecting drug users (2006 Illicit Drug Reporting System) suggests the reported recent use of crystal methamphetamine in the ACT has increased from 12% in 2000, through 62% in 2005, to 88% in 2006. Ice use also increased between 2005 and 2006 among regular ecstasy users (Campbell and Degenhardt 2007).
Drug use by school students
Illicit drug use among secondary school students is on the decrease across most drug types according to results from the 2005 ACT Secondary Students Alcohol and Drug Survey (Population Health Research Centre 2007). While trends for amphetamine (5.8%) and ecstasy (5.0%) use remained stable, reported use of most other drugs dropped further from 2002 to 2005 (Table 7).
The 2005 survey found that one in five (20.3%) secondary students reported using at least one illicit substance in their lifetime and about one in 20 (4.8%) reported having used such a drug at least once in the past seven days.
In 2005, inhalants were the most commonly reported illicit substance secondary students used with 17.6% reporting using them at least once in their lifetime and 5.2% reporting use in the past seven days.
Cannabis was identified as the second most used with 16.9% of students reported using it sometime in their life and 3.7% reporting use in the past seven days. Significantly, reported cannabis use has dropped to less than half the levels reported in 1996.
The reported illicit use of steroids by secondary students almost doubled between 1996 and 2002 but has decreased to be close to the 1996 level in 2005.
|Used at lease one illicit substance in lifetime||37.5*||35.0*||29.6*||20.3*|
|Current (used in last 7 days) users||11.6*||9.7*||7.8*||4.8*|
|Used cannabis at least once in lifetime||36.4*||33.5*||28.1*||16.9*|
|Current (used in last 7 days) cannabis users||10.7*||8.8*||7.6*||3.7*|
|Used inhalants at least once in lifetime||26.7*||25.1*||19.6*||17.6*|
|Used inhalants at least once in last week||6.5||6.4||6.2||6.2|
|Used tranquilisers at least once in lifetime||20.6*||19.1*||15.1*||14.7*|
|Used hallucinogens at least once in lifetime||8.0*||7.1*||4.0*||4.1*|
|Used amphetamines at least once in lifetime||6.1||7.7||6.1||5.8|
|Used steroids at least once in lifetime||2.5*||3.7*||4.1*||2.8*|
|Used opiates at least once in lifetime||4.6*||4.0*||2.5*||2.3*|
|Used cocaine at least once in lifetime||4.2*||4.7*||3.4*||3.4*|
|Used ecstasy at least once in lifetime||4.5||4.5||5.3||5.0|
Note: * Denotes statistically significant difference (p<0.05)
Source: Population Health Research Centre 2007, The results of the 2005 ACT secondary student drug and health risk survey (ASSAD), Health Series No. 39, ACT Health, Canberra, ASSAD confidentialised unit record files
The ACT continues to have the highest incidence of mental health disorders with around 20% (18% nationally) of people affected. The proportion (13.8%) of ACT people with a long-term mental health condition is the highest of any jurisdiction and 30% higher than the national average (10.7%; Australian Bureau of Statistics 2006a).
Mood affecting problems are the Territory's most common long-term mental health disorders (7.4%) followed by anxiety related problems (5.6%) and other mental and behavioural problems (5.0%), all higher than the national averages.
Researchers believe this significant and concerning health issue is closely related to workplace and lifestyle stress and balance, poor diet and alcohol and drug use (for example, Landers 1997). The Territory's high proportion of adults taking extra days off work or study (9% compared to 7.8% nationally) may indicate greater need to reduce stress and boost mental health and lifestyle balance. The ACT is second only to Tasmania in the incidence of people having days of reduced activity (12.0% compared to 7.8%; Australian Bureau of Statistics 2006a).**
High or very high levels of psychological distress were recorded for 13% of the adult population, similar to the levels recorded in 2001. Of those who recorded high to very high levels of distress, 59% were female (Australian Bureau of Statistics 2006a).
Mental health disorder is the third leading burden of disease for Australians and is a major cause of chronic disability. Depression accounts for about 3.7% of the total burden and research suggests this is on the increase.
Survey estimates suggest one in five residents of the ACT will experience a mental health disorder over a 12-month period. National estimates suggest half of those with a mental health disorder will suffer comorbidity (ACT Health 2007).**
Mental illness ranks only behind cardiovascular disease and cancer as the greatest disease burden for the ACT and, more broadly, Australia (ACT Health 2007). The World Health Organization predicts that depression alone will constitute one of the leading health burdens worldwide by 2020 (Murray and Lopez 1996).
Suicide continues to account for about 3% of ACT deaths with male suicides still typically three to four times the number for females. The ACT recorded 35 suicides in 2005 including 26 males and nine females. The Territory's incidence of suicide was 10.1 per 1000 people in 2005 – below the national rate of 11.2 per 1000 (Australian Bureau of Statistics 2007a). Self-harm accounted for 0.5% of ACT resident hospitalisations in 2004–05 to 2005–06.
Respiratory system diseases – asthma
Respiratory tract diseases make up a large part of the burden of long-term and chronic disease in Australia and the ACT. Respiratory system diseases accounted for 95 (6.4%) deaths in the ACT in 2005 (Australian Bureau of Statistics 2007b).
The ACT (33.1%) is second only to South Australia (33.3%) in the proportion of residents reporting a long-term respiratory system disease (national average 29.0%). Within this category, the ACT has the highest rates of hayfever/allergic rhinitis and other diseases but the lowest incidence of bronchitis/emphysema (Australian Bureau of Statistics 2006a).
Australia has among the highest known rates of asthma in the world and the ACT is consistent with the Australian average (10.2% report a long-term condition). ACT Health reports that hospitalisations with a principal diagnosis of asthma reached 495 (0.6% of total) in 2005–06 after being 432 in 2004–05 and 324 in 2001–02 (ACT Health 2004–05 to 2005–06).**
Children accounted for more than half (54%) of all hospital separations for asthma in 2003–04 (ACT Health 2007). The incidence of hospital presentations was higher among young children (3.9% for 1–4 years, 3% for 5–9 years, and 5.6% for adults over 65 years) in 2002–03. This higher incidence is attributed to higher prevalence, greater severity, poor management, or poor identification of the disease in these age groups (AIHW 2005).
An estimated 16.5% of kindergarten children currently have asthma and 22.4% have had asthma at some stage, according to the ACT Childhood Respiratory Symptom Surveillance Project being conducted by the Academic Unit of General Practice and Community Health (Academic Unit of General Practice and Community Care 2003, 7). About 23% of the ACT kindergarten children currently with asthma have a written asthma management plan (ACT Health 2007).
Arthritis and musculoskeletal disorders
Musculoskeletal disorders, most notably arthritis and back pain, account for a significant proportion of the disease burden in Australia and the ACT and levels have risen marginally concurrent with the ageing of the population.
In 2004–05, the ACT had the lowest incidence (28.3%) of long-term musculoskeletal conditions of all jurisdictions where the incidence is generally about one-third of the population (31% national average; Australian Bureau of Statistics 2006a).
The ACT had among the lowest rates of long-term arthritis (13.0% compared to 15.3% national average), rheumatism and other soft tissue disorders (2.5% compared to 3.0% national average), back pain (14.2% compared to 15.3% national average) and neck pain and about average rates of osteoporosis.** Long-term arthritis is more commonly reported among females (18% nationally) than males (13%) and the majority of cases are osteoarthritis (51%) followed by other types (39%) and rheumatoid arthritis (16%). The proportion of people reporting arthritis increases from less than 1% for people under 25 years to around 50% for people 65 years and older (Australian Bureau of Statistics 2006a).
Musculoskeletal conditions and arthritis are the most common cause of disability in the ACT. Arthritis accounted for 2.3% of all ACT resident separations from ACT hospitals in 2004–05 to 2005–06 (ACT Health 2004–05 to 2005–06). Arthritis and other musculoskeletal conditions are not a common cause of death resulting in less than 1% of all deaths among ACT residents in 2005 (Australian Bureau of Statistics 2006b). Rather, these conditions produce a significant disease burden through chronic pain, disability and reduced quality of life.
In 2006 the Reporting of Notifiable Conditions Code of Practice 2006 was introduced to guide the reporting of notifiable conditions by those obliged to do so under the Public Health Act 1997. Those obliged to report include medical practitioners, authorised nurse practitioners, pathologists and hospitals. In the ACT, 67 conditions are notifiable, with chickenpox (varicella-zoster virus) becoming notifiable in 2006.
The ACT has experienced significant increases in reporting of notifiable diseases including some notable 'outbreaks' over the reporting period. During 2006–07, 2255 reports of notifiable conditions were made (compared to 2315 in 2005–06) significantly more than the 1500 notifications in 2001–02 and 2002–03 (Table 8). Factors that may have contributed to the increase include actual increases in diseases incidence, increased disease testing leading to increased notifications and, to a lesser extent, increases in the ACT population. Inclusion of chickenpox as a notifiable disease in the reporting period may also have contributed to a small increase in overall notifications.
The sexually transmitted disease, Chlamydia trachomatis increased and was most commonly notified over the reporting period. Chlamydia infections notified reached 852 in 2006–07, approximately double the number reported in 2001–02, and occurring at a higher rate in the ACT than in the Australian population as a whole. Chlamydia can show no symptoms in up to 25% of men and 70% of women. Better education and increased testing may have had an impact on the increased notifications.
The foodborne gastrointestinal disease, campylobacteriosis, was the second most commonly notified disease, with approximately 400 notifications each year throughout the reporting period. Campylobacter commonly causes diarrhoea, fever and vomiting. Salmonella notifications spiked at 138 in 2006–07 after being typically 90 to 100 for most of the reporting period. To safeguard against outbreaks of foodborne diseases, such as campylobacteriosis and salmonellosis, the ACT Government Health Protection Service has conducted weekly microbiological testing at ACT food outlets of ready-to-eat foods including specialised milks, pre-packed long life milks and sushi.
Of the other food or waterborne diseases there was a notable increase in Cryptosporidium with 79 notifications received between January and June 2006 and a total of 86 notifications for 2005–06. This was significantly above the number of notifications received in any of the other years in the reporting period, which ranged from four to 19. There was also a sustained increase in the number of Giardia notifications each year rising from 24 in 2002–03 to 110 in 2006–07. The results for the Drinking water quality indicator show that tap water was not the source of infection.
Of the vaccine-preventable diseases, whooping cough (pertussis) notifications have increased markedly from 73 in 2002–03 to 146 in 2006–07. Increased notifications were observed in 2003–04 and 2005–06, with 364 and 362 notifications respectively. Increased rates of pertussis notifications in 2005–06 may be due, in part, to errors in the serological test for pertussis resulting in a high number of false positive results. A pertussis booster for 14 to 15 year-olds was added to the ACT Immunisation Program in 2003.
Two separate clusters of meningococcal infection occurred between November 2003 and January 2004 resulting in 17 notifications of the disease in 2003–04 compared to an annual average of six. This was the highest number of notifications on record and ACT Health responded by introducing an awareness campaign and providing free immunisation for 15 to 19 year-olds. Meningococcal notifications have since dropped to five in each of 2005–06 and 2006–07.
An outbreak of respiratory illness affected 75 people and led to eight deaths at the Jindalee Nursing home in Narrabundah in November 2006. Of those affected, 23 staff and residents had laboratory-confirmed H3N2 influenza. ACT Health reported 58 Influenza A notifications in 2006–07.
|No.||Per 100,000 pop||No.||Per 100,000 pop||No.||Per 100,000 pop||No.||Per 100,000 pop||No.||Per 100,000 pop||No.||Per 100,000 pop|
|Hepatitis Bb (incident)||0||0||0||0||4||1||3||1||1||0||14||4|
|Hepatitis Cc (incident)||11||3||8||2||14||4||10||3||14||4||11||3|
Notes: a All data is based on date of onset where known; b An incident Hepatitis B case is a newly acquired infection; c An incident Hepatitis C case is a newly acquired infection
Source: Communicable Diseases Control, ACT Health
Although information on Aboriginal and Torres Strait Islander people living in the ACT is limited, survey and administrative data indicate that they have some significant health issues compared to the rest of the population (ACT Health 2007). They have a lower life expectancy rate and are over represented in hospital statistics for mental health and behavioural disorders (ACT Health 2007). Aboriginal and Torres Strait Islander people were also diagnosed with major diseases, such as cardiovascular disease, cancer and diabetes mellitus, at a younger age than their non-Indigenous peers (ACT Health 2007).
On the positive side, Aboriginal and Torres Strait Islander children are well immunised with over 80% of the estimated 60% of Aboriginal and Torres Strait Islander children who are identified on records, being fully immunised (ACT Health 2007).
The Royal Australian College of General Practitioners, 2004, SNAPS – Smoking, Nutrition, Alcohol and Physical Activity Survey- a population health guide to behavioral risk factors in general practice, Melbourne, available at <http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/SNAPapopulationhealthguidetobehaviouralriskfactorsingeneralpractice/SNAPguide2004.pdf>
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ACT Minister for Health 2007, 'Young children encouraged to play active and eat well', media release, 1 April
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AIHW Australian Institute of Health and Welfare 2002, 2001 National Drug Strategy Household Survey, Drug Statistics Series no. 11, AIHW, Canberra available at <http://www.aihw.gov.au/publications/index.cfm/title/8227>
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Campbell G and Degenhardt L 2007, ACT trends in ecstasy and related drug markets 2006: findings from the Ecstasy and Related Drugs Reporting System, National Drug and Alcohol Research Centre Technical Report 276, University of New South Wales, Sydney
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Murray CJL and Lopez AD 1996, The Global Burden of Disease, World Health Organization, Harvard School of Public Health, World Bank, Geneva
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Population Health Research Centre 2007, The results of the 2005 ACT secondary student drug and health risk survey, Health Series No. 39, ACT Health, Canberra, available at <http://health.act.gov.au/c/health?a=da&did=10061968&pid=1172207898>
1 Infant mortality includes deaths of liveborn infants under the age of 1 year and includes neonatal and postnatal deaths up to one year.
2 Perinatal deaths includes stillbirths, deaths of infants less than 28 days of birth and more than 20 days gestation and weighing not less than 400 grams.
3 ACT health staff doubt these differences are statistically significant.
4 A long-term condition is defined as a current condition which has lasted or is expected to last for 6 months or more
** ACT Health officers believe this difference may not be significant