Chief Medical Officer's Report

Chief Medical Officer Professor Chris Baggoley 2011 marks the 30 year anniversary of publication of the first scientific account of HIV- AIDS, and it is timely to reflect on the significant public health efforts since then to curb the increase in the rate of new infections. It is worth noting that the 2010 Annual Surveillance Report on HIV-AIDS indicates that the annual number of new HIV diagnoses in Australia has remained relatively steady at about 1,000 in recent years. Despite the number of new infections, HIV prevalence in Australia remains one of the lowest in the world, at about 0.1%. In recognition of departmental efforts over the last thirty years to combat the spread of HIV-AIDS, the cover design of this year’s Annual Report features an image of the HIV-AIDS virus.

Also this year, Australia has experienced and responded to significant natural disasters in Queensland and Victoria, as well as contributing to international efforts to help New Zealand following the earthquake in Christchurch and Japan in the wake of their earthquake and tsunami. I will discuss these and other issues, including chronic disease prevention and organ donation, in greater detail in my report, but first I would like to briefly talk about the health of the nation.

The Health of the Nation

In 2009 Australia’s life expectancy at birth of 81.6 years continued to rank highly amongst OECD countries.

Four OECD Countries had higher life expectancies: Japan (83), Switzerland (82.3), Italy (81.8) and Spain (81.8);
The Australian life expectancy at birth for females was 83.9 years and 79.3 years for males; and
Females aged 65 could expect to live another 22 years, and males aged 65 could expect to live another 19 years.

Figure 1: Life Expectancy at birth in 2009

Figure 1: Life Expectancy at birth in 2009
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Australia has seen a reduction of over 50% for both males and females in premature mortality since 1970, as measured by Potential Years of Life Lost (PYLL).¹ Australia was better than the OECD median in 2006 (the latest year for which data is available).

Figure 2: Potential Years of Life Lost per 100,000 persons 2006

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Results from National Health Survey 2007-08, conducted by the Australian Bureau of Statistics, were released in late 2010. Of particular interest is self-assessed health status (Figure 3), a proxy commonly used to measure actual health status.²

The survey results show that Australians generally consider themselves to be healthy. In 2007-08, over half (56%) of Australians aged 15 years and over rated their health as very good or excellent, while 15% rated it as fair or poor.

Older people are more likely to report fair or poor health than younger people (39% of those aged 75 years and over and 7% of 15-24 year olds), while younger people are more likely to report excellent or very good health than older people (67% of 15-24 year olds and 29% of persons 75 years and over).³

Figure 3: Self-assessed health status⁴

Figure 3: Self-assessed health status
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Whilst Australia’s health outcomes are better than average for countries in the OECD, our health expenditure is close to average (Figure 4).

Total health expenditure across all levels of Government, the private health sector and individuals in Australia represented 8.7% of Gross Domestic Product (GDP) in 2008, which was below the OECD median of 9.1%.

Figure 4: Total health expenditure as a proportion of GDP, selected OECD countries, 2008

Figure 4: Total health expenditure as a proportion of GDP, selected OECD countries, 2008
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Like most developed countries, the burden of disease⁵ has changed in the Australian population. Success in the control of communicable diseases and increase in the general standard of living mean that the leading causes of disease burden (cancers, cardiovascular diseases, nervous system and sense disorders, mental disorders, chronic respiratory diseases, diabetes and injuries) now account for more than 80% of the burden of disease in the population.

Future trends in the major disease burdens in Australia are broadly favourable for coronary heart disease, anxiety and depression, and stroke (Figure 5). However, it is expected that the burden of disease due to dementia and diabetes will increase over the next 30 years.

Figure 5: Trends in leading causes of disease burden, 2003-2023⁶

Figure 5: Trends in leading causes of disease burden, 2003-2023
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Cancer incidence is also projected to increase over the next 20 years. In 2010-11, the department commenced implementing 21 regional cancer centre capital works projects worth $560 million in total, under the Health and Hospitals Fund. These important projects will better support and service all Australians to help close the gap in cancer outcomes between urban and regional Australia.

On 1 July 2011, Cancer Australia and the National Breast and Ovarian Cancer Centre merged to create a single national cancer agency known as Cancer Australia, to further strengthen the Government’s strategic focus on cancer control. Breast and ovarian cancer control will remain areas of priority for the new Cancer Australia in delivering the Government’s cancer programs and research priorities across all cancers.

Chronic Disease Prevention

Around one-third of the disease in our community is potentially preventable by changes in lifestyle including: decreasing tobacco smoking, blood cholesterol and obesity; increasing physical activity; and controlling blood pressure (Figure 6). The importance of these five risk factors provides an opportunity to substantially control the burden of disease in our community.

The Australian National Preventive Health Agency was established on 1 January 2011 to assist the Government to reduce the prevalence of preventable disease, including through research and evaluation to build the evidence base for future action, by managing lifestyle education campaigns and developing partnerships with non-government sectors.

The Agency is continuing the implementation of national social marketing campaigns relating to tobacco use and obesity. It will also manage the preventive health research fund focusing on translational research.

Figure 6: The keys to prevention⁷

Figure 6: The keys to prevention
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Responding to National and International Emergencies

The department worked closely with New Zealand and Australian health authorities to coordinate a national health response to the earthquake in Christchurch in late February 2011. An Australian Medical Assistance Team (AUSMAT) was deployed from Queensland, as was a 75 bed field hospital with six Queensland paramedics. The field hospital operated as a Community Medical Centre and was staffed by local medical professionals supported by the AUSMAT and paramedics. The centre treated 642 patients before services resumed in the displaced medical facilities.

On Friday 11 March 2011 at 1646 AEDT, Japan was shaken by its largest recorded earthquake, and minutes later devastated by a tsunami. Both caused extensive loss of life. The damage included significant leakages of radioactive material at a number of nuclear power plants, with significant damage to the Fukushima Dai-Ichi plant located within the Fukushima prefecture. The National Incident Room (NIR) was activated to contribute to Australia’s response to the disaster and to coordinate the provision of health support and advice. An Australian medical assistance team was put on standby, however, Japan had sufficient medical resources and the team was not required.

The situation at the power plant was assessed as serious and the department, the Australian Health Protection Committee and the Australian Radiation Protection and Nuclear Safety Agency, collaborated to monitor and assess the nuclear situation and provide health advice to Australians in Japan, especially those in the affected areas.

This included advice to medical practitioners and emergency departments about the management of people who may potentially have been contaminated, and to the Australian Customs and Border Protection Service, Australian Quarantine and Inspection Service, Australia Post and others who could come into contact with potentially contaminated goods arriving in Australia from Japan. The NIR also coordinated the secondment of two medical liaison officers to Japan and ensured supplies of potassium iodide were available in the event that the risk of exposure to radioactive iodine to Australians in Japan increased.

The expertise of the NIR was also called upon to coordinate the civilian health input into the Australian’s Government response to a request from the WHO to assist the people of Pakistan affected by extensive flooding in August 2010. Australian Medical Assistance Teams were formed utilising medical personnel from across Australia. They joined medical teams from the Australian Defence Force to treat 11,375 people affected by the flooding and suffering from a wide range of health problems (see case study in Program 14.1).

Following widespread flooding across eastern Australia, and then the impact of Tropical Cyclone Yasi, the NIR used its collaborative links to provide advice and support to state governments, as well as coordinating arrangements to ensure continuity of availability of Australian Government health services including Aboriginal and Torres Strait Islander health services, aged and community care, hearing services, Medicare, mental health, and pharmaceuticals.

The department provided additional assistance to those affected by the flood and cyclone emergencies in early 2011. This included extending the Pharmaceutical Benefits Scheme (PBS) listing for ciprofloxacin oral tablets from January 2011 for two months to increase treatment options for skin infections associated with contaminated flood water where other antimicrobial agents were ineffective or inappropriate.

The department worked collaboratively with Medicare Australia, the Pharmacy Guild of Australia and Community Service Obligation Distributors to ensure residents had continued access to PBS medicines. This included extending existing arrangements to facilitate quick approvals for community pharmacies to trade from new temporary premises, if required, and advising pharmacists what they can do to immediately dispense medicines to affected patients.

The collection and disposal of flood damaged medicines was managed through the National Return and Disposal of Unwanted Medicines Program.

Increasing Organ Donations

Australia’s organ donation rates are increasing with 2010 marking the first full year of implementation of the National Reform Package to implement a world’s best practice approach to organ and tissue for transplantation. This work is being driven by the Organ and Tissue Authority, in partnership with states and territories, to improve access to life-saving and life-transforming transplants for all Australians in need through a sustained increase in the donation of organs and tissues. The nationally coordinated approach being taken is exemplified by the DonateLife network. At the end of 2010, the DonateLife Network comprised 234 staff, including 162 clinical specialists of organ and tissue donation in 77 hospitals across Australia; and 72 staff in eight specialist organ and tissue donation agencies.
While the reform program is in the relatively early stages, there are encouraging signs that the measures are having the desired effect. In 2010, there were 309 organ donors, enabling life-saving and life-transforming transplants to be provided for 931 Australians. Compared to the baseline of 205 organ donors (the average for 2000-2008), this represents a substantial increase of 51%. In 2011, the second full year of implementation, we continue to make solid progress. Australia is achieving the highest donation and transplantation outcomes since national records began. The June 2011 year-to-date deceased organ donor (168) and transplant recipient (495) outcomes are respectively 13% and 10% higher than the equivalent period in 2010.

Figure 7: Deceased Organ Donors: 2000 – August 2011

Figure 7: Deceased Organ Donors: 2000 – August 2011
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[Signed in Hard Copy and PDF versions.]
Professor Chris Baggoley
Chief Medical Officer

¹ PYLL is a summary measure of premature mortality, calculated by adding age-specific deaths occurring at each age, and weighing them by the number of remaining years to live up to 70.
²Australian Bureau of Statistics, 1370.0 - Measures of Australia’s Progress, 2010.
³Australian Bureau of Statistics, 1370.0 - Measures of Australia’s Progress, 2010.
⁴Australian Bureau of Statistics, 4364.0 - National Health Survey: Summary of Results, 2007-2008 (Reissue).
⁵Burden of disease is measured by disability-adjusted life years (DALYs), which take into account years of life lost due to premature mortality (YLL) and years of ‘healthy’ life lost due to living with illness and disability (YLD).
⁶AIHW Australia’s Health 2010.
⁷AIHW Australia’s Health 2008.

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